Gulf War Illness: Additional Actions Needed to Improve VA's Claims Process

What GAO Found

The Department of Veterans Affairs (VA) completed processing about 11,400 Gulf War Illness (GWI) claims in fiscal year 2015, which was more than double the 4,800 claims processed in fiscal year 2010. GWI is a collective term for certain medical conditions among veterans who have served in the Gulf War region since 1990. Symptoms of GWI can include fatigue, headaches, joint pain, indigestion, insomnia, respiratory disorders, skin problems, and memory impairment, among others. On average, GWI claims have twice as many medical issues per claim as other disability claims, and take 4 months longer to complete. During fiscal years 2010 through 2015, approval rates for GWI claims were about three times lower than for all other claimed disabilities. Several factors may contribute to lower approval rates, including that--according to VA--GWI claims are not always well understood by VA staff and veterans sometimes file for benefits without sufficient evidence to support their claim.

VA's ability to accurately process GWI claims is hampered by inadequate training, and its decision letters for denied claims do not always communicate key information to veterans. VA claims rating staff often rely on VA medical examiners to assess a veteran's disability before a decision can be made on a claim. VA medical examiners told GAO that conducting Gulf War general medical exams is challenging because of the range of symptoms that could qualify as GWI. VA has offered an elective GWI training for its medical examiners since June 2015, but only 10 percent of examiners had taken the training as of February 2017. Federal internal control standards call for adequate training for staff so they can correctly carry out an agency's procedures. Medical examiners who do not take this GWI-specific training may not be able to provide information to VA staff to correctly decide whether to grant a veteran's claim. Once a determination is made, VA regulations also require a clear statement to veterans regarding claim decisions. GAO found that decision letters for GWI claims do not always include key information on why the claim was denied.

VA considers research when adding to the list of conditions it associates with Gulf War service, but it does not have a plan to develop a uniformly used case definition of GWI. In 2010, VA added nine infectious diseases to the list of GWI-related conditions. VA advisory groups noted, however, that researchers face obstacles in conducting GWI research, including the lack of a single case definition of the illness for research and treatment purposes. In its 2015 GWI Research Strategic Plan, VA included an objective to develop a single case definition, but an official told GAO that VA had no action plan in place to achieve it. Without a plan to achieve a single case definition, research on and treatment for GWI may continue to progress slowly.

Why GAO Did This Study

VA estimates that 44 percent of veterans who served in the Persian Gulf War in 1990-91 have medical issues commonly referred to as Gulf War Illness, and that those who have been deployed to the Gulf War region since then may suffer from similar medical issues. These medical issues may entitle a veteran to VA benefits. Recently, questions have been raised about whether VA is processing Gulf War Illness claims correctly. GAO was asked to review VA's handling of these claims.

GAO issued a report in June 2017, entitled Gulf War Illness: Improvements Needed for VA to Better Understand, Process, and Communicate Decisions on Claims (GAO-17-511). This testimony summarizes the findings and recommendations from that report, including (1) recent trends in Gulf War Illness disability claims, (2) challenges associated with accurately processing and clearly communicating decisions on Gulf War Illness claims, and (3) how VA uses Gulf War Illness research to inform the disability compensation program.