Three of the Big Six veterans groups complained this week after being locked out of the regulatory process for VA Mission Act rulemaking.

They are afraid VA will allow veterans full choice in selecting civilian health care over VA health care services. The latter, they believe, will outstrip resources from VA’s historic monopoly on veteran care. The new regulations will alter the agency’s health care system.

Disabled American Veterans, Veterans of Foreign Wars, and Paralyzed Veterans of America are the veterans groups actively complaining that VA is not being transparent. In a nutshell, they believe VA should provide access since they helped get the VA Mission Act approved.

“Up until this time, there has been very little corroborated reporting by the VA of what those access standards will be and what the impact will be,” said Peter Dickinson, senior executive adviser with DAV. “We have yet to find out how much consultation there will be with Congress or with the stakeholders who were part of putting this together.”

The groups are hopefully VA will provide a public viewing of the new rules in February, but the agency refused to commit.

Instead, communications from VA press secretary Curt Cashour suggest the agency will not rely on the Big Six in the same way as in the past. Instead, Cashour said VA will brief lawmakers once Secretary Robert Wilkie made final decisions on the new regulations.

“The Mission Act, which sailed through Congress with overwhelming bipartisan support and the strong backing of veterans service organizations, gives the VA secretary the authority to set access standards that provide veterans the best and most timely care possible – whether at VA or with community providers – and the department is committed to doing just that,” Cashour said.

DAV is very concerned that veterans will be given complete choice in care, and that those same veterans will not choose VA care.

“How these standards are set, how wide an aperture of choice, will have a critical impact on the costs of the new veterans’ community care program, and therefore – with limited resources – whether there’s an impact on VA care,” Dickinson said. “This is a critical time.”

Personally, I think VA leadership and these VSOs lost the right to complain about choice related to health care when they failed to reign in VA’s criminal fraud that ended in multiple deaths.

In 2014, VA was caught in a decade long fraud falsifying wait times veterans faced when seeking access to urgent care. As a fix, Congress created the Veterans Choice Program.

VA employees fought that program by obstructing veterans’ access to non-VA health care that included refusing to refer and refusing to cooperate with community health care providers. As a consequence, wait times increased and more veterans were harmed.

Given VA just signed a $50 billion multi-year contract with community health care providers, it seems likely veterans will be given greater access than VSOs want.

Overall, it seems unwise for VA to lock out VSOs even if the organizations were somewhat culpable in the agency’s unchecked fraud for decades. Given the weight the Big Six hold over VA policy, obfuscating the regulatory process could backfire by way of multiple legal challenges that result in a black eye for the president, later.

What do you think?

UPDATE: 1/25/19 Federal Circuit Challenge

One reader asked a question about what the Big Six could do that might result in a black eye. So, I want to explain that quickly with an example in a different part of VA regulations.

Some attorneys are readying their lances for the new RAMP appeals modernization regulations going into effect February 18, 2019. Those challenges will be at the Federal Circuit under Rule 47.12.

“An action for judicial review under 38 U.S.C. § 502 of a rule and regulation of the 
Department of Veterans Affairs must be filed with the clerk of court within 60 days after issuance of the rule or regulation or denial of a request for amendment or waiver of the rule or regulation.”

I posit that the VSOs will challenge the regulations if they are not included at this stage of implementation at the Federal Circuit. Such a challenge could hang up progress in this area, and it is a gamble to exclude VSOs at this stage despite their history in leading up to the wait list crisis.

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30 COMMENTS

  1. Ben, I respectfully disagree that locking out VSO’s from the rulemaking process will hurt POTUS. It only hurts the VSO’s, because those voicing the loudest complaints are doing so after demanding that OUR right to choose who provides our healthcare be restricted to solely VA. The VA made this bed and many of these “stakeholders” are complicit in its continued existence. Anyone standing on a soapbox, refuting our earned right to quality, timely healthcare; negates their message.

    For 15 years, we have watched thousands of scandals come out of VA and none of have permanently addressed or resolved. Heck, there were 27 healthcare related scandals alone, that were made public during (former) SecVA Shulkin’s reign as Under Secretary of Health and the administration STILL put him in charge of the entire VA!

