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.

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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

Comparing hospitals

Alex’s previous post was written from a private hospital.  His medical team had no knowledge of AO.  So frustrating.  (Would it be too much to ask medical schools to hold required seminars on military exposures to toxins, etc..?)

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“Where to?” Image: Open Clip Art

“How to pick a good hospital” and “medical transparency” are hot topics today.  Some online rating tools are available now–even for VA hospitals.  

In emergencies, we get help wherever we can.  Later one may have the luxury to study the hospital compare sites to pick the best follow-up care for one’s condition.  These tools are useful to find the best doctors for second opinions.   If an insurance company doesn’t pay for second opinions outside of their network, there are services like Medibid to turn to. (LINK)

Consumer Reports Free Hospital Tool for Safety scores/compare (LINK)

U.S. News Best Hospitals 2015-16  (LINK)

Medicare Hospital Compare (LINK)

va search

Click for basic VISN info with star ratings

VHA VISN Quality of Care Measures  (LINK); Advanced data in online excel format which I cannot decipher or understand the statistics.  (Can you figure it out?)

VA Quality of Care Homepage (LINK)

This site, Why Not the Best (LINK), has some VA hospitals in their database–use “veteran” as the keyword.  They also have an awesome interactive map. Good video tutorial (LINK).  Created by a The Commonwealth Foundation.  Really useful.

Any others you like or have used?

Posted in Agent Orange, Guest authors, Medical News, non-va care, Uncategorized, VA Health Care | Tagged , , | 4 Comments

IHD–ANOTHER ONE BITES THE DUST

downloadWho woulda thunk it? I’m immortal or so I thought. Saturday morning at 0400 I woke up and discovered I couldn’t breathe. Imagine being under water for several minutes and struggling to reach the surface to take a large, overdue breath. Now imagine not being able to reach the surface. Boy howdy, if that doesn’t get your undivided attention then you’re really out to lunch. 

Being the quintessential male, I got up and took a shower. Showers have immense therapeutic value to men. I’m almost positive that Mr. Einstein stumbled upon relativity in the rain locker. Standing also seemed to be the trick. Lying down was right out. Having learned back in 1996 about how delaying medical care sometimes makes you immeasurably worse, I decided to make coffee and analyze this. I let Cupcake sleep in because I correctly figured this might involve a meat wagon run.

At 0600, I spilled the beans. Females catastrophize everything. As men, we all know this and anticipate the downstream fallout. Thus it behooves you to make the coffee in advance and have the car warmed up before you hit the Claymore plunger. Wise I am, yessssssssssss. Born of many a ride in a meat wagon, I find sirens to be too ostentatious. I’m just not a parade kind of guy.

Therefore, due to my tardy announcement,  at 0614 Hours we proceeded to Saint Anthony’s Hospital at an unsafe speed.  I was chided quarter-hourly thereafter for delaying the inevitable expedition for two hours. As some of you know, I spent a year in the VAMC in Seattle with a few medical misadventures. That creates a bow wave of resistance to going near one. The flip side to tardiness is the endless recriminations I will suffer for the brief two-hour procrastination.

As expected, it’s ugly. Congestive heart failure with a side of pneumonia and a tentative diagnosis of Ischemic Heart Disease. The doctor asked me if I had any risk factors or a family history of this. Other than two years in-country with a breakfast diet heavy on  AO/ABlue, I told him I, too, was drawing a blank on risk. That’s when the doctor drew his blank. He had never heard of Agent Orange. Neither had the nurses.

download (1)I would never believe our country’s collective memory of Vietnam and all the attendant, subsequent fallout could fade into oblivion in one generation. Consider this. The true nature of  the rainbow defoliants didn’t even pop up on the radar of public opinion until a decade or more after the Vietnamese boundary dispute had been settled to everyone’s satisfaction in 1975. Beverly Nehmer’s 1989 class action lawsuit  was the culmination of years and years of  VA refusal to honor Congress’ unequivocal 1984  edict on the subject.¹

I had always considered myself lucky in some respects that I only suffered Porphyria Cutanea Tarda when all my fellow Vietnam Veteran friends were coming down with Parkinson’s, DM2, prostate cancer and worse. Somehow, I felt bulletproof. I’m an optimist in the truest sense of the word. Being physically active always seemed the panacea for avoiding the host of ills associated with AO. I’m not dumping on Vietnam Vets with DM2 when I say this but  honestly, when your body mass index is off the charts for your size, it might be appropriate to venture farther afield to consider other possible etiologies. This is why I never even considered I’d have corroded arteries.

So, goodbye to salt, Brad. You’re off the hook for smoking any more for us. If the ‘cardiac’ diet they have me on here in the hospital is any future indicator, life is going to have a boring menu. But that is minor. I feel lucky that I got the 0400 wake up call early on and not a full blown heart attack as the initial exclamation point. However, the suddenness of it all did take my breath away (pun intended).

So now we sit and wait, Cupcake and I. We’re on day 3 and have yet to see a designated Cardiologist of any stripe-let alone my regular one. Let this be a lesson. Never fall ill on a weekend in this new world of Obamacare. Nobody wants to sign off on a heavy diet of IV Lasix or Levaquin to nip this in the bud. Instead, caution is the watch word with a heavy dose of “Let’s wait for the cardio doctor.”  Waiting may have its own set of dangers. I have a hard time sleeping while standing up. Well, that and such an intense dislike of hospitals that I am half-tempted to blow this Popsicle stand and just make an appointment expressly to see the good doctor the old-fashioned way (by landline).

