VA updates the disability rating schedule for infectious diseases, immune disorders and nutritional deficiencies
As of Aug. 11, the U.S. Department of Veterans Affairs (VA) updated portions of the VA Schedule for Rating Disabilities (VASRD, or Rating Schedule) that evaluate infectious diseases, immune disorders and nutritional deficiencies.
The collection of federal regulations used by the Veterans Benefits Administration helps claims processors evaluate the severity of disabilities and assign disability ratings.
“VA is in the process of updating all 15 body systems of the VASRD to more accurately reflect modern medicine and provide Veterans with clearer rating decisions,” said VA Secretary Robert Wilkie. “By updating the rating schedule, Veterans receive decisions based on the most current medical knowledge of their condition.”
The complete list of updates to the rating schedule is available online. Claims pending prior to Aug. 11, will be considered under both the old and new rating criteria, and whichever criteria is more favorable to a Veteran will be applied. Claims filed on or after Aug. 11, will be rated under the new rating schedule.
Updating the rating schedule for conditions related to infectious diseases, immune disorders and nutritional deficiencies, enables VA claims processors to make more consistent decisions with greater ease and ensure Veterans understand these decisions. VA remains committed to improving its service to Veterans continuously and staying at the forefront of modern medicine as it has for decades.
Since Sept. 2017, VA has updated the schedules for dental and oral conditions, conditions related to the endocrine system, gynecological conditions and disorders of the breast, the general rating formula for diseases of the eye, skin conditions and the hematologic and lymphatic systems.
Pago Pago, AMERICAN SAMOA — Speaking at Thursday’s cabinet meeting, under a tent at the Su’igaula o le Atuvasa Beach Park in Utulei, Gov. Lolo Matalasi Moliga informed cabinet directors, that the Governor’s Office is preparing for a visit by the US Secretary of Veterans Affairs, Robert Wilkie, who is arriving next week.
He said the Office of Samoan Affairs is charged with setting the program for the Secretary’s visit, including the usual airport arrival and traditional welcoming protocol.
Lolo’s remarks came after LBJ Medical Center chief executive officer, Faumuina John Faumuina informed cabinet members that the hospital has been informed that Wilkie will be visiting LBJ next week.
Faumuina said the scheduled visit is for 10:40a.m on July 31st and LBJ will share with the VA secretary the programs and services the Hospital is able to provide for Veterans.
Two ASG officials told Samoa News yesterday that after the LBJ meeting, there will be public forums to provide the opportunity for Veterans to address their needs to the VA Secretary.
As of yesterday afternoon, LBJ was the only ASG entity that will meet with Wilkie, who has been serving as VA Secretary since last year, according to the officials, who noted that the agenda and program for the visit is being firmed up.
It’s unclear at this point if the ASG Department of Health will be involved in the discussions with LBJ.
Five years after the Department of Veterans Affairs was rocked by a scandal over appointment delays linked to Veterans' deaths, it still struggles with scheduling issues and tracking wait times, a government oversight official told Congress this week.
During a hearing Wednesday before the House Veterans Affairs Committee, Debra Draper, health care director at the Government Accountability Office (GAO), said that, while the VA has "taken action to ensure its facilities provide timely access to medical care," it must do more.
Draper said the VA has made progress since the GAO first warned in 2012 of shortcomings in its appointment scheduling and tracking system, as well as lengthy delays in patient care. But she added that the VA's data on wait times remains unreliable and appointment delays continue to be long.
"At this time, we continue to be concerned that VA has not sufficiently addressed the reliability of its wait time data," Draper said. "For example, we have found that VA's wait times do not capture the time it takes the department to enroll Veterans in VA health care benefits, which we found could be quite lengthy."
The issue is not restricted to appointments at VA health facilities, she said, adding that wait time data for the VA Choice program, a community care program that let Veterans seek care at a private facility, was incomplete or inaccurate. VA Choice has been replaced by the Mission Act, which consolidated all VA programs for community care.
"Since implementing our recommendation, VA has taken a number of actions. One is by annual audits of schedulers -- and the most recent, in 2018, they audited about 667,000 appointments, and they found the 8 percent error rate, so that affected about 53,000 appointments," Draper said. "There is improvement. [But] there's more work to be done, definitely."
