Taking Healthcare by Storm: Industry Insights with Shannon Barry

In this episode of Taking Healthcare by Storm, Quality Insights Medical Director Dr. Jean Storm speaks with Shannon Barry, an Army Veteran and a Department Service Officer with the Department of Pennsylvania American Legion. 

Shannon discusses her journey to becoming a department service officer with the American Legion, emphasizing the personal nature of her work compared to her previous role in the VA. She highlights the challenges veterans face with the VA benefit process, mental health care, military sexual trauma, and the importance of peer support and advocacy.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

The views and opinions expressed by the host and guests are their own and do not necessarily reflect the views, positions, or policies of Quality Insights. Publication number QI-013026-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

 Hello everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical Director of Quality Insights, and today I'm joined by someone who truly embodies service. Shannon Barry, a department service officer with the American Legion. Shannon is not only an Army veteran and a retired.

Put in quotes, air Force Wife, but also a mother and lifelong advocate who found her calling, helping veterans navigate one of the most complex systems in healthcare. The VA benefits process with over a decade of experience in veteran services and an unwavering commitment to improving the system from the outside.

And Shannon brings a powerful mix of expertise. Empathy and firsthand understanding, which is so very important. In this area. We're gonna be talking about the challenges veterans face in getting the benefits they've earned, the evolving landscape of mental health care. The impact of military sexual trauma.

A challenging and very difficult subject to discuss, but something that really needs to be addressed and what the future of veterans healthcare could and should look like. Shannon Barry, thank you so very much for joining us today. Hi Jean. Thank you so much for having me. I wanna jump in  and you've said that your time working with the Department of Veterans Affairs helped you find your calling in serving veterans.

Can you share what that journey looked like and what moment made you realize that this was your life's mission? Oh, wow.  I've been surrounded by veterans issues my whole life. My mother and my grandfather were both veterans, both of them very involved with another veteran service organization.

And so I grew up just being surrounded by veterans issues. I joined the Army at age 24, mainly because the army got me out of California where I grew up. But I met my husband in the army. And then after we were married, he crossed over from the army to the Air Force and made a career out of it. So most of my adult life has been also around either military or veterans.

But when we, when my husband retired from the Air Force, we moved to San Diego, and the first job that I got was. Working for the Veterans Benefits Administration, and it was in working there that I realized that the va, while they do great things for veterans, they advocate for the law that governs veterans benefits.

Whereas on the side that I am now as a service officer, I get to advocate for the veteran. So that was kind of the. Moment that I thought this is what I really should be doing is working on the veteran side, was when I realized that working for the va I was not advocating for the veteran. Okay, that makes sense.

And we're gonna get into that a little bit more 'cause I think some listeners may not be familiar. So what exactly does a department service officer do and how is your work through the American Legion different from what you experienced inside the VA system? As a service officer, what we do is we assist veterans with various benefits like disability benefits survivors, pension for widows and widowers of veterans.

 We help veterans who are not receiving service connected disability apply for pension. And then we also help veterans with adding their dependents onto their awards.  We refer veterans out to other benefits through the VHA, the Veterans Health Administration, such as caregiver support.  We refer people to other Pennsylvania specific agencies, but the difference between what we do now, and I keep saying we, because my husband and I are both service officers, but what we do now Is that we're like I said before, we're advocating for the veterans rather than for the va. And it's a lot more personal. When I worked for the va, I worked file numbers. I had to work so many file numbers per day because. VA employees work on production. They're expected to meet a certain production level every day.

There was no time to think of the person behind that file number when I was working for the va. Whereas now I'm meeting with these people face to face. I am  sometimes holding their hand as they mourn the loss of their spouse or as they recount their MST story. And so it's a, it's just a lot more personal now doing what I do than it was when I worked in a cubicle in  a big building.

