The Department of Veterans Affairs has launched an effort to digitally scan all paper-based military personnel files, an initiative the agency said should help resolve its current backlog and better prepare VA for future challenges that may disrupt disability claims processing.

The initiative is part of a partnership VA has with the National Archives and Records Administration to proactively scan millions of military personnel records, which the National Personnel Records Center (NPRC) stores on behalf of the federal government in more than a dozen warehouses in St. Louis.

Veterans need those documents to access certain burial services, medical treatment, home loans and other benefits from VA, and the Veterans Benefits Administration needs those records to begin processing disability claims.

But some Veterans have struggled to access their records during the pandemic, delaying an already complex disability claims process for many.

“Getting these federal records faster allows us to advance to the next stage [of the disability claims process],” Ken Smith, deputy assistant secretary for field operations, told reporters last week. “We have to know some facts and circumstances about service in order to determine whether or not we should order a [compensation and pension] exam. That’s the next touch point where we have to seek input from an external partner in order to complete the claim.”

The NPRC sent the vast majority of its employees home to telework last March at the start of the pandemic, meaning it didn’t have enough personnel available to pull paper records from the shelves, handle them and send them to VA so it can begin its own lengthy disability claims process.

By last September, VBA had nearly 80,000 Veterans’ claims awaiting records from the NPRC, the department said.

The delay for records was just one of several reasons behind VBA’s own backlog of disability claims, which grew during the pandemic.

“We need these records in order to process disability claims for Veterans. If NARA is unable to deliver or is having difficulty delivering, VA felt it was important to step in so that we could help take care of Veterans,” Smith said. “In NARA’s defense, they did what they could by prioritizing our requests, but because of the small number of people they had on the ground and able to serve these records themselves, they couldn’t fulfill them all in a timeframe that was sufficient to meet our claims processing requirements. That’s when our smaller unit became a bigger unit, and we began taking on additional responsibilities to pull and shift these files.”

VBA always had a small number of staff at the NPRC to help archives employees pull records responsive to Veterans’ requests, but VA expanded the number of its employees on-site during the pandemic.

VBA currently has about 60 of its own employees detailed to the NPRC, where they’re retrieving records relevant to Veterans’ requests and sending them to a contractor for scanning, Smith said.

VA also helped NARA set up additional shifts at the NPRC, so more employees can spend more time responding to records requests without breaking the building’s 25% occupancy limit during the pandemic.

As of April, VBA and NARA had reduced the number of Veterans’ claims awaiting records by 90%, Smith said.

NARA and VA are answering new requests for these records today within three-to-four days, a faster response time than before the pandemic, he added.

Smith said VBA’s efforts to help NARA expand its pandemic operations has obvious short-term benefits, but the records scanning initiative should have a bigger, long-term impact on both agencies.

The department received $150 million through the American Rescue Plan earlier this year to handle the scanning, which VA outsourced to a contractor.

The contractor will upload the files into VA’s electronic claims system, where VBA employees can access personnel records and begin processing a Veteran’s claim, Smith said.

In an interview with Federal News Network earlier this month, NARA also said the scanning initiative would benefit both agencies. NARA has its own backlog of outstanding records requests, and with VA’s help, it anticipates resolving the inventory within 18-to-24 months.

In the meantime, VBA said the work it’s doing now should help prevent delays within the disability claims process later.

“We are proactively scanning military personnel records so that when future claims come in, we are not waiting for those records,” Smith said. “As a secondary benefit we make all of those digital images available to National Archives to use for their purposes, so when another federal agency or a Veteran or a Veteran’s family seeks a copy of records, they have access to that and can respond [more quickly].”

Those files contain information about a Veteran’s unit and where they served, which may include details relevant to an individual’s claim, especially those seeking VA benefits for toxic exposure during their service.

VA last month announced plans to automatically review claims from Veterans who previously filed and were denied benefits for one of three presumptive conditions associated with Agent Orange, which include bladder cancer, hypothyroidism and Parkinsonism.

The department will also readjudicate about 60,000 disability claims under a recent court order. Again, Smith said VA’s proactive scanning effort should help speed up adjudication in the future, especially when Congress or the courts make decisions that prompt a large number of Veterans to refile or submit new disability claims.

“I don’t know that we have quite gotten to the point where we’ll have all of those records proactively scanned because we just recently started that initiative, but that would be a goal so that when we have these sorts of events in the future, we’ll have those records available,” Smith said.

To date, VBA has 520,000 claims pending for disability compensation, pension and dependency and indemnity compensation, the department said. Of those, 191,000 claims are at least 125 days old and part of the VBA backlog, Smith said.

Beyond the extra funding for its records scanning initiative, VBA also received an additional $100 million through the American Rescue Plan, which it will use to pay employees overtime for those working on the disability claims backlog.

Smith said it hopes to keep its disability claims backlog down under 200,000 by the end of the fiscal year, with the goal of reducing it to 100,000 by next year.

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A Maryland man was sentenced Monday to 30 months in prison and ordered to pay $150,000 in restitution for defrauding a U.S. Department of Veterans Affairs (VA) program dedicated to rehabilitating military Veterans with disabilities.

According to court documents, Francis Engles, 65, of Bowie, was the owner and operator of Engles Security Training School (Engles Security). In August 2015, Engles Security became an approved vendor of the VA’s Vocational Rehabilitation & Employment program, which provides disabled U.S. military Veterans with services. Thereafter, Engles Security obtained over 80% of its total revenue from the VA in exchange for purporting to provide certain courses to disabled military Veterans.

To further the scheme, Engles falsely represented to the VA that his company was providing Veterans with months-long courses for 40 hours per week and over 600 total hours. In fact, as Engles knew, Engles Security offered Veterans far less than what Engles represented to the VA. In some instances, it offered only a few hours of class per day for several weeks. Some Veterans did not attend more than one day of class. Engles nevertheless sent to the VA “Certificates of Training” stating that Veterans had completed courses that they had not completed or, in some instances, had not taken at all. Similarly, Engles submitted letters to the VA falsely stating that the Veterans were employed by Engles’ private security business. Engles also instructed Veterans to sign attendance sheets for classes that he knew they did not in fact attend. In total, Engles Security obtained $337,960 from the VA for the purported education of military Veterans.

Engles also attempted to obstruct the investigation into his fraud. During an interview with federal agents, Engles lied about Veteran students’ attendance at the school and later, when Engles Security was served with a grand jury subpoena, Engles prevented his employee from producing responsive documents that she had gathered. Some of these documents were later discovered in the government’s search of Engles Security’s office.

In February 2019, four other individuals were sentenced in related cases following their guilty pleas. James King, a former VA employee, was sentenced to 11 years in prison for committing bribery, defrauding the VA and obstructing justice. Albert Poawui, the owner of Atius Technology Institute, was sentenced to 70 months in prison for committing bribery. Sombo Kanneh, Poawui’s employee, was sentenced to 20 months in prison for conspiracy to commit bribery. Michelle Stevens, the owner of Eelon Training School, was sentenced to 30 months in prison for committing bribery.

Acting Assistant Attorney General Nicholas L. McQuaid of the Justice Department’s Criminal Division; Acting U.S. Attorney Channing D. Phillips for the District of Columbia; Special Agent in Charge James A. Dawson of the FBI’s Washington Field Office’s Criminal Division; and Special Agent in Charge Kim Lampkins of the VA Office of Inspector General’s Mid-Atlantic Field Office made the announcement.

Trial Attorney Lauren Castaldi of the Criminal Division’s Public Integrity Section and Assistant U.S. Attorney Peter Lallas of the U.S. Attorney’s Office for the District of Columbia are prosecuting the case.

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Sen. Chuck Schumer on Wednesday called on the federal government to recognize four ailments linked to Agent Orange exposure in Vietnam Veterans, labeling it a “disgrace” the former soldiers could not get treatment decades after the war ended.

The Department of Veterans Affairs recognizes 14 illnesses linked to the highly toxic defoliant widely used in Vietnam to wipe out jungle cover and expose the enemy. That list does not include bladder cancer, hypertension, hypothyroidism, and parkinsonism, even though scientific evidence links those illnesses to Agent Orange exposure, Schumer said.

“Bean counters” at the federal Office of Management and Budget apparently “deep-sixed” coverage for the ailments a few years ago, Schumer said at a news conference at the VFW Post in Albertson.

“What a disgrace, that because it costs money, the lives of these men and women and the service they gave us is totally just discounted, ignored, forgotten,” Schumer said, flanked by Veterans and local officials.

“I know at OMB their job is cut back on waste. Mr. OMB — this is not waste. This is what America is about. This is not just unfair. It’s cruel.”

OMB Director Mick Mulvaney, who also is acting White House chief of staff, did not respond to requests for comment.

Although it conducts regular review of emerging evidence on Agent Orange, the VA said, “the department will not be announcing any new presumptive conditions until there is sufficient evidence to support an informed decision.”

The agency said in a statement it awaited results of two studies, the Vietnam Era Health Retrospective Observational Study and the Vietnam Era Mortality Study, to guide its decision.

“VA remains committed to the care of Vietnam Veterans and the continued study of Agent Orange and its associated adverse health effects,” the agency said. “VA has already established a presumption of service connection for 14 diseases associated with Agent Orange exposure.”

Nassau County Executive Laura Curran said in a statement, “Agent Orange has permanently scarred thousands of Veterans, leaving a truly horrendous legacy with long-lasting genetic effects that are still being felt today. This disease is a painful reminder for far too many of America’s heroes who deserve to finally see their personal fog of war lifted.”

New York State is home to about 240,000 Vietnam Veterans, including about 84,000 on Long Island and New York City, Schumer said.

A few dozen Veterans attended the news conference, some becoming emotional as they spoke.

“You have to do this for us, because we paid a big price,” said Paul Masi, 73, of Bethpage, who fought in Vietnam as a U.S. Marine.

“This is the United States of America — don’t turn your back on us here,” he said, crying. “It’s not right.”

Many of the symptoms appear years or decades after the soldiers’ exposure to the herbicide, according to doctors and scientists.

“I came home from Vietnam sick and didn’t know it until 35 years later” when he came down with diabetes and other illnesses that didn’t run in his family, said John Rowan, president of Vietnam Veterans of America.

Many Veterans have spent years trying to get VA-funded medical attention for the ailments, Schumer said. Some die before they get an answer.

“They fought a war in Vietnam,” Schumer said. “Now they have to fight a war against the bureaucracy to get something that they are entitled to. That’s wrong.”

Under the Agent Orange Act of 1991, the VA automatically accepts that any Vietnam Veteran who served in-country between January 1962 and May 1975 probably was exposed to the herbicide, Schumer said.

Former VA Secretary David Shulkin was planning to add the four ailments, but was blocked by OMB , Schumer said.

The senator said he met recently with the OMB official in charge of the VA, who told Schumer he would take a “serious look” at the request.

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People with more severe obstructive sleep apnea and reductions in blood oxygen concentrations are more likely to have elevated concentrations of triglycerides in the blood, according to new research.

“Obstructive sleep apnea (OSA) is a syndrome characterized by partial or complete obstruction of the upper airways, resulting in intermittent hypoxia, variably accompanied by sleep fragmentation and daytime sleepiness,” said Professor Gary Wittert, from the Freemasons Centre for Male Health and Well-Being at the University of Adelaide and his colleagues.

“In male participants of the Swiss HypnoLaus cohort, the prevalence of moderate-to-severe OSA was 49.7%, with 74.7% men aged 40 or over having OSA syndrome.”

“However, OSA is often underdiagnosed and unrecognized in clinical settings.”

“OSA has been implicated in the development of cardiovascular conditions, however, OSA during rapid eye movement (REM) sleep and the resultant nocturnal hypoxemia are also longitudinally associated with cardiovascular disease and associated risk factors such as hypertension, insulin resistance, metabolic syndrome, and carotid atherosclerosis.”

“Animal models suggest that this increased cardiovascular risk is the result of intermittent hypoxemia leading to activation of the sympathetic nervous system, increased oxidative stress and systemic inflammation.”

“Furthermore, chronic intermittent hypoxia reduced clearance of triglyceride-rich lipoproteins and inhibited adipose tissue lipoprotein lipase activity.”

“The results of our study are concerning because the most striking effects were seen in people who were not overweight.”

The study involved 753 people from the Men Androgens Inflammation Lifestyle Environment and Stress Study (MAILES), a comprehensive assessment of the health of Australian men aged 40 and over.

Half of the participants were shown to have moderate to severe OSA, with 75% of men aged 40 or over having some form of the syndrome.

“The key message from this study is that testing for OSA should be considered even in lean men with elevated blood triglycerides concentrations,” Professor Wittert said.

The authors believe continuous positive airway pressure therapy (CPAP) delivered via machine overnight may be beneficial in reducing concentrations of triglycerides and the symptoms of OSA.

“Further studies are needed to evaluate the relationship between OSA and triglycerides in women and young men and assess the effectiveness of CPAP treatment for these groups,” Professor Wittert said.

The team’s paper was published in the journal Nature and Science of Sleep.

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John Vlahos, 95, had broken heater

SEABROOK, N.H. —

Seabrook police went above the call of duty and they say they'd do it all over again for a World War II Veteran who was in need of help.

"What happened, the heating system didn't work," said John Vlahos, of Seabrook.

Vlahos has seen a lot and done a lot for his country in his 95 years, enlisting in the Army in 1942 and fighting battles in Europe. But on a recent frigid winter morning, he needed a little help himself and called 911.

"It was one of those weekends where it was, like, 6 degrees. Got to the house and he was all bundled up and freezing," said Seabrook police Officer John Giarrusso.

It was hovering near 30 degrees in his home. Giarrusso responded to the call.

"World War II Veteran, part of the Greatest Generation. He shouldn't be freezing in his own home," Giarrusso said. "We got him some hot coffee and some breakfast, and we got him a room at the hotel so he could be warm until his heat was fixed."

It's a gesture Vlahos won't soon forget.

"They put me up in a hotel. They did just about everything for me. They took me to a donut shop where I had hot coffee, muffins and so forth. They took me to the hotel to relax, so they went along and they did a lot of work for me," Vlahos said.

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A federal jury convicted a Seattle doctor yesterday of fraudulently seeking over $3.5 million in Paycheck Protection Program (PPP) and Economic Injury Disaster Loan (EIDL) COVID-19 relief funds.

According to court documents and evidence presented at trial, Eric R. Shibley, 41, of Seattle, submitted several fraudulent PPP and EIDL loan applications to federally insured financial institutions, other Small Business Administration (SBA)-approved lenders, and the SBA, in the names of businesses with no actual operations or by otherwise misrepresenting the business’s eligibility. In the applications, Shibley falsified the number of employees and payroll expenses and concealed his own criminal history. To support the fraudulent applications, Shibley submitted fake tax documents and the names of purported employees who did not, in fact, work for the businesses for which Shibley claimed they worked. Shibley received over $2.8 million in COVID-19 relief funds as a result of the fraud.

Shibley was convicted of multiple counts of wire fraud, multiple counts of bank fraud, and money laundering. He is scheduled to be sentenced on Feb. 22, 2022, and faces 20 years for each count of wire fraud, 30 years for each count of bank fraud, and 10 years for money laundering. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division; U.S. Attorney Nicholas W. Brown for the Western District of Washington; Special Agent in Charge Weston King of SBA’s Office of Inspector General (SBA-OIG), Western Region; Acting Assistant Director Jay Greenberg of the FBI's Criminal Investigative Division; Special Agent in Charge Jeffrey D. Pittano of the Federal Deposit Insurance Corporation Office of Inspector General (FDIC-OIG), San Francisco Regional Office; Inspector General J. Russell George of the U.S. Treasury Inspector General for Tax Administration (TIGTA); Special Agent in Charge Bret Kressin of IRS–Criminal Investigation (IRS-CI), Seattle Field Office; Special Agent in Charge Robert Hammer of Homeland Security Investigations (HSI) Seattle; and Special Agent in Charge Steven J. Ryan of the Department of Health and Human Services Office of Inspector General (HHS-OIG), San Francisco Regional Office made the announcement.

SBA-OIG, the FBI’s Seattle Field Office, FDIC-OIG, TIGTA, IRS-CI, HSI, and HHS-OIG investigated the case.

Trial Attorney Laura Connelly of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Brian Werner of the Western District of Washington are prosecuting the case.

The Fraud Section leads the Criminal Division’s prosecution of fraud schemes that exploit the PPP. Since the inception of the CARES Act, the Fraud Section has prosecuted over 150 defendants in more than 95 criminal cases and has seized over $75 million in cash proceeds derived from fraudulently obtained PPP funds, as well as numerous real estate properties and luxury items purchased with such proceeds. More information can be found at https://www.justice.gov/criminal-fraud/ppp-fraud.

On May 17, 2021, the Attorney General established the COVID-19 Fraud Enforcement Task Force to marshal the resources of the Department of Justice in partnership with agencies across government to enhance efforts to combat and prevent pandemic-related fraud. The Task Force bolsters efforts to investigate and prosecute the most culpable domestic and international criminal actors and assists agencies tasked with administering relief programs to prevent fraud by, among other methods, augmenting and incorporating existing coordination mechanisms, identifying resources and techniques to uncover fraudulent actors and their schemes, and sharing and harnessing information and insights gained from prior enforcement efforts. For more information on the department’s response to the pandemic, please visit https://www.justice.gov/coronavirus.

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ORLANDO, Fla. — SeaWorld announced Tuesday that it is offering free admission for U.S. military Veterans and their families to its theme parks in Orlando, San Diego and San Antonio.

SeaWorld said the deal starts Tuesday and runs through June 27.

U.S. military Veterans and retirees must register their complimentary single-day ticket(s) for themselves and up to three dependents online at www.WavesofHonor.com before May 16. After registering, all tickets must be redeemed by June 27.

Veterans and active military service members can also purchase up to six additional tickets at 50% off.

“Following a challenging year, it’s a true privilege to honor the brave men and women who serve and sacrifice so much for our country,” said Marc Swanson, interim chief executive officer of SeaWorld Parks & Entertainment. “We are honored to continue this longstanding tradition as a small gesture of the deep gratitude we owe all those who serve and offer their families the chance to make unforgettable memories.”

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The United States military used a herbicide known as Agent Orange to clear plants, trees, and other foliage during the Vietnam War without regard to the potential health issues caused by herbicide exposure. In the decades since the Vietnam War ended, Agent Orange exposure has caused veterans to develop non-Hodgkin’s lymphoma, soft tissue sarcoma, chronic b-cell leukemias, ischemic heart disease, Parkinson’s disease, and other serious health problems.

The children of Vietnam veterans and occasionally even their grandchildren have also dealt with significant health problems from Agent Orange exposure as well. Birth defects such as neural tube defects are the most common effects of Agent Orange in the second generation exposed to Agent Orange. That’s the bad news. The good news is that children of Vietnam veterans with a qualifying health condition may be eligible for healthcare services, vocational training, and other benefits through the U.S. Department of Veterans Affairs.

Spina Bifida the Most Common Birth Defect Among Children of Vietnam Veterans

Spina bifida occurs when the neural tube of the spine does not close all the way as the fetus develops during pregnancy. The improper closing of the neural tube typically happens during the first few weeks of pregnancy when a woman might not even realize she is pregnant yet. Because of this neural tube defect, the backbone that normally protects the spinal cord forms incorrectly and results in nerve and spinal cord damage.

Spina bifida can cause both physical and intellectual disabilities that range from mild to severe. The severity of spina bifida depends on the location and size of the opening on the spine and whether the damage reaches the spinal cord and nerves. Some children of Vietnam veterans born with spina bifida can never live independently, especially those with the most serious form of the neural tube defect. The three primary types of spina bifida include:

• Myelomeningocele: As the most serious form of spina bifida, myelomeningocele develops when a fluid-filled sac protrudes through the opening in the developing baby’s back. A portion of the spinal cord and nerves contained within the sac grow abnormally for the remainder of the pregnancy. This type of neural tube defect causes moderate to severe symptoms such as loss of bladder or bowel control, inability to move the legs, and loss of sensation in the hands and feet.
• Meningocele: A sac of fluid also protrudes through an opening in the baby’s back with this type of spina bifida. Since the spinal cord does not grow in the fluid-filled sac with the meningocele type of spina bifida, little or no nerve damage occurs. This type of neural tube defect caused by Agent Orange exposure typically leads to minor disabilities.
• Spina bifida occulta: Also known as hidden spina bifida, this form is the mildest of the three types. Babies born with spina bifida occulta have a small opening on their spine but no opening or sac on their back. That means the nerves and spinal cord function normally. Spina bifida occulta usually does not cause disability. The child or a doctor may not discover it until late childhood or early adulthood.

Doctors can usually diagnose spina bifida in children of Vietnam veterans during the mother’s pregnancy. However, it may not be possible to diagnose milder cases of spina bifida until after the baby is born. Both male and female Vietnam veterans who faced Agent Orange exposure can pass spina bifida along to their children years after their military service ended.

Benefits Available to Children of Vietnam Veterans with Spina Bifida

The Department of Veterans Affairs (VA) assumes that a biological child of a Vietnam veteran born with spina bifida developed the condition in utero due to the Agent Orange exposure of one of the parents. Therefore, it does not require evidence showing a positive link between the parent’s military service and herbicide exposure to the child’s spina bifida. The only exception to this is when the child receives a diagnosis of occult spina bifida.

Eligible children of Vietnam veterans receive healthcare benefits and vocational training. The latter consists of up to 24 months of job training, job placement assistance, and rehabilitation services. Children of Vietnam veterans must be at least 18 years old or have completed high school, whichever occurs first. Depending on circumstances, some participants in the Department of Veterans Affairs vocational training program may be eligible for an extension of up to 24 months after completing the first 24-month period.

While the VA does not require medical proof of the relationship between the parent’s Agent Orange exposure and the child’s spina bifida, it does impose other requirements to receive healthcare services and vocational training. These include:

• The parent must be a Vietnam Veteran who completed military service between January 9, 1962 and May 7, 1975.
• The parent may also be a Vietnam veteran who faced herbicide exposure while serving in the Korean Demilitarized Zone between September 1, 1967 and August 31, 1971. The U.S. Department of Veterans Affairs presumes that any Vietnam veteran who completed military service between these dates faced Agent Orange exposure.
• The child born with spina bifida must be biological offspring. The conception must have also taken place after the parent reported for military service in the Vietnam War or Korean Demilitarized Zone.

Birth Defects Associated with Female Vietnam Veterans

Spina bifida is the only known birth defect associated with male Vietnam veterans of America. The VA recognizes several other negative health effects in the children of biological mothers who served in the Vietnam War or the Korean Demilitarized Zone. The health problems of children born to female Vietnam veterans do not relate to Agent Orange exposure, any other type of herbicide exposure, or dioxin exposure. The only correlation between the birth defect and the mother’s military service is that she served in Vietnam, according to VA.

Children of female U.S. military veterans born with a physical or mental deficit that doctors expect to last throughout his or her lifetime are also eligible for certain VA benefits. The list of eligible birth defects includes:

• Achondroplasia
• Cleft lip and cleft palate
• Congenital heart disease
• Congenital talipes equinovarus (clubfoot)
• Esophageal and intestinal atresia
• Hallerman-Streiff syndrome
• Hip dysplasia
• Hirschsprung’s disease (congenital megacolon)
• Hydrocephalus due to aqueductal stenosis
• Hypospadias
• Imperforate anus
• Neural tube defects other than spina bifida
• Poland syndrome
• Pyloric stenosis
• Syndactyly (fused digits)
• Tracheoesophageal fistula
• Undescended testicle
• Williams syndrome

The child’s birth defect cannot be due to an inherited genetic disorder, an injury that occurred during the birth process, or another identifiable cause. Children of female Vietnam veterans must meet these qualifications to apply for VA benefits:

• Be the biological child of a woman Vietnam veteran who served in the Vietnam War or Korean Demilitarized Zone between February 28, 1961 and May 7, 1975.
• The mother conceived the child after the date in which she began military service in Vietnam.
• Have one or more of the above birth defects that results in permanent mental or physical disability.

Even when you or your disabled adult child meet the qualifications to receive disability compensation, the Department of Veterans Affairs could still deny the request. This is often due to applicants for VA benefits not completing the requested forms correctly or failing to submit the required proof of dates of military service. The best thing you can do if you or your disabled adult child received a letter denying VA benefits is to work with the disability law firm of Hill & Ponton. We can also assist you with preparing your application for the first time.

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A Cure with a Kick: Secondary Autoimmune Disorders to New Cancer Therapy

Immunotherapy is a relatively new treatment for cancers such as Hodgkin’s lymphoma, small cell lung cancer, and other hard to treat cancers and has some wonderful results. The basic theory is that immunotherapy prompts the body’s own immune system to attack cancer cells. However, some people are developing new autoimmune disorders due to immunotherapy treatment.

About 1% of people treated with immunotherapy developed a rare, adult-onset of Type 1 diabetes. Unfortunately, the condition is often misdiagnosed as Type II and attributed to other issues in many adults. Currently, most people who have a comorbid autoimmune disorder and cancer are not eligible for immunotherapy treatment because of the fear that it will worsen their autoimmune disorder; however, the benefits may outweigh the risks.

What Is Immunotherapy?

It’s important to understand the function of immunotherapy before diving into the potential side effects. As mentioned above, this cancer treatment works by boosting the body’s immune system. The immune system can then attack the cancer cells. There are several types of immunotherapy, including:

• Checkpoint inhibitors: During this type of immunotherapy, drugs are administered to help the immune system recognize the cancer cells. The immune system can then attack the cancer cells.
• Chimeric antigen receptor (CAR) T-cell therapy: This therapy involves t-cells taken directly from the cancer patient’s blood. The medical professional then mixes these existing cells with a virus that causes the t-cells to attack the cancer cells. They then inject the car-t therapy mixture into the patient.
• Cancer vaccines: Some types of immunotherapy are administered as a vaccine.
• Monoclonal antibodies: Also called mAbs or MoAbs, these antibodies are synthetic versions of immune proteins. The proteins are designed to specifically attack cancer cells.

Other types of immunotherapy include cytokines, immunomodulators, and oncolytic viruses. All of these treatment options are designed to either boost the body’s natural immunity or simulate the immune system. The FDA has approved immunotherapy as a treatment for a number of cancer types, including bladder cancer, breast cancer, and prostate cancer. Immunotherapy drugs may be an effective alternative to traditional treatments like chemotherapy and radiation therapy.

Immunotherapy Side Effects

While immunotherapy treatments attack cancer cells, they may also harm healthy cells. This can cause a number of side effects. The most common side effects of immunotherapy include flu-like symptoms and skin reactions. Treatment can cause cancer patients to experience fever, fatigue, chills, muscle weakness, vomiting, nausea, body aches. Along with these flu-like symptoms, they may also have high or low blood pressure. Skin reactions may include dryness, redness, blisters, and sensitivity to sunlight. Other side effects may include:

• Headaches
• Weight gain (fluid retention)
• Leg swelling
• Sinus congestion
• Shortness of breath
• Cough
• Hormone changes (such as hypothyroidism)

It’s important that cancer patients keep their oncologist updated about any immunotherapy side effects. A cancer care team can help with immunotherapy side effects management.

Immunotherapy And Autoimmune Diseases

Recent clinical trials are studying the safety of cancer immunotherapy treatment in individuals with autoimmune diseases. Autoimmune diseases are conditions in which the body’s immune system attacks healthy cells. These are diseases like type 1 diabetes, celiac disease, multiple sclerosis, and rheumatoid arthritis. Oncologists have had concerns about this type of cancer care for patients with autoimmune diseases, as people with these conditions already have overactive immune systems.

If a cancer patient doesn’t have an autoimmune disease, the development of such diseases can be among the serious side effects of treatment. Veterans who may have developed an autoimmune disease from immunotherapy cancer treatment may be eligible for benefits based on their condition.

How Does Immunotherapy Affect Veterans?

Hundreds of thousands of Veterans are service-connected for cancers of all types. If a Veteran is service-connected for cancer and has immunotherapy treatment, then develops an autoimmune disorder, normally no one would associate the two and the VA would deny the claim, if there was a claim even filed. Most autoimmune disorders are not service-connectable unless they developed in service or within one year of discharge (7 years in the case of Multiple Sclerosis). However, this changes the ball game. These claims would now be secondary disorders to the current service-connected cancer.

How to File a Claim for Autoimmune Disorders after Cancer Treatment

If a Veteran has gone through immunotherapy treatment and later developed an autoimmune disorder, there are certain documents that are required to file a claim.

1. Documentation of immunotherapy treatment from an oncologist or healthcare provide=, preferably including the specific medications used in treatment;

1. How often the Veteran was treated with immunotherapy treatment (schedule of treatment);

1. What type of cancer was being treated (it must be service-connected cancer); and

1. Diagnosis of an autoimmune disorder that developed after treatment.

What Autoimmune Disorders are Connected to Immunotherapy side effects?

Even if the cancer is in remission, if a Veteran acquires Type 1 diabetes or systemic sclerosis from immunotherapy treatment, that could lead to an increased rating based on the severity of the disorder. Some potential autoimmune disorders linked to immunotherapy include:

1. Type 1 diabetes;
2. Dermatomyositis;
3. Systemic sclerosis;
4. Rheumatoid arthritis;
5. Sjogren’s syndrome;
6. Lupus;
7. Multiple Sclerosis;
8. Pneumonitis (inflamed lungs);
9. Colitis; and
10. Uveitis (inflamed eyes).

Some of these are symptoms to an autoimmune system gone awry and can be treated and others are permanent conditions. Regardless, if a Veteran who has undergone immunotherapy treatment is diagnosed with any autoimmune disorder, filing a claim for secondary service connection is warranted.

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Earlier this week, Secretary Denis McDonough ordered a review of VA policies to ensure that transgender Veterans and employees do not face discrimination on the basis of their gender identity and expression. Once completed, this review would put VA policies in line with Department of Defense policies and President Biden’s executive order ensuring that transgender Americans are treated with dignity and respect, and are able to live their lives free from worry that they could be discriminated against because of who they are.

The policy review that the secretary is mandating is far-reaching, requiring VA to examine the entire slate of services that the department provides to Veterans to ensure maximum equity and inclusivity, including the delivery of medically necessary, gender affirmation care and procedures.

However, some of the most impactful changes could also be the most basic, such as those that would afford Veterans the basic dignity of being recognized for how they self-identify. To that extent, changes could include ensuring that VA systems are able to accommodate a Veteran’s preferred name and pronouns when interacting with VA.

Ensuring better access to VA services could vastly improve the lives of LGBT Veterans, who are more likely to report poor health conditions and suffer from multiple chronic conditions than other Veterans. This disparity is partly a result of having to face stigma and discrimination, resulting in LGBT Veterans forgoing needed medical care.

The situation becomes more acute when examining the barriers that exist for the more than 134,000 Veterans and 15,000 service members who identify as transgender. The issues facing the Veteran community as a whole are magnified significantly for transgender and gender-diverse Veterans. Ensuring access to VA care and services could have a significant impact to this underserved community. Transgender Veterans, for example, die by suicide at almost six times the rate of the general population, and access to gender-affirming health care could significantly reduce suicidality.

Homelessness among transgender Veterans also increased by 89% between 2015-2018, even though it decreased by 48% among all Veterans. A strategy for reducing homelessness that addresses the specific barriers that transgender Veterans face could effectively end the prevalence of housing instability within the community.

Finally, better access to the array of VA Veteran readiness and employment services could improve the lives of transgender workers who are at greater risk of poverty and unemployment.

VA will be welcoming to all Veterans

The good news is that the department is not starting from scratch. Although VA still has a long way to go in ensuring that transgender Veterans are afforded the full scope of VA services that other Veterans are afforded, this policy review would build on the disparate efforts and programs across the department that are currently in place to ensure that VA is welcoming to all Veterans regardless of their gender identity and expression.

All VA Medical Centers, for example, have LGBT Veteran care coordinators who work with staff to ensure that LGBT Veterans receive the same level of care even after “coming out” to their providers. Additionally, programs like PRIDE are training VA employees to deliver a group wellness class to LGBT Veterans that teaches skills for coping with the specific challenges they face, including accessing VA care.

These programs are bridging some of the gaps in services that LGBT Veterans receive, and a 2015 survey that showed 87% of transgender Veterans being always or mostly treated respectfully indicates that we are more than ready and able to fully close that gap.

Fulfilling our commitment

A review of policies and procedures across VA would standardize the services and support that we provide to LGBT Veterans and could amplify the pre-existing programs that are already creating a more inclusive environment for all Veterans. This review, and the changes that it could herald, would bring us closer to fulfilling our commitment to care for those who shall have borne the battle.

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Department of Veterans Affairs Secretary Robert Wilkie released the following statement after President Trump signed the Commander John Scott Hannon Veterans Mental Health Care Improvement Act, into law.

“This legislation moves America closer to a goal that all citizens can support: increasing the local resources available to our men and women who answered the call to defend this Nation. This law will expand mental health care services at VA facilities and at the same time provide grants to make it easier for Veterans to access non-VA resources in their communities.

“Care in the community is a critical component of our effort to end Veteran suicide. About 60 percent of the Veterans who die by suicide aren’t getting care from VA, so it’s vital we do all we can to offer intervention and care to Veterans where they live. This bill takes a strong and meaningful step in that direction.”

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Today, Veterans Affairs (VA) Secretary Robert Wilkie dedicated a permanent memorial at the Camp Butler National Cemetery in Springfield, IL, celebrating President Lincoln’s second inaugural address which gave VA its mission and motto.

The plaque rests at a VA-run cemetery in the city that became Lincoln’s home. Next to the plaque is an interpretive sign that explains how Lincoln’s words would come to serve as VA’s motto and that vision grew into the department we know today.

March 4, 1865, Lincoln stood at the U.S. Capitol and sought to heal the nation in one of the most important speeches in American history. At the end of his remarks, Lincoln asked the nation to care for those Americans who take the oath and fight to defend us, a call that VA still answers today.

“With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation’s wounds; to care for him who shall have borne the battle, and for his widow, and his orphan – to do all which may achieve and cherish a just, and a lasting peace, among ourselves, and with all nations,” Lincoln said.

Under Secretary Wilkie’s direction, all 145 VA national cemeteries will display these interpretive signs, so all Americans understand the importance of VA’s mission.

“Today’s VA welcomes all Veterans, including the 10% of all Veterans who are women. The words that brought us here should not to be diluted, parsed or cancelled,” Wilkie said. “The words that brought us here ought to be preserved as they were spoken and displayed so every generation understands the origin of America’s progress in becoming the most tolerant nation on earth.”

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Department of Veterans Affairs Secretary Robert Wilkie released the following statement after President Trump signed the National Suicide Hotline Designation Act:

“People in distress and in need of timely care should face the fewest obstacles possible to get help. The bill President Trump signed today will soon make it easier for those at risk to be quickly connected to a trained responder and will help save lives.”

Currently, anyone in need of timely crisis suicide prevention resources can reach the National Suicide Prevention Hotline by dialing 1-800-273-8255. Veterans who call that number can press 1 to be connected to the Veterans Crisis Line.

During the transition to 988, Americans who need help should continue to contact the National Suicide Prevention Lifeline by calling 1-800-273-8255 (1-800-273-TALK) and through online chats. Veterans and service members may reach the Veterans Crisis Line by pressing 1 after dialing, chatting online at www.veteranscrisisline.net, or texting 838255.

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ATLAS provides ‘Patient Centered Care’ for Veterans

Accessing Telehealth through Local Area Stations (ATLAS) is part of VA’s Anywhere to Anywhere telehealth initiative. ATLAS enhances a Veteran’s access to care by bridging the digital divide.

Editor’s note: This blog has been updated with new information onFeb. 6, 2020.

ATLAS establishes convenient, video telehealth locations for Veterans’ appointments with VA providers in communities where there was otherwise long travel times to VA facilities, or limited internet connectivity at home.

VA is partnering with public and private organizations to provide comfortable appointment rooms at local access sites. Philips North America donated equipment to Veterans of Foreign Wars (VFW) and The American Legion to establish a total of 10 ATLAS sites. VA has also collaborated with Walmart to initiate an ATLAS pilot at five select Walmart stores for 12 months.

While there are no VA employees based at ATLAS sites, there is an on-site attendant to provide Veterans with information on how to join their appointment, troubleshoot technical issues, and clean the space. The attendant will not be present when the Veterans connect to the VA provider, and will not have access to the Veteran’s medical record.

ATLAS appointments do not replace or take away a Veteran’s option to receive in-person care. The choice of where and when to receive VA care is ultimately up to the Veterans and their VA care team.

Veterans interested in this program are encouraged to contact their local VA medical centers to determine service availability in their local area. For more information about ATLAS, visit the ATLAS webpage.

Contacts

Please use the contacts below for ATLAS questions that are location specific. These individuals will only be able to assist with ATLAS specific questions for their designated areas. For all other questions, call VA311 (844-698-2311) or the White House VA Hotline (1-855-948-2311).

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'This is a very grim reality, not just for the United States but for so many of our partners around the world,' lawmaker says on 'The Story'

Sen. Joni Ernst, R-Iowa, the first female combat Veteran elected to the U.S. Senate, condemned the potential collapse of Afghanistan to the Taliban, as the insurgent group gains control of one provincial capital after another in short order ahead of President Biden's August 31 troop withdrawal date.

Ernst blamed the president for the conditions on the ground, as the Pentagon engaged in a mission to help evacuate Americans from the U.S. embassy in Kabul.

She told "The Story" that while Rear Adm. John Kirby, the Pentagon's spokesman, has made himself available to reporters multiple times this week, Biden conversely remained silent on the issue Friday as he left Washington for a weekend vacation at Camp David near Sabillasville, Md.

"This is a very grim reality, not just for the United States but for so many of our partners around the world to see Afghanistan fall like this. It is all on President Biden's shoulders," Ernst said Friday.

"This rapid and haphazard withdrawal of American troops -- before we knew that our embassy would be safe, before we had our Afghan interpreters and other friends out of Afghanistan, to allow it to fall like this without any sort of plan or recourse, it is shameful."

"Again, it is all on President Biden"

Ernst said the potential return of Taliban control over Afghanistan could make it possible for Islamic extremist groups to again have a safe haven to "reconstitute" themselves. Afghanistan was a hotbed for terrorists before President Bush sent troops there following the 9/11 attacks.

Al Qaeda, the group behind the 9/11 attacks, has seen their numbers dwindle in the 20 years since to approximately 200, according to former Secretary of State Mike Pompeo.

"This did not have to happen," Ernst warned. She added the return of the Taliban brings new risks, especially to the women in the country who were enjoying fledgling freedom under the democratically-elected governments over the past decade.

Biden had been warned by other Republicans he would risk a "Saigon moment" – in reference to how the Vietnam War ended – if he went ahead with a swift withdrawal from Afghanistan.

House Armed Services Committee ranking member Mike Rogers of Alabama and Committee member Mike Gallagher of Wisconsin both made the reference in recent weeks, with Rogers saying in a statement this week that he pressed the White House for a plan to "avoid the very situation that is now happening in Afghanistan."

"Now, American lives are at risk because President Biden still doesn’t have a plan," Rogers said. Gallagher remarked in June that "chaos on the ground" is possible.

"This may be the ‘Saigon moment’ where you’ve got the helicopter leaving and that’s what everybody associates with his policy," he said at the time.

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A Navy Veteran in the Senate is calling on Defense Secretary Lloyd Austin to break up the logjam delaying upgrades of so-called "bad paper discharges" for Veterans with post-traumatic stress or traumatic brain injury.

In a letter to Austin citing a recent Military.com report on the issue, Sen. Gary Peters, D-Mich., asked for a detailed accounting of how the Pentagon has responded to the law passed in 2017 calling for the service branches to speed up the review process for these discharges.

Other-than-honorable discharges can cut Veterans off from a range of benefits, including the GI Bill and home loans.

"Expeditious review board decisions will give our brave men and women who are suffering from the invisible wounds of war an opportunity to access the benefits they have earned through their service," Peters said in the letter.

"A solution must be found so that transitioning service members as well as Veterans have access to the support they need," said Peters, a member of the Senate Armed Services Committee and a former Navy Reserve lieutenant commander.

Pentagon Press Secretary John Kirby had no immediate response to questions on whether Austin was addressing the issue, but said a written response was forthcoming.

"While I understand that the COVID-19 pandemic has added obstacles for Veterans seeking to have their records corrected due to the backlog at the National Personnel Records Center, these delays and difficulties predate the current pandemic and are concerning," Peters said.

In 2017, Peters sponsored an amendment that passed into law with the National Defense Authorization Act requiring discharge review boards to give "liberal" consideration for upgrades to Veterans who could show that they had been diagnosed with PTSD or TBI while in uniform.

Despite the law, the process has proven to be cumbersome and subject to lengthy delays, and is now the target of two class-action suits against the services to speed up the reviews.

"The long wait times need to be immediately addressed," Danica Gonzalves, program director for the Veterans Consortium Pro Bono Program, a 501(c)(3) nonprofit that has been assisting Veterans seeking upgrades.

Decisions can take more than three years, she said in a statement to Military.com, because of an "unconscionable backlog" of requests for necessary paperwork due to COVID-19 restrictions at the National Personnel Records Center.

The Center "is still not fully functional," Gonzalves said, and the Veterans who could show they suffered from PTSD or TBI "cannot obtain the records they need to apply for a discharge review."

Stephen Jordon, executive director of the consortium and a retired Navy captain, said there was a special urgency to speeding up the process for aging Veterans.

"There is nothing more heartbreaking than seeing a Veteran that passes away with what would have been a successful discharge upgrade case still bogged down in the system," Jordon said.

Military.com last month interviewed several Veterans who received other than honorable discharges although they had been diagnosed by the military with PTSD or TBI. They spoke of the benefits they have been denied, but also stressed the lifetime "stigma" they now feel they bear with a discharge status that essentially says their service did not count.

In his letter, Peters asked DoD to list the total number of discharge status upgrade requests received each year, the average length of time from submission to a decision, and the percentage of discharge upgrade petitions that are granted.

He also asked for details on what DoD was doing to streamline the review process and whether procedures would be standardized across the services on the reviews.

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WASHINGTON — A bipartisan group of senators on Thursday introduced a bill requiring the Department of Veterans Affairs to better Vet their health care providers after a report by a federal watchdog found the department has a track record of hiring unqualified doctors.

“Our nation’s Veterans have earned the right to the very best care, and it is outrageous that the VA is not sufficiently Vetting its health care providers,” Sen. Maggie Hassan, D-N.H., said in a statement.

The bill, which was introduced by Hassan and Sens. Joni Ernst, R-Iowa, and Kyrsten Sinema, D-Ariz., is called the Veterans Health Administration Caregiver Retention and Eligibility Determination Act. It would require the VA to improve guidance and policies on the hiring and credentialing processes and audit all providers with questionable records and determine whether those employees are still eligible for employment.

