July 31, 2025 • 62 mins
Jerome Spearman, accredited VA claims agent, shares his expertise on navigating the complex VA disability system and the future of veteran advocacy. As a veteran himself, Jerome brings a unique perspective combining military experience, nursing background, and passion for helping fellow veterans receive the benefits they deserve.
• The VA disability system faces significant challenges with a high denial rate for initial claims
• Creating clear, organized medical chronologies can help veterans present stronger claims
• Only 6 million out of 17 million veterans receive VA compensation benefits
• Gulf War veterans face unique challenges in navigating the claims process due to family and work responsibilities
• Many C&P examiners lack proper training or fail to exercise appropriate clinical judgment
• Veterans need to become their own advocates and approach claims with a strategic mindset
• Alternative treatments like acupuncture and massage therapy represent positive developments in VA healthcare
If you need assistance with your VA claim or want to discuss your situation, contact Jerome at Jerome@SpearmanAppeals.com.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Ray Cobb (00:00):
Good evening folks, and welcome to another broadcast
of Exposed Vet.
We're here tonight.
John Stacy's on the roadtraveling a little bit.
We've got a couple of folkssitting in with us.
I'm Ray Cobb, normally theco-host, and I guess I'm going
to kind of head things up alittle bit tonight.
But Bethany Spanberg, who'salso with Valor for Vet, is with
us, and Bethany, I think wehave a special guest with us as
(00:24):
well, don't we?
Bethanie Spangenberg (00:28):
Yes, we sure do.
So.
This is Jerome Spearman.
He is an accredited VA claimsagent and tonight he will be
talking to us about the futureof the VA claims process and his
opinion on how things arecoming and going and what to
expect.
Tonight I will replace John, ashe is living his best life and
(00:50):
today is Thursday, july 31st of2025.
Jerome, did you want to startby introducing yourself to
everyone?
Jerome Spearman (00:58):
Absolutely.
First of all, I always wantedto give gratitude for the
(01:20):
opportunity to be here, to speakwith you and to spend this time
and to be a voice in the darktunnels, if you will, of some of
the VA disability sides of thehouse.
Yeah, so my name is JeromeSpearman.
I believe that there's adifference between who I am and
what I do.
I am a proud graduate, first ofall, let me just say I'm a
(01:41):
proud son were Baptist ministers, and so if I happen to get a
little riled up about somethingthat I enjoy speaking about, I'm
just not going to apologize.
That's just who I am.
Second thing is I'm from theEast Coast, so we get a little.
We get a little riled up aswell of the Boulder Crest Path
Program, which is progressiveand alternative training for
(02:09):
helping heroes for those whosuffer from PTSD.
I am a graduate of thePermission to Start Dreaming
Foundation, which is PTSD, andwhat they do is they help
veterans and EMT individuals whoare first responders,
(02:29):
rediscover their mission andfind themselves, after perhaps
locking the door behind, whothey really are and experiencing
a newness of life.
So I'm very, very proud tofirst start there.
So I'm very, very proud tofirst start there.
(02:56):
That, through this program, hasallowed me to be here not a
number of the 22, but a numberamongst the veterans.
So, with that being said, whoelse?
Who am I?
I'm a proud husband to abeautiful wife, jessica.
I also have three amazing boysone who just graduated from
Hampton University in the fieldof marketing.
The second one is going intoWashington State University
studying criminal justice.
(03:18):
Hopefully he'll be able to playfootball this year for them.
And then my thirdeight-year-old, who will be nine
soon, is going into a languageemergent school, or is in a
language emergent school, andI'm very proud of him.
We just got back from CostaRica and he was speaking Spanish
and it was just awesome.
So that's just a broadintroduction of who I am.
(03:38):
I can go further with respectto what I do, but I could take a
brief moment there.
Bethanie Spangenberg (03:49):
Okay, I'm happy to hear you prefaced with
your Baptist background, becauseif you do get a little loud
I'll know where it's coming from.
So that's fun.
So I appreciate you sharingthat with us, so that's great
(04:15):
that you have all thisbackground.
Jerome Spearman (04:16):
The one thing you didn't mention is the
nursing background.
Did you want to talk a littlebit about that?
Not a nurse, what I do isnursing.
I am an advocate.
What I do is VA disabilityaccredited claims.
That's the job that I do.
But who I am is two separate,different things.
So anyway, yes, as a VAaccredited claims agent, I
(04:42):
primarily focus in on orthopedictype style conditions, but also
I'm a registered nurse.
I was trained in the army.
There was a funny story thatcomes along with that.
I, as my military background, Iwas in the United States Air
Force and the reserves back in95, and then got out of the Air
(05:05):
Force and went and worked onWall Street for a while, was
there for 9-11.
Talked to my aunt who was anurse 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 hadinterest in science but also
knew that I loved working withpeople and advancing them to the
(05:25):
best levels that they could bethrough management and things of
that nature.
So I took the plunge and wentto nursing school met Sergeant
First Class Lawrence, now PALawrence, major PA Lawrence, who
then introduced me to the Army,went over to Longstraw Regional
(05:49):
Medical Center, where that alsowas a pinnacle point that
changed my life, where we hadmet and I took care of service
members, marines, soldiers,contractors and seeing the kind
of things that I saw.
One, which was that most ofthese injured individuals, most
(06:13):
of these injured soldiers,service members, still had that
spree decor that, even though,in the situation that they were
in being injured, they werestill able to worry about their
people in the battle downrangeor about their battles on
different wards during theheight of both wars, but many of
(06:37):
them did not know that theirlives were about to be changed
and their military careers wereabout to be ended.
And so that led me to believethat I always wanted to be able
to advocate, for whatever I didwhen I got out of the military
was to be able to advocate forveterans.
I didn't know what it was, Ijust wanted to do it.
(07:00):
So, long story short, 2018, Ileft the military, got out of
the Army, a joint base, lewisMcCord, went right into the
reserves, found myself in amedical board because I had
challenges transitioning.
And then, from that perspective, I wondered what my life was
(07:22):
going to be about.
My wife was like bro, it'sgreat that you are medically
retired, but you can't just sitaround.
And I decided to embrace thatvision of taking care of
veterans and start my quest tobe an accredited claims agent.
(07:43):
That was in 2021.
As of last year, I finally satand took the exam, october 9th
2024, passed the exam and nowI'm coming up on my one-year
anniversary as a VA accreditedclaims agent.
So that's a brief background.
(08:05):
Sorry if I took so long, butit's just the Southern Baptist
coming out.
Bethanie Spangenberg (08:12):
No, that's okay.
I appreciate all theinformation.
I feel like in life, thingshappen to us individually and we
can use them as tools to helpthose around us, and it sounds
like you certainly have abackground that has placed you
in a position to be the bestadvocate for disabled veterans
(08:33):
through your experience.
So I think your story tells alot about why you are you're
here and why you're doing whatyou're doing.
So that's cool.
I love hearing that.
I love the story.
Jerome Spearman (08:46):
Thank you for that.
Bethanie Spangenberg (08:47):
Now you said that orthopedic cases are
your favorite.
Why is that?
A lot of veterans have hardtimes, gives ortho cases to be
more than just 10% or 0%.
So what's your perspective?
Jerome Spearman (09:00):
Well, one is because in the Army I was an OR
nurse and I always loved workingon those types of cases being
total knees, total hips,shoulders, all this.
So I was very familiar with theanatomy.
They're also very familiar withthe doctors.
I have a lot of friends who areradiologists and also
orthopedic guys From a VAperspective.
(09:22):
I think that there's mystrategy and my approach is, if
we can kind of work with some ofthe orthopedic conditions, such
as the back, right, the backcan have and can yield another
(09:43):
type of rating relative to theradiculopathy, and then we can
add on to there the bilateralfactors that come along with
that Right, and so I believethat there's there's a lot
that's available to to, to tokind of investigate there.
But that just opens the book tothe chapter.
And so what I found is that alot of veterans if you look at
the 2024 report, the topconditions that veterans have
(10:08):
are mostly orthopedic right Flatfeet or podiatry, ankles, knees
, blah, blah, blah hips.
To looking at the whole entireC file and exploring it from a
holistic perspective and saying,okay, so yeah, you have your
(10:30):
need only yields 10 to 20%.
There may be some other aspectswithin that need that we could
look at.
Perhaps you may have uh, you'retorn MCL right, or is it stable
right?
Is your?
Is your knee?
There's meniscus right.
There's ratings for meniscusright.
So there's different types ofratings that we can get involved
(10:53):
there.
As the mental health side of theclaim, what is your mental
health situations?
What have you seen?
If you've been in the militaryfor one day, specifically if
you've been through from thelistening side, if you were in
(11:16):
basic training, you've gonethrough some stuff that could
allude to other type of mentalhealth conditions, and just
military career and service initself can produce that.
So we look at it as a door.
I look at it as a doorway toattract veterans to be able to
look at their claim from anorthopedic perspective.
(11:36):
But it gives me the inside viewto do a holistic approach
beyond behavioral health downinto the general side of things.
So, okay, let's talk about yourGERD.
Do you have GERD?
Okay, great, let's talk aboutthat or other conditions that we
can connect the dots to.
So I'm not sure if I answeredyour question, but that's my
(11:58):
approach.
Bethanie Spangenberg (12:02):
Maybe the long route, but from what I'm
taking away is that you arecapable, because of your
experience in the medical side,that you're capable of looking
at the medical records andunderstanding where you can
gather more ratings and moreinformation to support that
veteran's claim.
Does that sound about right?
(12:26):
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 routeso you will have to bring me
back in.
So thank you for that.
But yeah, it's just the abilityto just to connect the medical
dots for a veteran so this waythey 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'reasking me okay, is my knee
condition related to service?
And so from a medical expertside, I do look at all their
current service connections andI see what happened in service,
(13:17):
how I could possibly tie theknee into these different
theories.
And so for you, you, you takethe holistic approach, so you're
, you're in it fully where Ilook at it almost piecemeal,
you're all in looking ateverything that they have and
connecting the dots in thatmanner.
