We Owe Our Military Veterans…
by Harold F. Hester
Rated "PG" by the Author.
edited: Tuesday, January 23, 2007
Posted: Friday, December 01, 2006
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Disabled veterans do not get anything from our government without 100% justification over and over and over. This article outlines a better way. Now all we have to do is have our government read the following 18,000 words... and understand and react to them.
If this is not THE Veteran Benefit Administration Solution, it is a good start…
Author of this short story/paper/article is Frank but could have been written by anyone of over 24,387,000 living veterans. I am two fingers he enlisted to tell you a story of “what was; what is and what should be.
Objective: Outlining and justifying the new direction for rightful and earned military Compensation & Pension and a way out of VA/VBA stagnate bureaucracy waters. A CHALLEGE near the end of this paper (page 24) will re-enforce my words and the words of ALL veterans.
Timeliness processing rightful C&P claims is only one of many problems confronting the veterans. We don’t have much time left and we need earned and rightful compensation yesterday.
Numbers quoted in this paper: Depending on which report, who is quoted and on any given day, numbers change. Please view numbers quoted here as “Yardsticks” and not “verbatim – locked in concrete”. No numbers quoted here are “made-up” but came from official documentations.
There are no inherently bad people in our VA or VBA system.
There are no veterans applying for C&P that have not earned it.
The Reality of the game: Rules and regulations for the VA and its VBA arm are quality documents, well written for the most part and offer criterion for existing and growing areas of compensation. The interpretation and action (or non-action in many cases) of those regulations, the action officers that make decisions for the veterans and the pure bureaucracy of approval are the focal points of this paper.
1 It is time to change the way our VBA does business. Everyone (from congress to everyone who has worn the uniform) say this and this paper shows how we can actually “change” and gain from it.
2. The many problems within the VBA are exponentially compounded by its action officers and antiquated government thinking on how to fix a problem. Studying the problem for 50 years, adjusting procedures, adding/deleting report procedures, adding people and throwing money at phantom problems does not work. VBA action officers are also discusses a bit later.
3. The Board of Veterans Appeal (BVA) is a major bottleneck but much of their problems percolate back and forth between the Regional Offices (RO) and procedures designed to protract claims as much as possible. More on the BVA later.
4. Congress, the VA, the VBA and Joe Public all realize there are major problems so this article will cover much of the same plowed grounds then offers virgin land for developing (Recommendations). 5. Most recently www.va.gov/budget/report/2005/MMC-Summary.pdf The Office of the Inspector General (OIG) surgically reviewed the VA and its VBA arm reported several reasons for slow responses and inconsistency of the organization; See GAO items # 4, 4A, 4B, 4C, 4D and 5D. As thorough and comprehensive of this OIG report was it still did not address what the VBA must do to accomplish their charter as envisioned 50 years ago. Their charter = the veteran. Nowhere in this report does the IG address the VBA action officers. They address:
a. “…complexity of ‘inferred medical issues…’ that refers to issues Not claimed by the veteran but which are reasonably raised by medical evidence of record (See item #4A Inferred issues).
b. Systematic Technical Accuracy Review (STAR) process reported the VBA at a low 59% efficiency.
c. VCAA process passed in 2000 ‘to help’ the veteran has added more steps to the overall approval process lengthening time it takes to develop claims.
d. Major inconsistency between all its ROs.
e. “March 2005 a working group of subject-matter experts identified rating elements needed for medical conditions.” This references Title 38, U.S.C. and the heart of rating disability claims.
f. Sharing of electronic health information.
g. The word “inconsistency” was paramount throughout the OIG report. See item #4B
See Chapter Eight this paper – Authoritative words from a person that has been “in the trenches”
Preface comments: I am humbled in relaying facts lived and the responsibility of required detailed research and this story/article. This paper that reads like a story will give you facts, reasoning, history, drama and final recommendations that should cause you to sit back and rationalize the real dilemma for your veterans and an other promised benefits we should not have to fight for - again!
You are to participate is a CHALLENGE at the end of this paper – please pay attention.
We live in a world of instant communication with computers that control our groceries, gasoline, banking, medicine, phones, our every technique, practice and mode of life but we still rely on nineteenth century philosophy, paper and pencils, chalkboards, the sequential steps in making decisions and the USPS when it comes to our veterans. WHY? The root problems of the VBA are the VA thinking, its structure and workers apathy toward their job. The three visible benchmarks are; guaranteed bi-weekly paychecks, a comfortable retirement at the end of the working days for the VBA workers and vastly protracted C&P for the veterans. These are hard words, harder to write and still hardest to admit.
How can I make such a challenging statement about government workers Apathy? I worked in the Pentagon for too many years not to recognize Apathy when I see it in my VA correspondence!
Along these same lines is the story of the dead horse (VBA) and the governments (VA & Congress) attempt to revive it by beating the carcass with long handled sticks (OIG studies, congressional meetings and reports and Monday morning reports, etc.) while having visions of a Phoenix arising from the souls of disabled forgotten veterans. It ain’t gonna happen! Change mean change, not camouflage.
The VA and our government are both fast moving trains. What is true at 0800 is not necessarily true at 0806 hrs or 0807 hrs. There is no one answer for ALL people/veterans but there is a solution for our veterans and ‘light-at-the-end-of-the-tunnel’. We veterans acknowledge our government, the VA and its one arm named VBA are trying to do the best they can for the veteran, but their thinking is flawed. Handicapped as they are because of much wasted efforts and resources there is clearly a new direction needed. We no longer can afford to take three steps forward and slide two back while trying to nail Jell-O to the wall. More is not better. Having action officers running in circles looking for and trying to justify “inferred” claims is trying to catch smoke in a bottle.
We MUST stop thinking and saying, “…we have always done it that way…”
You will soon realize which finger to use in what dike.
PROLOGUE: If your business is Service and your clientele is say 1,000 people and 993 of them are dissatisfied – would they be an indicator you maybe needed to change something? It is a know fact portions of the Veterans Administration (VA) are broken / dissatisfied. This article/story addresses the Veterans Benefit Administration (VBA) organizational arm and to offer a way to make your business a more pleasant place to work. If you have read any of the VBA Annual Benefits Reports for the last five years “broken” is maybe not the word you would select to describe a train wreck, but the meaning would be the same. The misguided (wrong direction) reports words are superbly written by intelligent people, but they are just well used words and numbers with no teeth.
Veterans have bitterly complained for years, congress has ordered studies and held meetings, the VA has looked inward and they know there are major problems awarding just Compensation and Pension (C&P), but no one has figured out (or admitted too) yet where to put what finger in what hole in what dike. The government and the VA have thrashed around in the bureaucratic waters since it’s inception in July 1930 and even as late as 2000 gave itself an over all grade of only a bit above average with a B-. “…The Veterans Benefits Administration, long notorious for slow performance, ran into a whole new buzz saw in 1998 when the Veterans Affairs Department's inspector general found errors in VBA reports of how long it took to process veterans' applications for disability and pension benefits. The mistakes made claims processing look faster than it really was - and the incorrect figures were none too swift. For example, VBA reported that it processed disability claims in an average of 128 days - more than four months - but the actual average was nearly a month longer, 151 days, the IG said. Today, VBA says, it's about 168 days.” In civilian terms that works out to be 5. 6 months… months. Those 5.6 months is not a bottom line, just one small decision step in a LONG decision making journey, as you know and is reiterated in this paper.
PROCESSING FACTS and CONCERNS: when you look at the real ramifications to the Veteran and the Veterans family, processing becomes cumulative damaging in nature when compared to how the Social Security Administration handles a much similar process. The main difference being of course that Social Security is looking for a 100% disability medical conclusion justification; where as the VA is administrating disabilities that range from a 0 (zero) percent to 100% or a combination of disabilities that renders the Veteran Unemployable status. The difference between the two federal agencies is the process of additional information as the medical condition develops or additional evidence is submitted.
The VA states a 5.6-month processing time-line on average. On the surface that sounds reasonable but this is a series of 5.6 months, which could be a multiplying factor of any X number of 5.6 months culminating in years waiting for a final decision. Please read the next paragraph a couple times for it’s reality to sink in.
This is a fact totally misrepresented by the VA as they clearly indicate that any changes to a claim, the claim goes back into the X number cycle of 5.6 months. Of which the 5.6-month is a conservative plus side performance to promote the agency in a good light to congress. At the local VA shops, this time line is even worse as every change or new evidence is estimated to be a cumulative additional 12 to 18 months.
A conflict of interest is clearly indicated when automatically associated Service Connected claims in some medical areas that require no (zero) complex medical decisions still take 12 to 18 months. This lack of performance is not only unacceptable by VA, it is indefensible. When a veteran dies, his/her claim dies - is there bias somewhere when compared to the government’s other disability agency - Social Security?
Recently the Veterans Affairs Committee in the House of Representatives tried to explain why veteran’s claims were not handled in a timely matter at the VBA levels. After much spin on the why of this over a many years concern, no conclusions were reached. What was brought forward that most Veterans were not aware of was the doubling of the VBA staff and costs that resulted in a net gain of a 50% reduction of claims processed. Something is horribly wrong here. To double the staff and reduce the output by ½ is unacceptable and again indefensible.
More on VBA a bit later – please read on … and carefully.
FACTS that turned up the last time the VA looked at itself:
In today’s systems our GS 5s and 7s “Examiners” (action officers) corps is a quantifiable failure: It is not the fault of the individual workers but of the system.
a. The first stop for a veterans C&P claim is a VBA Examiner (and there-in may be the problem.)
b. Attrition of over 15% is twice the number of new hires then all of the VA.
c. **Examiners are hired as GS 5 ($29k) and GS 7($36k) and can go no higher then GS 10 ($61k).
d. Examiners are “trained” by OJT (On the Job Training)
e. There are NO special educational OR special experience lever requirements to be an Examiner or Action Officer.
f. New action officer performance is in direct relationship to the supervision and their attitude.
g. http://www.va.gov/budget/summary/1514Chapter1.pdf - Please review your own Strategic Goals and Tables beginning on your page 1-23 – Especially Goal #1 Objective 1.2
** http://www.opm.gov/strategiccomp/whtpaper.txt dated April 2002 says such things as the federal government GS (General Schedule) system, “… Its structure suits the workforce of 1950, not today's knowledge workers.” See also page 10 that begins, “…this point is….” and page 17 that begins, “The System Is Performance Insensitive”
REASONS FOR CONCERN:
1. VBA Examiners (Action Officers) are the first people that review and make decisions on veteran claims. They set the tone and direction for the life of a claim. Once a mistake or misstep is made it never goes away and is carried from mistake to fact for the life of the claim. You will see true life examples as this paper unfold.