In October, Hassan, Ernst, Sinema, and Sen. Bill Cassidy, R-La., penned a letter to the VA that raised concerns about a Government Accountability Office report that found the department “overlooked or missed disqualifying information” when hiring health care providers. The senators never received a response to their letter.

“Following the VA’s failure to even respond to a letter asking how it will remedy the issues raised in the Government Accountability Office report, my colleagues and I are introducing bipartisan legislation to ensure that the VA takes action so that Veterans are not cared for by providers with a history of misconduct,” Hassan said.

The GAO reported unqualified hires were often the result in VA facilities not adhering to their hiring policies. In five health care facilities, officials weren’t aware of the policy of not hiring health care providers whose credentials have been revoked or surrendered due to incompetence or misconduct.

One example in the GAO’s report from February found was a physician who surrendered his physical-therapy license for not completing continuing education. The VA said it found no concerns with its work performance, according to the report.

In another case, the GAO found a nurse, who has been working at the VA since 2003, had her nursing license revoked in one state after not completing required training. However, the nurse continued her employment with the VA because the department found she had a license in another state. Once the GAO highlighted its concerns about medical licenses, the VA terminated five health care providers.

A VA spokeswoman said Friday that the department has not taken a position on the proposed legislation and completed an "extensive review" of all their health care providers' qualifications and license requirements in 2018, a year before the GAO issued its report. Early this year, the department said it revised decades-old policies to better assure providers meet qualification requirements.

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WASHINGTON — After years of inaction, lawmakers and advocates in 2018 rallied around an ambitious plan to modernize the sprawling, government-run health care system for Veterans, which still treats many patients in hospital wards built before World War II.

A commission, mandated that year by Congress, was tasked with weighing recommendations from the Department of Veterans Affairs for each of its 1,200 hospitals and clinics across the country and holding hearings in affected communities. The southward migration of Veterans from the Northeast and Midwest, the shift from costly inpatient to outpatient care and the age of each building would factor into whether facilities would be urged to close, reduce service or shift patients into private care. VA would finally catch up to modern private hospitals, saving billions of dollars it spends each year to shore up its aging health care facilities, proponents of the plan argued.

But a long-sought realignment of the country’s largest health care system was killed this week by bipartisan political resistance through a short news release from 12 senators who said they would not approve the nine nominees up for confirmation to establish the Asset and Infrastructure Review (AIR) Commission. And a costly four-year effort to reposition VA in an increasingly competitive health care market fell victim to the principle that, just as all politics is local, so, apparently, is any decision to shift services for a constituency as crucial as Veterans.

The lawmakers indicated that the politically explosive recommendations VA made in March made moving forward impractical.

“We share a commitment to expanding and strengthening modern VA infrastructure in a way that upholds our obligations to America’s Veterans,” the senators, led by Senate Veterans’ Affairs Committee Chairman Jon Tester, D-Mont., wrote in their release Monday. “We believe the recommendations put forth to the AIR Commission are not reflective of that goal, and would put Veterans in both rural and urban areas at a disadvantage.” The release said lawmakers were committed to a “continued push” to help VA invest in “21st century [health-care] facilities” for Veterans.

Lawmakers in both parties had expressed misgivings about a process they felt was flawed from the start. The data VA relied on to assess the hospitals was several years old and collected before the coronavirus pandemic, potentially skewing the number of patients and physicians in a community to appear lower than they really were.

The White House also was slow to nominate the nine-member commission, with the final member announced only last week. That left a too-tight window to complete its work by an early 2023 deadline, lawmakers argued, as well as uncertainty about whether a nominee would face pressure to weigh in on the recommendations in order to be confirmed.

But by halting the commission and the sweeping plan released by VA Secretary Denis McDonough with recommendations to build about 80 new clinics, hospitals and nursing homes of varying sizes and close a net of three major hospitals and dozens of clinics with unused inpatient beds, the lawmakers left the agency with no blueprint to modernize its aging system, current and former officials said.

“President Biden has insisted that our Veterans in the 21st century should not be forced to receive care in early 20th century buildings,” Melissa Bryant, VA’s acting assistant secretary for public and intergovernmental affairs, said in an email. She noted that the median age of VA hospitals is nearly 60 years. “Whatever Congress decides to do with the AIR Commission, we will continue to fight for the funding and modernization that our Veterans deserve,” Bryant wrote.

VA leaders going back years have said they are burdened by the need to maintain as many as 1,000 underused clinics and hospitals, some of which have more staff than patients, at significant cost. Closing them would require approval from Congress.

When the commission was created as part of the larger Mission Act, conservatives said the government would reduce wasteful expenses and shift more Veterans’ health care to the private sector. Democrats, including McDonough, embraced the possibility of caring for more Veterans in communities where they’re moving.

“We saw it as an opportunity,” said one VA official, who spoke on the condition of anonymity to discuss a sensitive issue. In a commitment to new investment, President Joe Biden requested about $18 billion in new money for VA construction in an early version of his infrastructure plan, although the money was eventually left out of the law.

But even before McDonough released his recommendations, members of Congress who were briefed on possible reductions to service in their districts went on the offensive, some holding rallies in opposition, others issuing defiant statements that previewed the battle to stave off reductions. The American Federation of Government Employees, the union representing more than 200,000 VA staff, pressured Democratic allies in Congress to oppose feared job losses. Republicans, most of whom voted for the Mission Act, became sensitive to local concerns that Veterans would lose access to doctors, as the plan called for closing or rebuilding 35 large hospitals in 21 states.

“It’s a total lack of courage,” Robert McDonald said of the decision to kill the commission, citing the midterm elections in November. “It’s obvious what’s behind it. There’s an election coming up. Elections are local.”

McDonald, who was VA secretary for several years under President Barack Obama, had tried to close a sparsely used hospital in South Dakota, only to see the Trump administration cancel the plan soon after taking office following objections from Sen. Mike Rounds, R-S.D.

Robert Wilkie, President Donald Trump’s second VA secretary, also expressed disappointment with this week’s decision. “We have to build a VA where the Veterans live now, not where they lived in 1945,” he said in a text message. “The VA dollar is being stretched to the breaking point and dissolving the commission does not help.”

It’s unclear if lawmakers who still support the commission have any options. Rep. Mike Bost, R-Ill., who with Sen. Jerry Moran, R-Kan., opposed the decision, said in a statement Wednesday that he is “still assessing how to move forward “as the law requires.”

“The fact remains that there is a serious and growing mismatch between the VA health care system as we know it today and how, and where, it needs to evolve for the future,” Bost wrote.

Darin Selnick, a senior adviser for Concerned Veterans for America who led efforts at VA and later the Trump White House to create the commission, said the Biden administration left VA to issue recommendations with no structure to Vet them, opening the process to political resistance.

“Anytime a legislator hears they might close a facility in their district they go ballistic,” Selnick said, “but if you had had a commission in place that wouldn’t have mattered.” He emphasized that VA’s plan “was only a set of recommendations” that could have been changed.

An official with the American Legion predicted dire consequences of inaction.

“Veterans are going to lose,” said Chanin Nuntavong, the group’s executive director of government and Veteran affairs. “Old infrastructure needs to be repaired or replaced. Veterans’ care will be degraded by a lack of technology and unsanitary conditions while construction costs go through the roof.”

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Senate leaders on Wednesday announced they have reached a deal to pass sweeping military toxic exposure legislation later this summer, paving the way for millions of Veterans exposed to burn pit smoke and other battlefield toxins to receive more medical care and disability benefits in coming years.

In a statement, Senate Veterans’ Affairs Committee Chairman Jon Tester, D-Mont., and ranking member Jerry Moran, R-Kansas, hailed the agreement as a framework for “the most comprehensive toxic exposure package” in American history.

They also said House leaders have already offered support for the deal, which is based largely on legislation already advanced in that chamber in March.

“For far too long, our nation’s Veterans have been living with chronic illnesses as a result of exposures during their time in uniform,” Tester and Moran said. “Today, we’re taking necessary steps to right this wrong with our proposal that’ll provide Veterans and their families with the health care and benefits they have earned and deserve.”

The House plan — the Promise to Address Comprehensive Toxics Act, or PACT Act — would establish a presumption of service connection for 23 respiratory illnesses and cancers related to the smoke from burn pits, used extensively in those war zones to dispose of various types of waste, many of them toxic.

The bill also provides for new benefits for Veterans who faced radiation exposure during deployments throughout the Cold War, adds hypertension and monoclonal gammopathy to the list of illnesses linked to Agent Orange exposure in the Vietnam War, and requires new medical exams for all Veterans with toxic exposure claims.

As many as one in every five Veterans living in America today could directly benefit from the new legislation.

Additions proposed by senators could indirectly benefit even more, but putting more money into Veterans Affairs claims processing and medical staff to reduce wait times for both services.

Specifics of the deal — including a final price tag — have not yet been released. The PACT Act advanced largely along party lines in the House in part because of the massive price tag: more than $207 billion over the next decade.

The addition of new VA staff is likely to push that figure even higher, although some of the costs will be deferred by a multi-year phase in of the new disability and medical benefits.

The measure also adds more resources for federal research on toxic exposure and creates a framework for “establishment of future presumptions of service connection related to toxic exposure,” something that Veterans Affairs officials have been working on in recent months.

Much of that work has focused on burn pits, large-scale fires used by troops in Iraq, Afghanistan and other war zones to dispose of a variety of waste.

Advocates have blamed the toxic smoke for a host of respiratory illnesses and rare cancers among younger Veterans, but scientific links between the fires and the sicknesses has been difficult because of incomplete monitoring of the air quality at the time.

Past estimates from the department have put the number of individuals exposed to burn pit smoke during the last 20 years at more than 3.5 million. But only a small fraction of that group has received disability benefits for long-term health issues, and typically only after years of paperwork and arguments with Department of Veteran Affairs claims staff.

Since VA officials began awarding benefits for a handful of respiratory conditions linked to burn pits last summer, more than 16,500 Veterans have received about $36 million in disability benefits.

The presumption of exposure included in the PACT Act and the expanded list of burn pit illnesses could dramatically expand those numbers in coming years.

Advocacy groups hailed the compromise announcement as long-awaited relief for Veterans and their families.

“The men and women of the U.S. Armed Forces confront health challenges of a scope and complexity that few others experience,” said Chanin Nuntavong, executive director of the American Legion.

“Despite U.S. troops being withdrawn from South Vietnam in 1973, the VA only recognized presumptive conditions associated with service in 1993. Almost 50 years later, Vietnam Veterans are still fighting for the care they rightfully deserve.

“We cannot repeat these injustices by failing to provide another generation of Veterans the care they need. The Honoring our PACT Act is the comprehensive legislative solution that toxic exposed Veterans of multiple generations desperately need, and Congress must act swiftly to ensure its passage.”

IAVA Executive Vice President Tom Porter said he is “greatly encouraged and optimistic” following the Senate announcement.

“This has been a top priority for IAVA and our partner organizations for years,” he said. “We will need many others to follow [Tester and Moran] and we will keep pushing until it finally passes Congress and is signed into law.”

The senators said they expect to finalize bill text in coming days, and will push for a Senate floor vote “as soon as possible.”

If the bill is amended in that process, House lawmakers will have to vote on the measure again before it can be sent to President Joe Biden to be signed into law.

On Tuesday night, during remarks before a Elizabeth Dole Foundation event, House Speaker Nancy Pelosi, D-Calif., told a crowd of Veterans advocates she was optimistic that final passage of the measure would come “soon.”

During his State of the Union address earlier this year, Biden called for Congress to “pass a law to make sure Veterans devastated by toxic exposures in Iraq and Afghanistan finally get the benefits and comprehensive health care they deserve.” With Wednesday’s announcement, that call is closer than ever before to becoming reality.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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PHILADELPHIA – United States Attorney William M. McSwain announced that Ralph Johnson, 54, of Kinzers, PA, former Chief of Environmental Management Services at the Corporal Michael J. Cresenz Veterans Affairs Medical Center (VAMC) in Philadelphia, PA, was charged by Indictment for soliciting and accepting bribes in connection with contracts and purchase orders at the medical center.

As the Chief of Environmental Management Services, Johnson was responsible for a range of sanitation, waste removal, linen and uniform services for the Philadelphia VAMC, and participated in the solicitation and award of contracts to vendors for those services. According to the Indictment, Johnson is charged with asking for, and receiving, thousands of dollars in cash from two Florida-based companies in return for steering purchase orders and contracts to those companies several times from about July 2018 until August 2019. He is also charged with seeking a $10,000 kickback on an $84,000 contract for tree trimming and removal awarded to one of those vendors, for which Johnson had fraudulently and grossly inflated the estimate of the work to be done and the price for that work under the contract.

“The allegations here are shameful. By giving us their best, we owe our veterans the same in return. As a senior official tasked with maintaining a healthy and safe environment for the care and treatment of our nation’s veterans, Ralph Johnson had a responsibility to do that job with honesty and integrity,” said U.S. Attorney McSwain. “Rather than being concerned about serving our veterans, Johnson was allegedly concerned with serving himself by lining his own pockets at taxpayers’ expense.”

David Spilker, Special Agent in Charge at the Veterans Affairs Office of Inspector General (OIG) stated, “VA OIG will vigorously investigate alleged instances when government employees solicit and accept bribes and kickbacks from vendors and contractors who seek to obtain business with the VA. As alleged in the indictment, Johnson’s actions breached the public’s trust, undermined the integrity of VA’s operations, and besmirched the vital work that honest hardworking VA employees do every day in support of our nation’s veterans.”

If convicted, the defendant faces a possible sentence of 45 years imprisonment, 3 years supervised release, and up to a $750,000 fine.

The case was investigated by the United States Department of Veteran Affairs, Office of Inspector General, and is being prosecuted by Assistant United States Attorney K.T. Newton.

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Device uses lights and sounds to comfort dementia patients

Veteran Thomas Wojtasiak looked carefully at the colorful light show displayed on the machine in front of him.

He is a resident in the Community Living Center on VA Pittsburgh Healthcare System’s H.J. Heinz III campus.

The machine, a Vecta Delight Mobile Sensory Station, appears to be part lava lamp, part laser show and part bubble machine. It can be programmed to emit colorful lights, project calming images onto the ceiling and play music chosen for the patient’s needs.

Therapists use the recently acquired sensory machine as part of the cognitive training they provide to Veterans. The sensory device helps connect Veterans on the memory care floor with their environment.

Above, Wojtasiak uses a color pad to match colors displayed by the mobile therapeutic sensory device. Assisting is dance/movement therapist Brianna Martin. (Photo by Bill George)

Machines can be calming or therapeutic stimulation

For some Veterans, the machine’s combination of lights, images and music are calming. Others find it a source of therapeutic stimulation.

For Wojtasiak, it was all about the interaction. “It really catches your eye,” he said.

Martin handed Wojtasiak two items for controlling the machine: a color pad and a squeeze ball.

The color pad is a handheld box with six colorful buttons. Veterans push the buttons to change the machine’s brightly lit colors as they wish. They can also tap buttons at their therapist’s direction to match colors as they are displayed by the machine.

The squeeze ball allows Veterans to control the speed of bubbles that float upward inside the machine’s narrow plastic tubes.

“It looks like Christmas over there,” Martin says as she moderates Wojtasiak’s therapy session.

Wojtasiak worked with the multimedia wonder machine for about ten minutes. He so enjoyed the machine’s calming influence he asked if it could be placed in his room to help him fall asleep at night.

Sanitized after each use

When Wojtasiak finished his therapy, Martin’s assistant, intern Helena Barker from Antioch University in New Hampshire, carefully wiped down the machine, color pad and squeeze ball for the next patient to use.

The Vecta, also known as a sensory cart, has quickly become the most popular and requested therapy at Heinz since its acquisition in September. It has different mood effects on different people. Martin said she can tailor its sound and vision show for each Veteran’s condition.

“The biggest advantage I see is that it helps Veterans to be more connected to their immediate experience or be more present in the moment with either myself or Helena,” she said. “We can help them calm down or wake them up to their surroundings more.”

On the wards, nurses have also noticed a difference in their patients.

Nurses: It helps patients concentrate and focus

“With our dementia population, we see episodes of confusion and frustration, and the sensory cart helps them keep calm and able to concentrate and focus,” said Michelle Clayton, assistant nurse manager.

The Vecta is easy to maintain because its bubble tubes and almost everything on it are made from high-impact plastic. The tubes are even waterless: A fan in the bottom of each gently circulates Styrofoam balls upward to mimic bubbles.

Martin said the machine has already positively impacted Veterans, including one who can agitate easily and has difficulty falling asleep. Just 20 minutes with the machine calms the Veteran to where he now gently falls asleep.

According to Jamie Sloan, recreation and creative arts supervisor, VA Pittsburgh acquired the sensory machine through a grant from the Military Construction, Veterans Affairs and Related Agency Appropriations Act of 2020.

Vendor modified equipment for VA patients

“We purchased it from a local vendor in neighboring Gibsonia and discussed our needs regarding safety, infection control, ease of use, and dignity related to adult versus child components,” said Sloan, explaining the vendor specializes in children’s sensory toys.

“They built a custom machine for us, modifying the equipment for our mature population, easy maintenance, and infection prevention,” he added.

Sloan said they will soon make the machine available for therapy sessions for all residents in the community living center, once leadership finalizes standard operating procedures.

For now, Veterans on the memory care floor can’t get enough of it.

“It’s an awesome tool to use for dementia,” said nursing assistant Michelle McFadden. “They do so well with it. A lot of our patients are very anxious and it really relaxes them into a whole different zone.”

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The heads of the U.S. military branches are calling on the Defense Department to stop the transfer of all medical facilities to the Defense Health Agency, saying the novel coronavirus pandemic has shown that the plan to convey the services' hospitals and clinics to the agency is "not viable."

In a memo sent to Defense Secretary Mark Esper on Aug. 5, the secretaries of the Army, Navy and Air Force, along with the branch chiefs of the Army, Navy, Air Force, Marine Corps and Space Force, called for the return of all military hospitals and clinics already transferred to the DHA and suspension of any planned moves of personnel or resources.

They said that the COVID-19 outbreak has demonstrated that the reform, which was proposed by Congress in the fiscal 2017 National Defense Authorization Act, "introduces barriers, creates unnecessary complexity and increases inefficiency and cost."

"The proposed DHA end-state represents unsustainable growth with a disparate intermediate structure that hinders coordination of service medical response to contingencies such as a pandemic," they wrote in the memo, first obtained by a reporter for Synopsis, a Capitol Hill newsletter that focuses on military and Veterans health care.

The DoD launched major reforms of its health system in 2013 with the creation of the Defense Health Agency, an organization initially established to improve the quality of health care available to military personnel and family members and reduce services such as administration, IT, logistics and training that existed in triplicate across the three service medical commands.

But the initiatives ballooned in 2016, with Congress passing legislation that placed the DHA in charge of military hospitals and clinics worldwide, as well as research and development, public health agencies, medical logistics and other operations run by the service medical commands.

On Oct. 1, 2019, all military hospitals and clinics in the continental United States were transferred to the DHA, with those overseas expected to move over by October 2021.

But in December, Army Secretary Ryan McCarthy asked for a temporary halt of the transfers of Army facilities and requested that the Army Public Health Center and Army Medical Research and Development Command remain permanently under the service's control.

Ryan said he had concerns with what he viewed as a "lack of performance and planning with respect to the transition" by the DHA and Defense Department Health Affairs, according to a memo he sent Deputy Defense Secretary David Norquist.

McCarthy's comments were the first public statements by a military service in opposition to the transformation, which also calls for cutting roughly 18,000 military medical personnel.

In early March, the Air Force and Army surgeons general weighed in, telling the House Appropriations defense subcommittee that the reorganization is an "extremely difficult" and "complicated merger of four cultures." They suggested that the Defense Health Agency isn't ready for some of the coming changes.

The DHA assumed management of all domestic military treatment facilities without the staff or management capabilities to actually run them. As part of the plan, the services were to provide support and guidance for the DHA to run the hospitals and clinics in the interim, until its personnel were ready to operate them.

But then the pandemic struck. And according to a source familiar with operations at several medical treatment facilities in the Washington, D.C., region, tensions that had been bubbling since the initial facility transfer erupted.

At one facility, commanders and DHA leadership argued over who was responsible for the COVID-19 screening tents in the parking lot.

"There are definitely turf battles going on," said the source, a DoD civilian employee. "[The services] are making it very hard."

The COVID-19 pandemic has delayed several elements of the military health system reform effort. In March, the DoD placed a 60-day hold on a step to establish administrative markets responsible for military treatment facilities in five regions in the U.S.

In April, the department paused the rollout of its Military Health Systems Genesis electronic medical records program to several new medical facilities, although it continued to modernize the IT infrastructure needed to support the system.

And in June, the Pentagon's top health official announced that the DoD would delay some of the changes planned for this year, including an effort to begin closing or restructuring 48 hospitals and clinics and sending at least 200,000 patients to private care.

But Assistant Secretary of Defense for Health Affairs Thomas McCaffery, a former health industry executive who took office last August, has said he remains committed to reform, which he believes will improve quality of care while also saving taxpayer dollars.

"There's been at least 12 times since World War II where there has been efforts to change our system," McCaffery said during a visit to military health facilities in Washington last week. "All focused on the best way to organize and manage for the mission, have a ready medical force and a medically ready force. The mission is still the same, and having a more integrated system is the way to do it."

In their letter to Esper, the service heads said the DHA has been helpful during the pandemic in developing standardized clinical practices for the coronavirus response.

But they still asked him to suspend any transfer activity and appoint a working group to explore different options for management of the hospitals.

They also asked that all military hospitals, including two that have operated under the DHA and the National Capital Region since 2013 -- Walter Reed National Military Medical Center in Maryland and Fort Belvoir Community Hospital -- be returned to their respective services.

They did not say which service Walter Reed would fall under; the medical center was created after a merger between the Army's Walter Reed Medical Center in Washington, D.C., and the Navy's National Naval Medical Center in Bethesda, Maryland. It remains housed at Bethesda, a Navy installation.

"We look forward to working together to achieve successful reform of the military health system," they wrote.

Lisa Lawrence, a public affairs officer at the Pentagon, said the department plans to continue pursuing reforms as spelled out in the fiscal 2017 defense policy bill.

"The Department remains focused on ensuring the Services maintain a medically ready force and a ready medical force, as well as [ensuring] all eligible beneficiaries have continued access to quality health care," Lawrence said.

A staff member for the National Military Family Association said that it "makes sense" the pandemic would lead to a reevaluation of the military health system reforms, adding that the organization hopes the DoD, DHA and military services will continue focusing on accountability, transparency and standardization across the system.

"Whatever the outcome, our priority is that service members and families have access to high-quality health care, wherever they happen to be stationed," said Eileen Huck, deputy director for health care at NMFA.

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DUBUQUE, Iowa — Steve Vincent glanced down at the dog standing patiently beside his chair.

“Get it,” he commanded.

Doc, a 2-year-old yellow Lab, immediately picked up the leash that Vincent had dropped, returning it to his owner.

“Thank you,” responded Vincent, a resident of Maquoketa, Iowa.

Nearby, Garland Shirley patted his own dog, Smitty, who lay quietly at his side. Like Doc, Smitty sported a black vest proclaiming his status as a service dog.

Vincent and Shirley were paired with Doc and Smitty through IOWA (Inspiring Our Warriors of America) Service Dogs.

The Dubuque Telegraph Herald reports the nonprofit, launched in 2019, provides mobility and psychiatric service dogs to first responders and Veterans at no cost. Shirley and Vincent are the first two “warriors” to graduate the program with their canine companions.

“These individuals went out and served for us, whether for our country or for a community, and they’ve seen a lot and done a lot for us,” said Jamie Fisher, executive director of IOWA Service Dogs.

Vincent served in the Army for 31 years, including two deployments to Iraq between 2003 and 2010.

During his first deployment, he sustained a substantial head injury during an explosion, an injury that went untreated.

“We were told that if you weren’t dead or shot, you keep on working, so that’s what I did,” he said.

Vincent was medically retired and honorably discharged in 2012. However, he struggled upon his return to civilian life.

Diagnosed with post-traumatic stress disorder in addition to his brain injury, he became anxious in public.

“It had been a year since I got back, and I never left the house,” he said. " … I don’t like people getting behind me and touching me. It’s like I turn around and go back into combat.”

Being matched with his first service dog, Dee, in 2013 offered Vincent a new lease on life. She kept him calm, gave him someone to talk to and provided comfort in tense or emotional situations.

After eight years of service, however, Dee was ready for retirement. So, Vincent’s wife, Julie, helped him apply for a new service dog through IOWA Service Dogs — and Doc entered the family.

For his part, Shirley served as a firefighter and paramedic for the City of Des Moines for four years. In 2007, while performing ice water training, he aspirated ice water into his lungs that caused severe scarring.

Due to the injury, he was forced to medically retire in 2009 and, following years of treatments, received a bilateral lung transplant in 2017.

Following his career as a first responder, Shirley pursued his passion for coaching softball and has served as Clarke University’s head softball coach since 2018.

The idea of a service dog never crossed his mind until a change in medication last fall caused chronic lung rejection. Doctors were able to halt the rejection but could not reverse the damage, and Shirley’s breathing became more difficult.

“We had a couple times where, for example, I was mowing, and it got to the point where I couldn’t breathe,” he said.

At a suggestion from his fiancee, Angie McGuire, Shirley applied for a dog through IOWA Service Dogs.

Now, Smitty can recognize when Shirley is short of breath and can bring help or an oxygen tank if needed.

It is a different role than the one Doc plays for Vincent, but an equally important one, according to Vincent’s wife, Julie.

“There’s invisible wounds here in both of these guys,” she said.

Shirley and Vincent were selected to receive service dogs after completing multiple applications and months of training with IOWA Service Dogs. They learned about dog behaviors and body language, laws surrounding service dogs and more.

“We trained so much, I got tired of it. That’s how I knew it was good,” said Shirley.

Fisher said the nonprofit’s dogs come from select breeders and must pass health and aptitude testing. When considering health care, food, training and supplies, each dog costs IOWA Service Dogs about $20,000 to prepare for service life.

Doc and Smitty spent two years working with volunteer guardians and trainers, with Shirley and Vincent joining them for classes in the final six months.

The men continue the dogs’ training with daily practice of the commands, and coordinators from IOWA Service Dogs will check in with them regularly.

Both men emphasized the depth of the dogs’ training and the discipline required to serve their owner on an almost-constant basis. They said it is that intense instruction that sets dogs like Doc and Smitty apart from emotional support animals.

“These dogs work from the time they’re puppies until they retire,” Vincent said.

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LUBBOCK, Texas (KCBD) - On Veterans Day you’ll find Willie Harris in his Air Force uniform. You’ll also most likely find him in The Wagon Shop, where what he learned in the Air Force is on full display.

“I was an air frame repairman,” Harris said of his 6 years in the service. “I could go out there today on the body or wings or any part of the airplane, the fuselage and fix anything that’s wrong with it and it’s been well over 40 something years since I got out of there. I loved the Air Force. I still have my uniform. I wear it on Veterans Day. It’s not the original uniform because I’ve grown just a little bit. But, I like to wear it on Veterans Day because that means a lot to me. It means a whole lot.”

Harris said his challenge in fixing things came during his time in Vietnam when aircraft came to him severely damaged. His challenge these days is bringing the “Old West” back to life.

“I started with a razor blade and a hacksaw blade and now I have 12 Dremel tools and two scroll saws, a band saw,” Harris said. “I can just about build anything when it comes to building a wagon.”

Harris constructs small-scale chuck wagons and other forms of transportation from western heritage, including saddles. It’s a hobby that takes up most of his time when he’s not at his day job or out to dinner with his wife, Donna, who takes care of the business of The Wagon Shop.

“It takes a lot of years to become an artist,” Harris said. “Most of the time when you become an artist, you don’t live very long and you don’t get to see how good your work is because you are gone. I love it. I do. I go out in the shop and it takes three months to turn one of these out from scratch from the time I start till I finish and that’s a lot of work. I don’t work little bitty hours, like 14-16 hours a day but it seems like five minutes in my shop. That’s where I spend a lot of time.”

His eye for proportions and dedication to his work, he said, comes from the discipline he learned in the Air Force. He is also a self-proclaimed perfectionist. You can see that in his final products and the cleanliness of his shop, home and closet, as well as the spotless CorVette, Lincoln Town Car and Lincoln Mark LT he has in the garage.

“I like things done right,” Harris said. “I like things clean. I like things neat and I like things where it goes. I want it to be there.”

The work done in The Wagon Shop is impeccable down to the last detail, even the working brakes on the wagon. Harris wouldn’t have it any other way and neither would the Air Force.

“I’m still as military as military can get,” he said.

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A bipartisan group of lawmakers has introduced legislation that would help thousands of military families get accountability in the courts for exposure to contaminated water that goes back generations.

The U.S. government acknowledges that for nearly 35 years, until 1987, those who lived on a Marine base in North Carolina were potentially exposed to dangerous chemicals, drinking, swimming, and bathing in potentially toxic water. As a result, the Department of Veterans Affairs will cover medical costs for Parkinson's disease and a wide array of cancers, including kidney, liver and leukemia.

But as CBS News senior investigative correspondent Catherine Herridge reports, to this day, we found families are still seeking justice, fighting to get their stories heard in court.

In an interview with CBS News, Senator Richard Blumenthal (D-Conn.), part of the bipartisan group who introduced the legislation, called on the Department of Defense to carry out a comprehensive review.

"The Pentagon ought to do a national audit of all its bases," Blumenthal said, "to determine where there may have been contamination, where it continues, and what can be done to stop it."

Tucked away in a remote corner of a North Carolina cemetery is row after row of infant graves. "This is what we call baby heaven," said retired drill instructor Jerry Ensminger. One marker reads, "Born October 6, died October 7."

Ensminger was among the first to call out the Marine Corps over toxic drinking water at Camp Lejeune, which is just down the road from the cemetery.

Herridge asked, "What killed all these children?"

"It falls right within that period of time when the water was contaminated," Ensminger replied.

From 1953 to 1987, those serving at the sprawling Marine base were potentially exposed to contaminated water. For years, toxic agents seeped into the soil and poisoned the groundwater at fuel depots, base junkyards, even a dry cleaner that has since been demolished and designated a hazardous site.

In some areas, tainted water was 400 times what safety standards allowed, according to the Agency for Toxic Substances and Disease Registry.

Ensminger said, "When I first heard about this, it was like God opened the sky up and said, 'Hey, Jerry, here's a possible answer to that question that has nagged you for …' By that time it was 14, 15 years."

In 1982, Ensminger's six-year-old daughter, Janey, was diagnosed with leukemia.

"Was toxic water to blame?" asked Herridge.

"I blame it," he replied.

Janey passed in 1985; she was 9 years old. "She died on Tuesday, it was in the afternoon," he said.

"You're a Marine. Was this the hardest thing you've ever had to live through?"

"Nothing compares to watching one of your kids suffer and go through hell," Ensminger said, "And I blame the Marine Corps and the Department of the Navy."

While the Marine Corps declined an on-camera interview, their experts showed CBS News the ongoing cleanup at Camp Lejeune, where they said the drinking water is tested every day.

But 40 years ago, at the base housing known as Tarawa Terrace, the water was not safe. Ensminger lived there.

So did the family of Latrell Watts. She told Herridge, "When my dad found out he called us. He said, 'That water on Camp Lejeune was poison. That's where we lived at.'"

Military records show her father, Booker, was stationed at Camp Lejeune in the mid-1970s when his wife was pregnant with Latrell.

Herridge asked, "You and your sister have been sick over the years. What about the siblings who didn't live on the base?"

"They're not sick," she replied.

With no family history of breast cancer, Latrell questions why it killed her mother at 42, and she says she struggles with chronic anemia and reproductive issues.

Senators Blumenthal, Thom Tillis (R-N.C.), Richard Burr (R-N.C.), and Gary Peters (D-Mich), introduced the bipartisan Camp Lejeune Justice Act that would address what they call unfair legal barriers that block military families from suing the government. "The clock ran out on these claims, because the United States government concealed it," he said. "Now the government is saying, 'Sorry.'"

Blumenthal said there are "Thousands, literally tens of thousands of Veterans who have very legitimate, serious claims for injuries they've suffered – cancer, Parkinson's disease."

Last month in Hawaii – decades after the contamination in Camp Lejeune – the Navy said 4,000 families moved into temporary housing after contaminated water was discovered.

"Approximately 4,000 families opted to move into temporary housing or lodging while about 4,000 families chose to remain in their residences," said a Navy spokesperson. In addition to investigations that will determine the cause, the Navy spokesperson said, "Approximately 8,000 homes on the Navy water system are being flushed out of an extreme abundance of caution. Restoring clean, safe, drinking water to our families and communities is our highest priority.

"We are partnering with and relying on the experts at Hawaii Department of Health, U.S. Environmental Protection Agency, and certified labs on the mainland to ensure the water is safe to drink," the Navy spokesperson added.

Environmental Working Group, an environmental research organization, reports 385 military sites "have contaminated drinking water or groundwater." A senior Defense Department official told CBS News they are working with the group to determine the most accurate data.

Jerry Ensminger told Herridge, "If this would have been a corporation that did this, their asses would have been in court decades ago."

Now working with a law firm, Lattrell Watts is putting her faith in the pending legislation, and working through her own pain by writing poetry:

"The babies of Camp Lejeune that lay in their grave,

that did not enlist but was kissed with the poison

who will lay the claim?

Who will take the blame?"

A senior Defense Department official told CBS News they are running hundreds of investigations to make sure the water is safe at military bases, and they are committed to more transparency in the future about their findings and the actions they take.

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What is S-DVI?

The Service-Disabled Veterans Insurance (S-DVI) program was established in 1951 to meet the insurance needs of certain Veterans with service-connected disabilities. S-DVI is available in a variety of permanent plans as well as term insurance. Policies are issued for a maximum face amount of $10,000.

Who Can Apply for S-DVI?

You can apply for S-DVI if you meet the following 4 criteria:

• You were released from active duty under other than dishonorable conditions on or after April 25, 1951.
• You were rated for a service-connected disability (even if only 0%).
• You are in good health except for any service-connected conditions.
• You apply within 2 years from the date VA grants your new service-connected disability.

Note: An increase in an existing service-connected disability or the granting of individual unemployability of a previously rated condition does not entitle a Veteran to this insurance.

Follow this link to learn more about how different types of service-connection ratings impact the S-DVI application period.

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Seven families whose loved ones were killed at the Veterans hospital in Clarksburg are on the verge of settlements. Funding has been approved, a lawyer for the families said, but there are still some steps in dealing with the government.

Nursing assistant Reta Mays of Harrison County entered a guilty plea last summer in the deaths of multiple Veterans she was supposed to watch while on the overnight shift.

Now settlements with the U.S. government are close at hand too.

“It provides some closure,” said Charleston attorney Tony O’Dell, who represents five of the families nearing settlement. “It provides government stepping up and accepting some responsibility.”

Mays hasn’t yet been sentenced after admitting she was responsible for the deaths. She faces consecutive life terms for seven murder counts and another 20 years for a count of assault with attempt to murder.

She began working at the Veterans hospital in June 2015. She was removed from her job in July 2018.

She worked the night shift, 7:30 p.m. to 8 a.m. in Ward 3A, which housed fragile patients who were not well enough to be discharged but whose conditions did not require the intensive care unit.

Her job as a nursing assistant required her to measure patients’ vital signs, test blood glucose levels and sit one-on-one with patients who required observation.

Autopsies on exhumed bodies have pointed to insulin injections that weren’t needed. The Veterans died of low blood sugar level — severe hypoglycemia — caused by the insulin shots.

U.S. Senator Joe Manchin, D-W.Va., called the impending settlements welcome news.

“No amount of money or admission of guilt can bring back their loved ones, but I hope that these settlements bring peace of mind to the victims’ families,” Manchin stated.

“While these settlements are a step forward in this investigation, we are still waiting on a report from the Department of Veterans Affairs on patient safety and quality care at VA facilities, which has yet to be released months after the mandated deadline. The West Virginia Veteran community deserves transparency on how these horrible murders were able to occur at a VA facility, and I will continue to press the VA to release the report as soon as possible.”

Families still want to see a report from the Office of Inspector General and specifics about changes at the Louis A Johnson VA Medical Center in Clarksburg to protect patients, O’Dell said, “so other families don’t have to go through this.”

O’Dell represents five of the seven families currently involved in settlements. Additional cases may still be brought by more families, he said.

“We’re still looking at others,” he said. “I feel very comfortable that at least two or three of the others would be strong enough to file claims on.”

But there are most instances of families whose loved ones died at the hospital unit who will always have the ache of questions, he said.

“There are still families that will never get answers. Their loved ones died on 3A. She worked 3A. They’ll always wonder.”

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Columbia, South Carolina --- Acting United States Attorney M. Rhett DeHart announced today that seven criminal defendants have pleaded guilty to charges related to a Medicaid fraud conspiracy arising from the false billing of behavioral health services for children.

The defendants are all former owners, employees, or business associates of Wrights Care Services, LLC, a North Carolina-based provider of rehabilitative behavioral health services. Today’s guilty plea of former owner Daniel Wright marks the seventh guilty plea in the case, the result of a years-long investigation and prosecution led by the United States Attorney’s Office and Federal Bureau of Investigation (FBI) in cooperation with the South Carolina Attorney General’s Office.

“Health care fraud will be prosecuted to the fullest extent of the law.” said Acting U.S. Attorney DeHart. “It is a betrayal of public trust and diverts scarce resources from Americans who need health care coverage.”

“For several years, Wright and the other defendants took advantage of Medicaid, which benefits over one million low-income South Carolinians,” said Susan Ferensic, Special Agent in Charge of the FBI Columbia Field Office. “Healthcare fraud continues to be at the forefront of crimes our office investigates, and this case should serve as an example to individuals and businesses that these schemes will not be tolerated.”

“Not only did this fraud scheme steal millions of dollars from our hardworking taxpayers, it took that money away from legitimate programs to help children who needed it,” South Carolina Attorney General Alan Wilson said. “This case is another example of the close and productive working relationship our office has with the U.S. Attorney’s Office and the FBI and I want to commend them for their diligence in this case.”

Evidence obtained in the investigation revealed that, in 2014, Wrights Care Services was approved by South Carolina Medicaid to provide behavioral health services. Wrights Care maintained associated franchise locations throughout South Carolina, including Columbia, Spartanburg, Pickens, Cheraw, Society Hill, Bennettsville, Hartsville, and Conway. From its inception, Wrights Care Services failed to provide qualified behavioral health services to the children in its care. Nevertheless, in order to receive payment from Medicaid, members of the conspiracy submitted inflated bills and false medical records. In the case of one franchise, members of the conspiracy began billing Medicaid for services before the franchise opened its doors.

In 2015, South Carolina Medicaid sought to audit Wrights Care Services, and members of the conspiracy met in Columbia at a “note party” to forge signatures and falsify records to support the audit. During the course of the scheme, Wrights Care and its affiliated franchises submitted bills to Medicaid in the amount of $6,657,810.43.

The following defendants have pleaded guilty so far:

• Daniel Wright, 39, of Greensboro, North Carolina
• Glenn Pair, 35, of Baltimore, Maryland
• John David Zachariah Wallace, 40, of Sugar Land, Texas
• Kathleen Dubose, 54, of Greensboro, North Carolina
• Sherel Lawson, 47, of Summerfield, North Carolina
• Latasha Bethea, 37, of Fayetteville, North Carolina
• Tonya Strickland Hall, 47, of Greensboro, North Carolina

Each defendant faces a maximum penalty of five years in federal prison for conspiracy to defraud the United States. Each defendant also faces a fine of up to $250,000 and 3 years of supervision to follow the term of imprisonment. United States District Judge Mary G. Lewis accepted the guilty pleas and will sentence the defendants after receiving and reviewing presentencing reports prepared by the United States Probation Office.

This case was investigated by Special Agents Neil Power and Mark McMahon of the FBI, and Assistant Attorney General Brent Yandle and Assistant Chief Investigator Jamie Seales of the South Carolina Attorney General’s Office Medicaid Fraud Control Unit. Assistant United States Attorney Brook Andrews is prosecuting the case.

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Leonard C Boyle, United States Attorney for the District of Connecticut, announced that DAVID CIANCIMINO, 62, of Trumbull, waived his right to be indicted and pleaded guilty today via videoconference before U.S. District Judge Omar A. Williams to a controlled substance offense related to his illegal distribution of prescription medication.

According to court documents and statements made in court, Ciancimino was a sole practitioner practicing psychiatry and neurology/psychiatry from an office located at 4 Corporate Drive in Shelton. In October 2020, law enforcement began investigating Ciancimino’s prescribing practices of various benzodiazepines, such as Xanax, and stimulants, such as Adderall. During the investigation, federal task force officers acting in an undercover capacity paid Ciancimino $200 during visits to receive a prescription for Xanax or Adderall, or their generic equivalents, with little to no medical examination.

Ciancimino pleaded guilty to one count of distribution of a controlled substance without a legitimate medical purpose and outside the scope of professional practice, an offense that carries a maximum term of imprisonment 20 years.

As part of his plea, Ciancimino has agreed to forfeit $175,773.45.

Ciancimino is released on a $500,000 bond pending sentencing, which is not scheduled.

As disclosed during today’s court proceedings, Ciancimino surrendered his medical license last week.

This investigation has been conducted by the DEA New Haven Tactical Diversion Squad and HHS-OIG’s Office of Investigations, with the assistance of the Connecticut Department of Consumer Protection – Drug Control Division and the Middlebury Police Department. The DEA’s Tactical Diversion Squad includes personnel from the DEA and the Bristol, East Windsor, Glastonbury, Hamden, Manchester, New Britain, Newington, Watertown and West Haven Police Departments.

This case is being prosecuted by Assistant U.S. Attorney Heather L. Cherry.

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Leonard C Boyle, Acting United States Attorney for the District of Connecticut, Brian D. Boyle, Special Agent in Charge of the Drug Enforcement Administration for New England, and Phillip Coyne, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), announced that Dr. DAVID CIANCIMINO, 62, of Trumbull, was arrested today on a federal criminal complaint charging him with health care fraud and controlled substances offenses related to the illegal distribution of prescription medication.

Ciancimino appeared before U.S. Magistrate Judge Robert M. Spector and was released on a $500,000 bond.

