Tuesday, May 20, 2014

Reform School, Redux

 Productivity is getting
higher and higher oh, oh, yeah

But profitability is getting

tighter and tighter oh, oh, yeah

--Think Visual
, The Kinks

Maybe you haven't been keeping up on current events,

but we just got our asses kicked, pal

--Aliens (1978)

Status quo, you know,

is Latin for "the mess we're in"

--Ronald Reagan


{This is a re-post from 14 MAR 2009 @ RangerAgainstWar.}

DAV Magazine
reports this month, ""New VA Secretary Pledges Reforms." That the new Veterans Administration Secretary Shinseki "pledges reforms" does not fill Ranger with HOPE for CHANGE.

The dictionary defines "reform" as "a change from worse to better," "to amend by removing faults and abuses"; "an improvement via alteration." And just how, you may ask, will the VA accomplish this rectification?

It seems the VA, with the appointment of Shinseki --
the fourth consecutive U.S. military graduate to head the VA -- is hoping to hit a roving banker quinella. If these previous heads were so crackerjack, why does the DVA need reform? Since the previous appointments failed so spectacularly, one can see why they might think the fourth time will be the charm.

The VA has a
"dire backlog of 840,000 unprocessed disability claims" seven years into our elective wars. Shinseki, who is being touted as a maverick who spoke truth to power and was "unceremoniously ushered in retirement," is their magic elixir to turn things around.

Ranger wonders if any DVA Secretary has ever gone into a VA Outpatient Clinic for a medical appointment? Has Shinseki ever used the VA health care system?

Not to attack the man, but Shinseki did not oppose the phony and aggressive wars of invasion.
He simply did what a General does -- requested more troops, which probably would have contributed to that many more wounded and disabled veterans. To have opposed the war would have been an actually maverick and courageous stance.

Shinseki, like the rest of the officer corps (until they retire, that is) supported the illegal invasions, yet now he is being hailed as a role model.

He is no maverick. He is No. 4.


NOTE [20 MAY 2014]:

Five years ago, everyone was cheering on the appointment of Shinseki. However, neither Ranger nor his buddy "Minstrel Boy" were among the cheering squad, the latter of whose unedited comments we append below --
Blogger The Minstrel Boy said...
there's a long, long, list of veteran's issues. many attribute the fall of rome to the generals of great personal wealth, like gaius marius, pompey magnus, crassus, and, after gaul and egypt, ceasar. the changing of the makeup of the legions during the 2nd and 3rd punic wars meant that many of the provincials, many of the urban poor, flocked to the standards when the property requirement for service was removed. many times, like during the years of hannibal running amok on the italian peninsula there would be promises of settlement in conquered land, or on public lands. with marius, pompey, and ceasar, when the state failed to compensate its veterans by keeping even a fraction of the promises they used their personal wealth to make good on those broken vows.

the upshot was that rome ended up with a military that held allegiance to a general, an admiral, or ship captain. they knew where the funds rolled from. this, in turn, led to many civil wars. for bloody conflict in the ancient world, it is impossible to be roman legions against roman legions. parnassus where caesar and pompey clashed was like a roman antietem. 5 hours of fighting and an ocean of roman blood.

after every u.s. war, one of the first orders of business in washington is to try and "move on" and find some way to forget the folks who fought for them. one of the few times that wasn't bordering on the criminal was after ww2. eisenhower knew what his soldiers and other men sacrificed and he would not allow things like the g.i. bill to be dismantled. it took reagan to do that. eisenhower made war, reagan made war movies. yet, they both had war stories. thing was, because his fighting front was in hollywood, reagan loved to tell his war stories.

when i was wounded for the last time, i was struck by how uncomfortable the sight of me was for my old buddies. the guys at silver strand training to go over there certainly didn't walk to look the fact that the shit's dangerous in the eye. i'm sure that even well intentioned soldiers feel that way.

when max cleland was in charge of the v.a. there was some progress made. max has a full and clear personal perspective on that system. absent a maimed or wounded vet who has dealt with that monolithic structure, how about nominating a doctor, or primary care giver?

i've met many doctors in the v.a. system who feel as obstructed and unable to do the work of healing as the patients they try bravely to bring care to. why not one of them?

rather than somebody with five rows of REMF ribbons on their chest, how about somebody who walks with a permanent limp, or needs a cane, crutches or chair?


