Veterans for Common Sense

Ill Gulf War Veterans Urge VA to Improve VA’s Policies

May 3, 2010, Washington, DC – VCS supports VA Secretary Shinseki’s genuine efforts to listen to the concerns of our ill Gulf War veterans.   VCS has provided VA with 15 measurable action items we urge VA to implement now.  Our ill Gulf War veterans have read too many reports and waited 20 years too long for answers about why we are ill, treatments for our conditions, and benefits for our disabilities.  We encourage VA Secretary Shinseki to move forward with strong actions demonstrating to Gulf  War veterans how VA is truly moving forward.

Our key action items include a public recognition from VA that 250,000 Gulf War veterans remain ill, a scientific conclusion reached by independent researchers at the Institute of Medicine and VA’s Gulf War Veterans’ Illness Research Advisory Committee.  VCS also urges VA to create a Gulf War office to quickly implement and oversee a series of regulations to streamline Gulf War veterans’ access to healthcare and disability benefits.  Our written comments are reprinted below.

Mr. Robert McFetridge, Director
(202) 273-9026, Fax
Regulations Management (02REG)
U. S. Department of Veterans Affairs
810 Vermont Avenue, NW, Room 1068
Washington, DC 20420

Dear Director McFetridge:

Veterans for Common Sense (VCS) recognizes and appreciates the recent attempts by the Department of Veterans Affairs’ (VA) to improve policies regarding our nation’s estimated 250,000 Gulf War veterans suffering nearly 20 years with multisymptom illness.

VCS believes Secretary Eric Shinseki’s efforts are genuine, as he truly wants to correct the wrongs committed by a few VA staff.  VCS supports the Secretary’s over-arching goals ensuring our Gulf War veterans receive answers about why we are ill as well as prompt access to treatment for our medical conditions and disability benefits.

We are impressed with Secretary Shinseki’s unprecedented move to place a notice about the Draft Task Force report in the Federal Register on April 1, 2010, and allow comment through May 3, 2010.  VCS thanks VA for the transparency it has started to show on this issue impacting 3.1 million U.S. service members deployed to the war zones and our families.

VCS solicited input from Gulf War veterans, and we thank the dozens of veterans, family members, and supporters who provided suggestions about VA’s Gulf War policies to VCS incorporated into our comments provided to VA.

Our experiences working at VA, assisting veterans with VA disability claims, dealing with our illnesses, and watching many of our fellow veterans die prematurely provide us with exceptional personal and professional expertise on this issue we hope VA takes into consideration.

VCS has led the fight on issues important to Gulf War veterans for many years.  In January 2009, VCS asked Congress to hold hearings about Gulf War illnesses.  In May 2009, Congress held a hearing where VCS testified.  On August 2, 2009, the 19th anniversary of the start of the Gulf War, VCS wrote Secretary Shinseki and requested he personally look into the needs of our ailing Gulf War veterans.

Shortly thereafter, VA Secretary Shinseki formed the Gulf War Veterans’ Illness Task Force, chaired by VA Chief of Staff John Gingrich, a move we applauded.  We hope VA’s Draft Task Force report and our comments prompt specific VA policy changes and additional Congressional oversight hearings bringing us closer to resolution for veterans and our families.

Combined, VCS directors and staff have more than 50 years of expertise on this issue, including serving in the Gulf War, researching Gulf War exposures, testifying before Congress, and fighting for several landmark laws related to Gulf War illness.

HISTORICAL CONTEXT: DoD DENIED EXPOSURES FOR MANY YEARS

We believe placing this issue in historical context is vital.  One Gulf War veteran contacted us and wanted us to make sure VA’s new leaders knew about the history of Gulf War illness.  He said veterans will never forget how, in a public letter dated May 25, 1994, Secretary of Defense William Perry and Chairman of the Joint Chiefs of Staff John Shalikashvili deliberately lied to all Gulf War veterans about potential causes for our illnesses:

There have been reports in the press of the possibility that some of you were exposed to chemical or biological agents.  There is no information, classified or unclassified, that indicates that chemical or biological weapons were used in the Persian Gulf.

Using the Freedom of Information Act (FOIA) over a period of several years, the Department of Defense (DoD) was forced by individual veterans, the National Gulf War Resource Center, Congress, and journalists to admit the following types of serious and significant widespread toxic exposures:

• Nearly all 697,000 veterans deployed to the war zone were exposed to pesticides, oil well fire pollution, and many other toxins
• Hundreds of thousands of veterans entered areas heavily contaminated with depleted uranium (DU) radioactive toxic waste
• 250,000 veterans were ordered to ingest experimental pyridostigmine bromide (PB) pills
• 150,000 veterans were ordered to receive experimental anthrax vaccines, others received an experimental botulinum toxoid vaccine.
• 145,000 veterans were exposed to chemical warfare agents at a single event, with other events still remaining classified – and not released.

VCS supports Public Law 103-446, passed in 1994 under the leadership of Senator John Rockefeller, where Congress expanded access to VA disability benefits so ill Gulf War veterans could obtain VA medical care.  Congress found, as a matter of law, Gulf War veterans were exposed to a long list of toxins, including:

Fumes and smoke from military operations, oil well fires, diesel exhaust, paints, pesticides, depleted uranium, infectious agents, investigational [experimental] drugs and vaccines, and indigenous diseases, and were also given multiple immunizations.

