VETERANS BENEFITS ADMIN CALLS IN ORDNANCE ON POSITION

VeteransAdministration.12755109_stdIn the last decade, I have been fascinated by just how long it takes to have your number called in VA Poker. In the pre-VBMS days of 1989, it took from July to October to get the shiny onion skin denial. I had a BVA denial in my hot little hands by March 15, 1992. In 1994, it took from April Fool’s to November 7th to get my lovely blue sheet and thirty more days to get the SOC on January 7th, 1995. Things moved right along back then. All-paper c-files. Manual readout of the M 21 in paper as well. Who could improve on a system like that?

I had even theorized, as I did on a “fully developed Appeal” at the BVA, that eventually, VA would sink up to its axles someday in paper or gigabytes of information.  At that time, and not a moment before, they would finally call in outside support. Remember, they couldn’t even integrate a common computer system with the Dept. of Defense to smooth the transition from military service to Veteran status. All these years their in-house IT gurus kept regurgitating bandaids and fixes to XP to keep it alive twenty years longer. They succeeded. Unfortunately, everyone knows the back door in by now and can enter and “remodel history” as they did when they were caught in flagrante delicto in Gene Groves VACOLS files down in DC. Getting into VISTA at VA is childsplay for a good hacker now.

downloadVA’s newer computer systems carry forward the same myopic need vs. size misconception like looking through a pair of binoculars backwards. Bandwidth is the name of the game these days and VA prefers to use two wires and Morse code. One of the primary reasons VBMS isn’t catching air and making claims as fast as a speeding bullet is that all-critical response time. Now throw in about four more computer systems, all antiques like CAPRI, and hum Jeopardy Music. I swear the 1990s “dial-up” internet connections of old were faster.

My Daddy (and probably quite a few others) used to say “To a hammer, everything looks like a nail.” If you or I were stuck in an electronic jungle of antique programming, we’d motor on down to Office Depot and have some snot-nosed pimple popper sell it all to us. We’d smartly get the number for tech service to the tech weenies. If you’re VA, ostensibly you’d put in a call to 3M or Xerox and say “What’s the best way? Better yet,  how much would it cost for you to build it?” Bids would go out. Promises would be made and gifts would be exchanged in Vegas. In the twinkling of an eye, a robust, viable VBMS would have emerged that could digest even my 10,078 pages (and counting) of c-file in a gigasecond. Room for add ons would be like a empty gymnasium instead of a walk-in closet.

VBMSApparently, Secretary Bob was finally apprised that not only was VA not going to be able to fire their way to excellence, but that VBA  was never ever going to hire their way to excellence either. After USB Allison Hickey’s failed deadline lo these 40 days past, the defecation has finally contacted the rotary oscillator. The in-house IT gurus, ably led by former Maj. Gen. (ret) Rob Worley, are finally texting each other- #VASESLIVESMATTER. No more bandaids. No more patches. No more fixes. No more M 21 1MR Amended (improved as of Feb. 2016) computer guides to lead you a denial. Shit or Get Off the Pot Day finally arrived and the boys were found constipated with poor solutions.

JIM DANDY TO THE RESCUE

CSRASo what should my wondering eyes come across on some backwater right wing conspiracy site? Yessiree, Bob. Secretary Bob is letting the contract out for a new “improved”  VBMS because VA’s ain’t working folks. Using the new VBMS toilet plunger at the VAROs to push DBQs and FDCs along at lightspeed has now simply resulted in a call to Roto-Rooter® to take it from there.

Here’s the article on it. If it was any more sparse, we need an electron microscope to view it. I’ve never heard of CSRA let alone SRA International  but apparently the Government has. Makes you wonder who made the call. What’s even more interesting is how much did it cost in wasted man hours and stupidity/micromanagement to realize they were in over their heads?

