Ray Cobb: 0:00

Good evening folks, and welcome to another broadcast of Exposed Vet. We're here tonight. John Stacy's on the road traveling a little bit. We've got a couple of folks sitting in with us. I'm Ray Cobb, normally the co-host, and I guess I'm going to kind of head things up a little bit tonight. But Bethany Spanberg, who's also with Valor for Vet, is with us, and Bethany, I think we have a special guest with us as well, don't we?

Bethanie Spangenberg: 0:28

Yes, we sure do. So. This is Jerome Spearman. He is an accredited VA claims agent and tonight he will be talking to us about the future of the VA claims process and his opinion on how things are coming and going and what to expect. Tonight I will replace John, as he is living his best life and today is Thursday, july 31st of 2025. Jerome, did you want to start by introducing yourself to everyone?

Jerome Spearman: 0:58

Absolutely. First of all, I always wanted to give gratitude for the opportunity to be here, to speak with you and to spend this time and to be a voice in the dark tunnels, if you will, of some of the VA disability sides of the house. Yeah, so my name is Jerome Spearman. I believe that there's a difference between who I am and what I do. I am a proud graduate, first of all, let me just say I'm a proud son were Baptist ministers, and so if I happen to get a little riled up about something that I enjoy speaking about, I'm just not going to apologize. That's just who I am. Second thing is I'm from the East Coast, so we get a little. We get a little riled up as well of the Boulder Crest Path Program, which is progressive and alternative training for helping heroes for those who suffer from PTSD. I am a graduate of the Permission to Start Dreaming Foundation, which is PTSD, and what they do is they help veterans and EMT individuals who are first responders, rediscover their mission and find themselves, after perhaps locking the door behind, who they really are and experiencing a newness of life. So I'm very, very proud to first start there. So I'm very, very proud to first start there. That, through this program, has allowed me to be here not a number of the 22, but a number amongst the veterans. So, with that being said, who else? Who am I?

Jerome Spearman: 3:03

I'm a proud husband to a beautiful wife, jessica. I also have three amazing boys one who just graduated from Hampton University in the field of marketing. The second one is going into Washington State University studying criminal justice. Hopefully he'll be able to play football this year for them. And then my third eight-year-old, who will be nine soon, is going into a language emergent school, or is in a language emergent school, and I'm very proud of him. We just got back from Costa Rica and he was speaking Spanish and it was just awesome. So that's just a broad introduction of who I am. I can go further with respect to what I do, but I could take a brief moment there.

Bethanie Spangenberg: 3:49

Okay, I'm happy to hear you prefaced with your Baptist background, because if you do get a little loud I'll know where it's coming from. So that's fun. So I appreciate you sharing that with us, so that's great that you have all this background.

Jerome Spearman: 4:16

The one thing you didn't mention is the nursing background. Did you want to talk a little bit about that? Not a nurse, what I do is nursing. I am an advocate. What I do is VA disability accredited claims. That's the job that I do. But who I am is two separate, different things. So anyway, yes, as a VA accredited claims agent, I primarily focus in on orthopedic type style conditions, but also I'm a registered nurse.

Jerome Spearman: 4:49

I was trained in the army. There was a funny story that comes along with that. I, as my military background, I was in the United States Air Force and the reserves back in 95, and then got out of the Air Force and went and worked on Wall Street for a while, was there for 9-11. Talked to my aunt who was a nurse and said you know, you should become a nurse. I'm like, absolutely not. I'm a Wall Street guy. What are you talking about? That's not what we do. But she also knew that I had interest in science but also knew that I loved working with people and advancing them to the best levels that they could be through management and things of that nature. So I took the plunge and went to nursing school met Sergeant First Class Lawrence, now PA Lawrence, major PA Lawrence, who then introduced me to the Army, went over to Longstraw Regional Medical Center, where that also was a pinnacle point that changed my life, where we had met and I took care of service members, marines, soldiers, contractors and seeing the kind of things that I saw. One, which was that most of these injured individuals, most of these injured soldiers, service members, still had that spree decor that, even though, in the situation that they were in being injured, they were still able to worry about their people in the battle downrange or about their battles on different wards during the height of both wars, but many of them did not know that their lives were about to be changed and their military careers were about to be ended. And so that led me to believe that I always wanted to be able to advocate, for whatever I did when I got out of the military was to be able to advocate for veterans. I didn't know what it was, I just wanted to do it.

Jerome Spearman: 7:00

So, long story short, 2018, I left the military, got out of the Army, a joint base, lewis McCord, went right into the reserves, found myself in a medical board because I had challenges transitioning. And then, from that perspective, I wondered what my life was going to be about. My wife was like bro, it's great that you are medically retired, but you can't just sit around. And I decided to embrace that vision of taking care of veterans and start my quest to be an accredited claims agent. That was in 2021. As of last year, I finally sat and took the exam, october 9th 2024, passed the exam and now I'm coming up on my one-year anniversary as a VA accredited claims agent. So that's a brief background. Sorry if I took so long, but it's just the Southern Baptist coming out.