So I think that's reallyvaluable.
Jerome Spearman (13:38):
Yeah, and I, and I think you know again,
bethany, you can't get mestarted about this because I'm
I'm I this, because I'm ready togo here.
But when we look at this right,and I failed to mention that,
(13:59):
while I was waiting to become aVA credit claims agent, I
studied to be a legal nurseconsultant and one of the great
things that I did with workingwith attorneys is, you know,
being able to make the storyclear.
The medical record is 7,000pages, you know, as you hand it
over to a VSO and he's like areyou kidding me?
I got to review, I don't have,I don't have time to review
7,000 pages to make this clear.
(14:20):
I think that with this, theskill sets of being able to, not
only as a nurse but from alegal nurse consultant
perspective, we take a look atthe whole entire medical record
and create the story for thatspecific condition, point in
case.
So let's just, we could justdeal with the knee for a second.
So, okay, this is when theinjury happened on January 1st.
(14:44):
On the 5th, he went and saw hisprimary care physician.
The primary physician sent himto, 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 themri?
Right?
And all of that is the keynuggets that I think a c&P
(15:04):
examiner hello, C&P examinerswould want to know, would want
to be able to look at in orderto quickly evaluate in a tabular
form this veteran.
And then also, the other aspectof it is if we can put it in a
timeline summary, where it isvisual versus table, then it
(15:25):
makes it even much more clearer.
So the point that I'm saying isthat we there's a change that
has to happen in VA disability.
There's a change that has tohappen.
We need to be able to provide,as advocates, clarity.
We need to provide clarity forthe system, because the system
(15:47):
is a bureaucratic system.
It's not designed to go throughall this paperwork although
they're creating some AItechnologies to do that but we
need to be able to provide thebest packet for the veterans,
because it means something to bea veteran.
I don't take that lightly Afterwhat I've seen in working in
(16:10):
Longstreet Regional MedicalCenter.
No, no, no, no, no, no.
And working with veterans,working with Vietnam veterans no
, they deserve that level ofservice.
And as advocates from VSOs andI'm talking to VSOs, to VA
credit claims agents, toattorneys we need to provide
(16:32):
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 withattorneys.
Now, a year later and you don'thave to give away your trade
secrets, but how are you usingthose tools that you learned to
make it better for the veteranand your clients, or your
(17:06):
veterans?
Jerome Spearman (17:09):
Well, there's a key.
There's a key document that Iuse and I'm more than happy to
share it.
It is called, and you can lookit up too it's called a medical
record chronology.
And so what a medical recordchronology helps a veteran.
And let me just take a stepback here.
Let me, can I, can I take astep back and just talk about
(17:30):
veterans for a second?
Uh, veterans are ones that Ifind that, as long as you give
them just a little nudge, alittle guidance, some light
clicks on and then they're ableto move forward.
But without that, sometimes inno guidance, they are out there
flapping, as we would say in theArmy.
(17:54):
So when I talk to veterans, Ihave that approach, which is on
the intake.
Let's do a holistic approach.
I'm coming from the top tobottom, although I specialize in
orthopedics and otherconditions.
As a registered nurse, I knowhow to look through the medical
record to pull pieces of thepuzzle out.
So I then, once we have ourreview, we review this with a.
(18:18):
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 notsure what software they're using
are putting their littlechronology Is all of the
information there.
(18:38):
Perhaps, maybe, maybe not.
In my year, I found that thechronology 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 beable to build packets for
(18:58):
veterans that has a chronology,a timeline, summary, and if
there is medical journals thatsupports what we're talking
about, for that supports thecase, then let's move forward
with it.
Bethanie Spangenberg (19:17):
Okay Now I would agree with you.
I have appreciated the C&Pexaminers putting out a timeline
, typically towards the top oftheir medical opinion or the top
of the queue that discusses it.
But it's not usually completefindings, like they denied
(19:37):
having foot pain at dischargeand then they denied having foot
pain X, y and Z, and so theyuse a lot of the negatives and
sometimes it's not even relevantto the timeline of the claim.
So I can see where you, as theadvocate, providing a separate
chronology to support theveteran's claim is valuable.
(19:59):
The other thing I don'tappreciate is in that chronology
summary they don't annotate keymarkers that the veteran may
express.
So if they're seen for aflare-up or if they're seen for
something else and the examinerhappens to annotate well, on
examination they had thesefindings relevant to that case
(20:23):
that examiner is not necessarilyannotating that in the
chronology, and so I find thatthe CMP examiners I don't know
what they're using either, but Ilike to see that chronology
because from the medical expertside I can attack it because I'm
like oh, you're missing this,you're missing this and this is
what the veteran's testimonysays.
Jerome Spearman (20:48):
Yeah, I agree, and that's where the knife hand
comes out, right, where we startto 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 ofthe VA claims process and that's
kind of what triggeredtonight's episode and what they
wanted, what John wanted to talkto you about.
Can you kind of give us an ideaof what that discussion was
(21:18):
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 intalking about the future.
What I see is, in my opinion,but my opinion of the future of
of the VA disability, not theprocess, but those who are
inside of the process.
(21:45):
There's a lot of changes thatare going on.
So let me set let which, 6million are receiving
(22:06):
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?
(22:28):
Oh, here we go.
450,000 new veterans have comeon the rolls, new rolls as of
2024.
So I'm just trying to paint thebackdrop to get the story for
you.
We have 17 million veterans.
We have 6 million that havereceiving compensation.
We have close to $457,000 thathave come on the rolls.
Last year, the VA has paid $152billion worth of payments and
(22:52):
compensation, to includeservice-connected death
compensation to veterans and ofthat 6 million we have about
61.4% of them are Gulf Warveterans, 23.4% are Vietnam
veterans, 14% are veterans whowere in this peacetime and then
(23:15):
less than 1% are Korean andWorld War II veterans.
So we have a situation whereveterans are coming into the
system.
The Gulf War veteran is nowtaking most of the type of
claims.
Then we have, you know, thesituation where 30% of those who
(23:41):
you know, according to a reportthat I read, get denied why.
So when I set it up like thatand I started to look at what is
the reason why they're gettingdenied, part of this is because
of, I believe, in my experiencein talking to some veterans and
my clients is because they justdon't know the process so they
(24:09):
go into it blindly.
And many of the Gulf Warveterans that I'm talking to
have perhaps and I know I'mtalking to advocates here, but
perhaps have lost some faith inthe accredited access or the
accredited advocates in a sensebecause of their experiences,
and so they have decided to goout on their own.
This is just my survey.
(24:30):
This is not a survey that ispublished anywhere.
This is my experience andtalking 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 thispuzzle of the VA disability and
I see that we have GWT veteranswho are now starting to lead the
(24:53):
way and we have a system whereyou have to come in and talk to
them.
You have to come in and talk toan advocate, spend an hour.
What is the?
How are we going to change withthe changing tides of the
global war on terror?
Veteran, who is a different typeof individual.
(25:13):
They some of them are working,some of them have, are married,
they have three or fourdifferent kids.
They are very active in theirkids' life because they may not
have been active while they wereon active duty.
So they have this time now todo that and they're working and
their wives are working.
So to take some time off to goand see somebody for an hour
(25:37):
that may not be there when theygot there, when they told them
they were supposed to be there,or to take some time off and to
get there and sit for threehours because the office is
backed up with six otherveterans, it doesn't sit well
with them.
They need flexibility, and sowhat I'm finding is that
(25:58):
veterans the ones that I'mtalking to would like to have
choice.
They would like to have somesort of a choice.
Now we can get into the creditclaims advocates and versus
sharks and all that kind ofstuff and I can give you global
war on terror and we have asystem that can't hold these
(26:32):
individuals such.
You know we have again 450,000are coming on the rolls every
this last year and they'relosing folks.
The VA is losing folks.
What does that mean for theveteran?
I believe that that means thatthey have to become their own
self-advocates because there's achanging in population with
(26:57):
that.
And I can stop there.
I can go a little further more,if you want.
We can go into advocacy, butthat'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 gotstarted in the Vietnam era.
That's when I came out.
But now I see a change.
I was on the phone today with agentleman for over an hour and
he is trying to—he's got realbad PTSD.
He got aggravated with the VAquit going to his counselor.
(27:35):
I convinced him to start back.
He's got his first appointmentgoing back in two weeks.
But at the same time, what I seeis that the VA laws the way
that I think it could workbetter, as the direction you
seem to be going, is that anagent like yourself should be
(27:56):
able to help the veteran firstgo around and receive some type
of a compensation for that.
If you did, then that meansthat these veterans who are
doing it on his own or countyservice officers, like we have
here in the state of Tennessee,they get four hours of training
every 90 days, which is notenough training to hardly wipe
(28:20):
their nose or their bottom.
You know you turn back aroundand they're making mistakes.
It causes veterans to makemistakes.
The veterans get rejected.
The last time I checked withthe state of Tennessee Veterans
Claims Service, we were having a96% denial rate on the first
goal round 96 percent.
(28:41):
And then, myself included, andI guarantee you, when I went for
my last claim of R2, you know Iknew exactly what had to be
done and had it crossed anddotted and everything else, and
I still had to get our friendAlex Graham to come on and help
me because it was to the pointwhere they just didn't even want
(29:06):
to listen to what the veteranhad to say, even though it was
printed off, highlighted, datedand submitted.
And you know, I mean, as Johnand Bethany could tell you, I
was the second case of AgentOrange exposure in the United
States and that sure wasn't easy.
(29:27):
You know, I had to know my rulesand my laws and go fight and go
all the way to the travelingboard, medical board at the time
, the time, and there wasn'tanyone that was allowed to help
me just due to the fact thatthey were agents and they
couldn't help you or if they did, they wasn't allowed to charge
(29:50):
for their services.
Do you think that needs to besomething 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 someform of that nature, but I think
that we would find morecredited agents that would be
(30:12):
willing to help a guy, for tworeasons.
Number one it would build therapport.
