Back to the Veterans Administration, Part 3: This is not the appointment you were looking for…

In my last blog entry I promised that I would update you on how my first official appointment with the VA went, and, well, that appointment has come and gone.  It was interesting, but not really what I had expected.  Or what I was hoping for.  It was, however, insightful because it provided a glimpse into the road that lay before me as a “customer” of the VA healthcare system as well as introducing me to many of my fellow veterans who frequent the local clinic.

The appointment was with the VA Clinic’s PTSD Services unit.  As I wrote in my last post, I spent an hour or so with my designated social worker whose job it is (among other things) to assess whether or not I needed to be evaluated for the effects of combat stress.  Her assessment was based on our meeting as well as the sixteen page questionnaire that I completed beforehand.  Since the questions were all about combat, and having spent a whole lot of time in and around a significant amount of combat in two different war zones, she determined that it was certainly appropriate for me to go for an evaluation.

A week later, I returned to the clinic for my first appointment: the Post-Traumatic Stress Disorder Services Orientation.  I wandered into the clinic’s Mental Health Services waiting room and, after checking in, was handed yet another set of forms to fill out.  After ten minutes of answering questions about my propensity for self-harm, manic episodes, and depression, I was finished.  Just in time, too, because as my government issued pen scratched out the last checkmark a young woman opened the waiting room door and asked those of us waiting for the PTSD orientation to follow her.

I joined a rather eclectic group as we accompanied her to a smallish room ringed with chairs padded with leather seats and backrests colored in the oddly disturbing green that is prevalent in hospitals and movies about psychiatric institutions.  They must have got them on sale somewhere, because I don’t think they would match anyone’s home decor.  To their credit, though, they were actually pretty comfortable.

Out of the twenty odd-colored seats ten or so were filled by my fellow attendees and me.  There was an elderly veteran of the Second World War, Korea, and Vietnam (as his hat proudly proclaimed), a man in his sixties, a few gentlemen in their 50’s, a young woman who never took off her sunglasses, a tattooed young man barely out of his teens, and me.  Not at all what I was expecting, to be honest.  I had figured that my meeting would be with young veterans from the recent decade of war, but to my surprise we veterans of Iraq and Afghanistan were in the minority.  There were three of us, one veteran of Desert Storm, the aforementioned WWII vet, and the rest were from the Vietnam War.

I know this because the young woman who led the session (another clinical social worker) had us introduce ourselves before we began the session.  In addition to asking where we served, she asked us to share why we were here.  The recently discharged veterans were pretty obvious, but the others were a surprise.  Each of them had been referred to the session by their primary care provider, which I found to be fascinating.  After hearing their introductions and listening to their conversations it became evident to me that many of these veterans were just now entering the VA medical system.  To me, that was a surprise because I had never really considered not entering the system.

That reveals a tremendous difference between the experiences that “new” veterans have in juxtaposition to the “old” ones.  Our transition process from active duty included a mandatory introduction to the VA, along with an education in the basics that the VA provides.  Many veterans of WWII, Korea, Vietnam, Desert Storm, and the Cold War received no such exposure to the Veterans Administration.  As a result, thousands and thousands of veterans who are eligible for help and care never bothered to pursue it until they really need the services that the VA provides.  Unfortunately, for many of them, the help that the VA provides ends up trying to make up for years or decades of neglected conditions.  That was the explanation for why so many of the people in the room with me were there for the first time despite having removed their uniforms back when Disco Fever ruled the dance floor.

Anyhow, back to the session.  After introductions, the social worker ran through a dozen or so power point slides that described the multitude of programs that the VA offered in the clinic.  This particular clinic was focused on combat veterans who were at risk for PTSD, and the services that they provide were all focused on countering and healing the effects of combat stress.  She started with textbook (according to the American Psychiatric Association, who writes such things) definition of PTSD, which included things like experiencing traumatic events, re-experiencing previous trauma, hyper-vigilance and hyper-arousal, and avoidance of things that remind you of traumatic events.  Considering that everyone in the room has served in combat, the probability that at least some of these symptoms would apply to us rocketed up to about 100%.

