John W. Tilford will speak regarding veterans benefits with emphasis on disability claims and appeals. John enlisted as a Private, E-1 in the Marine Corps in 1965, served 18 months in Vietnam, and retired from the Army Reserve as a full Colonel in 2006 after over 38 years of total service. He served two years of reserve active duty with the Defense Intelligence Agency in Washington, DC and the National Ground Intelligence Center in Charlottesville, VA before the terrorist attacks on 11 September 2001, was “by name” requested by DIA after, and then served almost three years of active duty for DIA and NGIC. John was Chief, Afghanistan Cell supporting the Joint Chiefs of Staff in the Pentagon with operational intelligence from April to October 2002, the only reservist to ever hold that position. He retired as Deputy Commander, National Ground Intelligence Center. John has worked for the Veterans Administration as a Veterans Benefits Counselor, for Monroe County as Veterans Service Officer, and was recently certified by the Department of Veterans Affairs as an accredited claims agent. He has represented veterans and survivors through the regional office and Board of Veterans Appeals levels, including in Washington, DC; and has filed a successful case before the United States Court of Appeals for Veterans Claims.
January 2015
There are
logical people who object to presumptive service
connected
disability ratings such as the current fourteen
“presumptives”
listed by the Department of Veterans
Affairs as
related to Agent Orange exposure. Some of these
people work
for the Government and are politically
motivated
by a desire to conserve resources, i.e., to reduce
the amount
of compensation paid to disabled
veterans.
Others are just regular civilians, like so many
who are
free only because members of the military made
and kept
them so. A lady who was a guest in our home a
few months
ago is one. She “just didn’t think it’s right”
that
compensation can be awarded to a veteran for a
disability
that he or she might have developed in old age
without
ever having been in the military. Specifically, she
and I were
talking about a high school classmate of
mine. Bob
and I were Marines in Vietnam at the same
time, but
neither of us knew of our proximity until decades
later. I
was extremely lucky and served a total of eighteen
months on
Monkey Mountain, east of Danang. I was
nominally a
computer repairman for the Marine Tactical
Data System
used for air traffic control and threat
acquisition.
But, since I really was not all that great a
technician,
I spent most of my Corporal, E‐4 time doing
general
snuffy work such as guard duty, mess duty, and
whatever
else was too dirty, too hot, too dry, too cold, or
too wet for
higher ranking and better motivated Marines
to do. I
was shot at a grand total of two times, and missed
each time.
Bob, on the other hand, served twelve months
in a
variety of not‐safe places, was shot at on a regular
basis, and
was much more exposed to the nasty stuff our
own planes
sprayed from overhead. Bob has peripheral
neuropathy
in both feet, diabetes type 2, and some of the
psychological
damage which affects normal people put
through
horrible things. I don’t think the nice lady would
question
Bob’s post‐traumatic stress disorder. She did
question
his neuropathy and diabetes. Her point was that
a high
proportion of such mid‐ to late‐60’s age men as Bob
and I would
have had – let’s focus on one condition –
diabetes.
Let me
interject one of Bob’s observations. He and five
other
former Vietnam Marines happened to meet at an
“MIA‐POW”
ceremony in 2011. They talked and
spray on
his skin eventually, as getting‐old men do, got
around to
discussing
physical problems. All six had diabetes. Five had
had at
least one of the Agent Orange presumptive
cancers.
The veteran with the worst cancers had actually
seen the
airplane spraying Agent Orange pass overhead
and felt
the chemical moments later. All of these Marines
had filled their canteens with water from
pools which were
open to the
sky. As Bob once pointed out to me, eighteen
year old
young men joining the Marine Corps in 1965 were,
compared to
the general population, a “rather robust
lot”. Now
all six are disabled, tired, pricking themselves to
check the
level of sugar in their blood, taking insulin
injections,
and in near constant pain.
I did not
point out to the nice lady in our living room that
there may
be an alternative universe wherein Bob never
joined the
Corps or any other branch of the active
military.
