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25–122 2017

TWENTY–FIVE YEARS AFTER THE PERSIAN GULF 

WAR: AN ASSESSMENT OF VETERANS AFFAIRS’ 

DISABILITY CLAIM PROCESS WITH RESPECT TO 

GULF WAR ILLNESS 

JOINT HEARING 

BEFORE THE

SUBCOMMITTEE ON OVERSIGHT AND 

INVESTIGATIONS 

JOINT WITH

SUBCOMMITTEE ON DISABILITY ASSISTANCE AND 

MEMORIAL AFFAIRS 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED FOURTEENTH CONGRESS 

SECOND SESSION 

TUESDAY, MARCH 15, 2016 

Serial No. 114–59 

Printed for the use of the Committee on Veterans’ Affairs 

( 

Available via the World Wide Web: http://www.fdsys.gov 

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(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

JEFF MILLER, Florida, Chairman 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida, Vice-Chairman 

DAVID P. ROE, Tennessee 

DAN BENISHEK, Michigan 

TIM HUELSKAMP, Kansas 

MIKE COFFMAN, Colorado 

BRAD R. WENSTRUP, Ohio 

JACKIE WALORSKI, Indiana 

RALPH ABRAHAM, Louisiana 

LEE ZELDIN, New York 

RYAN COSTELLO, Pennsylvania 

AMATA COLEMAN RADEWAGEN, American 

Samoa 

MIKE BOST, Illinois 

CORRINE BROWN, Florida, Ranking 

Minority Member 

MARK TAKANO, California 

JULIA BROWNLEY, California 

DINA TITUS, Nevada 

RAUL RUIZ, California 

ANN M. KUSTER, New Hampshire 

BETO O’ROURKE, Texas 

KATHLEEN RICE, New York 

TIMOTHY J. WALZ, Minnesota 

JERRY MCNERNEY, California 

JON TOWERS, Staff Director 

DON PHILLIPS, Democratic Staff Director 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATION 

MIKE COFFMAN, Colorado, Chairman 

DOUG LAMBORN, Colorado 

DAVID P. ROE, Tennessee 

DAN BENISHEK, Michigan 

TIM HUELSKAMP, Kansas 

JACKIE WALORSKI, Indiana 

ANN M. KUSTER, New Hampshire, Ranking 

Member 

BETO O’ROURKE, Texas 

KATHLEEN RICE, New York 

TIMOTHY J. WALZ, Minnesota 

SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL 

AFFAIRS 

RALPH ABRAHAM, Louisiana, Chairman 

DOUG LAMBORN, Colorado 

LEE ZELDIN, New York 

RYAN COSTELLO, Pennsylvania 

MIKE BOST, Illinois 

DINA TITUS, Nevada, Ranking Member 

JULIA BROWNLEY, California 

RAUL RUIZ, California 

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records 

of the Committee on Veterans’ Affairs are also published in electronic form. The printed 

hearing record remains the official version. Because electronic submissions are used to 

prepare both printed and electronic versions of the hearing record, the process of converting 

between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process 

is further refined. 

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(III) 

C O N T E N T S 

Tuesday, March 15, 2016 

Page 

Twenty–Five Years After The Persian Gulf War: An Assessment of Veterans 

Affairs’ Disability Claim Process with Respect to Gulf War Illness ................ 1 

OPENING STATEMENTS 

Honorable Mike Coffman, Chairman ..................................................................... 1 

Prepared Statement ......................................................................................... 32 

Honorable Ann Kuster, Ranking Member ............................................................. 2 

WITNESSES 

Mr. David R. McLenachen, Deputy Under Secretary for Disability Assistance . 4 

Prepared Statement ......................................................................................... 32 

Accompanied by: 

Mr. Bradley Flohr, Senior Advisor, Compensation Service, Veterans Benefits Administration, U.S. Department of Veterans Affairs 

Mr. Zachary Hearn, Deputy Director for Claims, Veterans Affairs and Rehabilitation Divison, The American Legion ........................................................... 5 

Prepared Statement ......................................................................................... 35 

Mr. Aleksandr Morosky, Deputy Director, National Legislative Service, Veterans of Foreign Wars ......................................................................................... 7 

Prepared Statement ......................................................................................... 38 

Mr. Rick Weidman, Executive Director for Policy and Government Affairs, 

Vietnam Veterans of America ............................................................................. 9 

Prepared Statement ......................................................................................... 40 

Mr. Richard V. Spataro, Director of Training and Publications, National Veterans Legal Services Program ............................................................................. 10 

Prepared Statement ......................................................................................... 43 

FOR THE RECORD 

Anthony Hardie, Gulf War Veteran and Director, Veterans For Common 

Sense ..................................................................................................................... 47 

Ronald E. Brown, Gulf War Veteran and President, National Gulf War Resource Center ........................................................................................................ 53 

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(1) 

TWENTY–FIVE YEARS AFTER THE PERSIAN 

GULF WAR: AN ASSESSMENT OF VETERANS 

AFFAIRS’ DISABILITY CLAIM PROCESS WITH 

RESPECT TO GULF WAR ILLNESS 

Tuesday, March 15, 2016 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON VETERANS’ AFFAIRS, 

SUBCOMMITTEE ON OVERSIGHT

AND INVESTIGATIONS, 

Washington, D.C. 

The Committee and Subcommittees met, pursuant to notice, at 

10:30 a.m., in Room 334, Cannon House Office Building, Hon. Mike 

Coffman [Chairman of the Committee] presiding. 

Present: Representatives Coffman, Lamborn, Roe, Benishek, 

Huelskamp, Walorski, Kuster, O’Rourke, Walz, Abraham, Zeldin, 

Costello, Bost, and Ruiz. 

OPENING STATEMENT OF CHAIRMAN COFFMAN 

The CHAIRMAN. Good afternoon. This hearing will come to order. 

I want to welcome everyone, especially our good friends from the 

Subcommittee on Disability and Memorial Affairs, to today’s hearing regarding VA’s handling of disability claims for Persian Gulf 

War veterans. 

As a preliminary matter, I would like to ask unanimous consent 

that statements from three Gulf War veterans, and advocates for 

the issues we will discuss today, be entered into the record. The 

statements are found in each Members’ packet. Hearing no objection, so ordered. 

This hearing is the second part of the Committee’s two-part series on the 25th Anniversary of the Persian Gulf War, a war in 

which I served. Today, we will examine VA’s own data that reveals 

a 16 percent approval rate and an 84 percent denial rate for claims 

of Gulf War veterans for undiagnosed illnesses and chronic multisymptom illnesses, both presumptive conditions under current law. 

VA often seems to deny these claims because it demands to know 

the specific cause for the illness. Yet, under the law, presumptive 

conditions do not require causality because they are presumed to 

have been caused by service in the Gulf War. The critical point to 

understand is that veterans cannot receive VA care for symptoms 

of Gulf War illness when a majority of those claims are denied by 

VA. 

We will also discuss former Under Secretary Allison Hickey’s 

email citing her, ‘‘concern that changing the name from chronic 

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multi-symptom illness to Gulf War illness might simply imply a 

causal link for veterans who served in the Gulf.’’ 

Ms. Hickey’s official email exposed VA’s efforts to block not only 

the use of the term recommended by the Institute of Medicine for 

Gulf War illness, but also VA’s practice of requiring causality for 

GWI claims, even though, again, presumptive conditions do not require causality. We also know—we also want to know more about 

an internal VA email, which has been provided to today’s panel, 

that reveals claims evidence that has been lost, even though VA’s 

system told veterans that such evidence was received. This is not 

particular to Gulf War veterans, but important regarding claims 

processing in general. 

I want to also mention that last Friday, March 11th, VA held a 

community of practice call to discuss issues related to our Subcommittee’s hearing held on February 23rd. The call included more 

than 50 participants, and it discussed how to improve care for veterans suffering from Gulf War illness. Unfortunately, the majority 

of the attention was given to a presentation by Dr. David Kearney 

regarding chronic pain with what seemed to be an emphasis on 

PTSD, and the use of mindfulness as a method of treatment for 

Gulf War illness. 

The call, coordinated by Dr. Stephen Hunt, shows that VA still 

clings to its often criticized efforts, and it contradicts his testimony 

from February 23rd, leading me to believe veterans suffering from 

Gulf War illness will never receive appropriate care while Dr. Hunt 

is at all connected to the issue. 

While the conversation during Dr. Hunt’s call warrants additional comments, I will save that for a later time. Before I turn 

my—to my friend Ranking Member Kuster, I want to highlight 

that the invitation for this hearing specifically cited our interest in 

discussing, ‘‘veterans who served in the Persian Gulf War,’’ and yet 

VA’s testimony has lumped information from 1990 with the current 

OIF, OEF veterans in an apparent effort to reflect better statistics 

than those specific to our issue today. 

With that, I now yield to Ranking Member Kuster for any opening remarks she may have. 

[THE PREPARED STATEMENT OF CHAIRMAN COFFMAN APPEARS IN

THE APPENDIX]

OPENING STATEMENT OF ANN KUSTER, RANKING MEMBER 

Ms. KUSTER. Thank you very much, Chairman Coffman, and 

Chairman Abraham, and Ranking Member Titus, who will be with 

us shortly, for holding this hearing on Gulf War veterans. 

As I have said during our hearing on Gulf War illness last 

month, in the 25 years since the end of the Gulf War, many veterans have suffered from symptoms that are not readily identifiable or well understood, and still struggle to receive compensation 

for their illness. 

During our hearing—the previous hearing, we heard from medical experts, researchers, and Under Secretary Clancy, and they all 

agreed that the symptoms of Gulf War illness vary and that research must continue so that we can better understand and treat 

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our veterans suffering from unexplained medical conditions associated with their Gulf War deployment. 

In 1998, Congress passed the Persian Gulf War Veterans Act, 

which granted veterans who served in the Persian Gulf during the 

first Gulf War a presumption of service-connection for their illnesses associated with their service. This gave our Gulf War veterans compensation for their illness and access to VA medical care 

to treat their symptoms. 

This change reflects our belief that veterans should not be denied 

disability compensation or access to VA health care because their 

symptoms may vary, or because it is not fully understood what 

caused Gulf War illness, or other unexplained symptoms. But 18 

years later, we continue to receive reports that veterans suffering 

from Gulf War illness and other unexplained medical conditions 

are improperly denied VA compensation for not being able to establish a service-connection when they were deployed to the Persian 

Gulf. Each time this happens, another veteran is being denied the 

compensation and health care that this Nation owes to them. And 

this is simply unacceptable. 

We have also received reports that as a cohort, Gulf War veterans have a higher disability claim denial rate, higher than her 

OEF and OIF veterans. This is why I am concerned about the end 

of the Gulf War presumption of services connection this year. I am 

concerned that veterans who may have been improperly denied 

compensation and health care by the VA will not have a chance to 

submit a claim after this point. I am also concerned that veterans 

who became sick later in life due to their deployment will be unable to receive compensation or VA health care. 

The VA has extended this presumption period once, but now it 

is up to Congress to decide if another extension is necessary. I look 

forward to hearing from our witnesses today about whether another extension is warranted and necessary. And I also want to 

know what needs to be done to improve the disability claims process for Gulf War veterans. 

I want to know if Veterans Benefits Administration employees 

are properly trained to rate Gulf War veterans claims, and how can 

we improve the quality of the claims rated so that veterans are not 

forced to appeal their claim every time. And with that, Chairman 

Coffman, I yield back. 

Mr. CHAIRMAN. Thank you, Ranking Member Kuster. I ask that 

all Members waive their opening remarks as per this Committee’s 

custom. Additionally, Chairman Abraham and Ranking Member 

Titus will provide their statements at the conclusion of the hearing. 

With that, I invite the first and only panel to the witness table. 

Thank you. On the panel, for the Department of Veterans Affairs 

we have Mr. David McLenachen, Deputy Under Secretary for Disability Assistance. He’s accompanied by Mr. Bradley Flohr, Senior 

Advisor for the Compensation Service of the Veterans Benefits Administration. 

Also on the panel we have Dr. Zachary Hearn, Deputy Director 

for Claims of the Veterans Affairs and Rehabilitation Division of 

the American Legion. Mr. Alexandra Morosky, Deputy Director for 

the National Legislative Service of the Veterans of Foreign Wars. 

Did I pronounce that right? 

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Mr. MOROSKY. It’s Aleksandr, sir. 

Mr. CHAIRMAN [continued]. Aleksandr. Okay, I’m sorry. Mr. Rick 

Weidman, Executive Director for Policy and Government Affairs for 

the Vietnam Veterans of America, and Mr. Richard V. Spataro, Director of Training and Publications for the National Veterans Legal 

Services Program. 

I ask for witnesses to please stand and raise your right hand. 

[Witnesses sworn.] 

Mr. CHAIRMAN. Please be seated. And let the record reflect that 

all witnesses have answered in the affirmative. 

Mr. McLenachen, you are now recognized for five minutes. 

STATEMENT OF DAVID MCLENACHEN 

Mr. MCLENACHEN. Chairman Coffman, Chairman Abraham, 

Ranking Member Kuster, and Members of the Subcommittees, 

thank you for the opportunity to discuss VA’s processing of claims 

for disability benefits from veterans who served and, in some cases, 

continue to serve in the Persian Gulf war. 

I am accompanied today by Mr. Bradley Flohr, Senior Advisor in 

our Compensation Service. We will discuss our efforts to ensure 

that Gulf War veterans receive the benefits they have earned, 

VA—VA’s processing of these claims, its training and quality assurance efforts, presumptive service-connection, the statutory authority for establishing presumptions, and the science and rationale behind such presumptions. 

This year marks the 25th anniversary of the start of the Gulf 

War. The initial conflict lasted from August 1990 until February 

1991. However, neither the President nor the Congress has declared an end to the Gulf War. So men and women who serve in 

the Southwest Asia theater of operations to this day remain entitled to presumptions of service-connection based upon their service. 

As of the end of fiscal year 2015, almost 7.2 million veterans 

served during the Gulf War era and over 1.8 million of these veterans were in receipt of disability compensation, which is the highest percentage of veterans in receipt of compensation from any era, 

war time or peacetime. Gulf War veterans who have received VA 

compensation average greater than six service-connected disabilities. Again, more than any other era. And Gulf War veterans now 

make up the majority of claims that VA receives. 

VA continues to improve the efficient, timely, and accurate processing of Gulf War veterans’ claims. It has reduced its overall backlog of pending claims by approximately 86 percent from its peak in 

March 2013 to the end of February 2016. VA has also reduced the 

average days for waiting for a decision to 93 days, which is a 189- 

day reduction from its peak in March 2013. 

The Veterans Benefits Administration is constantly looking for 

ways to improve the service it provides to this cohort of veterans. 

We closely review Gulf War issues with the Veterans Health Administration, the Department of Defense, the Institute of Medicine, 

and the National Gulf War Resource Center. 

VBA has a national quality review staff as well as quality reviewers in its local regional offices to ensure that employees correctly process and decide claims for Gulf War illness. Last year, VA 

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conducted a special focused review of decisions on claims for Gulf 

War-related illness which showed a 94 percent accuracy rate. 

Although the science and medical aspects of undiagnosed illnesses and multi-symptom illnesses are not yet fully understood, 

VA continues to review scientific and medical literature to gain a 

better understanding of the impact of these illnesses on Gulf War 

veterans. 

Presumptive service-connection fills a critical gap when exposure 

to toxic substances or certain disabilities resulting therefrom are 

not specifically documented in a Gulf War veteran’s service records. 

Service-connection for an undiagnosed illness or multi-symptom illness requires service in the Persian Gulf after August 2, 1990, and 

a qualifying chronic disability that rises to a compensable level of 

severity before December 31, 2016. 

Service-connection is also warranted for veterans who contract 

certain infectious diseases such as malaria, Q fever, and West Nile 

virus after Gulf War service, and that includes Afghanistan. The 

Secretary of Veterans Affairs has broad authority under Section 

501 of Title 38, United States Code to establish presumptions. 

To determine which diseases are associated with such service, 

the Secretary takes into account reports from the National Academy of Sciences, and all other sound medical and scientific information that’s available. Public Law 105–368 charges VA with the 

responsibility for notifying Congress of NAS findings that might 

impact presumptions of service-connection for diseases associated 

with service in the Southwest Asia theater of operations during the 

Gulf War due to exposure to biological, chemical, or other toxic 

agents, environmental or wartime hazards, or preventive medicine, 

or vaccines. 

That concludes my opening statement, we are happy to answer 

any questions that you might have. Thank you. 

[THE PREPARED STATEMENT OF DAVID R, MCLENACHEN APPEARS

IN THE APPENDIX]

Mr. CHAIRMAN. Mr. Hearn, you are now recognized for five minutes. 

STATEMENT OF ZACHARY HEARN 

Mr. HEARN. Thank you. 9,358 days. 9,358 days have lapsed since 

our Nation deployed nearly 700,000 brave men and women of an 

all volunteer military to soundly defeat an aggressor and secure 

the peace. Today, many of these veterans need our help, and sadly, 

they have not been able to receive the benefits associated with 

their service in Southwest Asia. 

Chairman Coffman, Abraham, Ranking Members Kuster, Titus, 

and distinguished Members of the Subcommittees on Oversight and 

Investigation and Disability Assistance and Memorial Affairs, on 

behalf of National Commander Dale Barnett, and the over 2 million members of the American Legion, we welcome the opportunity 

to discuss the struggles that veterans with service in Southwest 

Asia have faced in receiving disability benefits associated with 

their Persian Gulf service. 

According to VA’s March 2014 update for Gulf War veterans, 37 

percent of veterans that served during Operation Desert Storm sufLeonard.horne on VACREP0180 with DISTILLER

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fer from symptoms associated with Gulf War service. Yet, in over 

9,100 days since the final shots of Operation Desert Storm were 

fired, approximately 80 percent of all claims associated with Persian Gulf service were denied according to a separate VA report. 

The concept of the Department of Veterans Affairs presumptively 

service-connecting conditions associated with environmental exposures is not new to this generation of veterans. Veterans that participated in nuclear testing have conditions presumptively related 

to radiation exposure, and veterans with exposure to herbicides 

such as Agent Orange have a host of conditions that are presumptively related to their military service. 

So what separates the Gulf War generation from previous generations of veterans? For veterans with service in Vietnam, if they 

were diagnosed with conditions such as diabetes, ischemic heart 

disease, or a variety of cancers, outside of rare circumstances, they 

are presumptively service-connected for these conditions. It is simply a process of receiving a diagnosis and then determining the severity of the condition affecting the veteran. 

For veterans with service in Southwest Asia from August 2nd, 

1990, to the present, gaining service-connection for presumptive 

conditions is not as easily accomplished. Many of these—many of 

these conditions or symptoms associated with what VA has labeled 

as undiagnosed illness. The term is inherently gray and confusing. 

Veterans must endure years of medical testing and may even have 

multiple diagnoses associated with their symptoms. 

But here’s the catch. The moment that the veteran is diagnosed, 

it is virtually impossible to receive service-connection on a presumptive basis because the condition is no longer undiagnosed. 

The American Legion has over 3,000 accredited representatives 

located throughout the Nation. To ensure we provide effective advocacy for veterans, we bi-annually hold department service officer’s 

school. During last month’s training, we specifically discussed concerns surrounding Gulf War veterans and presumptive service-connection. Often, these representatives state that via medical professionals will assign symptoms to aging or, sadly, even malingering. 

For those that ultimately gain service-connection, it only comes 

after years of testing to exhaust the possibilities of other diagnoses. 

This process often causes significant stress for veterans and their 

families. 

Beyond concerns surrounding VA, many veterans of our National 

Guard and reserve components have an uphill fight regarding their 

medical records. While Operation Desert Storm serves as a first 

major conflict in the American Century with an all volunteer military, it also served as the impetus for frequent use of our guard 

and reserve forces. 

Unfortunately for guard and reserve veterans, treatment records 

become scattered between their duty station, mobility center, and 

foreign hospitals. As a result, these veterans have conditions that 

could be attributed to their military service, but due to unavailable 

records, are never able to receive the required positive nexus statement. 

To help correct problems facing Gulf War veterans, the American 

Legion believes that all of VA’s disability benefits questionnaire 

should include asking if, a) the veteran served in Southwest Asia; 

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and b) has the medical professional considered the relationship between the sought symptoms and conditions in Gulf War service. 

Additionally, we continue to call for a full implementation of the 

Virtual Lifetime Electronic Record. While VA has shown progress, 

concerns surrounding obtaining records from the Department of 

Defense continue to linger. Finally, there needs to be an increase 

in education for medical professionals regarding Gulf War veterans 

to decrease the delay in benefits and an increase in outreach to veterans to improve their knowledge regarding presumptive conditions 

associated with Gulf War service. 

Again, on behalf of National Commander Dale Barnett and the 

millions of dedicated veterans that comprise the Nation’s largest 

veterans service organization, we thank you for having the opportunity to speak today. I’ll be happy to answer any question—any 

of the Committee’s questions. Thank you. 

[THE PREPARED STATEMENT OF ZACHARY HEARN APPEARS IN THE

APPENDIX]

Mr. CHAIRMAN. Thank you, Mr. Hearn. Mr. Morosky, you are 

now recognized for five minutes. 

STATEMENT OF ALEKSANDR MOROSKY 

Mr. MOROSKY. Chairman Coffman and Abraham, Ranking Members Kuster and Titus, and Members of the Subcommittee, on behalf of the men and women of the Veterans of Foreign Wars of the 

United States, I’d like to thank you for the opportunity to testify 

on VA’s disability claims process with respect to Gulf War Illness. 

Today’s hearing is extraordinarily timely, as this year our Nation 

recognizes the 25th anniversary of the Persian Gulf war. While 

symbolic recognition is important, the VFW strongly believes that 

the most meaningful way to honor the service of Persian Gulf veterans is to ensure they have access to the benefits they need and 

deserve. 

