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

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.

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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

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IFN HCV TREATMENT– YES OR NO?

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

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

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IMPORTANT INFO FOR THE NOVITIATE

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.

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FORTY YEARS LATER–POWS REMEMBERED AGAIN

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.

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

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

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.

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HCV SVR IN THE REAL WORLD

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.

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CAVC–NICELY v. SHINSEKI-DRIVIN’ THAT CLAIM, HIGH ON PRO SE

downloadIt behooves us all to be humble when we read this. I honestly believe this is the product of a simply misunderstanding. Mr. Nicely was depending on his American Legion service organization representative to carry the water. Oddly, here he is up at the big house on Indiana Ave. and there’s no Amleggy-ons to be seen anywhere. Something’s amiss. Fortunately, being pro se, he’s going to get another piece of pie and a cup of coffee and another heapin’ helpin’ of VA hospitality. Nobody wants their name on this locomotive. You can almost envisage the headline in the Huntington, W.V.  fish wrap “Wheelchair bound Vet with psychiatric disabilities  given bum’s rush at VA-‘Not our problem says VA spokesman’.”

Here’s the condemned’s rationale for his appeal. If I parse it correctly, it seems he may have injured his back in basic. It also says he’s currently in a wheelchair which is some serious smack talk. VA takes notice if he starts getting diarrhea of the piehole up at the big house.

I’d love to be a fly on the wall down at Amleg Hqtrs.

Nicely

And here’s the kid gloves.

Order

Knowing that when you arrive at the CAVC unrepresented, you usually get 40 or 50 solicitations for legal services from attorneys, I find it difficult to see how our Veteran Parley here got this far without a winter’s worth of paper to burn in the wood stove.

Posted in CAVC/COVA Decision, VSOs | Tagged , , , , , , , , , , , , , | 4 Comments

NEGATIVE OBJECTIVE CORRECTED

SizemoreJE01c

Jim Sizemore and A-26

Member Frank opened up an old wound this morning when he mailed me this WP article published yesterday. I find it hard to believe it was a mere forty three years since I departed the Kingdom of Laos on the C-46 Klong flight from Wattay to Udorn. I also see the article descended into a political donnybrook of the worst sort in the comments section. I added my own.

I am saddened that anyone, be it from the infamous Westboro Baptist Church or any other individual or entity, would sink so low as to dishonor the commitment of a fellow American who volunteered to serve in any war. Anti-war, Monday morning quarterbacking seems to be in good form lo these four decades later.

So, with joyous heart for the families of Major James E. Sizemore and Major Howard V. Andre, I welcome home their husbands and fathers.

purcellI remember well those years from 1965 on as I watched the friends of my father, many with children I attended school with, fail to return. Those who did survive were often a hollow shell of their former selves like Bob Purcell. Captain (at the time) Purcell was a Thud driver for the 4th Fighter Wing. Bob ‘s son and I attended St. Mary’s when we lived at Seymour Johnson AFB in Goldsboro, N.C. from 1962 to 1964. When my parents were out of town, I was farmed out to stay over with them. I remember the dachshund they had that liked to poop at night indoors. Midnight trips to the bathroom were a careful undertaking.

66_134_221_117_122167We moved to Langley AFB, Virginia in 1964 and I never saw them again.  My father left to go to RVN slightly over a year later in June 1966. His replacement, Bob Worley, was shot down and died several months after Dad returned in 1968. I went to Hampton Roads Academy with his son Rob Worley in those years. Again, reassignments caused us to part company never to see each other again. And then I went to war.

As time moves on, we’ll eventually recover more lost souls. However, in Laos, those will be few and far between. When an aircrew augered in over the fence, rescues were dicey propositions. Often, an Air America chopper pilot was the first one on the scene.  With virtually little or no weaponry, they would often swoop in for a rescue long before our own ARRS choppers were wheels-up over at Long Tieng. As for a nighttime air rescue, I never heard of one. They might put up a gunship with flares overhead if they knew the location of a crash but this was rare. Armed recon at night in an A-26 painted black as a sack of cats did not often result in a lot of recoveries.

207310My fondest hope will be to see Major Park Bunker’s remains returned to his family in my abbreviated lifetime. Capt. Bunker was not an adventurer like most of his fellow FACs. He didn’t fit the mold. He actually was cautious and hidebound-one for doing it by the book- but had no qualms about getting down in the weeds. He augered in 30 December 1970.  Capt. Bunker was what we called a “negative objective”.  His O-1 was clobbered by groundfire and he actually landed in one piece. Knowing full well that there were no POW camps for us in Laos and that repatriation was not in the cards, he fought to the end with little more than a CAR-15 and his .38 cal. M&P revolver. With no air support, his fellow FACs watched from altitude as he and his Hmong GIB were killed. When this happened, the AF was rather a stickler that no more air assets be expended in recovery. Sadly, the forlorn radio message went out announcing Negative Objective. Thus Capt. Bunker joined the Sizemores and Andres in a long pantheon of KIA BNR (body never recovered). I’m sure that at some time on the 9th or the 10th of July, 1968 that negative objective was announced for Majors Sizemore and Andre. It always was.

This is why we celebrate so heartily when one of our fallen finds his way home. We talk of “closure” and giving the family a meaningful plot to visit at a cemetery but it is far more than that. The ethos of the military has always been that you do not leave your fallen on the field. People seem to think this is a Marine affectation. I can assure you it is not. In Laos, it was more often the rule rather than the exception that we lost our pilots-day or night.

It is enervating to see the eventual return of these brave men who volunteered for what they knew was a very dangerous job when they could do their 100 missions from a “normal base” in RVN or Thailand and not take inordinate risks.

Capt. Bunker’s photo above bears little resemblance to the man I met.  I enclose a picture of the Captain below which more will be familiar with. Welcome Home, gentlemen. I’m glad your remains were not desecrated.

laos1

Posted in Inspirational Veterans, Vietnam War history | Tagged , , , , | 3 Comments