NPR Finds Link To Disparities In VA Benefits Spending

VA benefits spending

Benjamin KrauseThis week, NPR is covering lives of veterans throughout America in its three part series that started out the revelation that there are disparities in VA benefits spending.

NPR’s report stretched far and wide to find a clear cause for the difference in spending disparities and cited the best guess of a Harvard VA health care expert.

A best guess… as in even a Harvard expert does not know why there is a disparity?

Harvard researcher Ashish Iha states the disparity is the result of nothing more than management quality and stewardship of the public dollar:

“Our best guess is that a lot of that probably has to do with management and stewarding the public dollar,” says Ashish Jha, who studies VA health care at the Harvard School of Public Health. “Even when you look across VA hospitals, some organizations seem to be a little bit better at managing resources than others.”

In an evaluation of data of 3,000 counties, NPR found West Virginia had the highest per capita spending ($7,600), while Indiana, New Jersey, Delaware and Pennsylvania had the lowest (< $5,000). It also found spending to be quite high in areas like San Francisco where spending was a monumental $30,000 per veteran patient.

NPR created database for readers to lookup their own county and state and curious veterans should check out spending in their area:

The article highlighted the impact of long drives to receive adequate VA health care and one theory for the irregular disbursement of funds:

“There’s a lot of veterans, I get them set up for a doctor’s appointment and everything else, and they don’t get down there for transportation reasons, it’s a long drive, their stress level,” says Rob Harrington, a vet whose convoy was bombed in Baghdad. He now works at the Cape & Islands Veterans Outreach Center on Cape Cod. “To drive all the way down to Rhode Island, definitely, it’s not fair.”

Harrington says some vets on Cape Cod give up on the VA.

“They get on MassHealth, or they allow them to use their own personal insurance, even if it’s combat related because of the inconvenience of it,” he says.

It also costs more to treat veterans in cities where doctors and nurses are paid more. Still, part of the spending gap is hard to explain.

The NPR piece highlights veterans where we live throughout America to see how VA benefits are affecting us in our daily lives. This added attention does not come a day too soon as traditional media grows tired of VA scandal after VA scandal.

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  1. I was diagnosed with PTSD, TBI, loss of use of an arm (nerve damage) migraines and herniated disks on back and neck, I was given antidepressants mixed with pain killers and several other pills to counter the side effects symptoms the VA almost killed me. I will never go back there ever again, if you want real medical help go to a private doctor.

    1. Also get a VA specialty lawyer or VA law conic and sue the VA Thyey deserve it !! They will put you off and off and off and put your anxiety and stress levels through the roof Once you sue a few times the treat you better but not always as they are afraid of lawsuits


  2. It seems to me the services that the VA offers all around are questionable. My husband, a Vietnam Veteran, soon to be 82 was given antipsychotic drugs, 3 all at once and they overlapped. They were to restrain him. During 2010 he was given the drugs without consulting with me. I learned in December 2013, he had a stroke when the drugs were given. He is now in a wheelchair. Was walking and talking prior to the drugs. Then the medical records show drug induced Parkinsonism. ?? You gave him the drugs. Then you deny his claims for Parkinson. He now has a private doctor treating him for Parkinson and without a bunch of drugs. Just one pill 1MG and it is helping with the stiffness and he is able to use the right side a little better. Those drugs had a warning from FDA. DO NOT GIVE TO ELDERLY PATIENT WITH DEMENTIA, MAY CAUSE STROKE, HEART ATTACK OR EVEN DEATH. Imagine that. The VA kept giving him drugs that were too strong for him.

    So now we seek care in our home. That is a joke too. The agencies hire the people who make very little money then those people are either undertrained or just there to make the money. Don’t clean my husband, will wait until everything runs out and will never say a word. Will actually sit all day and do nothing if you do not watch them. I find it is more stressful to deal with the agencies contracted by the VA. The people lie, steal and everything else.

