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tv   House Veterans Affairs Subcommittee Hearing on Gulf War Illness  CSPAN  July 13, 2017 11:30pm-1:04am EDT

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congress should renew portions of the foreign intelligence surveillance act. it allows officials to access electronic communications of people living outside of the u.s. you can watch both events online at c-span.org or listen live with the c-span radio app. "washington journal," live every day with news and policy issues that impact appeared friday morning, mary agnes carey will join us to talk about what is included in the latest senate republican health care bill. be sure to watch "washington journal," join the discussion. >> to health subcommittee's looked at how the v.a. reviews claims from gulf war veterans. a recent report found they denied more than 80% of claims
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from gulf war associated illnesses. officials from the the a and accountability office testify. -- testified. >> good morning and welcome everyone. this is a joint hearing of the subcommittee on disability oversight and investigation. we will come to order. i want to take a moment to thank for holding the hearing with me today on an important issue we are facing, and that is helping gulf war veterans get the benefits they have earned. itching go without saying we have a duty to take care of the men and women who have been wounded while serving in our military.
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unfortunately, too many injured gulf war veterans are not being taken care of. the v.a. estimates that 44% of gulf war veterans develop gulf war illness, yet 26% of these veterans are receiving benefits. something does not add up. similar 15, 2016, a , the v.a. testified it was taking steps to improve service for gulf war veterans, gao foundar later, they are only proving 17% of the claims of 04 illness, about one third of the approved rate for other claims. reports is only 13% of the claims were diagnosed of the illness and approved. i can't understand that at all.
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v.a. regulations state that veterans have certain symptoms such as headache, fatigue or joint pain, the v.a. is supposed to present these symptoms are related to the veteran's service in the gulf area, yet 80% of the claims are denied. 87% are denied. they found that one of the problems is the physicians are applying the wrong standards in exams. another issue is the ba employees are not -- ba employees are not ordering the exams when necessary. recently that the v.a. retained all of its employees on these claims and i am looking forward to hearing whether retaining these employees need a difference. i'm also frustrated because gao pointed out that the decision letters are not clear. this issue keeps coming up.
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as you know, my repeals reform bill would require the the a to make -- ba to make its decision letters more clear for the veterans but it should not take legislation to force the v.a. to act. or like to see them change their decision letters now so the veterans understand why they made the decisions they did. gao also found-- other issues. definitioningle case , for example. i'm looking forward to an honest discussion. none of us want to come back here next year to find the same problems. after this hearing, i intend to work with my colleagues to keep -- on va toake sure
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make sure these changes are made. consent --t britain written consent be placed into the record. without objection, so ordered. i want to thank the witnesses for being here today. with that, i want to call on the rankingt distinguished member for her opening statements. >> thank you, chairman, and to the gentleman and ms. este when she arrives. been 26 years since the beginning of the persian gulf war, and since then 44% who serve in the conflict have suffered gulf war illness. sadly, they struggle to receive accurate diagnosis for their symptoms, access needed health care and compensation for their service connected conditions,
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even with the presumptions that should result in more veterans receiving benefits and not denied claims. last year, our subcommittee held a hearing on access to treatment for gulf war illness, and more research is needed to get our veterans health care they need. now we are back here again. -- is way, this entirely entirely bipartisan across our committee, to determine what 83% of all four illness claims are va and what weth can do to ensure our veterans receive the treatment they have earned. this is an often debilitating disease and veterans suffering from it deserve compensation and have the condition recognized and treated i v.a. providers. the state veterans advisory committee in my home state of new hampshire were criticizing
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the process for adjudicating gulf war illness claims recently. one of the members of our advisory committee had his own claim for gulf war illness denied. process is poorly run and fails to adequately train personnel. whatatest report confirms our constituents continue to tell us on a regular basis. there claims continue to be night because medical examiners do not know how to diagnose all for illness or the v.a. fails to apply the assumptions that congress intends. when these claims are denied, v.a. does not communicate to veterans the reasons for to nile, losing faith in the v.a. and filing appeals.
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the report found that 90% of medical examiners the v.a. relies upon to assess disabilities have not completed the elected training on gulf war illness so they can better address illness levels. i would like to know why this is not a mandatory where and when it will become mandatory. i will also like to know if the web-based training is sufficient to train examiners, and if we need it or training requirements. all would also like to hear from the v.a. on his plan to communicate better. when veterans are not provided the reasons a claim is denied, they become frustrated and angry. they end up in the appeals process that is already flawed. if they do not know why the appeal was denied, they can spend years attempting to obtain their benefits through a lengthy appeals process. continuese know v.a.
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to support research on gulf war illness, but they lack a definition and as i understand, has no plan to develop one. a uniform definition was themmended in 2014 by research advisory committee and national academy of medicine. a single case definition is needed to improve research, diagnosis and treatment of gulf war illness and i would like to see a plan put in place to develop a single gulf war illness definition. the number of gulf war illness until 2015,ed 2010 and we can expect more veterans will file claims. it is imperative the v.a. implement the recommendations now so that veterans receive the claimant and disability benefits they deserve without having to fight the v.a. every step of the
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way. thank you, i yield back. thank you. i will ask all members way there opening remarks, per custom. i would like to welcome our witnesses again. thank you for taking the time to be here today. our first witness is senior adviser for compensation services. he is accompanied by dr. patrick joyce, the chief occupational health clinics. melissaso joined by emery hess, is that right? director of the gao. claimsuty director for
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for veterans affairs and rehabilitation division of the american legion. the department director of national veterans service of the vfw, and the director of veterans for common sense. i want to remind the witnesses that your complete written statement will be entered into the hearing record. you are recognized for five minutes. >> thank you, chairman. opportunity tohe discuss how v.a. processes gulf war veterans claims for undiagnosed illnesses. for purposes of my testimony i will refer to these illnesses as gulf war illness.
