VA Health Care

Persian Gulf veterans have reported an array of symptoms, including fatigue, rashes, headaches, muscle and joint pain, memory loss, shortness of breath, sleep disturbances, stomach problems, and chest pain. The efforts by the Department of Veterans Affairs (VA) to serve Persian Gulf veterans is a four-pronged approach involving medical care, research, compensation, and outreach and education. More than 65,000 Persian Gulf veterans have received a VA medical examination, or "registry exam." The Persian Gulf veterans that GAO contacted, along with the veterans' service groups that GAO spoke with, appeared to be confused by, frustrated with, and mistrustful of VA and the care they received for their illnesses. Veterans cited delays in receiving services, the nonsympathetic attitudes of some health care providers, the sometimes cursory nature of the registry exam, poor feedback and communication with health care personnel, and a lack of postexamination treatment. GAO observed that some doctors did not perform all of the recommended symptom-specific tests, meaning that veterans may not have received a clear diagnosis. GAO also found that personal counseling of veterans seldom took place. Moreover, form letters sent to veterans at the completion of the registry exam did not always adequately explain test results and diagnoses, leaving veterans frustrated. Doctors had mixed views on the origins of the veterans' symptoms. Some physicians believed that the veterans' problems were only "in their heads," while others displayed more open attitudes toward the veterans' symptoms.

GAO noted that: (1) the Persian Gulf veterans that GAO has talked with and who wrote to GAO, along with the veterans' service organizations GAO talked with, appeared to be confused by, frustrated with, and mistrustful of VA and the care they received for their illnesses; (2) while veterans appreciated the efforts of individual VA staff, they expressed dismay with the "system," which often extends beyond VA to other agencies and, for some, to the federal government in general; (3) specifically, veterans continued to cite delays in receiving services, the nonsympathetic attitudes of some health care providers, the sometimes cursory nature of the registry exam, poor feedback and communication with health care personnel, and a lack of postexamination treatment; (4) on the basis of GAO's work to date, it does not appear that VA's guidance regarding the evaluation and treatment of Persian Gulf veterans is being consistently implemented in the field; (5) GAO observed, for example, that some physicians did not perform all of the symptom-specific tests recommended by VA's Uniform Case Assessment Protocol, which could result in some veterans not receiving a clearly defined diagnosis for their symptoms; (6) GAO also found the personal counseling of veterans seldom occurred; (7) in addition, the form letters sent to veterans at the completion of the registry exam did not always sufficiently explain the test results or diagnosis, which leaves veterans frustrated; (8) physicians' views were mixed regarding the origin of the symptoms experienced by Persian Gulf veterans; (9) GAO heard and read physician comments indicating that they believe Persian Gulf veterans' problems are only "in their heads"; (10) however, other physicians displayed open attitudes about treating the veterans' symptoms and determining the origin of their illnesses; (11) medical center personnel cited limited resources and increased workloads as reasons their efforts are not as timely and responsive as they and veterans would like; (12) one medical center GAO visited had experienced delays of up to 6 months in scheduling registry exams; (13) however, steps are being taken at certain VA facilities to improve service; (14) for example, at one medical center GAO visited, veterans now have the option of receiving treatment in a Persian Gulf Special Program Clinic; and (15) the Clinic allows veterans to receive primary care from medical staff experienced with Gulf War veterans and their concerns and has established a focal point for providing clinical management of Persian Gulf veterans' care.