MMQB: Duckworth Hammers the West Point Loophole, Kind Of

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Duckworth Pounds West Point Loophole

Hi and thanks for tuning in for this week’s Monday Morning Quarterback. This is where I let my hair down so to speak and tell it like is.

This summer has seen some interesting trends. Most recently, there has been a great deal of focus on disability ratings. And, West Point was, either directly or indirectly, at the center of it last week.

Specifically, the trend is moving in the direction of streamlining veterans disability, which may or may not be a good thing.

While this trend is getting support from a West Point professor and many others, it is further supported, in bad example, by a former West Point Prep School student accused of gaming the system. I found this to be ironic, or maybe it is just a mere coincidence that both would surface just last week.

This trend was recently highlighted in the pummeling Congresswoman Tammy Duckworth gave a government contractor (the West Point Prep student) over his Service Disabled Veteran Owned Business status last week, around the same time the West Point prof’s argument against the existing broad VA disability system was published in the Wall Street Journal and now National Affairs.

Back to Duckworth, she could not believe that the contractor service his country while playing football in the West Point Preparatory School – at least enough to warrant winning $500 million in government contracts that should have gone to disadvantaged companies. I was quite surprised as well, and dubbed it the West Point Loophole – for athletes.

I’ll give you my take on that in a second. The biggest issue here is the new battle cry for a more simplistic and streamlined veteran disability system and we see West Point roots at the base of the argument, either directly or indirectly.

So, kick back for a bit, take a sip of coffee, and let’s begin. Here is what we’re going to talk about:

  • Tammy Duckworth’s Pounding of the West Point Loophole
  • Dan Gade’s Article from last week’s MMQB
  • The West Point Loophole
  • Feedback from LinkedIn: “Is it ‘perverse’ to claim disability benefits?”

 

Duckworth Hammers the West Point Loophole

There is a trend toward changing the disability compensation system. The issue I’m covering today will highlight some of this.

While changes might sound good on the surface, these changes may serve to upend the progress that Veterans Organizations have achieved through blood, sweat and years. That’s right, it has taken 150 years for veterans to achieve the successes we have now.

Indeed, it has taken 150 years and billions of dollars to wind up with a seemingly irreversible backlog.

It has taken 150 years for the Supreme Court to determine that over 70 percent of all successfully appealed claims were wrongly denied without any basis in law.

It has taken 150 years for the American public to finally be united behind disabled veterans to fix the broken system.

Luckily for us, some other people have a different idea of how the system should be fixed. Don’t believe the hype. These folks believe the system would be better off without most of you.

That’s right. Some politicians and bureaucrats believe the streamlining should exclude many disabilities we currently include. They fear veterans are faking out the system and getting more than they are due.

If we do not watch out, they will be successful and erode everything the veterans groups have fought for over the past 150 years in a very short amount of time.

After all, let’s not forget that your benefits take away from banker bailouts and other monies our world’s billionaires would rather spend in other areas – perhaps the next war.

Let’s hope that before we march off to the next big war, perhaps in Jordan or Syria, that we pause a moment to ensure we are writing checks that don’t bounce when it comes time to care for our troops when they come home.

I wanted to draw your attention to Tammy Duckworth’s interrogation of a government contractor last week. She did a good job of hammering the guy. However, some of her comments may be signs of where the system is moving – to a Combat Only disability model I will explain in a bit.

 

Tammy Duckworth’s Contractor Pummeling

(Here is the footage of contractor getting pummeled by Duckworth.)

During her questioning, the Congresswoman talked about how the contractor should feel bad for claiming a disability benefit. Her justification was that people like the contractor are the people who are clogging up the disability backlog…

“Errr…,” my head tipped like a dog watching a make out scene on TV.

I am pretty sure the backlog happened because VA was busy screwing veterans for the past decade. It is not debatable that the backlog happened because George W did not fund VA to help it prepare for war veterans and Agent Orange claims.

