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  • BWN Benefits

     

    A Jan. 29 federal appeals court ruling could expand the pool of Vietnam Veterans able to claim disability benefits connected to Agent Orange, a chemical weapon known to cause serious health problems in those exposed.

    “It’s about time,” Veteran John Ranson said Monday.

    That category — those exposed — for years did not technically include Navy Veterans like him.

    Agent Orange was a defoliant herbicide American soldiers deployed to thin out the Vietnamese jungle, depriving guerilla insurgents of both cover and food. When its deadly long-term health impacts became clear, Congress passed the Agent Orange Act of 1991 to provide some financial relief for all those who served.

    However, the Department of Veterans Affairs repeatedly denied the claims of so-called “Blue Water Veterans,” claiming only soldiers present on the Vietnamese mainland could reasonably claim to have interacted with the substance.

    That’s not what Rex Settlemore, who served from 1967 to 1998 and spent two tours in Vietnam, thinks. He watched from the U.S.S. Durham and U.S.S. Richard S. Edwards as airplanes releases chemical weapons overhead, and he remembers how close to the shore both ships sailed.

    Agent Orange particles must have made it into the ocean water he and the rest of the crew used, he said, if not the air they breathed. He believes some of the early deaths among his comrades from that time are connected to that exposure.

    “Ships who ingested the sea water, even if the sea water was distilled for fresh water on board, would still contain the Agent Orange contaminants,” he said, citing an Australian Naval study.

    Dr. Ralph Erickson, the VA’s chief consultant of post-deployment health, had repeatedly argued that ships never took in sea water fewer than 12 miles off the coast. Settlemore said he knew nothing about any similar rule during the war.

    “We served off the coast well within 200 yards, and we did not turn off the sea water suctions when we were operating in close,” he said. “I am unaware that was ever a policy, and it certainly was not a policy that was typically followed by the destroyers that were on gunfire support.”

    The VA may still decide to resist the court’s finding and continue adhering to a boots-on-the-ground retirement for disability benefits connected to Agent Orange. If it hopes to succeed, however, it will need the support of the Supreme Court of the United States.

    John Ranson is hopeful that court would rule in favor of Veterans like himself.

    “I hope they do and see the right side of this,” he said.

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  • Tricare provider

     

    Some Tricare beneficiaries still have problems trying to get medical care, and officials have taken actions to try to improve the performance of contractors, said Navy Vice Adm. Raquel Bono, director of the Defense Health Agency.

    Officials are closely monitoring the performance of the two U.S. Tricare contractors, Humana Military in the East region, and Health Net Federal Services in the West region, said Bono, speaking at a family forum Monday at the 2018 AUSA annual meeting.

    She said she recently was impressing upon some senior spouses that “it’s extremely important to me that we get the type of performance we need” from the contractors.

    And, she told them, “While I may not look like it, I can be a bad ass.”

    Defense health officials have issued several corrective action plans to the contractors, among other things. Through August, the contractors were meeting contract requirements at a level of about 80 percent.

    She said there are still challenges with the accuracy of the contractors' provider directories. Defense health officials have issued corrective action plans to both contractors regarding these issues. Families have had trouble finding area doctors and other medical providers who are in the Tricare network.

    Officials also issued a corrective action plan to Health Net regarding its customer call centers. Humana has corrective action plans regarding claims processing, correspondence, autism care/Applied Behavior Analysis therapy.

    Tricare underwent massive changes in January, as three regions were reduced to two, and Tricare Select replaced Tricare Standard and Extra. There have also been increases in some co-pays and some pharmacy costs.

    Help spread the word

    Bono asked for the help of those in the audience – which included many military spouses – in getting the word out about important changes coming up.

    There are new requirements for those who are retiring. To keep Tricare with no break in coverage, the service member must re-enroll within 90 days of retirement.

    There are new open enrollment seasons affecting three benefits, all of which will be held Nov. 12 to Dec. 10:

    • Those in Tricare Prime or Select who like their plan don’t need to do anything. But anyone wishing to switch from Prime to Select, or vice versa, must do so during that open season. Until now, families could switch at any time. But once the open season is over, a switch can be made only for a qualifying life event. A few examples of those are moving, retiring, separating from active duty, getting married, having children, and getting divorced. (Tricare.mil/openseason)
    • The Tricare Retiree Dental Program ends Dec. 31. To have dental coverage for themselves and their family members through the government in 2019, retirees must enroll in the FEDVIP plan during that open enrollment season which starts Nov. 12. (Tricare.benefeds.com)
    • Retirees and their family members and active duty family members (not active duty) will also have access to new vision coverage under the FEDVIP, during that open enrollment season which starts Nov. 12. (Tricare.benefeds.com)

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  • Charities Honored

     

    A new charity that pays for and helps organize reunions for combat Veterans has received a $50,000 grant, the highest honor in this year’s Newman’s Own Awards competition.

    “The prevailing narrative about my Veteran generation is wrong. We are not broken, we don’t need to be fixed, we don’t need over-engineered solutions. We just need each other,” said Marine Corps Veteran James Ferguson, founder of the Warrior Reunion Foundation of Cockeysville, Maryland, in accepting the award at the Pentagon Friday.

    In just over a year, the foundation has provided seven reunions to soldiers who deployed to combat together. The eighth reunion is scheduled for November.

    While the reunions so far have involved units in the post-9/11 conflicts, their eligibility spans all generations of Veterans — soldiers in any unit who served together in any combat zone during any armed conflict.

    This marks the 19th year of the awards, sponsored by Newman’s Own, the Fisher House Foundation, and Military Times. Since the program was launched in 1999, Newman’s Own and Fisher House Foundation have contributed $1.9 million to 179 organizations for their innovative programs to improve quality of life in the military community.

    Five organizations were awarded a combined total of $200,000 in a ceremony Friday at the Pentagon.

    The organizations’ work “transcends the 50 people, 1,000 people, 100 people” they touch in their work, said Joint Chiefs Chairman Marine Gen. Joseph Dunford. “It’s sending a message that you value our Veterans,” he said.

    And this message has an impact on retention and on recruiting, as Veterans in the community encourage younger generations to serve, he said.

    The ability of the United States to sustain the high quality all-volunteer force “is really about the loud and clear message that we respect, value and appreciate the service of those in uniform,” he said.

    “Your service is inspiring and your example is humbling,” said Dave Coker, president of Fisher House Foundation told the organizations. “Your efforts to improve the quality of life in the military community is what we’re celebrating today.”

    Newman’s Own, founded by Navy Veteran and actor Paul Newman in 1982, has donated more than $530 million to thousands of charities, donating all the profits and royalties from the sale of its food products.

    “Our giving is at its best when we meet organizations like those here today that address the needs that fall in between the pillars of what’s already in the establishment,” said Jeffrey Smith, vice president of operations for Newman’s Own, Inc. “In many ways, our giving and your doing has the connective tissue” that enables solutions to come together, he said.

    Andrew Tilghman, executive editor of Military Times, noted that over the years, the Newman’s Own award winners have provided a snapshot in time of what service members and Veterans need most — such as groups sending care packages overseas, and providing funding for phone calls, and providing various forms of support for families of deployed service members in the early 2000s. Today, the groups are focusing more on the long-term transition of Veterans.

    While the all-volunteer force has been an historic success, he said, sometimes it’s taken for granted.

    “This extraordinary American institution needs support, but the Defense Department can’t do it all alone," he said. “It’s organizations like these honored here today that are helping to do just that, by contributing to and strengthening the social contract between the American people and the service members and Veterans who volunteered to protect them.”

    Ferguson said his organization is helping to support those long-term needs by helping combat comrades easily reconnect, sharing experiences only those in the same unit may understand. They pay for the reunions and help guide unit members through the planning process.

    The warrior reunions are often held outdoors, in environments more similar to a field environment, with the Veterans sleeping in cots under tents. They share stories around bonfires and during activities; they hear from experts from support organizations serving a variety of needs; they do service projects; and they hold memorial services for the fallen in their unit. Often, some of their Gold Star families attend.

    The reunions are modeled after the first one Ferguson organized for his Marine unit in 2015, which he started because he needed to spend time with his fellow Marines.

    Judges in the competition are Dunford’s wife Ellyn, Tammy Fisher, Suzie Schwartz and Lynn Pace, all trustees of the Fisher House Foundation, and Smith from Newman’s Own.

    Those receiving awards of $37,500 are:

    • Code Platoon,Chicago,Illinois. Provides software coding training to help local Veterans and military spouses pursue careers as professional software developers. Students can use their GI Bill benefits or apply for scholarships. Classes of eight to 12 students spend 60 to 80 hours a week for 14 weeks. The course is a mix of lectures, advanced coding training in Python and Ruby on Rails and team projects.
    • West Virginia Health Right, Inc.,Charleston,West Virginia. Provides free dental care to low income West Virginia Veterans without dental coverage, through their Veteran’s Dental Program. The care includes cleanings, exams, fillings, extractions and dentures. This grant will be used to help fund a program that will use a mobile dental clinic traveling to six rural counties and the onsite dental clinic at their main office, treating 500 Veterans in need.
    • Healing Warriors Program,Boulder,Colorado. A nonprofit clinic that provides non-narcotic Integrative Care therapies to treat pain and symptoms of post-traumatic stress in Veterans, active duty members and their families throughout the Colorado Front Range and southern Wyoming. Their mission is to advance the well-being through these evidence-based Integrative Care services and education.
    • Vets on Track Foundation, Inc.,Garrisonville,Virginia. Furnishes homes for Veterans who have been placed into permanent housing after living on the streets or in a shelter. This “Fresh Start” program volunteers turn these houses into warm, loving homes with everything from sofas, beds, dining room tables and chairs, dishes and silverware, to pictures, pillows and blankets.

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  • Jeff Dettbarn

    IOWA CITY, Iowa – Radiology technologist Jeff Dettbarn said he knew something was wrong at the Department of Veterans Affairs hospital in Iowa City, Iowa, when a patient arrived in February 2017 for a CT scan, but the doctor’s order for it had been canceled.

    “To have a patient show up for a scan and not have an order – you’re like, ‘What the heck is going on?’ ” he told USA TODAY in an interview.

    Dettbarn started collecting cancellation notices for diagnostic procedures such as CT scans, MRIs and ultrasounds.

    “I knew something was not right,” he said. “Because none of them were canceled by a physician.”

    Cancellations of more than 250,000 radiology orders at VA hospitals across the country since 2016 have raised questions about whether – in a rush to clear out outdated and duplicate diagnostic orders – some facilities failed to follow correct procedures. At issue is a concern over whether some medically necessary orders for CT scans and other imaging tests were canceled improperly.

    The VA inspector general is auditing mass cancellations at eight VA medical centers “to determine whether VA processed radiology requests in a timely manner and appropriately managed canceled requests,” VA Inspector General Michael Missal said.

    Those hospitals are in Tampa and Bay Pines, Florida; Salisbury, North Carolina; Cleveland; Dallas; Denver; Las Vegas; and Los Angeles.

    After receiving inquiries from USA TODAY, a ninth was added – Iowa City.

    In Iowa City, Dettbarn alerted the hospital’s compliance officer about his concerns. He is now facing disciplinary proceedings and contends they are an effort to retaliate against him.

    The VA declined to comment on disciplinary proceedings without Dettbarn’s written consent to discuss personnel matters, which he did not provide.

    This much is clear: in sworn testimony in the disciplinary proceedings against Dettbarn, Iowa City administrative staffer Lisa Bickford saidshe and other employees were told by the hospital’s chief radiologist that they needed to “clean” up a backlog of incomplete diagnostic orders, some dating back years.

    The staff responded by “annihilating” thousands of orders in a matter of weeks, Bickford said.

    Bryan Clark, a spokesman for the Iowa City hospital, acknowledged the facility failed to follow national VA guidelines for diagnostic order cancellations but said that happened in only a “small number of instances” and “anything closed improperly was reviewed” and actions were taken to try to ensure Veterans received any needed exams. He said the process was intended to “ensure the quality and safety of the care delivered to Veteran patients.”

    The VA said many of the orders were outdated or duplicated. The agency said it welcomes the oversight and is working with the inspector general to improve cancellation guidelines. VA officials said efforts to close the loop on test orders with physicians and Veterans surpass private-sector practices.

    Laurence Meyer, the chief doctor overseeing specialty care for the national VA, told USA TODAY he didn’t want to comment on how individual VA hospitals handled cancellations, but he acknowledged “we’ve received word that a few places haven’t been following the directive as intended.”

    “We’ve sent out teams and have reviewed and are aggressively working to fix that,” he said.

    The VA’s guidelines on order cancellations have undergone revisions in the past few years.

    In 2016, hospitals were told to try contacting patients multiple times before cancellations. Last year, the rules required review by a radiologist or the ordering provider before canceling. If the tests were still needed, patients should be contacted to schedule them. Since last year, hospitals have been required to establish a fail-safe "triage" process, such as written verification of review by providers.

    Concerns about diagnostic test order cancellations have also been raised at the VA hospital in Tampa. Employees estimated they canceled thousands of radiology orders without checking first with doctors or patients, according to depositions in a discrimination lawsuit brought by four ultrasound technicians.

    Those technicians told USA TODAY they worry Veterans may have gone months, if not a year or longer, before they or their doctors realized tests weren’t performed – if they realized at all. Technologist Erin Tonkyro noted that risk factors for many Veterans are higher than for other patients.

    “Cancer grows very quickly, and our patients are not like those patients on the outside – it doesn’t mean that cancer doesn’t happen in private practice. But our Veterans have been exposed to such a large amount of toxic environments like Agent Orange; now we’re talking about the burn pits that have happened overseas,” Tonkyro said.

    ‘We knew it was bad’

    At the Tampa facility, radiology managers began tackling outstanding orders in fall 2016.

    As many as 10 people were tasked with the job, one administrative staffer testified in a deposition in the technicians’ lawsuit. Multiple employees testified they canceled orders by date and did not consult any doctors before doing so, nor was there patient contact.

    They disabled office printers because of the volume of cancellations – one employee estimated they canceled thousands of radiology orders, according to testimony.

    “That’s when we really started getting worried,” said Tonkyro, who attended the depositions with her co-plaintiffs, ultrasound technologists Yenny Hernandez, Kara Mitchell-Davis and Dana Strauser. “We knew it was bad, but we had no idea the magnitude of how bad it was.”

    Strauser told USA TODAY that administrators went beyond past orders and canceled future ones. Those could have been follow-up scans for Veterans who might have been at risk of developing medical conditions, such as cancer recurrence.

    “Doctors will put an order in for six months in advance and sometimes even a year in advance, and we were getting cancellations of those future orders,” she said.

    In a statement issued by VA spokesman Curt Cashour, the VA declined to comment on what happened in Tampa, citing the litigation. “However, we are confident the James A. Haley Veterans’ Hospital has processes and procedures in place to provide the best care possible for our patients,” the statement said.

    The Tampa Bay Times first reported the technicians’ concerns in July, and the hospital’s chief of staff, Colleen Jakey, wrote to providers the following month asking them to review canceled orders, according to a copy of the correspondence obtained by USA TODAY.

    “We believe appropriate action was taken,” Jakey wrote, adding that a review of a random sample of cancellations did not turn up any cases of harm to Veterans. “This is a second-level review of these orders to confirm that each of these patients received the appropriate care and/or follow up.”

    The technicians told USA TODAY some doctors have since reordered canceled exams but won’t know whether Veteran patients suffered any harm from the delays until they are performed and assessed.

    ‘An important patient safety issue’

    VA hospitals came under increasing pressure to address outstanding diagnostic orders after a conference call that national officials convened with radiology managers across the country in January 2017. More than 325,000 orders for scans of Veteran patients had not been completed nationwide.

    The VA’s top radiologist, Robert Sherrier, called it “an important patient safety issue” in a presentation for the call.

    “Ordered studies are not being performed on Veterans, and providers may not be aware that the ordered study has not been completed,” he said.

    In a dozen states, there were VA medical centers with more than 5,000 outstanding orders, his presentation said. The numbers reached 29,000 in Columbia, S.C.; 21,000 in Cleveland; and 12,000 in Washington.

    Radiology Orders

    Some dated back to the 1980s, but others were only months old. VA officials said that in some cases, staff may not have been able to contact Veterans to schedule exams. In other cases, Veterans may not have shown up, possibly because their ailments had gone away. Some orders may have been duplicates ordered by two different doctors.

    Others may have been tests that were still needed – to monitor tumors or follow up on emergency room visits, for example.

    A panel of medical and ethics specialists conducted thousands of chart reviews, Meyer said, and determined orders for exams due to be performed before June 2015 could be canceled outright without jeopardizing Veteran health.

    Orders due after that date required further steps to ensure patient safety.

    The national call to action triggered a dramatic reduction in pending exam orders overdue by two months or longer. As of last month, the VA said, there were 31,000 nationwide.  

    ‘We look terrible’

    At the Iowa City VA hospital, Bickford said the chief of radiology – who also was the top radiology official in the Midwest for the VA – told her after the conference call in January 2017 that the facility had more outstanding orders than any other VA in the region.  

    “He came to (us) and said, ‘We’ve got to get this cleaned up now. I mean, we look terrible,’ ” Bickford said. So she and other staff “went through and started annihilating orders,” she testified in the disciplinary proceeding against Dettbarn.

    Any radiology orders more than 60 days past due were considered “invalid” and “expired,” Bickford testified. That is at odds with VA guidelines at the time requiring doctor reviews.

    Cancellation records reviewed by USA TODAY show that in some instances, she and other staff canceled future orders.

    In one case, a nurse practitioner ordered an ultrasound for September 2017 as a six-month follow-up for a Veteran with a history of kidney stones. An X-ray technician canceled it in June 2017, calling it an “expired” order.

    That same month, records indicate, Bickford canceled an order for a follow-up CT scan to monitor a Veteran’s lung nodules. The test wasn’t due to be performed until September 2017. Also in June, she canceled a CT to monitor fluid in a patient’s lung not due until November 2017. Records show Bickford selected “patient failed to contact clinic” in both cases. None of the records reviewed by USA TODAY contained personal information identifying patients.

    In the disciplinary case against Dettbarn, his supervisors alleged he was “disruptive” and didn’t send one patient’s images to be interpreted – accusations he denied. The investigation was initiated soon after he reported his concerns about the order cancellations.

    The Office of Special Counsel, a federal agency tasked with protecting whistle-blowers, is investigating, according to a letter from the office.

    Bickford declined to comment and referred questions to the Iowa City VA. In her sworn testimony, she blamed scheduling clerks for not indicating on orders that exams were scheduled. That led employees to assume there was a “dead order” even though a patient had a future appointment, she said, but she estimated that occurred only “maybe a half a dozen times.” When patients arrived for appointments, the errors were discovered, new orders were created and the exams went ahead, she said.

    The chief of radiology, Stanley Parker, did not respond to a message seeking comment at a number listed in public records. In his deposition in the case, he testified that he believed physician-review would have been done before canceling.

    Clark, the hospital spokesman, said Bickford's testimony about “annihilating” orders was not in context and referred to the “success of the process to right size the number” of outstanding radiology orders at the hospital.

    Clark said he doesn’t know how many orders were canceled at the facility because officials didn’t track it, but he said more than 4,000 were canceled in January and February 2017 in the southern part of the Midwest region.

    Clark said “most” canceled orders were from before 2015, though he didn’t know how many. He said “some” exam orders were “canceled without following proper policies or procedures.”

    In those instances, Clark said, “appropriate personnel actions were taken to correct the behavior, and staff reviewed the cancellations to ensure every order that required action was appropriately reviewed by a radiology provider.”

    Dettbarn has been detailed to a job collating VA records since July 2017. He said that whatever happens to him, he wants the public to know about what he called a “horrible shortcut” administrators took to improve the numbers. Dettbarn said Iowa City officials should do a clinical review like the Tampa VA to ensure Veterans weren’t harmed.

    “It’s so far beyond wrong what was done,” he said. “This is someone’s health care, this is their body, their life you’re screwing with, and people are playing doctor that aren’t physicians.”

    Source

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  • Robert Chesser

     

    While “lend me your ears” may have been written by Shakespeare in the 16th century, it came true in a literal sense for a Veteran.

    Navy Veteran Robert Chesser received a new prosthetic ear, created for him by prosthetist David Trainer, to replace the ear he lost to cancer. The custom-made auricular prosthesis, as the silicone ear is more properly called, is one of many different prostheses Trainer has made for Veterans at James A. Haley Veterans’ Hospital over the last several years.

    Chesser was first diagnosed with squamous cell cancer on his right ear about three years ago. Since then he has endured 15 operations, two rounds of radiation treatment and a round of chemotherapy. The first surgeries were done in an attempt to save his ear, but the spreading cancer forced doctors to complete remove his outer ear, leaving him with his hearing but also with a large hole on the side of his head where the ear used to be.

    “I ended up with cancer in the whole ear area and down my jaw and my neck, the whole nine yards, and that’s when I lost the ear,” Chesser said. “They said, ‘That’s alright, never mind, they’ll fix you one up.’”

    He was referred to the Dental Service, which works with Veterans like Chesser.

    “We deal with restorations of head and neck cancer patients, both intraoral and extraoral (inside and outside the mouth) defects,” said Maxillofacial Prosthodontist Dr. Nicholas Goetz, who said he works primarily with patients needing restorations in the mouth. “There’s a lot of complex, large cases that I do, so David is able to come in here and do a great job for our patients with extraoral prostheses. They’re very time consuming, so it’s a great help for us.”

    The 73-year-old Veteran had did have some problems that complicated and delayed the day he could receive his new ear. Radiation had weakened the bone structure in the part of his skull that would normally be used to place pins usually used to attach the ear, and the surgery left him with an area of exposed bone that prevented the use of a prosthesis.

    Home treatments with homeopathic medicines helped bring skin back over the bone, while it was decided to use an adhesive to hold the prosthesis in place.

    Trainer, who has been making prosthetic ears, noses and eyes for patients for 35 years, has worked with the VA for the last several years out of his office in Naples, Florida. He drives almost 170 miles each way for at least three visits with the patient before the final prosthesis is ready.

    “On the first visit, I take an impression of both sides (including the left ear). With that I, then, I create models from which I sculpt the opposing ear for Mr. Chesser,” Trainer, who received his training in his native England, said. “I come back to the VA, I try that on, make sure it looks right, fits, everything is correct. Then I go back and I make a mold of that wax ear, then replace the wax with silicone. Then on the last visit I extrinsically paint it and fit it on the patient.”

    While he spends and average of an hour-and-a-half with the patient on each visit, it will normally take him four to five hours to sculpt the wax ear, then another two days making the mold and the silicon ear. He uses medical grade silicon that can be left attached for days at a time with no ill effect for the patient.

    For Chesser, Trainer brought three different silicone ears in different shades so he could most closely match the Veteran’ skin tone. Selecting one, he then laid out his paints and began the process of matching the patients skin tone, mottling and even vein structure found in his remaining ear.

    Trainer, who said he is not artistic, “… but I can copy well,” Constantly checking the copy against the real ear, Trainer worked for more than an hour before he was satisfied that the copy was as close to the original as possible.

    Using silicone adhesive to attach the prosthesis and petroleum jelly to smooth the edges. In the opinion of everyone in the room, it was almost impossible to tell the real ear from the prosthetic one, even to Chesser, who first put on his glasses and then sat looking at both ears in a hand mirror.

    For Trainer, each person who receives one of his prostheses makes his day.

    “It’s always a joy. For the last 35 years, I tend not to see people as patients. I call them my big happy family because you’re entering a very intimate part of their world,” Trainer said. “It’s something that they don’t want everybody to know about, so you’re forming a very close relationship with them, and as long as that person is happy at the end of the day, I’m very happy.”

    Chesser, who said he’s maintained a positive outlook during his entire ordeal, seemed happy enough that he joked with his wife when the session was finished.

    “I can’t wait until the day when she’s yelling at me, and I can take the ear off, lay it on the table, and tell here, ‘Talk to the ear.’”

    Source

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  • Fix VA Nursing Homes

     

    WASHINGTON – Six Veterans’ groups are calling on the Department of Veterans Affairs to improve the quality of care at its nursing homes following a story by USA TODAY and The Boston Globe detailing “blatant disregard for Veteran safety” at a VA nursing home in Massachusetts.

    “Anybody who respects Veterans should be angered by this,” American Legion National Commander Brett Reistad said. “America’s Veterans deserve better.”

    The groups, who together represent nearly 5 million members, said Veterans who risked their lives for our country shouldn’t have to risk their lives in VA nursing homes.

    In Brockton, Massachusetts, investigators found two nurses asleep during their shifts, even though the facility knew it was under scrutiny and inspectors were coming to visit, looking for potential signs of patient neglect. A whistleblower had reported that nurses and aides did not empty the bedside urinals of frail Veterans, they failed to provide clean water at night and didn’t check on the Veterans regularly. The VA said the napping nurses no longer work at the facility.

    The story was the latest in an investigation by USA TODAY and the Globe that revealed care at many VA nursing facilities was worse than at private nursing homes in the agency’s own internal ratings, kept secret from Veterans for years.

    The stories detailed disturbing examples of substandard care – a Veteran with undiagnosed scabies for months, another struggling to eat in Bedford, Massachussetts; and a third sitting for hours in soiled sheets and another writhing in pain without medication in West Palm Beach, Florida.

    A Navy Veteran was declared dead after he walked out of a supposedly secure VA nursing home and was never found in Tuskegee, Alabama. An Army Vet landed in intensive care suffering from malnutrition, septic shock and bed sores after a stay at a VA nursing home in Livermore, California.

    “The stories being reported about the treatment of some individual Veterans at these facilities are nothing short of horrifying,” said Rege Riley, national commander of American Veterans, known as AmVets. He called on VA Secretary Robert Wilkie to “take swift and transparent action to fix this.”  

    Veterans of Foreign Wars, Disabled American Veterans, Paralyzed Veterans of America and Vietnam Veterans of America joined AmVets and the Legion in calling for action. Together, the groups are known as the “big six” and wield considerable clout in Washington.

    “The VA must address and correct these issues,” said Garry Augustine, executive director of Disabled American Veterans.

    VA 'striving to improve'

    VA spokesman Curt Cashour said the residents the VA typically cares for are sicker than those in private nursing homes, making “achieving good quality ratings more challenging.” He said that overall, VA nursing homes “compare well” with the private sector.

    “We look forward to briefing each of these groups in the near future regarding these crucial facts,” Cashour said, adding that the VA is “continuously striving to improve all of its health care facilities.”

    The VA has 133 nursing homes across the country that serve 46,000 Veterans annually.

    Newly released VA data show that 95 of them – about 71 percent – scored worse than private nursing homes on a majority of quality indicators, such as rates of infection, serious pain and bed sores.

    Roughly the same number, 93, received only one or two stars out of five for quality in the agency’s own ratings.

    In a scathing statement declaring those facilities “failures,” VFW National Commander Vincent “B.J.” Lawrence said the VA “must improve its delivery of quality care at these facilities.”

    "(Veterans') families deserve to know that their loved ones – their heroes – are not being abandoned or abused, and America needs to be reassured that the VA is honoring our nation's promise to those who have borne the battle," he said.

    Call for transparency

    Reistad, the Legion's commander, added, “We not only expect VA to fix these problems immediately, but we want transparency.” On Sunday, after his group met with VA officials, he said he is confident they will work with the Legion and the other groups to “institute needed improvements.”

    The VA released the quality information on its nursing homes only after learning in June that USA TODAY and the Globe planned to publish it. The agency still has not released the results of inspections.

    “Why not?” asked Rick Weidman, co-founder of Vietnam Veterans of America. He said his group often has to “fight like hell with VA in order to get information.”

    The reports can include instances of neglect or poor conditions that can be a tip-off to current and prospective residents about problems at a facility.

    “I don’t see how Veterans are best served by the VA not being open about the level of care it’s providing,” AmVets spokesman John Hoellwarth said.

    Cashour said the VA is working with an outside contractor who conducts the inspections, Wisconsin-based Long Term Care Institute, to remove patient information from its reports before they are released, maybe by the end of the year.

    Private nursing homes have three years’ worth of inspection reports posted on a federal website, Nursing Home Compare.

    Lawmakers demand answers

    In September, Congress passed and President Donald Trump signed into law legislation requiring the VA to publish quality ratings going forward. The law does not mention inspection reports.

    The Republican-led House VA Committee launched an investigation of VA nursing home care after the initial USA TODAY and Globe reports, but a spokeswoman, Molly Jenkins, said the probe won’t be finished in time to hold a hearing this year as anticipated. The Democrat poised to take over the committee in January, Rep. Mark Takano of California, said it is a “critical issue that will continue to be a priority.”

    In Massachusetts, home to two, one-star VA nursing homes – in Bedford and Brockton – lawmakers are demanding to know what steps the VA has taken to improve patient care there and at other facilities around the country.

    “The continued care lapses at VA facilities raise questions about whether concrete, lasting measures are being implemented to prevent misconduct from occurring again – or whether certain VA facilities are unable to institute changes necessary to provide our Veterans with the care befitting their service to the country,” Sens. Ed Markey and Elizabeth Warren, both Democrats from Massachusetts, wrote in a letter to Wilkie.

    They demanded the most recent report from the Long Term Care Institute inspection of the Brockton VA nursing home.

    “The fact that we can’t treat Americans who put their lives on the line with dignity when their lives are on the line here at home later in life is disgusting,” said Rep. Seth Moulton, D-Mass, a Veteran who receives his medical care at the Bedford VA.

    Source

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  • Vets Get Billed

     

    Approximately 1,300 disabled Veterans were overpaid thousands of dollars under a Veterans Affairs Department education benefits program last year and now must figure out a way to pay that money back.

    Why? Mostly because staff at VA regional offices didn’t check emails, a recent investigation by the VA Office of Inspector General has found.

    The overpayments happened during the 2016-2017 academic year under the VA’s second-largest education program, Dependents’ Educational Assistance, which pays up to $1,224 for schooling per month to spouses and children of totally and permanently disabled Veterans or deceased service members.

    Veterans who are 100 percent service disabled are eligible to receive monthly stipends of $266 for each college-aged child they have in school as part of their disability check from the VA. But these benefits cannot overlap with DEA.

    Yet, in it at least 70 percent of cases during the 2016-17 school year, they did, in large part because emails from Veterans claim examiners were going unread at many VA regional offices.

    Now, Vets who were overpaid owe VA a total of $4.5 million for the department’s mistake — an average of more than $3,400 each.

    This represents “a hardship for seriously disabled Veterans,” the report states.

    In its review of all 58 VA regional offices, Office of Inspector General auditors found that as of May 2018, 25 had an approximate total of 4,600 unread emails dating back to August 2016. The majority of these emails, 67 percent, were about DEA benefits and potentially required adjustments to Veterans’ claims to keep them from being overpaid.

    In interviews recorded in the report, VA staff at seven of these offices said they had not been monitoring mailboxes related to the DEA program before the audit.

    For example, a representative from the Oakland, California, office “stated that the mailbox had not been monitored for three years because managers had been reassigned, but not their mailbox monitoring duties.”

    Another in Houston said the DEA inbox was “not considered a workload priority” because of other workload targets the office was required to meet, according to the report.

    Already, the VA has instituted a new policy requiring regional offices to check DEA-related emails twice a month, Susan Carter, a spokesperson for the agency, said in an email.

    Additionally, the VA Office of Field Operations has committed to sending weekly reminders to check the emails to the regional offices and will likely incorporate oversight of this into future site visits, according to the report.

    Joe Plenzler, a spokesman for Wounded Warrior Project, said the organization is concerned about the impact these overpayments will have on the affected Veterans and plans to work with VA on the department’s plans to remedy the situation.

    “We would hope that the VA would avoid any significant disruptions or financial burdens on the recipients,” he said in an email.

    Carter said the agency has already identified the Veterans who were overpaid and expects to complete all payment adjustments by June 30. Veterans will have several payment options available.

    “VA is implementing improvements that will focus on the timely establishment of compensation adjustments, ensuring receipt of DEA program benefit notifications by VA regional office staff, and promptly identifying and rectifying payment duplications,” Carter said.

    The inspector general’s report also recommends VA move to an electronic system to better identify when there’s a potential for Veterans to get paid out of both programs in order to cut down on overpayments.

    If delays continue, the report states, the VA could end up paying another $22.5 million in improper payments over the next five years.

    Source

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  • Natl VN War Vets Day

     

    On behalf of the Department of Veterans Affairs and the Veterans we are deeply honored to serve, I want to say thank you to our country’s more than six-and-a-half million living Vietnam Veterans and their families.

    Two years ago, President Trump signed the Vietnam War Veterans Recognition Act into law. That Act designates every March 29th as National Vietnam War Veterans Day. It was March 29th, 1973, when the last of our combat troops left Vietnam.

    It was on that day that the last American prisoners of war held in North Vietnam came home.

    Vietnam War Veterans Day is part of our nation’s ongoing commemoration of the 50th anniversary of the Vietnam War.

    In support, VA and more than 10,000 local, state, and national organizations join the Department of Defense as Commemorative Partners.

    We honor the nine million American men and women who served on active duty from November 1st, 1955, to May 7th, 1975. We solemnly remember more than 58,000 whose names are etched into the Vietnam Memorial’s polished black granite—constant reminders of the price of freedom.

    Take advantage of the opportunities this commemoration encourages and show your gratitude to this noble generation of American service members.

    Say, Thank you.

    And welcome them home.

    May God bless all of you, your families, and this great Nation.

    Source

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  • Service Connected Disability

     

    Service Connected Disability is a benefit that exists to compensation you for an injury

    Speaking plainly, a service connected disability is an injury, illness, or impairment that was caused or made worse because of some aspect of your service. This can be a distinct experience, or it can be something that occurs over time.

    The benefit itself exists to assign and provide a monetary reimbursement for the level of impairment that is said to be connected to your military service.

    You can collect Service Connected Disability concurrently with SSDI but probably not SSI

    SSI is a means tested benefit, meaning the amount you receive (if you receive any) is based strictly on your assets and level of income. However, SSDI – a similar benefit in many ways & also administered by the Social Security Administration, can be awarded at the same time as service connected disability compensation.

    This means that a Veteran could, and many do, collect SSDI for an injury that makes them unable to work, and collect a service connected compensation at the same time.

    *Note, you cannot usually collect SSI w/ VA benefits – and if you do, your award is usually split or offset.

    The wait time on appeal tends to be longer than Social Security Claims

    During the surge of claims that peaked around 2008-2015 it was normal for an initial claim to take almost a year, and for an appeal to a denial or improperly awarded claim to take several years. In many cases, wait times are down significantly. However, it may still be very geographically dependent how long your claims and appeals will take.

    Another factor affecting the length of claims is the complexity of Veterans claims. Many Veterans claims contain multiple claims with multiple sources of origination. Each of these injuries/impairments are essentially a separate claim unto themselves. And each of those claims can be appealed, mis-rated, etc. Veterans often have several claims for several injuries going at one time. And these claims are not always combined into a single decision, or timeline for decisions.

    Many Claims Advocates are Overworked

    As a result of the complexity of Veterans claims, and also in part to the nature of volunteer work, many Veterans advocates find themselves quickly overworked as they try to help Veterans with service connected disability claims.

    These advocates, VSO’s, are often responsible for doing other benefits based assistance in addition to VA claims. Including education, burial assistance, and fielding a plethora of questions from Veterans of all ages. Most of them have a lot of different directions they’re being pulled in, in addition to providing representation on claims.

    Despite this, many of the advocates are great. But some are not in the best place to provide support for Veterans disability claims. You should keep this in mind when choosing who to work with for your claim.

    There is a Lot of Information About How to Win a VA Disability Claim

    Forums, Reddit, legal blogs like this one, and so many more… are great places to find information about filing for and appealing a VA disability claim. It is possible to do this on your own, but it can easily become a complicated mess of moving parts too.

    Each Veteran that pursues these benefits finds a different path. Some of those paths lead to frustration, and we’re here to help with that.

    Some great places to start include:

    Not all the Information about Wining a VA Disability Claim is Correct

    The links above are great places to look for information on winning a VA disability claim. However, just as many claims have been butchered by bad information as have been successfully pursued with good. One of the biggest challenges with going solo on your VA claim is that you usually have little experience to assess whether a piece of advice is good or bad. Much of the claims process makes sense when you have the perspective to see how it got to be the way it is today. However, if this is your first, and hopefully only, foray into advocating a claim – be very careful whose advice you follow. And for the sake of your own claim, double check advice and cross reference.

    ^This is the reason bringing on a great advocate is good idea.

    The VA has Streamlined Several of the Processes in Recent Years

    It used to be that filing a VA service connected disability clam meant sending in a snail mail form filled out in ink. And it meant submitting all your supporting documentation in large parcel deliveries directly to the VA regional office handling your claim. Fortunately a couple changes have occurred recently to help Veterans and their advocates.

    One of the biggest improvements to the filing process is centralized evidence intake. It used to be the case that you had to submit your evidence directly to the regional office of record. This meant 50+ processes at 50+ facilities, and reports of lost (or unopened) files were rampant. Now you can send your supporting evidence to one location and it will be scanned into your claim c-file, queued up for review, and you sometimes even get a receipt that the files were delivered.

    Another fantastic improvement is the newish ability to file and review a claim online (when the system is working). Now you can see exactly where in the process your claim is.

    The Burden of Proof is: “As Likely as Not”

    One of the most important things to know about Veterans disability claims is that you don’t have to prove aspects of them “beyond a reasonable doubt.” You do not have to be 100% certain of minuscule details, you only have to believe that a cause is “as likely as not” (aka 50/50) the root of your current conditions. We cover this a lot in some of our other blog articles, but if you take one thing away from this list, remember this phrase, “As Likely As Not.”

    Veterans Have aLot of Choices

    As you work to develop your service claim, you have a lot of choices for who you’d like to work with. From a friend, to a Veterans Service Officer, to a VA Accredited Claims Agent, to even an VA Accredited Attorney – there’s no shortage of people who can provide assistance. However, not all assistance is created equally. Here’s how you can identify who to work with and how to assess if they’re who you want to work with.

    Service Connected Claims are Handled through the VBA

    The VA is made up of three parts: the Veterans Benefits Administration, Veterans Health Administration, and National Cemetery Association. Most benefits, including service connected compensation, move through the VBA. Whereas the VHA usually focuses solely on health care administration.

    Once you’ve achieved a certain threshold of disability compensation (usually 30%), some benefits are available through the VHA. In particular, we’re thinking about Vocational Rehabilitation, which is an educational benefit administered by the VHA. This is one of the best, essentially secret, benefits for those who have a service connected disability rating.

    Receiving a Service Connected Claim Qualifies You for other Benefits

    In addition to the Vocational Rehabilitation (Voc. Rehab) that we talked about just before this section, there is an enormous number of benefits specific to service connected disabled Veterans. Many states, schools, counties, and businesses provide discounts, free-passes, licenses, and preferential treatment for service connected disabled Veterans.

    Here’s A Benefit Guide for Veterans With Service-Connected Disabilities

    While You Can Still Serve with a Claim, you Cannot Double-Dip

    There are a number of Veterans still serving in the National Guard or Reserve. Some of these prior active duty troops currently have a service connected disability rating. It is typically incumbent upon a specific command to determine when an individual’s ratings preclude them from being able to carryout the capacity of their job. In a great number of cases, these troops can still function at a high level even with their partial disability rating.

    One thing to note; however, is that while actively serving – even if it’s only for a drill weekend – you cannot collect a wage for military service AND service connected compensation. This usually means offsetting the amount of compensation received from the VA, or through DFAS.

    If You Have More than 70% Service Connection and Cannot Work, You Should Consider TDIU

    TDIU is short for Total Disability Individual Unemployability. This is a rating that takes into account your constellation of previous ratings and recognizes that they pose a total barrier to you being able to work.

    There’s a quirk about the way the VA does service connected ratings that makes this a great benefit to know about. As you can surmise from the paragraph above, TDIU provides the beneficiary with a total disability rating even if they are less than 100% by individual ratings (also known as by schedule). So, you get paid 100% and receive all the benefits of a 100% service connected rating, even though you are technically less than 100% service connected.

    This quirk we’re talking about is the VA math used to assign ratings. If you have 50% for PTSD for instance and you are awarded a second rating of 30% for a physical injury to your back, you might assume that 50% + 30% = 80%. This isn’t how the VA does it. What the VA does is take your biggest disability rating and make it your core rating. In the case above 50%. The next highest rating is applied to the remainder between that rating and 100%. So, 100% – 50% (for your PTSD) = 50%. Then 30% of the remaining 50% = 15%.   50%+15% = 65% (rounded up to 70%).

    In the example above, you have 50%+30% = 70% (65%). Think about what it would take to get that to 100% going by adding disability ratings. You could have 50% (PTSD) + 30% (Back) + 20% Shoulders + 20% Knees + 10% Tinnitus and still only rate: ~80% service connection. To get to 100% from here you’d need an additional rating of 60+% from somewhere else. This exact situation is why TDIU exists. You can chase down 100% by different body parts and never reach it, but still be completely unable to work because of your disabling physical and mental health challenges.

    *You can collect a service connected disability compensation and SSDI at the same time!

    Using the DRO Process is Usually a Great Idea

    VA disability appeals can follow a couple paths on their way to a Board of Veterans Appeals hearing. One optional path is to request a DRO review of your claim prior to formally requesting a BVA hearing. A DRO (Decision Review Officer) is a senior adjudicator (often retired from and/or on contract with the VA).   They provide a second in-depth look at your claim and appeal, and you can even request a hearing, or even informal discussion, with the DRO. If you have a helpful DRO, your claim can be unscrewed prior to needing to go to a BVA hearing.

    One of the most important things you can ask a DRO is, “what would you need to see with this claim in order to approve it for what I’m asking?” When/if you get an answer, do it! You can argue with the DRO until you’re blue in the face, but your best bet is to help them help you – you still have a BVA hearing if you strike out at the DRO level.

    You Can Waive Your Right to a DRO Review

    One of the biggest drawbacks to requesting a DRO review is timeliness. It’s not necessarily the case that they take a long time, it is going to take more time though than to request a BVA hearing in lieu of DRO review. Some claimants want to push an appeal to the BVA as fast as possible, but doing so creates unique risk in a claim.

    Once the BVA has made a decision it becomes a lot harder to overturn, and doing so can either cost you more $ in the form of representation fees at the Court of Appeals for Veterans Claims, or in the form of losing your claim date and having to start all over again on a claim that was already previously denied by the BVA.

    In many/most cases, there’s little to gain and a lot to potentially lose by waiving your right to a DRO review. Nonetheless, you have the right to do so.

    Your Appeal can be Granted at Any Point But Only Denied Formally

    This statement might appear ambiguous at first. Meaning, a granted appeal would be just as formal as a denial. What we’re going for here is to convey that at any point during your appeal, your appeal may be granted. The appeal does not need to be heard by a BVA judge in order to be granted, a DRO, or other adjudicator can determine that the threshold of evidence/requirements have been met and issue a rating decision.

    And, in contrast, a denial of the appeal can only be issued by a BVA judge. If you’ve worked the process well, went through a DRO, submitted additional evidence where necessary, added context and reviews similar cases and still don’t have a favorable decision when going to meet with the BVA judge, don’t despair – that happens often. You can disagree with everyone up to the point of the BVA and still get your appeal ultimately granted.

    You Don’t Have to Use an Advocate

    You can work with a lot of people to help get your claim or appeal granted. However, you can also go it alone. There’s no requirement to utilize an advocate in your claim or appeal. Choose to work with an advocate because you want to and when you see the value in doing so.

    Your Award is Determined Based of Very Specific Criteria

    There is a ratings schedule (table) for impairments.   For instance, if you lost a finger due to some experience in the military, the finger you lost, the loss of function for your hand, the grip strength measurement, and other factors all combine on a table (codified in law) to provide your rating. So, if you wonder how something is 10% and why it wasn’t rated at 30%, getting to know this table will tell you everything you need to demonstrate to understand the rating provided.

    This table is also very useful if you are disagreeing with a rating percentage. It’s normal to have two people see a ratings criteria applied in different ways. This table is one of the things that will truly strengthen your appeal claim, if understood & used.

    There’s Usually One of Three Things Missing in a Denied Claim

    If a claim was denied, it is typically one of three reasons.

    1. Failure to demonstrated service nexus
    2. No measurable current condition
    3. Your current condition & history since service don’t clearly show a connection.

    Here’s a great article describing this more.

    Briefly though:

    1. Means something happened during your service, you have to demonstrate this in some way
    2. Something has to exist today, an impairment of some type
    3. Establishes a clear path between service injury/ailment and current condition and takes into account (or discredits) other possible explanations.

    Doctors, Providers, and Friends Don’t Know What This Is

    The items above, the three things most often missing in denied claims, are usually not understood by your treating doctors, therapists, friends, and most other Veterans. Successful appeals are not usually a matter of how much evidence is provided, but more often a matter of what type and how it supports the whole claim.

    The tendency is to try to provide an overwhelming amount of doctor statements, buddy statements, and other similar evidence. But without context or an understanding of how it fills in the gaps in the originally denied claim, it’s just as likely to confuse and possible harm your appeal as it is to help it.

    Service Connected Disability Doesn’t Usually Mean you Cannot Work

    While various levels of ratings might reflect an inability to do certain tasks, with the exception of TDIU, a service connected disability rating typically does not reflect an inability to work. Some ratings thresholds might be based upon their impact to employment.

    For instance 70% for a mental health rating is usually reserved for levels of impairment that provided significant to almost total inability to work.

    But for most ratings, the question of how or whether you work is not related at all to your compensation claim. With the exception that allowanced that have to be made for you to be successful at work might be something you want to highlight for your claim.

    Service Connected Disability Compensation is Tax Free

    Unlike military retirement pay (non medical), service connected disability compensation is tax free.

    Service Connected Disability Compensation is Different from Non-Service Connected Pension

    A non-service connected pension is similar in many ways to SSI. Generally it is for a disabling condition that is no service connected. Unlike service connected compensation, a pension is all or nothing (no % ratings), and it is means tested (based upon income and assets). You normally would be able to have been awarded SSI (even if you haven’t applied). For this reason, a lot of potential recipients have concurrent claims with Social Security, though the maximum benefit will be the highest of the two and not a combination of the two (as in the case of SSDI & compensation).

    This is all a bit complicated, but we’re more than happy to break it down for you if you contact us here. You really want to be aware of overpayments when dealign with both the VA & Social Security Administration.

    In Many Cases you cannot collect both Service Connected Disability Compensation and Pension

    Service connected disability compensation provides you a monetary reimbursement for injuries or illnesses that have an effect on you today. A pension is a ‘backstop’ benefit for other disabling conditions that stop you from being able to work. The pension is means tested, meaning it is based upon your assets and income – and if you had a disability rating and associated compensation, that would be considered income. This will reduce the amount of the pension, in an offset like manner.

