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March/april 2010

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Claims Processing: Not Fixed Yet

BY PATRICK W. WELCH, CHAIR, GOVERNMENT AFFAIRS COMMITTEE, WITH GOVERNMENT AFFAIRS STAFF

How many of you have a claim awaiting adjudication for more than six months for disability compensation for a service-connected health condition? Or for a non-service-connected pension? Or for Disability and Indemnity Compensation? How many of you have had to wait for a year, or two—or three or more—before a claim was finally adjudicated?

If you have been following the saga of the inefficient, fundamentally broken claims rating process, you will know that there are hundreds of thousands of claims, many of them that meet the “substantially developed” criteria as attested to by a certified veterans service representative, pending before the Veterans Benefits Administration. And there are tens of thousands more before the Board of Veterans’ Appeals.

Veterans’ benefits delayed are veterans’ benefits denied, often until too late.

Vietnam Veterans of America is party to a lawsuit (See article, Too Long To Wait ) that seeks the intervention of the federal courts to compel the VA to get its act together in the claims rating process. How? By beginning to pay a veteran who files a substantially developed claim a 30 percent rating six months after his or her claim has been filed and not acted upon.

The judge at the District Court turned us down, so we appealed. We are not optimistic that the ruling by the three-judge panel in this case will be favorable.  Two of the judges went out of their way during the hearing to note that a veteran waiting a very long time for a ruling on a claim has a means of redress: The veteran can file a writ of mandamus with the CAVC if he or she is not satisfied to wait. 

It is rare that veterans even know that they have this theoretical right, and even rarer that such an order is sought. The reason is that even the few motions seeking
to compel the VA to act are nearly always denied. The attorney for the VA did not inform the Court of the whole truth, which is that this is an empty exercise. Rather, the attorneys let the judges mistakenly think that this is a genuine means of redress.

But this whole broken system needs to be turned around this year. It is clear that anger among members of Congress is growing as they have provided funds to double the FTEE in the Compensation & Pension system in the last five years, yet the problems, delays, and erroneous decisions continue to get worse. They are hearing angry complaints from veteran constituents and their families in ever increasing numbers, asking them to take action.

We hope that VA Secretary Shinseki will take meaningful, effective action soon. VVA believes that the legal authority to take action already exists, and that if he needs any further statutory changes that Congress will provide it in short order. However, if steps are not taken to significantly improve the situation with regard to veterans’ claims this year, then we think it likely that Congress will take steps to try and fix what is a broad failure of leadership at the regional and permanent management level.

HOW HEROIC IS “HERO”?

When the VA’s four-VISN pilot, Project HERO, was unveiled more than two years ago, VVA and most other veterans service organizations were skeptical.  Our main concern: Would this lead to the shuttering of community-based outpatient clinics—CBOCs—and even VA Medical Centers?  We were concerned because there are folks in government, in high places, who would applaud if the VA were to become little more than an entity that would fiscally manage and oversee the widespread use of vouchers for veterans to receive medical care from the private sector.

VVA does not endorse this concept.

VA officials, along with top officials from Humana and Delta Dental—the two mega-healthcare companies that have the HERO contracts—did their best to assuage these fears.  They are here only to help the VA get a handle on the amount of money it spends on fee-basis care, as they testified before the Subcommittee on Health of the House Veterans’ Affairs Committee.

We were assuaged, but only a little.  Basically, Humana and Delta Dental are middle men. Their function ought to be handled within the VA—in the VISNs and VAMCs—by competent business staff who can make contractual agreements with health care providers in their areas, particularly in rural and remote parts of the country where such providers are really needed.

It is our hope that the VA’s business honchos will have learned from this experiment. As we testified:

“In fairness, VA officials who are overseeing Project HERO acknowledge that they are learning from their experiences with HERO and that, with hindsight, they would have structured the contracts differently. For this, we applaud them. But we do not believe that any wholesale outsourcing of health care services is either warranted or justified by the experiences of HERO.

“We agree with a statement by then-chairman Steve Buyer (R-Ind.) who stated, on March 29, 2006:  ‘This initiative is not intended to undermine our affiliations, or lead to expanded outsourcing or the replacement of existing VA facilities. It should instead help us learn how to improve some of the contracted care we now provide, and the way we provide it.’ If Project HERO accomplishes this, then it will have been a worthy experiment.” 

But that is all it ought to be: an experiment, not an answer. And it is not at all clear that the tremendous drain on resources has been worth the effort and the negative impact it has had on VA medical centers bringing their permanent staff up to acceptable levels. Unless the Secretary can show that there is a significant gain at the end of this fiscal year, this experiment should be dropped, and these tens upon tens of millions of dollars put to better use.

BURN, BURN, BURN

Wisdom, someone once wrote, is not making the same mistake twice.
By this standard, our military is not very wise. When it comes to protecting the health of the women and men who are in harm’s way in Iraq, they are, in fact, either quite stupid or terribly irresponsible regarding the long-term health of the young men and women risking their lives in defense of America. 

We say this because—after the experience with Agent Orange and other herbicides and defoliants sprayed so liberally in Vietnam—military leaders have permitted burn pits to proliferate throughout Iraq. According to a recent article in the Omaha World-Herald:

“Military contractors burned nearly every bit of waste from military bases—trash that included plastics, batteries, old weapons, ruined machinery, and a fuel known to cause cancer, according to government and independent reports. They burned because military leaders originally saw the pits as temporary, a congressman thinks, the simplest way to dispose of trash before troops quickly exited Iraq.

