Agent Orange - C-123K Aircrew & Maintainers - VA now honors our Agent Orange claims!: December 2015

27 December 2015

'Bad paper' haunts vets after leaving the military – as it must, in my opinion

I stand for careful review of dishonorable discharges to insure PTSD, TBI or other causes are not involved. Thanks to the National Veterans Legal Services Project this review is underway. Further, individuals have extensive review rights as well as the opportunity to seek redress through their service Board for Correction of Military Records.

I also stand for exclusion from any "veteran" status of an individual who so completely failed the military and his/her comrades through dishonorable conduct. A dishonorable discharge is the result of a judicial procedure with ample protection for the individual's rights.

An honorable discharge is earned by honorable service, and a dishonorable discharge should bring no benefits but instead, public awareness that the individual failed his or her duty, often through criminal acts.

JIM SALTER | Associated Press, December 25 2015

ST. LOUIS – No medical or mental health care. No subsidized college or work training. For many who leave the U.S. military with less-than-honorable discharges, including thousands who suffered injuries and anguish in Iraq, Afghanistan and elsewhere, standard veterans benefits are off limits.

The discharge serves as a scarlet letter of dishonor, and the effects can be severe: Ex-military members with mental health problems or post-traumatic stress disorder can’t turn to Veterans Affairs hospitals or clinics; those who want to go to college aren’t eligible for the GI Bill; the jobless get no assistance for career training; the homeless are excluded from vouchers.

“It’s an indelible mark of their service that follows them for the rest of their lives into the workforce, through background checks, social relationships, and it precludes them from getting the kind of support that most veterans enjoy,” said Phil Carter, an Iraq War vet and senior fellow at the Center for A New American Security.

The Department of Defense said of nearly 207,000 people who left the military last year, just 9 percent received what’s referred to as “bad paper.” Still, that’s more than 18,000 people last year and more than 352,000 since 2000, Defense Department data shows.

U.S. Rep. Mike Coffman, a Colorado Republican who’s on the House Armed Services Committee, believes many of those men and women suffered battle-related problems that affected their behavior, especially PTSD and traumatic brain injury.

A 2005 study showed Marines deployed to combat who were diagnosed with PTSD were 11 times more likely to receive less-than-honorable discharges, said Brad Adams, an attorney who works with the San Francisco-based organization Swords to Plowshares.

Varying levels of bad paper discharges exist. A general discharge is for those whose service was generally satisfactory, but who engaged in minor misconduct or received non-judicial punishment. Recipients are usually eligible for VA medical and dental services, VA home loans and burial in national cemeteries, but can’t receive educational benefits through the GI Bill.

Virtually no post-military benefits are available below that level.

An other-than-honorable discharge is an administrative action for those with behavior problems such as violence or use of illegal drugs. A bad conduct discharge is punishment for a military crime, and dishonorable discharges are for offenses such as murder or desertion. With those discharges, the VA doesn’t consider the former service members veterans for the purposes of VA benefits.

Maj. Ben Sakrisson, a Defense Department spokesman, said there is “substantial due process” for all cases where people receive a less-than-honorable discharge. Its statistics show that last year, 4,143 service members received other-than-honorable discharges, 637 received bad conduct discharges and 157 were dishonorably discharged.

Once people are discharged, the Department of Veterans Affairs can extend medical and mental health benefits on a case-by-case basis to those whose disabilities were service-connected, the VA said.

Studies show those who are less-than-honorably discharged are far more likely to end up in prison than honorably discharged veterans, and more likely to be suicidal.

24 December 2015

For Years, Colorado Legislators Have Blocked Property Tax Relief Due Some VA 100% Permanent and Totally Disabled Veterans

Colorado's statute provides property tax relief for VA-certified permanently and totally disabled state veterans. Colorado's law covers all of them, but some Colorado legislators have mentioned to the state's Veterans Affairs Department they'd like exceptions made, on the basis of their personal preference! The federal VA provides certification for this type of veteran and the state accepts that is the qualifier for relief, the benefit being half of the taxes on the first $200,000 of assessed home value.

The problem is that Colorado pretends there are extra words in its statute and adds, unofficially and without legislation, an unwritten preference suggested by some legislators to disqualify those disabled veterans certified by VA as "permanent and totally disabled" if any portion of the total disability is due to unemployability. Many vets are 60% or more for their service-connected disability but other disabilities make it such that the are unable to work even at the poverty level. They still are certified by VA as "100% permanently and totally disabled", but Colorado adds an unofficial, unmentioned qualifier...to exclude vets with any part of their VA award being for unemployability.

