J Basser: 0:00

Here we go, blog Talk.

Ray Cobb: 0:02

Radio.

J Basser: 0:04

It's time for the Exposed Ed Podcast. The Exposed Ed Podcast discusses issues related to today's veteran. To call in to the show, dial 515-605-9764. Now here's your host, john and Gerald. Welcome, ladies and gentlemen, to another episode of the Exposed Ed podcast on the whopping 12th day of October 2023. The month's just barely getting started and it's going to be a very busy month for some of our veteran friends and our representatives. October's the month of NOVA, the conference coming up in Fort Worth, texas, here next weekend. I think that's what it is. But today we're sitting here with our co-host, mr Ray Cobb, down in Tennessee, close to Alabama. How are you doing, ray?

Ray Cobb: 0:54

I'm doing good. I've got a chamber of commerce weather down here it's 73 degrees, light breeze, blue skies and a lot of sunshine.

J Basser: 1:04

We've had that all day today too, Sunshine. That's good. Now we've got another guest speaker today. She's a little bit north of me there in the hill country. Her name is Bethany Spangenberg, she is Balafervet, and Balafervet is a group that does independent medical opinions or examinations on veterans, and they know what they're doing, and Bethany drives the truck and leads them in the right direction. How are you doing, Bethany?

Bethanie Spangenberg: 1:33

I'm doing well. I wish I could have a positive forecast that Ray just gave, but I'll tell you what. All I know is there's ragweed galore, so it's been sneeze season. Oh yeah, I know, is there's ragweed galore, so it's been sneeze season.

J Basser: 1:48

This weekend, the rain will wipe it out for you.

Ray Cobb: 1:51

Yeah.

Bethanie Spangenberg: 1:53

I hope so.

J Basser: 1:55

It'll be better because you've got a trip to make here next week. You can't be getting sick.

Bethanie Spangenberg: 2:00

I do. I don't know. I've got enough decongestants and sinus medications.

Ray Cobb: 2:05

I think I could tackle it, yeah right, but we want to do it, bethany you better take your allergy pills with you, because you're going to be hitting Texas just the time that cedar fever starts down there. So I hated that stuff.

Bethanie Spangenberg: 2:26

Well, I appreciate the heads up.

J Basser: 2:28

Cinnapods, too, is bad stuff, but we're going to talk about Beth, and I have been discussing this little BVA case here the last few days. You don't see too many BVA wins on the word obesity. You don't see too many BVA wins on the word obesity and it's something you know. The BVA is always denied, saying you know, we couldn't help obesity or whatever. And Bethany was kind of tearing to this because I think it's got her. She's very interested in it, what's your take on that case, bethany.

Bethanie Spangenberg: 3:03

So that particular case makes me laugh how what the judge came out to say. The reason I wanted to talk about obesity in general is I'm going to touch on it actually at NOVA, and so I want to take the opportunity to introduce a little bit of what I'm talking about at NOVA but then also talk about this particular case specifically because obesity is such a challenge to get service-connected. It's different than most of your service-connected conditions and so definitely a topic I think it's worthy to have Exactly right.

J Basser: 3:46

People can gain weight in service.

Bethanie Spangenberg: 3:52

So, in particular, what's so fascinating about obesity itself is that for a long time, the medical world didn't really acknowledge it as a disease, didn't really acknowledge it as a disease, and then when medical professionals got an ICD like a billing code in order to get reimbursement for obesity, that was 2013. So it's just recent that the medical side is acknowledging it as a disease component, where the VA doesn't acknowledge it fully as a disease, but rather a pathway. They reference it as an intermediate step and that what that's what makes it unique in in the service connection world that's not an actual disease.

J Basser: 4:43

It's kind of a leading factor into a disease. Or is that what you're saying?

Bethanie Spangenberg: 4:47

Yeah, so from the legal side of things.

Bethanie Spangenberg: 4:51

So the memorandum is what we reference whenever we look at it from a medical expert side of things and the memorandum specifically talks about obesity, and it came out in 2017, and so what it says is that the VA doesn't recognize it as a disease, but as an intermediate step or a pathway to service connection. And in order for a veteran to get service-connected for obesity, there has to be three questions that need to be answered by the medical expert, and the three questions is did the veteran's service-connected conditions cause the veteran to become obese? If that's a yes, that's one of three. You're a third away there. The next question is is obesity a substantial factor in the development of the veteran's claimed condition? And if that's a yes, you're two-thirds of the way there. The final question that needs to be answered is a statement in the affirmative is the veteran would not have developed the claimed condition but for the obesity caused by the service-connected condition. So when you have those three components, or those three questions, answered in the affirmative, then a veteran can get service-connected for the condition.

J Basser: 6:24

I think this would open up Pandora's box to the world of diabetes.

Ray Cobb: 6:30

Yeah, that's exactly what I'm sitting here thinking. I mean, you know, my doctors have said just everything that she just got through mentioning. I mean all the way back gosh, 15 years ago.

Bethanie Spangenberg: 6:45

And I think that's why it's important to talk about it because the obesity itself can cause and lead to so many other diseases, and the regional office doesn't teach or the VA doesn't teach medical experts inside the VA about how to address these obesity cases. And so, unless you really study, you know the memorandums or you're aware of it or you study the law, you don't.

Bethanie Spangenberg: 7:15

that medical expert doesn't have a way of knowing the way to address the obesity cases, and so that board decision that I shared with you, john, is just that the board judge basically says that the VA medical opinions are worthless. But this opinion that Bethany Spangenberg did was adequate and it bought him a service connection.