It is not debatable that VA was wrongly denying claims from 2001-2003 on purpose to get them to go away.

It is not debatable that after 40 years of denying Vietnam Veterans proper disability compensation from Agent Orange exposure, VA in 2009 finally changed course and allowed these people their “due.”

All these things were planned and could have been planned for in a way that would have not resulted in a disability backlog.

In this way, I disagree it Congresswoman Duckworth’s interrogation – I disagree because it is dangerous to point fingers at one lone guy and claim he and veterans like him are the cause of the VA backlog.

To Congress, I say, “No, Congresswoman, the problem stems from years of political failures by Law Makers to hold VA and the Executive accountable. They should be held accountable for failing to care for the nation’s veterans after previously promising to do so. In any court, that would be a basic breach of contract.”

Some backstory on the hearing

Here is a little backstory. The contractor, Braulio Castillo, was in West Point Preparatory School – this is like the junior college for West Point where they send athletes who are not quite cut out for West Point. While there, Castillo sprained his ankle. He never made the cut into West Point, but he did play quarterback for UC San Diego.

Castillo bought a company that had $500 million in government contracts on the line. With a disability, Castillo’s company would qualify for the contracts.

Here is the real scandal. West Point students, prep school and regular, can file for VA disability if they hurt themselves while in college. The reason is because VA is told they must consider all experiences at West Point to be like basic training for regular troops.

So, if you are hurt playing sports while at college in West Point or similar, you will receive disability payments from VA for life, just like soldiers who served the country on active duty. If you never graduate from college there, you can still receive benefits – at least when it comes to Castillo.

This makes military academies the best deal in college sports for athletes who are injured.

Keep in mind, VA disability is a public form of Workers Compensation. It is intended to provide assistance to those who are injured on active duty, generally speaking.

Athletes who get hurt playing for regular colleges like Ohio State do not get disability. Athletes who play for the Air Force Academy do.

Personally, I’m not going to worry a whole lot about one guy who slipped through and gets a disability rating from sprained foot. However, I will worry when politicians start blasting away. They had better take particular care in ensuring they do not belittle the entire population of veterans who are hung up in the disability backlog, which is where I think Duckworth overstepped.

Back to Duckworth

So, why is Duckworth pointing the finger in this way? Duckworth shamed the contractor because VA disability for his injury was almost as high as her injury for an amputated foot.

Her point was to highlight the irregular and arbitrary nature of VA ratings. What I disagree with is that she publicly shammed the contractor for how high his rating was (30% disability) for a sprained foot from West Point. The contractor has no control over the percentage VA awards, and neither do other veterans.

Duckworth could have done a great job just slamming the guy generally, because he wrote letters claiming he sacrificed a lot and that getting a service disabled veteran owned business certification was fair for that reason.

In reality, as we all now know, the veteran sprained his ankle playing football for West Point. That should have been her focus – why should a person get any disability compensation for injuries they received prior to when they are on active duty?

Why Duckworth missed the mark

Castillo took advantage of the contracting system by claiming he sacrificed for this country when all he did was hurt his ankle playing college football. That, in and of itself, is ridiculous. I’m glad he was called out.

Unfortunately, she also shamed him for how high VA rates conditions like his. Isolated, this would not be a big deal. However, in context, I think this is a sign that change is afoot in the VA system that will negatively impact all veterans with less severe injuries that are not “Combat Only.”

I’ll explain by talking about Dan Gade’s article to provide context. My fear is that the trend will move away from allowing subtle disabilities like tinnitus and depression. It will focus only on disabilities with an outward manifestation.

 

Dan Gade’s Take

Last week, I wrote about Dan Gade’s Wall Street Journal article about the disability system.

He and I spoke after I wrote the article, and he gave me more insight into his position and where his research is going. I still disagree with him, but he was kind enough to speak with me after I slammed his research, which should speak volumes about the guy’s character. He seems like a good guy.

