My main questions:

-why would this case take two years?

-In order for Marco to get a ramp (before the lift), he had to go through the VA to get a wheelchair. So,
he wheeled himself into the doctors office to get a wheelchair from the VA. Why the extra step which
added months to the process?
-each time there is a misunderstanding, there is a delay. Marco said he was working with an
independent living counselor. Why couldnt they make sure all of the paperwork is correct and submit
the information?
-During our phone conversation, the Public Affairs Officer and I discussed how some of the issues may
be a breakdown of communication within the different VA departments. Whats being done to fix this
for others?
-The ramp was changed to a lift. Marco says the money to put in the lift doesnt cover other items like
fixing the irrigation and landscaping that the installation would change. So, the burden falls back on the
Veteran. How can this happen? What else can be done to try to cover the costs? What would be the
delay?
-The last conflict came with the mention of selling the house. Its my understanding Marco was not
serious with an intent to sell his house, he was venting the frustration. Can you explain how comments
like this are treated?
-I noticed congressional hearings regarding a backlog and understaffing over the last few years. Has this
led to these types of delays? If so, whats being done to change it.
-What needs to be done at a legislative level to prevent these types of delays?

These questions are from Marco, our vet. We do plan to use his questions online, stating that we sent
them to you as well.

VBA Questions

According to the VA website, Independent Living services may be provided to individuals who are not
currently able to work because of the effects of service-connected disabilities. Provided services are
limited to those required to improve independence at home and in the community.

Marcos first in-home inspection was conducted in March of 2015 and the occupational therapist
suggested the independent living goal of To become more independent in his home and communities
by removing physical and medical barriers.

Q. Do Independent Living counselors have access to a complete list of service connected

disabilities?

The VBA, the same organization that vocational rehabilitation employees work for rated Marcos
Multiple Sclerosis at the 100% rate with loss of use of two feet. The effective date of the SCD is 2.5 years
before he met with his IL counselor for the first time.

Q. Is it normal that IL counselors would omit the highest rated service connected disability from
the request for an in-home inspection?
 Q. Is it normal that the occupational therapist report would omit the highest rated service
connected disability from his in home inspection?

Q. Does the VA consider a veteran falling multiple times to be a significant threat to veterans?

In the OTs report it states, He reports having fallen 6 times over the last 18 months. Two falls required
medical attention including an emergency room visit. Four falls were inside, including one on the stairs,
one out of the shower, and two falls due to the hazard of carpet. Two falls were outside the home.

Outside the home, there are stairs both the front door and garage entries preventing safe entry or exit
from the home. lt appears that there are several levels of steps to enter the home. Also, the driveway
has a severe slope preventing easy access to the residence

Q. Would multiple falls inside the home suggest the veteran is fully independent within the
home?

Q. Would unsafe entries and severe slopes prevent Marco from being fully independent in the
community?

So since March of 2015, the VA was aware that there were physical barriers and medical that prevented
Marco from accomplishing the VAs stated objective for the program.

Q. Can you please state what was accomplished between March 2015 and March of 2016?
Please keep in mind that the inspection conducted in March 2015 was invalidated by VR&E
Officer Caroline Williams for being too old to be useful.

According to the VAs webpage for Independent Living Services these are three of the stated services
that IL provides.

Coordination of consultations with specialists such as physicians, physical and/or

occupational therapists, and rehabilitation engineers

Information about and referral to resources which may provide health care services, special
technology and equipment, community living support, disability support and family counseling

Information and assistance with exploring eligibility for VA home modification benefits
including the Specially Adapted Housing (SAH) grant and the Home Improvements and
Structural Alterations (HISA) grant

Q. Besides the OT that performed the in-home inspection, between March of 2015 and January of
2016, did IL coordinate any consultations for Marco?

Q. Between March of 2015 and January of 2016 did IL refer Marco to any resources listed on the
webpage?

Q. Between March of 2015 and January of 2016, did IL provide Marco with information and
assistance about SAH or HISA grants?
 Q. How did VR&E Supervisor, Debra Wilson, become involved with Marcos IL claim in February
2016?

In February 2015, President Barack Obama signed into law a veterans suicide prevention bill to aid
veterans suffering from PTSD. Marco is service connected for PTSD at a rating of 70%. According to VBA
standards a veteran rated at 70% is unable to function in most social and work areas with symptoms
such as obsessive behaviors, illogical speech, depression and panic so persistent that it interferes with
ability to function, suicidal thinking, inability to control impulses (including becoming violent without
provocation), neglecting self-care such as hygiene, inability to handle stress, and/or inability to maintain
relationships.

Q. In February 2016, was VR&E Supervisor Debra Wilson informed by the Waco Regional Office that
a potentially suicidal veteran was on the phone upset about independent living?

Q. Is the Waco Regional Office aware that a Veterans Crisis Line exist?

Q. Is the Waco Regional Office aware that preventing veterans suicide is a top priority for the VA?

Q. Is it the protocol of the VBA to refer potentially suicidal veterans to employees that do not work
in the mental health field?

Q. Can you please explain why Marco was handled in this manner?

Q. Who is John Limpose? In February of 2016, Marco emailed Mr. John Limpose an email requesting
help with the sentence, My home is not handicap accessible and I desperately need it to be. Did
Mr. Limpose contact Marco to help him? Marco reached out to Mr. Limpse on three other occasions
asking for help. Did Mr. Limpose contact Marco after any of the emails?