J Basser: 7:37

So you're the culprit in that bad boy. Okay, let's reach through the phone line and pat her on the back.

Ray Cobb: 7:48

Yeah, uh, let me ask you a question because it just popped in my mind. I hadn't even thought of this. The two things that I remember were being said to me one of my doctors said number one uh, that diabetes causes uh cause my weight problem. And number two, because of taking the insulin, it would never really come under control. And then, number three, they sent me to a. I guess it was kind of like a nutrition class that they sent Pam and I to where you sit in there and they go over all of everything as to how to read the amount of calories and starches and everything on a cereal box and on labels, which was actually I think it was like a. I think we had to go two different days.

J Basser: 8:45

Four, hours each day.

Ray Cobb: 8:48

I've been to it and I did I learned a lot. I mean, I guess I probably knew it or heard it, but never paid any attention to it. But those are the type of things if a doctor does, those does that fit into the category that you're talking about as far?

J Basser: 9:08

as the treatment plan or as far as what's accepted.

Ray Cobb: 9:11

Yeah for proving it. Like, for example, the doctor identified it, gave me the diagnosis for it and then set up a treatment program for it. How would that fit in? Or does it even fit in at all?

Bethanie Spangenberg: 9:26

So it does A lot of times. What happens is the diagnosis of obesity is made through your body mass index and in the clinical world, medical world. We understand that the body mass index is an estimate.

J Basser: 9:40

It's not 100% accurate it's not 100% accurate.

Bethanie Spangenberg: 9:44

It's just. Basically it's a way for us to understand what other risk factors and diseases you are at risk for, based off of that number. So when you look up, you know you try to figure out your BMI. If you put it into the computer or through your phone, you're going to get this chart and it's going to show you like your weight and this chart and it's going to show you like your weight and your height. Then it's going to put you in a category and once it gets to a certain number, it's above 30.

Bethanie Spangenberg: 10:13

Once you get above 30 BMI or 30 or above you're obese, and so your body mass index is normally a standard calculation in the chart alongside your weight, your height, your blood pressure, your pulse ox and your heart rate. So you'll see that BMI sit there. So the pure existence of that BMI being above 30 or 30 or above is enough to pursue a relationship from a service connection.

Ray Cobb: 10:47

Okay.

J Basser: 10:48

The question being as far as service connection, in this scenario that would have to be. I mean, I don't think they have presumptive conditions, so what would it be? You would have to be able to prove that you became obese in service. Is that not correct?

Bethanie Spangenberg: 11:03

Not in service, so this is going to be looked at as a secondary component. So we're talking about a foot or knee injury that limits your physical abilities, maybe a little bit of depression and anxiety that limits your motivation. Diet, exercise.

J Basser: 11:22

Okay, a lot of.

Bethanie Spangenberg: 11:25

PTSD those things. Correct, so let me give an example Go ahead, oh go ahead.

J Basser: 11:34

Go right ahead.

Bethanie Spangenberg: 11:36

Well, I want to give an example of what that opinion would look like. So let's say a veteran is trying to say that his left knee and left ankle condition caused his sleep apnea through obesity. Okay, and that's kind of what you want to put on your, your 526 application sleep apnea secondary to obesity from left knee, left ankle, ankle. So when I go to write the opinion and let's say that everything is supportive of that, that opinion should say the veteran service-connected left knee and left ankle caused the veteran to become obese. Obesity is a substantial factor in the development of his obstructive sleep apnea. The veteran would not have developed obstructive sleep apnea. The veteran would not have developed obstructive sleep apnea if the veteran was not obese.

Bethanie Spangenberg: 12:30

So those three components you're talking about how they're intertwined and how they play into the development of the obesity and the sleep apnea.

J Basser: 12:41

So you're going after the cause of the obesity in that situation.

Bethanie Spangenberg: 12:46

Correct, so that's why we, the way I reference it as a pathway, the terminology that the VA uses is an intermediate step.

J Basser: 12:58

So it could be the joint issues that you can't be mobile and exercise. It could be a pulmonary issue where you can't get O2 to exercise too right.

Bethanie Spangenberg: 13:09

Correct.

J Basser: 13:11

Okay.

Bethanie Spangenberg: 13:13

And I think if we look at the recommendations for the management of obesity, anything that would limit one's ability to follow those recommendations is going to play a part into it. So, for example, medical recommendations is exercise. So if you're not able to exercise, then that can play a part into the obesity. If part of the recommendations for obesity is for an individual to go through behavioral therapy, so then that way they're actively making decisions regarding their weight. Well, if you have an issue or service connection that limits your ability to control that behavior, that can play a part into the development of obesity. Some of the recommendations for obesity are surgery, so they get to the point where they cannot manage their weight and so that a stomach shrink or a device put around the esophagus to kind of limit the amount of food you eat is a recommendation for obesity management.

J Basser: 14:29

We had a case like that in the Navy. We had a guy that worked in the prayer office and he was real heavy set, real nice guy, and they gave him ultimately to lose weight or to keep him out. So he went to one of the naval hospitals and he had I guess he had some kind of stapled or something that stapled the stomach together. When he came back he lost a whole lot of weight About six months before I left. He gained most of it back. Yeah, unfortunately.

Bethanie Spangenberg: 15:01

And even in that scenario you have to address the behavior, you have to address the behavior you have to address the dietary exercise, I mean all of these.