Bethanie Spangenberg: 8:12

No, that's okay. I appreciate all the information. I feel like in life, things happen to us individually and we can use them as tools to help those around us, and it sounds like you certainly have a background that has placed you in a position to be the best advocate for disabled veterans through your experience. So I think your story tells a lot about why you are you're here and why you're doing what you're doing. So that's cool. I love hearing that. I love the story.

Jerome Spearman: 8:46

Thank you for that.

Bethanie Spangenberg: 8:47

Now you said that orthopedic cases are your favorite. Why is that? A lot of veterans have hard times, gives ortho cases to be more than just 10% or 0%. So what's your perspective?

Jerome Spearman: 9:00

Well, one is because in the Army I was an OR nurse and I always loved working on those types of cases being total knees, total hips, shoulders, all this. So I was very familiar with the anatomy. They're also very familiar with the doctors. I have a lot of friends who are radiologists and also orthopedic guys From a VA perspective. I think that there's my strategy and my approach is, if we can kind of work with some of the orthopedic conditions, such as the back, right, the back can have and can yield another type of rating relative to the radiculopathy, and then we can add on to there the bilateral factors that come along with that Right, and so I believe that there's there's a lot that's available to to, to to kind of investigate there. But that just opens the book to the chapter. And so what I found is that a lot of veterans if you look at the 2024 report, the top conditions that veterans have are mostly orthopedic right Flat feet or podiatry, ankles, knees, blah, blah, blah hips. To looking at the whole entire C file and exploring it from a holistic perspective and saying, okay, so yeah, you have your need only yields 10 to 20%. There may be some other aspects within that need that we could look at. Perhaps you may have uh, you're torn MCL right, or is it stable right? Is your? Is your knee? There's meniscus right. There's ratings for meniscus right. So there's different types of ratings that we can get involved there.

Jerome Spearman: 10:55

As the mental health side of the claim, what is your mental health situations? What have you seen? If you've been in the military for one day, specifically if you've been through from the listening side, if you were in basic training, you've gone through some stuff that could allude to other type of mental health conditions, and just military career and service in itself can produce that. So we look at it as a door. I look at it as a doorway to attract veterans to be able to look at their claim from an orthopedic perspective. But it gives me the inside view to do a holistic approach beyond behavioral health down into the general side of things. So, okay, let's talk about your GERD. Do you have GERD? Okay, great, let's talk about that or other conditions that we can connect the dots to. So I'm not sure if I answered your question, but that's my approach.

Bethanie Spangenberg: 12:02

Maybe the long route, but from what I'm taking away is that you are capable, because of your experience in the medical side, that you're capable of looking at the medical records and understanding where you can gather more ratings and more information to support that veteran's claim. Does that sound about right? Did I summarize it? Yeah?

Jerome Spearman: 12:27

sorry, that is the long and again suffering from, I say PTSD. We turn PTSD into PTSD. We tend to go along the route so you will have to bring me back in. So thank you for that. But yeah, it's just the ability to just to connect the medical dots for a veteran so this way they can win.

Bethanie Spangenberg: 12:55

Yeah.

Ray Cobb: 12:56

Yeah.

Bethanie Spangenberg: 12:56

No, I like that because you know I I typically, as a medical expert, I'm looking at one thing at a time. Veterans come to me and they're asking me okay, is my knee condition related to service? And so from a medical expert side, I do look at all their current service connections and I see what happened in service, how I could possibly tie the knee into these different theories. And so for you, you, you take the holistic approach, so you're, you're in it fully where I look at it almost piecemeal, you're all in looking at everything that they have and connecting the dots in that manner. So I think that's really valuable.

Jerome Spearman: 13:38

Yeah, and I, and I think you know again, bethany, you can't get me started about this because I'm I'm I this, because I'm ready to go here. But when we look at this right, and I failed to mention that, while I was waiting to become a VA credit claims agent, I studied to be a legal nurse consultant and one of the great things that I did with working with attorneys is, you know, being able to make the story clear. The medical record is 7,000 pages, you know, as you hand it over to a VSO and he's like are you kidding me? I got to review, I don't have, I don't have time to review 7,000 pages to make this clear. I think that with this, the skill sets of being able to, not only as a nurse but from a legal nurse consultant perspective, we take a look at the whole entire medical record and create the story for that specific condition, point in case. So let's just, we could just deal with the knee for a second. So, okay, this is when the injury happened on January 1st.

Jerome Spearman: 14:44

On the 5th, he went and saw his primary care physician. The primary physician sent him to, uh, orthopedic physician. What did the? What? You know, what did they do? Oh, they did x-rays? Oh, they did mris. What did the mri say? What was the impressions of the mri? Right?

Jerome Spearman: 14:59

And all of that is the key nuggets that I think a c&P examiner hello, C&P examiners would want to know, would want to be able to look at in order to quickly evaluate in a tabular form this veteran.

