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Information for Veterans Who Served in Iraq and Afghanistan 

enduring freedom review

Vol. 1, No. 1 December 2003

Department of Veterans Affairs

GULF VETS

Also in This Issue

Two Years of Free VA Health Care Available for

Combat Veterans... ...................................................2

VA Under Secretary for Health Testifies on

VA Efforts Towards a Seamless Transition 

For Returning Service Members...............................3

Disability Compensation and Other Benefits

for OIF and OEF Veterans........................................7

Pneumonia Outbreak Raises Questions

About Health Risks for OIF Veterans ......................8

DoD Issues Medical Advisory on

Leishmaniasis; Blood Donations Halted...................8

About the Review .....................................................9

First Analysis of DoD Roster of

Discharged OIF Veterans........................................10

WRIISC Offers Hope for All Combat

Veterans with Unexplained Illnesses......................10

Questions & Answers .............................................10

Web Sites Provide Information About

Programs for OIF and OEF Veterans .....................10

Where to Go for Information and Assistance.........11

Our Obligation

 Let me remind you of 

the words of my great 

predecessor, General 

Omar Bradley: “We are 

dealing with veterans, not 

procedures: with their 

problems, not ours.” 

I place tremendous 

importance on meeting 

our obligations to veterans 

returning injured or wounded from combat or 

military operations. It will be difficult for any 

VA employee to be overzealous in servicing 

the casualties of the war in which we are now 

engaged. Conversely, we will have failed to meet 

our very reason to exist as a Department if a 

veteran is poorly served—or because we are acting 

in a routine, “business as usual” manner. 

OIF/OEF Review – The Inaugural Issue

This newsletter is modeled on the Gulf War Review 

newsletter that was initiated by the Department of Veterans 

Affairs (VA) in 1992 in response to health concerns 

expressed by some Gulf War veterans and their families 

regarding the possible long-term medical consequences of 

military service in Southwest Asia. 

Technically, the Gulf War era began on August 2, 

1990, and continues through a date to be set by law or 

by Presidential Proclamation. On April 6, 1991, the first 

President Bush signed Public Law 102-25, which among 

other things established August 2, 1990, as the official 

starting date of the “Persian Gulf War.” That law also 

provides that the War would end “on the date hereafter 

prescribed by Presidential proclamation or by law.” To 

date, there has been no law or Presidential Proclamation. 

In 1995, we included an article, entitled 

“Persian Gulf War – Is the End in Sight?” about 

this situation in our national Gulf War newsletter 

(Persian Gulf Review, December 1995, page 3). 

In reality, there have been two periods of combat in this 

region of the world: the first was Operations Desert Shield/

Desert Storm in 1990-91, and the most recent is Operations 

Iraqi Freedom and Enduring Freedom that began in 2001 

and 2003 respectively. While military personnel faced 

many of the same exposures and potentially hazardous 

substances, there are also differences. 

Consequently, we decided that a separate and distinct 

publication focusing on the health and benefit concerns 

and problems of Operation Iraqi Freedom veterans and 

Operation Enduring Freedom veterans was called for. This 

newsletter is the product of that thinking. 

Anthony J. Principi

Secretary of Veterans Affairs

operations iraqi freedom/
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Two Years of Free VA Health Care 

Available for Combat Veterans, Including 

OIF and OEF Veterans

Military personnel who recently served in a combat 

zone or in an area of hostilities comparable to that seen 

during combat are now eligible for 2 years of free medical 

care from the Department of Veterans Affairs (VA) for 

most conditions.

“We are able to help the newest generation of combat 

veterans serving in Afghanistan and engaged in the war 

against terrorism in ways not available to previous 

generations of veterans,” said Secretary of Veterans 

Affairs Anthony J. Principi.

In the past, veterans have had to prove that a medical 

problem is connected to their military service to receive 

free VA care for that condition, or they must have relatively 

low incomes. Since November 11, 1998, however, VA 

has been authorized to provide free medical care for some 

veterans within 2 years after leaving active duty. Eligible 

veterans must have served in a combat zone or in an area 

and during a period of comparable hostilities. They do not 

have to prove either a service-connection for their health 

care problems or that they have low incomes. Operations 

Enduring Freedom and Iraqi Freedom veterans are the 

first large group of veterans to benefit from this policy 

change.

“The wounds of military conflicts are not always 

obvious,” said Principi. “We must be ready to assist combat 

veterans who have medical problems that are unexplained 

or difficult to diagnose.”

The benefit does not cover treatment for medical 

problems clearly unrelated to military service, such as care 

for common colds, injuries from accidents that happened 

after discharge from active duty, and disorders that existed 

before the person joined the military.

How It Works

To receive free medical care, veterans must be able to 

show that they served since November 11, 1998, in a theater 

of combat operations or in combat against a hostile force. 

The coverage lasts for 2 years after discharge from active 

duty. It applies to VA hospital care, outpatient services, 

and nursing home care.

“National Guard and Reserve personnel, who serve 

alongside their active duty comrades in combat will, in 

most cases, be eligible,” said Dr. Robert Roswell, VA’s 

Under Secretary for Health.

After 2 years, these veterans will be subject to the 

same eligibility and enrollment rules as other veterans. 

“This benefit builds upon the lessons learned from 

the undiagnosed illnesses of Gulf War veterans and 

Vietnam veterans exposed to Agent Orange,” said 

Principi. “Combat veterans should not wait for medical 

care while we weigh the evidence linking their problems 

to military service.” 

For additional information, see the following questionsand-answers and www.va.gov/environagents/docs/Speci

alHCforCobatVetsd2.pdf. 

