Veterans will soon hold models of their own hearts pre-surgery

Veterans with heart conditions will soon be able to hold a 3D model of their own heart while talking with their doctor about possible treatments, thanks to 3D printing.

VA Puget Sound Health Care System doctors, researchers and engineers are working with their counterparts at the University of Washington (UW) School of Medicine to use 3D printing to diagnose and treat complex heart conditions.

Hold your heart in your hands

“Imagine the power of holding a life-sized 3D model of your own heart in your hands while your cardiologist discusses your treatment plan and walks you through your upcoming procedure step by step. This is the reality that we want for all of our patients,” said VA Puget Sound radiologist Dr. Beth Ripley.

Currently, without a 3D model, a surgeon creates a plan for surgery by looking through hundreds or thousands of CT or MRI scans, putting together a rough picture of the actual organ from a series of flat images. To create a model, a radiologist uses those same images to make a 3D blueprint, which is then sent to a 3D printer. The result is an almost perfect copy of the patient’s body part.

Reducing costs and shortening surgery times

Three-dimensional heart models will come in handy for a procedure called transcatheter aortic valve replacement, in which the surgeon replaces a narrow heart valve that no longer opens properly.

“Beyond improving our understanding of a patient’s anatomy, it allows us to know which catheters and replacement valves will fit, and how best to approach the particular structure,” said UW research scientist Dmitry Levin. In turn, he said, that knowledge helps reduce the cost of devices and shorten the length of surgery.

3D frontier

VA Puget Sound doctors already print 3D kidney models that they use for planning kidney surgery. They also print 3D foot orthotics that prevent amputations for Veterans with type 2 diabetes.

The VA-UW team expects the partnership to result in new techniques and treatment approaches. As a result, it could eventually help heart patients worldwide.

Ripley said the next frontier is 3D printing of living tissue. “In the near future, we will be able to make living bone,” complete with blood vessels, she said.

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Last year, the London Metropolitan Police reported that 465 ‘acid attacks’ had been carried out in the city in just 12 months.

That’s 465 separate incidents involving a person (or group of people) dousing somebody with highly corrosive chemicals.

If that fact shocks you, it should also concern you to know that the number is growing.

The amount of reported attacks has increased five-fold over the last six years. In 2016, the Met recorded 395 cases of acid attack. This was itself a sharp increase from 2015, wherein 255 incidents were reported.

Accurate statistics for the whole of the UK are hard to come by. This is partly because many attacks go unreported. An Essex-based study found that only 9 in 21 victims sought criminal charges against their attackers.

In 2013, the BBC reported that the amount of acid attacks recorded worldwide was an estimated 1,500 per year. Even more damning, the actual figure is likely to be considerably higher. Today, the UK has one of the highest rates of acid violence found anywhere in the world.

In this feature, we will take a deeper look at this most malicious and cowardly act; why these attacks happen, who is most at risk from them and what can be done to treat people who have experienced an acid attack.

Acid attacks are a difficult subject to discuss. But discuss them we must, at ALL levels of British society. Only then, as a community united against hatred, can we truly begin to do something about them.

What is an Acid Attack?

The term ‘acid attack’ refers to the premeditated use of any corrosive substance (usually hydrochloric or sulphuric acids) to damage the face or body of another person.

The results of an acid attack can range from minor, yet painful, burns to permanent facial disfigurement, blindness or even death. Although acid attacks are usually not homicidal in nature, some victims have died as a result of their ordeals (most commonly after their wounds became infected).

Acid crime in the UK has a long and sad history. The UK’s first acid attack (possibly the first worldwide) was reported in 1736.

Beginning in earnest after ‘oil of vitriol’ (today known as sulphuric acid) was first manufactured and used on a large scale, acid attacks blighted 18th and 19th century Britain.

In Victorian Britain, jilted women sometimes used acid against the men who had crossed them. Known as vitriolage, it was a cruel punishment indeed. If it seems unfair to single women out, it is worth noting that between the years of 1837 and 1913, almost twice as many women stood trial at the Old Bailey for committing this crime than men.

Perhaps there is a link between the marginalised, downtrodden women of Victorian society and today’s ignored and often denigrated inner city youths?

By 1938, attacks were still common enough that ‘Brighton Rock’ author Graham Greene had his psychopathic protagonist Pinkie Brown carry a bottle of acid around for use against his enemies.

Today, acid attacks occur all over the world. They are common in some heavily patriarchal societies as a way for misogynistic males to ‘punish’ women for perceived transgressions (a darkly ironic twist on the Victorian example given above). In the UK, however, most victims are young men.

Although some UK incidents do appear to be gang related, a great many acid attacks are perpetrated against general members of the public who have no ties at all with gangs or gang culture. In some cases, the attacks are of a totally random nature, in others, they occur as part of the mugging or car jacking of an unsuspecting victim.

Criminologist Simon Harding of Middlesex University has stated that he believes acid attacks have increased in frequency in response to the rise in knife crime. If gang members believe that their rivals are carrying knives, then they may use acid as a form of ‘pre-emptive strike’ against them. However other commentators have suggested that the recent crackdowns on knife and gun crime have made traditional weapons harder to obtain, thus forcing violent criminals to look elsewhere for a way to harm their victims. On balance, both assertions could be correct.

The Facts About Acid Attacks

High profile acid attack victims have included an investigative reporter working for The Sun newspaper, as well as model and TV presenter Katie Piper, whose attack left her permanently scarred and blind in one eye (her vision has since been restored and Piper has subsequently become a spokesperson against acid violence).

However, victims are many and varied.

Last year, a British-Pakistani man, Imran Khan, was delivering a pizza when a gang of teenagers accosted him. The group assaulted Khan, hurled racial epithets at him and then sprayed his face with acid from a Lucozade bottle. He received scarring and severe burns.

Attacks in and around the same area included an incident on a tube train, another that took place during a football match and at least two carjackings. Elsewhere in London, shop assistant Naomi Oni was permanently scarred in a particularly malicious attack. The perpetrator was a former friend whom she had once referred to as ‘ugly’.

In 2017, five teenage boys were sprayed with acid at Ockendon Rail Station. Their attacker, a 17-year-old, received 8 years’ prison sentence.

Three years earlier, in 2014, another Londoner, Wayne Ingold, opened the door to a teenager who then threw acid in his face. His initial disfigurement was so severe that a police officer vomited upon arriving at the scene. Mr. Ingold’s attacker, a 15-year-old convicted drug dealer, had gotten the wrong address.

Acid attacks, however, are not limited to the capital. In recent years, there was a case of mistaken identity in Cornwall that led to permanent disfigurement, a drug-related attack in Dorset and an incident in Southampton whereby a mother-of-six was attacked.

In 2015, 29-year-old Mark Van Dongen was paralysed from the neck down, brutally disfigured and all-but blinded after his then-girlfriend threw acid at him. It took Van Dongen 5 gruelling months to regain his speech. After losing the use of his arms and then being told that he required a procedure that carried with it a 95% chance that he would never speak again, Van Dongen instead opted to travel to a euthanasia clinic in Belgium and end his life. His father told Bristol Crown Court that, “He completed his application for euthanasia. He said that, ‘My life has come to nothing and there is nothing left…He said, ‘All I have is a different ceiling to look at’.”

Victims of acid attacks have included the elderly (statistics reveal the over-75’s to be especially vulnerable) and, most distressingly, even young children. The list of attacks certainly makes for a sobering read – and it is growing every day.

Collating data compiled over a 15-year period, the Metropolitan Police have been able to reveal that the suspect in a typical acid attack case is usually male (around 74% of cases examined) and often young. The victims, too, are more often male (67% of cases) than female. However, the race of both attacker and victim varies wildly.

A common misconception has it that acid attacks are a problem within London’s Asian community, with some dismissing the incidents as ‘honour’ attacks. However, the statistics don’t bear this out. Through a freedom of information request since 2012, 86% of acid attack victims didn’t have any relationship with their perpetrator.

Such attacks do occur in other parts of the world, but in the UK, only one such ‘honour’ attack has been reported in 15 years. In addition, just 6% of suspects were of Asian origin.

According to the Met’s official statistics, 32% of acid attack suspects were white, whilst 38% were of African Caribbean origin. Detective Superintendent Mike West, speaking to the BBC late last year, added, “It’s very mixed (suspects come from) from various religions, backgrounds, different victims, different offenders.”

Most damningly, the same study found that 4 out of 5 of cases never reached trial.

So, what could drive somebody to perform such an unspeakable act upon another human being?

Mohammed Jawad, a plastic surgeon who operated on Katie Piper’s face and also works with victims in South Asia, told the BBC that acid attacks are a way of denying a person’s basic identity, “The attacker is saying: ‘I don’t want to kill her, I am going to do something to distort her.’ “

Acid attacks, then, are a crime that targets a person’s identity and self-image.

An ex-gang member, speaking to The Guardian in 2015 said, “People don’t think of the consequences. It’s easy to buy most of the ingredients legally … One of my cousins was done a few years ago. He was attacked on his shoulder and my uncle just dressed it for him at home. Acid is used as an extreme mark of dominance. It’s letting the individual know I haven’t killed you, but it’s almost worse than that, it’s a mark – on your face. It’s a sinister legacy.”

Intimidation makes up a big part of acid violence. Perhaps this goes some way towards explaining why the vast majority of cases never see trial. It appears to be partly because it is difficult for people to identify their assailants and partly because victims are often unwilling to press charges.

As one victim, who also talked to The Guardian, said, “I just didn’t want any backlash. It’s just me and my mum you see … I didn’t want her to be attacked”. She went on to voice fears that her attacker was well connected in the community.

In almost all cases, the survivor is left deeply disturbed by their ordeal. Acid attack victims have described being afraid to leave the house, as well as feelings of alienation and even prejudice from society. The disfigurement is often permanent, greatly disrupting a person’s sense of self. Truly, this is a life changing crime, an odious assault that indelibly marks not only the victim’s face, but also their psyche.

Motives for attacks can vary from gang-related disputes, to cases of mistaken identity. Disturbingly often, attacks are carried out as a result of females rejecting the sexual advances of males.

