In 2013, when her father returned from a third deployment, Mia Martin was diagnosed with autism at 3 years old.

Autism is a bio-neurological developmental disability that impairs normal brain development and ultimately cognitive function and social interaction.

Mia was enrolled in public school for a while.

Her days started at about 5 a.m. to catch a bus.

She’d sit in a classroom until about 1 p.m. then head off to therapy for four hours, ending her day at about 6 p.m.

The 12-hour days were part of Mia’s routine for four years.

Mia’s father, Fort Bragg combat Veteran James Martin, knew it took a toll on Mia.

The public classroom setting was too rigid.

“Even in a classroom of 15 kids with a special education teacher and an assistant, my daughter is quite the handful,” Martin said.

Last year, they found New Leaf Academy in Fayetteville where lights and sounds are controlled and the environment and curriculum are tailored to children with Mia’s needs.

The school provides a special education teacher, a clinic and behavioral analysis technicians for each of the six children in the classroom.

It’s meant shorter days for Mia, who is now 11.

“In that environment, she thrives,” Martin said.

James Martin: My autistic daughter is excelling thanks to NC grant, scholarship

However, changes to TRICARE, the military’s medical insurance, are concerning. Martin worries that Mia will be removed from the school where he said she's improving.

It’s not only his own daughter who Martin worries about — it's all the other military children with autism he believes will be negatively impacted.

What’s changing?

In March, the Defense Health Agency, which oversees TRICARE, announced that by May, advanced behavioral analysis services outside of clinical settings will no longer be covered by the military insurance.

Applied behavioral analysis is a popular intervention for autism that teaches behaviors by breaking down asks into small steps and training in a precise way, according to the National Institutes of Health.

For Mia, who is nonverbal, it’s helped her communicate her wants and needs, while also helping her to get back on track if she has “a meltdown," Martin said.

Redirecting Mia's focus doesn’t come from a teacher but rather from the behavior technician at her side.

Registered behavior technicians help implement treatment and behavior plans that teach behaviors and skills universally used.

From April: Autism services for military families could be cut under DoD plan

Prior to the TRICARE changes, technicians could accompany children with autism to school and help facilitate the child’s learning.

According to a July news release from TRICARE, behavior technicians were reclassified as non-clinical, thus not covered by the insurance, and as a result, not accompanying children into the classroom.

The release states a TRICARE contractor may authorize board-certified behavior analysts to provide time-limited clinical advanced behavioral analysis services for a child in the school setting.

Martin compared the change to going to a doctor’s office that has no support staff, physician assistant or licensed practical nurse.

Community settings such as dental appointments or sporting events are no longer considered the space for behavior technician unless determined “clinically appropriate” based on a child’s treatment plan, the news release states.

“These changes are based on several years of research and development,” Dr. Krystyna Bienia, a clinical psychologist and senior policy analyst at the Defense Health Agency, said in the statement. “We used lessons learned during the demonstration, and also feedback from providers, advocates, and leading researchers. The updates will help children reach their full potential through clinically appropriate services.”

Martin disagrees.

“Shouldn’t kids get acclimated outside of a clinic setting,” he asked. “That makes no sense. How does it address behavior in a real-world environment?”

Martin said it leaves families who received the services to choose between going back to public school or home schooling their children.

Impact to Fayetteville autism school

The changes remind Amy Sparks of her own fight to take on the Fort Bragg school system in U.S. District Court in 1997.

Sparks’ husband served in the Air Force for 23 years. Their son Jarred, born in 1992, is autistic.

“I know the battles that these parents are having — not only do I have the experience of having a child with autism, but I also have that experience with TRICARE,” Sparks said.

When her son was young and she brought the lawsuit against the school, there were no local clinics. Her husband would often drive Jarred to Greensboro for services she'd fundraise to pay for.

Sparks said Jarred was likely one of the first autistic children in the Fayetteville area to start applied behavioral analysis therapy.

In 1997, the family sued the Fort Bragg school district to seek an appropriate education for Jarred.

“I said, ‘You’re not going to babysit my child. You're going to educate my child,’” Sparks said.

Jarred didn’t say “mama” until he was 5. He was mostly nonverbal until he worked with a speech pathologist in Greensboro at age 7.

While enrolled for two years at Fort Bragg schools, he was unable to master 40 objectives, Sparks said.

She removed her son from school and enrolled him in the Lovaas Learning Program, a form of applied behavior analysis.

Once switching programs, Jarred was able to master 400 objectives, Sparks said.

An example, she said, is Jarred’s therapist worked with him to build block structures — a task he couldn’t previously accomplish.

“We saw rapid growth,” she said.

After legal motions and appeals, the U.S. court ruled in 2004 in the family’s favor, ordering they be compensated for the educational services Sparks said her son didn’t receive at the military school.

Sparks views the latest changes to TRICARE through multiple lenses.

She’s a retired public school educator, and after Jarred’s unexpected death in 2011 at the age 19, she opened a school in his memory.

“With my own son, I never wanted to say, ‘What if’ — What if I’d done that treatment? What if we enrolled in a specialized school,” Sparks said.

The Fayetteville-based School of Hope serves only children diagnosed with autism.

Sparks said she does not think teachers in public school settings with larger class sizes and only one aide are always equipped.

At Fayetteville's School of Hope, co-founded by the Sparks family, each classroom has one teacher, one teacher’s assistant and no more than seven children; and each child has a behavior technician.

If a child enters the classroom anxious, the behavior technician would help redirect the student and provided feedback for the teacher on the child’s capabilities, Sparks said. A behavior technician can help a child improve from the one percentile to the 96th percentile, she said.

That is why Sparks is concerned the TRICARE changes will impact students at her school.

“TRICARE is definitely doing an injustice to the military men and women who serve this country...,” she said. "So many of them are having to be deployed... They don’t need to worry about what’s happening to their autistic child.”

Autism tool cited in DOD study is misused, researcher says

Parents and educators aren’t the only ones with concerns about the changes.

Ira Cohen, who has worked in the field of autism research since the 1970s and has a doctorate’s degree in psychobiology, is the principal author of an analysis tool that evaluates children with autism and treatments and interventions.

His research and autism tool was cited in six Department of Defense reports to Congress on autism in military children.

The DOD reports, using Cohen's tool to note behaviors of autistic children before and after applied behavior analyst services, questioned whether the services led to improvements for children with autism.

“The end result is that families could be deprived of an important service that they receive based on misuse of the instrument that they were using, which was my instrument, and they didn’t listen to me,” Cohen said.

Criteria for diagnosing autism has broadened, Cohen said.

Some children have IQs average or below average. Others have difficulty communicating or are nonverbal. Some engage in repetitive behaviors, Cohen said.

Cohen wrote a 40-page analysis of the DOD reports, where he questioned how it gathered data to make conclusions.

In his analysis, he wrote the autism rating instrument is designed in two forms — one for parents to analyze their child with autism, and another for professionals to analyze.

He wrote that the tool evaluates core behaviors seen in autism and behavioral concerns.

Among the behaviors evaluated that could generate a higher score are sensory behaviors, such as staring at objects, hand flapping and resistance to change; repetitive behavior such as turning pages back and forth, opening and closing doors and turning lights on and off; social interactions; sleeping problems; aggression toward self or others; fears; speaking abilities and learning; and memory.

Cohen said the rating scale he created is based on a zero to three format, with zero meaning a behavior is not seen, one means it’s rare, two means sometimes it’s seen and three means a behavior is often seen.

Each of the ratings is added for an overall score, with scores between 30 to 40 considered mild features of Autism Spectrum Disorder and scores greater than 60 typically deemed as being severely affected or likely to have an intellectual disability.

The misinterpretation in the DOD reports, Cohen said, is that the reports made a zero seem as if a behavior is missing when in reality it means the child is not engaging in the behavior.

“They assume that you can apply this one measure to all of those cases; and, in fact, if you talk to people who do ABA therapy, what they do depends upon the problems or the abilities of that individual child,” he said. “Often you’re dealing with severe problem behaviors that are impairing the child’s ability to benefit from therapy, and if they are not looking at what the goals of the therapy are and measuring what those things are, they’re providing a disservice to the field.”

Cohen found that 90% of 14,700 patient assessments were not used in a 2018 DOD report that analyzed only 1,577 children.

Cohen wrote that omitting the children who were not showing a behavior could be instances of children having improved.

Omitting those cases, he wrote, likely biased the data of cases that did not change.

His other concerns were the lack of demographics of the analyzed children, and whether both parents filled out the assessment of autistic behaviors in their children.

Age is important because “younger children often respond better to intervention for a variety of reasons,” Cohen wrote.

He said that a “more appropriate statistical analysis” would note factors such as gender, age, degree of impairment and health status among others.

He noted similar issues in other DOD reports, writing that “it is clear that the Department of Defense authors have not bothered to read the manual,” related to the autism scoring.

Analyzing the DOD's latest report to Congress in 2020, Cohen wrote that conclusions cannot be justified, because of a “lack of understanding" as to how the autism tool “is scored and interpreted and the obvious failure to read the manual.”

“The conclusions one draws from an analysis are only as good as the quality of the information that goes into the analysis,” Cohen wrote. “If the data are sloppy, so are the conclusions and their validity...”

Latest DOD report

In the Department of Defense’s latest autism report to Congress in June 2020, the DOD stated it had 15,928 TRICARE-eligible beneficiaries diagnosed with autism in fiscal year 2019.

Officials said program costs were $370.4 million that year. .

According to the report, the program which administers TRICARE funding for autism was set to expire Dec. 31, 2018, but extended to December 2023.

The report states that TRICARE-covered services for autism include speech and language pathology, occupational therapy, physical therapy, medication management, psychological testing, psychotherapy and applied behavior analysis.

According to the report, 54% of the beneficiaries diagnosed with autism did not receive applied behavior analysis services.

The report states that while there is limited research about whether early behavioral-analysis interventions can significantly affect the development of some children diagnosed with autism, not all children diagnosed with autism receiving the services show improvement.

The report states that officials analyzed 3,794 TRICARE beneficiaries receiving applied behavior analysis services for at least 18 months.

The report states that factors such as age, symptom severity, number of hours of services and other services were not factors considered.

The report found that some of the autism scores changed, and noted although improvements after a year and 18 months of applied behavior services, most of the changes were small “and may not be clinically significant.”

The report reached the conclusion that the delivery of applied behavioral analysis services in its current format “is not working for most TRICARE beneficiaries.”

Officials wrote that the DOD is concernedwhether applied behavioral analysis services provide the most effective services for beneficiaries diagnosed with autism.

“As of now, ABA services do not meet the TRICARE hierarchy of evidence standard for medical and proven care,” the report stated.

In a Defense Health Agency news release from March, Bienia, a clinical psychologist with the agency, said there isn't a "one size fits all” approach when it comes to autism care.

The news release stated that applied behavior analysis services for beneficiaries diagnosed with autism will continue but changes would go into effect start May 1 and a rollout plan for all changes goes into effect by Jan. 1.

A spokesman for the Defense Health Agency said changes were based on three years of work with industry stakeholders.

Previous instructions in the TRICARE Operations Manual allowed certain applied behavioral analysis services to be conducted in a school setting if approved in the patient's treatment plan, the spokesman said.

"The intent was that active (applied behavioral analysis) services would be provided and that treatment would be separate from any parallel educational task," he said.

The change eliminated the role of the behavioral technician from a classroom setting since applied behavioral analysis services authorized under the program "are designed to be delivered in a one-on-one treatment modality," the spokesman said.

Parents still concerned

Cumberland County attorney Jessica Flowers works with autism advocates to brief legislators on the House and Senate Armed Services Committees about how changes affect families.

Flowers said it concerns her that she doesn’t see funding for the services in National Defense Authorization Act proposals.

“It’s just been a nightmare trying to get the services that we’ve had before May 1,” she said.

Flowers thinks limiting the applied behavioral analysis services to clinical settings will create retention problems for the military, because of parents opting to home-school their children because they can't afford services no longer covered by insurance.

Flowers is a disabled Veteran whose husband is still in the military.

Their son Jacob, who turns 6 this August, is on the autism spectrum, she said.

She said the only language he has is copying others.

Flowers said Jacob previously tried a public school and a clinic setting.

“We tried. It didn’t work,” she said. “We went another route and found a place where he’s able to flourish, and now it’s being pulled out from under us.”

Flowers said her son, with behavioral assistance, is able to learn the same as other children who are not in special education.

Despite developmental delays, Flowers said, her son is smart and could identify colors by touching them in kindergarten and knows letters, shapes and sounds.

Her son has attended a private school with a disability grant, but she said TRICARE paid for his therapist to be in the classroom.

The school — which requires children with autism to be accompanied by a behavioral technician — won't allow her son to return without one.

With the first day of classes beginning Wednesday, Jacob has been left in limbo at home as his family waits to see if he can be placed in a clinic or decides whether to enroll him back in public school.

In public school, he'd be placed in a special needs classroom without therapy. In a clinical setting, he'd receive therapy without an education, his mother said.

Flowers is grappling with limited options for Jacob.

“Do I let my son continue his education where the only option is public school in an autism classroom, which was dreadful for him?”

In a public school, she said, Jacob was placed in an enclosed special needs classroom and would come home “throwing a tantrum or lying on the ground banging his head on the floor.”

Since attending the private school, she said, he has not had any of those aggressive tendencies.

She said a disability grant covered her son’s education, and TRICARE covered the therapist who worked 40 hours a week with him.

Her son thrived at the private school and made best friends.

“I was told, having a child with autism, that he wouldn’t show those kinds of emotions or have the ability to interact with peers like that,” she said.

She said her son was able to participate in a meaningful education.

Related reporting:N.C. bill seeks to expand residents' access to applied behavior analysis for autism

She said without a behavioral technician, he is unable to go to the school and receive therapy at the same time.

She said he’s not the type to raise his hand if he needs to go to the restroom, but his behavioral technician picks up on cues and voices his needs.

The therapist, she said, helped ensure he'd behave and meet goals that were in place for his individualized education plan.

"We love Jacob and would not change him for anything," Flowers said. "But we also want him to absolutely become the most independent, most productive version of Jacob he can possibly be."

To cover the costs of a technician outside of a clinical setting, 10 hours a week would be $8,000, Flowers was told.

Martin and Flowers said other insurance carriers cover applied behavioral analysis services that are being cut for military families.

Martin said it seems as if the Defense Health Agency is limiting services, which he said is causing applied behavioral analysis companies to leave Fayetteville.

“It feels like this new policy change was backdoored and was not in the best interest of the families concerned,” Martin said. “I know the government needs to budget, but going after services for disabled children with autism is a new low.”

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There’s scant information on how widespread the problem of hunger is among currently serving military families and Veteran families, but there are some actions that could help those who are struggling to put food on the table, advocates told lawmakers.

One such suggestion is providing automatic SNAP benefits, formerly known as food stamps, to service members in the lower ranks as they separate from the military, said Colleen Heflin, professor of public administration and international affairs at Syracuse University. She and other advocates participated in a roundtable discussion of hunger in the military and Veteran communities before the House Rules Committee.

They discussed the stigma in asking for help that’s perceived by service members, Veterans and their families; difficulties families face in qualifying for assistance; and lack of real data to quantify the extent of the problem.

“Across America today, there are spouses and children of service members who may not know where their next meal is coming from,” said Rules Committee Chairman James McGovern, D-Mass. “And for too many men and women who served our nation and are back in the civilian community, they and their families are struggling to put food on the table.

“Too often, hunger is hidden among these communities. Service members are taught to make good with what they have. Numbers are hard to come by, because those who serve don’t want to risk their futures by coming forward, or struggle to ask for help.”

McGovern called the situation “a national outrage.” He and other lawmakers asked for suggestions from the advocates in addressing the issue.

There’s a clear need for more data about the problem, advocates said. “We suffer from a lack of systematic information about the level of food insecurity among active-duty members. This means we can’t identify and focus on the pockets of where it be higher than others,” said Heflin.

“If DoD collected systematic information and made it available on food insecurity and food assistance participation, this would identify the problem,” Heflin.

Some limited information has been available in recent surveys. For example, 14 percent of active-duty enlisted family member respondents to the online 2020 Blue Star Family Lifestyle Survey said they had food insecurity within the past 12 months, according to the organization’s CEO Kathy Roth-Douquet. That 14 percent isn’t necessarily representative of the entire population — it’s 251 people out of the 1,757 who identified themselves as active-duty enlisted family members in the online survey. The survey was available online from September 2020 to October 2020, so the responses also reflected pandemic experiences.

The percentage of those experiencing food insecurity was highest in the E1-E4 respondents, at 29 percent — 46 people out of 158 in the Blue Star Family survey. Food insecurity reports weren’t limited to junior enlisted families: 16 percent of E5-E6 family respondents, and 8 percent of senior enlisted, reported low or very low food security. The Blue Star Family survey “is an essential part of what we know, but it can’t be as comprehensive as what our government could do,” said Abby Leibman, president and CEO of MAZON: A Jewish Response to Hunger. She suggested calling on the Government Accountability Office to provide comprehensive, updated data on food insecurity among Veteran and military families, and said the departments of Defense, Veterans Affairs and Agriculture should collaborate and share data and information. The issue has been a priority for MAZON for nearly 10 years.

Leibman also suggested reexamining the pay levels in the military.

Kathy Roth-Douquet said the military lifestyle of frequent permanent change of station moves contributes to the financial insecurity of military families, with spouse unemployment, the lack of affordable child care, high out-of-pocket housing expenses, and other issues. Too many families are forced to make the impossible choice between affordable housing and more expensive housing in safe areas with school districts that provide a quality education for their children, she said.

Thus, Roth-Douquet offered up one solution that would address a number of financial issues with military families: Slowing down the rate of PCS moves, or allowing for some predictability and control over service members’ careers. “There’s lots of evidence this would increase financial security and would save [the government] those high moving costs,” she said.

Two other suggestions deal with service members’ allowances.

• The Basic Allowance for Housing shouldn’t be counted as income when determining a military family’s eligibility for federal nutrition assistance programs like SNAP, formerly referred to as food stamps, said Abby Leibman. This has long been an issue for military families, she said. While she believes U.S. Department of Agriculture could make the change, it may require a change in law, she said.

• Leibman and other advocates have been pushing for a military basic needs allowance, which has been proposed in Congress for the last several years. It’s part of the proposed Military Hunger Prevention Act being considered now by lawmakers, and would provide extra money for groceries for low-income military families. It would create an allowance that would supplement troops with a household income of less than 130 percent of the federal poverty line, which varies by family size.

Veterans’ food insecurity and a transitional SNAP benefit?

A recent U.S. Department of Agriculture report stated that 11 percent of Veteran households were food insecure in the 2015-2019 period, said Syracuse’s Heflin. Food insecurity is higher among female Veterans, minority Veterans and disabled Veterans, she said. There’s increased likelihood of hardship and food insecurity after separation from the military, she said, and SNAP participation among Veterans is 10 percent higher in the first year after leaving the military than for the general Veteran population.

She proposes creating an automatic transitional SNAP benefit for about six months for all families leaving the military, limiting those eligible to perhaps those in pay grades of up to E4 or E6, she said.

Based on the 2019 average SNAP household benefit of $258 a month, if there were 100,000 service members separating from the military a year within that general pay band, and the benefits continued for six months, it would cost about $154 million a year in taxpayer dollars, Heflin said.

It reduces the stigma because everyone would qualify, she said. “It’s a small dollar item that could really help service members during this critical transition period.” It would help provide some extra dollars as they establish themselves, and serve as an extra benefit to thank them for their service, she said. It might also make them more likely to apply for SNAP benefits if needed in the future

Heflin also suggested a categorical eligibility for SNAP benefits among different disability programs, for example, Veterans with high levels of service-connected disabilities.

It appears that when programs are built specifically for Veterans, the Veterans are more accepting of the services, said Chad Morrison, CEO of the Mountaineer Food Bank in West Virginia. “They don’t want to take away from someone else, but when it’s built for them, there’s less of a stigma, and they’re much more accepting.” He said he’s found that with their food distribution program, which participates in a program that provides a monthly food box for Veterans and households of Veterans.

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In the war against coronavirus, doctors and nurses do battle not only against the disease – they battle exhaustion, too.

Nurses meticulously take swabs at mobile testing sites and comfort those racked with fear. Doctors consult patients in triage tents via iPads. Emergency room nurses and doctors examine the critically ill patients. Support staff clear hallways and deliver coVeted ventilators, tubing, and protective gear. And so it continues, hour after hour, day after day.

Those suffering need comfort. Many are dying – and dying alone. However, one thing is clear: precious lives are being saved by the hospital staff risking their own.

We go inside one Florida hospital to document these medical heroes doing everything they can to save people.

After comforting a woman she swabbed for COVID-19 testing, registered nurse Jenna Puckett takes a momentary rest before resuming testing at a mobile site in Cape Coral, Fla. "She was afraid and overwhelmed," Puckett said of the woman she tested. "She just needed someone to listen."

Monitoring equipment cords from outside a COVID-19 patient's room are pushed under the door to registered nurse Aubry Sander in the intensive care unit at Gulf Coast Medical Center in Fort Myers, Fla. This is done to reduce the number of times a patient's door is opened and helps prevent cross-contamination.

Physician assistant Allison Ridgway reads a COVID-19 patient's x-ray at Gulf Coast Medical Center in Fort Myers, Fla.

Advance provider Brittiany Garrett listens intently to a coworker’s question about a COVID-19 test sample at a mobile site in Fort Myers, Fla. The increasing number of people being tested requires nurses to pay extreme attention to detail when gathering and transporting test samples.

A patient with COVID-19 symptoms is prepared for admission by emergency room nurses at Gulf Coast Medical Center in Fort Myers, Fla.

Registered nurse Aubry Sander cares for a COVID-19 patient in a negative pressure room (NPR) at Gulf Coast Medical Center in Fort Myers, Fla. NPRs help prevent cross-contamination from room to room. The room's ventilation system generates pressure lower than of the surroundings, allowing air to flow in but not out.

"Yes. I will pray for you," Chaplin Michael Schorin tells a COVID-19 patient who requested spiritual comfort at Gulf Coast Medical Center in Fort Myers, Fla. Schorin says he's been praying a lot lately. "God hasn't forgotten you," Schorin told the patient before leaving.

Emergency room nurse Tristan Manbevers checks in a woman complaining of COVID-19 symptoms at Gulf Coast Medical Center in Fort Myers, Fla.

Bags containing sterilized N95 masks await pick up by nurses and doctors at Gulf Coast Medical Center in Fort Myers, Fla. Masks can be recycled twice before they are thrown away.

A triage tent to examine potential COVID-19 patients is set up outside Lee Memorial Hospital in Fort Myers, Fla. The tents help prevent the virus from spreading into the emergency room and main hospital.

Dr. Karen Calkins and Kathy Richards-Bessshare give COVID-19 testing updates on a conference call at a mobile testing site setup in a park in Cape Coral, Fla.

Medical assistant Karen Spradlin and registered nurse Chris Blue input COVID-19 testing data at a mobile testing site in Cape Coral, Fla.

"We're saving everyone we can"

As COVID-19 spreads across Southwest Florida, so does the courage of nurses, doctors and staff at Lee Health, the area's largest healthcare system.

They're fighting for the lives of loved ones, co-workers and friends infected by disease, which attacks the respiratory system without warning. It's like the wind – invisible, far-reaching, uncontrollable.

Inside the COVID intensive care unit it is surprisingly quiet. Only the hopeful whooshes of ventilators sound off in the negative-pressure rooms. Nurses monitor vitals, adjust fluids and carefully reposition patients. Outside the rooms, they turn their protective gear inside out and get back to the fight.

This war is ongoing. More than 15,000 confirmed cases in Florida alone, more than 300 deaths. This week, the U.S. surpassed 10,000 deaths, topping the number of battle deaths from six U.S. wars combined.

How we did this project

In tents, emergency rooms and intensive care units, a war is taking place.

Visual journalist Kinfay Moroti, who photographed the Iraq War, now finds himself on the front lines in Southwest Florida, documenting the doctors, nurses and all who support them as they deploy everything they have against an invisible enemy — the novel coronavirus.

He gowned up, used his own N95 mask and spent several hours in the ICU observing these newfound soldiers to provide these moments exclusively to the USA TODAY NETWORK. They offer rare, unfettered access into one hospital system’s battle against the odds.

As our country makes its way through the coronavirus pandemic, history is happening fast. Generations from now, these days will make up whole chapters in the story of America. In this ongoing series, titled An Uncertain Distance, USA TODAY NETWORK photographers document the faces, the families, the playing fields, the farms, the factories – most of them in surreal states of being.

We found kindness, grief, boredom, puzzlement. We saw togetherness, aloneness, helpfulness, alienation. We captured scenes reflecting a common yet alien experience, where everything we see takes on a different shape, a new color, a newfound dimension. One overarching question looms: What will our “new normal” look like?

An insidious outbreak

The novel coronavirus, unknown to Americans earlier this year, has thrown every aspect of our society into turmoil. The strains on all corners of the economy have evoked comparisons to the Great Depression, as five years of employment growth and stock market gains were wiped away in days. Nearly every student in the country is out of school. Parks, roads and beaches are empty – often by order of local or state authorities. Most of what people so recently took for granted now hangs in question.

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It takes more than just awareness to respond to someone showing signs of distress. It takes conviction of care, compassion, and competence to help that someone in need, which describes precisely what Hospitalman Grace Pridmore did.

Pridmore, assigned to Navy Medicine Readiness and Training Command (NMRTC) Bremerton Detachment Puget Sound Naval Shipyard, was acknowledged for her selfless effort by Capt. Shannon J. Johnson, NMRTC Bremerton commanding officer, for identifying another sailor at risk and taking quick action to help get the sailor to the appropriate level of care, possibly saving a life.

“I knew my friend had been going through a lot since she arrived to her command and sadly her condition got worse as time went on” said Pridmore, of Kellyville, Oklahoma, and a 2019 graduate from Kellyville High school.

“I saw her well-being starting to quickly depreciate. Seeing this problem rapidly spiral out of control, I knew I had to be there for her as much as I possibly could,” explained Pridmore. “She fully explained everything she was going through, and I took quick action to get her to someone with the appropriate level of training to help her. I knew from my training that this was the right decision. I contacted my chain of command for additional guidance to ensure we were complying with the COVID-19 guidelines.”

Pridmore declares her chain of command went above and beyond – just as she did ­ to help out the sailor in need. “I stayed with her until she got transferred to higher care. I continued to talk and visit with her as she was receiving this care so she wouldn’t be alone. With the resources and training my chain of command provided me I knew I could be the friend to help her. I will always stick by her side no matter how hard times get,” stated Pridmore.

During the ongoing effort to help stop the spread of COVID-19, Pridmore has also found herself providing daily support against the pandemic, from directing traffic to assuring personal protection equipment is worn in order to ensure worker and patient health is maintained.

“At the clinic, we continue to see patients during this time. I ensure that our employees, active duty and civilian, remain healthy to go to work. Without them the shipyard could not operate properly, so their health is extremely important,” said Pridmore.

Although Pridmore has only been part of Navy Medicine for approximately one year, her interest in the career field has been long term. During high school, she attended Central Technology Center, a vocational school, for additional nursing and medical education and training.

“I have been interested in the medical field since as long as I can remember. I have been actively chasing this goal since I was a junior in high school, getting my certified nursing assistant, certified medical assistant, and phlebotomy licenses before I graduated high school. I’d seen other students in my school make the decision to join the Navy. I started researching everything the Navy had to offer. I didn’t have any money for college, and I didn’t want to be in debt so this just made sense to me. I could become a corpsman, and do what I love then eventually get a degree,” related Pridmore, convinced that the Navy was for her.

“The Navy to me seemed like the best route for medical in comparison to the other branches,” continued Pridmore. “I also see it as a steppingstone to my bigger goals of the future, like becoming a registered nurse. Being in the military was a way for me not to do the traditional thing and go straight to college after high school, but I get the opportunity to travel and learn about life.”

Pridmore attests her personal story is simple, growing up in a ‘very small town’ in Oklahoma with her mom and sister, proving herself in school and employed by age 16 as a waitress until entering the Navy.

“I have always put my full effort into everything I do, that’s how I was raised. I’ve been blessed enough to be surrounded by people that love and support me and made me into the person I am today. They taught me good moral values that I always keep in mind,” said Pridmore, adding that Navy Medicine has shown what it takes to be in her chosen field.

“I have gained leadership skills and learned how to push myself. You can’t get this kind of experience anywhere else,” Pridmore said. “I find it very gratifying that I can make people feel safe in their workplace and the satisfaction of helping others to feel safe in their occupation.”

When asked to sum up her experience with Navy Medicine in one sentence, Pridmore replied, “Life’s not about how hard of a hit you can give, it’s about how many you can take and keep moving forward.”

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Their helping Vets to create a purposeful future

Career transitions are hard for everyone, but the shift from military to civilian life can be particularly challenging.

Soldiers coming back from the Vietnam War were too often treated as damaged goods by employers, according to research by Alair MacLean, sociology professor at Washington State University, it remains to be seen how welcoming employers will be to service members returning from the long wars in Iraq and Afghanistan — especially those in the second half of life.

I grew up in a Navy family (and then Dad worked in the shipping industry). We moved every two or three years, living in places ranging from Fort Hamilton in Brooklyn, N.Y. to Guam. Perhaps that’s why I was so taken by the efforts being made by two military Veterans working with their peers to help them transition to a purposeful civilian life.

Michael Zacchea, 53, director of the University of Connecticut’s Entrepreneur Bootcamp for Veterans with Disabilities, and Larry Steward, 78, founder of ReinventU and the Officers Transition Alliance — are doing important work, and I’d like you to hear from them about how, and why, they’re assisting Vets; you’ll see their interviews below.

Veterans, generally speaking, bring many skills to their future employers, including an ability to work in multigenerational teams. Many Vets are worldly, having been exposed to different cultures and parts of the world during tours of duty. That said, some Veterans with combat experience can’t deal with loud noises; others may find it difficult to be surrounded by too many people in a crowded office.

For Vets, finding jobs in the U.S. workforce means starting with career-transitions basics such as explaining how their skills translate into job attributes, learning how to network, and figuring out which type of employment could be fulfilling.

Joyce Cohen, co-founder of the My Future Purpose membership organization and creator of Boots to Backyards, a mentoring program helping Veterans find new purpose, asks Vets: “What are the skills you picked up that you could use in the future?” She adds: “It’s like a jigsaw puzzle.”

Now, let me introduce you to Michael Zacchea and Larry Steward:

Michael Zacchea: Director of the Entrepreneur Bootcamp for Veterans With Disabilities

U.S. Marine Corps Lieutenant Colonel Michael Zacchea was commissioned a second lieutenant in 1990. His military career included deployment to Somalia and Haiti. He was sent to Iraq in 2004 to build and lead in combat the first Iraqi army battalion trained by the U.S. military and was wounded by a rocket-propelled grenade during the second battle for Fallujah.

He’s now medically retired and was awarded two Bronze Stars and Purple Heart for his service, as well as Iraq’s Order of the Lion of Babylon.

Zacchea’s first job after the military was on Wall Street, working on a trading desk at an energy firm. He hated it, especially because soldiers he knew were still being wounded and killed in Iraq and Afghanistan. So, Zacchea began earning his M.B.A. at the University of Connecticut part-time and got his degree in four years.

A professor at the school encouraged him to research Veteran entrepreneurship programs. He learned there wasn’t one in Connecticut, despite a documented track record of success elsewhere. So, in 2010, Zacchea created a local program targeted at disabled Veterans: the Entrepreneur Bootcamp for Veterans With Disabilities, which mostly helps Vets and family members start businesses.

“On the face of it you’re starting a business, but what it’s really about is creating a community of Veterans,” he says. “We believe entrepreneurship is a really significant force in the reintegration into civilian society.”

The first boot camp cohort had 13 graduates. The latest class is online because of the pandemic; it numbers 21 Veterans and one caregiver.

Most of Zacchea’s classes include caregivers, actually. The spouse of a disabled Veteran often must leave their job to be a caregiver, but starting a home-based business lets them generate an income while caring for the Vet.

Zacchea’s grads have started nearly 190 businesses, although only about 150 are still operating. Most of the shuttered businesses happened for health reasons.

About a quarter of the home-based businesses are in architecture, construction and engineering; another quarter are in IT; another quarter involve supply chain management or brokering and the remaining are an eclectic mix ranging from dog businesses to concierge services.

Why entrepreneurship?

Many Vets are comfortable with advanced technologies; they’ve been trained to act independently on missions and military leaders learn multiple skills, from supply chain management to project planning.

“The military is much more entrepreneurial than people think,” says Zacchea. “Especially small-unit leaders in the military, who are essentially running a small business.”

Another reason: building a business is an inherently optimistic act. You’re creating something that didn’t exist. Zacchea says entrepreneurship is “not just economic integration to create a new identity for Veterans, but it’s also a service program to build something.”

Larry Steward: Founder of ReinventU

Steward joined the Navy in 1962 after graduating from high school in Scottsdale, Ariz. In those days, young men either joined the military or waited to be drafted.

Steward became a medic, attended a Naval medical school and spent time in Okinawa, Japan. Eventually, with the Vietnam War heating up, he found himself in Da Nang.

Steward was involved in a battalion-size operation when a Marine buttonholed him and said his group needed medical help. He managed to get to the Marines under fire, but then got shot in the back.

“The immediate sensation was like being hit by a hot ax,” he recalls. “The other thing is I got my ticket home.”

Steward was awarded several medals for his service, including a Silver Star.

He then went to college and proceeded to work in the advertising industry. Steward enjoyed it but felt his career didn’t have much purpose. He wanted to find a way to help others with their careers, so he opened a career-consulting shop. “It never got off the ground,” he said.

Next, Steward worked for a corporate outplacement firm, became a home improvement contractor in Connecticut and New York and eventually decided to his own encore-career advising business focused on working with Veterans looking to help with the greater good.

That’s what he’s been doing since 2017, through ReinventU, working out of his home in Aiken, S.C. and through the national Encore Network organization.

“I have a career full of transitions,” Steward says. “That’s why I consider myself a transition expert.”

The military officers he consults with typically have a long launchpad for their transition to civilian life, perhaps as much as a year or two. His job is helping them figure out their skill set and finding an organization with a culture reflecting their values.

The four officers in his Officers Transition Alliance group are in their late 40s; one will be 51 when he leaves the military.

Steward notes that much of preparing for a transition involves cultivating an entrepreneurial mind-set, whether the goal is to start a business or not.

“The process of getting a job or starting a business is similar,” says Steward. “The process you’re learning is preparation for future transitions.”

As for himself, Steward has no intention of retiring. “Right now, this is the most exciting period of my entire career, my entire life cycle,” he says.

After speaking with Steward and Zacchea, I’m more convinced than ever that Veterans finding purpose and a paycheck are essential to the health of the U.S. economy.

It’s important to remember what we owe military retirees as a society. And thinking about the U.S. economy, it’s critical for us to understand how much better off we’ll be when our Vets have successful transitions to civilian life.

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About 15 years ago, a woman working for Steven Connor, the director of Central Hampshire Veterans’ Services, was commuting to the office through downtown Northampton when she ran into trouble.

The woman had recently returned from a military deployment in Iraq, where she ferried supplies for the Army across the border from Kuwait. There she learned not to drive on the right side of the road — where insurgents would bury improvised explosive devices — but down the middle.

Coming through Northampton Center, Connor said the woman heard something on the radio, her mind returned to a dusty Iraq road, and by the time she snapped back to Main Street, a police officer was pulling her over for driving over the double yellow line.

To Connor, the situation illustrated how anyone potentially working with Veterans needed to understand military service and how it can sit with a person years later.

At a Veterans Affairs hospital, staff members have that training and experience with Veterans, he said. Everyone from the secretary to the physician can recognize the signs of a service member in distress.

In private health care practices, not so much.

In a report published March 14, the Department of Veterans Affairs recommended shuttering its century-old hospital in Northampton, one of just three medical centers it slotted for closure across the country.

The future of the Edward P. Boland VA Medical Center is far from settled. It will need to pass multiple rounds of review by federal officials before its fate is final. But the possibility that it shuts down still has many Veterans concerned.

More than 24,000 former service members rely on treatment at the medical center. If it were to close, some of the hospital’s services would be redirected to VA facilities in Springfield and Connecticut. For urgent care needs, or for the Veterans who hope to receive their primary and specialty care closer to home, the VA intends for community providers to absorb the additional load of patients.

But going to a standard doctors’ office — whether it be the local community chiropractor or Main Street optometrist — is not as simple as it sounds for many Veterans.

“It’s not that they don’t know what they’re doing medically,” said James Oliver, a 65-year-old former military police officer living on the VA’s Northampton campus. “They don’t know us that well.”

After years of Western and Central Massachusetts Veterans getting treatment at a VA hospital, Connor worries many will be dispersed to community doctors’ offices and urgent care facilities where few of their care providers grasp what service members have been through.

Not many health care employees are skilled in working with people who have undergone military training or seen war, he said. Most are not prepared to recognize the effects that remain with a person long after leaving those environments.

“Under stressful situations, [Veterans] are trained to act a certain way, different from everyone else,” Connor said. “If they’re stressed, if their family is stressed in a doctors’ office or in a clinic, to the staff it could look very foreign. But to them, it’s the way they’re trained to cope.”

‘I wasn’t the same person’

When John Paradis, a retired Air Force Lt. Col., returned from overseas, he was elated to see his kids and wife, to sleep in his own bed, to eat a home-cooked meal.

“I thought I was the same man,” Paradis said. “But there were things I didn’t even notice were happening, things my family observed, and they knew I wasn’t the same person.”

Paradis would find himself falling into mood swings, he told a group of health care workers last year as he tried to describe the struggles of reentering a community after going to war. Sometimes he would tear up; other times he would get angry at things he may have previously smiled at or never even noticed.

“When you’re in a deployed environment overseas, you’re extremely vigilant about your surroundings, you’re in that battle mind situational awareness where you’re totally immersed into what’s right in front of you and around you,” Paradis said. “When you come back to your community, and you’re in a so-called ‘benign environment,’ you still have hyper-vigilance tendencies.”

The effects may be short-term for some Veterans. But many others feel the weight of their service long after they return home.

One evening, Paradis and his wife took their kids to the Friendly’s restaurant in Florence. In the booth beside them was a kid just being a kid — jumping around, tapping Paradis on the shoulder.

But Friendly’s was crowded, and in that stressful moment, Paradis was no longer in a family restaurant. He was back on the streets of Kabul or Baghdad or Sarajevo.

“I had a complete meltdown,” he said. “My kids had never seen me like that before and I really scared them and my wife.”

The moments can come with little warning.

He was in crowded, confined Big Y last year when he got that pit in his stomach.

“It felt like the shelves were crashing in on me and people were too close to me,” he said. “I told my very understanding and amazingly loving spouse I needed to leave. I think my words were, ‘Hey I’m not feeling well.’ And she knew. I didn’t have to say anything more.”

Understanding how trauma can interrupt daily life can be difficult for nonVeterans, but a 2017 video from the David Lynch Foundation (linked here) tried to illustrate the idea.

It shows scenes from a Middle East battlefield: a helicopter flying low over the desert, gunshots, mortars, explosions, the hum of a machine gun, the whoosh of a rocket taking off. But then a message comes across the screen — “These images are from the battlefield. The sounds are not. Listen once again.”

Suddenly, the sounds don’t seem so foreign.

The helicopter rotors are a ceiling fan. The gunshots are everything from a washing machine clanging around to a basketball hitting a backboard. The rockets are from the Fourth of July.

“Daily sounds can bring Veterans right back to war,” the video says.

But few public-facing employees can recognize the signs of a Veteran in an uncomfortable situation, Paradis said, and service members may struggle to connect with a doctor who cannot relate to their background.

“It took me some time to find someone for myself outside the VA system who I felt comfortable with,” he said.

‘It’s not the same as the service up here’

James Oliver lives on the VA’s Northampton campus in permanent housing built by Soldier On, a nonprofit providing shelter to otherwise homeless Veterans. He still feels the physical results of his military career.

In a combat training situation in the mid-1970s, he fell into a deep hole and was medevacked out. Between the lower leg damage from that accident and the results of two major car crashes later on, “everything hurts,” he said. “It’s kind of a struggle to get anywhere.”

From the porch of his unit in the Soldier On housing, Oliver can see the medical facilities where he visits a half-dozen providers. At the VA, he has known some of the doctors for more than a decade, and they know about the complications that weigh on him morning and night — ligament damage, spinal injuries, knee and shoulder surgeries.

As the VA has in recent years expanded Veterans’ ability to seek medical care locally, Oliver has seen “some great doctors in the community,” he said. “But it’s not the same as the service up here.”

Oliver trusts the VA doctors to understand military service and military training, to know how it changes a person’s way of looking at the world. He has not seen that level of experience with service members in the community.

“You never know what you’re going to get when you’re out there,” Oliver said.

William LeBeau first began his care at the VA in 2010. It was 15 years past his last service in the Army Reserve and nearly 20 years after he returned from overseas deployment. For years since, he suffered chronic migraines.

“On the civilian side, they would treat the migraine but they were never really worried about the cause of the migraine,” LeBeau, the state adjutant of the Massachusetts Veterans of Foreign War, said.

The VA determined his migraines likely were caused by chemicals he encountered during military service.

“They changed my treatment, rediagnosed me, gave me proper treatment for my condition,” he said. “I felt the VA was just more aware of many Veterans having similar complaints. Your regular doctor may not see another Veteran beside you. The VA would.”

LeBeau was 26 when he left home for the First Gulf War. He had never had asthma — in fact, he could have been disqualified from military service for the condition. Coming home, his breathing was not the same.

“I’ve had civilian doctors tell me I didn’t even have asthma. It turns out many of us who were serving in the Middle East now have asthma who didn’t grow up with it,” he said. “The VA has been doing this for a long time. When you go to a community provider you can get a different perspective and care, and it can be frustrating to many Veterans out there explaining things the VA would know.”

A future yet to be determined

The VA hospital’s closure is far from certain.

Recommendations to shutter the facility emerged in a report by VA Secretary Denis McDonough, the result of a nationwide assessment to “modernize or realign facilities” in the coming years to meet future needs. The study was mandated by the VA MISSION Act of 2018, which passed the House of Representatives and Senate with overwhelming bipartisan majorities before being signed into law by President Donald Trump.

An independent commission will now review the report and make its recommendations for the Northampton hospital and other VA facilities to President Joe Biden early next year. Federal officials, including Massachusetts Congressmen Richard Neal and James McGovern, have pledged to fight to keep the hospital in Northampton.

With the hospital’s ultimate fate yet undecided, LeBeau said his organization was “not necessarily for or against any changes at this point.”

“We need to study it more,” he said. “We’re aware of the proposed changes. Our national office is aware. Our whole goal is to make sure that Veterans can receive the best care they can possibly get and have access to the care.”

“Whether these changes are the right way to go, we’re watching and will try to have some input on that,” he continued. “This is the preliminary report and no decisions have been made.”

Complicating the report, a subsequent finding by the U.S. Government Accountability Office suggested local providers may not be equipped to handle a sudden influx of patients from VA hospitals.

From 2014 to 2020, the number of Veterans receiving medical care in their local communities increased 64%, from 1.1 million to roughly 1.8 million patients, the GAO said.

In examining whether community care providers could treat more Veteran patients, the congressional watchdog said it found gaps in the VA’s data collection during its nationwide review of facilities.

The GAO said federal officials used data that did not reflect the increased number of Veterans eligible as of 2019 to access local care outside the VA. The result, according to the GAO’s assessment, was that the VA lacked “a full understanding” of community care providers’ ability to supplement VA care.

The VA told MassLive that its study of health care facilities across the country, which began in December of 2018, included interviews with more than 1,800 experts. But the VA plans to establish a team to further review its market assessment and to delve into how the COVID-19 pandemic may have impacted the data.

Sarah Robinson, a spokeswoman for the VA Central Western Massachusetts Healthcare System, said that any recommendations about the future of the hospital “are just that — recommendations.”

“Nothing is changing now for Veteran access to care or VA employees. Any potential changes to VA’s health care infrastructure may be several years away and are dependent on Commission, Presidential, and Congressional decisions, as well as robust stakeholder engagement and planning,” she said.

Barely two miles from the VA facilities is Cooley Dickinson Hospital, which would likely absorb more Veteran patients if the VA closed.

Cooley Dickinson spokesperson Christina Trinchero said that the hospital’s leadership would be closely watching the decision and thinking about how to best serve and establish trust with Veterans and military families.

“Working with any specific population with unique needs requires understanding those needs and putting in place systems and training to best serve those patients,” she said. If the VA closure were approved, she said Cooley Dickinson would be proactive in training staff to understand Veterans and their families.

Just Ask

Have you or any member of your family ever been in the military?

That is the question the Western Massachusetts Veterans Outreach Project wants health care providers to ask anytime they meet a new patient. They say the answer may dramatically change how a doctor interacts with and treats a patient.

Connor, the director of Hampshire County Veterans Services, is also a leading member of the Western Massachusetts Veterans Outreach Project, an organization he said has recognized that many public-facing employees — not solely those in health care facilities — do not know how to work with former members of the armed forces.

The WMVOP — whose ranks include social workers, rehabilitation specialists, and many Veterans themselves — has worked for more than a decade to change that. The group has trained probation officers, first responders, and hospital employees on how to interact with and assist someone who may carry the burdens of military service. It has also launched the Just Ask Campaign to prompt health care providers to ask their new patients whether they had military service, so they can approach treatment accordingly.

“You’ve got about two minutes as the provider to gain [a Veteran’s] trust,” said Larry Cervelli, the lead member of the WMVOP.

“If you don’t get it in two minutes, you’ll never see them in a follow-up visit,” he warned.

In a series of trainings in recent years, the WMVOP has discussed with Baystate Health and Cooley Dickinson employees topics including the impact of military culture on mental health and the challenges military families face.

“The VA closure, if it happens, is going to be another shockwave through the Veterans community,” Cervelli said. “We’re trying to get the civilian health care community more efficient and more capable of caring for Veterans.”

Cooley Dickinson Nurse Practitioner Casey Fowler, a Navy Veteran, is also a WMVOP member. She said that “asking the question” can open the door to providing better, more informed care of Veteran patients. As the hospital’s Veteran liaison, she is working to make the Just Ask practice a standard.

“You need to be aware and sensitive to them as a Veteran as well as a patient,” Fowler said. “You listen to all they have been through and need to be aware of their families [and] support system as well. Families often get left out. They are important too.”

As a major in the Army Reserve, state Sen. John Velis, is aware that many Veterans can be hesitant to bring up their military experience. But with a VA doctor, Veterans may bring up concerns they wouldn’t share with another physician, the Westfield Democrat and chair of the Joint Committee on Veterans and Federal Affairs said.

“Providers who specialize in Veteran care do that for a reason,” he said. “It’s a calling. They know the population and speak the language and it’s absolutely critical that we maintain that.”

For some Veterans who now work in health care, the need for more trained civilian caregivers is clear.

Cindy Foster — a Williamsburg resident, paramedic and Army Veteran — was transporting a Veteran at risk of suicide to Baystate Medical Center three years ago when she realized the changes needed to sufficiently treat other Veterans.

In the hospital, she held the Veteran in her arms, trying to calm him down, Paradis recounted in a 2019 column in the Daily Hampshire Gazette. Of the police officer at the door, the Baystate nurse, the attending physician — no one could help.

“Why?” Paradis asked. “Because they weren’t trained in how to relate with Veterans and how to listen — really listen.”

Without knowing military culture and Veteran background, well-meaning caregivers can do more harm than good. Yelling at a Veteran or using physical constraints, for example, can push a Veteran to their limit, Foster said.

She told Paradis: “This is a kind of post-traumatic stress that no one understands until you’ve had it yourself and been there or have had the training or experience in working with Veterans.”

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"My dad is so cool he was that top 1%."

Military parents around the country rejoice: You just got a little more interesting to your kids.

“Top Gun: Maverick,” which debuted on May 27 after being delayed almost two years due to the Covid-19 pandemic, has given young people on TikTok a perfect opening to brag on their parents’ own real-life “Top Gun” accomplishments. Almost exclusively set to Kenny Loggins’ “Highway to the Danger Zone,” the videos feature photos from their parent’s time at the U.S. Navy Fighter Weapons School, otherwise known as TOPGUN, as well as patches, callsigns, flight suits, and plaques.

“My dad is so cool he was that top 1%,” one user’s viral video says, before showing a Navy Fighter Weapons School plaque from 1993, and various photos of fighter jets and men in uniform. It ends with a man, who is presumably the user’s father, smiling next to a “Top Gun: Maverick” movie poster.

Another similar video also shows off photos, plaques, patches, and keepsakes on a bookshelf. The video is captioned: “[Point of view]: your dad was the real life Maverick.”

“Thank you so much for all the nice comments!!” the user commented on their video. “My dad is so shocked by the outpour of support!!

The long-awaited “Top Gun” sequel, complete with aviator sunglasses, shots of Tom Cruise on a motorcycle, and shirtless beach activities, has brought in millions since it opened. CNN reported on Sunday that globally, the film has brought in $548.6 million so far. According to Deadline, it’s already set a domestic record for Tom Cruise, who returns in “Top Gun: Maverick” as Capt. Pete Mitchell.

Aside from showing kids that their parents are badasses, the film has taken over TikTok in other ways, too. There are videos of guys shaving their facial hair into a mustache like Rooster’s (and Goose’s before him), pilots sharing real footage from inside their cockpits, and clips of the uh, other 99%.