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i will describe some of our training efforts. when a veteran has served after areas, -- from december 31, 2016 until the super 31st, 2021. 2016, thousands of veterans received a claim for specifically gulf war illness. awarded service connection for this illness. unexplainedically multi symptom illness. continues to shake and
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is training for all four illness claims. 13owned -- we have developed new courses. we are currently developing a new training module which will focus on the proper development of these claims. the module is scheduled to launch in 2018. we have another -- a number of other initiatives, specifically to include a more thorough explanation when a claim is denied. in recent years, v.a. has developed tracking to specifically account for gulf war claims. it has amended its template to include important information for examiners when diagnosing multi symptom illnesses. is constantly looking for ways to improve benefits and services it provides to
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veterans. it works closely with the veterans health administration and reviewing research, as well as the by annual updates on goals -- gulf war issues. bba -- v.a. collaborates with medical examiners. finally, the national quality review staff, as well as local quality reviewers inshore employs correctly process and decide claims for gulf war illness. conducted two distinct special focus reviews on decisions for gulf war related illnesses in december 2015 and simmer 2016. in 2015, if focused on the fiscal years gulf war illnesses and showed a 94% accuracy rate.
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to 2016 expanded to review chronic, multi symptom illnesses starting from 2011. this showed an 89% accuracy rate. improve thees to efficiency, timely and accurate processing of claims involving service in the gulf war, although the science of undiagnosed illnesses and multi symptom illnesses is complex, the v.a. continues to review literature to have a better conversation of these illnesses. i'm happy to address questions. >> thank you. you are recognized for five minutes. andhank you, chairman members of the committee. i am pleased to be here to discuss a recent report on v.a. 's evaluation of gulf war
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illness claims. the causes of gulf war illness are not always known, and symptoms of very widely. they may experience symptoms such as fatigue, headaches, joint claim, insomnia, respiratory disorders, skin problems and memory impairment. they may also have infectious diseases like malaria. for gulfrs to claims war illness as medically and infectious disease claims. we refer to these claims as gulf war illness claims. my testimony today will focus on our findings related to three key areas. one, recent trends in gulf war illness claims, too, challenges v.a. faces, and three, gulf war illness research appeared in terms of claims trends, we felt the number of claims processed
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has increased in recent years. processed about 11,400 claims, more than double the 4800 and processed in 2010. many of these claims included multiple medical issues or symptoms related to gulf war illness. on average, we found that all four illness claims took four months later -- longer to process and other claims we also found gulf war illness claims were approved at the were rates than other types of disability claims. foround that approval rates gulf war illness medical issues were about three times lower than all other claims. found that 17%e of gulf war illness medical issues were approved, compared to 57% for all other types of medical issues. according to v.a., several factors may contribute to the
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lower rating. including the claims are not always understood by staff. additionally, veterans sometimes fall for all four illness benefits, according to some staff we spoke with, do not provide sufficient evidence that symptoms have existed for at least six months, as it generally required by regulation. in terms of challenges v.a. faces, we found there is an adequate training for medical examiners. claims of rating staff often reside on -- rely on these examiners to assess disability before they make a decision on a claim. the medical examiner's we interviewed said that conducting gulf war medical exams is challenging because of the range of symptoms that could mollify as gulf war illness. the v.a. has offered an optional 90 minute, web-based training for its medical examiners since 2015, but according to vha, training only showed 10% had
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taken as a february. we recommend the v.a. require the complete training. we also found the decision sense to veterans denying claims it do not always clearly explain to the veteran how the claim was decided, which can leave them on june -- them i'm sure and lead to unnecessary appeals. requiremend they letters that clearly explain how the claim was evaluated. in terms of gulf war illness research, we found v.a. does not have a plan to develop a single case definition of gulf war illness. advisory groups have emphasized that establishing a single definition could improve diagnosis and treatment. these groups recommended that in dataear term, v.a. analyze
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from its existing set, and in the long-term, conduct research appeared -- research. a plan, but they have no action plan in place to achieve it. they are plan, engaging in research not targeted toward its goal. we recommend they prepare a plan to develop a single definition and v.a. agreed with this recommendation. thank you. this concludes my remarks. >> thank you. you are recognized for testimony for the american legion. >> thank you. it is like deja vu all over again. you made this assertion in your upbringing remarks in the previous hearing on this. injured veterans later, we are here again to
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discuss the adjudication of gulf war illness claims i v.a. -- by v.a. and morning chairman, distinguished members of the committee. on behalf of national commander schmidt and the over two million members, i appreciate the opportunity to testify. gulf war illness claims are inherently complicated. veterans must read murky waters to get service connections for undiagnosed illnesses. and undiagnosed illness is a cluster of symptoms unexplained and undefined. veterans seeking treatment are often treated for years and often have multiple diagnoses the v.a. will acknowledge they are related to and undiagnosed illness. it is frustrating for veterans, and overwhelmingly denied by
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v.a. v.a. has previously acknowledged its frustrations with gulf war illness. one would think there would be mandatory training to improve the workforce understanding. ofever, only about 10% medical examiners successfully completed an optional course relating to gulf war illness. this is pathetic. only one of 10 examiners have taken the optional course, that to other nine are qualified conduct examinations. let's not forget that many examinations are also now done by private contractors. what requirements are being made of those examiners? the american legion has over 3000 accredited representatives throughout the nation. these dedicated individuals are the lifeblood for staff in washington. they are the souls that provide necessary feedback on issues that are in states regulate. one reported that a regional office employee stated that thanan service in ploys --
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our own employees. aremately these inconsistent decisions. officers spoken to this hearing said they had to accept claims will go to the board of appeals if they expect the going -- the claim to be granted, resulting in possible years before a decision. these statements will have little, if any impact on our own decisions, but the service officers report v.a. decisions are more favorable to veterans. combined with american legion findings, this is a bleak picture of gulf war related claims. 10% participate in the optional training. three generations of veterans
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have traditionally been impacted, and concerns of been swirling for over a quarter of a century. a 20 rolled deployed troops in iraq was not even born when these symptoms arose, and may yet suffer, but we have not it orined how to treat process the claims four. the american legion is willing to work toward these goals. we have worked with v.a. in designing and appeals monetization plan we collectively achieved. we have room for substantial changes to occur. we are eager to work to college this fee. this is a problem that will not shortly by finger-pointing, but by agreeing on identified problems and result -- and arriving at sensible solution. again, on behalf of the members of the american legion, we appreciate the opportunity to speak to you this morning. >> thank you.
