STATEMENT OF
JOSEPH THOMPSON
UNDER SECRETARY FOR BENEFITS
DEPARTMENT OF VETERANS AFFAIRS
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
HOUSE OF REPRESENTATIVES

February 5, 1998

Mr. Chairman and Members of the Committee:

I am pleased to be here with you today to provide a status report on the adjudication of Gulf War veterans' claims and to discuss the efforts we have made to improve Gulf War programs.

On May 14, 1997, the Director of the Compensation and Pension Service testified before the Subcommittee on Benefits on the status of Gulf War claims. At that time we were halfway through a readjudication of over 10,000 Gulf War cases previously considered under the provisions of 38 CFR 3.317, governing compensation for undiagnosed illnesses. This initiative had been undertaken in July 1996 to ensure that less traditional types of evidence, specifically lay evidence, had been accorded proper weight and that information about completed claims was being correctly entered into the Gulf War tracking system maintained by the Compensation and Pension Service.

Shortly before the May 14 hearing we had published the final regulation implementing the Secretary's decision to extend the presumptive period for undiagnosed illnesses through December 31, 2001. In our testimony, we stated that we expected a significant number of additional grants of service connection for undiagnosed illnesses because of the extended presumptive period. As of the end of April 1997, there were 4,435 cases requiring review. These cases were originally coded in the Gulf War tracking system as disallowed because of the previous 2-year presumptive period.

We also reported that the Secretary had approved VBA's recommendation to redistribute adjudication of Gulf War claims from four Area Processing Offices (APOs) to all regional offices.

Mr. Chairman, I would now like to bring the Committee up to date on where we now stand with regard to Gulf War claims adjudication.

Issues Arising from the Redistribution

At the May 14 hearing, we were aware of serious concerns that the regional offices lacked the expertise and resources to handle these claims efficiently and accurately. Many members of Congress were understandably anxious that we develop procedures to assist the regional offices and monitor their efforts and progress in adjudicating Gulf War veterans' claims. Let me summarize the assistance we have provided.

On May 29, 1997, the Compensation and Pension Service conducted a 2-hour satellite broadcast on Gulf War issues for all offices. This was followed by an in-depth training session on June 2 and 3 at the Cleveland Regional Office for representatives from all offices. Members of the Compensation and Pension Service subsequently participated in Gulf War issue workshops on June 3 and 4 for our Eastern Area offices, on June 4 and 5 for Central Area offices, and during the week of June 23-27 for the Southern and Western Areas.

After the redistribution, the Compensation and Pension Service established a Rapid Response Team of individuals highly proficient in Gulf War issues and rating procedures. The members of this team are available to provide immediate answers to general or claims-specific questions and technical support in evaluating Gulf War disabilities. Under the leadership of the Rapid Response Team, the Compensation and Pension Service has been conducting weekly Gulf War conference calls. At these calls, information is provided on such issues as how to deal with specific disabilities, the kinds of development most useful in obtaining evidence necessary to adjudicate a claim, how to distinguish between symptoms and actual diagnoses, and how to obtain complete physical examinations addressing the unique concept of undiagnosed illnesses. The Compensation and Pension Service held 29 Gulf War conference calls from June 25, 1997, through January 28, 1998. Additional calls have been scheduled for each Wednesday through March 25, and they will continue beyond that date unless there is a consensus that they have fully served their purpose.

The effectiveness of the regional offices in handling Gulf War cases is monitored not only by the Rapid Response Team, but also through evaluation of the results of local quality reviews conducted monthly at the regional offices. Each office is required to review a sample of its Gulf War claims as part of the local Quality Improvement program. The focus is on the areas of examinations and development, decision-making, and notification. Each office has provided a monthly report of its findings to the Compensation and Pension Service since July 8, 1997. The local Quality Improvement review provides each station a good snapshot of the technical accuracy of its claims processing and identifies areas for improvement and training. The Compensation and Pension Service shares the cumulative findings of these local reports with all offices in periodic special letters.

The Compensation and Pension Service also has undertaken several comprehensive reviews of Gulf War cases to ensure that all required procedures and instructions are being followed by the regional offices. The Service will begin another review of 100 cases in February as part of its ongoing oversight of these cases. We expect that the review and analysis of the findings will be complete by mid-April, and we will be happy to share them with the Committee at that time. The Service uses the results of their own quality reviews, together with the local Quality Improvement reviews and feedback from the Rapid Response Team, to assess the current status of Gulf War claims processing and to determine particular areas where future training would be beneficial.

Mr. Chairman, I am deeply committed to improving the technical accuracy and processing time of compensation and pension claims adjudication to ensure that our nation's veterans receive the best service possible. As one way of pursuing this, I have established a special work group to study Compensation and Pension workload issues. One of the key areas of their study will be accuracy of claims adjudication. Gulf War claims involving undiagnosed illnesses are unique, generally more difficult than others, and have their own special requirements. Over the past three years, we have devoted a considerable amount of training to develop the expertise needed to ensure proper processing of Gulf War claims. This same degree of commitment will continue. Furthermore, I will use the findings of the special work group to achieve improvements in the accuracy of claims processing in general and Gulf War claims in particular.

