Ineffective Governance – Chronicling the VA

I-CareIn a scheme fit to fully infuriate patients and pad wallets, the VA providers prescribe medications; generally, the medication provided is a cheap knock-off, a generic mixture, or drugs with rebate incentives where the hospital providers are “encouraged” to use one drug more than another and the “higher cost” is rebated back the hospital in a profit-sharing scheme.  All these schemes and more play out at your local hospital and VA facilities, so please do not think this is industry-specific to the government.  However, as proved by the Department of Veteran Affairs (VA) – Office of Inspector General (VA-OIG) reports, t improper controls and governance wastes the rebates, harms patients, and still cannot get the programs correct.

Angry Wet ChickenI have three prescriptions hindered by the pharmacy practices of the VA, where the knock-off drug is useless, the mixture of the medication does not do as well as the original medicines prescribed, and where the cost of an ingredient has changed one medication to another and made the prescription less effective to the point where more medication is required for less overall effectiveness.  If the patient has to take more medication, does that mean that the cost savings never happened or that the cost savings were pushed down to the customer?  Does the patient even have a voice in the pharmaceutical decisions?  Why?

We begin the VA-OIG reports with a New Jersey man, who from 2017 thru 2020 stole more than $8.2 million in HIV medication from the VA.  Where were the supervisors when procurement officers for the VA over-ordered medication, stole the excess, sold the stolen goods, and pocketed the profits?  Where were the oversight accountants?  Where were the hospital directors?  People had to know, yet somehow the scheme could exist and thrive; this is as much a failure of leadership as it is ineffective governance, poor inventory control, and useless organizational controls.  Truly a pathetic example of VA leadership!VA 3

On the topic of ineffective governance of pharmaceutical contracts, and diversions of drugs, the VA-OIG report the following:

The Veterans Health Administration (VHA) spent about $6.6 billion on prescription drugs in fiscal year (FY) 2019. Most were dispensed to veterans by medical facility pharmacies. VHA pharmacies can return drugs that become damaged or expire before use through a reverse distributor for credit or destruction. In FY 2019, VHA expected to receive about $52 million from drug returns.  The VA-OIG found VHA pharmacy chiefs did not effectively implement the program and did not follow requirements in VA’s contract with the reverse distributor, Pharma Logistics. These issues increased the risk of drug diversion and ultimately put about $18.1 million at risk. Pharmacy chiefs did not always secure, and track drugs held for return or complete required analyses to maximize returns. They also failed to meet contract requirements to return for credit-only drugs due to expire within 120 days. VA’s National Contract Service and network contracting officers needed to do more to ensure contract terms were met. The Office of the Deputy Under Secretary for Health for Policy and Services and the Office of the Deputy Under Secretary for Health for Operations and Management did not effectively govern the program or communicate requirements to medical facilities” [emphasis mine].

VA 3Someone help me out, for I cannot understand how incompetence can be designed into these systems, policies, procedures, and responsible parties retain their positions of power.  What happened in 2018, 2017, 2016, and earlier?  We have a single fiscal year (FY) snapshot at a program that is an absolute failure.  By any measurable standard, that should have ignited a full audit of previous years until finding a successful year when the program worked.  Will there be a follow-up to this investigation to see if the VA-OIG’s recommendations are followed and implemented?  The VA-OIG has the leadership caught dead to rights on ineffective governance of a program worth $6.6 Billion to the American Taxpayer, and no accountability or responsibility of personnel is to be found anywhere.  Why?

Plato 2In a separate investigation, the VA-OIG found:

In October 2020, VA ended its contract with Pharma Logistics.  The vendor continues to process and issue final invoices to facilities as the returned drugs become eligible for and receive manufacturer credit. The final invoice process will continue until at least April 2022.  VHA medical facility pharmacies lost at least an estimated $2.1 million worth of drug return credits because pharmacy chiefs did not always effectively monitor or review job settlement statements before Pharma Logistics issued final invoices.  In addition, although the vendor established a dashboard that provided information on the status of drug return credits at the facility level, it cannot provide a national report on all outstanding credits.  This hurt VHA’s ability to maximize potential drug return credits and minimize the risk of lost credits.  VHA will continue to be unable to ensure it is receiving all credits for drugs returned by medical facilities if pharmacy chiefs do not routinely monitor preliminary invoices, reconcile job settlement statements to identify outstanding credits, and request extensions to final invoices to allow additional time for credit processing. This risk will persist for any future drug return contract(s)—whether awarded nationally or locally—if the reimbursement structure remains the same” [emphasis mine].VA 3