Bethanie Spangenberg: 15:09

When it comes to obesity, it's not as simple as calories in, calories out, and I think both medical and non-medical people throw in the stigma that, well, just don't, don't eat as much, it's calories out, when that's really not the case. Even for somebody who has psoriatic arthritis or even psoriasis and they're on chronic steroids that can change the metabolism and cause somebody to be obese. The antidepressants, the medications themselves can cause a weight gain. That is a component of obesity.

J Basser: 15:50

There's a lot of causes for obesity to tell you the truth, I'm just thinking. The VA needs to recognize it more than what they do, because you know the rest of the medical profession already has right. I think so the medical world. You've got to listen to them, yeah.

Bethanie Spangenberg: 16:04

Yeah, social Security does. It does. Now I should mention I know we talked about like the intermediate step, but there is a case out there that says obesity can be a service connection, even though it's not on the rating schedule. But the limitation is is the obesity has to cause functional impairment of earning capacity. So in my opinion that's a legal argument. You have to prove from the legal side that the obesity is causing functional impairment of earning capacity. The medical expert examiner can say what you know what limits them in the occupational setting. But then the veteran has to go on and explain yes, I have these limitations and this is how it has limited my earning capacity. So we don't see a lot of those. You would get a 0% for the obesity and then you can tie everything in. We see more success through the intermediate step.

J Basser: 17:11

It seems you guys listen, folks, listen up this young lady, she knows what she's doing. She's even published now in the BVA with it. No, that's it. Now, what made you when you took this case? What drove you to do this? I mean, did you put your thinking cap on? Or what you had to have some idea before you even wrote the opinion? Right?

Bethanie Spangenberg: 17:47

Are you talking about the board, one that I shared with you?

J Basser: 17:49

Yeah.

Bethanie Spangenberg: 17:50

That particular case, I was actually approached by an attorney and he asked me this attorney I have a good relationship with. He's an over-attorney and he likes to run his cases by me. Well, what do you think about this connection or this pathway or this thought process? And he and I have had a relationship that spans back since 2017 and working cases together, and it's interesting to hear some of his theories. I'm like, no, we can't go that way, like we can't connect this crazy condition to another crazy condition. No, we can't go that way, like we can't connect this crazy condition to another crazy condition, but maybe we can tie it here.

Bethanie Spangenberg: 18:29

And so we've had several of those cases together, and this was one that he didn't come to me first. He was trying to argue, say that the VA opinions were not adequate, so he was trying to do the legal avenue first, and when he wasn't successful, then he asked for the nexus opinion and I reviewed the record. I felt that it was adequate, I felt that I could write a favorable opinion, and so I submitted that. I want to say that was 20. Oh my gosh, let me look at the date on that. Actually, that was a couple years ago, 2018. So in 2018, I wrote that opinion and we're just now seeing that decision come back from the board.

J Basser: 19:21

In DC. Yeah, before COVID.

Bethanie Spangenberg: 19:30

Before COVID yes.

J Basser: 19:34

Okay, good job. You did it on the head. That's great, you know, I mean it's. You know that's one good thing about being able to do what you do. You know you're able to understand the medicine, the science involved with it, and you're able to put it together. You know, as far as, of course, the old song, you know the hip bones connect to this bone and that bone. That makes sense, you know, yeah.

Bethanie Spangenberg: 19:58

You know why don't I read the judge's analysis?

J Basser: 20:06

I don't think I sent you the whole thing, did I? No, I got a summary, I guess Go ahead and read it.

Bethanie Spangenberg: 20:09

So the analysis is actually, I think, very valuable, so I'm going to read it to you here. All right, so the analysis. The veteran has been diagnosed with a disability sleep apnea in November 2016. He has been service-connected for his left foot since January 2011 due to a machine gun falling on his foot in service causing an injury which led to metatarsalgia, which is pain in the foot of the left foot with healed fractures, pain in the foot of the left foot with healed fractures. The veteran has documented the deterioration of his physical stamina and endurance following his injury and his ensuing weight gain.

Bethanie Spangenberg: 20:46

In January 2018, the veteran submitted a medical opinion from PA Bethany Spangenberg in which she provided a concise review of the veteran's medical history, including noting the progression of his BMI, chronic limp and obesity. Pa Spangenberg concluded that it is at least as likely as not that the veteran's severe obstructive sleep apnea is a result of his morbid obesity from physical limitations associated with his service-connected left foot condition. The board notes that there are also negative opinions of record, namely in January 2018 and June 2019, the VA examiner's negative opinions did not provide adequate rationale, finding only that quote conditions of the foot do not cause obesity. End quote and quote the veteran's sleep apnea did not occur until after being out of service for 12 years and then gaining weight. End quote.

Bethanie Spangenberg: 21:44

The board finds the negative opinions to be of limited probative value. First, the January 2018 examiner conceded that obesity is the best documented risk factor for sleep apnea. It concluded that conditions of the foot do not cause obesity. The examiner failed to provide any opinion on how the less foot disability could have contributed and continued the veteran's obesity, leading to chronic obesity due to less mobility and reduced ability to exercise. The June 2019 examiner offers an opinion which is not pertinent to the issue and perhaps not even accurate, by suggesting that the veteran could eliminate his obesity by restricting his diet and, to quote, just not eat as much. End quote. This opinion is not adequate as it does not provide rationale as to how the veteran's current obesity could have contributed to his sleep apnea, but instead suggests the veteran could have avoided obesity.