In a separate report released Wednesday, the GAO found that since the VA's tracking system captures only part of the appointment scheduling process, the department may show it is meeting its average wait time goal of 30 days. But when considering all factors, Veterans potentially are waiting up to 70 days for an appointment.
Speaking at the hearing, Teresa Boyd, Veterans Health Administration assistant deputy secretary for clinical operations, acknowledged that the VA still has challenges but added it also has "undergone tremendous transformation" since 2014.
Boyd said that, for established patients, the VA's average wait times for primary care and mental health are less than five days, and seven days for specialty care
"We recognize that there are still challenges ahead of us, but it is important to keep in mind that Veterans continue to receive the highest quality care, often with shorter wait times than in the private sector," she told the committee.
The GAO recommended that the VA implement its previous recommendations on improving scheduling at both VA facilities and community care programs. The VA will implement a new system to support appointment scheduling, authorizations and referrals in fiscal 2021, which VA officials have said will address some of the issues. But Draper said clear policies, oversight and effective training also are needed.
In his opening statement, committee chairman Rep. Mark Takano, D-California, cited recent media reports about ongoing private waitlists and an apparent lack of transparency on wait times within the VA and in the private sector -- obfuscation that limits a Veteran's ability to choose health services, he said.
"The lack of accurate information on wait times at VA hospitals, and with community providers, should cause us all to question whether the policy to send more Veterans to community care providers is sound or even if it's working," he said.
He added that the VA has an opportunity to lead the nation in crafting wait time standards and accessibility to data that allows patients to make "informed choices."
"If VA can get that right, make it simple for Veterans to understand, I believe we will do not only Veterans a great service, but we'll do the American people a great service by setting the standards that the private sector will have to match," he said.
Rep. Phil Roe, R-Tennessee, the committee's ranking Republican, said he'd be remiss not to "acknowledge the many ways in which access to care for Veterans has improved" since 2014, with the VA completing 1 million more appointments in 2018 than the previous year.
But, he added, there is "no doubt VA has farther still to go."
"The VA Inspector released an alarming report about delays in care for Veterans seeking mental health appointments at the Albuquerque VA Medical Center. That report paints a heartbreaking picture of why we must continue to focus on access to care," he said.
For years, VA employees, Veterans and community care providers have looked forward to a seamless electronic health record (EHR) solution to improve patient care and support.
Recently, that dream came closer to becoming reality with the successful transfer of 23.5 million Veterans’ health records to a shared data center with the U.S. Department of Defense (DoD). This massive accomplishment sets the stage for the “go-live” of VA’s EHR solution next year.
Go-live refers to the point when the current health record system, called Veterans Information Systems and Technology Architecture (VistA), is “turned off” within a facility, and VA’s new EHR system will be “turned on.” During go-live, all designated systems and services will transition to the new VA EHR platform.
VA Secretary Robert Wilkie shared VA’s community sentiments: “For decades, VA and DoD have been struggling to achieve interoperability and seamlessly share patient records between our health systems — placing an unfair burden on our Veterans and their families. No Veteran, family member or caregiver should have to carry boxes of paper, medical and service records around. This data migration is the first step to solving that problem for good.”
This initial data migration phase, which began in late spring, foreshadows even more exciting improvements to come. When the new EHR completes implementation, it will replace the 130 plus instances of the current VistA system in a streamlined solution that also powers DoD’s Military Health System (MHS GENESIS).
To put the magnitude of this OEHRM milestone into perspective, here are some fun data facts:
- Collectively, over 78 billion records have been compiled from all VA medical centers to include in this transfer.
- These records total 50 terabytes (equivalent to about 850,000 hours of music) of data storage.
- This data spans 21 clinical domains of patient health records, which includes lab results; pharmacy prescriptions; inpatient and outpatient diagnoses and procedures; and other Veteran medical data.
This milestone moves VA one step closer toward achieving an interoperable EHR system that will provide Veterans, service members and their families with a single health record and a lifetime of seamless care. The efficiency and improvements found in the EHR will also make for a more welcoming, customer-centric environment with streamlined messaging and scheduling capabilities, improved interoperability and enhanced self-service options for VA staff, Veterans and caregivers.