Did you catch that; the vendor created software to help track medications, making it easier to return medicines, and the VA pharmacy chiefs could not follow the dashboard and increased the risk of losing money for the VHA.  You were hired to perform a job; a collateral duty of your job is inventory management, tools are provided and supported to aid you in making decisions, and you refuse to use these tools.  How is this the vendor’s fault?  Why do you still retain your position?  Ineffective governance is barely the tip of the VA’s problematic iceberg created the good ship America has hit!

Liars, Thieves, and Fraud Artists Beware

GavelA Norwood, Massachusetts woman has been indicted, remains presumed innocent until proven guilty in a court of law, by a jury of her peers, for stealing social security and workman’s compensation benefits.  The Norwood woman’s actions are continuing to support the claim that complexity breeds criminal abuse.  Unfortunately, also proving that the government is not doing their jobs in checking tax records before providing benefits.

A man from Georgia has pled guilty to running a Ponzi scheme and defraud the American government during the COVID pandemic.  Frankly, I am thrilled to see another fraudster being stopped before his crimes become astronomical in scale.  I remain convinced that the government procurement system is wide open to abuse, and the complexity of the procurement system is too costly, cumbersome, and risk inviting.  The criminals see too much opportunity in the government procurement system, and the complexity breeds the ability to lie, steal, cheat the American taxpayer.

QuestionThe following remains a case where there are too many lawyers and not enough truth to ascertain what in the world is going on.  If you have further insight, please weigh in.  “Sunrhys LLC, a landlord and property management company, headquartered in Tacoma, Washington, agreed to pay $16,618 to resolve allegations that it violated the False Claims Act by overcharging a tenant and by fraudulently obtaining federal funds from a federal program designed to provide housing to homeless Veterans. The United States alleged that Sunrhys violated the agreement and the HUD-VA Support Housing program requirements by fraudulently overcharging a veteran for monthly rent between July 2019 and April 2020.”

Highlights, Audits, and Inspections

July 2021 – Highlights:

Each month, the Office of Inspector General (OIG) publishes highlights of our investigative work, congressional testimony, and oversight reports. Each month’s highlights are meant to provide a brief overview of the most significant OIG work conducted in that period.”

blue-money-burningThe VA-OIG conducted a financial efficiency review of the Miami VAHCS.  From the findings, the VHA, VBA, National Cemeteries, specifically, and the VA generally, could learn much about fiscal responsibility.  But this was already well documented!  The VA has never successfully passed an audit with transparency, accountability, and responsibility; why am I the only person demanding to know why?  Want to laugh; the VA-OIG recommends “more scrutiny” for financial transactions to the VA as a recommendation.  Like the current system for scrutiny is working, and just a bit more effort will help.  Go ahead and read the report for more specifics; my stomach cannot handle writing about the gross inefficiencies, the actual harm, and out-of-control governance failures.  Fiscal insanity is one thing; what is occurring at the Miami VAHCS is beyond insane and bordering on the unbelievable!  Almost the beginning of the Twilight Zone.

Survived the VAThe Sheridan VAMC in Wyoming continues to be performing well and deserves hearty congratulations for the results of their latest comprehensive healthcare inspection.  I prefer to issue congratulations than butt-kickings, and the congratulations are well deserved.  Keep up the good work moving forward.

© 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.

It IS ALL About Leadership – More Shameful VA Chronicles

I-CareRecently, guardianships have been in the news, and I doubt this story will make the lawyers very happy.  The department of Veterans Affairs – Office of Inspector General (VA-OIG) reports that an Albuquerque couple has been sentenced for defrauding guardians, which included veterans.  The criminal report claims:

Susan Harris acted as president and was the 95-percent owner of Ayudando, while Moore acted as chief financial officer and was a five-percent owner. They engaged in a pattern of criminal conduct from November 2006 to July 2017 that included unlawfully transferring money from client accounts to a comingled account without any client-based justification.  They wrote and endorsed numerous checks, often of more than $10,000, from these comingled accounts to themselves, family members, cash, and other parties where payment would benefit their families.”

