Veterans Healthcare Policy Institute
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Getting into the VA
By: Justin Straughan, Air Force Veteran
When, in 2008, the opportunity to become the first in my family to attend college was swiftly taken away due to the Florida State Legislature’s educational budget cuts, my feelings of overwhelming joy and pride quickly soured to something ugly, festering, and equally powerful. My desire to achieve a higher education set into motion a series of events, starting with military service, finding my own way to enter college, and challenges I never foresaw dealing with the bureaucracy at the US department of Veteran Affairs ~ the VA.
My VA story begins because I was disgusted with Florida for playing politics with my future. Coming from a family with no idea how to apply for college, let alone pay for it, I had stood alone before the monolith that is higher education. Now it was replaced with something more imposing: a life-changing swerve beyond my control.
I had made a promise to myself that I would find a way to pay for school without taking out loans, as I’d previously seen my family face financial turmoil after borrowing money and struggling to pay it back. And so, I began to research the military, and the G.I. Bill, an education benefit offered to service members by the military, yet administered by the VA. I needed a steady career that could overlap with my desire to make the world a better place. And so, I enlisted in the U.S. Air Force in 2009. I served for four years, as a Ground Radar maintainer in a combat communications unit. After I was injured in service, but before my discharge, I was reassigned to the Honor Guard to conclude my service. My injury developed from knee issues from cartilage damage due to flat feet and the intense high-impact lifestyle in a combat unit. My medical condition became became severe enough that the Air Force chose to code me ‘non-deployable’, meaning I was unable to re-enlist and faced imminent discharge.
Soon after my separation, I began seeking care at the VA. Like any healthcare system, the VA isn’t perfect. Yet I am fortunate enough to be treated by VA clinicians who’ve truly cared and inspired me to go into medicine myself.
My first major hurdle with the organization was securing a ‘service connection’, meaning the VA agrees your medical conditions happened because of military service. This opens the door to be seen at VA hospitals. A representative for Disabled American Veterans (DAV) advised me that I would need to file and win a disability claim against the VA before I could receive care for my military-related disabilities. The representative advised me that filing a claim while still in the military was recommended because it was ‘pre-emptory’. We filed my first claim two months before separation. That is when I learned the disability claim process can take years ~ and possibly decades if VA denies your claim and forces the veteran to appeal. Little did I know how correct the DAV’s statement about VA would turn out to be.
My first appointment was with a VA compensation department doctor in the Viera clinic to evaluate my claims. During this compensation and pension exam, he flexed my knee three times for my range of motion test under his own power, ignoring both the cracking sounds and my exclamations for him to stop. He incorrectly wrote in my chart that I was fine, that I had no disability. A VA bureaucrat then denied my claim. VA’s mistake meant that I went with limited care for my orthopedic conditions, as care is tied up to service connection, until a certain point. I later had non-VA doctors lose my imaging. It took me obtaining an independent doctor of my choice’s medical opinion as well as a lawyer for VA appeals to receive a fair rating for my knees. I should not have had to fight the organization for benefits because the information about my injuries was already contained in my USAF Medical Records.
VA’s claim process resulted in reduced care for approximately 8 months while I frantically wrote letters to Senators Bill Nelson and Marco Rubio, and my representative at the time, John Mica and later Ron DeSantis. I was largely ignored except by Senators Nelson and Rubio.
In contrast, the healthcare team outside of the Compensation and Pension department, on the medical side of VA’s facilities were faster and far more dependable. The New York Harbor Healthcare and Daytona Beach Orthopedic teams, for instance, was able to diagnose issues that other doctors had missed, including some musculoskeletal damage I have incurred. They’ve been able to recommend lifestyle changes necessary to prolong the use I have in affected areas, while my physical therapists have worked diligently through these injuries. In short, VA practitioners have been exemplary in their willingness to take the time to do little things that have made a large impact in my life.
My only other negative healthcare experiences with VA’s bureaucracy were through community care and billing departments. I have found that I do not feel well cared for by these private providers. Due to decades of underfunding and efforts to privatize the VA care system, VA sent me to private doctors, resulting in non-VA providers sending me bills for care that was supposed to be free.
I am a very knowledge-oriented individual, and as a person entering the medical field, I expect to be able to learn about the treatments doctors want to administer, not only because it is my body but also to be able to improve my own clinical knowledge.
When VA sends me to a for-profit provider, I often feel like just another number in a healthcare system that is all aboutnumbers and processing as many patients as possible in order to make as much money as fast as possible. On the two occasions I have had to visit Emergency Rooms, getting the private hospital billing department to properly bill the VA was a challenge. I ended up having to fight a black mark on my credit report for past-due collections for almost a year in each case.