They say this is because some of the legislators who drafted the legislation then told the Colorado Veterans Department that's how they'd like the extra, interpretation added but only AFTER the language had been approved by the people of the state, their legislators, and the governor. Time for a little extra-legal fine tuning, not by adding eligible veterans by but excluding eligible veterans otherwise clearly certified by the VA as eligible for Colorado disabled veteran property tax relief. They did this, not by the clear words of the Colorado statute nor the equally clear words of the VA letter certifying some disabled veterans with unemployability awards as "100% permanent and totally disabled." They did this by simply telling the Colorado Veterans Affairs how they'd prefer the statute to be more exclusive, despite the language of the law just passed.

Only by the legislators' personal preference is it that totally disabled unemployability-qualified veterans are to be excluded, despite their word-for-word qualification under the Colorado law.

Personal preferences of some Colorado legislators somehow trump the clear language of the law, the votes of both houses of its legislators, and the governor's signature and the massive support of Colorado's citizens who want the states veterans given a small and vital benefit.

Here's the law:

" (1.5) "Exemption" means the property tax exemptions for qualifying seniors and qualifying disabled veterans allowed by section 39-3-203.

(3.5) "Qualifying disabled veteran" means an individual who has served on active duty in the United States armed forces, including a member of the Colorado National Guard who has been ordered into the active military service of the United States, has been separated therefrom under honorable conditions, and has established a service-connected disability that has been rated by the United States department of veterans affairs as one hundred percent permanent and total disability pursuant to a law or regulation administered by the department."

Why the distinction? Anybody catch the word "unemployability" Anybody else notice that it is the United States Department of Veterans Affairs which certifies 100% permanent and totally disabled veterans, not the state of Colorado?

23 December 2015

"I figured they would take care of me, but so far they haven’t."

“They promised me health care, and I figured they would take care of me, but so far they haven’t.”

That's the story from so many VA patients in Oklahoma and elsewhere. More stories than there should be, given the standards VA sets for itself and the typically complex medical situation of aging veterans.

We've written before about how much it hurts all veterans to read about VA failures in providing essential medical services. The title of the USAToday news feature sums up its damning indictment of the Oklahoma City Veterans Hospital. Not only are veterans abused with a claims system making them wait months and years before allowed VA medical care and benefits, but the care they've been promised falls short of their needs.

My own care at various VA facilities has been excellent for the most part, especially in dental service, urology, medical imaging and the emergency department services.

However, I also had my second-worst experience at the VA when the Portland VA emergency department diagnosed avascular necrosis of my right hip. I was referred

to orthopaedics where a surgeon concluded I had simple bursitis, although I couldn't walk for the pain and had several falls. He made this conclusion despite his own hospital's emergency department and radiology physicians' written diagnosis of avascular necrosis, basing his conclusion on the fact that I had no history of taking prednisone, a powerful steroid.

Problem: the orthopaedist didn't bother reading the many pages in my medical record that detailed his own hospital's prescription for my massive doses of prednisone over a several year period. He wrote in my records "no history of prednisone use," and nothing came up in our conversation about it for me to realize his oversight...I discovered only on reading my records after a FOIA request.

His failure to diagnose cost me many more months of increasingly miserable pain, more falls, and failed to treat a hip that could have been saved. Like the patients in USAToday's article, my problem was finally diagnosed by a private physician. Complaining about it to my VA doctor's supervisor and then, filing what's called an 1151 complaint, only brought VA's official conclusion that my VA care (for the hip and for the probably unrelated earlier problem which required the massive prednisone) had somehow equaled the standard for care in the Portland medical community. The complaint was dismissed.

Avascular necrosis (large bone death caused by loss of blood supply to the bone) is progressive...and how! I eventually couldn't move the hip at all, and was bedridden until I sought care and was properly diagnosed at Oregon Health Sciences University. By then my hip was damaged past the point of recovery and I went through two painful replacements and less than optimal results.

Months later I felt ready to collapse and ended up once again at the VA emergency room –with an infection of the hip prosthesis I'd received at OHSU. I was shocked when the same VA physician came in to care for me, and for the first time in my life I refused care and asked to be transported to another hospital.

