Veteran: Comment on the Wolfe vs VA case

Comment on the Wolfe versus VA case

Wolfe & Boerschinger v. Wilkie, No.18-6091(DATED: September 9, 2019 PER CURIAM); 38 C.F.R. § 17.1005(a)(5) is invalid because it is contrary to 38 U.S.C. §1725; reimbursement of emergency medical care at non-VA facilities

References below.

The Court's opinion and the process leave me with big questions and that the VA can be ordered in a direction that will fix the problem.

The Court and NVLSP have the entire basis for the case wrong. The estimated cost does appear more sensational than factual. Unless the basis changes the DVA will not change its business rules. 

The Law says:

Statute 38 USC 1725 (c) (4) (D) states “The Secretary may not reimburse a veteran under this section for any copayment or similar payment that the veteran owes the third party or for which the veteran is responsible under a health-plan contract."

The statute means:  When the veteran’s insurance company pays a provider the insurance’s share of copayment, the VA will not pay back a veteran for the money insurance paid to a provider. That is all it means, that is all it can mean. The wording is exact. 

Without the statue, the veteran can claim the money from insurance belongs to veteran and invoice for reimbursement.   The statute prohibits double-dipping where insurance and the VA pay for the same medical expense. The VA does not have a regulation to prevent double-dipping.

The VA created CFR 17.1005 (5) "VA will not reimburse a veteran under this section for any copayment, deductible, coinsurance, or similar payment that the veteran owes the third party or is obligated to pay under a health-plan contract.”

The statute is correct, the regulation is fictitious.  The VA abuses the term reimbursement to include payment to the provider. 

Furthermore, the VA inappropriately uses the regulation to demand an explanation of benefits confidential business information from the patient and the provider. The Law defines third party to be the insurance company (patient, provider, insurer).  The VA switched the third party to mean (VA, veteran, provider).

The correct wording for CFR 17.1005 (5) is “The VA will not reimburse the veteran for a copay or coinsurance money paid under a health plan contractor.” ( A health plan contract can payout to either the medical services provider or to the insured.)  Or better: CFR 17.1005 (5) should be “The VA will not reimburse the veteran for an episode of care payments made to the provider or the veteran for episode’s medical expenses. “

Unless the regulation is like the above, the veteran can double-dip on payments made to the provider by asking to be reimbursed for payments made directly to the provider. In the case of medical insurance copayments, the title for the money belongs to the veteran patient. Medical insurance payment is exactly the same as if the veteran patient wrote at check to the provider.

Copay and coinsurance are terms specific to pay for a medical expense where the insurer pays some and the insured pays some. The definition of a medical expense is a fee for a medical service. 

The VA has no legal right to demand an episode of care explanation of benefits from the provider, the insurance company, or the patient. The patient, insurance, and provider have a private contract. By demanding the EOB and refusing to pay benefit is bureaucratic extortion. The Law requires the provider to reconcile all payout before invoicing the VA. That is all the information the VA needs.

The VA’s limit on medical expense payout is the maximum allowable amount (MAA) which is the same as the Medicare fee. Once the MAA is paid by any party, the Law exhausts further charges for the medical expense. I suspect the large cost estimate is calculated for the unpaid insurance payout rather than the MAA. 

If the VA suspects the provider being dishonest about reconciling payouts, the provider commits fraud in which case the problem belongs to legal and not a reason to deny veteran’s benefits.

The Court and the DVA treat reimbursement as a gratuitous act and not a formal business process. 38 USC 1725 instructs the VA to either pay the provider or reimburse the veteran. This statute defines the existence of 3 contracts and to make a payment the contracts require an invoice and a payment. Contracts: 

• Veteran & VA, 
• VA and Provider, 
• Veteran & Provider. 

Elsewhere in 1725, 2 other contracts exist. 

• Provider and The Veteran Patient, 
• Veteran Patient (insured) & The Patient Medical Insurance company (insurer)
• Note: no contract exists between the VA and the insurance company. A reimbursement requires an invoice before payment.  Unless the veteran files a Form 10-7078 (or equal)   invoice, the VA cannot make rules that bypass the Form.

Statute 38 USC 1725 (c) (4) (D) states “The Secretary may not reimburse …” Without a reimbursement invoice, the rest of the statue is void.  The VA regulation completely ignores the Law's reimbursement requirement.

Contract law and privacy law supersede Title 38.