For more information about VA’s Electronic Health Record Modernization, visit https://www.ehrm.va.gov/.
Simmering tensions between House Democrats and Veterans Affairs leadership boiled over this week over accusations that the department still hasn’t fully addressed medical wait time problems that prompted a national scandal more than five years ago.
On social media Wednesday night, VA Secretary Robert Wilkie accused House Veterans’ Affairs Committee members of playing politics and “uncritically amplifying allegations for which they have no evidence.” Committee chairman Rep. Mark Takano, D-Calif., in response blasted those comments as the latest in a string of department officials trying to avoid oversight of serious department problems.
The terse Twitter war was the most outward sign of increased animosity between the Republican VA administration and Democratic-led committee, though both sides have been sniping at the other for months behind the scenes.
Most of the committee’s work (and that of the Senate Veterans’ Affairs Committee) steers away from such fights, given the bipartisan nature of most Veterans issues.
Similar tensions were commonplace five years ago when then Republican leadership of the House committee frequently attacked then-VA Secretary Bob McDonald over accountability and management issues in the wake of the VA wait time scandal. In recent years, the relationship between the executive branch agency and legislative branch panel has been significantly more cordial.
Now, revisiting that scandal from five years ago appears to have revived that conflict.
During a committee hearing earlier on Wednesday, Takano accused VA officials of not doing enough to respond to concerns about new secret wait lists at department facilities and ignoring whistleblower warnings on the issue.
“I am alarmed that too much of what (officials) observed five years ago still rings true today,” he said. “This is unacceptable. We simply cannot put Veterans’ lives at risk while they wait for care.”
Debra Draper, director of the Government Accountability Office’s health care team, testified at the hearing that the department “has not sufficiently addressed the reliability of its wait-time data” in recent years.
She said in some cases, VA officials took three months to enroll Veterans in health care benefits but did not count that delay as part of their wait for getting medical appointments. Those “start date” problems have gone unchanged for more than six years, based on GAO research.
But VA officials insist the department has made impressive improvements since the 2014 wait times scandal, when high-level hospital administrators were found to have covered up lengthy delays in medical care to preserve personal bonuses.
Teresa Boyd, VA’s assistant deputy under secretary for health, said the department has operated with “renewed focus, unprecedented transparency and increased accountability” in recent years. She cited shorter wait times at VA hospitals and increased medical appointments across the Veterans Health Administration as proof of change.
As he has in the past, Wilkie countered the charges by referencing a Journal of American Medical Association report from earlier this year which found VA wait times are better than the private sector in primary care, and a Dartmouth College study which found VA hospitals outperform private hospitals in most health care markets.
He said there is “no evidence” to support the committee charges of continued problems.
The fight comes about two weeks after Democrats and Republicans on the panel sparred in a legislative mark-up over GOP amendments that were ruled out of order by Takano, prompting accusations from both sides of politicizing routine committee work.
VA officials have also bristled over committee Democrats’ requests related to implementation of new community care rules, accusing them of inflating minor problems into political talking points.
Committee leaders for their part have repeatedly complained that the department has been slow to provide information on internal department operations (in particular, items related to the influence of outside acquaintances of the president on policy decisions) and hostile in routine oversight work. Department officials have denied those charges.
Takano and other Democrats in recent days have also taken aim at VA for being “completely ill prepared” for future natural disasters in Puerto Rico, two years after a hurricane wiped out much of the island’s infrastructure. Part of that problem, the chairman charged, is a lack of preparation and focus from VA leadership.
Despite the turmoil, the committee has advanced 24 pieces of legislation this year, making it one of the more productive panels in terms of legislative activity.
Wilkie said that he “welcomes oversight and constructive criticism” of his department, but will continue to push back on false claims of problems at VA. Takano on Wednesday vowed that his committee “will not allow our Veterans to be harmed by the same deceptive practices” that have led to past problems.
OKLAHOMA CITY - The State Department of Veterans Affairs is promoting a registry that, the agency says, will help Oklahoma keep track of its Veterans while giving them important information about benefits.
The state has about 360,000 Veterans. No one really knows for sure.
“We don’t really know that number, because we just can’t nail it down. They only Veterans that we knew at the time were those that applied for state benefits,” said Sen. Frank Simpson (R) Springer.
