VA report fails to build confidence (Editorial in my own local newspaper, Fort Collins CO)

Note: I reprint this newspaper's editorial because it is about my local VA clinic, in which I,too, was unable to get timely appointments for a series of orthopedic and oncology issues, and instead sought surgeries elsewhere. It has always been on my mind how much VA has saved by not providing my three hip replacements, six neck and back surgeries, two shoulder surgeries, cancer surgery with subsequent radiation and chemo, It has also been on my mind how financially destructive it would have been on the family if I'd not had other insurance options – I would probably have not sought care for several issues. Are today's veterans forced to those hard choices?
The general public may not know that in many situations, a disabled vet isn't permitted VA medical care and other benefits until VA finishes evaluation his/her claim. That can take years, especially if the claim is first denied and forced into a three to five year appeals delay.That's a long wait when one already has cancer or other issues for which care is sought.
                  If you can get an appointment. I couldn't.

EDITORIAL BOARD
APRIL 24, 2016:


New reports published earlier this month show the Fort Collins Veterans Affairs office blamed its scheduling problems on a single manager in the business office who is no longer with the clinic.

Roughly two years ago, the Coloradoan reported the VA office falsified wait times for local veterans seeking medical care.

Fast forward to earlier this month, and spokesperson Samuel House said, "All appropriate action was taken against the employees."

The Editorial Board struggles with this determination for a number of reasons.

First, we know this problem is widespread. A VA inspector general’s report found it was possible that more than 300,000 veterans nationwide died before their applications, which precede appointments, were processed.

Are we to believe that persistent problems across the country, resulting in an unquantifiable number of delays for care, were isolated to a single person in the Fort Collins office?

In May 2014, the Coloradoan reported staff in Fort Collins was manipulating logs to make it look like they were following the VA’s policy of granting appointments within 14 days of the veterans’ desired dates.

Back in March 2013, the Fort Collins clinic “was having problems with scheduling, employee morale and professionalism, and lack of teamwork between the (medical support assistants)," the report from the federal Office of the Medical Inspector stated. To address those issues, employees were transferred between Cheyenne and Fort Collins, according to the OMI report. The transfers to Fort Collins reported that scheduling in Fort Collins was "fixed" by having staff change appointment dates to be within two weeks of the desired appointment date, an agency goal.

In the report released earlier this month, the employee who was let go defended her actions, saying "this had no effect on the veterans because they received the same appointment they otherwise would have received. When asked if she thought this was “gaming” the system she replied, 'yes.'"

My C-123 Agent Orange Claim Approved Yesterday

1,638 days after it was first submitted, my VA claim for cancer, heart disease and several other Agent Orange presumptive ailments was finally approved. I'm service-connected for a total disability rating of 380%.

I had to work long and hard on this claim, using it to advance all C-123 veterans' claims, for nearly all of the past four and a half years for this claim. I had to spend over $22,000, plus about $11,500 contributed by other C-123 vets (most of whom are already covered by VA) to pursue the final resolution.

I detail all this only because it should have been unnecessary, but became essential when VA opted to disregard its legal and moral duties. The effort was worthwhile because it led to coverage for thousands of Active Duty and Reserve C-123 aircrew, maintainers and life support veterans, and our families.

I sincerely appreciate the unfailing support from Senators Burr and Merkley and their staffs, and the more recent efforts by VA leadership and staff to resolve my claim and those of other C-123 veterans.

But, as Senator Richard Burr (R-NC) told the Associated Press about us,
"It shouldn't have been this hard or taken this long."

The worry remains: how many other veterans are in similar situations having faced different hazards, but perhaps don't even know it or can't self-advocate?

Study finds link between Agent Orange, bone cancer precursor

Stars and Stripes

Published: September 3, 2015 By Wyatt Olson

Large stacks of 55-gallon drums filled with Agent Orange.

U.S. ARMY FILE PHOTO

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  Agent Orange Act was supposed to help Vietnam veterans — but many still don't qualify

  The 1991 law presumes veterans were exposed to the defoliant if they have certain diseases and “set foot” in Vietnam, but Navy vets and Air Force vets in Thailand say they were also exposed. It turns out not all veterans exposed to Agent Orange are being treated the same.
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  Agent Orange decision turns attention to 'blue water' veterans

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  List of diseases linked to Agent Orange has grown over the years

  At his office in the Jefferson County Office Building, Peter J. Fazio, director of the county’s Veterans Service Agency, spread out on his desk data reflecting the growing list of diseases the government has attributed to Agent Orange exposure, a lingering issue for Vietnam War veterans.