Never met with veterans at all. Yeah. It sounds very different.  And sounds what you're like, what you're doing now has a lot more meaning. It does. It does. Yeah. So you've mentioned that veterans are often served better by outside organizations, helping them through the VA's Bureaucracy. Why is that system so difficult to navigate? And what are some of the biggest misconceptions veterans have about getting their benefits approved?  VA disability claims are bound by law. So there's the 38 Code of Federal Regulations.  The CFR, it dictates how every condition that can be claimed by a veteran is adjudicated.

So the rating schedule is huge. I actually worked with, when I was working as a Raider for the va, I had a coworker who printed the rating schedule out because she liked looking at it in paper. It looked like three New York City phone books stacked on top of each other. I mean, It's just a huge amount of law that.

VA disability claims are bound by.  So in order to to rate the disabilities that the veterans claim, the process has to be as standardized as possible. Meaning every veteran in the country who files a claim for say migraines, goes to an examiner who has to complete the exact same disability benefits questionnaire for that condition so that when it gets to a rater, the same information is entered into the rating system to determine a percentage of disability.

So the law is very black and white. So that the process can be the same for all veterans across the country. But if you think about that, thousands, maybe hundreds of thousands of claims are in the system at any given time for veterans seeing examiners of all different backgrounds and credentials, there are some that are doctors, some that that are PAs, some nurse practitioners, and then to have.

Those claims be rated at regional offices all around the country by people with various levels of training and trying to keep every claim as true to the law of the rating schedule as possible.  It's just crazy.  There's so much human nature involved in that. Also, you get examiners who have never served in the military who feel that they need to be  good stewards of the American tax dollar, which is something I actually had said to me by a physical therapist once in San Diego.

   He told me that. I was talking to him about something with a claim of my own and he's like, well, you know, I do need to be a good steward of the American tax dollar. So he refused to write a letter for me because of that.  You get veterans who work for the VA who bring their own personal opinions into the claim process even though they're not supposed to.

So as an example of that, I've heard when I was working for the va, I've heard other. Employees who are veterans say things like, oh, not on my watch. Like they look at, they bring their own prejudices to the claim process. As far as misconceptions, there's a lot, but I think veteran, the, one of the biggest concept misconceptions I see is that veterans think once they've served in the military.

Anything that they get from that point on for the rest of their life is something that they can file a claim for. And that's not how it works. Mean. The basics of the claim process is they have to have had an event, injury, or illness in service. They have to have a current condition that they're being treated for, and then there has to be a nexus, connection.

Between those two things. So oftentimes we have to be the bad guys because a veteran will come to us saying  I just got diagnosed with sleep apnea. That's a big common one, but they've been out of the military for 15 years.   There's no way to connect that back to service. And then the other misconception that really makes that even more difficult is on the healthcare side of things, VA healthcare providers don't necessarily always know how the benefits side works.

So they'll diagnose a patient with something and say, oh, you should file a claim for that. Not realizing that it had, it has nothing to do with their service. So that is. A big part of what we do is we try to educate the veterans we work with on how the disability claims process works and what is required to be granted disability, because most of them don't understand how that process works.

Yeah, it's huge.  And that's just in our, previous conversations, I was shocked by how many individuals are impacted by this. So you, from your perspective on the front lines, what are some of the most common or serious health conditions? You did mention sleep apnea that you see impacting veterans today, and how do these issues differ between generations of service members?

The biggest health conditions are the Presumptives.  Most people now have heard of the PACT Act. It was a big deal that came out in 2022. But really even prior to the PACT Act, Vietnam veterans have had presumptive conditions for years based on their exposure to Agent Orange. They have a list of conditions that if at any time in their life they're diagnosed with these things, they can file a claim with the VA and be granted service connection.

 Examples would be like diabetes, high blood pressure, ischemic heart disease, and prostate cancer. Those are presumptive conditions for Agent Orange exposure. The PACT Act brought out a whole new list of presumptives for the younger veterans that served in the Gulf War.  The new Presumptives added, or for the people that were exposed to things like the burn pits, their list of presumptive conditions. In my opinion, and maybe this is more because I'm the spouse of somebody who has deployed five times since nine 11, but these conditions are really scary. There's so many cancers on the list for the Gulf War veterans.

