News Flash: CNN–VA management not getting bonuses? Whoa…..

downloadI just checked the CNN app on my Android smartphone and breaking news (2-minutes) video/story caught me by surprise.

An audit of hundreds of Veterans Affairs facilities released Monday found that more than 63,000 veterans were waiting to be scheduled for care nationwide, and the Department of Veterans Affairs announced it was scrapping performance bonuses for all senior management in 2014 as part of its response to the review.

CNN has posted the audit as an interactive presentation that can be read and searched.  It is slow loading for me, possibly because the server is getting overloaded.

cnn

Do you think upper management should have to give back the performance bonuses they received for their previous crappy oversight?

Posted in Guest authors, VA Bonuses, VAMC Scheduling Coverup | Tagged , , , , , , , , , , , , , | 6 Comments

What’s the news on reactivation of HCV after SVR?

downloadThe VA has stopped testing my husband for any possible HCV viral load because he attained SVR after treatment (in private health care) almost ten years ago.   He’s considered (99%-100%) cured. His private gastroenterologist still tests him. Here’s one definition of SVR:

Sustained virologic response (SVR) is defined as aviremia 24 weeks after completion of antiviral therapy for chronic hepatitis C virus (HCV) infection. In analyses of SVR durability, the incidence of late relapse weeks after completion of antiviral therapy for chronic hepatitis C virus (HCV) infection. In analyses of SVR durability, the incidence of late relapse is extremely low (<1%). 

Can we relax now?  After all, treatment ended with excellent clinical results.  Should the VA spend any more money on these lab tests? Can’t we just deal with the lousy aftereffects of HCV and stop worrying about the virus reactivating?  The answer is NO! Besides the fact that one can be reinfected with a new HCV virus (because there is no immunity to it), it appears HCV can be reactivated if you get sick with other illnesses like cancers and/or HIV.

Here’s one recent (May 30, 2014) headline:

Hepatitis C Reactivation Does Not Worsen Survival Outcomes for HIV+ Patients Diagnosed with Lymphoma 

Two headlines from PubMed:

Reactivation of hepatitis viruses following immunomodulating systemic chemotherapy.

Reactivation of hepatitis B virus and hepatitis C virus in patients with cancer

HIV/HCV research is in a flux.  The VA/DoD/CDC and public health officials are still not transparent when it comes to HCV.   We have to be our own best friends when it comes to testing because as SVR boomers become ill with age-related diseases like cancers, HCV can rear its ugly head again and a worse nightmare begins anew.be-your-own-best-friend1

 

Posted in Guest authors, HCV Health, HCV Risks (documented), Interferon claims | Tagged , , , , , , , , , , , , , , , | 11 Comments

CAVC-SHELTON V. SHINSEKI–THE GOSPEL ACCORDING TO ST. BARTLEY

110I have crowed long and loud about Meg Bartley’s ascension to the CAVC throne with good cause. Her prior record working on the Veterans Benefits Manual ( Lexis Nexis VBM), as well as her staunch support of Veterans before the Court, was reason enough to crow. Her sense of fairness and the ability to actually look for reasons to find fault with the roughshod railroad justice that passes for same at the BVA makes her unique at the Court. This technique can’t be better expressed than in  Mr. Lloyd Shelton’s recent case before her this last February. 

Shelton reversal

Lloyd was a zoomie during the latter part of the Vietnam Boundary Misunderstanding and did not actually participate. He still got his “Battle for Lackland AFB ” National Defense Service Medal (NDSM) as did all of us who served in time of war. He had a mishap on his motorcycle in April 1974 that caused a lot of damage-most of it not immediately apparent to him. As with most young men his age, he was Joe Tough guy and signed off on his SF 88 exit physical as being 5-by on the health meter when he and the Air Force parted company in late 1975.

And, just like all of us formerly Joe Tough guys, by 1999 it was apparent he was not quite as bulletproof as he thought he was. Since he (and all of us) were taught the repair order was ‘Go see VA’, he knocked on their front door. I’m sure a large number of you are going to see some similarity in Mr. Shelton’s follow-on legal travails and your own. The reason is that they have one setting, default if you will, that permits only one interpretation of the evidence. This can be accomplished in many ways but the most common, which eludes your pro se ability to ascertain, is the most prevalent and utilized the most frequently. Coupled with a lackadaisical approach to “claims-solving”, the failure to fetch important documents you identify as crucial to your defense is the single most damaging aspect of ex parte justice. Well, that, semantics and a propensity to shade the truth or ignore it outright.

I wrote about this in Beraud v. Shinseki recently in Veterans Today and the same scenario unfolded there. The repercussions were horrendous to Mr. Beraud’s case. There, too, Judge Bartley demonstrated her deep knowledge of VA Statute and regulations such as 38 CFR 3.156(b) and forced a recall of that judgement due to the other members of her panel not being as well versed in the law. This is yet another example of why she should be considered for canonization as a Saint. Mr. Beraud suffered the same ignominious treatment when VA blew him off and made a decision fully well knowing that the evidence needed, and indeed requested or identified in queries, was never retrieved. Whether it was purposeful or an oversight, it nevertheless transpired and VA studiously attempted to mask the intransigence all the way up to the CAVC. They just didn’t anticipate the dogged determination of St. Meg to disassemble the decision and analyze each item in the Record Before the Agency. Baaaaaad idea.

Lloyd filed in March 1999 for “fluid and swelling in major joints” and authorized VA, via his filing of his 21-4142, to fetch certain records which would show continuity and chronicity of the injury over the years. He maintained that some of the records were in private hands and gave VA the GPS info. They, in turn, wrote said facility and got back a reply that the dates Mr. Shelton indicated were not correct “but that he had been treated there”. Well, shucks. In VAspeak, that’s all she wrote. If his dates didn’t comport with the hospital’s, then the evidence probably wasn’t material and there was not going to be any more discussion about it. No tickee-no laundry. Case denied. Next?

Fortunately for the Lloydmeister, he used the term ‘joints’ as in ‘other joints’ or ‘major joints’. This may have been his saving grace when combined with the failure of the duty to assist in fetching his medrecs. Here’s good ol’ Part 4  §4.45(f)of VA’s very own regulations that discusses what the meaning of “is” is and also happens to get into the subject of major and minor joints.

For the purpose of rating disability from arthritis, the shoulder, elbow, wrist, hip, knee, and ankle are considered major joints;

It’s too bad VA isn’t as up to speed as St. Meg on these things. This is just page two of the seventeen page reversal. They’ve already exhibited their total ignorance of their own regulations semantically and Lloyd’s legal snowball hasn’t even begun it’s inexorable downward path to comport with gravity’s dictates.

Over the next several years, Mr. Shelton got inveigled into sub-arguments of which ankle and which knee were actually being appealed. VA artfully played him like a largemouth bass and took him out into deep water away from the legal snags. Each argument he put forth in defense in his NODs and Form 9s was dismembered and made to look unsupported. I have pointed this technique out to in my book. It’s the ‘divide and conquer” method. Here’s what it looked like to Lloyd.