Maybe he went to Canada. Maybe he hid in the
National Guard. Whatever. She would have readily joined
this
conjecture and added, “And he still would have
developed
diabetes type 2 in his sixties!” I offer this
response to
the nice lady’s hypothetical comment and to
all those
who oppose presumptives: there may be such
alternative
universes, but we don’t live in any of them. We
live in
this universe. In this one, Bob passed his entrance
physical
with flying colors, served honorably in an
environment
poisoned with dioxin, and developed
diabetes
when he was twenty‐five. Twenty‐five. Also in
this
universe there is pretty convincing correlation
between any
service in Vietnam and diabetes type 2.
Let me
throw in an observation: no adjudication system is
perfect.
Medals, promotions, disability compensation, all
these
systems result in deserving individuals being denied
and
undeserving individuals approved. The very best
systems
have a higher proportion of the former and a
lower
proportion of the latter. Let me ask a question:
would you
rather deny a veteran compensation who
followed
orders, served in a nasty environment, and is now
permanently
harmed as a result in order to make it more
likely the
undeserving are also denied? Or tolerate the
approval of
a few undeserving in order to make it more
likely the
disabled veteran who served honorably is
compensated?
Welcome to the universe in which we live.
John Tilford – Service Officer
One Purple Heart
March 2014
Leonard Wayne McIntosh. Greg Swanson. One PurpleHeart.
Wayne grew up – if you consider seventeen grown up –in rural Greene County, Indiana. Born in 1925, he wasof the generation who felt the worst of the GreatDepression. They are almost all gone now, those whoreally know what a great depression is. It’s not yourhome losing value or your savings earning less than youplanned or postponement of your retirement. It’s goinghungry, watching men begging for work, not strugglingto keep faith in the future but struggling to keep hopeitself. Wayne was in high school on the 7th of December1941. He enlisted in the Army the next year, one of theultimately sixteen million who served in World War II.And did he serve! Of all the divisions in the Army,Wayne was assigned to the 3rd Infantry. George Patton:“Yeah, his guts and our blood!” – an observation of ananonymous 3rd Infantry soldier. The 3rd had the highestcasualty rate of any American division in World War II.In accordance with Patton’s combat emphasis, themedical care following most of Wayne’s woundsconsisted of stopping the bleeding, stitches, bandage,and get back to your unit. Wayne participated in anopposed amphibious landing in Morocco, North Africa.“Opposed” means the two‐way shooting gallery. Healso landed in Sicily and Anzio. One of Wayne’s woundsoccurred near the Mussolini Canal as described by hiscompany operational records declassified decades afterthe war – casualties carefully categorized, numbered,but unfortunately not named. Wayne landed on thesouth of France later in 1944 in Operation Anvil. Anvilwas intended to complement the Overlord D‐Daylandings at Normandy, envelop German infantry andarmor forces and thereby shorten the war. His personalcombat story was shortened a few weeks later in therubble of a stone French building, in a coma, backbroken.Wayne woke over a week later in a theater level generalhospital. Somewhere along the line the unconsciousinfantryman was considered missing in action – hecouldn’t very well identify himself while being pulledfrom the rubble – and the MIA telegram was sent toWebster McIntosh, Wayne’s father. Luna, his mother,never saw it. Dad never showed Mom the telegram anddiscarded it after Wayne’s return. Wayne was stillyoung and – other than his back – healthy. Some of thepieces of shrapnel embedded in his back, hand, andneck would work their way out over the years, but heworked hard, physical jobs. Maybe the work helpedhim sleep. The nightmares made sleeping difficult.Wayne married the prettiest girl in Bloomfield, OakleneMcElroy [check] . They raised fine children: Monte,Tom, Bob, Karen, and Kenny. The kids grew up,married, had children of their own, and Wayne grewolder. His body became progressively less able tocompensate for the spinal damage done in France.Wayne obtained medical care and ultimatelyappropriate