The Issues Arising From the Department of Veteran Affairs
Victor N. Ijoma
Texas Southern University

Abstract
The issue of veteran’s affairs is a very important aspect to who we are as a nation. There are thousands of men and women who put on uniforms to go and defend our rights thousands of miles away, they have fought to make our dreams of living free and equal a reality and I believe we owe them the least of caring for them when they return home. The situation currently going on in the Department of Veterans Affairs is a nightmare, veterans being denied care, not being able to receive adequate support when they come home is a national disgrace to us. The effect of not being able to attend to the need of our veterans is a very dangerous trend, and unless we take the matter as an emergency situation, the very strength of our armed forces will start to lose its glory. The most important means of making sure we are taking care of our veterans is by looking into the laws and policy that currently govern the department so as to find a more responsible approach to making these laws and policy’s even better. The veterans Affairs being the second largest department in the federal government, it is crucial to have a budget big enough to be able to sustain old working programs and implement new programs in order to help give our veterans the very best care they have earned and desire.

Department of Veterans Affairs
As early as 1636 when the pilgrims of Plymouth Colony were at war with the Pequot Indians. The Pilgrims passed a law that stated that disabled soldiers would be supported by the colony (US Department of Veterans Affairs, 2014). This was to set the stage for future means of assisting soldiers who have needs after serving their country. While the VA has seen a significant increase in its funding over the past several years, it is still very much underfunded—and much of the money going to the VA is misallocated, making the problems worse. As Peter Schuck has pointed out, the root of this problem is more with Congress than anyone else. Congress has jumped whenever veterans' groups say so, and that has included defining disabilities that can receive compensation far more broadly and generously than is affordable. This has left the agency swamped with claims. When people inside the VA pointed out that we now have 150,000 veterans receiving bundles of money for sleep apnea—not exactly a service-related disability—Congress shrugged. That is money that could be spent dealing with real and deep problems. When Congress tried to create new medical centers to respond to the demand, Republicans in Congress refused to fund them. Congress has created the rules that make it virtually impossible to fire or discipline employees—not just a VA problem, of course—and has failed to do the kind of vigorous oversight that would have uncovered these problems much earlier, and resulted in congressional actions (National journal, 2014).
The U.S. Department of Veterans Affairs handles three major categories for America's veterans: 1. Medical care for Veterans 2. Benefits for Veterans 3. Burials/memorials for Veterans
Understanding the limitation caused by funding for veterans, has contributed to the lackluster treatment being provided by the VA department. The problem in helping veterans find the much needed help they require in the United States, has underscored the need for physicians, politicians, and advocacy groups to function appropriately.
Medical Care for Veterans
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 (Zezima, 2014).
According to an online source, CNN reported on April 30, 2014 that at least 40 United States Armed Forces veterans died while waiting for care at the Phoenix, Arizona, Veterans Health Administration facilities. By June 5, 2014, Veterans Affairs internal investigations had identified 35 veterans who had died while waiting for care in the Phoenix VHA system. An investigation of delays in treatment throughout the Veterans Health Administration system is being conducted by the Veterans Affairs Office of the Inspector General, and the House has passed legislation to fund a $1 million criminal investigation by the Justice Department. On May 16, 2014, the Veterans Health Administration's top health official, Dr. Robert Petzel, retired early at the request of Secretary of Veterans Affairs Eric Shinseki. On May 30, 2014, Secretary Shinseki resigned from office amid the fallout from the controversy. As of early June 2014, several other VA medical centers around the nation have been identified with the same problems as the Phoenix facility, and the investigations by the VA Inspector General, the Congress and others are widening.
An internal VA audit released June 9, 2014 found that more than 120,000 veterans were left waiting or never got care and that schedulers were pressured to use unofficial lists or engage in inappropriate practices to make waiting times appear more favorable.
Benefits for Veterans
The widening scope of Veterans benefit problem has prompted the president to request for an investigation into the backlog in the VA system. Upon further review conducted by the senate on Veterans Affairs, a report released by nine senators acknowledged recent efforts by the VA to reduce disability and pensions claims backlogs but said it wasn't enough. Pointing to the VA's worst performers such as the Philadelphia regional office, the lawmakers were announcing legislation that would require the Government Accountability Office to investigate all 56 regional offices for problems. Influenced by "The VA system again finds itself engulfed in another scandal," said Sen. Dean Heller, R-Nev., co-chairman of the Senate's VA backlog working group. VA offices nationwide are suffering from poor management, he said, proving "it is time for an overhaul of the entire system." (Yen, 2015).
The search for the right long-term solution to the veteran’s benefits problem has been complicated. Many of the sort out solution brought up by senate have proved to be very disappointing. Sen. Bob Casey, D-Pa., the other co-chairman, said he too was worried that problems were not isolated to Philadelphia. "It's simply unacceptable to have a veteran with a disability wait hundreds of days for their claim to be resolved," he said. Delays in compensation claims prompted veterans groups to seek changes last year before attention shifted to problems at the Phoenix VA medical center. The VA ultimately found that patient waits and falsified records in its health network were "systemic," leading to the resignation of VA Secretary Eric Shinseki. According to an online contributor, Hope Yen, “Allison Hickey, the VA's undersecretary for benefits, has said she does not believe problems in Philadelphia are "systemic" but more likely a case of misunderstood policies”.