    We filed for Aid and Attendance to learn we were approved but no money. Then when checked learned it was considered Special Monthly Compensation. Then his Air Force Retirement pay was reduced even though he ended up getting maybe like $250 more with the reduction of his retirement pay. Now we are waiting for the BVA to look at the Parkinson Claim. Waiting for an expedited Aid and Attendance claim (listed as new claim now). But we have been filling since 2009.

    Write to Washington, and get responses but when it gets back to local VA, people still rude. As if you are not supposed to complain. Sad, very sad. However, even more depressing for caregiver. I totally believe these people will never understand, do not want to understand and have no clue that we have all paid our dues.

    Just sharing the grief and disappointments.

    1. Based on your information this goes on all the time at the VA You need to ell a lawyer all of this since the VA wont answer you . Find avery good VA lawyer to sue the VA in your town or city or find a VA legal clinic . You have a very good case for gross medical malpractice and negligence You need a lawyer to fight the VA . I have case I am fighting for giving veterans finasteride for enlarged prosatet for years causing many many problems they dont tell veterans at all claiming its safe when its not and its the only drug they have and use in the VA pharmacy Yet when you tell them go se the fimsateride lawsuits against the drug manufacturer they refuse Sue the VA

      I would also suggest you find out if the doctor was an intern or a licensed doctor in you state and go after him if an intern for not being supervised and if licensed a compliant against his license A federal freedom of information act request should give you the persons licensing and or position as a “doctor” at the VA You see there are many many many “interns” or “residents” that are practicing on you at the VA and are unsupervised That is the problem and they federal system allows them to be called doctors . There ar many unlicensed “doctors” fresh out of some school in In dis or wherever practicing but not licensed or who have lost their license in another state or have lawsuits for malpractice or negligence and come to the VA as they cant get malpractice insurance and then the]re are some doctors that are and have state licenses Go after their license with state boards or see complaints against therm with state licensing boards and definitely sue the VA with a VA lawyer for malpractice and gross negligence !!

      Lee Horowitz, M.Ed, CAGS
      US Navy disabled vietnam era vetran

  3. I have experienced the Choice program does not work. I saw a Civilian PCM for severe neck pain on 2 DEC. She orders x-ray and MRI and I pay for MRI out of pocket within 5 days. She also recommends physical therapy/orthopedics. Granted my neck is already SC so I figure I am authorized the Choice program and will get my treatments outside thinking the VA would be backlogged for appointments. DEC 3, I fax my scripts to the VA front desk, email my VA PCM through secure messaging, and hand deliver the same scripts for outside treatment using CHOICE. MY VA PCM finally get back to me after numerous calls and emails on JAN 7th. I called again on Jan 7th at 345 and they called back and said be here at 4 if I wanted to be seen. I am asking why can’t she just read the numerous scripts and refer me to the Choice program or get me an apt with the VA…why do I have to come see here when I just saw a civilian more qualified Doctor? Anyhow, during my call they said be here by 5 for an appointment. I get there, check in and on the Check IN screen it said appointment 430…they were hoping I didn’t make it in time, yet they told me 5. Games they play! Finally I get in there and the VA PCM acts like she has NO clue of why I am there. I mentioned the Choice program for my neck and she completely ignores my request. I mention it again and again. Mysteriously they have a PMR appointment JAN 16th after wasting 44 days of my time to get me there and not seen with the Choice program. So the Choice program does not work because the VA PCM must be seen before any authorizations are made. We all know getting to see your VA PCM could take weeks and even though we have clear scripts from the outside we still must be authorized by the inside and there lies the problem. Great effort and the program could work if there were not some many obstacles to overcome. Lesson learned is just to pay out of pocket for care as sad as it may be. We can’t get timely care for SC medical issues. Why does it take 44 days to get treatments for severe neck pain when the Choice program is an available program?

    1. Regarding the Choice program , you should be paying nothing out of your pocket as the VA choice program should pay everything. Howewver there is some very bad info being put out about the program . This bad information is that with your choice card you go to the scheduling desk and find out that your appointment is ( 30 day rule as example) is for 90 days Yes your eligible for Chioce but that appointment desk clerk you met tell you dont want 90 drays and you want choice to see private doctor. Now you just cant go automatically with your choice card to a doctor.