In 1998, based on work by VCS directors and staff then under the umbrella of the National Gulf War Resource Center (NGWRC), Congress significantly expanded the list of toxins it presumed Gulf War veterans were exposed to during deployment to Southwest Asia with the “Persian Gulf Veterans Act,” Public Laws 105-277 and 368.

The truly non-partisan effort in 1998, led by former Representative Chris Shays, former Representative Lane Evans, Senator Bernie Sanders, Senator John Rockefeller, and Senator Robert Byrd, among others, set a new standard in Congressional speed to respond to the pressing needs of veterans and the lethargic Administration response.

The previous year, Congress mandated full, face-to-face medical examinations (not screenings, not assessments as is the current DoD policy) for all deployed troops with the Force Health Protection Act, Public Law 105-85, Section 762.  We mention this because service members deployed to Southwest Asia anytime after August 2, 1990, are, as matter of law (38 USC Section 101(33)), Gulf War veterans, and the military has yet to fully implement mandatory examination law.

In 2001, Congress again expanded benefits for Gulf War veterans at the urging of the NGWRC with Public Law 107-103.  VA opposed all of these laws, and VA never individually notified the estimated 15,000 to 30,000 Gulf War veterans potentially impacted by the 2001 law.

VA supported Public Law 102-585, the law creating the Persian Gulf Registry and the Gulf War Veterans Information System (GWVIS) reports.  We support this law and urge VA to restore and expand GWVIS reports.

Starting in 1993, VA staff fought against several proposed Congressional earmarks designated for Gulf War research.  Even after the earmarks became law and were funded, VA staff fought to undermine these laws and the scientific search for answers.  One example is the University of Texas Southwestern Medical Center (UTSW) contract, improperly terminated by VA in 2009.

VCS strongly disapproves of VA’s outrageous mishandling of the UTSW contract.  We urge VA Secretary Shinseki to restore funding to UTSW using a grant, not a contract, a topic we mentioned during a conference call on February 22, 2010, about the Gulf War Veterans’ Illness Task Force.

VA STAFF INTENTIONALLY MISLED VA SECRETARY AND VA CHIEF OF STAFF

This section begins our comments on the Draft Task Force report.  Without the input of a single non-VA advocate for ill veterans, VA’s Gulf War Veterans’ Illness Draft Task Force report fails to address many of the significant issues of enormous concern to Gulf War veterans.

With misleading “questions” about veteran’s perceptions and equally dubious “answers,” VA pretends VA was without fault for two decades when VA fought against releasing information, launching research, listening to veterans, searching for treatments, providing care, and granting disability claims.  This undisputed fact is thoroughly documented in dozens of Congressional hearings.

VA staff drafted a self-serving and lengthy report overflowing with charts, diagrams, fallacious arguments, and fluff in an effort to outlast the tenure of current VA political appointees, and thereby prevent substantive changes in VA polices regarding Gulf War veterans.  VA staff failed to mention repeated failures caused by VA during the past 20 years.  After careful review by many staff, subject matter experts, and Gulf War veterans, VCS reaches the conclusion VA staff offered Secretary Shinseki, his top aides, and Gulf War veterans the appearance of change without actually doing anything significant for our veterans or VA.

Gulf War veteran advocates witnessed how a former VA Research Office Deputy Director, Kelly Brix, now a contractor working at DoD on Gulf War, Iraq War, and Afghanistan War health issues, spoke at a military medical conference in Kansas City in 2009.  She declared Gulf War illness was not real.  While VA leaders may not be aware of this recent event, Gulf War veterans remain sensitive to the misleading and outrageous comments by former high-ranking VA staff representing the Pentagon on official business on this subject.

One veteran participating at the Kansas City conference was shocked to hear Brix emphasize mental illness in a manner suggesting no other medical condition has adversely impacted Gulf War veterans.   Her narrow-minded approach to our medical needs is a travesty and an embarrassment.  Her uninformed comments gave veterans the impression she dusted off a press release from the early 1990s, and her actions indicate a serious lack of familiarity with the new and important medical knowledge gained during the past 20 years.

Therefore, VCS rejects most of VA’s Draft Task Force report because the content needs significant changes and additions.  The 95-page Draft Task Force report represents what is most undesirable in government: a filibuster by career staff in a desperate attempt to conceal their activities during the past several years.  Our goal is for any final Task Force report to be factual and contain specific regulations, measurable results, and heavy Gulf War veteran participation.   We do not want there to be any appearance of intentionally and actively misleading anyone.

The contents of the Draft Task Force report reveal VA Secretary Eric Shinseki and VA Chief of Staff John Gingrich appear to have been intentionally deceived by a handful of VA staff about the nature and solutions for our ill Gulf War veterans.   By inserting more than 90 pages of superfluous, out-dated, and incorrect information in the report, one can only reasonably conclude VA staff still want to deliberately delay research, confuse the issue of Gulf War illness, and otherwise prevent veterans’ access to answers about the causes of Gulf War illness, medical treatments, and disability benefits.  Therefore, commenting on 95 pages of incoherent nonsense would be an effort in folly.

