29 July 2014

Senate Confirms McDonald as Secretary of Veterans Affairs

Today the Senate approved President Obama's nomination of Mr. McDonald as the new Secretary of Veterans Affairs. He will take office after being sworn in.

Welcome aboard, Mr. McDonald. Your Department and the veterans' community look forward to constructive changes under your leadership.

VA Internal Survey Released Today Reveals Scandal Worse Than First Thought

From USA Today (reporters Gregg Zoroya and Meghan Hoye)

Internal VA documents show the depth of fraudulent scheduling, manipulation of data and in some
cases intimidation of staff to hide delays in medical care to veterans in the 6-million patient national system.

Auditors found at least one appointment scheduler at 109 VA medical centers who said wait times for veterans had been falsified, according to a USA TODAY analysis of internal VA survey data made public Tuesday. To keep evidence of delayed care out of the VA's official electronic tracking system, secret lists were maintained at 110 facilities, the analysis shows.

Workers at the Department of Veterans Affairs outpatient clinic in Wilmington, N.C., told auditors they "were fearful of retaliation" if they did not manipulate appointment data.

At the Edward HInes Jr. VA hospital in Hines, Ill., near Chicago, "staff felt they would be subject to disciplinary action" if appointment records were not changed, one report shows.

Managers instructed or "encouraged" schedulers to falsify appointment data at such VA medical facilities as those in Leeds, Mass.; Jacksonville, N.C.; Virginia Beach and Cleveland, according to the documents.

The audit by the VA's Veterans Health Administration was ordered earlier this year by then-VA Secretary Eric Shinseki. The results were provided to President Obama on May 30, the day Shinseki resigned.

The Senate on Tuesday confirmed Obama's nomination of former Procter & Gamble CEO Robert McDonald as Shinseki's successor. McDonald, 61, of Cincinnati, was approved on a 97-0 vote to replace Acting VA Secretary Sloan Gibson, who took over after Shinseki resigned.

Auditors interviewed more than 3,200 employees at more than 700 clinics and hospitals to gather their findings.

A broader investigation underway by the VA Inspector General and the Justice Department is scheduled to be completed next month. Gibson has testified in Congress that "several supervisors" are being investigated in connection with potential criminal charges.

The VA issued a statement late Tuesday saying it is seeking disciplinary action against six employees working at a hospital in Cheyenne, Wyo., and at an outpatient clinic in Fort Collins, Colo., for manipulating appointment data.

One of the six is a regional director; others include the director of the Cheyenne hospital and the chief of staff there. The VA said it is seeking to have two of the six fired. The agency said it found evidence that supervisors personally manipulated data, instructed subordinates to do so and withheld accurate information from higher officials.

Internal investigations found that clinic or hospital chiefs may have manipulated appointment data in order to look better on performance evaluations upon which their bonuses were based.

"As these new details make painfully obvious ...some VA executives are so driven in their quest for performance bonuses, promotions and power that they are willing to lie, cheat and put the health of the veterans they were hired to serve at risk," said Rep. Jeff Miller, R-Fla., chairman of the House Committee on Veterans' Affairs.

The internal audit made public Tuesday shows that schedulers who said they did not manipulate data worked at medical centers that reported the longest wait times, according to official VA data.

Westover Veteran Dan Kibe Dies, July 29

Friends, sad news.

Westover veteran Dan Kibe, a retired member of the 74th Aeromedical Evacuation Squadron passed away an hour ago, around 1:00PM Tuesday. He will be missed by all, and admired for a life of service to our country. God bless!

28 July 2014

Its a Deal – House & Senate Agree on Veterans Bill

They pulled it off somehow. 

Last week's mess with the House and Senate Veterans Affairs leaders disconnecting over funding for a vital veterans' bill was alarming. The congressional recess beginning this Friday might have spelled continued disaster for veterans nationwide, with proposed solutions to the current scandal abandoned.

But they did it. Senator Bernie Sanders, supported firmly by his Ranking Member, struck a compromise over the weekend with Congressman Miller, reducing the Senate's $35 billion goal, but increasing the House amount of just $10 billion, to $17 billion.

Amazing that this is the same figure quoted by Acting Secretary Gibbons for VA's immediate needs. Amazing, too, that Congress did something real for a change.

Congratulations for all the hard work on the Hill! 

27 July 2014

Secretary-Designate McDonald Not in Step with Post Deployment Health – Big Mistake Under Oath

VA Secretary-Designate McDonald
Post Deployment Health in VA's Veterans Health Administration had better get the word to the Secretary-Designate! According to those folks, Mr. McDonald's uncle was never exposed to Agent Orange while serving in Vietnam. His uncle's present care from the VA is only provided because VA is forced to by the Agent Orange Act of 1991.

In his confirmation hearings before the Senate Veterans Affairs Committee last week, Mr. McDonald described his service, and the service of his family, in the military from World War II, where his dad was a POW, to Vietnam, where his uncle was "exposed" to Agent Orange for which he now receives VA care. He said it, under oath. His uncle was exposed to Agent Orange in Vietnam.

...and under oath, too!
Careful there with your sworn testimony, Mr. McDonald. Big, big mistake!

You really should have run your testimony past your experts at Post Deployment Health. They have carefully explained to us, and to the Institute of Medicine, that none of the Vietnam ground troops was exposed to Agent Orange. Because your uncle can't prove bioavailability, he was never exposed! Give your uncle a call with the good news!

Forgive the sarcasm, please. We're on your side of the truth, but Post Deployment Health isn't.

What's the basis for this? Following the lead of their $300,000 per year consultant, VA Post Deployment Health has redefined exposure to require veterans also prove bioavailability...the presence of dioxin in the body. Like all other Vietnam vets, Mr. McDonald's uncle can't prove that, just as C-123 veterans can't prove such a thing three decades after our last flights.