Whatever it may be, it’s no doubt that “Top Gun: Maverick” has the youths talking about the military, and the Navy, in a way they weren’t just a few months ago. At the beginning of Russia’s invasion of Ukraine, TikTok was flooded with joking videos from Generation Z requesting not to be drafted, and highlighting how people were spamming Vladimir Putin’s alleged Instagram account with messages asking him not to start World War III.

Now, some people are commenting that the movie was so cool it almost makes them want to join up themselves. One video says just that, to which other TikTok users concurred, saying they researched the Navy right after watching the movie and joked that they’re re-thinking their career choices.

It’s unclear what kind of impact the new “Top Gun” could have on recruitment, though the Navy — and even the Air Force — are hoping it delivers a nice bump in numbers. And it’s not too much of a stretch to expect one; the original “Top Gun” resulted in a big recruiting boom for the Navy.

Either way, “Top Gun: Maverick” has already succeeded in one seemingly-impossible feat: Making parents cool again.

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Every military unit has at least one person who can crack a joke about anything at any time. Most of those people learn discipline, grow up and become productive members of society.

A surprising number of them never really get over that hump, so they go on the road and try to tell jokes for a living. Any look into the history of comedy reveals dozens of World War II Veterans who made a career out of being funny in the 1950s and ’60s.

Every generation since has produced a few more successful jokesters, and a few of them, such as Rob Riggle and Fred Willard, have gone on to even great fame as go-to actors in comedy movies and shows.

Heading out on stage armed only with a microphone and your own wits should be a terrifying experience, but the masters of the art make it look easy. Here are 11 of the most successful Veteran comics.

Don Rickles

Rickles enlisted in the Navy during World War II and served as a seaman first class on the motor torpedo boat tender USS Cyrene in the Pacific. “It was so hot and humid, the crew rotted,” he later observed about his wartime experience.

After Rickles was discharged, he struggled to become a dramatic actor and started doing stand-up comedy for the paycheck. That didn’t go particularly well, either, until he found his niche by humiliating hecklers and insulting the audience. As king of the insult comics, Rickles became a beloved show business figure before his death in 2017.

Don’s Navy sitcom, “CPO Sharkey,” and several of his stand-up specials are now available for streaming at the Shout! Factory TV website or via their apps for Roku, Apple TV, Amazon Fire and Android TV.

George Carlin

Carlin joined the Air Force in 1954 after he dropped out of high school. While stationed at Barksdale Air Force Base in Bossier City, Louisiana, he got a job as a disc jockey at radio station KJOE across the Red River in Shreveport. That gig, combined with his bad attitude, led to his discharge after three years of service.

Carlin enjoyed early success as a clean-cut comedian, appearing several times on “The Tonight Show.’’ Once he dropped LSD, he changed his entire approach. Carlin grew his hair long, got his ear pierced and started mixing in routines about drugs and profanity into his more traditional observational comedy.

His comedy albums were massive hits, and Carlin became one of the most successful acts of the 1970s. He walked away from live performance at his career peak in 1976, although he returned to the stage later in life. Carlin died in 2008.

Carl Reiner & Mel Brooks

Reiner was drafted into the Army in 1942, and after initially training as a radio operator, he eventually found his way into the Special Services entertainment unit and spent the rest of the war performing for troops in the Pacific theater.

Brooks was drafted in 1944 and was trained to defuse landmines. He fought in the Battle of the Bulge and served with the 1104th Engineer Combat Battalion, 78th Infantry Division as the Allies invaded Germany.

Reiner and Brooks met as writers on fellow WWII Veteran Sid Caesar’s NBC series, “Your Show of Shows.” The two writers began performing a routine with Reiner as a television interviewer and Brooks as a man who claimed to be 2,000 years old. The act took off, and the duo appeared onstage and on television and released comedy albums.

Both men enjoyed long careers as writers, actors and directors. Reiner created “The Dick Van Dyke Show’’ and directed Steve Martin in “The Jerk.” Brooks wrote and directed classics, such as “Blazing Saddles,” “Young Frankenstein” and “High Anxiety.”

Reiner died in 2020 at age 98, friends with Brooks until the end. Brooks is still with us at age 94.

Lenny Bruce

Bruce dropped out of high school and joined the Navy at age 16 in 1942. He served aboard the USS Brooklyn in the Mediterranean Sea before receiving a dishonorable discharge after he performed a comedy routine in drag for his shipmates and convinced the ship’s doctor that he was experiencing “homosexual urges.”

Bruce made his name doing material that was considered “obscene” by police forces all over the country but now wouldn’t raise an eyebrow. He was arrested multiple times for drug possession and obscenity onstage. He was convicted on obscenity charges in New York City after a six-month trial in 1964. Bruce died of a heroin overdose in 1966.

The comic’s act was most definitely not appropriate for television, but host Steve Allen was such a big fan that he helped Bruce get past the network censors and perform on his show.

Jonathan Winters

Winters dropped out of high school in 1942 to join the Marine Corps. He served two-and-a-half years in the Pacific Theater, notably on board the aircraft carrier USS Bonhomme Richard off the coast of Japan in 1945. He was also in the occupation force at Yokosuka.

Winters was one of the most inventive comics of the 1950s, performing wild shows that were often master classes in improvisation. He became a regular on the first generation of late-night talk shows and released a series of successful comedy albums.

The comedian walked away from live stand-up in 1961, but he influenced a generation of comics (most notably Robin Williams) through another five decades of television and movie performances. Winters, 87, died in 2013.

Richard Pryor

Pryor served in the Army from 1958-1960, but the story is that he spent most of his service in a military prison in West Germany after beating up a White soldier who made racial jokes during a screening of the controversial 1950s drama movie “Imitation of Life.”

Pryor kicked around as a struggling stand-up and television writer for the next decade, but his career took off after he appeared at the Wattstax concert in 1972 and released a series of hugely successful comedy albums. He became one of the biggest movie stars of his generation in films like “Uptown Saturday Night,” “Silver Streak” and “Stir Crazy,” appearing in the last two movies alongside Army Veteran Gene Wilder.

His profitable concert films brought stand-up comedy to theater audiences worldwide. Pryor was diagnosed with multiple sclerosis in the early 1990s and died in 2005.

Jerry Stiller

Stiller was drafted into the Army during the final days of World War II and served in Europe.

He convinced his wife, Anne Meara, to form a comedy team in the mid-1950s, and the duo broke through in nightclubs and on television in the ’60s. They quit the live performance circuit and made a career with radio commercials for Blue Nun wine in the ’70s and starred in their own sitcom in 1986. Jerry also fathered Ben Stiller with Meara, so the kid remains one of their most successful collaborations.

Stiller went on to play two of the greatest irate father characters in sitcom history, Frank Costanza on “Seinfeld” and Arthur Spooner on “The King of Queens.” Stiller died in 2020.

Bob Newhart

Newhart was drafted into the Army in 1952 after his graduation from Loyola University of Chicago. He served in the Korean War as a personnel manager until his discharge in 1954.

Newhart was an advertising copywriter who amused his co-workers with one-sided telephone conversations. He recorded a few of them and used them as radio-station audition tapes. That led to a radio gig, and a meeting with a Warner Bros. Records executive led to a recording contract before he’d ever performed a live gig.

Newhart eventually developed stage chops, and his albums were a sensation. He even won a Grammy award for Album of the Year in 1961. He later went on to star in “The Bob Newhart Show” and “Newhart,” two of the most successful sitcoms of all time. He later appeared as the adoptive father of Buddy in “Elf,” and he’s still with us at age 91.

Drew Carey

After dropping out of Kent State University, Carey joined the Marine Corps Reserve in 1980. He served for six years as a radio operator in the 25th Marine Regiment in Ohio. “The Marines gave me a really strong sense of discipline and a work ethic that kicks in at my job,” Carey told ESPN. “I think that attitude comes from my Marine days.”

He had a fast career rise in the clubs, making his first appearance on “The Tonight Show” in 1991. Less than four years later, he was starring in the sitcom, “The Drew Carey Show.”

Carey went on to host the popular improv comedy series “Whose Line Is It Anyway?” and eventually landed a sweet gig in 2007 as Bob Barker’s replacement on “The Price Is Right.”

Nipsey Russell

Julius “Nipsey” Russell enlisted in the U.S. Army in June 1941 and served as a medic in Europe during World War II, returning home to Atlanta as a second lieutenant.

He got his start in comedy while working as a carhop at Atlanta’s legendary drive-in restaurant, The Varsity, which is still in business serving its world-class chili dogs and onion rings. He made customers laugh, and they upped his tips. He later took his act into local nightclubs, and things took off from there.

Russell made his first national television appearance on “The Ed Sullivan Show’’ in 1967 and made dozens of appearances while also taking on a supporting role on the sitcom, “Car 54, Where Are You?” While he was one of the first Black comedians to cross over to White audiences in the era, he also was outspoken about the pay disparity between Black and White comics during the era.

Russell made a lasting impression in the ’70s and ’80s as a celebrity panelist on shows like “To Tell the Truth,” “Match Game” and “Hollywood Squares.” He died in 2005 but achieved a weird kind of new fame when he inspired the stage name of the late L.A. rapper Nipsey Hussle.

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WASHINGTON — A Department of Veterans Affairs plan that contains nearly $2 trillion in recommended facility closures, consolidations and upgrades across the country could be in jeopardy after 12 senators announced they oppose the agency’s reassessment of its facilities.

“As senators, we share a commitment to expanding and strengthening modern VA infrastructure in a way that upholds our obligations to America’s Veterans,” according to the joint statement by the senators. “We believe the recommendations put forth [by the Asset and Infrastructure Review] Commission are not reflective of that goal, and would put Veterans in both rural and urban areas at a disadvantage, which is why we are announcing that this process does not have our support and will not move forward.”

The statement was issued by Sens. Jon Tester, D-Mont.; Joe Manchin, D-W.V.; Mike Rounds, R-S.D.; Martin Heinrich, D-N.M.; Shelley Moore Capito, R-W.V.; Maggie Hassan, D-N.H.; John Thune, R-S.D.; Sherrod Brown, D-Ohio; Patty Murray, D-Wash.; Steve Daines, R-Mont.; Ben Ray Luján, D-N.M., and Rob Portman, R-Ohio. Six of the senators — Tester, Rounds, Brown, Murray, Manchin and Hassan — are members of the Senate Veterans’ Affairs Committee.

In May, Manchin, Rounds, Heinrich and Capito introduced a bill, "Elimination of the VA Asset and Infrastructure Review Commission," which would remove the commission. Thune, Lujan and Hassan are cosponsors. The bill doesn’t say why they want to eliminate the commission, but the senators have been vocal about their opposition to the VA’s closure recommendations in their respective states.

The VA was required to establish the Asset and Infrastructure Review as part of the Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018, or MISSION Act. The review was designed to analyze the health care needs of Veterans as well as the department’s infrastructure. That same year, Congress approved the creation of an Asset and Infrastructure Review Commission to work on the "modernization or realignment" of VA properties.

The review of VA facilities determined which facilities were underutilized, outdated and should be closed, where to invest more resources, the demand for which services, and the needs of the Veteran demographic in each market.

The VA released the commission’s report in March, which recommended facility closures and upgrades to provide better services to Veteran patients in their respective markets across the country. The report listed 35 medical center closures. However, some closures are recommended to be replaced by new buildings and, in some cases, other locations. Other medical centers were recommended to close permanently.

The VA report cited old, deteriorating buildings and a projected decrease in demand for VA services in the areas where it is suggested hospitals be closed. Furthermore, the Veteran population in each market varied.

Additionally, the VA proposed more than 100 multi-specialty, community-based outpatient clinics. The agency also recommended clinic closures and consolidation of services to other nearby VA clinics or medical centers.

But two different independent reports examining the VA’s review found the work was deficient.

The VA Office of Inspector General and the U.S. Government Accountability Office in December and March, respectively, issued reports that found the VA's infrastructure recommendations were incomplete, inaccurate and outdated.

VA Secretary Denis McDonough acknowledged the data was outdated at a House Veterans Affairs Committee hearing in April. He said he had a team of health care experts and former VA senior officials look at the data.

“They came back with an answer that I feared, which is that they think the data is not up to speed in light of the [coronavirus] pandemic,” McDonough told House lawmakers.

The senators in their statement Tuesday said they feel because the review is flawed the commission is not needed.

“The commission is not necessary for our continued push to invest in VA health infrastructure, and together we remain dedicated to providing the department with the resources and tools it needs to continue delivering quality care and earned services to Veterans in 21st century facilities — now and into the future,” according to the senators’ statement.

Because of this, the senators said they will not move forward with nominations to fill empty posts on the review commission.

There was supposed to be nine members on the review commission. The White House and the VA provided five nominees for the commission. Four others are nominated as commission members by leaders in the House and Senate. The final nominee was announced June 22.

Melissa Bryant, acting assistant secretary for VA’s public and intergovernmental affairs, said President Joe Biden requested nearly $20 billion in new VA infrastructure spending to replace and upgrade old buildings.

“President Biden has insisted that our Veterans in the 21st century should not be forced to receive care in early 20th century buildings,” Bryant said. “The median age of VA’s hospitals is nearly 60 years old, and that’s why the president requested nearly $20 billion in new VA infrastructure spending last year and it is why he has requested the largest ever investment in VA infrastructure in his [fiscal 2023] budget. Whatever Congress decides to do with the AIR Commission, which was called for in the 2018 MISSION Act, we will continue to fight for the funding and modernization that our Veterans deserve.”

The American Federation of Government Employees, a government employee union representing VA workers, applauded the announcement by the senators to block the review commission nominations.

“We thank the committee for listening to the voices of Veterans and front-line workers who have been rallying for months against rubber-stamping the VA’s recommendations to close Veteran hospitals and send our nation’s heroes into the private sector where they will pay more for worse outcomes,” Everett Kelley, the union’s president and an Army Veteran, said in a prepared statement.

But Sen. Jerry Moran of Kansas, the ranking Republican on the Senate Committee on Veterans' Affairs, said he was disappointed the committee will not hold confirmation hearings on the commission nominees.

“Many of the VA's facilities are empty, underutilized and severely outdated,” he said in a prepared statement on Monday. “We passed the VA MISSION Act to address these issues but by refusing to confirm commissioners, we are essentially shutting down the work of the AIR Commission and possibly our only opportunity to fix this long-standing issue."

Rep. Mike Bost of Illinois, the ranking Republican on the House Committee on Veterans' Affairs, also released a statement Monday that condemned the senators' opposition.

"The MISSION Act was signed into law with broad support from lawmakers on both sides of the aisle and every major Veterans service organization,” he said. “It established an Asset and Infrastructure Review — or, AIR — process with nine Senate-confirmed commissioners to recommend updates to VA's failing medical care infrastructure. This process is vital for the future of modern, state-of-the-art VA care. It is wrong for these senators to outright refuse to even consider the nominees put forth by the Biden administration. This decision does an immense disservice to Veterans and VA staff who will feel its repercussions for years to come."

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Sought TRICARE Beneficiaries to Receive Expensive Compounded Drugs

LITTLE ROCK-United States District Judge Brian S. Miller sentenced Bradley Fly, 36, of Germantown, Tenn., to 20 months in federal prison for violating the Anti-Kickback Statute. In July 2019, Fly pleaded guilty to offering two TRICARE beneficiaries’ money in exchange for signing up to receive expensive compounded drugs.

At sentencing, the United States introduced evidence that Fly bribed two people: his longtime friend (then a Marine reservist), plus an Army National Guardsman, whom Fly solicited while seated courtside at a Memphis Grizzlies game. Fly then facilitated prescriptions for both men and their wives, for which TRICARE paid over $500,000, earning himself over $180,000 in commission.

Judge Miller heard testimony from the Marine reservist and from a Special Agent with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) that the prescriptions were part of a larger network of prescription generation, including recruiters whom Fly paid for TRICARE beneficiary information and a group of doctors whom Fly used to sign prescriptions without consulting patients.

“There is no room for kickbacks in the healthcare marketplace,” said Acting United States Attorney Jonathan D. Ross. “Serious penalties and prison await those, like Mr. Fly, who fail to abide by the law. This office and its partners at the FBI and HHS-OIG are committed to rooting out such criminal conduct.”

“Mr. Fly paid kickbacks generating fraudulent claims to line his pockets without concern for the health and welfare of the patients,” said Miranda L. Bennett, Special Agent in Charge of the HHS-OIG Dallas Region. “We will continue working with our law enforcement partners to pursue individuals defrauding federal health care programs.”

“By defrauding TRICARE, Mr. Fly disgracefully cheated U.S. Veterans, their families, and American taxpayers,” said FBI Little Rock Acting Special Agent in Charge Jason Van Goor. “We are grateful for our state and federal partners who help us both investigate these cases and protect the financial integrity of our nation’s health care systems.”

In addition to the 20-month prison sentence, Fly was sentenced to three years of supervised release. The investigation was conducted by HHS-OIG and the FBI and prosecuted by Assistant United States Attorney Alexander D. Morgan.

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Military COVID-19 deaths are continuing to trend upward, even as more of the force gets vaccinated. The five most recently reported deaths all came in members of the Army’s reserve component, whose organizations are among the least vaccinated in the military.

In the 36 deaths reported since August, 19 ― or 53 percent ― were among Army Reserve and Army National Guard soldiers, though they make up roughly 20 percent of the military overall. Since the pandemic began, they have made up 26 of 67 total deaths, or 39 percent.

Of those 67, 66 were completely unvaccinated, while one had received a first dose of a two-dose vaccine, Pentagon spokesman Maj. Charlie Dietz confirmed to Military Times on Wednesday.

The most recently reported deaths include:

• An Army National Guard sergeant, 49, died Aug. 14. He was assigned to the 2225th Transportation Company in Jacksonville, Alabama. As of Wednesday afternoon, his family had not agreed to release his name.
• Army Reserve Sgt. 1st Class Matthew E. Harmon, 51, died Oct. 1. He was assigned to 8th Battalion, 104th Regiment in Salt Lake City, Utah.
• Army Reserve Sgt. Yancy Williams, 54, died Oct. 5. He was assigned to the 451th Civil Affairs Battalion in Houston, Texas.
• An Army National Guard Master Sgt. Billy Richardson, 53, died Oct. 6. He was assigned to Joint Force Headquarters in San Antonio, Texas.
• An Army National Guard sergeant first class, 53, died Oct. 7. His family declined to release his name, according to Tennessee Military Department spokesman Lt. Col. Marty Malone.

Those deaths bring the total in October so far to eight, less than half-way into the month. September saw 14 deaths while August saw 15, up from an average of one or two deaths a month previously.

As of Wednesday, 60 percent of the total force is fully vaccinated ― 1,383,388 troops ― with another 15 percent ― 338,000 troops ― who have received the first of a two-dose regimen.

That number belies a significant chasm between the active-duty and reserve components.

On Tuesday, Pentagon spokesman John Kirby told reporters that just under 97 percent of active-duty troops are at least partially vaccinated, while just under 84 percent are fully vaccinated.

The first active-duty deadline drops Nov. 2, for the Air Force and Space Force, followed by Nov. 28 for the Navy and Marine Corps, then Dec. 15 for the Army.

The reserve component is lagging much more behind. While the Army has given its Reserve and National Guard until the end of June 30 to both get its troops vaccinated and update their files to reflect that, the other services have deadlines closing in more quickly.

The Marine Corps Reserve, for example, is only 38 percent vaccinated, the Washington Post reported Friday, with a Dec. 28 vaccination deadline. The Army Reserve and National Guard are also roughly 40 percent vaccinated, according to that data.

“Commands will try to get these troops to make the right decision based on information and education,” Kirby said. “And for somebody that refuses, they’ll be given a chance to get more context from medical service providers, as well as their chain of command.”

If that doesn’t work, discipline comes into play, though not necessarily criminal charges. Commanders have the ability to involuntarily separate troops without getting the law involved.

“It’s a lawful order. So obviously, if after all that effort, the lawful order is disobeyed, there could be disciplinary action,” Kirby said. “But the secretary believes that there’s lots of tools available to leaders, short of using the Uniform of Code of Military Justice, to get these troops to do the right thing for themselves and for their units.”

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The numbers reflect the latest data available as of Jan. 29 from the CDC’s Vaccine Adverse Event Reporting System website. Of the 501 reported deaths, 453 were from the U.S. The average age of those who died was 77, the youngest was 23.

February 5, 2021 (Children’s Health Defense) — As of Jan. 29, 501 deaths — a subset of 11,249 total adverse events — had been reported to the Centers for Disease Control and Prevention’s (CDC) Vaccine Adverse Event Reporting System (VAERS) following COVID-19 vaccinations. The numbers reflect reports filed between Dec. 14, 2020, and Jan. 29, 2021.

VAERS is the primary mechanism for reporting adverse vaccine reactions in the U.S. Reports submitted to VAERS require further investigation before confirmation can be made that an adverse event was linked to a vaccine.

As of Jan. 29, about 35 million people in the U.S. had received one or both doses of a COVID vaccine. So far, only the Pfizer and Moderna vaccines have been granted Emergency Use Authorization in the U.S. by the U.S. Food and Drug Administration (FDA). By the FDA’s own definition, the vaccines are still considered experimental until fully licensed.

According to the latest data, 453 of the 501 reported deaths were in the U.S. Fifty-three percent of those who died were male, 43% were female, the remaining death reports did not include the gender of the deceased. The average age of those who died was 77, the youngest reported death was of a 23-year-old. The Pfizer vaccine was taken by 59% of those who died, while the Moderna vaccine was taken by 41%.

The latest data also included 690 reports of anaphylactic reactions to either the Pfizer or Moderna vaccines. Of those, the Pfizer vaccine accounted for 76% of the reactions, and the Moderna vaccine for 24%.

As The Defender reported today, a 56-year-old woman in Virginia died Jan. 30, hours after receiving her first dose of the Pfizer vaccine. Doctors told Drene Keyes’ daughter that her mother died of flash pulmonary edema likely caused by anaphylaxis. The death is under investigation by Virginia’s Office of the Chief Medical Examiner and the CDC.

Last week, the CDC told USA TODAY that based on “early safety data from the first month” of COVID-19 vaccination the vaccines are “as safe as the studies suggested they’d be” and that “everyone who had experienced an allergic response has been treated successfully, and no other serious problems have turned up among the first 22 million people vaccinated.

Other vaccine injury reports updated this week on VAERS include 139 cases of facial asymmetry, or Bell’s palsy type symptoms, and 13 miscarriages.

States reporting the most deaths were: California (45), Florida (22), Ohio (25), New York (22) and KY (22).

The Moderna vaccine lot numbers associated with the highest number of deaths were: 025L20A (20 deaths), 037K20A (21 deaths) and 011J2A (16 deaths), 025J20A (16 deaths) . For Pfizer, the lot numbers associated with the most reports of deaths were: EK5730 (10 deaths), EJ1685 (23 deaths), EL0140 (19 deaths), EK 9231 (17 deaths) and EL1284 (13 deaths). For 135 of the reported deaths, the lot numbers were unknown.

The clinical trials suggested that almost all the benefits of COVID vaccination and the vast majority of injuries were associated with the second dose.

While the VAERS database numbers are sobering, according to a U.S. Department of Health and Human Services study, the actual number of adverse events is likely significantly higher. VAERS is a passive surveillance system that relies on the willingness of individuals to submit reports voluntarily.

According to the VAERS website, healthcare providers are required by law to report to VAERS:

• Any adverse event listed in the VAERS Table of Reportable Events Following Vaccination that occurs within the specified time period after vaccination
• An adverse event listed by the vaccine manufacturer as a contraindication to further doses of the vaccine

The CDC says healthcare providers are strongly encouraged to report:

• Any adverse event that occurs after the administration of a vaccine licensed in the United States, whether or not it is clear that a vaccine caused the adverse event
• Vaccine administration errors

However, “within the specified time” means that reactions occurring outside that timeframe may not be reported, in addition to reactions suffered hours or days later by people who don’t report those reactions to their healthcare provider.

Vaccine manufacturers are required to report to VAERS “all adverse events that come to their attention.”

Historically, fewer than fewer than 1% of adverse events have ever been reported to VAERS, a system that Children’s Health Defense has previously referred to as an “abject failure,” including in a December 2020 letter to Dr. David Kessler, former FDA director and now co-chair of the COVID-19 Advisory Board and President Biden’s version of Operation Warp Speed.

A critic familiar with VAERS’ shortcomings bluntly condemned VAERS in The BMJ as “nothing more than window dressing, and a part of U.S. authorities’ systematic effort to reassure/deceive us about vaccine safety.”

CHD is calling for complete transparency. The children’s health organization is asking Kessler and the federal government to release all of the data from the clinical trials and suspend COVID-19 vaccine use in any group not adequately represented in the clinical trials, including the elderly, frail and anyone with comorbidities.

CHD is also asking for full transparency in post-marketing data that reports all health outcomes, including new diagnoses of autoimmune disorders, adverse events and deaths from COVID vaccines.

Children’s Health Defense asks anyone who has experienced an adverse reaction, to any vaccine, to file a report following these three steps.

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Amidst growing concern about COVID-19 infection, health officials have provided several recommendations to help individuals protect themselves and their families from infection, including washing hands regularly and maintaining a distance of at least six feet from anyone who is coughing or sneezing. Fortunately, a growing body of evidence suggests that an additional lifestyle modification could also dramatically improve your odds of avoiding infection – getting more sleep.

It has long been known that sleep is important for military performance. The Walter Reed Army Institute of Research has conducted sleep studies since the 1950s, showing that sleep loss negatively affects emotional regulation, judgment, cognitive performance, learning and memory, psychological resilience and reaction time – each of which could be critical for success in multi-domain operational environments—and almost all other environments as well, from the athletic field to the classroom to the boardroom. This is why elite athletes make sure they obtain 8-10 hours of sleep per night: to acquire that extra “edge” that can make the difference between success and failure.

In addition, and of particular relevance given current concerns about the spread of COVID-19, recent evidence suggests that sleep is also important for healthy immune function and the ability to fight off infection. "From a Soldier lethality perspective, we often state 'sleep is ammunition for the brain', as sleep is critical for decision making, vigilance and reaction time. When it comes to fighting the common cold and flu, sleep is your internal body armor that helps you fight some viruses and disease," said Army Col. Deydre Teyhen, Commander of the Walter Reed Army Institute of Research.

The relationship between sleep and infectious disease is now being explored by researchers across the world, and several interesting and important findings have been reported. For example, in one study, volunteers without previous exposure to the common cold were exposed to a live sample of the virus. Researchers found that no variable predicted whether a participant would fall sick better than sleep duration – not even age or stress level. In other words, those who habitually slept less were more likely to fall ill with the cold virus.

In another study conducted by the same group, a “sleep threshold” was discovered: individuals who averaged less than seven hours of sleep per night were found to have a three-fold greater risk of infection relative to those who averaged eight or more; that rate climbed to a 4 ½-fold greater risk for those with less than five hours of sleep.

Perhaps most surprisingly, it has also been found that six months after receiving a hepatitis B vaccination, individuals who slept fewer than six hours on the night prior to vaccination were at significant risk of being unprotected compared to those who had obtained more than seven hours of sleep.

In addition, there is now limited but exciting evidence from animal studies suggesting that sleep not only helps protect against initial infection, it also plays a direct role in aiding recovery from infectious illness.

Although there have not yet been any studies in which the relationship between sleep duration and COVID-19 infection have been studied directly, lessons learned from studying the relationship between sleep duration and other infectious diseases can readily be generalized to COVID-19.

"Sleep is critical for maintaining physical, cognitive and immunological dominance on and off the battlefield. Leaders must prioritize sleep as a valuable asset in maintaining readiness and resilience, especially in the context of multi-domain operations and increased health risks worldwide—including those risks associated with exposure to infectious diseases," says Army Lt. Col. Vincent Capaldi, director of the Behavioral Biology branch at WRAIR, responsible for studying the relationship between sleep, performance and military effectiveness.

Unfortunately, approximately one in three American adults do not obtain the American Academy of Sleep Medicine-recommended 7+ hours of sleep per night, a situation that is estimated to cost the US economy approximately $411 billion a year due to increased errors and accidents, lower productivity and increased absenteeism. And the problem is particularly pronounced in the military, where approximately two in three Soldiers average six or fewer hours of sleep a night.

Research laboratories under the U.S. Army Medical Research and Development Command including WRAIR, the U.S. Army Medical Research Institute of Infectious Disease and U.S. Army Medical Materiel Development Activity, are working diligently on a range of solutions to detect, treat and prevent COVID-19, including a vaccine.

WRAIR sleep and infectious disease researchers are also jointly exploring the relationship between sleep and immune function – a natural collaboration since the WRAIR infectious disease research programs are among the best in the world, having contributed to the development of many FDA-approved vaccines and every existing FDA-approved malaria prevention drug. Furthermore, WRAIR’s world-renowned sleep and performance research program has generated several technological and knowledge products, including wrist actigraphy (a precursor to current smart watch technology) to reliably measure and quantify sleep in the field; human functional brain imaging studies that have furthered scientific understanding of sleep and sleep loss and the discovery of “sleep banking”: the finding that extra sleep prior to a mission with sleep loss blunts the performance decrement and reduces the amount of sleep needed to fully recover afterwards.

As medical countermeasure development efforts progress, obtaining at least seven hours of sleep per night in a comfortable, cool, quiet, dark and safe area, in addition to regular handwashing with soap and water and maintaining a healthy social distance (6 feet), will continue to constitute the first line of defense against infection.

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A provision in the House's fiscal 2021 defense policy bill would give some service members an additional allowance to cover the cost of food and other basic needs -- a stipend advocacy groups say is needed to relieve financial and psychological strain on young military families.

But to become law, the measure must be agreed to by the Senate, where it faces the same challenges it endured last year before it was dropped, including a fiscally conservative Republican-led negotiating body and reluctant White House.

Still, advocates and House lawmakers from both sides of the aisle said Wednesday they are more optimistic about passage of the measure, which would give an additional monthly allowance to service members whose gross household income does not exceed 130% of the federal poverty guidelines.

Among the reasons for their hope: a tweak to the proposal that would take the application process out of the chain of command and make it incumbent on the Defense Finance and Accounting System to notify troops of their eligibility and require service members to furnish information on any spouse employment to receive the stipend.

Service members also could opt out of the effort.

Advocacy groups concede there is little data on the extent of food insecurity among military families, but say they know troops often rely on food banks located near their duty stations.

"The Pentagon says that, when you compare the pay and benefits counterparts in the private sector, it's more than fair. But the fact that we have food pantries that are serving military families across the country says otherwise," said Josh Protas, vice president for public policy at MAZON: A Jewish Response to Hunger.

The proposed stipend would be equal to 130% of the federal poverty guidelines minus the service member's gross income (not counting any allowances) divided by 12.

For an E-4 with several years in the military, a spouse and two children, this would equate to roughly $250 extra a month.

For Bianca Strzalkowski, that funding would have gone far to help feed her family of five, including husband Ron, a now-retired Marine gunnery sergeant, and three boys. As newlyweds at Camp Lejeune, North Carolina, Bianca earned a substantial income, and the couple "built their lives on the budget of two incomes."

But after receiving orders to Yuma, Arizona, she struggled to find a commensurate job that would cover the cost of child care. "We quickly spiraled into a sad, and what I would [call] shameful, time as he was a sergeant in the Marine Corps," she said.

They turned to the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program and a food bank, where they received recently expired food from grocery stores. They occasionally ate military-issued Meals, Ready to Eat, she said.

"While he was deployed to places like Iraq, Afghanistan and the Horn of Africa, we were unsure truly how we were going to make ends meet, pay our bills and feed our family on a continuous basis," Strzalkowski said.

She added that she only just now is speaking about her experience because her husband retired in 2018.

"The external message [in the military] is, you should seek help, but there is an unspoken code in the military to not talk out loud," she said.

Protas said that one in eight military families faces food insecurity, compared with one in 10 families in the general U.S. population.

A 2016 Government Accountability Office report found that more than 23,000 active-duty troops used the Supplemental Nutrition Assistance Program (SNAP), once known as food stamps, in 2013.

"One of the challenges has been that there is a lack of data on the issue. There hasn't been a lot of official data gathered by DoD," Protas said. "DoD has been reluctant to gather this data or has been asking the wrong questions. For example, in the Quadrennial Review of Military Compensation, they're just looking at how many military families actually participate in SNAP. But they're not asking how many struggle and can't get the help they need."

Last year, Office of Budget and Management officials objected to the measure when it was included in the House version of the defense bill, saying that service members "receive appropriate compensation" and "most junior enlisted members receive pay that is between the 95th and 99th percentiles relative to their private-sector peers."

Rep. Susan Davis, D-Calif., and Rep. Don Young, R-Alaska, said the issue is more important than ever, given the strain of the COVID-19 pandemic on military families.

"This is something we have the power to change. We have already enacted many programs during COVID that have helped prevent Americans from going hungry," Davis said. "This is all about kids, and military kids should not have barriers to access food."

Young agreed.

"We have people serving in the military who are not getting fed," he said. "Our job is to make sure they have food on their tables so they can do their duty and their mission. As an ex-military person, I was never hungry because I was by myself. But these people with a family, the members of the family, they need the food."

The process for negotiating the House and Senate versions of the defense bill has yet to begin, with neither chamber naming the members who will serve on the conference committee. The measures are expected to come up after the November election. The conference already is expected to be contentious, as both versions contain provisions to rename military bases that honor Confederate officers. President Donald Trump has said he would Veto any bill that contained such a measure.

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The insurer Allstate said Monday it will return more than $600 million in auto insurance premiums to customers as many Americans stay home and drive less during shelter-in-place orders to curb the coronavirus outbreak.

Most customers will receive a payback of 15% of their monthly premium in April and May, the company said.

The payback, which will apply to 18 million policies issued by Allstate and its Esurance and Encompass units, follows a data analysis by the insurer that showed mileage is down between 35% and 50% in most states, Allstate Chief Executive Officer Tom Wilson said during a call with reporters Monday.

The analysis, based on data that Allstate collects from tracking products that some customers agree to use in exchange for discounts, and other sources, showed no difference between states that had shelter orders in effect and those that did not, Wilson said.

Still, some people may be driving faster on what are now less densely traveled roads, which could lead to more serious accidents, Wilson said.

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For decades, dawn brought the clarion bugle call of reveille across the lush campus of the Veterans Home of California in Yountville, 60 miles north of San Francisco. The residents, the earliest among them Veterans of the Mexican-American war, rose early and dressed in strict accordance with a uniform-like code.

In the late 1800s and early 1900s, the Veterans home was a working farm, with chickens, pigs, and a whole herd of cattle, along with apple, peach, and plum orchards. The men spent long days tending to the animals and working the land. The labor was believed to be restorative, giving order and purpose to generations of Veterans suffering from what would soon become known as “shell shock.”

Nearly 150 years later, the facility is still in operation. After years of funding and other challenges — one inspection in 2016 found 14 separate fire safety deficiencies — investments in the home have ensured its future continuing to care for California’s Veterans. No longer a working farm, the campus is home to more than 1,000 Veterans, most of them elderly, with levels of support ranging from independent living to skilled nursing. Today, the campus hums with activity, as construction equipment reshapes the nation’s largest Veteran home into one that can effectively and compassionately meet the changing needs of the state’s aging Veteran population.

As Vietnam and eventually Gulf War-era Veterans grow older, they bring with them new needs, different expectations for care, and greater diversity than the Korean War and World War II Veterans who came before them. The Department of Veterans Affairs and Veterans organizations across the country are working to care for a new generation of older Veterans who tend to have greater expectations for longevity and independence than earlier generations, yet also may struggle with more complex medical conditions.

“We’re kind of compounding multiple variables, in the sense that not only are people living longer, but … many of them survived something that wasn’t survivable,” says Scotte Hartronft, the director of geriatrics and extended care at VA. “A lot of Veterans have survived significant injuries over the last couple of conflicts that [they] wouldn’t have survived in previous wars.”

In California, the most populous state in the nation and home to the highest number of Veterans, the California Department of Veterans Affairs, known as CalVet, the state’s Veterans department, is working to create a modern facility that centers the needs and dignity of older Veterans. While the Yountville Veterans Home is unique — as the largest and one of the oldest Veterans homes in the nation — across the country, people charged with caring for Veterans grapple with the same question that drives the redesign of the facility: How do we best care for those who have served on our behalf as they grow old?

‘The bulge of the snake is Veterans over 55′

Yountville Veterans Home is one of eight facilities across California that provide long-term care for older and disabled Veterans, and sometimes their spouses — part of a legacy that dates back to the decades after the Civil War, when states opened soldiers’ homes to care for the sudden influx of struggling Veterans.

With a Veteran population of more than 1.6 million in 2020, California is home to a sizable percentage of the nation’s Veterans — a population that is steadily growing older.

“A lot of the focus … is on OEF/OIF Veterans for obvious reasons, but really, the bulge in the snake, so to speak, of the Veteran population in California is certainly over 55,” says Keith Boylan, the deputy secretary for Veterans services at CalVet.

Other states see this trend mirrored: Between 2021 and 2041, the number of Veterans older than 85 is expected to increase by 31%, according to VA data. In part, that’s because the overall number of Veterans nationwide is actually decreasing. During World War II, military service was common; in subsequent wars, the proportion of the population who served has steadily fallen. Between 2000 and 2018, the number of Veterans in the country declined by a third — the bulk of Americans who have served in the military served decades ago.

But Vietnam and Gulf War-era Veterans represent a different slice of the population than Veterans who fought in World War II and Korea. The number of women Veterans over the age of 65 is expected to increase by a staggering 237% between 2021 and 2041, according to data from VA. Racial diversity is also increasing, and the geographic distribution of Veterans is shifting.

This means Veterans’ care must change as well. Women, for example, have a greater life expectancy than men do.

“They tend to live longer, and by living longer, they tend to [need] more assistance with daily living activity needs,” Hartronft says.

Women Veterans, as a cohort, will require more support to continue to live independently as they age for longer — a fact compounded by the fact that women, who tend to be informal caregivers to friends and family, often have more difficulty than men in finding their own caregivers when needed.

Other populations — such as Veterans who live in rural areas, far from health services, or without housing, or who deal with more complex physical and mental ailments — also require unique approaches to care. And behavioral health support more broadly, especially for Veterans who have lived through traumas they might not have survived in earlier conflicts, will be critical in the coming decades.

“We’re trying to always think of what programs can help with the specific individual needs and situation — both the socioeconomic and other situations — because not one thing fits or works for everybody,” Hartronft says.

In addition to higher rates of post-traumatic stress and other conditions affecting mental health, Veterans are more likely to be exposed to risk factors, such as traumatic brain injuries or toxic exposure, for Alzheimer’s and other dementias. Veterans also have a higher chance of being diagnosed with certain types of cancer, like lung and skin cancer. About 50,000 new cancer cases among Veterans are reported annually; that number is expected to rise as Veterans age.

“You’re shrinking the population, but the need is still very high,” says Thomas Martin, the head of future operations and planning for CalVet’s Veterans homes. “We want to try to do our best job to make sure that we’re helping patch any holes in the safety net.”

‘You don’t want to go from home to hospital bed’

Veterans homes like Yountville actually aren’t very common. There’s a reason for that: long-term in-patient care can cost thousands of dollars per month, according to AARP, and seniors often prefer to live at home, whether for financial, emotional, or other reasons. As baby boomers age, the focus of elder care has increasingly shifted from live-in facilities to aging-in-place services, allowing people to stay in their homes for as long as possible, while increasing support and services as needed. Keeping people at home longer reduces hospital visits, and recovering from some medical procedures at home leads to fewer inpatient complications and brings down the cost of care.

“When it comes to aging in place specifically, we’ve had one of the largest expansions of home care in the VA,” Hartronft says.

Within the next two years, every VA medical center will offer Veteran-directed care, a popular program that provides qualified Veterans with a stipend to hire local caregivers to assist them with daily living or even companionship. VA is expanding home-based primary care — which provides health care to Veterans at home, many of whom are housebound — to 75 new sites, as well as expanding its Medical Foster Care program, which allows some Veterans to live in a private home with a caregiver, rather than in a nursing home. They’re also piloting a program using predictive analytics to help determine which Veterans are at the highest risk of nursing home care in the coming years, to connect them with preventive services.

“Our biggest goal is really advertising the aging-in-place services so that people think of them proactively and don’t only think of them during a crisis,” Hartronft says.

But for some Veterans, continuing to live at home as they grow older isn’t an option — or they prefer to live with people who understand their history of service.

“They wanted to be in an environment of Veterans, and surrounded by Veterans,” says Martin of residents of California’s Veterans homes.

The Yountville renovation — designed by the architecture firm CannonDesign, and slated to be completed early next year — aims to set a standard for caring for a diverse population of Veterans who want to or need to live in a care facility. The project replaces a 90-year-old hospital building with a state-of-the-art skilled nursing facility and memory care center. The same principles that support the idea of aging in place — dignity and independence — guide its design.

“Most of these people have just come from home,” says David Hunt, who leads CannonDesign’s health practice in Southern California. “You don’t want to go from home to hospital bed.”

Instead, the project works to make Veterans feel as much at home as possible. Visually distinct “neighborhoods,” each with their own small shared dining and living areas, make up the facility. Designers avoided the glaring fluorescence of a hospital ward, instead using light fixtures that build on research into how the eye changes as it ages, as well as what makes a space feel comforting. The same goes for furniture and decor.

The more a long-term care facility feels like home, the happier residents are — and the better their health outcomes are, research shows.

“They have symptoms of less pain, they eat better,” Hunt says. “So it’s not just to make it homey. It’s also proven to be medically more efficient.”

The design considerations promote independence, even among Veterans dealing with cognitive impairment or dementia. Visual cues, such as photo murals of “amber waves of grain,” help orient residents who can no longer read, and outdoor walking paths enclosed in a garden allow dementia patients to wander without getting lost.

“You want to maximize their ability to be independent, to be able to walk around without having to keep a close eye on them,” Martin says. “You want to make sure that its environment is going to be safe and welcoming.”

Ultimately, many experts say, what matters is thinking through care in a “Veteran-centric” way — buying into the idea that honoring Veterans as they age means taking the time to understand who they are and what they want, and then incorporating that into real-world care considerations.

Take scooters, for example. When designers from CannonDesign visited the Yountville campus, they realized how many residents got around on motorized scooters.

“They’ve got this gorgeous 600-acre-plus community, and those scooters allow them to get around a bit,” says Margi Kaminski, a co-director of health interiors at CannonDesign. “I’m not sure I would call them a status symbol, but they definitely are a big thing.”

That human experience — the ease of mobility around the sunshine-soaked campus, the social capital that comes with being one of the scootering set — translated into real-world design considerations. Architects ensured that rooms were big enough for Veterans to about-face their scooters with a three-point turn. There’s even a repair shop on the first floor.

“It’s not just about having the bed,” Martin says. “It’s about having the right environment.”

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Save 10% off lowest fare options

Amtrak Passenger Discount for Military Veterans

Veterans receive a 10% discount on the lowest available rail fare on most Amtrak trains.

Use the Fare Finder at the beginning of your search on www.amtrak.com and select ‘Military Veteran’ for each passenger as appropriate to receive the discount.

Military Personnel Save 10% and Get Ahead of the Ticket Line

With valid active-duty United States Armed Forces identification cards, active-duty U.S. military members, their spouses and their dependents are eligible to receive a 10% discount on the lowest available rail fare on most trains, including for travel on the Auto Train.

Just use the Fare Finder at the beginning of your search on www.amtrak.com and select ‘Military’ for each passenger as appropriate to receive the discount.

Additionally, Amtrak supports and thanks troops by welcoming uniformed military personnel to the head of the ticket line.

Discount Limitations

• The Veteran/military discount is not valid with Saver Fares or weekday Acela trains.
• The Veteran/military discount does not apply to non-Acela Business class, First class or sleeping accommodation. Veterans can upgrade upon payment of the full accommodation charges.
• The Veteran/military discount is not valid for travel on certain Amtrak Thruway connecting services or the Canadian portion of services operated jointly by Amtrak and VIA Rail Canada.
• The Veteran/military discount may not be combined with other discount offers; refer to the terms and conditions for each offer.
• Additional restrictions may apply.

Visit www.amtrak.com for more information.

The sharing of any non-VA information does not constitute an endorsement of products and services on part of the VA.

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Kathy Roth-Douquet is the CEO of Blue Star Families and a Marine Corps spouse.

This past June marked the two-year anniversary of the tragic death of Brandon Caserta, a United States Navy petty officer who took his own life at his base in Norfolk, Virginia.

Unfortunately, suicide is not a new phenomenon among active-duty service members. But there are actions that lawmakers can take to help those struggling with mental health issues -- and work to prevent future tragedy.

According to the most recent U.S. Department of Defense Annual Suicide Report (ASR) from 2019, Caserta was one of 325 active-duty service members and one of 68 sailors who died by suicide in 2018. The report also found a five-year increase in the suicide rate for active-duty troops -- jumping from 18.5 to 24.8 suicides per 100,000 members. We have yet to see the 2019 data, but we mustn't wait on numbers to act.

After his death, Caserta's parents and friends discovered personal notes in which Brandon attributed his suicide to persistent hazing and bullying from members and leaders of his Navy helicopter squadron. Brandon's parents, Patrick and Teri, believe their son saw no options for getting medical care or mental health services, given that his chain of command was aware of the bullying and was allegedly even part of their son's harassment.

Governing bodies are trying to address the issue. In October 2018, the Defense Department enacted a requirement for the ASR to increase reporting, transparency and accountability for the department's suicide prevention efforts. Its goals included implementing policy guidance and a special governance body; standardizing and advancing data and research; and partnering with other groups across the nonprofit and private sectors. The plans also increased focus on working with some of the military's most vulnerable -- young service members and members of the National Guard, along with family members who struggle as well.

While this is a step in the right direction, there's a core missing piece that needs to make its way into Congress' Fiscal 2021 National Defense Authorization Act.

Military spouses are all too aware of the challenges that come with addressing mental health issues for service members. A spouse of an active-duty service member participating in Blue Star Families' 2019 Military Family Lifestyle Survey explained, "No soldier with career aspirations will reveal true physical or mental health issues under the current system. No one. It is the number one reason we have injured soldiers, chronic pain, and unresolved mental instability, which leads to suicide."

Part of what's missing from the federal response is anonymity -- an effective method for members to seek help without fear of retribution from their command units. It is an issue brought to light in the investigation of Caserta's death, and it is backed up by data year after year.

In the 2019 MFL Survey, troops and spouses revealed that concerns about potential impacts on a service member's career were the most common reason for not seeking mental health treatment for those who had seriously considered suicide or had attempted suicide in the past year -- and that spans across active-duty, National Guard and Reserve family respondents.

The Brandon Act, introduced in June by Rep. Seth Moulton, D-Mass., and named in honor of Caserta, would require the DoD to establish a standard phrase that service members can use anonymously to initiate a mandatory and immediate mental health evaluation referral, while receiving confidential evaluations without notifying their commands. The act was successfully included in the House's version of the NDAA but has yet to be included in the final NDAA.

In our fight to reduce suicide among service members and support the mental health and well-being of our active-duty, Reserve, National Guard and Veterans, it is critical for the Brandon Act to be included in the final fiscal 2021 NDAA. We are halfway there: We must call upon Congress to act and finish the job in order to protect those service members who sacrifice for us.

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While armed service members and federal employees are set to get an equal pay raise in fiscal 2020 – a new study calls into question whether a slew of raises throughout recent decades has pushed military pay too high.

A recent report from the RAND Arroyo Center, which looked at three decades’ worth of data, found that the current compensation structure might not be the most efficient for the armed services. RAND is a Department of Defense contractor.

The study found, for example, that military pay has exceeded the 70th percentile for both enlisted and officers, which the author said raises the question of whether military pay is set too high when compared with civilian pay.

The 70th percentile benchmark was put into place by the Defense Department in 1999, but researchers encourage the government to decide whether it is time to adjust that threshold in either direction.

“Over the course of the 2000s, military pay relative to civilian pay increased substantially,” the researcher wrote. “Compensation should be set high enough to attract and retain the quantity and quality of personnel the services require, and the level of compensation necessary to do this may or may not be at the 70th percentile.”

The study showed that enlisted member pay has been closer to the 90th percentile, while officers are near the 83rd.

Given that pay is so high relative to civilian pay, researchers say it is worth looking into whether recruiting and retention outcomes are as desired. They have not been for the Army, which saw no increase in top-tier recruits despite the increase in pay.

The researcher concludes it may be worth looking into whether the military could be more efficient at providing special incentives for retention and performance or increasing resources other than pay – and examining the paytable for areas where pay incentives could be expanded.

The military budget for fiscal 2020 is $738 billion. It will increase service member pay by 3.1 percent.

Civilian pay is also set to rise by 3.1 percent.

Last year, civilian pay increased by 1.9 percent, while military pay rose 2.6 percent. In 2018, it was 1.9 percent and 2.4 percent, respectively.

The Department of Veterans Affairs will also get its largest funding boost in history – a 9 percent increase in funds, or $217 billion.

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Fifteen months after launching an effort to develop a vaccine against COVID-19, the Walter Reed Army Institute of Research is preparing for a clinical trial, seeking volunteers for a small safety study.

The Army's vaccine candidate uses a new technology involving a Spike Ferritin Nanoparticle, or SpFN, that researchers hope can be adapted to protect against any coronavirus, including those that cause the common cold or deadly diseases such as COVID-19, Severe Acute Respiratory Syndrome, or SARS, and Middle East Respiratory Syndrome, MERS.