All too often we find that this does not happen. This is largely 

due to the fact that the signature condition associated with the 

Persian Gulf war, commonly known as Gulf War Illness, presents 

itself in a way that’s not conducive to the traditional VA disability 

claims process. Consequently, our VFW service officers and appeal 

staff report that VA denies Gulf War Illness claims at a consistently higher rate than other types of claims. 

Part of the challenge is that Gulf War Illness is an inherently 

difficult condition to diagnose and treat. This is because it presents 

itself as a host of possible symptoms rather than a single condition 

that is clearly identifiable and unmistakable. 

What is certain is that more than 200,000 Persian Gulf war veterans suffer from symptoms that cannot be explained such as 

chronic widespread pain, cognitive difficulties, unexplained fatigue, 

and gastrointestinal problems, just to name a few. Instead of Gulf 

War Illness, VA uses the term medically unexplained chronic 

multi-symptom illness, or simply undiagnosed illness, to describe 

those symptoms. Although undiagnosed illness is considered a presumptive condition for Persian Gulf veterans, there are certain factors that prevent them from receiving favorable decisions when 

claiming that condition. 

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When claiming undiagnosed illness, the veteran lists the symptoms he or she is experiencing. These symptoms are often seemingly unrelated to one another, affecting multiple body symptoms. 

As a result, VA assigns separate disability benefit questionnaires, 

or DBQ’s, for each symptom and separate exams are scheduled. 

The current Gulf War DBQ asks the physician whether there’s 

a condition of each body system present, and then asks them to 

complete the relevant DBQs. Only after that are questions about 

undiagnosed illnesses asked. We find that this practice of assigning 

separate DBQs for each symptom being claimed in connection with 

undiagnosed illness has the effect of promoting diagnoses even 

when those diagnoses are minimally supported. 

Once a symptom receives a diagnosis, it’s no longer considered 

connected with undiagnosed illness, which, as its name implies, requires that the illness be unexplained. Since undiagnosed illness is 

ruled out for that condition, the veteran no longer has the opportunity to be granted on a presumptive basis. Often lacking any evidence of the condition in the service treatment record, a nexus cannot be established, and the claim is denied. 

VFW staff at the Board of Veterans Appeals notes that remands 

become numerous in these cases, and veterans often receive several 

different diagnoses for the same symptom from different doctors as 

a result. They believe that this is due to minimal support for those 

diagnoses in the first place. It is apparent to them that VA seems 

to go to great lengths to find diagnoses for each symptom simply 

so that undiagnosed illness can be ruled out. 

The practice of parsing out symptoms has the additional effect of 

preventing a holistic evaluation for undiagnosed illness. When the 

claim is for an undiagnosed illness, the VFW believes the physician 

should be asked more questions about the cluster of symptoms, 

which could be one illness leading to symptoms in multiple body 

symptoms rather than separate conditions related to each symptom. Only if they’re confirmed diagnoses should separate DBQs be 

completed. 

To improve the current system, the Gulf War DBQ should be 

analyzed by a team of physicians, including those from a war-related illness and injury study center. Additionally, VA should grant 

veterans reasonable doubt when deciding whether or not a veteran’s symptoms should be considered undiagnosed illness. 

Mr. Chairman, we see this as the most significant barrier for veterans seeking service-connection for Gulf War Illness. As noted in 

my written statement, the VFW has several other recommendations, including analyzing whether it would be better to process 

Gulf War illness claims at a centralized location; better tracking for 

Gulf War related BDD claims; enabling contract physicians to conduct Gulf War Illness exams; and training for claims adjudicators. 

Mr. Chairman, this concludes my testimony. I’m happy to answer 

any questions you may have. Thank you. 

[THE PREPARED STATEMENT OF ALEKSANDR MOROSKY APPEARS IN

THE APPENDIX]

Mr. CHAIRMAN. Thank you, Mr. Morosky. Mr. Weidman, you are 

now recognized for five minutes. 

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STATEMENT OF RICK WEIDMAN 

Mr. WEIDMAN. Thank you, Mr. Chairman. No doubt each of you 

are asking yourselves the obvious question is, given that we’re a 

single generation organization, why are we here today? And the answer is, we are committed. Our founding principle is, never again 

shall one generation of American veterans abandon another, number one. But secondly, what is happening to the Gulf War veterans 

is all too reminiscent of the way in which we were bounced around 

on Agent Orange where they denied, denied, and most Vietnam 

veterans who’ve been through this, it’s almost a truism that delay, 

deny until they die. And they’re doing the same thing to those who 

fought in the Persian Gulf War. 

It is the sophistry involved in trying to break out the symptoms 

in multi-symptom Gulf War illness, is—and then forcing you to 

prove that what that is connected to is—the reason why I say it’s 

sophistry, is VA well knows that you cannot pin down exact cause 

when you have a multi-toxin environment, which is exactly what 

you had during the Gulf War. 

And given that together, it is—it is something that what we 

should be doing is doing epidemiological studies intensively of this 

population compared with their peers in the military and the same 

MOS who did not deploy to the Gulf, and their civilian peers because it may be something about military life in general. 

So it is—having—having attended the IOM meeting recently, I, 

for the first time really, understand the emotional impact that they 

keep saying that there’s nothing physically wrong with you. I mean 

they’ll beat around the bush on that, but basically, that’s what 

they’re saying. And they keep running in—that panel, as an example, was half neuropsychologists and psychiatrists and half hard 

science. 

So that they’re—and the chair was a psychologist, so it’s little 

wonder that that panel recommended no more hard science because 

that’s too hard to figure out what has caused all of this in order 

to, a) begin to come up with treatments that are effective, and b) 

protect our troops in the future by not exposing them in the same 

way to the same conditions. 

So—and in regard to those who are applying now, they play the 

game of divide and conquer on all this, and you’re chasing a rabbit 

hole about what one particular symptom, what is the etiology of it, 

knowing full well that you can never pin that down. And that’s the 

game that they put individual veterans in when they apply for benefits and file their claim for compensation, and that’s not just for 

compensation because you have to be service-connected unless you 

are almost indigent in order to have health care. So it is a denial 

of all of the rights of these folks. 

I was particularly shocked when I stumbled across this little 

puppy, and it’s called VA DoD Clinical Practice Guideline, and it’s 

from 2014. And in this, the whole—all of this is—the only thing 

missing in this bit of sophistry is a snake oil to wash it down, because it says nothing, produced at, no doubt, at great expense by 

VA and DoD, but doesn’t do a darn thing to enlighten the individual clinician who is trying to help that particular veteran. I 

could perhaps say that more elegantly, but that’s where it is. 

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We worked very hard with Chairman Benishek and with Chairman Miller in bringing along the toxic research—Toxic Exposure 

Research Act. And one of the reasons why we’re so committed to 

that bill is not just for children, but also understanding that any 

one of these toxic bills has to be multi-generational, that we’ve got 

to rationalize this process if, in fact, we’re going to get beyond the 

sturm und drung for every generation. 

The—we’ve already—we are going through it now on burn pits, 

there was a major article that came out today that VA and DoD 

are stopping any further research into the burn pits, and they are 

blaming the Congress for not appropriating more monies and vice 

a versa. 

Whatever the upshot is this, we need more research that is systematically, that is for real, into both toxicology, and even more importantly, the epidemiology of how these toxins manifest in the veterans’ population. 

I thank you for the opportunity, Mr. Chairman. I’d be happy to 

answer any questions. 

[THE PREPARED STATEMENT OF RICK WEIDMAN APPEARS IN THE

APPENDIX]

Mr. CHAIRMAN. Thank you, Mr. Weidman. Mr. Spataro, you are 

now recognized for five minutes. 

STATEMENT OF RICHARD SPATARO 

Mr. SPATARO. Thank you, Mr. Chairman, Mr. Chairman, Members of the Subcommittees. I am pleased to have the opportunity 

to testify on behalf of the National Veterans Legal Services Program. There are two topics I’ll be discussing today: VA’s handling 

of claims related to Gulf War illness, and the extension of the end 

date for the period during which a qualifying chronic disability 

must manifest in order to qualify for presumptive service-connection. 

NVLSP has vast experience with veterans claims for VA disability compensation under 38 U.S.C. Section 1117, which requires 

the VA to pay compensation to Persian Gulf War veterans for 1) 

undiagnosed illnesses, 2) medically unexplained chronic multisymptom illnesses, and 3) diagnosed illnesses that the Secretary 

determines warrant a presumption of service-connection. 

It has been over two decades since Section 1117 was added to 

Title 38 of the U.S. Code, yet VA adjudicators still have difficulty 

adjudicating claims for the first type of chronic disability in particular: undiagnosed illnesses. In our experience, there are four 

common types of errors that the VA commits when adjudicating 

these claims. 

The first type of error is VA failing to consider the favorable 

rules for presumptive service-connection for an undiagnosed illness 

when the veteran does not explicitly claim benefits under that theory of service-connection. This type of error typically occurs when 

the veteran claims entitlement to service-connection for a particular diagnosis the veteran thinks he or she has, but does not 

refer to Gulf War illness. 

And the—if the evidence ultimately shows that the veteran’s 

chronic complaints cannot be attributed to a diagnosis, the VA adLeonard.horne on VACREP0180 with DISTILLER

11 

judicator sometimes denies the claim due to the lack of a diagnosed 

disability, which is a requirement for establishing service-connection under all other theories of entitlement. 

Although VA adjudicators have an affirmative duty to consider 

all reasonably raised theories of service-connection, they often fail 

to consider the theory of service-connection for an undiagnosed illness when that theory of entitlement is reasonably raised by the 

evidence. 

The second type of error is VA erroneously attributing symptoms 

that have not been associated with a diagnosed condition to a diagnosed condition unrelated to military service. VA then denies the 

claim on the basis that the veteran does not have an undiagnosed 

illness. 

We have seen several cases like this in which a careful review 

of the medical evidence shows that contrary to the VA’s finding, not 

all of the symptoms identified by the veteran are linked to a specific diagnosis. 

The third type of error is VA denying the claim due to the lack 

of medical nexus evidence. Under Section 1117, a Persian Gulf War 

veteran is entitled to the presumption of service-connection for a 

chronic undiagnosed illness if certain requirements are met. In 

2004, in Gutierrez v. Principi, one of NVLSP’s cases, the CAVC emphasized that the medical evidence linking the disability to military service, or the Persian Gulf War, is not one of those requirements. 

The VA, however, continues to erroneously deny some claims for 

service-connection for undiagnosed illnesses on the basis that no 

medical expert has linked the veterans’ symptoms to Gulf War illness. 

The fourth type of error is VA denying the claim due to the absence of objective indications of a chronic disability without considering non-medical indicators capable of independent verification. 

One requirement for establishing service-connection is that a veteran exhibit objective indications of a chronic disability. 

Objective indications include both signs in the medical sense of 

objective evidence perceptible to an examining physician, and other 

non-medical indicators that are capable of independent verification. 

And that last part is the critical part. We have seen cases in which 

the VA erroneously denied the claim solely due to the lack of objective evidence perceptible to a VA physician without considering 

other non-medical indicators that are capable of independent 

verification. 

Now I’ll move on to the second topic. Under Section 1117(b), the 

Secretary must establish the period during which a qualifying 

chronic disability must manifest following service in Southwest 

Asia in order to qualify for presumptive service-connection. 

After initially establishing a two-year presumptive period, VA 

has repeatedly extended the end date. Most recently, in 2011, VA 

extended the end date to December 31, 2016, due to scientific uncertainty regarding the time period in which Persian Gulf War veterans had an increased risk of suffering from chronic illnesses, as 

well as the fact that National Academy of Sciences reviews were 

still ongoing. 

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Little has changed with respect to the level of scientific certainty 

regarding Gulf War illness. Due to this continued state of uncertainty, VA should again extend the date of presumptive serviceconnection during which symptoms of a qualifying chronic disability must first manifest to at least December 31st, 2021, if not 

indefinitely. 

I’d be pleased to answer any questions you may have. Thank you. 

[THE PREPARED STATEMENT OF RICHARD V. SPATARO APPEARS IN

THE APPENDIX]

Mr. CHAIRMAN. Thank you, Mr. Spataro. The written statements 

of those who have just provided oral testimony will be entered into 

the hearing record and we will now proceed to questioning. 

Mr. McLenachen, based on testimony from many today, it is apparent that VA is not doing justice to presumptive claims-related 

to undiagnosed illnesses and chronic multi-symptoms, and chronic 

multi-symptom illnesses. What good are your quality reviews when, 

across the board, VA isn’t correctly applying the law? 

Mr. MCLENACHEN. I thank you for that question, Mr. Chairman. 

I am not ever going to come to these Committees and say that we 

are perfect in the work that we are doing, so I am not going to tell 

you that. I will say that we have taken a lot of steps to improve 

how we process these claims to include some of the suggestions 

that you have heard today, such as improved training, which we 

did just within this last fiscal year. 

Training is now a part of our challenge training that we provide 

to new adjudicators. All adjudicators were required to take revamped Gulf War training beginning in October 2015, which is 

mandatory. I have heard the message about the DBQs. I intend to 

go back and look and see whether that is something we can improve on based on the suggestions that you have heard here today. 

But we have extensive quality review programs, both locally and 

nationally, where we do look at these claims, to include something 

that we did in addition to those two programs, which is to do the 

focused review that is discussed in my testimony. So we do have 

a very robust quality review program where we look at processing 

of these claims. Having said that, I intend to look carefully at the 

testimony of the other witnesses, and carefully consider their suggestions. 

Mr. CHAIRMAN. In 2015, the Board of Veterans’ Appeals remanded about a fourth of these claims, nearly a fourth were granted, only 6 percent were denied, and roughly half remained unresolved. These same percentages are similar to 2016, so far. This indicates a problem in the handling of these claims. We want to 

know what you are going to do to immediately fix these problems. 

Mr. MCLENACHEN. Mr. Chairman, I just want to challenge the 

idea that a remand means that VA did something wrong. In fact, 

due to the appeal process that we have, it is often because of the 

passage of time. Again, having said that, the goal is always to resolve the claim at the earliest point possible. And we have had 

some discussions recently about how we can do that better with the 

service organizations. If the Board points out errors that make it 

back to the regional office, we try to incorporate that in our training to the best that we can. 

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13 

Mr. CHAIRMAN. Yeah. Well, Mr. McLenachen, will VA extend the 

presumptive claims deadline? 

Mr. MCLENACHEN. We have a rule-making in progress that addresses that. Before I can provide you a definitive answer, we have 

to go through the rule-making process, but I can tell you we got 

a new IOM report just recently, which the Veterans Health Administration is looking at very carefully. 

Mr. CHAIRMAN. Okay. 

Mr. MCLENACHEN. I agree with what was said here today that 

the science has not really changed recently. 

Mr. CHAIRMAN. Mr. McLenachen, according to Ron Brown, president of the National Gulf War Resource Center, on August 17, 

2015, VA stated it would ‘‘do a statistically significant review of 

completed Gulf War claims to determine if there is a problem’’ in 

processing such claims. What is the result of that review? 

Mr. MCLENACHEN. I will let Mr. Flohr address that. 

Mr. CHAIRMAN. Mr. Flohr. 

Mr. FLOHR. Thank you, Mr. Chairman. We did do that review. 

It was approximately 360 claims, it was a statistically significant 

number. We found that we had two claims which actually were improperly denied. We have taken action to fix those. And there were 

another 6, or a little more than 12 or so, where we either had an 

examination that was not sufficient, or an improper examination 

was done by VHA, and we are returning those to have those corrected. So our rate there was 94 percent accuracy. 

Mr. CHAIRMAN. Mr. Flohr, can you provide that information to 

this Committee immediately upon completion of this hearing? 

Mr. FLOHR. Yes. We can do that, sir. 

Mr. CHAIRMAN. Very well. 

Ranking Member Kuster, you are now recognized for five minutes. 

Ms. KUSTER. Thank you, Mr. Chairman. Well, it appears to me 

that this is deja vu all over again. We are revisiting where we were 

with the Vietnam veterans. And it was shortly after I came to Congress that Secretary Shinseki worked on this presumption about 

Agent Orange and I think it, hopefully, has made a significant difference in the lives, certainly for veterans in my district in New 

Hampshire, and I really believe in following the science where it 

leads us, but sometimes we don’t have it in a timely way. 

And so I appreciate you being with us, Mr. Weidman, and I want 

to focus in on that, because it seems like we have a couple of different catch-22s that I am trying to catch up with and follow here. 

One is that I am impressed by the data, and thank you for providing it for my district, about the reduction in the backlog on disability claims, the reduction in time that it takes for an average 

claim, and the improvement in accuracy of claims, but I am trying 

to reconcile that with this data that the VA denies 80 percent of 

claims filed by Gulf War veterans for conditions related to the war. 

I mean, I meet veterans all the time that are trying to cope with 

this constellation of symptoms and it is very challenging, and so I 

am trying to determine if we believe in this, if Congress passed this 

presumption, why are we having such a hard time addressing, and 

is the 80 percent denial, is that these are somehow malingerers 

that are coming forward? I don’t meet those people. 

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Mr. MCLENACHEN. So Mr. Flohr has some of that more specific 

data that we can provide to the Committee as far as actual grants 

and denials, specifically for subsets of the Persian Gulf war period. 

I just want to point out, however, that to some extent I assume 

that the 80 percent figure that we are talking about relates specifically to those Gulf War illness presumptions. In many cases, the 

veteran is service-connected for other disabilities that are diagnosed, and for that reason, there may be a denial on the basis of 

the Gulf War presumption. 

Ms. KUSTER. I don’t follow. I mean, if they are service-connected 

for something else, why would you deny this? 

Mr. MCLENCHEN. Well, the condition may be diagnosable, is 

what I am trying to say, rather than undiagnosed. And for that 

reason— 

Ms. KUSTER. So I guess that is kind of the catch-22 that keeps 

coming up in the testimony of our witnesses, is we have defined 

this illness around chronic undiagnosed illness, but as soon as they 

get a diagnosis, then they don’t qualify. That seems like really 

counterproductive to our goal, which is servicing these veterans 

who so bravely and courageously fought for us. 

So I guess—let me cut to the chase. Do you need something different from Congress? And this leads to this extension because I 

am confused, you are talking about the VA, this is in statute. I 

mean, we need to introduce a bill, right? You need a statutory 

change to keep this going? 

Mr. MCLENACHEN. No, we don’t. We have authority to establish 

a delimiting date for the presumption. The current delimiting date 

is that December 31st, 2016. 

Ms. KUSTER. Which is going to be coming up on us pretty quickly. And what we learned from the situation with the schematic— 

is that what it is—heart disease. Ischemic, excuse me. That we 

didn’t even know that, right? So I am concerned there may be 

something that we don’t even know. And particularly with toxins, 

I have a big problem. And this isn’t on you, this is on us as Congress and on the DoD, about these burn pits and the toxins that 

are—and I think one of our witnesses said it best, I want to protect 

future troops. I want to know what is happening. 

So the science hasn’t caught up with us. I am very concerned 

about a fixed date of December 31st, 2016. And I just want to make 

sure that if you don’t get it done that we get it done here because 

we don’t even know the constellation of illnesses that are out there 

and we want to serve our vets. 

Mr. MCLENACHEN. We will have the regulation done. The last 

time that we extended the delimiting date, we did it by an interim 

final rulemaking, which allowed us to put it out as a final rule and 

then— 

Ms. KUSTER. In a timely way? 

Mr. MCLENACHEN. Yes. 

Ms. KUSTER. So that people aren’t stressing out over it. 

Mr. MCLENACHEN. And we intend to do the same thing in this 

case. 

Ms. KUSTER. And I do want to acknowledge the improvement 

that is being made, and, you know, we want to work with you to 

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15 

make sure that we are serving our veterans. So, thank you for your 

testimony and thank you for the rest of you. 

I yield back. 

Mr. ABRAHAM. Thank you very much, Representative Kuster. I 

will now question the panel. 

Mr. Morosky, in your written testimony, you note that part of the 

challenge with these claims is that the Gulf War Illness is an inherently difficult condition to diagnose and treat, because it presents itself as a host of possible symptoms common to many veterans that served in the Persian Gulf Region. As a doctor, I can 

understand that VA examiners are more familiar with evaluating 

a single condition that is clearly identifiable and unmistakable, but 

that being said, how do you suggest that the VA improve the quality of the examinations of veterans who served in the Gulf War? 

Mr. MOROSKY. Thank you, Mr. Chairman. 

So, as it has been pointed out, it is a bit of a catch-22 for veterans who are claiming the undiagnosed illness because it could be 

a host of symptoms that they are claiming. It could be chronic pain, 

chronic fatigue, or gastrointestinal problems, and these are all 

known symptoms that could be considered under the chronic multisymptom, undiagnosed illness. However, when VA looks at the 

claim, instead of giving one disability questionnaire to one physician to look at and consider whether or not those symptoms are 

Gulf War Illnesses, they are parsed out and one DBQ goes to a 

physician to look at the gastrointestinal problem. Another physician gets the questionnaire to look at the fatigue. Another physician gets the questionnaire to look at the chronic pain. 

And then, of course, when looking at them in a vacuum and not 

looking at it globally, what doctors do, as you point out, is to diagnose. So if the veteran comes back with diagnosis of Crohn’s disease, fibromyalgia, and depression for those, they are no longer 

considered an undiagnosed disorder, and, therefore, they can’t be 

considered undiagnosed illness, so they are not able to be adjudicated on a presumptive basis; whereas, if they were considered 

undiagnosed, they would have been adjudicated on an presumptive 

basis. So, since they are not, the claims adjudicators look into the 

service record and they don’t see these there, and so they are denied. 

Mr. ABRAHAM. So, how do you suggest fixing it, a different DBQ? 