One self-described acid attacker, interviewed by Vice in 2017, vividly described an incident in which his friend attacked the mother of a rival’s children. With chilling frankness, the interviewee describes the assault itself, as well as the minor events that led to it.

“[We] went to a rave, met some ‘ops’ (enemy) there. We were just fighting in the club. A couple of days later I just randomly see the ops and his baby mum. They’re there at Tesco, just shopping so I was like, ‘cool’. I ran to my boy who was in the car. My boy bought a bottle, like a Lucozade bottle. I was like, ‘what’s that?’ He was like ‘don’t worry, fam. Just come, let’s go, let’s go’. I’m racking up the guy, just punching him and whatnot. And my boy, he just undid the bottle and he just splashed the girl.”

He then added: “Like if I can’t damage you enough I’m coming for your people.”

The cost of treating an acid attack victim, which often includes treatments such as plastic surgery, specialist burn treatment, eye care, rehabilitation and psychological help, can cost the NHS as much as £34,000 per patient.

Dr. Avinash De Sousa, writing for the Indian Journal of Plastic Surgery, suggests that, “It has been noted that patients with orofacial trauma were more likely to report symptoms of depression, anxiety, and hostility (…) Depression places the patient at increased risk for suicide, poor compliance with treatment and poor rehabilitation outcome. This in turn will affect the quality of life and recovery from the facial trauma”

Types of Acid Used by Attackers

By far the most common type of acid used in acid attacks is sulphuric acid. Hydrochloric acid is also commonly used, although it is somewhat less damaging to the victims. Here, we will examine the different types of acid used, as well as the effects they can have on human skin.

Sulphuric acid – The original ‘oil of vitriol’, sulphuric acid is both colourless and odourless and is therefore an easy chemical for attackers to conceal. The key component in sulphuric acid is sulphur dioxide. Sulphur dioxide is formed when sulphur and oxygen are combined, this can then be specially refined (via a method known as the contact process) to produce sulphuric acid.

The resulting acid is then used for a wide variety of things, including making fertiliser, processing metals (notably copper and zinc), wastewater processing and the making of batteries. It is even used in the manufacture of other acids, such as hydrofluoric and phosphoric acids. Sulphuric acid is readily available in the form of drain cleaners, where it can be used to eat away at whatever happens to be clogging the pipes.

Exposing this substance to skin causes severe burns and intense pain. It can also cause blindness if enough of it enters the eyes. Sulphuric acid can even wear away tooth enamel. This chemical also gives off fumes that can cause pulmonary edema (water in the lungs). Despite all this, it is a cheap and easily obtainable substance.

Hydrofluoric Acid – Although it looks just like water, a high enough dose of hydrofluoric acid can be fatal after just five minutes. An especially corrosive solution, hydrofluoric acid is created from hydrogen fluoride gas, an extremely acute poison in its own right. In its aqueous form, hydrofluoric acid is an extremely potent contact-poison with the potential for initially painless, yet very deep burns that ultimately cause tissue death. When it comes into contact with human skin, this substance reacts with blood calcium, causing systemic toxicity and then cardiac arrest, often resulting in death.

Uses for hydrofluoric acid include the dissolving of rock samples (often to obtain delicate fossils within), glass etching, the separation of salt and even rust removal. Hydrofluoric acid can be found (in smaller percentages) in toilet bowl and bathroom cleaners and (in safe amounts) as an ingredient in common household products such as shampoo.

Ammonia – Another corrosive substance that is cheap and easily available is ammonia. A compound of nitrogen and hydrogen, ammonia is a naturally occurring (and highly corrosive) gas, found all over Earth and throughout the solar system. It is lighter than air and has a pungent, noxious smell. In its liquid form, ammonia can be used in the manufacture of fertilisers, the creation of a great many chemical compounds, as a fuel and also as an antimicrobial agent used in the preparation of food products. It is commonly found in oven cleaners, window cleaners, floor cleaners and drain cleaners and is therefore easy to obtain.

Hydrochloric Acid – Used to process steel, as well as sugar and gelatine, hydrochloric acid is a naturally occurring stomach acid found in humans. Fashioned from hydrogen and chlorine, the substance is a gas at room temperature, but becomes hydrochloric acid when dissolved in water. A key ingredient in toilet cleaners, as well as brick and patio cleaners, hydrochloric acid is, like everything else on this list, highly corrosive and extremely dangerous when exposed to a person’s eyes or face. Exposure can cause blisters, burns and even loss of vision if it enters the eyes.

Sodium hypochlorite – Formed via a combination of a sodium cation and a hypochlorite anion, sodium hypochlorite becomes liquid bleach when dissolved in water. It is most commonly used in household bleach, but also turns up in disinfectants and deodorants and is another chemical on this list that is used in water treatment. Many acid attacks are carried out using bleach (although in this case, ‘alkali attacks’ might be a more appropriate term). In contact with skin, bleach can remove melanin (pigment), cause dangerous burns, blistering and sometimes numbness. In some cases, the skin around the burn site may blacken and die.

Sodium hydroxide – Also known as lye (film fans will no doubt recall the scene in the movie ‘Fight Club’ in which the substance was used to create a painful chemical burn), sodium hydroxide is used in the creation of paper, aluminium and soap, as well as various detergents and cleaning products. It is also used to prepare foods such as olives, noodles and pretzels. Fashioned from sodium cations and hydroxide anions, sodium hydroxide is so corrosive that it was once used for the disposal of animal carcasses, swiftly reducing the bodies to little more than a brown, coffee-like substance, with only a few easily crushed bone hulls remaining.

In the home, this chemical is found in drain cleaner and some hair straightening products, as well as paint strippers. Sodium hydroxide dissolves protein in the skin and emulsifies all oil and fat, its PH is very different to that of the body – and the chemical reaction caused by this difference can be both agonizing and extremely damaging.

Nitric acid – Also commonly used in acid attacks, nitric acid can be detected by the fact that it reacts strongly with keratin in the skin, turning it yellow. When the ratio of nitric acid to water reaches 86% or above, it gives off fumes. Made from nitrogen and hydrogen, nitric acid is a powerful oxidising agent. It is used in inks, dyes, explosives and rocket fuel. Nitric acid, which can cause blood toxicity, is an active ingredient in dishwasher detergent. It also gives off toxic fumes when added to ammonia.

How to Treat an Acid Attack

If you witness an acid attack, or find yourself present shortly after one has occurred, it is of paramount importance that you respond quickly and efficiently.

The first few minutes are vital and can be the deciding factor regarding the severity of the victim’s burns. The NHS has released number of public campaigns detailing what to do in case of an acid attack and medical professionals have regularly spoken about the issue in the media.

Here, then, is a short list to consult in case you ever find yourself in this type of situation:

• Remain calm. It sounds obvious, but the more panicked you allow yourself to become, the greater the build-up of stress and anxiety will be for the victim. Try to speak clearly, take charge of the situation and keep a cool head.
• Dial 999 and ask for an ambulance. Begin the search for water as you are on the phone. If possible, enlist passers-by to obtain as much water as they can.
• Remove any item of clothing contaminated in the attack. Acid on a person’s clothes can still burn the skin and the affected areas must now be washed thoroughly.
• Covering your own hands, try to remove the chemical using an appropriate object such as a clean shirt or a towel.
• Rinse the burned areas with as much running water as possible. A shower is good, as is bottled water if running water is unavailable. This is by far the most important step.
• Be vigilant against the victim going into shock. Signs to watch out for include fainting, pale complexion and very shallow breathing.
• Dry gauze can be added to the skin, which can eventually be washed with gentle soap if it helps the victim. Creams, balms and ointments are best avoided.

Some victims may try strenuously to avoid emergency care. However, such care is essential if the victim has lost the first layer of skin, a blister has formed or if the burn covers an area greater than about seven centimetres (three inches). In general, it is always best to seek expert advice.

In the panic that follows such a horrific ordeal, it is often impossible to know straight away what type of acid was used. In many instances, the attackers probably don’t know (or care) either. Drain cleaners, bleach and disinfectants are all commonly used in acid attacks. The best advice if you witness such an assault, or are unfortunate enough to be the target of one, is to wash the affected area thoroughly with as much running water as you can and then call for an ambulance.

However, it should be noted that some acids can react badly to water, this is just one more thing that makes acid violence such a disgusting crime.

Chemical burns best not treated with water include:

• Carbolic acid or phenol. Used as a base for aspirin and present in chloroform, this acid does not dissolve in water. Wounded areas must be treated first with alcohol (although not in the case of eyes, obviously). The good news is that unless it was stolen from a hospital or science lab, this chemical is unlikely to be used in an acid attack.
• Hydrofluoric acid is best treated with a bicarbonate of soda (baking soda) solution. Mix the baking soda with water and add to the affected area, then heavily douse with water as suggested earlier.
• Carbolic acid or phenol. Used as a base for aspirin and present in chloroform, this acid does not dissolve in water. Wounded areas must be treated first with alcohol (although not in the case of eyes, obviously). The good news is that unless it was stolen from a hospital or science lab, this chemical is unlikely to be used in an acid attack.
• Hydrofluoric acid is best treated with a bicarbonate of soda (baking soda) solution. Mix the baking soda with water and add to the affected area, then heavily douse with water as suggested earlier.

The high likelihood is that the attacker has used a product intended for cleaning toilets or drains, such as bleach, drain cleaner or floor cleaner. In all cases, ensuring that lots of water is applied for an extended period (at least ten minutes) can help to minimize the damage inflicted and even save lives.

If the victim is not experiencing pain, then there is a possibility that hydrofluoric acid has been used. This is an insidious substance that, as noted above, eats into the skin and kills the tissue. In some cases, the results of the burn will not be visible for hours. This type of burn should be treated first with bicarbonate of soda and then in the manner suggested above.

What to do if a Victim Goes into Shock

Shock is a life-threatening condition that occurs when a person’s blood flow is restricted. Not to be confused with an emotional shock (a different thing entirely), the symptoms of this potentially fatal state can include low blood pressure, rapid heart rate, a weak pulse, confusion and loss of consciousness.

