The VA Choice Program

Newsletter | Aug 25, 2017 | Letha Sgritta McDowell

Regardless of your personal politics, there are criticisms from both political parties about our current president and the actions he takes or hasn’t taken. In particular, healthcare and the repeal and replacement of the Affordable Care Act, commonly called Obamacare, has consumed the news lately. Prior to the spectacle around Obamacare, many healthcare advocates protested the care our nation’s veterans received (or didn’t receive) through the Veterans Health Administration. On August 12, 2017, President Trump signed an emergency spending bill which authorized an additional $2.1 billion dollars to fund the VA Choice Program.

In 2014, reporters revealed that wait times to get an appointment within the VA Healthcare system were as much as 115 days. Many veterans died waiting to be seen by a doctor in the VA healthcare system. In addition, other problems were reported in the VA, including an outbreak of Legionnaires’ disease, mismanagement of prescription drugs, and cover-ups regarding care veterans were receiving. As a result, the government created the VA Choice Program which allows veterans to choose local healthcare providers outside of the VA system. Using VA Choice does not affect any other veteran’s benefits.

In order to be eligible for the VA Choice Program, the veteran must already be enrolled in the VA Healthcare system and meet one of the following requirements:

  • Be told there is more than a 30 day wait for their appointment
  • Reside more than 40 miles from the nearest VA Healthcare facility with a full time primary care physician
  • Need to travel by air, boat, or ferry to the closest VA facility
  • Face an unusual or excessive burden to travel to a VA facility
  • Reside in a state or territory without a full service VA facility

The ability to receive care from a provider in the community has reduced dangerous wait times for veterans and the continued funding of the VA Choice program is critical for many veterans, especially those in rural areas like eastern North Carolina. Appointments with local providers has increased by 10% since 2014 and the implementation of the VA Choice Program.

Unfortunately scandal is not new to the VA Healthcare system. In 1945, VA Administrator Frank Hines resigned amidst scandal of poor care provided at VA hospitals. In 1972, Ron Kovic publicly protested VA healthcare and led a 19 day hunger strike at a federal building in Los Angles to shed light on poor care at VA facilities. In 1986, the Inspector General found that 93 physicians providing care at VA facilities had sanctions against their licenses. In 2003, an investigative team under George W. Bush found that more than 236,000 veterans had waited for more than six months for follow-up medical visits. These are just a few of the headlines about the VA.

Many veterans feel that the VA Choice Program gives them the ability to get the care they need out from underneath the bureaucracy that exists within the VA and on which much of the blame for poor care is placed. The emergency spending bill which extends the VA Choice Program is seen by many as a welcome relief and will hopefully continue to improve the care received by those willing to sacrifice for this country.

Ask Kit Kat – Forest Fires

Hook Law Center:  Kit Kat, what can you tell us about forest fires, and why they sometimes may be beneficial?

Kit Kat:  Well, this is an interesting proposition—should we let forest forest fires burn themselves out or should they be actively fought? The case for letting forest fires burn without active efforts to contain them is gaining acceptance. There are several reasons for this. First, scientists now believe that, in North America before European settlement, 20-30 million acres would burn in an average year. Today, it is more typical that only 4-5 million acres burn every year. Second, burned-over land is not a wasteland. It is actually a fertile area where many types of species survive and even thrive. Take for example, the black-backed woodpecker—the mainstay of its diet is grubs which absolutely abound in burned-out trees. For some beetles, it is their ideal habitat to lay eggs. They can sense that an area has become burned over, and will rush from miles away to deposit their eggs. Third, forests periodically need to be thinned, and fire is nature’s way of accomplishing this. Finally, human lives of forest firefighters are put at risk in each fire that is fought. Families of firefighters have come to realize that fighting fire to protect property is a high price to pay, and they are increasingly suing governments for wrongful death. According to Dr. Timothy Ingalsbee, a former firefighter and now head of an advocacy group, ‘Families are no longer going to be mollified by politicians showing up at the memorial talking about their fallen heroes.’

Firefighting on a large scale started in the 19th century when it was in vogue to protect timberland for the commercial value. By the 1930s techniques had gradually improved to allow for large-scale firefighting efforts. So the debate continues. Most agree it would be better to let some acreage burn naturally—it’s a question of how much acreage. Also, some argue that money would be better spent on loans to homeowners who live on the edges of forests to build fire-resistant structures which actually have a good track record of being unharmed in fires, if the proper building materials are used. California could prove to be a test case. With 39 million inhabitants, the issue is very important. Even there, efforts by the US Forest Service are being made to allow fires caused by lightning to burn naturally in 3 national forests in the state. In summary, this is an important issue that can affect everyone, whether you live in a wooded area of not. Federal and state tax dollars to the tune of almost $2 billion annually are spent in firefighting.

(Justin Gillis, “Let Forest Fires Burn? What the Black-Backed Woodpecker Knows,” The New York Times, August 6, 2017)

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Letha Sgritta McDowell

Attorney, Shareholder, CELA
757-399-7506 | 252-722-2890
[email protected]

Letha Sgritta McDowell is a Shareholder of Hook Law practicing in the areas of estate planning, elder law, special needs planning, estate and trust administration, asset protection planning, long-term care planning, personal injury settlement consulting, guardianships & conservatorships, and tax law. Ms. McDowell’s clients range from high-net-worth individuals with over $75 million in net worth to families with limited assets.

Ms. McDowell is a past President of the National Academy of Elder Law Attorneys and was named as a Fellow of the prestigious American College of Trusts and Estates Council (“ACTEC”) in 2020. She is certified as an elder law attorney by the National Elder Law Foundation (“CELA”) and Board Certified as a specialist in Elder Law by the North Carolina State Bar Board of Legal Specialization. Furthermore, McDowell is accredited to prepare and prosecute claims with the Department of Veterans Affairs.

Ms. McDowell is currently the chair of NAELA’s strategic planning committee, a member of the Board of Directors for the North Carolina Chapter of NAELA, and a member of the Board of Directors for the Purdue Center for Cancer Research. She is the former Chair of the North Carolina State Bar’s Elder Law Specialization Committee and is the former Editor-in-Chief of “Gray Matters”, the newsletter for the Elder Law Section of the North Carolina Bar Association. She is a consultant for InterActive Legal and has worked on several law and technology initiatives including IBM’s Watson project. Along with her experience practicing as an attorney, she has dedicated much of her time writing for national publications including, but not limited to: Wolters Kluwer,, the NAELA Journal, Trust & Estates Magazine and many more.

Practice Areas

  • Elder Law
  • Estate & Trust Administration
  • Estate Planning
  • Asset Protection Planning
  • Long-Term Care Planning
  • Special Needs Planning
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