I have never been in a VA hospital - WP Lang

There is a lot of bad information about the Veteran's Administration being circulated in the sloppy reporting ever present these days in the US MSM.

The Veterans Administration exists to provide post-service benefits to former members of the armed forces.  The target population for these benefits are those who served for a period of time and then left the armed forces altogether.  The VA provides a variety of services; medical, home loans, life insurance, educational benefits and many others.  The focus these days is on the VA medical service which runs a very large system of hospitals and clinics where unlimited treatment is given gratis  to former servicemen who have disabilities that are judged by a VA board to be service connected.  Disabilities that are judged to be non-service connected are not eligible for treatment by the VA.  

People like me or TTG or any number of others who write on SST are not the target population for the VA medical service although we can use it if we choose to do so.  This is the case because we are RETIRED and not FORMER military people.  In other words we served long enough to be statutorily eligible to be retired for length of service or wounds.  Minimum length of service to be retired for length of service is usually 20 years but it can be well over 30 years as well..  

 If you are retired from the militry you are still a member of the armed forces.  You have been moved from the active to the retired list of your service, but you are still  a member.  You still hsve the use of various DoD facilities including the medical services of the armed forces.  You are eligible for Tricare, the DoD health insurance program.  For those retired people who are Medicare eligible Tricare is a second payer after Medicare.

In other words the VA medical service is intended for citizen soldiers who may have residual disabilities from their military service.  This is a very large group.  There are still over 7million Vietnam era veterans who may have service connected disabilities and thus be eligible. There are many millions potentially eligible from the post 9/11 period.  

The VA was created for the purpose of caring for WWI, non-Regular veterans.  The system has now existed for over 80 years and has become a thoroughly mature bureaucracy fixed in its ways and unwilling to adapt unless forced to do so.  Like many routinized Washington bureacracies it is inhabited by minimally qualified people who hide behind rules and regulations to avoid as much work as possible.  The same people are not keen on modern computer driven systems because they would have to learn to master the new system.  

The VA needs a massive housecleaning.  Retired professional soldiers generally avoid the VA medical service if there is an alternative.  The use of their facilities becomes necessary in matters like adjudication of disabilities.

The VA needs to adopt a voucher system for providing civilian health care as a supplement to what it does in its own facilities.  The demand for care will probably always exceed "in house" capacity.  This drives non-medical bureaucrats to try to game the system in order to avoid blame.   pl 

http://en.wikipedia.org/wiki/Veterans_Administration

Comments

[eakens]

On a side note, Hagel is not aware of Israel spying on the US. I don't know how they can keep a straight face.

http://www.reuters.com/article/2014/05/15/us-usa-israel-hagel-idUSBREA4E0H820140515

[no one]

PL, From what I've seen of the of VA hospital system recently and the way the Army handles combat veterans of Iraq and Afghanistan, it's becoming increasingly difficult to stay out of conspiracy theorist's frame of mind regarding the conduct of both organizations. Bureaucrats gaming the system to lower costs, indeed.

I am learning that my son is a typical example of what is happening to many combat vets. He was a 2Lt in Iraq and a 1st Lt in Afghanistan (combat engineers). Excellent OERs up until Afghanistan. In Afghanistan he suffered two, maybe three, blast concussions. He was evac'ed to Baghram after the last one. Diagnosed with mTBI and sent back to his FOB on light duty/restricted to the FOB for the duration of the deployment (this was an SFAT mission) after a couple of weeks. But he started screwing up. Couldn't remember orders, was wandering around like he was lost. So his CO sent him back to the states a month early - and wrote him a bad OER as a result of his performance post TBI. Back at Ft Bliss he was given a desk job and sent to the hospital for check ups. They filled him full of all kinds of psychiatric medications. He'd call me every day to talk and I could tell he didn't know up from down. More screwing up and he gets discharged with a general under honorable instead of honorable. IMO, he absolutely should have been medically DC'ed. This DC status is very common these days for soldiers with severe PTSD and/or TBIs. It's first step to screwing veterans.

So he comes home and the wife and I are helping him out with everything. The guy is a mess. A shell of his former self. On top of the TBI it's pretty obvious to me that he has serious PTSD. Some paper work and other evidence that he brought home with him tells me that he saw and participated in some pretty intense events and the PTSD makes sense.

Anyhow, all the VA wants to do is fill him full of even more drugs; which turn him into a complete zombie. That's it. Take the drugs, see you in a few months. My private physician tells me that the dosages and combinations of the drugs is actually dangerous and recommends that he not take most of what is prescribed.

