ILP–I CANE NA GIVE YEH NO MORAH, CAP’N

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That’s all she wrote, Cap’n

I’m sure that at one time or another in our foggy, golden pasts during that disagreeable, humid hot spell in the South Pacific we endured for a year (or more), we all overheard Scotty tell Kirk more than once the Dilithium crystals were smokin’ and threatening to nuke. The analogy has always been drawn as synonymous with dire straits.  In the VA context, because that is the way my brain works, I find no matter how many times you evoke the dreaded dilithium crystals story of how your house is in foreclosure, you’ve been held hostage to a claims system for umpteen years and your wife is threatening to decamp- the VA is unmoved. Not even the least bit perturbed.

As most know, I am now the master and Seattle’s VR&E is the padewan. I control the Force. I have a BVA decision ordering them to fetch me a greenhouse and be quick about it. VR&E folks are 20-year shelter-in-place personalities. While I may have prevailed after a prolonged battle, the BVA decision doesn’t have that “expeditiously handle” sobriquet attached. VR&E pukes take that to mean they can dawdle and meander for months before “discovering” it in their in-basket. Even with a generous dollop of low balling, the cost is ratcheting up at a phenomenal rate. When I began, I thought a $30-35,000 dollar g house was exorbitant and figured I’d have hard time selling them on it even if I could memorize the password and the secret handshake to join this prestigious club.

bruce-g-house-2Bruce McCartney, the ILP guru who began this greenhouse parade back in the dawn of the 21st Century, suggested I contact the good folks at Farmtek. After all, they have a wonderful ILP gal named Karen Meister who has a Masters in VAspeak.  Being a novitiate, I gave her my parameters medically and asked her if she could whip up a basic Earl Schieb package. I never mentioned square footage. Her “basic package” was 24’X48′ $74 K plus install. Apparently Obamanomics was more successful than I had thought and a rising National Debt floats all ILP boats. Labor, too, for this shovel-ready job was far more than expected- from $27 K up to a lofty $45 K at New York City prevailing rates. Fortunately, we wouldn’t be needing traffic cops but VA has to write that in.

And so, as with most shovel-ready VA jobs, the VR&E now requires a GSA contractor on top of all the other costs, to run the dog and pony show. VA no longer entrusts this to Vocational Rehabilitation Counselors. You have to figure someone somewhere let slip the contract info to a brother or relative general contractor who by chance happened to be on the approved list of VA contractors(or became one in record time using VA’s Fully Developed Contractor (FDC) form). Add in that GSA contractor/leech and you siphon off another $25 K because you just know they’ll bring him in from Tulsa and put him up at the Hyatt Regency  in Seattle for three months. Two hours each way to commute and the fact that booze in the United Soviet State Of Washington  is going to cost them spells cost overrun.  From my latest email, I now note I have no less than three Vocational Rehabilitation Counselors as well. Que si passe-t-il? Their collective annual salaries are $122,783 (2015 bonus $1,250), $103,904 (2015 bonus $932) and $100,217(2015 bonus $783). I’d like to think they get their bonuses for working so diligently to help us Veterans with ILP entitlement services rather than the opposite.

In order to overcome this built-in ennui, and now being an ILP Jedi Master, I decided to stir the pot. I have now waited eight months and ten days. Allowing things to progress at this pace might mean I will run the risk of being rendered into soylent green and added to my future hydroponic tanks. With my new found knowledge and success at writing Extraordinary Writs of Mandamus, I set to and started building a new tarbaby for VBASEAT (Veterans Benefits Administration-Seattle).

You’re going to like this one. Nothing gets their collective goat at the Local Puzzle Palace quite like playing Badminton with their own regulations. I always serve a few back to them to begin with. It salts the conversation with equality and lets them know the U.S.S. Mayflower didn’t sail up unannounced and drop anchor in front of your home last night.

THE FIRST SHOT ACROSS THE BOW

Dear Kris, 

In order to accomplish this grant, VA is required to have a licensed Vocational Rehabilitation Counselor (VRC) implement it if I am reading 38 CFR 21.160 and .162 correctly. Reading the Seattle VA leadership team resumes, I note that Mr. Boyd’s accomplishments are 

Prior to joining VA, Mr. Boyd served in the U.S. Army. Among other assignments, he patrolled the German border during the Cold War, commanded tanks in the European 7th Corps during Operation Desert Storm, and jumped out of airplanes with the 82nd Airborne Division.”

Nowhere do I see any of his professional qualifications that would permit him to be my VRC. 38 CFR 21.35 (k)(1)(2) is unequivocal as to what a VRC’s professional curriculum vitae need constitute and the professional requirements necessary to supervise my IILP- let alone write it. If, as you indicate,  he is in charge of my IILP (Individualized Independent Living Plan), my attorney questions the validity of his VRC qualifications. If he indeed has VRC credentials, please provide the attorney with them.

In addition, I see another insurmountable problem building here. It would appear from what you have said so far regarding GSA involvement, that you are looking at the new VR&E Manual 28R (M28 Revised)for guidance. Please be advised that my claim for the greenhouse was filed in 2011, several years  before the inception of the M 28R which became effective March 31, 2014. As such, the prior version (M 28) is still for application in this grant as it represents an unbroken claim stream from 2011 to present via my successful appeal. For legal cites, please see Holliday v. Principi (2001), Cohen v. Brown (1997) and Karnas v. Derwinski (1990). To wit, the regulation in effect at the time of filing will be the controlling one. Later changes to a regulation during the course of adjudication can never be for application unless the regulation grants retroactive reach. I see nothing in M 28 R granting that.

Further, the presumption of regularity assumes VA personnel are competent in the regular performance of their duties. However, that presumption can be overturned when what appears irregular is irregular. See Butler v. Principi 244 F.3d 1337,1340 (Fed. Cir. 2001). Considering the loss of not one, but two important documents I have submitted (2012 NOD & 2014 SSOC) which were documented via certified mail, return receipt requested, Seattle’s VR&E office clearly and unmistakably lost the protection of that presumption before my appeal began. I was forced to submit my SSOC with a waiver of review in the first instance at my BVA hearing April 29th, 2015 as it was nowhere to be found in the c-file. As for erroneously depending on the new M 28R for implementation of the IILP, once again, the presumption of regularity has been abrogated. Once abrogated, any and all presumptions of regularity regarding this grant became null and void.

