Will the VA Provide Better Service to Veterans?

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With much fanfare, Dr. David Shulkin, the new Secretary for the Department of Veterans Affairs (“the VA”), has moved quickly to address some of the recurring problems at the VA.

Dr. David Shulkin, VA Secretary

As the first VA Secretary without a military background, Dr. Shulkin appears committed to resolve several pressing concerns:

– Speedier processing of Veteran benefit claims and,

– Eliminate unnecessary bureaucracy and artificial constraints on “out-of-network” support for Veterans (Choice Program).

Indeed, Secretary Shulkin recently unveiled a 10 Point Plan to modernize the VA:

1. Firing bad employees

2. Extending the Choice program

3. Choice 2.0

4. Improving VA infrastructure

5. ‘World-class’ services

6. Better VA-DoD partnerships

7. Better electronic records

8. Stopping suicide

9. Appeals modernization

10. Internal improvements 

While there is little in these Powerpoint presentation bullet points that anyone would quibble with, implementing these broad goals tends to be far more complicated than listing the goals.   Unless there are rigorous benchmarks to assess progress toward achieving these goals, then this “goal-setting” exercise is rather fruitless.

In fact, it is difficult to reconcile the need for increased hiring within the VA unless one sees clear and conclusive evidence that “bad employees” are being fired.  In fact, the VA is recommending a hiring surge to deal with a backlog of benefit claims, a situation that has persisted for 4 years.

Are more employees needed or does the VA lack the “right” mix of employees to implement Shulkin’s 10 point plan?

For instance, State and Local VA coverage varies radically across the US.  For example, NPR reported in 2015 “that spending is nearly $30,000 per patient in San Francisco, and less than $7,000 per patient in Lubbock, Texas. Nationally, the average is just under $10,000. In places where more veterans are enrolled in VA health benefit plans, spending per veteran did tend to be higher.”   Why?  This is a huge variance that is not well explained.

Aligning the VA to Achieve Measurable Goals

As one looks at Shulkin’s proposed goals, it would be useful to determine their priority and the level of commitment (personnel and capital expenditure) that is required to attain them.  Furthermore, what are the benchmarks to chart progress toward achieving those goals.

For instance, “stopping Veteran suicides” is a goal that would find few naysayers.  Nevertheless, it is difficult to reconcile that goal with the sad fact that 30% of suicide watch calls are not currently attended by the Veteran Crisis Center.  Indeed, I find it disturbing that the Suicide Crisis Line has been centralized under the VA in the name of “efficiency.”

Perhaps, Dr. Shulkin and his staff have some measurable goals.  If so, they should be made public and both the Executive Body and Congressional Oversight Committees should receive regular updates from the VA on progress to date in achieving mutually agreeable goals.

Is this likely to happen?  Most certainly not!  This is an anathema to Big Government.

Is Firing Bad Employees Really Going to Occur?

With 365,000 employees, there are certainly going to be a few “bad eggs.”  While Dr. Shulkin praised the vast majority of VA employees, he told a cheering crowd  that “We’re going to make sure that the secretary has the authority to make sure that those (sic “bad”) employees … are leaving the VA system.”

J. David Cox

J. David Cox

Really?  It seems to anyone who has taken more than a cursory look at staffing within the VA, that David Cox, the President of the American Federation of Government Employees, will be calling the shots rather than Dr. Shulkin.

In most cases, distinguishing between a “bad” employee and an inefficient one is largely subjective.  Given the protection afforded by employees at the VA, it is highly unlikely that both the bad and inefficient employees will be “leaving the VA system” anytime soon.

In effect, this places a greater burden on both ” the good” and the many efficient and competent employees within the VA.  With little say or control on managing the workforce, I find it highly unlikely that Dr. Shulkin will be able to fulfill his promise to fire “bad” employees.

More importantly, it is unlikely that he will be able to realign staffing levels to implement his 10-point plan.

And Speaking of Bad Apples:  How About Dr. David Cifu?

If Secretary Shulkin is really serious about dealing with “Veteran suicides” and providing Veterans with alternative treatment for Veterans with PTSD, he would do well to question the credentials of Dr. David Cifu and others within the VA who continue to block Veteran access to better treatment alternatives.

When one looks at Secretary Shulkin’s complex agenda, one should focus on the signs that change is actually occurring.  Personally, I don’t expect to see much change over the next couple of years, unless there are clear bookmarks to measure that change.  Sadly, it seems likely that we will be looking at the same litany of complaints a couple years down the road.

Dr. Shulkin, I admire your bravado and enthusiasm, but question whether you have the right tools and authority at your disposal to bring about a much needed reform within the VA.

Veterans should be hopeful, but not too optimistic.

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Veteran Charities in Context

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Active Duty military personnel that I know generally despise being used as “poster-boys (or girls)” for political campaigns.  In fact, anyone who has served in the Armed Forces is well aware of DoD Directive 1344.10 which prohibits members of the Armed Forces from engaging in “partisan political” fundraising or actively campaigning on behalf of a political party, candidate or political cause.

