Nonadherence to Requirements for Processing Gulf War Illness Claims Led to Premature Decisions

A large population of veterans could be eligible for compensation for Gulf War illness, which 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. The VA Office of Inspector General (OIG) conducted this review to determine whether the Veterans Benefits Administration (VBA) processes disability claims related to this illness in accordance with applicable VA regulatory requirements. The OIG found that VBA’s Gulf War illness claims process did not ensure that all requirements were met before claims processors decided disability compensation claims. As a result, VBA prematurely decided an estimated 3,200 of the 13,800 Gulf War illness claims (23 percent) completed from October 1, 2021, through March 31, 2022, leading to at least $5.1 million in improper overpayments for those six months. Moreover, the team found that premature decisions are apt to continue due to shortcomings in exam requests and exam findings. About 5,500 of the 13,800 claims reviewed (40 percent) had medical examinations that did not contain the necessary information or related documentation. Among the shortcomings were that examination requests do not provide a full definition of some key terms. For example, while undiagnosed illnesses are defined, the instructions do not indicate what is needed to determine whether a veteran has a medically unexplained illness. Disability benefits questionnaires used for evaluating claims for Gulf War illnesses also do not ask specific questions that would show how a condition meets requirements to be an undiagnosed illness. The OIG made five recommendations to update instructions, definitions, and diagnostic criteria provided to examiners and clarify for claims processors that all regulatory requirements must be met to award benefits.