Bush Administration Proposes Cut in Veteran Benefits

kmchugh · Mar 26, 2005

This may be kind of a long post, but I want to show you exactly how decisions are made to treat veterans. I went to the VA website, and looked at eligibility criteria for treatment. Veterans looking for treatment either at the VA or at civilian hospitals through the VA are ranked according to priority status. The first think the VA considers is the discharge status of the veteran. Veterans who are discharged dishonorably are in most cases ineligible for treatment at the VA. Also, veterans who were disabled on active service due to injuries that were judged to be non-line of duty injuries are not usually eligible for treatment for those conditions. As an example, I remember a guy at the Army hospital at Fort Ord who had severely broken his leg in a motorcycle accident. At the time of the accident, a blood alcohol test revealed that the soldier was blind drunk on his motorcycle. Since it is clearly against regulations to drink and drive, the accident was determined to be non-line of duty. He was retained on active duty long enough to allow for completion of treatment (surgery, recovery, and rehab) of his injuries, then discharged as he was no longer able to perform the physical duties required in the military. Bottom line is that if you are injured on active duty due to misconduct, then you are not eligible for treatment at the VA.

Since all branches of the military expect service members to stay in shape, all have some form of physical training. In addition, service members are encouraged to participate in sporting activities. That includes intramural team sports, local organized sporting teams, even pick up games just played between troops. Every military facility has a state of the art gym. I had a First Sergeant once upon a time who told me that the only difference between the military and your high school gym class was that you never got to blow things up in gym class. Therefore, the disparaging insinuation made by MedicalMT1 notwithstanding, injuries sustained while participating in these approved activities would be considered line of duty injuries, and were they severe enough would allow for the service member to receive a disability rating. Consider this. While I was on my first tour in Europe, I considered myself something of a cowboy. I grew up around horses and could ride pretty well. At the time, there was a rodeo circuit in Germany, and a lot of Army and Air Force troops participated in the circuit. I tried my hand at riding bulls and bareback horses. Now, even though as a roughstock rider I truly sucked, I never got injured. If I had, however, the rodeo circuit was an approved activity, and my injuries would have been considered line of duty. (Well, at least as long as I wasn't drunk when I got on the animal.) End of story.

So how does the VA decide who to treat and when? This is from the VA's own website:

"The number of veterans who can be enrolled in the health care program is determined by the amount of money Congress gives VA each year. Since funds are limited, VA set up priority groups to make sure that certain groups of veterans are able to be enrolled before others.

"Once you apply for enrollment, your eligibility will be verified. Based on your specific eligibility status, you will be assigned a priority group. The priority groups range from 1-8 with 1 being the highest priority for enrollment. Some veterans may have to agree to pay copayments to be placed in certain priority groups."

It is strictly a funding-based decision. It is set up to ensure that those veterans with service connected conditions are treated first. Her sad story not withstanding, how fair would it be if the VA paid for the MedicalMT1's appy, but turned away a veteran for treatment who had a condition s/he incurred as a direct result of military service? If you are interested in seeing how the priority groups break down, you can go to this website:

http://www.va.gov/healtheligibility/eligibility/epg_all.asp

Those of you who decry the current "funding cuts" are simply incorrect. As demonstrated by the web site that Begalli sent us to, funding for veteran's issues are increasing, not decreasing. On the other hand, as Deb has pointed out, the numbers of disabled veterans may be going up, though I haven't seen any figures to back that up. Given that this is true, shouldn't the money we have allocated to veterans issues be spent on those with service connected conditions? Or are all of you suggesting that the VA should provide full care to ALL veterans free of charge? If so, be prepared to increase VA funding by at least 10 times the current levels.

That doesn't mean that there are not things to be concerned about where veterans care is concerned. There is room for nurses to advocate for veterans, but channel that energy in the right direction. I'll write more about that in my next post.

Kevin McHugh

barefootlady, ADN, RN · Mar 26, 2005

Hi Kevin,

Thank you for sharing your knowledge of the VA system with those of us who do not have much contact with it.

