VA Health Care

The number of veterans who suffer from illnesses linked to the Persian Gulf War remains unknown. The primary difficulty in assessing the impact of such illnesses lies in the fact that the connection between the veterans' symptoms and the causes of those symptoms has not yet been identified scientifically. In response to various symptoms and illnesses reported by Gulf War veterans--from skin rashes to muscle and joint pain to memory loss--the Department of Veterans Affairs (VA) in 1992 launched a program to help them receive VA health care. This free diagnostic and referral process has two stages: (1) an initial medical history and a physical examination with basic laboratory testing and (2) if needed, further evaluation through specialist consultations and additional symptom-specific testing. However, VA's guidance on the evaluation and the diagnosis of Gulf War veterans is not being consistently implemented at some of its medical facilities. Some physicians do not do all of the symptom-specific tests recommended by VA, and although VA records indicate that thousands of veterans remain undiagnosed, only about 500 have been sent to referral centers for additional evaluations. Mandated personal counseling of veterans often does not take place, and the form letters sent to veterans following examinations do not always adequately explain test results or diagnoses, often leaving veterans frustrated and confused. In addition, in four of the six facilities GAO visited, veterans were not treated by the staff who performed the initial examinations but were instead referred to primary care physicians or teams for treatment. Primary care physicians typically do not specialize in the care and treatment of Gulf War veterans but rather are responsible for serving the general veteran population. VA's diagnostic and treatment problems are reflected in Gulf War veterans' general dissatisfaction with their health care. GAO's work suggests the need to develop and implement a health care process that includes integrating diagnostic services, treatment of symptoms and illnesses, evaluation of treatment, and periodic reevaluations of veterans whose illnesses remain undiagnosed.

GAO noted that: (1) while the number of Persian Gulf War veterans who participated in the military operations known as Desert Shield and Desert Storm is well established at almost 700,000, the number who actually suffer, or believe they suffer, from illnesses related to their Gulf War service remains uncertain 7 years after the war; (2) the primary difficulty in assessing the impact of such illnesses lies in the fact that the link between the veterans' symptoms and the causes of those symptoms has not yet been identified scientifically; (3) thus, while some data on Gulf War veterans' symptoms have been collected and categorized, it is not yet known whether the symptoms reported are the direct result of the veterans' Gulf War service; (4) combined, VA and DOD report, however, that about 100,000 Gulf War veterans have requested Persian Gulf Registry examinations because of war-related health concerns; (5) in response to a variety of symptoms and illnesses reported by Gulf War veterans, VA implemented a program in 1992 to help them receive VA health care; (6) this free diagnostic and referral process has two stages: (a) an initial medical history and a physical examination with basic laboratory testing; and (b) if needed, further evaluation through specialist consultation and additional symptom-specific testing; (7) 212 VA facilities offer the Registry program to Gulf War veterans; (8) however, VA's guidance regarding the evaluation and diagnosis of Gulf War veterans is not being consistently implemented in some of its medical facilities; (9) while VA records show that thousands of veterans remain undiagnosed, only about 500 veterans have been sent to referral centers for additional evaluations, as recommended by the Registry guidance; (10) mandated personal counseling of veterans often does not occur, and the form letters sent to veterans at the completion of the Registry examination do not always sufficiently explain test results or diagnoses, often leaving veterans frustrated and confused; (11) VA's guidance provides that Registry physicians are responsible for giving veterans medical examinations and necessary treatment; (12) VA has not fully developed and implemented an integrated diagnostic and treatment program to meet the health care needs of Gulf War veterans; (13) VA's diagnostic and treatment implementation problems are reflected by Gulf War veterans' general dissatisfaction with their health care; and (14) based on GAO's nationwide survey, over one half of the veterans who received the Registry examination in 1996 and 1997 were dissatisfied with the examination they received.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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