HERE WE GO AGAIN ON FIDUCIARIES

downloadIn what looks like a straight up bill to curb bogus bonus awards to VA poohbahs who kill us, Congress is poised to go out and “fix” it. Just as they fixed health care for us, they are preparing to take another gigantic step backwards on VA fiduciaries.

As most know, we finally got a modicum of justice from VA after the Court struck down the practice of the VA summarily appointing any Tom, Dick or Harry with legal credentials as fiduciaries over mentally incompetent Veterans.  See https://asknod.wordpress.com/2011/09/27/cavc-freeman-v-shinseki-2011-assigning-fiduciaries/. The rub was that many of them were crooks and fleeced the poor Vets for years until being unmasked.

The problem with the new bill that is being proposed to curb ungodly bonuses also includes some dangerous language that will allow VA to reintroduce what Freeman took away.

It also gives reservists honorary “veteran” status if they serve for more than 20 years, allows veterans to access information about pending benefits claims, and allows the VA to appoint a fiduciary for veterans who are mentally incompetent to manage their finances.

That one little innocuous phrase is the cause for concern. No one in their right mind has a problem appointing fiduciaries for Vets in need of supervision. Most of us simply feel we should be involved in the process rather than a complete stranger who’s motives may be less than pure.

Posted in All about Veterans, Veterans Law | Tagged , , , , , , , , | 1 Comment

VERTEX ON THE WAY OUT

downloadI spotted this on the wire this morning. It was inevitable and I wondered when the boys at Vertex would pull up the stakes and fold the tent. The only sad facet of this is how many lives were inadvertently affected by using this drug. Incivek by itself is not to blame. The crime was injecting Interferon behind it with the sure knowledge that a new genre of medicine was on the horizon capable of accomplishing the same thing with little or no collateral damage.

I liken it to building Zeppelins and filling them with hydrogen knowing full well that the risk of fire and explosion were far greater than using helium. Few know that Interferon, in it’s first incarnation in 1957, was developed to combat cancer. When it was discovered that an inordinate number of patients were dying from it rather than their cancer, it was pulled off the shelves. In the eighties, it was trotted out once again for the HIV/AIDS epidemic. Having little success again, it was retired until the Hepatitis C virus reared it’s ugly head in 1989.

Thinking they had finally tuned it up, they overdosed thousands of us with it in doses far larger than they should have. When this failed, they began the introduction of Ribavirin. We have continued to watch scientists stumble around in the dark and grab any perceived panacea they come across in a vain attempt to give Interferon credibility. Vertex’ introduction of Incevik was simply more insult heaped on injury for many. Soon, Telepravir and Bocepravir will end up on the same ash heap of medical science. I can’t wait.

With the advent of Sofosbuvir, Simeprevir, Daclatasvir and the new nucleotide protease inhibitors,  patients are finally getting a useful drug that won’t kill them. The inventors of Interferon overlooked the golden rule of physicians-First do no harm.

For those of you out there who don’t get out much or have a newspaper subscription, please refrain from entering any new prophylaxis involving Interferon. It is yesterday’s news.

Posted in HCV Health, research, VA Health Care | Tagged , , , , , , , , , , , , , , , , | 4 Comments

National Veterans Law Moot Court Competition (NVLMCC)

downloadPro se veterans might find this competition interesting.

Hosts:

  • THE U.S. COURT OF APPEALS FOR VETERANS CLAIMS BAR ASSOCIATION
  • THE GEORGE WASHINGTON LAW SCHOOL
  • THE UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS

Using cases that look real, and with “dummy” medical records in the joint appendix pdf, teams of law students write briefs covering one side of a case (the Petitioner or Respondents) on a Competition Problem but must be able to give oral arguments–with no visual aids etc–for both sides. Briefs are scored on 100 points (official rules, D.) 

The 2013 problem and team briefs is about VA physician negligence are here.

