WOWSERUPDATE–ALL KINDS OF NEWS

eskenazi_aaaaaYes siree/madamee. Take your pick. We have news from our esteemed and unidentified Vermin Lane correspondents that the BVA has created what can only be described as a vacuum in VA space- a nether region where all VBMS-generated claims were heading at 125 DPC (days per claim) and 38% accuracy. Yes -that twilight zone of “not at the VARO but not actually at the BVA just yet.” VA observers of the Heavens have named this the “Eskinazi Paradox” or among the inner sanctum as “Laura’s Riddle”. My 2 year old grandson says it “How di do do dat?” Regardless of how you parse it, it’s heathen magic.

In a real accounting system such as GEICO, where metrics cannot be mutated, a claim goes from A-thru Z in a relatively short time. We can safely say that if it doesn’t involve a Ferrari, it can be concluded in less than two months with 98% accuracy and with everyone still smiling- maybe bleakly-but still smiling nevertheless (after the deductible).

Unbeknownst to Under Secretary Hickey, there is a dastardly  plan being hatched to erase the VBA’s claims backlog. In a rush to comply with the Treaty with the Great White Father in DC of 2013 , Gen. Hickey swore on a stack of Burger King Crowns that the backlog would be resolved and the claims process would begin installing Six Sigma-approved Drive-Thru windows at the VAROs across the Fruited Plain. Well, not exactly. 2015 has dawned but the backlog is still an issue. The latest we’ve heard was an acknowledgement that it would be “substantially” contained (tamed?)…

detroit

 

Apparently, the Veterans Service Center Managers’ emails spammed the USB’s follow-on admonition to do it fairly and give the benefit of the doubt to us. I’m getting reports from folks saying “Wow. That was quick. I don’t understand, though. I uploaded everything on the eBennies site just like they told me to and I don’t see where they got it. There must be a mistake”…

Cryo Fibro in appeal w o NOD

Well, boy howdy yes there’s a mistake. Welcome to 3 card VA monte. This is the ricochet we have been predicting. Give a rater a deadline and no strictures on technique or morals, and you’ll get a decision in the designated time. It won’t be right but there is no penalty for decisional error. The “decision” has been made. That is the measurement for VA. If your Father died and you put in a request for a flag, that grant would be a “decision”- albeit a positive outcome.

Unless you’re driving a wheelchair and missing some of you original-issue 2000 body parts, you’ll probably win eventually. Make sure to bring your Combat Action Ribbon and the Purple Heart though just for added insurance.

Once the denial process has run it’s three year course at the VARO, your appeal (the official receipt of the Form 9 and subsequent certification via Form 8) demands this c-file be transmitted to the BVA immediately for docketing. The Regional Offices show this has happened on paper. They are no longer technically in possession of the document(s). Said documents still officially reside in a segregated area away from the general filing area but no longer “belong” to the local Office. They are in the above described nether region where they await official receipt by the BVA.

VA FEDEXThe BVA denies this and merely considers them to be in a queue of sorts. The Phoenix analogy immediately comes to mind where there is a paper list of Veterans “benefits Patients” waiting for an appointment at the BVA with their meagre pool of Veterans Law Jurists. You cannot see these patients in VACOLS yet as they wait to be “transported” to DC. At best, they may show as in transit but that would make a mockery of the Panama Canal analogy. I can walk to DC from Seattle faster than my claim can get there via FEDEX. Here’s member Randy’s from that “nether region”. Apparently no one knows exactly where it is…

Mr. Randy

The Secretary has received your email dated February 17, 2015.  He has forwarded your inquiry to VA leadership for review and direct feedback to you.  Thank you for your communication.

Office of the Secretary
Department of Veterans Affairs
810 Vermont Ave NW
Washington DC 20420

—–Original Message—–
From: randy
Sent: Tuesday, February 17, 2015 4:00 PM
To: McDonald, Bob
Subject: [EXTERNAL] 29538960

Mr. McDonald:

I have followed procedure in regards to the VA compensation but yet again have to fight to get answers. My form 9 was sent in Sept. 2014 and we received a notice that it had been received. When I tried to check on the progress at the BVA I was told that the case had been returned to the RO and the file was closed. Neither my attorney nor myself were ever notified that the case was closed. We cannot seem to get an answer as to the whereabouts of my C-file at present. I originally filed the NOD in February 2013 and my health as a whole is going down the tubes with stage 4 liver cirrhosis and type II diabetes. I would appreciate your office looking into this and getting me some answers.

Respectfully submitted:
Sleepless in Colorado

You have heard of Laura’s “rocket dockets” that accelerate the easy-to-deny claims to the forefront in front of tennis shoe staff attorneys in robes- the so called Acting VLJs. Even this technique as exposed by VLJ Kelli Kordach cannot keep pace with the ever-metastasizing number of appeals. There used to be a time before all those VA-ambulance chasing attorneys showed up where a VLJ could just rule and be done with it. Allowing Vets to have attorneys, let alone a higher appeals path, was simply begging for trouble. Judge Eskinazi now is mouthing the words “I told you so.”

What, exactly, did anyone expect? If you step on a balloon, the air merely moves to where the pressure isn’t. In this case, adding VBMS Exlax™ to the system has accomplished the stated metric of clearing out the backlog. It makes no difference what the results were. They are, for the record, 100% correct unless, or until, a Vet successfully appeals them up to a higher level and prevails. download (1)If they come back on reversal or a vacate/ JMR , that drags the statistic down but a new decision also counts as a correct decision too. Only at VA can you count a failure a success twice. VA’s personal best (164 correct decisions on one claim) is held by the Cleveland Office where they invented shredding. Few know that they are still adjudicated Col. Harland Sanders’ claim to this day, either.