Mr. MOROSKY. Yeah. Sir, we would suggest a DBQ where, when 

symptoms are claimed by a Persian Gulf War veteran that are consistent when taken together with Gulf War Illness, that a single 

Gulf War Illness DBQ be given to a single physician who is trained 

to look for those symptoms and look at those globally; look at them 

holistically, so that the physician can then say, yes, this is consistent with Gulf War Illness. This veteran has an event which is 

serviced during the Persian Gulf War and then be able to grant on 

a presumptive basis in that way. So, a holistic view versus parsing 

out the symptoms and not looking at them individually. 

Mr. ABRAHAM. I understand. 

Any other VSOs wish to comment? Mr. Hearn? Mr. Weidman? 

Any suggestions as to how these examinations could be more productive? 

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Mr. WEIDMAN. Trying to parse it apart, when, in fact, you cannot 

separate the multi-toxic environment in which they were initially— 

had the problem originate is, you are never going to pin down what 

that silver bullet is. It just doesn’t exist in environmental health 

science. 

And VA knows that and that is why it is pulling it apart in order 

to come up with the wrong answer. The real question is, why 

haven’t they done the epidemiological work on this population in a 

serious way that would give us some of the answers as comparing 

those who served in the Gulf versus those with the same MOS who 

served elsewhere during that timeframe, and they haven’t done 

that in any kind of serious way. And once they do that, a lot of this 

will become clearer. 

Let me just add that this—VA has the authority to have a shutoff date. They did the same thing with lung cancer having to do 

with Agent Orange and we finally took them to court and they had 

to lift that delimiting date, because they had zero scientific evidence— 

Mr. ABRAHAM. And let me interrupt you. I apologize. I want your 

statement, but I want to ask one more question to Mr. Flohr. 

Given what you have just heard, Mr. Flohr, how is VBA ensuring 

that the quality controls are sufficient to ensure the raters are held 

accountable if they rely on inadequate examination results for Gulf 

War veterans? 

Mr. FLOHR. Yes, thank you for your question. 

As recently as the end of 2014, we actually revised our training 

materials for our claims processors, with respect to Gulf War Illness. We put into our training system, every one of our claims processors, including not only rating specialists, but the other—the initial people who review claims. We were required to complete that 

by last September and they did so. 

So we have updated it. We are always looking for ways to update 

our training to make it better where we find that there are problems with it. 

By the same token, Veterans Health Administration revised their 

training for examiners who do Gulf War Illness claims. 

Mr. ABRAHAM. And what about quality for purposes of STAR for 

a rating review, what is going on there? 

Mr. FLOHR. Quality where? I am sorry, where? 

Mr. ABRAHAM. STAR review. 

Mr. FLOHR. STAR review? 

Mr. ABRAHAM. Yes. 

Mr. FLOHR. Do we know about our STAR review quality? It is— 

our overall quality is like 92 percent. 

Mr. ABRAHAM. Okay. And I am out of time. I will ask some follow-ups in a written questionnaire. 

As a follow-up, what about the 90-to-91 group; what is going on? 

Mr. FLOHR. I don’t think we have that quality by group. That is 

our overall quality rate. 

Mr. ABRAHAM. We would appreciate it for the record, please. 

Mr. FLOHR. Okay. Thank you. 

Mr. ABRAHAM. Mr. O’Rourke, you are recognized, sir. 

Mr. O’ROURKE. Thank you, Mr. Chairman. 

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I wanted to ask Mr. McLenachen to respond to Mr. Morosky’s 

suggestion that you have one DBQ handled by a single physician 

to be able to look at this comprehensively, instead of breaking it 

out into separately diagnosed symptoms. 

Mr. MCLENACHEN. It may have been before you joined us, I am 

not sure, but I committed to going back and taking a look at what 

we are using as far as a DBQ, to see if there are those types of 

changes that we need to make, so I will go back and take a look 

at that. 

Mr. O’ROURKE. Okay. So your commitment is to review it; you 

are not necessarily committing to that process, which seems to 

make a lot of common sense to me. If we are concerned about what 

the Ranking Member referred to as a catch-22, that is, you begin 

to diagnose these individual symptoms, you are no longer—you no 

longer have an undiagnosed illness. That seems to be the answer 

to me, so I am not sure—why don’t you tell us the factors that you 

will look at, as you consider the proposal; in other words, I am 

wondering why you can’t just commit to adopting that as the way 

forward. 

Mr. MCLENACHEN. Well, I would like to show up here for a hearing and have all the information I need to answer that type of 

question, but I don’t have all that information with me right now. 

The best I can offer you is that I will go back and look at that specific issue and the recommendation and see whether that is something that we can and we should implement, and that is my commitment to you. 

Mr. O’ROURKE. What is the argument against it? 

Mr. MCLENACHEN. Well, based on what I am hearing, first, we 

have to confirm that that is the—that that is a real problem that 

veterans are experiencing, and if it is, then it is something that we 

need to fix. So, then, I would not disagree that it’s something we 

need to fix. 

Mr. O’ROURKE. Okay. And I am sorry to pursue you on this one, 

but it seems as long as we have everyone here, we might as well 

get to as close to the bottom of it as we can. You said you want 

to substantiate that veterans are really having this problem of 

these separate diagnoses. It seems like every single person up here 

has confirmed that that is the case. I don’t think that you doubt 

their credibility on this. 

Mr. MCLENACHEN. Not at all. 

Mr. O’ROURKE. We don’t, as the representatives of Gulf War veterans, doubt the stories we are told by our constituents, so that factor seems to have been eliminated. 

I am very open to a counter-argument to the one proposed by Mr. 

Morosky, but unless there is one, I think we have to move forward. 

We can’t, 25 years later, continue to extend deadlines or talk about 

this at another hearing. I have only been here a little over three 

years and it does not seem like we are making a lot of progress on 

it. 

Not because of any lack of commitment, necessarily, on your 

part, but I do think we need to have a conclusion and a solution 

to this. And this doesn’t solve everything, but I think gets to the 

catch-22 issue that so many of us have asked about and so many 

of the VSO representatives have highlighted. 

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So, all speed possible on your decision and I, for one, am sure, 

joined by the other Members of the Committee, would like to hear 

your response to that and would like to share it with the VSOs as 

soon as you have one. How long do you think it will take for you 

to get an answer on that? 

Mr. MCLENACHEN. I will start looking into it today when I get 

back. 

Mr. O’ROURKE. Okay. And when do you think we can hear back 

from you? 

Mr. MCLENACHEN. I can’t tell you exactly, but we are going to 

owe some information after this hearing, as far as what we have 

taken for the record. I think we can make it part of that. 

Mr. O’ROURKE. Mr. Hearn, a question on a separate topic. Do you 

happen to know what the average age of a servicemember during 

the Gulf War was, 20, 21, 22? 

Mr. HEARN. In 1990 and 1991, I don’t know that number off the 

top of my head, but— 

Mr. O’ROURKE. Early 20s? 

Mr. HEARN. I am sorry? 

Mr. O’ROURKE. Early 20s? 

Mr. HEARN. Yeah, I would certainly say early 20s, but let’s think 

about it like this, if you do the math on it, a person that was towards the tail end of their career could have served in Vietnam. 

The son or daughter served in Iraq or during Desert Storm or 

Desert Shield. And then the children of those people from the Gulf 

War. So we are talking about three generations now—three generations—of Americans. 

And I saw this—there was an article that came out in Fortune 

just this week—they said 25 percent of recruits that had served in 

the military. So it is very possible that this type of situation occurred. We are talking about three generations of the same family 

could be impacted from serving in the same area. 

Mr. O’ROURKE. Well, I wanted to ask you about a point Mr. 

Weidman brought up, which is how long it took for Vietnam-era 

veterans to have that presumptive condition awarded or recognized. And I wonder if someone who, let’s say, was 20 years old in 

1991 is 45 today, or if they were at the tail end of their career and 

they are in their mid-60s, if we are seeing different symptoms—in 

other words, cancers—as they get older. As this cohort ages, are we 

seeing more critical urgent issues that need to be attended to, that 

the urgency that I think was part of eventually recognizing the presumptive condition for Vietnam-era veterans? 

I am going to, unfortunately, have to take your answer for the 

record, because I am out of time, but I am very interested in how 

we can add additional urgency as this cohort ages, based on the 

conditions that we are seeing. 

Mr. HEARN. We will be happy to look into it and send it to you 

then. 

Mr. O’ROURKE. Thank you. 

I will turn it back to the Chair. 

Mr. ABRAHAM. Thank you, Mr. O’Rourke. 

Dr. Benishek, you are recognized. 

Mr. BENISHEK. Oh, thank you, Mr. Chairman. 

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Welcome. Actually, I want to do a little more follow-up on what 

Mr. Weidman had to say. I think all of us here would like to know 

what is going on with this Gulf War Syndrome a lot better and, you 

know a physician doesn’t like a vague diagnosis. I mean you want 

to be able to do a blood test and then a yes or no, right? We don’t 

have that here. 

And I think the point that he made is that more research needs 

to be done is the critical one here. And do you all, or are any of 

you are aware of what is going on in that department? Mr. 

Weidman, you mentioned, physically, the epidemiology studies 

that, you say, haven’t been done. What is going on in the research 

of this Gulf War Syndrome? 

Mr. WEIDMAN. The most useful research that is going on today 

is the CDRMP, the Congressionally Directed Medical Research Program, and the reason for that is that research and development at 

VA simply wasn’t concentrating on research that would lead anywhere, if, in fact, they committed monies at all. You know, it is 

real—if you decide you want to find nothing and you work really 

hard at it, the likelihood is, you are going to find nothing, and that 

is exactly what VA has done here and in regard to other generations both, those who served in the recent wars as well as Vietnam. 

What the Institute of Medicine has repeatedly, time and time 

and time again, has urged VA and DoD to start to mine the mountain ranges of data they have on all of us and they don’t do it. And 

that is how you can really start to make a difference. 

Let me just give you one example from Vietnam vets. Some of 

the most useful research that has been done was not directed from 

Washington, was not funded by Washington; it was individual clinicians in the field who were able to hustle some graduate students 

and did epidemiological work of Vietnam veterans who had served 

in Vietnam or Vietnam veterans who had not served in Vietnam 

and who was more likely to have prostate cancer, as an example. 

That is how we found out that prostate cancer among those who 

served in-country was almost three times that of the era vets. 

That kind of work is simply not being done by VA for any generation as a systematic thing. 

Mr. BENISHEK. I appreciate your answer, but I just want to get 

to a couple more items. Is there currently a registry for people who 

complain of Gulf War Syndrome symptoms? 

Mr. MCLENACHEN. Yes, there currently is a registry program. 

Mr. BENISHEK. I don’t understand, though. Do you object, personally, to extending the dates of eligibility for this, in view of the fact 

that there is a lot of vagueness to the diagnosis here, and that 

more time needs to be—I think more research needs to be done, 

than to have this cutoff date be an issue for people when there is 

so much uncertainty as to what the real etiology is. I mean it could 

be that there is some bacteria like TB or something that has just 

not been found that could be really the answer here. 

I don’t know what it is, but there is a lot of uncertainty. 

Mr. MCLENACHEN. I have no personal objection. We have to go 

through the rule-making process, but the reason why we did the 

five-year delimiting dates was because of that uncertainty in the 

medicine and the science. So, that still exists today, so if that reassures you— 

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Mr. BENISHEK. Are there cutoff dates to other—is this a common 

thing that VA does, to cut off dates for application for eligibility? 

Mr. MCLENACHEN. No. The statute that we are dealing with here 

gives the secretary authority to establish this particular cutoff 

date. 

Mr. BENISHEK. Does anyone else from the VSOs want to comment on what is going on? Mr. Morosky? 

Mr. MOROSKY. Sir, we absolutely agree that more research is 

warranted here. Right now, the only presumptive disorders for Gulf 

War Illness are either certain infectious diseases or you have this 

chronic multi-symptom unexplained medical illness. 

Under that, there are a lot of diagnoses, as I explained earlier, 

that come out of those symptoms. We would like to see research as 

to whether or not those diagnoses that are commonly given for 

those symptoms ought to be presumptive conditions in and of themselves. So if the gastrointestinal problems are being diagnosed as 

IBS, maybe IBS should also be a presumptive condition, which 

would lead to fewer denials, but that is what research would be for. 

Mr. BENISHEK. Mr. McLenachen seemed to indicate that a lot of 

the people were denied the undiagnosed disability, but were given 

a diagnosed disability. Is that the case? Or maybe I better take 

that for the record, because I am obviously running over time, but 

if you could give me the percentage of those numbers for the 

record, I would like to know that. 

Mr. FLOHR. With respect to that, when the first Gulf War veterans returned from the Gulf and started complaining of multiple 

symptoms, for which a diagnosis could not be established, VA had 

no way to compensate them because our statutory authority is to 

provide compensation for disability resulting from injury or disease. So we worked with Congress, the Congressional staff, and 

that worked in the 1994 legislation that created Gulf War presumptions and the whole Gulf War process. 

Mr. ABRAHAM. Mr. Flohr, we are going to interrupt you. The time 

is out, but if you’ll put that in for the written record, we would appreciate that. 

Mr. FLOHR. Okay. 

Mr. ABRAHAM. Mr. Walz? 

Mr. WALZ. Thank you, Mr. Chairman, and thank you for all 

being here. 

I am going to go off this issue on the research and the cutoff 

dates. I think a little history is warranted here. Last summer when 

the Agent Orange Act was coming to expire, 53 of us co-sponsored 

that and it ended with a whimper without even a floor vote. And 

the argument we made was, is that the research wasn’t in yet and 

we needed a little more time. 

That piece of legislation required the National Academy of 

Sciences to do a meta-analysis of all the research that was being 

done out there and compile that. I asked last summer, at least extend it to March until that study came out. Well, it came out last 

Thursday, again, with a whimper, and in that study, it showed a 

connection to bladder cancer and thyroid problems with Agent Orange. 

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My question is, now, because that expired and because there is 

no authority of that piece of legislation, do you have, under Title 

38, to do presumptions now for bladder cancer? 

Mr. MCLENACHEN. Yes, the secretary has very broad authority 

under Section 501 of Title 38. 

Mr. WALZ. Is it naive of me to think that after 25 years of that 

and the biennial reviews by the National Academy of Sciences, a 

meta-analysis of all the research that was out there, did we just 

do a wonderful job of picking the last two things they are going to 

find on the very last report that they will do? Would it have not 

made sense to extend it on for five more years to continue it—and 

I am going to segway into this that he has that broad authority; 

that broad authority, then, exists for Gulf War Illness. 

Mr. MCLENACHEN. So, for Gulf War Illness, there is actually a 

public law, Public Law 105–368 that was enacted in 1998 that requires both NAS and the secretary to report to the Congress on scientific study results that would impact presumptions for Gulf War 

veterans. That law still exists and the secretary still considers that 

information in creating presumptions. 

Mr. WALZ. And I don’t want you to speak for the secretary on 

this, sir. I know your issue is where you are at and giving us the 

answers. 

What will it take now for Vietnam-era veterans, with exposure 

to Agent Orange, to get bladder cancer and thyroid issues, which 

are going to be multi-symptom, which aren’t going to be difficult, 

what will it take now for them to get that covering that presumption done? What are the next steps involved here? 

Mr. MCLENACHEN. So, the secretary is required to consider all 

medical science to include the National Academy’s information that 

they provide, and based on the information that he considers, there 

is a workgroup that is established in the Department of Veterans 

Affairs whenever these presumptions are considered; it includes 

VHA experts, legal experts, our benefits experts. And they get together and prepare a recommendation for the secretary. 

Mr. WALZ. And that is what happened with Parkinson’s. We 

did—that same process went through for Parkinson’s and then the 

Nehmer claims, they came following that. 

Mr. MCLENACHEN. Yes. Whenever a presumption is created, it 

goes through this process and if the science is there to support it, 

then the secretary will create a presumption as to— 

Mr. WALZ. Am I hearing you right, that it is different for the 

Gulf War, then, that it is for Agent Orange? 

Mr. MCLENACHEN. Well, you had a concern about the expiration 

of the law that required us to go to NAS and then do a rulemaking 

within a specific period of time. Now, that law expired for the 

Agent Orange presumptions. 

My message to you is, that the expired authority has no real impact for us, because the secretary has separate authority to do it 

on his own, as far as Gulf War veterans, we are still required by 

law to receive those reports from NAS and consider them. So that 

gap does not exist for Gulf War veterans. 

Mr. WALZ. But I would suggest to my colleagues here, why were 

we so willing to give up to the executive branch the authority to 

make these decisions, and why we gave away our power with the 

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expiration of the Agent Orange Act. Now it makes it very difficult 

for us to go back and make the case here so that we can have a 

say, so that witnesses can have their input into this in a more direct channel. 

And this is no condemnation on you; you are following the rules 

as they are written for you. This is a soliloquy maybe to us that 

I think we need to take more of the lead on this. I think we need 

to make sure, because I think as science moves along, the research 

possibilities are still out there, and I think we are shutting doors 

and around here, once a door is shut, it is dang hard to get it back 

open again, and I think that is a mistake that we have laid the 

groundwork for. And this may give us the opportunity, through the 

Toxic Wounds Act, Mr. Benishek and others, maybe is an opening 

to that. 

So, I understand and I know you will do what is directed and you 

want to care for the veterans. I think we need to give you the tools 

to do that. I think the broad tools the secretary has are wonderful 

and I cannot say enough when then-Secretary Shinseki made the 

ischemic heart, the Parkinson’s, it was the right thing to do, but 

that was a long fight. 

And now I feel like if you have bladder cancer and you are listening to this and you have thyroid issues where you were told it 

wasn’t connected, as of Thursday, I am going to say it was. And 

my suggestion is that I wish we, as a Congress, could say it was. 

So, more of a clarification. 

I thank the Chairman for your time. 

Mr. ABRAHAM. Thank you, Mr. Walz. 

Mrs. Walorski? 

Mrs. WALORSKI. Thank you, Mr. Chairman. 

Mr. Spataro, I want to direct this question to you, but I want to 

tell you a quick story about a veteran in my district. She joined the 

Army in 1990 and was first deployed to the Gulf as a part of Desert 

Storm and eventually was deployed to Desert Storm. She eventually left the Army in 1993, but after leaving the service, she began 

to have stomach pain, severe headaches, muscle pain, irritable 

bowl syndrome, and trouble sleeping. 

In order to cope with these issues, she took over-the-counter 

meds, not thinking those conditions were a result of her military 

service. Years passed before she realized that all her medical issues 

were caused from her time serving in the Army. 

In 2011, she applied for benefits at the VA for Gulf War Syndrome, but was denied about a year later. In 2014, two years after 

her initial denial and appeals letters to the VA, she finally got an 

exam for Gulf War Syndrome. After three years of battling VA, she 

received partial benefits for her migraines and irritable bowl syndrome, but not for the rest of her medical issues. 

Her issues have been so debilitating that she had to quit her job. 

In her letter, she says, ‘‘Finally, on February 25th, 2015, I walked 

away from my job, my source of income, and the only source of reality that brought meaning to my life and amidst of pain and hurt, 

besides my family.’’ And this is—I am going to quote her. Here’s 

actually what she said to me in her letter, ‘‘I was more disappointed than surprised, after all, to the VA, we, as veterans, are 

nothing but a money business. We are numbers on a piece of paper 

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with no face. The VA denies claims or takes forever to answer 

them, hoping that we veterans will die before they come up with 

an answer. A VA representative advised me to write a letter to the 

VA telling them of myself, hoping they would think of me as a person, instead of a gold digger—and gold digger came from the person at the VA.’’ 

Our veterans should not feel like gold diggers when they seek the 

help for the benefits they deserve. They shouldn’t be treated just 

like another number on a piece of paper. And I wanted to tell you 

this story because it is what I hear from veterans almost every day. 

So, my question to you, Mr. Spataro is, in a case of this veteran 

from my district, many of her debilitating issues were denied by 

VA. Do you have an example of a case in which VA erroneously attributed symptoms of an undiagnosed illness to a diagnosed disability? And you kind of alluded to this before, but can you kind 

of share a little bit more in reference to this case? 

Mr. SPATARO. Yes, Congresswoman. It does seem like a fairly 

common problem that we see. An example where VA has attributed 

a symptom—an undiagnosed symptom to an illness, a case I had, 

for example, the VA—the veteran had liver problems. Testing 

showed—blood testing showed issues with his liver and the VA actually found that the veteran had Hepatitis C and we were flabbergasted. 

The veteran told me, ′′I don’t have Hepatitis C. Why was I diagnosed—why is the VA saying I have Hepatitis C?′′ We reviewed the 

record in the veteran’s case, and we noticed that there was another 

veteran with the veteran’s same name who had Hepatitis C. His 

records had been erroneously associated with that veteran’s claims 

file, and just carefully looking at it, you would have seen that the 

medical record numbers, the Social Security numbers were different, but that is the kind of error where there might be incorrect 

medical records associated with a claims file. 

Other times, it just seems that the VA adjudicators are very 

quick to overbroadly interpret medical records and medical evidence without very carefully looking at and separating each symptom and seeing if there is—that a doctor has specifically attributed 

a diagnosis to each symptom. 

Mrs. WALORSKI. Yeah, I appreciate it. 

And Mr. McLenachen, did you recognize this issue? When you 

came to this hearing today, did you expect this hearing to be what 

you are hearing from Members of Congress, and even in my case, 

a specific issue of veterans that we deal with every day, or did you 

think it was going to be about something else? Were you aware of 

the fact that this was going to be specifically about all of these 

‘‘undiagnosed diseases’’ and this Gulf War Syndrome? 

Mr. MCLENACHEN. Yes, that was the subject of the hearing. 

Mrs. WALORSKI. So, what do you do when you leave here? And 

you hear all this information and testimony, we have questions, we 

have numbers, we have all kinds of unanswered questions. Many 

of us are I think left with this issue of how quickly can you correct 

this? 

Is there something that is correctable or is this something that 

is going to take another action of Congress to fix? 