When:  Saturday, November 16, 2013, and Sunday, November 17, 2013.  Where: Washington, D. C. Building? All rounds are open to observation to the public and recorded.  I don’t find any previous competitions on Youtube.

Judges’ Criteria (excerpts) 

1. . Command of the Issues. “…how well each team member understands the issues presented in the problem and his or her knowledge of the facts and relevant law, including an ability to identify and finesse fine distinctions.
2.. Organization and Reasoning. ” …to what extent a team member presents a coherent and logical argument that flows smoothly and addresses all necessary points.”

3. Ability to Answer Questions. ” …her ability to interact with the Court. The Judges will evaluate how well each participant answers individual questions, including whether the answers are responsive, comprehensive, and supported by authority, and whether each
participant transitions easily from questions into the planned presentation.
4. Persuasiveness. ” …on the overall persuasiveness of the argument and whether the participant presents his or her position with conviction.
5. Deference and Courtroom Manner.  “…will evaluate the poise and
confidence of each participant, including the ability to maintain eye contact withjudge
panel members and quality of inflection. The Judges will also consider whether
each participant comports with courtroom decorum (e.g., by addressing each
Judge as “Your Honor” and deferring to Judges as they speak).

Update; Thanks to John D for pointing out that the cases and evidence are simulated.  This is backed up by the sentences in the About tab.  Had me worried.   

 

Posted in Guest authors, VA Health Care, Veterans Law | Tagged , , , , , , , , , , , | 3 Comments

SOFOSBUVIR DECLARED LEGAL

downloadToday the FDA approved what I pray is the cure for my illness 15-0 with nary a naysayer among them. Hepatitis C sufferers who failed the Interferon prophylaxis over the years now have one good shot at killing the dragon. 

We’ve waited a long time-some as many as 16 years-for this day. How soon Gilead cranks up the pill machine is the only delay I see. Scientists actually created the first Interferon product in 1957 but didn’t understand how to employ it. They killed a lot of people before they diluted the dose down further and further. After the introduction of Ribavirin in pill form, the two-drug cocktail jumped from 39% success in fifty two weeks to almost 54%. With the latest addition of Telepravir/Bocepravir triple-drug regimen the cure rate has risen to 62% with an average of forty weeks.

In contrast, Sofosbuvir plus Ribavirin in oral form (pills) have a twelve week course for the most intractable genotypes (1A and 1B) with a reputed 97% rate and no relapses. Guess that tells you all you need to know. It won’t kill you and it works.

Genotypes 2 and 3, normally the ones most amenable to treatment with Interferon, are quite the opposite using the nucleotide protease inhibitors. We hope follow-on research will yield better results which are currently in the 69-72% range. Hell, that’s still better than the bug juice.

P.S. The Stock market closed too early to reflect the 3 PM FDA conference review board’s decision. However the stock did rise from 68.68 at 2:30 PM to $69.68 at the closing bell. This one will be interesting to watch. They are pretty much not only the frontrunners in this new race but indeed the only runners with an approved product.

Posted in HCV Health, Medical News, research | Tagged , , , , , , , , , , , , , , , , , | 8 Comments

CAVC–KYHN v. SHINSEKI–NO ADDITIONS TO THE RBA

downloadWe have rules we live by. We have rules for appealing. We cannot modify the rules to “fix” what we forget in a judicial forum. If we appeal to a higher tribunal at the VA, we are allowed to add new and material evidence only up to, and including, the BVA. If we do not prevail there, we appeal to the CAVC but it can only be based on two basic theories-errors of fact or errors of law. We’ll leave prejudicial actions out of this list for now.

Overcoming an error of fact is difficult insofar as the CAVC is not an investigative body. As they are so fond of iterating, they are not a Court of equity nor are they a trier of fact in the first instance. Unless the preponderance of the evidence points to a clearly and unmistakably erroneous conclusion, the Court will affirm the BVA’s decision. On the other hand, an error of law is much easier to propound and indeed, more cases are overturned on this facet.