So, the Department of Veterans Affairs rolled out a registry on their website three months ago. Keeping the right numbers can save the state money by eliminating people who get state benefits who hadn’t earned them.
“We offer many of our Veterans benefits through our state agencies. We offer them a tax exemption through the Oklahoma Tax Commission. Our theory is, and we’ve had some evidence to show, that some of those benefits are being abused by non-Veterans,” said Sen. Springer.
The other advantage, Veterans can learn about benefits they have coming to them. Senator Springer sites one Vet as an example.
“She filled out her information, and in the process of verifying her information, they found that she had an outstanding VA claim that had been awarded to her years ago to the tune of $400,000 in back benefits, this lady is going to collect,” he said.
Filling out the information is simple. A News 9 crew watched as Veterans Affairs spokesman and Navy Veteran Shane Faulkner filled out his. It took about four minutes.
“It’s that easy. We’re not asking for a whole slew of information. Just your basic information,” said Faulkner.
The information won’t be sold or used for anything other than identifying you as a Veteran. Problem is only about 500 Vets have signed up so far. To sign up, log on to: https://odva.ok.gov/content/oklahoma-Veterans-registry.
One elderly Veteran with dementia went missing for days from Bay Pines VA Healthcare System after the facility misidentified the patient immediately after calling a Code Orange.
According to an IG report, VA police brought a Veteran to the emergency department at Bay Pines VA after finding him asleep on VA property. A few days earlier, the Veteran was previously admitted due to intoxication. While hospitalized, the Veteran was found “wandering around the hospital.”
A VA psychiatrist evaluated the Veteran and determined the Veteran had significant cognitive deficits and required continued monitoring and 24/7 supervision due to his impairment.
Later the same day, the patient went missing.
This is where Bay Pines procedures went sideways, which may not surprise many Veterans frustrated with the administration of healthcare at that facility.
Code Orange Telephone Game
Clinicians activated a Code Orange. This is a code VA is supposed to call in an emergency when an “at risk” patient goes missing at Bay Pines VA. At risk patients are deemed to be a harm to themselves or others if not located and returned to a safe environment.
Once the Code Orange was called, the facility misidentified the missing patient for two hours due to a look-alike or soundalike name. Policy for missing patients require that they are identified using two identifiers to avoid confusion.
Here is the sequence of events that led to the misidentification:
- The missing patient’s nurse notified the unit charge nurse, who in turn notified the flow coordinator that the patient was missing.
- The unit clerk allegedly provided the flow coordinator with the wrong patient’s information.
- The flow coordinator then contacted the VA police about the wrong Veteran.
So, due to the confusion, VA searched for the wrong Veteran for two hours, which was likely the key window of time to locate the wandering Veteran.
No AOD Elderly Veteran Search
Compounding matters, the administrative officer of the day (AOD) failed to follow agency policy requiring the AOD to contact hospitals and shelters to locate the missing patient. The AOD is a person acting on behalf of the Director who serves as the central point of contact. In this instance at Bay Pines VA, the AOD denied knowing of this search requirement.
Five days later, following an extensive search by VA social workers, the patient was located. He was apparently in the care of a community clinic elsewhere and was returned to VA.
I would be curious to be a fly on that wall listening to Bay Pines VA both explain what happened and also why the Veteran would be better off if returned to their facility.
At least the story ended with good news. The elderly Veteran did not die while suffering from a bought of dementia. Hopefully, he will now receive the care and support he requires.
The Department of Veterans Affairs issued a press release July 5 announcing the extension of Agent Orange claims for “Blue Water Navy” Veterans.
Agent Orange was the toxic herbicide used to clear plants and trees in battle zones in Korea and in Vietnam. Vietnam Veterans who served offshore of Vietnam between Jan. 9, 1962-May 7, 1975, and Veterans who served in or near the demilitarized zone in Korea from April 1, 1968-Aug. 31, 1971 are eligible for benefits.
The 2019 Blue Water Navy Veterans Act was signed into law June 25. According to the VA press release, 420,000 to 560,000 Vietnam Veterans may be considered Blue Water Navy Veterans. The law goes into effect Jan 1. Korean War Veterans in their late 80s may not live long enough to collect these benefits.