VA Eligibility for Veterans of a Combat 

Theater or Equivalent Hostilities

Who is eligible for this care?

The care is available to veterans who served on active 

duty in a theater of combat operations in a period of war, 

after the Gulf War or in combat against a hostile force 

during “a period of hostilities” after November 11, 1998, 

in accordance with the guidelines issued by the Under 

Secretary for Health.

How does this help veterans?

It provides needed medical care for 2 years to veterans 

who served in a combat theater without requiring them to 

make a copayment for the care they receive, even without 

proof that their injury or illness was caused or aggravated 

by their military service.

What type of injuries and illnesses does

this cover?

VA appreciates that many wounds are not always 

obvious and that unexplained or difficult to diagnose 

illnesses are often associated with military conflict. This 

benefit covers all illnesses and injuries except those clearly 

unrelated to military service, such as a common cold, 

injuries from accidents after discharge, or disorders that 

people had before joining the military.

How is this different from previous policy?

The key distinction is that these veterans will be 

provided free medical care immediately upon discharge 

and for a period of 2 years. They need not prove their 

injury or illness was connected to their service or show 

that they have a relatively low income or other grounds 

for eligibility. Previously, many of these veterans would 

be liable for a copayment until their illness or injury had 

been evaluated by VA and ruled to be a service-connected 

disability.
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Under what authority can VA offer this care?

VA’s policy is in accordance with the authority granted 

in section 102 of Public Law 105-368 as codified in Section 

1710(e)(1)(D) of Title 38 of the United States Code.

Is this limited to hospital care?

No. The policy includes other appropriate medical 

care and nursing home care as well.

What is the effective date for establishing the 

2-year time period?

The 2-year time period begins when the military member 

is discharged or retires from active duty. 

Does receipt of care establish proof of a serviceconnected disability rating?

No. The care is designed to meet the medical needs of 

combat veterans for 2 years after they leave active duty. 

It is expected that during this time veterans’ claims for 

disability compensation for these injuries, illnesses, or 

medical conditions will be adjudicated. If veterans’ claims 

are approved as service connected, they will be placed in 

the appropriate priority group and continue to receive their 

care without a copayment. If their claim is disapproved, 

they may still be able to receive care, but they may be 

required to make a copayment for the services.

Does this include members of the National Guard and 

Reserve forces?

Yes. The policy also applies to National Guard and 

Reserve personnel who were activated and served in a 

theater of combat or in combat against a hostile force. 

Members of the Guard and Reserve forces must be ordered 

to active duty by a Federal declaration, serve the full period 

for which they were called or ordered to active duty, and 

be released, discharged, or retired under conditions other 

than dishonorable.

How is VA defining “hostilities?”

“Hostilities” is defined broadly as conflict in which 

the members of the Armed Forces are subjected to danger 

comparable to the danger they would face in a period of 

war. This definition includes many areas in the world 

where U.S. service members are deployed in addition to 

OIF and OEF. To determine whether a period of hostilities 

is within the scope of this special authority, VA relies upon 

the same legal authority and criteria used to determine 

eligibility for VA Readjustment Counseling Service (the 

VA “Vet Center” program).

Why has it taken almost 4 years for VA to implement 

this policy?

An initial directive was issued on March 23, 1999, 4 

months after enactment of the law authorizing VA to provide 

this care; the directive was disseminated to VA medical 

centers, detailing the policy. As troops began to deploy 

to Afghanistan and other places around the world in the 

war against terrorism, VA officials believed it would 

be helpful to provide further information about postdischarge benefits for veterans who served in a combat 

theater. For this reason, the Secretary has directed the 

publication of a follow-on directive to ensure that those 

who are eligible for this program get the word.

What happens to these veterans after the 2 years 

are up?

After 2 years, a veteran’s copayment status will 

depend on whether their illness, injury, or medical 

condition was officially found by VA to be serviceconnected or whether they are otherwise qualified for 

care. They will be enrolled in the appropriate priority 

group for VA health care.

Veterans will be enrolled to the extent appropriations 

allow. For information regarding enrollment, see 

www.va.gov/elig/, contact the nearest VA health care 

facility, or call the VA Health Benefits Service Center 

at 1-877-222-8387.

VA’s Under Secretary for Health 

Testifies on Efforts Towards a 

Seamless Transition For Returning 

Service Members

On October 16, 2003, Dr. Robert H. Roswell, VA’s 

Under Secretary for Health testified before the House 

Committee on Veterans’ Affairs during a hearing 

on the transition of returning service members from 

military to VA care. Dr. Roswell heads the Veterans 

Health Administration, which includes all VA medical 

centers and health care facilities. His prepared remarks 

follow.

We have been working hard both internally and 

with the Department of Defense (DoD) to improve 

coordination to identify the men and women returning 

from combat theaters and provide those discharged or 

needing VA services while on active duty with worldclass VA service. Anyone who has been wounded or 

injured or has become ill in defense of our country 

deserves the best and most timely service possible from 

VA. As you know, these returning service members 

have high priority for access to VA care. 

Recent media attention focused on returning 

service members whose interactions with VA were 

not acceptable. We have developed processes to try to 

prevent these types of situations from recurring, and, in 
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addition, we have implemented a number of longer-term 

strategies, policies, and procedures to provide timely, 

appropriate services to our returning service members.

