March 16 Veterans News

March 16 Veterans News

VetsHQ News UpdateLawmaker: Poor wording in VA bill hurt victims of Gulf War Illness (Military.com) A lawmaker on Tuesday suggested Congress may have to redraft part of the initial legislation authorizing the Veterans Affairs Department to grant claims compensation to Persian Gulf War veterans suffering from multi-symptom ailments that make up Gulf War Illness. Responding to testimony showing the VA has denied compensation to more than 90 percent of veterans claiming Gulf War Illness, Rep. Ann McLane Kuster, D-New Hampshire, said it was not Congress’ intent to require VA accept an undiagnosed multi-symptom disorder as a condition. “We created this Catch-22,” Kuster said during a joint hearing of the Disability Assistance and Memorial Affairs and Oversight and Investigations subcommittee. “It sounds like an unintended consequence of what we were trying to do to help Gulf War veterans … They had multi-symptoms and we didn’t have the science and the words” to properly describe what we wanted VA to do. Gulf War veterans and advocates say that 90 percent or more Gulf War veterans who apply for compensation for Gulf War Illness are turned down. VA officials say veterans filing claims for Gulf War Illness may still be compensated when a particular symptom or symptoms are diagnosed and service-connected. But the compensation would be for the chronic symptom — sinusitis or gastritis, for example — but not for Gulf War Illness. Congress in 1994 authorized the VA to compensate Gulf War vets suffering from a chronic disability resulting from an undiagnosed — or combination of undiagnosed illnesses — linked to service in the Gulf War. But the result, Kuster suggests, is that VA awards claims for Gulf War Illness when symptoms cannot be diagnosed. She suggested the committee could urge VA Secretary Bob McDonald to move toward a single Disability Benefits Questionnaire tailored for Gulf War Illness claims. There are currently about 70 individual DBQs, according to the VA. “But we may need to also unravel the Catch-22 we created in our attempt to help Gulf War veterans,” she said. Also during the hearing lawmakers said there is a need to extend the deadline by which Gulf War veterans need file claims for benefits for undiagnosed illnesses. The deadline period is currently Dec. 31, 2016, and lawmakers want it extended by five years. David R. McLenachen, VA Deputy Under Secretary for Disability Assistance, told the panels that McDonald has the authority to extend the deadline but was unable to say if that would happen. But Ron Brown, president of the National Gulf War Resource Center, told Military.com on Tuesday that McDonald already informed him the presumptive date would be pushed back. He said McDonald told him in a letter dated Feb. 9, 2015 that he also was concerned with the “end date” for filing. “We, once again, plan to use our existing regulatory authorities to extend the presumptive date beyond the current December 31, 2016, deadline,” McDonald wrote. “This is consistent with our beliefs, our policy and our past actions.” In 2011 then-VA Secretary Eric Shinseki used the same authority to extend the date — then about to lapse — to the end of 2016. Rick Weidman, Executive Director for Policy and Governmental Affairs for Vietnam Veterans of America, likened the VA’s treatment of Gulf War Veterans to that experienced by Vietnam veterans, who were told for years that that chronic health issues were not related to exposure to Agent Orange in Vietnam. He said VA forces Gulf War veterans to try to link their conditions to the war when “VA knows that you cannot pin down exact cause when you have a multi-toxin environment, which is exactly what you had with the Gulf War.” The VA has relied on work from the Institute of Medicine, or IOM, in deciding how to handle Gulf War Illness, and Weidman said IOM appears predisposed to seeing the illness as psychological. During a meeting last month the IOM Gulf War panel recommended no further research into Gulf War Illness, said Weidman, who attended the meeting. He said half the member panel, along with the chair, is made up of psychologists and psychiatrists and the other by research scientists. Weidman said IOM should be conducting an epidemiology study comparing Gulf War veterans in certain military occupational specialties with troops in the same job who did not deploy to the war, as well as civilians with no military background. Brown said there has been 20 years of studies, though he does not know if one suggested by Weidman has been carried out.

