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allan
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Posts posted by allan
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>It never ceases to amaze how many people think the Government should just accept what they say as a truth.
We are learning how little truth has to do with operating a Government agency.
Hopefully, the Dept. of Veterans Affairs is better at it than the JUSTICE dept.
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It's good to see these troops are getting help.
If it wasn't for those troops at Walter Reed, practically dragging the news media into it, nothing would be changed today. "THEY" are the brave ones.
Guess theres some that missed the testimony, of the wife of a brain injured soldier before congress & what she endured. Wonder what she would change if put in charge.
Is that, "if" older vets are put back in line? or do we have to wait until the age of 70, before our claims are processed?
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Why we need Mandatory Funding for Veteran’s Healthcare
By Gene D. Simes
Chairman, Operation Firing For Effect
March 29, 2007
Many people are confused about what full funding of the Department of Veterans Affairs really means. Below you will find 8 very good examples of why full mandatory funding of the VA healthcare system is essential. Merely visit the links included to view substantial documentation.
On August 22, 1986, the VAMC in Atlanta Georgia released a Memorandum changing their procedures for self injections for diabetic insulin users. The change in policy was as follows; “Effective for new prescriptions written after September 2, 1986, you should use each disposable insulin syringe two times before throwing it away”. The only possible reason for this new policy was budgetary. This change in procedure was a blatant attempt to cut the year’s insulin syringe budget in half. Apparently, the VA needed funds elsewhere, and decided this very questionable and risky injection procedure was a good idea. Well known Georgia veterans rights advocate Jere Beery led a successful public campaign to have this unsafe practice stopped immediately. This one small example illustrates how budget restraints affect the quality of healthcare our veterans receive. Mandatory full funding would guarantee that our veterans would never be asked to use a dirty syringe again.
Documentation; http://jerebeery.com/va-syringe-useage.htm
Although the telephone has been around for well over a century, it wasn’t until 1996 that all VA hospitals nationwide were equipped with bedside telephones. Up until that time, unless you could make it to the pay phone down the hall, patients made no calls, much less receive any. In 1995, Mr. Francis Dosio of PT Phone Home and the Communication Workers of America Union took up the concept veterans activist Jere Beery had started several years earlier and launched a nationwide project to install bedside phones in every VA hospital in the country. All of the labor and equipment was donated but the story was not publicized. The VA didn’t have to pay one dine for the bedside phone project as all of the funds were donated from the private sector. Mandatory full funding would insure that our veterans do not have to depend on charity for the most basic amenities and services.
Documentation; http://jerebeery.com/bedside_telephones_in_va_hospita.htm
In 1998, the VAMC in Atlanta attempted to implement parking fees for all veterans visiting the facility. Vietnam combat veteran Jere Beery openly challenged the parking plan and stimulated public outrage which halted the idea before it was enforced. But once again, we see desperation by the VA to find funds while passing the cost onto our veterans. Mandatory full funding would guarantee that our veterans are never again ask to pay to access the healthcare services they have earned.
Documentation; http://jerebeery.com/va%20parking%201.htm
In 2006, two veterans died after they were refused entrance and lifesaving treatment at the VA hospital in Spokane Washington. The reason; they arrived after the emergency room had closed. Mandatory full funding would insure that all VA hospitals with a pre-existing emergency room could maintain 24/7 emergency services for critically ill veterans.
Documentation; http://jerebeery.com/offe_extremely_concerned_about_d.htm
In 1978, travel reimbursement for veterans traveling to a VA hospital for a scheduled appointment was 11 cents per mile, which was when gas was 49 cents a gallon. This reimbursement amount has remained unchanged for 29 years. In this case, Mandatory full funding would provide the funds to increase this allowance and allow for the payment of travel pay to fluctuate with the rising cost of fuel.
Currently, the VA has a backlog of over 90,000 claims waiting processing. Many veterans are required to wait well over a year for their VA rating decision. Under-staffing is the primary reason for these delays. Mandatory funding would make it possible for the VA to hire additional staff to process and expedite claims.
Low wages offered by the VA make it very difficult to entice and retain high quality medical professionals. Doctors, nurses, dentist, psychiatrist, counselors, and nutritionist all make significantly more money in the private sector. Mandatory funding would allow for increases in salaries which would attract more medical professionals into the VA healthcare system.
Mandatory funding would also insure that future medical research done by the VA would not be restricted by budget constraints.
These are just 8 examples of why we need full funding of the VA. There are many more examples just like these. I hope this report convinces you to support full mandatory funding for the VA healthcare system. I encourage you to visit our web site, http://offe2008.org/public_html/resolution.htm, print out our resolution, sign it and send it to; Operation Firing For Effect, P.O. Box 77303, Rochester, NY 14617. Remember, if you do nothing, you can expect nothing to change.
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That will get you quicker up to the BVA?
Hello Terry,
my appeal docket# is 9819625
That means my appeal was sent to the BVA in 1998. The BVA has not even began to process the claim. It has only been remanded.
These new Vets coming home, face 10 or 20 yrs of bullsh*t denials, twisted & fraudulent evidence to deny their claims, JUST LIKE WE DO.
Unless the widespread "unethical" practices of VA adjudicators are stopped, it doesn't mean squat what kind of time saving measures is implimented.
Why doesn't the VARO's pay for C&P's out of their budget? Why do the VAMC's have to pay for C&P's ordered by the VARO, DRO or Court out of health care funding?
This screws a vet from the begining if you ask me & is contradictory to VA manual.
You end up with a budget like Nicholson came up with to opperate under, so they provide a candystriper, or NP to provide a definitive diagnoses & determination as to wether your "neuromuscular disorder of unknown cause" is or isn't service connected. All, according to the manuals, codes & regulations with the highest regard for the veteran?
This crap is so obvious, even the dain bramaged can pick it out after the decades it takes to process a claim.
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Thanks Philip,
I'll try to pick something else that sounds better.
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Traumatic Brain Injury
Independent Study Course Released: January 2004
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Volume 42, Number 1, January/February 2005
Pages 29 — 34
Abstract - Event-related potential in facial affect recognition: Potential clinical utility in patients with traumatic brain injury
Henry L. Lew, MD, PhD;1-2* John H. Poole, PhD;2 Jerry Y. P. Chiang, MD;3 Eun Ha Lee, MD;1 Elaine S. Date, MD;1 Deborah Warden, MD4
1Physical Medicine and Rehabilitation Service, Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 1-2Defense and Veterans Brain Injury Center, Palo Alto, CA; 3Stanford University School of Medicine, Stanford, CA; 4Defense and Veterans Brain Injury Center, Walter Reed Medical Center, Washington, DC
Abstract — Traumatic brain injury (TBI) frequently leads to deficits in social behavior. Prior research suggests that such deficits may result from impaired perception of basic social cues. However, these social-emotional deficits have not been studied electrophysiologically. We measured the P300 event-related potential (ERP), which has been shown to be a sensitive index of cognitive efficiency, in 13 patients with a history of moderate to severe TBI and in 13 healthy controls. The P300 response was measured during detection of 30 pictures of angry faces (rare target) randomly distributed among 120 neutral faces (frequent nontarget). Compared to control subjects, the TBI group's P300 responses were significantly delayed in latency (p = 0.002) and lower in amplitude (p = 0.003). TBI patients also showed slower reaction times and reduced accuracy when manually signaling their detection of angry faces. Coefficients of variation (CVs) for the facial P300 response compared favorably to those of many standard clinical assays, suggesting potential clinical utility. For this study, we demonstrated the feasibility of studying TBI patients' P300 responses during the recognition of facial affect. Compared to controls, TBI patients showed significantly impaired electrophysiological and behavioral responses while attempting to detect affective facial cues. Additional studies are required for clinicians to determine whether this measure is related to patients' psychosocial function in the community.
Key words: affect recognition, brain injury, cognition, electroencephalograph, emotional processing, event-related potential, social perception.
Last Reviewed or Updated Tuesday, June 28, 2005 10:33 AM
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Could they be using a symptom for TBI(personality disorder) to deny PTSD claims?
If you have an increase in TBI claims, there would be an increase of reported personality disorders overlaping with PTSD claims. But they shouldn't be alowed to punish Vets for it.
Allan
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I have been reluctant to file a claim for ASBESTOS in the past.
I do not have a diagnoses for mesothelioma.
I served as a Boiler Tech & went through several overhauls at Longbeach, Mare Island, Hunterspoint, Valejo & the SanFrancisco dry dock.
My ship is on the list for Asbestos exposure.
Without a diagnoses, would it get tossed out with just having symptoms in records?.
COAD
bronchial chest spasms, chest pain when I breath
GERD
chronic nausea
hypertention
hypothyroid
elevated CK
elevated Lipids
elevated Cholesterol
elevated liver
Allan
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CORRECTED COPY
Department of Veterans Affairs VHA DIRECTIVE 2004-067
Veterans Health Administration
Washington, DC 20420 November 22, 2004
CATASTROPHICALLY DISABLED VETERAN EVALUATION
1. PURPOSE: This Veterans Health Administration (VHA) Directive issues policy for the clinical evaluation and, as appropriate, placement of eligible veterans determined to be catastrophically disabled into Priority Group 4.
2. BACKGROUND
a. The “Veterans’ Health Care Eligibility Reform Act of 1996”, Public Law 104-262 required the Department of Veterans Affairs (VA) to establish and operate a system of annual patient enrollment and created seven Priority Groups. The “Department of Veterans Affairs Health Care Programs Enhancement Act of 2001,” Public Law 107-135 subsequently expanded the seven priority groups to eight with Priority Group 8 having the lowest priority.
b. Priority 4 status is given to veterans who are in receipt of increased pension based on a need of regular aid and attendance or by reason of being permanently housebound, and other veterans who are catastrophically disabled as determined by VHA. Benefits of Priority 4 inclusion include elevation of the veterans’ existing enrollment priority status and the opportunity to enroll and receive VA healthcare services for those who may otherwise be ineligible due to a Priority Group enrollment restriction.
(1) Veterans are considered to be catastrophically disabled who have a permanent severely disabling injury, disorder, or disease that compromises the ability to carry out the activities of daily living to such a degree that the individual requires assistance to leave the home or requires constant supervision to avoid physical harm to self or others as defined by Title 38 Code of Federal Regulations (CFR) Section 17.36 (e).
(2) VA Form 10-0383, Catastrophically Disabled Veteran Evaluation, may be initiated at the request of the veteran, representative of the veteran, or the facility. VA Form 10-0383 can be found on the VA Forms website at: vaww.va.gov/vaforms. It can be used for local reproduction. Since it is a low use form, it will not be stocked by the Hines Service and Distribution Center (formerly known as the Publications Depot).
c. Effective January 17, 2003 VA restricted the enrollment of Priority 8 veterans applying for enrollment on or after that date. Veterans currently enrolled in Priority Groups 5 though 8, or those potentially not eligible for enrollment based on the enrollment decision, may continue to apply for enrollment into Priority 4 based on being catastrophically disabled.
3. POLICY: It is VHA policy to provide a Catastrophically Disabled Veteran Evaluation within 35 days of request.
THIS VHA DIRECTIVE EXPIRES NOVEMBER 30, 2009 VHA DIRECTIVE 2004-067 CORRECTED COPY November 22, 2004 2
NOTE: To request a Catastrophically Disabled Veteran Evaluation, veterans may call the Health Benefits Service Center, a toll-free number, 1-877-222-VETS (-8387), or the enrollment coordinator at their local VA medical center. Movement from a lower priority group to Priority Group 4 does not change the veteran’s applicable co-payment responsibility.
4. ACTION
a. Medical Center Director. Each medical facility Director is responsible for ensuring that:
(1) The Catastrophically Disabled Veteran Evaluation determines whether the veteran is catastrophically disabled and therefore eligible for inclusion in priority category 4. Health care facilities are encouraged to initiate Catastrophically Disabled Veteran Evaluations for known veteran groups whose conditions clearly indicate potential eligibility for this enhanced enrollment status, such as veterans participating in Spinal Cord Injury Programs.
(2) Appropriate staff involved in the Catastrophically Disabled Veteran Evaluation are properly trained and knowledgeable in the following processes (see Att. B):
(a) Upon request, the facility enrollment coordinator or designee, must initiate VA Form 10-0383, for each veteran requesting such evaluation. The enrollment coordinator, or designee, must obtain available VA clinical records and/or records provided by the veteran and have them reviewed by an appropriate clinician. If sufficient documentation is available from the medical records to determine the catastrophically disabled status, VA Form 10-0383 is completed, front and back, a recommendation made, and the complete package forwarded to the Chief of Staff, or equivalent clinical representative, for approval or disapproval of the recommendation, or:
(b) If sufficient information is not available, the enrollment coordinator, or designee, forwards the request for evaluation to the appropriate designated examining area (e.g., Compensation and Pension (C&P), Physical Medicine and Rehabilitation Service (PM&RS), a specialty clinic, or a primary care provider). Upon completion of the evaluation, the examining clinician must complete and return VA Form 10-0383 to the enrollment coordinator, or designee, who forwards the completed package to the Chief of Staff, or equivalent clinical representative, for approval or disapproval of the recommendation.
1. If approved, written notification is sent to the veteran and/or the veteran’s representative.
2. If disapproved, written notification, including appeal rights, is sent to the veteran and/or representative. It is recommended that telephonic contact be made as well.
NOTE: See Attachments C through F for appropriate sample letter usage. All correspondence, including VA Form 10-0383 and any completed assessment tool, must be placed, or scanned, into the veteran’s medical record.
© Appropriate information as well as data from VA Form 10-383, is entered into the Veterans Health Information and Technology Architecture (VistA). CORRECTED COPY VHA DIRECTIVE 2004-067 November 22, 2004 3
b. Office of the Assistant Deputy Under Secretary for Health (10A5). The Office of the Assistant Deputy Under Secretary for Health is responsible for collecting Catastrophically Disabled Veteran Evaluation data for reporting and analysis purposes. Results are posted on http://vaww.va.gov/vhaopp . This data is collected via appropriate VA Form 10-0383 VistA entries and includes:
(1) Number of new catastrophically disabled evaluations completed, both by record review and clinical examination.
(2) Number of cumulative catastrophically disabled evaluations completed, both by record review and clinical examination.
(3) Number of total estimated or potential catastrophically disabled evaluations.
5. REFERENCES: Public Law 104-262.
6. FOLLOW-UP RESPONSIBILITY: The Chief Business Office (16) is responsible for the contents of this Directive. Questions may be directed to (202) 254-0406. NOTE: For questions regarding the clinical evaluation or instruments, criteria, and threshold information, contact the VISN Clinical Manager (10N) or the Office of Patient Care Services (11) at (202) 273-8474.
7. RESCISSION: VHA Directive 2001-025, is rescinded. This VHA Directive expires November 30, 2009.
S/Jonathan B. Perlin, MD, PhD MSHA, FACP
Acting Under Secretary for Health
Attachments
DISTRIBUTION: CO: E-mailed 11/242004
FLD: VISN, MA, DO, OC, OCRO, and 200 – E-mailed 11/ 24/2004
CORRECTED COPY VHA DIRECTIVE 2004-067 November 22, 2004 A-1
ATTACHMENT A
DEFINITION OF CATASTROPHICALLY DISABLED
1. Catastrophically disabled (CD) means to have a permanent severely disabling injury, disorder, or disease that compromises the ability to carry out the activities of daily living (ADL) to such a degree that the individual requires personal or mechanical assistance to leave home or bed or requires constant supervision to avoid physical harm to self or others.
2. A veteran may meet the initial CD requirement by a:
a. Clinical evaluation of the patient’s medical records that documents that the patient previously met the criteria set forth in following paragraph 3 and continues to meet such criteria (permanently), or would continue to meet such criteria (permanently) without the continuation of on-going treatment; or
b. Current medical examination that documents that the patient meets the criteria set forth in following paragraph 3 and will continue to meet them, or would continue to meet such criteria (permanently) without the continuation of on-going treatment.
3. This definition is met if an individual has been found, by the Chief of Staff (or equivalent clinical official) at the Department of Veterans Affairs (VA) facility where the individual was examined, to have a permanent condition specified in following subparagraphs 3a, 3b, or 3c:
a. One of the permanent diagnoses found on website: http://vaww.va.gov/vhaopp/report01/report01.htm (see “View CD Diagnoses”).
OR
b. A condition resulting from two of the International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) procedure codes, or associated V codes when available, or Current Procedural Terminology (CPT) codes provided the two amputation procedures were not on the same limb. These codes can be found at the following website: http://vaww.va.gov/vhaopp/report01/report01.htm (see “View CD Diagnoses”).
OR
c. One of the following permanent conditions:
(1) Dependent in three or more ADLs; i.e., eating, dressing, bathing, toileting, transferring, incontinence of bowel and/or bladder, with at least three of the dependencies being permanent with a score of 1, using the Katz scale. NOTE: The Katz Index of ADL assigns a maximum of 18 points across all six ADLs. The most dependent rating on each ADL is a 1, and an intermediate functional limitation is a rating of 2, with independence rated as 3. To be catastrophically disabled, the veteran must have a rating of 1 on a minimum of three permanent ADLs. For example, a veteran dependent in all ADLs would have a total Katz score of 6. VHA DIRECTIVE 2004-067 CORRCETED COPY November 22, 2004 A-2
Similarly, a veteran dependent in three ADLs and needing less assistance in three other ADLs would score 9.
(2) A score of 10 or lower using the Folstein Mini-Mental State Examination (MMSE). NOTE: The MMSE has a maximum assignment of 30 points across eleven measures. A score of less than 10 is consistent with severe cognitive impairment. To qualify for CD status, there must be documentation in addition to the MMSE score of 10 or lower, showing that the patient has a permanent cognitive impairment. To show that the impairment is permanent, the reversible causes of cognitive impairment need to be ruled out. A common example is a delirious patient who may score very badly on the MMSE, but improve once the source of delirium is treated. It is also important for evaluators to remember that a low MMSE score by itself is not diagnostic (i.e., it is not specifically diagnostic of dementia), but it is an indication of cognitive impairment that warrants further evaluation.
(3) A score of 2 or lower on at least four of the thirteen motor items using the Functional Independence Measure (FIM). NOTE: The FIM contains eighteen measures in six domains. The thirteen motor items are in four domains: self-care; sphincter control; transfers; and locomotion. The scores across all these domains range from needing a helper because of complete dependence (score of 1 for total assistance and a score of 2 for maximal assistance), with intermediate scores 3 through 5 for modified independence, to scores 6 or 7 when no helper is needed. To be CD, the veteran must have a score of 2 or lower on at least four permanent conditions of the thirteen motor items using the FIM.
