Talking about health care, research and benefits for Gulf War Veterans – Part 2

Gulf War advocacy group sits down with Sec. Bob McDonald


shadow

The National Gulf War Resource Center (NGWRC), an advocacy group for Gulf War Veterans, spoke to VA Secretary Bob McDonald about health care, research and benefits for Gulf War Veterans. Part one of the discussion  focusing on health care and research. In part two, the discussion focuses on benefits and VA’s accomplishments for Gulf War Veterans.


National Gulf War Resource Center: Under current regulations fo, to be eligible for presumptive service connection, Gulf War Veterans must have experienced qualifying illnesses by Dec. 31, 2016. Since this date has passed, what is VA doing to extend it?

Secretary McDonald:  Disability benefits available to Gulf War Veterans under VA regulation 38 CFR § 3.317 were set to expire on Dec. 31, 2016.  We published a new rule that extended this expiration date five more years to Dec. 31, 2021. This allows Gulf War Veterans to be granted service connection for a presumptive health condition that began any time between the beginning of their active duty service in the Southwest Asia theater of military operations and Dec. 31, 2021.  A successful claim requires the presumptive health condition to be at least 10 percent disabling.   More information on benefits for Gulf War Veterans can be found at on the VA website.

NGWRC: What is the most recent data on the benefits approval and denial rate for Gulf War Veterans?

Secretary McDonald:  The most recent data we have show a grant (approval) rate of 21 percent for Veterans who have benefits decisions for either an undiagnosed illness or a medically unexplained chronic multi-symptom illness. Veterans whose claims have been denied are entitled to reconsideration on submission of new medical evidence.

NGWRC: Many Gulf War Veterans believe that the Veterans Benefits Administration (VBA) doesn’t feel they have a problem regarding Gulf War claims, and these Veterans disagree. What is VBA doing to improve its review and better track Gulf War Veterans disability claims? What steps has VBA taken to prevent errors in the claims process for Gulf War Veterans?

Secretary McDonald:  To assess the accuracy of Gulf War-related disability claims, VBA’s quality assurance staff conducted a special review between September and December 2015.  VBA reviewed 311 cases from across the nation for the first two quarters of fiscal year 2015 and found a 94 percent accuracy rate. To investigate further, the VBA quality assurance staff conducted another special focus review to assess the accuracy of Gulf War claims processing in fiscal years 2011, 2012, 2013, and 2014.  They are currently drafting a report on their review.

In an effort to ensure that all Gulf War Veterans receive a decision that is based on a thorough review of the evidence in a claim, VBA has amended its training protocol on two occasions in the last few years. The protocol is currently being updated again so that the most specific and helpful information is available not only for training classes, but also for reference for decision makers in the field.  All VBA decision-makers are required to complete updated training.

Additionally, whereas in the past VBA has used different documents such as training letters, fast letters, and frequently asked questions to provide guidance regarding rating Gulf War claims, VBA now has a consolidated live manual containing this information. It is a single, comprehensive reference that the decision maker can search and consult when developing and rating Gulf War claims.  It was last updated in July 2016.

NGWRC: As VA Secretary, what do you think are your accomplishments that specifically benefit Gulf War Veterans affected by Gulf War illness?

Secretary McDonald:  Under my and others’ leadership, VA continues to move forward in assessing and treating the needs of Gulf War Veterans.  Here are four (of many possible) examples:

  1. VA works to respond to disability benefits concerns from the Gulf War Veteran community. The Veterans Benefits Administration (VBA) recently conducted a nationwide review of completed Gulf War disability claims to evaluate and ensure accurate and consistent nationwide processing of these claims. A specific concern of Gulf War Veterans has been the issue of VA medical examiners providing opinions that an identified, undiagnosed illness or a diagnosed medically unexplained chronic multi-symptom illness was not related to Gulf War service. These opinions are not consistent with regulation 38 CFR § 3.317 because these disabilities are presumptively associated with Gulf War service and are automatically service connectable. VA medical examiners should not be providing an opinion when a disability is a presumption. VA has taken steps to provide clear guidance for an opinion provider on what they may or may not do when giving their opinion. For example, under 38 CFR § 3.317, there are some circumstances in which a claim can be denied, such as if the disability occurred before service in Southwest Asia. In cases like this, opinion providers should cite evidence and provide the basis for a negative opinion. VA has also added clarifying language on this issue to the Compensation Service procedures manual used by VA regional offices.
  2. VA has supported several important research projects on the care and treatment of Gulf War Veterans, including a randomized trial of cognitive rehabilitation, an evaluation of concordance of patient and provider illness perceptions on care outcomes, a randomized trial of an insomnia intervention, and a randomized trial of CoQ-10. In addition, VA investigators have competed for and received funding from the Department of Defense to better understand possible mechanisms of disease and treatments. At this time, there is a large body of important and original research advancing our knowledge of the pathophysiology and treatment options for Gulf War Veterans. Learn more at http://www.research.va.gov/topics/gulfwar.cfm
  3. The War Related Illness and Injury Study Center (WRIISC) program, whose patient population includes Veterans from Operations Desert Shield and Desert Storm and Veterans from subsequent Gulf War operations, amounting to a total of 70 percent of the patients visiting WRIISCs, has, under my leadership, proposed and has been developing a model for expanding their clinical, educational, and research expertise to the 168 VA medical centers around the country
  4. VA has reviewed the recommendations from the Institute of Medicine report Gulf War and Health Volume 10: Update of Health Effects of Serving in the Gulf War and the Research Advisory Committee on Gulf War Veterans’ Illnesses. VA is currently assessing the recommendations and with these partners will continue to work to expand efforts to promote research and science-based care for Gulf War Veterans. Additionally, employees at VA make every effort to engage with Veterans and Veterans Service Organizations by telephone, by e-mail, and in person, to find out which issues facing Gulf War Veterans are most important.