In November 2001, Mr. Shelton underwent a VA joints examination that appears to have addressed both knees, including measuring the extension and flexion of his left and right knees. However, the examiner provided a diagnosis and opinion only as to the left knee…

VA effectively ignored anything of or having to do with the rest of his body and myopically focused on one joint. So much for sympathetically developing the claim a la Moody v. Principi. He suffered the same treatment later on in 2005 at another C&P exam. They annotated a annular bulge but only mentioned it in passing as if everyone has these little defects in or on them. No harm. No foul. And importantly no nexus either connecting or disputing it’s being service connected. You could be missing an arm due to an IED these days and VA would merely mention it as “rt. arm enucleated-not service connected” if you were there for COPD.

The next big error VA is so accustomed to employing is to “misconstrue” what it is you are actually attempting to obtain. Considering they are in charge of deciphering our mish mash and sorting it out to maximize our contentions and give us all we are entitled to, they manage to get it wrong perennially. Mr. Shelton’s case was no different. He all but used a yellow hi-lighter pen to illuminate his contentions and VA goes off the reservation thinking he’s pursuing a wholly new issue. Of course, in the meantime they were vociferously denying he ever filed for his right knee, then his elbows ad nauseum.

Please respond on the enclosed VA Form 21-4138, Statement in Support of Claim, and tell us if you are claiming any new conditions for service connected compensation or if there are additional benefits that you are seeking. If you wish to claim new conditions for compensation, please clearly identify each issue so that we can better assist you.

Any dolt with a modicum of English comprehension would understand this to be a request to clarify the filing of additional claims for as-yet unannounced ailments. Since Mr. Shelton most obviously was not a dolt and had nothing new to claim, he properly ignored the request. He had all his claims in. Getting VA to actually address them seemed to be the issue.

Six years later, VA belatedly granted SC for his right knee and the battle began. I have not mentioned VA’s propensity to lowball us but it is endemic to the system. I rightfully consider it to be a post-claim issue after the initial fight has been won. Here, it became the focal point in conjunction with when he should be granted an effective date.

Beraud stands for obeying the de novo dictates of 38 CFR § 3.156(b) but in close conjunction with it, when VA sends you out something that purports to be shopping for more info (or new, informal claims) on something already in the adjudications mill, you and I would ignore it because it isn’t pertinent. Most Vets think that Part Three of 38 CFR is the begin all and end all of what we need to assemble our case. Au contraire, ma cher. Part 19 deals with the BVA’s responsibility once this gets into the preliminary venue of the appeals arena. A whole new chapter of requirements, some beneficial, some arrogant, rear their head and force VA adjudicators to make sure the knot on the hangman’s noose is constructed properly to ensure a quick claims death. My favorite is 38 CFR § 19.29 which instructs the hangman to make sure the poor, education-challenged Veteran can understand that which he needs to know to mount a suitable defense. Perusing this section is like a Whitman’s box of chocolates. There’s something for all of us to use in our defense. The reason is simple. VA is in such a rush to deny that they inadvertently step on their collective neckties in their haste. This provokes poor justice. It is also the seminal reason for my success in winning my claim back to 1994.

Remember the ‘major joints’ as defined in §4.45(f) above? Remember that Mr. Shelton also mentioned his lower back and other areas of his body (ankles, elbows etc.)?  VA interminably glossed over these until they had their feet held to the fire. They then begrudingly went back and looked at the contentions with no more inclination to grant than a blithe, woefully defective nexus from a hireling.

 The examiner opined: “[T]his man’s lower back examination at the time of discharge from the service was entirely normal. It is my opinion that the veteran’s current back disorder is not likely to be a result of his motorcycle accident in 1974.”

As you can see, the problems with his denials were piling up like a 10-foot snowdrift outside the BVA’s door. And here is where Mr. Shelton’s and my cases converge. VA raters at the local Regional Office level often come to unsupported conclusions and could care less. If the M21 1MR doesn’t cover the denial contingency, they simply craft one out of whole cloth. Unless you have a law dog to eviscerate their clumsy, unsupported rationale, it proceeds to the BVA as it did to both of us. There, absent any profound reassessment, it basically becomes a rubber stamp court and affirms the errors below.

Veterans can’t comprehend how this can be. We are supposed to get a de novo review but what we get is a rehash of the same reasons from the original RO denial replete with identical language and mistakes. The phalanx of BVA staff attorneys are adroit at refashioning the argument to comport with Part 19 but more often than not they fail the most important test. They simply don’t read the c-file. They are content to ‘top sheet’ it, look for the denial reasons and expound on them more fully without performing due diligence to ascertain that the evidence of record (EOR) actually supports the denial logic. This is why we have such a horrendous backlog now encroaching on the BVA. Quite simply, if all you as an adjudicator do is to assemble all the negatives and construct a denial platform devoid of the positives, you can only come to one conclusion. Handing it off to the next higher court doesn’t necessarily mean the defect will be discovered.

Veterans never get this in-depth review until they get to the CAVC. Sometimes, they still get the short end of the punji stick because, depending on who they draw as a judge at the CAVC, the same exact scenario of lethargy in reading the record can ensue. Beraud was a classic example and, by simply examining the timeline, it was glaringly evident that VA waited a mere 19 days before reissuing a denial. I guess I don’t need to point out that VA can’t blow their collective nose in nineteen days without the threat of a Writ of Mandamus hanging over their head. Absent the Writ, when this happens you can almost guarantee railroad justice is afoot.

Bartley looked at this and did the timeline test, the regulations test and lastly, the semantics test. VA came up short on all three. Not only that, they didn’t have a leg to stand on for their egregious behaviour. Without going into each item in detail, they plaintively decried that Lloyd never mentioned his right knee. After having that argument tossed, they grasped at straws to say that even if he did, he didn’t appeal it. After that was disproved, they said there was no substantial evidence that would lead them to this. Well, Boy Howdy did they ever walk into that one backwards. If you are asked to go fetch, only make noises like a labrador retriever and then don’t come back with the bird, it can be said that you failed in your duty to assist. Just because the ‘dates” as remembered by Mr. Shelton didn’t comport with the actual dates of treatment, one doesn’t throw up their hands and say “Well, there you go. It’s probably not probative evidence to the claim and we are under no obligation to proceed further.” You, being pro se, will never be apprised of this until you get your copy of the RBA and notice the defect. Since we as pro se idiots are not accustomed to encountering this adversarial form of evidence collection, we find ourselves at a decided disadvantage. We are not permitted to add more evidence to the claim after the BVA so our appeal is defective on arrival. VA is insulated against any defect because we didn’t complain before the last dance. Game , set and match.

I guess I'm not seeing any ankles or elbows here.

I guess I’m not seeing any ankles or elbows here.

VA bases a large part of their jurisprudence at the RO and the BVA on our ignorance-both that of pro se folks and the VSOs that ostensibly represent us in this endeavour. They fully well expect they can produce a sloppy, defective product with not a word of dissent. On appeal, the BVA can affirm the same errors and we are no wiser. When we finally arrive at the Court, we discover we got screwed. VA counts on this. They are so accustomed to operating in this venue illegally that when someone like Lloyd Shelton or me comes along and accidentally brings a pot to piss in and purchases a house with a window to throw the piss out of, that they are speechless and unsure of how to proceed.

After regaining their power of speech, they trot out post hoc rationalizations, each of which, in succeeding order, are more preposterous and far-fetched than the one before. Here. Judge Bartley wasn’t having any of it. Mr. Shelton asked for reversal on all counts and a rightful award of his claims. Bartley complied but not out of revenge or acrimonious feelings toward the VA. Her legal logic was unassailable. VA screwed this up on a massive scale that dwarfs what is afoot in Phoenix. Moreover, they then attempted to apply the lipstick and conceal the sheer volume of the evidence that mitigated for his contentions.