Frank sends us this tasty morsel from the Cleveland Clearinghouse:

My husband is a 68 year old Disabled American Veteran. I recently called VA Secretary Robert McDonald’s cell phone. After getting voice mail, I left my name and number. Two days later, a member of Secretary McDonald’s staff, Erin Gittens returned my call. She looked at my husband file. His appeal for compensation has been backlogged at the Cleveland Regional Office since 2010 Erin Gittens promised to send an email to the Cleveland Regional Office inquiring about my husband’s claim.
The very next day, we received a phone call from the Cleveland Regional Office. The gentleman’s name is Kevin Freedman.
Mr. Freedman was very upset that I had called Secretary McDonald.
He said he was TOTALLY IN CHARGE OF MY HUSBAND’S CLAIM, not anyone in Washington, especially Robert McDonald.
Mr. Kevin Freedman stated that he intended to immediately DENY THE CLAIM! My husband and I were shocked that this gentleman, Kevin Freedman could DENY THE CLAIM that has lingered at the CLEVELAND REGIONAL OFFICE for OVER 4 years, in less than 4 MINUTES!
It is boldly obvious that this VA WORKER, KEVIN FREEDMAN is angry because we phoned Secretary McDonald for help. In revenge, Kevin Freedman is denying the claim for compensation OUT OF SPITE!
During our phone conversation, I asked that he meet with my husband in person. Mr. Freedman’s reply was, “There is really no point, I am going to DENY the CLAIM! But, if you insist, Come on up to Cleveland!”
We are senior citizens. My husband is a veteran.
We do not deserve to be treated with such TOTAL DISRESPECT! Please Bob McDonald help us, like you promised!

http://www.washingtonpost.com/blogs/fact-checker/wp/2015/02/18/no-the-va-has-not-fired-60-people-for-manipulating-wait-time-data/

Our long time member Hey Mikey! He likes it!  from Oregon writes in with some disturbing news I was aware of subconsciously.

Good Morning Bro! Well my VA never seems to amaze me when it comes to blood. First thing in Basic I have A pos blood,1999 get transfusion I have A neg and now 2015 I have B pos. In 2003 when I had a Hep C biopsy they say in records my Hep C is 1b and now 2015 it has magically changed to 1a. And they wonder why I don’t want any more procedures done there.

Because my kidney lab tests are high they don’t want to do the Harvoni unless I have a colonoscopy, and scoped thru my nose and down my throat. Hate to tell them they can’t reach my kidneys thru those holes.

download (2)I got one of those medical cards, but when I called to have some other problems checked out that Boise doesn’t have, they told me only one disease per Veteran can be treated at a time and mine was Hepatology. HUH??? My Hep C Dr is a temp transplant and is getting a great training at VA BS from having me as a patient. When I told her what they said she was amazed. Yesterday I got an appt for some team for something different. I’ll find out next week what they specialize in.lol I think I will delay things till I get moved then use the card to see some civilians. Too much funny stuff going on here. Beginning to think they wanna have a whoops moment with their scope and make a new hole in my brain that unfortunately ends the whole movie.lol

Got any thoughts?? Mikey

Well, yeah. I have a whole lot of thoughts, Mikey. I see their butt tractors have been in the news a few times for being a little dusty where they forgot to wipe them down well. I see the UCLA having problems with their endoscopes they want to poke down your throat, too. As for the one disease to a customer, that actually doesn’t surprise me. VA has always rationed care. We know that. Phoenix was just the first time it was admitted in public.

In 2013, as I reported here, I made my pilgrimage to the VAMC American Lake and begged for Sofosbuvir. I was told to report for a butt exam and endoscopy too if I wanted to even get on the paper list. As you know, I don’t trust them not to kill us simply to reduce patient load. They pretty much made their intentions clear during my last 4-operation vacation there. I can sure understand Mikey’s concerns. We think he got this from either the VA’s butt tractor party in 97 (where they pierced his colon) or the transfusion  a day or two later that they said he didn’t need afterwards to save his life.

Why would anyone think that the nefarious schemes employed by VHA at VAMCs across the country to control the true count of Veterans seeking medical help would not spill over into the VBA? I’m country raised and look no further than to a bucket of apples. One of them is going to go rotten and ruin the rest if left alone. The Veterans Administration is in deep doo doo and Rep. Miller is uncovering more crap daily. The miracle is how it was kept from the public and Congress for so long.

Call me Bob is now catching the blow back after his local minions are forced to adjudicate his “email claims” ahead of those who have waited patiently in line. This is an uncomfortable truth. Every time one of you calls Bob, your complaint is fielded by a staff attorney at the BVA. He hits the action button to the local RO involved. They drop everything and have a Congressional Interests (CI) interface (usually a GS-12-13) contact you and innocently ask “Whazzup?” Your complaint is duly noted and a denial (Or SOC, Or SSOC, or Form 8 etc.) immediately is issued. They mark “decided” on it and put it in the steno pool for a denial letter. Next query?

I’ve noted a 39-4 ratio of “What just happened?” emails from many of you. It doesn’t shock me. No one at Bob’s office returns to visit these. I’ve heard from them too. “I emailed what happened back to the guy and he won’t answer.” One saved the BVA’s phone number of the staff atty. who called him. Seems the Staff atty. works out of New Orleans’ VA Regional Legal now. Was there someone else here that could help you?

