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Mr. MAGILL. Thank you. I would probably like now to be very brief in my comments. I can only echo what my colleagues have said at the table. What I would like to do is, with the remainder of my time, have Mr. John Muckelbauer of our staff who has dealt with the Persian Gulf Illness for quite some time to have comments on the previous testimony that we've heard.

The VFW certainly does support bringing the claims back to the regional offices. And what I would like to comment on is the outreach that we've not heard too much about. We believe the VA has made some great strides over the years in the way it reaches out to the veteran population.

But we have been hearing reports that the vast majority of the Persian Gulf veterans really do not know where to go to get the information. The VFW has conducted its own registry, and we have supplied that information to the VA.

We just can't stress enough that if we want to help these veterans, they have got to know where to go to get the help. At this point, I would ask, John, if you would like to make comments.

(The prepared statement of Mr. Magill appears on p. 94.) Mr. QUINN. By all means. And I apologize for not introducing you with the rest of the panel, John, but please feel at home to comment with the time that remains from your colleague sitting next to you there.

Mr. MUCKELBAUER. Thank you, sir. And just to echo a couple of items from Jim, the VFW is encouraged by some of the VA's recent initiatives on this matter, particularly as it involves the extension of the presumptive period to a total of 10 years now and for the finally the decentralization of the Gulf War claims back to the regional offices from the APO's.

We feel these two initiatives will go a long way to address the needs of the Gulf War issue, but it's not the final answer. There are still ways—issues that need to be improved; primarily I would say the adequacy of the exams.

It was addressed earlier by Mr. Mascara the clustering of symptoms. And I don't think that that issue was fully explored. It is a fact that a lot of the Gulf War veterans are exhibiting clusters of symptoms. And the problem, as addressed by some of my colleagues, is that some of these symptoms are being diagnosed, some of them are not.

Most often, it appears that they're not looked at collectively in rendering a decision as far as compensation is concerned. And I would submit that that has largely to do with the fact that the on examinations, the doctors are not giving a determination as to the etiology or the cause of these symptoms.

That's in the regulations. The examining physician should make that decision, what's the cause of these symptoms in their opinion. If they were simply to do that, that would again go a long way to address these concerns.

Outreach efforts-certainly those could be extended. The fact is, there is a lot of information about the Gulf War Illness, but we simply deal with too many veterans who do not know where to turn to get that information. I mean, there's Web sites, there's 800 numbers, there's bulletins.

But for the vast majority of the veterans that do not have access to it, we can't reach them and we need to address those issues.

Mr. QUINN. May I interrupt for just one second?
Do you have a suggestion on how we could do that better?

Mr. MUCKELBAUER. I would say more advertising in perhaps the national newspapers, perhaps public service announcements, more frequent public service announcements, things along those lines. Additionally, the Gulf War forums that we've held recently do go a long way in continuing that.

But finally, I would just like to add that one thing as far as lessons learned is that we should encourage the VA to listen to the veterans. It's now 6 years after the Gulf War and these regulations still are not ironed out.

And Mr. Chairman, I want to thank you for addressing this issue. It's not something that gets the glitz of a Khamisiyah or biological chemical exposure or the allegations of cover up. But to the veterans affected by this, it's clearly the most important.

And thank you for that.
Mr. QUINN. Thank you very much. Mr. Burns.


DIRECTOR, AMVETS Mr. BURNS. I do appreciate the opportunity to present our views. I am-fear I'm going to be the lone voice crying in the wilderness here this morning regarding I guess last night's decision by the Secretary to return these claims to the regional office.

AMVETS' opposition to returning them to regional offices is based solely on the fact that the expertise for processing these claims lies in the APO's. These APO's have had over 2 years of experience and expertise in putting these claims together and developing these claims.

It's my understanding in talking to the representatives at the four APÓ’s that the backlog has not so much been generated by a lack of expertise or a lack of adequate training.

