WASHINGTON — The Department of Veterans Affairs announced its health care facilities will soon be “smoke-free,” though a smoking ban set to take effect Oct. 1 does not apply to employees, the agency clarified Friday.
While Veterans, visitors, volunteers, contractors and vendors will be prohibited from smoking on VA grounds, employees will keep their smoking privileges because of a memorandum of understanding between the VA and the American Federation of Government Employees, a federal union that represents VA workers.
The memorandum requires the department to maintain smoking areas for employees, said Tim Kauffman, a communications specialist with the AFGE.
“By Oct. 1, VA will institute this commonsense policy for patients, visitors, contractors, volunteers and vendors throughout the Veterans Health Administration, but unfortunately, AFGE has not agreed to allow VA to curb employee smoking at department health care facilities,” the VA said Friday in a statement.
A VA nurse in Michigan called the discrepancy unfair.
“We are not a smokeless facility, then, so why are they even promoting it?” the nurse said, speaking on the condition of anonymity out of concern she would be reprimanded for criticizing the policy. "How can I look at a Veteran with integrity and say, ‘I can’t let you go out to smoke,’ but my coworker just went out there? My feeling is, it should be all or none.”
The VA announced in early summer the new smoke-free policy at its hospitals, clinics and nursing homes, citing “growing evidence” that smoking, as well as secondhand and thirdhand smoke, is a medical and safety risk. The policy prohibits cigarettes, cigars, pipes, vape pens and e-cigarettes.
Anyone caught violating the policy could be subject to a $50 fine.
The new policy also calls for the “dismantling” and “phasing out” of all designated smoking areas, though a federal mandate — the Veterans Health Care Act of 1992 — requires the VA to maintain them. At the latest count, there were nearly 1,000 outdoor smoking areas at VA hospitals, clinics and nursing homes nationwide, as well as 15 indoor smoking areas.
On Thursday, a bipartisan group of lawmakers, led by Rep. Brad Wenstrup, R-Ohio, introduced legislation that would apply the smoking ban to employees, as well as anyone else on VA premises. The measure would also repeal the section of the Veterans Health Care Act of 1992 that requires the VA to provide designated smoking areas.
Wenstrup introduced the same bill in 2017. It passed the House, but the Senate never considered it.
The U.S. Department of Veterans Affairs (VA) recently revised its directives permitting religious literature, symbols and displays at VA facilities to protect religious liberty for Veterans and families while ensuring inclusivity and nondiscrimination.
The move aims to simplify and clarify the department’s policies governing religious symbols, and spiritual and pastoral care, which have been interpreted inconsistently at various VA facilities in recent years, resulting in unfortunate incidents that interrupted certain displays.
Effective July 3, these changes will help ensure that patrons within VA have access to religious literature and symbols at chapels as requested and protect representations of faith in publicly accessible displays at facilities throughout the department.
“We want to make sure that all of our Veterans and their families feel welcome at VA, no matter their religious beliefs. Protecting religious liberty is a key part of how we accomplish that goal,” said VA Secretary Robert Wilkie. “These important changes will bring simplicity and clarity to our policies governing religious and spiritual symbols, helping ensure we are consistently complying with the First Amendment to the U.S.Constitution at thousands of facilities across the department.”
The new policies will:
- Allow the inclusion in appropriate circumstances of religious content in publicly accessible displays at VA facilities.
- Allow patients and their guests to request and be provided religious literature, symbols and sacred texts during visits to VA chapels and during their treatment at VA.
- Allow VA to accept donations of religious literature, cards and symbols at its facilities and distribute them to VA patrons under appropriate circumstances or to a patron who requests them.
The U.S. Supreme Court recently reaffirmed the important role religion plays in the lives of many Americans and its consistency with Constitutional principles. This includes the following values: a display that follows in the longstanding tradition of monuments, symbols and practices; respect and tolerance of differing views; and endeavors to achieve inclusivity and nondiscrimination.
When retired Army Capt. Ryan Kules purchased his first home about 10 years ago, he and his wife used a grant from the Department of Veterans Affairs to modify their 1970s-era house to accommodate his needs as a double amputee. Three kids later, Kules was looking to move into a house that better suited the needs of his growing family, but this time the expense of modifying his house was on him and his wife.
