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  • Jeff Dettbarn

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

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

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

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

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orders at VA hospitals across the country since 2016 have raised questions about whether – in a rush to clear out outdated and duplicate diagnostic orders – some facilities failed to follow correct procedures.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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    ‘We knew it was bad’

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

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

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

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

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

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

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

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

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

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

    ‘An important patient safety issue’

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

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

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

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

    Radiology Orders

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

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

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

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

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

    ‘We look terrible’

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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  • 3 charged

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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  • 3 deaths found

     

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

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

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

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

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  • Grad from High Risk

     

    Five VA hospitals are set to be removed from a list of 15 poorly performing facilities that are considered high-risk, according to an assessment that is set to be released this week by the Department of Veterans Affairs, according to a report Tuesday.

    Removing these hospitals from the list would mark an overall improvement in the quality of care that patient's receive at the nation's 146 Veteran hospitals, the Wall Street Journal reports.

    VA officials have recognized that it is important to improve care at the facilities as the VA Mission Act, which President Trump signed in June, will allow Veterans to receive care in the private health sector. The VA Mission Act would also allow VA Secretary Robert Wilkie to refer Veterans to other care centers if VA hospitals fall short on quality standards.

    The five VA hospitals that showed improvement were part of a program which transferred personnel from centers that performed better on the VA quality care rating system to high-risk centers that performed poorly. The program, additionally, funneled resources into these low-rank centers.

    While VA officials mark this as a success for the program, 10 hospitals are poised to remain in the high-risk category. Most VA care centers, however, have recorded improvements in their service quality, which is measured by death rates, complications, patient satisfaction, overall efficiency, and physician capacity under a system called Strategic Analytics for Improvement and Learning. Only seven have reported declines in care, and only one high-risk facility, located in Washington, D.C., has faced a rate decline.

    VA hospitals have shown continuous improvement in their quality of care standards since SAIL data was publicly released in 2015. Top VA officials and health care analysts attribute the success to increased transparency.

    The VA quality care rating system ranks centers on a scale of one to five stars, one being a center that performs poorly. VA officials expect the five high-risk hospitals to upgrade to two stars. The 10 remaining low-ranking facilities, officials say, are continuing targets for improvement.

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  • Suicidal Veterans 002

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

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

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

    After four days under observation, he was discharged.

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

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

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

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

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

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

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

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

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

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

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

    Young Veterans at risk

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Where is the money going?

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

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

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

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

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

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

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

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

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

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

    Troubling allegations

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

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

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

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

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

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

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

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

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

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  • Suicide Pushes VA

     

    Your kid can grow up, even join the Army and go to war, and you'll still do dad things when he comes back. David Toombs would make his son lunch.

    "I always made him extra, just in case he got hungry or he wanted a snack or he was running low on money. So I made his lunch like a typical dad," says Toombs.

    Toombs worked right next to his son, John, at a steel die shop in Murfreesboro, Tenn.

    John took the job after leaving the Army, but he couldn't leave his memories of Afghanistan behind so easily. He developed a drug problem that landed him in the residential treatment program at the Murfreesboro Veterans Affairs center.

    It's meant to be an intensive therapeutic atmosphere, but it also demands strict discipline, and on the morning of Nov. 22, 2016, John was abruptly kicked out for being late to take his medications.

    Later that day, his father came to pick him up.

    "I said, 'Come on John, let's go, I don't want to leave you out here,' " David Toombs recalls. But the 32-year-old didn't want to leave.

    "He said, 'I'm gonna be OK. I'm gonna sleep in the emergency room, go see the patients' advocate and the director in the morning, and try to get back in the program,' " Toombs recalls.

    John loitered around the campus all night. His father believes he went to the emergency room and was turned away; the Department of Veterans Affairs denies it. Sometime before dawn, John recorded a video on his phone.

    "When I asked for help, they opened up a Pandora's box inside of me and just kicked me out the door," Toombs said, "that's how they treat Veterans 'round here."

    In the message, he thanks the people who did help.

    "Some of you I love more than the whole wide world," he says and it ends.

    Then John went to a construction site on the campus and hanged himself.

    A struggle to improve

    Murfreesboro was, at the time, one of the lowest-rated VA medical centers in the country. It's part of a triangle of three VA centers — in Nashville, Memphis and Murfreesboro — that all had one star out of a possible five in the department's internal rating system.

    Most of the complaints the hospitals receive are about access rather than care. NPR heard complaints from a half-dozen Veterans who get their care at Murfreesboro. They described driving long distances only to find that their appointments had been canceled.

    Army Vet Kenny Yates said that happened to him repeatedly last year.

    "I would show up for my appointments early, and they'd be canceled while I was in the waiting room," says Yates. "They canceled while I was there and then mailed it to me like they had canceled ahead of time."

    Another Murfreesboro Vet, Dan Stott, says he was turned away from getting mental health care because he wasn't acutely suicidal or homicidal.

    When Yates and Stott complained to the White House Veterans' hotline, they did get a meeting with the new director of the VA medical centers in Nashville and Murfreesboro, who is herself a Vet.

    Former Navy Capt. Jennifer Vedral-Baron previously ran U.S. military hospitals. VA sent her to Tennessee in 2016 to help turn the medical centers around.

    "Study after study has shown that the VA does very well in quality measures, but across the board, we don't do so well in patient satisfaction," she says.

    Vedral-Baron says the VA in Nashville and Murfreesboro has better patient outcomes than local private care and can take advantage of affiliations with local medical schools like Vanderbilt. Since she has been in charge, the centers' ratings have gone up from one star to two stars.

    Some of the fixes to customer service have been basic, she says, like retraining staff how to take in patients on the phone.

    She also fired 47 staff members and moved many others into different posts. She hired a former Army doctor who served in Iraq to oversee mental health care. Dr. John Jackson had previously worked in the private sector, and he brags that the VA has much better results and access, including same-day appointments for mental health.

    "I can get you in here, that's what I love about this place," says Jackson.

    He has taken Murfreesboro's low-star rating as a challenge but says there is more to the VA's metrics than just the numbers. Improving the rate of follow-up calls to patients, for example, is a common-sense way to take care of mental health patients, says Jackson.

    Jackson wasn't working at Murfreesboro when John Toombs killed himself. Vedral-Baron was only three months on the job. It still makes her emotional.

    "My heart continues to go out for this family. I did meet with the family not long after Sgt. Toombs' death. We cried together, we talked about the future," she says.

    David Toombs says that made an impression.

    "I can honestly say that I have the highest regards for her," he says. "She was a Navy captain. She could only say what she was allowed to say. But she really really was emotional about it."

    A lawsuit and a memorial

    It was at that meeting that Vedral-Baron brought up the idea of naming the new building — where John Toombs died — the "Sgt. John Toombs Residential Rehabilitation Treatment Facility."

    David Toombs supports the idea, and it's now on a bill moving through Congress.

    But it's also an awkward thing, because Toombs is suing the VA for $2 million. He says that staff at the program callously kicked his son out and didn't follow the VA's own rules to make sure he was safe and stable. Toombs' suit claims that the director of the program was making an example out of John and should have known he was a high risk for suicide. In court documents, the VA denies that.

    David Toombs says he wants the people responsible for kicking his son out of the residential program to lose their jobs, but he says he doesn't hate the VA.

    "As far as saying I'm anti-VA? We don't need shut it down; no, we need to fix it," Toombs says.

    "That problem is the same as what happened with my son. You've got bad apples. And there's really hardworking people out there that care. They do good jobs, but unfortunately circumstances like this, they get overshadowed. Because we only hear the negative about the VA," he says.

    Vedral-Baron said she couldn't discuss the lawsuit. Since the suicide, all the senior staff at the residential program have left or been reassigned. But the only person who was fired from the program is a nurse, Rosalinde Burch. Burch said in an affidavit that she was fired for speaking out about mistreatment of John Toombs.

    Vedral-Baron said she couldn't comment Burch's firing because of privacy concerns.

    She would say that she is still in favor of naming the new building after John Toombs, even though it makes some of the VA staff uncomfortable. She hopes it will help to destigmatize suicide and mental health and be part of improving the VA.

    "I'm from the Navy, I look at it like a carrier," she says. "It doesn't turn quickly, but when it does start to turn, it's kinda hard to stop it. That's where I feel like we are right now."

    Congress turns at about the same speed, but the bill to name the new building after Sgt. John Toombs may become law this fall.

    Everywhere David Toombs looks reminds him of John — the grocery store in town, the sprawling VA campus he drives by and the steel die shop where he still works. He used to be a supervisor, but he asked to move back to a less demanding job because his thoughts of his son are too distracting. Toombs says if the lawsuit is successful, he'll use the money to fund a scholarship and other Veterans' causes.

    "My son died because of their arrogance and negligence," he says. "I can't honestly tell you I'll ever have days or weeks of happiness again, but if I can direct my life helping Veterans somehow, at least I'll maybe find some peace."

    Source

  • Donald Trump 025

     

    Three executive orders signed by President Donald Trump in May to address what he considers a bloated and inefficient federal workforce are working as intended, administration officials say, although Department of Veteran Affairs workers and union members say the implementation is hurting workers — and Veterans.

  • Montgomery VA

     

    MONTGOMERY, AL (WSFA) - A local Veterans service organization is reacting along with others to the Montgomery VA Hospital’s 1 star rating. This score was handed down by the The United States Department of Veterans Affairs as part of its hospital ratings for the 2018 Fiscal Year.

    Greg Akers spent more than 20 years in the Army. For him, the decision to serve was easy.

    “My father is a Veteran, my grandfather Veteran, great grandfather is a Veteran, great great great uncle is a Veteran. Every man in my family served in some capacity,” said Akers.

    Akers now finds great pride in serving his fellow Veterans.

    “It can be as simple as going over and sitting with a Veteran for the day,” said Akers.

    As the American Legion department of Alabama adjutant, it’s a mission he takes seriously.

    “We are the nations largest Veterans service organization. Our main priority is advocating for the rights of Veterans," said Akers.

    Akers said the Veterans service organization learned of 1-star rating Montgomery’s VA hospital received in a letter sent to them from the Central Alabama Veterans Health Care System Director, Dr. Linda Boyle.

    “We knew it was coming. It has been a process working with the VA. We work very closely with Director Boyle. We knew what kind of challenges she has had and what progress she has made over the year she has been there,” said Akers.

    In 2016, Montgomery’s VA received a 2-star rating. In 2017 a 3-star rating, but dropped to 1 star out of 5 in 2018. Akers believes there were a number of factors that weighed into this score from the United States Department of Veterans Affairs.

    “It is not necessarily the care the Veteran gets, it is getting access to the care. That seems to be the biggest hurdle," said Akers. “No one is going to say the lowest rating you can get is acceptable.”

