The VA "Choice" program was hoped to be a real life-saver for veterans. The intention was to create funds that would allow veterans to seek health care from a medical provider of their "choice" rather than have to wait for an appointment at an already overcrowded VA Medical Center or Clinic. While this sounded wonderful in theory, in practice it has been one mess after another, which is typical for a Government program.
VA Secretary David Shulkin announced in June that the finds allotted for the "Choice" program would be completely used up by mid-August unless something were done quickly.
While many U.S. House and Senate members attempted to grab headlines by spouting off how the "Choice" program cannot be allowed to end, they did little else initially to address the real problem.
The House passed a bill Friday to not only fund the "Choice" program with another $2.1 Billion dollars, but also to provide an additional $1.8 Billion dollars to be used by the VA to open a couple of new clinics, replace other clinics and trying to fill some of the 49,000 vacancies within the VA. The Senate then passed the Bill yesterday and it now heads to the desk of the President for signature.
Part of the problem with the current Bill is that the Congress is robbing Peter to pay Paul. They are funding the additional monies by extending pension reductions for Medicaid eligible veterans in nursing facilities and continuing fees on VA guaranteed home loans. These reductions and fees hurt those veterans that are often the most in need of every benefit they can obtain.
The current Bill is supposedly just a "stop-gap" measure until Congress, the VA and various veterans organizations can sit down and hash out real reform on how the VA handles private-sector care, and how it is funded by Congress.
There is no doubt but the current "Choice" program is confusing and very difficult to navigate. Even worse, it is highly likely that even if a veteran is authorized to seek private health care, the medical provider will never get paid, or will be strung along being forced to jump through hoops that ultimately are going to turn a lot of private-sector providers off of the whole system.
You should contact your U.S. Senator/Representative and let them know that as a veteran you expect the best and most timely health care available. That you expect to be able to seek care from a private-sector provider in order to avoid the never-ending waiting lists within the VA Medical Centers. Finally, that you expect the "Choice" program to be fully funded WITHOUT having to steal funds from other needed VA programs.
If your VA disability claim for Gulf War Syndrome is being handled by one of the 6 Regional Offices listed at the bottom of this article, then your claim has most likely been improperly reviewed and rated.
In a recent GAO investigation, it was found that the VA Regional Office in Waco, Texas was 4th in the Nation in denying Gulf War Syndrome/Illness type claims and the Muskogee, Oklahoma Regional Office was 2nd highest, just behind the Roanoke Regional Office. Being in the top 6 is a dubious honor which should have every veteran in these Regional Offices very concerned about their Gulf War Syndrome claim.
The VA estimates that 44% of the 700,000+ service members who served in the 1990-1991 Persian Gulf War have developed symptoms as joint pain, chronic fatigue syndrome, breathing disorders, sleep disorders, and neurological problems after returning from the Gulf War. The illnesses are thought to have been caused by exposure to toxic elements like smoke from burning oil wells, depleted uranium and chemical warfare agents such as mustard gas. “Burn Pits” are another possible source of exposure.
While the VA denies roughly 87% of all Gulf War Syndrome claims Nationwide, the Waco Regional Office is denying 92% of these claims. The recent investigation has found that poor training and inconsistent claims handling is partly to blame for the huge denial rate. A lack of a medical opinion relating alleged Gulf War Syndrome problems is also a leading cause of continued denials.
There is no doubt but that Gulf War Illnesses/Syndromes are hard to prove. There is not usually a distinctive set of symptoms that will allow a medical provider to make an reliable diagnosis. That is why these claims are called “Medically Unexplained Chronic Multisymptom Illness” or “Undiagnosed Illness”.
GAO found that the VA does a piss poor job educating examiners and raters about how to identify the illnesses. Several VA staff noted the complexity of Gulf War illness claims and some medical examiners stated they would benefit from additional training on Gulf War illness and how to conduct these exams. In response to the GAO report, the VA said it would make the web training mandatory and hopes to get examiners trained by November.
U.S. Rep. Mike Bost, R-Ill., a member of the House Veterans subcommittee on Oversight and Investigations, noted the discrepancy in the number of Gulf War veterans with successful claims. While an estimated 44 percent of service members developed Gulf War illness symptoms, only 26 percent receive benefits. “Something does not add up,” he said.
The six VA benefits offices that handled at least 1,000 Gulf War-related claims in 2015 (which is the most recent year for statistics) and their denial rates for veterans filing VA Disability claims for Gulf War Illnesses/Syndrome. The national average was 87%.
• Roanoke, Va.: 95% (of 2,124 total claims)
• Muskogee, Okla.: 94% (2,431)
• Atlanta: 93% (1,339)
• Waco: 92% (1,088)
• Columbia, S.C.: 90% (1,130)
• Nashville, Tenn.: 83% (1,763)
I know we spoke about this not long ago, but I had an example that shows just how powerful a properly prepared "nexus" letter from an IMO can be in winning benefits.
The surviving spouse of a veteran had been seeking "DIC" benefits, claiming that the veterans cause of death was related to one of his service connected disabilities.
The Death Certificate found "Acute Coronary Syndrome" as the "primary" cause of death, and "renal failure" as the secondary cause of death.
The VA Regional Office repeatedly denied the claim pointing out that the veteran only had Service Connected PTSD, Tinnitus, Hearing Loss and non-compensable residuals of Malaria. They relied upon the medical opinion of their chosen C&P examiner who went into great detail explaining how none of the Service Connected disabilities were at all related to the cause of death.
The surviving spouse contacted my office and we appealed the Regional Office denial to the BVA. I also contacted the physician I deal with exclusively in VA related claims, discussed the facts of this claim and set up a time for this “Independent Medical Examiner” to meet with the surviving spouse. I also, of course, provided the IME with a complete AND specifically organized copy of the VA Claims file for his review. Following his review of the Claims File, and his meeting with the surviving spouse, this IME provided us with a written Medical Opinion containing all the “magic language” required by the VA. His report further contained his reasoning as to why the Service Connected disabilities of PTSD and Malaria were "as likely as not", the underlying cause of death.
This spouse will now receive DIC benefits which NEVER would have been granted without getting a well-reasoned IMO of our own.
To learn a bit more about "nexus" or IMO letters, read my blog post HERE