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.

RubensGravesIn the world of public relations, an age-old trick to avoid negative publicity is to make an announcement on Friday afternoon once reporters have gone home for the weekend. The Department of Veterans Affairs employed this tactic late Friday when they announced that the two officials at the center of the relocation scandal would remain on VA payrolls.

Diana Rubens and Kimberly Graves, two senior VA officials who stand accused of abusing a government relocation progam to the tune of hundreds of thousands of dollars have been removed from their positions as directors of VA Regional Offices. According to the VA, both women will be demoted to assistant director positions and relocated to other states. There is no word yet as to whether taxpayers will foot the bill for theses additional relocations.

During a hearing before the House Committee on Veterans Affairs earlier this month, both Rubens and Graves refused to answer questions from members of Congress regarding their role in a scheme that came to light as the result of a damning report from the VA Inspector General. After learning of the VA’s decision not to fire Graves and Rubens, Representative Jeff Miller of Florida, Chairman of the House Committee on Veterans Affairs blasted the agency, saying: “For those wondering whether VA is committed to real accountability for corrupt employees, VA leaders answered that question today with a resounding ‘no.’”

Despite the announcement that the two women will not lose their government salaries, this does not appear to be the end of the scandal by any means. The VA Inspector General has referred the matter to the Department of Justice for possible criminal charges. Regardless of the outcome of the criminal investigation, the fact that VA leaders could not muster the courage to fire these women for their role in these events exposes a startling lack of accountability within the scandal-ridden agency.

On Friday, I told you about the enormous delays associated with filing an appeal after the VA denies a claim. After I posted that story, a letter arrived in our office suggesting that the delays associated with filing an appeal are far-longer than what is represented by the VA’s data. The letter so perfectly illustrates the problem of delayed appeals that I thought I would share it with you:

The Real Backlog-Part2Dear Mr. Ravin,

Thank you for your inquiry concerning your [client’s] appeal. We received your Notice of Disagreement on August 14, 2013.

Appeals are considered by the Appeals Team as promptly as possible, and in docket order. Currently, the Appeals Team is reviewing cases submitted in 2009 and early 2010. We expect your case to come up on the docket for review in the next 12-24 months.

We recognize that the appeals process can be lengthy and we remain committed to completing cases as quickly and accurately as possible. We apologize for the inconvenience that this may cause you and appreciate your patience and understanding during this time.

Sincerely Yours,

RO Director

This letter raises a number of concerns about the true nature of the VA’s backlog. Just the other day, the Secretary of the VA announced that his agency had reduced the backlog “by almost 90percent.” What the Secretary was referring to in his remarks was the reduction in the number of claims awaiting an initial decision from the VA and, indeed, the VA proudly touts the fact that the number of claimants waiting more than 125 days for an initial decision has fallen from over 600,000 in March 2013 to just over 75,000 today. What the Secretary’s statement, and indeed most coverage of the claims backlog, fails to account for is the tremendous wait associated with filing an appeal of an initial decision.

As I noted the other day, according to data published last year, it takes the VA, on average, 330 days to issue a Statement of the Case after a claimant files his Notice of Disagreement. However, according to the letter we received regarding our client’s case, it will take the VA between 1,184 days and 1,549 days to issue a Statement of the Case under the current circumstances. More troubling, the letter suggests that, as of November 2015, the VA is still working on appeals received in “2009 and early 2010,” which amounts to a delay of over five years.

What accounts for the enormous disparity between the VA’s published 330-day delay and the projected delay over 1100 days in this case? This is a difficult question to answer. One possible explanation is that the VA’s concerned efforts to reduce the backlog of claims awaiting an initial decision has led to a spike in the number of appeals being filed, thereby increasing the amount of time veterans must wait to clear the first hurdle of the appeals process. The disparity could also be due to the fact that the 330-day figure is outdated, having been released nearly a year ago in the Annual Report of the Board of Veterans’ Appeals. The Board is expected to release its latest annual report by the end of the month and at that point we should be able to see whether the delays encountered by our client are unique to the Pittsburgh Regional Office which sent us this letter or are the new norm across the VA system.

As I said the other day, while the reduction in the backlog of undecided initial claims should be applauded, we cannot allow such progress to make us lose sight of other bureaucratic delays encountered by our nation’s veterans. If the letter discussed above is any indication, the backlog of appeals will be the next big scandal.