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Mr. MCLENACHEN. Well, as I committed to Mr. O’Rourke, what 

I do is, when I am here and I hear these issues, I go back and I 

look into it. The DBQ is a good example. I wish—if that is the 

problem, I wish we could fix it overnight, but it requires coordination with VHA. We have to do the public notice that is required 

through the Paperwork Reduction Act. 

Mrs. WALORSKI. Do you think that it is something that can be 

fixed, though, inside the VA without additional action from Congress? 

Mr. MCLENACHEN. Yes. 

Mrs. WALORSKI. Okay. I appreciate it. 

Thank you, Mr. Chairman. I yield back. 

Mr. ABRAHAM. Thank you, Mrs. Walorski. 

Dr. Roe? 

Mr. ROE. I wish Mr. O’Rourke were still here. I went to Dr. 

Google and found out that during the Persian Gulf, it was the oldest Army that we have had since the Civil War, age 27, and six 

years older than average Vietnam, because a lot of reservists, I 

think, were called up as opposed to when I was in the service, it 

was mostly drafted individuals. 

I will start out by saying, you cannot have too much information; 

it is impossible to have too much information. I think you just extend the date, at least five years, or maybe indefinitely to study 

this issue. 

I would disagree with Mr. Weidman on one thing, though. Environmentally, you can specifically find—we may never in this case 

and probably won’t—but you can find an environmental substance 

that is the cause of certain problems. There is no question. I have 

seen that over and over again. 

The problem with this condition—and you have three doctors up 

here—is headache, fatigue, chronic pain, and GI issues. I mean we 

make our living seeing that and people never got near the Persian 

Gulf. 

And it is really hard—and I think, Mr. Weidman, you hit the nail 

on the head when you say we have to look—there may be a cohort 

of people in Iraq that you could study. There certainly are a cohort 

of people who never deployed, who were military age, who never 

deployed. And why we would stop investigating that is beyond me, 

when we don’t have a clear ideology of what this is. 

So, I am really going to strongly encourage the secretary, if they 

have the discretion to do that, to do that, to extend this date to get 

more information, because we want to get it right. I think everybody said up here, look, you served the country and if something 

in your service caused you a disability, we need to compensate that 

disability. It is that simple. If it didn’t, we don’t. 

Right now we don’t have the information to say one way or the 

other, and to play semantics with words bothers me. Whether you 

call it Gulf War or whether you call it whatever, you are still talking about the same thing and to presume somebody—I mean, to 

make a presumption based on how the verbiage is, may be silly. 

I think it doesn’t make sense to me. 

I want to encourage us to do that. It is a very, very difficult thing 

to pinpoint when you—and I am sure Dr. Abraham and Dr. 

Benishek, too, will attest to this—two things that made me the— 

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25 

that frustrated me the most in practice was if we didn’t know what 

was wrong with you, we just said you were nervous or you had a 

virus, when we didn’t know what the problem was. And that is sort 

of what has happened with these veterans, I think. 

I think we need to study it, make the presumption open-ended. 

I don’t think we need to stop at the end of this year. It makes no 

sense to me to do that. 

So, until we get more information, that is really all I wanted, and 

I am open to any comment from any of the panel Members. You 

have been a great panel. Thank you for being here. 

I mean, you are welcome to comment or I will yield back my 

time. 

Mr. MOROSKY. Thank you, Congressman. 

You know, as you pointed out, there are a group of disorders 

which can be common in the general public, as well. I think the 

way we look at it is, when it is taken together and put together 

with this event in service, which was service in the Persian Gulf 

war, and you start to see it over and over again as a cluster of 

symptoms, which is what we look at when we talk about Gulf War 

Illness, as opposed to just parsing them out. 

And if you would use an example of say, TBI, we see a lot of veterans—that is a signature of the current era war. You might have 

a veteran who comes in and says, you know, I am experiencing 

some dizziness, I have some memory loss and I have some sleep 

problems. If you looked at those individually, you might say, oh, 

you have vertigo or, you know, you have some sort of a cognitive 

disorder. But when you look at them as a cluster and then you look 

back in the record and say, oh, you have blast exposure— 

Mr. ROE. That is a little different, though— 

Mr. MOROSKY. —then that makes sense. 

Mr. ROE. —you can specifically point to an etiology there, where 

the veteran was within 50 meters of a blast or wherever. That is 

a lot easier than this one, than Gulf War Illness—Syndrome. It is 

much easier, I think. 

Mr. MOROSKY. I agree, but I just—the comparison is there, if you 

were to look at service in the Persian Gulf War, if we are going to 

assume, because there is already a presumptive basis for chronic 

multi-symptom disorder, if you were to look at that as an event in 

and of itself, but I agree with you that it is not a perfect comparison. 

Mr. ROE. Here is where Mr. Weidman is absolutely correct. 

Here’s a blast. That is definitive. We know it happened and document it, no problem. There may be people who have those symptoms that you—look, I probably have had all of those symptoms at 

one time or another in my life and probably everybody at the dais 

out there has also had most of those symptoms. You could have 

those symptoms and be in Iraq and not have Gulf War Syndrome. 

I mean that is the problem that you get into, is that these are so 

common that it makes it—it is extremely difficult of all the—even 

more so than Agent Orange, this much more difficult to nail down, 

I think, than Agent Orange is. Agent Orange, basically, I think we 

have the science, as Mr. Weidman clearly pointed and Tim pointed 

out a minute ago—Mr. Walz did. Here, we don’t have that and that 

is why it is foolish to stop studying this. 

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With that, I will yield back. 

Mr. ABRAHAM. Thank you, Dr. Roe. 

And I am going to start a second round of questioning, because 

I have a question and I want it answered. I will start. 

Mr. McLenachen, you stated that one of the challenges faced by 

the VA is making the call as to whether a diagnosis is appropriate 

before granting an undiagnosed illness; however, under Joyner v 

McDonald, it is inappropriate for VA to engage in this type of process of elimination. So why is the VA insisting that a diagnosis first 

be ruled out? I am a little confused there. 

Mr. MCLENACHEN. Well, I guess the problem is we are talking 

about different types of claims. I mean if VA gets a claim and an 

individual doesn’t specifically claim that these Gulf War presumptions apply and we are looking at the totality of the claim to grant 

what we can, it may be that that is what takes us down that direction of granting something that is diagnosed. 

Brad, do you have anything that you want to add? 

Mr. ABRAHAM. So, why does a veteran have to specify Gulf War 

specifically? Again, I am somewhat in the gray there. 

Mr. FLOHR. If I may say, the problem with undiagnosed illness 

is that— 

Mr. ABRAHAM. Well, all three areas of entitlement have to be 

considered. You understand that, right? 

Mr. FLOHR. Of course. 

Mr. ABRAHAM. Okay. 

Mr. FLOHR. Yeah. But when we schedule someone for an examination who claims various symptoms which have not been diagnosed, the first thing doctors do, right, is try to figure out what the 

diagnosis is, because if they can’t, they don’t know how to treat it 

appropriately. 

So, when they cannot come up with a diagnosis, then what we 

are looking for is a VHA or a contract examiner to say the veteran 

has an undiagnosed illness of the respiratory system, of the cardiovascular system, whatever it may be. But if they diagnose something, sinusitis, bronchial asthma, that becomes a disability and 

then the standard rules of service-connection apply. It has to be a 

current disability. It has to be something that happened in service. 

And it has to have a relationship between service and the current 

disability. 

Mr. ABRAHAM. When you start the exam, is that veteran flagged 

as a Gulf War veteran or no? Yes? 

Mr. FLOHR. Oh, no. When they file their claim, we get their service records. We have their DD214. We know they are a Gulf War 

veteran. 

Mr. ABRAHAM. But does the examiner know that? 

Mr. FLOHR. They should, because they—I think so. On the— 

when we schedule the exams, they have that information, yes. 

Mr. ABRAHAM. Okay. So why wouldn’t the examiner consider an 

undiagnosed illness in that case? 

Mr. FLOHR. If the veteran is only complaining of constellation or 

several symptoms, rather than the veteran claiming a specific disease— 

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27 

Mr. ABRAHAM. By my definition, that is an undiagnosed illness 

if he has a myriad of symptoms, but you can’t put a diagnosis on 

it. Well, by definition, to me, that is an undiagnosed illness. 

Mr. FLOHR. Correct. See, our claims processors are not physicians. They are not scientists. They can’t make that diagnosis of an 

undiagnosed illness themselves. They need a physician to tell them 

that. They need a physician to say, this veteran has an 

undiagnosed illness. We can’t do that ourselves. 

Mr. ABRAHAM. So, claims processors are just really not quite sure 

how to handle the undiagnosed illness; is that what you are saying? 

Mr. FLOHR. I am not saying we don’t know how to handle it. It 

is a problem because, generally, they end up being diagnosed with 

a disability, rather than an undiagnosed illness. 

Mr. ABRAHAM. Is that appropriate in all cases? 

Mr. FLOHR. Not in all cases, but quite often, that is what happens. 

We used to get—under—former Under Secretary Hickey used to 

get emails, 10, 15, 20 a day from Gulf War vets saying, I don’t 

know why I have been denied for my presumptive conditions and 

they say I have got sinusitis, I have bronchial asthma. 

Those are not undiagnosed illness. Those are diagnosed illness 

and then they have to be associated somehow with their service, 

rather than being a presumptive. 

Mr. ABRAHAM. Mr. Hearn, What is your take on that answer? 

Mr. HEARN. Well, it is a little bit like the insurance commercials 

when there is Tarzan and Jane and they say, well, you know, 

swinging around the jungles that is what they do. It is the same 

way with doctors to a certain extent, because it is in your DNA, 

right; make a diagnosis. That is what you do. Nobody wants to take 

their car to the mechanic and have the mechanic come back and 

say, I don’t know what it is. It is the same way there. 

But the other problem is, is that what we have seen time and 

time again in doing our quality review checks is that there really 

ought to be a culture of when the rater looks at it, when the doctor 

looks at it, what can we do to get the benefit to the veteran, not 

what does a veteran have? Those are two different thought processes. 

And a lot of times—there is nothing on the DBQ right now that 

says, is this veteran a Gulf War veteran? They go to the VBMS and 

it says that they would have to go all the way down—assuming 

that the VBMS isn’t mislabeled—and look for the 214 to show that 

the veteran has, you know, the Iraqi Campaign Medal, the Kuwait 

Liberation Medal, the Expeditionary Medal. So, there are all these 

parts that are going into this and it is inherently gray, and that 

is what the problem is. 

You know, I understand when they say that—and I guess I am 

a little bit confused because VA has said that a lot of those remands, that was time-constricted or that was because of the lapsing of time. But remember that we are trying to get something 

service-connected here, so I don’t know where the time lapse is 

going to cause the problem where you are going to end up getting 

remanded. 

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Now, if it is an issue where we are trying to get an increased rating, then, yeah, you have dated exams and you have other things 

that are going into play. 

So I think you have kind of got, you know, a mountain of things 

that are happening here. One is that we need to train the doctors. 

It is not right that veterans are being told by doctors that they are 

malingering; that is not fair. And you have to get them to get out 

of that DNA of diagnosing people, you know. And I think from 

there, if we can start tackling that issue, maybe we can start moving forward. 

Mr. ABRAHAM. Thank you, Mr. Hearn. 

Ms. Kuster? 

Ms. KUSTER. I am just wondering—just to continue this conversation—would it help if we changed the underlying presumption? Like, we have created this catch-22. As a matter of public policy, it sounds like it is an unintended consequence of what my colleagues, before I got here, were trying to do. We were trying to help 

Gulf War veterans who had a constellation of symptoms and we 

didn’t have the science and the words to catch up with what that 

should be called. 

And we have created—and we are putting the VA between a rock 

and a hard place. We have asked them—we have defined it as 

undiagnosed and then, I agree, when you have sinusitis or something else, and you go to get the benefits based upon that, that is 

no longer undiagnosed. 

But the rest of the constellation, we still don’t know the where 

or why or how. We know the wherefore; something to do with what 

was going on during that service. So, I guess it seems to me the 

short-term solution is—and we have been talking up here about a 

bipartisan letter urgency the secretary to move toward this single 

DBQ, but we may need to also unravel the catch-22 that we have 

created in our attempt to help Gulf War veterans. Because I agree 

with Mr. Hearn, our goal is to help them, but we have created 

these boxes where you start checking and it creates a problem. 

I want to get at, if we could, with either of our witnesses from 

the VA, that the science behind this and what is helpful to you. 

Who do you rely on and is the National Academy of Sciences or 

anyone else starting to look into what Mr. Weidman raised, which 

is, you know, my concern is going forward. We are exposing our 

troops to toxic chemicals and waste that we do not understand the 

significance of. 

I have had a respiratory illness myself based upon a trip to Alaska during a volcano, okay, and my doctor has had a hard time analyzing that and determining that. But I knew I got on a plane. I 

was in a volcano. I was in the—you know, I ingested the ash, 

which is crushed glass. It got in my lungs and I was sick; now, I 

am better. 

So, who are we looking to? What is the state of the science? And 

what could we be doing to encourage more science to determine the 

causation on this? 

Mr. MCLENACHEN. Unfortunately, I think we are generally going 

to have to defer to the Veterans Health Administration. I know you 

had Dr. Clancy here a couple weeks ago and she provided some testimony on that specific issue, so we will defer to her on that. 

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However, Brad does have a close relationship with the National 

Gulf War Resource Center. He meets with them every two weeks 

or so, I believe, so he may be able to add some additional information. 

Ms. KUSTER. Sure. Yeah, it would be helpful to know what they 

are doing at this point. 

Mr. FLOHR. Yes, we do work with them. Frankly, we have biweekly calls and meet with Ron Brown and Jim Bunker in person 

quite often. 

VA also has a—this is statutory, I believe—a Gulf War Research 

Advisory Committee that meets regularly. They recommend research and VHA has an Office of Research and Development. They 

look at the recommendations. If they have funding to do the research that is being requested, they do that research. 

So it is not a matter that we are sitting around not doing anything. 

Ms. KUSTER. I am concerned about this decision of IOM to recommend not researching it and it sounds as though the panel 

might have been skewed toward, this is all in your head, which is 

not where we are coming from. 

Mr. FLOHR. I know there was a lot of concern about that among 

the Gulf War Community— 

Ms. KUSTER. I think it may be something that we can look into 

in a bi-partisan way of whatever needs to be done to keep this research moving forward, because, again, deja vu all over again, what 

we went through with Agent Orange, there were symptoms and 

parts of illnesses and new illnesses that we didn’t even know at the 

time. And I would have to believe that there is something like that 

going on here, as well. 

So, I will yield back, but I would love to work with my colleagues 

on the Committee on that. Thank you. 

Mr. ABRAHAM. Agreed. Thank you, Ranking Member Kuster. 

Chairman Coffman? 

Mr. COFFMAN. Thank you, Mr. Chairman. 

Mr. Weidman, as a Vietnam veteran, you are probably familiar 

with the way Agent Orange claims were handled by VA. As I recall, presumptive conditions were frequently denied until VA was 

forced to resolve them under a Nehmer lawsuit; is that about right? 

Mr. WEIDMAN. That is correct, sir. 

Mr. COFFMAN. Mr. McLenachen, does VA need to be sued in 

order for the department to properly address presumptive claims 

pertaining to the 25-year-old Persian Gulf War? 

Mr. MCLENACHEN. I would not encourage that. No, I don’t think 

it is necessary. 

I think we are dealing with something—I think the point was 

made earlier that we are dealing with something a little different 

here. Agent Orange presumptive conditions are specific conditions 

and, yes, we have been operating under the consent degree from 

the Nehmer Court for a long, long time, but here, as I think we 

have all recognized in this hearing, we are dealing with something 

that is much more difficult, which is the undiagnosed illness issue. 

Can we do better? I believe we always can, so we will try to do 

that. 

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Mr. COFFMAN. Now, Mr. McLenachen, it seems to me that the 

2004 Gutierrez case underscored this very issue, citing VA’s ‘‘clearly erroneous standard of review’’ and that the veteran was not required to produce evidence ‘‘specifically linking his disability to the 

presumptive condition in his claim.’’ 

Are you familiar with this case? 

Mr. MCLENACHEN. I don’t recall that case specifically. 

Mr. COFFMAN. I am. So you are telling me that, as a former general counsel, and the guy who is in charge of this entire issue, you 

are not familiar with this court decision? If that is the case, perhaps you are the wrong person for the job. 

Are you really not familiar with this Court decision that is 

foundational to this issue? 

Mr. MCLENACHEN. I assure you I will go back and refresh my 

recollection. 

Mr. COFFMAN. Okay. 

Mr. MCLENACHEN. Yes, I am the right person for the job. 

Mr. COFFMAN. Well, Mr. Chairman, I just want to thank you for 

and thank the staff for holding this joint Committee, and I just 

want to say that as a Gulf War veteran, I am just really disappointed that the law was passed that—by the Congress of the 

United States, that a specific set of conditions was supposed to be 

presumptive and yet the VA does not seem to be following along. 

I am disappointed, as well, as the fact that I don’t think the VA 

has made best efforts in terms of research on this issue. 

Mr. Chairman, I yield back. 

Mr. ABRAHAM. Thank you very much, Mr. Coffman. 

Well, ladies and gentlemen, on behalf of the Oversight and Investigations and Disability Assistance & Memorial Affairs Subcommittees, I thank you for your testimony. I appreciate all the witnesses 

coming here today to discuss what has turned out to be a very, 

very important issue. 

Unfortunately, the medical evidence indicates that some Gulf 

War veterans are developing serious illnesses such as brain cancer, 

multiple sclerosis, amyotrophic lateral sclerosis, and Parkinson’s 

disease at relatively young ages. Moreover, the testimony we have 

heard today raises serious concerns about whether VA is accurately 

processing claims for veterans, who are suffering from Gulf War Illness, particularly those veterans who served during the first Gulf 

War. 

It is especially hard to understand why VA denies at least 80 

percent of claims for undiagnosed illness and chronic multi-symptom illness conditions, even though there is a presumption of service-connection for those veterans who served in the Southwest Asia 

theater of operations. 

I intend to continue to work with the department, my colleagues 

on both of these Subcommittees, and the stakeholders who took 

their time to present these concerns today, to ensure that veterans 

who are suffering from these serious diseases receive the benefits 

that they have earned. 

So, again, thanks to everyone for being here with us today. As 

initially noted, the complete written statements of today’s witnesses will be entered into the hearing record. I ask unanimous 

consent that all Members have five legislative days to revise and 

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extend their remarks and include extraneous material. Hearing no 

objection, so ordered. 

I thank the Members and the witnesses for their attendance and 

participation today. This hearing is now adjourned. 

[Whereupon, at 12:04 p.m., the Committee was adjourned.] 

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A P P E N D I X 

Prepared Statement of Chairman Coffman 

Good afternoon. This hearing will come to order. 

I want to welcome everyone - especially our good friends from the Subcommittee 

on Disability and Memorial Affairs - to today’s joint hearing regarding VA’s handling of disability claims for Persian Gulf War veterans. As a preliminary matter, 

I would like to ask unanimous consent that a statement from Mr. Ronald Brown, 

Gulf War veteran & President of the National Gulf War Resource Center be entered 

into the record. Hearing no objection, so ordered. 

This hearing is the second part of the committee’s two part series on the 25th Anniversary of the Persian Gulf War, a war in which I served. Today we will examine 

VA’s own data that reveals a 16% approval rate and an 84% denial rate for claims 

of Gulf War veterans for undiagnosed illnesses and chronic multi-symptom illnesses 

- both presumptive conditions under current law. VA often seems to deny these 

claims because it demands to know the specific cause for the illness, yet under the 

law, presumptive conditions do not require causality because they are presumed to 

have been caused by service in the Gulf War. The critical point to understand is 

that veterans cannot receive VA care for symptoms of Gulf War Illness when the 

majority of those claims are denied by VA. 

We will also discuss former Under Secretary Allison Hickey’s email citing her 

′′concern that changing the name from [chronic multi-symptom illness] to [Gulf War 

Illness] might imply a causal link.for veterans who served in the Gulf.′′ Ms. Hickey’s 

official email exposed VA’s efforts to block not only the use of the term recommended by the Institute of Medicine for Gulf War Illness, but also VA’s practice 

of requiring causality for GWI claims, even though, again, presumptive conditions 

do not require causality. 

We also want to know more about an internal VA email - which has been provided 

to today’s panel - that reveals claims evidence has been lost even though VA’s system told veterans that such evidence was received. This is not particular to Gulf 

War veterans, but important regarding claims processing in general. 

I want to also mention that last Friday, March 11th, VA held a Community of 

Practice call to discuss issues related to our subcommittee’s hearing held on February 23rd. The call included more than fifty participants, and it discussed how to 

improve care for veterans suffering from Gulf War Illness. Unfortunately, the majority of the attention was given to a presentation by Dr. David Kearney regarding 

chronic pain, with what seemed to be an emphasis on PTSD - and the use of mindfulness as a method of treatment for Gulf War Illness. The call, coordinated by Dr. 

Stephen Hunt, shows that VA still clings to its often criticized efforts, and it contradicts his testimony from February 23rd, leading me to believe veterans suffering 

from Gulf War Illness will never receive appropriate care while Dr. Hunt is at all 

connected to the issue. While the conversation during Dr. Hunt’s call warrants additional comments, I’ll save that for a later time. 

Before I turn to my friend, Ranking Member Kuster, I want to highlight that the 

invitation for this hearing specifically cited our interest in discussing ′′veterans who 

served in the Persian Gulf War′′ and yet, VA’s testimony has lumped information 

from 1990 with the current OIF/OEF veterans in an apparent effort to reflect better 

statistics than those specific to our issue today. 