Read More: Gulf War Illness and Exposure

VA gets ‘F’ for Persian Gulf War claims approvals (Military Times)
The percent of disability claims approved by the Veterans Affairs Department for Persian Gulf War-related illnesses has declined steadily in the past five years, resulting in record lows, according to a new report from the advocacy group Veterans for Common Sense. In the first two quarters of fiscal 2015, VA denied nearly 82 percent of claims filed by Gulf War veterans for two main conditions presumed to be connected to their military service — chronic multi-symptom illness and undiagnosed illnesses. In 2011, the denial rate was 76 percent, Veterans for Common Sense director Anthony Hardie said. The low approval rates, which “approach the limited odds of winning a scratch-off lottery,” are a “complete contravention of 1998 laws passed to improve Gulf War veterans’ ability to have their claims approved,” Hardie wrote in testimony to two House Veterans’ Affairs subcommittees Tuesday. “If we measure VA’s success by how it has approved Gulf War veterans’ claims 25 years after the war, VA has failed most ill and suffering Gulf War veterans,” said Hardie, an Army veteran who served in the 1991 war as well as in Somalia. Nearly 700,000 U.S. service members deployed to the 1991 Gulf War, and 54,193 have filed disability claims for illnesses related to their service, according to a 2014 VA report. Roughly a fifth of those claims were granted, and of the denied claims 42 percent were approved for another condition other than a presumptive Gull War-related condition, according to VA. To qualify for disability compensation for Persian Gulf War-connected conditions, veterans must have developed one of a number of infectious diseases during their service or have undiagnosed chronic symptoms or a chronic disability that began either during service or after. Currently, the conditions must appear before Dec. 31, 2016, to an extent that they are at least 10 percent disabling, existed for at least six months and not be attributable to any other circumstance or cause for consideration. But during a joint hearing of the House Veterans’ Affairs oversight and investigations and the disability assistance and memorial affairs subcommittees, veterans advocates pressed for an extension of the year-end deadline as well as improvements to the claims approval process. Citing a recent report from the Institute of Medicine that found two conditions occurring in Vietnam veterans — bladder cancer and hypothyroidism — likely are linked to exposure to the defoliant Agent Orange more than 40 years ago, advocacy groups and members of Congress said the deadline should be extended for at least five years if not indefinitely. … A VA official said the department is taking the steps needed to extend the deadline but the process has not been finalized. Dave McLenachen, acting deputy undersecretary for disability assistance at VA, also said the department is working to improve claims processing for Gulf War veterans but its own internal reviews indicate a 90 percent accuracy rate for claims decisions. McLenachen added that VA has taken steps to improve and accelerate claims processing but he would return to his office to “see whether there was room for improvement.” … Rep. Mike Coffman, a Colorado Republican who served in the Persian Gulf War, pointed out that the claims process for Gulf War veterans warrants improvement since VA is failing to expedite claims designated as presumptive, a moniker that is supposed to accelerate the process, not delay it. “I am disappointed that the law was passed that a specific set of conditions is supposed to be presumptive and the VA does not appear to be following the law,” Coffman said.

Read More: Bladder Cancer, Hypothyroidism Link Veterans and Agent Orange

3 more Phoenix VA officials to be fired over wait-time scandal (Fox New)
Three more executives are being fired from the troubled Phoenix veterans hospital where a national scandal erupted two years ago over secret waiting lists and unnecessary deaths, the Department of Veterans Affairs said. Dr. Darren Deering, the hospital’s chief of staff; Lance Robinson, the hospital’s associate director; and Brad Curry, chief of health administration services, were all formally proposed for removal from the VA on Tuesday. The officials will be able to challenge their dismissals under VA rules. Robinson and Curry had recently returned to work at the VA after being placed on leave in May 2014 as the wait-time scandal emerged. Deputy VA Secretary Sloan Gibson said he was disappointed that it took so long for the executives to be removed, but said the firings should help VA “move past” the wait-time scandal that has consumed the agency for nearly two years. The high-profile Phoenix cases “have served as a distraction to the progress being made to improve the care we provide in Phoenix and across the nation,” Gibson said. “Today marks an important step in moving past the events of the past and refocusing solely on caring for our nation’s veterans.” Attempts to reach the executives or other officials at the Phoenix VA hospital were unsuccessful Tuesday evening. The removal of the three executives follows the 2014 firing of Sharon Helman, the hospital’s former director. Helman pleaded guilty last month to making false financial disclosures to the federal government about yearly gifts. Helman, who oversaw the Carl T. Hayden VA Medical Center in Phoenix from 2012 to 2014, was fired after whistleblowers disclosed to Congress that veterans seeking appointments faced delays of up to a year and as many as 40 veterans died while waiting for care. Subsequent investigations found that veterans faced chronic delays for treatment and that VA officials in Phoenix and throughout the country had created secret waiting lists and other falsified records to cover up the delays. The scandal affected tens of thousands of veterans and prompted an outcry in Congress that continues as lawmakers and agency leaders struggle over how to improve the VA. A 2014 overhaul approved by Congress and signed by President Barack Obama has alleviated some of the problems, but the VA acknowledges that many problems remain. Gibson said he was confident that the latest firings would be upheld on appeal. At least three previous firings or other disciplinary actions taken by the VA have been overturned in recent weeks.