2. These action officers are all very young and inexperienced in a position that represents our government’s policies. Being young and at a low position in the “food chain” of government workers tend to follow orders, verbatim or how you ‘perceive’ the orders making any interpretation weak and recommendation and actions disastrous for the veteran. They are the wrong people sitting in the wrong pew in the wrong church. New hires, especially at the GS 5 and 7 lever are always young (mid to late 20s) with NO life experiences and usually not much formal education past High School. Even a college education is NOT helpful for this position – Kinda like putting a confectionary maker in a slaughter house with a dull knife. Having little to NO background for a VBA position is not good when a military combat veteran asks for compensation and your new office worker doesn’t have a clue who or what is on the other end of the claim. Claims then become just numbers. This low-level government position must be more then just a “job”, a “paper-pusher” but must have a person that sees their position as omni important – A quick and honest E-mail to these action officers will tell you ramifications of their actions are not their main consideration. Quantity not quality is all important and most likely their only goal.
3. “First line examiners are trained and supervised.” You will see these words in every official supervisors report but is not entirely accurate; Trained = OJT, supervised = “…read these rules and regulations, check with me on anything you don’t understand, all claims must meets our highest standards before approval, turn in your ‘progress sheet’ to me by noon each Friday…” Everyone will make mistakes, but the VBA has built into its systems guaranteed pitfalls just from the sheer numbers of hands a claim has to go through.
4. First-line supervision of examiners is critical; Supervisors, for the most part take the word of their examiners because it is not their job or position to do the leg work and filter information. Supervisors are not expected to make the recommendations of a claim but to trust, to a certain extent, their underlings have questioned a claim and would not pass it to the next lever without being correct. That said, all supervisors will change something within an action if for no other reason then to justify their position.
5. It is common practice for a government first-line action officer to do “bare bones” work on any action because they learn at an early age in the organization what they do will be changed. Makes no difference who you are (rookie, supervisor, manager, CEO, Senator, President) the one above you will change something in whatever you recommend – guaranteed. That’s not bad. What is bad is after a short time the rookie seeing this progression will stop doing 100% of their fact-finding and do just enough to “pass an action”. Supervisors will catch some problems but then numerous un-noticed errors will “fall in the crack.”
6. First-line supervisors have supervisors that have supervisors that have supervisors and as information, data and recommendations are passed up and down this chain the veteran’s words are lost in translation. In the present organizational structure there are too many eyes trying to make the right decisions.
7. In too many cases, what a veteran’s claim says and what the third or fourth lever supervisor sees are two entirely different sets of facts.
8. The Department of Veterans Affairs regional office in Wichita shares some of the same problems that plague offices around the country, including a large caseload and a shortage of fully trained workers. They added that as bad as their RO is, St. Louis and SF is worse. Their article needs reading: http://www.mercurynews.com/mld/mercurynews/news/special_packages/veterans/11066795.htm the disturbing, to me anyway, part of this article said, “Claims are handled by 10 service officers representing nonprofit service organizations such as the American Legion and VFW.” Does this Kansas article then mean each state has it own “system” and untrained civilian Joe Average is processing C&P claims? This point was addressed by the last OIG study mentioned above.
9. Does the VA have a handle on their TDA organization? Is the structure too layered? Are all these layers necessary or are they merely the way business has always been done? Go ahead and answer these questions – I dare you to be honest during the CHALLENGE part of this paper.
10. In an IME system these problems go away.
Two kudos for the VA: 1.The passage of Veterans Claims Assistance Act of 2000 (VCAA) 2. The veteran is FINALLY seeing Title 38: Pensions, Bonuses, and Veterans' Relief §3.102 (reasonable doubt) taken into account, sporadically but at least now - sometimes.
-The Good, the Bad and the Ugly-
Mind-set. The many very bright people trying to do the right thing by making the VA better are stuck in a well-worn government rut (‘we have always done it that way’) and the only difference between this rut and a grave is the depth. The present mind-set needs to stop trying to make a flawed arm of the VA manageable and concentrate and listen to both the spoken and unspoken words of your valued veteran. The many whispered voices all cry out, “Change the VBA / C&P arm. Stop bandaging a festering wound and look outside the envelope.” Just because “is what is” doesn’t make it right. There is a way out of this RUT and I cover that direction later in this paper.
There are many good people in the VBA but sometimes they can’t see the forest for the trees. To say that another way; there’s many good people working the problems but they all have their own agendas, their own problems, and most importantly they have their own priorities, their own supervisor to answer too and their own marching band. What the VA leadership (at the GS-14 and 15 level) doesn’t have is the free reign of their positions as such people as say, the first Emperor of China, Qin Shi Huang when he started building the Great Wall of China in 220 BC. Few people do and it will take the fortitude of a thousand brass monkeys to do the right thing, here now, for the Veterans. The Great Wall of China is known as the world’s longest cemetery. If we “stay-the-course” with our current VBA rules and direction we are destined to repeat the sins of our fathers, not learn from history and fill another long cemetery with bodies of our veterans that will die waiting for fair government promised compensation and pension.
Can the VBA be fixed? In its present organizational configuration, probable not because the current bureaucracy will need to die-off or retire before fresh ideas will be tried – current work force will immediately throw up their hands in rejection saying, “…we have always done it that way…” We need to cut off the existing VBA arm. I’ll explain this amputation later. The VA as a whole is not all that bad. Most huge organizations have both good and bad elements and the VA has its share of warts. The worst wart has been developing since 1953 and is named VBA with its generic name C&Pitus.
The Good – The VA provides care at a fraction of the cost of civilian due to big government discounts in medication, prosthetics and surgery. Medicare and Medicaid are going to adopt the VA way of purchasing so we are talking here about osmosis, growth and savings of major dollars. President Franklin D. Roosevelt leaned on congress to approve the building of major “arrow straight” concrete highway systems; he advocated portions of interstates would have one to three miles of “straight” stretches that could be used for emergency landing strips. Today, the VA hospitals are designated as a back-up medical system in case of large scale war or disasters like Katrina, Rita or when another Texas City or Galveston blows up leveling whole towns and the killing of thousand of citizens.
The Bad: Four are listed but are only the tip of this iceberg.
1. Approval ratings for veterans C&P claims are embarrassingly low? According to VBA’s own Monday Morning Workload Reports http://www.vba.va.gov/bln/201/reports/mmrindex.htm is only actively working less then 8% to 13% of its claims (depending on which column is read – “pending” or “total”) per year. Because this report has over eighteen (18) categories it is difficult to say just how many active claims are actually approved/denied/remanded for any given reporting period.
2. There are too many and unnecessary wickets a valid veteran’s claim must go through. Too many eyes must see words that are meaningless to them and they must approve (chop on) subjects they don’t have a cue about other then it being a number on a rating chart. IMEs change this.
3. Many whispered voices have said and a few have yelled; “I have noticed that treating physician statements are not given the weight and authority they should be given; instead, the VA will rely on VA physicians and doctors under contract with the VA (claiming that they are ‘Independent medical advisors’). These VA physicians and doctors under contract oftentimes examine the veteran in a cursory manner, sometimes within a matter of minutes, and thereafter render an allegedly ‘independent medical opinion’ stating that the veteran’s current disabilities are not related to injuries sustained in service. Sometimes the VA physicians who are under contract are not certified by the American Board of Medical Specialists in the areas for which the veteran claims disability. (See op-ed, Craig M. Kabatchnick, Greensboro News & Record, October 29, 2006)
When a VA examination is cursory, lasts only minutes and is done by a physician not ABMS board certified in the area for which the veteran claims disability, it is virtually impossible for that examination to fairly serve as a basis to deny the veteran his claim. Such ‘Independent VA examinations’ represent both factual and legal error and are an injustice to the veteran. In many instances, the VA rating board will offer no explanation for why it ignored the veteran’s physician’s opinion supporting the grant of the veteran’s claim and only considered the negative ‘independent medical opinion’ of the VA physician.” (See op-ed, Craig M. Kabatchnick, Greensboro News & Record, October 29, 2006)
4. Systematic Technical Accuracy Review (STAR) process reported the VBA at a low 59% efficiency. National average for all businesses using STAR is something close to 90%.
Bad – bad – bad - http://www.gao.gov/new.items/d03452t.pdf - OJT (on the job training) is a way of life and is used successes fully in many fields of endeavor. Two fields that OJT fail miserably are as a rifleman in combat and as an examiner in the VBA.
The Ugly – Hundreds of thousands of deserving veterans still are begging for their rightful due.
Is there a magic bullet out there to help? No – Yes - Well, maybe … you decide after reading Franks story.
Take a deep breath and let’s chat a bit.
Who or what is this guy named Frank? Like so many in our all-volunteer military, Frank is a college graduate, married family man, honorable person that lives by his word. He is a Bronze Star winner from Vietnam, a Masters bowling champion (the year before being sent to Vietnam), a military precision drill team member and leader for nine years, cartographic and architectural teacher and a leader of men. He practiced architecture before being drafted (1957) into the military was a 14 golf handicapper but then being medically retired from the military was reduced to being a draftsmen and computer operator when the ravages of the military and combat put him into a sedimentary life style. The master life plan of being a career military person was cut short, but not to worry, “The Military takes care of its own”.
We military people and fingers know and understand discipline, honor, know how to give and follow orders and deeply respect our government. To some, that mind-set is backward and antiquated but this is our lives shaped by discipline, fighting in wars, killing, burying our friends and believing in others.
As a nation we have basically lived in isolation and until lately never perpetrated a war. The world has always seen the United States as the “good guy”, the “land of milk and honey” and where our allies could call on us when in trouble by a neighborhood bully (Hitler comes to mind).
Our war history is long and heavily stained with blood of our youth. The numbers of veterans, living, dead or disabled is in direct ratio to our civilian politicians.
Following our Revolutionary War 1775-1783, President George Washington said, “we owe these veterans a debt of gratitude, indeed a debt of honor.”
In the year 344 BC Plato wrote “Only the dead has seen the end to war”. History is proving him right.
