Arizona veterans struggle to get access to health care as backlogs grow. Can it be fixed?

Despite a massive budget that is dwarfed only by that of the Department of Defense, the Veterans Administration is facing health care delivery crises due in part to miles of red tape and an arcane bureaucracy that blocks veterans from receiving the care they deserve from their service to the U.S.

What we know as the VA is in actuality a huge administration sub-divided into several parts. It is not connected to the Department of Defense or DoD’s giant $778 billion budget, but its $270 billion budget is, like the DoD’s, traditionally sacrosanct and not subject to public debates about “out-of-control spending.” 

VA Secretary Denis McDonough recently stated that nearly half of his agency’s budget will be spent on health care.

According to the budget the VA submitted in May, the 2022 funding represents a 10% increase over 2021. More than $30 billion will be devoted to various types of infrastructure updates and modernization.

The budget also funds the “largest integrated health care system in the United States,” serving more than 9.2 million veterans with the support of 425,428 full-time employees. The goal, the VA’s budget claims, is to “provide the necessary resources to meet VA’s obligation to provide timely, quality health care, services, and benefits to Veterans.”

Other programs administered by the VA include education and employment assistance for U.S. veterans, a home mortgage program and “the largest and highest performing national cemetery system projected to inter an estimated 136,000 Veterans and eligible family members in 2022.”

The VA estimates there are 19.2 million veterans worldwide, and as of 2017, Arizona is home to more than 500,000 veterans — about 7% of the state’s population, ranking 13th in the country.

Ghosted Vet: health care denied or delayed

Despite the amount of tax dollars devoted to the system and promises of veterans care, delays or denial of benefits are common occurrences, according to Derek Debus, director of military and veterans law for Phoenix-based Stone Rose Law Group.

“On the Veterans Health Administration side, we see people who are erroneously denied health benefits based on the characterization of discharge,” he said. “On the benefit side, we see they’re failing to get relevant service treatment records that show a disability was caused in service or complained about in service. Part of that is on VA being woefully understaffed. In this era of COVID, federal agencies (are) understaffed and unable to respond in a timely way to these requests from veterans.”

Debus compares the relationship between the departments to “stepkids that don’t like each other.”

When it comes to timely delivery of care, oftentimes getting in the door depends on where the veteran lives.

The VHA website includes a page that estimates wait times for general health care appointments. Wait times vary throughout Arizona, depending on location, from two days in rural Page to weeks in the Phoenix metro area. The longest wait time listed on Oct. 28 was the Lake Havasu City VA clinic, where veterans faced 48-day waits to see a doctor. Phoenix-area clinics rounded out the Top 5: 40 days for the northeast Phoenix clinic; 38 days for the Surprise clinic; 36 days for the Phoenix Midtown clinic; and 34 days for the clinic in Gilbert.

Army Reserve veteran Alana Antonich has become so frustrated with the health care she has received, and her situation has become so desperate she recently took to the sidewalk outside one Phoenix facility to protest after she says she was “ghosted” by the VHA. She has also been denied crucial care and medical equipment or had appointments delayed or canceled when she has faced mental or other health care crises.

Her September protest, the second time she has stood outside the Carl T. Hayden VA Medical Center, was cut short after she was told she was not allowed to protest outside the facility.

“My intention to go back with my signs was stopped immediately by two social workers and three police officers. They stopped me dead in my tracks on the street corner,” she said. “The police (told me) that technically that is VA property and I couldn’t be out there.”

The Carl T. Hayden Veterans’ Administration Medical Center on Indian School Road, where Antioch intended to protest, has a reported appointment wait time of 16 days.

She said the social workers were “very nice” to her and tried to help, but ran into the same “roadblocks” she has repeatedly dealt with throughout her odyssey.

Antioch, who spent a significant amount of time struggling with the VBA to qualify for her 100-percent disability status, has a story that is unfortunately all too common for those who served in the U.S. military, particularly for women. Her injuries, both physical and mental, were acquired during nine years of service and a deployment in Iraq.

She entered the Army Reserve in January 2006, serving a 13-month tour in Iraq in 2008 and 2009. The first of her injuries occurred when her unit was returning from a mission and the vehicle she was riding in hit a particularly big bump, bouncing her head off the roof. She never reported the incident, though, because she was not wearing her combat helmet and feared she would be blamed for her injury.

“I didn’t really think anything of it and didn’t say anything. I was like, ‘Oh, yeah, that was my bad, I wasn’t wearing a helmet,’” she said. “We also had a few mortar rounds go off on the base that kind of shocked us,” adding to the injury.

But her other damage came in the form of sexual assault, which happened on base late one night when she went to the restroom unaccompanied and was hit on the back of her head with a two-by-four.

“I woke up to another soldier on top of me who raped me, sliced me with a knife and ran away,” Antonich said. “I didn’t report it because I thought that I was gonna get in trouble because I was using the bathroom alone.”