(4) A score of 30 or lower using the Global Assessment of Functioning (GAF). NOTE: The GAF is taken directly from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), p. 32, except that VHA only includes scores from 1 to 100, excluding 0 (insufficient information).
(a) GAF is a 100-point scale divided into ten defined levels, with higher scores indicating a higher overall level of functioning. For example, the Description of the GAF level 21 to 30 is as follows: “Behavior is considerably influenced by delusions or hallucination or serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) or inability to function in almost all areas (e.g., stays in bed all day, no job, no home or no friends).”
(b) GAF is to be used only to reflect psychological, social, and occupational functioning. Impairment in functioning due to physical illness or environmental limitations are not to be taken into consideration in using this scale. The scale rates both functioning and, particularly in the higher ratings, the severity of symptoms due to a mental disorder. Using GAF for documenting the CD may be only done in the context of a mental disorder considered to be of a permanent nature. For example, a patient with a serious suicidal attempt might well rate a score under 30, but generally within a few days or weeks will return to a much higher level both symptomatically and functionally. CORRECTED COPY VHA DIRECTIVE 2004-067 November 22, 2004 A-3
4. References
a. Katz S, Downs TD, Cash HR, et al. “Progress in the Development of the Index of ADL,” The Gerontologist. Part I:20;1970.
b. Juva K., Sulkava R., Erkinjuntti T., et al. “Staging the Severity of Dementia: Comparison of Clinical (CDR, DSM III-R), Functional (ADL, IADL) and Cognitive (MMSE) Scales,” Acta Neurologica Scandinavica. 90:293;1994.
c. Folstein MF, Folstein S, McHugh PR. “Mini-mental State: A Practical Method for Grading the Cognitive State of Patients for the Clinician,” Journal of Psychiatric Research. 12:189; 1975. CORRECTED COPY VHA DIRECTIVE 2004-067 November 22, 2004 B-1
ATTACHMENT B
CATASTROPHICALLY DISABLED (CD) EVALUATION PROCESS
(35 CALENDAR DAYS)
(Yes)
(No)
(No)
(Yes)
(Yes/No)
Veteran requests a CD evaluation.
If request is through the Veterans Health Administration (VHA) Benefits Service Center, the call will be transferred to the preferred facility enrollment office where the clinical and data capture process begins.
VHA or non-VHA medical records available?
Clinical evaluation based on available records.
Able to evaluate?
Appointment made and
new records initiated.
Veteran evaluated clinically.
Meets criteria ?
Chief of Staff or designee decision.
Facility letter of acceptance or denial letter mailed to veteran.
Determination/approval request completed.
Copy of letter sent will be placed in the patient’s permanent record and all appropriate data fields are completed. CORRECTED COPY VHA DIRECTIVE 2004-067 November 22, 2004 C-1
ATTACHMENT C
VETERAN REQUESTED CATASTROPHICALLY DISABLED (CD) EVALUATION
SAMPLE OF WRITTEN NOTIFICATION FOR A VETERAN
WHO IS DETERMINED TO BE CD
NOTE: If the Catastrophically Disabled (CD) determination is that the veteran is CD, written notification of the outcome must be sent to the veteran from the Department of Veterans Affairs (VA) health care facility Chief of Staff using the following letter sample.
(Date)
(Name)
(Address)
(City, State, Zip Code)
Dear ________
The recent review you requested of medical records and/or a catastrophically disabled (CD) examination shows that you meet the definition of a CD veteran for Department of Veterans Affairs (VA) health care purposes. Based on this determination, your enrollment priority group should change to Priority Group 4. Official notification of any changes in your priority group will be sent in a separate letter.
Veterans enrolled in Priority Group 4 are eligible for all needed services included in the Medical Benefits Package. Veterans previously subject to co-payments will still be required to agree to pay those co-payments after moving to Priority Group 4. If you have any questions, feel free to call the enrollment office at _________(phone number)________ (or the appropriate locally designated office).
Sincerely yours,
___________(Signature)____________
VA Health Care Facility Chief of Staff CORRECTED COPY VHA DIRECTIVE 2004-067 November 22, 2004 D-1
ATTACHMENT D
VETERAN REQUESTED CATASTROPHICALLY DISABLED (CD) EVALUATION
SAMPLE OF WRITTEN NOTIFICATION FOR A VETERAN
WHOSE ENROLLMENT PRIORITY IS NOT CD
NOTE: If the Catastrophically Disabled (CD) determination is that the veteran is not CD, written notification of the outcome must be sent to the veteran from the Department of Veterans Affairs (VA) health care facility Chief of Staff using the following letter sample.
(Date)
(Name)
(Address)
(City, State, Zip Code)
Dear ________
You recently requested a medical record review and/or a catastrophically disabled (CD) examination to determine if you meet the criteria to be classified as a CD veteran for Department of Veterans Affairs (VA) health care purposes.
A thorough review was conducted by the VA medical facility located at ______(facility address)________ and the determination has been made that you do not meet the criteria to be classified as catastrophically disabled. I reviewed your medical records and/or your most recent CD examination results. Based upon this review I have confirmed that you do not meet the criteria of a CD veteran for the following reasons:
NOTE: This letter must contain both the reasons for the decision and a summary of the evidence considered by VA.
If you disagree with this decision, you may appeal it. You may choose one or both of the following options.
a. You may seek reconsideration of this decision. Your written request for reconsideration needs to be addressed to the VA health care facility Director, at __(name of facility)__ . Your request for reconsideration must be postmarked or received within 1 year of the date of this letter; and/or
b. You may appeal the decision to the Board of Veterans’ Appeals as outlined in enclosed VA Form 4107VHA, Your Rights to Appeal Our Decision. As part of this process, you will have a right to a personal hearing and the right to representation. To begin the appeal process, you or your representative need to express your dissatisfaction or disagreement with this decision in a written communication to this facility (a Notice of Disagreement). Your Notice of VHA DIRECTIVE 2004-067 CORRECTED COPY November 22, 2004 D-2
Disagreement must be postmarked or received no later than 1 year after the date of this letter and needs to be addressed to ____________________.
We regret that a more favorable decision could not be reached concerning your request for CD status. If you have any questions, feel free to call the enrollment office or your VA health care provider at _________(phone number)________ (or the appropriate locally designated office).
Sincerely yours,
___________(Signature)____________
VA Health Care Facility Chief of Staff
Enclosure CORRECTED COPY VHA DIRECTIVE 2004-067 November 22, 2004 E-1
ATTACHMENT E
FACILITY INITIATED MEDICAL RECORD REVIEW
SAMPLE OF WRITTEN NOTIFICATION FOR A VETERAN
WHOSE ENROLLMENT PRIORITY
CHANGES TO CATASTROPHICALLY DISABLED (CD)
NOTE: If the Catastrophically Disabled (CD) determination is that the veteran is CD, written notification of the outcome must be sent to the veteran from the Department of Veterans Affairs (VA) health care facility Chief of Staff using the following letter sample.
(Date)
(Name)
(Address)
(City, State, Zip Code)
Dear ________
A recent review of your medical records and/or a CD examination shows that you meet the definition of a CD veteran for Department of Veterans Affairs (VA) health care purposes. Based on this determination, your enrollment priority group should change to Priority Group 4. Official notification of any changes to your priority group will be sent in a separate letter.
Veterans enrolled in Priority Group 4 are eligible for all needed services included in the Medical Benefits Package. Veterans previously subject to co-payments will still be required to agree to pay those co-payments after moving to Priority Group 4. If you have any questions, feel free to call the enrollment office or your VA health care provider at _________(phone number)________ or ___the appropriate locally-designated office___
Sincerely yours,
___________(Signature)____________
VA Health Care Facility Chief of StaffCORRECTED COPY VHA DIRECTIVE 2004-067 November 22, 2004 F-1
ATTACHMENT F
FACILITY INITIATED MEDICAL RECORD REVIEW
SAMPLE OF WRITTEN NOTIFICATION FOR A VETERAN
WHEN A CATASTROPHICALLY DISABLED (CD) DETERMINATION
CANNOT BE MADE BASED UPON A MEDICAL RECORD REVIEW
(FOR VETERANS WITH A KNOWN PRIORITY GROUP)
NOTE: If the Catastrophically Disabled (CD) determination for a veteran who has an Enrollment Priority Group cannot be made based on a medical record review, written notification of the outcome must be sent to the veteran from the Department of Veterans Affairs (VA) health care facility Chief of Staff using the following letter sample. The letter encourages the veteran to schedule an appointment for a CD examination in order to complete the CD evaluation process.
(Date)
(Name)
(Address)
(City, State, Zip Code)
Dear ________
Our facility has recently completed a medical record review to determine if you meet the criteria to be classified as catastrophically disabled (CD) for Department of Veterans Affairs (VA) health care purposes. Based on the current information in your medical record, we are not able to complete our CD determination.
If you feel that you may qualify for CD status, we would encourage you to contact our enrollment office, or the appropriate locally designated office, for more information and to schedule an appointment for a CD examination at ______(phone number)__________.
Sincerely yours,
___________(Signature)_______________
VA Health Care Facility Chief of Staff
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http://www.2ndbattalion94thartillery.com/Chas/editorials.htm
VA myths and what it is this federal agency is actually charged to do
with a wink and nod of our own government.
A series of editorials and letters sent to all the major newspapers in our nation. Will it do any good? I doubt it! Unfortunately the national media seems to agree with the government's treatment of Veterans and especially treatment by the Veterans Administration.
You are encouraged to copy these and send these to your local papers.
1. Peripheral Neuropathy
2. VA CLAIM PROCESSING and DENIAL GOAL (Part 1)
3. VA CLAIM PROCESSING and DENIAL GOAL (Part 2)
4. VA WWII MUSTARD AGENT OUTREACH
5. Another Memorial?
1.
Many Vietnam Veterans ask WHY on denials by the VA for
Peripheral Neuropathy toxin nerve damage.
I receive quite a few e-mails from Vietnam Veterans on WHY and HOW can the VA continually deny Peripheral Neuropathy (PN), outside of their bogus and unscientific, one year removed from Vietnam diagnosis; and then cured within two years.
The why - is to save government money by using the VA to control "government expenditures for obsolete government assets (The Veterans); for justifiable and justified disability claims for one of the most prominent and prevalent Vietnam Veterans disorders.
The how - is the VA secretary is allowed to lie and cover-up to save the presidents coffers; and our congress will not challenge the VA. The VA is off limits and no congressional pressures are allowed on the VA for criminal activity.
The Aussies, the Kiwi's, the Koreans all report the same nerve damage disorders.
The Ranch Hand study, by our own government, found a linear dose rate to dioxin and PN. PN was touted as one of the highlights of this study; at least in the study transcripts and not the "redacted corrupt government report."
The Korean AO impact study of 2003 found PN with an Odds Ratio of 2.39. They found dioxin associated to PN at a p-value of 0.039. They found Non-Vietnam Veterans compared to Vietnam Veterans an incredible p-value of 0.0042 for PN. After adjusting for age, smoking, alcohol, body mass index, education, and marital status.
In all cases, proving medically and mathematically that PN is associated to dioxin and/or wartime service in Vietnam, regardless of cause.
Toxin workers and toxin accidents going back to 1949 show the exact same disorder, including warnings by the toxin manufacturer of nerve damage.
Totally cured the VA secretary says - about 50 board certified neurologist, my Army guys and my Marines have seen across this nation, state there is no cure for the debilitating neuropathy we have. Including that in at least 33% of the cases, the cause will never be known. Yet, veterans go uncompensated even when we have overwhelming mathematically and medical evidence that shows a direct correlation to either dioxin exposure and/or wartime service in Vietnam.
How and why? The VA is nothing but the "president's(s) government fox" guarding the government "hen house" which equates to "Veterans' disabilities and compensations" for their wartime service.
Disabilities caused by an arrogant Johnson Administration that was warned by our own scientists in 1966; and they still created a toxin legacy war, "the war that keeps on giving."
All Veterans remember the above, when it is time for the midterms and the 2008 elections, especially if your senator or congressman is on one of our Veterans Affairs Committees.
It is past time for them to step up and get to the truth; or get the heck out of DC!
I think it may be past time to vote for "anyone else"; other than what we have in the congress and the senate at present.
Note: The smaller the p-value, the less chance the comparison happened by chance alone. To get the more familiar positive association subtract the p-value from the number one (1).
Charles Kelley
DMZ Vietnam
The Toxin Corridor
1967-1968
2.
VA CLAIM PROCESSING and DENIAL GOAL
(Part 1)
Among some of the tasks of the now “adversarial VA,” besides denying the existence of many “independently found associated medical disorders and diseases” to Agents Orange, White, and Blue and radiation poisoning in the first Gulf War; using corrupted and controlled government studies and less than truthful government-contracted agencies. The VA is charged with Veteran’s claims processing.
This VA’s “processing goal” seems to be to “stall to the death” of the Veteran in concert with only a four percent “unstated government wink and a nod goal” of approval of Veterans benefits “per year.” In other words a lottery based on total amount of dollars per year. While congress stands by and takes no hard look at the factual data on how these processes are manipulated by this federal agency. Average first processing time alone is 223 days, with a present backlog of over 500,000 claims. Many of these claims are in their third year or more. While the VA for decades has stated their intent is to do better, these facts are twisted and manipulated. The “results” do not match the decades of “government rhetoric fed Veterans.” This is unacceptable for the nations finest and most noble citizens.
One of the creative reporting tactics of the VA is to report, “the claim is resolved” when there are more than just the one issue on the claim. This means the Veteran may get a “zero dollar award” for one issue, yet he is disabled or dying and cannot get the coverage for the disability and hardship he and his family are now enduring, especially when it comes to toxin wartime service in Vietnam or the Gulf War disorders.
This, of course, is “as planned” by the government and their manipulated medical studies surrounding this wartime service of toxin poisoning and/or radiation poisoning in order to do exactly what the VA does – stall and allow “no more” than four percent of the claims approved per year.
One of my Battalion members found out in November of 2004 he had lung and trachea cancer – an already “automatically associated disease” of his wartime service in our Vietnam Toxins (plural) Legacy. He passed away in April of 2005 before his claim submitted in November was approved for an “automatically associated toxin cancer.” His wife and children do not receive the more than $10,000 dollars that would have been approved and received prior to his death had the VA not done what they are so excellent at doing, and I would say directed to do by our own government on the QT; and that is stall! Stall to the death of the veteran for politics and money. When this family needed monetary help in his last months the VA’s response was to “stall to his death.”
A recent report was CHRIS ADAMS and ALISON YOUNG March 06, 2005:
”Knight Ridder news may be onto one of the biggest stories of the year: “13,000 veterans needlessly died” awaiting appeals on VA benefit payments, with a net savings of untold millions for VA.
Obviously, this 13,000 is just the tip of the iceberg of veterans that have died waiting on the VA stalling processes or as a direct result of the “government toxin medical information voids created.”
Look at it this way. If the VA, as they are told to do, can only steal $10,000 dollars from each of the present outstanding Veterans claim, alive or dead. You are now talking FIVE BILLION dollars. Five billion dollars our stalwart congress will use on failed social programs full of corruption and fraud, just so they can stay in office.
Is it any wonder the VA gives out bonuses for denying veterans claims? I might also, if I had zero integrity and if I was trying to save a minimum total of five billion dollars.
I will also categorically state that any veteran or veteran’s family that speaks out against the VA will feel the wrath of this federal agency. It not only is corrupt but very vengeful and is allowed to be by our own congress.
The Social Security Administration seems to have no trouble getting money in the claimant’s bank 10 to 20 days after approval of disability. The difference is, the Social Security Administration has “no automatic already associated to wartime service disorder and diseases.” How the VA can justify this despicable treatment, other than, we are doing exactly what the White House and congress wants is just mind-boggling.
Yet, one of my own dies a horrible uncompensated death from two already “automatically approved toxin cancers” because the VA cannot approve and get the approval to dispersement within 30 days or even five months. Yet, my guy was still proud of his service in that war and our battalion’s efforts, even though his own government killed him. Can this nation ask more of this veteran and this family? Then to be treated this way by our own government is just despicable. This goes on daily for tens of thousands of our veterans and their families at the VA.
Does a conflict of interest now exist between the government/VA and the Veterans; called saving government pandering socialistic money? You bet there is. Social programs, to stay elected, now take precedence over those that defend this country and indeed most of the world. Even when our own arrogant government was the “direct cause” of the Veteran’s disability or death.
Does the congress take the VA to task on any issues? You bet they do not. It seems they are gutless in this issue. One would have to wonder why.
The VA seems to have more power than the entire United States Congress and all Veterans should now ask, is this “a convenience factor” for politics and money. On the other hand, is the VA that omnipotent and should be brought back under some form of control and integrity.
“Rep. Joe Baca (D-California) reintroduced legislation that will benefit thousands of veterans by reducing the backlog of pending claims at the Department of Veterans' Affairs.”
“As a nation we have an obligation to provide the benefits and services that our veterans have earned through their honorable service," Baca said. “That is why I'm introducing the Department of Veterans Affairs Claims Backlog Reduction Act of 2005. It will tell our veterans that a promise made is a promise kept.”
While I appreciate the congressman’s efforts and you noticed, it said, “Reintroduced.” Apparently, as one Australian Vietnam Veteran told me, “these governments just do not care.” With all do respect to the congressman and his efforts; the VA does not abide by congressional acts or congressional mandates, and never has. In reality, our congress could care less.
An issue that is more recent is the Congressional Dioxin Act of 1984, after 16 full years of “government VA led toxin lies” while veterans died off by the thousands. This is still totally ignored by the VA. Bring that up and the courts review of the “intent of that act;” and the VA laughs at Veterans.
This has to go down in history of the government as one of the biggest “congressional lies” ever put out by our congress.
Congress needs to take the VA to the woodshed but they will not. The VA is saving them too much money by robbing and denying yesterday’s government obsolete and dying asset: The United State’s Veteran.
Note:
As I said in the editorial on “peripheral neuropathy:”
All Veterans and Veteran’s widows remember the above, when it is time for the midterms and the 2008 elections, especially if your senator or congressman is on one of our Veterans Affairs Committees or the Oversight Committees.
It is past time for them to step up and get to the truth at the VA; or get the heck out of DC!
I think it may be past time to vote for "anyone else"; other than what we have in the congress and the senate at present.
Charles Kelley
DMZ Vietnam
The Toxin Corridor
1967-1968
3.
