Propublica’s health apps

More valuable resources from Frank–

Not all docs/groups are listed in the Vital Signs search tool. At least 20 procedures are needed to be rated.  For surgeons, some may do hundreds of a repair with low complications and others perform fewer repairs with 0 complications.  

https://projects.propublica.org/vital-signs/

Treatment Tracker (Link)

Dollars for Docs (links)

Prescriber Checker (Link)

Surgeon Scorecard (Link) 

Article about surgeon complications.  https://www.propublica.org/article/surgery-risks-patient-safety-surgeon-matters

https://www.propublica.org/article/surgeon-level-risk-editors-note

The data we’re making public today has long been in the hands of the Centers for Medicare and Medicaid Services, the agency that oversees the Medicare program and pays for two in five U.S. hospital stays. CMS and most of the nation’s hospitals have taken the view that it’s better not to calculate or act on this sort of information, in part because it is so controversial. Though no one says it aloud, the attitude has been that the risk of unfairly tarring any doctor trumps all other considerations.

Our reporting suggests that this reluctance to focus on individuals is one reason that patient harm has persisted in the face of considerable effort by the medical establishment. The landmark 1999 study by the Institute of Medicine, “To Err is Human,’’ called on Congress to create a nationwide mandatory reporting system for patient deaths and serious harm so researchers could detect patterns. That has never happened. Surgeon Scorecard is a crucial step in the larger process of spurring accountability for breakdowns in patient care.

click for big image plano tx hospital

Also good:  https://www.medicare.gov/physiciancompare/

Posted in Food for thought, General Messages, Guest authors, Medical News, Veterans Choice card | Tagged | Leave a comment

My Kindle’s

I don’t know what is wrong with my gut but something is and I’m expecting to have a lot of bed time based on recent doctors’ comments.  So I might as well read something useful and Alex’s book makes a lot more sense to me now. And I still need to pull these concepts together.

My Kindle Fire HD is colorful and heavy. There are new lighter versions out.  The black and white Kindle e-reader is lightweight but doesn’t have a back light for night reading. The battery lasts a long time.  They are both great values.  You don’t actually need to buy a Kindle device because Amazon has apps for most gadgets and laptops. And Alex has set the price so low for the digital version, it’s silly for veterans not to own it. You just need wi-fi to enjoy a 5-star reviewed book.

Posted in All about Veterans, ASKNOD BOOK, Food for thought, General Messages, Guest authors, research, Tips and Tricks, VA Agents, VA Attorneys | 8 Comments

VETERAN”S TOOL BOX

Tattoo this number to the top of the keyboard for VA claims gratification. Just out on Ron Nesler’s VA Is Lying Facebook site, the accompanying email address is the equivalent of the ‘Call me Bob’ McDonald’s cell phone. Use it sparingly with care. In fact, I’d classify it as a DEFCON 2 alternative and give it fire extinguisher status of “In Case Of Emergency Only!”

veterans@donaldjtrump.com

Bon chance!

Posted in Complaints Department, VA Secretaries, VBMS Tricks | Tagged , , , , , , , , , , | 2 Comments

CAVC–PERCY V SHINSEKI (2009) — WHO OWNS IT?

I have an unusual case of a gentleman who filed to stop a reduction in his rating. At the same time, he had a newly denied claim at the Seattle RO. The gentleman filed his NOD and the presumption of regularity in Sikels v. Shinseki  kicked in. VA was presumed to be competent. The SEARO 346 krewe promptly (in VA time) certified this baby (sans the SOC) along with his reduction appeal with a Form 8 and called FEDEX for a pickup to DC.

Later, Johnny Vet sits for a Board hearing and discusses the whole new secondary (grand mal seizures due to 16 psychotropic drugs for PTSD arguing with each other). He had opted to quit taking them which pissed off the Brain Doctors. VBASEARO got wind of it and proposed to reduce from 100% to 70%. Reduce him they did. He appealed but the failure of the Seattle Gang who couldn’t shoot straight to issue an official SOC on the seizures, created an ownership problem.