To help understand Title 38, these are some of the first principles:

• Title 38 is Congress’s life grant of benefits to all veterans for the veteran’s national service.
• The Department of Veteran Affairs is Congress’s agent to pay veteran’s benefit expenses from the Federal Budget.
• Title 38 defines the veteran’s benefits and the business rules the DVA uses for operation and payout.
• A veteran’s benefit is a fee for a Title 38 service.
• By Congress’s grant, the veteran owns the benefit, the DHA has the responsibility to provide services and payout from the Budget.
• The DVA is not a veteran. The DVA is an agent of Congress, and cannot own benefits.
• The veteran owns all benefits.
• To receive Federal Budget benefits, the veteran must register with the DVA.
• The DVA likes to market itself as a benefits organization. While pleasant-sounding, the words misspeak its authority and responsibility.
•  Section 38 USC 1725 The Law instructs the Secretary to either pay-the-provider or reimburse-the-veteran.
• Pay-the-provider and reimburse-the-veteran is a formal business process of invoice and payment.
• Contract law and privacy law are the frameworks of business rules.

If NVLSP represented me with the Court of Veteran's Appeals, this is a list of conduct I would not expect the attorney to allow. 

• NVLSP allowed the VA to use the terms copayment, coinsurance, and deductibles in defense arguments.  These terms copay and coinsurance mean two payers, the insurer copay and the insured copay.  The VA created a regulation for the insured copay; however, the Law applies only to insurer copay.   The term deductible is not in 38 USC 1725.   If the DVA does follow the Court, the veteran can double-dip on other payments made directly to the provider. It is simple, the medical insurance payout is the property of the insured. When insurance pays a provider, the insurer acts as a broker for the insured to pay the bill for the insured.
• NVLSP allowed the VA to use the explanation of benefits (EOB) information to deny the veteran benefits. In a community provider episode of care, the EOB is private information, and the VA has no legal right or authority to demand.
• NVLSP allowed the VA to claim itself as the first party in separate contracts. The Law defines the veteran as the first party.
• NVLSP allowed the VA to substitute medical expense (fees for a medical service)  for insurance expense (cost of insurance)
• NVLP allowed the VA to limit the meaning of copay and coinsurance to mean the patient's share rather than the insurer's share.
• The CAVA, NVLSP,  and the VA tend to use the term reimbursement as a gratuitous act and not as a formal business process.

References:

United States Court of Appeals for Veterans Claims Docket Case Number:18-6091

Case NO. 18-6091 AMANDA JANE WOLFE AND PETER E. BOERSCHINGER, PETITIONERS, 

Contonx: Contonix Exertion Scales

The Contonix Exertion Scales is a self-assessment grading method on the effectiveness of Mind-It Training (MIT) exercises. Tone is an active event that occurs when forces act together to maintain balance. If a person extends an arm and holds is stead, all biological systems act together to hold tone. As soon as the moves, the biological systems continue to act together to sustain continue change in tone. The means to change from one tone state to another is connection toning.

Multiple Sclerosis: The cause of my MS.

Could something from 1971 point to reason I have multiple sclerosis?

When I was a teenager, my father earned extra money by doing did odd jobs for realtors like constructions, painting, cleanup. From the time I was 8 and until I was 18 and enlisted in the Marine Corps, I would go to many jobs with him. I think he had is own right of passage rules, because starting high school, he assigned me the high jobs like roof repair. I had no fear of heights. My enlisted ended in 1971, I  was 21 and often I would help him.  From an incident 50 years ago, my mind is still clear about what happened on a 1971 summer day.

Dad asked me to carry a bundle of shingles up to the roof where others worked. Putting the shingles on my shoulder, up the ladder, and walking across the roof, I put the shingles down for the roofers. I turned around to start down the roof, my legs froze. I could not move. Dad was calling me to come down for another bundle. I could barely hear him. He must have sensed something was wrong. He called out to one of the roofers to check on me. I am still standing frozen. The roofer looked at me, waved for my Dad to come up. The other roofer came oven and the three of them helped me to sit on the roof.  Dad told the roofers to help him get me down. They sat me on the roof. By pushing and tugging they slid me down to the ladder and help me turn over. One on the ladder, Dad is talking me down and help put my feet on the rungs while the roofers held my hands,  At halfway down, I could hold onto the ladder legs. And a few more rungs I was down.  Sill a little wobbly, Dad help me to lean on the pick-up.