As alleged in court documents and statements made in court, Ciancimino has been a sole practitioner practicing psychiatry and neurology/psychiatry from an office located at 4 Corporate Drive in Shelton. Since October 2020, law enforcement has been investigating Ciancimino’s prescribing practices of various benzodiazepines, such as Xanax, and stimulants, such as Adderall. The investigation, which has included the use of federal task force officers acting in an undercover capacity, revealed that Ciancimino was providing prescriptions for Adderall or Xanax to numerous individuals in exchange for $200 in cash, typically with little to no medical examination of his patients. Many of Ciancimino’s patients used Medicaid to pay for the prescriptions Ciancimino wrote for them.

It is alleged that between July 2020 to September 2021, Ciancimino deposited approximately $356,000 in cash into his bank account. Ciancimino also received dozens of payments of $200 through his Venmo account.

Ciancimino is charged with making false statements relating to health care matters, health care fraud, and distribution of controlled substances outside the scope of professional practice and not for legitimate medical purpose.

Acting U.S. Attorney Boyle stressed that a complaint is only a charge and is not evidence of guilt. Charges are only allegations and a defendant is presumed innocent unless and until proven guilty beyond a reasonable doubt.

This investigation is being conducted by the DEA New Haven Tactical Diversion Squad and HHS-OIG’s Office of Investigations, with the assistance of the Connecticut Department of Consumer Protection – Drug Control Division and the Middlebury Police Department. The DEA’s Tactical Diversion Squad includes personnel from the DEA and the Bristol, East Windsor, Glastonbury, Hamden, Manchester, New Britain, Newington, Watertown and West Haven Police Departments.

This case is being prosecuted by Assistant U.S. Attorney Heather L. Cherry.

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Yet another dangerous entitlement expansion could be coming soon. On Nov. 10, the House Agriculture Committee will discuss a bill that would put significantly more members of the armed forces on food stamps, weakening the military in numerous ways. Yet the federal government has no evidence to justify this policy — and even if there is a problem that needs to be solved, there’s a better option than greater dependency on government welfare.

The Equal Access to the Right Nutrition for Military Families Act, or EARN Act, is being sold with the usual tugging at the heartstrings. Its congressional sponsors are focused on “food insecurity” among U.S. forces. They must not have read their own bill, which fails to prove that such a crisis exists.

The EARN Act begins with a lengthy discussion of the Department of Defense’s lack of data on food insecurity in the military. The Pentagon has been tasked with discovering that information since 2016, yet government investigations have found little to no movement. Congress again directed the Pentagon in 2020 to submit a report on the matter, but it has yet to materialize. As a result, the officials who oversee the armed forces apparently have no idea how many military families are dealing with food insecurity.

The EARN Act’s co-sponsors don’t mind. They cherry pick food insecurity statistics from other sources, even though such findings are all over the map. The bill tacitly acknowledges that government data would be superior, since it appropriates money to prepare an official report within a year. Yet rather than start there, the bill begins by expanding welfare first and getting the facts later.

What’s worse is how the bill would affect the military itself.

My husband has a combined service of 20 years, active duty and Army National Guard, and he and I can both attest to the administrative nightmares surrounding pay and benefits. Yet the EARN Act would inject a new welfare bureaucracy into the already bloated military bureaucracy. There are programs within the military for families who need extra help and this duplication would add to the massive administrative complexities that frustrate military families. The Defense Department should focus on keeping the American people safe and keeping ahead of our increasingly aggressive and advanced adversaries — not administering welfare.

Most disturbingly, the EARN Act would remove personal responsibility. Each branch mandates that service members provide for their families — in the Army, it’s Regulation 608-99. For many, the bill would shift a big part of that responsibility to the government, undercutting the military’s efforts to train and maintain stable troops with strong families.

The potential for disruption is severe. Even if non-Pentagon estimates of food insecurity are accurate, the EARN Act likely would shift an even larger percentage of the military onto food stamps. Housing allowances wouldn’t be counted as household income, thereby expanding eligibility to troops making well above the federal poverty line. Families that don’t need the help would wind up trapped in welfare. That’s insulting.

The bill also would institute a six-month transitional program for troops leaving the military, regardless of their income, assets or pension. A full-bird colonel who made close to six figures a year could be swiping an EBT card at the local grocery store. Food stamps were never meant to cover people in that position — and it should not be allowed to happen.

This bill is just Congress’s latest attempt to shift more Americans onto welfare without proving the wisdom or need for such a move. Instead of the EARN Act, Congress should prioritize fact-finding. The only useful part of the bill is its requirement of — and funding for — an official Pentagon report. That should be the only part that passes. If a report finds evidence of widespread food insecurity, then Congress could consider raising military subsistence levels or enact larger annual increases to military salaries. That’s a discussion that should happen in the House and Senate Armed Services Committees, not the Agriculture Committee, which has no expertise in national security.

It says a lot about our current political moment that the go-to approach is putting more people on welfare, regardless of the need or its effects. Those in the armed forces deserve better, and so does America.

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ShopVCS.com has exclusive deals just for eligible Veterans. ShopVCS.com is an exclusive benefit with thousands of products from hundreds of top brands. Veterans can create a free account to get $15 off a first purchase of $50 or more during the first 30 days of membership.

ShopVCS.com

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Just recently, ShopVCS.com launched RX Eyewear, a prescription eyewear brand. The brand features single vision RX lenses, free anti-reflective and scratch-resistant coating. As an added convenience, Veterans can use the virtual try-on feature to see how glasses look before buying. All shipping is free on RX Eyewear purchases.

Additionally, for every $200 spent, Veterans receive a $10 reward credit added to their account at the start of the following month.*

Customers can make paying easier than ever with Affirm, a payment option that allows payment over time. This option offers monthly payments on orders over $50 with 0% interest on 3 and 6 month payment plans.**

Shopping at VCS supports VA programs

Proceeds from purchases support VA programs. These include National Rehabilitation Events, Veterans Crisis Suicide Prevention, Fisher House, Women Veteran Programs, National Disaster Relief, Homelessness Veterans programs, Beds for Vets, and much more.

To shop top brands and exclusive deals, visit ShopVCS.com to create a free account today.

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Patients who have problems with drugs and alcohol will respond to different types of treatment depending on the severity of their addiction. Contingency management is one of many behavioral treatment plans that the Veterans Health Administration and other hospitals have been using to treat substance abuse and similar types of behaviors.

It has been found to be effective when treating dependency on various types ofsubstances including opioids, alcohol, stimulants, nicotine, and marijuana, just to name a few. The ultimate goal is to get more states on board to use this type of treatment.

What Is Contingency Management?

Many states have started to allow VA hospitals the option to use contingency management therapy, or motivational incentives when treating veterans who are dealing with addiction or substance abuse problems. Incentives can include movie tickets, gift certificates, passes to a local event, or even money. Based on operant conditioning, this type of therapyrewards desired behaviors. Disciplinary action is taken if undesirable behavior is recorded.

While this may seem like an easy trade-off, veterans work hard to maintain their sobriety and get more rewards from regaining their health than the material rewards received through the treatment program. Working hard to receive a reward is much the same as working towards a goal. The only difference is that you receive something for your hard work instead of simply the satisfaction of completing a milestone.

Who Has Used It for Vets?

The Veterans Administration has usedcontingency management therapy for several years — long enough to know that it works effectively on the majority of patients who are treated with it. While many people don't agree with the “rewarding good behavior” tactics, others look at it like effective motivational tools. Motivation is a big issue for many servicemen and women who return home to a less structured environment and have difficulty adjusting.

Many soldiers who have returned home and found themselves on the streets and abusing drugs and alcohol have very few things to motivate them to get better. The VA looks at contingency management as a way to motivate them back to good health, one step at a time. In a way, it gives them back some of the structure they had while they were enlisted. For many, it is the loss of that structure that they find so difficult to overcome.

What Are the Results of Contingency Management?

With over20.4 million Americans (many of them veterans) admitting to some type of substance abuse in 2019, the numbers continued to rise in 2020. Studies performed across the country inVA hospitals have shown that contingency management is effective when used on its own or as part of a much broader behavioral health treatment plan.

About 70 clinics have implemented contingency management treatment in their facilities since 2011, but the push to get it established in more clinics has faltered. According to the findings at several VA hospitals over the last 40 years, contingency management is extremely effective, showing consistentabstinence in patients with substance abuse disorders.

Should More States Be Using It?

Contingency management has been proven time and again that it is effective when dealing with most substances. So why aren't more VA hospitals and rehab facilities using it? For some, the sticking point seems to be therewarding of bad behavior. Some critics also believe that patients shouldn’t be rewarded for doing things they should already be doing. There are also naysayers who believe that the patient may sell their rewards so they have the money to buy other things.

Part of the reason that contingency management isn't being used is that most insurers (public and private alike) will not pay for it. They will, however, pay for treatments like methadone. Federal agencies like the Department of Health and Human Services have failed to support the treatment program, even though it iswell-known that it works.

Contingency management techniques are effective and they are being implemented in certain facilities aside from the Veterans Administration. The goal of many veterans, as well as the behavioral therapists who work with them, is to bring contingency management to more VA hospitals and rehab facilities across the country. This will enable more veterans to receive the quality healthcare they need to overcome their substance abuse issues in a safe and effective manner.

Sources

• - VA Homeless Programs: Contingency Management
• - Contingency Management: What It Is and Why Psychiatrists Should Want to Use It
• - Comparative efficacy and acceptability of psychosocial interventions for individuals with cocaine and amphetamine addiction: A systematic review and network meta-analysis
• - Contingency Management Helps Veterans Stay Drug-Free
• - Nationwide dissemination of contingency management: The Veterans Administration Initiative
• - Contingency management for treatment of substance abuse disorders: a meta-analysis
• - Contingency Management Strategies and Ideas
• - This Addiction Treatment Works. Why Is It So Underused?
• - Drug Rehab in Huntington Beach, CA

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Veterans Affairs officials are confident they will be able to reduce the backlog of hundreds of thousands of compensation and pension exams by this fall, but watchdog groups are expressing more skepticism that such a goal is realistic.

“Yes, they have increased examiners across the nation, but the new alternate methods tend not to be as impactful as Veterans Benefits Administration officials had hoped,” Brent Arronte, deputy assistant at the VA Office of the Inspector General, told lawmakers during a House hearing on Tuesday.

“My fear right now in watching these numbers every month is that we might be getting into a situation where they’re just treading water.”

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.

All compensation and pension exams were suspended for two months in spring 2020 in response to the coronavirus pandemic. Veterans Affairs officials said that pause alone added about 200,000 exams to the backlog of unmet requests.

At the start of March, about 357,000 exam requests were pending, nearly three times the 130,000 pending at the end of February 2020.

Veterans Affairs officials have repeatedly promised that Veterans awaiting exams will not be punished for the delays, and will receive appropriate back benefits once their cases are approved. But outside advocates have noted that still means months of waiting for Veterans to have their cases finalized before those payouts begin.

David McLenachen, executive director of the Veterans Benefit Administration’s Medical Disability Examination Office, said officials hope to bring down the backlog to pre-pandemic levels by the end of this fiscal year, Sept. 30.

He said exam operations are returning to normal, and outside contractors have dramatically ramped up their workload in recent months. However, the department still needs to process about 8,000 more exams a week than they are today in order to reach the fall goal.

On Tuesday, Arronte said that online health meetings and other alternatives to in-person exams have helped efforts to address the backlog. But they still make up only a small fraction of total exams, meaning their impact thus far has been limited.

And officials from the Government Accountability Office this week released a new analysis of the backlog and chastised VA leaders for not developing a clear, long-term plan to address the issue.

McLenachen dismissed that criticism.

“I would love to do ordinary business planning and forecast out when certain events would happen and when we can achieve the goal,” he told lawmakers. “But simply stating that we need to plan for when exactly certain events will happen between now and the goal that we’ve established is a very difficult thing to do during the pandemic.”

However, members of the House committee said they have concerns about that approach.

“There should be a written plan,” said Rep. Elaine Luria, D-Va., chairwoman of the House Veterans’ Affairs Committee’s panel on disability assistance. “You can always use it as a planning tool and deviate from it as needed. But I think a written plan would help all of the stakeholders and the Veterans understand the timeline for reducing this backlog.”

Veterans groups said the challenge facing VA isn’t just the immediate backlog total, but the potential of what it can become.

The department already has about 30,000 new cases enter the system each month. But with new changes mandated by Congress in recent years to presumptive conditions for tens of thousands of Vietnam Veterans, those numbers could increase. Future approval of other toxic exposure benefits issues like burn pit exposure could lead to even higher levels.

“The moment VA suspended all exams an unavoidable backlog began building,” said Ryan Gallucci, director of the National Veterans Service at the Veterans of Foreign Wars. “Rebuilding from this pandemic will present challenges to everyone involved in the VA claims process, and we must all work to ensure Veterans do not slip through the cracks.”

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A voluntary recall of millions of CPAP breathing machines, used mainly to treat sleep apnea, has many users wondering if they've been inhaling cancer-causing toxins in their sleep.

At least 25 million U.S. adults have sleep apnea, a potentially serious sleep disorder in which breathing repeatedly stops and starts throughout the night, preventing them from getting a good night's sleep. A continuous positive airway pressure, or CPAP machine, pushes a steady stream of air into a user's nose and mouth, keeping airways open.

But CPAP users now face the choice of using a machine that the company says could actually hurt their health – or going without, which means they won't get a decent night's sleep.

In June, the manufacturer Philips voluntarily recalled millions of its popular DreamStation CPAP machines because of possible health effects.

Philips said sound-dampening foam used in the DreamStation "may degrade into particles" and "off-gas… chemicals." The FDA says breathing those in could "result in serious injury which can be life-threatening" or "cause permanent impairment" ranging from irritation to asthma… or even "toxic or carcinogenic effects."

"It's caused a lot of anxiety," said Dr. David Claman, the medical director of the Sleep Disorders Center at University of California, San Francisco. He says many of his patients have recalled machines.

CBS News consumer investigative correspondent Anna Werner asked, "What are you telling your patients to do?"

"I'm advising the more severe patients to stay on CPAP. and then I'm to some degree in the milder cases, letting them choose, because I also feel uncomfortable with saying I can't know that this is safe."

Werner heard from some frustrated sleep apnea sufferers, including James Colbert, who described his life 13 years ago before he started using a CPAP machine (including, for the past two years, the Philips DreamStation): "There were times where I would literally fall asleep mid-sentence talking to someone because I was so exhausted from not going to sleep the night before."

Since using CPAP, Colbert said, "I actually woke up refreshed, and could go throughout the course of my day with, you know, a ton of energy that I needed for work or, you know, time with my family."

Jozefa Kozyra, of Lehighton, Pennsylvania, relied on her DreamStation to sleep so she could provide round-the-clock care for her son, Kamil, who has muscular dystrophy.

Kamil told Werner, "She needs to bathe me, dress me, feed me, and other exercises to do during the day."

But since the recall, she said her doctor advised her not to use the machine – and she's struggling without it. "I'm very tired, I'm very slow," said Jozefa.

Werner asked, "How much sleep do you get without the machine?"

"When I don't have machine now, two hours, three hours," she replied.

Her son said Medicare turned her down for a replacement machine, and she can't afford to spend hundreds of dollars to buy a new one.

Kamil said, "She called several times to her insurance and Medicare, and they're saying, because it hasn't been five years, even though it's not her fault at all, they're not willing to pay for a new machine."

Philips now says it will "replace or repair devices" … "within approximately 12 months" once the FDA approves a solution.

It's unclear how many patients have suffered health effects; the company said it received complaints on 0.03 percent of its machines in 2020, including some the FDA sent about "the presence of black debris/particles" in some machines.

Philips said its testing revealed "possible risks," which raises questions for Dr. Claman: "Is this just the tip of the iceberg, or is this all there is?"

As for James Colbert, he said the risks of not wearing the machine are greater than possible unknown health effects, so he's continuing to use his.

"I cannot afford to not use it, because I would get so little sleep in," Colbert said. "And if I slept without it, I would stop breathing so many times during the course of the night."

But he has a message for Philips: "To tell me that it could take up to a year? That's a year that I could be putting myself in jeopardy," Colbert said. "People just cannot afford to wait 12 months for a resolution."

Colbert has also joined a lawsuit against Philips, he said, to push them to act faster on this problem.

Philips did not respond to CBS News' request for comment on the lawsuit. (In April, Philips came out with a new machine, the DreamStation 2, which it says is not affected by this recall.)

Connecticut Senator Richard Blumenthal is demanding answers about how many people are affected by the recall, and what Philips is doing to help them.

There's one other potential problem that may be coming into play here: many people with the machines use an ozone cleaning system to clean them, and that may be degrading the sound abatement foam faster.

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Soldiers, according to Army Chief of Staff Gen. James McConville, are the Army’s “most important weapons system.” Like with any other weapons system, preventive maintenance is necessary to ensure continuous readiness and maximum performance.

The Army’s Performance Triad is a public health campaign aiming to implement this upkeep through proper sleep, activity and nutrition, recognizing their critical role in developing the high-quality, physically fit, mentally tough Soldiers able to succeed during Multi-Domain Operations.

The current COVID-19 pandemic adds another layer of difficulty to continuously remaining fit and effective, requiring extra care to avoid infection or spreading the infection to family, friends, fellow Soldiers and the wider community.

Yet, researchers from the U.S. Army Research Institute of Environmental Medicine and Walter Reed Army Institute of Research, both subordinate commands of the U.S. Army Medical Research and Development Command, are finding that these same building blocks of Soldier performance may also prove to be techniques for fighting off the disease.

“As we’ve shifted our resources to help address this pandemic, we’re building from the understanding that the same strategies that help us optimize human performance in training and operational settings—eating well, exercising right and getting a good night’s sleep—also protect us from infection,” said Col. Sean O’Neil, USARIEM’s Commander.

Here is what these laboratories, leaders of the Army’s efforts to improve military nutrition, human performance, sleep, resilience and defense against infectious disease, have learned and what they advise:

Nutrition: The Building Blocks of Immunity

A balanced diet that meets energy demands and provides essential nutrients not only increases energy and endurance, enabling better performance—it also directly impacts the immune system.

The absence of key nutrients can directly limit your body’s ability to protect from invaders: a lack of vitamin D can limit the production of antimicrobials and compromise your skin, the primary barrier against infectious disease; a lack of iron and zinc directly threaten the function of white blood cells, which include your body’s “first responders” against pathogens.

Poor nutrition can even increase harm from infectious disease—one study found that low levels of the nutrient selenium caused viral mutations resulting in an even more damaging infection.

Obesity, or excess energy intake, can also stress the immune system. Studies have identified a greater risk of hospital-acquired infections, more severe infections from influenza and other respiratory infections and a greater overall risk of viral and bacterial infection.

Furthermore, individuals with obesity are still at risk of missing critical nutrients from their diets, further compounding potential risk.

“These findings highlight the critical role of diet and nutrition in Warfighter health and performance—including immune function and infectious disease. Optimal nutrition is a critical first step to immunity,” says James McClung, chief of the Military Nutrition Division at USARIEM.

Sleep—Your Internal Body Armor

Given its well-known impact on vigilance, learning, reaction time and mental acuity, sleep loss has long been a topic of concern for military leaders and a focus of research by military scientists. Less widely known, however, is the recent evidence showing that sleep is also critical for maintaining a healthy and effective immune system.

It is now understood that sleep duration is a powerful predictor of infection. In one study, volunteers were exposed to the virus that causes the common cold. It was found that those who averaged less than seven hours of sleep per night had a three-fold greater risk of infection than those who averaged eight hours or more; for those who habitually obtained less than five hours of sleep, the risk was 4 ½ times greater.

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

“These studies show that sleep can enable and enhance your body’s ability to establish physical, cognitive and now immunological dominance,” says Lt. Col. Vincent Capaldi, director of the Behavioral Biology Branch at WRAIR, responsible for studying the relationship between sleep and military performance.

Physical Activity: Boost Your Immune System

Physical activity and fitness are critical aspects of military service as well as overall health—they also can boost your immune system.

Even a single session of physical activity can improve your immune system, resulting in the redistribution of immune cells to your body’s “front lines”—places like your lungs or gut—to enhance surveillance of potential pathogens. Regular physical training also improves one’s immune response to infection challenges.

Conversely, excessive physical training without adequate time to recover has been linked to a suppressed immune system.

“Physical activity and fitness are key to optimal and enhanced health and performance of our Soldiers. Special care to practice smart physical training practices will help promote stronger immune system responses,” says Susan Proctor, chief of the Military Performance Division at USARIEM, responsible for targeted musculoskeletal health and military performance research.

Don’t Let This Information Stress You Out

In addition to emotional health, well-being and job performance, stress may impact our immune system as well.

One study found that self-reported stress predicted more symptoms in volunteers exposed to influenza virus. Another study found that individuals who reported high levels of stress over a period of at least a month were two to three times more likely to develop colds than those reporting less stress when challenged with a cold virus.

A range of evidence also suggests that in addition to increasing the risk of infection, stress also worsens outcomes: stress may increase the likelihood of disease becoming symptomatic (as opposed to having a mild, asymptomatic infection) or more active (some viruses like herpes can lay dormant after infection with symptoms recurring over time).

“Stress has significant direct and indirect impacts to both risk and severity of infection—alongside getting enough sleep and regular exercise, stress mitigation strategies like mindfulness can go a long way to improving overall wellness and staying healthy,” says Amy Adler, acting director of WRAIR’s Research Transition Office, which bridges the gulf between laboratory and field to get research advances into Army training.

The Performance Triad, Infection and COVID-19

Perhaps most significant is that deficits in each factor are separately linked to decreased vaccine efficacy. For example, being physically active heightens vaccine effectiveness compared to being sedentary. Also, hepatitis B vaccine efficacy was eight times lower in individuals with obesity than those at a healthy weight; individuals who slept fewer than six hours the night prior to vaccination against hepatitis B were less likely to have gained immunity six months later compared to those who had obtained more than seven hours of sleep.

Furthermore, nutrition, sleep, exercise and stress are all intrinsically linked—high levels of stress may result in difficulty falling asleep, poor diet or lack of motivation to exercise; overexertion is often linked with compromised nutrition and sleep disturbances—suggesting that addressing one factor can positively influence others.

“Sleep, activity and nutrition are all critical aspects of ready, resilient and healthy Soldiers and Family members—it is important that individuals and their families consider every one of them. Setting realistic, attainable, but ambitious goals can help you focus on your health during this pandemic while building your invisible body armor against infection,” said Col. Deydre Teyhen, WRAIR’s Commander.

Research laboratories under USAMRDC, including WRAIR, are working diligently on a range of solutions to detect, treat and prevent COVID-19, including a vaccine. As these efforts progress, the following resources can help you and your family improve their first lines of defense—the immune system:

• Army Performance Triad
• Activity
• Diet and nutrition
• Behavioral health resources for COVID-19
• Sleep resources
• Mindfulness strategies

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NEW ORLEANS, LOUISIANA – U.S. Attorney Duane A. Evans announced that SLOANE SIGNAL-DEBOSE, age 51, a resident of Slidell, pled guilty to misappropriating funds from a veteran while SIGNAL was the veteran’s fiduciary.

The government filed a one-count bill of information that charged SIGNAL with misappropriation by a veteran’s fiduciary, in violation of Title 38, United States Code, Section 6101. According to court documents, from 2016 until 2018 SIGNAL was a fiduciary for a veteran who needed assistance with the management of his affairs, and controlled the veteran’s finances and bank accounts. During that time, SIGNAL took over $100,000 from the veteran’s accounts, routed it through bank accounts in her own name, ultimately using it as the down payment on a home for SIGNAL that was only in SIGNAL’s name. SIGNAL also used additional funds from the veteran to pay contractors working on SIGNAL’s home. SIGNAL then submitted false records to the Department of Veteran’s Affairs to hide her misuse of the veteran’s funds.

SIGNAL faces up to five years in prison, up to three years of supervised release after release from prison, a fine of up to $250,000 or twice the gross gain to SIGNAL or the gross loss to any victims, and a mandatory $100 special assessment fee. Judge Sarah S. Vance set the sentencing hearing for February 15, 2023.

U.S. Attorney Evans praised the work of the Department of Veterans Affairs Office of Inspector General. Assistant United States Attorney Nicholas D. Moses is in charge of the prosecution.

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NEW ORLEANS – United States Attorney Duane A. Evans announced that BONNIE JEAN LAWLESS DIAZ (“DIAZ”) has been sentenced on January 18, 2022 to 36 months of probation after pleading guilty in federal court relating to her role in a health care fraud conspiracy.

DIAZ, age 46, a resident of Slidell, Louisiana, pled guilty on September 23, 2021 before U.S. District Judge Jay C. Zainey to Count One of a Superseding Bill of Information charging her with misprision (or knowing concealment) of the commission of a felony, in violation of Title 18, United States Code, Section 4.

According to the Indictment, in or around March 2014, continuing through in or around October 2016, co-defendants conspired to knowingly and willfully execute a scheme and artifice to defraud TRICARE, a federal health care benefit program affecting commerce, and other health care benefit programs.

According to the Superseding Bill of Information, DIAZ had knowledge of the commission of the health care fraud. DIAZ concealed the fraud by knowingly submitting or caused to be submitted compounded medications for which there was no medical necessity and did not as soon as possible make known the same to some judge or other person in civil or military authority under the United States.

The owner, on behalf of Prime Pharmacy, contracted with various entities, including Pharmacy Benefit Managers (“PBMs”), obligating Prime Pharmacy to collect copayments from beneficiaries in order to be reimbursed by various health care benefit programs, including TRICARE. Additionally, the owner of Prime worked with codefendant Donald Auzine to market the compounded medications produced by Prime Pharmacy. Auzine found other marketers outside of the state to find beneficiaries that were willing to receive medically unnecessary compounds and doctors willing to prescribe compounds without medical necessity.

Beginning in or around March 2014, and continuing through in or around April 2016, Prime Pharmacy dispensed prescriptions for High-Yield Compounded Medications to beneficiaries of TRICARE and other health care benefit programs that were not medically necessary, induced by kickback payments, or where copayments were either waived or credited by Prime Pharmacy, and accordingly, submitted or caused to be submitted false and fraudulent claims for reimbursement to TRICARE, other health care benefit programs, and PBMs.

DIAZ was also ordered to repay TRICARE $180,000 in restitution.

“Individuals involved in this scheme illegally billed TRICARE out of close to $15 million and I am pleased that the U.S. Attorney’s Office is requiring justice,” said Special Agent in Charge Cynthia Bruce, Office of Inspector General, Defense Criminal Investigative Service, Southeast Field Office. “There are no victimless crimes and DCIS agents will continue to pursue unscrupulous greedy individuals who steal from our military health care system and all taxpayers.”

“Those entrusted with providing health care services to Veterans and their family members will be held accountable should they violate that trust,” said Special Agent in Charge Jeffrey Breen of the Department of Veterans Affairs Office of Inspector General’s South Central Field Office. “The VA OIG is grateful to the United States Attorney’s Office and our law enforcement partners for their efforts to achieve justice in this case.”

U.S. Attorney Evans praised the work of the Office of Inspector General, Defense Criminal Investigative Service, the Department of Homeland Security, the Department of Veterans Affairs – Office of Inspector General, and the United States Postal Service – Office of Inspector General.

The prosecution of the case is being handled by Assistant United States Attorney Kathryn McHugh.

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A recent ruling by the Defense Department has granted Veteran status to a group of civilians who served in Vietnam.

Specifically, the group consists of "Department of the Navy civilian special agents who served in direct support and under control of the Department of the Navy within the Republic of Vietnam between Jan. 9, 1962, and May 7, 1975."

The ruling determines that this group will be "considered as having served on active duty for the purposes of all laws administered by the Department of Veterans Affairs."

That means that they and their family members may be eligible for health, disability and burial benefits, just like military members who served during that time period. They won't, however, be eligible for any retroactive benefits. They may also be eligible for state Veteran benefits.

If the Veteran is deceased, a surviving family member may still file the application for Veteran status.

To receive benefits, these Veterans must first get a DD-214 to use when applying to state or federal agencies. To get a DD-214, an affected person must submit a DD-2168, Application for Discharge of Member or Survivor of Member of Group Certified to Have Performed Active Duty with the Armed Forces of the United States.

The form must be submitted to the Navy Personnel Command in Millington, Tennessee, with all supporting documentation.

The burden of proof is on the individual. However, suggested supporting documentation includes:

• Employment records from the Navy Office of Naval Intelligence (ONI) or Naval Investigative Service (NIS).
• Copies of passports with appropriate entries.
• Military or civilian orders posting the applicant to an assignment in the Republic of Vietnam.
• Reports signed by or mentioning the applicant's work as part of ONI/NIS in the Republic of Vietnam.
• Letters of award or commendation.
• Expense reports.
• Military identification forms.
• Medical paperwork.
• Military passes/chits/liberty cards.
• Anything else, including postmarked envelopes, etc.

Remember, never submit the original documentation; always send copies and keep the originals for your own files.

If the Navy determines that a DD-214 should be issued, it will also forward the information to the awards and decorations office to determine whether any ribbons should be awarded, so include as much documentation as possible.

Check out the Federal Register notification for more details.

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Military retirees receiving care on bases nationwide are being quietly shifted to off-base civilian providers in a transition that has been taking place since at least 2018, Military.com has learned.

That's independent of a plan outlined in a recently obtained memo that would close 38 treatment facilities to all but active-duty patients.

The changes detailed in the Feb. 3 memo are a part of a review of military hospital operations and a system consolidation under the Defense Health Agency ordered by Congress in 2016. The memo did not list the affected facilities or make clear when the changes would start. A report on that review is expected to be delivered to Congress as early as this week.

The memo said changes would happen "in a deliberate, responsible fashion," and not until officials are "able to confirm there are available providers in the local Tricare network."

Care for military retirees enrolled in the Tricare Prime plan has long been offered at military clinics on a space-available basis, as a matter of policy.

"One of the biggest challenges and most important responsibilities we have is how to best align our resources with our patients' needs. Military hospital and clinic leaders constantly evaluate their facilities' capacity based on the number of providers available and their mix of specialties," Kevin Dwyer, a DHA spokesman, said in a statement provided to Military.com. "However, because the report to Congress has not yet been submitted, any previous changes are a result of the rebalancing of capacity based on available providers."

But as early as 2018, military hospitals and clinics had begun intentionally shifting retirees out of the hospital and into the community as a response to clinic and hospital staffing levels and restructuring sparked by the consolidation.

Military retirees pay an annual enrollment fee of $600 per family to use the Tricare Prime plan and gain access to on-base doctors. While care received on base has no out-of-pocket cost, retired Prime users must pay $20 per visit for primary care and $31 for specialty care received outside the military system. Tricare Select comes with slightly higher out-of-pocket costs -- $30 for primary and $45 for specialty care -- but no annual enrollment fee. Both plans have a $3,000 annual out-of-pocket cost cap.

For example, when Army officials announced plans to downsize Ireland Army Community Hospital at Fort Knox, Kentucky to a health clinic in 2018, retirees were told they could no longer be seen there for primary care.

"Military treatment facilities are able to see retirees on a space available basis, and Ireland has done that for years," Col. Kevin. Bass, commander of the medical center at the time, said in a news release. "But with a new clinic being built and the restrictions placed on its construction, we will not have the space to see retirees when it's finished."

At Naval Submarine Base Kings Bay, Georgia, retirees were sent letters late last year notifying them that they were no longer able to get appointments on base.

"Because our staffing won't accommodate everyone, we've taken a series of steps throughout this year to adjust [Naval Branch Health Clinic] Kings Bay's enrollment," says the letter, signed by Capt. Matthew Case, who commands Naval Hospital Jacksonville, Florida, of which Kings Bay is a subordinate command.

Hundreds of military retirees and their family members contacted Military.com following its first report about the memo Feb. 7, many of them stating that their local hospital or clinic had made a similar announcement. In other cases, readers said they were simply told their primary care provider was no longer available. In all instances, retirees who were no longer allowed on base faced new and unplanned out-of-pocket fees based on the Tricare Prime cost structure.

Readers reported being dropped from primary or specialty care at hospitals and clinics including Naval Hospital Bremerton, Washington; Tripler Army Medical Center, Hawaii; Scott Air Force Base, Illinois; FE Warren Air Force Base, Wyoming; Barksdale Air Force Base, Louisiana; Moody Air Force Base, Georgia; Robins Air Force Base, Georgia; Tyndall Air Force Base, Florida; and Submarine Base New London, Connecticut.

Only officials from Barksdale, Air Force Base and Naval Health Clinic New England, which oversees Navy medical care across the Northeast U.S., returned a request for comment.

A spokesman from Barksdale said they are waiting on a decision from Congress before determining whether or not their clinics will close to patients not on active duty. And Kathy MacKnight, a spokeswoman for the region, said while the clinics at New London and Naval Station Newport, Rhode Island, have not removed anyone, neither locations are accepting any new dependent enrollees, including active-duty family members.

Retirees aren’t the only ones concerned about the shift. Although the memo promised no immediate changes, active-duty families at Fort Bragg, North Carolina, Barksdale Air Force Base and FE Warren Air Force Base reported being either removed from care or blocked from enrolling at the military clinic.

In one case, for example, users at Fort Bragg's Fayetteville Medical Home reported losing their primary care doctor without warning in mid-December and being told to pick one in the community. In a separate case, a military spouse at the same clinic was told this week that clinic staff had been notified it is closing.

But a spokesman for Womack Army Medical Center, which oversees that clinic, said no changes have been made there.

"We are currently reassessing the best use of the space. No decision has been made. No one is being dis-enrolled and no employment is being terminated," Robert Kerns, a Womack spokesman, told Military.com.

Unlike retirees, active-duty family members enrolled in Tricare Prime but seen off-base do not pay out-of-pocket fees for care.

Despite an assurance in the memo that no patients will be moved "until we are confident the local market has providers available," many readers said they're worried that officials won't know care isn't available until it's too late. For example, one spouse at Fort Bragg reported having trouble finding an off-base provider with openings, while a retiree near Kings Bay said she had to wait over a month for her new off-base doctor to have an opening.

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Troops and Veterans in some cases are being “grossly” overcharged for VA home loans, and federal regulators need to suspend or ban alleged bad actors and strengthen their oversight over lenders, according to a new report from the office of Rep. Katie Porter, D-Calif.

The report alleges that NewDay USA and The Federal Savings Bank “continue to aggressively market cash-out refinancings with fees and interest rates that could cost borrowers tens of thousands of dollars more over the life of the loan compared to other lenders.”

“This report finds that grossly overpriced cash-out refinancings continue to scam Veterans,” Porter stated in an introduction to the report released Aug. 3.

The report noted that the actions of Congress and federal regulators in 2017 and 2018 decreased the incidence of predatory cash-out VA loan refinancing. But while the number of these loans decreased in those years, the problematic rates and fees continued, the report stated.

The report’s authors found that while the number of cash-out refinancings did decrease in 2020, it’s on the rise again — up by 50 percent since July, 2020.

“It is despicable that corporate executives would prey on Veterans and military families to line their pockets,” said Porter in an announcement of the report, titled “AWOL: How watchdogs are failing to protect servicemembers from financial scams.”

The report “calls out the lenders that are continuing to single out vulnerable military borrowers for overpriced, cash-out refi mortgages. The Administration has a duty to step in and prevent these scams from happening,” Porter said.

“Ginnie Mae should immediately suspend NewDay USA, The Federal Savings Bank, and any other lender with similar lending patterns from originating new cash-out loans,” the report recommended.

Ginnie Mae officials didn’t comment on this recommendation, but in a statement to Military Times emphasized that the government agency “continues to be focused on maintaining the market predictability and integrity of Ginnie Mae securities, which leads to low-cost mortgage financing available to homeowners who use various government-insured mortgage products.”

Active-duty members as well as Veterans generally qualify for a VA loan. The Veterans Affairs Department doesn’t make the loans; It guarantees them. This minimizes lenders’ risks and reduces their losses in the event of a foreclosure. The lenders set the interest rate and some other costs.

The Porter report also recommended the VA and the Consumer Financial Protection Bureau take additional action to address the issue. In recent years, all these government agencies have taken steps to tighten rules and strengthen monitoring, in order to limit overpriced cash-out refinancings and loan “churning,” where lenders convince borrowers to unnecessarily refinance their mortgages early to get new terms or take out cash, often costing borrowers more in the long run.

“Churning VA loans hurts all Veterans,” said Andrew Pizor, a staff attorney at the National Consumer Law Center. While some steps have been taken, more are needed, he said.

As the report notes, not all cash-out refinancings are necessarily predatory. These loans take cash value out of homes, but some loans tend to have bad terms which could leave borrowers worse off after refinancing. Lenders market these loans often to Veterans, enticing them to take thousands of dollars out of the equity in their home, to pay off debt, make home improvements, or other purposes. The cash-out loans can be used to refinance a non-VA loan into a VA loan.

In contrast, a VA Interest Rate Reduction Refinance Loan, IRRL, also known as the streamline refinance loan, is typically used to reduce the borrower’s interest rate on an existing VA loan, or to convert an adjustable rate VA loan to a fixed rate mortgage.

The quantity of cash-out refinancings decreased in 2020, both at NewDay and across the VA home loan industry, but the nature of the loans remained the same, according to the analysts. In analyzing the top 10 originators of VA cash-out refinancings in 2020, the analysts found NewDay’s customers were charged the highest average interest rate.

If these borrowers had used the VA streamline refinance with NewDay instead of the cash-out refinance, the analysts found, they would have paid competitive market rates and less than half the up-front costs of a cash-out mortgage.

“The disparity suggests that service members, Veterans and military families looking for cash-out loans at NewDay may be specifically targeted and exploited for profit,” the report stated.

NewDay’s response

NewDay USA defended their practices when reached for comment.

“NewDay USA’s mission is to serve our nation’s Veterans and we’re proud of the work we do to help them achieve the dream of homeownership,” NewDay officials said in a statement provided to Military Times. “We’re committed to continuing to help Veterans and their families gain financial security by providing them the best possible service.”

The vast majority of NewDay’s 2020 total loan originations were streamline refinancings and other products; 13 percent were VA cash-out refinancings, according to NewDay officials, which they say is consistent with the rest of the mortgage market.

These two types of refinancings should not be conflated, because they serve different purposes, officials noted. “Cash-out loans offer Veterans money in hand to pay off high-interest revolving credit lines, invest in home improvements, or cover other unexpected costs.” Their data shows that customers saved a “weighted average” of $617 per month with cash-out refinancing, officials said. By contrast, streamline refinancings are designed to lower the interest rate on the VA loan, or convert an adjustable-rate VA loan to a fixed-rate mortgage.

In response to the higher fees or interest rates, NewDay noted that the majority of its customers are enlisted Veterans, and that NewDay customers’ average credit scores are lower than those of other top lenders. In 2020, the average FICO credit score of its cash-out refinancing customers was 694, which was 35 to 75 points lower than the average FICO score of other top lenders.

“As is common practice, lower credit scores indicate greater risk to the lender and require higher interest rates,” NewDay officials stated. They provided statistics from Ginnie Mae showing NewDay’s customers’ average credit score was 694; Navy Federal Credit Union’s customers’ average credit score was 729; USAA, 738; and PenFed, 769.

Analysts in the Porter report acknowledged that “this situation might be partially explained by borrowers’ poor credit, but NewDay also had the second highest upfront costs, almost double what a borrower would pay for a cash-out loan from USAA.”

The average total up-front cost of a cash-out refinance at NewDay was $10,335 in 2019, compared to USAA’s average cost of $5,590, according to the analysts.

If the high interest rates were a function of poor credit, the report stated, “then NewDay USA was targeting the most vulnerable consumers with exorbitant fees.”

“If the high rates were arbitrary, it suggests that NewDay USA was charging service members, military families and Veterans higher rates than their credit warranted,” the report added.

However, there are other factors, NewDay officials said. In addition to lending to more consumers with lower credit scores, NewDay has a higher loan-to-value ratio than other top lenders, averaging 90.5 percent in 2020, NewDay officials said. This is the ratio of how much money is borrowed compared to the appraised value of the property. In lending, higher loan-to-value ratios indicate less collateral and more risk for lenders, who many charge higher fees or interest rates, NewDay officials said.

The report recommends that the Consumer Financial Protection Bureau require lenders to include customer credit scores in their required reporting of home loan details, to increase monitoring and transparency of potentially predatory lending. In 2018, the CFPB decided to exclude public reporting of credit scores because of privacy risks to individuals.

Among other things, the Porter report recommended that the VA add the VA home loan funding fee to the list of closing costs that should be recouped through savings from refinancing. VA had not responded by press time to questions about whether those recommendations are being considered.

The CFPB has taken a number of actions related to VA refinancings, including settlements with nine mortgage companies to address deceptive loan advertisements; and action against NewDay USA in 2015 for alleged deceptive mortgage advertising.

The Federal Savings Bank, also targeted in the report, offers competitive interest rates, but it has the “highest up-front costs and most discount points of any cash-out originator,” the report stated. For example, the average total loan cost in 2020 was $10,791, compared to USAA’s average total loan cost of $5,877.

Officials from The Federal Savings Bank had not responded to questions before publication, stating they haven’t had an opportunity to read the entire report.

Advice to VA borrowers

Many home loan borrowers don’t know what most of their charges are in a mortgage closing, said Pizor, staff attorney for the National Consumer Law Center.

“A lot of people don’t realize when they’re being overcharged,” he said.

Most Veterans do know what the VA funding fees are, which are one-time payments that the borrower pays on a VA-backed loan. For example, the funding fee for a VA cash-out refinancing loan is 2.3 percent of the loan amount for the first use; and after that, it’s 3.6 percent.

A VA home loan is one of the best loan products out there, Pizor said. “But aside from that, you really have to shop around,” he said. That means get written loan estimates from more than one lender — three, if possible.

“You’ll see the differences in price,” he said. It’s not enough to talk with the loan officers, who are essentially salesmen, he said. You have to look at the numbers on the loan estimates.

Some lenders may try to delay giving you these estimates, he said, but it’s worth insisting on. “Once you get it, certain rules apply about what changes are allowed…. Estimates are supposed to be pretty close.”

He also suggested visiting the Consumer Financial Protection Bureau’s web tool for exploring interest rates in your area. It quickly gives you a sense of what the interest rates are, and can be useful “because you’ll know if someone is giving you an estimate that’s way out of line,” he said.

When shopping for a loan, it’s always wise to get your credit scores beforehand. The higher your credit score is, the better the terms you’ll get. But a lot of people assume they have bad credit, without checking their credit scores, Pizor said.

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On a chilly Sunday morning before the sun came up, about a dozen of Mike Osenkowski’s friends gathered at the American Legion hall that houses Post 982 in Unity.

Just hours after the bar closed, guys like Dave O’Barto and Patrick “Rabbit” Quinn, members of the Sons of the American Legion, headed to the kitchen. They turned on the lights, put on the coffee, heated up the griddle and began mixing the pancake batter and unpacking the eggs, sausage and potatoes. In a short time, they began filling the buffet table that would feed scores of friends and neighbors who lined up to plunk down $6 a head, as well as the Vets, who eat for free.