I save the best one for last. Some entertaining Vet out there convinced his Congressional Representative to try to dial the VA Prize Redemption Hotline at 800-827-1000 and see how long it took to get through. At 43 minutes, they dropped the call. VA did, not the Congressman. He was less than impressed and promised to look into it. Real soon, hear?

images

That’s the weekly round up of VA’s Romper Room. Mark your calendars to tune in on the 2nd of March. The VA will be required to Show and Tell up at the CAVC on my Extraordinary Writ. I can tell they’re working on it. My eBennies account is going crazy on mute. I couldn’t even access it yesterday they were so busy remodeling.

 

P.S. If you really want to piss off the raters at St. Petersburg and slow down production, fire the rater who’s the vice-president of the union for telling the truth.

P.P.S. Silver Queen Leigh emails me this afternoon with the glorious news that she has finally won her VA appeal for her HCV. We’ve been fighting for years so it shows that the asknod Book works. She and Paul followed it to a T. Win or Die! I’ll be writing up their travails and the win when I can see the magic paper. Whoooooooooooooooooooooooo, doggies. We’ve been working on that since Jesus wore diapers.

 

Posted in All about Veterans, ASKNOD BOOK, Complaints Department, Medical News, Sofosbuvir, VA Health Care, VA Medical Mysteries Explained, vA news, VAMC Scheduling Coverup, VARO Misfeasance | Tagged , , , , , , , , , , , , , , , , , , , , , | 4 Comments

Access to taxpayer-funded VA research and public domain research

PMCI’m frequently frustrated by my lack of access to VA medical research because I’m not a student who has access to academic databases nor can I afford to subscribe to medical journals or databases.

Public databases like PubMed provide abstracts and citations but the full text of many studies are locked behind pay-walls.  For research funded by NIH tax dollars for FY 2009, and after, publishers have 12 months to deposit peer-reviewed works into PMC (formerly PubMed Central). Policy notes are here.

Here’s a citation of an article in PMC:

Chang, Harry et al. “Medicare and Medicaid Enrollment and Outside Hospitalizations Among HIV-Infected and Uninfected Veterans Engaged in VA Care: a Retrospective Cohort Study.” BMC Health Services Research 15 (2015): 27. PMC. Web. 20 Feb. 2015.

The beauty of PMC is the ability to read or download full articles in three different formats. Here’s the above article in classic view, ePub reader, or pdf. (I prefer classic view.)

pmc2

I’ve emailed NIH to see how I can read public domain articles.  There’s a brand new article cited in PUBMED that I would like to read but can’t:  Prevalence and Treatment of Chronic Hepatitis C Virus Infection in the US Department of Veterans Affairs.  

It states, “This work is written by (a) US Government employee(s) and is in the public domain in the US.”  That means it is owned by the U. S. public--us!

Yet this article is locked behind a paywall by Oxford Publishing (Epidemiol Rev. 2015;37(1):131-43. doi: 10.1093/epirev/mxu002. Epub 2015 Jan 19.).

public-domain-logo-slightly-nicer

Image from the fab. site: Open clip art https://openclipart.org/

To read this article tonight , I would have to pay Oxford $39.00 for 1-day access (pay-per-view).  I hope this is a just a mistake. I’ll let you know what I find out because up-to-date quality VA research can help win VA benefits claims and cannot be rejected by the VA as “Internet junk,”  a problem some veterans have reported.  After all, it’s from their own medical staff and researchers!  Not having free access to this information puts veterans at a large disadvantage to those with reading privileges.

Emoticons-Question-face

 

Update:  The author of the HCV research, Lauren Beste, has kindly emailed the paper to me (below) so I am grateful for that.  Lauren works at Veterans Affairs Puget Sound Health Care System.  The VA has some wonderful medical researchers on board and they want us to read the fruits of their hard work.

Also an ASKNOD reader with access to the article via an academic site has helped us with this.   I haven’t heard back from NIH.  As the saying goes, “Information wants to be free.”  

Beste_Epi Reviews_1 2015_Prev and Treatment of Chronic HCV

Posted in Guest authors, HCV Health, HCV Risks (documented), Jetgun BvA Decisions, Jetgun Claims evidence, Medical News, Nexus Information, research, VA Health Care, VA Medical Mysteries Explained, Vietnam Disease Issues | Tagged , , , , , , , , , , , , , , , , , , , , | 9 Comments

SMC–KEVIN ASKS THE BIG QUESTION.

download (3)Special Monthly Compensation fascinates me. There’s a valid reason. They can no more follow a standard path to granting it unless prodded to add it up themselves. In most cases, they make no attempt to award it if it’s a sum of smaller 10%s, 20%s and 30% ratings.  Obvious cases stand out and the mere presence of  a wheelchair immediately alerts a dimwit rater that 38 CFR           §3.350 will/may have to be consulted in the M-21 3MR.

I spotted Kevin’s remark several days ago and am only now getting back to him to decypher. I apologize for the delay.  Here’s a snapshot:

Kevin

a day ago

Thank you for defining the (SMC) so that we could better understand it’s meaning(s). I would like to ask you or anyone who is knowledgeable with (SMC’s) the following question’s please? I am receiving SMC-L for service connect seizures. I was wondering if I can apply for a higher rating as I do receive aid and attendance and am home-bound, and bedridden (due) to loss of use in both legs. I require the daily/nightly need of a person to assist me even with the simplest of matters as I live alone and have no family that can care for me. My son is on his 3rd tour in Afghanistan, and as we all know, the ARMY comes first. Is the $3602.02 per month I receive already inclusive of aid and attendance pay?