For specific scientific matters, we defer to the expert opinions of independent (non-government) scientists.  VCS does this because we are not scientists – we are veterans.  We list many of the independent panels in our comments below.

VCS refuses to fall into a trap and waste our time and effort responding to scores of incomplete and misleading VA statements.  Instead of commenting on a fatally flawed report, VCS takes a pro-active approach and provides specific recommendations for immediate action by VA.  The time for redundant VA reviews is over – Gulf War veterans now insist on the delivery of specific actions by VA in the near future.

MOVING FORWARD

Veterans for Common Sense asks VA to consider our comments as the views of many Gulf War veterans active on this issue for nearly two decades.   We consider our comments to be the opening of pragmatic negotiations with VA to resolve this very complicated issue over the next few years.  We ask to sit at the table with you for however long it takes until we resolve this issue in the best interests of our veterans and VA.  We have waited for too long, and we must take full advantage of this rare window of opportunity by describing where we have been and where we want to go.

VCS urges VA to move forward by explicitly denouncing the failed VA policies of the past.  An excellent place to start would be by joining VCS and endorsing the April 2010 findings of the Institute of Medicine (IOM), “Gulf War and Health: Volume 8. Health Effects of Serving in the Gulf War.”  After an exhaustive review of peer-reviewed, published research, the IOM concluded Gulf War veterans are ill, and the cause is not post traumatic stress disorder (PTSD):

The excess of unexplained medical symptoms reported by deployed Gulf War veterans cannot be reliably ascribed to any known psychological disorder.

IOM also acknowledged the multisymptom illness suffered by up to 250,000 Gulf War veterans is a distinct diagnostic entity and is significantly associated with service in the 1990 – 1991 conflict.  The IOM’s scientific conclusions parallel those reached by the VA Research Advisory Committee on Gulf War Veterans Illnesses (RAC) in their report released in November 2008, “Gulf War Illness and the Health of Gulf War Veterans: Scientific Findings and Recommendations,” a report endorsed by VCS.  We note how VA refused to create the RAC for nearly four years, an historical low-point in VA’s refusal to address the needs and listen to the views of an increasing population of ill Gulf War veterans.

VA’s Draft Task Force report, in several locations, erroneously links Gulf War illness exclusively with PTSD.  As a result, a significant portion of the Draft Task Force report is fatally flawed.  Not all hope is lost.  With our comments, VCS provides VA with our expert suggestions on how to move forward on this important issue in a spirit of mutual cooperation given VA leaders’ genuine offers to assist veterans.

VCS ACTION ITEMS

Veterans for Common Sense believes the time for VA obstruction, denial, and delay is over, and the time for pragmatic, pro-veteran action is now.  Until such time as VA leaders transfer intransigent VA staff, admit the scope of the problem, launch a broad set of research and treatment efforts, and publish new regulations, the Draft Task Force will be seen by many veterans as a public relations effort rather than a policy change.

VCS respectfully asks VA to adopt the following policies as soon as possible.  Many can be adopted within the next few months.  Many of our requests ask VA to use rule-making authority, under the Administrative Procedure Act (5 USC Section 551), to promulgate regulations that will serve as the strongest measurable indicator VA is moving forward.

In summary, our comments to VA provide insight to VA leaders about how Gulf War veterans view this issue through the lens of history and the need to act.  VCS provides detailed, pragmatic, and progressive policy solutions.

Each item below is framed to show the specific action Gulf War veterans hope and expect VA to take soon:

1. VA Acknowledges Scope of Gulf War Illness, 250,000 Veterans Remain Ill

In press releases, Gulf War Registry newsletters, and on the web site, VA leaders should publicly agree with the IOM and RAC and confirm 250,000 Gulf War veterans from the 1990 – 1991 deployment period remain ill after deployment to Southwest Asia during 1990 – 1991, a conclusion reached by the IOM and RAC after years reviewing thousands of peer-reviewed scientific articles.

We are disappointed that no such clear statement that 250,000 veterans remain ill exists in the Draft Task Force report when a VA researcher, Dr. Han Kang, is credited with this important conclusion in his peer-reviewed study, “Health of US Veterans of 1991 Gulf War: A Follow-Up Survey in 10 Years,” published in the Journal of Occupational and Environmental Medicine in April 2009.

2. VA Recognizes Nature of Gulf War Illness is Not Psychological

Similarly, VA should publicly agree with and confirm Gulf War veterans’ multisymptom illness is not psychological in nature, a conclusion reached by the IOM we have cited above.  VCS is outraged that VA staff placed discredited studies associating Gulf War illness with PTSD in the Draft Task Force report.

3. VA Apologizes for Mistreatment of Gulf War Veterans

VA should publicly apologize on national television and in newspaper editorials for blocking research, denying treatments, and withholding disability benefits for our ill Gulf War veterans, as documented in dozens of Congressional hearings and several VA internal investigations.