    The American Legion Department of Alabama plans to continue its work with Director Boyle. With a unified focus on the care of the Veterans. Akers is confident things will turn around with a community approach.

    “I think working with DAV, VFW, American Legion Marine Corps leagues all the service organizations. If we pitch in a little bit more than 110 percent, then we can help that facility grow. Director Boyle is not a one woman army so she needs help from all of us,” said Akers.

    The Central Alabama Veterans Health Care System sent us this statement:

    “Central Alabama Veterans Health Care System (CAVHCS) is continuing to refine and improve the way health care is delivered to Veterans. The focus is on patient-centered care. We are utilizing the Strategic Analytics for Improvement and Learning (SAIL) data and analytic supporting resources to guide process improvement to enhance the quality and efficiency of care. CAVHCS has improved quality care in mental health, in-hospital complications, utilization management, call-center responsiveness, and wait times. However, considering the current SAIL 1-Star rating, we are working closely with our VISN and Central Office experts as we develop strategies to continue addressing the opportunities to improve. We take pride in serving our Veterans – achieving the best possible outcomes for them is our top priority.”

    Alabama Rep. Martha Roby also responded to the 1-star rating in a statement:

    “The news that the Central Alabama VA has dropped from a 3-star rating to a 1-star rating is completely unacceptable. Our Veterans represent the very best of this country, and it is incumbent upon us to ensure they receive the best possible care we can provide. Significant work is needed to achieve this goal. I have been and will remain actively engaged with CAVHCS Director Dr. Linda Boyle and other VA leadership to improve care for our Veterans so that it is easily accessible and of the highest quality. As always, I encourage Veterans in Alabama’s Second District to contact my office with problems related to VA casework. I am deeply disappointed in this rating, and my top priority continues to be that we treat our Veterans properly."

    Source

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  • AZ Homeless Vets

     

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

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

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

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

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

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

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

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

    Source

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  • Suicide Prevention Month

     

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

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

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

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

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

    Employ ACE

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

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

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

    Know the signs

    Do you know the warning signs for suicide?

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

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

    Source

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  • TEE tournament

     

    Army Veteran Joni Mulvania (above, left) got a birdie on the first hole. No, really. Her tee shot hit a bird in mid-flight.

    “The bird was not injured but my game never recovered.” That good-natured approach and her considerable athletic ability earned Mulvania one of the top awards at last year’s TEE tournament. She will be back this week. All birds are duly notified.

    The TEE tournament is an annual golf rehabilitation program for Veterans who are legally blind, amputees, those who use wheelchairs and Veterans with other disabilities. It’s underway this week in Iowa City, Iowa.

    The award Mulvania received was the 2017 Wayne Earle-Hampton Hill Award given to the Veteran who best exemplifies the spirit of the games. And there are numerous other awards in her golf bag. Her teams were the champions in 2008, 2009 and 2015.

    The event provides legally blind Veterans and those with other disabilities an opportunity to participate in a therapeutic golfing event as well as other sports activities. The games enable Veterans to develop new skills and strengthen their self-esteem.

    Mulvania, a retired Army Veteran who served three tours in South Korea lives in Rock Island, Illinois, “With my min pins Bonnie and Scooby Doo.” She has been diagnosed with PTSD, Military Sexual Trauma, seizure disorder and chronic pain, but never misses the TEE tournament because she enjoys encouraging other Veterans and building her endurance and strength through swimming, biking and golf.

    “I love sports. My favorites are swimming, golf, and riding my trike. I also co-sponsor a women’s softball team. I enjoy cooking and barbecuing with friends and family. I also enjoy attending Veterans’ events and spending time with my best friend, my mother.”

    TEE is an acronym for Training, Exposure and Experience. Participation is open to Veterans with visual impairments, amputations, traumatic brain injuries, psychological trauma, certain neurological conditions, spinal cord injuries and other life changing disabilities.

    The TEE Tournament uses a therapeutic format to promote health, wellness, rehabilitation, fellowship and camaraderie among its participants. This is the 25th year of the tournament.

    Mulvania encourages Veterans to contact their local VA. “There are a lot of amazing opportunities out there.”

    Source

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  • Army Vet Survives

     

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

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

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

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

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

    Mental toolbox pulled him through

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

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

    Drives five hours to volunteer

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

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

    Volunteering weekly has given him a sense of purpose.

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

    “Suddenly, BAM, I’m a soldier again,” Adam said, after sharing how much these clinics have brought him back from the darkest days of his life.

    He frequently takes his children out surfing and snowboarding, knowing how many years he missed, watching them from the sidelines, unable to walk. He bought his first house in 2017 and is fixing it up with his dad. You can’t miss him in the crowd, just look for the man with the biggest smile.

    “It’s an honor to be here and watch my brothers and sisters grow in confidence every day. By the end of the week, they have permanent smiles! It’s a life saver, a game changer,” Adam said of the 2018 Summer Sports Clinic.

    “My life was spared for a reason. I couldn’t have done it on my own. I have three people to thank for getting me through it: My mom for her fierce faith in God, my nurse in Germany who put up a picture of my kids, reminding me of why I should fight, and my nurse case manager in Huntington, Cheryl, who pushed me past my own limits.”

    Greathouse was also named as a Veteran of the Day.

    Source

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  • Vets Urge VA To Prescribe

    Though medical marijuana is legal in most states, the Department of Veterans Affairs will neither recommend nor prescribe it because of a longstanding federal law.

    Charles Claybaker spent five tours in Afghanistan, kicking in doors and taking out terrorists. But an aircraft crash in 2010 left the Army Ranger with a crushed leg, hip and spine and a traumatic brain injury.

    Army doctors loaded him up with a dozen prescriptions to numb the pain and keep his PTSD in check.

    But Claybaker said the pills transformed him from a highly-trained fighter into a zombie for at least two hours a day.

    "I'm talking mouth open, staring into space," Claybaker said.

    Claybaker decided he would rather live in constant pain. He took himself off opioids and suffered for eight months.

    Then, after retiring and moving back to St. Petersburg, Fla. he discovered marijuana - and he said it changed his life.

    "I can just take a couple of puffs sometimes. It just depends on the day and what's going on or how bad it is," Claybaker said.

    He says marijuana relieved his pain and helped with his anxiety. Claybaker says marijuana also helped him focus and he finally started feeling more like himself.

    "I was a 2013 gold medalist at the Warrior Games in archery, I graduated summa cum laude from Eckerd College, I started my own charity. I adopted my 14-year-old brother who is now on a full-ride scholarship to Oregon State," he said. "I understand that marijuana has some ills, but for me personally, it absolutely helped me do all those things."

    In order to get the drug, though, he had to break the law. Though medicinal marijuana is legal in Florida, the federal government says it's a crime to use it. Claybaker and other soldiers can't get prescriptions from the VA, and their insurance won't cover the cost.

    Under VA policies, the agency says it will not recommend marijuana nor help Veterans obtain it. The VA says Veterans who use marijuana will not be denied VA care, but they need to obtain the substance themselves and pay for it out-of-pocket. A month's supply from a dispensary can be more than $500.

    Claybaker was among more than a dozen Veterans recently profiled in a 20-page report by the Sarasota Herald-Tribune. They're pushing the federal government to reclassify marijuana. The Vets are using the drug to treat conditions ranging from pain to PTSD.

    But the Veterans face an uphill battle. That's because marijuana is classified as a schedule 1 drug, which means it has no medical value. The classification, along with the its federal illegal status, means there hasn't been a lot of medical research on marijuana.

    "We're realizing that there's a lot of holes here in our knowledge," said Ziva Cooper, an associate professor of clinical neurobiology at Columbia University Medical Center.

    Last year, Cooper and other researchers published a study that evaluated 10,000 scientific papers in which marijuana was referenced. They found substantial evidence that chronic pain can be reduced by marijuana and substances known as cannabinoids that are found in it. Those cannabinoids include a widely sold product known as CBD.

    But, the report found no scientific studies on marijuana's use for PTSD.

    "We need those rigorous double-blind, placebo-controlled studies to inform us if cannabis can actually help with this, or cannabinoids," Cooper said.

    Janine Lutz said marijuana could have saved her son, John, who died from suicide after serving as a Marine Lance Corporal in Iraq and Afghanistan.

    He returned home to Davie, Fla. in 2011 with knee and back injuries and a severe case of PTSD.

    In 2013, doctors at the VA prescribed an anti-anxiety medication for his PTSD, despite a note in his records that it had led to a previous suicide attempt. His mom said he was dead within a week.

    "I would call that a pharmaceutically-induced suicide," Janine Lutz said. "And I actually sued the VA for that and I won my case."

    Lutz received $250,000 in a settlement with the VA.

    Today Lutz runs the Live To Tell Foundation, which supports military Veterans. Families of Vets who died by suicide send her their photos, which she laminates and links to her traveling Memorial Wall. Her "Buddy Up" events bring Veterans together so they can form bonds and look out for one another.

    It was at those events that she learned how many Veterans self-medicate with marijuana. Lutz said the government needs to act.

    "Stop playing games with the lives of America's sons and daughters, and if they want cannabis, give it to them and stop giving them these psychotropic dangerous drugs that are destroying their bodies and their minds," Lutz said.

    The American Legion polled its 2 million members and found 92 percent favored marijuana research and 81 percent support federal legalization.

    The group has since joined in the effort to push Congress to reclassify marijuana from a Schedule 1 drug.

    So far, that request has gone nowhere.

    VA Secretary Robert Wilkie said he has to follow the rules.

    "I'm not a doctor, never played one on television. I'm not a scientist," Wilkie said in an interview. "I will follow the federal law. And the federal law is very clear."This story was produced by the American Homefront Project, a public media collaboration that reports on American military life and Veterans. Funding comes from the Corporation for Public Broadcasting.

    Source

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  • Psychology is a career

     

    The rewards of building a career in psychology extend in all directions, personal, professional and financial.

    The need for competent and caring psychologists is growing, with the U.S. Department of Labor predicting that, through 2026, demand will rise 14 percent. That figure exceeds the average growth for all occupations, according to the department. Behind much of increase will be hospitals, schools and mental health clinics, and their expanding need for mental health services. Particularly in specialty areas such as counseling or health psychology, those with doctoral degrees should expect a very promising job market.

    At VA, psychologists play a huge role in making sure Veterans get the full range of services they need. The scars that combat Veterans wear are not always physical, and the care of a committed and compassionate psychologist can make all the difference. Throughout the country, at different levels and in a variety of clinical settings, VA psychologists touch lives every day. Telemedicine, including Telemental Health, is helping us reach Veterans in even more locations. There are few jobs as rewarding as helping a United States Veteran build a better life through quality mental health care.