A few minutes passed I was fine and could do other work. The building only was just a one-story house. During those few minutes, I was frozen with fear. Before the incidence, I had no fear of heights nor standing on the edge. The crew and I  had a good laugh about being me being afraid of work.  I never worked on a roof again. Forty-five years later, the exact same thing happened. I was at the gym, exercising on a spin bike. I felt fine, not physically exhausted. But, when I stood up, my legs froze, they would not move, I could not tell them to move. Standing there for a few minutes, the stiffness passed.  The legs became wobbly, and I was able to move to the next machine.

For 45years, the incidence on the roof caused self embarrassment. I did not understand. I always felt I let my Dad down. I showed weakness on the job but also the image of a Marine being afraid of a little old roof. I knew I was not a coward, I just did not understand what actually happened. Twenty years after the roof incident, I was diagnosed with multiple sclerosis. When the incident happened in the gym, I knew exactly what happened. Both the roof and the gym incidences was an MS exacerbation. In my life with MS, I spend a lot of time studying MS from the inside-out. systems perspective, not from the biological science perspective. The incident in the gym was a breakthrough event in my studies about MS and fatigue. For movement, we need three resources. The physical prowess to move. The neurological coordination of body systems. And, the cognitive capability to plan movement with the ability to send coordination orders for the plan.

The incident on the roof and in the gym was MS neurological fatigue. Both incidents had exactly the same pattern, frozen legs.  fear of being a lost and defenseless, and rest relaxing the frozen legs. If my analysis is true, then in the twenty years, before the MS diagnosis, from the time I was 21 until 40,  I experience undiagnosed  MS symptoms.  In 1976, I was a field engineering for a medical instruments company and my service territory was the central western states and the land area was a third of the United States.  The work involved fixing equipment in hospital labs and at university reseach labs. Travel to the cities meant flying. In a week's time could be one to four flights a day. In and out of Denver, to Salt Lake, to Phoenix to Albuquerque and back to Denver was an easy week.  Once I was so fatigued, I had to spend several days in a Salt Lake hotel room just resting.  I remember tossing the keys to the valet, bearly being able to walk to the front desk. I had to sit in the lobby and rest before going to my room. I thought I had the flu, but now I know the symptoms were from an MS attack.  When I returned to Denver, the family doctor gave me some vitamin shots along with bed rest. I was 25. A few months later the fatigue happened on the last flight home to Denver.  Will power got me to the parking lot and my car. For two days only I walked between the bedroom and the bathroom.  One the third day, I went to the family doctor again. More vitamin shots and rest.  At 26 I was burned out and 4 days later I quit that job.

The story just sounds like being overworked. The fatigue was MS.   At the time,  the fatigue appeared as job stress. The one thing I recall was not walking well and the legs being wobbly. Years later, I learned that wobbly walking is a symptom of MS. 

Could something have happened to me between 18 and 21 that caused MS? I am the only MSer in generations of past and present family members. I have an idea about what happened to me that is exclusive of others. I am still working on the idea.

Once I identified the fatigue pattern, I could recall other fatigue events before and after diagnosis with the same pattern. I named the pattern the -n event for the no-neurological coordination. Each fatigue event is different,  only a few are  -n severe disabling events. 

Psyc: Fear Threat Reactions

Fear Threat Reactions

When faced with a perceived threat, humans and animals exhibit a range of fear-threat reactions. These reactions are physiological and behavioral responses that help individuals cope with the perceived danger and protect themselves from harm. The most well-known fear threat reactions are the "fight-or-flight" responses, but there are other adaptations that organisms may employ in the face of fear.

Fight-or-flight response

The fight-or-flight response is a common physiological and behavioral reaction to perceived threats. This response is mediated by the sympathetic nervous system, which triggers a cascade of physiological changes that prepare the body for action. These changes include:

• Increased heart rate and blood pressure: This provides the body with the necessary oxygen and nutrients to fight or flee.

• Muscle tension: This allows for rapid movement and defense.

• Dilated pupils: This enhances vision in low-light conditions, which may be necessary for escape or defense.

• Release of hormones: Hormones such as adrenaline and cortisol prepare the body for action and increase alertness.

The fight-or-flight response is characterized by two primary behavioral options:

• Fight: This involves confronting the threat directly, either verbally or physically.

• Flight: This involves fleeing from the threat to a safe location.

The choice of whether to fight or flight depends on various factors, such as the perceived severity of the threat, the individual's assessment of their own capabilities, and the availability of escape routes.