You asked if the VA should provide care for non-service related conditions, and my first response is no, it should not. I do wonder about the vets who claim problems related to incidents that occurred during their service time and yet the VA denies a problem. Agent Orange comes to mind, Anthrax vac too.

I am just angry that as a nation we seem to be more concerned in handing out all types of goodies to other countries and letting our own citizens go without care. Sure, this is not a new story, but it is a sad one.

Anyway, thanks again and have a Happy Easter.

jnette, ASN, EMT-I · Mar 26, 2005

Kevin.. maybe I'm confused, or perhaps just been out of the loop too long.. but since when has the VA started providing care to vets for service related conditions only ? That's not what I was given to understand many moons ago.

And all the vets in my community as well as my patients at work all go to the VA for tx. of a variety of conditions.. none of which are "service related".

Please clarify. :)

allnurses Guide · Mar 26, 2005

Kevin -

Thanks so much. I knew there was another side to the story. My dear husband said essentially the same thing.

I'm not a vet so the VA stuff is new to me. My father-in-law is a WWII vet and gets great service at our local VA hospital.

steph

ayndim · Mar 26, 2005

Kevin.. maybe I'm confused, or perhaps just been out of the loop too long.. but since when has the VA started providing care to vets for service related conditions only ? That's not what I was given to understand many moons ago.
And all the vets in my community as well as my patients at work all go to the VA for tx. of a variety of conditions.. none of which are "service related".
Please clarify. :)

The VA will provide service to all vets who did not get dishonorably discharged -- providing their are funds/space available. There is a list of the priorities on the VA website. I agree with Kevin. It is a nice service but should not be relied on for non-service connected problems. I personally have never had a problem getting seen for any reason at our local VA hospital/clinic (Carl T Hayden). My co-pay is based on my household income. But since I give them my insurance info they bill my insurance for non-service connected issues. I pay a co-pay for things not covered by my insurance, such as immunizations. I think I paid $10 for my nursing school shots. Billing my insurance keeps me from paying co-pays while bringing in money for the VA so they can provide care for another vet. If you have a service-connected problem you will have no co-pay and are guarenteed to be seen.

With all of that said, I never expected, unless I was career, that I would get free medical for the rest of my life. BTW, careers get seen at the military hospital for free. If you are in a financial situation that you are in poverty and have no medical you should apply for medicaid. The VA is really only intended for service-connected disabilities. Seeing other vets is just a nicety.

My dad is a WWII vet. Although he doesn't normally use the VA if he chooses to he has never had a problem. In fact, when he could not get a flu shot from his regular dr during the shortage my hubby took him down to the VA. He had a wait but he got it free of charge. And since the VA was strict about only giving it to at-risk people everyone in line that day who needed it got it.

kmchugh · Mar 27, 2005

As opposed to the way you choose to look at it, which must be right? Everyone understands what Kevin is saying. What we are saying is that we owe our veterans more. It is a difference of opinion, not an inability to understand.

More to follow later, but it's not a matter of how anyone chooses to look at it. It's a matter of criticism based on incorrect information. The presumption of some is that at some point, the government promised all vets free medical care for life. It never happened. There also seems to be this lie running around that Bush is cutting veterans' benefits. Also not happening. Spending on veterans is going up, not down. If you feel that the US owes our veterans more, fine. But there is no need to believe false information to support your viewpoint.

Personally, I've always felt that there was more we could do to honor at least some of our veterans. Taxes are essentially a payment we all make to have our system of government, to support our common nation. I believe that veterans who are disabled at any level as a direct result of combat have already paid the bill in full, and should be exempted from federal and state income taxes for life. I can believe this with a clear conscience. None of my injuries were sustained as a result of combat, therefore I would not benefit from such a law.

Kevin McHugh

LydiaNN · Mar 27, 2005

I actually understand the information perfectly, thank you. My conscience is clear as a bell, over this issue anyway.

kmchugh · Mar 27, 2005

First, to answer a couple of other posters:

I do wonder about the vets who claim problems related to incidents that occurred during their service time and yet the VA denies a problem. Agent Orange comes to mind, Anthrax vac too.