    It is beyond time that we veterans are allowed to make choices for ourselves, rather than continue to be forced to deal with the crumbs from others’ agendas. Small advocacy orgs like mine are taking on cases by the thousands, of assisting veterans in getting even the most basic of services from VA, yet many in our arena still are drinking the Kool-Aid; claiming the VA can do it better than anyone. This is patently false and solely a P.R. ploy backed by a VA bought and paid for study. (“One lies the other swears to it”).

    It is incredulous that VSO’s are stomping their feet because they don’t get a say in how MISSION ACT will be interpreted. Have they forgotten that they are NOT VA or Congress??? They are REFUSING to assist with any healthcare related appeals, citing that “it’s not a benefit”; yet they are the ones yelling the loudest??? I’m getting dizzy trying to follow which side of their faces they are speaking from!

    • We agree on practically everything that you wrote. But, I do think legal challenges that could arise by not including VSOs in the discussion, at all, may result in a black eye later. The Big Six still holds a lot of clout amongst veterans, which is a fact that cannot be ignored.

      • I don’t think anyone should be concerned about a black eye on the POTUS. This is but a micro-zit on the bum of the bumb and will be overlooked due to a litany of uncounted self-inflicted black eyes. POTUS’s detractors may consider this merely another example of a lack of transparency. Fine, however it’s really nothing new with the VA, regardless of this or prior administrations.

        The bottom line is that there Pig Med is at the table, and they want a chunk of that VA money. Just like Pig Med was at the table writing Obamacare. The VA represents 9 million government subsidized carte blanche accounts. Follow the money brother. Focus grasshopper, focus.

    • That is what I smell. More P.R. tactics and in-fighting show or not. Distractions and still nothing being done much about the suffering, censoring, ignoring, VA/civilian retaliation games, attacks, pain med game, etc. They’ll all go out for five star steak dinner during or after the circus. WE will pay the price for pissing off someone over small complaints to offending some VA activist we are supposed to allow to walk all over us. And totally screw up years of care.

      I’d have to ask the ‘three’ (the entire six + outreach varmints actually) how does it feel to want? Their wants over our needs? They didn’t get into another sand-box to play in? None of them speak for me nor are they taking real actions to help in any way. Seemingly they all choose to step aside and join the herds that are ruining us. Or some of us. How many generations of corruption and suicides to-date? Round and around it all goes, where it stops nobody knows. Lives and daily suffering doesn’t seem to be in their agendas or of much concern like the censoring going on. They should be out in force together with their little gummy bear pitch forks or something to shut the works down until some fixes are in.

      In my old age the voting days are over for me. I live in a totally corrupt Dem ruled place under the oligarchs and censoring fascist that carried on with the VA crap and compounded the problems one hundred fold. NO help to be had from anyone anywhere including all religious or political elite. The ‘union’s stronghold’ state. Two parties, all the activist, corporations, associations, professions, stake/stock holders/etc., line the same crap hole of deception and total lacks of ethics. Some of our ‘needs’ are not in their agendas or line of concerns. Line the whole sheebang up for black-eyes cause any POTUS is a puppet and with millions of voter fraud issues and illegals voting, plus very sick lying media, it’s game over in this sick country. Where are all those “six” besides wasting time, bickering, or intentionally creating divisions? Why do we have to stand up alone to the entirety of the ‘big six’ that don’t want to get involved in some serious issues then claim to represent us or be out for our welfare? Horse poop. Then we are supposed to fear all the cogs and gears in the machinery?