SRA International will repair the system. It will deny even more efficiently and in less time than before. Expect a spate of new VBMS-oriented forms to emerge in mass quantities. Failure to use the correct one will result in rejection of the form until it is filled out and entered correctly. DBQs will be constructed for every disease/injury known to man. Vets will have to hire Sherpas to find their way. Nonadversarial will be the banner logo.

From the news blurb

SRA staffers in Kentucky and Georgia will work to convert the benefits claims into digital content and help mail handler services upload the huge volumes of files into the Department of Veterans Affairs’ benefit management system.

Shooo doggies. This is going to be a fun show. VA’s been remodeling since 2009. Wonder what kind of aces these fellers have up their sleeves?

Posted in Gulf War Issues, KP Veterans, M-21 info, Medical News, Nexus Information, VA Medical Mysteries Explained, vA news, vARO Decisions, VARO Misfeasance, VBMS Tricks | Tagged , , , , , , , , , , , , , , , , , | 4 Comments

VA SMC (t)– YOU’VE LOST THAT GIVING FEELING

imagesThe other day I read a front page story written by Tacoma News Tribune military writer Adam Ashton. The article is superb in what it conveys but lacks the linkage the two Veterans’ wives were so desperately looking for. Both of them had lost their tax-free $1275.00 a month Special Monthly Compensation at the (t) rate or what is also called the post 9/11/2001 caregiver rate. They were tearing out their hair looking for the link staring them right in their faces.

 

The (t) award is twofold. It also allows entry into special help from VA Medical Centers. I suppose that has a dollar value but how much is immaterial to this discussion. What is of import is the frank admission by both of the women that their husbands now had jobs. 

A caregiver is one who provides nurture, daily household chores, shopping and the like for someone with horrific agoriphobia or avoidance issues. These Vets are only comfortable in their own home environment and rightfully so. It’s like a gigantic woobie blanket on acreage. If your neighbors aren’t close , you feel more protected in Fort Livingroom. The key word here is “at home”.

But, on the other hand, if the spousal unit, be it a he or a she, who is the caregivee-i.e. recipient of the caregiver’s services- departs Fort Livingroom and takes a job as a medical technician or library clerk, then the doctors of psychiatry may get the misguided impression that these Veterans are slowly beginning to meld and reintegrate with society again. It may be due to all those mind-bending medications or it may be all those Kumbaya group therapy hug sessions paid off. That, too, is immaterial. At the VA, they are results-driven. Whatever works to improve the Christmas bonus payment is the order of the day.

Now we have two financially disenfranchised caregivers who are at a loss to decypher this conundrum. Mr. Ashton did them a disservice by not pointing out the obvious. I note this phrase which I was not aware of regarding SMC (t):

From the beginning, the money was not intended to be a permanent benefit and the program’s creation stipulated that the VA occasionally would reassess patients.

Naturally, VA always is busy reassessing our disabilities. We are also allowed to be covered by 38 CFR §3.344 and its five year codicil. Being a sporting man, I’d give fair odds that the VA schedules a re-evaluation of the medical necessity for a caregiver just about every 4 years and a few months in order to avoid conferring permanence on a SMC (t) rating.

SMC (t) GROWING LIKE OCTOMOM

I note Mr. Ashton cites statistics showing this program is growing like Octomom. That disturbs me. Certainly, I have no objection to the whole concept of caregivers, regardless of the age-discrimination clause that fences out any Veteran before 2001. Where I feel the misery begins is that the VA never communicates this lack of permanence to the recipients. Often, we grow dependent on the extra payments and this causes great hardship on Veterans when a third of a monthly payment suddenly evaporates. I base this on the $1,275.00 added on to a normal 100% at $3.017.00 a month. A Vet with two kids to feed could end up on food stamps with this severe a cutback-or worse. If they are given no warning in advance, they cannot plan for the future.

Whether the qualifying Veteran returning to the workforce increases the income above the lost compensation payment was not discussed. Naturally, if employment negated the loss or even increased household income above the stipend, the lost income from the VA would become a moot point. Nowhere was this discussed. Sadly, this article seems to revolve around two Veterans’ spouses who now face the prospect of going back to work themselves as opposed to taking care of their husbands at home. I don’t envy them a bit.

