VeteransFirstActYesterday, the leaders of the Senate Committee on Veterans Affairs held a press conference to announce that they had reached an agreement on a piece of legislation that would bring changes to many areas of the VA. The bill, known as the “Veterans First Act,” is the product of intense negotiations among Senators from both parties in recent months. The 391-page bill contains provisions dealing with accountability, healthcare, compensation, education, homelessness, and more. Below, we’ve summarized some of the key provisions.

Accountability

If you’ve been following the various VA scandals in recent years, then many of the bill’s provisions concerning accountability may sound familiar to you. The Veterans First Act would give the VA Secretary more authority to hire and fire employees, and allow him to make his personnel decisions more quickly. It would also limit the amount of time that employees can be placed on “paid administrative leave” to prevent bad actors from collecting government salaries during lengthy investigations. Under the bill, healthcare executives who lead a VA medical center would be entitled to significant pay raises to match what they would earn in the private sector. Perhaps most interestingly, the bill would establish an independent office within the VA known as the “Office of Accountability and Whistle-blower Protection.”

Health Care

Regarding healthcare, the proposed legislation would require the VA to make prompt payment to private facilities that have agreed to participate in the Veterans Choice program. This provision was likely included in response to the many headlines alleging that the VA owes millions of dollars to outside facilities, and that some private providers were electing to abandon the program altogether because they weren’t being paid. The bill would also expand the rules allowing family members to serve as caregivers for severely disabled veterans, and make it easier for the agency to hire mental health professionals. Additionally, the bill would attempt to address the over-prescription of opiate painkillers.

Disability Compensation

The proposed legislation would require the VA to launch a voluntary pilot program under which veterans who opt-in are forbidden from submitting additional evidence after filing a Notice of Disagreement. In exchange for giving-up this important right, veterans in the pilot program would skip the issuance of a Statement of the Case and go straight to the Board of Veterans’ Appeals where they would receive a final decision within one year of filing their Notice of Disagreement. The bill would also make it easier for the survivors of recently deceased veterans to receive benefits, and would increase the oversight of VA Regional Offices by permitting reviews by the Government Accountability Office.

Education & Employment

The Veterans First Act would expand the availability of Post-9/11 GI Bill funds to mobilized reservists, and authorize additional educational benefits to the spouses and children of veterans. It would also permit the VA to reinstate a veteran’s educational benefits in the event that the school the veteran was attending permanently closes. The bill would also require the VA to coordinate with the Department of Labor and state agencies to help increase the availability of jobs for veterans, and would require a non-governmental study of job counseling, training, and placement services for veterans.

Homeless Veterans

Homelessness among veterans has been a widely-discussed topic in recent years, and the proposed legislation aims at further reducing the number of veterans without a roof over their heads. Among the provisions of the bill is one would would expand the definition of “homeless” to include those veterans who are escaping from domestic violence, thus increasing the availability of benefits and services to such veterans. The bill would also expand the eligibility of the Department of Labor’s Homeless Veterans’ Reintegration Program and authorize the VA to form partnerships in order to provide legal services to homeless veterans.

U.S. Court of Appeals for Veterans Claims

The proposed legislation would once again reauthorize the temporary expansion of the Court from seven to nine judges through the end of the year 2020. This represents a compromise from what has been proposed by several lawmakers and veterans’ advocates which would make the increase to nine judges permanent. Additionally, the Veterans First Act would change some rules concerning the availability of certain benefits for judges, and would alter the manner in which the Chief Judge of the Court was determined.

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Overall, we are pleased with the provisions of the proposed legislation. We will say that we were somewhat surprised that the bill does not contain a complete overhaul of the Veterans Choice program, which has drawn much scrutiny for its failure to reduce the delays veterans face in receiving healthcare. The expansion of the Veterans Court is an important step, but we’re disappointed that Congress hasn’t decided to require more decision-makers in the locations they are most needed: at the Board of Veterans’ Appeals. Finally, we’re skeptical of the proposed pilot program for streamlining the appeal process because, simply put, it misidentifies the problem. The issue with appeals has never been that veterans are bogging-down the process by submitting new evidence, its that the VA doesn’t have adequate procedures or sufficient staff to handle the number of claims it receives. Thankfully, for now at least, the Pilot program is only a test.

The bill represents only a proposal from the Senate, and differs in some key ways from what has been proposed over in the House. We expect there to be some changes to the ultimate legislative package that reaches the President’s desk, and we will do our best to keep you posted on future developments.