      Think of the many issues there are for picking and choosing or after forced to walk away from lousy lying VA care is some places.
      1) Claimed shortages of MDs and health care workers or specialist. Going through the game of finding civy MDs that accept chronic pain patients, no new patients, out-dated MD lists, the waiting, no elder patients, false ads from the pros. Foreigners we can’t understand. Who wants to deal with some corruption or pounds of VA interspersed BS files, and lost ones from some clinic. Being treated like a criminal over some issues like civy MDs also playing cover-up for the VA and not wanting such patients like myself. Lying in more medical files and deceit to protect their own? Seems one call to a medical board plus the VA crap puts one on a state’s shit list.
      2) State law depending. Going through all the various wait times and checks about you from credit checks, pharmacy checks, criminal checks, VA records and their version of inner-office secretive notes, more releases to sign, more loss due to some IT system, lost records, lost test results, etc. Medicare and hospital failures/issues included. Any “red flagging?”
      3)The covering up for their comrades in professional services by medical boards to local associations, like with nursing, to many various cliques including the VSOs, tightly controlled media, and politicians. Gossip and a name associated with stepping on some ‘professionals,’ or politicians toes that need stepped on is swift and thorough. Bam you’re seemingly black-balled or shunned in a cesspool community of gaming. Especially if they took notice of your voting info in the many investigations having gone through. Identity politics/activism/protectionism that have seemingly usurped medical ethics, protective laws or our rights.
      4) The money game of a simple thing a new PCP could do, can’t do. Why? To spread the money around, period. Due to policy and forcing us to go yet to another clinic instead. Or them not accepting what is in our VA files or treatments that have worked for years. Like each MD or clinic wanting their own sets of X-rays or blood drawls, etc. Why? Dealing with more incompetence intentionally or not. What do the VSOs and others do locally? Play politics of the area and do grand photo-ops pretending to serve us all.
      5) Having more vets, media, and the public against us is not fun either. Time for the dividers and actors to have a moratorium on truth and ethics, cease the divisions, and take some serious action instead playing ‘As The Stomach Churns.’

  2. I’m with you Ben. The VSOs have no right to a say because they look to MIC (Military Industrial Complex) for donations to pay the salaries of executives that are higher than the salary of SecVA. They clearly side with reducing entitlements of flesh and blood to benefit hardware producing millions in executive salaries for MIC in the U S Budget competition.

    • We need real vets who are on our side to have a say. Simply send out a poll to the Veterans who are receiving care and benefits.

  3. This came out today!

    Lawmakers To The VA: Time To Grow A Pair And Start Studying Medical Marijuana
    JANUARY 24, 2019
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    This other stuff I don’t know how it applies to the title!

    2. In the torpedo room

    U.S. Navy photo by Chief Mass Communication Specialist Darryl Wood

    Nothing says “home away from home” like a temporary rack on a ship. “Join the Navy, see the world,” really should have been, “Join the Navy, see the water.” Sure, on paper, sleeping between strangers on a ship cruising the open seas sounds like a new app we should develop, but sleeping right next to five coworkers and that one mouth-breather isn’t probably what you had in mind. And if that wasn’t quite enough, add the knowledge that you’re in a room with several thousand pounds of bombs. Sweet dreams, kid.

    3. On a metal folding chair

    U.S. Army photo by Robert Timmons

    There’s nothing quite like waking yourself with a massive head bob after dozing off while sitting straight up. You know the kind: when the weight of your giant brain falls forward too quickly and bounces at the bottom with enough force you have to wonder if you may have permanently damaged your neck. You play it off with a neck roll and look around to see if anyone noticed. Spoiler alert: They did. And, don’t worry, you’ll do it again in three minutes. Kudos to this dude who probably did that six times before he put his backpack on his lap to prevent it from happening again.

    4. On the rocks

    ​U.S. Navy photo by Mass Communication Specialist 1st Class Peter D. Blair

    That might be how you want your bourbon, but definitely not how you want your nap. Just looking at where this guy is sleeping makes us uncomfortable (and not only because of the sunburn you know he’s going to have on his face). There’s something about gravel digging into that inch of exposed skin above your collar and tiny boulders in the small of your back that just screams nope.

    5. On a stretcher

    ​U.S. Army Photo by Staff Sgt. Erica Knight

    Pretty sure that bad boy is for the patient, but sometimes you just have to fold your body completely perpendicular to catch a few zzz’s. That’s gonna feel realll nice in about 20 minutes. Nothing says “hazmat suit” like throwing your back out.