Mike would have been proud.

He might have taken issue with his friends’ decision to label this event the Michael Osenkowski Memorial Veterans Breakfast Buffet. But he would have been happy to see them working together and having a good time in the community he loved.

His twin sister, Mary Stauffer, of Greensburg, said her brother loved the Legion, the great outdoors and his many friends.

Osenkowski was 58 when he died in April 2018 of cancer.

But more than a dozen years earlier Osenkowski, Quinn and their friends helped launch American Legion Post 982’s Sons of the American Legion or SAL program. Their SAL chapter that numbers 160 members as well as six junior members includes men— many now in their 40s, 50s and 60s— whose parents or grandparents had served in the military and were eligible for membership in the Legion.

Members of the SAL are committed to supporting the organization their parents and grandparents — members of generations that made America great when they reported to serve in its military — built in this rural community on the outskirts of Latrobe.

“This was one of his passions,” Stauffer said, as she poured drinks and welcomed friends and neighbors to the breakfast buffet.

Like her late twin brother, Stauffer is committed to the organization. She’s president of the auxiliary.

They’ll hold another breakfast later this spring.

Vets like Al Nagel, a Vietnam Veteran and member of the Legion appreciate their efforts.

Nagel, 76, and his wife, Marge, who are celebrating 55 years of marriage, joined two other couples, longtime friends of theirs, for breakfast at the Legion hall.

They laughed, boasting that the three couples married 55, 44 and 51 years respectively, represent more than 150 years of wedded bliss among them.

Their easy camaraderie spoke of many years of friendship.

Once among the younger members of the Legion, Nagel and his friends now make up the core of the post’s 294 active members.

In a region where military service remains a core value of the community, they’re hoping to break the 300 member mark soon.

“I’m a member and I could eat for free, but I paid. They support us,” said Nagel, who sported a black campaign cap that told of his service in Vietnam.

SAL members like Dave O’Barto, are happy to be a part of their community.

“I do it for the Vets,” O’Barto said, carrying an empty steam tray back to the kitchen.

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On Nov. 8, the U.S. District Court for the District of South Carolina entered a $9 million civil consent judgment for the United States against South Carolina chiropractor Daniel McCollum under the False Claims Act. On that same day, the U.S. Attorney’s Office for the District of South Carolina filed an information and plea agreement in which McCollum admitted to engaging in a conspiracy to pay illegal kickbacks and to defraud healthcare programs by billing for unnecessary medical services. The maximum criminal penalty McCollum could face is five years in prison and a fine of $250,000. A sentencing date has not been set.  

McCollum owned and operated pain management clinics, laboratories and a pharmacy in South Carolina. He also operated pain management clinics in North Carolina and Tennessee. McCollum’s clinics did business collectively as Pain Management Associates.

On May 31, 2019, the United States filed a civil complaint alleging that McCollum caused the submission of false claims to federal health care programs arising from kickbacks he paid for urine drug testing (UDT) referrals in violation of the Anti-Kickback Statute; referrals prohibited under the Stark Law from physicians with whom McCollum had financial relationships; and claims for UDT and other services that were not medically necessary and that lacked a legitimate medical purpose.

On Oct. 29, McCollum agreed to resolve the government’s False Claims Act allegations, including admitting that he violated the Anti-Kickback Statute by providing kickbacks in the form of a direct bill program whereby his laboratory, Labsource, gave referring providers an opportunity to earn revenue generated from their commercially-insured UDT referrals as an inducement for those providers to refer all of their federally-insured UDT patients to Labsource. McCollum also caused medically unnecessary prescriptions for pain creams often without the knowledge or approval of the patients’ healthcare providers and regardless of whether the prescription had a legitimate medical purpose. McCollum admitted that the aforementioned conduct constituted misrepresentations, fraudulent omissions and/or deceptive conduct, and that he engaged in this conduct with an intent to deceive the United States and cause the United States to pay false or fraudulent federal healthcare program claims.

Congress passed the Stark Law and the Anti-Kickback Statute to prevent financial incentives from improperly influencing medical decision-making, which can lead to excessive and unnecessary tests and services. Among other things, the Stark Law prohibits billing Medicare for laboratory testing services referred by a physician who has a financial relationship with the laboratory. The Anti‑Kickback Statute prohibits offering or paying anything of value to induce the referral of items or services covered by federal healthcare programs, including laboratory testing services.

“Improper financial relationships between healthcare providers and laboratories can lead to overutilization and increase the cost of healthcare services paid for by the taxpayers,” said Acting Assistant Attorney General Brian M. Boynton of the Justice Department’s Civil Division. “The provision of medical services and prescriptions should be based on a patient’s medical needs rather than the financial interests of providers.”

“This office will use all tools necessary to ensure justice, deterrence and prevention of healthcare fraud,” said Acting U.S. Attorney M. Rhett DeHart for the District of South Carolina. “The criminal guilty plea and the civil consent judgment entered against the defendant in this case demonstrates that effort.”

“McCollum engaged in deceptive conduct by exploiting the vital programs on which they depend,” said Special Agent in Charge Derrick L. Jackson of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “We will continue to work with our law enforcement partners to hold accountable individuals who endanger the integrity of federal healthcare programs and the beneficiaries they serve.”

“The TRICARE Program is vital to the health and readiness of our active duty service members, retirees and their families,” said Special Agent in Charge Christopher Dillard of the Department of Defense Office of Inspector General, Defense Criminal Investigative Service (DCIS), Mid-Atlantic Field Office. “Today’s announcement should leave no doubt that DCIS and its law enforcement partners remain committed to rooting out fraud, holding bad actors accountable and protecting the integrity of the Department of Defense.”

The civil judgment resolves claims brought under the qui tam or whistleblower provisions of the False Claims Act by Donna Rauch, Muriel Calhoun, Brandy Knight and Karen Mathewson, all former employees of pain management clinics owned or operated by McCollum. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam cases are captioned United States ex rel. Rauch, et al. v. Oaktree Medical Centre, P.C., et al., No. 6:15-cv-01589-DCC (D.S.C.); United States ex rel. Mathewson v. Dr. Daniel A. McCollum, et al., No. 6:17-CV-01190-DCC (D.S.C.); and United States ex rel. Hawkins v. Pain Management Associates of the Carolinas, LLC, et al., No. 8:18-cv-02952-DCC (D.S.C.). In connection with this matter, the United States previously was awarded civil judgments totaling over $140 million against entities owned or operated by McCollum: Oaktree Medical Centre P.C., FirstChoice Healthcare P.C., Labsource LLC, Pain Management Associates of the Carolinas LLC, Pain Management Associates of North Carolina P.C., ProLab LLC and ProCare Counseling Center LLC.

The civil judgment and criminal plea obtained in this matter were the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, and the U.S. Attorney’s Office for the District of South Carolina, with assistance from the FBI, HHS-OIG, the South Carolina Attorney General’s Office and the DCIS.

The investigation and resolution of this matter illustrates the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).

The litigation was handled by Fraud Section Attorneys Yolonda Campbell, Michael Kass, Christopher Terranova and David Wiseman and Assistant U.S. Attorneys Beth Warren and Bill Watkins for the District of South Carolina.

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Columbia, South Carolina --- Acting United States Attorney M. Rhett DeHart announced today that Joseph Benjamin Barton, 47, of Mount Pleasant, the owner and operator of Midlands Physical Medicine LLC in Richland County, has pleaded guilty to a felony count of health care fraud for billing Medicare for $194,000 that was not due.

Evidence presented in court showed that, from June 2016 until February 2017, Barton, through Midlands Physical Medicine, fraudulently submitted false claims to Medicare Part B for implantable neuro-stimulator pulse generators that beneficiaries did not receive and submitted “approvals” for such devices by a doctor no longer affiliated with the practice.

While Barton submitted claims to Medicare stating that another affiliated physician rendered the procedure, that physician was not a part of the practice, was living in Florida at the time, and was unaware that Barton submitted these claims using his identifiers as the provider that rendered the services.  In actuality, a physician’s assistant was providing Medicare beneficiaries an auricular electrical nerve stimulation device not covered by Medicare, in place of an implantable stimulator device, to provide relief from pain and/or headaches.

United States District Judge J. Michelle Childs accepted Barton’s guilty plea and will sentence Barton at a later date.  The maximum penalties Barton faces include ten years of imprisonment, a $250,000 fine, and three years of supervised release.

The Office of the Inspector General for United States Department of Health and Human Services is investigating the case, and Assistant United States Attorney Winston Holliday is prosecuting the case.

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Acting United States Attorney Bob Murray announced today that HOLLI TELFORD LUNDAHL, age 64, of Oelrichs, South Dakota, was sentenced by U.S. District Court Judge Nancy Freudenthal on August 27, 2021 to 27 months imprisonment, with three years of supervised release, and ordered to pay $76,626.65 in restitution, payable to the Wyoming Medicaid program, and a $500 special assessment.

The sentence comes after a jury found Lundahl guilty on three counts of health care fraud and two counts of aggravated identity theft after a one-week trial held in April of 2021 in the United States District Court for the District of Wyoming.

In March 2020, Holli Lundahl was indicted on the charges, which included three overlapping schemes to defraud Wyoming Medicaid by submitting false claims for long-term care provided to Lundahl’s sibling, and the unlawful possession and use of identity information of two individuals, including Lundahl’s niece, in furtherance of two of the charged schemes.

“Lundahl deserves every bit of that sentence. She robbed Wyomingites of receiving legitimate funds for necessary care through Wyoming’s Medicaid System,” said Acting United States Attorney Bob Murray. “The sentence speaks to the hard work put into investigating and prosecuting the case, and we thank the Wyoming Medicaid Fraud Control Unit and our prosecution team for putting a stop to this injustice.”

Wyoming Attorney General Bridget Hill complimented the work of both the U.S. Attorney's Office and her office's Medicaid Fraud Control Unit, noting that, “It was nice to have the opportunity to partner together to root out Medicaid fraud and protect the Medicaid program from these sorts of abuses. This is important work as it helps assure that the Medicaid program is available to provide medical care for those citizens who truly need it.”

The case was investigated by the Wyoming Medicaid Fraud Control Unit and prosecuted by Senior Assistant Attorney General Travis Kirchhefer of the Wyoming Attorney General’s Office and Assistant United States Attorney Eric Heimann.

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

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

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

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

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

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

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

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

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

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Tampa, FL – U.S. District Judge Virginia Hernandez Covington today sentenced Patsy Truglia (54, Parkland) to 15 years in federal prison for his role in two consecutive conspiracies to commit health care fraud and for making a false statement in a matter involving a health care benefit program. As part of his sentence, the Court ordered Truglia to pay $18.3 million to the affected government health programs and an insurance company. The Court also entered a money judgment against Truglia in the amount of $10,117,738 and ordered him to forfeit numerous assets, including $9,308,235.86 seized from various financial accounts, high-end automobiles (Rolls Royce, Lamborghini, and Mercedes), jewelry, and Truglia’s lakefront home, all of which were traceable to the charged criminal conduct. Truglia had pleaded guilty on October 5, 2021.

According to court documents, beginning in January 2018 and continuing into April 2019, Truglia and other conspirators, including co-defendant Ruth Bianca Fernandez (who worked under Truglia’s supervision), generated medically unnecessary physicians’ orders via their telemarketing operation for certain orthotic devices—knee braces, back braces, wrist braces, and other braces—referred to as durable medical equipment (“DME”). Through the telemarketing operation, federal health care program beneficiaries’ (i.e., Medicare beneficiaries’) personal and medical information was harvested to create the unnecessary DME brace orders.

The brace orders were then forwarded to purported “telemedicine” vendors that, in exchange for a fee, paid illegal bribes to physicians to sign the orders, often without ever contacting the beneficiaries to conduct the required telehealth consultations. The fraudulent, illegal brace orders were then returned to Truglia’s telemarketing operation, which used the orders as support for millions of dollars in false and fraudulent claims submitted to the Medicare program. To avoid Medicare scrutiny, Truglia and Fernandez spread the fraudulent claims across five DME storefronts operated under Truglia’s ownership and control and Fernandez’s day-to-day management. In all, through their five storefronts, Truglia, Fernandez, and other conspirators caused approximately $25 million in fraudulent DME claims to be submitted to Medicare, resulting in approximately $12 million in payments.

On April 9, 2019, multiple federal law enforcement agencies participated in a nationwide action referred to as “Operation Brace Yourself.” The Operation targeted ongoing schemes, such as Truglia’s, in which companies were paying illegal bribes to secure signed physicians’ DME brace orders for use as support for fraudulent claims submitted to the federal programs. In the Middle District of Florida, the April 2019 Operation included, among other efforts, the execution of search warrants at several of Truglia’s DME storefronts and a civil action under which, among other ramifications, enjoined Truglia and (by extension) his five storefronts from engaging in any further health care fraud conduct.

Undeterred, beginning in or around April 2019 and continuing into July 2020, Truglia and other conspirators—some of whom had worked with Truglia in the earlier conspiracy and some of whom were new conspirators—carried out a similar conspiracy using three new DME storefronts and different “telemedicine” vendors. Through this conspiracy, Truglia and his conspirators caused an additional approximately $12 million in fraudulent DME claims to be submitted to Medicare, resulting in approximately $6.3 million in payments.

“Every defendant in this case shared a common trait—greed,” said IRS-CI Special Agent in Charge Brian Payne. “The desire for money fueled them to commit crimes against our healthcare system and prey upon those in our society who deserve our highest respect, the elderly and military Veterans. Thanks to the financial expertise and diligence of IRS-CI special agents, as well as our partner federal, state, and local law enforcement officers, these criminals are off the street and are facing the consequences of their actions.”

“The significant sentence and financial restitution imposed today reflects the serious nature of Mr. Truglia’s criminal conduct and underscores that the Government will continue to vigorously prosecute health care fraud cases and seek the recovery of all illicitly obtained assets of these greed-fueled fraud schemes,” said Special Agent in Charge Omar Pérez Aybar of HHS-OIG. “Collaborating closely with our law enforcement partners, we will continue to thoroughly investigate fraudsters who seek to enrich themselves at the expense of vulnerable members of the public.”

“We have dedicated agents and analysts focused on uncovering the deceitful tactics used to cheat our federal healthcare system,” said FBI Tampa Division Special Agent in Charge Michael McPherson. “The cost of healthcare fraud impacts all of us. The FBI will continue to engage with our partners to protect taxpayers from fraudsters like Mr. Truglia and those identified in Operation Brace Yourself.”

“The sentence imposed today holds this defendant accountable for his prominent role in a reprehensible healthcare fraud scheme involving CHAMPVA and Medicare,” said Special Agent in Charge David Spilker, Department of Veterans Affairs Office of Inspector General, Southeast Field Office. “The VA OIG is committed to ensuring healthcare spending is directed only to deserving Veterans and those who serve them. We thank and commend our outstanding law enforcement partners in this important joint investigation.”

This case was investigated by U.S. Department of Health and Human Services – Office of Inspector General, the Federal Bureau of Investigation, the Department of Veterans Affairs – Office of Inspector General, and the Internal Revenue Service –Criminal Investigation, Tampa Field Office. The criminal case was prosecuted by Assistant United States Attorneys Jay G. Trezevant, Tiffany E. Fields, and James A. Muench. The civil action is being handled by Assistant United States Attorney Carolyn B. Tapie.

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PITTSBURGH, PA - A South Hills pharmacist pleaded guilty in federal court to charges of obtaining controlled substances by fraud, misbranding of drugs, and health care fraud conspiracy, Acting United States Attorney Stephen R. Kaufman announced today.

Timothy W. Forester, 46, of Venetia, PA pleaded guilty to three counts before Senior United States District Judge David S. Cercone.

In connection with the guilty plea, the court was advised that Forester was a licensed pharmacist who owned four pharmacies – Century Square Pharmacy in West Mifflin, PA and Prescription Center Plus with locations in South Park, PA, McMurray, PA and Eight Four, PA. From on or about November 14, 2018, to on or about February 14, 2019, Forester admitted he knowingly, intentionally and unlawfully obtained oxycodone and hydrocodone, Schedule II controlled substances, by misrepresentations, fraud, and deception. Forester admitted he did not place the controlled substances into the inventories of the four pharmacies and did not maintain records to show the controlled substances were dispensed. In addition, Forester admitted he relabeled generic drugs as name brand medications and then sold them as if they were the more expensive drugs. Finally, Forester admitted filling prescriptions with generic drugs, but billing Medicare and Medicaid for the more expensive name brand drugs, thereby committing health care fraud and causing a loss to Medicare and Medicaid of approximately $680,000.

“Timothy Forester ordered opioids without adding them to inventory, mislabeled generic drugs as name-brand medications, and billed Medicare and Medicaid for name-brand drugs when he provided generics, all in violation of federal law,” said Acting U.S. Attorney Kaufman, “We will continue to pursue medical professionals who engage in fraud schemes to enrich themselves at the expense of their patients.”

“U.S. consumers rely on health care professionals to follow FDA requirements pertaining to prescription medications. When they take actions to evade these requirements, they put patient health at risk,” said Special Agent in Charge Mark S. McCormack, FDA Office of Criminal Investigations Metro Washington Field Office. “We will continue to investigate and bring to justice those who threaten the safety of the nation’s drug supply and, ultimately, the patients who take those drugs.”

“Pharmacy professionals who mishandle opioids in an effort to enrich themselves only exacerbate the challenges and devastation families and communities experience as a result of our nation's opioid epidemic," said Maureen R. Dixon, Special Agent in Charge for the Inspector General’s Office of the U.S. Department of Health and Human Services in Philadelphia. “We will continue to work with our law enforcement partners to bring unscrupulous health professionals to justice.”

“Pharmacists such as Forester have an obligation to properly dispense and safeguard controlled substances such as oxycodone and hydrocodone,” said Thomas Hodnett, Acting Special Agent in Charge of the Drug Enforcement Administration’s (DEA) Philadelphia Field Division. “Forester used his position of trust and access to obtain these powerful painkillers for his own use through fraud and deception.”

Judge Cercone scheduled sentencing for February 8, 2020 at 11:30 a.m. As to Count 1, the law provides for a maximum sentence of four years in prison, a fine of $250,000 or both. As to Count 11, the law provides for a maximum sentence of three years in prison, a fine of $250,000 or both. As to Count 12, the law provides for a maximum sentence of 10 years in prison, a fine of $250,000 or both. Under the Federal Sentencing Guidelines, the actual sentence imposed is based upon the seriousness of the offenses and the prior criminal history, if any, of the defendant.

Assistant United States Attorney Robert S. Cessar is prosecuting this case on behalf of the government.

The investigation leading to the filing of charges in this case was conducted by the Western Pennsylvania Opioid Fraud and Abuse Detection Unit, which combines personnel and resources from the following agencies to combat the growing prescription opioid epidemic: Federal Bureau of Investigation, U.S. Health and Human Services – Office of Inspector General, Drug Enforcement Administration, Internal Revenue Service-Criminal Investigations, Pennsylvania Office of Attorney General - Medicaid Fraud Control Unit, United States Postal Inspection Service, U.S. Attorney’s Office – Criminal Division, Civil Division and Asset Forfeiture Unit, Department of Veterans Affairs-Office of Inspector General, Food and Drug Administration-Office of Criminal Investigations and the Pennsylvania Bureau of Licensing.

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The United States has reached a civil settlement with Saint Francis Medical Center (Saint Francis) resolving the Government’s claims under the Controlled Substances Act. According to the United States’ allegations, Saint Francis employed a Farmington, Missouri physician, Brett Dickinson (Dickinson), who wrote prescriptions for controlled substances without legitimate medical purposes and outside the usual course of professional practice. As part of the settlement, Saint Francis agreed to pay $1,624,957.67.

The United States alleged that Saint Francis, through Dickinson’s actions in the scope of his employment, issued invalid prescriptions for opioids such as morphine, hydromorphone, and oxycodone. According to the United States’ allegations, Dickinson prescribed these opioids to patients simultaneously with muscle relaxers and benzodiazepines. The United States claimed that such drugs are known to enhance the addictive, euphoric effects of opioids and, as a result, are commonly sought-after in combination with opioids by individuals with substance abuse disorders and individuals who seek to use opioids recreationally. The United States alleged that Dickinson issued these prescriptions while ignoring warning signs of drug diversion or misuse, including aberrant urine drug test results and patients’ previous hospital treatment for medical problems related to drug misuse.

Although not part of the settlement agreement, in August 2021, Saint Francis voluntarily incorporated the Foundation for Opioid Prescribing Education in the State of Missouri. According to Saint Francis, the Foundation, which it funded with an initial contribution of $1 million, will be used to fund education programs for physicians and other healthcare professionals in Southeast Missouri on best practices in prescribing opioids and managing patients with chronic pain issues.

Saint Francis fully cooperated with the United States’ investigation of the case. Additionally, as part of the settlement, Saint Francis agreed to cooperate with the United States’ investigation of individuals not released in the settlement agreement, including by furnishing documents related to “the prescribing of controlled substances by Dickinson.”

“When Dr. Dickinson recklessly prescribed controlled substances without regard for his patients’ well-being, he violated the trust our communities extend to healthcare professionals. We appreciate the steps taken by Saint Francis Medical Center to prevent such illegal behavior by its staff in the future,” said Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services Curt L. Muller. “In coordination with our law enforcement partners, our agents will continue to investigate such fraud schemes and protect the public from unscrupulous prescribers.”

The Office of Inspector General of the Department of Health and Human Services, Drug Enforcement Administration, and the Missouri Attorney General’s Medicaid Fraud Control Unit investigated the case. Assistant United States Attorney Amy Sestric handled the case.

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ASHEVILLE, N.C. – U.S. Attorney Andrew Murray announced today that Asheville-based Southeastern Physical Therapy (SEPT) and owner Darren Cady have agreed to resolve allegations that Cady received illegal kickbacks and violated the False Claims Act by submitting claims for reimbursement for certain durable medical equipment to the Veterans Affairs (VA) while participating in the VA “Choice Provider” program.

The Veterans Access, Choice, and Accountability Act of 2014 provided Veterans with expanded access to third-party providers outside the VA system. In 2018, the program was replaced by the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (“Mission Act”). The Mission Act provided for the same access to third-party providers. Under the 2014 Act and the Mission Act, Veterans could use third-party providers like SEPT for certain services. Provider participation in the program was memorialized in contracts with third-party administrators. The contracts required providers to comply with applicable local, State, and federal laws, rules, regulations and institutional and professional standards of care.

The United States alleges that, among other things, SEPT and Cady made materially false, fictitious, and fraudulent statements and representations, or material omissions, regarding the medical necessity of a medical device and received illegal kickbacks from the device manufacturer for prescribing the devices to VA patients. The United States alleges that Cady entered into a contract with the device manufacturer, which paid Cady for prescribing the devices. The United States also alleges that Cady gave a copy of his signature to a medical device salesperson, who used Cady’s signature to complete at least some medical necessity forms for VA patients, which forms accompanied invoices to the United States for payment for the devices. The United States alleges that Cady did not examine or personally treat the VA patients for whom he prescribed the devices, and further alleges that the patients were not instructed on how to safely or effectively use the product.

“Prescribing devices to VA patients that are not medically necessary is dangerous and wastes important resources intended to help our nation’s Veterans,” said U.S. Attorney Murray. “My office will vigorously pursue providers and other actors that seek to take advantage of VA benefits through the submission of false claims that promote fraud and abuse in these critical government programs.”

This settlement resolves allegations investigated by the government under the False Claims Act. The settlement is a result of the coordinated effort between the VA Office of Inspector General and the U.S. Attorney’s Office for the Western District of North Carolina.

The claims resolved in this settlement are allegations only and there has been no determination of liability against SEPT, Cady, or any other entity.

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Montgomery, Alabama – On July 23, 2021, a notice of dismissal was filed indicating that SpectraCare Health Systems, Inc. (“SpectraCare”) agreed to pay $1 million dollars to resolve a federal qui tam lawsuit alleging that it violated the False Claims Act, announced Acting United States Attorney Sandra J. Stewart.  The Government’s multi-year investigation, which spawned from a whistleblower complaint, investigated whether SpectraCare knowingly violated the False Claims Act by improperly billing Alabama Medicaid for Basic Living Skills services, and by failing to return overpayments to the Alabama Medicaid Agency, which constitutes a “reverse false claim” actionable under 3729(a)(1)(G) of the False Claims Act.

SpectraCare Health Systems, Inc. is a 501(c)(3) nonprofit organization headquartered in Dothan, Alabama, which provides integrated healthcare services, including developmental disability services, intermediate care medical services, behavioral health services, and preventative programs to a range of patients.  The company is contracted by the Alabama Department of Mental Health to provide services, which are paid for by the Alabama Medicaid Agency.

This lawsuit was initially filed in the United States District Court for the Middle District of Alabama by a former SpectraCare employee under the qui tam, or whistleblower, provisions of the False Claims Act.  Pursuant to these provisions, a private citizen can bring suit on behalf of the United States and share in any recovery.  The United States will receive $743,193.00 of the $1 million dollar settlement, 19% of which will go to the relator as her share of the Government’s recovery in the matter.  The remaining $256,807.00 will be paid to the Alabama Medicaid Agency.

The settlement resolves allegations that, from October 1, 2012 through December 31, 2019, SpectraCare (1) knowingly submitted to Medicaid claims for reimbursement for services that were billed without complete and correct documentation, billed in duplicate, over-billed, or otherwise improperly billed, and/or (2) knowingly made, used, or caused to be made or used, false records or statements material to SpectraCare’s obligation to return overpayments to Medicaid based on such improper billing procedures, and/or (3) knowingly, intentionally, or recklessly failed to repay, or to exercise reasonable diligence to determine whether it was obligated to repay, Medicaid for SpectraCare’s improper claim submissions and their attendant overpayments.

This Affirmative Civil Enforcement matter was handled by Assistant United States Attorney Samantha R. Miller and the Civil Health Care Fraud Investigator of the United States Attorney’s Office, with assistance from Assistant Attorney General James Hartin of the Office of the General Counsel for the Alabama Medicaid Agency.  The case was investigated in conjunction with the Office of Inspector General for the United States Department of Health and Human Services.  The claims resolved by the settlement are allegations only, and there has been no determination of liability.

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Smokeless tobacco use by service members is much higher than in the U.S. adult population. This fact concerns the military medical community. Users say it helps with alertness, and allows them to stay connected with peers. But evidence links products like snuff, dip, and chewing tobacco to cancer and poor oral health. Such products also contain nicotine and are addictive.

To the Military Health System, using tobacco in any form poses a threat to readiness and the overall health of the force. Smokeless tobacco contains over 30 chemicals that cause cancer. It’s not a safe alternative to other forms of tobacco, like cigarettes.

Today, Feb. 20, MHS encourages all smokeless tobacco users to stop – even if just for a day – for the Great American Spit Out. One day might lead to a second and set users on a path to stopping for good.

“We know that nicotine helps with alertness. But smokeless tobacco products also have negative effects on dental, readiness, and long-term health,” said U.S. Public Health Service Capt. Kimberly Elenberg, director of the Defense Health Agency’s Total Force Fitness office.

DoD’s tobacco education campaign, YouCanQuit2, urges tobacco users to assess their readiness to take action and make a plan to quit.

YouCanQuit2 provides many resources to service members and beneficiaries on their journey to becoming tobacco free.

“We’re providing them with education, and also support for quitting tobacco if they so choose,” Elenberg said. “This includes a 24/7 Live Chat for questions, support, and encouragement, as well as an interactive savings calculator.”

YouCanQuit2 can help people quit in several ways. There are tips for writing a quit plan, and for managing cravings and stress. There’s information on prescription and over-the-counter products to help people quit. There are even ideas to prevent weight gain. Plus, care providers can order and print out campaign materials.

YouCanQuit2 has Instagram, Facebook, and Twitter channels. All provide ideas on ways to quit.

TRICARE offers many benefits aimed at quitting smokeless tobacco use. TRICARE-authorized providers can counsel beneficiaries age 18 and older who live in the United States or District of Columbia. Medicare recipients are not eligible.

Research shows that using a program and a product together increases chances of quitting for good. As a result, coverage of tobacco cessation products is provided through military pharmacies or the TRICARE pharmacy home delivery program. These products include Chantix, Zyban, and nicotine replacement therapy, such as nasal sprays, inhalers, patches, gum, and lozenges. There’s no cost, although brands vary by pharmacy and generics may be provided. A prescription is needed for all products from a TRICARE-authorized provider, even if the product can be bought over the counter. The minimum age is 18 and Medicare recipients are not eligible. None of these products are covered at retail pharmacies.

Coverage of products and counseling for service members and beneficiaries stationed overseas is provided for those enrolled in TRICARE Prime.

A managed care option available in Prime Service Areas in the United States; you have an assigned primary care manager who provides most of your care.TRICARE Prime Overseas.

The government has other help available. Mobile apps found at Smokefree.gov make support as close as the smartphone. Smokefree.gov also provides DipfreeTXT, a texting program for those who want to quit.

On the Great American Spit Out 2020, there have never been more ways to spit out tobacco for good.

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Spokane, Washington – Christopher M. Valley, N.D., a Spokane-based naturopathic doctor, has agreed to pay $47,700 to resolve allegations under the Controlled Substances Act that he improperly prescribed controlled substances between December 2015 and December 2020. The Controlled Substances Act regulates certain drugs deemed to pose a risk of abuse and dependence. To protect public safety and prevent misuse and diversion, the Act requires practitioners to register with the Drug Enforcement Administration (“DEA”) to prescribe these controlled substances.

During the relevant time period, Dr. Valley was a naturopathic doctor licensed in the State of Washington. Under state and federal law, as a naturopathic doctor, Dr. Valley was only authorized to prescribe two types of controlled substances: codeine and testosterone products. In the settlement agreement between the United States and Dr. Valley, Dr. Valley acknowledged prescribing at least 318 controlled substances that he was not authorized to prescribe, including stimulants such as modafinil (typically prescribed for narcolepsy and sleep apnea); the sedative pregabalin (sold by Pfizer under the brand name Lyrica); the diet drug phentermine; the sleep aid zopidem (often sold under the brand name Ambien), and one prescription for ketamine, a Schedule III anesthetic that is commonly abused recreationally.

The settlement agreement also further sets forth that Dr. Valley ceased his improper prescribing practices in September 2020 when pharmacists contacted him regarding his improper prescribing, and that he cooperated with the United States’ investigation, including acknowledging his prior improper prescribing and voluntarily surrendering his DEA registration. Additionally, the settlement agreement sets forth that Dr. Valley has implemented additional controls and procedures to ensure that this conduct does not recur.

“I am relieved that it does not appear anyone was seriously harmed by any medications prescribed by Dr. Valley, and I am heartened by Dr. Valley’s acknowledgment of his conduct and commitment to strict compliance going forward. But when a healthcare practitioner prescribes controlled substances that he is not qualified or authorized to prescribe, the public is placed at risk of potentially dangerous side effects, drug interactions, and contraindications,” said Vanessa R. Waldref, United States Attorney for the Eastern District of Washington. “This resolution demonstrates our strong commitment to protecting public health and to keeping our communities strong and safe. In particular, I commend the excellent investigative work conducted by DEA’s Diversion Group and the Department of Health and Human Services. We will continue to partner with DEA, HHS, and other law enforcement agencies to hold health care practitioners accountable.”

“Dr. Valley’s careless and irresponsible prescribing habits violated federal law and constituted a serious breach of his naturopathic license, which presented a clear and present danger to the health and safety of our communities,” said Frank A. Tarentino III, Special Agent in Charge of DEA’s Seattle Field Division. “We will continue to work with our federal, state, local, and tribal partners in the relentless pursuit of all those involved in the trafficking of opioids and other controlled substances.”

The settlement was the result of a joint investigation conducted by DEA’s Seattle Field Office, Diversion Group, and the U.S. Attorney’s Office for the Eastern District of Washington, with support and assistance from the U.S. Department of Health and Human Services, Office of Inspector General, Seattle Field Office. Assistant United States Attorneys Dan Fruchter and Tyler H.L. Tornabene handled this matter on behalf of the United States.

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Tampa, Florida – U.S. District Judge Charlene E. Honeywell has sentenced David Naylor (59, Spring Hill) to two years and three months in federal prison, followed by 3 years of supervised release, for theft of government funds. As part of his sentence, the court also ordered Naylor to pay $730,561.73 in restitution and, separately, entered a forfeiture money judgment against him in the amount of $549,426.23, the proceeds of the offense of conviction.

Naylor had pleaded guilty on September 22, 2020.

According to court documents, Naylor engaged in a scheme to defraud the Department of Veterans Affairs (VA). To deceive and steal from the VA, Naylor made false representations regarding his physical limitations in connection with his application for VA Disability Compensation. Based on these false representations, the VA found that Naylor was entitled to Disability Compensation and other related benefits. In total, Naylor received $549,426.23 in VA benefits to which he was not entitled. Naylor also received $181,135.50 in Social Security Disability Insurance benefits as a result of relevant conduct.

This case was investigated by the Department of Veterans Affairs, Office of the Inspector General and the Social Security Administration, Office of the Inspector General. It was prosecuted by Special Assistant United States Attorney Suzanne Huyler.

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When Veterans move into stable housing after years of homelessness, many lack the resources to also purchase basic household items that they’ll need in their new homes. To address this need, schools and student councils across the country competed in the annual End Veteran Homelessness Challenge. The End Veteran Homelessness Challenge raises money and collects household essential items for Veterans who are exiting homelessness. VA’s Homeless Programs Office, in partnership with the National Association of Elementary School Principals (NAESP) and the American Student Council Association (ASCA), organized the challenge.

The challenge asked student councils in five states to help homeless Veterans by collecting clothing, everyday household goods and money for security deposits. The combined value of cash and goods collected by the five participating schools exceeded $5,000.

VA and its partners congratulate Kaʻōhao School in Hawaii for winning the challenge. Kaʻōhao students collected items valued at more than $3,000. Most of the donations they received were personal hygiene items, such as toothbrushes, toothpaste, deodorant, and shampoo — the personal care essentials that many people take for granted. Other items collected included toilet paper, laundry detergent, socks, pants, backpacks, sweaters, and ponchos.

“We are extremely proud of our Kaʻōhao School and student council for leading the charge to help homeless Veteran here in Hawaii and across the nation,” said Dr. Winston Sakurai, Kaʻōhao School Director. “Kaʻōhao School is located in a community with a large military population and this is our opportunity to give back and bring awareness by supporting our outstanding Veterans.”

Five schools participated in the challenge and helped make a difference for Veterans seeking safe, stable housing:

• Carrollwood Day School in Tampa, Fla.
• Eastman Avenue Elementary School in Los Angeles, Calif.
• Kaʻōhao School in Kailua, Hawaii
• Oliver McCracken Middle School in Skokie, Ill.
• Rocky River Elementary School in Concord, N.C.

“I think it is important to help [Veterans] because they have served our county. A lot of people in our school are really excited and passionate about helping end homelessness,” said Gemma Canevari, sixth grader and Kaʻōhao School student body president. “Our student council made announcements, counted the items and issued a challenge to see which classes could collect every item on the list and who could collect the most items.”

Other highlights of the challenge included Rocky River Elementary School, which raised $500 and mailed more than 700 holiday cards to current service members. Additionally, Oliver McCracken Middle School raised $106 to purchase restaurant gift cards for Veterans.

“Teaching our students empathy is foundational because we all have feelings, are human and need to care for one another,” said Espie Chapman, Kaʻōhao School Student Council Advisor. “The Homeless Veterans Challenge was an honor to be a part of to help those who made our lives better today.”

Since 2010, more than 800,000 Veterans and their family members have avoided homelessness or moved into permanent housing with help from VA programs and targeted housing vouchers from the U.S. Department of Housing and Urban Development. The End Veteran Homelessness Challenge is an example of how individuals of all ages can support the important work underway by VA and its partners to prevent and end homelessness among Veterans.

More Information

• Check out naesp.org to learn more about the National Association of Elementary School Principals and the American Student Council Association.
• Visit VA’s website to learn about employment initiatives and other programs for Veterans exiting homelessness.
• Refer Veterans who are homeless or at imminent risk of becoming homeless to their local VA medical center or urge them to call 877-4AID-VET (877-424-3838).

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The most rigorous study to date examining post-mortem brain tissue from those with PTSD has identified molecular changes in the brain that may lead to new ways to diagnose and treat the disorder.

The study appeared online in the journal Nature Neuroscience on Dec. 21, 2020. Researchers with the VA National Center for PTSD, VA’s National PTSD Brain Bank, and Yale University School of Medicine carried out the study.

`This is a historic step in PTSD research’

“This is a historic step in PTSD research that will mean better treatment for Veterans with PTSD,” says study coauthor Dr. John Krystal, director of NCPTSD’s Clinical Neuroscience Division and chair of psychiatry at Yale University. “We have advanced our understanding of the cellular and molecular alterations in PTSD brains, and this brings us closer to designing more effective treatment strategies.”

PTSD develops in some people who have experienced or witnessed a life-threatening event, and includes intrusion, avoidance and hyperarousal symptoms as well as negative thoughts and mood. Besides psychotherapy, current treatments include medications that researchers say are helpful in minimizing – but not eliminating – PTSD symptoms.

The study, led by Dr. Matthew Girgenti of VA and Yale, is the first to pinpoint genetic changes related to PTSD that are specific to gender, and to certain brain subregions.

Women more likely to develop PTSD after experiencing trauma

Understanding how PTSD differs within the brains of men and women is important, because women are more likely to develop PTSD after experiencing trauma. Also, there may be differences in how men and women respond to treatment. The finding underscores the need to develop different treatment strategies for men and women.

The study also showed major differences in how PTSD and depression look in the brain. Some symptoms overlap between the two conditions, and researchers say that about half of those diagnosed with PTSD are also diagnosed with depression. The finding could potentially help clinicians better distinguish between the conditions and offer more effective treatment.

The findings come from the first major research study using brain tissue from the National PTSD Brain Bank. The bank is led by study co-author Dr. Matthew Friedman of the NCPTSD and Geisel School of Medicine at Dartmouth. The program collects, processes, and stores human research specimens and provides them to qualified researchers to learn more about illness in Veterans.

More Information

Click here to read more about VA research.

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A new progress report shows improvement in the lives of Veterans who use Whole Health services.

The report gives updates from a three-year pilot study monitoring the effects of adding a Whole Health approach at 18 VA flagship sites. Whole Health is an approach to care where clinical care (such as medicines or counseling) and complementary care (such as acupuncture or yoga) work together as part of an overall treatment plan. A Whole Health approach lets Veterans make use of all appropriate therapies to help them explore what matters most in their health and well-being and live healthier lives.

The progress report—VA Center for the Evaluation of Patient Centered Care (EPCC): Whole Health Flagship Site Evaluation—now offers a glimpse into the success of the study after two years. Early results show higher employee engagement and early signs of potential cost savings in pharmacy and outpatient care.

But perhaps most importantly, the study reveals positive impacts of Whole Health on Veterans.

Veterans with chronic pain who used Whole Health services had a threefold reduction in opioid use compared to those who did not. Opioid use among Whole Health users decreased 38% compared with only an 11% decrease among those with no Whole Health use. Veterans who used Whole Health services also reported being able to manage stress better and noted the care they received as being more patient centered. These results indicate improvements in Veterans’ overall well-being.

The demand for Whole Health services remains high. Over 97% of Veterans responded they were either somewhat interested, very interested or already using at least one Whole Health service. During interviews for the report, Whole Health leads shared several stories of the impact of Whole Health approaches on Veterans, including reductions in the use of opioids and other pain medications, weight loss, smoking cessation, and improvements in mental health.

Whole Health leaders attributed these changes, in part, to a radical shift in approach to health care, from one that fosters dependence on medical professionals to one that empowers Veterans and promotes their active partnership with a medical team as they figure out what health and well-being looks like for them.

Equally noted was the effect Whole Health had on VA employees, many of whom are Veterans themselves. Employees involved with Whole Health at the flagship sites reported lower burnout, lower voluntary turnover, greater motivation, and were more likely to rate their facility as a ‘best place to work.’

Initial findings also suggest that using Whole Health services may reduce pharmacy costs. Whole Health service use among Veterans with mental health conditions (such as PTSD, anxiety and depression) was associated with smaller increases in outpatient pharmacy costs (3.5% annual increase) compared to similar Veterans who did not use Whole Health services (12.5% annual increase). Additionally, Whole Health service use among Veterans with chronic conditions was associated with smaller increases in outpatient pharmacy costs (4.3% annual increase) compared to similar Veterans who did not use Whole Health services (15.8% annual increase).

“These are early findings, but even so the opioid outcomes are striking, and we’re seeing this is good for employees and the system,” said Barbara Bokhour, Ph.D., the Principal Investigator for the study, and the Director of VA’s Health Services Research & Development (HSR&D) Center for Healthcare Organization and Implementation Research at the Bedford and Boston VAMCs. “This may take as many as 7-10 years to adopt a Whole Health approach across VA, and we have to ask, is this the way VA should go? Early findings are saying yes.”

Improving Veterans’ experiences with care may in turn improve Veteran engagement and foster better self-management of chronic illnesses. And self-management is critical to better health and well-being over time. Implementation of a Whole Health approach is complex and takes time. Yet, early findings demonstrate that when Veterans engage in Whole Health services, improvements in perceptions of care, engagement in care, and well-being are possible.

Additional resources regarding this report can be found below:

• VA Center for the Evaluation of Patient Centered Care (EPCC): Whole Health Flagship Site Evaluation report
• Infographic on Whole Health Evaluation Report

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For many who served in combat, their experiences strengthened them personally. But it made the transition back to civilian life more difficult.

This is the key finding in a new survey from pew research. The survey shows Veterans who served in the global war on terror are more likely to be deployed over-seas than Veterans from previous eras. Service members after 9-11 are more likely to have seen combat, and experienced emotional trauma.

They're also more likely than their predecessors to suffer physical or psychological combat scars. Nearly 50 percent of Veterans from the war on terror report some emotionally traumatic or distressing experiences. That's compared to only one in four service members from before 9-11.

"The 'trust factor' in a warrior when he's out there," Benny Guerrero, Commander with Veterans of Foreign Wars explained. "Who do you trust? You have to adopt a certain philosophy that... be cordial and nice to everyone you meet, but be ready to kill everyone you meet. That mindset really plays with people's heads."

A service member is only given five days of civilian behavior before they're discharged. Guerrero says that's not nearly enough, and it's up to other Veterans to support each other during that difficult time.

"We are those people that are gonna carry your pack for ya, until you get ready to carry your own pack, let us carry your load," Guerrero said. "I think those organizations, those Veteran service organizations, are vital to a successful transition."