Seamless Transition Taskforce

In August, the Under Secretary for Benefits and I 

charged a new VA Taskforce for the Seamless Transition 

of Returning Service Members to intensify and continue 

efforts to assure world class services are provided to 

our military and veterans. This taskforce, composed of 

VA senior leadership from key program offices as well 

as the VA/DoD Executive Council structure, is initially 

focusing on internal coordination efforts to ensure 

that VA approaches this mission in a comprehensive 

manner. An additional goal is improving dialogue and 

collaboration with DoD at all levels between our two 

departments, including the Military Services, Personnel 

and Readiness, Health Affairs, and Reserve Affairs. As an 

early focus, we are working closely with DoD to enhance 

our ability to identify and serve all returning service 

members that sustained injuries or illnesses while serving 

our country.

Thanks to the leadership of Dr. David Chu and Dr. 

Bill Winkenwerder, I am pleased to report that DoD 

transferred to VHA a roster of military personnel who 

served in the recent conflicts in Afghanistan and Iraq and 

subsequently separated from active duty. Our records 

indicate that of approximately 17,000 veterans listed in 

this initial roster, to date, about 2000 (12%) have sought 

health care from VA since separating from active duty 

for a wide variety of health problems. Of this group, 

most have been seen as outpatients.

Additionally, toward that end, working in collaboration 

with the military Surgeons General, who have been 

enthusiastic about improving coordination of care, the 

Veterans Benefits Administration (VBA) has detailed 

a full-time benefits counselor and the Veterans Health 

Administration (VHA) has detailed a full-time social 

worker to the Walter Reed Army Medical Center, the 

Military Treatment Facility (MTF) receiving the largest 

numbers of casualties. Beginning in late August, VHA 

social workers and VBA Veterans Service Representatives 

have also been assigned as VA/DoD Liaisons to the 

Brooke, Eisenhower, and Madigan Army Medical Centers; 

the National Naval Medical Center at Bethesda; and other 

MTFs receiving casualties. They work closely with 

military medical providers and social workers to assure 

that returning service members receive information and 

counseling about VA benefits and programs and to arrange 

for appropriate transfer of health care to VA facilities. 

Through this new collaboration, we have improved our 

ability to identify and serve returning service members 

that sustained serious injuries or illnesses while serving 

our country.

The VA social workers augment the clinical coordination 

through discharge planning activities at these MTFs. They 

are tracking these patients as they transfer to VA care, 

with the assistance of identified points of contact at every 

VA facility. Prior to discharge from the MTFs, the social 

workers enroll those transferring to VA care in order to 

expedite the transfer. By having representatives on site 

at military treatment facilities, we have also been able to 

assist those from recent deployments who have come into 

the medical center on their own. Utilizing the new case 

management and coordination strategies developed with 

the military services at the 5 MTFs, since August 25, we 

have met with more than 150 patients, transferred over 

30 and have over 30 patients pending transfer from these 

MTFs to VA. We are working to expand these efforts and 

have partnered with the Army Disabled Soldier Liaison 

Team to draft an agreement to standardize information 

transfer processes to sustain our progress. We believe 

these coordination and collaborative efforts have greatly 

improved and streamlined the transition for those seeking 

care through VA.

Further, we are working to improve our collaboration 

with DoD to enhance outreach to returning members of 

the Reserves and National Guard. Too often Reservists 

and National Guard personnel have not received timely 

information about the benefits and access to health care 

they have earned. To address this problem, working 

with DoD Health Affairs and DoD Reserve Affairs, we 

have jointly developed and distributed a new brochure 

summarizing the benefits available to this special population 

of veterans upon their return to civilian life. We have 

printed a million copies of this brochure to ensure the widest 

possible dissemination. It is also available on line at http:/

/www.va.gov/environagents/docs/SVABENEFITS.pdf. 

And we are actively working to ensure successful 

implementation of Public Law 105-368, authorizing VHA 

to provide health care for a two-year period to veterans who 

serve on active duty in a theater of combat operations during 

a period of war after the Gulf War, or in combat against a 

hostile force during a period of hostilities after November 

1, 1998. Consequently those who have served or are now 

serving in Afghanistan and Iraq, will have a two-year period 

of access to free VA health care for conditions related to 

their combat service. We are aggressively outreaching to 

this group of current and former service members, including 

those who served in the National Guard and Reserves.

To ensure that our commitment is understood and shared 

at every level of the Department of Veterans Affairs, the 

Taskforce has developed a number of training materials for 
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killed on active duty are provided specialized outreach 

services through our Casualty Assistance Program. Through 

this program, VBA works with military casualty assistance 

officers to schedule outreach visits with families. In addition, 

the Secretary recently authorized the VHA Readjustment 

Counseling Service to provide bereavement counseling to 

family members of active duty military personnel who are 

killed in the line of duty. Bereavement counseling is a 

natural extension of the core components of the Vet Center 

readjustment counseling service mission, which includes a 

welcoming consumer-oriented environment; recognition of 

veterans’ service and sacrifice to country; ease of access 

via 206 conveniently located community-based facilities; 

maximum sensitivity to the need for confidentiality; and 

expertise in providing psychological trauma counseling to 

veterans’ families.

In-service death claims for Dependency and Indemnity 

Compensation are generally processed within 48 hours of 

receipt. At the time of the initial outreach visit, family 

members are in an acute stage of grief and are not always 

able to absorb and understand the full range of benefits 

available to them. Accordingly, VBA initiates a 6-month 

follow up letter to surviving spouses and dependent children 

outlining benefits and services, which they may be ready 

to discuss in further detail at that later time. If requested, 

a second outreach visit is made.

