Presentation for the

25th Anniversary Commemoration of

the Gulf War
Hosted by the
U.S. Department of Veterans Affairs, Boston Healthcare
System
and the
Boston University , Schools of Medicine & Public Health
April 9, 2016 Boston, MA

Presentation by: Anthony Hardie,

Director, Veterans for Common Sense

SERVICES & BENEFITS FOR

GULF WAR VETERANS

INTRODUCTION
Anthony Hardie: Director, Veterans for Common Sense (education &
advocacy on veterans, military, foreign policy issues)

U.S. Army: 7+ years active duty (1986-93), 2 combat deployments (Gulf

War & Somalia), 4 non-combat deployments (N. & W. Africa, Guantanamo)

Advocate for fellow Veterans for more than two decades:

Gulf War/veterans organizations (1995-Present; NGWRC, VMW, DAV,

VCS)

Congressional Aide (veterans & military issues, etc.)

Wis. Department of Veterans Affairs (legislative, public, intergovernmental

affairs)

Medically retired

Federal Advisory Committees (RAC, GWI CDMRP x 3)

Testified before Congress numerous times

Press: Hundreds of interviews/quotes: USA Today, CNN, Fox News,

MSNBC, etc. etc. etc.
2

Services and Benefits for Gulf War Veterans

GULF WAR VETERANS OVERVIEW

1991 GULF WAR GROUND OFFENSIVE

A MULTI-NATIONAL COALITION

GULF WAR: AUGUST 1990-JULY 1991

697,000 GULF WAR VETERANS
6,838,541
Gulf War Era
Deployed & NonDeployed
Servicemembers
(8/2/1990 Present
(8/2007))

5,709,188 NonDeployed Gulf War

Era Veterans
(8/2/1990 Present
8/2007))

1,129,353
Deployed to Gulf
Theater of Operations
(8/2/1990 Present
8/2007))

696,842
Gulf War Conflict
Veterans
(8/2/19907/31/1991)

Source: Gulf War Veterans Information System

432,511
Post-Gulf War Theater
Veterans
(8/1/1991 Present
8/2007))

697,000 GULF WAR VETERANS

AGE

GENDER

27 (mean age
in 1991)

Male: 93%

Female: 7%

RACE
White: 70%

AfricanHispanic: 5%
American: 23%

Other: 2%

BRANCH OF
SERVICE
Army: 50%

USMC: 15%

Navy: 23%

Air Force: 12%

MILITARY
STATUS
Source: Joseph, 1997, cited in Institute of Medicine, Gulf War and Health, Vol. 1, p. 41.

Services and Benefits for Gulf War Veterans

GULF WAR HEALTH OUTCOMES

THE GULF WAR TOXIC SOUP

Burning
Trash/
Feces

Chemic
al
Warfare
Agents

Oil Well
Fire
Particulate
Matter

CARC
Paint

DU

Experimental
Vaccine
s

Tent
Heaters

Solvent
s

PB Pills

Petroleu
m
Products

Pesticides
8

KHAMISIYAH 100,000+ EXPOSED TO SARIN,

CYCLOSARIN, MUSTARD CHEMICAL WARFARE AGENTS

JANUARY PLUMES
Study: Wind blew deadly gas to U.S.
troops in Gulf War
Kelly Kennedy, USA TODAY 3:49 a.m. EST December 14, 2012

Troops were told chemical alarms that went off at U.S. bases in Saudi
Arabia during the Gulf War were false alarms, but a new study
indicates that sarin gas traveled hundreds of miles.
WASHINGTON -- U.S. bombings of Iraqi munitions factories in January
1991 released a plume of sarin gas that traveled more than 300
miles to affect American troops in Saudi Arabia, although military
officials claimed at the time that chemical alarms triggered by the
gas were false, a study released today shows.
The Jan. 18, 1991, bombings of the munitions plants in Nasiriyah and
Khamisiya blew a plume of sarin gas high above a layer of cold, still
air -- also called the boundary level -- and into a swift wind stream
that carried the gas to Saudi Arabia, said the study conducted by
researchers Robert Haley and James Tuite and published in the
journal Neuroepidemiology.
The gas plumes, the researchers said, can be blamed for symptoms 10

GULF WAR ILLNESS (GWI) OVERVIEW

Scientific research . . . supports and further

substantiates . . . that Gulf War illness is a serious
physical disease, affecting at least 175,000 veterans
of the 1990-1991 Gulf War, that resulted from
hazardous exposures in the Gulf War theater. 1 (p.1)

Symptoms typically include widespread pain, cognitive

difficulties, debilitating fatigue, gastrointestinal
problems, respiratory symptoms, sleep problems,
chronic headache, and other abnormalities not explained
by established medical diagnoses or standard laboratory
tests; affects 25-32% of the nearly 700,000 veterans of
the 1991 Gulf War.2

SOURCES: (1) Research Advisory Committee on Gulf War Veterans' Illnesses (RAC), U.S. Department of
Veterans Affairs, Gulf War Illness and the Health of Gulf War Veterans: Research Update and Recommendations,
2009-2013. Washington, D.C.: U.S. Government Printing Office, May 2014. Retrieved Jan. 24, 2016,
www.va.gov/RAC-GWVI/RACReport2014Final.pdf
(2) Gulf War Illness Research Program (GWIRP), Congressionally Directed Medical Research Program, U.S
Department of Defense, Program Website. Retrieved Jan. 24, 2016, http://cdmrp.army.mil/gwirp.