New VA firing rules, health care options moving quickly (Military Times)
A massive veterans reform measure including new employment rules for senior officials and an overhaul of outside care programs could be on the Senate floor early next month, the chair of the chamber’s Veterans’ Affairs Committee said Tuesday. Sen. Johnny Isakson, R-Ga., said progress on the promised omnibus measure has picked up in recent days, and he is hopeful to have the package before House lawmakers with enough time for final passage before Memorial Day. While the legislation will include a host of changes requested by VA officials on program updates and improvements, Isakson called new accountability provisions the centerpiece of the effort. “I’m not someone who likes to fire people, but sometimes you have to,” he told VA Secretary Bob McDonald at a hearing Thursday. “I want to give you the ability to hire good people, but I want you also to be able to hold them accountable.” McDonald has requested changing employment rules for a host of department senior executives, allowing more flexible salary options and quicker hiring processes than federal rules allow. But they would also change disciplinary rules, allowing them to be fired more easily and limit appeals options to the secretary’s discretion. Lawmakers have offered support for the idea. Officials from the Senior Executive Association, which represents federal workers across a host of agencies, have voiced strong concerns. SEA officials released a survey of 236 current and former VA senior executives last week which panned the plans; two-thirds opposed the idea, and more than half thought the plans would scare individuals away from seeking VA jobs. But McDonald said the changes would “treat health care career executives more like their private-sector counterparts,” giving them “accountability policies comparable to those of the physicians and dentists they lead.” The proposed move comes after a series of high-profile failures by the department to discipline executives. Lawmakers have blamed a culture of corruption within the federal worker ranks for the problems, while workers’ advocates have blamed past congressional efforts at changing disciplinary laws for the difficulties. Members of Congress have also criticized VA for mistakes in standing up the new Choice Card program, designed to expand outside care options for veterans who face long wait times or long travels to see VA physicians. McDonald has asked for consolidation of a host of outside care programs, including the Choice Card efforts, to better coordinate external care for veterans with internal programs. Isakson hinted that lawmakers are supportive of that change. The issues of accountability and outside care were at the heart of the last major veterans reform measure, passed in summer 2014 at the height of the department’s patient wait time scandal. It was signed into law just days after McDonald was confirmed as head of the department. That measure has met mixed success, with billions set aside for hiring physicians and leases but uneven progress on department firings and coordination with private physicians. House officials have passed a series of more minor department reforms in recent months, and have said they hope to work with the Senate on including them in the larger package. Isakson’s counterpart — House Veterans’ Affairs Chairman Jeff Miller, R-Fla. — last week announced his decision not to run for re-election this fall, but getting the omnibus through his chamber is one of his remaining congressional goals.