compensation from the Department ofVeteran Affairs. What he did not obtain from theDepartment of the Army was a Purple Heart. All therequired “official military medical records of combatwounds” were lost. The administrative staff at CampAtterbury, in their haste to separate over a half‐millionsoldiers so they themselves could go home, entered“None” in Block 34 of Wayne’s separation document:“Combat Wounds”. Even if Wayne had noticed, aPrivate First Class with no medical records would havehad – pardon the expression – no leg to stand on tocorrect this error. With what we now call posttraumaticstress disorder, I doubt Wayne hesitatedwhen told, “Here, sign this and you can go home!” ADepartment of Veteran Affairs physical examinationdocumented his many scars, embedded shrapnel, andbroken back less than two years after his separation.One would logically assume that, since Wayne had topass an entry physical in order to enlist, the damagenoted by the VA in 1947 either 1) occurred while he wasin combat exactly as indelibly burned into his memory,or 2a) Wayne was hit several times by German indirectfire as he worked in rural southern Indiana during thetime between his separation from active duty and theVA physical exam, and 2b) Wayne was confused as towhere he was located when wounded. (Odd his familyand neighbors did not recall this barrage, which wouldhave been extremely loud and left several craters in their fields.) See the conclusion of Wayne’s story in nextmonth’s newsletter.
John Tilford – Service Officer
A Visit to a
Senator’s Office
January 2014 Story
Some people think of the Department of Veterans Affairs
in terms of
“military”, such as, “My husband’s military
health care”
when the husband had only one enlistment,
left active
duty decades ago, is not eligible for TRICARE and
certainly
not active duty medical care, but who goes to the
VA clinic.
Yes, there is an obvious relationship between
the VA and
the military – the veteran had to have held up
his or her
right hand and been sworn into military service
at least
once to satisfy the first step toward
eligibility.
However, as has become more and more
obvious the
last few years, the Department of Veterans
Affairs is
a civilian agency. Most of the VA employees were
never in
military service and have no idea, until educated,
what an M14
is, or shrapnel, or – my favorite example – a
sucking
chest wound. “Isn’t that redundant? Don’t all
wounds
suck?” Well, yes and no . . .
There are
military benefits for veterans well outside the
responsibility
and administration of the VA. Different
procedures
are necessary to try to correct problems with
these
benefits. During a recent trip to Washington, DC I
visited the
office of a US Senator in an attempt to correct
two
problems.
First, a
WWII veteran now in a nursing home in Greene
County
still has shrapnel periodically emerging from his
body. You
can look through his 89 year old, nearly
transparent
skin and see some pieces in his hand and
back. He
was hit at least three times, the most obvious at
Anzio.
There are still deep scars on his left leg and back of
his head.
He has no Purple Heart. The Board for
Correction
of Military Records denied his request for a
Purple
Heart on the basis of there being no “official
military
medical records of combat wounds”. If such
records
were ever created by medics trying to cope with
his unit’s
nine enlisted wounded during that one defensive
action by
the Mussolini Canal, they are long since lost. His
1944
buddies are either dead or impossible to locate, so
there is no
chance of a “buddy statement”. However, the
VA employee
who physically examined our veteran 23
months
after his separation from Camp Atterbury
documented
the scars and embedded shrapnel. This was
the only “hard
evidence” submitted to the Senator’s office,
the VA exam
which logically showed that one of two things
must have
happened: our veteran came under German indirect fire
while
living in Greene County during those 23months, or he was
combat
wounded while on active duty.
Why involve
a civilian Senator?
Because the
military award
system,
specifically the Army G‐1 “exceptions” portion of
the award
system, had failed this veteran. The senior
staffer for
veterans and military issues for the Senator is a
young
former Air Force captain, probably in his late
twenties.
