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JIM STRICKLAND'S MAIL BAG: VOLUME #3 FOR 2008 --

Veterans' Advocate Jim Strickland answers

questions from VA Watchdog readers.

Veterans' Advocate Jim Strickland provides regular columns for VA Watchdog dot Org.

If you would like to contact Jim about his columns, you can email him here...

The archive of Jim's articles is here...

-------------------------

by Jim Strickland

Letters in my mailbag are reprinted just as they come to me. Spelling and grammar are left as is and only small corrections are made to improve readability, ensure anonymity or delete expletives that may offend some readers.

Jim;

This is a true story for you. I am copying this letter to the Hon Senator Patty Murray.

I had an experience at my VA hospital that I'm still extremely angry about: On Christmas morn 6:15 am this past Christmas, I was suffering from chronic abdominal pains, migraine, and totally fatigued, even after being in bed for several days. When I went in, there were no other patients in the waiting area. The attendant at the desk was pleasant and professional. She took my initial info and asked me to take a seat. After about 15 min, a nurse came out to triage me and take my vitals. She asked if I had chest pains (due to a heart attack a few yrs ago),to which I answered I didn't think so. She sent me back out to the vacant waiting area and after probably another half hr, I was ushered into a doctor's waiting room. The doc came in fairly soon as I recall and asked me a battery of questions. After that he stated "well it looks like we might have to keep you here most of the day for testing..." I said OK since I was in much pain and again totally drained of energy. With that he left and didn't return until just before 8 am saying he was off and another doc would see me shortly. All of this time I could neither see or hear any other patients but I did overhear two nurses or assistants just outside my door jabbering away about personal problems. Finally about 8:30 or 9 am, the new doc came in stating "he reviewed all my tests and could do nothing else for me." I told him after looking at both my arms, that no tests had been made, not even a urinalysis. He hesitated for a minute, bolted, and then came back in a few minutes later not even apologizing for not checking my records accurately or conversing with the earlier (now off shift) doctor. Shortly after that he sent in a nurse to draw blood and a urinalysis. About 10:30 am on that Christmas morning, he came back in again and proceeded to say all the tests looked normal and I would have to leave since they could do nothing further for me.


How's that for military appreciation and God help us all if this is a harbinger of things to come under some universal health care system. To top this all off, I got a phone call from my primary care doctor a few days later telling me I should come into primary care after this and I had made too many visits to Urgent/emergency care. Unfortunately Primary CAre has been unable to diagnose or successfully treat my issues except the heart attack and somewhat my urinary tract infection. (however even that continues since the antibiotics only seem to work as long as I take them.)

Reply;

Let me begin by telling you I'm empathetic and I understand how annoying this is to you. In my civilian career, I was a health care professional for over 3 decades. I served in numerous roles and I have experience as an orderly who cleaned up after others and I eventually ranked as an executive in a leadership capacity.

Your report isn't restricted to the VA hospital by any means. These issues occur with frightening regularity in all systems including many of the elite civilian hospitals where I worked in my job as a consultant. Far too many hospital workers consider it their right to carry on personal conversations within earshot of sick patients who are always hypersensitive to the noise of others. That the doctors didn't communicate with each other or you isn't unusual either I'm sorry to say.

If your primary care doc has notified you that you're accessing Urgent Care services too often does have some meaning that you must consider. You didn't say how often you use the Urgent Care service but if you do use it too often and there's really no treatment that happens in those visits, you should realize that there's an issue.

You tell me that you didn't feel well for several days but waited until Christmas morning to seek care. Then, there was nothing discernibly wrong with you according to the diagnostic tests and physical exams you were given.

Consider this...every time you go to Urgent Care and there's nothing wrong, there is a cost associated with your visit. I understand that from your perspective that cost probably isn't much but if you multiply that by all the visits made at all the centers, it adds up to real money. There was a cost to your lab work and a cost to any other tests you may have received. Nothing comes for free and that money isn't endless.

You say that primary care isn't able to diagnose or treat your issues but you tell me that the urgent care department isn't able to either ("all the tests looked normal").