You get no argument from me on this point. In fact, under the law, if a veteran claims a condition stems from military service and there is evidence that could back this claim up in the veteran's medical record, then the VA is required to presume the condition is service related. Then the VA must award a disability rating to that veteran. It has been my experience, and the experience of a large number of other vets that the VA does exactly the opposite. If they can in any way find against the veteran, they will do so. The only sure way to receive a disability rating is to receive it at your discharge from the service. I believe that with both the Agent Orange and the Gulf War syndrome debacles, the VA has fallen flat on their collective face.

Kevin.. maybe I'm confused, or perhaps just been out of the loop too long.. but since when has the VA started providing care to vets for service related conditions only ? That's not what I was given to understand many moons ago.
And all the vets in my community as well as my patients at work all go to the VA for tx. of a variety of conditions.. none of which are "service related".
Please clarify. :)

Jnette, please go to the VA site I referenced earlier. I didn't say that vets with conditions that were not service related wouldn't get treatment. I did say they came further down on the priority list for treatment. If there are limited dollars, then the veteran with the service connected condition will be seen first. As an interesting side note, even those with service connected conditions can't get everything they want. Given my history with the VA, I am terrified at the prospect of having a knee replacement done at any VA facility. But, in order to have it done at a civilian hospital, I have to apply for fee basis treatment first. If I just go out and get it done (as MedicalMT1 did with her non-service connected appy), the VA won't pay for it, even though the condition is service connected.

None of what I have written to this point is in any way meant to imply that I think things are "hunky dory" with our treatment of veterans. In fact, to quote myself from earlier in this thread: "You want to hear horror stories about the VA, I can tell them to you by the bucketful. But these horror stories cannot be laid at the feet of the current president. Nor can they be laid at the feet of past presidents. They are not the result of budget cuts. They are the result of an entrenched bureaucracy, with a total unwillingness to face reality." I wrote a rather long post about the problems I have seen at the VA in this thread:

https://allnurses.com/forums/showthread.php?t=58910&page=2&pp=10&highlight=Veteran%27s+administration

(Scroll down the page, you will find a rather long post from me about abuses at the VA.)

Since writing that post, I have moved again, and am now seen at the Memphis VA. Even though I have been here for less than a year, I could add still more stories to what I have written earlier, but I think my point is made. Thinking about it, I still don't really think that the problems our vets face can be laid at the feet of any presidential administration (which idea started this thread). The problems at the VA's are deeply entrenched and ingrained. I think the problems can be distilled down to just a few root causes:

-Current VA Facilities: In the middle of the last century, we had an astounding number of veterans with injuries related to military service. WW I vets were still around, and there was a new crop of vets from WW II. The numbers were staggering. Hence, a large number of VA Regional Centers and Medical Centers were built. At the time, it was the most efficient, cost effective way to deal with the large number of men and women with health conditions related to government service. However, as the years passed, veterans of these wars began to die, and we have not had a military of anywhere near that size since 1945. But the infrastructure to support that number of veterans continues to be operated even today. It is ludicrous.

Consider that all these facilities were built in the early 50's at the latest. That makes the youngest among them over 50 years old. This makes for very maintenance intensive facilities. In more than one VA Medical Center I have been to, entire wings have been shut down due to a lack of patients to fill them, and a lack of funding to keep them adequately maintained to a safe standard.

-Government employee syndrome: Its is such common knowledge in our society that it has become a cliché. You can't fire a government employee. On top of that, the government offers one of the best retirement plans in the country. Hence, there are a huge number of people working for the VA who know that whether they do a good job or not, whether they treat veterans with dignity and respect or not, their job will be there tomorrow. And keep being there right up to their retirement. So, they treat no one with any respect whatsoever. The studiously ignore people. I have been to wings of VA hospitals where the entire shift of nurses are sitting at the desk with four or five patient call lights going off, and no one doing anything about answering them. In fact, in one case, with no less than five patients looking for help, I watched four VA RN's sitting at a desk, ignoring the lights, complaining to one another about how hard they had to work. It is an entrenched philosophy, one which can no longer be easily overturned.