At the Tampa Bay VA Hospital, one worker faced retaliation after she tried to report inefficiencies and waste among her coworkers. Linda Madero was hired to work in a laboratory at the VA hospital, but says that instead she was paid to surf the internet all day for nearly a year. Despite repeatedly asking to to be allowed to perform her actual work, she was told not to worry about all of her “down time.” When she finally reported the blatant waste to investigators, she faced retribution from her supervisors. You can watch the whole story above.

Hat tip to WFTS Tampa Bay Action News for telling this important story.

VAOIGWe all get unwanted magazines, advertisements, and credit card offers in the mail. I usually let them pile up in my kitchen for while until I decide to just throw out the lot of them. A new report from the VA’s Office of the Inspector General reveals that the VA’s St. Petersburg Regional Office has taken a similar approach to mail it receives from veterans who have filed claims for benefits.

According to the report, investigators “observed a large amount of hard copy sensitive veteran information haphazardly commingled with contract company documentation, excess office furniture, and empty computer boxes that appeared to be trash.” The report concluded that the problem appeared to be a consequence of the St. Petersburg VA’s failure to make adequate arrangements for the processing of mail it received.

All told, the investigation found that more than 41,900 mail packages were allowed to pile-up. According to the anonymous tipster who initially brought attention to the problem, due to the delay in opening mail and adding it to the system, “claims were processed in the absence of supporting evidence.” This allegation, coupled with the findings from the Inspector General, offer credence to the notion that the VA’s recent efforts to reduce the backlog of claims has resulted in a push for quantity rather than quality.

The report also raised concerns about security protections for the VA mail and records that were sent to the private facility for processing. The report indicates that they observed “malfunctioning video surveillance of the rear storage area, employees freely roaming in this area, and adjacent unlocked … exit doors to the outside of the building.” This means that just about anyone would have been able to access or even steal confidential information about thousands of veterans, including their social security numbers and medical records.

While this report is alarming for all veterans, those living in Florida should be especially concerned. Not only has the VA exposed them to potential identity theft, it has been deciding claims without reviewing all the evidence that has been mailed to them by veterans. We would encourage any veterans in Florida who have had their claims denied to file an immediate appeal to protect their rights from being squashed by what appears to be a severely mismanaged VA regional office.

In the Washington, DC area, a news station investigation has revealed that VA whistle-blowers have been subjected to harsh punishments for their attempts to bring problems to light. Meanwhile, VA employees caught breaking the rules or even doing criminal things have been allowed to keep their jobs. Investigators uncovered instances of VA employees keeping their jobs after having sex on the job, sleeping at work, being drunk at work, selling drugs, and bringing guns to work. Hear the full story by watching the video above.

(Hat Tip to NBC4 in Washington for uncovering this story)

Note: If you have an advertisement-blocking enabled on your browser, it may prevent the video from playing properly. If the video does not display properly, click here to be taken to NBC4’s website to view the piece there.

EmailInternal VA emails sent last week suggest a new scandal is bubbling to the surface. The latest controversy surrounds the scheduling of medical consultations which, as we have explained before, have been a major source of delay for veterans seeking VA healthcare.

On November 20, Dr. Lara Wagner, the Director of Sleep Medicine Services at the New Mexico VA Medical Center fired-off an email regarding a strange issue she had encountered. According to Dr. Wagner’s email, she noticed that requests for consultations that had been pending for over a year were mysteriously being canceled and then re-entered into the system.

After listing a number of instances where consultations had simply disappeared, Wagner wrote “it is distressing to find out that many of the studies that we ordered have not been performed,” continuing by saying that “it is horrifying to think that these patients are going to fall through the cracks because these consults are being canceled.” Suspicious of why the consultations were being canceled, she inquired “surely we are not canceling [these year-old] consults in order to make it seem that care is not being delayed.”

After sending the message, Dr. Aaron Pierce echoed Wagner’s concerns, saying that he too had noticed that older requests for consultations were being mysteriously canceled and re-entered and asking whether “there is something particularly important/relevant about a consult still being open after a year?” Being more blunt that Wagner, Piece wrote that it “should be documented accurately” if it is “really taking a year for Integrated Care/Triwest to complete” consultations. He also complained that canceling an old consultation requests and creating a new one required him to repeat work unnecessarily.

In response to the messages from Wagner and Piece, Acting Chief of Staff James Groff responded by writing that “we have a major issue with open consults greater than [one year] and we are going through a facility wide herculean effort to resolve many old consults.” Continuing, Groff told the doctors “Do not shoot the messenger- get smart about the process.” What the Acting Chief of Staff meant by this is not clear.

While it is unclear what exactly is going on at the New Mexico VA Medical Center, it seems that doctors at that facility believe that the VA regularly cancels and then re-enters appointments into its computer system in an effort to conceal the amount of time that veterans are waiting for healthcare. When reached by comment on this issue by the Daily Caller, the source that originally broke this story, a VA official said that “no consults are being inappropriately cancelled.”