Servicemembers exposed to Agent Orange during the Vietnam War are at higher risk of developing the precursor stage of a bone marrow cancer, according to a study published Thursday in the Journal of the American Medical Association Oncology.

The study provides the first scientific evidence for a link between the precursor stage of multiple myeloma — a cancer of white blood plasma cells that accumulate in bone marrow — and veterans exposed to the herbicide Agent Orange, according to the study’s 12 authors, who are associated with medical centers across the U.S. The precursor, called monoclonal gammopathy of undetermined significance, or MGUS, is not in and of itself a problem.

“MGUS is not a cancer,” said Dr. Nikhil Munshi, who specializes in multiple myeloma at the Dana-Farber Cancer Institute at Harvard Medical School in Boston. “A very large majority of patients with MGUS remain MGUS all through their lives with no real consequence.”

MGUS virtually always precedes multiple myeloma, but the mechanisms that trigger its onset are not fully understood, said Munshi, who was not involved in the study but wrote an editorial published in the same issue of JAMA Oncology.

Previous studies have linked other insecticides, herbicides and fungicides to higher risks of MGUS and multiple myeloma.

Agent Orange was used during Operation Ranch Hand in Southeast Asia to clear jungle foliage from 1962 to 1971. It was usually sprayed via aircraft. Since then, Agent Orange has been linked to a host of health problems and diseases in many servicemembers.

The Veterans Administration maintains a list of “presumptive diseases” assumed to be related to military service that automatically qualify them for VA benefits. The Institute of Medicine has identified seven cancers with a positive association to Agent Orange, including chronic lymphocytic leukemia, Hodgkin lymphoma and non-Hodgkin lymphoma — all of which have been accepted by the VA as presumptive diseases.

Multiple myeloma is a VA presumptive disease, but it has been classified as having “limited or suggestive evidence” of a link to Vietnam War veterans’ exposure to herbicides, the authors of the JAMA study wrote.

The study looked at specimens from two groups of Air Force veterans that had been collected and stored in 2002 by the Air Force Health Study. A group of 479 veterans who had been exposed to Agent Orange during Operation Ranch Hand were compared with a second group of the same size that had similar duties in Southeast Asia from 1962 to 1971 but were not involved with the herbicide.

The Air Force Health Study had sampled servicemembers in the two groups in 1987, 1992, 1997 and 2002 for exposure to Agent Orange and to 2,3,7,8-Tetrachlorodibenzo-p-dioxin, or TCDD, which is an unintended contaminant of the herbicide considered the culprit for so many of its adverse effects.

The researchers found that the prevalence of MGUS in Ranch Hand veterans was twice as high as in the comparison group, with 34 of the 479 Ranch Hand veterans having MGUS compared with 15 out of 479 in the control group.

That translated to a 2.4-fold increased risk of MGUS for Ranch Hand veterans over their counterparts when adjusting for factors such as age, race and other physical traits. “That’s an important number,” Munshi said. Researchers also found significantly higher levels of TCDD in the Ranch Hand veterans who had developed MGUS, he said.

Because all cases of multiple myeloma originate from MGUS, the study has provided the first scientific evidence for a direct link between Agent Orange and multiple myeloma, he said.

C-123 Veterans' Agent Orange – Mission Complete

We're done here!

• In April 2011, C-123 veterans from Westover AFB began pursuit of Agent Orange exposure disability benefits from the Department of Veterans Affairs for toxic injuries resulting from duty aboard the former Operation Ranch Hand spray aircraft between 1972-1986.

• In January 2012 the CDC informed VA that C-123 post-Vietnam veterans had been exposed to harmful levels of Agent Orange, and that the planes were so contaminated aircrews should have been flying in full HAZMAT protection.

• In March 2013 the DOD Joint Services Records Research Center confirmed C-123 veterans' Agent Orange exposures to VA's Agent Orange desk in Veterans Benefits Administration, which opted to disregard the input despite VAM21-1MR and the Veterans Claims Assistance Act.

• In August 2013, VA approved via DRO the only C-123 veteran's claim to ever be approved without resort to the Board of Veterans Appeals (LtCol Paul Bailey.) Every C-123 claim before and since has been denied, all with VA insisting it considered each "on a case-by-case basis"without mentioning that VA HQ ordered every C-123 claim denied

• In January 2015 the Institute of Medicine, acting under contract from the VA, issued its report to Secretary Bob McDonald confirming the C-123 veterans' exposure and likely toxic injuries.

