Introduction to Veterans' Benefits: Recording

This recording "Introduction to Veterans Benefits" was produced by the Legal Aid Foundation of Los Angeles in 2009.
 In one short hour, it develops a basic understanding of the veterans benefits system, focusing on the two major income-based benefit programs for disabled veterans and their families. It also briefly reviews the Department of Veterans Affairs adjudication process and discuss practical tools for effective advocacy on behalf of VA claimants. It is aimed at lawyers serving veterans, but it can also be useful for veterans and their family members.
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A New Day at the Seattle VA: A True Story of Excellent Customer Service

Last week a veteran's mother called Veterans and Friends of Puget Sound with a problem. The veteran was at a VA facility in Washington State outside Seattle with a serious medical condition. The mother, who lived out of state, explained that the veteran needed and wanted to be transferred to a facility nearer his family so they could assist with his care. For medical reasons, this had to be done in a hurry and she was flying in to Seattle at the end of the week to escort him.

(I apologize if this story seems a little vague, but we can't use names, for privacy reasons.)

This posed problems. She didn't know how to make arrangements for the facility back in her home state to receive him, get his records, find a bed and so forth. Also, he had lost his photo ID, and we all know that it's almost impossible to fly without it. The need for speed was driving this situation right into major roadblocks.
Time was short. Frankly, it didn't seem likely that this could all be taken care of by the weekend.
VAF contacted the head of Customer Service at the VA Hospital in Seattle. Within a short time, he was talking things over with the mother and making arrangements for the veteran to get into the facility nearest the mother's home.
The ID was a harder problem. Fortunately the veteran was already registered with Puget Sound VA System, so they had photo on file. The Customer Service Manager pushed to get his photo ID reprinted and delivered in time for them to make their flight; he even stayed an hour after his work shift to ensure the ID got into the mother's hands on time.
It all worked!
This weekend we spoke with the mother, who tells us the veteran is now being cared for in the new facility. Mission Accomplished!
This is a good example of what looks like a new day at the Seattle VA. VAF is encouraged by stories like this, in which problems get solved by treating veterans like valued customers. While it's our job to keep looking for issues to work on, we're happy to report that many of them are now being dealt with and we stand in support of this positive trend. If we can all keep working in our various roles, there is no reason why Puget Sound VA Hospital System cannot return to being in the Top 10 VA facility and start competing for the Number 1 spot.

Hoorays For The Valets!

We would like to thank Yonatan Teklai and Kudus Ghebreslasie, part of the team of valets working at Veterans Administration Hospital in Seattle, for their help last week to an elderly veteran.
Why is the valet service so important? Imagine that you have trouble walking and are coming to VAH/Seattle for medical care. When you get to the main entrance, what are you going to do with your car? If you park in the lot, you have a long uphill walk into the building. If you're in a wheelchair, it's a difficult push!
To help out with this problem, valet parking has been available at VAH/Seattle ever since we got funding for it, and apart from an organizational hitch around New Years', it's been working pretty well. We don't have exact numbers, but from the samples we've observed whenever we visit, there must be several hundred veterans being served every business day! That's hundreds of veterans getting the practical help they need at the start of the process, in getting from their cars into the building.
Here's a true story. Last week we were helping a veteran who is unable to maneuver his wheelchair on his own. He got out at the main entrance and the valets parked his car while his wife took him to see the doctor.
When it was time to go home, she was prepared to wheel him to their car, but it can be difficult to take a chair down the hill safely. Also it can be hard to get from a wheelchair into a parked car when there are other cars parked next to it. Finally, the weather here in Seattle is often too wet for the comfort and safety of fragile elderly people to be out in.
No problem. Yonatan and Kudus were right there and went into action. One of them went to get the car, and then they both helped the veteran in and stowed his wheelchair. The veteran and his wife didn't have to fight the hill, the other parked cars or the weather; their departure from VAH/Seattle was just that much safer and that much faster.
We reserve the right to complain when things don't work, but that gives us the responsibility to praise when things do go right. On behalf of the veterans and their families who they have helped, we say to the Valets of the VA: THANKS!