While these regulations do not apply to Veterans, it has been my experience that most Veterans tend to avoid the limelight of partisan politics and, instead, pursue causes to support fellow Veterans that do not tend to attract much media attention.   Like Active Duty personnel, Veterans tend to avoid serving as “props” for political campaigns.

Donald Trump Veterans

As SFTT and others reported earlier when a Donald Trump fundraising event was announced during the Republican primaries:

. . .several Veteran groups accused Donald Trump of using Veterans like political pawns in his dispute with Fox News over the moderators of the last debate.    In many respects, I agree with Veterans that don’t want to be used as pawns in contentious posturing by politicians.  Sadly, every four years or so, most politicians tend to embrace Veteran causes as they might disingenuously cuddle a puppy dog to encourage voters to look favorably on them.

While it is completely understandable that some, many or all Veterans may not wish to be seen to embrace the policies of Donald Trump, it is most disingenuous – read dishonest – for the media to skew fund-raising efforts by anyone (including Donald Trump) to support Veterans.  

Yet, that is precisely what happened.  In a ridiculous article published on June 2 in the New Times entitled “Putting Donald Trump’s $1 Million to Veterans in Context,”  the author, Peter Eavis, argues that Mr. Trump’s contribution “to veterans’ charities is small compared with those of some fellow billionaires . . .” and that, “Mr. Trump’s $1 million gift to veterans not only came later than some expected, but it is also small for the plutocrat class.”

How silly to judge the merit of candidates on the amount of money they donate to charitable causes, but this is the insane world of partisan politics that dominates media channels rather than constructive solutions to the many issues faced by Veterans.

Last week, I noted Sebastian Junger‘s hope that we have a more united country to deal with  this nation’s many problems.   Even though SFTT has no political affiliation, it is very discouraging to see both the media and our politicians engage is such polarizing propaganda.  Mr. Junger clearly has his finger on the pulse of a huge adjustment problem facing returning Veterans when they see such a dysfunctional society.  It is certainly not comforting.

ZVets

Should the VA be Privatized?

With its colossal $180 billion annual budget, the Department of Veteran Affairs (the “VA”) is in the focus of those who say this giant institution should be privatized.  Everyone knows the VA is not functioning properly and there have been countless GAO studies suggesting that something be done to address these problems.

When issues like the privatization of the VA surface during an election year, it immediately becomes politicized.  SFTT doesn’t have an answer let alone a position on this issue; however, SFTT has seen enough to know that the VA does not provide adequate care to a large number of its constituents on a timely basis.

The Libertarian Party and several others are suggesting that the VA should be privatized.    Why not take off our partisan political armbands and have a look at the implications.  Maybe some elements now administered by the VA could be handled more competently in the private sector.  If so, it could be a major benefit for underserved Veterans?

If charitable contributions to Veterans can become politicized, imagine the outcry in entrenched political sectors when the VA comes under serious scrutiny.   From the perspective of the SFTT, if it ain’t working properly we might as well look at different approaches; however unappealing they may be to certain entrenched interests.  After all, it is the Veteran who is the focus of our attention and these brave warriors deserve better than what they are receiving

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Veterans with PTSD: Can We Unite As a Society?

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As one who watched a largely unappreciative nation heap scorn on returning Veterans from our war in Vietnam, I am struck by the contrived efforts to celebrate Veterans who have now served in the Afghanistan and Iraq wars.   In particular, I shed a tear for Veterans with PTSD who have difficulty coping with an unsympathetic society that seems far different from the camaraderie they experienced while serving in a war zone.

While I do not doubt that many Americans genuinely honor the sacrifices of young men and women who have served in these wars;  the American flag pin in one’s lapel or tributes to Veterans at major sporting events fall well short of the support these brave heroes deserve.

This point was made abundantly clear by Sebastian Junger in a recent MSNBC interview. Sebastian Junger, an acclaimed war-correspondent and author, has just published Tribe: On Homecoming and Belonging. In his book, Mr. Junger suggests that Veterans returning from Iraq and Afghanistan find a deeply divided and “alienated society” and argues passionately that our society may be as much to blame for Veteran suicides and depression as a Veteran’s war experience.

Mr. Junger articulates his views in a very moving Ted Talk that was filmed late last year.


As an anthropologist, Mr. Junger’s arguments are quite persuasive. It is hard to argue with his premise that the incidence of “suicides and depression” tends to decrease during periods of great stress: he cites 911, the bombing of London in WWII and many other similar situations. Junger suggests that people’s behavior tends to become “more tribal” during periods of great stress and that this provides a level of support and comfort that many returning Veterans do not presently encounter when they return home to our “alienating society.”

Mr. Junger concludes that many problems for Veterans with PTSD would be greatly diminished if we “can unite as a society.”

640px-Politics

As we watch an increasingly hostile and bitter presidential race unfold, it is not hard to understand Mr. Junger’s premise.  Imagine a young man or woman serving their country in a hostile and dangerous environment returning home to see a dysfunctional society at war with itself. How discouraging.

Indeed, if the Department of Veteran Affairs (the “VA”) doesn’t have your back, who does?

