CNN: VA disability payments could stop if shutdown is long

Posted on September 29, 2013 by Laura

imagesYesterday I emailed our representative to protest his anti-Affordable Care Act position and the possible government shutdown.  I pointed out that disabled veterans who were denied disability benefits (over 80%) are not eligible for VA health care if they are over the $80,000 income and asset limits.  Their only option is a high risk plan.  

Then I read this alarming article:

The Department of Veterans Affairs clarified itself Saturday, saying that if a government shutdown occurs, and lasts at least a month, not all compensation and pension payments would continue.

“Those benefits are provided through appropriated mandatory funding, and that funding will run out by late October. At that point, VA will be unable to make any payments,” spokeswoman Victoria Dillon said in a statement to CNN.   … Among the benefits in question would be disability and GI Bill payments.

Will active service members get paid?  Military-TabMaybe.

The VA has published some information:

Veterans Guide to Government Shutdown with a 2-page PDF that outlines the services that will be impacted:

http://www.va.gov/opa/docs/Field_Guide_20130927.pdf

VA Contingency Plan* Agency Operations in the Absence of
Appropriations

http://www.va.gov/opa/docs/VA_Contingency_Plan_Document_20130927.pdf

Certain House members are the culprits in this nasty drama.  The House VA website is silent on the shutdown.  News outlets are picking up the story slowly.  Our influence counts but only if they hear from us.

Ed. Note: I got an email giving me a brief on the BVA in DC. Seems they’ll (VLJs)keep on keepin’ on in ex parte chambers as it were but the little people will be laid off. Hence, no more BVA decisions issued until the impasse is surmounted.

In order to cast some humor on this, when the budget is approved, think of it as constipation with a vigorous application of Ex-Lax ®. There will instantly (in VA time) be a plethora of new decisions seemingly simultaneously. I read that as “Warning. Decisions are closer than they appear in mirror.” CNN was always one of those rather dramatic  news organizations with doomsday prediction scenarios of “What if?” Actually, I’m somewhat surprised FOX didn’t beat them to it. Too much focus on the TEA party and with good cause. But then that is why we do not discuss politics here because someone, somewhere, will take umbrage and voice their opinion and then we have mayhem. So, all the parties have been represented and identified. They comprise America. A loud, raucous cacophony of democracy. A Baskin and Robbins of ideologies. This will be interesting to watch- as long as the game of brinksmanship doesn’t continue too long.

Posted in Guest authors, VA Health Care, vA news | Tagged , , , , , , , , , , , | 2 Comments

American women and guns

Posted on September 28, 2013 by Laura
cold mountain

Image credit: Miramax film cover art

The Second Amendment codified the right for (free) people to bear arms in 1791. Long before the movie Cold Mountain famously portrayed circumstances in which women protected themselves during the Civil War, Colonial women owned and used guns. Scholarship of probate inventories by James Lindgren and Justin L. Heather, in their 2002 article, Counting Guns in Early America, state “..that at least 50% of all wealth owners (both males and females) owned guns.”  

Women have faced many social and educational barriers due to their gender throughout America’s past. In 1851,  Elizabeth Blackwell was the first woman to be awarded a medical degree. Free women were restricted from voting until 1920 with the passage of the Nineteenth Amendment by the all-male Congress–144 years after 1776.  (The votes were close & it’s quite a story.)  However, I am not aware of any restrictions on the rights of women to own firearms in American history.

There are more living females in the U.S. than living males (all ages).  In 2011, there were 150,643,000 males and 155,466,000 females (source: U. S. Census).  All elected representatives know that women vote in higher numbers than males.

HungerGamesPoster

Image credit: Lionsgate release poster for The Hunger Games in Wikipedia article.

According to statistics from Rutgers: Women hold 98, or 18.3%, of the 535 seats in the 113th US Congress — 20, or 20.0%, of the 100 seats in the Senate and 78, or 17.9%, of the 435 seats in the House of Representatives.  Some of these women are in favor of gun control but they know that legal gun ownership is a concern of.  Women have owned guns in America since the seventeenth century and they are highly unlikely to disarm now or in the future.  Women and weapons are an important part of the popular youth culture as we’ve been in the movie Hunger Games and the TV series LOST.

Kate Lost

Tough girl Kate in LOST– played by
Evangeline Lily.

