Saturday, June 20, 2009

The Department of Veterans Affairs by Martin Schram

When you leave the VA headquarters, turn right, walk south on Vermont Avenue, and turn right again, you are on H Street. And if you walk one block west, you come to Hay-Adams Hotel, just across from Lafayette Park from the White House. It is a posh place with a cozy bar and on one recent evening at about six o'clock, I found myself there, talking to a gregarious fellow with a gravelly voice, a stocky man, not tall, who was recounting to me a triumph at work that had obviously made his day.

He reviews benefits claims cases down the block at the VA, and he had just spent the afternoon researching the medical literature relating to a veteran's claims to see if experts had conclusively established that the veteran's cancer was most likely caused by something that happened during his military service. Finding no definitive connection in the literature had been his absolute triumph, which he told me about with bureaucratic exaltation. As he got to the key moment of his story, he announced his victory in a voice well oiled by the afternoon's alcohol, the decibels so loud lobbyists stopped boasting and turned to look a the VA man declared his adjudication triply:

"De-nied! De-nied! De-nied!"

Now, maybe the veteran who filed the case was indeed one of these fellows who had tossed a spurious spiel at a VA bureaucratic in the hopes of coming away richer than he deserved. But the VA reviewers unabashed glee as he shoveled through the medical volumes and dug out a factoid that cast doubt on the validity of the veteran's claim should make us wonder about the sort of mind-set we want our VA claims reviewers to have when they approach their cases. Do we want them to be intrepid investigators to find some thread of doubt somewhere, anywhere, no matter how long it takes to research- so they can shout "De-nied!" three times? Even if it is only on the basis of an inexact assertion that it is less likely than not that the cancer was caused by something that happened during the veteran's military service? Do we want our reviewers to be forever looking for the bad apples in the baskets? Or do we want them to move those baskets, which contain so many good apples, quickly and fairly to market- understanding that in the process we may let a few bad apples get through as well?

1 comment:

  1. Bob Filner has reached the station in life where he is a prestiguous House committee chairman, and on this autumn afternoon in 2007 he is sitting in his office, which is located in the prestiguous Rayburn House Office Building, but at the most unprestiguous south end and in a dead-end corridor at that, which means it is about as far away from the Capital dome as you can get and still not be out on the sidewalk.

    The chairman of the Veterans' Affairs Committtee is at his desk, in his shirtsleeves, wearing no tie. Power and prestige do not seem to be what Bob Filner is about. Indeed there is nothing about Chairman Filner that resembles a central casting prototype of a powerful and prestiguous chairman, and that seems to be just they way he likes it. He is a Democrat from San Diego, California, who has also cultivated one other habit that sets him apart from so many of the smooth talkers on Capital Hill: when he ask him a direct question, he gives a direct answer.

    As in this; What is the most important thing that you would change about the Department of Veterans Affairs?

    " The key point I would change at the VA is that we have set up an adversarial system between the Department of Veterans and the veterans", Filner told me. It is, he said, a "cultural thing":

    " Inside the VA they see their sole job is to say to the veteran, 'You are a liar, and we are going to prove that you are a liar and that you didn't deserve your benefits that you have claimed.' We have to get rid of this adversarial way of thinking at the VA. If we were to get rid of the adversaries, we'd get rid of tens of thousands of positions there."

    When asked what had gone so wrong, Filner focused first not on a single tangible thing but on the mind-set. The House chairman noted that in example after example the first reaction of the Veterans Affairs Department when confronted with big service related problems affecting huge numbers of veterans is to issue a blanket denial... ( e.g. Agent Orange, Gulf War Syndrome, PTSD).

    When asked what he thought of the recommendations of the presidential commission, Filner repled: "The Dole-Shalala Commsission danced around the big picture".

    He then switched to what he called a more "mundane" problem- the budget and the way that presidents and the Office of Management and Budget calculate the real costs of war. "Part of the cost is dealing with veterans. The administration gives us these budget supplementals and all of this crap and never mentions the veterans", Filner said.

    Filner's bottom line is that when budgeting for war, the executive branch must include the cost of all warmaking implements. That includes the procurement and maintentance of the weapons and other hardware during and after the war. It also includes the procurement and maintenance of troops during the war and after, when they will be eligible for various service-related benefits. Said Filner "When you give me a budget for the war, you must give me a budget for taking care of the warriors."

    Although the White House and Office of Management and Budget were unable or unwilling to provide a true picture of the cost of the war, others have, notably Linda Bilmes of the Kennedy School of Government in her 2007 study "Soldiers Returning from Iraq and Afghanistan: The Long-term Costs of Providing Veterans Medical Care and Disability Benefits". Bilmes's calculations were based on the huge increase in the ration of troops-wounded to troops-killed in Afghanistan and Iraq by comparison to other wars ( 16 to 1, compared to 2-1 in Vietnam, less than 2 to 1 in Korean and W.W.II). More than 1.4 million have served in Iraq and Afghanistan ( as of 2008)- three times the number in the original budget projection. The VA has a back-log of adjustments for the claims of 100's of thousands of veterans many of who must wait years to recieve their legitimate benefits, if at all or they if they don't die first.

    "Vets Under Siege; How America Decieves and Dishonors Those Who Fight Our Battles" by Martin Schram; Thomas Dunne Books, N.Y. 2008