Welcome Dane Olsen

The Seattle VA Hospital has a new Customer Service Manager: Mr. Dane Olsen. He's so new there that he doesn't have a business card to hand out or an official photo for us to post, but he met with two members of Veterans and Friends of Puget Sound last week in the PA's office.
We were duly impressed with his commitment to getting the best possible care to America's veterans who have earned it. We frankly pummeled him with questions, which he calmly received and then responded appropriately to.
Mr. Olsen is an Airborne Veteran of Operation Just Cause, the 1989 invasion of Panama. Apart from his evident fondness for jumping out of a perfectly good airplane to get shot at, he seems like a reasonable guy. If you see him in the halls of the hospital, why not step up, introduce yourself and talk with him a bit?
Veterans and Friends looks forward to working with him!

Why Give Up on MIST Treatment and Crow Boot? Jack Kegley's Story

UPDATDJack Kegley, USMC

UPDATED: 5/18/2013:
Mr. Kegley reports that he is now getting treatment that is satisfactory to him. Thanks for everyone's help!
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ORIGINAL STORY:

Jack Kegley USMC is a 100% disabled Veteran (Vietnam) currently receiving treatment at the Seattle VA.

With the use of treatment such as MIST therapy, skin grafts, negative pressure therapy and specialized boots to offload the wound, his wound shrunk to the size of a pencil lead and was continuing to heal. Then the VA decided to give up on him. Why?

In 2007 Jack sought treatment of a diabetic ulcer about the size of a quarter, on his right big toe. Elderly diabetics are frequently at risk for injuries of this sort and, if not properly treated, they can grow to the size of a nickel or quarter, and compromise the patient's health generally.  For two years he was treated weekly at the dermatology clinic where a nurse practitioner would debride the foot (that is, scrap off any dead tissue), wrap it in a bandage and send him on his way. This did not result in healing.

Typical "Crow Boot"

In 2009, a new approach was tried: instead of treating Jack as an ulcer with a patient to be managed, he was treated as a patient with an ulcer to be healed.. The more aggressive and holistic approach went after not just the dead tissue of the toe, but the entire patient's nutrition (vitamins and minerals), blood sugar, bio mechanics of walking and so forth. This included the use of a Celleration Corporation “MIST Treatment” (which is also approved at other VA facilities and at Madigan Hospital). Plans were made for a "crow Boot" made to offload the foot even further and perhaps a skin graft to close the wound completely. The ulcer began to shrink and reached the size of a pencil lead.

However toward the end of 2012 that treatment was terminated. The Mist Treatment device was taken away and the previous, ineffectual treatment of scraping the wound was resumed. What does this mean to Jack?

He wrote to the VA several times:

"Let me start this conversation by stating that I am pleased with the level of care that has been provided to me, under most circumstances, by those I have worked with at the VA Seattle and that the following is not reflective of the entire staff and facility.

I am now back at the position I was a year ago with no indications to what type of progress they expect to make, how they expect to offload the weight on my toes (I now have wounds of both large toes) or give me any indication as to the future plans.  They are even talking about taking the scooter away at some point in the future.  I will not tolerate going backwards, I will get out of the VA system and seek private care before I let this return to a point it was a year ago.
Now that they have cancelled the crow boot which was suppose to offload my right foot, and made other changes that do not give me confidence, there are no indications as to when they expect to do anything other than debride the foot.
It has now been 8 weeks since Podiatry took over care of the wound, I am no better than I was when they started, my second toe is healing as expected (but no indication as to why the foot blistered in the first place) and secondary wound has occurred on the side of the original injury.  When I was receiving the Mist treatments, infections were non existent ( I am now under antibiotic care for an additional 6 week to fight a new infection) and an explanation was never given as to why I only received 3 of 27 mist treatments authorized by fee services and why the treatments were cancelled. No plans have been discussed as to future offloading of the wounds or future treatments other than a weekly debridement.  That treatment has now been denied for the future with no explanation to me as to why.
As a Marine I learned the difficult we did right away and that the impossible took a little longer.  I will not stop this type of correspondence until my status returns to a satisfactory state or this issue is resolved.
Sincerely
John M Kegley
USMC"