Our wars continued with; The Indian Wars 1775-1890; Shay's Rebellion 1786-1787;The Whiskey Rebellion 1794;War With France 1798-1800; The Barbary Wars1800-1815; The War of 1812 - 1812-1815; Mexican-American War 1846-1848; United States Civil War 1861-1865; The Spanish-American War 1898; U.S.-Philippine War 1899-1902; Boxer Rebellion 1900; The Moro Wars1901-1913; The Banana Wars 1909-1933; U.S. Occupation of Vera Cruz 1914; World War I 1917-1918; Allied Intervention in Russian Civil War 1919-1921; World War II 1941-1945; The Cold War 1945-1991; The Korean War 1950-1953; The Second Indochina War "Vietnam War" 1956-1975; U.S. Intervention in Lebanon; 1958; Dominican Intervention 1965; The Mayaguez Rescue Operation 1975; U.S. Libya Conflict 1981, 1986; U.S. Intervention in Lebanon 1982-1984; U.S. Invasion of Grenada 1983; "Operation Earnest Will" 1987-1988 ; Invasion of Panama 1989; Inter-State War Panama; Second Persian Gulf War "Operation Desert Storm" 1991;Inter-State War Iraq; "No-Fly Zone" War 1991-2003 war Iraq; U.S. Intervention in Somalia 1992-1994;Civil War & Foreign Intervention Various Somali Militias; U.S. Occupation of Haiti1994; U.S. Embassy bombings and strikes on Afghanistan and Sudan (The bin Laden War)August, 1998; Kosovo War 1999 Civil War; Attack on the USS Cole October 12, 2000; Attack on the World Trade Center and the Pentagon September 11, 2001; Afghanistan War (Operation Enduring Freedom) October 7, 2001-Present; Third Persian Gulf War "Operation Iraqi Freedom" March 19, 2003-Present.
In our war history, hundreds of millions have served and 37,296,663 became casualties of which over 35 million now have no voice.
Outward appearances; a veteran surprisingly looks just like anyone else. The veteran may have a limp or sitting in a wheelchair, but so do non-veterans. How a veteran differs is in their eyes and nightmares and bank account. A veteran’s physical needs are no different then non-veterans, but what the veteran does not need is our government treating us as common numbers and faceless individuals in a sea of humanity. Sure there are many of us, so our government needs to tend to us one at a time. It is their job, their obligation and purpose in life. What the veteran does not need is to have to beg for what George Washington and our government promised. We volunteered to serve and protect, not to become casualties.
So… you volunteered for a few years, carried a rifle, killed some bad guy, drove a tank or flew a jet then after you hung up the BDUs, desert boots and dress blues and have prosthesis and a medicine cabinet crammed with pain killers, where do you the veteran go for help - the VA of course?
There are several government organizations set up for help such as; The VFW; The American legion; AMVETS to name but a few of the 46 other Veteran Service Organizations ranging from the War Mothers to Submarine Vets from WWII. No need to get all smiley-faced on me because that was the short answer. All of these organizations are the few – while you are the many.
Then there is the Independent Medical Examiner (IME) --- What is this?
What our government says and what they do to and for our veterans are two entirely different directions or so it seems. That is a broad statement and is not entirely true for ALL government and ALL veterans but when we talk about the Veterans Administration’s VBA, it seems to be.
Frank is telling this story because he is your every day, run-of-the-mill typical person/veteran. He worked in government for 23 years following a twenty (20) year, three-month and thirteen day military career so much of what you read here will not be biased but what Frank and his friends saw and experienced. If we didn’t see the world from our own eyes and using our own intellect to intrepid then we would be just robots plodding along doing what we are told. Human nature is designed to question and that is what he is doing here, questioning and expressing views and making recommendations. Some folks would say: his two-cents may well be THE solution for this major government sore.
However, if there are clear defined conflicts of interests by government with no (zero) separation of powers involved, then bias becomes more than a different view or opinion; and rewards are now the goal, not the human flaw.
For those of us with children remember when your young were learning to talk and questioned the world around them? Remember the incessant questioning of WHY? For years Frank tried to answer his son with correct answers as he knew them but with “why”, “why”, “why” never stopping he finally reverted to the standard parent answer; “Because I said so!”
That answer never worked but it made him feel good to assert a bit of parental power.
When Frank set out on his quest for what the government calls C&P (compensation and pension) the government or more correctly the VBA arm of the Veterans Administration (VA) took the Parent role and Frank assumed the child role. It is so because they say it’s so. I’ll cover the make-up of “they” shortly.
Of the over 24 million veterans currently alive, nearly three of every four served during a war or an official period of hostility. About a quarter of the nation's population -- approximately 70 million people -- are potentially eligible for VA benefits and services because they are veterans, family members or survivors of veterans. The task for our VA is not an easy one but consider their benefits, their take-home pay, they are well paid for doing their job. A mid-level VA General Schedule (GS) when finally retired from the work force their average government pay is just under $87,000. When you consider the normal Government workers pay ranges from something around $35K entry level to $105K mid-management, those are not bad numbers for an honest days pay. Where there may be a few exceptions it is an oxymoron to use “honest days pay” and “government worker” in the same sentence. The VBA numbers are a bit different that we talked to earlier in this paper.
Frank worked on the Pentagons A, E rings, in the Army War Room as a player and in the bowels of the building on a computer wired into ‘the world’ for many years, says he can not entirely fault the VA for their short-falls. They may be short-handed (I’ll give you how many people they employ in just a minute); they may be over-worked (much because of their own organizational fault) with a workload rivaling the 1920’s and 30’s sweat-shops of the NY and SF garment industry but they still have obligations. It is not uncommon for a veteran’s claim to drag on for 4 to 7 years or until the veteran gives up or dies.
I call it a “bottleneck” others just call it a “wicket” but just an example for protracted claims is the Board of Veterans Appeal (BVA) in Washington D.C. Their current and standing case load is in access of 475,009 active claims. The Board of Veterans Appeals is divided into four decision teams divided up by geography. Each team is comprised of at least two veterans’ law judges, staff attorneys and clerical staff. The BVA consists of 14 veterans’ law judges (including two chief veterans’ law judges) and at least 55-60 staff attorneys, some of whom have 20-25 years of legal experience. Each veteran’s law judge is assigned four or five staff attorneys who have varying degrees of experience. The duty of a staff attorney is to review the claim and draft a decision for a veteran’s law judge to proof and sign.
Is this overkill? The Board of Veterans Appeals reviews the rating decision rendered at the regional office level looking for errors in fact or law. Because the BVA is not a finder of fact, the board must rely on the record established at the rating board level. Thus, frequently the rights of veterans are lost because no legal assistance was available initially. The Board of Veterans Appeals allowance rate between FY 1982 and FY 1991 ranged between 12.8 and 14.4 percent. That rate rose with judicial review to 20.8 percent in 2005. The remand rate back to the VA regional office is much higher. It was as high as 48.8 percent after passage of the Veterans Claims Assistance act of 2000, which broadened the VA’s affirmative duty to assist the veteran in the development of his claim. But remanding back to the VA regional office causes even more delay. In most instances the whole process will be delayed for months, if not years, if such an event occurs. (See op-ed, Craig M. Kabatchnick, Greensboro News & Record, October 29, 2006)
Each RO has smart and ranked professionals so; the real purpose of the BVA is beyond this veteran’s comprehension – maybe it’s just another “Checks and Balance” barometer. If yes, then its usefulness needs to be re-evaluated because don’t we have smart finance people that watch the government’s purse strings? While we are chatting about money let me throw this tidbit at you. It’s all perfectly legal but have you ever wondered why government checks are all ‘rounded’ dollars? I have never been paid, say, $536.49 cents. It was $536 – Did you ever wonder what happened to that .49 cents? You know if you take a few million ‘rounded’ government checks (1,000,000 x .49) would pay a LOT of veterans miseries. Just a thought.
One final word on the BVA and I will leave them alone, for now. They have nine (9) 800 numbers but the main one is 1-800-827-1000 but don’t waste your time calling. Their Internet site is accessible at http://www.index.va.gov/search/va/bva.html and anyone with more then two fingers and knowledge how to query (ask a question) can read their cases and decisions. The BVA receives their cases from Regional State offices (ROs) (as of 22 November 2006 the ROs open claims load is in-access of 399,502) to make final decisions as to who shall benefit from their budget dollars. The way the system seems to work is a claim starts with the veteran that sends his paperwork to their state Regional Office who does the leg work looking up medical records, verifying the claims as factual and worthy to receive monthly C&P. If they can make that final C&P decision, they do. Someone called a DRO at the RO is the “decider”. If you are a GS 13, 14 or 15 you have had lots of experience and being in the $100,000 plus salary range “deciding” should be easy. But…sometimes decisions are difficult so the claim is forward to the BVA so they can be the “decider”. The BVA looks at all the records and verifies the veteran may or may not be eligible for Compensation or Pension. This is done by law people using law terminology, lawyer logic and the law - verbatim. This process is so far protracted it doesn’t seem to bother the BVA when 56% of their 475,009 cases are remanded back to the RO for further study and/or review. Each remand averages more then 400 days till the next time the claim see the light of day. The process is likening to rides at an amusement Theme Park. Wait in one very long line for a short ride then wait in another very long line for still another short ride, etc.etc.etc. Do I understand this picture correctly?
A veteran’s claims action folder that lives in the RO or BVA must be complete for rightful decisions. This folder should have ALL correspondence from the veteran, all hospital and doctor files/records, rebuttals, recommendations, back-up literature, etc. (An average folder has over 400 pages of data – Frank has more in three folders with heavy rubber-bands holding them closed) so the VBA action person can make an intelligent and rightful decision. When a veteran is to be denied… make it for the right reasons and not just because an eye is not dotted, a tee crossed or a “certain” paper has not been requested or worse, not read correctly, or miss-filed. Under the present VA/VBA structure, a workable idea would be a way for the veteran to access their files electronically to check their accuracy. Make sure all “players” are on the same sheet of music. See OIG report mentioned above.
But right now the system says until that happens you can now view your claims folder or request hard copy of the complete folder. See: http://www.hadit.com/library/freqrequests/reqcfile.htm that says you can view your claims folder at the regional office by calling 1-800-827-1000 and/or request an appointment to view your c-file. It took seven months for Frank to get a roster of his Vietnam unit from the government so not sure how long it would take to get more then 400 pages copied and mailed from his claims files.
Frank has sent (three times) a list of his chronological correspondence to his RO to make sure the RO and he was on the same sheet of music – He has yet to hear back from them that yes they are or no something is missing. There has to be a way other then the sited web site above to assure the RO or BVA has all submitted records! Action Officer Apathy or a file clerk error should not be factors in a claims denial.
American Legion quality audit: http://www.house.gov/va/hearings/schedule107/jun02/6-6-02/jfischl.html Statement of James r. Fischl, Director Veterans affairs and rehabilitation commission The American Legion Before the Subcommittee on Benefits Committee on Veterans’ Affairs U.S. House of Representatives On implementation of the VA Claims processing task force’s recommendations June 6, 2002 “…The American Legion’s Quality Review Team visited the St. Petersburg VA Regional Office. While there, they were confronted with graphic evidence of premature and erroneous denials of claims, a general lack of compliance with the Veterans’ Claims Assistance Act (VCAA) rules, and other types of inappropriate action. It almost appeared as part of an orchestrated policy of manipulation of the station’s production figures as a means of meeting its mandated production quotas. Management, rating board members, decision review officers, and front-line claims processors are under tremendous pressure from VA Central Office to produce the expected monthly quotas. There were cases in which veterans received letters stating that their claims were being denied, because their military records may have been destroyed in the 1972 fire at the National Personnel Records Center. The problem was that these veterans got out of the service years after the fire took place. As disturbing as these tactics are, what was even more shocking was the intentional neglect of the backlog of pending appeals and remanded cases from the Board of Veterans Appeals. Remands are not being worked, because the station receives no work credit toward their mandated monthly production quota. (See Charles Kelly - Sources November 2006)
This is not just a local issue.