My story, like every other individual's story, is only anecdotal. It takes many such stories to prove a fact, and we've seen those stories accumulate to the point of proving the case: VA care too often is substandard and veterans pay with pain, suffering and death. USAToday and other publications have certainly proven that VA care is too often below the standard of what aging veterans need and below the standard the Secretary expects of his Department.

Mr. President, Mr. Secretary and my own Colorado federal legislators, the entire country needs the VA to succeed. We need heros in the VA to pull it up to the standards in health care we deserve. With news like Oklahoma City, Phoenix and other problem facilities, we're losing the support of the American public. Without that support, the Department can only sink lower and lower into disrepute. Please lead the Veterans Health Administration into the ranks of America's finest!

Because I need it and my experiences warrant it, I'm a vocal supporter of the Department of Veterans Affairs and its leaders, but not VA's claims process. Stories like this in USAToday sadden VA's most enthusiastic supporters and threaten to make 2015 a repeat of 2014, which everyone called "the year of scandals."

22 December 2015

VA Now Pushing C-123 Veterans' Agent Orange Benefits!

It is absolutely wonderful to see 54 months' hard work on C-123 Agent Orange claims now appear on VA's own benefits web pages!!

19 December 2015

VBA Violated 38 United States Code 5103A(b)(2) – and more!

VBA Motto?

For nearly three years, Veterans Benefits Administration sat on vital evidence supporting C-123 veterans' claims for Agent Orange exposure injuries. Our inquiry about this, with copies of VA documents establishing our allegations, was provided the VA Office of General Counsel as well as VA IG and VA National Center for Ethics in Healthcare, without response. Actually, the Ethics Center did respond but said the issues are so serious it is outside their purview.

Input from (1) CDC, (2) National Institutes of Health, (3) US Public Health Service (4) The Concerned Scientists and Physicians and other agencies was received by VA as those agencies sought to confirm C-123 veterans' exposures. (5) Input was even submitted by the Department of Defense Joint Services Records Research Center (JSRRC) beginning in March 2013, but ignored by VA Agent Orange Desk other than in internal discussions about how to disregard it. JSRRC proofs weren't released to C-123 claimants. (6) Even VA physicians who are acknowledged cancer researchers were disregarded (Dr. Mark Garzotto, Cancer Society researcher and author, professor at Oregon Health Sciences University and my urology oncologist at VA Portland.) VA's Mr. Tom Murphy, Director of Compensation and Pension, disregarded every other physician and scientist who submitted evidence on my own exposure to Agent Orange.

Lots of evidence. Evidence even VA described as "credible." Yet for years, VA ignored every bit of it for every one of us. Even today, neutral observers cannot fathom VA having disregarding solid evidence, raising the barrier for C-123 veterans' claims far past its fundamental standard of "as likely to as not." Indeed, VBA's Mr. Tom Murphy, Director of Compensation and Pension, even stated to us and his staff that no amount of proof from whatever source would be permitted to let a C-123 claim be approved.

There's law about such things. VA is required under the Veterans Claims Assistance Act (VCAA) to assist veterans in obtaining records from all other government agencies. It is clear that VA's use of these laws and regulations is primarily procedural but the only enforcement seems to be against veterans and not to compel VA to be correct and legal. Until recently I hadn't found the specific language in the United States Code, but happened upon it today:

(2) If VA becomes aware of the existence of relevant records before deciding the claim, VA will notify the claimant of the records and request that the claimant provide a release for the records.
(Authority: 38 U.S.C. 5103A(b)(2))

That's pretty clear. If VA "becomes aware" it will notify the veteran. One can assume that if VA has "relevant records" in its own possession, it will "notify the claimant."

But the Veterans Benefits Administration neither notified the veterans of available relevant records nor provided those records once in possession of the VA. Instead, VA decided that input from DOD, CDC and other relevant agencies wasn't adequate for VA's purpose...which was to obstruct the C-123 exposure claims. VA even dismissed JSRRC input, writing that it wasn't the role of JSRRC to dictate VA policy.

There's more. VA's Manual M21-1 states:

Federal records are any documents in the custody of a Federal department or agency. Federal records include but are not limited to:

· service treatment records (STRs)
· other service department records (such as personnel records, line-of-duty determinations, inpatient treatment records or behavioral health records) that are not included with the STRs
· VA medical and other records (including Vet Center records and authorized VA medical treatment or examinations at a non-VA facility)
· Social Security Administration (SSA) records
· Public Health Service records, and
· Department of Labor records.

