Author: Hondo

(Part 5 of a series. Part 1 can be found here; part 2, here; part 3, here; part 4, here).

Maybe my previous articles haven’t p!ssed you off yet. If not, I guess I’m not trying hard enough. (smile)

However, if the previous articles haven’t made you angry . . . keep reading.  I’m guessing this one just might.

Why?  Because now I’m going to discuss us vets. As a group, our hands are far from clean.

If fact, collectively we are part of the problem. And we are part of the problem in at least 3 different ways.

No, not all of us. But enough of us that we vets as a group IMO indeed bear some of the responsibility for the current VA mess.

Here’s why.

The First Way:  Fraudulent or Exaggerated Claims

Some vets exaggerate – or outright lie through their teeth. That’s contributed to the VA’s current issues in several ways.

First, the obvious: some vets lie about what they did, and use those lies – sometimes along with forged documents – to get VA benefits they simply don’t deserve. (Hell, in some cases they don’t appear to have ever even served in the military, but have conned the VA into granting them benefits anyway.)  We’ve seen many examples of this kind of lie here at TAH.

Others simply exaggerate their “injuries”, or file claims for conditions that are easily faked but hard to disprove. (“Lower back pain” and PTSD come immediately to mind, but they’re hardly the only such easily-faked conditions.)  A fair number of such specious claims get approved by “easy” VA rating officials.

Both of those types of dishonesty hurt, in multiple ways. First (and most obviously): false or exaggerated claims steal money from Uncle Sam – money that could otherwise be used to hire additional claims processors or medical personnel, extend facility operating hours, lower copayments, or otherwise provide services of benefits to deserving vets. Or it could be returned to the US Treasury to help reduce the deficit (which would also benefit vets over the long by keeping the US government financially more stable, thus helping assure continuation of future benefits).

There’s another way fake and exaggerated claims hurts: they clog the system. More people to be served with a fixed-size staff means less time per person served – for everything – along with longer waits. I’m guessing this is a big part of why the VA takes so damn long to do anything.

Finally – and least obviously – such fake claims and stories affect the perceptions and attitudes of non-vets. Constantly hearing stores (some number of which are IMO fake or exaggerated) about PTSD, close combat, service-connected injuries and conditions, etc . . . , that have “messed up” veterans has two distinct effects on public opinion.

First:  those non-vets who are easily swayed (and gullible) will think that all vets are “messed up”, and need “help”. They’ll thus support additional VA services (e.g., more money) that aren’t legitimately needed – in order to “help those poor unfortunate vets who can’t help themselves”.  Take this too far (and IMO we already have), and this simply invites more fraud.

On the other hand, the cynics among non-vets will see that many such claims are obvious bullsh!t.  They’ll begin pigeonholing vets as a group as dishonest whiners too lazy to make it on their own and looking for a “gravy train” to ride.

Obviously neither of these perceptions is true. As a group vets are neither broken losers nor whiners looking for a gravy train.  But sometimes perception is as important as reality, if not more so.

The Second Way: We Vets Lobby. Bigtime. And Effectively.

Quick question: how many formally-recognized, nationwide Veterans Service Organizations (VSOs) are there? Five? Ten? Twenty?

Yeah, right. By my count, try over one hundred fourty (I get 144, but I only counted the list once) that are formally recognized by the VA. Plus God only knows how many more “informal” or “unofficial” ones.

To be recognized as a VSO by the VA, the entities “must be a Non-Profit that are (sic) National in scope, of good reputation, in existence and involved with Veterans for a minimum of three years, dedicated to a wide range of Veteran’s issues with a membership of at least 1,000 or be Congressionally recognized.”  So we’re not talking some club formed by a dozen guys in a bar when we’re talking about recognized VSOs.  We’re talking about organizations that are nationwide in scope, with 1,000 members or Congressional support, and which are going concerns.

So, what do these organizations do? They help vets, right? They provide support, assist with paperwork, and other such things to help vets “get what’s coming to them”?

Yeah, they do that. I’d guess maybe that’s about 10% of what they do.

What do they do the rest of the time? IMO, mostly “They provide a voice for veterans on veterans’ issues.”

Let me translate that: bluntly, they’re lobbyists.  They lobby Congress and the public. Why?  They try to “build more support” (i.e., get more $$$) for veterans programs, or to get new benefits approved.

And they do a pretty damn good job of that lobbying, too. Look no further than the recent changes (2009) regarding Agent Orange becoming a presumptive exposure for those serving in Vietnam or along the Korean DMZ (1968-1971 only). Yeah, that took a while – and it took having a Vietnam vet as VA Secretary to make that happen. But if you don’t think lobbying by VSOs played a huge part in making that happen, you’re fooling yourself.

That’s hardly the only case. The VA has established a Gulf War Registry along the same lines for “environmental exposure” conditions related to service in the Persian Gulf region from 2 August 1990 until, well, now. My guess is that a sh!tload more stuff will fairly soon become “presumptive” for service in that region, too – whether or not requisite exposure can be documented or causation is ever scientifically demonstrated. A few conditions already have been so recognized.

