operations iraqi freedom/

enduring freedom review 

Vol. 1, No. 2 Information for Veterans Who Served in Iraq and Afghanistan and Their Families June 2004
	

VA Secretary of Veterans Affairs

Anthony J. Principi Speaks About

Veterans of the War on Terrorism 

 Every VA employee has 

an obligation to ensure 

that each veteran who is 

wounded, injured, or ill from 

training for, preparing for, 

or fighting the war against 

terror receives priority service. 

The men and women who 

embody our department 

now have the rarest of 

opportunities: an important 

chance to make a good first 

impression. Our actions over the next few months will 

define our department for the lifetime of the veterans 

who are now returning from Iraq and Afghanistan. 

Anthony J. Principi 

Secretary of Veterans Affairs 

VA Expands Outreach to Veterans

The Department of Veterans Affairs (VA) is expanding 

its efforts to reach veterans of the wars in Iraq and 

Afghanistan to make sure that they are aware of the 

many benefits they have earned. 

On May 10, 2004, Secretary of Veterans Affairs 

Anthony J. Principi began sending a personal letter to 

more than 150,000 veterans of Operations Iraqi Freedom 

and Enduring Freedom who have recently separated from 

the military, to thank them for their service and to remind 

them of their eligibility for VA health care and other 

benefits. 

“I want these men and women to know that we are 

grateful for their service to our country,” Principi said. 

“Those who served in Afghanistan, Iraq and other places 

around the world have risked their lives to make America 

more secure. One of the ways the nation shows its 

gratitude is by ensuring veterans receive the benefits they 

deserve.” Principi’s letter includes brochures, telephone 

numbers, and links to Web pages at www.va.gov, that 

contain more details about VA benefits, including an 

opportunity to apply for benefits online. 

(Continued on pg. 2) 

Newsletter Sent to 136,000+ Operations

Iraqi Freedom and Enduring Freedom

Veterans; Welcome New Readers 

Welcome new readers. Welcome home!! We are 

happy to tell you about some of the benefits and services 

that VA can provide you. This is the second issue of the 

Iraqi Freedom/Enduring Freedom Review newsletter 

and the first issue to be directly mailed to large numbers 

of recently returned Gulf War and Afghanistan veterans. 

Approximately 180,000 copies of the first issue were 

printed and distributed to Department of Veterans Affairs 

(VA) medical centers, VA Regional offices, Vet Centers, 

and other interested groups and individuals. You can get 

the back issue and future editions at www.va.gov/gulfwar. 

(Continued on pg. 2) 

Also in This Issue 

How Returning Veterans Are Using VA Health Care ........... 2
	

Report on VA Health Care Use By Operation Iraqi

Freedom Veterans .......................................................... 2
	

Database of VA Health Care for Operation Enduring

Freedom Veterans .......................................................... 3
	

Information About Women Veterans of OIF/OEF......... 3 

VA is Prepared to Help OIF/OEF Veterans....................... 4 

Environmental Health Coordinators Can Help OIF/OEF

Veterans............................................................................. 5 

VA’s Commitment on Service to Returning Veterans ......... 5 

About the Review ............................................................... 6 

Two-Year Rule Helps Recent Combat Theater 

Veterans Get Health Care.................................................. 6 

Questions & Answers About the Two-Year Rule for 

Combat Theater Veterans .................................................. 6 

How to Get Disability Compensation............................... 8 

Q’s and A’s ........................................................................ 8 

Benefits and Services for U.S. Military Veterans Living

Outside the U.S ................................................................. 9 

Readers’ Survey ................................................................ 9 

What a Date!!.................................................................. 10 

VA Web Sites Have Information for Gulf War and 

Afghanistan War Veterans............................................... 10 

Women Veterans Are Eligible for the Same Benefits 

as Men............................................................................... 10 

Where to Get Additional Information and Assistance .... 11 

Concerns About Mefloquine (Lariam) ............................ 12 

1

Department of Veterans Affairs 

 
 

 

 

 

VA Expands Outreach to Veterans 

(Continued from page 1) 

As Iraqi Freedom and Enduring Freedom veterans 

continue to leave the active duty military, VA will mail 

additional letters each month from the Secretary. 

VA also regularly mails information packets to 

all service members separating from the military to 

remind them of eligibility for basic VA benefits, such 

as VA-guaranteed home loans and education benefits. 

In addition, there are provisions in these programs 

for reservists and National Guard members. More 

information about all VA benefits can be found at VA’s 

Web site, at www.va.gov. 