Jerome Spearman: 15:16

And then also, the other aspect of it is if we can put it in a timeline summary, where it is visual versus table, then it makes it even much more clearer. So the point that I'm saying is that we there's a change that has to happen in VA disability. There's a change that has to happen. We need to be able to provide, as advocates, clarity. We need to provide clarity for the system, because the system is a bureaucratic system. It's not designed to go through all this paperwork although they're creating some AI technologies to do that but we need to be able to provide the best packet for the veterans, because it means something to be a veteran. I don't take that lightly After what I've seen in working in Longstreet Regional Medical Center. No, no, no, no, no, no. And working with veterans, working with Vietnam veterans no, they deserve that level of service. And as advocates from VSOs and I'm talking to VSOs, to VA credit claims agents, to attorneys we need to provide that level of service for them, sorry.

Bethanie Spangenberg: 16:38

So you've been at it a year now.

Jerome Spearman: 16:41

Yeah.

Bethanie Spangenberg: 16:42

You've been at it a year now. You've spent time as a veteran, you've done the legal nurse consulting, you worked with attorneys. Now, a year later and you don't have to give away your trade secrets, but how are you using those tools that you learned to make it better for the veteran and your clients, or your veterans?

Jerome Spearman: 17:09

Well, there's a key. There's a key document that I use and I'm more than happy to share it. It is called, and you can look it up too it's called a medical record chronology. And so what a medical record chronology helps a veteran. And let me just take a step back here. Let me, can I, can I take a step back and just talk about veterans for a second? Uh, veterans are ones that I find that, as long as you give them just a little nudge, a little guidance, some light clicks on and then they're able to move forward. But without that, sometimes in no guidance, they are out there flapping, as we would say in the Army.

Jerome Spearman: 17:54

So when I talk to veterans, I have that approach, which is on the intake. Let's do a holistic approach. I'm coming from the top to bottom, although I specialize in orthopedics and other conditions. As a registered nurse, I know how to look through the medical record to pull pieces of the puzzle out. So I then, once we have our review, we review this with a. We build a chronology report. If you look on some of the DBQs, I'm starting to notice that even the C&P examiners I'm not sure what software they're using are putting their little chronology Is all of the information there. Perhaps, maybe, maybe not. In my year, I found that the chronology that the CMP examiner puts there is quite lacking, and so, anyway, that's what I use, that's what I do. I build a packet we need to be able to build packets for veterans that has a chronology, a timeline, summary, and if there is medical journals that supports what we're talking about, for that supports the case, then let's move forward with it.

Bethanie Spangenberg: 19:17

Okay Now I would agree with you.

Bethanie Spangenberg: 19:20

I have appreciated the C&P examiners putting out a timeline, typically towards the top of their medical opinion or the top of the queue that discusses it.

Bethanie Spangenberg: 19:30

But it's not usually complete findings, like they denied having foot pain at discharge and then they denied having foot pain X, y and Z, and so they use a lot of the negatives and sometimes it's not even relevant to the timeline of the claim. So I can see where you, as the advocate, providing a separate chronology to support the veteran's claim is valuable. The other thing I don't appreciate is in that chronology summary they don't annotate key markers that the veteran may express. So if they're seen for a flare-up or if they're seen for something else and the examiner happens to annotate well, on examination they had these findings relevant to that case that examiner is not necessarily annotating that in the chronology, and so I find that the CMP examiners I don't know what they're using either, but I like to see that chronology because from the medical expert side I can attack it because I'm like oh, you're missing this, you're missing this and this is what the veteran's testimony says.

Jerome Spearman: 20:48

Yeah, I agree, and that's where the knife hand comes out, right, where we start to look at how we can, you know, win for these veterans.

Bethanie Spangenberg: 20:58

Yeah, now I know you and John had a discussion about the future of the VA claims process and that's kind of what triggered tonight's episode and what they wanted, what John wanted to talk to you about. Can you kind of give us an idea of what that discussion was about and let us know, you know, your thoughts.

Jerome Spearman: 21:24

Yeah, yeah, it was a very. It was a very brief discussion, but but he asked me what do you want to talk about? And I had mentioned to him. You know I am interested in talking about the future. What I see is, in my opinion, but my opinion of the future of of the VA disability, not the process, but those who are inside of the process.

Jerome Spearman: 21:45

There's a lot of changes that are going on. So let me set let which, 6 million are receiving compensation. So where's the other 11 million? What are they doing? Did they apply? Did they not apply? Oh, here we go. Did it not apply? Oh, here we go.

