Harvard Business School reports significant VA improvement under Secretary McDonald

The VA, to be sure, was a national embarrassment a few years ago. So why has it every national veterans organization asked President-elect Trump to retain VA Secretary Robert McDonald?

In 2014 a wave of revelations found administrators falsifying documents in order to create the impression that they were compliant with departmental requirements regarding wait times. Veterans died while waiting for care, and overworked doctors began leaving the system in droves.

However, that was before President Obama tapped Army veteran and former Proctor and Gamble chairman and CEO Robert McDonald to take over the system in an attempt to turn it around. McDonald stepped into the role of VA secretary in July 2014, and since then, according to two recent reports by outside groups, the results have been dramatic.

VA Secretary McDonald "Indifferent?" NO! He is passionate about serving veterans.

I CANNOT agree with WSJ's January 13 report on VA "indifference." My experience since 1992 has been quite the opposite, other than a few instances where staffers were in an inappropriate position of authority. Instead VA has been amazingly attentive to my concerns, and concerns of the veterans of our C-123 Veterans Association.

For instance, this MLK holiday weekend a dedicated claims worker in the VA St Paul Regional Office has been reviewing veterans' claims and resolving many which have taken too long.

That worker has been available for detailed inquiries, and has resolved claims in as little as 16 days for a terminal veteran.

Mr. McDonald's leadership cannot inspire everyone at VA nor can he do the work of all 300,000 employees. His leadership, however, is as telling as it can be. I cannot imagine any cabinet officer working as hard at such a thankless job.

As for medical care, I've had some disappointments but in the decades since my injury, probably fewer complaints with VA than I'd have had with my civilian practitioners, and certainly a more comprehensive package of care offered me...dental, prosthetics, rehab, pharmacy, ophthalmology, general medicine and other benefits essential to a disabled veteran.

Veterans are lucky to be able to say to Secretary McDonald, "Thank you for YOUR service!"

C-123 Agent Orange Veterans Propose Line of Duty Investigation of Our Exposures (no answer from VA to either proposal)

In hopes that VA continues seeking a process to permit C-123 veterans' retroactive disability compensation, we reached out to VA leaders to restate our arguments. A particularly interesting tactic might be Line of Duty determinations through the Air Force for our exposure injuries to meet statutory requirements for "veteran" status. VA's Interim Final Rule liberalizing rule to grant veteran status wouldn't be necessary, and VA could reconsider its retroactive disability compensation barrier. 
Secretary McDonald' said when announcing his C-123 decision, “Opening up eligibility for this deserving group of Air Force veterans and reservists is the right thing to do,” said Secretary McDonald. “We thank the IOM for its thorough review that provided the supporting evidence needed to ensure we can now fully compensate (emphasis added) any former crew member who develops an Agent Orange-related disability."  

We say, Keep trying, VA!

Our email to VA, January 7, 2016:

If tomorrow VBA must continue denying C-123 veterans' retroactive disability compensation, we respect that endeavor but are disappointed with it.

Our C-123 folks have a different perspective. Mr. Gxxxxx Bxxxxxx is an example of one of your C-123 veterans who has waited over six years for VA to resolve the issues of his prostate cancer and, more recently, leukemia also. 

VBA approved his 2009 claim only in June 2015, and his leukemia claim in August 2015, with all retroactive compensation denied, of course. I don't know how the percentages of disability would have been calculated with his prostate cancer, but he is presently at 40%. 

Had that percentage held for the six years since VA got his claim, this vet's compensation due would be around $45,000. Compensation he has waited patiently for VA to take care of in its normal course of granting claims back to date received. Like all of us, Bradley was not expecting the negative impact of the Interim Final Rule's liberalizing effect and dismissal of the VA OGC precedential opinions.  

What he'd waited for was only partial compensation for his pain and suffering, and only partial compensation for considerable loss of working time from his cancers. There is no compensation for this veteran's reduced life expectancy.

Air Force LOD manual AFI 36-2910 has as its overall philosophy protection of the servicemember's military benefits and eventually, veterans' benefits as well. We're asking Air Force for that philosophy to have full play here. The AFI requires Air Reserve Component members to report exposure and other illnesses and injuries within the regulation's mandatory 180 days, after which only VA would have authority. 

Fortunately, this requirement is satisfied because we reported the issue in early 1979 after which the Air Force Armstrong Labs submitted its incomplete Conway Report on one of our squadron's airplanes, C-123K  #362 ("Patches") and identified military herbicide residue. Using that data and test date from 1994, CDC ATSDR confirmed to VBA in 2011, we have a 200-fold greater risk of cancer than screening values. Not 2X. 200X. CDC said we should have been flying in full HAZMAT, but that was too late to help anyone.