Low blood perfusion means that the cells can’t get enough oxygen for them to function properly. This, in turn, can lead to the damage of vital organs such as the brain or heart.

Shock can be caused by many things, including cardiac arrest, severe internal or external bleeding, dehydration, severe allergic reactions, infections and, of course, burns.

According to St. John’s Ambulance the key signs that a person is going into shock are:

• Paleness in the face.
• Cold, clammy skin.
• Fast, shallow breathing.
• Fast, weak pulse.
• Yawning or sighing.
• Confusion
• Unconsciousness or lack of response.

The best ways to respond to this condition are:

• Lay the person down with their head low and their legs slightly raised and supported. This will increase blood flow.
• Dial 999 and explain that you think the victim has gone into shock. Explain also what you think may have caused it.
• Loosen any tight clothing around the victim’s neck, chest or waist, as this may increase blood flow.
• Keep the suffering person warm, safe and calm. Try to maintain a comforting and soothing presence. Cover them in a blanket or coat and reassure them until help arrives.
• Regularly check the person’s breathing, pulse and level of response.
• If they become unresponsive at any time, but are still breathing, you are to place one hand on the person’s forehead and gently tilt their head back. After this, their mouth should fall open. Lift their chin slightly with your fingertips and listen for their breathing, check that their chest is rising and falling. Do this for no more than 10 seconds. This will keep the airway open.
• Next, place the victim in the recovery position (this can be found online) and wait for help. Check the person at regular intervals.
• If the person is not breathing, then you must begin CPR immediately.

One key thing to remember is the importance of keeping the sufferer calm and of staying calm yourself. Creating an atmosphere of tension only adds to the person’s anxiety and it is of vital importance that the person affected feels as safe, secure, warm and cared for as is possible under the circumstances.

Treating a person with shock requires vigilance, competence and care. The actions you take might just save that person’s life.

How to Prevent an Acid Attack

The terrifying, inescapable truth is that nobody is 100% safe from an acid attack.

Even if you live in a low crime area, have no ties to any gangs and venture outside only by the safe light of day, you could still be attacked in a case of mistaken identity, or worse still, you could become the victim of a random attack.

This is written not to frighten you, but to illustrate the point that the easy accessibility of corrosive materials, relative lack of risk to the assailant and low conviction rates overall make acid attacks an indiscriminate and immediate threat in modern day Britain.

Still, there are a few things you can do in order to lessen the risk of acid attack.

• Be alert. Take note of your surroundings and try not to be distracted or complacent. Keep an eye out for unusual or suspicious people.
• Where possible, stay grouped with other people. Try to travel with friends.
• Stay in the centre of the group if possible.
• Be aware that many attacks occur from the windows of moving vehicles, so avoid standing near to the road for extended periods of time.
• Be wary of anybody suspicious who is intentionally covering their face. Acid attackers will usually try to disguise their identities. Of course, hoodies, motorcycle helmets, balaclavas, niqab, hijab, burkas, even Halloween masks, can all be seen on Britain’s streets in 2018. The vast majority are nothing to be suspicious about, but if a person covering their face appears to be approaching you swiftly or in a threatening manner, then endeavour to get out of their way!
• Check a person’s hands. If you do find yourself suspicious of somebody, check their hands. An acid attacker will need something in which to carry their acid; a previously used plastic bottle or container seems to be the most common receptacle. If the person’s hands are concealed, be wary. Cover your own face immediately.
• If you feel that somebody has a vendetta against you, be wary of that person. Take any acid-related threats very seriously. Seek legal protection if you have to.
• Carry a bottle of water with you at all times.

It may calm you somewhat to know that, in accordance with the UK Health and Safety Act 1974 and the Control of Substances Hazardous to Health regulations of 2002, all employers and venue owners are required by law to carry appropriate equipment for immediately treating an acid attack victim.

According to the UK Home Office, this includes extra-strength gloves, water bottles with shower-like nozzles for cleaning wounds, a strong pair of scissors capable of cutting through acid-drenched garments and specialised face shields. Even still, it pays to be safe.

Legislation – What is Being Done?

In July of last year, Mayor of London Sadiq Khan called for the government to take a “zero tolerance” approach to acid attacks nationwide. Condemning them as “callous and horrific”, he suggested measures that included tougher sentencing for convicted attackers, as well as a general clampdown on the sale of corrosive substances. He also called for an increase in long-term support for victims of acid attacks.

“The emotional impacts of disfiguring and lifelong scarring are truly devastating for innocent victims” he said.

The Mayor called for these measures after 6 acid attacks were committed in the city in less than 24 hours.

Late last year, MP for West Ham Lyn Brown called for police and other emergency services to carry bottles of specialist rinse in the event of acid attacks. Like Khan, she backed restricting the sales of corrosive substances. East Ham MP Stephen Timms seconded her calls.

At around the same time, it was declared that the UK now has one of the highest numbers of acid attacks per person of any country in the world. Sadly, this number is expected to rise.

Police nationwide, already struggling as a result of government cuts to personnel and funding, have stated that without enforceable laws dedicated specifically to acid attacks; it is difficult for them to respond adequately.

Few of the victims admitted to hospitals are willing to speak to police, which is a huge obstacle in the way of punishing those responsible and preventing future attacks. Nevertheless, police are actively working with youth and community groups in an effort to raise awareness and stem the tide of these attacks.

Some police officers have suggested new legislation that would call for people to justify why they may be carrying a corrosive substance in the street. It certainly makes sense.

However, most commentators concede that banning the sale of such chemicals outright would prove impossible. Of the 15 – 20 substances known to have been used in acid attacks, the vast majority have legitimate household uses, can be purchased cheaply (in most cases, cigarettes are more expensive) and are completely legal. Worse still, almost all of these chemicals are easily found in most people’s homes, indicating that even with some sort of sales restriction policy in place, would-be attackers could still easily obtain them.

UK citizens’ initiatives, in the form of petitions, have been created to voice public outrage at the rise in acid attacks.

This one, created on Change.org by user Sarmad Ismail, calls for a licensing system to be created in an attempt to prevent the sale of corrosive substances to those that may misuse them.

In India, a similar petition started by attack survivor Laxmi Agarwal successfully called upon the Government to regulate the sale of acid.

Another petition, started by UK user Shaheed Rahman, formally asks that acid attackers receive a life sentence for their crimes. Signees include the author of this article.

Home Secretary Amber Rudd has strongly condemned acid attacks. The government is, at present, drafting new legislation to better combat this grim phenomenon.

A Home Office spokesperson said, “We are consulting on banning the sale of the most harmful corrosive substances to under 18s and introducing minimum custodial sentences to those who are repeatedly caught carrying corrosive substances without good reason, which mirrors the laws on carrying knives. This sends the clear message that the cowards who use these as weapons will not escape the full force of the law.”

However, it looks as if the situation is likely to get worse before it gets better and in that time, how many others will suffer?

Acid Attack After Care

An acid attack is a life-changing experience. Victims must overcome deep scars, both physical and psychological and this process can take years. Fortunately, there are organisations willing to help.

Groups such as Acid Survivor’s Trust International (ASTI) and, closer to home, the Katie Piper Foundation are working every day to help people heal their wounds, both inside and out. Other charitable organisations, such as Victim Support are also helping acid attack survivors each and every day.

If you know somebody who has lived through this ordeal, then you can help enormously by simply being a friend and supporting them as much as you can. If they have not already sought help for themselves, you might suggest one of the organisations mentioned above. In addition, you should also research the symptoms of depression and watch out for them.

Finally, in honour of the many people who have survived acid attacks and bravely lived with their far-reaching consequences, it might be appropriate to end on a note of hope.

Last year, a group of 10 acid attack survivors, all of them women, took to the catwalk for a fashion show in New Dehli. Their aim was to raise funds for their fellow survivors and to raise awareness of acid attacks in general.

The event, hosted by acid support charity Make Love, Not Scars, was a resounding success, greatly boosting the confidence of the models, all of whom had suffered severe facial burns and disfigurement at varying points in their lives.

One model, Reshma Bano Qureshi, told reporters that people had called her ugly and told her that no one would marry her, yet she described herself as “proud and confident”

“The face is not what makes you beautiful” she said, “It is your heart”

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LOS ANGELES – The former president and chief executive officer of a Long Beach substance abuse treatment provider was sentenced today to 84 months in federal prison for participating in a scheme in which more than $18.5 million in fraudulent claims were submitted to California’s Drug Medi-Cal program for alcohol and drug treatment services for high school and middle school students.

Richard Mark Ciampa, 67, of Commerce, was sentenced by United States District Judge Philip S. Gutierrez, who also ordered him to pay $17,640,325 in restitution. Ciampa pleaded guilty on January 6 to one count of health care fraud.

Ciampa founded the non-profit Atlantic Recovery Services (ARS), later called Atlantic Health Services, in 1996 and served as its president and CEO until its closure in April 2013 following a suspension in payments. ARS provided substance use disorder treatment services to students at local high schools and middle schools through Medi-Cal and its Drug Medi-Cal program.

From March 2009 to April 2013, Ciampa participated in a scheme to defraud Medi-Cal in which ARS billed the Drug Medi-Cal program for services to students who did not medically need alcohol or drug treatment. ARS also billed Drug Medi-Cal for group and individual counseling sessions that were not provided or did not meet the requirements for reimbursement as to size, length or setting. ARS employees falsified documents to support the false claims.

In March 2009, Drug Medi-Cal ordered ARS to repay an overpayment assessed to the organization, which caused a significant amount of financial pressure on Ciampa. Ciampa, in turn, passed along this financial pressure to his employees and threatened the employees that they would lose their jobs with ARS or have their hours reduced to part-time if they did not generate significant billings.

Ciampa was aware or willfully blind to the fact that, in response to his threats, ARS employees were generating false and fraudulent claims for submission to Drug Medi-Cal. He also encouraged ARS employees to engage in fraud, telling them they should “find a way” to enroll more students in ARS’ program despite Drug Medi-Cal’s medical necessity requirement.

