Printer Friendly Page
COMMON SENSE, LOGIC AND PLAIN OLD GOOD ADVICE
FROM JIM STRICKLAND -- Veterans' Advocate Jim
Strickland
answers more questions from VA Watchdog
readers.
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...
-------------------------
{NOTE: Spelling, grammar and punctuation
of all questions are as they were received from readers.)
Question:
Dear Max, I'm a Vietnam Veteran. Since 2004 I have petition VARO Houston
for a PTSD C&P Examination. I have already have 2 VA Psychologist
statement I have combat related PTSD and 46 pages of Stressor Letters I
have submitted to them. In 2005 through 2006, Senior VSR (Name Redacted)
has threaten my life said I might become missing if I continued emailing
and sending letters to VARO Houston for a C&P Examination, then he
started insulting my religious beliefs of God. Now, if I did that to
him, I would be in jail already! I contacted the (Name Redacted) in June
2006, but never heard anything from (that person). I contacted the
Inspector General he said I needed to deal with VARO Houston! I have
contacted every senator in USA but with no reply. I live in Mexico as I
recieve a Non Service Pension of $ 1,192.00 per month for 2 people.
"Does any politicans care about the treatment of Vietnam War Veterans
from the VA?" "Or they will always abandon us?"
Answer:
I confess to being a bit confused by your salutation. There's no "Max"
at this address. There is also no information that will tell me if a
formal application for disability benefits has been made, when the
application was made or if it has been denied, appealed and when.
I have very serious doubts that a VA employee has threatened anyone's
life over a benefits dispute and making those statements truly
undermines your credibility. This isn't one of the Godfather movies,
it's just the VA.
When an individual makes an application for disability benefits, the
individual must be prepared to wait until the process moves ahead at its
own pace. Today it's well known that most VA Regional Offices are at
least 12 to 18 months behind in their tasks, sometimes more. I'm not
giving an OK to this badly broken process, I'm only telling it like it
is.
I always advise against a letter writing, emailing or telephone calling
campaign to the VARO, the IG, or Congressional Representatives. In the
average case the flurry of angry communication does no good and may
actually slow down the processing of a file while the complaint is
investigated.
As always, I advise that you are sure that your initial application is
completed and submitted to the VARO with registered mail or some other
form of proof of delivery. Once you've done that you should only sit
back and wait. Eventually you will be notified that your application is
processing and that the usual routine has begun. Don't write to the VARO
unless you are submitting new and material evidence or responding to an
inquiry from them.
As frustrating as the lengthy wait is and as wrong as it is, that's the
situation we're faced with today. Pounding on their door and yelling at
the VA people inside only alienates everyone involved and
doesn't help your cause. Get in line with the rest of us, your case will
be adjudicated pretty much in the order it was received, just like
everyone else.
Question:
I have been reading your column for some time and really appreciate the
help you are providing veterans in dealing with the cumbersome VA
system.
I am sure there are many veterans who are in the same situation that I
am. I have been receiving SSDI for 24 years which enabled me to be
covered by MEDICARE. For 7 years I have been rated as having a service
connected disability, currently rated at 70% disabled. I live in a rural
area 200 miles from the nearest VAMC.
Under MEDICARE I could see physicians of my choice in the nearest town.
Some specialty physicians are available in the nearest town. Virtually
all specialties are available within 30 miles. There is a hospital with
emergency room in the nearest town and a major hospital center within 30
miles. Under MEDICARE, I had the same Primary Care Physician for 15
years. I was able to receive both primary and specialty care with only a
short wait and emergency care as needed within 8 miles.
At some point, in the last several years, the VA was designated as my
primary health care provider and MEDICARE as the secondary provider.
This has meant that I must receive primary care at a nearby community
clinic with long waiting lists and frequently changing physicians and
staff. Any specialty care must be referred to the VAMC with many months
waiting list for appointments.
I learned that MEDICARE had been changed to my secondary provider when I
severely fractured my wrist. I was treated at the local emergency room
and then referred to a hand specialist in a nearby
town. Eventually he ordered specialized occupational therapy by a hand
specialist 3 times a week for 4 months. Customized splints and other
appliances were required. As a result of this therapy, surgery
was avoided. Unfortunately, MEDICARE declined coverage since they are
now designated as secondary provider. The VA declined to cover saying
that I should have driven the 200 miles to the VAMC (a physical
impossibility) and there was no proof, despite multiple X- rays and
exert medical testimony, that the therapy was needed.
When an individual lives a considerable distance from a VAMC and has
MEDICARE or other insurance, it is no benefit to be forced into the VA
health care system. I understand the need for the VA to monitor my
disability and am happy to provide copies of any medical records for any
condition. However the burdens of the VA medical system are preventing
me from receiving medical care. How can I restore MEDICARE to my primary
healthcare provider? Thank you.
