“It’s Tommy this and Tommy that an’ “Tommy, fall be’ind,”
But it’s “please to walk in front, sir,” when there’s trouble in the wind ...”
Kipling’s satiric, poetic comment on the different treatments of “Tommies,” or British soldiers, in times of peace and war was written more than 150 years ago. But it still rings true today for thousands of American veterans who are fighting a losing war against the very organization that was created to protect their rights and serve their interests.
The federal Veterans Administration (VA) was established in the 1930s to provide care for all of America’s veterans with special emphasis on those who were disabled or injured in the line of duty. These veterans were promised the “best health care possible from a grateful nation.”
But today’s reality is far from that promise. Faced with the aging of the WWII and Korean War veterans and increased demands for services, the VA has not been able to keep up. Now the Vietnam Baby Boomers are reaching retirement age. In addition, for the past 15 years, Congressional budget cuts to the VA have been the rule.
Receiving health care from the VA has become a “Catch 22” nightmare for many veterans. Vets find the system is deliberately obstructive, having to navigate a maze of restrictions, limitations and exclusions that keep all but a very few from being eligible for benefits. Eligibility given at one level of the process may be taken away at the next.
The situation has grown so desperate that, three weeks ago, the American Legion filed a lawsuit against the Department of Veterans Affairs protesting that agency’s unannounced but binding decision to stop helping veterans in their efforts to file benefit claims. At issue is a national order sent to all VA regional offices—in writing—to stop helping veterans develop their requests for disability compensation. All VA assistance is now withheld until the VA decides the claim is “well-founded.”
According to the American Legion’s petition, the VA order violates federal statute, judicial precedent and existing VA regulations that require the VA to help veterans. The order was also in violation of the VA regulations that require public notice and comment on “major policy shifts.”
The suit claims that the VA has an obligation to help veterans obtain evidence to validate and establish claims, and that the veteran should not be responsible for something the government has an obligation to provide.
National American Legion Commander Al Lance of Meridian, Idaho, called the action “immoral and unconscionable,” adding that it guts existing VA benefits law. His is an opinion shared by veterans throughout Montana and across the Northwest.
“This directive puts the entire financial and procedural burden on the veteran,” he says, “increasing the probability that solid claims will be rejected on a technicality. That is a disgraceful way to treat the defenders of freedom, many of whom came to the VA wearing the irrevocable wounds of battle.”
Vision for Change?
Even before the American Legion lawsuit, things were difficult for the veteran. And many, like Dennis McIntyre, just gave up fighting the VA.
“This is not ‘the best health care the country has to offer.’ It’s the worst,” says McIntyre bluntly. The Hamilton-area veteran fought a three-year battle with the Veterans Administration—trying to get help for a back injury suffered in 1969 while he was in the U.S. Air Force. Now McIntyre is broke, bitter and defeated. He walked away from the struggle too emotionally overwhelmed by the effort to continue.
“I was warned what I nightmare it would be,” McIntyre says. “I was told I would be pushed around, ignored and lied to. I was told to be afraid—to be very afraid. I hurt and I needed help, so I tried. I met a lot of vets in the last three years and talked to a lot of people about being a veteran. You know what? Not one person on the outside gives a shit about veterans’ problems. If someone did care, these problems would not be going on.”
McIntyre enlisted in the Air Force in 1968 and served until 1972. He was injured on a flight line when another man accidentally dropped a portion of a jet engine assembly and McIntyre was slammed to the ground beneath it.
“I had back problems from then until I was discharged,” McIntyre remembers. “When I was released they told me the problem was ‘deformed’ vertebrae in my back. Later I found out it was a herniated disc from the accident. I wasn’t bright enough then to ask why I passed the physical to get in if I had a congenital problem.”
In 1996 McIntyre started having severe back problems. It hurt to move, to work, to sit, to lie down. He turned to the VA for help and was given a service-related disability rating. In 1997, the VA eventually sent him to six months of physical therapy with a licensed physical therapist at Hamilton’s Marcus Daly Memorial Hospital.
Then came the VA’s “Vision for Change,” a sweeping new program that was supposed to revitalize the department’s health care programs for veterans. Veterans, including McIntyre, believe it was to cut costs and eliminate many of them from existing programs.
McIntyre got a letter saying the VA had no record of ever authorizing treatment at the local hospital. McIntyre sent back copies of the authorization. The hospital mailed copies of the authorization. Then McIntyre hand-carried copies of all his paperwork to the VA center at Fort Harrison. To date, the VA has not acknowledged any of that paperwork . McIntyre is responsible for $8,100 in bills at the local hospital, which he is unable to pay.
But, the VA wasn’t done with McIntyre. The regional office at Fort Harrison set it up for McIntyre to attend a back-pain clinic in Salt Lake City at the regional VA center. The state VA arranged everything, did all the paperwork. They told him he would be staying in an outpatient-type setting, complete with a private room. The VA booked McIntyre onto a flight from Missoula and sent him off.