VCS urges VA leaders to thoroughly read the findings and recommendations contained in November 7, 1997, bi-partisan Congressional investigation, “Gulf War Veterans’ Illness: VA, DoD Continue to Resist Strong Evidence Linking Toxic Causes to Chronic Health Effects.”  The conclusion of the Committee on Government Reform and Oversight stands as a searing indictment of VA’s malice, indifference, and neglect of veterans VA should address immediately:

After 19 months of investigation and hearings, the subcommittee finds the status of efforts on Gulf War issues by [VA and DoD] . . . to be irreparably flawed.  We find those efforts hobbled by institutional inertia that mistakes motion for progress.  We find those [VA and DoD] efforts plagued by arrogant incuriosity and a pervasive myopia that sees a lack of evidence as proof…. we find the Federal Government too often has a tin ear, a cold heart, and a closed mind.

In 2002, VA’s Deputy Secretary issued an apology at 810 Vermont Avenue before veterans, VA employees, philanthropist Ross Perot of Texas, and many non-government scientists eager to begin research into why so many veterans remain ill.

Deputy Secretary Leo MacKay promised a new chapter recognizing our medical conditions and improving how VA treated veterans.  However, after he left VA, career staff once again undermined the search for answers, treatments, and benefits.  The hopes of Gulf War veterans were again crushed by bureaucratic inertia and inaction.

A public apology by the Secretary now should start healing the significant wounds inflicted by a handful of VA staff and begin a new era of increased cooperation between veterans, advocates, Congress, researchers, and VA.

4. VA Launches Scientific Research

VA should immediately launch a $100 million scientific research program to understand the relationship between toxic exposures and Gulf War illness, as recommended by the IOM last month.

The IOM said the government should launch a “Manhattan Project-style” research program to identify treatments and prevent this problem from happening again.  This research program should specifically exclude mental health so there is no doubt about VA’s intent.  We agree with the IOM.

VCS offers to work with Congress to press for this absolutely essential first step in the scientific process.  For too long, answers, treatments, and benefits were hindered by a handful of VA staff who blocked effective research.

As one specific example of VA’s failure to research a specific toxic exposure mandated by Congress, VCS urges VA to undertake a credible study of the thousands of veterans known or suspected to have had high exposures to depleted uranium (DU) toxic waste on Gulf War battlefields and after the 1991 Doha, Kuwait munitions fire.

VA’s current depleted uranium follow-up program includes only a small fraction of exposed veterans, and senior VA staff have concealed evidence of cancer and other health effects among the few veterans it has examined.

VCS asks VA to publicly acknowledge the findings of military and non-government studies implicating DU in adverse health outcomes, particularly in light of new VA information obtained through FOIA after VA’s 10-year follow-up limited to Gulf War veterans with DU shrapnel wounds.

VA confirmed the agency was unable to locate all of the veterans who were enrolled in the DU program in Baltimore.  While ignoring studies implicating DU, VA often points to Baltimore’s follow-up program as evidence of the lack of problems associated with DU, even though VA follows a small group of veterans, lost track of some veterans, and does not follow-up for inhaled or ingested DU.

In a closely related matter, VCS urges VA to use the best available (and more sensitive) depleted uranium exposure tests as recommended by the Institute of Medicine and sought by Dr. Randall Parrish and by Dr. Robert Haley.

VCS President Dan Fahey specifically requested some of these items during a telephone conference call with VA Chief of Staff John Gingrich on February 22, 2010, yet VA never responded to our request.

5. DoD Expands Research to Identify Treatments

Throughout the history of the Gulf War veterans’ fight, our primary goal has been, and will always remain, finding treatments to relieve symptoms and promote recovery.

VA should work closely with DoD’s Congressionally Directed Medical Research Program (CDMRP).  The goal of this program is to identify urgently needed treatments for ill Gulf War veterans.  VA Secretary Shinseki should work closely with Defense Secretary Robert Gates and Congress to fully fund CDMRP efforts for $30 million during 2011.  VCS offers to assist VA and DoD in a team effort to make this critical research a reality.  For the past few years, VCS has contacted legislators encouraging them to fund CDMPR.

VCS supports CDMPR as an encouraging step forward.  The program provides veterans with a seat at the table and a voice in medical research funding.  The CDMRP model is the same successful model used in other medical research programs such as breast cancer.

6. VA Notifies Gulf War Veterans to File Disability Claims

We strenuously object to years of VA press releases often framing our concerns as limited to a pursuit of disability payments and ask VA to understand our views.  Unfortunately, Gulf War veterans often need an approved disability benefit claim before VA provides medical care, leaving many Gulf War veterans stuck in the claims bottleneck.

In order to resolve the existing claim delays and open the doors for treatment, VA should notify, by phone and by mail, all 700,000 Gulf War veterans about the first five items listed by VCS.  VA should re-open any Gulf War veteran’s disability compensation claim and, when appropriate, pay retroactive benefits to the earliest possible date allowed under the law starting with the veteran’s first claim against VA.  VA should do this based on VA’s illegal act, in 2001, of failing to notify Gulf War veterans about changes in benefits laws  (Public Law 107-103) that would have granted access to healthcare and disability compensation for tens of thousands of veterans.

In a related matter, VCS supports the goals of VA’s new instructions on handling Gulf War veterans’ claims for Undiagnosed Illness (UDX) benefits.  VCS asks VA Secretary Shinseki to use his rule-making authority to transform VA’s temporary instructions (issued in a “Fast Letter”) as permanent VA regulations that can be reviewed and commented on by advocates in a transparent manner.

