Transcripts For CSPAN2 Hearing Examines Gulf War Illness Cla

Good morning and welcome, everyone. This is joint hearing of the subcommittee on disability assistance and Memorial Affairs an oversight and investigation will come to order. I first want to take a moment to thank my colleagues, chambering man. Ranging member esty who should be along this morning and Ranking Member Kuster Holding the hearing on important issue were facing helping gulf war veterans get benefits they earned. It should go without saying we have a duty to take care of the men and women who have been wounded while serving in our military. Unfortunately too many injured gulf war veterans are not being taken care of. Va estimates 44 of gull war veterans develop gulf war illness, yet 26 of those veterans are receiving benefits. Something doesnt add up. On march 15th, 2016 during a similar joint hearing on gwi claims va, va testified that it was taking steps to improve service for gulf war veterans. Yet one year later, gao found va is still only approving 17 of claims of gulf war illness, which is about a third of the approved rate for other claims. For example, gao report says that only 13 of the claims were diagnosed illnesses, diagnosed of the illness, that and are approved. I cant understand that at all. Va regulations state that if veterans have certain symptoms such as headache, fatigue, joint pain, va is supposed to presume that these symptoms are related to the Veterans Service in the gulf area yet 80 of these games are denied, 87 of these claims are denied. Fao found one ever the problems the va physicians are applying the wrong standards during the exams. Another issue that the va employees are not ordering exams when necessary. I appreciate the rise va, i appreciate recently that the va retained all of its employees on gwi claims and i am looking forward to, looking forward to hearing whether rao takenned, he retaining these employees made a difference. Im also frustrated because gao pointed out that the vas decision letters are not clear. This issue keeps coming up. As you know my appeals reform bill, hr 2288, would require va to make its decision letters more clear and useful for the veterans but it shouldnt take legislation to force the va to act. I would like to see the va change its decision letters now so that the veterans understand why va made the decisions it did. So, gao also found several other problems that may be keeping the approval rate for gwi claims low. Such as a lack of a single Case Definition for gwi. Im looking forward to an hon of the discussion about the vas need to do so and how to insure that they do. None of us want to come back here next year to find the same problems. After this hearing i intend to work with my colleagues to keep on va to make sure that these changes are made, and made this time where we wont have to do it again. I ask unanimous consent written statements provided for the record be placed into the hearing record. Without objection so ordered. I also want to take, want to thank the witnesses for being here today. With that i want to call on the oversight and investigation distinguished Ranking Member, for her opening statement. Thank you, chairman bost, and to general bergman and miss esty when she arrives and for the witnesses being here today. It has been 26 years since the beginning of the gulf war, 44 of the veterans served in that conflict suffered from gulf war illness. Sadly these veterans struggle to receive accurate diagnoses for their systems and health care and compensation for their Service Connected conditions even with the presumptions that should result in more veterans receiving benefits and not denied claims. Last year our subcommittee held a hearing as the chairman said on access to treatment for gull war illness more Research Needed to get our veterans the health care they need. Now were back here again. This is entirely bipartisan across our committee to determine why 83 of gulf war illness claims are denied by the va. What we can do to insure our gulf war veterans receive the benefits they earn. Gulf war illness is chronic, painful, often decan debilitating disease and they deserve disability compensation and have their condition recognized and treated by va providers. Just this past monday the state Veterans Advisory Committee in my home state of New Hampshire who i meet with on a quarterly basis were criticizing the va as process for adjudicating gulf war illness claims. In fact one of the members of the state advise very committee had his own claim for gulf war illness denied. In veterans in my state and across the country the vas process is poorlyrun and fail to adequately train personnel. This late of the report confirms what our constituents suffering from gulf war illness continue to tell us on a regular basis is. Their claims continue to be denied because medical examiners do not know how to diagnose gulf war illness or the va fails to apply the presumption that congress intends for to grant this serviceconnection disability. When these claims are denied, va does not communicate to veterans as the chairman said. The reasons for the denial, leading to veterans becoming frustrated, losing faith in the va, and filing appeals. The gao report found that 90 of medical examiners that the va relies upon to assess veterans disabilities have not completed the elective training on gulf war illness so they can better assess veterans disability levels. I would like to know why this train something not a mandatory requirement and when it will become mandatory. I would like also to know if this