Rao bulletin 15 January 2015 html edition this bulletin contains the following articles



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Fort Rosecrans National Cemetery
9. VA employees continue to work on the claims backlog. In FY 2014, VA decided a record-breaking 1,320,870 disability compensation and pension (rating) claims for Veterans and Survivors – the highest in VA history. Veterans waited, on average, 119 fewer days to receive a decision on their claims compared to the previous year. The claims backlog (any claim older than 125 days) has also been reduced from the peak of 611,000 in March 2013 to 239,000 as of Nov. 30, 2014 – a 61 percent reduction and lowest number of backlogged claims in four years.
10. Fully Developed Claims exceeding goals. VA continues to exceed goals with regard to Fully Developed Claims. In FY 2014, 39 percent of claims received were submitted as Fully Developed Claims, up from three percent at initiative start in 2012.
11. More Veterans and families sign up for eBenefits. By the end of FY2014, VA had registered 4.2 million Servicemembers, Veterans, and family members in eBenefits. In addition, approximately 2,000 VSO representatives have credentials for accessing eBenefits through VBA’s new Stakeholder Enterprise Portal, which enables them to file online compensation claims on behalf of Veterans.
12. VA goes digital. Under VA’s technology initiatives, one major achievement has been its transition from an outmoded paper-intensive process to a fully electronic processing system, the Veterans Benefits Management System (VBMS). Previously VA processed 5,000 tons of paper per year; now it is processing 93 percent of the disability claims inventory electronically. VA has converted over 1 billion documents to digital images that are being maintained in Veterans’ electronic claim folders. In FY 2014, 1.4 million rating decisions and 820,000 claims were completed using VBMS.
13. VA keeps reducing the number of homeless Veterans. VA, together with federal, state, and local partners, reduced the estimated number of homeless Veterans by 33 percent as noted in the Department of Housing and Urban Development (HUD) 2014 Point-in-Time (PIT) Estimate of Homelessness. In FY 2014 alone, VA provided services to more than 260,000 homeless or at-risk Veterans in VHA’s homeless programs. Not all Veterans required an intensive homeless program intervention, but for those that did, nearly 71,500 Veterans were either placed in permanent housing or prevented from becoming homeless.
14. VA hires more mental healthcare professionals. VA hired 782 psychologists and psychiatrists in 2014 as well as 257 other mental health providers, such as social workers, nurses and licensed professional counselors, and 45 mental health administrative support employees. These professionals are filling new positions and existing vacancies to meet the growing requirements for mental health services.
15. Veterans Crisis Line expanded to help more Veterans. In response to the President’s Executive Order, VA expanded the capacity of the Veterans Crisis Line by 50 percent, and enhanced its partnerships with community mental health providers. In FY 2014, the Veterans Crisis Line (VCL) answered 374,050 phone calls, assisted 64,593 people through chat services and 13,463 people through text services. VCL responders assisted in sending emergency services (rescue) to 9,719 Veterans. Call volume answered by VCL in 2014 increased by 30 percent. Chat contacts increased by 18 percent, and Text contacts increased by 19 percent.
16. VA expands care for Veterans with military sexual trauma. Under authority from VACAA, VA expanded eligibility for Veterans in need of mental health care due to military sexual trauma (MST) that occurred during their military service. The expansion primarily pertains to Reservists and National Guard members participating in weekend drill, gives the authority to offer Veterans the appropriate care and services needed to treat conditions resulting from MST that occurred during a period of inactive duty training.
17. More healthcare options for women Veterans. VA has enhanced provision of care to women Veterans by focusing on the goal of developing Designated Women’s Health Providers (DWHP) at every site where women access VA. VA has trained over 2,000 providers in women’s health and is in the process of training additional providers to ensure that every woman Veteran has the opportunity to receive her primary care from a DWHP. VA now operates a Women Veterans Call Center (WVCC), created to contact women Veterans and let them know about the services they may be eligible for. From April 2013 to April 2014 the WVCC received over 9,600 incoming calls and made over 93,000 outbound calls.
18. VA to reorganize and improve. VA is working to reorganize the department for success, guided by ideas and initiatives from Veterans, employees, and all of our stakeholders. This reorganization is a part of the MyVA initiative and is designed to provide Veterans with a seamless, integrated, and responsive customer service experience. The Department developed the Blue Print for Excellence- a detailed vision of how VA will evolve as a model national health care provider delivering both excellent health care and an excellent experience of care to all Veterans served.