  1. I for one am not going to join the wolfpack that is howling after Shinseki's blood. Not until we find out more, as it is after all an election year. It would be great to know the true story, but we won't get it from the media. Journalism no longer exists. My favorite radio fatman is claiming Shinseki set up death panels at the VA.

    Congress is now getting into their clown suit act. I for one hold them responsible as they are the ones who underfunded the VA. But you won't find that morsel on your TV news (oops I meant entertainment) show.

    The bigger scandal at VA is their doctors' over-prescribing of opioid painkillers to TBI, PTSD, and lower back injury patients. But that crime is not unique to the VA as the various service hospitals are just as guilty. We learned a lesson back 70 years ago from the overuse of morphine during and just after WW2. Unfortunately thew military medical community has forgotten it or seems to.

  2. I throw my hat in with mike. In 2002, when GWB and Congress decided to begin the endless war, they should have anticipated an increased demand for Veteran medical care and started priming the funding and provider pump. When Rummy decided he could pass the cost of disabled troops off to the VA, rather than in house, he should have been sacked. Our elected officials have been reactive, not proactive on this.

    And, I will also throw some stones at my fellow veterans. It has long been promoted amongst VN helicopter crew members to chase after a partial disability for hearing loss or tinitus, the latter being a significant drain on VA staff time. Can't tell you how many forum posts I've seen on how to "beat the system". And when Congress eliminated the offset, the guys went wild for their piece of the pie. Administrative staff being diverted from serious shit to cater to vets' wallets.

    Or my right wing friend who has Medicare, TRICARE For Life (reserve retiree) and a free Medicare supplement policy as a retirement benefit from his civilian employer and still regularly uses a VA hospital to monitor a minor knee injury he was able to have identified as service connected "because he earned it". One less really needy vet waiting in line behind someone with other taxpayer paid resources to receive civilian care at no expense to himself.

  3. My point is that Shinseki was not and will not be a miracle worker,nor will anyone, even when trumpeted by the professional veteran organizations.
    The weakness of the system is that we have category of vets and we are forced to compete for our piece of the pie.Mike is right -we have limited funds therefore we must create categories and different levels of benefits.It is a matter of funding, and is affected by attitudes.
    The fact is =our funding will never be adequate. Look at the 100% compensation,or the DIC? Are these adequate ?
    I say again, it's not the VA, but the entire system that is corrupt. We need national health care,not crummy insurance ponzi schemes.
    Another major problem is the adversarial relationship with the system when embarking on disability claims.
    Well guys,
    have a nice day.

  4. We need national health care,not crummy insurance ponzi schemes.

    Now you have addressed the heart of the matter. The VA is effectively a fixed budget medical system for those who prove eligibility. Not all veterans are eligible, and not all veteran health needs qualify. Too much time and effort is expended on who and what can be treated by the limited resources made available.

    it's not the VA, but the entire system that is corrupt.

    I would suggest that there is no "system", jim, just a series of disconnected entities delivering a similar product/service. Health care in the US is no more a "system" than fast food restaurants.