    The path to becoming a psychologist can be challenging, but it’s also entirely doable and extremely satisfying. A doctoral degree is required for most clinical, counseling and research positions. Psychologists working in educational or industrial settings may be able to maintain their positions with a master’s degree, but a Ph.D. will be much more widely welcomed. Clinical practice requires licensure in addition to education. In 2017, the median pay for a psychologist was $77,000 a year. Most psychologist roles at VA require both a license and a Ph.D.

    VA currently has numerous opportunities for psychologists, and we expect to maintain that need for some time to come. We also have opportunities for psychiatrists, psychiatric nurses, social workers and many other fields. Explore our opportunities for mental health professionals and more today.

    Source

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  • Financial Waste

     

    Since I am in Denver investigating fraud, waste, and abuse this week, I wanted to give readers additional insight into the outlandish waste VA engages in when no one is looking.

    Case in point is the recent exposure by Fox 31 in busing employees between facilities, a total of 176 yards, over five years while the new over-budget Aurora VA was built.

    I can’t wait to check that out now that the facility finally opened at a staggering $1 billion above budget. How many underground bunkers did the deep state secretly build into that budget? I hope they came equipped with caviar and some top-shelf champagne.

    Apparently, the five-year project involved specialty airport-transport buses that shuttled VA employees 176 yards:

    The Problem Solvers’ latest discovery is a nearly five-year program which provided a fleet of employee-only shuttle buses to drive staff between the North and South doors of the facility during the construction phase.

    AFOX31 investigative team spent significant time over the summer recording empty buses which drove in short circles.

     

    At times, three airport-passenger-type shuttles ran on 12-hour schedules. Each bus had an assigned driver. Based on our observations, the shuttle vehicles idled with engines running the entire day. Operators would sit and wait for about half an hour in one of two roundabouts before swapping positions at a different door. If a passenger did arrive to be transported, that bus would drive the staff person to the opposing door, while an empty shuttle would drive the 176 yards to swap positions with the prior shuttle.

    The VA spokesman provided the following explanation as to how the shuttling worked and why:

    “Shuttle services began prior to construction of the Rocky Mountain Regional VA Medical Center. Building A (Clinic Building South) was the only building on the campus and an agreement between VA and USAF resulted in the Buckley AFB clinic being temporarily located on the 4th floor of Building A. The shuttle’s purpose was to ensure that Buckley AFB patients and VA employees had access to Building A during construction.”

    When asked about cost, VA said they could not estimate the cost because there existed no line-item budget for the transportation program. This means, if VA wants to squirrel away money without oversight, they push the funds into something that lacks a line-item budget.

    Luckily, Fox 31 investigated the matter to bring it into the light using a calculator and a little common sense:

    The VA hired WG-6 employees to drive the shuttles. Based on pay scales, the average hourly wage for such employees is around $20 per hour.

     

    FOX31 figured two full-time drivers worked approximately 1,462 days.

     

    The VA said it “leased” the shuttles from General Services Administration over the final three years of the program at $768.30 a month per vehicle, plus $0.562 per mile.

    Bottom line: the short bus route for VA employees cost at least $769,000 in tax funds.

     

    Without an actual budget from the VA, theFOX31 Problem Solvers could not accurately or fairly calculate the cost of fuel, shuttle maintenance, mileage or the occasional use of a third shuttle and a third driver, so we did not include those. If added to the $769,000 known total, the cost of the transportation program could be several hundred thousand dollars more.

    When it comes to the Aurora VA facility $1 billion over budget, you have to wonder how many other expenditures were unaccounted for and how many cronies or family members owned contracting companies that profited from the lack of oversight.

    Source

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  • Medical Records 001

     

    Navy Veteran George Jackson, 76, has filed suit against the regional director of Louisiana’s VA for violation of his constitutional and statutory rights under FOIA – the Freedom of Information Act.

    He alleges that the director, Mark Bologna, instructed subcontractors not to release his medical records to him when he requested access. Jackson needed these records to show service-connection for the degenerative spinal condition that led to his tetraplegia (he has little use of his limbs).

    Having served over 30 years in the U.S. Navy, the plaintiff was restricted to light duty in 1992 and finally forced to retire the following year. Yet he was not given a medical or disability-related discharge from military service.

    He was given a normal honorable discharge, and then he moved right on into retirement. After two tours of active duty in Vietnam, in the one career that was always his childhood dream. At the ripe old age of… 50. Does that add up, for even a second?

    Mr. Jackson lives in Lake Charles, Louisiana with his wife Helene, who traveled to the district courthouse with a Veterans’ advocate to serve the suit on George’s behalf. George spends most of his time at home in a hospital bed, and occasionally manages outings in an electric wheelchair.

    As of last month, he has a 10 percent disability rating. Ten. Percent.

    Now, I will be the first to admit that the percentage rating system can get squirrelly, but 10 percent for any amount of service-connected paralysis is absolute highway robbery.

    Given that the percentage is supposed to represent a Veteran’s difficulty in employment, tetraplegia easily merits 100 percent disability. Maybe VA could get away with something like 70 in cases where the patient retains some independent movement.

    In Jackson’s particular case, we also have, let me see… literally the fact that this condition forced him to take light duty with physical therapy, and then have to retire.

    That is such obvious evidence for Veteran unemployability that it borders on the tautological. Jackson’s disability makes him unemployable because, in his real life, that is what it did.

    The Jacksons say that they are not filing this suit for the money, but for the sake of holding VA accountable for wrongdoing. They are seeking $50,000 in general damages for pain and suffering, and $100,000 in punitive damages.

    Before he lost the ability to walk, George Jackson had back and leg pain. This pain would have been a sharp shooting pain, nerve pain. When he went before a Navy evaluation board, it had likely been getting worse for years.

    When he finally reported the pain and had it checked, tests showed that his spinal discs were degenerating and that the spine itself was getting narrower. This type of degeneration is reasonable to deem service-connected, especially since it started well before the plaintiff retired.

    The progression of bone loss and deterioration culminated when Jackson broke several vertebrae in 2004, further damaging his spinal cord and permanently preventing him from walking.

    From 2011 forward, Jackson’s limited access to his own paperwork led to a denial of all disability benefits, despite his service and medical records. To eventually be awarded 10 percent disability on top of that is simply reprehensible.

    Law-wise, this case is virtually “open-and-shut.” Information-wise, Jackson’s legal team is going to have to wade through this quagmire with a machete.

    Should be familiar territory for a 30-year Vietnam Veteran.

    Source

  • Justice 003

     

    Hattiesburg, Miss. – Terry L. Magee, 38, of Bassfield, pled guilty yesterday before U.S. District Judge Keith Starrett to threatening to bomb the Veterans Administration Nursing Home in Collins, Mississippi, announced U.S. Attorney Mike Hurst and Special Agent in Charge James Ross with the Veterans Administration - Office of Inspector General.

    On February 17, 2018, Magee called the main phone line at the Veterans Administration Nursing Home in Collins and told the person who answered the phone that he was going to blow the place up. Magee was indicted on May 2, 2018.

    "These charges underscore the Veterans Affairs Office of Inspector General’s commitment to the safety of the Veteran Affairs’ patient population, as well as its employees, guests, and facilities," said VA OIG Special Agent in Charge James Ross.

    Magee will be sentenced by Judge Starrett on November 27, 2018, at 9:30 a.m., and faces a maximum sentence of 10 years in federal prison and a $250,000 fine.

    This case was investigated by the Veterans Administration - Office of Inspector General, the Federal Bureau of Investigation Joint Terrorism Task Force, Mississippi Homeland Security, and the City of Collins Police Department. Assistant U.S. Attorney Erin Chalk is prosecuting the case.

    Source

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  • BWN Stalled

     

    Paul Lawrence, Undersecretary for VA Benefits, recently unleashed a blistering attack against the Blue Water Navy Vietnam Veterans Act (HR 229), which would extend disability benefits to at least 70,000 Vietnam Vets suffering from dioxin-related ailments.

    Agent Orange, commonly used as a defoliant in the thick jungles of Vietnam, causes these ailments, and there is clear and convincing scientific evidence that these 70,000 Veterans were also exposed to this chemical.

    These soldiers were shipboard personnel who generally patrolled about 12 miles off the coastline, but precedent does suggest that this distance does not preclude Agent Orange exposure. Also, Congress does not differentiate between levels of exposure among land-based Vietnam Vets, only whether they were exposed or not.

    And yet…

    VA is raring to go, citing “lack of sufficient scientific evidence” to grant these benefits, urging Senators to worry about “uncontrolled demands” for future VA benefits.

    He specifically urged the Senate because this bill has already passed the House. UNANIMOUSLY. How rare must it be, in this age of polarized parties, that the House passes a bill unanimously?

    As the former, doomed VA Secretary David Shulkin said of this legislation, “these Veterans have waited too long and this is a responsibility that this country has.”

    Now, after blasting the bill, Blue Water Veterans may end up with nothing as the bill is stalled in the Senate Committee on Veterans Affairs.

    As it turns out, it is possible to be a discerning and conservative political official who is concerned about fiscal responsibility… and advocates for this legislation, given the evidence at hand. Shulkin was. At the very least, he refused to oppose Blue Water outright.

    The House and Senate VA Committees have worked on this bill in close coordination and even started to figure out how to pay for it. That not only shows the extent of their commitment to Blue Water but their relative certainty that it eventually WILL be funded.

    All $7 billion of it.

    A massive 2011 study conducted by the Australian government shows ample evidence that shipboard personnel were, in fact, exposed to Agent Orange and similar dioxins, entitling them to disability benefits under that government.

    Lawrence dismissed the impact of that study entirely.

    He also stated that VA home loans, the aspect of VA’s budget that would be cut most to pay for this initiative, are too important to raise even minimally, evoking predatory lenders as the only possible alternative for Veterans who would otherwise pay a VA home loan normally.

    In other words, “We will claim scientific uncertainty, as long as it helps us. You have evidence, but we have decided that it does not count for enough. We will prioritize deterring hypothetical predatory lenders over helping the real injured Veterans.”

    Regardless of party lines, this sort of conduct is not reasonable. It is not governed by facts or logic. It is tribalism, and it is money. Our guy said to oppose this, so we will. It would be expensive, so we automatically do not want it. We will say anything we believe will make us look good, and nothing else.

    This is what post-truth, “alternative facts” government really looks like.

    A majority of Senators continue to support this legislation, so the immediate impact of this testimony is unclear. That said, it would be wise to expect months of further turmoil in the Senate about this.

    What is your take on the agency’s flip on the Blue Water issue?

    Source

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  • Vista

     

    Cerner has pulled together a cadre of 24 health and tech companies to help it convert the Department of Veterans Affairs electronic health records from VistA to its own system in a $10 billion conversion project that will likely cost around $30 billion.