webbased train something sufficient to train medical examines and if claims processors need better training requirements as well. I wish to hear from the va on the plan to improve the way it communicates decision made on claims. When veterans are not provided the reason that the claim was denied, they become frustrated and angry and end up in our apples process which is already swamped. If they do knot know why the claim is denied they can spend years attempting to obtain benefits through a lengthy appeals process. Finally we know the va continues to conduct and support research on gulf war illness, however the va lack as single Case Definition and as i understand, it has no plan to develop one. A uniform Case Definition for gulf war illness was recommended in 2014 by the vas research Advisory Committee and the National Academy of medicine. A single Case Definition is needed to improve research, diagnosis and treatment of gulf war illness. I would like to see a plan put in place to develop a single gulf war illness definition. The number of gulf war illness claims doubled from 2010 to 2015 and we can expect that more veterans will file claims and we subsequently appeal denied claims. It is imperative the va implement the gao recommendations now so that gulf war veterans receive the treatment and disability benefits that they deserve without having to the fight the va every step of the way. Thank you, chairman bost, i yield back. Thank you, miss kuster. Im going to ask all members waive their opening remarks as per the committees custom. I understand chambering man and Ranking Member esty will give their statements at the end of the hearting. Now i would like to welcome our witnesses again. Thank you for taking time to be here today. Our first witness is bradly flohr, Senior Advisor for compensation services. He is accompanied this morning by dr. Patrick joyce, the chief Occupational Health clinics of the washington va medical center. Were joined by melissa emreyarras, is that correct . With a name like bost, where they say bost, make sure we get it right. Director of Education Workforce and income of the gao. Zachary hearn, the Deputy Director for claims for Veterans Affairs and Rehabilitation Division of the American Legion. And michael figlioli, correct . The Department Director and national Veterans Services of the vfw. Finally, Anthony Hardie National Board chair of veterans for common sense. I want to remind the witnesses your complete witness statement will be entered into the hearing record. With that, mr. Flohr, youre recognized for five minutes. Thank you, chairman bost, chambering man, Ranking Members esty and kuster, and members of the committee. Thank you for the opportunity to discuss how va processes gulf war veterans compensation claims for undiagnosed illnesses for medically unexplained multisymptom illnesses of the for purposes of my testimony i will refer to these categories as gulf war illness. Today i will provide overview of va processing of gulf war illness claims and some of our training and Quality Assurance efforts. Service connection may be awarded for gulf war illness when veteran has service in the southwest asia theater of operations after august 2nd, 1990, has a qualifying disability in according to 38cfr, 3. 187. Service connection may be awarded for gulf war illness from december 31st, 2016, to december 31st, 2021. In fest call year 201,618,681 veterans received a digs for a claim specifically for gulf war illness. From this, 4594 veterans were awarded Service Connection for one or more diagnosed illness or chronic multisymptom illness. 13 were for undiagnosed illness and 31 for medically unexplainedded multisymptom illness. Vba continues to strengthen Training Program for gulf war illness claims. Which developed 13 related courses for processors they mandated 10 hours training for rating Veterans Service representatives. Were developing a new training module which focuses on the southwest asia gulf war claims. This module scheduled to launch in fy 2018. Va simply minted number of initiatives to include improvement of the notification process, specifically to include a more thoroughly explanation when a claims issue is denied. In recent years va developed special tracking to specifically account for gulf war claims. Va also amended its gulf war general medical examination template to include Important Information for examiners when addressing undiagnosed and chronic multisymptom illnesses as well as information on various environmental exposures in the gulf war. Va constantly looking for ways to improve benefits and services it provides for veterans that served in the gulf. Va works closely with the Veterans Health administration reviewing research by offices Public Health and research of development and academy of medicines biannual updates on gulf war issues. We work with the department of defense in join work groups that Research Environmental exposures coincident with military service vba as well as medical capacity examiners. Finally have. Ba national quart review staffs as well as local quality reviewers in our regional offices continue to insure employees correctly process and decide claims for gulf war illness. As agreed upon with the National Gulf War Research Center vba conducted pox focus reviews on decisions for gulf warrelated illnesses in december 2015 and december 2016. The review in 2015 focused on fiscal year 2015 gulf war cases showed 94 accuracy rate. 2016 review expanded review from cases medically unexplained chronic multisome illnesses four year period starting from fiscal year 2011. This