My service connection(s) is 100% for seizures, and 20% for my lower back condition which worsened due to falls from seizures that have now left me incapacitated. Both leg’s are rated at 0%, but they were rated way back when, and perhaps now I should file a claim for a higher rating sense (A) caused (B)?

I am just wondering if I can apply for anything else as my monthly expenses for my care eat up everything I receive?

I look forward to anyone who could assist me with my question’s, and sincerely wish each of you a heartfelt thank you for your service to our great Nation.

Thank you all in advance,

~Kevin

Wowser. That’s some heavy baggage to be carrying, sir.  It always gives me pause to know others suffer far more than a lot of us.  I thank Someone for picking me up and dusting me off. Let me break down your questions into colors as each one needs a unique answer so all can understand the concept. Remember, we’re dealing with VA logic and VA Math so put your mental seat belt on.

Question #1 is most easily answered in reverse.  I’ll break it down so you can see how VA “builds” our VA comp. payment.

100% disabled @1 Veteran alone =  $29o6.83

If you were 100% belly up and had an additional 60% or more of disability unrelated to the 100% rating, you would get SMC- S. If you are clearly housebound and do not have that extra 60% , VA awards it anyway. The winning word definition is “substantially”.

100% disabled@ 1 Vet on SMC S =$3352.67

If you were belly up as Kevin is and need the Full Meal deal supersized with a Caregiver, we step into the next phase called Aid and Attendance 1 and 2.

Once you need a caregiver, it splits into two channels. If you are pre-9/11/2001, you take the old route of no caregiver money as a bonus rider. You simply move from SMC S to SMC L which is, in essence, SMC S with Aid and Attendance #1 (sometimes defined as A&A #1. Post 9/11 Vets get this plus a caregiver allowance of $2100.00 more. I didn’t make the rule. It’s brand new. Talk to your VSO about it.

100% disabled @ 1 Vet on SMC-L =$3,617.02. Either Kevin is off $10.00 or VA is shortsheeting him. Could be he has a VA-appointed fiduciary who is allowed to nick him $90 per year for “administering” his benefit.

That concludes how I answer the Bleu. Now let’s see how we can make Kevin a little more even though everyone by now has told him he’s hit the wall.

Let’s count all the ailments we can consider. First, you have no Special Monthly Compensation K ratings. You can legally have as many as you qualify for until you get to SMC O. Special K, as we call it, is $103.23 a month per each. The list isn’t that long but when you begin with SMC-L, it doesn’t take much to push you into SMC M or $3991.74. Remember, I’m not asking you to cheat. Perish the thought. I merely point out what VA will and will not do without a 300,000 volt cattle prod. What’s worse, either VSO reps will argue this doesn’t exist or that it is “gaming the system”. I say if you’re driving a wheelchair instead of a Prius, all’s now fair in love and war with the VA.

Common Special K ratings are loss of or loss of use of a creative organ. You can’t get it up due to a disease like DM 2 or IHD blood pressure medicine, or, if a woman, have lost 25% or more of one or both breasts to mastectomy. Missing nuts and ovaries are hunky dory qualifiers as well.

Loss of only one foot or one hand at the ankle or wrist. Again, you can have loss of use and pick up the $40% for the missing extremity and be dialing in $103.23 more for each K on top of your standard $2906.83 above.  

The Forrest Gump award of both buttocks is good for Special K. Total deafness in both ears is a K. Loss of one eye, or loss of use of one eye is another. Thus you can see if you were standing too close to a grenade or 60mm mortar rd., you can pick up some easy extras.

The gravy train maxes out if your combo goes over SMC L’s limit of  $3.617.02. Lot’s of Vets are housebound (SMC-S) when they are missing parts and pieces. Sometimes it’s hard to grasp the steering wheel or see where you’re going. In these cases, VA often opts up to SMC-L & 1/2  but only if prodded to do so. Any time they “forget” to do this, it’s not considered error. Remember always that in VAland, Justice delayed is not Justice denied. 

The next major move is as Kevin theorizes. Like the old Mark Eden commercials for young girls exhorting them  on how to expand their “upper endowment”, Kevin is going to have to begin filing for additional ratings that will increase his combined total “endowment” above the original 100%.  He mentions two viable alternatives- an existing 20% for a lower back injury that has increased in severity.  It sounds as though the legs are secondary to the lower back (A=B). If so, they will combine the ratings unless they are separately rated as due to two separate medical maladies.

The maximum for his back will be 60%. He can still possibly lasso a Special K for loss of use of the creative organ for a buck 3 and change. But most importantly, now that Kevin is in SMC- L through P country,  a whole new metric kicks in. The back injury can technically be considered another completely total rating-albeit the back ratings disability chart tops out at 60%. A simple increase to 50% or more entitles Kevin to bump up a half-level to SMC L 1/2 which is $3804 even. A special K would top it at $3,907. 23. Add additional increments of $103.23 as indicated unless you exceed the dollar value of SMC- M.

Helps build strong bodies 12 different ways and include the needed nutrients of Vitamins Blue, Green, Pink, Purple White as well as all the need Orange supplements.

Helps build strong bodies 12 different ways and includes the needed nutrients of Vitamins Blue, Green, Pink, Purple White in a new Orange-flavored  supplement.