After the explanation of what PTSD was completed she assured that recovery from PTSD was possible.  They offered over a dozen different methods to assist with recovery; including individual and group sessions on topics like anger management, coping, spiritually based recovery, couples and family therapy, anxiety disorders, and women’s groups.  The goal of each program is to help the veteran reach a positive outcome within three months, with a positive outcome being that the veteran being better able to cope with his or her condition.

Not surprisingly the clinic was overwhelmed with veterans who needed help.  The wait time to join in the programs was eight weeks or more.  The social worker explained the process for getting into one of the groups, and that is where I realized that this was actually not the appointment I was looking for.  Actually it was not even really an appointment, but instead just an introduction and orientation to the clinic.

Towards the end of the session she explained that for us to participate in any of the offerings we would have to set up another appointment in which we would actually meet with a healthcare provider who would then assign us to a group.  An intake appointment, she called it.  That was the first indicator that this was not the appointment I was looking for.  The second indicator was her announcement that the clinic did not have anything to do with disability claims.

As you know from my previous posts, I was actually hoping to get my disability claim back on track.  It had been five months since I had been notified that the claim had been partially settled and that I should wait to be contacted by the VA for further evaluation.  After spending almost half a year listening to the sound of no telephones ringing I called the VA to get the ball rolling.  I had wrongly assumed that once I was in the system that the claims process would proceed as a matter of course.

Nope.

I would need to call another number for that, or I could stop by the Veterans Service Office that happened to be just across the hall.  They would be able to help those of us working on our claims, she said, but unfortunately not today because their office was closed.

D’oh.

She then reviewed all of the forms that we completed prior to the session, and then she called each of us out individually to set up appointments for the intake interview.  I was a bit disgruntled, but resigned myself to just go with the flow and left the session with an appointment for an intake appointment some six weeks in the future and the phone number to the clinic’s VSO office which would help me with my claim.

I also left reminding myself that the VA was a bureaucracy and that patience was a virtue.  I was still disgruntled, though, and not feeling particularly virtuous.  So it goes.

__________

Lessons Learned:

1.  The medical side of the VA is different from the disability claims side of the VA.  Make sure to stay engaged with your VSO to ensure that your claim is moving forward, and also be specific with the VA representatives when you are making your appointments.  I was not specific enough because I made some errant assumptions, and as a result I have lost another month or two of forward progress on my claim.

2.  Be ready to devote a lot of time to the VA.  There are great programs available, but it will take a long time and plenty of seemingly repetitive red tape, paperwork, and meetings to actually see a provider.  Breathe deep, think happy thoughts, and go to your happy place.  Time will pass and you will get the help you need.  It will just take a lot more time than you would like.

3.  Ask questions up front.  Had I asked whether or not this appointment would help with my disability claim I would have saved some valuable time.  Assume nothing!

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Back to the Veterans Administration, part 2: Entering the system

I left you, my dear readers, hanging with my last post.  When we last connected I was about to go to my first live and in-person post-retirement Veterans Administration engagement.  After months of waiting for a call that never came I shouldered the responsibility for my own situation and, after more than a few phone calls, set up an appointment to become a customer of the VA.

The instructions were simple enough.  I was directed to arrive at the local VA clinic at ten in the morning, and upon my arrival I would be meeting up with the Benefits and Enrollment specialist.

So arrive I did, right on time.  I walked into the lobby of the recently built and still sparkly building and sauntered up to the reception desk.  To my chagrin, there was no one at the desk, so I rather aimlessly just leaned on the counter until somebody arrived.  There were two chairs behind the desk after all, and they looked recently abandoned.

After a few minutes of pointless leaning I decided to find someone who could help me.  I wandered past the reception desk and into the halls beyond.  After walking from one side of the building to the other in hopes of randomly finding the office I was looking for I gave in and asked an employee (whom was readily identifiable by her hospital scrubs and prominently displayed VA Identification badge) for help.

“Go to the lobby and check in with the girl up front,” said she.

After explaining the absence of said girl, the employee shrugged and pointed back the way I came.  “Just go back to the lobby. Someone will call for you.”

I was not particularly optimistic that said calling would occur, but I meekly headed back to the lobby anyway.  Joining a few other patient souls in the chairs that ringed the perimeter of the room, I found a copy of Time Magazine from the previous year to fill my time as I waited for the call that I was not certain would come.