Additional outreach to those recently deployed to 

combat theaters also alerts them to special eligibility that 

increases their access to health care for two years after 

separation from the military for illnesses and injuries that 

may be the result of military service. For those medical 

problems, VA waives copayments for inpatient and 

outpatient care. 

Goal: Smooth Transition

VA focuses special attention on those with servicerelated disabilities. The department’s goal is a seamless 

transition from military to VA services, with claims for 

financial benefits receiving expedited processing. For 

the seriously wounded, VA has counselors working at the 

bedsides of patients in military hospitals with the largest 

numbers of casualties to begin benefit applications before 

they leave the military. 

In addition, VA social service personnel work at these 

military facilities to plan health care coordination as 

service members move from military to VA care. This 

helps ensure a smooth transition to a VA hospital or clinic 

near the veteran’s intended residence for continuity of 

medical care. 

In partnership with state and local government 

benefits, counselors and veterans service organization 

representatives, VA annually briefs about 200,000 service 

members around the world before discharge to help 

prepare them for civilian transition and VA benefits. It 

operates benefits offices at 133 military installations to 

help service members with conditions arising during 

service preparation to begin receiving VA compensation 

promptly after discharge. 

“VA has learned many lessons since the Gulf War 

in 1991 and other conflicts, which will ensure that this 

newest generation of war veterans receives the health care 

and assistance they deserve when they return to civilian 

life,” said Principi. 

Newsletter Sent to 136,000+ Operations Iraqi 

Freedom and Enduring Freedom Veterans; 

Welcome New Readers (Continued from page 1) 

Some readers may be interested in seeing some of the 

issues of the “Gulf War Review,” which we primarily 

publish for veterans of the 1991 Gulf War. They can be 

accessed at the Web site mentioned above, are available 

from the Environmental Agents Service (EAS), and can 

be obtained from the Environmental Health Coordinators 

at many VA medical centers. The address for the EAS 

is: Environmental Agents Service (131), ATTN: 

GWR, VA Central Office, 810 Vermont Avenue, N.W., 

Washington, DC 20420. Thirty-four issues of the 

Gulf War Review, originally known as the Persian Gulf 

Review, have been published to date. 

While military personnel in Operations Iraqi Freedom 

(OIF) and Enduring Freedom (OEF) faced many of the 

same exposures and potential hazards as Operations 

Desert Shield and Desert Storm, there also were 

significant differences. In view of these differences, we 

decided that a separate publication that focused on the 

health and benefit concerns of OIF and OEF veterans 

was important. Now we have a mailing list of separated 

OIF and OEF military personnel that allows us to directly 

contact many of the most recent veterans. Because 

many of the readers are new to this publication, we have 

repeated some of the information included in the premiere 

issue, dated December 2003. We apologize to those of 

you who read some similar articles previously; however, 

there is a great deal of new information as well! 

We also publish two other newsletters: the Agent 

Orange Review, founded in 1982, and the Ionizing 

Radiation Review, which just began this year, first 

issue: February 2004, newsletters. Requests for these 

publications can be sent to EAS at the above highlighted 

address. (Substitute AOR or IRR in the attention line, 

as appropriate.) Forty-one issues of the Agent Orange 

Review and a single issue of the Ionizing Radiation 

Review have been released to date. 

How Returning Veterans are Using VA 

Health Care 

The following two articles analyze VA health care use 

by veterans of Operation Iraqi Freedom and Operation 

Enduring Freedom. A separate article regarding usage 

just by women veterans of these military conflicts is also 

provided. 

Report on VA Health Care Use by Iraqi 

Freedom Veterans 

This article summarizes a recent VA report on VA 

health care provided to Operation Iraqi Freedom veterans, 

who have separated from military service. 

2
 
 

Among 139,778 veterans of Operation Iraqi Freedom 

who have separated from active military duty, 15% 

(21,021) have sought health care from the Department 

of Veterans Affairs (VA) since they were deployed. 

Approximately 13,683 health care visits were made by 

Iraqi Freedom veterans, which represents a workload of 

about 87 medical visits for each of the VA’s 158 hospitals 

during a one month period. About 58 percent of Iraqi 

Freedom veterans who received VA health care have been 

members of the Reserve or National Guard. 

Veterans of Operation Iraqi Freedom have presented to 

VA with a wide range of both medical and psychological 

conditions, covering a broad range of medical diagnoses. 

The most common health problems of veterans of 

Operation Iraqi Freedom have been musculoskeletal 

problems, mostly joint and back disorders, and dental 

problems. 