Head to toe, just about any cancer you could get for those veterans. If they file a claim for it, they can get service connected because they were exposed to so many toxins.  Respiratory conditions like asthma, COPD, those are also presumptive conditions now from the burn pit exposure and considering how many military members deployed to those areas of the country in the last.

 25 years, there's a lot of really scary conditions out there that they can develop. So that's probably one of the biggest things right now are those presumptive conditions listed in the PACT Act.  generationally speaking, we still have Vietnam veterans that are filing  I've had Vietnam veterans get diagnosed with.

Prostate cancer, and they're in their eighties. They've been out of the military since you know, 1970s, but they still can file claims for those conditions and be granted service connection. Yeah, and it's good that you, they, you're bringing awareness to this because I think it's very important that they know this.

It's important because the list is really just scary. And, you know, I look at it and I look at my husband and if  if he twitches funny, I make him go to the doctor.  Yeah.   We talk a lot now in, in society about mental health awareness, but real change is slower to measure. I think there's a lot of stigma and there's a lot of other things   associated with mental health awareness.

So do you think we're making genuine progress in supporting the mental health of veterans? And what do you think? Needs to happen to make that care accessible and without stigma? Mental health is definitely a major issue in the veteran population. It always has been. Although we know that the older generation of veterans kept it hidden because there was so much negative stigma that went along with speaking up and saying, you need help.

I don't think that is as much of a problem now. I think veterans now have an easier time. Speaking up for themselves. They also have so many sources available through the VA besides just the mental health services. There's the veterans crisis line that's available 24 7 for veterans in crisis. The VA Medical Center here in Erie has crisis intervention and suicide prevention.

They have their psychiatry and psychology. They have great programs for homeless veterans  treatment for addictive disorders  residential rehabilitation treatment programs. There are employment services. There's a justice outreach service offered for veterans here in Erie. So there's a lot that I think a lot more maybe now than was available for veterans earlier.

And all of these help. Veterans who maybe have issues like PTSD find their way in the world that maybe doesn't understand the things they've seen and dealt with. And that's a big thing is most people don't talk about what they saw when they were. In a deployed location. So that makes it, if they don't talk about it, the people around them have no way of understand what they're understanding, what they're dealing with.

 If there's one thing that I think could improve for veterans, it's education for the civilian community. In my experience, I think there are too many people who don't bother to try to understand the veteran experience and how it leads to diagnoses like PTSD and how a veteran with that diagnosis is not crazy or a loose cannon.

I think that is. One of the biggest misconceptions on the civilian side about veterans is that a person can be perfectly functional, holding down a job, but they've got their own demons that they're dealing with. Yeah. Yes. And it's okay, right? You can still hold down a job and you can still have, be having a hard time with an experience that you had previously.

 Yeah, and I think that's true for anybody. Vet, not even just veterans,  if you've been fortunate enough to lead a completely trauma free life, wow, I'm happy for you. But most people have had something. Yes. Yeah. And they still have to go to work and pay bills and clean house and do all those things.

 Yeah. So you've said you've lived the military life yourself, soldier, spouse, mentor. Why do you think peer counseling and veteran to veteran support are often the most effective forms of healing and guidance? I think people are always more likely to feel comfortable with someone they can relate to. A great example of this is the Air Force Key Spouse Program.

When my husband and I were first married, he was still in the Army. The only other spouse I had to reach out to if something happened while he was in the field, was the commander's spouse. As a former enlisted person myself, I didn't necessarily feel comfortable talking to an officer's wife about a problem.