• In June 2015 the Secretary issued his interim final rule acknowledging the IOM's conclusions, and provided formal veteran status to C-123 veterans with diagnosed Agent Orange-related illnesses, with benefits to date from June 19 2015 forward, but blocking retroactive compensation and other benefits otherwise due claims in process before the interim final rule. The first C-123 veteran's disability claim under this scheme was processed within sixteen days (LtCol Ed Kosakoski.)

• In August 2015 the Secretary of Veterans Affairs announced a compromise of a one-year retroactive disability compensation scheme. This concluded all issues of concern to the C-123 Veterans Association. [NOTE: BIG MISTAKE. A FEW DAYS LATER VA STAFFERS EMAILED US. VA "MEANT TO SAY" NO TO RETROACTIVE PAY.]

Mission Complete. 

• We accomplished most objectives, with failures along the way including four years intolerable delay by VA which we were unable to overcome. 

• We must count as failure the suffering and loss of our veterans these last four years.

• The final failure was the inability to persuade VA to award full retroactive disability compensation due veterans with claims submitted before the interim final rule, settling instead for the compromise of one year retroactivity.

This very difficult effort, led only by Westover's veterans with some financial help from other units' members, served all the men and women who flew C-123s at Westover, Rickenbacker and Pittsburgh as well as scattered Active Duty units and airmen. We did the best we would, we achieved more than experts thought possible, and we won a small measure of success when VA agreed to at least a one year retroactive program.

I believe at this point our only work is to assist fellow C-123 veterans with their claims and to serve the needs of veterans in all situations.

Thank you everyone for your support, especially the encouragements and help covering some of the expenses. As Senator Burr said, "this shouldn't have taken this long or been this hard." If I'd known how bad it was going to be when I first worried about this mess back in 2011, which was when I picked up the phone to call Paul Bailey and see how he was doing, I'd never have gotten started! I wish Paul was still here to see how things resolved for our crewmates.

Today the Dean of the School of Law at Yale said we were "fierce, strategic and unrelenting." We shouldn't have had to be – no veteran should have to self-advocate or waste years of medical retirement struggling to get VA to do its job. Four years ago VA should have called us with some reasonable solution to this horrible problem. They didn't call. Instead they fought us every step of the way. 

Our duty is to make certain no other veteran faces VA alone.

God Bless America.

Title 38 United States Code 501(a), 1116(a)(3), and 1821)

Here is the basis for Agent Orange claims of Vietnam veterans, Korea DMZ veterans, and C-123 veterans. These are the three groups considered "presumptively exposed" as described in Title 38 United States Code 501(a), 1116(a)(3), and 1821.) C-123 veterans join the others as the only groups covered by VA's automatic presumption of exposure and coverage for illnesses recognized by VA as associated with Agent Orange.

I recommend veterans beginning the claims process include the VA C-123 Fact Sheet and the Title 38 USC C-123 page when you meet with VA or veterans service organizations – this is a new topic for everyone and very few understand our entitlements.

(6) Diseases associated with exposure to certain herbicide agents. (i) For the purposes of this section, the term “herbicide agent” means a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, specifically: 2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; and picloram.(Authority: 38 U.S.C. 1116(a)(4))(ii) The diseases listed at §3.309(e) shall have become manifest to a degree of 10 percent or more at any time after service, except that chloracne or other disease consistent with chloracne, porphyria cutanea tarda, and early-onset peripheral neuropathy shall have become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent during active military, naval, or air service.(iii) A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. The last date on which such a veteran shall be presumed to have been exposed to an herbicide agent shall be the last date on which he or she served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975. “Service in the Republic of Vietnam” includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam.(iv) A veteran who, during active military, naval, or air service, served between April 1, 1968, and August 31, 1971, in a unit that, as determined by the Department of Defense, operated in or near the Korean DMZ in an area in which herbicides are known to have been applied during that period, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. See also 38 CFR 3.814(c)(2).(v) An individual who performed service in the Air Force or Air Force Reserve under circumstances in which the individual concerned regularly and repeatedly operated, maintained, or served onboard C-123 aircraft known to have been used to spray an herbicide agent during the Vietnam era shall be presumed to have been exposed during such service to an herbicide agent. For purposes of this paragraph, “regularly and repeatedly operated, maintained, or served onboard C-123 aircraft” means that the individual was assigned to an Air Force or Air Force Reserve squadron when the squadron was permanently assigned one of the affected aircraft and the individual had an Air Force Specialty Code indicating duties as a flight, ground maintenance, or medical crew member on such aircraft. Such exposure constitutes an injury under 38 U.S.C. 101(24)(B) and (C). If an individual described in this paragraph develops a disease listed in 38 CFR 3.309(e) as specified in paragraph (a)(6)(ii) of this section, it will be presumed that the individual concerned became disabled during that service for purposes of establishing that the individual served in the active military, naval, or air service.(Authority: 38 U.S.C. 501(a), 1116(a)(3), and 1821)

