36C77618Q0085-003.pdf

022363

022364

022365 checkbox

VA Claims File (hard copy paper C-File) checkbox

VA E-Folder (VBMS or Virtual VA) checkbox

CPRS

checkbox

Other (please identify other evidence reviewed):

checkbox with associated memo box

Medical Evidence Comments:

label with an associated memo box

c. “Not Requested” and “No records were reviewed” will be mutually exclusive.

d. If “No records reviewed” is selected, the 4 evidence types below (C-File, E-Folder, CPRS, and Other) will be unselected and all data removed.

e. If “VA Claims File”, “VA E-Folder”, ,“CPRS”, or “Other” are selected, then “No records were reviewed” cannot be selected.

f. If “Other” is selected, then an memo box will allow entry for explanation of the Other evidence.

g. If “Other” is unselected, any evidence listed in the associated memo box will be cleared.

h. A new “Medical Evidence Comment” box will be added to the Medical Evidence Review section.

i. The new “Medical Evidence Comment” box will be available at all times.

j. Mock up:

7. Timeline for Right/Left changes: Currently there is not a timeline for the Right/Left changes.

BEST will discuss and return to the group with a schedule.

Updated Priority List

1. Right/Left changes-display Right first in all Sections for the 11 Musculoskeletal DBQs

2. Referral Clinic changes (requirements approved in 8/12 meeting)

3. Heart valve replacement issue- removal of duplicate question (requirements approved in 9/16

CONFIDENTIAL - VA-OGC

022366 meeting)

4. Male Reproductive & Prostate Cancer DBQs- changes needed to ED and meds(requirements approved in 9/23 meeting)

5. Medical Record Review section (requirements approved in 12/9 meeting)

6. Blank template/ADMIN/MISC DBQ (will address and define requirements 12/16)

Next Meeting on 12/16: Please be prepared to address Blank Templates during the next scheduled call.

Blank Template discussion: There are two solutions proposed

1. Multiple DBQS that will specifically address each issue.

2. One ADMIN DBQ that encompasses all solutions by adding checkboxes for each issue. So far the consensus is that this is the best solution moving forward.

3. Will need to add a Comment Box for general remarks.

4. Discussion to continue on this topic in the next meeting.

Current template

Proposed New Template(s)

Blank Template

DBQ ADMIN BVA Medical Opinion

DBQ ADMIN Response to Insufficiency

DBQ ADMIN Addendum

DBQ ADMIN Clarification

DBQ ENV EX Camp Lejeune

DBQ ENV EX Gulf War

022367

Office of Disability and

Medical Assessment

St. Petersburg, FL

CONFIDENTIAL - VA-OGC

b(6)

(B6)

(B6)

022368

Document ID: 0.7.5922.1728903-000001 Owner: </o=va/ou=visn 17/cn=recipients/cn= Filename: image001.png Last Modified: Tue Dec 16 14:41:58 CST 2014

CONFIDENTIAL - VA-OGC

(b6) (b6)

022369 image001.png for Printed Item: 809 ( Attachment 1 of 2)

022370

Document ID: 0.7.5922.1728903-000002 Owner: </o=va/ou=visn 17/cn=recipients/cn= Filename: image002.jpg Last Modified: Tue Dec 16 14:41:58 CST 2014

CONFIDENTIAL - VA-OGC

(b6) (b6)

022371 image002.jpg for Printed Item: 809 ( Attachment 2 of 2)

022372

022373

022374

Harry S. Truman Memorial Veterans’ Hospital

800 Hospital Drive

Columbia, MO 65201

Fax: (573) 814-6425

CONFIDENTIAL - VA-OGC

(B6)

022375

From: </o=va/ou=visn 08/cn=recipients/cn= To: </o=va/ou=visn 17/cn=recipients/cn= Cc:

Subject: Re: DBQ Control Group

Will that be captured in data or just on DBQ

From:

Sent: Tuesday, December 16, 2014 04:19 PM To:

Subject: RE: DBQ Control Group

The blank template will be re-named “DBQ Administrative Template” and will have in its body check boxes which allow the user to state what the purpose of the form is. The check box options will be Board of Veteran Appeals Response, Response to Insufficiency, Addendum/Clarification, Camp Lejeune, 1151 and “other.”

From:

Sent: Tuesday, December 16, 2014 3:16 PM To:

Subject: RE: DBQ Control Group

That is good news as currently it is impossible to release multiple DBQs with one 2507. If you know of another method to release exams like this, please let me know. Anything to make our jobs and the raters’ jobs more efficient is always welcome! Is there any way to rename the blank template (or was that part of the conversation I missed?)?

Thank you.

From:

Sent: Tuesday, December 16, 2014 3:11 PM To:

Subject: RE: DBQ Control Group

Our issue with blank templates are the transmission to- and identification in-VBMS. The template name is the file name for VBMS so the rater can see the name of the template and know what evidence it

Date: Tue Dec 16 2014 16:12:10 CST Attachments:

Bcc:

Document ID: 0.7.5922.1728917

CONFIDENTIAL - VA-OGC

(b6)

(b6)

(b6)

(b6)

(b6) b(6) b(6) b(6) b(6) b(6)

(B6) (B6)

(B6)

(B6) (B6)

022376

022377

Solution: Of course the best approach for the above would be to have the ability to complete all DBQs required for any given 2507 request.

Columbia, MO 65201

Fax: (573) 814-6425

CONFIDENTIAL - VA-OGC

(b6)

(B6)

022378

To: </o=va/ou=visn 17/cn=recipients/cn= Cc:

Subject: Re: DBQ Control Group

Can we see the other somewhere?

From:

Sent: Tuesday, December 16, 2014 04:29 PM To:

Subject: RE: DBQ Control Group

We tried to include the most common reasons for using a blank template based on information gathered by the informatics team. We did not want to list every possibility, as it would make the check box list quite long. The “other” check box will have an associated text box that will allow the user to type in what the other use is. Over time, if we see that there is large grouping in the other category, it can be added as a separate checkbox in future iterations.

From:

Sent: Tuesday, December 16, 2014 3:25 PM To:

Subject: RE: DBQ Control Group

Can a box be added for “SHA”, otherwise it will still be impossible to be found as it will only fit under the “other” category?