If you were in a civilian setting and had civilian insurance, I promise you that too many visits to an emergency room would result in a similar action. Eventually the insurance provider would notify you that they couldn't afford you any longer and you might be dropped, your rates may go up or they would refuse to pay for emergency room visits that didn't identify a problem.

You should take charge of this issue by working closely with your primary care physician to develop an action plan that will keep you out of the urgent care facility unless it's necessary. Talk with your PCP about triage options so that you may be seen quickly in your clinic. Ask about authorization to use a civilian facility emergency room if you believe it's required.

Talking with your PCP may prevent you from being labeled as one who abuses the care that's provided.

It's an unfortunate reality...whether in a civilian setting or a VA setting...that once you're known as a person who is there too often for no reason, your care may not be as good as it should be when you really do need it.

Jim;

I was Honorably discharged from my service in 1994.

I applied a service connection injury and was denied C&P. I was diagnosed with depressive disorder and was referred to take medication by VA professionals on 1996. I have been taking anti-depressant and anti-anxiety medications since 1999. I have been prescribed, by the VA, numerous medications to include doses to cure PTSD.

I saw an ad in one of the city bus one morning and the ad was for a PTSD, research study. I called the number up and inquired about getting into the program . . . to make my story short, I was accepted in the program and undergone a thorough evaluation which revealed that I did have PTSD.

With that being said, I took the necessary step to aid my personal search to my wellness. On 2007, I submitted a claim to the VA for Anxiety, depression, and PTSD. I, shortly after, received a denial from my VARO. However, I recently receive an order for a C&P exam for my joints instead of psychological exam to prove my illness stemming from my service in the military.

I'm a victim of hate crime while serving. I was attacked and sexually assaulted by men from my company. I suffered male on male Military Sexual Trauma (MST).

I was taken to the Battalion Officer of the Day right after my attackers fled. I did not disclose the whole event . . . leaving out the event that lead to my MST. On of the guys involved in the attack assaulted me a 2nd time hitting me with a baseball bat across my face. I was taken to a base clinic and nearly died (comatose). I managed to punch the face of the attacker that hit me, leaving him with a black eye. I was able to identify him when the Provost Martial Officer escorted me to the attacker's quarters.

I'm left with out any trace of the incident. I tried to get assistance from various Federal agencies, to include DOD, NCIS, Dept. of the (Military), but no luck. All I want is to backtrack the cases of BCD discharge of the men involved and it should render a clear and concise reasons for their UCMJ discharge. I know for a fact that the man that hit me in the face with a baseball bat was arrested and was sent to the brig, for assaulting me.

While in Mogadishu, Somalia, I was serving as an Engineer. My platoon received small arms fire in numerous occasions, but we were prevented to return fire by my platoon sergeant because we were operating under the U.N.'s Peace Keeping mission.

After I got diagnosed with PTSD, I applied for compensation from the events in Mogadishu and Hate Crime assault and MST which directly contributed to my Severe Anxiety, Chronic Depression, and PTSD. I have been taking many meds for a long time and tracks of documents shows just that. The VARO wants me to prove to them when they wrote to me to provide more factual documents of the events.

I'm undergoing PTSD group therapy and Family counseling.

Tell me if I have any way of obtaining additional proof from the OOD report and PMO reports that lead to the BCD of any of the men involved in my attack. The hell with the compensation, I just want to prove that my ordeal truly took place and I'm ready to come forward that MST for males does happen.

Do you think you can help me? My battle is not over, I know that somewhere in the military are archived files that could shed light to what I have been telling the VA that directly causing my illness. I could provide you with the incident letter that I provided the VA. However, I would rather have you read it in person. Could I make an appointment to meet with you? I don't know if you trust what I say or feel comfortable meeting with me.

Should I stop asking VFW or DAV to represent me? I have not received any positive result from their service. I'd rather do this by myself or get a professional guidance perhaps.

It does seem to me that my claim for psychological disorder has lost its importance and re-directed to a lesser degree of service related injury. If this is so, then I really do not know how to go about my case, my service connected illness has a significant impact on my life, wellness, and whole being.