We had a long talk outside the Senator’s office
in the Hart
Building. He took notes. As we were “winding
down” the
Senator himself returned from a meeting and
greeted me –
an Indiana voter. We’ll see how it goes, but
too many
times politicians with no military service and
staffers
with relatively little are hesitant to tell the military
what to do
regarding the military’s own internal
procedures
and regulations, such as awards.
Second, the
VFW, DAV, and a few other military service
organizations
remain in favor of granting Space Available
military
flight eligibility to 100% service connected disabled
veterans.
We seldom hear about this reoccurring proposal
because so
few veterans would be physically able to travel
– perhaps
30,000 nationally. Not a lot of votes. Also,
because the
Department of Defense steadfastly resists the
idea. I’ve
often wondered why. All the administrative
means are
already in place around the world, only
otherwise
wasted seats would be used, and even the Air
Mobility
Command’s own regulation for “Space A” includes
a section
on how to accommodate – where possible
without
compromise to the mission – handicapped
passengers.
I just don’t think the DoD wants to mess with
it. To
illustrate, when I’m older and have to be helped into
the
aircraft I’ll still be eligible as a military retiree, Category
6, whereas
a 100% service connected disabled veteran
who earned
the 100% rating due to being rendered
unemployable
by service connected disabilities (perhaps
due to an
IED in Iraq – he had no chance to stay in and
retire)
would not be eligible unless the AMC reg is
changed. I
can’t imagine any military retiree in decent
shape
hesitating for a moment to give the last seat on a
flight to a
100% service connected veteran. I gave a few
years for
retirement. The 100% service connected veteran
gave
everything but his life. The 100% service connected
veterans
have all the other privileges of a military retiree –
commissary;
Post Exchange; morale, welfare and
recreation
facilities – but not Space A. I closed my
conversation
with the staffer in the Hart Building by asking
for the
Senator’s support for the current version of this
proposal,
being sure to point out that it would not cost
anything.
What will happen as a result of one meeting with
a staffer
and one handshake with a Senator? Who
knows. But
it does not hurt to try.
John
Tilford – Service Officer
VA Update
December Story - Retired Colonel John W. Tilford
Thanks to John Martin who provided the below summary of the CBO report.Last week the Congressional Budget Office (CBO) released a report titled: Options For Reducing The Deficit – 2014 to 2023. Contained in this report are recommendations that would impact Veterans Benefits, Defense Spending and Military Retiree Benefits.· Elimination of concurrent receipt [of military retirement] pay and disability compensation for disabled veterans · Narrow eligibility for Veterans disability compensation by excluding certain disabilities unrelated to military duties · Restrict VA’s individual unemployability benefits to disabled Veterans who are younger than the full retirement age for Social Security · Introduce minimum out of pocket requirements under TRICARE for Life · Modify TRICARE enrollment fees and cost sharing for working age military retirees · End enrollment in VA medical care for Veterans in Priority Group 7 and 8Of these proposals, I’m not all that opposed to withdrawing VA medical care for vets in priority group 8, but I am opposed (with a qualifier) to withdrawing medical benefits from vets in priority group 7.
