VA Issues, Part IV: Some of this Sh*t Just Doesn’t Make Sense

(Part 4 of a series. Part 1 can be found here; part 2, here; part 3, here.)

Another issue with the VA is the fact that some of what the VA does simply doesn’t pass the “common sense” test.

No, I’m not talking about rating decisions gone awry, or bad medical care. I’m not talking about delayed or denied educational assistance, or secret waiting lists. I’m not talking about the fact that the VA – not DoD – defines who is and is not a POW for VA benefits purposes (and gives out former POW benefits to far more individuals than were ever legitimate POWs). I’m not talking about the fact that the VA does an execrable job of front-end screening for fraud, and lets fakes draw benefits they don’t actually deserve.

I’m talking about the fact that some of the benefits the VA provides – and the policies that govern them – simply don’t pass anything remotely resembling a common sense test.

I’ll give six examples; they’ll probably p!ss some people off. So be it. I could probably come up with at least that many more without trying too hard.

Example One: Veterans and Survivors Pensions

The first example is that of Veteran and Survivor Pensions. These are relatively modest tax-free payments provided to qualifying veterans and their survivors.

The intent is to provide an income supplement to ensure a poverty-level (e.g., subsistence) living.  Eligibility criteria thus includes means testing, so in that respect it there is some sanity.  And in this case (and unlike SNAP, aka food stamps), the means testing indeed appears to be more than a joke.

But the rest of the eligibility criteria really make me shake my head and mumble, “WTF?”.

Full eligibility criteria are found here. Here’s the short version (criteria below are for the Veterans pension, but those for the Survivor’s pension are essentially the same, except that a surviving spouse must not have remarried and neither a surviving spouse or dependent child need be 65):

• The veteran must have served 90 days or more on active duty (entry on active duty prior to 7 Sep 1980) or two years (or the first term of active duty to which called, if shorter), at least one day of which occurred during a defined wartime period;
• The veteran must be
  o   Age 65 or older, OR
  o   Totally and permanently disabled, OR
  o   A patient in a nursing home receiving skilled nursing care, OR
  o   Receiving Social Security Disability Insurance, OR
  o   Receiving Supplemental Security Income
• The veteran’s (or survivors’) family income must meet statutory limits.

That’s essentially it. If someone served one freaking day during wartime – regardless of where, or what they did – they qualify if/when they’re old or disabled and indigent. So do their survivors if they cash in their chips early.

This yields the following absolutely absurd hypothetical scenario.

Two friends graduate from high school in June 1974. After trying to find employment for about 9 months (1974-75 was a pretty tough time, economically), each enlists in the US Army under a delayed entry program option.

The first guy gets a report date to basic on Monday, 5 May 1975. The second (different MOS) receives orders to a different basic training class starting 1 week later – on Monday, 12 May 1975.

Both serve their active duty time in CONUS. The first gets out after six months on a hardship discharge due to a family tragedy. The second serves for 9 years, getting out in 1984. Neither gets hurt while serving, and neither files a VA claim when they get out.

The first guy serves at Fort Hood. The second guy serves at Forts Stewart and Bragg – and deploys to Grenada during Urgent Fury. Both receive honorable discharges.

Per the VA’s stated criteria, the first guy is eligible for a needs-based Veterans Pension (his survivors are similarly eligible for a Survivors Pension, if he dies early). The second vet and his survivors? Um, no.

Why? Because they went on active duty 1 week apart, based on the needs of the Army. The first guy served for 3 days during the recognized Vietnam War period (which ended 7 May 1975). The second guy served 18 times as long, and served in Grenada – but technically has no service during a “defined wartime period.“ (Service in Grenada in 1983 is not defined as serving “during a wartime period” by the VA.)  So for him and his dependents – nada.

Yeah, that makes one helluva lot of sense, doesn’t it?

Veterans and survivors pensions to me make no sense period. Unless a vet has a service connected disability, in my book Uncle Sam doesn’t owe them or their survivors squat simply because they are old and/or indigent; they’re not retirees. They served, then chose not to make the military a career.  If they’re seriously disabled they should presumably be eligible for Social Security Disability.

Frankly, this looks more like a welfare payment by another name to me than anything else. YMMV.

Example Two: Copayment Waivers

Here’s a second VA benefit-related policy that makes me scratch my head bigtime.

For many, the VA will treat non-service connected medical conditions. That makes me scratch my head in two ways.

First: why is the VA treating non-service-connected conditions at all for veterans who are not 100% disabled or in some defined group that receives enhanced or presumptive benefits? (More about that later.) And second: why do they charge some vets copayments for such treatment and not others?

Here’s today’s reality: the VA groups vets into various “priority groups” regarding medical treatment (rules for dental care are very different, and I’m not addressing dental). Those groups are listed here – along with the business rules of who pays a copayment for non-service-connected care and who doesn’t. Both the groups and the business rules are rather are complex (some would say convoluted), and I won’t attempt a detailed explanation of those policies here. If you’re interested, follow the link and read the table. If you’re a vet with a VA disability rating and ever use VA medical care, you also might want to download and keep a copy of that priority group chart.

