Issues with Veteran Medical Access
Over the years, as medical technology and access to battlefield care improved, many more veterans were able to return home alive – but with permanent disabilities that require years of consistent medical care. Even though the U.S. veteran population dropped by 5.8 million between 1986 and 2012, the number of service-connected disabled veterans increased by around 1.3 million.
Investigations at Phoenix VA Medical Center in December 2013 revealed that dozens of veterans may have died waiting for appointments with Phoenix VA hospitals and that the Phoenix VA Health Care System was keeping separate records to hide the dangerous patient appointment wait times.
Later investigations revealed the same problem existed in VA medical centers across the country.
In June 2019, VA launched a new Veterans Community Care Program under the 2018 MISSION ACT, giving veterans the option to seek medical care outside of the VA system. Yet quality health care for veterans is still an issue.
Under the Community Care Program, VA must ensure that the outside medical professionals who treat veterans meet a specific set of qualifications. VA continues to allow unqualified outside medical providers to care for our veterans – even those who have lost their medical licenses.
In February 2021, the U.S. Government Accountability Office (GAO) requested the VA take immediate action to exclude ineligible providers after it found that VA was offering care provided by outside doctors who had lost their license to practice medicine.
GAO recommended that (1) VA require contractors to instill credentialing and monitoring policies that ensure compliance with license restrictions and (2) VA assess the risk when providers with quality concerns continue to provide outside care to veterans.
VHA Medical Appeals
Veterans Receiving Health Care Deserve:
- Reasonable
appointment
wait times
- Minimal
emergency room
wait times
- Credible,
licensed doctors
and nurses
- Safe, sanitary
clinicial
environment
Veterans who are not receiving proper health care services can file a health benefit appeal (medical appeal) to dispute Veterans Health Administration (VHA) decisions on numerous health care issues, including those related to:
- At-home care eligibility
- Beneficiary travel costs
- Canes, orthopedic shoes,
back brace eligibility
- Disability-related home improvements
and structural alterations (HISA)
- Hearing aids / eyeglasses
- Hospitalization eligibility
- Non-VA unauthorized treatment claims
- Nursing home care eligibility
- Outpatient care eligibility
- Priority group assignment
- Prosthetic device, wheelchair eligibility
Veterans have two VHA medical appeal options – administrative appeal and clinical appeal.
Veterans who disagree with an administrative decision, like a failure to reimburse medical care costs, denial of fee-based care outside of the VA healthcare system, or denial of a VA medical service can file an administrative appeal.
Administrative appeals offer veterans strong due process protections and can be presented before the Board, the Court of Appeals for Veterans Claims (CAVC), the Court of Appeals for the Federal Circuit (CAFC), even the U.S. Supreme Court.
Veterans who disagree with a medical decision, like a denial of a certain treatment, at-home care, wheelchair costs, or hospitalization, can file a clinical appeal. Unlike administrative appeals, clinical appeals remain in the Regional Office. Because clinical appeals are disputing the opinion of a medical professional, they lack jurisdiction to go to the Board or higher courts.
Mind Body Interplay and Service Connection
Understanding the fundamental connection between mind and body is vital to establishing service connection or secondary service connection for VA benefits.
Many of our nation’s veterans suffer with mental or physical conditions that they feel couldn’t possibly be connected to their time in service. How could heart disease, diabetes, dementia, schizophrenia or other disorders that arise years after service be associated with events that happened years, even decades, in the past?
Unfortunately, a vast number of veterans fail to seek the VA benefits they deserve because they fail to realize that their time in service did indeed lead to their current mental or physical condition. For those that do seek these benefits, the VA often errs in granting service-connection because reviewers fail to recognize that the human body functions as one integrated machine, not a collection of separate physical and mental components.
In evaluating a veteran’s disabilities, the VA may not be aware of an interrelationship between physical and mental conditions. Without a claim containing scientific and clinical evidence, they don’t acknowledge how impairing one’s mental health will negatively impact one’s physical health, and vice versa.
Because the body and mind are fundamentally interconnected, mental disorders can often cause debilitating physical illness – and physical illnesses can lead to mental disability.
If a veteran begins gaining weight during service, the entire spectrum of obesity-related problems, including diabetes, heart disease and orthopedic problems, is open for service connection. Likewise, if a veteran with PTSD from his time in service develops obesity as a result of that PTSD, the entire spectrum of obesity-related problems, including diabetes, heart disease and orthopedic problems, is open for service connection.
To maximize disability ratings, veterans should consider seeking service connection for all health problems, not just those with an obvious connection to service. As long as you can provide scientific evidence suggesting a connection between the mental and physical (usually in a medical nexus letter), you can support your claim for secondary service connection and win VA benefits.
Decades of scientific research support that a number of physical diseases originate from error within a patient’s state of mind.
“There is no health without mental health,” according to the World Health Organization. “Health is a state of complete physical, mental and social well-being - not merely the absence of disease or infirmity.”
Many veterans suffering from PTSD or other mental health difficulties not only deserve benefits to cover their PTSD, but also their sleep apnea, chronic obstructive pulmonary disorder (COPD), liver disease and high cholesterol. These conditions go hand in hand.
One actually causes, or increases the risk of developing, the other.
PTSD Associated Diseases
A number of diseases associated with PTSD (though not all) relate to one of four common characteristics of PTSD patients, namely: (1) tobacco and/or alcohol abuse, (2) physical inactivity upon return from service, (3) anxiety levels associated with PTSD, and (4) medications taken to alleviate PTSD symptoms.