      As with a anything in the beaurocratic VA once you tell the scheduling clerk tat you wont accept a lest say 90 day appointment and you want the choice program , your request must go through that VAMC chain of command ( be sure you get something in writing of your request and signed by the scheduling clerk) then sent on to the VA choice program It is then up to the choice program to allow you to use your card and arrange private care payment to a private provider.

      The problem in all of this is the chain of command and time length it takes for approval of choice Who knows what that could take , another 30-90 days??

      Lee Horowitz M.Ed CAGS

  4. The Choice Program is not working nor will it solve the problem . First many rural veterans are served by VA clinics so the 40 mile as the crow flies rule under choice is crazy . . Also even though some one lives 25 or 40 miles as the crow flies from a VAMC or VA Clinic many of these facilities must refer veterans to needed service sion which they must travel many many miles from 70 to 200 miles or more to be serviced by the VAMC having those particular services.

    A recent early report shows that out of 235 veterans eligible for Choice program only 1 used such program !! The problem as I questioned Choice program people is that even they are not clear on the program itself. You
    may get a different answer dependent on whom you talk to and that information disseminates from the Choice office. Both I and my congressman (Josh) from Congressmen Pitts office (PA) who is on the VA committee were told I would not be eligible as there is a clinical appropriateness done by Choice . That means that the Choice program can tell vets that if their appointment is for lest say a colonostomy or to the eye clinic for serious eye problems then a past 30 to 9 month appointment wait maybe appropriate . Whereas a vet with a heart problem or cancer must have an appointment within the 30 day perameters.

    Upon calling DAV and other veterans legislative representatives I was told that both I and my congressman Pitts ( Josh) Reading Pa office were lied to and it was a bunch of bull given to me and my congressman’s office ( which did nothing to correct the situation) Finally Iwas told but never my congressman Pitts office (Josh) in Reading Pa the truth so that his office may pass the lies by the choice program on .

    I also questioned my Congressman who has down nothing as well as choice officials as to why there is no rule or requirement timeline between when a veteran is eligible and demands choice via a scheduling clerk ( 30 day appointment rule) and the request going all th way though the VAMC one applies to and then such request going to choice for approval and then notifying the vet he can use a private doctor or facility.

    Well there is not time line requirement in the choice program as should be. It could take 30 to 90 days or more just to get your choice approval between when you request such at your VAMC and it going up the line or someones desk at that VA and then over for final approval to the choice office itself !!

    This is how the VA is dissuading vets not to use Choice as the timeline defeats the use of the 30 day rule. This was intentially done by the VA and Choice to bypass the intent of the legislation. Write your congressmen and senators. We want rivage care and access to private facilties point blank !!

    Lee Horowitz, M.Ed, CAGS
    US Navy veteran- disabled Vietnam era veteran

    PS There is some very bad information being passed by veterans posts like my own that if you are not given a 30 day appointment by the scheduling clerk automatically then you can go out and use your choice card at any private doctor. Does not work that way. It must be approved via the VAMC you go to through that VAMC and then they send the request on to the Choice program who then notifies you of approval or not to use a private physician and your choice card That process has no time limit within the choice program and that is where there are huge problems as it may take 30-90 days or more to get such approval via a beauocratic system

    Lee Horowitz M.Ed, CAGS

  5. Brookings OR 170 mi each way to Roseburg no wonder Curry County only spends 7K compared to Rest or OR @ 9K.Just to get hearing aid’s adjusted 340 mi trip and 8+ hour’s of drive time. Local clinic in Brookings is good just not able to do what’s needed like Roseburg.

    1. The last time I heard that I had wrote Lou Dobbs in late December of 2007, had a White Cherokee Jeep out front of my house on the first day of work for the year 2008 and got fired as soon as I walked through the door. Soon after that Lou’s house got shot up. It still better than being thrown off the San Pedro’s cliff or dying in bed mysteriously [Ref: Judge McKee and Judge O’Neil in Torrance, CA].