    “We have formed a world class team that has the best interest of Veterans at heart,” Travis Dalton, president of Cerner Government Services, said in a statement Wednesday. “This is the beginning of a long transformational journey. We will continue to seek and bring the best talent available to the VA. Our nation’s Veterans deserve the highest quality care and we are confident we have brought the right players to this team to succeed in our collective mission.”

    Cerner selected seven companies as its “core team” that includes known characters to the VA scene:

    • Leidos
    • Guidehouse
    • Accenture
    • Henry Schein Inc.
    • AbleVets LLC
    • MicroHealth
    • ProSource360

    Another 17 companies will also be helping out including numerous Veteran-owned companies.

    “Cerner has brought together some of this country’s brightest industry leaders to transform Veteran health care delivery,” VA Secretary Robert Wilkie said. “This team will create a single longitudinal health record that can facilitate the efficient exchange of data among military care facilities, VA facilities and the thousands of civilian health care providers where current and former service members receive care.”

    The additional companies are:

    • ACI Federal
    • B3 Group Inc.
    • Blue Sky Innovative Solutions
    • Clarus Group LLC
    • Forward Thinking Innovations LLC
    • HCTec
    • HRG Technologies
    • KRM Associates Inc.
    • Liberty IT Solutions
    • MedicaSoft
    • MedSys Group
    • Holland Square Group
    • PM Solutions
    • Point Solutions Group
    • Sharpe Medical Consulting
    • Signature Performance
    • ThomasRiley Strategies.

    Source

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  • DVA 003

     

    Combat Related Special Compensation (CRSC) is a program that was created for disability and non-disability military retirees with combat-related disabilities.  It is a tax free entitlement that you will be paid each month along with any retired pay you may already be receiving.

    Eligibility 
    To qualify for
    CRSC you must:

    • be entitled to and/or receiving military retired pay
    • be rated at least 10 percent  by the Department of Veteran’s Affairs (VA)
    • waive your VA pay from your retired pay
    • file aCRSC application with your Branch of Service

    Disabilities that may be considered combat related include injuries incurred as a direct result of:

    • Armed Conflict
    • Hazardous Duty
    • An Instrumentality of War
    • Simulated War

    Retroactive Payment 

    In addition to monthlyCRSC payments, you may be eligible for a retroactive payment.  DFAS will audit your account to determine whether or not you are due retroactive payment. An audit of your account requires researching pay information from both DFAS and VA.


    If you are due any money from DFAS, you will receive it within 30-60 days of receipt of your first
    CRSC monthly payment. If DFAS finds that you are also due a retroactive payment from the VA, we will forward an audit to the VA. They are responsible for paying any money they may owe you.

    Your retroactive payment date may go back as far as
    June 1, 2003, but can be limited based on:

    • your overallCRSC start date as awarded by your Branch of Service
    • your Purple Heart eligibility
    • your retirement date
    • your retirement law (disability or non-disability)
    • six-year barring statute

    Disability retirees with less than 20 years of service will be automatically limited to a retroactive date ofJanuary 1, 2008 as required by legislation passed by Congress effective 2008.  

    All retroactive pay is limited to six years from the date the VA awarded compensation for each disability.

    If you have questions about your
    CRSC eligibility, please call us at 800-321-1080 or contact your Branch of Service.

    Source

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  • Research Funding

    Today, the president signed a bill that increases federal research funding and takes important steps to better support our nation's care partners. Through its tireless advocacy work, the Parkinson's community played a role in the passage of this important law.

    Law Bolsters Funding for Research

    A critical provision provides funding for the National Neurological Conditions Surveillance System. This database will capture demographic information on people living with neurological diseases, which is key to helping researchers target their work and increase understanding of these conditions. While it was signed into law in late 2016, the database was never funded or implemented. But with the passage of this bill, it now can become a reality. (As the law does not specify which diseases the National Neurological Conditions Surveillance System will track, the Foundation is working with the Centers for Disease Control and Prevention, which will house the database, to push for the inclusion of Parkinson's.)

    The law also includes a $2 billion funding increase for the National Institutes of Health (NIH). The NIH is the largest public funder of Parkinson's research, investing $169 million in the disease in 2017. This funding boost is key to supporting the foundational research the agency carries out to better understand, diagnose and treat various health conditions.

    Throughout 2018, the Parkinson's community made a strong push for these funding priorities. Thousands of people with Parkinson's and their loved ones sent their lawmakers more than 46,000 emails asking for money for the database and the NIH. These funding successes are a testament to the critical work of Parkinson's advocates across the country.

    New Council Seeks to Better Support Care Partners

    Another significant provision in the law provides $300,000 to fund activities outlined in the RAISE Family Caregivers Act. This act was signed into law in January 2018, thanks in part to the advocacy efforts of the Parkinson's community, and directs the government to create a national strategy to better support the estimated 40 million care partners across the country. The $300,000 will be used to create a Family Caregiving Advisory Council, which will identify actions that communities, providers, policymakers and others can take to better assist care partners.

    We encourage you to reach out to you legislators to thank them for passing this law. This helps members of congress better understand how they can use their votes to pass bills that positively impact our community. You can quickly send your lawmakers an email on our website.

    Source

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  • HERB EXPOSURE

    Veterans who served at Fort Drum, New York during certain years may have been exposed to Agent Orange, a toxic herbicide used during the Vietnam War.

    DOCUMENTSSHOW HERBICIDES WERE TESTED ATFORT DRUM

    A document from the Department of Defense (DoD) shows that a formulation of 2,4-D and 2,4,5-T, the two ingredients in Agent Orange, were tested by the U.S. Army Chemical Corps in an approximately four square mile area of Fort Drum in the summer of 1959. According the document, thirteen drums totaling 715 gallons of Agent Purple, made up of concentrated butyl esters of 2,4-D and 2,4,5-T, were sprayed by helicopters over 2,560 acres of Fort Drum.

    COURT ISSUES DECISION DETAILING HERBICIDE USE ATFORT DRUM

    The Court of Appeals for Veterans Claims recently issued a decision in a case in which a Veteran claimed service connection for multiples conditions due to exposure to Agent Orange at Fort Drum. The Court’s decision discussed numerous documents that the Veteran submitted for his claim which detail the use of Agent Orange and other herbicides at Fort Drum as early as 1959 up to the 1970s.

    SUMMARY OF THE CASE

    The Veteran served in the United States Army from February 1971 to December 1972. He then entered the US Army Reserves and spent two weeks training at Fort Drum, New York in August 1974. In December 2004, he applied for service connection for diabetes mellitus, a heart condition, hypertension, and erectile dysfunction due to exposure to Agent Orange at Fort Drum. He was denied service connection and eventually appealed twice to the Court of Appeals for Veterans Claims.

    VETERAN SUBMITTED EVIDENCE OF AGENT ORANGE ATFORT DRUM

    To support his claim of exposure to Agent Orange, the Veteran submitted a report from the Chemical Systems Laboratory at Aberdeen Proving Ground dated for July 1981, which discussed investigators finding ten five-gallon metal cans which contained chemicals found in Agent Orange. The report discussed how the herbicides were not properly stored at the base. The report also detailed testing in 1961 of an “experimental defoliant mixture” along the road of the base, and an herbicide that was similar to Agent Orange being used during the 1950s up to the early 1970s. Finally, from 1969 to 1978, herbicides similar to Agent Orange were also used along certain roads in the main impact area of Fort Drum.

    According to the documents detailed in the Court’s decision, Agent Orange was not only tested at Fort Drum, but it was also used for maintenance and to increase visibility around the base.

    Source

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  • New Lubbock Clinic

     

    The Amarillo VA Health Care System has received a contract award from the U.S. Department of Veteran Affairs to build a new Lubbock Community Based Outpatient Clinic on the campus of Texas Tech University. This $12.3 million project will provide nearly 94,000 square feet of usable clinic space, which more than doubles the footprint of the current clinic.

    “This project shows the commitment the U.S. Department of Veteran Affairs has for our Veterans in the Lubbock area, and the outstanding support by our community partners to provide a fully-modern clinic to meet the needs of Veteran health care in the Hub City,” said Mike Kiefer, Amarillo VA Health Care System Director. “I am beyond excited to see this project come to fruition, as I understand how important this facility is to our Veterans, Veteran family members and our staff in Lubbock.”

    For additional information and more job details, please contact 806-355-9703 ext. 17330. For media queries, please contact Joel Mease at 806-356-9703 ext. 4059 or by email at This email address is being protected from spambots. You need JavaScript enabled to view it.">This email address is being protected from spambots. You need JavaScript enabled to view it..

    Source

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  • Dothan Closes

     

    DOTHAN, Ala. (WDHN) - Dothan's Veterans Affairs clinic is closing, leaving thousands of military Veterans with major questions about where they will receive health care in the future.

    Nov. 30, 2018, will be the final day of operation for the Alexander Drive location across from Southeast Alabama Medical Center.

    There are contracted employees along with a small number of actual federal government employees in this facility.

    Once it closes, almost 5,000 patients — military Veterans — will be forced to use other VA options.

    WDHN is committed to finding more answers as to what the future holds for local VA patients.

    Source

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  • Video Visits

     

    This summer, VA launched a telehealth expansion initiative that includes significantly increasing the number of outpatient providers capable of offering video visits. VA Video Connect is an application that uses the camera on your phone, tablet or computer to create a secure connection with a member of your VA care team from the comfort of your home or wherever is convenient for you.

    If you’re a Veteran who is interested in using VA Video Connect, first consult with your VA care team to see if video appointments can be part of your care plan. Video appointments will display in your list of appointments in VA Online Scheduling. You can check to see if your facility currently participates in VA Online Scheduling at this link.

    How Do I Get Started?

    Before a VA Video Connect appointment is scheduled, a provider must determine if a video appointment is appropriate for you. Your provider will discuss the logistics and details of the video visit, and designated staff members will assist you to determine how you will connect to a video visit at home.

    Video visits are currently being scheduled for patients by designated scheduling staff. In the future, Veterans will be able to schedule video visit appointments through the VA Online Scheduling application.

    When your appointment is scheduled, you will receive an email with a link to join a virtual medical room. In the coming months, that link will also be available in VA Online Scheduling when you view your upcoming appointments.

    If you’re using a non-iOS system (e.g., desktop, laptop, Android device, etc.), just click the appointment link at your scheduled day and time to start your video visit. If you plan to use an iOS device for the video visit, you must install the VA Video Connect App on your device. You can find iOS download information on this page of the VA App Store and read more about how to get started with VA Video Connect in this My HealtheVet article.