From:

Sent: Tuesday, December 16, 2014 3:19 PM To:

Subject: RE: DBQ Control Group

The blank template will be re-named “DBQ Administrative Template” and will have in its body check boxes which allow the user to state what the purpose of the form is. The check box options will be Board of Veteran Appeals Response, Response to Insufficiency, Addendum/Clarification, Camp Lejeune, 1151 and “other.”

Date: Tue Dec 16 2014 16:16:40 CST Attachments:

Bcc:

Document ID: 0.7.5922.1728918

CONFIDENTIAL - VA-OGC

(b6)

(b6)

(b6)

(b6)

(b6) b(6) b(6) b(6) b(6) b(6)

(B6) (B6)

(B6)

(B6)

(B6) (B6)

022379

022380

022381

022382

022383

There are a handful of clinicians on the DBQ Change Control Group. This will be a much heavier lift. I would not include the statement below to the original written by

From:

Sent: Tuesday, December 16, 2014 1:19 PM To: Cross, Gerald M.;

Subject: RE: DEAP IPT

I would also add that has a cadre of clinicians assigned to review the CUI once they are given the access to the recommended content and view for clinicians. He is the one that provides the final stamp of approval for DBQ board for VHA based on clinical input. Were we going completely away f

From:

Sent: Tuesday, December 16, 2014 1:08 PM To: Cross, Gerald M.;

Subject: RE: DEAP IPT

Good Afternoon, The following is provided for your consideration with responding to :

Let me start by acknowledging your continued willingness to participate in the development of is expected to be an improvement over the existing CAPRI functionality is appreciated.

Your commitment and expected involvement with the review, feedback and development of the new application mirrors what I anticipated your involvement would be.

I would offer for clarification that the initial central approval of the CUI output is only the first step in the process. There will be a second step that includes a more in-depth review and approval of the CUI output with all of the appropriate stakeholders involved. This second phase of review and approvals will begin in January.

Again, thank you for your consistent open and honest assessment of the ongoing development of the replacement system.

CONFIDENTIAL - VA-OGC

(b6)

(b6)

(b6) b(6) b(6) b(6) b(6) b(6)

022384

022385

022386

Document ID: 0.7.5922.1728919-000001 Owner: </o=va/ou=va martinsburg/cn=recipients/cn= Filename: image002.png Last Modified: Tue Dec 16 18:16:41 CST 2014

CONFIDENTIAL - VA-OGC

(b6) b(6)

022387 image002.png for Printed Item: 832 ( Attachment 1 of 2)

022388

Document ID: 0.7.5922.1728919-000002

Filename: image003.png Last Modified: Tue Dec 16 18:16:41 CST 2014

CONFIDENTIAL - VA-OGC

022389 image003.png for Printed Item: 832 ( Attachment 2 of 2)

022390

To: </o=va/ou=visn 17/cn=recipients/cn= </o=va/ou=exchange administrative group ( cn=recipients/cn= Cc:

Subject: RE: DBQ Control Group

Are we supposed to bring all recommended changes from CCB to DBQ board? This would seem like one all need to agree.

From:

Sent: Tuesday, December 16, 2014 4:19 PM To: ;

Subject: RE: DBQ Control Group

The blank template will be re-named “DBQ Administrative Template” and will have in its body check boxes which allow the user to state what the purpose of the form is. The check box options will be Board of Veteran Appeals Response, Response to Insufficiency, Addendum/Clarification, Camp Lejeune, 1151 and “other.”

From:

Sent: Tuesday, December 16, 2014 3:16 PM To:

Subject: RE: DBQ Control Group

That is good news as currently it is impossible to release multiple DBQs with one 2507. If you know of another method to release exams like this, please let me know. Anything to make our jobs and the raters’ jobs more efficient is always welcome! Is there any way to rename the blank template (or was that part of the conversation I missed?)?

Thank you.

From:

Sent: Tuesday, December 16, 2014 3:11 PM To:

Subject: RE: DBQ Control Group

Date: Wed Dec 17 2014 07:05:44 CST Attachments:

Bcc:

Document ID: 0.7.5922.1728925

CONFIDENTIAL - VA-OGC

(b6)

(b6)

(b6)

(b6)

(b6) b(6) b(6) b(6) b(6) b(6) b(6) b(6) b(6)

(B6) (B6)

(B6)

(B6)

(B6) (B6)

022391

022392 at today’s meeting.

Solution: Of course the best approach for the above would be to have the ability to complete all DBQs

Columbia, MO 65201

Fax: (573) 814-6425

CONFIDENTIAL - VA-OGC

(b6)

(B6)

022393

17/cn=recipients/cn= To: </o=va/ou=visn 08/cn=recipients/cn= </o=va/ou=exchange administrative group (fydibohf23spdlt)/cn=recipients/cn= Cc:

Subject: RE: DBQ Control Group

Can add this to the update for the DBQ Board.

From:

Sent: Wednesday, December 17, 2014 7:06 AM To:

Subject: RE: DBQ Control Group

Are we supposed to bring all recommended changes from CCB to DBQ board? This would seem like one all need to agree.

From:

Sent: Tuesday, December 16, 2014 4:19 PM To: ;

Subject: RE: DBQ Control Group

The blank template will be re-named “DBQ Administrative Template” and will have in its body check boxes which allow the user to state what the purpose of the form is. The check box options will be Board of Veteran Appeals Response, Response to Insufficiency, Addendum/Clarification, Camp Lejeune, 1151 and “other.”

From:

Sent: Tuesday, December 16, 2014 3:16 PM To:

Subject: RE: DBQ Control Group

That is good news as currently it is impossible to release multiple DBQs with one 2507. If you know of another method to release exams like this, please let me know. Anything to make our jobs and the raters’ jobs more efficient is always welcome! Is there any way to rename the blank template (or was

Date: Wed Dec 17 2014 08:04:13 CST Attachments:

Bcc:

Document ID: 0.7.5922.1728932

CONFIDENTIAL - VA-OGC

(b6)

(b6)

(b6)

(b6)

(b6) b(6) b(6) b(6) b(6) b(6) b(6) b(6) b(6)

(B6) (B6)

(B6)

022394

022395

Cc:

Subject: DBQ Control Group

Question concerning the DBQ Administration template discussed at the meeting today. As I am sure you are aware providers are using the current blank template to submit SHA exams with XXXXX claims that won’t all fit onto one CAPRI exam form due to buffering. Two and three CAPRI exams are then cut and pasted onto a blank template in order to release as there is no way otherwise to send to VBA/DOD. I would expect that the number of cases in this area will be increasing. In order to track the actual number of SHA exams completed does there need to be a box to mark in addition to the ones agreed to at today’s meeting.

