Tuesday, September 29, 2009

Fixing Healthcare, Just Like Fixing Airplanes?

With all the talk lately of American healthcare troubles it got me thinking on the subject of problem solving. That IS the goal I think; but it seems that very few if any of the myriad techniques available are being applied, other than the amateurish principle of “trial and error,” which may well be the worst method there is. I’ve heard people in the administration actually say things like, “The problem is SO catastrophic that we NEED to do something, ANYTHING; we can always “tweak” it as we go later.”

Similarly, back in “the stupid old days,” the US military routinely used the “field and forget” method to employ new weapons systems,” a fiasco of a way of doing things that usually ended up as “field and fix.” The annals of our military history abound with horror stories of hastily-employed weapons; the extent of their failings discovered at the worst possible time, that is, “when the weapon met the war.”

The “fog of war” is murky enough without making it worse with untested equipment, yet until relatively recently we routinely did this foolishness. Usually it happened because of politics (sound familiar?), or where some high placed officials thought THEY knew better than the REAL experts, the experts of course being the enlisted folks and officers who have to actually use the stuff.

During my time “in” I was around quite a bit of problem solving, which started with my time as a technician and technical supervisor. But all that turned out to be preparation for what I got into during the last half of my career, when I graduated from repairing individual planes to resolving issues involving entire fleets of aircraft. If I’m completely honest though, rarely was I the actual “solver,” but always I was certainly part of “the problem solving process,” a process that invariably involved input from a team of “solvers.”

I got onto the whole “big picture” problem solving ride by accident. It started as I entered into the last 13 years of service, the half way point of my time in the military. From there my career path meandered to the extraordinary, at least compared to a lot of other airmen’s careers.

My job path took off on this “merry tangent” in 1989 when I left the position of shift leader for a new job in the Quality Assurance Office after being recruited into it by the master sergeant I eventually replaced. (I caught his attention one morning as he observed the no-nonsense way I handled my troops during the weekly “FOD walk”). During my next 6 years in the Quality Office I also took on the ancillary responsibility of overseeing a contract field team of around 25 or so civilian technicians whose job it was to strip out most of the original 30-year-old electronics in our vaunted C-130 “Hercules” cargo plane, and installing modern systems in their place.

What I found the most interesting about that 6 year QA gig was constantly running into new problems, some big, some small. There were about 80 airplanes on our flightline (including the Air Guard’s)—a lot of C-130s. With so many “birds” it took several years to modify all of them; so for quite some time we had a mix of newly modified aircraft, along with “birds” still creaking along with 30 and 40 year old technology.

As lead base for C-130s, often times we were first to get the newest systems, on a trial basis so to speak. In effect, we were the guinea pigs for the rest of the fleet; as such, I was confronted with glitches and gremlins almost on a daily basis. My job was to research these malfunctions, in the short term find out the “whys,” and finally, to come up with answers and even resolutions.

It was during this time of continuous problem solving that I began to simultaneously submit my “fixes” by way of the Air Force Suggestion Program, as well as to the primary approving agency being the Air Logistics Center at Warner Robins AFB in Georgia.

I remember the first time I had a suggestion approved just a few months before I joined the QA team. It was to modify an incorrect troubleshooting tree for engine oil pressure transmitters. It wasn’t all that complicated, but months later, seeing the pages amended in the technical orders to reflect MY changes was quite heady. In a small way I had affected the entire fleet of several hundred C130s. I felt pretty good about that, and about the little award check I got out of it as well.

The stars lined up perfectly when I joined the QA shop and found myself responsible for the proper installation of a host of new aircraft electronic systems. As part of these responsibilities I worked with the Lockheed “mod team” to write the installation workbook requiring that I saw and or touched every new wire bundle, screw and rivet that went into the plane. As part of that workbook I made it mandatory that I personally sign off the okay to reinstall every panel to make sure there was no debris left behind it before they were allowed to button it back up. There was a good chance that I would be the last person to inspect those areas for years to come; and believe me, I felt the pressure of knowing that. When it comes to aircraft work there is no such thing as being too critical; it either meets spec or it doesn’t. My very last signature was the one I made on the acceptance sheet which brought each airplane out of depot status back into operation with the Air Force.