VA CLAIM PROCESSING and DENIAL GOAL
(Part 2)
In addition to those Veterans dying or becoming disabled, while waiting for the VA to approve an “already associated and approved disorder.” I would estimate that hundreds of thousands of Vietnam Veterans have died from toxin related disorders that were covered up by the VA and our own government. Their families still do not know, 40 years later, our own government mortally wounded their husband or father; and they died from service to our nation by a hostile government, our own.
As soon as our Veterans starting coming home from our toxin war, dying and developing all kinds of medical issues. The VA was assigned the lead in these government cover-ups and government denials. Some VA heads went out into the scientific community and stated that any scientists that found an issue with dioxin were nothing but “Witch Doctors.” Just a tad bit of VA bias.
The VA met behind closed doors, not with the prestigious independent scientific research community of our nation or our own EPA, but with chemical company scientists and chemical company medical directors. From then on, the government and the chemical companies became a tag/team of co-conspirators and co-collaborators.
When a stalwart VA counselor with integrity in the Chicago area became suspicious and started pouring over spray records and asking questions of the chemical companies, the VA higher ups told her to cease and desist with the questions.
The main thrust of the VA was “not to find the truth” but to make darn sure that “the toxins were not associated” with the medical issues the Veterans were developing. Even though, in Vietnam itself, the Vietnamese were developing the same issues along with significant increases in birth defects and stillborns first noticed in early 1967, as well as our allies.
Check out HR 101-672 in 1991 that says the Reagan/Bush Administration interfered with the toxin studies because they did not want the monetary responsibility of supporting veterans.
This tried and perfected method of VA collaboration and government denial is now used on our Gulf War Veterans where government studies proved all these same issues the Veterans were developing were from stress. Stress in a war that took less time than the Thanksgiving Day holiday were more people are killed on the road by five times that amount than the entire war during the same amount of time. Yet, our media also eats this up instead of questioning these illogical findings by the government and its “government contracted hired medical guns.”
In addition, those that had normal children before that Thanksgiving Day Holiday stressor, 67% of them would now have deformed children from that same stress. How this nation continues to buy what our government and the VA are selling in these issues is just mind-boggling.
Fourteen years later, it is just about confirmed by everyone but the VA; the symptoms match neurotoxin damages. Which I think the whole world outside of the VA and our own government knows or will admit. This is the result of low dose DU shell radiation poisoning.
Another group of warriors left to die and become disabled by our own government and especially the VA and their so-called studies.
The same thing is going on now with the SHAD and Project 112 testing where the government is holding back life and death information from these Veterans used as government biological, gas, and toxin guinea pigs. How sick is that? Where is the congressional outrage that this even took place?
The impact of this “toxin information void” created on purpose is to do exactly what the government has done in the past with regards to mass Veterans issues that were caused by our own government. Deny – Deny - Deny until they can only deny a little, then put the VA in charge of the compensation lottery. I would say “litigation lottery” but as most veterans already know; our constitutional rights to charge our perpetrators in corrupt government studies and fraudulent government reporting is unconstitutionally withdrawn to us as Veteran Citizens. We are no longer a segment of society guaranteed the protection of the constitution against government corruption and indeed government tyranny.
Ironic, the Veteran swears an oath to protect and defend the constitution of the United States. Yet, when he then takes off his or her uniform; what the Veteran defended by offering up his or her life, his or her tomorrows, or parts of his or her body; this sacred of all guaranteed inalienable rights for the rest of the nation; now forsakes him or her.
WHY? Because they made the choice to wear the uniform of the United States Military and the Supreme Court or any other court no longer has jurisdiction as the government lays aside the Veteran Citizen. Our faithful and honorable congress has made sure of this fact. It is called the Feres Doctrine, which is unconstitutional.
This doctrine protects those in the government studies that change/modify medical scientific conclusions, or the use of command influence, or as one study scientists concluded and stated before congress; “the study for 20 years has never told the truth on what they were actually finding in the study cohort comparisons. The government has never given the veterans a fair assessment of their health in many different biological areas.”
This means our doctors never got the word either. Ladies and gentlemen that becomes criminal with criminal intent – federal agency or not. When you have information that could have saved thousands of Veterans lives or stalled their disability in life; and then kept it quite and covered it up. Any court in the land would call that criminal. If this happened to civilian segment of our society, those that perpetrated these crimes would be in federal prison.
For the identical government criminal activity against Veterans, the reward is keeping billions of dollars, maybe in the trillions, to pander to a segment of society that will vote as one. Plus promotions all around for those that participate in what has to be called government collaborations.
Yes, present and future veterans this same VA and government treatment awaits you.
Veterans must remember, the VA is nothing but the “government fox” guarding the “government henhouse” Veterans compensations.
Who appoints and who approves the head of this adversarial agency? The president appoints and the congress approves. Alternatively, in most cases it is a “coronation” not an approval.
I would suggest to the reader that both parties are happy with the results of the VA. Otherwise, one of the other or both would be taking the VA secretary to the woodshed. Just as congress took the Secretary of Defense to the woodshed on national TV.
The difference? Government money saved by allowing Veterans to die or become disabled.
Remember, the bottom line for our government is; it is much much cheaper to bury a Veteran than support him or her. It seems our national media feels the same way.
They, either democrat our republican, will get at least 40% of the Veterans vote based on history. So why would they worry about an old obsolete government asset (The Veteran) and spend billions in legitimate justified death and disablement claims in order to tie the other party at the voting booth; when they can criminally deny such claims and get away with it. Government morality and justice for veterans you say???
You have got to be kidding!
As I said in editorial (Part 1):
All Veterans and Veteran’s widows remember the above, when it is time for the midterms and the 2008 elections, especially if your senator or congressman is on one of our Veterans Affairs Committees or the Oversight Committees.
It is past time for them to step up and get to the truth at the VA; or get the heck out of DC!
I think it may be past time to vote for "anyone else"; other than what we have in the congress and the senate at present.
Charles Kelley
DMZ Vietnam
The Toxin Corridor
1967-1968
4.
VA WWII MUSTARD AGENT OUTREACH
This newly announced VA outreach program is typical of the government’s concern for their Veterans. Especially, when it involves “government causations” and government “guinea pig usage” of our own Veterans.
The year is 2005, some 64 years after the fact; and now we have a VA outreach program for those WWII veterans that just might still be alive. Talk about hedging your government insurance (compensation) tables! I would think the government would be totally embarrassed about this issue.
However, one must realize as most Vietnam Veterans and Gulf War Veterans already realize this is “typical government behavior” with regard to its Veterans.
History in other mass veteran’s issues such as nuclear, LSD, Project 112, SHAD, our Vietnam toxin(s), plural, legacy; and more recent the Gulf War syndrome all show the same government philosophy. Either totally ignore the issue, deny it ever existed until enough evidence leaks out to prove otherwise, blame it all on stress, corrupt and/or obstruct the government medical studies specifically designed to prove our toxin or radiation damages, and create a Congressional Federal Regulation (CFR) that denies and disallows any and all “independent scientific evidence and mathematical conclusions” to a p-value of less than 0.05. (1)
In the mean time, as California Congressman Mike Thompson claims that the government is holding back “life and death” information for thousands of sailors who were Saran gassed and exposed to toxin and biological agents.
The government, using the VA, either holds back information or creates a “medical information void myth.” The same issue is in play, veterans die or become disabled while the VA plays games. As directed, one would have to assume, by our own government.
One of the editors of the “Veterans News” newspaper suggested that eventually the government would finally admit all the issues of our toxin legacy, including the generational damages; but it would be greater than the 64 years. WHY? “The government never did like Vietnam Veterans anyway.” That would mean maybe in 2037 they might admit some admission of guilt and another bogus VA outreach program in a VA PR move will be announced for those few that are left. In addition, it goes on and on and on; and there is nothing Veterans can do about it. Our own congress has made sure the “Veteran Citizen” is laid aside and is no longer granted inalienable rights to the protection of the constitution and protection from government and VA tyranny.
In all cases, the VA outreach is minimal at best. In most cases, it is nonexistent.
The VA says they are contacting the individuals themselves, like they positively know all the men that were involved over a half-century ago.
The VA calls their propaganda magazine “Agent Orange Review” an outreach program. I consider myself a very informed Veteran and never heard of this propaganda magazine until two years ago. Then find it is so full of lies and misstated facts; that it is not worth reading. In fact, even the title is misleading. There has never been a government study for Agent Orange as an herbicide. Only dioxin that is only “one component” of the herbicide was evaluated and even those studies were less than forthcoming and had very little government integrity, if any.
Of course, they want every one to forget about Agent White and Agent Blue; or the combinational effects of all these toxins at one time, including Dapsone.
Compare VA outreach to the rest of our nation’s citizens.
Two mules and one person dies from West Nile Virus in a remote place called “Nowhere” for the lack of a better name. The CDC makes announcements on the national media; the reporters on Fox News and CNN News make announcements; the CNN streamer at the bottom of the TV screen runs on for two or three days. That is what I would call “outreach.”
The same thing for anthrax or ricin, it goes on for days with a half a thimble full or a letter with small amounts of powder. The nation gets this form of outreach but not the Veterans.
The VA is in charge of outreach for this segment of society. Do you really think the VA wants to find and notify veterans or their widows? Remember their primary goal is to limit Veterans expenditures at the behest of the president and congress.
After the VA and our government denied publicly for 22 years there was no toxin damages at all. When they finally announced our first mortality toxin caused cancer. Did I miss the media blitz to notify those thousands of widows or those Veterans that were developing these immune system cancers?
They can deny publicly and nationally for 22 years and when proof is found, the government silence was deafening. Including using proven fraudulent chemical studies in their proclamations of “no toxin damages.” Yet, when these chemical company studies were proven fraudulent did anyone see notification of this by our own government who used these studies to say, “see this study shows no problem.” Yet, when the study was corrected it showed an increase in cancers of 68% or greater. Not what you would call insignificant!
Where was all the bellowing and crowing of the government and the VA then? Silence!
So government outreach as defined by the VA means different things to them than what it means to the rest of the nation’s citizens.
Once again, all Veterans and Widows of veterans should remember the above, when it is time for the midterms and the 2008 elections, especially if your senator or congressman is on one of our Veterans Affairs Committees.
It is past time for them to step up and get to the truth; or get the heck out of DC!
I think it may be past time to vote for "anyone else"; other than what we have in the congress and the senate at present.
(1) The world scientific standard for proving an association to any one fact or issue is a p-value of 0.05 or less. However, remember the congress passed an act that stated the Veterans in these unknown issues must get the benefit of the doubt by the VA. Yet, the standard for the VA is p-value equals 0.05 which means there is no doubt the variant is associated. This congressional mandate, supposedly for veterans, has to go down as one the biggest lies ever perpetrated by the United States Congress.
Charles Kelley
DMZ Vietnam
The Toxin Corridor
1967-1968
5.
Another Memorial?
Ironic as it seems, our politicians seemed to want to build a memorial to our disabled veterans when they allow the Department of Veterans Affairs (VA) to totally ignore these men and women. Then allow the government to cover-up and collaborate against the very veterans for which they want to build a memorial. It seems the priorities are not where they should be. Politics and saved politician pandering government money seems to be the only logical conclusion.
The government and VA philosophy seems to be to “stall to the death of the Veteran” even when our own government was the “cause of the disability or Veterans death.”
Over 500,000 claims are being stalled and denied because of an unstated 4% “wink and nod approval” a year maximum and the use of corrupted government medical studies.
Building a memorial does not bring back lost health or death that could have been prevented if not for direct government collaborations and cover-ups.
John Deutch the newly confirmed Director of the Central Intelligence stated, “To my mind, there is no more “serious crime” than an official military cover up of facts
that could prevent more effective diagnosis and treatment of sick U.S. veterans.”
I would add that the description Mr. Deutch cited in any court in the land would be criminal charges, not just a misrepresentation of the facts.
I would submit this goes on daily in our government/VA/DOD and yes even some members of congress; and has for at least 40 years in our Vietnam Toxin Legacy and now our Gulf War issues. It is obvious our Presidents could care less. Guided by God and prayer or not, it seems to make no difference when it comes to government truth.
Prior to the 2004 national conventions, I had sent government collaboration and cover-up data to every candidate that was in the political process. The only one that had the guts to answer was General Wesley Clark. I was not a supporter and do not know the General I am just reporting the facts. He alone had the guts and the moral fiber to respond. The rest are spineless and seemed to think another memorial is the answer to calm the masses.
The General’s answer was:
• He would mandate a response time from the VA to the Veteran of no more than six months. (As it is now the VA can stall at any point in process from day one to 20 years or longer.) Might be the reason the total is at over 500,000.
• He would appoint a commission to review the previous administration’s transgressions against Veterans, especially with regard to AO.
This is the kind of responsible congressional activity the Veterans need, not another memorial.
As one study scientists stated; if the word ever gets out about how this nation has treated its Agent Orange Veterans and Gulf War Veterans it will become a “national security issue.”
It is time we Veterans made it one and get that word out.
If this nation does not have the heart to support its veterans and only has the heart to send these men and women into harms way; then allows the government cover-ups and collaborations to continue regarding the “governments own involvement” in creating death and disability as Mr. Deutch alluded to. Then it is time Veterans (past, present, and future) came together and tell this government and its “so-called honorable politicians,” NO MORE!
We Veterans are much much more than the former Secretary of State stated, “Military men are dumb, stupid animals to be used as pawns for foreign policy.”
While I will say, our own government treats us as if we were dumb stupid animals and we would not realize the government corruption and collaborations used against us.
However, even dumb stupid animals have the protection of the SPCA. Veterans have nothing but government tyranny that awaits them.
We are America’s finest and most noble of all citizens.
Can this nation ask more of a citizen?
Charles Kelley
DMZ 67-68
The Toxin Corridor
-
Former Naval Station Treasure Island
Historical Radiological Assessment
Fact Sheet No. 1
November 18, 2004
INTRODUCTION
The Department of the Navy (Navy) is providing this fact sheet
to inform the local community, tenants of the former Naval
Station Treasure Island (Treasure Island), and regulatory
agencies of the Navy’s progress in the preparation of an
Historical Radiological Assessment for Treasure Island. Navy
operations at Treasure Island were primarily for the purpose of
training. Some of the training included the use of radiological
material. Sailors were trained in the calibration and use of
radiation detection equipment and radiological decontamination
procedures. All radiological training activities were conducted
in accordance with strict Federal and State regulatory
requirements. Many of the radiological safety procedures in
use today were developed by the U.S. Navy.
The Navy is presently seeking to interview
current and former Navy personnel, civilian
employees, and contractors regarding
radiological operations at the former Naval
Station Treasure Island (Treasure Island), San
Francisco, California. The Historical Radiological
Assessment will document the historical radiological
activities conducted at Treasure Island including
former uses of radioactive materials and locations
where radioactive materials were used or stored.
Radiological operations at Treasure Island may have
been conducted by any of the following employers or
their contractors: Naval Station Treasure Island, Naval
Schools Command, or Naval Radiological Defense
In 1995, as part of the closure process for the Base, the Navy
confirmed all radiological material used at Treasure Island had
been accounted for and transferred off-base to other Federal
and State of California facilities. In 2003, information was
obtained from a 1950 report detailing the successful cleanup of
radium powder that was spilled in Building 233. However,
today’s allowable radiological levels are lower than 1950 clean
up levels and a radiological survey is currently underway to
verify Building 233 meets today’s allowable level. In an effort
to verify and document all the information about historic
radiological activities at Treasure Island, the Navy is currently
conducting a basewide Historical Radiological Assessment.
Laboratory. Face-to-face interviews, as well as
telephone or email interviews can be arranged.
Information resulting from interviews will be used
for preparation of the Historical Radiological
Assessment. The Navy is interested in obtaining open
and honest oral histories. The Navy is not interested
in pursuing adverse action against interviewees based
on information supplied during the interviews. If
you are a current or former member of the
Navy, civilian employee, or contractor and
have information about radiological
operations at Treasure Island, please contact
Mr. Robert O’Brien, before December 31, 2004
at email address robert.obrien@weston
solutions.com or call 1-800-538-9815.
COMMUNITY PARTICIPATION
WHAT’S NEXT?
The Navy is committed to preparing an accurate and comprehensive
Historical Radiological Assessment. This requires the following steps,
already underway:
• Thorough records research and analysis of military historical
archives.
➠ A records search is being conducted at the
historical records archives in San Bruno,
California, College Park, Maryland, and in
Yorktown, Virginia.
• Personal interviews with current and former installation
personnel who may have information about radiological
operations and Treasure Island.
➠ See page 1 for contact information if you or
someone you know has first-hand information.
• On-site inspections of Treasure Island and records kept on
base.
This information will be published in the Treasure Island Historical
Radiological Assessment, which has an anticipated completion date
of fall 2005. Regular updates on the Historical Radiological
Assessment process will be given at the Navy’s Restoration Advisory
Board meetings. For a schedule of the meetings see the Navy’s
environmental website at http://www.efdsw.navfac.navy.mil/
Environmental/RAB.htm.
DEFINITIONS
RADIAC - A military acronym for radioactive detection,
indication and computation. RADIAC is commonly used as a noun
to mean any radiation detection or measurement instrument.
Radioactive material - A substance that contains or emits
radiation.
Sealed Sources - Any radioactive material that is encased in a
capsule that is designed to prevent leakage or escape of the
material.
2
WHAT IS AN HISTORICAL
RADIOLOGICAL ASSESSMENT?
The Historical Radiological Assessment is a detailed report
documenting a Federal facility’s historic radiological activities where
radioactive materials were used or stored. Federal and State
guidelines have been developed detailing how to conduct an Historical
Radiological Assessment. Historical information is obtained by
conducting a thorough records search, interviewing people, and onsite
inspections of locations where radiological materials were
previously present. The Historical Radiological Assessment is also
used as a baseline document to determine if future radiological
evaluation may be necessary at a specific location.
WHAT IS KNOWN SO FAR?
Building 233 – Building 233 was the site of the RADIAC Instrument
Maintenance and Calibration School (see map on page 3). In January
1950, a glass capsule containing radium sulfate powder was broken
during a calibration exercise. Decontamination efforts in 1950
reduced contamination to allowable levels and the building was
reopened in April. However, residual radiological standards have
become more stringent since 1950 and the Navy began the process of
re-evaluating Building 233 in 2004 to ensure it meets current
allowable levels.