So if it did get to nine andyou got another year or two to
work on it, the back pay woulddefinitely be larger, but at the
same time he would becompensated for a little bit if
the veteran is approved thefirst go around, and that would
cut out a lot of this backlogfrom the get go all the way up
(30:35):
through the Board of Appeals.
You've hit like a stone.
Jerome Spearman (30:41):
Absolutely 100% .
I do agree that needs to beaddressed.
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 casesas well with him.
But to your point, 100%.
Now I have to say why.
(31:02):
Why is this system designedthis way?
Right, where the agent is notable to interact or can, but you
can't charge for that with theinitial claim.
I believe that that is somethingthat has caused other
individuals and other consultingcompanies to get into the game
(31:24):
and offer advice, and some ofthat advice may not necessarily
be according to CFR 38, partthree, four and all the other
different parts, as well as theUSC laws.
And then some of the otheradvice may not be great advice.
Medically, for example, I'veheard an individual I call them
(31:46):
the church of VA disabilitywhere they're all the gurus
online and they're saying onYouTube saying oh yeah, if you
want to change the settings onyour CPAP machine, just give me
a call, I'll teach you how to doit.
Absolutely not.
That is a no go.
We don't just change settings ona CPAP machine.
That requires an order.
So so what I'm saying to you isthat 100 percent, we need to be
(32:11):
able to.
The laws need to change and Ibelieve that I'm looking at some
of the legal congressionalhearings that we're moving in
that direction.
I hope we are moving in thatdirection because the reason why
there are so many denials, Ibelieve, is there's not enough
(32:32):
time in a day for someone toreally thoroughly look at the
record and to create claritywithin 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 Ithink it was Ray but I'm not
convinced that if agents orattorneys get involved from the
very beginning, that denial ratewould change a whole lot.
It may go from 96% to 90%.
(33:09):
And the reason I believe thatis because I believe that the
VA's way to balance the budgetis to force a veteran to appeal,
appeal, appeal, and so thenthat way the VA can limit how
much money they're putting outfor service connections.
And the reason I say that isbecause I would honestly say
(33:35):
probably 50% of the veteransthat we work with have all three
pillars that they need for aservice connection, and what
they are fighting is they arefighting the internal
administrative processors, likejust today.
(33:56):
Just today, I had a case wherethe veteran had all three
pillars he had an exposure inservice, he had a current
diagnosis and he had a positivenexus.
Well, three months after thatveteran was service connected,
the VA administrators went inand said, oh no, no, that
medical opinion wasn't goodenough, let's get a
(34:20):
clarification of their opinion,and then they severed the
benefits.
Now, this happened in 2022.
Excuse me, this happened in2020.
The veteran died in 2021, andthe widow is still fighting this
reversal of benefits.
(34:43):
They severed his benefitsbecause they said that the
medical opinion was not adequatethree months after they granted
service connection and so hehad all three pillars.
And then you know, there's alegal argument there.
But I believe that a lot of thedenials are coming from someone
, and there is people that Itrack at the VA and they've been
(35:06):
there for a long time and Ihear them speak and I hear the
numbers that they say in public,and then they go on the Hill
and then they completely reversewhat they said in public and
they have nothing to back uptheir bullshit.
So I believe, based on that,that their way of balancing
(35:30):
money is to deny the veteran andforce them into appeal.
I say all of that to say, youknow, maybe if we pay our
advocates up front a little bitmore, we may help improve that a
little bit.
But I'd be interested to seewhat 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 acouple different cans we can
get into if we want to open upworms, the cans of worms.
One is I think that within theVA they have so many new Raiders
that are there because theyhave the outflux right.
(36:12):
They've retired a lot of them.
One of my good friends,christopher Edwards, a retired
VA Raider friends, christopherEdwards, a retired VA raider,
was telling me about theexperiences that he had with
being asked to be retired and sothere's a lot of knowledge that
is left and we have youngerindividuals and they're just
hiring people.
(36:33):
Matter of fact, they reachedout to me when I retired from
the military and said hey, doyou want to become a raider?
No, I really want to advocateon another side of the house.
So anyway, you have theseyounger raiders and then they
rely on the C&P examiner.
So my question really is willit go down?
I don't know, but where arethey getting?
(36:55):
Nothing against my medicalprofessionals and all that great
stuff, but some of the opinions, some of the DBQs that I see,
I'm wondering where are theyusing their clinical judgment or
are they not using theirclinical judgment to make some
(37:16):
determinations in support of theveteran, and so there are some
that are very good C&P examinersand some that are not.
So what I'm trying tocommunicate is is that we have a
situation where the veteran islike here VSO, here or here
agent, or here attorney, here'sall my stuff, just go ahead and
(37:37):
handle it for me.
And then you have a C&Pexaminer's like, just go ahead
and handle it for me.
And then you have a cmpexaminer'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 Idon'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 theappeals, now the agents and
attorneys can come involved aswell as the, the vso's, and
(38:00):
we're trying to clean up whatwas there.
I think we need to have.
There needs to still be a shift, however, where we provide them
with the best foot forward andwith a strategy, and I think
that's what I'm trying tocommunicate.
Will it go down?
(38:35):
I can't, I don't know, but Ithink what we need to do is
educate veterans on a choice.
If veterans want to use anagent, veterans want to use a
disability attorney, they wantto use a consulting company that
is on them, but there has to bea logical and smart choice when
it comes to representation andalso following the claim.
So long story short, I don'tknow if it will turn around
(38:58):
Hopefully it would but I thinkthere'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 talka whole lot before this about my
previous experience, but I wasa C&P examiner in 2011 through
2013.
And when I left the VA, Istarted working with our VSO
because he would ask me to writenexus letters.
And then, in 2015, we formallyopened Valor for Vet it was
(39:31):
under a different name.
In 2016, we were approached bya major, major claim shark
company that was just a baby inits infancy and it's now large
and making lots of money andthere's a lot of questions that
(39:55):
surrounded that, surrounded that, but for us it wasn't the
ethical approach that I expectedin 2016.
And so my view is a little bitjaded.
When it comes to the claimsharks, because I have been
directly involved and I'vewatched it from the very
beginning and I've interactedwith those people from the very
beginning I do think that thereneeds to be a better system when
(40:20):
it comes to advocacy from thevery beginning, because if
somebody has skin in the game,they're going to dedicate more
time and energy and focus intothat individual, and I think
that carries a lot of value.
But since I have been in thisfor so long, the one thing that
(41:07):
I have preached since I went tothe dark side so the civilian
side is that our providers andmedical experts are not
appropriately trained andeducated on how to use the
verbiage, their brain and applythose clinical aspects.
We see a lot of verbiage likethere is no proof, there is no
causal connection, and inmedical school or PA school
you're taught about how to doyour job to prevent medical
malpractice claims, and medicalmalpractice claims are a
different legal standard thanthey are for compensation and
(41:29):
pension.
So when a clinician sits downto weigh the evidence, I don't
think they're applying theappropriate legal thought on how
to provide an opinion.
So I make a point to do the TMS, the talent management system,
(41:50):
which I think their contract'sgoing out now, but to redo those
compensation and pensionexaminer trainings on a regular
basis.
Now I'm only required to do itonce in a lifetime and I did it
clear back in 2011.
So I would never have to takethat again as a C&P examiner.
But I take it over and overagain because I want to see what
(42:12):
material they're teaching theseexaminers and I want to see how
they're explaining what theword nexus means and how to
listen to the veteran, and howto listen to the veteran and how
to weigh the testimony and howto weigh the buddy letters,
because that pertinentinformation is not in those
trainings.
And so still today I see a lotof new patterns of this copying
(42:36):
and pasting and I've talkedabout this before in the radio
show and it's like how does anexaminer for this veteran, word
for word, say the same thing ina veteran that has no physical
location anywhere near them?
But in that, when I was there,what I experienced was the
(42:56):
regional office would provide anemail to guide the C&P
clinicians on verbiage to use.
And so, because I saw thatfirsthand and I'm seeing similar
patterns now, I still believethat these email correspondence
on verbiage to use is reallysetting the tone for that
(43:21):
medical examiner's perspective.
So that tone is often not infavor of the veteran.
It's often teaching the wrongapplications 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 stillprevail, even beyond the
language?
You know what I mean.
Like, for example, I have notto give away you know situation
but say there's a, there's aveteran who is you know, has a,
(44:09):
had a uh calcaneal osteotomy andthen he had a fusion and they
and, and then they did a fusionwhich they put the, you know,
put the bones together, uh, andthen, um, he.
Then then we find that he had astatus post.
That was status post.
He filed status post calcanealosteotomy and things of that
nature and that surgical surgery.
But then he has a house valgus,he has a bunion and he has all
(44:32):
kind of foot deformities and allkind of arthritis that's going
on in his foot.
And when they looked at the DBQand literally he filed status
post calcaneus osteotomy, theydidn't, with a malunion,
malunion of the bone, of thecalcaneus bone, which is the
heel, and a nonunion of thecuboid bone, which is in his
(44:57):
foot.
And they checked, checked, no,but the operative report,
specifically in this particularcase, may have said failed
surgery.
So if it says a failed surgeryand you're looking at it as the
clinical professional.
(45:18):
Why wouldn't you put the piecesof the puzzle together and say
oh wait, I said that I read theoperative report that showed a
failed procedure and he has abone that did not come together
because of this procedure.
We should probably give him arating for that, I'm sorry, so
(45:43):
you know what I'm saying.
Wouldn't the clinical judgmentkind 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 toexplain something really quickly
, so give me just a second.
So yes, I absolutely hear youand I will tell you that, both
PA and nurse practitioner schoolI can't speak for medical
school, but my mother's a nursepractitioner and I sat in a lot
(46:14):
of her classes because I was inPA school at the same time, so
for me it was like extra studytime.
So from our clinical educationand training there is not a lot
of focus on gait changes andlower extremity changes during
ambulation.
I feel that there's two medicalprofessionals that are best to
(46:46):
discuss any type of gait changesand that's podiatrists, because
they focus on anything belowthe knee, so they're going to
look at the foot.