Priority Group 8 veterans 1) have a decent income, 2) don’t have any service connected disability or none rated over 0%, or 3) are ‘grandfathered’ from an earlier eligibility era when the VA was trying to get all the vets they could enrolled to support expansion of the VA medical budget. Some vets disagree, but I never considered I’d be entitled to health care for life just for one enlistment.Priority Group 7 veterans have incomes below the geographic means test income thresholds and agree to pay the applicable copayment for medical services. My objection is exactly that - these are low income vets who are still paying the copays. Maybe the VA loses a little money on them, but not much. I would not be opposed to withdrawing their VA medical care eligibility if the Affordable Care Act (ACA) was permitted to add these low income vets – estimated at around a half-million nationally – to Medicaid as was intended. Right now, Indiana and 20 other state governments are not expanding Medicaid. Kentucky, Ohio, Illinois, Michigan and 23 others are. One advantage of Medicaid compared to VA for these low income vets is that Medicaid medical care is more widely available and therefore more accessible to isolated vets than VA clinics. Think of the low income vets in Davis or Martin counties, for example.I’m not too sure about how I feel about not allowing vets over their Social Security retirement age to apply for 100% compensation via Individual Unemployability (IU). The rationale for this benefit is that the 60% (with one disabling event at least 40%) or 70% (no matter how he or she got to 70%) service connected vets may be prevented from gainful employment because of their service connected disabilities. The IU benefit has to be adjudicated individually considering the claimant’s physical and mental condition, education, training, and vocational experience. The authors of this cost saving proposal are concerned that the VA takes IU applications (and approves many) from vets in their late 60s, 70s and 80s who would probably not be employed anyway. On the other hand, in the 1970s there were a bunch of anti-age discrimination law suits settled by removing age restrictions on federal benefits. There’s probably some room for compromise here – maybe by consideration of other income. (Confusing this anti-IU proposal is that another CBO report summary describes not allowing IU benefits until after retirement age – exactly the opposite of the report John found. John’s source makes more sense.) I’m certainly in favor of IU for working age disabled veterans, and I don’t see a legal (or ethical) way to deny IU to those over their retirement age.
The proposals I definitely oppose are -· Elimination of concurrent receipt [of military retirement] pay and disability compensation for disabled veterans There is no logical or ethical basis for the below-50% offset on concurrent receipt still in effect. Retirement is paid for years of faithful service; compensation is paid for being service connected disabled. Retirees/disabled vets who are being denied any amount of one of these benefits because of receipt of the other are being screwed no matter how you look at it. The trend toward full concurrent receipt has existed since at least the 1980s. Sure, it costs money, but any kind of offset between compensation and retirement benefits never should have existed to begin with.· Narrow eligibility for Veterans disability compensation by excluding certain disabilities unrelated to military duties This cost saving idea comes up (or very similar ideas come up) every few years and never works. At one time the VA even had two compensation tables, one for combat-related disabilities and one for non-combat related. Didn’t last very long. If Joe had his leg run over by an armored personnel carrier before he could be inserted into combat, which is that? The ultimate resolution of this question has always boiled down to “You were declared healthy and whole when you entered active duty. If you are disabled when you get out, you are entitled to compensation.” The current ‘spin’ of ‘disabilities unrelated to military duties’ might apply to some internal medical problems that might have developed in the vet due to age. Sounds logical, but I call this the “Alternative Universe” argument: Bob, my high school friend, was in Vietnam the same time I was. His duties exposed him to much more agent orange than did mine. Bob has diabetes type 2, neuropathy, and some other service connected problems. Maybe he would have had these disabilities when they began in his 50s had he never been a Marine in Vietnam. But that Bob who never enlisted lives in a hypothetical alternative universe. We live in this universe, the real one. We have to deal in realities, not hypotheticals. In this universe, Bob was young and healthy, enlisted, served honorably in a very nasty place, and now is 70% disabled. Most of his disabilities have been statistically correlated with exposure to dioxin and other poisons in Vietnam.The proposals which might be adjusted (although unpleasantly) to work - · Introduce minimum out of pocket requirements under TRICARE for Life · Modify TRICARE enrollment fees and cost sharing for working age military retirees I could probably afford the deductibles and annual enrollment fees being considered, and would do so to keep TRICARE for Life. Maybe I should so pay to help reduce the deficit. But I was very lucky to get promoted far above my level of competence, therefore have a higher military retirement income than average, have a reduced (early out) civil service retirement and (somewhat reduced) Social Security benefits. There are many military retirees who would have a real problem paying the hundreds of dollars of deductibles and annual fees being considered. Almost 10 years ago, when the DoD was still under Rumsfeld, the Reserve Officers Association (ROA) agreed to support similar proposals – mainly to suck up to Rummie. None of the other military service organizations (Disabled American Veterans, American Legion, Military Officers Association of America, VFW) agreed. These proposals have come up in every Congress for the last decade. So far, every year they fail to be adopted. Members of Congress are afraid of voting against military retirees/veterans. If these proposals ever did pass, I hope the costs would be graduated according to the retiree’s or surviving spouse’s income.