Similarly, in addition to VA’s existing Gulf Registry newsletter, VA should develop a one or two page pamphlet informing Gulf War veterans about changes in research, treatment, and benefits.  The target audience should be Gulf War veterans and families.  The easy-to-read pamphlet should inform veteran service organizations, and other advocates about how to obtain disability compensation benefits, and how to obtain medical treatment for conditions associated with deployment to war zones on or after August 2, 1990.

7. VA Investigates and Reassigns Staff Who Blocked Gulf War Policies

VA should investigate the individuals within VA’s Chief Research and Development Office working on Gulf War illness and replace them with pro-veteran advocates supporting transparency, research, treatment, and benefits for Gulf War veterans.  We specifically disagree with the activities of a few VA employees, including Dr. Joel Kuppersmith, Dr. William Goldberg, and Dr. Timothy O’Leary.

In 2009, VA’s Office of the Inspector General (VAOIG) concluded that VA central office research staff, presumably Kuppersmith, Goldberg, and O’Leary, impeded Gulf War illness research contracts, according to VAOIG’s “Review of Contract No. VA549-P-0027 Between the Department of Veterans Affairs and The University of Texas Southwestern Medical Center at Dallas (UTSWMC) for Gulf War Illness Research,” released on July 15, 2009:

[VA’s] inappropriate use of an [Indefinite Delivery Indefinite Quantity] contract has also led to significant involvement of [VA’s Office of the General Counsel] and VA managers in Central Office and in VISN 17, in the operation of the contract which impeded the ability of the contracting officers to effectively administer this contract.  The [UTSWMC] has also expended unnecessary resources which were paid for with VA funding, attempting to comply with contract terms and conditions.

VA could have and should have sought to work with Congress to develop a grant for this vital research.  VA’s choice not to seek a grant speaks volumes about VA’s intent to obstruct research.

This request to investigate and reassign VA staff is important because their actions have made it nearly impossible for veterans and scientists to make progress on this issue.  Meaningful progress will remain more difficult so long as a handful of VA staff stubbornly refuse to acknowledge the nature and scope of Gulf War illness as well as block reasonable and responsible scientific inquiry.

Even if VA improved Gulf War veteran-related policies, promulgated new regulations, and increased funding for research as recommended by VCS, VA would continue failing veterans by allowing the same VA staff who fought against veterans for so long to be remain responsible for implementing VA’s new initiatives.

In November 2009, VCS sent FOIA requests to VA to determine the scope of the interference VAOIG confirmed.  However, VA has not yet responded to our requests.  We believe this information should be made public in the best interests of clearing the air on how VA staff impeded Gulf War veterans’ illness research contracts.

Similarly, VA should review the staff overseeing the DU follow-up program at the Baltimore, Maryland, VA medical center, specifically Dr. Melissa McDiarmid, on the grounds the staff has not worked in the best interests of veterans or VA.  We believe they concealed evidence of cancer and other health effects among Gulf War veterans exposed to DU and knowingly administered a flawed depleted uranium exposure test that could result in false negatives.  VA uses the flawed DU test even after acknowledging the test is insufficient and inaccurate.

VCS asks VA to investigate how many veterans not originally enrolled in the Baltimore follow-up program reported any DU exposure.  VA should also determine how many of those veterans were tested for exposure, what test was used, what the results were, and what other actions VA took to assist those veterans (such as providing healthcare and disability benefits).

8. VA Rescinds Draft Task Force Report, Uses Regulations to Set Policies

The Draft Task Force report, as written, pretends VA has been without fault for two decades.  VA should rescind the Draft Task Force report because the policies contained within the report have mostly been repudiated by science and by repeated Congressional and independent investigations.  The report is misleading, incomplete, and thoroughly discredited.  There are so many errors in the report it would take months to document all of them.

As mentioned earlier, independent scientists are submitting their own expert suggestions evaluating VA’s research and recommending new areas of investigation.   Based on their prior objective work, we are inclined to support most of their findings and recommendations.  Once we have read their comments, we plan to provide VA with additional comments.   VCS strongly prefers new VA regulations to demonstrate changes in policy, rather than using the Draft Task Force report as the sole vehicle for VA and Administration change.

9. VA Requests Funding, Issues Regulations for Gulf War Advocacy Office

VA should name a permanent office of Gulf War veteran advocacy and staff it with at least five ill Gulf War veterans.  This office will serve as the sole clearing house of all Gulf War veteran related matters, reporting directly to the Secretary.  VCS asks the Secretary to use his rule-making authority to create such an office.  VA should also request funding for staff, space, and expenses for this permanent office in the next budget request sent to Congress.

VCS offers to work with VA in promoting this item with Congress.  Our goal is to create a significant level of pro-veteran, fact-based subject matter expertise on this issue for the use of VA leaders to set and monitor VA’s new Gulf War policies.  In our view, the needs and voices of Gulf War veterans have been excluded (and rendered silent) for too long at VA central office.  We hope that by creating this office VA will seek invaluable veteran input and potentially avoid repeating past missteps.

10.   VA Issues New Regulations Defining Gulf War Service

Currently, Gulf War veterans are defined by 38 USC 101(33) and 38 CFR 3.317.  VA asks the Secretary to use his rule-making authority to update the definition of Gulf War service so it is accurate and conforms with the actual war zone nations and bodies of water when and where our service members deployed to conflicts on or after August 2, 1990, the official start of the Gulf War.