J Basser: 22:42

Delation right.

Bethanie Spangenberg: 22:47

That's what cracks me up about this case is he calls them out. It's not even accurate.

J Basser: 22:56

I've seen worse. I've heard them get angry. I've heard them get very angry. The court's worse than the BBA. The court's worse than the BBA, I'm serious. And the district court above the veterans court is even worse. They can get pretty snotty. I used to do a lot of studying on this stuff and it's amazing to see some of these decisions that came out. I'm glad the judge went that way and made your veteran happy and the attorney happy anyway.

Bethanie Spangenberg: 23:33

Yeah.

J Basser: 23:35

Yeah.

Bethanie Spangenberg: 23:37

He had a pretty significant gait issue after he had his injury and that's really what led this particular case to support the obesity development.

J Basser: 23:50

So normally it's not just He'll have more claims, he'll probably have knee and hip problems before too long. He'll have more claims.

Bethanie Spangenberg: 23:58

He'll probably have knee and hip problems before too long, very true. So a lot of times these obesity cases, I'll take multiple service connections and plug them in as contributing factors. This particular case, I didn't have to do that because his left foot was significant enough and the record showed that he had this chronic limp in his left foot. So a lot of the obesity opinions that we write it is grouping the mental health and the physical limitations as causing the obesity.

J Basser: 24:29

Now if you ever get any cases where a vet will say they're doing weight and service based on the same issues, you know a lot of times you look at the service medical records and you'll see the BMI and things like that when you go to medical but the biggest resource that we found is not in the medical part itself. You can tell your attorneys or your agents you're working with on the cases and get you the copies in the record of the veteran's illicit performance evaluation sheet, turn it over to the back page and there's kind of a review of every time he gets his performance thing.

J Basser: 25:02

So if he's obese they're going to put it down there, they're going to say they're above the you know so-and-so, but they have to write that down to do the evaluation if you had to do it myself, right. And it tells you as a play-by-play, what they did in the military and service.

Bethanie Spangenberg: 25:19

The.

J Basser: 25:19

Navy is good at getting the information out and having it done, the Marine Corps they should be the same. That document's golden. It helps a lot of veterans when they're clean. They don't realize it's there. And the VA don't realize it either because they're too busy looking and they don't know the set. You know, compared to the electronic data record system. You know, I think it's paper. They'd go through a file and read the file and they'd say, okay, this guy was a 4-0 sailor. But they didn't look on the back of the sheet, page two. Yeah, a little bit of a heads up there. You know I'm just talking about old experience. You know that hasn't been fought in the battles of the past history. We used that a whole lot back in the day. But obesity is an issue. It can cause a lot of problems. It can cause anything.

Bethanie Spangenberg: 26:15

You can have that and this stuff comes up later on with diabetes, right.

J Basser: 26:26

Diabetes, hypertension, sleep apnea, depression, heart disease, heart disease, untreated sleep that make is a major cause for a.

Bethanie Spangenberg: 26:30

She didn't in fact that's part of the workup. If somebody has the first onset of a fib and they go to the hospital, part of their workup of trying to investigate the cause of AFib is sleep apnea.

J Basser: 26:47

Is that a hypertensive heart disease, unchecked for 30 years?

Bethanie Spangenberg: 26:52

That too.

J Basser: 26:54

Yes, I hate to say it, but our lives are quite morbid, bethany, as far as you look at what we've been through and what we've done. So you know, I mean it's pretty sad. I know a lot of poor vets out there, you know, but we've walked in the same shoes, you know, and they've got most of the same issues and sleep apnea and obesity and heart disease and high blood pressure. Diabetes is a big one, though that's what's going to get us anyway.

Bethanie Spangenberg: 27:29

Yeah, diabetes is such a difficult disease because maybe you start to have high blood sugars because you're a little bit overweight. But once the disease really kicks in, you're in this hamster wheel of just trying to keep things in order. And diabetes itself not only can be triggered by obesity, but it can make the obesity worse because of the treatment, because of the disease itself. So it feels like a never-ending battle when it comes to type 2 diabetes.

Ray Cobb: 28:05

I can definitely, you know the best of the VA, you know slavery.

Ray Cobb: 28:10

I was going to say I can testify to that. I mean, I can remember when I first found out I was a diabetic, you know, I was still. I was a little overweight. They wanted me to weigh 205, and I think at the time I weighed about 235 or 230. And then, once I started on the medication and started trying to keep it under control, you know, it just mushroomed. I mean, the weight went up, and then the sleep apnea, and then they told me I had AFib and then the next thing you're having open-heart surgery. So you know, I mean it just built on top of each other.

Bethanie Spangenberg: 28:52

Yeah, and when you get the insulin involved and I can testify to the insulin portion because I'm a diabetic type 1 diabetes a little bit different as far trigger the pancreas to secrete more insulin. There's different components with the type 2 diabetes that can be for treatment purposes, but when you get insulin involved, whether it's type 2 or type 1, your exercise is such a battle because a little bit of exercise combined with insulin amplifies that insulin two to three times, and so now you're dealing with low blood sugars.

J Basser: 29:48

What's the VA cocktail when the first diagnosis of diabetes they get you in your borderline and the next thing you know you're taking glipizide. And after a while taking glipizide it's got you over to Jim Pibber's Hill and other stuff. And then comes the metformin.

Bethanie Spangenberg: 30:01

Yeah, I laugh because that is the typical VA medication treatment process and I laugh because it is familiar, but it's really not funny because it's sad that you know that.