Earlier I spoke of how the military has made a science of properly fielding new weapons systems (in fact, the army has a university devoted to perfecting and teaching acquisition at Ft Lee, VA); BUT, when installing so many new systems onto a 30 year old platform like our C-130s were, while still keeping much of the deteriorating original wiring and archaic electrical power, in the aftermath of that we were bound to have to do some major “tweaking.”

Indeed, MY CFT guys put a LOT of new gear into those old planes: Let’s see, one of the most complicated installations was a brand-new redundant Self-Contained Nav System that also provided attitude information to the flight directors; the team also put in a host of flat panel and digital instruments to replace the old spinning dial analog indicators, a new autopilot, GCAS (ground collision avoidance), a partial upgrade to aircraft power, a much improved radar altimeter and Doppler radar, as well as several new radios and associated antennas and secure voice kits. Toward the end of my tenure we also started to put in GPS, TCAS (aircraft collision avoidance) and electronic countermeasures to include the chaff and flare dispensers. After almost 15 years since my involvement I’ve forgotten some of the systems MY team installed, but per aircraft all that work took hundreds of man-hours, thousands of feet of wire, countless hundreds of wire pins and terminals, and scores of connectors; and it all had to be done perfectly and on schedule, aircraft after aircraft. All those long overdue upgrades were bound to lead to a host of problems, and boy, did it ever!

From 90 to 91 I took a short break from “my path” by going to war; during the two years it took those 7 months to pass I became a regular maintainer again. After the war I returned to Little Rock to find shocking changes in my absence; the Air Force had gone through a major organizational and philosophical shakeup—maintenance had become completely decentralized; there was no longer a single colonel in charge of maintaining all 64 aircraft. Overnight each of the four squadron commander’s took over complete responsibility for their own birds’ upkeep.

Not only that, but a new concept called TQM, or Total Quality Management (a term now long out of vogue), had become the latest management fad. Under it, all of us once scary QA boogiemen lost our scariness and instead we became nerdy “quality facilitators.” Lucky for us though, our Logistics Group commander was shrewd enough not to dismantle us the way other C-130 bases had done immediately to their QA shops once the reign of TQM had begun. The fact that our QA pretty much remained intact paid off big as far as I’m concerned.

I must admit though that I wasn’t sorry to see the days of inspection quotas ended; I never liked doing all those tedious exams anyway. Instead of inspecting individuals’ work (making them extremely nervous!) and checking out test equipment, we began concentrating on “process improvement.” And ho hum, I guess we did some of that, but what really excited me was getting all that new electronics correctly installed, and just as important, finding and fixing all the associated glitches and bugs.

And HERE is why our commanders were so brilliant in keeping us QA boys around—we became the corporate knowledge bank, the go-to-guys for oddball problems, and the overseers of high interest taskings from the command.

There is a very scary truism about airplanes: You don’t know what’s screwed up if you don’t know what’s screwed up. This strange axiom became obvious when our wing became the only one still conducting so-called acceptance inspections of those C-130s returning from the depot facility at Ogden, Utah. We had just way too many airplanes to let our contract field team do all the modifications, so Ogden and Warner Robins did them as well. The problem is that the colonel in charge at Ogden became upset with us because we were the only ones complaining about their work. I would go out to an airplane just arrived from Utah and fill page after page of squawks on a legal pad, and many of them were grounding write ups (I once found over 100 writeups). The Ogden colonel was so irked at us that he paid for me and my right hand man, a brilliant avionics troop by the name of Shawn Dougherty, to come to his facility so he could show US how wonderful HIS installers were. As it turned out, we were not the least bit impressed and in fact showed them the many errors of their ways. At first their resentment was disconcerting, but eventually I think we won them over with our earnestness.