11

GULF WAR ILLNESS: GULF WARS SIGNATURE HEALTH

OUTCOME

Gulf War illness continues to be

the signature health concern of
veterans who served in the Persian
Gulf region in 1990-91.
-National Academy of Sciences, Institute of Medicine, Gulf War
and Health, Volume 10: Update of Health Effects of Serving in the
Gulf War, 2016 (p.87)

12

IOM 2016: GULF WAR ILLNESS

A variety of studies in U.S. veterans and coalition
force veterans who served during and even after the
conflict continue to show that veterans who were
deployed to the Gulf War experience more
symptoms, signs, and ill-defined conditions, and that
their symptoms are more severe than their
nondeployed counterparts; furthermore, these
symptoms have persisted for more than 25 years
after the war. (p.87)
Therefore, the Volume 10 committee concludes that
there is sufficient evidence of an association
between deployment to the Gulf War and the
constellation of chronic symptoms (including fatigue,
musculoskeletal
pain,
sleepInstitute
disturbance,
cognitive
SOURCE:
-National Academy
of Sciences,
of Medicine, Gulf
War and
Health,
Volume 10: Update
of Health Effects
of Serving
in the Gulf
War,
2016
dysfunction,
alterations
of mood)
known
as
Gulf
War

13

IOM-RECOMMENDED GWI CASE

DEFINITIONS

SOURCE: p. 74, National Academies of Sciences, Engineering, and Medicine. 2016. Gulf
War and Health, Volume 10: Update of Health Effects of Serving in the Gulf War, 2016.
Washington, DC: The National Academies Press. http
://www.nap.edu/catalog/21840/gulf-war-and-health-volume-10-update-of-health-effects

14

LOST IN THE SHUFFLE: Veterans of the 1991 Persian Gulf War

VA DISABILITY CLAIMS

15

FIRST THINGS FIRST: REGISTRY

EXAMS
Have you had a Gulf War Registry
Exam?

Free to eligible Veterans and no co-payment

Not a disability compensation exam or
required for other VA benefits
VA Enrollment not necessary
Based on Veterans recollection of service,
not on their military records
Veterans can receive additional registry
exams, if new problems develop

http://www.publichealth.va.gov/exposures/gulfwar/benefits/r
egistry-exam.asp

16

BEFORE WE BEGIN

Veterans should obtain free help from an

accredited veteran service officer (VSO) before
filing a claim against VA.

There are many important filing and appeal

deadlines, so time is critical.

Presentation is general information, not legal

advice, as laws change.
17

VA DISABILITY COMPENSATION:
WHAT IS IT?

What is it? Monthly compensation by VA to Veterans

who are still affected (disabled) by an injury or illness
incurred or aggravated during active military service.

Why is it important? Veterans file a claim to get

service-connected, then receive free VA health care
for service-connected conditions. For veterans rated
50% or higher, all VA health care is free.
18

VA DISABILITY COMPENSATION:
WHAT IS IT? CTD.

Payment ranges from $133.17 for a single Veteran

rated at 10%, to $3,187.60 for a married Veteran
rated at 100% with one child, to higher rates for
certain special monthly compensation (SMC) rates.

Veteran receives payment for life (generally).

Most Veterans are rated at 30% or lower.

Source: U.S. Department of Veterans Affairs, Veterans Compensation Benefits
Rate Tables - Effective 12/1/14
http://www.benefits.va.gov/COMPENSATION/resources_comp01.asp

19

VA DISABILITY COMPENSATION:
HOW TO GET IT?

Veterans file a Claim with VA, then go through

the Claims Process
If approved, the veteran is now known as
service-connected
Claims are sometimes called by their full name,
service-connected disability (or SCD)
compensation claims
Service-connection is sometimes abbreviated
as SC or S/C
20

VA CLAIM PROCESS
Nine Steps

There are 9 VA claim steps described in this

presentation.

Most Veterans will only experience the first 2

steps: they apply and VA issues a decision.

Veterans who disagree with decisions on their

claims may experience as many as all 9 steps.
21

VA CLAIM PROCESS
Step One: Veterans Initial Claim

Veteran files a claim against VA.

Effective date of claim is:
The day VA receives the claim (most veterans), or
The 1 day after discharge from active duty military
st

service, if claim is filed within one (1) year of discharge.

22

VA CLAIM PROCESS
Step Two: VAs Rating Decision
VA conducts C&P Exam
VA Regional Office reviews claim, C&P exam,
VA and military records, other evidence
VA issues Rating Decision, describes reasons
for decision to grant or deny Veterans Claim.

23

VA CLAIM PROCESS
Step Two, Ctd: VAs Rating Decision

WHEN YOU CAN EXPECT A RESPONSE: VA

has no time limit to decide.

ERROR RATE: in 2012, VAs Inspector General

reported VAs error rate was 30 percent (30%).