Jerome Spearman: 22:29

450,000 new veterans have come on the rolls, new rolls as of 2024. So I'm just trying to paint the backdrop to get the story for you. We have 17 million veterans. We have 6 million that have receiving compensation. We have close to $457,000 that have come on the rolls. Last year, the VA has paid $152 billion worth of payments and compensation, to include service-connected death compensation to veterans and of that 6 million we have about 61.4% of them are Gulf War veterans, 23.4% are Vietnam veterans, 14% are veterans who were in this peacetime and then less than 1% are Korean and World War II veterans. So we have a situation where veterans are coming into the system. The Gulf War veteran is now taking most of the type of claims. Then we have, you know, the situation where 30% of those who you know, according to a report that I read, get denied why. So when I set it up like that and I started to look at what is the reason why they're getting denied, part of this is because of, I believe, in my experience in talking to some veterans and my clients is because they just don't know the process so they go into it blindly. And many of the Gulf War veterans that I'm talking to have perhaps and I know I'm talking to advocates here, but perhaps have lost some faith in the accredited access or the accredited advocates in a sense because of their experiences, and so they have decided to go out on their own. This is just my survey. This is not a survey that is published anywhere. This is my experience and talking to people in my community. So there may be other thoughts, but this is just what I'm seeing. And so when I look at this puzzle of the VA disability and I see that we have GWT veterans who are now starting to lead the way and we have a system where you have to come in and talk to them. You have to come in and talk to an advocate, spend an hour. What is the? How are we going to change with the changing tides of the global war on terror?

Jerome Spearman: 25:11

Veteran, who is a different type of individual. They some of them are working, some of them have, are married, they have three or four different kids. They are very active in their kids' life because they may not have been active while they were on active duty. So they have this time now to do that and they're working and their wives are working. So to take some time off to go and see somebody for an hour that may not be there when they got there, when they told them they were supposed to be there, or to take some time off and to get there and sit for three hours because the office is backed up with six other veterans, it doesn't sit well with them. They need flexibility, and so what I'm finding is that veterans the ones that I'm talking to would like to have choice. They would like to have some sort of a choice.

Jerome Spearman: 26:06

Now we can get into the credit claims advocates and versus sharks and all that kind of stuff and I can give you global war on terror and we have a system that can't hold these individuals such. You know we have again 450,000 are coming on the rolls every this last year and they're losing folks. The VA is losing folks. What does that mean for the veteran? I believe that that means that they have to become their own self-advocates because there's a changing in population with that. And I can stop there. I can go a little further more, if you want. We can go into advocacy, but that's where I'm going.

Bethanie Spangenberg: 27:09

So I can appreciate that.

Ray Cobb: 27:12

I have a question for you. I think you're right on. I mean, I deal with when I got started in the Vietnam era. That's when I came out. But now I see a change. I was on the phone today with a gentleman for over an hour and he is trying to—he's got real bad PTSD. He got aggravated with the VA quit going to his counselor. I convinced him to start back. He's got his first appointment going back in two weeks.

Ray Cobb: 27:41

But at the same time, what I see is that the VA laws the way that I think it could work better, as the direction you seem to be going, is that an agent like yourself should be able to help the veteran first go around and receive some type of a compensation for that. If you did, then that means that these veterans who are doing it on his own or county service officers, like we have here in the state of Tennessee, they get four hours of training every 90 days, which is not enough training to hardly wipe their nose or their bottom. You know you turn back around and they're making mistakes. It causes veterans to make mistakes. The veterans get rejected. The last time I checked with the state of Tennessee Veterans Claims Service, we were having a 96% denial rate on the first goal round 96 percent. And then, myself included, and I guarantee you, when I went for my last claim of R2, you know I knew exactly what had to be done and had it crossed and dotted and everything else, and I still had to get our friend Alex Graham to come on and help me because it was to the point where they just didn't even want to listen to what the veteran had to say, even though it was printed off, highlighted, dated and submitted.

Ray Cobb: 29:16

And you know, I mean, as John and Bethany could tell you, I was the second case of Agent Orange exposure in the United States and that sure wasn't easy.

Ray Cobb: 29:27

You know, I had to know my rules and my laws and go fight and go all the way to the traveling board, medical board at the time, the time, and there wasn't anyone that was allowed to help me just due to the fact that they were agents and they couldn't help you or if they did, they wasn't allowed to charge for their services. Do you think that needs to be something that needs to be addressed, even if it's not, let's say, it's only 10% of the back pay instead of 20% or some form of that nature, but I think that we would find more credited agents that would be willing to help a guy, for two reasons. Number one it would build the rapport. So if it did get to nine and you got another year or two to work on it, the back pay would definitely be larger, but at the same time he would be compensated for a little bit if the veteran is approved the first go around, and that would cut out a lot of this backlog from the get go all the way up through the Board of Appeals.

Ray Cobb: 30:39

You've hit like a stone.

Jerome Spearman: 30:41

Absolutely 100%. I do agree that needs to be addressed. I am a student of Alex Graham. He lives here in Washington, he's a good friend of mine and we are working on some SMC cases as well with him. But to your point, 100%. Now I have to say why. Why is this system designed this way? Right, where the agent is not able to interact or can, but you can't charge for that with the initial claim.

Jerome Spearman: 31:15

I believe that that is something that has caused other individuals and other consulting companies to get into the game and offer advice, and some of that advice may not necessarily be according to CFR 38, part three, four and all the other different parts, as well as the USC laws. And then some of the other advice may not be great advice. Medically, for example, I've heard an individual I call them the church of VA disability where they're all the gurus online and they're saying on YouTube saying oh yeah, if you want to change the settings on your CPAP machine, just give me a call, I'll teach you how to do it. Absolutely not. That is a no go.

