Just Ask an NSO!

Man in wheelchair shaking hands with a doctor in a white coatParalyzed Veterans of America employs 80 professional national service officers (NSO) to serve more than 30,000 clients across the country through a network of 69 national service offices. While most of these NSOs are stationed at VA Regional Offices, over 20 are permanently located in VA medical centers (VAMCs) in order to be more accessible to those we serve.

NSOs are recruited from the ranks of fellow veterans. All PVA NSOs are veterans, and most—if not all—have some type of disability. Approximately 20 are Paralyzed Veterans members. When an NSO is recruited, he or she is assigned to an office and begins a rigorous 16-month on-the-job training program. This includes a 22-chapter academic program and a gradual introduction to working client cases throughout the benefits  and healthcare spectrums.

Select NSOs later attend a ten-day Advanced Medical & Advocacy Training (AMAT) seminar for additional intensive training to hone their skills in healthcare advocacy. This takes place at one of VA’s Spinal Cord Injury (SCI) Centers to give the students a firsthand experience in dealing with paralysis and the changes a person goes through after spinal cord injury/disease (SCI/D). NSOs are expected to be proficient in many areas they deal with on a daily basis. Let’s look at some of them.

Medical Care

NSOs spend the majority of their time doing two important jobs. The first is serving as a healthcare advocate for paralyzed veterans and other disabled veterans. In accordance with PVA’s Mission Statement, ensuring quality healthcare for our members is a top priority. PVA’s are the only NSOs among all veterans service organizations (VSOs) specifically trained as healthcare advocates at the national level, and we consider quality healthcare is the most important issue for those we serve. Ask an NSO how to get a referral to an SCI Center. He or she will tell you that patients who have not been previously seen in an SCI Center need a consult from a primary or specialty care doctor.

Once the SCI Center receives the consult, an appointment for an evaluation will be scheduled. At the evaluation, an SCI physician will examine the patient, confirm a diagnosis of SCI/D, and determine what the next steps should be. This could be an inpatient admission for acute SCI rehabilitation, a prosthetics evaluation for appropriate durable medical equipment, referral to an adaptive driver training program, or referral to a physical or occupational therapist for customized therapy.

In-depth training
prepares service
officers to deal with
myriad issues
concerning healthcare
and benefits.
Acute SCI patients who sustain paralysis while on active duty or after service are most often transferred directly to one of VA’s 24 SCI units for acute rehabilitation. Ask an NSO what the goals of rehabilitation are, and you’ll hear that acute rehab is to maximize functional return of motor and sensory body systems, facilitate independence and mobility, educate patients and caregivers about living with SCI, and assist in preparing for an independent lifestyle with adaptive equipment, housing accessibility, caregiver treatment and support, respite care, and vocational rehabilitation.

NSOs visit SCI patients in VAMCs as well as private and military medical facilities as soon as possible after injury or diagnosis to explain the process of rehabilitation as well as to work with the patient and family to prepare for life after injury. They are a vital link between patients and medical professionals, often assisting in ensuring adequate communication between the treatment team and the patient and family. They assist in arranging transfers between medical facilities to help patients become admitted to an SCI Center when necessary. It is not unusual for an NSO to interact with a social worker or other professionals in a private or military medical facility to educate them on the need for transfer to the SCI Center and to advocate for the patient.

VA’s controlling document for SCI patient care is Veterans Health Administration (VHA) Handbook 1176. This lays out the “rules” for patient care throughout a lifetime of living with SCI/D. NSOs are trained in the specifics of the requirements and work hard to ensure VA complies with its own directive.

NSOs routinely visit hospitals to interview patients and staff about the quality of care provided and are trained to take action when deficiencies are discovered. At times, this can be as simple as talking to a maintenance person to have something fixed, or as complex as calling one of PVA’s SCI nurses to seek assistance or guidance in how to address a problem. Clinical concerns are addressed by our nurses (Medical Monitors), who frequently interact with clinical professionals across the spectrum to resolve care issues.

PN_Just_Ask_an_NSO1_010510At other times, service officers have to intervene to help patients obtain wheelchairs or other prosthetic devices. Ask an NSO how to get a wheelchair, and he or she will say you need a prescription to document medical need, an evaluation by a therapist to select the appropriate chair, and a workup to determine the specifications and equipment that should be ordered for the chair.

NSOs also help veterans obtain appointments, correct records, enroll in the healthcare system, obtain medications or supplies, and other types of problems veterans often cannot resolve without assistance. They must know the law, regulations, and rules that apply to each situation and work with VA to ensure they comply with them.

One of the most common problems when advocating for veterans on medical issues is that some employee has made his/her own “rule.” How many times have you heard, “We don’t do that here”? It is a daunting task to ensure consistency of treatment and care across a nationwide network of medical centers and supporting clinics. When NSOs encounter complaints from patients, they do everything possible to achieve swift and appropriate resolutions. Often, it is just a matter of making sure the medical professionals are communicating effectively with the patients.


Ask an NSO how they can help you with benefits, and he/she will ask, “Which ones?” Thanks to a grateful nation, myriad benefits are available to veterans. Unfortunately, obtaining them can be frustrating, confusing, and exhausting—especially for those who know little about the laws or regulations. 

NSOs are responsible for knowing and completing forms and applications for all these benefits. They know who is eligible and what evidence is required in order to establish eligibility. Every claim is followed through, from filing the original application, developing the evidence, and ensuring the case is input into the workload database to reviewing the decision.

After a decision has been made, NSOs review it carefully and advise the client as to whether it is appropriate or whether an appeal should be filed or other action taken. If an appeal is filed, the NSO knows the timeframes that must be met to “perfect” the appeal, and he/she submits a written argument on the claimant’s behalf. If the claimant requests a personal hearing, the NSO will prepare the claimant for the hearing and elicit questions at testimony to assist in the case.

Often, an appeal will result in a remand—a decision by the Board of Veterans Appeals (BVA) that the appeal needs to be sent back for additional work or information before the Board will issue a final decision. Upon remand, the NSO will inform the claimant of the remand and assist however possible to ensure the Board’s requests are met. Once BVA issues a final decision, the NSO reviews it and then follows up with VA to ensure the decision is carried out.

So, when you ask NSOs what they can do for you, you may be surprised at the answer!

Reprinted with permission from August 2009 PN Magazine.


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