The current health care debate reminds me of one of the most memorable episodes of the 1960's Sci-Fi series, The Twilight Zone. In this episode, a middle aged librarian, played by Burgess Meredith, stood before an enormous dias while a unformed bureaucrat repeatedly screamed that he was "obsolete!" The term "obsolete" was a code word for euthanasia and/or execution. Former Alaska Governor Sarah Palin’s reference to "death panels" invokes this scene. While not as dramatic as the Twilight Zone setting, many veterans claim that federal government health care "death panels" have been operating for decades by the Department of Veterans Affairs (VA).
The VA is required to provide free medical care to veterans who suffer from service connected illnesses or disabilities. Unfortunately, many of the reviewers who adjudicate these claims lack the medical or legal training or experience, to determine who actually suffers from service connected disabilities.
In the VA system, a veteran must first apply to the local Regional Office for benefits. After a six to nine month wait, the veteran may receive a compensation and pension exam, conducted by a VA doctor which may or may not validate his claim. Even if a disease or defect exists, the veteran must still show that it is service-connected. Although the VA is required to assist the veteran in developing a "well grounded" claim, the reality is that little or no assistance is provided. Rejection at this stage is common place.
The veteran may appeal a rejection to the Board of Veterans Appeals (BVA) and appear before a Veterans Law Judge hired by and paid for by the Department of Veterans Affairs. Veterans often wait years for these hearings. Although the system is supposed to be non-adversarial the burden is on the veteran to convince the BVA to overrule the Regional Office. In many cases, the BVA rules against the veteran or remands the matter back to the Regional Office where it will languish for additional months or years before being rejected again.
A veteran may appeal a decision of the Board of Veterans Appeals to the Court of Appeals for Veterans Claims, a court unique to the VA. Unfortunately this court is limited in its jurisdiction and can generally examines only legal issues. Factual review is extremely limited. Again the pace is excruciatingly slow and a decision by the court will take many months.
For decades the VA refused to allow attorneys to practice before the BVA or the Regional Office. Although volunteers and paid employees of service organizations tried valiantly to represent the veteran, they were not experienced attorneys. It was an unfair fight and the losers were the veterans. Even now, attorneys cannot be compensated until after the Regional Office has rendered their initial decision.
The key to solving the real and perception problem is the BVA. Thorough preparation and a fair non-adversarial hearing can go far to resolving the issues. This process allows the veteran to go one on one with a Veterans Law Judge to make his case. The careful application of laws and regulations to the facts should be the watchword of the BVA. The Veterans Law Judges must ensure that the issues are fully vetted and strive to make the right decision the first time. This will eliminate the need for costly and time consuming remands and increase the confidence of the veterans in the system. More importantly, it will allow scarce funding to be utilized for veterans benefits and not procedural missteps. Hopefully it will end the comparison of the VA health benefits system to the feared "death panels."
President Obama's choice of General Eric Shinseki for Secretary of Veterans Affairs was a good one and the process appears to be slowly improving. It is certainly headed in the right direction. A comprehensive approach at the BVA level will streamline the claims process and provide needed guidance to the Regional Offices to assist in their initial adjudication of veterans' claims.