The scheme was executed in several ways, including ARS counselors and managers maintaining student caseloads by enrolling students in the ARS substance abuse counseling program even if they had used drugs or alcohol only occasionally or even just once.

For example, in December 2011, ARS fraudulently submitted a claim for Medi-Cal reimbursement for an individual counseling session for a student on November 23, 2011 – a school holiday and the day before Thanksgiving – when the student was absent and the counselor listed on the claim did not provide any counseling.

In total, $18,530,927 in fraudulent claims were submitted because of the scheme, resulting in an actual loss to Medi-Cal of $17,640,325.

Prosecutors have obtained a total of 19 guilty pleas in this case and related cases, including former ARS Program Manager Lori Renee Miller, 60, of Lakewood, multiple former ARS managers and counselors, and Dr. Leland Whitson, 81, of Redondo Beach, the former Medical/Clinical Director of ARS who previously pleaded guilty to making a false statement affecting a health care program.

Gregory Hearns, 65, of Long Beach, the billing supervisor for ARS who compiled the monthly billing and arranged for its submission to Medi-Cal, LaLonnie Egans, 63, of Long Beach, a former manager, and Tina Lynn St. Julian, 57, of Inglewood, a former counselor, are expected to go on trial on January 6. They are charged with multiple counts of health care fraud.

An indictment contains allegations that a defendant has committed a crime. Every defendant is presumed innocent until and unless proven guilty beyond a reasonable doubt.

The California Department of Justice, Division of Medi-Cal Fraud and Elder Abuse; the United States Department of Health and Human Services, Office of Inspector General; and IRS Criminal Investigation investigated this matter.

Assistant United States Attorneys Cathy J. Ostiller and Karen E. Escalante of the Major Frauds Section, Nisha Chandran of the General Crimes Section and Victor Rodgers of the Asset Forfeiture Section prosecuted this case.

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WASHINGTON – House lawmakers unanimously approved a bill that would lay the groundwork for the Department of Veterans Affairs to start funding service dog programs and connect Veterans with canines that could be critical for their mental health care.

The Puppies Assisting Wounded Servicemembers for Veterans Therapy Act authored by Rep. Steve Stivers, R-Ohio, would kick-off a pilot program to issue federal grants to nonprofits that provide service dogs to Veterans suffering from mental health issues, and require the VA to assess the effectiveness of dog therapy.

“Our Veterans fought for our freedom, and I’ve heard from many Veterans who say that’s exactly what their service dog gives them – freedom. They’re free to go to restaurants, to fly on planes, to go to the movies, things that post-traumatic stress [disorder] had made impossible,” Stivers said.

Lawmakers on the House and Senate Committees for Veterans’ Affairs have made tackling Veterans suicide a top priority after years of legislative measures and efforts that haven’t stemmed the crisis. Some Veteran advocacy groups frustrated with Congress’ inability to make progress on the issue have called for more creative thinking.

"Congress continues to ignore damning reports released by [The Journal of the American Medical Association] and others regarding our current mental health approaches failing Veterans. We have not heard a peep about it from this leadership.” Joe Chenelly, national executive director of American Veterans, said in a statement last month. “When it comes to curbing suicide the time to act is now...Every day matters and the status quo is untenable.”

The number of Veterans committing suicide dwarfs combat fatalities since 9/11. Between 2005 and 2017, 78,875 Veterans took their own lives, according to the most recent data from VA. In comparison, about 7,000 troops have been killed in combat in Iraq and Afghanistan combined, across two decades.

Nonprofits are one of the only avenues for Veterans to adopt service dogs. The VA doesn’t provide any funds for service or emotional-support animals but concluded a congressionally mandated study on the benefits of dogs for PTSD care in July, according to Christina Mandreucci, a spokeswoman for the department. The results of one part of the study on whether service or emotional-support dogs can help Veterans with PTSD is expected to be released in the summer, and the results on whether dogs can lead to overall health care savings with fewer hospital stays and less reliance on medication is expected by the end of the year.

“Mental wellness does not have a one-size-fits-all solution, which is why VA must provide innovative and out-of-the-box treatments to help Veterans combat these invisible illnesses and thrive in their civilian lives,” said Rep. Phil Roe, R-Tenn., the ranking member of the House VA committee. “There is no question that the companionship and unconditional love offered by man’s best friend can have powerful healing effects on men and women from all walks of life, including our men and women in uniform.”

There is no vote scheduled yet for the Senate version of the measure.

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HR 105, TBI and PTSD Treatment Act, will direct the Secretary of Veterans Affairs to establish a pilot program to furnish hyperbaric oxygen therapy (HBOT) to a veteran who has a traumatic brain injury (TBI) or post-traumatic stress disorder (PTS). MVA has reviewed several studies concerning HBOT treatment for PTS and TBI and there are positive indications associated with this treatment. Our interviews with MVA members who served in combat or in Special Operations also point to an affirmative correlation between HBOT and PTS/TBI. We believe that HBOT could potentially allow for a more successful treatment pathway for these invisible wounds.

Please contact your elected officials and ask for their support.

TAKE ACTION

HR 1585 and S 565 are companion bills that will provide for the treatment of veterans who participated in the cleanup of Enewetak Atoll as radiation-exposed veterans for purposes of the presumption of service-connection of certain disabilities by the Secretary of Veterans Affairs.

MVA has supported similar bills in previous Congress'. It is time to move this bill off dead center and provide these veterans their earned benefits while they are still alive.

Please ask your Member of Congress and Senators to co-sponsor these bills.

TAKE ACTION

HR 1656, TREAT PTSD Act, will require the Department of Veterans Affairs and the Department of Defense to furnish enrolled members and veterans of the Armed Forces who have been diagnosed with Post Traumatic Stress Disorder with stellate ganglion blocks, should they elect to have them. Serving our nation in the Armed Forces is an incredibly taxing job both physically and psychologically. As such, we strongly believe that active duty members and veterans deserve the best quality of care that our country can provide. The stellate ganglion block treatment is a new but effective method for treatment of PTSD. This bill is a step towards the more complete care that our military and veterans deserve for whatever ailments they have incurred in service to our country.

Please contact your Member of Congress and Senators and ask them to co-sponsor this bill.

TAKE ACTION

HR 815, the RELIEVE Act, will expand eligibility for Department of Veterans Affairs (VA) reimbursement of emergency treatment for veterans who are treated in a non-VA facility. This bill will close a loophole that has been left open. Often by the time a veteran enrolls in the VA system, it can take months to get in to schedule a visit with a primary care doctor, let alone a specialty. If an emergency occurs and the veteran has to go to a non-VA emergency facility, it makes no sense that they would be held responsible for being seen prior to an emergency. These things are out of our control, and the veteran should not be penalized.

Please contact your elected officials and ask for their support.

TAKE ACTION

WICHITA, KAN. – Edward Parks, 60, Liberal, Kan., is charged with one count of submitting false claims for travel reimbursement to the Department of Veterans Affairs and one count of making a false statement to investigators from the Department of Veterans Affairs – Office of Inspector General. The crimes are alleged to have occurred in 2019 in Sedgwick County, Kan.

The indictment alleges he falsely claimed he travelled to Wichita, Kan., from Liberal, Kan., for medical appointments, in order to be reimbursed under the Beneficiary Travel Program.

If convicted, he could face up to five years in federal prison and a fine up to $250,000 on each count. The Department of Veterans Affairs – Office of Inspector General investigated. Assistant U.S. Attorney Debra Barnett is prosecuting.

OTHER INDICTMENTS

Loren Olson, 68, Marquette, Kan., is charged with four counts of producing child pornography and one count of the sex trafficking of a minor. The crimes are alleged to have occurred in May, June and July 2020 in McPherson County, Kan.

Olson initially was charged by criminal complaint Dec. 9, 2020.

If convicted, Olson could face a penalty of not less than 15 years and not more than 30 years in federal prison on each production count, and not less than 10 years on the other count. The FBI investigated. Assistant U.S. Attorney Jason Hart is prosecuting.

Alejandro Valerio Pineda, 45, Wichita, Kan., is charged with two counts of distributing methamphetamine. The crimes are alleged to have occurred during November and December 2020 in Wichita, Kan.

If convicted, he could face a penalty of not less than five years and not more than 40 years and a fine up to $5 million on each count. The Drug Enforcement Administration investigated. Assistant U.S. Attorney Mona Furst is prosecuting.

Troy Bong, 51, Wichita, is charged with three counts of possession with intent to distribute methamphetamine (counts 1, 4, 7), three counts of possession of a firearm in furtherance of drug trafficking (counts 2, 5, 8) and three counts of unlawful possession of a firearm by a felon (counts 3, 6, 9). The crimes are alleged to have occurred in 2020 in Sedgwick County, Kan.

Upon conviction, the crimes carry the following penalties:

         Count one: Up to 20 years in federal prison and a fine up to $1 million.

         Counts 4, 7: Not more than 40 years and not less than five years and a fine up to $5 million.

         Counts 2, 5 and 8: Not less than five years and a fine up to $250,000.

         Counts 3, 6 and 9: Up to 10 years and a fine up to $250,000.

The Drug Enforcement Administration investigated. Assistant U.S. Attorney Matt Treaster is prosecuting.

Treylis Presley, 31, Wichita, Kan., is charged with one count of unlawful possession of a firearm by a felon, one count of possession of cocaine and one count of possession of marijuana. The crimes are alleged to have occurred Sept. 4, 2020, in Sedgwick County, Kan.

If convicted, he could face a penalty of up to 10 years in federal prison and a fine up to $250,000 on the firearm charge, and up to a year and a fine up to $1,000 on each of the other two counts. The Bureau of Alcohol, Tobacco, Firearms and Explosives investigated. Assistant U.S. Attorney Molly Gordon is prosecuting.

Luis Contreras-Mata, 35, is charged with one count of unlawfully re-entering the United States after being deported. He was found Dec. 10, 2020, in Rawlins County, Kan.

If convicted, he could face a penalty of up to two years in federal prison and a fine up to $250,000. Immigration and Customs Enforcement – Enforcement and Removal Operations investigate. Assistant U.S. Attorney Lanny Welch is prosecuting.