All I asked for last month was an extended evaluation of two years versus your (or Mr. Boyd’s) suggested 60 days (or one year) rehabilitation initially proposed in the first Form 28-8872 which required little more than concurrence from Mr. Boyd. That is assuming, arguendo, that he is indeed “in charge”. That is within the parameters prescribed in 38 U.S.C. 3105 and 38 CFR 21.76. I do not see where this would require the involvement of a Vocational Rehabilitation Panel (VRP) or, for that matter, anyone above Mr. Boyd. 38 CFR 21.76 grants him that authority.

VA has been in constructive possession of the Farmtek bid now for over nine months. With this information in hand, planning for the grant can not come as an unexpected surprise requiring extensive planning. Knowing the cost, the obvious requirement was to forward it to VACO VR&E for their approval and action once the BVA decision was rendered. Eight months is ample time to coordinate this.

As all are aware, my health is tenuous and further delay based on inapplicable guidance dictated by relying on the wrong Adjudications Manual is no longer an operable excuse. I feel submittal of the IILP to Mr. Boyd along with the FL 28-520, IL Plan Approval Request this week is all that is required to get this project rolling. The old M 28 makes no mention of any GSA requirements or sending out for a GSA construction manager. As we have a qualified contractor on tap standing by ready to perform this at a confirmed price using both standard or prevailing Davis Bacon wage structure, the reason for further delay is useless posturing. Those in charge are free to disagree with my assessment and I welcome the dissent. Absent any positive action this week, Mr. Walsh or I will begin my legal quest to correct this at the Court.

Prompt attention is requested because any further delay will confirm one of two things: either an unwillingness to honor the BVA decision or an arbitrary refusal to act on the VA Secretary’s part. I do hope you understand my dilemma. I have been patient and awaited action now for eight months. Any further delay can only be, and indeed will be, construed as an implied denial.  Mr. Walsh  stands ready to file the Extraordinary Writ of Mandamus if I do not see tangible written progress this week in the form of a signed VA 21-8872. I would have hoped the Veterans Administration would have realized the tenor of my resolve after four long years of appeals and the filing of my last Writ in January 2015.

You indicated that once this surpassed $2,500.00, it was “above your pay grade” to authorize, Kris. I would strongly advise that I be put in touch with Seattle VA director Pritz Navaratnasingam in order to avoid this confusing chain of command of who is, or, perhaps, who is not, truly in charge. You have my telephone numbers.  Should Mr. Navaratnasingam feel it beneath his station to discuss this with me directly, please have him contact Mr. Walsh. He can be reached at 269-962-9693.  I don’t seem to be able to impress upon anyone there the enormity of the consequences of further delay. I am sorry that you have been caught in the crossfire and become a de facto message runner. A little foresight by your superiors and a professional hands-on approach could have avoided this contretemps early on. Sadly, it was lacking.

In the event you eventually become my VRC on this project, I do hope this unpleasantness can be put behind us and we can accomplish this in a professional manner. You have been very personable and easy to deal with over the ensuing four years we’ve been acquainted. I respect your professionalism and your willingness to roll up your sleeves and dig in to accomplish it. It’s unfortunate that all VA employees do not share your VA commitment to core values. I sincerely hope you can convey the urgency (and necessity) of a prompt response this week to the responsible individuals.

Respectfully,

Buckwheat sends

Dog and Pony show reponse

Dear Gordon,

 

Posted in All about Veterans, Independent Living Program, KP Veterans, Porphyria Cutanea Tarda, Presumption of Regularity, VR&E | Tagged , , , , , , , , , , , , , , , , , | 2 Comments

Important new CAVC ruling on emergency reimbursements 38 U.S.C. § 1725

My old Marine recently received emergency treatment (LINK) at a non-VA hospital.  He is enrolled in Ambulanza-300pxMedicare and VA health care. We want to know who is legally obligated to pay what portion of the bills when they start rolling in but there is significant bewilderment on this issue. 

Richard W. Staab (AF-52-56, Korea) and his attorneys (George, Berkshire, and Stichman) from the National Veterans Legal Services Program (NVLSP LINK) took this issue to the United States Court of Appeals for Veterans Claims (CAVC).  On 4/8/16, the court found that some improper VA regulations have been applied to the Emergency Care Fairness Act for years;  they were, in fact, “…arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law.”

Title: services provided at non-VA medical facilities  StaabRW_14-957 pdf.

Please note that I have no legal or medical training whatsoever.  I am merely sharing a few of my notes, the notes of a puzzled layperson.

Page 2:

  •  Mr. Staab had emergency open heart surgery at a private hospital.  A stroke rendered him unable to communicate with the VA (St. Cloud).  Nor was his family made aware of any need to seek treatment pre-approval from the VA.  His uncovered costs were about $48,000 after Medicare.

Page 3:

  • Mr. Staab “…sought reimbursement for the portion of medical expenses not covered by Medicare,” but was told to go away since he had partial coverage.
  • Section 1725 was amended to its present form (12/09), to “allow the VA to reimburse veterans for treatment in a non-VA facility if they have a third-party insurer that would pay a portion of the emergency care.”

Page 4

  • Because the Secretary made a rule disallowing reimbursement if veterans had any health coverage, “…the Court agrees with the appellant’s contention that the Board’s application of 38 U.S.C. § 1725 frustrates the intent of Congress to reimburse veterans who “…are not wholly covered by a health-plan contract or other third-party recourse.”
  • Medicare is a “third-party” insurer.
  • The statute establishes that VA reimbursement is warranted when coverage by a third-party is less than total.  But VA does not have to pay co-payments and similar cost-sharing amounts as per contract.

Page 6

  • Re: 2009 amendment to section 1725 “…Congress clearly intended that “…VA [be] responsible for the cost of the emergency treatment which exceeds the amount payable or paid by the third-party insurer.”
  • “Secretary’s regulation became wholly inconsistent with the statute, and the Secretary declined to remedy this inconsistency. Congress intended that veterans be reimbursed for the portion of their emergency medical costs that is not covered by a third-party insurer and for which they are otherwise personally liable, and because the regulation does not execute the language of the statute or the intent of Congress, it is invalid and will be set aside by the Court.”