Here is some background on Gade to give you context. He is a West Point graduate and now a West Point professor. He is a current active duty Army Lt. Col. with a PhD in Policy and has been researching veterans’ disability for some time. He is an amputee from combat, and once he separates from the Army he will join our ranks as a disabled veteran. And, we will gladly accept him into the fold, whether we agree or disagree with his scholarly work.

In his writings, Gade has highlighted that there are veterans gaming the system – I guess this would include people like Castillo – though I’m not sure how Castillo would be considered a “veteran.”

For the rest of this topic, I’ll refer to Gade’s type of ideology as “Combat Only” disability. Generally speaking, injuries in combat would get rated. And, those that get rated would only be serious injuries like loss of limb. It would not grant compensation for injures that merely impact quality of life. As time goes on, people in this camp may possibly restrict disability compensation to only veterans who were injured in combat.

So, Combat Only = serious combat injuries, only.

Combat Only believes the disability system should be streamlined to only include “serious” or “severe” disabilities like amputation, total loss of use of the limb, etc.

The ideology highlights examples of veterans they believe typify what a disabled veteran should look like.

This list includes Dawn Halfaker, Senator John McCain and Congresswoman Tammy Duckworth. Duckworth and Halfaker are both amputees. McCain has a total loss of use of an arm. All of these were officers, and two of the three went to a military academy.

The Combat Only camp believes these veterans are what all disabled veterans should strive to achieve regarding success after disability.

To those who support Combat Only ideology, injuries like tinnitus, depression, bad back, and similar would be considered less severe and probably should not get a rating. After all, these people can function in society and hold jobs, usually.

Problems with “Combat Only” Ideology

Now, there are two problems with the Combat Only ideological proposal.

First, it would force military personnel (and later as veterans) to not have a “public” workers compensation type coverage. Meanwhile, civilians would receive compensation for the same injury via Workmens Comp.

Let’s look at West Point again. For example, let’s say the marching band coordinator loses her hearing because the tuba player accidentally blows the horn next to her ear. If the hearing loss is permanent, she would probably receive civilian workers’ compensation for tinnitus.

If Combat Only wins the day in the marketplace of ideas, we would see a dramatic impact against servicemembers. Here, a military person who loses her hearing because a shell is detonated too close to her head in combat would not get military workers’ compensation – ie no VA disability for that person with combat induced hearing loss.

Remember, severe disabling conditions while in combat are the only ones that qualify.

In a Combat Only world, military sexual trauma victims would be out of luck – the rape is combat induced.  Those unfortunate women and men suffering from mere [sic] depression may not qualify because there is no outward manifestation of the injuries she or he suffered. Yet, the medical literature available now tells us depression is disabling on par with being a paraplegic.

For those reading this saying, “well you can fake depression,” there are tests available currently that can detect malingering. Malingering is a term used by doctors meaning the person is faking it. For over twenty years, doctors have been able to test for malingering symptoms with some degree of success.

Regarding tinnitus, the veteran exposed to the shell shock may have suffered a TBI due to the sound waves from the blast. <<Yes, it has been proven that explosions close to the head can cause traumatic brain injuries.>> TBI can impact a person in many devastating ways.

However, without testing for a disability of even tinnitus – which can be a sign of TBI – , VA would potentially not provide compensation for the injury.

This is my fear if Combat Only ideologies win the day.

Veterans who were harmed while truly serving their country, both on the battlefield and at home, supporting those who are in battle, will wind up with no safety net to compensate for any permanent injury. Meanwhile, their civilian counterparts get paid more and have safer job environments.

Instead, veterans’ family members will be forced to bear the burden of disability where VA disability, and related benefits, used to pick up the slack. Removing Workmens Comp from active duty will increase the burden soldiers are asked to bear long after they separate from the service.

This result will impact our Nation’s ability to recruit top quality soldiers. It will impact our ability to fight future wars.

Later, there will be higher instances of welfare and homelessness for the veterans and veterans families who are unable to provide care. Let’s remember, these systems like VA disability are in place because serving in the military is inherently dangerous. For that reason, societies for centuries have provided compensation to wounded soldiers.