This story seems to strike an odd chord with Vets I talk to. Why provide a stipend for this if the compensation is temporary at best? Why not grant it on a fixed time grant and ask for recertification annually? Biyearly? In other words, why clothesline a Vet after three or four years of SMC (t) right out of the blue- assuming he didn’t know that all the exhortations from the VA Psychiatric Peanut gallery shouting “Yes you can!” should include”until you get a job.”

SMC(t) = TDIU on Steroids

This is just like TDIU on steroids. You get 100% PLUS this valuable gift inside with the candy called SMC (t). You can go live in the country and cut down all your trees. You can be fit as a fiddle physically and just be uncomfortable around folks. I get that. I’ve been there and still am uncomfortable being in a large crowd.  I cut down all my trees, too. Doesn’t everyone? I’m not some treehugger. Hell, trees are big money around here in my Bugtussle town.

The problem arises just as it does on TDIU. If you exhibit the ability suddenly to make money working, then there has to be some VA quid pro quo. It’s like being on Social Security. If you start making money, you are no longer retired. If you make too much, they come and take some of what they pay you away. Why on earth this needs to be explained is unimportant. The financial shock wave that occurs is often traumatic.

But wait, here comes that valuable teaching moment…Now you know how to keep your SMC (t). Raise chickens and sell organic eggs. Get goats and sell goat’s milk. Buy a steer every spring and tie a rubber band you-know-where. In eight months you have prime rib for sale and to eat. Cool beans, huh?

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VA ART IMITATES VA HUMOR 9 MONTHS LATER

VA ringknocker

VA ringknocker

It’s not often when Veterans humor, driven by long waits and endless appeals, drives us to hypothesize on what (or how) a possible “rocket docket ” appeals system might coalesce in the minds of the Grand Poobahs. Veterans of all stripes, as we all too painfully know now, have once again been asked to move to the back of the New bus. Those three year adjudications at the Regional Offices now seem like lightspeed next to the new and improved VBMS BVA appeals system which somebody forgot to order. This unexpected phenomenon is the face of “the recent reinvention of how we do claims at the New VA”.

Notice the date/time stamp on my humor was April 22, 2015- over nine months previous. “Imitation is the sincerest form of flattery imaginable.” my mother once said. “Let them entertain the idea they birthed it. We know differently.” Simple as that.

In order to eliminate the backlog for certification and appeal permanently, however, Ms. Eskinazi proposes the new Fully Developed Appeal or FDA for short. FDAs can also be decided within 125 days with 98% accuracy as soon as the VBA can run it up the flagpole in the Federal Register. VA will propose that Veterans, through their VSOs, summarize, in 300 words or less, why they think they should prevail. Their lay testimony will be accepted without regard to credibility, they are free to opine medically on their symptoms and in all cases the benefit of the doubt will be employed assiduously as it always has in the past. Since most Veterans and their representatives are functionally illiterate, most will not need all three hundred words to communicate their desires. In fact, few, if any VSOs, will actually see any change in the process except for the accelerated time to a decision. This is a win-win for all.

Nine months ago that was tongue-in-cheek humor but trust your VA to cut the Gordian Knot of interminable delay. This is something everyone can get behind, right? It’s like a Veterans Charity. All the money goes to the Vets, right? Here, we have a problem and the solution is simple. Let the Vet have his say, regardless of how outlandish the story and keep it simple stupid for everyone. File a Notice of Disagreement at the BVA, maybe get a BVA video hearing to make it look like a genuine dog and pony show, 125 Days. 98% accuracy. Bring in the guys with the funny hats from the VSOs.  What could possible go wrong? Nonadversarial. Veteran-friendly. Benefit of the doubt. It’s like a full-meal-deal piping hot in just minutes at the drive thru window. Everyone gets closure, right?