Here is a summary of who are considered Gulf War veterans under the law:

Dates                  Locations                           Estimated Population
1990 – 1991         Gulf War / Southwest Asia   697,000
1992 – 2000         Southwest Asia                   433,000
2001 – Present     Iraq / Afghanistan                2,000,000
TOTAL                 All Deployments                 3,130,000 (and rising)

VCS asks VA Secretary Shinseki to use his rule-making authority so all findings from any IOM, RAC, or other research study considered for the purposes of determining access to VA healthcare and benefits under Title 38, for the full population or any sub-population, must apply to all 3.1 million service members who ever deployed to the Gulf War combat zones since August 2, 1990.

VCS urges VA to use recently proposed regulations on nine diseases associated with Gulf War deployment to permanently add Operation Enduring Freedom (the Afghanistan War, including all nearby nations and bodies of water) to the definition of the Gulf War deployment zone.

VCS asks VA to use VA’s rule-making authority and amend regulations and add Turkey (currently excluded) to the list under CFR 3.317.  DoD records indicate tens of thousands of U.S. service members supporting the 1990 – 1991 Gulf War and subsequent military operations through the present were based in Turkey.  The military also lists Turkey as an eligible deployment location for the Southwest Asia Service Medal (SWASM).

11.  VA Issues New Regulations for Multisymptom Illness

As mentioned above, in April 2010, the IOM concluded that as many as 250,000 Gulf War veterans remain ill with multisymptom illness associated with their deployment to Southwest Asia.  VCS asks VA Secretary Shinseki to use his rule-making authority to promulgate new regulations expanding disability compensation benefits to veterans with multisymptom illness.

In our view, based on the overwhelming scientific evidence, when a veteran can show deployment to the Gulf War theater on or after August 2, 1990, and a diagnosis of a multisymptom condition, then VA should automatically grant disability benefits and access to much-needed care on a presumptive basis.  It really is that simple.

Additionally, VCS asks Secretary Shinseki to use his rule-making authority to amend the VA benefits rating manual as it pertains to three chronic multisymptom illnesses presumptive for Gulf War Veterans under 38 CFR 3.317.

The first of the three presumptive conditions, Chronic Fatigue Syndrome (CFS), can currently be rated as high as 100{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} depending upon the level of debilitation.  VCS believes is appropriate and should remain as it is.

However, the second of the three conditions, Fibromyalgia (FM), can only be rated at a maximum of 40{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} under current VA rules, even though it can be totally and permanently disabling.  And, because CFS is a diagnosis of last resort, a diagnosis of FM excludes a diagnosis of CFS, even if the veteran is clearly suffering from both debilitating chronic widespread pain and debilitating chronic fatigue.  In other words, veterans who may be the worst off may only receive a maximum 40{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} rating if they have the diagnosis of FM, even with all the symptoms of CFS.  VCS calls for Secretary Shinseki to review these contorted rules so that veterans with FM can be rated as high as 100{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d}, depending upon the severity of symptoms and the level of disability.

For the third of the three current presumptive conditions, Irritable Bowel Syndrome (IBS), can only be rated currently to a maximum rating of 30{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d}.  This rating can be made in conjunction with a rating for CFS or FM (but not both, as previously stated).  VCS asks Secretary Shinseki to also review the rules governing the maximum rating for this condition to allow for higher ratings relative to the actual severity of symptoms and the level of disability.

Finally, given the predominance in epidemiological studies of Gulf War veterans complaining of upper and lower respiratory, digestive, neurological symptoms, and similar conditions, VCS asks Secretary Shinseki to review the rules to grant presumptive service-connection for upper and lower respiratory, digestive, and neurological conditions to grant presumptive service-connection for these conditions, including but not limited to Gastro-Esophageal Reflux Disease (GERD), diagnosed respiratory disorders including but not limited to asthma, bronchitis, bronchiolitis, and chronic obstructive pulmonary disease (COPD), and diagnosed neurological disorders involving pain, cognition, and other symptoms widely reported symptoms among Gulf War veterans.

Our goal in requesting new regulations is to allow VA to grant service connection for these conditions so our ill Gulf War veterans can receive the VA medical care they earned for conditions scientists concluded are associated with their military service.  In practical terms, this action item is of enormous significance.

In 2002, VA staff conducted a thorough review of granted and denied claims among Gulf War veterans at the diagnostic code level.  VA staff concluded that VA regional offices with large claim backlogs and without training on UDX claims under 38 CFR 3.317 approved few (~4 percent) of Gulf War veterans claims.  In contrast, VA regional offices with small backlogs that received training from VA Central office approved far more UDX disability benefit claims (~30 percent or more).

New VA regulations regarding disability benefit claims and access to medical care for PTSD are expected to be handled appropriately when VA publishes final regulations in the Federal Register within the next few months, a move endorsed strongly by VCS.

12. VA Transparency and Disclosure of All Gulf War Casualties

Veterans for Common Sense thanks VA for the agency’s new, higher level of transparency in some areas.  VA should immediately release a report detailing the human and financial costs of the Gulf War (using the definition in item 10).  VCS supports Public Law 102-85, where Congress mandated data collection and reports, the basis for Gulf War Veterans Information System (GWVIS) reports.