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After nearly a year’s effort, a policy change effective Jan. 1, 2020, will allow digital breast tomosynthesis, or 3-D mammography, to be used to screen for breast cancer. While the procedure may not be offered at all military treatment facilities, the expanded benefit will be available as a screening and diagnostic tool for beneficiaries with TRICARE coverage.

The procedure – known technically as digital breast tomosynthesis or DBT – will be offered to primarily women age 40 and older, and women age 30 and older who are considered high-risk for breast cancer. Practitioners can offer DBT to other patients should a diagnosis determine the presence of a risk factor

The procedure’s three-dimensional images provide a more thorough means of detecting the disease – particularly in patients with dense breast tissue. The digital breast tomosynthesis technique is similar to that of a CT (computed tomography) scan. The source of the CT X-ray repeatedly sweeps over the breast at spaced intervals. The final imagery offers a cross section of “slices,” or adjacent segments, of tissue.

"Mammography is the gold standard in detecting breast cancer, and the DHA is pleased to bring this advanced form of imaging to our patients," said Dr. Paul Cordts, chief medical officer for the Defense Health Agency. "We know how important it is to our patients to have access to the latest technology to improve their health outcomes. Digital breast tomosynthesis allows for earlier detection and diagnosis of smaller cancers and, if discovered early, it opens up more options to treat it quickly while in a nascent stage, with improved outcomes and potentially less side effects."

According to Amber Butterfield of TRICARE’s Medical Benefits Reimbursement office in Aurora, Colorado, the expanded benefit for breast cancer screenings is allowed through provisional coverage authorized by Assistant Secretary of Defense for Health Affairs Thomas McCaffrey. Provisional coverage is a special authority that allows extension of coverage for items that are undergoing evaluation or have beneficial effects not yet proven.

Between 2016 and 2018, roughly 80,000 TRICARE beneficiaries were diagnosed with either malignant abnormal growths of the breast, called carcinomas, or pre-cancerous cells, called neoplasms. To address this, leaders at the DHA were determined to find a way to expand breast cancer screenings using the DBT technology, while adhering to congressional requirements as they pertain to provisional authority.

“By regulation, TRICARE follows guidelines from the U.S. Department of Health and Human Services for preventive services,” Dr. James Black, medical director of the Clinical Support Division at DHA, said. “This includes the U.S. Preventive Services Task Force, which gives recommendations on provisional preventive services.”

Although the task force has yet to recommend DBT for cancer screening, the decision by DHA leadership to expand DBT to annual cancer screenings was made a year ago. Since the USPSTF does not currently recommend DBT as a more effective screening tool than 2-D mammography, the DHA had to find a way to offer coverage under current statutes that govern what health services TRICARE can provide beneficiaries.

Black cited the efforts of retired Navy Vice Adm. Raquel C. Bono, the former DHA director, along with subject-matter experts from the services, who provided guidance that led to the provisional adaptation of DBT coverage.

Their focus included which commercial insurance carriers cover DBT and other coverage criteria. From there, DHA’s medical benefits and reimbursement section put together a provisional coverage determination and submitted it to the office of the Assistant Secretary of Defense for Health Affairs – who, by law, is the approval authority for any such changes. The coverage determination was approved in September and coverage will begin Jan. 1, 2020.

Although the task force has yet to recommend 3-D breast DBT for cancer screening, DHA leadership is confident that within the five years DBT has been approved on provisional authority, the USPTF will obtain enough research to reach a firm recommendation.

Beneficiaries who have questions about DBT services offered in locations convenient to them should contact their TRICARE provider or regional customer service call center.

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Oglethorpe Inc. and its three Ohio facilities, Cambridge Behavioral Hospital, Ridgeview Behavioral Hospital, and The Woods at Parkside, will pay $10.25 million to resolve alleged violations of the False Claims Act for improperly providing free long-distance transportation to patients and admitting patients at Cambridge and Ridgeview who did not require inpatient psychiatric treatment, resulting in the submission of false claims to the Medicare program.

Oglethorpe Inc. is a Florida company that operates two Ohio inpatient psychiatric hospitals, Cambridge and Ridgeview, and one Ohio substance abuse treatment facility, Parkside. The settlement was based on analysis of the companies’ ability to pay after review of their financial condition.

This settlement resolves allegations that, between August 2013 and June 2019, defendants provided free long-distance van transportation to patients to induce them to seek treatment at the defendants’ facilities, in violation of the Anti-Kickback Statute, and then submitted claims for services provided to these patients, in violation of the False Claims Act. The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by a federal health care program, such as Medicare, Medicaid or TRICARE. Claims submitted to these programs in violation of the Anti-Kickback Statute give rise to liability under the False Claims Act. The government also alleged that Oglethorpe, Cambridge, and Ridgeview submitted, or caused to be submitted, false claims to Medicare for medically unnecessary inpatient psychiatric admissions and associated services at the two hospitals.

“Kickbacks to patients can result in unnecessary services that serve neither the patients nor our federal health care programs,” said Acting Assistant Attorney General Brian M. Boynton of the Justice Department’s Civil Division. “The Justice Department is committed to pursuing unlawful remunerations in whatever form they occur to safeguard taxpayer funded health care benefits.”

“Submitting false claims by billing for unnecessary inpatient psychiatric hospitalizations is not only inappropriate – it’s illegal,” said Acting U.S. Attorney Vipal J. Patel for the Southern District of Ohio. “This settlement shows that the United States will hold accountable those who seek to profit by flouting proper standards of medical practice and appropriate review and submission of Medicare billings.”

“Kickbacks in the form of free van rides and the false claims subsequently submitted to federal health care programs come at a tremendous cost to patients and the taxpayers,” said Special Agent in Charge Lamont Pugh for the Office of Inspector General of the U.S. Department of Health and Human Services (HHS-OIG). “We will continue to work with our law enforcement partners to pursue and hold accountable entities who engage in such acts.”  

Contemporaneous with the settlement, Oglethorpe entered into a corporate integrity agreement (CIA) with HHS-OIG. Among other things, the CIA requires that for the next five years Oglethorpe must retain an Independent Review Organization to review its claims to Medicare and Medicaid.

The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Darlene Baker, a former client advocate at Cambridge. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery if the government takes over the case and reaches a monetary agreement with the defendant. The qui tam case is captioned United States ex rel. Baker v. Oglethorpe, Inc., et al., No. 2:16-cv-1040 (S.D. Ohio).

The resolutions obtained in this matter were the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section; the U.S. Attorney’s Office for the Southern District of Ohio; and HHS-OIG.

The matter was investigated by Trial Attorney Christopher Wilson of the Civil Division and Assistant U.S. Attorney Andrew Malek.

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Aquablation therapy treats Veterans’ enlarged prostate symptoms with reduced risk of unwelcome side effects

A procedure called aquablation offers a new approach to treating an enlarged prostate.

In the photo above, Dr. Gopal Badlani uses a robot-guided water jet to treat enlarged prostate.

The medical term is “benign prostatic hyperplasia,” or BPH. Most men know it simply as “enlarged prostate,” and hope to avoid it as they grow older.

More than 12 million American men, most of them 60 or older, are being treated for non-cancerous enlargement of the prostate gland. Symptoms include a frequent need to urinate, increased nighttime urination and an inability to completely empty the bladder.

For more severe cases, pills might not give much relief. Surgery can help symptoms but can also cause sexual problems. So, many men simply avoid treatment.

Relief in sight for hundreds of Veterans

At Salisbury VA Health Care System in North Carolina, VA offers Veterans with BPH another option called aquablation. It’s more effective than pills but has fewer side effects than surgery.

The U.S. Food and Drug Administration (FDA) recently approved it for use with patients.

The doctor removes excess prostate tissue with a robot-controlled water jet, using 3D imaging to guide it. The procedure relieves symptoms with less risk of sexual side effects.

“As Salisbury Chief of Urology, I was part of the two trial studies that led the FDA to approve aquablation,” said Dr. Badlani. “The symptoms of an enlarged prostate can be frustrating and upsetting. There are hundreds of Veterans suffering from BPH in our area. That’s why we are so pleased by the results we see from this new treatment.

“One older Veteran who recently had the procedure said, ‘I’m glad I did it. I’m a blessed man, I’ll put it that way.’ When I told him that he would no longer have to take drugs for his symptoms he said, ‘That sounds pretty good. I got rid of two pills right there.’

“We believe this treatment has the potential to change the way we treat men with BPH in a very basic way.”

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Senators are launching an effort to again urge the Department of Veterans Affairs to explore medicinal cannabis as an alternative treatment for Veterans, introducing legislation that would kickstart clinical trials on using cannabis to treat chronic pain and post-traumatic stress disorder.

Senate Veterans Affairs Committee Chairman Jon Tester, D-Montana, and Sen. Dan Sullivan, R-Alaska, reintroduced the VA Medicinal Cannabis Research Act this week to test the effectiveness of cannabis on two of the most common health concerns among Veterans.

“VA needs to take its cues from the growing number of Veterans who find critical relief through medicinal cannabis in treating the wounds of war,” Tester said. “Our bipartisan bill ensures VA takes proactive steps to explore medicinal cannabis as a safe and effective alternative to opioids for Veterans suffering from injuries both seen and unseen. This is a necessary step in taking care of the folks who fought and sacrificed on our behalf.”

The devastation of the opioid epidemic in American has already shown the need for alternative treatments, especially for pain, Sullivan said.

"Medicinal cannabis is already in use by thousands of Veterans across the country, but we don’t yet have the data we need to understand the potential benefits and side effects associated with this alternative therapy," Sullivan added.

VA has long used marijuana's position on the federal controlled substances list as a reason not to incorporate it into Veterans' care. In a historic vote last year, the House passed a bill to allow VA to recommend cannabis to Veterans. That bill, the Marijuana Opportunity Reinvestment and Expungement (MORE) Act, would also remove federal penalties on marijuana and erase nonviolent marijuana-related criminal records -- allowing states to continue to take the lead on prohibition or legalization themselves. The House vote on the MORE Act last year was one of the most significant steps from Congress so far in changing federal cannabis policy, but the bill never got a vote in the Senate.

