MEMO TO: Veterans Affairs Secretary-designate Robert A. McDonald
RE: The VA's crisis is even worse than you think!
Your good news is that the White House, Congress and Department of Veterans Affairs are no longer in denial about the reality that things have gone terribly wrong in the VA hospitals. Indeed, all America finally knows the systemic shame of VA hospitals' treatment delays, faked records and cover-ups.
And apparently, the monstrous job of fixing the VA is yours. Republicans are praising your experience as Procter & Gamble's CEO. Your Senate confirmation seems assured.
But the publicly released summary of White House deputy chief of staff Rob Nabors' excellent tough-truth VA report to the president, which focused mainly on VA hospitals, leaves one major concern: Your news bosses probably still haven't grasped the full breadth, depth and pervasiveness of all that was allowed to go so wrong, for so long, at the VA.
VA pension and benefits claims bureaucracies are failing our military veterans and their families as shamefully as the backlogged VA hospitals are.
PENSIONS: Bill, a severely wounded World War II veteran, had a postwar career in the post office. When he died in January 2011, his widow, Diane, simultaneously sent the VA and U.S. Postal Service all the vital documents, requesting her share of both pensions as Bill's surviving spouse.
USPS immediately calculated Diane's pension share and her first check arrived when Bill's would have, in February. But half a year went by without a VA pension check. As her living expenses mounted, the VA asked for documents she'd already sent. I'd heard of Diane's plight, asked a VA official about it; Diane got a phone call from the VA the next day. Diane's first VA pension check arrived in August.
I asked a top VA official why the VA couldn't simply do what the USPS did for the widow. The official launched into a long explanation about VA lawyers and the need to determine if Bill died due to old war injuries, which would mean a larger pension. So I naturally asked: Couldn't the VA instantly pay her the base pension? And then pay her more, retroactively, if it proved to be a service injury death?
The VA official's eyes widened, he slapped his palm down on the conference table, then scribbled a note to himself. Yes, he said, that's a better way to do it. He's a good person; but his managerial mind has been shaped by the VA's cultural mindset. Changing that mindset is the new VA secretary's most urgent challenge.
BENEFITS: When VA claim adjudicators issue denials -- as they often do -- an appeals process begins. The appeals court remands some 60 percent of the claim denials back to the adjudicators for reconsideration due to one mistake or another. And it all starts over again. The top level appeals court has ruled the denials of the VA adjudicators and next level board of appeals were right in a mere 24 percent of the cases that got to the court. No wonder the VA's benefits claim backlog was recently reported to be one million.
HOSPITALS: Here's a proposal -- give veterans a Vet-Med card that works like a Medicare card, and pays for treatment where service is best and waiting times are brief. Not all hospitals need to provide top-level treatment for all maladies. In cities, some hospitals send major cardiac and cancer cases to another hospital specializing in those problems.
At the start of the Obama presidency, I sought to persuade the new VA secretary, Gen. Eric Shinseki, to focus on the full scope of VA failings. I'd just written a book chronicling sad cases of VA delays and denials of benefits and treatment. But back then Shinseki was in denial about what the book -- titled, "Vets Under Siege: How America Deceives and Dishonors Those Who Fight Our Battles" -- was warning.
Back then he didn't believe the subtitle. And especially, he probably didn't grasp the validity of my conclusion that an adversarial mindset had permeated the VA. Too many employees saw their jobs as assuring veterans didn't get benefits they didn't deserve. I urged that VA employees must see themselves first as veterans' advocates, tasked with what they'd earned. Nothing more, but surely nothing less.
Even in his last days, Shinseki told Congress there were only a "limited" number of "isolated" cases where VA hospitals falsified delay records. Only in his last hours did the four-star general admit he'd been deceived by a "systemic ... overarching environment and culture" within the VA.
There is one way our new bold VA secretary can change the VA mindset -- by changing the VA's name. Let all VA employees know, first and foremost, they now work for the Department of Veterans Advocacy.
Contact Martin Schram at firstname.lastname@example.org.