Mr. FILNER. Okay, I have a document that's labeled VA White Paper, Persian Gulf Development, and it's signed-it's apparently an internal review of the whole processes and it was undertaken last year signed by D. Rice, PGDEV. I don't know what that

means.

Do you know what that means?

Ms. MOFFITT. Dale Rice is a member of the Compensation and Pension Service.

Mr. FILNER. I mean, he outlined a whole series of problems based on internal review of the process which-I mean, I'll read you a couple of things, but just incredibly-I will say incompetent work to get-to give the veterans the knowledge of what they have to do to make the claims and what kind of evidence is suitable and the time frames that they have to do this.

For example, "evidence of continuity was not routinely requested." So if it's not requested, it's not provided; and therefore no evidence, and therefore claim denied because the folks involved from the VA's perspective did not give the assistance there's a term that you use for that-do assistance or-duty to assist apparently was never-not never-was not done in a great number of

cases.

There was no proactive communication from the VA when the law changed. For example, as noted by-in this report, "Public Law 103-446 established a use of nonmedical indicators, for example, to-for the diagnose-as indications."

And yet, those changes in the law were published in the Federal Register and not otherwise publicized, according to this report. Now most of us do not read the Federal Register, even the congresspeople.

Mr. QUINN. Oh, I beg your pardon.

Mr. FILNER. I'm sorry. My Chairman reads the Federal Register. But if you're not going-aside from the fact that it's so you know, it's so ridiculously, you know, incomprehensible, you've got to translate what is going on into language that people can understand and act on, and apparently nothing was done in a general way for veterans to understand the change.

And therefore, says this report, should that be considered an error on our part-that is, the VA's part-because-that the veterans were denied due process because they weren't told of the information?

In studying the Louisville APO, it was decided that there was no standard adjudication practices that were done. Now this goes on and on. I mean, it is extremely-very difficult to understand how such lack of standardization, lack of communication, lack of understanding of the issue was so widespread.

And if you couldn't do the training that was necessary and the standardization and the communication at four offices, I agree with local-decentralization. But I can't figure out, unless you have figured out I can't figure out from your testimony, unless you have figured out what was wrong with these four centers, how you're going to do it in 50-plus centers.

That is, the possibilities of non-standardization and lack of information and lack of communication, you know, are multiplied many hundreds of times now. And by the way, your response to why de

centralization was good, I assume I wasn't here at the time-but I would assume that congresspeople on this committee made the same arguments of why you shouldn't go to that process to begin with.

So apparently a mistake was made and now we're going back to the regional. But given all the given the problems with four of fices just in standardization and communication and in errors, how are you going, by June 1, with one-it sounds like one satellite conference you're going to solve these problems?

So are these real problems? Were they real problems? And how are you going to correct them so we don't have them again?

Ms. MOFFITT. The problems you outlined there sound like the very issues that brought Mr. Ross to the decision to review the 11,000 claims.

Mr. FILNER. Out of how many was that? What's 11,000 represent of percentage of that you could have reviewed? All, 50 percent, 10 percent-I don't

Ms. MOFFITT. That was—those were all of the cases that had been adjudicated by the four Area Processing Offices. Those were all of the denials.

Mr. FILNER. So every denial was readjudicated?

Ms. MOFFITT. Yes. And were redeveloped. A development letter went out to every claimant.

Mr. FILNER. That's a pretty significant statement, right, that you had to you have to go back and look at every single one to-because there was a fear of error on those parts? I mean, I'm glad you did it, but it's a very significant admission.

Ms. MOFFITT. We wanted to make absolutely certain that the issue of lay evidence was being fully developed so that we would be fully considering it in our rating decisions.

Mr. FILNER. Was that the only thing that you were looking for to redo?

Ms. MOFFITT. Lay evidence was the primary reason.

Mr. FILNER. I mean, how about this evidence of continuity that the veterans didn't know about? That is, if they did not place-if the first evidence of the illnesses was more than 2 years afterward, then they would be denied also, right?