Answer:
This was a new one on me. At about the same time I received this, I had
another Veteran reader who cautioned me, “Medicare Part A may not be
free to Veterans enrolled in the Va medical system. If you have
Medicare, It may cost you your Veterans benefit of being treated in a
non-Va hospital in case of an emergency...just having Medicare Part A
could disqualify a veteran.”
The rules that govern Veterans Health Administration (VHA) benefits are
complex. If you ask a question of 5 experts at 5 different places, you
may well receive 5 different answers. The Medicare benefit is no less
complex with its requirements for different plans for hospitals (Part A)
that are separate of those for physician providers (Part B) and the need
for a supplemental policy and a drug plan. When you mix them all
together, you concoct a witches brew full of hazards and pitfalls. Like
so many other aspects of our lives with benefits, stepping off on the
wrong foot may set in motion a situation that will take a lot of work to
remedy.
In the case of the Veteran with a broken wrist we discovered that there
is a little known program (at least to the average user) within Medicare
known as Medicare Second Payer or MSP. In concept, this is fairly easy
to understand. If a Medicare patient has another insurance provider,
that other insurance is almost always viewed as the one to bill first.
For example, if a patient is working and has private insurance through
the employer and also has Medicare, the private insurance should be the
first billing target by any health care provider. Then later, Medicare
may or may not pick up and pay any charges that the primary payer
didn't. If you have private insurance and Medicare, Medicare is clearly
seen as the Secondary Payer or...MSP. This also applies to civilian
(non-VHA) disability insurance or workman's compensation. Those payers
are billed first as the primary insurer and Medicare is second.
Are you confused yet? Just wait...
Enter the Veteran who has both VHA healthcare and a Medicare card. In
this instance, Medicare may or may not be the primary payer for
services...it just depends on circumstances. If our broken-wristed Vet
had gone to a VHA facility, the VHA would have automatically become the
primary payer...to the VHA. This means that VHA would have taken on the
total responsibility to fix that fracture or to refer the Veteran to an
outside specialist on a fee basis contract. VHA would have been
responsible to cover it all except for any copays the Vet may be
required to make with a rating of less than 100% disabled. In this case
though, our Vet took that fracture to a civilian facility. That's
understandable, she was in pain and needed emergency treatment.
So why the problems with billing?
As the Veteran and I thought this through, we determined that as she was
being checked in through the civilian facility's emergency department,
she probably handed over her VHA Identification card and also her
Medicare card. The hospital always wants to ID the patient and assure
themselves of future payment.
In formal medical terms, this important, complex procedure is often
referred to as The Wallet Biopsy.
Our Veteran, being in serious pain from that fracture, hadn't called or
even considered going to the VA facility. She was treated, released and
received some ongoing therapy without VA being involved. Then she was
notified that VHA wasn't paying the tab for all this and since Medicare
was designated as the Secondary Payer, neither were they.
It took us a couple of days before we had our “Ah-Ha!!!” moment. Once
the penny dropped, we soon determined that the hospital's insurance and
billing department, seeing that VHA card, had billed them first, then
Medicare. This was an error of the civilian facility's billing
department. Medicare saw that VHA had been billed and assuming that it
was an authorized (fee basis by VHA) procedure, declined to deal with
it. The VHA declared that they were not notified and had not
pre-authorized fee basis so it wasn't their problem.
Our Veteran, armed with all this information, called her local Medicare
offices and spoke with the Coordinator of Benefits or CoB. Incredibly,
the CoB understood and instantly agreed and said that it would be taken
care of and that in about 2 weeks, all the civilian providers should
re-submit their bills to Medicare for payment. Records were to be
corrected and would show Medicare as the primary payer.
If you are one of the very fortunate Veterans who have both a Medicare
benefit and also a VHA benefit, how you receive your care is largely up
to you. You may choose to use civilian providers for all or some of your
care or you may stick with your VA care all the way. If you have both
insurances available to you, you may have the most flexible health care
plan available anywhere.
On the cautionary side of all this is that you should plan in advance on
exactly what you want to do and what makes the most sense for your
health and your finances. Whether you have all these benefits or only
one, advance planning is the key to smooth sailing.
Question:
My husband was diagnosed with diabetes in 1996 and it is 2007 over the
years he had been diagnosed with high blood pressure, high cholesterol,
and peripheral neuropathy. They give him 20% for diabetes which we tried
to have increased and they denied us they also denied us for the HC and
the HB which I think is all secondary to his diabetes what should we do?
When he got out the army he was at 0 percent for a heart condition he
was recently released from the hospital and put on nitro have given up
on the VA they have let us down.