“At St. Petersburg, there were over 1,300 remands in which The American Legion holds power of attorney. Some of these cases had been remanded by the Board more than ‘five years ago’ and were still waiting final regional office action.” (See Charles Kelly - Sources November 2006)
IN ADDITION to inefficacy, auditors’ uncovered 136 cases of potential fraud or mishandling in the distribution of veterans benefit checks from offices in St. Petersburg and St. Louis, including the approval of $475,000 for a veteran who may have died 21 years ago. The whole story can be seen at http://www.sptimes.com/News/080100/TampaBay/VA_office_targeted_fo.shtml
Not all claims for C&P are as dramatic as the above St. Petersburg syndrome, amputation and PTSD or as profound as cancers and not all claims require the same amount of time to sort-out, gather medical background, etc. so not real sure why Trauma to tooth #9 takes as long (4-7 years) as PTSD. I suspect the GS 5 VBA action office is not given any approval authority and must have his section chief sign off on each claim then have a branch chief sign off, then a departmental chief before the claim ever gets to the C&P Associate Deputy under Secretary for Policy and Program Management desk who asked their DSO their thoughts on any particular claim. There are better and faster ways to get an official yes or no but the present organizational structure guarantees a need for more people that guarantee more jobs that guarantees higher positional rating that guarantees nicer retirement. Having worked on the Rings, in the Army War Room during some major decision times plus in the bowels of the pentagon for 23 years there has been too many organizational diagrams, coffee breaks, life and death decisions, Christmas parties and good-old-boy smokers that personnel, retirement and titles were discussed to not fully understand government hierarchy.
Growing up, did your mother ever say to you, “Always know which side of the bread your butter is on?”
If you follow this paper RECOMMENDATIONS all this lost time and wasted effort goes away. You will see your own graphic results when you conclude THE CHALLENGE (page 24).
To clarify some numbers it is important to know that each of our fifty states plus the Philippines, Puerto Rico, and Guam has at least one RO (California has 3, Pennsylvania 2 and Texas 2) and they all have their own case load. To see the numbers reported in the Internet, see http://www.vba.va.gov/bln/201/reports/mmrindex.htm - what some of these numbers show is of 11 November 2006 there are 398,519 outstanding cases in just the ROs then add the BVA cases you are looking at 873,528 disabled veterans waiting for their just compensations & pension. Still more disturbing numbers in the same report show in January 2006 369,081 active cases – This case load should be decreasing not increasing by over 29,000 cases for a time period covering just eleven months. Rabbits don’t multiply this fast but the word exponential comes to mind.
COMMENT: If you know about a problem and over the course of seven (7) years that problem exponentially manifests itself, you may need to re-look your procedures and direction. http://www.vba.va.gov/reports.htm
172 - Remember this number.
Then there is the Independent Medical Examination (IME). Is this important?
President Lincoln in his Second Inaugural Address indicated the importance of caring for the Nation's veterans said: "To care for him who shall have borne the battle and for his widow and his orphan." These words spoken by President Lincoln reflect the philosophy and principles that guide, or should guide the Department of Veteran Affairs and the Vocational Rehabilitation and Employment Service as their endeavors are focused on serving our Nation's veterans and their families. So says the VA doctrine.
Mark Twain wrote “Get the facts first. You can distort them later.”
Albert Einstein wrote “The important thing is not to stop questioning.”
Not sure, but I think Mark Twain may have worked for the VA while our veterans reflect Albert’s theory.
The stated Goal of the VA is: “…to provide excellence in patient care, veterans' benefits and customer satisfaction. We have reformed our department internally and are striving for high quality, prompt and seamless service to veterans. Our department's employees continue to offer their dedication and commitment to help veterans get the services they have earned. Our nation's veterans deserve no less.”
These are stellar and honest words when written but extremely difficult to live up to when dealing with a Government Organization as large and diverse as the VA. The VA is manned by GS Government workers that are told the day they begin work, “…begin planning for your retirement…” and “…an action passed is an action completed…” Ouch! Frank said that his dealings with the VA it seemed the Action Officers (AO) were given a set of rules for handling and answering veteran’s claims and to not deviate from them. Deviation converts to budget dollars so no matter what the veteran’s claims says, what medical documentation are submitted it seems AOs believe a veteran claim must match a number in their rules to “win”. What that boils down to is the AO looks for a number and awards or denies the claim based exclusively on that number. Most military people will tell you they consider themselves “second class citizens” and the actions of the VA amplify that feeling through their actions and deeds. In England the soldiers consider themselves “sixth class”.
More on these Action Officers later.
-Claims, Cause and Effect-
The government and/or the VA do not automatically give you anything. You have to ask for it, justify it, over and over, prove you deserve it, dot all the Eyes and cross all the Tees, jump through prescribed hoops and forms before any meager budget dollars show up in your name. A recent conversation between a veteran and the VA went something like this:
Vet – “My medical records show I have had Hypertension for seven year.”
VA – “That’s correct.”
Vet – “Hypertension is ‘ratable’, why aren’t you paying me compensation?”
VA – “You haven’t asked for it.”
Vet – “I have to ask for it?”
VA – “Of course – we don’t know anything unless you tell us.”
Vet – “OK. Can I have it and make it retroactive?
VA – “No.”
Vet – “You told me to ask for it.”
VA – “That’s right, but you have to ask for it nice like. You have to say please and you have to fill out all the forms, get in line then wait.”
Vet – “How long will that take?”
VA – “Did you ever read Violet Fane (1843-1905) in her poem - Tout vient ß qui sait attendre when she said, 'Ah, all things come to those who wait,'
Vet – “Yes, yes I did, but didn’t she also say, ‘but something answers soft and sad,
'They come, but often come too late.'
After much strained heavy puffing mixed with white-eyed-rolling embarrassing moments from the VA side of the house, she stomped out of the room muttering something that sounded like… “I just work here… that’s not my problem.”
Where do these “claims” for compensation for military physical problem come from? From the veteran, and remember the veteran, just as their civilian counterpart does not initially know ALL the rules and ramifications of his request. Mass communication or the lack thereof comes to mind. Also, the veteran is just a guy or gal that has done their duty for God and Country, put their lives on the line for politicians and now is only asking for what Washington, George and DC promised.
Depending on the Governments needs is a direct ration to Government speed. Frank’s medical retirement was swift and non-compassionate – Laying in a Walter Reed Hospital bed recovering from a major heart attack (MI) the following conversation took place:
MB – “We are retiring you and you must vacate your government quarters and return your TA-50 and any monies you are now not eligible.”
Frank – “I don’t want to be retired. I don’t have anywhere to move my family and I don’t have a civilian job, besides I feel fine now. ”
Medical Board (MB) member – “You are not ‘fine.’ Your heart has two major tears we call an MI and even if you survive the next two years you will not be able to function as in the past. Not having a place to go or a job is not our problem. You had the heard attacks so now we can’t use you anymore. You are now Permanently Unfit for the Military.”
Frank – “But… I don’t have a job. Can I have more time?”
MB – “No. We awarded you 30% disability – that should help”
Frank – “How much is that?”
MB – “30%”
Frank – “No, I mean what will my retirement money be after you retire me?”
MB – “30%”
The June medical board really didn’t know that the 30% translated to just twelve ($12.82) a month. It seemed to make no difference to them anyway as they gave Frank two chooses in his forced medical retirement – July or August. He chooses August then he was gone.
As many of Frank’s fellow veterans, he is dying and the VA has yet to open their doors to him to help pay bills and live out his days in some kind of comfort rather then to just exist from day to day. What the VA is doing is denying any rightful service-related health problems and is saying for low-cost medical help all he needs to do is drive 300 miles to the nearest VA hospital any time he can get an appointment for his cancer and heart problems and “…they will treat you…” Have you even visited a VA hospital? How about an automobile assembly plant? Or Krispy Krème donuts shop? They are all similar in their assembly-line approach to health care.
When Frank was medically retired his base military pay was $800 per month. He had a wife and young son as Frank was only 43, in the prime of life, military fit and trim… but his heart attacked him – twice - so the military gave him 30% retirement disability and deemed him “permanently unfit for military service”. Not to worry, the 30% disability was “tax-free”. That number does not fall into the WOW category as it only relates to about ½ tank of gas per month for his sixteen year old Nissan. Over the years Frank has provided for his family as best a disabled man can but when a service-connected cancer struck, he asked for help.
Percentages of disability are established by regulations. Government regulations are black and white with NO grays when it comes to, well - regulations. For example, METs (Metabolic Equivalent) is the benchmark for establishing C&P percentage you can be awarded if your heart is involved. If you have a MET of 3 or less, you are rated 100% disabled, a MET of 4 but <5 you are 60%, >5 but <7 you are 30%, 7 to 10 is 10% and more then 10 = 0%. A MET is the energy cost of standing quietly at rest and represents your oxygen intake… In other words METs are nothing more then normal breathing. METs can be measured BUT more likely then not for VA rating purposes your METs are ESTIMATED using your BP and heart-rate during a Bruce protocol treadmill exercise. What happens if you can’t walk a treadmill? Well then the VA Cardiologist takes your pulse and ESTIMATES. You know the difference between a 100% to a 0% disability in dollar terms? Round numbers is $2,400 monthly compensation. That is a huge difference for a 3-4-5-6-7-8-9 ESTIMATE, especially if your “estimator” is having a bad day - - or even a good day!! There are more criterion in Title 38 that should be considered and not JUST METs.
I am sure all these numbers are explainable BUT, if you are diabetic and depending on what RO is servicing your claim, awarding criterion is different: For example, the benchmark in the H.S. Truman VA hospital for one RNC is if your Hemoglobin A1C is 7 you are ratable diabetic. Another RNC at the same hospital, the same day the yardstick used is Glucose, BP, Urine sample numbers. These RNCs essentially are your “deciders”. The way the system works is, remember this when I tell you about the all important VA interview. That interview report when read by the RO action officer and whatever numbers and words are read is parroted to the veteran in a form of approval or denial to their claim for diabetes. Also, remember that BVA site I told you about http://www.index.va.gov/search/va/bva.html ? Some real head shaker numbers you see there are approved A1Cs below 5 and some A1C above 13 denied. Sounds like your deciders, decide each day what they will decide on any giver decision. See the OIG report Item #4D mentioned earlier about inconsistencies in the ROs.