A major area of concern identified through our reviews of Gulf War cases and questions from the field offices is the adequacy of medical examination reports. Thorough medical examinations are essential for accurate adjudication of these claims. Staff of the Compensation and Pension Service have been working with staff of the Under Secretary for Health to produce guidelines for conducting examinations involving undiagnosed illnesses. There is agreement that physicians who conduct C&P examinations must be familiar with the regulatory requirement that existence of an undiagnosed illness is established only when an acceptable clinical diagnosis has been ruled out through medical history, physical examination, and laboratory tests. The guidelines being developed will ensure that all issues are fully addressed during examinations. A draft of the guidelines is now under review in both VBA and VHA. Final agreement should be reached very shortly. As a supplement to these guidelines, a joint satellite video broadcast on Gulf War examinations for VHA and VBA employees will take place in early March. The tentative date is March 3.

Readjudication and Extension of Presumptive Period

At the beginning of the readjudication in July 1996, there were 10,736 cases to be reviewed, in which service connection for undiagnosed illnesses had been denied. As I stated earlier, 4,435 cases were later identified as requiring an additional review under the amended regulation extending the presumptive period for undiagnosed illnesses. In June 1997, following the Secretary's decision to redistribute Gulf War cases from the 4 APOs, 8,477 cases were sent to the regional offices. This number included readjudication cases, presumptive-period cases, and original and reopened claims that had been filed by Gulf War veterans in the interim. Priority was given to completion of the readjudication and presumptive-period cases, and shortly after the redistribution of claims from the APOs, the regional offices began submitting to the Compensation and Pension Service weekly status reports on the progress they were making on these cases. In October 1997, the Service asked the regional offices to make every effort to complete them by December 31, 1997. However, the Service recognized that due to the extensive development and overall complexities involved in these cases, some claims would in all likelihood remain uncompleted at that date. As of February 3, there were approximately 600 cases yet to be finalized. The Compensation and Pension Service will be monitoring the regional offices' progress on these cases and will provide me with a status report each month until all cases have been completed. Let me go on record as stating that I believe the regional offices have done extremely well in reducing the number of review cases. I commend them for their efforts.

Gulf War Data

An issue of continuing interest, to VA, Congress, veterans' service organizations, and others, is "How many Gulf War veterans are receiving service-connected compensation?" Last summer, we discovered that certain Gulf War numbers provided each month to Congress and to others were not accurate. This information cast doubt on all Gulf War numbers that emanated from our data bases. In response to growing concerns, Deputy Secretary Gober designated VA's Office of Policy and Planning as the focal point within the Department for coordinating all information pertaining to the Gulf War conflict. Under that office's guidance, the Department began to assess and evaluate VA's Gulf War data sources, determine existing gaps in the data, and establish procedures to match electronically disparate sets of data maintained by VBA, VHA, and DOD. The Department remains committed to providing the most accurate and complete data possible.

For our own part, we in VBA have been working closely with the Office of Policy and Planning and the Defense Manpower Data Center to identify all veterans who served in the Gulf War Theater and to ensure that those who have filed claims with VA are properly recorded in existing information systems. We also want to ensure that the indicators used to identify Gulf War veterans records in our data bases are not removed through accident or mistake. Because our efforts are still a "work in progress," we provide the following numbers recognizing that each of our information systems has limitations that may impact on accuracy.

These remarks being made by way of caveat, preliminary data from our Gulf War Management Information System, dated October 15, 1997, showed that we are paying compensation to 90,665 veterans who served in the Gulf War Theater at some point during the Gulf War era (which runs from August 2, 1990, through the present). Of the 90,655 veterans receiving compensation, 74,133 served in the Gulf theater during the period of hostilities, defined as lasting through July 31, 1991. Another 45,630 Gulf War Theater veterans had service-connected disabilities for which no compensation is being paid. Of these 45,630 veterans, 37,253 served in theater during the period of hostilities.

Let me also say a few words about data on Gulf War veterans who are have service-connected disabilities due to undiagnosed illnesses, which I know is a subject of particular interest to this Committee. On the basis of information from the Gulf War tracking system as of January 27 of this year, 2,306 veterans have been granted service connection for disabilities resulting from undiagnosed illnesses. Information from our benefits delivery network extracted on January 15, shows 1,590 veterans have been service connected for undiagnosed illnesses. Because of the differences and limitations of the two systems, we expect some discrepancies in the data extracted. We are currently matching these two groups of records and reviewing a sample of each to explain in detail the differences and correct any errors that are not legitimate. We will provide you an interim report on this effort by March 15. This report will contain a timetable for complete resolution of these data issues. Let me assure you, Mr. Chairman, that in this matter as in all matters involving Gulf War data, we are working constantly with VA's Office of Policy and Planning to refine and improve the information we provide to ensure that it is as accurate and complete as possible.

Mr. Chairman, this concludes my testimony. I will now be happy to answer any questions that you and other members of the Committee might have.