With that, I now yield to Ranking Member Kuster for any opening remarks she 

may have. 

f 

Prepared Statement of David McLenachen 

March 15, 2016 

Opening Remarks 

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Chairman Coffman, Chairman Abraham, ranking members Kuster and Titus, and 

Members of the Committee, thank you for the opportunity to discuss how the Department of Veterans Affairs (VA) processes Gulf War Veterans’ compensation 

claims. My testimony will provide an overview of VA’s processing of these claims, 

its training and quality assurance efforts, presumptive service connection, the statutory authority for establishing presumptions of service connection, and the science 

and rationale behind such presumptions. 

Gulf War Claims Processing 

This year marks the 25th anniversary of the start of the Gulf War. The initial 

conflict lasted from August 1990 until February 1991. However, neither the President nor the Congress has declared an end to the Gulf War, so men and women, 

who serve in the Southwest Asia theater of operations, to this day remain entitled 

to presumptions of service connection based upon their service. 

As of the end of fiscal year (FY) 2015, almost 7.2 million Veterans served during 

the Gulf War period. Through FY 2015, over 1.8 million Gulf War Era Veterans 

were in receipt of disability compensation (approximately 26 percent of Gulf War era 

Veterans receiving the benefit), the highest percentage of Veterans in receipt of compensation from any era, wartime or peacetime. Each Gulf War Era Veteran averages greater than six service-connected disabilities, again, more than any other era, 

wartime or peacetime. The most prevalent disabilities for Gulf War Era Veterans 

include tinnitus, knee conditions, back conditions, post-traumatic stress disorder 

(PTSD), migraines, and sleep apnea. Claims from Gulf War Era Veterans now make 

up the majority of claims received by VA. 

VA has made considerable progress in its claims processing performance, including claims from Gulf War Veterans. It has reduced its backlog of pending claims 

by approximately 86 percent, from its peak of 611,000 in March 2013 to 83,226 as 

of the end of February 2016. VA has also reduced the average days waiting for a 

decision to 93 days, which is a 189-day reduction from a 282-day peak in March 

2013. 

Training and Quality Assurance 

The Veterans Benefits Administration (VBA) is constantly looking for ways to improve the service it provides to this cohort of Veterans. We work with the Veterans 

Health Administration (VHA) in reviewing the research done by its Offices of Public 

Health and Research and Development, as well as the Institute of Medicine’s biennial update on Gulf War issues. We also work with VHA and the Department of 

Defense in joint workgroups that research occupational and environmental hazards 

coincident with military service. We collaborate with VHA to update training for its 

medical examiners, as well as VBA’s contract medical examiners. Finally, VA continues to collaborate with the National Gulf War Resource Center (NGWRC) in bimonthly meetings. 

VBA has a national quality review staff, as well as quality reviewers in its local 

regional offices, to ensure that the employees correctly process and decide claims for 

Gulf War illness. As agreed with NGWRC, VA conducted a special-focused review 

of decisions on claims for Gulf War-related illnesses for fiscal year 2015. This review 

showed a 94-percent accuracy rate. In the last year, VBA updated training for 

claims processors on Gulf War illness, including such topics as medical examinations, evaluating disabilities, assigning effective dates, and awarding special monthly compensation. Beginning in October 2015, we required all decision makers and 

quality assurance staff to complete these training modules. 

VA has implemented a number of other initiatives to improve Gulf War claims 

processing. VA has developed special tracking to specifically account for Gulf War 

claims. VA has also amended its Gulf War General Medical Examination template 

to include information for examiners on undiagnosed and chronic multi-symptom illnesses, as well as information on environmental exposures in the Gulf War. 

Gulf War Illnesses 

Service connection for undiagnosed illnesses or multi-symptom illnesses requires 

service in the Persian Gulf after August 2, 1990, and a qualifying chronic disability 

that rises to a compensable level of severity before December 31, 2016. 

A medically unexplained chronic multi-symptom illness means a diagnosed illness 

without conclusive pathophysiology or etiology. The objective signs and symptoms 

of these disabilities, as well as undiagnosed illnesses, include fatigue, skin conditions, headaches, muscle pain, joint pain, sleep disturbances, and cardiovascular 

symptoms, among others. The term ′′medically unexplained chronic multi-symptom 

illness′′ also covers diagnosed illness defined by a cluster of signs or symptoms, such 

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as chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders 

(excluding structural gastrointestinal diseases). 

Service connection is also warranted for Veterans who contract certain infectious 

diseases, such as malaria, Q fever, and West Nile virus. In addition to Gulf War 

service, service in Afghanistan may qualify a Veteran for a presumption of service 

connection under this provision. 

Processing these types of claims requires a careful review of service treatment 

records, military personnel records, and post-service treatment records. Claims processors must carefully review the claimed disabilities and symptoms to determine if 

a presumption will potentially apply. Medical examinations are generally required 

where VA identifies these disability patterns to determine whether there is a medical explanation of the disabilities. 

Should VA determine that a Gulf War Veteran does not have a presumptive disease/disability, he or she may establish direct service connection by showing the 

three elements described below. 

Overview of Presumptive Service Connection 

Direct service connection requires three elements: (1) evidence of a current disability; (2) an injury, disease, or event during active duty military service; and (3) 

medical or, in certain cases, lay evidence establishing a link or nexus between the 

two. A presumption relieves Veterans of the burden of producing evidence that directly establishes at least one of the elements they need to substantiate their claims. 

A presumption regarding exposure may establish the occurrence of an event in the 

military based on service in specific locations. The law may also presume a medical 

nexus or relationship of a disease to a presumed exposure. 

A presumption, whether based on location of service or medical relationship, provides a legal basis for establishing service connection for disabilities where a factual 

basis may not exist in the Veteran’s individual service and/or medical record. 

For example, presumptions regarding location of service provide a legal basis for 

establishing an in-service event, such as a toxic exposure, where factual documentation of the actual exposure event does not exist. Under the provisions of section 

1118 of title 38, United States Code, and section 3.317 of title 38, Code of Federal 

Regulations, VA presumes any Veteran who served in Southwest Asia since August 

2, 1990, and who develops a disease associated with certain environmental hazards 

was exposed to those environmental hazards in service (in the absence of conclusive 

evidence otherwise). 

VA may also establish presumptions for the purpose of establishing relationships 

between certain events in service and certain diseases and conditions, even where 

specific factual documentation may not exist. For example, 38 C.F.R. § 3.317 establishes malaria as a presumptive condition for Veterans who served in the Gulf War. 

In the absence of affirmative evidence of a cause outside of military service, including willful misconduct, VA presumes a Veteran’s malaria resulted from this military 

service and provides compensation for that disability if it manifests to a compensable level of severity within a certain time. 

Authority 

The Secretary of Veterans Affairs has broad authority under section 501 of title 

38, United States Code, to establish presumptions. To determine which diseases are 

associated with such service, the Secretary takes into account reports from the National Academy of Sciences (NAS) and all other sound medical and scientific information available. If the Secretary determines a presumption of service connection 

is warranted, he may issue proposed regulations setting forth his determination. VA 

issues a proposed regulation for public notice and comment outlining the presumption to be established. In proposing the regulation, VA outlines the scientific and/ 

or medical basis for the presumption as well as the eligibility criteria for the presumption. VA then drafts a final regulation taking into account the public comments 

it received. 

Scientific Bases 

Public Law 105-368 charges the Secretary of Veterans Affairs with the responsibility for notifying Congress of findings of NAS that might impact presumptions of 

service connection for diseases associated with service in the Southwest Asia theater 

of operations during the Gulf War due to exposure to biological, chemical, or other 

toxic agents, environmental or wartime hazards, or preventive medicine or vaccines. 

In preparing its reports for Gulf War health issues, NAS committees conduct comprehensive searches of all medical and scientific studies on the health effects of the 

environmental exposure being reviewed. In the course of this literature search and 

review, it is not uncommon for these committees to cover thousands of abstracts of 

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1 ′′VA denies 4 in 5 Gulf War illness claims, new data show,′′ - Patricia Kime, Military Times 

(June 5, 2014) 

scientific and medical articles, eventually narrowing their review to the hundreds 

of the most relevant and informative peer-reviewed journal articles. NAS then 

scores the strength of the total medical and scientific evidence available by utilizing 

broad categories of association such as ′′inadequate or insufficient evidence of an association,′′ ′′limited or suggestive evidence of an association,′′ or ′′sufficient evidence 

of an association.′′ NAS does not directly recommend new presumptions. 

Upon receipt of the finished NAS reports, VA establishes work groups comprised 

of experts in medicine, disability compensation, health care, occupational and environmental health, toxicology, epidemiology, and law. These work groups, along with 

senior VA leaders, review in detail the NAS reports and all available scientific and 

medical information before recommending to the Secretary any presumptions. These 

recommendations to the Secretary are based in the strength and preponderance of 

the medical and scientific evidence. 

Closing Remarks 

VA continues to improve the efficient, timely, and accurate processing of claims 

involving service in the Gulf War. Presumptive service connection fills a critical gap 

when exposure to toxic substances or certain disabilities resulting therefrom are not 

specifically documented in a Gulf War Veteran’s service records. Although the 

science and medical aspects of undiagnosed illnesses and multi-symptom illnesses 

are not yet fully understood, VA continues to review scientific and medical literature 

to gain a better understanding of the impact of these illnesses on our Gulf War Veterans. 

This concludes my testimony. I am pleased to address any questions you or other 

Members of the Committee may have. 

f 

Prepared Statement of Zachary Hearn 

MARCH 15, 2016 

In the summer of 2014, long held suspicions of The American Legion were confirmed by figures indicating an alarming trend in denial of Gulf War Illness related 

claims at the Department of Veterans Affairs (VA) - about 80 percent of those 

claims , 4 out of 5 veterans filing for service connection for the unexplained 

aftereffects of their service overseas in the Persian Gulf, were being denied service 

connection. 1 This figure stands out, because it is out of step with the overall denial 

rates for veterans overall in the VA system. Why is the system letting down these 

veterans, who answered the call and served, defeating an aggressor and liberating 

a nation within 100 hours of the use of ground forces? 

The reasons are as varied as the symptoms faced by the veterans who suffer from 

Gulf War Illness. Medical professionals are unsure how to address undiagnosed illness, some Veterans Benefits Administration (VBA) employees may not understand 

the rules regarding the treatment of such claims in the VA disability benefits process, and the massive reliance on National Guard and Reserve component service 

members to fight and win the Gulf War still contributes to problems with transmittal of military records to VA. These are challenges that must be met and overcome, with the same aggression and determination shown by the men and women 

who fought and served halfway around the world from their homes a quarter century ago. 

Chairmen Coffman, Abraham, Ranking Members Kuster, Titus, and distinguished 

members of the Subcommittees on Oversight and Investigations (O&I) and Disability and Memorial Affairs (DAMA), on behalf of National Commander Dale 

Barnett and The American Legion; the country’s largest patriotic wartime service 

organization for veterans, comprising over 2 million members and serving every 

man and woman who has worn the uniform for this country; we thank you for the 

opportunity to testify regarding The American Legion’s position on ′′Twenty Five 

Years After the Persian Gulf War: An Assessment of VA’s Disability Claim Process 

with Respect War Illness′′.Background 

The American Legion has long been at the forefront of advocacy for veterans exposed to environmental hazards. Whether the hazard is Agent Orange, radiation, 

chemicals used during Project Shipboard Hazard and Defense, Gulf War Illness or 

conditions related to burn-pit exposure in Iraq and Afghanistan, The American Legion’s position has been to: 

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2Gulf War Era Veterans Report: Pre-9/11(August 2, 1990 to September 10, 2001) 

3 http://www.rand.org/content/dam/rand/pubs/research—reports/RR100/RR145/RAND— 

RR145.pdf 

• Treat the affected veterans. • Study effects to improve treatment and protect future generations. • Fully fund research and publicly disclose all instances of contact so affected veterans can seek treatment. 

VA currently identifies dozens of medical conditions that are presumptively related to Gulf War service. Assigning medical conditions due to environmental exposures is not a new concept for VA. Conditions such as diabetes, ischemic heart disease, and a variety of cancers are presumptively related to herbicide exposure in 

Vietnam. Additionally, veterans of the era of atomic weapons and radiation testing 

have had multiple conditions presumptively ascribed to radiation exposure in service. 

For Persian Gulf veterans, they face a unique set of challenges in their quest to 

gain benefits derived from their military service. Unlike herbicide and radiation exposed veterans, many Persian Gulf veterans must prove they suffer from symptoms 

or clusters of symptoms and endure years of medical tests to indicate that they suffer from an undiagnosed illness. ′′Undiagnosed illness′′ is a frustrating explanation to a complicated medical situation. Numerous medical studies have revealed that veterans returned from Persian 

Gulf service to face serious health concerns following their deployments. However, 

a generation removed from Operation Desert Storm, and the medical community 

still is uncertain of how to properly diagnose or treat these veterans. 

According to a February 2011 report published by the Department of Veterans Affairs (VA), over 1.12 million servicemembers deployed to the Persian Gulf between 

August 2, 1990 and September 10, 2001 2; over 17 percent of those serving during 

these 11 years experienced a deployment to the Persian Gulf. A 2013 RAND Corporation report indicates 74 percent of the Army’s active components had been deployed to either Iraq or Afghanistan through 2011 3. 

It is easy to get blinded by statistics associated with veterans suffering from conditions associated with their service in the Persian Gulf. However, as the nation’s 

largest veterans’ service organization, The American Legion, we regularly hear the 

painful stories of veterans negatively impacted by clusters of symptoms that is believed to have manifested due to their Persian Gulf service. 

One veteran contacted The American Legion and discussed how he entered the 

United States Marine Corps as a ′′poster recruit′′. He was healthy, physically and 

mentally sharp. Upon returning from his deployment to the Persian Gulf in support 

of Operation Desert Storm, he began suffering weakness and malaise. No longer 

was he able to withstand standing in formation, and a once easy three-mile run became an impossible task. Headaches and gastrointestinal issues manifested. Sadly, 

the veteran’s rapidly declining health limited his academic pursuits. Throughout 

this process, VA medical professionals failed to properly treat this veteran, suggesting he was malingering. 

This is not the way veterans should be treated by the disability claims process. 

Problems With Gulf War Claims 

The American Legion has over 3,000 accredited representatives located throughout the nation. Through their dedicated efforts, The American Legion was able to 

represent over 775,000 veterans in Fiscal Year 2015. During our bi-annual training 

conducted in February 2016, over 130 accredited representatives were asked to discuss issues facing Gulf War veterans when seeking benefits. The problems highlighted by the experienced service officers could be grouped into three main clusters: 

• Problems with diagnoses 

• Problems with medical records for Guard and Reserve service members 

• Problems in the VA system 

Diagnoses: 

By far the largest complicating factor for Gulf War Illness is that in dealing with 

′′undiagnosed illness′′ medical professionals and claims adjudicators are operating 

outside the normal parameters they are used to working with. American Legion 

service officers note that it is quite common for medical professionals to hesitate to 

connect conditions to Persian Gulf service because they cannot identify a clear condition. Other obstacles include attributing symptoms to aging, suggesting the veteran is malingering as the veterans is ′′too young to be experiencing these sympLeonard.horne on VACREP0180 with DISTILLER

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toms,′′ or to send the veteran for multiple tests to different doctors, only to receive 

many different diagnoses, further confusing the veteran’s medical file. 

Medical professionals, doctors and examiners, by their nature are used to providing clear, defined diagnoses. Gulf War Illness defies this trend and creates as 

much confusion for the doctors as it does for the veteran who is experiencing the 

symptoms. Due to the complexity of Gulf War Illness, a veteran’s diagnosis may 

have changed multiple times during the course of their claim. VA raters are not 

medical specialists; often, they are unaware that the rapidly changing diagnoses are 

all essentially descriptions of the same condition. Moreover, the situation is further 

complicated by the fact that a medical professional rendered a diagnosis; once a diagnosis is provided, by definition, it is no longer an undiagnosed illness and therefore not subject to the regulations created to help Gulf War veterans obtain service 

connection. 

One solution to this problem could be better usage of VA’s disability benefits questionnaires (DBQs). DBQs are a standardized form utilized by medical providers to 

evaluate the level of disabilities suffered by veterans; both VA and private sector 

medical professionals have the ability to access the forms. 

Because many veterans are denied compensation benefits related to Persian Gulf 

related conditions upon receiving a diagnosis, even if the diagnosis changes over the 

course of months or years. This lack of access to benefits can provide an extraordinary hardship to veterans and their family members; meanwhile, their health continues to deteriorate. If VA would identify veterans with Persian Gulf service and 

allow medical professionals to opine on DBQs if the sought medical conditions could 

at least as likely as not be related to Persian Gulf service despite having diagnosis, 

it provides the necessary outlet to medical providers, VA, and most importantly, our 

veterans, to finally receive their VA disability compensation. Through this, examiners and VA would have the necessary latitude to provide benefits. 

Guard and Reserve Medical Records: 

The American Legion has spoken at length about concerns with the implementation of the Virtual Lifetime Electronic Record (VLER) for veterans. While there is 

some progress on the VA side, there are still issues with obtaining Department of 

Defense (DOD) records. Even whatever meager progress the DOD has made does 

not begin to address the serious problems tracking down records for Guard and Reserve component service members. Veterans’ claims for environmental exposures require proof of duty station, yet this is absent from medical records, and must be 

included in a veteran’s file for the record to be considered complete for benefits. Veterans’ claims for disability rely on the ability to prove events or symptoms manifested during a veteran’s period of service. This becomes impossible in the absence 

of records. 

The Persian Gulf War, beginning with Desert Shield and Desert Storm, represented a massive reliance on Guard and Reserve component service members. Unlike Vietnam, which saw little use of this portion of the force structure, the post 

Reagan drawdown of forces placed the military in a position where proper troop 

strength was not achievable utilizing solely the active duty components. The men 

and women of the National Guard and Reserve answered the call and have been 

doing so as a major and critical component of United State military strength ever 

since, right through the Global War on Terror. The quality and character of the 

service of these components has been excellent in the field. 

However, reliance on these reserve elements has led to problems obtaining military records. Each National Guard component relies not only on federal combined 

records maintained by DOD, but also state record keeping which can vary from 

state to state. Service members who deploy as part of an activated National Guard 

unit may find portions of their records in DOD files in St. Louis, portions in their 

state archives, portions in field hospitals in Kuwait, Iraq, or elsewhere overseas, and 

portions in the military posts such as Fort Bragg, Fort Dix, or Fort McCoy where 

the parent unit mobilized for deployment. Often there is little to connect these distributed files. 

Both the veteran and the claims adjudicator may not know that the critical information to prove the claims exists in one of these distributed files because they have 

some government records, so there is no reason to believe they don’t have all the 

relevant information. In this way a veteran’s file may be incomplete and there is 

not always an easy way to discover that fact. 

The way this must be fixed is to ensure better consolidation of records. There has 

to be a better way to ensure all players - VA, DOD, Guard and Reserve units, forward hospitals in the field - communicate freely and continuously update a veteran’s 

file to ensure a complete record. Without a complete record, veterans have little 

chance of a successful claim. 

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4 Resolution No. 127: GULF WAR ILLNESS - AUG 2014, Charlotte, NC 

Systemic Problems: 

Some of the systemic problems have already been addressed. VA employees who 

don’t know to look for clusters of symptoms diagnosed several different ways within 

a veteran’s file would never be able to see the pattern necessary to establish service 

connection. Other systemic problems involve improving outreach and understanding 

for veterans. 

Some of the problems involve perception amongst veterans. There is a belief 

among many Gulf War veterans, communicated to service officers, that ′′VA is more 

interested in helping the Vietnam veterans and the current crop of veterans than 

those of us who fought the first Gulf War.′′ While this is unlikely to be an accurate 

representation of the policy of VA, the fact that the perception is out there amongst 

veterans means there is work to be done. This is not uncommon or unprecedented. 

As a wartime service organization that has served members of all wars since our 

inception following the conclusion of World War I, The American Legion has seen 

some of this same perception among Korean War veterans, who feel lost between 

World War II and Vietnam. This is not the first ′′forgotten war.′′ Better outreach 

and education can help these veterans. 

Other veterans struggle with their claims just from dealing with the sheer weight 

of fighting such a long battle. For nearly a quarter century they have been passed 

from one doctor to another repeated told it was all in their head, repeatedly given 

conflicting diagnoses, repeatedly given more questions than answers. The whole 

time they are kept locked out of VA treatment because they cannot obtain service 

connection. This lack of access to benefits can provide an extraordinary hardship to 

veterans and their family members; meanwhile, their health continues to deteriorate. 

It is a long, very difficult road for Gulf War veterans, and the lack of answers 

and widespread confusion related to their suffering makes it all the more difficult. 

The American Legion appreciates the level of difficulty associated with claims pertaining to Persian Gulf service; however, veterans have now suffered up to 25 years. 

VA’s continuous reliance upon the medical community to discover the etiology and 

defined conditions have cost many veterans years of disability compensation. We 

call upon a liberalization of the manner Gulf War claims are adjudicated and provide an opportunity for our Gulf War veterans to finally receive the benefits they 

have earned their honorable service. 4

Conclusion: 

There have to be better answers for the men and women who served and continue 

to serve in the Persian Gulf region. There are some solutions that can and should 

see immediate implementation - improvements to VLER to include Guard and Reserve records, improvements to the DBQs to better educate medical professionals on 

how to evaluate veterans for undiagnosed illnesses, better training for VA employees to recognize the hidden patterns of Gulf War diagnoses in claims. Other solutions, such as improved outreach and better inclusion of the service members from 

the first Gulf War era will require more thoughtful responses and plans from VA. 

As with all plans to address concerns, they will be best formulated when they include all the stakeholders - VA, Congress and importantly the veterans themselves 

through the Veterans Service Organizations. Through this partnership we can find 

solutions to help address this dreadful denial rate for the men and women who have 

suffered without answers for far too long. 

