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.

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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.

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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

THE VETERAN WINE TASTER

LawBob SquarepantsAs usual, leave it to a VA rainmaker like LawBob Squarepants to come up with a good joke. He has been noticeably remiss in Veterans humor and consumed by Keith Robert’s protracted miscarriage of justice. Fortunately for us all, he has reverted back to form and graced us with suitable humor befitting our blog. 

 

Following the untimely death of their resident sommalier, a large California Wholesale vintner began a search for a new one with suitable credentials. They advertised  widely in all the major trade publications.

A bedraggled homeless Veteran drunkard with an unkempt, dirty look arrived to apply for the position a short while later.

The Human Resources director wondered how to politely send him away without hurting his feelings.

They poured him a glass to drink in the hopes that he would quickly prove himself ineligible.

“A Muscat , three years old, grown on a sunny north slope, matured in steel containers. Low grade but marketable to the uneducated.”

“Obviously you have an affinity for this”, said the boss. “Let’s try another vintage.”

Another glass….

“Cabernet, eight years old, a south-western slope, oak barrels, matured at 8 degrees. Requires three more years for finest results. Good color and fingers. It’ll last for a decade before it fades.”

“Outstanding. Where did you get your sommalier credentials? Let’s try another.”

A third glass…

unnamed”It’s a pinot blanc champagne. Epernay…high grade and exclusive. Not quite a Dom but higher than a Perrier Jouet Premiere Crux. Perhaps a private estate but nevertheless a 2007 vintage.  Definitely the north bank of the Rivière Marne. You’d better check the corks on those. I doubt they’ll hold for more than another six years.” said the drunk calmly as he took another sip.

The director was speechless.

11768413-woman-with-glass-of-wineHe winked at his secretary and pointed at his crotch.

She left the room, and came back in with a brimming glass of urine.

The alcoholic tried it.

“It’s a blonde, 26 years old, three months pregnant and if you don’t give me the job, I’ll tell her husband the name of the father.”

 

The teaching moment needs no explanation. That’s why they call us Veterans. Disabled physically perhaps- but never mentally.

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

WELCOME HOME, MARK AND EUDITH

I wish to welcome back my old friend and neighbor and his new wife. There can be joy in Mudville now with the advent of the new Direct Acting Antiviral (DAA) drugs to combat Hep C.  We had so little to look forward to other than inevitable suffering and death. It’s like being given a new lease on life. In this case, a new and glorious beginning. Congratulations to you both and may you live long and prosper. 

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Posted in All about Veterans, Food for the soul, HCV Health, KP Veterans, Sofosbuvir | Tagged , , , , , , , , , , , , , | 3 Comments

CALL ME BOB– BUT DON’T CALL ME

McBob 3

Hi, this is Bob Mc D. We’re sorry but the mailbox is all filled up. Try again later, hear?

I rest my case. Remember, I too reached out to “Bob” last fall. I never did get to talk to him but I got his email and opted for that route. He pawned me off on Seattle’s DRO Cheryll-Anne Mackey-Rivas (note that’s a personal best-two hyphens) who graciously called me first before sending me a brand new SOC. 

http://video.foxnews.com/v/4609149800001/fox-amp-friends-calls-va-secretary-robert-mcdonald/?#sp=show-clips

The smart money these days seems to be the Extraordinary Writ of Mandamus. Secretary Bob is required by law to answer those. Looks like I’ll be preparing yet another one to enforce the BVA decision for my greenhouse. I share this poignant vignette from VR&E’s residentura apologist at Seattle’s Famous Fort Fumble. He freely admits he’s no longer my “Counseling psychologist” or Vocational Rehabilitation Counselor in VAspeak, but nevertheless has the the disagreeable task of being the go-between. Apparently, being a untermenschen, I am not allowed to communicate directly with the VR&E hierarchy.

In three days, (May 4th, 2016), we will mark eight months since my BVA grant. Seems like a propitious date to file anew:

 

Posted in Extraordinary Writs of Mandamus, Humor, Independent Living Program, KP Veterans, Lawyering Up | Tagged , , , , , , , , , , , , , | 3 Comments

THE SEARCH CONTINUES

downloadI apologize for not posting this sooner. I wish to thank all those who have sent me get well reminders. After five days in the hospital, even less is apparent about what has happened. After my Tuesday morning rush to the operating room for a Cardio catheterization to determine the cause of my malady, my doctors are in an even deeper quandary. Everyone expected to see thick sheets of plaque in my arteries and slam me full of stents. No such luck.

The IHD diagnosis turned out to be a dog that didn’t hunt. No clogged arteries. Just a heart that has decided to mimic the old Maxwell House® coffee percolator commercial. It was disturbing to watch the sinus rhythm on the monitor. In terms of heartbeat, it looks frightful. If 1, 2, 3, 4, 5, 6, 7 etc. represented a normal rhythm, imagine 1, 2, …3456, 7, 8, 9, ………10, 11, 1213141516, 17, 18 etc. I have no conscious feeling of a 2-second delay between beats. Similarly, there is no adverse, uncomfortable feeling when Mr. Heart engages the hyperdrive motivator. I woke up this morning completely refreshed with a BP of 107/70. The problem was that I was blowing a 99 on the heartbeat.