Vietnam Veterans of America Comment to VA on C-123 Interim Final Rule

VVA's president Mr. John Rowan issued this statement today strongly challenging VA's proposed interim final rule restricting C-123 Agent Orange benefits. The concern of all veterans is on VA's failure to respect retroactive compensation based on date of claim submission.

Air Force Association Seeks VA Support for C-123 Veterans' Agent Orange Claims

C-123 Vets Meet With Secretary McDonald

Secretary McDonald generously gave me over an hour yesterday afternoon for our private conversation tat the Denver DAV National Convention.
He was aware that our initial alarm about VA's statement to HuffPo about widows not being protected by the interim final rule was resolved by VA last Friday in their "reinterpretation" of the issue...in other words, the VA was led to do the right thing regarding widows/widowers' DIC but acted as though that was their intention all along.

Discussion:
1. VA disregarded years of confirmation from other federal agencies, failing to act when there was more than adequate "benefit of the doubt" evidence. The two VA C-123 Fact Sheets were discussed with the important point that errors littered the June 2013 letter to Senator Burr and VA failed to reveal the JSRRC information received four months earlier. VA failed their duty to be pro-veteran and non-adversarial and would be seen to have done so by the CAVC when appeals reach that forum.
2. VA disregarded (another word could be "suppressed") that 2013 Joint Services Records Research Center exposure confirmation from veterans, their attorneys, legislators, claims offices and BVA, as well as the May 2014 confirmation JSRRC began providing on individual C-123 veterans. This violated VCAA and VAM21-1MR.
I said the CAVC would find this a compelling argument in our favor and that unless retroactivity were provided appeals would be inevitable. We reviewed dates of interest, such as the May 2011 general "awakening" of C-123 vets to our exposures, and the fact all scientific information had been provided VA by the end of 2011 – all of which they ignored. We discussed the famous VA phrase, "VA has an overwhelming preponderance of evidence against C-123 claims."
3. I raised the VA OGC precedential opinions and how they should have led to veteran status per Title 38. He was already familiar with the "liberalizing" issue, and also with the fact that retroactivity had been recognized for the active duty C-123 vets, but not us. I pointed out that the DRO C-123 awards and the BVA decisions thus far had all recognized the retroactive claims. In the end, he promised to read all three essays.
I also reviewed the surprisingly small number of claims predating the June 19 2015 effective date, which if each were awarded 100% SC back to May 2011 would only total $1.2M additional cost to VA assuming the same average SC % on claims processed thus far, added to the VA OGC $47M forecast for C-123 issues (excluding medical costs)
4. I discussed my concerns about physician recruiting and retention, the need for skilled former military medics to conduct "sick calls" at VA day clinics as a physician force multiplier, acceptability of board credentials from the American Board of Physician Specialties, DO recruiting, and formation of a "VA Physician Reserve Corps" of departing docs to continue a lower level of service.

In conclusion, I was given twice the time than scheduled for our discussion and we ended only because I had to leave. He was sincere and agreed that VA could have acted sooner, and he'd review our request carefully. Thus far, I'm satisfied and now we'll wait to see if VA delivers any changes to the interim final rule.

We're at the DAV National Convention (Denver) - waiting for Secretary McDonald's keynote presentation

Secretary Bob McDonald is the keynote speaker here in Denver at the DAV National Convention.
With his presentation at 9AM, America's veterans will learn more about the Denver VA hospital, physician recruiting, appointment times, and probably VA's financial travails.

More after his presentation!

Correction: C-123 Widows NOT abandoned by VA Interim Final Agent Orange Rule

This is an honor I've had to do twice. It is very hard. I wouldn't

like to turn to a C-123 widow and tell her VA has decided to

abandon her, which is exactly what VA has done.