Buildings 342, 343, and 344 – Buildings 342, 343, and 344 were
used by the RADIAC Maintenance Calibration School where
personnel were trained in the use and calibration of radiation
detection equipment. Sealed radioactive sources were used in the
training. The RADIAC Maintenance and Calibration School moved
to Orlando, Florida in 1990. The sealed radioactive sources used at
the Treasure Island school were transferred off-base to other approved
facilities. As part of the closure of the RADIAC Maintenance and
Calibration School, the Navy conducted an evaluation which
determined there were no outstanding issues that required further
investigation or cleanup.
Decontamination Training Area and Ship Mockup – In 1958
radiological decontamination training was conducted by Naval
Radiological Defense Laboratory personnel on a ship mockup
(Building 371) in an area near the intersection of 12th Street and
Avenue A. In 1969, the ship mockup (Building 371) was moved to a
location in Parcel T-111. Radiological decontamination training
ended in 1982. All sealed radiological sources used at the T-111 area
were transferred off-base to other approved facilities. The 1988
Basewide Preliminary Assessment/Site Inspection (PA/SI) concluded
that the Decontamination Training Area did not have any outstanding
issues that required further investigation or cleanup.
Treasure Island Historical Radiological Assessment Fact Sheet No. 1 November 18, 2004
0 500 1,000
Scale in Feet
San Francisco Bay
San Francisco Bay
Clipper Cove
1969-1982
Decontamination Training Area
(Ship Mockup Building 371)
Buildings 342/343/344
RADIAC Maintenance and
Calibration School
Building 233
RADIAC Instrument
Maintenance and
Calibration School
1958-1969
Decontamination
Training Area
(Ship mockup Building 371)
3
Treasure Island Historical Radiological Assessment Fact Sheet No. 1 November 18, 2004
Mr. Jim Whitcomb
Remedial Project Manager
Navy BRAC PMO West
1230 Columbia Street, Suite 1100
San Diego, CA 92101-8517
Treasure Island Historical Radiological Assessment Fact Sheet No. 1 November18, 2004
Mr. Jim Whitcomb
Remedial Project Manager
Base Realignment and Closure
Program Managment Office West
1230 Columbia Street, Suite 1100
San Diego, CA 92101-8517
(619) 532-0936
james.h.whitcomb@navy.mil
NAVY POINTS OF CONTACT
Mr. Lee Saunders
Environmental Public Affairs Officer
Naval Facilities Engineering Command
Southwest Division
1220 Pacific Highway
San Diego, CA 92132
(619) 532-3100
lee.saunders@navy.mil
-
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Types of Mesothelioma
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Because it is difficult to appreciate obstructive disease against a background of severe restrictive disease, the airways component of asbestosis has not received much attention until recently. Pleural fibrosis is particularly associated with these restrictive changes and probably represents the contribution of mechanical changes in the chest wall, but this is a relatively minor effect41-43). Pulmonary function studies also show a reduced diffusing capacity, both because of delayed diffusion across the thickened interstitium and mismatching of blood and air in the alveolar region due to the disruption of the fibrosis. This mismatching is also a reason for the progressive desaturation of oxygen in the blood that eventually results in hypoxemia and clinical respiratory insufficiency in severe cases. Mild cases of asbestosis may not necessarily show this interference with gas exchange and blood gases may be normal in such cases.
Unlike other outcomes associated with asbestos, there is no evidence that cigarette smoking plays any role in contributing to the onset of asbestosis, or that the effects of asbestos exposure and cigarette smoking are positively interactive in causing enhanced asbestosis44). There is some evidence that once established, asbestosis may be enhanced by cigarette smoking with an increased frequency of opacities detectable by HRCT for the same degree of asbestos exposure45). Since the frequency of opacities does not correlate closely with changes in pulmonary function and therefore impairment, it is not clear that this finding can be used as the basis for an apportionment formula.
Possible susceptibility states may contribute to risk of asbestosis, for example glutathione-S-transferase deficiency46). This is a common condition, affecting some 50% of Caucasian males, that might well be considered within the range of normal but that appears to predispose to asbestosis and may modify the outcome. However this observation is not helpful in apportionment. It is an inborn condition of the worker and so common that it may be considered a variant of normal.
The implications of these data simplify apportionment in most cases. Because asbestosis is a disease only caused by exposure to asbestos, and because other risk factors play only a minor role in modifying the outcome associated with the fibrosis (as opposed to complications such as cancer), there is no basis for apportionment by cause. If the diagnosis is asbestosis and causation can be established, the apportionment by cause is 100% attributable to asbestos and all respiratory impairment resulting from the fibrotic component of the disease is asbestos-related. Examiners often acknowledge the presence of asbestosis, but apportion the resulting respiratory impairment between asbestos and cigarette smoking, particularly when there is mixed obstructive/restrictive impairment. It is difficult to do this by cause for the obstructive component and the progression of mixed impairment makes separation of the restrictive and obstructive components uncertain. Given the caveat in workers' compensation that any substantial contribution by a workplace exposure is sufficient to consider the outcome to be work-related, the presence of any documentable asbestosis-related impairment, for example mild restrictive impairment, should be sufficient to apportion all impairment to the asbestos exposure.
The general rule that in the presence of asbestosis all respiratory impairment should be apportioned to asbestos. The exception may be a very mild case of asbestosis with minimal or no functional impairment associated with marked obstructive changes in a heavy smoker, a characteristic smoking-related respiratory impairment. In such a case, the restrictive component of the disease would be considered asbestos-related and the obstructive component, taken as FEV1/FVC(%) rather than FEV1 compared to predicted, would be more likely to reflect the influence of cigarette smoking. The treatment in such a case would then parallel that given below for chronic obstructive airways disease.
However, even in this case there is evidence that the asbestosrelated airways changes modify the effects of cigarette smoke, at least in experimental studies46, 47). The relative contribution by cigarette smoking may be overestimated by this approach in such cases.
Chronic Obstructive Airways Disease
It has been known for many years that exposure to asbestos is associated with obstruction to airflow as well as restrictive changes50-52). Functional changes are also correlated with respiratory symptoms such as cough, wheeze, and shortness of breath53). However, chronic obstructive airways disease (COAD) has not been emphasized as an asbestos-related outcome and has not been accepted by compensation agencies as a presumption or scheduled occupational disease. There are several reasons for this reluctance to recognize asbestosrelated chronic obstructive airways disease. The most influential has probably been that the effect of cigarette smoking is not easily separated from asbestos exposure and has confounded the association, influencing agencies and adjudicators to attribute all of the cause to the smoking50).
Another factor is that the predominant effect in advanced asbestosis is restrictive disease and the obstructive changes associated with lesser degrees of asbestosis have been largely overlooked37, 39). Yet another factor is that mandated surveillance for asbestos-exposed workers, such as the OSHA asbestos standard in the United States and the Alberta Fibrosis Program in Canada, have emphasized the early identification of restrictive changes and changes in the FEV1, which will reflect changes in the FVC, rather than an interpretation that emphasizes airflow taking changes in vital capacity into account.
Adults lose a fraction of their lung capacity and airflow velocity, as measured by routine spirometry, due to aging; this loss is predictable, and for FEV1 averages 30 ml/y. In theory, any person who lived long enough would develop obstructive disease, once the natural loss progressed far enough. Pulmonary injury may accelerate this loss and in cigarette smokers this rate of loss may easily double or triple, so that during their lifetime they dip well below the normal range and develop incapacity, the condition known as chronic obstructive pulmonary disease (COPD). (COPD and the less common term COAD are usually synonymous. Here, COAD is the more general term, and is used to avoid confusion with the complex illness associated with cigarette smoking that most clinicians have in mind when they refer to COPD.)
It is now well established that asbestos-exposed workers show accelerated loss of airflow and are at risk for obstructive airways disease54-59). Those with signs of early parenchymal fibrosis appear to be at higher risk for more rapid decline60).
Asbestos-exposed workers who develop persistent respiratory symptoms are at risk for even more rapid loss of pulmonary function61). There is also experimental evidence for a positive interaction (synergy) in airflow obstruction between asbestos exposure and cigarette smoking because of changes in compliance in the wall of small airways47).
Mesothelioma Info
Malignant mesothelioma is often confused with asbestos related lung cancer because the two diseases both affect similar regions of the body and are both caused by asbestos exposure. There are three distinct types of mesothelioma: pleural mesothelioma, peritoneal mesothelioma and pericardial mesothelioma.
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U.S. Court of Appeals for Veterans Claims_Search engine
http://search.vetapp.gov/isysquery/0679e57...2c0/11-20/list/
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SHIPYARDS
Source: http://www.mesothelioma-navy.com/shipyards.asp
Alabama Alaska California Connecticut District of Columbia Florida Hawaii Louisiana Maine Maryland Massachusetts Michigan Mississippi New Hampshire New Jersey New York Ohio Oregon Pennsylvania Rhode Island South Carolina Texas Virginia Washington
The following are some of the naval shipyards at which our clients were exposed to asbestos dust. Some clients were exposed to asbestos while aboard ship and others during overhauls in various shipyards. During the initial construction and maintenance of these vessels, military and civilian personnel were exposed to numerous asbestos-containing insulation products. Even a brief exposure to asbestos in these settings can cause mesothelioma.
Alabama
Alabama Drydock & Shipping Co. (ADDSCO)
Bender Shipbuilding
Ingalls Shipyard
Alaska
Seward Ships Drydock (Seward)
California
Bethlehem Shipyard (San Francisco)
Bethlehem Steel Shipyard (Terminal Island)
Consolidated Shipyards
Consolidated Steel Shipyard
Hunters Point Naval Shipyard
Kaiser Shipyard (Richmond)
Long Beach Naval Shipyard
Mare Island Naval Shipyard
Moore Drydock
NASSCO Shipyard
National Shipyards
Naval Repair Center (San Diego)
Naval Weapons Station
Pacific Ship Repair
Richmond Shipyard (Kaiser)
Rough & Ready Island Ship Repair
San Diego Naval Shipyard
San Francisco Drydock
Southwest Marine Shipyard (Long Beach, San Diego)
Terminal Island Naval Yard
TODD - Alameda Naval Shipyard
TODD Shipyards (Los Angeles, Oakland, San Francisco, San Pedro)
Triple A Machine Shop
U.S. Naval Shipyard
U.S. Naval Operating Base (Terminal Island)
Vallejo Shipyard
Western Shipyard
Connecticut
Electric Boat (Groton)
Naval Submarine Base
District of Columbia
Washington Navy Yard
Florida
Atlantic Dry Dock
Gulf Marine Repair
Hendry Corporation
Mayport Naval Station
Offshore Shipbuilding, Inc.
Pensacola Naval Air Station
Tampa Bay Shipbuilding
Hawaii
Pearl Harbor Shipyard
Louisiana
Avondale Shipyard (Avondale Industries)
Bollinger Shipyards
Conrad Industries
Maine
Bath Iron Works
Portsmouth Naval Shipyard
Maryland
Baltimore Marine Industries
Bethlehem Shipbuilding
Curtis Bay Coast Guard Yard
Ellicott International
Key Highway Shipyard
Massachusetts
Boston Navy Yard
Charlestown Navy Yard
Fore River Shipyard
General Ship Corporation
Michigan
Defoe Shipbuilding Co.
Mississippi
Ingalls Shipbuilding
Naval Station Pascaqoula
Trinity Marine Group
New Hampshire
Portsmouth Naval Shipyard
New Jersey
New York Shipbuilding
TODD Shipyard
New York
Brooklyn Navy Shipyard
Caddell Drydock and Repair
GMD Shipyard
New York Shipbuilding Corp.
TODD Shipyard (Brooklyn)
Ohio
American Shipbuilding
Oregon
Albina Engine & Machine
Astoria Voyage Repair Station
Cascade General
Commercial Iron & Steel Shipyard
Dyer Shipyard
Floating Marine Ways
Gunderson/FMC Shipyard
Kaiser Shipyard (Portland)
Northwest Marine Ironworks
Oregon Shipyard (Kaiser)
Portland Ship Repair
Swan Island Shipyard
Tongue Point Naval Shipyard
Willamette Iron & Steel
Zidell’s Shipyard
Pennsylvania
Penn Shipbuilding
Philadelphia Naval Shipyard
Sun Shipbuilding
Rhode Island
Newport Naval Yard
South Carolina
Braswell Services Group
Carolina Shipping Company
Charleston Naval Shipyard
Detyen’s Shipyard
Texas
American Bridge Shipyard (Orange)
AMFELS (Brownsville)
Barbas Cut Docks
Bloodworth Bond Shipyard
Boats of Freeport
Brown Shipyard
Brown & Root Shipyard
Galveston Docks
Houston Shipyards
Ingalls Shipbuilding
Kane Shipbuilding
MGM Marine
Naval Station Ingleside
Orange Shipbuilding Co.
Pennsylvania Shipyard (Beaumont)
Port Adams Shipyard
Ta Chiao USA Inc.
TDI-Halter
TODD Shipyard (Houston)
Trinity (Beaumont)
USX Shipyard
Virginia
Collona’s Shipyard (Norfolk)
Lyon Shipyard (Norfolk)
Naval Amphibious Base Little Creek
Newport News Shipyard
Norfolk Naval Shipyard
NORSHIPCO
Phillyship
Washington
Bremerton Naval Shipyard
Duwamish Shipyard (Seattle)
Foss, Launch & Tug
Kaiser Shipyard (Vancouver)
Lake Union Drydock
Lake Washington
Lockheed Shipyard (Seattle)
Masco Shipyard
Naval Station Everett
Puget Sound Bridge Yards
Puget Sound Naval Shipyard
Strategic Weapons Facility
Tacoma Boat & Drydock
TODD Shipyard (Seattle, Tacoma)
Vancouver Shipyard (Kaiser)
Voyage Repair Station Port Angeles
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mesothelioma navy, navy asbestos
Source: http://www.mesothelioma-navy.com/navyships.asp
NAVY SHIPS
The following are some of the navy ships on which our clients were exposed to asbestos dust. Some clients were exposed to asbestos while aboard ship and others during overhauls in various shipyards. During the initial construction and maintenance of these vessels, military and civilian personnel were exposed to numerous asbestos-containing insulation products. Even a brief exposure to asbestos in these settings can cause mesothelioma.
USS Abbott
USS Admiralty Islands
USS Ajax
USS America
USS Apricornus
USS Anzio
USS Aranac
USS Bache
USS Beale
USS Blue
USS Calvert
USS Capps
USS Cavalier
USS Constellation
USS Constitution
USS Coral Sea
USS Cushing
USS Darby
USS Des Moines
USS Dixie
USS Douglas H. Fox
USS Dwight D. Eisenhower
USS Dyess
USS Erben
USS Essex
USS Eversole
USS Fanshaw Bay
USS Farragut
USS Forrestal
USS Guardfish
USS Hancock
USS Herbert Thomas
USS Higbee
USS Homestead
USS Hornet
USS Huse
USS Idaho
USS Independence
USS Iowa
USS James C. Owen
USS John F. Kennedy
USS Juneau
USS Kalinin Bay
USS Kitty Hawk
USS Kwajalein
USS Latimer
USS Lee Fox
USS Lexington
USS Liscome Bay
USS Little Rock
USS Maine
USS Missouri
USS New Jersey
USS Noble
USS Olmstead
USS Oriscany
USS Piedmont
USS Puget Sound
USS Prairie
USS Princeton
USS Ranger
USS Rathburne
USS Roark
USS Saint Paul
USS Salem
USS Salt Lake City
USS Sarasota
USS Saratoga
USS Severn
USS Shangrila
USS Shelton
USS St. Croix
USS T.E. Chandler
USS Tarawa
USS Terror
USS The Sullivans
USS Thuban
USS Ticonderoga
USS Turner Joy
USS Twinning
USS Waller
USS Washington
USS Wasp
USS Wisconsin
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fwd from: Kelly
A few updates:
I have been going to the VA two times a week and this week three times. This is a 16-week course so it will continue into June. Therefore, I am running way behind on our issues and challenges.
Glenda's computer bled to death after many many band aides so we have been sharing my computer with the activities she has also. A new computer is on the way for her and I can tell you first hand, sharing is not what it is cracked up to be!
I am about a third of the way through the edits from Richard on the PN challenge with data and statistics to be submitted.
For Gulf War Issues please go to http://www.ipetitions.com/petition/GulfWarillness/index.html
and get that petition signed for more medical research in that area of Veterans Issue.
(My comment would be hopefully research done by someone independent from the VA and not a major player.)
Congressman Filner:
I received a letter from Congressman Filner’s office to contact his staff on pinpointing some of these Veterans Issues. I did so and spoke with a very nice staff member. I gave them my “rathers’” on what I would prefer to do in conjunction with staffers from other congress and senate folks as well as some VA folks in a three to four hour presentation. Not just pointing out the issues, we have done that repeatedly with none batting even an eye. But hopefully some 'March Order' directions on how to solve some of these issues.
I understand that now some Church organizations are offering to help in the VA paper work for claims, present and past, to try and get the numbers down. I do not think they realize the claims are “kept high” for obvious reasons for Presidents’ Budget Control and men like Dr. Chu at the pentagon.
This would be like in the documented Congress doubling of the staff of the BVA and the production is reduced by 50%. The difference is the VA could then blame the church volunteer staffers for the reduced production.
Congressman Filner said he wanted solutions and that is what we have to address. In many cases, solving one problem in the processes actually solves many associated problems and concerns in the fault tree flow down.
In my discussion, it seems the actual forum and format has not been decided yet. Of course, I am anxious to get started before one more of us dies or looses a home because of promises not kept (and even collusion); but whether this will ever get off the ground is entirely up to Congressman Filner and his staff.
I volunteered to go at my own expense, for however long it takes.
Remains to be seen what will happen on Congressman Filner’s passionate cry for help from Veterans in solving and recommending solutions for Veterans Issues.
I met with my civilian doctor of 25 years yesterday with a quarterly testing plan and prescription plan to eliminate VA health care for me. I finally realized even my service connected issues were now being paid for by my Medicare and my additional insurance I pay for. I guess I did just fall off the Turnip truck as they say on this one. No wonder VA wants me in there at every whipstitch.
I am tired of not knowing when I will be tested and the test results. Alternately finding out from an intern who happened to be talking out loud as she perused my computer file.
Senator Craig:
Senator Craig keeps putting out these glowing selected issues on DoD and VA performance issues. All of it which can be statistically selective to demonstrate some form of actual performance.
As you know and I have stated I support Senator Craig on the issues of Veterans being able to use a lawyer. I do not think even that cut-in has gone far enough. I believe a Vet is a citizen first and any legal matter at any level should be his or her prerogative to use a lawyer or not. I also believe the only way we are going to get this VA system fixed is to have lawyers involved to see just how one sided these legal issues are and actually go against the reasonable interpretation of law and evidentiary findings and how they are used – in the VA’s case they just say "not allowed" or "we do not give the evidence any weight." We run the Veteran's government and we have the power to say so. No matter how many studies the Veterans or his widow has to override the legal statements and legal pronouncements decided and made from Mount Olympus by the Presidents appointed Secretary.