  6. When I had moved to WA I had to go to the Puget Sound VAMC (Seattle) for most of my treatment and it was 86 miles one way. The route to get there was terrible. I had to leave three hours before my appointment to hope that I would make it. A few times I didn’t. The roads in that part of the country are fewer than the mid-west and the eastern part of the country. In Indiana (Indianapolis), I can make it to my appointment in less than an hour from my hometown. The Seattle VA to me, seems to have no problem in getting the vet the treatment he/she needed, looking into the problem a little more, and the care was pretty good. In Indianapolis, completely different. They will do as little as possible to help you. I went to the ER at the Indy VA on a Mon. for an abdominal pain that was doubling me over, the ER DR. took a couple of X-rays (thought it was a kidney stone) found nothing in the X-rays and sent me home with some antacid (thought it was just a bad case of gas). Returned Wed. because the pain was getting worse and this time they finally decided to do a CT scan and found that my Gallbladder was very swollen and inflamed. It also showed that I had a 2.3cm stone in the neck of my Gallbladder. I asked why wasn’t this found on the first visit and never received an answer.
    I was admitted to the hospital and my Gallbladder was removed. Doing much better now. If the Indy VA would have spent the extra money on my first visit (for the CT) it would have been found then and not two days later. I would not have had to deal with that pain for two more days. I think that the Seattle VA would have found it on the first visit. So I can see the difference in spending as a result of possibly the travel condition. The Seattle VA knows that it is hard to get to them so they do a little extra to make sure you do not have to make that trip again and in Indiana, you can get to the VA easier so the need to do more is not as important because you can make it back to the facility easier.

    1. I have tried to report to my congressmen and the VA IG my own problem years ago at the Philadelphia VAMC which is under investigation and I have has medical malpractice and medical negligence against . Why, because the VAMC are using all over the place unsupervised interns allowing to be called VA doctors in the VA who are taring on vets like Guinea pigs, and the VA is allowed to hire unlicensed doctors even out of medical school and who may have lost state licensing ( oe been in state malpractice or negligence lawsuits)
      These are facts and every vet should ask their so called actor one question “Are you a licensed doctor in the state where the VAMC is”??

      The VA emergency rooms and clinics are filed with unsupervised interns and specialists training on you !! Just one of my experices at the VA Medical Center Philadelphia VAMC. I was rushed by my friend at the time , a former nurse at the Wilmington VAMC Delaware who quite as she saw all the malpractice and negligence . We went to the emergency room of the Philadelphia VAMC being manned by two unsupervised interns as usual . She kept telling them in no uncertain terms it was a gall bladder attack I had. She saw it. SHE and I asked for a the test for gallbladder They refused . They tried to take blood with dirty needle and we stopped them > I was then diagnosed with having a gas bubble between my chest and lung by both interns. I was given malox . The nurse told me that if I took the malox I would be dead . The next day I went to DR Darlington a private doctor who gave me the test for gall bladder and I was in emergency surgery to remove ny whole gall bladder as a huge stone was in it. He also stated to me if I had drank the malox I would have been dead I filed grievance with Phial VAMC in which thy refused to get my private doctor and hospital records and closed the case saying nothing illegal was done My congressman Pitts despite my history of malpractice on vets by unsupervised interns at Philadelphia and Wilimington VA will do nothing to investigate this practice going on.

      I suggest you get a private malpractice attorney who handles VA matters
      and sue the VA for gross malpractice and gross negligence I bet if you check the credentials of the doctors they were in fact unsupervised interns or doctors with no license in your state and who may have lost their license in rivage practice, had lawsuits for malpractice or negligence and they then come to the VA to practice as they dint need malpractice insurance

      Always questions if in fact your :”doctor:\” is a real doctor at the VA who is licensed in your state You see at VA, federal and state hospitals anyone can be called doctor and is allowed to be They dont have to meet licensing requirementt of the state. Its why VA health stinks Its a practice -training ground to practice on veterans like guinea pigs with the amounts of unsupervised interns at VA facilities

      Lee Horowitz, M.Ed, CAGS
      US Navy Veteran
      Disabled Vietnam Era Veteran