Bottom line: VSOs lobby like hell for more benefits (and $$$) for vets across the board. It’s what they exist to do.

And we vets support the hell out of them. Because, well, “We deserve it, dammit!”

The Third Way: We Work the System, Because, Well, “We Deserve It, Dammit!”

Here’s an excerpt of a comment I ran across recently at TAH. I won’t ID the writer.

“This just strikes a nerve with me! When WE return home from a WAR it’s really just the beginning! This is when WE need the most help! WE should NEVER be turned away!! Never be put on a waiting list !!! We shouldn’t have to fill out b.s. paper work or claims!! All thi(sic) should be done (happily) for US!”

Let me translate that into what many non-vets see/hear when reading the above:

“I’m a vet, so Uncle Sam owes me. He should take care of me. I deserve it, dammit!”

There’s some truth there. And it is indeed true about the specific case about which the individual who wrote the comment was referencing. In that particular case, the VA miserably failed the individual in question, leading to his untimely death.

But that kind of statement also points out what I see as a larger problem. IMO, we vets – as a group – have fallen to some extent into the same “I/me/mine/you owe me/gimme” mentality that has become pervasive in the US over the past 30 to 40 years. We expect – no, we demand – that Uncle Sugar “take care of us”.

As a group, we vets “work the system” bigtime to make that happen.  And we do that in ways far beyond merely supporting VSOs and their lobbying efforts on our behalf.

Vets leaving the service today are filing VA claims at historically unprecedented rates. The rate of military personnel leaving the service filing a VA claim has risen from 21% in the early 1990s to 45% in 2012.

Yeah, that loads the system a bit.  But it’s not just claims from younger, Iraq/Afghanistan vets that are clogging the system. Those 2.5 million Iraq/Afghanistan vets filed only about 20% of VA claims that were pending last year. Another 8% weren’t clearly identified as to the vet’s era.

Who filed the other 72% of VA claims pending in 2013? Vietnam, Gulf War, and Peacetime vets. (Additional details to accompany the linked graphic are found in this article.) In fact, more claims were pending that had been filed by vets of both Vietnam (37%) and the Gulf War (24%) in 2013 than claims that had been filed by vets of Iraq/Afghanistan.

Older vets today are also filing additional claims and requests for reexamination and re-rating at historically unprecedented rates. And the increase really began to spike in 2009 with the announcement of presumptive Agent Orange exposure for Vietnam and the Korean DMZ.

In spite of IAVA and others’ claims, it isn’t just the “young vets” from Iraq and Afghanistan who are clogging the system with their claims and getting “screwed” as a result, though they are indeed part of the issue. Their claims are only a relatively small part of the huge increase in VA claims recent years.

There’s also the whole “presumptive” issue.  There are a sh!tload of conditions that the VA regards as presumptively connected to herbicide exposure (e.g., Agent Orange and other types of herbicides) – including heart disease, respiratory cancers, prostate cancer, various forms of leukemia, type II diabetes, and many others.  The VA has now decided that anyone who ever set foot in Vietnam (or a whole bunch of other places) is now “presumed” to have been exposed – whether or not there’s any evidence they actually were.  So guess who’s going to pay for treatment for those presumptive conditions for anyone who ever set foot in Vietnam (1962-1975) or offshore, or Thailand, or served near the Korean DMZ (1968-1971)?

You got it: the VA. Or in other words, the US taxpayer.

You and me.

Oh, and as I noted above the VA has already established a Gulf War registry and a few presumptive conditions for anyone who served in the Persian Gulf, too.  So it looks like this expansion of presumptive eligibility isn’t going to stay unique to Vietnam.  Stand by for multiple future rounds of lobbying for this type of expanded ‘presumptive coverage” for conditions someone thinks might be associated with service in the Persian Gulf or Central Asia.

Why? IMO, that answer should be kinda obvious. There’s money to be had – either directly (in terms of increased compensation) or indirectly (in terms of additional free medical care and avoiding having to buy private health insurance). Couple that with an increased, “We deserve it, dammit!” mentality, and the result is quite predictable.

In some respects, Pogo was right. Collectively, IMO we vets are indeed part of the problem too.

. . .

That’s it for the first part of this series.  Don’t like what I’ve said?  Take aim, and fire away.

That’s OK. That shows you’re aware of and thinking about the problem.

The VA today is seriously broken; it well may be FUBAR.  Continuing as-is today is simply not a viable option.

But some of what the VA does is absolutely needed.  So if possible, we need to figure out how to un-FUBAR it.

I’ll have some thoughts on what we might do to start un-FUBARing the VA at a future date – hopefully, soon.  They might be good ideas, or they might be unworkable.  But I’m willing to throw them out there for discussion.

 

 

(Part 4 of a series. Part 1 can be found here; part 2, here; part 3, here.)

Another issue with the VA is the fact that some of what the VA does simply doesn’t pass the “common sense” test.

No, I’m not talking about rating decisions gone awry, or bad medical care. I’m not talking about delayed or denied educational assistance, or secret waiting lists. I’m not talking about the fact that the VA – not DoD – defines who is and is not a POW for VA benefits purposes (and gives out former POW benefits to far more individuals than were ever legitimate POWs). I’m not talking about the fact that the VA does an execrable job of front-end screening for fraud, and lets fakes draw benefits they don’t actually deserve.