Because of such an impossible barrier which VA used to deny their disability claims for decades, in 1991 Congress simply provided presumptive exposure for Vietnam veterans. For non-Vietnam vets like C-123 folks, we have to prove an exposure situation, and then the presumptive eligibility for Agent Orange benefits applies.

At least, that's the law. Its not the way the VA sees it, in their determination to "draw the line somewhere."

VA unscientifically redefined exposure to skip out on its own commitments made in the Federal Register regarding post-Vietnam Agent Orange exposures..."exposure = contamination field plus bioavailability."

We wish Mr. McDonald great success in leading the VA to new levels of excellence. We certainly wish his
uncle well in the care he receives from the VA for his Agent Orange exposure. We wish VA would not reinvent "exposure" as their tactic to prevent giving us the same vital care.

26 July 2014

C-123 Veterans Charge to the Institute of Medicine C-123 Committee, June 16 2014

INDEPENDENCE.

The IOM web site, and staff emails, end in “.edu.” and not “.gov.” The Institute of Medicine is independent, say both the Department of Veterans Affairs and the IOM. Respectfully, we ask for your independence to be exercised.

But the VA charge restricted your independence, and gave rise to confusion when instead VA should have sought useful answers. We listened to the confusion and attempts to clarify the charge back on May 15 at the first public meeting.

Back on May 15, you weren’t briefed by VA that the report of this committee, if strictly in response to the VA’s charge, still won’t affect C-123 veterans’ access to VA care. The wording on the charge was chosen most carefully.

Yale Law, and other legal scholars, and the VA itself through publications in the Federal Register, have made it abundantly clear that the sole qualifier for Agent Orange illnesses to be treated by the VA is a veterans’ proof of exposure, or proof of service in Vietnam or on the Korean DMZ.

The real question is not how much harm. The real question is not how much exposure. The real question is not about bioavailability.

The answer to the real question is vital, yet the real question itself wasn’t even raised in the charge to the committee.

That question, one you are asked by us to answer more fully, is whether or not we were exposed and are thereby due care. Last month we discussed the “as likely to as not” decision point for medical claims. The level of proof, by veterans’ law, is only equipoise. We’re far past that.

The charge, as worded, avoided the real question of simple exposure. The reason for that has become clear: By not directly asking IOM to determine C-123 veterans’ exposure on a yes or no basis, there is no response to the challenges raised in our disability claims.

The C-123 contamination has been repeatedly proven over the decades by the military. The harm from our exposure, although the law frees us from having to prove it, has also been established. Please consider that the findings supporting our exposure claim were all offered by experts without compensation. If we’d paid as much to support our claims as the VA to oppose, we’d certainly have even more to offer.

Stretch the boundaries of your charge, to answer the real question before this committee, which is simply whether our C-123 crews were exposed and are due the care for ailments already identified by the IOM as Agent Orange-presumptive illnesses.

Certainly, your work on this committee to address the fullness of the VA charge is important and there are important answers you’ll uncover. But you must go further for the real problem to be resolved. Three years of this misery is enough.

I say there must be no barrier, no evasion, no acceptance of rigid blindfolds disguised as a committee charge. As worded, the charge which takes from you the independence needed to meet the real mission of the IOM and the National Academies, fulfilling what President Lincoln sought in 1863, a body of distinguished scholars “charged with providing independent, objective advice to the nation on matters related to science and technology.”

Please: Independently answer the real question the veterans and the Department of Veterans Affairs are contesting, and form an effective as well as scientifically accurate report.

C-123 veterans, the focus of all your work, ask you to provide the nation your advice in the fullest way with a more complete, responsive answer to the real question at hand: QUESTION – In fulfilling our duty to fly this transport for a decade, were we, more likely than not, exposed and are thereby due VA care for illnesses previously associated by the IOM with Agent Orange exposure?

That should have been the real charge to this committee.

VA Designs Institute of Medicine C-123 Study to Prevent Exposure Claims

Skillful folks, the staff at VA Post Deployment Health. And they're not there to let any more veterans onto the Agent Orange disability lists! As they told the Associated Press, "We have to draw the line somewhere."
But three years of their policy of simply telling us "no" began to face some opposition in early 2014 with publication in Environmental Research of the article, "Post Vietnam Military Herbicide Exposures in C-123 Spray Aircraft." While VA could, and would prefer to, ignore that and all other evidence of veterans' exposures, at about the same time Yale Law School released a detailed white paper confirming the C-123 veterans' rights to presumptive service connection for Agent Orange exposures.
Together, these developments added to political suggestions that VA pretend, at least, to follow the law. After all, VA had repeated three times via the Federal Register their commitment to treat non-Vietnam Agent Orange exposures the same as vets exposed in Vietnam. Those repeated commitments needed to be skirted somehow, which VA has successfully done by having reinvented the basic word, "exposure." Simply put, VA decided to redefine the word to include bioavailability, or the proven impact of Agent Orange on the body. Perfect solution...just change the words around so that nobody exposed to anything qualifies for any exposure claims. With Agent Orange, many decades after exposure, the bioavailability of dioxin is impossible for us to prove...and VA even prohibits the test anyway.
But VA had continuing pressure to comply with the 1991 Agent Orange Act, which is to refer fundamental disputes or inquiries about Agent Orange to the Institute of Medicine. Here VA excelled! They complied, yet insured that the IOM process will defeat veteran's exposure claims.
VA gets to make up the ground rules in this game. One is that VA issues a "charge," or assignment, to the IOM to investigate. Since the only question under the law regarding non-Vietnam exposures is exposure, the VA skillfully avoided tasking the IOM with deciding whether we'd been exposed. Instead, VA asked IOM to address fairly irrelevant issues, of interest of course, but irrelevant in terms of whether VA should be treating our Agent Orange illnesses.
Here's their "charge" to the IOM which is currently investigating C-123 issues:
This committee will determine whether there is an excess risk of adverse health among crew members who, after the Vietnam War ended in 1975, flew and/or maintained C-123 aircraft that had been used to spray Agent Orange in Vietnam. The committee will: 
Evaluate the reliability (including representativeness, consistency, methods used) of the available information for establishing exposure; and, 
Address (qualitatively as a degree of certainty, rather than in a quantitative fashion) whether any documented residues represent potentially harmful exposure (i.e., consider biological availability of dioxin), by characterizing the amounts available and the degree to which absorption might be expected.
You see it, don't you? The second bullet item specifically asks for an IOM conclusion about bioavailability, which isn't a requirement for any veteran, Vietnam or non-Vietnam, to prove in order to seek care for exposure to Agent Orange. But VA sneaks in the term, knowing in advance that forty years after the last spray missions and thirty years after our last flights in 1982, no such proof is possible.
The IOM committee can't but help to repeat conclusions about bioavailability from earlier IOM reports...that it can't be established for this population.
When the C-123 veterans spoke before the IOM C-123 committee on June 16, we asked them to act independently of their charge from the VA. They have that authority and responsibility. We have, however, repeatedly been told that the committee is interested only in the scientific data required to form a response to the VA charge.
If they do this, they play the VA's game. The IOM avoids meeting its responsibility to us, and avoids answering the only real question on the table: 
Were C-123 vets exposed and, if so, are they to be treated as per law?