The type of diagnoses of these 21,021 veterans has 

not changed much since earlier analyses of Iraqi Freedom 

veterans who had received VA health care. No particular 

health problem stands out among Iraqi Freedom veterans 

at present. Consequently, recommendations cannot be 

provided for particular testing or evaluation; these war 

veterans should be assessed individually to identify all 

outstanding health problems. 

It is important to note that this analysis includes 

only those veterans who received care from VA. Many 

veterans obtain their medical care elsewhere. Those 

who have been diagnosed by VA are not necessarily 

representative of all OIF or OEF veterans. Only carefully 

designed and well executed scientific studies can reveal 

if these veterans are at increased risk for illnesses or 

diseases and, if so, what these conditions are. 

The Veterans Health Administration (VHA), the health 

care part of VA, will continue to monitor the health status 

of recent Iraqi war veterans using updated deployment 

lists provided by the Department of Defense to ensure 

that VA tailors its health care and disability programs to 

meet the needs of this newest generation of war veterans. 

Database of VA Health Care for Operation 

Enduring Freedom Veterans 

This article summarizes a recent VA report of VA 

health care by Operation Enduring Freedom veterans. 

Among 43,622 veterans of Operation Enduring Freedom who have separated from active military duty, 9.9% 

(4,306) have sought health care from the Department of 

Veterans Affairs (VA) since deployment. The 9.9% rate 

of VA health care utilization among veterans of the war in 

Afghanistan is lower than the 15% rate of VA health care 

usage among a much larger population of 139,778 

Operation Iraqi Freedom veterans who have separated 

from active duty. 

While Veterans of Operation Enduring Freedom 

have come to VA with a wide range of both medical 

and psychological conditions, it is important to note 

that veterans of Operations Enduring Freedom and Iraqi 

Freedom have experienced about the same kinds of health 

problems since returning to the United States even though 

they served in separate theaters of conflict. 

The report concluded that because veterans of the 

conflicts in either Afghanistan or Iraq are coming to VA 

with a wide range of diagnoses, they should be assessed 

individually for all outstanding health problems. 

It is important to note that this analysis includes 

only those veterans who received care from VA. Many 

veterans obtain their medical care elsewhere. Those who 

have been diagnosed by VA are not necessarily typical of 

OIF or OEF veterans. Only carefully designed and well 

executed scientific studies can reveal if these veterans are 

at increased risk for illnesses or diseases and, if so, what 

these conditions are. 

The Veterans Health Administration (VHA), VA’s 

medical agency, will continue to monitor the health status 

of both Enduring Freedom and Iraqi Freedom veterans 

using updated deployment lists provided by DoD to 

ensure that VA tailors its health care programs to meet the 

needs of this newest generation of war veterans. 

Information About Women Veterans of 

Operations Iraqi and Enduring Freedom 

This article summarizes a recent report of VA health 

care by Operations Iraqi Freedom/Enduring Freedom 

women veterans. (Women are also included in the two 

reports above.) 

Among 15,291 women veterans who served in 

Operations Iraqi Freedom and Enduring Freedom and 

have since separated from active duty, 17.0% (2,603) 

have received health care from the VA. A higher 

percentage of female Iraqi Freedom veterans (18.4%) 

have sought health care from VA than Enduring Freedom 

veterans (11.5%); however, 1,309 individual women (9%) 

had served in both military operations. 

A slightly higher percentage of separated women 

veterans have sought health care from VA than the overall 

population of veterans of both Operation Iraqi Freedom 

(18% vs. 14%) and Enduring Freedom (12% vs. 9%). 

Higher health care utilization among women is a common 

finding among other populations of military personnel and 

civilians. 

3
 
 

 

 

 

 

 

 

 

 

About 88% of women Enduring Freedom veterans 

and 60% of women Iraqi veterans who received VA care 

have been members of the Reserve/National Guard.

 Like men, women veterans of recent military conflicts 

have a wide range of both medical and psychological 

conditions; the most common conditions have been 

musculoskeletal ailments, principally joint and back 

problems. 

Compared to the overall population of recent conflict 

veterans seeking health care from VA, women veterans 

have had similar health problems since deployment. 

It is important to note that this analysis includes only 

those women veterans who received care from VA. Many 

veterans obtain their medical care elsewhere. Those 

who have been diagnosed by VA are not necessarily 

representative of all OIF or OEF women veterans. Only 

carefully designed and well executed scientific studies 

can reveal if these veterans are at increased risk for 

illnesses or diseases and, if so, what these conditions are. 