To add insult to injury on this heart compensation drill, the regulations (Title 38: Pensions, Bonuses, and Veterans' Relief) says the first three months following a heart attack (MI) you shall receive 100% then revert to whatever rating your estimated METs say. This portion of the regulation is seldom made available to the veteran. The veteran is usually busy just trying to survive and the VA doesn’t give the extra 100% because the veteran doesn’t know to ask for this rule that has been on the books since 1964.
There has got to be a better way.
Before you start thinking the veteran is maybe getting something for nothing, consider this. When a civilian retires they receive a retirement (usually monthly half salary), stock options, pay for occurred leave, any disability (bad back or bunion on their butts, trick knees, etc.), IRAs, etc... In other words retirement may not be a golden umbrella as some CEOs but its not peddling apples on a street-corner either. The military retirement is a bit different, especially if the veteran has a low (under 50%) ratable disability. As the civilian counterpart the veteran, at 20 years, goes out with 50% of their base pay but any percentage disability is deduced from the retirement total and given then as “tax-free”. Statement by Daniel L. Cooper, Under Secretary for Benefits, Veterans Benefits Administration, Department of Veterans Affairs, Before the Military Personnel Subcommittee, Senate Armed Services Committee, March 27, 2003 maybe said it best when he described what his VA was doing for the veteran, he said, “…instead of merely a percentage of military retirement pay tax free”. Merely!
Social Security (SS) is also very different for the military and civilian. SS is based on your first forty working months and we all know military pay is just above the poverty level so to just give you the numbers: SS for a retired enlisted military person is under $700 a month while the average civilian is over $1,700.
Military and also civilian people seldom know if anything is physically wrong with their bodies. When we do have a pain we most often take an aspirin and forget about it. That works for most but not for example - cancers. By the time you see a doctor for a nagging pain caused by a cancer you are stage IV (you usually have a few months left) on a very downhill slippery slope. More on cancers just below.
Military life can be hazardous to your health. Walter-Reed and Civilian doctors have discovered not only does Frank have a bad heart and Kidney cancer he is diabetic, has out-of-control hypertension and Chloracne. During the last three years Frank has written twenty-seven (27) letters to the VA sending official medical documentation, lay statements and has justified over and over and over how he qualifies for just compensation – all according to their rules. To offer just one example of VA action officer apathy and narcissism toward Frank’s cancer, he gathered necessary medical documentation, forwarded to the VA RO in St. Louis citing the military connection to the cause and affect was from the diuretic and BP medication he was put on during active service. Medicine, The American Cancer Society agrees as did his civilian doctors ALL agree with Frank but the VA has denied compensation three times. Why? Because, read this next part carefully and try not to laugh, or shake your head in wonderment, but they said Frank’s cancer claim was denied because it was not caused or secondary to Agent Orange (not presumptive). Frank was in Vietnam during the massive defoliation of the country in the late 1960’s early 1970 so according to the VBA, Agent Orange (AO) can not cause his cancer so because he was in Vietnam and exposed to AO he can not be granted compensation for his cancer as AO couldn’t have caused it thus not making his cancer “service related” and compensateable. Remember Bud Abbott and Lou Costello’s routine about who’s on first? In three year now the VBA has yet to even address the original cited cause and affect.
Not sure where VCAA is during this VBA thinking process.
NOTE on Cancers: There is not a MD, oncologist, DO, etc anywhere on the face of the earth that will or can say for any certainty where cancer starts. They can only tell you what kind you have and when it will kill you. Why? On a cellular level, any type of cancer is caused by abnormalities in a cell’s DNA. These may be inherited from parents, or they may be caused by outside exposures to the body such as chemicals, radiation, or even infectious agents. All cancers involve the malfunction of genes that control the growth of cells in the body. Genes can be damaged (mutated) throughout a person’s life by many different things such as hormones, certain viruses, tobacco, chemicals, sunlight, and substances in food. Most of the time, it takes many years for the damage to produce cancer. And, as people get older, they are more likely to have damaged genes. There are over 200 different types of cancer. You can develop cancer in any body organ and there are over 60 different organs in the human body. (see the renowned Dr. James A. Goodyear North Penn Hernia Institute) Knowing this and knowing there are very young VBA GS action officers that can definitively deny a veteran because their rating charts may not specifically note the veteran’s cancer is beyond human comprehension or mine anyway. Maybe a criterion for the action officer should talk with and hold the hand of a cancer patient in a VA hospital so they could fully see and appreciate the power of their government position. I know… I know… the action officer doesn’t have that medical decision power as he/she must send the claim to a medical doctor BUT depending on what that doctor says the action officer should not have to interpolate stated findings and should NEVER have to send a denial letter to a veteran with cancer, any cancer. We have to assume the action officer handling your folder is doing all they can to get the right/correct answers so they can make the right/correct decisions and also remember - that action officer does have §3.102 (reasonable doubt) power. Please don’t take our word for this cancer criterion – Please ask, check with any and all Oncologist and they will ALL tell you the same.
Agent Orange (AO) is, to say the least, controversial. In AO issues Vietnam Veterans are not the arguable points of this paper they certainly have been a major concern to those Veterans now dead, those Veterans that are going to die and those that are disabled from government causation directly due to herbicides (plural) exposures. Alternatively, the more recent developments of what is being called Gulf War Syndrome. (see Kelly, Sources November 2006)
We have all heard horror-stories out of Vietnam and also about hospitals where you go in with a minor problem and a leg is amputated or a civilian buying a tainted leaf of spinach with e-coli and dying at the local pharmacy. If understanding the after-affect of what Government sponsored Agent Orange in the Vietnam War zone can do, has done and is doing, consider also the patient with hypertension (high blood pressure) in-service documented in several military doctor visits. This one particular patient, an atypical female major eventually exited service with a normal physical and nobody bothered to check her blood pressure in exit physical or during his VA exam for benefits. She went home with 10% disability and no medication for or diagnosis for hypertension and 5 years later had leg swelling went to an MD and found out that she had lost most of the function of her kidneys due to hypertension and now needed dialysis to live, Before she could revisit the hospital for treatment she had dizziness and a stroke from a hypertensive brain hemorrhage and she ended up spending 2 weeks in the ICU and lost function of the right side of her body, all of which would likely have been avoided with good treatment earlier from the military and VA. Coincidently the major’s military partner developed headaches and was discharged only to get a civilian MRI one year later that shows inoperable tumors. I could go on and on, but you get the idea.
If we can have, no child left behind can’t we also have NO Veteran left behind?
In our present system, veterans are not always the target, sometimes it can be the physician. A physician at a well known military hospital in the Mid West wrote favorable opinions for veterans and lost his job as specialist but being in the right, continues to support veterans and was assigned to the research floor. The doctor continues his support and was put in a room with no phone or computer while the physician continues to help as he could – honest help. He finally resigns and files suit and wins for an undisclosed amount. He won a few dollars but it cost him dearly. (see source – Dr. Bash)
Every coin has two sides emphasizing the VBA has major problem.
Another physician is told to not put anything supportive of a benefit claim into patent's records. He doesn’t and is alive, prosperous and now chief of his division. (see sources - Dr. Bash)
The VA may have a duty to assist but the system seems to prevent the rank and file from supporting any veteran....for example, only certain MD's at certain hospitals are allowed to write IME's. The IME process should be randomly assigned to prevent bias. Drunken roulette player in Las Vegas have better odds.
Then there is the Independent Medical Examination (IME) --- Why wasn’t I told of this?
-Benefit of the Doubt within the “VA Journey”
When Frank first applied for compensation he had to be added to the VA “roles”, get in-line for testing then start down the VA gantlet. First was an Agent Orange examination. This hurts to even tell you what that examination is because it is nothing but an interview with a VA nurse (an RNP), a standard blood test and chest x-ray. That maybe doesn’t sound that bad but consider in medicine there are only two laboratories in the world that even test for Agent Orange (AO) and they are expensive (over $1,600) and they only work on cadavers, BUT the VA requires its veterans have this worthless “test” that seems to be public relations oriented more so than fact finding .
VA interviews! Interviews with VA RNP (Registered Nurse Practitioner) personnel the veteran has to be very careful of his/her words. For example, how many times does someone say to you, “how are you?” and your response is “…fine, thank you” when you may be suffering from heart palpitation, have diarrhea, headache, just finished a gut busting lunch and feeling like what the cat hauled home. However “…fine thank you…” when spoken in the presents of a VA person your words are then locked into concrete and translated into, “...the veteran denied symptoms of…”, “…is centrally obese…”, “…there are no thumps, thrills and rubs…”, “…the patient plays golf 5 days a week… has regular sex 3-5 times weekly… walks the dog two miles a day… well tanned…”
To be a veteran during a VA interview you need be two people. One – You need to possess the same type personality as the beloved Labrador retriever. As their canine friends, the veterans need love, affectionate and patients with civilians. Don’t lie; just be careful of your phraseology. Two - veterans are also vain and use to telling war-stories so if truth be know, they watch golf on TV, reminisce about a fantasy sex-life from their twenties and the dog died fifteen years ago, shouldn’t have had that extra slice of Pizza and his heart will not allow any activity more strenuous then sitting behind a computer so why not sit in the sun as much as possible. All sounds quite innocent BUT when the action officer at your VA Regional Office reads that interview report they do not see any of the numbers on their Rating Charts and immediately send you a denial form letter.
Why is so much importance place with the VA interview(s)? Having been down this path as an over-worked AO in the pentagon it is my impression is because it is easier for a VBA action officer to parrot simple and abbreviated words of a VA RNP then by doing their job deciphering 20 years of medical official documentation.
What’s a Rating Chart? I’m sure it has many names but what we are talking about is what tells the Action Officer the parameters of claimed compensation outlined in Title 38: Pensions, Bonuses, and Veterans' Relief. It is a government regulation like all others that govern our lives. Where do “regulations” come from is not relative in this format but the simple answer is they evolve. The long answer would take all day trying to explain “…is what is…” Similar to the Bible and all written words, government regulations need to be not only read but to be interrupted as to their meaning and intent.
To get back to being denied…. After receiving a few, a denial form letter from the VA is fun to read because you know it took NO time for a clerk to print the form letter and just add your name. You know what the letter says before opening as they are usually heavy, thick and smells of sulfur. They are always long and wordy but never say anything of substance. When Frank received his first four letters denying additional heart and new cancer claims they all gave long generic explanations of what the VA regulations say but never tied their words to his specific medical problems. Generic letters designed to appease and placate rather then give the exact cause of denial. Remember the parent role “…because I said so...” is the common thread running throughout VA letters.