So for your guy with thecalcaneal issues, the cuboid
non-fusion, the hallux valgus,all that stuff, that is all
podiatry, that is their breadand butter.
The other people arephysiatrists, so your physical
medicine and rehabilitationdoctors.
They are trained just to thinkabout the nerves and the muscles
(47:15):
and the ligaments and how theyinteract, where, from a clinical
side, it's like well, there'sno proof that a non-union causes
any type of disability becauseit's, you know, whatever.
So I will tell you that Ispecifically have a gay analysis
book and I will use it todiscuss.
(47:36):
You know what things arepresent in that particular
veteran.
There is still not a lot ofresearch that is out there Like
like.
I have a textbook becausethat's educational from like
schools.
But when you go to like PubMedor you go to oh brain freeze,
there's another major medicalreference that we use but they
(48:01):
don't talk about gait changes.
That's not part of the researchthat they're doing.
And you have to actually lookat physical therapy textbooks.
You have to go and find thisliterature because you're not
going to be able to Google it,find it on PubMed or a lot of
these resources.
So we would typically use apodiatrist or a physiatrist when
(48:21):
it comes to those lowerextremity things.
So firsthand, my experience,especially with anything related
to the gait, is that it's notsomething that's a dedicated
discussion that we have in ourPA school, np school.
I will also say that aphysiatrist is trained to do a
(48:43):
gait analysis so they can watchsomebody walk down the hallway
and they can watch them comeback and they could tell you
everything that's internallyrotated, externally rotated,
where their source ofdysfunction is coming from and
all the accommodations thattheir body is making to adjust
for that.
And from the clinical side ofthings, when I was in the clinic
(49:06):
I would ask for a gait analysisbecause I used to do
occupational health.
So our physiatrist was right inthe next office and I would
refer somebody over there and Isaid, hey, can you, you, hey, I
find value in this gait analysis.
Can you just do one?
It takes them like two minutesand they describe it and it's
fascinating to see, but it'sjust not in the wheelhouse of
(49:27):
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 wasI hope I didn't hit any stuff on
your toes or anything and Iagree that there should be a
medical professional thatprovides that level of analysis.
Simple terminology, it's simplein the mean, from the clinical
(49:55):
side.
If the patient, if the veteran,is saying that they're filing
for a status post, which meansafter the surgery they had a
calcane, tried to union togetherand it failed, when we're, as a
(50:29):
, I would think, just from aclinical perspective, if you see
that that failed and he had two, he had two fusions, this
particular case may have had twofusions that did not fail.
Wouldn't we use our clinicaljudgments and say, hmm, let me
investigate and look more in therecord to see about the
operative report?
I may just be crazy, I don'tknow, 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 thoughtprocess was.
So I just they probably didn'tread the operative report, to be
honest.
Jerome Spearman (50:51):
They didn't, they said it was.
They read the operative reportand they said, oh yeah, no
fusions, no this, no this, noproblems with arthritis, he's
all good.
Meanwhile, this guy is limpinglimping anyway.
So so I just feel like there'sthere's there's a lot of changes
that need to happen, and Ithink one of the changes that I
think you know, we as, as youknow, as advocates is that
(51:14):
veterans are becoming more, arebecoming smarter, and they're
using AI to do it, and we, asadvocates and I know I've said a
bad word, you know a lot ofpeople may not like AI is here
to stay.
I don't think it's goinganywhere.
I think there's a lot ofproblems that we can get into
(51:35):
with it, but veterans are usingit and they're showing up in our
offices with reports.
So either we kind of you knowwe need to make sure that we
empower them with the rightinformation to help them along
their way.
Bethanie Spangenberg (51:55):
Now we've got about eight minutes left
here.
Ray, was there anything inparticular 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 youstarted talking about it, my
mind went back when you guyswere probably still in high
school, I guess, back into themid-70s, walt Disney came up
with the philosophy ofjust-in-time theory, and that
(52:26):
just-in-time theory was usedthat if you go to Disneyland or
Disney World and you're walkingor standing in line for an hour
and a half and every 10 minutesor 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
(52:47):
once.
Well, I think that to a certainextent, that same type of
theory is being used by the VAand you kind of touched on it,
bethany, when you talked abouthow to control their budget and
the amount of money they spendand I think they have found out
that if they deny veterans oninitial claims and things, after
(53:09):
two or three denials, they'regoing to get to the point that
they won't come back.
So that's money that they don'thave to pay, money they don't
have to ask Congress for.
So I think you may be exactlyon the right track, and you know
, I hate to think that.
I mean, I can remember usingthat back in the mid-'80s, when
(53:31):
I worked for a major corporation.
We had that same type of atheory and when you did a job
interview for a new person, whenthe first person looked at a
resume, that job was to throwout anything on that resume that
did not apply or would notencourage you to hire that
person.
The second person would look atit and they would do the same
(53:58):
thing.
The third person would look atit and their job was to say why
Not, why not, but why should Ihire this guy?
And then, if he passed to thatpoint, then he would start in on
the personal interviews.
But I think that's the samething that they're trying to do.
After a certain period of time,we don't like butting our heads
against the wall, so instead oftrying to learn how to go
(54:19):
around the wall or how to getover the wall, we just back off
and forget it.
And I know a lot of veteransthat have said that very thing.
I don't care, I'm not going tofile another claim, it's not
worth it, it's not worth my timeand my aggravation.
And they don't do it.
It's not worth it, it's notworth my time and my aggravation
.
Jerome Spearman (54:39):
And they don't do it.
I think, that goes with whatJerome was saying earlier.
No, please, please, bethany, goahead.
No, go ahead.
It's you, ladies, first.
Bethanie Spangenberg (54:51):
Well, that's kind of what you were
touching on earlier, becausethose 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 myexperiences with my clientele
and people in my community, whenthey hit that wall, though,
you're right, they're like I'mdone when I meet them and I
start talking to them about whata veteran really is and what
that really means and whatyou've been through in the
(55:28):
military, and kind of bring themback 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 themin the right way and give them
the tools to do it.
Many of them the clients thatI've talked to that are coming
to me now have tried to do thison their own, some very
(55:51):
successful and some that arehitting the wall, and they're
like before I, before I stop, Iwant to talk to you to see if
you can handle this, because I'mdone and take it on.
But if we provide them withenough strategy, upfront, it's
something about that kindling ofa fire that happens inside of
them that may take them.
(56:12):
I've seen it from myexperiences.
That takes them back to thosedays when they were on active
duty, where you had to do whatyou needed to do to make it work
with very little resources andstill get the mission done.
We in the military, we had anMD&B process, which is the
military decision making process.
One of the and I'll leave youwith this one of the main things
(56:33):
was commander's intent.
The other thing is course ofaction and a physical plan.
Within that process, veteransthey need to understand that
they are the commanders now.
What is your intent, what isyour goal?
And I'm speaking to veteransright now.
We as the staff help you withthe courses of action, but if
(56:56):
you don't know, as a veteran,what that issue is, what your
mission is, what you want to gofor, how can you expect others
to really help you in thatprocess?
Become your own commander andhave your own intent.
The rest will happen with theright type of strategy with the
(57:17):
right type of advocates, I agree.
Bethanie Spangenberg (57:19):
Now.
We've spent a lot of timetalking about the brokenness of
the VA and maybe both Ray andJerome can provide their opinion
on this but what is somethingthat 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 wantto go?
Yeah, go ahead.
I've got to think hard on thatone.
I can only speak from mypersonal, personal experience.
When I left the military, I hadchallenges with my transition.
It did not go well, recognizedthat something was wrong.
(57:59):
My wife told me you got to goget seen.
I went to the VA, went to theER, met with a gentleman by the
name of Marcus and he was ableto let me know that I had some
challenges that I needed to getfixed or else my wife and family
(58:20):
would probably be gone.
And had he not intervened atthat point in time, I don't know
if I would have probably beenhere.
What I can say about myexperiences is that the VA has
done me very well with respectto behavioral health services,
(58:43):
and here in Washington I don'tknow about around the country,
but here in Washington they havedefinitely supported that.
The other thing that I thinkthey're doing is getting
involved with other alternativemedicines acupuncture, massage
and other things like that thatcan help veterans and decrease
some of the consistency anddependency on opioids.
(59:03):
I think that's one thing thatthey are doing pretty well in my
region, the regional office.
That may there's somechallenges 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 wouldonly live to be 65, and they
hope to keep me alive longerthan that.
Well, they've done that Withgood medical care.
This last year I turned 76.
So as far as the medical carethat I'm getting, compared to
what they had estimated my lifeexpectancy to be when I was 50
(01:00:03):
because of Agent Orange exposure, they've done a great job.
Bethanie Spangenberg (01:00:10):
That's good.
I'm glad you're here, Ray.
Ray Cobb (01:00:14):
Yeah, good to be, here .
Jerome Spearman (01:00:18):
What about you, Bethany?
Bethanie Spangenberg (01:00:19):
So Jerome.
Jerome Spearman (01:00:20):
Can I ask that oh?
Bethanie Spangenberg (01:00:26):
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 thoseimplemented within the VA health
care, because I'm of the beliefthat we can't just take care of
(01:00:47):
our body as a system.
We have to take care of ourbodies as a whole, so we don't
just treat, you know, oneendocrinology system.
You really have to look at yourmental health, your overall
well-being, in order to be ahealthy individual.
So I'm glad to see that theyhave those alternative
(01:01:07):
treatments in there.
Jerome, I want to give you, youknow, your time to put a
commercial out there for us andlet us know how we can contact
you and all that goodinformation.
Jerome Spearman (01:01:23):
And honestly there really isn't a.
This whole, this whole entireinterview and just discussion
and podcast has just beenenlightening to me.
I'm very happy to be here tojust share my thoughts and you
allow me to ramble on and on andon about my thoughts about this
(01:01:43):
.
If there's anyone who justneeds to just talk or you want
to have a discussion about whatwe do further, just send me an
email.