    There is No Limit to When You Can File a VA Disability Claim

    You can begin the process of filing your service connected disability claim at any age, no matter how long you’ve been separated from military service. Though, the further you get from military service the harder it often gets to demonstrate that your current conditions are a result (in part or in whole) of experiences you had while serving.

    As the saying goes: “make hay while the sun shines.” Filing today is going to be far easier than filing tomorrow. Evidence will be easier to produce, a service nexus will be easier to identify, and you have more time to work through the process…because in some cases it can take longer than you would expect.

    Source

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  • 3 charged

    Federal authorities filed charges Wednesday against three Bell County residents in an alleged scheme to defraud the U.S. Department of Veterans Affairs.

    A Temple couple — Christopher Sebek and Melissa Sebek — and Killeen resident Jeffrey Pearson, 55, are each charged for their alleged roles to defraud the VA of about $250,000.

    Christopher Sebek, 55, operations supervisor in the Engineering Department at the Olin E. Teague Veterans’ Medical Center in Temple, and Pearson, owner and operator of Whitetail Industrial Parts and Service, a Temple VA contractor, are both charged with one count of conspiracy to defraud the government and one count of theft of government property.

    Melissa Sebek, also 55, owner and operator of MS. Bookkeeping Services, faces a separate but related charge of one count of theft of government property.

    The charges were announced late Wednesday by Waco-based U.S. Attorney John F. Bash of the Western District of Texas and Special Agent in Charge James Ross of the VA Office of Inspector General Criminal Investigations Division, South Central Field Office.

    The charges resulted from VA investigations that uncovered a scheme at the Temple VA motor pool to secretly profit from VA purchase orders.

    According to a preliminary report obtained by the Austin American-Statesman in November, investigators claimed they uncovered a complex scheme involving the VA motor pool that had funneled business to a Killeen firm, Whitetail Industrial Parts and Service, that made at least $400,000 by padding purchases with 30 percent surcharges. More than $1.3 million reportedly was funneled through Whitetail.

    The report, which also detailed alleged abuses of power and other possible criminal actions, prompted U.S. Rep. John Carter, R-Round Rock, to demand answers on questionable activities at the Temple VA, part of the Central Texas VA Medical Center.

    Carter sent a letter to Department of Veterans Affairs Secretary David Shulkin and VA Inspector General Michael Missal last year and said he expected changes

    “Our military men and women have bravely served our nation, and I expect the VA system to provide the very best care when they return to civilian life,” Carter wrote. “I am encouraged by Central Texas VA Health Care System Director Christopher Sandles’ strong condemnation of the behavior by these employees, including his comment that a ‘day of reckoning’ has come for those employees that have mistreated Veterans.

    The scheme to defraud the Temple VA began in February 2012, according to court records.

    Christopher Sebek and Pearson allegedly agreed to steal money from the Temple VA. Over a five-year period, they allegedly submitted fraudulent invoices for payment reportedly for goods and services designated for the VA medical center. Sebek reportedly presented bogus invoices to the VA from his wife’s company.

    Those invoices, however, were used by Sebek to pay for personal items and to cover Pearson’s 30 percent commission on each invoice. Court records allege that Sebek stole two VAMC credit cards and used them to pay for personal expenses.

    If convicted, the defendants each face up to five years in federal prison on the conspiracy charge and up to 10 years in federal prison on the theft charge. All three will receive summonses for their initial appearance in federal court in Waco.

    Assistant U.S. Attorney Greg Gloff is the prosecutor in the case.

    Source

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  • 3 deaths found

     

    FAYETTEVILLE, Ark. (AP) — A Veterans Affairs hospital official says investigators have discovered 11 significant errors and three deaths in more than 30,000 cases originally seen by a pathologist officials say was working while impaired at the VA hospital in Fayetteville, Ark.

    Veterans Health Care System of the Ozarks spokeswoman Wanda Shull said Monday the families of the deceased veterans have been notified. Previously, investigators said one death was potentially the fault of Dr. Robert Morris Levy, who has denied working while impaired.

    Eleven errors merited institutional disclosure, meaning mistakes in patient care that could or did result in "death or serious injury." Officials have discovered 1,119 total errors, but not all resulted in change to clinical care.

    Pathologists have now reviewed 14,980 cases, just under half of the total cases dating back to 2005.

    Source

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  • 3 Marines killed

     

    WASHINGTON — The Pentagon says the remains of three U.S. Marines killed when their helicopter was shot down during the Vietnam War will be buried next week at Arlington National Cemetery.

    The Defense POW/MIA Accounting Agency announced Friday that the remains of the three men will be buried as a group with full military honors next Thursday. The three men are: Capt. John A. House II, of Pelham, New York; Lance Cpl. John D. Killen III, of Davenport, Iowa; and Cpl. Glyn L. Runnels Jr., of Birmingham, Alabama.

    The Pentagon says their remains were identified in March 2017.

    Military officials say House, the oldest at 28, was the pilot of the Sea Knight helicopter that crashed after being hit by enemy fire on June 30, 1967. Four others also were killed, including 18-year-old Killen and 21-year-old Runnels.

    Source

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  • BWN Vets 43 Yrs Later

     

    • Tens of thousands of Navy Veterans are excluded from VA benefits related to Agent Orange exposure during the Vietnam war.
    • A bill making its way through Congress would extend benefits to cover blue-water Veterans, who were stationed in ships off the Vietnamese coast.
    • Early this month, VA Secretary Robert Wilkie sent a letter to lawmakers asking to stop the bill, saying its provisions are based on sympathy instead of science.
    • Veterans and their advocates are firing back, flooding the Senate with letters supporting the bill.

    Veterans groups are pushing a bill making its way through Congress that would extend VA benefits to tens of thousands US Navy Veterans who were potentially exposed to Agent Orange while serving off the coast of Vietnam. The bill is the latest glimmer of hope for Veterans who have fought for decades to receive the benefit, and would finally recognize their exposure to the toxic herbicide but come at an estimated cost of $5.5 billion to US taxpayers.

    The VA is attempting to delay this provision, saying that this vast increase in health care costs should only come after more study, which is likely to publish next year.

    "Science does not support the presumption that blue water Navy Veterans were exposed to Agent Orange," said VA Secretary Robert Wilkie in a letter to the Senate. The letter is yet another roadblock facing Vietnam Veterans who claim their health has suffered due to exposure.

    But the Veterans are fighting back. As of Thursday morning, Sen. Johnny Isakson, chairman of the Veterans affairs committee, has received at least three letters from advocates urging the Senate to pass the bill. They say the VA is "cherry-picking" evidence and overestimating the bill's true cost.

    Operation Ranch Hand

    Agent Orange was one of several chemical herbicides used during the Vietnam War to destroy enemy cover and food crops. Although primarily delivered via aircraft, the defoliant was also carried on vehicles, back-mounted equipment, and sprayed from ships.

    Operation Ranch Hand lasted about a decade before a scientific study reported that one of the chemicals caused birth defects in lab animals. The military stopped its use of herbicides in 1971; throughout the next decade Veterans began reporting instances of cancer and birth defects in their children.

    The legitimacy of their claims would be argued for the next 20 years, until the Agent Orange Act of 1991 directed the VA to conduct research into the chemical's potential side effects. In the decades since, Vietnam Veterans have slowly started to gain recognition of their Agent Orange exposure and its sometimes life-threatening consequences.

    As recently as 2010, the VA extended the list of diseases it would recognize as being linked to the herbicide. Just three years ago, the agency started accepting claims for Veterans who served in Agent Orange-contaminated aircraft in the post-Vietnam era.

    But since 2002, the VA took what advocates and Veterans say was a step backwards by invalidating claims presented by blue-water Veterans, saying there was no conclusive scientific evidence that the Vets, who served in warships off the coast, were ever exposed to Agent Orange.

    VA: Too much money, not enough science

    The question is whether the Veterans were exposed to the herbicide through chemical runoff that made its way into the South China Sea and was then converted into drinking water through the ships' distillation plants.

    Where the ships were located makes all the difference.

    The VA discredits arguments that US ships made water close enough to land to have used contaminated water. According to the Institute of Medicine, which is now known as the National Academy of Medicine, any chemical runoff would likely have been diluted by coastal waters before reaching the ships' intakes. But, as reported in extensive coverage by ProPublica, Veterans have said ships often distilled water well within that range.

    Surprisingly, both sides of the ordeal - the VA, which claims blue water Veterans were not exposed and Veterans advocacy groups that say they were - use the same IOM study to argue their side.

    That's because the IOM merely states it is "possible" the Navy Vets were exposed.

    The VA now says that's exactly why they should wait before extending benefits to blue-water Veterans.

    In a Senate hearing on August 1, Dr. Paul Lawrence, the VA under secretary for benefits, noted this as just one of three reasons the VA opposes the bill.

    One of the provisions would increase the fee charged to borrowers under the VA's home loan program. Lawrence said the VA is opposed to "increasing the costs that some Veterans must pay to access their benefits."

    He also maintained that the increased loan fees could not offset the costs associated with an extension of Agent Orange-related benefits. Secretary Wilkie's letter reinforced this idea, stating that Congress had underestimated the health care costs by a whopping $5.4 billion. He also argued that the addition of tens of thousands of eligible Veterans would only exacerbate an already extensive backlog of Agent Orange-related claims.

    These arguments echo one made in July, just days before the Senate hearing, by former VA Secretary and Vietnam Navy Veteran Anthony Principi. In an op-ed published in USA Today, Principi argued that Congress should stand on the side of science and pass "sensible laws that maintain the integrity of our legislative process."

    Veterans and advocates say that's 'poppycock'

    The Veterans won't face this battle alone.

    The Senate is hearing from a resounding chorus of supporters who say the VA is using a typical stall tactic.

    "These Vietnam Veterans have waited too long. It is time for us as a country to do the right thing," former VA Secretary Dr. David Shulkin wrote. Dr. Shulkin, who was fired by President Donald Trump in late March, said this bill is not driven by sympathy as the VA claims, but by a conscientious desire to uphold "our country's responsibility for caring for those who have borne the battle."

    Another letter, cosigned by four Veterans organizations, pointed out that it was the VA's "erroneous decision" to disqualify blue-water Veterans in the first place, and that the science is on their side.

    "The IOM found that there is not a scientific basis to exclude blue water Navy Veterans," the letter said.

    In his letter addressed to the Senate, Dr. Shulkin recognized the legitimacy of both sides of this nuanced issue.

    "The answer must not be to simply deny benefits," he wrote. "When there is a deadlock, my personal belief is that the tie should be broken in favor of the brave men and women that put their lives on the line for all of us."

    The Blue Water Navy Vietnam Veterans Act soared through the House of Representatives with a vote of 382-0. When - or even if - it will become law now rests in the hands of the Senate which, as of Thursday, has yet to decide.

    Source

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  • GI Bill 002

     

    Thousands of Veterans who attended a vocational school or college that closed will have their benefits restored under the "Forever GI Bill," experts say.

    Lawmakers this month sent an expanded GI educational benefits bill, known as the "Forever GI Bill" to President Donald Trump's desk to sign.

    The Forever GI Bill, which passed the U.S. Senate unanimously, is estimated to cost more than $3 billion over 10 years.

    "It restores benefits to Veterans who were impacted by school closures since 2015 and has special benefits for our reservists, surviving dependents and Purple Heart recipients," said Veterans Affairs Secretary David Shulkin in a statement.

    The new law will also eliminate the 15-year limit on educational benefits for new enlistees. As the bill's nickname implies, Veterans will no longer have a time limit for completing their education.

    Since the GI Bill's creation in 1944 during World War II, it has been updated several times to help Veterans pay for college and training. The last expansion, the post-9/11 Veterans Educational Assistance Act, often called the post-9/11 GI Bill, was eight years ago.

    The 2009 expansion increased Veteran student enrollment at colleges, says Liang Zhang, a professor at New York University's Steinhardt School of Culture, Education, and Human Development, who studies higher education policies. Zhang found in his recent study that the last expansion increased enrollment rates by 3 percentage points from comparing the 2005-2008 period with 2010-2015.

    According to the 2017 annual report by the Department of Veterans Affairs, 79 percent of Veterans who enrolled in a higher education program in 2016 were beneficiaries from the post-9/11 program.

    "If the last GI Bill had a significant enrollment, then we could probably expect an increase in general enrollment by the current expansions," Zhang says.

    [Explore ways community colleges serve Veterans.]

    Veteran advocacy groups say Trump is expected to sign the Forever GI Bill. Here are five big changes once the bill becomes law.

    1. Veterans whose colleges shut down in the middle of the semester will have their benefits restored. The closure of several colleges and universities in 2015 and 2016, many of which were for-profit, adversely affected many student Veterans, experts say.

    "So those who were attending ITT when it closed will have a full restoration of the benefits and be able to use the benefit at a different school," says James Schmeling, executive vice president of District of Columbia-based Student Veterans of America, a nonprofit advocacy group.

    But this benefit is not just for those who attended ITT Technical Institute, it also applies to service members who attended a postsecondary institution that closed after January 2015. According to the Congressional Budget Office, $50 million will go toward restoring benefits to thousands of Veterans next year.

    2. New service members can use the benefit throughout their lifetimes. The caveat is it's only for those who were discharged on or after Jan. 1, 2013.

    For those who meet this cutoff, the expansion will eliminate the 15-year time limit to use these benefits.

    Experts say this will enable more Veterans to complete college or higher education courses for a career, which are necessary for wage gains.

    3. The expanded benefits emphasizeSTEM programs. The expansion encourages Veterans to enroll in science, technology, engineering or math degrees through financial incentives.

    [Discover how Veterans can afford pricey private university tuition.]

    Schmeling says student Veterans often voice that they had to choose other fields since some STEM bachelor's degrees can take up to five years to complete.

    "They were choosing other degrees that they could complete during the availability of their GI benefit. So extending them allows them to take STEM more seriously than they might have before," he says.

    Veterans interested in these fields will be eligible to receive either nine months more of educational benefits or up to $30,000 in a lump sum, the maximum amount.

    While many of the bill's provisions go into effect next year, this provision won't be available until August 2019.

    4. All Purple Heart recipients sinceSept. 11, 2001 are now eligible for educational benefits. Previously, many reservists who were injured during active service didn’t meet the full requirements for the GI Bill.

    With this expansion, 1,500 Purple Heart recipients will become eligible for GI benefits, Veteran advocates say.

    5. GI Bill entitlements can be transferred to another dependent or spouse. Veterans will be able to transfer the remainder of their entitlement to another dependent in cases where the dependent who initially received the transferred benefits dies.

    A dependent will also be able to transfer the remaining benefits to another dependent after the death of the Veteran, too.

    "It's not really a large expansion, but it's a humanitarian need for those who need to transfer," Schmeling says.

    Source

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  • VA Rating Reduced

     

    You open the big white envelope you just received from the Department of Veterans Affairs, nervously anticipating what actions the VA has so wisely decided to take concerning your VA service-connected disability benefits.  “They are reducing me!” you shout.  “But my condition has become worse, not better!” Your frustration with the bureaucratic monster sets in, followed by a wave of fear and worry.  Your monthly income is going to be cut in half.  You think to yourself, “How can the VA do this!?!  How am I going to pay my bills and support my family?”  

    You are not alone in your frustration.  The VA can and does frequently take action to reduce a rating.  However, many times a rating is reduced without proper due process or observation of law.  Compounding the problem are VA examiner performing inadequate exams and under trained VA adjudicators.  I am going to give you seven actions you can take to if the VA proposes to reduce your rating.

    1. 1.Attend your re-examination!

    The VA may require a Veteran who receives service-disabled compensation benefits to be reexamined by a VA physician to verify the current severity of your disability.  Generally, reexaminations are ordered if evidence indicates a change in the disability or the VA thinks the disability is likely to improve. The examination will generally be scheduled five years from the date of the rating decision. There are five situations in which no reexamination should be scheduled:

    • The disability is unchanging;
    • Symptoms have persisted without “material improvement” for five or more years;
    • You are over 55 years old;
    • Your rating is  the minimum rating; or
    • Your combined rating will not be affected

    *TIP* If the VA schedules a Veteran for an examination and the disability falls within one of the categories listed above, the Veteran may wish to contact the VA and request that it reconsider its decision to schedule the exam.

    A Veteran who fails to report for a reexamination without good cause or without attempting to reschedule the examination may have his disability payments reduced or discontinued.  Good cause includes the VA sending notification of the reexamination to the wrong address; illness or hospitalization of the Veteran; or death of an immediate family member.  If you have a reasonable excuse for failure to report for a scheduled reexamination, the Veteran should notify the VA of this fact as soon as possible.

    At the exam, it is important that you make the examiner aware of all the symptoms of the service-connected disability that is being reevaluated.  Do not downplay or minimize your symptoms.  It is also important to fully describe to the examiner the effects of your disability upon your ordinary activity.  For example, say the Veteran’s back condition is being reexamined.  The Veteran’s back may not be painful at the moment the exam is being conducted, but he experiences painful motion and flare-ups in his back while at work.  It is important to make this information known to the examiner.

    Shy Veterans or those who minimize their symptoms may wish to bring a spouse or another loved one into the exam so that they can provide additional details on the Veteran’s observable symptoms to the examiner.

    1. 2.Request a hearing.

    An important protection in cases where the VA proposes a reduction of service-connected disability benefits is the Veteran’s right to a predetermination hearing.  The hearing must be requested within 30 days from the date of the notice of the proposed reduction.  If the Veteran requests a hearing within 30 days, the proposed reduction will not be implemented, if at all, until the hearing takes place.

    A benefit of asking for a hearing within the 30 day period is that the reduction of benefits is delayed.  The reduction will not be implemented until at least 60 days after the final decision to reduce is sent to the Veteran.  This buys the Veteran at least two months of benefits at the current percentage and gives additional time to gather evidence.  Further, the hearing provides another opportunity for the Veteran to describe his condition and symptoms to the VA adjudicator.

    1. 3.Obtain a copy of your reexamination report.

    You can’t contest a proposed reduction if you don’t know the content of the medical opinion upon which the reduction is based.  It is easy to obtain a copy of the report so that you can verify the physician accurately recorded the symptoms of your service-connected condition. Complete thisform:https://www.va.gov/vaforms/medical/pdf/vha-10-5345a-fill.pdf  and send or bring it to the VA medical facility which performed your reexamination.

    Once you receive the examination, review it and search for any inaccuracies reported by the examiner.  For example, perhaps the VA examiner reports that you have panic attacks only once a week, but you told the examiner you experience panic attacks at least three times a week.  You can report this discrepancy to the VA using VA Form 21-4138 or mention it to the VA adjudicator at your scheduled hearing.  An exam based on inaccurate facts should be considered of little value and the Veteran should request a new exam is given.

    1. 4.Acquire your treatment records.

    The VA must base any proposed reduction upon a review of the entire history of the Veteran’s disability and not on the single reexamination.  If you receive treatment for the service connected condition that the VA is proposing to reduce, it is important that the VA has copies of these records. Treatment records are important so the VA has an accurate picture of the disability.  If you receive treatment from a VA facility, you can obtain a copy of your treatment records using the form mentioned in point “3” above.  If you are privately treated, ask your private physician how you can obtain a copy of your treatment records and progress notes.  It is recommended that you request the last two years of records.

    *TIP* You should only submit treatment records that are relevant to the service connected condition that the VA is proposing to reduce.  If you overwhelm the VA with hundreds of pages of records, there is a good chance they will be overlooked or not thoroughly reviewed by the VA.

    1. 5.Ask for Buddy statements.

    Ask your friends, family, and co-workers to write letters on your behalf about symptoms they can observe of the service connected disability.  Laypersons cannot diagnose conditions, but they are able to testify as to the symptoms readily observable.  For example, a friend can write that a Veteran with PTSD once socialized on a regular basis, but that he rarely sees him now because he won’t leave the house.  Another example is a spouse writing on behalf of a Veteran with service connected knee injury who can only walk a few blocks before he has to stop due to pain.

    1. 6.Know the legal standards.

    Many VA adjudicators are overworked, under trained, and don’t  understand the nuances of VA law.  One of the most powerful things you can do for yourself, is educate yourself on the requirements the VA must meet before it may lawfully reduce a disability rating level.  If the requirements are not met, the improperly reduced benefits must be reinstated.  The rules that protect Veterans against reductions in ratings vary depending on how long the rating level has been in effect.

    Five years or more.  Any rating evaluation that has been continued at the same level for five years or more, may not be reduced unless all the evidence of record shows “sustained improvement” in the disability.  Sustained improvement means the disability has not temporarily improved and the improvement will be maintained under the ordinary conditions of life, such as at work.

    Less than five years.  The VA must determine if there has been an actual change in the disability.  Further, any improvement must reflect an improvement in the Veteran’s ability to function under the ordinary conditions of life and work.  Lastly, the examination reports reflecting any change must be based on thorough examinations.  For example, an exam is not thorough if it does not discuss the symptoms found in the treatment records.

    Twenty years.  If a disability has been continuously rated at a particular rating level for twenty years or more, the VA cannot reduce the rating below that level unless it discovers that the rating was based on fraud.  For example, if a Veteran is granted 30 percent for PTSD and for the next twenty years the rating varies between 30 percent and 100 percent, the rating cannot be reduced below 30 percent in the absence of fraud. The twenty year protection rule applies even to rating levels that are assigned retroactively because a previous final decision is revised based on a finding of clear and unmistakable error.

    1. 7.Appeal if necessary.

    If you do steps 1-6, but the VA still reduces your service connected disability rating, don’t fret!  Even if the VA reduces your rating, you can still appeal that decision.   If you want to contest the reduction, you have one year from the date of the final determination to file VA Form 21-0958, Notice of Disagreement.  It is advisable to speak with a VA accredited attorney or representative before submitting your appeal.  If it is found that the ratings were made without observance of law, the rating will be reinstated and the Veteran will be back paid to the date of the erroneous reduction.

    Edward M. Farmer is aU.S. Army Veteran and attorney. A majority of his career has been dedicated to assisting Veterans.  More information regarding Edward and his law firm can be found at www.Vetlawoffice.com

    The material and information contained on these pages and on any pages linked from these pages are intended to provide general information only and not legal advice. You should consult with an attorney licensed to practice in your jurisdiction before relying upon any of the information presented here.

    Source

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  • 7 Investigates

     

    PITTSVILLE, Wis. (WSAW) – More than two years after 7 Investigates witnessed a disabled north central Wisconsin Veteran tell his congressional representatives about U.S. Department of Veterans Affairs loopholes leaving Veterans liable for their own emergency medical bills, some of those same lawmakers are now seeking reelection as the loopholes remain.

    In the summer of 2016, disabled Pittsville Gulf War Veteran Jerry Zehrung told staff for Sen. Tammy Baldwin, Sen. Ron. Johnson, and Rep. Sean Duffy about VA leaders not guaranteeing emergency bill payments if Veterans are treated at their closet non-VA emergency room. And Veterans not being able to purchase extra health insurance at a discount, like every other eligible American, in case VA insurance does not cover their emergency bill.

    "Everyday this legislation is delayed is another day another Veteran has to ask themselves 'should I go the ER or should I wait?" Zehrung said in February.

    Zehrung said the loopholes kept him from going to the ER twice over the last couple years, after he dislocated his hip that was injured during his war service, and back in 2016, when he woke up with blood on his pillow.

    "I wasn't worried about my heath at that moment. I was worried about is my family's financial future going to be destroyed," Zehrung said in 2016.

    What Zehrung did not know is his, and so many other Veterans’ stories, are tied into 86-year-old Minnesota Air Force Veteran Richard Staab's story.

    In 2010, the VA secretary was ordered to cover emergency medical bills Veterans are "personally liable" for. However, the VA denied Staab's claim one year later because he went to his closest non-VA ER when a heart attack and stoke almost killed him. In the end, he was left with a $48,000 out-of-pocket bill.

    "And for the VA to call that non-emergent, that's just ridiculous," Staab’s lawyer Jacqueline Schuh said in January.

    Staab became the face of this loophole when he sued and won his appeal. However, the VA kept appealing until last year.

    In January, Schuh thought the legislative fix, now called the ‘Staab Rule,’ meant thousands of Veterans could finally be reimbursed for their emergency room bills. Wisconsin lawmakers also told 7 Investigates they hoped Veterans would not have future billing problems.

    "And so there is a process going forward to pay those bills," former VA Sec. David Shulkin told 7 Investigates in January.

    However, today, Schuh said Staab still has not been reimbursed. And another one of Staab's emergency medical bills, from last year, is now tied up in a lawsuit.

    As Staab, again, faced denials, this summer a new video showed up on the VA's emergency medical care webpage. There, the VA laid out what emergency bills they will cover under the Staab Rule.

    For Veterans whose emergencies are related to a disability from their service, the VA now says they will pay, "As long as the VA was not reasonably available."

    In the past, however, national VA call centers can end up telling Wisconsin Veterans "reasonable" emergency care is located hours away from where they live.

    "Emergency room care within the VA system for me is Pittsville to Madison. Pittsville to Madison is over 120 miles away,” Zehrung said in 2016. “So, while I'm having a massive heart attack, I should go to Madison for ER care?"

    For Veterans, whose emergencies are not related to an injury from their time in service, there is more fine print, including requiring the Veteran to have received, “Care at a VA facility in the last 24 months.”

    If the Veteran also has extra, private health insurance, the VA says it cannot pay "similar payments" to "co-pays, coinsurance, and deductibles."

    Sen. Baldwin’s office tells 7 investigates as a result of the Trump Administration’s Veterans Affairs Department’s interpretation of what is “similar payment,” the VA is denying emergency medical reimbursements.

    Sen Baldwin told 7 Investigates the VA’s interpretation, "Is severely limiting reimbursements to our Veterans."

    Sen. Baldwin, and six other senators expressed their frustration about how the VA is interpreting the Staab Rule in a letter sent to VA Office of Regulatory Policy and Management Director Michael Shores back in March.

    During her Feb. interview with 7 Investigates, Baldwin hinted another law may eventually be necessary if the Staab Rule did not work like lawmakers feel it should.

    "Given the bi-partisan group of senators I'm working with, I think there will be a commitment to introduce legislation," Baldwin said in Feb.

    In an anonymous VA Public Affairs statement, department staff reiterated how they are, “Prohibited by law from reimbursing an otherwise eligible Veteran’s copay, cost share or deductible he or she owes to a health-care plan.”

    For the VA to make those payments, the staff member said, “Congress would need to amend this section of the law.”

    While the statement did not address the use of the VA’s use of the term “similar payments” in denying payments, they did say Veterans have to provide, “Documentation that their remaining financial liability for a claim is other than a copay, cost share or deductible.”

    7 investigates has learned the MISSION Act, which Baldwin, Duffy and Johnson all supported when it became law in June, might be a potential starting point for fixing future payments.

    Part of the current law allows Veterans to receive walk-in care at urgent care-type clinics, if that medical facility receives federal funding.

    “I am continuing my work with a bipartisan group of Senators to build off of the MISSION Act and move a legislative fix forward that can pass with support from both parties,” Baldwin told 7 Investigates.

    Sen. Ron Johnson has not said if he would support that, but his spokesperson Aaren Johnson tells 7 Investigates the senator does support extending emergency room reimbursements back to 2010, when the Emergency Care Fairness Act was signed into law.

    Rep. Sean Duffy’s spokesperson Mark Bednar did not offer comment on using the MISSON Act as a framework for an emergency care billing fix, but did say, “The congressman supports providing comprehensive emergency care coverage for Veterans when the VA is a secondary payer.”

    While Duffy's Democratic opponent Margaret Engebretson said she would support expanding the MISSION Act to including emergency care, the campaign manager for Baldwin’s Republican challenger, state Sen. Leah Vukmir, did not answer that question, only saying she supports more options.

    Full Statements

    From Sen. Tammy Baldwin:

    “We need to make sure that when our nation’s Veterans need emergency care, they can get the care they need. If they need emergency care they should be able to go to any emergency room to get it, and I believe their VA health care should cover it. I strongly disagree with the way the VA is implementing the Staab rule and unfortunately, the Trump Administration is severely limiting reimbursements to our Veterans. Given the fact that the VA refuses to implement the final rule as it should be, I am continuing my work with a bipartisan group of Senators to build off of the MISSION Act and move a legislative fix forward that can pass with support from both parties.”

    From Sen. Ron Johnson’s Deputy Press Sec. Aaren Johnson:

    - Senator Johnson supported the VA MISSION Act. This law includes language that directs the VA Secretary to improve Veteran access to walk-in/urgent care (became law in June).

    - Senator Johnson’s staff has reached out to the VA for an update on the status of the January 2018 Staab rule and emergency care coverage for Veterans. The senator supports the VA extending its January 2018 rule on emergency room reimbursements to apply to claims that have been filed since the Veterans’ Emergency Care Fairness Act was signed into law in 2010.

    From Rep. Sean Duffy’s spokesperson Mark Bednar:

    - Congressman Duffy applauds the Trump administration for finally ending the Obama administration’s lawsuit to avoid paying for Veterans’ emergency care. Congressman Duffy and his staff have been in contact with the VA for an update on the Staab rule, including swift implementation of the reimbursement policies that are now fully in place. Congressman Duffy has also reiterated to the VA that he supports further changes to provide reimbursement for Veterans prior to the April 2016 court case.

    - The VA’s secondary-payer laws are clear about the VA’s inability to pay things like co-pays, deductibles, and co-insurance for Veterans who hold other health insurance (OHI), and the Staab rule is not related to that.

    - The VA already covers emergency room care for Veterans at non-VA facilities if the Veteran does not have other health insurance (OHI), and Congressman Duffy supports that. Congressman Duffy also supports providing comprehensive emergency care coverage for Veterans when the VA is a secondary payer, which is now the law thanks to the new Staab Rule.

    From Duffy Democratic Challenger Margaret Engebretson: "The intent of the Congress is clear - individuals with VA care should be reimbursed for expenses incurred when receiving necessary treatment at community emergency rooms. I will join with bipartisan efforts to close any remaining loopholes in VA rules regarding reimbursement for emergency room visits, and I will support legislation to accomplish this goal, if needed."

    From State Sen. Leah Vukmir Campaign Manager Jess Ward: “As a military mom, Leah Vukmir knows our Veterans deserve high quality emergency care. Right now, there are only two VA emergency departments in Wisconsin, and it is ludicrous to think a Veteran from Superior should receive emergency care in Madison or Milwaukee. Unfortunately, too much federal red tape gets in the way, and Leah is committed to ensuring our Veterans have more access and more options in emergency situations.”

    VA Public Affairs statements

    Q: What is your response to Sen. Baldwin’s statement?

    A: Based on VA’s interpretation of Title 38 United States Code 1725(c)(4)(D), Reimbursement for Emergency Treatment, VA is prohibited by law from reimbursing an otherwise eligible Veteran’s copay, cost share or deductible he or she owes to a health-care plan. For VA to make such payments, Congress would need to amend this section of the law.

    Q: When are Veterans eligible for Staab Rule reimbursements?

    A: Veterans may receive reimbursement for emergency claims when it is determined that their episode of care meets the eligibility criteria outlined in 38 Code of Federal Regulations 17.1002, Substantive Conditions for Payment or Reimbursement. Additionally, Veterans will need to provide documentation that their remaining financial liability for a claim is other than a copay, cost share or deductible. When this occurs, VA will be able to reimburse as secondary payer to a Veteran’s other health insurance.

    Q: How many reimbursement requested under the Staab rule have been received in total since Feb. 1, 2010. Of this number, how many requests have been denied? What is that specific breakdown for the state of Wisconsin.

    A: Once the rulemaking published and the pending claims processed, these claims became part of our normal workload. They are not tracked separately.

    Q: How many Staab rule reimbursement requests have been received since January of this year? Of this number, how many requests have been denied? What is that specific breakdown for the state of Wisconsin.

    A: Once the rulemaking published and the pending claims processed, these claims became part of our normal workload. They are not tracked separately.

    Q: Are cases dating back to Feb. 1, 2010, when the Veterans Emergency Care Fairness Act of 2009 was signed into law, eligible for reimbursement? Or are you only reimbursing claims after April 8, 2016, when an appeals court ruled in favor of Richard Staab.

    A: Following the court’s decision in the Staab case, VA held claims pending from the date of the decision, April 8, 2016, to the date VA published the interim final regulation, January 9, 2018, when processing for these claims began. All of the held claims were processed earlier this year. At this point, VA will process any claims received and will consider them under the revised authority.

    Source

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  • Purple Heart 005

     

    Donald Herman Voigt is 86. He earned a Purple Heart for his service in the Korean War. Not long after he received it, however, it was either lost or stolen.

    Now, he’s asking for help to find it before he goes fully blind.

    According to Fox News, Voigt was serving in South Korea when he was wounded in combat, with severe injuries to his arm.

    The soldier was still in sickbay when he received the Purple Heart in 1953, just around the time the cease-fire in the war was about to be signed. Almost immediately, the award went missing.

    “I only had it for 10 or 15 minutes,” Voigt said. “So I’m not used to having it anyway. But it would be nice.”

    Val Hobson, a friend of the Voigt family who’s been “working feverishly” to help find the medal, contacted Fox News about it.

    “Having the rare distinction of being awarded the Purple Heart surely categorizes him as a man among men who put his life on the line without any hesitation,” Hobson said in a statement to Fox.

    “And though he is amazingly humble and always minimizes his efforts, he deserves to have this medal and all the recognition and praise that goes with this accomplishment.”

    Voigt originally joined the National Guard in 1952 and then, on the orders of President Harry Truman, called up to the Army. He served with the 7th Infantry Division, 31st Regiment Infantry, Love Company until November of 1953, according to Fox.

    He received an honorable discharge at the rank of corporal.

    Hobson relayed Voigt’s memories of his time in the service to Fox.

    “Well, I was just a kid at the time and I wasn’t sure why I received the award as I was doing what I was sent and trained to do,” Voigt said. “It happened so fast — I was injured by shrapnel, sent to sickbay and given the Purple Heart.

    “Then — it was gone. I just thought I’d never get it back again so to have it would be pretty wonderful as I didn’t really realize at the time just how much it meant.”

    The Apache Junction, Arizona, resident is looking for it back. And he is hoping for help from both of the state’s senators — Republican Martha McSally and Democrat Kyrsten Sinema — as well as Rep. Paul Gosar.

    It’s a race against time, though. In addition to Voigt’s age, he’s also losing his sight due to macular degeneration.

    Voigt, Hobson said in a statement to Fox, is “a very special person. Humble to a fault, but kind, caring, loving and generous. Someone who never had an enemy.”

    Source

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  • Suicidal Veterans 002

    Washington (CNN)Burdened by suicidal thoughts, Justin Miller, a 33-year-old Veteran from Minnesota, reached out to the Department of Veterans Affairs in February for help, telling responders on the VA crisis line that he had access to firearms.

    Miller was advised to visit his local VA emergency department, which he did immediately.

    According to an inspector general report, Miller was admitted to the Minneapolis mental health unit after he described in detail symptoms of severe emotional anguish to VA clinicians.

    After four days under observation, he was discharged.

    Miller exited the hospital upon being released from care but never left the facility's grounds that day.

    Police found him dead in his car from a self-inflicted gunshot wound less than 24 hours later.

    With the permission of Miller's parents, Minnesota Democrat Rep. Tim Walz, the ranking member of the House Veterans Affairs Committee, shared this tragic story during a hearing on Capitol Hill on Thursday as lawmakers addressed the issue of suicide prevention among Veterans and former service members.

    "It is infuriating to know that there is a possibility that Justin's death could have been prevented. It should outrage us all that an entire health care system failed at something so serious and that it claimed to be their highest clinical priority," Walz said.

    Investigators were unable to determine "that any one, or some combination, was a causal factor" in Miller's death, despite identifying several "deficits in care provided to the patient."

    However, the investigation did find that staff members at the Minnesota medical center, including the suicide prevention coordinator, did not properly follow protocol while handling Miller's case and, according to Walz, failed to utilize the three-step REACH VET process, in which a clinician can assess a Veteran's risk of suicide so that he or she receives the proper level of care.

    "This is profoundly unacceptable," the Minnesota Democrat said about the inspector general's findings, which he called "deeply disturbing."

    And that frustration was only compounded by the fact that this was not the first time the inspector general had investigated many of these shortcomings.

    "The finding that the Minneapolis VA failed to sufficiently sustain relevant recommendations OIG made in 2012 should outrage us all," he said.

    Paul Sherbo, a spokesman for the Minneapolis VA Health Care System, told CNN that their "deepest condolences go out to Justin Miller's family and loved ones" and said that in response to his suicide and the inspector general's review, they have redoubled their efforts "to ensure every Veteran receives the best possible care. This includes improving care collaboration across departments and disciplines -- from initial treatment and planning to discharge and medication management -- and engaging family members in Veterans' mental health treatment plans, whenever possible."

    Sherbo added that the Minneapolis VA Health Care System has started implementing the inspector general's recommendations and would complete all but one this year. He also encouraged Veterans in crisis to visit the nearest VA health care facility, where they can receive same-day urgent primary and mental health care services, and provided the 24-hour national suicide prevention hotline: 1 (800) 273-8255.

    Young Veterans at risk

    The circumstances surrounding Miller's death, including his age and the use of a firearm, also seem to highlight two of the major issues related to Veteran suicide, according to data outlined in a new report released by the VA on Wednesday.

    The suicide rate among younger Veterans who, like Miller, fall between the ages of 18 and 34, continues to increase, a VA analysis of suicide data from 2005 to 2016 reveals.

    "Rates of suicide were highest among younger Veterans (ages 18--34) and lowest among older Veterans (ages 55 and older). However, because the older Veteran population is the largest, this group accounted for 58.1 percent of Veteran suicide deaths in 2016," the report says.

    The use of firearms as a method of suicide also remains high, according to the data, as the percentage of suicide deaths that involved firearms rose from 67% in 2015 to 69.4% in 2016.

    Although the overall number of suicides among Veterans decreased slightly between 2015 and 2016, the VA is bracing for an increase over the next five years as thousands of Vietnam Veterans enter mid-60s, joining what is already the largest age group.

    Additionally, VA officials acknowledged that the average daily number of Veterans who take their own lives has held steady for years despite efforts to combat the problem.

    "In 2016, about 20 current or former service members died by suicide each day. Of these, six had been in recent VA health care and 14 had not," VA spokesman Curtis Cashour told CNN, explaining that Wednesday's suicide prevention report defines Veterans "as those who had been activated for federal military service and were not currently serving at the time of their death."

    "VA also presents the yearly suicide count of never federally activated former Guardsmen and Reservists," he said.

    This report "simply reiterates what many of us have known for a long time: that our fight to end the tragic epidemic of Veteran suicide is far from over," Walz said in a statement.

    "We must continue to work together to provide Veterans with immediate access to quality, culturally competent mental healthcare and make bipartisan progress toward eliminating Veteran suicide entirely," he said.

    VA officials have said they would prefer to move away from using the per-day metric as an indicator of suicide rates, arguing that it does not account for changes in population size and can be misleading.

    But for now, lawmakers and department officials seem to believe that number appropriately underscores the severity of the issue.

    "Most of us have heard VA's staggering and heartbreaking statistic that every day, twenty Veterans end their own lives. Twenty," Republican Rep. Phil Roe, chairman of the House Committee on Veterans' Affairs, said during Thursday's hearing ahead of testimony from several suicide prevention experts.

    "We also know that over the past several years VA has invested significant resources towards addressing that number which stubbornly has not changed... We have the expertise. We have the support of the President. We can and must reduce suicide among Veterans. There is no excuse not to," he said.

    Where is the money going?

    President Donald Trump's recently confirmed VA Secretary Robert Wilkie told Senate lawmakers Wednesday that suicide prevention is a top priority for the department under his leadership and noted that the VA published "a comprehensive national Veteran suicide prevention strategy that encompasses a broad range of bundled prevention activities to support the Veterans who receive care in the VA health care system as well as those who do not come to us for care."

    He also highlighted the executive order signed by Trump in January intended to assist service members and Veterans during their transition from uniformed service to civilian life, "focusing on the first 12 months after separation from service, a critical period marked by a high risk for suicide."

    But despite a new budget of more than $200 billion, some critics argue that the VA continues to spend its money in the wrong ways.

    "Senior leaders like awareness campaigns and spend millions of dollars on them. They make a big splash in the media. It is measurable in how many outputs -- "views" or "hits" websites or social media pages get --- but does not generate outcomes," according to Jacqueline Garrick of the Whistleblowers for America.

    "These campaigns do not work because they cannot change behavior," she said in a statement to Congressional lawmakers.

    Rajeev Ramchand, a suicide prevention expert at the Rand Corp., told CNN that "while it may make people feel good, there is very little evidence that public awareness campaigns have a significant impact on suicide rates.

    "We do have evidence that public screening at emergency departments can reduce future suicide attempts," he said.

    However, he did note that areas with less evidence "should not be ignored as a comprehensive view of Veteran suicide prevention requires a thorough understanding of the environment where those events are occurring."

    In addition to developing and addressing the limitations around analytical tools like REACH VET, Ramchand told CNN that there are also a lot of things that "we know work," including initiatives that promote screening patients at emergency departments and then identifying those who are high-risk so that they receive the appropriate care.

    "Promoting quality evidence-based care... we know these things work, so let's get people to do them and do them more systematic way," he said.

    Troubling allegations

    In a written statement submitted to Congress, Garrick also said that her organization has been contacted by several VA employees who shared troubling accounts of workplace dysfunction that are having a direct impact of the quality of care provided and seem to undermine the programs currently in place.

    "At one VA medical center, a suicide prevention coordinator reported that they do not have time to complete suicide assessments or write prevention plans with every Veteran who potentially needs one because of the case load and its complexity," Garrick said.

    "She had 35 patients at one time. Administrators directed to note patients as 'moderate risk' for suicide so as not to raise red flags in the system. When a Veteran died by suicide on VA property, her supervisor refused to conduct a root cause analysis because that would be too time consuming," she added.

    According to Garrick, this VA employee asked to remain anonymous due to fear of retaliation for speaking out.

    CNN has independently contacted the employee and agreed withhold their name and place of work at the request of the individual.

    When asked for comment about the broader issue raised in the whistleblower statement, VA spokesman Curtis Cashour would only say: "VA asked CNN for specific details regarding these allegations so the department could look into them, and CNN could not provide them."

    "CNN's publishing of such vague allegations without any details that would allow the department to investigate them is highly irresponsible because it does nothing to help fix any issues that may exist and could actually discourage Veterans from seeking VA care," Cashour said.

    Griffin Anderson, a spokesman for the Democrats on the House Veterans Affairs Committee, told CNN that lawmakers take the allegations in the Whistleblowers of America report seriously and that the statement "certainly alludes to an alarming and unacceptable trend that we are going to look into."

    While the committee has not received a formal complaint pertaining to this specific allegation, Anderson said that lawmakers would work with the suicide coordinator in question to pursue an OIG investigation should they come forward.

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  • VA Expands

     

    The VA Mission Act passed into law with broad bipartisan support last year, but that unity began to wane immediately, when President Trump signaled after signing it that he wouldn't give it an additional stream of funding.

    The law expands a popular caregiver program and will examine VA's aging infrastructure.

    But the most controversial plank is a drastic increase in the number of Veterans who will be eligible to use a private health care provider and bill the VA, in what's known as the Veterans Choice Program.

    The VA has been defensive about the program ever since; last month, VA Secretary Robert Wilkie pre-empted the release of new regulations for private care with a statement.

    "Although these new standards represent an important win for America's Veterans, they will not be without controversy. Some will claim falsely and predictably that they represent a first step toward privatizing the department," Wilkie said.

    As predicted, the union representing VA workers did just that.

    "The Adminstration is setting us up to fail," said American Federation of Government Employees National Veterans Affairs Council President Alma Lee. "We believe that this push for further privatization cannot be allowed to happen, and the MISSION Act should not be implemented under the current schedule because the VA needs to do a thorough analysis of the huge impact it will have on Veterans their receiving care here."

    VA has been sending patients to outside specialists for years — but mostly that was VA doctors doing it for clinical reasons. VCP, which started in 2014, gave Vets the option of choosing a private doctor if VA care was too slow or too far away.

    It has had mixed results, says Iraq Vet Kayla Williams, who has been waiting for an appointment with a specialist.

    "I was notified recently that they have not been able to find any providers in the D.C. metro region who are willing to accept the Medicare rates that Choice uses," she said.

    VCP has gotten a reputation for paying providers late and confusing everyone with red tape. Williams' experience has been frustrating, even though she knows the ropes: She's not only a Vet, but she's also a former official at VA and currently directs a program on Veterans at the Center for a New American Security.

    Williams says that when the new expanded version of VCP goes into effect this June, there might not be so much choice to choose from, because health care is in heavy demand nationwide.

    "A lot of folks seem to believe that the capacity exists in the community, that providers are equally good. But that's not the data that I've seen," she says.

    VA defends its performance

    Studies show that VA care is on par or better than private care for speed and quality, in most regions. So even as it's about to expand private care, VA officials like Dr. Richard Stone, acting head of VA health, have been stressing that Vets who try outside care usually return.

    "They have had a choice for years about where to go for health care. Ninety percent chose to stay with us. Of the 10 percent that go out to commercial health care providers, the vast majority go once and then come back to us," he said in a VA webcast last month.

    But expanding the Veterans Choice Program could prove that wrong, says Dan Caldwell, an Iraq Vet with the conservative advocacy group Concerned Veterans for America.

    "When you give Veterans the ability to vote with their feet, you're going to see really how VA is performing and how Veterans perceive the VA," said Caldwell.

    Caldwell's group, which is backed by billionaire conservative Charles Koch, advocates for all Vets to have a choice between private care and the VA. He calls the new rules a good step in that direction.

    "We want to get to a place where Veterans have the ability to access a private provider without prior authorization from the VA," said Caldwell.

    But critics say that would amount to privatizing much of the VA and, because private care is more expensive, would also bleed resources away from the department.

    What it will cost is still an open question.

    House Veterans Affairs Committee Chairman Mark Takano, D-Calif., says the Trump administration hasn't been telling Congress how it intends to pay for it.

    "We don't know the cost, we don't know how they're going to pay for all those [patients]," said Takano, who says the VA has given "highly specious arguments about why they couldn't be more transparent with Congress."

    Takano signed on to a letter from Democratic and Republican committee chairs this month asking VA to collaborate more with Congress. Two days later, the VA put out a press release proclaiming "a new and unprecedented level of transparency to lawmakers in Congress." But the lawmakers are still waiting for the information they requested.

    For all the alarm about the new rules, they are something of a compromise, said Amy Fahrenkopf, former VA official in charge of the Veterans Choice Program.

    "My first impression is that this is not the giant step toward privatization that many were worried about or many were pushing for," she said.

    Fahrenkopf is a Republican who left the VA last year among an exodus of high-ranking officials during a period of leadership turmoil. She says she thinks the new rules could introduce an element of competition with VA, which could be good for the department.