The Veterans Health Administration (VHA) will 

continue to monitor the health status of both Enduring 

Freedom and Iraqi Freedom veterans using updated 

deployment lists provided by DoD to ensure that VA 

tailors its health care and disability programs to meet the 

needs of this newest generation of war veterans. 

VA is Prepared to Help OIF/OEF Veterans 

This article briefly describes some of the key steps 

that the Department of Veterans Affairs (VA) has taken 

to prepare to take care of veterans from Operations Iraqi 

Freedom (OIF) and Enduring Freedom (OEF). VA has 

developed many excellent programs in the anticipation 

of the needs of veterans from the current conflicts in 

Iraq and Afghanistan. Many of these were based on our 

experience treating veterans from the first Gulf War and 

even before that, treating veterans from the Vietnam War. 

Improvements in Veterans Health Care Eligibility

VA has supported new eligibility rules that provide 

reservists and active duty personnel who served in a 

designated combat zone such as Iraq or Afghanistan 

with 2 years of free health care from VA. This program 

now offers streamlined access to health care for recently 

separated combat veterans. Information is summarized 

in the brochure “Special VA Health Care Eligibility for

VeteransWho Served in CombatTheaters,” available on 

line at www.va.gov/environagents. 

Combat Veteran Health Status Surveillance

Today we can monitor the overall health status of 

combat veterans very well using VA’s electronic inpatient 

and outpatient medical records. This surveillance 

summarizes every single VA health care visit by veterans, 

including all medical diagnoses. 

We are developing a new Clinical Reminder (part of 

VA’s computerized reminder system) to assist VA primary 

care clinicians in providing timely and apppropriate 

medical and mental health care to new combat veterans. 

Medical Education Regarding Immediate 

 Health Care Needs for Combat Veterans
 

To better prepare VA health professionals for the 

immediate health concerns of OIF and OEF veterans, 

in March 2003, VA developed a special program called 

“Caring for the War Wounded,” which was broadcast over 

the VA Knowledge Network satellite broadcast system. 

It included VA experts on treatments for traumatic 

injuries; chemical warfare agent health effects; infectious 

diseases; radiological health effects; and post-deployment 

readjustment health concerns. The programs were made 

into a new Veterans Health Initiative (VHI) independent 

study guide, also called “Caring for the War Wounded,” 

which is available to all VA health care providers on 

VA’s Intranet at vaww.va.gov/VHI/ and on the Internet at 

www.va.gov/vhi/. 

New Clinical Guidelines for
 

Combat Veteran Health Care
 

In collaboration with the Department of Defense 

(DoD), VA developed two Clinical Practice Guidelines 

on combat veteran health issues, including one general 

guideline to post-deployment health, and a second dealing 

with unexplained pain and fatigue. The guidelines 

give providers the best medical evidence for diagnoses 

and treatment. They are highly recommended for the 

evaluation and care of all returning combat veterans, 

including OIF and OEF veterans. The new guidelines are 

available on line at www.va.gov/environagents, under the 

heading “Environmental Health Clinicians.” 

New Specialized Combat Veteran 

 Health Care Program
 

In 2001, VA established two new War Related Illness 

and Injury Study Centers (WRIISCs) at the VA medical 

centers in Washington, DC, and East Orange, NJ. These 

centers are currently providing specialized health care for 

combat veterans from all deployments who experience 

difficult to diagnose but disabling illnesses. The centers 

are addressing concerns about unexplained illnesses 

that are seen after all deployments, including OIF, and 

are building on our understanding of these illnesses. 

More information is available online at www.va.gov/ 

environagents under the heading “WRIISC Referral 

Eligibility Information.” 

4
 
Expanded Education on Combat 

 Health Care for VA Providers
 

In addition to the programs already described, VA has 

developed a VHI Independent Study Guide for VA health 

care providers called “A Guide to Gulf War Veterans 

Health.” Although this guide were originally on health 

care for combat veterans from the 1991 Gulf War, it is 

also very relevant for OIF and OEF combat veterans 

because many of the hazardous exposures are the same. 

It was designed to be useful for clinicians, veterans, and 

their families. It is available in print, on a CD ROM, 

and also on the Web at www.va.gov/gulfwar, under the 

heading Veterans Health Initiative (VHI) Gulf War. 

Outreach to Combat Veterans

VA has new informational products to offer combat 

veterans and their families. One new brochure is 

called “Health Care and Assistance for U.S. Veterans 

of Operation Iraqi Freedom,” on basic health issues 

for that deployment. It is available on our Web site at 

www.va.gov/environagents. 