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you are recognized to present for the vfw. >> thank you. however like to thank you for the opportunity to testify with regard to gulf war and-- illness. psw officers work hard to ensure familiesers and -- ive the maximum i will focus on the signature condition referred to as gulf war illness. it is intrinsically difficult to diagnose and treat. it has no clear and consistent several. no one distinctive set of symptoms that allow for a
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single, unmistakable diagnosis. it presents itself as a conglomeration of possible symptoms, which countless members of the general public could also be subject. as such, veterans have a steeper help climb in getting -- steeper hill to climb in getting service. none of this is possible without the benefit of a v.a. exam. evolve,continues to they developed questionnaires with an eye toward deficiency and timeliness. -- last year,w the vfw advocated on placing emphasis on multiple body symptoms as opposed to each symptom. we posit from the outset, the evidence needs the criteria.
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the current system of assigning , ultimately each results in the claim being denied. more than a year ago, these committees met to discuss this topic and press v.a. to develop a single dbq. regrettably, there is not reported progress in developing the eq and veterans continue to have claims tonight. v.a. continues on a general illness dbq. they rely on subjective, not medically claims assistants to determine whether to schedule exam. the response of record was v.a. would look into the issue. single dbq is a real problem.
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let's stop mincing words. we know this is a problem. this continued problem also has a downstream effect in the appellate process. advocates continue to find numerous inconsistencies when decisions are demanded to the regional office. favors notes that v.a. finding a debt -- a diagnosis for each symptom and rolling out gulf war illness -- ruling out gulf war illness. continuerges v.a. to these possibilities is existential. evidence as to -- the v.a.ence should develop a claim for the disability. it has suggested that inconsistencies in the rating system is universal across the
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office spectrum with guard gulf war's abilities. are not suggesting this is deliberate, we continue to put toward that a grant for gulf war illness in michigan should be the same as new hampshire or any other regional office. analysis andnce integrity has to maturity capability -- density capability to the keystroke. properly adjudicating illness will illuminate disparities. -- eliminate disparities. as one of the nations largest groups were providing direct assistance to veterans seeking benefits, we thank you for your oversight. us in urging join
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a single dbq for gulf war illness. this concludes my testimony. >> good morning and thank you chairman berkman and ranking members and members step of this hearing. thank you gulf war veterans. we know you're watching live and what happens here today matters to you. i am anthony hardy, national chair of veterans for common sense and the u.s. army. we appreciate lashes hearings and trying to fix these unresolved issues including are many under -- unidentified issues and pages of stories from veterans all over the country written in their own words. just a few was denied the a claims -- was denied the code blames just denied the code claims.
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i slept 14.5 hours, slept for another 8.5. this is right off my fitbit. how my supposed to work when i cannot get out of bed? this is not how us all my life. they read about losing their life, their jobs, their finances and even their homes, all right denying their goal for claims. one from louisiana writes about having to instruct a supervisor who had it wrong in calling the white house seeking resolution. the kentucky veteran wrote i filed and was night -- and was denied. others say the same thing whether it is symptoms exhibited -- being contributed. it is 22 years since congress enacted the 1994 law that created a presumption for undiagnosed symptoms. today we have heard about geo-confirming earlier findings.
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claims at a rate greater than 80%. the denial rate for a diagnosed illnesses are the worst of all in these trends are worsening over time and are 87% overall -- and get this, 90% undiagnosed illness. we see from the claims and report that his claims take 50% longer than other claims, meaning veterans who are the worst off suffer the longest. claims --nd reports under reports claims. the fact that the v.a. the -- leaves the door open for potential litigation. given gao's finding that they have not completed internal gladdations, we are leaders seem to be stepping up to the plate to fix the liquidations. in reviewing these benefit questionnaires using claims processing, many for diagnosed conditions would begin with this
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question, does the veteran have this diagnosis? -- and will always attribute a veteran symptoms to a diagnosable illness, that is most damming. how much training is conducted. collectively this body of evidence makes it clear, undiagnosed illness as it budget equal v.a. claim does not work. it is down clear what we need to do, the statutory fix along the lines that we proposed is needed . or we are going to keep having these investigations. decade after decade it we ask that congress work with president trump to enact legislation to fix gulf war illness claims and many issues we raised. the v.a. is serious about resolving this issues and the ones that the veteran late --
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veteran raises. deviation leap at the chance to work with congress to craft this legislation if for no other reason than any -- than the human impact. some carefully to these words written by fellow wisconsin veteran. i was told there is a two-year wait before my appeal will be open. that is now up to four years it over the last 10 years, have lost two jobs and my home. we've had to move twice and change schools. i feel like i am on the verge of losing another job and i'm afraid i cannot rebuild. i psychologist told me that it is a long time to hold on to life by my finger nails. i agree. i told my doctor wednesday that i would blow my brains out if i am denied again. per day do not kill themselves because of ptsd, is because they are called a liar idea and magician who is supposed to be helping us.