But after nine 11 when my husband and a lot of people from his squadron were deployed, I got involved with key spouse program. The idea behind it was to have spouses of airmen of all ranks lower, mid and high level enlisted to lower mid and high level officers available for other spouses in the squadron if they needed assistance.

An airman's wife who might be having issues, say with finances or something. If her husband was deployed, would probably feel more comfortable talking to the spouse of someone else of the same rank as her husband.  So this key spouse program, it offered that peer-to-peer kind of thing where you didn't have to call your husband's commander's wife if you had a problem.

And the key spouse program trained us all in. How to direct people to the right resources for what they need. That works for the veteran as well. Sometimes they need someone who isn't trying to treat them or analyze what they're going through. They just need someone who gets it. Someone who saw some of the things they saw or was in the same places.

My husband has a group of guys that he deployed with right after nine 11. These guys were together for seven months, right after this horrible attack happened on our country. I mean, this was really. New for everybody. They check in on each other. Now all of them are out of the military now, but they check in every few months.

They don't talk often.  But it's that small thing that means so much to each one of them to have that buddy out there that they can talk to and who gets it. Yeah, so very important in this area, especially with veterans.  I wanted to touch on military sexual trauma. It is as we previously talked about, one of the most painful and under-discussed challenges veterans face, and I'm gonna say under-discussed, what barriers do survivors still encounter when seeking help?

And how can we create safer, more supportive systems for them?

This one is definitely close to me.  As someone who experienced MST myself in the Army, I think the biggest barrier to treatment, and this will sound really funny, is the VA waiting room. I know that sounds weird  If you can imagine being a woman who was assaulted by a man in the military, you wanna get help.

You wanna talk to someone about the issue you were having, either occupationally or socially, because a certain type of man just triggers a response, a fight or flight response, whatever. Now, make that woman sit in a waiting room in the behavioral health department at the VA with various other men. If even one of those men reminds her of the person who assaulted her, the situation is now more, doing more harm than good.

But by the time she makes it into the therapist's office, she'll spend her entire hour talking about the waiting room experience more than anything else. So there are just so many veterans who have experienced MST, both women and men, and I think for them, for all of them, having separate waiting areas for treatment is vital.

The VA offers virtual therapy, which helps a great deal. But not every veteran lives near a VA medical center. They also offer  virtual groups. So peer support is there for veterans who want it without having to be face to face with strangers. But I think the biggest barrier is just finding that comfortable way to receive therapy.

 I've worked with, I've worked with numerous VE veterans filing MST claims. And most of them don't want to go talk to somebody face to face. They don't even wanna file the claim because they know part of the clean process is having to talk to somebody face to face. So I think that the VA would do really well if they created more comfortable spaces for people to go and receive help.

I know the waiting room idea sounds ridiculous, but it's amazing how much that. Environment before you go even get to someone to talk to can affect what you're feeling and what you're dealing with. I don't think it sounds ridiculous at all.  and I, I think that sounds wonderful in healthcare in general, right?

Let's create a comfortable environment for everybody, but especially in this case, when you, these individuals need that comfortable space to feel safe. And  I think it's, I think sounds great. So you've seen the system from both the inside and the outside. If you were in charge of redesigning the veterans benefits and healthcare system, what would you change first and what is your ideal future for veterans care look like? On the VA side of things. I would do away with, or at the very least, seriously overhaul the system they use to manage claims.

 Back around 20 15, 20 16, when I was working for the VA in San Diego, they began using a system called the National Work Queue. Prior to its implementation, claims were handled regionally. If a claim for disability was filed by a veteran in Erie, it would be worked at the Pittsburgh Regional Office from beginning to end.

Development to final adjudication, it would be handled in one location. But the problem with that was that some ROS would be overwhelmed because there are so many veterans in their region. Places like California, Texas, Florida would be really busy. But regional offices in places like Wyoming, Nebraska, or Vermont would be bored.