Each separating or retiring service member also 

receives information from VA through the Veterans 

Assistance at Discharge System (VADS) when his 

or her DD 214, Discharge Certificate, is received 

by VA’s Austin Automation Center directly from the 

military service departments. The initial “Welcome 

Home” letter includes a copy of VA Pamphlet 21-00-1, 

A Summary of VA Benefits; VA Form 21-0501, Veterans 

Timetable; and information on life insurance and education 

benefits, as applicable.

VHA is also partnering to conduct outreach by actively 

participating in discharge planning and orientation sessions 

for returning service members. Social Work Service, 

Readjustment Counseling Service, and other offices 

within VHA are involved in outreach activities. Posters, 

flyers, and information brochures are being produced to 

be distributed as well as posted in prominent places at 

VA medical centers and other VA offices explaining VA 

services to returning service members and “our newest 

veterans.” As service members are discharged from the 

military, and VHA is made aware, staff is making contact 

with the individuals to explain local services available and 

welcome them home.

We testified before the Oversight and Investigations 

Subcommittee in early July on the longer-term strategies 

involving outreach that VA is pursuing to assure the best 

staff including a script and video for front line staff to ensure 

that they can identify veterans who have served in a theater 

of combat operations and take the steps necessary to ensure 

they receive appropriate care. Through the Taskforce, each 

VHA facility and each VA regional office has identified a 

point of contact to coordinate activities locally and assure 

that the needs of these service members or veterans are 

met and that contact is made should the veteran relocate. 

Case management guidance has been produced and was 

recently distributed to VHA and VBA field staff to ensure 

that these processes and expectations are communicated. 

We are committed to reducing red tape and streamlining 

access to health care services and VA benefits programs 

for these veterans.

Veterans Outreach and Educational Activities

Earlier this year, the Secretary and I implemented the 

provisions in law necessary to open VA’s Vet Centers to 

veterans returning from the current conflicts in Afghanistan 

and Iraq. As the community-based outreach arm of VHA, 

the Vet Centers have initiated outreach to area military 

installations and are closely coordinating their efforts 

with military family support services on the various 

military bases. In addition to community outreach to new 

veterans, the Vet Centers provide trauma counseling, family 

counseling, employment services and a range of social 

services to assist veterans in readjusting from war-time 

military service to civilian life. To date the Vet Centers 

have seen approximately 1,400 veterans from the conflicts 

in Iraq and Afghanistan. The Vet Centers also function as 

community points of access for many returning veterans, 

providing them with information and referrals to VA 

medical facilities for health care and VA regional offices for 

benefits issues.

Each VBA Regional Office assigns a point of 

contact to offer information on VA benefits and 

answer questions relating to benefits to wounded 

or injured veterans and their families. Case managers are 

assigned to process expeditiously claims for compensation 

or other benefits, ideally within 30 days of receipt.

VBA’s Transition Assistance Program (TAP) 

disseminates information about VA benefits and services 

to separating and retiring service members. VBA military 

service coordinators have conducted several thousand 

briefings this fiscal year to service members, local 

Reserve Commands, and National Guard Units. VBA 

recently conducted a series of TAP briefings aboard the 

USS Constellation on its return to Honolulu from the 

Persian Gulf and will continue to support requests from 

the Department of Defense.

Surviving spouses, dependent children, and parents of 

military personnel, Reservists, and National Guard members 
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possible care is provided to returning Iraqi Freedom and 

Afghanistan Enduring Freedom service members. Many of 

these efforts are coordinated with DoD under the umbrella 

of the Health Executive Council.

Any health or exposure data that DoD collects regarding 

the deployment of service members potentially will be 

useful to VA. Through the Deployment Health Work Group, 

we are actively engaged with DoD in obtaining as much 

deployment health and exposure information as possible. 

Members of the Work Group are charged with reviewing 

appropriate coordination of data on troop locations and 

the data collected as part of pre- and post-deployment 

health screening implemented by DoD in their Recruit 

Assessment Program. Further we are actively working 

with DoD to develop separation physical examinations 

that thoroughly document a veteran’s health status at 

the time of separation from military service and that 

also met the requirements of the physical examination 

needed by VA in Connection with a veteran’s claim for 

compensation benefits. We are optimistic that as a result of 

the improved collaboration between VA and DoD in these 

programs, we will be better positioned to evaluate health 

problems among service members and veterans after they 

leave military service, to address post-deployment health 

questions, and to document changes in health status for 

disability determination.

A critical outreach activity to veterans and families 

concerns the potential health effects of hazardous military 

deployments. In addition to VA’s outreach efforts discussed 

above, VHA has produced a brochure that addresses the 

main health concerns for military service in Afghanistan, 

another brochure for the current conflict in the Gulf 

region and one recently distributed on health care for 

women veterans returning from the Gulf region. These 

brochures answer health-related questions that veterans, 

their families, and health care providers have about these 

hazardous military deployments. They also describe 

relevant medical care programs that VA has developed 

in anticipation of the health needs of veterans returning 

from combat and peacekeeping missions abroad. These 

are widely distributed to military contacts, veterans service 

representatives and are on VA’s website.

Another challenge for outreach is to address the 

specific concerns of veterans and their families over 

the potential health impact of environmental exposures 

during deployment. Veterans also have questions about 

their symptoms and illnesses following deployment. These 

concerns are addressed through newsletters and fact-sheets 

to veterans covering health and compensation issues, 

including environmental health issues; regular briefings 

of veterans service organizations; organization of national 

meetings on health and research issues; media interviews; 

other educational material and websites with information, 

like www.va.gov/environagents.