J Basser: 30:18

You want to know something funnier. All this medication is brought to you by the medication provided by the lowest bidder.

J Basser: 30:28

I can do this all day, I mean if you've been through it, you lived through it. All you can do this all day. I mean, if you've been through it, you lived through it all you can do is laugh at it. That's all you can do is laugh. I mean, there's so many different treatments for diabetes and the VA's got their own rules. They've got this how to treat diabetes. Book 101, step one do this, do that, do that. It's kind of comical in a way. Everybody doesn't react the same to medication. Everybody's body is different.

J Basser: 31:16

Well, in some medications she doesn't even react the same day. Oh, some do. There's some new medications out there. It's kind of dangerous, in my opinion.

Bethanie Spangenberg: 31:30

What medication is that?

J Basser: 31:33

That's the new super meds. I mean you need a lot of GI problems and things like that's going on with these things. I don't know if the folks in Hollywood are getting them out because they're the ones getting all the medication. The pharmacies don't have it because they're getting it out. You know the ones I'm talking about now.

Bethanie Spangenberg: 31:54

I do know.

J Basser: 31:57

Yeah.

Ray Cobb: 31:59

You talking about that shot that. I take every Tuesday morning.

J Basser: 32:04

Well, yeah, but it depends on the doses that shot, too, you take. It depends on how high the dose is. It might cause some issues. I'm not saying it does, I'm saying it might. You know, the jury's not out yet, but we'll let you know in about two weeks. Yeah.

Bethanie Spangenberg: 32:24

So the purpose what's interesting about those medications is the purpose is actually to slow the gut and force your body to absorb the food a little bit slower Some people. It does the opposite and it actually irritates the bowel and can cause diarrhea. Then, depending on what food you put in your belly, it can trigger episodes of diarrhea. The titration of starting on the lower dose and then slowly working up, and you really have to be mindful of that and I don't recommend that you start this medication and plan on doing lots of activity or going out and traveling, because it can be good and it could be bad, and I'm talking about like slow your clothing back.

J Basser: 33:24

Well, if I recommend, if you're going to travel or take this medication, make sure you invest in a good, classy RV, and that way you have to go and pull over and go.

Ray Cobb: 33:34

Yes, oh, my goodness.

J Basser: 33:40

I just got through taking a.

Ray Cobb: 33:43

I'd recommend anybody that's good at travel, like myself when I took that medication. It's kind of simple. All you do is you buy three packs of, or three boxes of, depends and just put them in the back seat and carry them with you. You know what I?

Bethanie Spangenberg: 33:58

mean.

J Basser: 33:58

It's pretty simple, Well, Ray we all don't plan on taking trips to Slapdab USA. Have you ever been to Slapdab USA? It's Slapdab in the middle of nowhere. Yeah, I've been there. I was there just a couple of weeks ago. Yeah, I've been there.

Ray Cobb: 34:23

I was there just a couple of weeks ago.

J Basser: 34:24

You know we haven't traveled as much since COVID came around. You know we were doing something. We were on the road all the time. I'll take some get back into it with things and situations. So if we get this grad student out of college I guess I'd be okay.

Bethanie Spangenberg: 34:47

I don't envy that part of life that's right.

J Basser: 34:51

You got a couple of them too, right oh yeah, in fact. I just had.

Bethanie Spangenberg: 34:57

The conversation went to. They had an Ohio PA conference and they're talking about the PA profession and where that's going doctorate and so they proposed like their different, like pathways to get it. And then there was. They were like oh, there's a 15 year track that all PAs have to have their doctorate.

J Basser: 35:24

And.

Bethanie Spangenberg: 35:24

I was like timeout. Can we like extend that to maybe 20 or 30? Cause I have three kids. I need to get through college first and I don't really want to go back to school while they're in school. So yeah, college is rough.

J Basser: 35:42

Is Michael 100%.

Bethanie Spangenberg: 35:45

Yes.

J Basser: 35:48

And what's Ohio's education benefits from the state.

Bethanie Spangenberg: 35:54

I don't know I know right now they do get the education benefits, but we're not at the point where we've really investigated and looked at it. I just know that.

J Basser: 36:04

Look at it for yourself too. That's a good idea. Look at it for yourself, because Kentucky is the same way, she's entitled to the same right. Yes, you would be entitled to the same, so that might be a benefit to you.

Bethanie Spangenberg: 36:19

I'll have to look into that, because that was my concern.

J Basser: 36:24

I know. Believe me, I do know.

Bethanie Spangenberg: 36:29

You know enough people. I should be able to look at your Rolodex and see if you've got any resources for education benefits in Ohio right, I'm serious.

J Basser: 36:43

If not, pick up Mike and the kids and come about 65 or 70 miles south to your Frost River, set up camp right there, give it about two or three years and then go for it, because I know they do here.

Ray Cobb: 37:01

Yeah, I think that's going more and more. We don't have a lot of benefits in Kentucky.

J Basser: 37:09

But that's probably one of the best benefits in the country.

Ray Cobb: 37:15

You know, in Tennessee now if a veteran son or daughter wants to go to an educational training facility or a junior college or a community college, it's free. And two years of education is free. And what I'm encouraging some of our veterans around here to do is start off and go to a junior college or community college close to the house here we have a Montlow Community College and go two years there, get their basics out of the way and then they can go over to one of the major state universities and draw their GI Bill and they have. I think it's $55,000 they can spend within four years.