25 July 2014

Earliest VHA Reference to Bioavailability in Exposure Definition Found

Yesterday, the Air Force released some of the documents requested by the C-123 Veterans Association...back in 2012! So much for the 20-day response provided for in the Freedom of Information Act laws. While most of the requested materials were simply not included at all. one of interest was VHA's 1 August 2011 "VHA Issue Brief."

As readers know, VA has redefined exposure to prevent exposure claims. We thought the earliest reference to this was the VHA Post Deployment Health poster display presented at the 2012 Society of Toxicology. Yesterday's USAF set of papers included VHA Issue Brief on the C-123. We don't know the genesis of the brief but it, and its insertion of bioavailability, showed up in the Air Force document set. We find that very disappointing.

The reason? The USAF Surgeon General's office was emphatic from the start...the USAF School of Aerospace Medicine was to conduct its research on the C-123 independently, without cross-pollination of opinions or perspectives between USAF and the VA. This high-minded approach failed immediately, with VA providing carefully selected materials to provide (shall we say, guide?) the Air Force researchers.

Both agencies had relevant materials directly supporting C-123 veterans' exposure...so both agencies made sure those were suppressed. VA's set of materials mailed to the Air Force included the Blue Water Navy IOM Report (why?) and the usual copies of the OSD consultant's Agent Orange articles.
How to block Agent Orange exposure claims

After losing the "Agent Orange is harmless" battle, VA's campaign against veterans shifted to claiming that none were ever exposed, not even the Vietnam War ground troops. In case that argument fails to convince, the VA also insists that even if Agent Orange was present, it couldn't expose via dermal, inhalation or ingestion.

Second reason for VA's opposition is its novel bioavailability dodge. VA tells us that Ranch Hand veterans have tested highest in dioxin levels yet seem to have reasonable health. VA suggests that "logically" other veterans' body levels of dioxin (bioavailability) are necessarily lower and thus proof that they weren't exposed. And certainly, VA insists that no C-123 exposures occurred because we have never been tested for bioavailability. And VA blends bioavailability into exposure so as to deny exposure.

Get it? No matter what, no problems with Agent Orange. Ever. The VHA and VBA realize that the law simply demands non-Vietnam vets establish exposure, so together they blend the two words into one – 'exposure'– in a scheme to block any and all exposure claims.

This is illogical, and even labeled "unscientific" by toxicologists. "Ludicrous" is Dr. Wayne Dwernychuck's appraisal of the VA definition. And because of the impact of VA refusing C-123 veterans vital medical care, ethics are also a consideration.

Exposure is defined as "skin (or eye) contact with a chemical (of any type) or its ingestion or inhalation." Simple definition from the CDC/Agency for Toxic Substances and Disease Registry, and one generally accepted in science and medicine. VA's weird definition, now is "exposure = contamination field + bioavailability."

Remember that our only problem with the VA is their gate keepers, not the clinicians. Their objective since Day One of our C-123 problems, as shown by VHA's brief, was to insure all C-123 claims are denied. They had to redefine "exposure" to do this, and at some point in our struggle they'll get caught in the deception.

24 July 2014

House Blocks Veterans Health Care Bill..."Collapsed" Says Senator Bernie Sanders

In its move to prevent improved veterans' access to vital medical care, the House today rejected plans for a conference committee to meet and resolve differences between House and Senate versions of legislation. By waiting until virtually the last moment before Congress adjourns, this effectively destroys any hopes for addressing the core problems so well revealed in the current scandals involving the Department of Veterans Affairs.

