[ The VA is unprepared for a flood of claims from veterans
disabled by toxic exposure.]
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PACT ACT PROBLEMS  
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Suzanne Gordon, Steve Early
April 6, 2023
The Progressive
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_ The VA is unprepared for a flood of claims from veterans disabled
by toxic exposure. _

n this February 4, 2013, file photo, US soldiers watch garbage
incinerate in a burn pit at Forward Operating Base Azzizulah in
Afghanistan., CNN

 

When President Joe Biden braved Republican jeers and boos to deliver
his State of the Union address
[[link removed]] in February, one of the
few lines that received bipartisan applause recalled Congressional
action last year on what he hailed
[[link removed]] then
as the “most significant law our nation has ever passed to help
millions of veterans.”

Called the Promise to Address Comprehensive Toxics (PACT) Act
[[link removed]],
this legislation allocates $280 billion over the next decade for
health care and disability pay for former service members harmed by
toxic substances. An estimated 3.5 million service members were
exposed to noxious fumes from open burn pits and other hazards
[[link removed].] during
three decades of U.S. military intervention in the Middle East. Many
others developed long-term health problems during the Vietnam War
[[link removed]],
Cold War weapons’ testing
[[link removed]],
and even from serving in the United States, where some drank poisoned
water
[[link removed]] at
North Carolina’s Camp Lejeune.

Veterans’ organizations
[[link removed]] fought
long and hard for federal recognition of a devastating array of
service-related ailments. The PACT Act directs the Department of
Veterans Affairs (VA) to consider twenty-three conditions ranging from
bronchial asthma to a series of rare cancers as presumptively related
to burn-pit exposure and other environmental hazards. By January of
this year, according to VA Secretary Denis McDonough, his agency had
received about 278,000 PACT Act claims
[[link removed]],
processing nearly 40,000 of them with a much-improved 85 percent
approval rate.

The VA-run Veterans Benefits Administration
[[link removed]] (VBA) decides what compensation
veterans should receive if they suffer from toxic exposures and
whether they are eligible for care from the nation’s largest public
health care system, the Veterans Health Administration
[[link removed]] (VHA).

A recent national survey
[[link removed]] of
VA staff, interviews with their local union leaders and frontline
staff, and reports by the government itself reveal that VA functioning
has, over the last nine years, been greatly impaired by understaffing,
costly and wasteful outsourcing, and other organizational problems
inherited from the administrations of Barack Obama and Donald Trump.
Despite pleas from frontline staff and even some of their managers,
McDonough has, so far, failed to address these challenges.

As a result, too many veterans will continue experiencing what one VA
benefits expert, Gulf War veteran Paul Sullivan, calls
[[link removed]] “an
adversarial, complex, and burdensome claims nightmare,” which breeds
anger and frustration over delayed disability payments and health care
access. And when hundreds of thousands of new PACT Act patients
finally join the nine million veterans already being treated by the
VHA, many will discover that its direct care capacity has been
undermined and disrupted by years of privatization under the Obama,
Trump, and now Biden Administrations.

When McDonough became VA Secretary in February 2021, he inherited a
huge backlog of unresolved claims, including those filed by burn-pit
victims whose denial rate
[[link removed]] before
the PACT Act was 78 percent. As _Military.com
[[link removed]]_ reported
on January 31, the VBA’s disability “claims backlog, defined as
claims older than 125 days, has grown by roughly 50,000 since
September to 200,140.”

To reduce that caseload, the PACT Act authorized the Biden
Administration to hire
[[link removed]] and
train 1,900 new VBA employees to help veterans navigate the overly
byzantine and always time-consuming process of getting a “disability
rating.” These ratings are necessary to qualify for financial
compensation for service-related conditions and for health care
coverage—which some veterans receive based solely on their low
income or recent active duty in a combat zone.

According to a Veterans Healthcare Policy Institute (VHPI) report on a
survey of VHA and VBA staff represented by the American Federation of
Government Employees (AFGE), staffing shortages, inadequate training,
bad management, and unnecessary outsourcing continue to plague their
agency. VHPI found that 95 percent of the VHA survey respondents said
they had shortages of frontline clinical staff. Nearly 60 percent of
VHA respondents said there were vacant positions for which no
recruitment was taking place. (It even took the Biden Administration
two years to nominate
[[link removed]] a
permanent VA Undersecretary for Benefits.) Nearly 80 percent of VBA
staffers complained about caseload quotas that limit their ability to
help individual veterans with confusing paperwork or complicated
claims.