Somehow, VBA opted not to provide C-123 veterans conclusive evidence of their exposures, preferring to simply deny the claims by insisting no evidence existed. Further, VA's manual has specific instructions for VA claims adjudicattors about JSRRC reports of veterans' exposures:

Has the veteran provided sufficient information to permit a search by the JSRRC?
● If yes, send a request to the JSRRC for verification of exposure to herbicides.
● If no, refer the case to the JSRRC coordinator to make a formal finding that sufficient information required to verify herbicide exposure does not exist. (Note: For a sample of a formal finding, see M21-1MR, Part IV,
Subpart ii, 1.D.16.c.),
● decide the claim based on the evidence of record.

(VA21-1, Part IV, Subpart ii, Chapter 2, Section C)

Here's an actual example of how VBA avoided its duties under VCAA, 38 U.S.C. and Due Process. In June 2014 VBA denied a C-123 veteran's claim for various Agent Orange presumptive illnesses, including prostate cancer and heart disease. In its denial, VBA wrote,

"JSRRC is unable to verify or document that aircrew members were exposed to Agent Orange residue or dioxin contaminated aircraft or aircraft parts. (JSRRC response dated May 2012.)"

But that's not correct! JSRRC had specifically informed VBA's Agent Orange desk (Mr. James Sampsel) in March 2013 that C-123 veterans had, per credible government scientific documents (as VBA itself described them,) been exposed to Agent Orange aboard their aircraft. Mr. Sampsel's emails circulated throughout VBA and VHA, yet nobody took exception to VA characterizing the information in an anti-veteran manner or staffers' decision to disregard the JSRRC input.

It is important to follow the dates. In 2012 JSRRC did provide VA an initial negative report but updated that with its confirmation in March 2013, yet VBA denied the veteran's claim in June 2014 citing old information and withholding the newer JSRRC response. VBA even termed the current JSRRC and other information as "unfortunate and credible scientific information."

"Credible scientific information" plus JSRRC confirmation...all vital, primary evidence to support all C-123 veterans' claims. All of it, however, withheld by VBA as it stalled C-123 claims until forced by the Institute of Medicine report to finally recognize the issue in June 2015. And then, VBA even found a way to block retroactive benefits for the years it stalled and violated veterans' rights.

Department of Veterans Affairs December 2015: One veteran's appraisal

This old vet

• It is a better department than last year. While problems still abound, there are fewer than last year and we understand more about dealing with remaining issues.

• The C-123 issue has been basically resolved, with only retroactive compensation a lingering concern. This wraps up a 54-month effort, largely thanks to the Secretary's own fist pushing through his Interim Final Rule. As a small group, we've received more attention than we're due, both from the Secretary and his colleagues.

• The principal news on benefits came this week with the VA's announcement that it intends providing presumptive service connection to Camp Lejeune Marines. This is the biggest event since Secretary Shinseki recognized IHD as a presumptive Agent Orange illness, and again is due to Secretary McDonald's leadership.

• Staff changes have been significant and not always for the better. Besides the new Secretary, new faces are in place for Under Secretary for Benefits and Under Secretary for Health Administration. Staffers at more junior levels have caused alarm due to FOIA releases showing their personal disregard for the Veterans Claims Assistance Act, the VA21-1 regulation and Due Process rights.

• The inappropriate use of outside consultants and subject matter experts is certainly receiving more critical attention within the Department.

Secretary Bob McDonald

• I find the Secretary, much like his earliest predecessor General Bradley, to be basically apolitical, completely dedicated to serving veterans, and more hardworking than I ever imagined a cabinet officer could be. If VA has a problem he wants it out. If VA has a success he wants it magnified. If a veteran has a concern he wants it addressed. If a veteran wants a harder working Secretary of Veterans Affairs, good luck – there's none to be found! Give him credit – he took a job leading this government's most toxic agency with no chance for wide acclaim, only criticism, but a job he could grab onto to make veterans' lives better.

• Homelessness among veterans is greatly reduced, and the public is becoming aware that not every panhandler on a corner with a cardboard sign "help a veteran" is one...as they usually aren't.

• Claims inventory is down but appeals are up beyond reason.

• The VA Center for Ethics in Healthcare remains challenged with too many failures, as does the VA's own Inspector General.

• The VA Office of General Counsel serves the Secretary and his department as their client, of course, but has completely forgotten that the best way to do so is to have veterans' needs as their paramount goal.

• VA's Denver hospital became a national disgrace and brought the Department into disrepute.

Good job, VA!