The budget-focused House, and the veterans-focused Senate, now look at veterans with a "blame the other fellow" grin, both proud of saving money on the backs of, and at the expense of, disabled veterans who will continue to be refused care. It seems only the veterans committees of each house truly wanted to help...everyone else gleefully took advantage of the problem and made political capital.

from the Washington Times, July 24:

Negotiations on the VA reform bill imploded Thursday morning as House negotiators planned to introduce their own bill rather than work with senators in a conference committee.
Sen. Jon Tester, Montana Democrat, said six weeks of negotiation have been stalled by GOP posturing in an election year.
“Republicans today will announce that they’re foregoing the veterans conference committee and introducing a bill of their own,” Mr. Tester said on the Senate floor. “I had real hopes that this conference committee could rise above the political process.”
The House and Senate both passed bills that would allow veterans waiting too long for an appointment or living too far from a VA facility to seek private care. The bills cost about $44 billion and $35 billion respectively, and negotiations stalled over if and how to offset the huge cost after one meeting weeks ago.
The House Veterans Affairs Committee announced that lawmakers involved with negotiating the compromise veterans reform bill would meet Thursday at noon. But a spokesman for Sen. Bernard Sanders, Vermont independent and chair of the Senate Veterans Affairs Committee, said the meeting would not involve Senate negotiators. Instead, the meeting is a chance for Rep. Jeff Miller, Florida Republican, to introduce his “take-it-or-leave-it gambit,” the spokesman said.
“This is a sad indication that the House leadership is not serious about negotiations. We don’t need more speeches and posturing. We need serious negotiations – 24/7 if necessary – to resolve our differences in order to pass critical legislation,” Mr. Sanders said in a statement.
Mr. Sanders offered Mr. Miller a $25 billion compromise bill last week, that would include private care and increased firing authority for the secretary, as well as other provisions in the Senate bill like hiring more doctors and changing the G.I. bill.
The disagreement does not bode well for finalizing a bill to send to the president before Congress leaves Washington at the end of next week for the whole month of August.


Read more: http://www.washingtontimes.com/news/2014/jul/24/veterans-affairs-reform-bill-collapses-capitol-hil/#ixzz38PdbO8gY

23 July 2014

Why C-123 Veterans Are Affected by Institute of Medicine C-123 Agent Orange Study

In what turned out to be a critical change in VA Agent Orange policy, Public Law 102-4, the Agent Orange Act of 1991, transferred the advisory function regarding dioxin and herbicides from the VACEH to the National Academy of Sciences (NAS). The NAS, an independent and highly regarded scientific body, then took the responsibility of reviewing the scientific literature concerning the association between herbicide exposure during Vietnam service and each health outcome suspected to be associated with herbicide exposure. Since responsibility for a scientific review was formally passed to the NAS, VA terminated publication of the scientific literature review mentioned in the previous paragraph.

Following receipt of the NAS reviews, the Secretary has 60 days to determine which, if any conditions evaluated will be recognized as service-connected. The legal standard that the Secretary of Veterans Affairs must use to evaluate what conditions should be presumptively recognized for service connection is described in Chapter 6 – Disability Compensation. The standard differs from the cause-and effect.

Further, the Agent Orange Act removed the requirement that veterans of the Vietnam War must prove both exposure and medical nexus...these are now presumed to have been proven. For veterans who've been exposed to Agent Orange in situations other than Vietnam's "boots on the ground," they must prove exposure. Once exposure to Agent Orange is established, they need not prove medical nexus for any of the Agent Orange-recognized illnesses.

Thus, the IOM study is only tangentially of interest to C-123 veterans because VA carefully chose the assignment wording to avoid asking whether nor not C-123 vets were exposed.

Instead, careful wordsmithing by VA's Post Deployment Health Section gave the IOM an assignment which asks whether or not "excess" risk can be proven. So they IOM can return a finding that the risk is excessive, yet VA continue their present refusal to acknowledge our exposure and thus exclude us from coverage. If IOM returns a finding that our risk cannot be established, VA will seize upon that as definitive "proof" that we are not eligible at all.

The deck is stacked – against us! No wonder Professor Peter Kahn called the whole process unethical, despite the sincere efforts by dedicated scientists on the IOM C-123 committee. At the June 16 2014 IOM meeting, the C-123 Veterans asked the committee to exercise its independence and report back an additional answer to an unasked question...were the C-123 veterans exposed or not?

That is the only question under the law. Besides, we have already established that exposure through juried scientific articles, opinions from dozens of scientists and physicians, as well as opinions from federal government agencies such as the CDC.

We were exposed. We are barred from VA care today because of the personal preferences of VA staff in Post Deployment Health...nothing more.

22 July 2014

VA Backlog Down - VA Appeals Through the Roof!

While Backlog Drops for Disability Claims
Backlog for Appeals Jump Dramatically

And now another serious problem facing the VAWhile there are clearly some doubters most people think that the backlog for disability adjudications has dropped dramatically. Indeed, this week the VA proudly announced that they had just adjudicated their 1,000,000th claim for this fiscal year. However, this is predictably leading to another backlog increase. There is now a backlog for pending appeals of denied claims… as well as increased delays in other claims matters.

One of the areas that have suffered while most of the VA’s focus has been on adjudicating initial disability claims is the simple job of changing the number of dependents that is covered by a claim. The VA’s own figures show that the number of claims to change the status of a dependent has risen from 35,734 at the start of 2012 to 191,464 on June 28 of this year.

As of June 28th the number of pending appeals has reached
279,435. This has been seen as a growing problem since 2012 when the VA’s Inspector General (IG) suggested that the VA "revise productivity standards" to ensure review officers get credit only for work that moves an appeal forward, according to the most recent IG report to Congress. That has not yet happened.

Laura Eskenazi, Principal Deputy Vice Chairman Board of Veterans' Appeals U.S. Department of Veterans Affairs and this the executive in charge of the Board of Veterans' Appeals, said appeals rates have held steady for nearly 20 years, but the total number has risen as more claims have been filed. "If the expectation is a short time frame [to get a decision on an appeal] that would require some trade-off in the due process," she said.

The average time for a denied claim to work its way through the VA’s appeals process shot up to more than 900 days last year After staying between 500 and 750 days for the past decade, what the VA refers to as its “appeals resolution time” hit 923 days in fiscal 2013. That is a 37% jump in one year, from 675 in fiscal 2012. The VA’s long time goal is for an appeal to take 400 days to resolve.

