Everything you need to know about the VA — and the scandals engulfing it

President Obama on Friday accepted the resignation of Veterans Affairs Secretary Eric Shinseki, who took responsibility for a report that confirmed allegations of long wait times and false record-keeping at the VA.

Announcing the change at the White House, Obama said that Shinseki "does not want to be a distraction, because his priority is to fix the problem and make sure our vets are getting the care that they need. That was Ric’s judgment on behalf of his fellow veterans. And I agree. We don’t have time for distractions; we need to fix the problem."

Deputy Secretary of Veterans Affairs Sloan D. Gibson will replace Shinseki on an interim basis.

Shinseki, whom Obama lauded as "good person who’s done exemplary work on our behalf," publicly apologized hours before submitting his resignation. Shinseki said the "breach of integrity" described in the report is "indefensible and unacceptable to me."

What is the VA? 

The U.S. Department of Veterans Affairs handles three major categories for America's veterans: medical care, benefits and burials/memorials. We will take a closer look at the medical system, the target of the report and allegations, and benefits system, which has been plagued by a significant backlog for years. Reports of problems have been dogging the VA for years, as have calls for fixing the system. Obama has been talking for years about rehabbing the VA and getting troops the care they deserve.

"This is not a new issue to the president," White House press secretary Jay Carney said. Obama first addressed the allegations last week, ordering deputies to complete a review of the system within a month and saying that he "will not stand for" veterans receiving substandard care.

How does the VA medical system work? 

According to Edward Lilley, a senior field service representative at the American Legion, once a veteran is discharged from the armed services, he or she must enroll in the VA system by calling a toll-free number, going to a clinic or applying online. Veterans must have their discharge forms — known as a DD214 — to start the process. Veterans go through a means test each year — a review of financial information to determine the priority group for enrollment and whether that person is able to make a co-pay. New patients are supposed to see a doctor within 14 days after their paperwork is accepted, Lilley said, and existing patients are supposed to see a doctor between 14 and 30 days after requesting an appointment. But that does not seem to be happening in many places and is at the crux of the scandal.

Robert Petzel, the VA's top official for health affairs, resigned earlier this month. He testified that he knew health clinics were using inappropriate scheduling procedures as early as 2010.

"I cannot say many bad things about the quality of care," said Katrina J. Eagle, a San Diego veterans lawyer. "It’s access to care that does seem to be the biggest problem across the board."

What are the allegations? 

An interim independent report by the VA's inspector general found that officials falsified records at a medical center in Phoenix, hiding the amount of time that veterans had to wait for medical appointments. According to the report 1,700 veterans were kept on such waiting lists and veterans waited an average of 115 days for an initial primary care appointment.

There have been claims of false record-keeping and long waiting lists for care at VA facilities across the country; the report called inappropriate scheduling "systemic" within the system. In some places, veterans have died while waiting for care, though there is no known link between the deaths and delays. Other allegations include an outbreak of Legionnaires' disease at a VA hospital and a mismanaged gastroenterology program that delayed treatment to veterans.

"We didn't conclude, so far, that the delay caused the death," said VA Inspector General Richard Griffin at a Senate hearing  on the state of the VA's health care. "It's one thing to be on a waiting list, it's another for that to be the cause of death."

Where have some of the allegations taken place? 

Phoenix

The inspector general's report confirmed press and whistleblower reports that employees of the VA in Phoenix kept a secret waiting list to make it appear that veterans were accessing care more quickly than they were in reality. A doctor at the facility sent letters to the VA's inspector general in December complaining about delays in care. It has been claimed that dozens of people on the waiting list have died, but their deaths have not been conclusively tied to delays in treatment.

The initial allegations in Phoenix sparked the broader scandal. Former Secretary of Veterans Affairs Eric Shinseki called for a review of all VA facilities after the allegations surfaced. Officials at the Phoenix facility were placed on leave and President Obama said Friday that many were being fired. Obama dispatched one of his top advisers. Rob Nabors, to oversee an investigation of the VA.

Fort Collins, Colo.

USA Today reported this month that a report by the VA's Office of Medical Inspector found that clerks at a clinic in Fort Collins were instructed on how to falsify records so it appeared that doctors were seeing 14 patients a day, a number within the agency's goal to help reduce the appointment backlog.

Miami

A VA police detective told WFOR-TV last week that coverups were ingrained into the hospital's culture and that powerful prescription drugs were illegally dealt there.

Columbia, S.C. 

According to a 2013 report by the VA's inspector general, there was gross mismanagement of the gastroenterology program at the Dorn VA Medical Center. The report said 52 patients had cancer that were "associated" with delays in diagnosis and treatment. The program also had 3,800 backlogged appointments. The report said the hospital used on;y $200,000 of $1 million designated to help reduce the glut of appointments. According to CNN, six deaths at Dorn have been tied to delays in care.

Pittsburgh

At least six veterans died after an outbreak of Legionnaires' disease at a Pittsburgh VA in 2011 and 2012. CBS News reported in March that hospital officials knew about the outbreak for more than a year before informing patients and that top officials at the hospital knew human error was behind the outbreak, not faulty equipment, as Congress was told in 2013.

What is this backlog of claims that officials are talking about? 

A tide of disability claims from soldiers who were injured in Iraq and Afghanistan has inundated the VA. The VA also recently made veterans suffering from additional ailments tied to exposure from Agent Orange during the Vietnam War eligible for disability claims, increasing the number of people filing claims. The claims seek financial compensation for injuries suffered during military service. About 300,000 cases were stuck in processing for more than 125 days, our colleague Greg Jaffe reported. The backlog peaked last year at 611,000 claims. Obama and Shinseki made it a point to reduce the glut.

"We launched an all out-war on the disability claims backlog, and just in the last year we’ve slashed that backlog by half," Obama said.

How does the claims system work? 

Disabled service members are typically told about disability benefits before being discharged and can file for them upon leaving the military. There is no time limit for a veteran to file a claim, Eagle said. The application can be filled out by phone, where it is rerouted to a call center, online or to a representative. Oftentimes servicemembers seek help from a veterans group. If a lawyer gets involved at the start of the process, he or she must do so on a pro-bono basis; for a lawyer to be paid, he or she cannot get involved until a monetary value has been assigned to the claim or it has been denied.

If there is a 50 percent certainty or more that an injury was suffered during military service, a veteran is eligible for disability benefits.

The backlog that Congress and the public are focused on comes from when a veteran has filed a claim but the VA has not made a decision on whether to grant it, Eagle said. There is a separate backlog among cases that have been decided but appealed.

 

Katie Zezima covers the White House for Post Politics and The Fix.
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