The WRAIR vaccine candidate has been tested in mice and monkeys and is now ready for human safety trials, according to officials at the institute, which falls under Army Medical Research and Development Command.

"Even before recent COVID-19 variants were identified, our team was concerned about the emergence of new coronaviruses in human populations, a threat that has been accelerating in recent years," Dr. Kayvon Modjarrad, director of the Emerging Infectious Diseases Branch at WRAIR, said in a released statement. "That's why we need a vaccine like this: one that has potential to protect broadly and proactively against multiple coronavirus species and strains."

The study is being conducted at WRAIR's Clinical Trials Center and will enroll 72 healthy adult volunteers ages 18 to 55 who will be randomly placed in placebo or experimental groups.

WRAIR began its work on a coronavirus vaccine Jan. 11, 2020 -- the day after Chinese researchers published the coronavirus' genetic sequence, enabling scientists to more fully understand the lethal pathogen.

With that genetic makeup in mind and building on research on the coronavirus that causes Middle East Respiratory Syndrome, or MERS, WRAIR scientists developed SpFN as a protein base that can carry one or more spike proteins engineered to block infection and elicit an immune response, according to Modjarrad.

While commercial manufacturers have produced four distinct vaccines against COVID-19, three of which are currently being distributed under emergency-use authorization in the U.S., WRAIR is playing the long game when it comes to developing a coronavirus vaccine for the future.

"We are in this for the long haul," Modjarrad said in a release. "We have designed and positioned this platform as the next generation vaccine, one that paves the way for a universal vaccine to protect against not only the current virus, but also counter future variants, stopping them in their tracks before they can cause another pandemic."

The vaccine was developed with support from the Henry M. Jackson Foundation for the Advancement of Military Medicine.

More than 176,000 U.S. service members have tested positive for COVID-19 since the beginning of the pandemic and 24 have died. Another 307 civilian DoD employees, contractors and family members also have died.

Worldwide, 132.1 million people have been infected with the coronavirus, and 2.8 million have died. There have been nearly 30.8 million cases in the U.S. and 556,307 American deaths as of April 4, according to Johns Hopkins University.

Across the Defense Department, 2.1 million doses of the COVID-19 vaccine -- made by Moderna, Pfizer or Johnson & Johnson -- have been administered to U.S. troops, family members, civilian employees and other essential workers, according to the Centers for Disease Control and Prevention.

On Tuesday, President Joe Biden implored Americans to get their vaccines, especially with cases on the rise in some areas and the spread of variants.

"We’re getting more and more data on just how effective these vaccines are," Biden said. "We’re making a lot of good progress … but we’re not even halfway to vaccinating 300 million Americans. We are still in a life and death race against this virus."

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I prayed to God to just take me. For one, I was a coward, I didn’t want to do it, and I would prefer He do it on his terms,” recalled Army Sgt. Maj. Patrick McGrath, 108th Air Defense Artillery Brigade, of contemplating suicide in 2019.

McGrath’s story goes back to his childhood. He detailed how this was a relevant point because the soldiers he serves with in the Army come from all walks of life.

“I didn’t have the best childhood,” said McGrath, who was born at Marine Corps Base Camp Lejeune in eastern North Carolina, but grew up in Huntsville, Alabama. “My father was in the Marines for seven years, but not during a time I can remember. My mother was a drug addict and alcoholic.”

McGrath said it was after high school that he discovered the taste of alcohol.

He said he attempted to go to college, but it didn’t pan out. He ended up becoming a pizza chain manager, but didn’t feel a sense of purpose.

“I went home and told my dad I was going to look at all the services,” he said.

After joining the Army, McGrath said he still had a “backpack full of stuff” stemming from his childhood, such as low self-esteem and no sense of value, but he felt he had a purpose.

“The Army gave me a little tag that told me this is how you wear your uniform, this is how you’re supposed to act and follow the five Rs (right place, right time, right attitude, right uniform and right appearance),” he said. “This will ensure you’re successful.”

McGrath said he was on the pathway to success, but there came a moment when he drank until he blacked out. He said it was the first time in his life he thought he was like his mom, a road he didn’t want to travel.

McGrath said he was ‘boozing it up’ only on the weekends. He hid his drinking habit, and no one suspected he had a problem. He had soldiers who relied on him. He stayed focused all the while struggling with his own challenges, but his soldier gave him a sense of purpose.

“When I came down on orders and went to Korea, everything was still good,” McGrath said. “I was a first sergeant. I still had that sense of purpose, but I started drinking more. Weekends morphed into weekdays. My performance declined, but I was really good at what I did, so it appeared to those around me, I was doing what I needed to do. I had manipulated my leadership because I was getting results.”

In November 2017, the sergeants major’s list came out. His name was on the list and in August 2018 he’d be heading to Fort Bliss, Texas, to attend the U.S. Army Sergeants Major Academy.

“I’m in trouble,” he remembered thinking to himself. “I knew I was going to have to leave my family, and I had no self-discipline. For 17 years, I had manipulated the Army.”

On July 13, 2018, he left Ft. Bragg, North Carolina, for Texas, and regressed back to drinking. “I showed up to the academy, was assigned a squad leader for accountability and stayed in a hotel for about 20 days before the class started Aug. 8,” McGrath said. “Following the accountability check, I would go back to my room and be drunk by 1300 (1 p.m.). I was in my room crying because I already knew I had gone too far.”

McGrath said when school started, he became a bit more disciplined because there was a requirement from the Army. However, in order to thrive and succeed in the academy, he had to be self-disciplined, an area he failed at.

“I would wake up each day and tell myself I wasn’t going to drink,” he said. “I had the shakes, but no one knew I was going through this; it was a secret. I had three roommates, too, and they had no idea.”

McGrath explained how one day he was driving to the Academy and started to plan how he was going to kill himself. “There’s these crazy overpasses in El Paso and people jump off there all the time,” he said. “That was my plan, too.”

But Feb. 5, 2019, he bolstered the courage to ask for help.

“I went into the instructors’ office at the academy and said ‘If I don’t get help, I’m going to kill myself,’ ” McGrath proclaimed. “I ended up going to resident treatment at Brooke Army Medical Center in San Antonio, Texas (now Joint Base San Antonio). I went back to the academy on April 9, 2019, was dropped for medical reasons, and came back to Fort Bragg.”

The support he received was opposite from what he thought it would be.

“I couldn’t comprehend the academy instructors being so supportive,” McGrath said. “I thought they would say I was letting the NCO Corps down and the academy down. Their reaction gave me hope that I could still one day wear the rank of sergeant major. The experience also impacted my spiritual relationship with God. God was using them to tell me it was going to be OK!”

Elizabeth Bechtel, Fort Bragg’s Suicide Prevention Program manager, said it is important to educate the community on Suicide Prevention/Intervention for a couple of reasons.

“The one thing we hear time and time again from those who survived an attempted suicide is they just wanted someone to listen to them,” she said. “So, teaching active listening skills and how to care when someone is in crisis is very important."

McGrath echoed that sentiment. He added how his family, the academy instructors, the treatment in San Antonio, Alcoholics Anonymous meetings, and having the opportunity to help others who are struggling has renewed his purpose.

He said there are a lot of people like him and he wants them to know their darkness can turn into light.

“I finished the non-resident portion of the academy on April 3, 2020 and was promoted to sergeant major August 1, 2020,” McGrath said. “I’ve been sober for 569 days.”

All service members, Veterans, and their families are encouraged to contact the Military Crisis Line at 800-273-8255 and press 1 to speak with a trained counselor. The support is free, confidential and available every day 24/7. If you or a loved one is seeking information about psychological health concerns, contact the Psychological Health Resource Center at 866-966-1020 to confidentially speak with trained health resource consultants 24/7. Additionally, the National Suicide Prevention Lifeline at (800) 273-8255 provides help.

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Congress required the Defense Department to conduct the audit

The Defense Department has dragged its feet on protecting service personnel from "forever chemicals" at military installations and isn't doing enough to track health effects from exposure to the toxic compounds, according to an internal audit.

Officials have taken steps to find and clean groundwater contaminated with firefighting foam containing PFAS, or perfluoroalkyl and polyfluoroalkyl substances, the department's inspector general found. But its recently released report said the Pentagon has fallen short on dealing with other sources of the chemicals as its rules require.

It also found that despite plans to test military firefighters' blood for PFAS this year as required by Congress, officials have no plan for tracking and analyzing results on a department-wide basis.

The department "is missing an opportunity to capture comprehensive PFAS exposure data for DoD firefighters to be used for risk management, including future studies to assess significant long‑term health effects relating to PFAS," according to the audit, which is dated July 22.

The report included responses from two assistant secretaries of defense who largely agreed with the findings and promised to address them. The inspector general said the case will remain open until its recommendations are carried out.

"This inspector general’s report confirms that the Defense Department must urgently do more to protect service members and their families from PFAS chemicals," Rep. Dan Kildee, a Michigan Democrat and co-chairman of the Congressional PFAS Task Force, said Tuesday.

A Pentagon spokesman had no immediate comment.

PFAS refers to thousands of man-made compounds used in countless products, including nonstick cookware, water-repellent sports gear, cosmetics and grease-resistant food packaging, along with firefighting foams.

Public health studies on exposed populations have associated the chemicals with an array of health problems, including some cancers, weakened immunity and low birth weight. Widespread testing in recent years has found high levels of PFAS in many public water systems. They're called "forever chemicals" because they don't degrade in the environment.

PFAS substances have been found in groundwater on or near more than 300 military bases, according to the nonprofit Environmental Working Group.

Military crews began using foam containing PFAS to extinguish petroleum-based fires in the 1970s, the audit said. The Pentagon was informed in 2000 that leading manufacturers were phasing out products, including foam, made with some of the chemicals after one was found to be toxic and to build up in blood over time.

Yet the department waited until 2011 to issue an alert and took an additional five years to list risk-management actions such as preventing uncontrolled releases of the foam during training and removal where practical, according to the audit.

"Some of highest detections anywhere in the world been found in groundwater" at military installations, said Scott Faber, the Environmental Working Group's senior vice president for government affairs. That means personnel "were drinking extraordinarily polluted water for much longer than they should have been, in violation of the department's own policies."

In recent years, the Pentagon has tested wells and groundwater at bases for two widely used PFAS chemicals and begun removing foam containing one of them from its stockpiles, the audit said.

But aside from firefighting foam, the department hasn't addressed potential pollution from other PFAS-containing materials as its rules require, the report said.

"As a result, people and the environment may continue to be exposed to preventable risks," it said.

In comments attached to the report, acting Assistant Secretary of Defense for Sustainment Paul Cramer said risk management options for PFAS-containing materials other than foam would be developed by early 2022.

Responding to the audit's call for tracking and analyzing blood test results to monitor long-term health effects, acting Assistant Secretary of Defense for Readiness Thomas Constable said data would be shared with the National Institute for Occupational Safety and Health to assist a study on cancer among firefighters.

Additionally, the department will analyze PFAS serum lab results at the Navy and Marine Corps Public Health Center and develop exposure limits, which will take more than four years, he said.

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Background

The Camp Pendleton Marine Corps Base site covers 125,000 acres in San Diego County, California. The base provides housing, training, logistical and administrative support for the Fleet Marine Force units. Past disposal practices have contaminated the groundwater and soil. In an initial investigation, the Marine Corps found nine areas of contamination. Waste generation operations include maintenance and repair of vehicles (trucks, tanks and aircraft), landfill operations, waste disposal areas such as scrap yards, and firefighting drill areas. The base contains wetlands, streams and rivers that feed into the Pacific Ocean. This land is the only remaining undeveloped area between Los Angeles and San Diego. The site’s long-term cleanup is ongoing.

What Has Been Done to Clean Up the Site?

The site is being addressed through federal actions.

Group A (OU-1): The long-term remedy included institutional controls and monitoring for Site 9. No further action for other sites.

Group B (OU-2): Landfills, Surface Impoundments and Groundwater: The long-term remedy included deferral of groundwater sites to OU-4 and the Site 7 landfill was included as part of OU-3. The landfill is capped as part of the OU-3 remedial action.

Group C (OU-3): Other Soils and Groundwater: The long-term remedy included excavation and disposal of contaminated soils at an on-base landfill designated as a Corrective Action Management Unit (CAMU). The remedial action finished in 2002. A methane capture system is under development. The site has also been chosen as the location for a solar panel array to generate energy for several on-base projects, including powering the methane recovery system. A remedy update in 2008 covered the work.

OU-4: Remaining Areas: Soils removal has begun and several sites have been cleaned.

OU-5: Sites 1D, 1A1, 21, 1111, 6A and 13: The OU is made up of sites that required a greater level of cleanup funding than previously proposed or were uncompleted when Site 7 was prematurely closed. Soils removal is ongoing. The Navy is updating the remedy to address unexpected groundwater encountered at Site 1-D.

What Is the Current Site Status?

The site is being addressed in four long-term remedial phases focusing on cleanup of soils; landfills, surface impoundments and groundwater; other soils and groundwater; and remaining areas.

In December 1995, 14,000 cubic yards of soil containing trichloroethane (TCE) and Total Petroleum Hydrocarbons (TPH) was removed from a former fire-fighting drill field. The TPH-contaminated soil was treated through bioremediation. The TCE-contaminated soil was removed and disposed of at an off-site landfill.

In January 1997, 12,000 cubic yards of soil containing organochlorine pesticides was removed from a former pesticide disposal area – Site 3. The soil was stabilized at an on-site treatment facility and disposed of at an on-site landfill. Thirty-two 55-gallon drums of material containing pesticide and medical waste were also removed and disposed of off site.

Also in January 1997, 25,000 cubic yards of soil containing pesticides, metals and PAHs was removed from Site 6 and stabilized at an on-site treatment facility and disposed of at an on-site landfill.

In 2002, the Marine Corps completed construction of a landfill cap for a 28-acre class III landfill that operated from 1946 to 1970.

In February 2007, Site 1111 was excavated to remove drums containing pesticides and solvents. Groundwater was removed from the excavation, treated on site and removed from the facility. The excavation was continued until all soils were clean. Four new monitoring wells were installed and will be monitored to assess if further groundwater remediation is necessary.

The site’s most recent Five-Year Review concluded that remedies that have not yet been completed, but are still in the construction phase for IR Sites 1A (OU3), 1D and 30 (OU4), and 1A-1 and 1H (OU5), are expected to be protective upon completion. In the interim, exposure pathways that could result in unacceptable risks are being managed. The remedy for IR Site 7 was found to be protective of both human health and the environment. However, methane levels in compliance gas monitoring probe GP-9 continue to be near the 5 percent by-volume state criterion.

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As President Joe Biden stood outside Philadelphia’s Independence Hall on Thursday night, making the case ahead of the midterm elections that “equality and democracy are under assault,” he wasn’t standing alone.

For most Americans watching the prime-time speech, the uniformed Marines flanking him were just part of the setting for the address.

Yet to others who are connected to the military or follow the politicization of the armed forces with concern, it raised questions about why the White House would undercut its message about the need to protect democracy and to respect its institutions by posting service members behind the President as he delivered a political speech.

As someone who thinks a lot about the health of military families and the military as an institution, both as a journalist covering stories about the Veteran and military family community, and as a member of a military family myself, the Marines immediately caught my eye.

Genuinely surprised the White House had made what appeared to me and many others to be an obvious visual error for such a high-profile prime-time address, I tweeted:

“Whatever you think of this speech the military is supposed to be apolitical. Positioning Marines in uniform behind President Biden for a political speech flies in the face of that. It’s wrong when Democrats do it. It’s wrong when Republicans do it.”

That tweet got ratioed. The tsunami of online opposition included some Veterans who disagreed, but also White House chief of staff Ron Klain retweeting a thread from a liberal blogger who called me a propagandist; commentator Keith Olbermann saying I should be fired; and one account that tweeted pictures of my husband in his Army uniform with our children, questioning whether he even owns a suit (he does, but I think it would also be fine if he didn’t). Multiple White House press staffers pushed back on the characterization of the speech as political.

Some Veterans – including liberal ones – disagree on the optics

In the minority were some noteworthy voices, who were concerned about the visual of the Marines even as they agreed with the substance of Biden’s speech. They included Allison Jaslow, the former executive director of the Democratic Congressional Campaign Committee, the election arm of House Democrats. She is also a combat Veteran who served two tours in Iraq.

“I think it’s very clear that a political message was being elevated through this event,” she said on CNN the following morning. “I agree with the President’s message, and I’m glad that he is speaking up in this way. That doesn’t make it right that they picked, you know, window dressing for their event that included Marines in it.”

Paul Rieckhoff, a self-described independent who founded Iraq and Afghanistan Veterans of America and is now an advocate for Veterans, said on Twitter that “it’s just sloppy. Plenty of people in the White House know better. Or should. Either way, there’s just no need to have it even as a concern. It just shouldn’t be done in America.”

“Beyond the Marines part, it was a very powerful and important speech,” Rieckhoff continued. “Overdue in many ways.”

Veterans are certainly not monolithic in that opinion.

“This idiotic criticism of the @POTUS by media elites is absurd,” tweeted retired Army Lt. Col. Alexander Vindman, who testified before Congress ahead of Donald Trump’s first impeachment trial. “They take umbrage over the use of the military as props, completely missing the content of his message… THE NATION IS IN DANGER! MAGA fascist (sic) are trying to end our democracy. Get a clue and some perspective.”

The White House expected Republicans to pounce on the speech, but it did not appear to anticipate blowback for the optics of the address from other quarters: journalists who highlighted the breaking of a norm or even critics of the optics who otherwise embraced the substance of the speech.

On Friday, White House press secretary Karine Jean-Pierre responded to the criticism and brushed it off, explaining why Marines were featured during the address.

It “was intended to demonstrate the deep and abiding respect the President has for these services – service members, to these ideals and the unique role our independent military plays in defending our democracy, no matter which party is in power,” she said. “It is not abnormal. It is actually normal for presidents from either side of the aisle to give speeches in front of members of the military, including President … Ronald Reagan and President George H.W. Bush. It is not an unusual sight or is not an unusual event to have happened.”

Past presidents, Democratic and Republican, have politicized the military, and faced criticism for it, but not all speeches and events where the military is present are equal in this debate.

There are countless examples of presidents giving speeches to or standing in front of service members that do not, in the view of many who take issue with the optics of the Philadelphia event, violate the norms it did: President Barack Obama announcing a pivot in the war on terror at West Point in 2014, President George W. Bush gave many military policy addresses at military bases in the US and overseas, for instance.

Those speeches were about military policy. And Thursday’s speech did not include any announcements related to the military or new policies.

‘Hold yourself to a much higher standard’

Trump is in a league of his own among modern-day presidents when it comes to politicizing the military, including in political speeches and at events.

Uniformed Marines notably appeared in a Republican National Committee video filmed at the White House for Trump’s reelection bid in 2020.

Rieckhoff was critical then as well, saying, “Using the Marines in this segment is just the latest example of Trump shamelessly and damagingly politicizing our military. They’re just political props to him.”

In 2019, Trump attacked a group of then-freshman female Democratic lawmakers of color, known as the “squad,” at an event on the South Lawn of the White House flanked by Marines. He appeared to single out Minnesota Rep. Ilhan Omar, a Somali American who came to the US as a refugee, when he said, “If you’re not happy here, then you can leave.”

The loudest Republican criticism of uniformed Marines appearing in the background of Biden’s speech highlights a double standard many in the GOP have for Trump and Biden.

They admonish Biden for a transgression that was relatively minor compared with what they had ignored during the Trump years, including the June 2020 appearance of Chairman of the Joint Chiefs of Staff Gen. Mark Milley in Lafayette Square after federal officials forcibly cleared a street of peaceful protestors so that Trump could have a photo op in front of a church.

Milley later apologized for his role that day, and recently we learned he had drafted a scathing resignation letter at the time, though he ultimately did not resign.

“It is my belief that you were doing great and irreparable harm to my country. I believe that you have made a concerted effort over time to politicize the United States military,” he wrote then, according to “The Divider: Trump in the White House, 2017-2021,” a book by CNN contributor Susan Glasser and Peter Baker.

Democrats were highly critical of Trump and his administration for their actions.

That’s why Jaslow believes Democrats shouldn’t dismiss the optics concerns with Biden’s speech.

“You can’t criticize a prior administration and not also hold yourself to a much higher standard,” she said. “Some people might see this as like small ball, but it really is important. And if you don’t want the so-called MAGA Republicans or any Republicans to be politicizing the military, of which many administrations have done, then you shouldn’t do it yourself.”

Biden knows this. After all, he set the standard for himself.

Shortly after he entered the White House in February 2021, he made a visit to the Pentagon to reorient the workforce following the Trump administration.

“You’re incredible heroes and incredible patriots,” he told them. “I will never, ever … dishonor you. I will never disrespect you. I will never politicize the work you do.”

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A leak from a suspected Iranian hacker crew has revealed just how it’s snooping on American officials’ online lives by taking control of their Google accounts, according to IBM researchers. The same hackers have reportedly been linked with attacks on President Trump's campaign staff, according to an IBM report shared with Forbes.

The 40 gigabyte leak was discovered in May by IBM X-Force IRIS, a cyber intelligence unit within the tech giant. A simple misconfiguration of a server had left the data wide open to anyone who could find the relevant web address. The most revealing information came in the form of training videos, one of which showed how the hackers, dubbed ITG18 (though more widely referred to as Charming Kitten), had breached the Google account of a U.S. Navy official.

There was also evidence of failed phishing attempts targeting the personal accounts of an Iranian-American philanthropist and officials of the U.S. State Department, including one associated with the U.S. Virtual Embassy to Iran. And the leak uncloaked a number of fake online personas that the hackers were using to to target persons of interest, with one other victim being a member of Greece’s Hellenic Navy.

‘Alarming’ hacker training videos

Allison Wikoff, senior cyber threat analyst at IBM, said that the military officials had been notified of the hacks. When Wikoff uncovered the leak in May with fellow IBM researcher Richard Emerson, she was astonished that training videos from an Iranian hacker crew had been spilled and at the speed at which the hackers could siphon off data from a Google account. She also found evidence Yahoo accounts were targeted.

“It was alarming just how quickly they were able to navigate through these different flavours of account,” Wikoff told Forbes. “They were just so fast at it… And it just, to me, it [indicated] they've been doing this a really long time and they're really good at it.”

Wikhoff said the leaky server had been used to host websites previously used by the Charming Kitten crew and so was directly linked to the Iranian group. She said it appears to be a large, well-resourced unit of the Iranian government or an entity working in the interests of the regime. “This is a pretty large operation. And the fact that they're creating training videos, sort of speaks to the volume of people that are probably affiliated with it.”

By getting access to their Google accounts, the hackers could acquire a “plethora of information” on targeted individuals, including Chrome logins, location data, personal pictures and much more, Wikoff added. This could help Iran map out military bases or even gain information about sensitive government operations if the target has been lax with their operational security. Or it could be used for future, more personalized targeting of the same official. “So you can glean maybe where they lived and … you can build a very specific profile on the individuals that have been compromised as a part of this campaign.” And by looking through personal information it’s possible to get more intelligence on their employer, whether that’s the government or a private entity, she added. “The perimeter of an organisation doesn't end when you log off and shut your computers the way that people work now. The perimeter is not just the organisation.”

Iran v.US cyber espionage

American and Iranian spies have been fighting a cold war from behind their keyboards for over a decade. Since the death of Iranian general Qassem Soleimani in an American airstrike in January this covert cyberwar has heated up.

Google's security team revealed in June that Charming Kitten had tried to break into the Gmail accounts of Trump's campaign staff. Microsoft had previously warned that the same hackers had targeted the president's staff.

Most recently, there were suspicions that explosions at Iran’s Natanz nuclear plant earlier this month were caused by U.S. cyber attacks. A Yahoo News report this week suggested the CIA had been granted more powers by President Trump to target adversaries such as Iran with destructive attacks.

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LUBBOCK, Texas– The Veterans Outpost and the Military Veteran Peer Network, in coordination with Texas Tech Equestrian Center, will hold their 3rd annual Boots and Spurs Equine Therapy event for military Veterans on September 11, 2021.

The event encompasses therapeutic riding for Veterans and service members who have struggled with PTSD. The morning sessions include grooming/tacking, horse handling, and riding instruction.

After the morning session, lunch is served. In the afternoon, with the help of team members at the Texas Tech Equestrian Center and local cowboys, the Veterans are able to use the skills used in the morning to compete in fun and easy equestrian events with prizes going to top teams.

This event is free to our Veterans and reservations are required so we do not exceed the horse/rider limit. Feel free to contact me at 432-238-5524 or you can contact me by e-mail at This email address is being protected from spambots. You need JavaScript enabled to view it. should you have any questions.

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Traumatic brain injury remains a key health concern for the military. TBI ranges in severity from mild, moderate, severe and penetrating. Most traumatic brain injuries in the military are mild, otherwise known as concussion and most service members return to duty after recovering from their injuries, according to the Defense Health Agency’s Defense and Veterans Brain Injury Center. Together with other elements of the Military Health System, DVBIC will offer resources and tools to educate the military community about TBI during Brain Injury Awareness Month this March.

A division of the Defense Health Agency Research and Development Directorate, DVBIC is the DoD’s TBI center of excellence. The center leverages state-of-the-science research to inform clinical recommendations and educate providers and patients and their caregivers.

More than 400,000 service members have been diagnosed with a first time TBI since 2000, according to figures published by DVBIC, which is charged with tracking TBI data in the military. Service members who may have been involved in a potentially concussive event need to see a medical provider as soon as possible since research shows getting treatment early helps to maximize outcomes. Most service members who sustain a mild TBI return to full duty within seven to 10 days through the “progressive return to activity” process--a standardized approach informed by the latest evidence-based research.

“This yearly observance (of Brain Injury Awareness Month) showcases the wide variety of MHS and DVBIC resources tailored to the needs of patients, providers, and caregivers,” said DVBIC Division Chief Navy Captain Scott Pyne. “These tools facilitate return to duty for active service members, and return to all aspects of civilian life for Veterans. We welcome the opportunity afforded by Brain Injury Awareness Month to highlight these endeavors.”

This year, DVBIC is highlighting how the military community – service members and Veterans, health care providers, researchers, educators, and families – works together to address TBI in the military with the theme, “TBI: Me, You & Us.”

Service members and Veterans have to be prepared to prevent a TBI while training or deployed, and need to educate themselves about TBI symptoms so they will know when to seek care. During March, DVBIC along with other organizations in the Military Health System, will share key resources to enable service members to help themselves and their fellow service members and Veterans. “A Head for the Future,” a DVBIC TBI awareness initiative, will feature videos highlighting “TBI Champions.” The videos share real stories of service members, Veterans, family members, providers, and advocates in the military TBI community. They reveal people coping successfully with TBI, as well as the people who support them.

DVBIC is the leading DoD authority on the development of clinical recommendations, guidelines and tools that inform health care providers who treat service members and Veterans on the latest scientific evidence regarding prevention, diagnosis, treatment and rehabilitation of traumatic brain injuries. DVBIC’s revised screening tool, the Military Acute Concussion Evaluation 2 or MACE 2, can be used by all trained medical staff, not just corpsmen or medics. This revised tool has modernized the screening and evaluation of mild TBI by adding new assessment areas such as assessing eye movements and balance after a possible mTBI. Clinical guidelines regarding the “progressive return to activity” process are helping improve care of warfighters dealing with TBIs they experience at home and abroad. DVBIC’s medical surveillance and clinical education efforts help ensure providers are armed with the cutting-edge tools and resources to ensure that service members are ready when called to duty.

TBI recovery, however, relies on an entire community of caregivers and family members that are full partners in the healing process. DVBIC features a wide array of resources for caregivers who play a critical role in supporting the health and well-being of individuals with TBI, recognizing the emotional, physical and financial toll that is so often associated with caregiving.

Military Health System organizations, like the National Intrepid Center of Excellence at Walter Reed National Military Medical Center and the National Museum of Health and Medicine, will join DVBIC in sharing resources and tools online via websites, social media campaigns on Facebook and Twitter, and podcasts. Regional outreach events at numerous military and VA hospitals will engage local audiences with helpful resources for service members, Veterans and caregivers. Find relevant Brain Injury Awareness Month resources by using the hashtag #BIAMonth and join the conversation.

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PHILADELPHIA – Acting United States Attorney Jennifer Arbittier Williams announced that Richard Meleski, 58, of Chalfont, PA, was sentenced to three years and four months in prison, three years of supervised release, and ordered to pay $302,121 in restitution for a particularly disgraceful fraud scheme to steal Veterans Administration (VA) benefits by pretending to be a Veteran who had been captured by the enemy during combat.

In July 2020, the defendant pleaded guilty to one count of healthcare fraud, two counts of mail fraud, one count of stolen valor, two counts of fraudulent military papers, as well as two counts of aiding and abetting straw purchases, and one count of making false statements in connection with receiving Social Security Administration disability benefits.

The charges stemmed from Meleski fraudulently claiming to have served as an elite Navy SEAL and falsely representing that he had been a Prisoner of War in order to secure healthcare benefits from the VA worth over $300,000. Due to his false representation as a Prisoner of War, the defendant received healthcare from the VA in Priority Group 3, effectively receiving healthcare before other deserving military service members. In reality, Meleski never served one day in the United States military.

The defendant also filed for monetary compensation from the VA for PTSD suffered during an armed conflict in Beirut in which he rescued injured teammates. In his application for disability benefits for PTSD, Meleski falsely represented that he had been awarded the Silver Star for his heroic actions during his time as a Navy SEAL. Again, Meleski never served a single day in the United States military and was never awarded such commendation. Meleski also submitted another application to the VA for monetary compensation in which he included obituaries of actual Navy SEALs alongside whom he falsely said he had served. He traded on the actions of these true service members in an attempt to bolster his application for monetary benefits.

The defendant also filed for disability benefits from The United States Social Security Administration (SSA) for injuries he claimed to have received during his time in the military. Meleski falsely testified under oath in connection with an SSA Disability proceeding.

“The defendant faked a record as a decorated U.S. Navy SEAL in order to collect numerous forms of taxpayer-funded compensation,” said Acting U.S. Attorney Williams. “The fact that Meleski chose to put himself ahead of true war heroes in order to take advantage of benefits designed specifically for those serving in the U.S. military is profoundly offensive. Our Veterans fought for the freedoms we hold dear, and as we approach the twentieth anniversary of the attacks of 9/11 this Saturday, their sacrifices are even more meaningful. The defendant’s actions dishonor all of their legacies.”

“We are grateful to our federal partners for their work in pursuing and prosecuting those who impersonate our nation’s hero’s and unlawfully obtain benefits meant for those who served,” said RADM Karen Flaherty-Oxler (RET), Medical Center Director for the Corporal Michael J. Crescenz (Philadelphia) VA Medical Center. “It is disheartening to see someone who benefited from the service of our Veterans, dishonor them in this manner. Nonetheless, our day-to-day mission of caring for our Veterans continues uninterrupted and with the same vigor and commitment.”

“Today’s sentence sends a clear message that those who benefit from falsely claiming to have served in the United States military will be held accountable,” said Special Agent in Charge Christopher Algieri, Department of Veterans Affairs Office of Inspector General, Northeast Field Office. “The VA OIG appreciates the support of the United States Attorney’s Office and our law enforcement partners in securing justice for our nation’s true heroes.”

“This defendant defrauded the government in many different ways for several years,” said Matthew Varisco, Special Agent in charge of ATF’s Philadelphia Field Division. “The outcome of this investigation is the result of several law enforcement agencies working together for a common goal – to keep our communities safe from criminals like Meleski. I want to thank our law enforcement partners at the VA OIG, SSA OIG and the U.S Attorney’s Office for this successful prosecution.”

The case was investigated by Department of Veterans Affairs Office of the Inspector General, Social Security Administration Office of the Inspector General, and the Bureau of Alcohol, Tobacco and Firearms, and it is being prosecuted by Special Assistant United States Attorney Megan Curran.

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• By referring to COVID-19 vaccines as “vaccines” rather than gene therapies, the U.S. government is violating its 15 U.S. Code Section 41, which regulates deceptive practices in medical claims
• The mRNA injections are gene therapies that do not fulfill a single criteria or definition of a vaccine
• COVID-19 “vaccines” do not impart immunity or inhibit transmissibility of the disease. They only are designed to lessen your infection symptoms if or when you get infected. As such, these products do not meet the legal or medical definition of a vaccine
• Since a vast majority of people who test positive for SARS-CoV-2 have no symptoms at all, they’ve not even been able to establish a causal link between the virus and the clinical disease
• By calling this experimental gene therapy technology a “vaccine,” they are circumventing liability for damages that would otherwise apply.

TAP. Forecast rates of death amongst those receiving COVID gene ‘therapy’ are 50% within 5 years. Some therapy. (Dr Dolores Cahill). It’s a similar story to AIDS being spread via the Hepatits B vaccine. That killed 120 million Africans alone. Organised by Dr Antony Fauci. This Fauci ‘vaccine’ could kill in the billions if it is not stopped.

Did you know that mRNA COVID-19 vaccines aren’t vaccines in the medical and legal definition of a vaccine? They do not prevent you from getting the infection, nor do they prevent its spread. They’re really experimental gene therapies.

I discussed this troubling fact in a recent interview with molecular biologist Judy Mikovits, Ph.D. While the Moderna and Pfizer mRNA shots are labeled as “vaccines,” and news agencies and health policy leaders call them that, the actual patents for Pfizer’s and Moderna’s injections more truthfully describe them as “gene therapy,” not vaccines.

Definition of ‘Vaccine’

According to the U.S. Centers for Disease Control and Prevention,1 a vaccine is “a product that stimulates a person’s immune system to produce immunity to a specific disease, protecting the person from that disease.” Immunity, in turn, is defined as “Protection from an infectious disease,” meaning that “If you are immune to a disease, you can be exposed to it without becoming infected.”

Neither Moderna nor Pfizer claim this to be the case for their COVID-19 “vaccines.” In fact, in their clinical trials, they specify that they will not even test for immunity.

Unlike real vaccines, which use an antigen of the disease you’re trying to prevent, the COVID-19 injections contain synthetic RNA fragments encapsulated in a nanolipid carrier compound, the sole purpose of which is to lessen clinical symptoms associated with the S-1 spike protein, not the actual virus.

They do not actually impart immunity or inhibit transmissibility of the disease. In other words, they are not designed to keep you from getting sick with SARS-CoV-2; they only are supposed to lessen your infection symptoms if or when you do get infected.

As such, these products do not meet the legal or medical definition of a vaccine, and as noted by David Martin, Ph.D., in the video above, “The legal ramifications of this deception are immense.”

15 U.S. Code Section 41

As explained by Martin, 15 U.S. Code Section 41 of the Federal Trade Commission Act2 is the law that governs advertising of medical practices. This law, which dictates what you may and may not do in terms of promotion, has for many years been routinely used to shut down alternative health practitioners and companies.

“If this law can be used to shut down people of good will, who are trying to help others,” Martin says, “it certainly should be equally applied when we know deceptive medical practices are being done in the name of public health.”

Per this law, it is unlawful to advertise:

“… that a product or service can prevent, treat, or cure human disease unless you possess competent and reliable scientific evidence, including, when appropriate, well-controlled human clinical studies, substantiating that the claims are true at the time they are made.”3

What Constitutes ‘The Greater Good’?

Martin points to the 1905 Supreme Court ruling in Jacobson vs. Massachusetts,4 which essentially established that collective benefit supersedes individual benefit. To put it bluntly, it argued that it’s acceptable for individuals to be harmed by public health directives provided it benefits the collective.

Now, if vaccination is a public health measure that is supposed to protect and benefit the collective, then it would need to a) ensure that the individual who is vaccinated is rendered immune from the disease in question; and b) that the vaccine inhibits transmission of the disease.

Only if these two outcomes can be scientifically proven can you say that vaccination protects and benefits the collective — the population as a whole. This is where we run into problems with the mRNA “vaccines.”

Moderna’s SEC filings, which Martin claims to have carefully reviewed, specifies and stresses that its technology is a “gene therapy technology.” Originally, its technology was set up to be a cancer treatment, so more specifically, it’s a chemotherapy gene therapy technology.

As noted by Martin, who would raise their hand to receive prophylactic chemotherapy gene therapy for a cancer you do not have and may never be at risk for? In all likelihood, few would jump at such an offer, and for good reason.

Moreover, states and employers would not be able to mandate individuals to receive chemotherapy gene therapy for a cancer they do not have. It simply would not be legal. Yet, they’re proposing that all of humanity be forced to get gene therapy for COVID-19.

COVID-19 Vaccines — A Case of False Advertising

Now, if the COVID-19 vaccine really isn’t a vaccine, why are they calling it that? While the CDC provides a definition of “vaccine,” the CDC is not the actual law. It’s an agency empowered by the law, but it does not create law itself. Interestingly enough, it’s more difficult to find a legal definition of “vaccine,” but there have been a few cases. Martin provides the following examples:

•Iowa code — “Vaccine means a specially prepared antigen administered to a person for the purpose of providing immunity.” Again, the COVID-19 vaccines make no claim of providing immunity. They are only designed to lessen symptoms if and when you get infected.

•Washington state code — “Vaccine means a preparation of a killed or attenuated living microorganism, or fraction thereof …” Since Moderna and Pfizer are using synthetic RNA, they clearly do not meet this definition.

Being a manmade synthetic, the RNA used is not derived from anything that has at one point been alive, be it a whole microorganism or a fraction thereof. The statute continues to specify that a vaccine “upon immunization stimulates immunity that protects us against disease …”

So, in summary, “vaccine” and “immunity” are well-defined terms that do not match the end points specified in COVID-19 vaccine trials. The primary end point in these trials is: “Prevention of symptomatic COVID-19 disease.” Is that the same as “immunity”? No, it is not.

There Are More Problems Than One

But there’s another problem. Martin points out that “COVID-19 disease” has been defined as a series of clinical symptoms. Moreover, there’s no causal link between SARS-CoV-2, the virus, and the set of symptoms known as COVID-19.

How is that, you might ask? It’s simple, really. Since a vast majority of people who test positive for SARS-CoV-2 have no symptoms at all, they’ve not been able to establish a causal link between the virus and the clinical disease.

Here’s yet another problem: The primary end point in the COVID-19 vaccine trials is not an actual vaccine trial end point because, again, vaccine trial end points have to do with immunity and transmission reduction. Neither of those were measured.

What’s more, key secondary end points in Moderna’s trial include “Prevention of severe COVID-19 disease, and prevention of infection by SARS-CoV-2.” However, by its own admission, Moderna did not actually measure infection, stating that it was too “impractical” to do so.

That means there’s no evidence of this gene therapy having an impact on infection, for better or worse. And, if you have no evidence, you cannot fulfill the U.S. Code requirement that states you must have “competent and reliable scientific evidence … substantiating that the claims are true.”

Why Are They Calling Them Vaccines?

As noted by Martin, you cannot have a vaccine that does not meet a single definition of a vaccine. So, again, what would motivate these companies, U.S. health agencies and public health officials like Dr. Anthony Fauci to lie and claim that these gene therapies are in fact vaccines when, clearly, they are not?

If they actually called it what it is, namely “gene therapy chemotherapy,” most people would — wisely — refuse to take it. Perhaps that’s one reason for their false categorization as vaccines. But there may be other reasons as well.

Here, Martin strays into conjecture, as we have no proof of their intentions. He speculates that the reason they’re calling this experimental gene therapy technology a “vaccine” is because by doing so, they can circumvent liability for damages.

You’re being lied to. Your own government is violating its own laws. They have shut down practitioners around the country, time and time again, for violating what are called ‘deceptive practices in medical claims.’ Guess what? They’re doing exactly that thing. ~ David Martin, Ph.D.

As long as the U.S. is under a state of emergency, things like PCR tests and COVID-19 “vaccines” are allowed under emergency use authorization. And as long as the emergency use authorization is in effect, the makers of these experimental gene therapies are not financially liable for any harm that comes from their use.

That is, provided they’re “vaccines.” If these injections are NOT vaccines, then the liability shield falls away, because there is no liability shield for a medical emergency countermeasure that is gene therapy.

So, by maintaining the illusion that COVID-19 is a state of emergency, when in reality it is not, government leaders are providing cover for these gene therapy companies so that they can get immunity from liability.

Under the Cover of ‘Emergency’

As noted by Martin, if state governors were to lift the state of emergency, all of a sudden the use of RT PCR testing would be in violation of 15 U.S. Code FTC Act, as PCR tests are not an approved diagnostic test.

“You cannot diagnose a thing [with something] that cannot diagnose a thing,” Martin says. “That a misrepresentation. That is a deceptive practice under the Federal Trade Commission Act. And they’re liable for deceptive practices.”

Importantly, there’s no waiver of liability under deceptive practices — even under a state of emergency. This would also apply to experimental gene therapies. The only way for these gene therapies to enjoy liability shielding is if they are vaccines developed in response to a public health emergency. There is no such thing as immunity from liability for gene therapies.

Propaganda and Vaccine Rollout Run by Same Company

Martin brings up yet another curious point. The middleman in Operation Warp Speed is a North Carolina defense contractor called ATI. It controls the rollout of the vaccine. But ATI also has another type of contract with the Department of Defense, namely managing propaganda and combating misinformation.

So, the same company in charge of manipulating the media to propagate government propaganda and censor counterviews is the same company in charge of the rollout of “vaccines” that are being unlawfully promoted.

“Listen,” Martin says. “This is a pretty straight-forward situation. You’re being lied to. Your own government is violating its own laws … They have thrown this book [15 U.S. Code Section 41] on more people than we can count.

They have shut down practitioners around the country, time and time again, for violating what are called ‘deceptive practices in medical claims’ … Guess what? They’re doing exactly that thing.”

Martin urges listeners to forward his video to your state attorney, governor, representatives and anyone else that might be in a position to take affirmative action to address and correct this fraud.

Defense contractors are violating FTC law, and gene therapy companies — not vaccine manufacturers — are conducting experimental trials under deceptive medical practices. They’re making claims of being “vaccines” without clinical proof, and must be held accountable for their deceptive marketing and medical practices.

CDC Owns Coronavirus Patents

On a side note, the CDC appears to be neck-deep in this scam pandemic, and is therefore wholly unsuitable to investigate the side effects of these experimental COVID-19 therapies. As noted by Martin, it’s like having a bank robber investigate its own crime.

Details about this came out in the documentary “Plandemic,” in which Martin explained how the CDC has broken the law — in one way or another — related to its patenting of the 2003 SARS virus.

Martin is a national intelligence analyst and founder of IQ100 Index, which developed linguistic genomics, a platform capable of determining the intent of communications. In 1999, IBM digitized 1 million U.S. patents, which allowed Martin’s company to conduct a review of all these patents, sending him down a proverbial “rabbit trail” of corruption.

In 2003, Asia experienced an outbreak of SARS. Almost immediately, scientists began racing to patent the virus. Ultimately, the CDC nabbed ownership of SARS-CoV (the virus responsible for SARS) isolated from humans.

So, the CDC actually owns the entire genetic content of that SARS virus. It’s patented under U.S. patent 7776521. They also own patents for detection methods, and for a kit to measure the virus.

U.S. patent 7279327,5 filed by the University of North Carolina at Chapel Hill, describes methods for producing recombinant coronaviruses. Ralph Baric, Ph.D., a professor of microbiology and immunology who is famous for his chimeric coronavirus research, is listed as one of the three inventors, along with Kristopher Curtis and Boyd Yount.

According to Martin, Fauci, Baric and the CDC “are at the hub” of the whole COVID-19 story. “In 2002, coronaviruses were recognized as an exploitable mechanism for both good and ill,” Martin says, and “Between 2003 and 2017, they [Fauci, Baric and CDC] controlled 100% of the cash flow to build the empire around the industrial complex of coronavirus.”

How the CDC Broke the Law

The key take-home message Martin delivers in “Plandemic” is that there’s a distinct problem with the CDC’s patent on SARS-CoV isolated from humans, because, by law, naturally occurring DNA segments are prohibited from being patented.

The law clearly states that such segments are “not patent eligible merely because it has been isolated.” So, either SARS-CoV was manmade, which would render the patent legal, or it’s natural, thus rendering the patent on it illegal.

However, if the virus was manufactured, then it was created in violation of biological weapons treaties and laws. This includes the Biological Weapons Anti-Terrorism Act of 1989, passed unanimously by both houses of Congress and signed into law by George Bush Sr., which states:6

“Whoever knowingly develops, produces, stockpiles, transfers, acquires, retains, or possesses any biological agent, toxin, or delivery system for use as a weapon, or knowingly assists a foreign state or any organization to do so, shall be fined under this title or imprisoned for life or any term of years, or both. There is extraterritorial Federal jurisdiction over an offense under this section committed by or against a national of the United States.”

So, as noted by Martin in the documentary, regardless of which scenario turns out to be true, the CDC has broken the law one way or another, either by violating biological weapons laws, or by filing an illegal patent. Even more egregious, May 14, 2007, the CDC filed a petition with the patent office to keep their coronavirus patent confidential.

Now, because the CDC owns the patent on SARS-CoV, it has control over who has the ability to make inquiries into the coronavirus. Unless authorized, you cannot look at the virus, you cannot measure it or make tests for it, since they own the entire genome and all the rest.

“By obtaining the patents that restrained anyone from using it, they had the means, the motive, and most of all, they had the monetary gain from turning coronavirus from a pathogen to a profit,” Martin says.

Dangers of mRNA Gene Therapy

I’ve written many articles detailing the potential and expected side effects of these gene therapy “vaccines.” If all of this is new to you, consider reviewing “How COVID-19 Vaccine Can Destroy Your Immune System,” “Seniors Dying After COVID Vaccine Labeled as Natural Causes” and “Side Effects and Data Gaps Raise Questions on COVID Vaccine.”

In the lecture above, Dr. Simone Gold — founder of America’s Frontline Doctors, which has been trying to counter the false narrative surrounding hydroxychloroquine — reviews the dangers discovered during previous coronavirus vaccine trials, and the hazards of current mRNA gene therapies, including antibody-dependent immune enhancement.

Antibody-dependent immune enhancement results in more severe disease when you’re exposed to the wild virus, and increases your risk of death. The synthetic RNA and the nanolipid its encased in may also have other, more direct side effects. As explained by Mikovits in our recent interview:

“Normally, messenger RNA is not free in your body because it’s a danger signal. The central dogma of molecular biology is that our genetic code, DNA, is transcribed, written, into the messenger RNA. That messenger RNA is translated into protein, or used in a regulatory capacity … to regulate gene expression in cells.

So, taking a synthetic messenger RNA and making it thermostable — making it not break down — [is problematic]. We have lots of enzymes (RNAses and DNAses) that degrade free RNA and DNA because, again, those are danger signals to your immune system. They literally drive inflammatory diseases.

Now you’ve got PEG, PEGylated and polyethylene glycol, and a lipid nanoparticle that will allow it to enter every cell of the body and change the regulation of our own genes with this synthetic RNA, part of which actually is the message for the gene syncytin …

Syncytin is the endogenous gammaretrovirus envelope that’s encoded in the human genome … We know that if syncytin … is expressed aberrantly in the body, for instance in the brain, which these lipid nanoparticles will go into, then you’ve got multiple sclerosis.

The expression of that gene alone enrages microglia — literally inflames and dysregulates the communication between the brain microglia — which are critical for clearing toxins and pathogens in the brain and the communication with astrocytes.

It dysregulates not only the immune system, but also the endocannabinoid system, which is the dimmer switch on inflammation. We’ve already seen multiple sclerosis as an adverse event in the clinical trials … We also see myalgic encephalomyelitis. Inflammation of the brain and the spinal cord …”

Making matters worse, the synthetic mRNA also has an HIV envelope expressed in it, which can cause immune dysregulation. As we discussed in previous interviews, SARS-CoV-2 has been engineered in the lab with gain-of-function research that included introducing the HIV envelope into the spike protein.

Are You in a High-Risk Group for Side Effects?

Mikovits’ hypothesis is that those who are most susceptible to severe neurological side effects and death from the COVID-19 vaccines are those who have previously been injected with XMRVs, borrelia, babesia or mycoplasma through contaminated vaccines, resulting in chronic disease, as well as anyone with an inflammatory disease like rheumatoid arthritis, Parkinson’s disease or chronic Lyme disease, for example, and anyone with an acquired immune deficiency from any pathogens and environmental toxins.

The chart below lists 35 diseases that are likely to render you more susceptible to severe side effects or death from COVID-19 gene therapy injections.

Many of the symptoms now being reported are suggestive of neurological damage. They have severe dyskinesia (impairment of voluntary movement), ataxia (lack of muscle control) and intermittent or chronic seizures. Many cases detailed in personal videos on social media are quite shocking. According to Mikovits, these side effects are due to neuroinflammation, a dysregulated innate immune response, and/or a disrupted endocannabinoid system.

Another common side effect from the vaccine we’re seeing is allergic reactions, including anaphylactic shock. A likely culprit in this is PEG (polyethylene glycol), which an estimated 70% of Americans are allergic to.

Experimental Gene Therapy Is a Bad Idea

Circling back to where we began, COVID-19 vaccines are not vaccines. They are experimental gene therapies that are falsely marketed as vaccines, likely to circumvent liability. World governments and global and national health organizations are all complicit in this illegal deception and must be held accountable.

Ask yourself the question Martin asked in his video: Would you agree to take an experimental chemotherapy gene therapy for a cancer you do not have? If the answer is no, then why would you even consider lining up for an experimental gene therapy for COVID-19 — a set of clinical symptoms that haven’t even been causally linked to SARS-CoV-2?