It should be remembered that veterans have a provision in our appeals process that almost no one else has. It permits all appellants (veterans, survivors or their representatives) to submit at any time in the appeal new evidence or information. That triggers a fresh review of the entire appeal. The Board of Veterans’ Appeals can grant, deny or remand the case to one of the VA’s regional offices for additional review. This of course slows appeals down but it is a terrific advantage for the veteran and his/her family.

C-123 Webmaster: It should also be noted that claims can take a year or more from a veteran already ill with cancer or heart disease to be approved, or denied. Submitted then to the BVA the issue can sit on somebody's desk for three or more years, and the veteran's cancer isn't going anywhere in the meantime and VA will continue to refuse to treat the illness unless the vet is eligible for some other reason or injury. Years pass with no pharmacy, no rehab, no prosthetics, no counseling, no pension, no medical care at all. Board of Veterans Appeals make sad reading as claim after claim is resolved in one way or another for the survivors because the veteran has died waiting for the VA.

21 July 2014

Retired Enlisted Association Confronts VA, But Stall Continues Blocking C-123 Claims

TREA Meets With Undersecretary for VBA

Last week TREA (The Retired Enlisted Association,) represented by Deputy Legislative Director Mike Saunders, met with Undersecretary for Veterans’ Benefits Allison Hickey to discuss the claims backlog and other claims-related issues. This was unrelated to all of the recent news surrounding the lack of access veterans have been dealing with related to the Veterans’ Health Administration (VHA).

·         The C-123 issue is currently being actively reviewed by VBA. This is the issue about the planes that were contaminated by carrying Agent Orange toVietnam; crew members who worked on those planes years later are suspected to have been exposed to dioxin from Agent Orange. No final decisions have been made yet.

Actual Result: Stall. Stall until we die. Amazing that VBA wants to "actively review" the C-123 issue. To us, not an issue but a threat to our lives, and amazing that VBA feels it must "review," instead of following the law the way it is written today.

New VA Scandal Revealed ... Veterans Under Secretary for Memorial Affairs Critcized

from Steve Straehley, AllGov.com
Timing is everything. Steve Muro, the VA’s Under Secretary for Memorial Affairs, retired June 20 after more than 35 years with the agency. A month later, the Department of Veterans Affairs’ Inspector General issued a report (pdf) criticizing Muro for improper personnel practices.
The report charged that Muro created a job for a friend in violation of civil service regulations; that he had an improper relationship with a contractor for the National Cemetery Administration (NCA), which he managed; and that he improperly gave that contractor business for educational services that were already available through VA channels.
Muro’s friend, whose name is redacted in the report, originally planned to retire in 2003. Muro gave the friend retention incentives and other raises over several years to dissuade him from retiring. Eventually, Muro created a job at a higher civil service rank and ensured it would go to his friend, thus enhancing the friend’s pension by $400 a month.
Muro’s relationship with contractor Patricia Noonan was deemed improper by the IG. He continued contacting Noonan after being advised to stop, he used his position improperly in giving her a letter of recommendation and improperly supported her efforts to win VA contracts. The IG report tersely described it as "less than arms-length relationship."
In addition, NCA gave Noonan contracts to provide over $374,000 for services for recently promoted NCA employees or those who were seeking promotions. The services involved professional coaching in giving presentations and completing individual development plans. Noonan received $250 an hour for providing that coaching, which was already available internally through VA’s Learning University.
This isn’t the first time problems have been found in Muro’s domain, according to The Washington Post. A 2012 VA review discovered that sets of remains were buried in incorrect graves and some grave markers were missing or incorrect. Muro worked to correct those issues by the following year.
Since Muro has retired, the recent IG report recommended no punitive action against him. The report urged that VA to investigate whether corrective action should be taken in regards to two applicants who did not get the job given to Muro’s friend, and to review any contracts still in force with Noonan to ensure there is no conflict of interest or other problems.
note: he may be beyond the VA IG, but certainly not beyond the US Justice Department!!

18 July 2014

"Leave No Man Behind." Veteran C-123 Pilot Fights VA for Agent Orange Exposure Benefits Due Stateside Crew Mates


BELCHERTOWN — One lesson retired Air Force Col. Archer Battista says he learned in his six years in Vietnam was never to leave anyone behind.

This explains why Battista, 68, has since 2010 thrown his energy into an effort to get pilots who flew stateside planes contaminated by Agent Orange qualified for disability services and compensation.

Battista knows about Agent Orange, a defoliant the United States dumped on the Vietnamese countryside during the war. In early 2009, when he was 62, he was diagnosed with prostate cancer, for which he is still being treated. Because he served in Vietnam from 1968 to 1973, he qualified for a variety of benefits won for Vietnam veterans after a long and drawn-out fight with the government. This explains why Battista, 68, has since 2010 thrown his energy into an effort to get pilots who flew stateside planes contaminated by Agent Orange qualified for disability services and compensation.

Battista knows about Agent Orange, a defoliant the United States dumped on the Vietnamese countryside during the war. In early 2009, when he was 62, he was diagnosed with prostate cancer, for which he is still being treated. Because he served in Vietnam from 1968 to 1973, he qualified for a variety of benefits won for Vietnam veterans after a long and drawn-out fight with the government.

In 1991, the government acquiesced and began authorizing disability, medical and survivor benefits for “presumed exposure” to Agent Orange. Veterans who served in Vietnam (as well as the Korean demilitarized zone during the Vietnam era) are presumed to have been exposed to Agent Orange. This qualification means these veterans suffering from illnesses.