19. Enhancing accountability. In 2014, VA established the Office of Accountability Review to ensure leadership accountability for improprieties related to patient scheduling and access to care, whistleblower retaliation, and related matters that impact public trust in VA. The U.S. Office of Special Counsel (OSC) certified VA under their Whistleblower Protection Certification Program after VA worked to achieve compliance and protect employees who identify or report problems from unlawful retaliation. VA also worked closely with OSC to successfully resolve whistleblower retaliation complaints filed by three individuals from the VA Phoenix Health Care System. In 2014, VA also began posting regular data updates that show progress in efforts to accelerate access to quality health care for Veterans who have been waiting for appointments. This data includes both pending and completed appointments at the facility level.
20. VA looks to recruit the best and brightest in the medical field. VA faces a competitive market to recruit and retain highly skilled health care providers, particularly mental health specialists, given the growing demand for these jobs in the private sector. Complex hiring processes for clinicians, to include requirements for boarding, credentialing, privileging, physicals, security/backgrounds, add to the department’s challenge. We are working to close the pay gap between VA and private sector clinicians to make VA an employer of choice.
21. VA listening to Veterans and VA employees. In the aftermath of Phoenix, Secretary of Veterans Affairs Bob McDonald instructed all VA facilities to hold town hall meetings to engage Veterans as well as the VA employees that serve them. As a result of that first round of meetings coast-to-coast, Secretary McDonald mandated quarterly town hall meetings as a way to continue to improve communications with Veterans. These quarterly town-hall events are an important step toward improving the delivery of benefits and services and rebuilding trust among all those VA serves.
Looking Forward to 2015
While many recognize these milestones, VA continues to tackle the challenges of the department. It also embraces the opportunities for transformation that they bring. To achieve lasting success for the department, VA must develop a strategy for meeting an increased demand for services and benefits, and for meeting the needs of a changing Veteran population. This includes preparing for the increasing numbers of women Veterans coming to VA for care; looking at the unique needs of post-9/11 Veterans; and using innovative approaches to reach every Veteran who needs services. Sec. Bob McDonald wrote in the Baltimore Sun in October “Veterans need VA, and many more Americans benefit from VA.” By focusing on three fundamental priorities in 2015 – rebuilding trust, improving service by putting the Veteran first, and setting the course for longer-term excellence and reform – VA’s employees can better serve our Veterans and the American people. [Source: VAntagee Point | Reynaldo Leal | Jan. 01, 2015 ++]
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VA Veteran Transportation Service ► How to Use
The Department of Veterans Affairs (VA), Veterans Health Administration (VHA) Healthcare System provides primary care, specialized care, and related medical and social support to serve America’s Veterans’ health and wellness needs. To do this, VHA needs to be a comprehensive, integrated healthcare system providing excellence in health care value, excellence in service as defined by its customers, and excellence in education and research. To enhance the VHA system, the Central Business Office (CBO) is launching a new transportation program for immobilized and remote VA patients to enhance existing programs implemented by local VA Medical Centers (VAMCs). Veterans Transportation Service (VTS) seeks to provide transportation services to include vehicle routing/scheduling software for VA Medical Facilities. The ride scheduling and routing systems will include GPS modules for VTS vehicles.

VA especially recognizes the problems Veterans who are visually impaired, elderly, or immobilized due to disease or disability, particularly those living in remote and rural areas, face in traveling to access VA health care. To work toward providing these Veterans with the most convenient and timely access to transportation services, VA’s vision is to explore the establishment of a network of community transportation service providers that could include Veteran Service Organizations (VSO’s); community and commercial transportation providers; federal, state and local government transportation services as well as non-profits, such as United We Ride, operating within each VISN or even local facility. This initiative will not replace current activities, but will rather supplement existing benefits and programs to improve access to VA health care.