I’m talking about the fact that some of the benefits the VA provides – and the policies that govern them – simply don’t pass anything remotely resembling a common sense test.

I’ll give six examples; they’ll probably p!ss some people off. So be it. I could probably come up with at least that many more without trying too hard.

Example One: Veterans and Survivors Pensions

The first example is that of Veteran and Survivor Pensions. These are relatively modest tax-free payments provided to qualifying veterans and their survivors.

The intent is to provide an income supplement to ensure a poverty-level (e.g., subsistence) living.  Eligibility criteria thus includes means testing, so in that respect it there is some sanity.  And in this case (and unlike SNAP, aka food stamps), the means testing indeed appears to be more than a joke.

But the rest of the eligibility criteria really make me shake my head and mumble, “WTF?”.

Full eligibility criteria are found here. Here’s the short version (criteria below are for the Veterans pension, but those for the Survivor’s pension are essentially the same, except that a surviving spouse must not have remarried and neither a surviving spouse or dependent child need be 65):

• The veteran must have served 90 days or more on active duty (entry on active duty prior to 7 Sep 1980) or two years (or the first term of active duty to which called, if shorter), at least one day of which occurred during a defined wartime period;
• The veteran must be
  o   Age 65 or older, OR
  o   Totally and permanently disabled, OR
  o   A patient in a nursing home receiving skilled nursing care, OR
  o   Receiving Social Security Disability Insurance, OR
  o   Receiving Supplemental Security Income
• The veteran’s (or survivors’) family income must meet statutory limits.

That’s essentially it. If someone served one freaking day during wartime – regardless of where, or what they did – they qualify if/when they’re old or disabled and indigent. So do their survivors if they cash in their chips early.

This yields the following absolutely absurd hypothetical scenario.

Two friends graduate from high school in June 1974. After trying to find employment for about 9 months (1974-75 was a pretty tough time, economically), each enlists in the US Army under a delayed entry program option.

The first guy gets a report date to basic on Monday, 5 May 1975. The second (different MOS) receives orders to a different basic training class starting 1 week later – on Monday, 12 May 1975.

Both serve their active duty time in CONUS. The first gets out after six months on a hardship discharge due to a family tragedy. The second serves for 9 years, getting out in 1984. Neither gets hurt while serving, and neither files a VA claim when they get out.

The first guy serves at Fort Hood. The second guy serves at Forts Stewart and Bragg – and deploys to Grenada during Urgent Fury. Both receive honorable discharges.

Per the VA’s stated criteria, the first guy is eligible for a needs-based Veterans Pension (his survivors are similarly eligible for a Survivors Pension, if he dies early). The second vet and his survivors? Um, no.

Why? Because they went on active duty 1 week apart, based on the needs of the Army. The first guy served for 3 days during the recognized Vietnam War period (which ended 7 May 1975). The second guy served 18 times as long, and served in Grenada – but technically has no service during a “defined wartime period.“ (Service in Grenada in 1983 is not defined as serving “during a wartime period” by the VA.)  So for him and his dependents – nada.

Yeah, that makes one helluva lot of sense, doesn’t it?

Veterans and survivors pensions to me make no sense period. Unless a vet has a service connected disability, in my book Uncle Sam doesn’t owe them or their survivors squat simply because they are old and/or indigent; they’re not retirees. They served, then chose not to make the military a career.  If they’re seriously disabled they should presumably be eligible for Social Security Disability.

Frankly, this looks more like a welfare payment by another name to me than anything else. YMMV.

Example Two: Copayment Waivers

Here’s a second VA benefit-related policy that makes me scratch my head bigtime.

For many, the VA will treat non-service connected medical conditions. That makes me scratch my head in two ways.

First: why is the VA treating non-service-connected conditions at all for veterans who are not 100% disabled or in some defined group that receives enhanced or presumptive benefits? (More about that later.) And second: why do they charge some vets copayments for such treatment and not others?

Here’s today’s reality: the VA groups vets into various “priority groups” regarding medical treatment (rules for dental care are very different, and I’m not addressing dental). Those groups are listed here – along with the business rules of who pays a copayment for non-service-connected care and who doesn’t. Both the groups and the business rules are rather are complex (some would say convoluted), and I won’t attempt a detailed explanation of those policies here. If you’re interested, follow the link and read the table. If you’re a vet with a VA disability rating and ever use VA medical care, you also might want to download and keep a copy of that priority group chart.

Now, I can understand why no co-payment is charged for service connected conditions. That’s one of the VA’s primary reasons to exist – to provide medical care for those conditions a vet incurred or aggravated while serving this country, and which still require treatment. Morally a vet has a right to expect that.

I can also see why copayments are waived for those rated at 100% disabled – although even in those cases, one can make an argument for applying means-testing and charging those who can afford to pay.  (I don’t necessarily agree, but the argument can be made and has some logical validity.) Ditto for ex-POWs (those recognized by DoD, anyway); those legitimately rated as permanently and completely disabled for non-service-connected reasons; and those other defined groups receiving enhanced or presumptive benefits (though the declaration of “military sexual trauma” as such a special group seems to me more due to politics than legitimate reasons).