    But Fahrenkopf also points out that by eliminating any need for co-pays, the new program could entice millions of Veterans who currently get private health care from their employer to switch to VA. It could cost the department billions, at the same time as private providers are required to accept Medicare rates for their services.

    "It's almost a Medicare-for-all type program," Fahrenkopf said, adding that she can't imagine why any fiscal conservative Republican would support it.

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  • Migraine

     

    For sufferers of migraines, the term “bad headache” doesn’t come close to describing their experience. The pounding, pulsing ache can take over the entire head. Migraines can be relentless, affecting vision and balance, coursing to the stomach and beyond, and lasting for days or weeks if untreated.

    “A higher percentage of women than men suffer from migraines,” said Briana Todd, clinical psychologist, Psychological Health Center of Excellence. “Research suggests women experience them approximately two to three times more frequently.”

    According to National Institute of Health National Institute of Neurological Disorders and Stroke, researchers believe migraines result from fundamental neurological abnormalities caused by genetic mutations at work in the brain. Navy Lt. Cmdr. Kent Werner, who recently served as chief of the neurology clinic at Ft. Belvoir Community Hospital, said migraines are caused when a circuit in the brain fires when it should not.

    “The location of the pain is likely dependent on which circuit is active, but sometimes the active circuitry spreads, like a fire, to other nerve centers that control balance, nausea, sensitivity to light, hearing, and balance and vertigo,” said Werner. “It’s quite an interesting disease and the range of presentations is broad.”

    The National Institutes of Health reports 18 percent of all adult women in the U.S. suffer from migraines. According to Todd, many migraines in women are related to a drop in estrogen levels, particularly around a woman’s menstrual cycle. It’s just one of the triggers and warning signs that may precede a migraine.

    “Tracking triggers is a key component of managing migraines,” said Todd. “Many times people feel as though they are coming out of nowhere.”

    According to the U.S. National Library of Medicine, triggers may include aged cheese and meats, alcohol, monosodium glutamate or MSG, citrus fruits, chocolate, spicy foods, or foods or drinks containing aspartame. Caffeine can also be a trigger, although acute treatment of headaches with caffeine is sometimes effective.

    Todd said there are many strategies to managing migraines, such as avoiding or limiting the triggers and promoting relaxation.

    “A trigger in one person may not be a trigger for another,” said Werner. “Disruption of sleep and elevated stress are known to increase migraines, and those triggers run rampant in the military.”

    Todd said triggers are personalized for each individual, and in the case of a women’s menstrual cycle impacting migraines, there are things the woman can do around that time, such as adjust lifestyle factors.

    Werner agrees simple lifestyle changes can reduce the frequency of migraines. For example, he said the NIH has linked exercise to reductions in migraines. In addition, regular, adequate sleep (seven to eight hours a night) leads to fewer headaches. Managing anxiety and stress can also significantly reduce migraines. Some service members have found success with acupuncture, acupressure, and diet change, said Werner.

    Conventional approaches can also help. Werner typically starts his patients with supplements, such as vitamin B-2, magnesium, or coenzyme q10. These are available over the counter and have been effective for some participants in clinical trials.

    However, if lifestyle changes and the other approaches described are ineffective, medications are available. Werner said some women have found success controling migraines with birth control pills. In addition, several over-the-counter medications have proved effective as a timed strategy just before menstruation.

    Prescription blood pressure and anti-seizure drugs can be prescribed by a primary care provider. In addition, Botox injections or other medications have been used, and last year, Werner said, the U.S. Food and Drug Administration approved the first medication developed specifically to prevent migraines.

    If the pain associated with a migraine persists and interferes with your daily routine, Werner suggests you go to urgent care or the emergency room. A primary care doctor can also refer service members to a neurology specialist for further tests.

    “Doctors are actively pursuing novel therapies and testing them in clinical trials, which is important to keep in mind,” Werner said. “We do not stop until we help you find the treatment that is right for you.”

    Source

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  • Vet Suicide Conv

     

    WASHINGTON — Melissa Bryant said the 5,520 flags placed along the National Mall Wednesday to illustrate the toll of Veteran suicide this year alone were more than just a visual reminder of the scope of the problem.

    “When we came out here this morning to plant these flags, every one of us had a friend or family member in mind,” said Bryant, chief policy officer for Iraq and Afghanistan Veterans of America. “Some of us standing here could have been one of these flags, but for an intervention.”

    The event — which has become an unfortunately annual occurrence for Veterans advocates — is part of a broader push in recent weeks by lawmakers, Veterans groups and Veterans Affairs officials to bring the issue of suicide among former military members back into public consciousness.

    Last month, VA officials released new data that showed the overall rate of suicides among Veterans has held steady at around 20 a day for roughly a decade, but researchers are seeing a troubling increase in the rate of younger Veterans taking their lives.

    Those realities come despite a concerned push in recent years by policy makers who have increased crisis intervention and mental health treatment resources for Veterans.

    Rep. Mark Takano, D-Calif., and vice ranking member of the House Veterans’ Affairs Committee, said the next step for Congress is to ensure that VA facilities are properly staffed to respond to the needs of suicidal Veterans, and to better identify what programs are working to help stem the problem.

    Last week, in a hearing before that committee, health experts said they see a gap in integrating those lessons learned into local community services, to provide a broader safety net for Veterans in distress.

    But to help fix that gap that, advocates said, they need to remind the public of the problem.

    “I have seen far too many Veterans and members of my community fall to suicide,” Said Kristen Rouse, founding director of the New York City Veterans Alliance, at Wednesday’s event. “What we see behind us represents a national crisis … These are Veterans from your home state, from your hometown, from your home city.”

    During Wednesday’s event — held between the Capitol building and the Washington Monument, in an area with heavy tourist foot traffic — dozens of onlookers stopped to take pictures of the display and talk to the advocates involved.

    Stephanie Keegan, whose son Daniel served in Afghanistan but died in 2016 because of delays in receiving treatment for his post-traumatic stress disorder, said she was grateful to share her families struggles with those visitors.

    “It absolutely makes a difference,” she said. “Not enough people understand the problem and the consequences of our wars. As a country, we need to pay more attention.”

    To contact the Veteran Crisis Line, callers can dial 1-800-273-8255 and select option 1 for a VA staffer. Veterans, troops or their families members can also text 838255 or visit VeteransCrisisLine.net for assistance.

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  • Donald Trump 023

     

    By all accounts, 2018 has been an eventful year and it has been especially so for Veterans. As noted by the departing chairman and soon to be ranking member of the House Veterans’ Affairs Committee, Phil Roe (R-Tenn.), the House passed more than 80 Veterans bills, 30 of which were signed into law.

    Many of these laws centered around creating a culture of transparency and accountability for the Department of Veterans Affairs (VA).

    To this end, the year 2018 is also significant for Veterans because it is the 30th anniversary of VA being elevated to a Cabinet department. In 1988, when the Department of Veterans Affairs Act was being considered before Congress, John Glenn (D-Ohio), the chairman of the Senate Governmental Affairs Committee, stated that he wanted VA’s elevation to Cabinet status to be more about substance than symbolism.

    At the time, the stated goal of those in favor of elevating VA to a Cabinet department was to bring more accountability to VA, at a time when a House Government Operations Subcommittee investigation found that “[i]nternal VA reports indicate that the VA has covered up serious deficiencies” in its processes.

    Skeptics of Cabinet status, including those at the National Academy of Public Administration (NAPA), felt that there was “little evidence that the vitally mission of providing for the present and future needs of our Veterans would be materially improved” by the elevation. As stated by GAO in response to their report, “VA urgently needs to address its serious management problems, regardless of its status.”

    Similarly, NAPA conveyed further concern that Cabinet status would, in effect, served only to “enhance the status of the agency’s senior officials” and that it would not “significantly improve either access to the president, the adequacy of necessary resources for the organization, management and delivery of high-quality services and benefits.”

    Thirty years later, VA’s elevation to a Cabinet department seems to be exactly what Glenn advised against, a symbolic gesture that, unfortunately, ultimately lacked substance.

    The concerns highlighted by critics in 1988 could easily be said about today’s VA. Problems surrounding VA management persist, despite Cabinet status, as evidenced by the recent debacle over inaccurate GI bill payments and confusion over how or even whether VA would fix them, as well as the failure to spend millions of dollars earmarked for Veterans suicide prevention, despite the seriousness of the epidemic.

    Similarly, current VA critics would argue that Cabinet status has indeed enhanced the status of senior officials without increasing access to the president or significantly improving how quality benefits and services were delivered.

    If this were not the case, significant pieces of legislation recently passed, such as the Department of Veterans Affairs Accountability and Whistleblower Protection Act, would have been completely unnecessary.

    And, despite this law, Congress is still focused on accountability for VA leadership, focusing on issues such as the elimination of reassignments for personal gain and prevention of moving managers around in lieu of disciplining them, showing that the issue is still not completely resolved.

    With regard to improving the quality of benefits and services, VA has, overall, fared slightly better. As a recent Annals of Internal Medicine article highlighted, VA hospitals often perform at least as well as non-VA hospitals and in certain markets, performed even better.

    Nonetheless, VA’s Cabinet status and increased clout have not been able to solve the agency’s issues surrounding access to care. In response, Congress passed the Mission Act in June 2018 to facilitate Veterans’ access to care in the community, but as highlighted by the 115th Congress’s final hearing on Veterans’ issues — a joint House and Senate hearing on the Act’s implementation — VA currently lags sorely behind important benchmarks set by the law for implementing the legislation.

    As noted by Senate Veterans’ Affairs Committee ranking member, Jon Tester (D-Mont.), the Mission Act was “passed... with the best of intentions, but it could be a train wreck, too.”

    Like the Mission Act, the Department of Veterans’ Affairs Act in 1988 was passed by Congress with the best of intentions. However, as we reflect on thirty years of Cabinet status, the elevation of VA, sadly, appears to have been more train wreck than accountability measure.

    So what happens next?

    De-elevating VA from its current Cabinet status is not practical. The traditional means of ensuring accountability, such as through the passage of legislation and Congressional oversight, has thus far proved to be only mildly effective. And calls from Veterans themselves about what they need from VA itself have largely gone unheeded.

    One idea that is seldom discussed would be downsizing some parts of the VA by redistributing several business lines to other government agencies, rather than privatizing parts of VA or continuing to increasing its funding.

    To this end, the Social Security Administration already has infrastructure in place to adjudicate disability benefits claims and could absorb parts of the Veterans Benefits Administration.

    Likewise, the government has laws and regulations in effect for providing healthcare through Medicare, Medicaid and Tricare and parts of thus parts of the Veterans Health Administration could be absorbed by the Department of Health and Human Services or the Department of Defense.

    As we have seen with the VA’s ballooning budget over the past 17 years, bigger is not always better. Thus, instead of fighting over politically impractical ideas such as privatization or unrealistic budgets, the time is right to discuss government reorganization, instead.

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  • Robert Wilkie 10

     

    In a wide-ranging interview with NPR, Secretary of Veterans Affairs Robert Wilkie said his department is on the mend after a tumultuous 2018.

    "I do think it is better, because the turmoil of the first half of this year is behind us, the waters are calmer. We're not where we need to be, but we're heading in that direction," he said.

    Early in Donald Trump's presidency, the VA was considered an island of stability in an unpredictable administration.

    Secretary David Shulkin was a hold-over from the Obama administration, already familiar with the VA's massive bureaucracy. Bipartisan reforms moved through Congress with relative speed, and Trump could point to a list of legislative accomplishments.

    But the president fired Shulkin last March after weeks of intrigue during which VA political appointees plotted openly to oust him. Trump's first nominee to replace Shulkin, Rear Adm. Ronny L. Jackson, sank under accusations of misconduct (which are still being investigated by the Pentagon).

    Numerous high-ranking officials left the department, and records showed that friends of the president outside of government - who weren't even Veterans - had been lobbying Trump at Mar-a-Lago on how to run the VA.

    Wilkie takes charge

    After a stint as acting VA secretary, Robert Wilkie was confirmed by the Senate last July. Since then, Wilkie says he's been "walking the post," visiting as many VA facilities as he can. And he's reached the same conclusion as many of his predecessors.

    "I have been incredibly impressed by the caliber of VA employee I've encountered everywhere, from Alaska to Massachusetts to Florida," Wilkie told NPR's Steve Inskeep.

    "I have no quarrel with the quality of medical care our Veterans receive. My biggest problem is actually getting them into the system so that they can receive that care, which means the problems are primarily administrative and bureaucratic," said Wilkie, himself a Veteran of the Navy and a current Air Force reservist, who counts generations of Veterans in his family.

    "I am the son of a Vietnam soldier. I know what happened when those men and women came home," Wilkie said. "So that is incredibly important to me."

    Wilkie is navigating an important moment for the VA – while major reforms have already been passed by Congress, he's the one who has to implement them. And plenty of political controversy hides in the details.

    The VA Mission Act of 2018 was signed into law in June. It's intended to consolidate about a half-dozen programs The VA uses to buy Veterans private health care at a cost of billions of dollars, into one streamlined system.

    Critics fear that leaning too much on private care will bleed the VA's own medical centers, and lead to a drop in quality there – and amounts to a starve-the-beast strategy of privatization.

    Wilkie says that won't happen and is not President Trump's goal, but he has yet to present a budget for expanded private care to the White House and to Congress.

    "You're not going to privatize this institution. I certainly have never talked about that with anyone in this administration," Wilkie said.

    Resisting outside influence

    Wilkie also maintains that he has had little contact with the group of outside advisers who meet with the president at Mar-a-Lago, including CEO of Marvel Comics Ike Perlmutter and Florida doctor Bruce Moscowitz. Records show they had extensive communication with the previous VA secretary, sometimes influencing policy decisions.

    "I met with them when I was visiting the West Palm Beach VA - my first week as acting (secretary), and have not had any meetings with them ever since that day," Wilkie said. "I'll be clear. I make the decisions here at the department, in support of the vision of the president."

    Despite rumors that Wilkie would clear out many of the Trump political appointees who clashed with former secretary Shulkin, he said he didn't expect more staffing changes.

    The one notable departure is Peter O'Rourke, who was acting secretary for two months while Wilkie went through the confirmation process. O'Rourke clashed repeatedly with Congress and the VA's inspector general. Wilkie himself cited a Wall Street Journal report that O'Rourke is poised to go and said he's "on leave."

    "I think there will be an announcement soon about a move to another department in the federal government – I know that he's looking for something new," said Wilkie, "He's on leave."

    Another major new plan that Wilkie must implement is a $10 billion, 10-year plan to make the VA's medical records compatible with the Pentagon's.

    He once again mentioned his father's experience as a wounded combat Vet.

    "He had an 800-page record, and it was the only copy, that he had to carry with him for the rest of his life. He passed away last year," said Wilkie.

    "One of the first decisions I made as the acting secretary was to begin the process of creating a complete electronic health care record that begins when that young American enters the military entrance processing station to the time that that soldier, sailor, airman, Marine walks into the VA."

    But that process has actually been underway for a decade – with little to show and about a billion dollars already spent on the effort. The non-partisan Government Accountability Office says it's in part because neither the Pentagon nor the VA was put in charge of the effort — which is still the case. Wilkie says he has signed an agreement with the Pentagon to jointly run it with clear lines of authority.

    "I think we'll have more announcements later in the year when it comes to one belly-button to push for that office," he said.

    As for staff shortages, another perennial complaint at the VA, Wilkie acknowledged there are 35- to 40,000 vacancies at the agency.

    "We suffer from the same shortages that the private sector and other public health services suffer from, particularly in the area of mental health," he said.

    New legislation passed this year gives Wilkie the authority to offer higher pay to medical professionals.

    "I'm using it to attract as many people as we can into the system," said Wilkie

    But Wilkie also added that he was shocked, upon taking the post, that it's not clear how many additional people are needed – because it's not even clear how many people are working at VA.

    "I had two briefings on the same day and two different numbers as to how many people this agency employs."

    Wilkie says he's in the process of finding out the answer to that question, and many others, as he starts his second 100 days in office.

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  • Cabins for Homeless

     

    The cabins will house up to 21 Veterans and were built on land leased from theU.S. Department of Veteran Affairs.

    TOGUS — Tim Buckmore is delighted by his new digs, even if the cable TV hasn’t arrived yet.

    Until this summer, Buckmore, 57, was one of dozens of homeless Veterans living in Maine. Now, he’s among 19 Veterans who have moved into small houses on a quiet corner of the VA Maine Healthcare Systems-Togus campus.

    For at least seven years, various organizations and agencies have been developing the so-called “Cabin in the Woods” housing project, which cost $5.1 million to build and is located on 11 acres of land that have been leased from the U.S. Department of Veterans Affairs.

    On Friday, they celebrated the project’s opening with a ribbon-cutting ceremony that was attended by more than 100 guests and dignitaries. The project is part of a larger effort to end Veteran homeless and was developed by Volunteers of America Northern New England, a Brunswick-based group.

    Of the roughly 2,280 people who were homeless in Maine last year, 131 were Veterans, according to U.S. Census data compiled by the U.S. Interagency Council on Homelessness.

    Multiple Veterans who have received new housing through Cabin in the Woods said Friday they appreciated the natural surroundings and lack of noise pollution on the 11-acre property, where 21 cabins have been built. Each of the properties are free-standing and contain one or two bedrooms. The site also includes an office and community space, and is within walking distance of the medical facilities on the 500-acre hospital campus.

    Buckmore, who worked as a generator mechanic in the U.S. Army from 1983 to 1989, has been intermittently homeless for the last three years. He first learned about Cabin in the Woods from a social worker at the Bread of Life Ministries’ Veterans shelter in Augusta. Now, he particularly appreciates the quiet natural setting and the radiant heating that comes out of the floor of his one-bedroom cabin.

    “This is really nice and quiet,” said Buckmore, a Gardiner native, during a tour of the pre-furnished home. “I’d like to see more of these go up.”

    This past summer, Buckmore suffered two strokes and now uses a cane and wheel chair to move around. As someone who has worked in the mental health field and been diagnosed with depression, anxiety and bipolar disorder, he also hopes the new housing will bring stability to a vulnerable population of Veterans.

    “There’s a high suicide rate among homeless Veterans,” he said. “Something like this can help take their mind off anything bad they’re thinking about.”

    Buckmore’s one qualm, he said, is that Spectrum has yet to run cable television to the new homes. But he added, “That could be a blessing in disguise.”

    Multiple groups provided funding and donations for the Cabin in the Woods project, including the Maine State Housing Authority, the U.S. Department of Housing and Urban Development, the Home Depot and T.D. Bank Charitable foundations. At the ceremony on Friday morning, officials from some of those groups delivered prepared remarks.

    There were also speeches by two members of Maine’s congressional delegation, U.S. representatives Chellie Pingree and Bruce Poliquin, and delegates for U.S. senators Susan Collins and Angus King. Also attending the event was Poliquin’s predecessor as representative of Maine’s 2nd District, Mike Michaud, who served as chairman and ranking member of the House’s Committee on Veterans Affairs.

    Another speaker was Ryan Lilly, the former director of the Togus system who was recently elevated to another role in the U.S. Department of Veterans Affairs: director of its New England systems.

    Just as some cities have eradicated poverties in their homeless populations, Maine is trying to do the same, Lilly said. After the ceremony, he said the Togus campus still has between 30 and 50 acres that could be developed and that the agency is now considering whether it could lease out land for a similar project oriented toward seniors.

    “It was our first experience with this process,” Lilly said. “We’re thinking about what we can do next.”

    While there are other housing developments for Veterans around the country, Lilly said that Cabin in the Woods is unique because it’s in a secluded area and its units are individual homes, as opposed to apartments.

    Another Veteran to benefit from the new housing project is Jesse McGahuey, 41, who last month moved into a two-bedroom cabin with his wife Sheena, 33, and their 5-year-old son, Jerrick. While living on federal land isn’t a perfect arrangement, they said that the arrangement has made it considerably easier for McGahuey to attend his weekly medical appointments at Togus.

    McGahuey suffered a series of injuries during and outside his service in the U.S. Army from 2000 to 2002. As a child, he suffered a brain injury. Then, when he was working as a heavy equipment operator while stationed at Fort Lewis in Washington, he was pulled under a piece of machinery, injuring his legs and back. Finally, in 2014, he was working at an oil-change business in Waterville when a driver accidentally lost control of her car, giving McGahuey a head injury and exacerbating the previous problems.

    After that 2014 accident, McGahuey lost the ability to work or pay for housing. Since then, his family has spent long periods camping outside. They were one of the first families to apply for housing in Cabin in the Woods, and they’re now able stay there with subsidized rental costs.

    Now that some stability has been reintroduced to their lives, McGahuey hopes that he can start taking classes at a community college and working again, even if it’s part time. His wife, Sheena, is unable to work and receives disability payments because of medical problems she suffered when giving birth.

    “This does ease the pressure of it,” Sheena McGahuey said. “It does help.”

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  • AO Activist Andover

     

    A Vietnam Veteran from Andover is heading to Washington D.C. for the State of the Union Address on a mission to rally support from federal lawmakers to make health care more accessible to Veterans exposed to the toxic chemical known as Agent Orange.

    Gerry Wright spoke exclusively to NBC Connecticut about his upcoming trip to the Capitol, the next step in a journey that has already taken him to 32 states speaking with Veterans and their families about the long-term side effects of Agent Orange exposure.

    American soldiers sprayed the herbicide that came to be referred to as Agent Orange over dense jungle in Vietnam in a military effort to kill foliage providing cover to enemy soldiers.

    Wright has amassed shelves full of photographs, testimonials, newspaper clippings and studies at his home in Andover. He pointed to one picture in particular of a truck he remembers riding while spraying the toxic chemical.

    “We would stand on the back of here and spray around our compound. No hat, no shirt, no masks,” Wright said.

    He now suffers from heart, skin and nerve conditions associated with Agent Orange. He receives treatment from the VA hospital for heart disease, but does not qualify for treatment of his other ailments because of a rule requiring soldiers to have reported symptoms within a year of chemical exposure.

    Wright says he and many of his fellow Veterans did not recognize those symptoms until it was too late.

    Last year, he traveled 10,000 miles around the country towing a trailer painted, “sprayed and betrayed,” and collecting more than 6,000 signatures from supporters, he said.

    Now, he is working with Connecticut congressmen Joe Courtney and John Larson, who are co-sponsors on a house bill introduced last month to remove that requirement. Senator Richard Blumenthal is expected to introduce a corresponding Senate bill soon, and invited Wright to be his guest at Tuesday night’s State of the Union Address.

    Lawmakers introduced similar bills in both houses of Congress last year that were not successful.

    Wright hopes to use the remainder of his trip to Washington to speak to as many lawmakers as he can on both sides of the aisle. He believes the stakes could not be higher for Veterans like him who need treatment. “We’re still dying from this,” he said.

    Source

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  • AO Presumption Policy

     

    For Vietnam Veterans, having a medical condition presumed related to Agent Orange exposure is linked to greater use of Veterans Affairs health care.

    That is the main finding of a study by researchers with the War Related Illness and Injury Study Center (WRIISC) at the VA New Jersey Healthcare System. They say the results show that a law passed by Congress nearly 30 years ago has largely met its goal: helping affected Veterans get the care they need.

    The study results appeared in May 2018 in the journal Medicine.    

    Agent Orange linked to 14 conditions

    Agent Orange is a chemical defoliant that was sprayed by the U.S. during the Vietnam War to kill plants and clear land. It was contaminated with dioxin, which is known to cause cancer and other conditions. Twenty million gallons of Agent Orange were sprayed during the Vietnam War. About 2.7 million U.S. military personnel may have been exposed.

    Veterans are eligible for compensation from the Veterans Benefits Administration if they have a service-connected disability. The higher the disability rating, the more compensation they are due. Veterans with higher service-connected disability ratings also have greater access to no-cost health care through the Veterans Health Administration. However, it is often difficult to prove direct service connection for Agent Orange-related conditions because they may develop years after exposure.

    To address this problem, Congress passed the Agent Orange Act of 1991. The act directed VA to presume service-connected disability for conditions the National Academy of Sciences deemed related to Agent Orange. Veterans with these conditions qualify if they were in Vietnam between Jan. 9, 1962, and May 7, 1975.

    Seven non-cancer conditions have been designated as presumptively service-connected for Vietnam Veterans: chloracne (a severe acne-like skin condition), ischemic heart disease, Parkinson’s disease, peripheral neuropathy, porphyria curtanea tarda (a skin condition that causes blisters, hair growth, and discoloration), AL amyloidosis (an immune-system disorder that can damage the organs), and Type 2 diabetes. Several forms of cancer are also included: chronic b-cell leukemias, Hodgkin’s disease, multiple myeloma, non-Hodgkin’s lymphoma, prostate cancer, respiratory cancers, and soft-tissue sarcoma.

    Veterans with connected conditions use VA health care more often

    To find out how this policy affected VA health care use, the researchers looked at 2013 data on 85,699 Vietnam Veterans. They found that those with one or more diagnoses of a presumptive condition were more likely to have multiple disabilities than those without one of the named conditions. While they were less likely to have a 100 percent disability rating than those with no presumptive condition, they were more likely to have individual unemployability. This means they cannot maintain employment because of service-connected disability.

    Of those with any presumptive condition, 73 percent had Type 2 diabetes. About 44 percent had ischemic heart disease, and 16 percent had some form of cancer.

    Looking at health care usage, the researchers found that 35 percent of those with a presumptive condition had five or more primary care visits in fiscal year 2013. Only about 15 percent of those without a presumptive condition had this many visits.

    Forty-five percent of the presumptive condition group had five or more specialty care visits, compared with 15 percent of those without presumptive conditions. Of the presumptive-condition patients, 37 percent had at least one mental health visit, compared with 16 percent for those without any of the conditions.

    In other terms, those with presumptive conditions were more than twice as likely as those without the conditions to be frequent users of primary and specialty care in the VA health care system. They were also more likely to visit emergency rooms than the other group.

    The study shows that Agent Orange legislation has been effective, write the researchers, at lowering “the threshold for accessing [Veterans Benefits Administration] and [Veterans Health Administration] benefits for Vietnam Veterans who may have been exposed to dioxin.” The findings highlight the importance of presumptive service connection in serving Veterans, they conclude. The results may also indicate that Vietnam Veterans with these service-connected conditions are more likely than those without these conditions to choose VA for their care.

    Dr. Dennis Fried, corresponding author on the paper, summed up the importance of the results: “In our era of increased Veteran choice with regard to health care delivery sites and greater integration of VHA and community care, these findings support the importance of VHA provision of services for conditions possibly related to military service.”

    For more information on Agent Orange exposure, visit VA’s Agent Orange website. To learn more about VA research concerning Vietnam Veterans, visit www.research.va.gov/topics/vietnam.cfm.

    Source

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  • Dave Zielinski

     

    The Vietnam War has claimed another soldier.

    His name was Dave Zielinski — a former Providence cop and lawyer. He was 71 and a direct casualty of his Vietnam service.

    That’s not journalistic sentiment. It’s the official view of the Veterans Administration.

    Zielinski died of leukemia. The government declared it a result of Agent Orange.

    The link is so strong that all soldiers with that form of cancer, and a list of other syndromes, are considered to have service-related disabilities.

    Steve Kelley, a retired Rhode Island National Guard colonel, told me a few days ago that his friend, Dave Zielinski, had lost his battle.

    Kelley knew him well, through Zielinski’s service beyond Vietnam.

    Zielinski grew up in the Hartford Park Housing Project, raised by a single mom and never making it through high school. But with the discipline he’d learned in the war, he moved up the ranks of the Providence police and graduated from law school. And Kelley got him to put on an Army uniform again as a JAG — Judge Advocate General’s Corps — officer with the Guard.

    Kelley feels there’s an image in America of Vietnam Vets left hobbled by war and an unwelcoming homecoming. Both traumas are legitimate. But Zielinski, he says, is a reminder that most overcame it to lead inspiring lives.

    Zielinski told me in January that returning Vets like him were indeed “treated as lepers.” When applying for a job as a cop, he didn’t even mention his service — he thought it might hurt him.

    It didn’t. He became a police major.

    Then he got the law degree and went on to work for Rhode Island’s secretary of state, and then the federal government as watchdog looking for misconduct.

    He later joked: “If anybody knows anything about corruption, it’s someone from Rhode Island.”

    I interviewed him about his cancer battle, reaching him by phone in New Bern, North Carolina, where he and his wife, Jeanne, had retired.

    But their hearts remained in Rhode Island, and he told me he began each day reading The Providence Journal online.

    The chemo was rough, but Zielinski had always been a fighter. He opened up to me about it to raise awareness. He hoped his story would prompt fellow Vietnam Vets to explore the Agent Orange connection if they faced health problems.

    His buddies, he said, kept him alive in Vietnam; maybe he could return the favor today.

    In the end, the wounds left in him by Agent Orange were too much.

    Although the rules don’t allow it, Kelley thinks his friend Dave should join the other 58,000 names now on the Vietnam Memorial wall. It took 50 years, but Kelley feels it’s still a “combat-related” death.

    Kelley wrote me a week ago to say Zielinski had taken a bad turn. A few days ago, he wrote again to say another soldier had paid the ultimate sacrifice.

    Zielinski’s wife, Jeanne, sent a message to let folks know.

    “I held his hand while he passed into the hands of God,” she wrote.

    She thanked everyone for their prayers. She said he’d run a good race in his years, and touched many lives.

    Kelley said Jeanne had returned “Davie” back to Rhode Island; he will be laid to rest as a soldier, with full military honors at Rhode Island Veterans Memorial Cemetery.

    Let it be noted here how many other realms Dave Zielinski touched too — the city of Providence as a police officer, the federal government as a servant, and as a life-force among family and friends.

    Kelley is sure his will not be an unvisited grave.

    Source

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  • AO Ships Logs

     

    During the Vietnam War, hundreds of U.S. Navy ships crossed into Vietnam’s rivers or sent crew members ashore, possibly exposing their sailors to the toxic herbicide Agent Orange. But more than 40 years after the war’s end, the U.S. government doesn’t have a full accounting of which ships traveled where, adding hurdles and delays for sick Navy Veterans seeking compensation.

    The Navy could find out where each of its ships operated during the war, but it hasn’t. The U.S. Department of Affairs says it won’t either, instead choosing to research ship locations on a case-by-case basis, an extra step that Veterans say can add months — even years — to an already cumbersome claims process. Bills that would have forced the Navy to create a comprehensive list have failed in Congress.

    As a result, many ailing Vets, in a frustrating race against time as they battle cancer or other life-threatening diseases, have taken it upon themselves to prove their ships served in areas where Agent Orange was sprayed. That often means locating and sifting through stacks of deck logs, finding former shipmates who can attest to their movements, or tracking down a ship’s command history from the Navy’s historical archive.

    “It’s hell,” said Ed Marciniak, of Pensacola, Fla., who served aboard the USS Jamestown during the war. “The Navy should be going to the VA and telling them, ‘This is how people got aboard the ship, this is where they got off, this is how they operated.’ Instead, they put that burden on old, sick, dying Veterans, or worse — their widows.”

    Some 2.6 million Vietnam Veterans are thought to have been exposed to — and possibly harmed by — Agent Orange, which the U.S. military used to defoliate dense forests, making it easier to spot enemy troops. But Vets are only eligible for VA compensation if they went on land — earning a status called “boots on the ground” — or if their ships entered Vietnam’s rivers, however briefly.

    The VA says Veterans aren’t required to prove where their ships patrolled: “Veterans simply need to state approximately when and where they were in Vietnam waterways or went ashore, and the name of the vessel they were aboard, and VA will obtain the official Navy records necessary to substantiate the claimed service,” VA spokesman Randal Noller wrote in an email.

    Once the VA has that documentation, the vessel is added to a list of ships eligible for compensation, streamlining future claims from other crewmembers. But proactively searching thousands of naval records to build a comprehensive list of eligible ships — as some Veterans have demanded — “would be an inefficient use of VA’s resources,” Noller said.

    But because the historical records are sometimes missing or incomplete, Veterans groups say the fastest and surest way to obtain benefits is for Vets to gather records themselves and submit them as part of their initial claims.

    More than 700 Navy ships deployed to Vietnam between 1962 and 1975. Veterans have produced records to get about half of them onto the VA’s working list, with new ships being added every year. Still, Veterans advocacy groups estimate about 90,000 Navy Vets are not eligible to receive benefits related to Agent Orange exposure, either because their ships never entered inland waters, or because they have yet to prove they did.

    Joseph Pires, 68, spent 2 1/2 years working to convince the VA that his ship, the aircraft carrier USS Bennington, should be added to the list.

    He reviewed the daily deck logs to find the latitude and longitude recordings and read officers’ descriptions of the ship’s movements. He found a listing for Dec. 26, 1966, when the ship entered Qui Nhon Bay Harbor to pick up comedian Bob Hope and his troupe for an onboard Christmas show.

    “Now I had the proof,” he said.

    He submitted it to the VA, waited a year and received an email on Dec. 31 notifying him the Bennington had been added to the VA’s list. That makes about 2,800 crew members aboard the ship on those two days eligible for benefits if they have illnesses associated with Agent Orange.

    Now Pires is waging the next battle: His personal application for benefits, based on his prostate cancer and ischemic heart disease, has been pending for nine months.

    “They put everything on your shoulders,” said Pires, who serves as the Bennington’s historian.

    Pires, of Calabash, N.C., is among more than 4,000 Vietnam Veterans and family members from across the country who’ve shared Agent Orange-exposure stories with ProPublica and The Virginian-Pilot over the past several months.

    The importance of proving to the VA which ships went inland during the war was underscored last month, when the VA rejected a request from Veterans and members of Congress to extend benefits to all Navy Veterans who served within 12 miles of the Vietnamese coast, the so-called Blue Water Veterans. Those Vets believe they were exposed to Agent Orange even if they stayed off the coast, arguing that their ships sucked in water tainted with the herbicide, which contains the dangerous chemical dioxin, and used it for showering, cooking and cleaning.

    When Congress passed the Agent Orange Act in 1991, the VA initially approved benefits for any sailor who had earned the Vietnam Service Medal. But in 2002, it began denying sick Blue Water Navy Vets compensation for Agent Orange exposure, maintaining that the placement of a comma in the original legislation made a distinction between those who served on the ground in Vietnam and those who served elsewhere.

    Last year, the U.S. Court of Appeals for Veterans Claims directed the VA to review its rules for compensating Blue Water Navy Veterans. In February, 10 months later, the VA affirmed its policy of providing benefits only to those who served on land or in inland waters. If anything, the VA tightened its policy by excluding ships that entered certain bays and harbors that had previously been accepted.

    The VA estimates it would cost taxpayers $4.4 billion over the next decade to provide benefits to all Blue Water Veterans, but its policy of excluding them has complicated the task of determining who’s eligible for compensation.

    By 2006, Veterans had begun presenting evidence of those ships’ activities, and the VA began granting Agent Orange benefits to Blue Water Veterans on a case-by-case basis. A couple years later, Veterans advocates succeeded in convincing the VA to use the evidence submitted by individual Veterans to maintain a list of approved ships.

    John Rossie, executive director of the Blue Water Navy Vietnam Veterans Association and a Vietnam Veteran, agreed to help the government collect information from affected Veterans, hoping to speed up the process. He said he put out a message in 2009 telling Navy Vets that if they sent him their ship’s deck logs, he would get them to the VA.

    “A month later, I smacked myself on the forehead, because I started getting buried under boxes full of these deck logs.”

    The first published list came out in January 2010 and had 16 ships on it.

    As Veterans have come forward with records — and as the VA has conducted its own searches — the agency has added a few dozen ships each year. More than 430 ships are listed now. The pace has slowed, but Rossie is confident more need to be added.

    “It’s been a lot of work,” Rossie said. “A lot of individuals have invested a lot of hours in this.”

    To make the process easier, Blue Water Vets pressed for legislation in 2013 that would have required the Navy to pull all of the deck logs and compile an accurate accounting of which ships spent time inside Vietnam’s border. That bill passed the House, 404–1, but didn’t advance in the Senate.

    A year later, in 2014, advocates got the House to insert language into the National Defense Authorization Act that would have required the same thing. John Wells, a Louisiana lawyer who has spent more than a decade advocating for Blue Water Veterans, said the language was stripped from the Senate version after the Navy objected, contending it would cost the service $5 million to conduct a study to locate each ship.

    The Navy did not answer questions for this story.

    Marciniak, the Veteran from Pensacola, says he was fortunate. He’d held onto paperwork proving that he’d spent time in Saigon before flying back to the U.S.

    That yellowing page spelling out his orders was enough to prove to the VA that the 76-year-old Navy Vet was eligible for compensation after he was diagnosed with type 2 diabetes and heart disease a few years ago. The claim was approved in 2013, a year and a half after he initiated the process.

    Others he served with aboard the Jamestown, a research vessel, off the coast of Vietnam had a harder fight. The ship, along with the USS Oxford, intercepted enemy radio traffic and frequently sent crew members ashore to deliver sensitive information to commanders on the ground. As a result, the ships’ activities were classified, making it more difficult for Veterans to come up with records proving where they served.

    Former Oxford and Jamestown crewmembers were eventually able to get their hands on declassified command reports that included details about the trips ashore. Those records helped get both ships added to the VA’s list in 2011.

    “Even with the ship listed, it took the VA more than 18 months before they approved my claim,” Marciniak said. “I’ve written letters for three widows addressed to the VA explaining how the the Jamestown operated and describing our regular courier runs, because their husbands’ died before they were able to get VA compensation.”

    Another challenge: Veterans who were denied benefits before their ships were added to the list must start the process all over again. “The problem there,” Rossie said, “is these guys are sick and dying. They don’t have a lot of time to jump through hoops.”

    Rory Riley-Topping, a consultant and former staff director for the House VA Subcommittee on disability assistance and memorial affairs, said the VA has many pressing issues to deal with — health care wait times, construction delays, benefits backlogs. “Bureaucracies that are large are not known for their efficiencies, and this is a great example of bureaucracies being shortsighted and not understanding the big picture. A lot of people thought this issue would go away, and obviously it didn’t.”

    For John Kirkwood, the push to get the amphibious command ship USS Mount McKinleyadded began in March 2010 when he went to the VA hospital in San Diego because he wasn’t feeling well. He spent 40 days in the hospital after a heart attack. His wife and stepdaughter initiated a claim for benefits. A little over a year later, it was denied because he couldn’t prove he was in Vietnam or exposed to Agent Orange.

    Kirkwood wasn’t able to get deck logs from the National Archives or the Navy. Both said they didn’t have them and had no idea where they were. “I didn’t know what the hell to think at that point,” said Kirkwood, a 66-year-old retired auto body technician.

    In May 2011, he posted a note on the ship’s website that read, “I was a shipmate of yours on the last cruise of the Mount McKinley in 1969. The purpose of this comment is to see if any of you remember going into Da Nang harbor on that cruise for liberty, parties at China Beach and water skiing in the harbor behind the Captain’s Gig.”

    Emails began streaming in from shipmates he knew and those he didn’t. “I remember going ashore,” one wrote in an email he shared with ProPublica and The Pilot.

    “You are not the first one to ask these questions,” another wrote.

    Kirkwood also found a cruise book in his garage, which is essentially a scrapbook of the tour. “I was able to take photocopies out of there showing that we actually went to Da Nang Harbor,” he said. “I can’t make up a cruise book.”

    A fellow shipmate sent him a calendar he kept, showing the ship was anchored in Da Nang Harbor over 60 days of that cruise. Kirkwood’s own claim for benefits was approved in January 2013. Kirkwood then forwarded his documentation to Rossie, who forwarded it to the VA. The ship was added to the VA’s list in July of that year.

    “Sometimes I felt I was fighting a losing battle, but I’m persistent,” Kirkwood said.

    Others are still fighting. Brad Davidson began researching the process in November after being diagnosed with two conditions associated with Agent Orange.

    Davidson, who declined to disclose his specific health troubles, remembered going ashore for leisure breaks multiple times during his deployment aboard the destroyer USS Brinkley Bass in 1970, but he had no records to prove it. He tracked down the deck logs, which showed the ship spent time anchored in Da Nang Harbor, Cam Ranh Bay and Ganh Rai Bay, but nothing in the handwritten notes mentioned crew members being ferried ashore during those stops.

    “That is a problem, trying to get a clear recollection all these years later,” said Davidson, 69, who lives near Chicago. “And beyond that, getting hard evidence. … They don’t make it easy.”

    Earlier this year he got in touch with his crew’s reunion group, and a few former shipmates responded with photographs of crew members at a beach party at Cam Ranh.

    His memories from that time are a blur, Davidson said, but that afternoon spent drinking beer on a beach 46 years ago could be the difference between receiving thousands of dollars per year in disability benefits and receiving nothing.

    “I think we’ve certainly convinced ourselves,” Davidson said. “But we’re not sure what it’s going to take to get us on the VA’s list. We think it’s enough, but we don’t know for sure what the VA requires.”

    He faces an uphill battle. Generally, the VA hasn’t accepted photographs to prove a Veteran spent time on the ground in Vietnam. Davidson hopes the agency makes an exception in his case.

    “I don’t really have time to wait and find out.”

    ProPublica and the Virginian-Pilot are interested in hearing from Veterans and family members for our ongoing investigation into the effects of Agent Orange on Veterans and their children. Share your story now at propublica.org/agentorange or hamptonroads.com/agentorange.

    Source

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  • Heath Sommer

     

    A psychologist at Travis Air Force Base in California was found guilty on Friday of sexually assaulting military officer patients who were seeking treatment for post-traumatic stress disorder, The Daily Republic reported.

    Heath Sommer may face up to 11 years and eight months in prison after receiving a guilty verdict on six felony counts of sexual assault, according to the Republic.

    Sommer used a treatment known as “exposure therapy” to lure his patients, who were military officers who had experienced previous sexual assaults, into performing sexual activity, the Republic reported.

    According to charges brought by Brian Roberts, the deputy district attorney who prosecuted the case, Sommer raped his patients through “fraudulent representation that the sexual penetration served a professional purpose when it served no professional purpose,” the Republic reported.

    One of Sommer’s reported victims, an Air Force colonel, testified that Sommer made her eat dirt and leftover Chinese food from his fridge to replicate her memories of the dirty training facility in Afghanistan where she was sexually assaulted, the Republic reported.

    According to the Republic, Sommer then told her she needed a “positive and loving” sexual experience before taking her to his bedroom and having sex with her while his wife waited in the kitchen.

    Sommer is set to be sentenced on January 25, 2019, according to the Republic.

    Source

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  • New Commissioner

     

    The Alabama Board of Veterans Affairs today selected retired Rear Admiral W. Kent Davis as the next commissioner of the Alabama Department of Veterans Affairs.

    Davis will replace Clyde Marsh, who retired late last year. Marsh, who was also a retired rear admiral, had served as commissioner of the Department of Veterans Affairs for 13 years.

    Davis, an Alabama native, began his Navy career as a supply corps officer aboard the battleship U.S.S. Missouri in 1986. He retired from the Navy in October 2016.

    Davis is the chief communication officer at Air University at Maxwell Air Force Base in Montgomery, a civilian job he has held since August 2017.

    Davis worked as city manager for the city of Anniston from 2016 to 2017. He was deputy superintendent of the U.S. Department of Homeland Security’s Center for Domestic Preparedness in Anniston from 2014 to 2016.

    In 2012, Davis served as director of public affairs for U.S. detention operations in Afghanistan.

    Davis is a 1985 graduate of Louisiana State University and has a law degree from Georgia State University, where he graduated second in a class of 157 students in 1998. He has worked as an attorney for the Department of Homeland Security and as a public affairs officer for the Navy Reserve.

    The Veterans Affairs Board voted to authorize Gov. Kay Ivey, who is chairman of the board, to officially offer the position to Davis and negotiate a salary and start date. That will happen next week, according to Ivey spokesman Daniel Sparkman.

    Source

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  • Amputees in High Heels

     

    Researchers from the Department of Veterans Affairs have played roles in a number of scientific and medical breakthroughs that have had a profound impact on modern life: the liver transplant, the nicotine patch and artificial lungs, to name just three.

    And now, as they seek to meet the needs of an increasingly diverse population of wounded and disabled Veterans from the current era of war, VA design experts say they're going beyond barebones medical needs and aiming to help Vets live more comfortably, with technology adapted to their lifestyle and interests. It's work that requires them to listen to Veterans more closely and involve them and their feedback in the development process to a greater extent than ever before.

    One example of this work can be seen at the Office of Research and Development of the Department of Veterans Affairs, where they've come up with a 3D-printed ankle and foot device for a prosthetic leg to give amputees adjustable heels.

    Thanks to this research, stilettos are no longer out of the question for Veteran amputees. Outside researchers at Johns Hopkins University and elsewhere have developed similar devices, but Dr. Andrew Hansen of the Minneapolis VA Healthcare System said the VA's "Shape & Roll" prosthetic foot is unisex.

    "This study focused on high heels, but the results work just as well for cowboy boots," Hansen said in a VA release.

    The adjustable-heel prosthetic was an example of VA's commitment to research in areas that haven't been pursued by the private sector, said Dr. Rachel Ramoni, the VA's chief research and development officer.

    "Actually, there's a couple of things going on with 3D printing; you can print a foot for every type of shoe," Ramoni told Military.com.

    The foot-ankle prosthetic also demonstrates a willingness at the VA to take feedback from wounded and disabled Veterans themselves on what they need to accommodate the lifestyles they wish to return to or pursue, she said.

    Ramoni also cited current research into upper-arm prosthetics for women as an example of this work.

    "That's a small segment of the population; it's a small market," Ramoni said. "It's not an area where somebody would say 'Well, it's an obvious money making opportunity.' So it might not be good business, but it's the right thing to do."

    The other challenge with research on upper-arm prosthetics for women is that so little work has been done in the field previously, Ramoni said.

    "The sizing of the prosthetic is a big deal," she said, and "we don't know about women's upper arm satisfaction, because all of the surveys were designed for men."

    The work on adjustable heels and the upper-arm prosthetic research are among more than 2,000 projects involving 3,400 researchers now underway at the Office of Research and Development. ORD operates on a budget of about $722 million from the VA, supplemented by contributions from the National Institutes of Health, the Department of Defense and others, for a total of about $1.5 billion, Ramoni said.

    The money is being spent with a new emphasis on listening to Vets regarding where they want the research to go, Ramoni said.

    A Disabled Vet Tackles Design

    Dr. Rory Cooper was an Army sergeant in Germany in 1980 when he lost the use of his legs from spinal cord injuries in a bicycle accident.

    He now is a director and senior research career scientist for the Human Engineering Research Laboratories, a VA Rehabilitation Research and Development Center and home of the VA Technology Transfer Assistance Program.

    Cooper is also a Paralyzed Veterans of America distinguished professor at the University of Pittsburgh. As such, he is an advocate for what leaders in his field call "participatory action engineering," or, more simply put, listening to the people you're trying to help.

    Cooper said his frustration with the ivory-tower approach to human engineering grew out of his own experience trying to get a better wheelchair.