We all have a keen interest in seeing that people known to be a danger to others or themselves, not have access to guns.  Gun safety education is extremely important.  Journalists are writing about women and guns. I don’t take any rights for granted, but I believe the Second Amendment will be upheld as long as the political entity called The United States of America continues to exist and women have a say in the matter.

rirle

Meme poster on Google images Artist not known.

Ed. note: Kiedove examines the female side of gun ownership in response to all of the MST coming to light in the military. Interesting viewpoint.

Posted in General Messages, Guest authors, MST | Tagged , , , , , , , , , , , | Leave a comment

CAVC–WILSON V. SHINSEKI–SIGN HERE, HERE AND HERE

Posted on September 28, 2013 by asknod

downloadI always troll the CAVC decisions site and look for these. The key word is “reversal.” If you see that, you know it’s going to be brutal. Most of them contain a “The Secretary seems to think that…” and concludes with “This is what the Secretary gets for thinking…” I often speak of Mission Creep -the inexorable ability of Chapter 38, Code of Regulations to get pregnant and give birth to new meanings while we sleep.  The Secretary’s minions attempt this with varying degrees of success at the CAVC and the Fed. Circus. Given too egregious an error, the Court puts it’s foot down.

Mr. Earnest Wilson was a ground pounder in Vietnam. He got a bit of bent brain syndrome and picked up a PTSD rating. Later as it progressed he applied for an increase. Again, several years later he did so. This is the established pattern VSOs use gradually attain a higher rating-bit by slow bit. It worked right up until Ernie hit the wall at 50% and VA refused to go higher. The battle lines were drawn. He eventually got his increase to 70% ten years later and an effective date of 2011 but in the meantime had picked up a 100% rating for CAD. When they denied his earlier effective date he was asking for on the 70% original 2001 filing,  he dug in.  Here’s the bones of contention:

In an appeals satisfaction notice, dated March 26, 2012, Appellant endorsed the document, which read, in relevant part, “Please only return this document if you no longer want to pursue the remaining items contained in your Board of Veterans[‘] Appeals remand.” (R. at 26 (26-27)). It was stamped as received by the Board on April 20, 2012.

And this:

In another document, also dated March 26, 2012, Appellant responded to the most recent SSOC, electing the following option, “I have no other information or evidence to submit. Please return my case to the Board of Veterans’ Appeals for further appellate consideration as soon as possible.” (R. at 29 (29-30)). This document was stamped as received by the Board on April 10, 2012.

download

VAland

In our wonderful world of nonadversarial, veteran friendly rainbows and unicorns, we have come to understand a different truth. The regulation says that but it is in theory only. Ernesto had signed two documents, one after the other in short order. He probably thought it was all part and parcel of the same thing. Not. One said he was happy and heading on down the road and the other said the exact opposite and also requested a new hearing on the subject. The one that said he was happy had instructiions on where to mail it but Mr. Wilson also overlooked that and mailed it to his VARO. In our unicorn world, that form would have rotted for a year in limbo before it again saw the daylight in DC. Yet miraculously it appeared only ten days after his correctly filed missive. Wonder of wonders. VA efficiency is sometimes legendary when it works against you.

VA would have us believe that because he filed a form surrendering, VA can only assume that anything else they received was rumors and propaganda.  Nowhere is there even a discussion about the enigma associated with two disparate, diverse documents -or a hearing which somehow never materialized.

