What GAO found
The GAO reported on the use of research by the Department of Veterans Affairs (VA) to identify and add new diseases to its list of suspected conditions for both Gulf War disease and Agent Orange. , a tactical herbicide widely used during the Vietnam era. VA has made agreements with the National Academy of Sciences to assess the link between certain exposures and illnesses suffered by veterans, and uses the Academy’s findings to inform its lists of suspected conditions. The GAO also reported in 2017 that VA did not have a single set of uniform criteria to define Gulf War disease (a case definition) that could improve research, clinical diagnosis, and treatment for veterans of the gulf war. The GAO recommended that VA prepare and document a plan to develop a single case definition. In response, VA convened a group of subject matter experts from VA and the Department of Defense to create a multi-step plan to develop a case definition. According to VA, it’s in the final stages of the plan and will bring together experts in 2021 to review the new research and work on defining a definition. Additionally, according to VA, the department continues to support research into Gulf War service-related conditions as well as Agent Orange exposure and will use the results to examine suspected future conditions.
In 2017, GAO reported on the challenges VA faced in processing complex and alleged disability claims from veterans who served in the Gulf War, claims that were denied at rates higher than other disability claims. At the time of GAO’s review, VA officials said Gulf War illness claims may be denied at a higher rate, in part because they are not always well understood by staff at the GAO. VA and that veterans sometimes do not have a medical record to adequately support their claims. . The challenges we identified included:
Inconsistent requests for medical examinations for people with disabilities. VA claims processors may request that a veteran undergo a disability medical examination to help determine if the conditions of the claim exist and are service-related. The GAO found that claims processors were inconsistent when requesting a review, in part because of confusion over guidelines. VA provided training on the subject and, in April 2017, completed a Gulf War Claims Review to assess the effectiveness of the training and help ensure future consistency.
Inconsistent disability medical examination reports. Veterans Health Administration forensic pathologists did not always complete medical examination reports correctly and sometimes offered medical advice when it was not needed. The GAO recommended that VA require all examiners to complete Gulf War medical exam training before performing these exams, and VA has implemented this recommendation. Since our 2017 report, VA has allowed contract medical examiners to take these exams, and in 2018, GAO found that VA was not monitoring whether all contractors had completed the required training. The GAO recommended that VA improve its oversight of training, but the department did not fully implement this recommendation from the 2018 GAO report.
Why GAO did this study
VA provides disability compensation to millions of veterans with service-related disabilities. Veterans are generally entitled to these benefits if they can prove that their injuries or illnesses were contracted or made worse by active military service. For some claims, VA assumes that a condition is due to a veteran’s service. For example, VA can provide benefits to any veteran with certain symptoms, ranging from respiratory problems to gastrointestinal problems, who served in Southwest Asia from 1990 to the present, without the veteran needing to. prove the cause. The GAO calls them claims related to Gulf War disease.
In 2017, GAO issued Gulf War disease: improvements needed for VA to better understand, process and communicate claims decisions (GAO-17-511), which identified improvements needed in the VA’s handling of Gulf War illness claims. In 2018, GAO issued Agent Orange: Actions needed to improve the accuracy and communication of information on test and storage sites (GAO-19-24). This statement summarizes information from those reports on how VA determined certain suspected conditions and the challenges VA faced in processing Gulf War illness claims.