It's very simple and easyJerome at Spearman Appeals dot
com.
Jerome at Spearman Appeals dotcom.
And let's just keep it there.
Bethanie Spangenberg (01:02:07):
All right, did you want to close us out?
Ray Cobb (01:02:11):
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, johnand all of us will be back again
next week with another show.
And on behalf of Bethany andJerome, this is Ray Cobb signing
off and saying y'all have agreat week.
Jerome Spearman (01:02:34):
Bye.
Good evening folks, and welcome to another broadcast
of Exposed Vet.
We're here tonight.
John Stacy's on the roadtraveling a little bit.
We've got a couple of folkssitting in with us.
I'm Ray Cobb, normally theco-host, and I guess I'm going
to kind of head things up alittle bit tonight.
But Bethany Spanberg, who'salso with Valor for Vet, is with
us, and Bethany, I think wehave a special guest with us as
(00:24):
well, don't we?
Bethanie Spangenberg (00:28):
Yes, we sure do.
So.
This is Jerome Spearman.
He is an accredited VA claimsagent and tonight he will be
talking to us about the futureof the VA claims process and his
opinion on how things arecoming and going and what to
expect.
Tonight I will replace John, ashe is living his best life and
(00:50):
today is Thursday, july 31st of2025.
Jerome, did you want to startby introducing yourself to
everyone?
Jerome Spearman (00:58):
Absolutely.
First of all, I always wantedto give gratitude for the
(01:20):
opportunity to be here, to speakwith you and to spend this time
and to be a voice in the darktunnels, if you will, of some of
the VA disability sides of thehouse.
Yeah, so my name is JeromeSpearman.
I believe that there's adifference between who I am and
what I do.
I am a proud graduate, first ofall, let me just say I'm a
(01:41):
proud son were Baptist ministers, and so if I happen to get a
little riled up about somethingthat I enjoy speaking about, I'm
just not going to apologize.
That's just who I am.
Second thing is I'm from theEast Coast, so we get a little.
We get a little riled up aswell of the Boulder Crest Path
Program, which is progressiveand alternative training for
(02:09):
helping heroes for those whosuffer from PTSD.
I am a graduate of thePermission to Start Dreaming
Foundation, which is PTSD, andwhat they do is they help
veterans and EMT individuals whoare first responders,
(02:29):
rediscover their mission andfind themselves, after perhaps
locking the door behind, whothey really are and experiencing
a newness of life.
So I'm very, very proud tofirst start there.
So I'm very, very proud tofirst start there.
(02:56):
That, through this program, hasallowed me to be here not a
number of the 22, but a numberamongst the veterans.
So, with that being said, whoelse?
Who am I?
I'm a proud husband to abeautiful wife, jessica.
I also have three amazing boysone who just graduated from
Hampton University in the fieldof marketing.
The second one is going intoWashington State University
studying criminal justice.
(03:18):
Hopefully he'll be able to playfootball this year for them.
And then my thirdeight-year-old, who will be nine
soon, is going into a languageemergent school, or is in a
language emergent school, andI'm very proud of him.
We just got back from CostaRica and he was speaking Spanish
and it was just awesome.
So that's just a broadintroduction of who I am.
(03:38):
I can go further with respectto what I do, but I could take a
brief moment there.
Bethanie Spangenberg (03:49):
Okay, I'm happy to hear you prefaced with
your Baptist background, becauseif you do get a little loud
I'll know where it's coming from.
So that's fun.
So I appreciate you sharingthat with us, so that's great
(04:15):
that you have all thisbackground.
Jerome Spearman (04:16):
The one thing you didn't mention is the
nursing background.
Did you want to talk a littlebit about that?
Not a nurse, what I do isnursing.
I am an advocate.
What I do is VA disabilityaccredited claims.
That's the job that I do.
But who I am is two separate,different things.
So anyway, yes, as a VAaccredited claims agent, I
(04:42):
primarily focus in on orthopedictype style conditions, but also
I'm a registered nurse.
I was trained in the army.
There was a funny story thatcomes along with that.
I, as my military background, Iwas in the United States Air
Force and the reserves back in95, and then got out of the Air
(05:05):
Force and went and worked onWall Street for a while, was
there for 9-11.
Talked to my aunt who was anurse 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 hadinterest in science but also
knew that I loved working withpeople and advancing them to the
(05:25):
best levels that they could bethrough management and things of
that nature.
So I took the plunge and wentto nursing school met Sergeant
First Class Lawrence, now PALawrence, major PA Lawrence, who
then introduced me to the Army,went over to Longstraw Regional
(05:49):
Medical Center, where that alsowas a pinnacle point that
changed my life, where we hadmet and I took care of service
members, marines, soldiers,contractors and seeing the kind
of things that I saw.
One, which was that most ofthese injured individuals, most
(06:13):
of these injured soldiers,service members, still had that
spree decor that, even though,in the situation that they were
in being injured, they werestill able to worry about their
people in the battle downrangeor about their battles on
different wards during theheight of both wars, but many of
(06:37):
them did not know that theirlives were about to be changed
and their military careers wereabout to be ended.
And so that led me to believethat I always wanted to be able
to advocate, for whatever I didwhen I got out of the military
was to be able to advocate forveterans.
I didn't know what it was, Ijust wanted to do it.
(07:00):
So, long story short, 2018, Ileft the military, got out of
the Army, a joint base, lewisMcCord, went right into the
reserves, found myself in amedical board because I had
challenges transitioning.
And then, from that perspective, I wondered what my life was
(07:22):
going to be about.
My wife was like bro, it'sgreat that you are medically
retired, but you can't just sitaround.
And I decided to embrace thatvision of taking care of
veterans and start my quest tobe an accredited claims agent.
(07:43):
That was in 2021.
As of last year, I finally satand took the exam, october 9th
2024, passed the exam and nowI'm coming up on my one-year
anniversary as a VA accreditedclaims agent.
So that's a brief background.
(08:05):
Sorry if I took so long, butit's just the Southern Baptist
coming out.
Bethanie Spangenberg (08:12):
No, that's okay.
I appreciate all theinformation.
I feel like in life, thingshappen to us individually and we
can use them as tools to helpthose around us, and it sounds
like you certainly have abackground that has placed you
in a position to be the bestadvocate for disabled veterans
(08:33):
through your experience.
So I think your story tells alot about why you are you're
here and why you're doing whatyou're doing.
So that's cool.
I love hearing that.
I love the story.
Jerome Spearman (08:46):
Thank you for that.
Bethanie Spangenberg (08:47):
Now you said that orthopedic cases are
your favorite.
Why is that?
A lot of veterans have hardtimes, gives ortho cases to be
more than just 10% or 0%.
So what's your perspective?
Jerome Spearman (09:00):
Well, one is because in the Army I was an OR
nurse and I always loved workingon those types of cases being
total knees, total hips,shoulders, all this.
So I was very familiar with theanatomy.
They're also very familiar withthe doctors.
I have a lot of friends who areradiologists and also
orthopedic guys From a VAperspective.
(09:22):
I think that there's mystrategy and my approach is, if
we can kind of work with some ofthe orthopedic conditions, such
as the back, right, the backcan have and can yield another
(09:43):
type of rating relative to theradiculopathy, and then we can
add on to there the bilateralfactors that come along with
that Right, and so I believethat there's there's a lot
that's available to to, to tokind of investigate there.
But that just opens the book tothe chapter.
And so what I found is that alot of veterans if you look at
the 2024 report, the topconditions that veterans have
(10:08):
are mostly orthopedic right Flatfeet or podiatry, ankles, knees
, blah, blah, blah hips.
To looking at the whole entireC file and exploring it from a
holistic perspective and saying,okay, so yeah, you have your
(10:30):
need only yields 10 to 20%.
There may be some other aspectswithin that need that we could
look at.
Perhaps you may have uh, you'retorn MCL right, or is it stable
right?
Is your?
Is your knee?
There's meniscus right.
There's ratings for meniscusright.
So there's different types ofratings that we can get involved
(10:53):
there.
As the mental health side of theclaim, what is your mental
health situations?
What have you seen?
If you've been in the militaryfor one day, specifically if
you've been through from thelistening side, if you were in
(11:16):
basic training, you've gonethrough some stuff that could
allude to other type of mentalhealth conditions, and just
military career and service initself can produce that.
So we look at it as a door.
I look at it as a doorway toattract veterans to be able to
look at their claim from anorthopedic perspective.
(11:36):
But it gives me the inside viewto do a holistic approach
beyond behavioral health downinto the general side of things.
So, okay, let's talk about yourGERD.
Do you have GERD?
Okay, great, let's talk aboutthat or other conditions that we
can connect the dots to.
So I'm not sure if I answeredyour question, but that's my
(11:58):
approach.
Bethanie Spangenberg (12:02):
Maybe the long route, but from what I'm
taking away is that you arecapable, because of your
experience in the medical side,that you're capable of looking
at the medical records andunderstanding where you can
gather more ratings and moreinformation to support that
veteran's claim.
Does that sound about right?
(12:26):
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 routeso you will have to bring me
back in.
So thank you for that.
But yeah, it's just the abilityto just to connect the medical
dots for a veteran so this waythey 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'reasking me okay, is my knee
condition related to service?
And so from a medical expertside, I do look at all their
current service connections andI see what happened in service,
(13:17):
how I could possibly tie theknee into these different
theories.
And so for you, you, you takethe holistic approach, so you're
, you're in it fully where Ilook at it almost piecemeal,
you're all in looking ateverything that they have and
connecting the dots in thatmanner.
So I think that's reallyvaluable.
Jerome Spearman (13:38):
Yeah, and I, and I think you know again,
bethany, you can't get mestarted about this because I'm
I'm I this, because I'm ready togo here.
But when we look at this right,and I failed to mention that,
(13:59):
while I was waiting to become aVA credit claims agent, I
studied to be a legal nurseconsultant and one of the great
things that I did with workingwith attorneys is, you know,
being able to make the storyclear.