The American Legion thanks this committee for their diligence and commitment 

to our nation’s veterans on this topic. Questions concerning this testimony can be 

directed to Warren J. Goldstein, Assistant Director in The American Legion Legislative Division (202) 861-2700. 

f 

Prepared Statement of Aleksandr Morosky 

March 15, 2016 

Chairmen Coffman and Abraham, Ranking Members Kuster and Titus and members of the Subcommittees, on behalf of the men and women of the Veterans of Foreign Wars of the United States (VFW) and our Auxiliaries, I would like to thank 

you for the opportunity to testify on VA’s disability claims process with respect to 

Gulf War Illness. 

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Today’s hearing is extraordinarily timely, as this year our nation recognizes the 

25th anniversary of the Persian Gulf War. While symbolic recognition is important, 

the VFW strongly believes that the most meaningful way to honor the service of 

Persian Gulf veterans is to ensure that they have access to the benefits they need 

and deserve. All too often, however, this does not happen. This is largely due to the 

fact that the signature condition associated with the Persian Gulf War, commonly 

known as Gulf War Illness, presents itself in a way that is not conducive to the traditional VA disability claims process. Consequently, our VFW service officers and 

appeals staff report that VA denies disability compensation claims for conditions associated with Gulf War service at a consistently higher rate than other types of 

claims. 

Part of the challenge is that Gulf War Illness is an inherently difficult condition 

to diagnose and treat. This is because it presents itself as a host of possible symptoms common to many veterans that served in the Persian Gulf region, rather than 

a single condition that is clearly identifiable and unmistakable. What is certain is 

that more than 200,000 Persian Gulf War veterans suffer from symptoms that cannot be explained by medical or psychiatric diagnoses, such as chronic widespread 

pain, cognitive difficulties, unexplained fatigue, and gastrointestinal problems, to 

name a few. Since these conditions also exist in the general public, Persian Gulf veterans often have a difficult time proving the nexus between their conditions and 

their service necessary for VA to establish service connection. 

Instead of Gulf War Illness, VA uses the term ′′medically unexplained chronic 

multisymptom illness′′ (MUCMI) to describe those symptoms. Although MUCMI is 

considered a presumptive condition for Persian Gulf veterans, there are certain factors that prevent many veterans from receiving favorable decisions when claiming 

that condition. MUCMI claims prove to be problematic for a number of reasons. 

When claiming MUCMI, the veteran lists the symptoms he or she is experiencing. 

These symptoms are often seemingly unrelated to one another, affecting multiple 

different body systems. As a result, VA assigns separate disability benefits questionnaires (DBQ) for each symptom, and separate exams are scheduled. The current 

Gulf War DBQ asks the physician whether there is a condition of each body system 

present, and then asks them to complete the relevant DBQs. Only after that are 

MUCMI questions asked. 

We find that this practice of assigning separate DBQs for each symptom being 

claimed in connection with MUCMI has the effect of promoting diagnoses, even 

when those diagnoses are minimally supported. Once a symptom receives a diagnosis, it is no longer considered connected with MUCMI, which requires that the 

illness be undiagnosed. Since MUCMI is ruled out for that condition, the veteran 

no longer has the opportunity to be granted on a presumptive basis. Often lacking 

any evidence of the condition in the service treatment record, a nexus cannot be established, and the claim is denied. 

VFW staff at the Board of Veterans Appeals notes that remands become numerous in these cases, and veterans often receive several different diagnoses for the 

same symptoms from different doctors. They believe that this is due to the minimal 

support for those diagnoses in the first place. It is apparent to them that VA seems 

to go to great lengths to find diagnoses for each symptom, simply so MUCMI can 

be ruled out. 

The practice of parsing out symptoms has the additional effect of preventing a holistic evaluation for MUCMI. When the claim is for an undiagnosed illness, the physician should be asked more questions about the cluster of symptoms, which could 

be one illness leading to symptoms in multiple body systems, rather than separate 

conditions related to each symptom. Only if there are confirmed diagnoses should 

separate DBQs be completed. To improve the current system, the Gulf War DBQ 

should be analyzed by a team of physicians including those from War Related Illness and Injury Study Center. Additionally, VA should grant veterans reasonable 

doubt when deciding whether or not a veteran’s symptoms should be considered 

MUCMI. 

Another common problem anecdotally reported by VFW service officers is inconsistency in the way Gulf War claims are decided from one Regional Office to the 

next. To correct this, we suggest that VA should be required to provide current statistics on how many veterans are service connected for undiagnosed illnesses, and 

for Gulf War Presumptive Conditions, broken down by Regional Office of adjudication to analyze consistency. There are specific diagnostic codes used for these, so the 

numbers should be easy to obtain. Statistics should be compared to other toxic exposures claims that are decided at a centralized location versus those that are decentralized. A good example would be Agent Orange claims (decentralized) and Agent 

Orange C-123 claims (centralized). Future decisions about distributing work in the 

National Work Queue could be informed by this analysis. 

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40 

VFW service officers report that there are two types of Gulf War claims that are 

consistently granted at a normal rate. The first are claims for presumptive conditions other than MUCMI. These include certain infectious diseases and amyotrophic 

lateral sclerosis (ALS). Since these conditions are relatively easy to identify, veterans with those diagnoses need only prove that they served in the Persian Gulf 

theater in order to receive favorable ratings. Unlike with MUCMI, a clear diagnosis 

of a known condition benefits their claims. 

The second category that is regularly granted is benefits delivery at discharge 

(BDD) claims. Since BDD examinations are conducted prior to separation, any diagnoses are necessarily linked to service and service connection may be granted on a 

direct basis. Because of this, however, conditions that are presumptively related to 

Persian Gulf service are not indicated by VA as being presumptive. VFW BDD service officers report that VA decisions sometimes say that the condition is not presumptive, simply because the veteran did not have a Gulf War Registry exam. 

While direct service connection often produces more favorable results, the VFW 

believes that these claims should be tracked as being associated with service in 

Southwest Asia, to form a more comprehensive database of which medical conditions 

are related to deployments to those locations. In addition, separating service members should be offered Gulf War Registry exams, if they have deployed to Southwest 

Asia at any point in their careers. These could be provided at DOD facilities as part 

of the separation physical. Once the fully integrated health record is implemented, 

VA would easily be able to see which conditions should be considered presumptive 

for tracking purposes. 

More troublingly, VFW service officers report that, on at least two occasions, veterans were contacted by VA staff encouraging them to drop their BDD claims for 

MUMCI. It was explained that those exams could not be completed by QTC contract 

physicians, and it would take longer to process their claims. Instead, they were advised to refile these claims after separation so that a VA physician could perform 

the exam, and they would receive the same effective date, so long as they did so 

within the first year of separation from service. While the VFW cannot speculate 

on why BDD contract examiners are forbidden from conducting MUCMI exams, we 

believe that asking the veteran to refile separately is not only overly burdensome, 

but also undermines the entire purpose of the BDD system. For this reason, we believe that the Gulf War DBQ and proper training on how to complete those exams 

should be provided to all examiners VA utilizes, including contract physicians and 

those located abroad. 

Finally, we note that VA recently updated the M21-1 adjudication procedures 

manual section on Gulf War Illness. With that in mind, we ask that Congress exercise oversight to ensure VA continuously provides proper training on Gulf War Illness to all those involved in adjudicating these claims. 

Mr. Chairman, this concludes my testimony and I will be happy to answer any 

questions you or the Committee members may have. 

Information Required by Rule XI2(g)(4) of the House of Representatives 

Pursuant to Rule XI2(g)(4) of the House of Representatives, the VFW has not received any federal grants in Fiscal Year 2016, nor has it received any federal grants 

in the two previous Fiscal Years. 

The VFW has not received payments or contracts from any foreign governments 

in the current year or preceding two calendar years. 

f 

Prepared Statement of Richard Weidman 

March 15, 2016 

Good afternoon Mr. Chairman, Ranking Member Kuster, and distinguished Members on the Subcommittee on Oversight & Investigation, House Committee on Veterans Affairs. On behalf of VVA National President John Rowan and all of our officers and members, we thank you for the opportunity for Vietnam Veterans of America (VVA) to appear here today to share our views on the adjudication of Compensation claims of Persian Gulf War Veterans by the Department of Veterans Affairs. 

I ask that you enter our full statement in the record, and I will briefly summarize 

the most important points of our statement. 

No doubt you are each asking yourselves the obvious question: ′′Since Vietnam 

Veterans of America (VVA) is a single generation organization, what are you doing 

here? Did you get lost and wander in here?′′ The answer to this question is severalfold. 

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41 

First, the Founding principle of VVA is ′′Never again shall one generation of 

American veterans abandon another.′′ We take that principle as words to live by, 

both individually and as an organization. The buttons you see me and some others 

wearing this morning, ′′Leave no veteran behind′′ is merely a shortened version of 

that founding principle that will fit on a button. 

Second, the parallels of what the Persian Gulf War veterans have been going 

though in regard to Gulf War Illness is all too familiar to those of us who have had 

similar experiences with the VA and with DOD in regard to Agent Orange, Agent 

Blue, Agent White, Agent Pink, SHAD or Shipboard Hazards and Decontamination, 

Project 112 in all of its multiple machinations, all of it presided over by Dr. J. Clifton Spendlove, located in the arid high country at Deseret, Utah. Trying to winnow 

out the baloney thrown out by both the Department of Defense and VA to try and 

prevent us from making any progress was (and still is) just shameful. 

The DOD kept (and still keeps to this day) much of the material that documented 

what toxins in what quantities American service members had been exposed to in 

the period that went at least from 1962 through 1973 classified as Secret or Top 

Secret. This was not done to protect the nation (al Qaeda, ISIS, and other assorted 

bad guys already had this information because our military gave it to the Iraqis in 

their war against Iran, and from there became available to the world wide networks 

of terrorists of various flavors). 

No, this material is being kept classified to keep it from the American public and 

from the patriotic service members injured by one or another of a number of toxic 

substances. This is being done so that DOD can shirk their responsibility, as well 

as to avoid any liability or culpability. 

It is worth noting, by the way, that the herbicide program was by 1962 part of 

Project 112. There were two principle purposes to the herbicide program, which 

were crop destruction and defoliation to deny the enemy cover. In late 1969 Kissinger had the herbicide program removed from Project 112, which was for all chemical and biological weapons programs. Kissinger did not want to go to the upcoming 

sessions to re-negotiate the Geneva Accords on the Rules of Warfare with the herbicides under the command of the Chemical & Biological command of the US Army. 

That was when the ′′D′′ in SHAD was changed from ‘decontamination’ to ′′defense′′ 

so that they could claim that this was all to test defenses, and not to test offensive 

weapons. Similarly, there was a concerted effort from that point on to only stress 

herbicides was to deny the enemy cover, inasmuch as destruction of the civilian food 

supply was specifically outlawed under the Geneva Accords. (The North Vietnamese 

Army (NVA) and the Viet Cong or National Liberation Front (NLF) taxed the farmers in areas they controlled for a percentage of their civilian food supply crops in 

order to feed their troops.) 

That level of lying by DOD went on for the next 45 years, up to this day, and 

we still see no sign that the lies are going to stop until both DOD and VA clean 

out the rat’s nest of the arrogant spinners of mendacity from both the key sections 

of VA, (both VHA and VBA), and from DOD. 

The DOD/VA ′′Management of Chronic Multi-symptom Illness′′ is a real study in 

how to cloak claims that there are no physical cause(s) of Gulf War Illness, but rather symptoms that cannot be tracked to any exposures in the Gulf. In fact, however, 

there is clear evidence that multitudes of troops were exposed to a variety of toxins. 

All of that is disregarded in this little bit of clever doublespeak. 

All that is missing from this so-called ′′clinical practice guideline′′ is the snake oil 

to wash down this pseudo-prescriptive pabulum of puerile prognostications 

masquerading as a serious clinical guide. 

The fact is that VA has never really tried to do serious research work into the 

causes of Gulf War Illness. It is all too reminiscent of the lack of serious research 

into the long term adverse effects of the herbicides used in Vietnam or of the organic phosphates pesticides used in the Vietnam War and in the Persian Gulf War, 

as well as in the Iraq and Afghanistan wars that continue to this day. 

Given the fact that there are VBA policy people who think that a hack who has 

never published any article in a reputable peer reviewed scientific journal is the preeminent scientific expert on Agent Orange and other herbicides in the whole world, 

it should surprise no one that VA continues to drag its feet on the epidemiological 

studies that IOM and others have strongly recommended for year, or that there is 

almost no real work into looking at toxicological research looking seriously into the 

various toxins that our troops were exposed to during Vietnam. 

The same dearth of serious scientific effort is now being perpetuated against Persian Gulf War veterans, as well as the troops who served in the current wars. 

It is no wonder that 80% of all Gulf War illness claims are denied, given the 

science denier motif of some of the key permanent staff members in VBA. At VVA 

we were astonished at the sham of ensuring that in the latest IOM review of Gulf 

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War Illness, that half of the panel, including the Chairwoman, were mental health 

clinicians. Is it any wonder that this bunch recommended abandoning any ′′hard′′ 

science investigations into the cause(s) of Gulf War Illness? The mental health clinicians on that panel may all be very good mental health clinicians, but it is the manipulation of the process by the VA that is maddening. 

If you set out to make sure that you find nothing, and you structure the process 

to find no physical cause, and you work assiduously toward ensuring you find nothing, then it should be no surprise that you indeed find nothing. That would sum 

up the latest IOM panel on Gulf War Illness, which has the effect of setting science 

on its head. 

As you know, Mr. Chairman, VVA has worked very hard with Chairman Benishek 

and with Chairman Miller on the Toxic Exposures Research Act of 2016 which we 

need to enact as soon as possible this year. It will force VA to do the research it 

should have been doing right along regarding toxic exposures and toxic wounds. Secretary McDonald has said that he does not need any additional authority to do what 

HR 1769 directs him to do. That is technically true, but VA has done nothingin the 

way of funding serious research regarding the ionizing radiation that so dramatically affected the health of so many in the World War II generation, and those who 

came right behind them. 

Nor has the VA funded serious research into the adverse health impact of Agent 

Orange and other toxins used in Vietnam. Virtually all of the useful studies utilized 

in the biennial reviews were from the countries of the Pacific Rim such as Japan, 

Taiwan, New Zealand, Australia, or from Europe. 

Similarly, VA has not funded any serious work on the toxins that have affected 

Persian Gulf War Veterans, nor research into the toxins that affect Iraq and Afghanistan veterans. In fact, I cannot recall any useful research into toxic exposures 

by VA that the Congress did not specifically mandate the VA to do, and then follow 

up with assiduous oversight. I would point out, Mr. Chairman that I have been at 

this for a day or two, so that observation covers a bit of a time span. 

It is not only time to pass the Toxic Exposures Act, but to utilize any and all 

means that will force the VA to stop wasting money and time, and get on with the 

business of ensuring veterans get the assistance they need, when it will still do 

some good. 

Thank you, Chairman Coffman and Ranking Member Kuster, for this opportunity 

to share some of these observations of Vietnam Veterans of America with you and 

your distinguished colleagues. I will be pleased to answer any questions. 

VIETNAM VETERANS OF AMERICA 

Funding Statement 

March 15, 2016 

The national organization Vietnam Veterans of America (VVA) is a non-profit veteran’s membership organization registered as a 501(c) (19) with the Internal Revenue Service. VVA is also appropriately registered with the Secretary of the Senate 

and the Clerk of the Senate of Representatives in compliance with the Lobbying Disclosure Act of 1995. 

VVA is not currently in receipt of any federal grant or contract, other than the 

routine allocation of office space and associated resources in VA Regional Offices for 

outreach and direct services through its Veterans Benefits Program (Service Representatives). This is also true of the previous two fiscal years. 

For Further Information, Contact: 

Executive Director for Policy and Government Affairs 

Vietnam Veterans of America. 

(301) 585-4000, extension 127 

Richard F. Weidman 

Richard F. ′′Rick′′ Weidman is Executive Director for Policy and Government Affairs on the National Staff of Vietnam Veterans of America. As such, he is the primary spokesperson for VVA in Washington. He served as a 1-A-O Army Medical 

Corpsman during the Vietnam War, including service with Company C, 23rd Med, 

AMERICAL Division, located in I Corps of Vietnam in 1969. 

Mr. Weidman was part of the staff of VVA from 1979 to 1987, serving variously 

as Membership Service Director, Agency Liaison, and Director of Government Relations. He left VVA to serve in the Administration of Governor Mario M. Cuomo as 

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statewide director of veterans’ employment & training (State Veterans Programs 

Administrator) for the New York State Department of Labor. 

He has served as Consultant on Legislative Affairs to the National Coalition for 

Homeless Veterans (NCHV), and served at various times on the VA Readjustment 

Advisory Committee, the Secretary of Labor’s Advisory Committee on Veterans Employment & Training, the President’s Committee on Employment of Persons with 

Disabilities - Subcommittee on Disabled Veterans, Advisory Committee on Veterans’ 

Entrepreneurship at the Small Business Administration, and numerous other advocacy posts. He currently serves as Chairman of the Task Force for Veterans’ Entrepreneurship, which has become the principal collective voice for veteran and disabled veteran small-business owners. 

Mr. Weidman was an instructor and administrator at Johnson State College 

Vermont) in the 1970s, where he was also active in community and veterans affairs. 

He attended Colgate University (B.A., 1967), and did graduate study at the University of Vermont. 

He is married and has four children. 

f 

Prepared Statement of Richard V. Spataro 

Executive Summary 

National Veterans Legal Services Program (NVLSP) has two main areas of concern with respect to the VA’s disability claim process related to Gulf War Illness. 

First, the Department of Veterans Affairs (VA) repeatedly commits certain types of 

errors when adjudicating Persian Gulf War veterans’ claims for disability compensation for chronic undiagnosed illnesses. Second, the VA should extend the end date 

of the period during which symptoms of a qualifying chronic disability must first 

manifest in order to qualify for presumptive service connection. 

VA’s Handling of Claims Related to Gulf War Illness. The VA frequently commits 

errors when adjudicating claims for disability compensation for a chronic disability 

resulting from an undiagnosed illness. The four most common types of errors 

NVLSP sees VA adjudicators commit are: 

1) failing to consider the favorable rules for presumptive service connection for an 

undiagnosed illness under 38 U.S.C. § 1117(a)(2)(A) and 38 C.F.R. § 

3.317(a)(2)(i)(A), when a Persian Gulf War veteran does not explicitly claim 

benefits for Gulf War Illness, but that theory of entitlement is reasonably 

raised by the evidence; 

2) erroneously attributing a symptom that has not been medically linked to a diagnosed disability with a diagnosed disability unrelated to military service; 

3) denying the claim due to the lack of medical nexus evidence, when medical 

nexus evidence is not required to establish entitlement to service connection 

under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317; and 

4) denying the claim due to the absence of ′′objective indications′′ of a chronic disability, without considering non-medical indicators capable of independent 

verification, which are sufficient to satisfy the ′′objective indications′′ requirement for establishing service connection under 38 U.S.C. § 1117 and 38 C.F.R. 

§ 3.317. 

Extension of the Date by Which an Undiagnosed Illness or Medically Unexplained 

Chronic Multi-Symptom Illness Must Manifest to a Disabling Degree of 10 percent. 

Under 38 U.S.C. § 1117(b), the Secretary of Veterans Affairs must establish the period during which a qualifying chronic disability must manifest to a disabling degree 

of at least 10 percent following service in the Southwest Asia theater of operations 

during the Persian Gulf War in order to qualify for presumptive service connection. 

After initially establishing a 2-year presumptive period, the VA has repeatedly extended the end date of the presumptive period, which is currently December 31, 

2016. The scientific community is still uncertain about the cause of illnesses suffered by Persian Gulf War veterans and the time period during which symptoms of 

such illnesses might first manifest. NVLSP, therefore, believes that the VA should 

again extend the end date of the presumptive period during which symptoms of a 

qualifying chronic disability must first manifest, if not indefinitely, to at least December 31, 2021. 

Messrs. Chairmen and Members of the Committees: 

I am pleased to have the opportunity to submit this testimony on behalf of the 

National Veterans Legal Services Program (NVLSP). NVLSP is a nonprofit veterans 

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service organization founded in 1980 that has represented thousands of claimants 

before the Department of Veterans Affairs (VA), the United States Court of Appeals 

for Veterans Claims (CAVC), and other federal courts. NVLSP’s efforts over the last 

35 years have resulted in billions of dollars in VA disability and death benefits for 

veterans and their families. 

NVLSP also recruits and trains volunteer attorneys, and trains service officers 

from such veterans service organizations as The American Legion, Military Order 

of the Purple Heart, and Vietnam Veterans of American. NVLSP has trained thousands of these veterans advocates in veterans law. NVLSP publishes numerous advocacy materials that thousands of veterans advocates regularly use as practice 

tools to assist them in their representation of VA claimants. On behalf of The American Legion, NVLSP conducts local outreach and quality reviews of VA regional office claims adjudications. 

NVLSP is one of the four veterans service organizations that comprise the Veterans Consortium Pro Bono Program, which recruits and trains volunteer lawyers 

to represent veterans who have appealed a Board of Veterans’ Appeals decision to 

the CAVC without a representative. NVLSP attorneys also mentor the Pro Bono 

Program’s volunteer attorneys. 

I. VA’s Handling of Claims Related to Gulf War Illness 

NVLSP has vast experience with veterans’ claims for VA disability compensation 

under 38 U.S.C. § 1117, the statute that provides for presumptive service connection 

of qualifying chronic disabilities in Persian Gulf War veterans, and VA’s associated 

regulation, 38 C.F.R. § 3.317. We have represented many veterans with such claims 

before the CAVC, the Board of Veterans’ Appeals, and VA regional offices. We have 

mentored attorneys in their representation of veterans with such claims before the 

VA though our Lawyers Serving Warriors program. We have mentored attorneys 

representing veterans with such claims at the CAVC through the Veterans Consortium Pro Bono Program. Nearly all of our representation and mentoring has occurred after the VA denied the claim. Our work on these cases has revealed that 

the VA frequently commits errors when adjudicating Gulf War Illness claims. 

