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.

Courtesy of: KVOA, Tucson, Arizona

Delays and long wait times are nothing new at the VA. But some veterans say that when they sought emergency medical attention at a VA medical center on Tuesday they were forced to wait well-over 12 hours to see a doctor. The VA claims that this was a fluke, but several veterans report that wait times are often five or six hours. Check out the full story by watching the video above.

During Vietnam, many veterans were infected with hepatitis C as a result of battlefield blood transfusions or through vaccinations. Today, many of those veterans face a life-threatening illness and even death. But hope for these men came in the form of a pill which promises to cure the disease in over 95% of individuals. The catch? The six-week treatment costs well-over $80,000. With limited resources, the VA finds itself telling many veterans facing near certain death that they must wait to see if funds become available to pay for the treatment. Perhaps worse, the treatment was invented by a VA doctor who earned more than $400 million by selling the drug he designed. Take a moment to watch this tragic story about the intersection between drug prices and veterans healthcare.

(Hat Tip to the CBS Evening News for uncovering this story)

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.

MarijuanaMany reasonable people have differing opinions on medical marijuana. Most advocates argue that it offers a level of relief to patients that is unavailable from conventional pharmaceuticals, while opponents worry that it can lead to drug abuse. In recent years, an increasing number of states have made the move to legalize marijuana for medical and even recreational purposes, bringing these states into conflict with federal laws outlawing use of the drug. The legal tension between states and the federal government has placed the Department of Veterans Affairs in a difficult situation.

The case of veteran Robert Lee highlights the legal gap into which many veterans have fallen. Lee, a Vietnam veteran with arthritis and PTSD, uses medical marijuana to deal with the symptoms of his ailments. His VA doctor also prescribes him a small dose of opiate painkillers. He lives in Oregon, where medical marijuana has been legal since 1998, and where voters recently approved a measure to legalize the drug for recreational purposes. Yet, after a recent change of doctors at the VA facility where he receives treatment, Lee found himself in a tough spot.

Lee’s new doctor gave him an ultimatum: choose opiate painkillers or marijuana. According to Lee, his former VA doctor had gone as far as writing a letter saying that a small dose of opiate painkillers combined with marijuana was good for Lee’s health. Despite this, the new doctor told him that his dosage of opiate painkillers would be increased and that he must cease all use of medical marijuana. Lee says he is wary of increasing his dosage of opiates due to the risk of addiction and the fact that it has wreaked havoc on his liver. The doctor says he will not allow the combination of painkillers and marijuana to continue.

Studies have suggested that marijuana and opioids do not have dangerous interactions, and that when used in combination, the marijuana might actually enhance the effects low-dose opiate painkillers. Further, statistical analysis has suggested that the use of opioids with marijuana does not increase the risk of substance abuse. Thus, from this standpoint, it is unclear why Lee’s doctor would be reticent to allow the combination. However, with the existing legal conflicts between state and federal governments, it is understandable why a doctor employed by an arm of the federal government might be hesitant to allow a patient to use both opiates painkillers and marijuana at that same time.

Nonetheless, recent headlines have suggested that VA doctors are over-prescribing opiate painkillers to the detriment of veterans. In fact, one VA doctor in Wisconsin became known as the “Candy Man” for his liberal prescription of opioids. Congress taken notice of the problem and just this week legislation was introduced to curb the abuse of opiate painkillers among veterans. Still, the path forward for the VA remains unclear.

With the recent scrutiny of VA’s use of opiate painkillers in treating veterans, it is worth noting that a study has found that states that legalize marijuana have seen a decrease in opioid overdoses and a reduction in addiction treatment admissions. In other words, the use of marijuana appears to have curbed the abuse of opiate painkillers in states that have legalized medical marijuana.

