DUNEDIN, Fla. - Seven years after Congress passed a law reforming the scandal-plagued Veterans' Healthcare Administration, the VA appears to have made a great deal of progress. The reforms, which increased VA staff and allowed some Veterans to receive private medical care, improved access to healthcare for many sick and wounded Vets. But there still many Veterans getting caught in a bind.

In February, Gary Smith wasn’t feeling right, but the Vietnam-era Air Force Veteran couldn’t say why. It was during the heart of the pandemic and at the height of mask-wearing and social distancing, when just about everyone was locked down or locked out. Smith says that included the VA.

"If VA could not specifically define what was going on health-wise, they really didn't want people in the facility," he said.

As a back-up for his VA health care, Smith has a Medicare advantage plan, which he used it to visit his Pinellas County cardiologist, who diagnosed the problem on the spot -- even as it was happening.

"He’s sitting here looking at me saying, 'You are having a heart attack right now,'" Smith recalled.

The next thing Smith remembers is waking up in Mease Dunedin Hospital, where doctors installed four stents.

"I had 98% blockage." he explained.

The good news is, the Medicare plan covered much of it. The bad news is that the VA would not pick up any of the rest.

The first bill he got was $600. The second one was $250. Smith soon discovered he was caught in a bureaucratic quagmire over the definition of an "emergency" and policies that didn't match up to his situation, at least according to the VA.

First, the VA denied Smith's claim on grounds that what happened to him -- a major heart attack in his doctor's office, during which he passed out -- "does not meet a prudent layperson’s definition of emergency," even though he had a letter from his physician attesting to the fact that it did meet the definition of an emergency.

The VA denial also stated that a VA facility was available to provide the emergency services -- and it notes Smith's failure to give the VA timely notification.

The VA policy states failure to report emergency care to the VA within 72 hours from the start of treatment may impact coverage.

But after passing out from a heart attack in his doctor's office, Smith didn't have much say over where he wound up. And after waking up in the hospital, he'd be there another three days for procedures and monitoring.

"I wasn’t stabilized until I had four stents and I still needed two more so they kept me in until Monday when they did the last two," Smith told FOX 13.

VA policy does state that even if the notification did not occur timely, the emergency treatment may still be eligible for reimbursement.

But not in Gary’s case -- or others around the country. In 2019, a federal appeals court ruled the VA has to reimburse Veterans for their emergency care outside the VA. That was a class-action that includes Veterans’ claims from 2016 to future claims through 2025. Pending further review, that may or may not apply to Smith, who lives on a fixed income and cannot afford an $850 medical bill.

"It put me in a bind financially," he said, forcing him to cut back on essentials, like food -- at a time when everything is getting more expensive.

FOX 13 reached out to the VA for comment on Smith's case but have yet to receive a response.

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WASHINGTON — A Department of Veterans Affairs official on Wednesday drew the ire of some House lawmakers during a hearing over the agency’s continued resistance to providing health care to more service members and Veterans for toxic exposure, stating more data is needed to conclude exposure leads to illnesses such as cancer.

“More scientific investigation is needed to enable VA and [the Defense Department] to perform a reliable assessment of the possible or known long-term adverse health effects,” said Dr. Patricia Hastings, chief consultant for post-deployment health services at the VA.

But recently declassified Defense Department documents show the Pentagon knew troops were exposed to multiple toxins and hazards that have led to hundreds of cancer cases and dozens of dead Veterans after deploying to the Karshi-Khanabad Air Base, known as K2, in Uzbekistan in the early days of the War on Terror.

Some lawmakers responded harshly to the VA’s stance during the hearing of the House Oversight and Reform Committee’s subpanel on national security.

“The VA’s continued denial has left hundreds, if not thousands, of K2 Veterans ineligible for certain preventative health programs and unable to receive VA disability benefits in connection with their service at K2,” said Rep. Stephen Lynch, D-Mass., chairman of the committee’s subpanel. “This is an injustice that must be rectified, and [VA] Secretary [Robert] Wilkie has the authority to fix it by granting presumptive status to K2 Veterans today.”

K2 is a former Soviet air base in southeastern Uzbekistan that shares a border with northern Afghanistan. After the 9/11 attacks, U.S. forces established Camp Stronghold Freedom at K2, which was used to support combat missions from 2001 to 2005. Veterans have described a toxic environment at the post, where pond water glowed green, black sludge oozed from the ground and the government posted massive white and yellow signs warning troops to keep out of certain areas due to chemical agents.

Lawmakers argued during the hearing that the VA isn’t providing presumptive care, which it has the authority to do without approval from Congress or the White House. Lawmakers agreed conclusive research is needed, but the evidence is increasing that young Veterans got sick after deploying to K2. And it isn’t just K2, thousands of Veterans have been exposed to burn pits all over the world, most notably Iraq and Afghanistan, and VA has denied nearly 78% of those claims as well.

Former service members who spent time at K2 testified on Capitol Hill in February that they were aware of at least 400 individuals diagnosed with cancers who served at the base. They said at least 30 have died.

During a health assessment test in 2001 by the Defense Department, military analysts found the base had “elevated levels of volatile organic compounds and total petroleum hydrocarbons were detected at numerous locations throughout Stronghold Freedom, including tent city, eastern expansion area and adjacent to the aircraft maintenance facility.” It also found ambient air is the “main concern for environmental contaminants.”

The assessment found that “inhalation of vapors from exposed, subsurface fuel contaminated soils could potentially cause adverse health effects to personnel at Stronghold Freedom if sufficient exposure circumstances occurred.” As a result, the assessment recommended “prohibit digging into soil contaminated with jet fuel,” but those areas were populated with aircraft hangars and tents in which soldiers slept.

An area near the tents was found to contain pieces of depleted uranium in 2001, and external radiation measurements in 2002 detected elevated radiation levels. K2 also had open-air burn pits used to get rid of waste, which the VA has posted on its website “may affect the skin, eyes, respiratory and cardiovascular systems, gastrointestinal tract and internal organs.”

Yet, VA officials remain unconvinced and said the issue needs more science to back up Veterans’ claims for health care and disability compensation.

Hastings said the agency is still studying the K2 mission and how it might have impacted the health of troops serving there. She said the study will take about 12-18 months to complete. She added the study is being conducted with a “very small staff.”

“Good science takes time... it will take some time,” she said.

Hastings also noted the Defense Department made efforts to reduce health risks at K2.

“Remediation efforts were completed to reduce potential exposure and risk to service members deployed there. In accordance with environmental science best practices, DoD covered contaminated areas with clean dirt and declaring them ‘off limits’ to prevent mitigate the threat of radiation hazard and fuel,” Hastings said.

But lawmakers said they are losing patience with the VA, which took decades to provide care for victims of Agent Orange exposure during the Vietnam War. Lawmakers said they fear toxic exposure is the post-9/11 generation’s Agent Orange and questioned who would criticize opening up presumptive care.

“The downside is maybe one of these Veterans got cancer from somewhere else and they’d be covered, I’d absorb that risk,” Lynch said. “If that’s the downside for the government here, embrace it...Don’t deny them all for the misplaced concern a couple of Veterans with cancer might get the treatment that might not be connected to service at K2.”

Lynch and Rep. Glenn Grothman of Wisconsin, the ranking Republican on the subpanel, penned a letter to Wilkie to request a senior VA official testify at the K2 hearing, which the department declined to do. The lawmakers said while they appreciate Hastings’ medical expertise, she has no role in crafting VA policy and determining eligibility for benefits.

“Hundreds of Veterans have been diagnosed with various forms of cancer and other health ailments since deploying to K2 between 2001 and 2005. We believe these Veterans deserve to hear directly from VA leadership about why the department continues to deny that their illnesses are service-connected despite the growing evidence to the contrary,” the letter reads.

Some Veterans advocates said they believe toxic exposure is likely to be a top issue in President-elect Joe Biden’s administration since he believes his son Beau Biden’s brain cancer was caused by burn pit exposure in Iraq when he deployed there as a part of the Delaware National Guard. The issue has gained more public attention after comedian Jon Stewart has started to lead the lobbying effort to get care to Veterans suffering from illnesses linked to toxic exposure.

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It’s no secret that the VA appeals process can be long and complicated. In any given year, the Board of Veterans’ Appeals issues tens of thousands of decisions to Veterans around the country, and many of these decisions can take years to come to fruition.

But how many of these appeals are successful?

The Board of Veterans’ Appeals Annual Report for Fiscal Year 2020 offers the latest data on appeals and Board decisions. By breaking down the statistics, we want to help you understand how your appeal fits into the bigger picture.

How Many Cases Did The Board of Appeals Receive?

In fiscal year 2020, the Board received 174,733 cases and completed 102,663 decisions. That breaks down to 85,461 legacy decisions and 17,202 AMA decisions. This volume of decisions marks a clear increase from the previous three years, jumping from 52,661 in 2017, 85,288 in 2018, and 95,089 in 2019. But that linear increase doesn’t necessarily correlate with the number of cases received per year.

What Was The Disability Appeal Success Rate?

Veterans likely want to know their chances of success when making an appeal. And while numerous factors play into the Board’s decisions, it can be helpful to understand the yearly approval rates.

The Board of Veterans’ Appeals scheduled 37,345 hearings and held 15,669 in 2020. Here’s how their decisions played out:

In fiscal year 2020, the Board allowed (approved) 33.8% of the legacy appeals and 37% of the AMA. As for denials, the Board denied 20.3% of legacy appeals and 27.6% of AMA. The largest portion of the claims were remanded, meaning they were sent to the Veteran’s regional office (RO) with instructions. Board members remanded 40.6% of legacy appeals and 28.2% of AMA.

How Long Did The Appeals Process Take?

The Board has different data collection systems for legacy and AMA appeals, and it can be tricky to predict how long any one decision will take. However, data from this report may give Veterans an idea.

According to the Board’s 2020 report, the average time lapsed between the filing of the appeal and the Board’s disposition was 1,583 days. As for the AMA, the VA breaks the average time down per docket. For Veterans who chose the direct review docket, the average time lapsed between the NOD and Board decision was 225 days. It was 277 days for the evidence docket and 377 for the hearing.

Key Takeaways for Veterans

Congress authorized the Veteran Appeals Improvement and Modernization Act of 2017 to give Veterans more options for their appeal and speed up the process. But it’s important to remember that many Veterans are appealing through the legacy system as well.

If you’re a Veteran looking for support for your VA disability appeal, the attorneys at Hill & Ponton are here to help. Contact us today for a free case evaluation.

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The COVID-19 pandemic has led to a backlog of about 300,000 new disability claims at the Department of Veterans Affairs, the head of the Veterans Benefits Administration (VBA) said Tuesday.

"We've got to get this backlog down," VBA Chief Paul Lawrence said in an interview with Military.com. "We're really trying hard to figure this out."

By last November, the department had succeeded in processing clams at a high rate and brought the new claims backlog down to an all-time low of 64,000 cases, he said. In March 2013, the backlog of new disability claims at the VA had reached a peak of 611,000.

From January through the end of March this year, the number of backlogged claims increased slightly, to 70,000. Then, the spike began, as restrictions were imposed across the government in an effort to limit the spread of COVID-19, wiping out the progress the VA made last year in processing new claims, Lawrence said.

On April 1, the VA announced that "as concerns about COVID-19 infections increased and the president declared a national emergency, VA suspended its in-person medical disability examinations for its compensation and pension (C&P) programs."

The VA did not restart in-person exams until late August, and then only on a limited basis.

In addition, COVID-19 restrictions at the vast National Archives warehouse in St. Louis limited the VA's access to records needed to verify Veterans' claims, Lawrence explained.

"That really set us back in terms of the ability to grant benefits," he said. "The two bits of information we need are the C&P exams and the personnel records."

To break the logjam, the VA began sending its own personnel to assist the National Archives.

"We actually have people in their warehouse in St. Louis [going through the files and] getting them scanned into our records," Lawrence said.

At one point, the VA had 48 of its own personnel working in the National Archives warehouse, he said.

Encouragingly, the increase in backlogged new cases appears to have leveled off in recent weeks, Lawrence added.

"We're processing at about the same rate we're receiving," he said. "Now, we're looking forward to the fall and beyond when we can drive it back down."

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If you experienced a back injury during active duty, or an injury that later contributed to back pain, you may be eligible for disability benefits. As with most medical conditions, the VA disability rating for back pain depends on a variety of factors. This guide will break down how the VA rates back pain and spinal disabilities, so you can take the first steps toward making a claim.

Understanding BackPain VA Ratings

Claims involving both the cervical spine and the thoracolumbar spine are rated under the same general rating formula. The following spinal conditions are all rated under the same general rating formula:

• Lumbosacral or cervical strain (diagnostic code 5237): This would be the diagnostic code assigned to a Veteran experiencing pain in their neck or back.
• Spinal stenosis (diagnostic code 5238): Spinal stenosis is when the spaces in the spine are narrowed and cause pressure on the spinal cord and nerves. Frequently, spinal stenosis is present in the low back, but can be present in the cervical spine area as well.
• Spondylolisthesis or segmental instability (diagnostic code 5239): This is a condition that causes one bone in your back (a vertebra) to slide forward over the bone below it. The condition can result in the spinal cord or nerve roots being squeezed can cause back pain and numbness, or even weakness in one or both legs.
• Ankylosing spondylitis (diagnostic code 5240): This is a form of spinal arthritis that causes inflammation of the spinal joints and can result in severe, chronic pain. Ankylosing spondylitis can also cause inflammation, pain, and stiffness in the shoulders, hips, ribs, heels, and small joints of the hands and feet.
• Spinal fusion (diagnostic code 5241): Spinal fusion is a type of surgery that is performed to join two or more vertebrae together so that there is no movement between the two vertebrae. This surgery is often performed in individuals with spondylolisthesis and spinal stenosis.
• Vertebral fracture or dislocation (diagnostic code 5235): A vertebral fracture occurs when a vertebra becomes compressed due to trauma. Typically, a vertebral fracture results in symptoms such as limited spinal mobility, and standing/walking will make the pain worse while lying down on the back makes the pain better. A vertebral dislocation is when one of the small vertebrae in the neck is displaced following a traumatic injury to the head or neck. Symptoms of a vertebral dislocation include pain that spread into the shoulder and arms, tingling or numbness in the arm, muscle spasms in the neck, and weakness in the arms.

The general rating formula that is used to rate the conditions listed above is mainly based on range of motion (ROM) measurements. The cervical spine (neck) and the thoracolumbar spine (low back) are rated according to the following criteria:

As you can see, ROM measurements play a significant role in rating spinal conditions. Because the rating formula is almost entirely based on ROM measurements, it’s important to make sure that a doctor performs ROM testing as accurately as possible. Also, the VA requires that all ROM measurements be taken with a goniometer. If a doctor doesn’t use a goniometer to measure your ROM, the VA will not consider the results.

In addition to the ROM measurements, the general rating criteria for spinal involves whether the cervical and/or thoracolumbar spine is frozen in a favorable vs. unfavorable position. A favorable position means the ROM measurement for flexion or extension is 0 degrees. Unfavorable means any position that is not 0 degrees in flexion or extension.

Secondary Spinal Conditions

Oftentimes, spinal conditions will cause other conditions, and these conditions qualify a Veteran for another rating. For example, fractured and/or dislocated vertebrae can lead to pain and weakness in the arms, hips, shoulders, etc. People with spinal conditions also often change how they walk to compensate for the pain which can lead to knee and hip problems.

Spinal conditions can cause nerve problems as well. One of the most common conditions secondary to spinal conditions is radiculopathy. Radiculopathy is caused by compressed nerves in the spine and results in pain, numbness, tingling, or weakness along the nerve. If radiculopathy is caused by a low back condition, the individuals will feel the symptoms in the lower extremities (thigh, calf, foot). If radiculopathy is caused by a neck condition, the symptoms will be felt in the shoulder and can travel down the arm and into the hand.

If your spinal condition results in the development of a new disability or makes an existing disability worse, remember that you may be entitled to secondary service-connection for the new or aggravated disability. These secondary conditions would be rated separately from the underlying spinal condition.

VA Ratings For Spinal Arthritis & Back Pain

In order to ensure that you’re getting the most out of your disability claim, you need to understand how the VA rates your condition. Errors are frequently made when rating conditions. The VA not only makes mistakes in evaluation the severity of a condition, but sometimes they evaluate a condition according to the completely wrong rating criteria.

With this in mind, it’s important to know which spinal conditions are not rated under the general rating formula. The VA has a separate rating system for these conditions. Some of the conditions included in this category are degenerative arthritis, traumatic arthritis, and rheumatoid arthritis.

The rating systems used for arthritis of the spine is the second most common rating system for spine conditions. There are two types of arthritis that are rated under the same rating system; degenerative arthritis, and traumatic arthritis. Rheumatoid arthritis is rated under its own rating system.

Degenerative And Traumatic Arthritis

Degenerative arthritis is the chronic breakdown of the cartilage surrounding the joints. Degenerative arthritis of the spine, sometimes referred to as facet joint osteoarthritis, causes a breakdown of the cartilage between the facet joints in the back of the spine. Lack of cartilage causes pain and limitation of motion.

Traumatic arthritis occurs after an injury, excessive movement, or other physical trauma. Traumatic arthritis causes symptoms similar to other types of arthritis such as pain, inflammation, and build-up of fluid around the affected joint.

Both degenerative arthritis and traumatic arthritis, regardless of the joint affected, are rated under diagnostic code 5003. Depending on what joint is affected, there will be an identifying diagnostic code assigned to the condition. For example, the specific code for degenerative arthritis of the spine is 5242. However, the VA still rates degenerative arthritis of the spine under the criteria listed for diagnostic code 5003. Because there are technically two diagnostic codes associated with one condition, you would see the condition listed on rating decisions as 5242-5003.

What is the diagnostic code for traumatic arthritis?

The diagnostic code for traumatic arthritis is 5010. So if a Veteran has traumatic arthritis in his spine, the final diagnostic code would appear as 5010-5003. Think of the first number as an identifying diagnostic code that tells you what joint is affected, while the second diagnostic code tells you the rating system the condition is being rated under.

Keep in mind that arthritis will only be rated under diagnostic code 5003 when the condition does not result in severe enough limitation of motion to be rated under the general rating formula for the spine. If there is decreased range of motion of the cervical or thoracolumbar spine, the condition would be rated according to the general rating formula for the spine that is based off of range of motion measurements. There must be x-ray evidence of arthritis in the cervical or thoracolumbar joints for the VA to rate a spinal condition under the code for degenerative arthritis.

As mentioned above, many different joints are rated under the rating criteria for degenerative arthritis. This includes the shoulder, wrist, elbow, hip, knee ankle, fingers, toes, spine, and the sacroiliac joint. Some joints are referred to as major joints, while others are referred to as minor joints. The spine is considered as a minor joint. The rating assigned under the rating criteria for degenerative arthritis depends on how many joint groups are affected and whether there is painful motion. If two or more major OR minor groups are affected a 20% rating will be assigned if the arthritis is occasionally incapacitating. If the arthritis does not cause any episodes of incapacitation, but 2 or more joint groups are involved, then a 10% rating will be assigned. If a Veteran only has one joint group affected by arthritis then there must also be painful motion present in order for a rating higher than 0% to be assigned. If there is painful motion, a 10% rating will be assigned. For example, if a Veteran has degenerative arthritis of the spine with no other joints affected, and he experiences pain when bending over he will receive a 10% rating.

Rheumatoid Arthritis and Back Pain

Rheumatoid arthritis is a disease that causes destruction of the joints in the body. Although this type of arthritis is most common in the small joints of the hands and feet, it can occur in any joint. When rheumatoid arthritis affects the spine, it typically occurs in the cervical spine (the neck) rather than the thoracolumbar spine (the low back). Rheumatoid arthritis of the spine leads to neck pain, back pain, and sometimes causes pain to radiate into the arms and legs. Symptoms are similar to the symptoms involved with degenerative arthritis and include pain and swelling of the joints.

The diagnostic code for rheumatoid arthritis is 5002. The VA assigns rating percentages based on the frequency of incapacitating episodes. The following percentages are available under the rating criteria for rheumatoid arthritis:

• 100% if you are completely incapacitated and are confined to staying in bed
• 60% if there are severe incapacitating episodes that occur 4 or more times per year
• 40% if there are incapacitating episodes that occur 3 or more times per year if there is a definite (but not necessarily significant) decrease in health
• 20% if there are less than 3 incapacitating episodes per year

It’s possible for rheumatoid arthritis to be rated under diagnostic code 5003 like degenerative and traumatic arthritis. If the condition is not severe enough to meet the above criteria, then the VA rating for back pain / arthritis will be based on specific symptoms. For example, if rheumatoid arthritis of the spine results in pain with motion, the condition will be rated according to the criteria set forth in 5003 as described above.

When pursuing a VA disability rating for back pain, it’s important to know your options. Keep in mind that a Veterans disability law firm can work with you to build a claim for a higher rating.

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VA Disability Benefits and Ratings for GERD: What Veterans Should Know

Among gastrointestinal disorders, gastroesophageal reflux disease (GERD) is a very common condition that is associated with heartburn. In fact, according to the National Institute of Diabetes and Kidney Digestive Disease, approximately sixty million people experience heartburn at least once a month, and twenty-five million experience the symptoms daily. If you experienced GERD following military service, you may be able to seek VA benefits for your condition and get a GERD VA Rating.

This post will outline the basics of GERD, as well how former service members can obtain service-connection from the VA despite the lack of a disability rating schedule for this condition.

What Is Gastroesophageal Reflux Disease?

Gastroesophageal reflux disease, or GERD, is a condition in which gastric acid and partially digested food flow up from the stomach into the esophagus. This results in the painful sensations that are associated with heartburn. Continuous irritation of the esophageal lining poses a risk for developing more severe complications such as esophageal cancer.

Symptoms of GERD include:

• Heartburn
• Nausea
• Pain in chest or upper abdomen
• Difficulty swallowing or painful swallowing
• Respiratory problems
• Vomiting

How Does GERD Occur?

The esophagus, commonly called the food pipe, is a narrow muscular tube that is about 9.5 inches long. It connects the back of the mouth with the stomach. When you swallow food, muscles in the esophagus move the food toward the stomach. At the base of the esophagus is a band of muscle, called the lower esophageal sphincter (LES), which opens and closes to allow food and liquids to pass into the stomach. Except for belching, this is the only time that the LES is supposed to open. Once food and liquids have passed safely into the stomach, the stomach acids and enzymes in the stomach begin to break down the starch, protein and fat in the food. While the stomach has a lining tough enough to withstand the acid, the esophagus does not.

What happens in cases of GERD is the LES opens when it is not supposed to—namely after the enzymes and acids have started working on the contents of the stomach. When this occurs, gastric acid and partially digested food flow back up into the esophagus. The lining in the esophagus, as mentioned before, is not thick enough to withstand acid, and this causes the burning sensation in the chest and throat. This sensation is more commonly called heartburn, pyrosis, or acid reflux.

What Causes GERD?

It is a well-established fact that certain medications, lifestyle choices, and non-related physical disorders can contribute to GERD. Not only do some medications weaken the LES, but some medications and outside factors can aggravate the already-irritated esophageal lining.

Medications

There are some medications that are known to weaken or relax the LES. Many of these act as muscle relaxants, and can cause the wrong muscles to relax, such as the LES. These medications include:

• Calcium channel blockers
• Anticholinergics (used to treat urinary tract disorders, allergies, and glaucoma)
• Beta adrenergic agonists (used to treat asthma and obstructive lung diseases)
• Dopamine agonists (used to treat Parkinson’s)
• Antidepressants
• Sedatives
• Narcotics

There are also medications that irritate the esophageal lining, such as:

• NSAIDs, such as ibuprofen and naproxen (Aleve)
• Potassium
• Iron pills
• Bisphosphonates (used to treat osteoporosis)
• Antibiotics

Risk Factors

There are many risk factors for heartburn and GERD. Many of them necessitate the regular consumption of medications listed above.

• Eating pattern: People who eat heavy meals and then lie on their back or go to bed are at risk for heartburn and acid reflux.
• Pregnancy: Symptoms of GERD are often unavoidable during the third trimester, then the growing uterus puts pressure on the stomach and forces acids and partially digested food back up through the LES.
• Obesity
• Respiratory Disorders: People with asthma and COPD have a high risk of GERD. This is due not only to the medications which they must take to control their symptoms, but also due to the chronic irritation that these disorders inflict on the esophagus..
• Smoking: Studies have shown that smoking reduces LES muscle function, increases acid secretion, impairs muscle reflexes in the throat, and damages protective mucus membranes. Smoking also reduces salivation, which helps neutralize acid.
• Alcohol Use: There are mixed opinions on this particular risk factor. Alcohol is known to relax the LES muscles and, in high amounts, may irritate the lining of the esophagus. Other studies, however, have shown some types of alcohol, such as wine, to actually protect the lining of the esophagus.

Certain health conditions like a hiatal hernia can also cause GERD. It’s important to always consult a doctor if you are experienced recurrent epigastric distress, discomfort in the digestive system, IBS, or other symptom combinations. Doing so is an important part in seeking VA disability GERD benefits.

Making a Disability Claim: How Do GERD VA Ratings Work?

GERD is one of those interesting and rather inexplicable exceptions to the VA rules. For example, the VA’s regulations on presumptive Persian Gulf War conditions (conditions which are automatically considered service-connected if you meet the qualifying criteria) include gastrointestinal disorders.

However, there is a caveat to this and VA Ratings for GERD.

These regulations only apply to functional gastrointestinal disorders, which involve abnormal functions of an organ in the gastrointestinal tract, without a structural alteration in the tissues (such as irritable bowel syndrome). GERD is not considered a functional gastrointestinal disorder; rather, it is considered a structural gastrointestinal disorder. On top of it all, there is not even a rating schedule for GERD in the VA rulebook. So, the typical percent evaluation VA rating system and diagnostic code may not apply in your disability compensation case.

One can argue that this does not make any sense. But while this particular regulation does make it harder to obtain service-connection for GERD, there are ways to get around this. Since there is not a specific GERD VA Disability rating system, individuals may choose to obtain Veterans disability compensation by proving direct or secondary service connection.

Direct Service Connection

In order to show a direct service connection for GERD, you will need to gather medical evidence and show severe impairment of health. If you were diagnosed with GERD while on Active Duty, and if a medical expert provides a favorable opinion that your GERD condition began during and has continued since service, you can obtain service connection on a direct basis.

Secondary Service Connection

Service connection can be granted on a secondary basis if a medical expert can provide a favorable opinion that one condition was developed secondarily to a condition that has already been service-connected. In this particular case, we mentioned respiratory conditions as being a risk factor for GERD. Say, for example, the VA has service-connected you for COPD. Over time, you developed GERD due to chronic irritation of the esophagus and due to the effects of the medications that help control your COPD. You can file a VA claim for GERD secondary to COPD. However, you will need a doctor or health care practitioner’s opinion that your COPD condition caused or aggravated GERD.

Need Help With Your GERD VA Rating?

While the VA ratings for GERD may not mimic that of other conditions, that doesn’t mean you can’t obtain Veterans benefits for your medical condition. The Veterans disability law firm Hill & Ponton is available to help former service members obtain disability benefits from the department of Veterans affairs. Whether you want to discuss the rating schedule, service connection, or medical evidence for an appeal, be sure to call 1-888-373-9436 to speak with our knowledgeable team. You can also click here to request a case evaluation.

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VA Disability Benefits and Ratings for GERD: What Veterans Should Know

Among gastrointestinal disorders, gastroesophageal reflux disease (GERD) is a very common condition that is associated with heartburn. In fact, according to the National Institute of Diabetes and Kidney Digestive Disease, approximately sixty million people experience heartburn at least once a month, and twenty-five million experience the symptoms daily. If you experienced GERD following military service, you may be able to seek VA benefits for your condition and get a GERD VA Rating.

This post will outline the basics of GERD, as well how former service members can obtain service-connection from the VA despite the lack of a disability rating schedule for this condition.

What Is Gastroesophageal Reflux Disease?

Gastroesophageal reflux disease, or GERD, is a condition in which gastric acid and partially digested food flow up from the stomach into the esophagus. This results in the painful sensations that are associated with heartburn. Continuous irritation of the esophageal lining poses a risk for developing more severe complications such as esophageal cancer.

Symptoms of GERD include:

• Heartburn
• Nausea
• Pain in chest or abdominal pain
• Difficulty swallowing or painful swallowing
• Respiratory problems
• Vomiting

How Does GERD Occur?

The esophagus, commonly called the food pipe, is a narrow muscular tube that is about 9.5 inches long. It connects the back of the mouth with the stomach. When you swallow food, muscles in the esophagus move the food toward the stomach. At the base of the esophagus is a band of muscle, called the lower esophageal sphincter (LES), which opens and closes to allow food and liquids to pass into the stomach. Except for belching, this is the only time that the LES is supposed to open. Once food and liquids have passed safely into the stomach, the stomach acids and enzymes in the stomach begin to break down the starch, protein and fat in the food. While the stomach has a lining tough enough to withstand the acid, the esophagus does not.

What happens in cases of GERD is the LES opens when it is not supposed to—namely after the enzymes and acids have started working on the contents of the stomach. When this occurs, gastric acid and partially digested food flow back up into the esophagus. The lining in the esophagus, as mentioned before, is not thick enough to withstand acid, and this causes the burning sensation in the chest and throat. This sensation is more commonly called heartburn, pyrosis, or acid reflux.

What Causes GERD?

It is a well-established fact that certain medications, lifestyle choices, and non-related physical disorders can contribute to GERD. Not only do some medications weaken the LES, but some medications and outside factors can aggravate the already-irritated esophageal lining.

Medications

There are some medications that are known to weaken or relax the LES. Many of these act as muscle relaxants, and can cause the wrong muscles to relax, such as the LES. These medications include:

• Calcium channel blockers
• Anticholinergics (used to treat urinary tract disorders, allergies, and glaucoma)
• Beta adrenergic agonists (used to treat asthma and obstructive lung diseases)
• Dopamine agonists (used to treat Parkinson’s)
• Antidepressants
• Sedatives
• Narcotics

There are also medications that irritate the esophageal lining, such as:

• NSAIDs, such as ibuprofen and naproxen (Aleve)
• Potassium
• Iron pills
• Bisphosphonates (used to treat osteoporosis)
• Antibiotics

Risk Factors

There are many risk factors for heartburn and GERD. Many of them necessitate the regular consumption of medications listed above.

• Eating pattern: People who eat heavy meals and then lie on their back or go to bed are at risk for heartburn and acid reflux.
• Pregnancy: Symptoms of GERD are often unavoidable during the third trimester, then the growing uterus puts pressure on the stomach and forces acids and partially digested food back up through the LES.
• Obesity
  
  
• Respiratory Disorders: People with asthma and COPD have a high risk of GERD. This is due not only to the medications which they must take to control their symptoms, but also due to the chronic irritation that these disorders inflict on the esophagus..
• Smoking: Studies have shown that smoking reduces LES muscle function, increases acid secretion, impairs muscle reflexes in the throat, and damages protective mucus membranes. Smoking also reduces salivation, which helps neutralize acid.
• Alcohol Use: There are mixed opinions on this particular risk factor. Alcohol is known to relax the LES muscles and, in high amounts, may irritate the lining of the esophagus. Other studies, however, have shown some types of alcohol, such as wine, to actually protect the lining of the esophagus.

Certain health conditions like a hiatal hernia can also cause GERD. It’s important to always consult a doctor if you are experienced recurrent epigastric distress, discomfort in the digestive system, IBS, or other symptom combinations. Doing so is an important part in seeking VA disability GERD benefits.

Making a Disability Claim: How Do GERD VA Ratings Work?

There are different ways to receive benefits for GERD including through direct service connection as well as Secondary service connection.

GERD is one of those interesting and rather inexplicable exceptions to the VA rules. For example, the VA’s regulations on presumptive Persian Gulf War conditions (conditions which are automatically considered service-connected if you meet the qualifying criteria) include gastrointestinal disorders.

However, there is a caveat to this and VA Ratings for GERD.

These regulations only apply to functional gastrointestinal disorders, which involve abnormal functions of an organ in the gastrointestinal tract, without a structural alteration in the tissues (such as irritable bowel syndrome). GERD is not considered a functional gastrointestinal disorder; rather, it is considered a structural gastrointestinal disorder. On top of it all, there is not even a rating schedule for GERD in the VA rulebook. So, the typical percent evaluation VA rating system and diagnostic code may not apply in your disability compensation case.

One can argue that this does not make any sense. But while this particular regulation does make it harder to obtain service-connection for GERD, there are ways to get around this. Since there is not a specific GERD VA Disability rating system, individuals may choose to obtain Veterans disability compensation by proving direct or secondary service connection in their VA disability claim.

Direct Service Connection

In order to show a direct service connection for GERD, you will need to gather medical evidence and show severe impairment of health in your medical records. If you were diagnosed with GERD while on Active Duty, and if a medical expert provides a favorable opinion that your GERD condition began during and has continued since service, you can obtain service connection on a direct basis.