Similarly, for pro se claimants, there is a modicum of kid gloves treatment accorded us if we do forget something or decide to argue a new concept or perceived error when we arrive at the Court.  Add to that the precept that VSOs are not Leaglebeagle.com and you are considered such automatically. The VA secretary abhors this because he has his game plan carefully constructed around what you are complaining of. If you then take off on a new tack and question the Presumption of Regularity as Mr. Arnold C. Kyhn did, it wrenches the monkeys at the OGC. Conflustication reigns supreme and a new legal noose must be fashioned in short order. Witness the latest Texas necktie party to emanate from 810 Yellow Brick Rd. NW. This was handed down this week. The hamster wheel is in working order and Mr. Kyhn has been aboard for ten long years.

Arnie began this whole deal over a 10% tinnitus rating. He was one of America’s Greatest Generation and answered the call to combat fascism in 1945. His hearing was clobbered and in 1998 (after a protracted appeal) he got what most would say was a generous 50% rating for hearing loss. Unfortunately, he didn’t get the tinnitus ice creme on top. Speaking from a position of knowledge, my tinnitus, in no small measure, is part and parcel of my hearing impairment. When the ringing is at it’s loudest, it often interferes with hearing anything. Hence, the two are part and parcel of one injury and inextricably intertwined much like Harris v. Derwinski. Besides, we’re talking 10%. Remember that.

The Arnold didn’t file for all this until 1998 but VA, in a surprising twist, didn’t hold Maxson v. Gober against him and granted the aforementioned 50% following a BVA remand decision. What they just couldn’t bring themselves to do was give him the piddling 10% for the ear ring. He didn’t appeal it either. In 2004, he decided to come back and revisit that. Mind you, he had an excellent nexus letter (IMO) in 1998 and supplemented it again in 2004 that conclusively tied the two together. VA, as is their wont, decided the audiologist’s 2004 medical conclusions were not new and material and declined to reopen the claim. Arnold was off to the BVA again in short order measured in VA time. In 2006, the ping pong match began in earnest. The VLJ remanded the claim back to the Lincoln, Nebraska RO and  positively insisted they actually do a C&P to ascertain whether his tinnitus was service connected and compensable.

This is where the battle royale began. Arnie maintained he never got the C&P reminder to show up for the hearing test. I’ll buy that. Knowing how sloppy those chuckleheads are, it’s a wonder anything ever succeeds in getting done. As per VA reg 38 CFR §3.655, if you don’t show up for a C&P, you’re screwed.

In February 2006, the Lincoln, Nebraska, RO forwarded an audiological examination request to the VA Nebraska Western Iowa Health Care System. That examination was scheduled for March 7, 2006; however, Mr. Kyhn failed to appear for the examination. On March 31, 2006, the RO issued an SSOC in which it denied service connection for tinnitus based on Mr. Kyhn’s reported failure to appear for his March 7, 2006, examination.
In April 2006, Mr. Kyhn responded to a March 2006 request for information by stating that he had no other information or evidence to give to VA and requested that VA decide his claim
as soon as possible. The matter was returned to the Board and in its May 17, 2007, decision, the Board denied service connection for tinnitus after finding that the record contained no probative evidence that Mr. Kyhn’s tinnitus was incurred in or causally related to service or aggravated by any service-connected disability. As part of its decision, the Board determined that
the Secretary had complied with his duty to assist, pursuant to 38 U.S.C. § 5103A, because a VA audiology examination was scheduled and “notification of the examination was mailed to the veteran at his correct address of record.”

We’ve discussed the much-vaunted presumption of regularity in several other decisions I’ve written up, but the interesting thing about Mr. Kyhn’s predicament was that the C&P exam request is generated, according to VA, in a computer format and a copy of the actual document mailed to Arnie was not in the c-file. Biiiig mistake. It exists somewhere “in the cloud”.  Here’s the 2011 CAVC decision.  At the BVA hanging, the staff attorney merely said they’d mailed it and it was presumed he got it. No document. No date stamp. Nada. Just the word of an honest VA employee reciting the procedure on how this process worked. The BVA bit into it hook, line and sinker.

