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A Veterans Administration for the Veterans

During the Agent Orange litigation in the summer of 1981, evidence of horrendous treatment of Vietnam combat veterans was uncovered at the Los Angeles VA hospital. When the matter was brought to the attention of the Veterans Administration, their bureaucracy claimed that there were priorities involved: “The Vietnam combat veterans will just have to wait their turn; we still have veterans of World War II and the Korean War to take care of!” Victor Yannacone was forced to sue the VA on behalf of the veterans.
Apparently the same attitude prevails today. The veterans of our wars in the Middle East and Afghanistan will have to wait until the Veterans Administration bureaucracy is finished with its lackadaisical and unenthusiastic treatment of the Vietnam combat veterans.
Just as wounded Vietnam veteran Max Cleland before him during the 1980s, Veterans Administration Secretary Eric Shinseki, another Vietnam combat veteran and former chairman of the Joint Chiefs of Staff was pilloried by Congressional demagogues for the failures of the essentially unaccountable, civil service protected bureaucrats who really run the VA medical system.

Why didn’t anyone prepare for casualties from the Middle East wars?

Apparently when President George W. Bush decided to go to war against Iraq, he forgot to tell the Veterans Administration bureaucracy and the Congress to prepare for the casualties of that war.
With each war the United States has fought since the American Revolution and the War of 1812, medical advances have saved the lives of seriously wounded combat veterans from all of our military services. The number of veterans surviving serious spinal cord injuries and multiple amputations has increased exponentially from war to war.
Since the War in Southeast Asia medical science now recognizes that modern ordinance can produce serious damage to the human nervous system without clear evidence of trauma. In addition, the stress of combat in a war without clearly defined goals and objectives to which our soldiers and sailors can relate leads to serious problems when those soldiers and sailors return to civilian life and try to live among people who cannot understand much less appreciate the meaning of combat.

Vietnam combat veterans had to sue the VA in 1981

In 1981, the Vietnam combat veterans who brought the Agent Orange litigation took the VA to the federal courts (CV–81–0055, USDC/EDNY). The claim was simple: treatment of the Vietnam veterans by the Veterans Administration medical system was so barbaric and unfeeling as to constitute the kind of “cruel and inhuman punishment” prohibited by the Eighth Amendment to the United States Constitution—part of the Bill of Rights.
The specific claims of the Vietnam combat veterans in 1981 were:
• Veterans have a right to timely and complete medical care for any injury, disease or disability resulting from their service in Vietnam
• As it affects Vietnam combat veterans … present VA policy constitutes “cruel and unusual” punishment in violation of the Eighth Amendment.
• The individual bureaucrats responsible for VA policy have conspired to deny the constitutional rights of the veterans and their families.
In 33 years, very little has changed at the Veterans Administration as far as the humane and compassionate treatment of all our veterans is concerned.

Dismantle the VA bureaucracy

Regardless of the constraints imposed by federal civil service rules and regulations, the management of the bureaucracy in the VA medical system has to be dismantled.
When General Shinseki was Chairman of the Joint Chiefs of Staff he had direct authority over the individual men and women in our armed services and was responsible only to the President of the United States as commander-in-chief of those armed services. Later, as a cabinet officer he was still responsible to the President of the United States, but he had no real and meaningful authority over the essentially unaccountable bureaucrats protected by the federal civil service system who actually manage the day-to-day affairs of the VA medical system.
Rather than force his resignation as Secretary of the Veterans Administration, Congress should have allowed General Shinseki the freedom to run the Veterans Administration the way he once ran the Armed Forces of the United States. There is really no place for the federal civil service system in our Veterans Administration any more than there is any place for civil service rules and regulations in our Armed Forces.

A modest proposal to restructure the VA

• Look at the structure of the VA medical care system and isolate its mission-critical individual units — the VA hospitals, the VA nursing homes, the VA long-term care facilities, the VA outpatient clinics, and the VA dispensaries.
• Identify the staffing at every VA healthcare facility and review the function, authority, and exercise of power by every individual who does not provide direct healthcare to the veterans.
• Establish a nationwide VA electronic medical record system and utilize modern methods of data mining to determine the timeliness and effectiveness of the medical care and treatment provided our veterans.
• Assure that the medical treatment staff at VA health care facilities has an understanding and appreciation of service in the Armed Forces and the acute and chronic effects of combat.
• Promote and encourage sharing of information about a veteran among all the healthcare professionals who may be engaged in treating the veteran.
• Integrated medical care and treatment, improvement in the quality of life and living, and expediting the return of each veteran to substantial gainful employment in the national economy should be the declared unwavering goal of the entire VA healthcare system.
• Provide procedures and promulgate rules and regulations for a civilian equivalent of a summary court-martial for any VA healthcare facility employee charged with neglect or incompetence in the care and treatment of individual veteran patients at their healthcare facility.
• Treat the VA healthcare system as a unit of the Armed Forces of the United States.
• Establish a command and control system for the Veterans Administration which is no less efficient and effective than that provided for Special Operations units in the military.
• Eliminate the position of Secretary of Veterans Affairs and its attendant bureaucracy from the civilian Cabinet of the President and bring the Veterans Administration under the direct supervision and control of the Chairman of the Joint Chiefs of Staff.
Any change in the administration and management of the Veterans Administration is doomed to failure, however, unless the ineffective procedures, rules and regulations which cripple military procurement practices and have led to overpriced, suboptimal weapons systems since the conclusion of the Korean war are overhauled and brought into conformity with the modern business practices of successful large enterprises providing services to consumers and the public.