Secondary Service Connection

Service connection can be granted on a secondary basis if a medical expert can provide a favorable opinion that one condition was developed secondarily to a condition that has already been service-connected. In this particular case, we mentioned respiratory conditions as being a risk factor for GERD. Say, for example, the VA has service-connected you for COPD. Over time, you developed GERD due to chronic irritation of the esophagus and due to the effects of the medications that help control your COPD. You can file a VA claim for GERD secondary to COPD. However, you will need a doctor or health care practitioner’s opinion that your COPD condition caused or aggravated GERD.

Need Help With Your GERD VA Rating?

While the VA ratings for GERD may not mimic that of other conditions, that doesn’t mean you can’t obtain Veterans benefits for your medical condition. The Veterans disability law firm Hill & Ponton is available to help former service members obtain disability benefits from the Department of Veterans Affairs. Whether you want to discuss the schedule of ratings, service connection, or medical evidence for an appeal, be sure to call 1-888-373-9436 to speak with our knowledgeable team. You can also click here to request a case evaluation.

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The U.S. Department of Veterans Affairs recently granted service-connected compensation to Vietnam Veterans for heart disease. This is due to the recent addition of ischemic heart disease to the list of Agent-Orange related disabilities. In an earlier post, I discussed how Veterans can establish VA service connected compensation for Ischemic Heart Disease from Agent Orange.

In this post, I will focus on VA service-connected compensation ratings for heart disease in general. You need to know what VA needs to have in order to assign the proper disability rating for your disease, so you can obtain VA disability compensation.

What Is Heart Disease?

Heart disease is a broad term for a number of cardiovascular medical conditions. Heart disease is also the leading cause of death in the United States, accounting for one in four deaths. Some of the heart conditions under the heart disease umbrella include:

• Coronary artery disease (CAD)/Ischemic heart disease
• Congenital heart defects
• Cardiomyopathy (heart muscle disease)
• Cardiomegaly (enlarged heart)
• Atherosclerosis (hardening of the arteries)
• Arrhythmia (abnormal heart rhythm)
• Heart infections

These conditions and more can lead to heart attack (myocardial infarction) or heart failure.

When applying for VA disability benefits for any type of heart disease, you will need to prove service connection. This shows that your condition is connected to your military service. Be sure to obtain medical evidence of your condition, including a specific diagnosis and any medical records that show service connection.

Ischemic Heart Disease

Ischemic heart disease, also called coronary artery disease (CAD), is the most common type of heart disease. The condition occurs due to the buildup of plaque in the arteries of the heart. This buildup can hinder blood flow to the heart and cause a heart attack. CAD is also among the most common conditions in claims for disability benefits.

What Are Symptoms of Ischemic Heart Disease?

Ischemic Heart Disease infographics. Signs, symptoms, treatment.

VA specifically looks for:

• shortness of breath,
• fatigue,
• chest pain,
• dizziness,
• fainting

You need not have all of these symptoms to qualify for a particular rating. It is, however, important to know what the possible symptoms may be. That way you can inform your doctors, and the VA, if you are having these symptoms.

Hypertension

Hypertension, or high blood pressure, is another common condition that may lead to heart attack. You can read more about how the VA rates hypertension here.

VA Ratings for Heart Disease

The VA uses a specific rating schedule for the cardiovascular system (38 CFR § 4.104). When rating these service-connected disabilities, the VA considers what is called METs testing.

The higher levels of disability ratings for the heart are based on your symptoms at various levels of exertion. Every level of exercise is assigned a range of METs (or metabolic equivalents). The higher the level of exertion, the higher the METs number. In assigning a heart rating, VA specifically looks at what range of METs causes you to have certain symptoms.

Where you experience these symptoms after activities like jogging, biking or climbing stairs (a level of 7-10 METs), a minimum 10% rating is appropriate. VA should rate you at a 30% rating where you experience the symptoms at a level of 5-7 METs. This level of activity would include heavy yard work such as digging or mowing with a push-mower. It would also include recreational activities such as golfing without a cart. The 30% rating would also be appropriate where the Veteran has certain test results on an electrocardiogram, echocardiogram, or X–ray. So, again, make sure VA is aware of these tests. Especially, if a non-VA doctor performed the test.

VA assigns a 60% rating where you experience symptoms at a less stringent level of exercise. These symptoms include fast walking or light yard work. VA includes in light yard work weeding or mowing the lawn with a power mower (a level of 3-5 METs). A 60% rating would also be appropriate if you have heart failure. If, in the last year, you had more than one episode of acute congestive heart failure in the past year.

Make sure, then, that the VA is aware of any heart medications you have been prescribed by your non-VA doctors

When Does VA Give a 100% Rating for Heart Disease?

VA assigns a 100% rating where the Veteran experiences the symptoms of heart disease at a minimal level of:

• exercise
  • such as slow walking for one or two blocks,
• showering,
• dressing or
• eating (1-3 METs).

Additionally, VA assigns a 100% rating to a Veteran who has chronic congestive heart failure.

What Factors Does VA Consider for Ischemic Heart Disease Specifically?

First, if you take any continuous medication for your ischemic heart disease, VA should provide a minimum rating of 10%.

Another factor the VA will consider, outside the symptoms the Veteran is experiencing, is any heart surgeries. VA will look at whether you had any procedures which might qualify you for a higher rating, at least temporarily. VA will assign 100% for procedures such as:

• heart valve replacement,
• coronary bypass surgery,
• cardiac transplant surgery, or
• implantation of a pacemaker

Can I Get IU for a Service-Connected Cardiovascular Disability?

Finally, as with rating most disabilities, VA must consider whether the Veteran’s heart disease prevents the Veteran from maintaining employment. Knowing the symptoms of heart disease allows you to keep your doctors informed if you are having these symptoms. In addition, if your doctor is aware of your symptoms have him document them in your medical records. This makes it easier for the VA to assign the proper rating for your disability.

For more information about Ischemic Heart Disease specifically, download our free e-book.

Have Questions About Your VA Disability Benefits?

Cardiovascular diseases can cause impairment in daily life, no matter your level of disability. If the VA denied your claim or awarded a lower percent rating that you believe you deserve, the team at Hill & Ponton can help. Our Veterans disability attorneys work with former service members to obtain disability compensation. Contact us today for a free consultation.

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When you have scoliosis, it means that your spine has an abnormal curvature. Typically, the spine forms a curvature in the lower back and at the top of the shoulders. The most obvious sign of scoliosis is when the curvature in you back resembles the letter C or S instead. If you developed scoliosis during military service, you may be eligible for full or partial disability benefits. You could also qualify to file disability claims if you already had scoliosis, and it became worse during military service.

According to the American Association of Neurological Surgeons (AANS), approximately 80 percent of scoliosis cases are congenital. That means the degenerative spine condition was present at birth, often without a discernable cause. When adults develop scoliosis, the AANS describes this as the neurological type caused by abnormalities in the nerves that affect the spine. The most common scoliosis symptoms include:

• Back pain
• Difficulty breathing because the chest does not provide enough room for the lungs to expand.
• Limited mobility and range of motion
• One shoulder blade is higher and sticks out further than the other.
• Rotating spine
• Uneven hips

Service Connection for Scoliosis

If you are considering filing disability claims for scoliosis, you need to receive an official diagnosis from a doctor with a diagnosis code confirming the scoliosis. You will also need to provide documentation that proves your military service caused your scoliosis or caused it to become worse. Your injuries of the spine may have developed as the result of a single episode or from repeated painful motions you had to make to complete your military service duties.

Lastly, you will need a nexus letter that connects your military service with your current diagnosis code indicating scoliosis. Without a service-connected disability, the Department of Veterans’ Affairs (VA) will deny your claim. A nexus letter provides documented evidence from your medical provider that supports the information you provide to the VA. Here are some tips to help you and your doctor write a persuasive nexus letter to accompany your disability claim.

• Resist the urge to allow emotion to take over as you write the letter by focusing on proven facts like back pain and limited range of motion.
• Ask your current doctor to add his or her input as to your level of disability to the nexus letter.
• Make sure your doctor has access to all your medical records related to your musculoskeletal system. Having your doctor state that he or she has viewed medical records and has ongoing access to them could help to influence the decision made by the Department of Veterans Affairs.
• Remind your doctor to act as a neutral party when assisting you with the nexus letter and that the main purpose is for him or her to confirm it is at least as likely as it is unlikely that your back pain and limited range of motion has a service-related connection.

Keep in mind that you do not have to experience incapacitating episodes of spine or back pain to qualify for disability benefits. The VA typically looks at the limitation of motion caused by your scoliosis when assigning a disability rating and approving or denying your disability claim.

Secondary Service Connection for Scoliosis

When you have a disease or disability related to a secondary service connection, it means that the condition developed in response to your primary disability of scoliosis. Spinal stenosis and arthritis of the spine are closely related to scoliosis and may develop as a result of this painful spine and back condition.

Spinal stenosis occurs when the spaces within your spine narrow and cause pain by putting pressure on nerves that travel through the spine. Arthritis of the spine, also known as spinal arthritis, develops due to inflamed facet joints located in the spine or the sacroiliac joints that connect the pelvis and spine. Degenerative arthritis of the spine is the 10th most common reason that the VA grants a secondary service connection for scoliosis.

Service Connection by Aggravation | What if you were diagnosed with Scoliosis before service?

Service connection by aggravation means that you had scoliosis before signing on for military service, and it became worse while you were on active duty. However, you will need to submit documentation proving that you had scoliosis when you entered military service before the VA will consider you for service connection by aggravation disability benefits.

Proving service connection by aggravation will be easier to do if your military service entrance exam noted that you already had scoliosis. If your military service record does not mention this, contact your doctor to see if he or she will write a letter outlining your pre-existing condition of scoliosis.

You will also have to prove that your scoliosis worsened during military service. Unlike your primary disability claim, you do not have to document a specific event or duties that caused a worsening of your scoliosis. However, the progression of your impairment cannot have been due to its natural progression or occasional flare-ups. Creating a compelling case of service connection by aggravation requires input from your medical provider.

Compensation and Pension Exam (C&P exam) for Scoliosis

The VA requires some applicants for disability benefits to undergo a C&P exam when it needs more information to approve or deny a disability claim. The main purpose of a C&P exam is to help the VA understand the severity of the injury or illness. This information helps VA disability claims processors

assign an accurate disability rating. A staff member at your local VA Center will contact you to schedule the exam. Here is what you can expect when you arrive at your C&P exam.

• The doctor will review your disability claim and may ask questions about your medical records. Questions regarding your medical records typically come from the VA Disability Questionnaire.
• The doctor will perform a physical exam that may test the range of motion in your neck and spine.
• The doctor may request that you get a follow-up X-ray or other medical tests to support your disability claim.

You can expect your C&P exam to last several minutes to more than an hour depending on the severity of your back curvature, back pain, and other symptoms. Once you have completed the C&P exam, the doctor forwards visit notes to VA disability claims processors. After reviewing the information in your medical records and appointment notes, the VA disability claims processors assign a disability rating and notify you of their decision by mail. This can take three to four months.

You have the right to appeal the decision of the VA disability claims processors if you received a denial or disagree with the disability rating. As of February 19, 2019, you will need to go through the decision review process on the Department of Veterans’ Affairs website to file an appeal.

VA Disability Ratings for Scoliosis

The VA uses a system called the Veterans Affairs Schedule for Rating Disability (VASRD) when assigning a disability rating for conditions related to spine and back conditions, including scoliosis. However, scoliosis does not have a separate disability rating system on its own. The VA uses a general rating formula for all conditions related to spine and back conditions and then bases its disability rating primarily on limited range of motion of the spine. Here are some of the specific conditions included in the general rating formula for spine and back conditions.

• Ankylosing spondylitis
• Arthritis of the spine
• Intervertebral Disc Syndrome
• Favorable ankylosis
• Limited range of motion of the sacroiliac and lumbosacral joints
• Limited range of motion of the coccyx bone
• Spondylolisthesis
• Unfavorable ankylosis
• Other diseases of the musculoskeletal system

The VA uses a general rating formula that considers the degree of flexion you have in both your cervical spine and thoracolumbar spine. You would receive a 100 percent disability rating if scoliosis caused your entire spine to freeze in an unmovable position. The greater the percentage of flexion you have in your spine after a diagnosis of scoliosis, the lower your disability rating will be.

TDIU for Scoliosis

You may qualify for a Total Disability Rating Based on Individual Unemployability (TDIU) if your service-connected disability of scoliosis prevents you from finding or keeping gainful employment. This is true even if your disability rating from scoliosis is less than 100 percent.

Feel free to reach out to Hill and Ponton, a law firm serving the Veteran community, with additional questions about disability compensation for scoliosis or assistance with appealing your VA disability claim.

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Department of Veterans Affairs leaders disagree with scientists’ findings that link Agent Orange exposure to more diseases Congress has pushed VA to cover.

That decision could provide disability benefits to tens of thousands of Veterans and their families, to the tune of $15.2 billion.

In a report sent to the House and Senate Veterans Affairs committees Monday and obtained by Connecting Vets, VA Secretary Robert Wilkie said his experts disputed the findings of the National Academies of Sciences, Engineering and Medicine (NASEM).

NASEM scientists previously determined that there is evidence connecting bladder cancer, hypothyroidism, hypertension and Parkinson’s-like symptoms to exposure to the toxic herbicide.

But Wilkie said VA experts “noted significant concerns and limitations” with NASEM scientists’ findings, alleging that NASEM included “no definitive causal links” between the toxin and the four diseases in their findings.

Wilkie specifically mentioned that two of the four illnesses -- bladder cancer and hypertension, or high blood pressure -- have “many alternative risk factors” such as diet, tobacco use, genetics, age and race.

NASEM scientists also used members of the Army Chemical Corps for its “most rigorous study,” which “does not necessarily reflect the experience of the general population of Veterans deployed to Vietnam” because the Chemical Corps were known to have a higher exposure to Agent Orange, Wilkie said in the report.

The cost to extend VA benefits to cover those illnesses would likely run from $11.2 billion to $15.2 billion, depending on a pending court decision.

Wilkie and VA previously said the agency has no plans to decide on the four diseases until the completion of VA’s own in-house studies, the results of which aren’t expected to publish until late this year at the earliest.

“The soonest the secretary would be able to consider adding any new presumptive conditions is in late 2020,” the report said.

VA Agent Orange report 012820

Those studies are:

• The Vietnam Era Health Retrospective Observational Study: A study that began in 2014 to analyze overall health of Vietnam-era Veterans, including a survey of 45,000 randomly selected Veterans of the 9.9 million who served from 1961-75. The survey was fielded in 2016-17 and the results “are now being analyzed and prepared for submission to peer-reviewed literature in 2020,” Wilkie wrote previously.
• The Vietnam Era Mortality Study: An analysis comparing overall mortality and specific causes of death between Vietnam theater and era Veterans to standard U.S. civilian deaths. That study is expected to be completed and available for peer review and publication in “late 2020,” Wilkie wrote.

On Tuesday, Sen. Jon Tester, D-Mont., one of the loudest critics of VA's delayed decision, accused VA of denying scientific evidence.

“For far too long, the Trump administration has failed to acknowledge the tens of thousands of Vietnam Veterans who, as a result of their service, are continuing to suffer the detrimental effects of Agent Orange," Tester said in a statement to Connecting Vets. "Instead of justice, these Veterans have been subjected to unwarranted delays, and are consistently denied access to the critical care and benefits they desperately need. This report is particularly troubling because the administration is denying the overwhelming scientific evidence that has already been put forth, and is instead changing the rules by seemingly forcing Veterans with bladder cancer, hypothyroidism, Parkinsonism, and hypertension to meet a different — perhaps unattainable — standard. For these Veterans and their families, this is absolutely unacceptable.”

Two years ago, then-VA Secretary David Shulkin decided to add more diseases to the VA's list of health concerns that qualify a Veteran for Agent Orange disability benefits. According to documents obtained by a Veteran through the Freedom of Information Act and provided to Connecting Vets, White House officials stood in Shulkin's way expressing concern about the cost of covering additional diseases and requesting more research. Military Times first reported on the documents.

Earlier this year, Veterans Health Administration acting head Dr. Richard Stone told Congress VA "hoped" to make a decision on those illnesses "within 90 days," which was previously reported by Connecting Vets.

Expanding the list of health conditions presumed to be caused by Agent Orange exposure could provide disability pay and health benefits to more than 83,000 Veterans.

Repeated attempts by Connecting Vets to get an update from VA officials on whether the department had a forthcoming decision have been consistently met with the same statement: "VA has no announcements on Agent Orange presumptive conditions at this time."

A list of the diseases currently linked to Agent Orange and eligible for benefits can be found here.

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If a second wave of the coronavirus pandemic hit tomorrow, the Department of Veterans Affairs wouldn’t have enough personal protective equipment stockpiled to adequately handle another surge.

As the largest integrated health care system in the country, VA has been competing for medical supplies just like everyone else during this pandemic. But many manufacturers haven’t been able to keep up with global demand, and VA can’t depend on these manufacturers and suppliers to keep shelves stocked during the health crisis, department officials said.

VA currently has a 30-day supply of personal protective equipment, but it’s not enough to safely support a resurgence of the virus down the road, Richard Stone, executive-in-charge of the Veterans Health Administration, told the Senate VA committee Tuesday afternoon.

“We need to move to a 60-day supply,” he said. “For a full second wave, we’ll need an additional six months of supply. Either that can be supplied by the vendors or must be in our readiness centers.”

“So Dr. Stone, we’re not where we need to be?” said Sen. Jon Tester (D-Mont.), the committee’s ranking member.

“That is correct,” Stone said.

To better prepare for whatever comes next with the pandemic, VA is planning to establish four “regional readiness centers” around the country where it can collect and store medical supplies, PPE and other equipment.

“We are working with our partners at the Defense Department, FEMA and the Department of Health and Human Services and our commercial partners to get the material to build up and to sustain the operations that we currently have today,” said Deborah Kramer, VHA’s acting undersecretary for health for support services. “But what I need to share with you is that the supply chain system is still broken. There is still a tremendous demand [for] PPE, not just in the United States but worldwide. The manufacturing system has not caught up to the requirement.”

At the height of the pandemic, VA consumed 250,000 N95 masks a day, Stone said. The department spent $10 million per month on personal protective equipment (PPE) a month before the pandemic began. But during the current health crisis, VA is buying $100 million in PPE each month.

No facility at VA ever ran out of protective equipment, though the guidelines on how many masks employees should receive and how often they could reuse PPE changed throughout the course of the pandemic, Stone said.

He dismissed the idea that VA’s approach to PPE and testing have put employees in danger.

To date, 34 employees have died due to complications from the virus, according to VA public data.

“My number one responsibility is the safety of Veterans and the safety of employees who have pledged their work lives to the VA. It is impossible for any of us to understand how these employees got this disease,” Stone said. “To suggest that somehow we have endangered our personnel is just not borne out by the facts.”

The department is evaluating every employee death, and the Occupational Safety and Health Administration is involved in those investigations as well, Stone added.

VA last week admitted it “wasn’t there yet” in its efforts to provide on-demand coronavirus testing for its employees, again, due to a lack of swabs, cartridges and other supplies needed to process those tests.

VHA has tested 17% of its workforce to date, and it’s testing 600-to-700 employees a day, Stone said.

With only a few manufacturers making swabs in the entire world, VA is turning to its own 3D printing network for help. The department has been making “a few thousand” swabs a week, but it has a plan in place to begin making “about 100,000” swabs a week by this fall, Stone said.

Stone also clarified VA’s relationship and coordination with FEMA for supplies.

“At no time did FEMA take our supplies,” he said. “There was a short period of time immediately after the activation of the Defense Production Act, that every vendor and supplier in this nation paused delivery of some materials to await further guidance. As a result, there was a single week where we simply were not receiving supply orders. Therefore we deployed measures to ensure our employees had the PPE needed to be safe.”

To better involvement and perhaps improve collaboration between the department and other federal agencies, both Tester and Sen. Jerry Moran (R-Kan.), the committee’s chairman, are urging the president to include VA on the Defense Production Act committee.

“The federal government must ensure that the VA can continue to provide this care, starting with providing the VA with the means to ensure its medical facilities are stocked, and staff is appropriately equipped,” the senators wrote in a letter to president earlier this week.

Supply chain management issues compound VA pandemic challenges

Longstanding supply chain management challenges at VA are only complicating the department’s efforts to manage medical supplies during the pandemic.

Currently, VA supply technicians must switch back and forth between a few separate systems to view current inventory and then make purchases.

“A large percentage of our purchases are done locally at medical centers using government purchase cards with literally billions of dollars traversing those government purchase cards,” Stone said. “It’s very difficult for us to track those, as well as to track the contracts that are being used and to assure the validity and transparency of the system that you expect.”

Local VA medical facilities often make purchases based on what’s best for them, not for the entire VHA enterprise, said Kurt Heyssel, a former VHA chief supply chain officer.

“Often times the left hand doesn’t know what the right hand is doing,” he said. “VA corporate is not in control, as it must be, to achieve supply chain success.”

During the pandemic, VHA developed a makeshift, centralized system where all 170 medical centers could manually report on their supply. But senators were skeptical such a system could truly support such a large health care enterprise during a public health crisis.

Adopting the Defense Medical Logistics Standard Support (DMLSS), which has been the plan, should resolve many of VA’s challenges.

But implementation will take seven years, though the pandemic has proven VA needs to move faster, the department acknowledged.

The initial DMLSS roll-out at a VA facility near Chicago is scheduled for August. Two other sites in the Pacific Northwest will go live in the fall, Kramer said.

“Five years is perhaps possible, but we have to talk to our Department of Defense colleagues,” she said. “They are on the critical path to getting this system fielded. We cannot do it without their support, and we need to understand what their constraints are before we can actually tell you what a realistic schedule will be.”

Meantime, DoD is developing the next iteration of DMLSS, called LogiCole, which will move the current system to a cloud-based platform.

LogiCole is supposed to be ready in 2022, Stone said.

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LITTLE ROCK—A former program analyst for the Department of Veterans Affairs (VA) was sentenced to prison on Thursday afternoon after stealing personal information from Veterans and VA employees. Phillip Hill, 35, of Malvern, was sentenced to 46 months in federal prison by United States District Judge Kristine G. Baker.

In the fall of 2017, federal agents learned that Hill, who worked at the North Little Rock VA Medical Center, had access to Veterans’ and current VA employees’ personal information to include names, dates of birth, and social security numbers.

Agents learned that Hill had contacted another individual and attempted to sell personal identifying information to a buyer for approximately $100,000. Multiple recorded conversations with this individual and Hill were monitored by agents. Throughout one monitored conversation, Hill repeatedly acknowledged the illegality of his conduct. Hill explained that he was offering to sell the personal identifying information for any Veteran who had received VA compensation or a pension, visited a VA medical center, or had completed a VA financial assessment. Hill also offered to sell personal identifying information for VA employees, explaining the employees’ data would be particularly valuable to identity thieves, as it would include personal identifying information and personal account information for employees who were earning over $50,000 a year.

Hill was arrested on December 17, 2017, at the VA Regional Office by agents. As part of the investigation, his phone was searched. Records found on the phone indicated that a VA database spreadsheet containing personal information had been loaded onto Hill’s Google drive account had been accessed by Hill on his phone days prior to his arrest.

“This defendant took advantage of his position of trust within the VA healthcare system,” stated Jonathan D. Ross, Acting United States Attorney for the Eastern District of Arkansas. “His fraudulent scheme had the potential to create financial chaos for those whose information he stole. This sentence demonstrates our office’s commitment to prosecuting those who would defraud the heroes who have served our country.”

“This sentence sends a clear message that those entrusted with the protection of the personal information of our nation’s Veterans and VA employees will be held accountable should they violate that trust,” said U.S. Department of Veterans Affairs Office of Inspector General (VA OIG) Special Agent in Charge Jeffrey Breen, South Central Field Office. “The VA OIG thanks the United States Attorney’s Office and our law enforcement partners at the United States Secret Service for their joint efforts to achieve justice in this case.”

Hill was indicted in January 2018 with attempted trafficking in access devices, aggravated identity theft, and possession of access device-making equipment. In September 2019, he pleaded guilty to attempted trafficking in access devices in exchange for dismissal of the remaining charges. In addition to 46 months in prison, Judge Baker sentenced Hill to two years of supervised release following his term of imprisonment. The case was investigated by the VA OIG with assistance from the United States Secret Service and prosecuted by Assistant United States Attorney Jana Harris.

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The U.S. Department of Veterans Affairs (VA) announced today, employees in the national capital region launched their 2020 Combined Federal Campaign (CFC) season to support causes ranging from Veteran suicide prevention to children with special needs.

As the “Show Some Love” theme continues for this year’s campaign, VA personnel will once again step up to pledge money and volunteer their time for local, national and international charities.

“The department contributed more than $3.7 million dollars in monetary donations and 4,807 volunteer hours last year,” said VA Secretary Robert Wilkie. “Our VA employees are not only committed to our Veterans, their families and beneficiaries — they are also committed to the causes they believe in. CFC is another way we can help those in need, especially in these tough times.”

In 2019, federal employees and retirees pledged over $86.4 million. For nearly 60 years, members of the federal community have contributed more than $8.4 billion to help those in need locally, nationwide, and around the world. These pledges help people and communities in need and reflect the generous nature of the federal community.

The 2020 CFC encourages federal employees to:

• GIVE. Donate through payroll deduction or a one-time gift.
• VOLUNTEER. Pledge volunteer hours as an additional way to support the impactful work of local, national and international charities.
• ENGAGE. Be the Face of Change by submitting your selfie through the CFC website and get involved with the campaign.

In this challenging year, the steadfastness of the federal community has been awe-inspiring, as they continue to fulfill professional responsibilities and keep our country moving. At the same time, nonprofit organizations face increased demand for their services responding to increased needs in the past year. They struggle with reduced resources due to limited donations and canceled fundraising events during economic hardships.

New legislation in 2020 allows taxpayers to deduct $300 ($600 for married couples) in qualified charitable donations even when taking the standard deduction. Federal employees are encouraged to go beyond their call to public service by contributing to the thousands of CFC charities that work to improve the quality of life for all. Federal retirees can give via their annuity, and if they need to take a required minimum distribution from a retirement account, the CFC can help with that too.

Donors are encouraged to Show Some Love at CFC’s page.

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The U.S. Department of Veterans Affairs (VA) is encouraging Veterans to leave smoking behind for good Nov. 19, during the Great American Smokeout by combining cessation counseling with other VA clinical resources and support.

Research shows behavioral counseling can significantly improve one’s chances of quitting and combining counseling and medication works better than medication or counseling alone.

“VA’s counseling programs are one of most effective tools available for Veterans who want to permanently stop smoking,” said VA Secretary Robert Wilkie. “The Great American Smokeout is the perfect time for Veterans to connect with their health care provider and take the first step toward improving their physical and mental health —to stop smoking for good.”

VA health care providers can help Veterans explore the role tobacco plays in their daily routine, including the activities or situations that trigger them to use tobacco, such as talking on the phone, drinking coffee or alcohol or feeling bored or stressed. Providers work with Veterans to develop strategies for coping with those triggers and to tailor plans for quitting that will fit into a Veteran’s daily life.

In addition to counseling, VA provides other services designed to help Veterans stop smoking, including prescription medications, nicotine replacement products like gum and patches, and resources such as Quit VET and SmokefreeVET.

Learn more about tobacco cessation.

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WASHINGTON — As part of President Biden’s Unity Agenda commitment to support the nation’s Veterans, the Department of Veterans Affairs is adding nine rare respiratory cancers to the list of presumed service-connected disabilities due to military environmental exposures to fine particulate matter.

The following list of rare respiratory cancers will be added to VA’s regulations through an Interim Final Rule published in the Federal Register on April 26, 2022:

• Squamous cell carcinoma of the larynx.
• Squamous cell carcinoma of the trachea.
• Adenocarcinoma of the trachea.
• Salivary gland-type tumors of the trachea.
• Adenosquamous carcinoma of the lung.
• Large cell carcinoma of the lung.
• Salivary gland-type tumors of the lung.
• Sarcomatoid carcinoma of the lung.
• Typical and atypical carcinoid of the lung.

VA determined through a focused review of scientific and medical evidence there is biological plausibility between airborne hazards and carcinogenesis of the respiratory tract — and the unique circumstances of these rare cancers warrant a presumption of service connection.

The rarity and severity of these illnesses and the reality these conditions present, is a situation where it may not be possible to develop additional evidence, prompted VA to take this action.

“Veterans who suffer from rare respiratory cancers associated with their service deserve the very best America has to offer—but they’ve had to wait for the care and benefits they deserve for far too long. That ends now," said Secretary Denis McDonough. “With these new presumptives, Veterans who suffer from these rare respiratory cancers will finally get the world-class care and benefits they deserve, without having to prove causality between their service and their condition.”

VA will begin processing disability compensation claims for Veterans who served any amount of time in the Southwest Asia theater of operations beginning Aug. 2, 1990, to the present, or Afghanistan, Uzbekistan, Syria or Djibouti beginning Sept. 19, 2001, to the present.

Any Veteran who has or had one of the listed cancers at any time during or after separation from military service may be eligible for disability compensation benefits. VA will contact impacted Veterans and survivors to inform them about their eligibility and will provide information on how to apply.

Veterans, survivors or dependents who had claims previously denied for any of these respiratory cancers are encouraged to file a supplemental claim for benefits. If you are a Veteran, survivor or dependent applying for the first time, file a new claim here.

To apply for benefits, Veterans and survivors may visit VA.gov or call toll-free at 800-827-1000.

The official version of this rule is scheduled to publish in the Federal Register April 26, 2022. However, the document is available for previewing.

Source: Paul Sutton

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The U.S. Department of Veterans Affairs (VA) Board of Veterans’ Appeals (Board) today announced it is expanding access to virtual hearings to all Veterans awaiting their Board hearing after successfully testing the capabilities during the last year.

Virtual hearings are a secure, confidential and convenient option for Veterans and their representatives to have their Board hearing held from a location of their choosing.

The Board moved quickly to put this option into place in response to COVID-19 and the temporary suspension of in-person hearings. For Veterans who opted to have a hearing, choosing the virtual hearing will allow the Board to decide a Veteran’s appeal more quickly.

Virtual hearings became a permanent option for Veterans, April 10, when President Trump signed the VA Tele-Hearing Modernization Act into law. To date, the Board has successfully held more than 640 virtual hearings and has the capacity to hold 250 per week. There are many openings on the virtual hearing docket for Veterans and their representatives considering this option.

“Providing Veterans the option to participate in their Board hearings from a location of their choosing is yet another way VA and the Board are continuing to modernize,” said VA Secretary Robert Wilkie. “This option helps VA ensure Veterans continue to receive important benefits and services, especially in these difficult times.”

More information on virtual hearings can be found here.

Source

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On Jan. 1, 2020, the Department of Veterans Affairs said it began processing disability claims for Veterans exposed to Agent Orange while serving aboard ships in the territorial seas of Vietnam.

But a Veterans advocacy group says the new policy still excludes some Veterans exposed to the deadly herbicide on ships and in aircraft during the Vietnam War.

“This may be a good start,” Rob Maness, retired Air Force colonel and executive director of Louisiana-based Military-Veterans Advocacy (MVA), said in a statement. “But the battle continues. The new policy specifically exempts those Veterans who flew close air support missions and those who served outside of the territorial sea.”

In 2019, a federal court ruled that VA must recognize Veterans exposed to Agent Orange who served offshore, the so-called Blue Water Navy Vietnam Veterans. Congress and the president passed and signed into law the Blue Water Navy Vietnam Veterans Act to further codify that decision.

But some Veterans could be left out.

“The VA has chosen to interpret the Blue Water Navy Vietnam Veterans Act too narrowly,” said retired Navy Commander John B. Wells, MVA chairman of the board and director of litigation. “The Congressional action was poorly worded and provided ambiguities seized on by the VA to limit coverage. Although the Act did not replace the original law and did not supersede Procopio, the VA’s constricted reading effectively does so."

That could be particularly true for pilots, who were not explicitly included in the Blue Water legislation or in the court decision.

“Often these Air Force and Navy pilots flew through clouds of Agent Orange to perform their mission,” Maness said. “They should be covered.”

Service members who worked on the perimeter in Thailand, where Agent Orange was also used, are covered. But those who worked or even slept near the perimeter and who may have been exposed, are also left out.

“This policy is way too narrow,” said Bill Rhodes, retired Marine staff sergeant, Thailand Veteran and MVA director of Thailand Veterans. “Many of the barracks backed up to the perimeter and personnel who did not have duties on the perimeter slept there, yet they are not covered. Additionally, vehicles and personnel would track the herbicide into the base interior, increasing the exposure.”

The Army Field Manual on herbicide exposure required a 500-meter buffer area for spraying, Rhodes said. But service members who worked in that buffer area also are not covered under the new policy. Nor are service members stationed on Johnston Island, where Agent Orange was stored and leaked, said Brian Moyer, MVA director of Central Pacific islands.

"Leakage from the steel barrels, stored in the open salt air, resulted in the exposure of military personnel in the area," he said.

The island of Guam, where MVA says testing showed the presence of herbicides as late as 1980, also is not covered in the new policy, though MVA has made a request from VA already to include it.