VA letters never talk TO the veteran. They talk generically and usually condescending and more likely then not will leave the veteran muttering, “…what the hell are they talking about, that is not what I said…”
As many of our disabled Vietnam veterans out there Frank has Chloracne. Chloracne is a skin disorder akin to adolescent acne. Chloracne is a by-product of Agent Orange and is listed as one of the VA’s eleven presumptive diseases. Frank furnished the VA thirteen 1970s thru 1980s medical care official document three years ago asking for compensation but the VA has denied the request four times. Why? Because they said so. By the way - the official military documentation Frank submitted, four times, stated in clean and plain language “…condition is a result of the Vietnam war”. The decision makers get a bit fuzzy here because Frank’s four denial letters all said, “…did not manifest within 12 months of exposure to AO…” It did, but there is no way to prove it 36 years later other then by carbon-testing and for that they would have to kill the patient. Everyone knows what precedent means and all you have to do to see where precedence lives and is at work is check out the BVA online files. There are 1,270 approved Chloracne claims in the BVA case files all dated within the last five years and in all cases the approved veteran was exposed 30-35 years ago. Maybe Frank’s medical records were not understood when they said, “…caused by the Vietnam war…”??
CONSISTANCY: In some cases the BVA is trying to do right for the veteran by giving them the benefit of the doubt. Don’t get all bubbly because they only just started. Before 2000 they routinely denied claims because “the claim is not well-grounded”. In today’s BVA files you can find 4,726 claim that have been approved in their 1992-2006 case files all citing, “… under the benefit-of-the-doubt rule, for the veteran to prevail, there need not be a preponderance of the evidence in his favor, but only an approximate balance of the positive and negative evidence. In other words, the preponderance of the evidence must be against the claim for the benefit to be denied.” Not sure if this has filtered down to the VBA or if it has, IF it is understood and honored.
EDITORAL: In any legal system, the order of legal precedence is the backbone of the legal system. Yet for our BVA this order of precedence does not seem to exist. Many bad things can be the fall-out but for the veteran the processing and ambiguity of individual issues leads to years and even decades of (pick a bad sounding word describing frustration and wasted effort).
Take a few minutes and rummage through the case files of BVA decisions, you will get a mixed bag of outcomes for almost the exact same numbers in different claims.
For example the Benefit of the Doubt rule. One claim will deny because even though the evidentiary facts are clearly stated as 50/50 the medical issue or issues are associated to exposures to the herbicides, diseases, military problems while others will even approved. Nevertheless, an identical case will also say disapproved. On the other hand, the ruling may be remanded back to the lower level. Who’s on first?
The Benefit of the Doubt rules say, “….the preponderance of the evidence must be against the claim for the benefit to be denied.”
Now you would think the courts would have some concern on why their directions are not being followed. It seems no one, including our congress, has any concern over this totally government biased mandated budget process which seems to track only budget; not justice for the Veterans or their widows. (see Kelly, Sources, November 2006)
These decisions are all searchable on BVA computer database.
Then there is the Independent Medical Examination (IME). --- Finally! What is this IME?
The IME is a way for the VBA to step out of their rut and do right for their charges – the veteran.
The MES IME Network has over 17,000 credentialed physicians and allied health professionals across the country that are expertly trained and prepared to deliver evidence-based opinions. Now… these guys are there, in place ready to go. Our government doesn’t have to develop any, they are already there. All Uncle has to do is now HIRE them and sic them on our veterans population.
MES Solutions, (MES) was founded in 1978 and was the first organization ever established to provide the claims community with access to physicians with expertise in conducting Independent Medical Examinations and Peer Reviews.
IMEs are current NOT affiliated or aligned with the federal government
When (if) hired, the IME will take your records, review them and come to their own conclusions. It would be nice if the veteran could suggest the IME find in their favor for “xyz” problems but that doesn’t happen and is a quick way to the exit door. The civilian medical profession is one of the most ethical on earth and because of what the IMEs do, they lead the pack in morals, principle for just and honest evaluations.
IMEs charge a fee for what they do and any report they submit to the VA for you. There are no free lunches out there.
Not sure what the different IMEs charge for their services but an educated guess for the bottom line would be a percentage of one month compensation you would receive for whatever compensation your VA claim asked for or how complicated your case might be. For example; if you can’t hear it thunder and asked the VA to approve a Tinnitus 20% claim you might be looking at a IME bill for around $485.00 or if you had higher claim expectations of say 100% for a really bad heart and reams of legal documents your IME bill might be around $2,393.00.
As in life, the same holds true for the IMEs, there are no guarantees. The IME will give you an honest evaluation, submit to the VA in all the proper formats and in language to support the claim, then it is up to the VA to accept or deny yours and the IMEs words.
HONESTY – Now that would be a breath of fresh air.
To lessen the pain in the pocketbook just a bit consider this: Remember the story of the retired engineer that was called by the Turkey Point nuclear plant in Florida to solve a major problem that had everyone baffled for a solution? He inspected the machinery what was sick, walked around it several times, poked this, turned that and after fifteen minutes turned to the plant manager said, “Turn this handle ¼ counter clock-wise every hour on the hour for four hour and that will fix your problem.” He did and the problem went away and the plant is happy and humming. The following week the plant received a bill for $50,000 for “service rendered”. A quick phone call to the retired engineer complaining of the high charge when the engineer worked only fifteen minutes and actually didn’t do anything other then tell them to turn a handle. “Your right, but I knew where to look for the solution and you didn’t.” The bill was paid in full that afternoon.
-Prelude to a decision-
A stated goal in 2001 from the BVA said, “…the Annual Benefits Report (ABR) has become a meaningful tool for VA, VBA and a variety of interested program stakeholders. Similar to the first three years of publication, this edition of the ABR does not attempt to analyze work processes associated with the day-to-day administration of these benefit programs. However, one of our goals is to broaden the analysis and use of the data contained in the ABR. Towards that objective, we are exploring the feasibility of including in future editions information about our performance against established measures.”
Do you hear that dead horse syndrome drum beat in the background?
Government workers are not overly compassionate and to them, a letter, a claim is just words on paper and not a living human being on the other end. To them the veteran is a number (C12 345 678). The VA doctrine says differently but those are just words written yesterday. The mere fact they work for the U.S. Government tells you that. Decisions made on you are a numbers game. If your claim numbers and medical history numbers match their action manuals you have an even chance to being awarded just compensation. Few government people “answer the mail”. In civilian board meetings ever utterance is addressed, ever note is finalized, ever phone call is answered and every letter, e-mail, fax is answered. Government workers and the VA seem to answer what they please - see parent rules.
If you are warm, have a heart beat, know someone that knows someone and have decent credentials, you can work for the government. Where you work is a crap-shoot unless you know somebody. Not to worry because what cubical your desk is, they will train you. You will be trained to look for a number, a phase, certain wording and that’s OK. What isn’t OK is the action officers within the VA must or should process the ability to ANALYSE words in a veterans claim. Analytical ability can not be trained but it can be learned and one way is through dedication to the veteran. VBA action officers need to be special because they service special people, the veteran.
VBA action officers are the key to the system we now have.
IF the system is to remain status-quo criterion to be a VBA action officer MUST change.
The most disturbing facts toward the VBA action people they are all basically nice and decent people but they are not overly smart in ALL fields of medicine and anatomy and they are required to made medical decisions because that is what medical disability compensation is. Our body is made up of hundreds or trillions of cells that each one has a mind of its own. They have their own names, terminology and language. The VBA action person deciding your claim is probably not a PhD, MD, or even have a masters degree is Liberal Arts or even an engineering BS, BA or even a AS but when a claims folder is setting on his/her desk with words like, “This is a Positive study with an inferior fraction, scar and periinfarct ischemia” not even a PDR or Webster’s can help… BUT the IME can.
Before closing I know there are at least a couple questions still in your mind.
1. Are we bound by any set of rules that REQUIRE us to continue down this same slippery slope? Not really. Rules can be amended, changed or broken as long as it is for the good of the people. Rules that applied to yesterday’s world do not necessarily apply today. For example: On 18 Jan 2005 during her Senate Confirmation hearing Condoleezza Rice said to a Senator Dick Lugar question as to how the United States should now and in the future deal with the Soviets for world peace. She responded, “…work to do the right thing… if there are laws or rules in the way, then we must break them…” A follow-up question from Senator Joe Biden about her chooses of words about “breaking” the rules, she clarified her response from Senator Lugar to mean, “…change the rules…”
…and the one I like best, maybe because I was sitting in the briefing and heard the words;
For me, an unforgettable moment when….In a 1984 pentagon staff meeting Vice Chief of Staff General Maxwell R. Thurman was being briefed by a LOGCENT Major General and he said to a Thurman question, “… those are the rules…”, General Thurman replying in a tone and words that left no one in doubt as to his feeling, “…G_d-damnit general, we make the rules… change them…!!” Few enjoy having that kind of influence but Secretary of State Rice, congress and the VA does.
2. Are IMEs our magic bullet? I’m sure there are folks out there that will argue the point, but from this ex-military, ex-government servant and current veteran the answer is YES.
Prelude to Recommendations
The VA is the second largest department run by the U.S. Government that employs just over 235,000 people. Just the benefits portion of the VA’s 2006 budget alone is $38,525,965 of which over 35.8 Million is labeled “discretionary”. The 2007 budget calls out 80.6 Billion for veteran’s benefits and services and 38.5 Billion for discretionary spending and 42.1 Billion for entitlements. What these billions represent is just an arm of one government department. What I do know if you take the 235,000 workers and multiply that number with their average salaries you get a very large number and there is a very real way to make that number smaller – a lot smaller. Franks suggestion to Outsource and IMEs will, over time, saves more federal dollars then spent on Katrina and the whole Iraq and Afghanistan war.
IMEs are the key to better run a more efficient care-taker sized C&P VA organization and Veterans receiving rightful compensations.
Think - IME and change.
VFW just completed a 7 year review and found that for each 1 dollar spent on IME claims the return to the veteran was 55 dollars in retro benefits!
If I were a VBA action officer would I approach my supervisor with this IME suggestion? I might as would Frank and 20 million other veterans BUT if I were that supervisor and knowing the more people I had under my supervision the higher my pay would be, I would file your suggestion where it would never see the light of day.
A couple really scary claims today would go away if change within the present system took place: Some physicians are told to not put anything supportive of a benefit claim into the patent's record; the VA may have a duty to assist but the system prevents the rank and file from supporting any veteran; only certain MD's at certain hospitals are allowed to write IME's. The IME process should be randomly assigned to as to prevent bias.
Remember that number I told you to remember? There are 172 VA hospitals where any one of thousands of remanded claims can be sent. Not sure if this is good or bad for the veteran, but continuity and time constraints comes to mind and must be considered.
