Saturday, May 1, 2010

Op-Ed: Advice for VA and Gulf War Veterans

Editor’s Note:  Jim Bunker served during the 1991 Gulf War under the command of John Gingrich, who is today the VA Secretary Eric Shinseki’s Chief of Staff.  Gingrich also heads the VA’s internal Task Force on Gulf War Veterans’ Illnesses.

Public comments on the Task Force Report are due Monday, May 3, 2010, and can be submitted online including uploading a file.


Written by James Bunker

April 30, 2010 (TruthOut) - I have been working with veterans all over this country of ours in their fight with the Department of Veterans Affairs (VA). The one thing that stands out is this: The VA has many regional offices throughout the country, and few rate veterans' disability claims in the same way.

It does not matter if it is a claim for Post Traumatic Stress Disorder (PTSD) or Gulf War Illnesses (GWI), or something else. There seems to be little uniformity or standardization in the methods used to decide these claims from one region to another. This is not right!

When all factors are identical in two different claims, a veteran in one state will be approved for a 50 percent disability and the veteran in a different state is told that the disability is not related to his or her service. Where are the standards?

Did these Rating Specialists (RS) not all get the same training? They all have to follow the same law - CFR 38. The VA has published a book that all of the RS's are supposed to use in adjudicating claims. It is called the M21-1R. Yet despite these clear-cut instructions, we see vast disparities from one VA region to another.

The problem, as I see it, is that RS's are poorly trained and overworked. Their daunting workload quite obviously has prevented many of them from remaining current on new protocols and training letters. They have to get through so many claims in a day and are not given the time for reading training letters or new instructions from headquarters.

Perhaps it's time for the VA to conduct a "Training Stand-Down," much like the military conducts periodic Maintenance and Safety Stand-Downs in order to address ongoing organizational and safety deficiencies.

The VA can add all the new RS's it wants, but if these people are not properly trained in claims adjudication policies they will continue to make the same mistakes that have created a huge backlog of appeals before the Board of Veterans Appeals in Washington, DC.

The VA needs to do a better job of training the workers it has now. Then, as new RS's are hired, they can get help from those who know the right methods to use in deciding a claim.

The cases I get most upset about are the Gulf War Veterans (GWV) claims. I have been focusing on these types of claims for many years.

These should be some of the easiest to work on given the clear-cut language contained in the laws concerning "presumptive" conditions for Persian Gulf War Veterans. Yet I see so many that are denied.

A lot of the denials include the same language - the RS denying the claim because there is no proof that the medical problem started in the service. Had the RS read the law, he or she would have noticed that GWV's have until December 31, 2011, for the signs or symptoms to develop. In other words, the symptoms do not have to have started while the veteran was on active duty.

It is clear that far too many RS's do not understand what "presumptive" is all about when it comes to adjudicating claims by GWV's. Perhaps we need to give them a checklist.

In all claims there are two parts. The first is the hardest, and that is proving that the veteran's illness is due to his or her service. The second part is determining to what degree the veteran is disabled, expressed by a percentage, 0 percent to 100 percent.

Here is my proposed RS checklist for GWI:

1.  Was the veteran present in the theater of operations during the timeframe established for the Persian Gulf War? Yes or No.

2. Does the veteran have an undiagnosed illness or one that is a medically unexplained chronic multi-symptom illness defined by a cluster of signs and symptoms or any diagnosed illness as outlined in VA regulations to a degree that warrants a presumption of service connection? Yes or No.

3.  If the RS marks Yes to both of these questions, then the veteran's disability is to be considered service-connected (SC) under Section 1117 - Undiagnosed Illnesses due to service in Southwest Asia. All that remains is a determination as to the percentage of disability.

The last part of my complaint about getting GWV's their service-connected disability claims is the VA's outdated computer check-in system. A GWV may have four to six problems but is able to have only one listed for his or her check-in. When the RS looks over the veteran's file he/she does not see all of the problems that the veteran has because the VA's computer system cannot handle it. This will affect the claim in terms of the percentage of disability awarded.

The veteran must ensure that the examining physician at the VA adds all complaints to the comment area. If the physician refuses to do so, the veteran should go to the VA's ER for the other problems. Also, have someone keep track of when you are ill and how bad it gets.

For some of us, mostly men, admitting we are sick can be problematic. The common thing for us veterans is to "tough it out" and downplay how bad it really is. Veterans need to tell their doctor the truth about how bad it hurts and how they have a hard time working. Be truthful at all times.

The last thing I would like to talk about is Veterans Service Officers (VSO's). There are some good ones and some bad ones. A veteran should not pay too much attention to who the VSO works for (DAV, American Legion, VFW, etc.) because it does not matter. The important thing is how well the individual VSO is versed in the laws concerning PGW veterans.

Veterans need to talk to the other veterans in their area. Having a good VSO involved with the claim will make a lot of difference in the outcome.