From Huffington Post (Lynne Peebles, reporter) July 21,2015:

"Meagan Lutz, a spokeswoman with the VA, confirmed that the new help is only available beginning on June 19, when the rule was published, or from the subsequent filing date. Widows of C-123 veterans, she said, will not be eligible for the disability compensation." 

In an email from VA to the Vietnam Veterans of America, this "clarification" was offered late on Friday, July 31:

"I don’t know what the source of the below communication was but it is not correct.  As we discussed during our meetings with VSOs on the C-123 rulemaking, the survivor of a covered C-123 crew member would be entitled to DIC if the cause of the crew member’s death is service connected.  We would make that determination based upon a survivor’s DIC claim that is pending on or after the effective date of the regulation.  With respect to prior denials, there is nothing that prevents a survivor from reopening a claim based upon the new regulation.  To the extent that the communication alleges that we have unlawfully denied retroactive benefits, section 5110(g) of title 38, United States Code, is clear that the effective date of any award of benefits pursuant to the regulation cannot be earlier than the date that we issued it."

VA: We're not abandoning our C-123 widows and widowers!

Dear VA: Thanks for the proposed interim rule for our Agent Orange exposures. It took work.

But respectfully, no thanks. We're not abandoning the financial and medical needs of our widows and widowers! What a simply horrible demand. 

Please...your Plan B?

VA Awards First C-123 Agent Orange Claim to Ed Kosakoski

Great News!

Retired LtCol Ed Kosakoski, former commander of the 74th Aeromedical Evacuation Squadron, Westover AFB MA, was awarded service connection for his Agent Orange exposure and resultant prostate cancer. The VA's action was taken yesterday, July 17 and retroactive to June 19. 

Staffers for Under Secretary for Benefits Allison Hickey notified his family of the good news. Ed's claim happened to be the first to be processed under the VA's interim final rule ordered by Secretary McDonald for post-Vietnam C-123 veterans, with the St. Paul VARO assigned to process all C-123 claims.

A pharmacist in civilian life, Ed's military service began in the Army, rising to Master Sergeant before earning his Air Force commission and transfer to the Air Force Reserve. As a squadron commander he took special interest in helping his senior airmen earn their commissions, and so many did his unit developed a reputation as "Colonel K's OCS." He is married to retired active duty LtCol Ingrid Kosakoski.

Good job, VA!

C-123 Agent Orange Exposure & Breast Cancer

Breast Cancer: I need input on this as we try to convince VA to extend their Agent Orange coverage to include breast cancer. 

Please let me hear from survivors, researchers, epidemiologists...all those with an expert insight to this problem.

VA Answers Basic Questions About C-123 Agent Orange Claims! Hotline=1(800) 749-8387

July 2 - phone number the hotline is corrected here
 and is actually 1(800) 749-8387

A very kind response from Veterans Benefits Administration leadership! We asked for clear and simple instructions for our folks to follow and VBA just emailed us exactly that. Here's the scoop...read carefully and get those claims in if you have what you believe to be one of the Agent Orange-related illnesses. 

Thank you, VA!  (HOTLINE NUMBER CORRECTED HERE!)

Specific claim situations:

a. no claims submitted yet 

Veterans with disability they believe is caused by Agent Orange exposure should file a claim for service-connected benefits on VA Form 21-526EZ (available at your local regional benefits office, through a Veterans Service Officer (VSO), or online athttp://www.va.gov/vaforms/ or file a claim online at https://www.ebenefits.va.gov/. 

Survivors whose spouses died from Agent Orange related disease should file a claim for Dependency and Indemnity Compensation on VA Form 21-534EZ (available at your local regional benefits office, through a VSO, or online at http://www.va.gov/vaforms/. 

b. claims submitted no decision

If you already informed VA that this was a C-123 claim, you should just sit tight while we resolve the claim.  We generally work claims on a first in, first out basis, so if your claim has been pending six months or more, it should be near the top of our list.  If VA is not already aware that your claim is C-123 related, you should contact your VSO or call us at 1 (800) 749-8387 and request that we add that notation to your file and route your claim to the St. Paul, MN regional office.