According to previous finding, “data were independently abstracted using a one-page abstraction form. Data for surgically related articles were abstracted by our surgical reviewer, and for non-surgical articles the internal medicine reviewer completed the abstraction process. Once the forms were completed, all data were reviewed by the review team. The following data were abstracted from included trials: sample size for both VA and non-VA sources, years of data collection covered for both VA and non-VA sources; control variables; primary outcomes; and secondary or associated findings”.
Recently, the Veterans Administration (VA) Under Secretary for Health has designated functional status as one of the domains of value for the system, given its increasing importance for clinical care. The Veterans Health Study (VHS) was designed to assist the VA in monitoring outcomes and measuring the case mix of patients who use the VA. The Veterans SF-36 (short form functional status assessment for veterans) was administered to 2425 veterans receiving ambulatory care. Measures of the Veterans SF-36 were strongly correlated with sociodemographics and morbidities of the veterans. Young veterans had poorer mental health status than older veterans. Veterans who used ambulatory care in the VHS reported lower levels of health status, reflecting more disease than a non-VA civilian population. These measures of health are important indicators of the disease burden or case mix of the patients and are pertinent to health systems such as the VA for resource allocation decisions and as outcomes of care (Qual, 1999).
Burials/memorial for treatment
Burial benefits available for spouses and dependents buried in a national cemetery include burial with the Veteran, perpetual care, and the spouse or dependents name and date of birth and death will be inscribed on the Veteran's headstone, at no cost to the family. Eligible spouses and dependents may be buried, even if they predecease the Veteran.
The Veterans family should make funeral or cremation arrangements with a funeral provider or cremation office. Any item or service obtained from a funeral home or cremation office will be at the family's expense. Most of the Department of Veterans Affairs national cemeteries display an Avenue of Flags on patriotic holidays and during special events. The Avenues consist of burial flags donated by the families of deceased Veterans and provide a unique visible tribute to all of our Nation's Veterans. A Certificate of Appreciation is presented to the donor for providing their loved ones' burial flag to a national cemetery
A Vietnam veteran, Avdek understands what it means to serve. But on this Memorial Day, as events take place across the Bay area and the nation to honor those that gave their lives in military service to America, a controversy swirls. Thousands of people convened at the C.W. Bill Young VA Medical Center in Bay Pines today for Memorial Day ceremonies - as lingering issues at national VA Hospitals continue. "They gave their lives the ultimate for our country I believe we should honor them," Avdek said.
“As a country, we have a solemn duty to serve our veterans as well as they have served us,” president Obama said in a statement. Veterans Affairs is the second-largest department in the federal government and it is still unclear as to why the high volume of scandal and controversy that trails the department over its inability to provide proper care for the veterans. As far back as 1921 when Congress created the Veterans Bureau to administer assistance to World War I veterans. It quickly devolves into corruption, and is abolished nine years later under a cloud of scandal. Then in 1930, The Veterans Administration is established to replace the troubled Veterans Bureau and two other agencies involved in veterans' care. Nowadays, the problems confronting our veterans is still ongoing with the long waiting list and access to care. VA continues to face difficulties, articles in the New York Times, have shed some light on records being manipulated to cover up the back logs of patient claims. These problems are said to have been caused by the lack of employees to fill in vacant position at the VA hospitals. In addition to the spectrum of problems being faced in the Department of Veterans Affairs, both Republicans and Democrats have pushed for bills to allow veterans to go to private doctors to avoid long wait times plaguing Veterans Affairs hospitals and clinics.
According to an article on the Washington post, it would cost $17.6 billion over the next three years to hire thousands of medical professionals and take other measures necessary to resolve the immediate concerns facing the department. The plans to increase funding for hiring medical personnel and lease additional facilities will help the VA meet growing demand. With congress voting on a bill proposed by the Obama administration releasing an estimated $17 billion dollars to revamp the VA hospitals. The truth according to Republican Jeff Miller is to give veterans the option to choose whether to wait on the VA hospitals or to visit a private hospital which will reduce their waiting period for care. With all the steps taken, the best expected result is for the improvement of the way veterans are taken care of when they come home.
In the articles I have read pertaining to the veterans’ administration, it is clear that there are problems in the way veterans are being taken care of. An example of such articles is the one from the New York Times. In the said article it was discussed how the long waiting list, might be connected to the deaths of some veterans. According to other articles, when employees try to report the problems, they are forced to keep quiet and those who refuse to be quiet are retaliated against by supervisors and executives by means of firing and suspension. This continuous problem faced in the VA, has resulted in the resignation of Eric Shinseki, the secretary for veterans’ affairs. With the resignation of Eric Shinseki, the house committee on veteran’s affairs is currently screening Robert McDonald as the next in line to replace Shinseki. The soon to be secretary of the VA has set out some proposals that will further reduce or stop the delay of care for veterans. Among other improvements, Mr. McDonald said the agency would eventually need to change the way it evaluated and rewarded employees, which has been blamed for encouraging hospital officials to hide long waiting lists as they struggled with a shortage of doctors to meet veterans’ growing treatment demands.