After ten minutes of reading about Time Magazine’s view of the world circa October 2011, a door that previously gone unnoticed burst open.  An energetic gentleman with short graying hair and an startlingly positive outlook on life fairly leapt onto the scene and immediately started asking each of us in the lobby why we were there.

After a staccato interchange between the people sitting next to me, he turned in my direction and asked if he could help me.  I explained that I was there to meet with the enrollment section.  He smiled and said “That’s ME!” and pointed me towards the still-open door and one of the vacant offices on the other side.  “Take a seat, I’ll be right there.”

So in I went, clutching my sheaf of medical records and other documents, wary to see what would happen next.

John, as I learned his name to be, had obviously introduced a few people to the VA system before I showed up.  Probably thousands of people.  He had it down!  He handed me a sixteen page long questionnaire to fill out and began firing questions at me faster than a belt fed machine gun.

“Retired?”  “Yep.

“How long were you in?”  “Twenty seven years.”

“Social?”  (As in what was my social security number, which is the key that opens my files in pretty much every government database).  I gave him my precious nine digits.

“Marine?”  “Yep.”

“What did you do in the Marines?”  “Where do you live?”  “Do you have TRICARE?”

Each question was accompanied by his furious banging on the computer keyboard as he entered my information into the computer.  I was trying to complete the form as he talked, which he noticed.

“Don’t worry about that right now.  That is for the social worker, who I will introduce you to in a few minutes.”

Social worker?  Really?  What was that all about?

“For now, let’s just get you in the system…”and from there we were off on a journey of questions and answers that lasted ten or fifteen minutes.  I won’t subject you to the lengthy details, but here is a rundown of the pertinent ones for those of you who will be headed to the VA:

– The difference between TRICARE and the VA.  He patiently explained that TRICARE is insurance, and the VA provides traditional medical care, just like your regular family physician.  While that statement sounds obvious, the ramifications are significant.   If you are injured in an accident or have an emergency away from your normal VA provider, TRICARE takes care of it because that is what insurance is for.  The VA is not insurance, so you would be in trouble when the bills came due for emergency treatment because the VA does not pay for such events because the VA is not insurance.  Kapisch?

– Online enrollment.  I had previously enrolled into the VA healthcare system because they had thoughtfully sent me an email several months ago.  The email, which suspiciously looked like spam (but wasn’t) encouraged me to register via the VA website by following this link: https://www.1010ez.med.va.gov/sec/vha/1010ez/  I filled out the form, and I am glad that I did because it reduced the amount of time I spent with with the enrollment specialist by at least half.

– The Packet.  The sixteen page packet that he handed me was the OIF/OEF/OND (Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn) enrollment questionnaire.  In a nutshell, it was a long questionnaire that asked a lot of questions about my mental health, combat experiences, and exposure to traumatic brain injury (TBI).  The form would be used by my social worker.  More on that later.

– Explanation of how the clinic works.  This particular clinic is divided into three teams (Red, White, and Blue…pretty catchy!) and each team had a staff of its own.  In my case I became a member of Team White, and with my assignment came my choice of primary healthcare providers.  Since I did not know any of the doctors personally, I happily chose the one with the next available appointment time (which happened to be a month away).

– My first appointment with the doctor would be a “welcome aboard” type of physical examination, and I would be required to visit the lab and submit various bodily fluids beforehand.  Joy.

– Appointments.  In order to set up an appointment, I would not be allowed to call the doctor or the clinic directly.  I must call central appointments (via a 1-800 number) in order to contact someone at the clinic.  That is pretty much the same as life in uniform, so it wasn’t a shock, but it is annoying.  If I want to ask the doctor about a medication, for example, I need to call central appointments and leave a message for him.  Then, when he gets the message and has the time, he is supposed to call back.  I hope I don’t have any time critical severe allergic reactions!

-ID Card.  Towards the end of the interview he announced that it was time for me to get my VA ID.  I sat up straight and looked at the camera that was mounted above his computer screen, and when he said smile I did so.  In a week or two my card should show up in the mail, and then I will know just how stupid I look.  No second chance for a new picture!