“We are reviewing our options and may seek judicial review of this policy," Wells said.

For more information on filing an Agent Orange disability claim, click here.

Source

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VA will extend the existing moratorium on evictions and foreclosures, as well as extend VA loan forbearance requests, to June 30, because of COVID-19.

The current moratorium extensions for evictions and foreclosures were set to end March 31.

“We will do everything in our power to help Veterans, their families, survivors and our caregivers get through this pandemic,” said VA Secretary Denis McDonough. “The department’s moratorium and forbearance extensions support President Biden’s Jan. 22 Executive Order to deliver economic relief to Americans amid the COVID-19 crisis by addressing economic hardships the Veteran community faces, through no fault of its own, during the ongoing pandemic.”

A forbearance allows Veterans time to resolve the reason that they can’t pay the regular monthly installment and get back on a regular monthly repayment schedule again. The missed payments due at the end of a forbearance period do not have to be made up in a single payment. However, if Veterans can make up the all the payments in a lump sum and resume making regular monthly mortgage payments, then they may do so.

VA’s Borne the Battle podcast previously tackled questions that many borrowers are facing during the pandemic, providing answers to questions on homeownership, borrowing, forbearance, VA Loans, complaint filing, and tips on financial decision-making during the pandemic.

The Consumer Financial Protection Bureau (CFPB) has a “Find a Counselor” tool to find counseling agencies approved by the Department of Housing and Urban Development (HUD). Veterans can also call the HOPE™ Hotline open 24 hours a day, 7 days a week, at (888) 995-HOPE (4673) for personalized advice. Other mortgage and financial resources are available at: https://www.consumerfinance.gov/coronavirus/.

VA borrowers experiencing financial hardship due to COVID-19 can review VA guidance for borrowers or call 877-827-3702 for additional information.

Source

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A Department of Veterans Affairs hospital in Richmond, Virginia, rehired a pathologist who had been previously fired for failing to diagnose or misdiagnosing cancer in at least a dozen patients, the VA Office of Inspector General reported Wednesday.

None of the incidents were reported as adverse events to patient safety officials at the facility, the Hunter Holmes McGuire VA Medical Center, including one involving a patient whose misdiagnosis caused their condition to worsen, later requiring advanced medical treatment.

The report is the second in two days from the VA OIG to expose physician failures at VA hospitals that went unchecked by administrators. On Tuesday, the VA OIG released a report finding that the department took nine months to fire an emergency room contract physician who, after deciding a patient was "malingering" and "ranting," called VA police to have the patient escorted off property and said they could go "shoot [themselves]. I do not care."

The veteran died by suicide six days later from a self-inflicted gunshot wound.

In 2017, the Government Accountability Office reported that VA medical center officials regularly failed to investigate complaints lodged against providers or waited months to look into allegations.

The report also found that when the VA revoked doctors' privileges, officials often failed to inform state licensing boards or a national database, allowing the doctors to practice elsewhere. The VA also sometimes reached settlements with physicians that allowed them to resign in exchange for not reporting their errors.

In subsequent congressional hearings on the issue, VA officials pledged to address the problems, including reporting adverse actions at the state and national levels.

But the OIG report released Wednesday indicates that hospital officials continue to engage in cover-ups.

According to the report, the hospital's Pathology and Laboratory Medicine Services chief wasn't even aware of the VA's requirement to report the misdiagnoses to higher-ups. Senior officials also weren't aware they were supposed to participate in a state licensing review board process following the incidents.

The physician was fired but appealed the termination. In March 2019, the doctor was rehired, and clinical privileges were restored. As of last September, the physician continued to work at Hunter Holmes McGuire as an investigation was ongoing into his or her ability to turn around surgical readings in a timely manner.

Likewise, at the Washington, D.C., VA Medical Center, officials failed to dismiss the physician, a contractor, who verbally abused the suicidal veteran even though other employees reported the incident and the doctor had been the subject of other reports of "verbal misconduct."

The report noted that the doctor remained as a physician at the VA because reviews found his or her care of patients to be sufficient.

The Washington, D.C., VA eventually ended the physician's contract, according to the report.

President Donald Trump frequently touts changes that his administration has made to "fix" the VA, including accountability legislation approved in 2017 that accelerated the process for firing workers for misconduct or poor performance, as well as shortening the time employees have for processing appeals.

"I signed the VA Accountability Act into law, and we've removed more than 9,000 VA workers who were not giving our veterans the care, respect, attention that they've earned. And now that we have accountability -- it's 'accountability;' a very nice word -- if an employee of the government mistreats our veterans in any way, does something wrong, isn't good for the VA, the secretary looks at them and says, "You're fired. Get out," Trump said in a speech June 17 to introduce his plan for reducing veteran suicides.

The OIG reports this week, however, indicate that the VA still struggles to hold physicians accountable and to protect veteran patients or the public, in cases of physicians who go on to practice at civilian facilities after leaving the department.

In Richmond, VA officials failed to conduct a state licensing board review and in Washington, D.C., the doctor was never reported to the state and national boards that record physician misconduct.

"Facility leaders did not report [the Washington, D.C.] physician to the State Licensing Board or National Practitioner Data Bank. Although facility leaders did not conduct a formal investigation, they removed [the physician] from the VA contract... and therefore, facility leaders had a duty to report," the VA OIG wrote.

"Neither the former Facility Director nor the Chief of Staff completed all elements of a [VA]-required review upon discovery of the subject pathologist's 'egregious performance,'" the VA OIG wrote.

Source

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VA Northern Indiana Health Care System (VANIHCS) has received national recognition for their Mobility and Sensory Aids Clinic under the Prosthetics Services.

The VANIHCS Mobility Clinic evaluates all specialty manual and power wheelchairs, specialty cushions and mattresses, outpatient hospital beds, and home access issues. The clinic employs three occupational therapists, owns three mobility vans, and serves over 1,400 Veterans a year. All Veterans that are eligible for VA services are also eligible for the Mobility and Sensory Aids Clinic services. The clinic travels to all six VANIHCS locations, nursing homes, and Veteran residents in northeast Indiana area.

“Our Mobility and Sensory Aids Clinic strives to look at the ‘big picture’ for the Veteran’s quality of life,” said William Bockover, Chief of Prosthetics. “We are always looking for ways to improve our services and work with other VA departments to enhance Veteran-centric care.”

The Mobility and Sensory Aids Clinic serves a variety of clinics, including Poly Trauma, Spinal Cord Injury, Ortho, Amyotrophic Lateral Sclerosis, Plastics, Physical Medicine and Rehab Services Wounded, Primary Care, and Amputee Clinics.

“Adding a Spinal Cord Injury Clinic to the Fort Wayne Campus has allowed our Veterans to receive care at their home VA and not have to travel to Chicago,” said Bockover.

The model was first developed by Mitch Allard, Registered Kinesiologist Therapist, Assistive Technology Professional in early 2000. In 2015, VANIHCS opened their Mobility and Sensory Aids Clinic with the help of Bockover, who worked with Allard at the Indianapolis VA before transferring.

Empowering theCommunity Living Center

The Mobility Clinic also assess the Marion Community Living Center’s resident’s power wheelchairs and scooters before they can utilize them on campus.

“My power scooter makes it much easier for me to get around the campus than my manual wheelchair,” said George Gorsuch, VA Northern Indiana Resident. “I struggled to wheel myself up the ramps because of a shoulder injury. My scooter allows me to have more freedom.”

The clinic also offers Home Improvement and Structural Alterations (HISA) grants for disabled Veterans. The HISA grant helps disabled Veterans modify their home to help ease certain home challenges. Some of the modifications include remodeled bathrooms, widening doors and lowering counter tops.

Source

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In a move that should speed up disability claims for some Vietnam Veterans, officials announced Monday they have completed digitizing thousands of deck logs from ships stationed offshore during that war, enabling researchers to better determine where troops served and what toxins they may have encountered.

Completion of the project is the culmination of more than a year of work between Veterans Affairs and National Archives and Records Administration officials. The move was prompted by legislation passed in summer 2019 mandating VA award presumptive benefits status to Veterans who served in the waters off Vietnam during the war there five decades ago.

Department officials said they have awarded roughly $641 million to more than 22,524 blue water Navy Veterans or survivors since the start of this year. But advocates have estimated that as many as 90,000 Vietnam Veterans may be eligible for those payouts, and the digitized deck logs are expected to help with that application process.

In a statement, VA Secretary Robert Wilkie said the move should make it easier for Veterans “to receive the benefits they’ve earned without burdening them with paperwork.”

At issue is how the department had handled claims related to Agent Orange exposure during the Vietnam War.

Under previous VA rules, service members who were stationed on the ground or on ships near the coast were presumed to have had exposure to the chemical defoliant and other carcinogenic herbicides. When illnesses arose later in life and they applied for disability claims, their claims were approved without requiring additional documentation.

But because of scientific disputes over the level of exposure to those toxic chemicals in the seas around Vietnam, the so-called “blue water” Veterans who served on ships offshore were not granted the same preferential status by VA.

As a result, they were required to provide specific proof that their illnesses later in life were related to their military service, and in some cases told to find ship logs proving that they had spent time in the waters around Vietnam.

Advocates for years lamented that the level of documentation was an unfair burden on aging and infirm Veterans. Lawmakers agreed, passing the legislation last year and mandating VA’s efforts to update the decades-old records.

Work on the Navy deck logs was completed in late 2019, before VA began awarding the blue water Veteran claims. But work on Coast Guard deck log digitization wasn’t completed until this month.

“Through this scanning project, VA contractors digitized declassified Navy and Coast Guard deck logs from 1956-1978 in NARA’s holdings, including the log of the hospital ship USS Sanctuary which I served aboard during the Vietnam conflict,” David Ferriero, Archivist of the United States, said in a statement Monday.

“As a Veteran from this era, I recognize the unprecedented value this provides to Veterans making these logs easily accessible online.”

NARA is making the newly-digitized records available to researchers, Veterans advocates and other groups.

VA officials have encouraged Veterans, dependents and surviving spouses looking to file a claim related to the records to contact an approved Veterans service organization for help with the process.

Source

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Changing How the VA Rates Mental Conditions:GAF Scores vs. WHODAS 2.0

Veterans can experience a variety of mental health issues following military service. From mild anxiety to occasional panic attacks to PTSD, there are many mental illnesses that can affect a Veteran’s daily life. In order to award disability benefits for mental health conditions, the VA uses a scoring system to rate the symptom severity.

While they once used GAF scores (the Global Assessment of Functioning) as their main rating system, they now use a system called WHODAS 2.0. This is because WHODAS 2.0 is the new standard of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders guide.

This guide will outline the main differences between these two systems and why the VA made the switch.

What is aGAF Score?

GAF stands for the Global Assessment of Functioning Scale. A clinician can use this to measure a Veteran’s overall level of functioning and their ability to carry out activities of daily living. For Veterans who are claiming PTSD or any mental health condition, they should know that their GAF score can play an important role in how the VA decides their claim. Before proceeding, you should know that the VA has now been using the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V or DSM-5). The DSM-V no longer uses GAF scores, but instead now uses the assessment tool known as the WHODAS 2.0.

The Global Assessment of Function scale is a 100-point score that measures a Veteran’s overall level of psychological, social and occupational functioning on a hypothetical continuum, with 100 measuring minimal limits of daily functioning and the measurement of 0 indicating that the Veteran or individual is having severe difficulty with daily activities and functions.

TypicalGAF Score Psychology: Ranges In The Rating Scale

• 100-91: Superior functioning in a wide range of activities – no symptoms
• 90-81: Absent or minimal symptoms, good functioning in all areas, interested and involved in a wide range of activities. Socially effective and generally satisfied with life
• 80-71: Transient symptoms and expectable reactions to psychosocial stressors; no more than slight impairment in social, occupational or school functioning
• 70-61: Some mild symptoms or some difficulty in social, occupational, or school functioning, but generally functioning pretty well; has some meaningful interpersonal relationships
• 60-51: Moderate symptoms or moderate difficulty in social, occupational, or school functioning (i.e., few friends, conflicts with peers or coworkers)
• 50-41: Serious symptoms or serious impairment in social, occupational, or school functioning
• 40-31: Some impairment in reality testing or communication or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood
• 30-21: Behavior is considerably influenced by delusions or hallucinations or serious impairment in communication or judgment, or inability to function in almost all areas
• 20-11: Some danger of hurting self or others or occasionally fails to maintain minimal personal hygiene; or gross impairment in communication
• 10-1: Persistent danger of severely hurting self or others or persistent inability to maintain minimal personal hygiene or serious suicidal act with clear expectation of death

Based on these GAF ratings, the VA would decide the severity of the Veteran’s condition to determine the amount of disability benefits they would receive. However, the WHODAS 2.0 system has since become the standard for mental health evaluations.

Global Assessment of Functioning: What is a WHODAS 2.0?

As mentioned above, the DSM replaced GAF scores with the WHODAS 2.0 tool. WHODAS is based on the model of diseases where the assessment of impairment and disability is separate from the diagnosis of the disease. The actual test for WHODAS 2.0 is a self-report of assessment by the patient which evaluates six domains and the patient’s ability to perform in each of those domains over the last 30 days:

• Understanding and Communicating
• Getting Around (mobility)
• Self-care
• Getting along with people (social functioning and interpersonal functioning)
• Life activities (home, academic, and occupational functioning)
• Participation in society (participation in family, social, and community activities).

The WHODAS 2.0 comes in two versions a 36- and a 12- question format. Each format is available in three versions: a self-administered, proxy-administered, and a rater-administered. (Proxy versions are meant for a third party, such as a caregiver or family member to take if the Veteran is unable to complete the test himself.)

After completing the test, there are two scoring methods available: a simple scoring method and a complex scoring method. The simple scoring is done by hand and gives no weight to individual items, nor does it convert to a standardized scale. The complex method requires a computer to score and is based on an item-response theory. For rating purposes, this will likely be the version implemented by the VA to standardize scores.

Why Has VA ReplacedGAF For WHODAS?

The WHODAS test is more reliable and responsive to change across different communities and geographic regions than GAF. It’s considered a more reliable global assessment scale. WHODAS has demonstrated good facial reliability across countries, populations, and diagnostic groups including both ages and genders. For these reasons, the DSM-V has decided to remove GAF from its diagnostic toolbox and add the WHODAS 2.0.

For VA PTSD ratings, the GAF score is not now meaningless for VA ratings. In fact, many VA PTSD decisions still consider GAF scores, but there is a change coming. The change should mean more reliable and consistent ratings for Veterans seeking help for their mental disorders. The change also means that there are going to be errors as raters adjust to the new criteria. As a result, make sure examiners are recording your PTSD symptoms and not just checking boxes on a sheet. Inadequate information could mean an inaccurate assessment.

How Does The VA Rate Mental Health Claims?

The VA recognizes and grants service connection for a number of mental health disorders. Some of the most common ratings are post-traumatic stress disorder (PTSD), major depressive disorder (MDD), general anxiety disorder, and bipolar. Each of these mental health disorders are described by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, more commonly referred to as the DSM-V. Let’s look at how PTSD is rated with the DSM.

How Does VA rate PTSD?

Prior to the DSM-V, the VA used the DSM-IV-TR for rating mental disorders. The DSM-IV uses the global assessment of functioning (or GAF) score to rate the severity of a mental disability that a Veteran suffers. GAF scores reflect the impact of a Veteran’s disability on his social, occupational, and psychological functioning. GAF scores range from 0 – 100. A score of 0 represents total impairment, and a score of 100 would represent normal functioning. A GAF score below 50 represents serious to severe social impairment. The VA has used GAF scores in its determination of the impact that mental illness has on the affected individual.

Does VA Still Use TheGAF Scale to Rate PTSD?

Critics complained that GAF scores were too subjective to be reliable in reporting the disorder’s actual impairment. Generally, a rater’s training and performance are essential to a GAF score’s reliability. GAF scores often correlate more with the severity of the symptoms that an individual is experiencing. The scores do not usually reflect the functional impact those symptoms have on an individual in day to day situations. For these reasons and others, the authors of the DSM-V decided to exclude GAF scores in rating PTSD and other mental disorders. In the place of GAF, the DSM-V uses the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0).

How Does The VA Use WHODAS 2.0?

The DSM-V writers recommend using WHODAS 2.0 to assess PTSD for clinical uses.   The first difference between GAF and WHODAS is how it rates mental disorders and the resulting disability. Rather than assigning one numerical score, WHODAS separates the medical and psychiatric disorders from the disabilities that those disorders cause. In effect, the WHODAS score assesses the disability first. Then lays out what kind of impairments that disability causes in the daily functioning of the affected individual.

How does WHODAS 2.0 Affect My VA PTSD Rating?

So, what does the WHODAS look like? In WHODAS classifications, PTSD results in particular impairments to functioning. The PTSD classification covers activity limitations, participation restrictions, and the impact on a person’s interaction with his environment. Unlike the GAF scale, the new test takes into account the personal factors of a person rather than trying to fit everyone into broad categories.

The WHODAS uses the International Classification of Functioning to assess social factors related to the individual’s functioning. This includes personal circumstances (age, education, and motivation) as well as the individual’s environment. The individual’s environment is not limited to just the physical aspects, but also takes note of accommodations and support available.

WHODAS, unlike GAF, recognizes two individuals can have PTSD and its functional impairments. But those individuals could have different degrees of disability due to personal and environmental factors. For example, one individual might experience a mildly depressed mood or mild insomnia, while another might report suicidal ideation. The new rating scale would assess these Veterans as individuals, taking all factors into account. This differs from GAF score psychology.

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The Department of Veterans Affairs will see nearly a 12 percent increase in total funding under the full-year spending deal approved by Congress on Monday, another significant financial boost for a department that has seen steady growth over the last two decades.

Under the budget measure approved by Congress in last-minute legislative work, the fiscal 2021 budget for the department is set at $243 billion, up $3 billion from the president’s initial request earlier this year and up $26 billion from fiscal 2020 levels.

That includes boosts for big department projects such as the electronic medical records overhaul, whose funding nearly doubled from about $1.5 billion last year to $2.6 billion this year. VA officials are expected to expand the program to multiple new sites in 2021, resulting in new costs.

The new fiscal year began on Oct. 1, but the agency has been operating on budget extensions since then as lawmakers argued over federal spending levels and a new pandemic economic relief package. Both of those were approved late Monday night, and signed into law by President Donald Trump early on Tuesday morning.

VA officials for years have pushed to increase department funding even as other federal agencies have seen their budgets held flat or reduced. They argue that increasing demands on the department — not just medical and benefits costs from the recent wars, but also new services for all Veterans — warrant the changes.

But while some lawmakers on Capitol Hill have begun to raise concerns about the ever-increasing VA budget, none have taken extra efforts to block the funding raises.

The VA budget has soared nearly five-fold in the past 20 years. In fiscal 2001, the VA budget totaled $45 billion. Ten years ago, it was about $125 billion, a little more than half of the House-passed plan for fiscal 2021.

The new money carries with it a host of expectations from lawmakers, including new reports on VA hiring practices, barriers to women Veterans in seeking VA medical care, cases of sexual misconduct at VA facilities and progress in efforts to prevent Veterans suicide.

About $10.3 billion of the funding would be set aside for mental health programs, with $312 million specifically earmarked for suicide prevention efforts. Another $1.9 billion would be earmarked for homeless Veterans projects.

Lawmakers added about $6.1 billion in additional money for compensation and pensions payouts for this fiscal year, noting problems this fall with processing some payments because of changes in available funding accounts due to the budget uncertainty.

Capitol Hill officials wrote that “while Congressional action prevented Veteran payments from being impacted, the department must be more attentive to ensure that this needless risk is not repeated in the future.”

The full-year budget deal likely ensures that President-elect Joe Biden will not have to deal with a partial government shutdown threat in his first eight months in office.

Even if political fights cause budget issues next fall, the new deal includes $130 billion in advance appropriations for fiscal 2022, to ensure Veterans services are not disrupted.

Source

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VA professionals help blind Vet learn to live and work independently

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

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

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

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

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

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

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

The meeting that changed everything

A chance meeting in a parking lot changed that.

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

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

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

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

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

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

“You know there is hope”

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

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

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

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Challenging logistical accomplishment by VA staff

The Gulf Coast Veterans Health Care System’s Biloxi VA Medical Center administered the organization’s 10,000th dose of the Moderna COVID-19 vaccination Feb. 13. The shot was given during the organization’s COVID-19 appointment-only vaccination clinic at the Mississippi Coast Coliseum in Biloxi, Mississippi.

Navy Veteran Camille Spencer received the vaccine during the day-long event, an effort Director Bryan C. Matthews said is the result of the organization’s employees, many of whom are Veterans themselves.

Pictured above, VA employee Sascha Kaletsch gives Spencer her COVID-19 vaccination pin.

“Our medical professionals, supply chain, and administrative personnel have been part of an outstanding effort to provide these much-needed vaccinations to our nation’s heroes. Being able to administer the 10,000th dose of this vaccine during what can only be described as a challenging logistical feat speaks to the continued efforts of our staff.”

Spencer received the vaccination during the vaccination clinic, including Biloxi, Mississippi, and Pensacola, Florida. So did more than 1,000 other Gulf Coast Veterans. Using the mass vaccination model used by numerous public health organizations, both the Biloxi and Pensacola facilities offered appointment-only COVID-19 vaccinations.

Maximizing efforts to minimize risk

Dr. M. Christopher Saslo is associate director for patient care services and a nurse executive. Saslo said: “This effort helps boost the number of vaccines being delivered to our Veteran population with the support of the VA Network Office and VA Central Office efforts.

“With more than 75,000 registered Veterans throughout the Gulf Coast, it is vital to maximizing these efforts in order to minimize risk to our Veterans at risk for exposure.”

The health care system has been administering doses of the vaccine since January 2021. It provides vaccinations to Veterans in accordance with Centers for Disease Control and Prevention recommendations and VA guidelines.

The guidelines include Veterans over the age of 65, Veterans with high-risk medical conditions determined by their Patient-Aligned Care Team (PACT) and Veterans who are essential workers.

Caregivers in Support Program included

Clinics also receive a monthly VA allotment for caregivers of Veterans enrolled in the Comprehensive Caregiver Support Program.

Matthews added that as more doses of the COVID-19 vaccine become available, other priority groups will be vaccinated.

“Like medical facilities across the nation, we’re currently receiving limited doses of the COVID-19 vaccine. We’re providing these to Veterans in the CDC-recommended priority groups.

“But as we receive more, we’ll begin vaccinating other Veterans living along the Gulf Coast and receiving care at our clinics in Pensacola, Eglin and Panama City Beach, Florida; Mobile, Alabama; and at the Biloxi VA Medical Center in Biloxi, Mississippi.”

The Biloxi VA Medical Center, Mobile Community-based Outpatient Clinic (CBOC) and Pensacola, Eglin, and Panama City Beach CBOCS are part of the Gulf Coast Veterans Healthcare System. The system is headquartered in Biloxi, Mississippi, and provides a variety of medical outpatient services to more than 75,000 Veterans.

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Lawmakers on Thursday told leaders from the Veterans Affairs Department that they intend to add "tighter controls" to ensure the agency's electronic health record project is moving on schedule.

"Our implementation of a project of this magnitude, this significance, this cost, and the kind of arc of the timeline that this includes requires trust," said Chairwoman Rep. Debbie Wasserman Schultz (D-Fla.) during a House Appropriations Committee's Subcommittee on Military Construction, Veterans Affairs and Related Agencies hearing to discuss the VA's fiscal 2021 budget request.

"You have, for lack of a better term, stripped the trust that existed," she said.

Earlier this month the VA delayed plans to begin end-user training for its new EHR, which could signal a delay for the VA's overall implementation timeline. The department was slated to bring its first site—Mann-Grandstaff VA Medical Center in Spokane, Wash.—live on a new Cerner Corp. EHR on March 28.

While lawmakers have said they support the decision to not rush the go-live, Representatives at the hearing took the opportunity to question what they see as the VA's lack of timely communication to Congress about problems with the EHR project. Lawmakers said they hadn't learned of the potential for the delay until two weeks ago.

"I apologize for the anger, but I am furious," said Rep. Nita Lowey (D-N.Y.), who chairs the House Appropriations Committee. "Billions and billions of dollars, my friends, and we don't have a system."

The VA inked a multi-billion contract with Cerner in May 2018 for a 10-year rollout of an EHR system it's co-developing with the Defense Department.

VA officials earlier this month attributed the delay in end-user testing to needing more time to build the EHR system, which they said is 75% to 80% complete.

Dr. Melissa Glynn, the VA's assistant secretary for enterprise integration, explained that the agency's initial schedule had planned to begin end-user training with the incomplete EHR, as suggested by Cerner , since the system was mostly completed. However, she said clinicians raised concerns that the EHR was missing "critical requirements and capabilities" that needed to be available for training.

"A revised go-live date allows us to include additional capabilities," Glynn said.

In response to questions over when the VA realized it might need to delay its go-live at Mann-Grandstaff VA Medical Center, Dr. Richard Stone, executive in charge at the Veterans Health Administration, said he had brought up concerns over the plan to train clinicians on an incomplete EHR system to former VA Deputy Secretary James Byrne as early as last year.

"Training on products that are similar to your product doesn't work very well for the VHA," he said.

Byrne, who was fired from his post earlier this month, had reassured lawmakers that he was "very confident" the Mann-Grandstaff VA Medical Center would have a successful go-live on March 28 as recently as November.

Schultz suggested it was inappropriate to be "pointing the finger at someone who's no longer here to be held accountable."

"What we can't have in a multi-, multi-billion dollar implementation is finger pointing from the agency who is responsible, which is a multi-headed agency," she said. "I look forward to working with the leadership of the VA, including the Secretary, in ensuring that we don't have these kinds of surprises again."

VA leaders said it's still adhering to the EHR project's overall 10-year timeline. The agency plans to share an updated implementation schedule with Congress on March 10.

While Representatives voiced frustration with the VA's EHR project, Schultz stressed that "we're at the point now where we have to replace outrage with accountability, and that accountability's going to need to go in this bill."

That includes plans for the subcommittee to "establish tighter controls" over the VA's EHR implementation, Schultz said.

"We tried 'trust me,' and we're now going to have to try 'show me'," she said.

The VA requested $2.6 billion for its EHR modernization office in fiscal 2021, $1.1 billion more than fiscal 2020's $1.5 billion. That additional funding would support the EHR's implementation, chiefly by upgrading the technology infrastructure at facilities prior to go-live.

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Through public-private partnerships with the U.S. Department of Veterans Affairs (VA), since early April, all Veterans have been able to securely connect to their health care data online.

Online Veteran health care records first only available on iOS operating systems, are now also accessible on Android mobile devices and web applications.

iBlueButton and MyLinks are free health information exchange apps providing Veterans the ability to securely access, manage and interact with their health information. They also make it easier for Veterans to set and achieve health care goals regardless of their device.

“Veterans having access across the board to mobile and web health app services

increases interoperability and eases the flow of information, while keeping their personal data secure,” said VA Secretary Robert Wilkie. “Data security and Veteran’s consent are essential to maintaining trust and credibility with our stakeholders.”

A Veteran must first authorize access to their health information using a VA-approved authentication method before an app can access their data. At any time, the Veteran can revoke the privileges they’ve granted to these apps through their account settings on VA.gov.

iBlueButton, which makes critical health care information readily available to the Veteran, has been connected to VA’s My HealtheVet Blue Button since 2010. With this app, Veterans can generate an organized medical history from both VA and Medicare. In December 2019, the iBlueButton applications used the new VA Health API to create a new feature that organizes and visualizes a Veteran’s lab values.

MyLinks enables patients and caregivers to view and share aggregated health records, manage multiple family records, and store and share other important documents and images. Since January, MyLinks has leveraged the VA Health API to help Veterans and their caregivers securely share health information across the Veteran’s care team network of providers.

The apps allow VA application programming interfaces (APIs) to be available for developer use through the Lighthouse developer portal. Lighthouse is an API platform that gives developers secure access to the VA data they need to build helpful tools and services for Veterans.

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The Veterans Affairs Department’s benefits division is looking to bring several thousand hires onboard to “maximize its capacity,” as it prepares to implement legislation that will make millions of new Veterans eligible for VA health care and benefits.

Charles Tapp, the Veterans Benefits Administration’s chief financial officer, told reporters Tuesday that more than 145,000 Veterans already filed claims under the PACT Act.

“We want to encourage every Veteran to come in and file. If you believe that you’ve been exposed to toxins or served in the areas of responsibility, we encourage you to come out and file a claim,” Tapp said. “That’s the gateway to open the door for the benefits and services that certainly have been earned, and certainly the gateway to open up the opportunity to receive health care.”

The PACT Act, which President Joe Biden signed into law in August, gives VA the resources it needs to staff up its health care workforce to treat approximately 3.5 million Veterans exposed to toxic burn pits, Agent Orange and other toxic substances during their military service.

Hiring is currently underway to add more claims processors, and Tapp said the first cohort of these hires are onboard at VBA and going through agency training.

“There’s millions of eligible Veterans who are going to come in and file claims, which we highly encourage. We want to make sure that we have the right number of people and the trained staff that we need to process those claims. The worst thing we want to do is have this certainly once-in-a-generation-level legislation come forward and become law, and then not be able to process them timely,” Tapp said.

VBA set a goal of hiring nearly 2,100 claims processors this spring, prior to the PACT Act becoming law.

While VBA is onboarding additional new hires, Tapp said the agency is “hiring to our maximum capacity,” with plans to hire “several thousand more” full-time hires to process PACT Act claims.

“We’re looking at the volume of claims we’re anticipating and then aligning the size of our workforce accordingly. We’re grateful that Congress has been very accommodating in terms of getting us the resources to successfully process these claims,” Tapp said.

VBA is seeing an uptick in calls and training its call-center employees on how best to assist Veterans seeking to file a claim under the PACT Act. The agency is also contacting Veterans who may be eligible for PACT Act benefits to educate them about the program, and reduce misinformation about how to apply.

“Veterans that are flagged as being Gulf War era, Vietnam era or post- 9/11 era that fit the criteria for PACT [Act], we’re sending out communications to them to invite them to come in and file claims this so they’re knowledgeable on what PACT is, and how to go about filing claims,” Tapp said.

Veterans can file a claim for free online at VA.gov. The site also provides Veterans with a list of accredited agents and Veterans service organizations (VSOs) that can also assist Veterans with filing an initial claim, free of charge.

“There are some charges and fees that are allowable for appeals and other sequent claims, but for initial claims, they absolutely cannot charge you, by law,” Tapp said.

VBA is also taking steps to mitigate fraudulent claims or schemes that prey upon benefits-eligible Veterans.

“We’ve very aware of some of those schemes and the commercials and the emails and the posts and the blogs, and we always encourage Veterans to be conscious of who they’re working with,” Tapp said.

Veterans who receive a call from an organization looking to assist them with filing a PACT Act claim can call the VA’s national call center (1-800-827-1000), and have an agent verify if the organization is accredited.

Tapp said VBA is urging Veterans not to sign any contracts with any unauthorized company agreeing to pay a fee to help with filing a claim. He also urged Veterans to closely monitor their personal finances.

“A lot of times fraud happens when direct deposit accounts are changed. So we want to make sure that you keep your information with VA up to date, in terms of your email address, your phone numbers and your addresses,” Tapp said.

Tapp urged Veterans to also check for any mailed notices sent from VA, since the agency sends written correspondence any time direct deposit information changes.

VBA is also using data analytics in the background with some of its industry partners to track potentially fraudulent activity.

“We can track and trace when we see things that are out of tolerance, or things that could be perceived or eventually be signs and indications of nefarious activities, in terms of fraudsters trying to engage our systems and to try to go about infiltrating our systems to divert funds away from Veterans,” Tapp said.

VBA is able to track, for example, if multiple direct deposit changes are being requested from the same Internet Protocol (IP) address.

“Those are absolute red flags for us when we start seeing things that are not normal, out of tolerance, or certainly would be considered as a bit fishy,” Tapp said.

Tapp said the VBA anticipates a possible uptick in fraud cases in January, once it starts adjudicating PACT Act claims. The agency works closely with the VA inspector general office and the Justice Department to handle any potential fraud cases.

The VBA, meanwhile, is finalizing regulations that will provide guidance on how the agency will move forward with processing PACT Act claims at the start of calendar year 2023.

“The law is telling us the ‘what,’ and now the regulations allow us to do the ‘how.’ We want to make sure we’ve got the proper procedures in place to make sure that our rating specialists are moving forward smartly, as they’re processing the claims, so that we can do them both timely and have high quality because that’s what Veterans deserve,” Tapp said.

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Veteran Kenneth Tutt, age 79, starts his weekdays with an 8:00 a.m. telephone call to his Home Based Primary Care provider of four years, Nurse Practitioner Rhonda Weinhold. Together they review his weight, blood pressure and sugar levels.

Like most HBPC patients, Tutt takes a high number of medications to treat multiple health conditions. Weinhold’s 80 HBPC patients average 14 daily medications. Some more than thirty.

