Tuesday, March 2, 2010

VA cites “Culture Change” for Gulf War veterans

VA’s new Gulf War Task Force report – which will be open for public review -- will be “a step in the right direction,” says a top official

By Anthony Hardie, 91outcomes Publisher/Editor

(Washington, DC – 91outcomes.com) Chief of Staff John Gingrich of the U.S. Department of Veterans Affairs (VA), the highest ranking Gulf War veteran in the Obama administration, today provided an encouraging view of what he called a major “culture change” in his agency with regards to veterans of the 1991 Gulf War.  The comments were made as part of a public presentation by Gingrich to the Congressionally chartered Research Advisory Committee (RAC) on Gulf War Veterans’ Illnesses at the VA’s offices in Washington, DC.

Following a meeting with members of the RAC last July at which the task force concept was recommended, Gingrich created the VA’s new Gulf War Task Force the next month, and the Task Force’s report is due out shortly.

“I do not see the report as the end, I see it as a step in the right direction,” said Gingrich. “The Task Force isn’t done, and won’t be done until we have worked through as many issues as we can physically work through,” he added.

The report is still in draft form, and is currently being rewritten.

According to one VA official who serves on the Task Force but wished to remain unnamed, “Gingrich has kept the Task Force on a tight timeline,”

Gingrich says he anticipates that the redrafted report will be sent out to the Executive Branch, including DoD and OMB. 

He said he hopes that it will be back to VA within about another week, after which VA will adjust the report based on their concurrence or non-concurrence.

The report will then be made open to public comment for 30 days, and the availability for public comment will be announced in the Federal Register (and then here on 91outcomes).

“This is personal, we have to get this right,” said Gingrich.  “We’re going to do our best to change the culture” at VA.

“I ask that people read the report, understand that it’s a step on the path, and request clarification where it’s need,” said Gingrich.

According to Gingrich, the report will be made public, every recommendation email and call and letter logged, every comment reviewed, and the final report will be published.

When asked about how long before that might be, Gingrich said that given the large amount of expected comment, not sure.

Gingrich explained that part of the report’s contents include recommendations for changes to federal rules regulating veterans’ service-connected disability conditions.

When the three rules are published, Gingrich said VA would go back and inform every veteran who applied for service-connected disability compensation of information on the new rules, which, “should be final very soon,” he said.

Among those changes are examining the current rule dealing with service-connection for multi-symptom symptom illness and whether fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome – currently “presumptive” conditions – are the only conditions that should qualify under that rule.

“We don’t think so, we think they are ‘examples’ of undiagnosed illness,” said Gingrich.

Another rule change will be in the definition of the geographic area of that defines the Gulf War area for Gulf War illness issues, and another will be related to PTSD.

Developing and providing new training materials for doctors, including those in primary care, is another key component of the culture shift documented in the upcoming report.  Other key times Gingrich cited will be:

  • Holding seminars on environmental exposures.
  • Looking at VA’s benefits laws and rules differently.
  • Newsletters, website will be updated.
  • Added to performance metrics for VA healthcare facilities.
  • Telephone survey of Gulf War veterans.
  • Longitudinal studies to track long-term health outcomes.
  • Better focus on  female veterans.
  • Partnerships, including doing much more with DoD.
  • Need to have a transparency of records between DoD and VA health care facilities, including with the VLER (Veteran Lifetime Electronic Record).

Gingrich also said that VA needs to learn from the experiences of Gulf War veterans for veterans of later generations.  “

We need to look at environmental exposures as a whole, not just a slice of individual exposures,” such as burn pits and Camp Lejeune drinking water exposures affecting current veterans, said Gingrich.

Ginrich said, “One of the things that the Secretary [Shinseki] said over and over to me was, ‘Remember, we’re trying to treat veterans, secondarily find out the issues that caused it.  Find a way to help them.’”

“What we don’t want to do is be sitting here in 2020, and someone saying, ‘What about the burn pits, what do we do about it?’”, said Gingrich.

With regards to outreach, Gingrich was surprisingly candid. 

“With Gulf War veterans, I’m not sure the federal government could contact half of them, but we should, 20 years from now, not be able to say that,” he said.

Dr. Lea Steele, past scientific director of the RAC and now at Baylor University, asked whether VA would be allowing for input into the training manual for doctors.  Gingrich agreed to look into it. 

Steele’s concerns about allowing RAC scientists and doctors to have input into the clinical training were echoed by Dr. Kimberly Sullivan, RAC scientific coordinator and scientific faculty at the Boston University School of Public Health.

Dr. James O’Callaghan, chief toxicologist for the U.S. Centers for Disease Control and Prevention (CDC), noted that “there is always a feel-good period,” but expressed concerns that there needs to be sustained effort to make all the necessary changes.

Gingrich said he had spoken on the phone with one ill Gulf War veteran on Wednesday night. 

“I wish I could make you whole.  But I can’t.  But what I can do is everything that is physically, scientifically, humanly possible right now,” said Gingrich.

But he concluded, “This is a long-term situation, that we have the obligation to stand up and do what we can for the veteran, and we have an opportunity right now,” said Gingrich.

Time will tell how successful Gingrich’s efforts are, but at this point, the news is more encouraging for Gulf War veterans than in a long time.


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