Many physical disease states are associated with these four characteristics
-
1
Alcohol and tobacco use linked to chronic obstructive pulmonary disease (COPD), heart disease, cancers
-
2
Inactivity linked to sleep apnea, heart disease, diabetes, orthopedic problems
-
3
Anxiety linked to heart disease, stroke, dementia, autoimmune disorders, cancers
-
4
PTSD medication linked to aggravated COPD, gastrointestinal complications
Veterans who are service-connected for PTSD and have developed cancer, diabetes, heart disease or any other disease that can be linked to PTSD are able to obtain secondary-service connection for that disease.
Non-PTSD Mental Disorders and Disease
Non-PTSD mental health psychiatric diagnoses of depression, anxiety, adjustment disorder, bipolar, panic disorder, chronic pain disorder, schizophrenia, schizoaffective disorder, adjustment disorder, delusional disorders and other psychotic disorders can also lead to major adverse health conditions.
Physical Conditions Cause Mental Disorders
Physical conditions can also lead to mental health problems. Medical causes may account for between 10% and 46% of psychiatric symptoms exhibited by patients. Head trauma and brain injuries can cause behavioral, emotional and cognitive problems. Likewise, certain infections, gastrointestinal disorders, heart problems and chronic pain can also cause a number of debilitating mental issues. Veterans with service-connected physical disorders may be able to establish secondary service connection for any resulting mental health problems.
TBI and Behavioral, Emotional and Cognitive Disorders
One of the signature injuries of the wars in Iraq and Afghanistan is traumatic brain injury (TBI), due to the frequent use of roadside improvised explosive devices and the resulting blasts. Other causes of TBI include in-service motor vehicle accidents, in-service falls, personal assault or any other type of trauma where the head is injured. TBIs often produce not only physical problems, but cognitive and behavioral problems.
Common physical symptoms of a traumatic brain injury include vision loss, hearing loss and tinnitus, constant headaches, seizures, motor or sensory dysfunction, and perhaps pain in the face or other parts of the body. Some veterans also report a loss of smell or taste and they may suffer from inability to communicate as they previously did before. There are also endocrine dysfunctions and bladder or bowel impairments and other autonomic nerve dysfunctions.
Cognitive symptoms of TBI include decreased memory, concentration, attention, and executive functioning of the brain. Executive functioning skills include goal setting, information processing, planning, organizing, prioritizing, problem solving, judgment, decision making, and mental flexibility.
Emotional symptoms of TBI include depression, anxiety and other mental disabilities. Behavioral symptoms include irritability, aggression, withdrawal, and poor impulse control. Additionally, cognitive, emotional and behavioral problems can lead to social problems including immature behavior, over-dependency, excessive talking, inappropriate sexual behavior, and over spending.
In-Service Infections Cause Mental Disorders
Several infections that veterans may acquire during service are recognized to induce symptoms of mental disorder. Often, a veteran will not realize that prior infection is causing his mental difficulties as symptoms can take years to develop.
Scientists have associated numerous pathogens with mental illnesses, including Borna disease virus, Epstein-Barr virus and certain strains of herpes virus. Other infections that can cause mental disorders include malaria, syphilis, Legionella, typhoid, HIV, diphtheria and rheumatic fever. Psychiatric symptoms have also been associated with parasites like ascaris, giardia, trichinae and borrelia. Toxoplasmosis gondii infection can cause delusions, emotional disturbances and auditory hallucinations.
Anyone with a VA appeal for the denial of VA benefits should take great care to fully research the possible underlying diseases of any symptoms noted in service treatment records.
Chronic Pain and Mental Disorders
Claims of mental disorders may be secondary to service-connected medical conditions that involve chronic pain. For example, a veteran may be service connected for orthopedic problems involving his joints. This state of chronic pain can produce debilitating depression. Depression caused by chronic pain can render one incapable of maintaining a gainful occupation.
GI Disorder Effects on Mental Status
There are numerous gastrointestinal problems for which service-connection can be obtained, including ulcers, gastroesophageal reflux disease (GERD), cancer and hemorrhoids. We frequently see cases of irritable bowel syndrome (IBS), functional dyspepsia, and functional abdominal pain syndrome, which fall under the category of Gulf War Syndrome.
A service-connected gastrointestinal disability can affect your mental outlook and produce a state of depression. This depression can be service connected on a secondary basis.
Heart Disease and Cognitive Decline
Cardiovascular disabilities like ischemic heart disease, hypertension and other conditions affecting the cardiac system can produce secondary effects that can cause disabling stroke and/or heart attacks. As many as 47% of coronary artery bypass surgery patients experience some form of cognitive decline. This means that if you are service-connected for ischemic heart disease and underwent a coronary artery bypass procedure, and you have suffered cognitive and mental decline, a secondary service-connection claim should be made for the mental deficiencies.
Veterans can use the mental-physical health connection for any number of VA claim scenarios. For example, a veteran can use it to help verify a traumatic event that occurred during service for which he has no medical record. A creative-thinking, experienced advocate can help you determine how to establish connections that can help you win your claim for VA benefits.
Lifestyle and Health
The lifestyle a veteran creates for themselves after returning from active duty can have a strong impact on both physical health and mental well-being. A wide variety of valuable resources exist to help veterans build and maintain healthy lifestyle, including resources on nutrition, sleep habits, physical fitness, and community impact.
Nutrition and Healthy Eating
Healthy Sleep Habits
Physical Fitness Resources
Veteran Community Impact