Did I just hear you say, “That could take a long time?” Your right, it can and does but that is the system we now have. Does “…is what is…” and “because I said so...” ring any bells?
The way the BVA is now structured it can send opinions to local RO or any RO in country. Maybe VA headquarters is already thinking IMEs because recently they just approved 2000 opinions a year to be paid at $500 an opinion from anybody outside the VA... (?)
The VA has favorite medical school staffs but nothing has been made public as to what the thinking is within the VA. Sometimes when the opinion is not supportive they will send it back for a second look. A bit unusual but it has happened that opinions have been sent back three times to have the doctor write against the VA and in favor of the veteran and it is not uncommon to see the VA form Physician committees to over rule one of their lower level staff Doctor or have Congressmen put pressure on the VA to have a doctor change his opinion. If a manipulation can be made, it has and is done.
Being raised in Texas it shouldn’t have surprised me when a few years ago my mother was telling me she had to send her federal income tax paperwork to the Three-Rivers Correctional Facility as her CPA was doing two years hard time. What did surprise me was when I heard one VA lawyer in BVA who is in prison because he removed positive evidence from a veterans file so as to make the veteran lose benefits.
During the last 7 years the VA has undergone a profound transformation. They are trying to redesign the Top heavy, top down organizations network. http://www.va.gov/ofcadmin/ViewPDF.asp?fType=1 page 7.
Note: VA is in the process of rewriting whole medical evaluation process; in fact Institute of Medicine met 8-9 November 2006 in Washington to write recommendation for March publications. If they are NOT on the right track for the veteran, then everyone needs to seriously consider the below recommendations.
- Craig M. Kabatchnick-
The below article was written 29 October 2006 by Craig M. Kabatchnick an attorney who lives in Greensboro NC. Reach him at (336) 456-3751 or (919) 382-2800. Mr. Kabatchnick is and has been a long-time player in this theater we call C&P.
“The $10 limit
Because of a $10 limitation on attorneys’ fees for helping with veterans’ initial claims — a limitation that dates back to the Civil War! — Veterans usually can’t obtain legal counsel initially. For example, for nearly two years I was the only attorney registered with the N.C. Bar Association’s Lawyer Referral Service to handle initial veteran’s claims. I did so primarily as a public service and because I had acquired unique experience with veterans claims while I served in Washington in the VA’s general counsel office.
Veterans need the support of permanent legal representation at the initial claims adjudication level. That attorneys can only receive compensation after the VA has rendered a final Board of Veterans Appeals decision creates a vast void. There is great need for immediate long-term assistance for veterans through a permanent veteran’s law clinic, such as the one that will open at the N.C. Central School of Law in January 2007.
Veterans’ problems are further increased because oftentimes denials by the Board of Veterans Appeals are based on a defect made because the claim was not initially processed by an attorney. Thus, frequently the rights of veterans are lost because no legal assistance was available at the beginning of the claims adjudication process.
The average time for an initial claim for compensation and pension to be processed and a final Board of Veterans Appeals decision rendered is four to seven years. Oftentimes an elderly veteran will die before his/her claim has been fully adjudicated. VA rating boards are slow and lackadaisical in processing claims for benefits because of heavy caseloads caused by inadequate staffing, poor supervision and inexperience among rating board members. Oftentimes rating board employees are hired right of high school. Many have little or no college and little or no medico-legal, military or pertinent work experience.
Normally claims are handled by rating boards made up of one or two VA employees, and a great number of these claims are handled by junior level employees who are evaluated with an emphasis on productivity and quantity of decisions produced, rather than quality. Often, haste causes crucial items in the veteran’s claims folder — items that would favor granting a claim — to be overlooked. Furthermore, the VA’s statutorily mandated affirmative duty to assist the veteran in developing his claim is often overlooked.
All of this makes for a veterans claims adjudication process that is bogged down and adversarial.
Regional rating boards are to review the evidence contained in the veteran’s file, assist the veteran in developing his/her claim and to render a decision. Under law, rating boards must give veterans the benefit of the doubt when deciding whether current disabilities are connected to injuries and incidents that occurred during military service.
But many decisions do not apply the benefit of the doubt standard or, if it is applied, it is done in an inappropriate fashion. The VA will fail to fully develop the medical evidence and will instead base its decision on medical evidence in the record favorable toward a denial. Sometimes the VA rating board will fail to assist the veteran in obtaining appropriate medical records and military records (many of which are stored in Greenbelt, Md.), buddy statements, unit reports and any other information that might assist the veteran in developing his/her claim.
The VA rating boards also often fail to examine the veteran’s claims folder for claims not raised by the veteran but which exist and must be evaluated by the VA rating boards in light of evidence already of record. The VA also must inform the veteran of what information is necessary to make his claim for benefits sufficient.
I have noticed that treating physician statements are not given the weight and authority they should be given; instead, the VA will rely on VA physicians and doctors under contract with the VA (claiming that they are “independent medical advisors”). These VA physicians and doctors under contract oftentimes examine the veteran in a cursory manner, sometimes within a matter of minutes, and thereafter render an allegedly “independent medical opinion” stating that the veteran’s current disabilities are not related to injuries sustained in service. Sometimes the VA physicians who are under contract are not certified by the American Board of Medical Specialists in the areas for which the veteran claims disability.
When a VA examination is cursory, lasts only minutes and is done by a physician not ABMS board certified in the area for which the veteran claims disability, it is virtually impossible for that examination to fairly serve as a basis to deny the veteran his claim. Such “independent VA examinations” represent both factual and legal error and are an injustice to the veteran. In many instances, the VA rating board will offer no explanation for why it ignored the veteran’s physician’s opinion supporting the grant of the veteran’s claim and only considered the negative “independent medical opinion” of the VA physician.
Veterans dissatisfied with the regional VA rating decision can file a substantive appeal with the Board of Veterans Appeals in Washington. Veterans who appeal must file a Notice of Disagreement with their regional office within one year of the VA rating decision along with a VA Form 9.
The Board of Veterans Appeals is divided into four decision teams divided up by geography. Each team is comprised of at least two veterans’ law judges, staff attorneys and clerical staff. The BVA consists of 14 veteran’s law judges (including two chief veterans’ law judges) and at least 55-60 staff attorneys, some of whom have 20-25 years of legal experience. Each veteran’s law judge is assigned four or five staff attorneys who have varying degrees of experience. The duty of a staff attorney is to review the claim and draft a decision for a veteran’s law judge to proof and sign.
The Board of Veterans Appeals reviews the rating decision rendered at the regional office level looking for errors in fact or law. Because it is not a finder of fact, the board must rely on the record established at the rating board level. Thus, frequently the rights of veterans are lost because no legal assistance was available initially.
The Board of Veterans Appeals allowance rate between FY 1982 and FY 1991 ranged between 12.8 and 14.4 percent. That rate rose with judicial review to 20.8 percent in 2005. The remand rate back to the VA regional office is much higher. It was as high as 48.8 percent after passage of the Veterans Claims Assistance act of 2000, which broadened the VA’s affirmative duty to assist the veteran in the development of his claim. But remanding back to the VA regional office causes even more delay. In most instances the whole process will be delayed for months, if not years, if such an event occurs.
If after filing an appeal with the Board of Veterans Appeals, the veteran or his lay advocate submits a newly discovered material piece of evidence, the veteran will lose any back benefits he might have received had the claim been adjudicated in his favor solely on the basis of evidence presented when the initial claim was filed. Of course, had the $10 limitation fee not essentially barred the veteran from obtaining legal assistance in preparing the initial claim, key material that weighed in the veteran’s favor probably would have been presented initially?
Indeed, veterans are at a distinct disadvantage until after a final decision is rendered by the Board of Veterans Appeals. It is only after that time that they can hire an attorney for a reasonable fee.
It is my hope that the student involvement in a permanent veteran’s law clinic will help veterans seeking legal assistance with their claims.” See op-ed, Craig M. Kabatchnick, Greensboro News & Record, October 29, 2006
1. Reduce the C&P (VBA) arm of the VA to caretaker strength.
a. 57 Regional Offices
2. Award C&P requested by veterans with valid DD 214s and supported IME and two or more certified lay statements.
3. IMEs will become the Standard Bearer for the veterans C&P
4. IMEs will be paid their going rate – Procedure to be work by smart finance people.
a. Hire 10,000 IME doctors
b. Because of the tens of thousands of case files awaiting decisions transfer those files to an IME for finalization.
5. Exercise a one-year BETA test.
6. 2003 GAO report on VBA personal needs to be seriously re-read and analyzed for another direction to do business for the veterans.
7. All ROs and scaled down BVA will have access to all IME on the pay roles. All ROs, BVA and IMEs will be electronically connected with 24/7 capabilities for anyone - anywhere.
8. A veteran with an open claim must have access to their, ROs and BVA files and interaction capability.
9. At the outside, a valid claim should be in the new VBA channels no more then six months.
How to implement these recommendations… DO NOT FORM A STUDY GROUP OR TASK FORCE OR HOLD TRADITIONAL Government style MEETINGS!!(Remember the dead horse). Send this paper to all ROs, VA headquarters, VBA, OIG, Budget Office, and any “Deciders” I can’t remember, and make sure there are some financial (budgetary) smart people involved. Have this paper staffed amongst the “deciders”, hold a video-conference of 1-3 deciders from each office that are authorized to make decisions and talk to each of these items of concern in this paper, i.e. RO Action Officers, apathy, low grade deciders, inexperience, IMEs, staffing procedures, etc.. Send final decisions to the Director of the VA, Congress and Cabinet members. Set realistic due-dates and expect final decision(s) within three months. Have all “Deciders” chop (approve) the charts produced by the CHALLENGE in the following pages.
Who will be the “Deciders” under the new IME program?
1. RO buildings and staff will be no more then one floor of now leased multi storied building and a total staff of no more then 21(plus administrative staff) will be required (1-GS 15, 4-GS 14s, 8-GS 13s and 8 GS 12s) – This personnel configuration will be different for each RO because of demographics.
2. The one GS 15 in each RO will be its “Decider”
3. The BVA will be no more then 9. Supervision and “Decider” of 1 SES V with 8-GS 15 (one per time zones within the lower 48 and 1 each GS13 for Alaska, Hawaii, Guam, Philippines and Puerto Rico)
1. The VBA numbers just do not lie. They tell a sad story of many good people thrashing around trying to make do and make a sick system workable but in 50 years it just isn’t happening. It is time to bite the bullet and go in another direction (see brass monkey theory). If the VBA was rated against its own criterion it would be 130% disabled.