VA Update
November Story - Retired Colonel John W. Tilford
The Department of Veterans Affairs continues to report significant progress in reducing the number of outstanding claims. Secretary Shinseki’s stated goals continue to be elimination of the claims backlog, processing new claims within 125 days, and 98% accuracy by 2015. Shinseki confirmed these goals in his address to the 2013 National Convention of the American Legion.However – how very, very, however: The VA has applied “whack-a-mole management”, striking the highly visible and politically sensitive claims backlog while intentionally neglecting other critical functions which are now raising their ugly mole heads. I recently talked by telephone with a friend who works within the Indianapolis VA Regional Office. She checked on a veteran’s appeal which was filed early in 2012. It’s still in the untouched stack and will remain there for the foreseeable future. As the veteran said, with all seriousness and no longer rhetorically, “I may die before I hear anything on my appeal.” In this veteran’s case, winning the appeal will ultimately, someday, over the rainbow, mean an increase in his compensation of over a thousand dollars per month. This veteran has not been able to work since 2005 due to his several severe service connected disabilities. He is in financial hardship. No doubt many veterans who have had appeals pending for years have died during this period of intentional neglect. In a macabre trickledown effect, these first delays cause secondary delays in processing surviving spouses’ claims for death benefits. There are two reasons for the extended delay in the Indy Appeals Team even looking at the veteran’s appeal. First, the VA Central Office under Shinseki has mandated that all VA regional office employees qualified to work initial claims will do so and neglect any other duties. The Appeals Team’s “any other duties” are appeals. Second, my VA friend was speaking to me on her first day back from the government shut down. The flow of thousands of incoming new claims did not stop during the furlough. Much of the VA’s narrowly focused progress in reducing the backlog was lost because of Congressional political childishness, which – trickledown again – means more months before our example veteran’s appeal is even opened. Imagine the VA employees desperately bailing out a leaking boat. About a year ago the rate of bailing (claims completed per month) finally exceeded the rate of leaking (incoming claims). The water in the boat (backlog of new, unprocessed claims) actually started to slowly decline. The Congressmen who used shutting down government as a political ploy stopped the VA employees from bailing for 16 days. But the VA boat continued to leak and the water level went back up. Sticking with the VA boat analogy: while the employees continue to face inboard and bail as hard as they can there are torpedoes getting closer and nobody seems to care – and these threats are of the VA’s own making: adjudication errors and associated appeals. VA spokesmen report, evidently believing what the regional offices tell them, adjudication accuracy rates progressively increasing to over 90%. But the American Legion stated before Congress in September that these VA data are “inconsistent with our Regional Office Action Review visits nationwide, where errors are found routinely in over half of the cases reviewed.” Claimants who meekly accept erroneous, “get this case off my desk now” VA denials will remain cheated, and their cases are unlikely to ever show up as errors in the VA data. Claimants who file appeals before the Board of Veterans Appeals are winning over 70% of their cases. What does that tell us about the initial processing accuracy? Processing an appeal is time consuming and expensive for the VA, but this additional effort occurs later in the timeline of the claim. The VA remains primarily concerned about the near term: “What will please Congress now?” They remain oblivious to processing errors which result in disservice to veterans and ultimately increase overall employee work time due to appeals. They point to increased training and streamlined methods, but the bottom line is that the VA does not include accuracy in employee performance appraisals. As Patton told his officers, “Soldiers will do what you review, and not do what you don’t.” The VA reviews how many cases the employees crank out, regardless of the quality. If the water in the boat (backlog of new cases) was the only threat to the vessel, that might make a heartless kind of sense. The VA will stay afloat (look good to Congress). But the twin torpedoes will assuredly strike soon (poor accuracy and appeals) – nay, they have hit already – and are the greater long term threats. Only now is the VA grudgingly considering adding an accuracy metric to employee performance appraisals. Why has not the VA previously reviewed employee adjudication accuracy? Every other federal employee performance appraisal system I have ever known has included quality metrics. During my short time as a human resources contractor I helped teach a two day course in establishing performance standards. Two days. With breaks every hour and for lunch. We might conjecture that the unpleasant parts of reviewing quality performance standards, communicating bad news to the employees and helping a marginal employees do better, are somehow frightening to VA supervisors. ‘Easier to avoid unpleasantness by faking accuracy data and reporting that to Central Office. Somehow the real customers have been forgotten. Who are the real customers? Oh, yeah! Veterans! I knew that!