Page 7

  • “The Board’s December 6, 2013, decision is VACATED; the determination that the appellant’s partial Medicare coverage is a bar to eligibility under 38 U.S.C. § 1725 is REVERSED; and the matter of reimbursement for the appellant’s claimed emergency medical care costs is REMANDED for readjudication. Further, 38 C.F.R. § 17.1002(f) is held invalid and SET ASIDE.”

If a vet has Original Medicare Part A, or Part A and Part B, and no expensive Medigap policy, uncovered expenses could be as high as 20%.  Similarly, cheaper Medicare Advantage plans will also result in large bills after an emergency, although they have an annual OOP cap.

In this article (LINK), According to Court of Appeals, Veterans Affairs improperly rejected vets’ emergency medical reimbursements, veterans like Mr. Nolsheim of Arizona (LINK) will be able to appeal past denials (showing CUE) when the regulations are corrected.

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Really can’t transfer now. PD Image: Open clip art

Many questions remain.  Does the VA still have to act as secondary payer if a vet declines transfer to a VHA? After all, numerous hardships could exist. Geographical.  VHA inpatient fees based on ridiculous income/asset rules may be prohibitive. Should the 72-hour notification rule still play a role in emergencies now? What about service-connection/non-service connection factors?

This wise decision by judges Lance, Pietsch, and Greenberg, offers financial safety net for some veterans, their families, and regional acute care community hospitals.  It advances the cause of quality health care close to veterans’ residences and the co-ordination of care between the private and VA sector. It exposed the regulations in question to be intentional errors.  True disrespect; perhaps even true hate.

Other resources:

Article: Court rules for veterans to receive medical payments (LINK).

Cornell  LII–38 U.S. Code § 1725 – Reimbursement for emergency treatment.  Read the amendments.  (LINK)

CAVC homepage (LINK)–at this time, fewer than a dozen hits have been recorded on the webpage.

NVLSP Brief for Appellant  Vet. App. No. 14-0957  (LINK to pdf)

Posted in BvA Decisions, CAVC Knowledge, CAVC ruling, CAVC/COVA Decision, Complaints Department, Food for thought, Guest authors, Important CAVC/COVA Ruling, Lawyering Up, non-va care, Remanded claims, Uncategorized, vA news | Tagged , , | 3 Comments

THE RAINBOW COLORS OF FALLOUT FROM DEFOLIANTS

Helps build strong bodies 12 different ways and include the needed nutrients of Vitamins Blue, Green, Pink, Purple White as well as all the need Orange supplements.

Helps build strong bodies 12 different ways and include the needed nutrients of Vitamins Blue, Green, Pink, Purple, White as well as minimum daily  requirement of Orange supplements.

While I cannot say I’ve seen Agents Green, Purple or Pink, in a barrel or out, I have seen Agents Orange, Blue and White (Tordon 101)-both falling from the sky and in drums. Fifty gallon drums are hard to miss. Either they are full, empty, marked as contaminated or stored in a specific area according to use.

AvGas or 130 octane was specifically marked and had nomenclature printed to that effect. 130 was generally in oversize numbers to distinguish it from JP 4 kerosene for jet engines and Hueys. 90 weight gear lube was indistinguishable in its OD green paint from any other petroleum product. They didn’t have color bands like AO and A Blue. Agent White didn’t have a white band at all. It was labeled as Tordon 101 and had a list of goodies including : 21.2% (acid weight basis) triisopropanolamine salts of 2,4-D and 5.7% picloram .Other than the stable 2,4- D, Agent White had no dioxin and was not prone to break down into toxic subchemicals…. that we know of… yet… This is why I so vividly remember seeing the drums in their own protected revetments. Moreover, in the helter skelter world of 20 Alternate, those colored bands stood out in a sea of OD green drums.  

At Udorn, all these were stored in the POL/bomb dump area at the far east side. At 20 Alternate, they were loosely shoved into a side area to the north of the C-123 that hit the Vertical speed brake (the Titty Karsts) at the end of runway 31 in 65. I’ve searched photos but found none during 1970 showing them.

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Why they were stored there after the 123 ran out of laterite is beyond me. They weren’t over in the POL/bomb dump. The Meo (Hmong) kids younger than 12 had access to this and spread it via bleach bottle scoops in each hand. They used it undiluted, without addition of any petroleum distillates.  By the time you were over 12, you got a reprieve from this job. You were inducted into Vang Pao’s army.

I often wondered in the intervening years after 1991, when I first became aware of the potential for disease and birth defects, just how much damage ensued. Not since the Thalidomide disfigurements in the late 50’s-early 60’s have we seen horrific damage due solely to a chemical so well documented. This morning I ran into a link sent me on FB that attests to the damage. While the article deals with South Vietnamese groundwater poisoning, the same identical circumstances were afoot at Ban Long Tieng and Ban Luang Prabang (L-54), not to mention our sister site five klics away over Skyline Ridge  at Ban Sam Thong (LS-20).

Flying to the east of the Plain of Jars near the Ho Chi Minh trail, you began to see light tan vegetation that had died out and never came back. Jungle plants are incredibly resilient but even they have limits as to what they can withstand. So too, humans.

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Vietnamese child born with no eyes courtesy Reuters “Legacy of Vietnam”

Having now had over thirty five years to connect the dots, the Institutes of Medicine,  or IOM, has only managed to figure out spina bifida may have a connection to dioxin. This flies in the face of what’s going on at ground zero- in Vietnam and Laos.  We, as in-country Veterans, know this stuff is more toxic than discussed. That VA continues to lollygag about and stare at the proverbial ceiling when shown the evidence is proof of a concerted effort to ignore it in hopes it will just go away.  The lag time from consideration of a disease to inclusion has always been interminable. Congress now has let VA off the hook entirely for investigating further and given them free rein to research as they see fit. We all know that is tantamount to no research at all.

Here’s the link. The pictures are pretty brutal but so is the dioxin.

https://widerimage.reuters.com/story/legacy-of-agent-orange

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Another link of graphic deformities is here

http://www.dailymail.co.uk/news/article-2579939/Children-suffer-horrific-effects-Americas-use-chemical-weapons-Vietnam-War.html

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Xuan Minh, right, 5 years old. Courtesy of the article above.