The cat was out of the bag. The Board (three back then in 1991) had heard testimony on the seizures and its inextricably intertwined (Harris v. Derwinski)  Harris_90-240 bearing on bent brain syndrome in general and pharmaceutical toxicity in particular. By even permitting Johnbo’s testimony and agreeing to hear it, they accepted that it was properly before them. Concurrently, the Seattle krewe, by ignoring procedure and issuing the VA 8, had also declared the seizures claim ready for ‘one decision, on appeal’ as they say before your BVA hanging.

As an aside, many of you in the readership have seen your claim declared “awaiting certification”-sometimes for 16 months. Nowadays, due to the constipating backlog at the BVA, certification means 4 years. The BVA solved some of this problem by leasing more warehouses to store the paper claims. Thank goodness for the belated electronics transformation. Now they can do it in a six by nine closet. You see,  that actual act of certification could occur in about five minutes. VA rater sticks old paper file in FEDEX box. Tapes it shut. Puts label on it. Sends it to basement to await “certification” and shipping to DC to be docketed at the BVA. BVA folks don’t want to see anything until it’s time to take a gander at it. If it gets lost before the magic certification, it can’t be the BVA’s fault. When you receive a Notice of Certification, it’s more about like finding out it’s going to finally get docketed and assigned a case number. Expect a hearing in about a year or so.

No Bozos

In my Vet’s case, the BVA realized the mistake before washing their hands of it. By rights, any smart attorney would file a waiver of review in the first instance at the RO just to keep it there before the judges. Absent that, a true remand was in order to correct the SOC error. That would have added a year to the appeal but would have avoided the next bozo. So, in the interests of the Veteran, the Veterans Law  Judges semantically stepped on their collective necktie and “referred” it back to Seattle instead of remanding it and continuing to retain control of it. A denial decision  had already been made and a substantive appeal begun (NOD). The only thing amiss was the lack of a SOC and the submittal of a VA Form 1-9. VA, of course, issued the obligatory SOC but demanded a new VA 1-9 to recertify what was by now legally owned and properly certified- complete with docket number- at the BVA. My Vet’s VVA rep. suddenly evaporated for parts unknown and no one ever complained or intervened to get this back on track.

In VA law, a referral from a higher court would be if you filed for DM2 and the gomers at your RO were working the claim. Meanwhile, you have another issue with a VA 9 already signed for a bad back increase from 40% to 60%. When it gets to the BVA, they spot the DM2 claim hasn’t been decided yet and ‘refer’ it back to the RO to issue an up or down decision in the first instance. Go ahead and laugh. It’s a brand new claim with no history and needs a preliminary denial to begin the NOD process. The problem is that the Veterans Law Judge does all of this once- at the end when he announces the decision on the reduction appeal. He has held the seizure claim hostage for 9 months before “referring” it back to the RO.

On the other hand, a legal appeal to a Court in which a judicial error occurred below at the Agency level during the substantive appeals process, requires a “remand” to complete the appeal process to the BVA. Think repair order once construction has begun. Or read this one –https://asknod.org/2012/02/16/everything-you-always-wanted-to-know-about-remands/ Once the BVA hears a matter, or accepts it, and/or takes testimony at a hearing and begins to review it, they have formally accepted the claim and now exert ownership. A remand is merely to gather more info with which to use for a more informed decision, or a true remand to correct an adjudicatory deficiency below. Regardless the cause, the appeal(s) once free of defect, are properly returned to the BVA for the promised “one decision on appeal” as promised in statute. One of the oldest tricks in the book was “forgetting” to include a Vet’s SSI/SSD records in his c-file to the BVA for TDIU consideration. Bingo. Remand. One year (or more) delay.

Mr. M.C. Percy

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Mr. M.C. Percy, with no identifier as to what “M.C.” stands for, suffered much the same as my client. In 1970, Mr. Percy had an unfortuitous  encounter with a hand grenade in the former Republic of South Vietnam. one piece missed Winky by thaaaaaaaat much, thank his lucky stars, but it was that sensitive suprapubic area above Mr. Winky that continued to bother him. The typical rating in 1971 was 0% and Mr. Percy was afforded no different attention. In 1998, they gave him a raise to 30% with an effective date of 94. He must have been playing golf with his DAV rep. and got in good with him by buying his drinks and greens fees. VA doesn’t often cough up four year retro payments to anyone but good ol’ boys and malfeasanating VISN directors.