She was never able to identify her attacker and suffered what the military terms “military sexual trauma” or MST.

Three months later, Antonich had the first of the grand mal epileptic seizures that began affecting her life and her ability to work. The Army released her in December 2014, but she was not given benefits in the wake of her life-altering injuries.

“The Army decided that I wasn’t allowed to stay in because my epilepsy was a no-go,” Antonich  said. “They said I wasn’t eligible for retirement benefits or benefits through the military, so I got a, ‘Thank you for your service, go f— yourself.’”

It took Antonich 18 months to finally get her VA benefits, with help from the Wounded Warrior Project. For a portion of the year-and-a-half period she spent filing the necessary paperwork, she and her young daughter, now 16, were homeless and sleeping on friends’ couches as they waited for the VA to approve her benefits.

She may have had them earlier, but one of the requirements for applying for benefits was to write out in detail the events that led to her trauma and post traumatic stress disorder, something she was in “no mental place to be able to deal with.”

Antonich had moved to Arizona after being kicked out of the Army, and in 2015 was working for La Frontera, an organization that helps connect people to social services, behavioral health, psychiatric treatment, substance abuse treatment and crisis intervention.

Her seizures became so bad — she was having dozens at that point — she had to quit working and filed for VA disability in June 2015.

Finally, in late 2016, the VA granted her benefits and back-paid her claim to when she first applied. The reimbursement allowed Antonich and her daughter to move into a place of their own.

Since then, she has spent an inordinate amount of time trying to get health care, from equipment to monitor conditions related to her epilepsy and the side-effects from the medication she takes to try to control it, to the mental health care she needs as a result of the trauma she has endured.

Antonich has been misdiagnosed, had appointments and surgeries canceled with no warning, and has waited for calls from the VHA that never come.

At one point, Antonich had to get a grant to help pay her mortgage so she could afford to pay for a piece of medical equipment to monitor her seizures after previously being assured it would be covered by the VA. 

Her condition is so bad, she says she spends about 80% of her time at home because she never knows when she might have an epileptic seizure.

Despite the help of well-intentioned people and some good doctors throughout the VHA, both her mental and physical health have suffered as she tries to navigate an arcane system that does not seem to have any answers for her. She even asked the veterans representative for Congressman Andy Biggs to intervene and help seek relief, but nothing happened.

“His VA representative told me that they’re even having a hard time getting the VA to call them back to schedule a meeting,” Antonich said. “They’re getting a [lot] of complaints from veterans everywhere and the VA is not even responding to them.”

Getting to healthcare: different departments with different functions

To understand the problems facing veterans who qualify for health care through the VHA, it is important to look at the structure of the organization.

Veterans seeking benefits must go through the VBA, which is in charge of determining and allocating benefits. The VHA is the department that delivers care to veterans of various status.

“They have different rules regarding what is and is not acceptable, different rules about appeals, and they’re both very complicated systems for veterans to navigate on their own,” Stone Law’s Debus said. “But the shared issue between both the VHA and the VBA is the VA failing to fulfill their statutory duty to assist a veteran. The VA by law has a duty to assist the veteran in getting all relevant medical or federal records pertaining to their claim.”

Debus said he has many clients going through similar travails as Antonich, including those with MST and Vietnam vets who have been “getting screwed for decades,” although he is not able to speak about any individual case.

While the VHA wrestles with health care delivery issues, the VBA is facing troubles of its own that are creating a backlog of veterans literally dying for care.

The VBA recently announced its strategy to address systemwide backlogs that have been exacerbated by the inclusion of “presumptives,” benefit entitlements given to veterans who serve in areas where exposure to toxic environments has been proven to cause a variety of health problems from Parkinson’s Disease to cancer.

Presumptives remove the onus of proof from the veteran seeking benefits, because it is presumed health problems are directly correlated and caused by when or where they served.

In a press release, the VA said there were more than 204,000 backlogged claims out of 603,000 being processed as of Oct. 11. More than 70,000 are reviews for “additional entitlement stemming from the presumptive relationship between Agent Orange and Parkinsonism, bladder cancer, and hypothyroidism.” Pending claims were projected to hit 260,000 by the end of October.

“VA is committed to ensuring timely access to benefits and services for all veterans. This includes making sure that veterans who may have experienced adverse health effects from military related exposures can get access to the benefits they need,” VA Secretary McDonough said. “As we process claims such as those for three new disabilities presumptively linked to Agent Orange exposure, including proactive application of Nehmer provisions, as well as three new Gulf War particulate exposure presumptives, we anticipate the claims backlog to increase this fall.”

In order to address the backlog, the VBA proposes hiring and training 2,000 new employees to assist in claims processing; tapping federal funding from President Joe Biden’s American Rescue Plan [CARES Act], and using future funds in order to process Agent Orange claims. All of that should reduce the current backlog to 100,000 claims by April 2024, the VBA says.