These injections are not vaccines. They do not prevent infection, they do not render you immune, and they do not prevent transmission of the disease. Instead, they alter your genetic coding, turning you into a viral protein factory that has no off-switch. What’s happening here is a medical fraud of unprecedented magnitude, and it really needs to be stopped before it’s too late for a majority of people.

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U.S. special operations forces who deployed to a military site in Uzbekistan shortly after the 9/11 attacks found pond water that glowed green, black goo oozing from the ground and signs warning “radiation hazard.”

Karshi-Khanabad, known as K2, was an old Soviet base leased by the United States from the Uzbek government just weeks after the Sept. 11, 2001, attacks because it was a few hundred miles from al Qaeda and Taliban targets in northern Afghanistan.

The base became a critical hub in the early days of the war to provide airdrops, medical evacuation and airstrike support to U.S. ground forces in Afghanistan.

But K2 was contaminated with chemical weapons remnants, radioactive processed uranium and other hazards, according to documents obtained by McClatchy.

At least 61 of the men and women who served at K2 had been diagnosed with cancer or died from the disease, according to a 2015 Army study on the base. But that number may not include the special operations forces deployed to K2, who were likely not counted due to the secrecy of their missions, the study reported.

As part of McClatchy’s continued investigation into the rising rates of cancers among Veterans, members of those special operations forces units who were based at K2 are speaking out for the first time because of the difficulty they have faced in getting the Department of Veterans Affairs to cover their medical costs.

“After returning from combat years later, we are all coming down with various forms of cancer that the [Department of Veterans Affairs] is refusing to acknowledge,” said retired Army Chief Warrant Officer Scott Welsch, a special operations military intelligence officer who deployed to K2 in October 2001. He was diagnosed with thyroid cancer in 2014.

Some of those who served at K2 are about to submit a letter to Congress asking for help.

“Please come to our aid to assist us in dealing with these illnesses that have forever altered the courses of our lives and the lives of our families,” wrote retired Lt. Col. Omar Hamada, flight surgeon for the Army National Guard’s 1st Battalion, 20th Special Forces Group, which went to K2 in 2002.

Hamada said nine of the unit’s approximately 50 soldiers who deployed to K2 have been diagnosed with cancer.

“BLACK GOO”

The Defense Department knew that K2 was toxic from the start, based on documents obtained by McClatchy that are being reported publicly for the first time.

After Uzbek workers who were preparing the grounds for arriving U.S. forces in October 2001 fell ill, U.S. Central Command directed an intelligence review of the hazards at the base.

“Ground contamination at Karshi-Khanabad Airfield poses health risks to U.S. forces deployed there,” said the classified report, dated Nov. 6, 2001, that was obtained by McClatchy.

That report found the “tent city” the military was building at K2 — including tents for sleeping, eating, showering and working — were “in some cases directly on top of soil that probably was contaminated” by four hazards.

First, there was a missile storage facility that had exploded in June 1993. “Ground contamination from the explosion, and subsequent expulsion of missile propellant throughout the area is very likely,” the report said.

Two other hazards listed were an abandoned fuel storage facility and an abandoned aircraft maintenance facility identified as the likely sources of the “black goo” which the report said “is most likely a combination of oils, hydraulic fluids, glues, paints, solvents and lubricants.”

The fourth hazard noted in the report was that the northeast corner of the tent city was likely affected by “runoff from a CW [chemical weapons] decontamination site” which had appeared on U.S. intelligence imagery in 1987.

A separate Army environmental health study of K2 in November 2001 found small areas of dirt contaminated with asbestos and “low level radioactive processed uranium, both from the destruction of Soviet missiles.”

As more personnel populated the base, it had to expand. Additional assessments were conducted, one found pools of solvents about 3 feet underground.

“Part of this area has already been fenced off by US forces as an expansion area,” a Nov. 15, 2001, document obtained by McClatchy said. “To call this site a landfill is an insult to landfills.”

The U.S. military jumped on using K2 because it had few other good options in the immediate response to 9/11, said former Army Reserve Capt. Ken Richards, who deployed to the base in 2002, and was diagnosed with kidney cancer in 2009.

“There were a lot of good reasons to accept what they [the Uzbeks] gave us,” Richards said. “Safety was never an issue.”

“YOUR INQUIRY IS FALSE”

Years after their deployments, as K2 Veterans approached the Defense Department and the VA for help, they met a defense health establishment trained to doubt them.

“The most important messages to communicate are there were no K-2 exposures of health consequence,” instructs an undated three-page “Information for Health Care Staff” guide published by the Pentagon’s Deployment Health Clinical Center that was obtained by McClatchy.

“Some may believe they were exposed to dangerous chemicals and that they haven’t been told the truth,” the guide states. “Your reassurances may not lessen their level of concern.”

The guide emphasized that medical staff should show K2 Veterans respect for their service to the country, observing “It often helps rapport if you thank them for that service.”

The VA responded to a query by McClatchy on the number of cancers among the service members based at K2 with a statement saying, “the premise of your inquiry is false. There is no indication of increased cancer rates among Veterans who served at Karshi-Khanabad, which is why cancer is not a presumptive condition for Veterans who served in that area.”

That phrase — “presumptive condition” — can mean the difference between the service member paying the bill for cancer treatments out of their own pocket or having the cost covered by the VA.

A presumptive condition is any medical issue that the VA has accepted as likely connected to a Veteran’s military service.

McClatchy interviewed 15 former members of Air Force and Army special operations forces who served at K2, six of whom were diagnosed with cancer, and reviewed more than a dozen documents about the conditions at the base. McClatchy also interviewed two widows whose husbands were deployed to K2 and have died of cancer.

“We were doing a great thing” at K2, said retired Air Force Tech Sgt. Jeff Frisby, who deployed there in October 2001 with the 16th Special Operations Wing. “But then you look back on it and you almost feel kind of betrayed that there may be something going wrong, and nobody wants to help with it.”

In 2009, Army Master Sgt. Jeff Skinner found that the secrecy of his mission had limited what documents he could get to the VA. He was 39 and fighting stage 4 brain cancer.

“The VA continues to deny my claims. I am desperate,” Skinner wrote. “All of my savings and my spouse’s 401K have been dissolved.”

Skinner had deployed to K2 in 2002 with the 1st Battalion, 20th Special Forces Group and was asking the Army to release classified documents to the VA about his service at the Uzbek base.

Army special operations command got involved, and Skinner’s appeal was finally approved, said his widow Missy Skinner. But when she looked through his paperwork to see what changed the agency’s mind, she could not find anything that cited his deployment.

“Nothing about K2,” she said.

Skinner died in April 2017. He was 47.

A FISHBOWL

By 2002, the Defense Department reported that K2’s contamination issues had been addressed by new soil and gravel overlays, caps on suspected vapor areas, and fencing.

“The contaminated area was covered with clean fill in November 2001, fenced and marked off-limits. It was determined that the uranium posed minimal health risk. The radiation hazard from this material is low,” a 2002 health assessment reported.

Veterans say their experiences on the ground do not mesh with that assessment.

“There was no warning for us. We just went in and we just dug,” said retired Master Sgt. Kliengsak Nimpchaimanatham. He flew into K2 about three weeks after 9/11 with the Air Force 1st Special Operations Wing, 16th Civil Engineering Squadron.

Nimpchaimanatham’s team was tasked with digging deep trenches to set up the base’s water lines. They dug 8 feet down, sometimes with backhoes, sometimes by hand shovel.

“It was hard to breathe,” Nimpchaimanatham said. “It was kind of like being in [a] room with gas fumes.”

The squadron was not wearing protective gear, he said.

“There was no heads up of, ‘Hey guys, this is an area — there’s a lot of contamination in here. Be sure to wear protective gear.’”

More dirt was disturbed to build a berm, a 20-foot dirt wall that protected the base. But it created what Veterans described as a “fishbowl” around the tents.

“So when it rained, it flooded,” said retired Senior Master Sgt. Carmen Bellard, who deployed to K2 as a loadmaster for the 711th Special Operations Squadron in 2002.

Water pushed into the tents ankle-deep and often had an oily, multi-colored sheen, K2 Veterans told McClatchy and provided photos of the water surrounding their tents. Gravel and new soil added to alleviate the flooding became mud.

In November 2001, former Air Force Tech Sgt. Jason Massey was asked to help dig a trench around his operations tent, to keep the floodwater out and protect the electronics inside.

“There was a clank,” said Massey, who arrived at K2 in October 2001 as a special operations intelligence analyst.

Explosive Ordnance Disposal technicians who specialize in disposing of bombs were called in. The men had dug down to a 250-pound buried explosive.

“RADIATION HAZARD”

Eventually warning signs were erected. Outside the berm, a new bright yellow sign went up with black and red letters that said: “Danger Keep Out. Chemical Weapons.”

Another black and white sign — “Danger. Off Limits. Radiation Hazard.” — was in front of a row of ponds nicknamed “Skittles” after the candy because the water glowed bright green but often had other colors too. The ponds were located just outside the berm.

As the base grew, briefings for new arrivals included a caution about the ponds and an assurance that the berm would protect them.

“I remember raising my hand and going, ‘Since when does dirt stop radiation?’” said former Master Sgt. John Kiser, who deployed to K2 with the 774th Expeditionary Airlift Squadron.

The Veterans also remember warnings by detector tubes and Geiger counters for chemical or radioactive threats.

Former Master Sgt. Raymond Towner said he was watching TV in an old aircraft hangar in June 2002 “when two guys in white hazardous contamination suits walked in and told everybody to get out.” Towner served as an aerospace ground equipment mechanic at K2.

Later, base leadership told them it was a false positive, Towner said. “They briefed us, ‘look, you can go back in there,’” he said, but nobody moved back in.

Towner, 47, has a brain cyst, had cancerous lymph nodes removed from his neck, and lost half of his tongue to cancer.

“It seemed like every time something was raised, it was ‘Oh, we have an explanation for that,’” said former Senior Master Sgt. Tony Harris, who deployed to K2 in 2002 as a maintainer with the 919th Special Operations Wing.

CONCERNED DOCTORS

Military doctors started raising concerns about the number of personnel who served at K2 being diagnosed with cancer.

A 20th Special Forces Group battalion surgeon, Lt. Col. Frank DeAngelo, wrote the VA on Skinner’s behalf in 2009, asking them to look deeper. DeAngelo had learned of three brain cancer cases of service members who were at K2.

“If one uses an annual incidence rate of 1 per 16,000 cases of primary brain malignancy diagnosed in the U.S. population, these cases diagnosed in former K2 personnel become extremely suspicious,” DeAngelo wrote in a 2009 letter to the VA.

In 2015, the Army published an in-depth look at illnesses reported at the base, prompted by a number of U.S. Army Special Operations Command forces at K2 who had developed various types of cancer.

Despite the Army Special Operations Command requesting the review, “special operations forces personnel could not be identified,” the study reported. It was “likely” that the roster of 7,005 U.S. service members who served at K2 did not count them or their cancers.

Still, among the conventional forces at the base, the study found 11 reported cancers among service members who were 25 years old or younger when they were stationed at K2, including one brain cancer. There were 50 cancers reported among service members who were older than 25 during their deployment, including four brain cancers. The study cautioned that there may be other factors besides serving at K2 connected to the cancers.

“These findings may motivate further investigation,” the report said.

VA was provided a copy of the study and responded that it did not change their position.

“The 2015 report you reference is inconclusive and the limitations section (1.3) says as much,” VA spokeswoman Susan Carter said. “It states, ‘the results of this investigation should be considered preliminary.’”

Chief Pentagon spokesman Jonathan Hoffman said that between 2001 and 2005, when K2 was used by U.S. forces, “military public health personnel collected and assessed thousands of occupational and environmental health samples to monitor the health risks to our personnel.”

Those measurements found that long-term exposure could lead to developing some lung and heart conditions, but “we did not find any evidence that there were hazards capable of increasing the cancer risks faced by our service members,” he said.

While the VA would decide if any additional illnesses should be added as presumptive conditions for K2, “we would support the continued monitoring of Veterans health status,” Hoffman said.

DEPLETED URANIUM

The VA also provided a fact sheet on K2 that said “long-term adverse health effects would not be expected from depleted uranium contamination based on site assessments and the proper use of protective measures by personnel.”

That angers K2 Veterans who remember how the Defense Department moved the soil to create the berm, which exposed layers of contaminated soil that was then further dispersed by floods and wind, and during the winter months just became a muddy muck that stuck to everything.

“I never would have had depleted uranium in my system if I hadn’t gone to K2,” Bellard said.

She had chronic fatigue, headaches, respiratory issues and muscle twitches after her deployment and began looking for a cause. A VA-conducted urine test detected depleted uranium, but the amounts were too low to “have any health consequences related to it,” the agency notified her in June 2018.

Massey, who dug up the 250-pound explosive, had to leave the military just before he would have qualified for retirement benefits because of debilitating chronic migraines and other illnesses. He is now seeking additional medical care from the VA because he keeps collapsing without warning.

More than 1,100 K2 Veterans and a few of the surviving spouses have joined a Facebook group, “K2 Karshi Khanabad, Uzbekistan Radiation and Toxic Exposures.”

The site was started in 2012 by retired Master Sgt. Paul Widener, who served at K2 for multiple deployments starting in late 2001 with the Air Force’s 8th Special Operations Squadron.

He started the Facebook group to help Air Force Veteran Tech Sgt. Mike West connect with other K2 Veterans. West, who served with the 9th Special Operations Squadron, was seeking help in finding evidence to file a claim with the VA. West was diagnosed in 2010 with colon cancer, he died in 2013.

The Facebook site has become a critical resource for the Veterans, where they post requests for help after VA denials and access a library of photos and documents they can use to file appeals to the agency.

There are notices from families and final posts from members who are in the last stages of their cancer fight and have decided to enter hospice care.

“There is nothing more to do as far as treatment goes (last line of chemo). The tumors on the pancreas and liver are getting bigger, not smaller,” retired Air Force Col. John Partain wrote in April 2019. He had deployed to K2 in 2002 with the 711th Special Operations Squadron.

Partain, 59, was entering hospice care. He wanted to file new paperwork to the VA, because his initial claim had been denied. He was trying to get the VA to recognize his cancer as service connected so that his wife, Claire, and their kids would receive retroactive disability compensation payments after he passed away.

“He brought up the VA, and how it was time to hire an attorney,” Claire Partain said. “I asked him, ‘Is this really how you’d like to spend the rest of your life?’”

John Partain decided to let it go. He died in September.

“You shouldn’t have to spend your final days fighting for this,” Claire Partain said.

Widener, who set up the Facebook site, was diagnosed with colon cancer in 2007. He has been helping care for retired fellow 8th Special Operations Squadron Lt. Col. Rich Riddle, another K2 Veteran, who has stage 4 pancreatic cancer.

Widener continues to be contacted by K2 Veterans who don’t want to be on Facebook, but want him to know they are also ill.

“I don’t go to the funerals anymore,” Widener said. “It got to the point where there were just too many.”

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FALLS CHURCH, Va. – There are changes coming soon to the TRICARE retail pharmacy network. Starting Dec. 15, 2021, CVS Pharmacy will join the TRICARE network. At the same time, Walmart, Sam’s Club, and some community pharmacies will leave the network.

Express Scripts is the TRICARE pharmacy contractor. They manage the TRICARE retail pharmacy network under a contract with the Department of Defense. Express Scripts reached a new agreement that adds CVS Pharmacy to the network of pharmacies.

“Beneficiaries will continue to have many convenient and nearby in-network options,” said U.S. Public Health Service Cmdr. Teisha Robertson, a pharmacist with the Defense Health Agency’s Pharmacy Operations Division. “Express Scripts’ partnership with CVS Pharmacy ensures most beneficiaries have a network pharmacy located near their home or work.”

The current TRICARE retail pharmacy network offers access to over 59,000 pharmacies. With this change, nearly 90% of beneficiaries will have access to a network pharmacy within five miles of their home.

Walmart and Sam’s Club have more than 5,300 locations nationwide. CVS Pharmacy has nearly 10,000 pharmacy locations. You can find CVS pharmacies inside many Target stores.

A group of around 3,000 community pharmacies will also leave the TRICARE network this year. But more than 14,000 community pharmacies will remain in the network.

Keep in mind that using home delivery or a military pharmacy are still lower cost options for you. You have to pay copayments when you use home delivery or any retail network pharmacy. Although these copayments are set to change next year, it isn’t because of this network change.

If you have a prescription at Walmart, Sam’s Club, or any other impacted pharmacy, you need to transfer it to a new network pharmacy before Dec. 15. If you filled a prescription at one of the impacted pharmacies, you’ll receive communication from Express Scripts. These communications will have recommendations on how you can fill your prescriptions at a new network pharmacy. You can also find a network pharmacy near you by visiting the Express Scripts website. CVS Pharmacy will be in the network starting Dec. 15.

Do you use specialty or limited distribution medications? If so, you’ll get a letter from Express Scripts detailing how you can transfer your prescriptions to a new specialty network pharmacy. You may also receive a phone call from an Express Scripts representative. They can help you move your medication to a new specialty network pharmacy that’s near you.

If you fill a prescription at Walmart, Sam’s Club, or community pharmacy leaving the network on or after Dec. 15, it will be a non-network pharmacy. This means you’ll have to pay the full cost of your prescription up front. You’ll also need to file a claim for partial reimbursement. Check out Filling Prescriptions to learn more. You can also refer to the TRICARE Pharmacy Program Handbook.

If you need to find a new network pharmacy, you can search for one on the Express Scripts website. You can also call Express Scripts at 1-877-363-1303 to help you find one close to you. Do you have questions about your pharmacy benefit? You can learn more by visiting Pharmacy on the TRICARE website.

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A Chinese government spokesman said Thursday that "it might be U.S. Army who brought the epidemic to Wuhan," pushing one of several popular coronavirus conspiracy theories in China.

Zhao Lijian, a Ministry of Foreign Affairs spokesman, called attention to the admission Wednesday by Robert Redfield, the director of the U.S. Centers for Disease Control and Prevention, that some Americans who were said to have died from influenza may have actually died from the coronavirus (COVID-19).

"When did patient zero begin in US? How many people are infected?" he asked. "What are the names of the hospitals? It might be U.S. Army who brought the epidemic to Wuhan. Be transparent! Make public your data! U.S. owe us an explanation!"

In a short thread on Twitter, a social media platform inaccessible in China, Zhao demanded to know how many of the 34 million influenza infections and 20,000 associated deaths during this latest flu season were related to COVID-19.

The coronavirus, now a pandemic, first appeared in the central Chinese city of Wuhan, capital of hard-hit Hubei province and the epicenter of a serious outbreak that has claimed the lives of thousands, the majority in China.

As China has faced criticism, Chinese authorities have been pushing back, suggesting that the virus may have originated somewhere other than China. Dr. Zhong Nanshan, a leading Chinese epidemiologist, said in late February that "though the COVID-19 was first discovered in China, it does not mean that it originated from China."

Zhao, in his role as a government spokesman, stressed the same point in a recent press briefing.

"No conclusion has been reached yet on the origin of the virus," he told reporters, adding that "what we are experiencing now is a global phenomenon with its source still undetermined."

One popular conspiracy theory that has emerged about the coronavirus is that American athletes participating in the Military World Games, an event held in Wuhan last year, may have brought the virus, either intentionally or accidentally, into China. There is, however, no evidence to support this accusation.

The Trump administration has laid the blame firmly at China's feet though. "Unfortunately, rather than using best practices, this outbreak in Wuhan was covered up," White House national security adviser Robert O'Brien told reporters Wednesday.

"It probably cost the world community two months to respond," he added.

Another Chinese foreign ministry spokesman, Geng Shuang, called O'Brien's efforts to denigrate China's efforts to fight the virus "immoral and irresponsible."

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A commissary customer in Sigonella, Italy says their store “has consistently been empty of meat, dairy, cheese, butter, infant formula, and more for almost two months,” in a post on the official Defense Commissary Agency Facebook page.

“We keep getting told that supply chain is to blame, but other overseas military installations in Italy, Germany, etc. don’t look like this. Neither do stores out in town. The commissary is an entitlement to support the military and their families, which we rely upon dearly. This is unacceptable,” writes Payton Leigh Perez.

In Guam, commissary customers “have to go to the fully-stocked out-in-town stores where milk is $13/gallon,” writes Jenny Potter.

From Millington, Tenn., to Europe and the Pacific, commissary customers are seeing empty shelves, just like many people are seeing in civilian grocery stores. Customers have posted comments on a number of installation Facebook pages.

The commissary agency hears you. They’ve been fighting this problem of shortages for more than a year, but it has been exacerbated lately by the surging number of COVID cases. All military commissaries worldwide are seeing the effects of the supply chain disruption, officials said.

”We want our customers to know we are doing everything we can, and more, to get the products they need onto their store shelves, especially to our overseas commissaries,” said Kevin Robinson, spokesman for the Defense Commissary Agency. “If they happen to see empty shelves in the store, please be patient; the store will be restocked often the very next day.”

All product categories are affected except for meat, he said.

“In my view, the real food insecurity issue with the military right now is making sure we get sufficient quantities into the stores so people can shop,” said Steve Rossetti, president of the American Logistics Association, the trade organization representing manufacturers and distributors of products that are sold in commissaries. “The Defense Commissary Agency is doing everything they can. The distributors are doing everything we can.”

He said there are about 2,300 grocery items across the board where there are limited quantities available, and the commissaries and other civilian stores are allocated a certain number of those items by manufacturers. ALA has been pressing manufacturers to increase their allocations to commissaries, citing the unique worldwide needs of commissary customers.

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As the number of U.S. COVID-19 cases rise and more Americans are being tested for the virus, communities near military installations where travelers are quarantined are asking why suspect patients can’t stay on base for testing.

San Antonio Mayor Ron Nirenberg and Bexar County, Texas, Judge Nelson Wolff wrote Defense Secretary Mark Esper last week questioning a Centers for Disease Control and Prevention protocol that transfers patients from Joint Base San Antonio-Lackland to San Antonio-area hospitals for testing.

The two say the requirement is “counter to prudent management of a contagion in a quarantine environment.”

“The threat of moving patients to other destinations like hospitals or the Texas Center for Infectious Disease unnecessarily poses risk to Joint Base San Antonio personnel through exposure, in addition to the community at large,” they wrote.

At Travis Air Force Base, Calif., the city of Costa Mesa blocked an effort to move coronavirus patients to an empty facility in the town that once served developmentally delayed patients called the Fairview Developmental Center.

The town requested a temporary restraining order to prevent the move from occurring — a motion granted Feb. 22 by a U.S. District Court judge.

On Friday, the government announced it would not pursue the effort, primarily because most of those in isolation at Travis are at the end of their 14-day quarantine.

The Department of Health and Human Services and the Centers for Disease Control and Prevention instituted a quarantine plan in early February that placed evacuees from Wuhan and elsewhere in China in isolation at several military installations across the U.S.

A new round of evacuees arrived in mid-February from the stricken cruise ship Diamond Princess, which was docked for weeks under quarantine in Yokahama, Japan.

Under an agreement, the Department of Defense provides lodging for those under quarantine while CDC and local health agencies conduct daily medical screenings for signs of the virus. If a case is suspected, patients are transported to local hospitals for testing, observation and treatment.

While Nirenberg and Wolff said they understand the need for evacuees to be transported to “prevent active duty personnel from contracting the virus, thereby affecting military combat readiness,” they added that the current system of isolation is better than moving patients to be tested.

“It is our understanding that evacuees are already isolated from military personnel and that testing and evaluation capabilities exist on base. As such, we believe the transports present an unnecessary risk to both the military and the community.”

According to the letter, 6 of 235 evacuees from Wuhan and the Diamond Princess cruise ship at San Antonio-Lackland have required hospital care, but at least 18 people have been transported off-base for testing and hospitalization with mild or no symptoms.

The situation, they said, has “filled valuable beds with patients which could appropriately be managed in isolation at Joint Base San Antonio Lackland,” they wrote. “We respectfully request that the DoD permit on-site CDC medical staff to collect test samples.”

Pentagon spokesman Army Lt. Col Christian Mitchell confirmed Esper’s receipt of the letter but did not respond to Military Times’ request for comment.

DoD is posting its updates on the coronavirus on its own home page.

At Travis Air Force Base, the CDC planned to move potential patients to Costa Mesa due to a shortage in hospital beds near the installation, located in Fairfield, Calif.

But Costa Mesa Mayor Katrina Foley said she wasn’t informed of the plan that included her city 400 miles south of Travis.

“This is at least a temporary victory for the citizens of Costa Mesa and Orange County,” Foley said in a statement to the Los Angeles Times. “But the government has not promised not to place future infected persons there, so the battle is not over. We will continue to ask the court to prohibit the government from using this completely inappropriate facility for housing people infected with a highly communicable and potentially fatal disease.”

At Travis, at least 11 quarantined passengers have been transferred to nearby medical facilities for testing. Five additional passengers were transported to hospitals for monitoring. One patient has been determined to have the virus.

As of Monday, there were two confirmed cases of COVID-19 in Solana County, including the first possible “community transmission” of the virus. A woman in Vacaville, eight miles north of Travis, was confirmed to have the coronavirus, despite not having come in contact with any known infected individuals or a history of recent travel.

A second Solana County resident, a health care worker who treated the woman, has contracted the virus as well.

As of Sunday night, according to the CDC, the U.S. has seen 91 cases of the virus, including 48 among those evacuated from China by the U.S. State Department and Diamond Princess passengers. Seventeen individuals have been hospitalized and six have died, beginning March 1, including a man in his 50s with underlying medical conditions in King County, Wash. Five others have died, all in Kirkland, Wash., which is in King County.

Among U.S. military personnel and family members, a U.S. Forces Korea soldier and his wife have tested positive for the virus, and the widow of a military retiree also living in South Korea contracted the virus last month.

The virus has now infected more than 90,000 worldwide and killed at least 3,000 people, mainly in China.

Chairman of the Joint Chiefs of Staff Gen. Mark Milley said Monday that the “overall broad impact to the uniformed U.S. military [has been] minimal.”

“It’s not surprising because we have a very young demographic, young health demographic, lots of vaccinations, etc.,” Milley said.

He added while there is not currently a vaccine for the COVID-19 coronavirus, military research laboratories are working with partner agencies on a vaccine.

Abroad, U.S. Department of Defense schools in Italy, Bahrain and South Korea remain closed, as do many on-base morale, welfare and recreation facilities.

In the U.S., commanders also are monitoring their local communities to determine what steps, if any, may be needed to to protect troops and their family members, according to Milley.

“We are making all due preparations to protect our bases, camps and stations... We’ve got lots of capabilities — medical capabilities, housing that if required by the secretary of defense we will do our part,” he said.

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Congress wants the Pentagon to provide service members and Tricare dependents broader access to treatment for eating disorders -- a behavioral health issue legislators say is a "significant problem in society, as well as in military beneficiaries."

The House and Senate versions of the fiscal 2021 National Defense Authorization Act both contain measures that would encourage -- but not require -- the Defense Department to cover residential treatment centers under Tricare for adults with eating disorders and train leaders to recognize the signs of such behaviors.

The House bill would require the Pentagon to report to Congress on the feasibility of including residential treatment facilities in coverage, as well as the cost, while the Senate bill encourages the DoD to ensure that all resources and facilities are available to treat beneficiaries regardless of age.

The existence of the measures in both versions of the bill greatly increases the likelihood that the final bill -- expected to be developed in the fall -- will include a portion on eating disorder treatment.

The proposed legislation still falls short of two bills introduced last year in the House and Senate that would have required the DoD to cover eating disorder residential treatment.

The Supporting Eating Disorders Recovery Through Vital Expansion, or SERVE, bills, introduced by Sens. Jeanne Shaheen, D-N.H., and Martha McSally, R-Ariz., in the Senate and Reps. Brian Mast, R-Fla., and Seth Moulton, D-Mass., in the House, would have required the DoD to train military leaders to recognize the signs of eating disorders.

They also would have required Tricare to cover inpatient or residential services, partial hospitalization, and intensive outpatient or outpatient services at certified facilities regardless of age.

According to a report released last week by the Government Accountability Office, the DoD usually outsources treatment for eating disorders among military personnel and family members because the therapies are highly specialized and the Pentagon does not have the staffing needed to focus "exclusively on eating disorders."

Diagnoses of eating disorders are rare among active-duty personnel, although the conditions are among the most common behavioral health disorders hidden by patients.

Between 2013 and 2017, 1,788 active-duty troops were diagnosed with an eating disorder, according to the Armed Forces Health Surveillance Branch.

The rate among military women was 11 times that among men. At highest risk for developing eating disorders were white women ages 20 to 24, according to the branch's June 2018 Medical Surveillance Monthly Report.

By service, female Marines had the highest rate of diagnosed eating disorders, nearly twice that of the other military services, at 20.4 per 10,000 persons. The Army was second at 11.9 per 10,000; the Navy third, at 11.4 per 10,000; followed by the Air Force, at 10.4 per 10,000.

For males, Army soldiers had the highest diagnosed rate of eating disorders, 1.2 per 10,000 persons, followed by the Marines, at 1.1 per 10,000. The Air Force was third, at .9 per 10,000 and the Navy, .8 per 10,000.

The Pentagon relies on its Tricare network to provide care. According to the GAO, Tricare's two contractors work with 166 eating disorder facilities, 40 in the West Region and 126 in the East.

The requirement that residential treatment centers are covered for only those under 21 largely excludes active-duty personnel from receiving treatment at residential stand-alone facilities.

The Eating Disorders Coalition, a group of associations, facilities and family members who advocate for eating disorder research, education and legislation, say, however, that military members and their families have higher prevalence rates of eating disorders than the civilian population -- an estimated 7% to 8% of all troops.

According to the group's research, 34% of female active-duty service members and 20% of female adolescent dependents are at risk for an eating disorder, while 16% of female Veterans are affected by an eating disorder.

According to the GAO, the Defense Health Agency did not receive any complaints about access to eating disorder treatment or therapy from 2018 to 2019.

For years, family members have thought that Tricare did not cover treatment of freestanding eating disorders as "they don't meet the requirements to be Tricare-authorized providers." But according to the GAO, this statement -- posted on the GAO's website until March 2020 -- was erroneous.

"Tricare can cover services delivered in certified freestanding clinics unless they fail to meet the certification requirements for institutional providers," GAO analysts wrote.

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The good news came on Feb. 18 for about 180 people who'd been holed up at the Westwind Inn, the on-site hotel at Travis Air Force Base in Fairfield. The two weeks in quarantine after their evacuation from China had crawled by as they interacted with a team of local, state and federal health officials.

On that Tuesday, most everyone who'd visited Wuhan was cleared to go home. A handful had been sent to local hospitals for monitoring. The others dispersed, many boarding flights from Sacramento to their homes throughout the U.S.

About the same time, two American evacuees from the Japan-docked Diamond Princess cruise ship were being admitted into isolation rooms at a Napa hospital. One traveler had tested positive for COVID-19, the other showed symptoms of the virus. In a radio interview that day, Feb. 18, a Napa County spokesman repeated the line that's been trumpeted continuously in recent weeks, at least in the U.S.: For the public, there's "minimal risk of exposure."

As eyes increasingly turned to the Fairfield military base, a Solano County woman went to a small Vacaville hospital 8 miles away with symptoms associated with the new coronavirus. She stayed at NorthBay VacaValley hospital for four days, her condition apparently worsening, and on Feb. 19 staff moved her on a ventilator to UC Davis Medical Center in Sacramento.

The nation would learn about a week later that, although she apparently had no close contact with any travelers to China, she had been diagnosed with the new coronavirus.

It was the nation's first infection that had unknown origins. The director of California's Public Health Department last week called her case a "turning point" that could signal widespread infection is increasingly difficult to stop.

The woman's case unleashed a deluge of questions and concerns about how local, state and federal officials responded to the mounting public health concern after the evacuees arrived at Travis Air Force Base -- and what future responses might look like. A U.S. government whistleblower now says federal workers did not have the necessary protective gear or training when they were deployed to help quarantined people, including those at Travis.

Since the Solano County woman's illness became known, teams of health care investigators have fanned out across Northern California trying to understand exactly how -- and how widely -- the virus has spread.

"We have deployed there," Secretary of Health and Human Services Alex Azar told McClatchy this week. "We'll send whatever we need to assist the state and local public health authorities with the contact tracing and getting to the bottom of her case."

But sharp questions are being asked about the timeline between the arrival of hundreds of people at Travis and the coronavirus infection of a woman who lived in the same county as the military installation.

For investigators, that timeline could shed light on how the disease is spreading and whether federal authorities botched the re-entry process for those returning from China. For others, the sequence of events is too coincidental to be ignored. Did health authorities allow the Travis evacuees to bring COVID-19 to California -- and for those who came in contact with them to spread it?

Local Health Authorities are Skeptical

Dr. Bela Matyas, a Solano County public health officer, told The Sacramento Bee that concerns about ill-prepared personnel working with evacuees did not extend to Travis Air Force Base. By the time repatriation flights landed at Fairfield, Matyas said, a robust federal operation had been established.

"They were CDC folks -- we met them. They were very meticulous," Matyas said. "We couldn't enter without the proper equipment. They've handled three planeloads and we're grateful. They've helped to protect our community."

Azar on Friday said the department was conducting interviews and gathering information about the whistleblower's concerns, adding that he was unaware of the complaint when he testified before a House committee earlier in the week.

"We will take remedial measures if needed," he told reporters Friday. "...We will very transparently investigate, and if there's any problem, we will take remedial action."

How February Unfolded at Travis

On Feb. 1, federal officials announced Travis Air Force Base would be among three installations in California to house travelers who may have come in contact with the virus that originated in Wuhan, China. The base would soon be populated with hundreds of travelers.

A flight carrying some 181 American evacuees landed on a chartered Boeing 747-400 during the predawn hours of Wednesday, Feb. 5.

Medical personnel had screened and monitored them before, during and after the 11-hour flight over 6,500 miles, officials said. Passengers considered high-risk were kept in a separate part of the plane, divided by a plastic sheet.

The first passengers, some holding luggage, were escorted one by one and in small groups out of the plane. Officials walked them beneath the jumbo jet, emblazoned with the name of cargo carrier Kalitta Air, and into the adjacent Hangar 16.

Between deplaning passengers, KGO-TV video showed personnel in white protective suits, some wearing respirators, unloading luggage from the cabins using the air stairs. The passengers were met with applause as they exited the plane and headed toward their temporary home at the Westwind Inn.

Jeff Ho was among the first passengers from China to land at Travis. He had been visiting his in-laws during the Chinese New Year festivities early in January as the series of lock-downs and quarantines rippled near Wuhan. Ho, who works in San Bernardino as a mechanic, coordinated with the U.S. embassy to secure his flight to California.

"I got lucky and had three seats to myself," Ho told The Sacramento Bee on Saturday. Airport and embassy staff in China wore protective suits, but on the plane, the atmosphere was more relaxed. Travelers and workers wore masks and goggles.

When they landed at Travis, emergency vehicles were parked near the hangar, Ho said. They turned in their paperwork at tables inside the hangar and, at the end of the line, received their room keys.

"No one was really wearing the full suit anymore because they already screened the people," Ho said, adding they instead wore masks and eye protection but otherwise normal clothing. "We were there at that quarantine because we were not sick."

In the two weeks that followed, he binge-watched movies, documented his day on social media and befriended the workers who regularly took his temperature. He returned to his home in Southern California on Feb. 19, where he continues to video-chat daily with his wife and daughter -- they remained with his in-laws.

Ho disagreed with critics and the whistleblower who allege workers were untrained and did not properly protect themselves from spreading the virus. He's spoken with some workers and others who were quarantined with him in recent days, and they also said they did not see anything that would corroborate the whistleblower's complaint.

"I'm actually more worried that people are going to go crazy and overreact," he said.

After Ho's arrival at Travis, another flight landed on Friday, Feb. 7, and 53 passengers from China were sent into isolation, bringing the total number to 234 passengers at the base. Ultimately, none of those Wuhan evacuees housed at Travis tested positive for the new coronavirus -- it is possible, however, to carry the illness without knowing it.

Dr. Henry Walke, an infections-preparedness official with the CDC, previously described the early quarantines at Travis as an "unprecedented action." But, he added, "this is an unprecedented threat."

"We know this situation may be concerning to people in the Travis Air Force Base community," he said. "Based on our experience with other coronaviruses, we don't believe these people pose a risk to this community because we are taking measures to minimize any exposures."

Whistleblower Offers Doubt

Suspicion about the Travis Air Force base protocols, and the comings and goings of those assigned to work with travelers, jumped into public view when The Washington Post reported that a whistleblower had filed a complaint with the Office of the Special Counsel.

The whistleblower alleged about a dozen personnel with the Administration for Children and Families responded to Travis Air Force Base but were "not properly trained or equipped to operate in a public health emergency situation," even though they had face-to-face contact with travelers.

Although team members had gloves at times and masks at other times, they lacked full protective gear and received no training on how to protect themselves in a viral hot zone, according to a description provided to the Associated Press. They had no respirators but noticed that workers from the CDC were in full gear to protect them from getting sick.

"Our client was concerned that ACF staff -- who were potentially exposed to the coronavirus -- were allowed to leave quarantined areas and return to their communities, where they may have spread the coronavirus to others," said Lauren Naylor, an attorney representing the whistleblower, according to the law firm's Twitter profile.

Rep. Jimmy Gomez, D-Calif., said the whistleblower had contacted his office and was alleging retaliation by higher-ups for having flagged the alleged safety issues.

In response, the U.S. Department of Health and Human Services, which manages the Administration for Children and Families, said it was evaluating the complaint.

"We take all whistleblower complaints very seriously and are providing the complainant all appropriate protections under the Whistleblower Protection Act," HHS spokeswoman Caitlin Oakley said in a statement to The Bee.

'Floating Disaster'

By the middle of February, as quarantines came to an end for the Wuhan travelers isolated at Travis, stays would soon begin for passengers from a cruise ship being denied ports around the world -- a petri-dish at sea.

The 3,711 people aboard the Diamond Princess cruise ship were on their final night of a two-week luxury cruise when the captain came on the intercom. A person had left the ship nine days earlier and tested positive for the virus. It was unnerving, guests would later recount, but it did little to dissuade many from mingling in theaters and bars in what would later be described in the New York Times as a "floating epidemiological disaster."

As a two-week quarantine dragged on, an international argument intensified: How to handle repatriating citizens without allowing the virus to increase its rate of spread?

By the middle of the month, the U.S. had crafted a plan to fly Americans to bases in California and Texas, citing measures that were "consistent with the most current medical assessments available, and the careful policies we have instituted to limit the potential spread of the virus," the State Department wrote in an letter dated Feb. 16.

That day, after a testy debate between the State Department and the Department of Health and Human Services, hundreds of mask-wearing Americans -- including 14 confirmed to have had the virus -- were cleared to return to the U.S. While 178 people arrived at Travis from the Diamond Princess, the CDC reported, 144 others went to Joint Base San-Antonio-Lackland in Texas.

At Travis, six passengers were immediately sent for care at the National Quarantine Unit at the University of Nebraska Medical Center/Nebraska Medicine in Omaha. More than 600 travelers who had been on the ship later tested positive for the virus. At least six around the world would later die.

Following screening procedures at Travis, 16 other passengers were sent to hospitals near the base for isolation and further evaluation. None were sent to Sacramento-area hospitals. And four travelers in the coming days developed symptoms of respiratory illness while quarantined at Travis, despite being cleared in Japan days earlier.

Then, on Feb. 18, the officials in Napa County said two evacuees who arrived at Travis were hospitalized; one tested positive for the new coronavirus and the other had symptoms. They were being treated in isolation at Queen of the Valley Medical Center, 30 miles west of Travis.

As evacuees and workers dispersed, it became increasingly difficult to keep track of their whereabouts. Counties up and down the West Coast -- including several that do not yet have known cases of COVID-19 -- declared local health emergencies.

Solano County and Travis Air Force Base followed suit last week.

"This is an emerging, rapidly evolving situation," base officials said in an announcement. "We will continue to partner with local agencies to ensure the safety and welfare of our force and families."

Quarantined travelers, however, might not have been the most concerning piece of the puzzle.

A Unique Case inSacramento

The same day last week that whistleblower complaint was filed in Washington, hospital officials in Sacramento issued a memo with the news many had long feared: The first confirmed case of COVID-19 that had unknown origins had finally emerged in the United States. And that woman, who checked into the Solano County hospital, had been transferred to the UC Davis Medical Center.

"This is not the first COVID-19 patient we have treated, and because of the precautions we have had in place since this patient's arrival, we believe there has been minimal potential for exposure here at UC Davis Medical Center," according to the memo sent to staffers Wednesday night.

UC Davis Medical Center nevertheless sent several dozen employees home to await further testing. On Friday, the National Nurses United union said there were 124 nurses and health care workers sent home.

In a separate staff memo Thursday, UC Davis Chief Medical Officer J. Douglas Kirk said the "incident is not impacting our ability to provide care for any patient, any time, or anywhere."

"This incident involves a patient, a real person, with a real family, who is worried about their loved one's condition and thankful for the care delivered by our teams here," he wrote. "As such, we must respect the patient and the family's privacy."

Additionally, Solano County public health officials on Friday said 93 people at Vacaville NorthBay VacaValley came in contact with the patient before her transfer to Sacramento. Of the 93, 82 people without novel coronavirus symptoms are under home quarantine.

Eleven more who are showing symptoms have been told to isolate themselves at home away from family members and other contacts and have been tested for the virus. Test results are expected "in the next day or two," Matyas, the county public health officer, said Friday. Matyas said that number may change.

The people represent the entire spectrum of the care team from nutrition services to medical assistants to the bedside physician.

"We're double-checking and ensuring we've identified everyone," said Steve Huddleston, a hospital vice president. "We look at everybody who had clinical contact with the patient. We are looking at every hour of hallway camera to verify visitors who signed in and were badged (and) went into that room."

That roster of names was sent to local, state and federal public health agencies.

Their investigation is two-pronged, Matyas said: interviewing the patient's contacts at the hospital and in the community. There's a three-day window where the patient was probably able to spread the illness. Contacting family and co-workers was relatively easy, Matyas said.

Finding other contacts outside that circle is more vague.

"But," Matyas said, "it has to be done."

By Saturday evening, more than 86,000 people globally had been infected, with increasingly growing pockets outside of China, according to a map maintained by Johns Hopkins University. That country has also suffered the vast majority of 2900-plus deaths from new coronavirus.

"Our greatest enemy right now is not the virus itself. It's fear, rumors and stigma," World Health Organization Director General Tedros Adhanom Ghebreyesus said in a Friday morning press briefing.

Santa Clara County on Friday announced the second known instance of person-to-person transmission in the general public.

Hours later, Oregon, announced the third.

And on Saturday, officials in Washington state announced what might be the latest turning point, capping a month already filled with them: A man died near Seattle, marking the first COVID-19 death in the U.S.

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With news of the contagious and potentially deadly illness known as novel coronavirus grabbing headlines worldwide, military health officials say that an informed, common sense approach minimizes the chances of getting sick.

Many forms of coronavirus exist among both humans and animals, but this new strain’s lethality has triggered considerable alarm. Believed to have originated at an animal market in Wuhan City, China, novel coronavirus has sickened hundreds and killed at least 4. It has since spread to other parts of Asia. The first case of novel coronavirus in the U.S. was reported January 22 in Washington State.

Anyone contracting a respiratory illness shouldn’t assume it’s novel coronavirus; it is far more likely to be a more common malady. “For example, right now in the U.S., influenza, with 35 million cases last season, is far more commonplace than novel coronavirus, said U.S. Public Health Service Commissioned Corps Dr. (Lt. Cmdr.) David Shih, a preventive medicine physician and epidemiologist with the Clinical Support Division, Defense Health Agency. He added that those experiencing symptoms of respiratory illness – like coughing, sneezing, shortness of breath, and fever – should avoid contact with others and making them sick, Shih said.

“Don’t think you’re being super dedicated by showing up to work when ill,” Shih said. “Likewise, if you’re a duty supervisor, please don’t compel your workers to show up when they’re sick. In the short run, you might get a bit of a productivity boost. In the long run, that person could transmit a respiratory illness to co-workers, and pretty soon you lose way more productivity because your entire office is sick.”

Shih understands that service members stationed in areas of strategic importance and elevated states of readiness are not necessarily in the position to call in sick. In such instances, sick personnel still can take steps to practice effective cough hygiene and use whatever hygienic services they can find to avert hindering readiness by making their battle buddies sick. Frequent thorough handwashing, for instance, is a cornerstone of respiratory disease prevention.

“You may not have plumbing for washing hands, but hand sanitizer can become your best friend and keep you healthy,” Shih said.

Regarding novel coronavirus, Shih recommends following Centers for Disease Control and Prevention travel notices. First, avoid all non-essential travel to Wuhan, China, the outbreak’s epicenter. Second, patients who traveled to China in the past 14 days with fever, cough, or difficulty breathing, should seek medical care right away (calling the doctor’s office or emergency room in advance to report travel and symptoms) and otherwise avoid 1) contact with others and 2) travel while sick.

CDC also has guidance for health care professionals, who should evaluate patients with fever and respiratory illness by taking a careful travel history to identify patients under investigation (PUIs), who include those with 1) fever, 2) lower respiratory illness symptoms, and 3) travel history to Wuhan, China, within 14 days prior to symptom onset. PUIs should wear a surgical mask as soon as they are identified and be evaluated in a private room with the door closed, ideally an airborne infection isolation room if available. Workers caring for PUIs should wear gloves, gowns, masks, eye protection, and respiratory protection. Perhaps most importantly, care providers who believe they may be treating a novel coronavirus patient should immediately notify infection control and public health authorities (the installation preventive medicine or public health department at military treatment facilities).

Because novel coronavirus is new (as its name suggests), there is as yet no immunization nor specific treatment. Care providers are instead treating the symptoms – acetaminophen to reduce fever, lozenges and other treatments to soothe sore throats, and, for severe cases, ventilators to help patients breathe.

“Lacking specific treatment,” Shih said, “we must be extra vigilant about basic prevention measures: frequent handwashing, effective cough and sneeze hygiene, avoiding sick individuals, and self-isolating when sick.”

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Active coronavirus cases within the Department of Veterans Affairs hit new pandemic highs this week, with no indication that the problem will abate heading into 2022.

As of Thursday morning, VA officials recorded more than 27,000 active cases among patients, employees and Veterans in department care spread out across 140 department medical centers.

It’s the third consecutive day of record highs for the department in active cases. Prior to this week, the most VA had reported in a single day was Jan. 11 of this year, during the second major wave of virus spread, when the department had just under 21,000 cases.

As recently as mid-November, VA had fewer than 6,000 cases across its healthcare network. But the rapid advance of the Omicron variant of the virus has led to a worldwide spike in cases, and a return to some pandemic restrictions.

VA officials are seeing a dramatic rise not just among patients but also among staff.

In the last five days, more than 2,900 employees have reported new infections, according to data released by the department. In the 20 days prior, only about 2,800 staffers had reported COVID cases.

The rise in cases at the department mirrors the spike in cases across America. Officials from the Centers for Disease Control and Prevention said the average number of new coronavirus cases last week topped 240,000, with daily totals hitting new record highs several times.

VA leaders have repeatedly noted that unlike the Department of Defense — whose personnel are at least partially contained on military bases — their patient and staff population are part of the broader American public, making it vulnerable to the same infection swings.

At least 17,700 individuals in the VA medical system have died from coronavirus-related conditions since the start of the pandemic in America in March 2020. That equates to roughly 26 deaths a day.

Of that total, about 30 percent — more than 5,200 — have died since July 1 of this year, after vaccines for the virus were made widely available.

VA officials have not released data on how many deaths were among unvaccinated patients, but have noted in recent months they have seen higher infection rates for unvaccinated individuals.

However, VA patients are more likely to be older and have additional health concerns, making them more vulnerable to the virus and other infections. About 4 percent of all confirmed VA COVID cases have resulted in death, compared to less than 2 percent of all coronavirus cases across America.

VA leaders have mandated that all department employees get vaccinated against the virus in an attempt to limit the chance of spread among patients and visitors to VA hospitals. Suspensions and firings related to refusal of that mandate are scheduled to begin next month.

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Veterans Affairs officials would set up 31 major medical clinics across America and hire thousands more claims processors and health care staff under compromise toxic exposure legislation unveiled in the Senate Tuesday.

The provisions would be attached to the already massive Promise to Address Comprehensive Toxics Act (or PACT Act) which passed out of the House in March. That measure carried a price tag of more than $200 billion over the next decade and would potentially affect as many as one in five Veterans living in America today.

Concerns about the scope of the bill and the potential of the new Veterans benefits to overwhelm existing VA systems led to resistance from Republican lawmakers.

But last week, the Democratic and Republican leaders of the Senate Veterans’ Affairs Committee announced a breakthrough to advance the legislation, somewhat surprisingly by broadening the bill’s scope even further.

In a statement released Tuesday afternoon, committee Chairman Jon Tester, D-Mont., and Jerry Moran, R-Kansas, said they believe the new plan can pass through Congress and provide Veterans suffering from toxic exposure injuries with the services they deserve.

“This legislation expands VA health care eligibility for post-9/11 combat Veterans, improves VA’s claims processing, and delivers VA the necessary resources to take care of our Veterans from every generation,” they said.

“While our work is far from over, together we’re committed to keeping up our end of the bargain to those who sacrificed on behalf of our freedoms by getting this bill across the finish line as soon as possible.”

In a separate statement, House Veterans Affairs Committee Chairman Mark Takano, D-Calif., offered support for the compromise bill, which will have to be again approved by his chamber before becoming law.