Seems VA could do a fly over at 25,000 feet and find this detritus of human life in the wake of AO. Hell, they don’t have to look any further than my Band of Brothers (and me). Seems some of these Vietnamese kids going into several generations now would be the irrefutable proof. My son was born with Ulcerative Colitis in 1988. I came down with it’s precursor, Crohn’s disease, twenty years after I left SEA in 1994. Most who are familiar with Crohns’-like diseases know this begins in childhood – and rarely, if ever, when you’re 45.

http://www.nytimes.com/video/us/100000002872288/agent-orange.html

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The truth is out there but why bother looking for it? The pesky truth is that the more you find out, the more you will be held accountable. At the VA, this means more work- pure anathema to them.

The smart money says VA will have their come to Jesus meeting on dioxin a few days before the last Vietnam Veteran passes in about twenty years-if any of us are lucky to survive that long. Much chest thumping and brow beating accompanied by mea culpas will fill the air. “If only we’d known.” will become the watchwords. VAOIG folks will be unable to substantiate that any of this was intentional but that new protocols have been instituted to prevent a recurrence in the future. In a tired hackneyed phase-Same Old Shit- Different Day- the IOM scientists will continue to research it-just in case.

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Meanwhile, I am being inundated by my friends coming to me asking how to file for Parkinson’s disease. I hold my own hands up every morning waiting to see the beginnings of the tremors.

Posted in Agent Orange, All about Veterans, DM II, From the footlocker, KP Veterans, Medical News, Military Madness, Porphyria Cutanea Tarda, Thailand AO presumptive path, VA Medical Mysteries Explained, vA news, Vietnam War history | Tagged , , , , , , , , , , , , , , | 1 Comment

HADIT.COM RADIO SHOW TODAY– BOOKNOTES YOU NEED

Hugh Cox

Hugh Cox Esq.

I received this update on VBSM VBMS technique recently from Hugh Cox, one of the older premiere VA attorneys still standing. He cofounded NOVA in 1992 with several other prominent law dogs. These talismans are required now because we are dealing with VADHD issues at the Evidence Intake Center in Cheeseville,  Wisconsin. I leave it in Microsoft Word for you to revamp it  as necessary.  

VBMS Medical submissions to VA

Remember also that the VA OIG visited the Newnan, Georgia VA intake center last month semi-unannounced and found  rooms of unopened mail awaiting processing. Shocked. I am shocked.

Believe it or not, Secretary Bob (almost) immediately shut them down for the near-term and everything is being routed to Cheeseville until then. I wonder why he can’t do that with Diane and Kimberly? And about 500 other gomer VA GS and SES losers.

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photoNot to bogart but I proudly display the decal of the Vietnam Dustoff Association “So Others May Live” and it inspired me to think that what I do is triage. I’m the last one they come to for advice and some are pleasantly surprised at what I can dredge up out of an old, old c-file. And so you just know what came to mind…

LOGO THAT OTHERS MAY WIN

Brings to mind a lot of old memories. Thank you all for letting me help…back then and now.

Somebody please call in and ask about “de novo review”  today. Also another topic of interest is Buddy Letters with too much kill zone and not enough Joe Friday “just the facts, ma’m. Just the facts…

Eleven minutes to the show.

Link to Federal  Circuit Bar Journal:   http://www.veteranslawlibrary.com/files/Articles/NowistheTime.pdf

And the ILP Greenhouse line…

Mr. Graham,

 

We acknowledge that this has been a long process and we thank you for your patience on what you may interpret as our unwillingness to honor the BVA decision or an arbitrary refusal to act on the VA Secretary’s part. The earlier delay in providing services was because your request is a highly unusual independent living request that required us seek advisory opinions from our higher headquarters to answer questions raised about the delivery of services. I would also like to clear up a few misconception you may have about the process, this is not a grant, but a service delivered by VR&E Services.  The greenhouse you are requesting must be provided by VR&E Services and we must certify both at the beginning of the process and again at the end of the process that it meets the required intent.

Although we are the regional representatives of VR&E Services, we cannot deviate from prescribed policies and practices for delivering those services.  As vocational specialist, we are not trained or prepared to oversee major construction projects, therefore we had to submit your request through the regional contracting office to solicit bids for a Construction Manager that will be assigned to work with Mr. Hollaway to deliver the services prescribed.  I contacted the contracting office today and they are working to bring closure to your bid process, they anticipate another 30 to 45 days for completion.  The intervention by a Construction Manager is necessary because in the past there were concerns raised by reviewing officials, permitting officials, as well as rehabilitation counselors themselves about assigned construction projects, therefore VR&E Services changed procedures a few years ago requiring the assignment of Construction Managers to provide guidance and expertise on these IL projects.

Again, I thank you for your patience on this endeavor and hope as you do that it can be accomplished as soon as possible.  If you have further questions or concerns, please contact your Vocational  Rehabilitation Counselor, Kris Holloway at (206)

Posted in Uncategorized | Tagged , , , , , , , , , , , , | 3 Comments

HADIT.COM RADIO SHOW THURSDAY EVENING AT 1900 HRS EASTERN

haditlogo2007One thing about getting over the immediate symptoms of  heart failure (I hope) means  Jerrel and John are going to call and tell me it’s time for another show. I seem to break glass no matter what I do or say in this business, so I just stumble on through to the next blunder. John and I finally came to grips with the discussion of another website on a recent thread I posted. Rather than let it putrify and stink up the Veterans Help sites, we’re going to lance the boil and let it drain. 

I’m sure you’ve traveled all the major sites and seen what’s to offer. Some sites have blogs like mine and many use the Hadit.com forum style. All the older sites were constructed this way to allow questions to be posed and answered. Everyone benefited if…. if the one answering the question was knowledgeable in the subject matter. I stumbled upon Hadit.com in late 2008. I probably have another moniker in the system like gaegraham or GAG but I soon began my own site and worked exclusively on it. Patricia Lupole of HCVets.com built it for me on the forum model of all the others. Gradually I began looking at these other sites to offer Hepatitis C info to help win the new breed of jetgun claims.

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Which brought me to what some of call Peggy’s Pink Site or Veterans Benefits Network.  I kind of thought of it as the Jim Jones Koolaid Klan.  Veterans there would take anything said by a moderator as Gospel.  It wasn’t long before I hit an imaginary trip wire and began receiving demerit points for arguing law with idiots. This is the primary reason my present blog evolved into a one-sided conversation. It teaches the correct way to accomplish a VA task and then allows for discussion from the Peanut Gallery. Anyone is welcome to jump in and say what they please but the basic knowledge of “How To…” is presented without ten theories on the best way to get there confusing you in the process.

