Category: Veterans’ Affairs Department

(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.