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?