When Mr. Kyhn arrived at the Court in 2011, he got the bitchslap. Kyhn 2011 CAVC decision. The Court hit the same lure and merely affirmed it. Presumption of Regularity was proven. End of story. Or not. Back the boat back up to the dock, Gilligan. Aye, Skipper. Here’s my first writeup. This was in response to the Federal Circuit reversal and remand to the Court in May of this year (2013).

The CAVC panel has now been appropriately chastised and will have to refamiliarize themselves on their own rules on the admissibility of evidence. When you arrive, hat in hand, at the CAVC, you have a sealed Record on Appeal. How else would you ever be able to decide a claim if you could endlessly add evidence to the file supporting your position? The VA Secretary didn’t feel this applied to him. The Court has always taken a dim view of this and rarely allows anything in after the BVA has spoken. They sometimes “take notice” of generally accepted principles of law or medicine but it happens so rarely that is it is materially inconsequential. Here, however, they welcomed the VASEC’s new evidence in heartily and based their decision on the Presumption of Regularity in large part on the testimony of two VA employees. The Feds weren’t buying and the whole thing came crashing down around Shinseki’s ears. Back to the drawing board.

The OGC maintains that Arnold didn’t raise a stink about the Presumption at the BVA and did not address it until he got to the Court. All well and fine. But the BVA did and that is the problem here. When you file your substantive appeal (Notice of Disagreement) you begin to shape your contentions as to why you feel you got the short straw. When you complete the process by filing your Form 9 (the second step, or what the VA calls your substantive appeal), you further refine your arguments to rebut the Statement of the Case (SOC) that the VA has prepared where they have distilled the essence of their denial. By law, VA is supposed to defend the propriety of their actions and address your contentions. They are not supposed to go far afield and drag in new things to justify their position. Most assuredly, when called on it at the Court, they are not permitted to begin adding to the record with testimonials illustrating how the system works.

The whole purpose of sealing the record before the agency (RBA or R) is to create a static document such that everyone can point to this and that as proof. If you have an electronic transfer of a request for a C&P and it is nowhere to be found in the RBA, it would be hard to say it is a matter of record. Yes, indeed you can aver that you mailed it and the P of R should attach, but absent a concrete document that can be massaged and examined for a date stamp, it is merely one person’s word against another’s. As for supplementing the RBA, that is right out. This was the crux of the argument that caused the Fed. Circus to vacate and remand.  It is also the sole reason the Court was hoist on its own petard.

What will now ensue will be interesting. Will the BVA craft a new decision that somehow tries to artfully skirt this by including Madames Bash and Bunde’s affidavits that order and decorum were observed vis-a-vis the P of R? Will they simply decide too many trees have been slaughtered and this needs to be put to rest before any more P of R cats are let out of the bag? Simply put, this is a tempest in a teapot over 10% that has dragged on interminably for ten long years. It reminds me of the two drunks arguing over who was going to pay the bar bill on the Titanic that fateful evening.

Assume, if you will, that the Ahnold is married and his missus is still making life miserable for him.  That nets them $888.000 a month for the 50% hearing loss. Were he to prevail on this and get his 10%, it would increase his rating to 55% and thus round up to 60. Idiot’s delight. It will mean $1120.00 – a net increase of $232.00 a month. VA has by now squandered untold judicial resources they value so dearly since 2004 in an abortive attempt to deprive an old codger of  chump change. Why, in the scheme of things, they’ve  paid out more in Bonus Bucks to the Veterans Law Judges, Jo Ellen Bash, Margaret Bunde (the Lincoln, Nebraska VSC manager) and a cast of thousands than they’ll ever deliver to Mr. Kyhn in his lifetime. If you throw in hourly wages and salaries on top of it devoted entirely to making life miserable for him, the cost is staggering. Didn’t anyone sit down and do a cost-analysis determination and say “Whoa. Let’s focus our resources on reducing the backlog instead of making life miserable for one Veteran.”? No. Of course not. Can you say myopic? Sure you can. Let’s sound it out, kids. V… A… Backlog…

