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Hon. Charles L. Cragin

Hon. Charles L. Cragin, U.S. Department of Veterans Affairs, Chairman, Advisory Committee on Gulf War Veterans

Good morning, Mr. Chairman, Ranking Member and Committee Members.  Thank you for the opportunity to discuss with you the findings of the Department of Veterans Affairs (VA) Advisory Committee on Gulf War Veterans and our recommendations for improvements. 

I had the honor of serving as Chairman of this Advisory Committee throughout its tenure from April 2008 through September 2009.  It was a privilege to serve with the fine men and women of this Committee.  As you know, the Committee was chartered by the Secretary of Veterans Affairs to examine the health care and benefits needs of those who served in the Southwest Asia theater of operations during the 1990 – 1991 period of the Gulf War and to advise the Secretary on the issues that are unique to these Veterans.  I should emphasize that the committee saw its assignment to conduct information gathering, assess the current situation, and then provide advice to the individual who requested it, namely, the Secretary of Veterans Affairs. 

I would like to recognize the VA for the work it has done with respect to the Gulf War Task Force.  I was encouraged to find many of the recommendations of the Committee referenced within the action plans.  I look forward to the VA implementing the plans it has outlined and offer my support and assistance in reaching our shared goal of improving service and benefits to Gulf War and all veterans. 

During its tenure, the Committee held eight public meetings in Washington, DC; Baltimore, MD; Seattle, WA; and Atlanta, GA.  Due to the lack of reliable data concerning Gulf War I Veterans, the Committee was forced to base the majority of its findings on scattered scientific research and anecdotal information.  Because of the reliance on such information, the Committee took extra efforts to contact Veterans, both users of VA services and those who did not use VA services, and invited them to come before the Committee and report on their personal experiences.  The Committee, in an additional effort to open communications, broadcast its meetings over toll-free telephone lines and maintained an active, up-to-date Committee web site.

In general, the Committee’s findings are summed up in the title of its report: Changing the Culture: Placing Care Before Process.  This was a resounding theme, pockets of people trying to do their best, stymied by process or lack of vital information.  Many of those who came to VA in the early days after Gulf War I were turned away.  In many cases, health care professionals were not able to connect the symptoms experienced by these Veterans to defined or known illnesses.  Consequently, Veterans were not able to access medical care and treatment and their claims for service-connected disabilities were often denied.   The process served as an impeding wall preventing Veterans who were hurting from getting over the wall to take advantage of the care they needed and deserved.  Consider for a moment that all of the fine men and women were considered in excellent health and “deployable” when they went to war.  In many instances, shortly after their return home, these Veterans began complaining of feeling ill and seeking help.  Many were turned away as “malingerers” or having a “psychosomatic illness.”  Why did a department of government designed to care for Veterans not identify that something was happening to men and women who had recently been healthy who now were sick, the common denominator being that they had deployed in Gulf War I?  The process should have been constructed in such a way that these folks could have immediately been welcomed into the system, rather than rejected because the process required a diagnosable service connection.  These Veterans were not engaged in a massive, national conspiracy to defraud the government.  Rather, they were sick, sought help, and in many instances were rebuffed by the agency established to care for them.  The “Process” became a wall, rather than a door.

The Committee has discovered many programs and initiatives within the Department of Veterans Affairs to assist Gulf War I Veterans. Unfortunately, these programs and initiatives are not easy to find and it is often incumbent upon the Veteran to ask the “right question.” This is not how these men and women should be treated.   As the Committee observed, “newer approaches to more systematic health evaluation of service members’ pre- and post-deployment and newer approaches to more effectively organizing and integrating care and benefits for Veterans with health problems have been very beneficial for Veterans of more recent conflicts, but have not been inclusive of Gulf War I Veterans.  There is a clear need to move beyond the somewhat narrow and restrictive confines of treating diagnosable illness to addressing the broader functional limitations which remain as ongoing problems requiring health and social interventions.”

As I mentioned, the lack of data contributed to the frustration of the Committee and prevented us from conducting any substantive analysis.  The Committee discovered that the one database that had come to be relied upon as the authoritative source of information, the Gulf War Veterans Information System, had been corrupted.  To date, the issues with this data system have not been addressed.  The last valid report to be generated by the system was in February 2008. 

Gulf War I Veterans view themselves as the forgotten era of Veterans.  Because the military operations were relatively short and successful, the residuals of the war were not at the forefront of the American consciousness.  They are a relatively small group by war era standards and are easily eclipsed by the larger, more vocal coalitions of Veterans.  Because these Veterans are not uniquely identified in VA systems and databases, many who work for VA may have no idea who these Veterans are nor have VA employees been educated in the special issues related to this deployment.  