New legislation introduced last week in the House and Senate aims to remedy this gap and make the VA’s Specially Adapted Housing grant available to qualified Veterans every 10 years, instead of as a one-time opportunity. The law also increases the value of the grant to about $90,000 and allows Veterans to receive funds up to six times. The maximum the grant provided Veterans now is about $85,000.
“Peace of mind is definitely what that is,” Kules, 38, said of the upgraded law for disabled Veterans. “Wherever we chose to live, just like anybody else would want that flexibility and peace of mind, we’ll have that opportunity.”
The grant program began in 1948 and has been updated during the years for inflation and cost of living adjustments. It is open to Veterans with certain permanent, service-connected disabilities, with the most common being bilateral amputees. Some of the modifications made to homes include widening doorways and hallways, adding walk-in showers with bench seats, lowering countertops and adding wheelchair ramps outside the house.
While Kules, who works in Washington, D.C., as the director of the Wounded Warrior Project Combat Stress Recovery program, was grateful for the grant, he saw two shortfalls in the program. First, the maximum $64,000 that was available at the time that he received the grant did not come close to covering the $100,000 that it cost to complete projects such as widening doorways and hallways and modifying the kitchen and bathroom in his home. Second, it only helped at one moment in time and does not support the lifelong needs of the Veteran.
Last year, Kules testified before Congress about the VA program and his efforts helped pave the way for new legislation.
In the House, the upgraded loan program is named in his honor, the Ryan Kules Specially Adaptive Housing Improvement Act of 2019. Introduced by Reps. Gus Bilirakis, R-Fla., Phil Roe, R-Tenn., and Mike Levin, D-Calif., the bill is expected to pass with two GI Bill upgrades affixed to it, said Derek Fronabarger, legislative director for the Wounded Warrior Project.
The cost of the program upgrades will be paid for by VA home loan funding fees, as will the GI Bill upgrades.
The bill was introduced in the Senate as the Paul Benne Specially Adaptive Housing Improvement Act of 2019 by Sens. Jerry Moran, R-Kan., and Kyrsten Sinema, D-Ariz., who are members of Senate Veterans Affairs Committee. It is named after retired Army Col. Paul Benne, a native of Spring Hill, Kan., who developed a medical condition that led to his retirement in 2013. Benne struggled for more than a year with the VA to receive an adapted housing grant.
“This modernized and expanded grant program will allow Veterans to utilize vital [Specially Adapted Housing] grants in a way that best fit their needs – providing greater support and improving the quality of life for many of our nation’s Veterans,” Moran said in a statement about the bill’s announcement.
“Many Veterans carry wounds from their service that make everyday life more challenging,” Sinema said. “That is why our bill is so important. It breaks down barriers and helps Veterans access the specially adaptive housing benefits they’ve earned.”
Fronabarger was less optimistic about the fate of the Senate version of the bill because of time constraints as congressional lawmakers turn their attention toward passing the federal budget.
In the past decade, grant approval numbers have nearly doubled, according to VA data. In fiscal year 2017, 1,926 grants were approved.
Aside from modifying newly purchased homes, accessing the grant multiple times would also allow Veterans to make changes in an existing home as their needs evolve or previous modifications need repair.
Kules, for example, anticipates he will one day rely less on his prosthetic leg and more on a wheelchair. Injured by a roadside bomb in 2005, Kules was only 24 years old when he lost his right arm above the elbow and his left leg above the knee.
“That’s an age where there’s lots of life left ahead,” he said.
Should the legislation pass, Kules said he looks forward to accessing the grant in the future to update a home after his children are grown.
The Department of Veterans Affairs recently launched a major expansion aimed to improve Veteran health care by opening up access to private doctors. But critics say the program offloads government responsibility to the private sector. Judy Woodruff sits down with the department’s head, Sec. Robert Wilkie, to discuss that issue as well as mental health, homelessness and supporting female Veterans.
Read the Full Transcript
Last month, the U.S. Department of Veterans Affairs launched its Community Care program, a major expansion designed to give Veterans access to private doctors to decrease wait times for health care.
But Veterans rights groups say the program's goals are unrealistic, and off-load the department's responsibilities to the private sector. The $51 billion measure signed by President Trump builds on legislation passed in 2014 called Veterans Choice, which allowed Veterans to seek private care.
That came in response to a scandal at the Phoenix, Arizona, Medical Center, where at least 40 Veterans died waiting months for appointments.