In addition, in collaboration with DoD, VA published 

and distributed one million copies of a short new 

brochure called “A Summary of VA Benefits for National 

Guard and Reserve Personnel.” This brochure does a 

tremendous job of summarizing health care and other 

benefits available to this special population of combat 

veterans upon their return to civilian life. It is available 

online at www.va.gov/environagents near the bottom of 

the page. 

Special Depleted Uranium (DU) Program

OIF veterans concerned about possible adverse health 

effects of exposure to depleted uranium (DU) can be 

evaluated using a special DU exposure protocol that 

VA began after the 1991 Gulf War. See www.va.gov/ 

environagents. 

Environmental Health Coordinators 

Can Help OIF/OEF Veterans 

Veterans of Operations Iraqi Freedom and Enduring 

Freedom can expect help from the Environmental Health 

Coordinator at their nearest VA medical center. These 

employees, previously known as Veterans’ Registry 

Coordinators or Gulf War Registry Coordinators, are 

responsible for scheduling appointments (generally within 

30 days of the requested date), monitoring field station 

compliance with VA regulations, reviewing records for 

accuracy and completeness, and collecting certain data 

for reporting purposes. 

These coordinators are an important part of a team 

with the Environmental Health Clinicians at nearly every 

VA medical center. The coordinators may be the first 

and last persons that the veteran has contact with during 

his or her outpatient visit, and can play a major role in 

determining whether veterans examined at a VA health 

care center leave with a positive or negative image of VA. 

VA’s Commitment on Service to 

Returning Veterans 

Under Secretary for Health Robert H. Roswell, 

M.D.*: 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 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...VA will continue to improve services and 

coordination to ensure that the needs of these service 

members are met. 

 *On April 5, 2004, Dr. Roswell resigned from the 

Department of Veterans Affairs (VA) after a distinguished 

career of 28 years at VA. Dr. Jonathan B. Perlin, VA’s 

Deputy Under Secretary for Health assumed the duties 

of Acting Under Secretary pending action by a national 

search committee. Before being appointed as head of the 

Veterans Health Administration where he lead the nation’s 

largest integrated VA’s health care program, Dr. Roswell 

held a number of top management positions in VA (both 

in headquarters and in the field), including Executive 

Director, Persian Gulf Veterans Coordinating Board, 1994-

99. The Board, which coordinated Gulf War activities 

within the Executive Branch of the Federal Government, 

was jointly chaired by the Secretaries of Veterans Affairs, 

Defense, and Health and Human Services. 

In August 1992, Dr. Roswell, as Associate Deputy 

Chief Medical Director, took the initial steps to start the 

Gulf War Registry pending the passage of legislation 

then under consideration by Congress. He was a national 

spokesperson for VA on Gulf War health issues before 

many of today’s programs were in place. 

5
 
 

 

About the “Review”
	

The “Operations Iraqi Freedom/Operation Enduring 

Freedom Review” is produced by VA’s Environmental 

Agents Service (EAS) to provide information about the 

long-term health 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 and agencies to respond to 

these concerns. For other issues of this newsletter, and 

related information regarding the current conflict in Iraq 

and Afghanistan, 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 on 

budgetary considerations. This issue was completed in 

early April 2004 but postponed for budgetary reasons, 

and then revised in late June. It 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, DC. 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. 

Two-Year Rule Helps Recent Combat 

Theater Veterans Get Health Care 

This article and the questions and answers that follow 

were printed in Volume 1, Number 1, the first issue of the 

newsletter. We are repeating this information (with some 

minor clarifications) to help first-time readers. 

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 many 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 veterans serving in a combat theater 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, then 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.” 

Questions & Answers About the 

Two-Year Rule for Combat Theater 

Veterans 

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. 

6
 
 

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 worsened 

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 separation 

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. 

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 separated or retires from active duty. (Some 

veterans with adverse discharges may not qualify for this 

benefit.) 

Does receipt of care establish proof of a service 

connected 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 (approved 

or denied by VA). 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 the 2-year rule 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 does VA define “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 some 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). 

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 service-connected or whether 

the veteran is otherwise qualified for care. He or she 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. 

7
 
How to Get Disability Compensation 

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 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 example, in 2004, an 

OIF or OEF veteran with a disability rating of 10 percent 

receives $106 a month; a veteran with disability rating 

of 50 percent gets $646; and a veteran who is totally 

disabled and evaluated at 100 percent receives $2,239. 