Most importantly, the tenor of conversation at Theresa’s and my sites practices respect for one another. Civilized discourse doesn’t need to descend into Ancestors.com© and  the concommitant research on whether you were raised by wolves. We were all raised properly by adults and can act like adults. If you can’t meet those baseline tenets of transactional analysis, then you probably hang out over at Peggy’s. There’s always someone there who has to find a problem with the tone of words another Vet uses to express his or her problem or observation. God forbid you find a flaw in the Department of Veterans Affairs. VA bashing is right out and exorcised as quickly as possible.

And then there was a soothsayer and Prophet who held sway every evening and enthralled his audiences with his wisdom as seen from his many years high in the VA Ivory Tower. The problem was the tone.  According to this Oracle at Delphi, most all Veterans were malingerers with the noted exception of His Band of Brothers there at Yuku. One never argued with the Guru because he had been a Senior DRO and reached an exalted height of GS-Maximus 15 Step 10. He had had more and varied jobs that any human known -and all of them before he enlisted. 

He was a combat medic with nary a combat medal. He talked policy with Tony Principi. He had the ear of Jim Nicholson. According to him, he walked the length and the breadth of the 11th floor of Vermin Ave. at will like he owned it. This was the era of Cruiser-VSO and the go-to expert for VA law. Every teaching moment always seemed to segue into a Vet who had filed for bogus injuries and was trying to game the VA benefits scheme. The 85% denial rate merely mirrored the number of claims which were meritless. Not withstanding the nearly 67% rate of reversals, vacates and remands with instruction to incorporate the CAVC judge’s findings, VAROs were the true Halls of Justice and mistakes were nonexistent. “C&UE” , as he was fond of writing it, was so rare, he’d never witnessed one-let alone committed the sin. The 22% success rate at the BVA merely reflected weak-willed  VL judges who caved in to Veterans with implausible, unsubstantiated stories. Likewise, the CAVC/CAFC.

I had the misfortune to cross swords on a “C&UE” claim I was fleshing out. He tried to set me straight and then began getting “snippy” when I didn’t accept the advice. This is the “CUE” I won up at the CAVC four years later all the way back to 1994. Apparently everyone in the Office of General Counsel had a different opinion from his on the regulations in question. Anyone with a copy of 38 CFR could run circles around him but…. everyone was quarantined or evicted who disagreed. No ifs ands or buts. If you argued with Him, you were shown the door. I could see it if I were wrong. I could walk away from it if I was willing to concede defeat and ignore CAVC and CAFC precedence. Slamming the door in my face via censorship and eradication of my comments simply made it worse. To this day, if I arrive and try to sign in, I am politely greeted by the bouncer. This is good. It simply proves the validity of my argument:

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Hit log in and voila!

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That’s right, Pilgrims. This is the nifty VBN tool for getting new members and tolerating the opinions of others. This is the VBN “big tent” everyone can fit under as long as everyone practices groupthink. And that’s what we’re gonna talk about tomorrow evening.

Be there or be square. The call in number remains

347-237-4819

The gal who says Blawg Tawk Radio remains

ss-call-me

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One thing you will not find on my site is censorship. I have never demanded a membership or entrance gate. I have never removed anything but the occasional expletive to maintain good taste. The body of any disagreeable comment will always remain. You have the right to remain stupid. Any stupidity you voice will not be held against you. We try like the devil to set you straight but there simply is no cure for stupid. There is no room in Veterans law for secret societies. Knowledge is to be shared with other Veterans, not husbanded and doled out full of errors to the Koolaid Drinkers.

Posted in Tips and Tricks, VBMS Tricks, Veterans Law | Tagged , , , , , , , , , , , , , , , , , , | 2 Comments

Who is Doctor Gold?

Last year my spouse received a VA PCP appointment letter with the unfamiliar name on it:  Gold. Huh? Report to Gold? We emailed his PCP RN, “Who is Dr. Gold?”  “Oh, that just means Gold Team.”  Oh……okay.

teams

Circa: 1960 Image: CC Flickr

Now I’m curious.   Are VISNs everywhere creating PCP colorful tribal teams or is this a blast from the past--way too corny to survive?  

Dayton: Green, Gold, Red, and Blue; Philadelphia:  Blue, Gold, Green, Pink (Women), Purple (Geriatric), and Red;  Waco and Temple:Green, Gold and Maroon; Boise: Silver, Red, Purple, Orange, Blue, Gold;  Milwaukee: Blue, Yellow, Red and Gold.  

Hey, whatever helps. Go, (your color), Go!

Posted in General Messages, Guest authors, Humor, Uncategorized | Tagged , | 4 Comments

VARO–HIDE AND SEEK

CaptureI have had numerous queries as to where to find all my widgets listed above. Some of you even desire to know the name of that brain dead VA rater who absolutely refused to have the decency (or courage) to put his/her name on the denial they sent you for sleep apnea.  To accomplish this task, I’m going to walk you through this and teach  you how you can always find these turkeys. Simply place your cursor on the desired widget (VARO- Who’s Who-see picture above) and “left click” (push down) that little movable piece of plastic on the upper left of the mouse you are holding. Pull the trigger, dude. It ain’t a boobytrap. Bingo.

A new window opens and you now see

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The purple words circled in red above are called a link. By putting your cursor on this and left-clicking, it will take you to the Federal Database of all the 57 VAROS across our fruited plain of existence. It gives you access to all the VA’s GS-rated gomers and even tells you what their bonus was in 2015. Whoa. Silly you. You thought they quit giving bonuses out? They just changed the name to “speshull awards”. Fortunately, they can do this because there are plenty of ‘spechull’ employees there who work hard for your money-i.e. the money you should have been awarded. That’s why they call it an award instead of a bonus. VA is a stickler for truth in advertizing.

When you click on this link, this Federal Data Page will appear. To enlarge any of these, left click on them.

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In blue above,  left click on the Federal Employees UPDATED. This is another link that is going to open to this

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Here’s where you begin to take your data from your VA denial decision and apply it to the database. But first, let’s take a gander at an actual decision and extract the data you are going to need. Several things come into play. The information is always printed in the upper right hand corner of the introductory page. You will note the three digit number of the VA regional office and the three initials of the VA rater. Let’ look at one from Winston Salem, N.C.