This program is currently enabled at forty-five sites, and will be implemented at remaining locations by 2015. If VTS is currently available in your location you may get more information on scheduling a ride by clicking on the link for your location at http://www.va.gov/healthbenefits/vts/locations.asp?location=44. The information available there will tell you how to schedule a ride and provide a POC name, telephone number, and email addee. If you enter your zip code it will also provide a map of your geographies area showing the locations of VA facilities included in that area. [Source: http://www.va.gov/healthbenefits/vts Jan 2015 ++]
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VA Health Care Stories Update 05 ► Denied Colonoscopy Claims
Five years ago, V.A. hospitals mistakenly exposed thousands of veterans to potential infections like HIV/AIDS and Hepatitis. Ronan Farrow Daily and the NBC News Investigative Unit report that, for some that was just the beginning of the nightmare. VA sent letters to over 10,000 of them advising of the possibility of their exposure to a small amount of bodily fluids containing another patient’s virus. Subsequently, when some of these vets became ill and submitted claims for illnesses related to that exposure during their colonoscopies, they received denial letters stating there was no proof of exposure. To hear the full story of what happened and what the VA has done to date about it, listen to the NBC News video report at http://www.msnbc.com/ronan-farrow/watch/inside-the-v-a-colonoscopy-horror-374666819747. [Source: NBC News: Inside the VA | Ronan Farrow | Dec 18, 2014 ++]
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VA Whistleblowers Update 17 ► Unauthorized Disclosure Of Info Case
A DVA credentialing official who said VA supervisors sought to fire him for reporting the arrest of a high-ranking VA executive has been suspended from his job but won’t be fired. In a case that’s attracted the attention of Congress, Puerto Rico-based VA employee Joseph Colon-Christensen was put on notice of his proposed firing earlier this year after alerting the VA about the arrest of his boss, DeWayne Hamlin, director of the VA’s Caribbean network. A VA official presiding over Mr. Colon-Christensen’s case ruled that “the penalty of removal is not appropriate nor within the range of reasonableness,” according to a 23 DEC ruling on the notice of proposed termination. The termination notice against Mr. Colon-Christensen made no mention of Mr. Hamlin’s arrest, but Mr. Christensen said he learned about his possible firing soon after he’d alerted VA officials in Washington. And both Mr. Colon-Christensen and his attorney told The Washington Times in September that the timing of the termination notice raised questions about whether the move was retaliatory at a time when the VA was encouraging whistleblowers to come forward.
Mr. Hamlin repeatedly refused a breathalyzer and declined to identify the source of a narcotic painkiller pill found in his pocket after a Florida sheriff’s deputy spotted him in a parked car after 1 a.m. back in April, according to a police report. However, the Pasco County State’s Attorney’s Office later dropped drug possession charges over “concerns about the stop,” according to a memo obtained by The Times through an open records request. A drunken driving charge also was tossed. In email to The Times earlier this year, Mr. Hamlin called the arrest a misunderstanding. He also noted that he was being treated for a medical condition. He declined to discuss the arrest report, saying he did not want to discuss his personal medical information.
Mr. Colon-Christensen, a veteran himself, was suspended for three days over what the VA deemed an unauthorized disclosure of information. Records in the case reviewed by The Times, which were provided by Mr. Colon-Christensen, show that violation stemmed from emails that he had sent to a VA employee at another facility raising concerns about hiring practices. Mr. Colon-Christensen said he was disappointed with the suspension, even if the VA rejected the termination proposal. “The leadership in San Juan is trying to use me and others as an example to stop reporting wrongdoing,” he said 30 DEC. Mr. Colon-Christensen also said the suspension was the result of a “bogus fact finding” and that he did nothing wrong.
VA officials have previously declined to comment on the case, citing privacy rules that prohibit the agency from commenting on personnel matters. However, the agency directed The Times to previous statements by Veterans Affairs Secretary Bob McDonald, who has called whistleblower retaliation “unacceptable and intolerable” and who got the Cabinet job in the wake of the waiting-list scandals brought to the public’s attention by whistleblowers. “We are working hard to create and sustain a climate that embraces constructive dissent, welcomes critical feedback and ensures compliance with legal requirements,” Mr. McDonald told reporters earlier this year. “That climate mandates commitment to whistleblower protections to all employees.” The case attracted the attention of a key House Republican earlier this year. Though he did not mention Mr. Colon-Christensen by name, Rep. Mike Coffman (R-CO) wrote to Mr. McDonald about an accusation against a whistleblower for “voicing his concerns and complaints” about issues that included Mr. Hamlin’s arrest, which the lawmaker called “very concerning.” [Source: Washington Times | Jim McElhatton | Dec. 30, 2014 ++]

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VAMC Hampton VA Update 02 ► Longest Wait Times in Country
Local veterans have to wait a month on average to get an appointment with a primary care physician at the VA Medical Center in Hampton, longer than any other veteran’s facility in the country and significantly more than the national average of one week, according to the most recent data released by the Department of Veterans Affairs. The average wait time at the Hampton VA Medical Center and its regional clinics is 30.53 days. The second-longest wait time is 28.45 days at the VA in Fayetteville, N.C. Only four VA facilities in the country have wait times over 20 days. The national average, measuring from the preferred time for the appointment to the actual appointment, is 6.95 days.