As soon as John was done with me he guided me to another office and introduced me to a very nice woman who would be my social worker.  She asked if I had completed my form, and as I had not she gestured for me to take a seat and fill it out.

I did so, and after ten minutes of scribbling I knocked on her door.  She invited me in, and after taking the sheaf of papers from my clutches she began her own interview.

Now, you should understand that this is probably the first time in my life that I have ever been in a room with a social worker.  I have met people in that line of work in the past, but never have I actually been professionally engaged by one.  Honestly, I had no idea what social workers actually did, but after spending a half hour with a pro I was pleasantly surprised to learn that they fit a niche that is needed in the VA: helping veterans who are having difficulty transitioning back to the civilian world deal with the often confusing processes that come with  the title “veteran”, not to mention little things like PTSD, TBI, and other psychological issues.

At any rate, she had the unenviable task of manually inputting the responses I scribbled on my questionnaire into the computer database.  Obviously some parts of the VA could use a little modernization, but she explained that she actually got more out of re-inputting the data because she could interact with the client (me, in this case) and flesh out her perspective on the information.  This is important because she was evaluating things with real impacts on veterans, such as combat stress problems and indicators of violence, self harm, and suicide.  She was there to make sure that we, the combat veterans, were looked at objectively and offered the appropriate levels of care.

After an hour or so spent chatting with the social worker, she led me to the appointment desk at the combat stress clinic.  The results of my survey indicated that meeting with them would be a good idea, and to be honest I believe it is a place that all combat veterans need to visit.  The wars of the last decade have seen an unprecedented  level of stress on the military forces, with many veterans deploying to war time and again, and then again, and again.  The frantic deployment tempo means that many veterans bring issues and problems home, and the VA is there to help deal with them.  Going to the clinic is the first step along the way to getting better, and whether you think you need it or not you should stop by.

So now I am officially in the VA system, and I have several appointments in the future that I will tell you all about.  Stay tuned!

___________

Lessons Learned:

1.  After your claim settled, either partially or in full, you should be receiving an email inviting you to enroll in the VA via their website.  Initially I thought the email was spam, but after several attempts I finally paid attention and registered.  Doing so greatly streamlined my in-person registration process.  As an aside, they used the email address that I provided months earlier as I was transitioning out, so it behooves you to make sure that you provide an address that you will utilize for a long time to come.

2.  The VA is just like every other government bureaucracy.  Get ready to do some things twice, and if your are lucky, three times or more.  It is just the way it is.  Suck it up and march on.

3.  It will help for you to bring whatever documentation from the VA you have accumulated thus far.  I recommend that you buy a pocket folder or folio to keep everything in.  Even better, get yourself a dedicated filing system for all of the stuff that you are amassing because if you don’t you will end up with a disorganized pile of documents approaching the stature of the Eiffel tower.  If you don’t believe me, just look at the pile next to my desk at home.

 

Back to the Veterans Administration

Several months ago I received a rather large package from the Veterans Administration.  Inside was the copy of my medical record that I had submitted with my claim some nine months earlier as well as a sheaf of rather official looking documents.

Hooray, thought I!  My claim was settled.

Well, kind of.  Actually about half of my claim was settled, and the other half was not.

You see, as I departed active duty I was thoroughly examined by both military and veterans administration physicians as a part of the final physical process.  The Navy doctors and corpsmen checked me out and documented everything that was relevant into my records, and the VA then followed up with an examination of their own to determine what conditions, if any, that I had developed during my service would be considered disabling.  Having the conditions rated as disabling is important because the VA treats those conditions free of charge.

In my case, about half of the conditions that had been identified during my physicals were rated as disability-related conditions and would be addressed by the VA in the future.  The other half were marked as “deferred” because they needed additional information.  The letter went on to say that they had requested a medical examination, and that I would be “notified of the date, time, and place to report.”  It sounded reasonable, so all I had to do was be patient and wait.

One month went by.

Then two.  Then three.  Four.  Finally at month five I decided that my phone wasn’t going to ring any time soon and I needed to do something about it.  But what?