As in my case, I was not even allowed to present the data to the egg-sucking dogs. In addition, as we know, lobby money is the big dog inside 495 and lawyers lobby has plenty of it to throw around. As to whether their lobby money can match the chemical lobby money or not, remains to be seen. Ultimately for Vets and widows that is what wins – not justice.
As I recall the below legislation that was passed was fought for by the Senate with Senator Craig in the lead. Senator Craig stood tuff with twin forty’s hammering away when the House VAC and our pinhead VA secretary did not want this legislation or at least in the way it was written. Tempers did flare some as I recall.
However, any time the VA is given credit for anything it must be tempered with what they are not doing and the subcommittee, even on this legislation, had better stay on top of it. If there is wiggle room VA, will find it.
While some of this is great news, there is much more to be done for past, present, and future Veterans including mandates for AO issues that VA is failing on in performance still after 40 years, as well as Gulf War Issues.
A PROGRAM FOR WOUNDED VETERANS THAT IS WORKING WELL
(Washington, DC) According to new data provided by the Department of Veterans Affairs, servicemembers are receiving payments for serious wounds and trauma within 8 weeks from when the injuries are first sustained. The payments range from $25,000 to $100,000, depending on the severity of the injury. The average payout is approximately $64,000.
The payments are made possible thanks to legislation sponsored by U.S. Senator Larry Craig and passed by Congress two years ago. The benefit, officially known as the Traumatic Injury Protection under the Servicemembers Group Life Insurance program (TSGLI), is informally referred to as the Wounded Warrior legislation. Coverage includes everything from the loss of limbs, hearing and sight, to less visible injuries, including the inability to carry out activities of daily living due to traumatic brain injury.
"Out of terrible tragedy, this is at least some good news for those who are injured and their families. That money is helping them cope during a time of incredible personal challenges," said U.S. Senator Larry Craig (R-Idaho), who authored the legislation.
The proposal for such a benefit was presented to Sen. Craig by three young veterans who had served in Iraq and been injured there. One of them had lost a leg, another had lost both legs, and the third had lost his sight. The young men explained the financial difficulties their families had experienced while they had recuperated during lengthy hospital stays. They said they did not want to see future veterans go through the financial difficulties they had suffered.
That meeting led to swift passage of legislation, which has now provided nearly $200 million to servicemembers seriously, injured since the war on terror began.
"Getting this money out quickly to our seriously injured men and women is very important to me. At my request VA officials are now doing a top to bottom review to see how they can speed up the process. I look forward to the results of that examination," said Craig, the Ranking Member of the U.S. Senate Committee on Veterans’ Affairs.
Since the legislation became effective in December of 2005, more than 3,000 servicemembers have received a total of $193,820,000. Eighteen of those individuals are in Craig’s home state of Idaho. Collectively those Idahoans have received $1.025 million.
In January Sen. Craig introduced legislation (S. 225) which would expand the coverage area now specified by law. The expanded definition in Craig’s new legislation, if adopted by Congress, will allow servicemembers injured outside the Iraq and Afghanistan theaters – from October 7, 2001, but before December 1, 2005 – to receive payment for their serious injuries. Craig’s new legislation is cosponsored by Chairman Daniel Akaka (D-Hawaii).
Discussion – Agent Orange cancers as well as some of these Gulf War issues must also be considered a serious government caused war wound with only a 25% survival rate. Yet, the entire congress has not demanded even the slightest emergency from the VA on these cases. As described above these men also lose money, homes, family assets, and even families. They start treatment and have no income. AO cancers are 100% automatic from VA and require three data points to grant compensations. Two of them are given. This process takes VA from 12 to 18 months. Result – The Vet dies using his family savings to sustain his family during that period. Total result - VA stalls enough not to provide any financial support at all and the family ends up subsidizing the government for “government caused mortality cancer” or morbidity.
Not only the time to rating that intentionally stalled at the local VA shops but also the BVA process is a joke and broken.
"…figures support the contention that the Army purposefully tries to hold down costs by giving lower ratings to enlisted members…
“…Army and Marine Corps pay their disabled several hundred dollars less than the Navy and Air Force, according to DOD data…Broken down differently, all services grant officers disability ratings 50% or higher than enlisted…figures support the contention that the Army purposefully tries to hold down costs by giving lower ratings to enlisted members…the average disability for an Air Force officer is $2,604.00 per month…$600.00 more than the Army…average enlisted airman disability pay is $926.00 per month… while the Army is $770.00 and the Marine corps is $753.00…The Army and Air Force have a percentage gap of 12 points…39% of Naval officers receive ratings of 50% or higher compared to 22% of Naval enlisted."
The disability review process is too subjective and it differs from review board to review board. In other words, two identical disabilities each being reviewed at different board locations will not merit the same degree of scrutiny or even pass/fail (approve/disapprove). The net result will vary in the degree of impairment. It boils down to the reviewer and how liberal or how conservative (s)he will be in the reviewing process. The number of BVA approvals versus denials should be questioned because they tend to fluctuate based upon the amount of money saved or available in any given budget year.
CHRIS ADAMS and ALISON YOUNG Kansas City Star - March 06, 2005:
"Knight Ridder news may be onto one of the biggest stories of the year: 13,000 veterans needlessly died awaiting appeals on VA benefit payments, with a net savings of untold millions for VA."
What else has the Senator not told this nation's Veterans since enactment of the Bush Administration initiated Veterans Disability Commission?
Within the issues of holding down levels of compensation and/or stalling for monetary gain as noted above, the disparity between officer and enlisted disability awards from the various services are ridiculous. Once disabled an individual's livelihood will be forever affected regardless of his military rank at the time of injury.
I will say this, upon hearing the below, one old fart in a dark blue suit in the audience stated, “why not - how well the Veteran married in the social circles, or his or her IQ, or how many proms he or she went to.
Enlisted versus Officer
Rank
Earning potentials over life
Former job and salary
The old fart in the Blue Suit you probable guessed – was me!
The Senator certainly has much work to do if he is going to fix problems within the V.A. The Veterans Disability Benefits Commission should be dismantled and recognized for what it is: an illegal committee appointed by the President to cut benefits for the Nation's wounded warriors. The White House philosophy followed by the Veterans Administration to stall rulings on thousands of claims awaiting the death of the Veteran so that the V.A. could avoid payment must be changed. The corrupt legal system granted by the Congress to allow a sitting president to render such philosophy serves only to reward the president by granting him his requested budget.
We shall see how successful the House and/or the Senate will be in controlling a runaway, omnipotent federal agency known more appropriately as the Veterans Administration.
Disabilities: Many of you have asked what type of disabilities I have and some of what I have been fighting for all along - for all of us.
Diabetes Type II AO associated
PN with limb wasting – requiring knee braces now since the PN has weakened the joints to the point of no stability. (Subcutanious wasting of feet, legs, and tendons) Walk on bones instead of cutanious cushion. Chronic pain in the legs especially. AO connected? - The scientific transcripts (at least three different Ranch Hand transcripts) say yes; the VA/IOM and the published flawed RH says no. Other studies say yes by statistical analysis < 0.05 associated to dioxin exposures; as well as p-values of difference < 0.05. Odds ratios were found at OR = 2.39. A second study confirmed PN as the most prevalent disorder associated with Agent Orange. Is this a stand-alone disorder regardless of clinical or sub-clinical causes? By all scientific protocols it is. Except by our DoD/VA/IOM.
Some lipid issues recently but mostly “triglyceride issues” discovered since 1979 as well as elevated ESR. {hs-CRP in acute phase (7.1)} (This means inflammatory conditions form chronic dosing) Described and found the exact same way” in the Ranch Hand (RH) transcripts – AO connected? - The scientific transcripts say yes; the VA/IOM and the published flawed RH says no.
1979 developed an autoimmune disorder dealing with histamines. This is called urticaria and usually has a life of about 8 to 10 years. For some reason it does resolve with those symptoms but what permanent damage is done, I am not smart enough to know. Mine lasted about 14 years with a very acute phase that was on the verge of debilitating for about 8 of those years. I stumbled on to this form of damage found in the Korean study on dioxin exposures. While there was no connection to the four levels of exposure; dose response was not concluded. However, the p-value of difference found was 0.0614 with none in the comparison group found.
1979 time frame found repetitive motions in my legs would produce weakness. Example I had to quit playing drums as the muscle and tendons would get so weak I could not move them after a few repetitious movements. Found in RH study? Yes Found in other studies? YES
IgA and IgE antibody increased issues as well as deceased issues in IgG1 – IgG4. IgG antibody class leading defense mechanism for infections. Found in Ranch Hand transcripts as well as German, Dutch, and Korean studies. Korean studies indicated confusion in what type of response was required by the body for certain reactions. Probably why the immune system cancers and such. Cells exposed to high levels of IL 4 and IL 10. I have not had that test for immune system dysfunction yet but am working on it.
Chronic infections in the sinuses, throat, and ear. Associated to the confused and ineffective immune issues? More than likely.
Debilitating Daily Chronic Fatigue – Found in Ranch Hand transcripts? Yes Associated to immune system issues? Probably.
Unusual COPD form – lung capacity is “better than normal” but processing is only about 42%. Associated to exposures? Flawed Ranch Hand indicated no finding of lung cancer but chronic breathing issues should be monitored with the chronic findings in personnel. Seveso found COPD. Recently VA study found:
SOURCE: American Journal of Industrial Medicine, November 2006.
…However, exposure to herbicides among Vietnam veterans confirmed a 50 percent increased risk of diabetes, a 52 percent greater heart disease risk, a 32 percent increased risk of hypertension and a 60 percent greater likelihood of having a chronic respiratory problem such as emphysema or asthma.
"Almost three decades after Vietnam service," the researchers conclude, "US Army veterans who were occupationally exposed to phenoxyherbicide in Vietnam experienced significantly higher risks of diabetes, heart disease, hypertension, and non-malignant lung diseases than other veterans who were not exposed to herbicides.”
You will notice the VA is very careful in stating non-malignant lung disease and not using the medical term Chronic Obstructive Pulmonary Disorder (COPD) that has been found in dioxin exposures as well as Vietnam Veterans. While the concert of VA and BVA directed by our White House has continuously denied this disease of the processes associated with pulmonary functions.
Gastrointestinal Issues – in Vietnam during my 6th month I had cyanosis for about two weeks’ probably from AB. At this time, my gastro system went to hell and hand basket. I had no (zero) issues prior to that. At that time, I also developed an aversion to any form of alcohol which sounds like a liver issue. Coming home, I was on a bland diet along with a sudden development of lack of the enzyme that assists digestion of the double sugar in milk products. During a period of about five years I had many many many tests including several upper GI and lower GI – result was called IBS or spastic this or spastic that. Meaning? They had no clue why in one year I went to eating anything I wanted, drinking milk by the gallon, and at least being able to drink a beer without causing flu like symptoms to a bland diet that; even that did not solve the symptoms.
As I became more and more disabled from these cumulative effects culminating in 2001 to the point I could no longer work full time, I started my research on why me and none of my family on either side had any of these issues.
I stumbled across the gastro problems referenced in many studies including the Aussies.
After a long search that took me to medical findings anywhere from University of Iowa to the University of Michigan and other published medical journals trying to find the connection. I succeeded.
After what I call reverse engineering I found a path to the intestinal problems, at least in my case. Lucky for me in the issues I found in the Ranch Hand transcripts I had gone to my family doctor of 22 years, asked questions, and even recommended tests to do. He listened as he had no idea why I was degenerating except he concluded probably because of the toxic chemicals. Most of it correlated exactly what I had found in RH transcripts. Was my doctor surprised? No! Did he know about it many of the found issues I brought up that I found unreported? No!
Of course in many cases as he said, yes we identified it but there is little if anything that can be done to fix it, only treat the symptoms.
On the gastro issues, I had recommended a screening panel for antibodies produced by macrophages and lymphocytes in the small intestines. The connection was I found that some of these intestinal lymphocytes were the same as in the lymphoma cancers already associated and the longer you had these intestinal issues that the more likely you were to develop one of the AO immune system cancers.
The test came back positive. However typical with this test is a false positive so we decide to wait six weeks and repeat. No since being in a hurry after 37 years of suffering. The second test also came back positive. Now the only way to verify damages is with an endoscope’s test. The test confirmed what I had thought in intestinal Celia damages and in addition found Barrett’s esophagus probably related to the decades of gastro problems. The Celia were damaged. This is where some of the digestive enzymes are produced for double milk sugars. Possibly, why before I went over I could drink milk and then after coming home milk was like a fast acting laxative.
I solved that problem which was solvable - some of this is not. I am now having endoscopes test done every 18 months. After being on medication for a year, I can now drink any milk products I want {INCLUDING MILK SHAKES} and actually am back somewhat to what I was before going to Vietnam 38 years ago in digestion, with little or no indigestion in eating anything.
The latest test also showed an improvement in the Barrett’s esophagus.
Do I think the DoD/VA/IOM/Ranch Hand has known about this for decades? Yes I do.
Bone Density Loss
Here again I think as a probable hardheaded idiot in this mess that the above is another reason why Nam Vets as well as I exhibit a known loss of bone density. Ranch Hand transcripts did point out this to a level but then I could not get my hands on all the transcripts for obvious government reasons. I believe it was Dr. Titelbaum had contacted the committee stating he had found a connection to bone loss and the dioxin exposures and someone was going up to see him. If the antibodies are blocking the intestinal cell receptors then the essential vitamins and minerals absorption also slow down. This includes the Nam Vets that exhibit a loss of B12.
It will be interesting to see if the bone density loss has slowed down some or even possibly improved in the next test in about a year.
Now in studying these issues I did find out (University of Iowa) that you do not have to exhibit the acute gastro symptoms as I did to have these issues or it may wax and wane. Just so happens mine has been acute as well as a daily event for the past almost four decades.
Is all of this just a coincidence in many areas and commonality? I would think that would require statistics to the level of hitting the power ball at least two times in a row. Is it logical conclusions based on science and scientific findings? I would think so. However, DoD/VA/IOM and the ESD BVA say no.
Of course you know the issues with my waiting for five years and the BVA judge would not let me present my case and how this all applies for the official VA transcripts.
After five years of fighting with VA, I am now at 20% for diabetes and 10% for each limb because of PN for a total cumulative 50% disability rating.
Was a concerted effort put forth to keep me as well as many of you under 60%? I think the answer is no longer in question and is just another additive to the VA stalling/controlling methodology.
There is obvious evidence in the testing compared to what Ranch Hand (and other studies) found that indicates many issues and results are common to those exposed. Do I think and the doctors think this is primarily resulting in damaged immune system test results? The answer is of course yes.
The interesting thing is when my family doctor sent me to a well known immunologist with a back ground in rheumatoid issues his comment was after reviewing my test results; "I am not a liver expert but these results looks like a liver issue."
I think Dr. Birnbaum of the EPA and her staff may be closer to root cause to at least where all these chronic dioxin issues emanate from than they give themsleves credit. Whether it is clinical liver (found by non invasive testing as found in Ranch Hand) or subclinical (only found when an experienced pathologist gets involved).
Regardless, the above symptoms or syndromes seem to capture what many Vietnam Veterans have developed in some testing and systemic symptoms. Some, of course, going on to systemic mortality damages from parallel issues caused by their exposures.
One of the questions I was asked in my class at the VA was: "What do I believe now that was different before Vietnam."
Department of Defense is no longer to be trusted on War Issues.
Department of Defense is no longer to be trusted on Veterans Issues.
Politicians, with few exceptions, on War Issues are no longer to be trusted.
Politicians, with few exceptions, on Veterans Issues are no longer to be trusted.
Did I get a loud Amen from the rest of the Nam Veterans in the group? You bet they did!
"I cannot fight a cowardly government and its officials that have all the rules of engagement on their side and 'still will not stand and fight'."
Kelley
Source: http://www.2ndbattalion94thartillery.com:8...quickupdate.htm
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Going to the VAMC ER for narcotic pain medicine will not work.
It's fairly routine for the VA to go pass the renewal date for pain meds. I usually get skipped a whole months supply every yr. Often recieve them a week or so late.
Withdral symptoms? Thats one of the reasons, I "refuse" to take Methadone.
Feel like your going to die? Thats not going to matter to "anyone" at the VAMC. It happens way to often to matter. Almost like it's a cost saving agenda, isn't it?
Allan
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Losing Their Minds
By Mark Benjamin
Salon
January 5, 2006
More U.S. soldiers than ever are sustaining serious brain injuries in Iraq. But a significant number of them are being misdiagnosed, forced to wait for treatment or even being called liars by the Army.
After fighting in heavy combat during the initial invasion of Iraq, Spc. James Wilson reenlisted for a second tour of duty. Now 24 years old, he loved the life of a soldier.
In the fall of 2004, his 1st Cavalry Division was mostly fighting in Sadr City, a volatile sector of Baghdad. On Sept. 6, Wilson was manning a .50-caliber machine gun atop a Humvee when a bomb or bombs went off directly under the vehicle, rocking his head forward and slamming it into the machine gun. A fellow soldier told Wilson that his Kevlar helmet had been split open by the impact. The heat from one blast felt like "a hair dryer" on his skin, multiplied "times 20," Wilson later wrote in his diary. To the best of his recollection, the force of the blast also knocked the gun from its mount, smashing it into his leg.
Although battered in the attack, Wilson didn't appear badly hurt -- on the outside, at least. But in the days that followed, the young soldier from Albany, Ga., says he often felt "really dizzy, lightheaded and dazed." Two weeks after the battle, Army medics felt Wilson was suffering from post-traumatic stress disorder and evacuated him out of Iraq for medical evaluation. Wilson was first flown to Landstuhl Regional Medical Center in Germany, where wounded troops are stabilized, and then sent to Walter Reed Army Medical Center in Washington, D.C., in October 2004.
After arriving at Walter Reed, Wilson repeatedly told doctors that he had experienced a hard blow to the head during combat in Iraq. He suffered from symptoms strongly associated with a traumatic brain injury, which occurs when the brain is rocked violently inside the skull, tearing nerve fibers: seizures, short-term memory loss, severe headaches with eye pain, and dizzy spells that have made him vomit. During a visit to the Pentagon around Christmas 2004, Wilson got so dizzy he vomited "all over" the carpet while meeting Deputy Secretary of Defense Paul Wolfowitz in his office.