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liar by the administration who is supposed to be helping us. i will do my best to let them know i was destroyed by the v.a. >> as soon as i turned my microphone on, i will start. i do want to thank you all for being here and for your testimony. i want to start with the question. mr. hearn, do you think the education manual provides useful guidance for employees related to the gulf war illness? mr. hearn: when preparing for the testimony i was reviewing the manual and i think it is fairly clunky and the way it is written. i question as to whether or not cases are more recent applied properly. vsr's itand why the
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having difficulty understanding what to do. when you look at the via so, they do not use the manual when advocating for a case. you know who else doesn't? the board of veteran appeals. it is funny that the one aspect that seems to be different is this manual. that certainly is a concern with the way the v.a. goes about dealing with these types of cases. >> how do you respond to the statement about where we are at? .> thank you, sir first of all, i would like to say the week before last, i had my 42nd anniversary working at the department of veterans affairs. all kinds of jobs from a basic adjudicator to where i am now. we used to have a very -- a
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manual was all in paper. it took forever to make changes to get them to educators out in the field. now it is a live my annual because it is live -- it is a live manual does it is online. we make changes easily. we have a large staff that can do that. it is very much compared to what we staff. is it perfect? no. nothing is going to always be perfect because there always changes. there is either a court decision or legislation that is going to require us to make changes. we do a lot of training. we have a very large train staff who works very hard to train our adjudicators in our specialists in making the right decisions. .hese claims are difficult for example, and nine diagnosed illness coming -- and undiagnosed illness, anyone
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presents you a constellation of symptoms, the first thing you do is try to diagnose them. if you cannot diagnose it, you cannot treat it. if you treat it with the wrong type of medication, and you could do some harm. that is one reason why it is so difficult, undiagnosed illness claims. to request an examination, the examiners to all tests to try and determine what the veteran has. if they can't, we ask them to report to us. the veteran has an undiagnosed illness -- whatever body system it may be when that gets relayed to us, we make the claim. a diagnosis is often made and when it is made, then the direct service connection criteria comes in to play it we must find evidence. >> i do have another question
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that i want to get to. the v.a. issued a training thatr on february 2010 entails that the v.a. should the gulf war illness. however, the v.a. found that employees have different interpretations of the policy, despite the steps to clarify with guidance. i think we can all agree that adequate exams, if one was requested, or critical to correctly processing this claims. the fast letter that was issued seven years ago, even despite the lack of additional clear guidance in the manual, so why is it the v.a. employees still have such difficulty knowing when to request an exam for these claims? question: it is a good
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. our live manual is pretty clear, at least in my view. -- there was ar recommendation made by geo-, it was an expression that we should do a consistency study on the schedule -- only to schedule an examination. melissa: melissa is fine. >> what you think the reason is? melissa: the v.a. told us they were planning to do a consistency study to violate the issue and referral to medical exams. they would be doing in the third quarter so i think that is a next like question to ask a v.a. in terms of the status of the consistency study. april.as completed in we gave it to a lot of the srs .hen there was a wrong answer
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after these exams were given, then the people who took the exam were taken to a room and provided post examination training to ensure they knew the right answer, what it is going forward and would not make the same mistake. >> can we get results of the studies for the record, please? >> yes. >> my time is expired. i to do that -- i hate to do that but miss custer did have to leave for another meeting. i hope to do that for you. much.nk you all very i appreciate you being here. this is the fourth or fifth -- i
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started at 6:00 a.m. this morning. it is one of those days. i really want to thank all of you very much for your efforts and for a really partnering with us. this committee park -- prides itself on partnership and getting things done for veterans. and we are serving people the way we need to it as technology changes and the need for a veteran change, the population is going to change over time. we are not always going to get it right but we are going to try. out how we can do this better. at,ssue that i want to look because i hear about it all the time in my district and i talked about it before in hearings here is on decision letters. on the lack of clarity in decision letters. i'm a lawyer. i read those letters and i don't
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-- i cannot tell what they mean. how can our veterans what they mean? they are disrespect for the lead to appeals and frustration and a feeling of disrespect. if people could talk a little bit about what can we do. this is an incredibly high priority for me. it is just wrong to be sending out letters that don't have clarity. what can we do to get greater clarity in average people speech? you should not need to have a phd to figure out what these letters mean. i do think it is disrespectful which is a number one problem. number two, it leads to appeals. we have to find a better way forward. let's hear your thoughts on this as we are moving forward. ms. emrey-arras: i would say that we found that the letters
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are not specifically inform veterans that their claims have been considered in terms of presumptive eligibility. the language made it seem like me direct service connections have been considered. if you are a veteran expecting a presumptive claim and you saw the letter, you would think that was not evaluated appropriately. >> v.a. accepted that recommendation echo -- recordation? we need to look at it to see where we can make it even more clear. >> this is a great concern to our organization as it is to the american legion. the number one thing about these letters, as you said, their convoluted. they're not written in english. they are not written in plain language that the average citizen can understand. this is for every disability. this is for every medication with eva -- every communication
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-- the v.a. we had to deny the claim because there's no diagnosis. that tells a veteran nothing. make them simpler, make them straightforward and allow the veteran to understand the shortcoming so that we can go ahead and prove the claim -- and approved the claim. thank you. issues we have noticed over time, especially in the appeals inventory is the v.a. shot themselves in the foot with these letters, because a lot of veterans are appealing cases or appealing their claims, what they are appealing, they just know they feel like they got messed over by the v.a.. saying, they will sit there and say to gain
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service connection you have to have the following. you have a diagnosis, you have an incident of service yet we do not have a doctors note making the two conditions. -- doctors note linking the two detent -- the two conditions. he shouldn't have some sort of phd to figure this out. this has been a problem that we have been calling for for years. that was a caveat for the sole thing. we are looking forward to this. when thesuggest that v.a. has a draft letter ready, they circulated to this committee test they circulate it to this committee? i agree, i think it should be broken up with a checklist, numbered, so you can see this criteria must be met. these would be documentation. it is really clear and easy to do a checklist. that is the military way. do not bury it in the middle of
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. break it out so you can -- middle of a paragraph. break it out so you can see it. i work with behavioral economists. i like to see actual veterans read it. that would help us all get to the objective. i see i am over time. my apologies, chairman. >> no apologies necessary. quality -- you should never put a time limit on good quality. mr. kaufman, you're recognized for five minutes. >> i want to say, as a gulf war i wasn, how disappointed in the aftermath of the war. and to this day that the department of defense participated in a cover-up and that cover-up was the exposure to chemical weapons.