For the better part of 11 years, this couple has spent money not their own, abused their charges, and defrauded vulnerable clientele.  While the federal attorneys and investigators crow about catching this couple and ending this situation; what about all the rest of the guardianships where abuse is occurring?  I have read horrific stories about victims of guardianship abuse and hope more will be done on this topic very shortly!VA 3

For 11 years, where were the VA and the Social Security Administration?  Where were the local hospital leadership, social workers, and other federal employees who had to have known something fishy was going on?  Where are these Federal Employees now?  Where are the politicians scrutinizing this incident to ensure that protection for vulnerable citizens never happens again through legal guardianships?

Now traveling to Eastern Oklahoma VAHCS in Muskogee where an audiologist provided poor care and billed for unrendered services.  Pay close attention to the VA-OIG report; the leadership failures on this report alone are voluminous and unforgivable!

A facility fact-finding review revealed the audiologist provided poor care to eight of 43 patients reviewed, including misinforming patients who needed hearing aids that hearing aids were not needed. Although the audiology leaders reported the fact-finding results to the OIG, they failed to evaluate whether patients needed clinical follow-up; determine whether additional patients were affected by the audiologist’s poor care; evaluate whether clinical disclosures were required for the affected patients; and communicate the fact-finding results to the Facility Director, who was, therefore, unable to initiate the process to determine the necessity of a large scale disclosure. The instances of poor care were also not reported to the Patient Safety Manager, who was, as a result, unable to assess the adverse events to determine if patient safety interventions were indicated. The VA-OIG also found that performance monitoring of facility audiologists was not conducted as required. Annual competency assessments and annual performance appraisals were not consistently completed and did not contain adequate performance standards. Audiology leaders failed to consider whether the audiologist’s actions warranted a report to the state licensing board due to a lack of understanding of the requirements for reporting and, therefore, the Facility Director was not informed of the need to initiate a state licensing board review” [emphasis mine].

Will, someone please tell me, were the audiology leaders who failed to perform their jobs removed from Federal Employment?  What about the audiologists causing the problems?  Are they removed from Federal Employment?  Were their licensing practices curbed to protect other populations of patients?  The leadership failures here read like a Steven King horror story but do not have the satisfaction of finishing the story.VA 3

Yet, the Department of Veteran Affairs (VA) will continue to market that they are “defining quality in healthcare.”  The jokes write themselves but cannot be fired from Federal Employment!  Politicians, why can these jokers not be fired from Federal employment for such egregious abuse of their positions and failures to do their jobs?

I-CareTraveling further to North Carolina, we find that the perpetrator of this fraud has pled guilty, but again responsibility, accountability, and correction of the VA is being skirted.

John Paul Cook, 57, of Alexander, North Carolina, pleaded guilty to defrauding the VA. After enlisting in the Army in 1985, Cook sustained an accidental injury and complained the injury worsened a preexisting eye condition. In 1987, Cook was discharged, and he began receiving benefits that would increase over the next 30 years due to Cook’s repeated false claims of increased visual impairment and unemployability. In 2005, the VA declared Cook legally blind, and he began receiving disability-based compensation at the maximum rate despite repeatedly passing vision screening tests to obtain or renew his driver’s license and purchasing vehicles that he routinely drove.”

1987 to 2020, we will be generous in counting the years here; regardless, we are looking at 30+ years this fraud continued.  Where were the verification protocols?  I have had to produce a valid driver’s license at the VA to obtain and keep current my VA identification card.  How did this fraud go on for so long?  What is the VA doing to stop, or at least hinder, those who would defraud the government before the problem becomes 10 years old, let alone 30?!?!  I cannot fathom how this fraud went on for so long without a routine checkup, a routine exam, a follow-up exam, etc.VA 3

Going north from South Carolina, we find more fraud, this time in New Jersey, where a man did not report his mother had deceased and continued to claim her benefits for a total of over $200K.

Melvin Greenspan, 72, of Perrineville, New Jersey, pleaded guilty to defrauding VA of over $200,000 in survivor’s pension benefits. After the death of his mother in 2006, who had received survivor’s pension due to his father’s prior military service, Greenspan failed to notify the VA about his mother’s death and made withdrawals of the benefits through 2018.”