In this case, the Court is unable to conclude that the context and content of the “appeals satisfaction form”fulfilled these withdrawal requirements. First, the appellant executed the “appeals satisfaction form” and the SSOC notice response seeking appellate consideration on the same day.  In accordance with the nonadversarial claims adjudication process, VA should have resolved any apparent discrepancy before proceeding to dismiss the appeal. See Verdon v. Brown, 8 Vet.App. 529, 533 (1996) (holding that it is insufficient to conclude that the appellant has withdrawn his claims “without providing an adequate statement of reasons or bases supporting that claim.”); see also Kalman, 18 Vet.App. at 524. Regarding the content of the “appeals satisfaction form,” the Court agrees with the appellant that it “speaks in terms of discontinuing other actions that were
requested by the Board in the May 2010 remand; it does not speak in terms of withdrawing new issues or the issues that were deferred.” App. Br. at 9; R. at 26 (“Based on the decision rendered, I am satisfied and wish to withdraw any remaining issues that have been remanded (sent back) to the
Appeals Management Center by the Board of Veterans Appeals for further development.”); see Kalman, 18 Vet.App. at 524 (holding that the veteran’s statements must be understood in context). After considering the nonadversarial nature of the VA claims adjudication process, the content of the appeals satisfaction notice, and the context of the appellant’s submission of that document, the Court is left with the definite and firm conviction that the Board lacked a plausible basis for its decision. See Kalman, supra; see also Padgett v. Nicholson, 19 Vet.App. 133, 147 (2004) (en banc) (holding that reversal may be appropriate even if there is “existence of some controverting evidence (that is, evidence that is not in the appellant’s favor).” ) (opinion issued nunc pro tunc to November 2, 2004, sub nom. Padgett v. Peake, 22 Vet.App. 159 (2008) (en banc)).  Accordingly, the Court holds that the Board’s determination that the appellant withdrew his appeal is clearly erroneous, and the decision will be reversed and the matters remanded for further
adjudication. See 38 U.S.C. § 7261(a)(4); Kalman and Gilbert, both supra.

So our teaching moment here is if you accidentally sign a fistfull of papers and send them in to all the wrong folks, that VA will take the absolute worst choice for you judicially and assume that you do not want any more money or a higher rating in spite of what you said on the other one that you meant to file. The CAVC has caulked yet another little hole in the wall for Vets and VA henceforth in the future will actually have to put off your hanging for a day or two and ask you what it is you were trying to file for. Rats. Foiled again.

Here’s the excuse factory:

Wilson 1

And here’s the Don’t ever do this to another Vet admonishment:

Wilson 2

Posted in CAVC ruling | Tagged , , , , , , , , , , , | Leave a comment

IFN HCV TREATMENT– YES OR NO?

Posted on September 28, 2013 by asknod

1imageHere’s the smartest bit of deductive (and inductive) thinking to come along in a great while. Pop Smoke sends us this enlightened exposé of the outcomes of those SVR versus the great unwashed like myself who are glow in the dark autoimmune. Dr. Ronald R. Koretz finally analyzes whether being the King and naked in his invisible finery (SVR) is infinitely  preferable to being infected and slowly disintegrating into end stage liver disease. The results will astound you. Bookmark this one to add to your cites. 

Posted in HCV Health, HCV Risks (documented), Interferon claims | Tagged , , , , , , , , , , | Leave a comment

CLASS OF 2013

Posted on September 27, 2013 by asknod

Ladies and Gentlemen, I proudly present to you the class of 2013-an eclectic bunch to be sure.

001

 

 Stretch (left, below) was elected class valedictorian and Chubby was voted most likely to be eaten first.

002

Posted in Food for the soul, Independent Living Program | Tagged , , , , , , , , , , , , , | 2 Comments

IMPORTANT INFO FOR THE NOVITIATE

Posted on September 27, 2013 by asknod

av-2625I found this over at Hadit.com., a sister site for Veterans help posted by 71M. He deserves a big thank you from us for ferreting out these things. This is how we learn to win.

Posted in Veterans Law | Tagged , , , , , , , , , , , | 5 Comments

FORTY YEARS LATER–POWS REMEMBERED AGAIN

Posted on September 27, 2013 by asknod

downloadMember and four-tour dustoff medic (68-72) Bruce sends me this poignant reminder of May 1973. I had been home from Vietnam one year and was struggling to make ends meet as a cab driver in Lancaster, California. While not terribly fond of politics in general or Nixon in particular, I nevertheless cheered the release of the POWs- some who were family friends from my youth. 

Fortunately for us, warfare has evolved sufficiently that Search and Rescue does not leave quite so many scattered about on the battlefield. It is my fondest hope that Laos or the Democratic Republic of Vietnam, Jane Fonda’s adopted country, would step up to the plate and relinquish the information on pilots still held from that theatre. To date, we have only one repatriated from Laos in spite of all that augered in there. We know categorically that many survived punching out as they were observed alive on the ground or were in contact by survival radio shortly thereafter. Their absence with no explanation is the heart of the MIA conundrum and why I will never hold out an olive branch to zipperheads until all have been accounted for. Similarly, I will never just say “Let bygones be bygones” and welcome Jungle Jane back into the fold of civilized human beings. She hasn’t earned it nor will she ever.