The fact is, it really does take a village when it comes to fighting wars – not just those on the battlefield as some suggest.

Here is a partial listing of those service-members who would be out of luck if we cut our public workers compensation for military members. Good luck getting insurance with those documented injuries after the fact – they will be considered pre-existing.

Out of this list, pick out which “veterans” you believe should be eligible for disability benefits, if any, who were injured outside of combat:

  • Service-members injured while loading planes to fight a war
  • Those injured from exposure to radiation
  • Those injured from experimental medications/vaccines
  • Those injured while doing “police actions”
  • Those injured during exercises simulating real world events
  • West Point football players
  • West Point Preparatory School football players

Back to the West Point Loophole

In light of these changing perceptions, we need to be on guard against naysayers who come against the following two things in support of their Combat Only ideology.

First, veterans are entitled to claim compensation for injuries or illnesses that are the result of military service, period. Second, VA deems the ratings we receive as being reasonable and within the purview of what Congress demanded.

Since the people elect Congress, it would lend to reason that the will of the people is in support of veterans to received the disabilities to which they are entitled. Most American’s like the idea of ensuring that any American willing to put on a uniform should be taken care of if injured.

This “West Point Loophole” of claiming a disability from “service” while in college does seem like a huge stretch. It makes me wonder how the loophole was even created and when. At least we can figure out that much.

Nonetheless, the West Point Loophole should be closed. People playing football for college are not entitled to any kind of Workmens Compensation regardless of what school they are at. I’m not clear as to why West Point football players should be any different than those at Ohio State.

 

Veterans on LinkedIn Respond: Is it “perverse” to claim disability benefits?

A West Point professor and Army officer is the most recent voice against the current disability system. Only, his plan for vets may not be a good one. According to Dan Gade, the current disability system creates a “perverse incentive” by allowing too many veterans to claim too many disability ratings.

I wrote about this topic on LinkedIn and received a ton of feedback from other veterans. If you’re reading this and curious about what veterans really think, check out the group. It’s called Military Network.

Stay informed on VA news, scandals and benefits. Get our daily newsletter via email.

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21 Comments

  1. I’m not sure about the statement: “That should have been her focus – why should a person get any disability compensation for injuries they received prior to when they are on active duty?” Would this also be applicable, with that thought, for some that have suffered MST before going on active duty, such as has been the case for some in dealings with recruiters, as an example? This whole idea in the heads of some is all about the money and who is perceived as worthy, or not. Yet, the body takes the brunt from service in more ways than one, not only through combat, not to mention the psychological for those that have been traumatized in service. This whole bashing of that guy seems as just another excuse of the mess of the system and there has to be somebody to take the fall…no?

    • I agree bellamari. I think we need to pay a lot of attention to the players here. Any chance they have to try to split veterans apart they will take a shot. The goal is to get military to take a lower wage and for veterans to take little or no disability after service.

  2. You addressed a salient point that I will comment abut, it is central to a VA claim that is finally getting filed 34+ years after the fact. Here is what you said above:

    “Regarding tinnitus, the veteran exposed to the shell shock may have suffered a TBI due to the sound waves from the blast. <> TBI can impact a person in many devastating ways.

    However, without testing for a disability of even tinnitus – which can be a sign of TBI – , VA would potentially not provide compensation for the injury.”

    In 1979, I made my first PCS to a USAF TAC base out west after tech school. I went through the typical 2 week in-processing and orientation t the base, its mission,etc.

    Then came the AFSC and mission-specific orientation, training, and certification to perform my duties. Part of this was a base tour, and the mission/role-specific agencies I would have operational control over. This specifically included the alert facility with two ADCOM (Aerospace Defense Command) birds we had for protecting the coastal ADIZ.

    On this specific orientation day, we had a “practice scramble” drill, during which time I stood outside the alert hanger bays for these aircraft. Behind me, a short taxiway led to the main runway at this base, with a “quick-check area” to the side of the runway threshold.

