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
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: QT and LHI – Let’s Talk Customer Service

Thank you!For a long time, I have deeply respected QuickTrip (QT).  Their customer service is of such outstanding quality; even when their fuel is more expensive, I still prefer shopping at QT.  The people go out of their way to help you have a fantastic customer experience.  I have never had a rude employee, a poor customer interaction, or left with an unresolved problem.  I struggle with a cane and neurological issues and have had doors held open for me; cashiers have brought me my change, always a good experience at QT.  Thank you!

On the other end of the spectrum, you have the Department of Motor Vehicles, and they are joined by Logistics Health Incorporated (LHI).  I have had my share of detestable customer service experiences; I am a customer service subject matter expert and have been regularly published on customer service topics.  When I rate LHI as competing for the DMV for the worst possible customer service provider, LHI might even have the DMV shaded!Angry Wet Chicken

16 April 2021 – I enter LHI at 5333 N 7th St, Phoenix location; I am 35-minutes early to a 1200 appointment.  On 25 March 2021, the Gov. of Arizona stopped enforcing mandatory masking.  As a person with a documented medical condition where I struggle to breathe enough volume per breath and cannot physically wear a mask, I did not wear a mask to this appointment.  I was rudely asked to wear a mask by the receptionist.  I showed her my Dr.’s note about having breathing problems where I cannot wear a mask.  The receptionist, after making considerable noise, canceled my appointment as a no-show.  Guess who is not going to be paid for my mileage to and from the facility.

I went to my car, called LHI Customer Service number 866-933-8387; the representative tried calling the facility.  After several hold sessions, she told me she would find me a provider who would work with me on the mask issue to complete the VA Contracted Compensation and Pension Appointment.  I never heard back from this representative.

Angry Wet Chicken 27-10 days later, I receive a call to reschedule an appointment spending more than 2 hours talking to the representative, who finally schedules me an appointment with another non-LHI provider in Phoenix for 10 May 2021.  I received a call from that provider confirming I have an appointment.  Yet, a bait and switch occurred, and my appointment was then rescheduled for the same provider, same LHI facility, and I attended this appointment.

0750, 10 May 2021 – I arrive early for the 0800 appointments.  The receptionist is belligerent when I walk through the door about me not being seen without a mask.  She further stipulated that since I can talk, I can wear a mask, and nothing I say will change that “medical opinion.”  She eventually tells me to call customer service and have them call her to relate treatment instructions.  She refused me a supervisor and then proceeded to make a bunch of calls, often holding her iPhone in one hand and the office phone in another.

While on the phone with Emily at LHI, at 33:35, into my call with the LHI customer service center, the Phoenix Police arrive.  The receptionist had called 911 and claimed, “I have a disruptive patient, who refuses to follow directions, is swearing, and throwing things, and refuses to leave the building.”  Officer Pacheco Badge #11039, Report # 21-725905, and his partner arrive, speak with the receptionist, who repeats her claim, then they talk to me.Apathy

I report I have not used swear words.  I have not thrown anything.  I have not been told to vacate the premises.  I have a medical condition that precludes me from wearing a mask, and I cannot physically wear a mask.  I show the officers my Dr.’s note to this effect.  The officer then turns to another patient who happened to have come in after me, and he confirms to the officer everything I said.  The worst language that the receptionist can truthfully claim that was used at her was “belligerent” and “snowflake.”  I will own the fact I called her belligerent and a snowflake.

Angry Grizzly BearThe officers go back to the receptionist, who two other people have now joined, names unknown, wearing scrubs presumably from the treatment rooms in the back.  They then make several calls.  Then one of the people asks if I can wear a mask but not over my nose.  I explain it is a breathing volume problem I have, and any mask hinders my volume of air per breath and makes breathing difficult.  The people behind the desk are seriously unhappy that my breathing problem does not have a name, a disease, or some identifying characteristic: the receptionist, the officers, and the people from the back return to a hushed conversation.  I am still on the phone with Emily and on hold while Emily is trying to contact the site.quote-mans-inhumanity

Finally, a decision is made, would I wear a face shield.  I claimed I have offered to wear a face shield twice and been told, face mask or nothing by the receptionist.  A nurse practitioner finally agrees if I wear a face shield, she will see me.  She then spent the next two hours complaining about me being an hour late to the appointment, her “very full schedule,” and how we had to “get this done quickly.”

Then, the nurse practitioner proceeds to lecture me twice about getting the vaccination for COVID-19 and how if I had the vaccination, they would be more comfortable with me not wearing a mask.  At no time, in the first or second interactions with the receptionist, did anyone ask me if I had received the vaccination.  I then finally left with a lecture about not being “anti-vax.” How she had no symptoms or post-injection problems, and how since I already have breathing problems, my comorbidity meant I should be seriously considering getting the vaccine.VA 3

I am not “Anti-Vax!”  I want my questions answered before I get the vaccine.  I want truthful information from peer-reviewed resources that I can reference and discuss with my primary care provider, neurologist, podiatrist, and other specialists who help me manage my health.  I want to know about drug interactions and the vaccine.  I need to know how this will affect diabetes because the experiences of Indians who are diabetic have been horrible!

I have no idea if the nurse practitioner did her job or just wasted my time.  What I do know is that LHI is about 100% useless in their customer service!  Failure to keep promises is the number one reason why trust is built or shattered.  Failure to carry through with what you promise is the second most common reason why trust is Bird of Preydestroyed in customer service.  Face-to-face providers need to be looking for solutions, not actively looking to inconvenience the customer.  100% of the medical profession IS customer service.  How the provider approaches the customer (patient) is the number one factor in how that patient will respond to treatment.

LHI, if you decide to respond, I will indeed include your response in a follow-on article.  However, at this moment, you have scored with the DMV as the worst possible example of customer service, and I hope you learn fast to care for the patient better!  I am fed up with your treatment, and change is mandatory; immediately!

© 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.