One of the Department of Veterans Affairs – Office of Inspector General (VA-OIG) reports I wrote about in 2019 was how the Department of Veterans Affairs – Veterans Benefits Administration (VBA) was inaccurately deciding spinal claims for veterans. Apparently, the complexity of primary injuries and secondary problems was causing confusion at the VBA, and when the VA-OIG came around to investigate, 100% of the claims from 01 January to 30 June 2018 were inaccurate in some way, shape, or form. The VA-OIG reviewed 62,5000 spinal injury claims in the designated window; 34,700 were incorrectly processed, with approximately 5000 receiving inaccurate decisions resulting in over or underpayments totaling $5.9 Million. Thus, each of the 5000 veterans had about an over or underpayment of $1180; whether this is monthly or in total is not detailed.
Something to think about those 5000 veterans mentioned does not include the 29,800 veterans’ claims which contained processing errors that could have had a monetary effect on veterans. The VA-OIG could not determine monetary over or underpayments on these 29,800 claims. Hence, $35,164,000 in possible over or underpayments was still in question if the average per person holds from the 5000 mentioned above.
More details on the other 34,700 veteran claims incorrectly processed for these claims with processing errors, VBA staff decided on the claims before completing all required evaluation steps. The Department of Veterans Affairs (VA) conveniently designs its processes to fail, and this is referred to as designed incompetence. Think I am wrong; check out what the VA-OIG discovered as the root cause of incorrect spinal claims processing.
“The OIG found that all incorrectly decided veteran claims resulted from VBA’s inadequate process for ensuring accurate and complete evaluation. The disability rating schedule—the primary criteria for evaluating disability—contains minimal guidance on neurological and peripheral nerves. A procedures manual detailing the rating schedule is too subjective about peripheral nerve disability evaluations, which can lead to an inconsistent evaluation for a secondary service-connected condition” [emphasis mine].
The manuals, designed and published by the VBA, are inadequate to decide spinal claims consistently. The VBA created these books to be a ready-made excuse for cheating veterans with improperly decided claims on spinal injuries. Why is this such an issue for me; I have been fighting chronic pain in my spine since 2002. I fell multiple times onboard the ship after being pushed by a First-Class Petty Officer while carrying a load of D Cell batteries. I experienced weakness and shortness of breath on the boat, went to medical; none of those records exist anymore. The Chief made Senior Chief and was “encouraged” to retire shortly after I left the ship. After leaving the service, I discovered that the Independent Duty Corpsman, a US Navy Chief, was consistently sinking medical records for the Engineering Department to Davey Jones’ Locker.
Today, 10 May 2010, I had a Compensation and Pension appointment with LHI. I discovered the VBA had edited my claim, and my C-Spine information again was missing from the evaluation. Since my spine was inappropriately decided in 2014, I could not add the C-Spine problems into today’s appointment. I was sent back to the VA to file a supplemental claim, using the VA-OIG report from 05 September 2019, as “New and Material Evidence” to have my 2014 claim reopened. That 2014 claim, called bulging disks in C-Spine, bulging disks in L-Spine, and a trauma-induced S-Curve in my T-Spine as “lumbar strain with chronic pain.” Today, I was asked how the peripheral nerve problems in my right arm were connected to my lumbar spine! Not joking, a Nurse Practitioner asked me to explain the connection, without mentioning the C-Spine, the fact that my Right Shoulder is 1-1/2 -2” shorter than my left shoulder, not to mention the headaches at C-0, but all this has something magical to do with my lumbar spine. After all the tedious bureaucratism I have experienced with the VA, I was not surprised; other adjectives fit, but not surprise!
Upon returning home, I filed a supplemental claim, as advised by a customer service representative at the VBA. Best of all, the customer service representative confirmed I could use the VA-OIG report as my “New and Material Evidence.” This is good because none of the MRIs since 2014 are allowed as “New and Material Evidence,” the neurological decision claiming I have an unknown neurological disease is not permitted. All the lost jobs, employer letters claiming a need for ADA Accommodation, or physical therapy notes are also not allowed as “New and Material Evidence.” All because of those published books the VBA uses to make determinations, which continue to fail to accurately and consistently aid in deciding spinal claims for the VBA and for the VHA to treat.
The VA-OIG Report has the following to report, which also played a significant role in confusing the nurse practitioner interviewing me today.