    If you need help with VA Online Scheduling or VA Video Connect, call the VA Help Desk at 1-877-470-5947 (for TTY assistance, dial 711). The Help Desk is open weekdays from 7 a.m. – 7 p.m. CT.

    Feedback Wanted

    Finally, VA wants to hear about your experiences trying VA Video Connect and VA Online Scheduling. The feedback will help us make future improvements to the applications.

    • For VA Video Connect, go to the app’s page on the VA App Store and click the “Feedback To VA” tab.
    • The VA Online Scheduling Feedback tab is located under the User Menu when you are logged into the application.

    Both brief feedback forms include a few questions and an opportunity to provide comments. Your comments are anonymous and valuable to our app development teams.

    Source

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  • CO Homeless Vets

     

    HUD, VA team up to places homeless Vets in permanent housing

    Funding from the U.S. Housing and Urban Development and the Veterans Affairs departments will help provide permanent homes to about 100 homeless Veterans in Colorado.

    The $782,869 in rental assistance announced this week comes from the HUD-Veteran Affairs Supportive Housing program, which combines rental assistance from HUD with case management and clinical services by the VA.

    “We are lucky to have such strong partnerships with the VA and housing authorities throughout the state and the Rocky Mountain region, all of whom work together to build on the success of the HUD-VASH Program,” HUD Rocky Mountain Deputy Regional Administrator Eric Cobb said in a statement.

    As part of the program, VA medical centers assess Veterans experiencing homelessness before referring them to local housing agencies for vouchers. The decisions are based on a variety of factors, including the duration of homelessness and the need for longer term, more intensive support.

    Veterans participating in the HUD-VA housing program rent privately owned housing and generally contribute no more than 30 percent of their income toward rent. The VA offers eligible homeless Veterans clinical and supportive services through its medical centers across the U.S., Guam, Puerto Rico and the Virgin Islands.

    Source

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  • Whistle Blowers 002

     

    LAKE CHARLES, LA (KPLC) -There are allegations of patient neglect, fraud, and other corruption concerning home health care provided to Veterans in Jennings.

    In addition to this clinic in Jennings, frail Veterans who are home bound are provided with home health services. According to complaints filed by two former employees the system is fraught with corruption.

    One former employee says there was patient neglect, falsification of Veterans’ medical records, fraudulent billing, misuse of government vehicles, tampering with vehicle tracking systems and more.

    Local Veteran and advocate for others, Jim Jackson, has no first-hand knowledge of the situation, but he says he’s not shocked or surprised.

    "Where there's this much smoke, we better look for the fire, we better put it out. And it goes back to supervision. Without the supervision, quality supervision, quality people throughout, we don't have anything. The VA doesn't have anything."

    Another part of the complaint describes nurses allegedly documenting home visits, miles traveled and serves when logs show the cars never moved.

    "It's a paper trail. So, these people who drove three and four hundred miles in a half a day and saw nine patients, but their paperwork was straight. Did they see anybody or do anything? Probably not."

    There is even one allegation about fraudulent visits after a patient had passed away.

    Jackson says the VA needs more employees who care about Veterans.

    "We have so many people who are there for the insurance, for the paycheck, for whatever and so few there for God and country to be responsive to the needs of that Veteran."

    A spokesman says the VA takes the allegations seriously and that their office of accountability and whistle-blower protection is looking into them.

    Both former employees say they have suffered retaliation and have filed complaints seeking whistle blower protection.

    Source

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  • Gout

     

    Avoiding the Ache and Agony

    Sudden, painful swelling at the base of the big toe is often the first warning sign of gout. It can affect other joints as well. Without treatment, gout can lead to severe joint damage and make it hard for you to move. The good news is, most types of gout are treatable, especially if caught early.

    About 4% of adults in the U.S. have been diagnosed with gout. It’s a form of arthritis—in fact, the 2nd most common form after osteoarthritis. And it’s a growing problem.

    “The prevalence of gout more than doubled nationwide between the 1960s and 1990s, and the increases have continued into the 1990s and 2000s,” says Dr. Hyon Choi, a physician who studies gout at Boston University School of Medicine.

    Experts suspect that climbing rates of obesity and high blood pressure are partly to blame for the rise in gout. Gout has also been linked to other medical conditions, such as kidney problems, diabetes, and heart disease.

    Gout is caused by tiny needle-like crystals that build up in the joints, leading to sudden inflammation and intense pain. The crystals are made of uric acid, a substance that normally dissolves in the blood and passes out of the body in urine. But in people with gout, high blood levels of uric acid allow crystals to form in the joints and sometimes in the kidneys, where they create kidney stones.

    Uric acid comes from the breakdown of substances called purines. Purines are naturally found in your body’s tissues and in many foods. Eating purine-rich foods—such as organ meats, mussels, and mushrooms—can bring on or worsen a gout attack. Alcohol or stress can also trigger an episode.

    Gout symptoms usually arise at night. It normally affects one joint at a time, often in the feet, hands, elbows, or knees.

    “Gout primarily affects men who are middle aged or older,” Choi says. “Postmenopausal women are at risk too, especially if they are obese or have high blood pressure or unhealthy dietary habits, such as drinking large amounts of alcohol or sugary soda.”

    The risk also rises if you have a family member with gout or if you take certain medicines, such as water pills (diuretics) or low-dose aspirin.

    Early gout attacks tend to fade within a week. It may be months or even years before the next attack hits. But over time, gout may appear more often and last longer if left untreated.

    Most people with gout can control their symptoms through lifestyle changes and medications. Non-steroidal anti-inflammatory drugs (NSAIDs) can ease the swelling and pain of sudden attacks. Oral or injected steroids and a drug called colchicine can also help.

    If frequent gout attacks become a problem, doctors may prescribe uric acid-lowering medicines. But once begun, these drugs often must be taken long term.

    “If it’s left untreated, gout can eventually lead to damage and deformity of the joints—a condition called chronic gout,” says Choi. “In general, chronic gout arises only after many years of suffering.”

    If you have repeated attacks of pain and swelling in your joints, talk to a health care provider. “If you have gout, the earlier you’re diagnosed and treated—along with making healthy lifestyle changes—the better off you’ll be,” says Choi.

    Source

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  • PTSD Key

     

    Veterans who have symptoms of PTSD often ask us for help, as do their families. The National Center for PTSD provides education and conducts research on trauma and PTSD. We do not provide diagnosis or treatment of PTSD.

    For direct care, see both of the following:

    Below are the answers to some questions about PTSD that are often asked by Veterans and their families.

    Do I have PTSD?

    A natural first question is whether your symptoms might be due to PTSD. A good place to start learning about PTSD is the PTSD Basics page on our website. You should know, though, that having symptoms does not always mean that you have PTSD. Some reactions to stress and trauma are normal. Since many common reactions look like the symptoms of PTSD, a doctor must decide if you have PTSD

    Also, stressors other than trauma may cause symptoms that are like those of PTSD. For example, work or money problems can lead to symptoms. Medical problems such as heart disease or diabetes, or mental health problems such as depression or anxiety, can have symptoms that look like PTSD. That is why you should see a provider who is trained to know which of your symptoms might be PTSD.

    If I have other problems, can I also have PTSD?

    Veterans with PTSD often have other types of problems. They might have other stress, medical, or mental health problems. Sometimes PTSD is overlooked when other problems seem very pressing. If you have questions, ask your doctor if PTSD also needs to be treated.

    Am I eligible for VA services?

    All Veterans could possibly be eligible. Here is a brief list of factors that make up whether you are eligible:

    • You completed active military service in the Army, Navy, Air Force, Marines, or Coast Guard (or Merchant Marines during WW II).
    • You were discharged under other than dishonorable conditions.
    • You are a National Guard member or Reservist who has completed a federal deployment to a combat zone.

    You should also be aware that:

    • Health care eligibility is not just for those who served in combat.
    • Other groups may be eligible for some health benefits.
    • Veteran's health care is not just for service-connected injuries or medical conditions.
    • Signing up for health care is separate from signing up for other benefits at VA.
    • Veteran's health care facilities are for both women and men. VA offers full-service health care to women Veterans.

    For Veterans who served in a theater of combat operations after November 11, 1998, some benefits have been added. In January, 2008, the period of eligibility for free health care was extended from two to five years.

    VA operates a yearly enrollment system that helps make sure that Veterans who are eligible can get care. For information, see VA Health Care Eligibility & Enrollment. Your DD 214 is used to enroll for VA services. If you have trouble locating this form, VA Enrollment can still assist you.

    What help is there for me (or my Veteran family member)?

    PTSD is treatable. Many places within VA provide PTSD treatment. General programs that provide mental health services include VA medical centers, community-based outpatient clinics (CBOCs), and Vet Centers. Use the VA Facilities Locator to find the closest VA facility.

    An extra note about Vet Centers

    Offered through the Readjustment Counseling Service, Vet Centers are located in the community. They provide information, assessment, and counseling to any Veteran who served in a war zone. This includes conflicts such as in Somalia, Iraq, or Afghanistan.

    Vet Centers also offer services to families of Veterans for military-related issues. There are no fees or charges for Vet Center services, and services are confidential. That means no information will be given to any person or agency (including the VA) without your consent. Most of the staff are Veterans themselves.

    During normal business hours, you can call 1-800-905-4675 (Eastern) or 1-866-496-8838 (Pacific). The Vet Center program also has a 24/7 hotline, with all calls answered by combat Veterans: 1-877-WAR-VETS (1-877-927-8387).

    VA special PTSD clinics and programs

    VA also has special PTSD clinics and programs that can help eligible Veterans. For more on these programs, see our fact sheet PTSD Treatment Programs in the U.S. Department of Veterans Affairs.

    What to expect when you see a VA provider

    When you see a VA provider, he or she will first assess whether or not you have PTSD. If you do have PTSD, remember that it can be treated. Several types of education and treatment are helpful to Veterans and their family members. These include:

    • Classes on dealing with stress, anger, sleep, relationships, and PTSD symptoms
    • One-to-one, group, and family counseling
    • Medications

    For more information, please see Treatment.

    I think I am disabled due to PTSD caused by military service. What can I do?

    Service-connected disability for PTSD is determined by the Compensation and Pension Service. C&P is an arm of VA's Veterans Benefits Administration:

    Compensation. This decision is not made by the providers who care for you in VA's PTSD clinics and Vet Centers. The process for making the decision involves several steps:

    • A formal request (claim) must be filed using forms provided by the VA's Veterans Benefits Administration.
    • After all the forms are submitted, you must complete interviews about your:
    • social history (a review of family, work, and education before, during, and after military service).
    • psychiatric status (a review of past and current mental health symptoms and of traumas gone through while in the military).

    The forms and information about the application process can be obtained from Benefits Officers at any VA medical center, outpatient clinic, or regional office.