It’s one thing to fail in the duty to assist and get caught. That’s a vacate and remandable as an oversight. It’s okay to ‘disremember’ the regulations in § 4.45(f) and have a brain fart. That warrants a ‘set aside and remand’. It’s okay to mail out things that purport to ask a Veteran if he is perhaps seeking to apply for ‘informal’ or otherwise nebulous claims they are unable to parse. The line is drawn by any astute judge when they see a misogynistic pattern of purposefully misunderstanding the facts or just blatantly lying and saying the Veteran never mentioned the ailment(s). When as here, the evidence of record becomes so voluminous and resembles an original printing of the Gutenberg Bible on an offset press, the VA would be advised to fold up the circus tent and go home. That they didn’t and ventured up to 625 Wagon Burner Lane NW with such a defective denial defies the imagination. I guess they figured Judge Bruce “Hang ’em high” Kasold might get it and they’d win.

Mr. Shelton got not one but three reversals and a ”set aside and remand’ for a correct reading on his back and all the other two thousand body parts. This time we can assume that with the CAVC looking over their shoulder, the decision will entail a more nuanced reading of Part 4 and an informative C&P with supporting rationale. At least we would hope so.

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Posted in CAVC Knowledge, CAVC ruling, CAVC/COVA Decision, Implicit denial, Informal Claims | Tagged , , , , , , , , , , , , , , | 2 Comments

ER rapid HCV testing results support HCV infection projections for baby-boomer cohort

Kudus to James Galbraith, MD, a professor at University of Alabama,

UAB: Leaders in HCV screening

UAB: Leaders in HCV screening

Birmingham (UAB).  He designed and conducted an HCV free screening study of baby boomers at UAB’s Emergency Department (ED).   This is a 51-bed, Level 1 trauma center.  Infectious Disease online reports (5/14):

In a six-week period during 2013, the UAB ED had 2,363 unique visits by baby boomers. Of the 1,721 individuals who completed questionnaires, 74.8% were unaware of their HCV status and 90.8% agreed to testing. Of the patients who underwent testing, 12% had a positive anti-HCV test and 72.5% of those also tested positive for HCV RNA. 

The offer of free HCV testing was embraced by most of the boomers and test results were given before they were discharged from the ER!  The team followed up with information for patients who received bad news.

Dr.J. Gregory Fritz, dean of the University of Texas Southwestern Medical School, commented on the study:

“You have an enormous reservoir of disease out there…This is a quick study and an early study, and it is consistent with my own experience, but it really does need to be reproduced in a much larger population over a much longer period of time.”

Dr. Galbraith can feel very proud that he has probably saved many lives by being curious and caring enough to put energy into this valuable project.  Who knew that UAB Hospital is considered a “great” American hospital by peers?

Boomers can get one free test under the Affordable Care Act.  And wouldn’t it be great if veteran service organizations sponsored testing days across the country for all veteran family members who would like the test?

I’m going to email this post to a few regional hospitals and the VVA in my area.  Maybe they too will get motivated to test for HCV and treat those afflicted.

HCV_Healthed_d02

American veterans have far higher rates (18.4%) of HCV than any other group mainly due to dirty blood transfusions, the unsafe injection and medical practices prior to 1990, and other causes.

To see where the 18.4% veteran HCV prevalence figure comes from, please revisit this post for information and links to Lisa Backus, M.D. study (JAMA 9/9/13) entitled Hepatitis C Virus Screening and Prevalence Among US Veterans in Department of Veterans Affairs Care.

 

Posted in Guest authors, HCV Health, HCV Risks (documented), Medical News | Tagged , , , , , , , , , , , , , , , , , , | 3 Comments

VAMC SCHEDULING HOTSPOTS–INTERACTIVE MAP

vaHere’s the latest on where the “scheduling misunderstandings” occurred in VA. Pretty soon we’ll have a real map that shows 150 stars on it-one for each VA medical facility. VAMC American Lake maintains they are pure as the driven snow. Try a dental appointment for cleaning every three months as I am required to do. The conversation goes like this at the end of my appointment.

VA desk employee at Dental Clinic.: Okay, Mr. Graham. You’re good to go. Call us in three months for your next appointment.

Me: Well, I always do but you guys are all booked out by the time I call.

VA: Well, the trick is to call when we start answering the phone at 0630. I’d also suggest you call on the first of the month as all the appointments are usually gone by 1000 hours. We have a lot of Veterans who use this facility if you hadn’t noticed.

Me: I do but I still end up with an appointment over a month after the three month checkup so it is four months and change in reality.

VA: Yeah, well. What can I say? We’re pretty busy around here. Veterans have teeth, you know? Well, actually you old guys don’t. Ha-ha. Get it? False teeth?

Me: I also noticed this last time that even if I call at 0630, there is  no one answering the phone anyway. When did that change? So why do I need to call early if no one is answering?

VA: Well, if you didn’t, you’d be 5 months out. We schedule on a first come-first served basis. If you call in late, it means we have to schedule you in late. We encountered a lot of angry Veterans so the receptionist decided to just let it all go onto voicemail to avoid the stress.

Me: What if I have a dental emergency and need to get in immediately?

VA: Then you call 911. Or we have a walk-in clinic on Thursdays at 0715 and the first available dentist will see you. You may have to wait a few hours though. But if a Veteran forgets his appointment and doesn’t show up, we usually can get you right in in less than three hours.

Me: Back to the scheduling.  You tell me you can only schedule one month in advance. So If I call for an appointment on March 1st, and you give me an appointment of April 16th, then it’s actually more than a month out. How does that work?

VA: Well, we are required to schedule you in so that’s the earliest date. You’re rated 100% or over so you get Priority 1 status.

Me: I understand that but if you schedule an appointment in mid-April when I call in on March 1st, you’re scheduling it over a month in advance. You do realize that, right? You’re doing what you say you are not permitted to do.

VA: Well, you have to understand. We are not allowed to take appointments until you are scheduled to be scheduled for them. In that case, we have to schedule you in for the next available one. Sometimes that’s over a month. There’s nothing sneaky about that.

Me: I can’t get an appointment sooner than a month after when I’m supposed to have it but I have to call in on the month I am scheduled to have the appointment. Is that  correct?

VA: Exactly. And since we are booked out 45 days right now, you need to call in at the appropriate time in order for us to give you the earliest available appointment. I know it sounds complicated but if you understand how our scheduling rules work, it wouldn’t sound quite so stupid. It works fine. Just call in early on the first of the month and we’ll make sure you get in when the first appointment is available. Is there anything else I can help you with?

Me: What happens when you get to two-or even three months out for the next available appointment?

VA: Well, then we send you up to Seattle’s dental clinic because they have more dentists there and we can avoid a long wait. We have a shuttle bus that leaves here at 0545 every morning and comes back at 1730 for your convenience in getting there…

SWEET.

The VA loser cruiser except ours is a short 1970 Bluebird.

The VA loser cruiser except ours is a short 1970 Bluebird.

