While Walter Reed has been dominating the news lately, the conversations surrounding it on TV are often followed by comments implicating the VA system as well. For example, Paul Rieckhoff of Iraq and Afghanistan Veterans of America writes on the Huffington Post,
But problems at Walter Reed are just the tip of the iceberg. When these same veterans leave Walter Reed...they will be entering the chronically underfunded and understaffed Veterans Affairs system—where these very same veterans will again face the long wait times, aging facilities, and inadequate staffing."
So what exactly do vets face at the VA? Well, for starters, the VA is currently taking away benefits of soldiers who have been diagnosed with post-traumatic stress if the soldier misses a scheduled re-examination appointment. In these cases, the severity of the PTSD does not matter—if the soldier doesn’t respond to the appointment, the soldier loses the benefits and is no longer considered disabled by the VA.
This is the pinnacle of cost-cutting laziness on the part of the Department of Veteran’s Affairs. Here’s what happens:
Let’s say Bob is a soldier. Bob goes to Iraq. Bob sees some pretty heavy combat and eventually starts having nightmares. When Bob leaves the Army, he doesn’t adjust well to life on the outside. He’s uncomfortable in crowds and he’s prone to some nasty mood swings. So Bob goes down to the local VA. They tell him he has PTSD and suggest to him that he apply for disability benefits that entitle him to not only monetary compensation, but also free treatment for his condition. Bob does this and, after waiting a few months, is granted a VA disability rating of 30% (although PTSD disability ratings can range anywhere from 0% to 100%). Bob is happy about this and feels somewhat vindicated that the government is recognizing what they put him through in Iraq. Bob starts getting treatment and a monthly check from the government. One year later Bob gets a letter from the VA telling him that he has to report back to the hospital for a re-examination of his condition. With furrowed brows, he thinks, "Hmmm...."
Re-examination appointments are scheduled by the VA to determine whether or not a patient has been cured of their disabling condition. It’s a method by which the VA can cut waste, fraud, and abuse and it’s a very responsible way of running such a large organization. The VA doesn’t want to—nor should it—continue paying people who aren’t disabled. The problems start when the VA itself begins abusing this mechanism as a way to slash costs. One way they’ve devised to do such a thing is by reducing a soldier’s disability rating to 0% if the soldier fails to show up for a re-examination appointment. This can save the VA anywhere from $115 to $2,935 per veteran per month. I detailed my own experience with this issue in a diary last November. If a soldier misses the appointment, they get a letter that starts off like this:
Dear Mr. XXXXX,
You failed to report for a scheduled VA examination and we have reviewed medical records concerning your service-connected condition and noted some improvement in your post traumatic stress disorder. We propose to reduce the prior evaluation of its disabling effect from 30% to 0%.
By "improvement" they mean that you haven’t shown up at the hospital lately. It doesn’t matter if you missed the appointment because you were curled up in the fetal position on your bedroom floor crying and delusionally yelling about "incoming mortars." It doesn’t matter if you missed the appointment because you were fighting with your wife about your listless, depressive moods. It doesn’t matter if you or the postal service simply lost the letter. According to the VA, the bottom line is this:
The evaluation of posttraumatic stress disorder is proposed to be decreased to 0 percent disabling because you failed to report for a scheduled VA reexamination without good cause. (38 CFR 3.655(c )(2))
In the letter, the VA explains the only way to refute their decision:
You may submit medical or other evidence to show that we should not make this change. You may submit this evidence in person, through the mail or through your accredited representative. The best type of evidence to submit is a statement from a physician who recently treated or examined you. It should include detailed findings about the condition(s). If we do not receive additional evidence from you within 60 days, we will reduce your evaluation.
For a person in a normal frame of mind, this may not be such a big deal. But for an Iraq veteran with a PTSD-addled brain, it could be a very big deal. In fact, if a veteran with PTSD fails to show up for a scheduled appointment, this should be seen as a warning sign, not an opportunity to save a quick buck by cutting his or her benefits. It is possible that the soldiers who need the VA the most are the ones incapable of keeping appointments.
The VA does have a valid complaint, however, if many unresponsive veterans are not keeping appointments. But rather than simply cutting benefits if the VA doesn’t get a response from veterans, they should implement something like a "three strikes" rule. Notifying and re-notifying veterans may be a hassle for the VA, but I don’t think sending out a second or third letter would be too much to ask. I think the government owes veterans the benefit of the doubt—considering the circumstances in which the veterans have been placed.