A Long Reserve Career
After his six years of active duty, Archer Battista logged a 27-year career in the Air Force Reserves, retiring May 1, 2001. He also has had a long career as a civil litigation lawyer as a partner with the Holyoke law firm Lyon & Fitzpatrick. These days, he is listed on the firm’s letterhead as “of counsel,” which is legalese for semi-retired.
And while Battista may have wanted to devote his retirement years to some of his many interests (history) and civic pursuits (YMCA boards), his cancer diagnosis — and then his increasing involvement in the effort to get this new group of veterans covered for Agent Orange benefits — got in the way.
When he was in Vietnam, Battista flew the Cessna 02A observation airplane for missions from Danang to Laos.
When he was back home on duty with the Air Force Reserves, he started flying the C-123 cargo planes on training missions, steadily from 1974 until 1982. Battista estimates he flew hundreds of these training missions, and he recalls that a couple times each winter — most notably when the plane’s heater was cranked up — crews would fall into bouts of uncontrollable vomiting.
He says he’d get a report in the cockpit from the loadmaster in the back of the plane with some variation of, “Art, the smell back here is unbearable. We can’t go on with this mission.” Battista adds: “They'd be saying what we already knew, because we could smell it, too.” Battista says his immediate response would be that he couldn't abort a training mission, until he realized that a training mission in which most of the crew can’t stop throwing up is not much of a training mission. So, he'd wind up canceling the flight. The source of the danger was dried Agent Orange residue left after Vietnam, fouling areas in the wings and below the cargo deck, in nooks and crannies impossible to reach to clean.
In those days much less was known about Agent Orange and its noxious elements — but still, Battista says, he and other crew members started wondering what was wrong with the Spray Birds.
“We knew they were Spray Birds that flew the Ranch Hand Mission, but they told us that there was no risk of any kind,” he said.
One of the men who flew the C-123 Provider cargo planes alongside Battista was Wes Carter, a retired major who now lives in Colorado, but who flew at Westover from 1974 to 1991. Carter, who founded the C-123 Veterans Association in 2011, did not serve in Vietnam, and is fighting to receive Agent Orange-related coverage from his many years at Westover. For him, as for Battista, the fight is deeply personal — but also being waged on behalf of others.
“We have our crew mates dying from recognized Agent Orange illnesses,” he said. Carter has testified before government hearings, filed complaints with the Department of Defense, fought for data through the Freedom of Information Act and worked with other veterans groups to agitate for the government to widen the net to cover more veterans. He is web master for the site C-123 Veterans Agent Orange Exposure 1972-1982.
For his part, Battista said when he was first diagnosed with cancer, he didn't link it to his military service at all.
But when a former Air Force buddy reminded him that prostate cancer is one of the Agent Orange presumptive diseases, he sought out and received care from the U.S. Department of Veterans Affairs Central Western Massachusetts Healthcare System in Leeds. He says he received excellent care, though subsequently, he moved elsewhere for continued care. Battista he has no quibbles with the care he has received. As he puts it, “I don't have any skin in the game.”
But he’s got plenty to say about men he flew with at Westover Air Base in Chicopee, who he, Carter, and others believe have been abandoned by the Veterans Affairs department. “It’s appalling. I'm a pretty mainstream guy. I spent 22 years in the U.S. Air Force. I loved all of it,” he said. “I just shake my head. I’m thinking what in the hell is the matter with these people?”
In an interview at his secluded home at the end of a long driveway off Summit Street — where an American flag was stationed on the mailbox on the day a Gazette reporter and photographer visited this month — Battista was overcome with emotion several times. Neatly dressed in blue jeans, a gray and yellow “Livestrong” T-shirt and yellow Livestrong rubber bracelet, with white hair and wire-rimmed glasses, he apologized each time his eyes welled up, saying this was not like him. It’s a combination of the medicine he takes for his cancer, and his feelings about the issue.
“Here’s the point. The point is there are all these guys and gals who spent just as much time in a C-123 as I did, but they didn't happen to go to Vietnam," he said. "Its abominable. Its inexcusable, and incomprehensible to me."

Battista has written letters to political leaders, met with a representative from U.S. Rep. Richard Neal’s office and been involved in spreading the word about the issue online by supporting Carter’s efforts through the group he founded. The two first met when they flew together at Westover.

The appeals to Neal’s office paid off. In a letter to Ronald Maurer, director of the Congressional Liaison Service dated June 2, Neal wrote:
“According to a Yale Law School study on this matter, a 1994 Air Force commissioned study of a C-123 plane flown both in Operation Ranch Hand and after the Vietnam War found it still contained enough of the carcinogen dioxin to subject a restoration worker repairing the plane to ‘an acceptable level for lifetime exposure.’ The plane as a result was deemed ‘heavily contaminated,’ 12 years after active crews worked on the plane. This surface presence of dioxin coincides with the National Academy of Science statement that ‘exposure of humans to TCDD [dioxin] is thought to occur primarily via the mouth, skin and lungs,’ confirming the exposure of the crewmen of these planes to dioxin."
“Taking into account this information and the high levels of illnesses known to be linked to Agent Orange occurring in these Westover veterans, I believe these men and women are entitled to the same benefits granted to those who served on the ground in Vietnam.”
Battista believes with letters like that and other forms of political pressure, Veterans Affairs will change a policy he says is wrongheaded and unfair. He takes particular issue with comments from a former Air Force officer, now consultant to the VA, saying veterans seeking coverage for exposure while in the United States are "freeloaders." 

“This isn't a fight that should be personalized. We shouldn't be name-calling,” said Battista. “Every time I read that, it makes me very angry.”

Meantime, he is waiting for the government to change its policy and do what he believes is the right thing.

“I just can’t believe this is happening,” he says. “They've gotta flip. They've got to understand they’ve got this wrong.”