The Committee had the opportunity to meet with Dr. Steve Hunt in Seattle and see first hand the Post-Deployment Integrated Care clinic VA had there.  The Committee was impressed with the model of integrated care designed to recognize and respond to the post-combat needs of Veterans.  The Committee recommended that Gulf War I Veterans be included in the Post-Deployment Integrated Care Initiative and that VA track and evaluate the utilization and effectiveness of the program for Gulf War I Veterans.  The Committee further recommended that individuals with training in neurology and neuropsychology be included on the integrated care team.  In the alternative, the Committee felt that the Department may want to consider expanding the current Environmental Agents Service to perform clinical evaluations of Gulf War I Veterans. 

Concerns about the health of these Veterans and the consequences of their exposures continues to exist today.  The Institute of Medicine continues to issue reports on Gulf War and Health and I encourage VA to respond to these reports in a timely manner and to establish new presumptions as they are warranted.  VA should keep in mind that the difficulty in determining the causes of the illnesses experienced by Gulf War I Veterans has contributed to the ongoing lack of treatments.  Gulf War I Veterans want to be healthy.   

The Committee developed several recommendations contained in the report.  I will not go into all of them in this testimony, but on behalf of the Committee I ask that the entire report be submitted for the record.  I would like to take this opportunity to briefly highlight a few more of the recommendations contained in the report. 

The Committee recognizes that a culture change is necessary within VA and that such a change does not happen overnight.  The Committee recommended, as part of the foundation of the transformation effort underway, that VA implement special programs to educate VA and contract medical personnel on Gulf War I medical issues, research, and regulations.  To improve care and the delivery of benefits, staff needs to be aware and knowledgeable about medical issues that may be related to service in the Gulf War.  Training of staff should be mandatory and conducted annually.  An educated work force will serve to assist Veterans as they navigate VA’s complex system of health care and benefits.

The Committee also recommended that the end date for the presumptive period for compensation for Undiagnosed Illness in Gulf War I Veterans be extended indefinitely.  The presumptive period for compensation for undiagnosed illness in Gulf War I Veterans will expire on December 31, 2011.  This presumptive period demonstrates VA’s recognition that, although not yet officially named, Gulf War I Veterans are experiencing adverse health consequences.  There are service members who fought in Gulf War I who have not left service yet, and who may experience these same symptoms in the coming years.  VA should not confine Gulf War Veterans to a timetable not supported by medical science.  Veterans must receive the benefit of the doubt with respect to undiagnosed illness while VA awaits the conclusions of Gulf War Illness research.

Technology can also help bridge the gaps.  The Committee recommended mandatory clinical reminders be established in the system to trigger VA medical professionals to ask specific follow-up questions for Gulf War I Veterans.  This would require that Gulf War I Veterans have a unique identifier in the VA system.  VA should also build upon the good work begun early in its response to Gulf War I.  VA should contact Veterans who participated in the original Gulf War Registry Exams and invite them back for follow-up exams.  This will not only be beneficial to the Veterans, but provide valuable information about the evolution of Gulf War I Veterans physical and mental conditions over the past 18 years. 

With respect to outreach, VA has a real opportunity to try to make up for the lack of outreach and awareness that has been afforded this cohort of Veterans.  VA should use the 20th anniversary of the Gulf War as a positive opportunity to attract Gulf War I Veterans back to the VA. 

VA should increase its responsiveness to Veterans and other stakeholders.  The Committee experienced a number of delays in getting responses from VA on questions pertinent to our charge.  Again, this had a negative affect on the analysis and review we were able to conduct.   

In general, VA learned many valuable lessons from Gulf War I Veterans and those lessons have substantially improved the treatment received by Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF) Veterans today.  VA needs to include Gulf War I Veterans in the improved programs and initiatives it offers returning OIF/OEF Veterans.

Obviously, the report, in its entirety, represents the work of the Committee and the direction which it has recommended that the Department travel in its mission to serve Gulf War I Veterans.  Recently, the Department of Veterans Affairs provided a written response to the recommendations made by the Committee.  I would like to thank VA for its responses and encourage VA to continue efforts to improve benefits and services to Gulf War I Veterans.

Thank you for inviting me to participate in this hearing representing my colleagues on the Committee.  I am available to answer any questions you may have.