This video should make shivers run down your back. “Welcome home” does not begin to communicate the emotion owed by America to her troops who served there and were captured. We have never seen such atrocious behavior accorded prisoners of war in  recent history with the exception of the Japanese in World War II. Even North Korea was more accommodating albeit not by much.

The humble nature of these POWs is unique. They are proud to be Americans and not apologists. They kept their faith in spite of the bleak prospects of incarceration and torture. They continue to this day to be thankful to a President who, though  in no way responsible for beginning hostilities, did not shrink from what what was necessary to bring them home alive without turning it into the typical political Dog and Pony show. I don’t know about you all but it makes me very proud to have fought with them. And that’s all I’m going to say about that.

Posted in Inspirational Veterans | Tagged , , , , , | 2 Comments

Decisions, decisions: Stay with the VA or move on? Enroll in the VA or Obamacare?

Posted on September 26, 2013 by Laura

downloadI hope I haven’t made any gross errors in this post.   Please fact check everything because I am a layperson trying to figure this out like everyone else.

KEY FACT FROM THE VA ACA WEBSITE THAT IS HIDDEN IN THE FAQ:  

I am enrolled in a VA health care program. Would I be eligible for assistance to pay health insurance premiums on the Marketplace if I choose to purchase health care outside of VA?

Since VA care meets the standard for health care coverage, you wouldn’t be eligible for assistance to lower your cost of health insurance premiums if you chose to purchase additional health care coverage outside of VA. However, you may still purchase private health insurance on or off the Marketplace to complement your VA health care coverage.

My assumption:  The term “assistance” refers to a potential tax subsidy.  If so, buying additional health care coverage will be very expensive as we will see a few paragraphs down.

Since over 80% of veterans who apply for disability benefits are denied, let’s look at the situation for Non-Service Connected (NSC) and 0% SC veterans with regard to co-pays.  The first number to know about is the $80,000 limit on gross income and assets to avoid co-pays.

What kind of property is considered an asset? Although there’s very little guidance for this accounting concept, if you don’t report your secret assets, five years prison time is one penalty. However, make no mistake about this: your retirement fund and your spouse’s retirement fund are assets!  Add both IRAs together.  Add up the value of your cash, rare coin, stamp, or fire arms collections, vintage wine, stocks and bonds, your fishing cabin, canoe, boat, ATM, snow mobiles, motorcycles etc…  (Your car, house, house lot, and furniture–things you use everyday–are excluded.)  To determine your net worth, deduct liens and mortgages.  Is the other side of your duplex an asset? Yes. A riding lawn mower used in the summer? Who knows? An outbuilding like a shed? Hmmm..maybe.  If your house is sitting on acreage, beware! 

Section VII – Previous Calendar Year Net Worth. Your net worth is the market value of all the interest and rights you have in any kind of property. However net worth does not include your single-family residence and a reasonable lot area surrounding it. It also does not include the personal things you use every day like your vehicle, clothing and furniture.

2012 Gross Income is used in 2013 to determine status for VA cost-free care.  Here is the figure for a veteran with 1 dependent:  $39,304 or less.  (You can exempt $907 in medical expenses.)  This means that the veteran and spouse can own no more than $41,603 in retirement funds (and/or other assets) together to keep under the $80,000 income and asset limit. 

Post UPDATE (10/7/13  I’ve found a VA online calculator called Health Benefit Explorer that you can use to plug in your own numbers and zip code.  There may be some leeway depending on where you live and other rules I haven’t found:  http://hbexplorer.vacloud.us/

Now, some veterans aren’t required to fill out Form 10-10 EZ Financial disclosure sections IV-VII but they won’t enroll new applicants who don’t! Two examples: You were at Camp Lejeune for 30 days or you served in Vietnam within certain dates.  Why bother paying for ink to print this list when veterans disqualify themselves for care by not filling out the financial disclosures!

Means test

The last paragraph is nonsensical. If you’re not going to provide financial information, and you’re in one of these groups, don’t bother applying for VA health care. Click image to read over the whole form.