More recently, I visited a private provider chiropractor who refused to see me if I didn't submit to a full back X-ray. This was a strange demand, as respected physician resources say that for acute lower back pain, X-rays are not recommended or required for treatment. The opulent office décor along with the doctor’s assurance that this was a necessity for any patient suggest that billing for unnecessary medical imaging on the taxpayer’s dime is commonplace.
My undergraduate degree was in Political Science, after attending Columbia University. This was funded largely through the Post 9/11 GI Bill and Yellow Ribbon Programs. I utilized this degree to work in local level politics and work toward learning about writing healthcare policy. I have since taken pre-med courses to round out my experience and apply to a Master’s Degree program in Physician Assistant in order to become a healthcare provider myself. This degree is through the VA’s Vocational Rehabilitation program. Through my entire post-military life, the VA has paradoxically erected barriers and given me the way to move forward and become something more than a statistic. It would be wrong of me to look back at the organization and not want to return the favour in some way, so I share my story and work to improve the bureaucracy within in order to help veterans avoid similar pitfalls and make the system for fair and equitable for all while still respecting and being a proper steward of taxpayer monies.
I have ironically found the highest quality of healthcare at the hands of an institution with a bad reputation: the Department of Veteran Affairs. Is VA perfect? No, especially their Compensation and Pension department’s delay and error prone system for veterans trying to make use of the system. But I have found myself far more satisfied with care in their hands than the times I have had to utilize civilian healthcare. The bottom line, 13 years later, is that I am finally nearing my goal of a productive civilian career, a decade and a half to overcome systemic challenges caused by out-of-touch ‘bigwigs’ in Florida’s legislature.
A Few Hours at the VA
By: Denny Riley, Air Force Veteran
I was recently given the first shot of the COVID-19 vaccine. It was made available to me because the VA is offering it to all veterans in the system who are 75 or older.
Here's how it went: First, I received a phone call from the VA asking when I'd like to schedule a time to get the shot. I picked a specific day at 10:30 a.m. because I already had a CAT scan appointment scheduled for 8:30 a.m. This way, I'd only need to make one trip to the VA.
On the day of my appointment, I also decided to bring my hearing aid charger along for the ride because it hadn't been working. I figured after my two appointments I'd go to the audiology department and see what could be done.
In the end, the CAT scan took only a few minutes. In no time, I was back in the lobby wondering what I was going to do with the almost two hours until I was set to receive my shot. Audiology!
I climbed the stairs to the second floor. The audiology technician was behind the counter. We went into his office, where he fiddled with my charger, saw that it didn't work, threw it in his wastebasket, and handed me a new one.
It was still an hour-and-a-half until my vaccine. What the heck, I thought, you never know. I walked over to the vaccine area.
"Hi," the woman behind the counter said. "I'm really early," I said.
"That's okay. Name and last four?"
I gave her my name and the last four of my Social Security number. She looked on the sheet, flipped to the second page, put a yellow line through my name, handed me a vaccine information sheet and a form to fill in.
I brought the form back in three minutes and she sent me to an alcove where an informative and pleasant nurse stuck a needle in my shoulder. Then I sat in socially-distanced chair for 15 minutes to see if I had any ill effects. Twice someone came to me and asked how I was doing.
During those 15 minutes, I was able to watch this efficient and effective clinic in action. A steady stream of older vets came in, filled out the form, went to an alcove and were vaccinated. All of it moved along like a well-oiled machine.
When my time was up, I went to another station and made an appointment for my second shot. That's three appointments (plus one scheduled) in less than two hours!
I also picked up a story. The audiology tech guy was the same fella I saw a year ago when I was previously having trouble with the charger. That day, it appeared, he fixed it.
I'd said then, "You made that look easy."
With a challenge in his voice he'd said, "What branch were you in?"
"Air Force."
"That's why!" he'd said. "Marines! I was in the Marines!" and went on to tell me about being a sniper in Iraq."
Today, he said he had no record of me seeing him before. I told him I'd been in a year ago as a walk-in. To prove it I said, "You were in the Marines."
"Yeah," he said forlornly. "My dad was a Marine. I joined trying to please him, trying to be a good son. I shoulda joined the Air Force."
The End of Life Inside VA
By: Sally Covington
I want to share my story about the amazing care my partner Tom Moore received at the end of his life from the VA. The story is, in a sense, a tale of two healthcare systems, Kaiser Permanente, a private, profit motivated system and the Veterans Health Administration (VHA) a mission driven, public system.
Tom, who was 85 when he connected with the VA, had served in the Army during the Korean War but never outside of the United States. Although being in the Army was, for him, a formative experience, being a veteran wasn’t a major part of his identity.