Using the reliable and credible GWVIS reports (and all available VA data), VA staff should issue monthly reports so VA, Congress, the public, and advocates can closely monitor the situation.

VCS remains disappointed in the fact a former VA employee who left VA in 2009 undermined GWVIS reports by refusing to provide healthcare use statistics for GWVIS reports for several years.  VCS became further disappointed in VA’s neglect of GWVIS reports, including a failure to update GWVIS computer programming concurrent with VBA’s development of VETSNET to process disability claims.

As of March 2010, according to official VA and DoD reports obtained by VCS using FOIA, the total combined casualties for the Gulf War, Afghanistan War, and Iraq War were:

DoD
91,022: U.S. Service Member Battlefield Casualties
– 5,759: Deaths
– 37,373: Wounded in Action
– 47,890: Medically Evacuated Due to Injury or Disease

VA
913,158: U.S. Veteran Patients Treated at VA Hospitals
823,662: U.S. Veteran Disability Claims Filed Against VA

(Note: there is a possible over estimate, as about five percent of 1990 – 1991 Gulf War veterans also deployed to the Iraq War / Afghanistan War.  There is a possible under estimate, as VA stopped reporting healthcare use in 2004 for 1990 – 1991 Gulf War veterans.  The number of patients and claims continue increasing at the rate of about 9,000 per month because the wars in Iraq and Afghanistan continue indefinitely.)

As of 2009, VA was spending $4.3 billion per year for healthcare and disability benefits just for Gulf War veterans deployed during 1990 – 1991.  Approximately half of all Gulf War veterans ever deployed since 1990 are expected to use VA healthcare and/or disability benefits, with an average cost of $1 million over the veteran’s lifetime.  Using these statistics, the estimated lifetime cost for all 3.1 million Gulf War service members could be well in excess of $1.5 trillion over the next 40 years.

This conservative estimate of up to 1.5 million patients and claims costing $1.5 trillion is based on the research by Columbia University Professor and Nobel Prize winning economist Joseph Stiglitz and Harvard University Professor and former Assistant Secretary of Commerce Linda Bilmes, based on documents obtained by VCS using FOIA, in their highly acclaimed book, The Three Trillion Dollar War: The True Cost of the Iraq Conflict.

After 20 years of war, and nearly one million new, first time veteran patients from the conflict, VA and DoD have never released to the public an estimate of the human and financial costs associated with the deployments.  The lack of transparency at VA and DoD on this narrow issue can easily be subscribed to efforts to conceal the enormous human and financial costs of starting wars in Southwest Asia to secure oil supplies.

In a related matter, the Central Intelligence Agency and DoD still refuse to declassify salient documents related to toxic exposures, especially for chemical warfare agents, depleted uranium, and vaccines.  An effort is underway in Congress, let by Representative Rush Holt, to force our intelligence agencies to tell our veterans, researchers, Congress, VA, and the public what actually happened in the Gulf War.

VCS strongly urges VA Secretary to work with Defense Secretary Gates and Director of Central Intelligence Leon Panetta to declassify and analyze toxic exposure reports and the use of experimental / investigational drugs and vaccines so both government and non-government researchers have all the factual information needed to provide for the best interests of our veterans’ health as well as future deployments.

13.   Amend Presidential Review Directive 5

VA should ask the White House to amend Presidential Review Directive 5 (PRD5), written in 1998, before passage of the “Persian Gulf Veterans Act” (PL 105-277 and PL 105-368) and before eight IOM reports and the RAC report concluded there were links between toxic exposures in the Gulf War and multisymptom illness.

PRD5 sets the Executive Branch policy for Gulf War veterans.  In light of the tremendous amount of new information about toxic exposures and illnesses in Gulf War veterans, VA should work with the White House so PRD5 reflects the science-based findings by the RAC and IOM.

During the 1990s, when little was known about Gulf War illness, mainly due to VA and DoD intractability, the military used tens of millions of dollars to wage a public relations battle to declare Gulf War illness was not real, as mandated by PRD5.  One of the people working at DoD and VA during that time was Kelly Brix, who now works at the Pentagon as a contractor.

The Pentagon efforts to mislead Congress and the press became so toxic that the military actually sought a “Bronze Anvil” award for military propaganda efforts against veterans seeking answers, care, and benefits.  According to their web site, the Public Relations Society of America’s “Bronze Anvil” awards recognize outstanding public relations tactics — the individual items or components that contribute to the success of an overall program or campaign – in this case, the military’s fierce effort to portray the Gulf War as a successful, low-casualty, and low-cost conflict.  With up to 250,000 sick veterans suffering from multisymptom illness, and more than 900,000 veteran patients already treated by VA with an estimated lifetime cost of $1.5 trillion, the facts show the Gulf War is a high-casualty and high-cost conflict.

VCS is disappointed that VA’s Draft Task Force report cites PRD5.  VCS asks VA Secretary Shinseki to use his rule-making authority and declare Gulf War illness is a serious public health issue and a long-term cost of war worthy of research, treatment, and benefits.  VCS asks VA Secretary Shinseki to repudiate prior government policies that declared Gulf War illness to be primarily psychological in nature that should be addressed with public relations efforts aimed at dismissing veteran’s reports of toxic exposures and illness.