38 U.S.C. § 1117 requires the VA to pay compensation on a presumptive basis 

to Persian Gulf War veterans for three types of chronic disabilities: (1) undiagnosed 

illnesses; (2) medically unexplained chronic multi-symptom illnesses, such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome; and (3) diagnosed 

illnesses that the Secretary of Veterans Affairs determines warrant a presumption 

of service connection, which presently consist of brucellosis, campylobacter jejuni, 

coxiella burnetii (Q fever), malaria, mycobacterium tuberculosis, nontyphoid salmonella, shigella, visceral leishmaniasis, and West Nile virus. See 38 C.F.R. § 3.317. 

NVLSP has seen relatively few problems with the VA’s adjudication of claims for 

service connection of the second and third types of chronic disabilities-medically unexplained chronic multi-symptom illnesses and diagnosed disabilities that the Secretary has determined warrant a presumption of service connection. In our experience, however, the VA frequently commits errors when adjudicating claims for disability compensation for a chronic disability resulting from an undiagnosed illness. 

As background, it is important to know the requirements a Persian Gulf War veteran must satisfy to establish service connection for a chronic disability resulting 

from an undiagnosed illness. As the CAVC explained in Gutierrez v. Principi, 19 

Vet. App. 1, 7 (2004), a case in which the veteran was represented by NVLSP, in 

order to establish service connection for a chronic disability resulting from an 

undiagnosed illness under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317, the veteran must 

present evidence that he or she: 

(1) exhibits objective indications; 

(2) of a chronic disability such as those listed in paragraph (b) of 38 C.F.R. § 3.317 

[fatigue, signs and symptoms involving skin, headache, muscle pain, joint pain, 

neurologic signs or symptoms, neuropsychological signs or symptoms, signs or 

symptoms involving the respiratory system, sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal 

weight loss, and menstrual disorders]; 

(3) which became manifest either during active military, naval, or air service in 

the Southwest Asia theater of operations during the Persian Gulf War, or to 

a degree of 10% or more not later than December 31, 2006 [later extended by 

the VA to December 31, 2016]; and 

(4) such symptomatology by history, physical examination, and laboratory tests 

cannot be attributed to any known clinical diagnosis. 

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It has been over two decades since § 1117 was added to Title 38 of the Unites 

States Code, yet VA adjudicators still have a difficult time adjudicating 

′′undiagnosed illness′′ claims. Although not the only types of errors committed by the 

VA when adjudicating ′′undiagnosed illness′′ claims, in our experience, the following 

are the most common errors: 

A. Failing to address the veteran’s entitlement to service connection for an 

undiagnosed illness 

One of the most common errors we see is VA adjudicators failing to consider the 

favorable rules for presumptive service connection for an undiagnosed illness under 

38 U.S.C. § 1117(a)(2)(A) and 38 C.F.R. § 3.317(a)(2)(i)(A), when a Persian Gulf War 

veteran does not explicitly claim benefits under that theory of service connection. 

This type of error typically occurs when the veteran claims entitlement to service 

connection for a particular diagnosis the veteran thinks he or she has (for example, 

′′knee arthritis′′), or more generally describes the anatomical area of the disability 

(for example, ′′a shoulder disability′′), but does not refer to Gulf War Illness. In such 

cases, if the evidence ultimately shows that the veteran’s chronic complaints cannot 

be attributed to a known diagnosis, the VA adjudicator sometimes denies the veteran’s claim due to the lack of a diagnosed disability, which is a requirement for 

establishing service connection under all other theories of entitlement. Although VA 

adjudicators have an affirmative duty to consider all reasonably raised theories of 

service connection (see, e.g., Robinson v. Mansfield, 21 Vet. App. 545, 552 (2008), 

aff’d sub nom. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009)), they often fail 

to consider service connection for an undiagnosed illness under 38 U.S.C. § 

1117(a)(2)(A) and 38 C.F.R. § 3.317(a)(2)(i)(A), when that theory of entitlement is 

reasonably raised by the evidence. 

Similarly, we sometimes see cases in which the VA fails to consider a Persian 

Gulf War veteran’s entitlement to service connection for an undiagnosed illness 

manifested by symptoms of chronic fatigue under 38 U.S.C. § 1117(a)(2)(A) and 38 

C.F.R. § 3.317(a)(2)(i)(A), when the veteran claims entitlement to service connection 

for ′′chronic fatigue′′ or ′′chronic fatigue syndrome,′′ but is ultimately found not to 

meet the full diagnostic criteria for chronic fatigue syndrome. Persian Gulf War veterans are entitled to presumptive service connection for chronic fatigue syndrome 

as a medically unexplained chronic multi-symptom illness under 38 U.S.C. § 

1117(a)(2)(B) and 38 C.F.R. § 3.317(a)(2)(i)(B). However, if the veteran suffers from 

symptoms of chronic fatigue that are not attributable to a diagnosed illness such 

as chronic fatigue syndrome, the veteran is likely entitled to service connection for 

an undiagnosed illness manifested by symptoms of chronic fatigue. We have seen 

multiple VA adjudicators deny a veteran’s claim solely on the basis that he or she 

is not diagnosed with chronic fatigue syndrome, without addressing the veteran’s 

entitlement to service connection for an undiagnosed illness manifested by the 

symptom of chronic fatigue. 

B. Attributing symptoms that have not been associated with a diagnosed condition 

to a diagnosed condition. 

VA adjudicators often erroneously attribute a symptom that has not been medically linked to a diagnosed disability with a diagnosed disability unrelated to military service. The VA then denies the claim on the basis that the veteran does not 

have an undiagnosed illness, because all of the veteran’s disability symptoms are 

associated with known diagnoses. We have seen several cases like this in which a 

careful review of the medical evidence shows that, contrary to the VA’s finding, not 

all of the symptoms identified by the veteran are linked to a specific diagnosis. In 

some cases, the medical evidence is equivocal regarding the cause of the symptom. 

In other cases, the medical evidence attributes some, but not all of the veteran’s 

symptoms to a diagnosed disability, and the VA adjudicator over-broadly interprets 

the medical evidence as showing that all of the veteran’s symptoms are attributable 

to the diagnosis, even those not specifically listed by the medical expert. In one of 

our cases, the VA denied the veteran’s claim for an undiagnosed liver disability on 

the basis that he was diagnosed with hepatitis C. The only medical record that provided the hepatitis diagnosis, however, was for a different person and had been erroneously associated with the veteran’s claims file. There are many possible reasons 

why VA adjudicators commit this type of error, but the most likely is simple lack 

of attention to detail. 

C. Denying the claim due to the absence of medical nexus evidence or the presence 

of negative nexus evidence 

Under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317, a Persian Gulf War veteran is entitled to the presumption of service connection for a chronic undiagnosed illness if cerLeonard.horne on VACREP0180 with DISTILLER

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tain requirements are met. In 2004, the CAVC emphasized that medical evidence 

specifically linking the disability to military service or the Persian Gulf War is not 

one of those requirements. See Gutierrez v. Principi, 19 Vet. App. 1, 19 (2004). 

Rather, as noted above, service connection is warranted if the veteran: (1) exhibits 

objective indications; (2) of a chronic disability such as fatigue, headache, muscle 

pain, joint pain, etc.; (3) which became manifest either during active military, naval, 

or air service in the Southwest Asia theater of operations during the Persian Gulf 

War, or to a degree of 10% or more not later than December 31, 2016; and (4) such 

symptomatology by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. See Gutierrez, 19 Vet. App. at 7. 

The VA, however, continues to deny some claims for service connection for 

undiagnosed illnesses under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317, due to the erroneous imposition of a medical nexus requirement. We have seen VA decisions stating that symptoms for which a medical explanation has not been found must be 

linked by a medical expert to an undiagnosed illness. We have seen claims denied 

because the veteran did not present medical evidence of a relationship between his 

symptoms and an undiagnosed illness or service in Southwest Asia. We have seen 

decisions in which the VA denied the claim because a medical expert expressed an 

opinion that the symptoms were less likely than not related to the veteran’s Persian 

Gulf War service, without offering a diagnosis or alternative etiology for the symptoms. All of these denials were erroneous, because medical nexus evidence is not required to establish entitlement to service connection under 38 U.S.C. § 1117 and 38 

C.F.R. § 3.317. 

D. Denying the claim due to the absence of ′′objective indications′′ of a chronic disability, without considering non-medical indicators capable of independent 

verification. 

As noted above, in order to establish entitlement to service connection for an 

undiagnosed illness, the veteran must exhibit ′′objective indications′′ of a chronic disability. ′′Objective indications′′ include ′′both ‘signs,’ in the medical sense of objective 

evidence perceptible to an examining physician, and other, non-medical indicators 

that are capable of independent verification.′′ 38 C.F.R. § 3.317(a)(3) (emphasis 

added). We have identified multiple cases in which the VA erroneously denied the 

veteran’s claim for entitlement to service connection for an undiagnosed illness on 

the basis that the veteran did not exhibit ′′objective indications′′ of a chronic disability, solely due to the lack of objective evidence perceptible to a VA physician at 

a Compensation and Pension examination, without considering other, non-medical 

indicators that are capable of independent verification. In these cases, the VA adjudicators relied on the findings in the VA Compensation and Pension examination 

report. The adjudicators, however, ignored corroborating lay statements about the 

veteran’s observable symptoms, such as joint swelling, twitching, and complaints of 

pain; and ignored records showing that the veteran sought medical treatment for 

the symptoms. Such lay statements and medical treatment records are ′′indicators 

that are capable of independent verification′′ sufficient to satisfy the ′′objective 

indications′′ requirement for establishing service connection under 38 U.S.C. § 1117 

and 38 C.F.R. § 3.317. 

II.Extension of the Date by Which an Undiagnosed Illness or Medically 

Unexplained Chronic Multi-Symptom Illness Must Manifest to a Disabling 

Degree of 10 percent. 

In 38 U.S.C. § 1117(b), Congress directed the Secretary of Veterans Affairs to prescribe by regulation the period of time following service in the Southwest Asia theater of operations during the Persian Gulf War that the Secretary determines is appropriate for the presumption of service connection for qualifying chronic disabilities. The Secretary initially established a 2-year post-Persian Gulf War service period during which symptoms of an undiagnosed illness needed to manifest to a degree of 10 percent in order to qualify for presumptive service connection. See Compensation for Certain Undiagnosed Illnesses, 60 Fed. Reg. 6660 (Feb. 3, 1995). In 

1997, the Secretary updated 38 C.F.R. § 3.317 to require manifestation of the symptoms no later than December 31, 2001. See Compensation for Certain Undiagnosed 

Illnesses, 62 Fed. Reg. 21,138 (Apr. 29, 1997) (Interim Final Rule). In 2001, the VA 

extended the end date of the presumptive period to December 31, 2006. Extension 

of the Presumptive Period for Compensation for Gulf War Veterans’ Undiagnosed 

Illnesses, 66 Fed. Reg. 56614 (Nov. 9, 2001) (Interim Final Rule). In 2006, the VA 

extended the end date of the presumptive period to December 31, 2011. Extension 

of the Presumptive Period for Compensation for Gulf War Veterans, 71 Fed. Reg. 

75669 (Dec. 18, 2006) (Interim Final Rule). 

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Most recently, in 2011, the VA extended the end date of the presumptive period 

to December 31, 2016. Extension of Statutory Period for Compensation for Certain 

Disabilities Due to Undiagnosed Illnesses and Medically Unexplained Chronic 

Multi-Symptom Illnesses, 76 Fed. Reg. 81,834 (Dec. 29, 2011) (Interim Final Rule). 

The VA noted that the scientific and medical literature available at that time suggested that ′′while the prevalence of chronic multi-symptom illness may decrease 

over time following deployment to the Gulf War, the prevalence remains significantly elevated among deployed veterans more than a decade after deployment. At 

present, there is not a sufficient basis to identify the point, if any, at which the increased risk of chronic multi-symptom illness may abate.′′ Id. at 81835. The VA concluded that extension of the presumptive period was warranted because ′′scientific 

uncertainty remains as to the cause of illnesses suffered by Persian Gulf War veterans and the time period in which such veterans have an increased risk of chronic 

multi-symptom illness′′ as well as the fact that National Academy of Sciences reviews were ongoing. Id. 

A review of the most recent report of the Institute of Medicine of the National 

Academies of Science, Engineering, and Medicine, Gulf War and Health, Volume 10, 

Update of Health Effects of Serving in the Gulf War, 2016 (prepublication copy), reveals that little has changed with respect to the level of scientific certainty regarding the cause of illnesses suffered by Persian Gulf War veterans and the time period 

during which symptoms of such illnesses might first manifest. Due to this continued 

state of uncertainty in the scientific community, NVLSP believes that the VA should 

again extend the end date of the presumptive period during which symptoms of a 

qualifying chronic disability must first manifest to a disabling degree of at least 10 

percent. NVLSP believes that end date should be extended indefinitely, but at the 

very least to December 31, 2021. 

I would be pleased to answer any questions you may have. 

Thank you. 

f 

Statements For The Record 

ANTHONY HARDIE 

Thank you, Chairmen Coffman and Abraham, Ranking Members Kuster and 

Titus, and Members of the Committee for today’s hearing and for this opportunity 

to present this information to you. 

I’m Anthony Hardie, a 1991 Gulf War and Somalia veteran, and Director of Veterans for Common Sense. VCS and I have provided testimony on many previous occasions, most recently my testimony as a witness at your February 23, 2016 hearing 

on Gulf War veterans’ health outcomes on the 25th anniversary of the 1991 Gulf 

War. 

1998 PERSIAN GULF WAR VETERANS LEGISLATION 

As I noted in my testimony of February 23, it took almost eight years after the 

war before Gulf War veteran’ major legislative victory, with the enactment of the 

Persian Gulf War Veterans Act of 1998 (Title XVI, PL 105-277) and the Veterans 

Programs Enhancement Act of 1998 (PL 105-368, Title I-′′Provisions Relating to Veterans of Persian Gulf War and Future Conflicts′′) - two landmark bills that set the 

framework for Gulf War veterans’ healthcare, research, and disability benefits. 

For those of us involved in fighting for the creation and enactment of these laws, 

they seemed clear and straightforward, with a comprehensive, statutorily-mandated 

plan that would guarantee research, treatments, appropriate benefits, and help ensure that lessons learned from our experiences would result in never again allowing 

what happened to us to happen to future generations of warriors. 

The legislation included a long list of known Gulf War exposures. VA was to presume our exposure to all of these, and then, with the assistance of the National 

Academy of Sciences (NAS), evaluate each exposure for associated adverse health 

outcomes in humans and animals. In turn, the VA Secretary would consider the reports by the NAS’s Institute of Medicine (IOM), ′′and all other sound medical and 

scientific information and analyses available,′′ and make determinations granting 

presumptive conditions. There was a new guarantee of VA health care. There would 

also be a new national center for the study of war-related illnesses and post-deployment health issues, which would conduct and promote research regarding their etiologies, diagnosis, treatment, and prevention and promote the development of appropriate health policies, including monitoring, medical recordkeeping, risk communicaLeonard.horne on VACREP0180 with DISTILLER

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tion, and use of new technologies. There was to be an effective methodology for 

treatment development and evaluation, a medical education curriculum, and outreach to Gulf War veterans. Research findings were to be thoroughly publicized. To 

ensure the federal government’s proposed research studies, plans, and strategies 

stayed focused and on track, VA was to appoint a research advisory committee that 

included Gulf War veterans - presumably those who were ill and affected - and their 

representatives. 

Instead, we learned that enactment of those laws was just another battle in our 

long war. 

From the beginning, VA officials fought against implementing these laws, dragging their feet and upending their implementation. 

In addition to the failures I noted in my February 23 testimony, the process for 

determining presumptions has failed to yield new presumptions without Congressional intervention. And, the laws aimed at providing at clear path for Gulf War 

veterans’ compensation by VA while awaiting the development of effective treatments has been not just problematic, but with extraordinarily high denial rates, as 

VA’s own data shows and as will be discussed below. 

For Gulf War veterans, getting VA to approve a disability claim for a presumptive 

condition has been nearly impossible for most. And, as with all denied VA claims, 

the backlog of appealed claims is daunting and adds years to the process. 

DESPITE REPEATED VA INTERVENTIONS, VA’S GULF WAR VETERAN 

CLAIMS DENIAL RATES ARE WORSENING OVER TIME 

The rates of VA’s denial of Gulf War veterans’ presumptive claims - for 

′′undiagnosed illness′′ and for the ′′chronic multisymptom illnesses′′ such as 

Fibromyalgia, Irritable Bowel Syndrome/Functional Gastrointestinal Disorders, and 

Chronic Fatigue Syndrome - have been getting worse over time. 

This worsening has been despite repeated high-level interventions by VA - interventions made ostensibly to improve VA’s review processes for Gulf War veteran’s 

presumptive claims. 

2007 VA Denial Rate of Gulf War Veterans’ Presumptive Undiagnosed Illness Claims 

In 2007 and 2008, I did a series of presentations about Gulf War veterans’ severe 

challenges with VA research, healthcare and benefits. The presentations were made 

to a number of national and regional groups around the country and were entitled, 

′′Lost in the Shuffle′′. Among the data presented was VA’s abysmal claims failures 

for Gulf War claims: 

Based on a May 2007 report from VA’s Gulf War Information System (GWVIS), 

out of 696,842 Gulf War veterans, 280,623 had filed service-connected disability 

claims. Of those, 13,027 were ′′undiagnosed illness claims′′ (what VA terms ′′UDX′′ 

claims), just 3,384 had been approved - a 74 percent denial rate. 

2010 VA Intervention 

According to a February 4, 2010, ′′All VA Regional Offices Training Letter,′′ (10- 

01), with the subject, ′′Adjudicating Claims Based on Service in the Gulf War and 

Southwest Asia,′′: 

′′The chronic disability patterns associated with these Southwest Asia environmental hazards have two distinct outcomes. One is referred to as ′′undiagnosed 

illnesses′′ and the other as ′′diagnosed medically unexplained chronic multisymptom 

illnesses′′ that are without conclusive pathophysiology or etiology. Examples of these 

medically unexplained chronic multi-symptom illnesses include, but are not limited 

to: (1) chronic fatigue syndrome, (2) fibromyalgia, and (3) irritable bowel syndrome.′′ 

This letter preceded regulatory amendments and provided guidance to VA claims 

examiners to more appropriately adjudicate Gulf War veterans’ claims. 

2014 VA DENIAL RATE OF GULF WAR VETERANS’ PRESUMPTIVE CLAIMS

Data provided by VA to the office of then-Congressman Kerry Bentivolio on March 

28, 2014 showed a nearly 80% denial rate for what VA termed in the response, ′′a 

Gulf War-related illness′′. It appears that this is the cumulative VA denial rate of 

all presumptive undiagnosed illness and presumptive chronic multisymptom illness 

(Fibromyalgia, Irritable Bowel Syndrome; Chronic Fatigue Syndrome) claims by 

Gulf War veterans. 

Key findings (2014) 

• 80% Gulf War Illness Claims Denial Rate. Of 54,193 Gulf War-related illness 

claims filed with VA, four out of five - nearly 80 percent (80%) - were denied. 

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• 52% of the denied for something else. A full 52 percent of the denied Gulf Warrelated illness claims were approved by VA for something else, implying a VA 

bias against approving Gulf War Illness claims. 

• 38% denied for everything. A full 38 percent (38%) of veterans’ claims for Gulf 

War-related illness were had their claims denied entirely, both for Gulf Warrelated illness and other conditions. 

By the Numbers (2014) 

696,842 Veterans: The total number of veterans deployed to the Persian Gulf theatre of operations during the 1991 Gulf War. 

54,193 GWI Claims: The number of Gulf War-related illness claims veterans have 

filed with VA, to March 2014. [VA notes this figure represents original claims for 

service-connection; it does not include reopened claims or claims for an increased 

disability rating.] 

11,216 Approved: The number of Gulf War Illness claims that VA granted. [VA 

notes that due to data limitations, this figure does not include some Veterans who 

have been granted service connection on a direct basis (meaning that the disability 

became manifest during active service) rather than under the provisions of 38 

C.F.R. § 3.317.] 

42,977 Denied: The total number of Gulf War-related illness VA has denied. 

20% Approved: The percentage of Gulf War-related illness that VA granted 

(11,216 approved out of 54,193 filed = 20.7%). 

80% Denied: The percentage of Gulf War-related illness VA has denied (42,977 

denied out of 54,193 filed = 79.3% denial rate). 

22,470 Approved for Something Else: The number of veterans filing Gulf War-related illness claims that were denied but VA approved the veterans’ claims for some 

other condition(s). 

42% Denied for GWI but Approved for Something Else: The percent of veterans 

filing Gulf War-related illness claims that were denied but VA approved their claims 

for some other condition(s) (22,470 approved for something else out of 54,193 total 

Gulf War-related illness claims filed = 41.5%). 

52% of the Denied were Approved for Something Else: The percent of denied Gulf 

War-related illness claims approved for some other condition. (22,470 approved for 

something else out of 42,977 denied Gulf War-related illness claims = 52.3%) 

20,507 Denied for all Conditions: The number of veterans filing Gulf War-related 

illness claims that were denied for GWI and not receiving compensation for other 

conditions. (54,193 Gulf War-related illness claims filed minus 22,470 claims approved for something else = 20,507) 

38% Denied for all conditions: The percent of all Gulf War-related illness claims 

filed that were denied for Gulf War-related illness and also not receiving compensation for other conditions (20,507 denied out of 54,193 = 37.8%) 

67% Average Disability Rating: The average disability rating granted by VA for 

Gulf War-related illness claims filed. 