The Department of Veterans Affairs is the government's second largest agency, with more than 300,000 employees and an annual budget of $200 billion.
Running it all is Robert Wilkie, the secretary of Veterans affairs.
And we welcome you to the program.
Thank you for having me, Judy.
So, you stepped into this job. You were at the Pentagon in a high position.
You moved over to the VA. You have been there now coming up on a year.
Have you been able to make significant progress?
I hope so.
I think what we have seen — and I think validating those changes — is that VA's been pretty quiet. We have just finished embarking on the most transformative period in our history, at least going back to the G.I. Bill.
And I want to say something that our reform is not. It is not libertarian VA. It is not me giving a Veteran a card and saying, go out in the private sector and prosper.
What it does do is, it puts Veterans on the same plane as their neighbors. It allows them for the first time access to urgent care, to keep them out of emergency rooms, and promote holistic health by doing that.
The other thing that it does is that it offers Veterans the option of going into the private sector, only when we can't provide them what they need.
Well, as you are, I'm sure, well aware, a number of Veterans advocacy groups are saying the intention may be good, but what's happening is that Veterans, many of them may end up in the hands of private health care providers, whose care is not as consistent, not as — frankly, as competent as what they might get at the VA, that the VA needs to do a better job of overseeing all of this.
Well, I think we are.
We don't allow that people into our system unless we have fully Vetted them. The other thing that…
You mean in the private sector?
In the private sector.
We have just certified 4,500 urgent care facilities across the country. My goal is to certify 7,000.
But what we are seeing is, Veterans are voting with their feet. I have seen the explosion in requests for urgent care. I haven't seen that in the explosion and requests for other medical care in the private sector.
Our statistics show us that our Veteran satisfaction rate is at an all-time high. It's about 89.7 percent. So they're voting with their feet to stay with us.
But, at the same time, you have Veterans groups, they're — we talk to them.
A number of them are saying the responsibility here ultimately lies with the VA, and they want to make sure the VA isn't trying to push this responsibility off on somebody else.
Well, it's an interesting argument, because it's a variation on the privatization argument, which was raised when MISSION was brought up in the Congress.
And this is an act that only had four negative votes in the United States Senate. I just presented the largest budget in the history of this department to the Congress, $220 billion, calling for 390,000 employees. That's a very strange way to privatize care.
I think we're expanding care, and we're expanding care in a good way.
Mental health, a big part of this story that we're talking about.
Mental health problems for Veterans, we know, are still enormous in this country. Suicide rate among Veterans has been — has stayed at a disturbing number, 20 a day.
Why has that been so hard to tackle?
Well, I think it's been hard to tackle because the majority of those Veterans who are taking their lives are not part of the VA system.
Now, some of them are on active duty. Some are in the Guard. A significant number come from the Vietnam era and have never had any contact with us by their own volition.
Our job is to do a couple of things. One, it is to begin a national conversation. And if we just focus on the last tragic act in a Veteran's life, we're never going to get anywhere. We have to look at mental health.
I have said that we're not even at the Sputnik stage in this country when it comes to talking about mental health. The other thing we need to do is take a hard look at addiction and how we treat those who need care for pain, and make sure that they're not addicted to the medicine that's supposed to help.
So, we know President Trump signed a proclamation made, moves with regard to suicide among Veterans last spring.
But, still, this is an entrenched problem.
Should President Trump make a high-profile speech, raise the level of visibility of this…
Well, I think he has.
And I think by calling attention and calling forth a whole-of-government approach to suicide in a way that we have never had it, he is raising the profile of this issue.
I sit at the head of a task force that includes HHS, HUD, NIH, Indian Health, and the goal is to have this national conversation at the end of the process, open the aperture in terms of financial and educational support to all elements in the country, tribes, states and localities, to help them help us address this issue.
One thing we are doing, though, that has changed, we provide same-day mental health services. We have spent tens of millions of dollars on outreach. We are taking it seriously. It is our number one clinical priority.
A piece of this, as you know, is homelessness.
It's one of the ways those with mental illness deal with what they're going through.
And President Trump made a comment not long ago. Wasn't just talking about Veterans. He was talking about homelessness broadly when he described it as a new phenomenon. He said it's only been around for two years. He described it as something almost politically aimed at him.