The MORE Act also included measures to treat Veterans' physical and mental health conditions, allow Veteran patients to travel across state lines with their medication and decriminalize the drug at the federal level. Now, Tester and Sullivan have introduced a standalone bill specifically for more research for Veterans.

VA senior leaders have told Capitol Hill lawmakers again and again that the reason they will not allow VA physicians to recommend cannabis use for Veteran patients -- even in states where it is legal -- is because of the federal prohibition. It would put doctors and VA at legal risk, they argued, as lawmaker after lawmaker and advocate after advocate questioned, pushed and promoted the drug's potential use for a variety of Veterans' health concerns. VA leaders said it would take an act of Congress for things to change at the department.

Past attempts by Congress to expand Veterans' access -- even those with some bipartisan support -- have been met with opposition from VA leaders. In the Senate, some of those measures have been met with opposition from Republican leadership.

Cannabis use for Veterans has gained some traction among lawmakers in Congress, but none of the legislation has made significant progress, and some of it has been shut out entirely, especially in the Senate. While some Veterans have, anecdotally, shared that cannabis has benefitted them, including in some cases helping to prevent suicide, many lawmakers remain unconvinced, calling for more evidence-based conclusions before a decision can be made. But lawmakers also have supported other alternative treatments and therapies for Vets that, in some cases, have questionable efficacy for Veterans' health concerns.

Some Veterans fear their use or potential use of cannabis could jeopardize their VA benefits and lawmakers have even introduced bills to prevent exactly that. But VA says on its website that "Veterans will not be denied VA benefits because of marijuana use." Lawmakers have filed a few bills to codify that and ensure that VA could not take benefits from Veterans for their cannabis use. None have passed so far.

Dr. Ben Kligler of the Veterans Health Administration told Connecting Vets previously that Veterans can talk to their VA doctors about cannabis use and ensure use will not interact negatively with existing medications, but VA doctors cannot prescribe or recommend its use to Veterans, or replace existing medication with medical cannabis.

The legislation introduced by Tester and Sullivan this week already has backing from some of the largest and most influential Veteran service organizations in the country. The bill not only calls for clinical trials for cannabis but also requires that the trials examine the different forms and methods Veterans could take the drug.

"VFW members tell us that medicinal cannabis has helped them cope with chronic pain and other service-connected health conditions," said Tammy Bartlet, associate director for national legislative affairs at VFW. "They cannot receive these services at VA because of VA’s bureaucratic hurdles. VA uses evidence-based clinical guidelines to manage other pharmacological treatments of post-traumatic stress disorder, chronic pain and substance use disorder because medical trials have found them effective. VA must expand research on the efficacy of non-traditional medical therapies, such as medicinal cannabis and other holistic approaches.”

"Eighty-eight percent of IAVA members support the research of cannabis for medicinal purposes and Veterans consistently and passionately have communicated that cannabis offers effective help in tackling some of the most pressing injuries we face when returning from war," said IAVA CEO Jeremy Butler.

“DAV has long-supported further VA research into medicinal cannabis, along with other alternative approaches, as a means of alleviating chronic pain, symptoms of PTSD and other conditions that affect so many disabled Veterans,” said Joy J. Ilem, national legislative director for Disabled American Veterans. “As with any other form of treatment, it is essential to understand the safety, efficacy, potential side-effects and risks, and we believe the VA Medical Cannabis Research Act will be an important step in that process.

Multiple polls show a vast majority of Veterans agree that medical cannabis should be legal. Most Americans overall believe cannabis in all its uses should be legal. Surveys by Iraq and Afghanistan Veterans of America and Wounded Warrior Project have consistently shown a majority of Veterans who responded are interested in using cannabis or cannabinoid products if available, some already use them, and most want more research and for VA to drive that research.

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After a seven-week trial, a federal jury in the Southern District of Florida convicted two operators of two South Florida addiction treatment facilities for fraudulently billing approximately $112 million for services that were never provided or were medically unnecessary, and for paying kickbacks to patients through patient recruiters, and receiving kickbacks from testing laboratories. One defendant was also convicted of money laundering, and of separate charges of bank fraud connected to Paycheck Protection Program (PPP) loans.

According to court documents and evidence presented at trial, Jonathan Markovich, 37, and his brother, Daniel Markovich, 33, both of Bal Harbour, conspired to and did unlawfully bill for approximately $112 million of addiction treatment services that were never rendered and/or were medically unnecessary, and that were procured through illegal kickbacks, at two addiction treatment facilities that they operated, Second Chance Detox LLC, dba Compass Detox (Compass Detox), an inpatient detox and residential facility, and WAR Network LLC (WAR), a related outpatient treatment program. Jonathan Markovich, who owned both facilities, was also convicted of bank fraud in connection with PPP loan applications in which he falsely stated that Compass Detox and WAR were not engaged in illegal conduct.

The evidence showed that defendants obtained patients through patient recruiters who offered illegal kickbacks to patients (such as free airline tickets, illegal drugs, and cash payments). The defendants then shuffled a core group of patients between Compass Detox and WAR to fraudulently bill for as much as possible. Patient recruiters gave patients illegal drugs prior to admission to Compass Detox to ensure admittance for detox, which was the most expensive kind of treatment offered by the defendants’ facilities, therapy sessions were billed for but not regularly provided or attended, and excessive, medically unnecessary urinalysis drug tests were ordered. Compass Detox patients were given a so-called “Comfort Drink” to sedate them, and to keep them coming back. Patients were also given large and potentially harmful amounts of controlled substances, in addition to the “Comfort Drink,” to keep them compliant and docile, and to ensure they stayed at the facility. Certain patients were also routinely re-admitted and repeatedly cycled through Compass Detox and WAR to maximize revenue.

“These substance abuse treatment facility operators orchestrated a massive, multi-year fraudulent billing scheme by taking advantage of patients seeking treatment,” said Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division. “The convictions today further demonstrate the success of the Department of Justice’s Sober Homes Initiative in protecting patients and prosecuting fraudulent substance abuse treatment facilities.”

“Their tactics were brazen and the dollar losses immense,” said Special Agent in Charge George L. Piro of FBI’s Miami Field Office. “These health care fraudsters, driven by greed, sought to cheat their way to riches by billing tens of millions of dollars from various health care programs. The FBI and our law enforcement partners will investigate and criminally prosecute such fraud to the fullest extent of the law.”

Both defendants were convicted of conspiracy to commit health care fraud and wire fraud. Jonathan Markovich was convicted of eight counts of health care fraud and Daniel Markovich was convicted of two counts of health care fraud. They were also convicted of conspiracy to pay and receive kickbacks and two counts of paying and receiving kickbacks. Jonathan Markovich was separately convicted of conspiring to commit money laundering, two counts of concealment money laundering, and six counts of laundering at least $10,000 in proceeds of unlawful activities, as well as two counts of bank fraud related to his fraudulently obtaining PPP loans for both Compass Detox and WAR during the COVID-19 pandemic. Both defendants are scheduled to be sentenced on Jan. 13, 2022. They each face a maximum of 20 years for the health care fraud and wire fraud conspiracy count, 10 years for each substantive count of health care fraud and paying and receiving kickbacks, and five years for the kickbacks conspiracy. Jonathan Markovich faces additional maximum sentences of 20 years for conspiracy to commit money laundering, 20 years for each substantive count of concealment money laundering, 10 years for each additional count of money laundering, and 30 years for each substantive count of bank fraud. A federal district court judge will determine the sentences after considering the U.S. Sentencing Guidelines and other statutory factors. A related trial is scheduled to begin on Feb. 28, 2022, in the Southern District of Florida, for four other defendants charged in this case.

The FBI, the Department of Health and Human Services, Office of Inspector General, and Broward Sheriff's Office investigated the case.

Senior Litigation Counsel Jim Hayes and Trial Attorney Jamie de Boer of the Criminal Division’s Fraud Section are prosecuting the case.

The National Rapid Response Strike Force and Los Angeles Strike Force lead the Department of Justice’s Sober Homes Initiative, which was announced in the 2020 National Health Care Fraud Takedown to prosecute defendants who exploit vulnerable patients seeking treatment for drug and/or alcohol addiction.

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Tampa, Florida – U.S. District Judge Mary S. Scriven has sentenced Marcus Lloyd Anderson (36, St. Petersburg) to one year and a day in federal prison for health care fraud. As part of his sentence, the court also entered a money judgment in of $323,248, which were the proceeds of the offense.

Anderson had pleaded guilty on April 30, 2020.

According to court documents, Anderson submitted bogus claims to the Florida Medicaid program and related managed care organizations for services that were never provided to patients. Anderson falsely claimed that patients had received counseling at his treatment facility when, as he knew, they were not there. In fact, some patients were hospitalized or placed in assisted living facilities elsewhere when Anderson lied, claiming they were in his care. Anderson also stole and misused the billing credentials of multiple doctors by billing for services he claimed they had rendered to patients at his facility, when those doctors had left his employment many months before. By lying about the services rendered and misusing billing credentials, Anderson stole more than $300,000 from these programs.

“Stealing from Medicaid, a taxpayer-funded safety net program, is a reprehensible crime that diverts funds intended to serve some of the most vulnerable individuals in our country,” said Special Agent in Charge Omar Pérez Aybar of U.S. Department of Health and Human Services Office of Inspector General. “Such greed-fueled scams will not be tolerated. Thanks to our hardworking investigators and our law enforcement partners, fraudsters are being held accountable for engaging in these illicit activities.”

“We are thankful that this matter has been resolved and Mr. Anderson is being held accountable for his actions,” said Anthony Holloway, Chief of St. Petersburg Police. “We appreciate our partnership with the U.S. Attorney’s Office and their continued commitment to seek justice for those who are victimized by schemes to defraud.”  

Attorney General Ashley Moody said, “This fraudster misused billing credentials of physicians and charged the government for services not rendered to steal from taxpayers. Thankfully, our Medicaid Fraud Control Unit investigators, working with federal authorities, uncovered the scheme and now, this fraudster will serve time in a federal prison.”