HBPC teams set-up 30-day medication boxes for patients. “Instead of having to take their medicines out of 10 or 15 bottles, we put them in a medication organizer for them,” Weinhold said. “We love doing it, but more and more we noticed our patients were on so many medications. We just stopped and thought, are there medications we could potentially get rid of that actually might be doing more harm or that are not needed?”

VA Geriatric Scholars Program

Weinhold recently participated in the VA Geriatric Scholars Program, a workforce development program to integrate geriatrics into primary care practices. One cornerstone of this training is understanding appropriate and potentially inappropriate prescribing practices for older patients. With this in mind, she developed a local quality improvement project to improve medication management, including reducing the average number of medications taken by patients in her panel.

She teamed up with HBPC team member Jena Willis, Doctor of Pharmacy. They decided to consolidate the pharmacist’s medication de-escalation recommendations into a plain-language addendum to the patient’s shared electronic health record—the digital version of a patient’s medical file. “These are the meds we think could possibly be taken off the patient’s medication list,” Weinhold explained.

“I would go into the home and review it face-to-face,” she said. In-person outreach allowed her to engage patients in the decision-making process. When she asked Veterans how they felt about getting off some medicine, reactions were positive. “It was a terrific idea,” Tutt recalled. “Overall, everyone was completely satisfied. We had no adverse effects or outcomes.”

Innovation

Once Weinhold and Dr. Willis fine-tuned their process, Weinhold brought the registered nurses and the others onboard. It was a team effort. Three registered nurses met in person with 80 patients over six months. “We were able to decrease the number of medications by two medicines per patient on average,” Weinhold said. “That’s huge when you’re taking 15 to 20 medications.”

“It worked like clockwork with the Staunton team,” said Dr. Willis, who will soon introduce the program to all HBPC teams at the Salem VA Medical Center.

“Right when we started this project our pharmacy residents just happened to be working on a grand rounds presentation,” said Dr. Willis. “The grand rounds lecture series was on the de-escalation of therapy for the medical department. When the pharmacy residents sent out their presentation for review, Dr. Willis brought them up-to-speed with what they were already doing in HBPC. The residents added the information to their presentation as an introduction to the rest of the medical facility.”

“Research shows the more medication patients are on, especially for the elderly population, the greater the risk for falls,” Weinhold said.

“The most rewarding thing is providing improved quality of life for our patients, whether it’s three more days, three more years, or thirty more years,” Dr. Willis said.

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Although the Department of Veterans Affairs backed a record 1.44 million home loans for Veterans and service members in the past year, members of Congress and Veterans' advocates said Wednesday that sellers remain leery of VA-backed loans.

Misinformation about VA appraisals, which many sellers believe are more complicated than others because homes must meet a series of minimum requirements determined by the department, has contributed to a prejudice against VA-backed loans.

"Many Veterans attempting to purchase a home using a VA loan are finding they simply cannot compete," House Veterans Affairs Subcommittee on Economic Opportunity Chairman Mike Levin, D-Calif., said during a hearing Wednesday.

Sellers are less likely to accept VA-backed offers than conventional ones, according to a survey by the National Association of Realtors released earlier this year. While 89% of sellers said they were likely to accept an offer from a buyer using a traditional bank loan, only 30% said they would do the same for a VA-backed purchaser.

Sellers' fears aren't totally misplaced. The average wait time for an appraisal conducted by the VA is 14.8 business days, VA Loan Guaranty Service Acting Executive Director John Bell told the subcommittee. Non-VA appraisals can take less than two days to process.

The VA has 6,000 appraisers nationally, according to Bell, but advocates on Wednesday called for a bigger workforce and suggested paying workers more as an incentive.

"There's a shortage of certified appraisers, and VA appraisers are even harder to find," said National Association of Realtors President Leslie Rouda Smith.

Of the association's 1.5 million members, fewer than 1% are formally certified to work with Veterans, active-duty service members and eligible military spouses to find the best housing options through the group's Military Relocation Professional Certification program, she said.

Higher inspection standards among VA appraisers also deter sellers from accepting VA-backed offers, said Veterans of Foreign Wars Associate Director Emily DeVito. Fifty-nine percent of sellers said stricter inspection requirements reduce the attractiveness of the VA loan, according to the National Association of Realtors survey.

"[The VFW] also recommends funding VA to conduct outreach and marketing to the public to combat misinformation on how much longer VA-guaranteed loans truly take," DeVito told committee members.

Levin said that the "trepidation of sellers" toward offers attached to VA loans is going to have to be fixed.

"We have to make sure that people are competitive," he said.

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During National Family Caregivers Month this November, the U.S. Department of Veterans Affairs (VA) will honor the caregivers of Veterans for their invaluable health care, acknowledging the critical role they play in caring for Veterans every day — and even more so during the COVID-19 pandemic.

VA medical centers nationwide will host virtual events to raise awareness of the Caregiver Support Program’s recent expansion and to highlight the contributions of Veterans’ caregivers.

“Caregivers are important members of a Veteran’s health care team and the pandemic has amplified their significance,” said VA Secretary Robert Wilkie. “We recognize their ongoing commitment to the well-being of Veterans and the roles they play in Veterans’ lives daily. Providing a wide range of resources to help them care for Veterans and themselves is paramount.”

As part of VA’s historic change to the Caregiver Support Program, the department began the first phase of expanding its Program of Comprehensive Assistance for Family Caregivers (PCAFC), Oct. 1, which extended the program to eligible Veterans who incurred or aggravated a serious injury in the line of duty on or before May 7, 1975. The second phase, effective Oct. 1, 2022, will expand the program to eligible Veterans who incurred or aggravated a serious injury in the line of duty between May 7, 1975 and Sept. 11, 2001. PCAFC offers assistance to Family Caregivers of eligible Veterans, including education and training, respite care, a monthly stipend and more.

VA also offers caregivers of Veterans services under the Program of General Caregiver Support Services (PGCSS). PGCSS is available to all caregivers who provide personal care services to covered Veterans enrolled in VA health care. PGCSS participants have access to education and training, respite care, and additional services such as VA’s Peer Support Mentoring.

To learn about local events or more about VA’s Caregiver Support Program, contact your local facility’s VA Caregiver Support Coordinator or call the Caregiver Support Line 8 a.m.-10 p.m. EST Monday-Friday and 8 a.m.-5 p.m. EST Saturdays.

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If you have a clean driving record and a little extra time, you can help a local Veteran in a big way.

The Disabled American Veterans Transportation Network needs volunteer drivers to get Veterans to their medical appointments at the VA Medical Center in Syracuse.

Officials said typically the number of volunteer drivers in the winter time goes down as some of the older retired volunteers head south. But, in mid-July the DAV Transportation Network is in dire need of more volunteer drivers.

Program officials said this service is crucial across a 14-county area of New York. Some Veterans need transportation to the VA while others need rides to appointments that may be at regional medical centers.

They said unfortunately, some drivers gave up their volunteering duties because of the pandemic and never came back. As we get back to normal, there is a need for more people to come forward, even if it is driving just once a week.

"Currently, we have about 150 active DAV drivers. There's always a need for more, especially as the community begins to open back up. So, it's really important to get our Veterans in so they can get to their necessary appointments. Again, especially since last year many of them got canceled. So, we're always looking for people who are interested in volunteering," said V.A. Medical Center Acting Volunteer Services Chief Jeff Gamble.

Officials said there is a need to fill openings from the North Country to the Southern Tier. The DAV program has been helping Veterans get to their medical appointments in Central New York for more than 25 years.

There are a few requirements to be a volunteer driver. You need to be at least 21 years old, have a valid driver's license and pass a background check and a physical.

If you're interested, you can contact the DAV Transportation Network at 315-425-4353.

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PITTSBURGH – A resident of Pittsburgh, Pennsylvania, has been indicted by a federal grand jury in Pittsburgh on charges of violating federal narcotics laws, United States Attorney Scott W. Brady announced today.

The Indictment, returned on August 19, 2020, named Ann Makepeace, age 30, of 519 South Braddock Avenue, Pittsburgh, PA 15221, as the sole defendant.

According to the Indictment, from on or about February 24, 2020, continuing through on or about March 20, 2020, Makepeace used her position as a registered nurse at the VA Hospital to obtain vials of Dilaudid, a Schedule II controlled substance.

The law provides for a maximum total sentence of not more than four years in prison, a fine not to exceed $250,000 or both. Under the Federal Sentencing Guidelines, the actual sentence imposed would be based upon the seriousness of the offenses and the prior criminal history of the defendant.

Assistant United States Attorney Timothy M. Lanni is prosecuting this case on behalf of the government.

The Veterans Affairs – Office of Inspector General and the Veterans Affairs Police conducted the investigation leading to the Indictment in this case.

An indictment is an accusation. A defendant is presumed innocent unless and until proven guilty.

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As the first anniversary of MISSION Act implementation approaches, the Department of Veterans Affairs (VA) is in an entirely unexpected position. While the MISSION Act of 2018 broadened the criteria by which Veterans can seek non-VA care with the intention of reducing wait times and increasing choice for Veterans, VA was instead asked to be willing to open its doors to civilians when the pandemic hit.

The need for VA to step in to support the civilian health care sector was particularly concerning given that Veterans represent a population at increased risk from the novel coronavirus: 75 percent of Veterans are over age 50, with 34 percent of those over the age of 70, and younger Veterans may have been exposed to toxins that harm and thus compromise the lungs. Many of these Veterans depend on VA full-service medical centers for care, even as non-VA options have been expanded under the MISSION Act.

When faced with choices between restaurants, hotels, or retail products, many of us turn to user reviews — but that type of information is harder for the average patient to find or understand when it comes to choosing where to get health care. And according to our new research, public perception of VA medical center care is often discordant with the actual high quality of that care.

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WASHINGTON — The Department of Veterans Affairs handed out about $311,000 in improper disability payments after an agency employee miscalculated claims, according to the department’s inspector general.

The overpayments stemmed from a single employee at the VA’s Little Rock Regional Office in Arkansas making bad decisions and improperly processing paperwork during the disability claims process, and the failure of managers to provide the proper oversight on 11 disability rating decisions, according to a report by the VA Inspector General’s Office. The employee, who was not named in the IG report, has resigned.

“As a result of the inaccurate rating decisions, Veterans Benefits Administration made nearly $311,000 in improper payments to beneficiaries,” the IG wrote in its report. “In addition, nearly $6,700 in improper payments were being paid on an ongoing monthly basis at the time of the review.”

The system failure in Arkansas resulted in compensation that wasn't warranted, according to the IG report. In some cases, these claims were previously denied. The erroneous payments were not the fault of the Veterans, the IG report stated, and no one has to pay back the money.

VA officials said the improper disability claims were processed up to two years ago and actions are being taken to ensure Veterans get the appropriate disability ratings and checks.

"The Little Rock VA Regional Office has started implementing each of the [inspector general’s] recommendations, including a complete review of the decisions made by this former employee," said Bobbi Gruner, a spokeswoman for the department. "VA will take appropriate action at the conclusion of this review, ensuring any benefits that were improperly administered are not continued."

The overpayments underline the department’s history of botching benefits claims for Veterans. However, in many cases, the issue is underpaying or not issuing any compensation when a Veteran is entitled to it.

Several issues came up in 2018 when the VA tried to implement the Forever GI Bill, a major expansion of education benefits. The issues caused thousands of incorrect or delayed payments to student Veterans who rely on education benefits for food, housing, and tuition. Missed payments force some students into critical financial circumstances, taking out loans and maxing out on credit cards. Some of them faced eviction threats.

In 2019, the IG reported the VA wrongfully rejected thousands of emergency-care claims during a five-month period, sticking an “undue financial burden” of millions of dollars on across thousands of patients.

The errors affected an estimated 17,400 Veterans who were stuck with a total $53.3 million in medical bills that the VA should have paid, the IG reported. In that case, the IG blamed a culture that “created a systemic pressure to favor speed over accuracy,” leading to staff incorrectly rejecting 31% of Veterans’ emergency-care claims.

Also in 2019, the inspector general found the federal government owed at least $189 million to 53,000 disabled Veterans who overpaid on their VA home loans.

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The U.S. Department of Veteran Affairs (VA) announced Dec. 11, key changes to increase transparency and ensure Veterans have the best information regarding the performance of VA health care facilities.

As part of this effort, VA will discontinue its star-rating system, making it easier for Veterans to compare VA facilities with non-VA facilities in their local area.

“Star ratings were developed as an internal tool meant to compare one VA facility to another,” said VA Secretary Robert Wilkie. “These ratings do not provide insight as to how our hospitals stack up against nearby non-VA facilities and are therefore of little value in helping Veterans make informed health care decisions. This change will make it easier for Veterans to choose the best possible care close to home, when and where they need it.”

The website home page for each VA hospital now features links to comparative tools relating to wait times, quality of medical care and patient experience ratings. This information is drawn from quality-of-care measures provided by industry-standard sources including, but not limited to the Centers for Medicare and Medicaid Services, National Committee for Quality Assurance and the Agency for Healthcare Research and Quality.

Star ratings are often misinterpreted, as they compare VA facilities by ranking them across the department’s health care system, rather than by geography, population characteristics or unique care offerings. Additionally, Veterans in VA focus groups have indicated they do not consult the star ratings in making decisions about VA care.

The National Quality Forum’s, Nov. 6, issue brief, Hospital Quality Star Rating Summit, points out, star ratings of health care facilities can often misrepresent an assessment of overall hospital quality, “leading consumers to choose hospitals that were not the best at delivering the care they needed…when they might have been the best place for a person with a particular condition to receive care.”

While VA has published star ratings for the final time, the department will continue to make public its own detailed, Strategic Analytics for Improvement and Learning (SAIL) data, to monitor and internally manage hospital system performance within the Veterans Health Administration. SAIL assesses more than 60 quality metrics in areas such as death rates, complications, safety and patient satisfaction, as well as overall efficiency and physician capacity at individual VA Medical Centers.

In accordance with Government Accountability Office recommendations, in 2017 and 2019, these changes will help Veterans navigate the many new choices available to them under the MISSION Act, a landmark law that puts Veterans at the center of their health care decisions.

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With about four months to go until the initial go-live date, the Department of Veterans Affairs insists it’s ready to deploy a new electronic health record at the first site on time.

The department is supposed to achieve initial operating capability on Cerner’s new, highly-anticipated EHR at the Mann-Grandstaff VA Medical Center in Spokane, Washington, on March 28, 2020.

Congress is “cautiously optimistic” VA will achieve that goal.

But the department has dozens of additional tasks and decisions to make ahead of the March go-live, and members say they’d rather see VA push back a “symbolic deadline” rather than rush the process and make a critical mistake.

And without a specific, joint VA-Pentagon governance and leadership structure, members are worried the department won’t know who to turn to if and when something goes awry.

Jim Byrne, VA’s deputy secretary, said he was “very confident” VA would have a smooth go-live in Spokane next year. If clinical staff at the Spokane facility believes they’re not ready, Byrne and other members of the VA leadership team said they’ll be ready to push the deployment back.

“If anything is going to impact patient safety, that is a no-go,” he told the subcommittee. “That rules over everything.”

John Windom, executive director of VA’s Office of Electronic Health Record Modernization, said he’d rely on Spokane’s clinical staff to advise him on whether the deployment should be pushed back.

Byrne said the department had already met several key milestones for EHR modernization.

The Spokane VA medical center, for example, is in the process of hiring 108 additional staff to “augment” the existing workforce and account for anticipated productivity losses during the initial go-live, the center’s director, Robert Fischer, said.

VA will conduct the first of two “dry-runs” with the new system in a few weeks.

But Congress is concerned these “dry runs” may reveal unexpected problems before the Spokane go-live.

To be clear, the March “go-live” won’t deploy the full-blown EHR. VA will launch an initial set of Cerner capabilities in March, meaning VA employees will need to navigate back and forth between the new system and the Veterans Information Systems and Technology Architecture (VistA).

“It is so important that the Spokane employees be able to train on the actual production system before go-live, not merely a mock-up training system. If a few more weeks are needed to make the training more meaningful, I urge VA to take it,” Jim Banks (R-Ind.), ranking member of the House Veterans Affairs Technology Modernization Subcommittee, said Wednesday at a hearing on the new EHR. “Similarly, if an interface cannot be completed in time or DoD does not grant an authority to connect when needed, I hope VA will seriously consider taking additional time to complete the task, rather than allowing that particular Cerner module to fall out of block one and until block two.”

DoD’s troubled, initial EHR deployment in the Pacific Northwest last year is front-and-center for VA as it prepares for its own rollout next March.

The Pentagon has been sharing their lessons-learned with VA since the beginning, Windom said. VA, for example, is ramping up its help desk capabilities following DoD reports that its own system was overwhelmed by a backlog of unresolved trouble tickets.

“We made sure we put in a robust help desk support mechanism, because we want end-users’ questions answered the first time, the right way,” Windom said. “That eliminates frustration.”

Training for VA Spokane employees is also critical, lawmakers said.

“I know that Cerner has been engaged in testing individual modules, but we need the entire integrated system so it can be used for training. We cannot make the same mistake that DoD did in its IOC where it tested on a mocked up system,” Susie Lee (R-Nevada), chairman of the House subcommittee, said. “I’m concerned that the VA has not given itself enough time to fully test the system nor have they allowed time for all users to adequately train on it.”

The department said “no one will touch” the Cerner system unless they’ve been trained on the new EHR — and passed an examination to measure their competency.

Training requirements will depend on VA employees and their roles within the organization. Registration clerks, for example, may have fewer training hours to complete over a specialized cardiac nurse, said Laura Kroupa, chief medical officer for VA’s Office of Electronic Health Record Modernization.

Where’s the FEHRM?

It’s been more than a year since both the Defense Department and the VA signed a joint memo of understanding recognizing the two agencies’ common goal to achieve interoperable health records. Both departments were supposed to recharter their Interagency Program Office and rename it as the Federal Electronic Health Record Modernization Office (FEHRM).

Two individuals are leading the FEHRM on an interim basis, but no permanent leadership has been named.

“Not withstanding their tiny budget and shoestring staff, they have taken the initiative to unblock as many decisions as they can between VA and DoD,” Banks said of the interim leadership. “However, after several letters, staff meetings, a hearing and a roundtable discussion with leaders from both departments, I am still uncertain what the ultimate plan for the FEHRM is.”

VA and DoD plan to finalize the FEHRM’s organizational structure over the next six months, with additional governance processes coming later next year, Banks said.

The timeline is far later than what he initially expected, he added.

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The U.S. Department of Veterans Affairs (VA) is encouraging community members, individuals, businesses and organizations to help support hospitalized Veterans nationwide by turning good intentions into action on this International Volunteer Day Dec. 5.

Each year, thousands of Veterans spend the holidays at VA inpatient facilities away from family and friends.

“The holidays can be an especially lonely and challenging time for hospitalized Veterans,” said VA Secretary Robert Wilkie. “Volunteering is a meaningful way to provide kindness and get into the overall spirit of giving by showing these Veterans that they are not forgotten.”

International Volunteer Day, designated by the United Nations in 1985, aims to encourage people around the world to volunteer in their communities. Through VA’s Voluntary Service program, upwards of 61,000 volunteers have donated more than 8 million hours to Veterans nationwide this year. To learn more about VA’s many volunteer opportunities, visit VA’s Voluntary Service website.

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The employee has been removed from a position with access to Veterans' records “for the foreseeable future” and an investigation is underway.

Unless you’re a professional comedian, the excuse “it was just a joke” doesn’t work as well as you might think.

That seems worth stating considering an employee with the Department of Veteran Affairs is currently under investigation for allegedly sharing a patient’s medical information on Twitter in a (poor) attempt at a joke about how a penile implant to treat an older Veteran’s erectile dysfunction is a waste of taxpayer dollars.

On Monday morning, an administrative officer in the anesthesia department of the Washington, D.C. VA Medical Center allegedly tweeted a partial photo of a medical note for a Veteran patient’s penile implant surgery — an operation sometimes used in cases where patients don’t respond to other erectile dysfunction treatments.

The image, shared by a user with the Twitter handle @CarrieeeeC, included the caption “72 y/o male gets government funded surgery,” along with an eggplant emoji.

The tweet drew almost immediate criticism since it included a patient’s private medical information and raised concerns that it violated the Health Insurance Portability and Accountability Act, known as HIPAA. Although the photo did not reveal the identity of the patient, it did include private information about his pending medical procedure and health.

“VA is aware of the incident and takes it very serious[ly],” said VA spokesman Terrence Hayes in a statement provided to Task & Purpose. The partial photo was of a preoperative anesthesia note for a Veteran who had surgery last week. The employee has been removed from a position with access to Veterans’ records “for the foreseeable future” and an investigation is underway, Hayes said.

Both the original tweet, and the VA employee’s account, have since been deleted. However, prior to doing that, the employee in question attempted to walk back the tweet and claimed that they did not take the photo, but actually found the image online.

“The photo I posted was from the internet. I did not take a photo of a patient’s medical record. I’m sorry for the confusion,” reads a follow-up tweet from @CarrieeeeC which was posted on Tuesday morning.

The post drew fire not just because it appeared to be a violation of patient privacy, but because it also specifically mocked the patient’s penile implant surgery in a trite “haha, why’s an old guy need a working penis” kind of way.

It’s the same kind of hot-take or quip that grabbed headlines back in 2017 when then-President Donald Trump cited “tremendous medical costs” for why he wanted to ban transgender people from serving in the military. That (debunked) claim prompted others to point to the $84 million that the Pentagon spends on Viagra, Cialis and other erectile dysfunction medications each year. And that in turn led to a bunch of ill-humored jokes about older service members and erectile dysfunction.

But as Adrian Bonenberger wrote for Task & Purpose at that time, erectile dysfunction in the military isn’t a punchline for those dealing with it, nor is it reserved for older men. Erectile dysfunction can be brought on by physical or mental injuries, or as a side effect to treatments for other health issues.

In a November 2015 study of 247 Veterans of the wars in Iraq and Afghanistan, as many as 18 percent reported dealing with some form of sexual dysfunction.

“Sexual dysfunction is as prevalent as other conditions we think of as being related to military service, such as posttraumatic stress disorder and traumatic brain injury,” said Dr. Drew Helmer, one of the authors of the study.

Additionally, a VA review of related studies published online in March 2015, showed the prevalence of erectile dysfunction among current and former servicemen, with 85 percent of male combat Veterans with PTSD reporting that they had experienced erectile dysfunction, compared to 22 percent of male combat Vets without a mental health diagnosis.

Additionally, there are physical wounds that impair sexual function. These injuries, and the frequency at which they occur, vary by era due to a variety of reasons, from the type of warfare waged, to the speed of casualty evacuations, and advancements in body armor. During the Vietnam War, the reported rate of these wounds, called Genitourinary Injuries, ranged from 3 to 4.2 percent, according to a July 2010 issue of the “Journal of Trauma Injury, Infection, and Critical Care.”

These injuries continued during America’s most recent wars. Between 2001 and 2013 more than 1,300 servicemen suffered injuries to their genitals, the New York Times reported in 2017. The prevalence of these wounds in the U.S. military campaigns in Iraq and Afghanistan was due in part to the use of improvised explosive devices, which are often buried in the ground and blast upwards, making them more likely to cause traumatic damage to the groin area.

It’s also not the first time a VA employee has been investigated for making light of a serious health issue facing some Veterans. In 2015, a manager at the VA Medical Center in Indianapolis was placed on leave and investigated after sending an email mocking the care of Veteran patients at the facility. As Task & Purpose previously reported, the email, sent during the holidays, showed a toy elf in a Santa Claus outfit and included photos of the elf performing a pap smear on a Barbie doll, trying to get a prescription for Xanax, and committing suicide by hanging itself with an electrical cord.

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When it comes to exploring new ways to care for patients, VA has a unique advantage: We’re the nation’s largest integrated health care system. And that means we can access the nation’s largest store of voluntary patient data.

Voluntary data

The Million Veteran Program is our national research effort that uses voluntary health data to identify genetic factors that contribute to disease, and even conditions like PTSD.

Voluntary data is allowing VA medical professionals across the country to conduct their own innovative research that will benefit millions of Americans.

In Virginia, researchers spent years studying how eye movement is affected by neurological disorders such as Parkinson’s Disease. They discovered that each disease is associated with a different eye movement abnormality. That means the presence of these disorders can be detected by having patients undergo simple, non-invasive eye tests. And it means they can be detected more accurately and much earlier – in some cases, up to 10 years before more serious symptoms emerge.

Precision Oncology

Data is also playing a big role in the groundbreaking work we’re doing in precision oncology.

For decades, cancer has either meant surgery or administering poison to kill the cancer that severely weakens the patient, or both.

But through precision oncology, we can study the genetic makeup of tumors and design treatments that attack the cancer, not the patient. VA has already built targeted therapies to attack some forms of leukemia. These therapies are more effective and are already making these cancers less lethal.

Precision oncology means earlier and more accurate cancer detection, less guesswork about treatment, and patients who are more comfortable and have more peace of mind. It’s no wonder one researcher called VA’s precision oncology program “the future of cancer care.”

Your family’s story

Creative use of data is also driving our new Veterans Legacy Memorial service, which lets families call up information about any Veteran buried in a national cemetery on a computer or their phone.

Soon they’ll be able to add their own stories to these pages, so everyone can learn about their loved ones who served this nation so bravely.

I’m proud to lead a VA in which so many skilled professionals are using technology and data to improve the lives of Veterans.

And I’m proud to say we are upholding VA’s lasting legacy as a center of innovation.

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The U.S. Department of Veterans Affairs (VA) today announced it is helping 38 states and territories with their response to the coronavirus disease 2019 (COVID-19), providing care, services and supplies to hundreds of non-Veterans in this time of uncertainty.

In coordination with the Federal Emergency Management Agency (FEMA), VA has deployed doctors, nurses and nursing aides to state-run nursing homes in several states where COVID-19 has emerged among vulnerable populations.

Most recently, VA dispatched more than 80 medical professionals to 26 non-VA nursing homes in Florida. These employees have begun rotations at the facilities to deliver direct care and advice about controlling infectious diseases.

The Florida mission follows an April 19-June 1 deployment of 90 VA nursing staff to two state-run nursing homes in New Jersey. VA has deployed staff to other state-run nursing homes in Alabama, Massachusetts and Tennessee, and is coordinating similar requests for help across the nation.

The department’s experience in caring for more complex nursing home patients makes its nursing home workforce a valuable service during this national emergency.

“Americans are coming together to fight COVID-19 in ways we haven’t seen since World War II and VA is proud to provide crucial support to non-Veteran nursing home residents around the country,” said VA Secretary Robert Wilkie. “Our ‘Fourth Mission’ is to serve all Americans in times of crisis and VA is here for the duration.”

Also, in coordination with FEMA, VA has committed to opening 1,500 beds in VA facilities to treat COVID-19 patients and ease the stress that some local hospital networks are facing.

During the last few weeks, the VA facility in Rhode Island cared for 7 community nursing home patients and the VA facility in Bedford, Massachusetts cared for 10 state Veterans Home patients.

Additionally, to help the U.S. Naval Ship Comfort close out its mission in New York, remaining patients were transferred and are being cared for by VA New York Harbor Health Care System and James J. Peters “Bronx” VA Medical Center. As part of VA’s Fourth Mission to help community hospitals with humanitarian patients through the COVID-19 pandemic, VA received 12 patients over the past few days: 11 patients are now being cared for by VA health care providers in Brooklyn and Manhattan, while the Bronx has accepted a Veteran patient from the ship.

VA facilities in California, Mississippi, New Mexico and Texas have also taken in non-Veteran patients, and dozens of intensive care unit and medical/surgical beds have been made available in Illinois, Iowa, Louisiana, Michigan, New York, Oregon and Washington.

The department is also aiding non-Veteran patients in American Samoa, California, Guam, Iowa, North Carolina and Texas.

In addition to VA’s work with FEMA, VA is providing a range of services to Veterans and their families in more than a dozen states on its own. For example, VA’s Mobile Vet Centers are offering counseling services and outreach to health care workers, and screening assistance in Colorado, Pennsylvania, Ohio and Texas. In South Dakota, a Mobile Vet Center is providing blood drawing services.

VA is working with several other states on a range of services, such as the provision of masks and test kits, in Arizona, Arkansas, Connecticut, Delaware, Hawaii, Idaho, Kentucky, Minnesota, Mississippi, Nebraska, Nevada, NewMexico, Oklahoma, South Carolina, Virginia, West Virginia and Wisconsin.

States that require assistance from VA should request it through their local Department of Health and Human Services Regional Emergency Coordinator — part of FEMA’s National Response Coordination Center. Counties, cities and other municipalities should route all requests for federal support through their respective states.

VA continues to encourage Veterans, staff members and their families to take precautions to protect against respiratory illnesses caused by COVID-19, the flu and the common cold, and to follow the guidance of their local and state health care and emergency management officials.

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Plan to visit a VA health care facility? Here’s what to expect

By now, you’ve heard about the coronavirus disease, known as COVID-19, that’s causing illness around the world.

Fortunately, VA is ready. We have plans in place to protect everyone who gets care, visits or works at one of our facilities.

For Veterans, families and visitors, that means your VA visit will be different for a while.

Call before visiting

If you’re a Veteran seeking medical care, call your VA health facility if you have symptoms of the virus. Or sign in to My HealtheVet and send a secure message. You may be able to get diagnosed and receive care through VA telehealth without having to come in at all.

If you visit a VA health care facility, you will be asked screening questions

VA health care facilities are adding protocols to ensure the safety of its patients and visitors. If you visit a VA hospital, clinic, community living center or other health care facility, you’ll be met at the entrance by a staff member. They will greet you and ask screening questions. Depending on your answers, a VA health care professional will assist you on the next steps of your visit. Some facilities, especially community living centers, may have visitor restrictions in place. Call before visiting so you’re aware of changes.

Leave time for screening

If you’re a Veteran coming in for an appointment, plan to leave home earlier than usual to allow time for the screening.

We’re doing all we can to make sure everyone in every VA facility — patients, families, visitors, staff and anyone else — stays as safe as possible during this situation.

For the latest VA updates on coronavirus and common-sense tips on preventing the spread of disease, visit https://www.publichealth.va.gov/n-coronavirus/.

For more information about coronavirus, please visit https://www.cdc.gov/coronavirus/2019-ncov/index.html.

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The U.S. Department of Veterans Affairs (VA) launched a new campaign this month to give Veterans a better understanding of their diabetes numbers, which are critical to their well-being.

The Understand Your Diabetes Numbers campaign educates Veterans and their families on hemoglobin A1C, glucose meter, blood pressure and kidney tests, and other vital measurements.

“One in four Veterans enrolled in VA health care services has diabetes,” said VA Secretary Robert Willkie. “This public health campaign encourages Veterans to be proactive with their health care teams by improving their understanding of diabetes test results. The campaign reflects VA’s ongoing commitment to improve the health care experiences of Veterans by empowering them to be active partners in their care.”

VA’s Office of Patient Care Services is overseeing the year-long campaign, which addresses treatment goals, medication and nutritional management, and patient safety. Key topics include understanding the importance of hemoglobin A1c test results, shared decision making between Veterans and their health care team, hypoglycemia safety, insulin differences, good nutrition and carbohydrate counting, and kidney function and blood pressure measurement. Hemoglobin A1c (HbA1c) is a marker, along with blood pressure and cholesterol control, of good diabetes care.

VA’s diabetes campaign is guided by Choosing Wisely® which is a collective effort among professional societies whose goal is to reduce medical tests, treatments and procedures that may be unnecessary. For more information, watch the VA roundtable videos Diabetes is a Disease of Numbers and Healthcare Teams Helping Veterans Understand Diabetes Numbers.

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The U.S. Department of Veterans Affairs (VA) recently launched an innovative new training program to support its electronic health record modernization (EHRM) effort that, as of Sept. 12, had selected 76 trainees who have begun projects that address real-world VA health care challenges.

Leveraging the experiences of the Department of Defense’s (DOD) current EHR rollout, VA developed the VA Innovative Technology Advancement Lab (VITAL) training program, recognizing the importance of providing advanced training to selected end users who will support continuous performance improvement.

“VA established VITAL to specially train staff who can identify possible challenges and work across the entire VA organization to make improvements,” said VA Secretary Robert Wilkie. “VITAL is an important component in our larger training strategy, which will help ensure efficient and timely user adoption of the modernized EHR system.”

The new EHR solution will be the single source of Veteran health information. Its advancements will allow users who solve a problem at one facility to share the solution with other facilities in near real-time. The VITAL program, a 12-18-month training series, develops both the technical and supporting change management skills necessary to drive greater efficiency and effectiveness in all aspects of Veteran health care.

VA identified key clinical and frontline staff who require advanced training to ensure smooth EHR modernization implementation, enhance functionality and support continuous performance improvement.

In May 2018, VA awarded Cerner Corp. a contract to replace the department’s legacy patient record systems with the commercial-off-the-shelf solution currently being deployed by DOD. A single interoperable solution across VA and DOD will facilitate the secure transfer of active-duty service members’ health data as they transition to Veteran status. This modernization effort will create a lifetime of seamless care for service members and Veterans.

For more information about VA’s Electronic Health Record Modernization program, visit www.ehrm.va.gov.