Despite Wilson's description of his injury and his symptoms, Walter Reed officials repeatedly questioned his mental state and the authenticity of his combat story. In a June 2005 memorandum from an Army Physical Evaluation Board, some Walter Reed doctors stated that Wilson exhibited "conversion disorder with symptoms of traumatic brain injury." Conversion disorder holds that symptoms such as seizures arise from a psychological conflict rather than a physical disorder. Col. James F. Babbitt, president of the Physical Evaluation Board, accused Wilson of being a liar. "I believe that the preponderance of the evidence available to the Board supports an alternative diagnosis … one of malingering," Babbitt wrote in that memo.
Wilson and his wife, Heidi, who has been staying with him at the hospital, vigorously fought the psychological diagnosis and furiously sought medical treatment. The malingering charge was especially painful. "I want my dignity, pride and respect back," Wilson says. After serving his country, being accused of misleading doctors, he says, "is the worst thing in the world."
Today, Wilson is thin and has a shaved head. He often clenches his eyes shut, as if to squeeze at the pain in his skull, or search out an elusive word or memory. Whenever a dim detail of his combat duty bubbles up in his mind, he types it into his diary. He holds his hands awkwardly, with his thumbs folded over his palms. His speech is at times slow and slurred. "I have been dealing with this all year because no one would help me," he says.
On Dec. 19, 2005, more than a year after he was admitted, Walter Reed finally sent Wilson to a neurological center to be treated for traumatic brain injury. Neuropsychological testing done at Walter Reed on Oct. 11, 2005, led officials to conclude that "there was no indication of malingering." According to a neurosurgeon with extensive experience treating combat head injuries, an October 2004 MRI of Wilson, combined with a description of his symptoms, showed that he should have been treated for a traumatic brain injury right then. Medical experts say the failure to treat a brain-injury victim promptly could hinder recovery.
Spc. Wilson is not alone among Iraq veterans who have been misdiagnosed or waited for treatment for traumatic brain injury. Other soldiers interviewed at Walter Reed with apparent brain injuries say they too have been deeply frustrated by delays in getting adequately diagnosed and treated. The soldiers say doctors have caused them anguish by suggesting that their problems might stem from other causes, including mental illness or hereditary disease. According to interviews with military doctors and medical records obtained by Salon, brain-injury cases are overloading Walter Reed. As a result, a significant number of brain-injury patients are falling through the cracks from a lack of resources, know-how, and even blatant neglect.
Exactly how many brain-injured patients are being missed, going without care, or left waiting, as opposed to those who get prompt, top-shelf treatment, is difficult to say. Walter Reed officials and doctors say the Army is getting better at treating brain-injured patients but admit cases like Wilson's are a significant problem.
A November 2003 report from the Army News Service states that because brain injuries aren't always obvious, they "may be neglected, or even pushed aside as merely psychological." Patients with traumatic brain injuries "are suffering as much, but may not get the same support as someone who has an observable injury like a bullet wound or a broken leg," says Dr. Louis French, a neuropsychologist at Walter Reed, in the article.
One thing is certain: Due to today's military technology and insurgent tactics in the Iraq war, more U.S. soldiers than ever before are sustaining and surviving serious head injuries. In fact, traumatic brain injuries are a major problem among soldiers arriving at Walter Reed. According to the hospital's brain injury center, 31 percent of battle-injured soldiers admitted between January 2003 and April 2005 -- 433 patients -- had traumatic brain injuries. Half of those had what the hospital calls a "moderate, severe or penetrating brain injury."
In past wars, brain-trauma rates among combat casualties hovered around 20 percent, according to the Army. The rate of brain injuries among troops wounded in Iraq has shot much higher because the bomb, rather than the bullet, is the weapon of choice for insurgents. In addition, today's better body armor and helmets save soldiers' lives in explosions that would have otherwise killed them.
Through a spokesperson, Walter Reed and other Army officials, including Col. Babbitt, who accused Wilson of malingering, declined to be interviewed. "We cannot discuss specific cases with anyone except the Soldier due to the Privacy Act and HIPAA [the Health Insurance Portability and Accountability Act], nor could we address the case or responsibilities of the president of the [Physical Evaluation Board] without violating some portion of HIPAA," wrote Lt. Col. Kevin V. Arata, an Army public affairs officer, in an e-mail. "Therefore, I cannot arrange an interview."
But according to a written statement that hospital officials provided to Salon, Walter Reed does have a plan to identify and treat brain-trauma patients. The military has a network of eight brain-injury rehabilitation programs under the rubric of the Defense and Veterans Brain Injury Center.
The program was created in 1992 to prevent brain-injured soldiers from being misdiagnosed as mentally ill, or missing treatment completely. Some brain injury patients get treatment from neurologists or neurosurgeons; others get treatment from physical, occupational and speech-language therapists. The hospital says it screens for brain trauma all patients who arrive at the hospital who were injured in blasts, vehicle wrecks or falls, or who have obvious, penetrating head wounds.
There are many success stories, says John DaVanzo, clinical director at Virginia Neurocare, a rehabilitation center in Charlottesville, Va., where Wilson is receiving treatment. "Yes, there are soldiers being missed," DaVanzo admits, but many others with brain injuries, who would've been overlooked in past wars, are being identified and treated. Still, working in partnership with Walter Reed, DaVanzo has seen the strain on the system during the Iraq war. "There is a massive influx of injured soldiers," he says. "People are overworked."
Walter Reed hospital is renowned for state-of-the-art technology and certain kinds of care. One Walter Reed physician tells Salon that the care for amputees at the hospital is "amazing," and praises the work of colleagues, adding that the nurses "work their butts off." However, the physician is worried that a distressing number of patients at the hospital with brain injuries aren't getting adequate screening and care, and says many doctors at the hospital know little about brain injuries and are prone to making a wrong diagnosis.
"A lot of things are missed because the doctors are swamped," the physician says. Many military doctors are away serving in Iraq or Afghanistan, and some patients are forced to wait too long for surgeries they need. "We're overwhelmed in terms of resources," the physician says. (Salon agreed to withhold the identity of the physician, who was not authorized to speak to the media, and feared retribution from the hospital.)
The delay in proper diagnosis and treatment for Wilson and others with apparent brain injuries is particularly troubling because patients tend to benefit from a prompt response. An April 13, 2005, article about brain trauma from the Department of Defense's own press service says that "if the injury is detected and treated early, most victims can recover full brain function, or at least return to relatively normal lives."
Traumatic brain injury can come from a car wreck, or when the sudden pressure from shock waves from an explosion collide with the fluid-filled cavity around the brain. Diagnosis can be tricky because the memory loss, personality change or depression that can accompany traumatic brain injury can also mimic other combat injuries connected with mental health, including post-traumatic stress disorder.
But Dr. Gene Bolles, a former chief of neurosurgery at Landstuhl Regional Medical Center in Germany, says it is plain wrong to place the burden of proof on wounded soldiers. Soldiers coming out of combat who say they've suffered a head blow and who show symptoms of traumatic brain injury should be treated for it, says Bolles. "You do what you can for them," he says flatly. "You believe them."
Bolles reviewed a summary of Wilson's October 2004 MRI from Walter Reed. He says it showed "evidence of loss of blood supply" to the brain and was "compatible with a head injury." Alongside Wilson's story and symptoms, he says, "This sounds like typical head injury syndrome to me; you can make that diagnosis."
He notes that the "shearing effect" on nerve tissue that comes with a serious head blow can be invisible to MRIs and CAT scans and that "there are no definitive tests that prove this syndrome." But soldiers even remotely suspected of having a brain injury, he says, should be treated aggressively for it, rather than with skepticism.
Bolles, who now practices at Denver Health Medical Center, treated U.S. soldiers evacuated from Iraq and Afghanistan for two years at Landstuhl. While many soldiers get good treatment, in other cases "the system is kind of like you have to prove yourself with an injury before anyone believes you," he says. "I wish we would accept the word of a patient if a patient says, 'This is what I'm feeling,' rather than trying to prove somebody is malingering." It is better to treat soldiers for what they say is wrong with them, he says, even if that means a few cheaters get through the system.
Annette McLeod says her husband, Spc. Wendell McLeod Jr., was belatedly diagnosed with a traumatic brain injury. McLeod landed at Walter Reed in August after being hit by a truck in Iraq but was not diagnosed with a brain injury until December. "If you come in and are missing a limb, they know how to handle you," says Annette McLeod. "Anybody with injuries you can't see is shoved to the side."
McLeod says that to her knowledge her husband, Wendell, was not initially screened for brain injury, even though he'd been hit by a truck. But his behavior was so erratic and his memory was so horrible, she says, that she badgered doctors until they ran some tests that identified his problem. "I knew there was something wrong because of the changes in him," she says. "He kept saying, 'I can't remember. I can't remember.' This is a man who used to remember everything."
McLeod, 40, arrived at Walter Reed last August with a fractured vertebra, a chipped vertebra, four herniated discs in his back, and a shoulder injury. He also began suffering from bizarre mood swings. "I can't hardly remember anything," he says. Annette, who is staying with him at Walter Reed, took McLeod to the supermarket recently. "He walked down the aisle three times and could not remember what I asked him to get," she says. She makes her husband sit in the back seat of the car because ever since his accident he wildly grabs at the steering wheel.
McLeod was tested for traumatic brain injury in September but did not hear anything about the results until he was diagnosed in the first week of December. In the meantime, McLeod was told by officials that he might have been born with his brain problem. "They tried to say it was inherited," McLeod says. Annette says they were also told it could be psychological. The misdiagnosis and delays have been excruciating, she says angrily, with a lot of "just waiting around and waiting around and waiting around."
Sgt. Steve Cobb, age 46, tells a similar story. Injured in an armored personnel carrier accident in Iraq in 2004 while serving with the West Virginia National Guard, a head blow left him with short-term memory loss, hearing loss and the loss of peripheral vision in his left eye. He slurs his words and is so dizzy that he walks with a cane. Medics in Iraq first missed his brain problem completely and gave him aspirin. He served another eight months after the accident.
Cobb arrived at Walter Reed last May. In July, he was diagnosed with traumatic brain injury, but did not start getting therapy until September. He says that he, too, was told by hospital officials that he may have been born with his problem. "They said it was hereditary," Cobb says with disgust.
His memory is so bad that his wife, Natalie, is afraid he can't take care of himself. She has left her 13- and 19-year-old kids at home with family in West Virginia to be with her husband at Walter Reed. "We heard it was brain disease. We heard it was hereditary," she says over dinner one evening at a restaurant near the hospital. "I feel that they are letting the traumatic brain-injury patients slide through the cracks."
The stress of being misdiagnosed can further harm soldiers, says Bolles, the neurosurgeon, especially if patients get stuck in a pattern where doctors are denying that their injuries exist. "That in and of itself becomes a disability to these people if they get angry and frustrated," Bolles says. "That alone makes it worth treating these people early."
Wilson came back from Iraq a totally different man, according to his wife Heidi. In a photo of the couple from before his injury, the two are sitting on the edge of a fountain. Wilson stares squarely at the camera with a deft, slight smile. Heidi, in a white dress, sits in his lap, holding a bouquet.
Wilson's injury has left him so sensitive to light that his room at Malogne House, a residential facility behind the main hospital at Walter Reed, looks cavelike, lighted only by two dim bulbs. Looking at bright light, Wilson says, "is like welding without your mask on." Sometimes even the dim bulbs are too much. "It kills him," Heidi says one evening in the room. "He puts little blankets over them." Heidi says her husband's brow turns a deep red during his worst headaches, which he says feels like his eyes are being sucked back into his skull. "I just want to take a drill and drill into my head," he says.
Sometimes Wilson remembers events from long ago, but not what happened five minutes ago. He still writes bits in his diary, attempting to piece his memory back together. He used to enjoy cooking Cajun food but now that's gone. "Everything tastes like rubber," he says. "I look at stuff I want to taste. I feel like I remember what it tastes like, but I can't." When Heidi is away for a few days, his memory loss and olfactory problems collide, though he tries to keep a sense of humor about it. "If she is away, I may not take a bath for six days, until she gets back," he says. Heidi nods vigorously. "I'll get his bath ready and say, 'Time to get in the tub,'" she says.
But when the conversation returns to Wilson's treatment, their smiles quickly fade. It's hard for them to believe, after two hard tours of duty, that this is the kind of treatment he has received. "I just want to be taken care of," he says. "I just want healthcare."
SOURCE: Losing Their Minds - UN Security Council - Global Policy Forum
http://www.globalpolicy.org/security/issue...6/0105minds.htm
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Can I hire an attorney now?
Appeals center said once the claim has sat in "ready to rate" for a yr, it's sent back to the BVA with a, "couldn't get to it" status.
Claim for Multiple Sclerosis has not been decided on since they received an IMO from Dr Bash back in 2005. They refuse to decide it until the claims for spinal issues,etc are decided on. They won't process the spinal issues Dr Bash wrote IMO's for at the appeals center, their to ignorant to process it at the RO's & unwilling to decide it at the BVA. The BVA acts like they think the Regional Offices are competent enough to process claims. Can't understand why. There wouldn't be a need for the BVA if that was true.
Allan
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"war widows pension"
Yes, thats it Mike.
They used many of us like lab rats during Vietnam. In my opinion, they havn't stopped their practices either.
TBI's, MS & neurological disorders of so called,"unknown" causes due to enviromental factors? My guess is, not all TBI's coming out of IRAQ, is due to IED's.
Talking to health care staff about SHAD is like trying to get the truth out of the Bush administration. Nobody knows anything, & if they do, they ain't talking about it.
It's good to know you found some answers to the puzzle & hope it helps you.
Allan
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Hello Testvet,
I believe the serviving spouse "can" file for pension. But I can't say for sure from memory.
Allan
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The 1994 Rockefeller Report
Examining Biological Experimentation on U.S. Military
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Traumatic Brain Injury National Data Center (TBINDC)
http://www.virec.research.va.gov:80/Non-VA...rces/TBINDC.htm
Presumptive Service Connection Does Not Preclude Consideration Of Direct Service Connection When Medical Nexus Has Been Provided.
in VA Disability Claims Research
Posted
http://www.warms.vba.va.gov/admin21/m21_1/part6/chg110.doc
presumptive service connection does not preclude consideration of direct service connection when medical nexus has been provided.
Veterans Benefits Administration M21-1, Part VI
Department of Veterans Affairs Change 110
Washington, DC 20420 February 5, 2004
Veterans Benefits Manual M21-1, Part VI, “Rating Board Procedures,” is changed as follows:
Page 7-i: Remove this page and substitute page 7-i attached.
Pages 7-IV-1 through 7-IV-11: Remove these pages and substitute pages 7-IV-1 through 7-IV-12 attached.
Paragraph 7.20c is revised to
reflect that chloracne and chronic lymphocytic leukemia are not subject to the provisions of 38 CFR 3.816 (the Nehmer Stipulation)
show May 8, 2001 as the effective date that Type 2 diabetes mellitus was added to the list of presumptive diseases associated with herbicide exposure, and
add chronic lymphocytic leukemia to the list of presumptive diseases, effective
October 16, 2003.
Paragraph 7.20d is revised and rewritten to
show that 38 CFR 3.816 was added effective September 24, 2003 to provide guidance for awarding benefits under the Nehmer litigation
provide definitions of “Nehmer class members” and “covered herbicide diseases” under 38 CFR 3.816
state the eligibility and effective date provisions of 38 CFR 3.816
provide additional examples of Nehmer claims
reflect that Type 2 diabetes mellitus was added to the list of presumptive diseases in 38 CFR 3.309(e) effective May 8, 2001, rather than July 9, 2001
clarify that the estate of the deceased Nehmer class member’s falls last in the line of succession for payment of unpaid benefits
show that development for other survivors is required before the unpaid benefits can be released, and
remove the instructions to notify payees of the Nehmer district court order.
RESCISSION: Change 67
Change 90
By Direction of the Under Secretary for Benefits
Ronald J. Henke
Director, Compensation and Pension Service
Distribution: RPC: 2068
FD: EX: ASO and AR (included in RPC 2068)
LOCAL REPRODUCTION AUTHORIZED
February 5, 2004 M21-1, Part VI
Change 110
CHAPTER 7. RATING PROCEDURES FOR SPECIFIC ISSUES
CONTENTS
PARAGRAPH PAGE
SUBCHAPTER I. SERVICE CONNECTION
7.01 Service Connection--Direct or Presumptive 7-I-1
7.02 Determination of Service Incurrence 7-I-2
7.03 Disabilities Related to Combat 7-I-3
7.04 Definition of Injury--38 U.S.C. 101(24) and 38 CFR 3.6(a) 7-I-3
7.05 Aggravation of Preservice Disability 7-I-3
7.06 Claims For Secondary Service Connection By Aggravation 7-I-4
SUBCHAPTER II. UNEMPLOYABILITY DETERMINATIONS IN COMPENSATION CASES
7.07 Individual Unemployability 7-II-1
7.08 Evidence Requirements 7-II-1
7.09 Rating Practices and Procedures 7-II-2
7.10 Multiple Injuries Incurred in Action or as Prisoner of War (POW) 7-II-4
7.11 Claims Requiring Central Office Approval 7-II-4
7.12 Control of Evaluations Based on Individual Unemployability 7-II-4
SUBCHAPTER III. UNEMPLOYABILITY DETERMINATIONS IN PENSION CASES
7.13 Requirements 7-III-1
7.14 Unemployability 7-III-1
7.15 Marginal Employment 7-III-3
7.16 Factors Relating to Unemployability or Marginal Employment of Farmers 7-III-4
7.17 Unemployment Due to Loss of Industry in the Community 7-III-4
7.18 Rating Practices and Procedures 7-III-5
SUBCHAPTER IV. ENVIRONMENTAL HAZARDS
7.19 Reconsideration of Previously Denied Claims Based on Exposure to Ionizing
Radiation During Occupation of Hiroshima or Nagasaki or in Nuclear Testing 7-IV-1
7.20 Presumptive Diseases Associated With Exposure To Herbicide Agents 7-IV-1
7.21 Asbestos-Related Diseases 7-IV-5
7.22 Compensation for Disabilities Associated with Gulf War Service 7-IV-7
SUBCHAPTER V. POW RATINGS
7.23 Rating Claims Based on Prisoner of War Status 7-V-1
SUBCHAPTER VI. 38 U.S.C. 1151 RATINGS
7.24 Compensation or DIC under 38 U.S.C. 1151 7-VI-1
7-iFebruary 5, 2004 M21-1, Part VI
Change 110
SUBCHAPTER IV. ENVIRONMENTAL HAZARDS
7.19 RECONSIDERATION OF PREVIOUSLY DENIED CLAIMS BASED ON EXPOSURE TO IONIZING RADIATION DURING OCCUPATION OF HIROSHIMA OR NAGASAKI OR IN NUCLEAR TESTING
Veterans whose claims for service connection based upon exposure to ionizing radiation as a consequence of service with the occupation forces of Hiroshima or Nagasaki, Japan, or in connection with nuclear testing were denied prior to October 24, 1984, are entitled to a de novo review (a complete, new review) of their claims under Public Law 98-542, the "Veterans' Dioxin and Radiation Exposure Compensation Standards Act," which was enacted on October 24, 1984. New and material evidence need not be submitted to reopen these claims.