The figure of $39,304 for a family size of 2 translates to a Federal Poverty Level of about 251%.  The VA considers this the threshold income before crossing into “high income” veteran status.  I use $39,000 in the following example to see what a veteran & spouse would pay for Obamacare.   I’m using the Kaiser Subsidy Calculator (which calculates a Silver Plan). For a hypothetical non-smoking couple in Charleston, West Virginia (zip 25301), it appears as if this veteran (64) and spouse (62) would pay about 8.09% of their income for a Silver Plan or $263.00 a month ($3,156 a year).  But oddly, if only 1 person is covered, again using the Kaiser Subsidy Calculator,  the premium is the same! The government subsidy for this zip code would be about $12,749 for 2 or $4,625 for the one younger person.

If a veteran keeps the VA AND signs up for Obamacare, the veteran’s portion of the premium will be the retail cost . The un-subsidized premium for 2 is $15,905.  A subsidy for 1 is $4,625.  My best guess is that the cost for a couple to keep the VA and sign up for insurance in the exchange marketplace, the premium could be as high as $11,280 annually ( $15,905 – $4625 =$11,280).   The Kaiser calculator doesn’t allow this scenario but this option would not be affordable for most people earning $39,000!  (If the couple are both veterans, keep the VA and buy private insurance, there will be no tax subsidy for either.)

Therefore Congress is forcing veterans to choose between the two alternatives even though VA health care is not health insurance but a health benefit.  I think this is a disgrace because veterans have earned this benefit which they may not be able to use.   Why? Because Congress doesn’t want to give veterans tax subsidies for private insurance like other Americans.

Certain politicians in Congress are hysterical about granting health care subsidies to anyone (except themselves).  The VA is trembling too because they don’t know if they’ll be overwhelmed with new patients or the opposite, see an exodus.  Some veterans may be willing to trade the VA for a tax subsidy and the opportunity for flexible, convenient, private health care–without threats of prison terms for mistakes made on their 10-10 EZs.  Some will join, probably young uninsured veterans, for the sake of simplicity. 

calendar-159098_1280

Image credit: Public domain image on Pixabay

And if a veteran needs a lot of medication and care, the VA would be more attractive than a Silver Plan.  However if the veteran’s spouse (62) is in very good health, she could opt for a Bronze minimal plan for $164.00 a month as a bridge policy to Medicare. Uninsured spouses are probably crossing off the days on their calendars to Oct. 1 when they can shop for a plan, and in 2014, get health care coverage despite pre-existing conditions.  But veterans should be furious when they realize that they’ll still be paying “retail” if they want to see a private specialist and keep their VA benefits.  That’s my current understanding of the situation.  I welcome your input and information and check out the multi-state Kaiser subsidy calculator. 

 

 

Ed. note: Is this too cool for school or what. Kiedove is crunching unbelievably large quantities of numbers and data for us here. Devotion to duty is on overtime. I commend her. Two attagirls and a warm Asknod thank you are overdue.

Posted in VA Health Care, VA Medical Mysteries Explained | Tagged , , , , , , , , , , , | 10 Comments

Short-term care in Skilled Nursing Facilities (SNF), Medicare and VA benefits

Posted on September 26, 2013 by Laura
Funny Dog Meditation

SNF sounds like Sniff—-Ommmmm….Sniff Sniff

I’m left with more questions after looking into this but here goes.  Short-term care is defined as 90-100 days or under.  Medicare Part A (Hospital) stops paying for care at SNFs at day 101 and beyond:

For Medicare, you pay

  • Days 1–20: $0 for each benefit period in 2013.
  • Days 21–100: $148 coinsurance per day of each benefit period in 2013.
  • Days 101 and beyond: You are personally liable for ALL costs.

Looking at some information on the Medicare website, I see lots of gotchas.  You need a qualifying 3-days (in a row) inpatient hospital stay, not observation (inpatient) stays which are considered outpatient days.  Got that? Orwellian to be sure. Oh, and you have to stay out of the hospital or SNF for 60 days to have the benefit period renew.

The VA has about 132 nursing home units but also contracts with with “Community Nursing Homes” (CNH) for short-term rehab and long-term care.

The VA charges this after 21 days:

  • Inpatient: Up to $97 per day (Community Living (Nursing home), Respite, Geriatric Evaluation)

**Copayments for Long-Term Care services start on the 22nd day of care during any 12-month period — there is no copayment requirement for the first 21 days. Actual copayment charges will vary from Veteran to Veteran depending upon financial information submitted on VA Form 10-10EC.