    "I was trying to solve some of my own problems," he said of his approach to design research. He found that he and other Veterans often were in "isolation" from the researchers.

    Cooper said that surveys and talking to the Veterans themselves are "ways to initiate the design process, rather than having somebody sitting at their desk or surfing their computer, trying to understand what you want."

    Designers and researchers should "start by asking [the Veterans]... to prioritize," Cooper said.

    He said his current research was focused on robotics, artificial intelligence and what he called "adaptive reconditioning technology" to help Veterans participate in sports and recreation.

    One such example: a robotic bed. One of the little-known everyday problems for disabled Veterans, and their caregivers, is getting in and out bed, Cooper said.

    "If you don't have the use of your arms or legs, or you're weakened, that's a huge problem," he said.

    The bed is currently a work in progress, but Cooper said the initial thought was to have a "chair-into-bed kind of a docking system, and the chair kind of puts you into the bed while a conveyer pulls you into the bed."

    A Secret Weapon: Veterans

    The VA has a major advantage over the teaching hospitals and the private sector in conducting wide-ranging tests and surveys that require huge numbers of volunteers, said Ramoni, the VA's chief research officer.

    "Veterans are absolutely core to our program," she said. "Our program is able to make these discoveries because of the thousands of VA patients volunteering here," and "what we do is driven by their needs."

    Outside researchers, she said, often ask how they can learn from current VA practices and how VA scientists get so many people involved in the development process.

    "We say what we have is not something you can learn; that you have a population of Veterans who want to continue to serve their fellow Veterans and the entire nation by participating in these studies," Ramoni said. "It's just amazing to me how committed Veterans are to continuing to serve and continuing to make discoveries that will help everybody."

    The Next Big Breakthrough

    Ramoni noted that VA's ongoing Million Veteran Program (MVP) on genome research has now enrolled more than 670,000 Veteran volunteers, to make it by far the world's largest genome database.

    In the program, begun in 2011, participants donate blood, from which DNA is extracted. Then a baseline and periodic follow-up surveys track the Veterans' military careers, and their health and lifestyles.

    The research seeks to determine whether the genetic information in the database could hold keys to preventing and treating diseases.

    "We believe MVP will accelerate our understanding of disease detection, progression, prevention and treatment by combining this rich clinical, environmental and genomic data," former VA Secretary Dr. David Shulkin said.

    The MVP research opened the possibility for determining whether genetic factors were contributors to PTSD and Gulf War illness, Ramoni said.

    Many Veterans shared the same experiences in the same places in combat, and others were in the same places in the Gulf War; some developed PTSD and Gulf War illness, others didn't, Ramoni said.

    "The question we all ask is, why is that? Are there genetic markers for PTSD susceptibility, or are there genetic markers for Gulf War illness? Genes might help reveal that," she said.

    Source

    #veterans #military #amputees #womenvets

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  • Bryan Perry

     

    An Army Veteran was left to die from a drug overdose while in the custody of an Oregon sheriff’s office as deputies laughed and filmed the entire ordeal, according to videos released Thursday.

    • Bryan Perry, a 31-year-old Iraq War Veteran and Purple Heart recipient, was arrested along with his girlfriend on suspicion of drug use. In the video, he is seen thrashing and groaning in pain while in custody on October 4, 2016, while Clackamas County Sheriff’s Office deputies are heard laughing and mocking his behavior.
    • “We should go show this to his girlfriend and be like, ‘You love this?,'” one deputy suggests, an apparent reference to Perry’s affirmation of love for his girlfriend before they were led to separate holding cells, according to 18 pages of documents released sheriff’s office along with the video.
    • Perry became unresponsive around 11:45 pm and was rushed to the hospital, where he was pronounced dead at around 12:16 am. An autopsy revealed that Perry had amphetamines and methamphetamines in his system at the time of his death, although he had told police he’d used heroin and bath salts at the time of his arrest.
    • The video and documents only came to light following a wrongful death lawsuit filed by Perry’s family and a resulting public records request from The Oregonian newspaper.
    • “I cannot comment on the pending lawsuit, which focuses primarily on Mr. Perry’s medical care provided by the Jail medical contractor,” Clackamas County Sheriff Craig Roberts said in a statement. “But I will say this: The laughter, substance, and tone of several comments heard from my employees in that video were inappropriate, and do not conform to our professional standards.”

    You can watch the entire video below. Warning: It’s disturbing — and infuriating.

    (Click on the source link at the bottom to view the video)

    Source

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  • AZ Homeless Vets

     

    An annual event sponsored by the Sonny Montgomery VA Medical Center is working to connect Mississippi's homeless Veterans with services they desperately need. MPB's Desare Frazier reports.

    Forty-year old Roselyn Hutton, is a U.S. Navy Veteran from Utica. When she was going through a divorce and attending college, Hutton says her G.I. Bill benefits didn't cover the cost of living during breaks, holidays and summers. She and her 9-year old son ended up going from house to house staying with people. Hutton sought help from the homeless program at the Sonny Montgomery VA Medical Center in Jackson.

    "And I was able to utilize their services in order to be able to sustain life and still be able to go to school and still drill a little while and still take care of my son," said Hutton.

    Hutton, says she now works as a medical supply technician at the VA facility and she's a homeowner. Hutton is at the medical center's annual Standdown event in Jackson encouraging homeless Veterans to take advantage of all the services available. Kimberly Moore is with the medical center. She says state and community agencies link Veterans with services that include finding a job, housing and medical care. Moore wants to make it convenient for them.

    "To prevent Veterans from having to go here for one thing, another place for another, bringing all the services under one roof. This is where Veterans can come, they can fellowship with their fellow Veterans, relax, and just get back on their feet with this resources," said Moore.

    Moore says 150 to 200 homeless Veterans attend the program. Navy Vet Roselyn Hutton tells them:

    "We deserve it. We served this country. It's important to know what benefits and what things are available to us," said Hutton.

    A Standdown event is scheduled for September 29, in Greenville.

    Source

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  • Antibiotic Resistance

     

    More than 400,000 Americans get sick every year from infections caused by antibiotic-resistant foodborne bacteria, according to CDC estimates. People who are infected with antibiotic-resistant bacteria may experience more severe illness, including hospitalization and death, because these infections can be harder to treat. Learn what CDC is doing and how you can protect yourself and your loved ones from these types of infections.

    Antibiotic Resistance and Food Production

    Antibiotic resistance is the ability of bacteria to resist the effects of an antibiotic. This means that bacteria are not killed by the antibiotic and can continue to grow. About one in five resistant infections are caused by germs, such as Salmonella and Campylobacter, from food and animals.

    Improving antibiotic use can help slow antibiotic resistance.

    Antibiotics are medicines that kill bacteria. They are extremely important in treating serious bacterial infections in people. However, bacteria can become resistant to antibiotics when these drugs are given unnecessarily to people or animals who don’t require them. Improving antibiotic prescribing and use is critical to ensure that bacteria don’t become resistant to antibiotics. Prescribers should only treat people and animals with antibiotics when they need them for medically sound reasons.

    All humans and animals have bacteria in their gut. When they are given antibiotics, many of these bacteria are killed, but the resistant ones may survive and multiply. This is why the responsible use of antibiotics is so important in both humans and animals.

    When animals are slaughtered and processed for food, the bacteria from the animal can contaminate meat or other products. Bacteria also can spread from animal feces (poop) to the environment, which can then contaminate soil and water used to grow fruits and vegetables. Food and the environment can get contaminated with bacteria in these ways, including with bacteria that are resistant to antibiotics.

    People can get resistant infections by handling or eating raw or undercooked meat or produce contaminated with resistant bacteria. They can also get sick from contact with animal poop, either through contact with animals and animal environments, or through contaminated drinking or swimming water.

    What CDC is doing

    CDC is working to prevent infections caused by antibiotic-resistant bacteria by:

    • Tracking resistant infections and studying how resistance emerges and spreads.
    • Detecting and investigating antibiotic-resistant outbreaks quickly to solve, stop, and prevent them.
    • Determining the sources of antibiotic-resistant infections that are commonly spread through food and animals.
    • Strengthening the ability of state and local health departments to detect, respond to, and report antibiotic-resistant infections.
    • Educating consumers and food workers on prevention methods, including safe food handling, safe contact with animals, and proper handwashing.
    • Promoting the responsible use of antibiotics in humans and animals.

    Protect yourself and your family

    There are steps you can take to help protect yourself and your family from antibiotic-resistant foodborne illnesses.

    • Take antibiotics only when needed.
    • Follow simple Food Safety Tips:
    • COOK. Use a food thermometer to ensure that foods are cooked to a safe internal temperature: 145°F for whole beef, pork, lamb, and veal (allowing the meat to rest for 3 minutes before carving or consuming), 160°F for ground meats, and 165°F for all poultry, including ground chicken and turkey.
    • CLEAN. Wash your hands after touching raw meat, poultry, and seafood. Also wash your work surfaces, cutting boards, utensils, and grill before and after cooking.
    • CHILL. Keep your refrigerator below 40°F and refrigerate foods within 2 hours of cooking (1 hour during the summer heat).
    • SEPARATE. Germs from raw meat, poultry, seafood, and eggs can spread to produce and ready-to-eat foods unless you keep them separate. Use different cutting boards to prepare raw meats and any food that will be eaten without cooking.
    • Wash your hands after contact with poop, animals, or animal environments.
    • Report suspected outbreaks of illness from food to your local health department.
    • Review CDC’s Traveler’s Health recommendations when preparing to travel to a foreign country.

    Source

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  • iPhone

     

    Active members of the military and those who’ve left the service who receive care through Veteran Health Administration hospitals will be able to view all their personal medical data through the Health Records feature on their iPhones. Apple and the U.S. Department of Veterans Affairs made the announcement on Monday.

    Starting this summer, Vets will be able to view an integrated snapshot of records from such providers pertaining to allergies, immunizations, vitals, test results, medications, procedures, conditions, and so on. The data is encrypted.

    Following a visit to a VA health care facility, the participating Vet’s Apple device will automatically receive updated health record information within 24 hours.

    The Health app on the iPhone isn’t new, nor is the Health Records feature within the app where the data will be stored. It was updated last year to make it simpler for patients to chase down records from disparate medical providers, and keep them in one convenient repository. The feature itself is still technically in beta.

    Among the growing list of more than 200 providers in the program are institutions such as Johns Hopkins in Baltimore, Cedars-Sinai in Los Angeles, Cleveland Clinic in Cleveland, Stanford Health Care in Palo Alto, Calif., NYU Langone Health in New York, and Rush University Medical Center in Chicago. Quest Diagnostics and LabCorp are also participants.

    How it works: Apple Watch ECG feature to detect irregular heartbeat launches.

    Discounts available: Apple launches online store for active military and Veterans

    The latest announcement brings the VA hospitals into the fold.

    To add health data from the VA, Vets will sign in with their military credentials inside the Health App, just as people seeking records from other medical providers sign in with the credentials used to access the various institution's respective patient portals. An Apple ID is never used.

    The VA indicated a willingness to partner with other companies to bring similar capabilities to other mobile platforms.

    In a release, Apple CEO Tim Cook said, “We have great admiration for Veterans, and we’re proud to bring a solution like Health Records on iPhone to the Veteran community. It’s truly an honor to contribute to the improved health care of America’s heroes.”

    Apple’s move is just the latest by the company to salute the country’s fighting men and women. In December, Apple launched a dedicated online store for military members, Veterans and their immediate families featuring 10 percent discounts on almost all the products available in the store.

    "We don't view (Veterans) as a market, per se," says Jeff Williams, Apple's chief operating officer. "It's not about the business, it's about taking care of people who have done so much for our country."

    Source

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  • Vets Golden Age Games

     

    Today the U.S. Department of Veterans Affairs (VA) announced that it will begin accepting applicants on Feb. 25 for the 2018 National Veterans Golden Age Games, scheduled to take place June 5-10 in Anchorage, Alaska.

    The National Veterans Golden Age Games is the premier senior adaptive rehabilitation program in the United States, and the only national multievent sports and recreational seniors’ competition program designed to improve the quality of life for all older Veterans, including those with a wide range of abilities and disabilities.

    The annual competition is one of the most progressive and adaptive rehabilitative senior sports programs in the world, and hundreds of Veterans from across the country are expected to take part.

    Veterans ages 55 and older who receive VA health care may complete applications at www.Veteransgoldenagegames.va.gov. Registration will close once the maximum number of applicants are reached.

    “We encourage every Veteran to embrace an active and healthy lifestyle, and this annual event encourages participants to make physical activity a central part of their lives,” said VA Secretary Robert Wilkie. “The National Veterans Golden Age Games is a VA rehabilitation event for our senior Veterans who have dedicated themselves to remaining active, healthy, and living the Games’ motto – ‘Fitness for Life.’”

    Competitive events include the following: air pistol, air rifle, badminton, basketball, blind disc golf, boccia, bowling, cycling, golf, horseshoes, nine-ball, pickleball, powerwalking, shuffleboard, swimming, table tennis, and track and field.

    The games encourage participants to continue in local senior events in their home communities, and every other year serve as a qualifying event for competition in the National Senior Games. The Alaska VA Healthcare System, host of this year’s games, provides care for more than 80,000 Veterans across the state’s 586,400 square miles.

    For more information, visit www.Veteransgoldenagegames.va.gov; follow VA Adaptive Sports on Instagram, Twitter and Facebook at @Sports4Vets.

    Source

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  • Suicide Prevention Month

     

    The Army is committed to the health, safety, and well-being of its Soldiers, Department of the Army civilians, and families. To emphasize this commitment, the Army is joining the nation in observing September as National Suicide Prevention Month.

    Every person has a responsibility and commitment to reach out and help fellow Soldiers, civilians, or family members who need the strength of the Army. Together, a difference can be made by helping those who are at risk and suicides can be prevented.

    Effective suicide prevention requires everyone to be aware of the risk factors for suicide and know how to respond.

    If a person seems suicidal, the time to take action is now. Talk to that person before it is too late. Be direct and talk openly. Listen, and allow them to express their feelings.

    Battle buddies are the front line in surveillance and detection of high-risk behavior. Be a buddy, learn the warning signs of suicide, and find out how to help someone threatening suicide.

    Employ ACE

    Ask, care, escort, or ACE, is an easy-to-remember acronym that any Soldier, leader, family member, or civilian can use.

    • Ask your buddy – Have the courage to ask the question, but stay calm. Ask the question directly, “Are you thinking of killing yourself?”
    • Care for your buddy – Remove any means that could be used for self-injury. Calmly control the situation; do not use force. Actively listen to produce relief.

    Escort your buddy — Never leave your buddy alone. Escort to the chain of command, a chaplain, a behavioral health professional, or a primary care provider.

    Know the signs

    Do you know the warning signs for suicide?

    If anyone you know exhibits the following signs, get help as soon as possible by contacting a mental health professional or by calling the National Suicide Prevention Lifeline at 800-273-TALK.

    • Threatening to hurt or kill oneself or talking about wanting to hurt or kill oneself.
    • Looking for ways to kill oneself by seeking access to firearms, available pills, or other means.
    • Talking or writing about death, dying, or suicide when these actions are out of the ordinary for the person.
    • Feeling hopeless.
    • Feeling rage or uncontrolled anger or seeking revenge.
    • Acting reckless or engaging in risky activities.
    • Feeling trapped.
    • Increasing alcohol or drug use.
    • Withdrawing from friends, family, and society. This includes feeling anxious or agitated, being unable to sleep, or sleeping all the time. It also includes experiencing dramatic mood changes or seeing no reason for living or having no sense of purpose in life.

    Source

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  • Army Vet Survives

     

    Adam Greathouse is an Army Veteran, corporal in the Third Infantry Division, Field Artillery.

    In 2001, near the end of his duty day in Kosovo, his sergeant gave him the rest of the day off so he took a nap. When he woke up, he couldn’t move. There was pressure on his chest and he started hallucinating.

    He was sent to a German university hospital where his organs started failing, his heart became enlarged, tubes going in and out of his body, all while he passed in and out of consciousness. He had no control. With the magnitude of trauma to his body, having lost oxygen to his brain, he suffered a traumatic brain injury (TBI).

    Suffering from a severe anoxic event that damaged many organs including his lungs and brain, he went into a coma lasting two months. He was diagnosed with a traumatic brain injury (TBI) including partial amnesia, memory loss, and physical paralysis.

    Uncertain of his condition, months went by and depression set in. Beaten to the core both physically and mentally, he lay there broken, waiting to die. He had lost more than half his body weight and was frail with hardly any muscle mass.

    Mental toolbox pulled him through

    With the help of VA, Greathouse has learned to adapt to the disabilities caused by the TBI over the years. He pulls tools from his mental toolbox to handle life’s situations and to maintain his current active lifestyle. Each night, he sets cell phone alarms to make sure he is on time in the morning. He does brain training games before bed.

    Today he helps other Veterans conquer challenges as an ambassador at the National Veterans Summer Sports Clinic. His first VA Adaptive Sports event was the National Disabled Veterans Winter Sports Clinic in 2012, which he followed up with the National Veterans Summer Sports Clinic later that year.

    Drives five hours to volunteer

    In 2014, he started volunteering at the Huntington VA Medical Center in West Virginia as the first voluntary recreational therapy peer support specialist, driving more than three times a week over two and a half hours each way.

    He was very involved with sports before his injuries, so he continues to eat right and stay active. In social settings, he says he must be fully present to not deter his concentration, knowing how many distractions are all around him.

    Volunteering weekly has given him a sense of purpose.

    “I know that when I was in the process of going through it if someone I should have been able to count on said they were going to be there and they didn’t show up, then I would know the whole system failed and I would never come back. I’m not going to let that happen,” he said.

    “Suddenly, BAM, I’m a soldier again,” Adam said, after sharing how much these clinics have brought him back from the darkest days of his life.

    He frequently takes his children out surfing and snowboarding, knowing how many years he missed, watching them from the sidelines, unable to walk. He bought his first house in 2017 and is fixing it up with his dad. You can’t miss him in the crowd, just look for the man with the biggest smile.

    “It’s an honor to be here and watch my brothers and sisters grow in confidence every day. By the end of the week, they have permanent smiles! It’s a life saver, a game changer,” Adam said of the 2018 Summer Sports Clinic.

    “My life was spared for a reason. I couldn’t have done it on my own. I have three people to thank for getting me through it: My mom for her fierce faith in God, my nurse in Germany who put up a picture of my kids, reminding me of why I should fight, and my nurse case manager in Huntington, Cheryl, who pushed me past my own limits.”

    Greathouse was also named as a Veteran of the Day.

    Source

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  • Ask A Vet

     

    Here is the first thing to know about Veterans: No single voice can represent them. Each service member is shaped not only by their race and gender, but also the branch of the military they chose, the rank they held, where and if they deployed, and so much more. The breadth and variety of our experiences in our big ol’ machine of war are immense, and it would be foolhardy to let some jackass who rolled around Iraq in a tank 15 years ago speak for everyone.

  • Ask A Vet 002

     

    Welcome to Ask A Veteran, a place for civilians (or anyone!) to ask questions about the military or Veterans issues.

    Alex asks: I teach social studies in a public high school in NYC. I did not serve. Many of my students see military service as their only chance to change their prospects for the future. They idealize the benefits the recruiters describe without, I fear, giving real thought to what comes with their signature. I’m looking for some questions to ask kids (and their parents/extended family, who are often supportive of enlistment) to get them to contextualize what they’re signing up for and to get them to be thoughtful about what military service would likely mean for them.

    First, allow me to applaud your dedication to your students. Anyone brave enough to face teenagers every day and still care about their future is someone who should walk tall in this forum. You live life in constant danger of being owned by those Juul-wielding savages and somehow are still invested in their betterment as people. I salute you.

    Now, on to the matter hand: If my read on your question is correct, you are trying to approach this matter with sensitivity and an open mind, but the underlying vibe I get is, “How can I convince these kids not to sign up for military service?” Of course, given the lack of interest and accountability in the Forever War from our government (and, by extension, the American populace), your concern is not unfounded. You’re also right to be skeptical of recruiters; they are under enormous pressure to meet their recruitment quotas, and that pressure manifests in selling dreams that often go unfulfilled.

    But consider, for a moment, the benefits of military service that your students find appealing. An enlistment bonus? It may be more money than that student has ever seen before — and possibly more than the family has ever seen before (which may explain the parental support for enlistment). Money for college? Frankly, going through college as an adult on the G.I. Bill seems to me like a better recipe for success than starting to accrue student loan debt at age 18.

    I am, admittedly, a tainted source on this matter. My father, an Air Force pilot, was the first person in my family to graduate from college thanks to the military. I went to an expensive university not because my family had money, but because I had four years of my life to give to the Marines. I grew up believing that the military was a way for bright people from humble roots to gain entry into the middle class, and because I am able to look back on the benefits it gave me — tenacity, courage, confidence, character — I am unable to discourage others from the path.

    Back to your students. We mustn’t forget the strongest siren song of all: The promise of adventure and world travel. This promise can deliver, or it can bite you in the ass. Or both. I often joke that the Marine Corps gave me a tour of the world’s deserts, but the specifics are more interesting than the punchline they serve. For three years, I lived a ten-minute drive from Joshua Tree National Park; the Mojave is mountainous and full of hardy plant life that erupts in color during the short spring when the hard rains release the smell of creosote. I spent the month after 9/11 in the Western Desert of Egypt — long flat stretches of brown sand punctuated by rock formations that were both easier and harder to navigate than the Mojave, depending on your map skills. In Kuwait, where we staged before the invasion of Iraq, the only feature was the horizon. Kuwait can go eat shit.

    And that still only scratches the surface of what I saw and learned in four years. I lived in Kentucky and developed a taste for bourbon thanks to the Armor Officer Basic Course at Fort Knox. I’ve been to Australia with the best friends I’ll ever have; we taught locals the dice game Ship, Captain, Crew. I’ve crossed the Indian, Pacific, and Atlantic Oceans on Navy ships. I’ve flown in helicopters and driven tanks and landed on a beach in a hovercraft. I can hit a man-sized target from 500 yards with an M16 using only iron sights. What might a civilian life have offered me out of college? Safety, I suppose. But less of everything that was vibrant and meaningful, and nothing that made me who I am today.

    I do not mean to whitewash the danger. It is a deadly job even in peacetime. A good friend of mine, John Wilt, a lieutenant who was my classmate both in high school and at the Marines’ Basic Officer Course, was killed in an aircraft accident when he was at flight school. One of my Marines was airlifted from Twentynine Palms to the Naval Medical Center at Balboa after he got his head partially crushed during routine maintenance of an Abrams tank; he lived after surgeons cut open his skull to relieve the swelling from his brain.

    Combat is worse, of course. I have the benefit of hindsight about my experience because I didn’t get shot in the head like my buddy Brian McPhillips. I have the luxury of nostalgia because, unlike my friend Andy Stern, my life didn’t end with an IED exploding in my face. My lot in life is to go around repeating their names to people who can never know them. As my body gives way to middle age, their names are as familiar and well-worn as a rosary, but their pictures always stop me in my tracks. The youth of the dead is breathtaking, and I can barely believe that I stood shoulder to shoulder with them — that I was ever so young, and believed myself invincible.

    You said you were looking for questions to ask kids that would “get them to contextualize what they’re signing up for.” But I’m not sure that’s possible. How can you give young people wisdom without experience? They will be drawn to the military the way I was drawn to it — for the benefits, yes, but also to fill a hole inside them, a deep-seated craving to challenge and prove themselves. They will be drawn to service knowing, intellectually, that it is dangerous, but without really believing that the danger can touch them. Their peers will drive recklessly or do drugs or similarly dangerous things, and none of them will ever believe that harm can come to them. It is a feature of youth, not a bug.

    I do not wish to discourage your noble effort, but I don’t want you tilting at windmills, either. I will leave you, and your students, with the best reflection I have on my military service: It is a wonderful thing to have done, but it was often miserable to do. Or, more succinctly: It is a great thing to do with your life — if it doesn’t kill you.

    Source

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  • James Woods

     

    Updated: After actor James Woods used his Twitter account to call attention to a Veteran who sent a distressed tweet, authorities located the man who had tweeted he was contemplating death by suicide.

    "After numerous attempts to locate (Andrew) MacMasters yesterday, several of our officers were able to make contact with him to verify his well-being as well as ensuring that the appropriate resources were made available to him in reference to his tweet," Maitland (Fla.) Police Department Lieutenant Louis Y. Grindle told USA TODAY.

    The "Salvador" actor, 71, alerted the Orlando Police Department Monday night and asked authorities to perform a wellness check on MacMasters, a former Marine.

    "A man named Andrew MacMasters just said on @Twitter that he is sitting in a parking lot and is going to kill himself," Wood tweeted to his nearly 2 million followers. "He’s sitting with his dog, a black lab, possibly in a WalMart parking lot."

    Woods' plea for help included a screenshot from MacMasters' Twitter account, which has since been deleted.

    "I'm on Twitter every day, I retweet all the time but this is the first tweet I've ever written," user @macmasters_a tweeted Thursday. "I'm (a) good guy, I'm a Veteran, I love America. I'm gonna kill myself tonight. I've lost everything I have nobody, nobody cares."

    Woods responded to MacMasters' cry for help in a series of tweets, initially asking the Veteran to "tell me where you are."

    "We can talk. I don’t care what anybody thinks. Do you? Let’s have a conversation. Just you… and I," Woods said in one tweet to MacMasters, adding in another, "I’m following you now, so you can DM me. We can talk privately. Or we can talk openly right here. Lot of people worried about you right now."

    The actor tried to engage the distraught Veteran: "Someone said you’re Andrew. In Orlando? Im not trying to trap you. Let’s just talk. You also have your dog. Your little schnoot. Boy or girl?"

    "So think about this. A lot of Vets, I understand, have come to where you are tonight," Woods continued. "If you could just push this decision off tonight, at least, maybe you would also inspire another Vet to seek help. You could save another man, too. By waiting to do this."

    In 2016, the most recent data available, the Department of Veterans Affairs said about 20 Veterans a day take their own lives, a suicide rate 1.5 times greater than Americans who never served in the military. And Veterans accounted for 14 percent of all adult suicide deaths in the U.S. in 2016, even though only 8 percent of the population has served.

    In a last-ditch effort, the actor tried to comfort MacMasters. "I’m driving cross country. Sitting in a motel room. I have all night. I know that sounds dorky, but here I am! I would love to talk. Just talk. I won’t push you into anything," he said.

    Once it was clear the suicidal Veteran could no longer be reached on Twitter after deleting his social media account, Woods turned to his followers to gather information on MacMasters' location.

    The "Casino" actor learned his home address and forward it to authorities in Maitland, Florida, who promptly checked his residence. MacMasters was not there.

    "If only Andrew could see the THOUSANDS of fellow Americans who are pulling for him. It’s like he’s lost behind enemy lines and we are cheering him home, willing him to survive," Woods tweeted. "Andrew, do this for the 'other 21' Vets a day who don’t make it home from the darkness. Stay alive!"

    Woods continued to update the search on Twitter, sharing tweets from people who notified MacMasters' family, including the Veteran's mother and brother.

    Maitland Police Public Information Officer Lt. Louis Y. Grindle informed USA TODAY Tuesday morning that authorities were able to reach MacMasters, though his whereabouts are unknown.

    "Our agency was able to make contact with him by phone earlier this morning, where he advised he was OK but did not wish to have contact with law enforcement," the emailed statement read. "Our officers are still working to try and physically locate him to determine his well-being."

    Woods, who frequently uses his Twitter page to share his conservative political views, recently used his account to help link people together with family members following the California wildfires.

    Source

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  • Beer and Wine

     

    With beer and wine for sale at 12 commissaries nationwide, sales seem to be chugging right along -- pun intended.

    Beer and wine hit some commissary shelves for the first time ever in July as Pentagon officials explore ways to lure more customers into stores. Operated through a partnership with the military exchange system much like the one under which commissaries carry tobacco, proceeds from sales go back to the exchange, not to the commissary.

    Since the initial rollout, the system has sold about $150,000 in beer and wine, Kevin Robinson, a Defense Commissary Agency (DeCA) spokesman, said in an email.

    The items are currently carried only on store shelves, not in cooler cases. And if what's available at Port Hueneme, California, is any indication, selection is very limited. In mid-September, that store had only a selection of light beers and low-cost red and white wine bottles and boxes.

    Robinson said the system hasn't yet received enough feedback to determine whether patrons like that selection.

    It is "still too early yet to gauge overall patron response since this rollout is still within the 90-day initial deployment to 12 stores," he said.

    Officials also haven't announced a rollout of beer and wine at stores outside the 12 pilot locations, although an April 27 Pentagon memo states that availability systemwide will occur "efficiently and expediently thereafter" after the 90-day test.

    Source

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  • Kidney Donation

     

    Donating a kidney hasn't slowed down Air Force Col. Dave Ashley. Two years after his life-saving act, Ashley is running in ultramarathons and training for a multiday team event in Fiji that includes mountain climbing and whitewater rafting. And what began as an impulse to help a desperately ill former West Point classmate has turned into a campaign to make sure other Military Health System beneficiaries know that living organ donations are an option.

    “I worried I might get pushback because I’m an active-duty, senior officer,” said Ashley, now senior materiel leader for the Air Force’s Advanced Extremely High Frequency satellite program office at Los Angeles Air Force Base. “But I received outstanding help from my flight doc and the entire medical chain of command as I went through the process.”

    More than 100,000 people in the United States are on the waiting list for a kidney donation, according to the National Kidney Foundation. For many of these patients, time runs out. About 13 people die every day while waiting for a kidney transplant, according to U.S. Department of Health and Human Services data.

    "There are so many people in need," said Vilda Desgoutte-Brown, a registered nurse and the living donor coordinator at Walter Reed National Military Medical Center in Bethesda, Maryland. "Right now, I have at least five 19- and 20-year-old, active-duty service members on dialysis."

    Dialysis is the process of using a machine to remove excess fluid and waste, such as creatine, from the blood. Creatine, a chemical waste byproduct of normal muscle function, usually is filtered by the kidneys and eliminated through urine.

    About half of all kidney transplant patients receive organs from relatives, according to the Kidney Foundation. Another 13 percent receive them from spouses or life partners. Approximately 37 percent of kidney transplant patients receive organs from friends or other nonrelated donors.

    Ashley donated a kidney to Chris Connelly, a U.S. Military Academy classmate and five-year Veteran of the 101st Airborne Division. Connelly was working in the financial services industry in New York when inexplicably, he experienced total kidney failure. He was a candidate for a transplant, but his parents and two sisters weren’t medically eligible to donate. A Facebook post on the West Point Class of 1997’s closed group page caught Ashley's attention.

    “I thought the odds of me being a match were probably pretty slim,” Ashley said. “But getting tested seemed like the right thing to do.”

    Transplant coordinators at Brigham and Women’s Hospital in Boston, where Connelly was a patient, sent Ashley a testing kit. Ashley asked his physician at the Pentagon Flight Medicine Clinic to help him complete and return it.

    Service members who want to become living organ donors must submit a package of documents for approval after they’ve been matched with a recipient. Army and Navy service members’ requests go to the Army Surgeon General’s Office. Ashley’s request package was coordinated through the Air Force Medical Operations Agency for review and approval.

    The request package must include a letter from the potential donor’s commander granting permission, and a letter from the donor’s primary care physician asserting the potential donor is in excellent health and has been advised of any risks. Those risks include complications after the surgery that might limit or even end military service.

    Direct donations aren't the only option, Desgoutte-Brown said. Walter Reed-Bethesda, the only transplant center in the MHS, participates in regional as well as national kidney paired-donor exchange programs. People who cannot donate a kidney to a specific person because of medical incompatibility, or who want to donate but don't have a particular person in mind, are entered into the exchange programs after all relevant testing is completed. Adding these potential donors enables Walter-Reed Bethesda to find compatible kidneys for its own patients. To date, 23 MHS beneficiaries have received kidneys through the exchange program, Desgoutte-Brown said. Five recipients were active duty service members.

    “Being a living donor genuinely saves lives,” said Connelly. "I'm healthy and strong, thanks to Dave. I love having the ability to just go out and run or lift weights or hike, but most importantly, doing things with my wife and son that I was unable to do before the transplant."

    More information about Walter Reed-Bethesda's transplant program or becoming a kidney donor can be requested by This email address is being protected from spambots. You need JavaScript enabled to view it..

    Source

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  • Best Jobs

     

    When returning from active duty and transitioning to civilian life, one of the first things a soldier must do is find a job. While military service provides many critical skills that can translate well into civilian jobs, sometimes the transition itself and communicating those skills to a non-military hiring manager is a big challenge to overcome.

    Sadly, for many Veterans, this can be a battle, even after fighting for our country for years. According to the Bureau of Labor Statistics, the unemployment rate of Veterans is dropping, declining from 4.3 percent to 3.7 percent in 2017. However, of those Veterans who are unemployed, 59 percent are between the ages of 25 and 54, which indicates the working-age Veterans are the ones having the biggest problem finding work. Also, even younger Veterans, those between the ages of 18 and 25, continue to have a hard time both finding and keeping a job.

    That may sound like poor statistics, but the truth is that programs assisting both Veterans and employers are helping to make a difference. The key is to help Veterans connect with those programs so they can find the training they need and the available jobs that are hiring people with their skill sets.

    Also, some jobs are perfectly suited for members of the military. All it takes is a little knowledge about how to translate military skills to the civilian workforce and find jobs that build on your skills. This guide is designed to help today’s Veterans overcome the challenge of finding a job, translate their abilities into marketable skills, and land a civilian job where they can thrive.

    Translating Military Skills into a Civilian World

    In the military, you learn discipline, leadership, strategic thinking, efficiency, and in many cases, highly technical skills. All of those skills have real-world applications that are valuable in the civilian workforce, but it’s not always easy to see how. Here are some tips to make it easier for you to capture your military skill and translate them into a new civilian life.

    Find Work in Fields Similar to Military Jobs

    First, start looking for work in fields that have similar work to the work you did in the military. Some places to look include:

    • Put physical fitness to work in constructionThe construction industry can be a great place for Veterans to find work. Since the military builds temporary and permanent structures regularly, many Veterans already have experience in this field.
    • Use physical fitness in landscaping.
    • Tap into military strategy in law enforcement. Soldiers have already proven that they can work in tense, stress-filled scenarios, and law enforcement jobs put those skills to good use.
    • Embrace tech training in technology-centered jobs. Today’s soldier works in a high-tech environment, and many get on-the-job training using sophisticated computer navigation, surveillance, logistics, data, and communication systems, which can land them good jobs in the tech world after discharge.
    • Use military skills in car or aircraft mechanic jobsWorking on aircraft and military vehicles in the field is good preparation for similar maintenance and repair work in the civilian world.

    Understanding the Challenges of Civilian Job Searches

    While many jobs are perfectly suited for military people, finding them can be a challenge for many Veterans who might never have made a resume or been on a job interview before. Here are some of the specific challenges that Veterans sometimes face when starting a job search and ways to mitigate these challenges.

    • Understand the mind shift from “we” in the military culture to “me.” This is, perhaps, one of the biggest shifts that a member of the military can make mentally. In the military, you are a part of a group, where everything is done for and with the group. The military teachers “service before self,” which can make it difficult to learn to promote yourself as you must do in a civilian job. While you still need to be a team player, your focus needs to shift inward a bit in civilian work.
    • Be prepared to negotiate your salarySoldiers have little room for negotiation for their salary and benefits packages. Civilian job hunters do. Before accepting a salary that you are being offered, make sure it is fair, and be willing to negotiate for better or different terms.
    • Know that civilian jobs aren’t always secureOne of the benefits of living in the military is the fact that, as long as you follow the rules and stay fit, you have job security. You know what is expected of you, and if you can perform those expectations properly, you won’t have to fear for your job. This is not the case in the civilian world. Companies can downsize or go bankrupt with little notice, leaving you in search of a new job. Staying connected to the job market and keeping skills up to date will help reduce the risk.
    • Learn to think outside the box. In your military career, your job was to obey orders without question. Working with your new civilian work team will be different. Thinking creatively to find solutions to problems, rather than just following orders, is encouraged in civilian workplaces.
    • Learn to sell a personal brandAfter shifting from “we” to “me” in your focus, you must learn how to sell yourself as a personal brand. Determine who you are as a worker, and craft everything you use in your job search around that.

    For more information about starting this transition, visit:

    Embrace the Advantages of Being a Veteran

    As you start the search for a civilian job, it’s important to know that there are several significant benefits to your Veteran status, beyond the financial and other perks you got with your discharge. The skills, character training and abilities you learned in the military will give you a distinct advantage in your job search. The key is knowing how to highlight them well. Here’s a closer look at how to embrace these advantages as you search for a job.

    • Acknowledge that Veterans have many skills that translate into civilian jobs. The key to making those skills work for you as you search for a job is learning how to pinpoint them.
    • Take note of the high-level technology training you have receivedIn general, most Vets have more high-technology training than their similarly-aged peers. Make sure that you highlight this in your resume and interviews.
    • Perform a skills inventory to identify important skills. A skills inventory looks at the skills you have and how they might translate into your civilian life.
    • Use a Military-to-Civilian Translator. O-Net has an excellent tool that will help you translate your military experiences into beneficial skills for civilian employment. Simply type in your military job code or title into the translator, and a list of matching civilian job skills is generated that you can add to your resume.
    • Use your Field Service Record to detail your skillsAfter leaving the military, Veterans will receive a Field Service Detail. This will showcase the training and skills learned during the time in the military. This can be proof to potential employers of your abilities.
    • Understand the advantages of being physically fitMembers of the military must stay in good physical health to perform their military service. This can be a benefit to them in their search for a civilian job.
    • Embrace the confidence that comes from being in the military. Being a skilled fighter or filling another role in the military brings confidence and a high level of resiliency.
    • Highlight the benefit of being able and willing to relocate. Moving is simply a way of life for members of the military. You can highlight your flexibility for a quick location change, and if you still have relocation benefits from the military, be sure to mention this. This saves your hiring manager money if they are recruiting over a long distance.
    • Focus on your educationOne of the perks of being in the military is the education you receive throughout your training. Focus on this as one of the benefits of hiring you. Take advantage of all of the potential certifications and licenses you can train for while in the military, and then add them to your resume.

    For more information about the benefits of a military career in your civilian job search, visit:

    Learning to Mitigate Disadvantages Veterans May Have

    Unfortunately, civilian job searches for Veterans are not without their challenges. Knowing what these challenges are and having a plan to mitigate them will make them slightly less of an issue as you head out there in search of a job.

    • Realize that your military skills may have different names in civilian jobs. Even though they translate well into civilian jobs, your military jobs may not be called the same thing. Find out what the layman’s terms are for the military skills you have obtained, and then use the right jargon when you head into your interview.
    • Recognize the real problem of civilian disconnectThere is a disconnect between members of the military and their families and the general population. Lack of understanding of military culture and an inability to accept the civilian way of things can create problems in job searches. Recognize this problem, and learn to make an effort to overcome it in your interactions with civilian employers.
    • Understand that hiring managers may not appreciate military experienceHiring managers who are not familiar with the military may not fully appreciate all of the benefits of hiring a Veteran. You must learn to convey those benefits in your resume and your interview, appearing confident and skilled.
    • Learn the interview skills you needPeople who join the military right out of school may never have any formal job interviews or job interview training. Find a way to practice for interviews, so you appear confident and capable.
    • Find ways to quantify achievementsSuccessful interviews will have numbers to back skills. Take a look at your skills inventory, and find ways to quantify any of the skills that you have. This is often an excellent way to highlight leadership skills in particular. Saying you led a squadron of 100 men shows your leadership potential. However, make sure to phrase your experience in a relatable way. Instead of saying you lead a squadron, say you were responsible for or managed a group. This is phraseology that hiring managers look for and understand.
    • Build a resume that highlights the right experiencesYour experience in the military is a benefit, but you must build a resume that highlights it correctly. Focus on the skills, rather than the time spent serving, so your resume stands out.
    • Overcome preconceptions about hiring Veterans. Unfortunately, some hiring managers have preconceptions about Veterans. They hear stories about Vets that are fighting PTSD or dealing with severe injuries and resulting handicaps, may fear to hire a Veteran. The best way to fight these misconceptions is to communicate your value well and talk candidly about your military experience when interviewing.
    • Highlight the right soft skills to overcome missing work experienceSometimes Veterans lack the practical, real-world work experience that hiring managers want, but they can overcome this with the soft skills their military careers gave. Don’t underestimate the value of soft skills, like problem-solving, leadership, working well under pressure, discipline and ability to work as a team, that you earned in the military. Highlight these in your resume and interview.

    For more information about disadvantages that Veterans often face when transitioning to civilian work, read these:

    Common Jobs That Require Skills Veterans Typically Have

    When seeking a civilian job, you need to look for two things. First, you need to look for a career field that utilizes the skills you have. Second, you need to look for a career field with excellent potential growth. Here are some career fields that offer both to Veterans who are entering the job force again. Several career fields do both. Here are some to consider:

    • Construction – The construction industry is seeing explosive growth as the economy continues to improve after the recession. The Bureau of Labor Statistics anticipates job growth as high as 14 percent. Construction has opportunities for both men and women, with an average annual salary of over $62,000. Construction work builds on skills like organization, leadership and physical abilities that many members of the military have.
    • Operations Managers – Operation managers, help companies improve the efficiency of their operations. They often coordinate work between different departments and may manage people. Other titles for this job may include manager or superintendent, and the potential pay is as high as $100,000 per year on average. This particular field has a slightly lower projected job growth of around 9 percent. The leadership experience that many receive in the military is a benefit in this field.
    • IT Systems Manager – Combining IT experience with leadership experience, an IT systems manager helps oversee the computer activities of an organization or company. Like construction, IT Systems Manager jobs have a much higher than average rate of growth, with growth expected at around 12 percent. Veterans who worked with technology and pursued an IT education while in the service will be ready to take these jobs.
    • First Line Supervisor Mechanics – This job field combines mechanic skills with leadership skills. First line supervisor mechanics supervise teams of mechanics in repair shops or fleet management. This particular job field has an anticipated growth rate of between 5 and 9 percent, but it is a field where military skills are readily accepted as hiring managers to understand the combination of real-world and leadership skills that military leaders have.
    • Cyber Security Analyst – This field is seeing tremendous growth as cyber attacks are increasing exponentially. Many military members who work in IT already have on-the-job experience in fighting cyber attacks, since the military’s systems are prime targets for hackers. This makes this field a strong one for the right Veterans. The best benefit of this field? The job growth potential is 28 percent, and the expected annual salary is over $90,000 on average.
    • Software Applications Developer – The in-depth IT training that often goes along with military service gives Veterans the right tools to develop apps and software. This is a high demand field as companies are constantly in need of new software to reach their target markets and perform internal functions. High job growth potential of 24 percent and an average salary of over $100,000 added to the appeal of this line of work.
    • Electricians – Electricians are always in demand, as people need trained professionals to help them with electrical work. Many Veterans get electrical training as part of their military careers, making this a natural transition. The expected job growth in this field is around 9 percent, with average salaries of over $50,000.
    • Diesel Technicians – The fleet industry is facing a shortage in diesel technicians, which means these jobs are going to be easy to come by shortly. Veterans who have experience working on military equipment can easily translate those jobs into diesel engine work. Diesel techs get slightly higher pay than regular mechanics, and the job growth potential is expected to be around 9 percent.
    • Aircraft Technician – For soldiers who worked on military aircraft, a career in the aircraft repair industry is a natural transition. Though the job growth isn’t expected to be tremendous in this field, job security should remain, as there will always be a need to fly people and product around the world. The average salary in this field is around $60,000.
    • Web Developer – If you have creativity and love technology, consider a career in web developing. You won’t need any training other than learning how to code to tackle this job, so your military training should suffice. The explosive job growth potential, expected to be around 15 percent, combined with the entrepreneurial opportunities in this field make it a great choice for Veterans.
    • Security Systems Technician – No one understands security quite like someone who has served in the military. These professionals install, repair, maintain and program security systems for homes and businesses. It has a job growth potential of around 14 percent.
    • Landscaper Architects – The ability to create beautiful landscaping is always in high demand, and a military member’s physical fitness and creativity can translate well into this work. Landscape architects can expect to earn around $65,000 per year on average, and growth is steady in this field.
    • Law Enforcement – A skilled soldier can also be a skilled law enforcement officer. This field has income potential of an average of $62,000 and average, steady growth potential. The rigorous physical and personal qualifications are easy for most members of the military to meet after their tours on active duty.

    Other fields tap the potential that Veterans have, but do not have the same income growth potential. Some places that are seeing slower growth and demand that you may wish to avoid searching in include:

    • Agriculture – Farmers, rangers and agricultural management jobs are on the decline. While these jobs do tap some of the skills of Veterans, you will want to consider a different field in your job search if you’re looking for job security.
    • Data Entry – If you can type quickly, data entry is a good field, but it sees a decline in demand. You will be better off putting those typing skills to use elsewhere.
    • Food Service Managers – Your mess hall experience may make you highly qualified for this field, but you won’t find much demand anymore.
    • Computer Operators – IT jobs are often a good fit for members of the military, but general computer operator jobs are on the decline. Perhaps this is because most office personnel now know how to operate a computer properly. Consider more in-depth training to help you find computer work.

    In addition to finding the right field to work in, Veterans also must choose the right geographic area to settle in where jobs in that field are plentiful. Here are some tips that might help.

    • Look near big cities for IT and management jobs. Big cities tend to attract tech and manufacturing companies, both of which need IT pros and managers.
    • See where development is occurring. Development means the need for construction work and skilled mechanics, so look for areas of the country that are seeing explosive growth.
    • Reach out to potential employers before making a move. It’s not uncommon for someone to find a job then move, so consider applying for jobs in your skill set then choosing your location once you’ve found work.

    For more help finding the right city for your job search, visit:

    Getting Trained and Qualified for New Jobs

    Many jobs require qualification or certification, which is an important step in the transition between military life and civilian life. Here are some tips to help you find and acquire the certifications you may need for your future career success.

    Medical jobs are also popular among members of the military, particularly those who work as medics, doctors or nurses during their military service. Some certifications for this field include:

    • American Nurses Credentialing Center Certifications

    Mechanics, HVAC repair technicians, and other skilled labor professionals will need certification. Consider these options:

    Finally, don’t overlook the value of civilian life training programs. These can help you adjust to a new life as a civilian after years of military service. Some programs to consider include:

    • Soldier for Life Transition Assistance for the Army

    Programs to Help with Training and Certification

    Thankfully for Veterans, many organizations offer programs to help them achieve certification or receive job training. These programs, most of which are free, can help you get the certificates or licenses you need to launch a successful civilian career path. Take advantage of these programs to help you make sense of the transition period. Here are some organizations who specialize in training Veterans for civilian jobs.