• VA continues to disregard legitimate Freedom of Information Act requests, including those for patient records for veterans' claims; too much money is wasted opposing FOIAs, both in VA staff, VA attorneys, Department of Justice attorneys and fees paid veterans' advocates for unjustly withholding public information.

• Clinic and hospital appointment wait times are improved.

• The Veterans Choice program is far from perfect but is helping speed up urgent care.

Conclusion:There isn't much more we could have hoped for from any Secretary of Veterans Affairs or any president's administration than Secretary McDonald has delivered for America's veterans. Whoever our next president may be, "Bob" is needed right where he is.

18 December 2015

C-123 Veterans Association Works Washington – One Last Trip

I spent a week working various issues with VA and Senate staffers, including a very special luncheon on December 15 in the nice house just over my shoulder.

Worked with law firms providing our pro bono legal assistance, plus ROA, NVLSP, DAV and other advocates, finishing just a day before VA announced its new Camp Lejeune water policy which, like the C-123 policy, denied Reservists retroactive compensation benefits.

I had the opportunity to make suggestions to the Secretary of Veterans Affairs:
a) utilize fire department and military medics for VA home health care visits.
b) VA should inform America's 20 million veterans of steps ordinary Americans can take to help oppose terrorism.

17 December 2015

"Never-Ending VA Appeals Process Hurts All Vets" -Yes, but appeals are for VA's errors, not veterans' greed!

Claims at VA Regional Claims Office

By Francis Rose, from Government Executive, December 2015. (Veteran's response at bottom)

One of the deepest questions philosophers have considered over the centuries is the sometimes conflict between the rights and needs of society, and the rights and needs of each individual member of that society.
The latest point in the debate over fixing the Veterans Affairs Department is a microcosm of that debate.

The claims backlog the Veterans Benefits Administration has been dealing with for years is finally below 100,000, according to numbers from late summer. The agency promoted the backlog reduction then as a sign that its management strategy was working, in contrast to scandals inside the agency’s other main branch, the Veterans Health Administration. The timing was unfortunate, though; whatever good publicity the VBA, and its then-leader Alison Hickey, might have gotten out of the news was obliterated by the scandal surrounding two employees who received enormous relocation benefits after engineering jobs for themselves outside Washington, displacing other VA officials who held those jobs.

Those numbers look different, though, in light of a Los Angeles Times article on the backlog. Given what the Times reports, it seems unlikely the agency will ever be able to make it go away. The biggest holdup to making the backlog disappear is the most politically unpalatable element of the claims process to do something about.

The biggest roadblock, the Times story makes it seem, is the veterans themselves.

The major reason the backlog doesn’t shrink any faster, the way the story tells it, is that vets submit appeals over and over again when they get outcomes they don’t agree with, hoping against hope for a different outcome. The article tells the story of one vet who did indeed get a different outcome after many tries. He’s still in the system, though – now trying to get retroactive benefits.

The reason he and the other vets do so? Because they can.

“Unlike U.S. civil courts, the appeals system has no mechanism to prevent endless challenges,” the Times’ Alan Zarembo writes. “Veterans can keep their claims alive either by appealing or by restarting the process from scratch by submitting new evidence: service records, medical reports or witness statements.”

The logistics of the backlog is complicated, and has lots of qualifications. The 100,000 number VA celebrated in August was for initial claims applications that were 125 days old. Since that number was well over half a million when the agency declared war on it two years ago, the progress looks real.

The news isn’t all good, though. The Times reports while the claims backlog has shrunk, the appeals backlog – vets who don’t like the response they get from VA and ask to have it reviewed – has climbed from 167,412 in September 2005 to 425,480 in October 2015.

“VA officials say there are two possible solutions to the bottleneck,” Zarembo writes. Those are “money to hire more lawyers, judges and other staff to process appeals, or a rewrite of the law by Congress.” In essence, the VA has pushed the backlog from claims to appeals by applying its resources to claims. It appears to be playing Whac-A-Mole with the claims/appeals process; one goes down, the other pops up.

Since more money for more staff isn’t likely, a rewrite of laws seems more possible. And that is where the philosophical question of the needs of the many versus the needs of the individual comes in. Cutting the number of appeals vets can file would make sense from a purely logistical perspective. Some vets appeal dozens of times – or more – and never win. Is infinity the right number of allowable appeals? Probably not. Is one the right number of allowable appeals? Probably not. But where in between those two is the right number? And how does Congress make that decision, as it will inevitably have to do?