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In a landmark event for Veteran health care, VA began using its new electronic health record (EHR) system at select facilities in the Pacific Northwest and Las Vegas on Oct. 24.

This modern EHR will help improve the health care experience for Veterans by connecting VA medical centers and clinics with the Department of Defense (DOD), the U.S. Coast Guard and community care providers. It will allow clinicians to easily access a Veteran’s full medical history in one location, without needing to track down information such as pharmacy or lab records.

“This is great news for our nation’s Veterans, who deserve the best health care in the world,” said John H. Windom, executive director of VA’s Office of Electronic Health Record Modernization, which leads the nationwide EHR deployment effort. “This technology will help VA improve health outcomes and access to care for our Veterans.”

First locations

Mann-Grandstaff VA Medical Center in Spokane, Washington, and its associated clinics in Wenatchee, Washington; Libby, Montana; and Coeur d’Alene and Sandpoint, Idaho, are the first VA medical facilities using the new EHR system. Together, these locations serve more than 24,000 Veterans. The other deployment site, the West Consolidated Patient Account Center in Las Vegas, is an administrative facility that supports Mann-Grandstaff and other VA facilities in the Pacific Northwest.

VA clinicians and administrative staff at these sites can now more easily access patient information directly within the EHR itself, rather than using multiple systems as they had before. This includes patient medications, allergies, immunizations, past medical procedures and ongoing health concerns, as well as contact information, such as addresses, phone numbers and emails.

With this information more accessible, VA care providers will be able to view patient medical histories that will support clinical decision-making and improve Veteran health results. This more complete view of a patient’s records will also allow clinicians to make better connections between Veterans’ time on active duty and potential medical issues they might experience later in life.

“Once it is fully implemented, VA’s new EHR will transform the country’s largest integrated health care system and benefit over 23.9 million Veterans, as well as their families and caregivers,” Windom said. “No other health care organization in the world is attempting something of this scale and complexity, and we are committed to getting this absolutely right for our Veterans.”

Next locations

VA will deploy the new system at facilities across the country over a 10-year period, scheduled to end in 2028. After the implementation at Mann-Grandstaff, VA plans to roll out the EHR at sites in Alaska, Idaho, Ohio, Oregon and Washington state.

For more information about VA’s EHRM program, visit https://vaww.ehrm.va.gov.

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The U.S. Department of Veterans Affairs (VA) announced today its Veterans Crisis Line (VCL) formally launched the Caring Letters Program, an evidence-based suicide prevention intervention that involves sending periodic messages with simple expressions of care and concern to Veterans who use VA health care and contact the VCL.

The program aligns with the 2019 VA/DOD Clinical Practice Guidelines, which suggests brief, nondemanding follow-up communication keeps Veterans engaged and could facilitate opportunities for connecting them with treatment options.

“In the first 11 weeks of the program VCL has mailed Caring Letters to almost 30,000 Veterans,” said VA Secretary Robert Wilkie. “This is one of the largest caring letters programs ever implemented. We’re planning to send letters to over 90,000 Veterans over a 12-month period of time.”

Research has found caring letters can reduce the rate of suicide and suicide behaviors for individuals receiving them. Caring letters are thought to reduce suicide by promoting a feeling of caring connection and reminding Veterans that help is available if they need it.

Learn more about VA’s suicide prevention resources and programs.

If you or someone you know is having thoughts of suicide, contact the Veterans Crisis Line to receive free, confidential support and crisis intervention available 24 hours a day, 7 days a week, 365 days a year. Call 1-800-273-8255 and Press 1, text 838255 or chat online at VeteransCrisisLine.net/Chat.

Reporters covering this issue can download VA’s Safe Messaging Best Practices fact sheet or visit Reporting on Suicide for important guidance on how to communicate about suicide.

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The U.S. Department of Veterans Affairs (VA), National Cemetery Administration (NCA) launched the Veterans Legacy Memorial (VLM), Aug. 14, the country’s first digital platform dedicated entirely to the preservation of the memory of the 3.7 million Veterans interred in VA national cemeteries.

Each Veteran will have their own memorial page on the VLM, a secure, web-based platform that creates a perpetual memorial extending beyond the physical border of the national cemetery.

“Veterans Legacy Memorial ensures “no Veteran ever dies” by honoring the legacy of our nation’s Veterans, not just in our cemeteries, but in a new and innovative digital setting,” said VA Secretary Robert Wilkie. “It enhances the onsite national cemetery experience and extends the experience to those who otherwise are unable to physically visit the cemetery.”

NCA, in conjunction with VA’s Office of Information and Technology, built the architecture for the site starting with the information contained on every Veteran’s headstone.

In the initial rollout, the public will be able to search the site for Veterans, find out where they are buried and read the basic details of their lives and service. Future capabilities may be expanded to allow families, survivors, fellow Veterans and others to add historic photos and share memories to a deceased Veteran’s memorial page. Such capabilities will include provisions that allows NCA to manage the site in a manner that maintains the same level of decorum our customers experience in our national cemeteries.

For more information about the Veterans Legacy Memorial, visit www.va.gov/remember, or contact Dr. Bryce Carpenter, Veterans Legacy Program Manager, at This email address is being protected from spambots. You need JavaScript enabled to view it.">This email address is being protected from spambots. You need JavaScript enabled to view it..

Have questions about Veterans Legacy Memorial? Find what you’re looking for at VLM FAQ.

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The U.S. Department of Veterans Affairs (VA) today launched White Ribbon VA, a month-long national call to action to prevent and eliminate sexual harassment, sexual assault and domestic violence in observance of National Domestic Violence Awareness Month.

VA invites everyone to participate in this campaign by pledging to stop violence against others and to wear a white ribbon as a symbol of commitment throughout the month of October and beyond.

“White Ribbon VA promotes positive cultural change and a respectful, safe and welcoming health care environment for patrons, volunteers and visitors in VA health care settings and surrounding communities,” said VA Secretary Robert Wilkie. “It is critically important everyone, including VA employees, feel welcome and physically and emotionally safe at all VA facilities. This means creating an environment that is free from incidents of all types of harassment, including sexual and discriminatory harassment. VA will not tolerate behaviors that create an intimidating, offensive or hostile atmosphere.”

White Ribbon VA was inspired by the White Ribbon organization, a thought-leader in gender-based violence prevention and promoter of gender equity and healthy relationships. VA employees and community partners examine the far-reaching impact and implications of harassment, sexual assault and domestic violence by pledging to never commit, excuse or stay silent about sexual harassment, sexual assault or domestic violence against others.

VA collaborates with community partners to educate and help Veterans, their families, staff and community partners to honor VA health care settings as safe and welcoming environments by:

• Recognizing that touching, comments about appearance or referring to people by condescending derogatory names may make them feel uncomfortable.
• Talking to others in my life about the repercussions of unwanted hugging, touching or flirting.
• Giving everyone extra individual space.
• Understanding some Veterans and others may have invisible wounds and experiences I may not fully understand.
• Leading by example through my thoughts, words and actions.
• Remembering every single person expects courteous treatment or RESPECT.

The campaign also challenges negative, outdated concepts and inspires people to understand and embrace being part of positive change through awareness-raising, capacity-building, partnerships, outreach, technical assistance and other educational opportunities. White Ribbon VA supports the continued implementation of the Stand Up to Stop Harassment Now! Campaign launched in VA health care facilities nationwide in fall 2019.

VA has been committed to applying the Intimate Partner Violence Assistance Program (IPVAP) since 2014 to promote safe, healthy relationships for Veterans, their intimate partners and VA staff. Currently, more than 90% of VA Medical Centers have a designated IPVAP coordinator and programming designed to raise awareness, provide professional development and education, develop professional standards in clinical practice, use data to inform program operations and identify best practices using evidence-based and trauma-informed practices.

Additional information can be found at about VA’s Intimate Partner Violence Assistance program.

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Last week, news outlets reported Department of Veterans Affairs (VA) Secretary Robert Wilkie sent a letter to Rep. Mark Takano (D. Calif.), Chairman of the House Committee on Veterans’ Affairs, with an update on the department’s response to staffer Andrea Goldstein’s allegation of being sexually assaulted at the D.C. VA Medical Center. Wilkie wrote that the matter has been closed with no charges filed. The letter stated that “VA is a safe place for all Veterans to enter and receive care and services” and further called Ms. Goldstein’s claims “unsubstantiated.”

This letter is a breathtakingly inappropriate response to a well-documented concern within the VA medical system. Secretary Wilkie should apologize to Ms. Goldstein — and all the women Veterans whose similar concerns he has undermined by extension — and immediately commit to redoubling senior leader support for the End Harassment campaign.

VA’s own research shows that women Veterans do not find the VA to be a safe place to enter to receive care and services. To the contrary, one in four women Veterans reported having experienced sexual harassment, typically by their fellow patients. These women were “less likely to report feeling welcome at VA, and more likely to report feeling unsafe and delaying/missing care.” Previous VA research has also shown that women Veterans who have previous experiences of sexual trauma feel even less safe at VA facilities, which represents a significant barrier to care for individuals with a high burden of health care challenges in particular need of VA’s subject matter expertise in treating trauma.

Changing the culture that has allowed this behavior to flourish requires strong leadership. Research has shown that employees take sexual harassment seriously when leaders do. By publicly sending a dismissive, belittling letter about the negative experience of a woman Veteran patient, Secretary Wilkie has sent a strong message to VA staff, including VA police, as well as women Veteran patients and potential perpetrators, that he does not take this problem seriously. It has been made excruciatingly clear to other women Veterans that should we report sexual harassment or assault in a VA facility, not only will there be no consequences to the bad actor, but that we ourselves may face public humiliation for coming forward.

Because make no mistake: calling the claims “unsubstantiated” is a subtle way to impugn a reputation.

A reported sexual assault may be determined to be “unfounded” or “unsubstantiated” for any number of reasons, such as a lack of physical evidence. That does not mean it was a false report or that the incident did not occur. However, news coverage sometimes mistakenly conflates concepts like false and unproven, which perpetuates dangerous myths that false accusations are common. Not only does this line come across as victim-blaming and gaslighting, but it’s also untrue in this specific case: VA’s Inspector General wrote, “Neither I nor my staff told you or anyone else at the Department that the allegations were unsubstantiated.”

To be sure, I was not present and do not know precisely what happened to Ms. Goldstein. However, what is not disputed by anyone at VA is that when she immediately reported the experience to multiple VA employees, they did not call VA police.

This clearly demonstrates that VA staff did not understand their obligation to take complaints seriously and respond appropriately. Nascent efforts to train personnel on effective response have been inadequate, and Wilkie’s letter demonstrates that senior leaders continue to not take the issue seriously.

I am a woman Veteran who previously worked at VA, uses VA for health care, and has publicly written about my generally positive experiences with VA health care.

As a patient and advocate, I strongly believe it is vital for women Veterans to feel safe getting care at VA — and that requires believing appropriate action will be taken if we experience sexual harassment or assault.

In this case, a woman Veteran with a strong sense of personal agency and the platform to raise concerns about her experience had her personal reputation publicly attacked by the VA Secretary. That is precisely the wrong response. Treating women Veterans’ concerns as part of an ongoing political dispute rather than taking them seriously will drive women away from an exceptional system of care.

Secretary Wilkie should apologize to Ms. Goldstein for this serious misstep and use his position to push for profound culture change to improve the environment of care and the patient experience for women Veterans within VA.

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VA has provided life insurance for over 100 years to our nation’s service members, Veterans, and their dependents. Life insurance protects loved ones financially after the death of the insured. When selecting the coverage type and amount that is best for you, it’s important to keep in mind the purpose of life insurance, which includes income replacement, end of life costs, and financial flexibility.

VA Life Insurance offers several benefit options:

• Servicemembers’ Group Life Insurance (Serving)
• Family Servicemembers’ Group Life Insurance (Serving)
• Traumatic Injury Protection under Servicemembers’ Group Life Insurance (Serving)
• Veterans’ Group Life Insurance (Separation from Service)
• Service-Disabled Veterans Insurance (Service Connection)
• Veterans’ Mortgage Life Insurance (Severely Service Disabled)

Once you’ve identified the life insurance program that best suits your stage of the journey from service member to Veteran, VA offers a variety of products and services that make obtaining and maintaining a policy efficient and easy. The VA Life Insurance website has several key features that allow you to:

• Apply for coverage
• Select electronic payment options
• File claims
• Upload documents
• Download forms

In the near future, policyholders will have the ability to pay for premiums using a credit card.

VA Life Insurance consistently seeks out better ways to accomplish its mission and is committed to innovating and collaborating with stakeholders to design customer-centered processes and products. We welcome feedback to help us increase outreach and awareness.

For more information, visit http://www.benefits.va.gov/insurance.

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Listen, there are a lot of benefits to military service. There are so many the military actually hires people to explain them all to you. But chances are good this information was in a handout packet from your Transition Assistance class you didn’t read.

Luckily, I’m going to give you a quick and dirty rundown of the major points. It would behoove you to go seek out the details of these benefits, since they cover basic needs that people will need their whole lives, like income, housing, work and things like that, since your mama and Uncle Sam aren’t footing the bill anymore.

The first thing you need to do is file a claim for your VA benefits. The second thing you need to do is keep following up on it. Based on your submission and the VA’s subsequent (likely terrible) review of your records and a physical exam, the VA will designate a disability rating for you and assess if any of your chronic conditions are a result of your military service. If they find a condition like that, they call it a “service-connected disability” and will take care of that condition for the rest of your days. If they find enough things wrong with you that are related to service, they’ll just take care of all of you for life. You will also get a check in the mail every month to help ease your pain.

See how important that is? So you are strongly advised not to go through this process by yourself. Once you give up your military medical records, you will likely never see them again so you should photocopy everything and fill out your VA disability claim with an expert. Many Veterans Service Organizations (Like the American Legion) are more than just old guys sitting around drinking beer in the middle of the day. They can connect you with someone who can shepherd you through this process. If you do nothing else, take the time to do this right before you go to that new job or start school.

Now, if you decided more education isn’t for you, that’s okay. Be sure you transfer those G.I. Bill benefits to your spouse or children, though. But if you’re six months away from your discharge date, you still need to get moving. It’s time to find a job for yourself. By now you should at least have a post-military career resume squared away and know what field you want to go into. If you’re looking to go into government, you’re in luck, the government’s Veterans preference policy gives you an edge over other applicants. Governmental agencies are required by Congress to weigh their applicants with this preference.

Not everyone automatically gets Veterans preference. There are even different levels of it. You also need to be discharged under an honorable or general discharge, so I hope you kept your nose clean. You get a ten-point preference if you have a service-connected disability with the VA or were awarded the Purple Heart. You have a five-point preference if you are authorized to wear a campaign or expeditionary medal. There are actually a few gray areas and exceptions to these rules, so be sure to actually look up the details before you start applying.

The next thing we need to talk about isn’t something everyone in the military just gets, but it can be clutch when finding a job if you do have it: your security clearance. Chances are good that somehow the military actually trusted you with sensitive information. Lucky you.

If your military career required a security clearance and you want to do the same job as a civilian, you’re still gonna need it. Even if you’re looking to work in another field but still need a clearance, that clearance is going to save your new company time and money in hiring you, and they know it. So don’t go crazy after your last day in the military and lose that clearance. You can still pull stupid stunts when you retire from your $200,000/year aerospace defense job, so don’t risk it all now.

That’s not even the biggest benefit. There is one benefit so powerful as soon as you activate it, your phone will not stop ringing and your email inbox will explode: the VA Home Loan. The VA guarantees part of these loans, making them so attractive to lenders, they’ll throw themselves at you like you’re a female deployed to a tent city. If you’re smart about this, you’ll know exactly what kind of interest rate you want and how much you can afford. Do your research and get the right loan, the banks will take your money but they won’t do the legwork for you.

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The Department of Veterans Affairs is preparing to transform its workforce and health care facilities in anticipation of legislation that would deliver a historic expansion of health care to Veterans.

The Senate on Thursday passed the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (Honoring Our PACT) Act. The bill now heads back to the House for final approval before heading to President Joe Biden’s desk.

The legislation, at its core, would expand disability compensation and health care benefits for Veterans exposed to toxic substances during their military service.

VA Secretary Denis McDonough told the Senate VA Committee on Tuesday that the PACT Act, combined with the agency’s fiscal 2023 budget request, will give the VA the resources it needs to prepare its health care workforce to treat up to 3.5 million additional Veterans.

“This is a very important piece of legislation. I think it’d be very difficult to implement, but oftentimes, the most important things are difficult, and I think we’re ready for it,” McDonough said.

The VA said in a statement last month that the PACT Act would be one of the largest substantive health and benefit expansions in VA’s history, comparable in scale and impact to the 1991 Agent Orange Act.

The VA’s budget request for fiscal 2023 includes $42.2 billion for medical service staffing, and provides for 22,789 full-time equivalent hires, an increase of 14,000 FTEs compared to last year.

McDonough said the PACT Act would give the VA much-needed authority to set higher pay caps for certain health care positions, and that the VA’s ability to get Veterans into care more quickly is “obviously impacted by the tightness of the labor market.”

“The first thing we need to do is retain the docs that we have, and you’re giving us new authorities to do that. Pay is a big one, and you’re giving us enhanced recruiting authorities as well. We’re thinking very diligently about this and planning very diligently about making sure that we have the people in the spots, and that we have the buildings for the increased demand that we anticipate seeing,” he said.

White House Press Secretary Karine Jean-Pierre said in a statement last week that the PACT Act marks “one of the most significant and substantive expansions of benefits and services in the Department of Veterans Affairs history,” and that the Senate is taking steps to ensure the VA has the support it needs to effectively implement the legislation.

The Congressional Budget Office estimates the bill would increase spending subject to congressional appropriations by $147 billion through 2031. CBO estimates that 5.4 million Veterans, nearly a third of the 19 million Veterans in the U.S., will receive some disability compensation this fiscal year.

The PACT Act contains a slew of provisions meant to bolster the VA’s workforce, health care facilities and claims processing capabilities, and is the latest in a series of bills meant to recruit and retain in-demand health care workers and address the agency’s record-high rate of turnover.

Committee Chairman Jon Tester (D-Mont.) and Ranking Member Jerry Moran (R-Kan.) introduced the bill.

Congress in March also passed the RAISE Act, which raises the pay caps for certain VA nurses and physician assistants. McDonough said about 10,000 nurses will see their salary increase next month under that legislation — that’s about one out of every nine VA nurses.

McDonough said the Office of Personnel Management recently gave the VA another year to continue with its direct-hire authority for health care workers.

But even with that expedited hiring authority, Veterans Health Administration officials recently told the committee it’s taking 95 days on average to hire new employees.

“The direct-hire authority, of the many variables in the equation of bringing people on, it’s perhaps the most impactful. It accounts for probably a third of the savings we were able to get, in terms of time to hire. But the hiring and onboarding process is still so sclerotic, that we’re finding things that can change,” McDonough said.

Among the changes the VA is looking at, McDonough said nurses have to write an essay as part of their onboarding process.

“I think that’s antiquated, and we should get rid of that,” he said.

The PACT Act outlines many provisions meant to make the VA a more attractive employer for health care workers in a competitive labor market.

The bill would also give the VA up to $40 million a year to buy out the contracts of certain private-sector health care professionals in exchange for employment at rural VA facilities.

The bill also expands recruitment and retention bonuses for VA employees, including merit awards and pay incentives for employees that have a “high-demand skill or skill that is at a shortage.” The critical-skills pay incentive cannot exceed 25% of an employee’s base pay.

The bill also includes expedited hiring authority for college graduates into competitive service jobs.

The PACT Act also gives the VA 180 days to work with OPM to establish qualifications for each human resources position within the VA, and to establish standardized performance metrics for its human resources positions.

The bill gives the VA a year to submit to the House and Senate committees a plan on how it will recruit and retain HR employees.

The agency would also have 90 days to provide enhanced monitoring of the hiring and other human resources that happen at the local regional and national levels of the department. The agency must also provide at least annual training to human resources professionals in VHA.

VHA officials told the committee last month that non-standardized HR processes at the local level have led to hiring and onboarding inefficiencies across the agency. The legislation, if signed, gives the VA 18 months to develop a national rural recruitment and hiring strategy for VHA.

As part of this strategy, the VA must determine which clinics or centers have a staffing shortage of health care professionals, and develop best practices and techniques for recruiting health care professionals for such clinics and centers. The PACT Act requires the VA to provide the House and Senate VA committees with updates on its progress in implementing the rural recruitment and hiring strategy within 18 months of the bill going into effect and then annually.

The bill would waive pay caps for VHA impacted by the closure or realignment of their official duty stations, which may happen if the agency’s recommendations to the Asset and Infrastructure Review (AIR) Commission come into focus.

The PACT Act also waives pay caps for VHA employees providing care to Veterans exposed to open burn pits.

While Senate Majority Leader Chuck Schumer and House Oversight and Reform Committee Chairwoman have opposed the planned closure of VA medical centers in New York, Sen. Richard Blumenthal (D-Conn.) said the VA can’t continue to deliver modern health care in outdated facilities.

“This strategy is untenable. In fact, it’s not a strategy,” Blumenthal said. “There is no way that the Veterans Administration can continue quality care with facilities of that age at a time when technology requires that the entire structure of a facility be designed and built to accommodate the most modern means of delivering care, of monitoring patient health.”

McDonough said that if the AIR Commission process doesn’t move forward, the MISSION Act still requires the VA to conduct four-year reviews of its real-estate needs in each of its regional health care markets.

“We’re watching to see what you all choose to do with the nominees for the AIR Commission. In all cases under the MISSION Act. We’re required to go back and look each four years at what the needs are in each of those markets across the country,” he said.

Meanwhile, the PACT Act authorizes 31 leases for new VA health care facilities across the country.

Bill mandates VA updates on claims automation

The PACT Act also gives the VA 180 days to submit a plan to Congress on the state of IT modernization at the Veterans Benefits Administration.

The report should identify any legacy systems the VA plans to retire or modernize, as well as update Congress on the progress the VA is making in automating claims processing decisions.

The bill states that automation “should be conducted in a manner that enhances the productivity of employees,” but keeps VA employees in charge of making the final decision of granting benefits to claimants.

The bill makes clear that the automation should “not be carried out in a manner that reduces or infringes upon the due process rights of applicants.”

McDonough told the committee that the current claims backlog is 188,000, which is down from 265,000 claims only a few months ago.

The VA announced in January that the automation pilot, through its newly created Office of Automated Benefit Delivery, is processing claims within a day or two, while the traditional method of processing these claims currently takes well over 100 days, on average.

The VA began the pilot by automating claims of service-related hypertension, and is adding three new diagnostic codes each quarter.

McDonough said that by the end of the year, the 12 most common claims will be automatable.

While the Biden administration and some lawmakers have pressed for federal employees to return to the office, McDonough said the VBA productivity increased during the pandemic.

“As we think about questions about do people come back in the office, or do they work virtually, we’re taking that into consideration,” he said.

VA is also in the process of hiring 2,000 additional claims personnel.

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Lawmakers in the House Appropriations Committee want the Department of Veterans Affairs to develop a plan for countering extremist recruiting efforts within the Veteran community.

In its $270 billion budget proposal for the department, the Appropriations Committee wrote in a June 30 summary, “The Committee is concerned by foreign and domestic actions to exploit Veterans through the use of online misinformation and manipulation. These efforts to spread extremist views and conspiracy theories among the Veteran community have severely damaging effects, such as spreading conspiracies that may have motivated participation in the Capitol insurrection on January 6, 2021.”

The Democrat-controlled House committee’s language is in reference to the Jan. 6 incident in which demonstrators entered the U.S. Capitol and delayed a joint session of Congress called to certify the results of the 2020 U.S. Presidential election for Joe Biden. The incident saw some demonstrators enter the building as some Capitol Police stood by, while on other parts of the Capitol grounds demonstrators clashed violently openly with other police officers. Ashli Babbitt, a 14-year U.S. Air Force Veteran, was among several military Veterans within the group of demonstrators who entered the building. Babbitt was ultimately shot and killed by a Capitol Police officer.

About 500 people have been arrested since the Jan. 6 incident, including current and former U.S. service members.

In their report for the VA budget proposal, lawmakers said the department “should engage with the Veteran community to better understand the unique vulnerabilities that Veterans face online, and that the Department should establish a comprehensive, evidence-based program to educate Veterans about malign influences, transition assistance to include specialized counseling services, as well as research into operations and methods to discern against disinformation.”

“This should include developing evidence-based social media and internet propaganda literacy programs that are appropriately targeted to different Veteran populations and an understanding of appropriate counseling options,” the report reads.

The committee said the VA should work with the Departments of Justice (DOJ) and Homeland Security (DHS) and other “civil society partners” to develop its plan for addressing extremism within the Veteran community.

The proposed budget legislation, if enacted, would also require the VA to report back to Congress “within 60 days of the enactment of this Act on

its plans to implement this program, including a cost estimate of

additional resources that would assist in implementation.”

The committee’s call for the VA to enact this new counter-extremism plan comes after Biden’s Defense Secretary Lloyd Austin ordered a 60-day Department of Defense-wide stand-down for military commands to address extremism within the ranks.

Military Times reported VA officials have been relatively quiet about extremism, compared to their DoD counterparts. In May, VA Secretary Denis McDonough said the department was looking into ways to the involvement Veterans had in the Jan. 6 incident, but has yet to announce any new anti-extremism measures.

Military Times also reported the VA counter-extremism proposal could ultimately be dropped from the budget language during negotiations on the Senate side.

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Some services offered virtually

MANCHESTER, N.H. — As more sectors of New Hampshire's economy reopen, officials with the Veterans Affairs Medical Center in Manchester want veterans to know they are open for business.

Many of the services at the VA Medical Center, such as elective surgeries, were postponed because of the COVID-19 pandemic, but officials said services are being offered again, with some changes. Wellness offerings, for example, are now being offered virtually.

Veterans who postponed seeking medical help because of the pandemic should call the VA Medical Center, officials said.

"We are open for business and encouraging our veterans to contact us so we can deliver their health care," said Kevin Forrest, director of the VA Medical Center.

The newly appointed director said he understands that given the current pandemic, some veterans might be reluctant to go to the hospital. But he said every precaution is being taken to make sure it's safe.

"When you come through the entrance to the medical center, expect to get your temperature taken and answer some screening questions," Forrest said.

Anyone who enters the center is required to wear a mask. The director said all services are being offered, with some done virtually.

"It's an effective way to deliver care with the same outcomes," Forrest said. "It's safer, and it can be more convenient."

The medical center is transitioning back to more face-to-face meetings, Forrest said. In April, the center averaged about 50 in-person meetings each day, primarily for blood draws. On Tuesday, 351 face-to-face meetings were scheduled.

Forrest said an effort is being made to take care of several issues during a single visit.

"If a veteran has a health care need, (we want to) take care of all of those needs when the veteran is in the facility, so they don't need to come back," he said.

Visitors are also allowed.

"If a veteran needs medical assistance during appointments, that is certainly OK, and we encourage that family member to come in and support," Forrest said.

Otherwise, people are being asked to stay outside the facility.

"Whether it's urgent care or they need a face-to-face appointment, we are here," Forrest said.

He added that the VA Medical Center's crisis line is always available at 1-800-273-8255.

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Provides easy access to services and program coaches

The VA Nebraska-Western Iowa Health Care System looks toward whole health and asks, what matters to you?

What better way of doing this than by unveiling a new web page?

Whole Health is VA’s cutting-edge approach to care that supports your health and well-being. It centers around what matters to you, not what is the matter with you.

This means your health team will get to know you as a person, then help you to develop a personalized health plan based on your values, needs and goals.

The new pages introduce Veterans to the system, coaches, recreational assistants and programs available throughout the service areas. The new Whole Health page also will provide downloadable calendars with current schedules for the Omaha, Lincoln and Grand Island areas.

Whole Health sets you in the right direction

The Introduction of Whole Health class gets Veterans in the right direction. During the class, Veterans learn more about the Whole Health approach to care and the concepts behind Whole Health living. They complete a personal health inventory before they even step into the class.

The VA Nebraska-Western Iowa Health Care System also just introduced a nine-week course called Taking Charge of My Life and Health. The class will be held in Omaha, Lincoln and Grand Island. It promises Veterans an opportunity to reflect on what really matters to them. Veterans choose an area of their life they want to enhance and develop a plan for reaching their goals.

The Whole Health approach to care empowers, equips and treats Veterans to take charge of their health and well-being and live their lives to the fullest. Health coaches and peer facilitators support and listen as Veterans learn to live Whole Health.

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Dr. Randall D. Gehle of Belmont has never forgotten what it is like to go to war for his country, to be separated from family and loved ones, to be willing to make the ultimate sacrifice as a part of his military duty.

Indeed the memory of his time as a surgeon for the 3rd Battalion Second Marines during Operation Desert Shield/Desert Storm in 1990-91 is his primary motivator in his position as chief of staff for both the W.G. Hefner Veterans Administration Medical Center in Salisbury and the Veterans Administration Health Care Center in Charlotte.

Many Gaston County residents will remember Gehle from his time as a family physician with CaroMont Family Medicine in McAdenville from 1996 until late in 2013.

Others may know him from his continuing service as an attending physician providing rotating weekend coverage for the Robin Johnson Hospice House in Dallas.

But as he talks about his career and his current position, it is to his passion for Veterans and for seeing that they receive the best care possible that he keeps returning.

“We want to set a tone here,” Gehle said of the Salisbury and Charlotte facilities. “A tone of Veterans caring for Veterans. A tone of Veterans doing what is right for Veterans. A tone of compassion and support.”

That passion prompted Gehle to leave his successful private practice eight years ago.

“I had always wanted to be a small town doctor,” said Gehle, who received his bachelor of science degree in microbiology from the University of Florida and his doctor of osteopathic medicine degree from the Southeastern College of Osteopathic Medicine in North Miami Beach, Florida.

“But even when I was in private practice,” he continued, “I loved taking care of Veterans. Making sure they received the very best care available.”

Joining the staff of the W.G. Heffner Veterans Administration Medical Center in Salisbury as a primary care physician in November of 2013 allowed Gehle to be on board when the Charlotte Veterans Administration Health Care Center opened in 2016.

The Charlotte facility is a gleaming, five-story edifice that sits on a 35-acre site surrounded by nearly 2,000 parking spaces.

The center offers more than 20 different medical specialties to patients, including primary care, cardiology, behavioral health, rehabilitative therapy, and oncology.

Although the center encompasses more than 425,000 square feet, Gehle emphasized that it is designed to be accessible and user-friendly.

“The entire facility is built around the idea of keeping patients and their family members comfortable at the center,” Gehle said. “Clinics and diagnostic centers are grouped like ‘neighborhoods’ that are warm and welcoming.”

Indeed as Gehle shows off the facility with a quick tour, a visitor is impressed with the artwork which highlights the natural beauty of North Carolina, with each floor devoted to separate geographical regions of the state.

The outside of the Charlotte center features a wellness garden, external courtyards, natural lighting and water fountains, all designed, Gehle said, to enhance the healing environment.

The shining new medical center stands in sharp contrast to the often outdated and rather shabby facilities that served Veterans back in the 1970s and 1980s. But that, Gehle emphasized, is exactly as it should be.

“Veterans Administration health care is not some sort of charity program,” Gehle said. “This is health care that these men and women have paid for. This is health care that they have earned with their minds, their bodies, their sweat, and their blood.”

Referring back to his service in the first Gulf War more than 30 years ago, Gehle said, “Those memories stay with me. The surgery, the oil fires. Being separated from home with no communication. I know what military families have been through.

“All Veterans are my family,” he continued. “We are all brothers and sisters in combat. I honor and embrace the reality of what their service meant to them and to our country.”

Although the hours of his job are long as he shuttles between Charlotte and Salisbury, Gehle said he finds his work “incredibly fulfilling, mainly because I’m working with men and women who give 100 percent every day.”

Indeed, Gehle still takes time away from his administrative duties each week to see and serve patients as a primary care physician.

“I don’t want to separate myself from that work,” he said in explanation. “I still want that contact. I still want to be a working doctor.”

Asked if he had a message for Gaston County Veterans, Gehle replied, “Take advantage of your benefits and your eligibility. We’re a 20-minute drive from most of Gaston County.”

Gehle also urged Veterans to never think they don’t deserve their care or that they might be taking care away from others.

“The more Veterans we serve, the more Veterans we are able to serve,” he said. “Let us be a part of your care. Let us be a part of your life. You have earned it.”

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When we began implementing the VA MISSION Act this past June, we knew it had the potential to make an enormous positive impact for Veterans. Now, more than six months later, we know that that is the case: With the MISSION Act, VA is helping more Veterans access the care and services they need, when and where they need them.

One of the biggest accomplishments we’ve achieved under this law is the launch of a new, consolidated community care program. This program uses simplified eligibility standards that are easier for Veterans, their families, VA staff, and community providers to navigate. Our new network now includes 880,000 community providers across the country.

This program also includes a new urgent care benefit that allows Veterans to seek care for minor injuries and illnesses from urgent care clinics that are a part of VA’s contracted network. Since June 6, 2019, we estimate that our network of community urgent care clinics has provided care to Veterans through more than 140,000 visits.