And yes. I did consider the idea that the VA’s Vocational Rehab counselor that came out last week might have salted the ILP forms with Ricin or Cesium 137.

News and film at six.

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¹”Veterans’ Dioxin and Radiation Exposure Compensation Standards Act,” 98 Stat. 2725 (1984)

Posted in Agent Orange, AO, DM II, KP Veterans, Vietnam Disease Issues | Tagged , , , , , , , , , , , | 14 Comments

First non-VA care denial letter received

Although there is no mention of the Veterans’ Choice program in my husband’s recent non-VA care denial letter, our “geographical hardship” plea fell on deaf ears at the White River Junction VHA.  They received a pulmonary consult and treatment request from his sharp PC doc at the Burlington Clinic. We were able to specify (using secure messaging) exactly which local pulmonary specialist we wanted to see at UVM; that request was forwarded to WRJ–but all for naught.

WRJ VA works with Dartmouth (NH) and has good doctors.  That is not the issue.  The issue is accessibility. Why should we drive 200 miles round-trip? We’re talking an all-day proposition.  Here’s the text since my scan isn’t too good:

“This letter is in regards to denial of the recently submitted consult for VA payment of non-VA medical care. VA Regulations require that VA facilities must be utilized whenever possible unless there is a valid medical reason why they cannot.” 

va denial

We are not going to appeal this decision but we will call and find out if this denial letter is a blanket Veterans’ Choice denial, as well as a non-VA care denial. It was a test case since we felt it more prudent to use Medicare given that the VA is ruining veterans’ credit scores by paying slow.

I suppose we should complain to our senators, Leahy and Sanders, and to our one lonely representative, Peter Welch, about this on-going barrier to local non-VA care. Add our voices to the choir.  They got rid of the “as the crow flies” rule but local specialized care is still a pipe dream. (In fact, some VT vets have to travel to the Boston VHA for care–a congested traffic ordeal.) And as for the appeal option–it takes years to figure out their crazy methodologies as we have learned here.

Then there is the matter of the travel allowance.  It has been reported to only cover one way versus round-trip mileage in VT.  If that is true, the trip is simply not affordable for some vets.  And if a veteran is working, he/she will miss a whole day of work, probably without pay. Another hardship.

To their great credit, VT DAV volunteers provide transportation to the WRJ VA and there is a DAV shuttle from the Burlington area.  A veteran can be picked up at his/her residence (LINK) and then must wait in the lobby for a return ride.  This could be stressful depending on a vet’s condition.  A vet with PTSD may have to skip riding with a well-meaning stranger for a host of reasons.  But without other healthcare options, the DAV transportation is a welcome practical service.

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Thank you DAV for your free transportation program. Click image for informtion

Posted in All about Veterans, Complaints Department, Food for thought, General Messages, Guest authors, Medical News, Medicare for VETS, VA Health Care | Tagged , , , | 6 Comments

HADIT.COM BLOG TALK RADIO SHOW @1600 HRS ON LEFT COAST TODAY

haditlogo2007Jerrel called me up last night and asked if I wanted to do a show on the new VA shredder scandals. I said Loyal (BroncoVet) would be the go-to Vet to have on as well. Loyal caught them in Dayton back in 2008 remodeling his c-file. The show starts on the East Coast at 1900 Hrs because they are always behind the times. We’re better time managers on the Left coast and that allows us to be three hours earlier. 

The call in number is still

347-237-4819

Dial a one (1) if you wish to speak to us.

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The Regional Offices were in Atlanta, Chicago, Houston, New Orleans, Philadelphia and Reno, Nev. At least two of the 69 documents headed to the shredder directly affected benefits and nine had the potential to, according to the website. This means, with 56 VAROs, that 50 other offices were lucky there aren’t more VAOIG investigators running around.

Posted in Uncategorized | Tagged , , , , , , , , , , , , , , , | 8 Comments

BVA–LONG COOL WOMAN IN A BLACK DRESS

Capture

Jeany Mark Esq.

What could be better than a long cool Veterans Law Judge in a black robe than a red hot Vet’s law dog  on your team named Jeany Mark Esquire. Ms. Mark is one half of the tag team of Lieberman and Mark. The VLJ is no other than Ursula R. Powell. Imagine. An all-woman production with no testosterone involved. Given another day or two, they could probably solve Global Warming. I respect women for what they can accomplish unimpeded. No wasted words during work. Cupcake is a shining example. So is Ms. Powell here.

Several months ago, I had a query about who was a better Veterans Law Judge versus another. With about 78 to pick from, that’s a tall order. The Honorable Ms. Powell’s name came up and she was being cast as a hanging judge. I looked for myself on the BVA site and found her to be remarkably well-grounded when someone representing the Veteran actually shows up with the ingredients (Caluza/Shedden/Hickson) for baking the pie. Sadly, too many walk to the hangman’s noose oblivious to fact that their VSO representatives let this get in front of judge without an IMO. Service reps are taught

Kumbaya §3.102 (a)

Benefit of the doubt will carry the day.

They rhyme it so the reps won’t forget it. Anyway, I ran into this gem which illustrates a couple of really fancy ways to get around not the Hanging Judge but the Hanging RO RVSRs, DROs and VSCM “Judges” who deny this because they are forced to. Roger that. download-13It’s a jetgun decision. You could have the signed and notarized Buddy Letter from Jesus F. Christ. You could have service med recs that said you got Hep while you were in country in 68. If you blame the jetgun, all that flies out the window. 4th and long. Punt to BVA automatically. This is another Whacko RO, Texas decision. Caluza? Never heard of him.