The medical record is 7,000pages, you know, as you hand it
over to a VSO and he's like areyou kidding me?
I got to review, I don't have,I don't have time to review
7,000 pages to make this clear.
(14:20):
I think that with this, theskill sets of being able to, not
only as a nurse but from alegal nurse consultant
perspective, we take a look atthe whole entire medical record
and create the story for thatspecific condition, point in
case.
So let's just, we could justdeal with the knee for a second.
So, okay, this is when theinjury happened on January 1st.
(14:44):
On the 5th, he went and saw hisprimary care physician.
The primary physician sent himto, 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 themri?
Right?
And all of that is the keynuggets that I think a c&P
(15:04):
examiner hello, C&P examinerswould want to know, would want
to be able to look at in orderto quickly evaluate in a tabular
form this veteran.
And then also, the other aspectof it is if we can put it in a
timeline summary, where it isvisual versus table, then it
(15:25):
makes it even much more clearer.
So the point that I'm saying isthat we there's a change that
has to happen in VA disability.
There's a change that has tohappen.
We need to be able to provide,as advocates, clarity.
We need to provide clarity forthe system, because the system
(15:47):
is a bureaucratic system.
It's not designed to go throughall this paperwork although
they're creating some AItechnologies to do that but we
need to be able to provide thebest packet for the veterans,
because it means something to bea veteran.
I don't take that lightly Afterwhat I've seen in working in
(16:10):
Longstreet Regional MedicalCenter.
No, no, no, no, no, no.
And working with veterans,working with Vietnam veterans no
, they deserve that level ofservice.
And as advocates from VSOs andI'm talking to VSOs, to VA
credit claims agents, toattorneys we need to provide
(16:32):
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 withattorneys.
Now, a year later and you don'thave to give away your trade
secrets, but how are you usingthose tools that you learned to
make it better for the veteranand your clients, or your
(17:06):
veterans?
Jerome Spearman (17:09):
Well, there's a key.
There's a key document that Iuse and I'm more than happy to
share it.
It is called, and you can lookit up too it's called a medical
record chronology.
And so what a medical recordchronology helps a veteran.
And let me just take a stepback here.
Let me, can I, can I take astep back and just talk about
(17:30):
veterans for a second?
Uh, veterans are ones that Ifind that, as long as you give
them just a little nudge, alittle guidance, some light
clicks on and then they're ableto move forward.
But without that, sometimes inno guidance, they are out there
flapping, as we would say in theArmy.
(17:54):
So when I talk to veterans, Ihave that approach, which is on
the intake.
Let's do a holistic approach.
I'm coming from the top tobottom, although I specialize in
orthopedics and otherconditions.
As a registered nurse, I knowhow to look through the medical
record to pull pieces of thepuzzle out.
So I then, once we have ourreview, we review this with a.
(18:18):
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 notsure what software they're using
are putting their littlechronology Is all of the
information there.
(18:38):
Perhaps, maybe, maybe not.
In my year, I found that thechronology 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 beable to build packets for
(18:58):
veterans that has a chronology,a timeline, summary, and if
there is medical journals thatsupports what we're talking
about, for that supports thecase, then let's move forward
with it.
Bethanie Spangenberg (19:17):
Okay Now I would agree with you.
I have appreciated the C&Pexaminers putting out a timeline
, typically towards the top oftheir medical opinion or the top
of the queue that discusses it.
But it's not usually completefindings, like they denied
(19:37):
having foot pain at dischargeand then they denied having foot
pain X, y and Z, and so theyuse a lot of the negatives and
sometimes it's not even relevantto the timeline of the claim.
So I can see where you, as theadvocate, providing a separate
chronology to support theveteran's claim is valuable.
(19:59):
The other thing I don'tappreciate is in that chronology
summary they don't annotate keymarkers that the veteran may
express.
So if they're seen for aflare-up or if they're seen for
something else and the examinerhappens to annotate well, on
examination they had thesefindings relevant to that case
(20:23):
that examiner is not necessarilyannotating that in the
chronology, and so I find thatthe CMP examiners I don't know
what they're using either, but Ilike to see that chronology
because from the medical expertside I can attack it because I'm
like oh, you're missing this,you're missing this and this is
what the veteran's testimonysays.
Jerome Spearman (20:48):
Yeah, I agree, and that's where the knife hand
comes out, right, where we startto 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 ofthe VA claims process and that's
kind of what triggeredtonight's episode and what they
wanted, what John wanted to talkto you about.
Can you kind of give us an ideaof what that discussion was
(21:18):
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 intalking about the future.
What I see is, in my opinion,but my opinion of the future of
of the VA disability, not theprocess, but those who are
inside of the process.
(21:45):
There's a lot of changes thatare going on.
So let me set let which, 6million are receiving
(22:06):
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?
(22:28):
Oh, here we go.
450,000 new veterans have comeon the rolls, new rolls as of
2024.
So I'm just trying to paint thebackdrop to get the story for
you.
We have 17 million veterans.
We have 6 million that havereceiving compensation.
We have close to $457,000 thathave come on the rolls.
Last year, the VA has paid $152billion worth of payments and
(22:52):
compensation, to includeservice-connected death
compensation to veterans and ofthat 6 million we have about
61.4% of them are Gulf Warveterans, 23.4% are Vietnam
veterans, 14% are veterans whowere in this peacetime and then
(23:15):
less than 1% are Korean andWorld War II veterans.
So we have a situation whereveterans are coming into the
system.
The Gulf War veteran is nowtaking most of the type of
claims.
Then we have, you know, thesituation where 30% of those who
(23:41):
you know, according to a reportthat I read, get denied why.
So when I set it up like thatand I started to look at what is
the reason why they're gettingdenied, part of this is because
of, I believe, in my experiencein talking to some veterans and
my clients is because they justdon't know the process so they
(24:09):
go into it blindly.
And many of the Gulf Warveterans that I'm talking to
have perhaps and I know I'mtalking to advocates here, but
perhaps have lost some faith inthe accredited access or the
accredited advocates in a sensebecause of their experiences,
and so they have decided to goout on their own.
This is just my survey.
(24:30):
This is not a survey that ispublished anywhere.
This is my experience andtalking 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 thispuzzle of the VA disability and
I see that we have GWT veteranswho are now starting to lead the
(24:53):
way and we have a system whereyou have to come in and talk to
them.
You have to come in and talk toan advocate, spend an hour.
What is the?
How are we going to change withthe changing tides of the
global war on terror?
Veteran, who is a different typeof individual.
(25:13):
They some of them are working,some of them have, are married,
they have three or fourdifferent kids.
They are very active in theirkids' life because they may not
have been active while they wereon active duty.
So they have this time now todo that and they're working and
their wives are working.
So to take some time off to goand see somebody for an hour
(25:37):
that may not be there when theygot there, when they told them
they were supposed to be there,or to take some time off and to
get there and sit for threehours because the office is
backed up with six otherveterans, it doesn't sit well
with them.
They need flexibility, and sowhat I'm finding is that
(25:58):
veterans the ones that I'mtalking to would like to have
choice.
They would like to have somesort of a choice.
Now we can get into the creditclaims advocates and versus
sharks and all that kind ofstuff and I can give you global
war on terror and we have asystem that can't hold these
(26:32):
individuals such.
You know we have again 450,000are coming on the rolls every
this last year and they'relosing folks.
The VA is losing folks.
What does that mean for theveteran?
I believe that that means thatthey have to become their own
self-advocates because there's achanging in population with
(26:57):
that.
And I can stop there.
I can go a little further more,if you want.
We can go into advocacy, butthat'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 gotstarted in the Vietnam era.
That's when I came out.
But now I see a change.
I was on the phone today with agentleman for over an hour and
he is trying to—he's got realbad PTSD.
He got aggravated with the VAquit going to his counselor.
(27:35):
I convinced him to start back.
He's got his first appointmentgoing back in two weeks.
But at the same time, what I seeis that the VA laws the way
that I think it could workbetter, as the direction you
seem to be going, is that anagent like yourself should be
(27:56):
able to help the veteran firstgo around and receive some type
of a compensation for that.
If you did, then that meansthat these veterans who are
doing it on his own or countyservice officers, like we have
here in the state of Tennessee,they get four hours of training
every 90 days, which is notenough training to hardly wipe
(28:20):
their nose or their bottom.
You know you turn back aroundand they're making mistakes.
It causes veterans to makemistakes.
The veterans get rejected.
The last time I checked withthe state of Tennessee Veterans
Claims Service, we were having a96% denial rate on the first
goal round 96 percent.
(28:41):
And then, myself included, andI guarantee you, when I went for
my last claim of R2, you know Iknew exactly what had to be
done and had it crossed anddotted and everything else, and
I still had to get our friendAlex Graham to come on and help
me because it was to the pointwhere they just didn't even want
(29:06):
to listen to what the veteranhad to say, even though it was
printed off, highlighted, datedand submitted.
And you know, I mean, as Johnand Bethany could tell you, I
was the second case of AgentOrange exposure in the United
States and that sure wasn't easy.
(29:27):
You know, I had to know my rulesand my laws and go fight and go
all the way to the travelingboard, medical board at the time
, the time, and there wasn'tanyone that was allowed to help
me just due to the fact thatthey were agents and they
couldn't help you or if they did, they wasn't allowed to charge
(29:50):
for their services.
Do you think that needs to besomething 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 someform of that nature, but I think
that we would find morecredited agents that would be
(30:12):
willing to help a guy, for tworeasons.
Number one it would build therapport.
So if it did get to nine andyou got another year or two to
work on it, the back pay woulddefinitely be larger, but at the
same time he would becompensated for a little bit if
the veteran is approved thefirst go around, and that would
cut out a lot of this backlogfrom the get go all the way up
(30:35):
through the Board of Appeals.
You've hit like a stone.
Jerome Spearman (30:41):
Absolutely 100% .
I do agree that needs to beaddressed.
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 casesas well with him.
But to your point, 100%.
Now I have to say why.