14.  DoD Performs Pre- and Post-Deployment Exams for Gulf War Troops

In 1997, Congress passed Public Law 105-85, Section 762, mandating DoD to conduct face-to-face physical and mental health medical examinations for all service members deploying to and from war.  VCS staff and directors, then working for the NGWRC, supported this law.  The universal DoD examinations were mandated as a “lesson learned” based on DoD’s failure to determine the health of service members before and after deployment to Southwest Asia during 1990 and 1991.

In the past 13 years, DoD has failed to hire enough medical professionals to conduct the mandatory exams, and only a few Gulf War veterans have these exams in their medical records.  Instead of exams, DoD performs assessments and screenings where returning service members usually complete paper or computerized questionnaires outside the presence of medical professionals.   While better than doing nothing, the assessments do not comply with the 1997 Force Health Protection law.

We raise this issue because DoD’s inaction causes very serious problems for veterans and VA.  As a result of DoD’s inaction for more than a decade, VA often makes incorrect claim decisions based on veterans’ incomplete medical records.   These pre- and post-deployment medical examinations are vital in order to identify toxic exposures and medical conditions early, when treatment is more effective and less expensive.

These exams are essential for VA disability claim adjudication staff so they can make accurate and timely decisions.  These exams remain significant today due to widespread exposure to depleted uranium, burn pit toxins (for example, at Balad, Iraq), experimental Lariam pills, the use of experimental anthrax vaccines, and other exposures.  The pre- and post-deployment medical exams also reduce stigma for mental health conditions for all deployed veterans by ending the improper practice that currently requires veterans to specifically request a mental health exam.

If this specific request is not implemented, then DoD will be knowingly and intentionally violating the law and repeating past mistakes.

15. VA Improves Transparency and Responds to FOIA Requests

Over the past four years, VCS submitted dozens of Freedom of Information Act (FOIA) requests to VA in search of objective information about Gulf War veterans.  In many cases VCS was forced to appeal VA delays and denials for information that existed and should have been promptly released.  In one case, the National Security Archives at George Washington University had to threaten legal action before VA would release statistics about Gulf War veterans who deployed to Operation Iraqi Freedom and Operation Enduring Freedom.

As of today, VA has failed to respond to ten FOIA requests properly submitted by VCS to VA asking for the release of documents from several VA employees who may have “impeded” Gulf War research, according to a VA Office of the Inspector General conclusion.

VCS urges VA Secretary Shinseki to order the release of the documents VCS seeks under FOIA so we may finally learn the name of the VA employees who “impeded” Gulf War research so they can be properly held accountable and so barriers to research can be removed.

In order to build trust between VA and veterans, VCS recommends more reports about veterans be made available to the public.  We have seen progress, yet more needs to be done in the best interests of transparency.

CONCLUSION

VA Secretary Erik Shinseki’s assertive actions over the next few months will decide if and when Gulf War veterans will receive answers about why we are ill as well as urgently needed access to high-quality VA healthcare and benefits.

VA’s new leaders inherited serious problems unaddressed for nearly 20 years by previous Administrations.  VCS believes VA’s performance on each of these items can be objectively measured, and we plan to work with VA to monitor and report on what we hope will be VA’s successful implementation of the 15 items above.

As suggested by VA’s Gulf War Veteran Advisory Committee last year, VCS agrees with the idea of using the 20th Anniversary of the start of the Gulf War as a launch date for a new set of VA regulations and policies.

The most positive first step VA must take is to stop the filibustering and endless delays in research, treatment, and benefits by a handful of staff at VA headquarters in Washington, DC.  The actions of a small group of VA staff have prevented cooperation and progress in the best interests of veterans and VA’s reputation.

The next step veterans will be looking for is the establishment of a new Gulf War office that begins aggressively implementing the additional action items we propose.  August 2, 2010, although 20 years too late for many of our friends who died and their families who grieve, would be an appropriate date for VA begin this new chapter that former VA Deputy Secretary Leo MacKay promised us.

In our view, VA Secretary Shinseki is pro-veteran.  He is both capable of and intending to correct decades of problems.  We fully support his efforts to clean house and move forward with the best interests of both veterans and VA.  We thank him and Chief of Staff Gingrich for the opportunity to provide our public comments, many of them presented directly and publicly to VA leaders for the first time.

VCS respectfully asks VA to respond, in writing, to each of our 15 requests in a timely manner so we can have the answers we seek, the treatment we need, and benefits we earned without further delay.

Sincerely,

Dan Fahey, President, VCS, Gulf War veteran
Charles Sheehan-Miles, Director, VCS, Gulf War veteran
Michael Zacchea, Director, VCS, Iraq War veteran
Paul Sullivan, Executive Director, VCS, Gulf War veteran
Thomas Bandzul, Associate Counsel, VCS, Vietnam War veteran
Chris Kornkven, past President, NGWRC, Gulf War veteran
Michael Blecker, Executive Director, Swords to Plowshares, Vietnam War veteran
Amy Fairweather, Director of Policy, Swords to Plowshares