 

About a year into this Johnny Vet figures out the password and the secret handshake and hires Dr.  K. Gutta M.D. to write his IMO. It’s a good one.

In a letter dated in February 2009, K. Gutta, M.D., wrote that the Veteran has been diagnosed with hepatitis C and cirrhosis, and has been stable. Dr. Gutta opined that it is more than likely that the Veteran obtained the Disease in 1971 at Fort Polk, Louisiana. As a rationale for the opinion, Dr. Gutta noted that a number of the Veteran’s colleagues also developed hepatitis C and, hence, there appears to have been cross contamination of a number of soldiers from that time. Furthermore, the Veteran does not have any other obvious sources of acquisition for the infection.

That should have rung the RO’s bell and provoked a grant right there. No. VA dawdles another four years and finally calls for their C&P/VA Examiner to read the tea leaves.

The Veteran was provided a VA examination in August 2013 for hepatitis, cirrhosis, and other liver conditions. The VA examiner interviewed the Veteran, and acknowledged the Veteran’s belief that he contracted hepatitis C through injections administered through air gun injectors during active service. The examiner indicated that the Veteran had “no known risk factors.” The examiner opined that it is as likely as not that the Veteran’s hepatitis C was incurred in or caused by the claimed in-service injury, event, or illness. As a rationale for the opinion, the examiner stated, “it is as likely as not that vet hepatitis c is related to military service in 1971 at Fort Polk, Louisiana, where he received air gun injection, which would be due to possible cross contamination.”

Obviously Nursey Nurse Examiner was new and had not been given the “briefing”- yet. Concerned SESs above telephoned downstairs a week or so later and asked Nursey Nurse to clarify her thinking just in case she had the vapors during the recent full moon.

Later in August 2013, the RO contacted the examiner who conducted the August 2013 VA examination for further rationale for the positive nexus opinion. In an August 2013 VA addendum opinion, the VA examiner stated that the cross-contamination was “due to poorly sterilized equipment causing transmission of hep C virus harboring in liver.”

Now, put this on pause for a moment and go back up to the Introduction. Read that last sentence.

Following issuance of the statement of the case, additional evidence was associated with the record. The Veteran has waived initial consideration of the evidence by the Agency of Original Jurisdiction (AOJ). Accordingly, the Board may proceed with appellate consideration. See 38 C.F.R. § 20.1304(c) (2015).

This is how you play VA Poker. Pry it loose from the VARO and get it to appeal. In the interim, crank out a new nexus letter or refurbish the old. I suspect it was an IMO kicker on the cirrhosis, secondary to the hep C. It’s glaringly obvious that this already had two concurring medical personnel saying it was SC and the RO denied with no nexus/IMO of their own. Pray tell, how? Well, come on, dude. If the legal help is free, you better supervise them a little bit. I’d give my eye teeth to see that denial. $100 says the mention of the word “speculative” was in there somewhere.

VLJ Powell is probably wondering why she has to be King Solomon the Wise to make this decision. Remember, too, that this poor guy began this in 2008-eight long years ago. This is VA poker show and tell finally explained. Vet 2, VA 0. Any Questions? Good. Give him his rating and a secondary on the cirrhosis and be quick about it. You can tell Ursula was brought up right. You didn’t hear a single word about those a–holes back in Waco who didn’t do their jobs.

Eight years, ladies and gentlemen Vets. Eight years. For something a first year law student could figure out in a heartbeat? Nonadversarial?

Next?

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Posted in BvA HCV decisions, C&P exams, HCV Risks (documented), IMOs/IMEs, Jetgun BvA Decisions, KP Veterans, Lawyering Up, Nexus Information, VA Attorneys, vARO Decisions, VARO Misfeasance, VBMS Tricks, Veterans Law, VSOs | Tagged , , , , , , , , , , , , , , , , , , , | 2 Comments

BVA–OPEN MOUTH, SHOOT FOOT

FROM THE DAVID KORESH MEMORIAL  VARO IN WHACKO, TEXAS

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VA examiners, over the decades I have witnessed the phenomenon, have reached conclusions no one else in the medical field could hope to. With perfect aplomb, they make pronouncements that are far reaching and totally unsupported by fact. I do give them credit for their imagination but the damage it wreaks on Vet’s claims can have serious, long term implications. Considering 85% of all claims are denied, it behooves VA to examine the M21 1MR process that drives such a high error rate. Here is a case in point.

Virginia Girard Brady VA Dragonslayer

Virginia Girard Brady
VA Dragonslayer

I always get a bang out of Virginia Girard-Brady, Vet’s attorney extraordinaire. Her office is prolific and successful in pursuit of claimants’ appeals. She always has tremendous success with HCV claims and here she hits one out of the park. However, her case was made for her, rather than by her,  due to the bumbling VA examiner who couldn’t string two sentences together and come up with a viable denial. The sum of the VA’s attempted denial consisted of 1) a positive nexus at worst and b) a misreading of 38 CFR 3.301(c) (1). While painful and ill-advised, the contraction of a venereal disease will never rise to the level of willful misconduct. Stupidity, yes but always in the Line of Duty!

