STATEMENT
OF ASSISTANT DIRECTOR VETERANS BENEFITS POLICY BEFORE THE
SUBCOMMITTEE ON BENEFITS COMMITTEE ON VETERANS’ AFFAIRS UNITED STATES HOUSE OF REPRESENTATIVES WITH RESPECT TO PERSIAN GULF WAR VETERANS’
ISSUES WASHINGTON, D.C. OCTOBER
26, 1999 MR. CHAIRMAN AND MEMBERS OF THE
SUBCOMMITTEE: Thank you
for the opportunity to present the views of the Veterans of Foreign
Wars of the United States with respect to Persian Gulf War veterans’
issues. There are two
issues stated for this hearing -- the first is that some veterans and
advocates perceive a disparity in treatment and claims’ adjudication
at the Department of Veterans Affairs. The second is, in some instances, that claims are decided
differently because in one case a physician may have diagnosed a
specific ailment while in another case symptoms are attributable to an
undiagnosed illness. Issues such
as these are one of the very reasons the Veterans of Foreign Wars
decided two years ago to establish a toll-free “help-line” that
veterans could use to inform us of problems they may be encountering
on any aspect of VA health care. Since that time, we have received over 17,000 inquiries and,
as could be expected, many of those inquiries also involve benefit and
entitlement issues. (Presently,
about half of those inquiries now pertains to questions such as
compensation and pension.) Of
the total inquiries we have received, only 30 have been specifically
related to Gulf War health-related problems.
While the “help-line” inquiries do not reflect any
complaints directly received by our service officers throughout the
country, our overall experience does not show that there is a systemic
problem with either the law or the VA’s implementation of it. Any veteran
suffering from disabilities or illnesses associated with environmental
hazards exposure has a mandate for VA health care as a member of
enrollment priority category six.
Further, if a veteran is receiving compensation for any other
diagnosed service-connected disability, he/she will at least be in
enrollment priority category three and treatment will be provided for
essentially all health-care problems. We did not
restrict ourselves to Gulf War health-care issues.
Last year, we asked our service officers to send us rating
decisions on seven specific areas so we could monitor the Veterans
Benefits Administration’s quality assurance programs, specifically
the Systematic Technical Accuracy Review (STAR) program.
Gulf War Undiagnosed Illness claims is another of those seven
areas monitored. So far,
we have reviewed approximately 50 of these cases and have found an
error rate of approximately 20 percent.
This figure is below VBA’s overall STAR error rate and
everyone must agree that 20 percent is still an unacceptable rate. However,
this does not address the entire spectrum on the issue of Gulf War
Undiagnosed Illnesses. The
purpose of Public Law 103-446, as it pertains to Gulf War veterans,
was to “provide compensation to Persian Gulf veterans who suffer
from disabilities … that cannot now be diagnosed or defined.”
This is a benevolent law but one that naturally added much
complexity to the VA’s system of veterans’ claims processing.
For the first time ever, rating specialists in the Veterans
Benefits Administration have to determine issues of service-
connection based not on actual medical diagnoses of particular
disabilities and illnesses but just on described symptoms. It is
therefore understandable that there are many questions on the VA’s
implementation of the law. Of
those cases that have been brought to our attention, either on health
care or adjudication of claims, we have found that errors resulted
more out of confusion and misunderstanding than any deliberate failure
to implement the law. In
our opinion, there has not been one case that we have not been able to
resolve in accordance to how Congress intends the system to be
conducted. Where
then does the difficulty arise concerning Gulf War Undiagnosed
Illnesses? There are
really two problems, in our opinion.
The first is directly related to the second purpose for this
hearing. It is very
difficult for medical professionals to make a determination of an
“undiagnosed illness”. The
natural instinct for a doctor is to find out what’s medically wrong
so that a proper regiment of treatment can be initiated.
Consequently, there certainly may be instances of “forced”
diagnosis. Therefore, if any described “evidence” of a disability is
not directly related to military service or within the limited
presumptive period ascribed to that diagnosed condition, service
connection most likely will not be granted. This
indicates a major problem currently with Gulf War Undiagnosed
Illnesses. If a veteran
is specifically diagnosed with a recognized disability or illness (for
example, Amyotrophic Lateral Sclerosis [ALS]) and it is done outside
the designated presumptive period for Gulf service, the condition will
most likely be classified as non-service connected.