But why do vets with disabilities rated at 50% to 90% get a waiver, while vets rated between 0%(but with one or more service-connected conditions) and 40% get means-tested to see whether or not they pay copayments for treatment of non-service-connected disabilities? What’s magic about the number 50%?  Why isn’t anyone below 100% subject to the means test?

A fair number of people rated by the VA at 50% disabled or more indeed work full-time, or have substantial other sources of income. Many work for employers that offer medical insurance, or in jobs that pay well – or both. Why should they get copayment waivers for non-service-connected care, when one of their fellow vets that simply happens to have a lower disability rating (and perhaps a much lower-paying job as well) doesn’t get the same deal?

There are some other odd things regarding copayments and waivers for non-service-connected conditions. Let’s just say that much about the area of copayments and waivers for non-service-connected conditions IMO doesn’t seem to pass the common-sense test.

Example Three: Non-Service Connected Care

A related question comes to mind: other than those who are ex-POWs, 100% disabled, and other defined groups getting enhanced or presumptive benefits – why is the VA providing non-service connected medical care at all?

As I said previously, one of the main reasons the VA exists is to provide medical care for those conditions a vet incurred or aggravated while serving this country, and which still require treatment. So providing medical care for any service-connected medical condition – even if it’s a non-disabling, 0% condition – is IMO legit.

But non-service-connected conditions are, by definition, not related in any way to military service. They were not caused or aggravated by military service. Ergo, they would exist whether or not the individual ever served in the military. So why in the world is Uncle Sugar providing medical care (and often, free medical care) for such conditions at all to anyone who’s not 100% disabled, an ex-POW, or in a defined group receiving enhanced or presumptive benefits?

I wish someone could explain that one to me. I just don’t “get it”.

Example Four: “Blanket” Medical Care for Recent Combat Vets

Here’s another benefit that I don’t quite “get” – this time courtesy of Congress.  Today, veterans “who have served in a theater of combat operations after November 11, 1998, and have been discharged under other than dishonorable conditions” are entitled to VA medical care for 5 years after discharge. Period. NQA.

It doesn’t matter if the vet got hurt or not, or actually served in combat – or were even ever personally at risk. It doesn’t even require good conduct or honorable service. All that’s required is serving “in a theater of combat operations” for some period of time.

Here’s a scenario for you.  Picture a guy or gal who (1) was deployed to Qatar or Bahrain, or served afloat in the Persian Gulf; (2) never was hurt or saw combat; (3) went downtown one day and got high as a kite on khat/meth/whatever, or drunk as hell; (4) came back to base/ship, assaulted their CO or NCO, and was facing court-martial; and (5) got thrown out on their ass with an OTH or BCD.  That individual is still freaking eligible for 5 years VA care if they can document service in-theater.

Why? Because the individual did not get a Dishonorable Discharge, and served “in a theater of combat operations” after 11 November 1998.  That’s why.

Frankly, I don’t see the logic behind any vet getting a freebie of 5 years of VA medical care simply because they served in-theater. Vets who get mobilized to CONUS, Germany, or Korea after 11 November 1998 are not by law authorized that same benefit. And based on what I saw in the CENTCOM AOR, other than no alcohol most of the tours in-theater outside of Iraq and Afghanistan were no worse or more dangerous than an unaccompanied tour in Korea. Many in-theater tours in the USAF, Navy, or USMC are also quite a bit shorter than a 1-year unaccompanied tour in Korea, too.

This just doesn’t make sense to me.

Example Five:  Presumptive Conditions

Another VA area that has me scratching my head is presumptive conditions.

Here’s the VA’s regulatory list of presumptive conditions and to whom the presumptions apply.  The Vermont state VA department also has a list of VA presumptive conditions; their list is perhaps a bit more easily understandable.

Some of those presumptions make at least some sense.  Take the tropical disease presumptions, for example.  Tropical diseases are, well, tropical diseases.  If someone serves in the tropics they’re not always avoidable, even with proper prophylactic medications and care.  They are a legitimate risk of service, are in some cases chronic conditions requiring long-term treatment, and are a legitimate service-connected condition.  So yes:  if they manifest within the statutory time frame, the presumption that they’re service-connected is reasonable.

I can also see the logic behind the presumptions for radiation-exposed vets and former POWs.  The former group was exposed to some pretty nasty stuff before the full dangers of such exposure were known, and the latter group served under extremely abusive conditions.

I can even understand some of the  presumptive conditions related to herbicide exposure (including Agent Orange) for those who can document probable exposure to same.  Herbicides can be nasty, and dioxin (the contaminant in Agent Orange that’s responsible for the majority of its problems) is particularly nasty stuff.

But with Agent Orange, some of the VA’s policies concerning presumption begin to strain credibility.  And the VA’s 2009 policy making Agent Orange exposure itself presumptive for anyone who ever set foot in Vietnam or served offshore, regardless of where in-country they served or under what conditions, is IMO exceptionally ill-advised policy.