HOW WOULD THEY DO THAT?

VLJ signature stamp

VLJ signature stamp

Well, gee I don’t reckon there’s a big problem if you get a couple of them signature stamps so’s the staff attorneys and the judges can all be stamping denials at the same time. Anyone can see this little efficiency alone could cut months or even years off the delay. If you could teach them to insert the paper and mail the Big Brown Envelope, or BBE as we Vets know it, there’d be another month or more. Kinda reminds me of Homer Simpson’s monkey Mojo. You could teach him anything.

I guess the boundary where dismay turns to ironic humor is where you find it. We’ve been insulted, guaranteed relief down to the year, promised three-month decisions with almost flawless accuracy, and none of these pipe dreams have come to fruition. In fact, the same exact system which presently is denying 85% of claims eerily resembles the same pre-2014 15-month wait for the very same 85% denial statistic.  Develop to Deny is the wormdrive gear of the VBMS.  The old one to two-year process with in-depth VA hands-on duty to assist in obtaining evidence is gone. Vets are instructed to obtain it all themselves for the Fully Developed Claim or FDC. Disability Benefits Questionnaires are crunched down to a “yes” or “no” where a “because” or “due to” is needed. And lastly, the most egregious. VSOs are letting the VA make the nexus link and failing to inform the Veteran of the need for a truly independent one.

Telegraph that from the Regional Office level as a confirmed  denial and send it up to the new, improved VBMS  BVA site. With no further development (read IMO), a new denial is inevitable and fully expected by VA. Bingo. No more backlog. Except….

downloadAgain, Occam’s Razor posits the simplest explanation is invariably the correct one. Given the proclivity of Veterans to appeal to the BVA currently, what could possibly dissuade them from going on to the Court of Veterans Appeals? Outside those hallowed gates at 625 Native American Avenue NW are members of the storied National Veterans Legal Services Program (NVLSP). These Law dogs are just standing around waiting for you to ask them to represent you absolutely free. How long do you think that knowledge is is going to go unnoticed?

Last year, the CAVC’s caseload expanded yet again.  Last month and again several days ago, the CAVC recalled two of their retired judges to deal with the tsunami of claims arriving daily. The volume of Extraordinary Writs is continuing right through the roof. 4,888 claims arrived in all of 2015. One of them, #15-112 was mine. Using the monthly volume already for January 2016, as of tonight, 400 cases are already docketed at the CAVC. I’d guess in reality there are 25-30 more awaiting their anointment with a number as we speak. Multiply that times 12 and you get into a skinny 5,000. I don’t see how Moorman and Greene are going to be enough. That’s eleven judges total.

All Veterans really want or strive for is to gain what they bargained and signed for on Induction Day  [__/__/____.]

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HADIT RADIO SHOW THIS PM AT 1800 HRS (L) EASTERN

haditlogo2007A great show is planned on Waiver of Review in the First Instance of new and material evidence submitted at the Board of Appeals level. You do not want to miss this one. Technique is everything nowadays and the latest tricks are helpful during this period of excessive backlog. Currently, the BVA has 444,000 appeals in the queue that they are willing to admit to. I suspect the number, were it to include all the appeals in a holding pattern at VAROs, would easily exceed twice that number.

Please join Jerrel, JBasser and myself this evening for a new show heavy on technique an full of the usual humor.

The call in number remains

347-237-4819

Please dial one (#1) if you wish to talk to us.

We’ll also be discussing the new documents and the need to use the latest with the little boxes on them. VBMS is getting mighty picky about how they record the data. If you send the older versions in, you get the leper treatment and six months later it comes back requesting you submit on the new forms.

Capture22

 

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States that have sent presidents to the White House

Which of our 50 states have actually sent people to the White House? Wikipedia lists and maps present birthplace and primary state affiliations of former presidents.  Can we make any quick predictions based on the birthplaces (not where raised) and primary state affiliations of the current leading candidates?  Sure, why not?

