Thursday, March 29, 2012

If he had an uncle, he would look like Onyango





Framingham District Court Judge Douglas Stoddart sentenced Obama to one year probation and imposed the statutorily mandated probation conditions of attending a driver alcohol education program and incurring a license loss of 45 days. Additionally, Stoddart found Obama not responsible for the failure to yield at an intersection charge



US House Rep Jerry McNerney: I think the goal is to make it seemless for the service member to go from -- obviously, that's the goal. Are there technical issues like communication between computers or any of that a problem at all? Or can we just put that one to bed now or do we need to talk about that for a little while?
John Medve: [. . . Microhphone not on at the start of remarks] the question, we're working on that. You're familiar that we're trying to develop or have on the boards developing an integrated lifetime health record which once that comes into fruition will be, I think, a great asset for us. In terms of the Integrated Disability Evaluation System and moving people through that process, we have one system called the Veterans Tracking Information that we use to manage where people are in the process so that we have the metrics and understand where they're at. We monitor those things every two weeks at the VA. The VA chief of staff holds a bi-weekly performance, uh, meeting with every single executive that manages a part of that process down to the local level. As part of those discussions, if there are issues that we're having in terms of transmissions of data or any of that, he immediately calls our office of information technology to bore in on the problem and to fix it.
Ranking Member Jerry McNerney: Well that sounds good. Is there a -- except for -- I want to get an idea of when these medical records are going to be standardized so that we can get this transition, that part of it, out of the way. So do you have an idea about when that can be expected to be finished?
John Medve: Sir, I know the two Secretaries, as Mr. Neabors alluded to, meet every quarter. At the last meeting, at the end of February 27th, one of the marks on the wall is that we're putting the integrated health record at the James A. Lovell Federal Level Health Care Center, that's the pilot site for it. They have required that there be two additional sites be in place by 2014 in order to build this and so it's going to be a growing development over the next several years.
Ranking Member Jerry McNerney: That's -- that's not good enough. That's not even good enough.
McNerny was question the VA's John Medve (Office of VA-DoD Collaboration) this morning. The House veterans Subcommittee on Disability Assistance and Memorial Affairs was addressing a number of issues. Subcommittee Chair Jon Runyan noted at the start of the hearing, "This is my hope that this oversight hearing will shed some light on some of the problems that we have encountered in the implementation of IDES so we may work together to find the best solution possible."
Medve and DoD's Jim Neighbors made up the first panel. The second panel was Project HOPE's Dr. Gail Wilensky, Fisher House Foundation's Ken Fisher and the Advisory Committee on Disability Compensation's retired-LTG James Terry Scott. The third panel was Disabled American Veterans' John Wilson, Wounded Warrior Project's Phil Riley and The Mission Continues' Eric Greitens.
There have been too many problems for service members and veterans in the system.This includes the transition of a service member to a veteran. Congress has been asking for this to be fixed, Congress has generously funded all techonology requests on this issue and Congress has repeatedly asked both DoD and VA if additional funding was needed. One of the most basic problems was that DoD used one computer system and VA another and the two couldn't communicate. This was eye rolling -- some might say typical -- six years ago when we first started hearing about it in hearings we attended (and it may have been addressed prior to 2006). It's no longer excusable. Too much money has been spent, too many years have passed. This issue should have been completely dealt with some time ago. Two years from now, VA testified, there will be a pilot site to test these things that were identified over six years ago? Eight years after identification and after all the funds Congress has provided to fix this issue, a pilot program will take place. ("At least eight years" -- again, we've only been attending the veterans committee hearings since 2006.)
In the section we were quoting at the start, Ranking Member Jerry McNerney was informing the first panel that it wasn't good enough. That describes the first panel: Not good enough. They would go on and attempt to mislead as McNerney's questioning continued.