This sounds like the semantic meanderings of someone far afield who cannot bring themselves to make a clear pronouncement pro or con. In the process, they accidentally give equipoise to the very arguments they set out to demolish.

steel-toed bootThe examiner opined that the “Vet was not treated for hepatitis or had any symptoms of hepatitis in his STR. He denied that he was jaundiced. The air jet vaccine gun is plausible way [sic] of his getting this. However, he has other risk factors, like h/o multiple sexual partners w/ STD. The air jet injector gun is associated with hepatitis B transmission (see http://www.ncbi.nlm.nih.gov/pubmed/17879809). Hep C has similar transmission. The June 29, 2004, VBA Fast Letter (04-13) says that this is plausible. However, the vet also had multiple sexual partners which is also risk factor for developing Hep C. So the airjet gun, may have been the cause of his Hep C. This may be related to his military service, but he has other strong risk factors that make this less likely than not that this is service connected.” The examiner provides no rationale for why the Veteran’s multiple sexual partners is a more likely risk factor. The Board finds this opinion to be contradictory in that the VA examiner found that the air jet gun theory is a plausible basis for the Veteran hepatitis, but he also found that the Veteran’s multiple sexual partners may have been the cause of the hepatitis. The Board finds that this examiner’s opinion places whether the Veteran’s hepatitis B and C were caused by an air jet gun into equipoise as it both supports the theory and also finds another basis for the Veteran’s hepatitis. The question of a nexus now in equipoise, the Board finds that 38 U.S.C.A. § 5107(b) is controlling and that the benefit of the doubt should be provided to the Veteran, and thus service connection for hepatitis B and C is warranted.

(As an aside, I want everyone to take note. I began referring to the “air inoculation device” as a jet gun in my blogs back in 2008. With great pride, I see the term jet  gun  finally catching on.)

Assuming the Whacko’s  VA examiner in this case was also pontificating the same day on other claims from our Texas Johnny Vet, how about a few of these gems.

DVT and/or Peripheral Vascular disease

45-inch-hole-plus-peripheral-traumaIn the Board remand, the examiner was directed to expressly address and reconcile the contemporaneous in service findings of lower extremity pain, tenderness, and swelling documented, the SSA determinations showing that his DVT has rendered him unemployable since February 1995, and the lay statements attesting to a history of “blood clots” and related peripheral vascular disease symptoms persisting since his active service. See August 2013 Appellate Brief, March 2010 Statement from D. McGee. The examiner’s opinion consisted of only this remark “Vet checked no to cramps in his legs on his discharge physical. So his legs did not bother him. He was seen for acute knee and ankle injuries, however, there is no documentation of blood clots in his STR. His knees or ankles didn’t seem to bother him at discharge either. Therefore, the evidence is lacking that his DVT is service connected.” In addressing the DVT issue the VA examiner only wrote “Vet’s STR does not have evidence that his current chronic DVT is related to another service condition. His STR does not have any evidence of peripheral vascular disease.”

The vernacular of the examiner(s) is uniquely the same  again here.

Respiratory Disorder

dorsal aspect showing expansion of projectileIn the 2014 remand, the respiratory examiner was directed to expressly address and reconcile the contemporaneous in service findings of congestion and wheezing, the post service evidence of treatment for chronic bronchitis beginning in the mid-1990s, and the lay evidence regarding a history of recurrent coughing and related respiratory complaints persisting since his active service. The examiner wrote “The vet had one episode of wheezing on 5/24/77 which was attributed to a “cold.” He did not have any other episodes in his STR. He also said he did not have asthma on his discharge physical. The examiner did not note any wheezing either. So the evidence is lacking that his asthma is service connected.“ The Board notes that the VA examiner did not comment as instructed on the chronic bronchitis beginning in the mid-1990s or address the lay evidence of continuous symptomatology. Therefore, the Board finds that the Board’s remand directive was not fulfilled.

These are the ruminations of Veterans Law Judge Gail E. Strommen. If this is the new standard by which we will be judged, God forbid. We’re heading into a perfect storm of remands in search of coherent VA examiners who can read at a 9th grade level and remember to fetch the pertinent contemporary records before ruminating. Once they analyze each individual’s claims, they will be required to opine and subsequently support their findings or this just becomes another exercise in stupidity. We, who live in trailer parks or under posh, well-furnished overpasses, are required to produce cogent, well-reasoned treatises on why we are afflicted with disease and injury. Further, we are required to tie it to our service. Lastly, we are precluded from making any observations requiring medical expertise in diagnosing our ills.

Apparently, VA is not bound by these same codicils.

Asknod's VA Logo

Posted in BvA HCV decisions, HCV Risks (documented), Jetgun BvA Decisions, Jetgun Claims evidence, KP Veterans, Nexus Information, Tips and Tricks | Tagged , , , , , , , , , , , , , , , , , , | 8 Comments

CAVC–GOPAN V SHINSEKI- LINE OF DUTY FOR DUMMIES

vetcourtappealspromoOver the last eight years I have read law. Lots of it. Line of Duty (LOD) determinations are one of those fuzzy areas where everyone can agree to the same thing for five minutes. Then along comes another LOD appeal and all the existing law flies out the window. Here’s a 2009 Single Judge decision by old Judge Greene that illustrates the propensity of the BVA boards of three back in the early days to deny for no other reason than that they could. 