    The process of applying for a VA disability for PTSD can take several months. It can be confusing and quite stressful. Veterans Service Organizations (VSOs) can help Veterans and family members with VA disability claims. VSOs provide Service Officers at no cost. Service Officers know all about every step in the application and interview process. They can provide practical help and moral support. Some Service Officers are experts in helping Veterans with PTSD disability claims.

    Even if you have not been a member of a given VSO, you still can ask for help from a Service Officer of that VSO. To find a Service Officer to represent you, just contact the local office of any VSO. You may also wish to ask other Veterans who have applied for VA disability what they would suggest. A mental health provider at a VA PTSD clinic or a Vet Center may also have some tips.

    My claim for a VA PTSD disability has been turned down by the Benefits Office, but I believe I have PTSD due to military service. What can I do?

    A Veterans Service Officer can explain how to file an appeal. The Service Officer may be able to help you gather the information you need to make a successful appeal. You may want to contact a Service Officer who is an expert in helping Veterans who have PTSD-related claims.

    I can't get records from the military that I need for my disability claim. What can I do?

    Veterans Service Officers can help you file the paperwork needed to get your military records. If your Service Officer is not able to help you get needed records, ask him or her to direct you to another Service Officer who has more experience in getting records.

    Source

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  • Best Worse

     

    WASHINGTON — Veterans Affairs officials claimed improvements at 66 percent of their medical centers across the country last fiscal year, with 18 earning the highest level of excellence in the department’s internal ratings system.

    But nine others remain on the VA’s list of underperforming facilities after getting the lowest possible rating. They include the embattled Washington VA Medical Center, which sits just a few miles from the White House and has seen a series of leadership shake-ups in recent years.

    The VA ratings — made public in 2016 after a USA Today report on the internal scorecards — grade each of the locations on metrics like patient mortality, patient length of stay, reported accidents and patient satisfaction. Officials have said the system is used to collect best practices from high-performing facilities to use in underperforming ones.

    In a statement, VA Secretary Robert Wilkie touted improvements across the 146 medical centers.

    “With closer monitoring and increased medical center leadership and support, we have seen solid improvements at most of our facilities,” he said. “Even our highest performing facilities are getting better, and that is driving up our quality standards across the country.”

    he number of one-star facilities dropped by six from the start of fiscal 2018 to the end. Of the nine medical centers still at that level, four were cited for significant improvements: El Paso and Big Spring in Texas, Memphis in Tennessee, and Loma Linda in California.

    The five others — Washington, Phoenix and Tucson in Arizona, Montgomery in Alabama, and Atlanta in Georgia — saw no overall change.

    Earlier this year, VA placed 12 medical centers on a high-risk list for “aggressive” management intervention. Of those, eight were removed from the program after showing sufficient improvement by the end of last month.

    Wilkie said while he is pleased with the results thus far “there’s no doubt that there’s still plenty of work to do.”

    The full ratings list is available on the VA web site or in the chart below:

    VISN

    MedicalCenter

    Performance Star Rating

    Improvement from 2017

    5

    Washington

    1

    No change

    7

    Atlanta

    1

    No change

    7

    Montgomery

    1

    No change

    9

    Memphis

    1

    Improvement (small)

    17

    Big Spring

    1

    Improvement (large)

    17

    El Paso

    1

    Improvement (large)

    22

    Loma Linda

    1

    Improvement (small)

    22

    Phoenix

    1

    No change

    22

    Tucson

    1

    No change

    2

    East Orange

    2

    Improvement (small)

    5

    Beckley

    2

    No change

    5

    Martinsburg

    2

    Improvement (small)

    6

    FayettevilleNC

    2

    No change

    6

    Hampton

    2

    No change

    7

    Augusta

    2

    No change

    7

    ColumbiaSC

    2

    Improvement (small)

    8

    LakeCity

    2

    No change

    8

    San Juan

    2

    No change

    9

    Murfreesboro

    2

    Improvement (small)

    9

    Nashville

    2

    Improvement (small)

    10

    Battle Creek

    2

    Improvement (large)

    10

    Fort Wayne

    2

    Improvement (small)

    15

    Kansas City

    2

    Improvement (small)

    15

    Marion IL

    2

    Improvement (small)

    16

    Alexandria

    2

    No change

    16

    GulfCoast HCS

    2

    No change

    16

    Jackson

    2

    Improvement (large)

    17

    Dallas

    2

    Improvement (small)

    17

    Harlingen

    2

    Improvement (large)

    19

    Cheyenne

    2

    No change

    19

    Denver

    2

    Improvement (small)

    19

    Montana

    2

    Improvement (small)

    19

    Muskogee

    2

    No change

    19

    Oklahoma City

    2

    Improvement (small)

    20

    Puget Sound

    2

    Improvement (small)

    20

    Roseburg

    2

    Improvement (small)

    20

    Walla Walla

    2

    Improvement (large)

    21

    Fresno

    2

    Improvement (small)

    21

    Honolulu

    2

    Improvement (small)

    21

    Las Vegas

    2

    Improvement (large)

    21

    Palo Alto

    2

    No change

    22

    Albuquerque

    2

    Improvement (small)

    22

    Long Beach

    2

    No change

    22

    Prescott

    2

    Improvement (small)

    1

    Manchester

    3

    Improvement (small)

    1

    Providence

    3

    No change

    1

    White River

    3

    Improvement (small)

    2

    Albany

    3

    Improvement (large)

    2

    Brooklyn

    3

    Improvement (small)

    2

    HudsonValley

    3

    No change

    2

    Northport

    3

    No change

    2

    Syracuse

    3

    No change

    4

    Philadelphia

    3

    Improvement (small)

    4

    Wilkes Barre

    3

    No change

    4

    Wilmington

    3

    Improvement (large)

    5

    Baltimore

    3

    Improvement (small)

    5

    PerryPoint

    3

    Improvement (large)

    6

    Durham

    3

    Improvement (small)

    6

    Salisbury

    3

    Improvement (small)

    7

    Dublin

    3

    Improvement (large)

    7

    Tuscaloosa

    3

    Improvement (small)

    8

    Bay Pines

    3

    No change

    8

    Gainesville

    3

    Improvement (small)

    8

    Miami

    3

    No change

    8

    Orlando

    3

    No change

    8

    West Palm

    3

    Improvement (large)

    9

    Louisville

    3

    No change

    10

    Ann Arbor

    3

    Improvement (small)

    10

    Dayton

    3

    No change

    10

    Detroit

    3

    Improvement (small)

    10

    Indianapolis

    3

    Improvement (small)

    12

    Chicago

    3

    Improvement (small)

    12

    Danville

    3

    Improvement (small)

    12

    Hines

    3

    Improvement (small)

    12

    Milwaukee

    3

    No change

    12

    Tomah

    3

    No change

    15

    ColumbiaMO

    3

    Improvement (small)

    15

    Poplar Bluff

    3

    No change

    15

    St Louis

    3

    Improvement (small)

    15

    Topeka

    3

    Improvement (small)

    16

    FayettevilleAR

    3

    No change

    16

    Houston

    3

    No change

    16

    Little Rock

    3

    Improvement (large)

    16

    New Orleans

    3

    Improvement (small)

    16

    Shreveport

    3

    Improvement (small)

    17

    San Antonio

    3

    Improvement (large)

    17

    Temple

    3

    Improvement (small)

    19

    Salt Lake City

    3

    No change

    20

    Anchorage

    3

    No change

    20

    Boise

    3

    No change

    20

    Portland

    3

    Improvement (large)

    20

    Spokane

    3

    Improvement (large)

    20

    WhiteCity

    3

    Improvement (large)

    21

    Reno

    3

    No change

    21

    Sacramento

    3

    Improvement (large)

    21

    San Francisco

    3

    Improvement (small)

    22

    Los Angeles

    3

    Improvement (small)

    22

    San Diego

    3

    No change

    23

    FortMeade

    3

    No change

    23

    Iowa City

    3

    Improvement (small)

    1

    Boston

    4

    No change

    2

    Bronx

    4

    Improvement (small)

    2

    Buffalo

    4

    Improvement (large)

    2

    Canandaigua

    4

    Improvement (large)

    2

    New York

    4

    Improvement (small)

    4

    Altoona

    4

    No change

    4

    Pittsburgh

    4

    Improvement (small)

    5

    Clarksburg

    4

    Improvement (large)

    5

    Huntington

    4

    Improvement (large)

    6

    Richmond

    4

    No change

    7

    Birmingham

    4

    Improvement (small)

    7

    Charleston

    4

    No change

    8

    Tampa

    4

    No change

    9

    Lexington

    4

    Improvement (small)

    9

    Mountain Home

    4

    Improvement (small)

    10

    Chillicothe

    4

    No change

    10

    Columbus

    4

    Improvement (small)

    12

    North Chicago

    4

    No change

    15

    Leavenworth

    4

    Improvement (small)

    15

    Wichita

    4

    Improvement (small)

    17

    Amarillo

    4

    Improvement (large)

    19

    Grand Junction

    4

    Improvement (small)

    19

    Sheridan

    4

    Improvement (large)

    23

    Central Iowa

    4

    Improvement (small)

    23

    Fargo

    4

    Improvement (small)

    23

    Minneapolis

    4

    No change

    23

    Omaha

    4

    No change

    23

    Sioux Falls

    4

    No change

    1

    Bedford

    5

    No change

    1

    Connecticut

    5

    Improvement (small)

    1

    Northampton

    5

    Improvement (large)

    1

    Togus

    5

    Improvement (large)

    2

    Bath

    5

    Improvement (small)

    4

    Butler

    5

    Decline in performance

    4

    Coatesville

    5

    No change

    4

    Erie

    5

    Improvement (small)

    4

    Lebanon

    5

    Improvement (small)

    6

    Asheville

    5

    Improvement (large)

    6

    Salem

    5

    Improvement (small)

    10

    Cincinnati

    5

    Improvement (small)

    10

    Cleveland

    5

    Improvement (small)

    10

    Saginaw

    5

    Improvement (large)

    12

    IronMountain

    5

    Improvement (small)

    12

    Madison

    5

    Improvement (small)

    23

    Hot Springs

    5

    Improvement (large)

    23

    St Cloud

    5

    Improvement (small)

    Source

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  • Dental Coverage

    Military retirees eligible for the new dental and vision coverage — as well as active duty families eligible for the new vision benefit — can start researching their options in earnest now, with the release of new rates for 2019.

    The enrollment period for coverage under the Federal Employee Dental and Vision Insurance Program, or FEDVIP, is Nov. 12 to Dec. 10, but the time to start comparisons is now, said Kathy Beasley, director of government relations, health affairs, for the Military Officers Association of America.

