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The VA: Department of Delay, Deceit, and Dumb Disorder

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The two largest components of the Department of Veterans' Affairs (the VA) are the Veterans' Health Administration (VHA) and the Veterans' Benefits Administration (VBA). Both are riddled with dishonesty, inefficiency, and ineptitude.

The VHA is in the news for a scandal involving the falsification of records. The VHA runs hundreds of hospitals called Medical Centers (VAMCs) and clinics, especially Community Based Outpatient Clinics (CBOCs). The VHA's primary mission is to treat all diseases and injuries incurred in the line of duty, as well as the other diseases and injuries of the most severely disabled in the line of duty.

The VHA provides additional services to other veterans, depending on the overall health of the veterans and their resources, based on a complex system of priorities. Veterans who do not meet the requirements for free care and do not actually use the VAMCs often carry a VA card and are counted into patient statistics.

For the most part, the VAMCs provide excellent medical treatment; for typical war injuries, such as amputations, brain trauma, paralysis, and post-traumatic stress disorders, it is the best care in the world. The problem with VA health care is primarily administrative, rather than medical.

The large national veterans' service organizations make budget requests to Congress every year. Typically, Congress gives the VA a little less than everything the organizations ask for. The exception is facilities' construction.

The budget for the construction of new buildings or wings at VAMCs is so small and inadequate that the VHA is often given an increase in doctors and other health professionals without corresponding space for them to work.

When doctors leave the VHA, it usually takes at least six months to replace them. The doctors are bureaucratically unable to step outside of their specialties, and veterans often are left without care until their specialists are replaced.

The money appropriated for the VHA is too often used for middle-level management, rather than for doctors and other health care professionals. The number of injured veterans returning from our recent wars has grown substantially, in part because so many lives of severely injured soldiers and Marines can now be saved. Although the budget for veterans' health care keeps increasing, it is insufficient to meet the increasing demand.

Getting an initial appointment to see a specialist is a lengthy process. One reason for the delay is the requirement that veterans see general practitioners before they can see specialists for the first time. Another reason is the low skills and poor training of VA receptionists and telephone operators. The result is that VAMCs are unable to meet the national target of seeing every veteran within 14 days of the date requested. Instead, veterans often wait months for the first appointment.

Several years ago, the VHA circulated an eight-page list of prohibited ways to falsify the statistics. Despite this measure, we are now learning that the practice has survived of not entering veterans' information in the computer until virtually the eve of their first appointments, so that the appointment requests appear later than they actually were. The practice of giving veterans appointments at nonexistent clinics and changing them to real clinics on the eve of the appointments has also endured.

Civil Service laws make it impossible to fire VAMC directors or supervisors without lengthy hearings. Although they can be relieved of duty, they remain on the payroll but do nothing to earn their pay.

The main mission of the VBA is to award compensation to veterans injured in the line of duty. It also administers other benefits, including GI Bill education ones and VA mortgages. It is just as riddled with incompetence and dishonesty as the VHA.

Furthermore, delays in the award process delay the eligibility of some veterans for free VHA treatment.

VBA employees have been fired for shredding claims so they do not have to decide them. It can easily take a year for a claim to be decided. Ask any member of either house of Congress what the main source of constituent complaints is; the answer will be, far and away, VA delays.

Some progress has been made in reducing the enormous backlog of undecided claims from over 600,000 to less than 400,000. The Regional Offices (VARO) began computerizing claims files in the past two years; previously, all work was done from foot-thick folders of papers. Making the U. S. Department of Defense computer medical records readable by the VA computers has recently occurred in some cases, but this important step seems to be on the back burner at the moment. I once accompanied a client to an appointment at a VARO that we had confirmed the day before; when we arrived, we were told that the file was in the wrong city due to an error, and the hearing had to be postponed.

If the relatively low-skilled employees of a VARO deny a claim that should have been granted, the appeals process starts. One recent year, the average length of the first stage of the process (the appeal to the Board [BVA]) exceeded 1,000 days. If the matter is so complex that it requires a court order, the BVA's 1,000-day process (or at least most of it) may be repeated as often as necessary for the BVA and the VARO to understand what the Court is telling them. It is not uncommon for the process to drag on for 10 or 20 years.

Computerization will probably help shorten the claims process, but it has also generated a new way for the VAROs, either stupidly or deliberately, to avoid work. Recently, the BVA instructed the VARO to schedule a quick hearing for a 79-year-old veteran. About 15 months elapsed, with the VARO telling the veteran that his case was dismissed and refusing to answer three monthly letters from his attorney. When the Court got involved, the VARO finally read the BVA's decision and scheduled the hearing. The VARO's explanation was that the BVA decision had been accidently coded into the computer as "dismissed" instead of "remanded," and nobody had actually looked at the decision.

There are calls for the Secretary of Veterans' Affairs to resign. Eric Shinseki is a good man, a permanently injured war veteran, a former chief of staff of the Army, and a commander of the U.S. Army in Europe. The unavoidable truth, however, is that he either ignored system-wide problems in the VA, or his top-level subordinates hid them from him. Either way, he failed to meet the high standards that would have been required of him if his present position had been a military command.

The Confederate Lawyer column is copyright 2014 by Charles G. Mills and the Fitzgerald Griffin Foundation. All rights reserved.

Charles Mills, Esq., is the Judge Advocate (general counsel) for the New York State American Legion.

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