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Chicago VARO Blues

By Ray Parrish

If you are a veteran trying to get a difficult VA claim approved, I'm afraid that I have to advise you to try it anyplace but Illinois. Recent stories in the Chicago Sun-Times by Cheryl Reed revealed that, thanks to the work of the "service center" at the Chicago VA regional office (VARO), Illinois veterans are the most dissatisfied in the nation and have one of the lowest per-capita VA disability payments. I wrote about this problem in a 2002 article in the Veteran. The unserved veterans here are the homeless—mentally ill veterans with the most severe PTSD, anger-control problems, or mood disorders—who are being abused by the system that's supposed to help them.

As a result of the initial story, the Chicago city council and Senator Obama held hearings overflowing with veterans waving sheafs of documents. After my testimony, I began working on a solution with the Veterans Strike Force One, a group of mostly African-American veterans who have spent five years gaining a lot of respect and an office at the newly renamed Jesse Brown VA Medical Center (formerly Chicago West Side). They wanted to add mental-health VA claims and discharge-upgrade counseling to their already-successful veteran outreach and job-placement programs. We hope to use the publicity of this crisis to initiate programs to help those veterans who have been left behind.

We can only hope that the VA inspector general comes to town and reviews the rating decisions on a case-by-case basis rather than relying solely on a statistical analysis. Complaints from veterans about these decisions should be resolved only after review by a sympathetic veterans' advocate who has experience reviewing claim files. A quantitative analysis of Board of Veterans' Appeals (BVA) reversals and remands should be followed up, in order to identify rating specialists whose misconduct may be criminal.

Ray Parrish at Veterans Day in Chicago, 2004

While it may be true that racism motivates some rating specialists to delay and deny some claims, pure laziness and perceptions about job performance expectations seems to play as great a role in their work process and in the decisions they make. Yes, there are good, honest people working at the VARO, and it is only a small number of VA employees who are treating veterans unfairly.

Many raters try to avoid working on complex claims, because they take too much time and therefore hurt their productivity numbers. In addition, many raters behave as if they see certain veterans as malingerers and they feel a responsibility to deny their claims, regardless of the supporting documentation. Many raters think that bonuses or promotions are tied to the money that they award to claimants. When decades worth of retroactive benefits are involved, it seems that some raters are trying to balance the budget on the backs of veterans.

A rater who doesn't want to approve a legitimate claim can avoid having an unjust denial overturned by allowing it to be sent to the BVA, knowing that the decision was flawed in such a way so that it will be "remanded" back to the local VARO for "further development and a new rating decision." When the claim comes back, it will be somebody else's problem. Some decisions are remanded when raters "neglect" to obtain all the relevant medical records before making decisions. Oops! Sorry! Or they might fail to deal with all of the claimed disabilities—another oops. Raters face no consequences for these failures. Repeated use of this tactic leads to the chorus: "The veteran died while his claim was on appeal." After a little experience, some veterans look forward to a BVA denial, because only then can they get a lawyer when they file an appeal at the US Court of Appeals for Veterans Claims, which is impartial and very veteran-friendly. But this only happens when both the VARO and the BVA have run out of reasons to avoid making a decision.

Some raters take advantage of mentally ill veterans by provoking them into behavior that sabotages their claims. Many vets don't make it past the first page of an eighteen-page rating decision or "statement of the case." They fail to respond by some deadline or fail to understand that they are being asked to provide information concerning the location of medical records. Or vets simply reply with curses or declarations amounting to "forget it," which is heard by unsympathetic raters as "dropping their appeals."

Veterans with mental illnesses are unlikely to be any kinder or more cooperative to any of the VSOs (veterans service officers) from the veterans' groups who have been unable to help them in the past and who they suspect are in league with the VA. These veterans need a different kind of VSO, with special skills and patience. Most of the local offices of veterans' groups seem to be embarrassed by the Sun-Times report, and may see the mere suggestion as another not-too-subtle criticism of the effectiveness of their VSOs. Fear that their dues-paying membership may, in turn, decline may cause them to deny any shortcomings and oppose any changes.

At this point, we must confront the catch-22 that has resulted in the disparity in VA claims. We must realize that most of the mentally ill homeless veterans aren't eligible for VA treatment and compensation because they don't have honorable discharges. Medical opinions saying that the misconduct that led to the bad discharge was due to a service-connected mental illness has caused many VAROs to grant entitlement to benefits after a "character-of-service hearing." The catch is that the medical professionals that you need in order to get the "evidence" aren't available until after you've proven your case. Most VAROs, including Chicago, don't see their "duty to assist" to include obtaining the records and opinions needed to win the claim.