That’s cheaper than the cost of non-VA nursing care charges according to a U. S. News article if you are in a higher Priority Group or run out of Medicare benefits.

According to Medicare Manual (50.1.1), VA enrolled veterans–with dual Medicare/VA eligibility–have an advantage if they need therapy in a non-VA SNF.

The VA may authorize up to six months of care in non-VA SNFs for veterans requiring such care after transfer from a VA hospital. Services furnished pursuant to a VA authorization do not count against the 100 days of extended care benefits available in a benefit period. Where a veteran remains in a SNF until VA benefits are exhausted, extended care benefits could begin under Medicare. Such benefits begin with the first day after the VA benefits are exhausted, provided a physician certifies that the individual still requires skilled nursing care on a continuing basis for a condition for which the patient received inpatient hospital services or which arose while the patient was still being treated in the facility for such a condition. The 3-day qualifying hospital stay and 30-day transfer requirements of the law must be met as of the time of entrance to the facility….

Generally it is advantageous for Medicare beneficiaries who are veterans to have items and services paid for by the VA where possible, since in most cases the VA has no deductible or coinsurance requirements. Also, services paid for in full by the VA do not count against the individual’s maximum number of benefit days or visits available in a Medicare benefit period. 

For veterans who do have a VA co-pay, this is also good to know:

NOTE: Medicare can reimburse veterans for (or credit toward Medicare deductible or coinsurance amounts) VA copayment amounts charged for VA authorized services furnished by non-VA sources.

The VA website is vague on details because VA social workers have to get involved and more involved financial information is required.

My late father suffered a major stroke in his seventies.  After his hospitalization, he was moved to a skilled nursing facility until all of his Medicare and “MediGap” benefits were exhausted (about three months).  Then, ready or not, he was transferred into my mother’s unskilled hands and the semi-skilled hands of home health aides.  He still needed therapy services. However, when he used up his allotted time at the SNF, he had to first be re-admitted to a hospital as an inpatient. To accomplish this, my assertive mother had to gain a physician’s cooperation.  My mother constantly battled with Medicare over it’s restrictive rules.  Dad made progress, used a walker, but aphasia prevented him from conversing.  He lived ten more years.

Eligible veterans have more options. Suppose a veteran (dual-enrolled) found himself in bad straights and needing rehab five days a week.  What should he do? It would be probably be less expensive to get transferred to a VA hospital, and then placed in a contracted “Community Nursing Home” with therapy services. You can also request the VA pay for a different SNF/CNH if you have a preference.  If more rehab is needed later, one can tap into Medicare benefits when (or if) the VA benefits run out.

This VA health benefits calculator “HB Explorer” may shed some light on this matter for individual veterans.  Click on “nursing home placement” link after making all entries. http://hbexplorer.vacloud.us/

This brief video (right menu) “Choosing Short-Term Care” impressed me with the importance of visiting SNFs before you need them–especially those with VA contracts.   Medicare has a nifty Nursing Home Compare online app..  http://www.medicare.gov/nursinghomecompare/search.html

I entered my zip and up popped 12 local nursing homes (showing several categories with 1-5 stars).  I could then compare any three and drill down for more gory details.  Most enlightening.

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

HCV SVR IN THE REAL WORLD

Posted on September 25, 2013 by asknod

downloadVA is always trying to suck in a new cohort of victims for their triple drug cocktail called Victrelis. They bought in hard with about three trainloads  early on in hopes of knocking out HCV as we know it in the living Vets population.  It was a win-win for all. No active acute disease equals 0% noncompensable so this was a no brainer. Only problem seems to be those rapscallion Vet drug/alcohol abusers who are dragging down the success rate. 

VA’s recipe for a repair order is cook the books, bay-bey! Tell them it 80-90% so they’ll all jump in. Who cares if you’re 72 and a triple non-responder? This drug’s for you. Now along comes someone who decided to add up columns A, B and C and find out who’s been naughty and who’s been nice. Seems VA was selling underwater real estate. Go figure.

Posted in HCV Health, VA Health Care, vA news | Tagged , , , , , , , , , , , , | 1 Comment