But improving access to community care is just one piece of the puzzle. Under the MISSION Act, VA is now implementing “anywhere to anywhere” telehealth, meaning we can bring provider expertise across state lines and into Veterans’ own living rooms – meeting them where they are. VA recently announced the delivery of telehealth services to more than 900,000 Veterans over 2.6 million episodes of care in fiscal 2019 – an increase of 17% over the previous year. This extraordinary progress gives Veterans more convenient care options without traveling to their provider’s office.

Looking toward the future

The MISSION Act also enables us to look toward the future, giving us more tools to recruit and retain the best health care providers. This year we launched a new scholarship pilot program for Veterans pursuing a medical education through Historically Black Colleges and Universities and Teague-Cranston institutions. The program will help VA recruit the best talent to our ranks by providing scholarship funding in exchange for a commitment to practice with VA for four years. In 2020, this program will welcome 18 Veteran medical students at nine universities across the country. In the coming years, we will also expand our education debt reduction program and roll out new scholarships for other health professionals who aspire to serve the Veteran community.

The provisions of the MISSION Act stretch out to 2034, and our progress will continue. In the next few months we will enhance secure information sharing with community providers, delivering safer, better-coordinated care for Veterans. We have also stood up a new Innovation Center, intensified focus on underserved facilities, started a pilot program to include Veteran peer support in primary care, and will expand our Program of Comprehensive Assistance for Family Caregivers to support Veterans of all eras.

The MISSION Act has augmented VA’s ongoing transformation, and this progress will fuel VA’s leadership of the future of U.S. health care.

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Have a sore throat, earache, or strained muscle? Then consider contacting your VA facility or using the community urgent care benefit available to eligible Veterans under the MISSION Act. VA facilities across the country offer same-day primary care and mental health services, and many offer additional services as well. With the new community urgent care benefit, eligible Veterans can also visit a local walk-in retail health clinic or urgent care center that is part of VA’s contracted network. Urgent care providers treat non-emergent symptoms or conditions such as ear infections, minor burns, and mild skin infections.

If you believe your life or health is in danger, call 911 or go to the nearest emergency department right away!

To be eligible for the urgent care benefit, you must be enrolled in the VA health care system and have received care from VA (either in a VA facility or a community provider) within the past 24 months. To check eligibility, contact your local VA medical facility or call 1-833-4VETNOW (1-833-483-8669).

Eligible Veterans can receive urgent care from an urgent care provider in VA’s contracted network without prior authorization from VA.

Top 10 Frequently Asked Questions:

1. How do I find the nearest in-network community urgent care provider?

Use VA’s Facility Locator at https://www.va.gov/find-locations/ and click on the VA-approved urgent care locations and pharmacies near you. There are currently two types of urgent care network locations: walk-in retail health clinics and urgent care centers. Seek care at a retail location for an uncomplicated illness such as a sore throat. Visit an urgent location for more pressing illnesses or injuries requiring services such as splinting, casting, or wound treatment.

2. What do I do when I arrive at an urgent care location? What type of identification will I be asked to show?

There is no identification card needed for VA’s urgent care benefit. When you arrive, verify they are part of VA’s contracted network, complete the intake form, and tell the provider you would like to use your VA urgent care benefit. The provider will check your eligibility. Both Veterans and providers can call 1-833-4VETNOW (1-833-483-8669) to confirm eligibility. Veterans can call 1-866-620-2071 for other issues related to the urgent care benefit.

3. Does urgent care cost anything?

No, you do not have to pay anything at the time of the visit. If you owe a copayment, VA will send you a bill. Copayments are $30, but your liability will depend on your assigned priority group and the number of times you have used your urgent care benefit in a calendar year. Learn more about urgent care copayments.

4. How does prescription medication work for urgent care?

VA will pay for or fill prescriptions for urgent care. For routine prescription medication longer than a 14-day supply, the prescription must be submitted to VA to be filled. Before filling the prescription, VA will verify the urgent care visit. If there are issues with filling your prescription, call 1-866-620-2071.

5. There are no urgent care clinics in my area. What do I do?

Contact your local VA medical facility to discuss options. Same-day primary and mental health services are available at all VA medical centers. In addition, VA continues to expand its contracted network of urgent care providers so that most Veterans are within a 30-minute drive time from their home to a network urgent care/retail location.

6. If there are no in-network urgent care facilities nearby, can I visit an Emergency Department (ED) instead?

If you are having difficulties receiving urgent care services, contact your local VA medical facility. Same-day primary and mental health services are available at all VA medical centers. If you believe your life or health is in danger, call 911 or go to the nearest emergency department immediately. Please note that VA can only pay for a Veteran’s emergency care under certain conditions.

7. Can I use the in-network urgent care provider at my local pharmacy as my primary care provider (PCP)?

No. Urgent care is not a replacement for services your PCP offers. Use urgent care for treating minor, non-emergent illnesses and injuries. The urgent care benefit does not cover preventive health care offered by your primary care physician. Always consider talking with or seeing your PCP if you are concerned that the urgent care provider will not understand the complexities of your medical history or medications.

8. How do I know if I need urgent care or emergency care?

Urgent care is for non-life-threatening illnesses or injuries such as strep throat, pink eye, or a strained muscle. Emergency care is for an injury, illness, or symptom so severe that a prudent layperson reasonably believes that delay in seeking immediate medical attention would be hazardous to life or health. Such life-threatening major illnesses or injuries could include severe chest pain, seizures, loss of awareness, heavy uncontrollable breathing, or severe burns. For emergency care, call 911 or go to the nearest emergency department right away. Please note that VA can only pay for a Veteran’s emergency care under certain conditions.

9. What if I arrive at an in-network urgent care location and have difficulty receiving care?

Call 866-620-2071 or your local VA medical facility.

10. How do I get a free flu shot?

Veterans can receive a flu shot at their local VA medical facility or from any Walgreens location, paid for by VA. Veterans can also receive a flu shot, paid for by VA, at an in-network urgent care location, but it must be administered in conjunction with a condition requiring urgent care.

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WASHINGTON — The Department of Veterans Affairs failed to thoroughly Vet medical providers for its community care program, resulting in doctors with revoked or suspended medical licenses being approved to treat Veterans, according to a new report from the Government Accountability Office.

The GAO investigated the VA’s community care program, which sends Veterans to private-sector doctors in certain situations. When Vetting doctors to allow them into the program, the VA was “cutting corners,” the investigation found. The GAO identified 1,600 providers who were ineligible for the program under the VA’s policies but had been accepted into it.

In some cases, the doctors had criminal records or had previously committed health-care fraud.

“Our work … basically found that they were really cutting corners,” said Seto Bagdoyan, director of audits at GAO. “They were not performing monthly checks, for example. And even when they did flag someone as ineligible, that individual… was not removed in a timely manner.”

In one instance, the VA approved a doctor who had been convicted of patient abuse and neglect. The doctor also had an expired medical license, had been arrested for assault and had been excluded from participating in other federal health-care programs.

Another doctor who was accepted into the program had a revoked medical license and posed a “clear and immediate danger to public health and safety,” the GAO reported.

“This individual was somehow deemed eligible for referrals in the program,” Bagdoyan said. “Both of these examples help illustrate that having ineligible providers poses a risk to Veterans’ health.”

The VA refers Veterans to community care in certain cases, including when they must wait longer than 20 days for an appointment or drive more than 30 minutes to reach their VA health-care provider. The program expanded under the VA Mission Act, a measure approved in 2018.

During its investigation, the GAO assessed 800,000 of the approximately 1.2 million providers involved in the community care program. Of the 800,000, the watchdog found 1,600, or 0.2%, shouldn’t have been approved.

The GAO recommended the VA follow its own regulations for community care doctors “without cutting corners.” It also suggested the VA improve its systems to automatically flag providers who don’t meet the criteria for the program.

The VA agreed to implement all the recommendations this year. Bagdoyan said the department was “eager” to review the providers flagged by the GAO.

After the GAO’s findings were released Thursday, four lawmakers on the House Committee on Veterans’ Affairs wrote to Steven Lieberman, deputy to the VA undersecretary for health, urging him to review and deactivate the 1,600 providers.

Reps. Chris Pappas, D-N.H., Tracey Mann, R-Kan., Julia Brownley, D-Calif., and Jack Bergman, R-Mich., signed the letter. They asked the VA to update them by Feb. 28 about the actions taken.

“This put Veterans at risk of receiving care from unqualified providers, and it put [the Veterans Health Administration] at risk of making payments to fraudulent providers,” the lawmakers wrote.

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The Department of Veterans Affairs will create a list of conditions thought to be linked to burn pits and other air-quality problems experienced by Veterans who served in Iraq, Afghanistan and elsewhere since the Persian Gulf War.

VA Secretary Denis McDonough announced Thursday that the department will start the rulemaking process to add chronic respiratory conditions such as asthma and sinusitis to a list of presumptive illnesses considered linked to service.

The move comes after an internal VA review "resulted in the recommendation to consider creation of new presumptions," based on existing reports and scientific evidence, he said.

"VA is establishing a holistic approach to determining toxic exposure presumption going forward. We are moving out smartly in initiating action to consider these and other potential new presumptions, grounded in science and in keeping with my authority as secretary of VA," McDonough said.

Rulemaking is the first step in ensuring that affected Veterans have an easier time receiving approval for certain conditions. McDonough said the initial list includes asthma, sinusitis and rhinitis, but more could be added as the VA obtains additional information.

"This is just the beginning of our efforts to help Vets suffering from toxic exposure. … This is an urgent ongoing process," he said.

Establishing federal policy by rulemaking is a lengthy process that can in some cases take years. McDonough promised that the VA would approach the process as an "urgent matter."

"It breaks all of our hearts that we have Veterans who suffer. It makes me particularly sad that we have Veterans with terminal diagnoses," he said.

Congress is considering a massive health care package for Veterans with illnesses caused by exposure to pollutants. Both the House and Senate Veterans Affairs Committees are working on legislation that would provide health care and disability compensation for those sickened by burn pits and other environmental toxins during their military service.

The VA estimates 3.5 million Veterans were exposed to burn pits, which were acres-wide and used to dispose of waste in combat zones. The department historically has maintained that the science is unclear on the link between conditions such as cancer and breathing in burn pit fumes for months at a time, although McDonough now says the department is looking at reports not only from the National Academies of Sciences but also across the research spectrum.

The VA also announced Thursday it will begin processing claims for new presumptive conditions linked to exposure to herbicides used in Vietnam and elsewhere in the 1960s and 1970s.

McDonough said the department will implement provisions of a law passed earlier this year that added bladder cancer, hypothyroidism and Parkinsonism, or Parkinson's-like symptoms, to the list of presumptive conditions linked to Agent Orange exposure.

"Many of our nation's Veterans have waited a long time for these benefits," he said. "VA will not make them wait any longer."

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Despite concerns from lawmakers, Veterans Affairs officials are moving ahead with plans to outsource nearly all compensation and pension exams in coming months, a move they believe will improve service for Veterans.

“This is just the evolution of the process,” said Under Secretary for Benefits Paul Lawrence in an interview with Military Times last week. “Right now, contractors are already doing the bulk of them. We think the value of having contractors available to do them is flexibility and the ability to surge.”

The compensation and pension exams are a key part of the process for Veterans to receive disability benefits. In most cases before payouts begin, VA requires some type of review by a medical expert to confirm a Veteran’s injuries and the severity of its impact.

Before the coronavirus pandemic, about 25 percent of those exams were conducted at VA medical centers or health clinics. When many of those were partially shuttered due to virus prevention efforts, the backlog of C&P exams swelled to more than 350,000.

Lawrence said as of the start of November, the Veterans Benefits Administration has erased most of that backlog and now sits at pre-pandemic service levels. Only about 15 percent of the exams are handled by VA health staff now, with the rest outsourced to private-sector contractors.

He sees that remaining the norm as the department moves forward.

“The Veterans Health Administration is still dealing with the Covid-19 pandemic, so the question is what is the best use of those doctors in terms of helping Veterans?” he said. “That’s the kind of balancing act we’re looking at.”

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The Department of Veterans Affairs is considering whether Veterans' ability to get telehealth appointments should be part of its decision on who is eligible for care outside of VA facilities.

Whether that would limit Veterans' access to community care, and where the VA foots the bill for Vets to be seen by private doctors, remains to be determined. But the move could alter the wait-time criteria established to get that care, resulting in more former service members receiving treatment from the VA.

VA officials have said the department is trying to find the most efficient way to provide medical care to patients, while opponents say the move could severely curtail private care for Vets.

Speaking before the Senate Veterans Affairs Committee on Wednesday, VA Secretary Denis McDonough said that telehealth has improved the VA's ability to provide timely medical services and should be included when the VA weighs a Veteran's eligibility for community care.

Saying that studies indicate that Veterans in the VA's direct care system "do better in terms of outcomes," the VA is looking for ways to ensure that Veterans are able to receive care within the VA, including telehealth.

"Telehealth is part of the evolving way in which care is delivered, and it improves our ability to provide that care," McDonough said.

The cost of community care in fiscal 2021 was $18.5 billion -- nearly twice what it was in fiscal 2014, according to a study by the Washington, D.C.-based RAND Corporation. The proposed fiscal 2023 budget calls for $28.5 billion for community care, roughly 29% of the VA's entire medical services budget of $99.1 billion.

But critics say the move to consider telehealth availability in community care considerations would reduce access to private in-person care, which a growing number of Veterans have used since the 2018 MISSION Act broadened eligibility for receiving that care.

"The concern is that this might be a way that VA would manipulate the numbers and prevent Veterans from seeking care outside the VA," said Sen. Marsha Blackburn, R-Tenn. "If a Veteran wants an in-person visit, but the VA can provide a telehealth visit within the waiting time eligibility category, will that Veteran be allowed access to an in-person visit in the community?"

Before the MISSION Act, roughly a quarter of all VA-covered medical appointments were in the private sector; a VA report sent to Congress Sept. 16 noted that "nearly one-half of all appointments" are now in the community, according to committee Chairman Sen. Jon Tester, D-Mont.

In 2021, VA covered the cost of 33 million appointments at private providers for Veterans.

To address the rising cost of the program and solve issues with private care that include growing wait times for appointments in the private sector, communications problems between the VA and civilian providers and medical record update delays, McDonough said in June he was considering changing the access standards under the MISSION Act, which would send more Veterans back to the VA for medical care.

Prior to the MISSION Act, Veterans only were eligible for community care if they lived more than 40 miles as the crow flies from a VA medical center or they were unable to get an appointment in less than 30 days.

The Mission Act expanded the standards to include Veterans who face drive times of at least 30 minutes to a primary or mental health appointment or 60 minutes for specialty care, or those who must wait 20 days or more to be seen for primary care or 28 days for specialty care.

After consulting with the VA Under Secretary for Health Dr. Shereef Elnahal, however, McDonough said he decided not to change those standards and incorporate telehealth instead.

"I intend to carefully consider and propose such a change," McDonough said during the hearing.

He did not offer a timeline for the proposal but added that lawmakers and the public will have the chance to comment on it.

The extent of VA-covered, private-sector care for Veterans has been debated for more than a decade, the sides aligning largely along party lines. Democrats typically have favored improving VA infrastructure and staffing to ensure that Veterans stay within the VA system, while Republicans prefer broader access to private care.

Sen. Bernie Sanders, I-Vermont, sought a commitment from McDonough to include telehealth in the access standards as well as wait-time calculations, which may demonstrate that appointment wait times are often shorter at the VA than in the community.

"The VA report on access to care issued last Friday stated that VA should allow telehealth care to satisfy the wait times standard for VA access to care. It went on to say, "only if the VA cannot meet demand should community care be provided,'" Sanders said.

Some lawmakers, however, say the VA is striving to force Veterans back into VA care to bolster flagging facilities and cut costs.

"I worry that there is a bias... against community care, so every time the VA does something, I'm worried. We were so intentional in the MISSION language to try to overcome the capabilities of the Department of Veterans Affairs to undo community care," said Sen. Jerry Moran, R-Kansas.

McDonough sought to reassure lawmakers that the VA aims to ensure that Veterans have access to the best care available.

"I will keep arguing that no one is trying to limit a Veteran's access to community care," McDonough said. "If I'm trying to stop Vets from going into the community, and we set a new record the last two years for completed appointments in the community, then I'm a really bad manager."

Nonetheless, the department could see pushback as it pursues efforts to make any changes to access standards. Darin Selnick, a senior adviser to the conservative group Concerned Veterans for America and former adviser to VA secretaries Dr. David Shulkin and Robert Wilkie under President Donald Trump, called the proposal a "Trojan Horse."

"The VA says it's not changing access standards... but is instead proposing to incorporate telehealth into availability determinations. VA rejected this in 2019 because it can be used to game the system as a way to gut access standards and reduce community care eligibility," Selnick said during the hearing.

The VA would need to propose a rule to alter the eligibility criteria. The public, including Veterans and Veteran service organizations, would have an opportunity to weigh in once the proposal is published.

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Despite years of significant budget increases, the Department of Veterans Affairs will need billions in additional funding in fiscal 2023 to keep pace with the health care and support services needs of Veterans and their families, according to a new report released by advocacy groups today.

The Independent Budget — an advisory spending plan compiled by Disabled American Veterans, Paralyzed Veterans of America and the Veterans of Foreign Wars — calls for a 23 percent increase in VA program spending over the latest White House request in order to boost money for priorities like mental health services, caregiver support, and homeless Veterans assistance.

The figure is likely to draw concerns from lawmakers who have grumbled about the ever-rising VA budget in recent funding cycles.

In fiscal 2001, the entire VA budget totaled about $45 billion. By fiscal 2011, it was about $125 billion, almost triple that total. Ten years later, in 2021, the department’s budget was nearly double that again, at $245 billion.

The White House budget request for fiscal 2022 — which began last October — sits at $270 billion. Lawmakers have not yet approved a full-year budget for the department, but are expected to advance discussion on that issue in coming weeks.

The administration’s fiscal 2023 budget plan for VA is expected to be released sometime next month.

Authors of the Independent Budget said their calls for even more VA money next year aren’t wishful thinking but a real assessment of the challenges ahead for the department.

“As we enter into 2022, COVID’s impact remains a challenge for VA, with the spread of the virus and disruptions to health care systems continuing,” said Randy Reese, executive director of DAV’s Washington Headquarters.

“In this environment, we made cautious recommendations based on historical trends to ensure the needs of our nation’s ill and injured Veterans are met.”

Under the Independent Budget plan, VA officials would see a $1.8 billion boost to health programs to “close the gap in clinical care” at department medical centers.

“The lack of adequate health care staffing has been a major driver of longer waiting times for Veterans seeking VA care, and ultimately has the effect of suppressing the true level of Veterans’ demand for care,” the report states. “It also forces many Veterans who would prefer to receive their care from VA providers into community care providers.”

The groups also want to add $490 million above the pending White House request for caregiver support programs, $395 million more for homeless Veterans’ programs, and $288 million more for mental health services and suicide prevention efforts.

The advisory budget also calls for an extra $3.8 billion for major and minor construction programs — an issue that the groups have been pushing for years, but one that has largely gone unanswered in White House budget plans.

The Independent Budget focuses only on discretionary spending, and not mandated increases in benefits that federal planners must account for in their own fiscal plans.

As such, the document isn’t an exact blueprint of what the final VA budget proposal would look like, but it does serve as an important point of discussion for lawmakers as they enter their annual budget debates.

The authors noted their proposal is a snapshot of future VA needs at this moment, but lawmakers need to be wary of the ever-changing nature of the pandemic as they conduct their budget debates.

Given the uncertainty surrounding VA’s future resource needs, Congress and the Administration must regularly review and be prepared to adjust funding levels whenever necessary to ensure VA has sufficient resources to care for our nation’s Veterans,” the report states.

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One ofAmerica’s fastest growing Veteran populations

Dallas-Fort Worth has one of the largest Veteran populations in the country, and demand for medical care at the VA North Texas Health Care System has grown for 10 years straight.

The Dallas VA Medical Center cut the ribbon on its newest in-patient unit with 13 private beds December 18. In the photo above, cutting the ribbon are, from left, April Gould, nurse manager for 6C400; Kendrick Brown, associate director; Dr. Gwen Robinson, chief nursing executive; Yolonda Patrick, chief nurse for acute care; and Dr. Jeff Hastings, chief of staff.

The new unit features private rooms with private bathrooms and greater capabilities for infectious disease and special needs patients. It also is telemetry capable, which means it’s capable of hosting patients who are in critical condition and need constant care.

“This is the second inpatient unit in our health care system to have all private rooms,” said Patrick. “More importantly, it adds 13 beds for use by our growing patient population.”

In with the new

The Dallas VA Medical Center campus features 279 inpatient bed spaces. Up to 200 eligible Veterans wait in community hospitals daily for open bed space there. Inpatient space also is at a premium in the surrounding Dallas-Fort Worth area.

“This new unit was greatly needed. Our demand for bed space surpasses our capacity on a daily basis,” said Jeff Allen. Allen is a registered nurse and a VA North Texas clinical program manager. A renovation is planned to convert another unit with dual occupant rooms into private rooms.

In 2018, the VA North Texas Health Care System provided over 69,000 bed days of care and 1.5 million individual episodes of care.

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Amid the threat of coronavirus, the Department of Veterans Affairs said it would stop visitations and new admissions at its 134 nursing homes to protect two of its most susceptible patient populations: nursing home residents and spinal-cord injury patients.

“While the COVID-19 risk to average Americans remains low, these commonsense measures will help protect some of our most vulnerable patients,” said VA Secretary Robert Wilkie in a statement. “VA will make every effort to minimize the impact of these policies on Veterans while putting patient safety first.”

The only exceptions are special cases such as when Veterans are in their last stages of life in hospice.

The nursing homes are home to more than 41,000 Veterans across the country.

The virus has infected more than 700 people in the U.S. and killed at least 27, with one state after another recording its first infections in quick succession. New Jersey reported its first coronavirus death Tuesday. Worldwide, nearly 120,000 have been infected and over 4,200 have died.

For most people, the virus causes only mild or moderate symptoms such as fever and cough. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia. Most people recover in a matter of weeks, as has happened with three-quarters of those infected in mainland China.

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RICHMOND, Va. (WRIC) — Thousands of Veterans and their families are in danger of losing their homes due to the COVID-19 pandemic. A new government-wide effort could help them keep a roof over their heads.

The U.S. Department of Veterans Affairs is offering two mortgage relief programs to help those impacted by the pandemic stay in their homes.

Jeffrey London, Executive Director of the Veterans Affairs Home Loan Program, said, “VA wanted to take additional measures to make sure no Veteran slips through the cracks.”

Under the new COVID-19 Refund Modification, Veterans could see a significant reduction in their monthly mortgage payments.

London said, “VA will actually work with the mortgage servicer to target a 20% reduction in their mortgage payment.”

This program is only available until Sept. 30, 2021.

Another option is the VA Partial Claim Payment Program. In this case, the VA will pay your overdue mortgage payments and create a second mortgage on the property interest-free.

“That takes that financial burden off their backs if they’re ready to start making their mortgage payments again,” London said.

For both programs, you don’t have to pay the VA back until you either refinance or sell the loan. This program will remain in effect until Oct. 28, 2022.

Applicants must meet the following eligibility requirements:

• Must currently live in the property
• Be less than 30 days overdue on any mortgage payment as of March 1, 2020.
• Enter into a forbearance agreement with the lender
• Must have faced a COVID-related financial hardship

To apply you can contact your lender or call 877-827-3702. You can learn more on the VA’s Housing Assistance Section on its website.

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VA this month announced its commitment to extend debt relief to Veterans adversely impacted by COVID-19 to the end of 2020 by suspending certain debt collection actions.

The department recognizes Veterans and beneficiaries are still being greatly impacted by the coronavirus prompting the extension of financial relief.

“Veterans and their families should be focused on their health and safety during the pandemic,” said VA Secretary Robert Wilkie. “VA is taking action to give those with pending debts greater flexibility during these challenging times.”

VA is suspending all actions on Veteran debts under the jurisdiction of the U.S. Treasury Department. This includes the suspension of collection action or extending repayment terms on preexisting VA debts, whichever the Veteran prefers.

For benefit debts, Veterans should contact the VA Debt Management Center at 1-800-827-0648.

For health care debts, Veterans should contact the Health Resource Center at 1-866-400-1238 or https://www.pay.gov for payments.

More information

Ordinarily, Veterans, members of the Armed Forces and family members who incur debts as a result of their participation in most VA compensation, pension and education programs as well as home loans closed before January 1, 1990, would receive letters from the Debt Management Center notifying them of their rights as well as their obligation to reimburse VA.

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Firearms play a significant role in many Veterans’ lives, with nearly 50% of Veterans owning firearms. VA respects the importance of firearms for these Veterans and is dedicated to helping them learn about safe storage options.

Safe storage is an important part of VA’s comprehensive suicide prevention strategy. Research has shown that many suicidal crises are brief, so putting space between someone experiencing a crisis and a firearm — or other potentially lethal means, like prescription medication — can provide enough time for the crisis to pass before a tragedy occurs. In addition, safe storage can help protect a Veteran’s loved ones — including children and grandchildren — from accidents.

New resources to help Veterans understand lethal means safety

VA’s Office of Mental Health and Suicide Prevention recently released two resources to help Veterans and their loved ones understand the potentially lifesaving benefits of safely storing firearms and other potentially dangerous household items.

1. The Reducing Firearm & Other Household Safety Risks for Veterans and Their Families brochure provides best practices for safely storing firearms and medications, along with advice for Veterans’ loved ones on how to talk to Veterans about safe storage.
2. The Means Safety Messaging for Clinical Staff pocket card provides medical professionals with easily digestible information for talking with Veteran patients about safe storage. Clinicians looking for more information on speaking to Veteran patients can read the From Science to Practice review on how lethal means safety saves lives.

These resources are designed to help Veterans, their loved ones, and the supporting clinicians find the safe storage option that aligns with the Veteran’s values and priorities.

Safe and affordable solutions

VA’s partner organization, the National Shooting Sports Foundation, recommends several effective ways to safely secure firearms, including:

• Cable locks
• A lockbox
• A gun safe

The following are safe storage recommendations to help Veterans prevent intentional or unintentional overdose:

Have a family member or friend help manage your medication dosages.

Ask your doctor or pharmacist to limit the number of refills or the amount of medication prescribed.

Use a daily pill box to set aside pills for a week, and then lock the rest away.

Staying safe

While Veterans who may be at risk for suicide can take these steps themselves, we all have a role to play in empowering Veterans to stay safe. If you are concerned about a Veteran in your life, ask them directly whether they are thinking about suicide, encourage them to seek care, and start the conversation about safe firearm and medication storage.

If you or someone you know is having thoughts of suicide, contact the Veterans Crisis Line to receive free, confidential support and crisis intervention available 24 hours a day, 7 days a week, 365 days a year. Call 1-800-273-8255 and Press 1, text to 838255, or chat online at VeteransCrisisLine.net/Chat.

Reporters covering this issue can download VA’s Safe Messaging Best Practices fact sheet or visit www.ReportingOnSuicide.org for important guidance on how to communicate about suicide.

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VA opens residential gambling addiction center in Las Vegas

VA’s Southern Nevada Healthcare System is proud to announce the grand opening of the Las Vegas VA Residential Recovery and Renewal Center (LVR3). It’s only the second residential gambling addiction recovery center in the nation.

Pictured above: Medical Center Director William Carron (left), Dr. Roxanne Untal and Tim Jobin, Chief of Behavioral Health, cut the ribbon to mark the opening of the center.

LVR3 is a 30- to 45-day substance use and gambling residential treatment program. It is a 20-bed facility, with a separate wing with five rooms for female Veterans. The center provides research-based, high quality interventions to help residents:

• Help learn about addiction and triggers and developing a sustainable relapse-prevention plan.
• Develop individualized and person-centered recovery plans.
• Provide a whole health approach to help improve emotional, physical and mental health.
• Assist residents choose, access and use community and social supports.

VA’s first residential program in Southern Nevada

This is the VA’s first residential program in Southern Nevada. As a result, “there is definitely a great need for this here in Las Vegas,” said LVR3 Program Manager Roxanne Untal.

“Gambling and substance abuse already exist here. It’s important that we are responsive to that when problems arise for our Veterans. The biggest goal is to provide residential care for Veterans when more intensive care is needed than what they would receive in outpatient treatment.”

“This facility fills a gap in our mental health continuum of care,” said Tim Jobin, chief of Behavioral Health. “The staff has dedicated countless hours of planning, mindfulness and reviews to make this happen here today. This is a great day for Veterans.”

Treatment at LVR3 includes daily activities. Recreational therapists provide instruction in exercises like archery, horseback riding and yoga.

LVR3 also provides a staff attendant who is available 24/7.

Veterans interested in a referral for the LVR3 can talk to their primary care provider or can take advantage of the same-day mental health service.

“One of the biggest services we offer is the same-day walk-in service for mental health care,” said Dr. Untal.

“Even if you aren’t an enrolled Veteran yet, if this is something you need to address, come on in. Any licensed provider can put in a consult, and we are doing quick turn-arounds for screening them for admission.”

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WASHINGTON — The Department of Veterans Affairs voiced its opposition Thursday to legislation that would require the department to provide dental treatment for all Veterans enrolled in VA health care.

The bill, introduced by Rep. Julia Brownley, D-Calif., aims to phase in dental care at the VA within four years. Now, the department provides dental treatment only to Veterans whose dental issues are related to their military service. Brownley said that is equal to about one in 17 VA enrollees being eligible for dental care.

“Current law restricts the VA’s ability to provide dental care to most Veterans,” Brownley said. “The cost of private-sector dental care is often too expensive, leaving too many Veterans without dental care at all.”

The House Committee on Veterans’ Affairs considered the bill during a hearing Thursday. The VA was strongly opposed.

“We don’t have the resources from a capacity perspective, and we don’t have the resources from a funding perspective,” said Maria Llorente, an assistant deputy undersecretary of the VA.

About 9.3 million Veterans are enrolled in VA health care. Of those, 1.35 million are eligible for dental care through the department. The legislation would increase the number of eligible Veterans by more than 670%, Llorente said, and “create a significant spike in the need for resources to meet the increased demand.”

If Congress approves the bill, Llorente estimated the cost of expanding dental care would be about $7 billion the first year after the legislation is enacted. The measure would increase costs by more than $150 billion for 10 years.

In response, Brownley cited a 2019 report, in which the VA said “poor oral health can have a significant negative effect on overall health.” She argued providing dental care for Veterans would lead to better health outcomes and lower costs in the long term.

In a statement after the hearing, Brownley called the VA’s opposition “baffling and disappointing.”

“When we send our young men and women to war, we rarely ask how we are going to pay for it, so it is frustrating to me that when they come home, we constantly hear the refrain that Veterans’ health care costs too much,” she said.

It was unclear Thursday when the committee would vote on the legislation. If passed by the committee, the bill would be sent to the House floor for consideration.

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Veterans Affairs officials are overhauling their application process for caregiver benefits while simultaneously fighting a court ruling that would force them to allow a legal review for individuals rejected for the program.

The move follows an order last month from a panel of U.S. Court of Appeals for Veterans Claims judges, which ruled that families rejected by the Program of Comprehensive Assistance for Family Caregivers should have an opportunity to appeal those decisions to the Board of Veterans’ Appeals, which handles other VA benefits disputes.

But VA officials have opposed that idea, arguing instead that keeping program decisions within the clinical side of department operations will produce better health care options for Veterans and less complexity for families.

“We believe that participation in this program is part of a Veteran’s overall medical care plan,” said Meg Kabat, senior advisor on families, caregivers and survivors at VA. “These clinical and medical decisions being thrown into the litigation process is not what is best for Veterans.”

On Monday, VA asked the full Veterans claims court to revisit the April decision. At the center of the case are concerns over how applications to the caregiver program are handled. For Veterans who need significant home care from a spouse or family member, the program awards up to $2,300 a month in stipends and access to additional support services.

About 25,000 Veterans are participating in the program today, and another 27,000 applications are pending. Currently, leaders from individual VA medical centers review applications and make decisions on who receives the benefit.

That has led to complaints about inconsistency and a lack of transparency with the application process from a number of Veterans advocates, and formed much of the basis of the recent lawsuit.

Kabat said those applications will now go to clinical teams at each of the department’s 18 Veterans Integrated Service Networks. More than 200 new medical professionals are being hired for the work.

Veterans who are rejected for the program by the new review panels will be able to appeal to a different VISN twice if they believe the decision was made in error. VA officials said the new process will allow families and outside advocates to better understand the reasons for the decisions, and ensure that similar applications across the country are handled in a similar way.

But the new process will likely do little for families rejected in the past who could be in line for a substantial financial payout under the appeals court’s April order.

In that case, Jeremy Beaudette, a Marine Corps Veteran who left legally blind and suffering from traumatic brain injury after multiple combat tours in Iraq and Afghanistan, was rated as 100 percent disabled by VA officials because of his wounds.