“… The medical examiners did not always choose disability levels that were consistent with documented symptom details from the exam. Examiners told the review team that VBA did not provide any guidance on the definition of these disability levels. In addition, they are VBA terms, not medical ones, and there are no standardized criteria for the examiners to determine severity.”
The nurse practitioner could not explain the difference between mild, moderate, and severe. The VHA uses a pain scale from 1-10; thus, confusion reigned during the LHI compensation and pension evaluation. Imagine that; the VBA cannot train a third-party contractor on VBA-specific terms designed to create confusion between the language used in the VHA and the language used in the VBA. Color me shocked; NOT!
There have been no changes to these terms, and the confusion generated since the VA-OIG called out the VBA on their inability to communicate and accurately decide veterans claims. Imagine my surprise when a reader claimed I was too harsh on the VA Administrators and their failures to lead, correct, and design anything that fundamentally fixes the VA. The VA-OIG issues “recommendations,” the VBA, The VHA, and the National Cemetery ignore the recommendations and continue with business as usual. Hey taxpayer, how would you rate the VA and evaluate their job in not wasting your tax dollars?
What blows my mind is that this is what the marketing department for the VA calls “Defining Excellence” in VA Healthcare! The VA-OIG report continued claiming:
“The same form also asks medical examiners to provide an opinion about whether the veteran’s range of motion is limited during flare-ups or after repeated use. The medical examiner can decline to provide an opinion, but a sufficient explanation is required if the medical examiner takes that route. The VBA manual states the opinion may be insufficient if the conclusion is not adequately justified or implies a general lack of knowledge or an aversion to offering this statement on issues not directly observed. Most of the errors the OIG team identified did not have the required and sufficient explanation about why the examiner could not express an opinion.”
Recognize a problem here; if I replicate a movement that causes me severe pain, I fall to the floor, insensate, and become an ER issue. For the last spinal compensation and pension evaluation, the evaluator collapsed my legs four times in her office by placing her hand on my L-Spine where the disks are known to be bulging. What did the VBA call this? Insufficient evidence for a secondary peripheral nerve problem. I had to report to the Albuquerque ER for a shot of morphine and a shot of Toradol. Missing the next three days of work due to pain in my spine where the medication was insufficient to the task of relieving the suffering. Those days missed directly led to my being dismissed from VA employment and spending the majority of the next two years unemployed!
So, not the VBA cannot communicate using medically acceptable terms. They cannot understand when nerves have a primary, secondary, and tertiary issue causing a veteran loss of employment, severe pain, repetitive injuries. Then the VBA has the gall to refuse to accept all VHA medical records as “New and Material Evidence.” Do you know how hard it is to replicate a secondary or tertiary problem when it occurs intermittently on one side of the body but is a regular 24/7 injury on the other side of the body? My right side is neurologically worse than the left side, but how do you communicate that to the interviewer? How do they properly communicate that to the VBA when the VBA does not use medically recognized terminology?
Worse, all the problems have a root cause in the technology forced upon the medical reviewer. There is an insufficient explanation to describe to a veteran what the VBA is asking for, so the veteran can answer the questions correctly. The person who made my spinal claim originally had been writing VBA claims for 20+ years. She was still disregarded by the VBA because the Veterans Service Representative reviewing the claim could not, or would not, interpret the doctor’s note correctly for an accurate decision. Any fourth-grade biology student can tell you that the T-Spine is different from the L-Spine, and damage in one does not mean damage can be added to the other, and all the damage can be lumped together! Yet, that is precisely the asinine decision I was handed and have been fighting!
If you want more details on this egregious example of leadership failure and VBA insanity, the whole report can be read here. I am not joking, and adjectives are expended describing how deplorable the VBA processes are and the problems these decisions place the veteran into! The rules are ineptitude hiding behind designed incompetence to the Nth degree, and that is an absolute disgrace!
I believe in the little rocks that start landslides. I know the power of tiny snowflakes that create an avalanche. I know that if enough veterans, their families, friends, and communities rise up, the elected politicians responsible for scrutinizing the government will be forced to make veteran safety and health at the VA a priority, and blessed change will finally arrive in the VA Administration and administrators. Imagine how you would feel about learning a close friend or family member was being refused treatment at the VA because their claim was inaccurately decided. Please respond accordingly!
© 2021 M. Dave Salisbury
All Rights Reserved
The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.