Lest you think that MIST Technology is some strange, new-age things, see the Bibliography of studies proving its effectiveness. It's not as cheap in the short run as debridement but, on the other hand, it was fixing the problem. The crow boot is not exotic either.
The VA system is not a privilege or a nice-to-have; it is a right that was earned by service to our nation. It is not a place to mess around; it is a place to implement effective treatment. Why was the treatment that was working ended and the treatment that was not working resumed?
Why the change?
Who benefited from stopping the treatment that worked?
So far, Jack has written several times to the VA and not received any response giving him a satisfactory response as to why the Seattle VA Hospital decided it didn't like MIST treatments and the crow boot. What will it take to get these questions answered and effective treatment resumed?

Saluting The Speechless

This week at the VA Hospital on Columbian, I was working with a client. He was there with two family members, I was with another volunteer from Veterans And Friends of Puget Sound, and jointly we were shepherding this elderly veteran through the process of getting the basic exam necessary for medical assistance there.

He was certainly deserving; he was a member of The Greatest Generation and I won't go into the details, for the point of my story was this: he could no longer speak or write. Communication was difficult. It seemed as if he had lost mental function, and it's hard to tell whether he had, for his hearing was not the best either. People around him typically spoke of him in the third person; there seemed little point in speaking to him since he could not respond and it was not clear that he understood anyway.
This changed when one doctor was told that the client was hard of hearing. The doctor started giving directions in a loud voice: "Can you raise your right hand? Can you give me a thumbs' up with your left hand?" and so forth. The client did all that, subject to some restrictions obviously of a physical nature. It became apparent to me that he was mentally alert to a significant extent.
I didn't know what to do about that. I made an effort thereafter to speak loudly into his ear where we were going next, "We need to get a blood draw, is that all right?" But it is hard to keep this in mind, when the responses are minimal. The responses were there, but they were purely physical and difficult to feel as communication.
Then it happened. We were in a waiting area and, as often happens, struck up a minor conversation with another waiting person. When that person left, he looked straight at the client and gave him a salute. The client gave him a relatively sharp salute right back.
This nonverbal message communicated a lot: respect, presence, interaction, normalcy. It is a part of the military culture that was important to him. It was something he could do and feel good doing, and in the process receive the respect he merited.
For the rest of the visit, I made a point of encouraging those present to give him the salute. He always responded. After we loaded him into his vehicle to be taken home, I faced him and did what I have not done since the Boy Scouts: gave my best salute. He returned it with firmness.
There is nothing more to say.

What Does "It's Taken Care Of" Mean To You?

Last week I sat in a meeting with an Associate Director and a Patient's Advocate at the Seattle VA Hospital, and the question came up of necessary medical supplies for a disabled veteran with whom we are working.
"It's been taken care of," said the PA.
Now, in the real world, a problem is taken care of when it is solved. When a patient needs some supplies, it is taken care of when the patient has the supplies.
In fact, in business the problem isn't "taken care of" until the patient has the supplies and has been asked whether the patient is satisfied with the way things went.
That's how you stay in business. You take care of problems by taking care of your customer. They will then take care of you!
How it appears that "take care of" has another meaning: "not take care of".
Today I called the veteran's family and was told that none of the supplies had arrived. This is nearly a week after being told to my face that the matter was taken care of, I learned that not only was the matter not taken care of at that time, but nearly a week later it was still not taken care of ... and the veteran/customer/client had not been given any idea as to when it would actually be taken care of.
If this is what employees at the Veterans Hospital think is meant by "take care of", they need to be tested for their comprehension of the English language.
I will be checking with this veteran's family on a regular basis to see when the matter is truly "taken care of".
I have not named any names here so far. First, the veteran's privacy will be respected absolutely, and until the veteran receives the care earned by fighting for our country, I'm not going to risk the quality of care by even asking to print the name. Second, what has happened so far in this matter is an employee not doing his jobs, but the reason for it is not yet known; is it policy? is it the culture at the institutition? is it a failure of training or leadership? I know for a fact that there are some very, very good employees at that hospital, so until we find out, I won't blame or shame the individual employee, but only report the facts necessary to get the problem solved.