The National Gulf War Resource Center provides education and support for Veterans, active duty personnel, and their families. Learn more about this organization at http://www.ngwrc.org/.

 

 

Author

VAntagePoint Contributor

-- VAntage Point Contributors provide insight and perspective on a wide range of Veterans issues. If you'd like to contribute a story to VAntage Point, learn how you can submit a guest blog at http://www.blogs.va.gov/VAntage/how-to-submit-a-guest-post/

Comments

  1. Dave Westlake    

    Let me start with I do not have a problem with Secretary McDonald, understand that change takes time to implement and be accepted. Personally I hope he stays to provide stability and leadership. It may not seem that way with what follows, but it is the truth. I have had a mixed experience with the VA, and what is below would be considered complaining. At the same time I am currently using VHA for my care unless I cannot get in for an acute condition. Many of the workers on the VHA side have been courteous. I really like the PCP I had at a CBOC, but he transferred to another VAMC in another state. I have not had nearly as good of an experience when it comes to the VBA side. I am a Desert Storm vet with over 325 days spent in Saudi Arabia. Thank you for the time taken to sit down and be interviewed by this veterans’ organization.

    1)Twenty-one percent approval rate equates to a seventy-nine percent denial rate. That is outrageous. Reading about QA teams checking the accuracy often seems to me that it is the same as having the fox guard the hen house. And, if I heard and understood correctly at a town hall meeting, a claim is considered done properly if on a multi-condition claim one item is granted, the rest are denied, and even if others are granted on appeal the entire claim is considered correct. If something is granted on appeal it seems to me that it should have been granted in the first place. I understand if the claim was granted because of new evidence that the claim may have been properly adjudicated. I may have misunderstood, hope I did, and would be happy to be proved wrong on that.

    I know an individual who went for an increase C&P exam for undiagnosed illnesses-systemic diseases, and the physician told the patient Gulf War Illnesses were confusing and he did not understand it. This individual also thinks a shell game is played with the approvals/denials with the letters that are sent or the way names of conditions are manipulated, and wonders how many others are impacted by this type of game. The example the person gave was when an application for an increase in a 20 year old undiagnosed illness rating in late 2013 was filed; had a chronic multi-system illness officially diagnosed in mid-2014; was under the VA’s care from December 2013 seeking help for the problems; denied the increase for the undiagnosed; appealed it; worked with VSO in late 2015 to ensure VBA knew he had been officially diagnosed with multiple, chronic multiple symptom illnesses; was granted the rating for the CMI, but only back to late 2015 because that was the first time it was seen as medically worsening. When asked why the VBA did not go back to the 2013 submission date the reason given was that they were two different diseases, and the CFS was not claimed until late 2015. Now the individual has to play the waiting game while the case works its way through the system.

    2) It amazes me as I surf the web how often I see the VA or DOD talk about the lack of evidence in exposures causing health issues. It is often phrased like “at this time there is no evidence that exposure to ____ has contributed or caused any long term health consequences,” or “____ has not known to cause any long term. If you have concerns about your health from your time in service please contact ….” We know smoking is bad for a person. We know firemen/women wear self contained breathing apparatuses to protect their respiratory system. Other professions wear protective gear when exposed to hazards. Yet, all those who spent days or weeks, near or down wind from the fires, breathing in smoke or particulate matter from the oil well fires are told there is no evidence to support your claim, or, as in the case of the oil well fires, the fire was so hot it burned off the bad stuff so military personnel were not breathing harmful air. While the VA may grant exposure to the hazards, it does not make presumptive those issues that could arise from those exposures because of a lack of evidence on the harm they cause regardless of the fact there may be considerable research on exposures in the civilian world. In addition, I have seen people argue that it is impossible to know the amount of exposure time and quantities of exposure due to the lack of monitoring thus making it impossible to know the health effects of the exposures. Should not benefit of the doubt go to the veteran when making claims based on exposure.