Posted in VA BACKLOG, VA Health Care, VA Medical Mysteries Explained, vA news, VAMC Scheduling Coverup | Tagged , , , , , , , , , , , , | 4 Comments

Evidence Alert!: Bloody shared razors from “Barber’s Assistant” Dirty Jobs, Season 6, Episode 5

Modern American barbering demonstration 2011-2012

Discovery Channel, Dirty Jobs (Season 6, Ep. 5, released 2012)

I have queried my spouse about the practices of  village barbers in Vietnam and learned that their methods were unsanitary.  (Village barbers also came to the compound to cut hair and shave soldiers.)  Therefore a show on the Discovery Channel, Dirty Jobs, caught our attention last weekend. We were staying in ND at a hotel watching  Mike Rowe learn how to cut and shave in a barber shop in Mobile.  About 20 minutes into the video, ouch!  The customer’s neck got nicked in numerous places during his shave with a straight razor–by the experienced licensed barber.

I had to buy the video for $1.99 from Amazon so I could share the above screen shot (which has actually tricky to capture at 20:19).  The banter between Rowe, the barber, customers, and camera guys is light-hearted.

Barber:  “Now remember now, this is very sharp.”  

Rowe:  “…you can see the blood pulsing through his jugular.”  Rowe: ” Is it natural for him to be bleeding like that?”  

Barber: “That’s the way it goes…a brand new blade got in my way…”

Then the barber pulled out a dirty styptic pencil!  Can’t sterilize those.  And those blood-STYPTIC_PENCILsoaked nubs are rubbed into face after face. Perfect transmission mode for blood- borne pathogens.

Customer/cameraman, upon seeing the bloody towel used on his face: “Is that MY blood?”

Since all the barbering tools are shared between customers the answer might be, on the towel, yes, but that’s the best we can offer.

barber2

Second close-up of bloody scraped neck.

For $2.00 this can be downloaded/copied to a device for personal use such as to support a HCV claim in which a vet has testified that he shared razors and/or used the services of village barbers.  And folks, don’t forget the clippers that trim hair from all facial orifices, necks etc…they nick skin too and are not cleaned between customers.  Barbers don’t run their offices like good dental offices.  If they did, a haircut/shave would cost upwards of $100.00.  Why, because barbering is a very dirty job and I’m glad Rowe included it in his show which was released in 2012.

Posted in Guest authors, HCV Health, HCV Risks (documented), IMOs/IMEs | Tagged , , , , , , , , , , , , , , , , , , , , , | 4 Comments

VA ILP– THE SECRET HANDSHAKE

downloadFor five days I have sat, picked berries, contemplated my navel and wondered how I could apologize to all of you for being so incredibly dense. Cupcake says I’m oblivious to my surroundings yet I see many things she doesn’t. In public, I constantly gauge those around me for aberrant behaviour that might signal mental illness. She finds these types “quirky” and stimulating. If someone is toting a shotgun into Safeway, I notice it because I was trained to see danger once. She might be able to tell me what the color of the lady’s handbag was across the parking lot and whether it accessorized with her blouse . Colors don’t kill you. On that count, I plead guilty.

Here, for over six years, I have been sounding the alarm on the Caluza triangle, aka the Hickson elements, aka the Shedden principles et cetera. Every day I read decisions from the BVA clearly stating the VA claimant, ably represented by the _____________(pick one of the Big Forty Six) arrived all the way up to DC on appeal with no nexus letter. Somehow, everyone who represented the poor fellow had overlooked this important element in their presentation of his claim. The mere fact that it has been enunciated law since Mr. Mario Caluza appealed his migratory left/right  ankle/knee/lower leg injury claims to the Court of Veterans Appeals in 1995, we have known the need for this. VA attorneys who represent us have known VA required it even before that. It was just unwritten until Caluza legally. Therein lay the problem. I call it the secret handshake or the “club password” to get into the treehouse. No tickee-no laundry as they say at the Chinese cleaners in town. Without it we were and are lost.

download (3)When I wrote my book I didn’t enunciate all of the history of VA jurisprudence and the gradual forfeiture of secret handshakes and passwords. Over the years, via the CAVC, the Federal Circuit Court of Appeals and sometimes even the lofty heights  of the Supreme Court, we Veterans have forced the VA to relinquish a wealth of information they hoard regarding adjudication of our claims. Each revelation, each stone overturned-indeed, each case- be it  single judge memorandum or panel ,uncovers a heretofore basic, fundamental right and corrects the path of justice for us. It’s been a long haul since 1989 and the Veterans Judicial Review Act (VJRA). Each day brings new epiphanies to the CAVC judges.

Of note, we were accorded the Veterans Claims Assistance Act (VCAA) in 2000. It compelled the VA to tell us what the defects were in our claims and suggest possible remedies. Few of you will remember the old days. I’ll show you one. In 1989, when you got denied or received a Statement of the Case (SOC), it merely informed you that you weren’t going to get the new Corvette with AM/FM stereo and cassette player. What it failed to discuss was why. Thus began the “reasons and bases” part of our jurisprudence. If you lost, the only way to fight it was to be able to dissect it. VA was not very forthcoming and surprisingly, neither were our National Service Officers (NSOs) who were representing us.  To say we were mushrooms in the basement being fed poop was an economy of words.  By 1994, they were giving us some vague idea but it was written by retards in the typist pool or Adobe 1 for Neanderthals. Dangling participles were the least of our worries. Getting the correct tense on the verbs was often the issue.

1990 VA denial letter

 

By 2000, we had amassed a wealth of Veterans Case law in the legal library but the process still seemed stilted and adversarial. This provoked Congress to lower the bar still further and force VA to suggest remedies for our predicament when we didn’t prevail. That law is still evolving and we see brief glimpses every several years where a new paradox emerges that needs a special band aid. Nevertheless, some precepts like the Caluza triangle are immutable, bedrock principles. How that manages to escape the Big Six twenty -plus years later will remain an enduring mystery.  This is where my obtuse mentality ran aground, too.

download (4)All these years, I always thought the principles of compensation claims adjudication (and by extension, the evidentiary requirements) were parked when we entered into the Vocation, Rehabilitation and  Education (VR&E) Temple. Here, we were to be accorded the “Hail, fellow Veteran. Well met. And how can we be of assistance?” speech. We had passed the test of compensation and were inside the wire. Our bona fides were established and now it was a matter of what services could be rendered, in what quantities and how soon. Sound familiar? Seems I got this speech when I went to the Disabled American Veterans in 1989. They even showed me the compensation rates in $US. Hell, back then they probably could have sold me a Pacific ocean condo time-share in Arizona. I trusted them implicitly.

Recently, as you know, I received my Supplemental Statement of the Case with the latest “What part of ‘No’ don’t you understand? This is the fourth time we told you the greenhouse isn’t in the cards.” After putting it down in disgust, I had to begin research to rebut their latest logic. I had a thirty-day suspense date this time out and time was of the essence.  This was the VCAA moment. All these years, the VR&E crews had been operating in “splendid isolation” as Senator Alan Cranston said it back in 1988 during the discussions that led up to the VJRA.  Similarly, over at VR&E,  the VCAA’s tenets somehow seemed to evaporate or revert to the pre-1992 technique of a simple, polite “No. I’m sorry but it wouldn’t improve your life one bit. Of course, you are free to come back and beat your head against our wall any time you’d like to. We’re open Monday through Friday, 9 to 5 except for Federal holidays.”