This, of course, means no mandate for VA health care or, for
that matter, compensation. However,
if the veteran receives a medical finding of, for example “motor
neuron disorder, etiology unknown”, the veteran will be granted
service connection for an undiagnosed illness (even though the medical
professional might suspect that the “major neuron disorder” could
very well be the early manifestation of ALS). The second
problem with Gulf War veterans’ claims is really no different than
for any other veterans’ claim with the VA -- the processing of that
claim is not being accomplished as expeditiously or with the desired
quality that the VA would like. The
problem here is something that we have identified and discussed in
congressional testimony over the past two years: the adjudicators and
rating specialists in the Veterans Benefits Administration do not have
the time to do the job expected of them. Translated another way, there are simply not enough people. This should
not come as a surprise to any one.
No one can rightfully expect an agency -- the VBA in this case
-- to undergo an overall 22% reduction in Full-Time Employee
Equivalency (FTEE) in six years and then add an intricate and complex
mission, such as the adjudication of Gulf War Undiagnosed Illnesses,
without some major and/or serious degradation in services.
And, that is exactly what we now have within the VBA. This problem is further
exacerbated because VA’s succession planning estimates indicate that
1,106 Veterans Claims Examiners (VCEs) and 79 Hearing
Officers/Decision Review Officers (HO/DROs) will be eligible to retire
over the next five years. Coupled
with other transition actions, the VBA is projecting the loss of as
many as 1,400 highly experienced VCEs in the next five years!
When considering that it takes at least three years of involved
training and experience to achieve a qualified rating specialist, the
Under Secretary for Benefits is now faced with a pending catastrophe. We realize
that the fiscal year 2000 VA appropriations has a programmed overall
164-FTEE increase for the VBA with a 440 increase for the Compensation
and Pension Service after implementing transfers from other VBA
business lines. But, in reality, this is just “smoke” without the
attendant and necessary authority to the Under Secretary for Benefits
to offer buy-outs. That
authority has not yet been extended and, consequently, we simply do
not see any hope for improvement of veterans’ claims processing.
Indeed, we project that it will soon get worse with the
Systematic Technical Accuracy Review (STAR) quality figures reaching a
40-percent error rate and with average processing time for an original
compensation claim going well over 200 days. This
Committee has listened to us hold forth on this very point in the
past. We don’t need to
belabor it now. We assert
it is not solely Congress’s mission to correct this situation, the
Administration bears equal responsibility. Mr.
Chairman, the Congress, and particularly you and your colleagues on
the Veterans’ Affairs Committee, must be commended for the
achievements in veterans entitlements during this congress.
We would ask that the committee direct its focus toward the
personnel situation in the Veterans Benefits Administration. Mr.
Chairman, this concludes my statement and I will be glad to respond to
questions. Attached are
germane resolutions. Resolution
No. 625 SUPPORT
FOR GULF WAR VETERANS WHEREAS,
during the Gulf War, according to official military reports, members
of the armed forces were exposed to various toxic substances and
environmental hazards; and WHEREAS,
many of these veterans are now suffering from illnesses, or
manifesting symptoms of illnesses that may be attributed to their
service in the Persian Gulf; and WHEREAS,
many Gulf War veterans did not begin to manifest symptoms until
several years after returning from the Persian Gulf; and WHEREAS,
according to reputable scientific studies and reports, Gulf War
veterans are reporting symptoms at a greater rate than their peers of
the same era who did not deploy to the Persian Gulf; and WHEREAS,
section 1117 of Title 38, United States Code, requires the Department
of Veterans Affairs to use the available medical evidence to help
determine an appropriate time period for when symptoms associated with
such service will manifest; and WHEREAS,
current available medical and scientific evidence has yet to determine
the cause, effects, or latency period for the illnesses associated
with service in the Persian Gulf; now, therefore BE
IT RESOLVED, by the Veterans of Foreign Wars of the United States,
that we continue to urge the Secretary of Veterans Affairs to
establish an open ended presumptive period until the medical and
scientific community determines an appropriate time in which
conditions associated with Gulf War service will manifest; and BE
IT FURTHER RESOLVED, that we urge the Department of Defense and the
Department of Veterans Affairs to provide health care for all active