7.20 PRESUMPTIVE DISEASES ASSOCIATED WITH EXPOSURE TO HERBICIDE AGENTS
a. Herbicide Agents. "Herbicide agent" means a chemical used in support of the United States and allied military operations in the Republic of Vietnam during the Vietnam era, specifically: 2,4-D; 2,4,5-T and its contaminant, TCDD; cacodylic acid; and picloram. (38 CFR 3.307(a)(6)(i))
b. Exposure. Unless there is affirmative evidence to the contrary, a veteran who served on active duty in the Republic of Vietnam during the Vietnam era is presumed to have been exposed to a herbicide agent. The last date of exposure is the last date on which he or she served in the Republic of Vietnam during the Vietnam era (38 CFR 3.307((a)(6)(iii)). Any exposure to herbicide agents in circumstances other than Vietnam service must be established on a factual basis.
c. Presumptive Diseases
(1) Requirements for Service Connection. In order to establish presumptive service connection, all diseases listed in 3.309(e) must become manifest to a degree of 10 percent or more after exposure. Chloracne (or other acneiform disease consistent with chloracne), porphyria cutanea tarda, and acute and subacute peripheral neuropathy must fulfill the 10 percent requirement within a year of last exposure to herbicides. Previously, respiratory cancers (cancers of the lung, bronchus, larynx, trachea) had to become manifest within 30 years of last exposure. Public Law 107-103 eliminated this requirement effective January 1, 2002. There is no time limit for the other listed diseases. (38 CFR 3.307((a)(6)(ii))
NOTE: The requirements for presumptive service connection do not preclude consideration of direct service connection when medical nexus has been provided. See 38 CFR 3.303(d).
(2) Acute and Subacute Peripheral Neuropathy. When processing claims for service connection for acute and subacute peripheral neuropathy based on herbicide exposure, it is important to remember that "acute and subacute peripheral neuropathy" means transient peripheral neuropathy that appeared within one year of last exposure to an herbicide agent and resolved within two years of the date of onset. It does not include chronic peripheral neuropathy. A "zero percent" evaluation should not be assigned based on a history of acute and subacute peripheral neuropathy that manifested within one year of last exposure and resolved within two years of the date of onset. Absent proof of a present disability there can be no valid claim (see Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992)). Because any acute or subacute peripheral neuropathy will, by definition, resolve within a short time after exposure, any later-occurring peripheral neuropathy, whether transient or chronic, will not be presumed to be related to the prior herbicide exposure or the previously-resolved acute or subacute peripheral neuropathy. Claims of service connection for such later-occurring peripheral neuropathy should be evaluated under the ordinary standards governing direct service connection.
7-IV-1
M21-1, Part VI February 5, 2004
Change 110
(3) Dates of Entitlement. The diseases listed in 38 CFR 3.309(e) were made subject to presumptive service connection on the dates shown below:
Effective Date Disability
February 6, 1991* and *** Chloracne or other acneform disease consistent with chloracne
February 6, 1991* Soft-tissue sarcoma (other than osteosarcoma,
chondrosarcoma, Kaposi’s sarcoma, or mesothelioma)
February 6, 1991** Non-Hodgkin’s lymphoma
February 3, 1994 Porphyria cutanea tarda, Hodgkin's disease
June 9, 1994 Respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), multiple myeloma
November 7, 1996
Prostate cancer, acute and subacute peripheral neuropathy
May 8, 2001 Diabetes mellitus (Type 2)
October 16, 2003*** Chronic lymphocytic leukemia
Unless an earlier effective date is determined pursuant to the Nehmer Stipulation, the provisions pertaining to retroactive payment under 38 CFR 3.114(a) apply.
* originally September 25, 1985 under section 3.311a
** originally August 5, 1964 under section 3.313
*** not subject to the provisions of 38 CFR 3.816 (See 7.20d.)
(4) Conditions for which the Secretary has determined there is no positive association with herbicide exposure. Under the Agent Orange Act of 1991, the Secretary receives periodic reviews and summaries of the scientific evidence concerning the association between exposure to herbicides and diseases suspected to be associated with those exposures from the National Academy of Sciences (NAS). To the extent possible, NAS determines: (1) whether there is a statistical association between specific diseases and herbicide exposure; (2) the increased risk of disease among individuals exposed to herbicides in the Republic of Vietnam during the Vietnam Era; and (3) whether there is a plausible biological mechanism or other evidence that herbicide exposure causes specific diseases. Based on cumulative scientific data reported by NAS since 1993, the Secretary has determined that there is no positive association (i.e., the evidence for an association does not equal or outweigh the evidence against an association) between herbicide exposure and the following conditions:
hepatobiliary cancers
nasal and nasopharyngeal cancer
bone cancers
breast cancer
cancers of the female reproductive system
urinary bladder cancer
renal cancer
testicular cancer
leukemia (other than chronic lymphocytic leukemia)
reproductive effects (abnormal sperm parameters and infertility)
Parkinson's disease
7-IV-2February 5, 2004 M21-1, Part VI
Change 110
chronic persistent peripheral neuropathy
lipid and lipoprotein disorders
gastrointestinal and digestive disease (other than diabetes mellitus)
immune system disorders
circulatory disorders
respiratory disorders (other than certain respiratory cancers)
skin cancer
cognitive and neuropsychiatric effects
gastrointestinal tract tumors
brain tumors
amyloidosis
d. The Nehmer Stipulation (38 CFR 3.816)
(1) Background. Title 38 CFR 3.311a, which became effective on September 25, 1985, was the first VA regulation to provide guidance for the adjudication of claims based on dioxin exposure. In February 1987, a class action entitled Nehmer v. United States Veterans Administration, et al. was filed in the United States District Court for the Northern District of California. On May 3, 1989, the district court invalidated a portion of 38 CFR 3.311a. All denials on or after September 25, 1985 based on that regulation were voided, and a moratorium was placed on further denials. The moratorium was lifted on February 15, 1994. Effective September 24, 2003, 38 CFR 3.816 was added to provide guidance for awarding disability compensation and DIC benefits under the Nehmer litigation.
(2) Nehmer Class Members. Nehmer class members under 38 CFR 3.816 include a veteran who served in the Republic of Vietnam during the Vietnam era who has a covered herbicide disease, and the surviving spouse, child, or parent of a deceased veteran who served in the Republic of Vietnam during the Vietnam era and died from a covered herbicide disease.
(3) Covered Herbicide Disease. “Covered herbicide disease” under 38 CFR 3.816 means a disease for which VA has established a presumption of service connection before October 1, 2002 under the Agent Orange Act of 1991, other than chloracne. These diseases are
Type 2 Diabetes (also known as type II diabetes mellitus or adult-onset diabetes)
Hodgkin’s disease
Multiple myeloma
Non-Hodgkin’s lymphoma
Acute and Subacute peripheral neuropathy
Porphyria cutanea tarda
Prostate cancer
Respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), and
Soft-tissue sarcoma (as defined in 38 CFR 3.309©).
(4) Entitlement to Benefits. A Nehmer class member is entitled to disability compensation or DIC benefits under 38 CFR 3.816 if a claim for service-connected disability or death from a covered herbicide disease was (1) denied in a decision issued between September 25, 1985 and May 3, 1989, (2) pending on May 3, 1989 or, (3) received between May 3, 1989 and the effective date of the regulation establishing a presumption of service connection for the covered disease.
Note: Minor differences in the terminology used in the prior decision will not preclude a finding, based on the record at the time of the prior decision, that the prior decision denied compensation for the same covered herbicide disease.
(5) Effective Date. The effective date of compensation benefits under 38 CFR 3.816 is the date of receipt of the claim on which the prior denial was based or the date on which the disability arose, whichever is
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later. The effective date of an award of DIC benefits under 38 CFR 3.816 is the later of the date of receipt of the prior claim or the date of the veteran’s death.
Exceptions: If VA received the prior claim for compensation within one year after the veteran’s separation from service, the effective date of compensation is governed by 38 CFR 3.400(b)(2). If the prior claim for DIC was received within one year after the veteran’s death, the effective date of DIC is governed by 38 CFR 3.400©.
Note: The provisions of 38 CFR 3.114(a) limiting effective dates to no earlier than the date of a liberalizing law or issue do not apply to benefits awarded under 38 CFR 3.816.
Example 1: The veteran’s initial claim for lung cancer was received on August 4, 1985 and denied on November 19, 1985. Medical evidence showed a diagnosis of lung cancer in July 1985. In this case, the date of entitlement to benefits under 38 CFR 3.816 would be from the date of claim, August 4, 1985. If the claim had been denied prior to September 25, 1985, it would be unaffected by the Nehmer Stipulation, and the effective date would be governed by 38 CFR 3.114(a).
Example 2: The veteran’s initial claim for service connection for lung cancer was received on October 14, 1992 and denied on December 23, 1992. Medical evidence showed a diagnosis of lung cancer in September 1992. Since the claim was received before June 9, 1994, the effective date of the presumption of service connection for lung cancer under 38 CFR 3.309(e), compensation benefits under 38 CFR 3.816 may be awarded from the date of claim, October 14, 1992.
Example 3: On November 3, 1986, a veteran with Vietnam service died from Hodgkin's disease. His widow filed a claim for DIC on December 10, 1986, alleging that his death was related to Agent Orange exposure. On February 12, 1987, entitlement to DIC benefits was denied. The effective date for an award of DIC benefits would now be determined with reference to the date of claim, December 10, 1986. Since, in this case, the date of claim is within one year of the veteran's death, the date of eligibility would be the first day of the month in which the veteran's death occurred as required by 38 CFR 3.400©(2).
(6) Scope of Retroactive Payment Provisions
(a) No Requirement of a Claim That Specifically Mentions Herbicide Exposure. In its February 11, 1999 order the district court held that a Nehmer class member’s compensation or DIC claim need only have requested service connection for the condition in question to qualify as a Nehmer claim. It is not necessary that the claim have asserted that the condition was caused by herbicide exposure.
Example: A veteran with Vietnam service filed a claim in 1994, expressly alleging that his prostate cancer was caused by exposure to ionizing radiation in service prior to his service in Vietnam. VA denied the claim in 1995. The veteran reopened the claim in 1997, and service connection was granted. On these facts, the effective date must relate back to the 1994 claim, even though the veteran alleged a different basis for service connection.
(b) Porphyria Cutanea Tarda (PCT). Title 38 CFR 3.311a(d), which was published on October 21, 1991, stated that sound scientific and medical evidence did not establish a significant statistical association between herbicide exposure and PCT. A denial of PCT under 38 CFR 3.311a after October 20, 1991, was valid and an earlier effective date for benefits would not be assigned under 38 CFR 3.816. However, a claim for PCT which was denied between September 24, 1985, and October 21, 1991, would be considered for an earlier effective date under 38 CFR 3.816.
© Type 2 Diabetes Mellitus. Effective May 8, 2001, Type 2 diabetes mellitus became subject to presumptive service connection under 38 CFR 3.309(e). Retroactive benefits under the Nehmer review may be warranted for claims for service connection for Type 2 diabetes filed or denied during the period from September 25, 1985 to May 7, 2001. If a prior claim did not involve service connection for Type 2 diabetes, it generally would not provide a basis for an earlier effective date. However, a lack of specificity in the initial claim may be clarified by later submissions.
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Example 1: In January 1987, a veteran claimed compensation for hyperglycemia. In developing the claim, VA obtained medical records indicating that the veteran was diagnosed with Type 2 diabetes in February 1987. On these facts, it would be reasonable to treat the January 1987 claim as a claim for service connection of Type 2 diabetes. Under 38 CFR 3.816, benefits may be paid retroactive to the later of the date of that claim or the date the disability arose, as determined by the facts of the case.
Example 2: In 1995, a veteran claimed compensation for hyperglycemia. Medical records obtained by VA indicated the veteran did not have Type 2 diabetes. In 2001, the veteran claimed compensation for Type 2 diabetes, submitting evidence showing that the condition was diagnosed in 1996. On these facts, the 1995 claim was not a claim for service connection of Type 2 diabetes, as neither the application nor the evidence of record suggested the presence of Type 2 diabetes.
(d) Payment to the Survivors or Estate of a Nehmer Class Member
1. Identifying Appropriate Payee. If a Nehmer class member entitled under 38 CFR 3.816© and (d) dies before receiving the payment of retroactive benefits, award the unpaid benefits to the first individual or entity in existence in the following order: spouse; child or children (divided into equal shares, if more than one child exists), regardless of age or marital status; parents (divided in half, if both parents are alive); estate.
Note 1: The survivor or estate of a Nehmer class member is not required to file an application in order to receive the unpaid benefits.
Note 2: The provisions of 38 U.S.C. 5121(a) limiting payment of accrued benefits to amounts paid and due for a period not to exceed two years prior do not apply to payments under 38 CFR 3.816.
2. If Appropriate Payee Cannot Be Identified. If a class member is deceased and the claims file does not clearly identify an eligible survivor, use all available information in the file to determine an appropriate payee. For example, if the claims file identifies an authorized representative or relative, this person should be contacted for information on the existence of a surviving spouse, children, parents, or estate. If this development does not identify an appropriate payee, annotate the rating decision that it was not possible to locate any payee eligible for Nehmer payment.
3. Developing for Other Survivors. Before awarding benefits to an identified payee, ask the payee to state whether there are any other survivors of the class member who may have an equal or greater entitlement to payment under 38 CFR 3.816, unless the circumstances clearly indicate that such a request is unnecessary. If, after the claim is developed, the full amount of benefits is awarded to a payee, do not pay any portion of the amount to any other individual, unless the payment previously released can be recovered.
7.21 ASBESTOS-RELATED DISEASES
a. General
(1) Asbestos fiber masses have a tendency to break easily into tiny dust particles that can float in the air, stick to clothes, and may be inhaled or swallowed. Inhalation of asbestos fibers can produce fibrosis and tumors. The most common disease is interstitial pulmonary fibrosis (asbestosis). Asbestos fibers may also produce pleural effusions and fibrosis, pleural plaques, mesotheliomas of pleura and peritoneum, lung cancer, and cancers of the gastrointestinal tract. Cancers of the larynx and pharynx as well as the urogenital system (except the prostate) are also associated with asbestos exposure.
(2) Asbestos, a fibrous form of silicate mineral of varied chemical composition and physical configuration, derives from serpentine and amphibole ore bodies. The asbestos fibers are obtained from these minerals after the rocks have been crushed. Africa has been the source of large quantities of crocidolite and amosite. The main asbestos product now used in the United States is chrysotile which consists of varied mixtures of chrysotile, tremolite, actinolite, and anthophyllite fibers. The biological actions of these fibers differ
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in some respects. Chrysotile products have their initial effects on the small airways of the lung, cause asbestosis more slowly, but result in lung cancer more often. The African fibers have more initial effects on the small blood vessels of the lung, the alveolar walls and the pleura, and result in more mesothelioma. True chrysotile fibers are hollow and extremely thin. All the other varieties of asbestos fibers are solid.
(3) Persons with asbestos exposure have an increased incidence of bronchial, lung, pharyngolaryngeal, gastrointestinal and urogenital cancer. The risk of developing bronchial cancer is increased in current cigarette smokers who have had asbestos exposure. Mesotheliomas are not associated with cigarette smoking. Lung cancer associated with asbestos exposure originates in the lung parenchyma rather than the bronchi. About 50 percent of persons with asbestosis eventually develop lung cancer, about 17 percent develop mesothelioma, and about 10 percent develop gastrointestinal and urogenital cancers.
All persons with significant asbestosis develop cor pulmonale and those who do not die from cancer often die from heart failure secondary to cor pulmonale.
b. Occupational Exposure
(1) Some of the major occupations involving exposure to asbestos include mining, milling, work in shipyards, insulation work, demolition of old buildings, carpentry and construction, manufacture and servicing of friction products such as clutch facings and brake linings, manufacture and installation of roofing and flooring materials, asbestos cement sheet and pipe products, military equipment, etc. Exposure to any simple type of asbestos is unusual except in mines and mills where the raw materials are produced.
(2) High exposure to asbestos and a high prevalence of disease have been noted in insulation and shipyard workers. This is significant considering that, during World War II, several million people employed in U.S. shipyards and U.S. Navy veterans were exposed to chrysotile products as well as amosite and crocidolite since these varieties of African asbestos were used extensively in military ship construction. Many of these people have only recently come to medical attention because the latent period varies from 10 to 45 or more years between first exposure and development of disease. Also of significance is that the exposure to asbestos may be brief (as little as a month or two) or indirect (bystander disease).
c. Diagnosis. The clinical diagnosis of asbestosis requires a history of exposure and radiographic evidence of parenchymal lung disease. Symptoms and signs may include dyspnea on exertion and end-respiratory rales over the lower lobes. Clubbing of the fingers occurs at late stages of the disease. Pulmonary function impairment and cor pulmonale can be demonstrated by instrumental methods. Compensatory emphysema may also be evident.
d. Guidelines
(1) When considering VA compensation claims, RVSRs must determine whether or not military records demonstrate evidence of asbestos exposure in service. RVSRs must also assure that development is accomplished to determine whether or not there is preservice and/or post-service evidence of occupational or other asbestos exposure. A determination must then be made as to the relationship between asbestos exposure and the claimed diseases, keeping in mind the latency and exposure information noted above. As always, the reasonable doubt doctrine is for consideration in such claims. If assistance is needed, contact the Compensation and Pension Service Regulations Staff.
(2) Rate asbestosis under diagnostic code 6833 and pleural effusions and fibrosis, and pleural plaques analogous to asbestosis. Rate cancers under the diagnostic code for the appropriate body system. Rate
mesothelioma of pleura analogous to diagnostic code 6819 and mesothelioma of peritoneum analogous to diagnostic code 7343.
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7.22 COMPENSATION FOR DISABILITIES ASSOCIATED WITH GULF WAR SERVICE
a. Background.