Reference
McDonald, R. (2011, August 17). VA Hospital Scandal. Retrieved April 28, 2015, from http://www.cbsnews.com/feature/va-hospitals-scandal/
House approves VA heal care over haul. (2014, July 27). Retrieved August 2, 2014, from http://www.washingtonpost.com/politics/health_care/house-approves-va-health-care-overhaul/2014/07/30/3cdb7726-184c-11e4-88f7-96ed767bb747_story.html
Miller, J. (2014, June 7). Weekly Republican Address. . Retrieved July 27, 2014, from http://www.c-span.org/video/?319851-2/weekly-republican-addres
Zezima, K. (2014, March 30). Everything you need to know about the VA — and the scandals engulfing it. Retrieved March 9, 2015, from http://www.washingtonpost.com/blogs/the-fix/wp/2014/05/21/a-guide-to-the-va-and-the-scandals-engulfing-it/
HUETTEMAN, E. (2014, June 22). Confirmation Hearing Becomes Debate on Veterans Affairs. . Retrieved August 2, 2014, from http://www.nytimes.com/2014/07/23/us/politics/confirmation-hearing-becomes-debate-on-veterans-affairs.html?module=Search&mabReward=relbias%3Ar%2C%7B%222%22%3A%22RI%3A12%22%7D
Yen, H. (Ed.). (2015, May 4). Senators want independent review of VA to see if mismanagement of veterans' claims is systemic. Retrieved May 3, 2015, from http://www.usnews.com/news/politics/articles/2015/05/06/senators-seek-va-probe-to-see-if-mishandled-claims-systemic
Qual, M. (1999, January 28). Result Filters. Retrieved May 7, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/10446661
Hopper, C. (2014, May 12). Memorial Day ceremonies take place as VA issues linger. Retrieved May 7, 2015, from http://www.baynews9.com/content/news/baynews9/news/article.html/content/news/articles/bn9/2014/5/26/memorial_day_ceremon.html

Author Note
This paper was prepared for Government Budgeting and Financial Management Section E1, taught by Professor Christophe.

Footnotes
The hospital indicated that the data submitted for this measure were based on a sample of cases.
A rate may be based upon the total number of cases treated by a hospital with a large caseload, a rate may be based on a random sample of the cases the hospital treated. This footnote indicates that a hospital chose to submit data for a sample of its total cases (following specific rules for how to the select the cases)

Figures