Solution: Of course the best approach for the above would be to have the ability to complete all DBQs

Columbia, MO 65201

Fax: (573) 814-6425

CONFIDENTIAL - VA-OGC

(b6)

(B6)

(B6)

022396

To: </o=va/ou=visn 17/cn=recipients/cn= </o=va/ou=exchange administrative group (fydibohf23spdlt)/cn=recipients/cn= Cc:

Subject: RE: DBQ Control Group

SHA and MST too. It sounds like is building something based on what said on call about SHA

From:

Sent: Wednesday, December 17, 2014 9:04 AM To:

Subject: RE: DBQ Control Group

Can add this to the update for the DBQ Board.

From:

Sent: Wednesday, December 17, 2014 7:06 AM To:

Subject: RE: DBQ Control Group

Are we supposed to bring all recommended changes from CCB to DBQ board? This would seem like one all need to agree.

From:

Sent: Tuesday, December 16, 2014 4:19 PM To: ;

Subject: RE: DBQ Control Group

The blank template will be re-named “DBQ Administrative Template” and will have in its body check boxes which allow the user to state what the purpose of the form is. The check box options will be Board of Veteran Appeals Response, Response to Insufficiency, Addendum/Clarification, Camp Lejeune, 1151 and “other.”

Date: Wed Dec 17 2014 09:03:40 CST Attachments:

Bcc:

Document ID: 0.7.5922.1728628

CONFIDENTIAL - VA-OGC

(b6)

(b6)

(b6)

(b6)

(b6) b(6) b(6) b(6) b(6) b(6) b(6) b(6) b(6) b(6) b(6) (B6)

(B6) (B6)

(B

022397

022398

022399

022400

Document ID: 0.7.5922.1790211-000001

Filename: Staff Meeting-2-17-15.docx Last Modified: Tue Feb 17 07:50:16 CST 2015

CONFIDENTIAL - VA-OGC

b(6) b(6)b(6)

022401

Office of Disability and Medical Assessment (DMA) Staff Meeting - Agenda

February 17, 2015 | 9 am (EST) 1-800-767-1750, Access Code: 54644

Agenda for Discussion:

Topic

Due Outs from the 2/2 Joint Briefing/Discussion with ATSDR and VA on Camp Lejeune Scientific Studies-Due by COB Feb 18, response sent fro ad

Psychologists in need of guidance- conflict between the expected caseload demands of our supervisor versus the minimum CPU expectation specified by DMA- Fayetteville VAMC-has this been closed?

Due out from 325th Maint C, Fl Army National Guard –request for listing made PD UFR Data Call - Response Required by COB Friday Feb 6th- submitted h-awaiting her review Request for Hiring Freeze Waivers— Submitted Feb 13.

Discussion

PCP assistance-review as grp to inc r, Drs. GM ain re: WRIISC referrals to be scheduled

Completion of DBQ's by MH providers-email from I/USH

Time motion study for DBQ completion times- VBA policy change on increase claims will spur more VHA exams- ) jl9783: HVAC O&I staff member request for briefing-status? DD? l at the ARC to prepare response. Response due 2/20/15 F/U CL call to incl. Brad Flohr & OPH—Call scheduled for Feb 17

Featured Topics

SHA

IT

Analytics Contracts

NWQ

Noon Topics

Upcoming Meetings IDES VTC Prep Call-2/17 @ 3:30 pm IDES VTC-2/18 @ 3:30pm

Parking Lot VOW funding memo-DMA had call w/VISN POCs-1/30; memo to follow this week.

VACAA unfunded requirements MST trainings- monitor, bi-weekly, the number and location of providers completing the MST course-LB-next due 2/2/15. Reports are run the first of ea. month.

STR-transition mobile app for Vets-Carlos

AF Pilot sites-Whiteman AFB, Missouri (V15); JB Elmendorf, Alaska (V20); Wright-Patt AFB, Ohio (V10);

Holloman AFB, New Mexico (V18)

Payment to contract vendors Environment of Care-reducing stress w/C&P exams

Staff Meeting-2-17-15.docx for Printed Item: 848 ( Attachment 1 of 1)

CONFIDENTIAL - VA-OGC

b(6) b(6) b(6) b(6) b(6) b(6) b(6)b(6) b(6)

022402

23/cn=recipients/cn= To: </o=va/ou=visn 17/cn=recipients/cn= Cc:

Subject: FW: CLCW: March Training

You have received a message with restricted permission.

Open this item to read its content.

If you are not running an e-mail application that supports messages with restricted permission, such as Microsoft Office 2003 or later, you can view this message by downloading the Rights Management Add-on for Internet Explorer from http://officeredir.microsoft.com/r/rlidRestrictedPermissionViewer?

clid=1033&ver=14&app=outlook.exe&lidhelp=0409&liduser=0409&lidui=0409

Date: Wed Feb 18 2015 12:56:19 CST Attachments: message.rpmsg

Bcc:

Document ID: 0.7.5922.1559606

CONFIDENTIAL - VA-OGC

(b6) (b6) b(6)

022403

Document ID: 0.7.5922.1559606-000001 Owner: </o=va/ou=visn 23/cn=recipients/cn= Filename: message.rpmsg Last Modified: Wed Feb 18 12:56:19 CST 2015

CONFIDENTIAL - VA-OGC

b(6) b(6)

022404

022405

022406

022407

From:

Sent: Monday, April 13, 2015 2:21 PM To: VHA 10N Action; VHA 10NC8 Action Cc: VHA 10B3 Staff; Cross, Gerald M.;

Subject: FW: for action - sen burr - : Follow Up Notes from Joint Briefing/Discussion with ATSDR and VA on Camp Lejeune Scientific Studies

Good Afternoon, Following the DMA teleconference on Friday; Sen Burr’s staffer, , had some follow-up questions. Please provide a response to each of these four questions NLT COB April 24th.