“I have long said that we cannot let cost or implementation hurdles get in the way of making good on our promise,” he said. “Toxic-exposed Veterans do not have time to wait.”

Senate officials did not release any estimates for what the revised PACT Act may cost.

Benefits for burn pit victims and more

As in the House plan, the Senate compromise would establish a presumption of service connection for 23 respiratory illnesses and cancers related to the smoke from burn pits, used extensively in those war zones to dispose of various types of waste, many of them toxic.

The bill also provides for new benefits for Veterans who faced radiation exposure during deployments throughout the Cold War, adds hypertension and monoclonal gammopathy to the list of illnesses linked to Agent Orange exposure in the Vietnam War, expands the timeline for Gulf War medical claims and requires new medical exams for all Veterans with toxic exposure claims.

Veterans who served in Thailand, Laos, Cambodia and Guam during the Vietnam War era would be covered for the first time under the same Agent Orange presumptive policies as those who served in Vietnam itself.

The bill would also require a significant reconsideration of how VA handles toxic exposure claims, with a formal working group on toxic exposure injuries and research advising top officials on future improvements.

VA officials would be granted “the authority to determine that a Veteran participated in a toxic exposure risk activity when an exposure tracking record system does not contain the appropriate data,” a sharp contrast from the science-only system in use at VA today.

Advocates have lamented that in many cases, Veterans with serious illnesses obviously connected to their service have been turned away by the department because ironclad data showing chemical exposure during their service does not exist.

Phasing each of those provisions into law won’t happen immediately, however.

For example, hypertension will be added to the list of presumptive conditions caused by Agent Orange exposure during the Vietnam War right away for individuals “who are terminally ill, homeless, under extreme financial hardship, or are over 85 years old.”

For other Vietnam War Veterans, that won’t go into effect until October 2026.

Chronic bronchitis would be added to the list of presumptive illnesses caused by burn pits in October 2023. Kidney cancer would not be included in the same category until two years later.

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The Department of Defense issues identification cards to service members, their family members and others to prove their identity and their connection to the Defense Department. These military ID cards also give you access to military services and programs.

Keep reading to learn about the different types of military ID cards, how to get or replace them and how to use them to access military programs and services.

• The Common Access Card is the standard ID for active-duty service members, as well as Selected Reserve members, Department of Defense civilian employees and some contractors. The CAC facilitates physical entry to installations and buildings, and logical access to secured computer networks and systems. It also documents your affiliation with the Department for use of military services, programs and benefits for which you may be eligible.

• The Uniformed Services ID Card is for military family members – including military spouses and dependent children over 10 – retirees and former service members, members of the Individual Ready Reserves and inactive National Guard. Other military community members also are eligible for military benefits because of their affiliation with the Defense Department including former spouses who have not remarried, 100% disabled Veterans, eligible foreign military, Transitional Health Care recipients, and other eligible populations as described in DoD policy. This ID lets you use certain military services and programs.

• The Department of Defense Civilian Retiree Card is for civilians who have retired from any Department of Defense agency.

Visit the Department of Defense’s official military ID card website for more information about card types, eligibility, renewal and other services.

How to use programs and services with your military ID card

Your military ID card unlocks more than just buildings and computer systems. It lets you and your family use the military benefits for which you may be eligible. Use your military ID to:

• Enter the installation at the security gate
• Use Morale, Welfare and Recreation facilities like libraries, swimming pools, golf courses and more, if authorized
• Get TRICARE military health benefits, if authorized
• Shop at any commissary or exchange, if authorized

How to get your military ID card

To get any military ID card – including the CAC, the Uniformed Services ID Card and the Civilian Retiree Card – you must be registered in the Defense Enrollment Eligibility Reporting System.

Service members, retirees, DoD civilians and former members have their information fed to DEERS through automated data feeds.

To enroll a dependent or other eligible individual in DEERS, you will need a DD Form 1172-2. You can submit the form through the ID Card Office Online or in person at a RAPIDS site. Use this RAPIDS Site Locator to find a location near you to make an appointment.

You will need to go to a RAPIDS site with your completed DD Form 1172-2 and two forms of identification, including a state or federal government photo ID. Newly married military spouses should bring their marriage certificate. Children under 18 will need proof of relationship to their military sponsor, like a birth certificate, to get their Uniformed Services ID Card. You may require additional documentation depending on your eligibility or circumstances.

After your appointment at the RAPIDS site, you’ll get your first CAC, Uniformed Services ID Card or Civilian Retiree Card.

For more details on how to apply for your first military ID, read this pre-arrival checklist.

How to renew, change or replace your military ID card

If your status changes in some way – you leave active duty, for example, or your card expires in the next 90 days – you’ll need to have your ID reissued. How you renew or change your ID is similar to how you first got it, but with two changes:

• Your current, unexpired CAC, Uniformed Services ID Card or Civilian Retiree Card counts as one of the two forms of identification you need to provide.
• You can apply to the Department of Defense to renew or replace your military ID online using the ID Card Office Online.

If you lose your ID you can apply for a new one at a RAPIDS site or through the ID Card Office Online. Service members should also report missing CACs to their chain of command.

To renew, change or replace your ID card, your profile in DEERS will need to be up to date. You can check or change your DEERS information online at MilConnect. And, check out this pre-arrival checklist to learn more about renewing your military ID.

How to keep your military ID card safe

If you live or work on an installation, you may find yourself pulling out your military ID card several times a day. Make sure you put your card back into a wallet or badge holder – not into a back pocket or thrown on the dashboard of your car.

If you don't live near an installation and only use military facilities a couple of times a year, then you may want to keep your military ID in a safe place at home instead of in your wallet. Store it with other important papers, like passports and Social Security cards.

If a local business offers a military discount with proof of affiliation, you may show your military ID card to the cashier, but for security reasons, never let a cashier photocopy your ID or take it from you.

Your ID is an important part of your military life. Keep it updated, safe and ready to use. And remember: If you ever have a question or need a hand – whether it’s about your military ID card or any other part of military life – Military OneSource is here to back you up.

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The Department of Defense is providing an additional way for military parents to find child care solutions for hourly care. Military OneSource will expand its offerings through a national online service that enables families to find, hire, and pay for care.

The new offering provides access to a monthly subscription service with a secure, searchable network of care providers. The subscription, provided at no cost to eligible military families, offers a user-friendly way to explore providers who can assist with hourly, flexible and on-demand child care services. Families can find out more and access the service through MilitaryOneSource.mil or call Military OneSource at 800-342-9647 to speak with a consultant who can support their search.

“We are committed to taking care of our service members and military families, and understand that families may need assistance with their hourly care needs,” said Kim Joiner, deputy assistant secretary of defense for military community and family policy. “This new service provides a flexible way that empowers modern military families to find child care services that best meet their hourly care needs.”

“Child care is a workforce issue that directly impacts the readiness and retention of the Total Force,” said Carolyn Stevens, director of the Office of Military Family Readiness Policy. “This new service provides another opportunity for the department to support our military families.”

About Military Community and Family Policy

Military Community and Family Policy is directly responsible for establishing quality-of-life policies and programs that help our guardians of country, their families and survivors be well and mission-ready. Military OneSource is the gateway to programs and services that support the everyday needs of the 5.2 million service members and immediate family members of the military community. These Department of Defense services can be accessed 24/7/365 around the world.

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When Army Lt. Gen. Ronald Place visits military hospitals and clinics and conducts town halls with staff, he introduces himself not only as the director of the Defense Health Agency, but also as an Army surgeon, a son, husband, father, and grandfather. For Place, all his roles influence his decisions.

Place admits it was easy to get lost in his role as a surgeon back when he began his residency training. “Yet I would still go home as a military spouse, or I would go home to my military children,” he recalled. “I would wonder, ‘What did I do today to make the system better for my spouse?’ or ‘What did I do today to make the system better for my kids? And often the answer to that, at least for me personally when I was a junior officer, was nothing.”

Today as the director of the DHA, Place is responsible for all the activities that happen in the DHA, most of which impact the 9.6 million eligible TRICARE beneficiaries who depend on the MHS for their health care. “I like everybody to consider all of their roles when they make decisions,” he said. “To me, it's a reminder from a decision-making perspective, who are we? And why are we there as a part of the Military Health System?”

As an integrated system of health and readiness, the MHS is a complex matrix of people and priorities with a unique role supporting the National Defense Strategy, said Place. “Much of what we do to measure ourselves, our productivity, and the quality of the work that we do [is] based on civilian standards and benchmarks,” he said. “Yet we're a Military Health System, and some of the things that are required for that balance between health and readiness don't earn productivity points in the same way they would in a civilian system.”

Place said the MHS isn’t where it needs to be in terms of defining the elements of readiness -- troops being medically ready and health care teams being proficient to perform their wartime missions -- or how the MHS measures productivity and quality in relation to readiness.

While the task at hand seems great, Place sees promise in the staff inside the DHA headquarters and at the military medical treatment facilities. “I see excellence. I see passion. I see dedication. I see desire for improvements in our system.”

Place has seen that passion showcased during the national emergency brought on by the COVID-19 pandemic. Through excellence, ingenuity and agility, health care providers continue to find ways to adapt how they deliver care without degrading the quality of care patients receive. Place cited the CAMIC invention and rethinking therapeutics such as the use of convalescent plasma for treating COVID-19 patients as examples of how passion and innovation have come together to create solutions that may have applications for years to come.

Place sees process standardization as a key to improvement. “Across the entire Military Health System, there are literally thousands of things that could be standardized to improve our system,” he said. It won’t be easy because there’s a lot of fear associated with change, he added.

But Place believes the DHA is primed for the challenge. “With the talent and passion and commitment of the entire team, at headquarters and at our health care delivery sites, I’m confident we can do it, but it's going to take a significant effort and it's going to take us some time,” he said.

Asked about his short-term goals, Place said he hopes to be able to cite examples of how standardization has improved the system. “That improvement might be quality of care or clinical outcomes for our patients; it may be the overall satisfaction of our patients,” he said. “I also hope we've done something to improve the system so that the staff, whether it's across the entire organization or even particular functional communities, have more joy in the work that they do and more fulfillment in their missions.”

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The Department of Defense denied a medical malpractice claim from Master Sgt. Richard Stayskal, the soldier whose name is attached to legislation that allows service members to file such claims against the Pentagon.

“The denial of my claim by the Department of Defense, in my opinion, is a blatant act of betrayal, not only to myself, but every service member out there,” Stayskal said Wednesday at a press conference in Washington.

Stayskal, a Purple Heart recipient, received an advanced lung cancer diagnosis in June 2017 after being misdiagnosed by Army doctors at Womack Army Medical Center at Fort Bragg, North Carolina.

Lawmakers and advocates joined the 41-year-old Green Beret outside the Capitol building Wednesday, calling out the Pentagon for what they say is still a problematic claims process.

“When our men and women in uniform make the brave decision to serve our country, they should know that we will take care of them and have their backs,” Sen. Markwayne Mullin (R-Okla.) said, according to a press release.

Of the 155 medical malpractice claims that have been processed by the Army, 144 have been denied, the release added.

Following his diagnosis, Stayskal lobbied Congress to reform a decades-old precedent known as the Feres Doctrine, which originated following a 1950 Supreme Court decision that keeps troops from suing the government for injury or harm sustained as a result of military service.

Legislation that bears Stayskal’s name was included in the 2020 National Defense Authorization Act. It allows service members to now file suit against DoD for instances of harm or negligence in the military medical system.

Stayskal reportedly plans to appeal the decision. He told the Washington Post the Army Claims Service notified him earlier this month that Army Secretary Christine Wormuth intended to use a “special discretionary funding authority” to pay him $600,000, the maximum amount allowed for pain and suffering damages in the military’s medical malpractice system.

That amount is far less than the separate $20 million claims sought by Stayskal and his wife, whose claim also got denied, the Post reported.

“The fox is guarding the hen house,” said Mullin, a member of the Senate Armed Services Committee, “and changes must be made.”

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The Defense Department is making plans to combat the coronavirus, DOD leaders said during a news conference.

For the past six weeks, defense leaders have been meeting to plan for any possible scenario with the virus that first surfaced in China. "We've issued a variety of [memoranda] and directives advising the force on how to deal with coronavirus," Defense Secretary Dr. Mark T. Esper said.

The DoD civilian and military leadership, including all the service secretaries and combatant command commanders, have worked together to ensure the department is ready for short- and long-term scenarios, as well as domestic and international situations. Esper stressed that commanders at all levels have the authority and guidance they need to operate.

"(U.S. Northern Command) remains the global integrator for all DOD efforts and entities," Esper said. "My number one priority remains to protect our forces and their families; second is to safeguard our mission capabilities and third [is] to support the interagency whole-of-government's approach. We will continue to take all necessary precautions to ensure that our people are safe and able to continue their very important mission."

Army Gen. Mark A. Milley, the chairman of the Joint Chiefs of Staff, said the military has existing plans to combat an infectious disease outbreak. The military is executing those plans.

DoD is communicating regularly with operational commanders to assess how the virus might impact our exercises and ongoing operations around the world, the general said. A command post exercise in South Korea has been postponed, but Exercise Cobra Gold in Thailand is continuing.

Milley also said that military research laboratories are working "feverishly" to try to come up with a vaccine.

Commanders are taking all necessary precautions because the virus is unique to every situation and every location, Esper said. "We're relying on them to make good judgments," he said. As new issues come up, DoD planners will work with all to combat the spread of the virus.

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Some troops and families are having to drive three hours to get routine medical care during pregnancy, or commuting 53 miles to work on an installation that are remote or isolated in the U.S., according to a new government report, highlighting the need for Defense officials to look at the full picture of support services for troops and their families at these bases.

DoD needs to gauge the risks of not providing those support services, and develop a strategy to meet those needs of troops and families, according to the report from the Government Accountability Office, which took a deep dive into life some of these U.S. installations.

Since 1989, 43 installations in the United States have been given that “remote or isolated” status for the purposes of morale, welfare and recreation, by either DoD or Congress, auditors said. Three of those were designated by DoD between 2011 and 2020 — Naval Support Activity, Crane, Ind.; Naval Air Weapons Station China Lake, Calif.; and Fort Hunter Liggett, Monterey, Calif. While there are more than 207 remote or isolated installations worldwide for MWR purposes, this congressionally-mandated report focused on those in the U.S.

For now, that designation matters when it comes to MWR programs. When these installations get that designation of “remote” or “isolated,” they may qualify for additional MWR funding for service members and families, under a process established by DoD. Some key MWR programs are child care and fitness centers, among others.

But there’s more to be considered than MWR, auditors said, and DoD’s current policies for housing, medical care and education don’t include a process for designating a base as remote or isolated for the purpose of extra resources for that particular support service. And without a system for assessing whether those support services are meeting the needs of service members and their families, DoD and the services may not be able to target funding to those needs.

In their response to GAO, DoD officials agreed with the recommendations, and committed to review its policies and to look at the ways military families’ needs are met at these remote locations.

While DoD policies generally rely on communities near the installations to provide troops and families with the support services they need, those community services may not be available at the remote or isolated installations, auditors found. They may not even have a local community within close proximity.

Auditors examined the services available at four such remote installations: Dugway Proving Ground, Utah; Naval Air Station Key West, Fla.; Clear Air Force Station, Alaska (for unaccompanied personnel only); and Marine Corps Mountain Warfare Training Center, Calif.

Auditors said officials at the installations and service members surveyed described a number of financial effects experienced, such as increased commuting costs, higher costs of consumer goods, travel distance and time needed to reach grocery stores, and the high cost of off-base housing. Officials from two of the bases said that in some instances, young service members leave the military after being posted at a remote or isolated base.

Medical care: Service members at three of the locations faced commutes of an hour or more to reach health care providers within DoD’s Tricare network. For example, at Naval Air Station Key West, neither the on-base medical clinic nor the community outside the gate can provide certain types of specialty care, such as obstetric and gynecological care. Service members and their dependents must drive three hours to Miami to get this care. Officials at the installation told auditors that a policy that designates installations as remote or isolated for health care purposes would help them draw wider attention to that situation and boost their argument for more medical resources.

Defense Health Agency officials told auditors that requirements related to improving services in rural, remote and isolated areas of the U.S. are expected to be addressed in the next generation of Tricare contracts that are expected to being in 2023.

Housing: At Marine Corps Mountain Warfare Training Center in Bridgeport, Calif., the privatized family housing community is located about 21 miles from the installation; but most of the service members live in a local community about 53 miles away. Officials at three of the installations GAO auditors visited identified the condition of base housing as a concern, too. A little more than half of the service members at the four remote installations who responded to a GAO survey said they were satisfied with the condition of their housing, whether it was located on or off the base. They cited problems such as mold in base housing and dormitories, inadequate air conditioning, and general disrepair.

GAO auditors note that the web-based survey size was small —– sent to 756 service members at those four installations, with 28 percent, or 212, responding. So the results can’t be generalized across all the remote or isolated installations, they said, but can be used to identify issues at those specific bases.

Auditors identified two key problems with housing — the lack of available, affordable housing and insufficient Basic Allowance for Housing. This has increasingly become an issue this year with service members, whether they live in remote areas or not, because of the hot housing market affecting both purchasers and renters.

Education: None of the bases examined have Department of Defense schools for children. The three installations with families rely on public schools to provide education for their children, as do most other military bases in the U.S. About 83 percent of the respondents to the GAO survey at the four installations said that their public schools met the needs of their school-aged children to a “moderate” extent. About 29 percent expressed dissatisfaction with the education options available for their children. Some cited lack of special education resources, athletic programs and extracurricular activities.

MWR: While bases are designated as remote or isolated for MWR purposes, there’s dissatisfaction with some MWR programs among the troops.

Nearly half of the survey respondents at these four installations said they were “somewhat” or “very” dissatisfied with the availability of recreation programs and travel services at their installations; and nearly half also said they were dissatisfied with the quality of these programs.

Installation officials said their ability to provide MWR services is negatively affected by their difficulty in attracting and retaining civilian employees because of factors like low pay, commute time and cost of living.

DoD guidance states that the military services should provide comparable and consistent MWR support to all eligible personnel on DoD installations — to include the remote installations. While DoD expects many MWR programs to be self-sufficient, it provides flexibility for more funding for MWR programs at remote or isolated installations.

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For any patient who suffers from an opioid overdose, naloxone represents the best shot at reversing the symptoms long enough to receive medical attention. Naloxone provides a temporary antidote for opioid overdose as it gives short-term airway relief. The Food and Drug Administration encourages providers to prescribe naloxone alongside an opioid if patients or their families are at risk for potential overdose. However, naloxone prescriptions carry a stigma due to misconceptions about the drug’s intent.

Last year, representatives from the Defense Health Agency, Uniformed Services University of the Health Sciences, and the Defense and Veterans Center for Integrative Pain Management established the Opioid Overdose Education and Naloxone Distribution Program, or OEND. The program was created as a way to reduce the stigma of naloxone as a drug strictly for patients struggling with opioid addiction.

OEND promotes education throughout the Military Health System on naloxone’s life-saving properties. Based on the Department of Veteran Affairs program of the same name, OEND’s goal is to increase co-prescribing of naloxone to reduce opioid-related overdoses and death.

Patients can be at risk for opioid overdose for factors not related to opioid abuse. Conflicts with other medications, underlying medical conditions like lung problems and sleep apnea, and even taking opioids after not taking them for a long time can increase risk of opioid overdose or death. OEND provides information about safe opioid use and naloxone on its website, through social media campaigns, and by train-the-trainer programs for providers. These resources and tools all contribute to what Army Lt. Col. Lori Whitney sees as the program’s top priority: patient safety.

“That is our concern. That is the work we do,” said Whitney, who chairs the Defense Health Agency’s Pain Management Clinical Support Service. “A naloxone prescription along with an opioid is just like having an inhaler for asthma or a fire extinguisher in your kitchen. You’re not planning to have a fire every time you cook, but it could happen. Naloxone is that fire extinguisher for opioid overdose, so you want to have naloxone handy to save a life.”

Whitney expects that use of the OEND Program will increase the number of naloxone prescriptions for at-risk patients and their families when opioids are prescribed. The MHS goal is a 90% prescription rate of naloxone to at-risk patients. The OEND program is one way that the organization will meet this goal and has already been successful at its pilot sites.

OEND was piloted in 2019 at Madigan Army Medical Center at Joint Base Lewis-McChord, Washington, to see how the program affects knowledge and prescription rates of naloxone. The medical staff at Madigan took a multipronged approach, training not only opioid prescribers but also outpatient and clinical pharmacists on best practices for naloxone. Dr. Ji Eun Kim, pharmacist and one of the program leads for OEND at Madigan, emphasized the importance of this approach for opioid safety.

“The first time that a patient is prescribed an opioid is with the medical provider who's prescribing it, so that's our first chance to provide naloxone,” Kim said. “Another opportunity is when the patient goes to the pharmacy and the outpatient pharmacy staff reviews the patient's medication list. The pharmacy staff can also provide naloxone if indicated. That's why we thought it’s important and also necessary to train our outpatient pharmacists. We knew that this would work best as a team effort.”

The team at Madigan measured knowledge and understanding of naloxone both before and after completing the OEND pilot program. Kim said Madigan saw an increase in knowledge and comfort for both providers and pharmacists when it comes to naloxone.

“I think with the current opioid crisis and sometimes negative light around using opioids, patients feel like they have to justify why they’re on the prescription,” Kim said. “We need to be able to have a conversation about it with each other and with our patients. I think OEND is a good program and provides information where the pharmacist and providers feel comfortable about having this discussion.”

Whitney hopes that OEND can help more commands and providers reduce stigma and educate patients on opioid safety so they become more comfortable with accepting a naloxone prescription.

“We want to continue to train the providers to have a conversation with their patients and let them know that the answer to pain management isn’t always opioids,” she said. “But if we're going to give you opioids, we also want to give the lowest effective dose for the shortest amount of effective time and we want to keep you safe while you have them. Naloxone is part of that.”

For more information and resources from the Opioid Overdose Education and Naloxone Distribution Program, visit Health.mil.

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FALLS CHURCH, Va. -- The Department of Defense is preparing for the next major step in consolidating military hospitals and clinics under a single agency, one of the largest organizational changes within the U.S. military in decades.

On Oct. 1, the Army, Navy and Air Force begin the final two years of a multi-year transition to shift administration and management of their medical facilities to the Defense Health Agency by October 2021, changes that are "transformational and far-reaching," said Vice Admiral Raquel Bono, the DHA Director.

"For the first time in our modern military's history, a single agency, the DHA, will be responsible for all the health care the Department of Defense delivers to our 9.5 million beneficiaries," Bono said. "Whether you receive your care at an on-base facility or through our TRICARE civilian networks, DHA will oversee your care.  This consolidation will drive higher levels of readiness for operational and medical forces and integrate health care services to standardize practices across the entire Department, which means patients will have a consistent, high-quality health care experience, no matter where they receive their care."

The primary driver for this change is the National Defense Authorization Act of 2017. Congress mandated that a single agency will be responsible for the administration and management of all military hospitals and clinics to sustain and improve operational medical force readiness and the medical readiness of military members, improve beneficiaries' access to care and experience of care, improve health outcomes, and eliminate redundancies in medical costs and overhead across three separate Service-run systems.  DHA will be responsible for health care delivery and business operations across the Military Health System including budgets, information technology, health care administration and management, administrative policies and procedures, and military medical construction.

Bono said that even though congressional directives mandate this change, "it's the right thing to do."

"We have more than 40 years of independent studies and internal reviews that demonstrate the current structure of the Military Health System is unsustainable," she said.  "What makes us unique from other health systems is that we are heavily embedded with combat forces around the world focused on operational medical readiness and the health of our warfighters. The transformational changes underway will improve that focus, support the DoD's priority for a more lethal force, and improve our ability to deliver high quality health care to all of our beneficiaries. Improving medical readiness is the key driver of the overall effort."

During this transition, the quality of care won't change for beneficiaries of the Military Health System. More important, Bono said, is that over time, it will improve that care by enabling changes to improve access, patient experience, and outcomes.

"Ultimately, what this transition means for all of us in the Department of Defense is a more integrated, efficient and effective system of readiness and health, and integration of health care services that leads to a more standardized and consistent experience of care for patients," Bono said. "Central to that is having one agency oversee MTF operations while supporting the Services' effort to focus more on readiness."

Since October 2018, the DHA has been operating eight hospitals and clinics as part of the first phase of what was at first a four-year transition period. In June, the overall timeline adjusted to three years to reduce the amount of duplicative management by the Military Departments and the DHA, said Dr. Barclay Butler, the DHA's assistant director for management and MTF transition head.  "The primary driver of that is to measurably and precisely coordinate the reduction of the Military Services' Medical Department support and oversight of the MTFs to the DHA," Butler said. "We want to create a simple and clear transfer of authority that positively impacts healthcare for our patients."

From Oct. 1 of this year through October 2021, the transition will focus on four primary objectives:

• Centralized administration and management: On Oct. 1, all hospitals and clinics in the continental United States transition to the DHA, with the Army, Navy and Air Force medical departments maintaining a direct support role. Butler said this means that while DHA assumes overall management, the existing intermediate commands of the Military Departments will continue management duties until the transfer is complete to ensure uninterrupted medical readiness operations and patient care. The Military Departments and the DHA are currently working out final plans to maintain continuity of operations.
• Establish Health Care Markets:  At the center of the reorganization is the creation of health care markets. The DHA will stand up 21 large markets during the transition period to manage MTFs in local areas. A market is a group of MTFs in a geographic area - typically anchored by a large hospital or medical center - that operate as a system sharing patients, providers, functions, and budgets across facilities to improve the coordination and delivery of health care services. "These markets are really key to the entire reorganization," Butler said.  "Market offices will provide centralized, day-to-day management and support to all MTFs within each market."  Readiness support is at the heart of a market's responsibilities, Butler added, and they will ensure the clinical competency of all MTF providers within the market. The 21 large markets will collectively manage 246 medical facilities and centers of excellence.
• Establishment of a Small Market and Stand-Alone MTF Organization: For stateside hospitals and clinics not aligned to a large market, this office, referred to as SSO, will provide managerial and clinical oversight. As with the large markets, the Military Departments will continue managing the MTFs until they are realigned under the SSO. There are 16 small market MTFs and 66 stand-alone MTFs assigned to the SSO.
• Establish Defense Health Regions overseas:  The transition period for standing up Defense Health Regions in Europe and Indo-Pacific begins in 2020.  All MTFs overseas would then report to their respective DHA regional offices. The Indo-Pacific region has 43 MTFs, while the European region has 31.

(For a complete list of markets and their assigned MTFs, go to the MHS Transformation web page at www.health.mil/mhstsransformation.)

"Change can be challenging, and this is a complex transition," Butler said. "We will see changes in reporting relationships and communication channels while instituting standardized clinical policies and procedures and business practices. We place a premium on communicating often as we move through this together with the Military Departments."

Bono said that from a patient perspective, these changes should be transparent. "Our patients expect the same high quality care regardless of who is in charge. Doctors, nurses, and technicians will continue to focus on practicing medicine and improving their skills and readiness. In the end, this really is about the patient - integrating into one system will improve readiness for our medical professionals and result in better care and better health outcomes for our patients."

For more on the DoD's medical reorganization, go to the military health web site at www.health.mil/mhstransformation for fact sheets, an informational video, and more articles.

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We all know what dog tags are — those little oval disks on a chain that service members wear to identify themselves in combat. But have you ever wondered how and when that tradition started, and why they're called dog tags?

We did some research to find the answers.

Origins of the "Dog Tag" Nickname

According to the Army Historical Foundation, the term "dog tag" was first coined by newspaper magnate William Randolph Hearst. In 1936, Hearst wanted to undermine support for President Franklin D. Roosevelt's New Deal. He had heard the newly formed Social Security Administration was considering giving out nameplates for personal identification. According to the SSA, Hearst referred to them as "dog tags" similar to those used in the military.

Other rumored origins of the nickname include World War II draftees calling them dog tags because they claimed they were treated like dogs. Another rumor said it was because the tags looked similar to the metal tag on a dog's collar.

Regardless of where the nickname started, the concept of an identification tag originated long before that.

Civil War Concerns

Unofficially, identification tags came about during the Civil War because soldiers were afraid no one would be able to identify them if they died. They were terrified of being buried in unmarked graves, so they found various ways to prevent that. Some marked their clothing with stencils or pinned-on paper tags. Others used old coins or bits of round lead or copper. According to the Marine Corps, some men carved their names into chunks of wood strung around their necks.

Those who could afford it bought engraved metal tags from nongovernment sellers and sutlers — vendors who followed the armies during the war. Historical resources show that in 1862, a New Yorker named John Kennedy offered to make thousands of engraved disks for soldiers, but the War Department declined.

By the end of the Civil War, more than 40% of the Union Army’s dead were unidentified. To bring that into perspective, consider this: Of the more than 17,000 troops buried in Vicksburg National Cemetery, the largest Union cemetery in the U.S., nearly 13,000 of those graves are marked as unknown.

The outcome of the war showed that concerns about identification were valid, and the practice of making identification disks caught on.

Making It Official

The first official request to outfit service members with ID tags came in 1899 at the end of the Spanish-American war. Army Chaplain Charles C. Pierce — who was in charge of the Army Morgue and Office of Identification in the Philippines — recommended the Army outfit all soldiers with the circular disks to identify those who were severely injured or killed in action.

It took a few years, but in December 1906, the Army put out a general order requiring aluminum disc-shaped ID tags be worn by soldiers. The half-dollar size tags were stamped with a soldier's name, rank, company and regiment or corps, and they were attached to a cord or chain that went around the neck. The tags were worn under the field uniform.

The order was modified in July 1916, when a second disc was required to be suspended from the first by a short string or chain. The first tag was to remain with the body, while the second was for burial service record keeping. The tags were given to enlisted men, but officers had to buy them.

The Navy didn't require ID tags until May 1917. By then, all U.S. combat troops were required to wear them. Exact size specifications were put in place, and the tags also included each man's Army-issued serial number. Toward the end of World War I, American Expeditionary Forces in Europe added religious symbols to the tags — C for Catholic, H for Hebrew and P for Protestant — but those markings didn't remain after the war.

Slight Differences

During World War I, Navy tags were a bit different than Army's. Made of monel — a group of nickel alloys — they had the letters "U.S.N." etched on them using a specific process involving printer's ink, heat and nitric acid. If you were enlisted, the etching included your date of birth and enlistment, while officers' included their date of appointment. The biggest difference was the etched print of each sailor's right index finger on the back, which was meant to safeguard against fraud, an accident or misuse.

According to the Naval History and Heritage Command, the ID tags weren't used in between World War I and World War II. They were reinstated in May 1941, but by then, the etching process was replaced with mechanical stamping.

Meanwhile, the Marines had been required to wear ID tags since late 1916. Theirs were a mix of the Army and Navy styles.

World War II

By World War II, military ID tags were considered an official part of the uniform and had evolved into the uniform size and shape they are today — a rounded rectangle made of nickel-copper alloy.

Each was mechanically stamped with your name, rank, service number, blood type and religion, if desired. An emergency notification name and address were initially included on these, but they were removed by the end of the war. They also included a "T" for those who had a tetanus vaccination, but by the 1950s that, too, was eliminated.

During World War II, Navy tags no longer included the fingerprint. By the war's end, they also included the second chain that the Army had implemented decades before.

At this time, all military tags included a notch in one end. Historians say the notch was there due to the type of machine used to stamp the tags. By the 1970s, those machines were replaced, so the tags issued today are now smooth on both sides.

Dog Tags Today

Regulations have gone back and forth regarding whether the two tags should stay together or be separated. In 1959, procedure was changed to keep both dog tags with the service member if they died. But by Vietnam, it was changed back to the original regulation of taking one tag and leaving the other.

For Marines, a person's gas mask size was eventually included on the tags.

By 1969, the Army began to transition from serial numbers to Social Security numbers. That lasted about 45 years until 2015, when the Army began removing Social Security numbers from the tags and replacing them with each soldier's Defense Department identification number. The move safeguarded soldiers' personally identifiable information and helped protect against identity theft.

Considerable technological advances have come along since Vietnam, including the ability to use DNA to identify remains. But despite these advancements, dog tags are still issued to service members today. They're a reminder of America's efforts to honor all those who have served — especially those who made the ultimate sacrifice.

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For many years, researchers have looked for objective measures to help diagnose traumatic brain injury or post-traumatic stress disorders.

Information from the Defense and Veterans Brain Injury Center’s 15-year natural history study is assisting medical researchers in determining whether a protein found in a patient’s blood could be a promising candidate for future diagnostic tools.

A blow to the head is one of the ways a service member can sustain a TBI, and after witnessing psychologically disturbing events, they may also experience PTSD. Diagnosing these can be complex as they have similar symptoms that can be compounded when both are present.

Since 2000, more than 400,000 active-duty service members have been diagnosed with TBI, according to figures from DVBIC, the Department Department’s center of excellence for traumatic brain injury and a division of the Defense Health Agency Research and Development Directorate. However, a statistic revealing those co-presenting with PTSD has not been compiled.

In a 2018 research review on mild TBI (mTBI) and PTSD, the DVBIC noted that “differential diagnosis will likely continue to be a challenge.”

Jessica Gill, a researcher at the National Institutes of Health, and Dr. Kimbra Kenney, an associate professor of neurology at the Uniformed Services University of the Health Sciences, both located in Bethesda, Maryland, are currently examining patients’ blood to see whether it can help in diagnosing and treating TBI.

“By pairing advances in the laboratory, we are now able to detect very small proteins in the blood that provide key insights into pathology that contribute to long-term symptoms in military personnel and Veterans with TBIs, as well with PTSDs,” said Gill.

At a recent conference, Kenney explained how specific types of blood proteins were significantly elevated among those with concussions, compared to subjects who had been deployed but not sustained TBIs. Blood samples are being collected at Walter Reed National Military Medical Center as part of their research in a study of the natural history of TBI funded by the DoD and Department of Veterans Affairs.

In another project using data from the 15-year natural history study, researchers are examining blood proteins in subjects who had both sustained a TBI and reported PTSD symptoms. Earlier studies had shown that tau and amyloid-beta-42 proteins indicated the presence of TBI; now researchers believe the presence of both proteins could reveal individuals with both TBI and PTSD.

Study participants consisted of 107 service members. Evidence of TBI was obtained from medical records and interviews at Walter Reed Bethesda. Most participants were diagnosed with a mild traumatic brain injury while the remaining subjects experienced an injury unrelated to TBI but did not lose consciousness. Each participant provided a blood sample and completed a detailed questionnaire. Three groups were formed: those with both TBI and PTSD; those with some other injury and no PTSD; and those with TBI but no PTSD.

The researchers found “tau in plasma is significantly elevated in military personnel who have sustained an mTBI and display concurrent PTSD symptomology.” This finding agrees with earlier civilian studies. Following a TBI, tau elevations are associated with poor recoveries and greater neurological problems.

These studies may show relationships between neurological outcomes and changes at the molecular level. “The novel design of the 15-year study provides the first longitudinal data to untangle complex pathological processes that result in lasting neurological and psychological symptoms and impairments,” Gill said. “By better understanding these processes, we can personalize the care we provide to treat military personnel and Veterans to have the biggest impact on their health and well-being.”

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The COVID-19 pandemic has brought many changes to how we live daily life. Social distancing, quarantine, and isolation can overwhelm and cause feelings of insecurity, confusion, hopelessness, and, ultimately, depression.

The National Institute for Mental Health within the National Institutes of Health defines depression as a common but serious mood disorder that negatively affects how a person feels, thinks, and handles daily activities such as sleeping, eating, and working. People dealing with depression typically experience one or more of the following symptoms:

• Persistent sad or “empty” mood
• Feelings of hopelessness, or pessimism
• Irritability
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies and activities
• Decreased energy or fatigue
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, early-morning awakening, or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide, or suicide attempts
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease with treatment

We all have days when we feel down, but when the periods of sadness persist and are severe enough to impact daily functioning, it may be time to assess your emotional health by completing a self-assessment. A free, anonymous, and confidential mental health screening can be found at the Department of Veterans Affairs website. Screening results are educational, not diagnostic, but are provided so participants may find out quickly if a consultation with a mental health professional would be helpful.

Learning self-care strategies can help you take charge of your life and improve your mental and physical health. A few guiding principles can help all of us cope effectively during this time is to focus on what we can control.

• Keep routines as much as possible. Maintaining structure and routine is critical because it reinforces order and predictability, and is something over which we have control.
• Stay connected. Identify friends and family that you can check in with regularly. Video teleconferencing, phone calls, and other social media platforms can be a great way to connect family and friends.
• Take breaks from listening to the news. Constant news about COVID-19 from all types of media can heighten fears about the disease. If the news cycle impacts mood and increases stress levels, it may be time to limit exposure.
• Engage in self-care. Participate in regular physical activity to reduce stress and improve mood. Eat healthy, nutritious foods and drink plenty of water. Avoid tobacco, alcohol and drugs. Get at least seven hours of sleep each night.
• Protect personal and family health. Wash hands frequently and thoroughly, wear a mask in public, and practice social distancing from people outside the household.

What’s the difference between a few bad days or weeks and clinical depression that requires help? A consultation with a mental health professional is recommended when feelings or tendencies have lasted for more than two weeks. Don’t be afraid to reach out.

Getting support plays an essential role in coping with depression. Professional counseling services are available for all Department of Defense beneficiaries and their families.

Military members can contact their local mental health clinic for services. Military OneSource is another option for military and their families. For more information, call (800) 342-9647 or visit the Military Onesource website.

Civilian employees may contact the Employee Assistance Program for free, confidential counseling services at (866) 580-9078 or visit the EAP website.

Comprehensive information on mental health can be found at the National Institute of Mental Health website.

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With safety at the forefront, elective surgeries are set to resume at the end of August across the San Antonio Military Health System.

“We have a military population whose non-urgent procedures were delayed in some cases for safety purposes and in order to preserve resources and capacity,” said Army Brig. Gen. Shan Bagby, commanding general for the Brooke Army Medical Center aboard Joint Base San Antonio-Fort Sam Houston. “We are eager to resume these important medical services.”

SAMHS had resumed ambulatory elective surgeries at Wilford Hall Ambulatory Surgical Center earlier this month, already doubling the number of procedures performed in July. Meanwhile, BAMC has focused on providing urgent and emergent inpatient surgical care. Next week, BAMC will increase surgical capacity by 50% for more complex elective surgeries, said Air Force Col. Patrick Osborn, San Antonio Military Health System surgeon-in-chief.

Patients whose procedures were delayed will be contacted by their surgical team or clinic, and new cases will be scheduled based on patient acuity and available capacity, said Osborn, adding that evaluation of patients’ surgical needs has been ongoing, often through virtual technology.

“Elective procedures are an important aspect of a person’s overall health care and, while they may not be urgent in nature, they should not be put off indefinitely,” Osborn said. “After careful assessment, we are confident in our ability to resume these procedures safely.”

SAMHS will monitor the pandemic situation daily and expand or scale back procedures as needed, said Air Force Maj. Gen. John DeGoes, SAMHS market manager and commander, 59th Medical Wing.

“Our highest priority is safeguarding the health and wellness of our patients and staff,” DeGoes said. “We will continue CDC-recommended safety precautions to help prevent the spread of COVID-19 and protect our most valuable asset – our people.”

SAMHS had paused elective procedures July 1 due to the surge in COVID-19 and in line with Texas Governor Greg Abbott’s executive order. The intent was for hospitals to reserve capacity for COVID-19 patients from the community.

Despite a resumption of elective surgical services, everyone should continue to social distance, wear a face covering, and wash hands thoroughly and often, Osborn said.

“We all have a continuing role in stopping the spread of this virus,” he said.

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Certain transplant recipients, cancer patients and others can soon get a third dose of the Pfizer-BioNTech or Moderna vaccine

The United States Food and Drug Administration (FDA) authorized an additional Covid-19 vaccine dose to boost protection for certain immunocompromised people. The decision comes after mounting evidence that vaccinations may not trigger an adequate immune response in some groups of people. A panel of advisors from Centers for Disease Control and Prevention gave final authorization Friday, and vaccine distributors are now permitted to administer booster doses immediately, report Manas Mishra and Michael Erman for Reuters.

Those eligible for boosters include some organ transplant recipients, those with certain cancers, and others with similarly compromised immune systems, report Laurie McGinley and Lena H. Sun for the Washington Post. Both the Pfizer-BioNTech and Moderna vaccines have been given the green light to distribute booster shots. According to the CDC, either mRNA shot may be administered if an individual's original vaccine is not available. Per Reuters, proof of a medical condition will not be required to receive additional dosage.

"The country has entered yet another wave of the Covid-19 pandemic, and the FDA is especially cognizant that immunocompromised people are particularly at risk for severe disease," Acting FDA Commissioner Janet Woodcock wrote in a Tweet late Thursday evening. "After a thorough review of the available data, the FDA determined that this small, vulnerable group may benefit from a third dose of the Pfizer-BioNTech or Moderna vaccines.”

The mRNA-based Pfizer-BioNTech and Moderna vaccines work by showing our immune system what a viral invader looks like before it arrives. That way, our body is already trained to spot, neutralize and destroy the virus if we’re infected. For some people with compromised immune systems, two doses of the Pfizer-BioNTech or Moderna vaccination may not have triggered a robust enough anti-virus response to offer long-term protection, reports Jacqueline Howard for CNN.

“As we’ve been saying for weeks, emerging data show that certain people who are immunocompromised, such as people who have had organ transplant and some cancer patients, may not have had an adequate immune response to just two doses of the Covid vaccine,” said CDC director Rochelle Walensky during yesterday’s White House Press Briefing. “To be clear, this is a very small population. We estimate it to be less than 3 percent of adults.”

Organ donor recipients and other immunocompromised people are especially vulnerable to infections, hospitalization, and death from viruses like SARS-CoV-2. For those without compromised immune systems, there is no evidence yet that a booster dose is needed to provide added protection against the virus.

“Others who are fully vaccinated are adequately protected and do not need an additional dose of Covid-19 vaccine at this time,” said Woodcock in a Tweet.

The rampant spread of the Delta variant and rising breakthrough infections in healthy, fully vaccinated people—though extremely rare—has put pressure on wealthy nations to consider widespread booster shots. Meanwhile, many developing countries are struggling to access the first doses necessary to halt the virus’ spread and mutation, report Manas Mishra and Michael Erman for Reuters. In an effort to close the vaccine gap between high- and low-income countries, the World Health Organization has called for a moratorium on booster shots until at least the end of September.

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An online lender has agreed to pay more than $1 million to settle a lawsuit alleging violations of the Military Lending Act, including paying up to $300,000 in refunds to service members and family members covered by the law.

In a lawsuit filed Dec. 4 in federal court, the Consumer Financial Protection Bureau accused LendUp Loans, LLC, of Oakland, Calif., of charging in excess of 36 percent annual percentage rate to active duty members and dependents, as well as other violations of the Military Lending Act. The allegations involved more than 4,000 loans made to more than 1,200 borrowers since October, 2016, according to the lawsuit, filed in the U.S. District Court in the Northern District of California.

If approved by the court, the settlement filed Jan. 19 would require LendUp to refund interest, fees and other money to the borrowers, and prevent the company from future violations of the Military Lending Act. LendUp would also be required to correct or update information provided to consumer reporting agencies about these borrowers.

This action “is the first resolution in the Bureau’s broader sweep of investigations of multiple lenders that may be violating the MLA,” CFPB officials stated in their announcement of the settlement.

LendUp will also pay a $950,000 civil money penalty to the CFPB, under the provisions of the settlement.

The settlement acknowledges that LendUp has already refunded interest and fees to a number of the borrowers. LendUp neither admits nor denies the allegations made in the lawsuit.

LendUp officials said they reported the problems themselves to CFPB and fixed the problem three years ago.

The settlement addresses the final closure “of matters we proactively self-reported to the CFPB in 2017,” LendUp officials said in a statement to Military Times. “The issue was remedied by LendUp at that time. For impacted customers, LendUp refunded all interest and fees, whether or not mistakenly collected, and removed all improperly made [Military Lending Act] loans from credit reporting that had delinquency.”

LendUp stopped making loans that didn’t comply with the law in 2017, and they don’t offer loans to active duty service members, officials stated.

The proposed settlement calls for $300,000 to be paid to the affected customers, and the money already paid to these customers will be included in that $300,000. Information was not available from LendUp on how much money has already been paid to customers.

If the total amount of money provided to customers is less than $300,000, LendUp must give the difference to the CFPB. The CFPB will be allowed to use those remaining funds to pay additional restitution to the affected customers; or CFPB can deposit the remainder in the U.S. Treasury.

“We have worked intently and collaboratively to prioritize and bring full relief to our impacted customers and are pleased to have closured with the CFPB,” stated LendUp officials.

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Flu and COVID-19 can both lead to serious illness

Getting a flu vaccine this fall is more important than ever to protect yourself, your family, friends, and coworkers. We are facing a tough 2020 flu season as we prepare to battle the coronavirus at the same time.

Flu shots protect you against flu. By getting a flu shot, you will be less likely to spread flu to others. By keeping you healthy, our VA facilities won’t be overwhelmed with flu patients during the pandemic.

Flu and COVID-19

Flu and COVID-19 can lead to serious health complications resulting in hospitalization or death. The good news is both may be prevented by wearing a face covering, practicing physical distancing, washing your hands frequently and coughing into your elbow.

Everyone needs a flu shot

The Centers for Disease Control and Prevention (CDC) recommends that everyone six months or older should get a yearly flu shot. Flu can be serious among young children, older adults and those with chronic health conditions, such as asthma, heart disease or diabetes.

Every year, hundreds of thousands of Americans are hospitalized with the flu.

During the 2019-2020 flu season, more than 4,600 Veterans were hospitalized at VA medical centers. More than 600 of them required intensive care stays. VA providers also saw over 27,000 Veterans for flu and spoke to more than 13,000 during phone triage calls.

Flu season is near, so talk to your health provider about where to safely get a flu shot this fall.

Shots at retail pharmacies

If you are enrolled in VA health care, you can receive the seasonal flu vaccination at more than 60,000 locations through the Community Care Network in-network retail pharmacies and urgent care partners. VA will pay for standard-dose and high-dose flu shots. Even if you haven’t had a flu shot lately, make this the year that you do!

On Sept. 1, enrolled Veterans can visit https://www.va.gov/communitycare/flushot.asp to find locations to get a no-cost flu shot.

Help us help you: we are fighting flu and COVID-19 together.

Important Resources

• Influenza
• COVID-19
• Coronavirus Frequently Asked Questions
• CDC Similarities and Differences Between Flu and COVID-19

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Flu and COVID-19 can both lead to serious illness

Getting a flu vaccine this fall is more important than ever to protect yourself, your family, friends, and coworkers. We are facing a tough 2020 flu season as we prepare to battle the coronavirus at the same time.

Flu shots protect you against flu. By getting a flu shot, you will be less likely to spread flu to others. By keeping you healthy, our VA facilities won’t be overwhelmed with flu patients during the pandemic.

Flu and COVID-19

Flu and COVID-19 can lead to serious health complications resulting in hospitalization or death. The good news is both may be prevented by wearing a face covering, practicing physical distancing, washing your hands frequently and coughing into your elbow.

Everyone needs a flu shot

The Centers for Disease Control and Prevention (CDC) recommends that everyone six months or older should get a yearly flu shot. Flu can be serious among young children, older adults and those with chronic health conditions, such as asthma, heart disease or diabetes.

Every year, hundreds of thousands of Americans are hospitalized with the flu.

During the 2019-2020 flu season, more than 4,600 Veterans were hospitalized at VA medical centers. More than 600 of them required intensive care stays. VA providers also saw over 27,000 Veterans for flu and spoke to more than 13,000 during phone triage calls.

Flu season is near, so talk to your health provider about where to safely get a flu shot this fall.

Shots at retail pharmacies

If you are enrolled in VA health care, you can receive the seasonal flu vaccination at more than 60,000 locations through the Community Care Network in-network retail pharmacies and urgent care partners. VA will pay for standard-dose and high-dose flu shots. Even if you haven’t had a flu shot lately, make this the year that you do!

On Sept. 1, enrolled Veterans can visit https://www.va.gov/communitycare/flushot.asp to find locations to get a no-cost flu shot.

Help us help you: we are fighting flu and COVID-19 together.

Important Resources

• Influenza
• COVID-19
• Coronavirus Frequently Asked Questions
• CDC Similarities and Differences Between Flu and COVID-19

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DOVER AIR FORCE BASE, Del. – Air Force Lt. Col. Alice Briones, Armed Forces Medical Examiner System deputy director, has been named director of AFMES, effective February 21, 2020, making Briones the first female director.

Army Lt. Gen. Ronald Place, Defense Health Agency director, selected Briones after she served as deputy director of AFMES since April 2017.

“Dr. Briones brings a tremendous level of experience and capabilities to AFMES,” said Place, Defense Health Agency director. “She has done an outstanding job serving as the deputy director and I look forward to her continued leadership in the role as director. AFMES does so much to positively impact our nation.”

As director of AFMES, Briones leads an organization of approximately 300 military, civilian and contractor personnel who provide comprehensive services in forensic pathology, forensic toxicology, DNA technology and identification and mortality surveillance for the Department of Defense.

“It’s an honor to be selected as the new director of AFMES,” said Briones. “There’s no greater place to work, than beside the men and women of AFMES.”

