Veterans Law Prof Blog

Choosing to Medicate PTSD Instead of Direct Intervention

The debate on the VA’s habit of prescribing drugs to veterans dealing with severe PTSD symptoms and providing treatment or hospitalization as an after-thought has been raging for quite some time.  Clay Hunt’s mother, Susan Selke, tells poignantly that it is her opinion the VA’s decision to heavily medicate her son’s severe PTSD symptoms and failure to give him treatment and therapy were big factors in his suicide in 2011.  (The Clay Hunt Veterans Suicide Prevention Act is the culmination of a large amount of advocacy done on this issue).   For more on Clay’s story see here: http://thelead.blogs.cnn.com/2014/07/10/mother-of-vet-who-committed-suicide-va-didnt-give-him-the-care-he-needed/

Yet another report of a veteran in need of help and sent away with medication is in the news.  This veteran, Richard Miles, went into the VA Medical Center in Des Moines to seek help for PTSD that was spiraling out of control.  The VA gave Miles medication and sent him out the door.  He was found days later, frozen to death with an excess of sleeping pills in his system.  Calls for revamping the VA’s response to veterans in crisis is again underway.  New legislation is already being proposed.  Until we as a nation, and the VA specifically, can get a handle on the treatment of veterans with severe PTSD symptoms with more beds for in-patient treatment, faster appointment times for individual therapy, loosened standards for access to the VA Medical Centers, and less dispensing of drugs without monitoring the effects, we will sadly see more of these cases in the news.  It is a criminal epidemic.

For more on Richard Miles see here: http://whotv.com/2015/03/23/veterans-gather-to-honor-richard-miles-and-call-for-change/ and http://dailycaller.com/2015/03/20/veteran-freezes-to-death-after-veterans-affairs-hospital-turns-him-away/

New Policies and an Apology for Iraq Veterans Exposed to Chemical Weapons

Changes in the DoD’s policy towards veterans exposed to chemical weapons in Iraq are in the works.  Many servicemembers in Iraq injured by chemical weapons were exposed to the substances when road side bombs containing the agents went off near their convoys.  While many rules were in place to deal with the injuries of these veterans, the rules were being ignored or applied inconsistently across the board.  Thus, the apology from Under Secretary Brad R. Carson, who was appointed by Secretary Hagel to review the military’s policy on these injuries.  New rules are also being added to allow veterans burned by sulfur mustard gas to be entitled to a Purple Heart for their injuries. 

For more on this issue see here: http://www.nytimes.com/2015/03/26/world/middleeast/army-apologizes-for-handling-of-chemical-weapon-exposure-cases.html?_r=1

Is Jon Stewart’s Comedy Central Show Impacting Policy at the Department of Veterans Affairs?

Within six hours of Jon Stewart’s comedy news show airing a piece on the impact of the VA’s rule requiring veterans to live 40 miles “as-the-crow-flies” from a VA Medical facility to use the choice care plan, the VA changed its rules.  The new rules allow a veteran to live 40 “driving miles” away from the facility.  While this change makes imminent sense, is it a coincidence that Jon Stewart’s criticism came before a major VA policy change that doubled the number of veterans eligible for the choice care program?  It wouldn’t be the first time Jon Stewart has criticized the VA and brought national attention to its problems.  His Red Tape Diary series in 2013 brought national attention to the VA’s backlog of disability claims by breaking the issue down to a segment of society who otherwise would probably have no reason to know about this issue.  He ridiculed the VA’s lack of technology and a year later the VA began implement major technological changes that had been talked about but slow to come around.  His episode about the difficulties of Vietnam Veterans with PTSD and poor discharges brought major media attention for the first time to an issue that now has several media outlets interested and finally has a new Department of Defense policy in place to attempt to resolve the issue. 

Perhaps all of these are coincidence, but Jon Stewart’s mockery of intransigent government policies keep veterans from benefits have been invaluable to those veterans who have received help after these pieces aired.  With Jon Stewart leaving this arena shortly, let’s hope someone else in media picks up this mantle. 