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Posted in CAVC Knowledge, CAVC ruling, Presumption of Regularity | Tagged , , , , , , , , , , , | 2 Comments

NEW MARINE UNIFORM CRITICIZED BY OLD TIMERS

1375217_10151825139502740_1755625231_nIn the news today, old timers still in uniform are numb with fear that they will have to convert over to the new, 21st Century vision of the Marine Corps. Open rebellion is brewing at several bases and the Training Instructors at Paris Island are reputed to be mulling resignation en masse. While the new uniform will be Dress, it will not be worn into the field. Standard BDUs with an as-yet to be determined camo pattern will still be de rigeur there. This has quelled some soldier’s fears but the very idea of dressing up as “girly men”, as Gunny Sgt. Vic Morrow phrased it, has many on edge. 

“This is going too far. We were fine with just fragging the queers as we identified them and then they came out with the DADT bulljive. But this new same sex marriage thing blew it wide open. Throw in the uniform thing and I can safely say it’s a dealbreaker.” said Morrow. “I’m turning in my papers tomorrow. No way I’m going out in public looking like that.” His fellow NCOs voiced their agreement in unison over salt and pepper (Jack Daniels with beer chasers) farewell toasts.

Morrow’s second in command,  Gunny Sid “Vicious” Tremont added “If the President was trying to downsize the Corps, I can’t think of a better way than to decapitate the hierarchy of the Non Commissioned Officers’ ranks with a moronic stunt like this. I’ll be interested to see who’s gonna train our guys when they get a load of their new suit.”

imagesAt today’s news conference, Secretary of Defense Chuck Hagel said “It’s time for the barbaric reputation of the Marine Corps to be softened a little and we felt this was the quickest way to take them down a notch. They have to know I’m the boss and I give the orders. Besides, the President feels this will be less intimidating to the Taliban and the Al Qaeda if we staff our embassies with the troops dressed this way.”

A special thank you to Diane Barnett for shhharring that with us.

 

P.S. LawBob Squarepants sends me this as a rejoinder which is real. Girlyhats? What next? Man, I know a shit ton of Marine Vets who are going to go NASDAQ over this. We’re going to be lucky if we even have any Marines by this time next year. The rifle-bearing kind, I mean.

Posted in Humor | Tagged , , , , , , , | 1 Comment

The policy statement that keeps giving us laughs

Posted in Guest authors, Humor | Tagged , , , , , , , , | Leave a comment

SOFOSBUVIR–HOT OFF THE WIRE

downloadWe had expected glowing reports this Friday after the FDA review of the new HCV Gilead drug Sofosbuvir. What, then, to our utter surprise than to spot this promising FDA blurb today- three days prior to the upcoming FDA discourse. Whooo-doggies. By the way, the stock closed this afternoon at $69.01. Smokin’.

Nod’s suggestion.  Ugggh! Buy stock. Nod take protein pill.  Nod put helmet on and tighten safety belt. Nod like grape-flavored Sofosbuvir.

Posted in HCV Health, Medical News | Tagged , , , , , , , , , , , , , , , , , , | 3 Comments

IT’S SHOWTIME.

download (2)I filed in 1994. I was denied. I submitted new and material evidence. Nothing happened. In 2007 I refiled and submitted the same evidence again. I won-but only from 2007 forward. I filed an appeal for my 1994 date. I lost at the BVA. I went to the CAVC in June 2012. On April 3, 2013, VA decided they were in error. The same sawed off runt BVA Judge now has the ugly task of admitting he was wrong in denying me in 2012. It has been nineteen years and some change. My children have grown up, graduated and now have children. My son was one year old when I filed my first claim and lost. Vengeance is a dish best served chilled as they say. I spotted this on eBenefits today:

BVA1 Ah, to be a fly on the wall…

P.S. If you’re as blind as me, put your cursor on it and click once. Read ’em and weep,  Judge.