    • Veterans’ Employment and Training Service – A service from the Department of Labor, VETS offers some programs that assist Veterans in making the transition to civilian jobs, including job training programs.
    • Assistance from the VA – The Department of Veterans Affairs offers apprenticeship opportunities that allow Veterans to get the training they need on the job while pursuing their civilian careers.
    • Hire Heroes USA Training Programs – Hire Heroes USA has some training programs available to help members of the military get back into the working world or start a new career after their time in service.
    • Free Apprenticeship Programs for Veterans – GI Jobs lists some free apprenticeship programs designed specifically for Veterans.
    • Career One Stop – Career One Stop offers some tools and opportunities for Veterans seeking to transition into civilian life.
    • Onward to Opportunity – This program partners with local universities and private sector organizations to provide no-cost, industry-focused training, and career skills education for those transitioning from active duty to civilian life. Onward to Opportunity also provides training to military spouses.
    • Veterans Inc. Employment & Training Program – This is a nationally-recognized program that helps Veterans get and keep jobs, partnering with businesses and educational institutions in New England to provide training, career assessment, job search support, and job placement services.
    • Free Custodial and Janitorial Certification for Veterans – HirePatriots.com offers a comprehensive list of free certification courses for Veterans that allow them to learn important skills for cleaning and custodial jobs.
    • Leaderquest IT and Cyber Security Training – This program focuses on training Veterans for IT and cybersecurity jobs. After finishing the training, Vets will be qualified as Department of Defense 8570/8140 credentialed IT professionals.
    • Cisco Veterans Program – The Cisco Veterans Program provides both networking and job search opportunities as well as the Cisco Networking Academy, that helps them learn important IT skills.
    • Power 4 Vets – This program from IncSys, Inc., is designed to help Veterans find careers in the energy sector through online training programs and job placement services for Veterans.
    • Veterans Multi-Service Center – The Veterans Multi-Service Center offers on-site training programs that give Veterans the skills they need for jobs that are currently in demand. Each Veteran who attends the program gets a job developer who serves as a case manager to help the Veteran ultimately find a job.

    For more help with training and certification, visit:

    Entrepreneurship Opportunities for Veterans

    Not all job opportunities require Veterans to work with companies. Often the skills and abilities learned in the military translate well into starting one’s own business or other entrepreneurial opportunities. The extraordinary discipline that members of the military gain throughout their service can make them skilled business owners because they can stick to a task through completion. Branching out on your own to start a business can be quite intimidating. Here are some important considerations to make if you are seeking the entrepreneur path.

    • Determine your level of riskBeing an entrepreneur is not without its risk. Determine if you are willing to shoulder that risk. Do you have financial savings to fall back on, or would you be putting your entire family at risk if your business endeavor fails? Is that a risk you are willing to take?
    • Consider your skill set. What skills do you have that could translate into a business opportunity? Look at the skills inventory you created and ask yourself how those would translate into a business.
    • Consider your interests and passionsMost entrepreneurs are successful because they are passionate about what they do. What are you passionate about? Is this something that you could turn in to a business?
    • Look into fundingIt takes money to start a business, but luckily there are some funding sources you can consider to get the funds you need to start your business. Research your options to determine where the money will come from.
    • Get some business training. Being an entrepreneur requires some business knowledge and understanding. Get some business training if you lack in this area.

    For Veterans who would like to branch out and start their businesses, some resources exist to help. Here are some opportunities and resources for Veterans who are considering entrepreneurship.

    • Institute for Veterans and Military Families Free University Entrepreneurship Training – IVMF organizes some entrepreneurship training options for Veterans, including the Entrepreneurship Bootcamp for Veterans with Disabilities, as well as a similar program for Veterans families and one for female Veterans. The main program includes a 30-day online course followed by a 9-day residence program.
    • Patriot Boot Camp – The Patriot Boot Camp is a program that trains Veterans, active duty military and their spouses on the principles of entrepreneurship. This is a three-day boot camp hosted in numerous cities to teach Veterans how to become innovators, entrepreneurs, and creators in the modern economy.
    • Launch Lab Online from Bunker Labs – Launch Lab Online gives Veterans the jump start they need to start their businesses. It provides entrepreneurship education through videos and online courses, as well as homework and self-assessments designed to let you determine how far your learning has taken you.
    • StreetShares Foundation Veteran Small Business Award – The StreetShares Foundation provides grants to Veterans who are ready to start their businesses. Veterans with businesses that are legal entities that are poised to have a social impact on the Veteran community can apply for awards which are as big as $15,000.
    • VetToCEO – VetToCEO offers online education programs specific for Veteran entrepreneurs. What makes these programs unique is the fact that they are taught by Veteran entrepreneurs who clearly understand the need in the field. They are free and available online for convenience, though the core entrepreneurship program is offered on occasion in in-person meetings.
    • Small Business Administration’s Office of Veterans Business Development – This branch of the SBA offers small business programs to Veterans, including services like business training, counseling, referrals, and transitioning services. They have programs designed for all Veterans, including women Vets, reserve and National Guard members, and disabled Veterans.
    • Office of Veterans Affairs Veteran Entrepreneur Portal – The Veteran Entrepreneur Portal gives Vets direct access to the resources they need to work through entrepreneurship.
    • Center of Excellence for Veteran Entrepreneurship – The Center of Excellence for Veteran Entrepreneurship offers resources for Veteran entrepreneurs for every step of the process.

    For more information about entrepreneurship for Veterans, visit:

    Conclusion

    The days and months after a Veteran leaves active duty service and starts searching for a civilian job are an important time. This is when a Veteran can dip into that military experience to use it in search of a new job. With the right knowledge and understanding, as well as the myriad of resources available to today’s Vets, you can put your military training to good use, overcome the obstacles associated with transitioning and start a career that is rewarding and financially beneficial. As long as you understand the challenges you face and how to mitigate them best, you will come out on top with the best possible civilian job.

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  • Care for the Elderly

     

    VA teams provide specialized treatment for Veterans with geriatric needs

    The median age of the approximately 20 million Veterans who are alive today is 64, with those who fought in Vietnam, Korea, and World War II on the north side of that age demographic. Members of this cohort are often faced with multiple chronic ailments and declining mental and physical abilities.

    VA has recognized that these Veterans and other former service members with geriatric health issues could benefit from a team-based, multi-disciplinary approach to medical care. Dozens of VA medical centers have thus formed Geriatric Patient Aligned Care Teams (GeriPACTs) at their respective sites. GeriPACTs are essentially primary care teams that serve older patients with complex health care needs.

    GeriPACTs are like a one-stop shop. They combine traditional health care services with community-based services, featuring doctors, nurses, pharmacists, social workers, and other specialists. The goal is to streamline the health care experience of Veterans with geriatric needs and expedite their visits to a VA facility, rather than requiring them to set up multiple appointments with providers.

    The GeriPACT is a spinoff of VA’s PACT model. PACT providers treat Veterans of all ages in a team-based setting but aren’t required to have expertise in geriatric health issues.

    In two VA studies, researchers assessed the impact of the GeriPACT program by surveying staff members at the 71 VA medical centers with GeriPACTs. Officials at 44 of the sites responded, within which there were a total of 101 GeriPACT teams. Many of the facilities had multiple GeriPACTs.

    In one of the studies, published in the May-June 2018 issue of the Journal of the American Board of Family Medicine, researchers found that GeriPACTs are “providing services above and beyond standard PACT care. Most notable among these were practices that would be expected of programs devoted to preserving the function, autonomy, and ability to age for frail elders.”

    The researchers write: “GeriPACT is one approach for bringing an interdisciplinary, patient-centered perspective to primary care in a manner that can likely [justify] the higher staffing costs,” with diminished reliance on placing people in long-term care institutions. “It is a model which can provide training for the next generation of providers and clinicians.”

    Composition of GeriPACTs varies from site to site

    In the other study, published in August 2018 in the journal Geriatrics, VA investigators observed a large variation in GeriPACT structure and adherence to VA guidelines—for example, those dictating how the units should be staffed. The researchers noted that GeriPACTs were characterized by a range of staffing, clinic space, and patient assignment practices.

    “For example, GeriPACTs recruited patients in different ways, and not all programs had patient educators and care managers to assist with coordination with other services or had collaborative agreements in place with a PACT,” the researchers write. “More research is needed to understand how these variations are related to processes and outcomes of care.” A collaborative agreement between a GeriPACT and a PACT, for example, may call for patients who are at least 80 years old or have geriatric conditions to be seen by the facility’s GeriPACT team.

    Dr. Jennifer Sullivan of the VA Boston Healthcare System led both studies. She and her colleagues were not surprised by the structural variation of the GeriPACTs. Regarding the core GeriPACT members, 37 of the 44 sites had a social worker, 33 had a registered nurse, 32 had a doctor or geriatrician, 25 had a clerical associate, 24 had a licensed practical nurse, and 23 had a pharmacist or clinical pharmacist specialist.

    “The GeriPACT model was developed and advocated for at the national level,” says Sullivan, who is also a research assistant professor at Boston University. “However, its implementation has been led locally by staff at the medical-center level. Additionally, GeriPACT implementation is influenced by local factors like a history of having geriatric programs, geriatrics-trained staff, and strong support for GeriPACT care provision, including support for clinical space and hiring extra staff as needed. These factors influence GeriPACT implementation and variation in the way the teams and care are structured.”

    Sullivan points out, for example, that instead of having one full-time social worker per team, GeriPACTs cited in the study often shared a social worker if a facility had more than one GeriPACT, or the social worker was shared across GeriPACT and PACT teams due to staffing shortages. These shortages often fall outside the control of the GeriPACT leader when GeriPACT teams intersect with other hospital services that may control hiring processes, such as social work or nursing.

    In addition, only 6 percent of the 44 VA medical centers followed all guidelines from the VA handbook on the implementation of GeriPACTs. There were two notable areas where more resources may be needed to help meet those inconsistencies: GeriPACT staff and dedicated space to run the clinic.

    “Often times, staffing a GeriPACT team at the appropriate levels can be difficult because of turnover,” the researchers write. “In addition, there is a national shortage of providers trained in geriatrics. Furthermore, medical centers may lack resources [i.e., budget] to hire enough staff to cover more than one GeriPACT team at a facility. To further implement the model, more support will be required to bring in appropriate staff and space to serve older Veterans.”

    GeriPACT providers have specific geriatric training

    The GeriPACT model is a modification of a former VA program of multi-disciplinary coordinated care known as Geriatric Primary Care (GPC). More than 60 VA facilities had GPC programs in 2007, with at least 66,000 patients receiving care that year. In 2010, when the VA Office of Patient Care Services implemented PACTs nationwide, GPC was rebranded as GeriPACT.

    Compared to GPCs, GeriPACTs provide much better organization and structure to geriatric care through teams that are aimed at improving the quality of life and optimizing independence for vulnerable elderly Veterans with complex health care needs.

    “GeriPACT has formalized elements of patient case management and links to community resources and has a larger, more integrated interdisciplinary team working together,” Sullivan says. “In the past, GPC teams may have had a smaller staff, resulting in a greater investment in time to link up with other staff like social workers and clinicians to secure services and assessments for a patient. Also, patients may not have been transferred to a GPC team to be followed for all care needs, although that would have varied per facility.”

    “Some GPCs could have been rebranded GeriPACTs with few changes in the way care was structured,” she adds. “But other GPCs have reorganized to provide more coordinated care management and integrated linkages to VA and community resources through their GeriPACT clinic. Additionally, some medical centers did not have an existing GPC and started a new GeriPACT without previous GPC experience.”

    In 2015, about 60,000 patients received GeriPACT services, out of the 1.5 million Veterans at least 65 years in age who were enrolled in the VA system.

    In comparison to a standard PACT, three characteristics differentiate a GeriPACT: team composition, patient capacity, and provider experience.

    • The core PACT team consists of a provider and, for each full-time equivalent of a provider, one nurse care manager, one clinical associate who is usually a licensed practical nurse, and one administrative associate who is dedicated to the team. A core GeriPACT team includes typical PACT staff, plus a social worker and a clinical pharmacist.
    • PACTs are normally capped at 1,200 patients per full-time provider. GeriPACTs average 800 patients per full-time provider.
    • PACT providers treat patients of all ages, including frail elderly patients, without any specialized training. GeriPACT providers have advanced training in geriatric medicine, meaning they are board -certified or -eligible, or they have demonstrated advanced experience in geriatric care as outlined in the VA handbook.

    In the study published in the Journal of the American Board of Family Medicine, researchers wrote that based on survey data from the VA facilities with GeriPACTS, “Standard PACT practices may at times be a poor fit for GeriPACTs and the populations they serve. In keeping with their advanced age, medical complexity, and high use of health services, virtually all GeriPACT patients could be identified as 'high risk’ patients by using standard metrics. In contrast, a PACT panel is more apt to be comprised of a wider range of clinical presentations, ranging from younger, healthy patients in the workforce to the frail elderly.”

    Dr. Rina Eisenstein, a co-author of the study in the Journal of the American Board of Family Medicine, is a primary care doctor who specializes in geriatric medicine at the Atlanta VA Medical Center. She points out that one of the main differences between a GeriPACT and a PACT is that GeriPACT teams have a lot more time to see their patients.

    “I believe we do a lot more care coordination than many PACTs do,” she says. “That means we try to coordinate people’s appointments on the same day because of possible transportation difficulties. We are staffed by fully trained and board-certified geriatric doctors, meaning they’ll go through an extra year or two or three of specific geriatric training. They look at people who have geriatric syndromes, the most notable of which are depression, dementia, functional decline, urinary incontinence, and chronic pain. In addition to providing regular primary care, we evaluate and manage geriatric conditions.”

    If a patient is no longer able to travel, Eisenstein notes, that person is assigned to a home-based primary care program. Those services are normally provided by an agency that VA contracts with.

    GeriPACTs treat patients of all ages with geriatric needs

    In addition to the elderly, GeriPACTs treat younger patients with geriatric-type needs. Eisenstein says one of her patients at the Atlanta VA, for example, is a 59-year-old Veteran with early-onset Alzheimer’s disease. “These types of patients are no way geriatric age, but they are geriatric-appropriate because of their inability to function,” she says.

    With the Veteran population not getting any younger, Eisenstein hopes GeriPACTs will eventually be in place at all VA medical centers.

    “We have a lot of Vietnam War Veterans who are getting older and had possible exposure to Agent Orange," Eisenstein says, pointing out that such exposures can lead to numerous medical problems. "Those patients are very difficult to care for, but GeriPACTs are very well-equipped to provide care for them.”

    Sullivan notes that since her team’s evaluation of the GeriPACT model, new GeriPACT teams have been launched at several VA medical centers.

    “In addition, some other sites have expressed interest in implementing a GeriPACT,” she says. “The future looks promising for GeriPACT implementation in the VA health care system, with continued support from VA’s central office.”

    Veteran 'so grateful’ for geriatric services atAtlanta VA

    As one who wore the uniform of the U.S. Marine Corps for 22 years, serving in World War II and the Korean War, Henry Holley subscribed to the Marines’ Latin motto: Semper fidelis—“always faithful, always loyal.”

    Today, Holley is quick to apply that tag to VA. He believes the VA health care system has been incredibly faithful to him in the three years he’s been a patient of the geriatric clinic at the Atlanta VA Medical Center. The 91-year-old Veteran has serious back and knee pain stemming from his military service that inhibits his ability to walk.

    “Every need I’ve had, they’re right on the spot helping me,” he says. “I just can’t get over the service and how wonderful and committed and qualified they are. They bend over backward to help me. I’m so grateful.”

    Holley is one of some 1,500 patients who are enrolled in the geriatric clinic at the Atlanta VA, which formed one of the first dedicated geriatric clinics in VA. The clinic, which transitioned in 2011 to the GeriPACT Patient Aligned Care Team (GeriPACT) model, is known as the “Bronze GeriPACT.” Its patients average 86 years in age (see main story).

    A review of VA GeriPACTs that appeared in the May-June 2018 issue of the Journal of the American Board of Family Medicine included a case study of the Atlanta GeriPACT. The facility has one GeriPACT team that is divided into six units. Each one includes a geriatric provider with advanced training for managing multiple illnesses in vulnerable elderly Veterans, a registered nurse care manager, a licensed professional nurse, a medical support analyst, a clinical pharmacist, a clinical psychologist, and a social worker.

    GeriPACT members meet to prepare for patients

    In addition to informal team communication, members of the Atlanta GeriPACT huddle on a daily and weekly basis to discuss the schedule of patients. True preparation for a patient visit starts with a huddle the day before involving the primary care physician, registered nurse care manager, and licensed professional nurse.

    In the huddle the day before, “Patient charts are reviewed for any recent changes in medications, specialty care encounters, hospitalizations, lab results, or missing vaccinations,” the researchers of the case study explained. “This review enables the [professional nurse] to notify the patient of lab work, logs, or other information required for [his or her] visit in a reminder call. The huddle enhances care coordination, as the team can help the patient manage multiple appointments on the same day with different members of the care team or other subspecialty clinics. Huddles are valued by team members, as they feel better prepared to anticipate the needs of the patients seen in the clinic the next day.”

    Plus, the Atlanta GeriPACT adheres to the “open access” model that is required in the design of an inter-disciplinary PACT team, which see patients of all ages. That means patients are seen on a walk-in, same-day, or prescheduled basis. Every effort is made to ensure that continuity with the patient’s primary care physician is preserved.

    Dr. Rina Eisenstein, a primary care doctor in the Atlanta GeriPACT, says about 80 percent of the walk-in geriatric patients are seen by their own geriatric provider. While it may be harder to be seen on a timely basis as a walk-in in a general PACT, GeriPACT providers will do everything they can to see walk-in patients as soon as they come to the clinic, she says.

    “If a nurse is calling me to urgently see a [walk-in] patient, I’m going to jump out of my room in the middle of seeing another patient,” Eisenstein says. “You never know because a very sick elderly patient may appear not as sick as a younger one. Most things in geriatrics are atypical. I’ve been here for 12 years. My patients know if I must leave in the middle of a visit, something bad is going on with another Veteran. They don’t want to be in that other person’s shoes. They tell me 'go and do what you need to do. We’ll wait for you over here.’”

    Continuity with the same provider is also assured by offering telephone-based care during regular clinic hours, with communication via a secure online messaging platform. The Atlanta GeriPACT also participates in an after-hours live telephone help program that is staffed by clinic nurses who provide guidance, potentially reducing emergency department use when the GeriPACT clinic is closed.

    “As a result, Bronze GeriPACT matches or exceeds key performance metrics of the general PACT teams at the medical center,” the researchers write. “For example, satisfaction scores are 7 percent to 23 percent higher for GeriPACT providers than comparable PACT providers. Although GeriPACT patients are older and sicker than PACT patients, emergency department use in GeriPACT is comparable to that in PACT.”

    Insufficient staffing a problem at Atlanta GeriPACT

    But the Atlanta GeriPACT, the researchers note, comes up short in some areas. For one, there’s a scarcity of clerical staff, social workers, and mental health providers. Eisenstein says it all comes down to “having adequate staffing for our team,” noting that medical staff are now tasked with faxing forms and mailing letters because there are not enough clerical employees.

    Space has also been a limitation, with multiple providers having to share one examination room. Atlanta VA officials are taking steps to resolve the spacing problem, according to Eisenstein.

    However, the facility isn’t alone in its struggles to maintain a top-notch team that is dedicated to serving patients with geriatric needs. “Bronze GeriPACT shares challenges reflective of national variation in PACT and GeriPACT implementation,” according to the researchers on the case study.

    Henry Holley would likely disagree that the Atlanta GeriPACT is deficient in any way. The GeriPACT team has provided him support in geriatric primary care, pharmacy, nursing, mental health care, and social work, and it has referred him to other departments for optical and dermatology services. The Atlanta VA has also arranged to get him a walker and a scooter, as well as a chair lift, a physical therapist, and a caregiver for use in his home.

    “I even get valet parking at the Atlanta VA,” Holley says. “I try to tip the boys, but they won’t take anything.”

    To show his appreciation to the Atlanta geriatric clinic, Holley has written letters to VA Secretary Robert Wilkie and Georgia Sen. Johnny Isakson, chairman of the Senate Committee on Veterans’ Affairs.

    “Johnny is a good friend of mine,” says Holley, who for decades organized international crusades for the late Rev. Billy Graham. “He appreciated the letter and came by my house. He knows I’m drawing disability and am not doing well. I thought that was a very nice gesture on his part.”

    Source

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  • Bible Dispute

     

    Group says inclusion of Bible gives preference to one faith over another

    MANCHESTER, N.H. — A Bible that was on display at the Manchester Veterans Affairs Medical Center is at the center of a controversy.

    The Bible was carried by a prisoner of war in World War II and then made part of a memorial at the Manchester VA until a Veterans group objected and it was removed. Now, there's an effort to put it back.

    VA officials said they consider the Bible to be an historical artifact, but people on both sides of the debate said they believe it represents something much more

    The Missing Man Table is intended to honor the nation's missing Veterans and POWs, but a spokesman for the Military Religious Freedom Foundation said the organization received complaints about a Bible that was originally part of the memorial.

    The group asked the VA to remove it, calling its presence intolerable and unconstitutional.

    "That is still a Christian Bible," said Mikey Weinstein of the Military Religious Freedom Foundation. "It is still promoting -- particularly in the surrounding aspect of the POW-MIA remembrance, one of the most sacred things you could do in the military -- one faith over another faith."

    In response, the VA moved the Bible from the table to a nearby display case, something Weinstein called even more objectionable.

    VA officials released a statement saying they "consulted with appropriate legal counsel before placing this treasured WWII artifact, which happens to be a Bible, with the display, and is confident that this does not impinge on Constitutional protections."

    The Bible was donated by a World War II Veteran when Paul Martin and his organization, the Northeast POW-MIA Network, put together the missing man display late last year.

    "That Bible is not just a religious artifact," Martin said. "That some people would say they're stuffing religion down my throat. What it means is this guy held on to a lot of faith and hope, family and trust in this nation that they would do everything they possibly could to bring him home."

    Martin said a project is in the works to put the Bible back on the table in some type of secure casing so it won't be damaged or stolen.

    Source

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  • Big Change Benefits

     

    Improved Pension with Aid and Attendance

    First, John explains the VA’s Aid and Attendance benefit. If a Veteran served at least 90 days of active duty, with one of those days being during a period of war, that person is a “wartime Veteran.” If that wartime Veteran needs help with their activities of daily living, and the costs associated with that care outweigh the Veteran’s ability to pay for it, then the VA will potentially kick in some extra money.

    Technically, this benefit is called the improved pension with aid and attendance, but most people just call it aid and attendance.

    It’s not only available to the Veteran, but it is also available to the surviving spouse of the Veteran, if they were married at least one year, married to the Veteran at the time of the Veteran’s death, and not remarried.

    This income can be a life-saver, especially if it makes it possible for the Veteran or survivor to live in a facility that can care for their needs.

    The Changes

    A few of the rules about eligibility for the Aid and Attendance benefit have changed. This includes clarification of the assets test, and a look-back period for any transfer of assets.

    Clearly Defined Assets Test

    This is a need-based benefit. In the past, the assets test for this benefit was very vague. One of the new rules is that there is bright line rule for net worth. There is now a clearly defined $123,600 limit on countable assets in order to qualify for this benefit.

    John is concerned about how some of the changes are written. For example, a home is not a countable asset, but it is the home plus two acres. This means that folks who live on larger lots, or own extra land, will have a more complicated situation.

    There is also a strange way that the VA is now calculating income as part of that net worth. In determining your assets, the VA will now look at something called your “income for VA purposes.” This takes your annual income, minus your unreimbursed medical expenses, and adds that to your net worth. This does not make any sense – there is no other context in which you included someone’s income in their net worth.

    Adding A Look-back Period

    The biggest change is that historically, the VA did not have a penalty for transferring assets. They now have a 3 year look-back period, similar to Medicaid. Any transferred that occurred in the 3 years prior to your application , any gift that happened during those 3 years, they can penalize you up to 60 months in the future.

    The penalty period is calculated by taking the amount of the gift, and divide that by the maximum aid and attendance benefit for a single person with one dependent, which is about $2,170 per month. The VA won’t provide benefits for the number of months you’ve been penalized.

    This only applies to gifts that are over the asset limit.

    The maximum penalty can be no longer than five years.

    This creates a tricky situation where you have to be sure that you wait at least the three years after transferring any assets or else you may find yourself penalized for longer than the look-back period.

    What This Means For You

    The big takeaway from these changes is that if you may be eligible for this benefit, you might need to do some advance planning. In the past, there was no reason to plan until you were going to apply for the benefit. Because of these changes, you might want to take some actions in advance to ensure you are eligibility for this benefit when the time comes.

    Source

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  • LB Healthcare System

     

    Can you imagine yourself blind and making pottery? How would you feel? How would you do it?

    Would you be able to walk on a straight line if you could not see? Change a light bulb? Cook?

    VA Long Beach’s Blind Rehabilitation Center (BRC) invites you to experience the world of blindness and visual impairment, and learn how it has been helping those without vision remain independent.

    With proper training, blind and visually impaired individuals can perform most, if not all, our daily-life activities.

    During our BRC Open House, you will have the opportunity to wear google simulators or blind folds and walk the Center’s corridors with the help of a guide dog or a staff member.

    You will also be able to make pottery without the help of your eyes, and check out the latest interactive assistive technologies.

    Blind Veteran musicians will play, light refreshments will be served, and prizes will be drawn from a raffle at the end.

    The Open House will take place on Thursday, March 7, 2019, from 10:30 a.m. to 2 p.m.

    VA Long Beach’s BRC is located at 5901 East 7th Street, building 165, in Long Beach, California.

    Source

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  • Robert Wilkie 13

     

    U.S. Veterans Affairs Secretary Robert Wilkie doesn’t want any sunlight on his agency’s “shadow rulers.” By blowing off a recent congressional document request, Wilkie is blocking the public from determining whether a secretive trio of outsiders is calling the shots at the VA.

    Wilkie was just confirmed by the Senate in late July. His handling of the data request from the House Veterans’ Affairs Committee raises serious questions about his judgment so early in his tenure. After the scandal involving clinic wait times, public faith in the VA is lagging. Yet Wilkie’s stunning refusal last month to turn over the documents undermines trust even further, creating the damning perception that his priority isn’t Veterans but protecting the three outsiders, all of whom belong to President Donald Trump’s glitzy Mar-a-Lago club.

    The Pulitzer Prize-winning ProPublica news organization first reported about the behind-the-scenes decisionmakers in a story published Aug. 7. E-mails and other documents obtained through the Freedom of Information Act revealed that the three have “leaned on VA officials and steered policies affecting millions of Americans.” They weighed in on high-level staffing changes, meddled with a major software contract and pushed the agency to make a seismic and expensive push — outsourcing care to private providers.

    One of the three also wanted the agency to bring in his son to develop an app. Despite this access to agency inner circles, none of three men ever served in the military. Nor is their expertise relevant. The three men are: Marvel Entertainment Chairman Ike Perlmutter, attorney Marc Sherman and Bruce Moskowitz, a doctor who runs a company catering to wealthy medical patients.

    The congressional request for additional documents, filed on Aug. 8 by Rep. Tim Walz, the Veterans’ Affairs Committee’s ranking member, is sensible. The documents obtained by the reporters may have been redacted. The congressional request would also go beyond the correspondence the reporters were able to obtain through the Freedom of Information law. A thorough review is a must, especially when Veterans sense that “an ideological war is being waged within the VA below the radar of the media and of the public,’’ said Paul Rieckhoff, founder and director of the Iraq and Afghanistan Veterans of America advocacy group. “Veterans’ healthcare, benefits and general well-being are ending up as collateral damage.”

    Yet on Sept. 15, Wilkie tersely declined the House committee’s document request. His reasons do not hold up to scrutiny. He said the documents are the subject of ongoing litigation. Yet that lawsuit was filed after the congressional committee’s data request. And its existence does not exempt the agency from complying with the committee’s request.

    Walz, who is also the Minnesota DFL gubernatorial candidate, gave a deadline extension — until Oct. 31 — in a forceful letter this month. It is Wilkie’s best interest to meet that. Failure will sour the VA’s relationship with a key oversight committee and will only accelerate the public trust deficit in him and the agency.

    A noncommittal response this week from a VA spokesman about whether Wilkie will release the documents did not inspire confidence. Wilkie made a mistake saying no once. He owes it to his agency and more important, to the 9 million Veterans served by VA medical facilities, to correct course.

    Source

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  • Blue Water 001

     

    Today, January 29, 2019, the Court of Appeals for the Federal Circuit released a decision which marks a seismic shift in the field of Veteran’s law. A decade ago, the Haas case allowed the Department of Veterans Affairs to exclude Blue Water Veterans from receiving the same benefits as other Veterans who served in the Vietnam theater. Today, in Procopio v. Wilkie, the Federal Circuit undid the damage done by Haas and restored those benefits to the Blue Water Veterans.

    As a little bit of background, Veterans who served “boots on the ground” in the Republic of Vietnam are entitled to a presumption that they were exposed to Agent Orange, a herbicide which is known to cause a host of health concerns such as cancers, diabetes mellitus, and ischemic heart disease. This presumption of exposure was extended to Veterans who served on the rivers or “brown waters” in Vietnam. The VA determined that so-called Blue Water Veterans, those who served aboard ships in the territorial seas of the Republic of Vietnam which did not enter the rivers, were not entitled to that presumption of exposure.

    “Blue Water and Brown Water” Distinctions

    The Haas Court found that the VA was allowed to draw a line determining where brown water becomes blue water, to clarify the intent of Congress, and that the Court had to give deference to that line. The line was supposed to be based on the likelihood of exposure. However, as the Blue Water Veterans are painfully aware, the dividing line was an arbitrary line, excluding Veterans whose ships anchored in harbors into which those rivers flowed and excluding Veterans whose ships came so close to the shore that they described bouncing off of the sand. As Blue Water Veterans are also aware, the drinking water on those “blue water” ships and the very air drifting from the shore was likely contaminated with Agent Orange as well.

    The Blue Water Veterans were exposed to Agent Orange, and they were plagued by the same diseases and disabilities as the Veteran who served on the ground and in the brown water, but they were not allowed the presumption of exposure which would allow them to receive benefits for their disabilities. Today, the Procopio case attempts to right the wrong done to the Blue Water sailors.

    Blue Water Sailors Today

    The Procopio Court looked back to the plain language of the 1991 Agent Orange Act and determined that the legislation which provides a presumption of exposure to Veterans who served in the Republic of Vietnam unambiguously includes those Veterans who served in the territorial seas of Vietnam. Any ambiguity in that language was inserted by the VA itself. Where the language Congress included in the Agent Orange Act was clear, the Procopio Court held that the VA’s interpretation was not needed and, thus, owed no deference by the Court.

    The Federal Circuit decision speaks directly to the point, “Congress has spoken directly to the question of whether those who served in the 12 nautical mile territorial sea of the ‘Republic of Vietnam” are entitled to [the] presumption . . . . They are. Because ‘the intent of Congress is clear, that is the end of the matter.” The fight for Blue Water Veterans to get their benefits has been long and hard, but they are now finally legally entitled to the presumption of exposure to Agent Orange…as they should have been all along.

    Source

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  • Tony Altano

     

    SARASOTA — Decorated Green Beret Tony Altano still can’t discuss what he did before retiring in 2000. Nor can he go into detail about the vicious, 20-year-old, hand-to-hand combat wound that would ultimately change his life forever.

    What the NFL-sized West Virginia native does volunteer is that his specialized duties and real-world taskings pulled him away from home for up to 11 months a year, that he took to high-stress high-adrenaline challenges like a duck to water, and that he was “100 percent successful” on his secret missions.

    But it wasn’t until years later, long after he left the Army, that this giant of a man met his match and became a virtual ghost. It was a passing encounter with a little girl, at his two sons’ taekwondo class near his home in Fayetteville, North Carolina. What occurred within a span of seconds sent an elite warrior with hair-raising tales of pain tolerance into a tailspin of self-imposed exile that lasted for roughly a decade.

    Early this month, Altano’s wretched ordeal would bring him to Sarasota, where his former Special Forces team leader, two medical professionals, and the board of a nonprofit outfit dedicated to helping Veterans gathered to bring him back into the world.

    The final verdict was up to the mirror.

    • • •

    “I had no idea.” John Vislosky blames himself for not finding out sooner. “I hadn’t seen him because we’ve gone on with our lives. But we kept in touch, I’m communicating mostly by email, ‘Hey brother, are you doing?’ ‘I’m doing fine’ — that’s always Tony’s answer. ‘I’m doing fine.’ He’s keeping it to himself and he’s not letting me know.”

    The first time Vislosky laid eyes on Altano, in 1986, was at a secret special operations compound in the middle of nowhere at Fort Bragg. Vislosky, a West Pointer, describes himself as a “green captain, all starched up and polished boots, and here I am walking in on all these guys in a hand-to-hand combat pit.”

    At 6-foot-7, Vislosky cast an imposing shadow. There was only one guy who hadn’t paired off with a sparring partner, and that guy, 6-foot-6 Altano, pointed a beckoning finger directly at Vislosky. Little did he know that Altano’s father — Korean War Veteran, Vietnam — had been one of the original Green Berets. Dad had groomed his son for this stage since he was a kid. The boy learned every word of Barry Sadler’s 1966 hit, “Ballad of The Green Berets,” his destiny embedded in the lyrics about “put(ting) silver wings on my son’s chest.”

    “And for the next two hours,” recalls Vislosky, who would become the A-Team commander, “Tony beat the crap out of me. That’s a true story, that was my introduction to the team, and I’ve loved him ever since.”

    Altano had been in the Army since 1978. He pushed himself through Special Forces, Ranger school, and on into special operations, with some FBI close-quarters battle training thrown in. He and Vislosky would serve together on the same team for years. Their missions were real. Their responsibilities worldwide. Their bonds unbreakable.

    Vislosky wasn’t with Altano in 1996 when he suffered a broken nose during an overseas mission, a combat wound from a rifle butt to the face left him able to breathe only through his mouth. Surgery at Fort Bragg’s Womack Army Medical Center would set it straight. At least, that was the plan.

    • • •

    Altano says he bucked all protocols and refused general anesthesia. “I don’t get put to sleep, I don’t take pain medicine,” he insists. “I told them, I want to watch to make sure they don’t mess up.” While submitting only to local anesthesia, he would divert his pain to a mind-over-matter fantasy beach in Hawaii with a “hot Korean chick.”

    The surgeon turned it into a teachable moment. With a live audience of several dozen students attending the procedure, the challenge became more complicated than a simple nose reset. The impact trauma had produced a deviated septum, which the surgeon addressed by splitting the upper palate to the nasal cavity, wedging the mouth open, and installing a temporary metal plate for stability.

    Altano remained alert through the process, at times asking the doc to move a little to one side or the other so he could get a better look at the bloody mess reflected in a nearby mirror. Even as his mind languished on an idyllic island, Altano’s hands were “gripping the s--- out of the steel railing” during the operation, which he estimates took three to four hours. “I remember, (the surgeon) told the class, it’s not normal for a patient to refuse anesthesia.”

    • • •

    Mouth locked shut, Altano spent the next month straining pudding as the swelling went down. Although his nasal airways were restored, the surgery was a failure. The realignment left him without an overbite, which meant that whenever he chewed, his front teeth ground into each other. Altano was classified as non-deployable — a major blow to the highly motivated special operator.

    He spent the next year riding a desk, in charge of operational planning, preparing troops for missions he was determined to someday rejoin. He was fitted for braces in hopes of restoring the overbite, but that eight-month experiment didn’t work either. So there was one last option: file the teeth down to posts and fit them with caps, which he did.

    The fix was flawed, but good enough to get him back into classified mission rotation, where those glued caps kept “popping out like popcorn.” Often working alone, miles from civilization, Altano used peanut butter from MREs to stick them back in place. “Problem was,” he says, “everywhere I put peanut butter in, it rotted the post.” So he took to capping his teeth instead with his “squishy” ear plugs.

    The Army could apparently live with it. Twice, he retired. Twice, they coaxed him back to active duty, bad teeth and all.

    “I remember, every two, three weeks I would heat up a needle and pop it into my gums and a whole handful of pus would come out from that infection,” he says. For three months in a row, an Army dentist “would take a razor blade and cut my gums on both sides of my teeth, and every damn time he’d say I can’t see what’s going on in there, there’s no infection, there’s nothing.”

    Altano retired for good in 2000, but the bad teeth followed him home.

    • • •

    In 2014, after months of failing to get Altano to tell him the truth, John Vislosky threatened to travel from his home in Bradenton and pay him a face-to-face visit in Fayetteville. They hadn’t seen each other in eight years. Altano said no, I won’t let you in my house.

    “At first I thought maybe he’d gotten some PTSD and was homeless or something, indigent in some way,” says Vislosky. “I knew he wasn’t drinking because he’s too stable and strong for that. He’s always been a role model of strength for me.”

    Finally, Vislosky ordered Altano to get on Skype and turn on his camera. His old sergeant reluctantly complied. “And it just ruined me. It was like a train hit me,” Vislosky says. “He had no teeth.”

    Left with tooth remnants in his lower right rear, upper left rear and right rear jaw lines, unable to eat “normal” food, the gregarious Altano managed to shrug off the looks and stares of strangers for years. But a chance encounter with a little girl at his kids’ martial arts studio finished him off.

    “She was standing there beside me, smiling, so I smiled back at her, and she got scared,” he remembers. “She went and hid behind her mom and she said, ‘Oh, he’s a monster, he don’t have no teeth, Mommy.’ So I left, and I never went back.”

    Altano’s eyes well up as he recalls his decision to become invisible, making only trips of necessity to the grocery store, unwilling to show his face at the funerals of his grandmother, his grandfather, his mother, his older brother. Years later, the guilt and the shame of his absence quiver just below the surface.

    “I understand there are Veterans losing limbs and you find them doing incredible things, they’re being mainstreamed and heralded,” says Vislosky. “But how many pictures do you see of a guy missing all his teeth, smiling into a camera in some VA photo saying here’s our hero of the week? You don’t see that, you barely see burn victims, because that sort of scarring is not what society will accept as a Veteran injury. But this was as catastrophic to a guy like this as losing a limb.”

    Vislosky told his buddy to send him every scrap of paper he could get his hands on to document what happened. Among other things, Vislosky learned that Altano’s appeals to the Department of Veterans Affairs for new teeth had been rejected five times. Vislosky began working other channels for VA assistance, which resulted in two additional snubs from the agency.

    That’s when Bradenton-based Operation Patriot Support, or OPS, stepped up.

    An offshoot of the national Veterans’ charity Operation Second Chance, OPS acquired its own nonprofit status in 2016 to assist Veterans, largely via two annual fundraisers, the “Florida Fun Shoot” in February and the “Evening With Heroes” in August. From service dogs to wheelchair batteries to fishing expeditions, “Our mission statement is to serve those who serve us,” says OPS president/director Dave Pfeiffer who, like most of the other unsalaried board members, is not a Veteran himself.

    “We are not a charity,” adds attorney and OPS CEO Pete Skokos. “What these guys get is thanks.”

    Impressed by the group’s efficiency, Vislosky mentioned Altano’s predicament in September. Long story short, OPS jumped into action and brought Altano to Sarasota to resolve the problem once and for all.

    • • •

    A prominent pair of local dental professionals, an oral surgeon and a prosthodontist, contributed their skills for free. What might’ve been $30,000 worth of out of pocket expenses came in at roughly $4,000 worth of lab work, which OPS will absorb.

    The surgeon agreed to talk only under condition of anonymity. “There’s nothing special about us,” he insists. “It’s only Tony that’s special. Whatever I can do for Tony pales in comparison to what he’s done for the country.”

    On a scale of 1 to 10, with 10 being the worst, the challenge presented by Altano’s teeth was “I’d say a 1.5,” says the surgeon. “I’d love to say this was a huge elaborate case, but it’s not. We simply stabilized him by taking out infected teeth, sharp teeth, carious teeth, painful teeth, and we transitioned him to an upper denture.” In the lower jaw, the surgeon continued, “we left him with a good premolar to premolar situation, which is most of his lower teeth. We see this a lot.”

    Altano will return for follow-up tweaks over the next few months. But the face Altano put on for his Sarasota supporters, before and after surgery, was apparently quite different from the one he wore back home.

    “I know you’re looking for the ugly-duckling-to-swan type of scenario, but honestly, Tony never acted like an ugly duckling. He may have felt that way with his family,” says the surgeon, “but he came in here with a swagger the first time we met and that never changed. The guy’s pretty awesome.”

    • • •

    Tony Altano shows off his new choppers by biting down rigorously and clicking. No more letting his Raisin Bran soak forever in milk before gumming down the raisins. The smiles are effortless and uninhibited now. What his doctors regard as a routine procedure, Altano calls miraculous. “And without (OPS),” he says, “none of this would’ve happened.”

    What happens next is up to Altano. “My family — I’ve gotta connect with them again.” His teenage sons are fired up. “They said, ‘Now, dad, we all get to go out of the house.’”

    Source

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  • VA Qtrly Research

     

    Dr. Steve Martino is chief of psychology at the VA Connecticut Healthcare System and professor of psychiatry at Yale School of Medicine. He specializes in the treatment of patients with substance use disorders, including those with co-occurring conditions. He also does research in the area of implementation science and how to move best practices into real-world clinical settings.

    Dr. Marc Rosen is an addiction psychiatrist at the VA Connecticut Healthcare System and professor of psychiatry at Yale School of Medicine. He is the director of addiction recovery services at VA Connecticut, and conducts research on substance use disorders and related problems for affected Veterans.

    KEY POINTS:

    • Dr. Rosen and his team conducted a pilot study that used the VA compensation and pension exam to engage Veterans who were applying for a service-connected disability because of musculoskeletal pain.
    • The pilot study showed that Veterans assigned to brief counseling were more likely to obtain pain treatment at a VA facility than those receiving the usual compensation and pension exam without additional counseling.
    • The pilot study also showed that when Veterans with risky substance use were assigned to counseling, they were significantly less likely to engage in risky use than those not assigned to this counseling.
    • The new study involves delivering the counseling by phone from a single hub site to Veterans having compensation exams throughout New England.

    VARQU spoke with the two researchers about their work on chronic pain management among Veterans.

    The Department of Defense, National Institutes of Health, and VA have just co-funded a large grant to study non-drug approaches to pain management. What is the significance to the VA health system?

    Dr. Rosen: This project has the potential to engage Veterans early in non-opioid pain treatment, and interrupt what can really be a harmful and dangerous course.

    How did VAConnecticut become part of the larger grant?

    MR: There are about 600,000 post-9/11 Veterans who are service-connected for back or neck pain. We had a developmental grant to intervene with people who were applying for service connection for musculoskeletal disorders. In the pilot study, most of the Veterans applying for service-connection for musculoskeletal disorders had considerable pain and impairment, and a high proportion were engaged in risky substance use. We found that they were amenable to intervention and that it helped them engage in VA pain-related treatment.

    Dr. Martino: In addition, we also found that as a result of the early intervention, Veterans reduced their risky substance use, as well. So we thought that this was a very promising approach to bring forward to the grant application.

    Can you tell us about your study, "Screening, Brief Intervention, and Referral to Treatment for Pain Management"?

    MR: That's the title of the study, actually; it’s not the title of the grant. I like the title of the grant better, it's more descriptive. The title is actually a pretty good summary: "Engaging Veterans Seeking Service Connected Payments in Pain Treatment."

    So why is that a good point in time to have this discussion with Veterans? Why not in the clinician's office?

    SM: Well one of the main reasons is these Veterans may not be in the health service system of the VA. They are reporting problems they are experiencing, and may not be aware of the services they could avail to help themselves. There's traditionally been a limited amount of information provided to Veterans at the point at which they are seeking a disability compensation exam, just because the nature of the exam is really determination for disability, not a clinical assessment.

    Marc's work has been fairly innovative in trying to use this as a point to provide Veterans who are seeking disability evaluations an opportunity to learn more about what is available to them and try to engage them in various services. And so that's why we think this is a great opportunity to work with Veterans who are experiencing chronic pain and who may have risky substance use—to try and get them engaged in services that they currently are not participating in.

    Can you walk us through a brief description of this intervention?

    MR: We talk to the Veterans a little bit about their claim: We ask them about their pain and inform them of the variety of services available at the VA health care system. We explain that pain treatment can involve not only medication, but also attending to other aspects of whole-body health. We then allow that many people in pain drink or use drugs to relieve their pain, and ask the Veteran about the extent of his or her substance use.

    There's a format for this type of brief substance use counseling that Dr. Martino is an expert in. We follow that format to engage Veterans in reducing their substance use. That style of working with people is based on motivational interviewing. And so a large part of what we are doing is to motivate Veterans to participate in non-drug treatments, and commit to reducing or stopping their risky substance use. And engaging in specialized addiction services if that makes sense and they are willing to do so.

    Part of the counseling involves not giving people exactly what they are expecting. The Veterans are coming for a compensation claim, and we are trying to say, "Hey, there are also some treatments available here that you are entitled to—that you've earned." We are also taking Veterans whose presenting complaint is pain and saying, "Substance use is something that could make your pain worse. Here are some ways you might want to think about that." We think that Veterans who have filed a claim are at a teachable moment.

    How is motivational interviewing different from a traditional doctor/patient interaction?

    SM: Motivational interviewing has been around for several decades. It began in the risky alcohol use field, and then has cut across all types of behavioral problems where motivation is part of the issue—particularly in the medical field. So the style of interaction really involves being very patient-centered, being empathic, collaborative, being compassionate to the needs of patients, and in particular being attentive to the ways in which patients speak about their problems that might support them making a change.

    So what people do when using motivational interviewing as a framework is try to illicit or draw out people's reasons for change and get people to elaborate more about those matters, such that they talk themselves into changing based on their own motivation. It's a way of helping people talk themselves into changing based on what is unique about their own experiences.

    You mentioned whole-body wellness earlier. Many studies show that opioids are not effective for long-term pain. What are some of the other treatments that might help patients deal with their pain?

    MR: There are non-opioid medications. There are various physical treatments like physical therapy, exercise and activity, chiropractic services. There are mind-body based treatments like yoga and mindfulness. And there are psychological treatments like cognitive behavioral therapy and relaxation techniques. And finally, treating other issues that make pain worse: poor sleep makes pain worse, depression makes pain worse. Treating conditions that we know how to treat well can make a big difference.

    SM: The mantra is that people need multi-modal pain care, and that the idea of medication as the sole form of treatment for chronic pain relief is misguided. We are trying to help people find a variety of ways in which they can approach pain treatment in order to get the best possible outcomes.

    MR: There is a vicious cycle that people in pain can get into, in which they become less active, which is depressing. They don't sleep well which worsens their overall physical condition, which worsens their pain. A lot of these treatments involve interrupting that vicious cycle.

    Can you tell us about the different phases of your study?

    SM: For all of these grants, there is an initial preparation phase where we have to meet certain milestones to prepare for the pragmatic trial. That's a two year process. And at the end of the two years, those grantees who are successful in meeting their milestones presumably will continue to be funded for a four-year pragmatic trial. And we fully expect to be successful and be funded for pragmatic trial.