The VA spokesperson said “in some cases, consults are sometimes cancelled at the request of the patient, or when no longer clinically indicated.” Yet neither of these reasons could explain the issues revealed by the VA doctors, who say that the consults are being canceled and then immediately re-entered into the system. While it is too early to tell, the VA physicians appear to suggest that deleting the delayed consultations and then re-entering them into the system serves to conceal the amount of time that veterans are waiting for treatment.

More often than not, Congressional hearings are excruciatingly boring. Today’s subcommittee hearing was no different. Luckily for you, I watched the hearing so you don’t have to. You can read my summary below. If however, you have a lot of time to kill, you can watch the full hearing above.

The Subcommittee on Health of the House Veterans Affairs Committee met today to hear remarks on a number of pieces of legislation which would impact healthcare for our nation’s veterans. The goals of these bills varied from decreasing wait times to improving care options for survivors of sexual assault. Given that these bills are very early in the legislative process, it is difficult to know what chance they stand at becoming law, but the fact that a hearing was held at all may be seen as encouraging.

ORourkeOne of the more interesting pieces of legislation discussed during the hearing was the Ask Veterans Act (H.R. 1319). To introduce his bill to the committee, Representative Beto O’Rourke of Texas (pictured) described how, after raising concerns about wait times with VA Officials, the VA told him that what he was “dealing with here are some cranky ornery veterans” and that  “some of these folks you just can’t make them happy.” Because something just didn’t add up between the stories he heard from veterans and the VA’s statements that the vast majority of veterans saw doctors within 14 days, he commissioned a study to determine whether the veterans he spoke with were exaggerating or if the VA was being misleading. His study found that “on average, veterans in El Paso waited over 80 days for a primary care appointment, and over 70 days for a mental healthcare appointment.”

Based on these experiences, O’Rourke crafted the Ask Veterans Act which “would simply require that the VA contract with an independent third party to assess true wait times.” Unlike some VA data which is essentially hidden from the public, O’Rourke’s bill would require the VA to “publish these reports publically on the web for everyone to see and to be held accountable.” This bill stands-out among those discussed during the hearing, and we are hopeful that independent oversight of the VA will become a reality through this legislation.

MosleyNext up was the Military SAVE Act (H.R. 1603) which would amend the Choice Act to allow veterans who were the victims of military sexual trauma to receive treatment at non-VA facilities. The most powerful testimony of the entire hearing came from Susan Moseley (pictured), a veteran who faced sexual assault by a superior during her service. After her discharge, Moseley faced a difficult life but, after sixteen years, was able to find a VA therapist who could help her. Unfortunately, due to staffing burdens, she could only see that therapist once every three weeks. “That was all the VA could offer us,” she said. The Military SAVE Act would answer the lack of specialized VA therapists by allowing survivors of military sexual trauma to seek outside treatment. As explained by LaRanda Holt of American Legion, “this is about trying to find the right treatment and therapy for every veteran, and in the case of [military sexual trauma], unique circumstances can shape treatment and therapy needs.” As people who have represented victims of military sexual trauma in our professional lives, we unreservedly support the Military SAVE Act.

RobyThe only legislation to face any obvious opposition from members of the subcommittee was the Failing VA Medical Center Recovery Act (H.R. 3234). The bill’s sponsor, Representative Martha Roby of Alabama, explained the goals of her bill by saying, “similar to how a state superintendent would take-over the day-to-day operations of a failing school, this legislation requires the establishment of highly-specialized teams to take over the day-to-day operations of the worst VA facilities in the nation.” According to Roby, the worst of the worst among VA medical centers would be managed directly from Washington until they were able to improve. Representative Phil Roe of Tennessee questioned the wisdom of the bill, observing that “just because the VA gets centralized doesn’t mean it gets better.” Citing issues with the Choice Act, Representative Roe expressed that he was “not sure making it more bureaucratic and putting it up to people who are in charge [in Washington] who weren’t successful to begin with is going to work.” While this legislation may sound good at first blush and has some admirable goals, we share Representative Roe’s concern that more bureaucracy might not be the right solution to the problem.

During its hearing, the committee also heard about bills that would address more technical concerns about the delivery of VA healthcare. Citing an instance where a veteran was nearly thrown from his vehicle due to an incorrectly installed chair lock and a case where a veteran’s bumper was ripped-off by a wheelchair lift, Representative Jackie Walorski advocated for her bill (H.R. 3471) which would impose licensing standards on contractors who install wheelchair lifts and similar equipment on vehicles for disabled veterans. Also addressed was a bill (H.R. 1904) aimed at increasing the number of professionals who create prosthetics for veterans by issuing grants to colleges and universities that establish programs to train such workers. Highlighting the importance of such action, the bill’s sponsor Representative Matthew Cartwright of Pennsylvania stated that the number of veteran’s requiring prosthetics has increased 300% since 2000, yet there is a shrinking workforce of professionals who create their prosthetics. The committee also heard testimony on a hyper-technical piece of legislation that would redefine the qualifications for Marriage and Family Therapists employed by the VA (H.R. 2639).