Everyone in politics today wants to “support the vets.” Certainly doing anything that appears to harm veterans individually is a ticket to political trouble; I can hear the negative ads in my head already.

But endless appeals inevitably mean endless backlogs. And the person who can make the political argument that some limit – however big or small it turns out to be – will help vets collectively, will make a huge difference for the rest of the vets waiting in line for their cases to be decided.

A Veteran's Response:

Ms. Rose's essay basically blames veterans for gaming the VA system via the appeals process. "Why do they do it," she asks. "Because they can."

I say, because we must! I can only understand VA's appeals process from my own perspective, and part of that is VA's claims process as well....they cannot be separated.

Veterans currently face an average of 315 days for an initial claim to be processed. In 2012, the Board of Veterans Appeals (BVA) overturned 28.9% of the denials issued for compensation claims, and errors were found in another 46% of appealed claims. These claims were sent back to the original VA Regional Office for an additional review.

Tom Murphy, VBA’s director of compensation services, agreed that initial accuracy has a significant role in keeping down the backlog of both repeated claims and appeals. “If you’re having quality issues, it takes longer to work a case the second or third time than it takes to get it right the first time,”

An appeal is submitted when a veteran claims VA errored on his/her claim. A claim is an initial application for benefits – medical care as well as compensation, Yes, I agree some of my brothers and sisters do submit an inappropriate number of claims, as also appeal with faint justification VA's inappropriate VA's decisions on the claims.

But: Claims are more typically for illnesses and injuries the veteran legitimately believes tied to military service. Appeals more typically are for errors the veteran believes (correctly or not) VA made in deciding the claim. Appeals mount up because of errors made by the Veterans Benefits Administration (VBA) in evaluating claims and also because veterans and their advocates (veterans service officers from VFW, DAV, etc.) themselves made errors in preparing claims. There are many other reasons, and certainly gaming the system is one of them, but the system's errors are basically to blame.

First among them is the remand procedure. Remands are where the Board of Veterans Appeals finds mistakes by VA in processed the claim. A remand vindicates the veteran but does nothing to resolve the claim, instead squeezing it back into the workload of the regional claims staff. The VA makes mistakes on more than 50% of all claims it processes, most of which are never appealed.

• First Solution: Better quality initial claims decisions
• Second Solution: Faster preparation by regional offices of appealed claims for forwarding to BVA
• Third Solution: BVA must be given authority to resolve an issue without a useless remand!
• Fourth Solution: Regional offices should be given reconsideration authority when VA errors are noted while preparing appealed claims before forwarding to BVA
• Fifth Solution: VA should impose a token $10 filing fee for subsequent appeals...a vet's very first appeal is free but a $5 threshold is imposed thereafter for all appeals
• Sixth Solution: Some common sense. For instance, once the C-123 issue was resolved for post-Vietnam veterans, BVA began remanding claims with airplane details but completely outside the scope (by years, location, other facts) of the C-123 Agent Orange issue

Why a failed appeals process, choking on nearly a million frustrated claims?

1. An evolving medical situation, or age, presenting additional illnesses or injuries requiring new claims
2. VA decisions which only partially address issues claimed, leaving particulars to be appealed
3. VA's evolving rules. For instance, C-123 veterans were for years denied all benefits but ground rules changed and permitted claims and appeals
4. The veteran learns from the denied claim what proofs or arguments should have been made in the initial application, and either appeals or repeats the claim with new and material evidence
5. VA's errors in deciding claims
6. VA regional offices taking years to prepare an appealed denied claim before forwarding to the BVA; BVA actually decides appeals rather quickly once received, but the majority of the years a veteran must wait for an appeal is wasted at the regional office waiting for the claim to be readied for the BVA
7. VA has an inadequate system for veterans to request reconsideration of denied claims, and veterans too often leap to an appeal rather than a faster reconsideration process
8. VA permits no input from a vet's own VA physician in support of a disability claim or appeal, yet VA staffs the BVA with medical experts to help oppose appeals. Similarly, VA staffs the BVA with attorneys to argue against veterans' claims. An appeal is thus an uphill battle for a veteran with VA bringing in big guns to oppose a claim...and leaving an incentive to appeal
9. VA's regional office Decision Review Officer (DRO) program is overburdened by its DROs working claims and not appeals
10. One need a veteran continues with claims and appeals even after 100% service connection is granted is to address Combat Related Special Compensation requirements
11. Sometimes a veteran believes strongly an important issue is unresolved even with a 100% service connected decision on a separate issue, and seeks VA acknowledgement. Awards for 100% service connection should include language to encompass all remaining but unresolved issues under the one decision
12. Veterans service organizations should exercise judgement in supporting veterans' appeals, rather than rubber-stamping them past all reason; at some point VSOs should decline to represent a veteran any further
13. Legislation is needed to help address a failed appeals system

Air Force Medics – Always There!