In particular, for Agent Orange five conditions that are presumptive are IMO hugely problematic. Those conditions are ischemic heart disease, diabetes, all forms of chronic B-cell leukemia, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), and prostate cancer.

Well, I guess that each of those five conditions can indeed be “aggravated or caused by” herbicide exposure.  However, they can also be caused by a huge number of other chemical exposures unrelated to military service – or can simply occur, period, with no apparent causes.  They also have exceptionally strong dietary and lifestyle linkage as well (e.g., tobacco use, obesity, physical condition and exercise).  And particularly in the case of prostate cancer, leukemia, and heart disease they appear to have a strong genetic predispositions as well (these conditions appear to run in some families).

In short:  automatically assuming these 5 conditions are linked to military service is IMO a stretch if there is no definitive proof of exposure to high levels of a known causative agent (e.g., herbicides).  Yet that’s precisely what the VA is doing today.

These five conditions are also generally associated with aging.  And couple that with the presumption that anyone who ever set foot in Vietnam (or on various ships offshore, or who flew in certain aircraft, or who served in Thailand) is now deemed somehow to have been “exposed” to Agent Orange – the US taxpayer is on the hook for essentially lifetime medical care for a huge number of folks.  About 3.1 million, to be precise.

Here’s a hypothetical scenario that illustrates the absurdity.of the current Agent Orange presumptive policies.  Picture two brothers – identical twins.  They come from a family with a strong history of prostate cancer.

Both go into USAF ROTC in 1957.  Both are commissioned in 1961.   Both get their pilot’s wings in 1962. One brother gets assigned to Langley AFB; the other, to Hickam AFB in Hawaii.

Each serves 5 years, and gets out.  Each gets a job with a major US airline as a pilot, and later retires from that post-service career at age 60.

While serving, the brother at Hickam serves for a year as a General’s Aide in 1964. During that assignment, he makes a 5 day TDY trip to Vietnam.  He flies into Tan Son Nhut on a VIP plane, stays at the Brinks Hotel (before the bombing), and flies out four days later.  He never leaves the Saigon metro area.

Between ages 70 and 72, both brothers unfortunately develop prostate cancer (strong family history) within a 18-month period.

The brother who went TDY for 5 days to Vietnam is covered by the VA for his prostate cancer treatment (and presumably will be rated at or near 100%-service connected if the disease becomes advanced).  The other brother?  “Xin loi, GI.”

Oh, and the VA seems to be starting down the same path regarding service in the Persian Gulf.   The VA has now established a short list of conditions that are presumptive for service in the Persian Gulf, too – though the VA policies associated with Persian Gulf conditions are much more stringent than those relating to Agent Orange exposure today.  (Then again, VA policies associated with Agent Orange exposure were much more stringent until 5 years ago, too.)

Further:  we’re seeing new possible Gulf-service-related issues brought up in the press from time to time, as Jonn’s recent article about Camp Victory dust shows.  We’re also seeing extensive lobbying by VSOs for Persian Gulf related presumptions like the VA has done for Agent Orange. So I’m guessing we’ll see a boatload of automatic “presumptive conditions” for service in Iraq and Afghanistan in the future, too.

Bottom line:  yeah, presumptive conditions work to the vets benefit.  But IMO, the VA appears to have gone entirely too far in that direction based on what we know today.  The whole concept IMO needs to be re-looked, top to bottom. It’s out of control.

Example Six: Most VA Bennies Don’t Even Require an Honorable Discharge

This is a no-brainer. It’s so blatantly nonsensical IMO that I won’t discuss it further here.  VA benefits simply should require an honorable discharge – and nothing else.  Doing what one signed up to do is not that damn hard.

I’ve probably p!ssed you off enough for today. More tomorrow.

(Part 3 of a series. Part 1 can be found here; part 2, here.)

IMO one of the biggest problems with the VA today is blindingly simple.  Unfortunately, that problem will be very difficult to correct.

The VA doesn’t really know what it’s trying to do as an organization.  The problem begins with the VA’s mission statement itself – and as a result, permeates the agency.

Compounding the problem, the VA is also trying to do too damn much. It’s become unmanageable.

. . .

The VA traces its origin to this lofty phrase from President Abraham Lincoln’s Second Inaugural Address:

“. . . . to care for him who shall have borne the battle, and for his widow, and his orphan . . . .”

Indeed, the VA’s formal mission statement includes exactly this phrase – and not a helluva lot else.  It’s the VA’s formally-stated raison d’être.

But what does that phrase really mean?

I regard Abraham Lincoln as the one of the two truly indispensable figures in all of US history; the other IMO was George Washington. Without either IMO today we would not have a United States.

With all due respect to Lincoln, remember:  he was also a politician.   Politicians deal in flowery phrases that, on analysis, are ambiguous as hell by design. It’s simply what they do, and how they get elected.  Then as now, good “sound bites” worked – even when they actually said nothing.

Lincoln’s statement above was no exception. That fine-sounding phrase? It means pretty much whatever the hell you want it to mean.