Veterans will continue experiencing “an adversarial, complex, and
burdensome claims nightmare.”

One of the biggest concerns raised by VBA employees involves the use
of private contractors to evaluate veterans’ health care conditions.
Most compensation and pension exams, as they are called, were once
handled by VHA clinicians with specialized knowledge of military
culture and the signature wounds of particular wars. During the Trump
Administration, thousands of VHA positions were left unfilled
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so these medical examinations were outsourced on a larger scale than
ever before. Private doctors working for the VBA were even permitted
to assess complex conditions like military sexual trauma, traumatic
brain injury, and Gulf War illness
[[link removed].].
According to a 2021 Government Accountability Office
[[link removed]] (GAO) report, about 1.1
million of the 1.4 million exams completed in fiscal year 2020 were
handled by outside physicians, who were projected to receive more than
$6.8 billion for this work over a ten-year period.

Unfortunately for veterans, the GAO found that “exam reports for
selected complex claims were returned to [outside] examiners for
correction or clarification at about twice the rate that exam reports
were returned overall.” This faulty work results in additional
claims processing delays and makes it even harder for overburdened VBA
staff to assign fair and accurate disability ratings—which are
themselves subject to further administrative and legal appeals, often
dragging on for years.

Other members of the AFGE and National Nurses United (NNU) warn that
VHA outsourcing has left their hospitals and clinics understaffed,
drained of resources, and, in some cases, facing the threat of
facility closings. Begun under President Barack Obama, the
ever-expanding privatization of veterans’ health care got a big
boost in 2018, with passage of the VA MISSION Act
[[link removed]], a
Republican legislative victory aided by many Congressional Democrats.

This enabled Trump’s VA Secretary, Robert Wilkie, to promulgate new
administrative rules that opened the floodgates for patient referrals
outside the VHA. To further accelerate privatization, Wilkie
intentionally left tens of thousands of VHA 
[[link removed]]caregiving
jobs unfilled
[[link removed]].
When Biden ran for President three years ago, he promised
[[link removed].] veterans
he would fill those vacancies and, unlike Trump
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[[link removed]] defund,
“dismantle,” or “privatize” the VA. But by 2022, almost
one-third of the VHA’s total annual budget was being diverted
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from direct care to reimbursement of 1.2 million private-sector
providers, whose treatment is often costlier and, studies show
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far less effective.

In a report to Congress last September, McDonough made the alarming,
but accurate, prediction that the “VA is rapidly approaching a point
where one-half of all care” will be outsourced. In the same
document, he acknowledged that in-house care is cheaper, faster, of
higher quality, and preferred by veterans themselves. Unfortunately,
McDonough has neither revised Wilkie’s patient referral rules nor
acted swiftly enough to fill a reported 59,000 VA
[[link removed]] vacancies.

Ending the severe shortage of VHA caregivers—documented in a VA
Office of Inspector General’s report last July—is essential for
proper in-house treatment of PACT Act patients. But rapid recruitment
of new employees has been impeded by a Trump-era human resources
modernization
[[link removed]] scheme
that made the VA’s notoriously cumbersome hiring process worse, not
better. That failed experiment centralized control over new hiring,
reduced the role of local HR staff, and replaced person-to-person
contact with an online system that McDonough continues to employ.

McDonough’s inaction on this and other fronts is a subject of great
concern among frontline VA staffers, a third of whom are veterans.
“We know that the VA delivers care that is far superior to the
private sector, particularly when it comes to emergency
care,” wrote
[[link removed]] James
Martin, a VA physician in Chicago who previously worked in non-VA
hospitals. “So why are we sending so many patients out to the
private sector? Why is my job caring for them becoming harder?”

By 2022, almost one-third of the VHA’s total annual budget was being
diverted from direct care to reimbursement of 1.2 million
private-sector providers.