Now, I can understand why no co-payment is charged for service connected conditions. That’s one of the VA’s primary reasons to exist – to provide medical care for those conditions a vet incurred or aggravated while serving this country, and which still require treatment. Morally a vet has a right to expect that.

I can also see why copayments are waived for those rated at 100% disabled – although even in those cases, one can make an argument for applying means-testing and charging those who can afford to pay.  (I don’t necessarily agree, but the argument can be made and has some logical validity.) Ditto for ex-POWs (those recognized by DoD, anyway); those legitimately rated as permanently and completely disabled for non-service-connected reasons; and those other defined groups receiving enhanced or presumptive benefits (though the declaration of “military sexual trauma” as such a special group seems to me more due to politics than legitimate reasons).

But why do vets with disabilities rated at 50% to 90% get a waiver, while vets rated between 0%(but with one or more service-connected conditions) and 40% get means-tested to see whether or not they pay copayments for treatment of non-service-connected disabilities? What’s magic about the number 50%?  Why isn’t anyone below 100% subject to the means test?

A fair number of people rated by the VA at 50% disabled or more indeed work full-time, or have substantial other sources of income. Many work for employers that offer medical insurance, or in jobs that pay well – or both. Why should they get copayment waivers for non-service-connected care, when one of their fellow vets that simply happens to have a lower disability rating (and perhaps a much lower-paying job as well) doesn’t get the same deal?

There are some other odd things regarding copayments and waivers for non-service-connected conditions. Let’s just say that much about the area of copayments and waivers for non-service-connected conditions IMO doesn’t seem to pass the common-sense test.

Example Three: Non-Service Connected Care

A related question comes to mind: other than those who are ex-POWs, 100% disabled, and other defined groups getting enhanced or presumptive benefits – why is the VA providing non-service connected medical care at all?

As I said previously, one of the main reasons the VA exists is to provide medical care for those conditions a vet incurred or aggravated while serving this country, and which still require treatment. So providing medical care for any service-connected medical condition – even if it’s a non-disabling, 0% condition – is IMO legit.

But non-service-connected conditions are, by definition, not related in any way to military service. They were not caused or aggravated by military service. Ergo, they would exist whether or not the individual ever served in the military. So why in the world is Uncle Sugar providing medical care (and often, free medical care) for such conditions at all to anyone who’s not 100% disabled, an ex-POW, or in a defined group receiving enhanced or presumptive benefits?

I wish someone could explain that one to me. I just don’t “get it”.

Example Four: “Blanket” Medical Care for Recent Combat Vets

Here’s another benefit that I don’t quite “get” – this time courtesy of Congress.  Today, veterans “who have served in a theater of combat operations after November 11, 1998, and have been discharged under other than dishonorable conditions” are entitled to VA medical care for 5 years after discharge. Period. NQA.

It doesn’t matter if the vet got hurt or not, or actually served in combat – or were even ever personally at risk. It doesn’t even require good conduct or honorable service. All that’s required is serving “in a theater of combat operations” for some period of time.

Here’s a scenario for you.  Picture a guy or gal who (1) was deployed to Qatar or Bahrain, or served afloat in the Persian Gulf; (2) never was hurt or saw combat; (3) went downtown one day and got high as a kite on khat/meth/whatever, or drunk as hell; (4) came back to base/ship, assaulted their CO or NCO, and was facing court-martial; and (5) got thrown out on their ass with an OTH or BCD.  That individual is still freaking eligible for 5 years VA care if they can document service in-theater.

Why? Because the individual did not get a Dishonorable Discharge, and served “in a theater of combat operations” after 11 November 1998.  That’s why.

Frankly, I don’t see the logic behind any vet getting a freebie of 5 years of VA medical care simply because they served in-theater. Vets who get mobilized to CONUS, Germany, or Korea after 11 November 1998 are not by law authorized that same benefit. And based on what I saw in the CENTCOM AOR, other than no alcohol most of the tours in-theater outside of Iraq and Afghanistan were no worse or more dangerous than an unaccompanied tour in Korea. Many in-theater tours in the USAF, Navy, or USMC are also quite a bit shorter than a 1-year unaccompanied tour in Korea, too.

This just doesn’t make sense to me.

Example Five:  Presumptive Conditions

Another VA area that has me scratching my head is presumptive conditions.

Here’s the VA’s regulatory list of presumptive conditions and to whom the presumptions apply.  The Vermont state VA department also has a list of VA presumptive conditions; their list is perhaps a bit more easily understandable.