I don't think that anyone can truly assist me with my case. I tried VFW, and contacted many Federal and DOD agencies' to include IG's and base commanders. The VA wants me to provide proof that even the Federal agencies that I contacted could not produce such sort of proof. I have many documents that support my claim and I'm left alone to deal with this problem. I did not ask for this to happen.
 

Reply;

It's unfortunate for us all that I'm familiar with other cases of male on male Military Sexual Trauma that are very much like yours. Men sexually assaulting or raping other men doesn't happen often but it isn't rare either. I trust what you tell me is true. You aren't the only man that this has happened to. Others write to me with records of similar events.

It is disturbing that often all records of MST seem to vanish. Military leaders who should be responsible in dealing with these crimes are poorly trained to face the realities of such offensive misconduct and are likely to do their best to sweep it all under a rug. This is true in instances of male of female assault and rape but particularly true when it's male on male. No right thinking man understands this offense and most don't even want to contemplate it.

I have no confidence in DAV or VFW to handle your case. I can't meet with you. You and I are separated by about 1000 miles.

I wouldn't be uncomfortable meeting you as I'm all too aware of the vagaries of human behavior. You and others, male or female, who have experienced similar crimes must be encouraged to speak out. The only way to prevent such things happening to others is to recognize the reality of it all.

I would like you to contact a lawyer and I'll provide you with his name and telephone number. I don't know him personally but I do know he was a great help to a Veteran who writes me often. This Veteran was sexually assaulted in during his service. This attorney fought and won his case and he has an outstanding reputation as a hard fighting advocate. Tell him that I referred you. Then, get back with me and tell me how it went for you and whether he will be able to help.

I need your feedback so I can help other Veterans in the future. If this attorney can't help, we'll go other places that may be able to.
 

Jim;

Enjoy you columns they are very informative and helpful. Thank you for giving you time to helping vets with their claims. I have a quick question I would value your advice on. I was given after a long drawn out process a 100% rating for Generalized Anxiety Disorder. I filed for PTSD but the claim came back as awarded 100% for Generalized Axiety Disorder Claimed as PTSD. However I was told in the end that since there is a likelihood of improvement the assigned evaluation is not considered permanent and is subject to a future review examination. I have had this condition for over 18 years and the condition continues to grow worse and I have treatment for it on a regular basis. Want angle should I take to proving to the VA that although I may have some good days here and there that the condition is permanent and not likely to improved. My rating decision was made in 2007. Thanks!

Reply;

In the last year, I've seen an increase in the number of claims that have been awarded as "temporary". The areas of focus by VA have been in claims of cancer and claims of mental health/PTSD.

The logic of the VBA is that these conditions show promise of treatment that will equal improvement. The VA is mandated by law to appropriately rate the disabling condition awarded to a Veteran. In theory, this should mean that VA would as aggressively seek to raise some Veterans ratings as well as lower others.

In practice, if you want your rating raised, you must plea for it and show expert supporting evidence in a process that can take years. If VA seeks to lower your rating, they can and will do so with a very short notice and flimsy evidence.

In many cancers and in many mental health issues, VA is correct in assuming that there could/should be improvement after treatment. For example, many men with prostate cancer get treatment and live many more productive years.

An unfortunate and frustrating effect that's happened is that the VBA is now lumping many cancers and other conditions together. I've spent a great deal of time and effort in the last year trying to explain to the VBA that there's a vast difference in cancers. A Vietnam Veteran who has a non-small cell lung cancer is very likely going to die from that disease. It's well known and understood that the treatment for the disease is never a cure and that residuals from radiation and chemotherapy treatment are usually devastating. In spite of those facts, VBA is continuing to rate lung and even brain cancers as temporary conditions that are likely to improve.

Recently, it's been pointed out that a majority of Veterans who seek compensation for mental health issues attend treatment and therapy and take medications regularly right up until they get their desired rating. Then, they are lost to follow up.

Here is a recent article about that http://vawatchdog.org/08/nf08/nfJAN08/nf012508-9.htm

The VA is assuming if you aren't being treated, you've improved and by law, they're required to attempt to lower that rating or bring it in line with the current disabling effects of the disease and any residuals of treatment.