24

VA CLAIM PROCESS
AGAIN:
Most Veterans have only the first 2 steps: they apply and
VA issues a decision.
HOWEVER:
If veteran disagrees with VA decision, including VA error,
new evidence, etc., see Step 3 and beyond.
25

VA CLAIM PROCESS
Step Three: Veteran Disagrees with VA
Decision

If a Veteran disagrees with any part of VAs

Rating Decision, then the Veteran files a
Notice of Disagreement (NOD) in writing
with VA Regional Office.

DEADLINE: Veteran has one (1) year from

mailing date of VA Rating Decision to file an
26
NOD.

VA CLAIM PROCESS
Step Three, Continued:

OPTION: A Veteran may also ask a for a VA

Decision Review Officer (DRO) to review claim.
Ask your VSO for guidance.

POSSIBILITY OF APPROVAL: A DRO is a

more experienced VA employee and often finds
VA errors.
27

VA CLAIM PROCESS
Step Four: VA Responds to NOD with SOC

When VA receives an NOD, then VA prepares

and mails the Veteran a Statement of the Case
(SOC) further explaining VAs actions.

WHEN YOU CAN EXPECT A RESPONSE: VA

has no time limit to mail SOC. VA averages 8
months to mail an SOC.
28

VA CLAIM PROCESS
Step Five: Veteran Completes Formal Appeal

If Veteran disagrees with VA, then the Veteran files a

Substantive Appeal, also called a Form 9 Appeal.

DEADLINE: Veteran has 60 days from date of SOC

(or remainder of one year from Rating Decision) to
appeal to the Board of Veterans Appeals.

WHEN YOU CAN EXPECT A RESPONSE: VA has

no time limit to review and respond to a Form 9
appeal.
29

VA CLAIM PROCESS
Step Seven: Board of Veterans Appeals

The VA Board of Veterans Appeals (also called the

Board or BVA) issues a decision.

WHEN YOU CAN EXPECT A RESPONSE: The

Board has no time requirement to issue a decision.
Average is additional 240 days from Board receipt
to Board decision. Average wait from veteran filing
initial claim to Board decision is 1,598 days (4.4
years) (Source: 2012 VA IG Report).

WORTH THE WAIT APPROVAL RATE: Board

30

VA CLAIM PROCESS
Step Eight: Veteran Appeals Board Decision

If a Veteran disagrees with the Board, then the

Veteran may appeal to the U.S. Court of Appeals
for Veterans Claims.

DEADLINE: A Veteran has 120 days from the

date of the Board decision to appeal to the U.S.
Court of Appeals for Veterans Claims (the
Court).
31

VA CLAIM PROCESS
Step Nine: U.S. Court of Appeals for Veterans
Claims

The U.S. Court of Appeals for Veterans Claims

(also called the Court) issues a decision.

WHEN TO EXPECT A DECISION: The Court

averages almost one (1) year from receipt to
decision (Source: Court documents).

WORTH THE WAIT APPROVAL RATE: The

Court either grants or remands (sends back to
32

VA Claims Process Overview:

Levels of Appeal
U.S. Court of
Appeals for
Veterans Claims
VA Board of
Veterans
Appeals
VA
Regional
Office

VA
Regional
Office

Grants or
Remands
61%
Grants or
Remands
75%

VA
Regional
Office

30%
Error
Rate
33

1)
1)
Veteran
Veteran
Files
Files
Initial
Initial
Claim
Claim

VA Claims Process Overview:

Appeal Steps, Deadlines, and
Wait Times

Some types of
presumptive
claims have
deadlines
2)
2) VA
VA Reviews
Reviews
Claims,
Claims, Issues
Issues
Rating
Rating Decision
Decision

3)
3) Veteran
Veteran
Submits
Submits
Notice
Notice of
of
Disagreemen
Disagreemen
tt

DEADLINE: 1 Year
from Date on
Rating Decision
4)
4) VA
VA
Responds
Responds
with
with SOC
SOC

Average Wait Time: 8 months

5)
5) Veteran
Veteran
Completes
Completes
Form
Form 9
9
Appeal
Appeal

Average Wait times:

Step 1-Step 8: 1,598 days =
4.4 years
Step 1-Step 9: 1,919 days
= 5.26 years

DEADLINE: 60 Days
from Issuance of
SOC
6)
6) If
If Veteran
Veteran
Submitted
Submitted
Additional
Additional
Evidence,
Evidence, VA
VA
Issues
Issues SSOC
SSOC

Average Wait Time: 1

year

7)
7) Board
Board of
of
Veterans
Veterans
Appeals
Appeals Issues
Issues
Decision
Decision

Average Decision Time: 240

Days

8)
8) Veteran
Veteran
Appeals
Appeals BVA
BVA
Decision
Decision

DEADLINE: 120
Days
9)
9) U.S.
U.S. Court
Court
of
Appeals
of Appeals for
for
Veterans
Veterans
Claims
Claims Issues
Issues
Decision
Decision

Average
Decision
Time:
321
Days

34

KEYS TO A SUCCESSFUL
To win Service Connection
(SC) for most VA
CLAIM
disability claims (direct service-connection),
generally, a Veteran must meet three criteria:
A) A current medical condition
B) An event in the military where the current
medical condition was incurred or
aggravated
C) A medical opinion linking the current
condition and the event (VA calls this a

35

KEYS TO A SUCCESSFUL
CLAIM, CTD.
A) A current medical condition:

The veteran must have a diagnosis of an

existing medical condition.
An exposure alone without identifying a medical
condition/symptoms, is not a disability/claim.
(Examples: Gulf War toxic exposures; Agent
Orange exposure; exposures to a oil well fires
in Kuwait; exposure to burn pits in Iraq or
Afghanistan)
36

KEYS TO A SUCCESSFUL
CLAIM, CTD.
B) An event in the military:

Veterans military records show corroborating

evidence of an event in the military (such being
wounded in combat, accident, injury, assault, or
illness), where (generally) the current medical
condition was incurred or aggravated.

