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June 05, 2014 9:00 AM VA Care: Still the Best Care Anywhere? Part II

By Phillip Longman

On Tuesday, I offered some background information that called into question the now almost universal assumption that there is a “systemic” problem at VA hospitals with excessive wait times. Yes, VA hospitals in some Sunbelt retirement meccas like Phoenix face serious capacity issues due to the large number of aging vets who have moved to such areas. But in most parts of the country a shrinking population of vets threatens to force the closure of many VA hospitals for lack of patients.

Now let’s consider another, more serious, and often conflated wait time issue surrounding the VA—one that also been bringing forth all kinds of claims and accusations that are in desperate need of being put into context. I’m talking about the huge backlog of vets caught in the often protracted process of just trying to establish their eligibility for VA care.

This issue is confusing to most people, including many in the military, because they assume that vets are legally entitled to VA care, just like most seniors are entitled to Medicare or Social Security. But VA care is not an entitlement. Rather, reflecting the public’s deeply conflicted and often changing views about veterans, access to VA care is limited to vets who can establish that are “deserving” according to convoluted, arcane, and often impossible-to-prove sets of ever evolving metrics and standards.

In general and on paper, combat vets returning from Afghanistan and Iraq have access at least some VA health care for five years, few questions asked. But after that, they join most vets in having to demonstrate their worthiness for treatment by the VA. In general, to get or keep access to VA care most vets must either meet a strict means test or prove that they suffer from specific disabilities directly resulting from their military service.

Now if you want a sense of how inane, insane and time consuming the process of adjudicating such rules can be, then check out this, very typical case, recently brought before the Board of Veterans’ Appeal. Here we have an aging vet who is seeking access to the VA health care by claiming that during his service as a marine in late 1950’s and early 1960s he was exposed to the sound of grenades and gunfire, and that this exposure has since resulted in his hearing becoming so bad that it is disabling.

Now think of what proving (or disproving) this claim involves. Just establishing that he was in the military may well be a problem, due a 1973 fire in St. Louis that destroyed many military service records going back decades before. Today, if one picks up the membership magazine of the Vietnam Veterans of America, one finds pages of fine-print notices in which vets with missing records are searching for witnesses who can testify they were indeed once in the service.

But let’s assume the man filing this case can prove he was in the military and honorably discharged. Then he has to come up with the hearing test he took upon joining the military in 1956. And then he needs to get his hands on the hearing test he took upon discharge in 1962. And then he needs paperwork from doctors showing the extent of his hearing loss now. And then (and here’s the really big one) he needs to prove that his initial hearing loss really did result from being to exposed to too much gun fire and explosions during military service, as opposed to too much rock and roll, and that the subsequent worsening of his condition is not just a function of aging or some other chronic problem.

In this case, the veteran was denied his claim, and maybe that is just and maybe it isn’t. But suppose this vet could have proved that his increasing deafness was a service-related disability. Then that would have set off a whole new adjudication process to determine just how much of a disability his hearing loss might be. Under the laws and regulations under which it operates, the VA must, for example, charge some vets for co-payments, and others not, depending on whether they are rated, say, 25 percent, 30 percent, or 50 or more percent disabled. And so we have lawyers, bureaucrats, judges, caseworkers, doctors and ordinary vets caught up in debating another set of metaphysical questions. Just how much louder do vets with 30 percent hearing disabilities have to turn up the TV compared with to vets with 25 percent hearing disabilities?

Now to be sure, there are things the VA could have done and is now doing to streamline the claims process, such as making greater use of digitalized records and coordinating better with the Department of Defense. Through such efforts, the VA reports that the backlog of disability claims that have been awaiting a decision for more than 125 days is now down 283,762, which believe it or not is a sharp reduction from a year before.

But let’s get real. The fundamental reason for the still huge backlog of cases does not lie with inefficiencies of the VA’s bureaucrats, most of whom are vets themselves. Nor does it come from an increase in the numbers of vets because, as explained in my last post, the number of veterans is actually shrinking dramatically. Rather, it fundamentally lies with the American people and their representatives in Congress, who despite all their fine talk about honoring those who have served their country, have tasked the VA with administering laws and regulations that presume most vets don’t deserve VA care unless they can prove otherwise.

It wasn’t always so. As I describe in my book, the Clinton Administration opened the doors to the VA in 1996 to anyone with an honorable discharge, and many folks who got in then remain grandfathered. But the Bush Administration slammed that door shut again in 2003, and while it has reopened a bit under Obama, we are still spending enormous resources enforcing policies designed to exclude most vets from VA care.

If you don’t think most vets deserve any better, then fine. You are hardly alone. But don’t imagine that the VA’s bureaucracy should be blamed for carrying out laws and policies that reflect your views.

Phillip Longman is senior editor of the Washington Monthly.

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