The point is that WE KNEW what to look for because we were were intimately familiar with every disturbed and new wire bundle and connector, so we immediately recognized the improprieties, but we were the only inspectors left at the wing level who continued to do these post-depot inspections. A chilling thought—what about the OTHER aircraft never looked at with the same knowledgeable eyes? As far as all the other users the installation was A-okay. The only actual acceptance inspection done at the depot was done by an aircrew that had no clue about what was physically done to the aircraft and whose only worry was to accomplish the checkflight. As far as they were concerned, if the systems worked on that flight, then it was good to go. In other words, “Ignorance is NOT bliss.” …shudder…

And NOW, to finish up this LONG post—my counterpart, Shawn Dougherty, and I, began to LOOK for problems or just ways to make maintenance actions less cumbersome and more efficient. Here’s what we learned: if you stay your ass in the office, you will NEVER learn a thing. You GOT to find out what you DON’T know. A common fault of problem solvers is that they THINK they KNOW; they DON’T. Following that premise we made our rounds to the flightline, to the squadrons, to the shops, to the contractors, all with the goal of talking to “the experts.”

Hardly a day went by where some sergeant or senior airman didn’t come up to me to complain about some new glitch or malfunction. It got to the point that troops seeing me drive by would jog over and flag me down, something they NEVER used to do when I wore my white boogieman QA hat. They loved that I always had a sympathetic ear and asked lots of questions. Complaints, moans, and groans—I LOVED it. If they had a problem I WANTED to hear about it. Their squawks became my bread and butter.

To finish blowing my own horn, we began to establish a reputation, especially once all the approved suggestion awards began to roll in along with the award checks. Every month during commander’s call Shawn and I would receive not one or two checks, but usually 5 or 6. This went on month after month, for almost three years; and once the word got out that WE were the people to see to get things fixed, even more folks approached us with their tales of woe. I’m pretty sure our success inspired others to do the same thing. I loved it, being able to make a difference.

As I said, seldom if ever was I the one that came up with the fixes. Most of those ideas came from the same folks who came forward with the problems in the first place. Ask someone for a problem and chances are they can also tell you how to solve it.

But my REAL secret weapon in tackling especially big problems was my contract field team. Those fellows were incredibly brilliant at finding the best solutions. Most were retired military with decades of experience working on aircraft long before they started modifying planes as civilians. Whenever I approached them with a problem, I’d make my pitch, usually at the break table, and then I’d leave them to mull it over. Without exception, within a few days they’d have a workable solution, usually complete with diagrams and written procedures. They always told me that they wanted nothing in return since by contract everything they came up with officially belonged to Lockheed. It was a joke to them; they said they’d rather I have credit than Lockheed. Absolutely remarkable men!

In 1992 or 93 the base commander even chose me to be his Suggestor of the Year, or at least some one in the suggestion office did, not that I was even aware that such an award existed. It was nice but it could easily have gone to Shawn, since we collaborated on most of our projects. I always say that THE best idea I ever had was hiring him to work with me in QA.

I learned during those exciting times that my strong suit was seeing the brilliance in others and tapping into that brilliance as a primary resource; and I found that the best answers invariably come from the same folks who come forward with the problems in the first place. If the solution is the drink then I was the humble vessel. I did my job best by completely defining the problems and their scope, usually after that, what had to be done became obvious. I’m sure the answers to our healthcare dilemma can be found in exactly the same way; and not by a bunch of self-serving politicians and lobbyists who THINK they know the answers; THEY don’t.

Sunday, September 13, 2009

Thoughts on ObamaCare

News coverage of Obama’s healthcare bill has eclipsed all other news for much of the summer and it looks like this same controversial topic will stay on the front burner well into autumn. Personally, when it comes to health insurance, I’m covered by three separate government health care systems—TriCare, Medicare, and the VA. Asking myself if any of this stuff concerns me, of course the answer is YES, it does. Reading the news and researching the bill, I feel extremely apprehensive.

Its complicated nature is one thing that bothers me—it’s a hulking Frankenstein monster cobbled together by disparate authors each with their own special interests. And no one really knows anything about how it will specifically work to accomplish the objective, which supposedly is affordable healthcare for virtually everyone. I ask rhetorically, does this mean if you’re broke or indigent that you will still have access to by-pass surgery, ultrasounds, MRI’s, CAT scans, chemotherapy, x-rays, or whatever your medical needs might be? If so, then in a nutshell, the way it works is we spend lots of money—billions upon trillions in fact.