Do you agree with his interpretation?
Well, I agree that homelessness is part of this continuum that we have to deal with when it comes to not only taking care of our Veterans, but also in addressing suicide.
I will say…
But that it's new?
Well, no, I wouldn't say that it's new.
But I will say that the numbers have gone down. Several years ago, we were looking at hundreds of thousands on the street. Today, we're looking, tragically, at about 40,000. But cities that you know very well, Atlanta, Houston, New Orleans, have eliminated Veterans homelessness by getting in partnership not only with the VA, but with charities and non-governmental organizations.
Most of our homelessness is concentrated in one area of the country. And that's the West Coast.
And — but do you — and you feel progress?
Oh, I — much progress — 40,000 compared to the hundreds of thousands a few years ago is progress.
But we still have to work on it.
Women, they are the fastest growing demographic in the U.S. military, more women serving in combat than ever before.
That means more women becoming Veterans, coming under the purview of the VA.
Again, what we're hearing from some of these Veterans groups is, women Veterans tell them, when they go into a treatment center, they often feel disrespected. They even feel hostility toward them.
At the same time ,a month ago, there was a study done by an internal government watchdog group that found more harassment of women and men at the VA over a recent two-year period than any other government agency.
Pull that together.
Well, if you look at that study, that harassment is not coming from VA employees. I can't — I can't change the perception of older Veterans who are not used to seeing women in uniform.
What I can say is that, in this budget, $9.5 billion is set aside for women's care. Each one of our hospitals has a women's clinic. The culture is changing rapidly. The notion that I, as a youngster, would have ever seen women wearing the red beret of my father's division, the 82nd Airborne Division, would have been — that would have been unheard of.
Today, they are. And I think the military as a whole is changing with that culture. And VA now, with 10 percent of those we serve being Veterans, and having those clinics in all of our hospitals, is changing with those times.
But how do you change those attitudes?
Well, you change that by — it's a cultural change.
And you also change it by confronting those who engage in that kind of behavior. Again, it's not our employees. It's people who come in. And there are still elements in this country who refuse to accept that the times have changed, that women are warriors on the front line in numbers that we have never experienced before.
And what about the harassment inside the Veterans Administration?
Well, that's one — if we see it, we act on it.
And I read that report. And, again, it is an instance of people who have not caught up with the times. But it's certainly not a part of our employee makeup.
Robert Wilkie, who is now coming up on one year as secretary of Veterans affairs, thank you very much.
Thank you, Judy. Thank you very much.
SAN ANTONIO — The Alamo Area Council of Governments is accepting applications from Veterans and low-income families to get up to $15,000 to help repair their homes.
We spoke with them to tell us how Housing for Texas Heroes works.
Basilio Serrano, a Navy Veteran talked about the ship he was on from 1963-65.
Now 74, he's thankful for the work AACOG had done on his home.
In his case they repaired his foundation.
"And I'm grateful that I could get the grant to do this work because the house was leaning," Serrano tells us.
Serrano qualified for a program called Housing For Texas Heroes.
Last year the program helped 16 Veterans with a $300,000 grant.
"The Housing for Texas Heroes grant is a grant that we receive from the Texas Veterans commission, this year we have received another $300,000," Weatherization coordinator Alicia Penalver said. "So we do up to $15,000 per low-income household as long as they are a Veteran or spouse of a Veteran."
There are other programs that Serrano and even non-Veterans can qualify for.
"Then we have the weatherization program that is available to any household that is of low income status," Penalver said. "We can go in and put in insulation, maybe replace a refrigerator or gas stove or water heater."
Last year AACOG weatherized almost 250 homes.
This year, they've received more than $1 million to help these families.
The head of Kansas City VA Medical Center is now accused of withholding details about the death of an elderly Veteran at the hands of VA Police.
Local officials believe withholding of evidence and obfuscation is a pattern well known to the agency’s local director, Kathleen Fogarty. Once dubbed “the VA queen of cover-ups” after getting caught approving secret recording of a Veteran’s family, Fogarty is no stranger to withholding information.
For some background, the problem at Kansas City VA Medical Center is all too familiar and was well addressed in a recent story by The Kansas City Star that I’m providing the cliff notes of here.