A year later, in 1999, within the NOD window, Mr. Percy filed a substantive appeal up to the Big House on Vermin Ave. NW. Mr. Percy was subsequently informed after his hearing that his Regional Office had screwed up and they didn’t have authority to talk about an increase because he’d failed to discuss it on the VA 9. Mr. Percy did, however, file about two more VA 9s to try to get it right on what he was appealing. Apparently, there were three other things that were in the same judicial limbo, too- one of which was his effective date for the Winky-area wound.

I have to hand it to Terry L. McElyea, his pro bono attorney, though. Terry’s a  Judge Advocate General (JAG for short) kind of guy for the most part. He’s a Prosecution whiz for the Court of Appeals for Uniformed Servicemen. This whole claim was headed for the denial pile until Terry pointed out that VA justice however imperfect and crude, still affords us a different, friendlier attitude and cannot consider a BVA Veterans Law Judge the equal of a COVA Justice approved by the US Senate. He had to point out the obvious- that Bowles v Russell  127 S. Ct. 2360 (2007) was not on point. Bowles was civil law, not VA Law. Henderson dealt, again with civil law but not at the agency level below. Henderson, thus, was not on point either. Ol’ M.C. was filing at the agency level and appealing to the upper level of the Board of Vets Appeals-still below the federal level. To say Percy’s timing on any VA 9 filings made to the BVA were beyond the suspense date and final defeats the warm, fuzzy admonition in 38 USC §7105…

The filing of a substantive appeal to the Board is not jurisdictional because 38 U.S. C. §7105 explicitly permits relief from prescribed appeal periods with the Agency and permits the Secretary to prescribe regulations to allow a claim even if the appeal period has expired (60-day period prescribed for filing formal appeal with the Board of Veterans’ Appeals “may be extended for a reasonable period on request for good cause shown”). Additionally, the Board may waive or equitably toll its filing requirements. Furthermore, Bowles and Henderson are not applicable to the Appellant’s case because those cases deal with civil cases appealed to federal courts and the Appellant’s case deals with an administrative appeal within the Agency.

38 USC §7105 has to have some built-in slack. VA screws things up so badly so frequently, they’d look bad if they really got nasty with the 60-day SOC suspense date and were dogmatic in enforcing it as being jurisdictional in everyday practice.

Not bad for a JAG, huh? This guy does US military law and he still picked up on this dichotomy between the Agency and the next step up into the Federal level. An Agency has to know its limitations in order to win. This is one more glaring example of why you don’t want your drinking buddy from VFW, who is also your service representative for VA claims, handling something like this.

I finally learned the difference between referred and remanded- even though I knew my Vet was due a remand that should have been returned to the Board after the SOC was issued. Thank you Brad. More importantly, this is a great teaching moment for Vets. Many of you may have suffered this indignity of appealing it up to the BVA and a final remembrance that it seemed something was still amiss but unsure of what. My Vet sniffed it out and asked why he’d won in 2010 with basically the same evidence. Just like any train wreck, you have to go back and reconstruct the accident scene with the c-file. Boy howdy. Can you believe a Marine in 1991 would have the intelligence to ask for a c-file? This boy sure did and it can’t be lost, stolen, accidentally shredded, suffer shrinkage or be misplaced now.

I love forensic claims. The cachet of old claim is more pungent and redolent with VA mistakes than any other. There are three ways you can get back to the past now. 38 CFR §3.156(c) is the best known. Finding Clear and Unmistakable Error (CUE) is a very hard path as many know. But, if you find an unreturned remand to the BVA in your c-file, you discover your old, dead substantive appeal is still alive  and vibrant- de novo once again. With the help of a few law dogs, I can now better understand the semantics of why they got misplaced or waylaid on the claims road. A wrong legal word spelled disaster for twenty six years. Presumption of Delay.