37

KEYS TO A SUCCESSFUL
CLAIM, CTD.
C) A medical opinion linking the current
condition and the event (nexus):

A medical professionals opinion the

Veterans current condition is related to
service is called a nexus statement.
VA rules say veterans win a tie. For example,
as likely as not is a tie.
NOTE: A special kind of claim (presumptive)
doesnt require a nexus

38

REVIEW: 3 KEYS TO A SUCCESSFUL

CLAIM
(GENERALLY, NON-PRESUMPTIVE
CLAIMS)
A) InService
Event

B) Medical Evidence of
Nexus Linking Event to
Current Medical Condition

C) Current
Medical
Condition

39

PRESUMPTIVE CONDITION
CLAIMS
(GENERALLY)
A) InService
Event

(Statutory or Regulatory
Presumption of connection between
Event and Current Condition: No
other proof of nexus needed)

B) Current
Medical
Condition

40

GULF WAR PRESUMPTIVE CLAIMS

Gulf War veterans may obtain

disability compensation for
disabilities under same rules as other
veterans
However, there are additional special
rules that apply to Gulf War veterans
No nexus requirement (Gutierrez v.
Principi)
Unacceptably high VA denial rates
Greater than 80% denied in 2015

41

GULF WAR PRESUMPTIVE RULES

Must be a Gulf War veteran (Southwest Asia
theatre of operations, Aug. 2. 1990 or later)
AND
With a qualifying chronic disability (at least
6 months or wax/wane during at least 6
months)
AND
Condition must have manifested during
Gulf War service OR become at least
10% disabling within the presumptive
period (currently, before December 31,
2016).
9 infectious diseases have different

42

GULF WAR PRESUMPTIVE CLAIMS

(A) An undiagnosed Illness (UDX)
(B) A medically unexplained chronic
multisymptom illness (CMI) that is defined by
a cluster of signs or symptoms, such as:
(1) Chronic fatigue syndrome (CFS);
(2) Fibromyalgia (FM);
(3) Functional gastrointestinal disorders
(FGIDs), excluding structural
gastrointestinal diseases.
REFERENCE: 38 CFR 3.317(a), (b)

http://www.ecfr.gov/cgi-bin/text-idx?SID
=9455393d1e81372be32a98bc63592566&mc=true&node=se38.1.3_1317&rgn=div8

43

GULF WAR CLAIMS: USE DBQS

Disability Benefits Questionnaires

(DBQs) are medical examination forms
used for evaluating VA disability claims.
Use the appropriate DBQ for CFS, FM,
FGIDs including IBS, and Gulf
War/Afghanistan Infectious Diseases
No DBQ for Undiagnosed Illness (UDX)
claims
Full list of DBQs: www.benefits.va.gov
/compensation/
44

CMI: FUNCTIONAL GASTROINTESTINAL DISORDERS

FGIDs include but not limited to:

Irritable Bowel Syndrome (IBS)
Functional dyspepsia (indigestion)
Functional vomiting
Functional constipation
Functional bloating
Functional abdominal pain
syndrome
Functional dysphagia (difficulty

45

.OR FGID SYMPTOMS

Abdominal pain,
Substernal burning or pain
Nausea
Vomiting
Altered bowel habitsdiarrhea/constipation
Indigestion
Bloating
Postprandial fullness
Painful or difficult swallowing
46

UDX CLAIMS

Undiagnosed Illness -- by history,

physical examination & laboratory
tests cannot be attributed to any
known clinical diagnosis

Catch-22: Diagnosis of
conditions/symptoms (i.e., chronic
sinusitis, GERD) = no longer
undiagnosed

Can use objective medical

evidence perceptible to an
examining physician or

47

UDX: MEDICAL EVIDENCE YOU MAY SUBMIT

Medical evidence you have from your

service in the Persian Gulf (Service
medical records; anything else showing
medical treatment while in the Gulf).
Medical evidence from after you left the
Persian Gulf (Reports or statements
from doctors, hospitals, laboratories,
medical facilities, or mental health
clinics, x-rays, physical therapy
records, etc.)
48

UDX: MEDICAL EVIDENCE YOU MAY SUBMIT,

CTD

Medical statements: Show dates

of examination or treatment,
findings, and diagnoses.
Doctor's statements: State when
the doctor first noticed your
disabilities, how they appeared,
how long they lasted.
Include Gulf War Health Registry
Examination, OR inform VA in
writing when the examination