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that i can remember the marine corps limited advance in the first gulf war was the northern end of kuwait on the iraqi border. i can remember in the aftermath of the fighting and you have tremendous visibility in the open desert seeing this white cloud close to the ground not moving. i didn't think there was a question at that time i knew later on what was. it was that combat engineers of the net states army were blowing chemical weapons in place, because they didn't want to go through the hassle of all the decontamination stuff. we were fortunate that we were not downwind from it, that the wind patterns were moving in the other direction. none of the marines i served
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with came down with gulf war illness. the department of defense denied for a five-year deal in the aftermath of the war that the u.s. troops were exposed to chemical weapons. it wasn't until they were forced to admit it later on that they did blow chemical weapons in place. we got off to a very bad start in terms of research, that that was not one of the aspects that were researched because the department of defense were so became it ended -- were so vehement in denying. moutht a bad taste in my as a gulf war veteran in terms of the integrity in terms of the united states government. i think my question at this point is, in the training of these disability -- folks that do the processing -- review the claims.
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there doesn't seem to be uniformity in the training, and that as i understand it, there is a course that is optional for the to take that is online. let me ask the v.a., why isn't that mandatory training for our folks who do this -- to review these claims? >> are you referring to the training for the medical examiner's? or the people who make the decisions? >> i think that is a good question. how is it for both? hire a newme we group of individuals, they get sent away to baltimore or denver . we're training academies there. they go through a lot of training. >> relative to? >> to all particular claims. group ofan initial
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training in every year they are required to complete training as well. >> the medical examiners are not required to take trainings, specific to gulf war illness issues. it is elective and because of their high caseloads and the fact they do not have a lot of time for elective training, only about 10% of the medical examiners have taken training on gulf war illness. congressman.k you the training -- that is something we have a lot of concerns about peer i addressed it done my remarks was that on the medical side, you have to remember these are doctors. doctors are a lot like mechanics. you don't take your car into the mechanic it's a fix my brakes and the guy comes out and says, i don't know what it is. the doctor comes back and says i don't know, that is a pretty rare circumstance. the concern is you have the v.a.
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as a department who said this is a priority of hours, but then only 2% have taken it -- only 10% have taken it. is wecond aspect of it have started going to these contacted examinations. if they cannot get a right with her own employees, what is good to happen when did you see -- qtc -- positions? >> my time is up. i yield back. you, mr. coffman. >> thank you, mr. chairman. this is a very important topic. presented vba with a set of recommendations on this issue. you have said and agree to all
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of those recommendations. in a general way, can you give me an idea of when you might complete all of these recommendations? and have them operating in a way that is more effective? >> yes, thank you for the question. we did accept and concur with the three recommendations. we appreciate gao's looking at this. there always is to mental and helping us do a better job. we appreciate that. the recommendation to ensure the medical examiner's take this 90 minute training has been accepted by and be made mandatory. >> do you think matt -- do you think 90 minutes is enough? let -- i will let dr. joyce answer that. dr. joyce: the course is a mere
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fraction of a training required to do a gulf war examination. these positions tested these decisions are -- these physicians are experienced before they do well for examiners desk before they do gulf war examiners. this will be completed by november. it is supplemental to the underlying training as health care professionals which allows them to address the complex subject. the subject that is not easy to define and is challenged even the learned colleagues at the national academy of medicine. >> as far as number two, i think we already said we concur as well. we'll have our decision completed in changes made by the end of next month. three, the single case
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definition. .e do have a plan to do that >> what is the plan? >> get a lot of smart people together and try and figure it out. >> what is the timeline? >> march of 2018 right now. they could not do it, it was difficult so they threw it back to us. .e are going to try and do that we are going to give people from dod, veterans health administration, the ba, the national academy, whoever we can get. they see a lot of gulf war veterans and we will appreciate their out -- then put -- appreciate their input. v.a. expectation is the would be the experts when it comes to gulf war illness.
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the v.a. should not have to look to other entities for that. the research -- this is what it is all about. why the v.a. in its mission, is because they are serving our veterans with all kinds of illnesses, but there are specialty illnesses that are not in the world, other than within the v.a. back to the medical training, yeah, i agree that the doctors that come to the v.a. are well-trained. i do not dispute that. a 90 minute web-based course to me seems like it is really not deep enough. to really understand what veterans are going through, and understanding it. certainly that is a step in the right direction to require that everybody take the course. i agree with that.