THAT ANNUAL VA CLINIC PHYSICAL
October Story - Retired Colonel John W. Tilford
I can’t tell you the veteran’s name, but his first namerhymes with “Ron” and his last with “Rowe”. So Rongoes to his VA Community Based Outpatient Clinic(CBOC) regular, annual physical last year. Ron’s aboutmy age, so an electro‐cardiogram (EKG) is a standard part of his physical. Ron had been having some flulikesymptoms, so he’s fully cooperative. Shave thehairs, stick the little color‐coded contacts on the skin, fire up the machine, run the paper tape, the techlooks at the tape a little funny but does not sayanything. The tech rips off the tape and walks it backto the doctor on duty – still standard procedure.Then things get a little unusual. The tech, nowlooking a lot funnier, comes back into the examinationroom and tells Ron, “Now don’t getworried. Everything should be OK. We’ve called 911and the ambulance is on the way. It should be here infive minutes. You are going to the hospital.”Time out. Ron had not had any pain in his chest atall. No pain in his left arm, or right arm for thatmatter; no pain in his jaw; no pain period. No nightsweats. He’d been a little more tired than normal,but supposed that was due to a mild case of theflu. Maybe a little “pressure” in his chest, but stillconsistent with flu‐ or cold‐related breathing congestion. No anvils or elephants on hischest. Nothing dramatic.Time in. “To the hospital? Why?”“You are having a heart attack now. You might wantto call your wife and tell her to meet you at thehospital.”Ambulance shows up, backs in next to the clinicdoor. The EMTs jump out, pop open the back doorsof the ambulance, slide out the gurney, snap downthe wheeled legs, and roll the gurney to Ron’sexamination room. Ron, still dumfounded, is placedon the gurney, strapped on, wheeled out and placedinto the ambulance. One of the EMTs tells him on theway, “You are not going to the emergency room. Youare going straight to the cath lab. They bumped some other surgical patients to get to you now.”But it was too late to get that last bit of information toRon’s wife. Her name rhymes with“Amanda”. Amanda was, understandably, speeding infrom east Highway 46. Amanda slides in to a parkingspace outside the emergency room door, and jogsinside (not too fast, new right knee). No Ron. But anice person looks up where he is – the cath lab.Ron watches a series of different ceilings passby. Somewhere along the route he loses hisclothes. He’s transferred from the gurney to anoperating table. Sharp things are stuck into him,some stay stuck. He’s briefed on the procedure. Hisupper leg, femoral artery is carefully opened andmysterious long thing fed up through his arteries tohis heart. By this time Ron’s past seeing any ofthis. He’s sleeping.Ron wakes up. Amanda is there. One of his newsurgical friends comes in to tell both of them whathappened. Two stents in coronary arteries. One hadbeen almost totally blocked with plaque, one around90%.Ron does his therapy, changes his diet, exercisesmore, lives a few more decades.Don’t screw around. 1) Not all heart attacks havedramatic symptoms. When something’s not right, getit checked out. 2) Go to your VA Clinic annualexam. Don’t let your name rhyme with “Gone.”