49

UDX: NON-MEDICAL EVIDENCE YOU MAY SUBMIT

Any evidence which is written or

can be verified, such as:
Time you lost from work
Changes in your physical
appearance
Changes in your physical abilities,
and
Changes in your mental or
emotional attitude.
50

UDX: NON-MEDICAL EVIDENCE YOU MAY SUBMIT

Statement(s) from person(s) who knew

you during and/or after the Gulf War who
have personal knowledge of your
disabilities.
Submit on VA Form, Statement in
Support of Claim
Statement should describe exactly what
the person observed and mention
specific dates and places.
A person on active duty at the time
should include their service number
51

UDX/CMI SIGNS OR SYMPTOMS

Include, but are not limited to:

(1) Fatigue.
(2) Signs or symptoms involving skin.
(3) Headache.
(4) Muscle pain.
(5) Joint pain.
(6) Neurological signs or symptoms.
(7) Neuropsychological signs or symptoms.
(8) Signs or symptoms involving the respiratory system (upper
or lower).
(9) Sleep disturbances.
(10) Gastrointestinal signs or symptoms.
(11) Cardiovascular signs or symptoms.
(12) Abnormal weight loss.
52

UDX/CMI DISQUALIFIERS

Affirmative evidence UDX/CMI was

not incurred during active Gulf War
service.
Affirmative evidence UDX/CMI was
caused by a supervening
condition or event that occurred
after Gulf War service and before the
onset of the UDX/CMI.
Affirmative evidence UDX/CMI is the
result of the veteran's own willful

53

9 INFECTIOUS DISEASES
Persian Gulf (Aug. 2, 1990) or Afghanistan
(Sep. 19, 2001) or later (Use DBQ):
1.
2.
3.
4.
5.
6.
7.
8.
9.

Brucellosis
Campylobacter jejuni
(Coxiella burnetii (Q fever)
Malaria.
Mycobacterium tuberculosis.
Nontyphoid Salmonella.
Shigella.
Visceral leishmaniasis.
West Nile virus.

REFERENCE: 38 CFR 3.317(c)http

://www.ecfr.gov/cgi-bin/text-idx?SID=9455393d1e81372be32a98bc63592566&mc=true&node=se38.1.3_1317&rgn=div8

54

OTHER WAYS TO GET SERVICE

CONNECTED:
Presumptive Conditions Related to
Exposures:
Herbicides (Agent Orange): AL
Amyloidosis; Chronic B-Cell Leukemias;
Chloracne; Diabetes Mellitus Type 2; Hodgkins
Disease; Ischemic Heart Disease; Multiple
Myeloma; Non-Hodgkins Lymphoma;
Parkinsons Disease; Peripheral Neuropathy,
Early Onset; Porphyria Cutanea Tarda; Prostate
Cancer; Respiratory Cancers; Soft Tissue
Sarcomas. Bladder cancer, hypothyroidism may
be added (Mar. 2016)
55
Ex-POW, Ionizing Radiation, etc.

OTHER WAYS TO GET SERVICE

CONNECTED:
Other Presumptive Conditions: (note that
some have deadlines for manifestation for VA SC
purposes):
Amyotrophic Lateral Sclerosis (ALS)
Multiple Sclerosis (MS) (within 7 years of
service)
Etc.

56

OTHER WAYS TO GET

SERVICE CONNECTED,
CTD:

Secondary Conditions: Claim for a

condition related to an already VA-rated
SC condition

Common examples:
Sleep apnea, secondary to PTSD
Erectile dysfunction, secondary to
mental health medications and/or
PTSD

57

PTSD CLAIMS
Three Types of PTSD Claims:

War Zone: (formerly combat), where

deployment is the event. [See next slide]

Non-Deployment: Claim may be supported by

event in records (such as a training accident).

Military Sexual Trauma (MST): Claim may be

successfully supported by in-service markers
such as transfers, non-judicial punishment, etc.
58

PTSD CLAIMS, CTD.

PTSD Deployment Rule Change in 2010
expanded PTSD claims:

If a Veteran was deployed to a war, and

If a Veteran is diagnosed after service with
PTSD, and
If a VA exam confirms the diagnosis is
associated with deployment,
Then VA is supposed to grant claim.
59

TBI/MTBI CLAIMS
Too complex to cover here today.
Symptoms may include: Headaches;
Dizziness/vertigo; Weakness or paralysis; Sleep
disturbance; Fatigue; Malaise; Mobility/balance
problems; Memory or other cognitive impairment i.
Decreased attention; Speech or swallowing
difficulties; Pain; Bowel or bladder problems;
Psychiatric symptoms (mood swings, anxiety,
depression, other); Erectile dysfunction; Sensory
changes (numbness, paresthesias); Vision or hearing
problems; decreased sense of smell/taste; Seizures;
Hypersensitivity to sound or light; Neurobehavioral
symptoms (irritability, restlessness); symptoms of
autonomic dysfunction (heat intolerance, excess or

60

SECONDARY CONDITION
CLAIMS
(GENERALLY)
A)
Approved
ServiceConnected
Disability

B) Medical evidence of connection

between SCD and additional
secondary condition
C) Current
Medical
Condition
secondar
y to
existing
SCD