Jedi warriors can always count on Air Force medics, whenever and wherever!

VA Proposes Disability Benefits for Camp Lejeune Marine Veterans Exposed to Contaminated Water

WASHINGTON – The Department of Veterans Affairs (VA) announced today that it plans to propose expanded disability compensation eligibility for Veterans exposed to contaminated drinking water while assigned to Marine Corps Base Camp Lejeune. Without a doubt, this is one of the most pro-veteran decisions ever reached by a Secretary of Veterans Affairs!

From 1953 to 1987, water sources at the base were contaminated with industrial solvents that are correlated with certain health conditions. Secretary of Veterans Affairs Robert A. McDonald decided to propose presumptions of service connection for certain conditions associated with these chemical solvents following discussions between environmental health experts at the Veterans Health Administration and the Department of Health and Human Services Agency for Toxic Substances and Disease Registry (ATSDR).

“The water at Camp Lejeune was a hidden hazard, and it is only years later that we know how dangerous it was,” said Secretary McDonald. “We thank ATSDR for the thorough review that provided much of the evidence we needed to fully compensate Veterans who develop one of the conditions known to be related to exposure to the compounds in the drinking water.”

ATSDR determined that the drinking water at Camp Lejeune was contaminated with perchloroethylene, trichloroethylene, vinyl chloride, benzene and other petroleum contaminants from leaking storage tanks from 1953 to 1987. ATSDR also determined that prolonged exposure to these chemicals increases the risk of certain health conditions.

Based upon VA’s review of current medical science and ATSDR’s findings, Secretary McDonald intends to propose creation of a presumption of service connection for the following conditions:

Kidney Cancer
Liver Cancer
Non-Hodgkin Lymphoma
Leukemia
Multiple Myeloma
Scleroderma
Parkinson's Disease
Aplastic Anemia / Myelodysplastic Syndromes

The Secretary’s proposal would also expand benefits eligibility to Reserve and National Guard personnel who served at Camp Lejeune for any length of time from August 1, 1953, through December 31, 1987. These personnel would be presumed to have been exposed to the contaminated water during their Reserve or National Guard service and, in appropriate circumstances, to have been disabled by such exposure during service, thus allowing them to qualify for VA benefits under the statutory definition of “Veteran.”

This would make them eligible for VA disability compensation and medical care for any of the presumptive conditions, and their surviving dependents would be eligible for dependency and indemnity compensation and burial benefits. A VA spokeswoman said compensation awarded as a result of the proposed regulations, if adopted, will "be effective no earlier than the date the final rule is published."

VA is working on regulations that would establish these presumptions, making it easier for affected Veterans to receive VA disability compensation for these conditions. While VA cannot grant any benefit claims based on the proposed presumption of service connection for these conditions until it issues its final regulations, it encourages Veterans who have a record of service at Camp Lejeune between August 1, 1953, and December 31, 1987, and develop a condition that they believe is related to exposure to the drinking water at the base, to file a disability compensation claim with VA.

VA will continue to grant claims for disabilities claimed to be associated with exposure to the contaminants that can be granted under current regulations and review of the evidence in each case. If a claim for service connection for one of the proposed presumptive conditions would be denied under current regulations, the denial will be stayed until VA issues its final regulations. VA will announce when the regulations are final and presumptive benefits can begin to be awarded.

Veterans who served at Camp Lejeune for 30 days or more between August 1, 1953, and December 31, 1987, are already eligible to receive VA healthcare for up to 15 health conditions.

GREAT move, Mr. Secretary!

Veterans can establish eligibility for healthcare benefits by submitting VA Form 10-10EZ online at www.1010ez.med.va.gov/, downloading it at www.va.gov/vaforms/medical/pdf/1010EZ-fillable.pdf and returning it to any VA Medical Center or Clinic, or by calling 1-877-222-VETS (8387), Monday through Friday, between the hours of 8:00 AM and 8:00 PM (Eastern Time).

VA is reimbursing certain veterans’ family members for eligible out-of-pocket medical expenses related to the 15 covered conditions.