Reaction	Description
Fawn	Hide - make oneself invisible, the threat still exists.
Fight	Attack - self-defense by disarming the threat
Flight	Run - move away as fast as possible.
Freeze	Stop - cannot move, moving an make the threat worse
Finesse	Wade - Facing the threat and preserve anyhow.
Forget	Ignore - The cause for fear is not a threat.
Fold	Surrender - Give up, accept the fact the threat is beyond one's control.
Fade	Backup - Disassociated from the threat.

Neurological Reactions

The neurological reactions, also known as the "four Fs," involve specific neurological pathways and activations. These reactions are:

1. Fawn: The fawn response is associated with the activation of the parasympathetic nervous system, which promotes relaxation and conservation of energy. This response is mediated by the release of neurotransmitters such as gamma-aminobutyric acid (GABA) and acetylcholine.

2. Fight: The fight response is mediated by the sympathetic nervous system, which triggers a surge of hormones such as adrenaline and cortisol. These hormones prepare the body for physical action by increasing heart rate, blood pressure, and muscle tension.

3. Flight: The flight response, like the fight response, is mediated by the sympathetic nervous system. Adrenaline and cortisol play a key role in this response, preparing the body for rapid movement and escape.

4. Freeze: The freeze response is associated with the activation of the dorsal vagal complex, a part of the nervous system that regulates freeze behavior. This response is mediated by the release of neuropeptides such as opioid peptides, which promote stillness and reduce pain perception.

Neurocognitive Reactions

The neurocognitive reactions, also known as the "four Fs," involve cognitive processes and emotional regulation mechanisms. These reactions are:

1. Fade: The fade response involves suppressing or diminishing the emotional intensity of the fear response. This is achieved through cognitive reappraisal, which involves changing the way one interprets the threatening situation.

2. Fold: The fold response involves avoiding or withdrawing from the perceived threat. This may involve physical avoidance or mental disengagement from the situation.

3. Forget: The forget response involves suppressing or erasing memories of the fear-inducing event. This is thought to be mediated by the hippocampus, a brain region involved in memory formation and consolidation.

4. Finesse: The finesse response involves managing or controlling the expression of fear, often through coping strategies such as deep breathing or relaxation techniques. This response is mediated by the prefrontal cortex, a brain region involved in executive function and decision-making.

Phases of a Fear Threat Reaction

The four shock phases of a fear threat reaction are:

1. Trigger: This is the initial phase, where the individual perceives a threat and the fear response is activated.

2. Action: This is the phase where the individual reacts to the threat through either neurological or neurocognitive reactions.

3. Recovery: This is the aware phase, where the individual's physiological and emotional state returns to baseline.

4. Reaction: This is the safety phase, where the individual makes cognitive plans to change risks associated with the trigger.

The body's means to execute these reactions involve a complex interplay of hormonal, neurotransmitter, and cognitive processes. These mechanisms allow individuals to cope with perceived threats and protect themselves from harm.

While the threat reaction has a physical-behavioral transition response, the transition seems seamless in life practice.

Contonx: Four Square Fitness

Four Square Fitness

 

S.A.F.E Conditioning

              S - Strength
              A - Agility
              F - Flexibility
              E - Endurance

In the Art of Contonx, strength, agility, flexibility, and endurance are the finite elements of tone. Everything in the body's anatomy elements moves, cells, organs, fluids, nerves, bones, muscles, etc. A SAFE condition defines the relationship between the elements.

Pysc: Did Adam Have a Bellybutton?

Did Adam Have a Bellybutton?

“Did Adam have a belly button?”, the Question is a philosophical question related to a bible story. The Question proposes a polar answer of either a yes or a no. The Question itself makes the suppositions that the character Adam exists, that something exists called a belly-button and that Adam may have the procession of the belly-button. 

The Question defines the affirmative to be "Adam has a belly-button", then negative to be "Adam did not have a belly-button.  A "no response" cannot be either yes or no,  but yes response means a proof argument. The negative response is an absence of proof, the response is a negative answer.

The Question suggests the scope of understanding is context similar to both the proposer and the proposed.  Although the answers may include valid responses where the proposer and the proposed to have different or distinct context.

If the proposer and the proposed have a mutual context with similar exposure to bible stories,  the Question's proposition is a philosophical interrogation related to creation and God. Four options provide the bases for opinions.

1. Creationist -- No. God created Adam, therefore no need for a bellybutton.
2. Evolutionist -- Yes. Homo sapiens evolved as a biological natural occurrence.
3. Interventionist -- Yes. Some eternal force triggered evolutionary species to gain abstract rational thought. The bible story suggests God choose the homo sapien Adam to have free will. Perhaps some other unknown source of external force triggered or deposited a person with advanced brain capability.
4. Exclusionist - No. Knows about the story but discards it and considers the story fiction.