For Stewart’s most recent clips see here: http://www.huffingtonpost.com/2015/03/25/jon-stewart-veterans_n_6937380.html

For an article about his past Red Tape Diary episodes see here: http://www.huffingtonpost.com/2015/03/25/jon-stewart-veterans_n_6937380.html

To see a summation of some of his most popular veteran episodes see here: http://www.wearethemighty.com/jon-stewart-military-veterans-2015-02

The VA Changes Its Rules – Filing a Claim

This week the Department of Veterans Affairs dramatically changed the rules for filing new claims and appealing decisions of the VA.   On March 24^th the VA implemented a new rule that prohibits veterans from filing what had been referred to as an “informal claim.”  An informal claim allowed a veteran to file a claim by merely sending the VA a letter or any other communication that was enough to put the VA on notice that the veteran wanted to begin the claims process.  Admittedly, this process was very veteran-friendly because the burden was on the VA to liberally read and review what a veteran sent in to determine if a claim was being filed.  The effective date of the claim was the date the informal claim was filed. 

The new rules require that a veteran file claims and appeals on special forms the VA has created for these purposes.  Claims or appeals sent in any other fashion will not be considered.  (See 38 CFR 3.155 – 38 CFR 3.157 is no longer in effect and has been repealed). 

Interestingly, the head of the Compensation and Pension Service, Thomas Murphy, told Stars & Stripes in an interview that very few veterans would be affected by this change.  However, Stars & Stripes reports that the information the VA gave to Congress to advocate for this change in the rules in fact shows that about one half of the claims filed have been through the informal claims process.  The report notes “If the VA numbers in the Federal Registry are correct, hundreds of thousands of veterans have been filing informal claims and appeals each year.” That is a lot of veterans who will need to now understand the new rules or suffer the consequences.  A heavy push is also being made to get veterans to file these claims electronically, which for our older veterans would be a truly difficult exercise since many do not use computers extensively.  There are legal challenges in the works to these changes in the rules challenging the legality of the changes and arguing that these changes are certainly not in keeping with the VA’s “pro-veteran” stance.  Keep your eyes open for the challenges and we will post about them here.

To read the Stars & Stripes article click here: http://www.stripes.com/news/veterans/va-grossly-underestimates-paper-claims-as-new-forms-policy-begins-1.336579

The VA's Problem with Perception

Yesterday it came out in the news that in December 2014, a VA social work manager at the VA Medical Center in Indianaoplis sent photos around to her coworkers that appeared to be mocking veterans - in particular those with mental health conditions.  The email showed photos of an elf in various scenes in a specific clinic at the hospital.  One photo showed the elf begging for more Xanax with a caption that indicated the elf was trying to self-medicate.  Another photo in the email showed an elf apparently hanging itself by the neck from a strand of Christmas lights and was captioned that the elf was now showing suicidal behavior.

While the employee has apologized and reiterated her committment to veterans, one is forced to ask how the VA can continually fail to see its reputation being tarnished by these reports? 22 veterans commit suicide every day.  This email seems far from harmless when viewed in light of that statistic.  While I have no doubt that most VA employees take the issue of veterans' mental health treatment seriously, it is pretty obvious the culture at this VA hospital clinic does not - not when the manager doesn't think twice about joking about it.

 How can veterans perceive that the VA wants to help when a manager makes remarks that appear to denegrate the circumstances surrounding the veterans' concerns?  To make it worse, the remarks come from the manager, who sets the culture, in charge of primary care services surrounding reintegration of Iraq and Afghanistan veterans from war to home.  Some might remember the story last summer of the VA briefing at one hospital that compared veterans to Oscar the Grouch when giving advice to VA employees on interacting with veterans.  http://www.washingtontimes.com/news/2014/aug/27/va-office-depicts-veterans-oscar-grouch/  These types of swipes at veterans really demonstrate the VA is tonedeaf while it is trying to rebuild its reptuation amongst veterans after the Pheonix VA Medical Center fiasco.  

Perhaps before veterans adjust their perception of the VA, the VA needs to take a hard look at its perception of veterans and their concerns.  