The OIG or some enlightened soul suddenly noticed VR&E folks weren’t complying with the Reasons and Bases part of the denial gig. Moreover, they were also violating the VCAA by not suggesting a repair order. While reviewing the SSOC, I began to look in earnest at the requirements they were suddenly iterating for the first time. The denial was still in force but suddenly it wasn’t simply couched in “You have all the greenhouses you’ll ever need. You can buy your veggies like normal folks in the organic section.” Suddenly there was a new, belated explanation for what the actual requirements were that we need to prevail. Granted, they are the new March 31st, 2014 revisions but they are the first glimmering of a “VCAA for ILP claims”. Yup. Prior to this it was simply “No.” Maybe a blithe reference to 38 USC §3120 or 38 CFR §21.160 to make it look official but no substantive paragraph on a 4107 telling you what you might do to prevail. Until now. It’s still not on a 4107 . Hell, I didn’t even get a 4107 as far as that goes which is probably a remandable action in its own right.

However, what finally penetrated my hardwood-encased noggin was this seminal phrase that evoked the echo of “nexus”. When you are trained to examine these denials with a fine-tooth comb looking for the smoking verb as to why you lost, things like:

“The following criteria must be met before providing services designed to promote the pursuit of an avocational interest:

1. The disability condition(s) limits or prevents participation in the avocational interest.
2. The activity must have been previously performed for a significant amount of time, defined as over a twelve-month period.
3. A medical and/or mental health provider must provide documentation that continued support of the activity is not contraindicated.
4. An expert consultation to identify accommodations required to enable continued support of the activity must be completed by a qualified person, such as an occupational therapist.
5. The pursuit of the avocational interest must improve the individual’s independence in daily living in a measurable and verifiable manner.
6. The individual must have the ability and resources to sustain the activity or pursuit after the period of rehabilitation services are completed.

download (1)This is the Rosetta Stone we’ve been looking for. It’s the secret handshake. It’s the guarded password known to everyone at VR&E’s ILP shop that forbade entry. Their problem was that I was bold and laid my cards out on the table from the outset with the gomers up in Seattle. I let them know in no uncertain terms that I was President and Founding member of the Win or Die Club. I made sure they knew this would be appealed as high as necessary and to make sure they had their Is dotted and the Ts crossed. In order to make sure they had complied, they promptly sat on it for six months and changed the regulations to comport with the VCAA. Above, in red, is the crucial element that had eluded me. It was right there in front of me all these years and I should have suspected as much. Roger that. You need a nexus letter for your dream greenhouse. Who woulda thunk it?

VA is as predictable as the snow in winter in the northern climes. They are hidebound and have a one-size fits all to their madness. Thus it should come as no surprise to expect them to copy the M-21 Adjudications Manual chapter and verse and relabel it the M-28. The one thing missing all these years was the above requirements finally committed to paper to make the Texas Necktie Parties perfectly legal. As you can see, the problem is that it’s three years too late. I filed in 2011 so it is inapposite to my claim.  Had they included this in my November 2011 denial, they might have had a quasi-legal leg to stand on. I think they outlawed changing laws in mid-stream after they disenfranchised all the Indians Native Americans out of their land holdings and penned them up on reservations.

VA just showed us the secret handshake, man.

VA just showed us the secret handshake, man.

We at asknod and the eastern consortium of The Tip of the Spear in Georgia (Bruce McCartney) are bound and determined to see this excised from the M21 as it, and other recent additions, are unsupported in ILP law as it is written. The problem is someone will have to carry the flag forward. Since I planned on this anyway, it may come to pass that I’ll be the guinea pig. I feel honored to be tasked with this. I remember the immortal words of old Wavy Gravy the day after I got to Max Yasgur’s farm back in August 1969- “We must be in Heaven, man.” Man, I just love going up to the Court and playing with Willy Gunn. It could be that VA and the VR&E crew will realize they don’t have a pot to piss in or a window to throw it out of and grant me the greenhouse. I know better after all these years. Once VA sets their heels in the dirt, they begin to manufacture reasons and become a prodigious denial machine. They hire even more lawyers to research how this can be sustained. They’ll do this for years if they find a compliant VLJ. If s/he affirms the Fort Fumble decision, the Office of General Counsel will bring their 16-inch guns to bear and spend hundreds of thousands of dollars more with specious arguments defending their defective logic.

Here’s the repair order, Vets. If you’re like me, you go to your personal care provider and ask for a referral to an occupational therapist just as it says in red in #4 above. You have a complete consult with all your evidence at hand. You present the why and the how. You knock down every straw man argument they propose of the six above. You prove by a preponderance of the evidence why you need your tempurpedic bed, your woodworking shop, your riding lawnmower or tractor, your digital photography gear, your metal detector for beachcombing, ad nauseum. The only obstacle is impressing this need for “independence in the activities of everyday living” and all the other horsepucky phases VA VR&E people contrive to prove you are independent of the community etc. I like to throw in “self-actualize” as that’s one of their buzzwords. Here. Let me use it in a sentence. “A greenhouse would allow me to self-actualize my desires while occupying many hours in pursuit of activities which will help other Veterans in my community as well as activities in my own everyday life. It will also help me gain proximity to the outdoors as that avenue is currently not available to me because of my Porphyria Cutanea Tarda”.

I dropped by my provider this morning and asked for a referral because the new Obamacare requirements state I can’t do this without a note from my doctor. It will cost $40 as a co-pay to obtain this home visit/assessment on my Obamacare-approved Medicare Advantage Plan. I  will have a lot of information pre-printed to provide the occupational therapist every thing she or he needs to understand the VA mindset, requirements and restrictions. I also will have everything ready for inspection in the garden.

VA for years played the game and the VSOs were accomplices in it. They still are today. The “game” is allowing VA to provide the nexus fully well knowing what that will say. They’ve gone so far now as to construct the Disability Benefits Questionnaires (DBQs) with no “nexus box”. Thus, when you have you doctor fill it out, there is no place for him to include that all-important, Caluza-required statement that your disease/ injury is service connected. Similarly, applying for an ILP grant requires it as well and getting one in advance should be the opening shot across the bow in the future for all of you who aspire to tap into this rich vein of opportunity.

Fortunately for me, I found out before I got to the CAVC and am still able to add this to my evidence pile. It also occurs at a fortuitous time since this is apparently headed to DC. The new occupational therapist’s assessment will be reviewed in the first instance by a Veterans Law Judge (VLJ) de novo. The Seattle Bozos will be unable to rebut it, though how they would is an interesting thought. Would it boil down to who’s psychology degree was shinier or which institution of higher learning issuing the sheepskin was more august?

Apologies are in order as I said. I cannot believe I could stare at a forest for so long and never see the trees. I do hope this will embolden each and every one of you with “severe disabilities” to throw your hat in the ILP ring, too. There is strength in numbers. VA has been artificially abbreviating this program and desperately trying to put it in mothballs. They are on the verge of it with the bogus “revisions” in M 28R which are unsupported by their own regulations and the pertinent statute. But what the hey? Mission creep is VA’s middle name. Look at the fine job they did in revamping patient scheduling at VAMCs nationwide.

Win or Die VA

Posted in Independent Living Program, Porphyria Cutanea Tarda, VR&E | Tagged , , , , , , , , , , , | 6 Comments

Time for humanitarian medical tourism to get Solvaldi?