    As we were wrapping up the observation of this drill, two F-4E’s in the quick-check area departed and lined themselves up on the runway for takeoff. A few seconds later, both aircraft advanced their power to full thrust, and then engaged their afterburners.

    What followed was a massive concussive blast that I could feel from the bottom of my toes and through my head, and everywhere in between. Since that time, 34 years, 3 months and about 19 days, my life has never been the same. I cannot concentrate for more than a few moments at a time, and while the world seems to be moving in real time to me, I am, according to those around me, moving at a fraction of the speed.

    The tinnitus in my head has two tones, and it changes pitch, exacerbating concentration, functional performance, and at times when I am not conscious of it, behavior. All of that is a black hole to me, that for years, friends and coworkers observed, and even complained about.

    Fast forward now to VA care, and new screening criteria. TBI comes into the picture, and after 34.5 years of frustration, mystery, and abject failure for most of my life, I can finally see some light and make sense about the dark shadows I have been under.

    I obtained my service records, and I saw in written form, my professional Airman’s life disintegrate before my eyes. I recall dark moments when I was given my honorable discharge for marginal performance, that I was like a deer in the headlights, frozen as that awful pronunciation was given, and then my untimely departure which followed.

    I have “sucked it up” for all this time, and fought to achieve, excel, and be a success. I can’t concentrate some days long enough to finish the food I started to eat! Or experience a near black out as I did twice at the wheel of a car and a truck respectively.

    Hours pass that I cannot account for, and I either do not show up for appointments, or I am chronically late, because of my inability to operate at the same speed as the rest of the world.

    (excerpts from my statement for my claim)

    I cannot abide with the marginalization of myself, or anyone else for the sake of fiscal, political or governmental expediency. And yet, that is part of the tactical battle in play here. Divide, conquer, or find means to impose submission go with it. Fuel the misery factor until you either break, bail, or prevail.

    My pastor gave me a motto to use as my own: “I cannot be defeated, and I will not quit!” That is why I am here today.

    As for our West Point Textbook jockey, his first and biggest mistake about various health and psychological issues, is that he is not a practitioner of any of those professions.

    I can see that he, like me, refuses to be handicapped by an injury, and to fight back, it is the way of the warrior inside that never dies. it is also pride, and the selfless attitude that the overwhelming majority of us have towards our families, nation and our Service Branches.

    But back to his lack of training or insight as a healing practitioner: He is in no way qualified to sit in judgment or “diagnose” what is appropriate or not for any wounded service member, large or small.

    That is pure arrogance for one, and secondly, as a show-pony for the current Administration to trot out as proof that we all ought to suck it up even more, and silently endure our pain in a manner that looks “honorable” in appearances, is pure hypocrisy.

    Lt. Col Gade, if he were in a more serious health battle, would unlikely be singing the tune he is, or if some complication of his amputation ensued. This is an insidious form of moral relativism leveraged against us, to shame us into shutting up, stop whining, etc.

    And if we want to be dramatic for a second, why don’t we have a videotaped scene where Gade walks into a VA clinic, and upon hearing a PTSD veteran from Vietnam complaining, He slaps the guy in the same manner that Gen. Patton allegedly did decades ago.

    Cowboys may get back up and attempt to get back on the horse, but we must also keep in mind that a lot of cowboys also “died with their boots on” while trying. The alarming number of post-conflict deaths from Vietnam should be a striking example of that.

    Lt Col. Glade, with all due respect, you are blaming the victim, rather than holding the perpetrator accountable! Quit pandering to the politics of the day, and and fulfill your Constitutional duty, which includes the rule of law that we as Veterans are appropriately afforded protection as a SACRED and HONORABLE duty/obligation.

    It begins with the Commander in Chief, the NCA, and all agencies of government, whether military or civil at every level. What part of “Oh yes you will!” don’t you understand? Because we promise you, as much as we swore our oath the same as you, without proper resolution of this matter, this is OUR reply: “OH YES WE WILL!!”