    For retirees, the FEDVIP replaces the Tricare Retiree Dental Program, which ends Dec. 31. In order to have dental and vision coverage on Jan. 1, retirees must sign up during the enrollment period. Active duty families are still eligible for dental coverage under Tricare, but if they want the new vision coverage, they must sign up during the enrollment period.

    “We want to get this information out as soon as we can to give people extra time to make their decisions,” Beasley said, noting the Office of Personnel Management had provided the information early, in advance of being published on Tricare.benefeds.com. The rate information is available here, and will be available in early October on the website, along with a comparison tool that helps in making the choice.

    The rates and options vary among the different plans, but according to Beasley, officials with the Office of Personnel Management said the average gross dental premium for 2019 increases by 1.2 percent compared to rates for 2018. That does vary; for example, the FEP BlueDental rates for 2019 are decreasing on average by 6.8 percent for the high option and by 7.8 percent for the standard option, according to William A. Breskin, senior vice president of government programs for the Blue Cross Blue Shield Association.

    The actual premium will depend on the plan chosen, but across the carriers, the average dental premium rates for 2019:

    Average biweekly dental premium*

    Average monthly dental premium*

    Self

    $17.41

    $37.73

    Self + 1

    $34.14

    $73.97

    Self + family

    $49.23

    $106.68

    *Actual premium may be higher or lower

    *Actual premium may be higher or lower

    The average vision gross premium is decreasing by 2.8 percent in 2019.

    The actual premium will depend on the plan chosen, but across the carriers, the average vision premium rates for 2019:

    Average biweekly vision premium*

    Average biweekly vision premium*

    Self

    $5.10

    $11.05

    Self + 1

    $10.23

    $22.16

    Self + Family

    $14.75

    $31.96

    *Actual premium may be higher or lower

    *Actual premium may be higher or lower

    It’s difficult to compare costs under the new plan with current costs under the Tricare Retiree Dental Program because the TRDP is a “one size fits all” program.

    Beasley said many MOAA members have said they looked at the 2018 FEDVIP prices compared to TRDP, and can’t find the exact same coverage and prices for comparison purposes. The FEDVIP offers a variety of different plans and options, with 10 different companies offering dental options for dental coverage, and four different companies offering vision coverage.

    She said officials at OPM, the Defense Health Agency, military service organizations and Veterans service organizations have joined forces in the last few months to get the word out to retirees about the new retiree dental plan options, but some apparently don’t know about the changes. She said she was in Huntsville, Alabama, giving a briefing, and about half of the retirees she spoke to had heard about the changes.

    As retirees evaluate their choices for the new dental plan, Beasley suggests that if they like their current dentist, they should ask their dentist whether they accept a FEDVIP plan, and talk about next year’s dental needs.

    “Your dentist knows your dental health and what you might anticipate in the future," she said. "Do your due diligence and look at the pricing. Use the plan comparison tool, and make your decision based on that.”

    Source

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  • Alzheimer

     

    Over time, people with Alzheimer’s disease become less able to manage around the house. For example, they may forget to turn off the oven or the water, how to use the phone during an emergency, which things around the house are dangerous, and where things are in their own home.

    As a caregiver, you can do many things to make the person’s home a safer place. Think prevention—help avoid accidents by controlling possible problems.

    While some Alzheimer’s behaviors can be managed medically, many, such as wandering and agitation, cannot. It is more effective to change the person’s surroundings—for example, to remove dangerous items—than to try to change behaviors. Changing the home environment can give the person more freedom to move around independently and safely.

    Create an Alzheimer’s-Safe Home

    Add the following items to the person’s home if they are not already in place:

    • Smoke and carbon monoxide detectors in or near the kitchen and in all bedrooms
    • Emergency phone numbers (ambulance, poison control, doctors, hospital, etc.) and the person’s address near all phones
    • Safety knobs and an automatic shut-off switch on the stove
    • Childproof plugs for unused electrical outlets and childproof latches on cabinet doors

    You can buy home safety products at stores carrying hardware, electronics, medical supplies, and children’s items.

    Lock up or remove these potentially dangerous items from the home:

    • Prescription and over-the-counter medicines
    • Alcohol
    • Cleaning and household products, such as paint thinner and matches
    • Poisonous plants—contact the National Poison Control Center at 1-800-222-1222 or www.poison.org to find out which houseplants are poisonous
    • Guns and other weapons, scissors, knives, power tools, and machinery
    • Gasoline cans and other dangerous items in the garage

    Moving Around the House

    Try these tips to prevent falls and injuries:

    • Simplify the home. Too much furniture can make it hard to move around freely.
    • Get rid of clutter, such as piles of newspapers and magazines.
    • Have a sturdy handrail on stairways.
    • Put carpet on stairs, or mark the edges of steps with brightly colored tape so the person can see them more easily.
    • Put a gate across the stairs if the person has balance problems.
    • Remove small throw rugs. Use rugs with nonskid backing instead.
    • Make sure cords to electrical outlets are out of the way or tacked to baseboards.
    • Clean up spills right away.

    Make sure the person with Alzheimer’s has good floor traction for walking. To make floors less slippery, leave floors unpolished or install nonskid strips. Shoes and slippers with good traction also help the person move around safely.

    Minimize Danger

    People with Alzheimer’s disease may not see, smell, touch, hear, and/or taste things as they used to. You can do things around the house to make life safer and easier for the person.

    Seeing

    Although there may be nothing physically wrong with their eyes, people with Alzheimer’s may no longer be able to interpret accurately what they see. Their sense of perception and depth may be altered, too. These changes can cause safety concerns.

    • Make floors and walls different colors. This creates contrast and makes it easier for the person to see.
    • Remove curtains and rugs with busy patterns that may confuse the person.
    • Mark the edges of steps with brightly colored tape so people can see the steps as they go up or down stairs.
    • Use brightly colored signs or simple pictures to label the bathroom, bedroom, and kitchen.
    • Be careful about small pets. The person with Alzheimer’s may not see the pet and trip over it.
    • Limit the size and number of mirrors in your home, and think about where to put them. Mirror images may confuse the person with Alzheimer’s disease.
    • Use dishes and placemats in contrasting colors for easier identification.

    Touching

    People with Alzheimer's may experience loss of sensation or may no longer be able to interpret feelings of heat, cold, or discomfort.

    • Reset your water heater to 120°F to prevent burns.
    • Label hot-water faucets red and cold-water faucets blue or write the words "hot" and "cold" near them.
    • Put signs near the oven, toaster, iron, and other things that get hot. The sign could say, "Stop!" or "Don't Touch—Very Hot!" Be sure the sign is not so close that it could catch on fire. The person with Alzheimer's should not use appliances without supervision. Unplug appliances when not in use.
    • Pad any sharp corners on your furniture, or replace or remove furniture with sharp corners.
    • Test the water to make sure it is a comfortable temperature before the person gets into the bath or shower.

    Smelling

    A loss of or decrease in smell is common in people with Alzheimer’s disease.

    • Use good smoke detectors. People with Alzheimer’s may not be able to smell smoke.
    • Check foods in your refrigerator often. Throw out any that have gone bad.

    Tasting

    People with Alzheimer’s may not taste as well as before. They also may place dangerous or inappropriate things in their mouths.

    • Keep foods like salt, sugar, and spices away from the person if you see him or her using too much.
    • Put away or lock up things like toothpaste, lotions, shampoos, rubbing alcohol, soap, perfume, or laundry detergent pods. They may look and smell like food to a person with Alzheimer’s disease.
    • Keep the poison control number (1-800-222-1222) by the phone.
    • Learn what to do if the person chokes on something. Check with your local Red Cross chapter about health or safety classes.

    Hearing

    People with Alzheimer’s disease may have normal hearing, but they may lose their ability to interpret what they hear accurately. This loss may result in confusion or overstimulation.

    • Don't play the TV, CD player, or radio too loudly, and don't play them at the same time. Loud music or too many different sounds may be too much for the person with Alzheimer’s to handle.
    • Limit the number of people who visit at any one time. If there is a party, settle the person with Alzheimer’s in an area with fewer people.
    • Shut the windows if it's very noisy outside.
    • If the person wears a hearing aid, check the batteries and settings often.

    It may not be necessary to make all these changes; however, you may want to re-evaluate the safety of the person’s home as behavior and abilities change. For more on home safety and Alzheimer’s, read Home Safety Checklist for Alzheimer’s Disease.

    Is It Safe to Leave the Person with Alzheimer's Alone?

    This issue needs careful evaluation and is certainly a safety concern. The following points may help you decide.

    Does the person with Alzheimer's:

    • Become confused or unpredictable under stress?
    • Recognize a dangerous situation, for example, fire?
    • Know how to use the telephone in an emergency?
    • Know how to get help?
    • Stay content within the home?
    • Wander and become disoriented?
    • Show signs of agitation, depression, or withdrawal when left alone for any period of time?
    • Attempt to pursue former interests or hobbies that might now warrant supervision, such as cooking, appliance repair, or woodworking?

    You may want to seek input and advice from a healthcare professional to assist you in these considerations. As Alzheimer's disease progresses, these questions will need ongoing evaluation.

    For more home safety tips, visit the Home Safety Checklist for Alzheimer's Disease.

    For More Information About Home Safety and Alzheimer's

    NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center

    1-800-438-4380 (toll-free)

    This email address is being protected from spambots. You need JavaScript enabled to view it.">This email address is being protected from spambots. You need JavaScript enabled to view it.

    www.nia.nih.gov/alzheimers

    The National Institute on Aging’s ADEAR Center offers information and free print publications about Alzheimer’s disease and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.

    Family Caregiver Alliance

    1-800-445-8106 (toll-free)

    This email address is being protected from spambots. You need JavaScript enabled to view it.">This email address is being protected from spambots. You need JavaScript enabled to view it.

    www.caregiver.org

    Eldercare Locator

    1-800-677-1116 (toll-free)

    https://eldercare.acl.gov

    Source

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  • SD 100 Homeless Vets

     

    About 100 homeless Veterans in San Diego County will receive vouchers for subsidized housing through $1.1 million in funds released this week from the U.S. Department of Housing and Urban Development and the U.S. Department of Veterans Affairs.

    The money will fund 50 housing vouchers administered by the city of San Diego Housing Commission and 50 vouchers administered by the San Diego County Housing Authority.

    The new vouchers are in addition to 1,031 vouchers already in use to subsidize housing for San Diego Veterans countywide.

    “We have few responsibilities greater than making sure those who have sacrificed so much in service to their country have a home they can call their own,” HUD Secretary Ben Carson said in a statement Thursday.

    “The housing vouchers awarded today ensure homeless Veterans nationwide have access to affordable housing and the critical support services from the VA,” Carson said.

