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WHEN YOU'VE GOT QUESTIONS, JIM STRICKLAND'S GOT
THE ANSWERS -- More great information you'll
want
to know from Veterans' Advocate Jim Strickland.
Veterans' Advocate Jim Strickland provides
regular columns for VA Watchdog dot Org.
If you would like to contact Jim about his
columns, you can email him here...
The archive of Jim's articles
is here...
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Question:
My daughter-in-law's uncle is a post Vietnam
era veteran (with no s/c disabilities) who went to an Ohio VA med center
for a broken ankle, he somehow was able to be treated (and here the
story gets fuzzy), a week later the break was infected with staph which
went to the bone causing VA to amputate 1st his big toe, then in another
operation his entire foot. Can he file for compensation? What are his
options?
Answer:
Yes, he can file for compensation via an 1151 claim. Briefly, a Vet may
be compensated whenever treatment by a VA facility or employee results
in damage or a condition that would have been service-connected had the
Vet been active. As you know, I have a background in health care and I
can almost envision what happened. He likely was seen by orthopedics.
They either pinned his broken ankle or operated and used fixation
devices (plates, screws, etc.) to put it together. He then acquired an
infection, probably one of the bad ones known as MRSA (pronounced mer-sa)
or Methoxyn Resistant Staphylococcus Aureus.
MRSA is rampant in all hospitals today and is often untreatable by the
most powerful antibiotics available. In my capacity as leadership in
hospitals I've seen numerous cases like his. It's one of the biggest
risks of going into a hospital today. VHA is as on top of the problem as
any other health system but MRSA infections still happen.
He can make the claim himself by simply writing a letter to the VARO
that states the facts of what has happened. In that letter he should
tell them he wants 100% disability for the loss of his foot. It should
be mailed via registered mail, return receipt requested. It is very
likely that it will be denied. These are like malpractice lawsuits and
no hospital ever just rolls over. After it is denied, he is then able to
hire a lawyer for the appeal. Writing that first letter himself will
start the process.
Question:
I have a question about TDIU (VA Total Disability Individual
Unemployment) and SSDI (Social Security Disability Insurance). I have
applied for the TDIU and am now in the wait game, however; I'm also 61
1/2 and will be applying for normal Social Security in November/December
time frame, should I apply for the SSD and if so do you think it would
mess me up on getting my normal Social Security. What I mean is would it
slow everything down? If it would slow down everything on the SS side
than i would probably just not worry about it. Let me know you thoughts
on it...Thanks.
Answer:
You don't want to bother with SSDI. Little known is that if you receive
SSDI at an age below 62, when you reach your 62nd birthday, that SSDI
payment quietly converts to your regular Social Security benefit
payment. You don't collect both (SSDI and Social Security)
simultaneously and the amount of the SSDI payment is exactly what you
will receive taking your benefits at 62. However, you are allowed to
receive both SSDI and VA Disability benefits simultaneously.
Question:
I just read your article of 5/2/07, on PTSD claims and I'm concerned
about how to keep my rating. I search the web and found your article.
After winning my claim of 50% about 3 years ago, I started thinking
about when they might come after me to get it back. Now in your article,
you state the importance of taking there help. Med's and philological
visits, things like that. That if you don't take it, they will think you
don't need it. And -----. But on the other hand, if you do go to all
there help and take the meds, they can say the same thing, that your
better now, and there for don't need compensation. Please, any help on
this catch 22, will be greatly appreciated. I need your advise they want
me to do this. I haven't had any recalls yet.
Answer:
You make a good point. You may be damned if you do, damned if you don't.
As with all things VA though, I prefer to play the game as close to
their rules as I can. I think that attending the meetings and accepting
the medicines and taking the therapy achieves two things. First, it may
actually make you feel better. A friend of mine recently completed anger
management for 6 or 8 weeks and he said that it helped. He isn't cured
but better controlled from within himself. Second, if you're playing by
the rules, you can document how hard it is for you to work at making
improvements...the time it takes, the effort you put into it and so on.
If you can't prove how hard you're working at controlling your issues,
what do you say if they ask?
I'm also a control freak. I'd rather be in the game where I have input
as to what's happening so I can steer it all a little. Overall, there's
probably nothing at all for you to worry about. Odds are you'll never be
bothered with a reexamination. But if you are, at least you've given it
some thought and you're better prepared..
Question:
(Jim's Note: Enclosed were copies of lengthy letters to the VA Inspector
General and the VA hospital director from the Veteran and his wife. I've
excerpted from these letters to form the following question and
commentary. Some sentences were modified for brevity but the original
thought remains as it was.)
From the vet to Jim:
I'm sure you've seen this before...the poor
treatment of a Veteran at a VA hospital.