He had never used the VA and was a life long member of Kaiser in California. Toward the end of his life, Tom suffered from Alzheimer’s disease and worsening chronic obstructive pulmonary disease (COPD. In dealing with both problems, I was becoming increasingly concerned about the lack of quality care Tom was getting from Kaiser. Let me give a couple of examples.
As Tom’s COPD was getting worse, the Kaiser seemed inflexible and unable to trouble shoot. Tom was having a terrible time breathing at night. His doctor recommended that he sleep propped up at a 30 or 40 degree angle. So we’d try to prop pillows under his head, but that just didn’t work. I asked Kaiser for a hospital bed that would raise and lower and help Tom sleep. What was the answer? No, that couldn’t be done unless Tom was on hospice. Kaiser didn’t have much specialized geriatric support either, and certainly there was no respite or home care services for me.
I had never thought about going to the VA until a friend suggested that that might be an option when she learned Tom was a veteran. I called the VA. We provided the necessary paper work and he was enrolled. We went to a VA clinic in Martinez, California and met with a primary care physician as well as with a team that included a social worker. The team was very thorough and not only gave Tom a complete physical evaluation but asked what challenges we were having. After I talked to the social worker, much to my surprise, the VA suggested enrolling Tom in a day care program for people with dementia in Berkeley with which the VA contracted. Tom went to the program three days a week from nine to four and It was completely paid for by the VA. This was the first glimpse I had that the VA was very different from a private sector healthcare provider. I felt very lucky that the VA made that service available to Tom and us as a family. I also felt that every family bearing the weight of caring for someone with progressive dementia should have the same.
The team also told us we could get Tom’s medications from the VA with lower co-pays. The team asked about Tom’s swallowing and if we would prefer liquid versions of the medications he was taking, if available. We said yes. Then three to four days later I found a box of medication at my door, I didn’t have to activate any prescription to get it.
They also asked about what equipment Tom needed at home to keep him safe. Then they arrived at our apartment and installed a grab bar in the shower, gave us a shower bench and a raised toilet seat for the bathroom, and a bedside commode. Everything seemed so geared to helping solve daily problems at home.
Another serious problem Tom had was with chronic obstructive pulmonary disease (COPD). As I said, Kaiser said it could not provide Tom with a hospital bed, so I called the VA and within a couple of days it was set up in the bedroom and Tom was breathing a lot better.
We were also able to switch to getting care at the San Francisco VA Healthcare System at Fort Miley rather than Martinez, which was logistically a bit easer for us. That switch was totally seamless and we got an initial appointment with geriatric primary care. There, we met with a geriatric fellow (a medical doctor doing a specialization in geriatric care) and then with a geriatric team, a team of four wonderful women that included two physicians, a nurse, and a licensed medical social worker. The purpose of that meeting was to help us understand what services Tom could access as his health declined and to talk about what I might need as his primary care giver. They talked with Tom alone and I talked with the team and the social worker.
The geriatric fellow was fantastic. She called me when she had quiet moments to do so to find out how things were going. I received no less than three calls from her unprompted just to check in. So caring and human. I was stunned. She was a physician, and I wasn’t calling her she was calling me.
When Tom’s breathing took a sudden, sharp turn for the worse, I took him to the ER at Kaiser. Kaiser discharged him in an unstable condition on Friday evening and I quickly realized the next morning that Tom needed an emergency admission to a home hospice program. He couldn’t stand up on his own, I couldn’t lift him. I was totally panicked. It was Saturday and because the VA team had been so responsive, I emailed the social worker hoping that she might get and respond to my message, even though it was the weekend. She did, then called the geriatric fellow, and they both got on the phone with me to discuss the best way to get Tom quickly enrolled in home hospice, which happened the next day. I am forever grateful for their care, kindness, responsiveness to me and to Tom, who died 10 days after his entry into hospice.
From start to finish, my and Tom’s experience with the VA was excellent, so seamless and oriented to making things as easy as possible during a stressful time. While individual clinicians within Kaiser seemed excellent, caring and kind, the system itself lacked the flexibility, integration and problem-solving capacity that the VA demonstrated when we needed it most.
Giving Back
BY: Jay Keyser, U.S. Army Veteran
July 7, 2014 was my 79th birthday. I spent the morning in an ambulance. As ominous as that might sound, it was a blessing. I was being transferred from a not-for-profit private rehabilitation hospital to the Veterans Administration (VA) hospital in West Roxbury, Massachusetts where, over the course of the next year and a half, as an inpatient and outpatient, I would receive the best possible care a spinal cord injured person could hope for.