When I go back to the VA with him and present my physician's opinion of the prescriptions, they just shrug. They have a live-in PTSD clinic, but there are no vacancies for months. The DC status effects where he is on the waiting list. Ditto with the application for service related benefits and the level of benefits available. There is no available VA TBI help; just the drugs.

Very frustrating sub-standard care for someone who put his life on the line for his country and was damaged in doing so.

The only solution is to get him signed up under the ACA (which I am loath to do) and get him care outside of the VA.

[turcopolier]

noone

Firstly - The armed forces are heartless bitches who use you up and spit you out. Whatever those who served either temporarily or permanently get after departure has been fought for every foot of the way. One of my uncles was a long service navy man with two Navy Crosses. He was a warrant officer and had been selected for a commission as a full lieutenant. When he was so badly wounded that he could not serve the US Navy decided not to commission him. This saved them a few dollars. All the services are IMO doing the same crap now. Your son seems a very similar case.

IMO your son should have been medically retired from the Army rather than simply discharged As you know that would change his status immensely in a multitude of ways. IMO you should approach the IG of the Army in this matter and demand an investigation into his status. If he is medically retired you can go to the army central board for the correction of military records to get the the poor OER thrown out. The big thing would be to get him medically retired. That would mean retired pay w/disability, PX, Commissary, Tricare, the works. Remember that you have a congressman. pl

[Old Gun Pilot]

The Board for Correction of Military Records (BCMR) may be the best vehicle for sorting this out. See: http://www.dtic.mil/whs/directives/corres/pdf/133241p.pdf

[VietnamVet]

Colonel,

I have Federal Blue Cross and Blue Shield and have a service connected disability. Through the years I’ve migrated to being mostly treated at the VA. Yes, you have the deal with the bureaucracy but it is not a money making conglomerate out to steal your last dollar. Hospitals are buying up private practices and consolidating. In Washington DC one is MedStar.

God help those who don’t have insurance.

This is being pushed by corporate media to give Vets vouchers. Another money making scheme for the 0.01%. If you think Vets will get better care, I have a bridge in Brooklyn to sell you.

[r whitman]

I have been a patient at the Houston VA hospital for a number of years. I find the care adequate and the drug co=pays quite cheap. The real problems of the VA hospital are twofold:
1. The system is clogged with old farts like me who are being treated for any number of non service connected problems. We go there because the pharmaceuticals are inexpensive ($9.00/mo maximum per prescription). 80% of the people I see there are over 60.

2.When it comes to the new patients enrolled since 2003 who have war wounds or PTSD, the doctors and staff have no real clue as how to treat them. Therapies and cures just have not been invented or disseminated to really help these veterans.

One thing I would like to add is that the patient computer system at least here in Houston, is up to date. Within 3 days of my annual physical the results of my exam, blood test and UA are posted on Myhealthvet on the internet and available to me and my other healthcare providers.. My monthly billing of co-pays is paid electronically over the internet.

[jonst]

I worked at the VA, and was treated at the VA, back in the 70s. My wife worked years at the VA, specializing in PTST. She still sees veterans in her private practice that are referred by the VA. So we have a rather long perspective on the institution. Suffice to say, it has gone down hill, IMO, at precisely the same time expectations of what it was supposed to do have gone up. I think the rather cynical and often, not always, but often, phony gestures of support for GI's 'thank you for your service' and all that bullshit, raised some of those expectations.

Why have things gone downhill? Well, first off, the fact is we Americans don't do a lot of things well anymore. Full stop. Period.

Further more, an old timer once told me back in the mid 70s, after the draft we shitcanned, 'you'll see less and less veterans, and less and less veterans in Congress and the govt, and then you are gonna see less and less support for the VA, despite whatever they say.' He was correct I believe

To me, when I go up for visits at Togus, the VA in Maine, it looks like they gutted the place internally. A shell of itself. The big VA outpatient clinic where I worked on 7th Ave in Manhattan? Half a city block long...condos now. Million Dollar plus Condos.

[Fred]

"Like many routinized Washington bureaucracies it is inhabited by minimally qualified people who hide behind rules and regulations to avoid as much work as possible."

That is the truth. I'm one of those citizen soldiers who avoids the VA whenever possible.
"Remember that you have a congressman." Wise words. The late Sam Gibbons was of immense help to me when I was having troubles with the VA in the late 80s. Just dropping his name cleared up a few administrative hurdles at UF too.