Much of the backlog can be laid directly at the feet of VA and the fact that, since these claims started being processed, they've sent out three new development letters telling the officers how to develop these claims resulting in the fact that each claim has to be redone again.

We have 56 rating specialists now around the country handling these claims. At the APO's, if the best trained VA personnel right now—if we are wound up with 11,000 claims being readjudicated, what is going to happen when these claims go back to the RO level?

I simply don't think that, as Ms. Moffitt indicated this morning, that 2 to 3—or 2 days of training via satellite or over a conference call is going to replace the 2 years of experience that's been gained at the Area Processing Offices.

It defies logic to assume that. I know in talking to the Phoenix office the comment that was made to our—to the AMVETS rep

resentative in Phoenix by the VA regional director out there was "God help your claimants.”

Again, it's the AMVETS position that the locality of the claim, while it's probably comforting to the claimant to have it close at hand, the veteran should get the best adjudication of his claim possible no matter where that adjudication takes place.

We simply cannot transfer the expertise and experience gained over the last several years back to the regional offices in a two day training session. We believe if VA would reallocate its resources, put more people in the Area Processing Offices, this backlog could be diminished.

To get to the smoking issue, while I haven't seen the proposed legislation the VA has—I don't know if anybody has seen it-I have a great deal of trouble with Ms. Moffitt's statement this morning that virtually equated smoking while on active duty with alcohol and drug abuse.

I am very troubled by that, not just because I am a smoker, but it seems like to me that VA is setting up a preemptive strike on proper processing of these claims. As has been mentioned by a couple of my colleagues here, cigarette smoking was fairly well encouraged when I was in the service.

We got free cigarettes in boot camp. I remember at Paris Island we had smoking circles. And for guys that had never smoked, it was a great excuse to get outside and not have to clean a rifle or shine boots.

The sea rations had been mentioned. VA also either furnished cigarettes for free or greatly discounted prices at their hospitals and the commissaries. We think, as part of my written testimonywhich I'm sure if any of you have read, you probably thought I was smoking something else when I talked about this perhaps VA and DOD should look to the private sector for funding sources for these claims since the tobacco companies are presently in negotiations with the several states to satisfy the claims.

Why shouldn't VA and DOD pursue this course using every legal means necessary to have the tobacco companies set up a trust fund to be administered by a third party to satisfy these claims? In essence, DOD and VA were acting as agents of the tobacco companies in distributing these cigarettes to active duty military personnel.

If they're going to be held liable to—if VA's going to be held liable to pay these claims, they should at least examine the possibilities of going to the tobacco companies and seeking their assistance in paying for these claims.

Mr. Chairman, that concludes my remarks. We appreciate again the opportunity to testify this morning.

(The prepared statement of Mr. Burns appears on p. 96.)

Mr. QUINN. Well, thank you very much, Mr. Burns. And you're in a great spot in case you get paged again. You can get out that door very quickly and no one will get in your way. Thanks for being with us.

Thank you all for your time today. And Mr. Puglisi, you mentioned the hearing scheduled today. We're not sure if it nudged the VA to make that decision last night or not. But certainly it doesn't hurt to have these scheduled and the content of what we're talking

about well known because that's how some of these decisions are made many times.

And thank you for your kind words.

I want to get back to the question that Mr. Mascara raised earlier and at least-I think Mr. Russo, Mr. Puglisi, and others may have mentioned it this morning about the difference between allowance rates at the western—the Phoenix APO compared to the others.

And I think you began to talk about it, but we of course limited your time here this morning.

Mr. Puglisi, you seemed to point out that you thought one of the reasons for the differences was that Phoenix, the western APO, received a lot more training. And you suggested further that if we're going to do training, that's the model that we should use.

I want to give you a couple of minutes now maybe to expand on that. Is it the fact that they're do we know the difference between the training? And then I have a question of why it didn't take place at the other three sites, of course.

And Mr. Burns, in arguing his side of that matter, says that it's not going to be done and that's why all of us were concerned this morning as to when it's going to take place, when it's going to be finished. A couple hours on TV and the satellite makes me anxious, I know that much.