(1) The Persian Gulf War Veterans’ Act. On November 2, 1994, Congress enacted the "Persian Gulf War Veterans' Benefits Act," Title I of the "Veterans' Benefits Improvements Act of 1994," Public Law 103-446. That statute added a new section 1117 to Title 38, United States Code, authorizing VA to compensate any Persian Gulf veteran suffering from a chronic disability resulting from an undiagnosed illness or combination of undiagnosed illnesses which became manifest either during active duty in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more within a presumptive period following service in the Southwest Asia theater of operations during the Persian Gulf War.
(2) The Persian Gulf War Veterans Act of 1998. The “Persian Gulf War Veterans Act of 1998”, Public Law 105-277 authorized VA to compensate Gulf War veterans for diagnosed or undiagnosed disabilities which are determined by VA regulation to warrant a presumption of service-connection based on a positive association with exposure to a toxic agent, environmental or wartime hazard, or preventive medication or vaccine associated with Gulf War service. This statute added section 1118 to Title 38, United States Code.
(3) The Veterans Education and Benefits Expansion Act of 2001. The “Veterans Education and Benefits Expansion Act of 2001,” Public Law 107-103, expanded the definition of “qualifying chronic disability” under 38 U.S.C 1117 to include, effective March 1, 2002, not only a disability resulting from an undiagnosed illness, but also a medically unexplained chronic multi-symptom illness that is defined by a cluster of signs and symptoms, and any diagnosed illness that is determined by VA regulation to warrant a presumption of service-connection.
(4) 38 CFR 3.317. Title 38 CFR 3.317, which implements 38 U.S.C. 1117, defines qualifying Gulf War service and qualifying chronic disability as well as establishes a broad but non-exclusive list of signs and symptoms which may be representative of undiagnosed or chronic multi-symptom illnesses for which compensation may be paid, and the presumptive period for service connection.
b. “Gulf War Veteran”. The term "Gulf War veteran" under 38 CFR 3.317 means a veteran who served on active military, naval, or air service in the Southwest Asia theater of operations during the Gulf War. The Gulf War extends from August 2, 1990, through a date yet to be determined by law or Presidential proclamation (38 U.S.C. 101(33). The Southwest Asia theater of operations includes:
Iraq
Kuwait
Saudi Arabia
The neutral zone between Iraq and Saudi Arabia
The United Arab Emirates
Bahrain
Qatar
Oman
The Gulf of Aden
The Gulf of Oman
The Persian Gulf
The Arabian Sea
The Red Sea
The airspace above these locations
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c. Qualifying Chronic Disability
(1) Definition. The term “qualifying chronic disability” under 38 CFR 3.317 means a chronic disability resulting from any of the following (or any combination of any of the following):
(a) An undiagnosed illness.
(b) A medically unexplained chronic multi-symptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs or symptoms.
© Any diagnosed illness that is determined by VA regulation to warrant a presumption of service-connection.
(2) Signs or Symptoms of Illness. Title 38 CFR 3.317 specifies 13 categories of signs or symptoms that may be a manifestation of an undiagnosed illness or a chronic multi-symptom illness. They are listed below. However, the list of 13 illness categories is not exclusive. Signs or symptoms not represented by one of the listed categories can also qualify for consideration. If a disability is affirmatively shown to have resulted from a cause other than Gulf War service, however, it cannot be compensated under 38 CFR 3.317.
Abnormal weight loss
Cardiovascular signs or symptoms
Fatigue
Gastrointestinal signs or symptoms
Headache
Joint pain
Menstrual disorders
Muscle pain
Neurological signs or symptoms
Neuropsychological signs or symptoms
Signs or symptoms involving the respiratory system (upper and lower)
Signs and symptoms involving the skin
Sleep disturbances
(3) Chronicity. The claimed illness must be chronic. To fulfill the requirement for chronicity, the claimed illness must have persisted for a period of 6 months. Disabilities which are subject to intermittent episodes of improvement and worsening within a 6-month period would be considered chronic. The 6-month period of chronicity will be measured from the earliest date on which all pertinent evidence establishes that the signs or symptoms of the disability first became manifest.
d. Presumptive period for service connection. Title 38 CFR 3.317 establishes the presumptive period as beginning on the date following last performance of active military, naval, or air service in the Southwest Asia theater during the Gulf War. This period extends through December 31, 2006.
e. Special Considerations for Undiagnosed Disability Claims
(1) Diagnostic Codes. In order to properly identify and track claimed undiagnosed disabilities, the following diagnostic code series beginning with "88" has been established. The 88 code will be the first element of a hyphenated analogous code. It will be assigned according to the body system of the analogous code which it precedes. (See subparagraph 9b.)
DIAGNOSTIC
CODE DESCRIPTION
8850-50__ UNDIAGNOSED CONDITION--MUSCULOSKELETAL DISEASES
8851-51__ UNDIAGNOSED CONDITION—AMPUTATIONS
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8852-52__ UNDIAGNOSED CONDITION--JOINTS, SKULL, AND RIBS
8853-53__ UNDIAGNOSED CONDITION--MUSCLE INJURIES
8860-60__ UNDIAGNOSED CONDITION--DISEASES OF THE EYE
8861-61__ UNDIAGNOSED CONDITION--HEARING LOSS
8862-62__ UNDIAGNOSED CONDITION--EAR AND OTHER SENSE ORGANS
8863-63__ UNDIAGNOSED CONDITION--SYSTEMIC DISEASES
8865-65__ UNDIAGNOSED CONDITION--NOSE AND THROAT
8866-66__ UNDIAGNOSED CONDITION--TRACHEA AND BRONCHI
8867-67__ UNDIAGNOSED CONDITION--TUBERCULOSIS
8868-68__ UNDIAGNOSED CONDITION--LUNGS AND PLEURA
8870-70__ UNDIAGNOSED CONDITION--HEART DISEASES
8871-71__ UNDIAGNOSED CONDITION--ARTERIES AND VEINS
8872-72__ UNDIAGNOSED CONDITION--UPPER DIGESTIVE SYSTEM
8873-73__ UNDIAGNOSED CONDITION--LOWER DIGESTIVE SYSTEM
8875-75__ UNDIAGNOSED CONDITION--GENITOURINARY SYSTEM
8876-76__ UNDIAGNOSED CONDITION--GYNECOLOGICAL SYSTEM
8877-77__ UNDIAGNOSED CONDITION--HEMIC AND LYMPHATIC SYSTEM
8878-78__ UNDIAGNOSED CONDITION--SKIN
8879-79__ UNDIAGNOSED CONDITION--ENDOCRINE SYSTEM
8880-80__ UNDIAGNOSED CONDITION--CENTRAL NERVOUS SYSTEM
8881-81__ UNDIAGNOSED CONDITION--MISCELLANEOUS NEUROLOGICAL
8882-82__ UNDIAGNOSED CONDITION--CRANIAL NERVE PARALYSIS
8883-83__ UNDIAGNOSED CONDITION--CRANIAL NERVE NEURITIS
8884-84__ UNDIAGNOSED CONDITION--CRANIAL NERVE NEURALGIA
8885-85__ UNDIAGNOSED CONDITION--PERIPHERAL NERVE PARALYSIS
8886-86__ UNDIAGNOSED CONDITION--PERIPHERAL NERVE NEURITIS
8887-87__ UNDIAGNOSED CONDITION--PERIPHERAL NERVE NEURALGIA
8889-89__ UNDIAGNOSED CONDITION--EPILEPSIES
8892-92__ UNDIAGNOSED CONDITION--PSYCHOTIC DISORDERS
8893-93__ UNDIAGNOSED CONDITION--ORGANIC MENTAL
8894-94__ UNDIAGNOSED CONDITION--PSYCHONEUROTIC
8895-95__ UNDIAGNOSED CONDITION--PSYCHOPHYSIOLOGIC
8899-99__ UNDIAGNOSED CONDITION--DENTAL AND ORAL
(2) The Issue
(a) Issue for Consideration. State the issue for rating as "Service connection for [specify signs or symptoms] as due to an undiagnosed illness."
(b) Single or Multiple Issues. The decision to rate multiple symptoms or signs separately or as a single disability will depend on the most favorable outcome to the veteran. Although rating multiple manifestations under a single body system will in most cases allow the maximum benefit, be alert to symptoms affecting fundamentally different body systems which may clearly warrant separate consideration. If service connection for several symptoms or signs is denied for the same reason, consider such symptoms and signs as a single issue. Whether granted or denied, assign one hyphenated diagnostic code in the coded conclusion to each issue which is separately considered.
(3) Evidence. If there is a disability due to the existence of an undiagnosed illness, generally there are three facts that must be established before service connection for an undiagnosed illness may be granted or denied: when the disability arose; whether the condition was of compensable severity (unless manifested while in the Southwest Asia theater); and whether the condition chronically persisted for at least six months.
(a) Medical and Lay Evidence. When the object of service connection is a diagnosed illness, medical findings are of paramount importance because a physician specializes in identifying disabilities through
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diagnoses. However, the concept of "objective indications" expressed in 38 CFR 3.317 makes clear that the evidence required for undiagnosed illnesses--illnesses which are outside the scope of medical understanding--is not so dependent on formal medical findings. The veteran's testimony to the effect that he or she is experiencing these symptoms, when combined with an examining physician's inability to make a diagnosis, may be sufficient to establish existence of the illness. Similarly a lay person's statement regarding the veteran's complaints beginning at a certain time, lasting for a certain duration, and having a particular level of severity may be adequate to establish the requirements for consideration. Non-medical indicators include such information as time lost from work, evidence that the veteran has sought medical treatment for his or her symptoms, evidence affirming situations such as a change in the veteran's appearance, physical abilities and mental or emotional attitude. Lay statements from knowledgeable individuals may be accepted as evidence providing objective indications if they support the conclusion that a disability exists.
(b) Unnecessary Development. Lay evidence is credible if the person was in a position to know the alleged facts and if not contradicted by evidence of record which is more credible. Do not dismiss any evidence as "self-serving." It is reasonable to expect claimants to provide evidence which they believe is in their best interests. Similarly, unless there is affirmative reason to doubt the credibility of evidence, do not develop for corroboration. For example, if lay evidence alleges that the veteran lost a certain amount of time from employment, accept that statement without further development if otherwise credible.
© PGW Registry Examination. In all cases, ask the veteran if he or she had participated in the VHA Persian Gulf Health Registry and had been examined as part of the Registry, and where he or she was examined. If he or she has been examined, secure examination results from the VAMC.
(4) Future Examination. Because the course of an undiagnosed illness cannot be predicted, monitor the case by establishing a future examination control within 24 months of the last examination of record. At the expiration of the control, review the evidence of record to determine if a reexamination is necessary.
f. Decision. State the rating decision as "Service connection for _____ is denied," or "Service connection for _____ is granted with an evaluation of _____ percent effective _____ ." The earliest effective date for entitlement to service connection under 38 CFR 3.317 is November 2, 1994.
g. Reasons For Decision
(1) Granted. Service connection established under 38 CFR 3.317 is considered service connection for purposes of all laws.
(a) During Active Duty. Service connection will be established if the qualifying chronic disability (as defined in subparagraph 7.22c(1)) became manifest, whether to a compensable degree or not, while the claimant was on active service in the Southwest Asia theater of operations during the Gulf War. Include the following sentence in the "Reasons and Bases" or “Analysis” section of the rating if service connection is established under this circumstance: "Service connection is established for _____ (or for _____ as due to an undiagnosed illness) which began in the Southwest Asia theater of operations during the Gulf War."
(b) During Presumptive Period. Service connection will be established if the qualifying chronic disability arose to a compensable degree after the veteran last served in the Southwest Asia theater during the Gulf War, regardless of the veteran's active duty status at the time. If service connection is established during the presumptive period, include the following statement in the "Reasons and Bases" or “Analysis”: "Service connection may be presumed for qualifying disabilities resulting from undiagnosed or diagnosed illnesses which arose to a compensable degree after service in the Southwest Asia theater of operations during the Gulf War. Service connection for _____ has been granted on the basis of this presumption."
(2) Evaluation by Analogy
(a) Evaluate the level of impairment of chronic undiagnosed disabilities by analogy to an existing diagnostic code in the rating schedule (38 CFR 4.27). Precede a discussion of the evaluation criteria and next
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higher level in the “Reasons for Decision” with the following statement: "Since the disability at issue does not have its own evaluation criteria assigned in VA regulations, a closely related disease or injury was used for this purpose."
(b) The RSVR will use a hyphenated diagnostic code as described in subparagraph 7.22e(1) for undiagnosed disabilities. For the second code, use the diagnostic code that most closely fits the evaluating criteria. Examples of analogies for the 13 signs or symptoms found in 38 CFR 3.317 are provided below. However, use of analogies is not limited to this list.
Abnormal weight loss, 8873-7328 (resection of intestine);
Cardiovascular signs or symptoms, 8870-7013 (tachycardia), 8870-7005 (ASHD);
Fatigue, 8863-6354 (chronic fatigue syndrome), 8877-7700 (anemia);
Gastrointestinal signs or symptoms, 8873-7305 (ulcer), 8873-7319 (irritable bowel syndrome);
Headache, 8881-8100 (migraine headaches);
Joint pain, 8850-5002 (rheumatoid arthritis);
Menstrual disorders, 8876-7622 (uterus displacement);
Muscle pain, 8850-5021 (myositis);
Neurologic signs or symptoms, 8885-85__ (peripheral neuropathy);
Neuropsychological signs or symptoms, 8893-9300 (organic mental disorder);
Signs or symptoms involving the respiratory system (upper or lower), 8865-65__, 8866-66__, 8868-68__ (respiratory system);
Signs and symptoms involving the skin, 8878-7806 (eczema);
Sleep disturbances, 8894-9400 (generalized anxiety).
© Denied. Begin a discussion of any denial in the "Reasons and Bases" or “Analysis” with a description of the general requirements for service connection under 38 CFR 3.317: "Service connection may be established for qualifying chronic disability resulting from an undiagnosed illness, a medically unexplained chronic multi-symptom illness that is defined by a cluster of signs or symptoms, or a diagnosed illness that is determined by VA regulation to warrant a presumption of service connection which became manifest either during active service in the Southwest Asia theater of operations during the Gulf War, or to a degree of 10 percent or more after the date on which the veteran last performed service in the Southwest Asia theater of operations during the Persian Gulf War."
1. Diagnosed Illnesses. A condition having a known clinical diagnosis cannot be favorably considered for service connection under 38 CFR 3.317 unless it meets the criteria for qualifying chronic disability shown in subparagraph 7.22c, but it will receive consideration for service connection under other provisions. If service connection is denied, include the following language in the "Reasons and Bases" or “Analysis”: "Service connection for _____ is denied because this disability is determined to result from a known clinical diagnosis of _____ , which neither occurred in nor was caused or aggravated by service."
2. Illness Not Chronic. The fact that a claimed disability is not found on last VA examination does not necessarily preclude entitlement under 38 CFR 3.317. The requirement for chronicity is fulfilled if the disability has persisted for at least 6 months. Disabilities subject to episodic improvement and worsening within a 6-month period are considered chronic. If the disability does not meet the 6-month requirement, include the following statement under “Reasons for Decision”: "The disability must have persisted for a period of at least 6 months. Service connection for _____ is denied since this disability was first manifested on _____ and lasted less than 6 months."
3. Attributable to Some Other Etiology. Service connection under 38 CFR 3.317 cannot be established if there is affirmative evidence that the illness was not incurred during active service or was caused by some intercurrent circumstance. Affirmative evidence that the illness is caused by willful misconduct or alcohol or drug abuse will also preclude entitlement. Include the following statement under “Reasons for
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Decision,” if service connection is denied on this basis: "Service connection under this provision is precluded if there is affirmative evidence that the disability was unrelated to service in the Gulf War. Service connection for _____ is denied because evidence established that this disability resulted from _____ ."
4. Illness not shown by the evidence of record. There is no evidence that the condition ever existed.
5. Qualifying Chronic Disability Less than 10 Percent. In order to qualify for service connection, the qualifying chronic disability must have become manifest either during active duty in the Southwest Area Theater during the Gulf War or to a degree of 10 percent or more after the date on which the veteran last performed active service in the Southwest Asia theater of operations during the Gulf War. If the veteran fails to qualify for service connection because the severity of disability is noncompensable, include the following statement in "Reasons and Bases" or “Analysis”: "Service connection for _____ is denied since this disability neither arose during service in the Persian Gulf theater, nor was it manifested to a compensable degree after the last date of service in the Persian Gulf theater during the Gulf War."
(d) Description of Dates. Under “Reasons for Decision,” explicitly refer to any date which is pertinent to the decision. This particularly includes the dates during which the veteran served in the Southwest Asia theater, and the earliest date a qualifying chronic illness may have become manifest.
h. Coded Conclusion
(1) A decision regarding service connection will be shown under either code 1. SC or 8. NSC in the coded conclusion. The parenthetical entry following 1. SC will be "GW PRES."
(2) Hyphenated codes will be used for all undiagnosed conditions. The first code will always be one of the diagnostic codes established for Gulf War undiagnosed conditions (see subparagraph 7.22e(1)) followed by the analogous diagnostic code. For example, if the analogy is 6354, the hyphenated code would be 8863-6354; or if the analogy is 5002, the code would be 8850-5002.
i. Severance and Reduction. Once service connection is established under 38 CFR 3.317, it is considered service connected for the purpose of all laws, including the provisions pertaining to protection under 38 CFR 3.951 and 3.957. Situations may arise, however, that will require termination or reduction of payments previously awarded under section 3.317; for example, establishment of a known clinical diagnosis as the cause of a veteran's disabilities. Title 38 CFR 3.500 was amended to add a paragraph (38 CFR 3.500(y)) specifically requiring severance or reduction under 38 CFR 3.105(d) or (e) to be effective on the first of the month 60 days after expiration of the predetermination period and final notice to the veteran. Apply the usual procedures for reduction or severance outlined in chapter 9. Termination or reduction of benefits paid under section 3.317 would not preclude continuation of payments if entitlement is established under other regulations governing grants of service connection by incurrence, aggravation, or presumption.
j. Participation in Research Projects. Effective December 27, 2001, if a Gulf War veteran participates in a VA-sponsored medical research project, service connection established for disability under 38 U.S.C. 1117 or 1118 will be protected, regardless of the project’s findings, unless the original award of compensation or service connection was based on fraud, or it is clearly shown from military records that the veteran did not have the requisite service or character of discharge. A list of VA-sponsored medical research projects for which service connection is protected will be published in the Federal Register.
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