c. claims denied not yet appealed

If you believe VA’s decision was wrong, initiate an appeal on VA Form 21-0958, Notice of Disagreement, available through your VSO and online at http://www.va.gov/vaforms/.  You have one year from the date we notify you of our decision to file an appeal that may protect the effective date.  After one year, you will have to file a reopened claim.  The process to reopen is the same as described under “no claim submitted yet”, but usually requires new and material evidence.  Because of the rule change, VA will consider the reopened claim even if you don’t have additional evidence.

d. claims denied and appealed

If the appeal is currently pending at a regional office or the Board of Veterans Appeals (BVA), you should make sure that VA is knows this is a C-123 claim.  If you’re not sure, you should contact your VSO or call us at 1 (800) 749-8387 and request that we add that notation to your file.  If your appeal is still at the regional office and you have more evidence to submit, mail it to the regional office intake address below. 

If you’re unsure where your appeal is inside VA, you can send evidence and information to either of the addresses and we will locate the file and forward the new evidence for consideration.

e. claims appealed, denied

If the claim was appealed and the appeal was denied, you can submit a reopened claim.  VBA requires new and material evidence to reopen a denied claim, but in this case the rule change is sufficient to reopen your claim. 

Veterans with disability they believe is caused by Agent Orange exposure should file a claim for service-connected benefits on VA Form 21-526EZ (available at your local regional benefits office, through a VSO, or online at http://www.va.gov/vaforms/) or file a claim online at https://www.ebenefits.va.gov/. 

Survivors whose spouses died from Agent Orange related disease should file a claim for Dependency and Indemnity Compensation on VA Form 21-534EZ (available at your local regional benefits office, through a VSO, or online at http://www.va.gov/vaforms/). 

f. anything else?

I think we’ve covered all the bases, but we’re happy to answer any questions you or other C-123 Air, ground maintenance, and aeromedical crewmembers have.  If someone needs individualized advice on their claim, they should call 1 (800) 749-8387 and the experts will help sort out the issues.

.

Survivors should file reopened claims on VA Form 21-534EZ (available at your local regional benefits office, through a VSO, or online at http://www.va.gov/vaforms/).  If they’re experiencing extreme financial hardship or fall into any of the other categories below, they should inform us and provide whatever supporting evidence they have.  Evidence that would support a finding of financial hardship, and allow us to move their claims to the head of the line, include things like

• an eviction notice or statement of foreclosure
• past due utilities notices, and/or
• collection notices from creditors.

If they need help, they should work through a Veterans Service Organization or call the specialized C-123 claim processors at 1 (800) 749-8387.  They can also call VA’s primary claims help and information line at 1 (800) 827-1000.

Our response...Good job, VA! Thanks!

Here's How VA Calculated the Cost of C-123 Veterans' Agent Orange Benefits

It sounded like a lot but is such a paltry sum: $47 million to address the needs of 2100 or so C-123 veterans. It works out to something under $200 per month per veteran, assuming the wonderful gift of living another ten years.

VA's C-123 press release didn't stress the money issue but many news reports sure did. "Veterans in Line for Millions in Compensation" being the basic theme. But do the math: 2100 veterans dividing $47 million by ten years and then by twelve months is only $186 per month.

So it should be clear to all this struggle wasn't and isn't about the money. It was to get our folks VA medical care and other benefits vital for quality of live and extension of life, and once VA begins processing our exposure claims we'll finally be inside the system.

VA presented a detailed explanation of how it came up with the $47 million price tag for their C-123 response. Some of it makes sense, but much is obscure, such as survivors' benefits and medical care itself. Still, their best effort was made.

We disagree. Using the statistics developed by the Kennedy School of Government for current conflicts, that price tag per veteran is much higher.

Here's how the government calculated our 2100 veterans, assuming about 320 apply for benefits:

Impact Analysis for RIN 2900-AP43

Title of Regulation: Presumption of Herbicide Exposure and Presumption of Disability During Service For Reservists Presumed Exposed to Herbicide

Purpose:  To determine the economic impact of this rulemaking.

The Need for the Regulatory Action:  The Department of Veterans Affairs (VA) is amending its regulation governing individuals presumed to certain herbicides.  Specifically, VA is expanding the regulation to include an additional group consisting of individuals who performed service in the Air Force or Air Force Reserve under circumstances in which they had regular and repeated contact with C-123 aircraft known to have been used to spray an herbicide agent (“Agent Orange”) during the Vietnam era.  In addition, the regulation will establish a presumption that members of this group who later develop an Agent Orange presumptive condition were disabled during the relevant period of service, thus establishing that this service constituted “active, naval, military or air service.”  The effect of this action is to presume herbicide exposure for these individuals and to allow individuals who were exposed to herbicides during reserve service to establish veteran status for VA purposes and eligibility for some VA benefits.  The need for this action results from a recent decision by the Secretary of Veterans Affairs to acknowledge that individuals who had regular and repeated exposure to C-123 aircraft that the United States Air Force used to spray the herbicides in Vietnam during Operation Ranch Hand were exposed to Agent Orange.