    We have several things that we will be doing in phase one. First because we will be moving from the pilot trial which was done at VA Connecticut to all eight medical centers in VISN 1, we will get a grip on how pain care services and addiction services are delivered at each of those medical centers.

    We will be doing semi-structured interviews and qualitatively analyzing them, to appreciate the various factors that are at play at each medical site. We'll be talking with community medical providers and administrators and primary care folks, including nurse care managers, and anyone else who can tell us what's unique about their medical center.

    We will also be pilot testing this early intervention with five Veterans at each of the medical centers. The original trial was done face-to-face, in person. For this trial we will be using a hub-and-spoke model—so they'll be clinicians based in VA Connecticut who will be delivering the intervention entirely by phone. We want to see how that goes and if there are any adjustments that we need to make before we go to the full trial.

    Another key feature of the two-year preparation phase is it is very hard to characterize Veterans' use of non-drug treatments. There aren't codes for many of these treatments in the electronic medical record. So we have partnered with investigators from George Washington University to use what's called natural language processing, to develop algorithms that will basically use computer programs to screen CPRS (Computerized Patient Record System) for Veteran's use of non-drug treatment modalities.

    Another important piece of this study is the cost-effectiveness. How much is this all going to cost? And what kind of impact will this have on the budgets of medical centers, if they wanted to implement this if we were to be successful? So we also have a health economic component to this, and we will also be devising our methods for costing out everything for the trial.

    If this all works, would it be something that the clinicians could provide at the different medical centers, or would it be delivered through telehealth?

    SM: One of the reasons why we decided to do this within a VISN is because the VA is organized in regions—networks of medical centers organized together. Our hope would be if we could demonstrate this hub-and-spoke model, centered in a VISN, is effective, then it could be replicated in many other VISNs across the country. So we would be advocating for a telehealth means of administering this, which would provide greater access to people who may not be able to physically get to a medical center or who receive most services at rural sites across the country.

    MR: One feature of the VA that would facilitate the adoption of this is that VA regions receive capitated payments for each Veteran, but the amount of payment is based on what services the Veteran receives. So if a Veteran comes to a hospital and only has a compensation and pension exam, that region gets a limited amount of money. If providers engage the Veteran in treatment, the region gets more money for that Veteran. So unlike in some other healthcare systems, the region doesn't lose money by providing more comprehensive care.

    What are your long-term goals for this study?

    MR: Our first goal is to test the intervention as proposed. We tested this at a single site: It was done through face-to-face encounters, and it was promising. This next study is needed to see if it works in a setting in which we are treating many more people by phone, which is likely going to be less expensive and more easily spread throughout the region.

    So the first goal is to evaluate the cost and benefits of this intervention, and see what works in the real world, not just in a research setting.

    If it does works, then we would like to see it rolled out nationwide. We are not testing in some super complicated, super expensive form that couldn't be done anywhere else. We are testing it as a relatively simple phone call and evaluation and referral. The hope is, if the results merit it, that this will be adopted in other regions.

    SM: That last point I think is very important. The way we are studying this is consistent with the way that services are often delivered in VA. So we are hoping that this will make it attractive to the broader health care system because they will be able to relate to it. From an implementation standpoint, it won't be discrepant with what is commonly done here.

    MR: Sometimes it is hard to get health care systems to do things that will bring long-term benefits because the problems are subtle or the harms are long term. The harm from the opioid epidemic isn't subtle, and there's a real consensus that we need to treat pain better, and intervene early. In this case, I don't think it will be hard to convince decision makers that early, better pain treatment is necessary; this is a cause that people have embraced.

    SM: The other feature of this study that I think will be attractive to providers is we are creating a model where the providers are not going to be asked to do much more than what they are already doing. We are creating a system that complements what they are doing. One of the things that you hear constantly when you try to bring more behavioral interventions into medical centers is "We are too busy." They are very taxed. Asking them to do one more thing that is often seen as outside of their usual scope of practice is a difficult ask. So this is something that we think clinicians have not only embraced as a goal, but have embraced because it is not taxing all the other duties and responsibilities that they have.

    Source

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  • Burn Pit Widower

     

    It was in 2009 when Brian Muller first met his wife, Amie.

    "We actually met at a music venue. And at the time I was playing music in a band and she had some friends there that were at the event," Muller, 45, from Woodbury, Minn., recalls in a recent interview with Fox News. "Her friends forced her to go out. I forced myself to go out and just to see some music."

    He remembers how they discussed her service with the Minnesota Air National Guard.

    "We ended up talking about what she does with the military," he says, "and at that time, she was doing a project to make video memorials for gold star families. Families that lost loved ones in Iraq or Afghanistan or any type of war."

    "She asked me to write a song for those videos. And that's how we kind of started our relationship, as-- friends, and then it developed from there."

    Brian has never served in the military but was impressed by Amie's service -- including her two tours in Iraq.

    "She wanted to fly, and she joined the Air Force. And she got deployed and had her life kind of uprooted there for a while."

    Amie was stationed at the Iraqi air base in Balad during both of her tours in 2005 and 2007. While her active service was already behind her, the effects from her time on that base still lingered.

    "She didn't really want to talk about her time over there," Brian says. "Anytime a door would slam or a loud noise, she'd get startled very easily. She had a lot of PTSD [episodes] from just little things."

    A decade after returning from Iraq, Amie's physical health also suffered. She was diagnosed with Stage III Pancreatic Cancer.

    "I still remember Amie getting the call, and she looked at me," Muller says about the day they found out about her diagnosis back in April 2016.

    "We walked around the corner just to make sure the kids didn't see. I could tell by the look in her face how scared she was. And I just kind of listening in to the call. And we just started shaking.

    Both she and Brian believed it was related to her exposure to open-air burn pits used to destroy trash generated on the base. Nearly every U.S. military installation in Iraq during the war used the crude method of burn pit disposal, but Balad was known for having one of the largest operations, burning nearly 150 tons of waste a day.

    The smoke generated from these pits hung above Amie's barracks daily.

    "She talked about the burn pits even before she got cancer," Muller recalls, "and how the fact that they would change the filters on these ventilation systems quite frequently. And every time they'd change it would just be this black soot, so thick that you would think you'd have to change it every hour."

    "After she told me what they were burning, you know, all I thought about is all the campfires that we had in our backyard. You don't burn Styrofoam. You don't burn plastic. We all know that, but they were burning all those things. Highly toxic."

    As early as Operation Desert Storm in 1991, burn pits were used at U.S. military bases in Iraq. At the height of the Iraq War in 2005, more than 300,000 troops were stationed there and potentially exposed to the smoke and fumes from burn pits.

    Thousands of Veterans and former contractors returned from the Middle East and have developed rare cancers, respiratory problems, and blood disorders from what they claim are their exposure to toxins from the flaming pits. More than 140,000 active-service members and retirees have put their names on a Burn Pit Registry created by the Department of Veterans Affairs.

    After Amie was diagnosed and her treatment began, she and her family went public with her story in the hopes that it would bring awareness to the dangers she and countless Veterans faced after what they believe was a result of burn pit exposure.

    Amie succumbed to her illness just nine months after she first diagnosed.

    In her absence, Brian continued Amie's work in raising awareness by sharing her story. He also worked closely with Sen. Amy Klobuchar, D-Minn., toward getting "The Helping Veterans Exposed To Burn Pits Act" -- a bipartisan bill recently presented in Washington and signed by President Trump -- passed.

    The bill will help fund a new center by the Department of Veterans Affairs that will study the effects of burn pit exposure and eventually assist with treatment plans. He also started the Amie Muller Foundation, which helps other Veterans who were diagnosed with pancreatic cancer.

    "I just hope that our Vets are going to get the help they need," Brian says, "and it's not going bring back Amie, my wife, but it's going to get Veterans the help they need."

    But recent findings show that the Pentagon was aware of the dangers of burn pits during the height of the war in Iraq.

    Fox News recently obtained a series of memos drafted by top officials at Balad during the same years that Amie served at the base. The authors of the documents -- which include commanding officers as well as environmental officials -- stated that the operation of burn pits was a danger to those stationed there and that precautions needed to be taken urgently to improve conditions.

    "In my professional opinion, there is an acute health hazard for individuals," reads a line from one memo written by a Bioenvironmental Engineering Flight Commander and the Chief of Aeromedical Services at Balad in 2006. "There is also the possibility for chronic health hazards associated with the smoke."

    The memo also includes an assessment of the pits in Balad where one environmental inspector said that Balad's burn pit was "the worst environmental site I have personally visited."

    After inquiries by Fox News regarding the memos, Officials for the Department of Defense said that they would look into the matter and explained their procedural policy and that open-air burn pits are to be operated in a manner that prevents or minimizes risk.

    "DOD does not dispose of covered waste in open-air burn pits during contingency operations except when the combatant commander determines there are no feasible alternative methods available," reads the statement provided by a Defense Department spokeswoman. "DOD minimizes other solid waste disposal in open-air burn pits during contingency operations. Generally, open-air burn pits are a short-term solution. For the longer term, we use incinerators, engineered landfills, or other accepted solid waste management practices whenever feasible."

    Muller finds the memos troublesome.

    "I don't understand why they didn't do something," he says after being shown a copy of the memos. "These are people that volunteered to serve our country, and it just disgusts me to see memos like that, from high ranking officers that expressed this concern."

    Muller adds that the underlying issue is a lack of accountability.

    "The issue is they were doing something they shouldn't have done, that they constantly warned was an environmental hazard," he says. "And our Vets are getting sick. Our Vets are dying."

    "You know, there was a fellow that did a video--'Delay, Deny and Hope You Die.' And that's kind of what's been going on. They're delaying this as long as possible so that they won't have to deal with as many claims, because most of them will die before they do anything about it."

    Muller also believes that Amie would have never fallen ill if it wasn't for the fact that she was stationed at Balad.

    "I don't think she would have gotten cancer. I really don't. Maybe she would have later in life. Maybe it would have been some other type of cancer. I don't know," he says. "But something caused inflammation -- for something to grow in her body for a long period of time before it was ever seen and diagnosed. There was something going on with all of the Vets when they got back."

    In a recent interview with Fox News, Gen. David Petraeus, the former commander of U.S. Central Command and Multi-National Force-Iraq in 2007, offered an explanation when asked about why burn pits were used on military bases, conceding that the realities of war kept concerns about how to dispose of waste a low priority at that time.

    "At that time we weren't worried about burn pits," The general said back in September. "We were worried about just getting enough water for our troops in the really hot summer. We were looking forward to the time where we might get some real food, real rations, as opposed to MREs and so forth."

    The general also expressed that the U.S. has a commitment toward helping those Veterans.

    "It's a sacred obligation," Petraeus said. "But comparing what our VA does to any other country's care of Veterans... this is the gold standard. Certainly, a gold standard that can always improve, without question. This is an issue, though, where we have a sacred obligation, and we need to meet that obligation."

    Muller believes the general's recent comments to be a sign of a move in the right direction.

    "When you start seeing men in uniform, or women in uniform, people higher up in the military starting to voice their concerns, you know we're making progress."

    Source

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  • RAPID TURNOVER

     

    My good friend Vicki sent me a link the other day that really rolled my socks down. I was mortified to think how this impacts the backlog at the BVA for docketing our appeals. Mind you, I take some of these internet sites with a wheelbarrow of salt grains. This one would be legitimate from my standpoint. Either that or Not really a lawyer and his buds are the most elaborate hoaxers of all time.

    The website jdunderground.com explores many post doctorate jobs and their focus of law. This particular vein is a discussion of how over privileged, under worked little snowflakes’ real life crises are dealt with every day in the real world of the VA’s movers and shakers at the Board of Veterans Appeals. Just imagine if all these disgruntled souls were required to be Veterans with at least two continuous years of active duty to qualify for the job.

    Check it out.

    https://www.jdunderground.com/all/thread.php?threadId=143754

    The thought that comes to my mind is…why on earth would any soul with that much knowledge of 38 USC/38CFR squander it all at 810 Yellow Brick Road (at the corner of Delay and Deny)? Why, with that certain knowledge used to deny, could one not eke out an equally above-average financial existence in far less stressful conditions as a … yep… VA attorney for Vets? Pick a state to practice in. It’s not geographically exclusive. No Errors and Omissions insurance. Form an S Corp. and pay 21%. Work from home on your schedule. Learn how to make Macrame Beer hats. Take up Yoga and Yogurt. #Doitdude.

    Currently, there are far too many Vets who finally arrive at Hadit and other sites and hear the deja vu rejoinder- “I can’t get ahold of my rep. He won’t return my phone calls.” Hey. Remember those same VSOs have been doing their dangdest to deter the participation of attorneys and private agents in this business since The War of 1812. We get a shot at it after the VSOs finish reducing it to Hamburger Helper at the BVA. Or, if the Vet finally wakes up to the need for a nexus or IMO, he’s usually waiting in line for a docket number at the BVA and discovering the need on Hadit or here. Ruh-oh Rorge! AstroVet Need Nexus faaaaaaaast!

    The obvious 800-lb. gorilla in the VA living room is war-continuous war in Southwest Asia. It is now becoming an inter-generational phenomenon. Fathers who served in 1991 have sons serving in Afraqistan. Count ’em folks. 17 years of on again, off again combat not to mention a shit ton of PTSD claims. This phenomenon has been variously described as ‘the lump in the python’ to VA’s descriptive Adobe 9- “an unforeseen seventeen year glitch in the statistics which no one could have programmed in to the equation.” VA fully expects this cohort to begin decreasing in 2019 based on their prediction models.

    Business demand hates a vacuum. Someone will fill it. NOVA ought to advertise there. Imagine if you turned loose two or three thousand more attorneys into this VA fray. Seems like the easiest to train to think pro-Vet rather than the obverse would be those already entrusted with our appeals. Oddly, in most cases, it boils down to whipping up a good IMO at the BVA at the eleventh hour to save the day. Always remember. In ex parte jurisprudence, you want to be the very last to submit your killer IMO. This deprives those BVA staff attorneys of the opportunity to rebut it at the eleventh hour. Protect it from a remand back to the AOJ and those chowder heads are going to be forced to eat it in order to make their 2.5 appeals per day quota.

    I was taught once by a warrior to always think about how your opponent operates. What is his/her Prime Directive? What motivates them? How do your defeat them or neutralize them as a threat? What are their ROEs? If you know their limits, you can exploit them. In the legal jungle, you bide your time and they’ll eventually let their guard down.

    VA raters and DROs are not morons but they do have a propensity to deny all but the most obvious without clear and convincing evidence to rebut their mistakes. Absent even rudimentary bipartisanship, you make your stand at the BVA. Present a good VA 9 argument and a SME review and a waiver of review in the first instance at the VARO to keep the DRO’s mitts off it. Sit back, remodel the kitchen and convert the garage into that fourth bedroom w/ bath. Before you know it the oldest kid is ready for college and you get TDIU and P&T. Problem solved.

    The teaching lesson today is to give these tired overworked, mentally stressed out VA staff attorneys an easy way out and a simple path to your success that they feel they figured out by themselves with Phonics®. Arrange it so they can ‘sound it out’ legally. In truth, the last thing Veterans of all stripes want to see is an exodus from the BVA’s staff ranks. Golly, no. The backlog would become enormouser.

    Source

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  • Jim Sherman

     

    COLORADO SPRINGS, Colo. (KKTV) - Hundreds of Veterans in our community who are turning 65 years old will need to find a new doctor. Right now, they go to Evans Army Hospital on Fort Carson. Fort Carson told our 11 Call for Action team they are making changes to make room for an influx of active duty soldiers.

    Jim Sherman, a 64-year-old Veteran, gets his care at Evans Army Hospital. But he got a letter saying when he turns 65, because he is eligible for Medicare and TRICARE, his coverage will change and that he will no longer be able to see his doctor at Evans.

    "I was discharged almost 40 years ago, and since that time, that's where I've received my care," Sherman said. "I'm down there -- not every week, maybe every other week, and definitely every month."

    "To just kick everybody to the curb, is not right," he added.

    We reached out to Fort Carson and they told us about 365 letters were sent out to beneficiaries.

    Evans Army Community Hospital said in a statement: "Our mission atEvansArmyCommunityHospital is to ensure the medical readiness of active-duty Soldiers atFortCarson. Due to the increased assignment of Soldiers toFortCarson, Evans is reaching its capacity to provide quality healthcare to our beneficiaries. Evans is notifying beneficiaries approaching their 65th birthday about changes to their healthcare eligibility within the medical treatment facility. Once beneficiaries turn 65, their coverage becomes TRICARE for Life after they enroll in Medicare Part A & B. TRICARE for Life is a Medicare-wraparound coverage for TRICARE-eligible beneficiaries. We are trying to provide beneficiaries sufficient time to find primary care providers in the local community before they turn 65. TRICARE for Life beneficiaries will continue to receive Emergency Care and other services on a space-available basis atEvansArmyCommunityHospital, such as the Pharmacy, Laboratory and Radiology."

    If patients are over 65 and have been getting care at Evans for more than a year, they can stay at the hospital.

    "I am where I want to be," said Sherman. "That's really the only home that I've ever known for hospital care."

    Jim turns 65 in January. He applied for an exception and is waiting to find out if he can stay at Evans.

    In the next two years, Fort Carson said they expect to see an increase of about 1,000 soldiers and 1,500 family members.

    Source

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  • Wait Times 002

     

    The VA Debt Management Center just announced it reduced call wait times by over 75 percent while also increasing calls taken by 40 percent from 2016 to 2018.

    As part of the agency’s Veteran-focused initiatives, they agency reduced call wait times from 21 minutes in 2016 to under 5 minutes during 2018. The initiatives include increasing staff levels, improving technology, and driving better employee development.

    “The team at the DMC has enhanced services to our Veterans,” said VA Secretary Robert Wilkie. “It’s our mission to take care of our Veterans, no matter what their needs are. DMC is in concert with our priority of improving customer service and will continue to gather customer feedback through direct feedback, surveys and outreach in FY19 to further enhance the Veterans’ experience.”

    According to the press release:

    For the past three years, DMC received around 1 million calls annually with an average call wait time of about 21 minutes. In FY 2017, DMC launched a series of internal efficiencies and process improvements to enhance contact center capabilities.

    Initiatives included enhancing staffing levels to meet demand, enhancing contact center technology, focusing on employee development and engagement, and implementing an automated 12-month payment plan.

    These Veteran-focused initiatives represent a 79 percent reduction over two years to the average time for waiting and a 40 percent increase of actual calls taken. These are all indicators of successful initiatives providing a better experience for Veterans and VA employees.

    The DMC’s inbound contact center serves as the central point for Veterans and their family members to make payment arrangements, or receive guidance regarding the collection process on overpayments which could include debts created from education or pension payments.

    Debt counselors at the DMC work with callers in a professional and service-oriented manner to help them understand their options to address overpayments with Veterans either through extended repayment plans, the dispute process, compromise process or waiver process

    DMC’s contact center provides debt counseling for the Veterans Benefits Administration, and consolidated collection services of non-health care debt for Veterans Health Administration and National Cemetery Administration, enabling these entities to focus resources on accomplishing their core missions.

    DMC has provided centralized debt collection programs of Veteran benefit overpayments since 1975 and became a fee-for-service Enterprise Center in 1996.

    This is great news for Veterans trying to deal with the agency as a debt collector.

    LACK OF INFORMATION

    What is not great is the amount of information the agency publishes for Veterans dealing with the Debt Management Center for the first time. The agency gives us little information about how to advocate for yourself and what elements of your fact set to focus on when creating your argument – – whether for a waiver or to plainly dispute the alleged debt in full.

    They instead focus on how to pay and how to submit a waiver with no limited discussion of disputing the alleged debt in full.

    Ever have a run in with DMC? If you have a debt story, I would like to hear it below.

    Any idea how the Fair Debt Collection Practices Act might apply to VA or one of its contractors attempting to collect an illegitimate debt from a disabled Veteran?

    Source

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  • Unsterile Tools

     

    When the Department of Veterans Affairs released the annual ratings of its hospitals this fall, the facility in Atlanta dropped to the bottom, while the one in West Haven, Conn., shot to the top. It was something of a mystery as to why.

    The Atlanta hospital was downgraded to one star from three on the agency’s five-star scale, even though there had been only a “trivial change” in its quality data from the year before, according to the department. The Connecticut hospital climbed to five stars from three, even though numerous operations had to be performed elsewhere or canceled at the last minute because of problems with sterilization of surgical tools, according to an internal assessment and other accounts cited by Senator Richard Blumenthal in a letter to the agency.

    Veterans Affairs set up the rating system in 2012 in the hope of pushing its hospitals to improve, and it has been increasingly aggressive in using the ratings to hold hospital managers accountable. Leaders with low ratings can be ousted, as happened last week in Atlanta, where the chief of staff and heads of the emergency department, primary care and clinical access services were removed because of low scores.

    But former senior officials at the agency and experts in health care metrics say the system can be confusing, and so arbitrary that hospitals may gain and lose stars based only on statistical error. More than a dozen hospitals improved care but lost stars; another did not improve and gained one.

    What is most worrisome to some experts is the role that the star ratings now play in grading performance of hospitals and their managers. They say it creates an incentive to conceal problems rather than grapple with them, in order to collect bonuses or sidestep penalties.

    “It’s a big mistake,” said Dr. Ken Kizer, a former under secretary for health at Veterans Affairs who is widely credited with pioneering the use of health care quality metrics at the agency.

    Dr. Kizer said that it made sense to track quality measures when the goal was improving patient outcomes, and the agency had made important strides in that way. But he said that using the data to single out hospitals for discipline could lead to problems like the 2014 wait-time scandal, when managers who could not meet goals for prompt scheduling of patient appointments started keeping secret off-the-books waiting lists.

    “It’s the same pathology that perverted things then,” Dr. Kizer said. “As soon as you tie metrics to pay or performance, they become subject to gaming.”

    The gaming can put patient care on the line. At the hospital in Roseburg, Ore., administrators turned away some of the sickest patients to keep them from affecting the facility’s scores, doctors there have said.

    The chief of surgery at another Veterans’ hospital in a major metropolitan area said in an interview that administrators discussed whether the hospital should not perform certain operations because they could impact the hospital’s quality statistics.

    “That kind of thinking is driven by these ratings,” said the surgeon, who spoke on the condition of anonymity, adding that he feared being fired if he spoke publicly. “My life right now is continuously filling out reports and going to meetings, trying to figure out how to improve the numbers.”

    There is broad consensus in health care that quality should be tracked and reported, but little agreement on the best way to do it. As in education and law enforcement, a drive to collect data and use it to direct strategy has led to both improvements and frustrations. Often, experts say, the way care is measured can alter the care itself, and not always for the better.

    The Department of Veterans Affairs defended its hospital rating system, saying in a statement that it “has been successful in moving systemwide performance upward.” But the department declined to make key officials available to discuss the system.

    The ratings may soon take on even more importance. A law signed in June may allow more Veterans to get care from private providers if Veterans’ hospitals fall short of performance standards.

    Veterans Affairs has been tracking hundreds of health care metrics for decades, but it had no overall performance gauge for its 146 hospitals until 2012, when it started using a process called Strategic Analytics for Improvement and Learning, or Sail, to combine many of the metrics into a single score. Executive performance and pay were tied to Sail scores in 2015 in the wake of the wait-time scandal.

    The department has reported steady improvement in Sail scores, noting in September that 71 percent of Veterans’ hospitals did better this year than in 2017. But experts say some of that improvement may exist only on paper.

    The former quality director of a large Veterans’ hospital with a five-star rating, who spoke on the condition of anonymity to avoid harming a continuing relationship with the agency, said the hospital employed two analysts whose full-time job was to find ways to improve the Sail data. Some of their work focused on spotting ways that services could be improved, but much of it focused on finding ways to improve the numbers, such as by changing how patients’ conditions were entered in hospital records. “We learned how to take the test,” the director said.

    Sail was designed by Dr. Peter Almenoff, a longtime hospital administrator who was moved to a quality control post in the department in 2008 despite questions about his track record. This spring he was also put in charge of the team that revamps hospitals that get low ratings.

    The department refused multiple requests to interview Dr. Almenoff, and he did not respond to direct inquiries seeking comment.

    Veterans Affairs now relies on Sail to warn about failing hospitals. But Dr. Stephan Fihn, who was the department’s chief quality and performance officer before he retired this year, says the system is not reliable.

    “It has serious flaws and always has,” Dr. Fihn said. “The first is statistical: The numbers may not be mathematically sound. Second, it’s not transparent and lacks independent oversight.”

    A draft internal evaluation in 2014 found that combining dozens of metrics into a single Sail score was “akin to adding apples and oranges and trying to express the total as the number of pineapples.”

    An outside audit in 2015 found that many of the score’s ingredients had “never been assessed to see if they were actually valid measures of quality,” and that hospitals could gain or lose a star solely from statistical error.

    According to the report, 70 percent of Veterans’ hospital directors interviewed by the auditors with a promise of anonymity said Sail scores did not accurately reflect the quality of their hospitals.

    The New York Times contacted eight Veterans’ hospitals, including those in Atlanta and West Haven, asking to interview their directors about Sail. None were willing.

    “A lot of people don’t like this system, but they won’t speak up because they are afraid of what will happen,” Dr. Fihn said.

    Problems in measuring health care quality are not confined to Veterans’ hospitals. A 2015 comparison of four popular commercial systems used by private hospitals found their ratings so inconsistent that not one of the 844 hospitals examined earned a top rating from all four.

    Medicare tried to institute a five-star hospital grading system, but postponed releasing the latest results indefinitely in July after several hospitals threatened to sue, saying the grading method was inaccurate.

    Veterans’ hospitals, however, do not have that option, nor can they choose among commercial rating systems.

    The department says its star ratings help keep Veterans informed. But Dr. David Shulkin, who was President Trump’s first secretary of Veterans affairs, says the stars are not much help in gauging progress from year to year or in making comparisons with nearby civilian hospitals, because Sail grades Veterans’ hospitals on a national curve.

    “It’s not useful for our patients. It’s confusing. I wanted to move away from Sail,” said Dr. Shulkin, who clashed with political appointees in the department and was dismissed by Mr. Trump in March.

    Agency employees say that only Dr. Almenoff and a few members of his staff know exactly how the system weighs and adjusts the 60 publicly available measures that go into a score.

    “That’s the problem with Sail — what happens to make the scores is invisible,” Dr. Fihn said. “A person could move the stars arbitrarily, and you would have no way of knowing.”

    That lack of transparency became a problem for Lisa Nashton, who is in charge of tracking quality at the Veterans’ hospital in Columbia, S.C.

    After the hospital received one star, Dr. Almenoff visited the facility in 2016 to brief the staff on ways to improve. While he was there, Ms. Nashton said, she took him out to dinner to talk more about quality metrics.

    The effort seemed to pay off. The hospital got its rating up to three stars that year, and it looked forward to a similar rating in 2017, Ms. Nashton said, because it had sustained its quality measures at basically the same level.

    So when the word came that the hospital had actually lost a star, “it was a gut punch,” she said. “I kept going over the numbers again and again. I compared us to other hospitals. The math didn’t make sense.”

    Ms. Nashton said she then alerted the department’s Office of Accountability and Whistleblower Protection that Sail was statistically unsound and open to gaming, and submitted a lengthy paper showing how a host of problems made the system a “credibility crisis waiting to happen.”

    The reply came nearly a year later: The department planned to take no action.

    Source

    {jcomments on}

  • CBO Budget Cuts

     

    Mandatory Spending Options

    Option 34: Narrow Eligibility for Veterans’ Disability Compensation by Excluding Certain Disabilities Unrelated to Military Duties

    CBO 001

    Background

    Veterans may receive disability compensation from the Department of Veterans Affairs (VA) for medical conditions or injuries that occurred or worsened during active duty military service. Such service-connected disabilities range widely in severity and type, from migraines and treatable hypertension to the loss of limbs. VA also provides dependency and indemnity compensation (DIC)— payments to surviving spouses or children of a Veteran who died from a service-related injury or disease. The Department of Defense (DoD) has a separate compensation system for service members who can no longer fulfill‌ their military duties because of a disability.

    Not all service-connected medical conditions and injuries are incurred or exacerbated in the performance of military duties. For example, a qualifying injury could occur when a service member was at home or on leave, and a qualifying medical condition, such as Parkinson’s disease, could develop independently of a service member’s military duties. In 2017, VA paid a total of $2.7 billion, the Congressional Budget Office (CBO) estimates, to compensate for seven medical conditions that, according to the Government Accountability Office (GAO), military service is unlikely to cause or aggravate. Those conditions are arteriosclerotic heart disease, chronic obstructive pulmonary disease, Crohn’s disease, hemorrhoids, multiple sclerosis, osteoarthritis, and uterine fibroids. There were‌ 758,085 instances of those conditions in 2017.

    Disabilities being considered as not a qualifying injury for compensation.

    Option

    Beginning in January 2020, this option would cease‌ Veterans’ disability compensation for the seven medical conditions GAO identified. Under the option’s first alternative, Veterans now receiving compensation for those conditions would have their compensation reduced or eliminated, and Veterans who applied for compensation for those conditions in the future would not be eligible for it. The second alternative would affect only new applicants for disability compensation. The option would not alter DoD’s disability compensation system.

    Effects on the Budget

    By CBO’s estimates, the savings from the first alternative, in which VA would no longer make payments to all Veterans for the seven medical conditions, would be $33 billion between 2020 and 2028. Most of the savings would result from curtailing payments to current recipients of disability compensation. In 2020, VA would no longer provide compensation for about 846,000 cases of those seven conditions, CBO estimates. That number would rise to 976,000 cases in 2028. (The number of Veterans affected by the option would be fewer than the number of cases because some Veterans would have more than one of the seven conditions.) In addition, CBO estimates that Veterans’ loss of eligibility for the seven conditions would result in fewer cases of DIC. The option would result in about 1,200 fewer of those cases in 2028, CBO estimates.

    Savings from the second alternative, in which only new applicants for disability compensation would be ineligible to receive payments for the seven conditions, would be about $4 billion over the 2020–2028 period, CBO estimates. The number of cases for which VA would not provide compensation would increase from 15,000 in 2020 to approximately 225,000 by 2028.

    The largest source of uncertainty in estimating the savings from this option is the estimate of the population receiving benefit payments for each of the seven conditions. CBO projects the number of Veterans receiving payments for those conditions on the basis of historical information on the number of Veterans receiving a disability rating for such conditions, the growth of the overall disability compensation program, the mortality rate of the disability compensation population, and other factors. Savings per Veteran are estimated by calculating the average rating and payment for each of the seven conditions and reducing the Veteran’s payment by a corresponding amount.

    Other Effects

    An argument in support of this option is that it would make the disability compensation system for military Veterans more comparable to civilian systems. Few civilian employers offer long-term disability benefits, and among those that do, benefits do not typically compensate individuals for all medical problems that developed during employment.

    An argument against this option is that Veterans’ compensation could be viewed as a lifetime indemnification the federal government owes to people who become disabled to any degree during service in the armed forces.

    Option 35: End VA’s Individual Unemployability Payments to Disabled Veterans at the Full Retirement Age for Social Security

    CBO 002

    Background

    In 2017, 4.5 million Veterans with medical conditions‌or injuries that were incurred or that worsened during active-duty service received disability compensation from the Department of Veterans Affairs (VA). The amount of compensation such Veterans receive depends on the severity of their disabilities (which are rated between zero and 100 percent in increments of 10), the number of their dependents, and other factors—but not on their income or civilian employment history.

    In addition, VA may increase certain Veterans’ disability compensation to the 100 percent level, even though VA has not rated their service-connected disabilities at that level. To receive the supplement, termed an Individual Unemployability (IU) payment, disabled Veterans must apply for the benefit and meet two criteria. First, Veterans generally must be rated between 60 percent and 90 percent disabled. Second, VA must determine that Veterans’ disabilities prevent them from maintaining substantially gainful employment—for instance, if their employment earnings would keep them below the poverty threshold for one person. In 2017, for Veterans who received the supplement, it boosted their monthly VA disability payment by an average of about $1,200. In September 2017, about 380,000 Veterans received IU payments. Of those Veterans, the Congressional Budget Office estimates, about 180,000 were age 67 or older. That age group has‌ been the largest driver of growth in the program.

    In addition, VA may increase certain Veterans’ disability compensation to the 100 percent level, even though VA has not rated their service-connected disabilities at that level. To receive the supplement, termed an Individual Unemployability (IU) payment, disabled Veterans must apply for the benefit and meet two criteria. First, Veterans generally must be rated between 60 percent and 90 percent disabled. Second, VA must determine that Veterans’ disabilities prevent them from maintaining substantially gainful employment — for instance, if their employment earnings would keep them below the poverty threshold for one person. In 2017, for Veterans who received the supplement, it boosted their monthly VA disability payment by an average of about $1,200. In September 2017, about 380,000 Veterans received IU payments. Of those Veterans, the Congressional Budget Office estimates, about 180,000 were age 67 or older. That age group has‌ been the largest driver of growth in the program.

    Option

    This option consists of two alternatives, both beginning in January 2020. Under the first alternative, VA would stop making IU payments to Veterans age 67 or older (the full retirement age for Social Security benefits for those born after 1959). That restriction would apply to both current and prospective recipients. Therefore, at age 67, VA disability payments would revert to the amount‌ associated with the rated disability level.

    Under the second alternative, Veterans who begin receiving the IU supplement after January 2020 would no longer receive those payments once they reach age 67.‌

    In addition, no new applicants who are age 67 or older would be eligible for IU benefits after that date. Unlike under the first alternative, Veterans who are already receiving IU payments and are age 67 or older after the effective date of the option would continue to collect the IU supplement.

    Effects on the Budget

    By CBO’s estimates, the savings from the first alternative, in which Veterans age 67 or older may no longer collect the IU supplement, would be $48 billion between 2020 and 2028. That reduction in spending is the result of a decrease in the number of Veterans who would qualify for the supplement. CBO estimates that the number of Veterans who would no longer receive or qualify for the IU supplement would total nearly 235,000 in 2020. That number would increase to 382,000 Veterans in 2028, with savings totaling $7 billion in that year. Disability payments for those who lost eligibility would be reduced by an average of $1,300 per month in 2020, increasing to $1,600 by 2028.

    The savings from the second alternative, which would end IU payments to new recipients and bar applications from Veterans who are age 67 or older after the effective date of the option, would total $7 billion between 2020 and 2028. The number of Veterans who would not collect IU payments under this alternative grows from 8,300 in 2020 to 83,000 in 2028. The savings from this alternative equal $2 billion in that final year of the projection period.

    CBO projects the number of Veterans receiving the IU supplement on the basis of past growth in the number of new recipients (by age) and adjusts that number to account for the morbidity of beneficiaries and other factors, such as the backlog of disability cases to be decided. For IU recipients who would no longer receive the supplement under this option, CBO determines per-Veteran savings by reducing the payment amount to a level that corresponds to the Veteran’s overall disability rating.

    CBO estimates that rating on the basis of historical data on IU recipients and anticipated changes in the distribution of their ratings. The largest sources of uncertainty in the estimate of savings over the next 10 years are CBO’s estimates of the number of participants who would be affected by the option and of the disability ratings of those affected. Changes in policy, such as increased efforts by VA and private organizations to inform Veterans about this benefit or the level of assistance given by those entities in developing a claim, may affect the number of applicants with fully developed claims, and consequently contribute to uncertainty regarding the savings from this option.

    Other Effects

    One argument for this option is that most Veterans older than Social Security’s full retirement age would not be in the labor force because of their age, so their lack of earnings would probably not be attributable to service-connected disabilities. In 2017, about 35 percent of men ages 65 to 69 were in the labor force; for men age 75 or older, that number dropped to about 10 percent. In addition, most recipients of IU payments who are older than 65 would have other sources of income: They would continue to receive regular VA disability payments and might also collect Social Security benefits. (Recipients of the IU supplement typically begin collecting it in their 60s and probably have worked enough in prior years to earn Social Security benefits.)

    An argument for retaining the current policy is that IU payments should be determined solely on the basis of a Veteran’s ability to work due to his or her disabilities and that age should not be a factor in deciding a claim. In addition, replacing the income from the IU supplement would be hard or impossible for some disabled Veterans. If they had been out of the workforce for a long time, their Social Security benefits might be small, and they might not have accumulated much in personal savings.

    Option 36: Reduce VA’s Disability Benefits to Veterans Who Are Older Than the Full Retirement Age for Social Security

    CBO 003

    Background

    In 2017, 4.5 million Veterans with medical conditions or injuries that occurred or worsened during active duty service received disability compensation from the Department of Veterans Affairs (VA). Service-connected disabilities vary widely in severity and type: Some examples are the loss of a limb, migraines, and hypertension. The amount of base compensation Veterans receive depends on the severity of their disabilities (which are rated between zero and 100 percent in increments of 10). In calendar year 2018, base compensation rates generally ranged from $135 to $2,975 per month. Additional compensation may be awarded to Veterans based on the number of their dependents and other factors. By law, VA’s disability payments are intended to offset the average earnings that Veterans would be expected to lose given the severity of their service-connected medical conditions or injuries, whether or not a particular Veteran’s condition actually reduced his or her earnings. Disability compensation is not means-tested: Veterans who work are eligible for benefits, and, in fact, most working-age Veterans who receive such compensation are employed. (In contrast, Social Security Disability Insurance pays cash benefits to adults who are judged to be unable to perform “substantial” work because of a disability, and they eventually lose the benefits if they return to work and earn more than the program’s limit on earnings—for most beneficiaries, $1,180 a month in calendar year 2018. Those Social Security disability benefits are based on previous earnings and usually rep ace wages and salaries on less than a one-to-one basis.)

    Even after Veterans reach full retirement age, VA’s disability payments continue at the same level. By contrast, the income that people receive after they retire (from Social Security or private pensions) usually is less than their earnings from wages and salary before retirement. For instance, the ratio of benefits from Social Security to average lifetime earnings is usually much less than 1 to 1. For workers who have earned relatively low wages over their career, the ratio is around one-half; for higher-income workers, it is around one-quarter or less. As a consequence, once Veterans reach retirement age, the combination of their VA disability payments and Social Security benefits may be more than the income of comparable Veterans without a service-connected disability. In 2016, about 87 percent of Veterans who received VA’s disability compensation and who were age 67 or older were out of the labor market.

    Option

    Under this option, VA would reduce disability compensation payments to Veterans by 30 percent at age 67 for all Veterans who begin receiving those benefits after January 2020. (Social Security’s full retirement age varies depending on beneficiaries’ birth year; this option uses age 67, which is the full retirement age for people born after 1959.) Social Security and pension benefits would be unaffected by this option. Veterans who are already collecting disability compensation as of January 2020 would see no reduction in their VA disability benefits when they reach age 67.

    Effects on the Budget

    By the Congressional Budget Office’s estimates, the savings from this option would be about $11 billion between 2020 and 2028. CBO estimates that the number of Veterans age 67 and older who would no longer receive their full preretirement disability compensation from VA would increase from 60,000 in 2020 to about 470,000 in 2028. On average, Veterans’ benefit would be reduced by about $320 per month in 2020, increasing to a reduction of $385 per month in 2028.

    The largest source of uncertainty in the estimate of savings over the next 10 years involves determining the number of new disability beneficiaries who will be 67 after January 2020. The number of Veterans age 67 and older who receive disability compensation has increased in the past decade as Vietnam Veterans have aged. CBO projects that the number of new recipients age 67 and older will decline in the coming years as the share of the Veterans’ population in that age group falls. However, the health of the Veteran population also affects the number of older Veterans on the rolls, as do outreach efforts by VA and others to inform Veterans about the benefit and other factors.

    Other Effects

    Because earnings from wages and salaries typically decline when people retire, this option would better align Veterans’ benefits with the loss in income after retirement that is typical of the general population.

    An argument against this option is that it would reduce the support available to disabled Veterans. If they had been out of the workforce for a long time, their Social Security benefits might be small, and they might not have accumulated much personal savings. In addition, VA’s disability payments may be considered compensation owed to Veterans—particularly combat Veterans— because they faced special risks and became disabled in the course of their military service.

    The reduction in VA’s disability benefit could affect older Veterans’ participation in the labor force and the age at which they would begin claiming Social Security benefits. This option might induce some older Veterans with disabilities to remain in the labor force longer or work more hours than they would have under the current system in order to preserve their income; some Veterans, however, would not be able to maintain employment that would accommodate their disabilities as they age.

    Option 37: Narrow Eligibility for VA’s Disability Compensation by Excluding Veterans with Low Disability Ratings

    CBO 004

    Background‌

    In 2017, 4.5 million Veterans with medical conditions or injuries that were incurred or that worsened during active-duty service received disability compensation from the Department of Veterans Affairs (VA). Such

    service-connected disabilities range widely in severity and type, from migraines and treatable hypertension to the loss of limbs. The base amount of compensation Veterans receive depends on the severity of their disabilities, which are rated between zero and 100 percent in increments of 10; a 100 percent rating means that Veterans are considered totally disabled and probably unable to support themselves financially. The most common rating is 10 percent. In 2018, base compensation rates generally ranged from about $140 to $3,000 per month. Additional compensation may be awarded based on the presence of dependents and other factors. The amount of compensation is intended to offset the average amount of income Veterans lose as a result of the severity of their service-connected medical conditions or injuries.

    Option

    Under this option’s first alternative, VA would narrow eligibility for compensation to Veterans with disability ratings of 30 percent or higher. The second alternative would impose the same limits on eligibility, but it would only affect new applicants for disability compensation.

    Effects on the Budget

    By the Congressional Budget Office’s estimates, the savings from the first alternative, in which current and future recipients would be ineligible for payments for disability ratings of less than 30 percent, would be $38 billion over the 2020–2028 period. In 2017, about 1.3 million Veterans received compensation for a rating of less than 30 percent. Under current law, that number is projected to rise to 1.5 million in 2020 and then to 1.9 million by 2028. Under the first alternative, VA would discontinue compensation for those Veterans.

    Savings from the second alternative, in which VA would no longer make payments for future cases in which Veterans’ disability rating was less than 30 percent, would be $6 billion between 2020 and 2028. The number of Veterans who would no longer qualify for compensation under this alternative would be small at first but would rise to 500,000 by 2028.

    Additional savings would be possible if eligibility was further limited to Veterans with disability ratings higher than 30 percent. However, the amount saved would not be proportional to the level of the disability rating, because neither payment amounts nor the beneficiary population increase at the same rate as their associated disability ratings.

    The largest source of uncertainty in estimating the savings from this option is the future size of the population with disability ratings of less than 30 percent. CBO projects that number based on the number of Veterans who received such disability ratings in the past, the growth of the overall disability compensation program, the mortality rate of Veterans receiving disability compensation, and other factors.

    Other Effects

    One argument for this change is that it would permit VA to concentrate spending on Veterans with the greatest impairments. Furthermore, there may be less need than in the past to compensate Veterans with milder impairments. Many civilian jobs now depend less on physical labor than was the case in 1917, when the disability-rating system was first devised; the rating system that is the basis for current payments has not undergone major revisions since 1945. In addition, medical care and rehabilitation technologies have made great progress. Thus, a physical limitation rated below 30 percent might not substantively reduce a Veteran’s earning capability, because it would not preclude work in many modern occupations.

    An argument against this option is that Veterans’ compensation could be viewed as a lifetime indemnification the federal government owes to people who become disabled to any degree during service in the armed forces.

    Discretionary Spending Options

    Option 30: End Enrollment in VA Medical Care for Veterans in Priority Groups 7 and 8

    CBO 005

    Background

    The Department of Veterans Affairs (VA) offers a wide range of medical care to Veterans, including providing inpatient and outpatient care, filling prescriptions, and offering assistive devices to Veterans. That care is provided at little or no charge to enrolled Veterans. Veterans who seek medical care from VA are assigned to one of eight priority groups on the basis of disability status and income, among other factors. For example, enrollees in priority groups 1, 2, and 3 generally have service-connected disabilities (as determined by VA), and their income does not affect eligibility for VA medical care. Veterans in priority group 7 do not have service-connected disabilities, and their annual income is above a national threshold (about $32,000 for a household of one in 2017) set by VA but below a (generally higher) geographically adjusted threshold.

    Those in priority group 8 do not have service-connected disabilities, and their income is above both the national and the geographic thresholds. In 2017, about 2 million Veterans were in priority groups 7 and 8.

    Although Veterans in priority groups 7 and 8 do not pay enrollment fees, they make copayments, and VA can bill their private insurance plans for reimbursement. Together, the copayments and reimbursements cover about 14 percent of VA’s costs of care for those groups. In 2017, VA incurred $6 billion in net costs for those patients, or about 9 percent of the department’s net spending for Veterans’ medical care. When priority groups were established in 1996, the Secretary of the Department of Veterans Affairs was given the authority to decide which groups VA would serve each year.

    Because of budgetary constraints, VA ended enrollment of Veterans in priority group 8 in 2003. Veterans who were enrolled at that time were allowed to remain in VA’s health care system. In 2009, enrollment was reopened to certain Veterans in that group.

    Option

    This option would end enrollment in VA’s health care system for Veterans in priority groups 7 and 8: No new enrollees would be accepted, and current enrollees would be disenrolled starting in October 2019.

    Effects on the Budget

    The Congressional Budget Office estimates that ending enrollment for Veterans without service-connected disabilities and whose income exceeds the national threshold would reduce discretionary spending by $57 billion from 2020 through 2028. Under this option, about 2 million fewer Veterans would be enrolled in VA’s health care system each year. Because not all enrolled Veterans use VA medical care each year, an average of about 1 million Veterans would no longer be treated by VA in any given year. The result would be an average annual savings of about $6,000 per disenrolled patient over that period.

    Mandatory spending for other federal health care programs—such as Medicare and Medicaid and federal subsidies provided through the health insurance marketplaces established under the Affordable Care Act— would increase because enrollees would seek medical care through other sources. (More than half of the enrollees in priority groups 7 and 8 are over the age of 65.) CBO estimates that, overall, mandatory spending would option.

    The greatest sources of uncertainty in this estimate of savings over the next 10 years are CBO’s estimates of the number of Veterans affected by the option and how their reliance on other forms of health care might change. Under current law, enrollees in priority groups 7 and 8 receive nearly 20 percent of their medical care from VA. As the health care delivery and insurance markets evolve over the projection period, that pattern of reliance might change.

    Other Effects

    An advantage of this option is that VA could focus on Veterans with the greatest service-connected medical needs and the fewest financial resources. In 2017, nearly 90 percent of enrollees in priority groups 7 and 8 had other health care coverage, mostly through Medicare or private health insurance. As a result, the vast majority of Veterans who would lose access to VA health care would have other sources of coverage, including the health insurance marketplaces.

    A disadvantage of the option is that Veterans in priority groups 7 and 8 who have come to rely on VA, even in part, might find their health care disrupted. Some Veterans—particularly those with income just above the thresholds—might find it difficult to obtain other care.