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Ignore the 213. I also blacked out the Vet’s name and SSN. That’s extraneous to what we’re doing here. As I mention, 318 is merely the identifier of Winston Salem. VA sometimes farms these out to another Regional Office if they are extremely backed up. In their infinite wisdom, they’ll send it to Detroit (329)who is under water and more constipated than an opioid addict. Here’s the list of Regional Offices by numerical identifier:

Albuquerque VA Regional Office (340/00)

Anchorage VA Regional Office (463/00)
Atlanta VA Regional Office (316/00)
Baltimore VA Regional Office (313/00)
Boise VA Regional Office (347/00)
Boston VA Regional Office (301/00)
Buffalo VA Regional Office (307/00)
Cheyenne VA Medical/Regional Office Center (442/00)
Chicago VA Regional Office (328/00)
Cleveland VA Regional Office (325/00)
Columbia VA Regional Office (319/00)
Denver VA Regional Office (339/00)
Des Moines VA Regional Office (333/00)
Detroit VA Regional Office (329/00)
Fargo VA Regional Office (437/00)
Ft. Harrison VA Regional Office (436/00))
Hartford VA Regional Office (308/00)
Honolulu VA Regional Office (459/00)
Houston VA Regional Office (362/00)
Huntington VA Regional Office (315/00)
Indianapolis VA Regional Office (326/00)
Jackson VA Regional Office (323/00)
Lincoln VA Regional Office (334/00)
North Little Rock VA Regional Office (350/00)
Los Angeles VA Regional Office (344/00)
Louisville VA Regional Office (327/00)
Manchester VA Regional Office (373/00)
Manila VA Regional Office (358/00)
Milwaukee VA Regional Office (330/00)
Montgomery VA Regional Office (322/00)
Muskogee VA Regional Office (351/00)
Nashville VA Regional Office (320/00)
New Orleans VA Regional Office (321/00)
New York VA Regional Office (306/00)
Newark VA Regional Office (309/00)
Oakland VA Regional Office (343/00)
Philadelphia VA Regional Office (310/00)
Phoenix VA Regional Office (345/00)
Pittsburgh VA Regional Office (311/00)
Portland VA Regional Office (348/00)
Providence VA Regional Office (304/00)
Reno VA Regional Office (354/00)
Roanoke VA Regional Office (314/00)
Salt Lake VA Regional Office (341/00)
San Diego VA Regional Office (377/00)
San Juan VA Regional Office (355/00)
Seattle VA Regional Office (346/00)
Sioux Falls VA Regional Office (437/438)
St. Louis VA Regional Office (331/00)
St. Paul VA Regional Office (335/00)
St. Petersburg VA Regional Office (317/00)
Togus VA Medical and Regional Office Center (402/00)
Waco VA Regional Office (349/00)
Washington DC Appeals Management Center (372/00)
White River Junction VA Regional Office (405/00)
Wichita VA Regional Office (452/00)
Wilmington VA Regional Office and Insurance Center (460/00)
Winston-Salem VA Regional Office (318/00)
Trying to be too finite will net you a lot of air. I cast a broad net and look in a general area. Let’s fill in the search block I pointed to in blue up above.

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Hit submit and you are inside the wire, Pilgrim. Welcome to the VA alphabetical Employee directory.

Recently, doing a search for a fellow member, I ran across a possible glitch in this new database. They tend to be lazy in organizing by alphabetical order. Here you will see some ‘O’s scattered before and after all the rest of the ‘O’s. Just be sure to check three or four pages before and after your search to make sure you find them. If the one you search for has been recently married, and many of these folks are young and foolishly inclined to, they may not have updated their metrics in the database. I had a Decision Review Officer in Seattle named Cheryl Anne Mackey who went by CAM. When she remarried, she became CMR (Cheryl anne Mackey-Rivas). Fortunately, they still listed her under M and I spotted the rationale for the change.

In the present case, we see something similar. We’re searching for ‘CKO’ but there would appear to be none by searching.

318 VARO W-S CKO possibilities 1318 VARO W-S CKO possibilities 2318 VARO W-S CKO possibilities 3318 VARO W-S CKO possibilities 4

So, by default, we look for ‘CK’ and another clue. All raters at VAROs are identified by their GS rating nomenclature of “VA Claims-Examining” . Their GS ratings can vary from Apprentice coffee runner GS-6 to Decision Review Officer (senior) GS-13. The rank  from bottom to top is Veterans Service Representative (VSR), Rating Veterans Service Representative (RVSR) and Decision Review Officer (DRO). At the end of each individual you find out if they were naughty or nice last year. The more denials generated the higher the award. Below we find the combination we seek. With 98% chance of accuracy, you can assume Miz Cynthia Kosmatka is our mysterious CKO. She may have married and the O is her new last name. She may be one of those anomalies whose parents were brain dead and it never occurred to give her a middle name. What’s for sure is she is a rater and not a newbie. She’s a GS-11 and got an award for denial excellence last year for a buck fifty seven. Global warming and Congress have seen these awards dry up for the most part so any wins in this column tell us this gal kicks ass and takes names. She’s on the fast track to a GS-12 and an early DRO promotion.  I’m guessing she probably dries each individual bristle of her toothbrush every morning before leaving for work, too. She has two spare snow tires in her trunk year-round just in case. You know the type.

318 VARO W-S CKO possibilities 5

Capture7So, you get the picture. Now you too can find anyone in VA with a GS rating. This doesn’t work for the Senior Executive Service (SES) but you can usually find your “Leadership Team” on the next “VAROs” widget to the right. Click on the widget and then click on your state. Then click on the Regional Office link. Then click on the left side on “About us”. It opens to “Leadership Team“. Click on that and you’ll see ( Fort Harrison, Montana  for example) some slippery individuals such as this gomer. These poker players move around every two or three years to collect max bucks for moving fees. Back in my day, I can remember my rater who did my VA mortgage approval in 1976. He was also my rater and DRO officer at my hearing in 1990. Mr. Peterson went on to become Seattle’s director by the time of my refiling in 2007. The newfangled “Head ’em up and move ’em out” mentality of musical directorships began under Shinseki. His SES handlers conned him into a mega spending boondoggle. This was what all the ruckus was about last year with Dianna Reubens and Kimberly Graves. But that’s another sordid story for another day. You can practice your new link knowledge on them purple words above now. Go ahead. I know you can.

