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“What the AFGE doesn't want you to know is that there is no reason for the VA health care system to exist but to employ federal workers. These workers choose to get their health care in the civilian sector, much like Congress, they won't use the system they want to force down our throats. "The VA is the only provider that can care for the unique needs of Americas heroes", is the usual refrain from VA. That old song and dance VA has offered for decades doesn't hold water. Fact: VHA has consistently failed to provide high quality, timely health care while simultaneously wasting billions of taxpayer dollars. The civilian sector can treat all manners of health care problems faster, better, cheaper.”
I read the above commentary in today’s Watchdog and found it incredibly on point.  The role and function of VHA needs to be closely reviewed.  The existing VHA system made sense in the post-WWII demobilization era, as local civilian hospitals were ill-equipped to take care of the needs of otherwise healthy young Americans who had suffered debilitating diseases unseen or unknown in the US or who had suffered severe wounds requiring critical care or necessitating the use of prosthetics. 
Today, treatment of gunshot wounds and debilitating physical injury resultant from car wrecks is common place for almost any local hospital and telemedicine and support from the CDC makes treatment of infectious disease a possibility at any local hospital.  
So, why have VA-unique facilities?  I will make the case that VA is the lead provider in terms of PTSD and in that regard, VA treatment facilities make sense.  Otherwise, why not let local providers take care of the veterans and simply be reimbursed for that work.  That’ll take care of the backlog of appointment times and should drive efficiencies in cost of care as the VA would have to enter a competitive marketplace.
That then leads to the question of what to do with the capacity of existing VA health care facilities—why not let VA then become a provider for Medicaid recipients?  Just a thought or two for folks to ponder….
Drew Early, Esq.
Shewmaker & Shewmaker, LLC
2845 Henderson Mill Rd., NE
Atlanta, GA  30341-5772

From the Desk of Drew Early
Veterans Law Attorney

Nehmer v. US Dep't of Veterans Affairs, CV-86-6160 (N.D. Cal)See also 38 CFR 3.816.

The Nehmer rules are somewhat like the Bible--often quoted, less often understood, less often 
read.  At the heart of Nehmer, though, is an extension of presumption for certain Agent Orange related diseases.  Unique to Nehmer, as opposed to other types of claims, VA can go back and make an earlier effective date determination if there is evidence that the veteran had previously claimed an Agent Orange presumptive condition BEFORE the presumption had become effective.
It gets complicated in that the "track" of the claim is dependent upon when the predecessor claim was made and there are different ways of treating it for the purposes of determining the earlier effective date, (typically referred to as a Nehmer 1 or a Nehmer 2 claim).  Also, as a result of Nehmer, VA was supposed to do a review of all files of veterans who were potential Nehmer claimants, in a search for those who might have a valid claim for an earlier effective date or an outright claim that was never awarded.  As VA also has certain medical information loaded into claims files, the very existence of that information in the file might spur a Nehmer award if the medical information would have, or should have, indicated a presumptive condition for Agent Orange.  There is an extensive Nehmer Training Guide online that is informative.
Oh, and the Nehmer rules apply to DIC claims as well--spouses shouldn't forget that. Veterans and their families are their own best advocates; information is their best tool.
/s/ Drew​

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From the Desk of Drew Early

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Hello Jim,
I see VA is bemoaning a lack of funds again for the Veteran’s Choice Program—very easy to go back to the well again and again to Congress when a popular program is threatened.
How does that coincide with the 300% cost overrun in the Aurora Colorado VA hospital project?  Why were the lead project manager and overseeing staff design manager for that project allowed to retire?
There is a dichotomy here as to accountability when it comes to differing programs and projects.  Certainly, in the outside world, management conduct like that of Aurora would probably result in changes in employment.
I would hope the outcome of the current Veteran’s Choice popularity is that VA seriously look at why that program is so popular.  Why do so many vets want referrals to local providers?  Maybe there’s not a need for extravagant and over budget fixed medical facilities like Aurora if veterans can get treatment from local providers…something to consider.
Drew Early, Esq.

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