Jerome Spearman: 32:01

We don't just change settings on a CPAP machine. That requires an order. So so what I'm saying to you is that 100 percent, we need to be able to. The laws need to change and I believe that I'm looking at some of the legal congressional hearings that we're moving in that direction. I hope we are moving in that direction because the reason why there are so many denials, I believe, is there's not enough time in a day for someone to really thoroughly look at the record and to create clarity within the story. So, yes, we do need to do that.

Bethanie Spangenberg: 32:47

So I'd like to add that one of you quoted a 96% denial rate maybe I think it was Ray but I'm not convinced that if agents or attorneys get involved from the very beginning, that denial rate would change a whole lot. It may go from 96% to 90%. And the reason I believe that is because I believe that the VA's way to balance the budget is to force a veteran to appeal, appeal, appeal, and so then that way the VA can limit how much money they're putting out for service connections. And the reason I say that is because I would honestly say probably 50% of the veterans that we work with have all three pillars that they need for a service connection, and what they are fighting is they are fighting the internal administrative processors, like just today.

Bethanie Spangenberg: 33:56

Just today, I had a case where the veteran had all three pillars he had an exposure in service, he had a current diagnosis and he had a positive nexus. Well, three months after that veteran was service connected, the VA administrators went in and said, oh no, no, that medical opinion wasn't good enough, let's get a clarification of their opinion, and then they severed the benefits. Now, this happened in 2022. Excuse me, this happened in 2020. The veteran died in 2021, and the widow is still fighting this reversal of benefits. They severed his benefits because they said that the medical opinion was not adequate three months after they granted service connection and so he had all three pillars.

Bethanie Spangenberg: 34:53

And then you know, there's a legal argument there. But I believe that a lot of the denials are coming from someone, and there is people that I track at the VA and they've been there for a long time and I hear them speak and I hear the numbers that they say in public, and then they go on the Hill and then they completely reverse what they said in public and they have nothing to back up their bullshit. So I believe, based on that, that their way of balancing money is to deny the veteran and force them into appeal. I say all of that to say, you know, maybe if we pay our advocates up front a little bit more, we may help improve that a little bit. But I'd be interested to see what that would look like.

Jerome Spearman: 35:48

May I add a little bit to that? Go for it. Yeah, I mean, I think there's a couple different cans we can get into if we want to open up worms, the cans of worms. One is I think that within the VA they have so many new Raiders that are there because they have the outflux right. They've retired a lot of them.

Jerome Spearman: 36:15

One of my good friends, christopher Edwards, a retired VA Raider friends, christopher Edwards, a retired VA raider, was telling me about the experiences that he had with being asked to be retired and so there's a lot of knowledge that is left and we have younger individuals and they're just hiring people. Matter of fact, they reached out to me when I retired from the military and said hey, do you want to become a raider? No, I really want to advocate on another side of the house. So anyway, you have these younger raiders and then they rely on the C&P examiner. So my question really is will it go down? I don't know, but where are they getting? Nothing against my medical professionals and all that great stuff, but some of the opinions, some of the DBQs that I see, I'm wondering where are they using their clinical judgment or are they not using their clinical judgment to make some determinations in support of the veteran, and so there are some that are very good C&P examiners and some that are not.

Jerome Spearman: 37:24

So what I'm trying to communicate is is that we have a situation where the veteran is like here VSO, here or here agent, or here attorney, here's all my stuff, just go ahead and handle it for me. And then you have a C&P examiner's like, just go ahead and handle it for me. And then you have a cmp examiner's like this is the 16th one, I don't really fight, don't want this check the box and you have a raider is like I don't really know what I'm doing here. What did you say? Oh, you said it was cool. Okay, deny all right, cool, I'll deny it, bam. And so now we here comes the appeals, now the agents and attorneys can come involved as well as the, the vso's, and we're trying to clean up what was there.

Jerome Spearman: 38:03

I think we need to have. There needs to still be a shift, however, where we provide them with the best foot forward and with a strategy, and I think that's what I'm trying to communicate. Will it go down? I can't, I don't know, but I think what we need to do is educate veterans on a choice. If veterans want to use an agent, veterans want to use a disability attorney, they want to use a consulting company that is on them, but there has to be a logical and smart choice when it comes to representation and also following the claim. So long story short, I don't know if it will turn around Hopefully it would but I think there's something that we can do within our own control. What are your thoughts?

Bethanie Spangenberg: 39:08

So I have been. You know you and I didn't talk a whole lot before this about my previous experience, but I was a C&P examiner in 2011 through 2013. And when I left the VA, I started working with our VSO because he would ask me to write nexus letters. And then, in 2015, we formally opened Valor for Vet it was under a different name. In 2016, we were approached by a major, major claim shark company that was just a baby in its infancy and it's now large and making lots of money and there's a lot of questions that surrounded that, surrounded that, but for us it wasn't the ethical approach that I expected in 2016. And so my view is a little bit jaded.