Ray Cobb: 38:12

So, if they did all of that and they, you know, kept the grades to be I think it has to be a 2.0 or higher then they have enough for six years of college, which you know could probably get them a master's.

J Basser: 38:28

Yeah, so a doctorate? I mean you've got a master's already, right, bethany, correct? Okay, so you'd have to go. How many more years would it take you, if you weren't full-time, to get your doctorate? So they have two pathways.

Bethanie Spangenberg: 38:46

There's a PhD option, but there's also a doctorate of physician-assisted studies. They're trying to figure out specifically how they're going to name.

Bethanie Spangenberg: 38:55

You know each university has their own name, but they're trying to figure out what they want that standard to be. So the university that I went to for my master's no longer provides the master's track but now provides the doctorate track, and for that it was a distance learning program, but I would have to go there periodically for certain sessions and so I'm familiar with them. I really enjoyed that program because when I first finished school I didn't have to have my master's.

Bethanie Spangenberg: 39:27

I was able to practice on my full my bachelor's and shortly after I graduated they required the master's in order to prescribe. But it's got a long history. It's actually PA week right now. Today's the last day of PA week, so October 6th through the October 12th, so it's actually a good little topic to discuss.

J Basser: 39:54

We can lead right into that. You know that's good. I mean it's up to you to do what you want to do, but I mean it's going to be required in the future. You might go ahead and try to knock it out if you can, even though I know you've got smaller kids and stuff. So I'm going to take a. Just, you need some help and you've got help to do it. You realize too, you've got your profession. You've got battle for debt a bunch of you kind of got your hands full.

J Basser: 40:21

Maybe I'll study in my sleep. Yeah, that's true too well, like us, we don't sleep much at all, you know. But it's a good thing. I mean, it's the battle it's got to be fought so you can do it. And you got a good head and shoulders and you know you already created that. So you know, the sky's the limit well, thank you, I appreciate that.

Bethanie Spangenberg: 40:45

Yes we do.

J Basser: 40:48

Are you getting ready to go to Fort Worth, Texas?

Bethanie Spangenberg: 40:51

I am. I'm going to be presenting there talking a little bit about obesity, but I'm also going to talk about sleep apnea and migraines, tbis and some orthopedic cases. So, pretty broad presentation for those common conditions.

J Basser: 41:12

So how's the treatment for migraines? How's the Botox injections going for migraines?

Bethanie Spangenberg: 41:19

You know, I just had this conversation with somebody the other day. You know there's certain criteria in order for the insurance to cover that and it's like 30 small injections around the base of the neck and around the head. So if you're, if you're needle shy, if it can be effect pending on the type of migraine headache that you have, but it's not for everyone.

J Basser: 41:51

When I first started doing that, I was in the program to do it and I got abruptly removed from it, from doing it.

Bethanie Spangenberg: 42:00

You got what.

J Basser: 42:03

They had a little program. They were starting Botox injections and stuff for migraine sufferers. I was part of it. The University of Kentucky had a neurologist. She had to do the PA and her husband was a neurologist and they were in charge of it. They were going to go ahead and do it. They just removed me kind of abruptly. I guess insurance wouldn't pay for it. And after about six months I got to figure what do you mean? Why is insurance even paying for it? They can't charge insurance for it. I'm already service-connected for it. That kind of rubbed me the wrong way, yeah.

J Basser: 42:44

I'm trying to see how it's done them if they're doing.

Bethanie Spangenberg: 43:05

You know our VA doesn't do the Botox, but you know other neurology departments that should be covered if you're service-connected.

J Basser: 43:12

There's a lot of issues. If this ever gets out, I think it'll blow the lid off a whole lot of stuff there's a whole lot of stuff that needs a lid blow off on it.

J Basser: 43:22

But I'm not in physical health enough to blow a lid off. I'd wish somebody else would take the reins. We're fighting the battle of Little Bighorn here, you know. I haven't made it down to the bottom of the hill yet, but they're waiting on us, you know. But now you're going to present on migraines. You're going to discuss obesity, yes, and are you going to have a booth set up too, or are you just going to mingle?

Bethanie Spangenberg: 43:52

You know, what's interesting about that is I was set up to be a vendor. We got you know the plans to set up and what product we were going to give out, and then they go. You know, no, nova doesn't allow you to be a vendor if you're a speaker and I was like what you could have told me that before I purchased my vendor products.

J Basser: 44:16

So I can't be a vendor at.

Bethanie Spangenberg: 44:17

NOVA this time around.

J Basser: 44:21

Well, maybe keep your products for next time, maybe.

Bethanie Spangenberg: 44:26

So that's the plan. Next time, if they ask, I'll be like no, no, thank you, I've got supplies.

J Basser: 44:32

I need to get rid of. Yeah, make the expense a venture, because, hey, no, it's not cheap. Even being a member's not cheap. I charge a pretty good amount of money every year, just you know, for membership. Yeah, I mean, it's an amazing group, so you know, and they do kind of look out for each other, so it's good.

Bethanie Spangenberg: 44:59

Well, I feel like NOVA's very important for attorneys that practice on a regular basis. It's important to be involved with NOVA because things do change so quickly as far as case law and then even with things that go on in the background. So one of the things that NOVA is really trying to support and push through is the GARD Act. Have you heard of the GARD Act?

Ray Cobb: 45:29

Yes, no.