For the story on the elf emails see:

http://www.stripes.com/news/veterans/indiana-va-manager-s-email-mocks-veteran-suicides-1.333377

 

 

More Mental Health Discharge Concerns...

A recent GAO report found that the Armed Forces cannot count the number of troops who have been discharged for mental health problems that, in the military’s estimation, did not rise to the level of a disability.  When servicemembers are discharged for mental health conditions, the Department of Defense has ordered that one of five codes should be used to designate that the separation was for “mental conditions.”  None of the branches have been using these codes, making it impossible to count accurately the number of servicemembers who have been separated for mental health concerns. 

A Military Times article highlights that this failure on the part of the branches is important because it can obscure the number of servicemembers separated erroneously with no benefits who instead should have been medically retired.   With all of the problems that have plagued the services regarding misdiagnosis of mental health conditions, this concern is a legitimate one.  Now, how will the DoD deal with this development?  Do a blanket review of all discharges that are not coded (a mighty undertaking!)? 

See the Military Times article here:  http://www.militarytimes.com/story/military/benefits/health-care/2015/03/02/gao-pentagon-mental-health-discharges/24262045/

See the GAO report here: http://www.gao.gov/products/GAO-15-266

Why Employ a Veteran?

Nick Swaggert published a thoughtful piece in the Huffington Post regarding the upcoming changes to the Vietnam Era Veterans' Readjustment Assistance Act (VEVRAA).   http://www.huffingtonpost.com/nick-swaggert/veterans-become-protected_b_6699100.html   “This act requires covered federal government contractors and subcontractors to take affirmative action to employ and promote veterans protected by the Act and prohibits discrimination against veterans. The new mandate becomes enforceable as part of a company's 2015 Affirmative Action plan and established a hiring benchmark commensurate with the national veteran population, or 7.2 percent.” 

The thought part of Mr. Swaggert’s piece is why America has arrived at the need for forced hiring of veterans in the first place?  Mr. Swaggert notes correctly that after WWII employers clamored to hire veterans.  Who wouldn’t want to? Veterans know how to show up at the right place, at the right time, and in the right uniform.  They are responsible, loyal, and work hard.  But, Mr. Swaggert also notes that recently hiring veterans has turned into a liability, not a bonus.  A 2011 Fortune magazine article suggests that many employers appear to fear that veterans may be suffering from PTSD or Traumatic Brain Injury, which are seen as impediments to work.  Additionally, employers tend to believe that veterans today are too rigid or fear that veterans may be deployed in the future and miss work.  Veterans’ job skills are also often misunderstood by employers who are more and more likely not to be veterans themselves.   http://fortune.com/2013/11/11/3-reasons-why-companies-dont-hire-veterans/ 

With less than 1% of our population serving in the military, it’s obvious that more needs to be done to help veterans bridge the gap with civilian employers to negate these stereotypes.  Hopefully, more companies will voluntarily step up and welcome our military back home with jobs and not have to be forced into doing so.

For more information on VEVRAA see The Dept. of Labor’s VEVRAA site at: http://www.dol.gov/compliance/laws/comp-vevraa.htm  

More money problems at the VHA?

A newly released Inspector General report finds that two senior members of the Veterans Health Administration’s Chief Business Office illegally moved $96 million dollars  in medical support compliance funds to pay for  a claims processing system.   http://www.va.gov/oig/pubs/VAOIG-14-00730-126.pdf  and http://www.washingtonpost.com/blogs/federal-eye/wp/2015/03/04/va-illegally-shifted-funds-to-pay-for-new-it-system-in-frank-underwood-fashion/.  This news combined with the President’s desire to move unused money out of the VHA’s new program that allows vets the ability to choose a health care provider outside a VA when wait times are too long (http://lawprofessors.typepad.com/veterans_law/2015/02/choice-card-woes.html) appears to signal that the VHA is having some significant issues in managing the funds it is being granted by Congress.  While it is unlikely that VHA’s funding will be significantly affected in the wake of the Phoenix VA Medical Center fiasco, perhaps more thought needs to be put into where the VHA’s money is being spent?