Phase II, which is to be undertaken if veterans still have debilitating symptoms that are undiagnosed after phase I, includes additional laboratory tests, medical consultations, and symptom-specific tests. Estimating the Number of Veterans Suffering From Gulf War-Related Illnesses Remains Problematic

While it is widely accepted that almost 700,000 U.S. service members took part in the Gulf War from August 2, 1990, to July 31, 1991, estimating how many of these veterans suffer from illnesses related to their service in the Gulf region is much more problematic. For example, VA reports that over 68,000 Gulf War veterans have participated in its Persian Gulf War Registry program by receiving the Registry examination and being included in the Registry database. Combined, VA and DOD report that over 100,000 Gulf War veterans have requested a Registry examination. VA Not Fully Meeting the Health Care Needs of Gulf War Veterans

Although VA has a program in place to help guide physicians in the diagnosis and treatment of Gulf War veterans, this program has not been fully developed and implemented to effectively meet their health care needs. Specifically, VA’s diagnostic protocol is not being consistently implemented, and VA referral centers are being underutilized. Mandated personal counseling of veterans often does not occur, and form letters that are sent regarding examination results are not always clear and understandable. Some form letters sent to veterans at the completion of the examination generated considerable anger among Gulf War veterans. At the second facility, the Registry physician served as the veterans’ primary care physician. Although each facility’s approach is slightly different, all eight provide links between the diagnostic and treatment phases of care and are focused on the special needs of Gulf War veterans. One half reported that they did not know that VA offered the examination. Based on our survey results, we estimate that about half of the veterans who received the Registry examination in 1996 and 1997 were dissatisfied with that examination. Conclusions

Although VA has made progress in some of its VA locations, it has not fully implemented an integrated diagnostic and treatment program to meet the health care needs of Gulf War veterans. Recommendation

We recommend that the Secretary of Veterans Affairs direct the Under Secretary for Health to uniformly implement a health care process for Gulf War veterans that provides for the coordination of diagnoses of illnesses, treatment of symptoms and illnesses, evaluation of treatment effectiveness, and periodic reevaluation of those veterans whose illnesses remain undiagnosed. Scope and Methodology

Our review consisted primarily of four data collection efforts: (1) reviews of existing databases showing the number of veterans of the Gulf War that VA and DOD report as potentially suffering from related illnesses, (2) work performed at VA’s central office and one Veterans Integrated Service Network (VISN) office, (3) case studies at six VA medical facilities including discussions with groups of Gulf War veterans, and (4) implementation of a questionnaire sent to a nationwide sample of veterans who received the Persian Gulf Registry health examination. We met with groups of Gulf War veterans served by each of the six VA facilities we visited to collect information on their Gulf War experiences, their past and present health status, and the types of health care services they received from VA. We inquired specifically about their satisfaction with VA’s Persian Gulf Registry examination and the treatment they received for their symptoms. The first copy of each GAO report and testimony is free.
Why GAO Did This Study

Pursuant to a congressional request, GAO provided information on the Department of Veterans Affairs' (VA) provision of health care services to Gulf War veterans, focusing on: (1) the number of veterans VA and the Department of Defense (DOD) report as suffering from Gulf War-related illnesses and the criteria used to identify these illnesses; (2) how VA diagnoses, counsels, treats, and monitors Gulf War veterans for the health problems they report; and (3) Gulf War veterans' satisfaction with the health care they receive from VA.

What GAO Found

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.