Some of those presumptions make at least some sense.  Take the tropical disease presumptions, for example.  Tropical diseases are, well, tropical diseases.  If someone serves in the tropics they’re not always avoidable, even with proper prophylactic medications and care.  They are a legitimate risk of service, are in some cases chronic conditions requiring long-term treatment, and are a legitimate service-connected condition.  So yes:  if they manifest within the statutory time frame, the presumption that they’re service-connected is reasonable.

I can also see the logic behind the presumptions for radiation-exposed vets and former POWs.  The former group was exposed to some pretty nasty stuff before the full dangers of such exposure were known, and the latter group served under extremely abusive conditions.

I can even understand some of the  presumptive conditions related to herbicide exposure (including Agent Orange) for those who can document probable exposure to same.  Herbicides can be nasty, and dioxin (the contaminant in Agent Orange that’s responsible for the majority of its problems) is particularly nasty stuff.

But with Agent Orange, some of the VA’s policies concerning presumption begin to strain credibility.  And the VA’s 2009 policy making Agent Orange exposure itself presumptive for anyone who ever set foot in Vietnam or served offshore, regardless of where in-country they served or under what conditions, is IMO exceptionally ill-advised policy.

In particular, for Agent Orange five conditions that are presumptive are IMO hugely problematic. Those conditions are ischemic heart disease, diabetes, all forms of chronic B-cell leukemia, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), and prostate cancer.

Well, I guess that each of those five conditions can indeed be “aggravated or caused by” herbicide exposure.  However, they can also be caused by a huge number of other chemical exposures unrelated to military service – or can simply occur, period, with no apparent causes.  They also have exceptionally strong dietary and lifestyle linkage as well (e.g., tobacco use, obesity, physical condition and exercise).  And particularly in the case of prostate cancer, leukemia, and heart disease they appear to have a strong genetic predispositions as well (these conditions appear to run in some families).

In short:  automatically assuming these 5 conditions are linked to military service is IMO a stretch if there is no definitive proof of exposure to high levels of a known causative agent (e.g., herbicides).  Yet that’s precisely what the VA is doing today.

These five conditions are also generally associated with aging.  And couple that with the presumption that anyone who ever set foot in Vietnam (or on various ships offshore, or who flew in certain aircraft, or who served in Thailand) is now deemed somehow to have been “exposed” to Agent Orange – the US taxpayer is on the hook for essentially lifetime medical care for a huge number of folks.  About 3.1 million, to be precise.

Here’s a hypothetical scenario that illustrates the absurdity.of the current Agent Orange presumptive policies.  Picture two brothers – identical twins.  They come from a family with a strong history of prostate cancer.

Both go into USAF ROTC in 1957.  Both are commissioned in 1961.   Both get their pilot’s wings in 1962. One brother gets assigned to Langley AFB; the other, to Hickam AFB in Hawaii.

Each serves 5 years, and gets out.  Each gets a job with a major US airline as a pilot, and later retires from that post-service career at age 60.

While serving, the brother at Hickam serves for a year as a General’s Aide in 1964. During that assignment, he makes a 5 day TDY trip to Vietnam.  He flies into Tan Son Nhut on a VIP plane, stays at the Brinks Hotel (before the bombing), and flies out four days later.  He never leaves the Saigon metro area.

Between ages 70 and 72, both brothers unfortunately develop prostate cancer (strong family history) within a 18-month period.

The brother who went TDY for 5 days to Vietnam is covered by the VA for his prostate cancer treatment (and presumably will be rated at or near 100%-service connected if the disease becomes advanced).  The other brother?  “Xin loi, GI.”

Oh, and the VA seems to be starting down the same path regarding service in the Persian Gulf.   The VA has now established a short list of conditions that are presumptive for service in the Persian Gulf, too – though the VA policies associated with Persian Gulf conditions are much more stringent than those relating to Agent Orange exposure today.  (Then again, VA policies associated with Agent Orange exposure were much more stringent until 5 years ago, too.)

Further:  we’re seeing new possible Gulf-service-related issues brought up in the press from time to time, as Jonn’s recent article about Camp Victory dust shows.  We’re also seeing extensive lobbying by VSOs for Persian Gulf related presumptions like the VA has done for Agent Orange. So I’m guessing we’ll see a boatload of automatic “presumptive conditions” for service in Iraq and Afghanistan in the future, too.

Bottom line:  yeah, presumptive conditions work to the vets benefit.  But IMO, the VA appears to have gone entirely too far in that direction based on what we know today.  The whole concept IMO needs to be re-looked, top to bottom. It’s out of control.

Example Six: Most VA Bennies Don’t Even Require an Honorable Discharge

This is a no-brainer. It’s so blatantly nonsensical IMO that I won’t discuss it further here.  VA benefits simply should require an honorable discharge – and nothing else.  Doing what one signed up to do is not that damn hard.

I’ve probably p!ssed you off enough for today. More tomorrow.

Category: Veterans Issues, Veterans' Affairs Department