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a -- i'm in complete agreement with you. is not sufficient. it is a supplemental course to make us better abled to answer the questions. i would be doing a disservice to my colleagues to suggest you be served that quickly. >> with regard to the manual that has been spoken of and you talked about it being live and you can make changes as ago, the american legion described it as clunky. you described it as clear. the you think the manual -- do you think the manual is clear? >> it is large. it is very large. and it is full of a lot of information. i have not assess claims myself for many years -- i have not processed claims myself for many
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years so i have not used the manual. there is a lot of information there that needs to be digested. people totimes lead be confused. i am not sure about that. there is a lot there. we need to change something, we can do it immediately. that is what is the best part about it. everyone else can see it as well >> that is good. the transparency pieces good. -- see it as well. that is good. the transparency piece is good. i will -- i know my time is up but i would just like to hear from vba, not now but if you can get back to me. i would really like to know, the
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work that has been done since last year of until this point, now we are talking a year later. we're talking about needing some recommendations yet into the future. i would like to have a conversation off-line and i dr.ogize, i yield back >> done, you're recognized. unelected -- i will like to channel -- we don't like that. we can be trained to say that. iss is -- my next comment directed to dr. joyce. i want to stipulate something among us. can we agree that we do not understand gulf war illness syndrome as a disease? none of us do and there are no experts anywhere that have some competence of understanding of the pathology of this disease.
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do you agree? you do. we all agree that the claims denials are rising. some of our veterans are not having their conditions properly recognized and treated. we can agree on that. yes? some of the veterans are not being mechanized and treated for gulf war illness syndrome? them.not all of >> using the were some as we medical doctors do, i will agree with you. i have not been up here long enough to use anything other than. given that and we know the dod 1994 and to the 16 over $194 million on research in hopes of clarifying the list of
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that fit into the gulf war syndrome and we haven't made any new changes in seven years, since it doesn't 10. -- since 2010. finalize somey diagnostic criteria for gulf war illness syndrome? rolloutess the prompt of action to did -- to help these deserving soldiers? emphasis on "prompt." >> you're talking about prompt training for medical providers? >> going back to mr. hearns remark, doctors still to say they don't know. if you go to a doctor and say nobody knows in this clinic, gulf war illness syndrome, but here's this basket of syndrome -- this basket of symptoms, use
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this basket of pathologies, then they present only have go for illness syndrome -- present only have -- i spent my evening studies of gulf war illness and fascinating stuff, but not clinically relative yet. i think you can go to your doctors. i worked in the a hospitals and say nobody knows, not just you, can you make this diagnosis? >> you know, the gulf war illness is described in statute and regulation. chronicran has a symptom which is defined as -- >> pretty clearly, the system isn't working yet. getting the lawyers involved was the wrong group.
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>> that would be good but if the veteran has one of those five amount you -- one of those fibromyalgia, that is presumptive and we should be granting those immediately. if not, please let me know. >> my charger be -- and i heard you suggest we might do this by march of 2018 is to roll this out really promptly. no more phone around. -- no more fooling around. we need to take some clear actions to take these war soldiers. -- these poor soldiers. what would you have us say to our constituents who perceive that they have a medical condition arising from their service in the gulf war? yet that is not being recognized by the v.a. and that happens to us on a weekly basis. understand.
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i would say to them that if they have a disability they think resulted from the gulf war service and if it has been diagnosed, they certainly need to provide that medical evidence when they file their claim. symptoms andhave they don't have a diagnosed illness, then we are going to do what we need to do is request an examination. under the law, if after all indicated tests are done, the examiner cannot derive that a diagnosis. >> this should be cookbook, right? let's get the cookbook out there. >> it is not easy. that is the thing. >> mr. chairman, i yield back. >> thanks. you're recognized for five minutes. >> think you very much and good morning everyone. thank you for joining us.
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i asked to join because i have seen a spike of veterans coming to the congressional office asking for help. they go see a doctor or a medical professional in their told nothing is wrong with them. here we are discovering the nobody really knows the entire story or whatever it makes of some of the illnesses from gulf war. i'm talking about gulf war veterans, primarily -- i had a week months ago dedicated to talking to veterans in a group setting. one-to-one basis. all of these veterans have filed claims, and they are still suffering. some of them suffer and quiet. they quietly suffer because they are told nothing is wrong.
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mentioned that ava usually examines a gulf specializes in this issue. -- what makes you determined that that dr. knows what they are doing. >> as a general rule, gulf war
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exams are an exemption to the regular contact exams done to .hese nonspecialists >> if i go to a doctor and the doctor says nothing is wrong, they can i get a referral to go to hawaii. some of these people have no money. it costs thousands of dollars to go to hawaii. yet to get a car -- you have to get a car, rent a hotel. a doctor is saying that nothing is wrong with you, so someone has to make that appointment for them. they have to go to a doctor. >> i think i'm going to have to say we are going to have to get back to you because i'm not familiar with the referral system. >> i'm sure there are other have a doctors in the nation. -- thank you for your
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42 years of service bulimia ask you -- service but let me ask thatthe gao recommends there should be required that medical examiners complete training courses before for gulfg these exams illness. [indiscernible] 90 minute gulf war illness and only 10% would. who do you what -- what do you do to the 90% that won't do it? do you give them a bonus? >> i can adjust that -- i can address and that. when the course is mandatory, we will be required to demonstrate on a computerized record list they goes all the way to the
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central office that we have completed the course and passed the test shown we took the course. .> i am not pointing fingers i'm making statements because i come from a place where there is no be a clinic. clinicthere is no v.a. in to go to guam or hawaii requires a lot of money. these people do not have money. they have no help and so they suffer in silence. they come to me especially when do? ire -- what can i can't file appeal papers for them. i don't have their documents. -- you have 42 years of service. do you need the gao to tell you some of these things? we have discussed the year ago.