Average Wait Time in Days-2

Take a look at this chart. This is what the real VA backlog looks like. The chart shows you the average number of days that a veteran must wait in order for the VA to take a particular action on his or her claim, based on the most recent data available. The figure highlighted in orange represents the number of days, on average, that veterans wait to receive an initial decision on their claim for disability compensation. This is the number that we hear about all the time when we read about the backlog of VA claims.

The other three figures represent the average amount of time a veteran must wait to reach the three major milestones associated with filing an appeal after an initial rating decision. Unlike the four month wait associated with a rating decision, the average veteran waits almost four years to receive a final decision on his appeal. This is a sad fact that is mostly overlooked when we talk about reducing the “backlog” of veteran’s claims but it is equally important. A few simple changes could drastically reduce the delays associated with appeals.

First, forcing veterans to wait a year to receive a Statement of the Case is an unfortunate and entirely avoidable problem. As I have explained in the past, the only difference between a Rating Decision and a Statement of the Case, or “SOC,” is that the “SOC contains a section of ‘pertinent laws’ which is little more than an extensive collection of boilerplate language highlighting the legal authorities applicable to the denied claim.” Because there is no apparent reason the VA could not simply list the “pertinent laws” in an initial Rating Decision, the SOC is an unnecessary part of the appeals process that adds nearly a year of delay for veterans who file appeals. The SOC should be eliminated entirely, and doing so would reduce the average length of an appeal by 330 days.

What is most striking about the delays associated with appeals is not the fact that veterans must wait a year for VA to send them an SOC but that they must wait almost two years for the VA to do the simplest of tasks. When a veteran receives an SOC, he files a form to complete his appeal to the Board. Once the VA receives this form all it needs to do is send the appeal documents to the Board of Veterans’ Appeals in Washington. Inexplicably, it takes the VA an average of 681 days to simply put your claims file in a box and send it to the Board.

From time to time, I have heard VA employees attempt to justify the 681 day delay by arguing that veterans often submit evidence after filing their appeals and this requires the issuance of a supplemental SOC. Assuming this is accurate, the elimination of the SOC for which I have advocated would go a long way toward eliminating this perceived issue. In any event, the fact that a two-year delay is associated with such a simple task of putting some papers in the mail is symptomatic of a broken bureaucracy. The greatest reduction of the appeals delays would be accomplished by requiring the VA Regional Offices to forward appeals to the Board in a timely manner.

Lastly, it takes the Board far too long to issue a decision once it receives the appeal. While I can acknowledge that Board decisions are considerably more complex than initial Rating Decisions, I see no reason why it should take 250% longer to issue a Board decision than a Rating Decision. For one, Board decisions are drafted by highly-trained attorneys. Thus, while Board decisions are more complex than Rating Decisions, the people who write Board decisions are also more skilled than the individuals who write Rating Decisions. The VA has a stated goal of issuing initial rating decisions within 125 days and I believe it should adopt a goal to issue a Board decision in the same amount of time.

Because we often focus on the delays associated with receiving an initial decision, we end up losing-sight of the far more extraordinary wait times that veterans face when they appeal a VA decision. Worse still, while the VA has adopted goals aimed at reducing the delay associated with receiving a Rating Decision, I am unaware of any goals which would aim to reduce the appeals wait times. Until the VA adopts a holistic approach to tackling the backlog, it has only committed itself to fixing half of the problem. It’s time we stop settling for half measures.

An interview with a former VA hospital appointment scheduler puts the healthcare delay problems in a startling new light. According to Nick McSwain, a man who scheduled appointments by the phone at a Tampa Bay area VA hospital, employees were instructed to manipulate appointment data in order to make the amount of time veterans were waiting appear smaller than it actually was. He quit his job earlier this year to clear his conscience after he realized that his participation in this scheme to fudge-the-numbers may have led to the deaths of veterans. You can watch the full interview above.

