VA needs Montana perspective to improve service

From an office in Washington, D.C., it's impossible to understand what it means for Montana veterans to have a VA outreach clinic in their hometown, to have a crowded clinic that hasn't grown with the number of veterans seeking care, to travel hundreds of miles to hospitals, to be told that there's a nine-month wait to see a needed medical specialist in Denver. VA Secretary James Peake learned these things in a crash course in rural medicine last week.

Visiting at the invitation of U.S. Sen. Jon Tester, the secretary received instructive insight from veterans who packed a forum in Billings to vent frustrations about VA health care and disability compensation. Some praised VA health care staff while complaining that there isn't enough staff. Difficulty accessing quality mental health care was a common concern.

Traveling long distances

How far is VA care? Jim Kerr of Billings, commander of Disabled American Veterans Chapter 10 gave Peake an idea when he told the secretary that Eastern Montana volunteers logged 418,000 miles last year driving 7,100 veterans to medical appointments in DAV vans.

Some solutions are obvious and relatively easy. For example, to address complaints that the Billings outreach clinic phone goes unanswered for many rings, the VA should hire additional staff and get a phone system that will promptly route calls to staff that can assist the caller.

Another solution is in the works. Peake last month approved a new Billings outreach clinic with double the space. But it might not open till summer 2009, a VA spokeswoman said last week. The actual timeline will depend on proposals received from private landlords. The VA seeks to rent space, which the landlord may have to build or remodel to meet clinic needs. The deadline for proposals is Friday.

To tour the entire VA clinic at King Avenue and 24th Street West, Tester and Peake had to walk outside twice. It's way too small for all the patients and services that the staff is striving to provide. Tester is justifiably concerned that the new Billings outreach clinic will be large enough to serve veterans well for many years. The number of veterans in the VA Montana system has nearly doubled since the Iraq War started and Yellowstone County is home to the state's largest veteran population. About a third of the state's 100,000 veterans are enrolled for VA health care.

Some solutions are more complicated. Several Billings area veterans told how lack of access to their military records – lost, destroyed or classified by the government – blocked them from getting health care or disability benefits. The VA must leap into 21st century and start utilizing electronic records with security features to protect them from loss or theft. Records snafus also involve lack of communications between the Pentagon and the VA.

"We're working continually on the Department of Defense-VA transition," said Tester, who is a member of the Senate committee on veterans affairs.

Regional disparities in VA disability ratings recently have been reported in national news stories. Veterans in some states, including Montana, tend to get significantly lower disability ratings than average American veterans. Lower ratings translate into lower income over the disabled veteran's lifetime and can affect eligibility for VA health care. Tester has already called for an investigation of disparities. He needs to follow through to push the VA to make timely corrections.

Hopeful for change

Peake has been VA chief for less than three months, appointed by a president who will leave office in January 2009. Many concerns voiced by Billings area veterans date back years, even decades. It's uncertain how much progress this secretary can make in a short tenure. But there's reason to expect he will try. A lieutenant general, Peake worked 32 years as an Army doctor, the last four as Army Surgeon General. He is eminently qualified to lead the VA.

In Billings, Peake told veterans that he's "pulling together a rural health council." He's focusing on access, including use of telemedicine and telepsychiatry. Peake acknowledged that the VA needs to do more community mental health.

As Tester said, the forums provided "a sampling of the kind of challenges people in Montana are experiencing on a daily basis." Thanks to Tester, the new VA secretary got an up-close, personal look at how his job affects Montana veterans.