However, if the proposer and the proposed have no mutual context, the Question is about a person named Adam and his bellybutton.   The Question does suggest other responses that are not yes or no.

1. Inquisitive - Why is Adam's belly button important?

2. Rationalist - What is the reason for the question?

3. Knowlege - No concept of creation.

4. Indifferent - I don't care.

5. Unknown - Not discovered.

6. Not important - No. important and unimportant are still important. Not important means no existence to make important.

7. Alternative - A different story about creation.

The world is full of different tribes and cultures. Each may have similar ideas about creation or the lack of ideas itself.  A rock has a complete response.

             

Veteran: 38.1725 ~ Information Model

Veterans' Benefit 38 USC 1725  Statues as an Information Model

38 USC 1725 is the Law about business relationships with veterans, DVA, community providers, private insurance, and others.

This information model describes the business relationships.

Technical Background

Dictionary: An information model in software engineering is a representation of concepts and the relationships, constraints, rules, and operations to specify data semantics for a chosen domain of discourse. Typically, it specifies relations between kinds of things, but may also include relations with individual things. It can provide a sharable, stable, and organized structure of information requirements or knowledge for the domain context.

Ontology Models – Formal structures (classification systems, assemblies, and parts, language)

Affinity Models – Abstract structures (diagnostic, association, disassociation, discrimination, acceptance)  

Social Models – Tribe structures (law, group dynamics, bias influences, behavior expectation, linguistics)

Modeler Skills – Psychology, Information Science, Data Systems, Computer Science, Business Science (contract law, accounting, finance, economics, marketing), Domain Knowledge (medical, manufacturing, service, sales), Systems Analysis & Design, Communications, Business Arts (writing, speaking, management, social networks), Negotiation Reduction.   

Information Bridges 

Every domain has collective and subjective models particular to the domain. Engineering, science, teaching, government, family, medicine, transportation, recreation, commerce has different information modals inclusive to the domain. In the theater domain is serval well-understood information elements.  During the analysis of other domains, often the theater elements functions can be useful for affinity identification. Sometimes in domain analysis, information modelers use the theater element names to provide a concept bridge into the domain under analysis. As the information model matures, the domain name replaces the theater name.

Theater	Function	Business
Actors	Participants	Principals
Role	Activity	Party
Play	Interaction	Contract
Property	Things of Interest	Deliverables, Services
Stage	Environment	Law
Director	Goal Insight	Operations
Audience	Client	Customer
Tickets	Demand for property	Invoice
Performance	Production	Payout
Writers	Title	Owners

Watchwords:

During the analysis process, word terminology can be overloaded based on many factors.  If the analysis is specific to a domain, the terms can still be overloaded. Even two people can misunderstand each other. Nature grants people the ability to build the mind’s information model. As a result, every person’s information model is specific to the person.  Watchwords are terms the modeler use to as alerts that may affect the model. In language, word order defines syntax elements. Each word has a definition, order relationships together with definitions create communication meaning. Watchwords signal information semantics.

Common Terminology:

• Wherever the term money appears, the term includes seven information attributes: name, title, asset, amount, use, event, warrant. Each attribute has one or more definite values. 
• name - a label to identify money conveyance
• title - the money's owner
• asset - the title's social collateral 
• amount - an asset's quantitive or qualitative measure
• use - purpose or encumbrance for conveyance
• event - the conveyance instance 
• warrant - title's ownership right and sustainability.
• value - data about the attribute
  
  
• The insured hires the insurance company, insurer, to limit the payout liability of the insured. When the insured pays premiums for the insurance policy, the premium provides an obligation on the insurer with a guarantee the insurer will transfer title of the insurer’s money to the insured. Sometimes the insured will delegate authority to the insurer to pay money to the entity the insured has an obligation.
• Agency is the most common type of contract for consumers.
• Invoices and payments are contract instruments identifying money transfer.
• A medical episode-of-care can have one or more medical expenses which is a fee for a medical service.
• Grantor and grantee are actors in a title transfer.
• Business accounting is a recording of money use.
• Assets = Liability + Owner Equity (Revenue – Expenses) (a.k,a Net Assets)
• Trade Þ Purpose Þ Needs & Wants Þ Contract
• Data Þ Value Þ Meta-data Þ Roles
• Program Þ Process Þ Schedule Þ Property Þ Value
• Value Þ Quantity & Quality
• Production Þ Cost D Quality D Schedule balance
• Title Þ Asset Ownership  ~ copyright, trademark, procession
• Follow-the-Money Þ Process Þ Trade Þ Money (conveyance)
• Payment Þ Money
• If exist Þ then Þ else
• Syntax (structure) Þ Semantics (meaning)
• Joint and Disjoint  Þ In contracts, the two principals (A & B ) have a joint agreement. When an activity involves more than two principals (A,B, C) . A & B and B & C are two separate joint agreements.. A & C are disjoint with no common agreement.  B may supply parts to A. C may supply parts to B, that B uses to make parts for A. 