Thank you, Teleconference Question: Regarding the clinical and scientific nature of VHA Occupational Health SME ’s knowledge, as it pertained to a specific disability claim denial for exposure to contaminated water at Camp Lejeune and association with kidney cancer. That VHA SME provided a rationale that their review of over two decades of research and metanalysis found no causal relationship between TCE and kidney cancer.

VA Responses: Both VHA SMEs said that this error in the decision’s narrative was essentially a “one off” and one went on to state that VA “certainly would not expect any language like that in future decisions.”

Follow Up Question: What was done within VA as a result of VA seeing that SME opinion to ensure that no other SMEs had same or similar misimpression of the scientific research and analysis on TCE’s harmful nature, specifically its association to kidney cancer? Did the SMEs who review Lejeune claims get any communication from VA in the form of a continuing education update and was VA’s formal training of SME’s altered to emphasize or include findings on TCE that were contrary to this specific false characterization? If either of the latter or some other approach was taken, please share the specifics and provide the most recent training materials and what scientific research papers or studies VA utilizes or its SMEs utilize in the case of Camp Lejeune claims review.

Teleconference Question/Observation: There appears to be a natural bias in the process that is really lowering approval rates for Lejeune claims. How does VA weigh risk factors, is there a formula SMEs

CONFIDENTIAL - VA-OGC

b(6) b(6) b(6) b(6)

022408 use to filter out any bias?

VA Responses: There is no bias. VA SMEs are professionals and scientists, bias goes against that mindset. SMEs consider all of the risk factors, many of which far outweigh the predetermined risk factor of Lejeune. Doctors come from a variety of backgrounds. Claims make up a small portion (10%) of their workload, 90% is spent in the clinic. The VA specifically targets occupational medicine doctors for claim decisions. No bias exists, it is a completely subjective process based on professional opinions of licensed medical professionals. Many factors outweigh Lejeune (like smoking where the claimant directly inhales benzene). There is no established threshold, however, for any risk factor, to include Lejeune.

Follow Up Question: To state that no bias exists and every assessment is subjective, because one is a Medical Doctor or an expert in a specific field is not a credible response. Human beings by our nature bring biases to every situation and decision. If there is not an objective supporting, not determinative, formula, per se, in a mathematical sense, please explain how SMEs weight certain risk factors in a quantitative manner to weed out bias that may be due to past misinformation or disinformation?

Teleconference Question: Explain how and when training occurs for SMEs working on Lejeune cases?

VA Responses: Gave a general description of training, but provided no demonstration of a structured approach or format. SME’s are apparently provided initial training and periodic follow-up sessions and monthly teleconference. It was implied that SMEs are emailed literature to keep them informed. VA did not discuss re-training or any after action review (self-assessment) process, but did state a peer review process was being developed.

Follow Up Question: Who conducts the entry level training for new SMEs and the recurrent formal training of SMEs. Who is packaging the literature for SMEs? Peers, someone at VACO? Please provide a copy of the most recent email and the most recent in person training session syllabus and summary of the literature that was provided to SMEs re. Camp Lejeune. When will the peer review process be implemented?

Teleconference Question: Will VA be sending representatives to the next ATSDR CAP meeting?

VA Response: Brad Flohr and Loren Erickson will attend, possibly others. But ATSDR has been meeting with VA on Lejeune for several years, separate from the CAP meetings.

Follow Up Question: Separate from the interactions with ATSDR at the quarterly CAP meeting sessions, when did ATSDR and VA begin meeting on Lejeune separate from the CAP forums, who from ATSDR and VA have been attending these interagency meetings on Lejeune, and how frequently have those meetings occurred?

022409

022410

Document ID: 0.7.5922.1570348-000001 Owner: </o=va/ou=visn 05/cn=recipients/cn= Filename: image001.jpg Last Modified: Mon Apr 13 13:40:41 CDT 2015

CONFIDENTIAL - VA-OGC

022411 image001.jpg for Printed Ite 853 ( Attachment 1 of 1)

022412

022413

Document ID: 0.7.5922.1570367-000001

Filename: Staff Meeting-4-14-15.docx Last Modified: Tue Apr 14 07:56:45 CDT 2015

CONFIDENTIAL - VA-OGC

022414

April 14, 2015 | 9:00 am (EST) 1-800-767-1750, Access Code: 54644

Happy Birthday to !!!!

Agenda for Discussion:

Topic Due Outs

Data Request for OMB's Statistical Programs of the United States Government FY 2016 Report-due by 10am, 4/16 Complaint for Compensation- Columbus GA ExecVA 25461-due NLT 3pm, 4/16-VST 1 has lead Updated slide deck for the BEC-due 4/17 Topic for next ND call-due 4/17 for the 4/24 call SVAC Minority - vets treated related to environmental exposures-sent to Terry Walters group & 10P2 Claim Trouble-pending ExecVA assignment??

ExecVA 9954-assigned to VBA re: impropriety on behalf of VA C&P Provider-we need to find out who conducted the exam- VBA/VHA-Magnum-VBA is sending to BVA, but VHA has to provide a response to the allegations.

OMB f/u questions-rescheduled for 4/22 @ 2-2:30 pm Follow Up Notes from Joint Briefing/Discussion with ATSDR and VA on Camp Lejeune –NLT COB, 4/23 MyVA Discussion with Employees-due by COB, 4/28/15-incl. mtg date & # in attendance

Discussion Proactive patient safety policy Dedicated call for clinicians who do the work-re: email Next Friday, ND call-4/24-topic due 4/17 2pm; presentation 4/21 10am

Featured Topics

IT

Analytics Contracts

NWQ

Noon Topics National Performance Update

DEAP-CUI (?)

Reminder of presumptive conditions, incorrect DBQs, cancellations- RAB Use of DEM Contractors for SHA Initiative Exams

Upcoming Meetings OMB f/u discussion to address 4 additional questions- -COB, 4/23/15 BEC IS/IT-4/28-BAS Conference Rm.

HVAC Hearing-4/30 @ 10:30 am Pre-BEC-5/8-USB Conference Rm.