But when his wife, Maya, applied for benefits through VA’s caregiver program she was rejected. Multiple appeals to department officials were also denied.

Thanks to their court victory, the couple can appeal the decision to the Board of Veterans’ Appeals, which could award back benefits as well as new eligibility for the caregiver program.

Nothing in the new application process unveiled by VA Monday would award back pay to Veterans previously rejected for the program. In a statement, Amanda Pertusati, supervising staff attorney at Public Counsel (which brought the lawsuit against the department), said officials are still reviewing the changes.

“We look forward to implementing the courts order to ensure that all caregiver program claimants have the ability to seek appellate review, as well as to obtain the benefits that they are entitled to,” she said. “It is unfortunate that the parties and the court will now have to be distracted by VA’s attacks on the court’s decision, rather than focusing all efforts to implement it.”

The court ordered VA to develop an implementation plan for the retroactive appeals by June 3. VA officials said they will follow that order, even as they fight the lawsuit.

Meanwhile, outside advocates say they are watching both the legal fight and program reforms closely.

“We commend VA for its commitment to comply with the lower court’s decision and we strongly encourage them to continue collaborating closely with the [Veterans] community on communications, planning, and strategy moving forward,” said Steve Schwab, CEO of the Elizabeth Dole Foundation

“We await the full court review of this case, but EDF is committed to working with the VA on a more equitable and transparent appeals process that provides all caregivers with a chance to access the benefits they have earned and deserve.”

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The U.S. Department of Veterans Affairs (VA) announced today it is partnering with OnStar’s emergency services to improve access to suicide prevention resources for Veterans.

This partnership will offer Veterans in crisis the opportunity to be transferred to around-the-clock, confidential support via VA’s Veterans Crisis Line (VCL) when they use the emergency services button in an OnStar-equipped vehicle or OnStar Guardian smartphone app.

“The VA-OnStar partnership aims to promote suicide prevention and reduce deaths by suicide by providing additional resources to Veterans,” said VA Secretary Robert Wilkie. “This partnership will help Veterans access suicide prevention support services and assistance directly and immediately. More than 400 VA suicide prevention coordinators and their teams, located at every VA medical center, connect Veterans with care and educate the community about suicide prevention programs and resources daily.”

An average of 20 Veterans die by suicide each day. Through this partnership, VA and OnStar, a wholly owned subsidiary of General Motors, will collaborate to provide education and training to VA clinicians and OnStar call center staff to facilitate suicide prevention efforts for Veterans. Additionally, VA will provide resources and education to OnStar about military culture and how to determine if a caller is a Veteran.

“OnStar services are designed to help our customers go out into the world feeling safer, and we recognize that for many people, and in particular Veterans, a crisis can start from within,” said Catherine Bishop, senior global emergency services manager for OnStar. “This partnership with VA allows our emergency-certified advisors to better serve the heroes who have served us.”

Suicide prevention is a top priority and VA has made great strides in Veteran suicide prevention, especially in crisis intervention. Partnerships such as this are coordinated by the Veterans Health Administration’s Office of Community Engagement.

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The U.S. Department of Veterans Affairs (VA) partnered with Verizon, Medivis and Microsoft, effective Feb. 12, as part of its efforts to deliver Veterans VA’s first advanced, 5G-enabled, clinical care system at the VA Palo Alto Health Care System.

The public-private partnership, Project Convergence, will be led by VA’s National Center for Collaborative Health Care Innovation and work to help identify potential clinical uses for technology that combine emerging health care innovations with 5G capabilities.

“Last year, President Trump challenged America to be among the first to provide 5G wireless services, and VA met that challenge,” said VA Secretary Robert Wilkie. “Our hospital in Palo Alto, California is currently one of only a handful of 5G enabled health facilities in the world. We’re excited to use this hands-on opportunity to work with our partners to develop foundational practices and deploy advanced medical solutions to serve our nation’s Veterans.”

Project Convergence will unveil and demonstrate initial clinical uses of the combined technology at the upcoming Health Information and Management Systems Society conference in Orlando, Florida, March 9-13.

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HOPE MILLS, N.C. (WTVD) -- We continue to fight for Veterans waiting for years to get answers when it comes to their pending claims with the Veterans Administration.

Rosie Milligan said she and her 75-year-old husband Willie Milligan got frustrated waiting for their disability claim to work its way through the VA system.

Rosie said she needs help taking care of her husband as his health continues to decline. "It was so frustrating to me because I'm looking at him, and his health is going down, down and down."

Willie Milligan, a Vietnam Veteran, is deemed 100 percent disabled through the Veteran's Administration. After several heart attacks and other medical issues, the Milligans said they applied for Aid and Attendance, which would help pay for care for Willie. It took some time and appeals, but the VA eventually granted that coverage in 2018. But even though the aid was approved, no money came to the Milligans.

"He would say things like I won't live to see it, and I was like don't say that," Rosie Milligan said.

With no answers from the VA, the Milligan's turned to Troubleshooter Diane Wilson, and she got in touch with the Veteran's Administration. Rosie said soon after getting in touch with ABC11, a representative from the VA reached out to them, and Willie's claim for Aid and Attendance was finally addressed.

It didn't take long for the Milligans to get the more than $40,000 that the VA owed to them in back pay for their claims. Rosie Milligan said, "There was a lot of relief, there was a lot of relief. We thank you."

When asked why it took so long for Willie Milligan to get his benefits, a representative for the VA said, "A maze of previous federal laws made VA's claim appeals process complex, inefficient and difficult to navigate for Veterans. That's why VA worked with Congress and Veterans Service Organizations on the Veterans Appeals Improvement and Modernization Act of 2017, which overhauls and modernizes our claims appeals process and thereby provides better, faster decisions for Veterans."

If you are a Veteran and need help, NC Serves has a list of Veteran services, including Veterans Service Organizations (VSOs) in the Central NC area. VSOs can assist Veterans filing claims and appeals with the Veterans Benefits Administration. Most organizations are listed by county for closer accessibility for Veterans.

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The U.S. Department of Veterans Affairs (VA) announced today plans to gradually and safely reintroduce volunteers to its health care facilities.

While volunteers are important to the operation of VA services and programs, most volunteer activities have been paused to prevent the spread of the virus that causes COVID-19.

“Just as our facilities are gradually reinstating services, volunteers are slowly reintegrating into them,” said VA Secretary Robert Wilkie. “Volunteers are an integral part of our health care teams, offering fundamental services. We look forward to their return.”

Some volunteer roles will be new, while others will stay the same, be modified, go virtual or remain paused as a precaution to prevent the spread of COVID-19. Individual VA facilities will tailor the reintegration of volunteers based on the facilities’ operational needs and the volunteers’ abilities.

Volunteers can expect the following safety measures:

• Phased reentry: Volunteers are being asked to return to duty on an as-needed basis while maintaining physical distancing. VA asks that volunteers do not return to the facility unless they have been approved to do so.
• Retraining: Volunteers must complete an orientation and training on VA’s policies and procedures. This includes the proper use of personal protective equipment including face coverings.
• Health screenings: Volunteers, like staff and patients, must consent to being screened for COVID-19 exposure and symptoms prior to entering facilities.

These actions are being taken to protect the health, safety and wellbeing of Veterans, staff and volunteers.

Visit VA Voluntary Service for more information.

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Veterans Affairs Department officials testified they’re continuing with plans to roll out their new electronic health record system in early 2020.

The Veterans Affairs Department continues to move forward with its plan to debut a new electronic health records platform, developed by Cerner, in March despite some concerns from lawmakers.

VA is in the process of adding full-time equivalent employees to properly staff up for the much-anticipated rollout, scheduled for March 28 at the Mann-Grandstaff VA Medical Center in Spokane, Washington.

“The augmentation plan is under execution now,” said Dr. Robert Fischer, director of Mann-Grandstaff VA Medical Center, during a hearing held by the House Veterans Affairs subcommittee on Technology Modernization.

Fischer said the medical center had hired “about 50%” of the 108 full-time equivalents necessary and is “continuing to recruit” leading up to the launch. The launch itself will be an initial rollout of some Cerner capabilities, not its final product. Nonetheless, as they have repeatedly done, lawmakers voiced concern over a lack of governance structure between VA and the Defense Department, which is also rolling out a Leidos and Cerner-built electronic health records system. The systems are designed to be interoperable, meaning health records from active-duty service members will be available to VA clinicians once they transition to life as Veterans.

Rep. Jim Banks, R-Ind., the subcommittee’s ranking member, warned VA officials to “seriously consider taking additional time” if issues arise in the coming months. Chairwoman Susie Lee, D-NV, asked several VA officials whether they would express concerns to leadership—should concerns arise—in the mounting pressure to launch on time. Each, including VA Deputy Secretary James Byrne—the highest-ranking VA official at the hearing—answered in the affirmative.

“I’ve not had that specific discussion with the Secretary about it, it has not ripened yet,” Byrne said. “It’ll be one of the two of us making the final decision and we’re both accountable in the end.”

John Windom, executive director of VA’s Office of Electronic Health Records Modernization, said officials from VA’s headquarters, medical centers and technical staff are in regular communication. Whether the decision is to proceed with rollout or delay, Windom said it “won’t be a decision that surprises any of us.”

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Updated once on VA.gov, updated everywhere

VA is empowering Veterans to manage their information through a simplified, personalized experience on VA.gov, called VA Profile. Once signed into the VA.gov website, Veterans can view, update and change their contact information, such as phone number, email, home and mailing address.

VA Profile updates VA databases across the network, which removes the burden from Veterans calling multiple VA administrations with the same information, at times impacting delivery of services.

VA Profile improves VA systems by synchronizing and sharing Veteran data across the VA enterprise, giving VA customers control, visibility and ownership of their information. In turn, employees have the up-to-date information they need to personalize interactions and provide excellent customer service.

More than 7.5 million Veteran contact information profiles have been created or updated since May 2018, and more than 700,000 of those updates were made online through VA.gov.

When VA has the most up to date information, it updates near-real-time access to critical Veteran data systems to support healthcare activities, including prescription refills, appointment reminders, lab and test results, and other important communications from their VA medical center.

It also actively synchronizes VBA contact information for disability compensation, pension, claims and appeals, enrollment, and Veteran Readiness and Employment (VR&E).

VA Profile reaches out to Veterans in multiple ways

VA Profile is part of a Veteran’s journey from the very early stages of their interaction with VA. VA Profile helps establish profile information for transitioning service members so that VA is ready to serve them from day one of their new Veteran life. In partnership with the DoD, VA launched the VA Solid Start program where military and contact information is used to proactively assist Veterans to receive VA benefits and services around 90, 180 and 365 days post-separation.

VA Profile information also helps serve Veterans and Non-Veterans during times of emergencies. At the beginning of COVID-19 pandemic, VA sent out a total of over 36 million text messages to more than 9 million Veterans with timely information and resources about VA’s services and support.

VA Profile has made wider outreach possible for research opportunities, too. For example, it enabled VA to quickly contact more than 300,000 women Veterans to gather information on topics most meaningful to them.  

What information is synchronized?

VA Profile provides a single source of truth for Veteran data across all VA systems. It synchronizes name, phone/email, address, military personnel data, awards, disability ratings, health benefits and other demographic information. VA Profile began sharing contact, health plans, and benefits information to assist community partners through the health information exchange, contributed to the new Electronic Health Record system and centralized scheduling solution.

Providers and Veterans can communicate securely about mental health assessments through the MyHealth Checkup Mobile app that leverages VA Profile phone numbers and emails.

VA Profile innovations efforts are planned to collect insurance, loans and education data, interaction history, communication preferences, information about persons associated with the Veteran (non–Veterans), such as spouse, dependents, beneficiaries, power of attorney, fiduciary, caregivers, Veteran service organizations, and crisis indicators (pandemic, natural disaster, homelessness) for outreach, determination of benefits eligibility, and other services.

Improving Veterans Experience

VA Profile is the ‘behind the scenes wiring’ connecting systems and serving data to improve Veteran experiences. Veterans will be able to choose how they would like VA to communicate with them. VA profile is committed to providing valuable benefits and service to our Veterans by reducing address errors and increasing data quality, which improves timely and accurate delivery of important information to Veterans, their families, caregivers and their survivors.

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The U.S. Department of Veterans Affairs (VA) announced today at least 25,000 more Veterans are now receiving monetary benefits through federally-insured banks and credit unions —  mitigating their risk of fraud occurrence.

Prior to the inception of the Veterans Benefits Banking Program (VBBP), established in December 2019, Veterans who did not have bank accounts were only able to receive monetary benefits through pre-paid debit cards or paper checks.

“At any given time, there are approximately 250,000 Veterans who do not have bank accounts, and as a result of the Veterans Benefits Administration working diligently to contact Veterans directly by mail and telephone calls to explain the benefits of switching to direct deposit, we are reducing this number,” said VA Secretary Robert Wilkie. “This is important because Veterans who don’t have an account with direct deposit are at risk for theft, fraud, or high fees when accessing their benefits.”

VA partnered with the Association of Military Banks of America and worked with the Defense Credit Union Council to leverage their consortium of military-friendly financial institutions that cater to service members to enhance the financial services available to VA beneficiaries.

VA will continue to reach out to Veterans without bank accounts or those with limited access to banking services, to let them know — they now have options.

Learn more about switching to direct deposit or benefits of the VBBP.

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The U.S. Department of Veterans Affairs (VA) announced today implementation of a new information technology (IT) system marking the official launch of the first phase of expansion of the Program of Comprehensive Assistance for Family Caregivers (PCAFC) to caregivers of eligible Veterans of earlier eras.

The Caregiver Records Management Application (CARMA) automates manual processes and integrates with other VA systems, resulting in increased efficiencies and effectiveness for VA staff.

The expansion rolls out in two phases. Effective Oct. 1, the first phase includes eligible Veterans who incurred or aggravated a serious injury in the line of duty on or before May 7, 1975. Effective Oct. 1, 2022, the second phase will include eligible Veterans who incurred or aggravated a serious injury in the line of duty between May 7, 1975 and Sept. 11, 2001.

Through CARMA, with a click of a button, an electronic health record will be created for a family caregiver where Caregiver Support Coordinators will document their clinical interactions. CARMA will also help guide consistency by systematically adjusting VA’s stipend payment calculations, as appropriate, and alerting VA users when annual reassessments of PCAFC participants are due, among other key functionalities. In addition, this program expansion also includes a new digital version of the application which allows individuals to apply for the PCAFC online.

“Caregivers provide stability and security to our most vulnerable Veterans, allowing them to stay in their homes with their loved ones for as long as possible,” said VA Secretary Robert Wilkie. “Today begins the first phase of expansion of the Program of Comprehensive Assistance for Family Caregivers. Through this expansion, VA is able to give more family caregivers access to essential resources so we can support them as they care for Veterans of earlier eras.”

Since publishing the final regulation July 31, to improve and expand PCAFC — VA also expedited hiring key staff who bring the clinical qualifications and organizational skill sets to ensure consistent eligibility decision making across the enterprise, support program needs and provide strong infrastructure for consistent and standardized application processing and adjudication.

This past year, the Caregiver Support Program expanded to approximately 1,100 staff and will grow to approximately 1,800 staff within the next six months. These changes ensure Veterans and caregivers receive timely, accurate assessments and eligibility determinations, as well as an improved customer experience.

Previously, only available for eligible Veterans who incurred or aggravated a serious injury in the line of duty on or after Sept. 11, 2001, PCAFC provides education, support, a monthly stipend, health care coverage and certain beneficiary travel to qualifying family caregivers of eligible Veterans.

VA’s Caregiver Support Program offers a wide variety of support services for caregivers of Veterans. Partnerships continue to be created or enhanced to broaden services and supports for caregivers. Learn more by visiting the Caregiver Support Program website or by calling the Caregiver Support Line at 855-260-3274 for more information.

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Self-stigma can be a major barrier to seeking mental health support

Military culture often focuses on the needs of the larger group over the individual. That culture can encourage service members to push forward even when they are suffering. When these cultural norms persist after a service member transitions from the military, they can be detrimental — and in some cases extremely harmful — to a Veteran’s mental health and wellness.

Add to this cultural pressure the stigma that many Veterans already associate with mental health conditions, and it becomes quickly apparent why seeking help can be extremely challenging for many of the Veterans who need it most.

The two most common types of stigma stem from external stereotypes and internal perceptions. Societal stigma involves prejudice and discrimination directed at a specific group by the larger population. For example, society often stigmatizes those with specific mental health conditions, such as depression and PTSD. Self-stigma occurs when people come to believe that negative stereotypes are true for themselves because they have a stigmatized condition.

When Veterans associate their mental health challenges with weakness, failure, or other negative and false stereotypes, this self-stigma can be a debilitating barrier to self-esteem and help-seeking. That’s why mental health staff members at VA are focusing on helping Veterans avoid and address self-stigma as an integral part of the mental health treatment process.

Addressing self-stigma among Veterans

Researchers at the VISN 5 MIRECC developed the Ending Self Stigma program, or ESS. This program helps people with mental health conditions mitigate the effects of both societal stigma and self-stigma through personalized strategies that embody cognitive behavioral therapy, recovery principles, and other coping techniques. The ESS program consists of nine sessions and is offered in groups of 6-8 Veterans led by 1-2 facilitators. Each session incorporates cognitive and skill-building techniques, strategy practice, and interactive discussions. Participants share their experiences, personalize the strategies, and learn from one another.

Lessons learned about reducing self-stigma

In developing the ESS program, and through research on its effectiveness and overall impact, the VISN 5 team has found the following tactics effective for Veterans dealing with self-stigma:

• Remind yourself consciously and repeatedly that stigmatizing messages and assumptions are not true.
• Grow positive aspects of your self-concept by identifying your values, strengths, and roles.
• Lessen your exposure to stigmatizing messages and experiences to reduce the risk of internalizing them.
• Delegitimize stigmatizing messages as untrue, ignorant, and harmful.

Get involved

The Ending Self Stigma manual provides a wealth of information, including the full curriculum and accompanying tips and worksheets. Ask your mental health point of contact if ESS is available at your location. VA staff members can download the free manual to start offering it at any VA facility.

The ESS team has created additional resources for specific audiences:

• ESS for PTSD, a program for Veterans, has been tailored to address specific elements of stigma related to trauma and PTSD. To learn more visit https://www.mirecc.va.gov/visn5/ and scroll to the bottom of this front page to find information on ESS and other stigma resources.
• Fighting Internalized Stigma’s Impact on Families and Consumers, a workshop for family members of Veterans with serious mental illness. This workshop offers information and strategies for addressing mental health stigma. To learn more, visit https://www.mirecc.va.gov/visn5/ and scroll to the bottom of this front page to find information on ESS and other stigma resources.
• EASE-ing Self-Stigma is a workshop to help mental health staff members serve as anti-stigma allies. Full directions and materials for conducting the workshop at your location are available online at www.mirecc.va.gov/visn5, along with a link to a recorded webinar in TMS. To learn more, visit https://www.mirecc.va.gov/visn5/ and scroll to the bottom of this front page to find information on ESS and other stigma resources.

To watch videos about how Veterans and their loved ones have created healthy environments to overcome self-stigma, visit MakeTheConnection.net.

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The U.S. Department of Veterans Affairs (VA) today published its final regulation to improve and expand the VA Program of Comprehensive Assistance for Family Caregivers (PCAFC) with the final regulation going into effect on Oct. 1.

Under the final regulation, PCAFC will include eligible Veterans that have a single or combined service-connected disability rating by VA of 70% or higher, regardless of whether it resulted from an injury, illness or disease.

This is a notable change to the definition of serious injury from the current regulations, among other improvements aimed at standardizing the PCAFC and improving transparency in the program.

Expansion of VA’s PCAFC to eligible Veterans of earlier eras will occur in two phases. The first phase will begin October 2020 and will include eligible Veterans who incurred or aggravated a serious injury in the line of duty in the active, military, naval or air service on or before May 7, 1975. Phase two will go into effect two years later and include eligible Veterans of all eras.

“The expanded regulation addresses the complexity and expense of keeping Veterans at home with their families who provide personalized care,” said VA Secretary Robert Wilkie. “This will allow our most vulnerable Veterans to stay with their loved ones for as long as possible. Expanding the program and eligibility for the Program of Comprehensive Assistance for Family Caregivers ensures we can continue to meet the changing needs of America’s Veterans and their caregivers.”

Additionally, the new regulation will change the PCAFC stipend payment methodology, define new procedures for revocation and discharge, and include certain advance notice requirements aimed at improving communication between VA and PCAFC participants as well as include information for current program participants. VA is also standardizing operating procedures for the Caregiver Support Program, providing new training for staff and caregivers, and boosting operational capacity by hiring additional staff. With this expansion, Primary Family Caregivers in PCAFC will also have access to financial planning and legal services. VA is also working to fully implement the new information technology system required by the VA MISSION Act of 2018 by October 2020.

VA’s Caregiver Support Program offers support services for caregivers including training, peer mentoring, respite care, a telephone support line, and self-care courses for caregivers of covered Veterans enrolled in VA health care who need personal care services.

Caregivers can visit VA Caregiver support website or call the Caregiver Support Line at 855-260-3274 for questions.

The final regulation can be found here. If necessary, search for RIN 2900-AQ48, Program of Comprehensive Assistance for Family Caregivers Improvements and Amendments under the VA MISSION Act of 2018.

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The U.S. Department of Veterans Affairs (VA) will publish a proposed rule in the Federal Register March 6 that would improve and standardize VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC) and ensure the program regulations reflect changes required by the VA MISSION Act of 2018.

A component of the Caregiver Support Program, the PCAFC was established in 2011 to provide additional benefits including a monthly stipend for qualifying family caregivers of eligible Veterans who were seriously injured in the line of duty on or after Sept. 11, 2001.

In the proposed rule, VA seeks to standardize eligibility by expanding the definition of serious injury to include any service-connected disability — regardless of whether it resulted from an injury, illness or disease — defining what it means to be in need of personal care services, and ensuring that the eligibility criteria capture the personal care service needs of Veterans and Servicemembers with cognitive or neurological impairment or mental health conditions, among other things.

Additionally, VA is proposing changes to the stipend payment methodology, definitions for financial planning and legal services and procedures for revocation and discharge, to include advance notice requirements aimed at improving communication between VA and PFAFC participants.

“We owe a tremendous debt of gratitude to caregivers who work tirelessly to provide critical support for our nation’s Veterans,” said VA Secretary Robert Wilkie. “This proposed regulation would improve the assistance we provide to help ensure our most vulnerable Veterans can stay in their homes with their loved ones for as long as possible.”

VA’s Caregiver Support Program is the first of its kind and addresses the complexity and expense of keeping loved ones out of institutions and at home with their families who provide personalized care. The program offers unparalleled support services including training, peer mentoring, respite care, a telephone support line and self-care courses for caregivers of all Veterans enrolled in VA health care who need personal care services.

The regulations are part of a broad effort to strengthen PCAFC in advance of a planned expansion under the MISSION Act which expanded eligibility for PCAFC to eligible Veterans from all eras, beginning with those who incurred or aggravated a serious injury in the line of duty on or before May 7, 1975. Two years after the first phase of program expansion, PCAFC will include eligible Veterans who were seriously injured in the line of duty between May 7, 1975 and Sept. 11, 2001. Prior to expanding, VA must fully implement an information technology (IT) system required by the MISSION Act.

In October 2019 VA launched a commercial off-the-shelf IT system and expects to complete deployment in late summer or early fall of 2020. The department also standardized operating procedures for the Caregiver Support Program, provided new training for staff and caregivers and is boosting operational capacity through hiring of additional staff. These changes are necessary as VA prepares to expand PCAFC.

Learn more about support services available for caregivers of Veterans or call the Caregiver Support Line at 1-855-260-3274.

The proposed rule will be open for public comment in the Federal Register for 60 days.

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The head of the Veterans Health Administration announced a series of major changes at an assisted-living facility days after a dying Air Force Veteran was twice found covered in ants in his bed.

Joel Marrable, who served in Vietnam, was living out his final days at the Eagles' Nest Community Living Center in the Atlanta VA Medical Center, a US Department of Veterans Affairs facility.

But in the days before his death on September 7, he was twice found with ants all over him. Photos showed scores of bites on his body, his daughter said last week.

"What happened at Eagles' Nest was unacceptable, and we want to ensure that Veterans and families know we are determined to restore their trust in the facility," Veterans Health Administration Executive in Charge Dr. Richard Stone said in a statement. "Transparency and accountability are key principles at VA, and they will guide our efforts in this regard."

Marrable's daughter, Laquana Ross, said last week she is not upset with the VA over the ants, but wanted her father's story to prompt change.

"Maybe this can move the needle and improve the process," she said. "The VA is busy. They have a lot of patients and huge needs they have to address."

Stone's statement said that the director of the regional VA network was placed on immediate administrative leave. Scott Isaacks, the Charleston, South Carolina, VA Medical Center director, will take over the position.

In addition, the regional chief medical officer has been detailed to administrative duties pending a review of the quality and safety of care, the statement said. Further, seven Atlanta VA medical center staff members were moved into non-patient care positions amid a review, and all VA personnel are being retrained in how to report urgent issues, the statement said.

In a statement to CNN, the Atlanta VA Health Care System said it "always strives to provide Veterans with the very best health care available. When we don't meet that standard, we hold ourselves accountable."

"That's why we have initiated a top-to-bottom review of this situation to ensure it never happens again. We have apologized to the Marrable family and taken immediate action to correct this issue and ensure no other Veterans will be affected in the future."

What happened

Ross said she was told by the staff last week that workers at the facility saw ants on Marrable in his bed.

She said they told her, "We thought Mr. Marrable was dead. We didn't know what had happened. Everyone jumped in and grabbed him and made sure we did whatever we could to get the ants off of him."

Marrable, 73, had a feeding tube, was weak from cancer and his ability to talk was limited. He was still alive.

Joel Marrable as a young man.

Ross said the staff said they stripped the bed and bathed her father, cleaned the room, put new sheets on the bed and put him back in the same room.

The next day he was covered in ants again -- on his stomach, feeding tube, diaper, everywhere.

Ross said she reached out to the administrator on duty and they said her father would be moved and they would check on him every 15 minutes.

An hour after being in the new room, he died.

"I felt very small in the world... when my dad died," she said. "Now I am able to share his story and my dad matters to someone beyond me and my family. Now the world knows and the world cares that this happened."

In a statement to CNN affiliate WSB, the VA said the bedrooms at the facility have been stripped, cleaned and inspected for ants. Other measures taken include the removal of open containers and food in the open being removed, staff making more room visits, daily pest control, a third-party exterminator visit and a future visit by a pest specialist from the VA.

Republican Sen. Johnny Isakson of Georgia said he had contacted the Veterans Affairs Department to "demand answers."

"I am shocked, horrified and downright maddened by the news that a Veteran under the care of the VA was treated so poorly and without any regard for his well-being," Isakson said. "This patient, at the end of his life, was clearly not being monitored closely enough, and I am so sad for his family who had to discover his insect-infested conditions before anything was reportedly done."

Ross told WSB her father has served in Vietnam in the Air Force and had cancer. She told the station she had asked the staff about bumps on her father and was told it was ants.

She told CNN her father should be remembered as a good person who loved God.

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How the VA Rates Degenerative and Rheumatoid Arthritis

Arthritis is the most common disability and affects 52.5 million adults in the United States, or one in every five. There are two main types of arthritis: degenerative arthritis and rheumatoid arthritis. For the purposes of this blog, the primary focus will be on VA disability for degenerative arthritis, which affects 27 million Americans.

Degenerative arthritis may also be referred to as osteoarthritis and is the most common form of arthritis. According to the American Academy of Orthopedic Surgeons, degenerative arthritis is the primary reason for discharge from active duty military service. Degenerative arthritis of the spine is listed as one of the most prevalent service-connected medical conditions in the 2018 VA benefits report, with 505,553 disability benefits recipients for the condition. The report then lists general degenerative arthritis and traumatic arthritis with 268,882 and 258,135 recipients, respectively.

In contrast to rheumatoid arthritis – a chronic, inflammatory, autoimmune disorder that can affect more than your joints – degenerative arthritis results from the wearing down of the protective cartilage that cushions the ends of your bones.   Degenerative arthritis leads to symptoms including pain, stiffness, limitation of motion, limitation of flexion, grating sensation or clicking with joint use (known as crepitus or crepitation), swelling, and joint instability or buckling (i.e., knee giving out). Osteoarthritis can theoretically affect any joint but typically occurs in your hands, feet, spine and hips. While it is known to result in the breakdown of cartilage, it also affects the entire joint.

As the condition worsens, the bone may harden, change shape or develop bone spurs.   Additionally, the connective tissues deteriorate and there is often inflammation of the joint lining. Some of the causes include joint injuries or repeated stress on the joint(s) from sports or job duties. For the average person, the cartilage breaks down gradually but for Veterans, the breakdown often occurs suddenly within one or two years post injury. In some cases, these conditions may lead to loss of use and incapacitating episodes. This functional loss could require surgery such as a knee replacement.

How to Prove Service Connection For Arthritis

As with all VA disability claims, proving service connection is the first important step.   Because of the nature of the condition, there doesn’t need to be a traumatic event, or injury, to prove service connection for osteoarthritis. Repetitive stress on your joints with documented symptoms can be sufficient to establish your claim since service connection for arthritis may be proven through continued symptomology. This means that the typical medical evidence of a diagnosis or nexus is not necessarily needed if you are able to show continuation of reported symptoms from service.

To establish service connection through continuity of symptomatology, the claimed disability must be considered chronic pursuant to 38 CFR 3.309(a), symptoms must be documented in service and after discharge, and there must be a connection between your post-service symptoms and your current disability.

But arthritis can also be presumptively service-connected. According to the VA regulations, if your symptoms of arthritis appear within one year of discharge from service and qualify for at least a 10% VA disability rating, the presumption of service connection applies.

Another option for service connection is to claim arthritis as a secondary disability.   In this scenario, your arthritis would have to be the result of, or secondary to, a separate disability that is currently service-connected. For example, the VA regulations provide that if you are service-connected for an amputation and subsequently develop arthritis, arthritis may be granted service connection secondary to the amputation.

VA Disability Ratings for Arthritis

Under the schedule of ratings in the VA regulations, arthritis may be rated under degenerative arthritis or rheumatoid arthritis. Several rating criteria affect the total rating decision. However, both are still rated under the musculoskeletal system conditions. Rheumatoid arthritis, as an active condition, may receive a 100% VA disability rating if you experience constitutional manifestations associated with active joint involvement and is totally incapacitating. The rating schedule then steps down to 60%, 40%, and then 20%, which involves one or two exacerbations annually with a well-established diagnosis. Rheumatoid arthritis, in terms of chronic residuals, will be rated under the appropriate diagnostic code for the joints involved. But, rheumatoid arthritis will only be rated either as an active condition or for its chronic residuals.

Osteoarthritis can manifest from mildly disabling to almost complete impairment, and will be rated by the VA accordingly once service connection is proven. The VA may schedule a compensation and pension (C&P) examination to evaluate your arthritis and assign the appropriate rating.   As with all VA disability ratings, the examiner will review your medical evidence looking for past diagnoses and symptoms. If there is insufficient documentation, the C&P examiner may order additional tests.

With any form of arthritis, your ranges of motion, and any associated pain, are important factors to be evaluated. Because limited motion is so vital to your arthritis rating, it is essential that physicians record the exact measurements for your range of motion measurements. For the most accurate measurement and associated rating, examiners often use a goniometer regarding your joint’s flexion and extension. Except for traumatic arthritis, the VA regulations state it is essential for your exam to cover all major joints.

The key is that the VA will initially look at each joint independently to decide whether there is limited motion and if there is joint pain with X-Ray of hand with joint explanation. VA Arthritis ratingsmotion. If there is limited motion in your joint, then your condition will be rated based on that joint’s limited motion. If limited motion is not present, then you will receive one overall combined rating under VA diagnostic code 5003 for degenerative arthritis. Any claimed joint conditions will be rated as degenerative arthritis if there is not a significant measurement of limited range of motion to rate under those applicable diagnostic codes. The VA does not rate a disability under limited range of motion and degenerative arthritis.

Moreover, if there is pain (without limited motion), then the VA’s painful motion principle kicks in. Under the painful motion rule, the minimum compensable rating of 10% must be assigned.   Therefore, the C&P examiner ought to test for active and passive, weightbearing and non-weightbearing, motion pain. If possible, the examiner should also test your unaffected joint for an accurate evaluation of your range of motion. Based on the painful motion regulation, you can theoretically receive a 10% rating for different joints as long as there is not overlap causing it to count twice.   Although range of motion is a big factor, the functional impairment ought to be addressed as well. Factors including frequency and severity of joint swelling, stiffness, tenderness should all be reported and discussed to achieve a full picture of the severity.

Under the VA rating schedule, there is a standard 20% disability rating if there is x-ray evidence of involvement of two or more major joints, or minor joint groups, with occasional incapacitating exacerbations. Major joints include the shoulder, wrist, elbow, hip, knee, and ankle while minor joints include toes, fingers, spine, and sacroiliac. If two or more major or minor joint groups are affected, but there are no incapacitating exacerbations, a 10% rating may be assigned.   If only one major or minor joint group is affected, you may only receive a rating higher than 0% under diagnostic code 5003 if there is also evidence of painful motion.