And that’s IMO essentially what the VA has done:  whatever.  It’s “chased the latest bright shiny object” for the last 50 years..

Just about every time the “good idea fairy” has flitted by during the last 40 or 50 years, the VA seems to have listened to her – cost be damned. Congress and the US public has gone along with it.  Hell, Congress has even added some extra stuff from time to time.

. . .

Theoretically, the VA is organized into a HQ (plus associated staff elements) and three major functional elements:  the Veterans Health Administration, the Veterans Benefits Administration, and the National Cemetery Administration.  A formal organizational chart may be found here.

However, IMO that chart doesn’t really tell anyone very much about what the VA actually does.  So allow me to try.  I’ve looked over their website and done a cursory analysis of what benefits they provide – and what functions the VA actually performs.

In addition to the normal internal administrative and management functions that any large organization performs to maintain itself (payroll, HR, IT, legal, etc . . . ), VA does a whole lot more.  Here’s what I believe is a partial list of what the VA does today to “care for” veterans. I say “believe is a partial list” because I’m pretty sure I’ve missed something.

• Determines who qualifies for VA benefits, and the benefits for which they qualify – including an extensive appeals system
• Conducts or reviews physical examinations to determine/verify physical disability connected with military service
• Provides counseling on available benefits
• Determines who qualifies, for VA benefits purposes, as a POW (this one really p!sses me off – but it’s actually part of Federal law)
• Provides healthcare and dental services
• Operates and maintains hospitals and other healthcare facilities
• Maintains medical records
• Runs pharmacies (traditional and mail-order)
• Provides mental health care services
• Provides or brokers life insurance coverage
• Provides health insurance coverage (CHAMPVA)
• Provides disability compensation, including additional allowances for dependents
• Provides additional grants and allowances for the severely disabled
• Provides financial assistance to defray costs associated with those veterans needing full-time assistance (Aid and Assistance)
• Runs Community Living Centers (formerly VA Nursing Homes)
• Makes arrangements with other, non-VA nursing homes and/or assisted living facilities to care for eligible veterans
• Provides needs-based financial assistance for destitute or nearly-destitute veterans and their dependents or survivors
• Provides counseling services (of various types other than mental health)
• Provides counseling services (of various types) for dependents of selected deceased veterans
• Provides financial benefits to the dependents of selected deceased veterans
• Provides financial assistance for the education for veterans and selected veterans’ dependents
• Operates and maintains perpetual care cemeteries
• Guarantees home loans for qualifying veterans and their survivors
• Provides limited employment placement services for veterans
• Monitors the financial affairs (at least theoretically, thru proxies) of mentally-incompetent veterans receiving financial benefits
• Provides financial assistance to help defray the cost of veteran’s funerals
• Provides headstones for veteran’s graves
• Provides burial flags for veteran’s funerals

Looking at that list, I’ll just be damned if I can figure out just what kind of “business” the VA is running. They determine eligibility for benefits. They hand out money left and right – for a sh!tload of different reasons. They run hospitals, clinics, and pharmacies. They store records. They provide mental health care. They run nursing homes and contract for nursing home services. They run cemeteries and provide headstones. They guarantee loans. They provide counseling services of various types.  They provide health and life insurance. They even provide funeral flags.

It’s not quite the IPhone with it’s ubiquitous “there’s an app for that” slogan.  But it’s pretty close.  If you can think of it, there’s a damn good chance the VA has a program that somehow can help do it.

If you qualify, of course.

At one point, I thought I’d come up with at least two things the VA would not help do:  send someone to go buy vets’ groceries, and walk vets’ dogs.  Then I realized that arguably they even do that too. The VA has a program that provides what are called “Aid and Assistance” payments to qualifying veterans or veterans’ dependents.  These payments are to help defray additional expenses for qualifying veterans and/or their dependents needing full-time assistance with daily living.  I guess some of those Aid and Assistance funds could be used to send someone to go buy the vets’ groceries or walk their dog.

The common thread? If there is one besides “the individual is a veteran or a veteran’s dependent”, I’ll be damned if I can find one. I just don’t see any business case connection.

. . .

Bluntly put: the VA today appears to be trying to be “all things to all people”. And maybe I’m wrong, but IMO it just isn’t possible to do that and to do it successfully.  There’s no wonder the VA has problems in managing all of those things simultaneously.

Further, doing each function takes money – lots of money.  And, bluntly, a lot of them have essentially nothing to do with military service or any disability an individual may have incurred due to such service.

But each function justifies a part of the VA’s budget. Doing more different functions justifies more dollars. So you tell me: unless forced, is the VA ever going to stop doing anything?

I’ll answer myself: “When pigs fly.” IMO the VA today is pretty close to a real-life example of the term “self-licking ice cream cone.”

(Part 2 in a series. Part 1 can be found here.)

OK, now it’s time to start p!ssing people off.  (smile)

IMO there’s another basic problem with the VA, too. Who does the VA work for?

I don’t mean who heads the agency.  And I don’t mean the POTUS, who in theory at least is responsible for all executive agencies of the Federal government.

What I’m asking is:  as an agency, who does the VA work for?