BEC-5/12-Bldg 1800 G. St. Rm. 542

JEC-5/28

Parking Lot MyVA Presentation-supervisors have received the information. Report is due back to me regarding dates of the conversations with staff and the number in attendance by COB, 4/27 CLCW Charter- in progress Sheridan, WY issue- keep USH closely informed HVAC Committee- re: C&P exams for MST & gender specific data-4/30/15 @ 10:30 am MST trainings- monitor, bi-weekly, the number and location of providers completing the MST course-LB-next due 4/15, and 4/30. Reports are run twice ea. month. As of 3/31/15: 2,785 clinicians have completed.

STR-transition mobile app for Ve s

Payment to contract vendors Environment of Care-reducing stress w/C&P exams

Staff Meeting-4-14-15.docx for Printed Item: 855 ( Attachment 1 of 1)

CONFIDENTIAL - VA-OGC

b(6) b(6)

022415

Staff Meeting-4-14-15.docx for Printed Item: 855 ( Attachment 1 of 1)

022416

022417

810 Vermont Ave., NW, Washington, DC 20420

Fax: (202) 495-5168

Blackberry:

Confidentiality Note: The information contained in this e-mail is privileged and confidential information intended only for the person or persons to which it is addressed, and may be protected from disclosure.

Dissemination, distribution, forwarding or copying of this e-mail message, or the information herein by anyone other than the intended recipient is strictly prohibited. If you have received this e-mail in error, please notify the sender by reply e-mail, and destroy the original message and all copies.

From:

Sent: Monday, April 13, 2015 2:21 PM To: VHA 10N Action; VHA 10NC8 Action Cc: VHA 10B3 Staff; Cross, Gerald M.;

Subject: FW: for action - sen burr - : Follow Up Notes from Joint Briefing/Discussion with ATSDR and VA on Camp Lejeune Scientific Studies

Good Afternoon, Following the DMA teleconference on Friday; Sen Burr’s staffer, , had some follow-up questions. Please provide a response to each of these four questions NLT COB April 24th.

Thank you, Teleconference Question: Regarding the clinical and scientific nature of VHA Occupational Health SME ’s knowledge, as it pertained to a specific disability claim denial for exposure to contaminated water at Camp Lejeune and association with kidney cancer. That VHA SME provided a rationale that their review of over two decades of research and metanalysis found no causal relationship between TCE and kidney cancer.

CONFIDENTIAL - VA-OGC

b(6) b(6) b(6) b(6) b(6) b(6)

(B6)

022418

VA Responses: Both VHA SMEs said that this error in the decision’s narrative was essentially a “one off” and one went on to state that VA “certainly would not expect any language like that in future decisions.”

Follow Up Question: What was done within VA as a result of VA seeing that SME opinion to ensure that no other SMEs had same or similar misimpression of the scientific research and analysis on TCE’s harmful nature, specifically its association to kidney cancer? Did the SMEs who review Lejeune claims get any communication from VA in the form of a continuing education update and was VA’s formal training of SME’s altered to emphasize or include findings on TCE that were contrary to this specific false characterization? If either of the latter or some other approach was taken, please share the specifics and provide the most recent training materials and what scientific research papers or studies VA utilizes or its SMEs utilize in the case of Camp Lejeune claims review.

Teleconference Question/Observation: There appears to be a natural bias in the process that is really lowering approval rates for Lejeune claims. How does VA weigh risk factors, is there a formula SMEs use to filter out any bias?

VA Responses: There is no bias. VA SMEs are professionals and scientists, bias goes against that mindset. SMEs consider all of the risk factors, many of which far outweigh the predetermined risk factor of Lejeune. Doctors come from a variety of backgrounds. Claims make up a small portion (10%) of their workload, 90% is spent in the clinic. The VA specifically targets occupational medicine doctors for claim decisions. No bias exists, it is a completely subjective process based on professional opinions of licensed medical professionals. Many factors outweigh Lejeune (like smoking where the claimant directly inhales benzene). There is no established threshold, however, for any risk factor, to include Lejeune.

Follow Up Question: To state that no bias exists and every assessment is subjective, because one is a Medical Doctor or an expert in a specific field is not a credible response. Human beings by our nature bring biases to every situation and decision. If there is not an objective supporting, not determinative, formula, per se, in a mathematical sense, please explain how SMEs weight certain risk factors in a quantitative manner to weed out bias that may be due to past misinformation or disinformation?

Teleconference Question: Explain how and when training occurs for SMEs working on Lejeune cases?

VA Responses: Gave a general description of training, but provided no demonstration of a structured approach or format. SME’s are apparently provided initial training and periodic follow-up sessions and monthly teleconference. It was implied that SMEs are emailed literature to keep them informed. VA did not discuss re-training or any after action review (self-assessment) process, but did state a peer review process was being developed.

Follow Up Question: Who conducts the entry level training for new SMEs and the recurrent formal

022419 training of SMEs. Who is packaging the literature for SMEs? Peers, someone at VACO? Please provide a copy of the most recent email and the most recent in person training session syllabus and summary of the literature that was provided to SMEs re. Camp Lejeune. When will the peer review process be implemented?

Teleconference Question: Will VA be sending representatives to the next ATSDR CAP meeting?

VA Response: Brad Flohr and Loren Erickson will attend, possibly others. But ATSDR has been meeting with VA on Lejeune for several years, separate from the CAP meetings.

Follow Up Question: Separate from the interactions with ATSDR at the quarterly CAP meeting sessions, when did ATSDR and VA begin meeting on Lejeune separate from the CAP forums, who from ATSDR and VA have been attending these interagency meetings on Lejeune, and how frequently have those meetings occurred?

022420

Document ID: 0.7.5922.1570592-000001

Filename: image001.jpg Last Modified: Tue Apr 14 14:38:00 CDT 2015

CONFIDENTIAL - VA-OGC

022421 image001.jpg for Printed Ite 857 ( Attachment 1 of 1)

022422

022423

Document ID: 0.7.5922.1571574-000001

Filename: Staff Meeting-4-16-15.docx Last Modified: Thu Apr 16 12:38:32 CDT 2015

CONFIDENTIAL - VA-OGC

022424

April 16, 2015 | 2:00 pm (EST) 1-800-767-1750, Access Code: 54644

Happy Birthday to !!!!

Agenda for Discussion:

Topic Due Outs

Updated slide deck for the BEC-due 4/17 Topic for next ND call-due 4/17 for the 4/24 call CHAMPVA programs - PLEASE UPDATE ATTACHED WORKBOOK - IN SUPPORT OF 2017 SecVA Budget Submission - DUE COB, TUESDAY, APRIL 21-VBA??