61

OTHER WAYS TO GET

SERVICE-CONNECTED,
CTD:

Aggravated: A pre-existing condition

worsened
by military service

62

PRE-EXISTING CONDITION
AGGRAVATED BY MILITARY
SERVICE
Pre-Existing Condition (Prior
to Military Service)

A) InService
Event
B) Medical Evidence of Nexus
Linking Event to Current Medical
Condition
C)
Current
Medical
Conditio
n

63

OTHER WAYS TO GET

SERVICE-CONNECTED,
CTD:

VA Malpractice: VA treatment caused

condition
(called an 1151 claim)

64

NON-SERVICE CONNECTED
PENSION
In general, to qualify:
Qualifying veteran
Very low income (indigent)
Qualifying current medical
disability/disabilities
Medical disability/disabilities are not
service-connected

65

Services and Benefits for Gulf War Veterans

OTHER BENEFITS & SERVICES

66

AIRBORNE HAZARD REGISTRY

Veterans who are eligible for the Gulf

War Registry may also join the Airborne
Hazards and Open Burn Pit Registry,
which includes additional data related
to airborne hazards, including burning
oil well fires and burn pits.
See more at:
http://www.publichealth.va.gov/exposures/gulfwar/benefits
/registryexam.asp
67

CAMP LEJEUNE DRINKING WATER

CLAIMS
Esophageal cancer

Breast cancer

Kidney cancer

Multiple myeloma

Renal toxicity

Female infertility

Scleroderma

Non-Hodgkin's lymphoma

Lung cancer

Bladder cancer

Leukemia

Myelodysplastic syndromes

Hepatic steatosis

Miscarriage

Neurobehavioral effects
www.publichealth.va.gov/exposures/camp-lejeune

68

WRIISCS

War Related Illness and Injury Study

Centers (WRIISCs): Referral centers
for veterans within VA healthcare
system for hard-to-diagnose health
conditions
Referred by VA physician
Most veterans say its very helpful
More information:
www.warrelatedillness.va.gov
69

MEDALS & RECORDS

With the aid of a CVSO,
VSO, Congressional office:
Lost/Stolen/Destroyed
medals can be replaced
Personnel records can be
released
Certain unawarded
medals may be awarded
(Congressional office
only)
70

EDUCATION BENEFITS

VA Vocational Rehabilitation due to

disability: www.benefits.va.gov/vocrehab
Chapter 35 (DEA) may pay for
education for spouse/children (under
age 26) due to the veterans total and
permanent disability: www.benefits.va.gov/gibill/
survivor_dependent_assistance.asp

Student Loans may be discharged due

to total and permanent disability: https
://studentaid.ed.gov/sa/repay-loans/forgiveness-cancellation/dis
ability-discharge
71

OTHER
PROGRAMS/SERVICES/BENEFITS

VA Home Loan funding fee (points)

waiver due to disability
Civil Service added points due to Gulf
War service, disability
VA Service-Disabled Life Insurance (SDVI)
Death benefits

Burial Plot Allowance

Headstones/Markers/Medallions
Survivors benefits

72

STATE VETERANS PROGRAMS, SERVICES, & BENEFITS

Each state has a state veterans

agency, department, commission, or
similar entity
Most states offer some form of statelevel programs, services, benefits
(education, loans, grants, property tax
benefits, licenses, etc.)
National Association of State Directors
of Veterans Affairs (NASDVA):
www.nasdva.us
73

COUNTY/LOCAL VETERANS PROGRAMS, SERVICES, &

BENEFITS

About half the states have County

Veterans Service Officers (CVSOs)
Some local governments offers veteran
programs, services, benefits
National Association of County
Veterans Service Officers (NACVSO):
www.NACVSO.org

74

Services and Benefits for Gulf War Veterans

CURRENT EFFORTS
FOR ILL GULF WAR VETERANS

75

YEARS SQUANDERED WITHOUT

RESULTS

Stress

Same as
After
Every
War

No Unique
Illness

The Three
Nos
Malingering

76

TREATMENT
Being seen is not the same thing as
being treated.
-Anthony Hardie, Testimony before U.S. House
Committee on Veterans Affairs, Subcommittee on
Health, July 26, 2007

Source: U.S. House Committee on Veterans' Affairs, Statement of Anthony Hardie, Legislative Chair and
National Treasurer, Veterans of Modern Warfare, Testimony Before the Subcommittee on Health of the
House Committee on Veterans' Affairs, July 26, 2007.
77
http://veterans.house.gov/hearings/schedule110/july07/07-26-07am/7-26-07hardie.shtml

NEW PROGRESS IN FEDERAL

RESEARCH

VA Research Advisory Committee (RAC) on Gulf War Veterans

Illnesses
Limited VA GWI research portfolio
VA Research Advisory Committee (RAC) on Gulf War Veterans Illnesses
DOD Congressionally Directed Medical Research Program
(CDMRP)
FY06-FY16: Gulf War Veterans Illnesses Research Program
FY17: In Congress now

78

VA VS. GWI CMDRP AWARDS,

FUNDING
VA

GWIRP-CDMRP

# of New
Proposals
# of New
Funded with
Proposal
this FYs
Funded this appropriated
FY
funding

Amount of
the
Appropria New Appropriation
tion made Made during this FY
for this FY (for future year)