Kenneth Farhner Wrongful Death
Kenneth Farhner, a 66-year-old Veteran, went to VA for hernia surgery in May 2018. The wound became infected. So, Farhner drove himself to the emergency room, but he drove the wrong way on VA property on the way to get emergency care.
VA police confronted Farhner leading to an altercation. Leaked documents published by USA TODAY showed the confrontation left the elderly Veteran nearly comatose. He died two years later from a brain hemorrhage.
A couple of things jumped out at me on this issue. First, the Veteran’s surgical site became infected – – possibly due to poor health care at the same VA. Second, why would a member of VA Police do anything to an elderly Veteran in distress that could result in death?
Thumbing Nose At FOIA
A local paper called The Star investigated after receiving an anonymous tip about Farhner’s death. Despite filing requests for records under the Freedom of Information Act, the local VA refused to cooperate.
The Star was not alone. Members of Congress were stonewalled. And, so was Farhner’s family who has since filed a wrongful death lawsuit against VA.
The agency’s behavior is typical whenever local leadership is covering up wrongdoing.
Randall Barnett, the president of Vietnam Veterans of America in Kansas City, is suspicious.
“If they weren’t at fault or didn’t feel through their investigation they were somewhat at fault, why would they cover everything up?” Barnett asked. “Or try to cover everything up?”
Spokesman for Kansas City VA Medical Center denies a cover-up.
“Federal law enforcement officials have already fully investigated this matter and determined that VA acted appropriately in its interaction with the Veteran,” Vernon Stewart said. “VA will cooperate fully with any additional official investigations.”
Fire Alarm At Tampa VA
Fogarty used to run the James A. Haley VA Medical Center located in Tampa, Florida.
While there, she ordered her staff to place a recording device inside a fire alarm to secretly record family members of a severely ill Veteran.
When investigated, her subordinates provided false statements about the nature of the secret recording including stating the family consented. Documents later uncovered by The Tampa Bay Times showed staff provided many other untruthful responses about the matter. I have a clip from a hearing addressing the recording at the bottom of this article.
Why would any party place a recording device inside a smoke detector if the recording was above board? No one does that. Just use a normal recording device.
After Tampa, Fogarty was shipped off to Phoenix VA Medical Center to deal with the falsified patient wait times problem that surfaced in 2014.
Tampa Bay Times previously reported Fogarty “cut Veterans’ access to outside care to help overcome a multimillion-dollar deficit as director of the Tampa, Fla., VA, in 2011 and repeatedly denied publicly that she was doing it.”
USA TODAY previously included Fogarty in a list of agency leaders who were “transferred to new jobs despite concerns about the care provided to Veterans at the facilities they were previously managing.”
VA Spokesman Calls Press Story “Irresponsible”
Stewart, the local spokesman, denied the allegations of USA TODAY and chastised The Kansas City Star for addressing the USA TODAY list within its own reporting on the Farhner battery, saying the data was “flat-out false and repeating it to your readers would be irresponsible.”
“When Director Fogarty became director of the Tampa VA Medical Center in 2011, she inherited a nearly $48 million budget deficit,” Stewart said. “She balanced the budget by using commonsense management principles such as not filling unneeded positions and eliminating unnecessary overtime and travel. Under Fogarty’s leadership, the facility expanded its services to Veterans, and the blueprint she developed for managing the resources remains in place at the VAMC today.”
However, that is not consistent with Fogarty’s statements in 2014, “Fogarty said she balanced the Tampa VA budget in three years by reducing the time Veterans spent in non-VA hospitals.”
In 2011, Fogarty denied the facility was at a deficit.
So, who is the public to believe? Should we trust Stewart’s spin about his boss’s record? Or, should we trust the reporting of at least four different news organizations about Fogarty’s checked track record?
Kathleen Fogarty Biography
Here is Fogarty’s VA bio in italics:
Kathleen R. Fogarty was appointed by the Secretary of Veterans Affairs to serve as Director of the Kansas City VA Medical Center effective March 8, 2015. As the Director, Mrs. Fogarty oversees the delivery of health care to more than 48,000 Veterans throughout Western Missouri and Eastern Kansas and manages the daily operations of the 157 Bed Medical Center, seven (7) Community Based Outpatient Clinics, a radiation/oncology outreach clinic, and a Medical Mobile Unit. The KCVA is a principle teaching hospital affiliated with the University of Missouri-Kanas City and University of Kansas, School of Medicine. The KCVA has an operating budget of approximately $340 million dollars and more than 1600 full time employees.