Based on what he’s said in his recent promotional speeches to push this legislation, or I should say, on what he didn’t or couldn’t say (long on promises, short on details), Obama himself doesn’t understand much of the inner workings of “his” own bill; and who can blame him? Have you tried to read it? Here’s a link to the contents of HR 3200 by subtitle and section. Scroll through it and see what I mean. Basically, he tells us not to worry, don’t be scared—TRUST him. (I’m supposed to trust someone with a background devoid of any real executive experience in any field other than “community organizing?”) I’m still baffled whenever he says it will cost MORE not to implement this bill. . . .Huh?

Here’s what I think—in our current economic state we cannot afford to pay for everyone’s medical care. Maybe it was possible decades ago, when medical care was bare bones, but now? No way. Back then, all the procedures and treatments, plus the equipment it takes to accomplish them, all things taken for granted today, had not yet been developed or invented. And pharmaceuticals?—antibiotics were just coming into development 70 years ago for one example, and compared to today there were few effective remedies of any kind. People either recovered (mostly on their own) or they died; and often a lot of suffering was involved before they died just the same. Seventy years ago the government was not involved in any of that.

So here’s the thing, if we ARE going to do this, if we really plan to provide all the latest medical care to everyone, no matter how much they do or don’t pay in, then we all have to accept the fact that we must sacrifice other things on a national scale, things like our high-priced military capabilities, educational programs, foreign aid, highway and bridge building and repair, space exploration, you name it, we have to let much of that and plenty of other stuff go; AND it’s a given that our taxes WILL necessarily go UP.
Look at overtaxed Europe for instance; they HAVE socialized medicine and due to the costs of funding it they mostly rely on us to defend them, the same as much of the free world does. If we do this then, our allies should start deciding what to do if Russia, China or Iran starts flexing imperialistic, and how to do it without us.

On that note, let’s talk cost on a human level. My dad had a kidney transplant that gave him about 15 years more of life. The costs of doing the actual procedure was probably on the order of hundreds of thousands, and the continuing costs of maintenance meds, plus the expense of paying for recovery from complications over the next decade and a half was probably even more. Who paid for it? Well, you did if you bought certain American autos. His GM health insurance paid for most of it initially, so GM recovered it by rolling it into the price of their cars. (None of that was a problem as long as General Motors was hugely profitable). I assume the rest of the costs were rolled into TriCare and Medicare, so again, we all paid; no argument from most, since we might need some of that action someday, right?

Next, the marvels of “the miracle” of modern medicine—both my grandfathers died of heart failure; after their attacks the treatment they got back in the 60s and early 70s was bed rest—that was about it. Can’t get much more inexpensive than that; but, you get what you pay for, because they both died! It’s a good bet that they would not have died from those same heart attacks today. Now, there are drugs that bring heart attack victims back from the brink, not to mention angioplasty, stints and by-passes—all miraculous, and all expensive.

All the new treatments are great, they extend life like no one ever thought possible during my grandfathers’ times; but let’s face it, the costs are enormous. To highlight on a personal (non-American) level, my Filipino buddy died three nights ago from a longstanding heart condition. His cardiologist told him months ago that angioplasty would easily give him another couple years or more of life. Yet, he didn’t have the procedure because he didn’t have the money and couldn’t get it, not even from his 6 kids in the States. The cost of angioplasty here is 700,000 Pesos or about $14,500 (cheap by American standards). Yet, his six successful children, all Americans, refused to chip in the measly $2430 each to save their dad. In effect, they exercised their own familial version of rationed health care, something we will certainly see under the ObamaCare system if it passes. I’m sure my buddy’s kids reasoned that their dad is old and weak—how much longer can he last? Am I judging them? Well, yes, I am; but similar decisions will surely be made by the new healthocrats waiting to happen with this bill!