    Also, there is a huge lack of knowledge when it comes to exposures. This lack includes both what they are as well as the danger they may pose. I had a C&P physician tell me that the sand in Saudi Arabia could not be inhaled into my lungs because the grain size is too big. I was looked at like a poor deluded fool when I mentioned reports were out there discussing the sand in Saudi Arabia being less than 10 microns and much of it being less than 2.5 micros. How is trust to be built when physicians do not know about exposures? It is not just C&P physicians with a lack of knowledge, but PCPs and specialists. Some are open to learning about them, others are not.

    3) The CARC Paint painters continue to have a hard time with their claims even though the evidence is there showing unsafe living and working conditions in preparation for combat operations. From not having the proper equipment, including respiratory, to living, eating, showering, using the bathroom and painting in the same site to having to buy solvents and other items on the local market without knowing what the contents are to being able to smell the site from miles away to also being exposed to the exhaust of thousands of vehicles in a small area and the combination of those fumes with the CARC and solvent fumes to the storing of open hazardous waste (the paint cans) on site many of the soldiers where exposed to large, multiple exposures through the respiratory tract, orally, and the skin. This may be one of the biggest travesties that has taken place since the return to the states. I am one of them, and finally was rated for respiratory issues of asthma and sinusitis after 20+ years and multiple attempts. Many of the ones who were on paint details, and specifically the ones in the 325th Maint Co out of Florida, have given up on receiving help from the VA.

  2. Robert A Henderson    

    I filed claims under the GWS and was shot down by the VA. I was on the front lines as a 12B and exploded a lot of the munitions. Now seriously breathing problems. VA lied about taking care of combat veterans. I gave the country 10 yrs of my life.

  3. Delilah Bartholomew    

    I am a Veteran of Desert Storm also and am still fighting VA for claims submitted in 1994. You are so right, no one seems to know the full extent to any of the environmental issues. I am a female Veteran but I did do my job to the fullest. I was an aircraft refueller and worked outside everyday and the heat and sun exposure was instrumental in developing skin cancer not to mention upper respiratory problems, sand storms and the oil well fires were a factor also. I have been denied but will keep on fighting. I will not give up. I have had two skin cancer surgeries and am constantly having precancerous removals.

  4. Richard J. Marquith    

    79% of these claims are denied. I would guess, the vast majority due to VA C&P Examiner opined it is less likely Han not. These opinions are generated from people that have little to no knowledge of experience in order to make an well thought out opinion. Some examiners just don’t care!!! It is much easier to weakly substantiate an less than helpful opinion, than research or ask someone At one of the three facilities.

    How do we fix it? After the C&P Exam, send the claim to one of the three facilities and have an expert review the medical evidence minus any medical opinions. This will require additional time and reviewers, but the veteran will get a correct rating.

  5. James Yarnell Becton    

    I am a Desert Storm Veteran , I was diagnosed with PTSD but denied my claim for crippling arthritis, sleep apnea, and my whole body aches all over . I have a lot of unexplained problems . I am in pain daily and cannot get the proper help.

  6. Mary Dianne DiBenedetto    

    I am a Veteran Liaison and Clinical Assistant to a Ph.D, psychologist. He is a veteran (Army), supervised at the Vet Center and has a patient case load that is 95% veterans due to our being located in Savannah, GA.,; home of HAAF and the 3rd ID. As a legal agent, I have had denial after denial (even after submission of new and material evidence) of claims for my Desert Storm veterans; and OEF/OIF. Yes, we signed up for Burn Pit, etc. I have men who were onsite at Kamiysagah, CARC, etc. After IOM issued a brief in 2015, I was extremely hopeful that these men would receive their compensation. I perform IMO and legal opinions and still examiners and RO’s deny, deny, deny. I have one Gulf veteran who supplied statements from his sleeping buddies in the field about his OSA, which is so bad that he would stop breathing repeatedly, and still denied. If you have an medical condition with a diagnosis, directly related to Gulf service, “it is not related to Gulf because of the medical diagnosis. Any physician knows a diagnosis is inevitable due to medical protocols. A medical diagnosis does not state that the etiology of the condition is known by the physician. These men need compensation. I see men and women in the late 30’s and early 40’s that can hardly walk the pain in their joints is so bad. You would think they were 70 years of age. Where are principles and ethics in serving these men and women who served our country?
    Dianne DiBenedetto, PA, CCTP

Comments are closed.