But no one in Salt Lake City was expecting him. There was no paperwork. There was no room. McIntyre was sent to stay in the psychiatric ward where he shared a room with two severely mentally ill patients.
“Why did I have to fly to Salt Lake City, Utah, for exactly the same therapy using the same exercises on the same machines as I did at Daly hospital just 15 minutes from my home?” McIntyre asks. “The big difference was that I was working with unlicensed medical students from the University of Utah, not a licensed physical therapist like at Daly.”
McIntyre was told there were no back pain specialists at the Salt Lake City VA facility. The back specialists were at the VA facility in Seattle—but under the regionalization plan, McIntyre is not eligible to go there.
“I guess when I was in Vietnam, I was only fighting for Montana, Wyoming and Utah —not the other 47 states,” he says bitterly. “The VA could get me help, but their new rules won’t allow it.”
They also wouldn’t let him leave Salt Lake City without a fight. The orderly in charge of the psychiatric ward where he was placed would not release McIntyre when he said he was leaving.
“He said, ‘You people aren’t allowed to leave’ and there was a big ugly fight,” McIntyre remembers. “I was terrified. I had nightmares about being locked up in that ward for eight months.”
Back in Montana, McIntyre sought help from Montana’s Congressional delegation to try to get the VA to cover the earlier, authorized physical therapy bills.
The VA reacted. McIntyre has a copy of a letter sent by the VA to Rep. Rick Hill, saying all of McIntyre’s bills have been paid. He also has the notice from a local collection agency that is trying to collect the still-unpaid bill at the local hospital. After he contacted the congressman, McIntyre’s previously scheduled appointment with a VA doctor was put off five months in a row. Then he was ordered to see a doctor in Missoula who was to completely reevaluate his VA claim. The doctor is a knee and elbow specialist who is paid $150 per exam or evaluation by the VA. He schedules four veterans per hour on the days that he sees them.
“I guess I should feel lucky,” McIntyre said. “The examination lasted 12 minutes. According to other vets I’ve talked to, that’s about four minutes longer than normal.” The doctor had McIntyre walk on his heels and toes and—when McIntyre tried to discuss his back with the doctor—said he didn’t need any comment from McIntyre and could refer to existing records instead.
Perhaps not surprisingly then, the doctor’s report said there was nothing wrong with McIntyre’s back that would keep him from working. McIntyre was told he could appeal the finding—but he’d need to hire an attorney.
“The VA is just like an insurance company—only you can’t sue it because it’s the government,” McIntyre says. “It doesn’t want to pay for any true treatment so it makes it so difficult to get help people just get frustrated and give up. That’s what I’ve done. I’m not strong enough to do it. I’m emotionally exhausted.”
“Where’s the Right In That?”
McIntyre’s story is all too familiar to Ruddy Reilly, the Montana representative for Veterans’ Affairs. Reilly is concerned by the regionalization and the constant budget cuts facing the VA centers across the nation.
“The VA is trying to keep costs down by closing hospitals and going to outpatient clinics,” Reilly says. “Fort Harrison was a 400-bed facility but today it only utilizes 40 beds. The VA hospital in Salt Lake City just closed the third floor of the hospital and laid off 33 nurses.”
Montana has nine out-patient clinics now—at Fort Harrison, Missoula, Great Falls, Billings, Bozeman, Anaconda, Columbia Falls, Glasgow and Miles City. Often appointments must be made months in advance and the appointments are usually handled by nurse-practitioners and physician’s assistants, according to Reilly.
“These vets are entitled to top medical care,” he states. “The nurse practitioners and physicians’ assistants are good, but they aren’t doctors. The bottom line is they are cheaper than MDs.”
As people in the VA’s administration—many of them former servicemen—have retired, they are being replaced with much younger people who have no practical understanding of veterans’ problems, Reilly says.
He considers it a national disgrace that at last count, there are 445,582 back-logged veterans’ claims in the VA system, with another 26,820 claims that have been remanded to local offices for one reason or another. It is not uncommon for veterans to wait three months or more for appointments with VA claim workers and even longer to see VA doctors.
“Now they won’t even be able to see VA claim workers until they can prove they have ‘valid’ claims,” Reilly said. “Without VA help, how can they prove anything?”
Veterans’ groups such as the American Legion and the Disabled American Veterans try to publicize the problems facing today’s vets and work constantly to involve local congressional delegations, but still, he says, little changes.
Reilly recently complained to the American Legion’s hospital inspectors that Fort Harrison was ordered to purchase and use second-hand laboratory equipment, cast-offs from other hospitals.
“I called all the way to Washington, D.C., everyone I could think of,” Reilly says. “I was told it would be looked into but nothing changed. Nothing will change.”