OMB f/u questions-rescheduled for 4/22 @ 2-2:30 pm Follow Up Notes from Joint Briefing/Discussion with ATSDR and VA on Camp Lejeune –NLT COB, 4/23-extension requested MyVA Discussion with Employees-due by COB, 4/28/15-incl. mtg date & # in attendance

Discussion Proactive patient Safety Policy Attendance in the War room/Noon call this week- to speak re: Vet experience Next Friday, ND call-4/24-topic due 4/17 2pm; presentation 4/21 10am HVAC hearing MST data

Featured Topics Quality Policy Training Gulf War/Medical Opinions/BVA/CLCW

Noon Topics National Performance Update

DEAP-CUI (?)

Reminder of presumptive conditions, incorrect DBQs, cancellations- RAB Use of DEM Contractors for SHA Initiative Exams

Upcoming Meetings OMB f/u discussion to address 4 additional questions- -COB, 4/23/15 BEC IS/IT-4/28-BAS Conference Rm.

HVAC Hearing- re: C&P exams for MST & gender specific data -4/30 @ 10:30 am Pre-BEC-5/8-USB Conference Rm.

BEC-5/12-Bldg 1800 G. St. Rm. 542

JEC-5/28

Parking Lot SVAC Minority - vets treated related to environmental exposures-sent to Terry Walters group & 10P2 Claim Trouble-pending ExecVA assignment??

ExecVA 9954-assigned to VBA re: impropriety on behalf of VA C&P Provider-we need to find out who conducted the exam- VBA/VHA-Magnum-VBA is sending to BVA, but VHA has to provide a response to the allegations.

MyVA Presentation-supervisors have received the information. Report is due back to me regarding dates of the conversations with staff and the number in attendance by COB, 4/27 CLCW Charter- in progress Sheridan, WY issue- keep USH closely informed MST trainings- monitor, bi-weekly, the number and location of providers completing the MST course-LB-next due 4/15, and 4/30. Reports are run twice ea. month. As of 3/31/15: 2,785 clinicians have completed.

STR-transition mobile app for Ve s

Payment to contract vendors

Staff Meeting-4-16-15.docx for Printed Item: 859 ( Attachment 1 of 1)

CONF DENTIAL - VA-OGC

b(6) b(6)

022425

Environment of Care-reducing stress w/C&P exams Staff Meeting-4-16-15.docx for Printed Item: 859 ( Attachment 1 of 1)

022426

022427

022428

022429

PERFORMANCE ELEMENTS/STANDARDS

VA FORM 0750, JUN 2011

SECTION A - PERFORMANCE PLAN (Continued) pdf for Printed Item: 861 ( Attachment 1 of 8)

CONFIDENTIAL - VA-OGC

b(6)

Standard #3 - Develops administrative regulations, project plans and guidelines for the conduct of IDES Program operations or new criteria or measuring program accomplishments and performance metrics.

Cooperations and Organizational Support (Critical Element) Standard #1 - This element includes your work relationships with the DMA and IDES program Offices and other stakeholders. It considers the degree and effort extended to achieve Program Office and DMA goals and objectives. It also entrains your initiative and overall creativity and support of all newly and existing VHA/DMA goals will participating and representing DMA/IDES.

Standard #2 - Incumbent must maintain a positive work relationship, function as a team lead, team member and contribute to assigned group by sharing expertise, insights and knowledge of the IDES process. Differences of opinion should be handled in business-like fashion. The incumbent is expected to perform in a professional, courteous, and cooperative manner 100% of the time and contribute positively to the goals of the group or entity supporting.

Customer Service and Accountability Standard #1- Incumbent anticipates and meets the needs of both internal and external customers and Veterans. Delivers high quality products and services; is committed to continuous improvement.

Standard #2- Incumbent holds self and others accountable for measurable, high-quality, timely and cost effective results.

Determines objectives, sets priorities, and delegates work. Complies with established control systems and rules. Comports professionally by exhibiting VA's core values of Integrity, Commitment, Advocacy, Respect and Excellence ( I CARE).

Information Security The employee is responsible for protecting information containing sensitive data, which must be protected under those provisions of the Privacy Act, Federal Regulations, VA statutes, policies and other applicable laws. The incumbent is responsible for protecting the data from unauthorized release, loss, alteration and deletion and must ensure full compliance with VA approved data encryption when conducting the transmission of sensitive data.

Achievement Levels:

Fully Successful - The employee will have no more than one (1) instance in the performance year of unauthorized access, release, loss, alteration, alteration or deletion of sensitive data; will be in full compliance with VA approved data encryption when conducting authorized sensitive data transmission. Employee will complete all mandatory information security and will provide documented proof of course completion.

Exceptional - The employee will have no instances in the performance year of unauthorized access, release, loss, alteration, alteration or deletion of sensitive data; will be in full compliance with VA approved data encryption when conducting authorized sensitive data transmission. Employee will complete all mandatory information security and will provide documented proof of course completion.

022430

CHANGES TO PERFORMANCE PLAN (Changes may be recorded anytime during the rating period)

SECTION B - PROGRESS REVIEW

ELEMENT DESCRIPTION/TITLE

STANDARD (S)

ELEMENT DESCRIPTION/TITLE

STANDARD (S)

SIGNATURE OF RATER DATE SIGNATURE OF EMPLOYEE DATE

At least one progress review is required during the appraisal year. Employee must be informed of his/her progress as measured against the performance plan. Additional progress reviews may be documented on page 6.

A performance review was conducted and discussed, and the employee's performance as of this date:

Is considered Fully Successful or better.

Needs improvement to be Fully Successful or better. (See VA Handbook, 5013/1, Part I, Paragraph 7, for additional required action.)

DATESIGNATURE OF EMPLOYEEDATESIGNATURE OF RATER

VA FORM 0750, JUN 2011

SECTION A - PERFORMANCE PLAN (Continued) pdf for Printed Item: 861 ( Attachment 1 of 8) b(6)

(MM/DD/YYYY) (MM/DD/YYYY)

(MM/DD/YYYY) (MM/DD/YYYY)

022431

EXCEPTIONAL

SECTION C - ACTUAL ACHIEVEMENT

Indicate the single, overall level of achievement that best describes the employee's performance for each ELEMENT shown in Section A. Do not indicate achievement for each individual standard. Specific examples of performance must be provided in the space below for each element where a level of achievement other than Fully Successful has been assigned. Assignment of the Exceptional level means that Fully Successful performance standards have been significantly surpassed. This level is reserved for employees whose performance in the element far exceeds normal expectations and results in major contributions to the accomplishment of organizational goals.