In 1961, VA instituted Boards of three Veterans Law Judges (VLJs), one of whom was a dual hatter-i.e. a Juris Doctor with a Medical Doctorate as well. I often wondered if s/he was remunerated at a higher rate. If not, s/he was a chump.  These VA Boards (twenty) were entrusted with hearing Veterans claims and deciding their merits. Rather than shuffle the Judges about geographically, each Board was assigned an area of the continental United States or one of the outlying areas such as Manila, Anchorage, Hawaii or Puerto Rico. If you, Joe Veteran, lived in Seattle, you would get the same Board over the life of any claims you appealed. This didn’t change until they reshuffled the deck after the passage of the VJRA in 1988 or the judges kicked the bucket/retired.

Another disagreeable aspect of the Board of Veterans Appeals back in the days of Mr. Joel L. Gopan was the lack of  a mechanism to appeal higher. Quite simply, if you lost at the BVA, that was all she wrote. Given the fact that most Judges realized which side of the bread was buttered, they tended to rule against Veterans. Their paychecks came from the VA and it was just de rigeur that they defend their own institution.

Meet Joel L. Gopan and his amazing 1971 technicolor CUE (clear and unmistakable error). Add in a side of earlier effective date and you just know this is going to be a good read.

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Also, in conjunction with Line of Duty, I include a newer one by Judge Coral Wong Pietsch on the same subject. They bring two different theories to the table on LOD claims. Mr. Gopan’s is intriguing solely for the proposition that VA refused to recognize a clear LOD determination by the Nasty Guard that his injury occurred as stated and he was subsequently discharged for medical reasons directly attributable to it. On the other hand, Mr. Raymond Alley’s decision was remarkable for VA’s refusal to recognize their own rules and regulations saying they are not bound by the military service’s determination of LOD-in certain circumstances.

AlleyRL_12-691

Early VA justice has always been considered lopsided, slipshod and poorly reasoned. The reason for this philosophy is simple. It was. This is one reason we have so much success opening up the books and getting SC for some who have lost repeatedly. Oddly and fortunately, those of us too dense to appeal to the BVA are somewhat blessed. A BVA decision subsumes a piss-poor Regional Office decision and rarely can be reversed as Mr. Gopan did here. By failing to file an appeal and allowing a decision to expire, it leaves open the possibility or overturning it later on CUE. This is not to say that a reversal of a BVA decision in 1971 based on CUE below at the Regional Office is impossible but the menu of options (read reasons) is far more restrictive.

Joel’s  1971 BVA decision was a whitewash.

Although the service department had assigned a line of duty determination to Mr. Gopan’s disability, the Board concluded that it was “patently inconsistent” with the law administered by VA to hold that Mr. Gopan’s old adhesions and regional entritis (sic) could have been aggravated during his few days of service, especially since there were no new internal injuries found.  Thus, the Board determined that Mr. Gopan had no in-service injury while on active duty for training that would entitle him to benefits.

When Joel finally won thirty years later in 2001, he filed for appeal on two separate counts. Number one was the clear and unmistakable error that 1971 was the correct effective date and two, that he was erroneously denied in 1971 due to a misreading of 38 CFR §3.1(k). The fact that the RO granted his claim in 2001 precisely because the medical evidence from his STRs in 1971 showed it occurred in service made this a no brainer. Nevertheless, the BVA was not going to okay a gazillion dollars in a Fenderson staged rating from 1971 to now without a very big fight to the CAVC.

In line of duty means an injury or disease incurred or aggravated during a period of active military, naval, or air service unless such injury or disease was the result of the veteran’s own willful misconduct. A service department finding that injury, disease or death occurred in line of duty will be binding on the [VA] unless it is patently inconsistent with the requirements of laws administered by [VA].

Mr. Gopan was on firm legal ground in 1971 and got a rotten deal. His CUE hinged on the red above. Mr. Alley’s win hinged on the second half in blue. Thus you can see there is much more to LOD than spotting the acronym in the contemporary service records.

The 1971 BVA Board, as well as the 2007 Board of One Judge, both got it wrong. Granted, VA is loathe to overturn old decisions based on CUE. We saw this phenomenon in Macklem v Shinseki play out all the way to the Fed. Circus and quietly disappear. I have often theorized that the BVA’s refusal to grant my earlier effective date back to 1994 was born of the same rationale. Deny it and force it up to the CAVC. Obviously there are two possible immediate outcomes. The Vet may not appeal and secondly, the CAVC may see it VA’s way.

Mr. Gopan’s tenacity and inherent sense of justice wouldn’t permit him to let this one go. Mr. Alley had nothing to lose. He was headed to the locker room with nothing if he lost. Granted, Alley’s circumstances were arguable to some degree but the bottom line is Chevron deference. VA clearly wrote 3.1 to encompass a benefit of the doubt as to the severity of the crime that would forbid service connection. Judge Coral’s reasoning on it was superb. The codicil of willful misconduct will always be the legal standard rather than a dry parsing of the term “Not in the Line of Duty”. Here’s how it shakes out.

The applicable VA criteria for a negative line of duty finding are different from the military criteria. Specifically, Army regulations in 1962 provided that a negative line of duty determination
required substantial evidence that an injury or disease was “[i]ncurred or contracted during a period of unauthorized absence.” AR 600-140, para. 16 (1962). Army regulations further provided that “a period of unauthorized absence” was established when a service member “voluntarily absented himself from his unit or organization or place of duty without proper authority, or was absent from a scheduled duty or restriction, at the time the injury or disease was incurred.” (emphasis in original). Applicable VA regulations, however, require a finding that the claimant was “absent without leave which materially interfered with the performance of military duty.” 38 C.F.R. § 3.1(m)(1). Thus, the VA regulations applicable in this case, unlike the 1962 military regulations, require a finding that the claimant’s absence materially interfered with the performance of his duty.