    6. On the top rack

    U.S. Marine Corps photo by Sgt. Allison M. DeVries

    If you ever rock, paper, scissored over who got the top bunk as a kid, then wow, do we ever have a treat for you. Now available on select C-130s in the New Zealand fleet: the top “rack.” We use that term super loosely because it’s more like sleeping on a web of lies that your time as a Marine would be spent doing actual things, not just training exercises.

  4. The last house committee on veterans affairs the va told the committee. We are in constant contact with the service organizations.

    They would not lie to the committee would they. The committee told the va, they are to not make or implement any regulations without the committee and Congress authorizing it.

    They told the committee, it’s been initiated and is a go. Ok, what is your end goal and where are the measurements so we can hold you responsible, if things go wrong.

    Va, we will have to get back to you.

  5. Missing the point of issue…. choice to utilize community care is a win for veterans as in msny cases the standard of care and accessibly is better. Let VA facilities cover conditions that are military specific, such as combat PTSD and TBI, and send the rest to better trained and available community xare

  6. Good things are happening right about now!

    The VSO need to go – Just another egocentric GOB organizations

    This has been my experience “VA employees fought the Choice Program by obstructing veterans’ access to non-VA health care that included refusing to refer and refusing to cooperate with community health care providers. As a consequence, wait times increased and more veterans were harmed”.

    Peace Out

  7. I am 100%IU Rated Disabled Marine Corps Veteran. I was medevac in the early 70’s after blackout and heart arrhythmia (misdiagnosed Stroke). I should. Have been medically discharged. Instead I fought a 42 year battle for my rating. Did a VSO ever help? No. Used private attorney: 20%.

    I went to a BVA hearing for hearing loss and tinnitus. I had a big 6 VSO at that time. Just before entering the video tape conference room; my VSO said if you say or mention anything about PTSD, Medevac, or stroke I will shit can your file. You will be abruptly escorted off the property. And you will never see another penny of disability compensation again.

    When the board asked me to stand up and introduce myself, I gave them my name, age, and address. Then proceeded to inform the board that my VSO just threaten me if I told you I was medevac to Madigon after blacking out and suffering from a heart arrhythmia (chest pain triggered by PTSD). Before I was through my VSO had disappeared. I concluded the hearing by myself. The look on the boards face was priceless.

    My VSO was absolutely correct. She shit canned my file. Lost my hearing. And security was waiting when I exited the conference room. It probably didn’t help my cause when I told Security, they hit like a bunch of little girls.
    Also, when I got a copy of the BVA hearing the transcripts were changed to reflect the VSO argued my case.

    JUL2017> I was going to the CHEHALIS CBOC for Healthcare (hard to call it that). I wrote the VISN 20 Medical Director, WA STATE DOH, and The Joint Commission complaining about “Substandard Care After Stroke” (had 2 more years later – Subrachnoid Hemmatoba).

    My pcp and healthcare team informed me that I am no longer welcomed at the CBOC. Cut me off formulary. And said to call the Choice Program. They Sabotaged my efforts to select my choice for PCP. And currently paying KP to provide healthcare.

    The VSO’s that I have dealt with here are devious. Even when I obtained my 100%IU, and brought my paperwork in for benefits, they did absolutely nothing.

  8. The Access Program, originally, was established to assist veteran who had difficulty in receiving VA care due to distance from a VA medical facility. They were then allowed to access medical/mental health care through a private provider in close proximity. The problem was, and still is, the outlying areas that met the required exceptions for Access did not, and do not, have the required providers to meet the need. This is because outlying, rural areas do not have specialty providers that would be found at a VA medical facility, and if they do, the providers are usually inundated with private clients.

    With this in mind, no matter if the exceptions allowing Access are expanded, the provision of services by private providers will not change.

    As one who meets the exception by both disability status and rural need, the Access program has proved beneficial for primary care, however any service beyond has required other geographical sources.