The VA is charged with caring for the needs of America’s more than 25 million veterans, but with Congressional budget cuts and increasing costs, more and more veterans are being turned away. First-time claims are “automatically” denied, according to Reilly, and only those veterans who are very determined manage to navigate the system successfully.
Both Reilly and Wales Davis, the VA’s service representative officer, are aware of many cases even more serious than McIntyre’s. Davis is upset by the case of another Montana vet who must have thrice-weekly, in-hospital treatments to remain alive.
“This guy’s disability is 100 percent service-related, but he is now being told he can no longer receive treatment in his home-town hospital, Davis says, adding that, until recently, he had gotten the help he needed for four years at VA expense. “Instead, if he wants to continue to receive VA help, he must travel—at his own expense—to Salt Lake City three times a week. Of course, that’s impossible.”
“Basically, the VA told him he could just die,” Reilly adds. “Where’s the right in that?”
The new regulations are bad news for the thousands of WWII and Korean War veterans whose health is failing and who are seeking VA benefits they believed were promised to them. There will be 9.3 million veterans over the age of 65 in 2000. By 2010, deaths will decrease that number slightly to 8.3 million. But by 2030, the Baby Boomer Vietnam-era vets will be in their 80s.
In a recent address to Congress, Rep. Sue Kelly (R-NY) stated, “A veteran who has been disabled while serving his or her country has no guarantee of receiving extended care. Today, they can only depend on 90 days of care. After that period the veteran must leave the VA hospital if it is determined there is nothing that can be done to improve his or her condition. That is wrong.”
But each year, VA budgets are cut by Congress and local hospitals and centers are pushed to make remaining dollars stretch farther and serve fewer people.
“The experienced claims people are all gone,” Reilly says. “They’re hiring college kids now with no experience, no empathy, who’ve never served in the armed forces. I’m not sure what the answers are—if there are any.”
Promises Not Kept
Eddy Christian of Hamilton is another veteran who is coping with the frustrations of the VA system. Christian is more fortunate than McIntyre. His original injury happened while he was in the navy and was the reason for his discharge. The navy paid for the original surgeries on his knee and the VA has acknowledged responsibility for the subsequent surgery. But he has been through a lengthy—and expensive—ordeal.
The knee replacement surgery he had done in 1981 in Tennessee finally failed in the fall of 1997; the knee refused to bend. Not a bad record for a knee joint that doctors told Christian would last about five years. In December 1997 he had his first appointment with the VA. In March 1998, VA doctors at Fort Harrison did an exploratory orthoscopic surgery, couldn’t find a cause for the failure, and scheduled Christian for a full knee replacement in July 1998. It was not successful. When he left the hospital 10 days later, he still couldn’t bend his knee.
“I couldn’t go up and down steps or drive a car or get out of a chair without help—and it’s still that way now,” Christian said. “The doctor kept saying he didn’t know what was wrong.”
Christian began physical therapy at the local hospital and was driven to Fort Harrison every six weeks. The leg stayed the same. In October 1998, another surgery at Fort Harrison “force-bent” the leg to try to gain more rotation. That also failed. In January 1999, yet another operation removed a screw and put lateral cuts in the back of the knee tendons to stretch them. That didn’t work either.
“I kept making that seven-hour drive for 30 minutes with the doctor, and he kept saying he didn’t know what was wrong,” Christian remembers. “Finally they decided to send me to Salt Lake City.”
In Salt Lake, it was determined that the lower portion of the knee joint which was screwed into Christian’s leg was probably too large for the upper position of the joint. The VA doctors have scheduled a replacement surgery for Dec. 1.
“They said that is not all that uncommon because these things are measured in millimeters and even a single millimeter can make a difference,” Christian says. “But I’ve had almost two years of constant pain and not being able to work because of that millimeter of metal.”
Under the new VA regulations, the VA pays temporary disability payments only for rehabilitation time. And that rehab time has a time limit. Christian has been out of work since the fall of 1997 but received no financial help until after the surgery in July 1998. That money ran out last September. Even though he is scheduled for more surgery—because of a VA error—he will not receive any more disability payments until January.
“The VA takes forever to get you started but they want to cut you off the first day they possibly can,” Christian said. “All paperwork has to go from the VA state office at Fort Harrison to the VA regional office at Fort Harrison. The two offices are in the same building—a two-minute walk apart—but it takes six weeks for papers to go from one to the other. The whole thing is a joke.”
McIntyre agrees. “Through all this I’ve lost my job, my business, my savings, my life. The promises have never been kept.
“There is some fraud in the VA,” he goes on, “but most of it is not done by the vets. Sometimes the person who needs help is telling the truth. I’m one of those people. I’d rather have my life back than live this way.”
For it’s Tommy this, an’ Tommy that, an’ “Chuck him out, the brute!
But it’s “Savior of ‘is country” when the guns begin to shoot;
An’ it’s Tommy this an’ Tommy that an’ anything you please:
An’ Tommy ain’t a bloomin’ fool—you bet that Tommy sees.