This can also go higher. If Kevin is diagnosed with another disease/ injury unique and separate that would be considered 100% schedular totally disabling (such as IHD) from too many Agent Tang cocktails in the morning, he can bump up a full rating from SMC-L to SMC-M which pays $3991.74. Again, as many Special Ks are permitted on top of it unless it takes you over the SMC M 1/2 rate. If that occurs- yep- you have to convert to SMC-M 1/2 for $4,266 even.  All good things have limits.  In addition to this, if Kevin has actual loss of, or loss of use of, three extremities (two hands and a foot or a like combo) he also can get yet another bump up one rate so he could conceivably work up to a SMC N 1/2 or -O  or $5,075.60. No more Special K when you get here. You’re getting too rich off of VA. This would actually be a matter of first impression as no one has been there and tested the waters of 38 CFR 3.350(f) (5) to see if you can partake of (3) or (4) as well.

Getting the extra Aid and Attendance caregiver rate at SMC T is a rough one unless you served after 9/11 as I mentioned. That extra $2200 a month is crucial to some in the inner-city who need more medical resources. Conversely, caregivers cost more and put a bigger crimp on an already small compensation payment in an urban environment. Until Congress equalizes this inequity, all you  pre-9/11 Vets must operate in an imperfect arrangement. I guess VA feels we should vote with our wheelchairs and move to the country. There, we’ll find poor folk willing to be caregivers for a pittance and we can balance our meagre paychecks on their backs. 

The only other way appears to be to turn into a living lump with no major responses. Being in a coma would qualify for R 2’s $8,318.95.  Since Kevin was already entitled to the old R1 back in SMC-L country, he could qualify for R1 now on a bigger rating combo of 200% or $7252.63 but he’ll need some unremunerated Special Ks to show his A&A entitlement should go higher. “Show” is a relative term because VA raters think Kevin will have to be blind and deaf to even think about applying. Scratch thinking. If you’re in a coma, you’re probably not engaged in cogent thought. That’s where that useless VA fiduciary comes in. He’s going to max your payment to help max his. Well, duh, Cowboy.

download (1)

Mr. VA fiduciary

 

 

 

Posted in SMC | Tagged , , , , , , , , , , , , , , , , , , , | 3 Comments

Amazing Proton Beam Therapy coming to Mayo

Two new Proton Beam Therapy (PBT) centers will be added to those already operating around the country.  CLICK IMAGE

mayo proton

Positively brilliant! The four-minute animation video gives an overview of this fantastic technology. click image to view.

We received a Mayo publication newsletter reporting that Proton Beam Therapy (with pencil beam scanning) will be available in Rochester in the summer of 2015 and in Arizona in 2016.  According to Mayo, this new more precise technology can avoid damaging tissues surrounding tumors.  They write, “The proton stops after hitting the target.”  This therapy can reach tumors deep within the body.

  Anderson Cancer Center in Texas also has this technology. “MD Anderson is currently using pencil beam scanning to treat cancers of the prostate, brain, base of the skull and eye. As the technology evolves, pencil beam will ultimately be applied to any tumor site where proton therapy is used, particularly for treating solid tumors in children, who are generally more sensitive to the adverse effects of radiation.”

mayo foun

Image from Mayo Clinic website Rochester and Arizona will both have four treatment rooms.

Who has access to protons?  The Loma Linda VA has (had?) clinical trial for proton beam for HCC but I don’t see much information on the website yet. Medicare covers some treatments.  The VA’s purchased care office could be queried if you are interested.  CHAMPVA Policy Manual approves different types of radiation therapies including proton beam for prostrate cancer (Section 30:13–accessed today). Private insurers are not covering some proton beam cancer treatments, according to these articles in the LA Times (8/28/13) and Kaiser Health News because they are more expensive than standard radiation.  However, a glance at the graphic below, clearly illustrated the desirability of the highly targeted beam.

There are fourteen proton centers in operation in the United States now.  Men will be interested in learning how to fight private insurance denials for prostrate cancer look here.

proton graphics

This graphic is from Provision Center for Proton Therapy in Knoxville.

Cancers that can be treated with PBT:  Bone Cancer; Brain Cancer; Eye Cancer; Head and Neck Cancer; Hodgkin ; Lymphoma; Lung Cancer; Pancreatic Cancer;  Pediatric Cancer;  Brain Tumors;  Pediatric Sarcoma;  Retinoblastoma; Neuroblastoma;   Lymphomas;  Other Rare Tumors;  Prostate Cancer;  Sarcoma.

 

Posted in Medical News, VA Health Care | Tagged , , , , , , , , , , , , , , , | Leave a comment

Strong words from Sen. Bernie Sanders regarding Gilead’s drug pricing in written testimony

Topic:  Senate Committee on Veterans’ Affairs, Hearing:  Hepatitis C Medications.  December 3, 2014, 11:30 a.m.. LINK–video doesn’t start until 21:41.  The video content varies from the written testimony (Link below). I believe that viewing the video will be a worth your time.  I give the hearing:starsThe lawmakers questions are commonsensical (no grandstanding) and the panelists are given time to answer them.  

bernie

There are also a number of interesting facts in Senator Sander’s written statement (4-pages here):  I learned that we the taxpayers (via the federal government) helped the lead researchers develop the drug with $18 million dollars when it was Pharmasett (now known as Solvaldi).  Then the developers sold it to Gilead for $11 billion.   They expect to make about $200 + billion on this investment in a very short time because the medication costs an “astounding” $1,000 a pill or $84,000 for a 12-week treatment.  The VA has negotiated a discount yet still pays $539.00 per pill.  

Bernie compares the VA’s discounted cost with the cost of $900 per treatment in developing countries.  Calling these sweetheart deals with foreign governments, Bernie asks “…is it really fair that these countries receive such a generous–and affordable–price while our veterans do not?”  The VA has had to ask Congress for $1.3 billion to treat veterans with HCV.  The VA is also going to be forced to ration the medication. There are approximately 174,000 known HCV patients but it’s not clear to me what percentage of them have chronic, active infection.  42K vets in VA care are estimated to also be infected but are as yet untested.