  5. Al,
    I take your point on disconnected entities.
    Now to your original cmt on tinnitis and hearing loss, specifically on gaming the system.
    The DVA has been in business for a long time, much longer than the ringing and buzzing in my ears, brain or head.Why should vets have to game the system, unless that's how the system is set up? Why not simple ETS exams that cover the topic? After all hearing injuries are common and are right behind mental issues for battlefield connected disability claims.
    Either you have it or you don't. It's service connected or it isn't.
    That's pretty simple.
    Tinnitis is a major cause of impotence,depression and suicide, and the DVA awards 5% per ear. It's a joke to award 10% for severe bilateral affliction.
    Why not a presumption of service connection for pilots /combat arms folks? Our ears are usually damaged early on in our service.
    I don't write the rules, but i see the results of the game.
    Except it ain't a game, it's our lives.

  6. jim

    The first step in all medical care in the US is a wallet biopsy. At the local doctor's office, it's acceptable insurance or proof of ability to pay. At the VA, it's proof of administrative eligibility for the VA to pay for it. Simply presenting a human being with medical needs is insufficient. That is what is corrupt.

    The tinnitus I was referring to was late onset tinnitus. Guys who flew for 3 - 4 years and 35 - 40 years later get a ringing in their ears and want a disability. And the "gaming of the system" is a long list of truthful answers NEVER TO GIVE, along with false answer to ALWAYS GIVE. And I have heartburn with that, and dropped out of a vets' forum because of it. Presumption of service connection is tenuous at best.

    Either give all vets TRICARE or full VA care without question, or live with the bitching, moaning and/or outrages that arise. The vet population is way too large to effectively and expeditiously screen each and every ailment for service connection. Hell, employers would be hiring vets hand over fist to avoid having to pay for their share of medical insurance.

  7. The system is irrational at best. Take the case of the guy I mentioned above with the minor knee problem. A few yeaqrs years ago, he decided to try for a disability, as his private orthopedic dr told him that it appeared that an old, traumatic injury contributed to his aging related problems. The guy had indeed injured the knee while in OCS. So he applies for a VA disability. That means the VA has to get his medical records from the Army and document the injury. Nothing in his records, as according to the guy, they simply wrapped him in Ace bandages and put him on light duty until the pain went away. So he tracks down "eye witnesses" to the injury from his OCS class. VA considers the eye witness statements and grants "service connected" status and schedules the guy for an orthopedic exam. Results are a disability rated at 0%, but eligibility for free VA care for the knee, up to and including surgery, when ultimately deemed medically necessary. The rest of his body is currently ineligible for VA care.

    So, every 90 days, he goes to the VA hospital to get the same injections in his knee as his TRICARE For Life was paying a civilian doc to do. Why? Because, 1) he "earned it", and 2) increases the probability of a paying disability if things get worse and surgery won't totally cure it - even though the VA orthopedic guy says that probability is microscopic, as surgery for this specific problem, when finally deemed "necessary" by the VA, generally provides a more than sufficient fix. Meanwhile, TFL would probably pay for the surgery now and put it all to rest.

    I realize that this is anecdotal, but it does illustrate the irrational nature of US health care. I say "US", as similar single malady eligibility exists in the private insurance sector.

  8. Al,
    The benefit of the doubt must go to the veteran in adjudication.
    I believe we should have universal health care ,BUT,if that happens then the services lose a major recruiting tool.
    I also wonder why we give dependents health care .
    My brother died in 1944 when my father was on a combat patrol in the Atlantic. My family had no gov't provided health care that i ever heard about.
    My concern is that the American way of war is so disjointed.
    In the GWHB war there were estimates of 30-35,000 US casualties ,but yet we went to war(so to speak),and we both know that the system woundn't and couldn't handle such mass casualties. We also in GHWB and GWB's wars executed the wars on wishes and prayers that chem/bio would not be employed. My point is that we play fast and loose with our 'WARRIORS' lives both before and after .
    I know i'm preaching to the choir, but somebody other than us'ns need to hear this stuff.

  9. jim

    I have no issue with the guy getting his knee treated. What is irrational is that it is only the knee that the VA will treat. He comes down with pneumonia or breaks his arm, and it has to be treated in a non-VA facility under his other insurance.

    It's a sad state of affairs if "free health care" is needed to recruit. Thus, a person who is already disabled is discriminated against?