If you've served, Guerrero urges you to join the Veterans of Foreign Wars, The American Legion, The Order of the Purple Heart or the Disabled American Veterans Organization. He says you're doing yourself a disservice if you haven't.

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CHICAGO — The U.S. Attorney’s Office in Chicago today announced that a suburban Chicago nursing facility has agreed to pay $360,000 to resolve civil allegations that it violated the False Claims Act by providing unnecessary and “upcoded” physical, occupational, and speech therapy services to increase Medicare payments.

A consent judgment and settlement agreement resolve allegations that, from 2008 to 2016, skilled nursing facility NORRIDGE GARDENS, of Norridge, Ill., provided medically unnecessary services to Medicare beneficiaries, first through a third-party skilled therapy vendor, Quality Therapy & Consultation Inc., formerly of Orland Park, Ill., and then through its own skilled therapy affiliate, REX THERAPEUTICS LLC, of Skokie, Ill. The allegations contend that Norridge Gardens pressured others to meet quotas for the proportion of Medicare Part A beneficiaries utilizing the highest-possible reimbursement level, known as the Resource Utilization Group (“RUG”) score, in an effort to increase Medicare payments. Norridge Gardens also allegedly claimed payment for therapy services without a physician order and other times reported that skilled therapy had been provided, when, in fact, the patients were not participating in therapy or were unable to undergo or benefit from it.

The consent judgment and settlement agreement resolve claims in two civil lawsuits filed in U.S. District Court in Chicago by a former employee of Quality Therapy and Rex Therapeutics under the qui tam, or whistleblower, provisions of the False Claims Act. The Act permits private citizens to bring lawsuits on behalf of the United States for false claims, and to share in any recovery. The United States intervened in both lawsuits prior to entry of the consent judgment and settlement agreement.

The settlement and consent judgment with Norridge Gardens and Rex Therapeutics were entered Friday in U.S. District Court in Chicago. The United States in 2019 reached a settlement with Quality Therapy and its owner, requiring them to pay $1.09 million to resolve alleged False Claims Act violations.

The civil resolutions were announced by John R. Lausch, Jr., United States Attorney for the Northern District of Illinois; Lamont Pugh III, Special Agent-in-Charge of the Chicago Region of the U.S. Department of Health and Human Services Office of Inspector General; and Emmerson Buie, Jr., Special Agent-in-Charge of the Chicago Field Office of the FBI. The government is represented by Assistant U.S. Attorney Sarah J. North.

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The U.S. Department of Veterans Affairs (VA) and National Board for Health & Wellness Coaching (NBHWC) successfully applied to the American Medical Association (AMA) for new Health and Well-being Coaching Category III Current Procedural Terminology (CPT®) codes that certified health coaches can now use to identify and report this service accurately.

As VA’s approach to care moves from “find it, fix it” health care to one guided by patients’ needs, “coaching is the lynchpin of the transformational model,” according to Dr. Kavitha Reddy, who led the VA team that made the AMA application. Dr. Reddy is an emergency and integrative medicine physician who also serves as the Whole Health System Clinical Director at VA St. Louis Healthcare System inMissouri. Whole Health is VA’s patient-centered approach to care that considers the full range of physical, emotional, mental, social, spiritual and environmental influences on Veteran patients.

There are nearly 2,300 VA trained Whole Health Coaches working in VA medical centers and clinics. Coaches help Veterans as they develop personal health plans, working with them to discover what matters to them and set goals. Together the patient and coach consider complementary and integrative health and well-being programs that may involve physical activities, contemplative practices, or creative expressions. Coaches offer patients support and attention to help them stay on track to meet their health and well-being goals and live Whole Health.

As a physician who looks to Whole Health Coaches to help with her patients, Dr. Reddy says, “Knowing I have a health coach who can dive deeper into the challenges for behavior change is awesome.”

VA made the application for codes in response to a growing enthusiasm for Whole Health and the desire for more precise coaching data. “We have seen a tremendous growth in the number of (VA) sites who want to implement this model of care, and our ability to track who was delivering coaching with specificity was really limited by the lack of CPTs,” Dr. Reddy says. “We thought it was the right time to approach AMA because we had the volume and the literature to support the need for these codes.”

The formalized tracking from the codes will provide VA more data on coaching to better assess how it is impacting the health and well-being of Veterans. Use of the codes may also increase recognition of Health and Well-being Coaching as a valuable service and make its usage more common in health care nationwide.

The new Health and Well-being Coaching codes are CategoryIII codes, a temporary designation to track new and emerging services and procedures.CPT codes are created, trademarked, and published by the AMA. The data generated is essential because Medicare and insurers look at evidence of effectiveness, improved outcomes, and potential financial savings when deciding if a treatment or service is covered.

These codes include:

• 0591T Health and Well-being Coaching face-to-face; individual, initial assessment
• 0592T individual, follow-up session, at least 30 minutes
• 0593T group (two or more individuals), at least 30 minutes

As the transition to Whole Health progresses, VA is looking at other well-being programs that might also benefit from assigned codes. For more information, talk to your provider about Whole Health offerings available to you.

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FRA has signed onto a letter to the Chairs and Ranking Members of the House and Senate Subcommittees on Defense Appropriations to provide funding for the treatment-focused Gulf War Illness Research Program (GWIRP), part of the Congressionally Directed Medical Research Program (CDMRP) within the Department of Defense (DoD). Peer-reviewed studies have consistently concluded that Gulf War Illness (GWI) affects approximately 25-32% of the veterans of the 1990-91 Gulf War. GWI is characterized by multiple, diverse symptoms that typically include chronic headache, widespread pain, cognitive difficulties, debilitating fatigue, gastrointestinal problems, respiratory symptoms, sleep problems, and other abnormalities that could not be explained by established medical diagnoses or standard laboratory tests.

TAKE ACTION

Exposure to toxins, whether herbicides or fumes of chemicals from a burn pits, has long been an issue facing certain service members both at home and abroad. Years of research has produced reports of the debilitating health problems and, in some cases, deaths attributed to exposure to these toxins. Sen. Thom Tillis (NC) and Rep. Mike Bost (IL) recently introduced comprehensive legislation to cover all possible toxicants developed by the TEAM (Toxic Exposure in the American Military) Coalition, which includes FRA. "The Toxic Exposure in the American Military Act" (TEAM Act- S.927/ H. R. 2127) expands access to preventative and diagnostic services for veterans exposed to toxins and establishes an independent scientific commission tasked with researching the health effects of such toxic exposure and reporting its findings to the Department of Veterans Affairs (VA) and Congress.

FRA wants to ensure that no veteran who had exposure to burn pits or other environmental toxins goes without access to VA health care benefits.

TAKE ACTION

Six Medical Practices and a Physician-Owner to Pay Over $7.4 Million to Resolve Claims of Improper Billing of Medicare and the Federal Employees Health Benefit Program for Acupuncture Procedures

Breon Peace, United States Attorney for the Eastern District of New York, Scott J. Lampert, Special Agent-in-Charge, U.S. Department of Health and Human Services, Office of the Inspector General, New York Region (HHS-OIG), and Norbert E. Vint, Deputy Inspector General, Office of Personnel Management (OPM), announced today that six surgery centers and medical offices affiliated with Interventional Pain Management Center P.C. (“IPMC”), a company owned by Dr. Amit Poonia, have agreed to pay $7,447,340.75 to resolve liability under the False Claims Act for claims submitted to federal health care programs for acupuncture treatment.

“This settlement holds the defendants accountable for mischaracterizing acupuncture as a surgical procedure in order to dishonestly obtain millions of dollars from Medicare and the Federal Employees Health Benefit Program,” said United States Attorney Peace. “Working with our partners at the Department of Health and Human Services Office of the Inspector General and the Office of Personnel Management, we identified the false claims that enabled our Office to negotiate resolutions that resulted in a significant recovery of taxpayer dollars.”

“Medical professionals are expected to bill taxpayer funded health care programs correctly to ensure that they remain solvent and available to those that need their services,” stated HHS-OIG Special Agent-in-Charge Lampert. “Along with our law enforcement partners, this settlement affirms our commitment to ensuring that individuals and entities that bill federal health care programs do so in an honest manner.”

“Today’s settlement reminds all providers that if they submit false claims, they will be held accountable,” stated OPM Deputy Inspector General Vint.        

The defendants treated patients with electro-acupuncture devices called P-Stim and NeuroStim/NSS (“NSS”). P-Stim and NSS procedures transmit electrical pulses through needles placed just under the skin on a patient’s ear. Both treatments are considered acupuncture under Medicare and Federal Employees Health Benefit Program (“FEHBP”) guidelines and are therefore ineligible for reimbursement by the government. From January 2012 through April 2017, the IPMC surgery centers and medical offices submitted claims to Medicare and FEHBP for P-Stim and NSS treatment and associated administration of anesthesia. In submitting the claims, the defendants used a billing code that mischaracterized the acupuncture treatment as a surgical implantation of a neurostimulator.

In addition to paying the civil settlement, Dr. Poonia, New Jersey Interventional Pain Management Center, PC; Advanced Interventional Pain Management Center, LLC; Global Anesthesia Group, LLC; Springfield Surgery Center, LLC; Park Avenue Surgery Center, LLC; and Endo Surgi Center of Old Bridge, LLC, have agreed to enter into an Integrity Agreement with the HHS-OIG. The Integrity Agreement requires that these entities and their owners implement specific measures intended to prevent future health care fraud and address evolving compliance risks. These measures include training for staff on applicable health care fraud laws and submitting to a claims review conducted by an Independent Review Organization to ensure compliance with Medicare billing requirements.

The allegations were brought to the government’s attention through the filing of a complaint captioned United States ex rel. Anu Doddapaneni and Christian Reyes v. Amit Poonia, MD., New Jersey Interventional Pain Management Center, P.C. et al., 18-CV-5214 pursuant to the qui tam provisions of the False Claims Act. Under the Act, private citizens can bring suit on behalf of the United States and share in any recovery. The claims resolved by the settlement are allegations only; there has been no determination of liability, nor a concession by the United States that its claims are not well founded.

The government’s case was handled by Assistant U.S. Attorney Jolie Apicella of the Office’s Civil Division with assistance from Civil Investigator Joseph Giambalvo.

The Defendants:

1. Dr. Amit Poonia, M.D.
2. New Jersey Interventional Pain Management Center P.C.
3. Advanced Interventional Pain Management Center LLC
4. Global Anesthesia Group LLC
5. Park Avenue Surgery Center LLC
6. Springfield Surgery Center LLC
7. Endo Surgi Center of Old Bridge LLC
8. E.D.N.Y. Docket No. 18-CV-5214 (ENV)

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LANSING – Two people were arraigned on charges recently for defrauding the U.S. Department of Veterans Affairs (VA) and Michigan Department of Treasury out of hundreds of thousands of dollars by submitting fraudulent documents in support of claims for VA survivor benefits and Michigan Unclaimed Property, Attorney General Dana Nessel announced today. A third individual has been charged in connection with this fraud but has not yet been arraigned.

The Attorney General's enforcement operation was conducted in close collaboration with the U.S. Department of Veterans Affairs Office of the Inspector General.

Melissa R. Flores, 53, and a co-conspirator allegedly created aliases and obtained or created fraudulent documents, including vital records like birth certificates, to make it appear that they were heirs to various individuals who had died.

Through this scheme, between 2013 and 2019, it’s alleged that the two individuals obtained more than $40,000 of Unclaimed Property from the Michigan Department of Treasury and more than $430,000 from the VA. Meanwhile, Steven Decker, 32, received proceeds from the scheme and used some of the money to conceal property used to conduct the fraud.

“Committing fraud against our state or federal agencies that directly give back to their communities will not be tolerated,” Nessel said. “Our Veterans voluntarily put their lives on the line in service to this country to protect the freedoms and liberties we as U.S. citizens enjoy. For someone to take advantage of the public benefits set aside for their families is a slap in the face to servicemen and women across the country.”

Flores, of Westland, is subject to sentencing as a habitual offender, fourth notice. She was arraigned on the charges Wednesday before Judge Sandra Cicirelli in 18th District Court. Flores is scheduled for a probable cause conference at 8:30 a.m. June 4 before Judge Mark A. McConnell and a preliminary hearing at 8:30 a.m. June 11 before Judge Cicirelli. She is charged with:

one count of conducting a criminal enterprise, a felony punishable by up to 20 years’ imprisonment, $100,000 fine and forfeiture of proceeds and items used during the crime;  two counts of false pretenses between $20,000 and $50,000, a felony punishable by 15 years’ imprisonment, $15,000 fine or three times the value of the money or property involved, whichever is greater;  forgery of documents affecting real property, a 14-year felony; and  four counts of false pretenses between $1,000 and $20,000, a felony punishable by up to five years’ imprisonment and a $10,000 fine or three times the value of the money or property involved, whichever is greater.

Decker, of Wyandotte, is charged with one count of criminal enterprises – racketeering proceeds, a felony punishable by up to 20 years’ imprisonment, $100,000 fine and forfeiture of proceeds and items used during the crime. He was arraigned Friday before Judge Elizabeth DiSanto in 27th District Court. He is scheduled to appear in court for a probable cause conference at 1:30 p.m. June 4. DiSanto set a $10,000 cash or 10 percent surety bond.

A third individual has been charged with conducting a criminal enterprise and multiple counts of false pretenses. The identity of that individual is being withheld pending arraignment on the charges.

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SOLON, Ohio – Swagelok Co., a global developer and manufacturer of fluid system products, is helping active military members transition to the civilian workforce.

Swagelok, based in Solon, is partnering with the United States Department of Defense on its SkillBridge program.

Through this national program, Swagelok invites transitioning service members to network, develop new skills and learn about the company.

“I think it’s a phenomenal program for Veterans,” said Joel Martin, manager of commercial training and services for Swagelok and steering team chair for the Swagelok Veterans and Military Resource Group.

“It allows them an opportunity to intern with a company or to learn a skilled trade and to build their network into the corporate world to help them with job placement after they separate from the military.

“This is one of the ways that people can get some professional experience, to start building their professional network and see what career options are out there for them.”

In addition to practical work experience, Swagelok SkillBridge fellows participate in an orientation process, attend personal and professional development classes, network with other program participants and meet with Swagelok leadership.

Their involvement is aided through the support of a mentor related to their work role, as well as a Veteran mentor. Opportunities are available in all areas of the organization, including operations, supply chain, sourcing, commercial, engineering and more.

“There are about 9,000 service members who separate from the military and move to Ohio annually,” Martin said. “So we recognize that demographic, and we wanted to reach out to them and connect them with opportunities to continue their career at Swagelok.”

Martin, who served in the U.S. Air Force, transitioned out of active duty in 2014. He currently serves as a major in the Air Force Reserves at Wright-Patterson Air Force Base in Dayton.

“As a Veteran myself, when I made the transition from active duty, this program wasn’t available nationwide, let alone at Swagelok,” he said. “I wish it was available then, but I’m excited to see what it has become now for Ohio Veterans.”

The program also has the support of the highest levels of leadership at the company, including military Veteran and Swagelok President and Chief Operating Officer James Cavoli.

“As a fellow Veteran, I appreciate the invaluable skills that our service members have and the experience that they can leverage in the corporate sector,” Cavoli said in a news release.

Swagelok supports active-duty military members and Veterans in a variety of ways. The Swagelok Veterans and Military Resource Group, founded and operated by Swagelok associates with the support of company leadership, has made it its mission to make Swagelok an employer of choice for Veterans.

A network of skill sharing, professional development and mentorship focuses on helping Veterans, active reservists and National Guard military members succeed in the civilian workforce. The group also promotes team-building activities as it participates in community events and supports local and national charities.

Interested active military members who are transitioning to the civilian workforce can find more information at the Swagelok SkillBridge website at jobs.swagelok.com/content/skillbridge/ or reach out directly to This email address is being protected from spambots. You need JavaScript enabled to view it..

Swagelok also encourages all Veterans to contact This email address is being protected from spambots. You need JavaScript enabled to view it. to network and learn about the company and potential opportunities.

Swagelok Co., headquartered in Solon since 1965, is a $2 billion privately held developer of fluid system products, assemblies and services for the oil and gas, chemical and petrochemical, semiconductor and transportation industries. It serves customers through about 200 sales and service centers in 70 countries.

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Sunrhys, LLC, a landlord and property management company headquartered in Tacoma, Washington, agreed to pay $16,618 to resolve allegations that it violated the False Claims Act by overcharging a tenant and by fraudulently obtaining federal funds from a federal program designed to provide housing to homeless Veterans.

The United States Department of Housing and Urban Development (HUD) and United States Department for Veterans Affairs (VA) jointly administer the HUD-VA Support Housing (HUD-VASH) program. HUD provides rental assistance for Veterans experiencing homelessness, while VA support services assist homeless Veterans in identifying, obtaining, and maintaining housing and other needed support services. At the end of Fiscal Year 2020, approximately 80,000 formerly homeless Veterans were receiving permanent housing through the HUD-VASH program.

“In creating the VA’s predecessor agency, President Abraham Lincoln said that we must ‘care for him who shall have borne the battle,’” said Joseph H. Harrington, Acting U.S. Attorney for the Eastern District of Washington. “No Veteran who has served our country and given everything to protect the safety and comfort of Americans should be himself or herself without the safety and comfort of a home. The HUD-VASH program provides important benefits to homeless Veterans. This settlement is an example of the United States Attorney’s Office for the Eastern District of Washington’s commitment to ensuring the integrity of that program.”

Between July 2019 and April 2020, Sunrhys was a participating landlord in the HUD-VASH program with respect to a Sunrhys rental property in Walla Walla, Washington that Sunrhys rented to Daniel Avila, an eligible Veteran. Each month, Sunrhys collected a portion of the monthly rent for the Walla Walla property from Mr. Avila. Sunrhys then submitted a claim for federal rent support funds for the remainder of the total agreed-upon rent. Pursuant to the Housing Assistance Payment Agreement governing Sunrhys’ participation in the program, Sunrhys was expressly prohibited from seeking or collecting additional rent from Mr. Avila in excess of the eligible amount. The United States alleged that Sunrhys violated the Agreement and the HUD-VASH program requirements by fraudulently overcharging Mr. Avila for monthly rent between July 2019 and April 2020.

Jason Root, Special Agent in Charge at the VA Office of Inspector General, stated, “VA OIG’s joint oversight of HUD-VASH is one of the agency’s highest priorities because of the importance of safeguarding grant programs designed to end Veteran homelessness. VA OIG thanks the U.S. Attorney’s Office for the Eastern District of Washington and the HUD Office of General Counsel for their partnership and commitment to protecting at-risk homeless Veterans.”

This matter originated when Mr. Avila filed a whistleblower, or “qui tam” complaint in February 2021. When a relator files a qui tam complaint, the False Claims Act requires the United States to investigate the allegations and elect whether to intervene and take over the action or to decline to intervene and allow the relator to go forward with the litigation on behalf of the United States. The relator is generally able to then share in any recovery. Here, the United States intervened in the action contemporaneous with the settlement. Mr. Avila will receive $4,154 of the settlement. Mr. Avila was represented by the Northwest Justice Project, Washington’s largest publicly funded legal aid program, which provides civil legal assistance and representation to low-income people in cases affecting basic human needs such as family safety and security, housing preservation, protection of income, access to health care, education and other basic needs.

“Under the False Claims Act, landlords that overcharge tenants under this program are liable not just to repay the amount that they overcharged their tenants, but for three times the total amount of federal funding that the landlord received in rent support payments plus additional penalties for each month, providing a powerful deterrent to fraud,” added Acting U.S. Attorney Harrington. “I want to especially commend the exceptional investigative work performed by the VA’s Office of Inspector General, Spokane Resident Agency, as well as the excellent work done by the Northwest Justice Project, which represented the whistleblower. Our office will continue to work together with our law enforcement partners, with whistleblowers, and with public interest groups like Northwest Justice Project to hold accountable landlords that abuse critical housing programs.”

The settlement was the result of a joint investigation conducted by the VA Office of Inspector General and the U.S. Attorney’s Office for the Eastern District of Washington, with support provided by HUD’s Office of General Counsel, Office of Program Enforcement and HUD’s Office of Inspector General. The investigation and prosecution for the U.S. Attorney’s Office for the Eastern District of Washington was handled by Assistant United States Attorneys Dan Fruchter and Tyler H.L. Tornabene. The claims resolved by the civil settlement are allegations only and there has been no determination of liability. The case is captioned United States ex rel. Avila v. Sunrhys, LLC, 4:21-cv-5013-TOR (E.D. Wash.).

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How the Washington, D.C. VA Hematology-Oncology team helped Veterans during the pandemic

As the pandemic began, staff at the Washington, D.C. VA Medical Center converted many medical appointments to telehealth to enforce the CDC’s social distancing and safety guidelines. This was not an option for most hematology and oncology patients and the team (pictured above) who takes care of them.

Dr. Joao Ascensao is chief of Hematology-Oncology. Ascensao said many of his team’s patients are vulnerable and at higher risk of poor outcomes from COVID-19. Still, they must physically come to the medical center to continue their treatments or undergo diagnostic tests.

“We see patients with blood diseases and cancer,”Ascensao said. “Many must come here for tests, such as blood smears, biopsies, and radiographic exams, as well as treatments like chemotherapy. At the onset of the pandemic when many clinics in the medical center shut down, the Hematology-Oncology Clinic did not.”

Nurses clean treatment rooms in between patients

Ascensao says the team’s challenge was to employ extra safety measures to keep Veterans and staff members safe while providing life-saving treatments and important tests to Veterans. Schedulers spaced out Veterans’ appointments and nurses cleaned the treatment rooms in between patients.

They curtailed the cancer support groups and canceled their big annual outreach event, Cancer Survivor’s Day.

The team converted Veterans who were already on a more routine follow-up schedule to telehealth. For those who needed an in-person appointment, the team established social distancing guidelines and ensured protections such as mask use and hand washing.

Commitment to patients’ safe environment

One major issue was to ensure effective communication with patients. The last thing the team wanted was for patients to forgo their treatment because they felt unsafe. “We spoke to them about the potential risks of traveling to the hospital, the importance of continuing treatment and our commitment to provide them a safe environment,” Ascensao said.

As the pandemic continues, Dr. Ascensao says his team and the Veterans they serve continually inspire him. “Our patients have always been a source of inspiration. I believe everyone on our team is committed to ensuring safe and timely care for Veterans.”

He says his team has always been quite cohesive, works well together and looks out for each other. “At times, we wondered if we would ever get over this pandemic,” he continued. “We dwelled on how it affected us personally. But in the end, we’ve all pulled together as a team to care for Veterans.”

The D.C. medical center is staying on its journey to become a high reliability organization led by teams like Hematology-Oncology that support a culture of safety by putting Veterans first.

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A federal grand jury in Newark, New Jersey, returned a superseding indictment today charging a Florida owner of multiple telemedicine companies with orchestrating a health care fraud and illegal kickback scheme that involved the submission of over $784 million in false and fraudulent claims to Medicare. This is one of the largest Medicare fraud schemes ever charged by the Justice Department. The superseding indictment also charges the defendant with concealing and disguising the proceeds of the scheme in order to avoid paying income taxes.

Creaghan Harry, 53, of Highland Beach, Florida, is charged in the superseding indictment with one count of conspiracy to commit health care fraud and wire fraud, and four counts of income tax evasion. Harry previously was charged in an indictment along with co-conspirators Lester Stockett and Elliot Loewenstern with one count of conspiracy to defraud the United States and to pay and receive kickbacks, four counts of receipt of kickbacks, and one count of conspiracy to commit money laundering. Stockett and Loewenstern previously pleaded guilty. If convicted, Harry faces a maximum penalty of 20 years’ imprisonment for the conspiracy to commit health care fraud and wire fraud, five years’ imprisonment on each count of tax evasion, five years’ imprisonment for the conspiracy to defraud the United States and pay and receive kickbacks, 10 years’ imprisonment for each count of receipt of kickbacks, and 20 years’ imprisonment on the conspiracy to commit money laundering. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

According to allegations in the superseding indictment, Harry and his co-conspirators solicited illegal kickbacks and bribes from durable medical equipment (DME) suppliers and marketers in exchange for orders for DME braces and medications. Harry’s telemedicine companies then allegedly paid physicians to write medically unnecessary orders for these braces and medications. Harry’s telemedicine companies provided orders to DME suppliers that fraudulently billed Medicare over $784 million. Medicare ended up paying over $247 million.

In order to conceal and disguise the health care fraud and illegal kickback scheme, the superseding indictment alleges, Harry directed DME suppliers and marketers not to directly pay his telemedicine companies and instead to pay shell companies that had been opened in the names of straw owners in the United States and foreign countries, such as the Dominican Republic. Harry then transferred the funds from the shell companies to his telemedicine companies in order to pay physicians to write the unnecessary orders.

The superseding indictment alleges that Harry falsely claimed to prospective investors, lawyers and others that his telemedicine companies had not received any kickbacks. Harry instead falsely represented that the telemedicine companies had been receiving revenue of “about $10 million per year” from fees paid by patients to receive telemedicine services, when in fact the revenue of the telemedicine companies was derived from illegal kickbacks and bribes.

The superseding indictment further alleges that Harry committed income tax evasion in the calendar years between 2015 and 2018 by receiving the proceeds of the illegal scheme in the accounts of shell companies belonging to nominee owners and using those proceeds to live a lavish lifestyle. Harry did not file an income tax return or pay taxes on this income.

Assistant Attorney General Kenneth A. Polite of the Justice Department’s Criminal Division; Acting U.S. Attorney Rachael A. Honig for the District of New Jersey; Special Agent in Charge George M. Crouch of the FBI’s Newark Field Office; Special Agent in Charge Scott J. Lampert of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG); and Special Agent in Charge Michael Montanez of IRS-Criminal Investigations, Newark, made the announcement.

HHS-OIG, the FBI and IRS-Criminal Investigations are investigating the case.

Assistant Chief Jacob Foster of the Criminal Division’s Fraud Section’s National Rapid Response Strike Force and Trial Attorney Darren Halverson of the Newark Strike Force are prosecuting the case.

The Fraud Section leads the Health Care Fraud Strike Force. Since its inception in March 2007, the Health Care Fraud Strike Force, which maintains 15 strike forces operating in 24 federal districts, has charged more than 4,600 defendants who have collectively billed federal health care programs and private insurers for approximately $23 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

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WASHINGTON – Ten Florida residents were charged in an indictment unsealed today in the Southern District of Florida for their alleged roles in a $67 million health care fraud, wire fraud, kickback, and money laundering scheme involving the submission of false and fraudulent claims to Medicare for medically unnecessary genetic tests and durable medical equipment.

Daniel M. Carver, 35, of Coral Springs; Thomas Dougherty, 39, of Royal Palm Beach; and John Paul Gosney Jr., 39, of Parkland, the owners and managers of independent clinical laboratories and marketing companies, were each charged with conspiracy to commit health care fraud, health care fraud, conspiracy to pay and receive health care kickbacks and bribes, paying and receiving kickbacks and bribes, conspiracy to commit money laundering, and money laundering offenses.

Galina Rozenberg, 39, and Michael Rozenberg, 58, both of Hollywood, were arrested on Feb. 6, attempting to board a flight to Moscow. Each were charged with one count of conspiracy to commit health care fraud, health care fraud, and conspiracy to commit money laundering. Galina Rozenberg was also charged with additional money laundering offenses.

Louis Carver, 30, of Delray Beach; Timothy Richardson, 29, of Lantana; Ethan Macier, 22, of Coral Springs; and Jose Goyos, 35, of West Palm Beach were each charged with conspiracy to commit health care fraud, health care fraud, conspiracy to commit money laundering, and money laundering offenses. Ashley Cigarroa, 29, of North Lauderdale was charged with one count of conspiracy to commit health care fraud and committing health care fraud.

The indictment alleges that, between January 2020 and July 2021, the defendants referred Medicare beneficiaries for medically unnecessary genetic tests and durable medical equipment. In exchange for doctors’ orders for such tests and equipment, the defendants allegedly paid kickbacks and bribes to telemedicine companies. The indictment further alleges that the defendants falsified Medicare enrollment forms to conceal the true owners and managers of certain laboratories, and submitted false and fraudulent claims to Medicare.

The defendants are anticipated to make their initial appearances in federal court beginning the week of Feb. 28. Federal charges for conspiracy to commit health care fraud and wire fraud, conspiracy to commit money laundering, and money laundering are each punishable by a maximum penalty of 20 years in prison. Health care fraud and anti-kickback violations are each punishable by a maximum penalty of 10 years in prison. Conspiracy to pay and receive kickbacks is punishable by a maximum penalty of five years in prison. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division; Assistant Director Luis Quesada of the FBI’s Criminal Investigative Division; Special Agent in Charge George L. Piro of the FBI’s Miami Field Office; and Special Agent in Charge Omar Pérez Aybar of the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) made the announcement.

The HHS-OIG Miami Region and FBI’s Miami Field Office investigated the case.

Trial Attorneys Patrick J. Queenan and Reginal Cuyler Jr. of the Criminal Division’s Fraud Section are prosecuting the case. Assistant U.S. Attorney Sara Michele Klco of the Southern District of Florida is handling asset forfeiture matters.

The Fraud Section leads the Health Care Fraud Strike Force. Since its inception in March 2007, the Health Care Fraud Strike Force, which maintains 15 strike forces operating in 24 federal districts, has charged more than 4,600 defendants who have collectively billed federal health care programs and private insurers for approximately $23 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Any doctors or medical professionals who have been involved with alleged fraudulent telemedicine or genetic testing marketing schemes should call to report this conduct to the FBI hotline at 1-800-CALL-FBI.

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Ten people, including two medical doctors, have been indicted in a $300 million healthcare fraud, announced U.S. Attorney for the Northern District of Texas Chad E. Meacham.

The defendants – who stand accused of accused of conspiracy to commit healthcare fraud, conspiracy to pay and receive healthcare kickbacks, offering or paying illegal kickbacks, and soliciting or receiving illegal kickbacks – were charged in a 26-count indictment filed Wednesday afternoon.

“Anti-kickback laws are designed to ensure that financial considerations do not cloud physicians’ judgement,” said U.S. Attorney Chad Meacham. “The Justice Department is determined to prosecute those flouting our nation’s healthcare fraud laws. Patients – and taxpayers – deserve rigorous enforcement.”

“Illegal kickback schemes corrupt the healthcare system. They cause billions of dollars in losses each year, generate business for dishonest service providers and erode trust in our health care system,” said Dallas FBI Special Agent in Charge Matthew DeSarno. “The FBI will continue to work with our law enforcement partners to expose fraud and protect the public from illegal schemes.”

According to the indictment, the founders of several lab companies, including Unified Laboratory Services, Spectrum Diagnostic Laboratory, and Reliable Labs LLC, allegedly paid kickbacks to induce medical professionals to order medically unnecessary lab tests, which they then billed to Medicare and other federal healthcare programs.

The medical professionals -- including internal medicine specialist Eduardo Canova, family medicine practitioner Jose Maldonado, and nurse practitioner Keith Wichinski – allegedly accepted the bribes and ordered millions of dollars’ worth of tests.

Meanwhile, Unified, Spectrum, and Reliable disguised the kickbacks as legitimate business transactions, including as medical advisor agreement payments, salary offsets, lease payments, and marketing commissions.

The labs, through marketers, allegedly paid doctors hundreds of thousands of dollars for “advisory services” which were never performed in return for lab test referrals. They also allegedly paid portions of the doctors’ staff’s salaries and a portion of their office leases, contingent on the number of lab tests they referred each month. In some instances, lab marketers even made direct payments to the provider’s spouse. (When the labs threatened one provider that payments would cease if he didn’t refer more tests, he immediately increased his lab referrals, averaging approximately 20 to 30 referrals per day.)

Knowing they could disguise additional kickbacks using a provider-ownership model, the founder of Spectrum and Unified, Jeffrey Madison, convinced the co-founders of Reliable, Biby Kurian and Abraham Phillips, to convert Reliable into a physician-owned lab. Reliable offered physicians ownership opportunities only if those physicians referred an adequate number of lab tests. In some cases, they made advance disbursement payment to physicians in an effort to appease the physician and ensure he would not send samples to other labs.

As a result of these kickbacks, laboratories controlled by the defendants were able to submit more than $300 million in billing to federal government healthcare programs. Between 2015 and 2018, Dr. Maldonado alone received more than $400,000 in kickbacks for ordering more than $4 million worth of lab tests and Dr. Canova received more than $300,000 in kickbacks for ordering more than $12 million worth of lab tests.

Defendants indicted are:

• Jeffrey Paul Madison, 56, founder of Unified Laboratory Services and Spectrum Diagnostic Laboratory
• Mark Christopher Boggess, 49, chief operating officer for Spectrum and Unified
• Biby Ancy Kurian, 49, co-founder of Reliable Labs, LLC
• Abraham Phillips, 50, co-founder of Reliable Labs, LLC
• Keith Allen Wichinski, 50, board-certified nurse practitioner based in San Antonio
• David Michael Lizcano, 56, ]owner of DCLH, a marketing firm engaged by Unified, Spectrum, and Reliable
• Laura Ortiz, 58, sister of David Lizcano and employee at his marketing firm
• Juan David Rojas, 34, owner of Rojas & Associates, another marketing firm engaged by Unified, Spectrum, and Reliable

An indictment is merely an allegation of criminal conduct, not evidence. Defendants are presumed innocent until proven guilty in a court of law.

If convicted, the defendants face up to 55 years or more in federal prison.

The Federal Bureau of Investigation’s Dallas Field Office, the U.S. Department of Health and Human Services’ Office of Investigations, the Defense Criminal Investigative Service, and the Veterans Affairs’ Office of Inspector General conducted the investigation. Assistant U.S. Attorney P.J. Meitl is prosecuting the case.

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A Tennessee doctor pleaded guilty yesterday in the Eastern District of Tennessee to maintaining his Knoxville, Tennessee, pain clinic as an illegal drug premises.

According to court documents, Dr. David Newman, 61, of Maryville, owned, operated, and was Medical Director of Tennessee Valley Pain Specialists (TVPS), a non-insurance, cash-equivalent pain clinic. Newman owned this clinic with Dr. Steven Mynatt. Newman continued to operate and serve as Medical Director of TVPS, despite knowing that Mynatt was prescribing opioids to patients outside professional practice and for no legitimate medical purpose. Newman and Mynatt were charged with drug-related offenses as part of the April 2019 Appalachian Regional Prescription Opioid Strick Force Surge. Mynatt entered a guilty plea related to his distribution of controlled substances at TVPS in February 2020 and will be sentenced on Feb. 9, 2022.

Newman pleaded guilty to unlawfully maintaining a drug premises. He is scheduled to be sentenced on Feb. 9, 2022, and faces a maximum sentence of 20 years in prison. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division; Acting U.S. Attorney Francis M. Hamilton III for the Eastern District of Tennessee; Special Agent in Charge J. Todd Scott of the Drug Enforcement Administration (DEA); Special Agent in Charge Joseph Carrico of the FBI’s Knoxville Field Office; Special Agent in Charge Derrick L. Jackson of the Department of Health and Human Services, Office of the Inspector General (HHS-OIG); and Special Agent in Charge Andy Corbitt of the Tennessee Bureau of Investigation (TBI) made the announcement.

The DEA, FBI, HHS-OIG, and TBI are investigating the case.

Trial Attorney Louis Manzo and Assistant Chief Jillian Willis of the Justice Department’s Fraud Section and Assistant U.S. Attorney Anne-Marie Svolto of the Eastern District of Tennessee are prosecuting the case.

The Fraud Section leads the Appalachian Regional Prescription Opioid (ARPO) Strike Force. Since its inception in October 2018, the ARPO Strike Force, which operates in 10 federal districts, has charged more than 85 defendants who are collectively responsible for distributing more than 65 million pills.

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A Tennessee nurse practitioner was arrested today for allegedly distributing prescription drugs unlawfully from the medical clinic she owned and operated.

According to court documents, Kelly McCallum, 39, of Dyersburg, unlawfully prescribed controlled substances, including oxycodone and hydrocodone, at the Convenient Care Clinic (Clinic). Over approximately four years, McCallum prescribed more than two million opioid pills and more than 900,000 pills containing benzodiazepines. McCallum is alleged to have provided prescriptions to individuals with whom she had close personal relationships, including individuals with whom she had sexual relationships. She is also alleged to have prescribed dangerous combinations of controlled substances to her patients and, when she was out of the office, left pre-signed prescriptions for staff to distribute controlled substances in her absence. McCallum also faces health care fraud charges for allegedly billing TennCare and Medicare for fraudulent office visits on days that she was away from the Clinic.

McCallum is charged with maintaining a drug-involved premises, unlawful distribution of controlled substances, and health care fraud. If convicted, McCallum faces a maximum penalty of 20 years in prison for the drug charges, and a maximum of 10 years in prison for health care fraud. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division; Acting U.S. Attorney Joseph C. Murphy of the Western District of Tennessee; Special Agent in Charge J. Todd Scott of the Drug Enforcement Administration’s (DEA) Louisville Division; Acting Assistant Director Jay Greenberg of the FBI’s Criminal Investigative Division; Special Agent in Charge Douglas Korneski of the FBI Memphis Field Office; Special Agent in Charge Derrick L. Jackson of the Department of Health and Human Services Office of the Inspector General (HHS-OIG) Atlanta Regional Office; and Special Agent in Charge Terry L. Reed Sr. of the Tennessee Bureau of Investigation (TBI) made the announcement.

The DEA, FBI, HHS-OIG and TBI are investigating the case.

Assistant Chief Jillian Willis of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Christie Hopper of the U.S. Attorney’s Office for the Western District of Tennessee are prosecuting the case.

The Fraud Section leads the Appalachian Regional Prescription Opioid (ARPO) Strike Force. Since its inception in October 2018, the ARPO Strike Force, which operates in 10 districts, has charged more than 90 defendants who are collectively responsible for distributing more than 105 million pills. The ARPO Strike Force is part of the Health Care Fraud Strike Force Program, which since March 2007 has charged more than 4,200 defendants who collectively have billed the Medicare program for more than $19 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at: https://www.justice.gov/criminal-fraud/health-care-fraud-unit.

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Tesla is known for supporting U.S. military Veterans and has said before that it “prioritizes building an inclusive and supportive environment.” Tesla’s Veterans Recruiter, Dirk Vanderlaan, shared a post on LinkedIn announcing the company’s plans to visit Naval Station Norfolk for the RecruitMilitary career fair that will take place on the naval base.

“This is big. Tesla Veterans Recruiting is coming to Norfolk, VA on October 26: #Veterans and families stationed at Naval Station Norfolk are invited to meet us at the RecruitMilitary career fair on base, and to RSVP for our Tesla Info Session later that evening,” wrote Vanderlaan.

“We are actively hiring from the Navy Nuclear community, electrician mates, machinist mates, cryptologic technicians, and across the skilled trades. If you’re in the Norfolk area, join us and learn how you can build your future at Tesla.”

The career fair will take place on Wednesday, October 26, from 11 am to 3 pm EST at Vista Point Center, Building Q-88, on the Naval Station Norfolk naval base. Base access is required. Later that evening, Tesla is having an info session at 6 pm in the Tesla Norfolk Showroom and requests anyone attending to RSVP.

According to Tesla’s 2020 DEI Impact Report, Veterans represent 4% of its total U.S. workforce. Tesla describes itself as a “natural next step for transitioning Veterans looking to continue their passion for service in the civilian sector.”

In its 2021 DEI Impact Report, Tesla emphasized Veterans’ vital role in achieving its goals.

“With dedicated Veteran recruiting resources and professional development opportunities, we prioritize an inclusive and supportive environment for transitioning Veterans. Tesla also supports numerous organizations that sponsor Veteran hiring and have expanded outreach efforts throughout the country to more military bases and community organizations,” Tesla wrote.

Tesla also added that its affairs teams ensure that it connects Veteran-owned businesses with opportunities with the company.

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New research from a Texas doctor has linked the onset of Gulf War illness in some Veterans to exposure to the deadly nerve gas sarin.

“Our findings prove that Gulf War illness was caused by sarin, which was released when we bombed Iraqi chemical weapons storage and production facilities,” said Dr. Robert Haley, professor of internal medicine and director of the Division of Epidemiology at the University of Texas Southwestern Medical Center. “There are still more than 100,000 Gulf War Veterans who are not getting help for this illness and our hope is that these findings will accelerate the search for better treatment.”

Haley, a medical epidemiologist who studies disease outbreaks in groups of people, has been investigating Gulf War illness for 28 years and used a genetic study that found some people have a stronger natural ability to fight the deadly chemical.

Troops who have genes that help metabolize the gas were less likely to develop the myriad of symptoms associated with the mysterious illness than those without it, according to the new research, which was released Wednesday. The findings were published in Environmental Health Perspectives, a peer-reviewed medical journal.

Following the Gulf War, which ended in 1991, returning Veterans began reporting a wide range of chronic symptoms, including fatigue, fever, night sweats, memory and concentration problems, difficulty finding words, diarrhea, sexual dysfunction and body pain. Since then, academic researchers and the Department of Veterans Affairs have been looking for the cause within the many toxic exposures that Veterans faced such as burning oil wells, pesticides, nerve gas and anti-nerve gas medication, and depleted uranium.

About 250,000 Veterans are affected by Gulf War illness, yet no cause has been widely accepted, according to the medical journal.

Sarin, which the military has confirmed as present during the war, is a toxic, synthetic nerve agent that was first developed as a pesticide. It has been used in chemical warfare and its production was banned in 1997.

When people are exposed to either the liquid or gas form, sarin enters the body through the skin or airways and attacks the nervous system. High-levels of exposure often results in death, but studies of survivors have revealed that lower-level sarin exposure can lead to long-term impairment of brain function, according to the Texas university’s research.

What causes the variety of symptoms in Veterans is the sarin exposure triggering inflammation in the brain, called chronic neuroinflammatory condition, Haley said. Knowing that, he would like to see other studies build on his research to develop treatments and cures.

“This is actually a very optimistic finding, because it’s not brain damage,” he said. “There’s nothing you can do about that.”

Haley said he first began his research on Gulf War illness at the urging of Texas billionaire and Navy Veteran Ross Perot, who funded Haley’s initial study in the early 1990s.

Even at the time, one of the strongest risk factors for those who were sick related to being in locations with increased possibility for nerve gas exposure, Haley said. The research contradicted the government’s conclusion of the time, which was the illness was caused by stress, he said.

“That set off a firestorm,” Haley said. “We were besieged for two or three weeks. Our phones didn’t stop ringing. It was incredible. Then we got some funding from the Defense Department.”