ELEMENTS/ACHIEVEMENT(S)

LEVELS OF ACHIEVEMENT

ELEMENTS

(Use the same key word description for each element as in Section A) UNACCEPTABLE

FULLY

SUCCESSFUL

Describe specific examples of performance for each element where a level of achievement other than Fully Successful has been assigned above.

Specific achievements at the Fully Successful level may be described.

VA FORM 0750, JUN 2011 4

pdf for Printed Item: 861 ( Attachment 1 of 8)

Programs Operation Management*

Policy Development*

Cooperations and Organizational Support*

Customer Service and Accountability

Information Security

*Denotes Critical Element

022432

SECTION E - HIGHER LEVEL REVIEW/APPROVAL

SECTION D - OVERALL RATING

NARRATIVE SUMMARY - OPTIONAL (Provide any additional significant accomplishments, as well as other factors such as details or training experiences related to the overall performance plan. Capacity to assume a more responsible position may also be addressed.)

TYPE OF RATING

SUMMARY RATING

(POSITION CHANGES - EMPLOYEE OR RATER)SPECIAL RATING OF RECORDANNUAL RATING OF RECORD

PERIOD COVERED BY THIS APPRAISAL

FROM TO

NOTE: Recommended Performance Rating - Using achievement levels assigned in Section C and the criteria described below, check the appropriate rating.

PERFORMANCE RATING

SIGNATURE AND TITLE OF RATER DATE

OUTSTANDING - Achievement levels for all elements are designated as Exceptional.

EXCELLENT - Achievement levels for all critical elements are designated as Exceptional. Achievement levels for noncritical elements are designated as at least Fully Successful. Some, but not all, noncritical elements may be designated as Exceptional.

FULLY SUCCESSFUL - The achievement level for at least one critical element is designated as Fully Successful. Achievement levels for other critical and noncritical elements are designated as at least Fully Successful or higher.

UNACCEPTABLE - The achievement level(s) for one (or more) critical element(s) is (are) designated as unacceptable.

Concur with recommended rating.

Do not concur with rating.

BASIS FOR PERFORMANCE RATING CHANGE

SIGNATURE AND TITLE OF APPROVAL OFFICIAL

A copy of this performance appraisal was given to me.

DATE

DATESIGNATURE OF EMPLOYEE

Approve rating of

MINIMALLY SATISFACTORY - Achievement levels for all critical elements are designated as at least Fully Successful. However, the achievement level(s) for one (or more) noncritical elements is (are) designated as unacceptable.

Required only for Minimally Satisfactory and Unacceptable ratings of record; unless organization has chosen to have higher level approval required for Outstanding ratings of record.

pdf for Printed Item: 861 ( Attachment 1 of 8) b(6)

(MM/DD/YYYY) (MM/DD/YYYY)

(MM/DD/YYYY)

(MM/DD/YYYY)

(MM/DD/YYYY)

022433

USE THIS AREA FOR ANY ADDITIONAL INFORMATION

pdf for Printed Item: 861 ( Attachment 1 of 8)

CONFIDENTIAL - VA-OGC

022434

Document ID: 0.7.5922.1573194-000002 Filename: CWEmbed1.xml <extracted>

022435

022436

022437

SECTION A - PERFORMANCE PLAN (Continued) pdf for Printed Item: 861 ( Attachment 3 of 8)

CONFIDENTIAL - VA-OGC

b(6)

Leads planning groups and identifies SME's for training initiatives, reviews storyboards and provides guidance in course development, and coordinates conference calls and meetings to expedite overall course development processes.

Takes responsibility and initiative, sets and meets priorities, follows through on commitments, safeguards information, and organizes and uses time and resources to achieve desired results. Demonstrates accountability by performing work in a thorough and conscientious manner, ensuring that work products and services provided are accurate and complete. Follows through on commitments and accepts responsibility for one's own actions. Follows relevant policies and procedures; knows when to ask for help.

Achievement Levels:

Fully Successful - No more than three (3) instances in the performance period of not meeting the above elements/standards/deadlines unless delays are encountered beyond the control of the incumbent.

Exceptional - No more than one (1) instance of not meeting the above deadlines/established deadlines, unless delays are encountered beyond the control of the incumbent.

III. Oral and Written Communication * (Critical Element) Communicates effectively internally and externally with the full range of agency stakeholders orally and written as warranted.

Establishes and maintains relationships with the key stakeholders, in order to communicate and disseminate information which results in an understanding of the C&P disability examination program and associated services.

Develops written materials that transmit information concerning the nature and purpose of the C&P examination process. Writes edits and/or produces C&P examination Program training materials that enhance understanding of the C&P process.

Communicates new initiatives/activities having a direct impact on C&P examinations. Maintains effective relationships with internal/external stakeholders and/or key officials including representatives of Congress, community groups, media and/or general public.

Ability to solicit and consider feedback from internal and external stakeholders and/or customers. Coordinates with appropriate parties to maximize input from the widest range of appropriate stakeholders to facilitate an open exchange of opinion from diverse groups and strengthen internal and external support. Explains, advocates, and expresses facts and ideas in a convincing manner and negotiates with individuals and groups internally and externally, as appropriate.

Achievement Levels:

Fully Successful - Represents the values and mission of the office in all communications, both internally and externally.

Exceptional - Shows expert knowledge of the values and mission of the office in all communications, both internally and externally.

IV. Customer Service Routinely identifies the customer's needs and resolves issues in a timely manner. Interacts with supervisors, and co-workers within the organization in a courteous and cooperative manner that contributes to effective program operations.

Demonstrates “I CARE” and VA Core Characteristics in interactions with Veterans, staff, and other stakeholders at all times.

Champions innovation by looking beyond the current reality and the “status quo.” Challenges assumptions in a culture that values, fosters, and rewards creativity and innovation. Supports the organization for success by identifying and developing new or cutting edge programs, processes or strategies. Anticipates the potential impact of decisions on existing delivery systems.

