Introduction of Dr. Bash

Today, our guest speaker is Dr. Craig Bash. He’s a specialist in medical diagnosis, radiology, and much more. Dr. Bash, how are you doing today?

Dr. Bash: Good, I’m good. Let’s answer some questions and see what topics you guys want to talk about.

Discussing SP Bill

Host: We wanted to start off with the SP Bill thing. What are your feelings on that, where they caused some veterans’ lives, and something should be done about it?

Dr. Bash: Good question. This is all a rebound from when they funded the Inspector General last year. They put a bunch of money and FTEs into the Inspector General’s office, making these detailed evaluations of doctors’ performance very difficult to do. The Inspector General has a bunch of doctors, and they heard about problems. They did deep dive research and found that the pathologist was impaired. Now, they are going back and trying to document all the different cases that he reviewed that were wrong. The problem with my field, radiology and pathology, is that we often make the final diagnosis. If a pathologist calls something normal or abnormal, or if a radiologist does the same, it can have a huge impact on the patient’s life because that diagnosis might not be reviewed again for years until the cancer gets out of control. It’s really sad. It sounds like a lot of patients were injured and died because of that process. It’s good that the VA’s Inspector General is looking at it and reviewing all those cases, which is taking some time, but impaired physicians can cause a lot of damage.

Host: I believe this issue goes back more than just three or four years. I had a brother-in-law down there who wasn’t diagnosed until he was in stage four cancer, and of course, he didn’t last long after that. Cancer was all through him, and that’s been about 10 years ago. I don’t believe this is a new problem.

Dr. Bash: Yes, you’re right. It went back to 2005 with this pathologist. Doctors can stay in one place for a long time, 30 years, so if he was marginal for a while, it could cause a lot of problems. They said he handled something like 30,000 cases in a year. Hospitals have a quality assurance program to double-check on doctors, but sometimes these pathologists or radiologists are the only ones in the whole hospital, making it hard to review their work. You have to send it out because clinic doctors can’t review what a pathologist or radiologist does.

Host: It’s too bad that it happened. There should be a way of keeping checks on this sort of thing.

Dr. Bash: Well, there is now. He got fired.

Host: Yes, he got fired, but in 2016 they found out he was messing up and put him in a special rehabilitation program geared specifically for doctors. It’s a good idea because a lot of doctors become addicts. I don’t know if his problem was alcohol or drug abuse, but they felt he was clean and let him back into the VA to do his regular job. After quite a few months in the rehabilitation program, he started messing up again. His co-workers complained, and he did get fired. So far, they’ve looked at 900 cases and found seven definite misdiagnosed veterans and two potentially possible deaths caused by this. A lot of the news is inaccurate, and I’m trying to get it squared away. Some news in Arkansas said Congressman Westerman was told by the VA that the pathologist caused one death so far. I called Westerman’s office in Washington, and his public affairs officer told me no; they said he may have caused one death. I think he may have caused two so far. The interim director is trying to keep this as a local incident, which is why you’re not hearing it yet on Fox News and other outlets. I’ve already called the White House and filed a complaint because I feel VA central office should make a statement on this. Veterans treated there from 2005 on up might have moved and not given their new address to the medical center. VA is not very good at sending out letters that get to the right people.

Dr. Bash: It should get really big because the VA has hundreds of radiologists and pathologists. All those guys’ work should be reviewed systematically, sent to other hospitals inside or outside for double-checking. This might just be the tip of the iceberg. There could be other pathologists out there doing the same kind of damage.

Caller: Absolutely. It’s scary. You know about what my husband went through. You did two fabulous medical opinions for me. If a misdiagnosis starts and goes on for years, it has a snowball effect. My husband ended up with one misdiagnosis and ended up being almost 300% disabled because they misdiagnosed three or four other situations. Only you, Dr. Bash, are so detailed. Unlike the VA, you read everything. These guys hand in their claims, but that doesn’t mean the VA will look through their medical records or service records real good. But you do that, and I commend you for it. You see things we can’t see in the medical work, and if we can’t see it, surely the VA hasn’t seen it.

Dr. Bash: That’s the way it’s supposed to work. The doctor should pick out a few things people don’t see. Docs are kind of afraid to change other docs’ diagnoses. You assume the doctor before you did a good job or had more data than you did, so we’re reluctant to change it. Especially a nurse practitioner or PA won’t change a doctor’s diagnosis. Once a bad diagnosis gets in the chart, it can be a big problem for years.

Host: Well, they better get it ironed out. They should get a hold of these veterans ASAP because there could be real misdiagnoses running around all over the country.

Caller: When I first heard of the story, it was in a Google alert. I emailed the law firm mentioned in the article, and a lawyer called me within a couple of hours. We talked for a long time. The law firm was already getting calls from veterans. Another problem is the statute of limitations. Veterans can still file an 1151 claim. They can still sue too because the statute of limitations is based on the date of discovery. If the discovery just happened a few months ago, they cannot use that 10-year rule.