The latest research from Haley and his colleagues studied 508 Veterans who deployed and contracted Gulf War illness and 508 Veterans who deployed but did not develop any symptoms. They gauged sarin exposure by asking whether the Veterans had heard chemical nerve gas alarms sound during their deployment and by collecting blood and DNA samples from each person.

The researchers tested the samples for variants of a gene called PON1. There are two versions of PON1: the Q variant generates a blood enzyme that efficiently breaks down sarin while the R variant helps the body break down other chemicals but is not efficient at destroying sarin. Everyone carries two copies of PON1, giving them either a QQ, RR or QR genotype.

“Your risk is going up step by step depending on your genotype, because those genes are mediating how well your body inactivates sarin,” Haley said. “It doesn’t mean you can’t get Gulf War illness if you have the QQ genotype, because even the highest-level genetic protection can be overwhelmed by higher intensity exposure.”

The research doesn’t rule out that other chemical exposures could be responsible for a small number of cases of Gulf War illness. However, Haley’s team carried out additional genetic analyses on the new data, testing other factors that could be related, and found no other contributing causes.

The VA presumes disability for Veterans with certain chronic, unexplained symptoms existing for six months or more are related to Gulf War service without regard to cause, including chronic fatigue syndrome, fibromyalgia and some gastrointestinal disorders, according to the department. Those Veterans might also be eligible for other benefits including a health exam, health care and disability compensation.

Since the study was published, Haley said he’s already received letters from two Veterans asking if getting tested for the different forms of the PON1 gene and blood enzyme levels would be helpful. The test isn’t clinically available yet, but should be soon, Haley said. Then there could be some value to getting tested, but it’s more important now to seek treatment for any symptoms that they are experiencing, he said.

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'I believe in standing up and doing my best and really appreciate the opportunity to serve Texas in this capacity' Buckingham shared

Former state Sen. Dawn Buckingham was sworn in as Texas' next Land Commissioner on Monday, making history as the first woman in the role and promising to "serve Texans and serve them well."

"This office is really the tip of the spear of what matters most to conservative Texans." Buckingham told Fox News Digital. "We are here to defend oil and gas. We are where the majority the border was being built. We are going to stand strong and defend our history."

The Texas Land Commissioner is in charge of the Texas General Land Office, the state’s oldest public agency. Buckingham is tasked with managing public land, including the enforcement of leases for mineral rights and selling land to raise funds for the Texas Permanent School Fund, the country’s largest statewide public education endowment.

In her new role as land commissioner, Buckingham is responsible for distributing natural disaster relief funds, like the funds Texas received in the wake of Hurricane Harvey as well as being in charge of the Alamo, including plans for its renovations and upkeep. The Texas Land Commissioner also chairs the Veterans Land Board, which manages nine group homes and four cemeteries for Texas Veterans.

Following Buckingham's swearing in ceremony on Monday, the Commissioner shared that her team is ready to get to work, sharing their plans to visit the majority of the Lone Star State.

"We're getting to know our employees. We're prioritizing what needs to be right sighted and moving ahead." Buckingham shared with Fox News Digital.

The Texas Permanent School Fund is a top priority for Buckingham, with the new Texas Land Commissioner sharing that her role is "maximizing the profits from the state lands to send dollars to education."

"I think educating our children is the most important thing we do." Buckingham said. "And I think we should do everything we can to get our kids into an educational system that works for them, whatever their goals are, whether it's to go straight into the workforce or to college."

The new Texas Land Commissioner also shared how she plans to defend the oil and gas industry in Texas despite the Biden administration's actions against the industry.

"The Environmental Protection Agency (EPA) is trying to shut down oil and gas and not even just oil and gas, but they consider cows walking across someone's pasture to be polluting. And so we're here to stand and fight for our agriculture and the oil and gas industries." Buckingham stated.

The Texas Land Commissioner is also charged with the renovations and upkeep of the Alamo, a monument revered in Texas history as the site of a pivotal battle in its war of independence. Buckingham's predecessor, George P. Bush, faced considerable backlash over some of the more controversial issues surrounding the Alamo restoration process.

The over $400 million plan to renovate and preserve the landmark has been shrouded in controversy stemming on how to remember the Alamo and whether to focus on the 1836 battle or present a "fuller view" that discusses the role of slavery in the Texas Revolution.

"I pretty much put my stake in the ground. There's not going to be any reimagining of our Texas history at the Alamo. We're going to stand proud and defend our history." Buckingham shared with Fox News Digital. "That being said, we have a lot of stories to tell. We want to tell all of those stories. But we'll be watching very closely to be sure that we're not redefining our history."

Buckingham will replace Republican incumbent George P. Bush, who unsuccessfully sought the Republican nomination for attorney general instead of seeking reelection. Bush first became Land Commissioner in 2015; he succeeded fellow Republicans Jerry Patterson, who had been in the role since 2003, and David Dewhurst, who filled the role for four years before Patterson.

Despite being the fourth Republican in a row to serve as the Texas Land Commissioner, Buckingham shared with Fox News Digital how her administration will make its individual mark.

“I'm fiercely independent, and we're building our own team. We're really looking forward to igniting this agency and leading them into action and really just taking bold steps on behalf of Texans who need our help."

Before serving the public as a Texas state Senator, Buckingham was as a volunteer firefighter and earned her medical degree as an eye surgeon specializing in oculoplastics.

"We don't play identity politics too much, but I am somebody who has been breaking glass ceilings my whole life." Buckingham shared. "I grew up a tomboy and loved to hunt and fish. As a volunteer firefighter, I broke the glass ceiling and I went into not only the male-dominated field of medicine, but also into the Senate and then into this role. I believe in standing up and doing my best and I really appreciate the opportunity to serve Texas in this capacity."

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A Texas man wanted in connection to a roof repair scam that tricked senior citizens, including a Vietnam War Veteran, out of thousands of dollars was arrested Friday, investigators said.

Joshua Bell, 36, was caught after the U.S. Marshals North Texas Fugitive Task Force located him in Dallas, the Arlington Police Department wrote on Facebook.

Bell was living out of his car and had plans to go to casinos in Oklahoma, a source told FOX4 Dallas-Fort Worth.

Bell was wanted in multiple fraud cases in Mesquite, Arlington and Flower Mound, where he posed as a roof repairman and took large sums of money for repairs he did not do, police said. He is accused of swindling a Vietnam Veteran out of $17,000, and two other senior citizens for $1,200 each.

In some cases, Bell would use the name of a reputable local roofing company he had no connection with to take advantage of the homeowners, police have said.

Bell has been convicted of two similar schemes in the past, and was released early each time only to repeat his offenses, FOX4 reported.

He was sentenced to 20 years in prison in 2004 after pleading guilty to theft and burglary, but records obtained by the station show he was released in 2011. In 2013, he was sentenced to nine years for similar roof repair scams in Cooke and Grayson Counties, but only served three years.

Before his latest release, Bell had begged a judge for leniency in a written letter, blaming his actions on his drug addiction, according to the station.

He is being held in the Dallas County Jail.

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LUBBOCK, Texas (NEWS RELEASE) — The following is a news release from Texas Tech University:

For the ninth straight year, Texas Tech University has earned a spot on the 2021 Military Times’ Best for Vets: Colleges rankings. This year, the university ranked 62nd overall and 49th among public institutions. Texas Tech has been on this list every year since 2013.

The Military Times conducts its annual survey of roughly 500 colleges throughout the U.S., evaluating the quality of each institutions’ military student services and rates of academic achievement. Public data from the Veterans Affairs and Defense department, as well as three U.S. Department of Education sources – the Integrated Postsecondary Education Data System, College Scorecard data and the Cohort Default Rate Guide Database – also are factors considered in the rankings.

“We are honored to be recognized as a national leader in service to our military-affiliated student population,” said Sierra Mello-Miles, director of Military & Veterans Programs (MVP) at Texas Tech. “This ranking is a testament to Texas Tech’s commitment to assisting Veterans and their families in achieving academic, personal and professional success.”

Beyond the Military Times’ recognition, Texas Tech also has been named a Military Friendly School each year since 2010, including a 2018-19 Top 10 designation, the highest of the recognition’s available accolades.

Through the MVP program, Texas Tech has consistently led the way in innovation when it comes to building a Veteran-friendly culture on campus. Since 2010, MVP has been dedicated to helping Veterans and their families succeed on and off campus. It offers resources for financial aid, academic assistance and navigating federal forms and educational benefits.

As part of its ongoing services, MVP is excited to offer TechVet Bootcamp in August. This is a half-day event for first-year students and is designed to help them transition into college life by introducing them to community and campus resources. It also is a time for students to meet and network with other Veterans.

Other MVP events include the annual Tournament for Heroes, which will take place in November at the Rawls Golf Course on Texas Tech’s campus. MVP also will take part in numerous community outreach events throughout the 2021-22 academic calendar.

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LUBBOCK, Texas (NEWS RELEASE) - Texas Tech University has consistently been recognized when it comes to its service to military members and Veterans. Most recently, Texas Tech ranked on the “Best for Vets: Employers” list by Military Times and as a “Top 10 School” in the Military Friendly® Schools Awards designation by Viqtory.

Texas Tech is one of three universities listed on the “Best for Vets: Employers” list and the only higher education institution in Texas to be ranked. Other employers on the list include Bank of America, Hilton and Southwest Airlines. The university was evaluated on its military-connected job openings, inclusive hiring practices, military caregiver programs, employment retention and other factors.

“Texas Tech is honored to be among the list of employers recognized on Military Times’ ‘Best for Vets’ list,” said LaDonna Johnson, associate managing director of human resources at Texas Tech. “We are incredibly proud to provide support to our military employees.”

Texas Tech employs 228 active service members and Veterans. Throughout the year, employees find support and service through Texas Tech’s Military & Veterans Programs (MVP). The unit exists to assist Veterans and their families in achieving academic, personal and professional success. But support does not stop with employees.

Texas Tech also has roughly 3,600 military-affiliated students enrolled, and their positive experiences are one of many reasons Texas Tech was named a “Top 10 School” in the Military Friendly® Schools Awards designation by Viqtory, a company that creates resources for Veterans. This award is determined by evaluating public data sources and responses from a proprietary survey.

Over 1,800 schools participated in the 2022-2023 survey and Texas Tech ranked No. 9.

This rating takes into account many factors such as academic policies and compliance, admissions and orientation, culture and commitment, financial aid and assistance, graduation and careers, and military student support and retention.

“Over the past year, MVP staff worked tirelessly at improving processes and strengthening our relationships with students, other departments and the community,” said Sierra Mello Miles, director of MVP at Texas Tech. “This allowed us to bolster the support network for our military-affiliated population on campus. Our slogan is ‘#1Family1Mission’ and we mean it. It’s in our hearts to do right by the servicemembers and their families for what they’ve sacrificed. I’m so proud of our team and grateful for our supporters across campus and the community.”

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Program honored for “Unrelenting effort and extraordinary service”

This summer, Veterans of Foreign Wars (VFW) honored the South Texas VA’s Integrated Medicine Fellowship Program (IMFP) and University of Texas Health San Antonio Hospice and Palliative Medicine Fellowship with its HERO Award.

The award was presented “For your unrelenting effort and extraordinary service and care you provided as frontline health care workers during the COVID-19 pandemic.”

The IMFP is one of six programs nation-wide that provides unique training opportunities to care for some of the most vulnerable Veteran populations. The program offers geriatric medicine, hospice and palliative medicine to over 100,000 Veterans living in South Texas.

“I’ve seen how hard you worked.”

Mike Toreno wears two hats. As one of two palliative care social workers on the disciplinary team, which also includes chaplains, pharmacists, psychologists, nursing and medicine staff, he is also a VFW Officer for Post 76 in San Antonio.

The admiration of his fellow VA colleagues was the catalyst for getting them the recognition they deserved. “Being a part of this program and being side-by-side with each of you, I’ve seen how hard you worked and your dedication to the patients,” Toreno said.

One palliative team member, Chaplain Eric Gonzales, said supporting families is something he will always cherish during his fellowship. “I was called to offer a bedside prayer by the family of a Veteran,” Gonzales said. “The Veteran’s family was having some difficulty letting him go. I helped them to understand the situation and use the time they had left to, “Just be and say the five things that matter most… please forgive, I forgive, I love, I remember, and I will never forget.”

“Admirable because it is such a challenge.”

VFW District 20 Commander and Veteran Bill Smith, whose wife is a physician, knows how difficult health care, and especially health care during a pandemic, can be. “The path you have chosen, you have chosen to take care of individuals as they depart this world and go into another,” Smith said. “That is admirable because it is such a challenge.”

Smith talked about the evolution of both organizations, and how the pandemic affected how each conducts its business. He drew similarities between the surge of COVID patients facing IMFP and the rush of Veterans flooding into VFWs after the beginning of the Global War on Terror.

Dr. Douglas Boyer, acting deputy chief of staff, thanked the VFW leadership for being such strong partners and told the audience about his first interaction with the VFW some two decades earlier. After going on leave, he found himself alone late at night in an airport. The only one around was a gentleman from the VFW. Boyer said he was given a gift card for Burger King and it turned out to be one of the tastiest meals he’s had.

“I knew right then the VFW would forever hold a place in my heart,” Boyer said.

“Our heart goes out to you.”

The Commander of Post 76, Marine Corps Veteran Robert Hernandez, echoed the sentiments of mission. “You know we all have one common mission and that mission is to take care of Veterans. We’ve been doing this for more than a hundred years and continue to do it today.”

Toreno said the team kept providing safe, timely and high-quality care under the most extreme conditions. For a palliative care team, one of the most important aspects is providing compassionate care.

“I see you,” Hernandez said. “Because I’ve been to several hospitals and I see what each one of you have been going through by taking care of our own. We know what you are going through. Our heart goes out to you, so please don’t stop doing what you’re doing because our lives depend on you.”

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SAN ANTONIO, Texas (KWTX) - A Dripping Springs woman was sentenced in a federal court in San Antonio on March 23 to 46 months in prison and ordered to pay $501,709.54 in restitution for defrauding the Department of Veterans Affairs (VA) and the Social Security Administration (SSA) of more than $500,000.

Josephine Casandra Perez-Gorda, 40, defrauded the VA and SSA by overstating the severity and extent of her spouse’s disability from October 2011 through August 2017. Mr. Perez-Gorda, now deceased, was an Army Veteran who participated in the fraud.

The couple claimed Mr. Perez-Gorda was paralyzed from the waist down from an injury he suffered while on active duty. The ruse included applying for and receiving a specially equipped vehicle, a specially adapted home, and additional compensation based on his disability rating.

The investigation began after San Antonio news station, KENS 5, aired a story titled, “Homes for Our Troops Questions Veteran’s Paralysis after Video.”

The story involved a specially adapted house in Dripping Springs that was gifted to the Perez-Gordas in December 2013 by the non-profit foundation Homes for Our Troops.

Although Mrs. Perez-Gorda claimed her husband was “paralyzed from the belly button down,” Mr. Perez-Gorda was seen walking around the neighborhood and playing basketball.

VA Office of Inspector General (OIG) agents videotaped Mr. Perez-Gorda walking around without assistance. Mrs. Perez-Gorda furthered the scheme by completing all the VA and SSA paperwork claiming Mr. Perez-Gorda was paralyzed in both legs.

Mrs. Perez-Gorda was found guilty on Sept. 22, 2022, of 11 counts of wire fraud; one count of mail fraud; one count of healthcare fraud; three counts of false statements related to a healthcare matter; one count of conspiracy to commit healthcare fraud; and one count of theft of government funds.

In addition to the imprisonment and restitution, Perez-Gorda is responsible for a $100 special assessment on each of the 18 counts and $100,000 for trial expenses.

“Fraudulently obtaining benefits from VA diverts valuable resources intended for the care of deserving Veterans,” said Deputy Assistant Inspector General for Investigations Carl Scott of the Department of Veterans Affairs Office of Inspector General’s Office of Investigations. “The VA OIG is grateful to the U.S. Attorney’s Office and the Social Security Administration OIG for their efforts in this joint investigation.”

The VA-OIG and SSA-OIG investigated the case.

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We know Veterans can be awarded a 100% rating for their service-connected disabilities. But the VA can also award a Veteran a temporary 100% rating. Let’s take a look at the three types of temporary 100% disability ratings that a Veteran can get.

1. Hospitalization Ratings

A 100% rating is available for periods of hospital treatment for a service-connected disability for more than 21 days. If you are hospitalized for a non-service-connected disability, you can still get assigned a 100% rating if during that hospitalization you were treated for a service-connected disability for more than 21 days. The rating is effective from the first day of the hospitalization and ends the last day of the month that you were discharged from the hospital.

2. Convalescent Ratings

A Veteran is entitled to a temporary 100% rating when a Veteran needs time to convalescence following a hospital discharge or outpatient release.

What does convalescence mean?

Convalescence is the act of regaining or returning to a normal or healthy state after surgical operation or injury.

The three circumstances for convalescence:

• The Veteran has undergone surgery that requires at least one-month convalescence
• The Veteran has undergone surgery that resulted in severe postoperative residuals
• The Veteran has a major joint that has been immobilized by a cast

What do you need to prove convalescence?

You will need medical evidence to establish that you need a convalescence rating. It is enough for your doctor to say that you cannot return to work. You will want to ask your doctor to specify in the discharge report whether convalescence is needed and the length of time that will be needed.

For how long are you entitled to convalescence ratings?

The 100% rating would be effective from the date of hospital admission or outpatient treatment and continue for one to three months from the first day of the month following discharge or release. Further extensions can be granted for up to six months if approved by the VA. The temporary 100% rating can last for up to one year.

3. Prestabilization Ratings

A Veteran may be assigned a 100% rating if:

• They suffer from an unstabilized condition,
• That condition was incurred in service,
• The condition resulted in severe disability, and
• That condition makes substantially gainful employment not feasible or advisable

Some examples might be:

• If you had a car accident in service and suffered a head injury, and have residuals from that head injury
• If you were in combat during service and suffered gunshot wounds and now have residuals from those wounds

If you are entitled to a 100% rating for these conditions or individual unemployability, then you will not be assigned a prestabilization rating. Prestabilization ratings are meant to be for the immediate period following discharge from service and continue without reduction for a 12-month period after discharge. The VA is supposed to examine the Veteran between 6 and 12 months after discharge. At that point, they can either change the rating to a regular 100% rating or keep the prestabilization rating. The VA may not reduce a Veteran’s rating until after the 12 months. So if you are receiving a 100% prestabilization rating, the VA can assign you a regular 100% schedular rating, or TDIU, but they cannot lower your rating.

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(CNN)With the country's attention focused on the Covid-19 pandemic, other deadly health crises continue unabated.

According to the Department of Veterans Affairs, the first known death of a US Veteran from Covid-19 was in March of this year. Since then, there have been over 2,500 Veteran deaths from coronavirus. And while every death from Covid-19 is tragic, it's worth comparing it to the number of Veterans who commit suicide.

A recent report revealed that, as of 2017, the US loses about 20 Veterans and former National Guard and Reserve members each day to suicide. If trends stay the same, in the months since the pandemic began, over 3,000 Veterans may well have taken their own lives.

But, in truth, the rate of Veteran suicide is likely increasing during Covid-19. One study says that with increased social isolation and higher Veteran unemployment, 550 additional Veterans beyond the projected 20 per day are expected to take their own lives within the next year.

Over the past decade, many efforts have been directed toward preventing Veteran suicide. But with limited progress, it's simply not acceptable to not do more.

As we have seen in this country's response to the Covid-19 crisis, federal actions have been too little and too late. White House press briefings may provide medical updates, but results are what matters. It's been over 500 days since President Donald Trump signed Executive Order 13861, creating the President's Roadmap to Empower Veterans and End a National Tragedy of Suicide (PREVENTS) interagency task force to end Veteran suicide. And yet, since then, an estimated 10,000 Veterans have taken their own lives.

Approaches to the fight against Covid-19 provide useful lessons for effectively addressing Veteran suicides. Three common elements are required for solving these dual health crises: appropriate case identification, effective interventions and prevention of further cases.

Much like deploying accurate testing for coronavirus, identifying Veterans at risk for suicide has been challenging. But new tools are becoming available. Recently, the VA and the US Army have utilized large data sets of demographic and clinical information to create predictive analytics that are used to identify Veterans at high risk and to allow for proactive outreach to individuals in need.

Genomic testing, too, now offers advanced ways to identify individualized responses to medications that may be helpful in treating underlying mental health conditions. Greater training of community providers and other ancillary health professionals, and broader use of tele-mental health, will also be important to screen and identify more Veterans at risk, particularly in rural areas.

In fighting Covid-19 and Veteran suicide, a number of interventions have been found to be useful, even though a cure remains elusive. For Veterans, this includes timely access to the treatment of an underlying disorder, whether that is depression, PTSD, substance abuse, chronic pain or other conditions.

Traditional therapies can work, and new research is bringing more therapeutic approaches to the market. We also know that peer support and participation in activities with other Veterans, such as adaptive sport programs, can have a lifesaving impact. Emotional support dogs can even make a big difference in a Veteran's life.

Similar to Covid-19, prevention is critical. However, unlike the virus, for many Veterans social distancing can be the enemy. Connecting Veterans at risk with others can help. Crisis lines, as well as suicide prevention coordinators who work to coordinate care for high risk Veterans, are just a few examples.

Addressing social determinants, such as economic security, is also important -- particularly given the connection between homelessness and suicide.

Finally, we know that the period immediately following active duty is when the highest rate of suicide occurs. The transition from military to civilian life can be traumatic. A transition program that begins six months prior to discharge in order to prepare active duty military for non-military life is an important part of a suicide prevention strategy.

While much hard work has been done in suicide prevention, the statistics remain alarming. Plans are good, but action is needed now. With Trump's proclamation in place and Joe Biden's proposal to address Veteran suicide, we are less than 150 days from inauguration day. During this time, without new efforts, we could lose thousands of Veterans to suicide.

In preventing Veteran suicide, the federal government must take a comprehensive approach to actualizing its national strategy. Doing anything less is not only unacceptable -- it's a failure of our country's commitment to care for those who have borne the battle.

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The way we treat Veterans today is the reason they will choose VA tomorrow

Earlier this month, 15 VA leaders came together at the Grand Junction VA Medical Center to plan out the VA patient experience transformation. Their mission: to promote a culture where every Veteran receives an exceptional experience when they visit or interact with VA.

This builds on the May 2019 event where VA codified customer experience into its core values, adding customer service into VA’s Code of Federal Regulations.

“The VA is about serving Veterans,” said Secretary Wilkie at last year’s American Legion 100th National Convention. “Our responsibility is to serve you well and honorably. My prime directive is customer service.”

The VA patient experience plan

1. Organizational alignment.
2. Engaged culture where people are focused on leaders and employees.
3. Expectations for employees and Veterans.
4. Welcoming and belonging environment.
5. Veteran engagement and collaboration: hearing their voice.
6. Continuous learning: improving, measuring and designing.

“In order to realize our vision – VA has to have the best patient experience anywhere. We will align our culture to one of service to Veterans as they are first in everything we do, say or think,” said Jennifer Purdy, VA’s Veterans Experience Office Director for Patient Experience.

VA facilities across the country have already implemented several patient experience programs. These programs ensure every employee is trained and focused to provide care in a consistently exceptional manner. A few of the programs VA health care systems have implemented include:

• Red Coat Ambassadors: These ambassadors welcome Veterans and their families at medical center entrances, then direct them to their destination.
• Own the Moment: This customer experience workshop encourages VA staff to guide Veterans through the moments that matter on their VA journey.
• WE-CARE Rounding: Medical Center Leaders and Administrators make “rounds,” speaking directly with staff and visitors about the care and services they received.
• Standard Phone Greeting: Creates a uniform way to greet callers, letting them know in a clear, friendly way who they have reached.

Assessing our performance

Earlier this year, we created patient experience self-assessments for VA health care systems throughout the country. The assessments weigh the outcomes of the implemented patient experience programs and identify opportunities for improvement. Then, the VA patient experience team created a patient experience “road map to excellence” and a patient experience guidebook. These resources assist facilities as they build the foundation for an unrivaled patient experience program. This allows employees and volunteers to show how VA has put Veterans and their families at the center of every process.

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The VA’s federal watchdog has uncovered filthy conditions at facilities across the country. Yet some 40 percent of all VA hospitals recently suffered from severe shortages of housekeeping staff.

On a warm November day in 2017, Representative Mark Takano, a California Democrat, met with a whistleblower who had serious concerns about the 270-bed Veterans Affairs facility in Loma Linda. Later that day, Takano took a tour of the hospital, and was shocked by what he saw. Grime encrusted the water fountains; the floors of the operating room were noticeably dirty. Takano called for the VA’s inspector general to launch an investigation, which found “inconsistent levels of cleanliness” in the main hospital building, and unwashed floors, dusty cabinets, and a sterile instrument resting on a dirty rack in the inpatient dental unit. The rate of infection among Loma Linda’s patients was higher than the agency average, and the housekeeping department was largely incapacitated by high turnover, poor pay, and shaky management. A separate investigation found the bacteria Legionella pneumophila, which causes Legionnaires’ disease, in the water supply—a discovery that the facility had failed to communicate to clinicians.

Today, in the midst of a pandemic that threatens everyone, but especially people with preexisting conditions, including the many Veterans who suffer respiratory illnesses likely brought on by exposure to Agent Orange and burn pits, problems with cleanliness at VA facilities endure. For nearly two decades, the agency’s federal watchdog has uncovered filthy conditions at facilities across the country. The problem is due, at least in part, to the fact that 40 percent of all VA hospitals suffered from severe shortages of housekeeping staff in fiscal year 2019—the most recent data available. More than 2,000 cleaning positions are vacant across the VA’s national network, according to granular workforce data released by the agency in late May. And despite Takano’s spotlighting of issues in Loma Linda, the facility still has 21 unfilled housekeeper positions.

“The way many think of custodial staff does not reflect the value that they provide to hospitals,” Takano told me recently. “They are critical to infection control; we need to see these employees as skilled workers.”

Thomas Chatterton Williams: Do Americans understand how badly they’re doing?

In the VA, housekeeping positions are generally reserved for those who served. Retired service members struggling with mental illness or physical impairments fill many of those slots. As of 2015, roughly 65 percent of VA housekeepers were people of color; currently 85 percent are Veterans. Unlike clinical hospital staff, who are less likely to be Veterans or minorities, housekeepers aren’t required to have advanced degrees, and they rarely win public accolades. But the VA’s 257-page COVID-19 battle plan relies heavily on housekeepers, and requires sanitizing everything from hospital chapels to body bags holding the remains of those who succumbed to the coronavirus. The VA, however, lacked enough cleaning staff to fully execute that plan. Ten days after its release, agency officials announced they needed to quickly hire housekeepers.

In an impressive feat, the department hired 1,126 cleaning staff over the next month. But it’s unclear how quickly these employees were onboarded and whether this boost meaningfully shrunk the vacancy number or simply replaced some of the staff lost to attrition each quarter. The VA did not respond to a request for comment for this story.

President Donald Trump earned historic support from Veterans in 2016, in part by promising to fix the VA. Yet one of his signature legislative achievements, the Department of Veterans Affairs Accountability and Whistleblower Protection Act of 2017, has disproportionately targeted lower-level employees, who are typically Veterans. Many of them are housekeepers.

From 2017 to 2018, nearly 900 cleaning workers were suspended or fired as a result of the bill, many of them for specious reasons or minor mistakes. The president, however, boasted of the office’s firing spree just a few weeks ago, in Memorial Day comments dedicated to America’s fallen. “They don’t take care of our Vets, we fire them,” Trump said. He enthusiastically estimated 8,000 employee terminations—many of them Veterans—calling the fired staffers “sadists” and “thieves.”

“They didn’t take care of our Vets,” Trump said. “Now they’re gone. We got ’em out.” Those no longer in the agency include housekeepers, yes, but also clinical staff crucial to COVID-19 care. Although an analysis by the American Federation of Government Employees showed housekeeping as the top position targeted by the Office of Accountability and Whistleblower Protection, nursing came second.

The necessity of va housekeepers—and the story of their mistreatment—is vividly illustrated on the grounds of the Pittsburgh VA’s University Drive campus, a sprawling, 14-acre system built on top of an abandoned mine shaft. When the virus reached the Steel City in March, it circulated on the third floor of the Pittsburgh VA’s mental-health ward. Four housekeepers manned the floor in good times, but staff fluctuations in recent years had brought that number to as low as two. Just before the pandemic, the Pittsburgh VA acknowledged 36 custodial vacancies, and had three housekeepers on the third floor, all of whom were Veterans. The oldest was in his 70s. The virus moved throughout the floor quickly. Soon most of its patients were sick.

None of the rooms in the mental ward were negatively pressurized, which heightened the chances of virus transmission. Staff witnessed dust spilling out of the building’s air ducts, and housekeepers spent precious time running water faucets—supposedly to prevent the spread of contaminants. Another puzzling policy that raised eyebrows on the third floor: COVID-19-positive patients were allowed to freely walk about, in and out of their rooms. This added stress to already-demanding eight-hour cleaning shifts. A VA Pittsburgh spokesperson did not respond to a detailed list of questions concerning conditions and policies on the floor.

“In that situation, you’re constantly having to disinfect,” one housekeeper, who requested anonymity because of a fear of retaliation from management, told me. “Even if [patients] were wearing a mask, anything they touched you had to bleach clean. But not knowing exactly what they touched or didn’t touch, we were constantly wiping. That’s your whole day. And after a while, that bleach gets to your head.”

In the early days of the pandemic, housekeeping staff lacked access to preferred cleaning supplies and nurses had to reuse protective gowns. N95 masks were also in short supply and seemed to come last for cleaners. “If they did have them, we weren’t the priority,” the housekeeper said. “We are the ugly stepchild.” As housekeepers shoulder additional risks related to COVID-19, only a few are receiving additional pay.

As of April, at least half a dozen Pittsburgh VA employees had caught the virus, including the oldest housekeeper, who fought in Vietnam. Reached by phone, he confirmed that he had been diagnosed with COVID-19, but declined to speak on the record. More than 24,000 VA patients and employees have been diagnosed, and nearly 1,700 have died, including at least 40 VA employees.

As the Pittsburgh va’s housekeeping staff contended with COVID-19, they surely could have used the hands of Kevin Patterson, a feisty Marine Veteran who, for 16 years, cleaned many of the hospital’s nooks and crannies. I first met Patterson more than two years ago when on a reporting trip to assess the immediate impacts of the VA’s Office of Accountability and Whistleblower Protection. The office was created under Trump’s 2017 law and was responsible for the VA purge. At the time, Patterson was busy fighting an overwhelming number of proposed terminations as part of his work as the local vice president of the Pittsburgh chapter of the American Federation for Government Employees. Speaking in his cramped union office in 2018, Patterson warned that the purge was “getting the guppies instead of the trout.”

The VA’s leadership has long undervalued housekeepers, and the federal Office of Personnel Management hasn’t updated the job description for VA housekeepers since the Vietnam War. As a result, many earn a lower hourly wage than their private-sector colleagues, which puts them on the edge of poverty. Their firing can be catastrophic to their personal finances.

The AFGE warned that the 2017 law’s provisions could be exploited to fire employees without cause and crack down on union activity, but few lawmakers took their warnings seriously. Although the OAWP no longer releases adverse action reports to the public, data from 2017 to 2018 show thousands of frontline employees were demoted, suspended, or fired, including the housekeepers.

Although some OAWP terminations were surely justified, many others relied on issues as minor as narrowly missing performance metrics or arriving late to work. Last October, the VA’s inspector general found that the OAWP “did not consistently conduct procedurally sound, accurate, thorough, and unbiased investigations.” In March, the Project on Government Oversight came to a similar conclusion, and found repeated instances of retaliation against employees who raised concerns about office dysfunction. (As of late last year, the OAWP’s current director had targeted just one department leader for punishment.)

In our 2018 interview, Patterson bluntly warned that the widespread termination of employees would cripple hospital services and hit Veteran households hardest. He and other sources also pointed me to a Pittsburgh VA administrator untouched by the accountability office despite his work to cover up the 2011–2012 Legionnaires’ outbreak and other accusations of misconduct. (He has denied any wrongdoing.)

Shortly after my story was published, Patterson was fired under Trump’s accountability statutes. The official justification for his departure cited a shouting match between him and a colleague, though multiple VA employees described the incident as a minor dispute.

During arbitration, Patterson argued that he was slapped with the charge as retaliation for his union activity, including his cooperation with my story. (In the course of his case, then-AFGE local president Colleen Evans, who also spoke with me on record, testified that after my piece went live, she was “approached by somebody from public affairs, who basically told me to watch my back.”) In May, a federal arbitrator overturned Patterson’s firing and ordered the department to reinstate him with back pay. (The arbitrator found no evidence that the firing was retaliatory.)

Patterson is eager to return to work, both to help out his fellow union members and to come back from the brink of his financial collapse. After being fired from the VA, he found a job at an Amazon warehouse. Within a few weeks, a colleague injured Patterson with a pallet jack.

As he healed and sought employment elsewhere, Patterson said his job history made it virtually impossible to secure a steady position. “My wife told me to stop saying I had been fired, but that was the truth; I couldn’t lie about it,” he told me. “Plus, some employers just don’t like to hear that word, union.”

Despite a couple years off the job, Patterson can still quickly run through a housekeepers’ best-practices list and can tick off specific uses for the cleaning chemicals tucked away in broom closets throughout the Pittsburgh VA. “You have to pay attention to detail,” he told me, “because cleanliness in a hospital is not just wanted—it’s necessary and needed.”

Many Veterans face an untenable economic future. The Veteran unemployment rate has nearly tripled since January, to 8.6 percent, only slightly lower than it was in the aftermath of the 2008 financial crisis. At the same time, the VA is grappling with roughly 50,000 vacancies across a host of departments. Hiring qualified Veterans into these positions would not only improve agency functionality but also provide security for struggling Veteran families. Patterson and his wife, Crystal, face foreclosure on their home and pressure to pay their daughter’s college bills. Even though he won his arbitration case, he noted the VA could still appeal the decision, preventing his return to work for months.

Takano told me he had reservations about the VA bill that led to so many terminations, but he voted for it, citing its statutes as strengthening whistleblower protections. He told me he now sees the OAWP’s work as “classist” and “galling.”

“They fired a lot of cleaning staff to prove accountability came to the VA,” he said, “only to create a situation where cleanliness during a pandemic is difficult.”

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High Blood Pressure Secondary to Obstructive Sleep Apnea: What Veterans Should Know

Are you suffering from obstructive sleep apnea syndrome and hypertension? Recently, it has been widely accepted by the medical community that obstructive sleep apnea (OSA) is a risk factor for the development of hypertension, also known as high blood pressure. You may be among the more than 18 million Americans that have been diagnosed with sleep apnea, but may be unaware that you have developed hypertension as a complication of obstructive sleep apnea.

According to the Centers for Disease Control and Prevention, there is a high prevalence of obstructive sleep apnea among Veterans. This may be because Veterans are disproportionately affected by risk factors that lead to obstructive sleep apnea, like psychological distress, mental illness, and respiratory conditions. Many Veterans, particularly Gulf war Veterans, develop respiratory conditions, like asthma and chronic bronchitis, due to exposure to chemicals and other toxic substances. This makes Veterans more susceptible to developing obstructive sleep apnea.

In order to better understand what this could mean for your VA claim, we must first discuss the relationship between obstructive sleep apnea and hypertension.

What Is High Blood Pressure?

Blood pressure is the force that the blood exerts on the walls of the blood vessels. According to the American Heart Association, high blood pressure, or hypertension, occurs when this force is consistently too high. This is measures by the relationship between systolic blood pressure, the force that occurs each time the heart pumps our blood, and diastolic blood pressure, the force that occurs between heartbeats.

High blood pressure occurs when the systolic pressure is 130 or higher and the diastolic pressure is 80 or higher (130/80 mm Hg). This is classified as stage 1 hypertension. The American College of Cardiology recently lowered the for stage 1 hypertension systolic limit from 140 to 130.

High blood pressure is a risk factor for heart disease and heart failure, so cardiology specialists will monitor hypertensive patients for signs of cardiovascular disease. Individuals with hypertension might take medication for their condition and track their levels through techniques like ambulatory blood pressure monitoring. Cardiology specialists will also recommend lifestyle changes like weight loss and a healthy diet for blood pressure reduction. The Journal of the American Medical Association (JAMA) frequently publishes recommendations for blood pressure reduction and control.

Some individuals may have a severe type of high blood pressure called resistant hypertension. This condition is hypertension that stays high despite the use of several antihypertensive medications.

What Is Obstructive Sleep Apnea (OSA)?

Obstructive sleep apnea (OSA) is a sleep disorder in which breathing stops temporarily throughout the sleep cycle. Experts estimate that of the general population of the United States, about 22 million individuals are living with OSA. Out of these individuals, about 80% of the mild to moderate cases are undiagnosed. Breathing can stop for a few seconds or several minutes. These episodes of sleep apnea can occur a few times or dozens of times.

It is important to note that we are only discussing obstructive sleep apnea at the moment. This is because hypertension is only linked to obstructive sleep apnea and not the other kind of sleep apnea – central sleep apnea.

Obstructive sleep apnea occurs when the muscles in the back of the throat and tongue relax. Consequently, blocking your airway and preventing breathing from happening. Episodes of obstructive sleep apnea typically end with the person waking up briefly in order to reopen his or her airway.

Some common symptoms of obstructive sleep apnea include:

• Loud snoring
• Coughing, gasping or choking
• Excessive daytime sleepiness
• Observable episodes of stopped breathing
• Sore throat or dry mouth
• Nighttime sweating
• Mood changes and difficulty concentrating
• Morning headaches

Diagnosis of obstructive sleep apnea generally requires a sleep study, which often uses a technique called polysomnography to measure breathing. If detected, there are several options for the treatment of OSA. Specific treatments will depend on OSA severity. Specialists measure OSA severity on a scale called the hypopnea index. The index measures the number of apneas that occur per hour.

Many people with obstructive sleep apnea need to use a continuous positive airway pressure (CPAP) machine during the night. They might use a nasal continuous positive airway pressure device or one that covers the mouth as well. CPAP therapy machines deliver air pressure into the nose and mouth to keep the air passages open during sleep.

While sustained CPAP treatment can be effective for many OSA patients, severe OSA may require treatments like surgery. Severe OSA is when the patient has 30 or more apneas per hour of sleep. This is particularly true when they don’t respond to airway pressure treatment.

What Is The Link Between Obstructive Sleep Apnea and Hypertension?

According to the American Heart Association, obstructive sleep apnea is implicated as a factor in the development of hypertension. Recent studies show that 50% of patients with hypertension also have associated obstructive sleep apnea. The Wisconsin Sleep Cohort study, which was a long-term sleep heart health study, also found that individuals with untreated severe sleep-disordered breathing were 2.6 times more likely to experience coronary heart disease or heart failure than adults without this disorder.

So, there is evidence that sleep apnea affects blood pressure. In individuals without these conditions, blood pressure naturally dips at night. Studies show that some people with OSA don’t experience this dip in blood pressure. These individuals are referred to as “nondipping.” The prevalence of nondipping OAS patients may indicate a link between high blood pressure and obstructive sleep apnea.

Obstructive sleep apnea impairs sleep quality by shortening sleep intervals. This causes elevated blood pressure. Why is this? Obstructive sleep apnea causes disrupted or limited breathing while you are asleep. When breathing is limited, oxygen levels in the body can drop. This drop in blood oxygen levels causes an increase in blood flow. Increased blood flow puts pressure on the blood vessels’ walls which causes elevated blood pressure levels. This suggests a connection between sleep apnea and blood pressure spikes.

Blood pressure levels are not just elevated at night. In many people that have obstructive sleep apnea, blood pressure remains elevated during the daytime when breathing is normal. Also, consider how proper diet and regular exercise help to control normal blood pressure. Obstructive sleep apnea is often accompanied by respiratory conditions, like asthma, shortness of breath, and other respiratory problems that may make it difficult to exercise regularly. As a result, blood pressure levels may be adversely affected.

What Does This Mean For My Disability Claim?

If you are seeking VA benefits for high blood pressure and sleep apnea, you need to file a claim for secondary service connection to receive compensation for both of these conditions. Secondary service connection is when a service-connected condition or injury causes a new condition or aggravates a non-service connected disability. In this case, if a Veteran is already service-connected for obstructive sleep apnea and later develops hypertension because of their obstructive sleep apnea, they can file a claim for hypertension secondary to obstructive sleep apnea. To receive compensation for this secondary condition, you need a current diagnosis of hypertension.

For VA purposes, elevated blood pressure, or hypertension, is considered a systolic blood pressure reading of 160 or more and a diastolic pressure reading of 100 or more, i.e. 160/100 mm Hg. Hypertension must be confirmed by blood pressure readings taken two or more times on at least three different days. If secondary service connection is granted for your hypertension disability, blood pressure readings help determine both the severity of your hypertension and the rating percentage that the VA could potentially assign to your claim.

When making an association between sleep apnea and hypertension for a VA claim, evidence is needed to support your claim. There are several kinds of evidence that can be used to support this secondary claim. Service treatment records and medical records from the VA or private medical facilities detailing your condition may be helpful. Medical articles and literature that discuss the relationship between obstructive sleep apnea and high blood pressure are also beneficial. A favorable medical opinion from a doctor, such as a cardiology specialist, that states that your hypertension is caused by, or a complication of, obstructive sleep apnea may also be very beneficial for your claim. You can file a claim for hypertension as secondary, or as a complication of, obstructive sleep apnea by visiting with the Veteran’s Administration by visiting their website.

The attorneys at Hill & Ponton are also available to help you with your claim. Our attorneys are dedicated to working with former service members, so Veterans can obtain the disability compensation they deserve. If your VA claim has been denied, contact us today for a free case evaluation. Association between sleep apnea and hypertension.

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A Larry Barker Memorial Day Investigation

NEW MEXICO (KRQE) – Tucked away among the ballfields and the bike paths at Albuquerque’s Bullhead Park is an obscure memorial marked by a pair of tarnished plaques. While the park is a place to relax and have fun, it has a solemn purpose too. Bullhead Park is named for a U.S. submarine sunk in the final days of World War II. The Park is dedicated to the memory of the 84 sailors who perished aboard that vessel.

Fifty-two U.S. Naval submarines were lost fighting the Pacific war. Among the thousands of Sailors who perished were 24 New Mexicans. They came from Springer, Cuba, Albuquerque, Mora, Los Lunas, Gallup. All disappeared. We can only surmise their fates. Their bodies never recovered. There were no funerals. Family members never got to say goodbye. We know their names, but we will never know their stories of bravery and heroism.