The most immediate need is for a review of the claims of the most desperate veterans, who have already complained about unjust treatment to congressional staffers, VSOs, and state, county, local, and independent veterans' advocates. Where appropriate, these long-suffering veterans should be given immediate compensation and treatment. In addition, a homeless veteran shouldn't have to wait for a decision on his claims in order to get room and board. VARO raters whose decisions have been repeatedly overturned will also be revealed in such a review. Both VSOs and VARO personnel need training to better deal with "difficult" claims and veterans. VA policies may need to be adjusted to allow for this and to encourage VARO personnel to take on these cases. To sum up: we must identify the most needy veterans, review their claims with input from veterans' advocates, and get them help immediately! Then we must reform the representation system for VA claims in Illinois.

Now that we know that Illinois vets need help, what is to be done?

We need to create a "veterans' community service center." It would provide access to housing, health care, legal assistance in qualifying for federal and state benefits and upgrading military discharges, and comprehensive mental-health treatment.

Once opened, our major outreach concern may be how to handle the overwhelming demand for our services. Groups such as the Veterans Strike Force One at the Jesse Brown VAMC have already made contact with many of Chicago's needy veterans. The most obvious resource for outreach statewide is the Illinois Department of Veterans Affairs. In addition, it could provide referrals for treatment, housing, and so forth in local communities. Working with other state agencies and community medical and mental health centers, these newly trained "veteran social workers" will be able to insure that veterans are provided immediate diagnosis and treatment, independent of VA actions. This will also produce medical documentation for the VA claims.

We need to recognize that these veterans need skilled advocates (to help them win VA benefits), mental-health professionals, and the financial resources that will allow them to live until they win those benefits. To that end, we need a staff of six lawyers and paralegals, who will help veterans obtain VA benefits and upgrade their military discharges. Veterans who have claims that have been difficult to win need VSOs with the patience and counseling skills needed to get the facts from the veterans, and the training needed to make sense of the medical records and claims files. We should invite the National Veterans Legal Service Program (NVLSP) to set up an office here. Housing, job training and placement, and mental-health referrals and services could be provided by additional caseworkers.

Since few people have all of these skills, we need to consider teams of specialists. For example, the challenge of finding the VA's mistake in a claim file may attract people who are uncomfortable in interpersonal or emotional situations, but who love a good mystery. Those who can help a veteran to remember and record his or her experiences may be unable to deal with the VA's legal and bureaucratic necessities. Both of these workers need each other to do their jobs, but neither one is providing what the vet finds most critical: housing, food, and treatment. To vets, a solution without the support that they need to live in dignity while their VA claims are decided is hollow. Most of the veterans that need our help have a difficult time relating to non-veterans. They should be matched up with the many caring veterans who would welcome the opportunity to get trained and paid to help their brothers and sisters.

The treatments that stand a chance of successfully returning these veterans to their communities can only happen with access to medical and mental-health clinicians and veteran caseworkers. Nonprofit service providers have full-service programs, providing housing and support, that can be expanded to include a veterans' unit or that can provide a model to be used in establishing dedicated veterans' programs.

Let me tell you about the Heartland Alliance program that I worked in for three years. (Swords into Plowshares operates a similar veteran-specific program in San Francisco. Both have annual budgets of over two million dollars.) We had twenty people working on three ACT (assertive community training) teams and another twenty working in the PSR (psychosocial rehabilitation) day program. Each ACT team had a supervisor with an advanced degree, a licensed social worker, a certified alcohol and drug abuse counselor, and three caseworkers (who needed a college degree in anything and enough experience or aptitude to impress the boss). We ACT caseworkers spent our time with the clients, shopping, learning to be polite, cleaning or cooking, and learning to sit quietly in benefit offices. The PSR has trained therapists who conduct daily AA and NA meetings and regular sessions of art, music, dance and writing therapy as well as instruction on personal hygiene, housekeeping and cooking. Doctors and nurses supervised medications and developed individual treatment plans for the clients, which the teams then implemented.

Our lengthy waiting list accepted only those whose mental illness was so severe that they were homeless and couldn't keep up with the forms for state and federal benefits. We had nearly two hundred "members," twenty-five of whom were vets. Each six-person team had about sixty members on its rolls. Two of the teams did outreach and helped the PSR to stabilize their members. I was on the transitional team that "graduated" about one member a month to "independence."

We owned and operated several buildings, providing housing with varying programs and levels of supervision. With a goal of obtaining subsidized housing for our members, we worked with the landlords of several studio-apartment buildings, who tolerated the frequent "failures" common to this population. In addition, we placed many people with Lakefront Supportive Housing, which runs several buildings for low-income, elderly, and disabled people. They have subsidized rents, in-house social workers, and various activities and meetings.

Chicago veterans need a similar program that can address all of the problems that they face.