(31:02):
Why is this system designedthis way?
Right, where the agent is notable to interact or can, but you
can't charge for that with theinitial claim.
I believe that that is somethingthat has caused other
individuals and other consultingcompanies to get into the game
(31:24):
and offer advice, and some ofthat advice may not necessarily
be according to CFR 38, partthree, four and all the other
different parts, as well as theUSC laws.
And then some of the otheradvice may not be great advice.
Medically, for example, I'veheard an individual I call them
(31:46):
the church of VA disabilitywhere they're all the gurus
online and they're saying onYouTube saying oh yeah, if you
want to change the settings onyour CPAP machine, just give me
a call, I'll teach you how to doit.
Absolutely not.
That is a no go.
We don't just change settings ona CPAP machine.
That requires an order.
So so what I'm saying to you isthat 100 percent, we need to be
(32:11):
able to.
The laws need to change and Ibelieve that I'm looking at some
of the legal congressionalhearings that we're moving in
that direction.
I hope we are moving in thatdirection because the reason why
there are so many denials, Ibelieve, is there's not enough
(32:32):
time in a day for someone toreally thoroughly look at the
record and to create claritywithin 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 Ithink it was Ray but I'm not
convinced that if agents orattorneys get involved from the
very beginning, that denial ratewould change a whole lot.
It may go from 96% to 90%.
(33:09):
And the reason I believe thatis because I believe that the
VA's way to balance the budgetis to force a veteran to appeal,
appeal, appeal, and so thenthat way the VA can limit how
much money they're putting outfor service connections.
And the reason I say that isbecause I would honestly say
(33:35):
probably 50% of the veteransthat we work with have all three
pillars that they need for aservice connection, and what
they are fighting is they arefighting the internal
administrative processors, likejust today.
(33:56):
Just today, I had a case wherethe veteran had all three
pillars he had an exposure inservice, he had a current
diagnosis and he had a positivenexus.
Well, three months after thatveteran was service connected,
the VA administrators went inand said, oh no, no, that
medical opinion wasn't goodenough, let's get a
(34:20):
clarification of their opinion,and then they severed the
benefits.
Now, this happened in 2022.
Excuse me, this happened in2020.
The veteran died in 2021, andthe widow is still fighting this
reversal of benefits.
(34:43):
They severed his benefitsbecause they said that the
medical opinion was not adequatethree months after they granted
service connection and so hehad all three pillars.
And then you know, there's alegal argument there.
But I believe that a lot of thedenials are coming from someone
, and there is people that Itrack at the VA and they've been
(35:06):
there for a long time and Ihear them speak and I hear the
numbers that they say in public,and then they go on the Hill
and then they completely reversewhat they said in public and
they have nothing to back uptheir bullshit.
So I believe, based on that,that their way of balancing
(35:30):
money is to deny the veteran andforce them into appeal.
I say all of that to say, youknow, maybe if we pay our
advocates up front a little bitmore, we may help improve that a
little bit.
But I'd be interested to seewhat 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 acouple different cans we can
get into if we want to open upworms, the cans of worms.
One is I think that within theVA they have so many new Raiders
that are there because theyhave the outflux right.
(36:12):
They've retired a lot of them.
One of my good friends,christopher Edwards, a retired
VA Raider friends, christopherEdwards, a retired VA raider,
was telling me about theexperiences that he had with
being asked to be retired and sothere's a lot of knowledge that
is left and we have youngerindividuals and they're just
hiring people.
(36:33):
Matter of fact, they reachedout to me when I retired from
the military and said hey, doyou want to become a raider?
No, I really want to advocateon another side of the house.
So anyway, you have theseyounger raiders and then they
rely on the C&P examiner.
So my question really is willit go down?
I don't know, but where arethey getting?
(36:55):
Nothing against my medicalprofessionals and all that great
stuff, but some of the opinions, some of the DBQs that I see,
I'm wondering where are theyusing their clinical judgment or
are they not using theirclinical judgment to make some
(37:16):
determinations in support of theveteran, and so there are some
that are very good C&P examinersand some that are not.
So what I'm trying tocommunicate is is that we have a
situation where the veteran islike here VSO, here or here
agent, or here attorney, here'sall my stuff, just go ahead and
(37:37):
handle it for me.
And then you have a C&Pexaminer's like, just go ahead
and handle it for me.
And then you have a cmpexaminer'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 Idon'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 theappeals, now the agents and
attorneys can come involved aswell as the, the vso's, and
(38:00):
we're trying to clean up whatwas there.
I think we need to have.
There needs to still be a shift, however, where we provide them
with the best foot forward andwith a strategy, and I think
that's what I'm trying tocommunicate.
Will it go down?
(38:35):
I can't, I don't know, but Ithink what we need to do is
educate veterans on a choice.
If veterans want to use anagent, veterans want to use a
disability attorney, they wantto use a consulting company that
is on them, but there has to bea logical and smart choice when
it comes to representation andalso following the claim.
So long story short, I don'tknow if it will turn around
(38:58):
Hopefully it would but I thinkthere'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 talka whole lot before this about my
previous experience, but I wasa C&P examiner in 2011 through
2013.
And when I left the VA, Istarted working with our VSO
because he would ask me to writenexus letters.
And then, in 2015, we formallyopened Valor for Vet it was
(39:31):
under a different name.
In 2016, we were approached bya major, major claim shark
company that was just a baby inits infancy and it's now large
and making lots of money andthere's a lot of questions that
(39:55):
surrounded that, surrounded that, but for us it wasn't the
ethical approach that I expectedin 2016.
And so my view is a little bitjaded.
When it comes to the claimsharks, because I have been
directly involved and I'vewatched it from the very
beginning and I've interactedwith those people from the very
beginning I do think that thereneeds to be a better system when
(40:20):
it comes to advocacy from thevery beginning, because if
somebody has skin in the game,they're going to dedicate more
time and energy and focus intothat individual, and I think
that carries a lot of value.
But since I have been in thisfor so long, the one thing that
(41:07):
I have preached since I went tothe dark side so the civilian
side is that our providers andmedical experts are not
appropriately trained andeducated on how to use the
verbiage, their brain and applythose clinical aspects.
We see a lot of verbiage likethere is no proof, there is no
causal connection, and inmedical school or PA school
you're taught about how to doyour job to prevent medical
malpractice claims, and medicalmalpractice claims are a
different legal standard thanthey are for compensation and
(41:29):
pension.
So when a clinician sits downto weigh the evidence, I don't
think they're applying theappropriate legal thought on how
to provide an opinion.
So I make a point to do the TMS, the talent management system,
(41:50):
which I think their contract'sgoing out now, but to redo those
compensation and pensionexaminer trainings on a regular
basis.
Now I'm only required to do itonce in a lifetime and I did it
clear back in 2011.
So I would never have to takethat again as a C&P examiner.
But I take it over and overagain because I want to see what
(42:12):
material they're teaching theseexaminers and I want to see how
they're explaining what theword nexus means and how to
listen to the veteran, and howto listen to the veteran and how
to weigh the testimony and howto weigh the buddy letters,
because that pertinentinformation is not in those
trainings.
And so still today I see a lotof new patterns of this copying
(42:36):
and pasting and I've talkedabout this before in the radio
show and it's like how does anexaminer for this veteran, word
for word, say the same thing ina veteran that has no physical
location anywhere near them?
But in that, when I was there,what I experienced was the
(42:56):
regional office would provide anemail to guide the C&P
clinicians on verbiage to use.
And so, because I saw thatfirsthand and I'm seeing similar
patterns now, I still believethat these email correspondence
on verbiage to use is reallysetting the tone for that
(43:21):
medical examiner's perspective.
So that tone is often not infavor of the veteran.
It's often teaching the wrongapplications 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 stillprevail, even beyond the
language?
You know what I mean.
Like, for example, I have notto give away you know situation
but say there's a, there's aveteran who is you know, has a,
(44:09):
had a uh calcaneal osteotomy andthen he had a fusion and they
and, and then they did a fusionwhich they put the, you know,
put the bones together, uh, andthen, um, he.
Then then we find that he had astatus post.
That was status post.
He filed status post calcanealosteotomy and things of that
nature and that surgical surgery.
But then he has a house valgus,he has a bunion and he has all
(44:32):
kind of foot deformities and allkind of arthritis that's going
on in his foot.
And when they looked at the DBQand literally he filed status
post calcaneus osteotomy, theydidn't, with a malunion,
malunion of the bone, of thecalcaneus bone, which is the
heel, and a nonunion of thecuboid bone, which is in his
(44:57):
foot.
And they checked, checked, no,but the operative report,
specifically in this particularcase, may have said failed
surgery.
So if it says a failed surgeryand you're looking at it as the
clinical professional.
(45:18):
Why wouldn't you put the piecesof the puzzle together and say
oh wait, I said that I read theoperative report that showed a
failed procedure and he has abone that did not come together
because of this procedure.
We should probably give him arating for that, I'm sorry, so
(45:43):
you know what I'm saying.
Wouldn't the clinical judgmentkind 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 toexplain something really quickly
, so give me just a second.
So yes, I absolutely hear youand I will tell you that, both
PA and nurse practitioner schoolI can't speak for medical
school, but my mother's a nursepractitioner and I sat in a lot
(46:14):
of her classes because I was inPA school at the same time, so
for me it was like extra studytime.
So from our clinical educationand training there is not a lot
of focus on gait changes andlower extremity changes during
ambulation.
I feel that there's two medicalprofessionals that are best to
(46:46):
discuss any type of gait changesand that's podiatrists, because
they focus on anything belowthe knee, so they're going to
look at the foot.
So for your guy with thecalcaneal issues, the cuboid
non-fusion, the hallux valgus,all that stuff, that is all
podiatry, that is their breadand butter.
The other people arephysiatrists, so your physical
medicine and rehabilitationdoctors.
They are trained just to thinkabout the nerves and the muscles
(47:15):
and the ligaments and how theyinteract, where, from a clinical
side, it's like well, there'sno proof that a non-union causes
any type of disability becauseit's, you know, whatever.