Finally if the veteran has a scar, and the VSO wants to file it under section 1117, the veteran should get a new VSO. Scars should never be filed as an undiagnosed illness. There is a nexus for the scar to your service. When your VSO files it as an undiagnosed illness he is causing a delay in getting the veteran's claim approved.

James A. Bunker served in the US Army from 1978 to 1992 and was medically discharged due to illnesses sustained in the Persian Gulf during Operation Desert Storm. He founded the Veterans Information Network (VIN) in 1993, which successfully lobbied for formation of the Persian Gulf Health Initiative study and advisory board. He has testified several times before Congress on Gulf War Illnesses.


KAL said...

Be very careful about using the term "medically unexplained." This is the term used by psychosomatic medicine practitioners to refer to patients whose symptoms they believe reflect a psychosomatic disorder. (See the proposed APA complex somatic syndrome disorder criteria for the upcoming DSM-V. Vaguely defined terms can contribute to misdiagnosis.)

Obviously, not agreeing with the medical explanation (s) is not the same thing as "unexplained." There are medical explanations for GWS as well as a number of other organic diseases similarly misdiagnosed.

The primary reason for a failure to differentiate between psychosomatic explanations and medical diagnoses is the failure to adequately measure severity in addition to frequency.

Nor should instruments designed to measure functional disability for public health uses be used for medical diagnosis of organic diseases. They were not developed as a diagnostic measure.

Inappropriate use of tests and testing are often behind the conflicting research.

Unknown said...

Commenting on a few issues on this story...

The article addresses...

How the employees at the DVA are overworked.

YES, they are overworked. Sometime ago, somebody had devised a method whereas, any RO that resolves so many claims within a certain amount of time, wins a monetary bonus in their paychecks.
This is known as a "Quota Bonus".

Now, there is nothing wrong with awarding individuals for a job well done, however there is something seriously wrong with this quota bonus.

Management at these RO's are pushing people to a point, that if they don't perform by resolving so many claims within a certain timeframe, that they are written up for poor performance.
After 3 reports of poor performance, the employee is either demoted or terminated.

How this affects the Veteran, is that employees under this sort of pressure, have a tendency of missing relevant information, especially if a Veteran presented a complex claim (more than 3 issues), or the Veterans' file has Multi-Volumes, that require a VSR to research past decisions, Doctor statements, etc.

Either the delay game is played (bypassing the fat file folders on the table) or the adjudicator goes through it and misses key evidence, thus the claim is Denied, and the Veteran is subjected to an unnecessary and lengthy appeal process.

This Quota Bonus MUST be removed, being that it promotes violation of law, unfair/unrealistic working conditions for the employees, unnecessary appeals, and corruption by all.

In the examples given in the paragraph above, can you see the 3
prongs that establish a Whistleblower claim?

There IS Gross Waste of Funds, when a Veteran is subjected to an unnecessary appeals process, and according to this article, when the Veterans' claim could have been resolved early on.
Multiply the amounts of appeals that were unfairly decided upon, and the amount spent by the DVA to process these unnecessary claims and it's staggering!

The paragraph also shows Gross Mismanagement (of Veterans Claims), being that the Veterans Claim(s) should have been reviewed more precisely at the start.

Abuse of Authority is also prevalent here because the managements' main goal is for employees to perform by resolving so many claims within a certain amount of time. This prong has dire consequences for both the employee resolving claims, AND the Veterans.
Keep in mind, that a Veteran loses hope, and assumes that the claim was decided upon based on law, thus he/she decides not to appeal/pursue the claim any further.

To ADD a Prong...
ALL of the examples shows Gross Misconduct by Gov't. Officials, when they knowingly perform such actions for their own personal gain...The Quota Bonus.
Being more Brief on this topic...

In order to assure fair treatment for the resolution to Veteran claims, the DVA MUST go paperless!

This will increase real estate, so that more employees can be hired.

With the technology now available, the Veterans entire file can be placed on a chip, the size of a quarter, or a key fobe, with a USB connector, so that it can hang on a wall mounted rack.
The actual folders can be stored in a warehouse within a reasonable distance for access to hard copy files.

CL said...

It concerns me that Soldier's returning since the onset of our ongoing wars in both Iraq and Afghanistan show the same symptoms of our comrades of the first Gulf War, yet the VA refuses to achknowledge that Soldier's with the same symptoms as those of a Gulf War Vet aren't linked somehow to pesticides, DEET, open sewage pits, and burn pits. It also amazes me that a Soldier who returns from overseas shows symptoms of PTSD, but the VA is now saying that they can't call it PTSD, they have to say that the Vet has a "mood anxiety disorder" as a way not to have to be responsible. I believe that every returning Vet has PTSD, the VA should automatically assume this instead of finding a "way out" so they can move on to the next Vet. I also believe that exposure to the burn pits, sewage ponds, oil, and DEET on a long term basis causes permanent injury to the brain, also resulting in memory loss and chronic migraines. So many Vets don't realize the damage they have until long after they return, yet the VA and the Military turn their backs saying it's not their responsibility. Who do we need to contact to start to turn this around, senators, congressmen?