Unless they were asked about evidence of continuity. And if they weren't even asked about it or told that that's what they should do, then they would be denied also, right?

Ms. MOFFITT. We looked for evidence within 2 years and then continuity requires that it have a duration of at least 6 months or more to be a chronic condition. So based on the regulation at the time, we were looking for the condition within 2 years and that it was chronic.

Now, of course, with the extension of the presumptive period, we will be looking at all of those cases that we denied for being outside the two year period and readjudicating them again to see if we can't grant based on symptoms being shown outside the presumptive outside the two year presumptive period.

Mr. FILNER. I interrupted you before you got-I mean, I mean, how-all right, so every case that was denied, we-you thought there might be an error. By the way, has that process been completed or how many have been overturned out of that?

Ms. MOFFITT. We've completed 4,966 cases.

Mr. FILNER. And how many

Ms. MOFFITT. Out of the approximately 11,000.

Mr. FILNER. No, but how many of those are now-been deemed that

Ms. MOFFITT. We granted service connection in an additional 683 cases and granted, for undiagnosed illnesses, in an additional 157

cases.

Mr. FILNER. So over 3,000 out of the 4,000 are denied again? Is that what you-I don't-am I using the right terminology here? Ms. MOFFITT. Remain denied.

Mr. FILNER. They remain denied?

Ms. MOFFITT. After readjudication, they remain denied.

Mr. FILNER. Okay, maybe I'll get back to that. So tell me about all this standardization, communication, and proactivity. How are you solving those problems by June 1 now with these 50 regional centers?

Ms. MOFFITT. Like I said, we will engage in the satellite broadcast as well as an onsite training.

Your comments regarding outreach to the veterans as well as communication with them is an important one. In our regional offices, as we move to the reengineered environment, the employees in the regional office already realize the need to have close personal contact with veterans.

And they are, in many instances, in teams where they do just that: where they have a group of veterans that they take care of, communicate with, and offer the services that should be provided to those veterans.

With regard to other outreach efforts, we looked to the service organizations to include information in their magazines, as well as us taking the approach of getting out to the community in public forums, town meetings, and the like with regard to Persian Gulf

Mr. FILNER. Who's doing the satellite thing, by the way? Who's actually doing the training by satellite?

Ms. MOFFITT. That will be provided by the Compensation and Pension Service as well as subject matter experts from

Mr. FILNER. If I were you, Ms.-let me just-I mean, you havewe have said that there's a casualness. You know, there's a nontaking seriously, we're angry and frustrated. It seems to me you ought to do something dramatic to deal with this.

I mean, for example, if the Secretary not just-I mean, did this satellite training with full media treatment of it that the Secretary of your Department at Cabinet level-get the President in on it.

We take this thing so seriously that we want to make sure that we have the absolute-we're going to tell everyone of the regional people and every person in the staff of the VA that this is a serious issue that we are-and we want people to look at it seriously, understand it, etc.

And from the very top, this is not just a bureaucratic situation where, you know, somebody-I'll say a faceless administrator in the bureaucracy is doing the training. I want, you know, the Secretary of the VA, and I want the President of the United States to tell your people that this is serious and let them start the training,

let them start the let them understand that from the top, this is a serious matter and we are not going to tolerate casualness.

We're not going to tolerate lack of understanding. We're not going to tolerate errors of the magnitude that we have seen here. So I mean, I would do something a little out of the ordinary for something as-for which you have been facing a lot of criticism on. Just some advice from someone who has to deal with these issues all the time.

Mr. QUINN. Thank you, Mr. Filner.

Do you have any reaction to that?

Ms. MOFFITT. I'll take your comment back to him-to the Secretary.

Mr. FILNER. Thank you.

Mr. QUINN. You wouldn't mind if any of us or staff joined at those satellite sessions would you?

Ms. MOFFITT. No, sir. No problem.