Briones enlisted in the U.S. Army as a Combat Medic in 1990 and completed basic training at Fort Jackson, South Carolina. She attended the University of Maine, earning a Bachelor of Arts in Clinical Laboratory Medicine in 1994 and earned certification as a Medical Technologist. In 1995, she was commissioned in the United States Air Force as a biomedical sciences corps laboratory officer.

She has served in many roles throughout her career, such as assistant chief of lab operations and squadron section commander at Luke Air Force Base, Arizona, and chief of lab operations at Hanscom AFB, Massachusetts.

“It has been an arduous road with numerous sacrifices and challenges from both my family and myself to get to where I am today,” said Briones. “I hope to be an inspiration to all the women in the military, science and medical fields as well as working mothers.”

Briones received the Health Profession Scholarship Program from the Air Force and attended the Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, and graduated with a Doctor of Osteopathic Medicine in 2005. She then completed her residency in Clinical and Anatomic Pathology at the University of Rochester Strong Memorial Hospital, Rochester, New York, from 2005 to 2009 and completed a Forensic Pathology Fellowship with the Office of the Medical Examiner, Albuquerque, New Mexico from 2009 to 2010.

Briones joined AFMES as deputy medical examiner in Rockville, Maryland in 2010, and Dover AFB, Delaware, and was appointed director of the DoD DNA Registry in 2014, coordinating services in both the Armed Forces Repository of Specimen Storage for Identification of Remains and the Armed Forces DNA Identification Laboratory.

Briones succeeds directorship from Army Col. Louis Finelli, who had been the AFMES director since June 2016.

“I look forward to leading this great organization into the future and exceeding the standard in forensic sciences for our greatest stakeholders – the families,” said Briones.

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Five military families are suing the privatized housing landlords for Randolph Air Force Base for their “deplorable” housing conditions which they say led to medical and financial problems.

The four Air Force families and one Army family allege a litany of problems, including pervasive mold, rodent and insect infestations, seeping sewage and leaking pipes, to name a few. In one family’s case, there was a hole in the floor so large, they couldn’t regulate the house’s temperature, causing expensive electricity bills. Another family was unable to move their household goods last May because of mold contamination; their belongings are still in storage.

The ranks of the service members range from E6 to O6. They allege the living conditions caused a host of medical problems, ranging from headaches and gastrointestinal issues to various allergic reactions and serious lung problems, according to the lawsuit, which was filed Dec. 29 in federal court in San Antonio.

The defendants are Hunt Military Communities and its business entities at Randolph, AETC II Privatized Housing, LLC; and AETC II Property Managers, LLC. According to its website, Hunt is the largest owner of military housing in the U.S., owning about 52,000 homes spread across more than 40 military installations, including Navy, Air Force and Marine Corps bases.

“Hunt takes these matters extremely seriously and is focused on providing our residents with healthy and comfortable homes,” said officials from Hunt Military Communities, in a statement provided to Military Times. “As part of our ongoing commitment to providing the best housing and living experience for our residents, Hunt has introduced reforms to the [privatized housing] program and has been developing, reviewing and executing on initiatives to improve living conditions at our own facilities, including at Randolph Family Housing.”

This lawsuit joins a string of others involving dozens of military families who have sued various privatized housing companies alleging persistent problems with the condition of their houses, including medical and financial issues. Following media reports and congressional hearings that brought attention to mold and other widespread problems with military housing, laws were enacted in late 2019 and late 2020 to address the problems and force defense officials to provide better oversight of privatized housing landlords, and to be more responsive to families frustrated by lack of action.

Some of the families in this lawsuit were experiencing problems as these issues were being publicly raised, and as defense officials and privatized housing company officials were acknowledging the problems and vowing to fix them.

This lawsuit alleges that Hunt was aware of the condition of the houses before families moved in and misrepresented that they were safe to occupy; that they failed to repair the houses after families repeatedly requested it; and committed acts of “gross negligence” by concealing those “persistent and toxic conditions” from the families before they moved in and then refusing to remediate the conditions, according to the complaint.

The lawsuit also alleges the companies violated federal law by failing to provide service members with all available reports and records regarding the presence of lead or lead-based paint hazards. The lawsuit doesn’t specify the amount of damages requested by the families, but because of these violations related to disclosure of lead-based paint hazards, attorneys ask for damages equal to three times the amount incurred by each person.

The Hill family’s home was one of those with lead paint problems. The lawsuit alleges that during the three years they lived in their home, “lead paint chipped off the walls, the home was riddled with wood rot, inadequate ventilation and water damage throughout the home.”

Kari D. Hill, said she hopes the lawsuit will result in improvements in how military families are treated.

“We want to care for the people who come after us who live in these houses,” she said.

Jennifer Neal, an attorney with Watts Guerra LLP in San Antonio, said that’s a common theme among the families bringing the lawsuit. Neal said her firm is representing other military families in similar lawsuits against privatized housing companies, and there are instances where multiple families have subsequently lived in the same house and suffered the same problems.

Hill and her husband, retired Army Maj. James C. Hill Jr., and their three children, left their home after three years when he retired, in May, 2020. But their household goods didn’t come with them — they’re still in storage. Because of tests revealing mold contamination, “the Hill family was informed that they should not take their contaminated belongings with them,” the lawsuit states, so they were forced to put all of their belongings in storage.

Their problems included water damage, mold growth, structural deficiencies, lead paint, and rodent infestations.

Kari Hill suffered from headaches, gastrointestinal issues, fatigue, insomnia, tenderness, congestion, excessive eye secretions, anxiety and a dry cough; in 2018, while they were still living in the home, she was diagnosed with fibromyalgia. The Hills’ three children also had “significant health problems” while living in the home, according to the lawsuit.

The other four plaintiffs in the lawsuit are Air Force families who lived at Randolph AFB:

*Chief Master Sgt. Michael English, his wife Elldwinia and their seven children and one grandchild, moved out of their house on Jan. 1, 2019, after one year. They had issues of mold, asbestos, water damage, sewage intrusion, lead paint, structural and flooring problems, and rodent and bug infestations. A hole in the floor made it impossible to regulate the home’s temperature, resulting in high electricity bills, according to the lawsuit. The family was healthy before moving in to the home, but their health began to deteriorate shortly after moving in. Elldwinia English had allergy problems and difficulty breathing, resulting in frequent hospital visits.

*Reserve Capt. Sean Skillingstad, his wife Ressia and their two children left their home on June 12, 2020, after nearly three years living there while he was on active duty. Ressia’s pre-existing autoimmune and rheumatological issues were worsened by mold exposure; their son was diagnosed with asthma as a result of his exposure to mold, according to the lawsuit.

*Tech. Sgt. Rodolfo Castillo, his wife Latasha and their five young children and nephew moved out of their home Nov.17, 2017, after a year. They faced mold and lead paint contamination, and a cockroach infestation that was so bad they didn’t feel comfortable unpacking all their belongings, according to the lawsuit. Cockroaches infested their couches and destroyed their other belongings. There were structural issues that caused stairs to detach from the wall and the ground; leaky plumbing, and faulty heating. The family members were healthy before moving in to the home, but continue to suffer a variety of health issues such as breathing complications.

*Now-retired Col. Bradley Oliver, his wife Deborah, and their two children left their home on April 12, 2019 after nearly two years of issues such as mold, rodent infestation, poor ventilation, filthy ductwork and structural problems. Maintenance workers insisted the issue was mildew, not mold. The landlords didn’t address the excessive moisture in the home or the rodent infestation during the time they lived there, according to the lawsuit. Deborah Oliver developed a multitude of health problems while living in the house, and shortly after leaving the home was diagnosed with COPD and Mixed Connective Tissue Disease. No longer able to work because of her deteriorated health, she is being treated by a pulmonologist, rheumatologist, cardiologist, neurologist, psychiatrist and therapist, and requires multiple medications to prevent lung damage.

Defense and service officials and the privatized housing companies have taken steps to improve living conditions and improve communications with families, over the last two years, including implementing a tenant bill of rights that addresses some of the issues.

In the statement to Military Times, Hunt Military Communities officials said among the steps they’ve taken is to create The Humidity Project for Randolph Family Housing, to ensure that all housing units are assessed for excess moisture, and corrective actions are taken when necessary. It’s aimed specifically at reducing humidity levels inside 300 historic homes at Randolph, and has produced positive results in homes where the work has been completed, officials stated.

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Nonprofit organization is providing educational scholarships to spouses and children of America's fallen and disabled service members

During an appearance on Thursday morning on "Fox & Friends," the CEO of Folds of Honor explained in detail why "freedom isn't free" — and why Americans might think about helping out struggling military families across America during this holiday season by downloading a runaway musical hit.

A chunk of the profits from that song is going to two amazing organizations — and, through them, some very deserving Americans.

Country music star John Rich and Lt. Col. Dan Rooney, who heads up Folds of Honor, appeared on Thursday morning to discuss the holiday-focused effort that is taking place right now to help American military families.

The Folds of Honor mission is clear and straightforward.

Since 2007, the organization "has carried forth this singular, noble mission: to provide educational scholarships to spouses and children of America’s fallen and disabled service members," it explains on its website.

Folds of Honor adds, "Our motto says it best: Honor their sacrifice. Educate their legacy."

The hit song this Christmas season, "Santa's Gotta Dirty Job" — a combined effort between John Rich and Mike Rowe — has now been the number-one downloaded song for eleven straight days, said Rich on Thursday morning.

Proceeds are going to both Folds of Honor and Mike Rowe's charity, mikeroweWORKSfoundation.

"We will be there to stand with his spouse and five kids," Dan Rooney noted at the top of the segment, referring to Navy SEAL, Cmdr. Brian Bourgeois, 43, who sadly passed away this past Monday after a training accident on Saturday in Virginia Beach, Va.

"Their Christmas is never going to be the same … Folds of Honor is standing with Cmdr. Bourgeois's family" and others, he noted.

Folds of Honor, by the way, receives 50% of its donations in December to help care for military families. Everyone can take part in helping others at this time of year.

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FORT HOOD, Texas (KWTX) - For the first time in U.S. history, the first VFW post on a military installation will be named after the first black command sergeant major of the first cavalry division.

A.C. Cotton, served in the Army for 3 decades, doing multiple tours in Vietnam and around the world, all while being a trailblazer for the first cavalry division.

“It’s just such a great honor and I know that he would be so proud but still humble that he’s getting this recognition,” said Delores Holt, Cotton’s oldest daughter.

“Even though he was away, he was always there for us. For my mother, me and my sisters. Through letters and telephone calls. I have one memory of him telling me something while I was doing a school project. He’d say, always do your best as if your name will always be on it in everything you do.”

While he passed away in September of last year, Fort Hood and the VFW gave yellow roses to his family to commemorate his dedication in helping others.

His family adds that this new post should be perfect for active-duty soldiers who endure the same or more stress than Veterans deal with.

“In the dedication of the post, I think that he would want it to be a place where soldiers can find structure and togetherness,” said Brenda Cotton, his daughter.

“This is for soldiers and their families to be together.”

Structure, love and comradery that they hope will last for generations at VFW post 12209.

“He was dedicated to the Army,” Cotton said.

“He loved his family, but he was a very dedicated person who always wanted to teach his soldiers to strive for perfection.”

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Please take action today to join DAV in our support of H.R. 2968, the Military and Veteran Student Loan Relief Act.

The caregivers of our nation’s disabled Veterans have dedicated so much to care for their injured and ill loved ones, often sacrificing or delaying their own career and educational goals to do so. In many cases, when they do seek to advance their education, the high costs are overwhelming—especially for those who lost income in order to take on caregiving responsibilities.

H.R. 2968 would help ease the financial burden caregivers face in pursuing their educational goals by including service as a military or Veteran caregiver as a public service job, making them eligible for the Public Service Loan Forgiveness (PSLF) Program. This program forgives remaining direct loan balances after an individual has made 120 monthly payments while working for a qualifying employer.

This bill will not only help provide much-needed financial relief for caregivers, it will offer well-deserved recognition of the commitment and dedication they have shown caring for their loved one.

DAV Resolution No. 018 supports legislation to improve and provide comprehensive services for the caregivers of severely disabled Veterans. Please contact your Representatives to request they co-sponsor H.R. 2968 to provide the nation’s military and Veteran caregivers with the financial relief they have earned by fulfilling such a critical role.

TAKE ACTION

There are many myths about having a Department of Veterans Affairs' disability rating and serving in the military. The most common is that, if you have a VA disability rating, you can never serve in the military again. Or if you do serve in the military, you have to waive your disability rating or all of your VA disability compensation. None of these statements is completely true.

The truth is, in some cases, it is possible to serve in the military with a VA disability rating.

Because you can file a VA disability claim only after leaving active duty, this article is making the assumption that the military member has left active duty and is either transitioning into the Guard or Reserves or trying to return to active duty after a break in service.

Can You Serve in the Military with a Disability Rating?

The answer is maybe. Simply having a VA disability rating does not prevent someone from joining the military. However, the underlying medical condition may prevent someone from medically qualifying to serve again.

For example, you can receive a VA disability rating for knee surgery that you had while on active duty. If your knee has otherwise healed and you can perform your military duties, remain deployable and pass your PT test, then you may be eligible for continued military service.

However, other underlying medical conditions may prevent you from joining the military again. For example, it may be difficult to join again if your VA disability rating stems from a serious medical condition that prevents you from being able to perform your military duties, maintain deployability status or pass your PT test.

If you had a break in service before trying to go back into the military, you may need to process through MEPS again. If you have a VA disability rating or certain other medical conditions, you may need to apply for a medical waiver to join the military.

Can You Serve on Active Duty with a VA Disability Rating?

Provided you have been medically cleared to serve, simply having a VA disability rating isn't enough to prohibit you from serving on active duty.

However, federal law prohibits members from receiving military compensation and VA disability compensation for the same day of service.

So, while you won't have to waive your actual VA disability rating, you would need to suspend your VA disability compensation payments until after your active-duty service ends. After that, you can contact the VA to resume your payments.

What About Serving in the Guard or Reserves with a Disability Rating?

The same rules apply to members of the Reserve Component as they do for active duty. However, there is one big difference: You don't have to suspend your VA disability compensation payments unless you are serving in a full-time capacity.

When you receive VA disability compensation, you receive it on a monthly basis.

When you serve in the Reserve Component, you receive military pay only on the days you serve (typically one weekend a month, and two weeks a year). You actually perform four drill periods on your weekend drill and receive pay for four days of work. You will receive only one day of pay for the other days you serve in the Reserve Component (Active Training, TDY, PME, etc.).

The typical Guard or Reserve member receives military pay for only a handful of days per month. They are in an inactive status and are not receiving compensation for the remaining days of the month.

Remember the rule above: "Federal law prohibits members from receiving military compensation and VA disability compensation for the same day of service."

The law requires members of the Reserve Component to waive either their military compensation or VA disability compensation for days in which they received both forms of compensation. Thankfully, it's easy to decide which pay to waive.

Deciding Which Pay to Waive

Simply compare your monthly VA disability compensation payment to the base military pay for your paygrade and years of service. Waive the lesser of the two (Spoiler: This will almost always be your VA disability compensation).

Keep in mind you have to waive your pay only on the days on which you receive both forms of compensation. In other words, the pay you waive is prorated -- you don't have to waive the full month of either of these payments, only the prorated amount for the days on which you received both.

Both the VA and Defense Finance and Accounting Service (DFAS) prorate the payments based on a 30-day month. This means each day of VA compensation is worth 1/30 of your monthly VA disability rate. Likewise, each day of military service is worth 1/30 of your base military pay.

So if you serve the traditional one weekend a month, two weeks a year, you would receive military compensation for 63 days of service (48 weekend drills and 15 AT days).

The VA sends members a copy of VA Form 21-8951 at the end of the year documenting the number of days on which they received military compensation and VA disability compensation for the same period of service.

You use this form to elect to either waive your VA disability compensation or your military pay. This article explains VA Form 21-8951 in more detail.

If you waive your VA disability compensation, the VA will simply withhold future payments based on the number of days for which you received compensation in the previous year. If you were paid for 63 days of military service, the VA would withhold a little more than two months' worth of disability compensation from future payments. You can even request that the VA withhold only a portion of your future payments until the full amount is withheld.

If you choose to waive your military compensation, you would need to repay the military in full. This would mean writing a large check to DFAS.

In most cases, you will have earned more military compensation than you received in VA disability compensation, so it would make much more sense to waive your VA compensation.

In Summary

Yes, it may be possible to serve in the military with a VA disability rating, provided your underlying medical condition doesn't prevent you from meeting requirements. If you serve on active duty, in the full-time Guard/Reserves, or you have been activated, you may need to suspend your VA disability compensation payments to comply with federal law. Otherwise, members of the Reserve Component may need to waive either their military compensation or their disability compensation for the number of days on which they received both forms of compensation on the same day.

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The Pentagon has spent $15 million in the past five years to treat 1,892 transgender troops, including $11.5 million for psychotherapy and $3.1 million for surgeries, according to Defense Department data provided to Military.com

Of the 243 gender reassignment surgeries performed on military personnel since 2016, 50 took place between Jan. 1, 2016 and Dec. 31, 2017, and 193 occurred from Jan. 1, 2018 to Dec. 31, 2019 -- the two years after President Donald Trump announced via Twitter that he would bar transgender individuals from serving in the U.S. military.

According to the Defense Health Agency, the surgeries were performed in military health facilities and included removal of breasts or testicles, hysterectomies and labiaplasty -- creation of or reshaping the flesh around a vagina.

The total number of transgender persons serving in the armed forces across all three components -- active-duty, Reserve and National Guard -- is not known as not all likely have sought treatment.

But as of May, 1,892 military personnel have been diagnosed and treated for gender dysphoria, including 726 Army soldiers, 576 Navy sailors, 449 Air Force airmen and 141 Marines, according to DHA spokesman Peter Graves.

The Palm Center, a public policy think tank that focuses on LGBT issues, estimated in 2018 that 14,707 transgender troops serve in the U.S. armed forces, including nearly 9,000 on active duty and 5,727 in the reserves.

In 2016, then-Defense Secretary Ash Carter announced that transgender people already serving in the military would be allowed to serve openly and transgender individuals were allowed to enlist as of July 1, 2017.

Trump announced via tweet in July 2017 that planned to ban transgender people from serving in the U.S. military, saying he consulted with military leaders and military experts before deciding that DoD did not need to be "burdened with the tremendous medical costs and disruption that transgender in the military would entail."

A policy was released by then-Secretary of Defense James Mattis in 2018 that prohibited individuals diagnosed with gender dysphoria from serving, with exceptions. It also said that transgender persons who didn't have the gender dysphoria -- defined as extreme anxiety or distress that may accompany a person's desire to be the opposite gender -- could serve, but only in their birth gender.

A number of lawsuits were filed over the policy, which was upheld by the U.S. Supreme Court in January 2019.

President Joe Biden reversed the policy on his fifth day in office, Jan. 25, 2021.

According to DoD, the department spent $11,582,262.99 on psychotherapy for service members with gender dysphoria from Jan. 1, 2016 through May 14, 2021. Within DoD, 637 service members received hormone therapy during the same time frame, at a cost of $340,000, and 243 surgeries were performed at a cost of $3.1 million.

The Pentagon's annual medical budget for health care programs in 2016 was $33.5 billion; the proposed fiscal 2022 budget calls for $35.6 billion in discretionary spending for health care.

The services have been rolling out branch-specific guidance regarding the treatment of transgender troops. The Air Force released its guidance on April 30, while the Navy issued a message June 3 stipulating its policy barring discrimination against any service members.

"The Navy remains committed to treating all persons with dignity and respect," the message read. "No person, solely on the basis of gender identity, will be denied accession, involuntarily separated or discharged, denied reenlistment or continuation of service, or subjected to adverse action or mistreatment."

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If you receive VA disability pay, Social Security or SSI and you haven't received your third stimulus check, your wait is almost over. The IRS just announced that payments to those receiving VA disability could be made in mid-April, while most payments for people who receive other federal benefits and aren't required to file a tax return will be made Wednesday, April 7.

The April 7 payment date applies to those who get benefits from Social Security retirement and disability, Supplemental Security Income and the Railroad Retirement System. A payment date for those who get VA benefits hasn't yet been announced.

Why Are VA Disability and Social Security Recipients Still Waiting?

If you file a tax return and receive benefits, chances are good that you're among the 127 million Americans who have already gotten their $1,400 stimulus checks. But about 30 million recipients of Social Security and other benefits are still waiting on stimulus money.

That's because the IRS is processing stimulus payments using 2019 and 2020 tax returns. But just as with the first two rounds of payments, the IRS didn't require recipients of Social Security and other benefits to file a tax return if they weren't otherwise required to. Instead, the IRS got the information it needed from the appropriate agency.

This time around, the IRS was waiting on Social Security and other agencies to provide updated direct deposit information and addresses for recipients. On March 25, after the House Ways and Means Committee issued a 24-hour ultimatum, the Social Security Administration provided the updated information. The VA and Railroad Retirement System provided the information earlier last week.

For recipients of VA benefits, the IRS news release announcing payment dates says: "The IRS continues to review data received for Veterans Affairs (VA) benefit recipients and expects to determine a payment date and provide more details soon. Currently, the IRS estimates that Economic Impact Payments for VA beneficiaries who do not regularly file tax returns could be disbursed by mid-April."

Do I Have to Do Anything to Get My Check?

Probably not. If you received the first two checks, you're probably in line to get this one, too. The only thing you can do right now is wait.

One exception: If you have dependents, you may need to file a tax return, because the IRS may not get dependent information directly from Social Security or another agency. This time around, you'll get $1,400 for each dependent, regardless of their age. If you have dependent children, submitting a return could also help you get a child tax credit of $3,600 for children younger than 6 or $3,000 for children 17 and younger.

You may not receive money on behalf of your dependent with your check. If you don't get it with your check, the IRS will send you the extra money once it processes your return.

You can expect to receive your third stimulus check however you get your federal benefits, either through direct deposit or a Direct Express Debit Mastercard. If you've closed the bank account the IRS has on file, your bank will reject the deposit and you'll get your payment in the mail.

Can I Track My Stimulus Check Yet?

If you receive federal benefits and don't file a tax return, not yet. The IRS Get My Payment tool will be updated the weekend of April 3-4 for benefit recipients who are getting paid on April 7.

The information is updated once a day. Avoid multiple log-ins, as you may get locked out for 24 hours.

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The decisions that 1.6 million service members are making this year about whether to stay with the old or jump to the new military retirement system have just one thing in common: Each decision is extremely personal.

So, as the deadline of Dec. 31 approaches for eligible service members to make the choice to opt in to the new Blended Retirement System, Military Times looked at how two service members approached their decisions. One of our volunteer participants chose the BRS, and one chose the legacy system. They both have about nine years of service. One is a Navy E-5, the other is an Air Force O-3.

If you’re in that group of people eligible to choose between the legacy system and the new BRS but haven’t made your decision yet, the thought processes of these two volunteers might help you start your research.

Those eligible to choose between the two retirement systems are active-duty troops with fewer than 12 years of service and reserve component members with fewer than 4,320 retirement points as of December 2017.

All troops entering the military now are automatically enrolled into the new BRS. Those with more than 12 years of service as of the end of 2017 automatically stay with the legacy system.

The BRS is a blend of the legacy retirement system and some new features. It still provides monthly retired pay after at least 20 years of service, but the pay is 20 percent less than under the current system.

Under the legacy system, if you leave before 20 years, you get nothing. Under BRS, you can receive matching contributions from DoD of up to 5 percent of your pay into your Thrift Savings Plan, and you can take that with you whether you leave after a few years or 20 years.

BRS also offers a one-time payout known as continuation pay at 12 years, with a commitment to serve an additional four years. And retirees can under BRS can opt for a partial lump-sum payout at retirement.

Both of our volunteers carefully considered all the pros and cons of both systems, but their own circumstances, career plans and perceptions led them to different decisions.

We put our volunteers in touch with professional financial planners to discuss their current finances, the retirement decisions they’ve made, their goals, and whether there are any tweaks to their finances that could shore up that financial bridge to their retirement goals.

One notable thing these service members have in common: They’ve made great strides in paying off debt. That alone puts them in a better position for their goals.

Air Force Capt. Brad Byington and his former wife paid off $105,000 in consumer debt.

Navy Hospital Corpsman 2nd Class Ronald Rhea and his wife have paid off $45,000 in debt in the last year, since she started working after finishing school. They’re still working on their debt, but they’ve made great progress.

Rhea did his research early and jumped into the new BRS on Jan. 1, as soon as the enrollment window opened. He increased his contributions to his Thrift Savings Plan to 5 percent of his basic pay in order to get that full match from the Defense Department.

He didn’t realize that less than 20 percent of service members serve long enough to earn full retirement benefits. While he hopes his prospects are good, he said, he knows there’s no guarantee that he’ll serve to retirement.

For him, the 20-percent reduction in retirement pay if he does reach full retirement eligibility is worth the tradeoff because of the uncertainty.

Byington, who is single and 31, is putting away 15 percent in his Thrift Savings Plan account. Although he doesn’t get any DoD matching contribution by staying in the legacy system, he’s still on track to building his nest egg in addition to the legacy retirement benefits.

He believes his prospects are good for retiring from the Air Force, which is a key part of his decision. After crunching the numbers, with his continued 15 percent contributions and the assumption he retires after at least 20 years, he said, the matched BRS contributions of 5 percent still never accumulate enough to make up for what he would receive under the legacy system.

“There’s just absolutely no way for the new retirement system to pay out as much as the old,” he said.

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Ah, super glue — the greatest-of-all-time fast-acting adhesive for all of your stuck-together needs.

Chances are, you have a tube of this in that kitchen drawer, you know, the one with all the takeout menus, rubber bands and random keys to who knows what doors (you should probably clean that out by the way), because it’s an undeniable necessity.

But before it occupied space in our junk drawers, and our hearts, it was accidentally developed for the U.S. military.

Too sticky for Army weapons

In 1942, companies across the country were looking to support the war effort, including the Eastman Kodak Company. One if its inventors, Dr. Harry Wesley Coover, accidentally created a new compound while attempting to make clear plastic gun sights for Allied soldiers.

The compound, cyanoacrylate, was incredibly durable but way too sticky to use. (Imagine getting Krazy Glue anywhere near your eye. No thanks!) So Coover and his team abandoned the substance, not wanting to get stuck, literally or figuratively, on it.

Over a decade later, Coover, who would become known as “Mr. Super Glue,” rediscovered the adhesive compound while researching heat-resistant polymers for jet canopies. Cyanoacrylate adhesives required no heat or pressure to stick items together and hold them permanently. Thus, in 1956, the patent for “Alcohol-Catalyzed Cyanoacrylate Adhesive Compositions/Superglue” was born. How’s that for a name?

Coover and the Eastman team took the patent and repackaged it for commercial sale as “Eastman 910″ – which was later changed to “Super Glue.” This name stuck and still is used for a number of similarly adhesive products today.

A savior for soldiers in sticky situations

Even though the glue was discovered during World War II, military doctors during the Vietnam War capitalized on the product’s adhesive properties to save lives.

Many soldiers suffered injuries off-base, often bleeding out before getting proper care. Thanks to Coover’s invention, medics were able to spray super glue directly on skin to stop bleeding until the patient could make it to a hospital for treatment.

“This was very powerful. That’s something I’m very proud of – the number of lives that were saved,” Coover said in an interview with the Kingsport Times-News.

At this time, the chemical was not yet approved by the Food and Drug Administration because it had the potential to cause skin irritation. A derivative from the same chemical (2-octyl-cyanoacrylate) was approved in 1998 and functioned as a liquid bandage. Marketed under the names Dermabond and Traumaseal, these products pose less danger of irritation and bacterial infection and are available for civilian use.

So the next time you break your mom’s favorite vase and need to glue it back together, give thanks to Mr. Super Glue for finding something that was too sticky for the Army to use.

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The Warfighter bills are essential to provide needed medical coverage and compensation for victims of military toxic exposure. For far too long our veterans have suffered and died while awaiting medical care because of the bureaucratic intransigence of the VA. We need a comprehensive toxic exposure plan, and these bills are a good first step. Please ask your Member of Congress and Senators to co-sponsor these bills.

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Two boys in Batesville, Indiana, stopped in their tracks when a funeral procession for a military Veteran passed by last week.

The procession was for 89-year-old Charles Everett Yorn, Jacqi Hornbach, who witnessed the boys paying their respects, told Fox News.

For the two boys, Yorn's funeral took precedent over their bike ride.

"To see these two young boys immediately stop and pay their respects to a passed serviceman, without any prompting or knowledge of anyone watching, was just so touching to see," Hornbach said.

According to Hornbach, who posted about the moment on Facebook, the boys "immediately jumped off" their bikes and "waited patiently for a few minutes."

As taps began to play, "they both stood with arms behind their backs, silently, the entire time," Honrbach said.

"It was as if they didn’t even have to discuss it before doing it," she added. "They knew that’s just what you do when you come across this. It was so natural for them."

Hornbach said she too felt inclined to stand up after seeing the boys stop and look on.

"They did the gun salute and the boys jumped back in their bikes and went on their way," she said.

Hornbach had initially debated on whether to post about the moment online, but eventually decided that with "all the negative things going on" it was needed.

Hornbach said the Batesville community is "very patriotic" to begin with. Moments like this made her realize that "there is so much good left in this world."

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With the new coronavirus outbreak on the mind, it’s a good time to make sure you’re well-stocked with emergency supplies.

No one really knows how all this will play out. But in the worst case scenario, if you were stuck in your house for a 14-day quarantine, or if you felt you needed to stay away from others for a few days, would you have enough supplies? Consider whether you’d have the supplies you need if you tested positive for coronavirus and had to stay home until you were clear, or if someone in your household tested positive and you needed to care for that person.

Military commissary and exchange officials advise those in the military community to be ready for any emergency all year long, wherever you live. As of this writing, some military stores have been seeing shortages of items like masks and hand sanitizers, but they were working to replenish the shelves. There’s a shortage nationwide.

Do some research about what is actually effective in preventing sickness. For example, the Centers for Disease Control and Prevention doesn’t recommend face masks for those who are well; they should be used by people who show symptoms of coronavirus to help prevent the spread of the disease to others. And CDC recommends washing your hands often with soap and water for at least 20 seconds, especially after going to the bathroom, before eating, and after blowing your nose, coughing, or sneezing. If soap and water aren’t available at the moment, use an alcohol-based hand sanitizer that’s at least 60-percent alcohol. That’s a good practice year round.

Early data suggests that older people, and those with underlying chronic medical conditions might be at risk for more serious complications from the virus.

So consider the list of emergency supplies, and think about your family’s needs. For example, if you have a family member with special needs, make sure you have plenty of the supplies they need.

Find out now how your local installation officials and local government officials will keep people informed about precautions and restrictions, closings and other actions. Check with your children’s school, child care center, family child care home, about how they will handle a possible outbreak, and create a contingency plan in the event of closings.

Here are some tips for emergency supplies that could apply particularly to a 14-day quarantine, from the American Red Cross and the Defense Commissary Agency:

*A minimum 30-day supply of your prescription medications.

*Other non-prescription health supplies that your family uses, such as pain relievers; cough and cold medicines; , fluids with electrolytes, like Gatorade.

*Thermometer.

*Hand soap, and soap for bathing.

*Household supplies like bleach, household cleaners and wipes, laundry detergents. Check out this list of products from the Center of Biocide Chemistries of more than 100 ready-to-use biocidal products that have been approved by the Environmental Protection Agency as effective at killing viruses like coronavirus: https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf.

*Paper products like tissues, toilet paper, paper towels.

*Diapers, formula and other items for young children.

*Feminine supplies.

* Food staples, such as dried, canned or frozen fruit and vegetables, because fresh fruits and veggies may not last for 14 days. Consider adding some frozen and/or canned meats to your supply.

*Any specialty foods needed.

*Extra cash.

*Plenty of books, toys and games to keep young children happy.

*Pet food and pet care supplies.

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None of my duties and experiences as second lady of the United States has been as fulfilling as the opportunity to work with those who have served and sacrificed for this country: America’s military service members, spouses, Veterans, and their families. As a proud Blue Star mom of a U.S. Marine, I have a deeper understanding of the daily sacrifices. Without a doubt, our Armed Forces deserve our respect and care.

In 2016, President Trump and my husband, Vice President Mike Pence, placed Veterans at the very center of their campaign, promising to do right by the men and women who put their lives on the line for this country, many of whom served in the decade and a half following Sept. 11, 2001. Veterans rewarded that commitment with their support, voting Republican by a ratio of nearly two to one in the 2016 presidential election and remaining steadfastly behind this administration ever since.

The president and the vice president have ceaselessly endeavored to honor this country’s promises to military service members and their families. First and foremost, this administration has fulfilled its pledge to remold American foreign policy and stop the open-ended overseas deployments that put Americans in harm’s way and separate them from their families for years on end.

While the realities of our unstable world and the continued existence of groups that would do us harm necessitate a continued American military presence in certain parts of the world, the past three years mark the first time in a generation that we’ve gone so long without new, large-scale combat deployments. That hasn’t stopped us from achieving extraordinary successes, including the eradication of the Islamic State's “caliphate” of medieval brutality and the elimination of Abu Bakr al-Baghdadi, the terrorist monster who once reigned as its despot.

Still, the sacrifices made during the years of war in Afghanistan, Iraq, and countless other deployments in the War on Terror — not to mention earlier conflicts — are still fresh in the minds of thousands of military families who must live with the physical and psychological consequences of those conflicts.

Over the course of this administration, I’ve had the honor to try to help alleviate those deep scars. I’ve worked to bring awareness and access to creative arts therapies for those with service-related traumatic brain injury and post-traumatic stress disorder. It’s been one of the most rewarding experiences of my life to hear wounded warriors tell me of the relief that treatment has brought them.

Americans consider it a sacred duty to reward Veterans for their service and ease the suffering many of them endure as a result. During the previous administration, our Department of Veterans Affairs (VA) sometimes fell woefully short of upholding that duty. Our president and vice president promised to rectify the shortcomings, and they have kept that promise.

The president recently signed into law the National Defense Authorization Act — the largest-ever investment in the United States military. Before President Trump and Vice President Pence took office, the military experienced destructive budget cuts on a regular basis. As candidates, they promised to reverse this devastating trend, and I’m proud to say they have delivered.

In the last fiscal year, the president secured the largest budget for the VA in history: $86.5 billion. But money alone was not enough. The president also signed the VA MISSION Act, a bill to dramatically improve healthcare quality and choice for Veterans, and the “Department of Veterans Affairs Expiring Authorities Act of 2019,” which extends key programs for Veterans such as anti-homelessness initiatives.

He has also implemented major reforms of VA management, signing a bill to create a new Office of Accountability and Whistleblower Protection at the VA in order to make it easier to fire bureaucrats who are not delivering for Veterans and replace them with competent employees who will give our Veterans the quality of service they deserve.

We all have a duty to the families of those who serve: men and women who make sacrifices of their own to support their spouses, parents, and children in uniform. That’s why I’ve been so proud to lead an awareness campaign to elevate and encourage our military spouses. I’ve met hundreds of spouses who live throughout the United States and other parts of the world in helping to address military spouse unemployment, one of their biggest challenges.

As part of the effort to encourage more business to hire and retain Veterans' spouses, I’ve had the honor of celebrating the new Military Spouse Economic Empowerment Zones (MSEEZ) around the country to help ensure those military family members are able to enjoy their fair share of the jobs and prosperity created by the strong and growing Trump economy.

As we move into the thick of the 2020 presidential campaign, the Veterans for Trump coalition will be an indispensable element of the movement to secure another four years of progress for Veterans and military families. My hope is that Veterans will look at the promises kept so far and decide to entrust this administration with another four years to continue this important work.

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Veterans exposed to toxic substances during their military service could qualify for additional care and benefits from the Department of Veterans Affairs under landmark legislation reintroduced in Congress this week.

The Toxic Exposure in the American Military (TEAM) Act creates sweeping mandates for VA to further research, track and care for eligible Veterans who fall ill because of exposure to toxic substances during service -- perhaps the most comprehensive legislation on military toxic exposures ever introduced in Congress.

The TEAM Act was introduced by Sen. Thom Tillis, R-N.C., who represents one of the largest populations of troops and Veterans in the country, including the largest Army base in the world, Fort Bragg. Sen. Maggie Hassan, D-N.H., who represents Pease Air Force Base where troops and their families have been exposed to high levels of "forever chemicals" including PFAS, cosponsored the bill at its introduction.

Last year, the bill passed out of the Senate Veterans Affairs Committee, a key endorsement, but did not receive a vote on the Senate floor before the end of the year, meaning it had to be reintroduced in 2021. Tillis said in a press conference on Tuesday he believed the reason the bill didn't pass last year was because of its late introduction, and now he and Hassan are working to partner with House members on a companion bill, and that additional amendments and provisions are on the table.

"We're trying to put a framework in place that lets us end mistakes we made dating back to Agent Orange," Tillis said. "When a Veteran is experiencing an illness, they've got so many other distractions on their mind, we should not make it difficult for them to get the care they deserve."

The bill aims to allow VA to potentially expand benefits and health care to thousands of Veterans by allowing VA to more efficiently add presumptive conditions for troops exposed to toxic substances, such as herbicides and burn pits, and provide consultations, testing and treatment, among other major mandates. Toxic exposures have increasingly gained attention as Veterans and troops sicken with rare cancers, respiratory and fertility issues, especially those who served in Afghanistan and Iraq.

"Burn pits are the issue on top of mind, but we really want to get to a point where it's on the independent commission (established under the bill) and a relationship with the National Academies to very quickly have a science-based approach to providing presumptions for Veterans," Tillis said Tuesday. "We're providing a presumption framework that favors the Veteran."

Millions of Veterans have been exposed to toxic hazards just since 2001, along with generations of troops who came before. But after nearly two decades of war, the Department of Veterans Affairs still denies the majority of claims for burn pits, one of the most common exposures troops experience.

As of March 10, 233,406 Veterans and service members have added themselves to the VA Airborne Hazards and Open Burn Pit Registry, open to those who have served since 1990. VA has previously estimated as many as 3.5 million Veterans and troops have been affected by burn pits alone.

Surveys from Veteran service organizations including Iraq and Afghanistan Veterans of America and Wounded Warrior Project show a majority of respondents report toxic exposures of some kind, and most said they were not receiving care for those exposures at VA. Veteran service organizations have made multiple presentations to Congress in recent years arguing that toxic exposures should be a top legislative priority. Veterans have testified before lawmakers again and again about the rare cancers and other severe, and often fatal, conditions they believe have been caused by toxic exposures they suffered, or lost friends to.

But progress remains slow, despite lawmakers continually saying they don't want to repeat the mistakes of Agent Orange exposures, forcing Veterans to wait decades for care and benefits. Meanwhile, VA continues to deny thousands of claims.

"We don't want to repeat the mistakes of Agent Orange," Tillis said again Tuesday. "If we don't get it right (burn pits) could be our next Agent Orange."

VA has received 15,513 claims from Veterans of conditions specifically related to burn pits. The most common issues claimed are respiratory conditions. VA has denied 11,964 burn pit-related claims, or about 77%, approving 3,549, or about 29%, according to data provided to Connecting Vets.

"Unfortunately toxic exposure has become synonymous with military service,” said Kristina Keenan of the Veterans of Foreign Wars.

Establishing a firm link between toxic exposures and the illnesses they cause has proved difficult over the years, as Pentagon records of exposures are notoriously incomplete or nonexistent -- including the locations of burn pits and other hazards -- leaving Veterans waiting as they grow more ill or die. Both VA and the Defense Department -- the two largest federal agencies -- place the burden on Veterans and their families to prove they were exposed, when and where with documents that often don't exist.

"We often place a huge onus on our Veterans and service members, especially those who have been exposed to toxic environments," Hassan said Tuesday. "We have to make sure we're addressing the health challenges that occurred as a result of their service."

"We need to start thinking, even before they reach Veteran status, about... potential exposures that we should be mindful of," Tillis said.

The TEAM Act is the culmination of years of effort from the TEAM Coalition of more than 30 Veteran service organizations, along with researchers, advocates and others working to codify care for Veterans afflicted by their toxic exposures.

"The TEAM Coalition has been working hard to ensure that toxic exposures are not something we're going to be fighting to address a generation from now," said Aleksander Morosky, Wounded Warrior Project government affairs specialist.

Veterans eligible for consultations, testing and treatment under the bill would include those who received hazardous duty pay for more than one day, or who have been identified by the Pentagon as possibly exposed inside or outside the U.S. to burn pits or other toxic substances or visited a location where service members were potentially exposed.

The authority to decide which illnesses qualify as service-connected resides with the Department of Veterans Affairs secretary.

The bill would:

• Require VA provide consultation, testing and treatment for eligible Veterans who received hazardous duty pay, or were exposed to toxic substances with no copays;
• Permanently reauthorize VA's authority to establish presumptive service connection for diseases associated with herbicide exposure;
• Allow the VA Secretary to establish additional presumptives for illnesses linked to certain toxic substances;
• Establish a Toxic Exposure Review Commission to authorize further research on exposures;
• Formalize an agreement with the National Academies of Sciences, Engineering and Medicine to report on scientific evidence for illnesses linked to exposures;
• Require analysis of Veterans exposed to toxic substances to help identify those most at risk and provide regular reports to Congress;
• Require VA create a list of resources to be published for Veterans exposed to toxicants, and an outreach program for those Veterans, their caregivers and survivors;
• Incorporate toxic exposure questionnaires during primary care appointments;
• Create a portal for Veterans to access their Individual Longitudinal Exposure Record;
• Require VA establish training for its staff on illnesses linked to toxic exposure.

The bill gives authority to VA leadership to determine illnesses that qualify for service-connected benefits, as has been the case in the past. But to avoid delays Agent Orange-exposed Veterans and others have faced as VA weighs whether to expand benefits, the bill requires VA to make a decision within 60 days of a National Academies of Sciences report linking illnesses to exposures.

—For information on how to add yourself to VA's burn pit and airborne hazard registry, click here.

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Local leaders say connecting Veterans with local Veteran groups can help fight this devastating trend

LUBBOCK, Texas (KCBD) - Lubbock leaders are encouraging Veterans to get involved in local groups as they try to fight a recent increase in the number of military suicides.

In 2020, there were 580 military suicides, compared to 504 the year before.

“When you peel it back, you realize that these guys and gals never sought treatment. They never went to go visit the place that we have fought for, which is the VA. We fought for years to make sure that we had a VA, not just locally but nationally there is a VA. And that VA, we need to take advantage of it because it offers us the resources that we need to make ourselves better,” says Benny Guerrero, retired marine and commander at the Lubbock VFW.

Guerrero says Veterans struggling with mental health issues can find community and understanding at local Veteran groups.

Congressman Jodey Arrington is also encouraging Veterans to reach out and take advantage of the extensive Veteran community in Lubbock.

“We have a great Veteran community here, with numerous leaders in those communities. Veteran service organizations, like the American Legion and others, and then we have this jewel of a Veterans super clinic.”

The new Lubbock VA clinic has a wide range of mental health resources.

Staff there say, based on annual reports, just being engaged with VA services greatly reduces the risk of suicide.

Just reaching out, Guerrero says, is the first step.

“When we deployed, we deployed as a unit. When you get better, you get better as a unit. So we get together with people who have already walked those shoes and build you back up and get you back well, and then eventually, you become the leader of a group that is helping someone else.”

If you, or a Veteran you know is struggling with mental health, speak with someone at the Lubbock VA clinic. There is also a Veterans crisis line available 24/7 at 1-800-273-8255 (and select 1).

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As the Department of the Air Force's chief of chaplains, Maj. Gen. Steve Schaick has seen firsthand the power of social media to forge connections during the COVID-19 pandemic. For example, airmen have signed onto Facebook Live events in increasingly higher numbers, said Schaick, who's also a chaplain. Participation has been so strong that the Air Force likely will continue to incorporate aspects of social media into religious outreach efforts even after physical distancing restrictions are lifted.

But sometimes, Schaick said, nothing beats IRL – in real life.

"I think social media is kind of like having plastic plants in the house," he said. "From a distance, they look good. And of course, they don't need to be watered so there's nothing to maintain."

But the rewards of caring for live plants are exponentially more satisfying, Schaick said. "Social media creates an illusion that we're having the meaningful connections our souls long for. And during this pandemic, even introverts have discovered their inherent need for actual social interactions, and the emptiness that comes with social media alone."

"People who used to think they were fine with just, you know, a good book and a comfortable chair are now saying, 'There's something missing in my life.' Humans are wired as social creatures. It's a piece of our DNA."

As the pandemic stretches into eight months and counting, more and more people are turning to social media as a substitute for risky in-person interactions. Facebook and other social media platforms have reported record use, compared to a year ago.

But is that always a good thing?

Social media "allows us to maintain connections with [far-flung] family members, and to reengage with people we may have lost touch with," said Nancy Skopp, Ph.D., a research psychologist with the Defense Health Agency's Psychological Health Center of Excellence.

"Social media also may serve as a creative outlet, as a means of self-expression," she said. "It can impart a sense of belonging for some and promote offline interactions."

But Skopp also recognizes the potential harmful effects. She was lead author of a 2018 study of Facebook use among 166 active-duty U.S. service members deployed to Afghanistan. For all of social media's benefits, "It makes it easier for people to make social status comparisons," she said. "This could be a risk factor for anxiety and depression among vulnerable people."

Social media engagements also may lead to aggression and exposure to bullying, she said, noting a study that found almost 25% of Facebook users felt regret about something they posed online. Skopp also points to another study of social media that was conducted before the pandemic. It found that over the course of 10 days, greater everyday use of social media resulted in lower feelings of overall well-being.

"I don't think anyone can make a blanket statement that social media is good, or social media is bad," Skopp said. "It's all about how you use it," even in times when in-person interactions are considered too risky, health-wise.

So participating in an interactive event is more beneficial, she said, than "just sitting around and scrolling through social media posts. That can be a little demoralizing and contribute to negative feelings and moods."

Skopp also says there are benefits to using social media to remain active and engaged in hobbies or topics you really care about – or have always wanted to explore. "This can help increase feelings about positivity for the future," she said.

Researchers can't say for certain how much time engaged in social media is too much. But it's important to spend quality time off line. For example, "there's a very large body of literature attesting that a regular exercise regimen is extremely helpful for mood regulation and just overall long-term mental and physical health," Skopp said.

Schaick said he rides his bicycle regularly and also goes for runs and walks. "Exercise is important for me," he said. "But so is this idea of taking control of myself – there are a lot of things I can do even in this restricted environment." He and his wife have created a social bubble with another couple and "carefully and responsibly" spend time together on the weekends.

"I think it's going to be years before we fully understand the psychological and emotional impact of COVID-19," Schaick said. "But even though the news seems bad and discouraging, I'm absolutely certain that we're going to get through this. And we will emerge as better, more resilient people."

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The Department of Defense delivered a report to Congress on Feb. 19, 2020 that provides the DoD's plan to restructure 50 military hospitals and clinics. The report, titled "Restructuring and Realignment of Military Medical Treatment Facilities," was required by law under Section 703(d) of the National Defense Authorization Act of 2017, which directed the DoD to analyze its hospital and clinic footprint and submit a plan to Congressional defense committees.

The Honorable Tom McCaffery, DoD's assistant secretary of defense for health affairs, discussed these changes with members of the media. Below is his complete opening statement, with a link to the transcript of the question and answer session.

McCaffery emphasized DoD's priority is to focus on wartime readiness while ensuring continued beneficiary access to quality health care.

"The idea of the Military Health System needing to focus our MTFs on their core mission of military readiness is not a new one," McCaffery says in his opening statement. "It has been the subject of outside analysis, internal health system reviews, examination by senior civilian and uniformed leaders, and very importantly, by the Congress. We are fortunate to have robust civilian provider networks in many locations that offer timely access to quality health care. And so we have an obligation to deliver access to care for our patients, but also to focus precious military resources on activities with the highest readiness value."

The complete opening statement:

Thanks for all of you joining us this morning. I think as many or all of you know, the Military Health System is in the midst of implementing several significant reforms aimed to building a more integrated and effective system of readiness and health. The National Defense Authorization Act of FY 2017, directed the Department to assess our hospitals and clinics, and to make recommendations for restructuring those facilities to ensure they are focused on military and force readiness. We reviewed all facilities through the lens of their contributions to military readiness. That includes making sure MTFs are operated to ensure service members are medically ready to train and deploy. It also means MTFs are effectively utilized as platforms that enable our military medical personnel to acquire and maintain the clinical skills and experience that prepares them for deployment and support of combat operations around the world.

Today, we submitted the required report to Congress that outlines the results of our analysis, including plans for changes in a scope of operations at 50 facilities across the U.S. This report details the department's readiness focus for medical facilities, while maintaining our commitment to provide all beneficiaries with access to quality health care. I will describe some of the changes in a moment, but first I'd like to reaffirm that the Military Health System remains committed to ensuring access to quality health care for every beneficiary we serve. Additionally, nothing is changing immediately, and we intend to mobilize every resource available to help our beneficiaries and our staff navigate these changes. Our analysis demonstrates we need to adjust operations at 50 hospitals and clinics. The majority of the changes will be to outpatient clinics that currently are open to all beneficiaries, that we will modify to clinics for active duty service members only. These are the most significant changes for facilities and affect the largest number of our beneficiaries. Roughly 200,000 beneficiaries, currently empaneled for primary care at these MTFs will move over time into our TRICARE civilian provider networks.

Many are asking when these changes will be implemented. And, the short answer is, not right away. And that's because of how we intend to implement the changes. Before we transition any beneficiary from one of our hospitals or clinics, we will connect them with health care providers in our TRICARE network. And as you might expect, that process will take time. In fact, in several locations, with several MTFs, it could take several years for implementation.