Veterans with disability ratings between 30 and 100 

percent are also eligible for monthly allowances for a 

spouse ranging from $38 to $127, and for each child, $19 

to $65. (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. 

Must Apply to Be Considered

Compensation is not automatically provided to 

the OIF, OEF, or 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 and benefits, 

veterans and other interested parties can visit the VA 

home page www.va.gov or call 1-800-827-1000.

Q’s and A’s 

The “Review” will occasionally include a questionsand-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. 

Gary M. Baker, Director, Health Eligibility Center, 

provided the answers for the following questions about 

recent combat theater veterans: 

Q: Do these veterans have to go through means 

testing to qualify for the 2-year post discharge 

program?

A: Yes. These veterans must complete the means test 

so that VA knows if their financial status exempts them 

completely from means test copayments or if they will 

be responsible for the cost of care and medications 

determined by their provider to be unrelated to their 

combat/military experience. 

Q. For those veterans with non-service connected 

conditions, assuming that they have some conditions 

that may be service connected, are they eligible for

medications without a co-payment?

A. See answer to question one. VA provides broad 

latitude for the health care provider to determine which 

conditions may be related to the veteran’s combat/ 

military experience. The guidelines are more generous 

than the formal requirements for approving a claim for 

service connection. If the provider determines care 

possibly related, the veteran is exempted from both 

means test copayments and medication copayment for the 

care of that condition. 

Q. Are they eligible for dental care?

A. No. No special dental benefits are part of the combat 

veteran authority. Recently discharged veterans with 

a service-connected noncompensable dental condition 

or disability who served on active duty 90 or more 

days and who apply for VA dental care within 90 days 

of separation from active duty may receive one-time 

treatment for dental conditions if the dental condition is 

shown to have existed at the time of discharge or release 

and the veteran’s discharge certificate does not indicate 

that the veteran received necessary dental care within a 

90-day period prior to discharge or release. 

8
 
 

 

 

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Additional questions should be sent as follows: 

Mr. Donald J. Rosenblum 

Deputy Director, Environmental Agents Service (131) 

ATTN: OIF/OEF REVIEW – Q’s & A’s 

Department of Veterans Affairs 

810 Vermont Avenue, N.W. 

Washington, DC 20420. 

We will answer as many questions as possible 

and will not identify the questioner. Questions about 

personal medical problems are not generally considered 

appropriate for inclusion in the newsletter. 

Benefits and Services for U.S. Military

Veterans Living Outside the U.S. 

VA provides benefits and services to veterans overseas; 

however, these benefits and services are provided in a 

different manner than for veterans who live in the United 

States. 

VA will pay for medical services for treatment of 

service-connected disabilities for veterans who are 

living or traveling in foreign countries (Canada and the 

Philippines excluded). Authorization and payment for 

medical treatment of service-connected disabilities are 

completed by our Foreign Medical Program (FMP) 

located in Denver, Colorado. The FMP address is: P.O. 

Box 65021, Denver, CO 80206-9021. Veterans living 

in Canada should contact the VA Center in White River 

Junction, VT 05009-0001, and veterans living in the 

Philippines should contact the U. S. VA Office, 2201 

Roxas Blvd., Pasay City 1300, Philippines. 

VA regional offices are responsible for processing 

and establishing service-connected conditions, pension 

ratings, and other benefit programs. Veterans who live 

in Canada should file a claim with the VA Center in 

White River Junction, VT, at the address listed in the 

above paragraph. Veterans living in Mexico, South and 

Central America, and the Caribbean should file a claim 

with the Houston Regional Office at 6900 Almeda Road, 

Houston, TX 77030. Veterans in the Philippines should 

contact the VA Office at the address listed in the above 

paragraph. Veterans living overseas in countries not listed 

above should contact the Pittsburgh Regional Office, 1000 

Liberty Avenue, Pittsburgh, PA 15222. 

Veterans and their dependents living overseas can also 

contact the United States Embassy, the Foreign Benefits 

Unit (FBU), in the country they are living for assistance. 

FBU staff can assist veterans and their dependents in filing 

VA benefit claims and in answering VA benefit questions. 

Veterans and their dependents can also find 

information about VA benefits and services provided 

overseas on the World Wide Web at: (www.vba.va.gov/ 

bln/21/foreign/index.htm). This Web site provides 

valuable information about VA’s Foreign Services 

Program, and it also enables the inquirer to ask questions, 

receive answers to questions, and apply online for a 

number of VA benefits. 