Where was the leadership?  Where are the leaders now?  Another fraud case, older than a decade, and still the VA cannot be held accountable for facilitating the fraud.  I am stunned!  How did this one continue for so long?  Doesn’t the VA check local newspapers, the Social Security Administration, other Federal Agencies?  Since the culprit was not held on defrauding SSA, one can only presume the mother’s death was reported there.  Why did the VA not get notified to ask the family questions?VA 3

On the topic of guardians and leadership, the following story makes me angry!  However, I will withhold further elaboration since those accused remain innocent until proven guilty by a trial of their peers.

Johnny Ray Gasca, 51, was arrested for allegedly abducting a 68-year-old woman with dementia from the West Los Angeles VA Medical Center in California. A witness recognized Gasca and reported he might have previously taken money from the woman’s bank and retirement accounts. Following his arrest, Gasca described the victim as his girlfriend and told agents that they stopped at a bank where the victim made a $15,000 withdrawal after leaving the medical center.”

In the first report from the VA-OIG discussed, we found guardianship rules being violated to the Nth degree.  In this story, we have no information of an assigned guardian, and we have a dementia patient being abused.  The dementia patient was traveling with a friend; who is the legal guardian for a dementia patient?  Where are the family or friends legally bonded to render aid for this patient and monitor finances to protect them from abuse?  How can the VA operate one way in one locale and 180-degrees differently in another locale and the leadership not held accountable?VA 3

Speaking of missing leadership, the following VA-OIG report is a beauty!  The Department of Veterans Affairs – Veterans Health Administration (VHA) has a program to help homeless veterans, where contractors are used, and the VHA uses case management documentation to verify the veteran is receiving the assistance being paid for, the program is called the contracted residential services (CRS) program.

The VA-OIG found facility staff did not consistently document case management and monitor the progress of veterans in the program.  Further, four of the 14 CRS contracts reviewed had performance deficiencies, with one resulting in improper payments of $592,000. These deficiencies may affect the health and safety of veterans living in transitional settings. Moreover, VA lacks assurance that veterans received required services. There were also contract administration problems in 13 of 14 reviewed contracts. Contracting officers did not always properly delegate responsibilities to staff functioning as contracting officer’s representatives. Further, one facility’s representative did not ensure contractors provided meals or the means to purchase them, as required, and another lacked invoice supporting documentation for approval. The VA-OIG audit team estimated that 107 of 119 contracts had monitoring and administration deficiencies. Furthermore, the team estimated that VHA made $35.3 million in improper payments, of which approximately $21.6 million was technically improper because the individuals authorizing payment were not delegated authority to serve as contracting officer’s representatives.”

If your accomplishment rate in your employment was 48%, would you retain your job for very long?  If 90% of your documentation claiming how well you do your job was missing or fabricated, how long would you maintain employment?  If you delegated people to complete your work who were unauthorized and you were contractually culpable, how long do you think you would stay out of prison?  How long would your boss stay out of jail?  How long would your company exist?  Now, answer me this riddler, why does the government get a pass on these questions?VA 3

Finally, we have Deputy Inspector General David Case’s testimony regarding the failure of VA leadership where the implementation of a new electronic health record (EHR) is being stalled.  If you care, the VA leadership and the VHA leadership are failing the EHR initiative.  Not that this was not expected, and not that this is not surprising, the IT and IS departments of the VA and VHA are so hopelessly lost it amazes me the VA is even using computers and not written records!  But, do not take my word for it, Case himself claims,

“Detailed in this statement, we have repeatedly found unreliable and incomplete estimates for upgrades and costs, inadequate reporting affecting transparency to Congress, and stove-piped governance with decision making that does not appropriately engage Veterans Health Administration (VHA) personnel who are the end-users of the new EHR system.”VA 3

Knowledge Check!Get that; the leadership failures are obstructing Congress and hindering the EHR progress!  What can we conclude from this batch of VA-OIG reports:

        1. The VA, VHA, VBA, and National Cemetery leadership are actively missing, like the Democrats from the Texas Legislature.
        2. If the leaders are present, the leaders are the problems in progressing.
        3. The leaders have created a system where fraud and abuse of the veterans and taxpayers can be achieved with ease.
        4. Nobody in the US House of Representatives or US Senate scrutinizes the legislative branch sufficiently to effect changes.
        5. When in doubt about where your leaders fall, check to see if they are in their offices. Oh, wait, that won’t help, their offices have locks on the doors!

