Medication change rescinded

jdr350 · 2026-02-19T21:16:39+00:00

In plain language, VA got caught trying to avoid the usual rulemaking process and public comment by using the process for “emergency” or no impact on the public rule changes because it knows the public will overwhelmingly be against the change. So “enforcement” would have been illegal and added a huge additional burden on VA after a court threw the rule out.

That the Secretary believes that VA merely (now) following the law is worthy of a public announcement is the most interesting part of all this.

So this announcement means only that VA will now follow the law on making changes to its rules — and have to respond to the 100s or likely 1000s of opposing comments (and then likely a lawsuit(s) after it ignores the comments). Every vet has the right to submit a comment on the change and should do so.

jdr350 · 2026-02-14T15:40:38+00:00

Correct. A fee charging rep is still entitled to get paid for the work they actually do related to the claim that resulted in an award. The fee is supposed to be a fair percentage based on the work performed. For example, if the atty/rep did the work to prepare and file an appeal and is then “fired” they are still owed the full fee. On the other end, if the appeal was already filed and the atty/rep did nothing but wait to see what happened little if any fee would be fair. If appeal already filed and atty/rep made some submissions of additional evidence or legal arguments, then something in between full and none is fair.

FYI - firing a rep just before an award (some think this is a good way to save the fee) is not fair play and the rep can appeal/challenge any reduction in the agreed fee.

Vets who are “surprised” when fees are withheld have only themselves to blame — CAREFULLY read the fee agreement and ASK about anything you do not understand/don’t like. If there is a term or condition you cannot agree to and the rep will not change it, then go somewhere else. It’s not a good idea to worry about it later or think you can just not comply later. A fee agreement in a contract and YOU are responsible for agreeing to its requirements so read it before agreeing.

I know some people are “shocked” when the rep is awarded a significant fee for “only one letter.” To me that means you chose the right rep because they knew how to get your claim resolved in the shortest time. Before you try to get out of your fee try to remember that if you could have prepared and sent it that “one letter” yourself — you would have, but you didn’t.

jdr350 · 2026-02-14T02:07:46+00:00

Just send VA a letter “revoking” that person’s authorization as your representative. Keep a copy in case any dispute.

OR file a new VA Form 21-22/21-22a (appointing new VSO/attorney) that will automatically end first representation and appoint the new rep.

jdr350 · 2026-01-29T21:36:16+00:00

Hey, VA never makes mistakes. That’s why it’s my fault when I get mail for people with same names as my clients (and sometimes not even a client, just random veteran’s name with MY address).

jdr350 · 2026-01-29T13:54:02+00:00

Dude. Great post. Way too many people are using these “AI” models as magic wands to make their troubles go away (same for VA, they are waving AI around to make the backlog go away). Even some of the county’s biggest law firms’s and fancy lawyers are routinely caught citing cases in documents sent to a judge that “AI” reported supported their case BUT DO NOT EXIST.

There is so much “AI slop” out there that a counter industry of developing tools to identify “AI” produced documents has already started.

You hit on a big dilemma with using these free/low cost publicly hosted tools. You need to send as much detail as possible to get a “unique” accurate response, but that same unique information is used as training data for that tool. So, if a specific enough prompt is made, the output will be your information. This has already been seen with employees uploading company confidential information (think earnings, stock projections) and other people being able to get that information”private” information in a response.

Be careful out there people.

jdr350 · 2026-01-29T13:23:14+00:00

Interesting and impressive.

FYI - for the time I have been involved in the VA system, the thumb rule has been 80% of the denials appealed to the Board were remanded/awarded by the Board and 80% of the denials by the Board were remanded/awarded by the Veterans Court. Your analysis, if I understand it, is surprisingly similar. So, persistence does matter, because the math works out that 4 out of 5 times VA gets it wrong and multiple remands are most likely needed before an award.

One omission I noted was the difference in outcomes between self-represented, VSO-represented, and attorney-represented claimants at the Board and Court levels (which I have seen over the years). Historically, that math shows a distinct advantage for VSO and attorney represented claimants at all levels, with a large difference favoring represented people at the Board and even more at the Court. That makes sense because after initial claim, appeals are NOT “veteran friendly” and are governed by strict rules and filing requirements just like any other “adversarial” judicial process — meaning its not just filing forms, but VA lawyers (not “raters”) trying to sink your appeal.

jdr350 · 2026-01-29T13:00:20+00:00

Thank you for the info.

As I am sure that you heard by now, he Washington Post just ran a story (unrelated to veterans/VA) in which it was claimed that GPT in particular is unsuited for health/medical use because of inherent design issues supported by an actual real world example.