What can be done?

Debus believes there are things the VA can do about the situation. The first is to expand the definition of presumptives to include those who served on bases in the U.S. that are Superfund Sites and in war zones, such as Iraq, where military members burned equipment the U.S. didn’t want falling into enemy hands as it pulled out of Iraq at the end of both Gulf Wars.

“The problem is, there’s so much red tape nobody can see what the answer is,” Debus said. “It’s not an issue of money, it’s an issue of why is there so much red tape? If we know that dioxin exposure causes coronary artery disease and different types of cancer, why do we need to demonstrate that in a guy who was at Marine Corps Air Station El Toro, which is a Superfund Site? Why do we need to go back 40 years, when all the records were handwritten in cursive and lost in the shuffle to try and do something that may not even be objectively provable?”

Other issues include “hoops and regulations” a veteran must navigate in order to get the VA to cover bills generated through outside healthcare providers.

“I take calls very frequently to help veterans because they get stuck and don’t know where to turn. They’ve got these astronomical bills, and the VA is saying, ‘Well, you didn’t call us within 72 hours, and won’t provide any coverage for this,’” he said. “It’s just bonkers.”

The VHA has patient advocates, but they often reportedly act as if they are not on patients’ sides. There is also the option of going to an elected official and asking them to intervene, but that is often a dead end, as well.

Another big issue with military members and veterans is cultural stigmatization for people who seek help for physical, mental or emotional issues.

“Take the example of individuals who suffered through MST,” Debus said. “Victims of sexual assault frequently don’t report, and what the VA was doing for a very long time was saying (if they) didn’t report it, it didn’t happen.”

He added that is changing, but there is still a long way to go.

Antonich agrees much of the problem is cultural and that change cannot come fast enough. She said no one should ever be forced into the position of powerlessness she felt on a U.S. military installation all those years ago.

“There’s so many times I was sexually harassed or forced into a position where I had to do something uncomfortable, because that’s the culture. You can’t say anything, you can’t do anything,” Antonich said. “Then they say, ‘Here, take all these opiates and go drink yourself to death.’ They’re literally waiting for us to die off so they don’t have to pay the benefits anymore.”

The VA responds

Arizona Mirror reached out to the VA for comment about concerns raised by Antonich and Debus regarding delays in care and halting Antonich’s protest in front of its Phoenix facility.

While it did not directly address delays in or denial of care, the VA said that outpatient care provided in 2021 was at an “all-time high — more than any other time in the (VHA’s) 75-year history.” 

“This includes disability compensation, survivor’s benefits, pension and fiduciary service, education and training, vocational rehabilitation and employment assistance, life insurance coverage, and home loans guaranties,” read a written response from the Phoenix VA Health Care System. “As for staffing at the Phoenix VA Health Care System, we hired more than 600 new (external) employees in the last fiscal year. During the same timeframe, VHA — as a whole — hired more than 42,000 new (external) employees.”

Pointing out that VA care access can vary from location to location like its counterpart civilian medical facilities, the email suggested veterans go to www.accesstopwt.va.gov/PWT/SearchWaitTimes for the latest information on wait times.

Additionally, the VA “strives to be transparent with patient experience and quality data,” referring to another web portal devoted to reported quality of care at www.accesstopwt.va.gov/Healthcare/QualityOfCare.

The VA also said it offers “same-day” services to those in need, 24/7 through the emergency department at the Phoenix VA, including treatment for injuries and mental health issues.

“The Phoenix VA continues, every day, to deliver quality and timely primary care and mental health care to Veterans, even when the COVID-19 pandemic made in-person care a challenge,” it states. “With virtual health care, VA did not miss a beat in providing high quality care to Veterans during the pandemic. In fact, the Phoenix VA conducted more than 275,000 virtual visits since the start of the pandemic.”

According to its response to the Mirror, the Phoenix VA healthcare system “provides health care to more than 100,000 Veterans with about 1.7 million outpatient visits in fiscal year 2021.”

VA directives and policies provide guidelines for the delivery of timely care, including VHA Directive 1230 Outpatient Scheduling Processes and Procedures, VHA Directive 1231 Outpatient Clinic Practice Management, VHA Directive 1232 Consult Processes and Procedures, and H.R. 3230 Veterans Access, Choice and Accountability Act of 2014.

As to Antonich’s case, the Phoenix VA said it has reached out to her to “directly address her concerns and are working with her to ensure we are meeting (her) needs,” adding that the protest was ended because of a federal law that states, in part, “All visitors are expected to observe proper standards of decorum and decency while on VA property. Toward this end, any service, ceremony, or demonstration, except as authorized by the head of the facility or designee, is prohibited. For the purpose of the prohibition expressed in this paragraph, unauthorized demonstrations or services shall be defined as, but not limited to, picketing, or similar conduct on VA property.”

***CORRECTION: An earlier version of this story misspelled Alana Antonich’s name.