So, what's the answer? What should nurses be vocal about if they want to see our veterans treated better? Here it is in a nutshell. Keep the VA Regional facilities, where the administrative work is done. Close everything else. Shut the doors of every VA hospital in this country, fire all the employees, and set up a program whereby veterans could seek care from physicians and facilities they trusted. Keep the priority system, yet have more money to treat vets with conditions that are not service related. No more money would have to be spent keeping antiquated facilities and equipment running. No more money spent on caregivers who couldn't possibly care less.

Want to see better treatment for more veterans? Shut it all down, throw it all out, and let private care providers compete for the same amount of government dollars to treat our veterans. The private medical sector at least understands what happens when they treat patients in a shoddy fashion.

Kevin McHugh

SmilingBluEyes · Mar 27, 2005

As opposed to the way you choose to look at it, which must be right? Everyone understands what Kevin is saying. What we are saying is that we owe our veterans more. It is a difference of opinion, not an inability to understand.

thank you. I am done trying to defend how I feel and others assuming I dont' understand what they or I am saying---- in their efforts to prove me wrong. I am simply not interested in "out-debating" anyone.

Emotional? Yes you bet. :angryfire I realize that does not make for good debate. Oh well. My feelings are unchanged. NOT ONE Veteran should ever be able to say he/she was neglected or refused treatment after honorable service to his or her country. By consistently denying things like Gulf War Syndrome exist and therefore refusing to treat them, shows me our government has no desire to care for our fighting men and women once they have gotten their use out of them..... these people who have made ultimate sacrifices--- broken bodies and minds left.

Until not ONE honorably discharged war veteran can tell stories of neglect by our government and its sorry VA System, I will not change my feelings or accept that cuts of ANY type be made in the budget for them.

Enjoy the debate. I am out of here.

kmchugh · Mar 27, 2005

Emotional? Yes you bet. :angryfire I realize that does not make for good debate. Oh well. My feelings are unchanged. NOT ONE Veteran should ever be able to say he/she was neglected or refused treatment after honorable service to his or her country.

Arguing from emotion is fine. However, it seems to me that at least the emotion ought to be based on factual, correct information. This is like getting angry because someone told you that the draft was reinstated already, and was only drafting people who earned less that $30,000 a year. You are getting mad about something that simply is not true. Someone jumps up and says "Look at what Bush is doing now!!" and there is a rush to get angry and believe whatever accusation has been hurled his way. In the rush, no one ever checks the facts, and even when the accusation is proven to be wrong, well, let's not let something as trivial as incorrect information get in the way of a good Bush bashing.

Once more, here are the FACTS:

1. Funding for veterans' affairs is going up, not down. See the article referenced by Begalli.

2. Service in the US armed forces does not guarantee free medical treatment for life. If there is space available, a veteran with a non-service connected condition will be seen (and I've never seen anyone turned away for treatment). However, if there are veterans with service connected conditions, they will have a higher priority for treatment than those without such conditions. That seems fair to me.

3. If a veteran goes to a civilian facility for treatment of a non-service connected condition, emergency or not, the VA is under no obligation to pay for that treatment unless there was prior approval for the treatment on a fee basis. If you are going to be angry with anyone regarding MedicalMT1's story, then you have to be angry with the first doctor at the VA who treated her, and at Maria herself. She didn't stand up for herself when she received treatment the first time at the VA. She didn't return to the VA for further treatment. She went to a civilian hospital for treatment of a condition that was in no way connected with her military service. She then expected the VA to pay for that treatment. And she didn't give all those facts up front, just those that would ensure anyone not familiar with the VA system would be angered at her "mistreatment." Now she's mad at me, because I am familiar with the system, and I called her on it.

These are not new facts. I got out in 1993 after a 14 year stint in the US Army. At the time, the same facts held true. In fact, on my discharge from the military, a VA representative explained all these facts to us. The priority system was explained.

Sorry, but the VA does not exist to provide free medical treatment to all vets for life. It can't, it is no where near adequately funded for such a mission. If you want to get mad, fine. Just be sure that you are elevating your blood pressure over facts that are nominally correct.