The bottom line for our beneficiaries is that we will help guide them through every step of the enrollment change process when the time for action arrives. We will implement changes in a deliberate fashion at a pace local healthcare markets can handle.

Where are we making the changes? Later this morning, health.mil will publish a copy of the report that will include lists naming the changing facilities. I want to note a couple of important points about the report in this list. Our initial analysis indicated that of the 200 hundred-plus U.S.-based MTFs, 77 warranted a detailed assessment. That detailed assessment concluded that for 21 of these MTFs, their current scope of services should remain unchanged. That is for a variety of reasons, but most commonly, it is because our review indicated that the local civilian health care market did not, and likely could not, offer our beneficiaries appropriate access to health care. Thus, we are leaving these facilities open to all beneficiaries because of our commitment to military and Veteran family access to quality health care. Second, you will notice several facilities listed as already in the process of changes. In some cases, locations have already completed a restructuring, not as a result of NDAA 2017 requirements, but because of previous decisions by the military departments. The Department’s analysis of these MTF’s readiness needs support those decisions.

Let me close by saying that the idea of the Military Health System needing to focus our MTFs on their core mission of military readiness is not a new one. It has been the subject of outside analysis, internal health system reviews, examination by senior civilian and uniformed leaders, and very importantly, by the Congress. But simply much of our daily work at many facilities, while vitally important to our beneficiaries, is less relevant to supporting readiness. We are fortunate to have robust civilian provider networks in many locations that offer timely access to quality health care. And so we have an obligation to deliver access to care for our patients, but also to focus precious military resources on activities with the highest readiness value.

We are aware that seeing new care providers may be a big change for families. The doctor-patient relationship is an important one. And we recognize the shift from MTF-based care to civilian care may involve new out-of-pocket costs for some retirees.

I want to make clear that we are taking a careful, deliberate approach as we assess the market capacity of each location to accept new patients. If we determine market capacity in a particular location is more constrained than we estimated, we will reassess our plans and adjust as necessary. The bottom line is we are committed to refocusing our hospitals and clinics on readiness, and we are committed to providing access to health care to our beneficiaries. I am confident that the Military Health System can accomplish both of those goals.

With me this morning is Dr. Dave Smith, who led the team comprised of individuals from Health Affairs, as well as the military departments and the Defense Health Agency. This team is the team that compiled information and conducted the analysis for plans, and he will be available to answer the questions about the process that we used, and the conclusions that we drew from that process and analysis.

I also want to acknowledge that General Place, the director of the Defense Health Agency, is here as well. General Place, at the DHA, oversees our US-based MTFs, as well as the TRICARE Health Plan. The DHA will be taking the lead role working with the military departments, the MTF leaders, installation commanders, and our network providers, on implementing the MTF-specific changes.

I also want to confirm that the change decisions that are reflected in the Report to Congress are made at a Department level, not at the Defense Health Agency. The changes in the report are not a result of DHA’s new responsibility for managing the MTFs which was another directive coming from Congress as part of NDAA 2017. That said, it is going to be DHA’s responsibility to, again, work with the military departments, our providers in the local communities, to plan and execute the detailed implementation plans at the MTF and market level. As the DHA collaborates on these plans, they will work with our managed care support contractors to help communicate details for each effective person when a time for action arrives. Until then, normal operations at these facilities will continue.

The health system is committed to maximum transparency at every step in this process. It's our priority to help approximately 200,000 out of the over 9 million beneficiaries who will be affected by these changes to retain uninterrupted access to health care as we help transition them to new providers. Again, I appreciate you carving out time this morning, and we are happy to answer any questions you may have.

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Sleep complications are common in the military, from the early-rise culture that can disrupt normal sleeping patterns to the bouts of insomnia resulting from night operations, early morning physical therapy workouts, sustained combat operations, and other such disruption. Researchers and doctors within the Military Health System work to address these concerns and improve the efficiency of service members suffering from sleep complications.

Army Lt. Col. (Dr.) Vincent Capaldi, sleep medicine consultant to the surgeon general and chief of behavioral biology at the Walter Reed Army Institute of Research in Silver Spring, Maryland, stressed the importance of the military perspective when addressing sleep concerns in service members. Capaldi pointed out that while proper sleep is necessary for mission effectiveness in the field, 62% of service members sleep less than six hours a night on average—resulting in chronic sleep deprivation and insomnia.

“When people are chronically sleep deprived and do a sleep study in the civilian sector, we found that they're being diagnosed with narcolepsy at significantly higher raters compared to those diagnosed in the Military Health System,” Capaldi said. “We're able to take a more nuanced approach in the MHS to evaluate what’s causing their difficulty and prevent a misdiagnosis that can result in a service member getting medically boarded.”

Doctors at the Walter Reed National Military Medical Center in Bethesda, Maryland, use a variety of techniques to diagnose sleeping problems. WRNMMC’s chief of sleep medicine, Lt. Col. (Dr.) Meagan Rizzo, stated that due to the COVID-19 pandemic, using respiratory sleep tests—such as positive airway pressure titration studies—have been temporarily halted to prevent the potential spread of COVID-19. Rizzo did note that WRNMMC’s Sleep Laboratory is still open for some in-lab diagnostic sleep studies. The laboratory also offers sleep tests that patients take home and bring back for further study.

“Home sleep tests can be good at picking up moderate and severe obstructive sleep apnea in high-risk patients,” Rizzo said. “It’s a good starting point, and something we can use while our labs are closed to still offer insight into sleep remotely.”

The home sleep tests can lead to further testing, like the multiple sleep latency test, administered through a medical device comparable to an activity tracking device that patients wear on their wrists at home to track sleep and check for signs of narcolepsy. Overnight pulse oximetry is also offered, which measures a patient’s pulse and the oxygen content in their blood to make sure that oxygen levels don’t drop too low during sleep.

Military medical professionals recognize that there are also military concerns that contribute to diagnosing sleep problems, like post-traumatic stress disorder and traumatic brain injury. Army Lt. Col. (Dr.) Scott Williams, director for medicine at Fort Belvoir Community Hospital in Virginia, explained the link between these conditions: “When you disrupt the brain either because of PTSD or TBI, it lowers a patient’s arousal threshold, making it easier to wake them up, so what someone might otherwise sleep through before their injury, like a snoring episode or a mild sleep apnea, now wakes them up.”

Gradually treating TBI and PTSD can have positive effects on the resulting sleep complications. But Carla York, who specializes in behavioral sleep medicine at WRNMMC, stated that treating one does not always eliminate the other.

“As we improve sleep, we can improve management of a psychiatric condition like PTSD, but we often find that even when there's an improvement in PTSD symptoms, sleep problems like insomnia can still persist,” York said. “So thinking about a psychiatric diagnosis and a sleep problem as being the same thing isn't helpful. We have to treat both conditions concurrently for optimal improvement.”

WRNMMC, FBCH, and other military medical treatment facilities use cognitive behavioral therapy for insomnia, or CBT-i, to treat patients with chronic insomnia. CBT-i uses stimulus control, sleep hygiene, sleep restriction, relaxation training, and cognitive therapy to provide patients with tools and resources to better manage their sleep. The U. S. Department of Veterans Affairs also offers a free mobile app called CBT-i Coach that walks patients through some of these techniques.

WRAIR’s sleep research has resulted in exploring treatment options like transcranial electrical stimulation, which Capaldi hopes will help patients get to slow-wave sleep faster and sleep more efficiently. Capaldi’s team is exploring the use of pharmacological treatments that target orexin, a protein-like molecule in the brain that regulates wakefulness. These efforts focus on the use of orexin receptor antagonists to allow service members to get to sleep quickly and wake without the grogginess of prescribed sleep aids. In 2004, WRAIR invented and subsequently licensed a caffeinated gum - Military Energy Gum. MEG is available in first strike rations for the military and sold commercially since 2012.

Capaldi hopes that through research and clinical efforts in the military medical community, proper sleep and the methods to get that sleep will be prioritized in military culture.

“Cognitive dominance is critical for success in the battlefield of today and tomorrow. Sleep is ammunition for the brain, necessary for the maintenance of sustained vigilance and cognitive dominance,” Capaldi said. “We would never send service members into the field and say they don't need to bring water along with them, so we have to reverse the culture within our military that views sleep as a liability instead of an asset to help service members keep their brains in the fight.”

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More than 200 participants from around the military ophthalmology and optometry communities gathered virtually on Jan. 8 to share ideas for the first time since the beginning of the transition to the Defense Health Agency.

The group participated in the “Refractive Surgery – Excellence for the Warfighter” virtual meeting where they discussed the latest techniques, safety protocols, and standards for refractive surgery. The meeting provided an opportunity for colleagues to share their experiences and get advice from experts, and was held in place of the annual Military Surgery Safety and Standards Symposium.

“We’ve been meeting since 2007 to talk about our best practices, our standards, lessons learned and safety,” said Army Maj. (Dr.) Gary Legault, Army Refractive Surgery Program manager and refractive surgery consultant to the Army surgeon general. “We emphasize key safety issues with the laser platforms and with our treatments and share the latest and greatest technology and updates.”

Refractive surgery is any surgery that eliminates the need for glasses or contact lenses. Refractive surgeries include LASIK (laser-assisted in situ keratomileusis), PRK (photorefractive keratectomy), ICLs (implantable contact lenses), and SMILE (small incision lenticule extraction).

Within the Military Health System, these procedures are designed to improve the functionality, lethality, and combat readiness of the warfighter through improving their visual system. Refractive surgery is offered at no cost to qualifying service members with conditions including nearsightedness, farsightedness, and astigmatism.

Legault explained that his hope was for the meeting to produce practical lessons that those in attendance could use on a regular basis.

“We hope this helps the people in attendance from around the world of military ophthalmology and refractive surgery learn something new that they can apply to improving their practice with their patients,” Legault said.

Among the positive outcomes from the MHS’s transition to the DHA is a tri-service effort to standardize refractive surgery across the DOD.

“For us, it’s a benefit as the DHA helps us improve our standardization and create a standard experience across the board as well as become more efficient,” Legault said. “I think the DHA can help us improve our outcomes by sharing best practices and working together as a group.”

Navy Lt. Cmdr. (Dr.) Tyler Miles, research director and division officer for Naval Medical Center San Diego’s Refractive Surgery Center, agreed.

“This is an opportunity for us to all come together and share what we’re doing. We have different flavors amongst the different services, and it’s nice to be able to share our gains across the board,” Miles said.

Paramount among the improvements resulting from the transition, is having a refractive surgery board at the DHA level, he explained.

“We now have a formal voice at that tri-service level, so that might bring some formal processes that empower our programs more than before,” Miles said.

As with many other areas of military medicine, COVID-related impacts to refractive surgery include a shift to a more virtual-heavy way of conducting consultations and pre-surgery briefs.

Legault said that the most important aspect what they do is improving combat readiness.

“We want to improve the warfighter in order for them to be better at their occupation, and we want commanders and leaders to know that we are here to help,” he said. “We’re here to assist.

“It can literally mean life and death where you can see your enemy through improved visual function versus your glasses fogging up or falling off,” Legault said. “These are procedures that can make a huge difference and occur within minutes.”

Miles agreed, saying, “This is one of the few instances where we’re actually enhancing the warfighter. We’re not just fixing them up and keeping them healthy, we’re making them better. We’re providing an enhancement by making them less reliant on glasses and contact lenses, which, although they’re effective in giving you clearer vision, may be a liability in certain areas where our folks are operating.”

Proof for him that their programs are headed in the right direction, he said, is in the outcomes he’s seen.

“You just have to spend a day in a clinic seeing post-operative patients,” Miles said. “They’ll tell you that it is life-changing to be able to wake up in the morning and open their eyes and see clearly, aside from the performance advantage that it’s giving our military.”

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Citing supply chain strains and anticipated shortages as a result of the novel coronavirus pandemic, the agency that manages military commissaries says some stores will start limiting how much fresh meat customers can purchase.

Starting May 1, commissaries within the 50 states and in Puerto Rico will limit purchases of fresh beef, poultry and pork, the Defense Commissary Agency announced Thursday evening. For fresh beef, pork, chicken and turkey, customers will be limited to purchasing two items per visit, according to the announcement.

"There may be some shortages of fresh protein products in the coming weeks," Robert Bianchi, a retired Navy rear admiral and the Defense Department's special assistant for commissary operations, said in a statement. "Enacting this policy now will help ensure that all of our customers have an opportunity to purchase these products on an equitable basis."

Military commissaries, located on military bases around the world, operate on a nonprofit basis and offer food items at cost. Considered a military benefit, they are open to active-duty troops, dependents, retirees and some other special Veteran categories.

Individual stores will have the ability to increase or decrease limits based on their inventory, DeCA officials added in the release. Some commissaries have already been posting quantity limits on high-demand items, such as toilet paper and hand sanitizer.

The move to limit meat purchases is a troubling one that comes on the heels of an announcement from Tyson Foods, one of the largest meat-processing companies in the nation, that it was being forced to close down plants due to the virus. Eventually, the company warned, the closures would lead to shortages in stores.

"The food supply chain is breaking," company chairman John Tyson said in a full-page ad that appeared in the New York Times April 26.

On Tuesday, President Donald Trump issued an executive order ordering Secretary of Agriculture Sonny Perdue to "take all appropriate action under that section to ensure that meat and poultry processors continue operations," calling the plants "critical infrastructure for the nation.

To that end, the administration will purchase $3 billion in excess dairy, produce and meat "to be distributed in order to assist Americans in need as well as producers with lost markets," the White House said in an announcement accompanying the order.

In DeCA's Thursday announcement, Bianchi said the supply chain for commissaries overseas remained strong.

"In addition, we continue to prioritize quantities for our overseas shipments, so we should be able to support the demand," he said. "If we experience any unexpected major hiccups in the pipeline, we will look at expanding shopping limits to other locations."

The release noted that purchase limits were also intended to head off the phenomenon of panic buying, which has led to bare shelves in supermarkets all over the country. As demand spiked, DeCA issued a March 14 directive allowing store managers to implement shopping limits as they saw fit to maintain stock availability. That directive remains in effect.

"We know this is a potentially stressful time for all concerned," Bianchi said. "But together we will meet these challenges and support our service members and their families throughout the duration of this crisis wherever necessary."

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The Defense Department is following restrictions on buying products for government use that contain a family of hazardous chemicals, but items containing the substances -- collectively known as PFAS -- may still be available at military exchanges, according to a government watchdog.

A review by the Government Accountability Office found that the department had "taken some steps" to implement the ban required by law on buying products containing per- and polyfluoroalkyl substances. But the DoD has not followed through on keeping products containing PFAS off military exchange shelves, according to the published update Wednesday.

That shortcoming could potentially expose consumers.

The DoD developed new guidance on the law to contracting officers and users of government purchase cards. But according to the GAO, the DoD should take steps to implement the ban at the exchanges.

"DoD has not updated its sustainable procurement guidance to reflect statutory prohibitions," GAO officials wrote in the report titled Persistent Chemicals: Actions Needed to Improve DoD's Ability to Prevent the Procurement of Items Containing PFAS. "As a result, DoD is at risk of continuing to procure items that contain certain statutorily prohibited PFAS."

A manmade group of substances, PFAS chemicals are used in industrial products such as lubricants and hydraulic fluids, non-stick cookware, food wrappers, cosmetics and stain repellents.

They also are a key ingredient in the firefighting foam used to combat ship and aircraft fires and often are dubbed "forever chemicals," because they do not break down into harmless components and can't be destroyed.

The compounds have been linked to infertility, ulcerative colitis and thyroid disease, and may contribute to testicular and kidney cancer.

The GAO found that the DoD has implemented policies on buying products containing PFAS in the government procurement process and purchase cards and agrees that the law applies to military exchanges. But the Pentagon has not figured out how to enforce the law in the exchanges.

DoD officials told the federal investigators it is unlikely that military exchanges would sell upholstered furniture and area rugs that contain PFAS, since many of the manufacturers in the U.S. have moved away from using the chemicals.

However, the exchanges do buy and resell imported goods, which could contain PFAS.

And the exchanges carry non-stick cookware or utensils, which the Environmental Protection Agency does not require to be labeled as containing PFAS.

The GAO made two recommendations to the DoD: Develop a plan to implement the law at military exchanges; and ensure that all its policies comply with the law and executive orders on limiting purchases of products containing PFAS.

DoD officials concurred with the recommendations and said they would communicate with exchange officials within 30 days about the requirements. And they added that they would "prioritize substitutes for PFAS."

On a separate note, GAO officials examined the DoD's progress on ensuring that packaging for Meals, Ready to Eat, did not contain PFAS -- a requirement that went into effect Oct. 1.

Defense Logistics Agency officials asked the vendors to confirm subcontractors that assemble MREs were not using food wrapping that contained PFAS and did not detect any "volatile" PFAS in the samples, meaning there were no detectable levels of chemicals in the air in and around the packaging.

But they did find non-volatile PFAS in all three of the samples.

The officials surmised that the detected chemicals probably came from contamination during the manufacturing process. They said their next step will be to sort out how the contamination occurs.

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Congress is on the verge of enacting a major change to the military justice system: stripping the authority from high-level military commanders to decide when sexual assault crimes should be sent to trial by court-martial. Instead, this authority will be shifted to military lawyers.

While this may seem like a logical measure to improve the military’s response to these terrible crimes, it is anything but. In fact, almost all credible studies of the problem of sexual assault in the military point to a very different conclusion: that this change is more symbolic than necessary. Symbolism, of course, can be positive. But what is troubling is that from the perspective of future victims of sexual assault this change might actually make it less likely their cases will ever see the inside of a military courtroom.

Anyone following this story knows that advocates for this change have finally broken through long-standing Department of Defense (DoD) resistance. A filibuster-proof majority of senators makes it significantly more likely that the Military Justice Improvement and Increasing Prevention Act (MJIIP) or the recently-reintroduced I Am Vanessa Guillén Act will be enacted into law. Each proposed bill aims to “fix” the problem with sexual assault in the military by taking commanders out of the prosecutorial equation.

So, what explains this seismic shift manifested most notably with Chairman of the Joint Chiefs of Staff Gen. Mark Milley’s announcement that he no longer opposes this change? Have senior military leaders suddenly realized that high-level commanders can’t be trusted to exercise this authority; or do they now believe this shift is in the best interest of military discipline? Not likely. And why should they, when almost all the information available to them (and to Congress) indicates that commanders are more willing to send hard cases to trial than their civilian counterparts.

The most persuasive answer is that the distorted narrative of high-level command indifference to sexual assault victims, coupled with the current political climate, indicates a futility in continued opposition. Or, more simply, the intense congressional and media attention surrounding the sexual assault issue over the past decade has created an environment where commanders are damned if they do and damned if they don’t when it comes to these cases. Therefore, why should they continue to fight to retain this authority?

Congressional concern for victims of sexual assault in the military is unquestionably laudable. But Congress is focused on the wrong end of the command pyramid. As the recent report from Fort Hood indicates, this problem is rarely the result of prosecutorial reticence among generals and admirals entrusted with the authority to send cases to trial. Instead, the true locus of the problem lies at the base of the pyramid and the failure of junior leaders to credibly discharge their duties to prevent and credibly respond to sexual assault in the ranks. By distorting this reality, Congress appears ready to tie the tourniquet around the limb that isn’t bleeding believing it will cure the wound where it exists.

Almost all military justice experts who have worked within the system share a common experience: senior commanders who refuse to allow acquittal aversion to negatively influence their decisions on whether to send tough cases to trial. Indeed, many current and former staff judge advocates — the military lawyers who advise commanders on the strength of a case and whether to send it to trial — have had the experience of their commander ordering a case to trial knowing full well the probability of success was minimal. These decisions were not dictated by the odds of victory. Instead, what mattered was that there was sufficient credible evidence a serious crime occurred. And ironically, the high number of acquittals in these difficult cases — a statistic critics of the military system cite as evidence of its failure — corroborate the fact that commanders entrusted with this authority rarely shy away from tough cases. A law premised on the assumption commanders are incapable of making this hard choice is deeply flawed, especially because commanders don’t make these decisions in a vacuum. They do so in close coordination with their military lawyers; ironically the same lawyers who Congress believes are somehow better-suited to make these decisions.

The proposed legislation is premised on the assumption that the sexual assault problem will be cured by shifting the prosecution decision to a career military lawyer. But this assumption is dubious at best. Unlike senior commanders, military lawyers — like their civilian counterparts — are instinctively more susceptible to acquittal aversion. In systems where attorneys make prosecutorial decisions, conviction rates are generally much higher. This is rarely due to the quality of the advocacy. It’s primarily due to the quality of cases. Why anyone thinks that a career military lawyer will be more inclined to send complex and hard-to-win cases to trial is perplexing; such cases are “no billed” all the time by civilian prosecutors. The proposals also mistakenly assume military lawyers are immune from the subtle influences of public perception and careerism.

There is no question that pursuing hard cases should not be driven by political pressure or the interests of career advancement no matter who exercises prosecutorial discretion. But there is simply no basis to conclude that a career military lawyer will be better insulated from these pressures or more inclined to send challenging cases to trial. This is why this “solution” may in fact lead to more cases being dismissed than would otherwise be sent to trial through the existing process of coordinated commander/lawyer decision-making. Indeed, a better title for this legislation might be the “Be Careful What You Ask For Act.” Why Congress believes this will improve victim confidence in the system is perplexing.

Ultimately, it is unlikely that anything Congress is proposing will fix the problem they originally set out to resolve — for the military to better protect the victims of sexual assault and purge such misconduct from the ranks. Advocates may characterize this change as a panacea, but it is more likely to produce outcomes that are similar to federal and state jurisdictions: conviction rates will go up because trial of the hard cases will go down. Congress should therefore reconsider these deeply flawed assumptions; it needs to release the tourniquet and focus on the right wound, even if it’s harder to identify.

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Military movies can often remind Veterans of their service. They can also bring up painful memories of the past.

Air Force Veteran and Silver Star recipient John Pighini is someone who knows both sides of this issue. He recently worked as a technical adviser on a major motion picture that showcased the bravery of service members, but also brought up a painful past. These movies can sometimes show Veterans dealing with their own struggles: anger, paranoia, edginess, regret and survivor’s guilt.

Pighini saw those struggles on the big screen after working on the movie. “It feels like they take post-traumatic stress and they set it right in your lap,” he said. “Don’t go to this movie and not take a handkerchief or tissues with you. You will not make it through.”

PTSD in Veterans

These are the feelings Pighini knows all too well. He served as a pararescueman during Vietnam, which led to his role on the movie as a technical adviser. As members of Air Force Special Warfare, pararescue specialists rescue and medically treat downed military personnel all over the world. These highly trained experts take part in every aspect of the mission and are skilled parachutists, scuba divers and rock climbers, and they are even arctic-trained in order to access any environment to save a life when called.

Dr. Paula Schnurr, executive director for National Center for PTSD in VA’s Office of Mental Health and Suicide Prevention, started studying PTSD in 1984. She said Vietnam Veterans are still dealing with effects because the lack of support when they returned from deployment.

“Vietnam Veterans, like Veterans of earlier wars, were expected to come home and get on with their lives,” she said. Schnurr added the publicly opposed war made Vietnam Veterans’ transition hard to come home.

The National Vietnam Veterans Readjustment Study, completed in 1988 by the Research Triangle Institute, was pivotal for Veterans and the medical community. At the time, it was the most rigorous and comprehensive study on PTSD and other psychological problems for Vietnam Veterans readjusting to civilian life.

The study findings indicated about 30% of all male and 27% of female Vietnam theater Veterans had PTSD at some point during their lives. At the time, that equated to more than 970,000 Veterans. Additionally, about one half of the men and one third of the women who ever had PTSD still had it.

A 2013 National Vietnam Veterans Longitudinal Study showed that 40 or more years after wartime service, 7% of females and 11% of males still had PTSD.

PTSD symptoms may increase with age after retiring from work, or from medical problems and lack of coping mechanisms.

Having a mission

Having a mission can help Veterans deal with PTSD. While working on a recent movie, Pighini recalled the struggles he still deals with–50 years after his Vietnam service.

“The early days, we didn’t know what we had,” he said. “As we get older, we become more melancholy. We’re not busy and we’re not out there on the firing line.”

While filmed in Thailand, Pighini said the smells from Southeast Asia raised the hairs on the back of his neck. Despite the flashbacks, Pighini said he hopes viewers realize the importance of putting a spotlight on PTSD. He added movies also depict the courageousness of military members. In the movie he worked on, the movie told the story of an Air Force pararescuemen who lived by their motto, “That others may live.”

“That means you lay it out,” Pighini said. “You do whatever you need to do to save a life. It’s the ethos we have. It’s what we live by. If you have to lay down your life or one of your limbs or whatever it is, you do it. It means everything.”

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A 44-year-old crew member of a NOAA scientific research vessel who downloaded child pornography found on the ship’s server was sentenced Wednesday to two years in federal prison.

Johnny Dale Hale was working aboard the Bell M. Shimada, a National Oceanic and Atmospheric Administration ship, in 2016 when he transferred to the ship’s server two folders of child pornography that included about 35 images from a cell phone, according to federal prosecutors.

Hale was identified as having accessed the pornography after special agents and a forensic analyst traced the images to a specific account belonging to Hale and his employee access card, according to court records.

The inquiry occurred during troubleshooting on Nov. 15, 2016, when the ship was having technical issues and two new folders were discovered on the ship’s server, according to Assistant U.S. Attorney William M. McLaren.

Hale, who worked as a contractor with NOAA, initially denied any responsibility for the questionable files but then selfie-style images of his genitals also were found on the vessel’s server and computers, according to the prosecutor.

The material was discovered as the ship was off the coast of Oregon in November 2016.

Hale, of Gig Harbor, Washington, pleaded guilty to possession of child pornography.

His lawyer, Assistant Federal Public Defender Bryan Francesconi, said Hale spent eight days in pretrial detention and was on pretrial supervision for just over four years. He argued for a sentence of time served and five years of supervised release.

Hale is a U.S. Veteran who served in active combat in multiple branches of the military and has no prior criminal record, the prosecutor and his lawyer noted.

“While Hale’s service must be honored, his choice must be acknowledged. He chose, for the sake of sexual gratification, to misuse taxpayer resources in a privileged technical position. He chose to possess these images. He then chose to attempt to mislead investigators in favor of owning these choices,” McLaren wrote to the court.

U.S. District Judge Ann L. Aiken issued the sentence in federal court in Eugene.

Hale also has agreed to pay $4,000 in restitution.

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Despite the unforeseen impacts of the COVID-19 pandemic, the transition of military medical treatment facilities to the Defense Health Agency is on track headed into the new year, explained Dr. Barclay Butler, DHA’s assistant director for management.

The Department of Defense made the decision early in the pandemic to pause transition activities due to the unprecedented burden on the Military Health System. However, in November, the Department resumed transition activities.

The strategic pause ended up having a positive impact on the transition, Butler added.

“The pause in Military Health System transition let us compile a number of lessons learned,” Butler said. “We then applied those lessons learned to MHS reform. We also used the pause to improve the transition planning, and the transition products.”

Lessons learned included standardization of military health metrics reporting to the DOD. Previously, each military service reported that information separately to the DOD, but the DHA was able to demonstrate the value of collecting information and reporting it collectively. The four regional areas, known as ‘markets’ that have already transitioned to the DHA also demonstrated speed of response as a result of integrating their market MTFs into an integrated health system.

This information also served to inform the DOD’s COVID-19 Task Force.

“That speaks largely to the lesson learned regarding the COVID response and to the markets’ ability to respond,” Butler said.

Butler added that one of the most important results of the past year was the confirmation that the DHA is progressing in the right direction with the market model, affirmed by the Department’s decision to continue the current plan.

“The services asked the Secretary to re-asses the approach and the Secretary took that information and made a decision on the 9th of November to continue forward with our plan,” Butler said.

Standardization across the military health enterprise, including clinical quality, is one example of how a market-based approach improves the quality of care for patients.

“Before the DHA started the transition, we found there were 38 different clinical quality standards in the MHS,” Butler said. “How many should we have? We should have one. When you get rid of unwanted variation, you see healthcare quality go up and costs go down.”

Going forward, Butler said, military medicine will be facing a ‘new normal.’ We will need to remain flexible, and adapt and react as we have over the past year.

“We don’t really know what that ‘new normal’ actually looks like, so we need that agility to be able to respond and continue to provide our patients with access to high quality care,” he said.

Hints of what is on the horizon include increased use of virtual health options.

“Use of virtual health has gone up thousands of percent from where we were pre-COVID pandemic” Butler said. “I think you’re going to continue to see a high utilization of our virtual health systems, which gives our patients greater access.”

In terms of facilities, the next step is transitioning five additional markets to the DHA.

“Our next five MTFs – Hawaii, Colorado, Puget Sound, San Antonio and Tidewater – will be stood up and operating as markets near the end of February,” Butler said. “That’s a big step for the DHA.”

He sees a relatively smooth transition, as all of the aforementioned were already Enhanced Multi-Service Markets, where multiple services have coordinated healthcare management for several years. Contrast that with remote single-service MTFs, such as Twentynine Palms in California and Minot Air Force Base in North Dakota, where these MTFs are “the only option,” and where the DHA will focus on providing support to these remote locations.

Other focus areas, he said, include extending partnerships with entities such as the Department of Veteran’s Affairs, other federal institutions, academic medical centers, and other partners in order to improve effectiveness and efficiency.

Army Col. Christopher Ivany, director of the DHA’s Transition Program Management office, explained how the pandemic highlights the need for the military health system to be able to respond to large-scale crises with a single, cohesive approach.

Ivany said that the response across the National Capital Region, where a market with each of the services is already established, was a perfect example.

“In those areas where all the facilities, the people, the resources were all applied to this huge problem in a way that was focused on what was best for the beneficiaries as a whole, it was done more effectively across all service lines,” Ivany said. “It reiterated the need for the MHS transformation to go forward.”

Those successes, he said, have shaped how the DHA will move forward with the next set of markets.

“The MHS is in the midst of a fundamental shift in how it manages healthcare, and while that shift can and will be difficult at times, the end state of where this change is going will have significant benefits for our patients, for our staff and for the medical readiness of the line units, and the healthcare teams themselves.”

Butler’s message to MHS patients is that the quality of their care is paramount.

“The DHA and the MHS are focused on delivering high-quality care to our beneficiaries. That high-quality care translates into having our care teams ready to do their deployed mission while it produces readiness for the department,” Butler said.

“Lieutenant General Place, the director of the DHA, is focused in on great outcomes. The number one great outcome is a medically ready force, without a doubt,” Butler said. “That’s what he wants us to do, and that’s what we do.”

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White House officials say the president’s new infrastructure plan includes enough funding to replace “10 to 15” aging Veterans Affairs hospitals across the country with new medical centers, but department officials haven’t determined yet which communities might benefit from the money.

Administration staff have been touting the $2 trillion infrastructure improvement plan in recent days as they try to build support among skeptical members of Congress — largely Republicans — and the public for the massive spending package.

Included in the total is about $18 billion for Veterans Affairs projects, with most of that total going to upgrading current department facilities and replacing others.

“This funding will also help accelerate ongoing major construction projects to … replace outdated medical centers with state-of-the-art facilities to provide our Veterans the care they deserve,” said Terri Tanielian, special assistant to President Joe Biden for Veterans Affairs.

VA Secretary Denis McDonough called the money a “down payment” on plans to modernize the department’s medical facilities, saying as many as 30 may need to be replaced in coming years.

“The median age of a private hospital in the U.S. on a national basis is roughly 11 years old,” he said. “The VA portfolio has a median age of 58 years old, and 69 percent of VA facilities are older than 50 years.

“So when you think about all the technology and everything else that we’re moving into modern hospitals, you can see why we’re so concerned about this footprint. A lack of modern infrastructure actually limits our ability to meet the evolving health-care needs of Veterans.”

VA today manages more than 1,700 hospitals, clinics and other health-care facilities. Department spokesman Terrence Hayes said VA has not yet determined which locations would be at the top of the list for replacement, if the infrastructure plan is approved.

“The foundational criteria for project selection are based on the age and condition of the existing facility, as well as projected demand in the facility’s catchment area,” he said. “Selection of these sites will be informed by a data-driven model currently under development that takes these factors into account.”

The White House’s push to replace some VA hospitals comes ahead of a congressionally mandated, multi-year review of the department’s footprint across America, with an eye towards possibly closing some facilities.

Under that plan — using a panel styled after the military’s base closure commission — Biden will select members of an Asset and Infrastructure Commission for VA later this year.

The commissioners — who will need Senate approval before starting their work — will spend seven months compiling their recommendations, which will be followed by a series of public hearings on potential facility closings or expansions. Final decisions on changes are expected in 2023.

McDonough said he is not concerned by critics’ questions on whether the department should be investing billions in new construction ahead of that commission review.

“The footprint of VA itself needs modernization and needs addressing, not least because of the age of the facilities,” he said. “This will be handled very transparently with our partners on Capitol Hill.”

VA has received significant criticism in recent years for the cost of new construction, especially as conservative groups have pushed for most department dollars to fund private care medical appointments instead of VA expansion.

For example, the Rocky Mountain Regional VA Medical Center, located outside of Denver, opened in 2018 after five years of delays and more than $1 billion in cost overruns.

But House Veterans’ Affairs Committee Chairman Mark Takano said he is not concerned that the new infrastructure spending bill will undermine future changes in VA’s infrastructure.

“We know right now in certain parts of the country where we have VA medical centers that we need upgrades,” he said. “But we need to go through the process of assessing where our VA footprint needs to go smaller or go bigger.”

For now, those potential improvements hinge on whether the infrastructure plan moves ahead. No timeline has been set by Democratic leaders in the House and Senate for when the proposal could be considered by members.

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While the focus of the COVID-19 pandemic has been on respiratory problems and securing enough ventilators, doctors on the front lines are grappling with a new medical mystery.

In addition to lung damage, many COVID-19 patients are also developing heart problems — and dying of cardiac arrest.

As more data comes in from China and Italy, as well as Washington state and New York, more cardiac experts are coming to believe the COVID-19 virus can infect the heart muscle. An initial study found cardiac damage in as many as 1 in 5 patients, leading to heart failure and death even among those who show no signs of respiratory distress.

That could change the way doctors and hospitals need to think about patients, particularly in the early stages of illness. It also could open up a second front in the battle against the COVID-19 pandemic, with a need for new precautions in people with preexisting heart problems, new demands for equipment and, ultimately, new treatment plans for damaged hearts among those who survive.

“It’s extremely important to answer the question: Is their heart being affected by the virus and can we do something about it?” said Dr. Ulrich Jorde, the head of heart failure, cardiac transplantation and mechanical circulatory support for the Montefiore Health System in New York City. “This may save many lives in the end.”

Virus Or Illness?

The question of whether the emerging heart problems are caused by the virus itself or are a byproduct of the body’s reaction to it has become one of the critical unknowns facing doctors as they race to understand the novel illness. Determining how the virus affects the heart is difficult, in part, because severe illness alone can influence heart health.

“Someone who’s dying from a bad pneumonia will ultimately die because the heart stops,” said Dr. Robert Bonow, a professor of cardiology at the Northwestern University Feinberg School of Medicine and editor of the medical journal JAMA Cardiology. “You can’t get enough oxygen into your system and things go haywire.”

But Bonow and many other cardiac specialists believe a COVID-19 infection could lead to damage to the heart in four or five ways. Some patients, they say, might be affected by more than one of those pathways at once.

Doctors have long known that any serious medical event, even something as straightforward as hip surgery, can create enough stress to damage the heart. Moreover, a condition like pneumonia can cause widespread inflammation in the body. That, in turn, can lead to plaque in arteries becoming unstable, causing heart attacks. Inflammation can also cause a condition known as myocarditis, which can lead to the weakening of the heart muscle and, ultimately, heart failure.

But Bonow said the damage observed in COVID-19 patients could be from the virus directly infecting the heart muscle. Initial research suggests the coronavirus attaches to certain receptors in the lungs, and those same receptors are found in heart muscle as well.

Initial Data FromChina

In March, doctors from China published two studies that gave the first glimpse at how prevalent cardiac problems were among patients with COVID-19 illness. The larger of the two studies looked at 416 hospitalized patients. The researchers found that 19% showed signs of heart damage. And those who did were significantly more likely to die: 51% of those with heart damage died versus 4.5% who did not have it.

Patients who had heart disease before their coronavirus infections were much more likely to show heart damage afterward. But some patients with no previous heart disease also showed signs of cardiac damage. In fact, patients with no preexisting heart conditions who incurred heart damage during their infection were more likely to die than patients with previous heart disease but no COVID-19-induced cardiac damage.

It’s unclear why some patients experience more cardiac effects than others. Bonow said that could be due to a genetic predisposition or it could be because they’re exposed to higher viral loads.

Those uncertainties underscore the need for closer monitoring of cardiac markers in COVID-19 patients, Jorde said. If doctors in New York, Washington state and other hot spots can start to tease out how the virus is affecting the heart, they may be able to provide a risk score or other guidance to help clinicians manage COVID-19 patients in other parts of the country.

“We have to assume, maybe, that the virus affects the heart directly,” Jorde said. “But it’s essential to find out.”

Facing Obstacles

Gathering the data to do so amid the crisis, however, can be difficult. Ideally, doctors would take biopsies of the heart to determine whether the heart muscle is infected with the virus.

But COVID-19 patients are often so sick it’s difficult for them to undergo invasive procedures. And more testing could expose additional health care workers to the virus. Many hospitals aren’t using electrocardiograms on patients in isolation to avoid bringing additional staff into the room and using up limited masks or other protective equipment.

Still, Dr. Sahil Parikh, an interventional cardiologist at Columbia University Irving Medical Center in New York City, said hospitals are making a concerted effort to order the tests needed and to enter findings in medical records so they can sort out what’s going on with the heart.

“We all recognize that because we’re at the leading edge, for better or for worse, we need to try to compile information and use it to help advance the field,” he said.

Indeed, despite the surge in patients, doctors continue to gather data, compile trends and publish their findings in near real time. Parikh and several colleagues recently penned a compilation of what’s known about cardiac complications of COVID-19, making the article available online immediately and adding new findings before the article comes out in print.

Cardiologists in New York, New Jersey and Connecticut are sharing the latest COVID-19 information through a WhatsApp group that has at least 150 members. And even as New York hospitals are operating under crisis conditions, doctors are testing new drugs and treatments in clinical trials to ensure that what they have learned about the coronavirus can be shared elsewhere with scientific validity.

That work has already resulted in changes in the way hospitals deal with the cardiac implications of COVID-19. Doctors have found that the infection can mimic a heart attack. They have taken patients to the cardiac catheterization lab to clear a suspected blockage, only to find the patient wasn’t really experiencing a heart attack but had COVID-19.

For years, hospitals have rushed suspected heart attack patients directly to the catheterization lab, bypassing the emergency room, in an effort to shorten the time from when the patient enters the door to when doctors can clear the blockage with a balloon. Door-to-balloon time had become an important measure of how well hospitals treat heart attacks.

“We’re taking a step back from that now and thinking about having patients brought to the emergency department so they can get evaluated briefly, so that we could determine: Is this somebody who’s really at high risk for COVID-19?” Parikh said. “And is this manifestation that we’re calling a heart attack really a heart attack?”

New protocols now include bringing in a cardiologist and getting an EKG or an ultrasound to confirm a blockage.

“We’re doing that in large measure to protect the patient from what would be an otherwise unnecessary procedure,” Parikh said, “But also to help us decide which sort of level of personal protective equipment we would employ in the cath lab.”

Sorting out how the virus affects the heart should help doctors determine which therapies to pursue to keep patients alive.

Jorde said that after COVID-19 patients recover, they could have long-term effects from such heart damage. But, he said, treatments exist for various forms of heart damage that should be effective once the viral infection has cleared.

Still, that could require another wave of widespread health care demands after the pandemic has calmed.

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163 service members committed suicide in Q3 2021

Over 150 members of the U.S. military took their own lives in the third quarter of 2021 which represents a greater total than the number of service members who have died from the coronavirus since the start of the pandemic.

According to data released by the Pentagon, 163 service members committed suicide in Q3 of 2021 which broke down into 70 active service members, 56 reserve members, and 37 members of the National Guard.

Suicides among active members of the military dropped from Q2 to Q3 but suicides rose among reserve and National Guard members.

Nearly twice as many members of the U.S. military died of suicide from July to September than have died from the coronavirus during the entire pandemic.

As of January 8, 86 members of the military have died from the coronavirus.

In September, the total number of coronavirus deaths in the military was 43 and the doubling of deaths from September to January is partially due to the Delta variant spike, the Pentagon says.

A total of 476 members of the U.S. military committed suicide in 2021 through three quarters. In 2020, Pentagon data shows that 701 service members committed suicide.

In December, the military began taking disciplinary action against U.S. service members who had not complied with the federal government's vaccine mandate. More than 200 Marines have been booted from the United States military for refusing the vaccine.

The Pentagon did not immediately respond to a request for comment from Fox News.

This summer, a research paper concluded that a staggering 30,177 American active military personnel and Veterans involved in post-9/11 wars are estimated to have died by suicide – a figure at least four times greater than the 7,057 service members who were killed in combat during that time.

The statistics emerged this summer in a report from the Cost of War Project – a joint research effort between Brown University and Boston University.

"Unless the U.S. government and U.S. society makes significant changes in the ways we manage the mental health crisis among our service members and Veterans, suicide rates will continue to climb," the paper warns. "That is a cost of war we cannot accept."

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More dental clinics, durable medical equipment shops and cryotherapy centers are coming to some installations, as part of the Army and Air Force Exchange Service emphasis on wellness services.

The durable medical equipment shops carry items to help with rehab, fitness and mobility, such as crutches, fitness bands, medical footwear, therapy aids, wheelchairs, canes and walkers. These shops— as well as the other wellness locations — accept Tricare and most other insurance plans, when applicable. The shops also fill prescriptions, said AAFES spokeswoman Marisa Conner.

Cryotherapy, which is the use of extreme cold in medical treatments. AAFES has cryotherapy offices at Fort Hood and Fort Bliss, Texas, and expects to open two more in 2020 at Fort Bragg and Fort Benning.

There are also optical and optometry clinics in 151 AAFES locations worldwide.

Currently, there are durable medical equipment shops in 18 AAFES locations, with five more scheduled to open in 2020. The shops are relatively new to AAFES shopping centers, but have been popular with shoppers of all ages, officials said. Their assortment also includes needed items that sometimes aren’t covered by health insurance plans.

The shops, which offer discounts to military-connected customers, are also open to the newly eligible customers such as all service-connected disabled Veterans, Purple Heart recipients, former prisoners of war, and primary family caregivers of eligible Veterans under the VA caregiver program.

These shops might be helpful for certain service-connected disabled Veterans who wouldn’t be eligible for free equipment from the VA — such as those with 0- to 40 percent service-connected disability ratings, said Jeremy Villanueva, assistant national legislative director of Disabled American Veterans.

Those with less than 50 percent disability ratings don’t get these medically-prescribed items free of charge from the VA if the items are related to a condition that isn’t service-connected. For example, if a Veteran has a 30 percent service-connected disability rating for their post traumatic stress disorder, and happens to have bad knees, that Veteran would pay for equipment for the knees, because the bad knees are not a service-connected condition.

AAFES plans to open durable medical equipment shops this year at Tripler Army Medical Center and Schofield Barracks in Hawaii; Fort Leonard Wood, Mo; Tinker Air Force Base, Okla.; and Camp Humphreys, South Korea.

Current AAFES durable medical equipment shops:

• Arizona: Davis-Monthan Air Force Base, Luke Air Force Base
• California: March Air Reserve Base, McClellan Air Force Base
• Colorado: Buckley Air Force Base, Fort Carson
• Georgia: Fort Stewart, Hunter Army Air Field
• Germany: Ramstein Air Base
• Kentucky: Fort Campbell
• Nebraska: Offutt Air Force Base
• Nevada: Nellis Air Force Base
• New Mexico: Holloman Air Force Base
• North Carolina: Fort Bragg
• Virginia: Fort Belvoir
• Texas: Fort Bliss, Fort Hood
• Washington: Joint Base Lewis-McChord

Dental offices

AAFES has dental offices at Fort Stewart, Ga., and Fort Hood, Texas. Mobile dental offices are operating at Fort Bragg, N.C., and at Joint Base Langley-Eustis, Va. Those mobile offices are scheduled to move to permanent locations in 2020.

Additional dental offices opening in 2020:

• Arizona: Luke Air Force Base
• Georgia: Fort Benning, Fort Gordon
• Kentucky: Fort Campbell
• Oklahoma: Fort Sill
• South Korea: Camp Humphreys
• Texas: Fort Bliss, Joint Base San Antonio-Fort Sam Houston

Cryotherapy offices

Cryotherapy, sometimes known as cold therapy, is the use of low temperatures in medical therapy.

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It’s no secret the funds Social Security uses to pay benefits are running low.

New proposals on Capitol Hill aim to fix the program’s solvency.

Just how dramatic those changes will need to be depends on how soon changes are put through.

Likewise, people who are planning for their retirement now may also want to make adjustments based on unforeseen events that could pop up.

That includes any potential cuts to Social Security retirement benefits.

“When you’re looking at all these ‘what ifs,’ the adjustments you make now in order to plan for something later are much smaller,” said Joe Elsasser, founder and president of Covisum, a Social Security claiming software company.

To that end, Covisum has developed a calculator to help consumers and financial advisors gauge just how impactful any Social Security benefit cuts could hit their bottom line in retirement.

To be sure, benefit cuts are not a given.

One year ago on Thursday, the Social Security Administration released projections indicating its trust funds could become depleted in 2035, at which point 79% of promised benefits would be payable.

An official update is expected to be released soon with the agency’s annual trustees report. Other projections have already speculated that the expiration date could be sooner due to economic repercussions from the Covid pandemic.

To fix that shortfall, experts generally expect some changes. Benefit cuts are among the possibilities, as well as potential payroll tax increases, or a combination of both.

In 1983, when President Ronald Reagan ushered in the last major Social Security reform to fix the program’s then-ailing finances, changes included gradually raising the retirement age to 67 and imposing some taxes on benefits for the first time.

The key for anyone who is looking toward claiming Social Security retirement benefits now is not to base the decision on worries of what changes could be coming.

“The temptation may be to act on fear,” Elsasser said. “It’s rarely the best track for financial planning.”

“Having a realistic understanding of the impact, even in a bad case, is better than going in with your eyes closed,” he said.

Covisum’s new calculator helps advisors evaluate Social Security claiming decisions. For many people, that is the cornerstone of their retirement plan, Elsasser said.

The calculator can stress test clients’ plans against benefit cuts and other negative scenarios such as poor market performance or negative health situations to see if their plan would still be OK.

“If it is, then you don’t have to act on fear,” Elsasser said.

If it is not, then adjustments like reducing lifestyle expenses or working longer may be necessary.

There is also a free version of the calculator available to consumers.

That version requires four data points: year of birth, benefit amount at full retirement age, percentage of a hypothetical benefit cut and the year that cut occurs.

Then it compares results of a person’s lifespan in five-year increments based on how early they claim — from age 62 or as late as 70 — and how that would be impacted if benefit reductions are put in place or not.

Ultimately, the results can be a starting point for people to evaluate what the potential results could be, which will hopefully lead them to avoid claiming early — and therefore take reduced benefits for life — just because they are afraid of benefit cuts, Elsasser said.

Research indicates those cuts would likely be less than 25%, if they happen at all, he said.

Notably, the calculator does not factor in the idea that benefits could go to zero. Because current tax revenues still support the program, that’s a highly unlikely scenario, Elsasser said. Even younger generations should continue to see income from the program in the future.

“The likelihood of it going to zero is as close to zero as you can get,” Elsasser said.

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"It's not about finding ships," Tim Taylor said. "The importance of our work is to connect families and bring some type of closure and peace even generations later."

Since she was a young girl, Helen Cashell Baldwin had been haunted by the mystery of what happened to the doomed Navy submarine USS R-12.

Baldwin's father, Fredrick Edward Cashell, and 41 other men died in June 1943 when the submarine sank off the Florida Keys during a World War II training exercise. The R-12 could not be found, and as Baldwin went from an 8-year-old girl to a 75-year-old woman, she all but lost hope that it would ever be discovered.

"As a teenager, I found myself looking for him, because there was never a funeral," Baldwin said. "There was never a memorial service.... There was nothing."

But in 2011, a relative forwarded her a website claiming that the submarine had been found. Ocean explorer Tim Taylor, who set up the site, wanted to get in touch with relatives of the victims.

Within months of speaking with Taylor, Baldwin and her two siblings boarded a boat and headed out into the Atlantic with Taylor and his wife and fellow explorer, Christine Dennison. About 11 miles off Key West, Taylor took out his computer and pulled up drone images of the long-lost vessel — a sight that Baldwin said took her breath away.

Then they held a memorial service for her father and the other men who died aboard the R-12, tossing 42 roses into the water directly above where the submarine lay at the bottom of the ocean.

"That was a completion of 70 years of waiting," said Baldwin, now 86, weeping as she spoke. "It was a life-changing experience."

Taylor's team has found a total of seven Navy submarines — five of which disappeared during World War II — bringing a measure of closure to hundreds of family members like Helen Baldwin.

Taylor was honored this week with the Navy's highest civilian award, the Navy Distinguished Public Service Award. His team is credited with having discovered the final resting places of 288 men, all locked inside what had become sunken tombs.

