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:
- 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.
- 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
- 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
- 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/.