Prior to this appointment, Mrs. Fogarty served as the Director of the James A. Haley Veterans Hospital in Tampa, Florida From 2011 through 2015 and the Interim Network Director for the Southwest Health Care Network VISN 18 from November 2014 through August 2015. She served as the Interim Medical Center Director of the Overton Brooks VA Medical Center in Shreveport, LA from September 2010 through August 2011 and the VA Gulf Coast Veterans Health Care System in 2009.
Mrs. Fogarty is a Senior Executive Career Development Program Graduate, a certified Fellow of the VHA Mentor program, a member of the Senior Executive Association, the American College of Healthcare Executives, and the American Dietetic Association, and a member of the Board of Trustees for the University of Saint Mary. Among Mrs. Fogarty’s many awards and honors are; the Presidential Rank Award for Meritorious Executive, the Vice President Gore Hammer Award for Subsistence Prime Vendor Team and the Deputy Secretary of Veterans Affairs Scissor Award.
Fire Alarm Investigation
I covered the fire alarm issue back in 2013 when I first caught wind of it during a House Committee on Veterans Affairs hearing.
Congressman Jeff Miller, Majority Leader of the House Committee on Veterans Affairs, pressed VA’s Scott Gould about the fire alarm recorder.
Ultimately, former Deputy Secretary Scott Gould stood by the VA’s decision. He asserted the secretive recordings were made to preserve the safety of the Veteran. In response to the allegations, Gould said, “Our greatest priority is safety and security of our patients, and we secured it with that camera.”
Safety and security? Like I said before, why not put the camera out in the open if the goal was purely to ensure the safety of the Veteran?
Former Chairman Jeff Miller agreed.
In response to Gould, Rep. Jeff Miller said, “Common sense would say if you’re going to put a camera up, just put a camera up where people can see it.” He continued, “For some reason, someone [in the VA] made the decision to hide the camera. It was installed without notice. It was installed without consent. What is interesting to me… is that there is a claim that consent is not required within a VA facility…”
The family tried to expressly state to VA that there was no consent given. Let’s not forget that Fogarty’s staff falsely asserted the family consented to the fire alarm recording.
What should the public think?
First, avoid VA Police when you’re distressed or you might get bodyslammed. Second, always act as if someone is recording you whenever on VA property. Third, if you do get bodyslammed and die, be sure it’s recorded on your iPhone because the agency will obfuscate at every stage of the investigation.
WASHINGTON — The Department of Veterans Affairs missed a self-imposed deadline at the end of June to decide whether to add conditions to the list of diseases presumed to be caused by Agent Orange exposure.
Researchers with the National Academy of Medicine released a report in November stating there was “suggestive” evidence that eight diseases — prostate cancer, bladder cancer, hypothyroidism, stroke, early-onset peripheral neuropathy, AL amyloidosis, ischemic heart disease and Parkinson-like syndromes — could be caused by Agent Orange, a chemical herbicide used during the Vietnam War. They also found “sufficient” evidence linking the tactical herbicide to hypertension.
Under questioning at a Senate hearing in March, Richard Stone, the executive in charge of the Veterans Health Administration, vowed to review the report and to decide this summer whether to add to the list of presumptive conditions. The list currently covers 14 diseases and gives Veterans who suffer from them a fast track to disability compensation.
“We’re working our way through that right now, and it would be my hope that within the next 90 days, we’ll have some decisions made,” Stone said March 26.
More than three months later, the VA hasn’t made any decisions.
“VA has no announcements on Agent Orange presumptive conditions at this time,” a VA spokeswoman said Monday.
Army Veteran Jerry Foreman of Montrose, Ark., heard Stone’s promise this spring and has been waiting for the VA’s decision.
Foreman, 72, served in Vietnam with the 5th Special Forces Group and retired from the Army as a captain after 21 years. In the past several years, he’s developed hypertension and Parkinson-like tremors.
He has a VA disability rating of 20% for tinnitus and diabetes, and gets about $280 in benefits each month. If hypertension and Parkinson-like syndromes were added to the presumptive list, he guesses he would receive a “significant” increase.
“The National Academy — they’ve recommended that all these be put forward, but it just doesn’t seem to be working,” Foreman said. “We’re on hold … it really makes you kind of angry. We need some kind of accountability in the VA.”