(Hat Tip to Fox 13 News of Tampa Bay for breaking this story)

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)

Last week we told you  about startling allegations of ineffectiveness, incompetence, harassment, and cronyism within the VA Central Office. Yesterday we learned similar allegations, these ones coming from a VA healthcare facility in Danville, Illinois. According to the documents, first obtained by the News-Gazette in East Central Illinois, the Director of the VA Illiana Health Care System was fired earlier this year amid allegations that inappropriately involving his employees in his own personal relationships, threatened to fire another employee who filed a complaint against him, and misled VA officials investigating the incidents.

The official at the center of the controversy, Japhet Rivera, is alleged to have taken a number of untoward actions motivated by romantic relationships. The first such instance is alleged to have occurred in November 2014, when Rivera sent messages to a trainee he supervised who happened to be the son of a woman with whom he was romantically involved. After the trainee responded that he wished “to be left out of the goings-on between my mom and you,” Rivera allegedly gave him a letter he had written which seemed to suggest that his Rivera would induce the woman to sever ties with her children unless the trainee gave his approval to the relationship.

Later, in February 2015, Rivera is alleged to have instructed his assistant to send harassing emails to another VA employee who had recently ended a relationship with him. After the assistant sent the message, the woman responded that Rivera was “acting crazy” and “in a dark place” due to the recent break-up of their relationship. Rivera is alleged to have forced his assistant to send these and other messages to his former girlfriend despite being uncomfortable having involvement in his personal relationships. Both this incident and the one involving harassing messages sent to the trainee were found to constitute “conduct unbecoming of a senior executive.”

The report also details an instance of apparent sexual harassment in which Rivera approached one of his subordinates and told her that she was “the only one who has permission to wear jeans and boots to work anytime [they] want.” The woman who was the subject of Rivera’s comment’s allegedly felt the comments crossed the line and led her to believe he was a “womanizer.” This incident was also found to constitute “conduct unbecoming of a senior executive.”

In January 2015, after one of Rivera’s subordinates complained to an Associate Director that he was not doing his job and had failed to respond to email or make timely decisions on important matters, Rivera cornered the employee who had complained and informed her that he was “preparing paperwork for her termination.” Because of these events, the report says that Rivera’s alleged threats were improper and “could be reasonably perceived as retaliatory” against the employee who made the complaint.

Senior VA officials ultimately found that Rivera should be removed from his job, stating in a letter to him that “your failure to conduct yourself professionally in your interactions with subordinate staff and your failure to fully cooperate with the administrative investigation of these matters demonstrates extraordinarily poor judgment.” After Rivera responded to the proposed termination and apparently challenged the credibility of the individuals involved in the incidents, a senior VA official informed him “your lack of remorse and your failure to take any responsibility for your misconduct have convinced me that you are not an appropriate candidate for rehabilitation.” Mr. Rivera was officially removed from his position on May 19, 2015, following a month-long suspension with pay.

While these incidents only concern improper conduct of one official at one VA facility, we saw last week that there are numerous ineffective leaders within the VA. Surely there are others whose misdeeds we do not yet know.

A startling report  has come to light revealing pervasive problems with the effectiveness of managers within the VA Central Office. The report, first reported by a blog  covering government executives, was prepared at the request of the Secretary by the American Federation of Government Employees. It recounts some shocking allegations of mismanagement, incompetence, harassment, and cronyism among top managers within the Central Office.  The most troubling thing about this report is not necessarily the allegations it contains, but the fact that many of the VA employees responsible for delivering benefits and healthcare to our nation’s veterans apparently are unable to unwilling to perform their jobs properly.

The union’s investigation led it to create a list of managers who were identified as “disruptive and ineffective” based upon meetings with employees within the Central Office. All names and identifying information from the report has been redacted, but here is a breakdown of the more serious allegations against the managers investigated.