    Enough said…

  3. As a disclaimer, I attended a service academy and a service academy preparatory school and and in your opinion would be an example of what you call “The West Point Loophole.”

    As a point of clarification, Prep School cadet candidates are techically Title 10 enlisted members of their military services. Cadets at service academies are considered active duty Title 10 as well. Nevertheless, they are no different than an officer candidate at OTS or an airmen at Lackland AFB during basic training as far as the VA is concerned.

    You stated in your article:

    “Nonetheless, the West Point Loophole should be closed. People playing football for college are not entitled to any kind of Workmens Compensation regardless of what school they are at. I’m not clear as to why West Point football players should be any different than those at Ohio State.

    Here’s why they are different.

    As you may already be aware, all cadets participate in some type of athletics (Intramurals or intercollegiate). They are required to do this as part of their officer development and training. And, it’s not optional. They are ordered to participate in some type of athletics.

    For cadets, playing sports is part of their training to become officers. If they are injured during training, they should be given the same benefits that other servicemen are given. After all, they are in the military. And, that’s the difference. The guy at West Point is in the military. They guy at Ohio State is not.

    • Good points Jason. I think few, included Tammy Duckworth, truly understand the nuances of service while in the academies. I am sure no expert. I think a person almost had to go through it to really understand it.

      On that note, I would also point out that most officers, especially those from the academies, do not understand enlisted since they never walked a day in our shoes, either.

      I think the difference is really highlighted when it comes to access of veterans benefits after service. Many times, those disability systems are designed by or implemented by government contractors who are former academy graduates. Does it make sense that a small minority of the veteran population are the same ones who design systems intended to help all veterans? That’s not really the subject of this post but I was just thinking about it after reading your comments on the academies.

  4. You take Tammy Duckworth to task for not pointing out the loophole that thousands of officers slip through to gain what they don’t deserve, VA disability compensation with priority timing while legitimately disabled Veterans wait YEARS for the adjudication of their disability claim by the VA ! Disabled Veterans.org YOU SUCK !

  5. As a disabled veteran non-combat, here is my comment. I signed a 10 year contract in 1958 with the air force. I would serve 4 years active duty and be on call for six more. Once i signed I was under military law meaning I couldn’t quit if I didn’t like my job. They could order me anytime to any part of the world. I accepted all that with the understanding if I died, they would pay 10,000.00 to my family and if I was injured while on duty they would take care of me. I fulfilled my obligation and some. So far the VA had held up their end of the contract but it is not easy dealing with people who don’t understand what a contract is. Without contracts we would be a lawless nation. We are envied around the world because we do honor contracts such as land titles giving a person the assurance he owns the land and can start a business without the government taking it a way from him as is the case in most of the world. I was always told we served in the military to protect those rights and in doing so we earned the right to be compensated for any injury we incurred while on duty. I wrote a email to the white house after 9/11 urging them to put money aside for returning veterans who were in need of medical help. No one dime was added to VA for this purpose. The then vice president and his buddies make millions in profits but those whose served, well we know what happened. This problem could have be easily solved 12 years ago. One comment on Duckworth. Young people shouldn’t wax eloquent on the needs of old veterans. Grow old then we will talk .

  6. This is how the socialist agenda works Duckworth has been a poster child since day one. If we continue to let this democrats run our country we are doomed.this if typical rules for raticals at its best

    • I think both sides are working toward reducing benefits for veterans – each just has their own unique way of going about it. Republicans tend to lean toward the tough guy, suck it up mentality, which reduces benefits payouts due to lack of documentation and overall smaller inclusion of disabilities generally. Democrats do it by failing to resolve procedural issues and not holding VA accountable to the law as it is written. They both let VA testify before Congress without being under oath. It has been that way since the 1980’s. Not sure why the allowed the “gentlemen’s agreement to happen, but they did. Now we all suffer.