The VA has a caring philosophy similar to the Air Force, but with specifically, a duty of insuring all the benefits due a veteran are provided, while at the same time taking a pro-veteran, non-adversarial and paternalistic perspective with every benefit of the doubt resting with the veteran. In clearer words, do all that's right by us within the law.

Last week VBA explained why DOD JSRRC confirmation (in 2013 and again in 2014) to the Agent Orange Desk of our exposures was not required to be shared with our veterans and why it did not apply to Reservists per VA 21-1MR and the VCAA. I don't understand their logic about why our being Reservists made it necessary for VBA to hide such official government confirmation of our exposures from us until after the Institute of Medicine C-123 hearings. 

I trust that VA can and will (if leadership approves) find a path forward which respects the rules you must operate under as well as the rights and benefits needed by and due C-123 veterans who volunteered for many years to fly these toxic airplanes, and who have already waited decades for your help.

An aside, please: VA has done a wonderful job with St Paul's processing C-123 issues. VA is also doing a great job using many different channels to get the word out to our veterans. Thank you!

Our email to VA, January 4, 2016:

I have raised the concern about C-123 retroactive disability compensation, presently blocked by the liberalizing rule per the Interim final Rule. The hope is to find a compromise for at least a year of retroactive compensation, presently blocked by the statutory "veteran" issue already much discussed. 

Our view is that by late 2011 VA had ample government evidence to form "an overwhelming preponderance of evidence" supporting our claims but instead insisted it had "an overwhelming preponderance of evidence" against them. VCAA and VA21-1 should have helped the input from ATSDR, NIH, USPHS and JSRRC be considered with our claims evaluation on the "case by case" basis Secretary Shinseki and Under Secretary Hickey assured us was the case. Instead, resolution was postponed until June 2015. 

The few C-123 grants made prior to June 2015 all received full retroactive disability compensation (all were granted either by DRO or BVA decisions, none by VARO actions.)

Months ago when we met at the Senate Russell building to discuss the C-123 IOM report prior to publication of the Interim Final Rule, I raised the hypothetical concern of Ebola exposures and asked whether VA would treat Air National Guard and Reservists as "veterans" if the disease were to develop two weeks after their aircraft returned from Africa and the aircrew returned to civilian life. 

VA answered, "No," as with the C-123 veterans. The "veteran" issue blocks VA care and benefits for Reservists and Guardsmen and exposure situations.

Researching this issue further, I contacted the Air Force Reserve Command Surgeon who said he'd resolve such an issue by generating Line of Duty determinations. AFRC is where LODs on C-123 veterans would have been initiated. He'd expect VA to respect an LOD as protection for the airmen. He would consider generating LODs months or perhaps even a year or so after an event to protect the airmen, although AFI 36-2910 specifies a limit of 180 days for Air Reserve Component servicemembers. 

For four years, USAF has taken a completely hands-off position, leaving us to VA's mercy, but perhaps somebody in a blue suit or green bag will be led to do right by us at last.

Our time frame of 1972-1986 would have to be addressed with an LOD request through the Air Force Board of Correction of Military Records (AFBCMR.) While Air Force regs specify a 180 day period to submit an LOD following an event, Secretary James has complete authority in AFI 36-2910 to waive that constraint and anything else. The Board acts with the Secretary's authority.

Any airman can submit an AFBCMR request. In this instance, I ask that VA indicate to AFBCMR acceptance of such an approach for a representative C-123 vet. Further, I hope that VA can raise the issue with Secretary James and seek her acceptance.

With the Secretaries' input with their acceptance of this approach, the AFBCMR can make its decision based on the history of the issue, the supporting documentation, the IOM and other reports, JSRRC input and the flexibility built into AFI 36-2910. 

The AFI specifies:

"An LOD determination is based upon the onset of the disease, illness or injury process, not existence of symptoms."(3.4.1.1)​

​Further:

AFRCI 36-3004

The objective of the Reserve benefit system is to compensate, to the extent permitted by law, members of AFRC who experience incapacitation or loss of civilian earnings as a result of an injury, illness, or disease incurred, re-injured or aggravated in the line of duty, and provide the required medical and dental care associated with the incapacitation.

It would be better if an LOD can even be considered by the normal Air Force channels for such decisions without the time delay involved with an AFBCMR appeal.

This could provide a resolution for the "veteran" issue otherwise dependent on the liberalizing rule and permit VA to consider claims and appeals submitted prior to June 19 2015.

