John Plahovinsak
According to a Department of Veterans Affairs (VA) Office of Inspector General (OIG) Audit Report released on September 7, 2023, the Veterans Benefits Administration (VBA) may have made a $25.6 million dollar error in the distribution of benefits.
These benefits were directed to veterans claiming illnesses from the Gulf War Syndrome. The veterans received $5.1 million dollars in claims filed between October 1, 2021, and March 2022.
The OIG estimated “at least $25.6 million in improper payments could occur when including the review period and the additional time from the end of the review period through one year after the publication of the report recommendations, which is 2.5 years from the start of the review period.”
The OIG Audit Report entitled, Nonadherence to Requirements for Processing Gulf War Illness Claims Led to Premature Decisions, stated that the VBA failed to assess whether the veterans met the requirements for receiving compensation before issuing compensation payments.
The Report estimated that the VBA “prematurely” approved twenty-five (25%) percent of the 13,800 Gulf War Syndrome disability claims.
Gulf War Syndrome is a term that refers to a group of unexplained or ill-defined chronic symptoms found in veterans deployed to the Persian Gulf during Operations Desert Storm and Desert Shield.
Nearly a quarter of veterans who served during the 1990-91 Persian Gulf War experienced an array of symptoms that led the VA and others to investigate whether potential “Gulf War exposures” might have caused the symptoms.
Common symptoms include diarrhea, fatigue, rashes, joint pain and cognitive issues, though experts have struggled to pinpoint an exact cause for any of the symptoms.
On November 2, 1994, Congress passed a law directing the VA to begin providing compensation for veterans who served in Southwest Asia.
The VA regulation provided compensation for Persian Gulf veterans who exhibit objective indications of a chronic disability resulting from an illness or combination of illnesses that by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis.
Since 1995, there have been numerous updates to the regulation that dictate how VA will pay compensation and to whom. Initially, only undiagnosed illnesses were included in the regulation. In April of 2023, the VA announced that it would conduct a five-year study into the origins and impacts of the illness.
The VA will pay compensation to veterans who may be suffering from a Gulf War illness if they exhibit objective indications of a qualifying chronic disability. A qualifying chronic disability may be either (1) an “undiagnosed illness” or (2) a “medically unexplained chronic multi-symptom illness.”
The OIG report contended that the “VBA lacked evidence needed to decide the claims because the VBA’s examination requests and disability benefits questionnaires do not elicit the information needed by claims processors to determine whether a veteran is eligible for benefits under the regulation.”
The disability benefits questionnaires are a disease and condition-specific documentation tool (used by VBA claims processors) to provide the precise medical evidence needed to make accurate decisions on claims.
This information includes medically unexplained illnesses being identified without findings that show they meet the specific diagnostic criteria of the regulation, or qualifying chronic disabilities are identified without the required explanation or medical opinion.
Additionally, some VBA manual provisions provided confusing information that caused claims processors to make decisions unsubstantiated by the overall evidence of record and to not require supporting medical opinions.
The OIG Report stated that “the act (PACT Act) expands the eligibility for veterans who may suffer from Gulf War illness and will have a significant impact on the future processing of their claims, as many more veterans may be eligible for benefits under the regulation. This legislation has no direct bearing on the findings in this report.”
My Opinion: I have reviewed the entire OIG Report and there is no requirement contained in the Report that the VA must financially recover any of the $5.1 million dollars of disability compensations already awarded “prematurely” by the VBA.
The disabled veterans did not make the error; it was the VBA claims processors that “prematurely” granted them the financial awards.
The OIG Report also indicated that the under-examined disabled veteran applicants may have been eligible for the disability compensation benefits they received, even if their claims were mistakenly approved by the VBA claims processors.
The outcome of the VBA errors (in terms of financial liability) in this specific instance is yet to be determined.
Bio Sketch: John Plahovinsak is a 32-year retired Army veteran who served from 1967 to 1999. He is the current Disabled American Veterans (DAV) Department of Ohio Hospital Chairman and Adjutant of the DAV Chapter #63 (Clermont County). He is at: plahovinsak@msn.com.