15 December 2015

"Study Solidifies Agent Orange and Myeloma Link" – JAMA Oncology 2015

Exposure to the herbicide Agent Orange has long been considered a potential risk factor for multiple myeloma (MM) and its precursor condition, monoclonal gammopathy of undetermined significance (MGUS), although the science behind the association was limited.

Now, new research brings definitive evidence that Operation Ranch Hand veterans, U.S. Air Force (USAF) personnel who conducted aerial missions spraying the chemical during the Vietnam War, are more than two times as likely to have MGUS as other veterans (JAMA Oncol 2015;1[8]:1061-1068, PMID: 26335650).

“There has already been approval by the federal government to compensate people who served in the Vietnam War and developed lymphoma and myeloma, but there was no scientific evidence behind that—it was a political consensus,” said lead researcher C. Ola Landgren, MD, PhD a professor of medicine at Weill Cornell Medical College and the chief of the Myeloma Service at Memorial Sloan-Kettering Cancer Center, both in New York City. “That motivated my colleagues and me to follow up on prior findings and investigate the link between MGUS and exposure to Agent Orange.”

To do so, Dr. Landgren and his colleagues carried out a detailed examination of data and stored blood samples obtained from Operation Ranch Hand veterans and comparison veterans who served in Southeast Asia at the same time, from 1962 to 1971, but were not involved in herbicide spray missions.

The main goals of the study were to determine the prevalence of MGUS in Ranch Hand veterans compared with controls, and to assess the risk for MGUS related to the body burden of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), an Agent Orange component known to be a human carcinogen.

The study’s base population consisted of 1,951 USAF personnel who took part in the Air Force Health Study (AFHS), in which serum specimens were collected and stored at six intervals between 1982 and 2002. The investigators also had access to AFHS questionnaires and physical exam and laboratory data, which provided a wealth of information on age, race, military occupation, body mass index, smoking history, drinking history, history of cancer treatment and causes of death for deceased USAF personnel.

The final study population consisted of 479 Ranch Hand veterans and 479 controls, all men, with a median age of 65 years and with similar medical histories and demographic and lifestyle characteristics.

The researchers found the crude prevalence of MGUS to be 7.1% in Ranch Hand veterans and 3.1% in comparison veterans. Being a Ranch Hand veteran also correlated significantly with having increased body TCDD levels, with 47.5% of exposed veterans having levels above 10.92 parts per trillion (ppt) compared with 2.5% of the unexposed veterans. Furthermore, veterans with TCDD levels of 10.92 ppt or higher had a 2.43-fold greater prevalence of MGUS than those with 3.65 ppt or lower.

Dr. Landgren, whose previous research definitively linked MGUS to MM (Blood 2009;113[22]:5412-5417, PMID: 19179464), chose to look for MGUS because it is more common than MM; the AFHS, which used the disease and other rare cancers as end points, was underpowered to assess the effect of Agent Orange exposure on Ranch Hand veterans.

“If you want to study whether there is an association between a given exposure and the subsequent risk of developing a relatively rare cancer—such as multiple myeloma—unless you have a very large study population and/or a very long follow-up, statistically it becomes very imprecise, and you cannot reliably tell whether it is true or random. But if you use a more common surrogate end point—such as MGUS—then you have statistical power to study whether there is an increased risk or not,” Dr. Landgren explained.

“If there is a tight link to the precursor condition, that allows you to clearly study the exposure in relation to the cancer years ahead, because you have the information already from the precursor. The other option would be to follow people for 10 years and see what happens. That’s the rationale for studying the precursor in this setting,” he added.

Saad Usmani, MD

Saad Usmani, MD, the director of Plasma Cell Disorders at Levine Cancer Institute/Carolinas Healthcare System, in Charlotte, N.C., said the findings are provocative, although not surprising. “The association between Agent Orange and several malignancies, including hematologic malignancies, has been reported, but this is the most comprehensive study to show this to be true. This puts a number to the risk,” he said.

“It would be important to follow these patients prospectively and see what happens. Are they at high risk of developing active multiple myeloma, or even systemic amyloidosis? It is important to monitor those patients and see the natural history of this MGUS,” he noted.

At this point, there is no evidence that MGUS associated with Agent Orange exposure will behave differently from any other MGUS, said Dr. Landgren, who has found no difference in the risk for transformation across a wide variety of populations. “There is no data to suggest that the etiology leading from the precursor has a different trajectory.”

—Monica J. Smith