  9. Whoa, HOSS! Veterans “choice” means that Vets choose private or VA health care. That would mean YOU would also choose. What is so bad about having choices? Im tired of being “forced” to go to the VA. Right now, its the VA way or the HIway. If many Vets DO opt for private care, that would take some of the overcrowding off VAMC’s. It does not mean you cant still go to the VA. It means Vets have a choice. And, YES, if there are lots fewer Vets using VA facilities, then, yes, they would not need as much money to care for fewer Vets. This is a good thing. “The government” is not always better at spending our money than we are. Im capable of deciding which medical facility to go to and I dont need a VSO earning 350k per year deciding on which medical facility is best FOR ME. The VSO’s record is pretty bad, and that is why we need choice, and why we need to also be able to choose our representative: VSO, attorney, or PRO se. Remember, these same organizations insisted that allowing Vets to hire an attorney would be “bad”, because Vets can get VSO services for free, so we dont need an attorney, right? So says the VSO’s. However, what happens when the VSO fails the Vet? Or when the VAMC fails the Vet? The VAMC’s are largely already overcrowded and VA PROOVED their are uncapable of managing to build a new VAMC with the Denver VAMC fiasco, billions over budget. Im tired of the VA mismanaging funds meant for Vets. Im also tired of VSO’s that think they know everything, when they cant seem to do much to fix a broken VA. We Vets are capable of making our own choices, we dont need 350 grand per year VSO’s making those blanket decsions for all Vets from their Ivory towered offices.

  10. The VA is the only access to some specialties over 200 miles away from me. Choice doesn’t have any and even wouldn’t pay the bill to a local mental health clinic. Give me choice but pay the bill.

  11. They’re upset because didn’t get to play in the sandbox. Anyone complaining that veterans will have a choice to get care has some loose bolts and left with nuts. Should have been a long time ago, but they are getting their lead from Trump which personally think would not get re elected. 2 years left, they’ll hold up in courts and will a new president will let back in the sandbox. VA wants to save money, stop funding veteran organizations, most are pitiful with helping with claims. When people are getting paid by the VA they don’t have you in their best interest. Everything changes and their best interest is their own.

  12. I’m living where Choice is used often, and civilians are now going to next county for Dr.’s. The Dr’s here have showed up in droves the past three years. You cannot tell the difference between VA Dr.’s and these useless new Dr.’s.. I’m beginning to believe that Choice is a scam created by people who will most likely make millions and these people won’t even be associated with the VA. Right now the AFGE treats Veterans like a cold. The clerks have been trained to make everything difficult.

    • My experience also but I have better Doctors on both sides, VA and Choice. Just my Choice bills weren’t paid forcing me to travel to the VA where my travel benefit is more than the Choice bill for one visit.

  13. Well…golly.

    I appear to be the only Veteran who has ever had their service-connected injuries “treated” by the suddenly-awesome “private sector health care services”.

    Because I can tell you, they are no more a panacea than the VA itself ever was. I can see many areas of concern with “privitisation”—which is what this is—that Mr. Krause appears insensitive to. Care quality does not automatically go up merely by moving from a huge government bureaucracy to a huge for-profit money-making industry. There are plenty of marginal and incompetent Physicians working outside the VA. The central role of fees in private sector medicine—I would imagine Mr. Krause understands about fees, being a lawyer—almost guarantees that the Veteran, in line with other government-payee clients (like Medicare and Medicaide) will not be seen by the very best in the industry regardless of the location.

    To date, the Republican fascination with privitisation has been unsuccessful. So far as I know, disasterously so. But maybe Mr. Krause can cite some instance where it worked that relates to caring for those without ample funds of their own.

    For a guy who’s not supposed to trust the VA, Mr. Krause seems to have suddenly become a True Believer. If one were to follow his own oft-stated creed, one would want to know why this sudden conversion took place.

    Why is making veterans subject to the same awful health care “system” the indigent are forced to endure, a good thing? Do you have any experience trying to get a private care provider to authorise an expensive procedure? No easier than getting the VA to do so. And you cannot call your Congressperson, because the Insurance Industry pays its way. Or are we pretending money doesn’t influence politics now, too?

    And why does Mr. Krause mix caring about Veterans with his personal admiration for Trump? WTF has that got to do with anything? Who cares if some elitist asshat gets a “black eye”? How about caring if disabled veterans get shoved into the same murderously indifferent health care slum those same elitists shove every other “burden on the state” (or in R-Speak, “entitlements”).