The case was investigated by Health and Human Services, Office of Inspector General, the Florida Office of Attorney General’s Medicaid Fraud Control Unit, and the St. Petersburg Police Department. It was prosecuted by Assistant U.S. Attorney Kristen A. Fiore.

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Service members will no longer need a waiver to get laser treatments for severe razor bumps at a civilian facility.

The Defense Department announced Dec. 17 that Tricare will cover claims filed by active-duty personnel who require laser therapy for pseudofolliculitis barbae, or PFB, from a non-military provider.

The change, which is backdated to July 17, 2019, follows the Navy’s termination earlier this year of its permanent no-shave chits for sailors with the condition.

Sailors had been allowed to request a waiver to a military requirement that all personnel be clean-shaven, but Navy leadership decided to scrap the practice, citing two Naval Safety Center reviews that found beard growth can obstruct the seal of face masks, potentially exposing service members to hazardous and lethal conditions.

“We are ensuring that all our sailors will remain safe in the operational, maintenance and training environment that they’re under,” said Rear Adm. Jeff Jablon, director of the military personnel, plans and policy division within the Office of the Chief of Naval Operations.

Under the new Tricare policy, active duty service members with PFB who have not responded to conventional treatment and receive a recommendation from a military dermatologist may be able to receive laser therapy off-base.

PFB is an inflammatory condition caused by ingrown hairs and irritation stemming from the process of shaving. It is more common in men of African and Asian descent, and an estimated 60 percent of African-Americans have the condition.

Several studies estimate the prevalence of PFB among black recruits and soldiers to be between 45 percent and 83 percent.

Roughly 6,000 sailors have sought medical treatment for the condition; data for members of the other military services was not readily available during the holiday break.

While the condition can be treated with topical ointments, chemical peels and steroids, removal of the hair follicle is considered to be among the most effective treatments, but therapies, including waxing and electrolysis, can be painful, expensive and cause unwanted side effects.

Laser treatments can thin and destroy the hair, reducing the chance of recurrence.

The new policy only applies to service members on active duty; Tricare does not cover most laser treatments, including those for hair removal and skin care, for other beneficiaries, including retirees and family members.

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VA professionals help blind Vet learn to live and work independently

Standing in front of a long stainless-steel table in the inpatient kitchen at the VA Salt Lake City Health Care System, Army Veteran Arthur Saenz prepared salads for the lunch rush, topping each bowl with cherry tomatoes.

You wouldn’t know from watching him work, but 25-year-old Saenz is blind.

“It basically took an army to get me to where I’m at now,” he said.

Saenz joined the military shortly after high school. While still at basic training, he noticed something going “wonky” with his sight.

“I just assumed I was tired because, you know, they like to tire you out in basic,” he said. “But the next day, I woke up with the sight I have today.”

Saenz received an irregular discharge and went back home to Iowa where he and his wife lived for several dark and confusing years.

“I was alone and felt like no one was there for me. I was consistently told I wasn’t good enough or that I couldn’t support my wife because I was blind. That was very difficult. Very difficult.”

The meeting that changed everything

A chance meeting in a parking lot changed that.

“We ran into someone from DAV (Disabled American Veterans). And they were like, ‘It can’t hurt. Let’s put in a claim for you and let’s get it figured out.’”

With the help of DAV and the local VA, Saenz received a service-connection for his disability. More important, he gained access to VA professionals who could help him learn to live without sight.

During a three-month intensive living and mobility course at the Hines VA Medical Center in Chicago, Saenz learned basic skills, such as using a knife, cooking, reading Braille and using adaptive technology to navigate the world. He also learned how to hike unassisted. He was able put those skills to good use when he and his wife moved to the mountain town of American Fork, Utah.

At nearby VA Salt Lake City, Saenz met recreation therapist Heather Brown, who introduced him to low vision clinic instructors Thomas Wolf and Darren Lindsay.

“His skills were really good when he came to us,” Wolf said. “He just needed to get familiar with his new neighborhood.”

Still, something was missing for Saenz: a job. Vocational rehabilitation counselor Mari Hanson connected him with the position he has today with the hospital food service.

“You know there is hope”

Saenz plans to attend culinary school and eventually open his own restaurant.

He’s eager to give credit to everyone who helped him get where he is today. And he has a message for visually impaired people who are struggling to find their place in the world.

“Please don’t give up, because you know there is hope. Get help, find someone that’s willing to take the time and help you get through these obstacles.”

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You have your dream job. You’re a fighter pilot – the king of the skies. But after you serve your country in one of the most dangerous jobs, you come down with cancer, a problem afflicting many former fighter pilots in the U.S. Air Force.

According to a recent study, if you are a fighter pilot or a certain member of the crew, you have a 29 percent chance of getting testicular cancer and you have a 25 percent increased chance of getting diagnosed with skin or prostate cancer.

Which Pilots Are Getting Cancer?

The 2021 study, “Cancer Incidence and Mortality Among Fighter Aviators,” revealed numbers that are startling. Social scientists affiliated with the Air Force Research Lab looked at fighter pilots and their weapons systems officers – an experimental group called “fighter aviators.” The sample was taken from fighter aviators who had at least 100 flight hours in a fighter plane from 1970 to 2004. So, this included the end of the Vietnam War, Operation Desert Storm, and the beginning of the Second Gulf War.

The sample had nearly 35,000 fighter aviators. The scientists compared their cancer rates to a control group of 316,262 officers who did not fly warplanes during that time period. Thousands of fighter aviators were diagnosed with cancer. The rates were shocking. Fighter pilots are 29 percent more likely to be diagnosed with testicular cancer; 24 percent more likely to be diagnosed with skin cancer; and 23 percent more likely to have prostate cancer compared to their peers.

The study also made a comparison with the fighter aviator sample and the general U.S. population. The Veterans are again more likely to get cancer. Fighter aviators were 13 percent more likely to get non-Hodgkin lymphoma, 25 percent more likely to be diagnosed with melanoma, and 19 percent more likely to get prostate cancer compared to the general population.

Policy Makers Want Answers

Senators such as Dianne Feinstein are getting involved and want to do studies across the service branches to learn more about Veterans with cancer. She already added authorization language in last year’s National Defense Authorization Act that will have the Defense Health Agency investigate other members of flight crews who are coming down with cancer. Defense Secretary Lloyd Austin wants a study to look at causes of the cancer among Air Force fighter pilots.

If You Are Fighter Pilot Get Screened Early

It’s not clear what is causing this outbreak. It could be radiation from the radar, jet fuel, solvents, or exposure to other chemicals. My brother-in-law served in the Air Force as an avionics technician for the F-16 and the F-117 during the 2000s. He was routinely exposed to jet fuel and other chemicals on the flight line. He was diagnosed with colon cancer at 38 and the U.S. Department of Veterans Affairs determined that his cancer was service-connected. After emergency surgery and aggressive chemotherapy, he is currently in remission.

Some aviators are calling for the Air Force to screen for cancer on pilots beginning at the age of 30. The Secretary of Defense should call louder for that study on the causes of cancer to be carried out promptly. No pilot should have to fight this alone if it is indeed service-connected. We owe much to our warriors in the sky and we should do anything possible to keep them from being afflicted with this horrible disease.

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Many Veterans are diagnosed with obstructive sleep apnea, and therefore—with an effective claim that includes the right evidence—should be eligible for a sleep apnea VA rating. Since this condition is nearly epidemic among Veterans, it’s important to learn what it takes to get a VA disability for sleep apnea, as well as how the condition may affect you.

What is sleep apnea?

Sleep apnea is a serious sleep disorder in which breathing is briefly and repeatedly interrupted during sleep. This can occur from ten times to hundreds of times per night. The constant interruption of breathing can lead to reduced sleep quality, short-term memory loss, irritability and even mood disorders, as well as major metabolic diseases such as diabetes and heart disease.

Sleep apnea often is thought of as a mild annoyance, but it is a significant condition that can lead to health issues ranging from hypertension, stroke and heart attack to depression, anxiety and headaches.

How do I know if I have sleep apnea?

Symptoms of obstructive sleep apnea include:

• Loud snoring
• Episodes where you stop breathing during sleep
• Gasping for air during sleep
• Awakening with a dry mouth
• Morning headache
• Daytime sleepiness (hypersomnia) or insomnia
• Lack of focus or difficulty concentrating
• Irritability or anger

If you experience many of these symptoms, we recommend seeing a doctor as soon as possible and seeking a diagnosis. If you meet the requirement of having a current diagnosis, you can obtain a service connection and VA rating for sleep apnea and receive disability benefits.

It’s likely your doctor will need to order a sleep study to determine if you have sleep apnea. A doctor’s diagnosis will be one of the keys to getting a sleep apnea VA rating.

Why do so many Veterans have sleep apnea?

Research shows a strong correlation between deployments and sleep disorders, and sleep apnea is extremely common among Veterans. The Office of the Inspector General found that 1.3 million Veterans enrolled in VA Healthcare have a sleep apnea diagnosis.

As a Veteran, you’re four times more likely than other Americans to develop sleep apnea. According to the VA, 1 in 5 Veterans has obstructive sleep apnea. Since 2009, the number of Veterans’ claims for sleep apnea has increased by over 150%, according to USA Today.

Why do so many Veterans have sleep apnea? There are many factors during and after service that make Veterans vulnerable to this condition. There are also many service-connected conditions that can result in sleep apnea. It can also work in reverse: sleep apnea can lead to other disabilities.

Sleep apnea can be aggravated by PTSD (secondary to PTSD), also an extremely common disorder for Veterans. The same goes for depression and anxiety—or any of the 33 mental health conditions rated by the VA—which can be highly disruptive to sleep.

Traumatic brain injury and physical pain are also conditions that affect many Veterans and can lead to sleep apnea. Exposure to materials such as dust and fumes, and the resulting rhinitis or sinusitis, is also a common issue for Veterans that’s associated with sleep apnea.

What is the current VA rating for sleep apnea?