Medical Business Terms

• Medical Expense = fee & medical service
• An Episode of Care Þ Medical Expense & Qualification {Edibility, Time, Purpose}
• Authorize Þ Permission to transfer title
• Reimbursement = A principal’s payback to a principal for money paid the principal paid on behalf of a contract.
• Copayment = the policy amount insurer pays and and insured each agree to pay for  medical fee. 
• Deductible = The insurer’s time-based threshold amount of medical fees the insured pays before the insurer’s payout.
• Premiums = the direct cost of an insurance policy. Usually an employer pays some and the employee pays some.
• Insurance = a contract, policy, between the insured and the insurer whereby the insurer guarantees liability protection for the insured. 
• Insurance payout = the insurer's liability protection amount given to the insured for purposes of paying the liability. 
• Patient = the person receiving medical treatment at a provider.
• Provider = the person or organization supplying medical treatment.
• In-network provider =  an agreement between the provider and the insurance copy on cost for medical expenses.
• Explanation of Benefits =  the insurer's calculation report based the in-network agreement detailing the copayment amounts.
• Provider Invoice =  a detail list of the treatment fees and services requesting patient payment
• Invoice Payment =  the money paid against the invoice

Veteran:

• Paragraph 38 U.S. Code § 1725. Reimbursement for emergency treatment Statue (a)(2) instructs (assigns) the VA either pay the veteran or pay the provider.
• Title USC 38 Veterans’ Benefits is a benefit grant from Congress to every veteran and an authorization for Veteran’s Administration to be Congress's Agent to use the Federal Budget for veteran's benefits payment. 
• 38 USC 1725 Contracts

1. VA & Veteran  ~ role: Benefit Payout

1. VA & Provider ~ role: Veteran assigns VA to pay medical expense treatmentPatient & Provider ~ role: treatment & payment responsibility
2.  Provider & Insurance Company ~ role in-network agreement
3. Patient (insured) & Insurance Company (insurer)

Note: the VA does not have a contract with an insurance company at non-VA faculty therefore not rights to policy terms. The VA is disjoint from the insurance company.

• Maximum Allowable Amount = Medicare fee
  
  
• Information Generation Distortion =  The VA's multiplication of business instructions causes errors in compliance with the Law:   Law > Regulations > Policy > Procedures
• The effect is the whisper game:

Bicycle: Letter to Jimmie Heuga

Happy Birthday Jimmie

Sept 22, 2012

Dear Jimmie,

This is a letter I wrote to Jimmie Heuga, ski racer, MS champion, my pedal partner on my first 150 Bike MS ride. His was the inspiration for Can    Do MS in Vail. September 22 was Jimmie’s birthday and he died February 2010.  Two years later, on his birthday, I did a bike ride that was a challenge for me. This is a letter I wrote to him about the ride.    

Dear Jimmie,

This is a letter I wrote to Jimmie Heuga, ski racer, MS champion, my pedal partner on my first 150 Bike MS ride. His was the inspiration for Can    Do MS in Vail. September 22 was Jimmie’s birthday and he died February 2010.  Two years later, on his birthday, I did a bike ride that was a challenge for me. This is a letter I wrote to him about the ride.  

  

On Saturday the 22nd, 4 friends and I rode a bicycle ride I tagged as the CanDo 50.  The ride heads west from Loveland. At the base of the foothills, the route turns north to Mansoville, which begins the climbs over the Horsetooth Reservoir Hills. Just before Bellvue is Bringham Hill Road that heads back east to Fort Collins.  At Overland Trail, we head south on streets and trails to Loveland.

At the start, the weather was slightly hazy and cool. I admit I was worried about doing this ride because I did not know if I could climb the six Horsetooth hills in the same ride. While the hills are not much by Colorado climbs, to me each represents overcoming MS challenges.  When I started riding to improve my overall health and put my MS on notice that I was in charge, I remember each of those hills because many times I had to get off the bike and walk up them.

