GLEN COVE, NY — Fixing the problems of the Department of Veterans’ Affairs (V.A.) will be a long, difficult, and complex undertaking.
The greater use of private hospitals is a step in the right direction, but it is a very small step. Although the V.A. has an established process for the use of private hospitals, it has only used this option for the cases that it absolutely cannot treat, not for the cases that it cannot treat in a reasonable time.
It is clear that there has long been extensive and willful ignorance at the highest levels of the V.A., including the level of Secretary. ...We cannot trust the internal investigations of the V.A. Inspector General to uncover the true extent of the dishonesty.
The private hospital process has its own difficulties. I had a client who did successfully benefit from the process, but it took him well over a year to get approval for it. Once it was approved, it took months for me to find someone at the V.A. medical center (VAMC) who understood the process; it took him more than a month to get the necessary V.A. form from another VAMC that had a stock of the right form.
Another measure to relieve the burden on the V.A. medical centers is to allow their pharmacies to fill all veterans’ prescriptions, not just those written by V.A. doctors, who often have to rewrite prescriptions already written by outside doctors.
The first step in reforming the V.A. is to understand the Byzantine nature of veterans’ benefits. When the V.A. replaced the former Veterans Administration (both are called V.A.), it did not receive jurisdiction over all veterans’ issues.
Military hospitals and veterans’ hospitals are completely different entities. Contrary to popular belief, the former Walter Reed Army Hospital (now part of the Walter Reed Armed Forces Medical Center at Bethesda) is not a veterans’ hospital. It is a military hospital. In order for veterans to use a military hospital, they must fall into one of the following categories:
• Have served honorably on active duty for 20 or more years
• Have served honorably for 20 or more years on a combination of active and reserve duty and be over age 60 years
• Have been 30 percent or more disabled on the day they finished active duty
• Held an important office, like President of the United States.
If the Army or Marine Corps thinks a veteran is 20 percent disabled on his last day of active duty, and the V.A. determines that he is 30 percent disabled the next day, he cannot use the military hospitals. Those who can use the military hospitals are still subject to a maze of regulations as to when they can and cannot use the military hospitals.
One part of the V.A. runs most of the national cemeteries where veterans are buried in the United States. Some cemeteries, however, like Arlington and West Point, are run by the Armed Forces, and some are run by state and local governments. Americans killed in action and buried where they died are in cemeteries under the control of the American Battle Field Monuments Commission, not the V.A.
There are V.A.-run nursing homes at the VAMCs, but there also nursing homes run by state governments.
The Veterans’ Employment Training Service (VETS) is part of the Department of Labor. Attempts to move it to the V.A. over the years have all failed, due to the bad reputation of the V.A. The V.A.’s 21 (Veterans’ Integrated Service Networks [VISN]) serve as an extra level of bureaucracy to filter any bad news before it gets to Washington, as well as another level at which standards can be changed.
Once we understand the V.A., we need to determine the extent of the problem and the extent of dishonesty about the problem. It is clear that there is significant dishonesty in both of the two major components of the V.A., the Veterans’ Health Administration (VHA) and the Veterans’ Benefits Administration (VBA).
This VA workforce (of approximately 320,000 employees) is permeated with a bureaucratic mentality that has to be replaced with an attitude of service. This is not going to be easy or quick.
It is also clear that there has long been extensive and willful ignorance at the highest levels of the V.A., including the level of Secretary. The V.A. has often suffered from the tendency of former generals serving in the V.A. to assume that their subordinates will tell them the truth, just as subordinate officers did. We cannot trust, however, the internal investigations of the V.A. Inspector General to uncover the true extent of the dishonesty.
Are 10 percent or 90 percent of the VBA Regional Officers (VARO) deliberately destroying or losing folders and claim forms to avoid work? It is probably somewhere in between. Are 10 percent or 90 percent of VAMCs falsifying records of time to schedule appointments? In which VAROs is this primarily in scheduling initial appointments? In which VAMCs is it primarily in scheduling part-time specialists?
All of these questions need to be answered by an independent investigation, able and willing to expose criminals. A bill, long urged by veterans’ organizations, to make it easier to fire V.A. bureaucrats has finally passed the House of Representatives but not the Senate. Another pending bill, not yet passed by either house, would allow all claims not ruled on for 120 days.
While greater reliance on private resources will help, this avenue alone cannot solve the whole problem. A thorough housecleaning is needed. The proportion of veterans in the V.A. staff is far too low. The overall structure of veterans’ benefits needs reform. Most V.A. employees are union members, and the union protection of bad employees needs to end.
The V.A. has approximately 320,000 employees. This workforce is permeated with a bureaucratic mentality that has to be replaced with an attitude of service. This is not going to be easy or quick.
Charles G. Mills is the Judge Advocate (general counsel) for the New York State American Legion. He has forty years of experience in many trial and appellate courts.
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Charles G. Mills is the Judge Advocate or general counsel for the
New York State American Legion. He has forty years of experience in
many trial and appellate courts and has published several articles
about the law.
See his biographical sketch and additional columns here.
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