Readers’ Survey 

We are seeking advice and recommendations from all 

readers. In a future issue of the “Review,” we will report 

to you regarding the comments we receive. Please send 

your comments and ideas to Mr. Donald J. Rosenblum, 

Deputy Director, Environmental Agents Service, ATTN: 

Gulf War Review, VA Central Office, 810 Vermont 

Avenue, NW, Washington, DC 20420. You can use this 

paper or write on your own. 

Are you a veteran? ____ Spouse of a veteran? ____ 

First time reader of this newsletter? ____ 

How and where did you get this newsletter? __________ 

What do you think of the “Review”? ________________ 

Does it meet your needs? Why or why not? __________ 

What changes would you like to see in this publication? 

Additions? Deletions? ____________________________ 

Additional comments or suggestions? _______________ 

Thank you for your comments. Please send the 

completed survey to the above address.

9
 
 

 

 

What a Date!! 

Saddam Hussein’s (Iraqi) troops invaded Kuwait, August 

2, 1990. 

U.S. troops began deployment in Operation Desert Shield, 

August 7, 1990. 

Coalition Air War began in Operation Desert Storm, 

January 16, 1991. 

One hundred hours ground war fought, February 24-28, 

1991. 

The first President Bush signed Public Law 10-2-25, 

establishing August 2, 1990, as official starting date of 

Persian Gulf War, April 6, 1991.* 

Terrorists attacked World Trade Center in New York and 

the Pentagon near Washington, DC, September 11, 2001. 

An Executive Order designated Afghanistan as a combat 

zone as of September 19, 2001. 

Operation Iraqi Freedom began, March 20, 2003. 

The second President Bush declared major combat 

operations in Iraq ended May 1, 2003, but fighting 

continues and the operation is still ongoing. 

The Department of Defense still has both Iraq and 

Afghanistan on the list for receipt of Hostile Fire and 

Imminent Danger Pay with the ending dates left open. 

*The law provides the ending date would be “on the 

date hereafter prescribed by Presidential proclamation 

or by law.” To date, there has been no law enacted or 

Presidential proclamation issued. 

VA Web Sites Have Information for Gulf War and Afghanistan Veterans 

VA Web sites provide a wide range of information about the problems encountered by Gulf War and Afghanistan 

veterans and the available benefits and services. Start with VA’s main Web site at www.va.gov, and see for yourself. 

If you do not have a personal computer, many libraries have them for public use. The librarians can assist you. 

Veterans Benefits Information www.vba.va.gov/ 

Information for Iraqi Freedom Veterans www.va.gov/gulfwar/ 

Afghanistan Service Information www.va.gov/environagents/ 

Post-traumatic Stress Disorder and Iraq 

Veterans www.ncptsd.org/topics/war.html 

VA Health Care Enrollment Information www.va.gov/elig/ 

Brochures and Publications, Including:

 * A Summary of VA Benefits for National Guard 

and Reserve Personnel

 * Health Care and Assistance for U.S. Veterans 

of Operation Iraqi Freedom 

www.vethealth.cio.med.va.gov/Pubs/Index.htm 

Online Benefits Applications vabenefits.vba.va.gov/vonapp/ 

Women Veterans Are Eligible for the 

Same Benefits as Men 

MYTH: Women can’t be veterans because they didn’t 

serve in combat. 

FACT: Women who served in the military are 

veterans and are eligible for the same benefits and 

services as their male counterparts. 

Many women who served their country in military 

service do not consider themselves veterans because 

they did not serve in combat. Consequently, they have 

not applied for benefits and services for which they are 

entitled.

 In fact, in recent years, VA has established a wide 

range of special services to provide appropriate, timely, 

and compassionate health care services to women veterans. 

These include the range of services available to men, 

as well as, sexual trauma counseling, homeless women 

veterans programs, victims of domestic violence programs, 

and reproductive health care, including maternity care, and 

infertility evaluations. 

Each VA medical center has a Women Veterans Program 

Manager to ensure that women veterans receive the proper 

attention. For additional information about these and other 

programs for women veterans, contact the Women Veterans 

Program Manager at the nearest VA medical center or 

outpatient clinic or see the VA Web site: www1:va.gov/ 

wvhp. 

10
 
Where to Get Additional Information and Assistance
	

Active duty military personnel with questions or 

concerns about service in Southwest Asia (including 

Operations Desert Storm, Desert Shield, Iraqi 

Freedom, and Enduring Freedom) - contact your 

commanding officer or call the Department of Defense 

(DoD) Gulf War Veterans’ Hotline (1-800-796-

9699) for information. DoD also offers the “Direct 

Veterans Hotline,” with the toll-free number 1-800-

497-6261. 