      1. Lee, I did try to drink the antacid as they said to do and it made the pain worse so I stopped after the fist dose. Now hearing your comments I think WOW I could have possibly died because of that! Great. They done the same thing with me as far as removing my Gallbladder; however, while in the ER they were trying to decide if they wanted to keep me (it was later in the afternoon) or send me home and have me come back in the next day to have the surgery. I said “I’m not leaving so you might as well get a bed ready for me”. They finally came back and said they were going to admit me (they made it sound as if it was their decision).
        To make this even better, I have dealt with an iron deficiency anemia for over two years now and I went to the same ER about two months ago and explained to them my condition and told them that I felt as if my iron was very low (I know how it feels when it gets real low) so they took me back to a room and drew some blood. After three hours the Dr. came in and said he could find nothing wrong with me and told me that I was just fatigued. I explained to him about the anemia and he left and came back about an hour later and told me again that he could not find anything wrong with me and again said that I was just dealing with fatigue. I asked him what my iron and ferritin was and he stated “we don’t check iron or ferritin”. I said that was my main complaint and it was on my record when they took my into the triage area. I said how can you keep me here for four hours, not check what I informed you that was most likely the problem and then tell me that you don’t check for that. He said that that takes too long so they don’t do it. I was so mad that I ripped out the IV port they had put in me, took a comment paper, left and went to my vehicle and filled out the paper (front and back and I was not nice about what I said) and took it back into the ER. I handed it to the woman at the desk and very loudly told her of my experience and how they completely misdiagnosed my problem and did it loud enough so everyone in the ER could hear me and then told them what a waste they were and left.
        I contacted my PCP about this and he ordered another blood draw and guess what, my iron and ferritin was so low that they ordered me to get an IV of iron. I ended up getting a gram of iron during the infusion. My complaint about this fell on deaf ears. Oh the wonderful VA.
        I will look into the malpractice now after hearing your story. This is terrible.

      2. What is very important is no the credentials of the supposed doctor in the VA you are seeing or dealing with as so many are in fact allowed to be called doctors but are in fact unlicensed and unsupervised (on site with you) interns . Th department head supervisor just rubber stamps what the interns say Also many so called doctors are not licensed at all or have had medical malpractice suit against them and is why they come to the VA – They dont need medical malpractice insurance which is amuse for the outside real licensed doctors.

        So always ask ” Are a a licensed doctor in the state of where the VA is” Many will answer” yes I am a doctor “(only the VA allows interns and residents to b allowed to be called doctors) Follow hop with yes your a doctor here in the VA but are you a licensed in this state ??

        Then you will know who you are dealing with and do you want to be seen by someone practicing medicine on you without the department head doctor overseeing them -present?? In private hospitals this is illegal but in the VA its killing veterans !! Pursue medical malpractice and negligence charges with a veterans attorney on the outside. Its the only thing the Va understands

        Lee Horowitz, M.Ed, CAGS
        US Navy Disabled Vietnam Era Veteran
        [email protected]

      3. Lee, thanks again for this info it has been helpful. In looking at my records for the first ER visit, the Discharge diagnosis (from my med record)

        Discharge Diagnosis: ABDOMINAL PAIN

        yet looking into the records anything that asks about “abdominal pain” and if I have it, it is stated as NO. Even when it asks about infection and could they be of this or that
        (Again from my record)

        Is the patient experiencing any of the following?
        – Chest pain
        – Shortness of breath
        – Arm, Neck, and/or Jaw Pain
        – Diaphoresis
        – Nausea/Vomiting
        – Abdominal pain of unknown cause


        Sepsis Screen:
        Is this patient’s chief complaint suggestive of an INFECTION, such as
        pneumonia, urinary tract infection, abdominal pain, soft tissue wound,
        or meningitis?

        However, my chief complaint from my record states:

        Chief Complaint: pt reports LUQ pain


        1. Abdominal pain
        cbc/cmp/ua/lactic acid/lipase/pain cortol/antitussive

        This was taken from my medical record from that day that as you can see, I was sent home with the diagnosis of abdominal pain and given Maalox.
        I will follow up on this as you have suggested and to keep from making this blog about just my problems I think we should probably keep this short. Thanks again and I have your e-mail if I have any other questions, I will contact you. If you would like my e-mail then please let me know and I will e-mail you.