Demonstrates the ability to adjust to change or work under pressure in a pleasant manner, handles differences of opinion in a professional manner, and functions as a team member (helping the group effort whenever possible).

Incumbent demonstrates commitment to VA's Customer Service Standards internally and externally, in such a manner to reflect positively on the program, the agency, and the mission.

Incumbent maintains positive relations with outside organizations and community groups, demonstrating sensitivity and responsiveness to their needs and concerns.

Achievement Levels:

Fully Successful: Demonstrates knowledge of I CARE and VA Core Characteristics in interactions with all customers.

Exceptional: Consistently deals with customers using expert knowledge of I CARE and VA Core Characteristics

V. Information Security The employee is responsible for protecting information containing sensitive data, which must be protected under those provisions of the Privacy Act, Federal Regulations, VA statutes, policies and other applicable laws. The incumbent is responsible for protecting the data from unauthorized release, loss, alteration and deletion and must ensure full compliance with VA approved data encryption when conducting the transmission of sensitive data.

022438

SECTION B - PROGRESS REVIEW

ELEMENT DESCRIPTION/TITLE

STANDARD (S)

ELEMENT DESCRIPTION/TITLE

STANDARD (S)

SIGNATURE OF RATER DATE SIGNATURE OF EMPLOYEE DATE

At least one progress review is required during the appraisal year. Employee must be informed of his/her progress as measured against the performance plan. Additional progress reviews may be documented on page 6.

A performance review was conducted and discussed, and the employee's performance as of this date:

Is considered Fully Successful or better.

Needs improvement to be Fully Successful or better. (See VA Handbook, 5013/1, Part I, Paragraph 7, for additional required action.)

DATESIGNATURE OF EMPLOYEEDATESIGNATURE OF RATER

VA FORM 0750, JUN 2011

pdf for Printed Item: 861 ( Attachment 3 of 8) b(6)

Achievement Levels:

Fully Successful - The employee will have no more than one (1) instance in the performance year of unauthorized access, release, loss, alteration, alteration or deletion of sensitive data; will be in full compliance with VA approved data encryption when conducting authorized sensitive data transmission. Employee will complete all mandatory information security and will provide documented proof of course completion.

Exceptional - The employee will have no instances in the performance year of unauthorized access, release, loss, alteration, alteration or deletion of sensitive data; will be in full compliance with VA approved data encryption when conducting authorized sensitive data transmission. Employee will complete all mandatory information security and will provide documented proof of course completion.

(MM/DD/YYYY) (MM/DD/YYYY)

022439

Indicate the single, overall level of achievement that best describes the employee's performance for each ELEMENT shown in Section A. Do not indicate achievement for each individual standard. Specific examples of performance must be provided in the space below for each element where a level of achievement other than Fully Successful has been assigned. Assignment of the Exceptional level means that Fully Successful performance standards have been significantly surpassed. This level is reserved for employees whose performance in the element far exceeds normal expectations and results in major contributions to the accomplishment of organizational goals.

ELEMENTS/ACHIEVEMENT(S)

LEVELS OF ACHIEVEMENT

ELEMENTS

(Use the same key word description for each element as in Section A) UNACCEPTABLE

FULLY

SUCCESSFUL

Describe specific examples of performance for each element where a level of achievement other than Fully Successful has been assigned above.

Specific achievements at the Fully Successful level may be described.

VA FORM 0750, JUN 2011 4

pdf for Printed Item: 861 ( Attachment 3 of 8)

I. Training Management*

II. Procedures and Systems Management*

III. Oral and Written Communication*

IV. Customer Service

V. Information Security

022440

SECTION D - OVERALL RATING

NARRATIVE SUMMARY - OPTIONAL (Provide any additional significant accomplishments, as well as other factors such as details or training experiences related to the overall performance plan. Capacity to assume a more responsible position may also be addressed.)

TYPE OF RATING

SUMMARY RATING

(POSITION CHANGES - EMPLOYEE OR RATER)SPECIAL RATING OF RECORDANNUAL RATING OF RECORD

PERIOD COVERED BY THIS APPRAISAL

FROM TO

NOTE: Recommended Performance Rating - Using achievement levels assigned in Section C and the criteria described below, check the appropriate rating.

PERFORMANCE RATING

SIGNATURE AND TITLE OF RATER DATE

OUTSTANDING - Achievement levels for all elements are designated as Exceptional.

EXCELLENT - Achievement levels for all critical elements are designated as Exceptional. Achievement levels for noncritical elements are designated as at least Fully Successful. Some, but not all, noncritical elements may be designated as Exceptional.

FULLY SUCCESSFUL - The achievement level for at least one critical element is designated as Fully Successful. Achievement levels for other critical and noncritical elements are designated as at least Fully Successful or higher.

UNACCEPTABLE - The achievement level(s) for one (or more) critical element(s) is (are) designated as unacceptable.

Concur with recommended rating.

Do not concur with rating.

BASIS FOR PERFORMANCE RATING CHANGE

SIGNATURE AND TITLE OF APPROVAL OFFICIAL

A copy of this performance appraisal was given to me.

DATE

DATESIGNATURE OF EMPLOYEE

Approve rating of

MINIMALLY SATISFACTORY - Achievement levels for all critical elements are designated as at least Fully Successful. However, the achievement level(s) for one (or more) noncritical elements is (are) designated as unacceptable.

Required only for Minimally Satisfactory and Unacceptable ratings of record; unless organization has chosen to have higher level approval required pdf for Printed Item: 861 ( Attachment 3 of 8) b(6)

(MM/DD/YYYY) (MM/DD/YYYY)

(MM/DD/YYYY)

(MM/DD/YYYY)

022441 pdf for Printed Item: 861 ( Attachment 3 of 8)

CONFIDENTIAL - VA-OGC

022442

Document ID: 0.7.5922.1573194-000004

022443

022444

022445

SECTION A - PERFORMANCE PLAN (Continued) pdf for Printed Item: 861 ( Attachment 7 of 8)

CONFIDENTIAL - VA-OGC

b(6)

II Customer Service (Critical Element)

Demonstrates awareness of the Veteran population, their needs, and the benefits and services available to them. Demonstrates an understanding that serving Veterans, families, and other stakeholders is VA's mission.