With characteristic chutzpah (in the positive sense) and the U. S. Constitution as his shield, Sen. Sanders doesn’t mince words in his written criticisms of Gilead. (And that’s why Vermonters will keep the ornery and independent Bernie Sanders in office for as long as he wants to serve.)  On the issue of corporate greed he says:

…Drug companies charge what they think the market will bear.  Gilead clearly made the calculation that they could charge excessive prices for this ground-breaking drug and that the federal government will pay.

We’re looking at a company that is milking a cash cow for everything it’s worth. Gilead could give Solvaldi to the VA and the impact on their profits would be marginal.

Companies like Gilead are gouging the American consumer and the American taxpayer and they are ignoring any sort of moral obligation to help very sick people access life-saving medications…our veterans deserve better.

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Information from the Vermont Historical Society: “Ira Allen designed the Great Seal of Vermont. Reuben Dean carved the image. Vermont adopted the seal in 1779, before Vermont became a state! Vermont used a different seal from 1821 to 1937. Then Vermont chose Allen’s seal again. The pictures in the seal show things that were important to the settlers. The cow and the wheat represent farming. The trees and the wavy lines represent mountains and lakes. The tall tree in the middle is a pine tree. Some people say the pine tree represents freedom from the king of England. “Freedom & Unity” is Vermont’s state motto. This reminds us to protect our freedom. But we must also work together as a state.

 

We’re all going to be footing these bills (VA, Medicare, DoD, Medicaid, private insurance, prisons, etc..).  I was pleased to note that the only exposures to HVC infection Bernie mentioned for olders vets were from blood transfusions and reused needles (verbally) with special mention of combat exposures (written).  Recall my post linking to a  1973 official study that showed that IVDU drug use in Vietnam was rare. The VA says that those not infected decades ago, that is, most NEW infections they’re seeing (20K per year), are from IVDU.  Drug addiction is horrible in itself but they must to get these vets into addiction treatment first (and clean) before they can receive anti-virals.  So there is hope in these urgent interventions.

Read other testimony here.  Other notes:

VA’s Dr. Valentino’s testimony (around 39 minutes) gives an overview on new meds in planning and challenges.  If Congress gives $1.3 billion for the new HCV treatments, only 25-35,000 veterans can be treated at current prices.  The high cost of these drugs is not sustainable for the VA. Rationing in the private sector is also taking place.  R & D costs for the product were only about $100 million and manufacturing costs are about $150-250 per person. How do we get to $84,000 per person, asks Bernie.  The answers: the patent monopoly, “escalator pricing” with no relationship to R & D costs, and desperate people. This situation is not rational, efficient, justified or moral.  Medical tourism is discussed and is something insurers are even looking at.

I’m looking forward to working with Bernie’s staff on HCV veteran issues when we return to Vermont in a few months.  If the cost of these drugs become affordable, and  HCV-veteran research doesn’t stall, I think  we have a shot at having HCV recognized as a presumptive disease associated with bucketmilitary service for many Vietnam-era veterans before we kick the bucket.

 

 

 

Posted in Guest authors, HCV Health, Sofosbuvir, VA Medical Mysteries Explained | Tagged , , , , , , , , , , , , , , , , , , | Leave a comment

LZ CORK–2015-DOING THE PUYALLUP

DSC01108I’ve looked forward to this day for almost eight months since I was told of Butch’s plight by my fellow Key Peninsula Veteran Christine Copeland. She is Best Friends for Life (BFL is one step above BFF) with Butch’s daughter Carol who was born while he was in-country in December 1968. 

Representative Derek Kilmer, who helped prod the Air Force Board of Corrections into disgorging my long overdue medals, immediately stepped up to the plate and worked miracles for us. Once we were armed with the correct names of the KHA (Killed by Hostile Action and now abbreviated as KIA) that night, it was easy to prove that Butch not only was entitled to his Purple Heart but the Combat Infantryman’s Badge (CIB) as well. Sadly, voices from the grave often speak louder and more forcefully when proof of valor is required. This was true of 2nd Lt. Barry Kellenbenz and PFC David Balzarini on that night. The US Army wasn’t going to award this on a grin and a handshake.

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Above from left to right: Steve Vermillion, Alex Graham, Butch Long and Christine Copeland (all Veterans).

It all came together yesterday afternoon among family and close friends in Puyallup Washington. Shortly after two o’clock, Rep. Kilmer pinned on the CIB, the Purple Heart, his Army Commendation Medal and the Vietnam Service Medal. His daughter Carol pinned the Vietnam Campaign Medal and the Cross of Gallantry with Palm Unit citation on his right breast. As the Republic of Vietnam is no longer in existence, I suspect the US Government doesn’t cotton to it’s elected congressional members awarding medals that antagonize the present Democratic Republic of Vietnam. Whatever the case, it’s a long overdue celebration of one of America’s heroes.

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Above: Butch and family gathered around him.

I also delivered all your donations for Butch’s new upper dentures which were inadvertently tossed in the trash during his ICU visit over Thanksgiving week. Nick Carr, Representative Kilmer’s assistant for all things VA, found Butch a denture clinic who offered to do it for $500 dollars. Oddly enough the contribution came to $510.00 so he has enough to buy a steak dinner at Applebee’s after he’s armored up. Jeri Berlanga of the Parkland Denture Center was the outfit who generously offered to do this at far below cost. Apparently they have done so in the past under similar circumstances. This speaks volumes to their commitment to Veterans.