Perhaps technicalities make an LOD approach or any other solution difficult, but we believe it is reasonable and just, given the facts of the C-123 vets' exposure, ailments, and difficulties receiving the same benefits as their Active Duty counterparts and C-123 vets whose claims were approved prior to the Interim Final Rule.

Please forgive the inexpert phrasing of my suggestion as my ability to research and present the issue is quite limited. We count on VA to offer the most pro-veteran assistance that is permitted.

Please stop finding avenues permitting (not requiring) VA to say "no" and instead, find ways within the law to do what's right for us.

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."

C-123 Vets AGAIN Request Response to USAF Public Affairs Complaint - 1298 Days Have Passed

Dear Chief and Mr. Clavette,

Gentlemen, may I know your thoughts on the inquiry I've lodged? 

It has been 1,298 days: Please do not think me impatient.

I am more grievously ill than when I first sought your counsel in 2011, as are many of my surviving crewmates.

The issue continues to affect the lives of over 2100 veterans, fewer alive today than when the question was first raised with AF PA in 2011. The issue, as managed by the PA shops involved, contributed to the Department of Veterans Affairs' delay in addressing veterans' Agent Orange exposure claims....a stated objective of the various memos and emails.

Quite predictably, there has been attendant financial loss, suffering and deaths from this deviation from Air Force regulations, Air Force values, and denial of the First Amendment rights of local media which prevented informing the public of significant government actions...actions destroying toxic airplanes and information about our health.

I request every kindness in expediting an answer to the questions raised, and welcome correction or clarification where helpful as to the supporting documents provided.

Regards,

   Wes Carter, Major, USAF Retired

  

On Mon, Feb 2, 2015 at 10:47 AM, BAILEY, TIMOTHY R CMSgt USAF AFPAA AFPAA/CCC <timothy.cccccc4@us.af.mil> wrote:

Sir,

I have forwarded your complaint up to the Mr. Larry Clavette, the Director of Air Force Public Affairs Agency. 

v/r

Timothy R. Bailey, CMSgt, USAF

Wall Street Journal Addresses C-123 Veterans' Agent Orange Exposure Problem

from today's Wall Street Journal:

Senators Seek Compensation for Veterans Exposed to Agent Orange in the U.S.

VA Typically Provides Coverage for Vets Who Served in VietnamBy BEN KESLING Feb. 5, 2015 5:20 p.m. ET 1 COMMENTS
Thousands of veterans likely exposed to Agent Orange during stateside service gained new momentum Wednesday in a yearslong fight for benefits and compensation after a group of senators highlighted the issue in a query to the Department of Veterans Affairs.

Six senators, including the top-ranking Democrat on the Committee on Veterans’ Affairs, Richard Blumenthal of Connecticut, sent an open letter to VA secretary Robert McDonald asking for compensation for as many as 2,100 veterans who served on Agent Orange-contaminated aircraft in the years following the Vietnam War.

The veterans served on C-123 cargo aircraft that had been used to spray toxic defoliants in Southeast Asia during the Vietnam War. The aircraft had been repurposed after the war and sent stateside for service.

Years after the conclusion of the war, veterans exposed to the herbicide began to have health problems, including cancer, diabetes and skin problems. In the 1990s, the VA instituted policies that allowed veterans who served in certain areas at certain times during the war to qualify for benefits under the presumption of exposure to Agent Orange, even if it wasn’t documented in their health records.

But some veterans say they fall into gaps in this presumptive coverage policy, creating a high barrier to prove their disease was definitively caused by exposure to toxins.

“Justice for these veterans is long overdue to compensate them for the constant effects of Agent Orange contained in dangerous levels in the aircraft they flew,” said Mr. Blumenthal said in an interview. “They’ve been left very unjustly and unfairly without recourse.”

Richard Matte falls into this group. He was a crew member on C-123s based at the Westover Air Force Base in Massachusetts and who has been fighting for full compensation for years with the help of veterans advocates and the Veterans Legal Services Clinic at the Yale Law School.

He and others flew on planes that had seen action in Vietnam and still carried residue from Agent Orange for years after returning stateside. The Air Force has documentation of persistent contamination going back to 1979, when it conducted tests on some of the planes. The aircraft eventually were destroyed by the Air Force because of the threat the Agent Orange contamination posed to crews.

“The tide may finally be turning for this group of disabled, elderly veterans that have long been fighting for recognition,” said Sarahi Uribe, a law student who works at the veteran clinic at Yale.

In January, the Institute of Medicine issued a report indicating between 1972 and 1982 as many as 2,100 Air Force reservists were exposed to toxic dioxins left over from Agent Orange and “some reservists quite likely experienced non-trivial increases in their risks of adverse health outcomes.”

