I’ve been working via the VA over the past six months attributable to having points with my blood. A number of time the platelets dropped as little as 1000 for days at a time. The answer is what remedy will work. Steroids, IVIGs don’t work. It isn’t until I get to most cancers drug Rituxan, my platelet depend begins to go up and the situation referred to as ITP goes into remission.
For 25 months I used to be based mostly at Camp LeJeune ingesting and showering within the water. The one time I used to be not there was after I was in Cuba for 9 months. There’s a direct hyperlink to ingesting the contaminated water and ITP (now persistent ITP) which I’ve been recognized with by Hematologist.
I’ve not discovered the VA to be denying my declare but. Then too, I left Camp Lejeune in 1971 and many people have died since then. They don’t transfer too quick to agree with you. And denials are widespread. I do have ~300 pages of documentation from weeks in hospitals.
One actually has to have lots of persistence and stubbornness to get one thing don there and the method is sluggish.
The Contracting Gold Mine That Hurts Veterans
– Jasper Craven
Exams to find out whether or not veterans qualify for sure advantages have been nearly totally privatized, and the businesses conducting the exams have lengthy been cited for poor high quality.
Poisonous publicity is a routine a part of army service. This was actually the case for Military veteran Brian Shumway, who was repeatedly uncovered to harmful chemical compounds all through his profession. In his home function in a fight arms department, Shumway labored with tanks and different heavy automobiles, usually dealing with gas and flame-retardant fluids. Then, in 2010, he was deployed to Iraq, the place he helped function and decommission bases.
A signature of those bases had been burn pits: large ash heaps that served as advert hoc sanitation methods. The supplies in these smoldering pits included delicate army data, medical and human waste, paint, and different types of trash. Shumway’s withdrawal work introduced him to 2 of essentially the most infamous pits: Ali Air Base in southern Iraq, and Balad Air Base simply north of Baghdad.
Three years later, in July 2013, Shumway, a Nationwide Guardsman, was getting a high-and-tight haircut stateside when his barber observed what seemed like small, scabby cuts above his ears. This psoriasis started to unfold throughout his physique, making his pores and skin uncooked and bloody and inflicting extreme joint swelling, stiffness, and degeneration. “I was basically bedridden for months—totally exhausted,” he advised the Prospect. “It was awful.”
A little bit of on-line sleuthing led Shumway to be taught in regards to the prevalence of autoimmune ailments amongst these uncovered to poisonous chemical compounds, together with 9/11 first responders and veterans who served close to burn pits. For years, Shumway handled his situation with allergy photographs and over-the-counter antihistamines, however his signs obtained worse. In February 2022, he filed a incapacity declare with the Division of Veterans Affairs for psoriatic arthritis, contending that his situation was instantly tied to his service.
It was an advanced declare, as autoimmune diseases are elaborate and considerably mysterious. “There’s a whole lot of factors that go into causing autoimmune disease,” he defined. “Essentially your genetics load the gun, and your environment pulls the trigger.” Nonetheless, Shumway constructed a powerful case. He additionally included pictures he’d snapped in Iraq whereas enveloped in a burn pit’s thick, noxious smog.
Nonetheless, the VA swiftly denied his declare.
In June 2022, Shumway launched an enchantment with the assistance of Wesley McCauley, a registered claims agent. McCauley aimed to strengthen Shumway’s case with extra medical proof, which is most frequently gleaned via what’s often known as a compensation and pension (C&P) examination, the place medical workers pore over army well being data and conduct assessments to know whether or not sure accidents are related to time within the ranks. Roughly 1.4 million C&P exams happen yearly, each probably important to the way forward for a veteran’s declare. A superb examiner will present a affected person with satisfactory medical documentation to win a case. A foul one can lead a veteran to be improperly denied entry to the division’s beneficiant care and advantages.
Traditionally, these exams had been undertaken solely by VA clinicians steeped within the distinctive well being challenges of former service members, whereas being strictly overseen by authorities regulators. However starting within the late Nineteen Nineties, lawmakers began opening this work to contractors, a pattern that has enormously accelerated in recent times. Within the waning days of his first time period, President Donald Trump introduced plans to denationalise just about all C&P exams, bursting open the floodgates to what was already a multibillion-dollar contracting gold mine.
Shumway in the end undertook roughly a half-dozen exams run by two of the most important contractors within the house: QTC and Veterans Analysis Companies. He introduced exhaustive documentation to his appointments, together with army and civilian medical data and prescriptions corroborating his diagnoses of psoriasis and psoriatic arthritis. “No one was interested,” he mentioned. “It felt like a puppy mill—these companies are trying to do as many exams as they can to make as much money as they can. They simply don’t do a thorough job, and they face no consequences.”