There isn’t a single rating for sleep apnea, but a range of ratings depending on the severity of your condition (as is true for other disability ratings). A disability rating at any given percentage (e.g., 30%, 50%, 100%) pays based on that percentage, no matter what condition(s) gives you that rating.

Your sleep apnea rating will compensate you based on your condition’s severity. The disability rating you’re given for sleep apnea is combined with any other disability ratings you have, if any, to give you an overall rating based on VA math.

Sleep apnea is classified by the VA as sleep apnea syndromes (diagnostic code 6847). The VA awards disability ratings for sleep apnea at the 0 percent, 30 percent, 50 percent, and 100 percent levels. The most common VA rating for sleep apnea is 50 percent.

The sleep apnea VA rating criteria are as follows:

• 100%: Chronic respiratory failure with carbon dioxide retention or cor pulmonale (a condition that causes the right side of the heart to fail), or requires tracheostomy
• 50%: Requires use of breathing assistance device such as a CPAP machine
• 30%: Persistent daytime hypersomnolence
• 0%: Asymptomatic but with documented sleep disorder breathing

If you feel groggy during the day, you may be rated at 30 percent. If you use a CPAP machine to address your sleep apnea, you’re likely to be rated at least at 50 percent. To be rated at 100 percent, you must experience chronic respiratory failure.

Can sleep apnea be service-connected?

Yes, sleep apnea can be service-connected—and will need to be service-connected in order for you to get a disability rating for sleep apnea.

Sleep apnea can be service-connected in two ways: either direct service connection or secondary service connection.

Direct service connection for sleep apnea can be difficult to obtain, as most successful cases require a diagnosis while on active duty. This would mean you had a sleep study conducted while on active duty and received a medical diagnosis of sleep apnea as a result of the study.

This is rare, because most Veterans don’t realize they have sleep apnea until after they’ve left military service. Many Veterans don’t even know what sleep apnea is while on active duty, let alone that they need a sleep study to prove they have it! For this reason, a secondary service connection for sleep apnea is much more common.

Sleep apnea and secondary service connection

A disability with a secondary service connection is a condition that was caused or made worse by an already existing service-connected condition.

If you have a service-connected disability aggravating or causing your sleep apnea, you may be eligible to get service connection for sleep apnea on a secondary basis. This is especially relevant for Veterans diagnosed with sleep apnea long after leaving the military.

With over 50 conditions that can be medically linked to sleep apnea, it’s important to understand the three elements required by law that must be satisfied in order for sleep apnea to be service-connected secondary to another service-connected disability.

1. A medical diagnosis of sleep apnea confirmed by a sleep study in VA medical records or private records
2. Evidence of a service-connected primary disability, such as musculoskeletal conditions or mental health conditions (PTSD, depression, anxiety, sinusitis, rhinitis), AND
3. A nexus (link) shown via medical evidence establishing a connection between the service-connected disability and the current disability (in this case, sleep apnea)

The three most common conditions resulting in a secondary service connection for sleep apnea and therefore a are:

• Sleep apnea secondary to PTSD or other mental health condition
• Sleep apnea secondary to a respiratory condition
• Sleep apnea secondary to medication side effects

Sleep apnea secondary to PTSD

Research shows that combat Veterans with PTSD may be at higher risk for sleep apnea than the general population. Both disorders have risk factors that affect both sleep apnea and symptoms of PTSD, and the conditions can aggravate each other.

A study conducted by the VA Healthcare System for San Diego and National Center for PTSD found that between 40 percent and 98 percent (!) of Veterans with PTSD also have a co-occuring sleep disturbance, including obstructive sleep apnea (OSA). If you’re dealing with sleep apnea as a secondary condition to PTSD, you aren’t alone!

Sleep apnea also ranks #2 on our List of the Top 5 Secondary Conditions to PTSD.

PTSD—and the side effects of medications taken to address PTSD—can lead to the development of sleep apnea in a few different ways. PTSD is well-known for causing sleep deprivation, chronic stress, and an increase in body mass or obesity due to prescribed medications. All of these can contribute to sleep apnea.

In order to prove a secondary service connection, you’ll need three things:

• A medical diagnosis of sleep apnea confirmed with a sleep study
• A service-connected PTSD disability rating (or another service-connected mental health condition)
• A medical nexus establishing a connection between your PTSD and sleep apnea

PTSD doesn’t have to be the main cause of your sleep apnea, but it does have to be connected. You can link these two by detailing the side effects of PTSD that impact your sleep apnea, with the doctor writing your nexus letter.

Also see our post on receiving a VA rating for sleep apnea secondary to PTSD.

What kind of CPAP machine does the VA use?

A Continuous Positive Airway Pressure (CPAP) machine helps treat sleep apnea by delivering a stream of air into your airways through a mask and a tube.

The VA prescribes several different types of CPAP machines. These include:

• A basic CPAP, which keeps pressure constant all night long
• A bilevel device (BiPAP), which provides two levels of pressure—more when you breathe in and less when you breathe out
• An auto-CPAP device, which changes pressure throughout the night based on your body position, sleep stage, and snoring

As you’re gathering medical evidence to file your VA claim for sleep apnea, remember that just having a CPAP alone doesn’t meet the VA’s requirements for service connection. You must have a medical statement from a doctor detailing how your sleep apnea is service-connected.

Is a CPAP machine the only treatment for sleep apnea?

Sleep apnea treatment depends on the type and severity of the condition. Before or in addition to CPAP therapy, lifestyle changes such as diet, exercise, and stress reduction may be recommended. Some Veterans with sleep apnea may experience improvement with lifestyle changes, but CPAP therapy is still among the most common treatments.

Why would a VA claim for sleep apnea be denied?

A VA claim for sleep apnea can be denied for many reasons. One common scenario is when a Veteran tries to claim sleep apnea as a primary condition when there was no diagnosis during active-duty service. Even if you have a medical diagnosis during active-duty service, without a sleep study this is difficult to claim successfully.

If you’re claiming sleep apnea as a secondary condition, make sure you already have a medical diagnosis before you make your claim. The most common reason for denial of secondary claims is not establishing a strong enough connection between the service-connected disability and the sleep apnea. Including a nexus letter for sleep apnea can be an important part of your claim to strengthen your case for a sleep apnea VA rating.

In addition, during the C&P exam for a sleep apnea VA rating, it’s important to make the case for how your sleep apnea impacts your ability to work, your daily life, and your social life.

Sleep apnea is proven to significantly reduce a person’s quality of life (in one study, the reduction in quality of life was equivalent to that observed with diabetes or hypertension). Obstructive sleep apnea can cause daytime sleepiness, snoring, depression, difficulties with concentration, and loss of memory.

Here are a few examples of how sleep apnea could be impacting your life, which you’ll want to clearly state and demonstrate in your C&P exam and in your claim:

• You have difficulty working and lose productivity during the day due to napping
• You have to use a CPAP or other breathing machine at night
• Your depression or anxiety, exacerbated by loss of sleep, affect your relationships and work
• Your inability to focus or concentrate or loss of memory affects your job or your safety

Do I need a nexus letter for sleep apnea?

We recommend a nexus letter from a medical professional to connect your condition to your military service (or secondary to a service-connected disability) in order to improve your chances of receiving a rating for sleep apnea as a secondary condition.

In our experience, a well-crafted nexus letter for sleep apnea is the single most crucial document you can provide to help prove service connection on an “at least as likely as not” basis. Having a doctor connect your sleep apnea to your secondary service-connected disability will greatly improve your chances of winning a sleep apnea VA rating.

(If you need an independent medical opinion in the VA’s language, take a look at our VA Claims Insider Elite program. Membership gives you your very own Veteran coach to walk you through the VA claim process from start to end, and access to proprietary resources. It also connects you with Vetted medical professionals in our independent referral network for medical examinations and credible medical nexus letters. It’s free to join and we don’t win unless you win.)

Can the VA take away my sleep apnea rating?

A sleep apnea VA rating can be reduced by the VA.

When you’re granted a sleep apnea VA rating, you may also be assigned a re-evaluation period (unless the condition is classified as static). Typically the re-evaluation period is anywhere from two to five years after your initial examination. At that time, the VA may schedule a re-examination to verify if your sleep apnea symptoms still exist, and if they’ve changed.

If your initial rating decision letter says that future examinations are scheduled, or you don’t have a 100% permanent and total rating, then your disability rating is not considered permanent or static by the VA.

There are cases in which your VA rating for sleep apnea would not be re-evaluated. These would include situations in which:

• Your disability is considered permanent by the VA
• Your disability is considered static by the VA
• Sleep apnea symptoms persist without material improvement for five or more years (this is known as a stabilized rating)
• You’re over age 55
• You have a continuous sleep apnea rating for 20 years or more

According to 38 CFR § 3.105(e), a rating reduction (for any condition) may only take place in cases where:

• The VA has reviewed your entire medical history
• You’ve undergoes a thorough examination
• The VA has found sustained improvement in your ability to function under the ordinary conditions of life,

The VA is also required to issue a Veteran notice of a proposed reduction and give you 60 days to submit evidence and 30 days to request a hearing (unless the reduction would not change your compensation).

Get service-connected, get compensated and get the care you need!

By covering all the bases in your sleep apnea VA claim process—having your sleep apnea diagnosed with a sleep study and connecting your sleep apnea to a service-connected condition with medical evidence—you’ll set yourself up for success to get a service-connected VA rating for sleep apnea. Also make sure to seek the care you need to get relief from the effect of sleep apnea on your health and life.

Want More Help with Your Sleep Apnea VA Claim?

At VA Claims Insider, we can help you win your claim and get the highest VA rating for sleep apnea.

At VA Claims Insider, we help Veterans understand and take control of the claims process so they can get the rating and compensation they’re owed by law. Our process takes the guesswork out of filing a VA disability claim and supports you every step of the way in building a fully-developed claim (FDC).

If you’ve filed your VA disability claim and have been denied or have received a low rating, or you’re not sure how to get started, reach out to us for a FREE VA Claim Discovery Call—so you can FINALLY get the disability rating and compensation you deserve. We’ve supported more than 15,000 Veterans to win their claims. NOW IT’S YOUR TURN.

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