The BVA generally is far more likely to deny anything which is not in the line of duty more so than they are to approve. Seeing the word ‘not LOD’ in the STRs virtually ends the discussion as does ‘willful misconduct’. Conversely, VA is loathe to grant when they see anything they believe smacks of willful misconduct even if the military record in question iterates it was LOD. This dichotomy throws off many VA attorneys and they never question it or the possibility the logic/regulation/statute is being transmogrified.

Simply put, a Line Of Duty determination is not determinative until the CAVC has spoken to it. We pretty much know what VA’s take on it is going to be. Considering they deny 85% of all decisions-right or wrong- we would be fools not to tug on the loose thread of this Walmarket® sweater to see if it unravels. Obviously, certain acts such as AWOL (absent without official leave) are inexcusable for the most part. I’ve seen them overturned for compassionate reasons so they, too, are not definitive examples of immutable case law.

Never for a moment think a Not LOD is the last word on the subject. Allow me to show you a glaring hole in Hepatitis C jurisprudence many VA attorneys fail to pursue. Remember, this is perfectly legal.

Imagine:

Johnny Vet is in combat in Vietnam. One of his buddies says “Here, shoot/snort some of this junk. It’ll calm your nerves before the gooks come through the wire tonight. It’s gonna be ugly.” Johnbo does this a few times and decides it’s not his drug du jour. He never does it again and 30 years later he discovers his actions  have caused a raging case of Hep C that’s killing him. Willful misconduct for doing drugs? No. And here’s why.

38 CFR §3.301(c) (3):

(3) Drug usage. The isolated and infrequent use of drugs by itself will not be considered willful misconduct; however, the progressive and frequent use of drugs to the point of addiction will be considered willful misconduct. Where drugs are used to enjoy or experience their effects and the effects result proximately and immediately in disability or death, such disability or death will be considered the result of the person’s willful misconduct. Organic diseases and disabilities which are a secondary result of the chronic use of drugs and infections coinciding with the injection of drugs will not be considered of willful misconduct origin. (See paragraph (d) of this section regarding service connection where disability or death is a result of abuse of drugs.) Where drugs are used for therapeutic purposes or where use of drugs or addiction thereto, results from a service-connected disability, it will not be considered of misconduct origin.

Hepatitis C is an organic disease. The plethora of secondary diseases associated with Hepatitis C is extensive. An infection often takes 30 + years to manifest itself. The clear reading of this regulation can only imply that if you contracted HCV due to using drugs/sharing a needle or straw and were never addicted or a chronic user is that your HCV can legally be service connected.

The mention of paragraph (d) is as follows:

(d) Line of duty; abuse of alcohol or drugs. An injury or disease incurred during active military, naval, or air service shall not be deemed to have been incurred in line of duty if such injury or disease was a result of the abuse of alcohol or drugs by the person on whose service benefits are claimed. For the purpose of this paragraph, alcohol abuse means the use of alcoholic beverages over time, or such excessive use at any one time, sufficient to cause disability to or death of the user; drug abuse means the use of illegal drugs (including prescription drugs that are illegally or illicitly obtained), the intentional use of prescription or non-prescription drugs for a purpose other than the medically intended use, or the use of substances other than alcohol to enjoy their intoxicating effects.

This was my chauffeur-driven Lexus many times. The "O" stood for obsolete. Note the pod with the marker rockets on the outboard pylon

This was my chauffeur-driven Lexus many times. The “O” stood for obsolete. Note the pod with the marker rockets on the outboard pylon

As you can see, paragraph (d) and paragraph (c)(3) seem at odds with one another unless you only focus on the phrase “organic disease” and can, in clear conscience, say you didn’t do it for it’s intoxicating effects.  Most importantly, you must reach the high ground of “I never abused drugs”. Hell, I smoked a joint fairly regularly before I took off to keep my hands from shaking and to get my courage up. Granted, I shared bongs but I doubt I got Hep C from it. I can’t say I did it for its intoxicating effects. I did it to remain sane. The very last thing I wanted to be was ‘intoxicated’ on any drug in a combat setting. You need every ounce of concentration to stay alive. And, no- rest easy, folks. I never shot up drugs. My Hep C was held to be caused by a transfusion subsequent to an errant 7.62 X 39mm projectile.

Before any of you ever just accept conventional wisdom on what a regulation or statute says, read it yourself and carefully parse the usage of each and every word/sentence to see how and why an action such as LOD or willful misconduct is, or can be, arrived at.

I have used the bolded purple above to help Veterans get service connection for hepatitis C, secondary to PTSD a few times. Again, a perfectly viable path to service connection exists if you are shaking like a leaf on a tree and decide a dose of white lady was preferable to desertion or going AWOL. I doubt any of us would have ever indulged in something we thought was going to result in a terminal disease a half century later.

The perfect cockpit seat we were never issued.

12932749_579936718840516_4301679800777096140_n

 

 

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ILP–THE LAST SUMMER

635646931319099161-veterans-administration-logoAssuming the VA makes good on its promises, August will be the month construction begins on the greenhouse. Having waited almost five years, five more months seems like a heartbeat away. Tuesday last, I met with my old Vocational Rehabilitation Specialist to go over the program’s objectives. As an aside, I wish to comment on the definition of ‘rehabilitation’ and VA’s interpretation of it. 