    Yes, NHC is the only rational solution, but you have a $3.8 trillion industry that sure as hell doesn't want that.

  10. Just a couple of quick comments.

    1. I'm not sure who's supposed to be "hailing (Shinseki) as a hero". Everybody who didn't have a hard-on for war back in 2003 pretty much gave him some props for telling the truth about Iraq. That was pretty much it. At the time I was still in and pretty much everybody in uniform I knew hated the poor fuck not for anything to do with the war but because he'd put everyone in the damned black beanie.

    2. Pinching pennies on old soldiers is...well, as old as soldiers. Some time in the 1600s an veteran of the English Civil War wrote out a little doggeral that goes:

    "In time of danger or in War
    God and the Soldier we adore
    Danger pass'd and all things righted
    God is forgotten and the Soldier slighted."

    3. Did I ever mention how much I loathe "Mallard Fillmore"? Okay, well, hoist Rush Limbaugh on a pile made of Karl Rove, Anne Coulter, and Michelle Malkin, pour oil on the pile made from fat rendered from Glenn Beck and I'd use a crumpled up "Mallard Fillmore" cartoon to set a match to light it. It takes some balls for the guy who draws "Mallard Fillmore" to slag off on the VA as being a boondoggle since the guy who draws "Mallard Fillmore" seems to think that ALL government is a boondoggle based on what he says in his comic. If he was being genuine rather than a hack for wingnut talking points he'd show his concept of "providing for disabled veterans" as a hand emerging from a limo to shower some largesse on the homeless GI crouching at the top of the off-ramp in the rain.

    Using a "Mallard Fillmore" cartoon to illustrate a post about a government agency or subsidized health care is like using a Palestinian oompah band to play at the opening of a B'nai B'rith convention.

    Other than that, what Al said.

  11. Granted, it was 20 years ago, but during my retirement outprocessing, a guy was going through my medical records while another guy was dealing with something else . I wasn't sure what he was up to at first, and he was filling out forms as he did so. When I finished with what I was doing with the first guy, the fellow going through my medical records introduced himself as a "Veterans' Advocate" from the VFW or some similar organization. Said he was screening my records for any and all bases for a disability claim, and found four "possibles". I pointed out that 6 months earlier, I had passed a flight physical with flying colors. He said it doesn't hurt "to be on record".

    I'll just delve into two of the possibles, degenerative arthritis in my ankles, and a shoulder separation in 1964. 10 years earlier, the orthopedic folks at West Point had diagnosed it and recommended biannual follow ups for possible profile. Three years before retiring, I was put on profile (no high impact activities) to prevent aggravating the issue. Broke my heart not to be able to participate in running activities. Wish I had been profiles out of sit-ups, however. Other than very occasional twinges of pain, no big deal, nor did it ever affect my flying status. VFW rep says, "If you were profiled, you could build a case that years of running and PT tests accelerated the damage and thus it would be service related. After all, the Army told you to stop running, so there's a case to be made."

    The shoulder separation was mentioned in my pre-graduation from flight school flight physical in the medical questionaire in the "Have you ever been treated in a hospital" section. The USMC record of it was, of course, not in my Army records. "Hey, this is definitely training related, and you never know if you will someday have problems."

    The other three "possibles" were equally tenuous. All four were issues that were not debilitating and/or could be addressed by either TRICARE or the wife's corporate retirement health plan in later years, if necessary. Indeed, 7 years after retiring, one ankle was surgically addressed at a total cost of $100 out of pocket, and the ankle is almost good as new, as predicted by the West Point docs.

    Point is, here's a guy who's sole purpose was to get retiring and ETSing troops to file as many claims as possible. In my case, three different medical specialties would have to review my claims and then schedule evals if found appropriate. I turned down his offer, but have since wondered how much of the VA backlog is fishing expeditions, while the [b]truly needy[/b] wait on those same long lines. Thing is, the VA is required to accept and evaluate any and all claims, regardless of merit. If there are still folks like the guy I met at Ft Lewis out there, then the beat goes on.