Bethanie Spangenberg: 45:31

So the GARD Act is actually an act that they're trying to re-implement penalties for non-accredited agents. Implement penalties for non-accredited agents, so they're trying to. Really NOVA is very active in trying to put out those non-accredited representatives. They're calling them claim sharks. So NOVA is really active in trying to suppress those individuals.

J Basser: 45:58

I think I'd be in prison taking care of you. Whoever sets it up in Congress needs to be removed too.

Bethanie Spangenberg: 46:08

We talk to a lot of veterans and we talk to a lot of people that used to be a part of those ClaimSharp programs and the millions of dollars they spend a month on advertising a loan to target veterans is unbelievable. Millions a month on advertising alone to target veterans is unbelievable Millions a month.

J Basser: 46:29

I'd like to see a good rule to pay everybody back and go out of business, of course. Now, if a veteran does use them and he does win, he gets his money and they start sending him bills for it. He could tell them to take a flying leap. There's already been one or two judges that say, no, you don't owe them nothing and your VA money is protected right.

Bethanie Spangenberg: 46:50

In fact, that's the word we're getting from other attorneys is that those attorneys are telling their veterans not to pay the bill.

J Basser: 47:01

That's right, of course. I mean, since you've got a name Guido to your front door, about six foot ten, try to collect the money that way, kind of like the old days in the mafia that were running around Chicago and New York. You know they'd walk into a business. Hey man, you've got to pay me half your money. What for? We're going to protect you? Who from Us? Right, it's a racket. It's a racket. Of course now they realize that some people realize when there's money to be had, everybody's going to try to get it right. Right, that's exactly what it is. But I hope this thing gets passed and I'm pushing for it very hard. The Card to Guard Act and of course right now they can't pass that in Congress because they don't have a Speaker of the House. But quick note, guys If any of you vets, disabled vets out there the CPI came out the other day You're going to get a whopping 3.2% raise on your VA check starting January 1st Well, december, but you'll get paid in January.

J Basser: 48:23

So expect a few pennies and a couple of greenbacks and you know it might get you a tank of gas or whatever, but you know it's better than nothing. Not as good as last year.

Ray Cobb: 48:34

Did you say 3 or 3.5?

J Basser: 48:37

3.2.

Ray Cobb: 48:39

3.2.

J Basser: 48:40

3.2, yep 3.2%.

Ray Cobb: 48:43

And.

J Basser: 48:43

Social Security the same points. Yeah, 3.2 percent, and so, excuse, the same way, 3.2 percent. I knew what furs and CSRs and timers were too, but somehow I think my left side of my brain is not working. I think it escaped, so I have to figure that later, but I don't know. I mean, it's that, that's. It's a pretty good thing what you do. I know you did a lot of traveling. You're going to vegas too, right?

Bethanie Spangenberg: 49:11

I am, so I'm going to. This is the first time that we've I've attended this. Michael's going with me on this one. Um, we're doing the military influencer conference, so there's um a few people there that are going to speak that I'm interested in. I've never you know, I'm not a veteran.

Bethanie Spangenberg: 49:28

My husband is, and so being involved in the veteran community is something that I, from that perspective, from like the conference itself and being beside a lot of other veterans. I don't spend day-to-day beside other veterans. I spend time talking day-to-day beside other veterans. I spend time talking with veterans who are seeking disability, so the mindset is different, the day-to-day function and things that they do is a little bit different. So I'm interested in being involved in not only the lifestyle but the community and kind of understand where some of these veterans are coming from. So the first time, we've ever been.

Bethanie Spangenberg: 50:08

I'm interested in learning some.

J Basser: 50:12

You and Michael need to invest in a can of Blue Emu and if you're both right-handed, make sure that you rub it on your elbows. That's the way you don't get carpal tunnel way. That's why you don't get carpal tunnel while you're there.

Bethanie Spangenberg: 50:25

So what's interesting is Cheryl Mason. She used to be. She's a oh, I'm going to have a brain fart for what she used to do, but she's actually from Portsmouth, which is not too far from here, and she went on to serve for the VA as the chairman of the board of veterans appeals, so that's what the position she was in.

Bethanie Spangenberg: 50:54

I couldn't remember but, she's from Portsmouth, which is like 30 minutes from where I live, and so for her to come from like a small town and be able to be there to make it to that position, well, she's actually speaking at this conference in Vegas, so I'm interested in you know what she has to say and hearing from her again, because she was replaced when Biden came in, so Okay, I understand.

J Basser: 51:21

Speaking of Portsmouth, I had one of my best buddies from the Navy was from Portsmouth a little bitty guy, maybe James Rozier, and we had an asbestos job.

J Basser: 51:32

We were usually on submarines and of course folks, a submarine is not a very big ship at all. You know, it's very compact and tight and the piping and stuff is a lot more compact and tighter than anything else. So in order to get some of those pipes you know big guys like us wouldn't fit so poor little Jim. He got the job. He was a hell of a worker. Pretty good people. I haven't heard from him in years. He just kind of reminded me. He's talking about Portsmouth and he's talking about I guess don't they have some nuclear reactor up there or something.

Bethanie Spangenberg: 52:07

They do so it's a uranium enrichment plant.

J Basser: 52:13

Okay, I've been through there a few times driving to Columbus the old way, the back way.

Ray Cobb: 52:20

Yeah.

J Basser: 52:23

We're getting pretty low on time. We've got about seven minutes left. Anything else you want to talk about, Betsy?

Bethanie Spangenberg: 52:29

So I think they're calling it like National Check on your Buddy Day for Veterans, and that's starting October 16th. So, john, why don't you reach out to that guy in Portsmouth and check on him and see how he's doing, if we can find him?