    Revenue Options

    CBO 006

    Include Disability Payments From the Department of Veterans Affairs in Taxable Income

    Background

    The goal of the Department of Veterans Affairs (VA) disability system is to compensate Veterans for earnings lost as a result of service-connected disabilities. By law, that compensation is meant to equal the average reduction in earnings experienced by civilian workers with similar medical conditions or injuries.

    Compensable service-connected disabilities are medical problems incurred or aggravated during active duty, although not necessarily during the performance of military duties. Applicable conditions range widely in severity and type, from scars and hypertension to the loss of one or more limbs. The amount of a Veteran’s base payment is linked to his or her composite disability rating, which can account for multiple disabilities and is expressed from zero to 100 percent in increments of 10 percentage points. Lower ratings generally reflect that Veterans’ disabilities are less severe; in 2017, about one in three recipients of disability compensation were rated as either 10 percent or 20 percent disabled. Beneficiaries do not have to demonstrate that their conditions have reduced their earnings or interfere with their daily functioning.

    Disability compensation is not means-tested (that is, restricted to those with income below a certain amount), and payments are exempt from federal and state income taxes. Veterans who have a job are eligible for benefits, and most working-age Veterans who receive disability benefits are employed. Payments are in the form of monthly annuities and typically continue until the beneficiary’s death. Because disability benefits are based on VA’s calculation of average earnings lost as a result of specific conditions, payments do not reflect disparities in earnings that might result from differences in Veterans’ education, training, occupation, or motivation to work.

    Although the number of Veterans in the total population is declining, the number receiving VA disability payments has risen each year. Both the share of Veterans receiving disability payments and the average amount of those payments have increased. Today, about 20 percent of Veterans receive disability compensation; in 2000, only 9 percent of all Veterans did. In 2017, VA paid about 4.6 million Veterans an average of $15,400 each in disability benefits. Of those Veterans, 1.3 million had a disability rating of 20 percent or less; their average payment was $2,200.

    Option

    This option consists of two alternative approaches to taxing VA disability benefits under the individual income tax. The first alternative would include all such disability payments in taxable income. The second alternative would include disability payments in taxable income only for Veterans with a disability rating of 20 percent or less.

    Effects on the Budget

    The staff of the Joint Committee on Taxation (JCT) estimates that, if implemented, the first alternative would increase federal revenues by $93 billion from 2019 through 2028. The second alternative would raise federal revenues by a smaller amount—$4 billion—over that period, according to JCT’s estimates.

    The total benefits included in taxable income would be much larger under the first alternative than under the second alternative. As a result, the second alternative would raise federal revenues by a much smaller amount. Estimates of both alternatives reflect the scheduled increase in individual income tax rates that begins

    in 2026.

    The estimates are uncertain for two main reasons. First, they rely on the Congressional Budget Office’s projections of the Veteran population and disability compensation, which are inherently uncertain. Second, they rely on estimates of how individuals would respond to the change in tax policy. Those estimates are based on observed responses to prior changes in policy, which might differ from the response to this option.

    Other Effects

    An argument in favor of the option is that including disability payments in taxable income would increase the equity of the tax system. Taxing VA disability payments would make tax liabilities similar among taxpayers with comparable amounts of combined income (from disability payments, earnings, and other sources). Eliminating income exclusions in the tax system moves the system toward one in which people in similar financial and family circumstances face similar tax rates. Further, military disability retirement pay—a type of disability compensation received by those who retired from service because of a disability—is included in taxable income unless it is related to combat injuries. Including VA disability benefits in taxable income would make the treatment of the two types of benefits more similar.

    An argument against this option is that VA disability payments are connected to military service, which is unlike civilian employment because it confers distinctive benefits to society and imposes special risks on service members. By that logic, enhancements to pay and benefits for service members — including the current exclusion of disability compensation from taxation — could be seen as a way to recognize the hardships of military service. However, Veterans are entitled to disability payments even for medical conditions unrelated to military duties, as long as those conditions were incurred while the individuals were serving on active duty. By contrast, disability benefits received by civilian workers for nonwork-related injuries are taxable if the employer paid the premiums.

    FULL REPORT

  • Tricare Fees

     

    With the federal deficit expected to top $1 trillion this year, the Congressional Budget Office in December published a list of options for reducing the imbalance over the next 10 years, including three suggestions on Tricare and six that address Veterans benefits.

    In its Options for Reducing the Deficit: 2019 to 2028, the CBO laid out 121 opportunities for curtailing spending and raising revenue. These include raising Tricare enrollment fees for military retirees, instituting enrollment fees for Tricare for Life and reducing Veterans benefits.

    The publication marks the fourth time in five years that the CBO has suggested raising Tricare enrollment fees for working-age retirees and introducing minimum out-of-pocket expenses for those using Tricare for Life.

    The CBO suggested that increasing Tricare enrollment fees for working-age retirees -- those under age 65 -- could help slash the deficit by $12.6 billion. To obtain this, it said, the Defense Department should more than double annual enrollment fees for individuals and families enrolled in Tricare Prime and institute annual fees of $485 for an individual and $970 for a family for Tricare Select. Most working-age retirees currently pay no enrollment fees for Tricare Select.

    The CBO also suggested instituting enrollment fees for Tricare for Life, the program that serves as supplemental coverage for military retirees on Medicare. Analysts estimated that the Defense Department could save $12 billion between 2021 and 2028 if it adopted annual enrollment fees of $485 for an individual or $970 for a family for Tricare for Life, in addition to the Medicare premiums most military retirees 65 and older pay.

    According to CBO analysts, these options would reduce the financial burden of Tricare for Life to the DoD in two ways: It would cut the government's share by the amount of fees collected and indirectly would save money by causing some patients to forgo Tricare for Life altogether, either by buying a private Medicare supplement or simply going without one.

    Another option would be to introduce minimum out-of-pocket requirements for those using Tricare for Life. In this proposal, TFL would not cover any of the $750 of cost-sharing payments under Medicare and would cover just 50 percent of the next nearly $7,000.

    Retired Navy Capt. Kathryn Beasley, director of government relations for health issues at the Military Officers Association of America, said her organization is concerned that the CBO continues to include health care rate hikes for military retirees in its list of options, which it publishes every few years or so. The CBO also ignored the fact that rate increases went into effect last year, she added.

    "CBO does this every year. Our biggest concern is that some of these options would make their way into the president's budget," Beasley said. "With all the changes to the military health care system in the past year, we think we simply need to stabilize Tricare. It's been a lot to absorb."

    According to the CBO, the Department of Veterans Affairs also presents several opportunities for cost-savings measures. Some suggestions in the CBO assessment include:

    • Narrowing eligibility for disability compensation for seven diseases the Government Accountability Office has said are not caused or aggravated by military service, including arteriosclerotic heart disease, chronic obstructive pulmonary disease, Crohn's disease, hemorrhoids, multiple sclerosis, osteoarthritis, and uterine fibroids. This option would save $33 billion over 10 years.
    • Ending the VA's individual unemployability payments to disabled Veterans when they turn 67, the retirement age for receiving full Social Security benefits, which would save an estimated $48 billion.
    • Reducing disability benefits to Veterans older than 67 who are receiving Social Security payments. This could save the government $11 billion.
    • Eliminating disability compensation for 1.3 million Veterans with disability rates below 30 percent, saving $38 billion over an eight-year period.

    The VA option with some of the largest savings potential, according to CBO, would be to end enrollment for the two million Veterans in Priority Groups 7 and 8 -- those who do not have service-connected disabilities and have income above the VA national threshold and below a geographically adjusted threshold (Group 7) or above both thresholds (Group 8). This could save the government up to $57 billion, CBO analysts said.

    Finally, the CBO said the federal government could raise revenue by including VA disability payments as taxable income. According to the CBO, if all disability payments were to be taxed, federal revenues during the time frame would increase by $93 billion.

    If just Veterans rated 20 percent or less paid taxes on their disability compensation, federal revenues would increase by $4 billion, it said.

    CBO analysts say their options only "reflect a range of possibilities" and are not recommendations or a ranking of priorities. "The inclusion or exclusion of any particular option does not imply that CBO endorses it or opposes it," they wrote.

    Source

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  • Celebrating female Veterans

     

    Throughout March people across the country will celebrate Women’s History Month, paying tribute to the vital role women have played in United States history. Generations of women have courageously blazed trails, broken barriers and fundamentally changed our society. At VA, we are proud to spend this month honoring and celebrating women Service members and Veterans for their past, present and ongoing service to our country.

    As the daughter of a Navy Veteran and someone who has had the privilege of working to advance Veterans for more than 23 years, supporting women Veterans feels very personal to me. My colleagues, mentors and friends are Veterans—many of them women Veterans. I am proud that here at VA, women are represented at every level throughout our organization. And while studies show that people typically imagine a man when they think “Veteran”—women Veterans have been around for much of America’s history.

    Well before the women’s rights movement came along in 1848, women in the military were breaking barriers to serve our county. During the Revolutionary War, women served in military camps as laundresses, cooks, nurses and spies. Up until World War I, women served as soldiers disguised as men. During the last two years of World War I, women were finally allowed to join the military in their own right. Thirty-six thousand women served in that war, and more than 400 nurses died in the line of duty.

    Today, about 219,000 women Service members are currently stationed throughout the world filling a diverse range of roles from radio operators, translators, and pilots to rangers. Times have certainly changed.

    As the number of women in military service grows, so does the number of women Veterans. Today, nearly 2 million Veterans are women. As the fastest growing Veteran subpopulation, women Veterans are making their mark. Before 2012, there had been only three women Veterans in Congress in history. Today, a record six female Veterans hold office on Capitol Hill.

    But while the success of our women Veterans is undeniable, the explosive growth in the number of women Veterans means VA must continue to adapt to better meet their diverse needs—and we are.

    I spent the first eighteen years of my VA career in Vocational Rehabilitation and Employment (VR&E) Service —and I know first-hand how essential it is that Veterans receive their benefits and services to put them on the path to a meaningful civilian career. It’s our job at VA to anticipate the services women Veterans need and to provide that to them.

    For instance, women Veterans are the fastest-growing group of entrepreneurs. Between 2007 and 2012, the number of businesses owned by women Veterans increased by 296 percent, to reach a total of 384,548 businesses, up from about 130,000. And the number continues to grow: over the past five years the number of companies owned by women Veterans has almost quadrupled.

    I hope you’ll take a look at the Center for Women Veterans’ new Trailblazers Initiative, which celebrates the contributions of women Veterans who served our country—especially those who blazed a trail for others to follow.

    At VA we are proud of our women Veterans, and we will continue to work to ensure that we anticipate and meet their needs as they continue to be a vital part of our military and nation. I extend my thanks to women Veterans who continue your service every day in big and small ways.

    Source

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  • Vets Teamed to Raise Millions

     

    On October 19, 2018, a crowd of over 700 guests gathered at Pier Sixty at Manhattan's Chelsea Piers for one reason: to help provide mental healthcare to the men and women who fight for our freedoms. During their 6th annual gala, Headstrong, an organization that provides cost-free, stigma-free, and bureaucracy-free mental healthcare to post-9/11 military Veterans, put on a fun-filled event — and raised over $2 million in the process.

    Headstrong is making a huge impact on the Veteran community.

    "We have served over 750 Veterans over 16,000 therapy sessions by 150 best-in-class clinicians in 23 cities across the country. All through private donations. Simply incredible," said Army Veteran and Headstrong Executive Director Joe Quinn."

    During the event, three Veterans seeking treatment through Headstrong, Amanda Burrill, Derek Coy and James Byler, opened up about their struggles and successes in finding effective mental healthcare. Their stories inspired the hundreds in attendance.

    Despite the seriousness of the organization's goals, the night wasn't without a good dose of levity — after all, it was more than a fundraiser, it was a celebration. World War II Veteran and former POW, Ewing Miller, was celebrating his 95th birthday — and he did so by being served cake by actor Jake Gyllenhaal and late night host Seth Meyers.

    Ewing Miller served from 1942 to 1945. On February 5, 1945, his aircraft was shot down — he was the sole survivor. He endured capture by the Germans until he was eventually freed by legendary military leader, General George S. Patton. Ewing earned several decorations during his time in service, including the Purple Heart, the Air Medal with two clusters, the POW Medal, the World War II Victory Medal, and the European-African-Middle Eastern Campaign medal.

    When the lights finally dimmed on the evening's celebrations, Headstrong had raised over $2 million, which will be used to directly improve the lives of many post-9/11 Veterans that are struggling with mental health — and it's a cause worth championing. Marine Veteran and Founder of Headstrong, Zach Iscol, said,

    "When you put goal-oriented Veterans together with top mental healthcare providers, they get better. The panic attacks go away, the anxiety goes away, the anger goes away, the self-medicating goes away…they blossom."

    To learn more about Headstrong, their initiatives, and what you can do to support Veteran mental healthcare, visit their website.

    Source

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  • Disabled Vets

     

    What's Not Talked About?

    Throughout the history of warfare, service members have been placed in unimaginable situations, often situations in which they have to make difficult decisions. Frequently, decisions made during deployment have lifelong consequences. Many Veterans have expressed a desire to be the person they were before they experienced trauma, and they often try to suppress or avoid memories of the trauma they have lived through. However, the use of avoidant coping strategies has been found to be counterproductive in the long run. By attempting to avoid the traumatic events service members have experienced, they end up exacerbating the intensity and frequency of their trauma memories and the sequelae and symptoms of those memories over time.

    Some Veterans are able to move past trauma with minimal dysfunction in their lives; however, for others, the traumatic event creates havoc and chaos. Trauma symptoms can become so problematic that they result in family discord, divorce, social dysfunction, significant substance use, employment difficulty, physical health difficulties, legal problems, and more. And the disruption of service members’ lives as a result of trauma symptoms is hardly uncommon. Due to the dysfunction and negative impact of trauma and its symptoms in the lives of service members, the VA has recognized and developed the VA disability rating system. The disability rating system considers both physical and mental health-related conditions. The more areas of a Veteran’s life that are impacted (i.e. social and occupational difficulty or physical limitation and/or pain), the more financial compensation that Veteran potentially could be warranted. I am a firm believer that Veterans are entitled to every dollar that they are afforded and then some...Many can argue that the lifelong implications and symptoms that Veterans have to endure cannot be quantified or compensated with a dollar amount. The VA does its best to equitably compensate Veterans based on their level of dysfunction. However, if the Veteran could eliminate the disabling experience that initiated their impairing symptoms, it is possible that they could exceed the amount of their VA compensation by functioning optimally in the civilian sector. Essentially, they would be able to have a greater positive economic impact and earn a higher living wage if they did not experience disabling symptoms. Given the high level of training military members receive, the values, discipline, and structure instilled by military training and service often lead most Veterans to make dependable, hard-working, and effective employees.

    Disability Rating System

    According to the VA Disability Rating System, in the year 2000, the average compensation provided to Veterans through the disability rating system was about $20 billion for 2.3 million Veterans. In 2013, that number rose to 3.5 million Veterans receiving $54 billion in compensation. This number has continued to rise over the last several years and will hopefully continue to do so, enabling Veterans to receive the compensation they deserve. A major reason for the spike in Veterans receiving compensation is the continued 14-year wars in Iraq and Afghanistan. When service members are sent to war and later return home, there are often significant consequences to service—economics being one of them. Unfortunately, many Veterans who are still in need of services and compensation for VA benefits have not taken advantage of the services offered. Many factors impact Veterans’ decisions not to seek care— a main one being stigma. Two examples of stigma are: one, a Veterans’ hesitation to seek mental health services due to being perceived as “weak” or “vulnerable;” and, two, the possibility of having negative career or job implications as the result of potentially impairing symptoms. As I have said in a previous blog, it takes a nation to build a military and go to war. And, it takes a nation to welcome them home. Compensating our Veterans for their service is the first of many steps that should be afforded to Veterans for their sacrifice. If we send people to war, it is a fundamental imperative that we take care of them when they come home. The tide is changing, and the VA has gone to great lengths to decrease wait times for compensation and pension evaluations so that Veterans are streamlined through the process. There is no perfect system, and the pendulum has and is continuing to shift in the right direction so that our brothers and sisters in arms are taken care of.

    To specify the rating system with an example, if a Veteran diagnosed with PTSD has a 50 percent service-connected disability rating and they have a spouse and one child, they would receive $978.64 each month. Yearly, that is roughly $11,745. The pay for a Veteran that is 100 percent serviced-connected increases significantly. They would approximately $3200 monthly. Although this money is not taxed, many Veterans still struggle to make ends meet. Anecdotally, there is a misconception that if a Veteran receives a 100 percent service connection, they will be able to live a “lavish” lifestyle. That is simply not true. This money can definitely help decrease financial distress, however, many Veterans still struggle to pay for things they and their families need.

    Once a Veteran receives a disability rating and compensation is provided, there can be fear that the disability rating might be decreased or taken away if the VA finds evidence the Veteran’s symptoms have improved to a more manageable level. Once Veterans receive a service-connected percentage of disability, it is not a fixed rate for life—although it could be. The VA has the right to decrease the compensation rate if the Veteran shows material improvement in their ability to function in daily life whether that be in relation to a physical or mental health-related condition. According to the Department of Veteran’s Affairs Service Connected Disability website (2017), if a Veteran has less than a 100 percent disability rating, has been receiving compensation for less than five years, and has shown medical and social improvement, the VA can reduce the percentage of disability and compensation based on the evidence found. However, if a Veteran has been receiving benefits for longer than 20 years, it is considered a continuous rating and the VA cannot lawfully reduce the rating. At 10 years, a Veteran’s rating cannot be terminated, but it can be reduced. If a Veteran’s disability rating is reduced, a Veteran has the option of requesting a reexamination, and they should contact a Veterans’ Service Organization representative to advocate on their behalf.

    The VA provides great and well-needed services, and they save lives every day. Unfortunately, some Veterans walk away from the VA dissatisfied and displeased. There is no perfect mental health and medical system, and the disability rating scale is not perfect either. There is no one program that provides a “fix all” solution. What it will take is public and private partnerships moving forward in order to maximize reach and expand access, frequency, and quality of care.

    Many Veterans who receive benefits fear their benefits may be taken away at any point in time. Unfortunately, this fear of disability ratings potentially being lowered if there is substantial evidence that the Veteran has made improvement deters people from seeking and fully engaging in well-needed treatment. For instance, if a service-connected Veteran engages in an evidenced-based trauma-focused treatment for PTSD that has been shown to reduce symptoms upon full completion, and as a result of that treatment their overall dysfunction decreases, that Veteran could be at risk of decreased disability ratings if that improvement is documented and gathered during a medical evaluation. Veterans who know the disability rating system may be deterred from seeking care at the VA because of that potential. The more dysfunction one has, the more money they receive; so increased symptomology is incentivized and reinforced. If Veterans struggle with employment and optimal functioning, it makes sense that those Veterans may not want to show improvement. This is one lens to look through.

    Unfortunately, there is no perfect solution to this problem. However, there has been plenty of debate about possible solutions. One solution discussed would be to extend the time period between the rating system from the initial evaluation and reevaluation. This solution could assist with decreasing stigma and reducing the fear of losing a percentage rating with the potential benefit of encouraging people to fully engage in well-needed treatment. This would allow Veterans to seek a high standard of care, receive benefits, and practice their skill-sets learned with a longer time to adjust for life stressors that may continue to exacerbate symptoms. If there is no reoccurrence of symptoms, then one may experience a reduction in compensation. If there continues to be notable impairment, then the percentage of disability rating could stay the same or increase. Another potential solution is to continue the private-public partnership so that Veterans can receive care outside of the VA. If Veterans fear that making progress would jeopardize their disability rating when seeking care at the VA, those concerns are potentially lessened with treatment in the private sector. These issues about disability ratings and improvement in functioning are only a few of the many issues debated in the current Veterans’ issues climate. Although they are hotly debated, the pendulum is moving in the right direction by placing our Veterans first.

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  • Charity for Vets

     

    To hear Army Veteran Troy D. Walker tell it, Dog Tag Furniture’s mission to aid Vets began after a service buddy killed himself and the family couldn’t afford a funeral.

    The Department of Veterans Affairs can only provide a few hundred dollars, the Minnesota man told “Fox and Friends” on Sept. 23, 2017.

    “The body was going to go unclaimed and be put in a baggie,” Walker said.

    Walker recalled going into debt to help pay his friend’s funeral costs and then realized no organizations existed to solely help fund Veterans' funerals.

    Roughly six years later, Dog Tag Furniture builds and sells wooden American flags and other patriotic products, billing itself on social media and TV interviews as an organization funding Veteran funerals via donations and wooden flag sales.

    “The money goes to pay for the funerals of these families who cannot afford one,” Walker told “Fox and Friends” during a return appearance on Nov. 22, 2017.

    “I hold the personal responsibility to make sure every dollar I received goes out to funerals," he said.

    But now, Walker, his wife Ranemma and Dog Tag Furniture are under investigation by the FBI and U.S. Postal Service amid allegations of money laundering and wire fraud in “a scheme to defraud donors who made charitable donations to their company,” according to court records.

    “Troy Walker...both solicited donations to Dog Tag Furniture and sold wooden flags to customers of Dog Tag Furniture by falsely representing to donors and customers that Dog Tag Furniture was a charitable organization and that all of the proceeds of donations and sales would be used to provide funerals for military Veterans,” according to a sworn affidavit attached to a federal search warrant request from last month.

    “Instead of using their money to pay for funerals for military Veterans, Troy and Ranemma Walker used a significant portion of the money for their own purposes," the affidavit added.

    “Personal purchases” allegedly included tattoo parlor payments, private school tuition for the Walkers’ children, $9,000 at Disney resorts, $5,000 in “food and entertainment expenses” and $7,000 to a law firm representing the couple “in connection with a dispute with the City of Norwood Young America,” according to the affidavit, which Military Times obtained from the U.S. Department of Justice.

    Walker has not been charged with a crime and the federal probe into misconduct allegations noted in the affidavit continues, according to Department of Justice officials.

    Although the charity received about $490,000 in sales and donations from August 2017 to July 2018, Dog Tag Furniture allegedly covered the expenses of just two funerals at a total cost of $3,295, federal authorities allege.

    Walker, 38, declined to comment on the allegations through Robb Leer, his Minneapolis-based spokesman.

    Dog Tag Furniture’s criminal defense attorney, Marsh Halberg, did not dispute some of the spending allegations detailed in the affidavit but said “the Walkers were sloppy in the use of their private checkbooks and the corporate checkbook.”

    The Walkers paid for other funerals, but those payments came out of their private accounts, he said.

    Because federal authorities have seized their electronic records “we’re kind of handicapped in that,” Halberg said.

    “They were not living an affluent lifestyle,” Halberg said. “These people were not used to that. They weren’t business savvy in that sense.”

    The Walkers did take a Disney trip, Halberg said, but the organization’s board of directors “encouraged them to do that.”

    The federal search warrant affidavit claims that Walker told radio host Glenn Beck during an April interview that his organization pays an average of $3,600 per funeral and has funded about 200 of them but law enforcement "has found no evidence of Dog Tag Furniture providing any funds for other funerals, including the funerals Walker specifically referenced on social media, such as…an unnamed female Minnesota National Guard member” and two others.

    About $17,000 in Dog Tag Furniture funds instead went to pay Walker’s mortgage “after the residence went into foreclosure in or about August 2017,” according to the affidavit.

    “In lieu of salary, the organization paid for basic living expenses so they could continue to live,” defense attorney Halberg said. “They did pay for mortgages and food.”

    Dog Tag Furniture was founded in 2015 as a for-profit corporation, according to the federal search warrant affidavit.

    It was initially created to provide a second income to bankroll a future trip to Disney World, but turned altruistic after Walker’s friend killed himself, according to the organization’s website.

    Walker applied for tax-exempt, non-profit status in September 2017 and received an approval letter from the Internal Revenue Service in February, a copy of which was shared with Military Times.

    Although walker told Beck during his radio interview that neither he nor his wife drew salaries from Dog Tag Furniture, about $90,000 was transferred from the organization’s checking account to the Walkers' personal coffers between August 2017 and July 2018, according to the affidavit.

    The transfers occurred when "the Walkers’ personal bank accounts had limited other sources of income,” wrote Christine Kroells, a U.S. Postal Inspector, in her affidavit seeking a search warrant.

    The affidavit states the couple received unemployment benefits and what appeared to be worker’s compensation payments in 2017 and 2018, but Walker denies they received unemployment assistance.

    During the Nov. 22, 2017, appearance on Fox and Friends, Walker said he nearly lost his home a few months earlier but “a donor stepped forward and got me caught up on my mortgage” after his initial appearance on the show.

    “I was getting into so much debt with this flag building business,” he added.

    That contribution was part of a flood of Dog Tag Furniture purchases and donations Walker reported receiving after his first Fox and Friends appearance. Dog Tag Furniture’s website crashed after that first appearance, he said, with folks sending pledges ranging between $5 and $5,000.

    “Within five minutes of me being on the show I found out my voicemail can only hold 112 messages,” he added.

    While welcoming him back for his second spot on the show, Fox host Ainsley Earhardt announced that “Troy’s website received over $100,000 in sales, thanks to you, our amazing, generous viewers," in the hours following the first appearance.

    “I love that even when you were in dire straits, you use all the money still to pay for funerals, because you get your paycheck from the military,” Earhardt said.

    “Thank you for fighting for our country,” she added.

    Dog Tag Furniture portrays itself as an organization where Veterans help Veterans.

    Its logo features two hanging military identification tags forming a “22,” an oft-reported estimate of how many Veterans kill themselves each day, and Walker notes his Army service in videos on the organization’s website.

    “I was a ’19-Kilo,’ which translates to Abrams tank crewman,” Walker said in one website video. “Yes, I drove around the big beast of the battlefield.”

    But military service records show it’s been a long time since Walker drew Army pay.

    Walker enlisted in 1999 and left active duty in 2002, and his most recent rank change was to private, or E-1, in November of 2001, according to service records.

    Walker disputed the 2001 demotion in an email forwarded by his spokesman.

    “After 9/11 some of us didn’t get paid due to the pentagon (sic) damage, I wasn’t paid for almost 4 months and told my commander no pay, no training and walked off post until I got paid,” Walker wrote. “After I got paid, I was given an article 15 for AWOL and reduced from E-4 to E-3 and promoted back in a few months, not sure why it says E-1???”

    Walker said he served in the “Inactive Reserves” until 2009, when he was honorably discharged. Army officials reported he was in the Individual Ready Reserve from 2002 to 2007.

    Army officials said he was administratively separated from the service but declined to characterize the nature of his discharge.

    When Military Times requested a copy of Walker’s DD214 discharge form or other service records that might shed light on the alleged discrepancies, his spokesman wrote in an email that “since Feds searched and seized his computers and files late last month — Troy was left without any hard copy paper files or his hard drive to access files like this from.”

    “All my battle buddies have seen my interviews and have NEVER publicly disputed anything I said in regards to my service,” Walker said in an email forwarded to Military Times.

    The federal search warrant executed last month does not appear to be the only time law enforcement has searched Walker’s home.

    Carver County Sheriff’s Office deputies combed it as well, according to an April press release from the agency.

    In March, authorities said Walker provided Carver County deputies with a suspicious email he asserted was written by an official from his town of Norwood Young America, about an hour’s drive from Minneapolis.

    But deputies determined the message had been sent through Walker’s own IP address, “suggesting the email had come through Walker’s own computer(s),” the press release states.

    An email from someone named “Jacob” also claimed Norwood Young America officials were harassing Walker but county investigators found it also came from Walker’s IP address, the agency wrote.

    Like federal probes, local investigations often peter out without prosecutors indicting their targets.

    Angella Erickson — the criminal division manager for the Carver County Attorney’s Office — told Military Times that the matters raised in the sheriff’s release remain under investigation but there are “no current pending charges” against Walker or his wife.

    In an email shared with Military Times through his spokesman, Walker said the Carver County allegations are “actually what started this investigation.” In fact, he wrote, the county charges “were dismissed shortly after for lack of evidence” and he blamed local prosecutors for instigating the wider federal probe.

    “Since they could not get me on those charges, they called the FBI,” he continued. “That is why our books are so (wacky) is because they keep getting taken.”

    Erickson disputed Walker’s allegation and said local officials did not contact federal law enforcement about him.

    “To my knowledge, the Carver County Sheriff’s Office is not involved with any investigation by the FBI,” she said.

    Defense attorney Halberg said Dog Tag Furniture is “pausing everything” because of “negative publicity.”

    Source

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  • Chinese American

     

    Five Chinese-American Veterans were awarded the Congressional Gold Medal at VA’s Central Office in Washington, D.C., in a ceremony celebrating their service. The Veterans were selected to represent more than 20,000 Chinese Americans who served during World War II.

    (Click Source Link below to view Video)

    Source

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  • Class Action Mental Health

     

    Veterans and their family members who were treated by the military or the VA HealthCare system for mental health conditions need to be aware of several class action lawsuits currently active against several psychotropic medications. The medications include Abilify, Depakote (during pregnancy), Lamictal, Lexapro (during pregnancy), Paxil, Prozac, Risperdal, Seroquel, and Zyprexa.

    While these drugs work wonders for most people, for some they have caused complications that can be debilitating, disabling, and even life-threatening. If you were prescribed one of these medications by the military or the VA and any of the following symptoms manifested after starting the medication, you may be eligible for VA benefits related to residual health effects of the medication as well as be eligible for additional funds from class action lawsuits.

    Mental Health Medications

    1. Abilify: (generic Aripiprazole) Abilify was approved to treat certain mood disorders, specifically bipolar, schizophrenia, Tourette’s disorder, and irritability associated with autistic disorder. Pharmaceutical companies encouraged prescribers to use Abilify for off label disorders such as anxiety disorders, dementia, insomnia, PTSD, and obsessive/compulsive disorders. In some people, Abilify has been linked to causing obsessive/compulsive behaviors such as gambling and drug addiction. Otsuka America Pharmaceutical and Bristol-Myers Squibb failed to inform doctors and patients of the links between Abilify and compulsive behaviors, they hid evidence from the FDA and convinced doctors to prescribe Abilify off label (for conditions not approved by the FDA).
    1. Depakote and Lexapro: (generic divalproex sodium and escitalopram) Both drugs have been linked to birth defects when taken by pregnant women and to increased suicidal behaviors. Users of Depakote had a 12-fold increased chance of having a child with spina-bifida and there are also links to lower cognitive function. Lexapro (an SSRI) is linked to the birth defects omphalocele, craniosynostosis, and anencephaly.
    2. Lamictal: (generic Lamotrigine) Approved to treat epilepsy and bipolar disorder, Lamictal has been linked to aseptic meningitis, suicidal thoughts, birth defects, Stevens-Johnson syndrome, and Toxic Epidermal Necrolysis (also known as Lamictal rash). Glaxo-SmithKline failed to warn of the rare side effects and utilized a very aggressive marketing campaign to increase sales of its drug. The resulting settlement of $3 billion was one of the largest in history.
    1. Paxil: (generic Paroxetine) An SSRI also distributed by Glaxo-SmithKline, Paxil was promoted as non-habit forming when the company knew of severe withdrawal symptoms including anxiety, insomnia, irritability, nausea, and fatigue. Paxil is also linked to birth defects (especially heart defects when taken in the first trimester) and suicidal thoughts, with a specifically increased risk among 18-24 year-olds.
    1. Prozac: (generic Fluoxetine) Another SSRI, distributed by Eli Lilly, Prozac is linked to birth defects and suicidal thoughts, especially among younger patients. Eli Lilly failed to report potential side effects for almost a decade. While studies have linked birth defects to Prozac, the FDA has specifically connected persistent pulmonary hypertension of newborns to Prozac taken during pregnancy.
    1. Risperdal: (generic Risperidone) An antipsychotic approved for the treatment of schizophrenia, it has been linked to the abnormal growth of breast tissue in young men. Johnson & Johnson was aware of the risks and failed to increase warning labels despite requests by prescribers and was also accused of manipulating dated and withholding key data from the FDA to gain approval of the widely used drug for use with adolescents. Makers Johnson & Johnson were also cited for failing to explore and explain what appeared to be an excessive number of deaths among elderly patients. Risperdal is limited to use for schizophrenia, bipolar disorder, and irritability associated with autistic disorder.
    1. Seroquel: (generic Quetiapine Fumarate) This medication was approved by the FDA for use in the treatment of schizophrenia in adults and adolescents 13 years old and up and bipolar disorder in adults and adolescents 10 years old and up but AstraZeneca marketed for the treatment of dementia. The FDA has determined that Seroquel has increased the risk of death among dementia patients due to various side effects, mainly due to cardiovascular or infectious disease issues. Seroquel is also related to Tardive Dyskinesia (TDK), which is an irreversible condition characterized by involuntary facial movements and Neuroleptic Malignant Syndrome (NMS) which is a potentially fatal disorder that causes hyperpyrexia, muscle rigidity, altered mental status, and irregular heartbeat or blood pressure.
    1. Zyprexa: (generic Olanzapine) Eli Lilly was approved to market Zyprexa to sufferers of schizophrenia and bipolar disorder, but was marketed as effective for people with other mental conditions including Alzheimer’s dementia. Zyprexa has been linked to diabetes, excessive weight gain, pancreatitis, TDK, and NMS.

    Are You Using These Medications?

    If you have been safely using any of the above medications and are not experiencing any of the symptoms listed, please review any concerns with your treating providers but do not discontinue your medications without speaking to your provider.

    Source

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  • Heriberto Hartnack

     

    Before Heriberto Hartnack became Eddie — the man with a knack for solving the U.S. Department of Veterans Affairs’ bureaucratic maze and the go-to contact for struggling Veterans in Collier — he was the new guy.

    And Veterans seeking help at the Collier County Veteran Services Office to secure their federal benefits had no time for a newbie.

    “Nobody wanted to see me,” recalled Hartnack, 65.

    Instead, they asked to meet with his boss. A month into his new gig, a frustrated Hartnack contemplated quitting. Then his boss ordered a Veteran to see Hartnack.

    “Give me a chance,” Hartnack pleaded with the Korean War Vet.

    The ex-Marine had received only 20 percent disability pay. But Hartnack knew that based on the man’s experiences during the war, he should be at 100 percent. He reopened the case and within six months, he got his client there.

    “He was the happiest guy,” Hartnack said.

    Hartnack can’t remember the man’s name. But it earned him a nickname he hasn’t shed.

    “He was the one who called me Eddie,” Hartnack said with a chuckle.

    Word of Hartnack’s competence soon spread among Veterans. "Go see Eddie" became the message passed on from one to the next. Since he got his start with the Veteran Services office in 1996, Hartnack estimated, he has helped thousands of Veterans receive the benefits they deserve.

    Now, 22 years later, Hartnack, an Army Veteran who worked in logistics for the military, is retiring from his job as manager for Veteran Services. His official last day will be Wednesday, Jan. 2, but by Friday morning, Dec. 28, his transition to retirement already had begun.

    The awards that decorated the walls in his small office on the second floor of the county’s health building already had been taken down. Letters to the editor thanking him for his services were still plastered across his overhead office cabinets. He told a caller he could still meet him Friday.

    “Today is my last day,” he told the caller. “Want to come see me here today?”

    County Commissioner Donna Fiala, first elected in 2000, has sent Veterans to see Hartnack to get help. The word she associates with him is “devoted.”

    “The buck always stopped with him,” Fiala said. “He never put things off.”

    Collier’s various Veterans organizations also sang his praises, Fiala said.

    “Eddie would go out of his way to help....,” she said. “It was always about the Veterans.”

    Throughout his career, Hartnack did more than just try to secure the maximum disability benefits for Veterans. He helped Veterans get the medals they deserved, even decades after their service. He would assist loved ones left behind by Veterans who had died. He even played matchmaker.

    Rita Habighorst, 92, of Estero, credits Hartnack, in part, for encouraging her and Art Habighorst, 94, to marry in November. Both were widowed and had been together for about five years. And both came to Hartnack for help; Art as a World War II Veteran and Rita as the former spouse of a World War II Vet.

    Every time the couple came to see him, Hartnack encouraged them to get married, Rita Habighorst said.

    “Eddie convinced us. He said that we were too happy together and there was no reason why we couldn’t....,” she recalled. “Eddie could see that we were in love all the time.”

    The Habighorsts count Hartnack and his wife, Emelina, among their friends now. The office where Hartnack has spent more than two decades helping Veterans will miss him greatly, Rita Habighorst said.

    “He’s a great, caring person,” she said. “He cares and he does details and he doesn’t forget. And that’s what is so important. Today’s life is everybody’s a number, and Eddie made sure that we were a person.”

    Hartnack lists the late-in-life love story as one of his favorite memories of his career.

    Another cherished accomplishment is putting together a welcome-back-home parade for Vietnam War Veterans during last year’s July Fourth celebration in Naples. Hartnack has a particular soft spot for Veterans of that war and had been working for years to make the parade happen.

    “The reason I focus more on them is because when they came back home, they weren’t welcome,” Hartnack said, referring to Vietnam War Veterans. “They were spit on.”

    Part of what likely made Hartnack so successful in helping Veterans, said Lee Rubenstein, commander at American Legion Post 404 on Marco Island, was that he was a Veteran himself. Hartnack was “very dedicated” and “a master” of getting Veterans their benefits, he said.

    “He gets Veterans what they deserve and not the runaround,” said Rubenstein, 71.

    Rubenstein, who is 70 percent disabled and was helped by Hartnack, would bring him in to speak to fellow Veterans.

    “It was a chance for the Veterans to ask a lot of direct questions without getting tied up with the VA” and the bureaucracy, he said.

    Getting Veterans the disability benefits they deserve was often the difference between Veterans living a good life or not, Rubenstein said.

    “I think his service to the Veterans of Collier County is priceless,” he said.

    Although he’ll be “sorely missed,” Rubenstein said Hartnack’s replacement, Alexandra Scardino, is “excellent.”

    “He’s trained Alex to do all the right things,” he said.

    Hartnack agrees. He has trained Scardino since she became a service officer for the county a few years ago.

    “I’ve been mentoring her and (the) other service officer, and I noticed that she cares,” Hartnack said. “One of the issues here is if you really care. You have to work from the heart.”

    Hartnack said he will miss his Veterans. He still plans to help them in his spare time, working as a volunteer at local Veterans organizations.

    To him, the office he served in for more than two decades is the best place to work in the county.

    “You enjoy working every day,” Hartnack said. “I’ve been working here 22 years. I never had a day where I said, ‘I don’t feel like working,’ because I knew I was going to help someone.”

    Source

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  • Justice 005

     

    MISSOULA—A Columbia Falls man accused of stealing government benefits by overstating his disabilities admitted fraud and theft charges in federal court on Dec. 12, U.S. Attorney Kurt G. Alme said.

    John Cicero Hughes, 46, pleaded guilty to theft of government money and Social Security disability insurance fraud.

    U.S. Magistrate Judge Jeremiah C. Lynch presided and will recommend that Hughes’ plea be accepted by U.S. District Judge Dana Christensen, who is assigned to case.

    Hughes faces a maximum 10 years in prison, a $250,000 fine and three years of supervised release. Sentencing is set for April 12, 2019. Hughes is released.

    The government intends to seek restitution for the Veterans Administration and the Social Security Administration for an estimated loss totaling $830,061, with the understanding that Hughes will dispute that figure and that a judge ultimately will determine loss and restitution before imposing sentence.

    If the case had proceeded to trial, the government would have presented the following information as evidence:

    Hughes, a Navy Veteran, was determined in 2009 to be 100 percent disabled by the VA based on confirmation of a prior diagnosis that he suffered from multiple sclerosis. Hughes represented he had total loss of both hands and feet in addition to other maladies. From 2009 through July 2018, Hughes received more than $7,000 a month from the VA.

    In addition, because the VA had rated Hughes 100 percent disabled, he qualified for SS disability insurance benefits. The Social Security Administration paid Hughes and some of his family members about $1,400 a month from 2009 until the present.

    During the nine-year period, Hughes misrepresented the nature and extent of his disabilities to VA doctors and other health professionals by claiming he could not drive or walk more than a few steps, had double vision, had little to no feeling in his left arm and leg, could not shop for himself or prepare his own meals and was essentially bound to either his bed or a motorized wheelchair.

    An investigation found that Hughes drastically overstated his symptoms and limitations. In June 2017, the VA and SSA began an investigation into the extent of Hughes’ disability, which culminated in a Compensation and Pension Examination on Jan. 23, 2018 in Helena.

    During the examination, Hughes claimed he had not driven since 2008 without adaptive equipment and did not drive to Helena for the appointment. He said he could not walk more than a few steps and chose to remain in a wheelchair during the entire exam. He also said he could not shop for himself, was essentially house-bound, had almost no feeling in his left arm and leg and could not open his left hand because of spasticity caused by MS.

    Unbeknownst to Hughes, law enforcement officers surveilled Hughes when he arrived for the appointment, recorded and monitored the entire exam and surveilled him when he left the VA. Officers saw Hughes drive himself to the appointment in a truck with no adaptive equipment and walk into and out of the VA. Hughes then drove himself around Helena, running errands, including walking with a cane around a grocery store and using both hands to play machines at a local casino.

    Agents also surveilled Hughes’ activities in the Flathead Valley in 2017. Agents saw Hughes drive a car and a Harley Davidson motorcycle several times, walk distances he had claimed for years he could not cover and do chores, including climbing a ladder during a snowstorm to brush snow off the roof of a recreational vehicle.

    On Aug. 1, 2017, Hughes received a direct deposit of $7,056 from the VA into his bank account. The same day, agents observed Hughes drive his motorcycle to and from a car wash and walk about 50 feet without a cane.

    When agents interviewed Hughes at his residence in February 2018, he stuck to his story about the extent of his disabilities but admitted to driving a motorcycle in the summer of 2017 and to driving to the VA exam in January. He eventually admitted to making some misrepresentations to the examiner at the VA and told the agents, “If it was wrong, it was wrong.”

    Assistant U.S. Attorney Timothy Racicot is prosecuting the case, which was investigated by VA’s and SSA’s Offices of Inspector General.

    Source

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  • Weed Killer

     

    Glyphosate, an herbicide that remains the world's most ubiquitous weed killer, raises the cancer risk of those exposed to it by 41%, a new analysis says.

    Researchers from the University of Washington evaluated existing studies into the chemical -- found in weed killers including Monsanto's popular Roundup -- and concluded that it significantly increases the risk of non-Hodgkin lymphoma (NHL), a cancer of the immune system.

    "All of the meta-analyses conducted to date, including our own, consistently report the same key finding: exposure to GBHs (glyphosate-based herbicides) are associated with an increased risk of NHL," the authors wrote in a study published in the journal Mutation Research.

    The potential carcinogenic properties of glyphosate are the subject of widespread scientific debate. The US Environmental Protection Agency said in a 2017 draft risk assessment that the herbicide "is not likely to be carcinogenic to humans," while the European Food Safety Authority maintains a similar stance. Bayer, which acquired Monsanto in 2018, said the same year that glyphosate is a "safe and efficient weed control tool."

    In 2015, however, the World Health Organization's International Agency for Research on Cancer classified glyphosate as "probably carcinogenic to humans." Moreover, the chemical has triggered multiple lawsuits from people who believe that exposure to the herbicide caused their non-Hodgkin's lymphoma. In 2017, CNN reported that more than 800 people were suing Monsanto; by the following year, that figure was in the thousands.

    One high-profile case against Monsanto was that of Dewayne Johnson, a former school groundskeeper diagnosed with terminal non-Hodgkin lymphoma in 2014. In August 2018, a judge ordered Monsanto to pay Johnson $289 million in damages, an award subsequently reduced to approximately $78 million after Monsanto appealed.

    The authors of the University of Washington report analyzed all published studies on the impact of glyphosate on humans. Co-author and doctoral student Rachel Shaffer said in a statement: "This research provides the most up-to-date analysis of glyphosate and its link with Non-Hodgkin Lymphoma, incorporating a 2018 study of more than 54,000 people who work as licensed pesticide applicators." The scientists also assessed studies on animals.

    Focusing on data relating to people with the "highest exposure" to the herbicide, the researchers concluded that a "compelling link" exists between glyphosate exposure and a greater risk of developing non-Hodgkin lymphoma. Senior author Lianne Sheppard, professor in biostatistics and environmental and occupational health sciences, said she was "convinced" of the carcinogenic properties of the chemical.

    In a statement, Bayer called the new analysis a "statistical manipulation" with "serious methodological flaws," adding that it "provides no scientifically valid evidence that contradicts the conclusions of the extensive body of science demonstrating that glyphosate-based herbicides are not carcinogenic."

    The authors of the new study acknowledged some limitations of their analysis, noting that "only limited published data" was available. Moreover, they wrote, studies they evaluated varied in the population groups they targeted: specifically, the glyphosate exposure levels of the participants differed between reports.

    The available studies also neglected to assess the impact of the "green burndown" farming method, which sees glyphosate herbicides added to crops before they are harvested. Glyphosate residue has probably increased since the introduction of this method in the mid-2000s, the researchers wrote.

    Francis Martin, a biosciences professor at the University of Central Lancashire, told CNN he welcomed the University of Washington report. He called the debate over the safety of glyphosate "important," explaining that "glyphosate is used as a general purpose herbicide so there will be exposure in the general population."

    However, he noted that the report was limited by the small number of existing studies on the subject, though he stressed that the authors were "honestly self-reflective on the limitations of the analyses."

    "[The report] highlights the need for new, well-designed and robust studies at appropriate exposure levels," Martin said, adding, "The number of robust studies in the literature examining this question is pathetically small."

    Source

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  • Research Funding

    Today, the president signed a bill that increases federal research funding and takes important steps to better support our nation's care partners. Through its tireless advocacy work, the Parkinson's community played a role in the passage of this important law.

    Law Bolsters Funding for Research

    A critical provision provides funding for the National Neurological Conditions Surveillance System. This database will capture demographic information on people living with neurological diseases, which is key to helping researchers target their work and increase understanding of these conditions. While it was signed into law in late 2016, the database was never funded or implemented. But with the passage of this bill, it now can become a reality. (As the law does not specify which diseases the National Neurological Conditions Surveillance System will track, the Foundation is working with the Centers for Disease Control and Prevention, which will house the database, to push for the inclusion of Parkinson's.)

    The law also includes a $2 billion funding increase for the National Institutes of Health (NIH). The NIH is the largest public funder of Parkinson's research, investing $169 million in the disease in 2017. This funding boost is key to supporting the foundational research the agency carries out to better understand, diagnose and treat various health conditions.

    Throughout 2018, the Parkinson's community made a strong push for these funding priorities. Thousands of people with Parkinson's and their loved ones sent their lawmakers more than 46,000 emails asking for money for the database and the NIH. These funding successes are a testament to the critical work of Parkinson's advocates across the country.