(On the subject of rationing, most of us low rent “bottom feeders” simply accept it. Insurance companies, the VA, even TriCare, they all govern who gets what procedures, tests and treatments and when, based on factors such as age, cost, and likelihood of effectiveness—that IS rationing. Of course, they HAVE to; there is only so much money to go around. And if Medicare doesn’t do it now, I have to wonder why they aren’t. Perhaps I’m hardened to it from my own experiences, but there’s just no way that everyone gets treatment, regardless of circumstance. ONLY the very rich get ALL the treatment they desire—nothing will EVER change that, not even ObamaCare. Brad Pitt supports ObamaCare without question, but when he gets to be 75 do you think he’s going to subject himself to the decisions of some healthocrat? Hell no, he’s going to go someplace else in the world and simply pay for whatever he wants, and more power to him!)

Now bear with me while I continue to talk this out, because I’m trying to understand a few things—first, explain what it is about healthcare that suddenly turned it into a human right? There is nothing about healthcare in the Constitution. All it says is that we have a right to the pursuit of happiness (and life and liberty) by guaranteeing our freedoms under the Bill of Rights to keep us free of government tyranny.

So, obviously, Obama’s crew and many of his big city constituents believe that modern medical care should be a basic human right, and, that as a nation we must all bear the costs for those that cannot afford it. Do I have that right? Okay, so let’s say they pass the bill and universal care becomes the new American human right. Well, as I just pointed out above, the miracle of modern medicine costs money and lots of it. Then again, so do a lot of things, like houses and cars. Shouldn’t those things also be added to the list of human rights? And why stop there? Shouldn’t we all be able to travel by commercial jet, just like the richest of us are able to whenever THEY want?

Isn’t that what much of this is about—envy? That if some of us are rich enough to have access to certain things, shouldn’t everyone have access to those things too? Well hell, carrying it out a little further, why should ONLY Americans have access to medical care, or homes, or cars, or food, or champagne, or to whatever? Why not provide all things to all people everywhere on the planet?

Sounds ridiculous doesn’t it? Well, it is ridiculous, because if we go down this socialistic path, we will end up the way the Cubans are today, the way the Soviets were 30 years ago. The Soviet system disappeared because of its socialist failings, and Cuba is a joke with a half-assed public medical system, despite what propagandist Michael Moore claims.

I’m wondering; considering the expense of contemporary medical care, shouldn’t we be willing to work hard INDIVIDUALLY to pay for the best health insurance we can get? Most of us don’t give it a second thought that homes cost hundreds of thousands of dollars (or millions) that new cars cost tens of thousands; so why get so angry when a steep bill comes in for chemotherapy or to have a fractured leg properly set? Healing a broken body can be way more complicated than building a car. Like it or not, hospitals, doctors, nurses, pharmaceutical companies, the entire medical industry, does not exist for free. If Obama forces them to operate under cost, that industry WILL start to go away. At that point we WILL have de facto rationed care exactly like the Canadians and Europeans.

(Then again, I HAVE seen what I consider gouging by hospitals. When she was pregnant with our first daughter I took my wife to an emergency room in New Jersey for stomach pain. Mostly she sat alone in an examining room before a doctor finally came in and checked her out for all of 5 minutes. Then a nurse came in and gave her a shot of Demerol and left. We sat in the room for another hour by ourselves with the nurse checking on her once more before we left. The charge for all that to TriCare was $850! I think TriCare paid them $200. Another time I took my son to Children’s Hospital in Little Rock after he had been diagnosed with the onset of diabetes. They did a wonderful job with him but their charges were definitely a gouge. $10 for an aspirin and $80 for physical therapy!? The so-called physical therapy consisted of one session of taking him down to the gym, handing him a basketball and letting him dribble and shoot unsupervised for a half-hour! That kind of BS overcharging makes you wonder doesn’t it? No wonder insurance companies don’t trust hospital billing!)