By mid-morning, the haze is lifting and the two of the west Horsetooth hills are finished. Because I trained on those hills, claiming them was still work, but not difficult.

A turn north and across the dam, the forth ill is a short steep climb above the reservoir. Silly, how sometimes just the thought of a thing will block success. Months before today, I walked that hill at least five times or more. At the base, looking up I said to myself, “That’s not much of a hill, what are you worried about?” Sure enough Jimme, it was not much of a hill today. Next was hill 5, it is long and steep, and provokes heavy breathing, but the MS never fatigued. The downhill is great  Hill six is a bump but it marks the turn back to Loveland.

I am sure you remember, that climbing hills with MS takes special conditioning, the descent takes even more conditioning. Because downhill is faster, it requires faster reaction times and coordination. It’s the same for all riders, but for MS’ers, fatigue is riding out in front looking for a way to cause trouble.   You get to the top, legs are burning, lungs gasping, heart-pounding, arms and hands weak from gripping the handlebar, and you see that downhill. In quick order, not only does the ride focus change, but you must shift from low gears to high gears, test brakes, relax tense muscles, change line-of-sight focus, switch mental fears, watch for obstacles, plan a safe path, adjust riding positions, anticipate curves, heighten the  back sense, and then look for that downhill freedom path to make the ride. 

 For me as an MS rider, both the climb and the descent have MS challenges. MS  has no place is during the downhill ride. The MS cannot catch me there. I let go of the struggles, trust my bike, tuck down, smile and laugh at the fatigue. 

By noon, my friends peeled off, each heading home. That left three miles to finish the ride by myself. This was a great day because those last minutes gave me time to reflect on the ride and remember the one time I met you, the day you signed my helmet as my first pedal partner. As an MS Ambassador, I told that story many times and the importance of fighting MS in many ways.

At the end, the CanDo ride was 47 miles. I rode the 6 hills without walking a single one.  After getting back to the start, I still had a couple of miles to get home. No problem.  We had a great ride pedal partner.

Happy Birthday, Jimmie!

Veteran: Veterans' Administration is Breaking the Law

This post is about the VA creating regulations that are not compliant with the Law, engaging in acts of bureaucratic extortion and bureaucratic racketeering. -- Ok, I am not a lawyer, so maybe the terms are expressions of frustrations. This article explains my use of the terms.

Breaking the Law

When a veteran has ER treatment at a non-VA facility, the VA will either pay-the-provider or reimburse-the-veteran. If the veteran does not have private insurance, the VA accepts the provider's bill. If the veteran has private insurance, that has copays and deductibles for the episode-of-care, the VA claims by Law the VA cannot pay the copays and deductibles. No statute in Law supports that claim.

On September 11, 2017 at 3 AM, my wife, an Army vet, woke with pains in her chest.  The nearest VA hospital is in Cheyenne, more than an hour away. The VA directs veterans who have an emergency condition to seek treatment at a community provider.  I took my wife to the nearest ER. The diagnosis was gallbladder problems. We followed all the VA protocols for adverse conditions.  Two weeks later a surgeon at the VA removed the gallbladder.

We followed all the reporting protocols expecting the VA would consider the community hospital treatment the same as if the treatment occurred at VA facility. We give the VA permission to use our private insurance for cost recovery at VA facilities. We did not expect the VA to use the information about the insurance to deny the ER benefits. A few weeks later, the hospital sent a statement for $3600 which is the $3500 insurance deductible and some patient copay. Because the VA is the primary provider, a $3500 deductible keeps the premiums down, yet still provide a cost recovery threshold.

Next, a letter from the VA arrived denying the ER expenses stating, "By Law, the VA cannot pay other health insurance deductibles and copays." The VA's letter shocked us. We followed protocol. We give VA cost recovery permission, the ER was not considered the same as at a VA facility, and the VA used the information about our private insurance with a third party. I thought we did everything right, yet the VA said we did not. I needed to understand why.  Next started months of study.

Until the VA's denial, I was ignorant about Contsutinal Law and executive department regulations. Starting with an empty mind has rewards, although, acquiring information the mind will postpone the rewards. Once in awhile, something happens that trips a mental trigger and all the pieces of information blend from chaos into order.