Other Long-Term Strategies

In addition to the outreach activities discussed above, 

our strategy to assist returning service members and veterans 

includes the following:

• In 2002, VA established two national centers for the 

study of war-related illness and post-deployment 

health issues in East Orange New Jersey, and 

Washington, DC, to provide specialized health care 

for veterans from all combat and peace-keeping 

missions who suffer difficult to diagnose but 

disabling conditions. These centers are available to 

eligible veterans from all eras, including the war in 

Afghanistan and Iraq. These centers also provide 

research and education programs for our health care 

providers.

• A screening instrument in the form of a clinical 

reminder triggered by the veteran’s separation date 

is being implemented for returning Iraqi Freedom 

and Afghanistan veterans that present for care in VA. 

This assessment tool will prompt the provider with 

specific data requirements to assure that veterans are 

screened for medical and psychological conditions 

that may be related to recent combat deployment.

• VA has developed evidence based clinical approaches 

for treating veterans following deployment. These 

clinical practice guidelines (CPGs) give health care 

providers the needed structure, clinical tools, and 

educational resources that allow them to diagnose 

and manage patients with deployment-related health 

concerns. Two post-deployment CPGs have been 

developed in collaboration with DoD, a general 

purpose post-deployment CPG and a CPG for 

unexplained fatigue and pain. Our goal is that all 

veterans will find their VA doctors well informed 

about specific deployments and related health 

hazards. The VA website contains these CPGs as 

well as information about unique deployment health 

risks and new treatments.

• VA and DoD will soon release a new CPG on the 

management of traumatic stress. This guideline 

pools DoD and VA expertise to help build a joint 

assessment and treatment infrastructure between 

the two systems in order to coordinate primary care 

and mental health care for the purpose of managing, 

and, if possible, preventing acute and chronic Post 

Traumatic Stress Disorder (PTSD).
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• The Veterans Health Initiative (VHI) is a program 

designed to increase recognition of the connection 

between military service and certain health effects; 

better document veterans’ military and exposure 

histories; improve patient care; and establish a database 

for further study. The education component of VHI 

prepares VA healthcare providers to better serve their 

patients. A module was created on “Treating War 

Wounded,” adapted from VHA satellite broadcasts 

in April 2003 and designed to assist VA clinicians 

in managing the clinical needs of returning wounded 

from the war in Iraq. Modules on spinal cord injury, 

cold injury, traumatic amputation, Agent Orange, the 

Gulf War, PTSD, POW, blindness/visual impairment 

and hearing loss, and radiation are available. We are 

developing additional modules on infectious disease 

health risks in Southwest Asia, military sexual trauma, 

traumatic brain injury, pulmonary diseases of military 

occupational significance, and Weapons of Mass 

Destruction Experiments and Exposures involving 

US veterans. Further, VA’s National Center for 

PTSD has developed the Iraq War Clinician’s Guide 

for use across VA. The website version, which can 

be found at WWW.NCPTSD.ORG, contains the 

latest fact sheets and medical literature available 

and is updated regularly. These important tools 

are integrated with other VA educational efforts to 

enable VA practitioners to arrive at a diagnosis more 

quickly and accurately and to provide more effective 

treatment.

• Section 110 of Public Law 98-528, as amended by 

section 206 of Public Law 106-117, established the 

Under Secretary for Health’s Special Committee 

on PTSD. This group, composed of PTSD experts 

from across VA, is charged with reviewing VA’s 

capacity to provide assessment and treatment for 

PTSD and guiding VA’s educational, research, 

and benefits activities concerning PTSD. The 

Special Committee, which is currently meeting in 

Washington to develop the last of its four mandated 

annual reports, has provided specific, prioritized, 

proactive recommendations designed to build, 

integrate, and maintain the continuum of PTSD 

services needed by veterans, present and future.

• VA and DoD are closely collaborating to develop the 

ability to share medical information electronically. 

Since June 2002, the Departments have successfully 

been sharing electronic medical information. 

Key initiatives in the Electronic Health Records 

Plan are the Federal Health Information Exchange 

(FHIE) and HealthePeople (Federal). FHIE provides 

historical data on separated and retired military 

personnel from the DOD’s Composite Health Care 

System to the FHIE Data Repository for use in 

VA clinical encounters and potential future use 

in aggregate analysis. Patient data on laboratory 

results, radiology reports, outpatient pharmacy 

information, and patient demographics are now 

being sent from DoD to VA via secure messaging. 

This second phase of FHIE has been deployed and 

is operational at VA medical centers nationwide. 

It includes admission, discharge, transfer data, 

discharge summaries, allergies, and consult 

tracking.

Summary

A service member separating from military service 

and seeking health care through VA today will have the 

benefit of VA’s decade-long experience with Gulf War 

health issues as well as the President’s commitment to 

improving VA/DoD collaboration. VA has successfully 

adapted many existing programs, improved outreach, 

improved clinical care through practice guidelines and 

educational efforts, and improved VA health provider’s 

access to DoD health records. Secretary Principi reemphasized VA’s commitment to returning combat 

veterans in a letter to all employees last August, in 

which he reminded us that every VA employee has an 

obligation to ensure that every veteran who is wounded, 

injured, or ill from training for, preparing for, or fighting 

for our war on terror receives priority service. In his 

words, “We will have failed to meet our very reason to 

exist as a Department if a veteran is poorly served.” I 

agree with that, Mr. Chairman, and VA will continue 

to improve services and coordination to ensure that the 

needs of these service members are met.