And then there are the folks who choose NOT to invest in the possibility that they will need a doctor to fix them up some day, so instead, they spend their money on other things. So be it. It’s a free country, or it is for now anyway, because ObamaCare is going to force everyone to pay premiums, whether they want to or not. And you know what, maybe as part of a REAL healthcare fix everyone SHOULD pay; especially if deadbeats have decided that they will get their future healthcare for free (at our expense) at emergency rooms or from Medicaid, etc. People like that are irresponsible, but currently THAT is their choice; if they opt out of paying insurance, when they get sick or hurt, hey, it’s on THEM! I say no more freebies at emergency rooms or any “public care” for anyone.

Ultimately, THAT is the real thing going on here then—that THESE people in THIS government are convinced that THEY know what’s best. This far left group that we inexplicably voted into power last November wants nothing less than for government to control EVERYTHING. This is about THEIR power; it’s about THEM reforming America into a new Europe. No thanks. My people escaped all that European bunk centuries ago—I do not want to be a European.

Healthcare problems we can fix with far less intrusive measures than what I see in that beast of a bill. I just hope that whatever bill Obama, Pelosi and Reid force down our throats, that is, IF they do, that its provisions are not so profoundly implemented that a future "more responsible" congress is not able to draw it back and eradicate it.

Wednesday, September 09, 2009

Screwed Since 1946! Updated! Unscrewed, but dead...

Almost four years ago I was at a table in a sprawling upstairs room in the American Embassy in Manila surrounded by a multitude of VA ratings specialists and review officers, all in their respective cubes or moving about the room doing what bureaucrats do. Reviewing several stacks of veterans’ case files I endeavored to learn how I could best help them in my role as a veteran’s service officer. Over the course of the morning I quickly made my way through the formidable mound of volumes, scribbling notes as fast as my arthritic fingers would allow.

I paid particular attention to one huge case file containing four thick brown volumes that easily stacked up to almost two feet. That’s a lot of documents. I grabbed Volume I and flopped it open with a thud. The first entries started late in 1946. It was awkward reading them as I had to lift the heavy mass of pages stacked upon the original papers all held together by two extra long metal prongs.

I got through the first half dozen pages and in spite of myself blurted out loudly, “My God, this poor guy has been getting screwed since 1946!” It was probably inappropriate to say such a thing out loud in that place but I couldn’t help myself.

The other service officer sitting across the table from me shushed me disapprovingly—mustn’t make VA employees feel bad, might be taken as adversarial!

I shrugged and lowered my voice, “Hey, it wasn’t THESE folks that messed him over; it was folks LIKE these, only 60 years ago!”

I read further and my indignation rose like water in a stopped up toilet bowl. Late in ’46, just 11 months after his discharge, he had submitted an initial claim for an arthritic condition affecting much of his body. In fact, his discharge orders put him out of the Commonwealth Army as being “physically disqualified for further service.”

“How could they have POSSIBLY denied this guy service connection for his arthritis? He applied for it less than a year from his discharge and the discharge document itself establishes that he had a condition serious enough to warrant putting him out for it. Something’s not right,” I muttered.

I continued to read the sequence of events, muttering and shaking my head for the half-hour it took me to get through the history of his decades of appeals. The veteran was nothing if not persistent; he had pressed his appeals through the 50s, 60s, 70s, 80s, 90s, through every decade until he finally enlisted me for one last crack at trying to make the VA to reverse this obviously unjust decision.

The problem with finding errors made by long dead VA employees is that it is almost impossible to get someone in the VA appeals hierarchy, namely a VA judge, to ever consider reversing the decades old decisions, no matter how wrong. The primary reason: cost—even a relatively small error can end up being extremely expensive for the VA, adding up to hundreds of thousands of dollars depending on how far back the payments go.

In the case of this octogenarian Fil-vet, his 1946 claim had been illegally denied outright by some self-righteous American ratings official. The pious jerk had seen a 1945 medical document calling the veteran’s arthritic condition as gonorrheal in origin and that idiot rater denied the claim based strictly on his moral outrage.

Consequently, the veteran, still not much more than a teenager at the time, was not even given the benefit of a compensation and pension (C&P) exam until almost 5 years after the original claim. It took that long for a Board of Veterans Appeals judge to finally acknowledge the unlawful denial from over four years before, and doing so, the judge remanded the appeal back to Manila, forcing them to finally examine the veteran.

