MILITARY UPDATE COLUMN
Isakson vows 'Blue Water' relief; Trump inflates Choice reform
By TOM PHILPOTT | SPECIAL TO STARS AND STRIPES Published: October 4, 2018
Veterans have reason to be uncertain over what Congress and the Trump administration plan both for “Blue Water Navy” Vietnam War veterans who have Agent Orange-related ailments, and for veterans seeking smoother access to more convenient and timely health care from private-sector physicians and hospitals.
Sen. Johnny Isakson, R-Ga., chairman of the Senate Veterans’ Affairs Committee, insisted throughout a hearing last week that he and Department of Veterans Affairs Secretary Robert Wilkie will deliver a solution to extend VA disability benefits and health care to veterans who served on ships off the coast of Vietnam during that war and today have conditions VA presumes are linked to toxic defoliants sprayed on land.
But Wilkie, the only witness at the “State of the VA” hearing, wasn’t prepared to echo the chairman’s assurances. Wilkie didn’t even mention the House-passed Blue Water Navy Vietnam Veterans Act (HR 299) in his oral statement highlighting priorities for improving VA’s organization and services.
In his written testimony, he reiterated VA opposition to extending benefits for up to 90,000 aging Blue Water Navy veterans and survivors, saying VA’s “commitment to science and an evidence-based approach to creating or expanding [Agent Orange] presumptions should be maintained.”
If HR 299 is enacted absent stronger scientific evidence that shipboard veterans were exposed to wartime defoliants, Wilkie wrote, it “would erode confidence in the soundness and fairness of the veterans’ disability benefits system, creating the impression that the system can be gamed by political activism.”
Also, he argued, it would increase pressure on VA to “expand additional presumptions administratively, under a similarly liberal approach, favoring less deserving but politically demanding veterans over more deserving veterans who trust VA to do the right thing for all veterans.”
VA estimates HR 299 would cost $6.7 billion over 10 years and affect efforts to reduce its backlog of claims and claim appeals. VA would have to reopen 30,000 previously denied claims and 230,000 additional claims over the next decade.
Despite Wilkie’s official hard line, Isakson said his talks with the secretary over the past month left him hopeful VA will cooperate with Congress on finding a solution. Why he thought so was hard to decipher throughout the hearing.
“The Secretary is right in the reasons he’s been opposed to just doing Blue Water period. But he’s not wrong about how we get to” a solution, Isakson said. That path, he suggested, is that his committee keeps working with VA. “The veterans who think they deserve that benefit ought to get it,” he insisted.
“So, I really want to set the table at this hearing with the secretary present. Thank him for giving me the time … to talk about this. And appreciate what his attitude is, about customer service being the principal foundation of his administration at the VA.”
Veteran service organizations and Blue Water Navy advocates should know, Isakson continued, that this “committee and VA will tackle your problems and try and do it as fairly and equitably and as right for everybody as we can. But we are not going to get bulldozed into a corner. And we’re not going to bulldoze somebody into a corner either. So, I want to bring that up because that’s going to take care of a lot of questions.”
It didn’t. Committee colleagues still pressed Wilkie to support HR 299, citing supportive language in a 2008 Institute of Medicine report and noting that Vietnam veterans in their states who served off Vietnam have Agent Orange-related illnesses, and continue to be turned down for VA care and compensation.
The closest Wilkie came to a concession was telling Sen. Dean Heller, R-Nev., that he had pledged to work with Isakson “to make sure that we get it right … for all of our veterans.” But Wilkie then referred to concerns raised by The American Legion, Veterans of Foreign Wars, Disabled American Veterans and Paralyzed Veterans of American that the House-passed bill would pay for Blue Water Navy benefits by raising VA home loan fees, including, for the first time, imposing fees on some disabled veterans who buy higher priced homes.
Wilkie said he agreed with those concerns. He assured Heller that Nevada veterans exposed to Agent Orange would qualify for compensation. But he didn’t concede that VA is ready to presume all Blue Water Navy veterans were exposed.
Isakson interjected that Heller had missed the chairman’s opening statement in which he explained the “issue of dealing with Blue Water Navy is no longer going to be a question. How we do it is going to be the question.”
Pointing to Wilkie, Isakson said he “has agreed to work with us to make that happen.” Isakson gave similar assurances to four more colleagues critical of VA’s opposition to HR 299. Finally, Sen. Richard Blumenthal, D-Conn., told Isakson, “I know what the conversations have been, Mr. Chairman. And I’m really looking for a somewhat less equivocal answer.” He didn’t get it, not at this hearing.
Real choice or not? President Donald Trump, at a signing ceremony for a funding bill for VA and military construction projects (HR 5895), made some unfounded claims about Veterans Choice, confusing a troubled program in effect since 2014 with reforms to VA community care programs set to kick in next year.
Thanks to him, Trump said to applause at North Las Vegas VA Medical Center on Sept. 21, “we have now VA Choice. So now if a veteran can’t get the care they need from the VA in a timely fashion, they have the right to go see a private doctor. Today, for the first time in American history, I am about to sign a bill that will fully and permanently give our great and cherished veterans choice.”
His declaration didn’t match details or nuances of statutory changes enacted that day or earlier this year. HR 5895 does provide, through 2021, billions of dollars more to fund sweeping reforms to VA community care programs as authorized in the VA Mission Act signed in June. But the impact of the reforms on veterans seeking outside care won’t be known until VA develops and publishes new access standards for VA-paid community care. That won’t occur until next summer.
“We had people waiting in line with a simple problem that, by the time they saw a [VA] doctor, they were terminally ill,” said Trump. “No more of that. If you have a line [at VA] you go see a [private-sector] doctor.”
No responsible VA official would make that claim. The Mission Act will end two current triggers under the Choice program for granting access to outside care: waits longer than 30 days for a VA appointment or trips longer than 40 miles from home to be seen by a VA primary care provider. Those will go away.
But Trump and veterans don’t yet know what will replace them. The new law mandates that VA schedule more timely appointments at its facilities, improve staffing, establish a network of commercial walk-in clinics and ensure prompt payment of outside providers. It also requires that veterans have access to community care if the VA is unable to provide timely care as needed.
The Mission Act, however, allows VA more leeway than under Choice to set access standards and decide how to use them. Whether patients are referred to outside provider networks will depend on “clinical needs” as determined by their VA health care providers in consultation with the patients. Factors to be considered will include distance to VA facilities, type of care required, timeliness of appointments and whether patients face an excessive burden if forced to rely on VA care.
Those are details veterans must understand and hyperbolic politicians ignore.