If asked, I’d bet long odds that most would say that since the VA “exists to care for and serve veterans”, that vets are the VA’s “boss”. This will p!ss off a lot of folks, but I hold that is 100% wrong.

The VA indeed exists because of vets. It indeed exists to provide specified services to vets. However, the VA does NOT work for us vets.   We vets are not the VA’s “boss”.

Rather, the VA works for the US taxpayer. Not for the Congress, not for the POTUS, not for themselves (though some certainly act as if that’s the case), not for us vets. The VA works for the US taxpayer.

Why? Because it’s the US taxpayer that pays for every damn thing the VA does. The VA thus owes the US taxpayer – not us vets – its primary loyalty.

It seems to me that at times, the VA forgets that simple fact.

Today, vets are only a rather small fraction of US taxpayers.  In 2012, only a bit over 21 million of the US’s population of over 300 million were vets.

The VA is charged with providing specified services to veterans, while also being “good stewards of public resources”. The first half of that is the part everyone loves – and hates, when it’s being done poorly.. When done successfully, it makes the American public (and US politicians) feel good; it p!sses those same groups off when it goes awry.

It’s also an easy sell to those paying the bills. After all, what could be an easier sell than “helping those who’ve defended the country”?

However, that second part – “good stewardship of public resources” – is equally important. But it’s not as much “fun”, and doesn’t make people feel as good. Indeed, doing that (being a good steward) means you have to tell some people, “I’m sorry, but you just don’t qualify for that benefit.” Yet that too is sometimes necessary if the VA is to faithfully serve and protect the taxpayer’s interests.

And when the media, the public, or politicians hear about such cases, well . .  out come the knives. “How dare they mistreat those poor veterans! They served!”

To an extent, the same is true for any government agency. Any government agency does (or is supposed to do) precisely two things: (1) provide a clearly specified public service of some type, while simultaneously (2) ensuring public funds are efficiently, effectively, and legitimately used. The VA is no different.

This in turns yields a certain internal conflict within the VA. The VA exists to “care for veterans”. But they also have a duty to ensure that public money is spent wisely – and legitimately.

People want to help. That’s natural. They want to see people get “what’s coming to them”. And most VA employees are no different in this respect than anyone else.

But there’s a danger in being overly “helpful” when spending (or approving  spending) public money, particularly when it’s being done to “help people”.  Because where there’s money to be had, there always will be those who try to get some of that money any way they possibly can.

Lord knows we’ve seen that enough times here at TAH. I’ll spare you the examples that come immediately to mind; search this site if you need a few.

So part of the VA – the part that determines eligibility and ratings – IMO absolutely has to be cold-hearted, ruthless, and cynical. They have no other choice. Why? Because they’re the gatekeepers that prevent fraud. In military terms, they’re the perimeter security.

Yet there’s pressure for the VA not to emphasize that role, or to do it at all.  That pressure comes from multiple sources.

The media loves to write about “those poor, mistreated veterans who are getting ignored by the VA” – regardless of whether those folks are truly getting screwed, or are even actually veterans at all. (Read Burkett and Whitley’s book Stolen Valor if you doubt that – or just spend an hour or two poking around on this website.) Ditto the American public, and Congress.

Veteran Service Organizations (VSOs) similarly lobby for their members to get them benefits.  Got turned down?  Get a VSO to help.  Better yet, get them to help in the first place!

VSOs are quite good at this.  They’re also good at lobbying for new bennies for vets.

Did I mention that we vets are a pretty vocal group, too?  And we can be pretty demanding?

Further:  Congress loves to throw money at things.  For the VA, this has come in the form of new benefits, liberalization of criteria, and a general push to “make it easier” for vets to “get their due”.

And I won’t event touch on the issues of dirty insiders and institutional corruption. Both exist, and both cost Uncle Sam a pretty penny.

Hell, part of that pressure is even internally generated. Why? A growing number of vets “helped” means more justification for the VA’s budget in future years. So there’s huge internal pressure working in favor of passing out more money or doing other stuff to “help veterans” with only a cursory examination of the individual’s application.  More bodies helped (or waiting to be helped) means more justification future budget.

In summary: at least part of the VA needs to behave as if it’s an IRS auditor looking over Al Capone’s business records – because they are protecting the US taxpayer from being robbed, and there are those who will try to steal the US taxpayer blind given half the chance. But there’s a great deal of pressure on the VA to act instead like a cross between Mother Teresa and Santa Claus with a full wallet after he’s had half a dozen stiff belts from his hip flask. And for some parts of the VA, that mindset is appropriate.

The VA’s boss – the US taxpayer – demands and deserves both, simultaneously. That’s a damn difficult thing to make work.

It’s even more difficult when an agency doesn’t really understand who they work for, and neither do those who depend on that agency’s services.  And when no one seems to want to hear the words, “Sorry, but you don’t qualify” spoken about anyone.

This subject has been mentally fermenting with me for a while, so I thought it was about time to “bottle it” – so to speak.

I’ve written a short series of articles giving my thoughts on current VA issues – and why they exist.  The first part follows this introduction.