In the interim, the doctors have decided to hose me with Metoprolol and Lasix in a desperate ploy to slow the heart down. I get the beta blocker application and the Lasix is great for ridding the fluid buildup in the lungs/congestive heart failure. The problem is the side effect of my blood pressure falling dangerously low- like 88/56. I guess I shouldn’t complain. I’m still here typing this.

I am generally uncomfortable talking about my problems with others. Too many of you suffer far more insidious medical maladies than I. It almost seems inconsequential when I consider what some of those I have helped endure. Therefore I won’t expend any more HIPPA time on that subject.

tumblr_n6qyoi6z7O1s7e6fno1_500Of far more import, I wish to point to Congress’ impending legislation to open up the VA caregiver program to all of us regardless of what period we served. As most of you know, my east coast compadre Bruce McCartney and I have railed ceaselessly for inclusion of all Veterans in this valuable SMC entitlement. As we have so vociferously argued over the last six years, how is an at-risk Veteran suffering horrific bent brain from the Iraquistan Olympics any different from one who was extremely successful in arranging beer summits between God and gooks in Vietnam 45 years ago? The George Orwell Animal Farm analogy that some pigs are more equal than other pigs in the VA barnyard comes to mind. Apparently, our illustrious Senators on Capitol Hill finally “get” it. Or we hope they will soon.

Wars have measurable consequences. The human fallout is never programmed in to the front end of the formula. That repair order is usually a decade out from the end of hostilities. In that respect, also, the VA is always a score or more of years behind the eight ball. Certain Veterans Charities whom we will not identify, who have the collective ear of their congressfolk, tend to drive policy and decision making re benefits. Bruce and I have long protested this inequity to any congressmen we could corner with little or nothing to show for it.

Bruce g-house 2

Bruce’s greenhouse

Likewise, most of you are aware of Bruce’ and my shared perseverance in the field of the VR&E Independent Living Program. Severely disabled Veterans- and I do emphasize ‘severely’- were granted a lovely program in 1980 to enhance our lives somewhat. It was clearly and unmistakably aimed at avocational (read hobby) pursuits in lieu of our ability to be productive, working members in society. It was never designed as a sop for prior shoddy treatment even though that is what it subtly purported to address. The immediate effect was to give us more independence and a feeling of self-worth in the face of an otherwise bleak future.

In 1996, VA began to disassemble this safety net and put more obstacles in our path toward attaining the goal. By 2001, it had effectively corralled the entitlement into one where a Veteran had to obtain his own Independent Medical Opinion from a Vocational Rehabilitation specialist (at his/her own expense) stating as much. In fact, the process began to take on the aura of a compensation claim that required the three Caluza/Shedden/Hickson elements demonstrating a correlation between the severe disability and potential for improvement with an IL program. In spite of the clear intent of Congress, the ILP as a program is rapidly becoming a mere shadow of its original intent. On March 31, 2014, VA remodeled the ILP aspect in M-28 (Revised) and accomplished by nonjudicial fiat what they could not do by law. As expected, the program now offers little more than gewgaws and Fat Tuesday trinkets. Gone are the photo studios, wood working shops, riding lawn mowers and snow blower attachments for your tractor.

Each succeeding year since 2004, when VA began recording ILP statistics, has witnessed a shrinking of this valuable entitlement with an increasing emphasis on independence in everyday living. “Independence” being defined as a grab bar next to the water closet to aid in standing up. “Independence” being defined as a cordless phone for when you have fallen down and can’t get back up. “Independence” defined as sock puller-uppers due to debilitating lower back pain. “Independence” as in an electric can opener to ameliorate your symptoms of peripheral neuropathy.   Redefining “independence” has gradually metamorphosed into denying Veterans anything of or having to do with avocational pastimes. This is tantamount to the Orwellian analogy I raised above. Why, asking for a Tempurpedic bed now results in your request being sent down to the local VAMC where their prosthesis gurus parse the wisdom of issuing you one of their cheapo depot hospital beds-sans heat/vibrator attachments.

ILP Case Record Rpt04-FY 15

In that same vein, Congress was inveigled into creating a new Special Monthly Compensation (T) in 2010 that would provide for the slew of Veterans returning home with severe traumatic brain injury and/or debilitating bent brain syndrome. The concept of the entitlement was long overdue. Throughout the last century and the beginning of the twenty first, hundreds of thousands of extremely disabled Veterans have come home from conflicts and saddled their spouses with extraordinary challenges in caregiving. VA never felt a need to reimburse us equitably until 2010. When they did make the commitment, it was only half-hearted and relegated to post-2001 Veterans.