The numbers come as little surprise. Veterans in the region have long complained that they can't get timely appointments with primary doctors at the Hampton VA, while the facility acknowledges it has struggled to meet increasing demand - up 7.5 percent between September 2013 and September 2014 - as the veteran population grows. In addition, the medical center has had difficulty recruiting and retaining primary care physicians while operating with too little physical space to efficiently provide its services. Those problems are being addressed, said Hampton VA Director Michael Dunfee, who spoke to reporters 6 JAN. The facility is actively hiring primary care doctors and has two expansion projects under way - one at the main facility in Hampton and a second in Virginia Beach, he said. "The challenge basically for us is first having the providers in place to provide the necessary capacity and then having the space - the clinical exam space - for them to provide care," Dunfee said. "We are working hard on both fronts and starting to turn the corner."
Dunfee said the medical facility lost a physician in December but added another to its staff last week, and it will add two more by the end of the month and another seven by the end of February. He said the medical center was able to boost its recruitment with a more enticing employment package that includes increased salaries and paying back student loans. That has generated more interest in positions at the VA and given the facility a better pool of applicants, he said. The expansion projects ultimately will give the VA 11 additional primary care rooms on its main campus in Hampton and as many as 20 more rooms at a second clinic in Virginia Beach, he said. Last year, the facility began offering night and weekend hours with primary care physicians because of the space limitations. Those services will continue even after the expansion is complete, but more daytime appointments will also be available.
Dunfee found some promise in the new data, noting that Hampton fared better in its wait times for other kinds of doctors. It still has the fourth-longest wait for mental health care appointments - an average of 14.7 days. But Dunfee said that number has held steady despite the increase in demand. And the wait time for specialty-care appointments, now at 12.7 days, has improved significantly, he said, pulling Hampton out of that top-10 list, though it's still double the national average. "I really do have a positive feeling about the actions we're taking," he said.
Dunfree said it's a mistake to compare wait times at facilities because each medical center deals with many variables, including patient population and the growth in that population, the types of services the facilities provide, the size of the actual facilities and its affiliations with local providers. Hampton suffered a higher than expected turnover in physicians in the past 18 months, losing nine primary care physicians between June 2013 and December 2014, compared with just three during the previous 18 months. With more doctors coming on board soon, Dunfee said, he believes wait times will improve by spring. He predicts that in six months, waits for primary care doctors will be nearer to 20 days. "This is not something that we take lightly in any way," he said. "But it's also not something that is an insurmountable problem." [Source: The Virginian-Pilot | Dianna Cahn & Mike Hixenbaugh | Jan. 07, 2015 ++]
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VAMC Grand Junction CO ► Vet Death Investigation Request
State lawmakers on 5 JAN asked the federal Department of Veteran Affairs to conduct a "rigorous, thorough and transparent investigation" into the care of a patient treated at the Grand Junction VA Medical Center who died in December. A legislative committee decided to send a letter to the Veterans Affairs after hearing from Chris Blumenstein, a former VA social worker who said he resigned last year to protest the kind of care Rodger Holmes received for his hepatitis C and urology problems. Holmes, a Vietnam veteran, died in December. "Rodger's treatment went very wrong," Blumenstein said. "I think our veterans from all over the state deserve better and I think we need to learn from this." The care Holmes received left him "sick, weak and depressed," Blumenstein said.