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>> [indiscernible] but we work with to make sure we get all that we need. >> i'm sorry. i don't mean to be critical. expressing, and i took the stories of veterans word for word. i added nothing. i presented them to secretary kelly. i really need help in my -- and iand i need can't -- i don't know what else to do it i joined this committee tried to find help. not to be critical of anybody.
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guys.eciate you i think gao also -- i think gao also. some of the best information i've learned over the series of hearings have come from these people. i only have the be as dubya in vfwistrict decile have it -- i only have the vfw in my district. it is going on my website. i'm telling veterans to join. i can't -- they could be helpful i apologize for being part-time general. >> no apologies necessary.
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my parents raised me to be kind. as a boy scout i was courteous, so i am going to try very hard to maintain my parents and my scoutmasters values hearing my questioning. you can tell by the questions from our members, there is a sense of urgency in this panel. a true sense of urgency. i am not sure i feel that i amghout the room, so going to look at you first. do you feel a personal sense of urgency in this? >> yes, not just for goldcorp -- gulf war veterans -- >> since you do, can you give me an example of the v.a. of the last two years, 10 years that
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actually would show a sense of urgency from the top on down to get some results? let me try it in a different way . can you give me an innovative program that was based on a sense of urgency to shrink the timeframe to develop the capabilities for the individual practitioners necessary to begin to get a handle on this problem? can you give me one example of innovation other than a 90 minute optional online training program? >> i can give you an example that is underway. >> underway? how about an execution phase? underway meaning we are working it up? defense tortment of achieve an electronic availability determining someone had exposure while they were on
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active duty. >> that is it echo -- that is it? .> yes sir >> so far the increase in the number of claims for gulf war illness is a demonstrable manifestation. >> great segue. , we -- in the military you have heard this term -- general betray us talked about creating the surge. can you give me an example of a search operation that has been instituted within the v.a.? notches asking for more money and more people but taking existing assets that you have and you pay every day of the week and redistribute those assets in a surge manner to begin to grab a handle on this?
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>> i don't know if this is what you're looking for, but over the past couple of years -- exxon >> at you read -- >> that you refocus. the enemies over here, biggest of over here. >> what we have done is developed training academies for newly hired employees where they get the training they need to make proper decisions in a group setting. they detested -- they get tested. >> is there a sense of urgency? sense gas sensing is a feeling. someone could write the word urgent, but unless you sense urgency, that is where i'm going with this. the the top down, if leaders and people in charge cannot have a sense of urgency, that is not going to filter down
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into the organization. it doesn't come from the bottom up. >> i believe we have a sense of urgency and that he is willing that all down to us. >> it is too bad it took this long to get the secretary, if you will -- secretary silken does have a sense of urgency. i'm trying to reinforce our support for his efforts to develop that sense of urgency throughout the v.a. here's a question for you. what is the single biggest challenge for us moving forward? i'm going to give you two of my choices. apathy or bureaucratic red tape. anthony p dien, would like to suggest that the biggest challenge is undying love's illness since 1994, it doesn't work. all of the training in the world is not going to fix this. we can write manuals all day
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long. it doesn't work because these conditions are diagnosed. i had a better and this morning who said i was diagnosed with sleep apnea. it is one of those nine conditions listed under sleep disorders. ?hy can't i get this done i explained that it was diagnosed and therefore it doesn't qualify under undiagnosed illness. >> is it apathy or bureaucratic red tape? there is no right or wrong answers here. it is what you perceive based on your understanding and research into this issue. >> mike, vfw. bureaucratic red tape in my opinion. too many steps, clunky, confusing. training is not conducted any way they can recognize either it is an illness and roadblocks abound. it was made -- if it was made more simple and said this is
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gulf war or we from gulf war illness and worked their way backwards. .- worked our way backwards this has been going on since 1997, mr. chairman. floor andn for mr. dr. joyce. justwould be the cost to to assume that all gulf war veterans had a base level of all for illness echo -- level of all for illness? >> i have no idea. >> would you take that for the record? staff.uld take it to our >> good. i don't care whether it is 10%, 20% -- i don't care. >> are you talking about any disability claim?
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>> get them into the system and perceptively assume that since they were there, they were exposed. i am agent orange. now can tell you that right gulf war veterans are service-connected to more than 14 million disabilities. next give me a cost. -- >> give me a cost. you were there in that specific timeframe, because when we talk about what are we number one, providing? what is the cost of providing it? how quickly are we going to come to some resolution? minetime, as a friend of told me about a month ago, he is still grieving for the recent loss of his wife to cancer. he said -- and he is writing a
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book on our experiences and bid now, but his -- expenses in vietnam. you think you have time, but you don't. i would suggest that that sense of urgency in thinking about how much time you have, but you really don't -- we need more people we need a lot more and we needed sooner. -- we need it sooner. . have gone over my time unless there are any other follow-ups, we are going to proceed with closing statements. >> i would like to thank all the witnesses to desperate participating -- witnesses for to spending. the panel is not excused. as you heard them say, our efforts as these subcommittees on behalf of the veterans are an example of true, bipartisan
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effort that we are all philosophically aligned, that is our job as a committee to do the right thing for the veterans. these subcommittees that we represent will continue to set the example for our 115th congress about doing the right thing for those involved. i am very proud to be a member of this committee. for years, this committee has been working to address the root cause of the high denial rate for gulf war illness claims. in that time, we have been met with a list of excuses from v.a. for failing to improve the process for claims. last year we held a hearing to assess the visible the claims process for gulf war veterans and highlighted that the a's approval rate for gulf war illness claims is less than 20%. the v.a. often seem to deny
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these claims because the demands to know the specific cause of an illness, yet under the law, presented conditions do not require causality because they are presumed to have been caused by service in the gulf war. the government accountability office reports that we have discussed in detail you today further assistance unit that the test further substantiated that the approval rates are three times lower than all other claims disabilities. the critical point to understand is veterans cannot receive appropriate v.a. care for symptoms of gulf war illness when the majority of those claims have been denied by the v.a. to make matters worse, the reason for claims denials are also not clearly communicated to veterans. we heard that in your testimony. it is not written in english. or they are representatives.