BLUF: IMO the VA today is fundamentally broken. Bluntly, IMO it’s so badly broken and so dysfunctional that as it’s currently structured I’m not sure it can be fixed.

But the VA nonetheless performs a necessary function. It fulfills a moral obligation our nation has to vets who were sickened or injured in the service of our nation. So we can’t simply throw up our hands, say, “F**k it!”, and disband it either. At least some of what the VA does needs to be done.

And I’ll give everyone fair warning: as a group, IMO we vets aren’t blameless, either.

I will absolutely guarantee that at least some of what I say will p!ss off some – and maybe all – of TAH’s readers. So be it.

That’s OK. Freedom is messy sometimes. But I think I can also guarantee that what I say will make you think, at least a little. Maybe collectively we can begin to figure out how to start fixing the problem.

The first 5 articles will discuss some current issues with the VA. I’ve got those written; they’ll be posted over the next few days.

The follow-on articles aren’t yet written. In them, I plan to provide my thoughts on how to bring some sanity to the current chaos. Those ideas won’t be painless. They might or might not be half-baked, or workable at all. But hell, maybe they’ll also stimulate some serious thought – and discussion on how to fix the problem.

Lord knows, the VA needs fixing. Badly.

Without more ado, here’s part one.

VA Issues, Part I: It Ain’t A Resource Problem

First, let’s discuss what the problem with today’s VA is not.

So, tell me:  what is the VA’s annual budget? How much do they spend?   And how much has that gone up since 9/11?

I ask that because I’ll virtually guarantee we’re likely to see claims from the VA that “we need more resources to fix things” due to the recent scandals.  And as we all know Congress loves throwing money at problems, real or imagined – even though as a nation we’re already as broke as a young E4 with a nonworking spouse, 2 kids, and a car payment living “on the economy” in a high-cost area about 2 days before payday.

The underlying question is nonetheless a fair one: does the VA have the resources to do the job it should be doing? IMO, the answer to that question is “Yes – in spades.”

Here’s why I say that.

• In FY2001, which ended on 30 Sep 2001, the VA’s total budget (adjusted for inflation with 2012 as the reference year), was just under $61.45 billion.
• In FY2009, which ended on 30 Sep 2009, the VA’s budget (again adjusted for inflation with 2012 as the reference year) was just under $102.43 billion. That’s an increase of over 2/3 (66.68%) in 8 years.
• This fiscal year, the VA is projected to spend just under $147.95 billion (again, adjusted for inflation with 2012 as the reference year; the actual amount in current dollars is higher). That’s an additional increase over 2009 of 44.44% – in 5 years.
• Next fiscal year (which ends on 30 Sep 2015), the VA is projected to spend over $156.69 billion – again, adjusted for inflation with 2012 as reference.

From 30 Sep 2001 to 30 Sep 2015, the VA’s budget will have grown (in inflation adjusted dollars) from roughly $61.5 billion to nearly $156.7 billion.

That’s an increase of 155% in 14 years.

Let that sink in for a moment. Today, the VA spends over 2 and 1/2 times as much money IN REAL TERMS (that is, after inflation is taken into account) as it did 14 years ago. That is a REAL growth rate of approximately 6.7% a year for 14 years.

Has DoD’s growth mirrored that? Has your paycheck grown similarly, in real terms? The answer to the former is “hell no”.  And I’ll be willing to bet that for virtually everyone reading this, the answer to the second is likely a resounding “no” as well.

If that continues, in another 17 years the VA’s budget will roughly equal – or exceed – that of DoD.

That’s not affordable.

I’m sorry, but we do NOT have over 2.5 times as many veterans today than we did in 2001. Nor, frankly, do we have over 2.5 times as many disabled veterans today than we had in 2001.  So I’m forced to conclude that the VA gets enough money – or maybe more than enough – to do the job it should be doing.

Indeed, the last 14 years has been the greatest sustained period of massively increasing VA spending in US history. Even the period of US involvement in Vietnam (1962-1975) did not show this large a proportional increase. VA spending during that 14-year period did not double, increasing by only approximately 91.3%. And a helluva lot more people were in the military during Vietnam than has been the case during the last 14 years.

Only the immediate aftermath of World War II comes close. And while VA spending was (in 2012 dollars) huge for about 6 years after the war, it peaked in 1947 – and declined by nearly 60% by 1952.

The problem IMO is not caused by a lack of money. The VA is now spending close to 1/3 annually of what DoD spends. And the VA doesn’t employ nearly 2.3 million people full-time, plus another million (or thereabouts) part-time.

And if the cause of the problem isn’t a lack of money, then obviously it’s something else.

 . . .

Notes on Data Sources

VA Budget Data, 1940-2012: https://www.fas.org/sgp/crs/misc/RS22897.pdf

VA budget data for 2013-2015: http://www.va.gov/budget/docs/summary/Fy2015-FastFactsVAsBudgetHighlights.pdf

CPI Inflation Adjustment Factors for 2013-2014: http://data.bls.gov/cgi-bin/cpicalc.pl

Inflation for the current year (affecting the 2015 VA budget’s purchasing power next year) is currently projected to be approx. 1.3%.