“But as the war continued, they burned because it saved money, according to subsequent lawsuits, allowing U.S. contractors to avoid having to install costly incinerators. For most service members, the resulting clouds of smoke were a nuisance, simply a part of deployed life, like the Iraqi sandstorms and the scorching desert heat. But troops and contractors stationed at al-Taqaddum Air Base, where Klayton Thomas eventually served, and all across Iraq started to complain about a grab-bag of symptoms often diagnosed as severe colds. But for a select few, those clouds of smoke represented something far more ominous.”

We have to trust the judgment and integrity of VA Secretary Shinseki, who has told military reporters, to continue from the article, “that his administration would not repeat the errors of Agent Orange. For decades, the military denied that the herbicide—used to destroy dense jungles during the Vietnam War—caused sickness. Eventually officials admitted the link between Agent Orange and the illnesses of thousands of veterans. President Barack Obama said last year that his administration had no interest in ‘sweeping things under the rug.’

“And, on Dec. 16, R. Craig Postlewaite, the American military’s senior health protection official, publicly acknowledged that the burn pits had probably caused serious illness. ‘We feel at this point in time that it’s quite plausible—in fact, likely—that there are a small number of people that have been affected with longer-term health problems,’ he told the Salt Lake Tribune.

“The Department of Defense is launching a more comprehensive study that could further validate outside research that indicates the burn pits have sickened troops. And the military has installed incinerators at Balad, closing Iraq’s most infamous burn pit.”

We fear this is only the beginning of another sad saga of men and women who gave their all in the combat zone, only to be wounded not by enemy bullets or RPGs or IEDs, but by the stupidity of expedience and by contractors who, in pursuit of big bucks, did not take precautions to protect the health of soldiers.

MONEY, THE VA, AND YOU

The VA wants to inform veterans and other beneficiaries of several changes that will take effect in 2010:

The VA Will Freeze Increase in Prescription Co-payments:

Any increase in veterans’ out-of-pocket payments for pharmaceuticals will be delayed until June 30. This means the department will delay a scheduled $1 increase—to $9—in copayments for each 30-day supply of medicine for the treatment of conditions not related to military service. During this period, the VA will also keep $960 as the maximum, annual out-of-pocket payment for pharmaceuticals for non-service-related conditions. The $960 cap will not apply to veterans in priority groups seven and eight. The yearly maximum out-of-pocket payment was scheduled to increase to $1,080. There are no copayments associated with the treatment of conditions related to military service.

The VA Will Distribute Insurance Dividends:

Approximately 900,000 veterans are in line to share $286.4 million in annual insurance dividends during 2010. The VA operates one of the nation’s largest life insurance programs, providing more than $1 trillion in coverage to seven million service members, veterans, and family members. These payments will be made to insurance policy holders on the anniversary date of their policies. Payments will be sent automatically through different payment plans and the amounts will vary based on the age of the veteran, the type of insurance, and the length of time the policy has been in effect.

Veterans who have questions about their policies may contact the VA insurance toll-free number at 800-669-8477 or send an e-mail to VAinsurance@va.gov They may also visit www.insurance.va.gov

There Will Be No Adjustment in COLA for Disability Compensation and Pension Benefits:

As a result of negative inflation and the Consumer Price Index going down over the past year, the Social Security Administration has announced there will be no COLA this year for Social Security recipients. Under federal law, VA’s COLAs cannot exceed the Social Security COLAs.  Therefore, the VA is barred from making a COLA increase for recipients of its benefits.

The VA provides compensation and pension benefits to more than 3.8 million veterans and other beneficiaries.  Presently, the basic monthly rate of compensation ranges from $123 to $2,673. Annual income limits for disability pension begin at $11,830 for a veteran without dependents and increase for veterans who have dependents, who are housebound, or who need regular aid and attendance. 

Veterans with questions about their benefits should contact the VA at 800-827-1000 or go to www.vba.va.gov/VBA

THE WIDOW’S TAX

Every year since 2005, the Senate has voted to eliminate the policy that denies widows the ability to collect both a military survivor’s benefit and the full annuity bought when their military husbands were alive. But in each of those years, the provision was dropped when House and Senate negotiators wrote the final bill in private.

This is an injustice. The so-called widow’s tax does not allow a surviving spouse to receive the retirement pay due when his or her spouse died from a cause related to military service, and at the same time collect the full annuity—essentially an insurance policy most of their spouses opted to buy. They paid an average of 6.5 percent of their retirement pay in premiums, often $100 or more a month, notes an article that ran in the Associated Press.

Because one benefit is subtracted from the other, affected surviving spouses lose on average about $1,000 a month. There are about 54,000 survivors who are affected by the policy. Their spouses served from World War II to Afghanistan. That number could grow.

Part of the problem is the cost. Eliminating the offset in benefits is expensive, said Sen. Bill Nelson (D-Fla.), who has been the widows’ longtime ally. Making good on the promise would cost $6.7 billion over a decade.

When she was Minority Leader, Rep. Nancy Pelosi, now Speaker of the House, took up the widows’ cause in 2005 as part of the Democrats’ GI Bill of Rights, before her party gained control of Congress.

Two years later, President Obama, then a senator, co-sponsored legislation to eliminate the offset just before he spoke at a Gold Star Wives reception on Capitol Hill. In his budget proposal to the Congress, he didn’t include it.

We understand that there are severe constraints on the budget and that all promises cannot be kept.  This is one promise, however, that would correct a rank injustice. And the cost? It’s amazing what gets passed in the budget, after all the rhetoric and all the bargaining. If Senators and Representatives are not going to pass legislation to right this long-standing wrong, they shouldn’t tell these widows that they will. 

In our book, that’s called hypocrisy.

 

 

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