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failure to communicate the reason for denials leads veterans -- leaves veterans confused which further delays access to care and compensation for injuries. gao's review of the medical examination process for gulf war illness also highlighted the a's medical staff are not ethically trained to conduct -- are not adequately trained. medical examiners inform gao that it is challenging to conduct gulf war medical exams due to their range of symptoms associated with the claims. although their concerns are legitimate, there is limited evidence to support the vha has taken the initiative to improve the examination process. that sense of urgency. februaryeported as of 2017, only 10% of examiners
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participated in the optional online training for those examiners. this statistic is troubling because the vba cannot accurately provide benefits ratings without a proper exam from vha. furthermore, the gao found that another consenting factor for claims denial was the lack of a single cause -- single case definition of gulf war illness. establishing such a definition could lead to improvement in diagnosis and treatment of gulf war illness. over the years, congress has appropriated millions of dollars for v.a. research programs and there's still strong resistance a singlestablishing case definition for a nine diagnosed illness related to gulf war illness. i am extremely concerned that v.a. does not have a plan to
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the existingeview medical status is an integrated information from recent and ongoing research to identify areas of future research and established a civil case definition. -- a single case definition. that sense of urgency when it comes innovating and come together to move forward. i look forward to continuing to veterans service organizations and other stakeholders to increase gulf war illness claims approval rates. improve the medical examination process, prioritize research related to gulf war illness and ensure the vba is providing straightforward information to veterans regarding their benefits decisions. yield to, i now esty.g member st --
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>> thank you to all of you on the panel. i want to thank mr. hardy. i know this is been a passion of yours and you have been a forceful and persistent and necessary advocate. to put a human face on what i know from my friend who has inspired me to try and move this along further. i want to thank you for your advocacy. i don't think we would be your today without you. i am sorry for the reasons it has brought to you here -- brought you here. as a newer member of the committee, i am struck by how much we need to learn the hard-earned lesson of agent orange and not do what was done then. i think the level of frustration you are seeing is a deja vu. this sticking too long.
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-- this is taking too long. the most important of those lessons is we have to be determined, we have to work together. the unwieldy and long research process which again i would agree with my colleagues, the expert on the gulf war illness is not the national academy of sciences, it should bbva or dod -- it should be the v.a. or the dod. the difficulty of medical examiners have understanding the multi symptom health conditions of gulf war illness and these are getting in the way of identifying and quantifying toxic exposures on the front end and providing timely care compensation, services and most important, top quality health care for our gulf war veterans on the backend. we only to them not to let this
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-- we owe it to them not to let this happen. i think it is clear and i want to acknowledge and thank the v.a. for taking steps in a positive direction. it seems to me the steps are too small and too incremental. they lack the urgency. surge that we need. it has been 26 years since the first gulf war started. many of the veterans are very sick and they have been being down by claims process that is confusing, it is unclear and in almost every case it seems to deny what they know to be true in their lives. it undermines their faith in the system. they have disconnected. that is quite something wrong. i'm to say for my part and i suspect i'm not the only one
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that if the v.a. doesn't use its authority, congress will begin to take steps. we will set time frames. we will mandate training for all examiners, whether they are in the v.a. or whether they are contract. that has to happen. we will mandate timelines within which we have to have a single definition that everybody can use. better.to do the general and i were talking about this point about cost. it often seems to me to be the reason behind the red tape. the point should be to care for our veterans. if we're spending too darn much time and expense and people dedicated to making people who are sick prove just how sick they are and how they got so what if we took those same resources and deployed them to
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saying yes to those who were deployed in the gulf? i think it is not just an academic exercise to answer the question. what would be the cost of truly presumptively saying anyone who has served, on your feet. that is our commitment to you and not spend our time trying to figure out what percentage, where were you exactly. the point is, people may help now and we should be able to expect and they should, too, that they get back on their feet and be productive members of society. we should not ask them to prove how disabled they are. we should be helping them to get as abled as they could be. and i think that is a really serious thing we all need to be thinking about. because i just, i'm new to this committee, but i'm not new to hearing from the veterans in my district and the frustration they feel, and the time and
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effort that goes into these fine hair distinctions, when i would rather see that money going to care for our veterans and get them back on their feet. i would ask you all to think seriously about that and ask everyone on this panel if the time has not come to rethink, particularly when we are at a point with a volunteer force. our veterans are changing and we need to think about changing with them. thank you for your service. thank you for working with us. we look forward to sing those letters in august. and i hope they will be shared so we can get this better and get this right. thank you very much. and with that, mr. chairman, general, i yield back. >> thanks, ranking member. i ask unanimous consent that all members have five legislative days to revise and extend the remarks and include extraneous material. without objection, so ordered. i would like to once again, thank all of our witnesses and audience members for joining in
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today's conversation. with that, this hearing is adjourned. [captions copyright national cable satellite corp. 2017] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org]
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>> eliza collins covers congress for "usa today." she joins us on capitol hill. what changes were made to try to get more support among the republican congress? >> there have been tweaked the route, but the two main changes are this amendment from ted cruz and mike lee. they are conservatives. it was to bring them on board and also senator rand paul, although he's a little further. he wanted a complete overhaul. basically what it would do is if you are

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