Jim Neighbors: Sir, if I could chime in -- thank you for your question. DoD and VA are actually sharing more information right now than any two organizations in the nation. Now if I could just give you some statistics, please, on what that sharing is. Service members' data, again, that has been shared with VA is over a million times already and what that turns into as far as laboratory results is we've shared 23 million of them to date and this is in IT form, this is machine readable, things we've pushed for. So they're not paper. Radiology 3.6 million reports, pharmacy 24 million records and patients have engaged on their medication and allergy recommendation from what was about 27,000 to now 1.2 million which is significantly improving patient safety. Those are just some areas, it's not an entire IDE chart. So between our organizations, we are actually are doing some of the sharing already. And, if I could, there are actually four locations pilot wise, which we're including private providers such as Kaiser Permanente or something. Where we would bring them into the fold here too. So between government entitites, we have that actually going on right now. So you're right. We're not where we need to be. We're not completely there. Absolutely. But there is stuff going on that is servicing our veterans. And the second thing I'd like to say, sir, if I could please, that's entity to entity. As far as giving of VA -- excuse me, a veteran or service member their records, we can do that right now. We're working very closely with VA to enroll our service members as they come in the door into a platform, an IT platform, called the E-Benefits Platform. That will then allow -- or that allows -- and we've got 1.4 million of them already signed up now. But then at any point in time after that, from anywhere in the world, 24-7, they can actually download their medical records and hand them off to a private provider or anybody that they are involved with through that continuum right now. And that's called the Blue Button Capability. Maybe you've heard that or not.
And if I can jump in, DoD and VA were sharing information -- as he's decribing -- some time ago. This isn't expected progress, this is more of the same. And to be even more clear on this, DoD and VA were always supposed to be 'sharing.' That's transporting the medical records from DoD to VA as the service members switches to the status of veteran. Neighbors repeatedly misleads. We could fill three more snapshots with examples. Instead, we'll just note two here.
Ranking Member Jerry McNerney: I haven't heard that. One of the things that Mr. Medve was saying is that you can track an individual through the process. But is there an advocate for that individual? Or does that get passed on and the individual finds himself or herself calling in and getting the run around? I mean, what we need is an advocate. Whether it's DoD or VA or the joint-effort, Mr. McDonnell, sort of going into that, an ombudsman, an advocate or some coordinator that that person can go to when they are in trouble from start to finish.
John Medve: Sir, yes, thank you for the question again, Congressman, in IDES, when someone is enrolled in it, there's the PEBLO, Physical Evaluation Board Liason Officer, that when that invidual is referred is who greets them at the entrance to that process. That is the single point of contact that will shepherd them through IDES -- as they are in each different stage, they are briefed by that person where they stand, where their medical evaluation schedules are done when they're supposed to appear before any boards and all that. Once we get to a point where they are going to be determined to be separated, we the VA sitting with the DoD PEBLO have what we call Military Service Coordinators that then sit down with the individual as a team and explain to that individual what their VA benefits. So that's what happens inside the IDES. Now also --
Ranking Member Jerry McNerney: Does the service member of former service member get to check off on that and say that they're okay with that transition at that point?
John Medve: I'll defer to Mr. Neighbor since that gets into the military administrative process.
Jim Neighbors: Absolutely, sir. At any point in time when an evaluation takes place, that service member has reclima capabilities at a number of venues. Each one of the services has a number of boards that does the exactly what we're talking about here which is the evaluation of their disability and the rating. They can then take that to a department wide -- Excuse me, let me say that again the service wide board that is more of a formal activity where they make sure that the rulings have been applied equally across from the local board itself. If the service member doesn't believe that is equitable, they actually can go to another level and they can actually go to what's called the Board of Correction for Military Records level also. So there are a number of points where the person can say, "You know what? This wasn't fair. I need another look." And they can be reversed or they can be upheld as any board can do. But, yes, sir, there is.
And now Neighbors misleads again. The question was about an advocate originally -- does the service member have an advocate with him or her throughout the process and then they were asked what about if the service member didn't feel ready for the switch: "Does the service member of former service member get to check off on that and say that they're okay with that transition at that point?"