Q. On multiple occasions, Marco contacted Congressman Lamar Smith, then VA Secretary Robert
McDonald and others asking for help. Was Mr. Limpose aware that these requests had been made
by Marco? Did Mr. Limpose contact Marco after any of these encounters?

In February of 2016, Marco emailed Mr. John Limpose an email requesting help with the sentence, My
home is not handicap accessible and I desperately need it to be. In December 2016, Congressman
Lamar Smiths Office received a letter from the VR&E staff claiming that Marco did not request any
construction to his residence.

Q. Can you please explain why Marco was desperately requesting a handicap accessible home in
February 2016, but VR&E staff informed Congressman Smith that Marco did not request any
construction in December 2016?

Q. Media outlets have made multiple requests for information about Marcos claim. Did Mr.
Limpose reach out to Marco after any of these requests were made?

Q. The Chief of Neurology at the Austin Outpatient Clinic signed a letter of items that he believed
Marco needed. Included on the letter was a zero-g recliner, but the VR&E Officer changed it to a lift
chair. How often does the VR&E Officer override the recommendations made by a neurologist?
 Q. Were you aware that the VAs Multiple Sclerosis Center of Excellence recommends the Sleep
Number Bed for veterans that want to sleep with their spouses? Did Marco request a sleep number
bed? Did Marco receive a sleep number bed?

On May 23, 2016 Marco received an email from VR&E Officer Carolyn Williams that stated he would get
a new counselor, that he could sign the existing ILP and it could be modified later, and requested that
Marco would agree to a new in-home inspection. Marco agreed to the new in-home inspection with the
following conditions:

. the new inspection will not negatively impact approved items of the existing lL plan

. the Administrative Appeal for previously denied items would run concurrently to new
efforts

. the second inspector could potentially affirm items under Administrative Appeal

Q. Did Marco receive a new counselor as stated by Ms. Williams?

Q. Can you please explain why items that were previously approved on an IL plan were denied after
the second inspection?

Q. Can you please explain why the Administrative Appeal did not run concurrently to the new
efforts?

The occupational therapist recommended a blender to help Marco with meal preparation. The VR&E
Officer denied the request.

Q. Is meal preparation and eating not considered part of Independent Living? Later, the blender was
actually approved, but then later denied for a clerical error. Should a clerical error prevent the veteran
from receiving approved of items?

Q. On 7/6/2016 Marco received an email threatening to kick him out of the program. Is there a reason
Marcos claim would not have been placed on hold as the VR&E policies state? Reviewing the claim
documents, Marco was in complete compliance at the time of the letter. How often does the VBA kick
veterans out of a program for non-compliance when they are in complete compliance?

Questions for the VHA

In January 2016, Marco was seen at the VAs Spinal Cord Injury Clinic in Dallas, Texas. During his
appointment he met with VA Social Worker Jennifer Helm to discuss obtaining handicap access into his
home. In January 2016, Jennifer Helm submitted a request for a ramp evaluation from prosthetics, but
the request was denied.
Q. Is it normal for the prosthetics department to deny a ramp evaluation for a veteran in a wheelchair
that is service connected with the loss of use of two feet?

Q. Marco was told he needed to get a VA-provided wheelchair before he would be eligible for a ramp
evaluation. Can you please explain why taxpayers would have to pay thousands of dollars for a new
wheelchair when the veteran already had a top-of-the-line wheelchair?

Q. Does it normally take 4.5 months to get a wheelchair for a veteran? Does the VA normally order
wheelchairs without brakes? Is there a reason that Marco still does not have the correct brakes on his
wheelchair?

After the wheelchair was received in mid-July the consult was made for a ramp evaluation and
subcontractors began reviewing and bidding on the job. On September 7, 2016, Marco received an email
that VA had approved a ramp layout and now needed his signature and HOA approval for work to begin.
The enclosed diagram showed that the ramp was not ADA-compliant.

Q. Does the VA normally approve handicap ramps that are not ADA-compliant?

Due to the number of problems and delays, Chad Martin, Assistant Prosthetics Chief met with Marco at
his residence on November 29th to discuss replacing the non-ADA compliant ramping with a vertical lift
gate. Marco agreed that the vertical lift gate made the most sense and asked Mr. Martin to move
forward. Marco was later notified that he would have to pay nearly $7,000 for concrete to have the
vertical lift gate installed where the VA would have paid for 100% of the ramping.

Q. What was accomplished between January 2016 and the time that Chad Martin got involved?

Q. Marco met with the patient assistance coordinator in Austin, but the coordinator was told they could
no longer work on his case. Are patient assistance coordinators often prevented from working on VHA
problems (specifically the ramp/lift gate issue).

Q. You cannot install a vertical lift gate without a reinforced concrete platform. So why does Marco have
to pay for concrete that is part of the installation requirements for a vertical lift gate?

Q. Is Marco also required to pay to move irrigation lines and landscaping required by the installation?

Questions for both VHA and VBA

Marco notified VA Staff (from VA Secretary to IL counselor) multiple times that the stress of this
program was causing him significant problems to the point he reached out to the veterans crisis line
multiple times specifically to handle the strain of the VR&E program.

Q. During any of this time did anyone refer Marco for treatment?

Q. Did anyone do a wellness check?

Q. Did anyone contact his primary care provider or another member of his medical team?

Q. Did anyone wear their "I Care" button?