Blumenstein broke down several times when testifying before the joint House and Senate state affairs committees, which received an overview from the Colorado Department of Military and Veterans Affairs Department. Some of those hearing testimony were lawmakers-elect, who will officially be sworn into office 7 JAN when the 2015 session convenes. The first two signatures on the letter came from the Democratic committee chairs, Sen. Jessie Ulibarri of Westminster and Rep. Su Ryden of Aurora. Holmes was formerly homeless and addicted to alcohol before he entered a treatment program and moved into a housing complex for veterans four years ago. Since then, he had been sober and had been volunteering 20 hours a week at the Salvation Army.
During a news conference last year on Veterans Day, Blumenstein and Holmes talked about how the Vietnam veteran became incapacitated during his treatment with three powerful drugs to kill the hepatitis virus. In a detailed time-line outlining his treatment at the VA hospital, he said his care was passed off to a primary care physician, a nurse practitioner and a pharmacist as his health deteriorated to the point that he was hospitalized and then placed in a VA hospice/nursing home unit for three months. Holmes said he was never given the option of seeing a liver specialist outside the VA medical center in Grand Junction. The center was one of those cited in nationwide federal investigations for deficient care and for not adequately addressing whistleblower complaints. Three days before Holmes' death, Colorado U.S. Sen. Michael Bennet sent a letter to the acting inspector general of the Department of Veteran Affairs requesting an investigation into Holmes' course of care at the Grand Junction VA Medical Center. [Source: The Denver Post | Lynn Bartels| Jan. 05, 2015 ++]
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VAMC Atlanta GA ► Lawsuit Pending over Erection Treatment
A U.S. veteran being treated for Post-Traumatic Stress Disorder was instead left with a weeks-long erection after prescribed a sleep aid by a VA Hospital, his attorney claims. A single dosage of antidepressant Trazodone in October was enough to not only "disfigure" Edward Stalling but leave him completely impotent and a laughingstock among the doctors and nurses at the Atlanta VA Medical Center, his attorney told the Daily News. "They treated him as some kind of spectacle to be viewed," Attorney Jonathan Johnson said of the former service member's treatment. "One had mentioned that I should line up all the women," Stalling recalled a doctor's alleged jest to CBS46. "I haven't had that many people who had seen it in my whole life, until I went to that hospital."
For the next 10 days the veteran remained hospitalized as doctors "essentially ran needles in his penis" after he developed fibrosis in his penis, said Johnson. "I think at one time he had up to 10 needles in his penis at one time," he said. Despite their efforts, Stalling remains without much feeling and with extreme difficulty urinating. ...his sex life is over, permanently. Johnson said he plans to send a written notice to the medical center this week, informing them of their intent to sue for monetary damage. "The wheels have been put in motion," he said. "People who hear about this tend to laugh or snicker ... but for him, his sex life is over, permanently." Johnson cited a previous lawsuit involving a Pennsylvania man who won a $10 million suit after suffering a prolonged erection after taking the same medication prescribed to Stalling for sleeplessness. Johnson further argued there being "conflicting scientific evidence on whether it should be used for that purpose."
Trazodone, according to Weill Cornell Medical College's Department of Urology, has an "uncommon side-effect of prolonged erection" that occurs in approximately one out of 10,000 to 20,000 users. "In some cases emergency and/or surgical treatment has been required and, in some of these cases, permanent damage has occurred," according to the U.S. National Library of Medicine. In a statement sent to the News Monday, the VA expressed their staff as having "the highest priority on delivering quality care while respecting the privacy of Veterans ... When issues occur in our system we conduct reviews to identify, correct and work to prevent additional risk. In light of potential litigation in this case, VA cannot comment further." [Source: New York Daily News | Nina Golgowski | Jan. 05, 2015 ++]


Atlanta VA Medical Center
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VARO Philadelphia PA Update 01 ► OIG Report Delayed
Two parallel probes into mismanagement and other problems at the Philadelphia VA benefits office have expanded because of a continuing stream of allegations from employees, according to a source familiar with the reviews. The results of an investigation by the VA's Office of Inspector General that had been anticipated last fall is now not expected until late February. And a team of congressional staff members that arrived at the office in mid-December for a two-day visit ended up staying for a full week to catalog complaints from employees. "Once at the [regional office] in a private conference room," the source said, "the onslaught of employees who wanted to share concerns regarding mismanagement prompted our staff to extend the length of the visit." The investigation of the regional office is now in its sixth month.



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