review showed 89 accuracy rate. Va continues to approve the efficient, timely processing of claims of service in the gulf war. Science and medical aspects of undiagnosed illnesses and chronic multisome illnesses are complex, va continues to review scientific and medical whether it literature to gain a better understanding of the impact of these ill necessaries on our gulf war veterans. This concludeses my opening statement. Im ready to address any questions you or the member of the committee may have. Thank you, mr. Flohr. Miss emreyarras are recognized for five minutes to give testimony for the gao. Thank you, chairman bost, chambering man and Ranking Members of the subcommittees. Im please to discuss our recent report on va evaluation of gulf war illness disability claims of the exact causes of gulf war illness are not always known and veterans symptoms vary widely. Veterans with gulf war illness may experience symptoms such as fatigue, headaches joint pain, indigestion, insomnia, respiratory disorders and skin problems and memory impairment. May have Infectious Diseases likes malaria or west nile virus. Va refers to claims for gulf war illness undiagnosed illness, medically unexplainedded chronic multisymptom illness and infect schusses it claims. We refer to the three types of claims as gull war illness claims. My testimony today will focus on our findings related to three key areas. One, recent trends in gulf war illness disability claims. Two, challenges va faces, and three, vas gulf war Illness Research. In terms of claims trends, we found that the number of gulf war illness claims processed increased in recent years. In fiscal year 2015 vba completed processing about 11400 claims which was more than double the 4,800 claims it processed in fiscal year 2010. Many of these claims included multiple medical issues or symptoms related to gulf war illness. On average we found that gulf war illness claims took four months longer to process than other claims. We also found that gulf war illness claims were approved at lower rates than other types of disability claims. We found that approval rates for gulf war illness medical issues were about three times lower than for all other claimed disabilities. Specifically, we found that 17 of gulf war illness medical issues were approved compared to 57 for all other types of medical issues. According to va several factors may contribute to the lower approval rates. Including that these claims are not always understood by vas staff. Additionally veterans sometimes file for gulf war illness benefit but according to some va staff we spoke with, do not provide sufficient evidence that their symptoms have existed for at least six month as generally required by va regulations. In terms of challenges va faces we found that there is inadequate training for vha million examiners. Vba claims rating staff often rely on these medical am examiners to before they make a claim. Medical examiners say conducting gulf war medical exams is challenging because of range ever symptoms that could qualify as gulf war illness. Vha offered optional 90 minute webbased gulf war illness training for its medical examines since 2015 but according to vha, Training Data only showed 10 of the examiners had taken this training as of this past february. We recommended that va require its medical examiners to campus pleat training on gulf war illness and va agreed with this recommendation. We also found that decision letters va sends to veterans denying benefits for gulf war illness claims do not always clearly explain to the veteran how their claim was decided which can leave the veteran uncertain how the claim was evaluated and potentially lead to unnecessary appeals. We remember that va require decision letters to clearly explain how the claim was evaluated and va agreed with our recommendation. In terms of gulf war Illness Research we found that. Have a does not have a plan to develop a single Case Definition of gulf war illness. Va advisory groups emphasized establishing a single definition could further improve research, diagnosis and treatment of veterans. Va advisory groups recommended in the near term that va analyze data from the existing data sets, in long term conduct Research Projects to contribute to the establishment of a single Case Definition. Va included in its 2015 Gulf War Research Strategic Plan an objective to establish a single definition but the agency has no action plan in place to achieve it. Without a plan, va risks engaging in research that is not targeted toward its goal. We recommended va prepare a plan to develop a single of anything and va agreed with this recommendation. Thank you. This concludes my remarks. Thank you, mr. Hearn, youre recognized to begin testimony for American Legion, please. Thank you. It is like deja vu all over again. Ranking member kuster, you made this assertion in our opening remarks during the march, 2016 hearing regarding gulf war illness. 486 days, one damning gao report, thousands of injured veterans and impacted dependents later were here to discussed a adjudication of gulf war illness claims by va, yes, Ranking Member kuster it feels like deja vu over again. Good morning chairman bost, Ranking Member kuster and members oversight investigation and on behalf of commander Charles Schmidt over 2 million members of the nations largest Veterans Service organization the American Legion appreciate the opportunity to testify regarding the adjudication of gulf war illness claims. Gulf war illness claims are inherently complicated. Veterans must tread murky waters for many undiagn