Knowledge is power. When you know who your rater is, you can roll their socks down by asking for them by name. Here’s an example. Call the VA’s Prize Redemption Center at 800-827-1000. When you do finally get a warm body to answer, try this one on for size.

 GS-2 Veterans Rep:  Good morning. Thank you for your service sir.  May I have your name, rank, airspeed, tail number and last known heading?

Vet: Hi, Roger that -Johnny Reb Veteran. DOB 12/25/51, USAF, entry 10/10/69 discharged 2/2/73.

 GS-2: I’m sorry. Did you say your first name was Roger?

Vet: I’m sorry. Johnny Reb Vet. DOB 12/25/51, Branch of Service USAF, entry 10/10/69 discharge 2/2/73.

 GS-2:  Middle initial?

Vet R as in Romeo

GS-2: Your middle name is Romeo?

Vet: No ma’m . It’s Reb. R-E-B.

GS-2: Don’t confuse me, sir.   What’s the name of the dog you used to have?

Vet: Dog’s name was Molly. Whelped 2/4/2004; died 3/8/2015.

GS-2: Okay, what is it you are calling about?

Vet: I recently received a denial for sleep apnea dated 2/14/16. In the upper right hand corner is 318 CKO. I’d like to have Cynthia Kosmatka call me back between eight and five Pacific time and tell me why she didn’t consider my private  sleep studies and nexus letter from my doctor in the denial decision. Perhaps a de novo review is in order.

GS-2: Denial nova?  Whoa. Could you repeat all that?

Vet: Cynthia Kosmatka. She an RVSR at the Winston Salem Regional Office. GS-11. Please route this inquiry to her and just have her give me a call. I’ll discuss it with her. Or you can give me her number and I’ll call her directly.

GS-2: Yes sir. I’ll note this in my report of contact. Oh, yeah. What was her name again? Can you spell it for me?

Today’s show was brought to you by the letter V for Veterans. Never a lower case ‘v’, I might add.

Asknod's VA Logo

P.S. From our sister site Hadit.com:

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Posted in KP Veterans, Nexus Information, Tips and Tricks, vARO Decisions, VBMS Tricks, Veterans Law | 8 Comments

A pneumonia emergency

Last Sunday, my old Marine, Jay, was coughing moderately at bedtime.  He was also wheezing but he has COPD so that’s not unusual.  He used his inhaler and went to sleep.  Around 3:00 a.m. he stumbled to the bathroom, and returned to bed shaking.  The trembling continued.  “Chills?”  I asked; he mumbled something.  The shaking subsided after 30 minutes. Later he awoke and tried to find his water bottle on the table, knocking things off of it in the process.  I turned the lights on. He looked as if he was having a seizure (not a grand mal) and couldn’t respond to me.  I called 911 and the ambulance took him to the ER.  Our son arrived at the ER before I did.  He has no memory of these early morning events.

Tests revealed pneumonia (1 lung) and what looked like a seizure to me was termed “altered mental state.”  He was in for one night and about 2 days, then released him with medication.  Pneumonia severity index III perhaps? (LINK)

Fortunately, just a week before, he had his first visit with a private PCP doc in our town. And this very same doctor was on duty in the ER when he was brought in. This young doctor took exceptional care of Jay, checking on him multiple times, day and night.  More VIP treatment came. Our next door neighbor, a fantastic young nurse, was also on duty; she transported him to his room and introduced him to the nursing staff.  But it’s troubling that pneumonia can progress so swiftly and with only mild symptoms.

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Notify VA within 3-Days/72 hours or emergency claim is DOOMED. Image: Wikipedia

The VA was notified within the narrow 72-hour window for emergency reporting. Although he has a back-up Medicare Advantage plan, I didn’t want to take any chances that the hospital would bill Medicare first.  I wrote a post on ASKNOD in 2014 that dealt with this very issue entitled Arizona Veteran receiving non-VA emergency care screwed by private hospital and the VA (LINK).

I called the hospital finance office (live person); I called WRJ VHA (mystery person’s voice message).  To PROVE timely notification, I sent an email to the VA clinic via myhealthyvet Secure Messaging.  A VA clinic nurse responded quickly. I called the hospital again today to confirm that they should bill the VA first and if denied, then bill his Medicare plan.

VA states in Working with the Veterans Health Administration: A Guide for Providers, page 9 (LINK): :

Payments for Veterans with Insurance In situations where a Veteran has coverage under Medicare or any other health plan, Federal law prohibits providers from receiving payment from both VA and the other health plan for the same services. Non-VA medical care providers may not bill any other payer for care authorized by VA.

If a Veteran chooses to use VA benefits, the Veteran is responsible for paying applicable VA copayments; however, VA payment for non-VA medical care is payment in full, and the non-VA medical provider is prohibited by law from billing the Veteran or the Veteran’s other health plan for charges beyond VA payment.

If a Veteran chooses to have a claim submitted to another health plan in lieu of VA benefits, the Veteran is responsible for paying any co-payment or deductible required by their other health insurance to the non-VA medical care provider. Except in specific instances, VA will not pay deductibles, co-payments, or the balance of the facility charges to the non-VA facility

It’s not surprising that VA Fact Sheets written for veterans don’t clearly explain the above options and potential financial consequences of emergency care.  Many private providers don’t want to get sucked into the VA’s crazy-eligibility rules as shown below and will bill Medicare first unless the veteran makes sure VA is listed as first payer.  I was told today that if the VA denies the claim, the veteran will receive the denial letter and the hospital will then bill Medicare, properly listed as secondary payer.

va emer

20-03 Claims Process for Emergency providers

Fact sheets

20-01     Overview of Non-VA Medical Care for providers  (LINK)

20-02    Non-VA Emergency Care  (for vets)   (LINK) 

20-03    Claims Process for Emergency Medical Services for providers  (LINK)

20-06    Ambulance Transport at VA Expense for ambulance providers– A Guide for Community Ambulance Providers  (LINK)

 

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The non-service connection versus service-connection emergency issue may result in Medicare being billed (see page 7) but I have no idea at this juncture. Image: CC Sean McGrath on Flickr

 

Posted in All about Veterans, General Messages, Guest authors, research, Uncategorized, VA Health Care | Tagged , , , , | 6 Comments

VARO–FROM SMC L TO R2 AT THE SPEED OF LIGHT

 

FROM THE CORREGIDOR MEMORIAL VARO IN MANILA PHILIPPINES

Aerial view of the ruins and a memorial to American defenders of the island during World War II.