"Every one of these lost submarines, along with our other ships, to the U.S. Navy is a hallowed site," Sam Cox, a retired rear admiral who is director of Naval History and Heritage Command, said at the ceremony at the Navy Yard in Washington, D.C.

"It's a last resting place of sailors who made the ultimate sacrifice in the service of our country, and in effect, it's the Arlington National Cemetery for the Navy," he said.

In an interview just before the ceremony, Taylor said he is motivated by a desire to bring comfort and closure to family members denied the chance to fully mourn their loved ones.

"It's not about finding wrecks. It's not about finding ships," Taylor said. "The loss of someone even 78 years ago, and not knowing where they are, leaves a hole in families. The importance of our work is to connect families and bring some type of closure and peace even generations later."

The son of a Navy Veteran who fought in World War II, Taylor has spent his life exploring the ocean's uncharted waters.

He began his career focused on scientific explorations, leading to his discovery of numerous reefs around the world. He participated in shark research projects and underwater archaeological missions, and he hosted several National Geographic expeditions.

Around 2010, Taylor became interested in finding historic military shipwrecks.

"I knew I had the technology and the skills and the background to find these things," Taylor said.

He began researching lost submarines. Then he started plotting them out using the same navigational programs he turned to for other exploration projects.

Technological breakthroughs changed the way exploration could be done. Gone were the days of lowering hundreds of feet of cable and dragging imaging devices through the waters.

Now he had access to autonomous robots that use sonar to detect objects in the dark depths of the seas and the oceans.

"These autonomous vehicles, we just throw them in the water," said Taylor, who said they have been programmed for the task.

Taylor likened the robots to the rovers used to explore Mars.

A needle in a haystack

Built in 1918, the R-12 was the oldest submarine used in World War II. It was recommissioned as a training vessel in 1940.

On June 12, 1943, the R-12 headed out from Key West to practice launching torpedoes. But as the boat prepared to dive, the forward battery compartment began to flood, and the sub sank in 15 seconds, according to a Navy Court of Inquiry.

The hunt for the R-12 came at a unique time in Taylor's life. He was set to be married two months later to Dennison, a polar ocean explorer who became an integral part of the expedition.

They put up $750,000 of their own money to fund the search. And in October 2010, Taylor ventured out into the waters off Key West and detected a large object about 600 feet below the surface. He knew almost immediately that he had discovered the R-12.

"It's like looking for a needle in a haystack, and when you realize you have found it, the magnitude of the moment hits home," Taylor said.

As Dennison put it: "It wasn't just locating that submarine, but it was locating a crew of heroes that had been in their final resting place."

Taylor and Dennison returned to the site a year later with a new underwater vehicle equipped with a high-definition camera. They returned to land with high-resolution images of the R-12.

The discovery became a turning point for the intrepid newlyweds. They launched the Lost 52 Project dedicated to locating the 52 U.S. submarines that disappeared during World War II.

"It was not like any other discovery I had ever made," Taylor said of finding the R-12. "There were 42 souls on board that vessel. And submarines contain and keep water out. They keep bodies and souls in. And it became a responsibility for us to connect those lost sailors with their families."

They set out to raise money to expand their operations. And in the last 10 years, Taylor's team has found six more submarines off Hawaii, Alaska, Panama, the Philippines and Japan.

Taylor and Dennison continue to search for more World War II-era Navy vessels that never returned to shore. They believe it is essential for private explorers — and the philanthropists who fund them — to take up the challenge of scouring the seas and oceans for lost military vessels.

"This is a daunting task," Taylor said after he accepted his award from the Navy. "We strive to set an example that others will follow."

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On April 5, 2022, we acknowledge and support the spouses of all those who served our nation

Gold Star Spouses Day is today, Tuesday, April 5. It honors the loved ones of U.S. military members who have lost their lives; it acknowledges and remembers the spouses who have stood behind our military members.

Originally called Gold Star Wives Day when it was founded in 1945, the day of remembrance is known now as Gold Star Spouses Day, though some still use the names interchangeably.

Tamra Sipes, national president of Gold Star Wives of America, a nonprofit service organization, is the surviving spouse of Navy SAR Corpsman Robert Sipes. He died in October 1995 in a house fire at age 34. She was only 28, with three small children, when she was widowed.

"You lose the love of your life, it's hard to put one step in front of another," Sipes told Fox News Digital in a phone interview.

"And it's week by week. And the first year. It's like a blur. [But] you just move forward," she added.

Robert Sipes served for 10 years in the Navy as a search and rescue corpsman, with over 50 missions completed. He was stationed at Naval Air Station Whidbey Island (NASWI) in Washington state.

After his death, Tamra Sipes, who is based in Washington state to this day, kept food on the table by working in the hospitality industry, she said.

Her son Steven Sipes, 35, is today in the Navy Reserves as a Seabee. He joined the military when he was 19; he spent almost a year in Afghanistan in 2010.

Since 2015, Tamra Sipes has been an active member of Gold Star Spouses. She also began volunteering with the Tragedy Assistance Program for Survivors (TAPS; taps.org) in 2017.

"Eventually, you start to move through [the grief and the loss] — then you want to help others," she said.

Sipes said that the Gold Star Wives group "is here for anyone who has lost a loved one, whether it was over in theater, whether it was here as an accident, whether it was during training or in combat, or whether it was a service-connected illness years later."

Among its goals: Gold Star Wives is fighting to enhance and improve the financial benefits for U.S military spouses and families today.

Referring to an earlier period of time, Sipes said of the benefits given to spouses years ago, "I think [people received] a $10,000 check. It was, 'Good luck, God bless, please move out of any base housing, you've got 30 days,'" she added, recounting what spouses were apparently once told.

"This has changed in the last 10 years," she added.

One issue that surfaced in the past was around the Survivor Benefit Plan (SBP) and the Dependency and Indemnity Compensation (DIC). Survivors did not receive the full amount from those funds, said Sipes.

Recently, Congress enacted changes; as a result, in 2023, the offset in annuity payments from the SBP for surviving spouses will be eliminated for those who are also receiving DIC benefits from the Department of Veterans Affairs.

Sipes credited her organization, as well as supporters such as Sen. John Boozman, R-Ark., and Sen. Jon Tester, D-Mont., for pushing for changes to help surviving family members.

Gold Star Wives of America also advocated for a Gold Star Children's Day, to recognize and acknowledge the sacrifices and the existence of the children of fallen service members. Sens. Roger Wicker, R-Miss., and Joe Manchin, D-W.Va., introduced a resolution to designate August 1 as such.

Yet another win was a change to the Remarriage Penalty. The DIC remarriage age has now gone from 57 to 55, which aligns it with other federal survivor programs, as Gold Star Wives notes on its website (goldstarwives.org).

‘New generation coming along’

Many surviving spouses of deceased military are from the Vietnam era of military service, Sipes indicated; many are living on little more than a Social Security check and their DIC payment.

"We’re trying to help this generation," said Sipes.

"Then you have a new generation that's coming [along], which has larger benefits when they lose someone," she said.

She said this group often benefits from orientation and education about how to maintain the benefits for themselves and their families, "to invest or whatever else they need to do" to maintain their family's security, she said.

There is so much more work to be done on behalf of these families, she said. That is why, she emphasized, "every voice counts."

She urged all Americans to contact their elected leaders in Congress.

"It is one letter at a time, one email at a time" that makes a difference, she said. "It takes everybody doing that in order to be heard — a small army."

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Raised in a small Alabama town, I signed up for the Air National Guard right after high school, intending to earn money for college and to see the world. My time in the Guard exposed me to new experiences and taught me the value of service and, after six years in the military, I thought I could handle anything that came my way.

But then I was sexually assaulted, and I became lost. Overwhelmed by trauma, I turned to drugs to escape. I left the military, and my addiction deepened, overtaking every facet of my life. At 29, I was arrested for a drug-related crime and sent to prison.

The shame I felt over my crime and incarceration was all-consuming. I'll never forget reading the title on my indictment, United States of America vs. Carla Bugg. I felt I'd forfeited any right to be recognized for my service, and I was pretty sure the military didn't want anything more to do with me.

What I didn't realize was just how many Veterans become incarcerated. One in three of our 19 million Veterans report having been arrested and booked at least once, and roughly 181,500 are behind bars. Many land there because of struggles with PTSD, traumatic brain injuries or substance use disorders, risk factors that make the jarring transition from military service to civilian life all the more challenging.

I now work at an agency that helps people leaving prison or jail by connecting them with treatment and jobs. Like me, many Veterans I meet feel they disgraced the uniform when they committed their crime. And like me, most did not mention their Veteran status when entering the criminal justice system. What's odd, however, is that nobody ever asks.

That oversight can have major consequences, and it's not a new problem. In 1979, President Jimmy Carter issued a memo noting that "we lack comprehensive information about imprisoned Veterans" and directing federal agencies to collect accurate data. Sixteen years later, Congress began requiring that states have a policy for identifying the Veteran status of people in prison in order to be eligible for certain grants. Unfortunately, these attempts never brought about much change.

The Department of Veterans Affairs has developed tools to help law enforcement, jails and courts verify a person's Veteran status, but they are rarely used. Just nine of 18,000 police agencies in the U.S. and 11% of 3,100 jails use the systems.

Further complicating the identification challenge is an inconsistent definition of the term "Veteran." The federal government, the states, criminal justice agencies and individual programs for Veterans all differ in the specific criteria they use to determine who is, and who isn't, a Veteran. Length of military service and type of discharge are among the conflicting variables.

All of this adds up to a big problem: Too many Veterans fail to receive targeted treatment for their unique set of problems while incarcerated, and many who might qualify for special treatment courts or other opportunities to be diverted away from jail or prison never get the chance. Without proper interventions to address their PTSD, addiction or other challenges, many Veterans struggle as they reenter society -- and some commit more crimes. That's bad for individuals and for public safety, as well.

I witness the fallout from this cycle every day in my work, and my frustration is one reason I joined the Council on Criminal Justice's Veterans Justice Commission. Our panel, led by former Defense Secretaries Chuck Hagel and Leon Panetta, both Veterans, is examining why so many Veterans land in prison or jail, and developing recommendations to help change that trajectory.

This month, we released our first proposals for action, addressing problems Veterans face at the front end of the justice system, from arrest through sentencing. Improving the identification of Veterans when they encounter the system is one of them. We also recommend expanding access to Veterans treatment courts and increasing other opportunities for Veterans to avoid prosecution, conviction or incarceration if they complete programs requiring them to take responsibility for their actions and address issues underlying their criminal offenses. Finally, we're urging the federal government to establish a National Center on Veterans Justice to fund badly needed research and coordinate Veteran support across the country.

As I know well, Veterans who end up in our justice system face a special struggle, one overlaid with shame over breaking the laws of a nation they once fought to protect. By identifying Veterans at the front door of the justice system, and getting them the treatment they need, we can reduce crime and do better by those who have served.

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Months after retirees overseas started getting word that their APO/FPO mail privileges would be cut off Aug. 24, they’re still waiting for a definitive answer.

“I think most everyone here is taking a ‘wait and see’ attitude and hoping DoD doesn’t cut us off,” said Mark Favreau, volunteer director of the U.S. Military Retiree Support Services Office for Metro Manila in the Philippines. He said retirees haven’t heard anything from DoD.

Defense officials have been reviewing retirees’ mail privileges since June. Information was not available from DoD about the status of that review.

In June, a DoD spokesman told Military Times “we are reviewing this issue to ensure authorized military postal service patrons are provided access worldwide.”

Many retirees are questioning why this change is being considered in the first place, after decades of being able to use APO/FPO addresses overseas.

According to DoD statistics, about 40,000 military retirees live overseas, plus family members of these retirees.

A major concern among military retirees is that they would no longer be able to get their prescription medications through the Tricare Express Scripts mail-order pharmacy. Express Scripts Pharmacy can only mail prescriptions to U.S.-based addresses, State Department Pouch Mail and APO/FPO/DPO addresses. The Military Postal Service Agency provides postal services to DoD personnel and their families at locations around the world.

It’s not clear where the idea for the policy change originated — the Military Postal Service Agency or someone higher up in the DoD chain.

In May, Defense Department officials published a policy change that has been interpreted to mean that the only people authorized to use the APO/FPO system are military members and their dependents, DoD civilians and their dependents, and contractors who are authorized to accompany the force. That leaves out military retirees and others, such as Red Cross employees.

After the May DoD policy change, Military Postal Service Agency officials notified their overseas postal communities that affected patrons would be given 90 days advance notice that they will no longer be able to use APO/FPO service, according to a Military Postal Service Agency email obtained by Military Times.

Agency officials “recognized the need to clarify authorized users of the [military postal system] after a legal review determined that some MPS patron categories included over time are either not authorized by law or not permitted by host nation agreement,” according to the DoD statement to Military Times in June. Those status of forces agreements vary by country.

Money is also a factor. “The same review was also unable to locate established fiscal authority for seven of the listed categories” of patrons, DoD officials told Military Times.

There are limits on the privileges. For example, in the Philippines, items are limited to one pound for retirees using the military mail system.

For retirees living overseas, losing APO/FPO mail privileges could affect a number of areas of their lives. For example, for retirees voting absentee in states that don’t have the ability to send or receive absentee ballots online, this could affect their ability to vote.

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Like many inventions, the discovery of Teflon happened by accident. In 1938, chemists from Dupont (now Chemours) were studying refrigerant gases when, much to their surprise, one concoction solidified. Upon investigation, they found it was not only the slipperiest substance they’d ever seen – it was also noncorrosive and extremely stable and had a high melting point.

In 1954 the revolutionary “nonstick” Teflon pan was introduced. Since then, an entire class of human-made chemicals has evolved: per- and polyfluoroalkyl substances, better known as PFAS. There are upward of 6,000 of these chemicals. Many are used for stain-, grease- and waterproofing. PFAS are found in clothing, plastic, food packaging, electronics, personal care products, firefighting foams, medical devices and numerous other products.

But over time, evidence has slowly built that some commonly used PFAS are toxic and may cause cancer. It took 50 years to understand that the happy accident of Teflon’s discovery was, in fact, a train wreck.

As a public health analyst, I have studied the harm caused by these chemicals. I am one of hundreds of scientists who are calling for a comprehensive, effective plan to manage the entire class of PFAS to protect public health while safer alternatives are developed.

Typically, when the U.S. Environmental Protection Agency assesses chemicals for potential harm, it examines one substance at a time. That approach isn’t working for PFAS, given the sheer number of them and the fact that manufacturers commonly replace toxic substances with “regrettable substitutes” – similar, lesser-known chemicals that also threaten human health and the environment.

Toxic chemicals

A class-action lawsuit brought this issue to national attention in 2005. Workers at a Parkersburg, West Virginia, DuPont plant joined with local residents to sue the company for releasing millions of pounds of one of these chemicals, known as PFOA, into the air and the Ohio River. Lawyers discovered that the company had known as far back as 1961 that PFOA could harm the liver.

The suit was ultimately settled in 2017 for US$670 million, after an eight-year study of tens of thousands of people who had been exposed. Based on multiple scientific studies, this review concluded that there was a probable link between exposure to PFOA and six categories of diseases: diagnosed high cholesterol, ulcerative colitis, thyroid disease, testicular cancer, kidney cancer and pregnancy-induced hypertension.

Over the past two decades, hundreds of peer-reviewed scientific papers have shown that many PFAS are not only toxic – they also don’t fully break down in the environment and have accumulated in the bodies of people and animals around the world. Some studies have detected PFAS in 99% of people tested. Others have found PFAS in wildlife, including polar bears, dolphins and seals.

Widespread and persistent

PFAS are often called “forever chemicals” because they don’t fully degrade. They move easily through air and water, can quickly travel long distances and accumulate in sediment, soil and plants. They have also been found in dust and food, including eggs, meat, milk, fish, fruits and vegetables.

In the bodies of humans and animals, PFAS concentrate in various organs, tissues and cells. The U.S. National Toxicology Program and Centers for Disease Control and Prevention have confirmed a long list of health risks, including immunotoxicity, testicular and kidney cancer, liver damage, decreased fertility and thyroid disease.

Children are even more vulnerable than adults because they can ingest more PFAS relative to their body weight from food and water and through the air. Children also put their hands in their mouths more often, and their metabolic and immune systems are less developed. Studies show that these chemicals harm children by causing kidney dysfunction, delayed puberty, asthma and altered immune function.

Researchers have also documented that PFAS exposure reduces the effectiveness of vaccines, which is particularly concerning amid the COVID-19 pandemic.

Regulation is lagging

PFAS have become so ubiquitous in the environment that health experts say it is probably impossible to completely prevent exposure. These substances are released throughout their life cycles, from chemical production to product use and disposal. Up to 80% of environmental pollution from common PFAS, such as PFOA, comes from production of fluoropolymers that use toxic PFAS as processing aids to make products like Teflon.

In 2009 the EPA established a health advisory level for PFOA in drinking water of 400 parts per trillion. Health advisories are not binding regulations – they are technical guidelines for state, local and tribal governments, which are primarily responsible for regulating public water systems.

In 2016 the agency dramatically lowered this recommendation to 70 parts per trillion. Some states have set far more protective levels – as low as 8 parts per trillion.

According to a recent estimate by the Environmental Working Group, a public health advocacy organization, up to 110 million Americans could be drinking PFAS-contaminated water. Even with the most advanced treatment processes, it is extremely difficult and costly to remove these chemicals from drinking water. And it’s impossible to clean up lakes, river systems or oceans. Nonetheless, PFAS are largely unregulated by the federal government, although they are gaining increased attention from Congress.

Reducing PFAS risks at the source

Given that PFAS pollution is so ubiquitous and hard to remove, many health experts assert that the only way to address it is by reducing PFAS production and use as much as possible.

Educational campaigns and consumer pressure are making a difference. Many forward-thinking companies, including grocers, clothing manufacturers and furniture stores, have removed PFAS from products they use and sell.

[Understand new developments in science, health and technology, each week. Subscribe to The Conversation’s science newsletter.]

State governments have also stepped in. California recently banned PFAS in firefighting foams. Maine and Washington have banned PFAS in food packaging. Other states are considering similar measures.

I am part of a group of scientists from universities, nonprofit organizations and government agencies in the U.S. and Europe that has argued for managing the entire class of PFAS chemicals as a group, instead of one by one. We also support an “essential uses” approach that would restrict their production and use only to products that are critical for health and proper functioning of society, such as medical devices and safety equipment. And we have recommended developing safer non-PFAS alternatives.

As the EPA acknowledges, there is an urgent need for innovative solutions to PFAS pollution. Guided by good science, I believe we can effectively manage PFAS to reduce further harm, while researchers find ways to clean up what has already been released.

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A new online library documents the CIA-led campaign that made it the most bombed nation in history, the effects of which are still felt by Laotian Americans today.

A new initiative is aimed at raising awareness about a dark and often forgotten chapter of U.S. history: the secret bombing of Laos during the Vietnam War.

Nearly half a century later, most Americans — and even many young Laotian Americans — know little about the clandestine, nine-year, CIA-led military campaign informally called the “secret war.”

Unlike the Vietnam War, the secret war is seldom taught in U.S. schools. For Laotian elders, most of whom came to the U.S. as refugees during and after the war, the memories can be too traumatic to revisit. Some take them to the grave.

The mission of the Legacies Library, a project of the Washington, D.C.-based group Legacies of War, is to keep the secret war from being lost to time.

A small team of volunteers has begun compiling educational materials about the war, including documentaries, scholarly research and government documents, and uploading free digital versions online.

They’re just getting started, said Sera Koulabdara, executive director of Legacies of War.

“We’re trying to preserve this history so we can protect the future,” said Koulabdara, who was born in Laos but largely grew up in Ohio. “We wanted to encourage more people to write about it and take interest in their history, including the American public.”

It wasn’t called the secret war for nothing.

The Johnson and Nixon administrations each oversaw U.S. military operations in Laos — technically a neutral country — without informing Congress of the full scale of the American involvement.

U.S. bombers were pummeling communist supply lines on both sides of the Vietnam-Laos border, often with little regard for civilian casualties.

They dropped an estimated 2 million tons of ordnance during the conflict, making Laos, on a per-person basis, the most bombed nation in history.

Congressional hearings in 1971 made the campaign known to the public. But by 1975, the U.S. had withdrawn from Vietnam and a weary nation was ready to move on.

In Laos, the communist Lao People’s Revolutionary Party took power, which it has held ever since.

The impact of the secret war continues to be felt today, including the danger of unexploded ordnance.

About a third of the American bombs failed to explode on impact. Leftover explosives still saturate the Lao countryside, posing a threat to farmers and children. Some 50,000 people have been killed or injured by unexploded ordnance since 1964, according to AUSLAO-UXO, a company with Lao and Australian owners that provides clearance services.

As the war wound down, thousands of refugees left Laos, with a large share settling in the U.S.

According to U.S. government data, there are about 200,000 Laotian Americans, nearly all of whom trace their heritage to this time, while the Hmong American community, which also includes many refugees from Laos, numbers around 300,000. The Hmong are a separate ethnic group — with a language and cultural traditions distinct from Lao — who have over the last two centuries migrated from China into parts of Southeast Asia.

Southeast Asian immigrants from this era often bury war memories in a “culture of silence,” mental health advocates say.

Some research suggests this trauma can be passed down through generations, manifesting in a sense of rootlessness or a lack of Lao identity among descendants.

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Legacies of War, formed in 2004, spent years pushing Congress to increase funding for bomb clearance in Laos. Its efforts paid off in 2016, when then-President Barack Obama became the first sitting U.S. president to visit the country. He doubled annual support for ordnance clearance efforts to $30 million.

That started to address one legacy of the secret war, but another one loomed: Americans’ continuing lack of awareness about it.

The idea for the Legacies Library came in 2020, after Koulabdara found herself sharing memories with Jessica Pearce Rotondi, a journalist and author in New York she met through social media.

Both had spent years rifling through musty boxes, trying to make sense of the family histories their loved ones could never tell.

After her father died in 2017, Koulabdara found photos from his childhood, old journals and notes from his career as a surgeon in Laos.

Rotondi had been researching her memoir “What We Inherit,” about her family’s search for answers about her uncle, an American pilot during the Vietnam War who never came home.

Searching her childhood home, she found boxes of heavily redacted, declassified CIA documents concerning his service, as well as stacks of letters that chronicled the family’s quest to find him.

Their exchanges convinced them of the need for more transparency about the bombing campaign in Laos.

“Those bars separated families and continue to keep Americans from knowing their history,” Rotondi said in an email, referring to the blacked-out portions of the documents. “Our goal with Legacies Library is to stop the silence around the Secret War.”

Two years later, the Legacies Library is taking shape.

Fact sheets and congressional testimonies offer a crash course on the continuing problem of unexploded ordnance in Laos. There are also links to books and documentaries selected by a Legacies of War review committee.

One of the library’s crown jewels is a group of 32 drawings by Lao villagers.

Collected by an American volunteer, Fred Branfman, in the 1970s, they depict what the U.S. air war looked like from below. They represent one of the only forms of direct testimony about the war by the Lao people.

Down the road, organizers hope to find funding for the library — it’s now run by volunteers — and add new, unique holdings.

One area where the library is lacking, Rotondi said, is its resources about the Hmong people, many of whom were key U.S. partners during the war. A museum in Minnesota, a state that nearly a third of Hmong Americans call home, commemorates that part of the story.

As for government materials, Sens. Patrick Leahy, D-Vt., and Sheldon Whitehouse, D-R.I.,are supporting efforts to declassify more CIA documents.

Another prospect is to add oral histories. As they become grandparents, some immigrants from Laos have started to open up about their war experiences.

It’s the curiosity of younger generations, though, that may make a fuller reconciliation possible.

In February, Laotian Ambassador to the U.S. Khamphan Anlavan gave an award to siblings Hyleigh and Prinston Pan, high schoolers in California, for their work to commemorate the secret war.

Hyleigh Pan has gathered testimonials for Southeast Asia-related legislation and helped produce a documentary about unexploded ordnance in Laos. Prinston Pan has recorded more than a dozen oral histories and organized school fundraisers for bomb cleanup in the country.

He has also written a children’s book, “Kong’s Adventure,” based on the experience of his grandfather, who served as a police chief in Laos under the U.S.-backed government before fleeing the communist takeover with his family and starting a new life in Kansas.

All proceeds go to the Legacies Library.

In an interview, Prinston Pan said that talking to the ambassador felt familiar, like talking to his grandfather.

The award, he thinks, “comes from a mutual care for the Lao community in general.”

“Over time, someone has to take the step forward in healing those wounds from the past.”

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President Donald Trump signed the FY 2020 National Defense Authorization Act (NDAA) on Dec. 20 in a ceremony at Joint Base Andrews, Md. This landmark legislation culminates the many efforts ranging from grassroots visits at home to coordinated campaigns on Capitol Hill over a period of time ranging from months to decades.

MOAA’s Storming the Hill in April, and the Summer Storm in August, were instrumental in increasing awareness and support for the military pay raise, repeal of the “widows tax,” and protecting TRICARE and military medicine. The NDAA represented success in all of these advocacy priorities.

These engagements and achievements led to MOAA being recognized for the 13th year in a row as a top lobbyist by The Hill, a news outlet based in Washington D.C.

Here’s what’s included in the NDAA, and a look at these critical issues moving forward:

Pay Raise

What’s In: A 3.1% raise effective Jan. 1, 2020. The raise matches the administration’s request and is the largest pay increase for troops in 10 years. A 3.1% increase equates to an annual raise of $1,200 for an O-3 with 10 years of service.

What’s Next: MOAA will again start working to ensure the president’s budget for the next fiscal year includes a pay raise based on the Employment Cost Index (ECI) report from October 2019. Based on that figure, next year’s raise should be 3.0%.

TRICARE

What’s In: Congress approved no new fees or pharmacy increases in 2020. Previously agreed upon increases for medical and pharmacy copays will take effect in January 2020.

What’s Next: MOAA will continue to lobby against any disproportional fee increases that may exceed cost-of-living adjustments.

Medical Billets

What’s In: MOAA’s extensive efforts on the medical billet reduction issue paid off with a provision that addresses concerns regarding both medical readiness and beneficiary access to high quality care.

What’s Next: The provision prohibits DoD and the services from reducing medical end strength authorizations until they complete a series of steps. MOAA will monitor and ensure DoD performs the following:

• A review of medical manpower requirements of each military department under all national defense strategy scenarios.
• An analysis of affected billets together with mitigation plans to address potential gaps in health care services.
• The creation of metrics to determine TRICARE network adequacy.
• The establishment of outreach plans for affected beneficiaries, including transition plans for continuity of health care services.

Survivor Benefits

What’s In: After nearly 50 years, MOAA’s efforts and the efforts of others finally paid off with the elimination of a financial penalty more than 65,000 military survivors face, known as the “widows tax.” Eliminating the widows tax has been a top legislative priority for MOAA for decades.

Earlier this year, more than 150 members from around the country came to Washington, D.C. to participate in MOAA’s annual Storming the Hill event. One of the main topics MOAA members raised with their elected officials was eliminating the widows tax.

What’s Next: According to the legislation, the offset will be phased out over a three-year period in this fashion:

2020: No changes. Current Special Survivor Indemnity Allowance (SSIA) and all current Survivor Benefit Plan-Dependency and Indemnity Compensation (SBP-DIC) offsets remain in place. MOAA will continue to follow the evolution of directives which will support the implementation and ultimate completion of this repeal.

2021: The SBP-DIC offset is reduced by one third. Annuitants will receive the amount that would exceed two-thirds of the Dependency and Indemnity Compensation.

2022: The SBP-DIC offset is reduced by two-thirds. Annuitants will receive the amount that would exceed one-third of the Dependency and Indemnity Compensation.

2023: The SBP-DIC offset is eliminated. Annuitants will receive the full amounts of both SBP and DIC. Further, on Jan. 1, 2023, survivor benefit eligibility is restored to those who previously elected to transfer payment of their annuity to a surviving child or children.

Guard and Reserve

What’s In: For those National Guard and Reserve servicemembers who served on 12304B orders, such service will now count toward their active duty time to lower the age when they receive their retirement pay.

What’s Next: MOAA will continue to work to identify and correct inequities in service and benefits borne by servicemembers and their families in the Guard and Reserve. MOAA recently engaged the Defense Finance and Accounting Service (DFAS) to address the inordinate delay for retiring reservists – many routinely having to wait over 6 months to receive their retirement pay. Additionally, MOAA will continue to seek a standardized service record for members of the reserve component.

Medical Malpractice

What’s In: To address non-combat related military medical malpractice, the NDAA directs DoD to develop a regulation for negligent malpractice to be addressed through the military legal system. Although this is not a repeal of the 1950s era “Feres Doctrine,” it provides a framework of redress for servicemembers who have suffered from medical malpractice. The NDAA authorizes a payment up to $100,000 by DoD judges and higher amounts by the Department of the Treasury.

What’s Next: MOAA will monitor implementation and ensure our members and prospects understand the procedures and policies to be written in support of this legislation.

Spouse and Family

What’s In: After identifying significant health and safety concerns in military housing, MOAA elevated these issues to DoD and Congress, culminating with congressional hearing that built the foundation of legislation to direct improvements. This bill underwrites the most comprehensive military housing reform since 1996.

What’s Next: MOAA will watch closely the implementation of this housing reform to ensure the results follow the rigorous efforts leading to the bill, ensuring compliance with the following legislated actions:

• Establish a tenant bill of rights and responsibilities.
• Ensure medical costs and relocation expenses are covered by landlords.
• Formalize a dispute resolution process.
• Ensures a proper work order system and complaint database are in place along with a number of other provisions correcting gaps and negligence in the Military Housing Privatization Initiative (MHPI) system.
• Expand direct hire authority for DoD for child care providers. Additionally, take a closer look at the capacity of child care centers on post and streamline hiring to ensure they are properly staffed.

The bill also expands spouse employment resources, such as an increase to $1,000 for licensure reimbursement as well as expansions to the My Career Advancement Account (MyCAA) program for any degree area and to include Coast Guard spouses.

This defense bill is a big win for servicemembers and their families. MOAA thanks Congress for its bipartisan work, and President Trump for endorsing the legislation and extending our nation’s streak of producing a defense bill to 59 years.

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An experimental vaccine designed to protect against many flu virus strains has yielded promising results in an efficacy trial. NIAID investigator Matthew J. Memoli, M.D., designed and led the trial, which involved administering one or two doses of the experimental vaccine or a placebo injection to healthy adults. All the volunteers were later exposed to a strain of seasonal influenza virus under carefully controlled conditions. The aim was to determine whether the experimental vaccine, FLU-v, lessened the chance that a volunteer would develop flu symptoms and viral shedding. Trial results were published March 13 in the journal npj Vaccines.

FLU-v is an example of a “universal” influenza vaccine candidate, a still-experimental vaccine that may provide long-lasting protection against most or all flu strains. Traditional seasonal flu vaccines trigger production of antibodies aimed at a part of a flu virus surface protein that varies widely from strain to strain and that changes continuously. Therefore, flu vaccines must be re-formulated and administered annually to match newly arising strains. In contrast, FLU-v is designed to prompt a response not by antibodies, but by a separate arm of the immune system—cellular immunity. Cellular immune responses include activity by white blood cells called cytotoxic T lymphocytes (CTLs). Recent research has shown that influenza-specific CTLs can seek out and remove virus-infected cells before and after flu symptoms arise. The FLU-v vaccine is designed to stimulate production of these flu-specific CTLs by targeting several proteins inside the virus that do not vary much from strain to strain, meaning that CTL responses against them may be effective against many virus strains. FLU-v is being developed by the London-based company PepTcell (SEEK).

In the recent trial, participants were randomly assigned to one of three groups and given two injections spaced 21 days apart. One group received two doses of FLU-v; a second group received one dose of FLU-v and one saline placebo; the third group receive two injections of placebo. The trial was blinded, meaning neither the volunteers nor any trial investigators were aware of group assignment. All volunteers were exposed via a nasal spray to live influenza virus either 43 or 22 days after the second injection. The flu challenge portion of this trial took place at Hvivo, London, UK.

Volunteers who received one or two doses of FLU-v were significantly less likely to develop mild to moderate influenza disease (MMID) than placebo recipients. In the placebo group; 23 of 42 volunteers (54.8%) experienced MMID, defined as virus shedding and clinical influenza symptoms, while 15 out of 41 (36.6%) volunteers in the two FLU-v doses group and 13 out of 40 (32.5 %) of those who received one dose of FLU-v experienced MMID. Dr. Memoli stated that the results of this study “suggest that cellular immunity may be a very important and necessary component of future broadly protective universal influenza vaccines.”

Dr. Memoli and his colleagues in NIAID’s Laboratory of Infectious Diseases developed both the challenge virus strain and model of human influenza challenge used in this trial. Previous human influenza challenge trials conducted in the NIH Clinical Center’s Special Clinical Studies Unit by Dr. Memoli demonstrated that the challenge virus reliably causes MMID in most recipients. In this video tour, Dr. Memoli shows special features of the unit where these trials were conducted.

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In an effort to level the promotion playing field, the Defense Department is considering stripping out identifying details from packets put together for board consideration.

Following a directive from Defense Secretary Mark Esper, to remove photos from that paperwork, top Pentagon leadership Friday discussed the possibility of further streamlining the information available to promotion boards, to focus on accomplishments and experience.

While senior officials have previously acknowledged that photos can affect a decision about a promotion, Esper is also considering whether names or sex “may trigger unconscious bias,” he said in a town hall livestreamed from the Pentagon briefing room.

The discussion came in response to a video message from a Black Army first sergeant, an immigrant.

“We’re a taking a very holistic look at the way that boards can look at packages, by virtue of merit, into promotion,” Senior Enlisted Advisor to the Chairman Ramon Colon-Lopez said. “I know that the secretary and the chairman can agree that we can do better on those boards.”

On Wednesday, following the Army’s example, Esper released a memo that directed the removal of promotion packet photos, but also ordered a review of ways to encourage diversity and inclusion in the services while rooting out bias.

Also on that lists were reviews of training and the Equal Opportunity program, as well as grooming standards, after some feedback suggested that regulations unfairly burden certain troops.

It was the first set of actions from a DoD team tasked with recommending improvements, with the goal of standing up an independent board of non-military, non-defense officials further down the road.

Beyond that top-down guidance, Esper directly encouraged leadership during the town hall to open up discussions in their units about diversity and inclusion.

He stressed “the importance of having that conversation and the difficulty in initiating it. The importance of giving our folks the lexicon ― the words, the definitions ― to start talking about things like discrimination, racism.”

His guidance came in response to a taped video message from a Black senior airman, who shared a success story in speaking to her chain of command about racial bias in her air wing.

“They are very difficult conversations,” Esper said. “I think once you get in a group and you get over that initial reluctance to have that conversation, people really start talking and you get great insights into their experiences, their perceptions.”

Esper said he had “put out word to leadership” to that end, in addition to holding sensing sessions around the country during his travels to installations coping with changes to their operations during the COVID-19 pandemic.

“You’ve got to have these conversations,” he said. “you’ve got to facilitate and you’ve just got to be able to have that discussion. People want to talk, and we have to be able to listen, as well.”

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The Manatee County Veterans community is making sure that an 87-year-old Korean War Veteran who died alone, without immediate family, and whose ashes went unclaimed for several months, goes to his final resting place with full military honors.

Pvt. Albert Leroy Hall died in Parrish on May 10, 2021. His remains will be interred at Sarasota National Cemetery on Oct. 7. Between his death, and his planned service, strangers who did not know Hall went out of their way to make sure that he received a respectful service and thanks for his time in the military.

Sandy Gessler, an Army Veteran and historian for American Legion Post 312 in Bradenton, said even though she never met Hall, she considers him family.

“I know him. He’s family. He is ours. He served for us. When you think about him, the tears come,” she said. “We leave nobody behind.”

Groover Funeral Home handled the cremation of Hall’s remains. When Duane LaFollett, an area general manager for Dignity Memorial, owner of Groover Funeral Home, heard that a Veteran’s remains had gone unclaimed, he began making calls.

One of those calls went to Gessler, who, with Manatee County Veterans Service Officer Lee Washington, was able to confirm Hall’s Veteran status and obtain approvals for a resting place and marker at Sarasota National Cemetery.

“We are glad to be able to work with Sandy and to make sure that someone who served the armed forces was able to be placed in the national cemetery,” Rick Groover, general manager of Groover Funeral Home, said.

‘He was a very quiet, private person’

Little is known about Pvt. Hall or his service. In 1973, a fire at the National Personnel Records Center in St. Louis, Missouri, destroyed the records of many Veterans. Hall entered the service in New York City when he was 18, and for the last 18 years of his life, he lived in Parrish, Gessler said.

“He was a very quiet, private person and did not venture out much, especially in his last years”, she said. “His significant other passed away eight years earlier.

“He did not even realize he could have gotten medical attention through the VA, or have been moved into senior housing,” she said.

Carolie Holbrook, a former neighbor of Hall’s who has moved out of the area, said he was a retired auto body worker.

“Al was very quiet, very private, but you would often see him riding his four-wheel cycle in the village,” Holbrook said.

Arrangements for Pvt. Hall include an escort by the American Legion Riders, Patriot Guards and Veterans. The Florida National Guard will provide military funeral honors.

“It is so important that Veterans work with their Veteran service officer and have their paperwork in order and know their benefits especially when a Veteran passes without family,” Gessler said.

The escort for Pvt. Hall will gather at 1 p.m. Oct. 7 at Christopher Cobb Memorial Post 312, American Legion, 1610 67th Ave. E., Oneco, and depart for Sarasota National Cemetery about 1:30 p.m. Services are set for 2:30 p.m. at the cemetery, 9810 State Road 72, Sarasota.

More than 33,000 Americans died during the Korean War between 1950 and 1953. A peace treaty has never been signed and the Korean peninsula remains one of the world’s most dangerous flash points.

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Large study hints that taking metformin before conception could raise risk of birth defects

Metformin, a first-line diabetes drug used for decades, may boost the risk of birth defects in the offspring of men who took it during sperm development, according to a large Danish study. Sons born to those men were more than three times as likely to have a genital birth defect as unexposed babies, according to the paper, published in the Annals of Internal Medicine today.

The genital defects, such as hypospadias, when the urethra does not exit from the tip of the penis, were relatively rare, occurring in 0.9% of all babies whose biological fathers took metformin in the 3 months before conception. But epidemiologists say the findings are important because tens of millions of people worldwide take metformin, chiefly for type 2 diabetes.

“When I saw the paper … I thought: ‘Yup, this is gonna go viral,’” says Germaine Buck Louis, a reproductive epidemiologist at George Mason University who wrote an editorial accompanying the report. “[Metformin] is widely used even by young men because of the obesity issue that we have. So that is potentially a huge source of exposure for the next generation.”

However, Buck Louis and every other scientist interviewed for this article stressed that the paper’s findings are preliminary and observational and need to be corroborated; they add that factors besides metformin may have influenced the findings. The scientists cautioned men with diabetes against abruptly stopping metformin before trying to conceive.

“Metformin is a safe drug, it’s cheap, and it does what it needs to do” by controlling blood sugar levels, says the paper’s first author, Maarten Wensink, an epidemiologist and biostatistician at the University of Southern Denmark. Any change in medication “is a complex decision that [a couple] should take together with their physicians,” he says.

Use of metformin, a synthetic compound that lowers blood sugar by boosting insulin sensitivity, has skyrocketed with the obesity epidemic and attendant diagnoses of type 2 diabetes. In the United States in 2004, 41 million prescriptions for the drug were written; by 2019 that number was 86 million.

The drug has been in use since the 1950s, but this is the first large study to rigorously analyze any paternally mediated impact on human birth defects. Although metformin’s use skews toward older people, the rise in diabetes means more men in their reproductive years are taking the drug. In the United States, prescriptions to 18- to 49-year-olds with type 2 diabetes grew from fewer than 2200 in 2000 to 768,000 in 2015.

The researchers analyzed records from more than 1.1 million babies born in Denmark between 1997 and 2016, using the country’s comprehensive medical registries to connect data on births, paternal metformin prescriptions, and birth defects. In the 1451 offspring of men who filled metformin prescriptions during the 90 days before conception, the period when sperm are being made, the team found a 5.2% rate of birth defects, compared with 3.3% among unexposed babies. That translated to 1.4 times higher odds of at least one major birth defect, including genital, digestive, urinary, and heart defects, after adjustments for paternal age and other factors.

For genital defects alone, the increased risk—only seen in male infants—was much larger. Among exposed babies, 0.9% had genital defects, compared with 0.24% in unexposed babies.

The numbers were small—13 metformin-exposed boys were born with genital defects. But after the researchers adjusted for factors including parental ages and maternal smoking status, they found a 3.39-fold rise in the odds of a genital defect. “The rate per se was surprisingly high,” Wensink says.

Reassuringly, the researchers saw no effect in offspring of men who took the drug earlier in life or in the year before or after the 90-day window of sperm production. “It really has to do with taking it in that window when the sperm … is being developed,” says senior author Michael Eisenberg, a urologist at Stanford Medicine.

The team also found no additional risk in unexposed siblings of metformin-exposed babies, or in infants of diabetic fathers who took insulin or were not on metformin. All those findings suggest it’s the drug’s impact on sperm formation, rather than diabetes or another factor intrinsic to the men, that’s responsible.

But the researchers acknowledge that men with diabetes who took metformin and those who didn’t may have differed in attributes such as obesity or how well their disease was controlled—data that were not accessible to the researchers.

Nor are scientists sure exactly how the drug may be impacting sperm. Studies in fish and mice suggest metformin can disrupt the development of male reproductive organs, and one small study found metformin reduced serum testosterone levels in men.

The caveats make scientists cautious about drawing conclusions from the paper. “This paper is the first word, not the last word,” says Russell Kirby, a birth defects epidemiologist at the University of South Florida. “It’s definitely going to require additional research.”

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Should the military license their logos to appear on private companies’ merchandise that also feature religious symbols or Bible verses?

Context

Service members are issued official identification markers known more popularly as dog tags. These are worn around the neck like a necklace, to identify the individual in case they die. They contain the person’s name, Social Security number, blood type, and religious preference (but not symbols or scripture).

Service members may add additional, unofficial tags to the chain if they wish. Some private companies create religiously themed, dog tag-shaped jewelry for service members which also include official service emblems and logos. A Christian company called Shields of Strength is one of the most popular businesses that produces these, creating more than four million since their 1998 founding.

But last July, the nonprofit organization Military Religious Freedom Foundation (MRFF) requested the military cease permitting the use of official logos on the company’s dog tags that feature both Bible verses or religious symbols in addition to official military logos.

The military agreed, noting that their regulations disallow any official military emblems alongside anything that explicitly “promotes religion.” Yet Shields of Strength continued producing such dog tags with the Army and Air Force logos in deliberate defiance of the order, in a dispute that may likely head to court.

Nothing in the military’s actions prevented Shields of Strength from continuing to produce and sell unofficial tags with bible verses on them provided there were no service logos. Nor did the withdrawal of the licenses prevent service members from acquiring unofficial tags with bible verses on them provided there were no service logos.

What the bill does

The Religious Insignia on Dog Tags Act would force the Secretary of Defense to allow the military to license their official military logos to private companies for the production of items that also contain religious insignia.

It was introduced in the House on January 17 as bill number H.R. 5657, by Rep. Gregory Steube (R-FL17).

What supporters say

Supporters argue the bill preserves the First Amendment right to freedom of religion, for those serving and fighting overseas to defend it.

“When I deployed to Iraq… I carried scripture and a cross my father had given me on my dog tags,” Rep. Steube said in a press release. “Recent action by the Department of Defense prohibits companies holding lawful trademark licenses for military emblems from producing dog tags that feature religious insignia, such as a Bible verse or a cross. This is unacceptable.”

“Our service members fight for our freedom and our Constitution, and one of those freedoms is our freedom of religion,” Rep. Steube continued. “Our service members should have access to dog tags that display that religious freedom and companies should not be penalized from producing those tags.”

(Rep. Steube’s statement incorrectly implied that, due to the license withdrawal, service members were no longer allowed to wear unofficial dog tags containing bible verses. This is false: they cannot purchase unofficial tags that combine bible verses and official service logos.)

What opponents say

Opponents counter that the bill would be an unconstitutional — and wrong — violation of American principles.

“The use of official Armed Forces emblems and logos on blatantly religious items like these dog tags is… an unconstitutional government endorsement of religion,” the Military Religious Freedom Foundation (MRFF) wrote in their original complaint to the military which sparked this whole story.

“The U.S. military should absolutely not be officially endorsing, through the use of its emblems and logos, the products of a company whose stated mission for selling these products is: ‘To share the love, hope, forgiveness, and power of God’s Word with others and to see people victorious in life’s battles and in a relationship with Jesus Christ.”

Opponents also counter that the military’s existing ban is actually relatively mild in scope.

“Troops are allowed to wear and carry religious items. Official military-issued dog tags are stamped with the religious affiliation of their choice. No one is denying service members the right to wear a or carry a symbol of their faith,” wrote Kayla Williams, Director of the Military, Veterans, and Society Program at the Center for a New American Security. “Rather, the Marine Corps has denied a for-profit corporation license to sell an item that includes both a religious verse and its trademarked symbol.”

Odds of passage

The bill has attracted six Republican cosponsors. It awaits a potential vote in the House Armed Services Committee. While passage is unlikely in the Democratic-controlled House, this bill could ostensibly receive some Democratic support as well.

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It's when Maurice Imhoff dons his vintage Union Army soldier uniform that he feels most connected to history. With his navy-blue wool jacket, a wooden rifle with a bayonet fixed into the muzzle and a gold eagle breastplate across his chest, he represents an often-forgotten group of soldiers – the United States Colored Troops.

"These men, once they got the opportunity, they stood up and took the call to action," Imhoff said. "They picked up the rifle, picked up the flag, and they led the way towards freedom and to free others."

Though Civil War reenactors are most often thought of as older men, Imhoff, 19, is a high school senior who graduates in June. He is a member of the 102nd U.S. Colored Troops Company C, a reenactment group in Jackson, Michigan, composed of mostly high school students.

They honor Michigan's only regiment in the colored troops, which was comprised of nearly 1,000 Black soldiers from Detroit, including men who were born in slave states. The original 102nd engaged with Confederate forces numerous times in the Deep South.

As the nation marks Memorial Day and pays tribute to those who died during military service, some remember the Black soldiers who fought on the Union side during the Civil War. Undeterred by racism, thousands of Black soldiers answered President Abraham Lincoln's call to fight for the United States and their freedom.

When the Civil War began in 1861, Black men throughout the free states were eager to volunteer, but federal law prohibited them from serving in the Army, said Kelly Mezurek, a history professor at Walsh University in North Canton, Ohio. Mezurek is a leading expert on African American service in the Civil War.

It wasn't until Lincoln signed the Emancipation Proclamation on Jan. 1, 1863, that Black men could participate in combat. This federal legislation freed slaves living in Confederate states and permitted African Americans to fight in the U.S. military.

Ulysses Grant, the Union's commanding general, wrote a letter to Lincoln expressing his support of African American troops. He and Lincoln understood that liberating Black people from slavery gave the Union an advantage on the battlefield.

"By arming the negro we have added a powerful ally," Grant wrote to Lincoln in August 1863. "They will make good soldiers and taking them from the enemy weaken him in the same proportion they strengthen us."

Even after federal law allowed African Americans to fight in the war, there were white citizens who were displeased with their participation. To make the transition more palatable, Lincoln established segregated regiments with white officers overseeing the Black units.

In May 1863, four months after Lincoln signed the Emancipation Proclamation, the War Department created the Bureau of Colored Troops, which established more than 100 African American regiments.

Even after they were accepted into the Army, Black soldiers had to prove their valor on the battlefield to win the respect of white America, said Joseph Glatthaar, a professor at the University of North Carolina who specializes in American military history.

They played critical roles in pivotal battles, including at New Market Heights, where 14 soldiers in the colored troops were awarded Medals of Honor; and the Battle of Appomattox, also in Virginia, which effectively ended the Civil War.

"We saw courage and determination in their coal-black faces," Army Capt. Luman H. Tenney, who fought alongside the colored troops at Appomattox, wrote in his diary in April 1965. He said the Black men deserved the right to vote because of their service. "Give them the ballot, for they [ensured] victory that day."

The value of the colored troops extended beyond their gallantry on the battlefield. Many of the Black regiments protected wagon trains, railroad cars and prisoners of war, Mezurek said.

"The contribution of these men is so significant that if we only look at what battles did they turn the tide of, we miss everything," she said. "The contributions were they showed up, they were there, and they did their job, and they did it well for the United States of America. We need to do better at recognizing why we have this country today is partly because of those men."

By the end of the Civil War, there were almost 200,000 colored troops, roughly 10% of the Union Army.

After the Civil War, Lincoln acknowledged the role the colored troops had in securing a Union victory. "Without the military help of the black freedmen, the war against the south could not have been won," he said.

Reenactors work to preserve those soldiers' legacies, said Algernon Ward Jr., president of the 6th Regiment United States Colored Troops Reenactors New Jersey. Though reenactments stalled during the pandemic, the group travels to schools to talk about the colored troops and participated in a flag placement ceremony to honor colored troops buried in New Jersey.

Ward worries that there aren't many young people interested in the history of the colored troops. The Michigan high school group does more than don uniforms for re-created battle scenes. The students raised $3,200 for a highway sign in Detroit honoring the original 102nd regiment.

"If it wasn't for us reenactors, who would be around to commemorate them?" Ward said. "We need the next generation to keep their memories alive."

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