To VA, and more explicitly, VR&E, the term ‘rehabilitation’ is a borrowed term from occupational therapy. In their context, it connotes a successful path to a new physical plane of existence. Were you to be granted a riding lawn mower, rehabilitation would mean you had mastered the transmission and throttle and were not in danger of navigating off a steep precipice on your property. You would accomplish this by going through the paces under the watchful eye of your assigned Voc. Rehab. Counselor. It might require as much as sixty days and several visits to confirm you were cutting the grass at the proper height and actually using the machine for the purpose intended. Knowing Veterans’ propensity to drink and imbibe drugs, the Counselor has to make sure you are not using it as a substitute for a ‘mobility device’ to get to the local bar. Apparently VA has caught more than one Vet with a suspended driver’s license doing this. Being easier to ride than say, a bicycle, and more forgiving, it has the potential for applications for which it was never intended. This may be why they are being denied more frequently these days.

When I prevailed with my request for a computer, I was assigned a private voc. rehab specialist in computers. My guru, Jim Moss, was very pleasant and actually planned for my future computer needs. Many may laugh and say “Dude. You got a Dell.” After four years, the machine is still a powerhouse simply because he had the foresight to give me a massive hard drive and a handful of thumbdrives that boost it into the 40 gig range. I have no desire to install Windows 10 and start over on software. It’s taken almost that long to master the intricacies of my Adobe 9 Pro.

In respect to a greenhouse, it appears my current VA-employed Voc rehab guys will want to be my mentors. Even though they are clueless as to which end of a garden hose to attach to the spigot, they know the value of free vegetables. The IL Plan calls for him/them to visit monthly to make sure I’m watering the plants properly. It says as much in the Individual Independent Living Plan (IILP). I have to stand and deliver my fruit and seasonal veggies as well as show I’m planting regularly.

As I mentioned in the Hadit.com radio show yesterday ( April 14th, 2016), the preliminaries are all but over. VA has decided to accept an old (August 1, 2014) occupational therapy assessment (private) as adequate for their requirements. This will speed up the eventual beginning of a construction date. VA is not one to rush into these things. You or I could call Farmtek and have this puppy up and running by late May. VA insists on a medical evaluation, a psychological assessment, a GSA assessment, another whizbang who will make sure the handle on the hosebib is ergonomically agreeable to my wrist strength, et cetera.

I can almost imagine what ensues when these ILP weenies come in to install grab bars and give you can grabbers.

“Okay, Johnny. Can you demonstrate how to properly hold that grab bar to avoid falling? Good. That’s good. Now, would you demonstrate the proper use of your can grabber on the can of Bush’s baked beans up there? Now be careful not to stand directly under it when retrieving the can on the off chance the can parts company with the grabber. Excellent. Now, let’s move on to the socks puller uppers. Shall we?” Keep in mind this takes several visits on a monthly basis to ensure the rehabilitation is successful. In theory, you could master the mysteries of a cordless phone in as little as six months.

My rehabilitation for the computer was several years and I called Jim periodically with questions as necessary. VA paid Jim mass quantities of $ for his services. The computer bill for all the goodies was about $1400. Jim’s bill was about thrice that.

I look forward to being rehabilitated. In fact, I was perfectly frank with Mr. Holloway when I said I didn’t think I could master the intricacies of hydroponics in 60 days. I suggested two years because I didn’t just dock on the USS Mayflower last night. Having learned a painful lesson, I have discovered VA is on the hook for all the peripherals. Thus I missed out on all the printer ink and paper for my printer for several years. In gardening, and more so in a heated greenhouse, VA is required to pick up the tab for the propane heating and the electricity. Two years of propane alone at 3 gallons a day @ $2.30 a gallon from October to early May is a sizable amount of money. You can see VA’s desire to rehabilitate me in as short a period of time as possible. What’s amusing is that they spend almost five years saying my gardening assets were adequate and now are required to don sack cloth and anoint themselves with ashes, all the while agreeing that what I desire is readily obtainable, necessary and long overdue.

still-saving-private-ryan05Cupcake’s dad, who was in the first wave ashore at Omaha Beach in 1944, passed in June 2010. He went from a corporal to a Second Lieutenant in 90 minutes. I was faced with much the same when he passed. I had no knowledge or training in horticulture and had to learn it from scratch that spring. In spite of my relative agnostic religious affiliations, it often felt her dad was guiding my hands. Of course it could have been all that Dilaudid pain medication too. Back then VA was handing it out like Halloween candy in Tomah, Wisconsin. I’ve never had a physician say “Here’s 218 hits a month. If it’s not enough, call me.”  I was having a hard time finding my zipper fast enough to pee after eating two of them puppies.

Nevertheless, I am now a Jedi Knight gardener. With the greenhouse, I will become a Master. The thoughts of all the past years working in dirt will fade. Someday I’ll look back and think of it fondly as the era before plow mules. No one can dispute that there is an inherent fondness among farmers for running your hands through rich loam and composted horseshit. I will keep half the garden in dirt just to do corn as I can never conceive of that as a hydroponic endeavor.

Here’s to the last summer in the sun. I aim to enjoy every moment of it. We have also preserved fond memories of it annually here in posts on ILP

https://asknod.org/category/independent-living-program/

photo 3 (1)

The Tactical Operations Center (TOC)

The old greenhouse

The old greenhouse

photo 1

photo 2

The future greenhouse site

The future greenhouse site. I didn’t think old Shadow (12) would live to see it. Or me, for that matter.