They were young men like J. W. Saint from Carlsbad. “He died on October 3, 1944. It was shortly before his twenty-sixth birthday,” his grandson Phoenix Attorney Robert Mitchell says. Mitchell has compiled a chronicle of his grandfather’s short life. “He was only 25 when he died, so the sacrifice that he and many others like him made is just astounding,” Mitchell said.

Born in Carlsbad, James William Saint was the oldest of six children. While working in Mountainair, J.W. enlisted in the Navy and was assigned to submarine duty aboard the USS Seawolf. While on patrol off the coast of Japan in 1944, the USS Seawolf disappeared, the victim of friendly fire. A U.S. destroyer mistook the vessel for an enemy sub and sunk it. All 100 sailors on board perished. J. W. Saint was officially declared dead one year later. He was survived by his wife Marie and two children. The remains of the USS Seawolf have not been found.

“He received the Bronze Star, he received the Navy Commendation for Outstanding Heroism and of course, the Purple Heart. He was a hero in every sort of the way. I think he was a very brave man,” J. W. Saint’s grandson Robert Mitchell says.

“They all paid the ultimate sacrifice,” says Naval Historian Charles Hinman. Hinman works at a Hawaii submarine museum near Pearl Harbor and maintains a website, “On Eternal Patrol,” to honor the men who lost their lives in submarine service.

“It’s a dangerous job, and often when the submarine goes down, with very few exceptions, everyone goes with it,” Hinman says. “You’re not just fighting the enemy. You’re also fighting the ocean depths,” Charles Hinman told KRQE News 13.

Neal Johnson grew up in Tucumcari. Fresh out of high school, he joined the Navy and served as a Machinist’s Mate Third Class onboard the USS S-28. In July 1944, during a training exercise off the coast of Hawaii, the submarine along with its 49-man crew disappeared. Three months later, the Navy confirmed Neal Johnson had died. He was just a kid, only 21 years old.

Four years ago, explorers discovered the USS S-28 wreckage off the coast of Oahu. The site remains undisturbed as a military war grave.

Albuquerque’s Robert Greenwell majored in Civil Engineering at the University of New Mexico. After enlisting in the Navy, he reached the rank of Lieutenant aboard an Attack Class Submarine named the USS Trigger. While on patrol off the coast of Japan in 1945, the USS Trigger was attacked by enemy forces and disappeared. The entire 89-man crew perished. Lt. Greenwell’s disappearance was reported in the Albuquerque Journal. He was just 23. Robert Greenwell was survived by his wife, Montelle. To date, remains of the USS Trigger have not been located.

George Wester was from Romeroville, a small village south of Las Vegas, New Mexico. He enlisted in the Navy in 1942 and served as a Seaman First Class onboard the USS S-44 Submarine. While on patrol in the Kuriles north of Japan, the USS S-44 was attacked by an enemy destroyer. George Wester, along with 55 shipmates, were killed. George was only 19. A marble marker at the Santa Fe National Cemetery honors his military service.

At Central New Mexico’s Stanley High School, J.T. Northam was a noted football and basketball star. He graduated from Stanley High in 1941. Cattle rancher Sam King was a classmate. J.T. enlisted in the Navy and served as an Electrician’s Mate Third Class on a submarine called the USS Grayback. In 1944, while on patrol south of Okinawa, the USS Grayback came under air attack and disappeared. All 80 sailors aboard were killed. Back home, at the Edgewood Cemetery, a stone monument honors the memory of J.T. Northam. He was 22.

In 2019, the USS Grayback was discovered by divers in 1,400 feet of water off the coast of Japan.

During World War II, Navy submarines suffered the highest casualty rate among all U.S. Armed Forces. More than 3,500 Navy Submariners perished, including two dozen young New Mexico men. Their memory is preserved in mere photographs. As we approach Memorial Day, those decades-old snapshots serve as a permanent reminder of individual patriotism, bravery, and sacrifice.

“It’s so inspirational for the time we live in today,” J. W. Saint’s grandson Robert Mitchell says. “We don’t always see that type of heroism that I think that whole generation demonstrated,” Mitchell said.

KRQE News 13 would like to acknowledge the following individuals who assisted in the preparation of this report: Albuquerque Genealogist Wynne Wood, David and Marty King (Stanley, NM), Charles Hinman (On Eternal Patrol), Robert Mitchell (Phoenix).

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The military’s non-partisan reputation is under attack. Divisive homeland deployments are yet another trend pushing the armed forces toward the crisis of legitimacy already afflicting our most important civil institutions. When President Donald Trump asked governors for National Guard troops to supplement the Washington, D.C., National Guard in late May, 10 Republican governors supplied all but about 85 of the 3,600 troops from 11 states.

Republican governors likewise provided nearly all the Guard troops for the president’s southwest border mission in 2018. Amid politically charged debates over border security and family separations, more than a dozen Republican governors and only one Democratic governor of a non-border state volunteered forces. The escalating political dispute led other governors, 9 of 11 being Democrats, to renege on sending their Guard troops. Support for the mission remains mostly split along party lines.

The administration extended the emergency border operation in June for a third year, but starting in October, National Guard units will be federalized for the operation and no longer under state command. It is unclear if governors will have a say in whether their troops are sent. Hopefully, this is not just another way to stir the pot until the election.

Employing the National Guard under state command when absolutely necessary to support law enforcement is not a partisan issue: Democratic and Republican governors alike put 40,000 National Guard soldiers and airmen on their streets a month ago. And governors are not at fault for exercising their prerogative to satisfy or decline the president’s request for non-federalized Guard forces. The problem lies in stoking a political fire and throwing troops in to crank up the sizzle.

The deployments to D.C. and the border were wrapped in incendiary pronouncements and controversial policies that deepened divides. President Trump did not create the unrest following George Floyd’s killing, but his rhetoric inflamed it and cast the response as a partisan wedge.

Trump’s approach diverged from past presidents who framed the domestic use of troops as a reluctant option, taken only in support of local law enforcement, or as a last resort to be exercised with minimal force. President George H. W. Bush invoked the Insurrection Act to federalize the California National Guard and send in active-duty military units to face the LA riots in 1992. That deployment drew little controversy following the governor’s request and Bush’s resolute but conciliatory words.

The National Guard is called up by state authorities to support law enforcement occasionally, but a controversial presidential request to move Guard troops across state lines under federal authority should remain extraordinary. No other modern president has done it. President George W. Bush’s National Guard border mission was conducted by troops from every state. President Obama’s border deployment relied overwhelmingly on the National Guard from the border states themselves. Although the response to Hurricane Katrina was fraught with partisan and federal-state tension, Bush did not characterize that military mission divisively, and governors from every state and territory volunteered National Guard forces for the Gulf Coast.

When governors representing one political party supply nearly all the National Guard troops for a contentious domestic operation, those in uniform are tainted as partisan no matter how professionally they behave. This is layered over politicians from both parties increasingly showcasing their popularity with the military, trading on the cache of brass as well as rank and file, on-duty and retired, creating the appearance of military partisanship. Trump has broken new ground with brazen claims that the military supports him politically and could turn on his foes. The military’s privileged position above the political fray is at risk as citizens increasingly identify the military with partisanship.

Bipartisan support undergirds American military professionalism and strength, and it has taken the armed forces generations to earn the trust enjoyed across most of the political spectrum. Wide support for the military has facilitated funding, recruitment, and a willingness to consider military counsel. That has not always been so. If the military is viewed as a partisan player, then uniformed leaders will be chosen for party over competence, military advice will be discounted, and the consensus supporting the institution will collapse.

This election season raises the risks for divisive partisan gambits involving home-front deployments. It will be incumbent on public servants in and out of uniform to muster their professionalism, and for those watching to speak out when politicians are caught maneuvering the military, Guard or active duty, into a partisan corner.

The response to recent unrest could have been more bruising. Fortunately, cooler heads in and out of the administration helped extricate the military from confrontations it could only lose. Wielding military power without broad consensus, especially on the home front, poisons domestic politics and undermines the armed forces.

Ian Bryan retired last year as a colonel with the Air Force, serving for the last several years as a congressional liaison at the National Guard Bureau. He flew B-1 bombers and KC-135 aerial refueling tankers and taught as a professor at the Air Force School of Advanced Air and Space Studies. He is an attorney researching civil-military relations in Alexandria, VA. The views expressed are his own and do not represent those of the Air Force or Department of Defense.

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To save money and keep patients, VA administrators are overruling decisions by VA doctors and their patients, in some cases cutting off care.

When Christine Russell read the message from the San Diego VA announcing it would no longer pay for her cancer treatment, all the pain came rushing back.

For nearly three years, the federally funded Veterans health care system had misdiagnosed her breast cancer as mental illness, she and her team of advocates contend. After discovering the cancer in late 2018 — when the tumors had already spread — the VA agreed to pay for the former Navy Reserve lieutenant to get her medical care from other doctors in the San Diego area.

Russell filed four federal complaints in early February this year about her ongoing challenges accessing health care, medication and caregiver services through the VA. Days later, a group of San Diego VA administrators mailed her a letter that called her “disruptive” and announced they would no longer fund her appointments outside the VA because her health care was too “fragmented.”

Russell was $30,000 in debt from medical expenses since developing cancer. She couldn’t afford to see her doctors if the VA didn’t pay for it.

“It was like they cut my legs off,” Russell said. “They cut off my lifelines, because all those doctors are my integrative support team. They are why I’m still alive.”

An inewsource investigation in partnership with USA TODAY has found that like Russell, Veterans across the country are caught in the crossfire of the VA’s battle to retain patients and funding since the passage of a landmark health care law known as the Mission Act.

When Congress and then-President Donald Trump passed the bipartisan law in 2018, they said it would ensure American citizens who fight to protect the U.S. can access high quality medical care after leaving the military. When the Department of Veterans Affairs can’t deliver that care for any of six reasons, it’s supposed to pay other health care systems to do it instead.

A review of thousands of pages of department manuals and medical records, along with interviews with dozens of patients, advocates and providers, shows that VA administrators are overruling doctors’ judgments and preventing them from sending their patients outside the VA health care system.

This bureaucratic process has ramped up over the past two years as part of an effort to save money and retain patients within the VA, records show.

“That’s tragic and jarring,” said Ryan Gallucci, a national director for Veterans of Foreign Wars, after learning what the VA’s manuals show.

“I think it warrants an organization like ours asking more pointed questions and ensuring the VA is upholding the intent of the Mission Act,” he added.

More than 9 million Veterans are enrolled in the VA, the nation’s largest health care system, which is composed of more than 170 medical centers and 1,000 outpatient offices.

The U.S. is facing urgent demands from Veterans for medical and mental health care. Veterans have faced almost 20 million cancelled or delayed health care appointments during the COVID-19 pandemic, and the U.S. withdrawal from Afghanistan in August has caused crisis hotline calls to spike as former service members have struggled to process the unfolding events.

Dozens of Veterans and caregivers throughout Southern California described their struggles to access health care outside the VA since the Mission Act was passed: A partially blind skin cancer survivor was told to take a dangerous trip to the VA when a new lesion developed, instead of visiting his neighborhood dermatologist. A Veteran with a seizure condition has waited years for a course of treatment outside the VA. Suicidal patients were cut off from what they considered “life-saving” mental health treatments by employees overwhelmed with paperwork — against the advice of the VA’s own psychiatrists.

In interviews, service groups and congresspeople from both political parties said Veterans should be offered the best health care available, and money should not affect the quality of care they receive.

“We just spent trillions of dollars prosecuting this 20-year war in Afghanistan, and by comparison we’re arguing nickels and dimes in caring for the Veterans who prosecuted those wars,” Gallucci said.

The Mission Act has had financial consequences for the VA. Since the law was enacted, more Veterans have left for other health care systems than the VA anticipated, forcing the government agency to shell out billions of dollars for private care. If the trend continues, the VA’s own hospitals could end up with smaller budgets to spend on their services and staff.

In late 2019, the VA began the “referral coordination initiative” to return Veterans to its hospitals. An internal department manual shows the changes are supposed to help the VA make “good financial decisions” and “maintain funding of specialty care” in the future.

Like the VA, private health care systems have financial incentives to retain patients and cut costs. The difference, experts said, is that Veterans represent a unique and vulnerable population that the government has pledged to care for.

“If they have a problem with the budget, they need to come and talk to Congress,” said Rep. Mike Bost, R-Ill., ranking member of the House Committee on Veterans’ Affairs. “They don’t need to go ahead and try to figure out how to take services away from our Veterans.”

Under department policy, VA doctors usually don’t send their patients outside the health care system on their own, records show. They can make recommendations that go through reviews by other staff — such as administrators, clerical workers or clinicians trained by hospital leadership — who can cancel treatment requests and insist patients come to the VA instead.

Following the VA’s new initiative, department hospitals have also set up select teams of health care personnel who can review medical records and use algorithms to decide if patients qualify for care outside the VA before interacting with those patients.

And for Veterans ultimately approved for treatments elsewhere, the VA can require checkups at its hospitals anyway — that includes Veterans facing severe disabilities, burdensome drives or long wait times for VA appointments.

“It basically defeats the whole purpose of the Mission Act,” said Darin Selnick, senior advisor to Concerned Veterans for America, an organization pushing for Veterans to have more access to private health care.

“We need to be Veteran centric,” he added. “It's about what the patient needs, not what the VA needs.”

Selnick helped write the Mission Act, working in the Trump administration and the VA as a health care policy expert to implement the law until July 2020. He read excerpts of the department manuals obtained by inewsource.

“If I was still at the VA and someone showed me this in July, I would have ripped it to shreds and I would have said there’s no way in Hell you’re going to use this stuff,” Selnick said.

The VA received its largest-ever budget this year — an amount that has doubled over the past decade. A national spokesperson said the department has “sufficient funds” to send Veterans out for private care.

VA officials said they are following Mission Act requirements, and treatment decisions are based on patients’ medical needs. They added that the review process is supposed to ensure Veterans can always get their care at the VA if they want to.

Hospital doctors and managers at the VA said they believe they can deliver the most effective care internally, because they offer high-quality services and can more easily coordinate treatments and paperwork.

Dr. Kathleen Kim, the San Diego VA chief of staff, said physicians sometimes incorrectly try to relocate patients for treatments her hospital can offer, and administrators are “regularly educating” them to help keep Veterans at the VA.

“Because of the nature of the Mission Act, the VA is sending a lot of care in the community, and frankly we're worried that we're not going to be able to pay our bills,” Kim said.

The VA has approved over 12 million referrals for outsourced care since the Mission Act was implemented, including 5 million in the most recent 12-month period, according to data the department supplied. inewsource, through a series of records requests and direct inquiries, attempted to determine how many doctors’ requests for outsourced care have been denied by the VA, but the data provided was incomplete.

An August inspector general report highlights the personal impact the VA’s administrative decisions can have. When the San Diego VA stopped paying for ketamine treatments at a private clinic, 28 mentally ill patients experienced unnecessary distress, the report found. Inspectors pointed out the drug’s unique properties for combating severe depression.

Shortly after learning the VA wouldn’t fund her treatments, a former Marine Corps pilot took her life.

“They need to do right by these Veterans,” said Rainelle Wolfe, a full-time caregiver for her husband Kiowa, another Veteran who was cut off from the private ketamine treatments over a year ago.

The San Diego VA has started offering a low-dose version of the drug that many Veterans have not found therapeutic, including Kiowa Wolfe.

Now, the Marine Corps Veteran spends most of his time lingering in bed, reliving trauma from the Afghanistan War.

“We’re not political,” he said. “It’s not in our nature to be political. But keep politics and all this BS out of Veterans’ health.”

Part I: A body on fire

Long before anyone realized she had cancer, Christine Russell walked slowly and painfully to the car waiting for her outside the San Diego VA emergency room. Her body hurt so much she could barely move.

The Lyft driver came out to assist her, then approached a nurse at the hospital entrance to ask if Russell would need any special care during her transport home. As the driver would later retell in a court filing, the nurse assured him the answer was no. The 39-year-old Navy Veteran was “crazy” and imagining her symptoms.

It was mid-2018, almost two years since Russell first felt the unbearable pain in her body. It had become too difficult to drive or take care of herself, so she started paying thousands of dollars out-of-pocket for caregivers to look after her.

In her medical chart from late 2016, Russell’s VA physician wrote that she “displays abnormal anxiety about her health, especially with an unwarranted fear of having a serious disease.”

Russell said doctors told her she had post-traumatic stress disorder and refused to run tests until she tried psychotropic medications. Without a clear explanation for her escalating symptoms, Russell rushed to the emergency room more than a dozen times.

Finally, in the summer of 2018, her new primary care doctor agreed to order a scan of her chest. A radiologist noticed something unusual and asked for more tests.

The diagnosis: stage IV breast cancer.

Her case was complex. Russell suffers from severe allergies and sensitivities, which she believes came from her exposure to hazardous chemicals on a counter bioterrorism mission in the Middle East. Perfumes, highly processed foods and a long list of medications can aggravate her symptoms.

The VA’s course of cancer treatment, chemotherapy pills, was excruciating.

“It felt like my whole body was burning and on fire,” Russell said.

The Veteran was also experiencing hormone imbalances and pelvis pain, which needed tailored treatments that wouldn’t cause their own unbearable side effects. Russell thought she would be better off getting care from specialists elsewhere — doctors she could trust who could better address her complicated symptoms.

Over the next three years, the VA approved a slew of requests for Russell to see at least eight specialists outside the department.

Her symptoms slowly improved. But traveling to her appointments was impossible without the help of an at-home caregiver. The VA tried to provide her with aides, but they didn’t follow the protocols Russell required for her sensitive immune system.

Russell hasn’t been able to get a new caregiver since November 2020, the same month she was supposed to begin radiation therapy. With no aide to assist her, the Veteran never got the treatment.

Months of correspondence with VA employees didn’t resolve the issue. In February, Russell filed complaints with the VA’s inspector general and the White House.

That’s when she lost it all.

In a three-page letter, VA administrators told Russell they would no longer pay for her health care outside the department and insisted she follow the “code of conduct” moving forward. They said she had engaged in “disruptive behavior” by intimidating social work staff with angry voicemails, using profanity and telling them they should be fired for not doing their jobs.

“The multidisciplinary team reviewed your current status and confirmed that your health care is fragmented due to a disproportionate amount of care received in the community,” the letter states.

The administrators said this care was “no longer reasonable or necessary” and would be “limited to services that cannot be provided in a timely manner or are unavailable” at the San Diego VA, “as required by” national policy.

The letter was signed on Feb. 19 by the director of the Veterans Experience Office, the section chief of primary care and the chair of the Disruptive Behavior Committee.

Russell was not consulted about her health care needs before the letter was sent.

“It was a nightmare,” Russell said, adding, “They really didn’t know me or what I had gone through or why I was even still alive.”

She described her reaction as a “heavy mental breakdown” as she struggled with thoughts of suicide and almost checked herself into a hospital for psychiatric care.

But she chose to argue her case instead.

Russell had done it before. When enrolled in the Navy, she filed a complaint about entry fees for military parties, which led officials to relieve her of her duties, escorting her out of Kuwait by military police. She then filed a whistleblower retaliation case, which was substantiated a year later by the Pentagon inspector general’s office.

“I’m always about integrity,” Russell said. “And if I see something that’s not ethical going on or if I see an error, because of what I’ve been through, I’m going to question that error.”

Part II: A Veteran’s best interest

Armed with a copy of the Mission Act and her long clinical history, Russell told the San Diego VA that it was in her best interest to continue her medical treatments elsewhere.

The federal health care system will pay for Veterans to get medical care from other doctors if the patients meet any of six criteria, including long drives or wait times for VA appointments.

The most contentious — and some argue, most critical — reason to send Veterans outside the VA is when it’s in their “best medical interest.” That decision should be made by the Veteran and their “referring clinician,” the law says, and can help address a patient’s unique needs.

For instance, a dermatologist might not specialize in a patient’s skin condition, or a Veteran suffering from military trauma could be triggered by trips to the VA. In these kinds of cases, if it would improve a patient’s health, a doctor could send them to another medical provider.

“Every patient experiences things differently,” Russell said. “And if they’re not getting all their needs met, then it is in their best medical interest to go somewhere else to have all their needs met.”

Russell told the VA that stopping her current treatments would exacerbate her cancer symptoms — and it would put her health care back in the hands of a hospital that didn’t have the expertise for her conditions.

Her VA primary care doctor requested she return to her medical team outside the hospital, the Veteran said, but warned the request probably wouldn’t be approved.

At the San Diego VA, these kinds of treatment requests are usually reviewed by “delegated authorities” who can deny them if they think the hospital’s own doctors can deliver the care.

Kim, the hospital’s chief of staff, said these designated physicians go through regular training, so they understand all the services the VA offers and can make more informed decisions than other doctors.

“Some of it, in my mind, is just a lack of knowledge about what the services are,” Kim said.

San Diego County is home to roughly a quarter million Veterans, the fifth-highest of any county in the nation. Its local VA health care system, which also covers the neighboring Imperial County, serves about 85,000 patients.

Kim, who oversees Veterans health care across the region, said it’s often best for patients to come to the VA, even if that’s not what their doctors want.

“The reality is that does not trump the fact that the service can be provided at the VA within a timely fashion,” Kim added.

For a complicated case, Kim and leaders at other VA hospitals can personally review medical records and decide what’s in a patient's best interest, documents show.

The VA’s many hospitals can rely on different procedures, but nationwide, employees are instructed to follow handbooks. VA spokespeople were hesitant about providing them, saying they were intended for internal use.

Over the past two years, the VA has started putting treatment requests in the hands of “referral coordination teams” made up of registered nurses and other personnel, according to the manuals. A team member is supposed to spend 10 to 25 minutes reviewing a patient’s medical charts and deciding if they qualify for care outside the VA. They can also forward requests to designated physicians for approval.

The initiative “shifts the referral responsibility” so most doctors aren’t choosing to relocate their patients themselves, the documents show, which will “decrease inconsistent and inappropriate” treatment plans.

Hospital leaders are told to monitor health care costs as a “key performance indicator” of success.

“That is not what the Mission Act says,” said Rep. Bost of Illinois about the review process.

“I understand my health care and my doctor understands my health care,” he added. “Between the two of us, we make the decision, not some (team) that’s put in place by some government agency, nor should it be.”

The National VA pointed to federal regulations stating it can conduct reviews of doctors’ decisions so long as they focus on health outcomes. Spokespeople also said that VA doctors still have the power to send their patients outside their hospitals.

To do that, doctors have to use a specific software program that offers a pre-established list of justifications — otherwise it’s not considered a “true” medical decision, according to department manuals.

Once Veterans are approved for care outside the VA, staff are supposed to call them and try persuading them to come to the VA anyway.

Employees are told to follow scripted language that outlines the benefits of staying at its hospitals and the burdens of leaving them. The scripts tell Veterans they will be responsible for transferring their own medical records if they choose a different provider.

“If you wanted to stay in the VA, you always can stay in the VA, but once you’ve made a decision to go to community care, you’ve decided for whatever reason it’s best for you not to,” said Selnick, who helped write the Mission Act

“Doing extra hoops to keep you in the system is counterproductive.”

When the VA stopped authorizing her treatments, Russell was left with two bad choices: pay out-of-pocket or stop seeing the doctors that had helped her through a complex cancer. She chose the expensive option.

With her credit cards maxed out, the Veteran began an online fundraiser for the accumulating bills and turned to her church community for food deliveries.

The cancer has worn on her. Russell, now 44 years old, wakes up disoriented and forgets where she is. It takes her hours to clamber out of bed, and she inches forward around her house with the aid of a cane.

When she manages to leave her home, Russell adorns her outfits with American flags and, with a smile, tells anyone who will listen that she is proud to be an American. She still remembers the enthusiasm she felt 25 years ago as a teenager in Barstow, California, enrolling in the Naval Academy.

Through months of heated conversations, Russell was able to reestablish most of her old doctors.

But maintaining her care outside the VA is an ongoing problem. In August, Russell received a voicemail from her VA primary care doctor’s office. The physician had requested more appointments with specialists outside the hospital, and the requests were denied.

Russell is still searching for solutions.

Part III: Living with demons

The mental health crisis among America’s Veterans can be told through a bleak series of statistics.

One in five Veterans who served in Iraq and Afghanistan suffers from depression or PTSD, and more than half of Veterans who need mental health treatments don’t receive them. About 17 former service members take their lives every day — double the rate of the general public — and the vast majority of Veterans who died by suicide never sought services from the VA health care system.

Recognizing the troubling trend, the government has boosted its focus on mental health in the past few years. The VA has expanded its resources for suicide prevention, and Congress has put forward numerous bills to help address the issue.

But the VA can’t always provide the mental health support Veterans need. Under the Mission Act, Veterans have the same treatment rights for physical and mental health issues. If a patient isn’t benefiting from the VA’s services, their doctor can try to send them somewhere else.

That doctor, however, might not have the final say.

A Veteran's fight for mental health treatment

At the San Diego VA, administrative staff dismissed the warnings of psychiatrists and denied community mental health treatments to suicidal patients, records show. Soon after learning the treatments had been discontinued, one of the Veterans died by suicide.

Over two and a half years, the San Diego VA sent more than 60 Veterans to a private clinic to try the drug ketamine, a therapy for people with severe, treatment-resistant depression. Many of the patients showed remarkable improvements, and VA psychiatrists continued sending them back for sessions.

One of them was Kiowa Wolfe, a 38-year-old Afghanistan War Veteran who was medically retired in 2018.

Nine years ago, Wolfe was defending a dam on a mountaintop in the Helmand Province when he took enemy fire. In the commotion, he stood up to get his bearings, and his 6’5” frame was instantly visible. Bullets flew in his direction and sent him tumbling down the side of the mountain.

The Marine returned from war with traumatic brain injury and wounds along his right side that demanded multiple surgeries. But his mental anguish hurt just as much. Intrusive memories of the battle overwhelmed him, and some days he felt he no longer wanted to live.

The VA classified him as 100% disabled, mostly due to his post-traumatic stress.

The government tried more than a dozen treatments, including a variety of medications and therapists. Nothing made a difference. Finally, Wolfe’s psychiatrist recommended ketamine. The VA didn’t offer it, so it paid for him to go to Kadima Neuropsychiatry Institute, a private clinic down the street.

Wolfe felt relief for the first time in years. He managed to walk into a movie theater and take his children to a Blink-182 concert — the kinds of activities he had once avoided at all costs.

“It cut down on the hyper-vigilance, where I’m not just freaking out and my head’s on a swivel everywhere, and I have to check out everybody and everything,” Wolfe said. “I could just actually relax and put my arm around my son and talk to him and act like a human.”

The drug’s effect typically lasts a few days. With the VA’s support, Wolfe returned for treatments twice a week, his wife always by his side.

That changed in October 2019, when a note appeared in Wolfe’s medical record from the VA Office of Community Care, which helps Veterans arrange external medical appointments.

Dr. Susan Trompeter, the former chief of the San Diego office, issued a directive about the mentally ill patients on ketamine therapy. She called the drug “experimental,” said the VA could no longer pay for it and told the hospital’s psychiatrists not to submit any more treatment requests.

Trompeter, whose research focus is women’s reproductive health, did not respond to interview requests.

The VA Chief of Psychiatry pushed back, arguing the hospital could not “precipitously stop these treatments” for patients with severe depression. But the decision had been made, and he relayed the message to mental health staff.

“So please do not discuss/offer this as a possibility to patients until further notice from me,” Dr. Brian Martis wrote in an email. He told them not to “make verbal comments to patients or written comments … expressing your frustration” about the change.

Medical records and emails show VA doctors feared the sudden decision could be dangerous for their unstable patients. One Veteran with a history of suicide attempts was a particular concern.

“We need to ensure he does not have a break in treatment,” one VA doctor wrote in his medical chart. Another warned of the “potential acuity of the situation” and said nobody had followed up with the Veteran.

“I am concerned as this is a HIGH RISK pt,” the doctor added.

Under the Mission Act, patients are allowed to continue treatments outside the VA if they have ongoing sessions, because cutting them off can have negative consequences.

Kadima’s founder, Dr. David Feifel, decided Veterans could keep their upcoming appointments even if the VA wouldn’t pay for them. He did it, he said, because he feared what would happen otherwise.

“Something’s out there that can help you, and now they’re taking it away,” Feifel said. “To have it and then not be allowed to have it makes living with those issues and demons even more difficult.”

After she learned the VA would no longer pay for her ketamine therapy, Navy and Marine Corps Veteran Jodi Maroney died by suicide. inewsource first reported the death last year, prompting an investigation by the VA inspector general’s office.

In an August report, inspectors found the San Diego VA’s denial of care was a “contributory stressor” leading up to her death. But the circumstances were “multifactorial” and “complex,” the report said, and they couldn’t conclude the VA was responsible.

Hospital staff said they faced a “large volume” of referrals when the Mission Act went into effect in mid-2019, according to the report. The health care system needed to sign a new contract to pay for ketamine therapy, but the situation “was overlooked” until the VA missed its deadline.

For three weeks, the VA had no way to pay for ketamine therapy and didn’t explain to Veterans why they couldn’t get their treatments. When Maroney died, the hospital quickly signed off on more sessions.

That lasted about five months. Starting in March 2020, the VA stopped paying for Veterans to get ketamine therapy, even though the hospital’s psychiatrists had requested additional treatments.

For Wolfe, the VA’s decision was tantamount to betrayal.

“It feels like I’m getting stabbed in the back with a bowie knife and getting it twisted,” Wolfe said.

“If I was held to such high standards in the Marine Corps, why are these people getting away with so much with mistreating Veterans?” he added.

Patients pleaded with hospital officials, describing how the drug had saved their lives, and shared suicidal thoughts and dreams with the private ketamine clinic.

Feifel sent frantic messages to VA psychiatrists and administrators, warning of a possible second death if the hospital didn’t act quickly.

“We were under the impression that the VA learned from its mistake and under no circumstance would it follow the same catastrophic path that resulted in that tragic outcome,” Feifel wrote. “And yet, here we are, watching a train wreck in slow motion… AGAIN!”

The VA never replied.

In an interview and emails, San Diego VA administrators have made multiple inaccurate statements about their ketamine program and health care services.

The hospital has repeatedly stated that community care staff don’t make clinical judgments and can’t overrule doctors — they process paperwork and help Veterans set up appointments outside the VA.

Later, national VA spokespeople clarified that these employees do have the ability to review referrals, ask questions about patients’ clinical needs and cancel requests if they “cannot verify the eligibility” of the Veterans.

In VA manuals, community care staff are also instructed to “consider funding availability” when offering treatment options to patients.

In mid-October, the VA announced it will be phasing out community care offices over the next year and restructuring their responsibilities in order to “operate as a high-reliability, Veteran-centric organization.” The VA has not explained if the transition will change how staff process treatment requests.

According to the inspector general report, San Diego’s community care employees chose to cut patients off from ketamine therapy the second time because of “administrative factors,” like outdated forms and misplaced paperwork.

The employees had “resistance to clinical input from mental health leaders” and caused serious distress to mentally ill patients, the report states.

Following the inspection, the San Diego VA hired more administrative staff and assured investigators they would base their decisions on Veterans’ medical needs.

Those needs, as Wolfe would later find out, are up for interpretation.

Part IV: Circling the drain

Wolfe laid in bed, crippled by the memories that had resurfaced since the U.S. withdrew its last troops from Afghanistan.

All he wanted was a moment of relief. But the one treatment he knew would help was the one the VA wouldn’t pay for.

At $300 per visit, Wolfe can’t afford to pay out-of-pocket for regular ketamine therapy. Private donors have funded some sessions, and in times of crisis, the Veteran has shelled out the full cost himself.

Wolfe and his wife Rainelle, who serves as his full-time caregiver, have spent the past year begging the VA to send him back to Kadima for more treatments.

“I do not have the ability to refer Kiowa to Kadima,” Wolfe’s VA psychiatrist wrote in a December message. “I am not involved in any way here at the VA with the implementation or adjudication of any aspect of the Mission Act.”

Medical records show Wolfe’s psychiatrist referred patients to ketamine therapy in 2018 and 2019, before the Mission Act went into effect.

“I know you are both suffering and wish you only health and happiness in the year to come,” the doctor wrote.

The hospital has refused to tell the Wolfe family who has the power to approve his treatment requests. VA doctors have told the Veteran these are “administrative decisions” and they don’t know who’s responsible for making them.

“If you get the answers, call me,” one physician told Wolfe.

San Diego VA spokespeople would not give inewsource the names of the hospital leaders in charge of mental health treatment requests or provide a reason they wouldn’t share the information.

“If they’re not making the decision and not telling you who’s making the decision, how can you even advocate for the Veteran?” said Renee St.Clair, Wolfe’s advocate and former chief operating officer at Kadima.

Veterans have avenues to fight the VA’s health care decisions, but attempting to use them can be a full time job. St.Clair, an attorney, is assisting the family pro bono. She has asked for help from more than a dozen service groups and government officials, including Congressional offices and the VA inspector general.

She also sends weekly emails to VA doctors and administrators asking them to approve Wolfe’s ketamine treatments.

“Kiowa gave so much and is asking so little — a signature on a form which could save his life,” St.Clair wrote in one message.

Veterans can submit clinical appeals to a VA hospital’s patient advocate’s office, which should be reviewed in three days by administrators, and then a second appeal that goes to regional VA leaders.

But Veterans and caregivers who tried contacting patient advocates said staff either didn’t return their calls or didn’t help resolve their issues. The Wolfe family has not gotten responses from the San Diego office, they said.

The VA has never sent Wolfe a written denial of his treatment requests, like its policies describe.

“This is madness,” Rainelle Wolfe said. “I cannot believe that everybody’s acting like their hands are tied and they’re all passing the buck. Nobody wants to stand up and have some integrity and treat Veterans the way they need to be treated.”

Waiting for VA health care

Since the San Diego VA stopped paying for his private sessions in mid-2020, Wolfe has been shuffled through the hospital’s attempts to build its own ketamine program. The ordeal has had disastrous consequences.

Over the course of two months, the VA administered different kinds of the drug at low doses. It didn’t work. Wolfe started backsliding into severe depression. But when the private clinic asked the VA to send him back for more appointments, a registered nurse in the local community care office denied the request.

It was “not clinically appropriate,” she wrote. The VA could provide the treatments he needed.

Then, in October 2020, VA nurses administered ketamine to Wolfe on a gurney in the post-anesthesia care unit. The family recalls that the Veteran’s psychiatrist wasn’t present for the infusions, and he wasn’t allowed to bring his wife or service dog with him.

The experience was traumatic. Wolfe blacked out and entered a fit of rage. He screamed uncontrollably at his wife. When he finally got his bearings, he knew one thing absolutely. He would not come to the VA for another ketamine treatment.

Because of ketamine’s psychedelic properties, the drug’s effects are highly context-dependent. Changing how the drug is administered or delivering it to a patient in an uncomfortable environment could lead to negative outcomes.

Four Veterans said the VA’s program has failed to provide the relief they need.

By personally paying for treatments and obtaining donor funds, St.Clair has helped nine patients return to Kadima for more ketamine sessions. She said at least twelve Veterans have not found the VA’s program therapeutic.

Wolfe’s psychiatrist — considered the San Diego VA’s “local expert” on ketamine — has acknowledged to the Veteran that the hospital’s program is “not the same” as what the private clinic offers.

Despite his towering height, Wolfe speaks softly and slowly, and he leaves most of the talking to his wife and four children. Their home is decorated with military memorabilia, the fridge featuring an old photo of the family patriarch in uniform. Rainelle, who met Wolfe in 2006 when he was 22 years old, has spent much of the past year rousing him out of bed, sometimes unsuccessfully.

“Is it really in his best interest to get all his care at the VA?” Rainelle Wolfe said. “Because he’s slowly circling the drain. He spends the majority of his time in his room in the dark.”

Asked why the VA won’t fund private treatments for Veterans failing out of the hospital’s program, the chief of staff said it was a legal matter.

“The relationship with that clinic has become highly contentious,” Kim said. “And one of the former administrators every Friday sends what I would call a nasty email complaining about this issue. And so at this point, we’ve turned it over to legal counsel.”

In May, the Wolfe family had a brief moment of hope. Congressman Darrell Issa’s office convinced the hospital to take another look at the Veteran’s case.

The VA conducted a “comprehensive review” of his medical needs, according to an email the Congressional office sent the Wolfe family.

The hospital “is confident that it is in your best medical interest to receive your mental health care (there) so that there is a comprehensive and integrated approach to maximize your treatment outcome,” it said.

The review was performed by an unnamed group of VA employees.

Part V: Closer to perfection

The Mission Act was passed in the midst of a fierce political debate over the future of the VA health care system.

The dispute dates back to 2014, when an overwhelmed VA hospital in Phoenix was caught concealing appointment wait times. The scandal prompted new laws and rules that let Veterans access private care more easily.

But navigating health care choices was still a confusing and complex process, and Congress was looking for solutions. Democrats pushed to strengthen the VA with more funding and services, while Republicans wanted to make it easier for Veterans to go to private doctors.

The Mission Act was their compromise. It created a network of approved community providers and expanded the reasons Veterans could visit them. It also funnelled billions of dollars into the VA so the department could cover the expenses.

Now, Veterans can get their primary and mental health care outside the VA if an appointment would take longer than a 20-day wait or 30-minute drive. For specialty care, that extends to a 28-day wait or a 60-minute drive.

“The Mission Act created an environment where all Veterans, no matter where they live, would have access to VA care,” said Rep. Jack Bergman, R-MI, who voted for the law in 2018. “It may not necessarily be at a VA hospital, but at a place close to them where they can actually receive the care in a timely manner.”

But Southern California Veterans said they are still struggling to get appointments with private doctors since the law was passed.

Former service members in rural areas — facing drives of an hour or more for VA visits — said they are routinely told to visit the department’s hospitals to assess whether care is necessary. Veterans facing long wait times said their private care can be cut off after a handful of sessions, and they have to return to VA physicians.

“It’s not working here,” former Army captain Gary Shearer said. “It hasn’t been working for some time.”

Shearer suffers from chronic neck pain and has gone blind in one eye, making each trek to the VA a dangerous burden. He lives in Yucca Valley, almost 50 miles from his VA primary care doctor and 80 miles from the closest Veterans hospital.

Because of the long drives, Shearer qualifies for private doctor’s visits closer to home. But the VA has asked him to return to its own offices for checkups and assessments.

In December, Shearer saw a bump on his forehead that he knew needed medical attention. The Veteran has a 20-year history of skin cancer and had cancerous lesions removed in the past. He wanted the Loma Linda VA to help him schedule an appointment with his neighborhood dermatologist.

The VA said no.

An “approving official” at the hospital reviewed his case, documents show. They decided a VA primary care doctor would have to conduct a skin exam first.

Shearer worried it would take months to go through this circuitous process: schedule an appointment at the VA, endure a long road trip for the visit, convince the doctor to request a dermatology appointment and wait for the VA to approve and schedule the request.

“The longer I waited, the more tissue they were going to have to take,” Shearer said.

The Veteran didn’t want to take any chances, so he went to the dermatologist on his own. Shearer’s lesion was diagnosed as basal cell carcinoma and required an urgent surgery with a price tag of $3,000. It was too steep for him to pay out of pocket, but he was able to use his private insurance plan to cover the cost.

About one-quarter of working-age Veterans — more than 730,000 people — don’t have a second medical payment option like Shearer does. If he didn’t have a backup insurance plan, the Veteran said, he would have to rely on the VA’s medical decisions.

Shearer has a long list of grievances against the federal health care system. The VA cut down his weekly neighborhood chiropractor visits to only 12 sessions per year, despite his severe spinal injury from a military tank accident.

The back pain feels like “someone has taken a ball bat and beat me around the rib cage,” the Veteran wrote in a complaint to the VA.

Shearer said he waited more than 50 days for an answer from the Loma Linda VA about extending his chiropractor appointments. The facility told him it could award up to eight more sessions per year if he agreed to drive all the way to the hospital for a pain assessment.

The former Army captain has sent many letters, ripe with colorful turns of phrase and religious proverbs, to the VA’s patient advocates. They led nowhere.

“The Mission Act, you say,” he wrote in one complaint. “What Mission Act? It is only a dream.”

VA manuals say Veterans can receive an unlimited number of outsourced treatments, but only if reviewers deem them “clinically appropriate.”

Dr. Peter Kaboli, a VA physician in Iowa and health care administration expert, said having the department conduct reviews — and encouraging patients to come to the VA when possible — is better for Veterans and the future of the health care system.

“Is there going to be an incentive to bring care back to the VA?” Kaboli said. “I think so, because I think we do it cheaper in most cases, and we do it as good if not better in most cases.”

Patients described their anguish when they have suddenly faced denials of care and letters demanding they return to Veterans hospitals. Some said they have waited months or years for the VA to set up or renew appointments with private doctors.

Warner Springs resident John Seymour, who lives an hour and a half from the closest VA facility, has waited two years for the VA to arrange a treatment plan for his debilitating illness.

Seymour suffers from a plethora of conditions that are commonplace among America’s Veterans, including PTSD, diabetes and severe spinal injury. He has also developed non-epileptic seizures from psychological distress, which cause uncontrollable spasms and leave him unable to communicate.

A VA neurologist diagnosed Seymour’s seizures about two years ago and recommended he try cognitive behavioral therapy, but the doctor didn’t submit a treatment request.

Over time, Seymour’s symptoms grew more extreme. He collapsed in the bathtub, unable to breathe, and in a similar incident, ended up in the emergency room. He waited months for another neurology appointment, which was cancelled twice.

In March, the Veteran’s VA primary care doctor offered to send in a treatment request, which was routed to the VA Office of Community Care. It’s still pending.

Amy Warix, the Veteran’s wife and full-time caregiver, said the VA has taken so long on the request that staff couldn’t find it in their computer system. Warix had to call her husband’s doctor and have the request resubmitted.

Now, when she asks for updates, Warix gleans little information.

“They can’t say, ‘No, you don’t get the care,’ and they can’t say, ‘Yes, you will get the care,’” she said. “They’ll just say, ‘It is processing.’”

Warix spends hours on the phone with the VA trying to manage incomplete medical requests.

She spent seven months asking the VA to restart visits with a private psychologist when they were suddenly cut off in November — just after her husband had shared thoughts of suicide. She is still waiting for the VA to approve more appointments with a neighborhood dentist to finish urgent work that began in March.

“He’s a patient that needs continuous care,” Warix said. “So I always have a referral that I am chasing down because they haven’t finished processing yet.”

Since the Mission Act launched, the VA decided to handle outsourced health care requests itself — taking over the job from its contractors — so its employees could have direct contact with Veterans about their needs. But the department was critically understaffed and unable to handle the workload, according to federal reports from the Government Accountability Office.

The staffing shortage has impacted Veterans seeking medical care. In mid-2020, patients were waiting an average of three weeks for the VA to process specialty care requests and six weeks until their community appointments. By comparison, referrals from one VA doctor to another took one week.