VA Secretary Robert Wilkie stated, “VA is dedicated to ensuring that all Veterans receive the benefits they have earned.” Wilkie further stated the VA will not begin to process the claims until Jan. 1 “we are working to ensure we have the proper resources in place to meet the needs of our Blue Water Veterans community and minimize the impact on all Veterans filing for disability compensation.”
Wilkie fails to mention the VA denied these claims for years, and fought a bitter court battle before Congress could finally pass the bill.
VA benefit claim representatives will not begin to deal with a backlog estimated to be 420,000 to 560,000 claims until Jan. 1 because they do not have to comply until that date.
Wilkie found a cause, which is of such importance, that he issued a press release on July 3 to let the public know the VA is overhauling religious and spiritual symbols to protect the religious liberty of Veterans effective immediately.
The reason given for this urgent action by Wilkie is “to make sure that all our Veterans and their families feel welcome at VA no matter their religious beliefs.”
In what universe have Veterans been beating the doors of their local VA Medical Center and demanding Bibles?
Veterans know every VA medical center has an all-faith chapel or meditation room. A VA may also have a reflection garden, hall of harmony, or corners of meditation, depending on the size of the VA facility. At smaller clinics, VA personnel have a list of local religious leaders to assist a Veteran in need of spiritual care.
Like many of my sister and brother Veterans, I have spent time in VA waiting rooms to see a health provider. In over 15 years of care from various VA medical centers across the country, I have never witnessed a Veteran being upset or on a rant because a Bible was not sitting on a table with the rest of the reading materials.
The waiting room conversations revolve around the weather, what branch of the military you served in and when. Veterans also tend to relate their personal experiences in getting care at the VA and if they have had problems with their benefit claims.
Nothing gets the attention of the public quicker than to mention religion. Wilkie is using this as a distraction from the backlog of claims.
Jeremy Redmon of the Atlanta Journal Constitution, in a July 14 article, cited the fact that, “the backlog just to achieve eligibility for VA care is 317,157 claims.”
Veterans know they have religious freedom. We all took the same oath to protect and defend the Constitution, which guarantees that freedom among others. Veterans want their claims for eligibility processed, their disability claims handled in a fair and timely manner, and health care they earned.
When I walk through the doors of Building 1 at the St. Cloud VA, I am not there for a prayer meeting. I am there to receive the best possible health care from one of the better VA centers in the country.
Let us handle our religious beliefs Secretary Wilkie. You get busy and light a fire under the VA to process the paperwork that will grant Veterans the care they need now!
Using the VA Mission Act to justify raising federal spending levels is bad for Veterans and taxpayers
Earlier this month, House Speaker Nancy Pelosi (D-Calif.) sent a letter to Treasury Secretary Steven Mnuchin demanding that an additional $22 billion above current federal spending levels be included in any deal to raise the debt limit in order to pay for new private health care options created by the VA MISSION Act - the Department of Veterans Affairs (VA) health care reform law signed by President Donald Trump but which was opposed by Pelosi. This requested increase comes in spite of the fact the 2019 VA budget is just under $200 billion under current non-defense spending levels, which is more than double what the VA budget was over a decade ago. The extraordinary increase in the VA budget has far outpaced the growth of patients and beneficiaries and has occurred during a decline in the overall Veteran population.
Ensuring Veterans get the care and benefits they earned is a critical part of the social contract our country has made with those who put their lives on the line in our defense. It is therefore vital to our national security to have a properly funded VA. But there is a difference between providing the resources the VA needs to accomplish its mission and raising federal budget levels to spend billions more on the VA without a meaningful assessment of whether those additional funds are needed.
Unfortunately, Congress has too often taken the latter approach, to the detriment of Veterans and American taxpayers alike.
In 2014, it was revealed that Veterans across the country were dying on secret lists while waiting for VA health care. Some ardent defenders of the VA claimed the long wait times for care were a result of lack of funding. But the Obama administration had massively increased the VA’s budget in the previous five years – growing more than $50 billion from 2009 to 2014. In the aftermath of the 2014 scandal, Congress passed and President Barack Obama signed into law a measure that gave the VA another $15 billion increase. In subsequent years the VA budget would continue to grow, reaching its current level of nearly $200 billion.