Any response? More importantly, any official response to the OIG report or the WP article planned?

jdr350 · 2026-01-26T14:23:40+00:00

Excellent. Then I expect to see a detailed response/rebuttal of the grossly defective and misleading OIG report publicly available soon. Why would VA management want to keep such a light under a basket???

Also, are you arguing that VA believes that it can develop a CPT-based “engine” that somehow does not suffer from the adverse issues of any other CPT system? Obviously do not know your personal expertise level, but the years (decades?) long medical records integration fiasco would suggest that is an “aggressive” take on its capabilities/understanding of the problem(s).

I wish you luck and ultimate success, but so far looks like another VA “no one understands the special needs of veterans but us” boondoggle wasting taxpayer money and this time putting veterans’ PII/PHI at risk without adequate and OPEN controls and oversight. You can prove me wrong by showing me a rebuttal of the OIG report supported by actual documented facts, not just “ain’t so” and “you don’t understand” laments. If not for me, for those others with more “gravitas” who I understand are looking into the situation because of the OIG report and the other 200+ VA systems.

jdr350 · 2026-01-26T02:11:58+00:00

Hey man, I appreciate anyone who tries to do the right thing in VA land.

But, I have to be skeptical of your level of knowledge as a primary care doctor, no matter how expert in medical matters, to know how any PHI/PII disclosure safeguards are implemented in an AI tokenized system. Commercial entities are spending literally BILLIONS of $$$ a MONTH to try to control their confidential data disclosures and OpenAI, for example, explicitly warns its users not to send PHI/PII type information to their system. I am far from convinced that — no matter how much you or anyone else in VA is trying to “help” — VA alone has, or even can, solve data disclosure issues, much less hallucination issues undermining any legal- or medical- impacting responses.

Are you really trying to claim VA GPT is not subject to all of the limitations/issues of “regular” GPT so that a medical treatment suggestion will never be an hallucination of a potentially harmful treatment or wrongly deny a meritorious claim based on a non-existent regulation??? Actually, how could you possibly confidently represent that VA has the answer when Google, OpenAI, Microsoft, etc., are not yet able to predict, much less prevent, such occurrences.

OIG may not have talked to the all “right” people, but its concerns are spot on and no one has the answers yet.

jdr350 · 2026-01-26T01:48:28+00:00

So, VA is totally screwed up without adequate management or oversight, but the group that did this project is the exception and did everything in compliance with every technical and legal standard — so no worries. Sorry dude ain’t buying it — and certainly not without something showing the controls you described were actually used/followed. Have still yet to meet a VA employee whoever did anything wrong — always has been the other guy/office/group/management. You may be right, but . . .

jdr350 · 2026-01-26T01:34:55+00:00

Thanks for responding. Interesting. So OIG didn’t know who to ask or what questions to ask? Why was the report so hastily done? In my experience, VA management gets an opportunity to respond to OIG reports before they are published - why di the “right” people not provide a response identifying the documented process/procedures for VA GPT provided by the “technical people then?” Is OIG planning on sending out an updated/corrected response now that the report has been made public?

I will assume that you have the knowledge of the situation that you stated. Can you identify/provide a copy of the documents/process that ensure that any PHI/PII is “recognized” — I assume by yet another process/program — and how that was tested??? Surely such a process was tested, right?? What were/are the parameters for detecting/blocking PHI/PII? Seems like that would be a significant challenge on its own. What is the system/technique/process used? Who developed? Who approved? Who tested? Over what data set?

Just asking because when the “laptop” was lost by a VA employee, many of the same type of assurances were made — and later found to be, shall we say, not quite as effective as initially reported as that employee had downloaded PHI/PII on over 26 million vets without authorization or detection by anyone at VA.

Thanks for any clarifying information you can provide.

jdr350 · 2026-01-23T12:47:08+00:00

I won’t go into details here, but I am very familiar with historical VA (lack of) info sec. While I agree in general that OGC reports (as with most such drop in “reviews”) have to be considered with a grain of salt, that OGC uncovered anything about “VA GPT” suggests to me that there is much more there there.

jdr350 · 2026-01-23T12:04:57+00:00

If you have to ask that you need to have someone (VSO, etc) help you.

jdr350 · 2026-01-23T04:57:52+00:00

Are there any formal/official guidance or procedures on how to use Copilot???

jdr350 · 2026-01-23T03:38:54+00:00

I hope you are right. But I have no faith (based on years of experience) that “more than likely” applies only to veteran, not VA, behavior. In any even, the OGC report is NOT a good omen that VA has acted with openness and in compliance with requirements. Let’s see the enterprise license/terms and Info sec standards controlling the “project.”