    New Council Seeks to Better Support Care Partners

    Another significant provision in the law provides $300,000 to fund activities outlined in the RAISE Family Caregivers Act. This act was signed into law in January 2018, thanks in part to the advocacy efforts of the Parkinson's community, and directs the government to create a national strategy to better support the estimated 40 million care partners across the country. The $300,000 will be used to create a Family Caregiving Advisory Council, which will identify actions that communities, providers, policymakers and others can take to better assist care partners.

    We encourage you to reach out to you legislators to thank them for passing this law. This helps members of congress better understand how they can use their votes to pass bills that positively impact our community. You can quickly send your lawmakers an email on our website.

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  • Ryne Robinson

     

    WASHINGTON — Everywhere he went in Iraq during his yearlong deployment, Ryne Robinson saw the burning trash pits. Sometimes, like in Ramadi, they were as large as a municipal dump, filled with abandoned or destroyed military vehicles, synthetic piping and discarded combat meals. Sometimes he tossed garbage on them himself.

    “The smell was horrendous,” said Mr. Robinson, who was in Iraq from 2006 to 2007.

    About nine years after returning home to Indiana, where he worked as a corrections officer, he began to suffer headaches and other health problems, which doctors attributed to post-traumatic stress. After having a seizure while driving on Christmas Day last year, though, he was told he had glioblastoma, an aggressive brain tumor.

    Of the ailments endured by the newest generation of Veterans — post-traumatic stress disorder, traumatic brain injuries, lost limbs and more — among the least understood are those possibly related to exposure to toxic substances in Iraq and Afghanistan, especially from those fires known as burn pits.

    Now, with the largest freshman class of Veteran lawmakers in a decade, Congress appears determined to lift the issue of burn pits from obscure medical journals and Veterans’ websites to the floors and hearing rooms of Capitol Hill. Members are vowing to force the Pentagon and the Department of Veterans Affairs to deal with the issue.

    Tens of thousands of those who served in Iraq and Afghanistan were exposed to burn pits, which were regularly used to dispose of all manner of refuse in giant dumps ignited by jet fuel. Discarding waste was an especially acute problem for troops there, as huge bases were established in locations that had no infrastructure for proper disposal or existing sanitation services had been shattered by combat.

    From June 2007 through Nov. 30, 2018, the Department of Veterans Affairs processed 11,581 disability compensation claims with at least one condition related to burn pit exposure, according to Curt Cashour, a department spokesman. Of those, 2,318 claims were granted.

    But almost 44 percent of burn-pit-related claims were denied because the condition had not been officially diagnosed, while roughly 54 percent were “due to a lack of evidence establishing a connection to military service,” Mr. Cashour said.

    Tens of thousands more Veterans have signed up with a national registry, noting that they were exposed to the more than 250 burn pits used in Iraq and Afghanistan, like those at the smallest outposts or the giant dump at Balad Air Base, where an immense pit burned 24 hours a day. There is no clearinghouse that enumerates deaths associated with these toxic exposures, something that advocacy groups seek.

    After Mr. Robinson’s diagnosis, his wife, Chasity, was grilled by a local Department of Veterans Affairs representative about his deployment. Where had he been and for how long? She wondered, What did this have to do with his tumor?

    “I started to do the research,” she said, and realized that many other Veterans and their families, including former Vice President Joseph R. Biden Jr., believed that such tumors stemmed from breathing toxic fumes from the open-air trash fires that were standard on American military bases in the desert war zones since Sept. 11, 2001. “I wish they would have told us about this instead of throwing us to the wolves,” she said.

    Congress is listening. Both the House and Senate Committees on Veterans’ Affairs plan to review the process for adding diseases to the Department of Veterans Affairs’ list of presumed service-connected illnesses used to determine disability compensation. That already worries department officials because of the potential for explosive costs — and the difficulty of accurately determining whether diseases are caused by burn pit exposure.

    “It is a top priority to make sure Veterans who have service-connected diseases have the care and benefits they are owed,” said Senator Johnny Isakson, Republican of Georgia and the chairman of the Senate Committee on Veterans’ Affairs. There are also concerns about exposure to depleted uranium, which was used in tank armor and in the ammunition intended to penetrate enemy-armored vehicles.

    “We are going to make a lot of noise this year,” said Representative Raul Ruiz, Democrat of California and the co-chairman of the bipartisan House caucus on burn pits. “You are starting to see more and more people come out of the military with illness and diagnosis and realizing they have been exposed to burn pits.” He and other members have already introduced a flurry of bills.

    In interviews, Mr. Biden has speculated that toxic substances from burn pits contributed to the brain cancer of his son Beau. The younger Mr. Biden served in Iraq, as a major in the Delaware Army National Guard in 2009, and died of the illness in 2015.

    Scores of other Veterans and their families have said they believe those toxic substances contributed to their illnesses, many of them fatal, a claim the Department of Veterans Affairs said is not supported by evidence.

    “The V.A. looks continually at medical research and follows trends related to medical conditions affecting Veterans,” Mr. Cashour, of the Veterans department, said.

    Megan Kingston, who was deployed to Iraq in 2007, described her path from the Army to civil servant, and now as a disabled Veteran in need of constant oxygen.

    “I looked at that trash pit and knew it was going to hurt us one day,” Ms. Kingston said. In 2014, she was training for a triathlon, and “one day, I went for a run,” she said. “Next day, I could not breathe.”

    “This is our generation’s Agent Orange,” said Senator Amy Klobuchar, Democrat of Minnesota, referring to an herbicide known to sicken Veterans in Vietnam. She has already gotten some research legislation passed on burn pits and has more on the horizon, motivated, like many members of Congress, by the stories of affected constituents.

    Proving a link between toxic substances in war zones and subsequent illnesses suffered by Veterans — especially years after a war — has long been difficult, expensive and politically onerous.

    Years after Agent Orange has become widely accepted as a cause of illness among Veterans of the Vietnam War, there has been a protracted struggle over benefits for those who were sickened after serving off the coast during that conflict.

    Last month, the United States Court of Appeals found those sailors, known as Blue Water Navy Veterans — an estimated 90,000 who served in ships off the coast of Vietnam — to be eligible for the same Agent Orange exposure benefits as troops who served on land in Vietnam. The Department of Veterans Affairs has yet to respond.

    The Supreme Court recently rejected an appeal to hold private companies responsible for burn pits, upholding an appellate court ruling that blocked more than 60 lawsuits from moving forward.

    “It took decades and decades for the U.S. government to acknowledge that Agent Orange created devastating health effects for soldiers,” Ms. Klobuchar said. “We can’t let that happen again. I think you’re not going to get help in the courts, so we are going to have to step up — a lot of this will be oversight.”

    Lawmakers and some doctors say that the Pentagon has also been doubtful of claims.

    “It thought it was telling that last hearing, D.O.D. refused to send a representative,” said Representative Tulsi Gabbard, Democrat of Hawaii, referring to the Defense Department. She has helped sponsor legislation to evaluate the exposure of service members to toxic chemicals.

    “There is no question a large number of individuals were exposed to high levels of toxic waste,” said David A. Savitz, who served as the chairman of a committee that studied the issue for the Veterans department. “But when you go to the level of ‘show me’ the increased risk of the health conditions, that’s where the evidence breaks down pretty quickly.”

    Some doctors — and many patients and their families — are more certain.

    “I started seeing young people with similar types of presentations of uncharacteristic malignancies at young ages,” said Dr. Warren L. Alexander, an oncologist who has worked extensively with Veterans at the William Beaumont Army Medical Center in El Paso. “There were about 10 percent of unexplained malignancies, where the patient had no history of drinking or smoking. When you have very aggressive cancers that do not respond to standard therapy, that’s what makes you think it was due to exposure.”

    In 2004, Dr. Robert F. Miller of Vanderbilt University studied soldiers who returned from Iraq with unexplained shortness of breath. He performed surgical biopsies on about 60 Veterans’ lungs, which in most cases revealed evidence of constrictive bronchiolitis, an incurable disease stemming from tiny particles lodged in the airways.

    Many believe that the small number of Americans serving in the military — less than 1 percent of the population — has kept the issue from public view.

    “The burn pit issue has not gained traction in terms of research money or public policy,” said Dr. Anthony M. Szema, an allergist-immunologist and the former chief of allergy medicine at the Veterans Affairs Department who has researched the relationship between particles and respiratory illnesses. “I have been invited to give lectures at the Pentagon and it’s two hours of them yelling at me. They understand there is a problem, but they don’t want to take the blame for it.”

    Pentagon officials acknowledge that the Defense Department is concerned that toxic substances from burn pit emissions may pose health risks and is assessing the long-term effects. “D.O.D. and V.A. are working to develop a standard approach to screening and evaluation of service members and Veterans with post-deployment respiratory complaints to improve care,” said Jessica Maxwell, a spokeswoman for the defense secretary.

    Advocates say that without a diagnosis and recognition of illnesses, benefits are often denied, especially for the families of the dead.

    “What happens when the Veteran has died, you have many families left with no benefit of the death,” said Rosie Torres, the executive director of Burn Pits 360, which helps press for those who believe they were sickened by burn pits. Her husband, Le Roy Torres, an Army captain in Iraq in 2007, has been told he has constrictive bronchiolitis.

    She said her organization has tracked at least 130 deaths related to toxic exposure.

    Veterans’ service organizations — which sometimes compete for attention on certain policy matters — are beginning to form a coalition around the issue.

    “We know that our government’s senior leaders need confirmatory data as the basis for changes to current policy,” said Derek Fronabarger, a legislative director for the Wounded Warrior Project. “And we are asking them to take the issue of toxic exposure seriously and work with us to determine correlation.”

    Source

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  • Congressman Wants Answers

     

    ST. PETERSBURG, Fla. (WFLA) - Alarmed by an 8 On Your Side investigation of a Veteran mistreated by the VA, Florida Congressman Gus Bilirakis made a beeline to his home state to get answers and offer help.

    The Pinellas County Representative wants to know why VA doctors couldn't figure out what is wrong with Veteran Mike Henry.

    "This is a Veteran, we've got to give him the best possible treatment you can get," Congressman Bilirakis stated.

    Last week, 8 On Your Side revealed Henry languished in pain for months under VA care.

    That changed quickly when Henry visited Tampa General Hospital, where he was diagnosed with a neurological disorder within an hour.

    Henry suffers from a condition in which nerve cells in his brain trigger uncontrollable muscle contractions in his face, neck and shoulder.

    It causes intense pain and swelling.

    "It actually feels like somebody has a knife, a steak knife in here, and they're just slowly twisting," Henry said as he pointed to his temple.

    According to Henry, one Bay Pines doctor called him a faker and accused him of being after drugs.

    "Then he grabs me right here, my neck was swollen and he's shaking me around. And then I said, 'what are you doing? Are you crazy?' He goes, 'oh you're talking normal now, you're just a faker, I told you that's what you were,'" Henry recalled.

    Henry explained what he experienced at the VA's C. W. Bill Young Medical Center at Bay Pines to Congressman Bilirakis.

    "We want to help them. I told them I'll help them, whether they want to stay with the VA at Bay Pines or transfer possibly to Haley or get private care, I'm here to help," Congressman Bilirakis said.

    The home visit left Mike and Shelly hopeful, especially since Bilirakis offered one of his staff to accompany Mike.

    "He would like to go with Mike to his next VA appointment and he's going to follow up with us," Shelly Henry added.

    Henry has a medical background. He hopes to sit with the VA to discuss mistakes he thinks the Bay Pines made.

    "Then maybe that would let them know, 'ah ha, maybe this is something we need to look at,'" Henry explained.

    The Henrys are thankful someone is watching out for them.

    "I will be forever grateful for you guys for doing this and hopefully you guys aren't just covering my case, you'll help some of the other Veterans and let the people know they have a voice," Henry added.

    "You have been wonderful," Shelly Henry said. "Thank you so much, I really hope this helps other Veterans.

    Now that a Congressman is watching over Mike Henry's case, he is hopeful a more meaningful dialogue will take place with Bay Pines about his care and treatment.

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  • Vet went without diagnosis

     

    ST. PETERSBURG, Fla. (WFLA) - An 8 On Your Side investigation into why the Department of Veterans Affairs failed a Pinellas County Veteran has two Congressman demanding answers.

    Rep. Gus Bilirakis (R) FL and Rep. Charlie Crist (D) FL want to know why doctors at the C.W. Bill Young VA Medical Center couldn't figure out what was wrong with Mike Henry.

    They also want to know if this Veteran was mistreated while he was a patient at Bay Pines.

    Mike Henry told 8 On Your Side that one VA doctor called him a faker and drug seeker and even grabbed and shook him.

    The VA says it investigated that allegation but can't confirm it.

    After months of tests it also couldn't confirm what was wrong with Mike Henry.  

    Congressman Gus Bilirakis labels it VA incompetence.

    "It's inexcusable for the Veteran to have that type of pain," Rep. Bilirakis said.

    Following 8 On Your Side's Thursday report detailing the inability of Bay Pines to diagnose Henry's problem, Congressman Crist is reaching out "to ensure he is receiving the medical care, support and assistance he needs."

    So is Bilirakis.

    "I'll go over to his house and talk to him personally," explained the congressman.

    "That way I get a better understanding of what happened and I hear directly from him and his wife and then we'll go to work for him."

    Henry's medical issues flared up in June.

    Severe swelling in his shoulder, neck, and face, caused excruciating pain.

    Why couldn't VA doctors figure it out?

    In an email Bay Pines told us, "The symptoms Mr. Henry presented....were evaluated...laboratory tests and imaging results were not conclusive."

    Nonetheless a VA doctor concluded, "This patient has no active neurological disease to require further attention from our neurology service."

    "I'm thinking I'm going to sit here and die," Henry stated.

    He left Bay Pines and went to Tampa General Hospital.

    Within an hour, doctors quickly determined a neurological problem triggered uncontrollable muscle contractions.

    According to Henry, one VA doctor called him a faker and a drug seeker.  

    "Then he grabs me right here, my neck was swollen, and he's shaking me around and then I said, 'what are you doing? Are you crazy?' He goes, 'oh you're talking normal now, you're just a faker, I told you that's what you were,'" Henry explained.

    The VA contends it investigated the allegation and could not substantiate it.

    His wife Shelly says Henry suffered tremendously at the VA.

    "It breaks my heart to see that happen to anybody, especially him and especially Veterans," Shelly explained.

    "The way Veterans are treated, they're treated like garbage. They're treated like garbage in this country, especially by the VA. It's really sad."

    An email from Bay Pines claims it offered to refer Henry to outside specialists but he declined.

    He contends that is just not true. He says the VA did not approve visits its doctors recommended.

    An email sent to the Bay Pines Chief of Staff by Shelly pointed out they ran up medical costs of close to $200,000 visiting outside specialists.

    The VA states Henry left the hospital against medical advice.

    Nursing notes show his attending physician said, "they've tried everything, now they will try nothing and see how bad it gets."

    At that point, Henry decided it was time to leave.

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  • Bad Paper Vets

     

    For an estimated 500,000 Veterans, being put out of the military with an other than honorable discharge is a source of shame and an obstacle to employment. "Bad paper," in most cases, means no benefits or health care from the Department of Veterans Affairs — even when the problems that got them kicked out were linked to PTSD, traumatic brain injury or military sexual assault.

    But last month, Connecticut opened state VA resources to Vets who can show that one of those conditions is linked to their discharge. For Veterans like Thomas Burke, now a youth minister at Norfield Congregational Church, it's part of a long path to recovery.

    "When I first started looking for jobs, I did not want to be a youth minister to kids, because my PTSD stems from a traumatic event where I failed children," says Burke.

    Burke did two combat deployments with the Marine Corps within the space of one year. After a rough tour in Iraq, he found himself in southern Afghanistan, based in a tiny village, living close to civilians. Burke had been trained in the local language, and he connected with the village kids. In one photo, Burke is in combat gear, playing with 15 laughing boys on a dusty road. He says local boys helped out — they would tell them where IEDs were. He grew to love them and they loved him back.

    "They'd bring us bombs," he says. "On one of those occasions they were bringing us [a rocket-propelled grenade], and it ended up exploding on them."

    When Burke heard the blast, he and other Marines rushed out to find eight of the kids from that photo dead.

    That sent him into a spiral — the local hashish was plentiful and many soldiers used it. Burke started smoking heavily and got caught.

    Suddenly a promising young Marine was getting kicked out with an other than honorable discharge — a sort of scarlet letter for a Veteran, which many say is worse than never having served at all.

    Burke was flown to his home base in Hawaii, where a mix of prescriptions and street drugs made things worse. Then, he flew back home.

    "I took a plane to Connecticut and slit my wrists in a state park," he says.

    Veterans with an other than honorable discharge have higher rates of suicide. They're at higher risk of homelessness. Mental health issues can snowball with economic ones: When employers ask about military service, they also ask about discharge status — so for job prospects, it is worse than never having served.

    "These individuals up till now were denied clinical support services and other programs and benefits, and we believe in many cases may have resulted in a worsening of their conditions," says Thomas Saadi, Connecticut's commissioner for Veterans affairs.

    Saadi says it makes both moral and practical sense to help these Vets before they're in crisis. And that's what Connecticut is now doing, thanks in part to the efforts of Veterans like Burke.

    After Burke's failed suicide attempt, the VA made a rare exception, and he was able to get services. He started down a different path — to become a pastor.

    And he joined a push to change the law around other than honorable discharge. He found allies in the state Legislature, like Republican Rep. Brian Ohler, also a combat Vet.

    "When we testified before the Veterans Affairs Committee, [Thomas] and I were sitting right next to each other," says Ohler. "And I said the only difference between Thomas and I is a piece of paper — one that says honorable discharge and the other that says other than honorable."

    It took years of lobbying, but as of last month, Connecticut Veterans whose other than honorable discharge is linked to PTSD, brain injury or sexual assault will qualify for state health care and benefits, including tuition to state schools.

    The national VA is changing too — earlier this year Sen. Chris Murphy, D-Conn., pushed through legislation that makes VA mental health care available nationwide to Veterans with other than honorable discharges, though it has been slow to roll out.

    For Burke, helping get recognition and treatment for other bad-paper Vets has been part of feeling whole again. When he hears kids laughing, it still triggers memories of Afghanistan, but he can smile through them now.

    "The opportunity to work with children fills me with the spirit and life and joy in a way that I can't even explain, because it also makes me recognize how far I've come from the person who got back from war," says Burke.

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  • Vets Felony Charges

     

    Majority in Felony Veterans Treatment court appear for drug, alcohol offenses

  • VA got it wrong

     

    TAMPA, Fla. (WFLA) - A federal court ruled the Department of Veterans Affairs got it wrong when it deprived tens of thousands of Vietnam Veterans the benefits they deserve.

    In an 8-3 decision, the U.S. Court of Appeals decided Navy Veterans of the Vietnam War are absolutely entitled to Agent Orange related medical and disability benefits.

    Alfred Procopio, a Veteran who served on the U.S.S. Intrepid off the coast the Vietnam, suffers from diabetes and prostate cancer, two diseases linked to Agent Orange exposure.

    The VA denied his claim, pointing out that Procopio never stepped foot in Vietnam.

    The Court of Appeals pointed out in its decision that Congress was specific when it passed the Agent Orange Act in 1991, to include "active military, naval, or air service... in the Republic of Vietnam."  

    The court decided Procopio served in Vietnam's territorial waters which are part of the "Republic of Vietnam."

    The ruling affects between 50,000 to 90,000 Navy Veterans the VA excluded from benefits.

    For nearly 20 years, the VA presumed that members of the military who served on the ground during the Vietnam War were exposed to the toxic herbicide.

    Agent Orange killed and made ill thousands of service members.

    The VA provided medical care and disability benefits to those who developed diseases linked to the toxic weed killer.

    However, it excluded Navy Veterans like Mike Kvintus of New Port Richey, who served along the coast of Vietnam.

    Kvintus' ship also anchored in Vietnam harbors.

    "We've been fighting them since 2001," Kvintus stated.

    Blue Water Navy Veterans argue Agent Orange ran into rivers and streams, ending up in Vietnam's bays and harbors.

    Their ships pulled in that water, for drinking, bathing and cooking.

    Distilliation systems didn't eliminate Agent Orange, they enhanced it.

    Kvintus has three diseases associated with Agent Orange exposure.

    Former Navy Commander now attorney John Wells, executive director of Military Veterans Advocacy, fought the VA in Congress and the courts.

    "It feels very good. I mean we've been fighting for this for eight years," Wells said.

    Last year, the U.S. House of Representatives unanimously passed a bill restoring the rights to Blue Water Navy Veterans that the VA stripped away.

    Senator Mike Lee (R) Utah effectively torpedoed the bill when he asked for more studies on the matter by the VA.

    The VA can fight the Court of Appeals the ruling by taking it to the U.S. Supreme Court.

    If it does, Wells is confident the VA will lose there too.

    Wells points out the fight for Veterans benefits doesn't stop here.

    "We have the Guam bill coming up and we have general toxic exposure," he said.

    "We have millions of Veterans exposed to various forms of toxic exposure. We can't stop with Blue Water Navy, this is just the first step."

    Source

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  • Vet Pensions

     

    VIRGINIA BEACH, Va. (WAVY) -- 10 On Your Side is helping Veterans prepare for a new rule that goes into effect on Thursday, Oct. 18.

    According to the U.S. Department of Veterans Affairs, pensions will change beginning Thursday for those of you using long-term care services.

    Shannon Laymon-Pecoraro, a lawyer with Hook Law Center, says failing to plan is planning to fail when it comes to these changes.

    "In a region like ours that is home to so many military Veterans, we think it’s important to tackle this issue head-on so people can start to address these changes before they take effect," Laymon-Pecoraro said.

    Laymon-Pecoraro is referring to Veterans like Frank Rough, a retired senior chief who served in Vietnam.

    "I planned all my life for retirement and to have that possibly taken away so I could have Veterans benefits is crazy," said Rough.

    Rough is talking about changes that could make it more difficult to qualify for certain important benefits, according to Hook Law. That's why Rough and other Veterans attended a Hook Law seminar regarding the changes.

    The VA pension program is a needs-based benefit for wartime Veterans who served at least 90 days active duty service, who have limited or no income, who are 65 and older and who may have a permanent and non-service connected disability.

    What's at risk? According to Hook Law, aid and attendance pension up to $2,170 per month for a Veteran and spouse -- which is money that could be used for long-term care.

    With the new rules, assets cannot exceed $123,600 to get the long-term benefits.

    According to the seminar presentation, gifts that you made in the past 36 months -- either to a family member or to an irrevocable trust and an investment in an annuity -- would be penalized with the new rules.

    This means you could be prohibited from qualifying for VA pension benefits for up to five years, depending on the amount of the gift.

    "I'm getting older and I may need long-term care and if I go into long term care and they start taking the money I've saved - that's awful," said Rough.

    So, what should you do between now and Oct. 18?

    Laymon-Pecoraro said, "Assess are there any significant transfers you want to make or any assets you want protected so that you can then qualify for this benefit if you think you may need within the next 3 to 5 years."

    It is important to note this change does not affect all Veterans.

    According to Hook Law, if you are receiving VA service-connected disability or compensation payments, your benefits will not be affected.

    Source

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  • Salathiel Gaymon Sr

     

    More than a year after her father died in his car in the parking lot of the Wilmington Veterans Administration Medical Center, Shelatia Dennis still struggles to understand why.

    Salathiel M. Gaymon Sr.'s body was found April 25, 2017, more than 17 hours after he walked out of the facility after his regular treatment in the Hemodialysis Unit.

    Dennis believes her father shouldn't have been discharged without having his condition assessed more closely.

    Gaymon's death prompted an investigation by the Department of Veterans Affairs Office of Inspector General, which published a report in September that judged the VA harshly but didn't place blame.

    The unit nursing staff did not appropriately monitor the patient's medical status, the report said, but could not "substantiate" that the care contributed to his death.

    An autopsy indicated that Gaymon had cardiovascular and kidney disease and "probably" suffered a fatal cardiac arrhythmia.

    The report did say that based on the available information and review of the electronic health record, quality of care concerns were identified related to Gaymon's clinical management while in the dialysis unit.

    Changes at the VA

    Wilmington VA Medical Center Director Vincent Kane said a day doesn't go by that he and his staff don't think about the events leading up to the tragedy. He was appointed shortly after Gaymon's death.

    The OIG report and internal analyses sparked changes in staffing and procedures, including many within the dialysis unit and police department.

    "If we could go back in time and know what we know now, I'm confident this wouldn't happen," Kane said. "We're committed to never letting something like this happen again."

    Chief among the 14 recommendations from the OIG was having the proper number of staff members in the Hemodialysis Unit and providing continuous education in all areas of the unit.

    According to Kane, that has happened and is now ongoing.

    "We've added a tremendous amount of staff since my arrival," said Kane. "We want to make sure we have processes and staffing in place to prevent tragedies moving forward."

    The police department has a new chief and those involved in the Gaymon tragedy were disciplined.

    Appointed rounds directed by VA policy were not done, meaning no one noticed Gaymon.

    "Those rounds should have happened. It's devastating to us," Kane said. "We've added more cameras and a training officer to make sure officers are compliant."

    A man of principles

    Dennis described her father as a man whose love of family was matched only by his love of God.

    She said he had no problem expressing the love and pride for his family and was an affectionate man who couldn't encourage his kids and grandchildren enough.

    But Dennis said her father also was all about advocacy and justice and often spoke out against injustices in the world. That is why one of his favorite musicians was Bob Marley, she said.

    Dennis believes what happened to her father was an injustice.

    "The quality of care that he was given was very poor," Dennis said recently from her Dover home on what would have been her father's 64th birthday. "It seems like anything that could have gone wrong did go wrong. It makes me so angry that they could get away with this."

    Questionable discharge

    Dennis said her father's blood glucose readings were through the roof that day in the Hemodialysis Unit, he was administered the wrong medication at the wrong time, his blood pressure was critically high and he was allowed to be discharged.

    "He was not OK," she said. "How could they not see something was wrong? If they had, maybe we wouldn't have had to have a funeral in May."

    Gaymon had been a regular patient at the Wilmington VA Medical Center since 1997 after he was diagnosed with diabetes. His medical records indicate he was often "noncompliant" in his treatment regimen and his diabetes was "uncontrolled" from 1997 to 2017.

    Dialysis was initiated in early 2016, and a few months later a kidney specialist ordered a blood sugar reading prior to each of his dialysis treatments.

    Critical to Gaymon's treatment were differences of opinions about unit policies concerning the patient's finger-stick blood sugar check.

    Gaymon's blood sugar was obtained 38 minutes after starting dialysis and it was shown to be critically high.

    According to the OIG report, a unit registered nurse believed it was acceptable to test the blood sugar within an hour of beginning treatment.

    The Office of Inspector General staff found no such policy.

    The OIG determined that the combination of the timing of the blood glucose test, which found Gaymon's blood sugar critically high and sparked a "routine" call for insulin rather than "stat," or immediately, resulted in more than a two-hour difference in treatment.

    The OIG report said the nursing staff did not check Gaymon's blood glucose before releasing him.

    Contributing issues

    Policies regarding treatment of Gaymon's critically high blood pressure also were called into question by the report.

    Gaymon was given medication to bring down his high blood pressure and then released 18 minutes thereafter.

    The medication given reduces blood pressure within 30 to 60 minutes, with the maximum decrease occurring within two to four hours, the report said.

    The report also said there was no evidence that staff conducted a full clinical assessment or provided Gaymon with instructions regarding the effects of the medication, including drowsiness and a recommendation not to drive.

    Dennis said video from the facility showed an unsteady, unhealthy individual in medical distress as her father walked out of the dialysis unit and fell on the hood of his car before getting in it.

    "The report was more confirmation," she said. "We already had a gut feeling that there was very poor quality of care and that there was definitely negligence on their part. We just didn't understand to what extent."

    Undignified death

    Dennis believes that even though the nurses and doctors failed her father, the Department of Veterans Affairs Police had an opportunity to "pick up the slack had they been doing their job."

    If police had done timely rounds in the parking lots as policy requires, they would have noticed Gaymon sitting in his car in a no-parking zone in valet parking.

    A hospital volunteer came across Gaymon in his car and alerted police.

    "If they would have noticed him within an hour, that might have been enough time to alert the doctors and get some help," Dennis said. "There was no dignity in the way he died."

    The officers were supposed to walk or drive the facility every hour, "so long as they are not on another call or doing a report.”

    The report said the facility's police officers violated policies by leaving the patient’s car in a visible illegal parking spot for more than 17 hours.

    Dennis recognizes her father's death affected changes, but said she will forever hold the facility accountable for taking her father away "too soon."

    "There were so many opportunities for people to make decisions that would have supported his life being sustained," Dennis said. "The healthcare was obviously the first misstep. But if the police force would have been doing its job, my father might still be alive today."

    Source

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  • VA Hospital Lags

     

    AUSA TODAY analysis of Veterans Affairs data provides the broadest picture of how each of 146 VA medical centers compares with non-VA care.

    When Navy Veteran Phyllis Seleska, 66, arrived at the emergency room at the Department of Veterans Affairs hospital in Loma Linda, California, in August 2017, the waiting room was crowded with dozens of Veterans, some in wheelchairs lined up to the entrance.

    Seleska suffered throbbing pain after shattering her wrist but received no medication and had to wait more than seven hours to see a doctor, records show. By then, the orthopedics staff had gone home. A nurse strapped a Velcro splint on her wrist and told her to come back in the morning.

    “I don’t know why it took so long to get back there to be told, 'We can’t do anything to help you,' ” said Seleska, who worked on the flight deck of aircraft carriers in both Iraq wars.

    Her experience wasn’t unusual. At roughly 70 percent of VA hospitals, the median time between arrival in the emergency room and admission was longer than at other hospitals, in some cases by hours, according to a USA TODAY analysis of the department’s data. That included Loma Linda, where the median wait is more than 7½ hours.

    The USA TODAY analysis provides the most comprehensive picture of how 146 VA medical centers compare with other health care facilities on an array of factors. The analysis is based on scores of spreadsheets the VA posted online in recent years containing comparisons of its medical centers with non-VA averages on everything from the ER wait times to infection rates and patient-survey results.

    The analysis produced some positive findings for the VA. As of June 30, a majority of VA hospitals reported lower death rates than other facilities. Many VA medical centers stacked up better on prevention of post-surgical complications such as blood clots.

    At the same time, dozens had higher rates of preventable infections and severe bed sores – a sign of potential neglect. Nearly every VA performed worse than other medical providers on industry-standard patient satisfaction surveys.

    Veterans are enduring longer emergency room wait times

    A USA TODAY investigation into VA Medical Centers shows that Veterans are enduring longer emergency room wait times than those at non-VA facilities.

    VA spokesman Curt Cashour said certain Veterans may have conditions that make them more susceptible to complications, and “caution should be exercised” when drawing conclusions from the comparisons.

    He said the VA “does recognize the need to improve the speed by which it can admit Veterans to the inpatient unit,” but he said non-VA hospitals also struggle with long waits.

    “VA provides some of the highest-quality health care available today,” Cashour said.

    CITY

    STATE

    HOURS

    WAIT TIME

    Fresno

    California

    11.9

    Worst 10%

    San Francisco

    California

    9.7

    Worst 10%

    Atlanta

    Georgia

    9

    Worst 10%

    Baltimore

    Maryland

    7.7

    Worst 10%

    Perry Point

    Maryland

    7.7

    Worst 10%

    Loma Linda

    California

    7.6

    Worst 10%

    Long Beach

    California

    7.5

    Worst 10%

    San Diego

    California

    7.3

    Worst 10%

    Buffalo

    New York

    7.3

    Worst 10%

    Memphis

    Tennessee

    7.3

    Worst 10%

    San Antonio

    Texas

    7.3

    Worst 10%

    Los Angeles

    California

    7.1

    Worst 10%

    Hampton

    Virginia

    6.9

    Worst 10%

    Tucson

    Arizona

    6.6

    Worst 10%

    Sacramento

    California

    6.5

    Worst 10%

    St Louis

    Missouri

    6.5

    Worst 10%

    Seattle

    Washington

    6.4

    Longer

    Miami

    Florida

    6.2

    Longer

    Albuquerque

    New Mexico

    6.2

    Longer

    Albany

    New York

    6.2

    Longer

    Philadelphia

    Pennsylvania

    6.2

    Longer

    Biloxi

    Mississippi

    6

    Longer

    East Orange

    New Jersey

    6

    Longer

    Durham

    North Carolina

    6

    Longer

    Montgomery

    Alabama

    5.9

    Longer

    Palo Alto

    California

    5.8

    Longer

    Chicago

    Illinois

    5.8

    Longer

    Syracuse

    New York

    5.8

    Longer

    West Haven

    Connecticut

    5.7

    Longer

    Washington

    District of Columbia

    5.7

    Longer

    Augusta

    Georgia

    5.7

    Longer

    Bay Pines

    Florida

    5.6

    Longer

    Gainesville

    Florida

    5.6

    Longer

    Lake City

    Florida

    5.6

    Longer

    Oklahoma City

    Oklahoma

    5.6

    Longer

    Lebanon

    Pennsylvania

    5.6

    Longer

    Little Rock

    Arkansas

    5.5

    Longer

    Bronx

    New York

    5.5

    Longer

    Dallas

    Texas

    5.5

    Longer

    Birmingham

    Alabama

    5.4

    Longer

    Phoenix

    Arizona

    5.4

    Longer

    Augusta

    Maine

    5.4

    Longer

    Ann Arbor

    Michigan

    5.4

    Longer

    Cincinnati

    Ohio

    5.4

    Longer

    Richmond

    Virginia

    5.4

    Longer

    Jackson

    Mississippi

    5.3

    Longer

    Tampa

    Florida

    5.2

    Longer

    Lexington

    Kentucky

    5.2

    Longer

    Detroit

    Michigan

    5.2

    Longer

    Reno

    Nevada

    5.2

    Longer

    Northport

    New York

    5.2

    Longer

    Charleston

    South Carolina

    5.2

    Longer

    New York

    New York

    5.1

    Longer

    Houston

    Texas

    5.1

    Longer

    Amarillo

    Texas

    5.1

    Longer

    Salem

    Virginia

    5.1

    Longer

    Milwaukee

    Wisconsin

    5.1

    Longer

    West Palm Beach

    Florida

    5

    Longer

    Salisbury

    North Carolina

    5

    Longer

    Orlando

    Florida

    4.9

    Longer

    North Chicago

    Illinois

    4.9

    Longer

    Salt Lake City

    Utah

    4.9

    Longer

    Indianapolis

    Indiana

    4.8

    Longer

    Louisville

    Kentucky

    4.8

    Longer

    Muskogee

    Oklahoma

    4.8

    Longer

    Shreveport

    Louisiana

    4.7

    Longer

    Las Vegas

    Nevada

    4.7

    Longer

    Dayton

    Ohio

    4.7

    Longer

    Murfreesboro

    Tennessee

    4.7

    Longer

    Nashville

    Tennessee

    4.7

    Longer

    Boston

    Massachusetts

    4.6

    Longer

    Kansas City

    Missouri

    4.6

    Longer

    Temple

    Texas

    4.6

    Longer

    Martinsburg

    West Virginia

    4.6

    Longer

    Beckley

    West Virginia

    4.6

    Longer

    Wilmington

    Delaware

    4.5

    Longer

    Hines

    Illinois

    4.5

    Longer

    Cleveland

    Ohio

    4.5

    Longer

    Pittsburgh

    Pennsylvania

    4.5

    Longer

    Cheyenne

    Wyoming

    4.5

    Longer

    Spokane

    Washington

    4.4

    Longer

    Prescott

    Arizona

    4.3

    Same

    Columbia

    South Carolina

    4.3

    Same

    Denver

    Colorado

    4.1

    Shorter

    Des Moines

    Iowa

    4.1

    Shorter

    Leavenworth

    Kansas

    4.1

    Shorter

    Topeka

    Kansas

    4.1

    Shorter

    Asheville

    North Carolina

    4.1

    Shorter

    Fargo

    North Dakota

    4.1

    Shorter

    Providence

    Rhode Island

    4.1

    Shorter

    Mountain Home

    Tennessee

    4.1

    Shorter

    Fayetteville

    Arkansas

    4

    Shorter

    Dublin

    Georgia

    4

    Shorter

    Wilkes Barre

    Pennsylvania

    4

    Shorter

    Minneapolis

    Minnesota

    3.9

    Shorter

    Roseburg

    Oregon

    3.9

    Shorter

    Portland

    Oregon

    3.9

    Shorter

    Huntington

    West Virginia

    3.8

    Shorter

    Madison

    Wisconsin

    3.8

    Shorter

    Marion

    Illinois

    3.7

    Shorter

    Boise

    Idaho

    3.6

    Shorter

    Fort Wayne

    Indiana

    3.6

    Shorter

    Marion

    Indiana

    3.6

    Shorter

    White River Junction

    Vermont

    3.4

    Shorter

    Clarksburg

    West Virginia

    3.3

    Shorter

    Iowa City

    Iowa

    3.2

    Shorter

    Omaha

    Nebraska

    3.2

    Shorter

    Fort Meade

    South Dakota

    3.2

    Shorter

    Hot Springs

    South Dakota

    3.2

    Shorter

    Wichita

    Kansas

    3.1

    Shorter

    Columbia

    Missouri

    3.1

    Shorter

    Grand Junction

    Colorado

    2.9

    Shorter

    Sioux Falls

    South Dakota

    2.8

    Shorter

    The Department of Veterans Affairs has been buffeted by crises since 2014 when news reports revealed that patients died awaiting appointments at the Phoenix VA hospital. There were lethal lapses in Oklahoma City, patient safety failures in Memphis, Tennessee, and equipment and sterilization problems in Washington.

    The USA TODAY analysis adds to evidence of uneven quality within the VA system. Some hospitals, such as those in Asheville, North Carolina, and Sioux Falls, South Dakota, excel on a wide range of measures while others, such as Memphis, lagged.

    The Trump administration is considering sweeping rules to widen Veterans’ access to outside health care paid for by the VA. That would deliver on a presidential campaign promise made by Donald Trump to expand health care choices for Veterans.

    Critics warned that increasing VA-funded private health care would drain money from the department and lead to its privatization.

    As the administration weighs the standards under which expanded non-VA options would be allowed, it is considering variables such as wait times, distance and – for the first time – quality.

    The VA began publishing online an array of spreadsheets it dubbed “scorecards” in the months after Trump took office. The quarterly assessments include comparisons on 65 measures.

    USA TODAY compiled and analyzed the scorecards from June 30, the most recent available, and found that death rates after heart attack, heart failure and pneumonia were the same or lower than non-VA averages at two-thirds of VA medical centers.

    Most VA hospitals had lower rates than other facilities for a majority of post-surgical complications such as hemorrhages, clots and death.

    Nearly 50 VA hospitals had higher rates on at least three of four avoidable infections, such as potentially life-threatening intestinal bacteria and bloodstream infections. More than half had higher rates of severe bedsores.

    At some facilities, problems happened far more frequently than at other hospitals – VA or non-VA.

    Cashour, the VA spokesman, said some quality measures are not risk-adjusted, so statistics could appear inflated. He said certain Veterans, such as those with spinal cord injuries, are at “much higher risk” of developing bedsores.

    Though some hospital-quality specialists said adjusting rates for risk factors is typical in the industry, others said such steps are unnecessary for preventable infections and post-surgical complications.

    Bill Finck, former chairman at the Leapfrog Group, a nonprofit hospital rating organization, said there should be zero – much like an airline aims to have zero crashes.

    “You either give a person an … infection or you don’t, whether or not they’re severely compromised or they’re in there for sniffles and colds,” said Finck, a longtime health care industry executive and Vietnam Veteran who gets care at the Philadelphia VA. “Safety is safety.”

    The VA hospital in Asheville was among the better performers on that front. The hospital had the same or lower rates on a majority of complications and infections than non-VA facilities.

    “I can’t say enough about how good it is,” said David Hall, 65, a Vietnam Veteran who has received care at the Asheville facility for years.

    “I wish the other VA hospitals could use their (example) and the other successful hospitals as a guideline and try to be more like them," he said. "I want all Veterans to have the same experience I have.”

    The VA has tried for years to spread best practices from higher-performing hospitals to more troubled ones. In 2015, the agency launched a “diffusion of excellence” program to replicate successful programs across the country, including direct scheduling of eye and ear appointments and text messaging of appointment reminders.

    In 2017, the VA set up a tracking system at headquarters to identify problem facilities and dispatched teams to help them improve.

    As of October, five VA hospitals ranked the lowest one star out of five for the third straight year in agency ratings, including in Loma Linda and Phoenix, the site of the wait-time scandal in 2014. The others were Memphis and the VA hospitals in Big Spring and El Paso, Texas.

    VA spokesman Cashour said those hospitals have undergone "intensive improvement initiatives over the past year," and each has "achieved significant gains in multiple areas."

    Veteran (dis)satisfaction revealed

    On patient satisfaction surveys, Veterans overall were less likely than non-VA patients to say medical workers treated them with respect or listened to and respected what they had to say, the USA TODAY analysis found.

    They were less likely to recommend VA hospitals to others and rated their medical care providers lower.

    The VA scorecards analyzed by USA TODAY feature questions for inpatients and outpatients about their health care experiences. Nearly every VA facility – 141 out of 146 – scored below other facilities on a majority of questions surveyed.

    The Memphis VA hospital received lower ratings from patients than the median of non-VA providers on 27 of 30 questions – the worst of any VA facility.

    Mary Alimenti, whose husband receives care at the Memphis VA – roughly 100 miles from their home in Huron, Tennessee – said hospital staff have been “really mean” when she accompanied him to appointments and “don’t listen.”

    “They don’t take the time that they need to with the Vets,” she told USA TODAY. “It’s like, you know, you’ve got a line of cows, and they’re coming in and going right back out again.”

    Cashour said the outpatient survey results are not adjusted for factors such as age that could influence the outcomes. He said older patients on average give higher ratings than younger patients for the same care, and sicker patients give lower ratings than healthy ones.

    Cashour said the VA does take age and health into account when calculating the results for inpatient surveys. He said results about whether Veterans would recommend VA hospitals are unreliable.

    "Veterans often will respond to the survey by telling us they rated the hospital highly but answered this question 'no' because their friends and family are not eligible for VA care," he said.

    Seleska, the Veteran who waited more than seven hours in the Loma Linda VA emergency room, said she had no such confusion and wouldn't recommend the hospital to anyone.

    She isn't looking to switch to non-VA care, even if the VA pays for it. She just wants the VA fixed.  

    “All we’re asking is do your job,” Seleska said. “Do what you’re supposed to be doing – your job is to take care of us.”

    She reached out to patient advocates and administrators in Loma Linda, the VA inspector general’s office and even Trump’s new White House hotline for Veterans over a litany of problems she had with VA care beyond the emergency room – to no avail. Seleska said she also went to her member of Congress and Veterans' organizations.

    “This is what motivated me to … keep accelerating until I got somebody’s attention, anybody’s attention – because it’s not just me,” she said. “It’s my brothers and sisters over here. I mean, people are in pain.”

    How does your VA hospital stack up?

    CITY

    STATE

    Measure

    THIS VA FACILITY

    Rank Among VA Sites

    National Median or Aberage

    Birmingham

    Alabama

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.03

    4

    0

    Montgomery

    Alabama

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Phoenix

    Arizona

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.18

    15

    0

    Prescott

    Arizona

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Tucson

    Arizona

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Fayetteville

    Arkansas

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Little Rock

    Arkansas

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.05

    6

    0

    Fresno

    California

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Loma Linda

    California

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Long Beach

    California

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.05

    6

    0

    Los Angeles

    California

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.03

    4

    0

    Palo Alto

    California

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.07

    8

    0

    Sacramento

    California

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    San Diego

    California

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.06

    7

    0

    San Francisco

    California

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Denver

    Colorado

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.08

    9

    0

    Grand Junction

    Colorado

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    West Haven

    Connecticut

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Washington

    DC

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.03

    4

    0

    Wilmington

    Delaware

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Bay Pines

    Florida

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.02

    3

    0

    Gainesville

    Florida

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Lake City

    Florida

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Miami

    Florida

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.11

    12

    0

    Orlando

    Florida

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Tampa

    Florida

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.01

    2

    0

    West Palm Beach

    Florida

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.05

    6

    0

    Atlanta

    Georgia

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Augusta

    Georgia

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Dublin

    Georgia

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Boise

    Idaho

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Chicago

    Illinois

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.1

    11

    0

    Danville

    Illinois

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Hines

    Illinois

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Marion

    Illinois

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    North Chicago

    Illinois

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Fort Wayne

    Indiana

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Indianapolis

    Indiana

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.03

    4

    0

    Des Moines

    Iowa

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Iowa City

    Iowa

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Leavenworth

    Kansas

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Topeka

    Kansas

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Wichita

    Kansas

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Lexington

    Kentucky

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Louisville

    Kentucky

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Alexandria

    Louisiana

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    New Orleans

    Louisiana

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.22

    16

    0

    Shreveport

    Louisiana

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.05

    6

    0

    Augusta

    Maine

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Baltimore

    Maryland

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.04

    5

    0

    Ann Arbor

    Michigan

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.04

    5

    0

    Battle Creek

    Michigan

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Detroit

    Michigan

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Iron Mountain

    Michigan

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Saginaw

    Michigan

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Minneapolis

    Minnesota

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.02

    3

    0

    Biloxi

    Mississippi

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Jackson

    Mississippi

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.07

    8

    0

    Columbia

    Missouri

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.06

    7

    0

    Kansas City

    Missouri

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.04

    5

    0

    Poplar Bluff

    Missouri

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    St Louis

    Missouri

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.06

    7

    0

    Fort Harrison

    Montana

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Omaha

    Nebraska

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Las Vegas

    Nevada

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Reno

    Nevada

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    East Orange

    New Jersey

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.05

    6

    0

    Albuquerque

    New Mexico

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Albany

    New York

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Bath

    New York

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Bronx

    New York

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.07

    8

    0

    Buffalo

    New York

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Castle Point

    New York

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    New York

    New York

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Northport

    New York

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Syracuse

    New York

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.04

    5

    0

    Asheville

    North Carolina

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Durham

    North Carolina

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Fayetteville

    North Carolina

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Salisbury

    North Carolina

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Fargo

    North Dakota

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Chillicothe

    Ohio

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Cincinnati

    Ohio

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.09

    10

    0

    Cleveland

    Ohio

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.02

    3

    0

    Dayton

    Ohio

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Muskogee

    Oklahoma

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Oklahoma City

    Oklahoma

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Portland

    Oregon

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Roseburg

    Oregon

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Altoona

    Pennsylvania

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Erie

    Pennsylvania

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Lebanon

    Pennsylvania

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0

    1

    0

    Philadelphia

    Pennsylvania

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.08

    9

    0

    Pittsburgh

    Pennsylvania

    Antibiotic-resistant staph (MRSA) infections per 1,000 bed days

    0.02

    3

    0