We still have a long way to go to get Butch his deserved VA compensation but we’re running into flak trying to get his claims file. It’s difficult to fight for your entitlement in a game of Indian Poker where you don’t know VA’s hole cards.

I also wish to thank Steve Vermillion (Dustoff 40) for his presence at the ceremony representing all our Air Evac personnel who so bravely risked their lives to get the Butch’s of that war to prompt medical attention that fateful night.

Yesterday’s actions represent how my Band of Brothers from the Vietnam War choose to honor and empower our own wounded warriors. We do it hands-on rather than to hand them off to other agencies. This is as it should be. We’re all in this together. No one is more or less entitled by their rank-be it officer or enlisted. Thank you -all of you- from the bottom of my heart for your outpouring of support for Butch and a special thanks to Bob Lockett for shining so much light on what transpired that night 46 years ago. Seems he doesn’t have any trouble remembering which chopper he was in or where he was when the balloon went up January 18th, 1969.

A special thank you also goes out to Shawn Kequom for her legal firm’s donation to the Key Peninsula Bischoff Food Bank, too.

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Left to Right:  Barbara Long, Christine Copeland, Butch Long, Alex Graham and Representative Derek Kilmer.

Posted in All about Veterans, From the footlocker, Inspirational Veterans, KP Veterans, Vietnam War history | Tagged , , , , , , , , , , , , , | 11 Comments

Veteran Choice Card recent headlines and updates

A new controversy is brewing about the allocation of these choice funds since use as been light.  On the other hand, my Marine just got his card.  I think we should keep an open mind to see what Sec. McDonald has to say on this subject. It is counterproductive to have funds sitting unused that could be used to say, house more homeless veterans and their families immediately. As we know, the financial, physical and emotional crises veterans are under are significant.  On the other hand, it’s a brand new program and the roll out has been rough going for some:

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Image source: American Legion Click image to read comments from frustrated veterans.

A commenter to the WSJ  and Am. Legion Hiiumaa wrote:  “I am priority 1, I live 99 miles from the VA hospital I go to,I must make my VA doctor appts 45 days in advance, I am 100% service connected, and the last day of January, I received a card ‘Choice’ in snail mail. I have made several phone calls, for hours, to the phone numbers on the brochures that came with the card and ‘they’ are STILL trying to decide if I qualify for Choice benefits. I am at a loss!  (To read more, go here.  She doesn’t have a car.)

Here are a few miscellaneous links to opinions and news from around the web:

2/2/15 Rep. Jeff Miller,  Miller Statement on The President’s VA Budget Request

2/13/15  Washington Post (blog):  Far fewer veterans use choice card and private health care than expected, VA says

2/13/15  Exeter PatchNH Reps. Work on Bi-Partisan Veterans Proposal, U.S. Reps. Ann McLane Kuster, D-NH, and Frank Guinta, R-NH, introduce legislation to stop cuts to Veterans Choice Card Program.

2/11/15  Washington Times: VA secretary: 24K vets have used Choice Card, Asks to reduce program funding

2/4/15  The Sun (CAL): Vets optimistic about new VA ‘Choice’ program

2/2/15 Wall Street Journal (blog).  Barack Obama Plan to Shift Veterans Choice Act Funds Faces Shelling on Hill

2/2/15 Military Times.com, White House plan increases VA budget

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image from military flickr stream

Well, that’s all for now.  Happy Valentine’s Day! 

 

 

 

Posted in Guest authors, VA Health Care, VA Medical Mysteries Explained, vA news | Tagged , , , , , , , , , , , , , , , , , , | 8 Comments

The post-1992 transfusion quandary with regard to blood safety

blood typesThe CDC estimates five million patients receive blood each year resulting in a total of 14.6 million transfusions per year.  People are uneasy when they have to be transfused.  The CDC is just one agency testing blood safety.  It is distressful to read statements such as this:

Improvements in donor and blood screening have greatly reduced the risk of transmitting disease through blood and blood products. However, transfusion-related infections with known viruses continue to occur, and new and emerging viruses pose potential new threats to the safety of the blood supply.

Medical researchers have determined that the risks of getting HIV or HCV from transfusions in the United States are reassuring.  The National Heart, Lung and Blood Institute writes: 

 Your risk of getting HIV from a blood transfusion is lower than your risk of getting killed by lightning. Only about 1 in 2 million donations might carry HIV and transmit HIV if given to a patient.

Hepatitis B and C. The risk of having a donation that carries hepatitis B is about 1 in 205,000. The risk for hepatitis C is 1 in 2 million. If you receive blood during a transfusion that contains hepatitis, you’ll likely develop the virus.

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Today, rarely from transfusions or transplants.

 NHLBI Biologic Specimen Repository’s web site allows to see what research has been done on transfusions, HIV, HCV and many other health issues using the specimens.  You will find a substantial body of work has been conducted over the last decades that has added greatly to scientific knowledge.

That said, should you or I consider post-1992 blood transfusions an important risk factor for viruses?  I have been debating this for five years since I spent a weekend in a hospital getting five units of blood. I was assured that I received safe blood but after lots of tests, they could not determine if I needed the blood because of my beta thalassemia or from a GI bleed from an anti-inflammatory medication I was on then.

