Which veterans do we care about and which are forgotten?

Wounded Times
Kathie Costos
July 20, 2014

Bill McClellan of the Saint Louis Dispatch has a good article on Who should go to the front of the line? at the VA. He raises a lot of good points focused on combat veterans wounded during their service and the veterans using the system for their general healthcare needs. McClellan wrote, "I do not know what a reasonable waiting time should be for a person who needs cataract surgery, but I fear that in our zeal to save the VA system, we will continue to ignore the most necessary reform. Who has priority?"

Part of the problem according to McClellan is "It was not intended to be socialized medical care for all veterans. It’s great if we have enough money to provide care for aging veterans with limited income, but we ought not lose sight of the primary mission."

While all of this sounds like a reasonable argument to have it avoids far too many other factors.

There has been a "fix" known as "fee basis" for veterans to get care outside of a VA hospital or clinic when they do not have enough staff or empty appointments slots to get veterans in.

What is Non-VA Care: Non-VA Care is medical care provided to eligible Veterans outside of VA when VA facilities are not available. All VA medical centers can use this program when needed. The use of the Non-VA Care program is governed by federal laws containing eligibility criteria and other policies specifying when and why it can be used. A pre-authorization for treatment in the community is required for Non-VA Care -- unless the medical event is an emergency. Emergency events may be reimbursed on behalf of the Veteran in certain cases. See the Emergency Non-VA Care brochure for information.

Unavailability of VA Medical Facilities or Services: Non-VA Care is used when VA medical facilities are not “feasibly available.” The local VA medical facility has criteria to determine whether Non-VA Care may be used. If a Veteran is eligible for certain medical care, the VA hospital or clinic should provide it as the first option. If they can’t -- due to a lack of available specialists, long wait times, or extraordinary distances from the Veteran’s home -- the VA may consider authorizing VA payment for Non-VA medical care in the Veteran’s community. Non-VA Care is not an entitlement program or a permanent treatment option.

While the latest bill in the congress has been cheered over allowing veterans to seek care outside of the VA, it has been done for a long time. The American Legion addressed this back in 2012.VA Fee Basis: Examining Solutions to a Flawed System, September 14, 2012

Title 38, United States Code (U.S.C.) Section 1703a states when VA facilities are not “capable of furnishing economical hospital care or medical services because of geographical inaccessibility or are not capable of furnishing the care or services required, the Secretary may contract with non-Department facilities in order to furnish medical care.”

It went on to point out,

In the last four years, non-VA purchased care has doubled from $2.2 billion in FY 2007 to $4.5 billion in FY 2011 along with a corresponding increase of 615,768 veterans served in FY 2007 to 970,727 veterans served in FY 2011 (2). VA program leadership has stated the reasons for growth of non-VA usage are: the increase of unique veterans seeking VHA care; economic conditions; waiting times because of more veterans enrolling in the system; and growth of number of CBOCs and emergency medical needs in rural areas (2). During our System Worth Saving site visits, Directors and VA hospital finance staff have told us the fee-care is between 15-25 percent of their medical center budgets and continues to grow. The facilities struggle with what services they can provide in-house and whether they should hire a full-time specialist to balance the number of veterans requesting the specialty services or contract out this care.

When a perfect system processes and determines claims on time, putting service connected veterans to the head of the line would work however this is far from a perfect system. Thousands of claims tied to combat are in the backlog. Without a compensation rating of the disability, they are considered "non-service" connected until the claim has been approved. What happens to those veterans? Do they get pushed to the back of the line on top of facing a true disability connected to their service and being billed for their care?

Until a veteran has the rating from the Veterans Benefits Administration (VBA) there is no compensation and no free care unless they meet the income threshold proving the lack of means to pay for care.

It happened to us back in the 90's. We had private health insurance but once the VA doctors determined the need for medical care was connected to service in Vietnam, they would no longer cover that condition being treated. The VA had not approved my husband's claim but did not turn him away to make room for someone else. He had great doctors. As we fought for his claim to be approved the VA instructed the IRS to send our tax refund to them to cover the cost of his care. That went on for six years until his claim was finally approved. We received a refund for most of the money they took but the damage done to us financially and emotionally was beyond what we received back. It was torture back then just as it is now for thousands of families of veterans wounded in war.

There is nothing happening today in the news that was not happening decades ago when the press was not interested. (You can read about what happened to us in FOR THE LOVE OF JACK, HIS WAR MY BATTLE.)

Veterans like my husband with a medical need caused by his service would have been disregarded and he would have to go to the back of the line until the VBA approved his claim on top of everything else.

Veterans without a disability rating from the VA also include combat veterans from Iraq and Afghanistan receiving 5 years of free care after discharge. Do they go to the back of the line as well?

This is not a perfect system and is a lot more complicated than what most people think they know. The trouble remains in congress as it always has. It is not about one party over another since we've seen the same issues making headlines for decades as reporters pretend it is all new and politicians use the Sgt. Schultz excuse of "knowing nothing" was happening. No one has been held accountable for what they have failed to do.