  7. If I can get off point here to ask a question. I just read in the latest Army Times that the average wait time for a decision from the VA Court of Appeals in D.C. is now eight years. Is that even remotely possible? Since my appeal is there for about 12 months now it does give me pause to wonder.

  8. I am a Vietnam combat vet (11B) rated 100% P&T (schedular) by the VA. I tend to agree with Wade’s point of view, but not to the extreme he takes it. What I think is ludicris are VA ratings for such things as Sleep Apnea and especially Prostate Cancer…PC is the most common form of cancer in men…..The VA, by making PC a Presumptive condition due to Agent Orange has opened the floodgates for vets claims and payments..99% of these claims are bogus because claiming PC due to AO 40 years later, when it’s the most common form of men’s cancer, is absolutely ridiculous!!

  9. Approximately 47,000 American service members died during the Vietnam War due to hostile forces, and approximately 62,000 American service members died during the Vietnam War due to other causes. There has been a trend toward counting only those that died due to hostile forces since (at least) Vietnam. While all military service is considered honorable, all military service is also hazardous.

  10. Before ~2011, what you conclude re: MST cases, i.e., a “culture of denial” at VBA, might very well have been true. But I don’t think it’s that way today.

    There are several areas of VA disability compensation for mental disorders that are major problems.

    But I think MST, from the VHA treatment perspective; the VHA C&P exam perspective (with some important caveats); and the VBA claim development and adjudication perspective; is one area where VA has made tremendous strides in the last couple of years.

    The fact that MST survivors receive free treatment for any MST-related condition (psych or medical) is a big deal. It’s rare for a VHA clinician to refuse to record a Veteran’s MST status in the electronic medical record system. In fact, I’ve never heard of it happening at 3 VAMC’s where I worked over several years. In other words, if a Veteran says she has MST, VHA clinicians pretty much take her word for it, and from then on she receives free medical and mental health care for any MST-related condition.

    Of course, VHA psychologists who conduct C&P exams cannot operate in the same manner. They must conduct an independent, objective, evidence-based forensic mental health evaluation of the Veteran to determine if he has PTSD due to MST (it could be another mental disorder due to MST, but PTSD is by far the most common). However, two big changes have occured in the past couple of years: 1) C&P clinics receive many more MST cases than in the past–previously, the claims never left the VARO due to “lack of evidence;” and 2) C&P examiners have received a good amount of high quality training in how to conduct MST-PTSD evaluations.

    And on the VBA side, my understanding is that they are rating as many MST-PSTD claims on a percentage basis as they are Combat-PTSD claims. If you have data that says otherwise, please let me know and I will admit my error, but that’s what I read recently. And I know a dozen or so RSVRs (“Raters”) at five different VAROs and they report that they have received a ton of training on MST claims and that they are rarely questioned during quality assuance reviews or the like if they rate a Vet for MST.

    Now, having said all that, there are definitely still some major problems that need to be resolved. Here are some:

    a) VHA Treatment – a1) MST Coordinators are swamped with treatment cases and don’t have enough time to do the ‘coordinating’ they were hired to do, which is very important work.

    a2) There are not enough psychologists and clinical social workers with expertise in treating sexual trauma survivors at many VAMC’s and CBOC’s. It’s gotten better but they still need to hire more (the VA’s bloated HR department causes multiple recruitment and retention problems).

    a3) Male MST survivors already struggle with excrutiating shame, confusion, rage (directed at themselves much of the time), depression, substance abuse, PTSD symptoms, etc. Then they have to navigate a system that is mostly geared to reaching out to, and treating, female MST survivors. And they have to deal with all the “male sexual abuse myths” (e.g., “if a guy is sexually abused, he wanted it because otherwise he would have fought back, and since he wanted it, common sense tells you that means he’s gay”) that 95% of people possess to some degree. One cannot grow up in our culture and not have these pervasive, prejudiced, pernicious myths seep into one’s subconscious. The VA needs to provide ongoing inservice trainings with healthcare providers to gradually extricate those faulty beliefs.