But there was a problem with this sneakily obtuse judge’s remand; he specifically ordered that the examiner was only supposed to determine if the arthritic condition could be likely determined to have stemmed from the long-resolved gonorrheal condition. In effect, he rigged the whole thing against any possibility of service connection.

At the exam, the doctor told the vet that his condition was easily 100% severe, but in his report he stated that it could not be determined if gonorrhea was the cause. So, once again, VARO Manila found a way to deny this man’s worthy claim, saying in the decision letter that the condition could not be proven to be compensable to at least the 10% level within a year of discharge.

To recap, the man is discharged because of arthritis; he applies for compensation and treatment 11 months after being processed out of the service; a self-righteous rater denies him an exam; he gets his exam, but 5 years later; and finally, his claim is denied by a judge because the VA did not examine him when they were supposed to. When I was in the military we used to call this being “railroaded.”

Yet, the veteran never gave up on this claim. He continually sought to reopen it; for 60 years he did this until he found me. And I did indeed manage to get it reopened by having a doctor review all the available medical evidence going all the way back to the 40s. He determined that the arthritis was never gonorrheal in the first place, because joint pain stemming from it disappears once the disease is resolved, which it had been months before his discharge. The doctor also stated that the remand was impossible to comply with from the start; there was no way that the arthritis etiology could ever have been determined five years after onset.

But, he did say that the patient’s arthritis was more likely to have stemmed from his participation in combat during the difficult 4 months of defending the Bataan perimeter, an ordeal that included starvation and diseases like beriberi, not to mention what he went through surviving the horrible trauma of The Death March. His joint pains started not long after his escape from the Death March, and continued off and on during his time as a guerrilla, right up until his discharge at the tender young age of 20.

I put together what I thought was a surefire package that definitely proved that this ancient veteran’s condition was surely caused by what he went through during the war, but no, we recently received a letter from the AMC (Appeals Management Center) in Washington DC, that simply stated there continues to be no current medical evidence showing a connection to service. Reading AMC’s “reason for decision,” it was if they had never bothered to read a single sentence of any of my dozen page narrative. I was furious reading it and it has not lessened in the week that has passed, which is partly why I now write this.

But I also write this because now, this old veteran who fought the bloodily suicidal delaying action from La Union south to Bataan, fought on through the defense of Bataan, survived the Death March, and then years as a guerrilla, is now in ICU with a terminal heart condition. It’s not likely that he will live the week.

So, in the end, the VA wins this battle after all. They waited him out and now he is about to pass on; and once he dies, his claim dies with him. If only I had been around to help him in 1946. I would surely have kicked the VA’s ass big time, since I would have known what to do to force them to do right, to make them comply. He had no clue as to what to do to win, just as veteran claimants of today, who try to deal with this institution, have no clue what to do. The only sure way is to get someone like me, an experienced trained service officer to guide them through the ordeal of the process.

As my time doing this stuff comes to an end in a few short months, I worry about all the other veterans out there, who even now, more than 60 years after this old Fil-vet got royally screwed by the “VA denial machine,” find themselves at the capricious whims of the same adversarial VA mindset that existed in 1946.

Here’s the problem, “you don’t know what you don’t know…”

Update: The veteran is gone now so I can mention his name. He was Baldomero, my friend and my client. His common law wife just left the house and for quite some time we talked about her beloved Baldomero. And there's a surprise: The BVA judge ruled in favor of Baldomero's 63 year old claim! The ruling shocked me to the core, especially considering that several Board of Veterans Appeals judges had ruled against the claim for service connected compensation, not just once, but time after time, going back 6 decades. I figured that even if we DID convince the judge of the error that had been committed that he would make the start date to maybe a few years ago; perhaps to the date of the beginning of the current appeal. But no, he properly awarded it retroactively all the way back to 1946. Incredible! I say that not because it was a wrong decision, but because this judge actually READ my arguments and he GOT IT. If only it could have happened a few months earlier. If so, Baldomero would be alive today. For only a few tens of thousands of dollars he could have had his stint. His heart would STILL be beating today. The fact that it's not breaks mine....