duty military veterans whose health has been adversely affected by the
Persian Gulf War, and to conduct all necessary tests to determine the
causes of these illnesses; and BE
IT FURTHER RESOLVED, veterans of the Gulf War be afforded the same
rights and privileges guaranteed to all other veterans; and BE
IT FURTHER RESOLVED, that we urge the Department of Veterans Affairs
to act in accordance with Title 38 USC, section 1117, and develop, at
the earliest possible date, appropriate definitions or diagnoses of
the illnesses associated with service in the Persian Gulf; and BE
IT FURTHER RESOLVED, that we urge Congress to adequately fund
appropriate medical and scientific research, and the Department of
Defense, Health and Human Services, and Veterans Affairs to implement
all relevant laws that support all research efforts; and BE
IT FURTHER RESOLVED, that we urge the Departments of Defense, Health
and Human Service, and Veterans Affairs and the Congress to fund
appropriate research into the causes of these illnesses; and BE
IT FURTHER RESOLVED, that the VFW continue to closely monitor this
issue and urge appropriate corrective action when necessary to assist
Gulf War veterans and their families to include veterans who served in
the nations of Turkey and Israel. Resolution
No. 634 OPPOSE
STAFF REDUCTIONS FOR
THE VETERANS BENEFITS ADMINISTRATION WHEREAS,
the timeliness and quality of claims processing in the VA has made
some improvement in recent years; and WHEREAS,
this improvement has occurred primarily through resorting to costly
and inherently inefficient short-term measures such as overtime,
“brokering” of cases between regional offices, and “help
teams”; and WHEREAS,
the VBA has an improvement plan known as Business Process
Re-engineering to resolve all of its claims processing deficiencies
and would help make the VA a premier government agency in customer
service; and WHEREAS,
under the VA budget plan for the next five years, the Veterans
Benefits Administration will continue to lose substantial manpower (FTEE
-- Full-time Equivalency);
and WHEREAS,
the National Academy of Public Administration (NAPA) in its August
1997 report, Management of
Compensation and Pension Benefits Claims Processes for Veterans,
was very critical of VBA’s planned staff reductions as premature and
jeopardizing any forward movement on Business Process Re-engineering;
and WHEREAS,
the VBA has already recently suffered staff reductions on an WHEREAS,
NAPA also urged that Congress take immediate action to sustain the VBA
work force at least at Fiscal Year 1997 levels; and WHEREAS,
the Administration has proposed an 125 FTEE reduction for VBA in the
FY 1999 VA budget; and WHEREAS,
the FY 1999 Veterans Independent
Budget and Policy found that, because of prior deep cuts in all of
VBA’s services, shifting workers internally will only rearrange the
areas of the manpower crisis and that instead, current staff levels
must be increased in Compensation and Pension Service and maintained
in the other VBA components; now, therefore BE
IT RESOLVED, by the Veterans of Foreign Wars of the United States,
that we urge Congress to include sufficient funding in VA’s
appropriations to increase FTEE in the Compensation and Pension
Service by 500 and maintain FTEE at the FY 1997 levels in the other
VBA components. Resolution No. 698 AMYOTROPHIC
LATERAL SCLEROSIS (LOU GEHRIG'S DISEASE) HIGH
AMONG GULF WAR VETERANS WHEREAS,
the Department of Veterans affairs is trying to determine why the
fatal wasting disease Amyotrophic Lateral Sclerosis, (ALS) may have
stricken more than 40 Persian Gulf Veterans; and WHEREAS,
ALS is a progressive disease that destroys motor neurons, the
specialized brain and spinal cord nerve cells that control muscles;
and WHEREAS,
while progression of the disease may vary, approximately 50 percent of
people with the disease die within three years of the first symptoms;
and WHEREAS,
an estimated 30,000 Americans (less than one percent of the
population) suffer from this disease; and WHEREAS,
it typically appears in people between the ages of 50 and 70; and WHEREAS,
the average age of Persian Gulf Veteran is 31; and WHEREAS,
the incidence of this disease among people in this age group is so low
that it cannot be reliably measured; and WHEREAS,
estimates suggest that normal risk for a person in their 30s to
contract ALS is less than one in one million per year; and WHEREAS,
the rate of contracting this disease in the Gulf War veteran
population would normally be expected to be around six cases given
their age and physical condition; now, therefore Be
It Resolved
by the Veterans of Foreign Wars of the United States that we call for
intensified medical and scientific research to determine the cause of
Amyotrophic Lateral Sclerosis among Gulf War Veterans, and in the
interim we urge the Department of Veterans Affairs grant an open-ended
presumption of service connection for Amyotrophic Lateral Sclerosis
for Persian Gulf War veterans until such time as the research is
complete. Back to Witness List |