If this is how the VA defines quality healthcare. In that case, the veterans are screwed, the taxpayer is sunk, and the leaders will enjoy their magnanimous federally approved retirement packages, ad nauseam ad infinitum!

© 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.

 

Glory and Gore go Hand in Hand – Stating the Obvious

Bait & SwitchLorde, from the “Pure Heroine” album, sings the song “Glory and Gore.”  From which both this title and the principle for this article originated.  The obvious is stated many times a day, oftentimes in an ironic accident, and today was no exception.  The headlines on several stories help prove this point and highlight some serious problems facing America.

From The Daily Signal, we find our first instance of stating the obvious when Lindsey Burke announces that “Unions are doubling down on inserting critical race theory (CRT) into education.”  Of course, the labor unions of teacher associations would be doubling- and tripling- down on applying political pressure to advance America, destroying malarkey for K-12 Educators.  Show a single instance when a Marxist labor union has ever done anything to support America, and I will show you the inner workings of liars, thieves, and cheats who will tell a thousand truths to convince you a lie is a truth.

Exclamation MarkCRT is dangerous, it is a lie thought up by academics, and the only people who will benefit from CRT are liars, thieves, cheats, and politicians.  Tell me, of all the people in history who have been enslaved, forced into indentured servitude, harassed, belittled, and betrayed by a different society, why are American Black populations the only ones ever targeted for pampering and coddling?  When you answer this question, you will discover that this population is being treated this way by racist antagonists who know they can rely upon this population for agitation, anger, and terrorism without thought, concern, and care about the consequences.  Why; because they have been intentionally groomed and carefully taught to act in this manner for the political ambitions of the same people pushing CRT.

Ever notice how President Biden and Hillary Clinton only talk at the American Black Populations, and even then only address the leaders of groups dedicated to rousing the population’s emotions, and not the population themselves?  When was President Biden ever in Harlem for a political rally?  When was Hillary ever in Compton, Philly, or Chicago?  What about a visit to Atlanta for a political rally down by the riverside?  The politicians talk to the NAACP and the Black Caucus, who then speak to the religious leaders and social justice minions. They talk to the local neighborhoods, reflecting the cowardice and true colors of the politicians as race agitators and race hustlers, not interested in the population unless it is election time.  What is CRT; trouble!

Theres moreThe Daily Signal also carried a story authored by Hans von Spakovsky, who declared that a former Justice Department lawyer testified that lawyers abuse their power at the Department of Justice.  What a revelation; lawyers were acting unethically, immorally, and illegally for personal gain in government employment.  Color me shocked!  Ever wonder why lawyers and attorneys have the most jokes written about them of any other profession; I never have!  Worse, I cannot believe how many can get elected!

Under the heading of stating the obvious, and how you cannot color me shocked, the Department of Veterans Affairs (VA) continues to blame inadequate training as the go-to excuse when the Department of Veterans Affairs – Office of Inspector General (VA-OIG) comes investigating.  In the almost two decades I have been chronicling poor behavior at the VA, VBA, VHA, and National Cemeteries, the number one most often cited excuse for failure is “poor or inadequate training.”  As a point of reference, this lack of training drove my desire to work in training at the VA to improve the training delivered.

Raymmond G. MurphyAs an adult educator with more than 20 years in distance learning and classroom training, I thought I would be a shoo-in for the positions.  Nope, I had not served in pay grades lower to “learn the VA.”  Even though I had more education and experience, was Schedule A, and more skilled than any other candidate, I was deemed not qualified, and internal people filled the open roles.  How do I know these facts, I asked those hired, and they were glad to relate their stories, experience, and time served in the VA to get into a plushy training position where they were grossly inadequate.  Only after leaving was the other reason revealed, the HR Director at the Albuquerque VAMC claimed too many veterans were in employment at the VA and refused to hire a single veteran while she directed the HR department.

Do the VA Leaders ever think that this is the problem? Only the worst of the worst can survive the mental depravity and mind-numbing bureaucracy at the VA to obtain promotion into higher leadership positions.  Worse, those who achieve these positions have agendas, lists of enemies to crush, and power empires to build, so they are never interested in doing the job!