I have been diagnosed with Hepatitis C and I am being denied treatment
at my local VA. I have been unable to locate any source that can or will
show me a Veterans Administration regulation or rule that allows any VA
GI Clinic to not immediately treat me for this horrible disease. In my
case Hep C contracted via some unknown means but most assuredly not
through the usual listed causes such as drug use or tattoos. We live a
clean quite life. Since so little is known about this disease that
affects 400,000,000 worldwide it is more than possible that this is
service related. In September of 2006, I was informed of the possibility
of the virus during routine Life Insurance exam blood tests. I have
struggled from September 2006 until August of 2007 to secure treatment
and have been told over and over that I would indeed be treated only to
find minutes before a scheduled liver biopsy that treatment could not go
forward at this time.
My wife and I were told in initial conference that you can not use drugs
or alcohol for 6 months prior to treatment. I guess I did not perceive
this as a direct order so, at biopsy I was badgered into admitting I had
purchased and consumed (part of) a beer at a baseball game on a hot day.
Did this seemingly minor infraction indeed end the possibility of
treatment? Now I have been diagnosed with Hep C I can not go to the
private sector for health insurance…they will assuredly assume no
liability and I’ll never be treated. My liver and related organs will
continue to deteriorate until my skin turns sickly yellowish orange,
teeth and gums will begin to rot, foul odors will emanate around me and
it will be far too late for medicine…and too late for a transplant.
Letter from vet's wife to VA:
I am writing you on behalf of my husband, a war veteran and patient at
your facility. He was diagnosed with Hepatitis and has been working
towards treatment since then. Today, he was finally scheduled for an
ultrasound and liver biopsy. We arrived at your medical center this
morning where he underwent the ultrasound. However, when it came time
for the biopsy, he was refused further treatment. One of your
physicians, playing God, had decided he was an alcoholic! I can assure
you, there is nothing farther from the truth. While, he used to have a
very occasional drink socially, he has not drank since being diagnosed,
with the exception of 1 or 2 beers.
I know my opinion isn’t what matters, but I come from a family of three
doctors and if necessary, they will forward letters on his behalf. We
also know many prominent, affluent citizens of America that can also
vouch for him. We understand that at your facility, you treat a lot of
drug and alcohol addictions. What we don’t understand is how your
personnel can so easily assume that every veteran that walks through
your facility has some kind of abuse and/or psychological problem.
My husband served you and me and our country and he, as well as other
veterans, do not deserve this profiling. It is wrong and I believe, also
illegal. My husband works 7 days a week, at least 12 hours per day. He
has worked like this since I met him 12 years ago. You tell me how an
alcoholic can function like this? We understand treatment is very
expensive for Hep C and wisely, you cannot treat those that will not
help themselves-those that have drug and alcohol problems.
I too have been diagnosed with hepatitis. I have been on treatment and I
have been testing negative for the virus. And quite honestly, I have had
an occasional drink. In fact, I believe if you were fighting this and
undergoing this treatment, which is basically like chemo, you, too,
would have an occasional drink! My husband and I have been patiently
waiting since November for treatment-we do not want and should not have
to wait another day.
And he most definitely is not going to waste more time going to
alcoholic classes where he does not belong! I can’t tell you how absurd
that is! You can and should apply those procedures to those patients who
really do have problems. I simply ask that you accept that not everybody
comes back from war with psychological and abuse problems. There are
those that just want to get on with life and somehow by the grace of
God, have been able to do just that. Please help us to move forward-I
will not give up on this situation until it has been quickly and
favorably resolved.
Answer:
No, I hadn't seen the letter but I have seen similar circumstances. You
and your doctor disagree. He rules. You're unhappy. It's common. The
first 2 thoughts that come to my mind are pretty basic...these are the
thoughts that decision makers will use when they see these
circumstances.
*Why is the Hep C service-connected? Just because you served 30 years
ago? There are hundreds of thousands of hepatitis cases in people who
didn't serve. What is your precise reasoning behind a service
connection? Why do you deserve VA treatment?
*How debilitating is the disease? How does it interfere with your
ability to earn a living and perform activities of daily living (ADL's)?
How much treatment do you require? How often have you been hospitalized
because of your liver disease?
You should understand that there is no bureaucrat who has any power over
a physician's decision. Unless there is some sort of outrageously
egregious behavior on the part of a physician, no Senator or Congressman
or VA director is going to try to second guess a doctor's diagnosis and
treatment. You can write letters to powerful people but none of them
will attempt to intervene with a physician's decision. Letters from your
wife may not even be read...what would a man's wife say? That applies to
letters from your pastor or friends who vouch for you.
To answer an earlier question of yours, I am very familiar with
hepatitis. My professional career, prior to my retirement, was spent in
health care. I've cared for hepatitis patients for over 4 decades.