Disability Compensation and Other 

Benefits for OIF and OEF Veterans

Like all veterans, Operation Iraqi Freedom and 

Operation Enduring Freedom veterans are eligible for 

monthly payments, called disability compensation, from 

VA if they are suffering with service- connected illnesses 

or injuries. The disability must have been incurred or 

aggravated during active military service. Furthermore, 

the service of the veteran must have been terminated from 

military service through separation or discharge under 

conditions that were other than dishonorable.

Disability compensation varies according 

to the degree of disability and the number of 

dependents. Benefits are not subject to Federal or 

state income tax. The receipt of military retirement 

pay, disability severance pay, and separation 

incentive payments know as SSB and VSI (Special 
8 

Separation Benefits and Voluntary Separation Incentives)

also affects the amount of VA compensation paid.

The disability ratings range from 0 to 100 percent 

(in increments of 10 percent). For 2003, an OIF or OEF 

veteran with a disability rating of 10 percent receives $104; 

a veteran with disability rating of 50 percent gets $633; 

and a veteran who is totally disabled and evaluated at 100 

percent receives $2,193 monthly.

Veterans with disability ratings between 30 and 100 

percent are eligible for monthly allowances for a spouse 

ranging from $37 to $125, and for each child, $19 to $64. 

(The amount depends on the disability rating.)

A veteran who is in need of regular aid and

attendance of another person, or who is permanently 

housebound may be entitled to additional benefits. VA 

must make that determination before the veteran can get 

these benefits.

Compensation is not automatically provided 

to the OIF, OEF, or to other veterans. VA veterans service 

representatives (VSR) can provide the necessary application 

and assist veterans who need help in completing it. VSR’s 

are located at all VA Regional Offices, in VA medical 

centers, and at most VA clinics. For help in locating a VSR 

near you, call the following toll-free telephone number: 

1-800-827-1000.

Other Benefits

In addition to the compensation program described 

above, individual OIF and OEF veterans may be eligible 

for the full range of other benefits offered by VA, including 

education and training, vocational rehabilitation, home 

loan guarantees, life insurance, pension, burial benefits, 

and more.

To learn more about VA’s programs, OIF veterans

and other interested parties can visit the VA

home page http://www.va.gov or call 1-800-

827-1000.

Pneumonia Outbreak Raises Questions 

about the Health Risks for OIF Veterans

Severe cases of pneumonia, including an unusual number 

of deaths, has raised questions and concerns about the 

health consequences of military service in Southwest Asia, 

in general, and in Iraq, specifically.

From April to late August 2003, approximately 

100 U.S. active duty troops in Southwest Asia were 

diagnosed with pneumonia or some form of respiratory 

ailment and 19 of them were found to have particularly 

severe conditions that required treatment with respirators. 

Two of them later died. Both soldiers had served 

in Iraq.

Dr. Michael E. Kilpatrick, Department of Defense 

deputy director of deployment health support, noted that 

the rate of pneumonia in the number of deployed individuals 

(about 160,000) was not excessive, but that the number 

of severe cases was unusual. In addition, the cases were 

widely spread; almost always single cases were in units that 

were widely separated in space and time. Dr. Kilpatrick 

noted that the Army surgeon general’s office found that the 

Army experiences 400-500 cases of pneumonia annually 

worldwide.

Dr. Kilpatrick reported that two medical 

teams were deployed to try to better understand 

the causes of the apparent pneumonia outbreak. 

They concluded that four of the 19 most serious 

cases were caused by bacterial infections. 

Dr. Kilpatrick indicated that the investigators were 

uncertain about the cause of the other 15 cases. There 

was no comparable pneumonia outbreak during or shortly 

following the 1990-91 Gulf War.

He pointed out that 10 of the service members diagnosed with pneumonia had taken up smoking again while 

they were deployed. He speculated that this could be a 

contributor to the cause of pneumonia (perhaps severe 

pneumonia) in some individuals.

DoD Issues Medical Advisory on 

Leishmaniasis; Blood Donations Halted

At least one chronic infectious disease, found in 

Southeast Asia, was definitely linked to military service in 

Gulf War during or shortly following the 1990-91 conflict: 

viscerotrophic leishmaniasis. Approximately 32 Desert 

Shield/Storm veterans were diagnosed with this condition 

or a milder form of the illness: cutaneous leishmaniasis. 

Because of this, veterans from the first Gulf War (1990-

91) were temporary excluded from donating blood, as a 

precaution.

Some observers wondered if this disease would 

affect the 2003 veterans as well. So far, cutaneous leishmaniasis has been seen in 150 OIF veterans. Department of 

Defense (DoD) and VA medical personnel are keeping a 

watchful eye on this issue.

Several months ago, on September 12, 2003,

Dr. William Winkenwerder, Jr, Assistant Secretary 

for Defense, issued a medical advisory concerning the 

threat of leishmaniasis, an infectious disease diagnosed 

in a relatively small number of U.S. military veterans of 

Operations Desert Shield/Storm. Most of these 1990-

91 veterans diagnosed with leishmaniasis suffered 
9

cutaneous leishmaniasis. The memorandum addressed to 

the Secretaries of Military Departments and Chairman of 

the Joint Chiefs of Staff reads, in part, as follows:

Recent reports from Iraq have raised concerns regarding 

the potential impact of leishmaniasis on deployed 

personnel. Please give this advisory the widest possible 

distribution to installation and operational commanders 

and medical personnel.