Thinking back to my experience at the Transition Assistance Course I remembered that a representative from the Disabled American Veterans had talked me through the VA medical evaluation process as he evaluated my medical record.  I had signed a limited power of attorney that appointed the DAV as the Veterans Service Organization that would represent me in my VA proceedings, and now it was time to give them a ring and ask for some help.

After rummaging through the rather tall pile of transition related documents that occupies a significant portion of my desk I found his business card.  “Aha!”  thought I.  “A call and it will all be fixed!”

Wrong again.

I did call the number, only to find that I was calling the wrong number.  It turns out that the gentleman that I had worked with during the TAP seminar was not the same gentleman that I would be working with in my dealings with the VA.  The guy at TAPS was fully engaged in meeting new veterans and helping get their claims processes started.  Once the veterans were in the DAV system they (including me!) would be working with representatives at their regional office located in San Diego.

So I called that number.  Unfortunately their offices were closed for the holidays, so I called back once the holidays were over.  I finally linked up with a live person and after speaking to a very nice lady who took down some basic information were instructed to wait for a representative to call me back.

After a day or two of swapping voicemails because of missed calls the DAV representative and I finally linked up on the phone.  I explained my dilemma to him, and he patiently explained what needed to happen next.

“What you have,” he said,” is a partially completed claim.  At this point there really isn’t anything the DAV can do for you because our process begins when the initial VA claim is settled.”

Sensing my frustration, he continued.

“What you need to do is to contact the VA and set up an appointment to get the ball rolling yourself.  You need to do this quickly because if you don’t follow up on the listed conditions they may be disallowed because you are not showing that they are still a problem.”  He then gave me the appropriate phone number for the closest VA office and we said our goodbyes.

Hmm… So I need to get my sore knees and bad back looked at again?  I had signed up for TRICARE Prime, so I could go to the doctor, but my decades of “sucking it up” had precluded me from making an appointment for something that did not involve broken bones or arterial bleeding.

So I called the VA the next day.  After a similar game of telephone and voicemail tag I spoke with a very helpful gentleman who understood exactly what my dilemma was.  He checked his calendar and squeezed me into an appointment this coming Wednesday, where he promised to get my ship sailing in the right direction.

And I promise to tell you how it goes…

__________

Lessons Learned:

1.  Contact your VSO immediately after you receive your VA claim settlement letter.  I lost about five months as I waited for the VA to contact me before I finally got on the ball and started engaging the system.

2.  The VA is buried in claims and the best thing to do is to take charge of your case.  Waiting just means that others who are being proactive are jumping in line ahead of you.

3.  Your VSO can explain the intricacies of the settlement letter in a phone call, but you have to contact them to initiate the conversation.

4.  The next call you make after the VSO should be your local VA office in order to initiate the next steps in the evaluation process.  If your claim is settled, then you need to contact them to be registered in their computer system so that you can access healthcare providers.  If your claim is not fully settled, then you need to get registered and schedule appointments with the appropriate professionals in order to finish up your claim.

After the interview: Now what?

So you have just finished interviewing with the company of your dreams.  As you walk out the door you need to remember, though, that even though the meeting part of the interview is over the whole process is not yet done.  You still have some work to do to finish it up.

Or, if you don’t want the job that badly, you can just get in your car, drive home, and have a cold one to celebrate the time that you wasted on the interview and the job opportunity you missed out on because your competition is going to go the extra mile and finish their interview properly.  The choice is up to you.

The smart thing to do is to continue to treat the job interview like a date.  Just as you want your relationship with a pretty girl or handsome guy to get more serious the same can be said about your interest in the company.  You are certainly curious as to how things went during the interview because you to want to step things up a notch and get into a meaningful relationship with the company.  Just like you want your date to call you back the day after dinner and a movie you desperately want the hiring manager to give you a ring with good news.