I'll be perfectly frank with you...because that's the service I provide.
You probably won't like what I'll say. In fact, if you're hoping that I
agree with you, you may want to stop reading now. You're way
over-dramatizing things. I have serious doubts that the doc was trying
to condemn you or that you have been exposed as a public threat.
Histrionics will not help you. You apparently don't have liver failure,
your teeth aren't rotting out, etc.
When your wife writes, "One of your physicians, playing God, had decided
he was an alcoholic!", she is totally wrong...he wasn't playing God, he
was performing in his position as a physician and made a medical
decision. There is no official on the planet who will second guess his
decision. That VA hospital director you wrote to can't even access your
records as privacy laws restrict viewing your medical records to only
medical professionals with a need to know.
Patient advocates will not have any authority to modify a doctor's
decision. If you feel like you need to know the staff and become
familiar and friendly with them, you're in the wrong place. VA does not
have time to do hand holding or practice familiarity. They do the job,
most of the time they do it very well and they move on to the next
Veteran.
I would advise that you stop making the situation sound worse than it
is. While you loudly deny any issues with alcohol abuse, your letter
shouts out that isn't the case: "I was badgered into admitting I had
purchased and consumed...a beer", "I have had an occasional drink", "I
believe if you were fighting this and undergoing this treatment...you,
too, would have an occasional drink!"
Those of us in health care understand that nobody tells us the truth
about their drinking habits. We anticipate that patients always
under-report the truth. In your letters your wife claims you had “a
couple of beers” while you claim less than one. In my experience, those
who make the biggest deal of how little they drink are the ones who
drink most. Wouldn't it have been better to be able to look that doc in
the eye and say truthfully, "No sir. I haven't touched even a drop of
alcohol in 6 months. I'll never drink again."
I can assure you that were I undergoing treatment for hepatitis, I would
not ever have "an occasional drink." Not a sip of a beer, not a glass of
champagne at a wedding...nothing, nada, zip, zero booze. It is probably
the single worst thing one could do to themselves. Frankly, it's
suicidal to consume alcohol after a diagnosis of hepatitis.
Your demands that the VA doctor treat you according to your own personal
standards when there is no reason to believe that this is a
service-connected disease is way over the top. The VA system today is
overwhelmed with people who are in need of treatment having just
returned from war and you want to be treated on your own terms? No
matter what the doctor says?
Why does VA owe you this?
The real story of hepatitis is that many people get it and live with it
forever, never realizing they have the disease. It only comes up on the
odd lab test and then is seen as a bit of a mystery. That your wife was
diagnosed with the disease before you is an indicator of where you may
have contracted it. Hepatitis may be passed along by casual contact in
some cases. Either of you may have had it 30 years ago and not known it.
My recommendation to you is that you begin to get serious about this and
pay attention to your doctor.
Alcoholism isn't always defined as being a person who is a drunk. It may
also be defined as someone who is not able to resist a drink. You spend
a lot of time defending your right to drink...just a little bit...when
you seemed aware that even a little bit was forbidden. You were told 6
months and you chose to ignore it.
Many Veterans don't drink...nothing at all. It's not particularly a
moral choice but one of health. On a hot day at a ball game, water is
actually a better choice. It may not be as social but it's better for
you.
If you want VA treatment, at your next meeting you should accept that
you weren't within guidelines that were set for you and that now you're
ready to get with the program. That doctor, in all likelihood, had your
best interests at heart. Keeping your ears open and your mouth closed is
the way to go. If you aren't happy with the VA treatment, you have
quoted a long list of health care contacts who you're related to as well
as many important people...why not contact them again and see if you get
advice more to your liking?
Finally...you don't seem to have any real health issues from the
disease. You cite that you're working long hard days, you seem to have a
good job and I'll presume you make a decent living. If you're over 50,
being a little tired isn't unusual. I'm pushing 60 and there are days
when I have very little energy, I can fall asleep in my easy chair but
often regular deep sleep is elusive. I don't have hepatitis, it's normal
to feel this way as we get a little older.
If you return to VA, play by their rules, let them do the job they need
to do. Otherwise, seek your care in the private sector where you may get
a little more TLC.
(Follow up; You wrote back to me and told me that my advice was sound,
that you appreciated it and that it seemed the smart thing to do. I'm
very happy that you made that choice. Telling your doctor how you want
to be treated, whether civilian or VA, just doesn't make a lot of sense.
The great majority [not all, most] of VA docs have your best interests
at heart and these are usually very smart people. Do as they say, take
your medicines, prepare to wait a while and enjoy what is often said to
be America's finest health care...Jim Strickland)
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Larry Scott --