J Basser: 52:50

If we can find him, I might do that. I like to check in with a lot of them. I've actually made contact with a lot of buddies of mine that did the job. Unfortunately, a lot of them that did the job, a lot of them are no longer here because of their job. You know what I mean. Yeah, mesothelioma is a bad thing. We lost three that I know of.

Bethanie Spangenberg: 53:15

That's kind of what we're seeing too. Michael and I were together when he was in the service, but I was in school and by the time I got done he was deployed, so we were together while he was in the military, but after he got out he's actually lost more people to mental health than he did while he was in the Marine Corps. So definitely the National Check on your Buddy Day is something I'm trying to push as well, because it's important.

J Basser: 53:45

Check on your buddy day is something I'm trying to push as well, because it's important. Well, it's good for your psyche, too, to get ahold of these people and talk to them, because I mean you know you guys had a bond back in the day, right, you know it's a camaraderie.

J Basser: 53:56

You know I mean you guys lived through certain things that you know you can't tell your family about it. I mean you can't. You know you can't tell your family about it, I mean you can't. You know you can't tell people whether you know working as a submarine or not get in trouble. You know things like that. So, but it's pretty good to be able to talk to most of them and see how they're doing, what they've done after they got out of service or whatever, and it's good to reach out every once in a while.

Bethanie Spangenberg: 54:23

You know we'll get a hold of a couple of them.

J Basser: 54:26

Okay, pretty cool. Some of these guys are the pillars of strength, but in those in service see them go downhill like that's pretty sad, pretty sad. One guy was in our next array, yeah.

Bethanie Spangenberg: 54:46

Yeah.

J Basser: 54:47

You can tell he was Tennessee. True, and true too. Buddy Big old guy had that Tennessee drag on his speech. Give him a pit bull and a Harley and he had it made.

Ray Cobb: 55:10

Go ahead, ray, it's interesting you're speaking of that Now. I can remember shortly after I started going to VA I had a doctor say when he found out the diabetes and the fact that I was Asian-Auric exposed he says my job is to keep you alive until you're 65. This past year I had my 75th birthday and you know I'm glad I made it that far. And now when we were talking about this, my mind just flashed back and there were six guys that I was pretty close to in Alabama and then over in Germany, and I've tried to follow up on all six of them and I'm the only one left out of that group of six. Oh, wow.

J Basser: 55:59

You're not even talking about the Uncalled Four. You're the sole survivor of that band I am.

Ray Cobb: 56:06

That hits me every once in a while too. Uh, the other day we were at a restaurant and somebody said something about rock and roll and pam pulled out her phone and pulled up the group and said that's him on the back of the hearse, and of course I'm 17 at the time, you know. And this young 15-year-old she said, oh wow, you did that and you know, it was kind of you know I'm sorry, you like older music.

J Basser: 56:39

Bethany, you like older music.

Ray Cobb: 56:40

Oh, you like the 60s, Bethany. She liked older music. Oh, she liked the 60s, Bethany.

Bethanie Spangenberg: 56:45

You know I've listened to so much music. Is there something in particular?

J Basser: 56:52

It's called the Uncultured. The song's called Do Like Me. You need to look that up and listen to it. Okay, and the drummer on that song was Mr Ray Cobb Really.

Ray Cobb: 57:04

Yeah.

J Basser: 57:07

He's kind of modest. You know he's a soul survivor. You know he's still got his drums to help.

Ray Cobb: 57:13

I do, I do. We put them up in storage about four or five weeks ago now, but guess what? I took the drum head off and it's hanging on the wall along with the record and some of the other stuff. So we have what we call a music room, and Pam has, of course, she played. She stepped in the last few years here with us and got to play some concerts and do some fun things like that and experience.

J Basser: 57:44

She's on the keyboard.

Ray Cobb: 57:44

Yep experience Down on the keyboard. That's cool.

J Basser: 57:48

Real quick, real quick, before we go. We talked about what to go. We talked about obesity. Yes, Explain what the difference between obesity and morbid obesity.

Bethanie Spangenberg: 58:01

Explain what the difference is between obesity and morbid obesity. So obesity, they don't actually use the term morbid anymore, they actually make it a classification. So class 1, class 2, class 3, obesity. When you hit class 3, obesity it's a body mass index of 40 or greater. Yeah, class 1 is 20, class 2 is 30, and class 3 is 40?. Class 1 is 30 to 34.9. Class 2 is 35 to 39.9. And then class 3 is 40 and above.

J Basser: 58:44

Okay, well, that's Class 3 is 40 and above. Okay, okay, Well, that's all we need to know. We want to thank you for coming on, girl. All right, thank you for coming on and helping out.

Ray Cobb: 58:52

As usual, we look forward to seeing you next month down in the great state of Taliban.

J Basser: 58:57

Yeah.

Ray Cobb: 59:01

We'll have Bethany on.

J Basser: 59:02

We'll have Bethany on the remote. We'll try to figure that out just now. She'll be in Vegas With that. This will be John Happy. Exposed Vet Podcast, ray Cobb and Bethany Spangenberg. We'll be signing off for now. You have been listening to the Exposed Vet Podcast. Any opinions expressed on the show are the opinions of the guest speakers and not necessarily the opinions of Exposed Vet. Exposedvetcom or Blog Talk Radio. Tune in next week for another episode of the Exposed Vet Podcast. Thanks for listening.