Bethanie Spangenberg: 40:09

When it comes to the claim sharks, because I have been directly involved and I've watched it from the very beginning and I've interacted with those people from the very beginning I do think that there needs to be a better system when it comes to advocacy from the very beginning, because if somebody has skin in the game, they're going to dedicate more time and energy and focus into that individual, and I think that carries a lot of value. But since I have been in this for so long, the one thing that I have preached since I went to the dark side so the civilian side is that our providers and medical experts are not appropriately trained and educated on how to use the verbiage, their brain and apply those clinical aspects. We see a lot of verbiage like there is no proof, there is no causal connection, and in medical school or PA school you're taught about how to do your job to prevent medical malpractice claims, and medical malpractice claims are a different legal standard than they are for compensation and pension. So when a clinician sits down to weigh the evidence, I don't think they're applying the appropriate legal thought on how to provide an opinion. So I make a point to do the TMS, the talent management system, which I think their contract's going out now, but to redo those compensation and pension examiner trainings on a regular basis. Now I'm only required to do it once in a lifetime and I did it clear back in 2011. So I would never have to take that again as a C&P examiner.

Bethanie Spangenberg: 42:08

But I take it over and over again because I want to see what material they're teaching these examiners and I want to see how they're explaining what the word nexus means and how to listen to the veteran, and how to listen to the veteran and how to weigh the testimony and how to weigh the buddy letters, because that pertinent information is not in those trainings.

Bethanie Spangenberg: 42:30

And so still today I see a lot of new patterns of this copying and pasting and I've talked about this before in the radio show and it's like how does an examiner for this veteran, word for word, say the same thing in a veteran that has no physical location anywhere near them? But in that, when I was there, what I experienced was the regional office would provide an email to guide the C&P clinicians on verbiage to use. And so, because I saw that firsthand and I'm seeing similar patterns now, I still believe that these email correspondence on verbiage to use is really setting the tone for that medical examiner's perspective. So that tone is often not in favor of the veteran. It's often teaching the wrong applications to use when they're making their opinion. Does that make sense?

Jerome Spearman: 43:38

Yeah, yeah, that makes a lot of good sense. A question though but still, wouldn't clinical, medical, scientific judgment still prevail, even beyond the language? You know what I mean. Like, for example, I have not to give away you know situation but say there's a, there's a veteran who is you know, has a, had a uh calcaneal osteotomy and then he had a fusion and they and, and then they did a fusion which they put the, you know, put the bones together, uh, and then, um, he.

Jerome Spearman: 44:16

Then then we find that he had a status post. That was status post. He filed status post calcaneal osteotomy and things of that nature and that surgical surgery. But then he has a house valgus, he has a bunion and he has all kind of foot deformities and all kind of arthritis that's going on in his foot. And when they looked at the DBQ and literally he filed status post calcaneus osteotomy, they didn't, with a malunion, malunion of the bone, of the calcaneus bone, which is the heel, and a nonunion of the cuboid bone, which is in his foot.

Jerome Spearman: 45:01

And they checked, checked, no, but the operative report, specifically in this particular case, may have said failed surgery. So if it says a failed surgery and you're looking at it as the clinical professional. Why wouldn't you put the pieces of the puzzle together and say oh wait, I said that I read the operative report that showed a failed procedure and he has a bone that did not come together because of this procedure. We should probably give him a rating for that, I'm sorry, so you know what I'm saying. Wouldn't the clinical judgment kind of prevail in that situation too?

Bethanie Spangenberg: 45:52

So I want to pull a textbook off of my shelf here because I want to explain something really quickly, so give me just a second. So yes, I absolutely hear you and I will tell you that, both PA and nurse practitioner school I can't speak for medical school, but my mother's a nurse practitioner and I sat in a lot of her classes because I was in PA school at the same time, so for me it was like extra study time. So from our clinical education and training there is not a lot of focus on gait changes and lower extremity changes during ambulation. I feel that there's two medical professionals that are best to discuss any type of gait changes and that's podiatrists, because they focus on anything below the knee, so they're going to look at the foot. So for your guy with the calcaneal issues, the cuboid non-fusion, the hallux valgus, all that stuff, that is all podiatry, that is their bread and butter. The other people are physiatrists, so your physical medicine and rehabilitation doctors. They are trained just to think about the nerves and the muscles and the ligaments and how they interact, where, from a clinical side, it's like well, there's no proof that a non-union causes any type of disability because it's, you know, whatever.

Bethanie Spangenberg: 47:30

So I will tell you that I specifically have a gay analysis book and I will use it to discuss. You know what things are present in that particular veteran. There is still not a lot of research that is out there Like like. I have a textbook because that's educational from like schools. But when you go to like PubMed or you go to oh brain freeze, there's another major medical reference that we use but they don't talk about gait changes. That's not part of the research that they're doing. And you have to actually look at physical therapy textbooks. You have to go and find this literature because you're not going to be able to Google it, find it on PubMed or a lot of these resources.