Also discussed were several proposals which have not yet been introduced, including legislation aimed at dealing with over-prescription of narcotic pain killers as well as a proposal that would better facilitate the VA’s arrangement of outside healthcare. We will be certain to keep you posted once ink meets paper on these proposals.

As part of his mission to improve transparency and cut through red tape, VA Secretary Robert McDonald has been telling veterans and VA employees to call his cell phone if they have a problem. When some TV commentators tried to reach out to the Secretary on his cellphone, he did not answer the call and his voicemail box was full. In many ways this situation is emblematic of the the broken VA. You can watch the full story above.

(Hat Tip to Fox News for calling-out the Secretary)

By nearly any metric, the Department of Veterans Affairs usually fails to achieve its mission of caring for veterans.  I’m sure that there are many categories which could be measured, but what good is any measurement if the results are kept a secret.  I don’t trust the VA to be either transparent or honest about its metrics, but if VA were more transparent, it would be a lot harder to be dishonest about its measurements.

VA maintains detailed, internal measurements about its performance in a multitude of categories, but these statistics are neither revealed to the public nor readily available to public inquiry.  Indeed, the only time that most of VA’s internal statistics come to light is when they are revealed to legislators as part of testimony to Congress.

Congress can mandate transparency, and indeed, Congress has mandated VA transparency in the past.

A number of years ago, Congress passed a law that requires the Chairman of the Board of Veterans’ Appeals to publish an annual report.  Although there hasn’t been a Chairman at the Board for a number of years (which is a story for another day), the Board is still required to publish the annual report each year.

The Board is required to report its activities during that year and the projected activities of the Board for the current and subsequent years.  Further, the Board must provide very detailed statistics in a number of categories.  For instance, the Board reports the number of decisions it issues, and the disposition of those decisions.  For example, there were 10,876 denials of compensation claims in fiscal year 2014.

The report also lists the average amount of time it takes VA to complete certain actions.  For example, the Board reported that the average length of time between the filing of an appeal and the Board’s decision of the appeal was 1,038 days in 2014.  In other words, the Board reported that it took nearly 3 years to decide an appeal.

Of course, this statistic is important, but it’s terribly misleading.  It’s misleading because it doesn’t take into account the time it takes for VA to issue a statement of the case after receipt of a notice of disagreement, which is an average 330 days. If you add in this time, it takes the Board nearly 4 years to decide an appeal.

Now that VA has revealed these statistics, the question becomes “Should it take VA four or five years to decide an appeal filed by a veteran or a widow?”  Asked in a different way, should a disabled veteran who is homeless have to wait four or five years for VA to decide his appeal?  What if that veteran had to wait a year for VA to make the initial decision before he filed an appeal?  Is VA achieving its mission if a disabled veteran has to wait four or five years for benefits?

Metrics, the measurement of certain processes, are important.  VA compiles these statistics daily, weekly, and monthly.  They aren’t always honest about their numbers, but they are under no legal obligation to reveal their numbers publicly.  Perhaps by next Veterans Day, VA will be required to publish their compiled statistics weekly, monthly, and annually.  I call on them to do just that.

Investigators at a local television station in Minnesota have unearthed some startling information about medical treatment at one of the state’s largest VA medical facilities. According to audio recordings of internal VA meetings, VA doctors raised concerns over patient safety alleging that the doctors were being overworked and that “mistakes are being made.” According to these doctors, they are being assigned far more patients than is deemed safe by the VA, and management covers-up these high workloads by creating false records indicating that patients were assigned to physicians who have not worked at the facility in years.

(Hat Tip to KMSP-TV Fox 9 for its excellent reporting)

There are no words to describe the strange video you can watch above, which shows VA workers playing a real-life version of the children’s game Hungry-Hungry-Hippos. According to the site to which the video was leaked, the footage shows VA employees participating in the “Halloween CREW Carnival” at the Tomah VA Medical Center in Wisconsin. This is the same facility that has been at the center of a scandal recently that resulted in the firing of its Chief of Staff. The carnival for VA workers apparently took place on October 30, 2015 and reports suggest that it lasted most of the day… time when these VA workers were presumably being paid to help veterans. 

(Hat tip to DisabledVeterans.org for obtaining this bizarre footage)