National spokespeople said Veterans with urgent needs are prioritized, and processing time for non-VA treatments is now under two days.

Lawmakers have sent numerous inquiries to the VA asking why Veterans in their districts are facing long waits for community care. In June, 10 Congresspeople from Washington told the department that their constituents were waiting two months for the VA to arrange health care visits and receiving little communication about the delays.

“We request your immediate action to resolve these issues and improve access to care,” the letter said.

Washington representative Dan Newhouse, who co-authored the letter, said Veterans account for roughly half of the calls he receives from residents in his rural district. The VA never responded to the concerns he and his colleagues raised.

“This is an effort to get closer to perfection on something that I think overall has been a big improvement, but can be better,” Newhouse said. “We all want to do better for our Veterans.”

Congresspeople from both political parties said the VA does a good job delivering health care, and pointed out that many of their constituents love the medical services they receive. A VA survey shows 90% of patients would recommend the health care system to another Veteran.

The VA performs as well as private hospitals on measures of quality, including cancer screenings and blood pressure control. Compared to civilians in the private sector, Veterans face shorter wait times to see VA doctors.

But like in every hospital system, some patients will need treatment the VA can’t provide.

The federal department dates back more than a century and has its roots in the Revolutionary War. For decades, the VA has purchased private care to help ailing Veterans.

“In most medical centers, there’s something they’re going to have to refer you out for at some point,” said Gallucci from VFW. “It’s unrealistic to think that VA can provide everything.”

Gallucci served eight years in the U.S. Army Reserve and was deployed to Iraq in 2003. Now, he helps other former service members access benefits through the VA.

“It’s not a question of, ‘Is VA care or community care better?’" Gallucci said. “It’s about how do these systems complement each other, how do they work to effectively deliver care that Veterans need?”

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As Veterans Day in America approaches, the U.S. will be commemorating all of the American Veterans who have served for their country — living and deceased. As these celebrations carry on across the country, there is another important issue surrounding Veterans that often gets pushed to the side: homelessness. Displacement and homelessness have always been issues for those who've formerly served in the American armed forces. In fact, the problem dates back to the American Revolution (via California State University, Northridge). Of course, recent wars such as those in Iraq and Afghanistan have also led to heartbreaking levels of homelessness, per the Department of Veterans Affairs. Despite there being more collective awareness regarding the number of homeless Vets — including federal and other special programs to help combat their displacement — the numbers just keep increasing. Per Military Times, the COVID-19 pandemic didn't help. Instead, it further magnified the problem, and homelessness among Veterans worsened last year. 

Today, there are currently some 40,000 homeless Veterans in the U.S., per Policy Advice. While the numbers have seen some changes over a 10-year period, the lack of economic stability caused by the pandemic spotlighted just how susceptible Veterans are to a downturn.

Homelessness Among Veterans

While the problem of homeless Veterans traces back to the 18th century, the biggest impact a conflict had in displacing Veterans was from the Civil War. During the Reconstruction era, there was a massive increase in displaced soldiers who were survivors or wounded Veterans of the war. And yes, even back then, there were federal and municipal efforts to address the rising problem, per California State University, Northridge.

Still, each war that the U.S. has sent soldiers to fight in has resulted in more Veterans returning to unstable housing situations. Veterans make up less than 10% of the U.S. population (via Pew Research) but 11% of all homeless Americans, per Policy Advice. According to Policy Advice, public awareness of the problem ticked up following the Vietnam War. Soldiers who served in the controversial war didn't exactly come home to a welcome mat. Veterans faced ostracization (via Solutions for Change) and Black Veterans, in particular, faced a distinct kind of snub — returning home only to be brushed off by Veterans Affairs, offered menial jobs, and seeing the interracial camaraderie they may have experienced during the war all but disappearing, says Time Magazine.

Currently, the rates of homeless Veterans vary per state, but the West Coast has the highest rates of homelessness among Veterans — with California topping the chart for the highest percentage of unhoused Veterans, shows a Military Times graphic.

A documentary titled "American Veteran" sheds light on the subject and will begin airing on PBS on October 26.

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The number of Veterans experiencing homelessness increased in 2020 even before the effects of the coronavirus pandemic damaged employment prospects and financial resources for the community, according to a new report released by the Department of Housing and Urban Development on Thursday.

The increase is a concerning backslide from improvements in the last decade, since then President Barack Obama announced a federal effort to address the issue.

From 2010 to 2019, the number of Veterans without stable housing decreased by more than 50 percent. However, the figure increased slightly in 2020, rising to 37,252 in HUD’s annual point-in-time estimate, up by a few hundred individuals.

The totals mean that of every 10,000 Veterans in the United States, 21 were experiencing homelessness at the start of last year. Veterans make up about 6 percent of the population of the United States but 8 percent of the country’s homeless population.

The estimate released Thursday is based on surveys conducted in January 2020, about two months before business closures and other financial impacts of the coronavirus pandemic began.

In a statement, Secretary of Housing and Urban Development Marcia Fudge called the results “very troubling, even before you consider what COVID-19 has done to make the homelessness crisis worse.”

Officials won’t know the full impact of the pandemic on the number of Veterans experiencing homelessness until later this year, when the results of the January 2021 point-in-time count are released. The 2020 numbers were scheduled to be unveiled last fall, but were kept hidden for months by President Donald Trump’s administration for unspecified reasons.

In a statement, Veterans Affairs Secretary Denis McDonough said the newly-released numbers indicate that more needs to be done to help Veterans facing crisis that could lead to homelessness.

“Even a slight pre-pandemic uptick in Veteran homelessness after significant declines since 2010 is extremely concerning,” he said. “The Biden Administration’s recommitment to Housing First — a proven strategy and dignified way to help Veterans and others achieve stable, permanent housing — will help accelerate progress in preventing and eliminating Veteran homelessness.”

Across all groups, the number of Americans experiencing homelessness increased about 2.2 percent from 2019 to 2020. HUD estimates about 580,000 individuals were without stable housing as of January 2020.

More than 90 percent of Veterans experiencing homelessness were men, according to the HUD survey. Black Veterans made up about one-third of all Veterans dealing with unstable housing, even though they make up just 12 percent of the total Veterans population in America.

California alone accounted for nearly one-third of all of the Veterans experiencing homelessness in America, with 11,401. California, Florida, Texas and Washington — four states with the highest total number of Veterans among their residents — together had about 70 percent of all of the homeless Veterans in American.

The HUD report notes that 28 states actually saw decreases in their total number of Veterans experiencing homelessness, a positive trend. North Carolina, Oregon and Utah all saw double-digit percentage decreases in their homeless Veterans population.

Officials from the National Coalition for Homeless Veterans said that any increase in Veteran homelessness should be “unacceptable.”

“People across the country are suffering due to (the pandemic’s) economic fallout, making it much more critical to work diligently to ensure Veterans can access housing as we continue our mission to end Veteran homelessness,” they said in a statement. “We are also hopeful that having new national leadership in place that has prioritized ending homelessness and focusing on racial equity and building a system of care that works for all Veterans will also have a positive effect.

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WASHINGTON — Army Veteran Toni Hackney has always wanted a family, but as a single woman with endometriosis, she knew she would need fertility assistance.

A year after she sought approval from the Department of Veterans Affairs to cover the cost of in-vitro fertilization treatments, she was denied for what she called a ridiculous reason: She’s not married.

“The whole time I'm fighting with them about, OK, this isn't fair, you know? Y'all say everything is on an equal basis and everything, but this don't feel equal basis,” Hackney said in an interview. “It's like they make it mandatory for you to get married in order to get treatment.”

In order to receive VA reproductive health care benefits, Veterans must have suffered a service-connected injury, be married, and be able to supply their own eggs or sperm. Surrogacy is not covered.

That excludes unmarried Veterans like Hackney, same-sex and transgender couples, and those who cannot produce eggs or sperm due to a service-connected injury or another medical issue, such as cancer treatments.

The VA added fertility coverage in 2016, largely because of the efforts of U.S. Sen. Patty Murray, D-Wash. Now some Veterans and infertility advocates say the coverage should be made permanent and expanded to cover more people.

“It's helping some, and trust me, we're very happy and grateful for that,” said Barb Collura, president and CEO of Resolve, a national infertility advocacy organization. “But it's showing, in very glaring form, who is being left out, and that's not acceptable to us.”

Hackney, 47, of Atlanta, served in the Army for 16 years as an imagery analyst on intelligence projects. She was a member of the first battalion called for duty after 9/11, serving in an undisclosed domestic location from December 2001 until 2003.

“I want to experience pregnancy and giving birth,” she wrote on her GoFundMe page to raise money for her treatments. “For me, the experience is just more than a want. I need it.” She’s raised just $1,250 of her $45,000 goal.

VA's 'hands are tied' by Congress

Last month, a House subcommittee on Veterans’ affairs held a hearing to discuss Veterans’ access to reproductive health care. Veterans advocates described the conditions Veterans must meet to qualify for IVF treatments.

Those rules are so restrictive, only 567 Veterans accessed the benefit between 2016 and 2019, according to news reports. Most are men with obvious external injuries, so their wives are the ones who receive the treatment.

Because most of the procedures are performed by third-party providers, the two parties must negotiate a rate. That requires extensive paperwork that is a burden on small centers, according to Joy Ilem, legislative director for Disabled American Veterans.

The VA’s “eligibility requirement is mandated by Congress,” a VA spokesperson said in an email.

Collura said that although the VA has said publicly it wants to offer the benefit to Veterans struggling to conceive, “their hands are tied by what Congress has said.”

Opinion:Military Veterans say nation must act now to ensure fair elections in November

Equal Rights Amendment:Will women ever have equal rights under federal law?

The legislation is as restrictive as it is simply because it lifted language from an existing Department of Defense benefit for active service members, Collura said.

Prior efforts to expand the VA's coverage have failed because the issue touches on the debate over abortion, specifically the destruction of leftover embryos, which some Republican lawmakers oppose. The Family Research Council, a conservative Christian group, advocates funding IVF treatments only if they don’t destroy embryos.

The VA's coverage pays for unlimited embryo storage to skirt that issue.

‘Power couple’ seeks biological child

Army Veteran Khris Goins, a transgender man, and his wife have been together 11 years. Their friends in Columbus, Ohio, have dubbed them “the power couple.”

Goins, now 33, served in the Army at Fort Bliss, Texas, from 2006 to 2009. In 2015, he and his wife wanted to start a family, so they tried to get IVF treatment through the VA using sperm donated by someone they know.

After going through fertility assessments at a local clinic, the couple was disheartened to learn IVF wasn’t covered for them.

Goins and his wife, Dashonda, are trying to save money from the financial services business they run together and from donations. One attempt at pregnancy costs $12,000 on average.

The family’s last chance at a biological child and grandchild is IVF using Goins’ eggs.

It would be a blessing to have “a child to continue our bloodline and fill the void in our lives” left by the murder of Goins’ only sibling, his brother, he wrote on his GoFundMe page.

He hasn’t raised any money, which he believes is because he set up the campaign as the coronavirus pandemic struck.

Thirteen states mandate insurance policies cover IVF treatments, according to Resolve, but it’s not universally available. Mercer, a benefits consulting firm, found that 44% of insurance plans for companies with more than 20,000 employees and 28% of companies with more than 500 employees covered in vitro fertilization in 2018.

Though some private insurance policies are restrictive, “none of them are as restrictive as the ones we see in the military,” said Karla Torres, senior counsel at the Center for Reproductive Rights. The health issues and working conditions unique to Veterans make expanded coverage of IVF even more important for them, she said.

What counts as a service-related injury?

Kerry Karwan, a Veteran in San Leandro, California, and an advocate for the Service Women’s Action Network, fought for almost a year to get her treatments covered by the VA because she couldn’t prove she had a service-connected condition.

She served in the Coast Guard for years in a shipyard that exposed her to asbestos, lead paint, mold and chemicals. A fertility specialist told her the mold levels in her blood, which can cause infertility, were “off the charts,” she said.

There’s little research on the subject, but Veterans advocates say infertility is tied to working conditions in the military. Ilem, of Disabled American Veterans, said that in addition to chemical exposure, infertility is tied to medication prescribed for psychiatric disorders — some related to one’s service, like post-traumatic stress disorder.

Many women also delay childbearing until after active duty — and after their peak fertility years — making it harder to conceive after they’re discharged.

But none of these are considered service-connected injuries, so the VA typically doesn’t cover IVF treatments in those cases.

“You can't document that [delayed childbearing] is a service-connected reason for being infertile because there isn't this clear, demonstrable, ‘I got blown up’ situation, though it could in fact be related to your military service,” said Kayla Williams, senior fellow and director of the Military, Veterans and Society Program at the Center for a New American Security, and a Veteran herself.

A recent study of Veterans who served in Iraq and Afghanistan found about 16% of women and 14% of men reported struggling with infertility, compared with 12% of all American women and 9% of all American men.

Disabled American Veterans, the American Legion and other Veterans’ groups call for more research on women’s reproductive health in the VA health care system. Women Veterans weren’t treated as a separate category in military health studies until the 2000s.

Karwan did get the VA to cover her in-vitro treatments after convincing the agency that her infertility was partly tied to her inability to get proper treatment for polycystic ovarian syndrome while on active duty.

But she faced more obstacles as she looked for a fertility clinic because so few work with the VA. She believed the clinics available to her were a poor fit and didn’t handle her case with care. One even broke tubes carrying embryos she and her husband had frozen.

Now that she’s 45, she’s worried she has missed her prime reproductive window. “Here I am defending everyone else's liberties and rights of happiness, and I'm getting denied my chance to have children,” she said.

Rep. Julia Brownley, D-Calif., chairwoman of the House Veterans’ Affairs subcommittee on health, announced in early August she plans to introduce legislation in the coming months “to address the needs of Veterans facing barriers to having children.” She said in a written statement her bill would expand the VA’s reproductive benefit to include surrogacy and IVF for Veterans “regardless of marital status, service-connection, or need for donated genetic material.”

In the meantime, Veterans like Hackney, Goins and Karwan are scraping together tens of thousands of dollars to pay for the procedures themselves.

Although she’s also looking into adoption, Hackney hopes Congress will loosen the rules in time for her to have a biological child of her own. “Since Congress’ laws regulate the VA, they really need to not play a political game with people's lives and futures,” she said. “This is my life.”

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The value of human life cannot be determined in dollars and cents, yet saving one often comes with a heavy price tag. After much too long a period of time and tens of thousands of deaths later, the Veterans Administration has admitted how they are powerless to stop the disproportionate number of American military Veteran suicides being committed every single day of every single month of every single year. The V.A. needs your help and they’re willing to pay big money for it.

Officials from the Veterans Administration have announced that they’re willing to pay $3 million to anyone from anywhere who can help them solve the Veteran suicide problem that they’ve thus far been unsuccessful in doing.

By way of a mountainous number of various funded programs, the VA said the long-standing number of 22 Veteran suicides per day has been reduced to 17, but that this is a far cry from being a success story. However, non-profit Veterans organizations devoted to this cause, largely run by Veterans for Veterans, disagree with the reduction in numbers. They live it every day.

The total cost of the VA’s new suicide prevention program called Mission Daybreak is a cool $20 mil. The concept is to create new ideas by challenging the public to get involved. Over a six-week period, the V.A. hopes to review thousands of ideas, and in the coming months the top 40 entries selected will be awarded prize money.

VA Secretary Denis McDonough said, “To end Veteran suicide, we need to use every tool available. Mission Daybreak is fostering solutions across a broad spectrum of focus areas to combat this preventable problem.”

Also in the coming months, the VA plans on forking over another $52 million to local communities with suicide prevention programs. The goal is in identifying Veterans in crisis mode prior to planning their funeral, and in the case of Veterans, especially combat Vets, special training and tools are required.

National director of VA suicide prevention, Dr. Matt Miller, said the new approach is similar in parameters to previous programs except that it’s more focused on immediate results rather than long-term goals.

“A key to innovation is rapid implementation and development,” he said. “So what we’re really trying to foster and harness is those ideas that can be rapidly developed, be scalable across our system, and make a big difference quickly.”

Suggestions can’t be scribbled on a bar napkin. Individuals or teams must submit their proposed solutions in the form of a 10-page concept paper. The paper must contain a plan of implementation, evidence of the submitted framework, and the impact the plan would have on each various era group within the Veteran community.

The best 30 ideas accepted will receive a special kicker by being invited to help the VA refine their ideas into workable solutions. The top two winners will each receive a full $3 million. The remainder of the top 30 will each receive $250,000 and the final ten will receive $100,000.

This program is long overdue and any step the VA takes toward Veteran suicide prevention is a step in the right direction. So get busy America. Regardless of the prize money, it’s time for paying back a debt that has no monetary value.

Veterans crisis line: 1-800-273-8255 Press 1.

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The Department of Veterans Affairs’ IT office is developing a new set of metrics to measure the agency’s success managing a cloud-driven digital transformation across several of its most important systems and missions.

CIO James Gfrerer said Wednesday his office is close to launching a “balanced scorecard” to measure the success of the VA‘s various digital transformation efforts, to include the modernization of its electronic health record, medical logistics supply, human resources and financial management systems.

He said at the AFCEA Bethesda Health IT Summit he’s headed to Capitol Hill later this week to brief members of Congress on the scorecard. (The idea of a “balanced scorecard” comes from business management, and it tracks financial and non-financial measurements together.)

“We are about 75% to 80% complete on our balanced scorecard that supports our digital transformation strategy,” Gfrerer said. “So we’re going to get a lot more focused around those measures, those metrics, those outcomes around the specific projects and start to be a bit more deliberate on what programs are succeeding or not.”

Gfrerer acknowledged VA’s “checkered past in terms of project development and releases” around major IT systems. The department has been working for decades, for instance, to modernize its digital health systems and retire the legacy Veterans Information Systems and Technology Architecture (VistA) platform. The new scorecard, he said, will help the VA assess its progress and make decisions more quickly if something isn’t working as intended. It could play a big role as the department goes live with its Cerner-based Electronic Health Record Modernization program at VA hospitals in the Pacific Northwest in March.

On top of this, VA, like many other federal agencies, has adopted DevSecOps and “product-line management” for its technology delivery. In the next year, Gfrerer said, “that’s going to create additional levels of accountability” for the department’s more than $4 billion IT budget.

VA’s enterprise cloud progress

In addition to those major system overhauls, the VA is pushing broadly to migrate its applications to its enterprise cloud environment.

Gfrerer said by 2024 about 350 of the department’s applications and systems — about half of its portfolio — will reside in that enterprise cloud. “That is not about cost savings, that’s about capabilities delivery,” he said, pointing to his department’s troubles with reliability and the effectiveness of its current on-premise systems. For instance, before moving VA’s internal single sign-on to the cloud — an app that every department system depends on — it was only available about 70 percent of the time.

“That’s horrendous,” he said.

With so many applications awaiting migration, the department has a “whole metric and methodology for how we score and prioritize applications in moving to the cloud,” Gfrerer said. “If something is in a particular aging environment or is suffering from some other software or hardware maladies, we’re going to probably put it high in the queue in terms of getting it into a more accessible and responsive infrastructure in the cloud.”

In migrating to the cloud, it’s also an opportunity to transition services that have historically been done or supported in-house to a managed service provider.

“One of the things we stress is we want to outsource and take away those things that are commoditized and we want to in-source complexity,” Gfrerer said. “The workforce that we have … we want them to stay focused on high-value work.”

Something like endpoint provisioning shouldn’t be the work of a VA employee, he said.

“Provisioning an endpoint these days is the 21st-century version of ditch-digging. Why are we doing that when we have truly more meaningful, high-value work?”

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The Department of Veterans Affairs is proposing spending $682 million more next fiscal year on mental health issues, and ramping up funding for suicide prevention efforts by one-third, as it faces Congressional scrutiny over a series of tragic incidents on VA premises over the past year.

The VA's budget request for fiscal 2021, released Monday, totals $243.3 billion -- a dramatic 10% increase from 2020. In addition to resourcing mental health and suicide prevention, it would nearly double the amount of funding for a joint VA-Defense Department effort to create a merged electronic health records system and provide a 9% increase to the budget for women's health care.

A series of highly public Veteran suicides in VA parking lots over the last five years has left the VA scrambling for better prevention measures. In a recent report on one such death in 2018, the Inspector General found institutional failures led to mental health clinicians not being alerted to the patient's condition before his death.

The proposed budget would provide $76 million over fiscal 2020 levels for the VA's suicide prevention programs like the Veteran Crisis Line, a suicide prevention hotline.

It also gives $53.4 million to the president's interagency task force on Veteran suicide prevention. The President's Roadmap to Empower Veterans and End a National Tragedy of Suicide, or "Prevents," was created last year to address the Veteran suicide rate, which averages 20 deaths each day.

"The Prevents Task Force will increase the government's return on investment by leveraging partnerships with private and community organizations to amplify messages and activities," VA officials wrote in a budget overview brief. "Prevents will further expand its reach through planning and implementation grants executed by other participant federal agencies."

Some $50 million of the proposed funding would go toward implementing the task force's findings, which are expected by March 5, while about $3 million would go towards its administrative functions, a senior VA official said.

However, some Democratic lawmakers are criticizing the request, saying the VA is outsourcing critical care capabilities.

"Despite significant investments in mental health care for Veterans -- a top priority for the President, this Committee and VA -- these funds direct resources outside VA into grant programs and the Prevents Task Force instead of being used to explicitly support Veterans in crisis at VA," Rep. Mark Takano, D-California, said in a statement Monday.

The House Veterans Affairs Committee chairman also raised issues with the president's other proposals to cut funding to the Supplemental Nutrition Assistance Program (SNAP) and eliminating new Housing and Urban Development vouchers for homeless Veterans.

"When you consider the Trump budget in its totality, it is a cruel document that cuts housing, food security, and key assistance that millions of Veterans depend on," Takano said.

Another point of contention with Congress is the electronic health records system (EHR). Designed to combine a variety of health records programs across the VA while also giving the Pentagon a way to transfer in its health records, the roll out has been delayed several times.

The VA's proposed budget would give the EHR effort $2.6 billion - nearly doubling the amount from FY 2020.

A senior VA official said this $1.2 billion increase is "basically a transition budget" as the VA plans to expand the system in about 15 sites in 2021.

These increased funds would go towards building the IT infrastructure needed at some facilities and managing its rollout, among other things like maintenance, testing, deployment and operation, the budget brief said.

VA Officials are also requesting an additional $53 million to spend on women's health care, making the total gender-specific health care budget $626 million.

With the population of female Veterans increasing by about 120,000 from 2014 to 2019, women are considered the VA's fastest-growing cohort. That means the VA needs to expand some women-specific services to meet growing demand, such as access to gynecologists. The 9% increase would let the VA provide more of those primary care services for women.

Details were thin on where the added funding would be spent, prompting criticism from one prominent Veterans' group.

"We applaud this administration's focus on Veterans and addressing the community's unique needs," Jeremy Butler, CEO of Iraq and Afghanistan Veterans of America, said in a news release. "However, much is still unclear on how and where these funds would be allocated."

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The Department of Veterans Affairs is seeking public comment on updating benefit eligibility for Veterans with "bad paper" discharges.

In a notice published in the Federal Register, the VA is proposing updating rules to clarify what is considered a dishonorable discharge for VA benefit eligibility purposes.

This move is necessary because federal law specifically allows only Veterans with an "other than dishonorable" discharge to receive VA benefits, but the Defense Department often characterizes discharges as "other than honorable." In these cases, the VA must determine whether the actual reason for discharge is considered "honorable" or "dishonorable."

These determinations can often be applied differently depending on the VA employee making the decision and their understanding of the law. Also, the actual wording of some of the regulations hasn't been updated for more than 40 years, and the VA is attempting to modernize definitions and the decision-making process.

Specifically, the new rules will clear up the definitions of "willful and persistent misconduct," "offenses involving moral turpitude," and "homosexual acts involving aggravating circumstances or other factors affecting the performance of duty," as these types of discharges can often be considered either honorable or dishonorable depending on the severity of the offense.

For instance, in the case of a military member who goes AWOL for more than 180 days, the VA normally characterizes an "other than honorable" discharge as "dishonorable" no matter what the circumstance.The VA is now proposing to consider what caused the member to go AWOL in its decision-making process. Was there a serious family matter, did the member go AWOL to avoid combat, or did the member go AWOL because they were an immature 18 year old, etc.? The new rule seeks to allow the VA to be more responsive to the actual situation.

The VA also wants to clear up confusion on "willful and persistent misconduct" by quantifying exactly what is "persistent" and aligning its definitions with the Manual for Courts-Martial. For instance, disobeying a lawful order one week and leaving the scene of a vehicle accident a week later would be considered "persistent;" however, if the offenses occurred six months apart, they would not, since each offense is minor in nature. But if a service member committed more serious offenses, they would be considered "persistent" even if they occurred as much as five years apart.

To define "offenses involving moral turpitude," the VA will consider whether the service member knew what they were doing when they committed the offense. The VA would adopt language from an earlier legal decision to say that a service member could be charged with moral turpitude if they willfully committed an act that could be expected to cause harm or injury, even if that act wasn't illegal. For instance, if a member failed to perform required maintenance on a piece of machinery and that machinery failed, causing an injury, they would have acted wrongly, and such an offense would prohibit them from receiving any VA benefits. However, if they were doing maintenance and broke the machine because they weren't trained properly, they wouldn't be found with committing a disqualifying offense. The new rule attempts to base an eligibility decision on the service member’s intent rather than the consequences.

The intent of the regulation change is to deny benefits to someone who willfully misbehaves, not someone who unintentionally causes an accident.

Finally, the VA is seeking to simplify the rule that makes "homosexual acts involving aggravating circumstances or other factors affecting the performance of duty" a reason for dishonorable discharge. To this end, the VA wants to change the offense to "sexual acts involving aggravating circumstances or other factors affecting the performance of duty." This basically expands the regulation and makes any act of sexual aggression serious enough to have an effect on good order and discipline an offense that disqualifies a Veteran for VA benefits.

There are more detailed explanations and details on the VA's posting to the Federal Register.

Rules regarding discharge types normally apply only to first-term enlistments. If a member receives an honorable discharge from their first period of service and any other type of discharge from a subsequent enlistment, the VA wouldn't have to make any determination, since the first period of honorable service would qualify the Veteran for benefits. The exception to this rule is those who are discharged to accept a commission.

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Five years ago, Marine Lance Cpl. Joshua Burch became the first paralyzed service member to walk to his own promotion ceremony, wearing an exoskeleton that helped him walk and stand to receive his corporal chevrons.

Now medically retired, Burch, 26, hopes again to be a trailblazer -- the first Department of Veterans Affairs patient to regain function in his lower body -- to include taking steps -- courtesy of an electrical implant in his spine that is designed to stimulate his body's sensorimotor networks.

"Even thinking about walking is crazy. I look at this as a stepping-stone to a future where others like me can walk. I look at my participation in this research as a way of helping people out," Burch said during an interview in March with Military.com.

Researchers at Hunter Holmes McGuire VA Medical Center in Richmond, Virginia, have launched a study to determine whether epidural stimulators can help paralyzed Veterans recover motor activity and/or control over their "inner systems" -- their cardiovascular and bladder functions, for example.

While epidural stimulators have shown some degree of success with limb paralysis in research elsewhere, this is the first such study at the VA, explained Dr. Ashraf Gorgey, chief of spinal cord injury research at the Richmond hospital.

Gorgey said the study has several goals: to see how well an epidural stimulator made by Medtronic for pain management can work on spinal cord injuries and to demonstrate the promise of the technology, which can be implanted with minimum surgery.

"With this study, we might get companies like Medtronic and Boston Scientific to start creating something more specific for spinal cord injuries," he said. "We also want to show that you don't need invasive surgery to use this device. We use just a needle under fluoroscopy, and through the needle, we thread the leads in. On the same day Josh had his surgery, he was down in this room working out on the mat."

Gorgey plans to implant the epidural stimulators in 20 Veterans, who will then take part in a year of intensive physical rehabilitation therapy and training.

Gorgey and Burch say that with any success, Burch may be able to take steps on his own within that period, going from strengthening his legs in an exoskeleton to walking across a floor with a walker.

"In Josh's circumstance, the signal that's coming from his brain through his spinal cord is interrupted. So now we are going to replace this signal with external signals that help trigger a step in movement. By using the exoskeleton, we can train him to … hopefully stand up and walk again," Gorgey explained.

Burch lost much of the use of his hands and all use of his legs in a September 2015 accident in Guam. He actually doesn't know what happened. He remembers being in a hotel room talking to his sergeant in the afternoon and waking up the next day on the ground outside the hotel, unable to move.

At 21, he had fractured his seventh cervical vertebrae, the lowest bone in his neck.

Burch underwent several surgeries in Hawaii before he was transferred to McGuire's Polytrauma Rehabilitation Center, where he met Gorgey and first learned about exoskeletons.

The Perfect Candidate

Fit, in good health and eager to push his broken body to its limits, he was the perfect candidate for using an Ekso GT, a lower-body, battery-powered exoskeleton, Gorgey said then.

"A person with a spinal cord injury who has the ability to stand and walk is a breathtaking thing," Gorgey told Military Times in 2016. "Not only are there obvious physical and psychological benefits, but the physiological impact is huge. The act of walking can prevent so many other health issues associated with long-term paralysis, including heart disease, diabetes, muscular atrophy, bone loss."

The first time Burch used the Ekso GT, he took 256 steps along a hospital hallway. Gorgey had to rein him in a bit, concerned Burch would injure himself.

"He definitely did not want to stop," Gorgey said.

The second time Burch used the exoskeleton, he clocked 486 steps. He also wore it later that afternoon to his promotion ceremony.

Now, the retired Marine hopes his new implant -- he received a temporary one March 8 to see how well he tolerated it, then got his permanent implant April 2 -- will let him one day take steps at the hospital and around his apartment free of the exoskeleton.

"That's what I'm working toward," he said.

Burch has reason to be hopeful: In 2018, in similar research conducted at the University of Louisville in Kentucky and the Mayo Clinic in Rochester, Minnesota, three people -- Jeffrey Marquis, 35; Kelly Thomas, 24; and Jered Chinnock, 29 -- were able to walk after receiving the same implants. Marquis eventually graduated to walking with balance poles, and Thomas now walks unassisted.

Claudia Angeli, one of the scientists at the Kentucky Spinal Cord Injury Research Center at the University of Louisville, has been studying epidural stimulators for spinal cord injuries since 2009.

Her past research focused on motor restoration. Currently, she is looking at controlling the systems of the body that regulate blood pressure and bladder control.

Rare individuals are able to achieve "full overground ambulation," Angeli said. But nearly everyone who has received an implant in her research has been able to take a few steps at a time during therapy, she added.

"In humans, spinal injuries are all different, so we find that the parameters are very individualized," Angeli explained. "We are working hard to improve the technology. A lot of potential exists for it to interact with the healthy spinal cord below the injury. It allows restoration of some of the functions that were there before the injury."

A $3.7 Million Grant

The VA study was made possible by a $3.7 million grant from the Defense Department under the Congressionally Directed Medical Research Program. Dr. Robert Trainer, a pain management specialist familiar with the Medtronic devices, does the implantation while Gorgey oversees the program and manages the Veterans' post-operative physical therapy.

Burch says he already has seen a benefit from his implant: a decrease in involuntary movements in his legs known as spasticity that he hopes will help improve his therapy at the VA and the gym near his home.

That immediate change following the implant bolstered confidence in his decision to enroll in the research, he added.

When he is not at the VA -- he spends 90 minutes there three times a week -- Burch works with his brother, Travis, also a former Marine, renovating and flipping houses in Portsmouth, and he plays on two wheelchair rugby teams. He credits the sport, once known as murderball, and his teammates on the Oscar Mike Militia, an all-Veterans team, for his recovery to date.

"The first tournament I ever went to, I had my mom with me because I couldn't really do anything. And my teammates were like, 'You gonna bring your mommy to every tournament?' I was like, 'OK, I need to learn to be independent,'" Burch said.

Gorgey said he is excited to see how the combination of the epidural implant and use of an exoskeleton works to improve muscle quality, cardiovascular health and bladder function in the Veteran participants.

"We have a whole team that has worked very hard to get to this point," he said.

Burch says he will apply the same quiet strength he relied on to get through Marine Corps basic training, through military occupational specialty training as an aircraft rescue and firefighting specialist and through the dark days following his accident to get the most out of the research.

"And if I don't walk? I'm going to be happy for the research that comes from the study," he said.

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The Department of Veterans Affairs just received over $17 billion as part of the American Rescue Plan Act of 2021. How will they spend that money?

Of the $17 billion-plus in emergency funding that will add to the department’s $243 billion fiscal 2021 budget, which runs through Sept. 30, $10 billion is earmarked directly for health-care and homeless programs. Another $4 billion is allocated to the Community Care or MISSION program that provides medical care from civilian providers in certain cases.

That means that the majority of the emergency funding will go right back to caring for Veterans. While no special or individual programs have been announced by the VA, the fact that the funding is earmarked to provide services directly to Veterans is not a bad thing.

Another $1 billion of the emergency funding goes to cover the medical bills of Veterans.

According to the law, that money is earmarked to write off Veterans copayments for medical care provided by the VA from April 2020 through September 2021.

Still more money is going to help Veterans who were affected economically by the COVID-19 crisis. A total of $386 million is designated for the Veteran Rapid Retraining Assistance Program, which offers up to 12 months of cash payments to eligible Veterans who enroll in job training programs for high-demand jobs.

The remaining money is divided between several programs, including:

• $100 million to modernize VA’s health-care supply chain
• $750 million in grants to state Veterans homes and nursing homes
• $272 million to speed up compensation claims processing and appeals
• $80 million to pay for special medical leave for VA employees affected by COVID-19
• $10 million to the VA’s Inspector General program to keep tabs on all that money.

This $17 billion is in addition to $19.5 billion in emergency funding provided to the VA as part of the 2020 Coronavirus Aid, Relief and Economic Security Act (CARES Act).

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In order to receive benefits through the U.S. Department of Veterans Affairs (VA), individuals must be classified as a Veteran.

But how does the VA define the term “Veteran”?

Whether they served in the Vietnam era or more recently in Afghanistan, all war Veterans are classified under the same definition. This guide will break down how the VA determines who is a U.S. military Veteran.

What is a U.S. Veteran?

The first step in determining whether a person is qualified for VA benefits is determining whether the person meets the VA’s definition of “Veteran.” While this may seem like a simple question, there are some nuances that are important to understand. The VA defines the word Veteran as “a person who served in the active military, naval, or air service, and who was discharged or released therefrom under conditions other than dishonorable.”

For VA purposes, when it comes to the definition of a Veteran, active military, naval, or air service includes not only the United States Army, Navy, Marine Corps, Air Force, and Coast Guard service, but also a member of the Reserves, Air or Army National Guard, or military academies in certain circumstances. Military service also includes commissioned officers in the Public Health Service on full-time duty, commissioned officers of the National Oceanic and Atmospheric Administration or Environmental Science Services Administration on full-time duty, and service by certain civilians whose work supported military operations and the armed forces during specific periods of conflict or period of war.

If your service qualifies as military, naval, or air service, the next step is to determine whether that service was “active” service. Active duty service means full-time duty. For Reservists and National Guard members, they must have been called up to active duty for federal purposes. Federal service includes periods during which a National Guard member is ordered into federal service by the President or to perform specified training exercises.

A Reservist or National Guard member may also be considered on active duty for training in certain circumstances. A period of active duty training is considered active military, naval, or air service if “the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty” during the period of active duty for training.

There are also circumstances in which a person qualifies as a Veteran during “inactive duty for training,” such as if he or she was disabled or died from an injury incurred or aggravated in the line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident that occurred during training. Note that the word “disease” is not included in these service requirements, which means that there is a more narrow set of circumstances in which a person qualifies as a Veteran for inactive duty for training.

Condition of Discharge

The second factor the Department of Veterans Affairs considers when determining whether a service member qualifies as a Veteran, thus eligible for Veterans’ benefits, is their official discharge or release “under conditions other than dishonorable.” This information is available in the Veteran’s service records.

It is important to note that the VA’s use of conditions other than dishonorable does not have the exact same meaning as the terms used by the military to characterize a person’s discharge. However, there are two types of discharges that the VA will automatically consider to be a certain type of discharge:

1. The first is a dishonorable discharge because such a discharge can only be issued by a general court-martial, which is a statutory bar to benefits.

2. The second is an entry-level separation administrative discharge, which is a discharge under conditions other than dishonorable and qualifies the person as Veteran.

But aside from these two situations, it is not possible to merely rely on the military’s characterization of discharge to determine whether an individual was discharged under conditions other than dishonorable. Instead, you must look to whether there is either a statutory or regulatory bar to benefits.

There are six statutory bars to benefits. If a person was discharged for one of the statutory bars, he or she is not eligible for VA benefits even if his or her discharge is characterized by the military as honorable or under honorable conditions.

The six statutory bars to benefits are:

1. Discharge as a conscientious objector who refused to perform military duty or refused to wear the uniform or otherwise refused to comply with lawful orders of a competent military authority
2. Discharge or dismissal by reason of a sentence of a general court-martial
3. An officer resigning for the good of the service
4. Desertion
5. Discharge as an alien during a time of hostility
6. Discharge under other than honorable conditions issued as a result of absence without official leave (AWOL) for at least 180 continuous days.

Note that there is an exception to the bar to benefits for AWOL. The statutory bar does not apply if the VA makes a factual determination that there were “compelling circumstances to warrant the prolonged unauthorized absence.”

There are also regulatory bars to benefits that apply under certain circumstances. Note that these regulatory bars do not apply to individuals who received an honorable discharge, a general discharge, or a discharge under honorable conditions. The VA will consider a discharge from a special court-martial, an undesirable discharge, or a discharge under dishonorable conditions to be “issued under dishonorable conditions” if the discharge was based on conduct that falls into one of the following categories: accepting an undesirable discharge or discharge under other than honorable conditions to escape a trial by general court-martial; mutiny or spying; an offense involving moral turpitude; willful and persistent misconduct; and homosexual acts involving aggravating circumstances or affecting the performance of duty. Note that a person who receives an undesirable discharge or other than honorable discharge that is subject to a regulatory bar is still entitled to VA health care for a disability that was incurred or aggravated during service.

An important thing to remember is that it is possible for a person to qualify for Veteran status for one period of service, but not for a prior or subsequent period of service. In such cases, it is necessary to show that the disability the Veteran is claiming resulted from the period of service where he or she qualifies as a Veteran.

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Dr. Adam Robinson wants the VA and the Army to better combine resources to help more patients since they already share the medical center in Honolulu.

The agency that oversees Veterans affairs for the Pacific has its headquarters at Tripler Army Medical Center in Honolulu alongside the medical command for active duty troops in the region, which runs the facility.

Despite some cooperation, the two entities largely operate separately and fall under different commands — often causing confusion and frustration for patients.

Dr. Adam Robinson — the director of the Department of Veterans Affairs Pacific Island Healthcare System and former Navy Surgeon General — wants to expand the relationship with the Army’s Pacific Regional Medical Command to make it easier for both to share patients and resources.

“It would be wonderful if I could become a partner with them in their in-patient facility, and actually spread the wealth of federal medicine, for active duty and for eligible family members and for retirees throughout the Pacific Islands,” Robinson said.

The VA’s Pacific Island Healthcare System is unlike any other VA system. Robinson is responsible for taking care of Veterans on all the islands in Hawaii as well as the island territories of American Samoa, Guam and the Northern Marianas.

The VA’s Pacific system is often short on facilities, relying instead on partnerships with military installations and various hospitals and community clinics spread across the Pacific — including Tripler. Though the VA has used telemedicine to reach Veterans on distant islands across 2.6 million square miles of ocean, some specialty medicine and procedures need to be done in person.

Robinson wants to make it easier for patients from across the Pacific to receive care at Tripler. But he said that doesn’t mean simply taking over hospital beds — he wants to share resources and expertise in an arrangement he hopes will equally benefit the military and the VA.

The military has highly trained doctors and nurses. But uniformed active duty medical personnel can be deployed in times of war and crisis for unknown periods of time.

When one of them is trained in a highly specialized medical field, that can sometimes leave patients with special needs without a local care provider for months and sometimes even require them to get treatment from military providers on the mainland.

“I think that I could provide assistance in hiring specialists in many of the different medical and surgical specialties, at Tripler,” Robinson said in a telephone interview last month. “And for that, they could then begin to take care of more of my patients, meaning more Veterans in their facility.”

The U.S. military has had a particularly high operations tempo over the last two decades with troops continually being sent to ongoing wars in Iraq and Afghanistan in addition to a range of other deployments.

Robinson said the VA staff could fill those gaps and take care of military patients in their absence. “When the specialists return from deployment, they will still have a department that’s functioning completely, and they’ll just reintegrate back into that specialty as a specialist within that department,” said Robinson.

The two organizations already cooperate to some degree.

“Resource sharing is a cornerstone of our partnership,” Tripler commander Col. Martin Doperak told Civil Beat in an email. “Not only do we share space between our two facilities for various programs, but we also benefit from embedded VA providers within our hospital, who provide specialty care to patients from both systems.”

Doperak noted that the VA also sponsors civilian residents to train within Tripler’s Graduate Medical Education and Graduate Health Education training programs.

Robinson said his idea is to expand that cooperation to include orthopedic surgery, psychiatry and other specialties.

“Everything I’m talking about already exists. I’m here, the VA is here,” said Robinson.

But reaching the right officials to get the right paperwork to allow expanded cooperation is a moving target.

The U.S. military health care system has been going through the largest restructuring in its history over the last decade with the creation of the Defense Health Agency in 2013. From a bureaucratic standpoint both the DHA and Army Medical Command would need to approve allowing Tripler to admit more patients from the VA and allow VA providers to treat Tripler’s patients.

“I’m not trying to get in front of any of that,” Robinson said.

The DHA is gradually creating a new organizational structure, establishing five health care “markets” in the third quarter of the 2021 fiscal year that would be based in the Virginia area, Texas, Colorado, Washington state and Hawaii.

The island of Oahu, home to the Indo-Pacific Command and the Navy’s Pacific Fleet, is considered particularly vital.

The VHA is also scheduled to assume management and administration of overseas military medical facilities in the fourth quarter of the fiscal year, which will include the establishment of Defense Health Region Indo-Pacific.

Last week, DHA Director Lt. Gen. Ronald Place visited military medical facilities in Hawaii as the military tries to step up vaccinations.

He also held discussions with Robinson and Doperak “on how they’re working together and things that may be barriers for them to work more closely together.”

“I do anticipate even closer collaboration in the coming months and year between the Tripler team and the VA team,” he said during a teleconference with reporters.

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