Dr. Bash: Yes, the most important term is the date of discovery.

Caller: Veterans need their medical records. The first veteran who brings their medical records will know the name of the pathologist. The lawyer I talked to didn’t realize they don’t need a name to start a lawsuit. I settled with the United States of America. There’s a lot to it, but I think I better shut up because I could talk about this all day and all night. I’m going to hang up and enjoy the show with my computer and a piece of chocolate cake. My cholesterol is real good. I’m a very old person and in excellent health. I just got a great checkup. Exercise, eating right, staying away from drugs, alcohol, and smoking makes a difference. I’ll hang up now and enjoy the show. If you’re listening, the call-in number is 347-237-4819. Press one to get into the caller queue. Bye, guys. Good talking to you again, Craig.

Dr. Bash: See you later. Thanks.

Host: Dr. Bash, you wanted to discuss some items on your webpage like C&P examinations and sleep apnea?

Dr. Bash: Yes, I have a bunch of things called Bash Bulletins on my website. People can read and ask questions about them. One of the new ones I’m working on is about why you should pursue a 100% claim. I have about 10 reasons. One reason is if the medical codes are wrong. If your rating decision has the wrong diagnosis, you should go back and make sure it’s correct. That can make a difference.

Host: Yes, a lot of times they’ve been lowballing veterans. They should be rated 20, 30, or 40%, but they’re given a 10% rating. That’s not right.

Dr. Bash: Yes, I see that too. I’m also seeing a lot of 100 percenters or 50% that get awarded and then get taken back to zero or UNR them in a couple of weeks. Are you guys seeing that more recently?

Host: Yes, we have. Some veterans were afraid that after they were awarded, the VA would come back and hit them.

Dr. Bash: They do that a lot these days. They lump diagnoses together. I saw a guy today with sleep apnea, asthma, and GERD. They lumped them together and gave him 50%. They lump spinal cord, bladder, and lung issues together for 20%. The veteran thinks they’re rated for everything, but if you split them out, they’d have a much higher rating.

Host: Another longer fight.

Dr. Bash: Yes, you’ve got to unwind all that stuff. The veteran doesn’t know these things aren’t related. He tells his buddy he’s rated for asthma, GERD, and sleep apnea altogether for 50%. Sleep apnea by itself is 50% if you’re on CPAP. Another reason to go back is to look for secondary medical conditions. If a guy has a spinal cord injury and then gets kidney failure, the kidney failure could be secondary to the spinal cord injury. He should get secondary conditions even if he’s 100%. Another reason is tertiary conditions. If he gets a stroke from kidney hypertension secondary to a spinal cord injury, that stroke might be a tertiary condition. He should get connected for that too.

Host: Yes, another reason is to prevent future reductions. If you have a lot of claims and they’re all interrelated, it’s harder for the VA to come back and reduce you because they have to go through a lot of hoops.

Dr. Bash: Yes, the more claims you have, the less likely they are to cut you from 100% down to something small.

Host: Yes, if you get up around 200-300%, it’s going to be hard to cut you back. It will be a lot more difficult.

Dr. Bash: Right, but where they have you lowballed going in, then they come along and maybe raise it a little bit. If they get upset with you, they cut your ratings.

Host: Yes, they do that. Asking for an increase often results in cuts.

Dr. Bash: Yes, I’ve had good luck with severances. I haven’t had a single severance yet where the VA tried to sever a guy, and I got it reversed. There’s a lot of rules around severances. The veteran shouldn’t be afraid to go after the benefits he needs, but he needs an advocate to help him too.

Host: Number four or five is that 100% is often not permanent. 100% is not permanent for 20 years. They can’t change the code for 10 years. A lot of veterans think it’s permanent and total, but permanent total is just a designator for taxes and other benefits.

Dr. Bash: Yes, they might change the codes and come back. Another one is TDIU. TDIU is not 100% forever. They’re talking about phasing TDIU out at a certain age.

Host: Right, that’s a bad one because it’s hard to get, and they mess over veterans by calling it a personality disorder.

Dr. Bash: Yes, they’re talking about phasing TDIU out when you get to a certain age, like when you get Social Security.

Host: I don’t see that happening.

Dr. Bash: Right, I hope not. The Agent Orange bill passed.

Host: Which part?

Dr. Bash: The Blue Water Navy Agent Orange bill.

Host: Yes, so if you go get a VA loan for a house, you have to pay extra fees to cover the Blue Water Navy. It’s called robbing Peter to pay Paul.

Dr. Bash: Right, Blue Water Navy is now considered like boots on the ground for Agent Orange.

Host: Thank you all for listening. That ends this show, and now I’m going to zoom off.