 

 

 

 

Posted in CAVC Knowledge, CAVC ruling, Important CAVC/COVA Ruling, KP Veterans, Nexus Information, Remanded claims, Tips and Tricks | Tagged , , , , , , , , , , , , | 6 Comments

VA HEALTHCARE-TOO COOL FOR SCHOOL APP?

capture-fedweekJust spotted this one. An excellent App. Will append it to the “VAROs and who’s who above in widgets.

http://www.fedweek.com/armed-forces-news/web-app-aims-yelp-style-reviews-va-facilities/

Here’s the link to the website: http://www.vareview.net/

The downside to this is obvious. It’s a VA site and you have to “join” to submit comments. One doesn’t have to be room temperature IQ to realize an off the cuff remark, no matter how flippant on its face or innocently intended, now has an address.  I’m not a conspiracy freak but I look at past VA history. It seems whistleblowers at VA who call the VA OIG to report their superiors’ mis/malfeasance suddenly become the focus of the investigation themselves.

It’s kinda like when you were a FNG in-country about a week. The first “perimeter breach” at 0200, you light up on full auto. All of a sudden there are more f___ing bullets than you can count humming around you. Nobody wants to play Army with you or sit anywhere near you. You’re a pariah waving a lightsaber with tracers. I hate that when that happens.

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Posted in All about Veterans, VA Health Care, VA Medical Mysteries Explained, vA news | Tagged , , , , , , , , | Leave a comment

LZ CORK–FIRE FOR EFFECT

isAs promised, and I’ve been asked numerous times, I give you the Joe Friday report. Hell. I expect I should have written it Monday morning for a more cliché’d VA approach. Butch and Barb have never had the august pleasure of a DRO review. It was an eye opener for them, I’m sure.

Our DRO (Decision Review Officer) was Karen Haynes-Palmquist. What is it with this hyphen-ation thing? Does the guy have to tote this twenty foot long word around, too?  It’s getting to be ominous-#hyphenatedwivesmatter. She’s running sub silentio as Karen Baker but they can’t hide from us. She’s a GS-13 Step 5 with an $800 bonus  “award” for excellence last year. VA eliminated the word ‘bonus’ from their lexicon. Not bad. I was expect one of the big gun Kahuna GS-14s from Veterans Claims Examining. I noticed there are three in the ratings hierarchy. I’d figured these were the ones who would bail out when they went into mandatory overtime several years ago. Many DROs did. Went to GEICO or Allstate they did. Yeeeeeeeeeeeeeeeeeeees.

Karen didn’t ask any questions. In fact, when queried as to what, if anything, she would add to improve Butch’s chances of winning, she was speechless. We had a broad, liberal grant of time from 0945 to 1121 hours. With no forewarning, I was asked to put on a Clear and Unmistakable Error defense at the outset. My menu didn’t have that item on it. I probably could have done it by rote but there isn’t any need. If you’re going to use §3.156(c) evidence to reopen 1970, why on earth would you begin using a Motion to Revise to put a can opener in it? That’s like driving from here to Los Angeles by way of Moscow.

The short CUE story is typical VA. ‘How about you reveal your game plan now so we can develop a dynamite defense when you file your NOD?’ Sorry. No dice, Karen. You’ve never seen the USS Mayflower tied up to my front porch and I wasn’t born that late at night. We stayed in the safe zone and emptied a vast array of very old documents on her desk. They were all sitting at the NPRC for the last 40-odd years. Nothing like the duty to assist, Huh. My favorite was the recent DBQ that denied Butch had any GSW or SFW wounds anywhere on his body and absolutely not one speck of retained foreign body or metal. His x rays said no evidence of broken bones anywhere. Yep. Quality –Training- Customer Service. I’m guessing their x ray machine was invented before Frankenstein.

I’ve been counseled by many VA attorneys to show deference to authority to keep the hearing on a friendly keel. I did so by continuously reminding Karen that she wasn’t born when Butch was taken to the gallows in 1970. Otherwise, the tenor of the presentation was one of “Were the raters in 1970 raised by wolves or did they hire based on room temperature IQs?” I pounded in every nail I saw sticking up. 38 USC §1154(b), 38 CFR §§ 4.1; 4.7; 4.41; 4.42, 4.56, 4.73 etc. We presented each and every reference to “numerous minute metal objects”, “extensive debridement”, “sutures to close SFWs, every mention of a muscle group, the close inter-relationship in the old 1970 Part 4 Schedule of Rating Disabilities between tinnitus and organic brain injury listed as a footnote under DC 6260. Every physical therapy class was noted and the therapy to increase range of motion. I even circled the Camp Zama note “Purple Heart not awarded this station.”