What would stop me from getting tested even if I wasn’t worried about my transfusion? Would asking for a test make me look immoral or perhaps a hypochondriac? The fact is I’m not alone in avoiding the issue.  According to 2013 Kaiser Foundation data,  Percentage of Persons Aged 18-64 Who Reported Ever Receiving an HIV Test, about 43.7% have ever been tested.  A few numbers by state to ponder:  MN: 32.6 %; VT: 36.4%; WV: 38%.

 In 2013, the VA was treating 26,784 for HIV making it the largest HIV provider in the country. Yet veterans ever tested remain low.  According to this VA slide presentation in 2009, fewer than 10% of veterans in care had ever been tested for HIV.  In 2011, only 20% had been tested.

Medicare will pay for a one HCV screening if ordered by a primary physician or under certain other conditions here.  That removes a significant financial barrier. Medicare Part B will pay for an HIV screening once a year with these conditions here.

Why are Americans so reluctant to get tested?  Fear? Stigma?  Don’t we owe it to our grandchildren to take care of ourselves so we can be there for them?  And why don’t our doctors suggest screening if only for our peace of mind? Frankly, even writing this post about HIV and HCV screening stresses me out.   I need to go lie down now…monster

More related resources:

WHO Fact Sheet # 279 June 2014Blood safety and availability

WHO 2009 bookletScreening donated blood for transfusion-transmissible infections: recommendations

Avert HIV & blood Safety facts

NHLBI studies

How veterans volunteer to help save lives:
blood_donationsKudos to The American Legion members for their generous yearly blood drives!

I’m impressed and grateful for their hard work as unpaid donors.

 

 

Posted in Guest authors, HCV Health, HCV Risks (documented) | Tagged , , , , , , , , , , , , , , , , , , | 6 Comments

President Obama signs veteran suicide prevention bill today

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President Barack Obama signs the Clay Hunt Suicide Prevention for American Veterans Act during a signing ceremony in the East Room of the White House, Feb. 12, 2015. Stage participants include: Veterans Affairs Secretary Bob McDonald; House Minority Leader Nancy Pelosi, D-Calif; Sen. John McCain, R-Ariz.; Sen. Johnny Isakson, R-Ga.; Sen. Richard Blumenthal, D-Conn.; Sen. Joe Donnelly, D-Ind.; Rep. Timothy Walz, D-Minn.; Rep. Jeff Miller, D-Fla.; Rep. Corrine Brown, D-Fla.; Rep. Tammy Duckworth, D-Ill.; Susan Selke (Clay Hunt’s mother); Richard Selke (Clay Hunt’s stepfather) ; Paul Reickhoff, Founder and CEO, Iraq and Afghanistan Veterans of America (IAVA); Bonnie Carroll, President and Founder, Tragedy Assistance Program for Survivors (TAPS); Gary Augustine, Executive Director, Disabled American Veterans; and Jake Wood, Co-founder and Executive Director of Team Rubicon. (Official White House Photo by Chuck Kennedy) (I see the back of Bernie’s head!)

I’m glad to report that the bipartisan Clay Hunt Suicide Prevention for American Veterans Act,  was signed into law today.  It is named after Sgt. Clay Hunt, a Marine who suffered from depression and PTSD; he took his own life in 2011. The President’s full remarks here give the background of Clay and I found them sad and touching. Secretary McDonald’s remarks are also recommended reading here.

The VA is creating meaningful and thoughtful materials.   There is a brief, perfect PSA video called the “Power of 1” on youtube in which a Vietnam Veteran reaches out to a depressed younger veteran.  And this is a great image.

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We certainly practice the “power of 1” here on this small weblog-support group called ASKNOD; every comment, post, star, like, and words of encouragement are so valuable to us all.  I see signs like these that lead me to believe that the VA is “getting it” and that it may turn out to be an institution President Lincoln would be proud of.  I like the direction and organization that Sec. McDonald is applying to the VA because there is so much work to be done.

President Obama finishes up his remarks echoing the theme of mutual support.

So we’re ready to help you begin the next chapter of your lives.  And if you are hurting, know this:  You are not forgotten.  You are not alone.  You are never alone.  We are here for you.  America is here for you — all of us.  And we will not stop doing everything in our power to get you the care and support you need to stay strong and keep serving this country we love.  We need you.  We need you.  You make our country better.

So I thank all of you.  God bless our troops, our veterans, our military families.  God bless the United States of America.

Isn’t it great that our younger veterans will hear words of understanding and kindness denied to their elder veterans?

 

Posted in Guest authors, PTSD, VA Health Care, vA news | Tagged , , , , , , , , , , , , , | 3 Comments

Supporting the One and Only safe injection campaign

The CDC’s “One and Only One” safe injection campaign is accepted by public health professionals globally but the desire for a safe jet injection needless device are still very much desired by many as a means to prevent accidental needlesticks and for other noble reasons.  Some devices have been approved for limited use. A 100% safe jet injector may not be attainable so the public needs to learn what a safe injection is and isn’t. 

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The visual materials developed for this campaign are clear and attractive and in the public domain.

The website has also been updated with excellent infographics about single and multi-dose.  Their twitter feed is also good.

My awareness has been raised!  A while back, a doctor applied a topical gel before giving me injections.  A long Q-tip was dipped into plastic jar, then rubbed on my skin, then re-dipped into the jar (which I’m sure will be used with other patients).  It happened quickly and I didn’t think about it until later.  By applying the concepts learned from “the one and only one” campaign, I realize that a new Q-tip should have been use instead of double-dipping the old one and mixing my DNA into the gel.

Posted in Guest authors, HCV Health, HCV Risks (documented), Jetgun Claims evidence, Medical News | Tagged , , , , , , , , , , , , , , , , , , , , , | 2 Comments