Estimated Impact:  Estimated Mandatory Cost. Benefit costs are estimated to be $3.8 million during the first year, $21.0 million for five years, and $47.5 million over ten years.  Benefit costs are estimated to be $3.8 million during the first year, $21.0 million for five years, and $47.5 million over ten years. 

	Veterans		Survivors		Total
Fiscal Year	Caseload	Obligations (000's)	Caseload	Obligations (000's)	Caseload	Obligations (000's)
2016	342	$3,822	0	$0	342	$3,822
2017	347	$3,952	3	$52	350	$4,004
2018	351	$4,086	6	$108	357	$4,194
2019	354	$4,215	10	$187	364	$4,402
2020	357	$4,349	14	$270	371	$4,619
5 Year Total		$20,424		$617		$21,041
2021	359	$4,474	18	$359	377	$4,832
2022	360	$4,589	23	$474	383	$5,063
2023	361	$4,708	28	$596	389	$5,304
2024	361	$4,816	32	$704	393	$5,520
2025	360	$4,913	37	$841	397	$5,755
10 Year Total		$43,925		$3,591		$47,516

Administrative Costs. There are insignificant FTE or GOE cost requirements associated with this proposal.

Assumptions and Methodology of the Analysis:

Veterans.  Data from the Office of Performance, Analysis, and Integrity (PA&I) indicates that 2,783,690 Veterans served in Vietnam, of which there are 453,782, or 16.3 percent, living Veterans with Agent Orange-related disabilities.  Based on the IOM study, up to 2,100 Air Force Reserve personnel trained and worked on C-123 aircraft and were potentially exposed to Agent Orange.  Assuming that 16.3 percent of these Reservists have Agent Orange-related disabilities results in an estimated 342 Reservists that would be eligible to receive disability benefits for Agent Orange presumptive disabilities under this proposal.  Mortality rates were applied to these 342 Reservists to estimate caseload in the out-years.

Data from PA&I also indicates that the 453,782 living Veterans with Agent Orange-related disabilities have, on average, approximately 1.5 Agent Orange presumptive disabilities.  The data also shows that the average rating for an Agent Orange disability is 36 percent.  Assuming that each Veteran has 1.5 Agent Orange-related disabilities at an average of 36 percent leads to an average combined degree of disability of approximately 50 percent for Agent Orange-related disabilities.  Estimated payments at the 50-percent level and annual cost-of-living adjustments from the 2016 President’s Budget were applied to the caseload to calculate annual obligations.

For purposes of this cost estimate, VBA assumes that these 342 Reservists would be granted Veteran status and begin receiving compensation in 2016 for their Agent Orange-related disabilities.  While some of these reservists may already be on the compensation rolls for service-connected disabilities associated with separate periods of active duty service, data is not available to identify these Veterans.  Therefore, for this cost estimate, VBA also assumes that these Veterans would be new to the rolls in 2016.

In addition to the Reservists that currently have Agent Orange-related disabilities, there are Reservists that do not currently have these conditions, but will develop them over the remainder of their lifetime.  While data is not available to predict if and when these Reservists will develop Agent Orange-related disabilities, for purposes of this cost estimate, VBA assumes that there will be 10 new Veteran accessions per year through 2025.  This is based on a straight line average number of cases per year since 1982 (i.e. an estimated 342 cases in 33 years since 1982).  Obligations for these Veterans are also calculated by applying the 50-percent payment rate beginning in the year of accession.

Survivors.  The caseload for survivor compensation is associated with the number of service-connected Veterans’ deaths.  VBA assumes, based on marriage statistics from the Census Bureau, that 50 percent of Veterans will have a surviving spouse.  For purposes of this cost estimate, VBA assumes that a survivor will access the rolls at the beginning of the year following the Veteran’s death and will receive the estimated average survivor compensation benefit from the FY 2016 President’s Budget.  Mortality rates were also applied to survivors to calculate caseload in the out-years