Answer:
I've received numerous letters similar to this one recently. I'll assume
he is a Vietnam Veteran, thus the 20% for diabetes. The neuropathy may
or may not be declared as a secondary condition to that diabetes,
depending on the severity of the condition.
The VA position is not unreasonable when considering hypertension and
high cholesterol. These conditions happen to a very sizable segment of
the population and the distribution is about even for both Veterans and
those who didn't serve. In other words, "aging happens".
You say that you "have given up on the VA" and that "they have let us
down....". I don't agree with you.
I have some of those same conditions, as do many other Veterans and
non-Veterans alike. If those conditions are caused by my service to my
country, how would I explain the same conditions in people who didn't
serve? I have high blood pressure and my wife has high blood pressure.
She didn't know me when I served and she has never put on the uniform so
I have a hard time justifying a service connected condition for myself
and not her.
Just because we served does not automatically qualify us for VA benefits
for every other thing that happens in our lives.
Recently, a Veteran who had some fairly routine gynecologic surgery
after her active duty sought my advice to establish a disability rating.
I asked why she thought the condition was service connected and how is
it disabling? Those are 2 of the criteria that VBA will use when
determing eligibility for a disability rating. Her reply was, “i was
thinking compensation...i though i was entitled to it I am not disabled
from the surgery. I feel 100% better and can do everything.”
Another Vet wrote seeking my help in establishing his disability rating.
He told me of an event where he was injured in basic training. There was
a minimal record of 2 days light duty for what seemed to be a knee
sprain in basic training. The x-ray report of that event showed a normal
knee. Today, he was seeking a disability rating for his current back
problems. In the decades that had elapsed between the basic training
event and about 2 years ago, he had not sought any treatment for back
problems. The Veteran insisted that the physician way back then was
incompetent because he didn't note the back problems. The Vet had gone
on to finish basic training and his term of service with no further
complaints of back injury.
Then there was the Vet who had been homosexually assaulted and abused by
others. The event was never reported to any authority and there was no
record that it had occurred. This Vet was relying on a statement from
his wife who recalled a conversation some 30 years ago where her soldier
husband had told her that something had happened.
These letters arrive in my mail every day:
“Dear Jim, I'm 65 years old and I have erectile dysfunction. VA has
denied me my 50% rating and I need your help.”
“Mr. Strickland, I was drafted and served 2 years as a quartermaster
clerk in East Dog's Breath, South Dakota. Today I'm depressed and can't
pay my mortgage. The VA has denied me my rightful disability benefits
and I want you to call me so we can talk about how I proceed.”
“JIM, I RECEIVED A BAD CONDUCT DISCHARGE AFTER BEATING UP THAT SERGEANT
HE WAS AN ASSHOLE. MY WIFE LEFT ME AND I HAVE NO INCOME AND MY FRIENDS
ALL HAVE VA DISABILITY BENEFITS AND I SURE NEED SOME.”
It's interesting to note that many of these letters I get also include
some verbiage about the VSO who represents the Veteran. All too often,
the Vet is encouraged to proceed by the VSO. According to many Vets,
their VSO advises them to participate in a shotgun approach and file
everything from dandruff to ingrown toenails as being caused by their
military service. The idea is to load up and fire it all up against that
VA wall in hopes something will stick.
Vets also write to me to tell me how badly they need their benefits.
They heard about CHAMPVA and need to get the wife covered. Maybe someone
told them of Chapter 35 Dependents Educational Allowance (DEA) and they
need the extra money to keep the kids in school.
Other Vets file their applications and sit back and wait for the VBA to
give them their money. They make no efforts to gather records, visit
doctor's offices, get copies of old x-rays or establish any evidence
that will help them win their award.
By time they write to me, most are already angry with the VBA because
they were denied or their benefits application isn't being processed
fast enough.
I've written about this before.
http://vawatchdog.org/07/nf07/nfMAY07/nf052107-1.htm
But, I suppose it may be time to refresh everyone's memory.
Here's the deal; Just because you served does not entitle you to a piece
of the tax money I paid over the years. I know that the concept may
prove a challenge for some but before you reap a disability benefit, you
must have a disability. And before you reap a disability benefit from
the VBA, you must reasonably prove that your disability was caused or
aggravated by your honorable (less than dishonorable) military service.
If you were discharged after 2 or 3 years service at age 23 and now
you're 58 and your back hurts and there is no record of your back being
injured in the military, you don't qualify for a VA disability award. If
you have smoked tobacco for all those years and now you have heart
disease or COPD or high cholesterol or erectile dysfunction, it isn't
the fault of the military or the VA. If you just realized that you owe
way too much money in credit card debt, you bought more car or house
than you can afford or your life is in a shambles because you haven't
managed your finances well enough over the years, you won't get bailed
out by VA because you suddenly recall a skin rash from 1969.