Foreman, as well as other Veterans and families, has been tracking the slow progress on these conditions.
In 2017, former VA Secretary David Shulkin recommended to the Office of Management and Budget that several of the conditions be added to the presumptive list. The recommendation didn’t make it any further.
“They’re going to say it costs too much money,” said Rick Weidman, executive director of policy and government affairs for Vietnam Veterans of America. “Well, you should’ve thought about that before you put poisons on people.”
Martha Edgin, the wife of a Vietnam Veteran with bladder cancer, has spent years researching and applying to the VA. Based in Norman, Okla., Edgin repeatedly has contacted the VA and the Office of Management and Budget, in addition to her congressional delegation and anyone else she believes might know something about when — or whether — bladder cancer would get approved for the list.
Edgin described the most recent delay as “shameful and unconscionable.” It creates a “lack of trust” for the VA among Veterans and their families, she said.
“The saying that so many Veterans believe is, ‘Deny, deny until they die,’ ” Edgin said. “In my opinion, Secretary [Robert] Wilkie needs to step up to the plate and say, ‘Enough,’ as should President [Donald] Trump. Immediately addressing this issue would go a long way in restoring a little faith in the system.”
Verizon partnered with the US Department of Veterans Affairs (VA) in a move that will give Veterans who are also Verizon customers access to the VA's telehealth app VA Video Connect — which enables remote consultations with healthcare professionals — free of data charges via Verizon's 4G LTE network, per Health Data Management.
Here's what it means: The VA is doubling down on telehealth efforts to expand its reach among rural Vets.
- The VA conducted over 1 million telehealth consultations last year, and a strategic partnership with Verizon should help it reach its lofty telehealth goals. Six million unique patients received VA treatment last year — a difficult task given there are only 172 VA medical centers nationwide — and telehealth could effectively expand VA providers' reach: The VA aims for all of its care providers to be telehealth enabled by the end of fiscal year 2021, according to a 2018 Veterans Health Administration notice.
- The VA is concerned that there are fewer care options for rural Vets — but hopes 4G-powered telehealth could provide reinforcements. The VA's major telehealth investments are almost primarily geared toward addressing the needs of the 4.7 million US Veterans living in rural areas: Rural Veterans may need to travel great distances between their homes and points of care — a problem exacerbated by uncertainty around the 21% of rural hospitals currently facing closure. Also, 27% of rural Vets don't use the internet at home, likely due in part to a lack of broadband coverage: Nearly 40% of individuals in rural communities don't have broadband access compared with 4% in urban areas, per The Conversation. Nevertheless, the VA has had success with telehealth in rural areas: Of the 1 million telehealth visits last year, over half were made by rural Veterans.
The bigger picture: Verizon likely sees the massive VA patient base as a proof-of-concept for a larger telehealth play on the horizon.
- Verizon isn't the only major telecom player interested in telehealth, but its superior 4G network could still give it the long-term edge. In addition to its partnership with Verizon, the VA has previously tied up with two other major players in the telecom space — T-Mobile and Sprint— on telehealth initiatives. However, Verizon performed better than the competition in terms of 4G mobile video streaming, and it also had the widest coverage area, according to insights from OpenSignal.
- And free 4G access for Veterans could be just the first step in a larger 5G telehealth play from Verizon.Of the three telecom providers linked up with the VA, only Verizon has a web presence fully dedicated to 5G in healthcare. As we've previously covered, 5G is the next step in mobile connectivity, and it's prepped to have a major impact on the efficacy and speed of digital health tools. I (Zach) think we could see Verizon leveraging 4G performance data from VA Video Connect in attempts to work out a more ambitious, paid contract to provide 5G digital health services to VA medical centers in the near future. However, Verizon will need to improve its 5G network before that point and could find itself competing with the reach of a potentially merged T-Mobile/Sprint.
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The VA has not announced any decision on whether it will provide disability compensation for four diseases linked to exposure to Agent Orange by a scientific panel, breaking a pledge to make a decision by late June.
Despite a promise in March from a Veterans Health Administration official that VA would decide within 90 days whether to add four health conditions -- bladder cancer, hypothyroidism, hypertension and Parkinson's like symptoms -- to a list of diseases presumed related to herbicide exposure, a VA spokesman said last week that none is forthcoming.