Additionally, while there are other forms of arthritis under the VA codes, such as pneumococcic or traumatic, these specific forms are rated within one of the two main umbrellas: degenerative or rheumatoid. If a condition is rated under degenerative arthritis, then your final rating may have a code listed prior to identify the condition itself and then list 5003 to show how it is rated (i.e., 5010-5003).

Temporary 100% Ratings For VA Disability Claims

Surgery can sometimes improve the function of the affected joints. Some Veterans will undergo a knee replacement, with hip and knee joints being the most common, to help with mobility and pain. These surgical procedures for your arthritis may open the door to other claims, higher ratings, and VA disability benefits.

One of these includes a temporary rating based on hospitalization. If you are already service-connected for arthritis and stay in a hospital for over 21 days as a result of your condition (i.e., joint replacement surgery), you may qualify for a temporary 100% total rating for the duration of your hospital admittance. Similarly, the VA may award a temporary 100% disability rating for convalescence. This involves the recovery period following a surgery related to your service-connected condition. For a convalescence claim to be awarded, the period must be at least one month, surgery has resulted in postoperative residuals like being housebound or a continuing need for crutches or wheelchair, or a major joint has been immobilized by a cast. If you need help with a service-connected claim for arthritis, feel free to give us a call or reach out!

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The U.S. Department of Veterans Affairs (VA) announced today, it has decided more than 34,000 Blue Water Navy disability claims, under the Blue Water Navy Vietnam Veterans Act of 2019, effective Jan. 1, — which extends the presumption of exposure to herbicides such as Agent Orange to Veterans who served in the offshore waters of the Republic of Vietnam during the Vietnam War.

As of Sept. 30, VA has processed 34,415 (48%) of 69,570 claims received, of which 24,328 (71%) have been granted  — awarding more than $664 million in retroactive benefits to eligible Veterans and families.

“It’s important we ensure Blue Water Navy Veterans and their families receive the benefits they’ve earned,” said VA Secretary Robert Wilkie. “As a result, VA  will continue to get the word out via our social media channels, public service announcements and Veterans Service Organizations (VSO) — to ensure every Veteran who is eligible applies as soon as possible.”

VA also collaborated with the National Archives and Records Administraton to digitize all Navy and Coast Guard deck logs for ships with known Vietnam service. Digitization of the Navy deck logs was completed in December 2019 and Coast Guard deck logs were completed in September. As part of the agreement, VA provided digital images of the deck logs to NARA to make digitally available in the National Archives Catalog. Veterans may contact This email address is being protected from spambots. You need JavaScript enabled to view it. if the deck log they are seeking is not available in the National Archives Catalog.

If you your claim was denied,  click here on how to appeal a VA claim decision.

For assistance in filling a claim, Veterans may contact approved VSOs.

Learn more about Agent Orange exposure and VA disability compensation or all 800-827-1000 for more information.

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Leaders of two U.S. Department of Veterans Affairs (VA) initiatives have been named winners of the 2020 Samuel J. Heyman Service to America Medals (Sammies) for improving health care access for Veterans and advancing 3D printing applications for Veteran care.

Neil Evans, M.D., Kevin Galpin, M.D. and Kathleen Frisbee, Ph.D. enhanced access to health care for Veterans through VA Connected Care services including telehealth, mobile apps and other digital health solutions — while Beth Ripley, M.D., Ph.D. has contributed to science and medical innovation through VA’s 3D Printing Network assisting health care providers with medical procedures and decreasing unnecessary surgeries.

“Telehealth and 3D printing in health care settings are the wave of the future,” said VA Secretary Robert Wilkie. “The tireless work of Drs. Evans, Frisbee, Galpin and Ripley has VA leading the way in providing access to these services.”

Among VA’s accomplishments in advancing connected care — more than 1 million Veterans or 18% of all enrolled Veterans completed a video visit at   home in fiscal year 2020, representing over 3 million video-to-home visits. My HealtheVet, VA’s health portal, has more than 3 million authenticated patients who average 440,000 prescription refill requests and send about 280,000 secure messages each week. VA has surpassed 60 mobile health apps on its VA App Store, many of them developed by VA for Veterans and staff to improve the care delivered by the department.

The department is also the first integrated health care system in the country to establish a national 3D Printing Network allowing its health care staff to share ideas, resources and best practices to deliver quality care to patients throughout its enterprise. Innovations in 3D printing across VA have led to advancements in surgery, prosthetics and the treatment of chronic illnesses. Additionally, 3D printing enables VA’s medical providers to customize and tailor solutions to unique, individual patient needs, putting the Veteran at the center of their treatment plan. In March, VA activated its 3D printing network to test 3D designs of medical equipment used by the nation’s health care providers to combat the COVID-19 pandemic.

Veterans interested in learning more about VA’s remote health care services, can visit Connected Care. Innovators interested in learning more about VHA’s 3D Printing Network can visit VHA Innovation Ecosystem.

The Sammies highlight innovative work and accomplishments in federal government that meet the needs of Americans. View VA Sammies winners.

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The U.S. Department of Veterans Affairs (VA) announced today, that for the second consecutive year, the organization received a top grade from the Center for Plain Language in its annual Federal Report Card.

The 2020 Federal Plain Language Report Card awarded VA an “A-” score in the category of “writing quality.”

In 2019, VA received an “A” grade in the same category and drew specific praise from the center for VA’s suicide prevention resource page.

“This recognition highlights the ongoing efforts VA makes to clearly communicate critical information to our Veterans, their families and their caregivers,” said VA Secretary Robert Wilkie. “As we continue prioritizing timely delivery of health care and other important services, it is incumbent upon us to continue ensuring the information we’re providing is not only accurate, but easy to locate and accessible to all.”

In the 2020 Federal Plain Language Report Card, only two other federal agencies, the Department of Health and Human Services and the Consumer Financial Protection Bureau, joined VA in receiving the highest score of excellence — an “A” level grade for writing quality.

The Center for Plain Language, a nonpartisan accountability organization, evaluates federal agencies’ communication to the public. Since 2012, the center has issued a yearly report card evaluating how well agencies follow the Plain Language Act approved by Congress in 2010.

Visit VA.gov to learn more about VA’s online communication and product portals where Veterans and family members can easily access the benefits and services they have earned.

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The U.S. Department of Veterans Affairs (VA) makes an impact, driving change and advancement, in the federal health information technology market.

FedHealthIT recognized VA for creating products and services that have a profound impact on the lives of Veterans through developments in digital and cloud-based solutions and health-IT modernization initiatives.

“Part of the department’s mission is its commitment to providing exceptional customer service,” said VA Secretary Robert Wilkie. “Among the Veterans’ calls VA heeded – building a simpler, more user-friendly VA.gov website and expanding telehealth services to the 40% of Veterans living in rural areas.”

Listening to Veterans and critically analyzing their thoughts has led to notable VA projects to include:

• The implementation of the Maintaining Internal Systems and Strengthening Integrated Outside Networks(MISSION) Act, which gives Veterans greater access to health care in VA facilities and the community.
• The launch of VA’s Electronic Health Record Modernization (EHRM), an initiative to migrate Veteran health data to a new system that will link in with the Department of Defense’s patient records.
• The creation of the National Artificial Intelligence Institute (NAII), which will use AI research and development for real-world impact and health care outcomes for Veterans.

For information on VA leaders, their transformative health-IT projects and how those projects help Veterans visit VA 2020 FedHealthIT 100 Awardees.

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The U.S. Department of Veterans Affairs (VA) announced today the Association of Marketing and Communication Professionals has awarded the Veterans Benefits Administration (VBA) Blue Water Navy (BWN) communications and outreach campaign with a 2020 MarCom Platinum Award.

The campaign increased awareness about the BWN Vietnam Veterans Act of 2019 which extended the presumption of exposure to herbicides such as Agent Orange to Veterans who served in the offshore waters of the Republic of Vietnam during the Vietnam War.

“VA supports BWN Veterans, their families and survivors around the country,” said VA Secretary Robert Wilke. “Ensuring Veterans and their families are aware of the benefits available to them is a priority and this campaign demonstrates our commitment to serving our Vietnam era Veterans.”

In fiscal year 2020, VBA’s BWN campaign included a national public service announcement (PSA) that aired more than 20,000 times with an estimated advertisement equivalency of $1.9 million, more than 30,000 landing page views and over 300,000 PSA views on YouTube. Additionally, the digital advertising portion of the campaign reached 328,000-plus Facebook users and 2.3 million YouTube users.

As of Oct. 31, VA processed 36,820 of 72,969 claims received, of which 25,918 were granted — awarding more than $696 million in retroactive benefits to eligible Veterans and their families. The most common claims granted included conditions such as type 2 diabetes, malignant growth of the lung, coronary bypass surgery, malignant growths of genitourinary system and coronary artery disease.

Learn more about Agent Orange exposure and VA disability compensation or call 800-827-1000 for more information.

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The U.S. Department of Veterans Affairs (VA) announced today the recipient of the agency’s Robert L. Jesse Award for Excellence in Innovation — for advanced work in expanding telehealth access for Veterans living in rural communities across the country.

Dr. Leonie Heyworth, M.D., MPH, director of Synchronous Telehealth, VA Telehelth Services and primary care provider at the VA San Diego Healthcare System, was presented the award during VA’s virtual Innovation Experience (iEX) event for her work in helping develop, implement and spur clinical adoption of real-time telehealth solutions for Veterans, such as the ATLAS (Accessing Telehealth through Local Area Stations) program and VA Video Connect (VVC).

“VA is continuously improving its systems to enhance Veteran’s health outcomes no matter their location, and achievements such as this are indicative of the work our employees are doing to accomplish this task,” said VA Secretary Robert Wilkie. “Dr. Heyworth’s eagerness to innovate, collaborate and lead — all while keeping Veterans at the center — made her a natural selection for the Robert L. Jesse Award. Her efforts played an integral role in VA safely caring for Veterans during the pandemic through virtual visits.”

The two award runners-up were Melissa Oliver, program manager for Assistive Technology and Rehabilitation at the Richmond VA Medical Center, for her work in expanding 3D printing capabilities across the country, and Rory Cooper, Ph.D., director of VA Pittsburg Healthcare System Human Engineering Research Laboratories, for his leadership and inventions, like a joystick used in virtually every electric-powered wheelchair in the world.

The winner and finalists were selected by a committee composed of leadership from across the Veterans Health Administration. The committee selected participants on a variety of criteria, including vision, community involvement/service, interpersonal effectiveness and Veteran-centric outcomes.

Learn more about VA innovations.

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The U.S. Department of Veterans Affairs (VA) recognizes Compensated Work Therapy Vocational Rehabilitation Week, Oct. 19-23, acknowledging the more than 1,000 VA Compensated Work Therapy (CWT) vocational rehabilitation counselors, managers and peer support specialists who provide services to more than 64,000 Veterans each year within the VA health care system.

VA’s CWT services are integrated with clinical care to assist Veterans with serious mental illness, Post-traumatic Stress Disorder, polytrauma and traumatic brain injury, substance use disorder, homelessness, and other psychological issues that may interfere with securing gainful employment.

“Compensated Work Therapy vocational rehabilitation is vital in helping Veterans with a physical or mental illness overcome employment barriers and return to meaningful work,” said VA Secretary Robert Wilkie. “All of our Veterans deserve an opportunity to live a secure and stable lifestyle with their families — and the work of our CWT team is helping with that effort.”

CWT programs are located at all VA medical facilities and aim to provide evidence-based and evidence-informed vocational rehabilitation services to Veterans while developing partnerships with local, regional and national businesses; industry and government agencies that provide Veteran candidates for employment. VA’s CWT staff works to assist these organizations and potential employers with hiring the right Veteran in the right job at the right pay.

Local VA CWT staff are being acknowledged at their respective medical centers and several will be recognized for the annual Dr. Jackie Bethany Leadership Awards for Compensated Work Therapy Excellence through virtual presentations with the individual facilities.

Learn more about VA’s CWT or email This email address is being protected from spambots. You need JavaScript enabled to view it. with questions.

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The U.S. Department of Veterans Affairs (VA) recognizes Compensated Work Therapy Vocational Rehabilitation Week, Oct. 19-23, acknowledging the more than 1,000 VA Compensated Work Therapy (CWT) vocational rehabilitation counselors, managers and peer support specialists who provide services to more than 64,000 Veterans each year within the VA health care system.

VA’s CWT services are integrated with clinical care to assist Veterans with serious mental illness, Post-traumatic Stress Disorder, polytrauma and traumatic brain injury, substance use disorder, homelessness, and other psychological issues that may interfere with securing gainful employment.

“Compensated Work Therapy vocational rehabilitation is vital in helping Veterans with a physical or mental illness overcome employment barriers and return to meaningful work,” said VA Secretary Robert Wilkie. “All of our Veterans deserve an opportunity to live a secure and stable lifestyle with their families — and the work of our CWT team is helping with that effort.”

CWT programs are located at all VA medical facilities and aim to provide evidence-based and evidence-informed vocational rehabilitation services to Veterans while developing partnerships with local, regional and national businesses; industry and government agencies that provide Veteran candidates for employment. VA’s CWT staff works to assist these organizations and potential employers with hiring the right Veteran in the right job at the right pay.

Local VA CWT staff are being acknowledged at their respective medical centers and several will be recognized for the annual Dr. Jackie Bethany Leadership Awards for Compensated Work Therapy Excellence through virtual presentations with the individual facilities.

Learn more about VA’s CWT or email This email address is being protected from spambots. You need JavaScript enabled to view it. with questions.

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The U.S. Department of Veterans Affairs (VA) announced today it honored Veterans Health Administration (VHA) National HeRO Award recipients for their contributions to VHA’s journey to becoming a high reliability organization (HRO).

VHA’s enterprise-wide journey to high reliability aims to continuously improve its processes by maximizing safety and minimizing harm to achieve the goal of ensuring every patient receives excellent care every time.

The awardees were recognized for their safety and process improvement initiatives as well as their COVID-19 response efforts to provide the best possible care to Veterans. Their accomplishments include COVID-19 communication and education, innovative and efficient COVID-19 screening and triage processes including the development of a screening app, and using 3D printing technology for personal protective equipment.

“Even during these unpredictable times and the COVID-19 response, these recipients responded swiftly and efficiently to ensure that VHA delivers the best care available to our Veterans,” said VA Secretary Robert Wilkie. “From developing new entry procedures to manufacturing personal protective equipment to staying in touch with Veterans, VA staff are handling the pandemic quickly and creatively.”

Each of the 11 teams and individuals were nominated by top leadership in one of five categories: Clinical individual from a Veterans Integrated Service Network (VISN) or facility, non-clinical individual from a VISN or facility, clinical team from a VISN or facility, non-clinical team from a VISN or facility and individual or team from VHA central office.

The National HeRO Award is the highest level of HRO recognition available within VHA and is reserved to honor employees who advance VHA’s journey to high reliability through demonstration of VHA’s HRO principles in action. The HRO steering committee votes quarterly to select one winner in each category for a National HeRO Award.

Learn more about VA’s journey to high reliability at VA National Center for Patient Safety.

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The U.S. Department of Veterans Affairs (VA) announced today it has successfully reduced prescription opioid use in patients within the VA health care system by 64%, from more than 679,000 Veterans in fiscal year 2012 to 247,000 in fiscal year 2020 through quarter three.

VA achieved this reduction by aggressively emphasizing the safe and responsible use of prescription opioids and transforming the treatment of chronic pain using alternative therapies and treatments often in place of or in conjunction with pain medication.

“Collectively, uncontrolled pain, distress and functional impairments can reduce the quality of life for Veterans and their families, increasing the risk for overdose, substance use disorders and suicide,” said VA Secretary Robert Wilkie. “More than one third of Veterans in the VA health care system live with some form of chronic pain, and given the opioid crisis, it is our duty to do everything we can to help Veterans avoid opioid overdose and provide them with alternative pain management treatment.”

VA’s Opioid Safety Initiative also reduced the number of patients receiving opioids and benzodiazepines together by 87% since 2012, from nearly 123,000 down to nearly 16,000 Veterans, as well as reduced the number of patients on long-term opioid medications by 70% and the number of patients on very high doses of opioids by 80%.

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Scientists say the VA and the DOJ have a history of stonewalling anyone who wants to conduct trials of plant-derived cannabis for therapeutic purposes.

Jason Dunlap found that cannabis eased his PTSD, chronic pain and insomnia, but he hid his pot use from VA doctors, believing it was taboo for Veterans relying on government care.

It took some research for the retired Army sergeant first class to determine he could actually tell the VA he was using cannabis, but even then his doctors couldn’t tell him how to use it safely and effectively. Dunlap, 42, has instead turned to YouTube, research papers online, dispensary workers — and even actor Jim Belushi, now a notable cannabis industry figure who offers tutorials.

Millions of Veterans are self-medicating their war-caused ailments with marijuana, and they are frustrated the VA continues to dismiss the drug's possible benefits. The VA will not expand the piecemeal cannabis research it is undertaking, despite recent bipartisan calls from Congress, doctors and Veterans. And without that research, the VA continues to deny cannabis recommendations to Veterans in 36 states that allow medical marijuana.

Veterans say that has forced many to suffer, while some researchers suggest the VA also may be ignoring potential ill effects when used inappropriately.

“It's doing wonders, but also there's so very little we know about what's going on,” said Dunlap, who lives in Maryland.

The federal government may be resistant not just because research could open the door to cannabis use by Veterans — but lead to wider legalization. The lack of empirical, FDA-approved research is one of the most-cited reasons for many lawmakers, even President Joe Biden, to refrain from taking federal action on cannabis.

Rep. Lou Correa (D-Calif.) has introduced a bill that would instruct the VA to study cannabis for PTSD, depression and a number of other diseases Vets often suffer from, just one of multiple proposals in the House and Senate that would expand research into cannabis for Vets. Despite broad bipartisan support, however, none has reached a floor vote in either chamber.

“The VA keeps saying, 'We have the authority, we don't need you to micromanage us.’ But we do — because they're not doing their job," Correa said.

Correa’s bill, which advanced out of the House Veterans' Affairs Committee on Thursday, is just one of multiple proposals in the House and Senate that would expand research into cannabis for Vets. Also on Thursday, Sen. Brian Schatz (D-Hawaii) introduced an amendment to a must-pass defense spending bill that would allow VA physicians to recommend medical marijuana under state-regulated programs and bolster research. Despite broad bipartisan support, however, none of these proposals have reached a floor vote in either chamber.

The recent withdrawal from Afghanistan has exacerbated the demand for more understanding of using cannabis for treatment. Calls to the Veterans Crisis Line, which is operated by the VA, increased by six percent in the weeks immediately following the U.S. withdrawal from Afghanistan, and Veterans of America’s longest war use cannabis at the highest rates among Veterans to self-medicate their ailments.

Advocates, Hill aides and former VA staff told POLITICO the VA defers on this issue to the Justice Department, which classifies cannabis as a Schedule I drug under the Controlled Substances Act. A Schedule I drug by definition has no medicinal value, which in turn prevents the VA from treating patients with cannabis.

For Veterans receiving VA health care, cannabis still occupies a gray area. Official guidance states that Veterans can talk to their VA doctor about their cannabis use without repercussions, but many Vets say they fear mentioning it because it is still federally illegal. VA doctors, meanwhile, still cannot prescribe cannabis or issue medical marijuana cards in any of the 36 states that have legalized medical marijuana.

An average of 18 Veterans a day committed suicide in 2018, according to data from the VA. Dunlap says that some medical dispensaries in Maryland, where he lives, give a 22 percent discount to Veterans — an homage to the 22 Veterans who committed suicide every day in 2012.

According to the VA, a number of studies have indicated that both PTSD and battlefield trauma contribute to a higher rate of suicidal ideation — and exposure to suicide, such as a friend or family member, can in turn contribute to PTSD. Many Veterans and their advocates point to anecdotal evidence that cannabis successfully reduces the effects of PTSD — as well as insomnia, which can worsen PTSD symptoms — but there is yet no clinical evidence.

“The very populations who have the greatest need are often the ones who are the most understudied,” said Staci Gruber, director of the Marijuana Investigations for Neuroscientific Discovery program at McLean Hospital and an associate professor of psychiatry at Harvard Medical School.

Officials from the National Institute on Drug Abuse have testified to Congress that there is “substantial evidence” that cannabis has medicinal value for treating chronic pain, and have urged Congress repeatedly to increase research into a myriad of potential positive and adverse effects of cannabis use.

The VA did not respond to POLITICO’s request for comment for this story. It testified before the House VA Committee in October that it is studying synthetic CBD as a treatment for PTSD, when used alongside psychotherapy. The agency also has approved a study on the efficacy of synthetic THC and CBD for neuropathic pain that will begin in 2022.

But scientists say the VA and the DOJ have a history of stonewalling anyone who wants to conduct trials of plant-derived cannabis for therapeutic purposes, even though the agencies regularly approve studies into the drug’s harmful effects.

“They just hear the word ‘cannabis’ and recoil,” said one scientist who spoke to POLITICO but requested their name be withheld in order to not jeopardize ongoing efforts to do research with the VA. “It's got to be the VA Secretary ordering his staff to do it, and [the] VA Secretary probably won't do that unless he gets the political cover from Congress.”

Sen. Dan Sullivan (R-Alaska) says his bill would give the VA that cover. This is the second time he’s introduced the bill in Congress — but it has yet to receive a hearing.

“I think sometimes on something controversial, agencies want to make sure they have legal cover,” said Sullivan, who cosponsors the bill with Sen. Jon Tester (D-Mont.). “That's what we're trying to provide them.”

A similar bill was approved by the House VA committee last year and garnered more than 100 co-sponsors from both sides of the aisle, but did not receive a floor vote.

“It drives me crazy,” said Rep. Earl Blumenauer (D-Ore.), the unofficial cannabis czar on Capitol Hill, who has worked on numerous pieces of cannabis legislation that would expand medical marijuana research — one of which passed the House last year but did not make it to the president’s desk. “[The VA] could, and they should.”

Gruber received approval from the FDA for a cannabis study that was not Veterans-specific in 2015, but says the DEA turned around and denied the study proposal, and it was another two and a half years before she finally received approval. Other scientists say they’ve been told by state VA medical facilities that they could not post FDA-sanctioned flyers calling for volunteers to participate in FDA-approved cannabis studies.

“There’s an awful lot of gaps in the research,” Gruber said.

She said that cannabis can be a panacea for some — helping with sleep, PTSD and more — but it also has the potential to be a problem for others, especially Veterans with a family history of certain mental health disorders. It’s a big problem, she said, that America does not have comprehensive scientific data on something its Veterans are using so widely.

”Imagine a world where people are using anything at that level without supporting information from an empirically sound source to guide them,” Gruber added.

Without research, lawmakers don’t have hard facts on the pros and cons of cannabis, and that unknown makes them loathe to back policy changes they believe could come back to bite them.

The VA’s legal standing is also a gray area. The agency already conducts research into synthetic cannabinoids, and holds a Schedule I research license — which theoretically gives it the ability to research any Schedule I drug. But a Schedule I drug has “no medical use,” and therein lies the hangup: If the VA researches cannabis for medical purposes, like the NIH proposes, they could run into conflict with the DOJ’s definition of a Schedule I drug.

“I'd probably stay completely the hell away from it [if I was the VA],” Correa said. “Why would you get in the middle of a dogfight?”

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The U.S. Department of Veterans Affairs today announced publication of its Coronavirus Disease 2019 (COVID-19) Response Report detailing its efforts to address the pandemic from early January through June 30.

The report results are a continuation of VA’s pledge to share best practices and lessons learned with other government agencies and the private health care system while the country fights COVID-19.

“As the nation’s largest integrated health care system, VA’s COVID-19 response has been robust and far-reaching. This includes 24 current and 75 completed Fourth Mission assignments involving more than 2,000 VA employees helping to support non-Veteran patients and non-VA health care systems,” said VA Secretary Robert Wilkie. “This report reflects VA’s agility throughout the pandemic to adapt based on lessons learned in order to continue providing safe, quality health care to Veterans as we continue to battle the pandemic.”

The COVID-19 Response Report provides an extensive look at VA’s complex COVID-19 response, including the department’s planning and preparation ahead of the pandemic; the initial crisis response; key COVID-19 policies and directives; interactions and interdependencies with federal and state agencies; and adaptations to health care operations. It provides a forthright view of challenges and issues that VA needed to address in order to effectively respond to the pandemic, such as exchanging supplies, Personal Protective Equipment and deploying health care personnel across the enterprise to meet critical needs in certain areas.

The department implemented a wide range of actions to ensure the safety of its patients and employees while never closing its doors. As of November 6, VA has tested 879,457 Veterans and employees for COVID-19 and diagnosed 67,905 Veterans with COVID-19, 14,168 of whom were admitted to a VA medical center for care. VA has hired more than 59,095 new employees since March 29 in response to the surge in demand for care during the pandemic. In addition, VA moved many appointments to telehealth meetings to keep Veterans and employees safe and has seen a 1,525% increase in home or offsite telehealth visits.

As of June 29, VA participated in more than 90 and led 28 multiple-site COVID-19 research studies. Notably, VA participated in research on 3D-printed respirator masks and convalescent plasma to treat COVID-19 patients, as well as other promising therapeutics, and laid the groundwork for participation in COVID-19 vaccine clinical trials.

The report was compiled through more than 90 interviews with health care leaders and stakeholders as well as a variety of documents and data pertaining to the Veterans Integrated Service Networks and health care enterprise. It cites conclusions, findings and recommendations across several categories, including recognition of the threat and planning; national and interagency coordination; emergency management and readiness; data and analytics; capacity, supply chain and testing; clinical operations; research; and moving forward.

VA expects to develop further reports to document the evolution of VA’s response to the pandemic and consider additional strategic follow-up actions informed by the ongoing experience.

A synopsis of VA’s COVID-19 Response Report and the full report are available on the VA website. VA also released its COVID-19 Response Plan in March and its Charting the Course Plan for how VA facilities would resume services temporarily halted by the crisis in May.

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The U.S. Department of Veterans Affairs (VA) announced today publication of its dynamic VA COVID-19 Vaccine Distribution Plan, being executed at 37 sites across the country.

VA began vaccinating Veterans and frontline employees this week, following the Food and Drug Administration’s Dec. 11 decision to issue an Emergency Use Authorization for the Pfizer-BioNTech COVID-19 Vaccine.

The distribution plan addresses vaccinations for Veterans, staff and other federal partners including a prioritization framework for identifying the population(s) at highest risk to receive the vaccine. The plan will be updated over the next two weeks to reflect final recommendations and specifications from FDA and the Centers for Disease Control and Prevention (CDC) on COVID-19 vaccines authorized through FDA’s Emergency Use Authorization process — and will continue be updated as FDA approves new vaccines.

“VA employees have provided life-saving COVID-19 care to thousands upon thousands of people, and the department continues to play a crucial role in the nation’s response to the pandemic,” said VA Secretary Robert Wilkie. “Dedicated professionals across many fields contributed to this plan, which will ensure a safe, evidence-based and equity-focused vaccine rollout for VA frontline workers and Veterans.”

The plan covers vaccine distribution in the United States, Puerto Rico, and U.S. territories where VA provides health care to Veterans, as well as vaccine safety monitoring and vaccine reporting as required by the CDC and Operation Warp Speed.

Veterans seeking additional information should visit the VA Coronavirus Vaccine FAQs webpage, contact their care team or visit their facility website.

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Reference guide to help during final arrangements planning

Each person experiences grief differently when a loved one passes, but survivors should not feel confused about what to do next. The Survivors Quick Start Guide provides Veteran family members and caregivers a reference guide for what to do next. (DOWNLOAD)

Part of VA’s Welcome Kit, the Survivors quick start guide begins with a step by step checklist for preparing, applying for, and following up on the available benefits. Each step spells out in plain language what to do, what forms to fill out, and who to call if you need help.

The guide also helps families identify VA Survivor benefits and services they may be eligible for.

“We hope this consolidated information helps clarify the process, streamline final arrangements and helps survivors focus on what should be done to ensure continuation of the Veteran’s earned benefits.” – Ann Duff, Director of VA’s Survivor Assistance Office.

Next, the quick start guide lists each of VA’s Survivor benefits and services. Including burial and internment, compensation, education, home loan and insurance benefits. It also highlights several counseling services available in one’s time of need.

The Survivor Quick Start Guide and VA Welcome Kit illustrate VA’s goal to not only serve Veterans, but their families as well.

Non-profit organizations such as Tragedy Assistance Program for Survivors (TAPS) also compliments the benefits. TAPS supports the VA by providing comfort and care to all who are grieving the death of their Veteran. Additional support available at no cost through TAPS includes access to a 24/7 emotional support Helpline at 800.959.TAPS, casework assistance for additional financial support and resources, peer based emotional support for your grief, and connections to grief and trauma counseling and support groups.

“Your loved one stepped forward to serve their country, and now we are there for you with resources and services. The VA Survivor Benefits Guide and the Survivor Quick Start Guide are a wonderful resource for navigating VA Survivor benefits and services” – Bonnie Carroll, TAPS President and Founder

The frequently asked questions in the guide include topics such as, “How would a spouse or dependent know what survivor benefits they may be eligible for?” and “As a surviving spouse am I eligible for healthcare?”

Please visit va.gov/welcome-kit/ to download and print the Survivors Quick Start Guide as well as the VA Welcome Kit. Information on burial and memorial benefits can be found at va.gov/burials-memorials.

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The Department of Veterans Affairs has released an updated list of locations outside Vietnam where tactical herbicides such as Agent Orange were used, tested or stored by the military.

Agent Orange was a weed killer sprayed on the jungles of Southeast Asia during the Vietnam War to eliminate forest cover and crops for North Vietnamese and Viet Cong troops. The name came from the orange identifying stripe used on the 55-gallon drums in which it was stored.

Veterans who were exposed to Agent Orange or other herbicides during service may be eligible for a variety of VA benefits, including an Agent Orange Registry health exam, health care and disability compensation for diseases associated with exposure. Their dependents and survivors also may be eligible for benefits.

Agent Orange exposure can cause several serious illnesses, as well as birth defects in the children of Veterans who were exposed to the chemical.

The news comes on the heels of the Jan. 1, 2020, VA expansion of Agent Orange benefits to Veterans who were exposed to the herbicide during their service. That expansion includes Navy Veterans who served in the territorial waters of Vietnam and Cambodia, as well as Veterans of all branches who may have been exposed in other locations, including stateside bases.

Previously, only Veterans who were exposed to the dangerous weed killer while serving in-country Vietnam were eligible for any VA benefits.

The expansion of Agent Orange exposure locations came as a result of Public Law 116-23, the Blue Water Navy Vietnam Veterans Act of 2019.

The new law adds an estimated 420,000 to 560,000 Veterans to those already eligible for care and benefits for possible exposure.

"This update was necessary to improve accuracy and communication of information," said VA Secretary Robert Wilkie. "VA depends on DoD to provide information regarding in-service environmental exposure for disability claims based on exposure to herbicides outside of Vietnam."

You should contact the VA immediately if you or a loved one served in one of the designated Agent Orange exposure locations.

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The U.S. Department of Veterans Affairs’ (VA) today released the VA Customer Experience Accomplishments Report detailing 71 major initiatives to improve customer service for Veterans, their families, caregivers and survivors.

Improving customer service as a top priority at VA was established in 2018 and it challenged the department to rethink VA customer interactions, designating the Veterans Experience Office as the ”voice of the Veteran.”

“The goal is to provide Veterans a modern, streamlined and responsive customer experience,” said VA Secretary Robert Wilkie. “VA actively engages in efforts that maximize the collective impact of stakeholders delivering federal, state and local services for improving outcomes where Veterans live, work and raise their families.”

Veterans have validated VA’s efforts with trust in VA health care reaching an all-time high in April and VA-wide trust up 16 points since January 2016. Relying on 5.7 million real-time responses from 66 customer feedback surveys to improve service recovery and guide program improvements, the report shares the accomplishments representing major achievements in the strategic deployment of VEO’s shared CX capabilities to include:

• Implementing a new electronic health record system providing seamless Veteran patient records access between Department of Defense, community care providers and VA.
• Connecting with transitioning Veterans during their first year of separation via Solid Start.
• Honoring nearly 4 million Veterans interred at VA national cemeteries with a digital memorial space.
• Improving access to the Board of Veterans’ Appeals with virtual hearings.
• Connecting Veterans to resources more than 238 million times via VA’s weekly e-mail.
• Answering close to 3 million customer calls via 800-MyVA411 and the White House VA Hotline which both offer general assistance agents available immediately.

VA has integrated this culture of customer service for creating the department’s first customer service policy and CX directive, codifying customer experience principles in the Code of Federal Regulations and publishing a practitioner’s guide — the CX cookbook to help other government agencies adopt customer-centric principles as part of its role as the Lead Agency Partner for the President’s Management Agenda Cross-Agency Priority Goal on Improving Customer Experience with Federal Services.

Watch the State of Veteran Customer Experience for more information or visit the Veterans Experience Office.

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