There are so many of you I’d like to thank for your help over the years. Moving dirt is a dicey proposition when you have no abdominal musculature to mention. In addition, to learn far more about all this, please visit our sister site at Hadit.com and check out the podcast we did yesterday on this subject.

http://www.blogtalkradio.com/haditcom/2016/04/14/haditcom-blog-talk-veterans-radio-show-with-jerrel-john-and-alex-ilp-specia

An ILP program in your future is much closer than you think. In 2011, I dreamed big. For five years I cherished that dream and fertilized it with NODs and VA 9s. It will all now come to fruition because I persevered. You can too.

In memory of Paul Burch’s passing recently, we’ll be planting Silver Queen again this year.

 

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HADIT.COM RADIO SHOW AT 1600 HRS ON THE LEFT COAST

haditlogo2007Today we’ll talk about the complete turnaround in attitude, the new VA Rodney King “Can’t we all just get along?” plaint and more. VA VR&E folks are not saddled with this phenomenon more than once in a lifetime. My original “Vocational Rehabilitation Counselor (VRC in VR&Espeak) was the low man on the totem pole and got the “Go deal with the nutjob but make sure the GPS on the vehicle is operational in case we have to come find you.” job.

10639533_10154768542645644_6478576956061279545_nKris arrived with knee pads and proceeded to apologize as only a VA weenie can. It began with”We were trained to ah work on getting you back to ah work… or… We always thought that ah, avocational pursuits were ah  right out… or…. The M 28 is mighty vague on a lot of this and we ah simply had nothing to ah go on…  The only thing besides too many ahhs and mouth breathers that ticks me off are people who use “yuh know” about sixteen times in a sentence. If you hear me use ‘you know’ it’s because you are the subject of the sentence and ‘you know’ is at the beginning.

Here are a few head notes to look at re the show. I present a live, defective Individual Independent Living Plan or IILP. There are several preliminary objectives.

New IILP for 2016 redacted

1) They want a c&p of sorts to make sure I don’t keel over from a myocardial infarct. They wanted me to go to the Bremerton Community Based Outpatient Clinic which they now call the Bremerton VAMC. One large room- two doctors, four nurses, four examining rooms. A lab to draw blood and urine for drug testing. Basically, the usual including about half of the population suffering from what sounds like double pneumonia. I traded and said we’d use my treating Medicare physician-you know, the one with the real nedical degree from an American hospital/Med school.

2) GSA Contractor will survey and build to suit me based on medical/ADA needs. (right!)

3) I promise to continue seeing my physician to make sure I am healthy

4) Lastly, the program will commence as soon as I sign it, not when the greenhouse is built. Worse, it will end in a year in April 2017. This is VA at their finest hour. I get free electricity, free propane and free fertilizer for eight months. I said I wanted a 2-year commitment as most ILP ‘rehabilitations’ run. They agreed 24 hours later without a blink of the eye. That’s a passel of propane, partner.

Next, I want to give you a jolt. The bid from Farmtek is almost eight months old but they promised to honor the price.

greenhouse + install quote redact  As you see, this is already up to $74,544.20 FOB.

Capture.JPG 22

Then there’s the utilities into the new structure. And the slab on grade foundation with a 36″ high foundation walls on the low sides for about $10 K-and of course the 24 X 48 X 4″ thick slab. And the rubber mats in case I fall down. And…

My VRC tells me there are more eyes in Washington’s VA Central Office (VACO) on this than there are eyes in a potato patch. Every comma, every change in the document I attached above requires 500 attorneys to parse it for the potential financial effects. Remember, we cannot go over $180,000.00. Oddly, when Bruce McCartney did this in Georgia back in 2007, he squeaked by on about $35 K. And for a 30 X sixty monster. All I originally asked for was a bigger greenhouse than the 6X8 I was in. VA could have gotten away for a song and a dance with a six by sixteen but they decided to fight. Now we’re talkin’ 1152 ft.². That’s bigger than a lot of houses I’ve built.

And that is what we are going to talk about today. Many of you have fought long and hard to win your VA benefits. Ratings shenanigans are a classic example of the VR&E’s techniques or vice versa.. They ignore the rules, they overlook evidence and then misinterpret the evidence they do have.  I don’t know it it’s on purpose. Who cares? You want to win so there’s nothing gained wondering what went wrong. We’re going to teach you how to do a VR&E nexus. Here’s mine.

ILP Evaluation 8-2014 redact

Here’s the BVA decision.

http://www.index.va.gov/search/va/view.jsp?FV=http://www.va.gov/vetapp15/Files5/1538123.txt

The Show starts a 1600 on the left Coast and 1900 on the (L)east Coast. And yes, I will answer Buck’s question at the beginning.

“say in a case that the vet was awarded a 50% back in 1998 but never received anything until 2001 and then it was just an award letter letting me know I been awarded a 50% increase  dated back to when I filed for the increase which was about a year later…..in my recent ptsd award letter they stated I been 50% since 1998  that is news to me because I seem to on;y have got the 50% award in 2001 or dated back to 2001 and was awarded it in 2002  so they did give me a years worth of retro.”

Remember, the telephone number to dial in and listen is

347-237-4819

ss-call-me

To open mouth and insert foot, press one (1) at any time. We welcome callers.

lightninghadit.com is not responsible for asknod’s comments or loose tongue.

 

 

 

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