 USA_states_presidents_birthUS_Presidents_by_state_of_primary_affiliation

The best birthplace states are Virginia and Ohio followed by Massachusetts and New York. Tiny Vermont boasts two native-born presidents: Chester A. Arthur and Calvin Coolidge although both were affiliated with different neighboring states (New York and Massachusetts) and were Vice-Presidents first. Surprise (!) presidents, so to speak. (Texas and North Carolina also have two presidents each.)

Primary affiliations are somewhat different.  Let’s assign some numbers now.

Trump has never held an elected office and he’s financing his own campaign.  But he’s affiliated with the New York primary this year so he gets 6 points and 4 points for birthplace (like Van Buren, Fillmore, Roosevelt and Roosevelt).

Sanders also gets 4 points for being born in New York and 2 points for being affiliated with Vermont for 6 points.

Hillary Clinton was born in Chicago, Illinois.  That gives her 1 point (Reagan).   She moved to New York and was a U.S. senator, so add 6 points.

Ted Cruz was born in Canada.  No points.  The legality of his bid is being challenged.  But he gets 3 points for his Texas affiliation (L. B. Johnson (D), Bush and Bush).

Marco Rubio was born in Florida so zero points; a U. S. Senator for Florida gives him zero points.

New York City consists of five boroughs, (Brooklyn, Manhattan, Queens, Staten Island, and the Bronx) and is also the birthplace of Theodore Roosevelt (Manhattan).  Sanders was born in Brooklyn and Trump in Queens.  Even though NYC is a mega city, I think Sanders and Trump should get an extra point for sharing a birth city with Roosevelt.

Keeping it very simple, Trump gets 8 points.   Sanders gets 7  points.  Clinton gets 7 points. Cruz gets 3 points–if he’s legal.  Rubio gets zero points.

So if historical patterns prevail, right now, based on birthplaces and primary affiliations alone, either Trump or Sanders, two natives of New York City, and independents, may face off after all the primaries are over and done.  Or Trump could tackle the Clinton family.

Pundits R US?  Nah.  Anything can happen.  But history is interesting.

Posted in General Messages, Guest authors, Humor, Uncategorized | Tagged , | 2 Comments

Revisiting VA dental care

money-48103_640

image: Pixabay Public domain

We’re dealing with dental insurance decisions again because I chipped a front tooth and my old Marine needs a tooth capped.  We purchased the cheapest VADIP group plan when it was first introduced–the Delta VADIP plan for my husband (non-Champa spouses are excluded) for one year.  Then we upgraded to the High Option Metlife which was more liberal.  

Neither of our dentists are in-network and mine is really pricey.  So we just purchased a secondary policy that will give us in-network rates and co-ordinate benefits with Metlife.  The good news is that there is no waiting period for major services because we’ve continuously had dental insurance for over a year.  The bad news is that we’ll be paying about $250 a month for the two plans. That’s a crazy figure but our expected 2016 dental out-of-pocket costs would be worse with co-pays and deductibles due at time of service.  Ugh!

Looking ahead to 2017, I’m pretty darn sure my spouse falls under the Class VI (LINK to FACT SHEET).  Or consult the VETERANS HEALTH ADMINISTRATION DENTAL PROGRAM/VHA HANDBOOK 1130.01 2013.

Class VI. Any Veteran scheduled for admission or who is receiving care under chapter 17 of title 38, U.S.C., may receive outpatient dental care if the dental condition is clinically determined to be complicating the medical condition currently under VA treatment. Eligibility for each episode of dental care will be predicated on referral and consultation, followed by a decision based upon clinical judgment. The goal is to provide focused care to treat only the oral conditions that are complicating impact the clinical management of the medical condition currently under treatment. This classification includes medically necessary dental care for Veterans receiving care for Military Sexual Trauma under Title 38 U.S.C. 1720D.