16 July 2014

Acting VA Secretary Seeks $18 Billion Extra to Solve Problems

Veterans Affairs Department officials want nearly $18 billion more in funding over the next three years to hire more clinicians, lease more space and cut down on wait times for medical appointments.
The money is also partly designed to serve as a down payment on rebuilding VA's reputation, proving to the public that with enough resources, the department can once again be a reliable asset for veterans seeking care.
In his first testimony on Capitol Hill, acting VA Secretary Sloan Gibson acknowledged to the Senate Veterans' Affairs Committee that VA today "has serious problems" that will take years to correct.
"We understand the problems we face. We own them. We are taking decisive action to begin to resolve them," Gibson said. "We can turn these challenges into the greatest opportunity for improvement in the history of the department."
Those challenges include nearly nonstop scandals over the past four months, including recent revelations about whistleblower retaliation and data manipulation in dozens of facilities.
But the overarching issue that forced the resignation of Gibson's predecessor — retired Army Gen. Eric Shinseki, who stepped down in May — was system wait time problems, covered up by administrators trying to protect performance bonuses.
As of July 3, more than 636,000 veterans — about 10 percent of VA's total appointment caseload — faced a wait of a month or more for medical appointments,
To fix that, Gibson wants to hire 10,000 clinicians in coming years and find more space for medical appointments through leases, VA facility improvements and new construction — moves that he said would provide not only a short-term fix but also a longer-term solution to the underlying resource issues.
"I know it sounds like huge numbers," he told lawmakers. "But [VA] historically has not managed to veterans' requirements, we've managed to budget numbers."
Congress is already considering an emergency VA reform bill that would boost funding by about $30 billion over the next three years, according to Congressional Budget Office estimates. But that measure would allot only $500 million to new hiring initiatives; the rest would be used to increase access to private care options for veterans having trouble accessing VA care.
The department already has seen dramatic jumps in funding over the last decade, adding about $100 billion to its base budget since fiscal 2004 and about $70 billion since fiscal 2008.
The additional funding request drew concerns from several senators, who questioned whether better management and use of existing resources would provide more results for veterans.
But Gibson insisted that addressing the fundamental problems behind the wait times will require more resources, and failing to back those plans "will mean that the wait times will get longer."
He also outlined a number of recent audits and policy updates to address the other scandals, and repeated his promise that VA whistleblowers will be protected — and those who retaliate against them will face punishment.

Its Official: VA Secretary Confirms VA Has Lost Trust of Public and Vets

The Department of Veterans Affairs has lost the trust of veterans and the American people as a
result of widespread treatment delays for people seeking health care and falsified records to cover up those delays, Acting Secretary Sloan Gibson said Wednesday.

The Secretary said the VA has created an environment where workers are afraid to raise concerns or offer suggestions for fear of retaliation and has failed to hold employees accountable for wrongdoing or negligence.

The agency also has devoted too many resources to meeting performance metrics -- such as prompt scheduling of patient appointments -- that were subject to manipulation and may not accurately reflect quality of care, Gibson said.

"As a consequence of all these failures, the trust that is the foundation of all we do -- the trust of the veterans we serve and the trust of the American people and their elected representatives --has eroded," Gibson told the Senate Veterans Affairs Committee.

From my sixtyeight years of toil and life experiences, trust rebuilt is never as strong as trust unbroken.

15 July 2014

Fort Collins VA Clinic Experience

Fort Collins (CO) VA Outpatient Clinic
Today I related to the American Legion Crisis Action meeting here in Fort Collins my most recent
appointment experience. Previously, I'd been disappointed only with the long delay arranging an initial primary care appointment (I'm 100% service connected) after we moved to Colorado. I didn't think much about it and subsequent experiences, both with health care and appointments, were perfect; nice folks, superb care, attractive facility, short waiting time...everything great. Good reason to move to Fort Collins!

But a real problem hit in June. I'd been in the Palo Alto (CA) VA War Injury & Illness Study Center for several days of extensive tests, with more problems identified. I was discharged with instructions to seek an appointment with my primary care within two weeks. Doing so, I left a message with the Fort Collins VA Clinic recorder - no live person free to answer the phone, I guess. Gave the details of the request and waited.

Eight days later, not having heard anything, I called again, only to have to leave a message on their machine again. The next day I was called (June 26) and we discussed my request to see my primary care.

I related my recent VA hospitalization in California, mentioned I'd also just had shoulder surgery three days earlier, repeated my issues with heart disease, cancer, spinal cord injury, diabetes, 100% service connected and other stuff. The scheduler explained that I saw my primary care twice a year and so the next appointment should be in September.

Just in case he didn't understand or I'd not been clear, I repeated everything, especially the Palo
Alto VA orders to see my local VA primary care in two weeks (which would be late June into early July.) Just in case I didn't understand, the scheduler then repeated that my next appointment should be in September.

"Okay," I said. I certainly didn't want to "bump" anyone needing care more urgently, and the next available appointment offered me was again, September. I told the clerk that because I felt I needed care more promptly than that, I'd seek it through non-VA means. I repeated I didn't want to bump anybody from ahead of me at the VA. We finished our call.

Three months. A long time for a vet already rated "catastrophically disabled" and 100% service connected by the VA to wait for an appointment to see his primary care provider. An especially long time given the VA Palo Alto discharge instructions to see the primary care provider within a couple weeks. An especially long time given the twice-repeated summary of the reasons behind the appointment request, and also because the primary care had referred me to Palo Alto's War Injury and Illness Study Center and follow-up with him was necessary.

Admittedly, I was passive, unassertive, letting the appointment clerk make his decisions without my pushing, but carefully waiting to see what the outcome would be. How quickly would I be seen or how long would my appointment be put off? I was already alarmed because my first call to their appointments recorder had been eight days earlier. Eight days passed and I heard nothing until I called a second time, and then a day passed before we connected. Nine days, with the first request left on their answering machine apparently lost and never acted on.

Today, relating my situation to the team of VA specialists helping the American Legion conduct their Veterans Crisis meeting, the VA gentleman from Cheyenne typed my info into his laptop (on line with the VA) and offered me three choices for appointments next week. No big deal – when did I want to come in? What time of day was most convenient?