  12. Chief, I'm with you re, Fillmore, as I am against any loathsome and hypocritical opportunist. His cartoons are never reads of mine, and I do not know how I even came into possession of this one. (Probably someone passed it to me from our very poor local paper, which runs pretty poor wire and graphics, overall. We are, after all, FLA's capital city, and the home of hypocritical politicos galore -- for two months of the year.)

    That said, I hope you know that I often use quotations and/or graphics for satirical effect. For example, I sometimes quote biblical verse, usually ironically and as suits my purposes (as most people use it.) However, I have gotten some very sincere Christers following me as a result, not seeing my irony.

  13. Lisa, you gotta love sincere followers.

    Does ironic irony cancel itself out?

  14. I do love the believers, Ael, and have thoughts to that effect swimming in my mind. I should write them.

    I would never think to castigate people for their beliefs, for that is paternal and elitist, and always leaves a bad taste in the mouth.

    I do, however, love the idea of ironic irony being a zed :)

  15. Al,
    I wasn't gonna write about my experiences with the DVA, but i will since you started the ball rolling.
    My experience is today, not years ago. My spinal injuries are SC and parachute related. Documented to 1970's injuries,and FORTUNATELY i had sick slips to verify my injuries.
    As an aside my loss of my left testicle was dicey to prove since the 24th evac burned their files upon their return to conus.
    As a SF guy i was treated in Long Binh and returned to my unit WITHOUT 1 shred of documentation. I was too young and dumb to realize how screwed this was.
    Anyway, back to today. I used to get treatment for my spine and it was for 1 year periods. Doctor documentation required EVERY time.Ok fair enuf,but now it's done every 3 months and the authorization is weeks old BEFORE we get it for action.Also it's been cut drastically to 1 treatment per month and it used to be as needed.
    Now for the treatment. It's a chiro appt with 30 minutes of massage, with NO ultra sound or wet heat applied. It's a joke.
    My injury is valid/SC and my treatment is pathetic.Every 3 months my fee basis Doctor/chiro must write a letter of justification for the fee basis service.
    Does anyone think my back and testicular area pains are gonna get better?
    I reckon i'm not hallucinating but my nuts and back are hurting as i write.

  16. jim

    You are dealing with a program that is "entitlement based" but given fixed resources. Thus, as demand grows, resources are just spread thinner. So the incentive is to reduce the number of people "entitled" or simply give them less treatment and/or longer waits.

    But we Americans don't like "entitlement programs" and all too many think we should run government like a business. Thing is, if Apple hasn't the resources to build enough iPhones to meet demand, they don't sell half iPhones to make it look like they are meeting demand. And, if Apple runs out of iPhones, no one suffers.

    Funny thing is that it is high camp to make public pronouncements of how much Americans love and "appreciate" veterans. However, if veterans' care were taken out of the fixed budget, put on an actual "entitlement" basis and a VetCare surtax were added every Apr 15th, to fully fund complete and comprehensive care to our Vets, how many "I Support" bumper stickers would disappear to be replaced by an outrage?

  17. Al,
    That makes my back feel better.

  18. I figured it would. Hang in there buddy. I'm with ya. Medical care in the US is an outrage, and not just at the VA. As you described it, "an insurance ponzi scheme". No coherent policy or plan to improve delivery, just more payment schemes for an already over priced industry.

    Ain't gonna get better until it collapses of its own weight and we have to start all over. Meanwhile, the pain will still increase. WASF.

  19. Aviator,
    I've had surgery at the DVA twice, or twisest as we say in the south and both were contract Doctors. Once from UAB Med school and once from Shands. This was a go,BUT i'd NEVER allow a DVA doctor to cut on my body.
    I use the Mayo clinic in JAX as a matter of course.