First Steps to Overhaul the Department of Veterans Affairs

Dr. David Shulkin continues to impress by tackling some rather entrenched “special interest” groups within the Department of Veterans Affairs (“the VA”):

- Personnel;

- Infrastructure

Earlier this week, VA Secretary Shulkin informed a Congress that he was considering closing some 1,100 underutilized VA facilities.  The Associated Press reports that:

Shulkin said the VA had identified more than 430 vacant buildings and 735 that he described as underutilized, costing the federal government $25 million a year. He said the VA would work with Congress in prioritizing buildings for closure and was considering whether to follow a process the Pentagon had used in recent decades to decide which of its underused military bases to shutter, known as Base Realignment and Closure, or BRAC.

“Whether BRAC is a model that we should take a look, we’re beginning that discussion with members of Congress,” Shulkin told a House appropriations subcommittee. “We want to stop supporting our use of maintenance of buildings we don’t need, and we want to reinvest that in buildings we know have capital needs.”

Last week, President Trump signed an Executive Order protecting VA whistleblowers from retaliation in a quest by the VA to shed incompetent employees.

Department of Veterans Affairs

While these measures may seem rather insignificant given the overall size and reach of the VA, they could mark an important change in the direction of the VA to help respond to the needs of Veterans.

The VA has evolved into a mammoth organization intent on serving the needs of all Veterans and their families.  Roughly 60% of the VA’s $180 billion budget (2017 budget) is allocated to mandatory benefits programs.

The VA’s discretionary budget of $78.7 billion is allocated to a variety of Veteran services,  but by far, is the the $65 billion allocated to medical care facilities.   Despite regular reports of shortcomings at VA facilities, the Rand Corporation recently (2016) reported that “the Veterans Affairs health care system generally performs better than or similar to other health care systems on providing safe and effective care to patients.”

While it appears that many Veterans – quite possibly the vast majority – receive quality health services from the VA, many Veterans complain about the timeliness and quality of service provided to them.

Like other healthcare providers in the private sector, the VA has determined what health events are covered, the type of coverage provided and where the health services are administered.

One program that has come under particular attack is the Choice Program, which gives Veterans access to medical services in the private sector if the VA can’t dispense services within 30 days or a VA facility is not located within 40 miles of the Veteran.

At his confirmation hearings, now VA Secretary David Shulkin, requested that Congress expand the coverage of the Choice program and eliminate many of its administrative constraints.  Needless to say, changes in the Choice program would certainly provide a greater number of Veterans with access to private sector care.

In cases of emergency, even minor improvements to the Choice program could be of major benefits to Veterans.

Nevertheless, these changes do not provide Veterans with access to alternative therapy programs not currently approved by the VA.  As SFTT has reported on numerous occasions, PTSD is currently treated with demonstrably ineffective “approved” treatment procedures while far better and less-intrusive programs like hyperbaric oxygen therapy (HBOT) are widely used with success throughout the world.

In effect, there are a number of activities within the VA that can best be performed by third-party services.  In fact, integrating these services with community resources may prove to be more of a long term benefit to the Veteran and his or her family.

Stand for the Troops remains hopeful that Secretary Shulkin and the dedicated employees of the VA will find the right balance in helping Veterans recover their lives.

SFTT Military News: Week Ending May 5, 2017

Found below are a few military news items that caught my attention this past week. I am hopeful that the titles and short commentary will encourage SFTT readers to click on the embedded links to read more on subjects that may be of interest to them.

If you have subjects of topical interest, please do not hesitate to reach out. Contact SFTT.

Is China Reconsidering Its Relationship with North Korea?
When North Korea’s founder Kim Il-Sung visited Beijing to sign a mutual defense pact with China in 1961, he was comforted by the military protection promised by his fellow communist neighbors. But half a century and a few North Korean nuclear tests later, the agreement is beginning to look like a musty Cold War relic that China would rather forget. Despite their alliance in the 1950 – 1953 Korean War, analysts questioned whether Beijing would now rush to Pyongyang’s defense in a military confrontation with the US and South Korea.  Read more . . .

Questions on Efficacy of “MOAB” bombing in Afghanistan
But a new investigation by independent analysts casts doubt on the efficiency of the bomb, suggesting it inflicted far less damage than initially reported – and raising questions again over why the bomb was dropped. Using satellite imagery, ground footage and 3D visualization, Alcis, an institute for geographical analysis, surveyed the targeted area in Nangarhar province. It found 38 buildings and 69 trees destroyed within a 150-metee radius, challenging statements from locals who told reporters the bomb had damaged houses up to two miles away. Alcis was also skeptical of the Afghan government’s assessment that the bomb killed 94 Isis militants. “I’m staggered by that,” said Richard Brittan, the institute’s managing director. “I simply don’t understand where they can get that number from.”  Read more . . .

Pituitary gland

Can Brain Concussion Injury be Properly Evaluated?
In an effort to fill that technology gap, Timothy Bentley, and his team at the Office of Naval Research’s Warfighter Performance Department in Arlington, Virginia, have engineered new sensor technology that could give medics on the battlefield a clearer idea of whether or not an injury actually occurred after a blast. The coin-sized sensors, placed in service members’ helmets and tactical gear, detect the impact of a blast wave—which moves faster than the speed of sound—and assign it a number, a measure of blast strength. The number is then run through an algorithm that computes how a service member was hit by a blast, which sensors were activated based on their placement, and then tells medics if the service member needs to get off the field immediately or not.   Read more . . .