Fantasy medivac of HCV vets needed Solvaldi NOW!

Fantasy medivac of HCV vets needed Solvaldi NOW!

Should the VA collaborate with the DoD to medevac the most seriously ill veterans with HCV to another country on Air Force cargo/hospital planes?  Taxpayers would save an enormous amount of money if so.

This would also be a great project for any veteran service organization to sponsor.  If big pharma wants to screw veterans, the VA should just outsource treatment to another country where Solvaldi is much cheaper.  Fly the vets in, spend a few days for exams, fly home, then consult via a virtual service like Skype with foreign docs working in partnership with VA hepatologists.

 

The cost for a 12-week course of Solvaldi differs drastically depending on where you receive the medication.

United States: $84,000; Germany $66,000; France: $50,000; Russia $45,000; United Kingdom: $34,000; Thailand-$5,000; Eqypt-$900.  India, Egypt and Brazil: $840; Burma, Iran, Mozambique, and Kenya: $900.

Indian HCV activists are asking the government not to give Gilead an Indian patent because it’s so cheap to manufacture ($68 -$138) for all twelve weeks of treatment.  I hope they win.

Forbes writes about medical tourism to places like Bumrungrad Hospital but sticks up for the insane US $1,000 per pill cost which has led to a policy of rationing at the VA.  Would one such heavily publicized “Solvaldi for HCV veterans” medevac trip bring costs down?

Do you think veterans would pack a suitcase and board a well-equipped C-17 to another country for immediate treatment?  I do.  Chicago to Sao Paulo is 10 hours and with no jet lag due to being in the same hemisphere.

The VA cannot afford to pay full price for Solvaldi because it’s NOT an insurance company.  We have the planes.  We have medics. Bernie Sanders, what do you say?

 

 

Posted in Guest authors, HCV Health, HCV Risks (documented), Sofosbuvir, VA Health Care | Tagged , , , , , , , , , , , , , | 5 Comments

VASEC FALLS ON HIS SWORD–WE LOSE

downloadUnfortunately, General Eric Shinseki has chosen the least controversial exit of all. Rather than stand and fight the endemic corruption the VA is awash in, he has opted for resignation. We are the losers and I say this with great sadness. In Gen. Shinseki, we had a warrior-citizen who was cognizant of what many of us endured while serving. Having that commonality is a prerequisite for the job in my mind. Former VASEC Jesse Brown was the only other one who could boast of this association. He, too, was an above -average Secretary. I think we all know what is in store for us soon. Can you say “whitewash”?

Just as the GM folks got their neckties in the dirt on the ignition fiasco that caused 12 or more deaths, greedy VA employees has bamboozled Shinseki and given him bogus info. He, to his detriment, took it as gospel and now has to pay the price. Now, here’s why we lose out.

-Gen. Shinseki has five years under his belt and is up to speed on the problems.

-He is now acquainted with who the culprits are and is expertly situated to introduce changes to correct it.

– He is the first VASEC in history to effect changes that have benefited Vets of the Vietnam War (Parkinson’s, B cell hairy leukemia, IHD etc.) in over a decade. The IOM and their ilk have been dragging their heels for years on presumptive issues. Ric cut to the chase and rammed it through. His record on homelessness in Veterans is stellar.

-He has the capability due to his long tenure as a leader/warrior to make bold changes rather than small baby steps. VA needs this desperately.

-He isn’t concerned with stepping on political toes at this point. His focus is solely on us Veterans. He is one so he “feels our pain”. Make no mistake about it. He walks the walk.

– He doesn’t have any “baggage” that drags him down. He’s happily married and has no Monica Lewinskys in the wings. He’s bulletproof on that front. That’s no small feat in this day and age of the roaming eyeball. Witness Gen. Petraeus.

-Given the nod from Congress and the legal authority, he’d go in and sweep out the scalawags who infest the VA hierarchy. He owes no one for his appointment other than the President and Congress. That’s a very tall mandate if the President was willing to stand behind him instead of a golf cart.

-He honestly cares about us as individuals and doesn’t consider us a liability or a lead weight around his neck holding him back from greater things. His focus has always been on a repair order, not a stepping stone to Secretary of State or a Vice Presidency.

-After 38 years in the Army, we can safely say he’s seen it all and knows the repair order for much of what infects VA currently.

– He’s being 86’d for political expediency-quite possibly the worst reason to do away with him. Congress folk are up for reelection this fall and without going into the specifics of which party feels threatened, it is safe to say that the party that flies the blue flag is under considerable approbation from the voting public over a number of fiascos that do not need elaborating here. We all know what they are assuming we read the papers.

-When an agency head with five years under his belt is finally apprised of the shortcomings on his watch, it is asinine to show him the door before he can attempt to correct it. This imbroglio is going to be censured, downplayed and relegated to the back page by the PR wonks both at the White House and the VA. They don’t want the bad press. Everyone knows that. General Shinseki would eviscerate the VA as we know it and an utter massacre would be a given if he was given free rein. I’m sure the thought of that keeps many in the White House up at night wondering just who will be unmasked and convicted.

-Most of the objectionable personnel guilty of these crimes are-yup- political appointees whose careers are in jeopardy. The party in power put a lot of them in there over the last five years and they are not going quietly into the night without a fight. General Shinseki owes them nothing and thus any leverage they feel they possess is nil. Unless he gets the ax. He did-and now they can breathe a sigh of relief.

-After the dust settles in Phoenix, the investigation will uncover a few more minor players and then it’ll be back to lather, rinse and repeat the mistakes. Nothing will ensue other than a lot of new hot air emanating from the usual sources and promises never to let our Veterans down ever again.

-The whole idea of a strong agency head as envisaged by the 1988 VJRA is being tossed out in favor of a congressionally-brokered fix. By that, I mean throwing Gen. Shinseki to the wolves to appease the press and get reelected this fall.

10371483_10203157900141196_7246146644956922799_nMark my words. Nothing positive will come of this. An apt analogy would be to fire the Captain of the Titanic minutes after his ship hit the iceberg. Never mind that White Star senior management ordered him to crank it up to 25 knots. He’s in deep doo-doo because his watchmen were asleep at the wheel or worse. To fire him now before launching the lifeboats and saving lives is pointless and shortsighted. He is perfectly positioned to repair the problems or prevent them in the future now. Why would anyone take the star quarterback out in the 4th quarter in a tie game on 4th and inches-in the red zone? Why, Congress, of course.

I have seen this same scenario far too many times in DC. Politics are Veterans’ worst enemy. Being beholden to them (senators and representatives) for our health and compensation is unworkable. What, exactly, the repair order is does not encompass firing the only one capable of fixing it in the shortest time possible and doing it professionally. I suppose that thought never entered Sen. McCain’s head.  That’s what happens when you’re buzzed on Coors, I suppose.

download (1)We understand the frustration Representative Miller feels over this but it is clearly a case of “Nobody told me” and ”I trusted the bastards”. You don’t just announce the buck stops here and unceremoniously boot him.  Much like a broken automobile, you fix it with the best tools, the best mechanic and newest technology available rather than tow the car to a new shop and hire a new, untried mechanic who is unfamiliar with the vehicle’s problems. Sometimes the shortsightedness of our politicians causes more harm to our Veterans cause than we imagine. Here, it is being perpetrated with anger and effrontery rather than with calm, reasoned logic. Such are the vagaries of politics.  Strangely, we didn’t see Secretary Kathleen Sebelius given this treatment after the Health Care Computer pancaked.  I guess it’s who you know, not what you know. SOP in DC-to our detriment again.