Shumway left certainly one of these appointments after a nurse failed to use a tourniquet to attract blood, sticking Shumway, a skilled medic, 5 – 6 instances with out success. “They didn’t know what the fuck they were doing,” he mentioned. “Plus, blood test information was already included in my file.”
In March 2023, McCauley submitted a claims accuracy request to the VA on behalf of Shumway, detailing practically two dozen company errors, many made by non-public examiners, who repeatedly failed to just accept his diagnoses regardless of sturdy proof. “It seems like they had a predetermined conclusion that they wanted to reach,” Shumway mentioned. “Whatever evidence I had, like prescriptions and paperwork from my rheumatologist, they ignored.”
It in the end took 485 days earlier than the VA declared Shumway one hundred pc completely disabled, acknowledging of their choice that his declare had been marked by “clear and unmistakable errors.”
Shumway’s lengthy, error-ridden expertise is way from an aberration. For years, lawmakers and authorities watchdogs have raised pressing issues over the standard and oversight of personal C&P exams. Their warnings have grow to be extra salient because the 2022 passage of the PACT Act, which opened the VA to thousands and thousands extra veterans sickened by exposures to Agent Orange, burn pits, and different chemical compounds whereas in service.
Amid a corresponding surge in claims, the VA is shifting comparatively rapidly, avoiding a significant backlog thanks largely to its non-public military of examiners. However whereas effectivity is up, high quality is down. “Crap at the speed of light is still crap,” mused Rick Rousseau, an Military JAG turned veterans’ incapacity lawyer.
“It’s pitiful,” added McCauley. “The quality of exams is so poor these days, and the taxpayer is paying for all of them.”
THE FIRM THAT BEST EMBODIES the extremely profitable rise of privatized, slipshod C&P exams is QTC. The agency’s former president and board chairman Anthony Principi, a U.S. Naval Academy graduate who ran a Mekong River patrol unit throughout Vietnam, was the pre-eminent VA whisperer to the Bush household. He served because the company’s deputy secretary and performing VA secretary for Bush 41 earlier than serving as Bush 43’s first VA secretary. Within the intervening years, Principi labored as a Republican Senate staffer, then helmed QTC, which was based as a small non-veteran-focused medical analysis clinic in 1981. The agency’s three-letter title is an acronym for its company pledge: high quality, timeliness, and buyer focus.
Principi helped usher QTC and different companies into the work of veteran examinations. In 1996, he chaired a congressional activity pressure on veterans’ points that beneficial, amongst different issues, standardizing bodily exams for retiring troops. That very same yr, Congress created a geographically focused pilot that, for the primary time, approved non-VA officers to conduct medical examinations, a part of a purported try to “improve … quality and timeliness.” QTC’s title explicitly promised such requirements, and in 1998, the agency was first tapped by the VA for C&P exams.
As VA secretary, Principi zeroed in on the post-9/11 claims backlog, making a activity pressure that explicitly lauded the providers of QTC, the corporate he as soon as led. Principi’s help helped lay the groundwork for language within the VA’s 2003 price range that expanded the C&P pilot. In December 2004, Principi resigned from the VA and returned to QTC as board chair.
In 2006, the Los Angeles Instances revealed that, throughout Principi’s time in authorities, QTC had secured as a lot as $1 billion in VA contracts for which they had been the one bidder. The reporting famous that “officials of other firms said they were not aware the contract was up for bid, though they had previously expressed interest to the VA.” The paper additionally highlighted information estimating that QTC exams price as a lot as 400 p.c greater than the VA’s in-house providers. “This is a conflict of interest in the most extreme form,” John Gage, then the president of the American Federation of Authorities Workers, advised the paper, insisting that the exams ought to stay below the VA’s area.
The report spurred a congressional inquiry that cleared Principi of wrongdoing, although one of many sources interviewed by Hill workers claimed afterward that investigators’ questions had been geared towards “looking to excuse possible wrongdoing and to dismiss my concerns.” In an interview with the Prospect, Principi insisted that his main rationale for personal exams was to shrink the backlog, and ease entry for veterans residing distant from a VA medical middle.
In 2008, QTC was formally flagged by the VA’s Workplace of Inspector Common for overbilling. (A extra latest inquiry discovered no irregularities.) In September 2011, QTC was acquired by Lockheed Martin, making certain that the large army contractor couldn’t solely revenue from warfare, but in addition from wounds incurred on the battlefield. (QTC is now owned by Leidos, a protection and biomedical analysis firm.)
