With two hours until her husband, Aaron, is due at the Salem VA clinic, Jennifer Olivas needs to make sure everything is just right if he's going to make it out the door.

It's been days since Aaron Olivas left the house. His trip for eggs last week was cut short by a panic attack.

Aaron, a 32-year-old Iraq veteran, has been waiting more than a year to see a VA primary care doctor. He was late once and got bumped. He can't miss this one.

Aaron, a former infantry sergeant, was repeatedly struck by explosions in Iraq. One improvised bomb went off while he was eating. Ever since, he's struggled to swallow. Thinking about food makes him anxious. His weight has dropped more than 60 pounds since he was deployed in 2007.

Starting in 2012, his recovery was aided by a Veterans Affairs program called Comprehensive Assistance for Family Caregivers. It recognized that family members of seriously injured post-9/11 veterans often substituted for home health care nurses, providing vital assistance with daily activities including feeding, planning and remembering tasks.

But the program in Portland is an outlier. VA officials here are more likely to kick veterans out of the caregiver program than elsewhere. Although the decision can be appealed, vets in Portland are forced to rely on an opaque system that offers little explanation. Not a single appealed case has been reversed here.

As Aaron's early afternoon appointment nears, Jennifer starts his coffee, makes him a sandwich (no crust), then carries his breakfast upstairs, where he is waking.

The dishwasher is whirring. She checks on their 4-year-old son, packs a bag with Tums, granola and snacks he'll need. Upstairs, the shower chokes to life. Jennifer again goes up to look after Aaron and tells him she'll return if he forgets to stop the water.

Until last June, Jennifer was paid $2,020 a month to be Aaron's caregiver. He returned from Iraq with a traumatic brain injury and post-traumatic stress disorder that leave him unable to work.

Jennifer provided a watchful eye. She says she calmed Aaron down during panic attacks, helped regulate his moods, developed a meal plan. Along with his $3,100 monthly disability check, the stipend helped them have enough to buy a home. Aaron says his wife's care made their lives less stressful. It let him focus on his recovery.

Last June, the money stopped. The Olivas family's participation in the caregiver program was revoked.

Aaron and his wife quickly felt the financial pinch. Nearly five months after they lost the payments, one of their two cars was repossessed.

The tow truck came on Veterans Day.

The VA's family caregiver program was overwhelmed from the moment Congress created it seven years ago.

A 2014 analysis by the nonpartisan Government Accountability Office found demand from the flood of vets returning from Iraq and Afghanistan caught the VA flat-footed, leaving medical centers across the country unable to manage the workload.

"We're unfortunately learning a lot as we go," says Meg Kabat, the national director of the caregiver program. "At the beginning, it was very difficult to get everyone up to speed rapidly and make things work efficiently."

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VA officials say the growing program, which now has a $725 million budget and 22,414 participants, is running better. The agency has increased support staff and eased requirements that called for a coordinator to conduct a home visit every 90 days.

But the Olivas family's struggle highlights one criticism that has plagued the program since before it was created: Local bureaucrats have sweeping discretion to remove participants with little explanation or recourse.

When the VA decides that veterans like Aaron Olivas no longer merit caregiver payments, the vets are allowed to appeal. But those reviews are routed through different processes depending on where vets live. The GAO warned that disparities were possible among medical centers whose leaders didn't think the caregiver program should be a priority.

On average, VA officials in Portland are more likely to decide a veteran is no longer eligible to participate in the caregiver program than other medical centers around the country. It's unclear why.

Nationwide, just 16 percent of all participants have been kicked out of the program because the VA decided they no longer met the requirements.

VA stats show it's far higher in Portland, where more than half of participants have lost caregiver payments because they were deemed ineligible.

Leah Christensen, the Portland VA's caregiver support coordinator, says the agency is not under any directive to cull the ranks of participants. She says the way Portland evaluates whether vets are eligible is considered a model for other regions.

"We do what we can here to treat everyone equally according to the guidance that comes down," she says.

But in response to questions from The Oregonian/OregonLive, a Portland VA spokesman, Daniel Herrigstad, said his agency had asked the national VA office to review its administration of the program.

Aaron and Jennifer Olivas aren't alone. Other veterans around the country have raised similar concerns when they've been removed from the program. A 2015 bill in Congress would have established an objective third party to adjudicate appeals. It passed the House of Representatives but went no further.

A spokesman for Rep. Elise Stefanik, the New York Republican who authored the bill, says the legislation will be reintroduced soon.

When Olivas returned from Iraq in 2008, he was assigned to Washington's Fort Lewis. Jennifer quit her job in Georgia, where they'd lived before, and moved west. He remained on active duty, but the problems he returned with prevented him from re-deploying to Iraq. He did administrative jobs and worked a desk while he waited for his medical retirement.