[no one]

Sir, Thank you. Yes, my congressman is where I am headed next. I have a rough draft of letter to him already composed. I had called his office and they promised me their man that handles veterans affairs would get back to me. He never did. That was two months ago. Now they get a return receipt letter. Next will be the media, if necessary.

[John Minnerath]

All,
I'm of the aging Viet-Nam era of vets, as many here. The VA currently has many categories of vets and what they can receive from the VA medical system, I'm not even sure just how many but I'm in the lowest level with nothing service connected. I have been cared for a couple times at the Cheyenne VA Hospital though. The medical personnel are excellent, but any visit there requires dealings with pencil pushing administration type. In Cheyenne as a whole retired double dipping AF from the nearby AF Base. They've managed cushy well paying jobs with the VA to supplement their military retirement. Their attitude towards many of the vets who are there is borderline hostile.
Why I don't know, but it's hard to deal with.
A number of other veterans I know who use the VA's care for some pretty serious service connected problems refuse to be sent there for that reason.

I was sent once to the VA hospital in Sheridan for some tests, that was a much different experience, but I've heard that hospital is much changed now.

My regular Doc though is at a nearby VA clinic, but I stay with him mostly because we're old friends and my few visits a year give us a chance to catch up on fishing and hunting stories. As long as VA continues to allow me this I'll continue.
As I've gotten older and developed more medical problems, Medicare and supplemental insurance handle the specialists I need to see.

The VA system from end to end needs a good house cleaning being badly over loaded with self serving dead wood, not unlike any other federal agency.

[Amir]

I happen to know that the Electronic Medical Record (EMR) of VA, though cumbersome, was very very good up until a few years ago. Obviously, there is a continuous need for investment when IT is involved. Just to put this in perspective, UC Irvine invested 200.000.000 to set up one of the first comprehensive EMR's with subsequent yearly operating cost of around 50.000.000.

In general, the VA and it's residency programs are considered to the less academically rigorous but more hands on. They give the chance to foreign medical graduates to gain an entrance into the US health system as lots of other employment opportunities are sought after by the US graduates.

I am probably going to offend some people here by saying that there seems to be a poverty draft based on my experience with medical trainees that are funded by VA/DOD. A patient population, based on income inequality, is selected towards VA hospitals. By definition, these patient are going to be sicker and challenging compared to patient's of a private hospital. Although having "only minimal qualification" might seem to be a big hurdle for streamlining the system, having people that "work from the heart" is more of a challenge. Qualifications can be obtained but you either have your heart in the job or you don't.

While interviewing in Roanoke, VA, in 2001, I spoke to the then program director and questioned whether creating a joint-venture with VT University and educating the communities' physicians, would be a growth industry. Although everyone is striving to be driven by humanism, it is only natural to assume that these locally educated physicians will have more of a stake in the game and will be more motivated.

It all comes down to the same old "Guns or butter" choice and for the VA, the choice has always been on more guns and less butter.

[turcopolier]

noone

I think the idea about the Board for the Correction of Military Records is am excellent idea. pl

[The Twisted Genius]

My dealings with the VA system have been positive. After years of cajoling by friends and nagging by SWMBO, I reluctantly applied for VA disability. Every office and every person I dealt with were professional, competent and respectful. And not in that sickening thank you for your service, hero worshiping way. I was kept informed by letter and through the VA eBenefits website. I visited a contract medical examination office in Alexandria, Virginia and the VA hospital in D.C. several times each. Except for the drive to and from the D.C. area, each experience was as pleasurable as a trip to the doctor could be.

Judging by the patient traffic at the VA hospital in D.C., the system is massively overloaded. I'm sure there are problems that need fixing. Viet Nam era veterans are deep into their "broken down" years. The new crop of SWA veterans with PTSD and TBI related problems are, like r whitman said, are a vexing challenge. Mental health treatment is a work in progress throughout the U.S. health system, not just in the VA.

[Imagine]

Iraq war estimated to cost the government another $Trillion or two, over the next thirty years, paying for health care. No one has budgeted for these costs. No one is even considering budgeting for such costs for the next war. God help a nation that crosses its fingers, ignores reality, and cannot do even basic accounting.