In the course of the interview, Principi mentioned his monetary relationship with QTC ended alongside his preliminary stint within the Nineteen Nineties, although his second function, as QTC’s “executive chairman,” is one that’s often compensated. In a follow-up e-email, Principi clarified that he was certainly compensated on this put up, which he left round 2012.
CONGRESS HAS SUBSEQUENTLY CONTINUED over the previous dozen years to increase the function of personal exams slightly than enhance in-house capability, resulting in billions in contracts and over eight million non-public exams. One of the monumental expansions in C&P outsourcing got here in 2016, by way of Rep. Jeff Miller (R-FL) and Sen. Richard Blumenthal’s (D-CT) Veterans Well being Care and Advantages Enchancment Act. It did away with the regionalized pilot program that had existed since 1996 and approved the VA to contract out exams in any state or American territory.
Months later, Rep. Miller retired from Congress and have become a lobbyist. Whereas he had as soon as launched a congressional investigation into allegations that QTC did not correctly consider disabilities regarding Agent Orange publicity, as a lobbyist he labored for one more infamous non-public examination supplier: Veterans Analysis Companies, also referred to as VES.
In 2015, the Tampa Bay Instances reported that VES despatched dozens of veterans to a Tampa physician who was below federal investigation. That very same yr, the corporate settled a go well with with an worker who alleged wage theft. In 2019, Margaret Rajnic, a nurse who briefly labored for VES in 2018, advised me that the group was poorly run and that a lot of its reviewers had been unfamiliar with primary medical phrases or procedures. Rajnic mentioned she was fired after elevating questions in regards to the firm’s enterprise practices. In one other 2022 go well with, a veteran alleged that VES made a number of errors in his claims course of.
Miller, who was significantly thought-about as a candidate for Trump’s first VA secretary, was a robust voice for VES. Beneath Trump, the agency secured a $205 million contract. (QTC, for its half, netted billions in VA contracts in the course of the Trump years.)
In 2022, the VA’s Workplace of Inspector Common discovered that VES, QTC, and different distributors “failed to consistently provide [the VA] with the accurate exams required by the contracts.” The OIG additionally reported that senior company officers discouraged the relay of personal examination points to the regional workplace stage and faulted VA leaders for not utilizing accountability instruments at their disposal.
“They’re not docking contractors’ money or assessing a penalty for mistakes,” mentioned Rousseau, the lawyer. “There’s not even a decent feedback loop, no after-action reports and thus no lessons learned on what they’re doing wrong.” Andy Gross, one other longtime incapacity claims lawyer, echoed Rousseau’s perspective, saying that “exam quality has cratered over the last few years and that’s because there is effectively no oversight over the process.” At this level, Gross estimated, 80 p.c of the claims enchantment instances he takes concern dangerous exams.
Nonetheless, contracts continued to circulation below Trump, due to well-connected figures like Kristy Park, a QTC lobbyist who beforehand labored for the Home Veterans’ Affairs Committee, and Joseph Lai, a lobbyist and former Trump adviser employed by VetFed, one other C&P firm that earned tens of thousands and thousands in contracts below Trump—way over what it was awarded below Obama. A former senior VA official advised the Prospect that Principi was in shut and frequent communication with Trump’s first VA secretary, David Shulkin, who didn’t reply to requests for remark.
Principi mentioned he’s communicated with numerous VA secretaries, together with Biden’s choose, Denis McDonough. He mentioned he hasn’t communicated together with his former employer in years, and by no means lobbied for them: “Why would I?”
BY 2019, KERI JACKSON WAS SO FRUSTRATED by the outsourcing of C&P exams that she give up the VA. A former army physician and Gulf Struggle veteran, Jackson started conducting inner C&P exams in 2004. Within the years since, she’d watched the company farm out exams to non-public contractors, resulting in frequent complaints from sufferers and colleagues. Exams that took her hours had been now being finished by the non-public sector in minutes. “My personal opinion is it’s fraudulent,” she advised the Prospect.
It took Jackson years to excellent the artwork of the C&P examination. Her expertise had been sharpened due to high quality management metrics throughout the VA, together with routine evaluations and suggestions on her work from VA advantages officers and medical workers. “The VA was motivated to do quality improvements,” she mentioned. “They have systems, they do training.”
When Jackson give up in 2019, simply 25 p.c of C&P exams had been being carried out by the VA. Lots of her former colleagues had by then been employed by contractors, and few had been glad. She recalled that one former VA examiner was prevented by QTC from reviewing veterans’ claims recordsdata—a crucial piece of the analysis course of—as a result of it was “time consuming.” When Jackson herself briefly inquired about potential work with VES, the corporate supplied her coaching supplies that had been outdated and alignment with the VA’s present guidelines and laws.