In southern West Virginia, AFGE Local 2198 President Melissa Miklos
says her facility not only is seriously understaffed, but also is
slated to lose funding for already approved and scheduled construction
projects. Because of MISSION Act-mandated outsourcing, 65 percent of
the patients already served by the Beckley VA Medical Center now get
outside appointments, whether they want them or not. So, not
surprisingly, regional VHA leaders now tell Miklos there is no way
they can justify adding “another square foot to the Beckley VA.” 

Because of this, she fears that PACT Act patients with respiratory
problems will have trouble accessing needed care inside or outside the
VHA. Miklos says there is only one pulmonologist at the Beckley VA
Medical Center, and “he will be unable to handle the new patient
load.” Things are even worse in the private sector, she reports,
because local wait times to see a pulmonologist can be six to eight
months.

Irma Westmoreland, the VA chair of NNU, says that her own VA medical
center in Augusta, Georgia, and many others must hire more nurses to
deal with the growing influx of new patients. Unless McDonough
overhauls the VA’s current HR system, that won’t happen anytime
soon, she believes.

“You can’t get in touch with an HR person in a local facility,”
Westmoreland tells us. “You call and no one returns your calls.
It’s taking months to hire a doctor or nurse. Nurses aren’t going
to wait for months for a VA job when they can get one at a
private-sector hospital or sign up with a temp agency and earn
thousands and thousands more than at the VA. We want these patients
but there are not enough people to take care of them.”

As a former White House staffer under President Obama, McDonough knows
better than anyone that overseeing an expansion of benefit eligibility
and related care can be a risky assignment if the VA is not
mission-ready. In 2010, Obama’s first VA Secretary, retired
four-star general and Vietnam veteran Eric Shinseki, added just three
[[link removed]]—much
fewer than the PACT Act’s twenty-three—new health conditions to an
existing list of maladies linked to Agent Orange, the toxic
herbicide widely used
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a defoliant in Vietnam. Much applauded by veterans’ organizations,
this allowed additional Vietnam-era veterans to qualify for VHA
coverage.

But the VBA was soon inundated with new claims, creating a huge
backlog
[[link removed]].
As more claimants succeeded in getting health care access, VA
hospitals—still struggling to cope with an influx of younger
veterans recently returned from the post-9/11 wars in Iraq and
Afghanistan—faced heavier patient loads. At one short-staffed
medical center in Arizona, this resulted in appointment delays that
local administrators sought to conceal
[[link removed]] to
protect their own bonuses (the VA offered financial incentives for
quicker care). In the wake of sensationalistic national media coverage
of this local cover-up, Obama sacked Shinseki
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despite an otherwise positive record of accomplishment. And the door
was opened for privatization as a solution to real or imagined VA
shortcomings.

That history is relevant today. Republicans on Capitol Hill, who are
even bigger advocates of VA outsourcing than the Democrats who have
supported it, will quickly become opportunistic critics of any PACT
Act implementation problems. The GOP will try to turn those failings
into partisan advantage in 2024, particularly if Biden ends up running
for re-election against an Iraq War veteran, former Navy lawyer, and
former reservist from Florida named Ron DeSantis.

Biden can avoid that predictable flak only by living up to his own
2020 campaign promises and more recent PACT Act press releases
[[link removed]]. But that
requires more insourcing of veterans’ services, rather than further
outsourcing of essential VA functions. The for-profit hospital chains
and medical practices now benefiting from privatization will fiercely
oppose this change in course. But most veterans will strongly applaud
efforts to properly staff and fund their own health care system,
rather than turn it into a piggy bank for the private health care
industry. 

_Editor's Note: Suzanne Gordon is co-founder of the __Veterans
Healthcare Policy Institute_ [[link removed]]_, which
contracted with the American Federation of Government Employees to
conduct the Department of Veterans Affairs employee survey mentioned
in this story._

Suzanne Gordon is co-founder of the Veterans Healthcare Policy
Institute. She and Steve Early are freelance journalists and
co-authors with Jasper Craven of 'Our Veterans: Winners, Losers,
Friends, and Enemies on the New Terrain of Veterans Affairs.'

A voice for peace, social justice, and the common good! Since
1909, _The Progressive _magazine_ _has aimed to amplify voices of
dissent and voices under-represented in the mainstream, with a goal
of championing grassroots progressive politics.

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