The VA hasn’t responded to the findings but in a statement said “VA has assembled a group of clinical subject matter experts to review and respond to findings and recommendations in the IOM report.”

The senators’ letter calls on the VA to provide compensation and benefits coverage to the C-123 veterans and to then reach out and let veterans know of their new disability status.

US Senators Demand Prompt VA Action on C-123 Agent Orange Claims

For Immediate Release: February 4, 2015

Contacts:             Martina McLennan/Ray Zaccaro (Merkley) (202) 224-3753

                                Rachel Hicks (Burr) (202) 228-1616

                                Josh Zembik (Blumenthal) (202) 224-6452

Following Institute of Medicine Study Confirming Agent Orange Exposure, Bipartisan Group of Senators Calls on VA Secretary to Ensure Post Vietnam Air Force Veterans Receive Proper Benefits and Compensation

WASHINGTON, D.C. – A bipartisan group of senators led by Oregon’s Senator Jeff Merkley (D-OR) and Senator Richard Burr (R-NC) today called on VA Secretary Robert McDonald to ensure that veterans long denied care for exposure to Agent Orange receive timely and proper benefits and compensation. The letter follows a recent Institute of Medicine (IOM) study that provides new and compelling evidence on exposure to Agent Orange of veterans who flew contaminated aircraft after the Vietnam war.

Merkley and Burr were joined in a letter by Sens. Ron Wyden (D-OR), Elizabeth Warren (D-MA), Richard Blumenthal (D-CT), and Michael Bennet (D-CO).

The IOM study, which was published in January, found “with confidence” that post-Vietnam veterans serving on C-123 aircrafts were exposed to potentially dangerous levels of dioxin from aircrafts that were used to carry and spray Agent Orange during the Vietnam War and that were never properly decontaminated.

According to the study, an estimated 1500-2100 personnel served on the affected planes, and numerous veterans among that group have developed symptoms, including cancer, consistent with Agent Orange exposure.  

The senators pushed the VA to reverse previous decisions that have denied veterans benefits and compensation, writing:

“Despite (1) multiple Air Force reports going back to 1979 showing that the C-123s were contaminated, (2) numerous expert opinions from inside and outside the government suggesting these veterans were  exposed to Agent Orange and other toxins, and (3) a judge’s order stopping the resale of these C-123s because the planes were a ‘danger to public health,’ the VA to-date has doggedly insisted  there is no possibility that post-Vietnam era C-123 veterans might have been exposed to dangerous levels of Agent Orange.  It also has denied all but one of the C-123 veterans’ claims for benefits.”

They continued, “It is our desire to see that C-123 veterans who suffer today because of service-related exposure to Agent Orange receive the help they need. To speed the award of benefits, we ask that you provide a presumption of service connection for these veterans.”

The senators also called on the VA to immediately review all C-123 Agent Orange exposure claims, including those that have been denied and are under appeal, and to work with the Department of Defense to proactively contact all veterans who served on any C-123s previously used in Vietnam to spray Agent Orange defoliant that were subsequently assigned to Air Force Reserve units based in the United States from 1972-1982 in order to notify these veterans that they may be eligible for benefits.

The full text of the letter follows below:

February 4, 2015

Dear Secretary McDonald,

We write to bring your attention to the Institute of Medicine’s (“IOM”) January 9, 2015, report on exposure to Agent Orange by veterans who served on Fairchild UC-123 Provider(“C-123”) aircraft post-Vietnam.  The report, commissioned by the Department of Veterans Affairs (“VA”), stated “with confidence” that these veterans were exposed to potentially dangerous levels of dioxin.  Given IOM’s recent finding, we ask that you use your authority to provide a presumption of service connection for C-123 veterans who flew or worked on planes that carried and sprayed Agent Orange and to revisit past and existing related claims.  

During the Vietnam War’s Operation Ranch Hand, the Air Force used approximately 30 C-123s to spray Agent Orange and other herbicides over Vietnam.  Though never properly decontaminated, these planes remained in the fleet until 1982.  An estimated 1500-2100 personnel who served on these planes were the subject of IOM’s recent report.  It found, “with confidence,” that these personnel were exposed to toxic levels of Agent Orange and other herbicides as a result of the failure to adequately sterilize the aircraft. 