US Government
As Americans, we know about Congress, the President, the Supreme Court. Our mental model includes Representatives, Senators, Judges, and the Federal Bank. Most citizen federal government interactions are with one of the

• 15 executive departments (includes VA and DOD)
• 41 commissions (includes National Council on Disability) or the 
• 66 independent agencies (includes NASA),. 
• 10 official agencies (includes Smithsonian Institution)

And we hear about law, regulations, and procedures. Until the VA's denial, my knowledge of government was intuitive. As I learned more about the Federal Government, the more I felt uneducated. United States Code (USC), the Law, defines the executive departments, operations.  Each of the department's code has a number and a title. The VA's title is 38 USC Veterans' Benefits.

The US Federal Budget is the corner post of government that enables government operations. Constitutional law is a business plan that directs operational activity for spending the Budget's money.

Other laws like contract law and privacy supersede and enable the Code. When the Code uses words like pay,  payment or reimburse, these words immediately invoke business processes and the laws related to business.

MS Inside-Out: History of MS

MS Inside-Out: History of MS

• 1399, 1st diagnosed case of MS

           Saint Lidwina of Holland

           1380-1434 

           Diagnosed with MS at 19 

           MSer for 34 years!  

• May 1, 1945 

          a New York Times classified advertisement read:

        “Multiple Sclerosis. Will anyone recovered from it 

          please communicate with the patient." 

             Placed by Miss Sylvia Lawry, Founder NMSS

•      March 11, 1946   

           The National Multiple Sclerosis Society founded. 

•     1993 - first disease-modifying therapy
   
•     2020 Still no cause, no cure.

MS Inside-Out: Your are my HERO

YOU ARE MY HERO

When I give MS Ambassador talks, I always thank those listening with this recognition:

When I rode my first Bike MS 150, wearing my first “I ride with MS” jersey, riders passing would call out “You're my hero.”  After about 100 miles, I realized, I am not the hero, but those out here riding to support the cure for MS are my heroes. 

After thinking about heroes, I realized “hero” is an 

acronym for Help Everyone, Respect Others.

When you give time, talent, treasure and tenacity, you show respect. For me, tenacity is the most important. 

Never give up.

Each of you is my hero.

Thank you

MS Inside-Out: Concurrent Complex Syndrome

Concurrent Complex Syndrome

Inside-Out:

For years I looked for a term that groups all the different interconnected complications with MS. In my "MS from the Inside-Out" study, an MS attack is a type of trauma. The factors of trauma are injury, emotional, social and disability. The term "Complex Trauma Syndrome" acknowledges the complicated interdependent trauma factors. An MS attack inherits some characteristics from complex trauma syndrome plus adds the labyrinth effects from "Complex Fatigue Syndrome” caused by the physical, neurological and neuropsychological MS wounds. By thinking of the "MS syndrome"   as a layered complex group of symptoms whose characteristics are distinguished by inherited or innate. For example, the MS emotional symptom of an outcast is inherited but denial is innate. However, both outcast and denial are each complex syndromes within the group.

The origin of a complex syndrome happens as the trigger from some event. Power engineering uses the term dark start to describe the process uses to restart the main power generation turbines following a grid backout.  To start the big turbine requires a motor strong enough to initiate turbine movement. Then another motor is used to start the turbine starter motor. And another motor starts the motor that start the motor that starts the turbine starter motor. When some flips a switch to turn on a room’s light bulb, the light’s glow happens as the result of a dark start switch. A simple power on switch has many dependencies on science, physics, chemistry, engineering, craftsmanship, architecture and more including the biomechanics of the hand, human physical prowess, neurological coordination and the neuropsychological wherewithal that creates a plan to turn on the switch.  Sometimes, all that is necessary to intuitively attribute a dark start as a common event. From the room’s perspective, the dark start trigger occurred at the flipping of the switch.

Every injury does not exist until a black start trigger event happens. In MS, the explanation “no known cause” means science has not found the true dark start source for MS symptoms. However, science does know the MS injury begins with a wound from the immune system removing myelin. This injury is the clinical dark start source that in turn causes wounds.  

Concurrent Dissonance Disorder – In wellness, concurrent dissonance disorder is multi-factor physical, mental or social disorders occurring near-simultaneously caused by a trauma event. A disorder is an injury where the injury provokes a wound that disrupts or creates an injury that affects other orders.

Imagine playing the guitar. Each string's normal order rests in the air quiesced and stretched in tune. As the pick strikes the string, the sting becomes disordered producing harmonic vibrations. The string's disorder provokes dissonance in the air causing the air to be disordered to be heard as sound. When the pick strikes several strings, the near-simultaneous disorder from each string produces a complex syndrome of sounds called music.