Bethanie Spangenberg: 48:16

So we would typically use a podiatrist or a physiatrist when it comes to those lower extremity things. So firsthand, my experience, especially with anything related to the gait, is that it's not something that's a dedicated discussion that we have in our PA school, np school. I will also say that a physiatrist is trained to do a gait analysis so they can watch somebody walk down the hallway and they can watch them come back and they could tell you everything that's internally rotated, externally rotated, where their source of dysfunction is coming from and all the accommodations that their body is making to adjust for that. And from the clinical side of things, when I was in the clinic I would ask for a gait analysis because I used to do occupational health. So our physiatrist was right in the next office and I would refer somebody over there and I said, hey, can you, you, hey, I find value in this gait analysis. Can you just do one? It takes them like two minutes and they describe it and it's fascinating to see, but it's just not in the wheelhouse of mid-level providers to do.

Jerome Spearman: 49:31

And to your point and I hope for you. I want to make sure that I was I hope I didn't hit any stuff on your toes or anything and I agree that there should be a medical professional that provides that level of analysis. Simple terminology, it's simple in the mean, from the clinical side. If the patient, if the veteran, is saying that they're filing for a status post, which means after the surgery they had a calcane, tried to union together and it failed, when we're, as a, I would think, just from a clinical perspective, if you see that that failed and he had two, he had two fusions, this particular case may have had two fusions that did not fail. Wouldn't we use our clinical judgments and say, hmm, let me investigate and look more in the record to see about the operative report? I may just be crazy, I don't know, maybe it's just me, maybe it's just me.

Bethanie Spangenberg: 50:43

I would have to see the opinion to even appreciate what their thought process was. So I just they probably didn't read the operative report, to be honest.

Jerome Spearman: 50:51

They didn't, they said it was. They read the operative report and they said, oh yeah, no fusions, no this, no this, no problems with arthritis, he's all good. Meanwhile, this guy is limping limping anyway. So so I just feel like there's there's there's a lot of changes that need to happen, and I think one of the changes that I think you know, we as, as you know, as advocates is that veterans are becoming more, are becoming smarter, and they're using AI to do it, and we, as advocates and I know I've said a bad word, you know a lot of people may not like AI is here to stay. I don't think it's going anywhere. I think there's a lot of problems that we can get into with it, but veterans are using it and they're showing up in our offices with reports. So either we kind of you know we need to make sure that we empower them with the right information to help them along their way.

Bethanie Spangenberg: 51:55

Now we've got about eight minutes left here. Ray, was there anything in particular you wanted to ask of Jerome before we run out of time? Well, yeah, I wanted to ask.

Ray Cobb: 52:04

Well, yeah, right here I got one other thing that you brought up which, after you started talking about it, my mind went back when you guys were probably still in high school, I guess, back into the mid-70s, walt Disney came up with the philosophy of just-in-time theory, and that just-in-time theory was used that if you go to Disneyland or Disney World and you're walking or standing in line for an hour and a half and every 10 minutes or 15 minutes a cold air from an air conditioner vent comes down, you'll return to go through that ride again. However, if it wasn't there, you would only go through it once. Well, I think that to a certain extent, that same type of theory is being used by the VA and you kind of touched on it, bethany, when you talked about how to control their budget and the amount of money they spend and I think they have found out that if they deny veterans on initial claims and things, after two or three denials, they're going to get to the point that they won't come back. So that's money that they don't have to pay, money they don't have to ask Congress for. So I think you may be exactly on the right track, and you know, I hate to think that.

Ray Cobb: 53:27

I mean, I can remember using that back in the mid-'80s, when I worked for a major corporation. We had that same type of a theory and when you did a job interview for a new person, when the first person looked at a resume, that job was to throw out anything on that resume that did not apply or would not encourage you to hire that person. The second person would look at it and they would do the same thing. The third person would look at it and their job was to say why Not, why not, but why should I hire this guy? And then, if he passed to that point, then he would start in on the personal interviews.

Ray Cobb: 54:09

But I think that's the same thing that they're trying to do. After a certain period of time, we don't like butting our heads against the wall, so instead of trying to learn how to go around the wall or how to get over the wall, we just back off and forget it. And I know a lot of veterans that have said that very thing. I don't care, I'm not going to file another claim, it's not worth it, it's not worth my time and my aggravation. And they don't do it. It's not worth it, it's not worth my time and my aggravation.

Jerome Spearman: 54:39

And they don't do it. I think, that goes with what Jerome was saying earlier. No, please, please, bethany, go ahead. No, go ahead. It's you, ladies, first.

Bethanie Spangenberg: 54:51

Well, that's kind of what you were touching on earlier, because those GWOD or Gulf War veterans, they're busy raising a family, busy trying to make money, trying to put food on the table.