In October 2020, the Trump administration introduced that just about all exams had been to be carried out by non-public companies. Trump’s undersecretary for advantages, Paul Lawrence, contended that the transfer was merely the “evolution of the process,” blasé remarks that prompted consternation from lawmakers who’d lengthy heard horror tales from their constituents. Sen. Jon Tester, then the rating member of the Senate Veterans’ Affairs Committee, mentioned the transfer created the “potential for serious long-term negative impacts on the services and benefits provided to our nation’s veterans.”
Because the VA elevated outsourcing, it diluted its already weak oversight. For years, the VA’s Medical Incapacity Examination Workplace was required to conduct random and complaint-based website visits at contractors’ amenities to make sure compliance with ADA and OSHA requirements. However in September 2021, contract language was quietly softened to stipulate that the workplace “may” conduct these visits, however was not required to. The VA additionally tasked non-public examiners with score their very own efficiency slightly than eliciting suggestions instantly from veterans.
In Could, the Workplace of Inspector Common launched its personal damming efficiency evaluation, figuring out deficiencies at 114 of the 135 non-public examination amenities it visited. The watchdog additionally reviewed quite a few veteran complaints, together with allegations of moldy, bug-infested places of work, and amenities that lacked correct exit doorways. Some companies had defective tools or a scarcity of ramps for wheelchair-bound veterans. In a single case, a veteran with a hip situation was directed onto a therapeutic massage desk that collapsed, inflicting the veteran to land flat on their again and, consequently, expertise much more ache. In one other instance, a veteran in a wheelchair was being assisted into an audio sales space with no ramp to check their listening to. Throughout this transfer, they fell to the bottom, their eyes rolled again, they usually started vomiting. (In the end, they had been taken by ambulance to an area VA hospital.)
In September, Gross and Rousseau gave a presentation on non-public examiners on the Nationwide Group of Veterans’ Advocates convention, which included extra dangerous examples, just like the case of 1 examiner who continued to follow regardless of being disciplined by the Texas Medical Board for making a misleading medical document throughout a veteran’s examination. One other contractor did not undertake the VA’s required trainings.
“These aren’t folks on their break from Sloan Kettering or Johns Hopkins,” Gross mentioned. “Most are not at the top of their game but are instead hoping to make a little extra money moonlighting as a veterans’ claim examiner.”
Gross, Rousseau, and different incapacity brokers have additionally raised issues that VES has subcontracted with an organization referred to as Maximus, which is hiring so-called “bookmakers” to additional streamline the examination course of by reviewing a veteran’s large medical file and paring it all the way down to just some pages. A job itemizing makes clear that no medical background or faculty expertise is important. “Someone with a GED is making complex medical determinations to see if burn pit exposure is related to a veteran’s cancer,” mentioned McCauley.
Sen. Elizabeth Warren (D-MA) not too long ago wrote a searing letter to VA Secretary Denis McDonough outlining extra “disturbing reports” from non-public C&P exams and demanding reform. Her letter contains the astounding accusation that contractors “shredded medical questionnaires instead of adding them to medical files,” and that some veterans had been additionally examined in nonmedical settings, together with co-working areas, resort rooms, and broom closets. A Warren spokesperson advised the Prospect that, months later, McDonough by no means supplied a response.
Terrence Hayes, a VA spokesperson, advised the Prospect that there was a document enhance in permitted incapacity advantages below the Biden administration, and pointed to larger examination accuracy charges and veteran satisfaction scores. He mentioned the VA would reply to Warren “as soon as possible,” and famous that the company is working to deal with the OIG’s suggestions as a part of a broader marketing campaign to “improve contract examination vendor oversight.” This, he mentioned, has included 400 website visits in fiscal yr 2024, plus “reducing the volume of work sent to contractors when performance concerns arise” and issuing “letters of concern.” He didn’t present requested particulars on the scope of such penalties.
One other Trump administration will possible abandon these enchancment efforts and dismiss requires reform, particularly as there’s extra cash to be constituted of no-bid contracts. However as high quality suffers, the dissatisfaction from veterans searching for advantages to which they’re entitled will solely develop.
Principi, for his half, mentioned he hadn’t been conscious of the near-total outsourcing of C&P exams and expressed fear over the event. “These exams should be done at the VA unless they can’t be,” he mentioned. “And if somebody is doing a shoddy exam or veterans are not being treated well, then somebody at the VA needs to look into that.”