Mr. QUINN. Might want to-Bob, that might be an idea too that some of our folks here could join, at least observe to see what's been done out there and maybe have some suggestions and constructive criticism for anything that follows up in June or the following weeks in June.

Ms. MOFFITT. Okay.

Mr. QUINN. Thanks.

Mr. Mascara has joined us this morning. Thanks for being with us. He missed the first round of questioning. So if it's okay with Mr. Reyes, I'll ask Mr. Mascara if he has a question this round? Mr. MASCARA. Good. Thank you, Mr. Chairman. I have a statement I'd like placed on the record.

Mr. QUINN. Without objection, so ordered.

Mr. MASCARA. Thank you.

[The prepared statement of Congressman Mascara appears on p. 53.]

Mr. MASCARA. My question is the Philadelphia Area Processing Center has consistently reported a significantly lower allowance rate on the Persian Gulf claims concerning undiagnosed illnesses than the Phoenix center.

Do you know what-and the numbers are the Phoenix center allowed 297 claims and denied 1,316 claims. The Philadelphia center allowed 100 claims and denied 1,388. Is there some rationale for or some reasoning behind those significant differences?

Ms. MOFFITT. When I got here in November and looked at many significant issues with regard to Persian Gulf claims, what I chose to attack first with regard to looking at the quality was to ensure the accuracy of the development on these 11,000 claims, as well as to look at the denials to determine if we were improperly denying claims.

So our reviews up to this point have focused on those two areas. We have now begun to call in cases that include grants of service connection and will now begin to be able to look at the differences in those grant rates and have an idea as to why there is a difference.

But I do not know that difference today.

Mr. MASCARA. They have not established why there is that significant difference between those two locations

Ms. MOFFITT. Right.

Mr. MASCARA (continuing). Philadelphia and Phoenix?

Is there anything that you have seen in the results from ongoing research that would lead you to believe that we can service connect any specific cluster of symptoms exhibited by the Gulf War veterans suffering from undiagnosed illnesses?

Ms. MOFFITT. Could you rephrase-repeat the question?

Mr. MASCARA. Well, I guess the question is, is there anything you can point to as a result of service connect clustering of symptoms exhibited by Gulf War veterans?

Ms. MOFFITT. If we look at where cases have been granted, they do cluster around particular body systems.

If you'd give me just a minute.

I think generally about 50 percent of all PGW claims are granted for musculo-skeletal conditions. There's also a large number due to systemic conditions.

Hold on.

About 47 percent of all PGW claims that we have granted have had to do with a musculo-skeletal-joint pain, that sort of thing. Respiratory, as you would expect, for environmental hazards, as well as undiagnosed systemic conditions seem to be the main areas in which we are granting service connection.

Mr. MASCARA. Okay, I thank you.

Thank you, Mr. Chairman.

Mr. QUINN. Thank you, Mr. Mascara.
Mr. Reyes.

Mr. REYES. Thank you, Mr. Chairman.

Ms. Moffitt, based on the comments that you've heard from this panel here this morning, have these observations-have you not heard of the frustration out in the veteran community about these issues before? Is this a complete and total surprise for you this morning?

Ms. MOFFITT. Oh, no, sir. You know, we have definitely heard of the frustration of the veteran community. I think that's a key reason why the Secretary made the decision he did.

I happen to have accompanied him on several public forums dealing with Persian Gulf issues, and very definitely we heard the frustration of veterans as well as the veterans' service organizations with regard to these issues.

Mr. REYES. Given that, are there any plans to perhaps put together some working groups or advisory groups of veterans? You know, I have found in my experience that oftentimes the solutions to some of these problems come from the very people that are affected.

Has that been considered by the Secretary or your Department, putting together veterans' advisory committees that could possibly give you some solutions or some recommendations about these very issues that are so demoralizing to the veteran community?

Ms. MOFFITT. My understanding is that the Secretary does have a Persian Gulf Advisory Board.

Mr. REYES. Comprised of veterans, affected veterans?

Ms. MOFFITT. I'm really not sure about that, but I can provide that to you for the record.