In an unfortunate analogy, Veterans Affairs Secretary Robert McDonald stated “‘When you get to Disney, do they measure the number of hours you wait in line? Or what’s important? What’s important is, what’s your satisfaction with the experience?'” McDonald said Monday during a Christian Science Monitor breakfast with reporters. ‘And what I would like to move to, eventually, is that kind of measure.'”

This is not the first time, Secretary McDonald has been embroiled in a controversy, but I am quite sure that Secretary McDonald wished he hadn’t been quite so candid.  Nevertheless, his “misspeak” provided plenty of fuel to other politicians.

House Majority leader Paul Ryan correctly pointed out that Veterans had lost their lives while waiting in line for someone at the VA to pickup the phone.

This is precisely the type of dysfunctional dialogue engaged in by “tribal leaders” that Veterans – and many others – find so frustrating and largely disingenuous.

Most everyone knows that the VA is not functioning properly.  Rather than simply point fingers to gain personal political leverage, let’s harness our efforts and begin solving the many problems faced by the VA.

One man or woman’s political advantage pales in comparison to the suffering of the many brave men and women who have placed their lives at risk for a society that seems hellbent on tearing itself apart.  How tragic.

Mr. Junger, your heartfelt appeal is noted and I sincerely hope that we as a nation can embrace the challenge.  I pray that our tribal leaders will unite to provide our country with the inspirational leadership that our brave men and women in the military service deserve.  Anything less is tragic.

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Prescription Drug Abuse Hits Center Stage

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Veterans have known for quite some time that something was amiss at the Department of Veteran Affairs (the “VA’) with their “go-to” promotion of prescription pain-killers to treat PTSD.

There are countless well-documented stories of extreme behavior changes – including suicide – of “over-served” Veterans that were provided a lethal cocktail prescription drugs by VA doctors.

A number of Veterans interviewed by SFTT indicated that they simply “flushed the drugs down the toilet,” while many others reported that there was a thriving black market for pain medication.    In quite a few cases, Veterans were reported to sell VA-prescribed pain medication to others to feed other substance-abuse habits or simply to support their family.

Homeless Veteran with PTSD

Using US government statistics, CNN provides these alarming statistics on prescription drug abuse for the general public:

Death from prescription opioid overdose has quadrupled since 1999, according to the Centers for Disease Control and Prevention.

The Substance Abuse and Mental Health Services Administration estimates that in 2014, about 15 million people in the United States older than 12 were non-medical users of pain relievers. On the agency’s website, it offers a behavioral health treatment services locator where individuals can type in their ZIP code and get directions to treatment centers in their community.

In fact, the CNN article goes on to suggest that Veterans should call  the Veterans Crisis Line which directs veterans and their loved ones to “qualified, caring Department of Veterans Affairs responders through a confidential toll-free hot line”: 1-800-273-8255, option 1.

Stand for The Troops (“SFTT”) has featured this Veteran Hot Line number prominently on its website for quite some time as well as other useful treatment options that Veterans or their loved ones may wish to consider.

In fact, I found it somewhat surprising that the CDC (Center for Controlled Diseases) should announce that “medical errors are the third largest cause of death in the U.S.” after cancer and heart disease.    The timing of this release over the public uproar of prescription drug abuse seems suspicious.

If we add “medical errors” and deaths attributed to “prescription drugs” together, one could argue that visiting a doctor is hazardous to your health.

It would be totally unreasonable and a specious assault on the integrity of the medical profession to suggest that malpractice and an undo reliance on prescription pain-killers is evidence of a medical profession that is out of control.

Clearly, more “good” is being done by the medical profession than “bad,” but it seems clear that individuals need to take more responsibility for the drugs they are ingesting.    In fact, our school system seems to have it right with their “Just Say No” campaign to cut back on drug addiction and substance abuse in general.

Just Say No

Veterans with PTSD and Treatment Alternatives

While the VA has often been singled out by SFTT and others – most notably by the GAO – for chronic mismanagement of Veteran care, most would acknowledge that this huge organization does a reasonable job to support our Veterans.

Nevertheless, there is clear evidence that the VA has been over-reliant on prescription drugs to treat Veterans with PTSD and publicly dismissive on other alternative treatment therapies recommended by third-party providers that conflict with their own treatment methodologies.

With substance abuse now rampant throughout the United States and fueled by a lackadaisical approach by an unsuspecting public and unscrupulous medical practitioners, it seems high time that the VA begin to encourage Veterans to seek alternative treatments that seem to provide better patient outcomes.

Indeed, SFTT lists a number of alternative treatments under its Rescue Coalition that provides community-based programs to Veterans without the dependency on addictive pain-killers.  Isn’t this the way forward?

The VA should take the lead in both nurturing and encouraging the  growth of these programs rather than rely on dated and stale practices which continue to rely on prescription drugs.

Samples of alternative treatments abound.  In fact, in a recent New York Times report, Dr. Denzil Hawkinberry, an anesthesiologist and pain management consultant for Community Care in West Virginia, imposes very rigorous standards on who should be prescribed opioids.  Perhaps, the VA could take a page out of Dr. Hawkinberry’s book and dial back the use of prescription drugs in favor of other treatment methodologies.

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