Posted in BvA HCV decisions, Veterans Law | Tagged , , , , , , , , , , , | 6 Comments

VA SLAYS BACKLOG DRAGON DURING SHUTDOWN

graphIn what is being remarked on as a new ploy to reduce the VA backlog, many government agencies are looking at the VA’s latest legerdemain as a new tool for reducing their inbasket overload.

Unable to explain why, after several dire predictions of doom, the VA is now touting the shutdown as being instrumental in reducing the claims backlog via various excuses- all the while ignoring the 900,000 Vets on the living room sofa. The graph to the right has two lines-one in blue and the other in red. They comprise two different numbers of Vets- backlogged and pending. If you add the two, you have a better idea of the problem. Viewed separately, they are far more innocuous and the numbers are semi-digestible if you work at the VA. If you were a major insurance corporation CEO, you’d be apoplectic and consider firing the loudmouthed Gecko with the fake Australian accent.

Let’s all retrieve our analog abacus’ and do some real counting without employing the foxes in the henhouse. The hard reality is that when you close the front door and forbid any claimants to enter, your intake is bound to diminish.  Add to it during that period, for five long days the raters continued to process claims until some government weenie realized they could furlough the lot and create even more pain for another class of Americans. Added to the closed Veterans Memorials, this was bound to arouse anger among us. Never let a perfectly good catastrophe go to waste.

VA uses computer models. The models are comprised of “Our current projections, based on computer modeling, are …”. If the models showed a gradual decrease due to raters working overtime blindly stamping “DENIED” on forms left and right, any perceived subsidence in the projected model would be fair game for anyone in the VA PR office to attribute to their finnesse. In this case, dire predictions of a new “lump in the python” not only did not manifest but, to the contrary, receded. Speechless at the conflusticating evidence, they had to gin up some measured response such as the timeworn “Our employees were so dedicated, they refused to leave their desks for the duration and peed in old milk cartons so that Vets would get what’s coming to them.”

Computer models at the VA are problematic for any number of reasons. VA has their own stable of computer geeks. Call the them the Veek squad. They have much in common. Most have or had parents who worked there so nepotism is still alive and well regardless of what you think about merit. Their training seems to derive from  Time Life Computers-An Introduction. Some actually have a degree from a trade school proving they passed the mandatory tests after their six weeks of training. As for a twelve year background with IBM/Xerox on the resume? VA can’t afford that type. They generally opt for the ones who were caught plagiarizing in college and can be snapped up for a song. Such is VA’s OIT. Of course, absence of any computer software knowledge is not a bar to employment which is painfully obvious. Simply look at the VA’s belated attempts to get the VBMS off the ground. It makes an albatross appear born to flight.

In a more nuanced examination, the actual reasons are glaringly apparent but VA is loathe to draw attention to them. If you cork the funnel, nothing comes in. In the interim, the remaining input in the pipeline subsides. Only at the VA can this set of parameters yield a fantastic result akin to alchemy and turning lead into gold. But then again, only at the VA do you have employees spraying grey, lead bricks gold-colored and proclaiming them as such.

Goldbricking is an art form. Over several score years we have watched the VA backlog as it mimicked the NYSE Dow Jones average. Up and up. In that period, more employees were hired, more money was appropriated and more innovations and programs to arrest the backlog were instituted to no avail. Along comes a government shutdown and voilá! Problem solved. Do nothing and the problem abates of it’s own accord.

How VA intends to spin this will bear watching. Thank you (Pop) Smoke for apprising us of this fortuitous news. What I take away from it is that Veterans need to quit filing claims and the backlog will simply resolve itself. Inertia will succeed where all else before failed. Who woulda thunk it?

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Posted in VA BACKLOG | Tagged , , , , , , , , | 2 Comments