Gulf War veterans, including OIF veterans 

with concerns about their health should contact their 

nearest VA medical center. The telephone number 

can be found in your local telephone directory 

under Department of Veterans Affairs in the “U.S. 

Government” listings. Medical care is available, and 

a Gulf War Registry examination is also available on 

request. 

The VA Gulf War Information Helpline can also 

provide information and assistance. The toll-free 

telephone number is 1-800-PGWVETS (1-800-749-

8387). 

Check our VA Web sites for more Gulf War 

information on health care and other benefits 

(including those for Operations Iraqi Freedom and 

Enduring Freedom veterans) at www.va.gov/gulfwar, 

www.va.gov/environagents. 

Gulf War veterans in need of marital/family 

counseling should contact the nearest VA medical 

center or VA Vet Center, also listed in your phonebook 

under Department of Veterans Affairs in the “U.S. 

Government” listings. For additional information 

about these programs call the Gulf War Information 

Helpline at 1-800-PGWVETS (1-800-749-8387). 

Gulf War veterans seeking disability compensation 

for illnesses incurred in or aggravated by military 

service can contact a Veterans Benefits Counselor 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). You 

can also start a claim online at www.va.gov. 

Gulf War veterans interested in learning about the 

wide range of benefit programs administered by VA 

should contact a Veterans Benefits Counselor 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). 

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), Paralyzed Veterans of America (1-800424-8200), 

AMVETS (1-877-726-8387), Vietnam Veterans of 

America (1-800-882-1316), 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 

laws 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. 

11
 
 

 

Concerns About Mefloquine (Lariam) 

During Operations Iraqi Freedom and Enduring 

Freedom the Department of Defense gave mefloquine 

(Lariam) to some U.S. service members to protect them 

against malaria. Mefloquine was not used in Operation 

Desert Shield or Operation Desert Storm. Melfloquine 

has been approved by the Food and Drug Administration 

for protection against malaria, and since the late 1980’s it 

has been widely recommended and used by both military 

and civilian health care personnel. However, it can cause 

common mild side effects including vivid dreams and 

mild psychiatric symptoms. 

A number of news reports have suggested that 

mefloquine has caused more serious effects, including 

violent and suicidal behavior, and symptoms similar to 

Post-traumatic Stress Disorder. Some of these accounts 

link reports of such behavior to mefloquine use among 

OIF and OEF veterans, for example, homicides and 

suicides among five service members returning to Fort 

Bragg, NC two years ago. 

Concerns that mefloquine use might cause violent 

behavior are not new. A Canadian soldier accused of 

homicide claimed that taking it during his deployment to 

Somalia in 1992, caused his violent behavior. 

In April 2004, a group of VA physicians and scientists 

met to discuss responses to this concern. The group 

concluded that VA needed a well-grounded response to 

the concerns about possible long-term health effects and 

disability among veterans from taking mefloquine. In 

particular, VA health care providers need concise and 

accurate medical information about mefloquine health 

effects to answer questions and concerns of veterans 

returning from deployment in Southwest Asia. The group 

conducted a literature review of the numerous reports, 

reviews, surveys, etc. 

On June 23, 2004, VA Central Office sent to all VA 

medical centers and other interested parties an Under 

Secretary for Health’s Information Letter, entitled Possible 

Long-Term Health Effects from the Malarial Prophylaxis 

Mefloquine (Lariam), which summarized the scientific 

literature. For additional information, see the Information 

Letter on our Web site: www.va.gov/EnvironAgents. 

Leading VA scientists do not anticipate that this 

medication, which has been administered millions of times 

during the past two decades, will be a serious long-term 

problem for OIF or OEF veterans. In particular, there 

is no scientific evidence that Lariam use can cause new 

health problems after a veteran stopped taking this drug. 

However, if you are an OIF or OEF veteran and have any 

concerns about mefloquine, you are encouraged to contact 

the nearest VA medical center for an appointment. 

Department of

Veterans Affairs 

Central Office (131) 

810 Vermont Avenue, N.W. 

Washington, DC 20420 


	 OFFICIAL BUSINESS
	 Penalty for private use $300

op erations iraqi 

/ freedom 

enduring freedom review 

Information for Veterans Who 

Served in Iraq and Afghanistan

and Their Families 

June 2004 

12