Even though you have left the building there are still several things you can, and should, do to increase your chances to land a job.  If you don’t do them the worst that will happen is that you won’t land an offer.  If you do the following things, though, you still may not get a job but you will come away from the experience with a stronger reputation and a better understanding of how to become a better candidate for employment.  Here, in my humble opinion (and in the opinions of many hiring managers) are the things that you should perform after the interview:

1.  Make some notes about the interview.  What questions were you prepared for?  What questions were you unprepared for?  What was the interviewer’s name and title?  You should have exchanged cards during the interview, and the back of the card is a good place to jot down the interviewer’s preferred form of address (“Mr. Smith” or “Bob”, for example).  You should take notes while the interview is fresh in your mind because otherwise you will forget those brain-hiccups that you had, and if you forget them then you are likely to repeat them again in future interviews.  I recommend getting a small notebook dedicated to the interviewing process and using it as a logbook or journal to record your post-interview notes.

2.  Send a follow-up note to thank the interviewer for their time and attention.  In the note make sure to use their preferred form of address (that you remembered to write down on the back of their business card as soon as you left the interview) and be sincere in your message.  You should be professional and courteous, but not overly familiar.  After all, you are still making an impression, and a poorly written note will do more harm than good.  Here is an example of a short and acceptable thank-you note:

Dear Bob,

Thank you for the opportunity to meet with you on Tuesday.  I am very excited about the opportunity to join XYZ Company, and I learned a great deal about the firm during the interview.  Our discussion about the corporate culture and dynamic work environment reinforced my strong desire to join the company, and I think that my skills and experience are a great fit for the _________ position.  I feel that I can be a strong contributor to the firm.

If you need to contact me for any follow up questions or additional information I can best be reached at xxx-xxx-xxxx or via email at mike@anymail.com.  I look forward to hearing from you soon.

Sincerely,

Mike Smith

3.  As you close out the interview ask the hiring manager for the best way to contact them in the future.  This is important because it gives the interviewer an opportunity to establish expectations for future communications.  He or she may be open to a call or email or may prefer that you wait to hear from the company before you contact them.  Make sure to pay attention!  You can shoot down your chances at a job if you call them after being asked to wait.  Just follow their lead.

4.  Think hard about your experience at the interview.  Are you going to be a good fit at the company?  Did you learn anything that was unexpected or that is not in line with your goals?  If you did, then do some serious soul-searching in order to decide whether or not to continue pursuing a job there.  Don’t just take the first job that comes along if it is not a good fit.

5.  Be ready for the company’s call.  It may be a letter, an email, or a telephone call, but regardless of how the firm reaches out to you the news will be either good or bad.  This is where character really counts; if the news is good then it means that you have a follow on interview in your future or a job offer letter on the way.  If the news is bad then it means that you will need to look elsewhere for a job.  If the news is good then you need to be humble, respectful, and thankful for the opportunity to work with the company.  If the news is bad, then you need to be humble, respectful, and thankful for the opportunity to interview with the company.  Even though you did not land a job with that particular company it doesn’t mean that you can be a jerk about it; remember, you are building a reputation along with your resume.  If you are obnoxious because you didn’t get the job the word will get out.  If you are respectful, the word will get out too.  The hiring manager who did not hire you may know of a company that is looking for someone with your skill set, and if you make a strong positive impression it may help network you into a new opportunity.

Remember that the hiring process does not end with the interview.  It ends with either a job offer, an invitation for a follow on interview, or a rejection.  You can improve your chances for a job offer by following up on the interview.

__________

Lessons Learned:

1.  Write down your impressions of the interview as soon as possible so that you can learn from it.  You want to make your strengths even stronger and eliminate your weaknesses, and the only way to effectively do that is to learn from your experience.

2.  The interview is not over when you walk out the door.  Hiring managers are people too, and sending a thank you note for their time is a nice touch that will be noticed.  It is a normal part of the hiring process, and if you don’t send a note then you are behind others who do. Send the thank you note immediately after the interview.  If you had to travel to the interview, then write the note and drop it in a local mailbox to ensure that it arrives quickly.  As the saying goes: “Strike while the iron is hot.”

3.  Reflect on the interview.  Did it reinforce your desire to work there or uncover some negative aspects about the job or the company that make you have second thoughts?

4.  Be gracious when you finally get the results of the interview.  This may take a while because the hiring process at most companies takes time, so be ready to wait.  When you get the news, be respectful and courteous regardless whether it is good or not.  Remember, your reputation is always growing, and if the word gets out that you are a jerk it will hurt your chances elsewhere.