Senate aims for VA Choice overhaul by May (Stars and Stripes)
The chairman of the Senate Committee on Veterans’ Affairs said Tuesday that he hopes Congress will pass an overhaul of the troubled Veterans Choice health care program by Memorial Day. Sen. Johnny Isakson, R-Ga., said his committee has helped hammer out legislation that will streamline the $10-billion program designed to provide private health care to veterans who cannot get timely appointments at Department of Veterans Affairs facilities and will send it to the Senate floor by April 1. The omnibus bill also makes changes allowing the VA to more easily fire health care executives guilty of wrongdoing. The Veterans Choice program was created by Congress in 2014 in the wake of the VA wait-time scandal and was designed to give veterans access to private health care providers if they could not get an appointment with the VA within 30 days or lived more than 40 miles from a VA facility. But veterans from across the country have since complained the Veterans Choice program is actually creating more frustration and delays in care, despite its intended purpose of easing such problems, according to lawmakers. “We are on the cusp — we are not there yet — but we are on the cusp of being able to bring to the floor of the United States Senate a major comprehensive omnibus veterans bill, get it passed through the Senate, get it to the House [and] find out where, if any, we have places of disagreement, and then get it to the president’s desk for signature,” Isakson said during a committee hearing. Isakson said he has been conferring closely with the White House on the progress of the VA legislation and that a finalized bill could be possible in May. “We can by Memorial Day have a signing ceremony somewhere to let our veterans know we do want accountability in the VA, we do want Choice to work.” VA Secretary Bob McDonald said Tuesday that reform of the Choice program is one of the department’s top priorities for the year and that it supports the Senate effort. “This needs to get done — and it can get done in this Congress — to ensure a strong foundation for veterans access to community care,” McDonald said. The bill has yet to be introduced but was negotiated by Veterans’ Affairs Committee member Sen. Jon Tester, D-Mont., and Sen. Richard Burr, R-N.C. It would reform how veterans are given appointments with private providers outside of the VA’s nationwide health care system and would create new requirements on how those facilities and doctors are reimbursed. Burr said the many “confusing” VA programs that now manage outside care would be consolidated into a single, simplified system that will be used nationwide to solve the delays in care and payments. In one instance, a veteran in North Carolina waited for more than a year to receive a VA referral for a spine specialist and when scheduling a second appointment was told the doctor stopped caring for veterans because the VA did not provide timely reimbursements, he said. “This is just one example of thousands and the reason I introduced the Veterans Choice Improvement Act,” Burr said.

Most VA senior executives pick job security over better pay (Government Executive)
Most senior executives at the Veterans Affairs Department don’t support moving the corps out of Title 5, even if it means better pay, according to a new survey. Sixty-four percent of respondents to a survey by the Senior Executives Association said they don’t agree with the VA’s proposal to move the department’s roughly 350 career senior executives from Title 5 to Title 38 as a way to ease SES hiring and firing. VA Secretary Bob McDonald and his top deputies have said that moving the SES corps into Title 38 will give them more authority to expedite hiring and offer higher pay to better compete with the private sector for top talent. But it also gives them more leeway to fire top career officials accused of wrongdoing. If senior executives are taken out of Title 5 and moved into Title 38 under the VA’s proposal, they would lose their rights to appeal disciplinary actions against them, such as removal, to the independent Merit Systems Protection Board. Instead, their appeals would be handled internally at the VA. … The SEA survey included responses from 236 senior executives at the VA—roughly 67 percent of the total SES corps at the department. SEA plans to release the full results of the survey before a Tuesday afternoon Senate hearing with McDonald to discuss the Title 38 proposal. The department appears to be distancing itself from the draft proposal on Title 38. VA spokesman Henry Huntley on Tuesday, in response to questions sent on March 7 from Government Executive, said that the VA doesn’t intend to take all the department’s senior executives out of Title 5, and that the draft proposal was “an idea that result[ed] from internal collaborative discussions,” and was not a department or Obama administration proposal. He added that “mobility of executives into and out of VA was one of the factors considered following some of the initial idea discussions.” Asked about SEA’s survey, and VA senior executives’ negative response to it, Huntley said the department’s “most recent efforts to seek to expand the current Title 38 hiring authority [apply] only to medical center director, network director, [and] other specified health care executive positions.” The “majority” of the VA’s senior executives would remain in Title 5, Huntley said. Among the survey’s other findings, 69 percent of the respondents don’t believe the proposal would improve services and care for veterans, while 59 percent don’t think it will help with retaining talented senior executives. Respondents cited frustration with Congress and VA leadership, as well as a fear of unfair media and congressional scrutiny as the top reasons they’d consider leaving the federal government. About a one-third said the attraction of the private sector wouldn’t sway them from leaving federal service, according to preliminary survey results. “Executives are leaving VA not because we don’t earn enough money, but because of the environment of fear that has been created,” said one respondent. The VA already is having a hard time recruiting and retaining top employees in hard-to-fill jobs. According to the draft Title 38 proposal, as of late January, nearly 30 percent of the department’s SES slots were vacant, while 70 percent of the current corps is “eligible to retire immediately or will become eligible this year.” The House Veterans’ Affairs Committee on Wednesday will hold a hearing on draft legislation to improve recruitment and retention of doctors and other employees at the VA.