    Not OK, brother. You have your priorities backwards on this one.

  14. Reaks in crime & corruption, and VA isolating itself from ANY VSO Groups.

    This is.EXACTLY how VA wants it, so as to continue with the same in the future

    Wake the hell up. Nothings new, and VA keeps creating black holes that keeps out the transparency of the VA.

    A brillantly calculated nice fucking move by VA.

  15. And its hard for me to stomach you ass-kissers, who sit back and act like nothing needs radically changed inside the operations of the VA.

    —– I TRUST YOU NOT —–

      • Yeah man. We need a change in integrity bro. These mf’ers are full of shit and dangerous due to no accountability.

        We know it, they know it.

      • I’ll third that motion for some integrity, accountability and ethics. It all does not end with VA care alone. The retaliation to all of it easily floods out into the civilian sectors too depending on location, location, location/politics. The entire system is corrupt, self serving, protective and broken. Their facade, prestige, positions are more important to them than human lives and suffering. When officials, agencies, pros, media, all turn their heads and cover-up it shouldn’t take a brick wall to fall on someone to wake people up to the mess we live in.

  16. I don’t use VAMC’s, don’t trust them. Can’t even get a pair of glasses from them. Could write a book on how FU va is but who would read it. The main reason for all the suicides is veterans getting so aggravated trying to get treatment and benefits they opt out… . VSO’s need to be left out, they do nothing to help veterans, just a bunch of remf’s upper level nco’s still wanting to run something… . Tried to go to college when I got out, was on my own… . The VA Mission Act retains Choice 40 which disqualifies all veterans in So West Louisiana from non-va healthcare, but drops Choice 30. 400,000 veterans lost their GI bill, did anybody do anything to help them? I haven’t read or seen anything. Nobody GAF….

  17. 01/26/2019

    Dear Benjamin Krause,

    You stated:
    Given VA just signed a $50 billion multi-year contract with community health care providers, it seems likely veterans will be given greater access than VSOs want.
    Overall, it seems unwise for VA to lock out VSOs even if the organizations were somewhat culpable in the agency’s unchecked fraud for decades. Given the weight the Big Six hold over VA policy, obfuscating the regulatory process could backfire by way of multiple legal challenges that result in a black eye for the president, later.
    What do you think?

    It is nice when someone packages all six together contributing the deaths of tens of thousands of Veterans for decades and they should be brought to justice for their past behaviors “unchecked fraud for decades” in this mind blowing criminal action against those who protected us from harm, the U.S. Veterans.

    What do I think? Stop the money, Stop the crime.

    Trump is catching on how to disrupt them [wait until 02/15/2019].

    Sincerely,

    Don Karg

  18. Yeah man. We need a change in integrity bro. These mf’ers are full of shit and dangerous due to no accountability.

    We know it, they know it.

  19. 2020 will be about a Single Payer System– it will be the end of the VAMC circus of malpractice stars like Walker of VAMC-Albuquerque.
    The big six should take the position of dumping the VAMC healthcare system. Single Payer means we all get the same care and it rids the US of the VA parasite budget, e.g., the VAMC-Albuquerque is $20 million per month. Holy Bananas Batman! That facility is a bona fide crap-hole. If you go there , watch out for the corrupt cops writing tickets in the parking lot, they like to stack-em just like Chicago Cops. I say let the VA healthcare system die on the vine. You are better off with indigent care at any emergency room outside the VA.
    Another option: move to California where everyone gets care , payment doesn’t matter to the socialists out there, its a single payer system coming in and its coming in 2020 to all of us. Who can buy America with the best healthcare deal–its not the AMA that’s for sure. Ask yourself , where the fuck has the AMA been all these decades on Veterans care. The AMA is PIG MED, the insurance companies, the hospitals and the clinics. The VA specializes in hiring scumbag doctors who take 1 class in medico-legal medical practice designed to shut down or deny claims. Its the prime directive at the VA: deny, delay and let die. Cheers brothers, we are still alive, heh heh.

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