Two months, two weeks and two days earlier I had suffered a fall. In a nanosecond, I was transported from the bipedal world into the world of tetraplegia. My arms and legs were paralyzed. I had no control over my bowels. I was, for all intents and purposes, an infant.
What caused that transformation couldn’t have been more ordinary. I was stretching my left leg on a staircase. I had done it countless times before. Suddenly my right leg collapsed. I fell flat on my back. A masterful neurosurgeon at the Massachusetts General Hospital (MGH) and his team performed a laminectomy. It was needed to relieve pressure on my spine. He told me I had “the crappiest spinal column” he had ever seen. It was half the diameter of a normal one. The forest of bone spurs that sprouted along it bruised the nerves between the 3rd and 6th cervical. A doctor at MGH told me I would never walk again.
Why was I in an ambulance on my birthday speeding toward a VA hospital? After a month at MGH, I had been transferred to a private rehabilitation hospital. It was one of the best in the country. Unfortunately, they had to discharge me because of the “length of stay” problem. My Medicare insurance was running out. The hospital planned to send me to an assisted living complex with little or no rehabilitation capability. Why? I couldn’t afford to pay $3,170.75 a day to stay.
The next facility would house me for three weeks. Then my United States healthcare insurance would again run out. After that, I was on my own. It did not matter that, as time would tell, with the proper rehabilitative care, my body would be able to defy the pronouncement of the doctor who said I would never walk again. I would be able to walk a mile a day with the help of a walker. I would regain control of my bodily functions. My wife would not be the widow of a husband who wasn’t dead.
Before my accident I had an active life as a jazz trombone player. I played Dixieland music with the New Liberty Jazz Band. We played on a firetruck and did 4th of July parades. I played in the Aardvark Jazz Ensemble, the oldest continuous jazz ensemble in the United States. When the VA therapists were finished with me, I was able to have to a musical life again.
Obviously, I am an incredibly lucky guy. At the last minute a caseworker at the private-sector rehab hospital realized that I had served in the US Air Force. It occurred to her—as it had not to me—that, because my injury was catastrophic, I might be eligible for admission to a health care system that would provide me with free medical care for the rest of my life.
When the ambulance drivers rolled my gurney inside the West Roxbury VA, it was close to noon on my birthday. The first person I spoke to was the admissions clerk. I sensed immediately that something was very different. It took me a month to get it. One day I wheeled myself into an elevator. Hospital workers I didn’t know were already there. As I was about to exit at my floor, they said, “Thank you for your service.” Shortly after that, Eddie, a painter in the hospital, invited me to listen to the jazz he was playing while he worked in the corridor outside the gym. A week later a CD player and a stack of jazz CDs showed up in my room next to my bed. Eddie had put them there.
That I am able to walk now and to live a relatively normal life is evidence that the staff at the West Roxbury VA are superb at what they do, from my primary care provider, to the nurses in my ward, to the extraordinary physical and occupational therapists who showed me how to use my body again. But on top of this expertise they bring something else. Helping me was their way of thanking the thousands of veterans who had sacrificed so much on behalf of our country. The VA hospital people have a unique perspective. They see what they do as a way of giving back. No wonder they are so good at it.
Shining a Light on Policy In Practice
BY: Diane Reppun, U.S. Army Veteran
It has almost become almost a running joke on Capitol Hill. The topic of healthcare comes up and at least one or two sitting members of Congress argue — sometimes verbatim — ‘I can’t get pregnant, why should I have to pay for women’s health?’ For a long time lawmakers said pretty much the same thing about female veterans. We weren’t seen, heard, or covered by policy. But that’s starting to change.
Women are the fastest growing demographic within the veteran population and face very real challenges that are not addressed through male-centered care. Although we’ve been serving our nation for decades, we’re finally being addressed. The Veterans Health Administration has made it a priority to address our needs — and often provides higher-quality, reliable service than its private sector counterparts. Gynecological care and mammograms may sound pretty standard for women’s health care but they take on a whole new level of complexity when teamed with the stresses and environmental hazards of active duty.
And that’s why I’m helping to kick off our new series, The Veteran’s Voice. VHPI strives to show how veteran’s unique healthcare needs are often misunderstood or misrepresented by lawmakers and the public. Consider The Veteran’s Voice as illustrating policy in practice.
Through our Veterans Voice series we’ll put veterans at center stage and let them speak for themselves. But throughout their narrative, we’ll expand upon and provide context to the programs they may not even be aware they’re utilizing.
As for my own story, I’ve found the VA care can be complimented well by private care if done correctly. But without the anchor of the VA, i’m not sure that my needs as a female veteran — with war wounds of my own — would truly be understood or treated.