New commissioner of Kentucky VA named (Virginian-Pilot)
Retired Brigadier Gen. Norman E. Arflack has been appointed commissioner of the Kentucky Department of Veterans Affairs. Kentucky Gov. Matt Bevin made the announcement in a release on Tuesday. Bevin says the state’s veterans “will benefit greatly from his four decades of service in the military, the Kentucky National Guard, and state government.” Bevin says Heather French Henry has agreed to serve as deputy commissioner. Arflack rose to the rank of Brigadier General after four decades in the Kentucky National Guard. He has also served as executive director of the National Guard Association of Kentucky and as member and vice chair of the Board of Directors of the National Guard Association of the United States. Arflack served in the Kentucky State Police for more than two decades.

New director appointed for Oklahoma City VA Health Care System (News OK)
Kristopher “Wade” Vlosich has been appointed to serve as the new director of the Oklahoma City VA Health Care System. Vlosich, who will assume his new duties in May, is coming to Oklahoma City from Columbia, Mo., where he held the same position at another veterans’ hospital. Vlosich will be taking over administration of one of two Oklahoma veterans’ hospitals that have been the objects of numerous complaints, including documented cases of poor care and questionable management that have been written about in USA Today and The Oklahoman. Sloan Gibson, deputy secretary of the U.S. Department of Veterans Affairs, announced Vlosich’s appointment Friday afternoon at a news conference in Oklahoma City. Joining Gibson for the announcement were U.S. Sens. Jim Inhofe and James Lankford, who have been highly critical of the way Oklahoma VA hospitals have served this state’s veterans in recent months. Both senators took a more conciliatory approach Friday. … Both senators said their offices have been inundated with complaints about an assortment of veterans’ issues. Inhofe and one of his staff members said they have received about 1,000 complaints about Oklahoma VA hospitals within the last 13 months, with about 600 complaints centered on the VA hospital in Muskogee and 400 directed at the hospital in Oklahoma City. Gibson said he believes veterans’ hospitals deliver great health care “the vast majority of the time,” but more needs to be done. … Gibson said VA officials are working to get call centers installed and properly staffed at every veterans’ hospital so veterans can get answers to their questions. … On a more positive note, Gibson said the quality of care delivered at the Oklahoma City VA hospital compares extremely favorably with other VA hospitals across the country in such key measures as length of hospital stays, mortality rates, mental health wait times and readmission rates for neurology, cardiology and congestive heart failure patients. Gibson said the Oklahoma City VA hospital increased staffing by 15 percent (238 full time equivalent positions) over the past two years. The Oklahoma VA medical center is one of the largest in the country, serving more than 61,000 veterans with an operating budget of $460 million.

Former VA secretary defends slow shift from legacy health record system (Bloomberg BNA)
A former head of the VA is standing behind the agency amid criticism by Congress over its information technology infrastructure. House lawmakers are pressing the VA to adopt a commercial electronic health record and complete its long-standing effort to integrate its EHR system with the DOD’s record system. Lawmakers are concerned that the Department of Veterans Affairs is continuing to develop its own proprietary EHR system and appointment scheduling service while the Department of Defense is moving toward adopting more private sector-built technologies, a spokeswoman for Rep. William Hurd (R-Texas) told me. VA officials are on the Hill today to be questioned by Hurd and other members of House Oversight and Government Reform Committee. The agency has struggled to overhaul its EHR system, the Veterans Health Information Systems and Technology Architecture (VISTA), largely because it’s deployed across a massive health system, which covers 8.92 million enrollees and operates more than 150 hospitals, R. James Nicholson, former secretary of the VA, told me. VISTA, which has been in operation for more than 20 years, still has advocates in VA, who want to see the system either maintained or upgraded rather than replaced, Nicholson said. “It has its fans and its legacy lovers, doctors and nurses who have been using it and the people who have made a living on keeping it around,” he said. While there is support for VISTA within the agency, the VA recently hinted it might seek a private sector EHR to replace it. Nicholson said he agrees it is time to replace the system. The agency in 2015 started a major overhaul of the agency’s IT procurement and development systems, VA officials said in October. Part of that overhaul is a “buy-first” strategy that will rely on using existing commercial technologies before building home-grown systems.

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