  • One manager was called a “bully” and noted that “employees avoid him and contractors fear him.” He was alleged to be “obstructive, divisive, combative, and argumentative,” and “he actively discourages teamwork.” He “practices favoritism” and is “especially fond of those who share his religious beliefs.” “He reprimands employees for being too proactive, and appears to believe that those who show initiative are trying to unseat him.”
  • One manager was described as “removed and aloof” and was found to not understand the subject matter of the division that she manages. She “ignores and even violates regulations and policy” regarding accommodations for employees who are “veterans with service-connected disabilities.” When an employee suggested “outreach to veterans who were over 65,” she reportedly stated “maybe we don’t want them in the system at the present time.”
  • One manager was hired “despite her lack of success at another Federal agency,” and her hiring “was a mistake of the highest order” due to “her reprehensible conduct and ethical shortcomings.” Upon receiving her management position, “she hired her best friend of more than 20 years,” and subsequently “hired the son of [an individual] who had hired her.” She required her employees to “request permission to use the bathroom.” Staff report that the “office resembles a prison ward.”
  • One manager was called a “disgrace” and “oppressive to his subordinates.” He “has a tendency to shout at employees” and “communicates in a confrontational manner.” He reportedly “delegates [work] but does little work himself,” and “is often seen playing games on his computer.” “He has a long history of harassing women,” and has been “the subject of numerous complaints by women.”
  • One manager, who was described as “unpleasant,” regularly “intimidated subordinates by shouting and swearing.” He reportedly allowed contract workers to share office space with government workers, allowing them to be privy to privileged information intended only for government employees.
  • One manager’s employees reported being “fearful, unhappy, and filled with dread when reporting for duty.” Her behavior has led some of her employees to seek “treatment for stress-related conditions that did not exist before encountering her.” This manager reportedly started working for VA “years ago,” and after “failing at that position” she “appears to have been placed in a position with no clear duties” that “was created just for her.”
  • One manager, described as a “high-level executive,” was said to have a “tendency to sweep problems under the rug.” She was noted to be the supervisor of another manager mentioned in the report and it was alleged that “she ignores [his] misdeed and sweeps up after him.”
  • One manager described as a “top executive” who “is featured as one of VA’s senior leaders on the VA website” supervises several managers detailed in the report. Despite being “well aware of their deficiencies,” he does nothing to correct the behavior of these managers. Despite his high pay and large bonuses, he does not work toward bettering the VA and his “sole interest is self-preservation.”
  • One manager of service-connected veteran-employees forced these workers “to return to the office despite documented medical advice indicating that a return to the office was ill-advised.” He has been the subject of at least seven complains for harassment and hostile work environment, and he retaliates against employees who make such complaints. “He asserts that he has an open door policy when his door is ajar, but his door and blinds are shut almost all of the time.”
  • One manager, whose “abuses are legendary,” was described as “grandiose, distrustful, jealous, vengeful, manipulative, resentful and vicious.” He reportedly “began to spread salacious rumors about a service-connected Veteran who worked for him, which caused her a great deal of distress and exacerbated a service-connected disability,” leading to her hospitalization. He reportedly made disparaging remarks about a subordinate who he suspects of being gay, and berates employees “who might greet each other in Spanish or exchange pleasantries in Spanish with the cleaning staff.”
  • One manager reportedly did not “like or respect African Americans” and made “racially-oriented comments.” She “screams when upset and whenever she is questioned,” and “employs street language to express her rage.”
  • One manager “sends harassing emails to subordinates whom she insults and treats in a derogatory and disrespectful manner,” and “once told a service-connected veteran to perform or get another job” despite the fact that there was no performance issue with the veteran.
  • One manager, who supervises the attorneys responsible for writing decision of the Board of Veterans’ Appeals and may even be one of its judges, is described as “unreasonable, unpleasant, and tyrannical.” She has reportedly violated the law by failing to comply with requests for leave from pregnant employees. “She uses her authority as a [tool] to bully staff attorneys.”
  • One manager “engages in cronyism by hiring personal friends for senior positions.” He reportedly “retaliates against employees who file complaints and more than one employee complained that [he] was particularly hostile to African Americans.” Several employees indicated they were “afraid to be alone with him.”
  • One manager refuses to give “direction” or “autonomy” to employees who commanded troops in Iraq with one veteran-employee noting that he was only allowed to exercise authority “over his pencil cup.” Reportedly, she “mistreats employees facing grave personal crises, she humiliates employees in public, and she states explicitly that those who are not happy should seek employment elsewhere.”
  • One low-level manager had “abhorrent” management practices and routinely harasses “veterans who deserve gratitude and respect, especially to the VA.” She “harassed and used petty incidents to propose harsh discipline based in a large part on the employee’s service-connected disabilities.”
  • One manager “causes apprehension among older employees because she discusses relative age and makes sure she always knows the identity of the youngest employee at the office.” Reportedly, “older employees are taken to task when she is dissatisfied whereas young employees do not suffer similar consequences.