Onward through the fog of stupidity.

Hey kids. Can you say whitewash? Sure. I bet you can. Try it.

Hey kids. Can you say whitewash? Sure. I bet you can. Try it.

 

Posted in VAMC Scheduling Coverup | Tagged , , , , , , , , , | 7 Comments

CAVC– STRONG V. SHINSEKI–WE HAVE ALL BEEN HERE BEFORE

thumb_d10d7a64-04ab-4462-9561-19cb885ef6d9My sincere apologies to Crosby, Stills, Nash and Young for bogarting the Déjà Vu.  It seems no matter how many times we go through this process, the BVA seems inclined to come up with the same tired excuses for their denials. Mr. Michael Strong is now beginning year 13 in a long judicial nightmare trying to prove, at this late stage of the game, that he never used a “glass pipe” to smoke crack cocaine. That’s how asinine the BVA has now become that they would be reduced to putting words in his mouth.

Mike’s history on this was written up in 2011 here. At that time. I pointed out the impossibility of  ever finding in any Veteran’s STRs (or SMRs) a report of sharing razors. Additionally, the chances of reporting minor scratches and cuts incurred playing around concertina wire were also slim to none. The military taught us to be strong- not girlymen. Judge Hagel concurred and saw the improbability of it as well.

Nevertheless, the BVA has once again denied Mike from the RO on up in much the same way they gave him the bum’s rush in 2003. Nothing has changed except the date on the calendar. The rationale for his denial has even become more ludicrous and far-fetched than the 2009 BVA denial. The BVA gomers and the VA examiners have worked overtime trying to pound a square peg into a round hole. Unfortunately it’s a poor fit and so obviously a put-up job that Judge Hagel once again has to wash the OGC’s mouth out with soap.

I include this case for the obvious HCV connection but Veterans pursuing justice would be wise to analyze why this returned like a boomerang. VA is intransigent. They have an agenda of deny until you give up or die. It never dawned on them to read this and try to swallow it hook, line and sinker themselves before asking Judge Hagel to buy in.

imagesIt’s like Chinese instructions on how to assemble a table from Home Depot. The directions simply don’t fit the object they purport to describe. Eventually, VA resorts to manufacturing statements by the Mikemeister that he told them he used a glass pipe to smoke crack. Keep in mind that they have maintained for years that just the mere smoking of crack was the equivalent of snorting it as a risk factor. I also doubt the Mikester got diarrhea of the mouth at this late stage of the game and gave them a blow-by-blow description of how he ingested crack. When that flamed out, they started in on the “He has no history of sharing razors in the service.”  In desperation the short, stubby overheated glass crack pipe materializes like they do in an episode of Cops. To the VA this is called “any port in a storm”.

VA insists that we, as claimants,  have a logical argument for any nexus . It has to be cogent, well-reasoned and easily verifiable. You cannot just up and say “Your Honor, Mr. Strong has a long history of drug abuse and alcoholism. Therefore it ain’t service connected.” You need facts. You need medical studies peer-reviewed and accepted nationally. In sum, you need a bulletproof denial buttressed amply by science- not an alien abduction scenario. Now comes before us Will Gunn of OGC fame with airy theories, illogical, unsupported facts and a blatant attempt to roll Judge Hagel with them. Kind of makes you wonder what Mr. Gunn was smoking.

Here’s a small sample of some of the most priceless illogic you may read this year. You will find ample cites to utilize in your own defense when they start in with the VA examination where you admitted to snorting (or smoking) the entire 1987 production of Peru’s finest export.

In his December 2004 statement, Mr. Strong stated that, in September 1977, a member of his “platoon and company” attempted suicide by slashing his wrists and that he was among the men tasked with cleaning up the soldier’s blood. The Board denied Mr. Strong’s claim, in part, because there was no documentation of this in his “service treatment records.” The Court is dismayed that the Board provided such a patently illogical reason for denying Mr. Strong’s claim.  The notation of another soldier’s attempted suicide is not the kind of information one would expect to find in Mr. Strong’s service records.

Fast forward to 2012 from the 2004 “non-probative” C&P:

In January 2012, Mr. Strong underwent a VA examination. The examiner stated: There is no documentation within the medical record of the patient having shared razors, if this had occurred, this would be considered an inefficient vector at best.

 

VA is cognizant of the risk factor associated with tainted blood. This is why you will find sharing personal items listed as one of the VA -recognized risks of contracting HCV. Yet here, our desperate Examiner is reduced (with no supporting medical logic) to opine that this is not the cause or a slim one at best. Please recognize this technique as VA uses it all the time. You have to read every word to excavate it sometimes. Here it was overt.

He also states that he helped clean up blood products resulting from the attempted
suicide of a fellow soldier. This involved using a mop, towels, and bleach. He was
not exposed to any needle sticks. There is no documentation in the medical record
regarding this event, however from his description of the event (using a mop, towels
and bleach), it is unlikely that he has had any significant exposure to blood products,
given that hepatitis C is not spread through intact skin or mucus membrane.

Well, pilgrim, except for those pesky glass crack pipes, that is. VA blithely glosses over the specifics and focuses myopically on mop, towels and bleach. No discussion of gloves, normal sanitary protocols, viral survival time outside the body or other recognized scientific tomes on the subject. Also note that it is a prerequisite that any nexus or opinion be couched in “at least as likely as not” or something similarly quantifiable. Here, the examiner concluded it was “unlikely” which could just as easily be equivocally stated “likely”.

Patient has a long history of drug and alcohol abuse and multiple admissions for detox in the 1980’s. While he denies IV drug abuse, he freely admits to smoking crack cocaine. Crack smokers use glass pipes to inhale the smoke. The pipes heat up and cause superficial burns on the lip. Sharing pipes carries the risk of transmitting hepatitis C.

Here’s the smoking gun. Nowhere in medical journals has anyone gone out on the little branches and opined that crack pipes cause superficial burns to your lips. It may very well happen but one cannot say categorically that it happens every time, nor can they say it is endemic to crack pipes -or even Mikey for that matter. Jez, what about pot pipes? The Examiner opined that sharing razors was a poor vector for transmission. It may well be the poorest imaginable but nowhere on the VA’s Risk Factor Questionnaire (RFQ)will you find smoking crack a risk for contracting HCV. Here’s the RFQ. Always remember VA is like an ADHD-addled kid. They say whatever pops into their noggin like someone with Tourette’s syndrome. When pushed onto unfamiliar ground, they turn up the bullshit setting. Here, they had to get the VA Examiner to manufacture new risk factors that the National Institutes of Health haven’t even researched-let alone recognized. This is a first for the BVA but then it should come as no surprise. It’s merely an instance that makes one’s eyebrows rise slightly higher on one’s brow. VA desperation knows no limits.

Of course, when you rebut their insinuations, you get an addendum that purports to call you a liar (again).