During
this FY

VA Funding
Expended
this FY

2011

$5.54 m

8 (CY2012)

$8 m

$10m (for FY12)

2012

$6.72 m

6 (CY2013)

$10 m

$20m (for FY13)

2013

$7.94 m

16 (CY2014)

$10 m

$20m (for FY14)

2014

$9.73 m

$20 m

$20m (for FY15)

2015

$11.63 m

$20 m

$20m (for FY16)

2016

TBD

TBD

21 (CY2015)
TBA
(CY2016)
TBD
(CY2017)

$20 m

TBD (for FY17)

79

AVOIDING DUPLICATION OF EFFORT

No GWI Research Program at NIH or elsewhere in the federal

government
In recent years, VA has been funding treatment-focused research
for Gulf War Illness; includes symptomatic treatment testing (7
RCTs as of Sep. 2015), animal models of exposure leading to
treatment development, etc.
Active, ongoing, substantive VA-GWIRP engagement:

VA ,Gulf War Illness program manager participates in Vision Setting,

Programmatic Panel meetings:
Formal presentation of VA GW Research Portfolio, Strategy, etc.
Active, ongoing interaction between VA and GWIRP
Active in PP discussions of funding overlapping or duplicative proposals or
aims
VA staff serves as voting member of External Advisory Boards overseeing
GWIRP Consortia
80

ABOUT THE TREATMENT-FOCUSED

GULF WAR ILLNESS CDMRP

81

GULF WAR ILLNESS CDMRP OVERVIEW

Vision: Improve the health and lives of

veterans who have Gulf War Illness.1
Mission: Fund innovative Gulf War Illness
research to identify effective treatments,
improve definition and diagnosis, and better
understand pathobiology and symptoms.1
Treatment-focused; Peer-Reviewed;
Research is competitively selected. 1
CDMRPs are specifically funded in each annual
Defense Appropriations Act; FY16, $20m.

SOURCE: Gulf War Illness Research Program (GWIRP), Congressionally Directed Medical
Research Program, U.S Department of Defense, Program Website. Retrieved Jan. 24, 2016,
http://cdmrp.army.mil/gwirp.
1

82

GWIRP PRIORITY AREAS

Improve understanding
of pathobiology and
symptoms

Improve definition and

diagnosis

Identification of
effective treatments

83

GULF WAR ILLNESS CDMRP PORTFOLIO

~1/3 of Funded Studies are Testing

treatments
Some are symptomatic-focused
Some are mechanistically
informed/informing
~2/3 of Funded Studies are Mechanism
Focused
Identifying treatment targets
Identifying biomarkers
Improving diagnosis
Improving defi nition
Improving understanding of the
underlying pathobiology

Most GWIRP-funded studies are active

84

GWIRP TREATMENT FINDINGS

Coenzyme Q10 (CoQ10) found to reduce pain, fatigue, cognitive and certain
other symptoms in veterans with GWI

Acupuncture may improve some GWI symptoms, including pain, fatigue, sleep
quality, and cognitive symptoms

FY08 CTA Dr. Lisa Conboy, New England School of Acupuncture ( GW080059)
Published in 2012 Contemp Clin Trials 33(3):557-562

Carnosine found to increase cognitive function and reduce gastrointestinal

symptoms in veterans with GWI

FY06 IIRA Dr. Beatrice Golomb, University of San Diego ( GW060036)

Published in 2014 Neural Computation 26(11): 2594-2651

FY06 IIRA Dr. James Baraniuk, Georgetown University ( GW060044)

Published in 2013 Glob J Health Sci 5(3):69-81

Xylitol- and saline-based nasal irrigation may mitigate respiratory (chronic

rhinosinusitis) and fatigue symptoms in GWI

FY10 ITEA Dr. David Rabago, University of Madison, WI (GW100054)

Published in 2015 Contemp Clin Trials 41:219-226

85

SOME IN-PROGRESS GWIRP

TREATMENT EVALUATIONS

Novel Anti-inflammatories (Younger, GW130015)

Inflammation reduction (Bach, GW130025).
Intranasal insulin (Golier, GW110054)
Methylphenidate plus a GWI-Specific Nutrient Formula
(Kaiser, GW130047)
Mifepristone (Golier, GW060048)
Monosodium Luminol (Shetty, GW130037)
Naltrexone and Dextromethorphan (Meggs, GW080064)
Nasal Irrigation for Chronic Rhinosinusitis and Fatigue
(Rabago, GW100054)
Polyphenol Preparations (Pasinetti, GW130070)
86

GWIRP ALTERNATIVE THERAPIES

Acupressure (Lin, GW110019)

Acupuncture treatment protocol development
(Conboy, GW130028)
Cognitive therapy for improvement of sleep
quality (Nakamura, GW100068)
Portable vestibular stimulator (Serrador,
GW130093)
Probiotic for bowel symptoms (Tuteja,
GW093043)
Yoga for pain management (Bayley, GW130022)

87

WHY IS THERE A GULF WAR ILLNESS CDMRP?