Could you comment for a couple of minutes on the success, if that's what it is, out in Phoenix and what we might learn from that?

Mr. PUGLISI. Yes, sir. There were a couple of things occurring in Phoenix that I think led to more success in Phoenix than perhaps the other Area Processing Offices.

Let me tell you what I know and what I don't know. What I do know is that the American Legion made site visits last spring in 1996 to all four Area Processing Offices.

We spent several days in each place where we reviewed a representative sample of claims that we had power of attorney for and looked for errors in adjudication, looked for errors in development-looked for good things as well, things that were going right.

And we also spoke with the adjudicating officer, the director of the regional office, and all the key players there to get a feel for how things were going at that APO.

Phoenix stood head and shoulders above the APO's for a number of reasons. At that time, only at the Phoenix APO had staff been trained. And as a matter of fact, they had been sent here, to Washington, DC, to the VA Central Office.

And our understanding was that Central Office offered training to the APO's, and the Phoenix director was the only one who took advantage of that training at that time.

Mr. QUINN. Excuse me. Why don't we make that training mandatory?

Mr. PUGLISI. That's up to VA. But that seems like that should have been done. Now since last spring, that training may have occurred, but we're not aware that it has occurred. So to be fair to VA, they may have trained these folks since then, but we're not aware that that training took place.

Another key factor of Phoenix is something that you can't really mandate, and that is the quality and the attitude of the director of the regional office. The director of the regional office at Phoenix had created a real positive atmosphere within the office.

The folks who were adjudicating Gulf War undiagnosed illness claims had a real positive attitude about the claims. They were getting the backing of their boss. He had ensured that they had gotten training. He was encouraging them to do the best job they could.

And the allowance rate at that time was 11 percent and has grown since then. That wasn't the case at the other APO's. We got the clear impression that again, you can't really quantify this, but we got the impression that this was a real hassle.

You know, we've been cursed now with Gulf War undiagnosed illness claims at the APO. We might as well be declared a leper. And it's preventing us from doing other work that we have. And as a result, a thousand claims were sent from Nashville to Muskogee, OK and some other claims were sent from some of the other APO's, to Cleveland, Ohio, because of the backlog.

Mr. QUINN. Thanks.
Mr. Russo, a minute or two to respond.

Mr. Russo. Yes, I don't have too much to add to what Mr. Puglisi has said, but I think what occurs when you hand a VA adjudicator a claims file with no training and perhaps the only guidance he has is some VA manual provisions or the actual regulation itself —

Mr. QUINN. Or a form letter.

Mr. RUSSO (continuing). Or a form letter, they come up with results that are just going to be completely wrong.

And the fact that—moreover, the fact that there was no supervision of these claims that allowed the erroneous form letters to go out, that allowed claims to be incorrectly decided—and I think by Ms. Moffitt's own statistics she gave you, the rereview has shown a 10-percent error rate just so far.

I think that's reprehensible and that specific, specialized training ought to be mandatory as you said, Mr. Chairman, any time a new type of Va benefit is provided to veterans, as was the case with Persian Gulf veterans.

Mr. QUINN. Thanks very much. I'll yield to Mr. Filner. But before I do that, just for one second, I'd like to introduce Congressman Rodriguez who joins us this morning. He's not a member of the committee yet, but we're thrilled to have you.

He's taken Frank Tejeda's seat here in the Congress and we're very excited about your interest in the committee and being with us this morning. And if you feel like you want to join with any questions, just give me a wave. We'd love to have you.

Also, Mr. Burns, a quick response about the VA's legislation on the smoking. We have a copy here. And when we're finished, if you all want to stop by, we called over and made some copies, you can pick them up and take them with you.

Mr. Filner.

Mr. FILNER. Thank you. I thought it exceedingly clever of you, Mr. Chairman, to take Congressman Rodriguez and put him on the majority side. (Laughter.)

Get him over to the wrong party before he even starts here.

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