If the original rating is awarded as temporary, VA is mandated to reexamine you according to a schedule. According to one thought process, this is for your own good so you will continue to receive necessary therapy. To many, it appears the VA is only looking for a way to cut the budget by conducting fishing expeditions. The truth is probably somewhere in the middle.

One very valid objection to continuing reexam of PTSD and some other mental health issues is that the reexam process itself will trigger dormant anxieties. Then, a proposal of a lowered rating can create a nightmare for a Veteran who thought he was doing OK.

As your award was recent, it falls right into line with the above. There's little you can or want to do until you've been reexamined at least once.

I would recommend (depending on variables like age, family, etc.) that you not apply to modify your rating to Permanent and Total until you've been reexamined, with no resulting proposal of a lowered rating, twice or more. By that time you will be able to argue that you've well established your condition as "chronic". I know you've said it has been present a long time...but it's only been VA rated a short time.

The biggest loss to you will be that your dependents don't qualify to apply for Chapter 35 DEA nor CHAMPVA until you're P & T with no future exams scheduled.

If you have dependents that need those benefits soon, that could change the timing of when you want to act. If you need the additional benefits, you can go to VA right now and petition for your award to be adjudicated as Permanent and Total. As your award was in the last year, you may accomplish this through a routine Notice of Disagreement (NOD) process.

You can tell VA in writing that you agree with 100% but disagree with the temporary status. That will get the ball rolling for you. Your basis for arguing that is that although you weren't collecting benefits for it, your history of the mental health issue has been documented and treated long enough to establish it as "chronic" and thus Permanent and Total. I believe you would have a reasonably good chance of winning that argument although it would be a stronger argument with some "VA time" on record.
 

Jim;

I need to know if I will my MGIB educational benefits? Well I'm getting out because I went thru a Medical Board and they denied me a percentage , so I took the Fit to continue Naval Service , wht i didn't remember was the eval I got previous the stated not recmmended for re-enlistment. I was accused of stealing money , but it came back that they couldn't prove I did it so I got a letter of reprimand and not ebiligle for re-enlistment . I will have 15 years in February the eighth. Thank you so much for your support for us sailor ,We need for sure! I pray that GOD BLESS you for that Jim..
 

Reply;

To use MGIB after you're separated from active duty, your discharge must be fully honorable. Discharges "under honorable conditions" and "general" discharges don't establish eligibility for MGIB. However, if you have more than one period of service, and receive an other than honorable discharge from one period, you may be able to qualify if you receive an honorable discharge from another period of service. (A period from which you were discharged in order to reenlist may meet the eligibility requirements.)

There is only one way to ultimately determine whether or not you may use MGIB. You should apply for it and wait for the decision. If the decision isn't favorable, you'll be notified in writing of any opportunities to appeal the decision. If that should happen, get in touch with me and we'll review the options.

Jim;

Am sure you're well aware of the effort of LtGen Scott to have all VA disabilities reevaluated every 2-3 years. There is already a program in place to do just that. ANY veteran can ask the VA for a reevaluation of his/her disability anytime they wish. Why make it mandatory? AND--I have had PTSD for several years, actually about 40 years but went untreated till 2004. How do I get the past 40 years of my "nightmare" life back? The VA might say"well well you're all better now". After 40 years of hell anything might "look" better.
 

Reply;

I read that article with the same feelings you had. I always advise everyone to stay in treatment. It doesn't matter if it's mental health or physical health...if you receive a rating for disability and then don't return for treatment, you open a door to questions. That was made apparent in the article where it said a large percentage of guys drop treatment when they get their ratings.

If one has a rating for high blood pressure but doesn't follow a treatment plan, does he really have high blood pressure? If your rating is for Type 2 Diabetes but you don't refill your Metformin or Insulin, do you really have diabetes?

Even were it to be made mandatory, the guys who have sought continuing treatment for their PTSD won't have much to sweat. I doubt it's going to be reality anytime soon. But, it's good to be prepared. Being prepared means staying in treatment and keeping your record intact.

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posted by Larry Scott
Founder and Editor
VA Watchdog dot Org

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