      4. I agree with Lee, fig8. Should you not get anywhere soon (by end of month,let’s say) with all the emails you dutifully sent out, then it’s time to speak to a CERTIFIED veterans lawyer. If they think you have a case they can get somewhere with, they will offer to take it on for a percentage of what you are awarded. You would have to talk with a few.

      5. Thank you I am nope in the process of getting a class action case against the VA and the pharmaceutical company peddling finasetride drug to all older veterans for enlarged prostate. The urologist at the VA have failed to inform any veteran of the dangers of such drug and it is causing many side effects permanently such as impotency, total lose of sexual interest and desire, total loss of sperm resulting in lose of fertility, deformity of the penis, cognitive and memory impairment, and even cancer with long term use. The VA urologists hand this pout like candy and for long term use ages, They site a PDR that is 5 to 7 years old and because the pharmaceutical company sells it in huge dosages to the urology departments of the VA Yes the pharmacy reps and doctors are in cahoots and get favors!! THey the VA urologist will not look up all the dangers of finasteride use on the internet and tell veterans falsely all these side effects are due to enlarged prostate – a lie !!

        I would suggest any older veteran begin given finasteride for enlarged prosate look at all the lawsuits and also complaints on the drug via the internet that the VA doctors (urologists wont do) Neither are any veterans being warned about many side effects of this drug. Finasteride is the only drug used to treated en;raged prostate in the VA pharmacy so if one asks to switch to a better drug without the permanent side effects they are denied.

        Any veteran fitting into this class with the drug finasteride please contact me at [email protected] to enjoin in a class action lawsuit against the VA.

        Lee Horowitz, M.Ed, CAGS
        US Navy disabled Vietnam Era Veteran

      6. You may have to travel to find a good VA layer or law form or veterans law project as many of them are in larger cities bout its well worth it and they do take cases pro bono usually on a % basis if they feel you have a winner Sometimes they may have many cases and refer you or you may have to find another one Its doesn’t mean you still dont have a case Try to put your demands for care in a certified documented letter to the VAMC your dealing with outlining dates and everything and what has has happened and your demands. They may try to ignore you but that is ammunition for your attorney i

        If they arrange a meeting with you have your lawyer or witness there They ban recording devices If they threaten you walk out . If you see people in secret service suit or boots, ext leave immediately Watch what you say and never get angry as they will take your compliant out of context and say you were “manic” and then lock you up in VA mental ward and label you as dangerous. THis is retaliation when veterans demand their cvil rights to proper care they use intimidation or any way they can discredit you They take justified anger as “manic” and then start telling you and very one your delusional to lock you up If any doubts about any meetings with VA officials leave and alway have someone with you to document They use intimidation and power to label you and your justified demands Be acre full. Also if your locked up they shoot you with all kinds of drugs as well.

        As a former psychologist I have often wondered how the VA can justify locking hop veterans in locked mental wards only that come in voluntarily i.e. depression, hit in the head with a pipe by a robber, etc In most VAMC there are only locked wards while in state or local facilities there are locked and unlocked wards based on on voluntary or involuntary and if one is a danger to ones self or others. The VA is in fact by having all locked wards is breaking the federal governments requirement and federal civil right for all patients to be put into least restrictive environment based on their disability We sued the city of Philadelphia and Philadelphia nursing home in which a disabled person using a wheelchair was illegally thrown into a nursing home as the city shelters were not handicapped accessible ( illegal) The VA needs a big lawsuit as well

        A veterans/aging and disability civil rights advocate

        Lee Horowitz , M.Ed, CAGS
        US Navy Disabled Vietnam Era Veteran
        [email protected]

  7. I’m going to sue the fed govt, the state of md. For exposure to chemicals during the viet nam war if my claim is not right from aberdee proving grounds md during the war. Ever heard of Erin brockovich?

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