Kevin McHugh

allnurses Guide · Mar 27, 2005

Arguing from emotion is fine. However, it seems to me that at least the emotion ought to be based on factual, correct information. This is like getting angry because someone told you that the draft was reinstated already, and was only drafting people who earned less that $30,000 a year. You are getting mad about something that simply is not true. Someone jumps up and says "Look at what Bush is doing now!!" and there is a rush to get angry and believe whatever accusation has been hurled his way. In the rush, no one ever checks the facts, and even when the accusation is proven to be wrong, well, let's not let something as trivial as incorrect information get in the way of a good Bush bashing.
Once more, here are the FACTS:
1. Funding for veterans' affairs is going up, not down. See the article referenced by Begalli.
2. Service in the US armed forces does not guarantee free medical treatment for life. If there is space available, a veteran with a non-service connected condition will be seen (and I've never seen anyone turned away for treatment). However, if there are veterans with service connected conditions, they will have a higher priority for treatment than those without such conditions. That seems fair to me.
3. If a veteran goes to a civilian facility for treatment of a non-service connected condition, emergency or not, the VA is under no obligation to pay for that treatment unless there was prior approval for the treatment on a fee basis. If you are going to be angry with anyone regarding MedicalMT1's story, then you have to be angry with the first doctor at the VA who treated her, and at Maria herself. She didn't stand up for herself when she received treatment the first time at the VA. She didn't return to the VA for further treatment. She went to a civilian hospital for treatment of a condition that was in no way connected with her military service. She then expected the VA to pay for that treatment. And she didn't give all those facts up front, just those that would ensure anyone not familiar with the VA system would be angered at her "mistreatment." Now she's mad at me, because I am familiar with the system, and I called her on it.
These are not new facts. I got out in 1993 after a 14 year stint in the US Army. At the time, the same facts held true. In fact, on my discharge from the military, a VA representative explained all these facts to us. The priority system was explained.
Sorry, but the VA does not exist to provide free medical treatment to all vets for life. It can't, it is no where near adequately funded for such a mission. If you want to get mad, fine. Just be sure that you are elevating your blood pressure over facts that are nominally correct.
Kevin McHugh

Just a personal thought - I miss your posts, thanks for joining in on this controversial issue. I appreciate your input.

steph

begalli · Mar 27, 2005

The president's budget recommendations would translate to $351 million in cuts nationwide from veterans' nursing homes, resulting in 28,000 fewer patients being served, he said. That would mean a loss of about $11 million annually for New Jersey, which could force the state to shut one of its three nursing homes for veterans, said Pallone aide Matt Montekio.
The Congressional Budget Office also has said the budget plan falls $762 million short of what is needed to maintain current veterans programs, Pallone said. To close that gap, the Bush administration has proposed a $250 annual enrollment fee for medical care and hiking prescription drug co-payments from $7 to $15. The enrollment fee would generate $1.75 million and the co-pay would raise more than $5 million from New Jersey veterans, Montekio said.
http://www.nj.com/news/ledger/jerse...67323266050.xml

Here is more from that above linked article:

"Although the proposed 2006 federal budget calls for a 1 percent increase in the overall veterans affairs allotment -- from $67.5 billion to $68.2 billion -- some programs are recommended for cuts, in part to compensate for rising disability and pension costs."

Once more, here are the FACTS:
1. Funding for veterans' affairs is going up, not down. See the article referenced by Begalli.

Some of this article speaks only of how Bush's plan would impact New Jersey veterans.

Looks clearly to me, according to the analysis in this article, that the Bush Administration's plan would have vets paying for that 1% increase in the overall allotment themselves. They will pay by losing existing services, paying an enrollment fee and paying more for perscription drugs.

We are NOT talking knees and appys here with this plan. We are talking medications that maintain life and taking care of such basic needs to those vets who require skilled nursing care. To cut benefits to veteran's LTC is the lowest of the low. Where are these people to go and who pays for it Kevin? Medicare. And what's that I heard? Bush wants to cut Medicare as well?

Something that bothers me here is that in one breath Bush says there will be an increase. His next breath stinks as it outlines exactly where the increase is coming from - the vets themselves.

Get real. This is wrong.