Despite the influx of resources, Veterans continued to die on wait lists and receive poor quality care. The reason is simple: Congress and prior presidential administrations refused to thoroughly address systemic issues within the VA that wasted money and hindered its health care delivery. They chose the easier path of just writing the VA a bigger check.
For example, as of 2017, most of the VA’s medical facilities were more than 50 years old. Considering the shrinking size and changing demographics of the Veteran population, most of these facilities are not in the best locations to provide the best and most convenient care. Many VA hospitals are operating either at significant under-capacity or over-capacity. For primarily political reasons, Congress prevented the VA from shifting infrastructure resources to account for this dynamic. Instead, the agency has been forced to spend billions maintaining aging and underutilized facilities.
Fortunately, the VA MISSION Act included provisions mandating the VA undertake an infrastructure review to ensure that funds for facilities are spent to best serve Veterans and not wasted on unnecessary or outdated buildings. Additionally, the law consolidated the VA’s community care programs and greatly expanded health care choice for Veterans. Unlike many past efforts effort to reform the VA, the VA MISSION Act took a different approach then just simply spending more money – it fundamentally changed how the VA delivers health care to Veterans.
The current overall federal spending levels provide more than enough budgetary flexibility to pay for any additional expenses incurred by the implementation of the VA MISSION Act. Further raising spending levels to provide additional money for the already-funded VA MISSION Act, as Pelosi is demanding, would set a bad precedent while also disincentivizing further reforms within the VA that would reduce waste and improve care for our Veterans.
No one wants to shortchange those who sacrificed in service of our country. But as recent history has shown, simply dumping more money into the VA without real reform serves neither our Veterans nor taxpayers. With a $22 trillion national debt posing a growing threat to our national security, additional unnecessary spending puts at risk the future of the very country our Veterans fought to defend.
An urgent supply shortage in one VA healthcare system impacting multiple hospitals has put Veterans’ health at risk.
A supply shortage at Pittsburgh Veterans Affairs Healthcare System has gradually increased to crisis levels over two years. A whistleblower to the Pittsburgh Post-Gazette revealed that nurses are running out of gauze, custodians have run out of bleach to disinfect rooms, and lab workers have run out of supplies to stop bleeding after blood draws. Clinicians are out of medication cream.
Sound like a VA medical center near you?
“We’ve run out [of the medicated crèam] before and it wasn’t too big of a deal,” said one employee familiar with the supply problems.
Like many employees at the agency, this one requested anonymity to avoid likely reprisal. “But now it’s in crisis mode because we’re running out of everything.”
“It’s getting to the point where patient care is being affected,” the employee told the Post-Gazette. “You can’t run a hospital this way. It’s bad. Something has to be done.”
The Department of Veterans Affairs started a new supply chain management plan. That plan was aimed at not keeping supplies on hand for more than 30 days. The consequence of that plan is now obvious. The agency is more reliant than ever on the scheduling of private sector vendors.
In response to reporter inquiries from the Post-Gazette, a VA spokesperson dismissed the concerns raised by the employee.
“Due to product availability, changes or unusually high demand, all health care facilities must overcome stocking challenges from time to time. Pittsburgh VA Healthcare System is no different. To ensure stocking challenges do not impact patient care, Pittsburgh VA Healthcare System uses multiple vendors and supply contracts.”
Is that not a typical response?
However, the anonymous employee says the agency is simply concerned with numbers that make the agency look good rather than the well-being of Veterans. “They’re just really hell-bent on statistics, just to make sure the numbers [of stock kept less than 30 days] are in line with what people [in D.C.] want.”
“They say we need to do it because it shows we’re not keeping unnecessary products on hand for a long time and it saves money.”
Once the Post-Gazette started sniffing around, with various inquiries, what do you think VA leadership did? Of course, VA leadership jumped to action once shortchanging Veterans and putting our health at risk was sure to make the news.
“Now they’re running around telling everybody to order anything they need from whoever we can get it from,” the employee said. “It shouldn’t be like that. They should have acted that way before you called.”
I think most of us could’ve called this one. For that past couple of years, VA has been swift to address problems once journalists start to snoop around most of the time.
Good on Post-Gazette for holding agency leaders accountable.