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§3.156(c) hyperdrive claim motivator machine

VA likes to play “Inferred” denial side-by-side with the “implied” denial theorem. Basically, that boils down to “We denied you. If we’d awarded it to you, you would have gotten the money. Since you didn’t get the money, it’s safe to say it was a denial -even if we forgot to rate it.” However, when you go back in the §3.156(c) De Lorean time machine, all those implied denials now are new claims that have not been addressed yet. It’s no use to ‘imply’ them off the table. Them’s inferred claims now and under the new precedence, a claim remains pending until there is some compelling evidence it has been addressed and dealt with.

Remember, Butch complained of headaches, earaches, blurred vision, ringing in the ears and a host of other things we associate from sitting far too close to exploding 60 mm mortars. Each and every one of those items can now be reviewed in a more Veteran friendly venue where the 2017 watchword is nonadversarial instead of the 1970 flying saliva salute of “Welcome Home!”

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We changed hands again

Yesterday morning, I got a call for Butch from our good friends in the C&P business in Diamond Bar, California. Seems QTC just received an urgent request to schedule him in for TBI and otitis media c&ps . Lupa, the QTC technician was flummoxed and couldn’t decypher Power of Attorney. She could only divulge the date of the appointment to him personally or have him give her permission to tell me. And we wonder why it takes years to complete something as simple as a bent fender or broken windshield claim at an auto insurance company.

Personally, I like Miz Lupa’s approach. Call the VA rep. This is why I always paint my phone number everywhere on VA forms. Don’t confuse the Vet. Why even have a POA if you’re going to go behind the rep’s back straight to the Vet? That contradicts everything we know about legal propriety. I don’t see the HIPPA violation about handing out a time and date.

And to my BFF in San Diego who wagered I’ll fail in my attempt to get Butch 10% for tinnitus back to 1970, I do so hope they have excellent old Chateau Lafitte in San Antonio this April. It’s hard to find good wine in Texas that isn’t well done like a charcoaled gray steak.

catbirdseat

Time for another Butch and Barb party , folks.

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Posted in 3.156(c), DRO and BVA Hearings, KP Veterans | Tagged , , , , , , , , , | 2 Comments

VA ILP– WE HAVE ANOTHER WINNER

vreMember Randy (always in good standing) has finally cut the ILP Gordian knot with the Denver VR&E krewe. After years of spewing misinformation and Catch 22 jargon at him, they finally realized he’s read Chapter 21 of 38 CFR and is proficient in English grammar. Once you conquer that mountain, the VR&E pukes realize Pandora is out of her box and bent on untold mischief. 

Here’s the early swaggar. Golly, it only took three years and the threat of an Administrative Review under 38 CFR § 21.98– Appeal of disagreement regarding development of, or change in, the plan. Read it he did. Yeeeeeeeeeeeeeessssss. It’s sad that we have to teach the VR&E employees their own regulations.

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Rock and roll, Randy. I got the plain white vanilla flavor of this in 2005 for Cupcake’s parents. Cost was $3,500. The cost of living went up. Randy says this puppy went for about $ 8 K +. I’m guessing the contractor’s brother works at the Denver RO or is somehow related by marriage to someone who is.

They tell me my greenhouse is in the pipeline…but to where? It’s only been seventeen months since I won. If it gets out to 2 years, I’ll saddle up and head back to 625 Wagonburner Lane NW for another attitude adjustment with Judge Bartley. Meanwhile here’s a shot of us last year in San Francisco getting in trouble.

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Alex and Randy @ Sofitel in Redwood City 8/2016

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Posted in Independent Living Program, Tips and Tricks, VA Agents, Veterans Law | Tagged , , , , , , , , , , , , , , | 6 Comments

WHAT’S UP, DOC?

bostonscientificlogoThe miracles of technology amaze. Think of this. A  a combo defibrillator/pacemaker all-in-one with a ten to thirteen year battery. In by ten- out by one- after the Versed wears off. Sounds like a Chinese Dry Cleaners. It weighs a pound and sets off all the metal detectors across the fruited plain. A metal detector wand turns it off, or rather, prevents it from working. Microwave safe and that snappy brushed nickel accessorizes with everything you own.