Jerome Spearman: 55:06

And so that hassle, you know, takes a back seat. It does, and I guess, from my experiences with my clientele and people in my community, when they hit that wall, though, you're right, they're like I'm done when I meet them and I start talking to them about what a veteran really is and what that really means and what you've been through in the military, and kind of bring them back and then guide them. See, we need to be guides. We're not the heroes here. Advocates are not the heroes. The heroes are the veterans. So we need to help guide them in the right way and give them the tools to do it. Many of them the clients that I've talked to that are coming to me now have tried to do this on their own, some very successful and some that are hitting the wall, and they're like before I, before I stop, I want to talk to you to see if you can handle this, because I'm done and take it on. But if we provide them with enough strategy, upfront, it's something about that kindling of a fire that happens inside of them that may take them. I've seen it from my experiences. That takes them back to those days when they were on active duty, where you had to do what you needed to do to make it work with very little resources and still get the mission done.

Jerome Spearman: 56:24

We in the military, we had an MD&B process, which is the military decision making process. One of the and I'll leave you with this one of the main things was commander's intent. The other thing is course of action and a physical plan. Within that process, veterans they need to understand that they are the commanders now. What is your intent, what is your goal? And I'm speaking to veterans right now. We as the staff help you with the courses of action, but if you don't know, as a veteran, what that issue is, what your mission is, what you want to go for, how can you expect others to really help you in that process? Become your own commander and have your own intent. The rest will happen with the right type of strategy with the right type of advocates, I agree.

Bethanie Spangenberg: 57:19

Now. We've spent a lot of time talking about the brokenness of the VA and maybe both Ray and Jerome can provide their opinion on this but what is something that you think the VA is doing well right now?

Jerome Spearman: 57:38

Well, ray, would you like to? You want me to go or you want to go? Yeah, go ahead. I've got to think hard on that one. I can only speak from my personal, personal experience.

Jerome Spearman: 57:51

When I left the military, I had challenges with my transition. It did not go well, recognized that something was wrong. My wife told me you got to go get seen. I went to the VA, went to the ER, met with a gentleman by the name of Marcus and he was able to let me know that I had some challenges that I needed to get fixed or else my wife and family would probably be gone. And had he not intervened at that point in time, I don't know if I would have probably been here.

Jerome Spearman: 58:33

What I can say about my experiences is that the VA has done me very well with respect to behavioral health services, and here in Washington I don't know about around the country, but here in Washington they have definitely supported that. The other thing that I think they're doing is getting involved with other alternative medicines acupuncture, massage and other things like that that can help veterans and decrease some of the consistency and dependency on opioids. I think that's one thing that they are doing pretty well in my region, the regional office. That may there's some challenges there, but that's what I would say.

Bethanie Spangenberg: 59:22

Ray. Oh, you're muted, ray, okay.

Ray Cobb: 59:40

Oh, you're muted, Ray. There we go. Am I on now? Yeah, they told me that I would only live to be 65, and they hope to keep me alive longer than that. Well, they've done that With good medical care. This last year I turned 76. So as far as the medical care that I'm getting, compared to what they had estimated my life expectancy to be when I was 50 because of Agent Orange exposure, they've done a great job.

Bethanie Spangenberg: 1:00:10

That's good. I'm glad you're here, Ray.

Ray Cobb: 1:00:14

Yeah, good to be, here.

Jerome Spearman: 1:00:18

What about you, Bethany?

Bethanie Spangenberg: 1:00:19

So Jerome.

Jerome Spearman: 1:00:20

Can I ask that oh?

Bethanie Spangenberg: 1:00:26

So I'm going to cheat and I'm going to take the one that you said. These alternative treatments, they're doing the battlefield acupuncture, chiropractic care, massage therapy, aromatherapy and I'm glad to see those implemented within the VA health care, because I'm of the belief that we can't just take care of our body as a system. We have to take care of our bodies as a whole, so we don't just treat, you know, one endocrinology system. You really have to look at your mental health, your overall well-being, in order to be a healthy individual. So I'm glad to see that they have those alternative treatments in there. Jerome, I want to give you, you know, your time to put a commercial out there for us and let us know how we can contact you and all that good information.

Jerome Spearman: 1:01:23

And honestly there really isn't a. This whole, this whole entire interview and just discussion and podcast has just been enlightening to me. I'm very happy to be here to just share my thoughts and you allow me to ramble on and on and on about my thoughts about this. If there's anyone who just needs to just talk or you want to have a discussion about what we do further, just send me an email. It's very simple and easy Jerome at Spearman Appeals dot com. Jerome at Spearman Appeals dot com. And let's just keep it there.

Bethanie Spangenberg: 1:02:07

All right, did you want to close us out?

Ray Cobb: 1:02:11

Well, that's it for tonight. We're out of time. Appreciate you being here, nice, to meet you. Bethany, good to see you again. And with that, hopefully, john and all of us will be back again next week with another show. And on behalf of Bethany and Jerome, this is Ray Cobb signing off and saying y'all have a great week.

Jerome Spearman: 1:02:34

Bye.