2. Statement of James P. Terry, Chairman, Board of Veterans' Appeals before the Committee on Veterans' Affairs, United States Senate July 13, 2006 where he testified saying: “…Other factors that may affect the increase in appeals to the Veterans Court are not so readily quantifiable. There is a heightened awareness among veterans of their access to the judicial process. It appears that veterans have become increasingly knowledgeable about their right to appeal to the Veterans Court and are increasingly willing to avail themselves of that right.” He continued by saying; “These changes would affect cases that have already been filed. As noted earlier, however, the sheer number of potentially appealable decisions from the Board of Veterans' Appeals is staggering. The problem of backlogs will be a theme that continues into the future, unless steps are taken to meaningfully reduce the actual number of appeals or to employ an expeditious means to dispose of them.”
3. Our government has been thrashing around with this problem since 1953 with no solid solutions in sight. Wasted cost: Unknown but has to be in the hundreds of billions.
4. Veterans do not deserve having to beg for their rightful due.
5. C&P staffs or another name is VBA range from a bit over 600 for California to the Philippines’s 78 so total numbers of GS employees look to be in the 8,250 range. These numbers need not be RIFed (fired) but absorbed into the 1.9 million (or 15.4 million – depending on which chart you reference) federal full-time civilian work force. This alone saves over $200,000,000 annual VA budget dollars.
6. Our VBA system is broken, there are honest people trying to do the honest and honorable things for the veterans but visible actions are similar to nailing jell-O to the wall.
7. C&P awards will initially increase but only proportional to the current back-logged claims. 8. New claims will not increase as the veteran has never accepted anything they did not earn.
9. Some pain now will save major pain down the road.
10. The present system simply does not work. Yes the system keeps lots of people employed and yes it works “sometime” but not all the time as it was designed over fifty years ago. The VA and VBA have enough band ads already so it is time to try something else. LET’S TRY IMEs. What do we have to lose?
11. The VBA said in 2001, “…Through the assembly, assessment and interpretation of historical participation and performance data, VBA can reasonably construct decision-making models that utilize knowledge gained from the past.” The 2001 BVA structure has exponentially decomposed itself. NOTHING has changed for the better! It is time to change!
12. The new VBA system will sure make long-range-budget (5 year) planning a lot easier, smarter and reliable.
1. Initially, a shortage of IME qualified doctors.
2. Bricking at the highest levels within government as to who finally came up with THE solution that works by saving budget dollars and making 20 million veterans content in the knowledge their country finally acknowledged their sacrifices. George and Abe would be proud.
IF YOU HAD YOUR “WHAT IFs…” as a veteran which would you choose?
1. …being awarded just compensation would be no worst then what is promised.
2. …your widow did not have to apply for your C&P.
3. …time from “Request” to “Approval” would be only three months and not 10 years.
4. …there actually is a “genie” that granted wishes, and it gave you two?
5. …keep what we have. What If Congress changed the VBA and it got WORSE?
The Constitution of the United States, Amendment 1, and The Bill of Rights has given you a voice and a genie has given you two wishes. Now…. Use them.
THE CHALLENGE**: for the VA and VBA – Give your VBA an honest test! Not the congressional White Paper “numbers”, finger pointing report, “we know the problems and working it”, meeting after meeting till the numbers seem ‘manageable’ - but a HONEST look at the NUMBERS* and people.
a. Select 4 people (two will be ladies, two will be male. Age needs to be greater then 50 except for the GS5 or 7 – A civilian, A veteran, A GS5 or 7 RO Action Officer, A GS14 VBA manager
b. Make four charts:
1. Dollars v. time spent on existing VBA procedures – use 100 to 300 random claims.
2. Using the same sampled claims – grant (approve) the claims as submitted. This is the one of interest as I feel the numbers will show the process will be cheaper and more efficient in the long run by automatically granting*** of claims rather then beating the claim to death until it matches the arbitrary numbers of a regulation. By the time you save all the middle processing dollars caused by “people- handles”, re-handling, massaging, the claim pays for itself.
*** Read through the claim, if it sounds honest, logical, either within your present guidelines or close and your gut tells you compensation is needed / warranted, and then grant. If claims have accompanying LAY statements read them to get a feel (another gut reaction) if the words are honest. Put yourself in their shoes as if you were asking for C&P then ask yourself, “Do I deserve what I am asking my government for?” A real veteran with ‘needs’ will never lie about that.
3. IME – using an average of $2,000 per IME times the sampled claims will be a line on the dollars chart.
4. Compute for how long? Assuming the average life spans for a veteran as:
aa. Female = 73 years
bb. Male = 66 years
Five years has been taken off the National averages simply because of wear and tear of the military on the human body.
c. Challenge to be completed within one month.
d. Publish honest findings on the Internet.
e. This same procedure can be repeated for 1,000 and 10,000 claims as time permits, but the bottom line will show proportionally huge savings in manpower and budget dollars as we move away from multi-layered bureaucracy to serving our veterans.
* I strongly suspect your numbers will show the VBA is too large, inefficient and not a lot different then most any government organization.
** If I am wrong and the numbers show you (VBA) are doing the absolute best you can under the circumstances and I have wasted your time with this paper then name your prize you require of me and I will do it.
I was further disappointed this week after I asked the VA if they would like to comment on this paper: They said NO. On 27 November 2006 M. Marsh, Veterans Service Center Manager said “No, we do not want to make a comment on your article.”
Thank you for staying with me throughout this hard-to-read story…. But there just was no easy way to say… “We need to help our veterans”
Web Site: haroldhester.com
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|Reviewed by William Heino Sr.
|Speaking of the BVA! Is there, a-light-at-the-end-of-the-tunnel? Why are some veterans being over-charged for their medication?
When you read the law on co-payments, 38 USC 1722a, think like a veteran. As simple, and short as it is, many cannot understand it, or I should say don't want to understand it. Because it is quite clear. For example, I asked the chief pharmacist at Hines VA Hospital to explain 38 USC 1722a. He got together with his colleagues, and determined that they could not explain it’s meaning. Because? They were looking for the VA answer. Doing otherwise would not have been wise. The BVA explained it, however, they should have been more careful, for they provided and substantiated my claim by providing me with the basis of my argument.
For split pill supplies, millions of veterans' are charged $16, over-charged in the copay cost for, using the (Board of Veterans' Appeals court) description, of an "actual dispensed" 30-day $8 medication supply. Why is this? Because, the prescription requires that a pill supply be split. No other reason. Add up the one month's split pill supply for the "actual dispensed" $8 supply over-charges by the well over 1.1 million prescriptions. Veterans $8 copay, as mentioned, of 30-day supplies can be anywhere from 30,60,90, or whatever. But if the veteran is required to split these pill supplies, the VA doubles, or over-charges, the copay cost.
Here is the law. The co-payment each 30-day period being $8.00, is explained in Title 38 USC 1722a “ Paragraph (a)(1) subject to paragraph (2),. the Secretary shall require a veteran to pay the United States $8.00 for each 30-day supply of medicine..if the amount supplied is less than a 30-day supply the amount of the charge may not be reduced.”
Paragraph 2. “The Secretary may not require a veteran to pay an amount in excess of the cost to the Secretary for medication as described in paragraph 1.”
I find no mention in either the USC or the CFR any mention of charging for split pill prescriptions. However, to the contrary, from the Federal Register12/6/2001, “Under these circumstances, we believe that a $7 [$8] copayment amount is reasonable....Also, as we stated in the proposal, under 38 USC 1722a, VA may not require a veteran to pay an amount in excess of the actual cost of medication and pharmacy administrative cost related to the dispensing of the medication.“ The Federal Register clearly states, “an amount in excess” of the cost of medication and pharmacy administrative cost. In two (2) supplies, the pill medication and administrative costs, being exactly the same, however, one pill supply being a split pill supply, double the copay. The amount in excess of the cost.
This is what happens to an appeal process. My claim filed with the Board of Veterans' Appeals, and denied, the BVA stated, “.. 1722a clearly pertains to VA‘s cost in dispensing the medication...,The VA incurred a cost...to dispense medication..”, I, like the Board, I am, “..unable to find any authority allowing for a deviation from the standard copayment.” As well, “The Board has no authority to act outside the constraints of the statutory and regulatory criteria.” My claim has been remanded by the United States Court of Appeals for Veterans' Claims, back to the BVA. I have been after them since March 2002. However, It's been 9 months now, and my claim perhaps has been lost a second time, as it has not been returned to the BVA.
So, to recap, the argument to my question in filing a claim is, if the cost, as explained above, and by the BVA, the VA incurred a cost, to dispense all outpatient medication, carries a copay cost of $8 for a 30-day supply of 30 pills, why does an exact same $8 supply in dispensing cost have to cost $16 because the prescription calls for the pill medication to be split?
And a final note. Federal Register: “VHA conducted a study of the pharmacy administrative costs relating to the dispensing of medication on an out-patient medication even without consideration of the actual cost of the medication.”
|Reviewed by Georg Mateos
|There are not RED-TAPE when it comes to send a soldier to war, it is done by simple orders and very few words.
When they awarded you with two Purple Hearts, it is done by a simple bureaucratic prelined order from the Pentagon, the Bronce and Silver Stars that were supposed awarded by the President...he didn't, they were awarded by a simple and preordinaided bureaucratic action, like, as the author said above, a clerk adding your name to a piece of already printed paper by the thousands.(no emotion or gratitude there)
Then, when you become a casualty and are disabled is when you fell from the hoorrah wagon and land on the famous RED-TAPE, because you aren't more a viable combatatnt to them you are sweep under the bureaucratic carped and God help you to survive that.(as Air Force Veteran, multiple andicaped Karen Lynn Dorman can testify after been told that she wasn't "enough handicaped" to claim her benefits)
The Department for Veterans should be managed by experienced bureaucratic Veterans, not by ninnies 9 to 5 jockeys that can't see beyond the Manuals & Directives or have a sensible common sense to take a responsible action towards people that aren't asking very much, but the same swift action retribution as it was used to send them overseas to defend their country.
God help us from bureaucrats, because any enemy else we can take care ourselves.
|Reviewed by Chuck Keller
|Powerful stuff. Thanks for sharing it with us.|
|Reviewed by Karla Dorman, The StormSpinner
|Thank you, Sir, for your service: welcome home, soldier, welcome home.
Does no good for your situation: God, I wish I could do more than vote, to help our Veterans.
Being disabled Veteran myself (barely, according to THEM), can't do anything.
Saving your articles to read again and again: this should be published and sent to every elected official who have FORGOTTEN--
(((HUGS))) and love, Karla. *tears*
|Reviewed by email@example.com Bennett
|God bless you for this and for being so brave.|
|Reviewed by Chrissy McVay
|Thanks for bringing this to everyone's attention. So many out there still don't realize how hard it truly is for veterans and no one seems to be listening.
|Reviewed by - - - - - TRASK
|Now E Mail It Copy To:
Attention: EL Presidente Bushed