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But wait. There’s more. It’s Bluetooth™ savvy and connects to your… wait for it…brand new integrated home monitor system.

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Yeppers. Stand within 12 feet of it and give it 30 seconds to “sample you” whenever you want. Put it near your computer and forget about it. Every month or so, it sends in all your data via its own onboard cellphone built in. Should  it detect an ‘event’, it telegraphs the info to the TOC (in Boston, I suppose). In that case, a small signal light on the screen displaying a doctor holding a phone also directs you to call in and find out ‘whazzup?’ An event can be an irregular atrial fibrillation that goes on for more than 30 seconds. A full blown V-Tac for over 30 secs trips the defibrillator for a 35,000 joule whammy to pull you out of a stall. If the defib goes off, I have standing orders to proceed to the ER nearest me immediately and not make any intermediary stops at Starbucks®. Apparently Boston Scientific Company has decryption machines at most major hospitals. I’m gonna go out on a limb and guess they don’t have a drive thru lane yet, though. It’s an idea whose time has come. drivethru

Could be in the future you will just “friend” Boston Scientific and drop them a PM on Facebook when you feel that telltale whammy in your chest. I  need an app for my iphone, too. I plumb forgot to ask when I was there.  Rumor has it that the Veterans Administration will be getting these in about 2030 and gradually phase in the Bluetooth by 2035-40. Their IT folks are still a little behind the curve  on this technology.

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Posted in Humor, Medical News, Vietnam Disease Issues | Tagged , , , , , , , , , , , , | 5 Comments

BVA–“CLEAN” JETGUN DECISIONS

 

From the Hallowed Entry Point into Heaven at the VA’s St. Petersburg Gate…

 

635646931319099161-veterans-administration-logoMuch has been recently discussed about how many jetgun Hepatitis C claims have been won at the BVA where we can see a win-be it on appeal or at the Agency of Original Jurisdiction (your local RO). To my knowledge, I have only unearthed about ten really valid ones that cite solely the jetgun and no other possibilities. Here is another. 

Please realize  we now have a much more responsible Veterans Law Judiciary willing to entertain credible testimony regarding this. My thanks goes out to Veterans Law Judge (VLJ) and far thinker Kathleen K. Gallagher for her openmindedness. Like many, Johnny Vet in this case is tarred and feathered like most with some unsubstantiated mention of drug abuse. I see far to many of these. Some have “Imperial entanglements” they will never be able to extricate themselves from. Others, for lack of any credible evidence against them, find a nebulous offhand remark about drug abuse discreetly inserted which can go undiscovered for years until you obtain your Vista records from the VHA.

Guard your records to prevent this creepage of drug innuendo into the medrecs. Contest it immediately upon discovering it.

This is a true jetgun claim that has no extra risk factors. Remember, they are rare and usless for anything more than the proposition that VA grants based on jetguns. Unless your circumstances are identicla to the person in question in every respect, the similarity is nothing more than remarkable. However, they are valuable for the insight as to how any given VLJ might address this based on the facts.

Win or Die VA

P.S. And from the Mile-high, get high city of Denver, the second case of service connection for Hepatitis C due to the geographical location of the unique gneotype. Yes sir. This is how I got my grant from VA-based on the genotype 3A unique to Southeast asia. Amazing to see someone eight years later follow in my footsteps.

P.P.S. Here’s another quasi-jetgun decision that is virtually based on it

https://www.va.gov/vetapp16/Files3/1620439.txt

And this one

https://www.va.gov/vetapp16/Files2/1616758.txt

Posted in BvA HCV decisions, IMOs/IMEs, Jetgun BvA Decisions, KP Veterans, Medical News, Nexus Information, Tips and Tricks | Tagged , , , , , , , , , , , , , , , , , , , | 2 Comments

THIS DAY IN HISTORY–1971

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O2 Chuck Engle

Butch Long’s DRO review couldn’t be on a more auspicious occasion than February 22nd. Not only is it George Washington’s birthday but also the day a friend passed away just north of Vientiane from what I heard. I was still in the civilian hospital up at Tango 11 recovering from Hepatitis. For lack of a shoe, the horse was lost. 

 

 

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Posted in Food for thought, KP Veterans, Milestones, Vietnam War history | Tagged , , , , , , , , , , , , | Leave a comment