The VBA system is meant to compensate those Veterans who were disabled
by and during their service. There is no directive to give money to a
Veteran who is aging and experiencing the normal events of the aging
process. The system wasn't designed to lend a hand to a Veteran who has
made a mess of his life.
In fact, when Veterans who don't have a case for benefits go ahead and
file anyhow and then argue their points endlessly through the numerous
levels of appeals available, it only ties up an already overburdened
system for those who deserve some help. By law, the VBA must give
consideration to every claim, no matter how frivolous it obviously may
be.
And for all you VSO's who encourage your vets to file it all “just
because”; stop that. It isn't unreasonable for you to be straight with
your client and tell him he has no case. Sometimes, not always but
sometimes, a denial of benefits is the right thing to do.
Question:
Just a few questions. I am a retired submariner. In tha past several
years a bunch of strange medical issues have come up and I'm sure that
most of them can be linked to my military service. Early on and
throughout my career, I had a very high radiation dosages all documented
and am currently waiting results of a Ionized Radiation Registry
physical and disability request. I am currently a 50% disabled due to
back and hearng loss and am not sure if I should also claim against
Agent Orange. I did not set feets on Vietnamese soil but we were in
inland waters for several weeks where we ventillated the boat taking in
outside air several times daily. Also we had a port visit in Korea where
we ate local food and drink and took on local food and water to supply
the ship. i have a list of some of the things going on with me. Diabetes
type II since 1998...was told many times I was borderline while on
active duty, depression, 30lbs weight loss combined with lesions under
arm pits, treated at mental health clinic for manicdepressive disorder
Son born problematic pregnancy. Placenta previa baby, Dr. stated that
Placentia was dying. Child has had respiratory issues and curvature of
the spine since birth. Grandson born in 1991 has had significant
learning disability and was diagnosed with epilepsy Spouse developed
marked Cervical Displasia requiring hysterectomy. nodule on rt lung-
Adenocarcinoma, Anemia cause not specifically identified
Latest blood test showed red blood cells
misshapen and bone marrow not producing red cells Clubbing of fingers
and toes Shortness of breath Exercise Intolerance can walk only about
100yds Diabetic type II since on insulin Depression Memory loss
Erectile/sexual dysfunction with hypergonadism Barretts esophagus
Arterial claudication and stents in Femoral artery and have had balloon
angioplasty on the right Sleep Apnea since 2000 - use of CPAP device at
night Cataracts beginning on both eyes Any advice you have would be very
welcomed. Thank you for your service
Answer:
Unfortunately, I don't see that you have a lot to work with. The Haas
case may provide you with an avenue depending on what the courts
eventually do with it. If you have conditions that you reasonably
believe to be caused by exposure to Agent Orange, you should proceed to
file that with the VA
and claim that you are owed benefits.
I can tell you that you face an uphill battle. The "Blue Water" Navy won
the right to benefits and currently that is on appeal and tied up in the
federal court system. A link follows that will bring you up to date.
Read about Haas here
http://www.nvlsp.org/Information/
ArticleLibrary/AgentOrange/AO-V
ABattleBlueWaterVets0407.htm
Until then, VA is steadfast in denying AO related benefits to almost
everyone who did not have boots on the ground in RVN. Some of the
compounds in Korea were known to have used AO to assist with perimeter
control and a Vet who can prove he was involved in spraying any of the
dioxin compounds may have a case if he has good supporting evidence.
Simply being in port isn't going to bring much attention from VA.
Your radiation exposure and Ionized Radiation Registry physical and
disability request may provide the avenue for you to increase your
disability rating, depending on the results.
The symptoms you cite (except for type 2 diabetes) aren't generally
accepted as being associated with exposure to AO. Many civilians who
never served develop many of those same problems as they age. Type 2
diabetes is "presumptive" as associated with exposure to AO if you had
boots on the ground. None of the conditions you cite for your family are
known to be caused by a Veterans AO exposure. In offspring, Spina Bifida
is presumptive and some other conditions may be accepted only if the Vet
can prove a cause and effect probability. The breathing and vascular
disorders you cite will likely be dismissed if you are or ever were a
tobacco smoker. There is significant science out for many years now that
link lung and vascular disease with smoking.
You should probably proceed with filing a claim for the diabetes based
on VN service and claim that as you were in inland waters that the
"Brown Water Navy" applies to you. If you were to be awarded a
disability rating for diabetes, then you could follow that up and claim
that other conditions are secondary to the service connected diabetes.
I would caution that it may not be a good idea to file for multiple
conditions up front as it will take more time and be more complex to
sort out for VA. Go with the one condition that is most likely to reap
an award and later build on that.
-------------------------
Larry Scott --