GearsThe result, designed incompetence is bred, excuses that could not hold reality become the accepted verbiage to deflect responsibility and accountability, and if all else fails, make sure your union dues are paid, and the union will defend your pension, your job, and your benefits.  Then you can lie, cheat, steal, and terrorize without prejudice and escape without any problems.

If you ever think that something is too far-fetched to believe, the VA will prove you wrong.  The VA-OIG continues to inspect five VAMC’s for inadequate and improper processes, procedures, and leadership where financial controls and payments to third-party or affiliated non-profit corporations are concerned.  In 2021, two additional VAMC’s have failed sufficiently to make the eternally under investigation list, Albuquerque, NM and Palo Alto, CA.  The original five are Boise, ID., Boston, MA., Cincinnati, OH., Nashville, TN., and San Francisco, CA.

The Albuquerque and Palo Alto medical centers made about $17.9 million in improper payments to affiliated non-profit corporations. The reason for improper payments was the same for all seven VA medical centers reviewed. Specifically, procedures for approving invoices did not satisfy VA policy requirements because they did not require verification that the services were provided. The audit team also noted an absence of required periodic reviews by VA supervisors of approved invoices at all seven medical centers.”

Now, here’s the other side of the coin, the internal controls at both the VA and the non-profits did not identify that their problems were internal or even an issue.  When I have worked in finance, the rule is, “no evidence, no payment!”  When the non-profit I volunteered at failed an audit with 27-pages of audit inconsistencies, I was called in and charged with fixing the problems.  Of those 27-pages of audit findings, 26 pages were for payments where documentation was missing.  Four months later, a follow-up inspection cleared all 27-pages.  Yet, no evidence continues to be the single most glaring problem at seven separate VAMC’s, and nothing has changed since this issue first reared its head in FY 2017-2018.  The VA-OIG has collected reports beginning in Boston, MA VA_OIG report number 18-00711-211, published 02 December 2019, where more than 3700 payments totaling more than $23 Million were made without evidence proving services rendered.Apathy

From the VA-OIG Report:

Of the estimated $1.6 million overpayment, about $1.5 million paid to the Boston non-profit was included in the total $35.7 million improper payments due to lack of evidence that services were received. The entire $1.6 million overpayment was for unallowable or prohibited reimbursements to the non-profit.”

The OIG previously reported a total of about $35.7 million improper payments to five affiliated non-profit corporations as shown in this report.”

VA 3Is it too obvious to declare the leadership in charge at both the non-profits and the VA needs immediate removal, transparent audits conducted, and those leaders held accountable for the money that has been lost?  Recently an author claimed the VA is more of a crime syndicate than the mob.  After reading that two additional VAMC’s have failed gloriously to prove services rendered for payments made, I can agree with this sentiment!

Our final entry today originates, unsurprisingly, with the Department of Veterans Affairs – Veterans Benefits Administration (VBA) and a VA-OIG inspection where 88% of the claims processed involved lengthy delays in making decisions.  Tell me, if you had an 88% failure rate at your job, how long would you keep your job?  How long would it be before your bosses were shown the door, the company shuttered, and investigated for fraud?  Now, why are government employees treated differently than private-sector employees?  The inexcusable delays have led to more than $232 Million in questionable payments projected for the next two years, while the VBA is “encouraged” to fix the delay problems and “catch up.”

Knowledge Check!For the record, stating the obvious, the entire US Government is sick.  The legislative branch keeps abdicating responsibility to the judicial and executive branches. Bureaucrats and bureaucracy have overcome common sense. The whole process has been rigged to keep the dregs of society in power while the taxpayer suffers.  Let us, the owners of representative governments, remind those supposed to be in charge that they have cause to fear the electorate.  Politicians should fear the ballot box, and they should fear having the electorate hold them personally accountable for the mess they have perpetrated.

© 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.

NO MORE BS: Revisiting the VBA and Spinal Claims Issues

VA SealOne 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.VA 3

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].

Angry Wet ChickenThe 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.

Angry Wet Chicken 2Today, 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.VA 3

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!  VA 3

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!VA 3

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?

LinkedIn VA ImageWorse, 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!VA 3

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!Apathy

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
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