Leishmaniasis is a preventable disease native to Iraq and 

other parts of Southwest Asia. Spread by sandflies (not 

person-to-person), the disease as found in Iraq presents 

itself in two forms. The skin form called cutaneous 

leishmaniasis (Baghdad Boil) causes mild to severe 

skin lesion that may take months to heal and may 

be permanently disfiguring, though highly effective 

treatment is available. The internal form called 

visceral leishmaniasis...[It] causes fever, weakness, 

wasting, an enlarged spleen, and a lowered blood count. 

If untreated, visceral leishmaniasis is generally fatal.

Currently, the greatest threat is in Central Iraq and 

the area around Baghdad with recent extensions 

into Southern provinces such as Dhi-qar and Al 

Basrah. Reports from some locations in Iraq 

indicate very heavy populations of sandflies,

2 to 3% of which carry the disease. Some service 

members at locations where sandfly numbers are high 

are reporting upwards of 100 bites per person.

So far, seven service members from Iraq and two 

from Afghanistan have been diagnosed with cutaneous 

leishmaniasis (the milder form) and successfully treated. 

Because the incubation period (the time for getting a 

sandfly bite to the development of disease) can be many 

months, it is also possible that deployed personnel may 

redeploy without knowing they are infected.

Given the potential severity of this disease, it is imperative 

that steps be taken to reemphasize procedures to reduce 

the risk of exposure and increase the awareness of 

possible infection with this disease. Personnel preparing 

for deployment should receive briefings on the disease 

and be provided with appropriate personal protective 

equipment including the use of DEET (chemical name, 

N,N-diethyl-meta-toluamide) and Permitherin treated 

uniforms, bed nets, and proper wear of the uniform to 

prevent sandfly bites. During deployment, command 

attention should be given to enforcing procedures that 

reduce exposure to sandflies and enhance awareness 

of the disease. Ongoing preventive medicine briefs to 

commanders and deployed personnel (re: the evolving 

threat and appropriate medical and environmental 

countermeasures) are essential....

Upon redeployment, personnel should receive 

information on how to access health care if they 

development skin lesions or become ill....

To obtain a copy of this memorandum in 

its entirety and additional information on this

subject, see www.pdhealth.mil or call 1-800-796-9699.

For a copy of a fact sheet on leishmaniasis, prepared by 

the U.S. Centers for Disease Control and Prevention, go 

to www.cdc.gov/ncidod/dpd/parasites/leishmania/

factshtleishmania.htm.

About the “Review”

The “Operations Iraq Freedom/Operation 

Enduring Freedom Review” is written by VA’s 

Environmental Agents Service (EAS) to provide 

information about the concerns of Operation 

Iraqi Freedom and Operation Enduring Freedom 

veterans, their families, and others interested in the 

possible long-term health consequences of military 

service in these recent military operations. The 

“Review” describes actions by VA and other 

Federal departments or agencies to respond to these 

concerns. For additional information and future 

issues of this newsletters and related information 

regarding the Gulf War, please see our Web site 

at www.va.gov/gulfwar.

EAS anticipates publication once or twice a 

year, depending on the amount of news on this 

subject and budgetary considerations. This issue 

was completed in early November 2003 and does 

not include developments that occurred after that 

time.

Comments, questions, and suggestions for 

future issues are encouraged and can be sent to 

the OIF/OEF Review, Donald J. Rosenblum, 

Deputy Director, Environmental Agents Service 

(131), VA Central Office, 810 Vermont Avenue, 

N.W., Washington, D.C. 20420.

Requests for additional copies of this and/or 

future issues should also be sent to Mr. Rosenblum. 

Supplies are limited. Please specify the quantity 

and issue date requested.

(DoD Issues Medical Advisory, Continued)
10 

Blood Donation Ban

In a related development, as a precautionary measure 

the Centers for Disease Control and Prevention have 

banned blood donations by all members of the military 

in Iraq for a year after they return home. A similar ban 

was implemented following the earlier conflict in Iraq 

because of concerns about leishmaniasis. Even without 

the leishmaniasis worries, some of these veterans who have 

been prohibited from donating blood because they were in 

places where malaria is common.

First Analysis of DOD Roster of 

Discharged OIF Veterans

A recent analysis of VA health care of veterans of Operation 

Iraqi Freedom (OIF) can be summarized as follows:

• Among 15,813 veterans of OIF who have separated 

from active military duty, approximately 12 percent 

have sought health care from VA.

• Veterans of OIF are presenting to VA with a 

wide range of both medical and psychological 

conditions.

• The health problems of veterans of OIF are similar 

to those found in other young military populations.

• To date, no unusual illnesses have been found among 

veterans of OIF.

• VA will continue to monitor the health status of recent 

Iraqi war veterans using updated rosters provided 

by DoD to ensure that VA tailors its health care 

programs to meet the needs of this unique veteran 

population.

WRIISC Offers Hope for All Combat 

Veterans with Unexplained Illnesses

VA health care providers occasionally see combat 

veterans with multiple unexplained symptoms or difficultto-diagnose illnesses. Two new VA centers offer specialized 

evaluations for combat veterans with disabilities related 

to these illnesses. 

In May 2001, Secretary of Veterans Affairs Anthony 

Principi approved two new War Related Illness and Injury 

Study Centers - WRIISC (pronounced “risk”). The WRIISCs 

opened at the VA Medical Centers in Washington, DC, and 

East Orange, NJ. Veterans who were deployed to combat 

zones, who served in areas where hostilities occurred, 

or who were exposed to environmental hazards may be 

eligible for services.