Can Putin and Trump “Broker” Syrian Deal with No-Fly Zone?
Once again it appears Vladimir Putin has seized the strategic high ground and initiative in Syria, as he declared yesterday that he has broad agreement for humanitarian safe zones across Syria after discussions with Donald Trump, Turkey and Iran. He claims he can enable the ceasefire brokered in Astana some weeks ago, which currently is an abject failure, by creating no-fly zones with the Russian, Turkish, Iranian and US militaries protecting safe zones on the ground. He also, thankfully, acknowledges that UN troops might be required.  Read more . . .

Antibiotic Doxycycline May Reduce the Risk of Developing PTSD
Doxycycline, a common antibiotic, appears to disrupt the formation of negative memories in the brain. According to a study in the journal Molecular Psychiatry, this could help prevent post traumatic stress (PTSD). The study suggests blocking matrix enzymes—proteins located outside nerve cells—may interfere with the ability to form memories. Doxycycline blocks these enzymes.  Read more . . .

VA Secretary Ponders Closing Up to 1,000 VA Facilities
Veterans Affairs Secretary David Shulkin says his department is seeking to close perhaps more than 1,100 VA facilities nationwide as it develops plans to allow more veterans to receive medical care in the private sector. At a House hearing Wednesday, Shulkin said the VA had identified more than 430 vacant buildings and 735 that he described as underutilized, costing the federal government $25 million a year. He said the VA would work with Congress in prioritizing buildings for closure and was considering whether to follow a process the Pentagon had used in recent decades to decide which of its underused military bases to shutter, known as Base Realignment and Closure, or BRAC.  Read more . . .

Drop me an email at info@sftt.org if you believe that there are other subjects that are newsworthy.

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Whistleblowers and the Department of Veterans Affairs

On April 27th, President Trump signed an Executive Order to create the Office of Accountability and Whistleblower Protection within the Department of Veterans Affairs (“the VA”).

According to the AP, VA Secretary David Shulkin said the office will help identify “barriers” that make it difficult for the department to fire or reassign bad employees. Another function of the office will be to help shield whistleblowers from retaliation.

To many, it may seem surprising that a new office within the VA is required to protect “whistleblowers,” since private and public whistleblowers have long been afforded protection under the Whistleblower Protection Act of 1989.

Clearly, additional protection is needed if doctors like Dr. Dale Klein can be relegated to an empty room for bringing VA abuse to the attention of the Inspector General.  Found below is a report for Fox News:

Dr. Dale Klein may be the highest-paid U.S. government employee who literally does nothing while he’s on the clock. A highly rated pain management specialist at the Southeast Missouri John J. Pershing V.A., Klein is paid $250,000 a year to work with veterans, but instead of helping those who served their country, he sits in a small office and does nothing. All day. Every day.

“I sit in a chair and I look at the walls,” the doctor said of his typical workday. “It feels like solitary confinement.”

A double board certified physician and Yale University fellow, Klein said the Department of Veterans Affairs (V.A.) took away his patients and privileges almost a year ago after, he alleges, he blew the whistle on secret wait-lists and wait-time manipulation at the V.A. in Poplar Bluff, Mo., as well as his suspicion that some veterans were reselling their prescriptions on the black market.

While one would like to be optimistic that the new “Whistleblower Office” within the VA would help improved efficiency within the VA, I suspect that there are far too many institutional barriers to be overcome in this mammoth organization.

Department of Veterans Affairs

Size Matters at the Department of Veterans Affairs

The VA’s simple mission laid down by President Abraham Lincoln is “to care for him who shall have borne the battle, and for his widow, and his orphan.”

Needless to say, each person has his or her interpretation of what that VA mission entails, but over time the VA has laid on layers of responsibility to fulfill that mission.   In the military, we often refer to that as “mission creep.”

In effect, the VA – whether pressured by Congress, the President or their own Administration – have taken on responsibilities that may or may not be what was originally intended under President Lincoln’s promise.

More importantly, the VA has centralized most functions under its umbrella to administer to the needs of Veterans.

Employing some 350,000 people and many outside consultants, the VA administers health and benefit programs to millions of Veterans.  In economic terms, one might characterize the VA as a monopoly.

While many of the services provided by the VA are excellent, it would be unrealistic to expect that ALL services are effective.

In fact, the IG, internal VA audits and the IG have reported many irregularities at the VA.  Unmanned Crisis Call Centers, unacceptable patient “wait times” and the heavy reliance on prescription drugs all contribute to public wariness and distrust of the VA.   More importantly, many Veterans reject the services provided by the VA.

SFTT has long argued that the VA is far too large to succeed on every front without compromising their main mission.  Shortly after Dr. David Shulkin was appointed Secretary of the VA, we wrote:

NO AMOUNT OF MONEY or CHANGE IN LEADERSHIP or ENACTMENT OF NEW LEGISLATION will bring about A MORE RESPONSIVE VA.

The VA has become a bureaucracy that answers only to itself and is not responsive to the needs of Veterans.  Frankly, the VA has lost its way and very little will change unless the VA is broken down into far smaller manageable components.

While smaller components of the VA will invariably fail, A SMALLER AND LESS CENTRALIZED VA WON’T COMPROMISE THE FULL MISSION.  

VA Whistleblowers and David Cox

Dr. Shulkin and others clearly realize that there are serious problems of accountability within the VA.  The April 27, 2017 Executive Order is designed to help “weed out” waste and inefficiencies within the VA.

J. David Cox

J. David Cox

Despite much needed reform within the largely ungovernable VA, I suspect that  J. David Cox, President of the American Federation of Government Employees, will continue to run a destabilizing campaign to block any meaningful reform.

We admire the courage of “whistleblowers,” but Veterans shouldn’t expect great changes considering the entrenched positions of David Cox and his henchmen.

It is reassuring to see Dr. Shulkin take action to confront the serious problems within the VA.  We wish him success in his endeavors and hope that he receives much needed support from our elected leaders to bring radical reform to the VA.

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