Wonderful! But I don't understand why I was tossed a 90-day delay with my earlier request, but today, before relating my situation in detail but simply saying I wanted to have an appointment,  was offered numerous possibilities anytime next week.

I do know the ninety day delay was bad enough that it could have left some vet dead. No non-vet would ever tolerate such a delay elsewhere in the medical community. Discussing it with VA managers today was unburdening but nobody took notes, nobody said it was something that wouldn't happen again, nobody said it was something to fix, everybody was polite.

I was told to mention it to my primary care when I see him next week. That's all.

I see no reason situations like this won't repeat, especially with confused, depressed, stoic or passive veterans who quietly accept whatever's offered in terms of appointments, scope of care, ancillary services, things which can be quite important to life and limb! The patient's role is to ask for help from the VA and explain the need.

In its ninety-day response, VA proved dangerously inadequate in my most recent experience. At least in this instance and in this place, VA's process depended on a patient to push past an appointment clerk for proper telephone triage appropriate for the urgency to be acted upon. VA cannot count on patients to push the system, and doesn't take well to them doing it, either.

Under Secretary for Benefits Allison Hickey: Her Testimony Monday July 14 2014

“I know that you don’t trust what we’re saying,” General Hickey
told the House Veterans Affairs Committee on Monday evening. “But I want every veteran in this country and all of you to believe us when we say we’re making good decisions. We care so much about those veterans … and they deserve nothing less from us.”

She cares. Deeply! I get it. I believe her implicitly. But the VBA mission still focuses on denying C-123 veterans' claims through extraordinary steps, through anti-veteran claims adjudicators, through warped and unscientific definitions of exposure invented by VHA's Post Deployment Health, through employment of consultants who target us with a vengeance, and through delaying claims through the lifetime of so many of our crew mates.
Ignored Claims Materials...six years old

VBA's view of what we C-123 veterans' deserve? Zero. Because VHA decided "to draw the line somewhere," as they told the Associated Press.

In other news yesterday, VA whistle-blowers revealed to investigators (and CBS News) that Philadelphia VARO had years of unscanned mail, had shredded claims materials, redated other claims, and justified the public's loss of trust.

We Know How Lucky We Are With CO-WY VA

Last night at the American Legion's Veterans Crisis Center Town Hall, hosted by the Legion's National Headquarters staff to discuss Fort Collins and Cheyenne VA issues, one vet reminded us all how lucky we are, regardless of local issues. Philadelphia, Chicago, Miami, and other cities seem much, much worse.

And they are. From today's news (July 16 2014) in Philadelphia:

Report: Disarray found at Philadelphia Veterans Affairs office

Inspector General found mail bins with claims from 2011, benefits that had been paid twice.
July 14, 2014| By Tricia L. Nadolny, Of The Philadelphia Inquirer 

Inspectors surveying Philadelphia's Veterans Affairs benefits center in June found two stunning signs of disarray: mail bins brimming with claims dating to 2011 and other benefits that had been paid twice.

More alarming, the team from the VA Office of Inspector General found evidence that staff tasked with managing pensions for the eastern United States were manipulating dates to make old claims appear new, according to a report obtained by The Inquirer.

The findings are the first clear evidence that the city's VA system is not immune from controversies that have plagued other centers and sparked a growing scandal over delayed care and services affecting veterans nationwide.

Two whistle-blowers who work at the Philadelphia Veterans Affairs Regional Office, where the offenses were discovered, described the process the same: "cooking the books."

"They're hiding the real numbers from the people and saying, 'We're catching up to the backlog,' " said Ryan Cease, 31, who has worked at the Germantown facility for about five years. "But they're not. They're just hiding it."

The inspector general's review was released by the House Committee on Veterans Affairs ahead of a Monday night hearing in Washington at which it will be presented.

Separate from the ongoing probe into appointment-setting practices at the VA Medical Center in University City, the report focuses on the VA Regional Office on Wissahickon Avenue, which oversees the administration of benefits to 825,000 veterans in eastern Pennsylvania, southern New Jersey, and Delaware. The site also houses a Pension Management Center, one of three nationwide, that services more than a dozen states and Puerto Rico.

In a statement released jointly, the Philadelphia and national VA offices said they have taken immediate actions to correct the practices in Philadelphia. The national office added that it is conducting on-site reviews at other regional offices where potentially similar issues have been identified.

The Inspector General's Office declined to discuss the review in Philadelphia, saying any public comments will be made at Monday's hearing.

The probe at the city's regional office was sparked June 18, when the inspector general received a tip from a whistle-blower, according to the report.

A team visited the site the next day.

There, they found employees were manipulating dates through the misapplication of a May 2013 VA memo that allows claims overlooked in veterans' files to be marked with the date on which they were found, known as the "discovered date."

The clearance -- which the VA gave a few months after it laid out an aggressive plan to eliminate its crushing backlog by the end of 2015 -- was meant for rare occasions.

But staff at the Philadelphia regional office's Pension Management Center have used the clearance to mark the discovered date on claims that didn't fit the criteria, the inspector general found. The action made claims look as though they were newer than they were, the report said. The inspectors, whose investigation is ongoing, found 30 occurrences on the June visit.

Kristen Ruell, a lawyer and a whistle-blower from the Philadelphia office who was scheduled to testify at Monday's hearing, said the discovered-date loophole is widely used and has been since it was instituted.

She said managers first instructed those processing claims to use the discovered date for claims a year or older. As the 2015 deadline nears, that has changed, and more recently staff members were told to use it on claims as little as six weeks old, she said.

"They basically use this as a free ticket, like the golden ticket, to make their old stuff new," said Ruell, 39, who has worked at the center for about seven years.