DoD and VA efforts had focused on stress,

psychological issues, and causation complexities.
No priority to find evidence-based treatments to
improve GWI veterans health and lives.
Federal efforts failed in nearly all regards, yielding
no identifiable quality of life improvements for
affected veterans
Extensive criticism of prior federal efforts by VSOs,
Congress, the media, and Gulf War veterans and
their advocates
Gulf War Illness CDMRP created by Congress in FY06,
in response to demonstrated need for a treatmentfocused GWI medical research program, outside of
VA.
88

WHAT MAKES GWIRP UNIQUE?

Treatment-focused a model for other environmental

injuries and Toxic Wounds.
Unique in the federal government.
GWIRP/CDMRP funds any qualified researcher; VA
funds only VA-employees
Includes Consumer (patient advocate) reviewers, who
offer focus, urgency, and impact insight. GWIRP: 1991
Gulf War veteran living with Gulf War Illness
Special emphasis on interdisciplinary and interinstitutional research collaborations to better solve
complex issues than single researchers working alone.
GWIRP is relatively small by federal research funding
standards.
89

CONGRESS ON CONSUMER REVIEWERS

The inclusion of patient advocates in

the CDMRP peer review has been a
highly regarded addition to the process,
and the Committee believes that these
voices provide a valuable contribution.
SOURCE: Senate Report 113-211 - DEPARTMENT OF DEFENSE APPROPRIATIONS BILL,
2015; July 17, 2014. (S. Rpt. 113-211, p. 254) URL:
https://www.congress.gov/congressional-report/113/senate-report/211

90

Congressional Intent
The FY08 National Defense Authorization Act (NDAA) conference
report directed the Secretary of the Army to utilize the authorized
funding to undertake research on Gulf War Illnesses. Conferees also
directed that activities under the Gulf War Illnesses program include:
Studies of treatments for the complex of symptoms known as Gulf
War Illness
No studies based on psychiatric illness and psychological stress as the
central cause
Competitive selection and peer review to identify research with the
highest technical merit and military value
Annual letters from the Senators and Representatives to the Defense
Appropriations Subcommittees provide similar guidance.

91

GULF WAR ILLNESS CDMRP FOCUS

The GWIRP focuses on funding innovative,
competitively peer-reviewed research to:
(1) provide a better understanding of the
pathobiology underlying GWI,
(2) identify objective markers (biomarkers)
for improved diagnosis, and
(3) to develop treatments for the complex of
GWI symptoms and their underlying causes.

92

GWIRP EMPHASIZES IOMS TWO

RECOMMENDED GWI CASE DEFINITIONS

SOURCE: p. 74, National Academies of Sciences, Engineering, and Medicine. 2016. Gulf
War and Health, Volume 10: Update of Health Effects of Serving in the Gulf War, 2016.
Washington, DC: The National Academies Press. http
://www.nap.edu/catalog/21840/gulf-war-and-health-volume-10-update-of-health-effects

93

GULF WAR ILLNESS CDMRP

SUPPORTERS

Supported by: American Legion; AMVETS; Association of the

U.S. Navy (AUSN); Burnpits360; Disabled American Veterans
(DAV); Lung Cancer Alliance; National Gulf War Resource
Center (NGWRC); National Vietnam & Gulf War Coalition;
Paralyzed Veterans of America (PVA); Sergeant Sullivan Center;
Toxic Wounds Task Force; Veterans for Common Sense (VCS);
Veterans of Foreign Wars (VFW); Vietnam Veterans of America
(VVA).
The FY15 Independent Budget Veterans Service Organizations
(IBVSOs, composed of AMVETS, DAV, PVA, VFW, and 53 other
organizations that serve veterans) stated that the Gulf War Illness
CDMRP, has made great strides in the short time it has been
operating.5 (pp. 126-27)
Strong support from GWI CDMRP Patient Advocates (Consumer
Reviewers)
SOURCE: The Independent Budget for the Department of Veterans Affairs: Fiscal Year 2015.
http://www.independentbudget.org/2015/IB_2015.pdf. Accessed February 26, 2015.

94

FY16 GWIRP PROGRAMMATIC PANEL

Anthony Hardie, former Staff Sergeant USA (Chair)

Florida Veterans for Common Sense

Roberta F. White, Ph.D. (Chair Emeritus)

Boston University School of Public Health

Daniel Havlichek, M.D.

Michigan State University

Carlos Maldonado, Ph.D.

Department of Veterans Affairs

K. Jeffrey Myers, M.D.U.S.

Department of Veterans Affairs

Marni Silverman, Ph.D.

Henry M. Jackson Foundation for the Uniformed Services University of the Health Sciences

Andrea White, Ph.D.

University of Utah

Services and Benefits for Gulf War Veterans

CONCLUSION

96

RESOURCES

91outcomes Gulf War health/news:

91outcomes.com
Gulf War Illness Research Program
(DoD-Congressionally Directed Medical
Research Program): http://
cdmrp.army.mil.GWIRP
Gulf War Illnesses Facebook Group:
www.facebook.com/groups/
125208941896
National Veterans Legal Services Program
(NVLSP): nvlsp.org
VA: http://www.va.gov/GulfWar
Veterans for Common Sense (VCS):

97

Thank You.
Questions?

98