Neighbors did not answer that question. He deliberately misled about an appeal process that was in place prior to the need for a seemless transition becoming a talking point of DoD. You are a service member. You have a PEBLO assisting you throughout your various processes. Now you're being informed you're about to discharge and transition from service member to veteran and you're not ready -- this was McNerney's question, remember? -- are you able to speak to someone or slow the process or get additional assistance with the change? That's never answered. (So the answer is probably no.) Instead, Neighbors attempts to distract by going into great detail about the appeals process that's been in place for decades and has nothing to do with seemless transition or efforts in the last six years (or even the last decade) to improve and simplify the process for today's service members and veterans.
But before we get to that, we're going to note the strong objection US House Rep Timothy Walz registerd.
US House Rep Tim Walz: But I'm going to highlight this issue of the discharges from DoD on personality disorder. I'm truly troubled about this. If this is truly about honoring the commitment to care, this is the third hearing I've sat here where we've talked about something like this. In 2007 we were going to get this fixed, we were going to get it fixed in 2010, September 15th. And there's a report today, my friends over at the Vietnam Veterans of American, through a Freedom of Information Act, we're at it again. So we've got soldiers, they go to war, they come back and they're being diagnosed with adjustment disorder or personality disorder. It gets stamped on their discharge papers "Discharged for Personality Disorder," they're denied VA benefits and that's on their permanent record to follow them for employment. So, Mr. Neighbors, I know this is not your area of expertise, if I could say, I'm not putting you on the spot for the entire Department of Defense, but I would like you to . . . What do you think when you hear this again? Because all the issues you're talking about -- and I don't want to distract us from this very broader issue, but I do feel like I need to speak up for these 31,000. I do need to try and figure out how we right this wrong. Because the idea that you would be diagnosed with an adjustment disorder after being in Afghanistan? I don't know. If I could just turn it over, I know it's very general but --
Jim Neighbors: I really appreciate the question and it is an important issue. I'm going to go out on a limb here and try to narrow it a little bit. I think what you're referring to is the reports of what's happening at Madigan and out on the West Coast? Am I correct on that or is it?
US House Rep Tim Walz: Well there was a new, I had the thing. We just had a new Freedom of Information request and the study was put together on this from Vietnam Veterans of America, I'll make sure we get a copy to you to make sure you see that.
And I'm stopping Walz there.
No, it's not the same thing. Walz didn't say it was. But there's no excuse for a VA or DoD official going before the Congress this morning not to know what VVA released. Madigan is about PTSD diagnoses being changed for active duty service members (it may be happening to other groups as well but that's what is known about Madigan at present). What Walz was asking about was service members returning to the US and being discharged. And their discharge is a PD (personality disorder) and it is done that way not to deny PTSD benefits but to deny all benefits. A PD discharge leaves a service member with the news that he or she will be paying out of their own pocket for all health care they may need. Just from what Walz described, Neighbors should have known this wasn't the same issue. And if Neighbors honestly doesn't know the difference between a PTSD diagnosis and a PD diagnosis, that's really scary. More likely, this was yet another attempt to distract and mislead.
Some idiot -- and I use that word intentionally and after careful consideration -- from DoD was called up by Jim Neighbors and began talking. Subcommittee Chair Jon Runyun instructed to speak into the microphone at which point he decided he was a race with his tongue and the losers were the listeners. Whatever his name was, he began talking about PTSD as well and continued doing so. As Walz was trying to get across, a PD discharge is based upon the belief that these service members came into the service with a mental issue or problem and it wasn't discovered until late in the service. That's how you do a personality discharge. We've covered War Criminal Steven D. Green repeatedly here. He got a personality disorder discharge and deserved it. It was a mistake to let him into the military (and he was one of those recruits who had a choice between doing time or joining the military -- had he not joined, the judge would have sentenced him to time behind bars).
Steven Green was a good case. What Vietnam Veterans of America is highlighting is using citizens to fight your wars and then, after you've used them (and often as they're ready to leave the military), 'discovering' a personality disorder that makes them unfit to serve and allows you to give them a PD discharge which means that they have no medical benefits which, for the government, means they don't have to pay out money for treatment. VVA's argument is that once again PD discharges are being used to deny those who have the benefits they have earned.

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