Last year, my spouse asked his MN VA PCP for a referral to get classified by the Dental Services via Secure Messaging.  The doc called him, told him NO, and muttered some BS.   We are hoping his new VA PCP (VT) will follow the rules and give a referral so the VA Dental Service Chief can review his medical records, and make a decision.  If classified, he’d keep private dental insurance for preventative/filings and use the VA for expensive “focused” services they might approve (see page 10 in Handbook) (b).

…Focused dental treatment is generally limited and may include supportive periodontal therapy, endodontic therapy, restorative dentistry, and oral surgical procedures…

Pre-VA dental classification exam, why not bring a nexus letter and some solid research to the classification exam with you to support how, for example, your dry mouth/oral disease case is related related to your VA meds or conditions. Think of it as a C & P exam. (Looking at some BVA dental claim denials, the dental examiners have a funny habit of not seeing any evidence of dry mouth etc…) If denied an appropriate classification, it might be worth it to file a NOD.

In our case, could my spouse get Non-VA Dental services?  Maybe under the new geographic inaccessibility concept mentioned in the Handbook (beginning on page 16 Link below).   (The nearest VA Dental Services is about 105 miles away from our house.)

With approval, veterans could see a general dentist of their choice, who accepted VA payments, or be referred to a dentist in a “Federal resource”.  It’s not clear if that would include dental care at a Federally Qualified Health Center (LINK) or (LINK hrsa).  These centers bill on a sliding scale, receive federal grant money and are good to know about.

dentist

Reading VA form 10-2570d, (LINKPDF Dental Record Authorization and Invoice for Outpatient Service) would turn any dentist off.

skull

Non-VA Dental Care Secrets Revealed in the Handbook? No, not really. Image: Open Clip Art

NOTES & LINKS:

VA Handbook dental 2013  VA dental 2013 (attachment on 2nd page).

  • Any Veteran eligible for dental treatment on a one-time completion basis only and who has not received such treatment within 3 years after filing the application must be presumed to have abandoned the claim for dental treatment. (see Title 38 CFR §17.164)

 

  • SC PTSD–No automatic Class III dental for you.  Really?  Is this a good idea?  Painful teeth wouldn’t directly impact PTSD or vise versa?  Class III.   “…However, there is no provision granting eligibility for dental care under this classification in case of the opposite relationship, where a medical condition (e.g. Post Traumatic Stress Disorder (PTSD), may be contributing to a dental condition (e.g bruxism) because the dental condition identified is not professionally determined to aggravate the medical condition.”  (Bruxism is tooth-grinding.)
  • If a non-VA dentist’s fee is over $1,000, trouble ahead.
  • Need a non-VA dental specialist? Forget it.
  • If a veteran doesn’t accept a treatment plan, (take it or leave it care) they will rue the day.
  • The Military Order of the Purple Heart has some VSO training slides online (LINK M-4 Dental Claims) Attachment 2nd page.
  • The Business Office decides who is eligible for VA dental care by statute except for classes III and VI which are decided by the Dental Officers after medical record reviews.

A few questions: When and who in our government decided that our teeth and mouth aren’t a part of our bodies?  Why have they allowed dental insurance scams to go unchecked?

Dental_hygienist

Image: Wikipedia

Why haven’t licensed dental hygienists been able to open their own practices to provide preventative non-VA dental care?

Any veteran out there receiving non-VA dental care?  If so, how did you access it?

Why is it that a VA employee can seek dental care by the Dental Service but if a veteran needs emergency care, and isn’t classified, he can expect a bill ($500)? Don’t we buy them their own federal gold-standard dental insurance which they don’t have to jump through hoops to use.

Posted in All about Veterans, General Messages, Guest authors, PTSD, Uncategorized, VA Health Care, VA Medical Mysteries Explained | Tagged , | 2 Comments

HADIT.COM RADIO SHOW IN 10 MINUTES

haditlogo2007Hadit.com’s Blog talk Radio Show in 10 minutes folks. Mighty interesting subjects today.

The Call in number is :

 

347-237-4819

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