    b) VHA C&P Examiners – b1) Lack of time to conduct a good, thorough, sensitive, detailed evaluation. The top examiners spend 6, 8, even 12 hours on MST-PTSD exams and they say that MST-PTSD exams are the most challenging of all mental health C&P exams. But at many VAMCs, examiners are required to complete four, or even six exams every day! (So two hours or less per exam). And that’s for all aspects of the evaluation–reviewing records, interviewing the Veteran, interviewing a family member if requested by the Veteran (they usually skip that b/c of lack of time); writing a report; psychological testing (also usually skipped); and many more tasks). Recent research shows that only 15% of VA C&P mental health examiners follow the VA’s own Best Practice Manual for C&P exams for PTSD. And although VHA denies it, I bet a big reason is lack of time at so many facilities. C&P clinics at VAMCs affiliated with major medical schools are, on average, more likely to have conscientious administrators who give their examiners enough time to conduct best practice evaluations (the standard is two exams per day at those clinics).

    b2) Lack of a QA (Quality Assurance) program. VHA will tell you they have a “quality review” program, but if you take a look at the “Audit Review Tool” they use for those reviews, it’s a joke. And the reviewers are not even mental health professionals! That’s like having a dermatologist review neurosurgery cases.

    b3) with the exception of some good MST trainings, C&P examiners receive no training beyond a very basic intro course, which is pretty good, but it’s simply an introduction. As you know, these cases can get very complicated, but examiners do not receive any training for such claims.

    c) VBA – There’s a big push to automate the adjudication process. It’s all about checklists and software that spits out a rating, complete with required documentation and a Decision Letter to send to the Veteran! Taking human judgment out of the adjudication process is sad. Can you imagine telling Associate Justice Scalia that he will no longer be able to write opinions because the new Supreme Court Opinion Writer software will be taking over that function? c2) Dialogue, discussion, and co-learning possibilities between RSVRs and C&P examiners rarely occurs. VA did just decide to send one C&P doc to each VARO to give advice, answer questions, conduct trainings, etc. I think that was a good decision on the big wigs part, and I hear from VBA colleagues that by and large, it’s been very helpful. The big exception is that the docs are usually internists, occupational medicine, emergency, etc., and the initiative did not include sending a psychologist or psychiatrist to the VARO. But RSVRs and C&P Examiners are not given the opportunity to communicate with each other, which is a shame because when the do the both learn a lot of very valuable information, which ultimately leads to more efficent, accurate claim adjudication for veterans.

    • I was seen for 15.5 years at a va med ctr, and not a word in my records about ANYTHING that happened to me on active duty. and there was plenty including mst.
      they didnt want to know and dint ask. always rotating or NEW providers, that one cant talk to. STRANGERS! SWC

  11. The last three sentences of my previous post are poorly written. Here is a rewrite:

    I think that was a good decision, and I hear from VBA colleagues that by and large, it’s been very helpful. The big exception is the lack of mental health expertise. While I’m sure the VHA physicians tasked to VBA have some psychiatric knowledge, they do not have experience conducting C&P exams for PTSD and other mental disorders. You learn the most actually doing the evaluations. Perhaps they will also send experienced C&P examiners (psychologists or psychiatrists) to VBA in the near future.

    My last critique is that RSVRs (VBA) and C&P Examiners (VHA) are not given the opportunity to communicate with each other, which is a shame because when they do, they both learn a lot of very valuable information, which ultimately leads to more efficent, accurate claim adjudication for veterans.

  12. I also suffered a permanent muscle,back and neck injury that eventually turned into fibro. No career, no retirement. worked till my body could no longer work and had suffered ever since i was 19 and overworked by a horney C.O. Waaa! 5x denied w/ smrs to prove all and post service records. going on 2 year wait for 6th attempt. Now Im 54. My life really sucked by and large, in many ways. SWC

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