So the idea behind this national work queue was to spread the claims work evenly across the va. The problem with that system is it doesn't work the way it should because humans are using it.  Claims are entered into their system and given a suspense date for each action. Ideally, these suspenses keep the claim moving forward.

But remember I said VA employees work on production, so each employee based on what their job is, has a point expectation that they should meet every day. Different actions in the national work queue. Give a point to an employee. A claim assigned to an employee might have five different actions that can be taken, each of which would assign a point, but if the employee takes all five of those actions, they still only get one point.

So rather than spend the time it takes for all of those actions, the employee might just take one action. It might be  ordering personnel records or something. And then they move on to the next claim. That leaves all those other possible actions not done. And then the claim's gonna sit and wait 30 days until the national work queue drops it on another employee to do something.

So if you think about it,

if the employee does exactly what they should do and everything that they can do, a claim could get completed in. Three months. But because of this point, production expectation that these employees have, they're taking the minimum action to get their point and move on. Because if they don't make their points, they can lose their jobs.

So the claims process is now at the whim of people who are really just trying to keep their jobs.  So I can, you know, I can see this both sides. I remember the production expectation when I was a Raider was, it was so stressful. There were days when it was like, I'm not gonna make my points, I'm not gonna make my points.

That's taken away from those people being able to do right by these veterans that have filed the claims. That would be one of my first overhauls would be that national work queue, because it is just making the process take longer and longer. We have claims that, we file for veterans that take over a year, and it's just because there are so many different actions that need to be taken and the employees that are working the claims are taking the minimum possible.

So it's a just a broken system. On a healthcare side, I think the first thing I would change is what I mentioned earlier. I would separate women's health from men's at least on the behavioral health side of things. I think that it's important for those to be separate. I'd also create a program to educate VA providers on how the benefit side of the VA works.

I stated before, sometimes they'll tell people, you should file a claim for that because they think that. They're a veteran. They're being treated by the va, so they should be able to get VA disability. I definitely educate them on how the benefits process works and what the requirements are for VA disability so that they're not misleading their veterans and making us have to be the bad guys and educate them.

 As far as my ideal future for veteran.  It's probably a pipe dream, honestly, but I would love to see all sides of the va, the healthcare and the benefits side working together more understanding how each side works.  I'd like the non-veteran community to understand exactly what veterans have done for them.

 There's this old saying that says, you know, a veteran is someone who at one point in his life wrote a blank check, made payable to my country for an amount up to and including my life. I don't think that people really. See that as the big thing that it is.  The freedoms we all experience are in large part due to people who are willing to write that check, but I don't think it's appreciated as much as it has been in past eras of our country.

So I would love to have just an overall education for everyone on how the veterans benefits process works. I love that. And  you just, your words are inspiring. I'm so happy that there are people like you out there doing the work that you are doing. If people wanna get in touch with you, how can they do that?

  The easiest way to get in touch with me, probably by email It's shannonb@pa-legion.com. My husband and I work these jobs. They call us mobile service officers because we belong to an office that is in the VA Medical Center in Erie, but we don't ever actually work in that office.

We meet veterans out in the community more, so that's why email is the best way to get  of me, and then I can. Work with a veteran and figure out the most convenient place for us to meet up. And really that's the whole thing is just meet up, discuss what happened to you in the military, what do you have going on now that you think is, was caused by that event or injury or something in the service.

 And then we just go from there. I mean, We do our as our best to make it easy for the veteran. We do all the hard work, we fill out the forms, we. Watch the claims as they go through the process to make sure that the VA's doing their jobs right. That's the advantage of being ex VA employees, is that we can watch what they're doing and catch little things that maybe we can  talk to the VA employee and keep the claim on track.

 And just try and let the veterans sit back and relax and let us handle the, dirty work of it. Yeah, that's great and I hope you know, if anyone needs help out there, they'll reach out to you. Shannon Barry? Definitely. Yes. Shannon Barry, thank you so very much for being with us today. Thank you for having me.

It was, this has been fun. 

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.