Waitlisted To Death At The VA, Ctd

by Chris Bodenner

A reader cautions:

Before heating up the tar and getting the feathers that weren’t used during the IRS “scandal”, can we wait and see what the IG report comes back with? Hopefully it will be more professional than the IRS hit job. I rather suspect that many of the problems are due to the soaring number of vets between Iraq/Afghanistan and the aging Vietnam era vets and a Congress that is intent on reducing federal spending. I seem to remember that some of the Bush war critics said that we would be paying trillions in veterans care over the next few decades. I guess the GOP will just put it on the credit card like they did the actual combat.

Another looks to the root of the problem:

Just why are wait times so long at some VA locations? Seems obvious, but I don’t hear any of the outraged people in Congress saying it: the VA is surely under resourced. The lists are almost certainly the result of how things are often done in the government: some high-ranking person removed from day-to-day reality sets an unrealistic performance measure (often based on politics). Underlings are then put in the situation where there is no way to meet the performance measure, so they cheat in order to not be reprimanded, demoted, or fired. As a federal employee myself, I know things sometimes end up working this way. I’m not saying the creation of the secret wait lists was right or justified, but I can certainly see how it happened.

Another goes in depth with his personal experience:

I am a physician who has done disability exams for the VA. I felt compelled to help after I watched Jon Stewart discuss the problem on the Daily Show. He berated the VA for the backlog and for being so out-of-date as to use paper documents.

I have to say it was quite an eye-opener to work on VA disability cases.

There is a very good reason why the charts are paper: they date back to World War II! In recent decades, notes from the VA system are in a good database, where information is categorized and easily accessed by type of visit, radiology report, lab report, consultation, etc. But go back not too many years ago and many if not most of the records are hand-written. It can be like taking a tour through a medical museum. Service records from active duty time-periods are usually quick notes scrawled by sometimes remote military medical personnel. Veterans also add to their files notes from their private physicians and non-military / non-VA hospitals, as well as testimonials from family, employers, and fellow servicemembers, and those notes are all paper-based. One veteran could easily have six bankers boxes full of file folders that I was supposed to quickly sort through to find relevant information. The Veterans Benefits Administration (VBA) tries to flag the important information, but the flags most frequently were not sufficient.

Somewhat of a solution is to scan all of the paper documents and put them in a database. The VBA is in the process of doing that. I have to say, though, that I dreaded getting the scanned records because all you see on the computer is that there are batches and batches of scanned documents that you have to look through. Doctor scrawl from 1963 on a scanned page is not an easy source from which to glean information. The nominal organization of the file folders is lost in the scanning as well. It’s just 80 or 90 pages at a time of unknown documents that you have to scroll through in hopes of finding the information you need. I even had to get a special computer mouse because my hand would ache by the end of the day from scrolling. It was very difficult to feel I was doing justice. I rarely processed the cases as fast as the VA’s goal, and yet I usually wondered if there was something relevant in all those papers that I had not seen.

Most veterans clearly need the disability benefits and I was glad to do my part in helping them, but there are also a not insignificant number who game the system. Some file appeal after appeal after appeal, doing their best to tie any condition they currently have with something that happened while they were in the service, in hopes of getting listed as 100% disabled. Each appeal represents an additional stack of documents that must be reviewed and questions that must be answered. People who misuse the system can make the work discouraging.

It was also quite interesting to me to learn what “service connected” means. Veterans can claim disability benefits for any medical condition that was caused by or incurred during active military service. So if you are on active duty and develop an ovarian cyst or acne or a thyroid problem or high blood pressure, you can claim a service connection for those medical conditions and collect disability benefits for not only for those particular problems, but also for any secondary problems that develop as a result. All requiring more exams, document review, and charting. I would say that far fewer than half of the disability claims I saw were for combat-related injuries. Furthermore, veterans get re-examined with more paperwork when they claim an increase in level of disability, or when the VBA thinks they may have become less disabled.

This is all to say that the problem of processing disability claims is much more complicated than it seems from the outside. It wore me down.

Update from my mother, a retired Army colonel with 26 years of active duty in the Nurse Corps:

After retirement, I was a case manager at a major military medical center in the early 2000s, when our military was fully engaged with Iraq and Afghanistan. My role was to help navigate returning vets through the process of disability evaluation for either a return to active duty or a release back to reserve status (reserve also includes National Guard). I also volunteered at a major VA hospital on the West Coast, working with the social workers who labored every day to help veterans struggling with re-entry into our society.

From my perspective, all of your readers’ comments are spot on. The VA is woefully underfunded for its mission. The documentation requirements and the process of determining disability is extremely difficult to navigate. The pressure against the VA staff to “make the numbers look good” is very strong (though not unique to the VA of course). The volume of needy vets is staggering. On and on.

The whole issue of service connection for disability also needs to be addressed. Combat vets get more money than ever before, and not all of it is justified. For example, we really need to look at why a female soldier who loses her uterus because of fibroids unrelated to active duty needs 20% disability pay – for the rest of her life.

So I agree to wait for the Inspector General Report. The IG is still respected in the military and VA system. But more generally, if the US wants to fight wars, we need to understand the cost after the wars are over. From the beginning of both Iraq and Afghanistan, I was concerned that the public was not realize that the tail of these wars would be very long and extremely costly. We are just now living with that reality.