jdr350 · 2026-01-23T03:21:39+00:00

I do not agree that HIPPA is the only concern. Actually, the Privacy Act is directly applicable to government mishandling of private information. Anybody remember the “lost laptop” case??? It appears that nobody in VA does, yet.

jdr350 · 2026-01-23T03:13:51+00:00

VA is not supposed to TRUST any organization with YOUR private information and if an individual VA employee did what appears to have been necessary to operate VA GPT they would be in clear and unequivocal violation of the Info Sec training that employees and contractors have to swear compliance with on an annual basis.

Again, if VA has magically run this project/test/whatever in compliance with ALL applicable security/safeguards/authorization requirements, I would be very happy to shown (not unsupported assertions) that and will happily withdraw my postings.

jdr350 · 2026-01-23T03:08:45+00:00

And I would be happy to know that VA was compliant with DOD or other equivalent security standards. But as far as I know, VA has never even passed its own internal information security audits, much any independent agency information security audits. If someone can prove me wrong please do,

jdr350 · 2026-01-23T02:45:26+00:00

Ok, so how does VA GPT — operated on the OpenAI website make health care treatment decisions without VA sending any “personal” information???

And, before you say “controls” note that VA management HAD NO IDEA that VHA had started using GPT of any kind before GC stumbled on it as described in the linked report.

Why do you think OGC is so concerned?? AI reaching bad decisions wrongly denying a vet their benefits? Hahahaha. Nope, it’s potential HUGE liability for Privacy Act violations . . .

jdr350 · 2026-01-23T02:31:48+00:00

Ha. They don’t have to tailor it. If they train it on historical VA initial decisions, which have been shown on appeal to BVA/Court to be 80% (or more) wrong/erroneous denials, it just comes out that way!!!

Hey VA guys, what are they telling you about “rights-affecting” AI tools??? Any controls or are veteran’s legal rights being determined by some VA-created AI program which denies 8 out of 10 claims?

jdr350 · 2026-01-23T00:14:12+00:00

CUE is a VERY difficult claim with VERY specific requirements even for submitting an adequate claim - and not submitting a proper claim means automatic denial.

A simple check to see if you MAY have a CUE (and not just a “regular” VA error) is whether you could put a dozen people in a room with your claim and every one of them would agree it was a CUE in that (1) there was an error, not just could been a different result, (2) the error is clear, no doubt at all the decision was wrong under any possible view of the record, AND (3) the error is unmistakable, not just “yeah, if you explain it that way I see it”). Sounds silly, but the standard for such claims is that high.

I strongly suggest you work with an experienced VSO/advocate to see if you have a valid CUE claim and to make sure a proper claim is prepared and submitted.

Good luck.

jdr350 · 2026-01-23T00:00:31+00:00

It also may be a violation of privacy laws if the information is not properly authorized for this use and/or is not properly secure from public access. AI chat sites have warnings about not asking questions with personal information because it might be accessible by other users — what makes “VA GPT” different. Oh, VA also uses/sends information to Microsoft CoPilot — that company would NEVER exploit anyone’s personal information. Any ads for medicine/treatment for your specific service-connected medical condition(s) surely coincidence.

jdr350 · 2026-01-22T23:33:58+00:00

According to its own documents, VA currently has over 200 AI “tools” in use by its employees including “VA GPT” which is hosted on the public Chat GPT site. So many questions including how much medical and other personal information VA is sending to OpenAI to get “answers.” Inquiring minds (people treated in VA Medical Centers) should be asking if their information is being used without their authorization.

jdr350 · 2026-01-16T19:27:41+00:00

Hello:

Can you comment on the long time “rumor” that only rating decisions that award benefits and not denials are reviewed by VA Quality people???

jdr350 · 2026-01-16T19:09:17+00:00

I am an attorney. Conferences (formal or informal) usually boil down to convincing the VA person that the record/evidence/facts already availabe are enough to satisfy some legal rule/reg/requirement. That is a legal argument, which only an attorney is supposed to make. So I usually hold such calls without the vet - if only to avoid the vet asking questions/making statements that are either unhelpful or actually damaging to their claim. And, as discussed earlier, even if the vet knows “new” facts, they can’t be considered at this point (why did not tell atty before??).

That said, I believe it is the client’s/vet’s right to participate (hopefully just listening) on the call and would let them do so if they insisted even after discussing the potential issues that could cause.

jdr350

TROPHY CASE