Aerial view of the ruins and a memorial to American defenders of the island during World War II.

No, it wasn’t R2D2. No droids  or hyperdrive motivators were involved. Some may recall Kevin contacted me back in February 2015 with a passel of ratings questions and an equal number of screwed up decisions. After digging into his particulars, I have to admit I’d never seen a more adversarial VA posture towards a Vet-ever. That his DRO was willing to ‘fess up and come clean after ‘we’ called them on it is no small feat, either. As usual, they’re trying to minimize the collateral financial damage by granting effective dates that are wildly off the mark. Ne problemo. That’s what a NOD is for. 

We decided to set out to correct the fustercluck and get him what he’s owed. Sadly, VA began their defense by using the wrong DBQ and kept denying his “peripheral neuropathy”. Once we convinced them that he wasn’t going to saw off his legs to qualify for SMC O, I set out to find a way through the maze for him. Remember, up until 2015, they had been maintaining that if he could stand up to make the transfer from bed to wheelchair (assisted) then he had not exhibited loss of use of his lower extremities. According to the VA medical poohbahs in Manila, if you can pirouette in place like a ballerina and hit the wheelchair from the bed on the first try, you are ambulatory, dude.

When Kevin laid out the whole medical picture for me, including the loss of bowel/bladder control, I knew VA was blowing bubbles. The subset of disabilities he had documented, including Grand Mal seizures, could never be misconstrued by any rater or DRO who professes to do this for a living. The only way to right the wrong was to go afield and get real, independent assessments from unbiased doctors who were not in the employ of VA. The gomers promptly changed their tune when we let that cat out of the bag.

Kevin has more 100% ratings than I do. Way more. VA wasn’t even willing to concede more than SMC L solely on Aid and Attendance in spite of 38 CFR 3.350(f)(4). That, alone boosted him to SMC M. Being a lowly Veteran with no credentials, I had to hand Kevin the playbook and make him appear the equivalent of Hurricane Katrina Eagle or Ken Carpenter. He submitted this brief in a last-ditch effort to revamp the Fort Fumble assessment. It worked. They did about four more C&Ps in a desperate attempt to deny and finally were forced to use the right DBQ that applied. Once they did that, the denial rhetoric subsided and a long period of silence began. My guess is this turned into a frenzied flurry of emails to and fro from Manila to VACO begging for ammo to rebut the unrebuttable.

Kevin argument for (r-2) redacted

downloadEach time it appeared a decision was close at hand, I suspect they uncovered yet another CUE. Never, since Arlo Guthrie’s storied  1966 AFEES induction physical, has anyone been subjected to so much medical inspection in a vain attempt to discount or downplay his ailments. Much like a cliff face with no purchase, they finally had to concede defeat. And I do mean utter defeat.

Here’s what they decided. You may get eyeball cramps after reading the same preface describing what a Clear and Unmistakable Error constitutes over and over again.

Redacted DRO for R2 for Kevin

Some of you folks might not understand this. It’s not a fluke. It’s what VA does for a living. They deny. They make up reasons and purposefully use wrong DBQs to substantiate their findings. They hire doctors who will kowtow to their demands to be subservient and say what they are instructed to say. Kevin sat through several exams by the same doctor who came at the loss of use of the lower extremities from three different directions and each synopsis was that the Kevmeister still was ambulatory and fully mobile. Not until confronted with a real doctor’s IMO of his abilities were any of the Manila wunderraters willing to concede he was less than good to go.

Bringing up all the other disabilities that qualified him for R2 such as being bedridden, bladder/bowel incontinence and truly needing a full time caregiver merely provoked them to grant him the benefit of the doubt as to just how disabled he was. This is classic VA jurisprudence. I’m guessing this is the first time Manila has ever granted an R2 rating. In their book, it’s administered like Extreme Unction-when death is certain and can no longer be ignored.

Congratulations Kevin on a job well done- before you died waiting.

Asknod's  VA Logo

Posted in Aid and Attendance, C&P exams, KP Veterans, SMC | Tagged , , , , , , , , , , , , , , , , , , | 20 Comments

WHERE IN SAM HILL WAS I IN 1970?

0-1 Bird Dog FAC aircraft.I found this site many years ago when trying to figure out where I got the silver BB that rainy monsoon September morning during Operation Leapfrog/Forward Thrust. Truth be told, I can’t say where it (the internet site) was but it may have been the Ravens site known then as the Edgar Allan Poe Literary Society (EAPLS).  I don’t see this one listed there anymore but its value is immeasurable.

This is gold when you are trying to research a PTSD claim. Far too often we forget the AO and the names of towns or provinces we were traveling through. 45-50 years can take a toll on our collective memories. Knowing many of you were brought in as replacements to replenish casualties, and the added effect that no one wanted to develop close ties due to the pain of losing them abruptly to  an errant bullet or B 40, we  often have no collective resource to turn to in the form of buddies.

Place names tend to stick in our minds more than nicknames. I always remembered Ban Moung Soui (Lima 108) as being close to where I almost got immortalized on the Wall but I was wrong. Ban, in both Thailand and Laos, means home. It also connotes a collective noun meaning village. Thus you can see why every large bump in the road began with it.

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These maps were used by air crews during the war because they were a) there; b) fairly accurate and c) we needed them pronto. The French did a magnificent job of cartography during their one hundred plus years of colonial rule. Our military used their own maps in Vietnam  but they still were based largely on these earlier ones. Since we were not “in” Laos in the military context, we used these. They listed all the Lima sites which were generally villages that had a short airstrip. Some folks can’t conceive of there being no roads. I liken the analogy to Alaska.

The author of the map site, Jim Henthorn, has no idea how valuable this trove of geographical detail can and will be for Veterans working on their VA Claims. Here’s the link to his site. http://911gfx.nexus.net/vietnam.html

I will put this post up as a widget for your easy reference in the future. It’s now up at the top in the black widgets section under SEA maps.

Posted in KP Veterans, PTSD, Vietnam War history | Tagged , , , , , , , , , | 2 Comments