So I will tell you that Ispecifically have a gay analysis
book and I will use it todiscuss.
(47:36):
You know what things arepresent in that particular
veteran.
There is still not a lot ofresearch that is out there Like
like.
I have a textbook becausethat's educational from like
schools.
But when you go to like PubMedor you go to oh brain freeze,
there's another major medicalreference that we use but they
(48:01):
don't talk about gait changes.
That's not part of the researchthat they're doing.
And you have to actually lookat physical therapy textbooks.
You have to go and find thisliterature because you're not
going to be able to Google it,find it on PubMed or a lot of
these resources.
So we would typically use apodiatrist or a physiatrist when
(48:21):
it comes to those lowerextremity things.
So firsthand, my experience,especially with anything related
to the gait, is that it's notsomething that's a dedicated
discussion that we have in ourPA school, np school.
I will also say that aphysiatrist is trained to do a
(48:43):
gait analysis so they can watchsomebody walk down the hallway
and they can watch them comeback and they could tell you
everything that's internallyrotated, externally rotated,
where their source ofdysfunction is coming from and
all the accommodations thattheir body is making to adjust
for that.
And from the clinical side ofthings, when I was in the clinic
(49:06):
I would ask for a gait analysisbecause I used to do
occupational health.
So our physiatrist was right inthe next office and I would
refer somebody over there and Isaid, hey, can you, you, hey, I
find value in this gait analysis.
Can you just do one?
It takes them like two minutesand they describe it and it's
fascinating to see, but it'sjust not in the wheelhouse of
(49:27):
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 wasI hope I didn't hit any stuff on
your toes or anything and Iagree that there should be a
medical professional thatprovides that level of analysis.
Simple terminology, it's simplein the mean, from the clinical
(49:55):
side.
If the patient, if the veteran,is saying that they're filing
for a status post, which meansafter the surgery they had a
calcane, tried to union togetherand it failed, when we're, as a
(50:29):
, I would think, just from aclinical perspective, if you see
that that failed and he had two, he had two fusions, this
particular case may have had twofusions that did not fail.
Wouldn't we use our clinicaljudgments and say, hmm, let me
investigate and look more in therecord to see about the
operative report?
I may just be crazy, I don'tknow, 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 thoughtprocess was.
So I just they probably didn'tread the operative report, to be
honest.
Jerome Spearman (50:51):
They didn't, they said it was.
They read the operative reportand they said, oh yeah, no
fusions, no this, no this, noproblems with arthritis, he's
all good.
Meanwhile, this guy is limpinglimping anyway.
So so I just feel like there'sthere's there's a lot of changes
that need to happen, and Ithink one of the changes that I
think you know, we as, as youknow, as advocates is that
(51:14):
veterans are becoming more, arebecoming smarter, and they're
using AI to do it, and we, asadvocates and I know I've said a
bad word, you know a lot ofpeople may not like AI is here
to stay.
I don't think it's goinganywhere.
I think there's a lot ofproblems that we can get into
(51:35):
with it, but veterans are usingit and they're showing up in our
offices with reports.
So either we kind of you knowwe need to make sure that we
empower them with the rightinformation to help them along
their way.
Bethanie Spangenberg (51:55):
Now we've got about eight minutes left
here.
Ray, was there anything inparticular 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 youstarted talking about it, my
mind went back when you guyswere probably still in high
school, I guess, back into themid-70s, walt Disney came up
with the philosophy ofjust-in-time theory, and that
(52:26):
just-in-time theory was usedthat if you go to Disneyland or
Disney World and you're walkingor standing in line for an hour
and a half and every 10 minutesor 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
(52:47):
once.
Well, I think that to a certainextent, that same type of
theory is being used by the VAand you kind of touched on it,
bethany, when you talked abouthow to control their budget and
the amount of money they spendand I think they have found out
that if they deny veterans oninitial claims and things, after
(53:09):
two or three denials, they'regoing to get to the point that
they won't come back.
So that's money that they don'thave to pay, money they don't
have to ask Congress for.
So I think you may be exactlyon the right track, and you know
, I hate to think that.
I mean, I can remember usingthat back in the mid-'80s, when
(53:31):
I worked for a major corporation.
We had that same type of atheory and when you did a job
interview for a new person, whenthe first person looked at a
resume, that job was to throwout anything on that resume that
did not apply or would notencourage you to hire that
person.
The second person would look atit and they would do the same
(53:58):
thing.
The third person would look atit and their job was to say why
Not, why not, but why should Ihire this guy?
And then, if he passed to thatpoint, then he would start in on
the personal interviews.
But I think that's the samething that they're trying to do.
After a certain period of time,we don't like butting our heads
against the wall, so instead oftrying to learn how to go
(54:19):
around the wall or how to getover the wall, we just back off
and forget it.
And I know a lot of veteransthat have said that very thing.
I don't care, I'm not going tofile another claim, it's not
worth it, it's not worth my timeand my aggravation.
And they don't do it.
It's not worth it, it's notworth my time and my aggravation
.
Jerome Spearman (54:39):
And they don't do it.
I think, that goes with whatJerome was saying earlier.
No, please, please, bethany, goahead.
No, go ahead.
It's you, ladies, first.
Bethanie Spangenberg (54:51):
Well, that's kind of what you were
touching on earlier, becausethose 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 myexperiences with my clientele
and people in my community, whenthey hit that wall, though,
you're right, they're like I'mdone when I meet them and I
start talking to them about whata veteran really is and what
that really means and whatyou've been through in the
(55:28):
military, and kind of bring themback 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 themin the right way and give them
the tools to do it.
Many of them the clients thatI've talked to that are coming
to me now have tried to do thison their own, some very
(55:51):
successful and some that arehitting the wall, and they're
like before I, before I stop, Iwant to talk to you to see if
you can handle this, because I'mdone and take it on.
But if we provide them withenough strategy, upfront, it's
something about that kindling ofa fire that happens inside of
them that may take them.
(56:12):
I've seen it from myexperiences.
That takes them back to thosedays when they were on active
duty, where you had to do whatyou needed to do to make it work
with very little resources andstill get the mission done.
We in the military, we had anMD&B process, which is the
military decision making process.
One of the and I'll leave youwith this one of the main things
(56:33):
was commander's intent.
The other thing is course ofaction and a physical plan.
Within that process, veteransthey need to understand that
they are the commanders now.
What is your intent, what isyour goal?
And I'm speaking to veteransright now.
We as the staff help you withthe courses of action, but if
(56:56):
you don't know, as a veteran,what that issue is, what your
mission is, what you want to gofor, how can you expect others
to really help you in thatprocess?
Become your own commander andhave your own intent.
The rest will happen with theright type of strategy with the
(57:17):
right type of advocates, I agree.
Bethanie Spangenberg (57:19):
Now.
We've spent a lot of timetalking about the brokenness of
the VA and maybe both Ray andJerome can provide their opinion
on this but what is somethingthat 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 wantto go?
Yeah, go ahead.
I've got to think hard on thatone.
I can only speak from mypersonal, personal experience.
When I left the military, I hadchallenges with my transition.
It did not go well, recognizedthat something was wrong.
(57:59):
My wife told me you got to goget seen.
I went to the VA, went to theER, met with a gentleman by the
name of Marcus and he was ableto let me know that I had some
challenges that I needed to getfixed or else my wife and family
(58:20):
would probably be gone.
And had he not intervened atthat point in time, I don't know
if I would have probably beenhere.
What I can say about myexperiences is that the VA has
done me very well with respectto behavioral health services,
(58:43):
and here in Washington I don'tknow about around the country,
but here in Washington they havedefinitely supported that.
The other thing that I thinkthey're doing is getting
involved with other alternativemedicines acupuncture, massage
and other things like that thatcan help veterans and decrease
some of the consistency anddependency on opioids.
(59:03):
I think that's one thing thatthey are doing pretty well in my
region, the regional office.
That may there's somechallenges 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 wouldonly live to be 65, and they
hope to keep me alive longerthan that.
Well, they've done that Withgood medical care.
This last year I turned 76.
So as far as the medical carethat I'm getting, compared to
what they had estimated my lifeexpectancy to be when I was 50
(01:00:03):
because of Agent Orange exposure, they've done a great job.
Bethanie Spangenberg (01:00:10):
That's good.
I'm glad you're here, Ray.
Ray Cobb (01:00:14):
Yeah, good to be, here .
Jerome Spearman (01:00:18):
What about you, Bethany?
Bethanie Spangenberg (01:00:19):
So Jerome.
Jerome Spearman (01:00:20):
Can I ask that oh?
Bethanie Spangenberg (01:00:26):
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 thoseimplemented within the VA health
care, because I'm of the beliefthat we can't just take care of
(01:00:47):
our body as a system.
We have to take care of ourbodies as a whole, so we don't
just treat, you know, oneendocrinology system.
You really have to look at yourmental health, your overall
well-being, in order to be ahealthy individual.
So I'm glad to see that theyhave those alternative
(01:01:07):
treatments in there.
Jerome, I want to give you, youknow, your time to put a
commercial out there for us andlet us know how we can contact
you and all that goodinformation.
Jerome Spearman (01:01:23):
And honestly there really isn't a.
This whole, this whole entireinterview and just discussion
and podcast has just beenenlightening to me.
I'm very happy to be here tojust share my thoughts and you
allow me to ramble on and on andon about my thoughts about this
(01:01:43):
.
If there's anyone who justneeds to just talk or you want
to have a discussion about whatwe do further, just send me an
email.
It's very simple and easyJerome at Spearman Appeals dot
com.
Jerome at Spearman Appeals dotcom.
And let's just keep it there.
Bethanie Spangenberg (01:02:07):
All right, did you want to close us out?
Ray Cobb (01:02:11):
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, johnand all of us will be back again
next week with another show.
And on behalf of Bethany andJerome, this is Ray Cobb signing
off and saying y'all have agreat week.
Jerome Spearman (01:02:34):
Bye.
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