VSO Response to 2014 Denial Rates 

In a July 16, 2014 letter from two of the largest veterans service organizations 

(VSOs), AMVETS and VVA, to then-Acting VA Secretary Sloan Gibson highlighted 

the newly released VA claims denial information and provided insight into why this 

was being allowed within VA: 

′′VA acknowledges that 250,000 suffer from Gulf War illness. (The recent VA ‘Gulf 

War Review,’ for example, states that nearly 700,000 U.S. troops deployed to the 

1991 war and that VA’s major 2005 study showed that 37% of those (roughly 

250,000) have chronic multisymptom illness, VA’s term for Gulf War illness. The 

2010 report of the Institute of Medicine also found 250,000 veterans were ill and 

that their illness was associated with Gulf War service. 

′′Yet, VA’s own most recent statistics, provided in response to a Congressional inquiry this Spring, show that only 11,216 Gulf War-related illness claims have been 

granted and 80% of such claims are denied. (See VA report to Congressman 

Bentivolio, attached.) Even including all claims approved for other conditions, the 

total number of Gulf War veterans approved for care and benefits is only 36,000, 

out of the 250,000 afflicted. 

′′VA hides that damning fact in its official statements. The April 2014 VA Gulf 

War ‘Fact Sheet’ states that ′′currently, nearly 800,000 Gulf War era Veterans are 

receiving compensation benefits for service-connected issues.′′ What VA doesn’t say 

is that their definition of the ‘Gulf War era’ includes every veteran who has served 

from 1990 to the present, not just 1990-1991 Gulf War veterans. (See Fact Sheet 

attached.) 

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′′Recent statements by Undersecretary for Benefits Allison Hickey provide the answer why VA is hiding this information. An April 22, 2014 article in Military Times 

reported that she was concerned that even using the term ‘Gulf War illness’ ‘might 

imply a causal link between service in the Gulf and poor health which could necessitate legislation for disability compensation for veterans who served in the Gulf.’ 

And on December 13, 2013, she testified that VA would be able to meet its 2015 

goal of processing claims within 125 days, barring ‘something like we experienced 

in Agent Orange [when we added] 260,000 claims in our inventory overnight in Oct. 

2010. That will kill us.’′′ 

Recent Rates of VA Denial of Gulf War Veterans’ Presumptive Claims 

Despite the latest VA intervention in 2010, the rate of denial of Gulf War veteran 

presumptive claims has been steadily worsening, year by year, as showna by data 

provided by VA for fiscal years 2011 through the first half of 2015. These claims 

include two types: chronic multisymptom illness claims (Fibromyalgia; Irritable 

Bowel Syndrome/Functional Gastrointestinal Disorders; Chronic Fatigue Syndrome); 

and, undiagnosed illness claims authorized under 38 U.S.C. 3.317. 

A. VA Denials of Presumptive Chronic Multisymptom Illness Claims 

The rate of denial of Gulf War veteran presumptive chronic multisymptom illness 

claims (Fibromyalgia; Irritable Bowel Syndrome/Functional Gastrointestinal Disorders; Chronic Fatigue Syndrome) has been steadily worsening, year by year. By 

the first half of FY15, VA was denying these claims at a rate of nearly four-outof-every-five. 

FY2011: 72.5% 

FY2012: 72.1% 

FY2013: 75.3% 

FY2014: 77.0% 

FY2015 Q1, Q2: 79.2% 

′′CMI = Chronic Multisymptom Illness (fibromyalgia 5025, IBS 7319, and chronic 

fatigue syndrome 6354) in either the hyphenated or primary code. If condition is 

both UDX and CMI, it is included in UDX counts.′′ 

(G) = Total Conditions Granted (′′Vets′′) 

(D) = Total Conditions Denied (′′Vets′′) 

(T) = Total Conditions Granted or Denied (′′Vets′′) 

Formulas: (G) + (D) = (T); (D)/(T) = denial rate 

FY2011: 743 (G) + 1,961 (D) = 2,704 (T); 1,961 (D) / 2,704 (T) = 72.5% CMI denial 

rate 

FY2012: 1,114 (G) + 2,877 (D) = 2,704 (T); 2,877 (D) / 3,991 (T) = 72.1% CMI denial rate 

FY2013: 1,638 (G) + 5,002 (D) = 2,704 (T); 5,002 (D) / 6,640 (T) = 75.3% CMI denial rate 

FY2014: 1,300 (G) + 4,341 (D) = 2,704 (T); 4,341 (D) / 5,641 (T) = 77.0% CMI denial rate 

FY2015 Q1,Q2: 746 (G) + 2,849 (D) = 2,704 (T); 2,849 (D) / 3,595 (T) = 79.2% CMI 

denial rate 

B. VA Denials of Presumptive Undiagnosed Illness Claims 

VA’s denial of Gulf War veteran presumptive undiagnosed illness claims is at 

even higher rates than VA’s denial of presumptive chronic multisymptom illness 

claims. 

The rate of denial of Gulf War veteran presumptive undiagnosed illness claims 

has also been steadily worsening, year by year. By the first half of FY15, VA was 

approving only 14.7 percent of these claims - approaching the limited odds of winning a scratch-off lottery. 

FY2011: 80.5% 

FY2012: 78.4% 

FY2013: 78.6% 

FY2014: 83.1% 

FY15 Q1, Q2: 85.3% 

′′UDX = Undiagnosed Illness, defined as diagnostic codes containing 88xx in either 

the hyphenated or primary code.′′ 

Formulas: (G) + (D) = (T); (D)/(T) = denial rate 

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FY2011: 480 (G) + 1,977 (D) = 2,457 (T); 1,977 (D) / 2,457 (T) = 80.5% UDX denial 

rate 

FY2012: 628 (G) + 2,278 (D) = 2,906 (T); 2,278 (D) / 2,906 (T) = 78.4% UDX denial 

rate 

FY2013: 925 (G) + 3,402 (D) = 4,327 (T); 3,402 (D) / 4,327 (T) = 78.6% UDX denial 

rate 

FY2014: 627 (G) + 3,086 (D) = 3,713 (T); 3,086 (D) / 3,713 (T) = 83.1% UDX denial 

rate 

FY2015 Q1,Q2: 339 (G) + 1,970 (D) = 2,309 (T); 1,970 (D) / 2,309 (T) = 85.3% UDX 

denial rate 

C. VA Denials of Gulf War Presumptive Claims (Chronic Multisymptom and 

Undiagnosed Illness Combined): 

FY2011: 76.3% 

FY2012: 74.7% 

FY2013: 76.6% 

FY14: 79.4% 

FY2015 Q1, Q2: 81.6% 

Formula: [(CMI D) + (UDX D)] / [(CMI T) + (UDX T)] = denial rate 

FY2011: [1,961 (CMI D) + 1,977 (UDX D)] / [2,704 (CMI T) + 2,457 (UDX T)] = 

76.3% CMI+UDX denial rate 

FY2012: [2,877 (CMI D) + 2,278 (UDX D)] / [3,991 (CMI T) + 2,906 (UDX T)] = 

74.7% CMI+UDX denial rate 

FY2013: [5,002 (CMI D) + 3,402 (UDX D)] / [6,640 (CMI T) + 4,327 (UDX T)] = 

76.6% CMI+UDX denial rate 

FY2014: [4,341 (CMI D) + 3,086 (UDX D)] / [5,641 (CMI T) + 3,713 (UDX T)] = 

79.4% CMI+UDX denial rate 

FY2015 Q1, Q2: [2,849 (CMI D) + 1,970 (UDX D)] / [3,595 (CMI T) + 2,309 (UDX 

T)] = 81.6% CMI+UDX denial rate 

VA Intervention: Amending the M21-1 

It appears that VA has made a new intervention by amending the M21-1 ′′Veterans Benefits Manual,′′ which is supposed to be used for rating VA claims. 

However, it is not clear whether VA rating staff are aware of, let alone utilizing this 

manual to rate Gulf War veterans’ claims. 

With no new Gulf War claims data released since the second quarter of FY15, it 

is unclear whether this intervention has had any positive effect on improving VA’s 

terrible denial rates for Gulf War veterans’ UDX and CMI claims. 

Given VA’s past record, it is unclear whether this latest intervention will be just 

one more in a long line of ineffective ′′solutions′′. Past VA ′′solutions′′ have done 

nothing to quell VA’s extraordinarily high denial rates of these veterans’ claims. 

Claims Denial Conclusions 

In short, VA’s denial rates for Gulf War UDX and CMI claims remained high over 

time. In recent years, VA’s denial rates have been increasing for these Gulf War veterans’ claims. 

This is in complete contravention to the intent of the 1998 laws passed to improve 

Gulf War veterans’ ability to get their claims approved, while prioritizing treatments was made an even higher priority - but not by VA. 

CLAIMS DATA RECOMMENDATIONS 

VA Needs to Track, Analyze, and Regularly Report VA Utilization Data for 

1990-91 Gulf War Veterans. 

In 2010, VCS Director Paul Sullivan testified, ′′In 2002, VA staff conducted a thorough review of granted and denied claims among Gulf War veterans at the diagnostic code level. VA staff concluded that VA regional offices with large claim backlogs and without training on UDX claims under 38 CFR 3.317 approved few (about 

4 percent) of Gulf War veterans claims. In contrast, VA regional offices with small 

backlogs that received training from VA Central office approved far more UDX disability benefit claims (about 30 percent). At present, VA has no idea how many UDX 

claims have been granted or denied.′′ 

Today, it is unclear whether VA is consistently tracking UDX claim denials and 

approvals. Certainly, VA is not publicly reporting that data, at least not in any way 

that is regularly and readily accessible to Gulf War veterans or the veterans advocacy community. 

VA must return to the regular public reporting of carefully collated and analyzed 

Gulf War veterans’ claims and VA usage data. 

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VA must return to the regular public reporting of carefully collated and analyzed 

Gulf War veterans’ claims and VA usage data. VA must be held accountable for its 

actions, and without easy public access to this VA data, accountability will remain 

difficult to achieve. 

CONCLUSIONS 

If we measure VA’s success by how it has approved Gulf War veterans’ claims 

twenty-five years after the war, VA has failed most ill and suffering Gulf War veterans. VA has circumvented or ignored most of the aims of the 1998 laws. Despite 

various high-level interventions by VA to improve the claims process, the denial 

rates remain unacceptably high and are getting worse each year. 

In twenty-five years, VA has made little progress in finding effective, evidencebased treatments for Gulf War Illness, denied Gulf War veterans disability claims 

nearly across the board, and relegated these veterans to the realm of mental health 

interventions. 

VA has the authority to develop new presumptives for these ill and suffering veterans, but unlike with Agent Orange, has failed to identify any new conditions beyond a set of rare endemic infectious diseases that affect almost no one. The latest 

report by the Institute of Medicine, shaped by VA’s contract, argues that individual 

Gulf War exposures are forever unknowable. We knew that when seeking the 1998 

legislation, aimed at connecting generic exposure data with health outcomes. VA has 

stymied those efforts. 

Twenty-five years later, ill Gulf War veterans are still in pain. They are suffering. 

They have been begging for help for years and years. As I noted in my February 

23 testimony, the letter, the spirit, and the intent of the 1998 Persian Gulf War 

laws have yet to be achieved. 

On this 25th anniversary of the war, our Gulf War veterans are still waiting for 

VA to provide effective, evidenced-based treatments for Gulf War Illness. Given 

their level of disability, the least we can do is to cause VA to approve their presumptive, service-connected disability claims. 

Please help fix these serious issues, once and for all. 

**** 

ADDITIONAL INFORMATION 

Public Law 102-1, enacted in January 1991, authorized the President to start the 

Persian Gulf War, known at the time as Operation Desert Shield and Desert Storm. 

Offensive U.S. military action against Iraq began on January 17, 1991 local time 

(the evening of January 16 in the United States). 

Public Law 102-25, enacted in April 1991, retroactively established the start date 

of the Gulf War as August 2, 1990, the date Iraq invaded Kuwait. Neither Congress 

nor the President have ever ended the Gulf War, and the conflict continues through 

to the present. According to 38 CFR 3.317(e)(2), ′′The Southwest Asia theater of operations refers to Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and 

Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, 

the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace 

above these locations. (Authority: 38 U.S.C. 1117, 1118).′′ 

Public Law 102-85, enacted in November 1992, authorized the creation of the Gulf 

War Registry as well as the Gulf War Veterans Information System (GWVIS). VA 

began preparing GWVIS reports in 2000, and VA ceased producing the reports in 

2008 after VCS observed that VA’s GWVIS reports were incomplete. VA has since 

confirmed that it failed to update computer programming to identify all disabled 

Gulf War veterans. 

Public Law 103-210, enacted in December 1993, required VA to provide healthcare 

on a priority basis (Priority Group 6). 

Public Law 103-446, enacted in November 1994, expanded access to VA disability 

benefits so ill Gulf War veterans could obtain VA medical care under for the 

undiagnosed illnesses. The law included a long list of toxins to which Gulf War veterans were presumably exposed, including depleted uranium, fumes and smoke from 

military operations, oil well fires, diesel exhaust, paints, pesticides, depleted uranium, infectious agents, investigational drugs and vaccines, indigenous diseases, 

and multiple immunizations. 

Public Law 105-277, enacted in 1998, significantly expanded the list of toxins it 

presumed Gulf War veterans were exposed to during deployment to Southwest Asia, 

and mandated contracts between VA and the National Academy of Science (which 

ultimately was conducted by NAS’s Institute of Medicine (IOM)) to determine association between Gulf War exposures and Gulf War veterans’ health conditions. 

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Public Law 105-368, enacted on Veterans Day 1998, expanded Public Laws 103- 

210 and 103-446. It also directed the creation of the the Research Advisory Committee on Gulf War Veterans’ Illness (RAC), which VA failed to create the RAC until 

2002 - more than three years after the statutorily mandated deadline. 

f 

RONALD E. BROWN 

Thank you, Chairman Coffman, Ranking Member Rep. Ann McLane Kuster, Rep. 

Dr. Ralph Abraham, Rep. Dina Titus, and Members of the House Veterans’ Affairs 

Subcommittee on Oversight and Investigations. I thank you for holding this joint 

investigative hearing on the VA’s Disability Claim Process with Respect to Gulf War 

Illness claims. 

My name is Ronald Brown; I’m President of the National Gulf War Resource Center (NGWRC). The NGWRC is a small 501 (c) (3) non-profit veteran service organization, which is comprised of sick Persian Gulf War veterans who volunteer our 

time to advocate for our fellow veterans suffering from the complexities of modern 

warfare. We specialize in Gulf War Illness claims, we work with veterans to educate 

and assist them in the claims process. We also work with policy makers inside the 

VA, in an attempt to accomplish two goals: first, to insure clinicians are better 

trained about conditions facing this group of veterans to insure the veterans receive 

the best health care possible. Secondly, we are working to address and correct issues 

affecting this group of veterans, such as the high denial rate of Gulf War illness 

related claims. 

This year marks the 25th anniversary of the liberation of Kuwait. Of the nearly 

700,000 U.S. military personnel that served in the 1990-1991 Persian Gulf War (Operation Desert Storm) studies indicate that approximately 25-32% of these veterans 

became ill with what is now referred to as Gulf War Illness. These U.S. Warfighters 

face a higher denial rate than any other era veteran. 

In May 2015 the VBA provided the NGWRC data on Gulf War claims. The data 

wasn’t exactly what we had asked for but it did show some very disturbing numbers. Out of 193,436 Undiagnosed Illness (UDX) or Chronic Multi-Symptom conditions claimed only 32,631 was approved service connection leaving 160,805 conditions denied. That’s an approval rate of 17% and a denial rate of 83%. The VBA 

has stated that the denial rate is actually around 70%-74%. 

This data shows that Desert Storm veterans are compensated for direct service 

connection conditions (50,523) equivalent to other era veterans. Emphatically, this 

data revealed disturbing data that showed most Gulf War veterans are denied presumptions of service connection for illnesses (CMI) associated with service in the 

Persian Gulf Theater. 

The NGWRC asked the VBA for clarification. The VBA provided us with data in 

July 2015 that shows the reasons for denials of first time claims filed from 2011 

through 2015. 

This data is for denials of claims for the diagnosable but medically unexplained 

chronic multisymptom illness (CMI) conditions such as Chronic Fatigue Syndrome, 

Fibromyalgia, and Functional gastrointestinal conditions which are presumed by 

Congressional intent (See: U.S.C 38 § 1118) to be caused by service in the Southwest Asia Theater of operations. This data shows that a total of 18,218 veterans 

filed claims for 22,863 conditions that were denied. 

The data is broken down by specific categories with the number of claims denied 

in each category, they are as follows: 

• No Causation - 8 conditions. 

• No Diagnosis - 9,710 conditions. 

• Not aggravated by service - 25 conditions. 

• Not Established by Presumption - 2,176 conditions. 

• Not in Country - 10 conditions. 

• Not Caused/Incurred by Service - 10,568 conditions. 

• Not Secondary - 344 conditions. 

• Not Well Grounded - 1 condition. 

• Not in Line of Duty - 3 conditions. 

The NGWRC finds two of these categories extremely troubling and evidence of 

systemic problems within the Veterans Benefit Administration (VBA) in regards to 

Gulf War Illness claims. The categories ′′Not Established by Presumption - 2,176 

conditions denied′′ and ′′Not Caused/Incurred by Service - 10,568 conditions denied′′. 

These two categories account for 57% of the 22,863 conditions that were denied. 

These two categories absolutely make no sense given the fact that by statue (U.S.C 

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38 § 1118) these conditions are presumptions of service connection for illnesses associated with service in the Persian Gulf War. Congressional intent is such that these 

illnesses ′′shall be considered to have been incurred in or aggravated by service notwithstanding that there is no record of evidence of such illness during the period 

of such service′′. To date the Veterans Benefit Administration (VBA) has not been able to provide 

a rational explanation as to why these two categories warrant denials given the 

statue. I addressed this issue with former Under Secretary of Benefits Allison Hickey who acknowledged a potential problem and stated that she would have VBA randomly pull a statistical portion of these claims to check for accuracy. She stated that 

she would have the results by October or November 2015. Her replacement, Danny 

Pummill, has also promised to get us the results from this accuracy check but as 

of today we still do not have the results. 

The Veterans Benefit Administration (VBA) has worked with us to update both 

their training and procedure manual, the M21-1. They did an outstanding job, the 

new changes to their M21-1 provides sufficient guidance to enable C&P examiners 

to provide accurate Gulf War Illness exams and it provides VA adjudicators all the 

necessary information to accurately decide these claims. 

Unfortunately, the Veterans Benefit Administration (VBA) has been ineffective in 

getting the front line raters at the regional Benefits offices to do the training or use 

the updated M21-1 manual. This is evident by recent denials of chronic multisymptom illness (CMI) claims in which the adjudicator or the C&P examiner imposed a 

nexus requirement and denied the veteran’s claim because ′′no record or evidence 

of such illness was found in the veteran’s military medical records′′. The front line 

adjudicators are not following statue, VA regulations, VA procedure (M21-1) and 

U.S. Court of Appeals for Veterans’ Claims case law. 

The NGWRC has been very successful in winning appeals at the Regional Benefits Office level, by simply pointing out the statue, VA regulation (38 CFR 3.317), 

the appropriate section in the M21-1 procedure manual, and the U.S. Court of Appeals for Veterans’ Claims case Gutierrez v. Principi, 19 Vet.App.1 (2004) in which 

the court upheld U.S.C 38 § 1118 and determined that a Gulf War veteran does not 

have to prove any link to the veteran service and his or her current CMI condition. 

The NGWRC has also been successful working with policy makers inside the Veterans Benefit Administration (VBA). We are very thankful to these policy makers 

for the positive changes made to the M21-1 manual, yet we find ourselves awestruck 

by the VBA’s inability to train the front line adjudicators on these types of claims. 

As positive as the changes are to the M21-1, these changes are useless if the examiners and raters aren’t using and following the regulations highlighted in the manual. 

The only hope Gulf War Veterans have to fix the high denial rate of Gulf War 

illness related claims is for the Veterans Benefit Administration to first recognize 

the problem and provide ongoing training to the front line adjudicators in all Regional Benefits Offices. This training would further serve to reduce the growing 

number of appeals. 

Recommendations: 

• Training. Training the front line adjudicators concerning Gulf War illness related claims would be the most effective tool in solving the high denial rate of 

Gulf War illness related claims. Gulf War illness related claims make up 29% 

of the current back log. This training would further serve to reduce the growing 

number of appeals. If the policy makers in the Central office are serious about 

fixing the high denial rates of Gulf War illness related claims, they need to ensure that each regional office around the country is doing mandatory training. 

• The upper management in the Central office should direct the directors of each 

Regional Benefits Office to ensure their front line adjudicators are using the 

M21-1 manual. This manual provides the adjudicators all the references needed 

to accurately adjudicate claims. References in this manual include U.S. code, 

VA Regulation (CFR) and related U.S. Court of Appeals for Veterans’ Claims 

cases. This manual is an excellent tool if used. 

• Transparency, the VBA must continue to provide Veteran Service Organizations 

with data on these types of claims. This ensures that VSO organizations can 

monitor and keep tract of denial and approval rates as well as provide critical 

information to the veterans they represent. 

• I think it would help if VA also provided more specificity to veterans on why 

their claims are denied. For example, VA doesn’t always inform the veteran 

about what exactly could be done to help move the claim - but I believe the following is critical for veterans to know so they can meet the 10% threshold: 

• The veteran must specifically indicate the condition is ′′due to Gulf War;′′ 

Leonard.horne on VACREP0180 with DISTILLER

55 

• The veteran must describe the symptoms related to the condition and its existence of more than 6 months; 

• The veteran should provide any medical or nonmedical evidence (such as personal statements from family on the impact of the condition to the veteran, family, etc. 

Respectfully, 

Ronald E. Brown 

President 

National Gulf War Resource Center 

Æ 

Leonard.horne on VACREP0180 with DISTILLER