In July 2012, Mr. Strong submitted a statement in support of his claim. He asserted that the examiner incorrectly stated that he had smoked crack cocaine out of a glass pipe–”I never indicated this and I have never done it.” Mr. Strong subsequently submitted another statement: “I have never used a glass pipe to smoke any type of substance. When I did smoke it was always in a cigarette type paper. To conclude that my condition is the result of using drugs through a glass pipe is totally erroneous.” In August 2012, eight months after the initial examination, the VA examiner submitted an addendum stating, “the evidence used to determine that the veteran used a glass pipe to smoke crack cocaine was the veteran’s own testimony given to this examiner during the course of the [examination].”

I’ve been through this process before. When called on it, the VA C&P exam will not have any such thing written in it or, if it does, it will be penciled in after the fact as “post hoc proof” Sometimes the VA Examiner is queried and recalls very clearly that old Mikey said exactly that but he neglected to enter it in. However, with his eidetic memory and  expert recall, it comes back like yesterday. Of course if you or I tried this stunt, we’d get laughed out of Dodge. The denial would discuss our credibility issues and how no one could remember that far back with such alacrity.

Judge Hagel shouldn’t have to explain this to attorneys schooled in the art of deductive thinking but nevertheless he finds himself doing it not once but twice. Here, he has to carefully explain Evidence Gathering 101 taught to aspiring young policemen with no Juris Doctorate.

[t]he Board found that, although Mr. Strong denied drug abuse intravenously or
intranasally, “he freely admitted to smoking crack cocaine, which the examiner noted involved use of glass pipes to inhale the smoke. The examiner explained that the glass pipes heat up causing superficial burns on the lip and that sharing pipes carries the risk of transmitting hepatitis C.” The Board wholly ignores the fact that there is no evidence that Mr. Strong shared glass pipes with anyone else and instead relies on mere speculation on the part of the medical examiner. It is well recognized that speculative medical opinions are of little probative value and should not be relied upon by the Board. See Hood v. Shinseki, 23 Vet.App. 295, 298-99 (2009).

As you read your denials, you will see this time-worn trick VA employs. They start with a willful misconduct flaw and build upon it like a runaway locomotive. By the time you offer rebuttal, you’re tried and convicted. The trick is so old it doesn’t have a descriptive adjective anymore. It’s built into the M21R.

[t]he Board found that the “[s]ervice treatment records are entirely negative for any
reference to symptoms associated with what is now known as hepatitis C.” However, the Board also acknowledged that Mr. Strong had “a cough and other cold-symptoms” while in service…  Considering that “[i]n the early or acute state, hepatitis mimics a variety of flu-like illnesses and may be difficult to diagnose,” Secretary’s Exhibit at 2, the Board failed to adequately explain its finding that there is no evidence of symptoms in service that may be associated with hepatitis C.

This is another age-old ploy. Describe the evidence and then promptly gloss over it as being immaterial as though it is of no consequence. The technique is necessary so the Board can, in good faith, on appeal to the CAVC, honestly say they mentioned it- ergo- it was part of the Reasons and Bases considered before assembling the inevitable hangman’s noose.

And last, but certainly not least, is our old friend Maxson v. Gober which VA trots out religiously at the drop of the HCV hat. Unfortunately it is apposite to Mr. Strong’s claim for all manner of reason which the OGC is all too aware. They’ve been taken out behind the woodshed numerous times for this on HCV cases and still respond with the same Pavlovian response at the ring of the BVA appeal bell.

Sixth, the Board found:

[Mr. Strong’s] post-service medical records first document his hepatitis C in 2000,
more than 2 decades after his separation from service. So[,] even accepting that
hepatitis C may be dormant or have a latency before the associated symptoms
become evident, the lapse of so many years in this particular instance after his
separation from service and the first documented complaint of this claimed disorder
is also probative evidence to be considered in determining whether his hepatitis C
dates back to his military service. The Federal Circuit Court has held that such a
lengthy lapse of time between the alleged events in service and the initial
manifestation of relevant symptoms and/or diagnosis after service is a factor for
consideration in deciding a service-connection claim. Maxson v. Gober, 230 F.3d
1330, 1333 (Fed. Cir. 2000).

The Board cites to Maxson in support of its finding; however, this case is distinguishable. In Maxson, the medical condition was an aggravated colon, not a disease like hepatitis C which, as noted above, can have a long period of dormancy. Additionally, the holding was specific to “evidence of whether a pre-existing condition was aggravated by military service,” which is also not the case here as Mr. Strong is not seeking benefits based on a theory of aggravation. Maxson, 230 F.3d at 1332. Thus, for the Board to use the length of time between Mr. Strong’s service and his diagnosis of hepatitis C as probative evidence is clearly erroneous, based on the Secretary’s own exhibit. See 38 U.S.C. § 7261(a)(4).

 

And just like moles, Will Gunn and company are industriously trying to undermine the underpinnings of your claim. Mr. Strong’s first “trial” and this do over are classic examples of grabbing any excuse off the shelf without seeing if it fits. Desperate in their attempts to deny at all costs so as to avoid a stampede to the cash trough ( and thus endanger their anticipated bonuses), they grasp at straws to fashion their arguments. The old saw about throwing spaghetti at the wall to see if any sticks is an apt analogy.

So, use this to your advantage. Always rebut the rebuttal as Mikey here did. Don’t allow a lie to go unchallenged. Do not ever, under any circumstances, allow a SOC or SSOC to go by without a vociferous response and a correction of the records.

Mike might not be a saint but neither am I. We all have our Dark side and we also have the ability to right the ship of life. Here, he has done so but is still being tarred and feathered for “drugs”.  VA would blame his predicament on anything but something in service regardless of how far afield they have to go. Prepare to see a revision in the RFQs adding glass crack pipes to the list of risks. On remand, the BVA is going to have to throw some serious money at this to get it to stick. I smell a BVA-ordered IMO at Duke University or the University of Oregon Health Sciences Center (funded by who else- VA) where a noted medical scholar will take his thirty pieces of silver and thrice deny Mr. Strong before dawn based on being Extremely Trashed Or Hammered (ETOH abuse), or any of a panoply of other risks we were unaware of. The Veterans Law Judge will carefully eschew from the mention of glass crack pipes this time and hew to established law. Gone will be any reference to Maxson. Instead, a whole new legal epiphany will emanate from the new VA examiner carefully buttressed by antique CDC handouts. In 2017, it will surface like a bobber after a strike and Judge Hagel will inveigh anew.

I fear Mr. Strong’s legal battle is just beginning. The good news is he and Judge Hagel have demolished 90% of their defensive options.  A refined hanging a la Macklem is what they desire. Or, the OGC will take him aside and fashion a financial modus vivendi and nondisclosure documents will be signed around. For Mikey, a more propitious time could not be asked for, what with the Phoenix brouhaha afoot. I expect Will Gunn is going to be busy this summer up on the hill trying to explain how the VA infrastructure is laid out and how he neglected to prosecute all these Bozos who were cooking the books.

downloadMeet Mikey and his excellent second adventures at the CAVC. This is definitely one of those “Mikey! Hey, Mikey. He likes it.” moments. We commend him for his perseverance and desire to create precedential jurisprudence for those that would follow.

StrongMJ_12-3738

 

 

 

 

Posted in CAvC HCV Ruling, CAVC/COVA Decision, HCV Health, HCV Risks (documented), Tips and Tricks, VA Medical Mysteries Explained | Tagged , , , , , , , , , , , , , , , , , , , , | 4 Comments