Despite (1) multiple Air Force reports going back to 1979 showing that the C-123s were contaminated, (2) numerous expert opinions from inside and outside the government suggesting these veterans were  exposed to Agent Orange and other toxins, and (3) a judge’s order stopping the resale of these C-123s because the planes were a “danger to public health,” the VA to-date has doggedly insisted  there is no possibility that post-Vietnam era C-123 veterans might have been exposed to dangerous levels of Agent Orange.  It also has denied all but one of the C-123 veterans’ claims for benefits. 

The VA’s position has been disappointing.  In a June 7, 2013, response to an inquiry from Senator Richard Burr, then-Secretary of Veterans Affairs Eric Shinseki provided a fact sheet that concluded, “(1) any residual TCDD (dioxin) [the carcinogenic element in Agent Orange herbicide] in the Operation Ranch Hand aircraft had solidified and is unable to enter the human body in any significant amount, and (2) there is no scientific evidence that a Veteran’s presence in an aircraft containing solidified TCDD can lead to adverse long-term health effects.”  Further investigation was impossible due to the fact that the Air Force destroyed all the remaining C-123s before additional testing could be conducted. 

Because of mounting independent scientific evidence concluding that these veterans were exposed to dangerous levels of dioxin, the VA ultimately contracted with IOM to review the available data.  On January 9, 2015, IOM issued its final report.  The IOM committee concluded that C-123 flight crews “were exposed when working in the ORH C-123s and soexperience some increase in their risk of a variety of adverse [health] responses.”  (Emphasis in original).  The IOM’s report also “emphatically” refuted the VA’s long-standing argument that residual TCDD in the C-123s posed no risk for veterans, noting instead that it is “accepted in the field of exposure science” that the TCDD contamination “persist[ed] long after the[] [aircrafts’] use” during the Vietnam War, and that Air Force reservists serving on those planes were exposed to TCDD and herbicides “through multiple routes.”

We hope IOM’s findings will allow C-123 veterans finally to receive the benefits they have earned. However, our offices remain concerned  about the VA’s ability to provide these individuals with consistent, fair access to critical services.  For instance, the VA has repeatedly told some of our offices that it did not have a “blanket policy” of denying C-123 veterans’ claims.  Each claim, they assured us, was “evaluated on a case-by-case basis to determine if the available evidence support[ed] a service connection on a facts-found basis.”  However, at least one VA denial letter stated, “The VA and DOD have specifically provided guidance that such secondary [Agent Orange] exposure cannot be granted service connection, to include working on planes that carried or sprayed . . . the herbicide . . . .”  This discrepancy raises questions about the accuracy and validity of information provided to some of our offices, and the knowledge within the VA about VA policy towards these veterans.  This is why we are bringing the IOM’s findings to your attention. 

It is our desire to see that C-123 veterans who suffer today because of service-related exposure to Agent Orange receive the help they need.  To speed the award of benefits, we ask that you provide a presumption of service connection for these veterans.  Further, we ask that the VA immediately review all claims, including those that have been denied and are under appeal, made by C-123 veterans for post-Vietnam exposure to Agent Orange.  Finally, we ask that the VA proactively cooperate with the Department of Defense to contact all veterans who served on C-123s used to spray Agent Orange and other covered herbicides during the war and notify them that they may be eligible for benefits. 

We thank you for your attention to this matter.  We look forward to working with you to make sure the C-123 vets receive the benefits they deserve. 

Sincerely,

--

Martina McLennan

Deputy Communications Director

U.S. Senator Jeff Merkley

(202) 224-3753

VA to Continue Town Hall Events at VA Facilities Nationwide

Good move, VHA and VBA!

 Secretary BobAnnounces VA to Continue Town Hall Events at VA Facilities Nationwide
Posted on October 8, 2014 by Donnie La Curan in Veteran News

Secretary of Veterans Affairs Robert A. McDonald has directed all Veterans Affairs (VA) healthcare and benefits facilities to continue to hold quarterly town-hall events to improve communication with, and hear directly from, Veterans nationwide. This follows the recent completion of town-halls at these facilities held between August and the end of September of this year.

“Every one of our medical centers and regional benefits offices held town hall meetings around the country in August and September, but we have more listening to do to better serve Veterans and their families,” said Secretary McDonald. “As part of our Road to Veterans Day, VA is taking a hard look at everything we do in order to reorganize the Department around the needs of Veterans. Direct feedback from Veterans, employees and stakeholders is an important component of that Roadmap, and key to improving our services and operations,” Secretary McDonald added.

Details of events at each location will be forthcoming from local facilities. Additionally, VA is looking to continue to improve the town hall notification process, making sure we have the benefit of extensive local input. In addition to Veterans and their families, the quarterly meetings are open to Congressional stakeholders, Veterans Service Organizations, Non-Governmental Organizations and other community partners.