The divisive nature of the entitlement has rankled many of us who strive to help our fellow Veterans who had the misfortune not to have served post 9/11. Therefore, it is with great joy and expectations that we welcome this unfolding change in philosophy. It certainly outweighs any of my problems in importance. Should the House decide to go along with what the Senate is proposing, a great weight will be lifted off our chests. My fear is that the sentiment will be greeted with derision and a veto. I won’t beat a dead horse named Swale, but it seems there is always an endless pot of money for indigent immigrants and little, if any, left for those of us who have borne the battle.

This is also all the more incomprehensible in light of the administration of the Independent Living Program. Imagine a targeted entitlement (much like SMC T, I might add) that allots up to $180,000 per Veteran to a lucky 2,700 severely disabled which VA insists they cannot find enough of who qualify. Has anyone considered that they set the bar too high? If I am 100%+100%+60%+40++30%+10%, would that not suffice to be considered “severely disabled”? I had to fight 5 years to prove my worthiness.  Ambiguously parsing 38 USC § 3120, to extract an interpretation of “necessary and vital” as the prescribed entrance fee, is incongruous to say the least. By that metric, virtually no one, regardless of even those with the longest laundry list of severe disabilities, can qualify. Perhaps the spectre of this going before the CAVC induced Ronald McDonald to grant my greenhouse? Who knows? Anonymous sources at 810 Vermin Ave. NW have acknowledged as much.

Similarly, any of you who have attempted to scale the VA caregiver mountain in search of SMC T have discovered a similar ‘necessary and vital’ codicil in your path. In order to qualify, the VA demands an in-depth examination of the proposed Veteran seeking it. Following that, the designated spouse/caregiver must attend classes to be taught the art. If and when all these hurtles are accomplished, only then is the entitlement awarded. Additionally, during the award of entitlement, the Veteran must attend the VA’s Kumbaya classes to move her/him towards normalcy. Keep in mind, the VA never intended this entitlement to be permanent. It is a transitory aid to parachute you back into society as soon as possible. Woe betideth those of you who opt to take a volunteer position at the food bank or your local library. That will sound the death knell to your SMC T instantly. You will have demonstrated your miraculous ability to reintegrate back into society. Likewise, if your spouse takes even so much as a part-time job outside the home-again you have demonstrated ( by his/her absence) you are now far more independent and no longer in need of a “minder”.

The teaching moment here is not in looking a gift horse too closely in the mouth so much as it is trying to locate said gift horse. Ofttimes this in nothing more than a fig newton of the imagination-much like God. We know He exists. It’s just that no one has ever seen Him.

Nodster

 

Posted in Independent Living Program, SMC | Tagged , , , , , , , , , , , , | 10 Comments

Veterans and Agent Orange: final update released

ao

Click cover to go to contents page with a search inside the book box. Image: NAP

Frank (VT) has sent us a link to the article Vietnam Vets Push VA to Link Bladder Cancer to Agent Orange (LINK).  It concerns the newest update on the government research series called, “Veterans and Agent Orange.”  The 1000-page book can be read online or can be downloaded for free (LINK); over 2,700 DLs so far. This is the “tenth and last congressionally mandated biennial update.”  As such, it behooves us to be aware of its existence and how its conclusions may effect veterans’ claims going forward. 

(A 2014 study (LINK) linking AO to bladder cancer (and other diseases) in Korean veterans was influential in the judgement of these researchers.)

Book blurb:

“Based on the entire body of evidence, the committee Update 2014 changed the categories of association with exposure to the herbicides sprayed in Vietnam for three health effects.  Bladder cancer and hypothyroidism were moved from “inadequate or insufficient” evidence of association up to “limited or suggestive” evidence of association, while the birth defect spina bifida in the offspring of Vietnam veterans was demoted from “limited/suggestive” down to “inadequate/insufficient.”

The committee clarified that Vietnam veterans with “Parkinson-like symptoms,” but without a formal diagnosis of Parkinson disease, should be considered eligible under the presumption that Parkinson’s disease and the veterans’ service are connected. For this last volume in the Veterans and Agent Orange series of reports, the committee distilled “lessons learned” into recommendations for the continued monitoring of the health of Vietnam veterans.”

A Google Agent Orange image search displays heartbreaking images of bodily malformations these toxic chemicals have caused in populations that have been constantly exposed to them since the 1960s.  This cannot be the end of research and our duty to deal with the harm done by AO.

A recent Military.com article (LINK) provides these figures but how many Vietnam veterans have already died from AO diseases?

Roughly 1 million Vietnam veterans are enrolled in the VA health system, according to the department. Based on a review of data for one year, 5,484 of these veterans have been diagnosed with bladder cancer, 15,983 suffer from hypothyroidism and an estimated 1,833 have Parkinson’s-like symptoms.

hands-walking-stick-elderly-old-person

The article also says the VA will act on the updated research in about two years. Image: Pixabay

Hmmm.  It’s going to take the VA two years to read the report?

Posted in Agent Orange, All about Veterans, AO, Food for thought, Future Veterans, General Messages, Guest authors, research, Uncategorized, VA Health Care, vA news, Vietnam Disease Issues | Tagged , , , , | 3 Comments