04 March 2014

VA's National Center for Ethics in Health Care

Beginning in January, C-123 veterans brought a series of ethical concerns to the VA National Center for Ethics in Health Care. We had both intrinsic and extrinsic ethical concerns on a wide variety of VA actions.
We have been told the Center is not able to assist in our ethical questions. Although our confidential inquiries were elevated to the Center's chief, we were referred to the VA IG or perhaps US Attorney for any further discussions. It is disappointing to have a number of ethical concerns and not find understanding and resolution from the Center charged with that responsibility. We sought help understanding where we might be in error or have inadequate perceptions of situations. But as they suggested, many of the issues do seem to surpass "mere" ethical concerns.

As veterans, we are invited to turn to the Center for such a consult. This was very important because while we could describe the facts surrounding situations we were unskilled in correctly relating them to the highly sensitive area of ethical concerns...and wanted to insure that our situation, expressed with
caution and supporting materials, was received with the Center for help making a determination as to the ethical implications and search for a resolution with concern for avoiding any inferences of individual wrong-doing. Turning to the Center, however, turned out not to be the solution.

Among the many concerns about VA were raised:
• Selective use of references to achieve pre-determined conclusions against veterans' fundamental claims
• Improper reference to selective literature review as "all available scientific information which instead dismissed literature not contributing to predetermined conclusion
Questionable scientific methods
• Failure to obey the laws, and regulations, concerning veterans proving exposure to military herbicides being entitled to seek VA service-connection for recognized illnesses
• Failure to seek peer review, and failure to respond when independently offered by leading experts
• Failure to react to veterans' claims in a pro-veteran perspective
• Misstatements by senior leadership to veterans' legislators denying blanket policy of denying all Agent Orange C-123 claims
• Redefinition of "exposure" for policy objectives, without peer review or regulatory authority, and failure to respond to peer input contesting the redefinition, to circumvent the laws and regulations requiring VA to recognized exposed veterans' claims for Agent Orange-associated illnesses
• Official findings by other federal agencies confirming veterans' claims being mischaracterized into failure to support the claims
• Providing "boilerplate" claims denial language to regional offices, with questionable rejection reasons such as "regulations prohibit recognizing C-123 exposure claims" (there being no such regulation)
• Overriding regional office recommendation for claim approval, directing all claim be denied (but telling the Senate each claim is evaluated on its own evidence)
• Denying claims citing "a thorough search for supporting evidence failed to substantiate" but ignoring all submitted references of valid scientific and medical input since 2011
• Failure to accept input from NIH/National Institute of Environmental Health Science finding confirming C-123 veterans' exposure claim, the NIESH having statutory authority in this area
• Failure to accept input from US Public Health Service confirming C-123 veterans' claims, the USPHS having scientific and medical expertise in this area
• Failure to properly characterize expert toxicologists' scientific input confirming veterans' exposure, instead dismissing input as from scientists unqualified to comment on medical nexus; rejecting all toxicological input in violation of both 8th and 9th US Circuit Court decisions
• Unscientific dismissal of federal agency confirmation of C-123 exposure, inserting manipulative and deceptive sentence implied to be part of that agency's finding, that  no "conclusive evidence exists of TCDD exposure implications." Additional failure to correct when deception was repeatedly brought to the attention of senior personnel in Veteran Health Administration. Veterans Benefits Administration, and General Counsel.
• Failure to honor obligations specified in Federal Register 31 August 2010, with VA determined to prevent veterans' exposure claims; general failure to assist
• Deceptive Internet pages, some stating the inclusion of C-123 veterans with proof of exposure as able to submit claims, but Catch-22 hyperlinks to other pages asserting these veterans disqualification by predetermined rulings from Post Deployment Health
VA War Related Illness and Injury Study Center, which offers exposure assessments, has on its Internet site the VA's explanation as to how our exposures never occurred, despite all evidence to the contrary from other federal agencies and scientists (none of which is cited in "The science behind their conclusion"...which was instead a mere very selective review focused solely on C-123 exposures and designed for prevention of such claims, regardless of the law:
• Failure to reveal large potential savings by denying C-123 veterans exposure benefits
• Failure to resolve confusion regarding veterans' access to Agent Orange Registry, with the Secretary earlier issuing a directive that all veterans believing themselves exposed can receive an exam, but Post Deployment Health overruling the Secretary and forbidding C-123 veterans those exams, without clarification on the Internet page for the Registry
• Highly questionable use of Agent Orange Committee of the Institute of Medicine. The 2012 promise by VA to contract with IOM for a study was broken, but raised again two years later with a forecasted two year delay in any results from the study. Improper to scheme to use IOM as a delaying tactic faced with recent significant legal and scientific evidence surfacing which confirms C-123 veterans' claims. Ample proof exists today to meet the fundamental qualification under the law...these C-123 veterans were exposed to military herbicides – no moral or legal excuse for denying medical care to these veterans. VA seeks to postpone providing expensive medical care to ill and elderly veterans – the longer the delay, the greater the savings by refusing all care and benefits (dental, prosthetics, vision, pharmacy, rehab, primary care, counseling, etc.)
• Questionable influence upon the Joint Services Records Research Center to obstruct collection of documentation confirming veterans' exposure claims
• Questionable influence upon DOD/DCS/Logistics & Mission Support preventing designation of Agent Orange Exposure Sites

This is the VA motto...Defining Excellence in the 21st Century. In medical care...yes, most certainly. But if this is how VA expects to define Department-wide excellence...with deception of our legislators, mistreatment, broken promises, delayed medical treatment, unjustified dismissal of valid claims, use of consultants hostile to veterans issues, and other failures, VA has indeed redefined "excellence" with the same scientific precision as in their unique redefinition of "exposure!"

There is no shortage of medical and scientific excellence – once a veteran gets past the VA hospital doors, guarded so carefully by Post Deployment Health The care is loving, skillful, and life-saving...we want it for all our C-123 veterans!

The only excellence evidenced outside those doors is in the recognized skill of C&P and PHD in obstructing valid veterans' exposure claims.

Where can we turn? We've sought help from our VA doctors, Patient Affairs, General Counsel, VA Ethics Center, senior VA executives, the press, other veterans' organizations, expert scientists and physicians...but nothing will permit a C-123 veteran's claim for exposure to military herbicide to be approved. So, the only excellence we're able to acknowledge is that of Post Deployment Health.

They were charged with preventing our claims and they have succeeded perfectly. 100% of the VARO claims have been denied, and, other than spreading unscientific and misleading information with the hope it will help prevent claims, PDH has only an indirect role with the BVA. This small staff took on all of science and medicine by redefining exposure just for their own use. This small staff took on multiple federal agencies confirming the C-123 veterans' exposure and dismissed them all. This small staff successfully stalled all C-123 veterans' claims for the last three years, and with their suggestion for another IOM study, skillfully employed another stall good for two and perhaps, even three more years of denying all care and benefits to these aircrews.

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