And this brings us back to Mr. Lee, the veteran from Oregon. His VA doctor wants him to replace his marijuana use with a higher dose of opiate painkillers, a type of drug which is responsible for more deaths each year in this country than suicide, guns, or car crashes according to the CDC. At the end of the day, while his doctor may feel that marijuana is not the answer for Mr. Lee’s pain, it is clear that a better answer will not come from painkillers. As we work to solve the opiate epidemic among veterans, our lawmakers would be wise to look at Mr. Lee’s case, and to consider for a moment whether medical marijuana might be part of a solution, rather than part of a problem.

ChoiceAct-NewDevelopmentDuring a hearing today before the House Committee on Veterans Affairs, several high-ranking VA officials outlined the agency’s plans to overhaul the Veterans Choice program. That program–created in response to scandals concerning the amount of time veterans were waiting for medical appointments–has faced criticism since its implementation last year that it was overly bureaucratic and did not achieve its intended goals. During the hearing, VA officials told Congress that the current system is simply “too complicated.”

The new plan would expand veterans access to healthcare outside the VA system by consolidating various existing programs into larger integrated networks across the country. In his prepared remarks, Deputy Secretary Sloan Gibson said that the changes to the program “will clarify eligibility requirements, build on existing infrastructure to develop a high-performing network, streamline clinical and administrative processes, and implement a continuum of care coordination services.” One of the most notable changes revealed in the VA’s new proposal is the establishment of “a single set of eligibility criteria” for access to private doctors on the VA’s dime. Under the current system, access to outside providers is limited by numerous factors that are confusing to veterans, doctors, and VA employees alike.

The VA said it would need an initial $421 million in the year 2016 to get its ambitious program off the ground. Some lawmakers seemed skeptical of the revised program, with Representative Mark Takano of California saying that the “VA does not have a great track record when it comes to implementation.” But other representatives were quick to jump to the defense of the proposal, with Representative Tim Walz of Minnesota calling the plan “the silver lining out of Phoenix,” a clear reference to the 2014 scandal involving manipulation of wait time data at Arizona facilities.

Yet one of the most significant themes from certain members of Congress was a concern that this was a privatization measure. To this, Assistant Deputy Undersecretary Baligh Yehia  simply said that it did not make economic sense to “provide every [medical] service in every location to every single veteran.” Committee Chairman Jeff Miller of Florida echoed this sentiment saying that the program would “supplement, not supplant” the current VA healthcare system.

Detailed information on the VA’s new plan is sparse as of now, but a general overview can be obtained from reading Gibson’s prepared remarks. We will follow this story and keep you updated as more detailed information becomes available.

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)

Billboards are popping-up around the country proclaiming “VA is Lying, Veterans are Dying.” According to a spate of news reports from the past few days, these billboards have gone up in Phoenix, Indianapolis , and Tampa , with one source  reporting that the billboards now appear in at least six states.

The man behind the billboards is Ron Nesler, a Vietnam veteran from southern Indiana who has launched a social media campaign to draw attention to the problems veterans encounter with both VA healthcare and the VA claims process. “The point of these billboards is to embarrass the VA and embarrass the Congress and force them to do something right for the veterans,” Nesler said to KTAR News, a Phoenix-based radio station.

Nesler’s Facebook group, simply called “VA is Lying,” represents one of many grassroots movements by veterans who have grown frustrated by their encounters with the VA. The group’s Facebook page, which has nearly 20,000 followers, represents a place where veterans and their families can voice their dissatisfaction with the VA.

The billboards, which are funded by Nesler and donations, have been strategically placed  near various VA facilities, with one billboard directly facing the windows of VA executives at the Phoenix VA. The VA in Phoenix in particular has been mired  in  controversy  in recent years, starting with a CNN investigation  revealing that at least 40 veterans had died while waiting for appointments at their facilities.

The billboards “came about as way to voice our concerns. (It’s) a movement – a peaceful movement to show that us veterans have kind of had enough of the rhetoric with Veterans Affairs,” said  Mike Stifner, a Marine associated with Mr. Nesler. We at brokenVA applaud Mr. Nesler and his group for its creative approach to highlighting the issues veterans face at the VA. To learn more about Mr. Nesler and his group, you can visit their website by clicking here.