"We have no announcements on Agent Orange presumptive conditions at this time," a VA spokeswoman said Wednesday, three months after a hearing in which a VA official told a senator the decision was pending.
During a Senate Veterans Affairs hearing March 26, Dr. Richard Stone, the executive in charge of the Veterans Health Administration, said it was his "hope within the next 90 days that we'll have some decisions made."
In March 2016, the Institute of Medicine, an arm of the National Academies of Sciences, found evidence that two conditions, bladder cancer and hypothyroidism, are likely linked to Agent Orange exposure and that a third, Parkinson-like symptoms, should be added to the list of diseases presumed to be related to contact with the herbicide.
CINCINNATI — In the 11 months since Robert Wilkie became United States Secretary of Veterans Affairs, he’s booted medical directors from their roles, visited individual VA centers to assess their weaknesses and created history by requesting and receiving the largest-ever budget for his department: $220 billion.
The problems facing the VA as he entered it were numerous and well-documented — long wait times for appointments, allegations of misconduct, over prescription of opioids, a poor work environment and improperly kept records that led to delayed GI payments, to name a handful of the most prominent. Many still linger.
However, during a recent visit to Cincinnati, Wilkie said the agency’s approval ratings are rising as it takes a series of new approaches to fight its longtime bugbears.
“Most of the issues in the VA — not here in Cincinnati — have nothing to do with the technical competence of the employees,” he said. “It had everything to do with leadership walking the post.”
As the face of new leadership, Wilkie has overseen the implementation of the MISSION Act, which allows Veterans to see pre-screened private practitioners if their local VA is more than a 30-minute drive from home or if the soonest available appointment time (for primary and mental health care) is more than 20 days away. For services falling under the umbrella of "specialty care," Veterans can see a community health care provider if their VA is over an hour away or the nearest available appointment is not within 28 days.
Wait times differ from need to need, but the average number of days elapsed between a request and appointment is 12 in Cincinnati, according to Wilkie. It’s 39 at the clinic in Hamilton.
“MISSION was designated to make sure those numbers did not affect the Veteran’s health,” Wilkie said.
He also hopes to deal more effectively than his predecessors with issues such as mental illness and addiction, he added. Although Wilkie has in other interviews partially attributed the high rate of Veteran suicide to Veterans not being in contact with their local VA, he acknowledged the agency’s responsibility to provide better-quality services and outreach. He’s invested $9 billion this year — more than any year before — in improving those aspects of the agency.
“We are not even at the Sputnik stage in this country when it comes to getting our arms around mental health issues," he said at the National Coalition for Homeless Veterans conference in late May.
He echoed that statement during his trip to Cincinnati, noting that providing nuanced mental health care has practical benefits alongside humanitarian ones.
“This is not a draftee army anymore,” he said. “These are all volunteers, and you have to take better care of them than you did in the draftee days, where it didn’t matter what the individual soldiers did (because) there were 10 coming in to replace them on any day.”
Only comprehensive culture change can be the real answer, he added. That could take a significant amount of time, and it means focusing on more than suicide prevention. It means emphasizing wellness, exploring supplemental forms of treatment such as yoga and training Veterans to look out for one another.
Mental health should be a significant element of Veterans’ everyday care, he said. And everyone else’s, too.
If that $9 billion is spent wisely, Wilkie said he thinks it’s possible the VA could lead the conversation on effective psychiatric treatment in the United States.
“We have a community-based system here,” he said. “We have a culture that promotes communication, and what I see across the country — today, sadly, the fourth new York City policeman (in three weeks) has sadly taken his life. We’ve seen suicide among teenagers spiking. So it’s not just Veterans. It’s the entire country that needs to be brought into this.”
Despite years of setbacks, many of which still weigh on his agency, Wilkie said he has generally witnessed encouraging progress since he assumed his post in June 2018.
He hopes to see much more ahead.
“Most of my professional and political career, the VA has always been 16 or 17 out of 17 in terms of best places in the government to work,” he said. “We’re No. 6 now and will likely be higher when the next ratings come out. So (those are) incredible steps forward, and I think it’s incumbent upon me, as someone who comes from the military — I was working for General Mattis when this offer came — to tell that story and encourage Veterans to use the VA.
“This is a home for them with people who have served.”