[turcopolier]

TTG

That's me, more broken down all the time. Other than for disability classification have you used VA medical for anything? pl

[John Minnerath]

Are VA health services, the care received and who gets what, uniform across the system or does it vary by region?
I ask because of a comment made about using the VA prescription drug services. I tried it and with my co-pay was as high or higher than I would pay by just going to a regular drug store. A nurse at a local VA clinic told me that was a common issue. Questions to other health professionals got the same reply. Why?, that makes no sense at all.
The state of Wyoming has 6 VA out patient clinics and several more that operate on a smaller scale and some using mobile units. Until the VA began building those clinics some years ago veterans seeking medical care had to make a trip to one of the large regional VA hospitals.
Those veterans living out here in the so called "fly over" country just had no easy access to any VA medical care.
There must be some variation by region because some I know will go to either Denver or Salt Lake City for their needs before they will use anything available instate.

[William Herschel]

VistA is the best electronic medical record system in the United States and the world.

http://en.wikipedia.org/wiki/VistA

[The Twisted Genius]

PL,

I've never used VA facilities other than for the disability classification. I seldom seek medical care anyways. Last visit to a doctor was over five years ago to finally get rid of recurring ear infections. Last physical was my over 40 physical. The VA doctors told me they'd call me if their tests found anything unknown and serious. They didn't call, so I figure I'm good. There's a VA primary care clinic in Fredericksburg affiliated with the Richmond VA center so that's convenient if I need one. Anything to avoid traffic around D.C. That shit'll kill ya.

Here's an appropriate song for all us broken down vets.
http://www.youtube.com/watch?v=qHDdqubE7zQ&feature=kp

[turcopolier]

TTG

I keep forgetting that you are too young for Medicare and Tricare for life. you will like it if we still have it. pl

[The Twisted Genius]

PL,

That's my plan. It's only a little over three years to go. My wife had to deal with Tricare for the care of her father. Dealing with them was a pleasure compared to both Medicare and Blue Cross/Blue Shield. The Tricare reps were responsive and proactively helpful every time.

[turcopolier]

TTG

Yup. The Tricare managers do a great job. Something like that but separate should be used to provide civilian care for the non-retired veteran population. I was unaware that VA treats conditions that are not service connected. pl

[John Minnerath]

PL,
They do and always have to some extent.
This link from VA helps some:
http://www.va.gov/healthbenefits/
The VA seems to have a lot of lee way on just how much they will provide.

When I was checking into a hospital that did eye surgery in SLC the lady getting my info asked me why I was there since I was a veteran and the VA hospital in Cheyenne usually provided that service. I had no answer.

[Ramojus]

TTG,

As an eternal fan of Warren Zevon, I thank you for the link. I had forgotten about this song and find that it resonates with me now.

[John]

I went to the VA as a bridge to Medicare and have ended up staying except for a few specialties. I just had my 6mo checkup and am quite pleased with the care I encounter in the VA system. The people are great.
I suspect the VA system is equal to or superior to the for profit system. I know plenty of horror stories from the for profit system.
For those needing mental health services, good luck on getting anything except a lot of meds anywhere in the US.
Unless you have money, drugs and the prison system are the US solution to mental health care.
And let's face it, the US doesn't have a very good health care system. It costs twice as much as that of the other developed countries and delivers much less.
Like war, health care is just another profit center for the US oligarchy.

[Tyler]

I used the VA once when I got out of the Army and went back to Delaware. Couldn't sleep, audial hallucinations, hair trigger temper, all that fun stuff. They gave me a bunch of pills and sent me on my way.

It was a late friend of mine, a Vietnam Vet, who saw I was having problems treading water in society and came and got me into a support group that was made up of Vietnam War era veterans mostly, with me the youngest guy in there. It was this organization that got the ball rolling on my disability claim for PTSD.

So I go to the VA, sit down with the head shrinker and provide my documentation of combat action, loss of squadmates, etc etc. She nods in all the right places and asks how the medication they gave me is working. I told her I wasn't taking it because it zonked me out and I was about useless on it. She said that'll pass and to keep taking it. I nodded in all the right places and ignored her.

I got my decision back from the VA a few weeks later. Concurred with all the statements (combat action, documented medical problems, etc) except for the fact that I had PTSD. There it did not concur. I guess someone saved themselves a few bucks.

I still have my problems, but I've learned to recognize the signs and take appropriate action. I've got my health and all my fingers and toes and I haven't eaten the business end of a pistol. I can function effectively and successively. That's more than many of my comrades can say.

I am thankful for what I have.