Jennifer soon began helping him manage the anxiety he came back with, taking only temp jobs. But it wasn't until mid-2012, shortly after his medical retirement from the Army, that she was paid to be his caregiver. Aaron says his problems got worse after he left the military.

"My brain had a lot of time to think about stuff," Aaron says. "My circles got smaller and smaller."

Enrolling in the caregiver program, then just a year old, was as simple as answering a few questions in a 10-minute phone call, Aaron says.

The appeals process after the payment was revoked was far more difficult to navigate.

Aaron filed two appeals after he was removed. Each time they were rejected, decision-makers offered him no explanation. It's still not clear why he was determined to be ineligible.

Decisions about disability benefits for vets can be appealed to an independent body called the Board of Veterans Appeals. The quasi-judicial process allows veterans to present evidence and receive exhaustive rulings, detailing exactly why a disability is or isn't related to an injury sustained in service.

That's not true of the family caregiver program. Because of the way the law was written, the payment was deemed a medical treatment, not a benefit - explicitly putting it outside the reach of the rigorous appeals process.

That small bureaucratic difference sends veterans like Aaron Olivas into an opaque process.

VA rules say veterans must be given a fair and impartial review of their loss of caregiver payments and a detailed rationale when appeals are decided.

Olivas appealed first to the director of the Portland VA, then to a VA official at the Pacific Northwest regional level.

Both denied Olivas' appeal without explaining why, saying only that he no longer met the requirements. He received little more than form letters, which he shared with The Oregonian/OregonLive.

Since the caregiver payments started in 2011, 24 of the 207 Portland veterans kicked out of the program have appealed their removal. None has been reversed on appeal.

A VA spokeswoman said the agency couldn't say how many appeals have been granted nationally without opening every single case file. The VA is working on a way to better track the information, she said.

By the time Olivas filed his second, final appeal with regional officials, two VA psychologists had examined him, according to medical records he also provided to The Oregonian/OregonLive.

One wrote in a letter that Olivas should stay in the program.

"He should have been in the program without disruption," wrote the clinical psychologist, Krista Rodriguez. "His symptoms have become worse since he stopped receiving benefits from the program."

The other psychologist signed off on his removal.

Olivas' final denial, received in February, did not explain why VA officials rejected one of their own psychologists' recommendations.

Though VA patient advocates are supposed to be available to guide vets through their appeals process and mediate disputes, Olivas says he didn't get a call back from one until after his final appeal had been rejected.

Now he has asked for Rep. Kurt Schrader, a Salem Democrat, to review his case. The VA has said Olivas can apply again, but he isn't sure whether he will.

Portland VA officials declined to discuss specifics of Olivas' case, despite being told by a reporter that the former soldier was willing to grant written permission. A VA spokeswoman, Megan Crowley, also refused to disclose the names of the officials that review appeals like his, citing privacy laws.

As a result of The Oregonian/OregonLive's inquiries, VA officials say they plan to change how they notify veterans whose caregiver appeals are denied. Christensen says the VA wants to "make sure we are using language that's descriptive and easy-to-understand."

Aaron says he had no problem understanding the form letters telling him about his rejection.

"I couldn't understand why," he says. "We could never get any answers."

After the caregiver payments stopped, Jennifer started a small dessert shop, working full time to help make ends meet. Her mother and Aaron's sister fill in as his caregiver, and Jennifer stays home with Aaron when she can. Still, she worries about him when she's gone.

"We know we need it," Jennifer says. "I need to be here."

Jennifer is home with Aaron as he readies for his doctor visit. With 30 minutes left before they leave, she sits down for the first time in more than an hour, to put her shoes on. She walks outside to start the car. The engine roars. She returns and sits alongside her husband.

"How you feelin'?" she asks.

"I'm getting there," he says.

Aaron nurses his coffee and a glass of water. He tunes his guitar, his way of focusing and calming himself, and plays a few chords.

"What time is it, love?" he asks.

"Ten 'til. We're doing good."

They have a code they use to communicate his stress levels that goes from one (normal) to 10 (I can't breathe).

"I'm an 8-and-a-half," he tells her. "An 8-and-a-half."

"It's all right," she says.

And then it is time for the 1.1-mile trip to the clinic. Four minutes. He puts his shoes on. Three minutes. He grabs his jacket.

Two minutes. Aaron grabs the bag that Jennifer has prepared.

And then they move toward the front door. Together, they walk out into the rain.

-- Rob Davis

rdavis@oregonian.com

503.294.7657