Wednesday, April 20, 2016

US MEDICINE: Advocates Describe Difficulties in Getting Gulf War Illness Diagnosis

SOURCE:  U.S. Medicine, April 2016, written by Sandra Basu


Advocates Describe Difficulties in Getting Gulf War Illness Diagnosis 

Legislators Agree That Research on Causes Needs to Continue
By Sandra Basu
WASHINGTON — Veterans are experiencing a high number of denials of Gulf War Illness-related claims at least partly because the condition “presents itself in a way that is not conducive to the traditional VA disability claims process,” an advocacy group told lawmakers last month.
“Gulf War Illness is an inherently difficult condition to diagnose and treat,” said Aleks Morosky, legislative service deputy director for the Veterans of Foreign Wars of the United States (VFW). “This is because it presents itself as a host of possible symptoms common to many veterans, rather than a single condition that is clearly identifiable and unmistakable.”
Morosky made his comments at a hearing on VA’s disability claims process for Gulf War Illness held jointly by two House Committee on Veterans’ Affairs subcommittees.
At the hearing 25 years after the Persian Gulf War, lawmakers expressed concern that Gulf War veterans are being unfairly denied disability compensation. Rep. Mike Coffman (R-CO), chairman of the Subcommittee on Oversight and Investigations, cited a 16% approval rate and 84% denial rate for claims of Gulf War veterans for what is known as “undiagnosed illnesses” and “chronic multisymptom illnesses,” both presumptive conditions under current law.
“VA often seems to deny these claims, because it demands to know the specific cause for the illness,” Coffman pointed out. “Yet, under the law, presumptive conditions do not require causality because they are presumed to have been caused by service in the Gulf War.”
Source: American Jnl of Epidemiology Volume 174, Issue 7
Source: American Jnl of Epidemiology Volume 174, Issue 7
Diagnosing Conditions
Advocates described how a physician’s diagnosis for symptoms — making a veteran’s illness no longer fit in those categories — changes everything.
“Here is the catch. The moment that the veteran is diagnosed, it is virtually impossible to receive service connection on a presumptive basis, because the condition is no longer ‘undiagnosed,’” explained Zachary Hearn, American Legion Deputy Director for Claims, Veterans Affairs and Rehabilitation.
Hearn further stated that his group suspects that medical professionals sometimes might incorrectly assign veteran’s symptoms to aging or even malingering, rather than to their Persian Gulf War service.
For his part, Morosky said the VFW is concerned about the process that veterans must undergo in making their claims. When making the claim for undiagnosed illness, the veteran must list the symptoms experienced, which might seem unrelated to one another, he said. As a result, VA assigns separate disability benefits questionnaires (DBQs) for each symptom, and separate exams are scheduled.
The practice of “assigning separate DBQs for each symptom being claimed in connection with undiagnosed illness has the effect of promoting diagnoses, even when those diagnoses are minimally supported,” Morosky said.
Rep. Ralph Abraham, MD, (R-LA), chairman of the Subcommittee on Disability Assistance and Memorial Affairs, asked panelists how the VA can improve the quality of examinations for veterans.
“As a doctor, I can understand that VA examiners are more familiar with evaluating a single condition that is clearly identifiable and unmistakable,” Abraham stated.
Morosky suggested that, instead of using separate DBQs for each symptom and scheduling separate exams, veterans’ symptoms need to be looked at holistically by one physician.
“When symptoms are claimed by a Persian Gulf War veteran that are consistent when taken together with Gulf War Illness, a single Gulf War Illness DBQ [should] be given to a single physician who is trained to look for these symptoms and to look for them holistically, so that the physician can say, ‘Yes, this is consistent with Gulf War Illness,’” he explained.
When asked by lawmakers, VA Deputy Under Secretary for Disability Assistance David McLenachen said the agency would look into the DBQ issue.
“Based on what I am hearing, first we have to confirm that that is a real problem that veterans are experiencing,” McLenachen responded. “If it is, then it is something we have to fix.”
Source: American Jnl of Epidemiology Volume 174, Issue 7
Source: American Jnl of Epidemiology Volume 174, Issue 7
Gulf War Illness Research
Advocacy groups also called for  more research into the causes of Gulf War Illness by VA, an especially current concern in light of a recent Institute of Medicine report urging that the agency cease searching for the cause of Gulf War illness and focus instead on monitoring deployed veterans and treating the health problems associated with the conflict. .
“The real question is, ‘Why hasn’t [VA] done the epidemiological work on this population in a serious way that would give us some of the answers by comparing those who served in the Gulf vs. those with the same military occupational specialty who served elsewhere during that timeframe?” said Rick Weidman, executive director for Policy and Government Affairs at Vietnam Veterans of America. “They haven’t done that in any kind of serious way,”
Lawmakers agreed that more research is needed to help with diagnoses.
“I think all of us here would like to know what is going on with this Gulf War Syndrome a lot better. A physician doesn’t like a vague diagnosis,” emphasized Rep. Dan Benishek, (R-MI), who is a physician. “We want to be able to do a blood test and it be ‘yes or no.’ We don’t have that here.”
VBA Compensation Service Senior Advisor Bradley Flohr said VA has a cohort research advisory committee that meets on a regular basis and recommends research.
“VHA has an office of Research and Development; they look at the recommendations,” Flohr told legislators. “If they have funding to do the research that is being requested, they do that research.”
Rep. Ann McLane Kuster (D-NH), however, said she was concerned with the IoM’s recent recommendation, adding, “I think it may be something we can look into in a bipartisan way of whatever needs to be done to keep this research moving forward.”

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