Q’s and A’s

The “Review” will occasionally include a 

questions-and-answers section in which VA 

officials respond to inquiries from readers 

regarding possible health problems and concerns 

of Operation Iraqi Freedom and Operation 

Enduring Freedom veterans and their families 

and about programs initiated by VA and other 

Federal departments and agencies to help these 

veterans.

Questions should be sent to 

Mr. Donald J. Rosenblum, Deputy Director, 

Environmental Agents Service (131), 

ATTN: OIF/OEF REVIEW – Q’s & A’s, 

810 Vermont Avenue, N.W., Washington, DC 

20420.

A referral for services at a WRIISC can be made after 

a veteran has had a comprehensive medical evaluation at 

their local VA Medical Center. The veteran’s primary 

care provider must make all referrals to the WRIISC. 

Information on the referral process can be found at 

www.va.gov/environagents.

The WRIISCs also have programs engaged in scientific 

research on deployment health questions, such as war 

related illnesses and injuries, risk communication regarding 

deployment related hazards, and outreach education for VA 

patients and their families and health care providers.

Web Sites Provide Information About 

Programs For OIF and OEF Veterans

The VA Web site for Gulf War veterans (that is, 

www.va.gov/gulfwar) is presently serving as the Web site 

for the OIF newsletter. As more information regarding OIF 

veterans becomes available, we will consider establishment 

of a Web site devoted solely to the issues and concerns 

related to OIF veterans.

The VA Web site for and about OEF veterans is 

www.va.gov/environagents.
11

Where to Go for Information and Assistance

Active duty military personnel with questions 

or concerns about their service in Southwest Asia - 

contact your commanding officer or call the Department 

of Defense (DoD) Gulf War Veterans’ Hotline 

(1-800-796-9699) for an examination. DoD has changed 

its “Incidents Hotline” to the “Direct Veterans 

Hotline” to more accurately reflect the work done 

by the Hotline’s contact managers. The new toll-free 

number is 1-800-497-6261.

Operation Iraqi Freedom (OIF) veterans with 

concerns about their health - contact the nearest VA 

medical center. The telephone number can be found 

in the local telephone directory under Department of 

Veterans Affairs in the “U.S. Government” listings. 

A Gulf War Registry examination will be offered. 

Treatment will be provided to eligible veterans. The 

VA Gulf War Information Helpline can also provide the 

latest information and assistance. The toll-free telephone 

number is 1-800-PGW-VETS (1-800-749-8387). 

Operation Enduring Freedom (OEF) veterans

with concerns about their health - contact the nearest 

VA medical center. The telephone number can be found 

in the local telephone directory under Department of 

Veterans Affairs in the “U.S. Government” listings. 

OIF and OEF veterans in need of marital/family 

counseling - contact the nearest VA medical center 

or VA vet center. For additional information, call the 

Gulf War Information Helpline at 1-800-PGW-VETS 

(1-800-749-8387).

OIF and OEF veterans seeking disability 

compensation for illnesses incurred in or aggravated 

by military service - contact a Veterans Services 

Representative at the nearest VA regional office or 

health care facility at 1-800-827-1000, or call the VA 

Gulf War Information Helpline at 1-800-PGW-VETS 

(1-800-749-8387).

OIF veterans seeking participation for their spouses 

or children in the VA-funded health examination 

program for spouses and children - call the VA Gulf 

War Information Helpline at 1-800-PGW-VETS (1-

800-749-8387). Veterans interested in the alternative 

self-funded examination for spouses or children 

- contact the Gulf War Registry Coordinator at the 

nearest VA medical center for forms and information. 

There is no comparable program for the families of 

OEF veterans.

OIF and OEF veterans interested in learning about 

the wide range of benefit programs administered by 

VA - contact a Veterans Services Representative at the 

nearest VA regional office or health care facility at 

1-800-827-1000, or call the VA Gulf War 

Information Helpline at 1-800-PGW-VETS 

(1-800-749-8387).

For additional information about VA’s program 

initiatives concerning these veterans, see the home page 

for VA’s Environmental Agents Service at www.va.gov/

environagents.

OIF and OEF veterans who encounter difficulties at 

a VA medical facility can contact the “patient advocate”

at that facility for assistance in resolving the problem. 

The medical center telephone operator should have the 

telephone number.

Representatives of veterans service organizations, 

including the American Legion (1-800-433-3318), 

Veterans of Foreign Wars of the United States 

(1-800-VFW-1899), Disabled American Veterans

(1-877-426-2838), etc., have been very helpful to Gulf 

War veterans, especially veterans who are seeking 

disability compensation. (These organizations are 

cited as examples. There are many other excellent 

organizations. VA does not endorse or recommend 

any one group over another.) 

County Veterans Service Officers also have been 

of great help to many military veterans, including those 

who served in the Gulf War, who are seeking benefits 

they earned through their service to the Nation. 

For additional Federal benefit information, see 

VA’s Federal Benefits for Veterans and Dependents

booklet. It is updated annually to reflect changes in 

law and policies. It is available for purchase from 

the U.S, Government Printing Office, Superintendent 

of Documents, Washington, DC 20402, Web site: 

bookstore.gpo.gov. VA’s World Wide Web pages are 

updated throughout the year to present the most current 

information. 

The VA home page (www.va.gov) contains links 

to selections on compensation and pension benefits, 

health care benefits and services, burial and memorial 

benefits, etc. 
21

December 2003

Central Office (131)

810 Vermont Avenue, N.W.

Washington, DC 20420

Department of

Veterans Affairs

OFFICIAL BUSINESS

Penalty for private use $300

operations iraqi freedom/

enduring freedom review

Information for Veterans Who

Served in Iraq and Afghanistan