It is not often that we get to look behind the scenes at the VA, and the union’s report suggests a high level of dysfunction among leaders within the agency. Without a question, the report shows that the VA is broken.

“The findings of this report unfortunately shed an unflattering light on a culture at VA that is still broken,” declared Representative Jeff Miller, Chairman of the House Committee on Veterans Affairs, firing the first shot in what is sure to be a new scandal involving the Department of Veterans Affairs. This morning, the House Committee on Veterans Affairs held a hearing in relation to a September report issued by the Office of Inspector General at the VA which revealed that senior officials within the Veterans Benefits Administration had abused their positions and misused a government relocation program.

Although other individuals were investigated, the Inspector General’s report centers on the case of Diana Rubens, a VA executive formerly based in Washington, who took a new position as the Director of the Philadelphia and Wilmington VA Regional Offices. A total of approximately $274,000 was spent by the government in order to facilitate the relocation, the majority of which, approximately $212,000, was paid to a government contractor who purchased Ms. Ruben’s home through a government-sponsored program. Another $16,000 was spent on moving and storage, and a further $33,000 was paid to Rubens for expenses relating to lodging, meals, and other expenses associated with her relocation.

The scandal centers on the fact that Ms. Rubens’s relocation was apparently unnecessary, and proper procedures were not followed. Deputy Inspector General Linda Halliday testified that there were in excess of 120 candidates for the position, yet the job opening was never advertised and was simply given to Ms. Rubens. According to Chairman Miller, the fact that there were over one hundred applicants for the opening contradicted previous statements from the VA that positions at the Philadelphia office were “tough to fill.” Worse still, the position to which Ms. Rubens relocated “involves significantly less responsibilities” than her previous position, according to testimony provided Halliday and, despite this, Ms. Rubens’s salary remained at the same level at it had in her previous position.

The hearing did not go as it was originally planned. Despite the fact that the committee had asked several VA employees to appear for questioning, Chairman Miller indicated that they were “not allowed” to attend due to instructions from senior VA officials. “They were asked to be here to go over the facts of the report, not to determine their innocence or guilt,” said Miller before the committee unanimously agreed to issue subpoenas to compel five VA officials involved in the scandal to appear before the committee. Unless circumstances change, the five officials will be required to attend a November 2nd hearing, or risk being held in contempt of Congress. Underscoring the seriousness of this turn of events, Chairman Miller noted that this was only the fourth occasion in the committee’s history in which subpoenas were issued.

The hearing came only days after of Undersecretary for Benefits Allison Hinkey resigned in the wake of the initial publication of the Inspector General’s report. While Hinkey’s role in the scandal is less than clear, Halliday noted in her testimony that Hinkey had encouraged Ms. Rubens to pursue the relocation and ultimately signed-off on the move. Hinkey’s absence from the hearing did not go unnoticed, and she was one of the individuals called-upon by the committee to appear at another hearing early next month.

Comments from the members of Congress who sit on the committee largely focused on their frustration with the scandal-ridden VA, and the perception that it has done little to improve. Representative Jackie Walorski called the Inspector General’s report another “crisis of confidence,” referencing the numerous other humiliations that the VA has faced in recent years. Noting that “there is ample evidence that VA does not move quickly when it comes to accountability,” Chairman Miller argued that Congressional attention was necessary, lest the VA just sweep another scandal “under the rug for an extended period of time and wait for public attention to be refocused elsewhere.”

A large portion of the hearing was consumed by members of the committee questioning the wisdom of government programs for relocating employees. The members were especially concerned about a Government Services Administration program under which the government facilitates the sale of an employee’s house. Under that program, a relocating government employee who cannot sell their house within 60 days is permitted to sell their home for its appraised market value to a government contractor, who will then charge the government a fee of 27.5% of the home’s value. For example, a home sold to the contractor for $500,000 would result in the government paying the contractor a fee of $137,500. The committee members seemed startled by this program, which is apparently used by all government agencies, with several suggesting the need for hearings to investigate whether such a program is a wise use of taxpayer funds.

Given the seriousness of this new scandal, it would seem that today’s hearing was only the opening act in what will likely be months of investigation and possible criminal prosecution. BrokenVA will continue to cover this scandal as it unfolds.