    Nationwide, $35.3 million has been released to fund 4,077 Veterans Affairs Supportive Housing vouchers. Of that, $18.3 million is going to California for 1,658 vouchers.

    The rental assistance announced Thursday is provided through the HUD-VASH Program, which combines rental assistance from HUD with case management and clinical services provided by the VA.

    “When our neighbors answer our country’s call to service, we must answer their call when they return home,” HUD Deputy Regional Administrator Wayne Sauseda said in the news release. “Together with the VA, HUD remains committed to meeting the supportive housing needs of Veterans, so that, one day, we end Veteran homelessness in San Diego.”

    Since 2008, more than 93,000 vouchers have been awarded and about 150,000 homeless Veterans have been served through the HUD-VASH program nationwide.

    More than 600 public housing agencies administer the HUD-VASH program, and this most recent award includes 22 new agencies, increasing coverage to many communities.

    The program also helps VA Medical Centers assess Veterans experiencing homelessness before referring them to local housing agencies for vouchers.

    Decisions are based on how long a person has been homeless and the need for longer-term care, among other factors.

    Veterans participating in the HUD-VASH program rent privately owned housing and generally contribute no more than 30 percent of their income toward rent. VA offers eligible homeless Veterans clinical and supportive services through its medical centers across the U.S., Guam, Puerto Rico and the Virgin Islands.

    Source

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  • Womens Mental Health

    Women currently comprise approximately 16 percent of the United States military. As of 2016, service women are permitted to serve in any military position for which they meet the gender-neutral performance standards and requirements. These expanded roles have increased the cadre of responsibilities that service women have, as well as increased their potential challenges. As such, it is more important than ever for military leadership, researchers, and health care providers to understand women’s health.

    The Departments of Veterans Affairs (VA) and Defense (DOD) collaborated to host the National VA/DOD Women's Mental Health Mini-Residency Aug. 28-30 in Arlington, Virginia. This mini-residency brought together more than 150 VA and DOD mental health providers so they could gain knowledge and skills in the provision of gender-sensitive care to women Veterans and service members. Specific topics included:

    • Complex trauma
    • Psychopharmacology
    • Safety planning
    • Suicide prevention
    • Compassion fatigue
    • Sexual functioning
    • Impact of health conditions
    • Ostracism, and many others

    During the mini-residency, attendees developed an action plan to disseminate these best practices and facilitate practice change at their local facilities -- to optimize women's mental health care in VA and DOD. Requests from DOD mental health providers to attend in person far exceeded the number of spots available, so we posted all DOD presentations and posters on the mini-residency website for you to read, download and share with colleagues.

    Today also marks the start of Women’s Health Month, a time to highlight women’s health, to include the mental health of service women. Throughout the month, we will showcase some of the exciting presentations from the mini-residency through our Clinician’s Corner blog series.

    Dr. Nancy Skopp, PHCoE research psychologist, will describe the impact of gender stereotypes on diagnosis and treatment. Dr. Laura Miller of the Hines Jr. VA Hospital in Hines, Illinois, will highlight mental health across the female lifespan, and Dr. Margaret Altemus of the Yale School of Medicine in New Haven, Connecticut, will discuss perinatal and postpartum depression. Dr. Lauren Messina of the Consortium for Health and Military Performance will discuss a total force fitness approach to physical and mental health, which can help women and men improve their emotional health and manage symptoms of mental health disorders.

    For updated research and resources, be sure to check out our Women’s Mental Health webpage and follow us on Facebook for more women’s mental health-related posts and resources. Like, comment and share on your channels so we can promote women’s health awareness, and particularly the importance of women’s mental health, during October.

    Source

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  • DVA Logo 29

    CLARKSVILLE, Tenn. – (CLARKSVILLENOW) – The United States Department of Veterans Affairs (VA) has released a data sheet from 2016 that details the suicide rate of Veterans in Tennessee, compared to the Veteran suicide rates in the southern region and the nation; as well as the general suicide rates in Tennessee, the southern region, and the nation.

    There was a total of 156 Veteran suicides in the state of Tennessee in 2016. Broken up by age range, the numbers are as follows:

    • 18-34: 26
    • 35-54: 38
    • 55-74: 66
    • 75+: 26

    By comparison, there were 2,611 Veteran suicides in the southern region, and 6,079 in the nation.

    Further, it was found that there was a total of 1,070 general suicides in Tennessee, 17,011 in the southern region, and 43,427 in the nation.

    There was a Veteran suicide rate (based on per 100,000 people) of 32.8 in Tennessee, 30.6 in the southern region, and 30.1 in the nation. This indicates that Veteran suicide rate in Tennessee was not significantly different from the national Veteran suicide rate.

    Despite that conclusion, it was also found that the Tennessee Veteran suicide rate of 32.8 was significantly higher than the general national suicide rate, which was found to be 17.5. The general suicide rate for the southern region was found to be 18.2.

    You can view the data sheet in its entirety here.

    If you are a Veteran or a family member of a Veteran, and you struggle with depression, there are resources available to help you. If you are in the Clarksville area, one such resource is Soldiers and Families Embraced, or SAFE. SAFE is an organization dedicated to counseling and helping Veterans and Veterans’ families. For more information on SAFE, you can read about some of their methodologies and processes. You can also listen to a Clarksville’s Conversation interview with the executive director of SAFE, Lantz Smith.

    Source

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  • Whistle Blower

     

    VA critics say other reports back up complaints

    A draft report from an internal investigation into the Manchester VA Medical Center states that most claims made by whistleblowers about the care there are unfounded, but the report is being criticized as biased.

    The 62-page report obtained by News 9 is from the Office of the Medical Inspector, which is an office in the Department of Veterans Affairs. It details the office's findings regarding claims made by 12 former Manchester VA staff members.

    Among the complaints were that operating rooms weren't properly cleaned or cared for, that blood and rust were present on surgical instruments and that patients with cervical myelopathy were victims of malpractice.

    According to the OMI, those claims were unfounded.

    The report also addresses the whistleblowers, saying they became "distrustful and frustrated when they felt as if their clinical concerns were not addressed by their leadership."

    But critics of the VA said the motivations behind the writers of the report are clear.

    "It's a PR move. It's pure and simple," said Andrea Amodeo-Vickery, a lawyer for the whistleblowers. "The other three reports weren't publicized yet. They substantiated these same claims that this new report didn't substantiate."

    “Oh, I think they have it terribly wrong,” said Dr. Stewart Levenson, former chair of the department of medicine at the Manchester VA and one of the whistleblowers. “There are several incidents that are truly tragic, where they say there are no problems because they followed VA protocols, which are blatantly wrong.”

    Levenson said the VA system needs faster, safer patient care.

    “The patients, the Veterans, suffer the most,” he said. “Several suffered horrible complications, maybe even death, because they didn't get their care on a timely basis.”

    U.S. Rep. Annie Kuster, D-N.H., who is on the House Veterans Affairs Committee, also questioned the findings.

    "I have spoken with highly regarded physicians that have serious concerns about the quality of care, and thus, I question the outcome of this particular investigation," she said.

    Kuster said she's pleased with the current leadership at the Manchester VA and has asked the U.S. Office of Special Counsel for an independent investigation into the VA's previous practices.

    Source

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  • Iraq Vet Declared Dead

     

    ASHEVILLE, N.C. (WLOS) — A Candler Veteran who was trying to get medical treatment through Veterans Affairs found out the agency has declared her dead.

    "I said, 'I look pretty well preserved for being dead for 26 years,'" Judith Herren, an Iraq War Veteran, said.

    Herren said the problem started back in November when she decided to consider getting treatment at Charles George Veterans Affairs Medical Center in Asheville.

    "They couldn't process anything because I was listed as ‘deceased’ in September of 1991," Herren said.

    Herren served in the military for eight years -- four in the Army and four in the National Guard, where she found herself in Iraq.

    "We were the first units in Desert Shield and Desert Storm, and we really didn’t know what to expect," Herren said.

    What she also didn’t expect is having to prove she was alive when she came back.

    "I finally got listed as ‘non-deceased’ back in April of this year," Herren said.

    But then another problem came up.

    "It took another three months to get my ID card,” Herren said. “Because I was listed as ‘deceased’ on that system, too."

    Which leads us to now, where Herren said she wasn't able to renew her 12 daily prescriptions because she was also listed as "deceased" on that system.

    "It shouldn't have happened the first time, much less three times," Herren said.

    Herren said she is thankful for all the help she’s received from Charles George VAMC employees.

    This is a statement sent to News 13 by Armenthis Lester, Public Affairs Officer at Charles George VAMC, regarding Herren's case:

    "The issue Ms. Herrin is having originated with the Health andEligibilityCenter inAtlanta,GA. This is a national office separate from Charles George VAMedicalCenter. However, our administrative office staff worked with the Health andEligibilityCenter to assist this Veteran, and as ofMonday, August 27, 2018, her issue is resolved. We honor Ms. Herrin's service to this country and our desire is for Veterans to get the care they need, when they need it."

    News 13 also reached out to the Health and Eligibility Center with the VA to find out what initially led to the problem. We're still waiting to hear back.

    Source

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  • Keith Thompson

     

    Army Veteran Keith Thompson (pictured above) is no stranger to conquering life’s challenges.

    A 2006 motorcycle accident left the former firefighter in a 27-day coma and paralyzed from the waist down. Not one to be kept down, Thompson strives to be the best at everything he does and that paid dividends at this year’s National Veterans Wheelchair Games (NVWG) held in Orlando, Florida.

    Thompson was awarded the prestigious Spirit of the Games trophy, an award presented to “the Veteran that through their athletic achievement, leadership and support of their fellow Veterans exemplifies the values of the games.”

    To illustrate the award’s significance, Thompson was selected from the record-setting 611 athletes that participated in this year’s games and is the 32nd recipient since the award’s creation in 1987. The theme for this year’s games was “Conquer the Challenge,” and that’s exactly what Thompson did.

    “There are no limits,” said Thompson. “My wife told me I can do anything I want. I just have to do it from a chair.”

    Thompson defines the word competitor. He’s competed in various events over his NVWG career including archery, trap shooting, air rifle, air pistol, 9-ball, shot put, discus, javelin, boccia ball and softball.

    Played through multiple injuries

    While at this year’s games, Thompson attempted to catch a softball hit his way when he fell out of his chair and dislocated his shoulder. Also, in 2016, Thompson competed at the NVWG despite having a broken wrist and torn rotator cuff after being rear-ended by a distracted driver. He truly knows no limits.

    “We are all at the games to compete and leave our best on whatever field we play on,” Thompson said.

    Thompson was introduced to Carl Vinson VAMC when he accompanied a friend to the medical center to check on the status of his benefits. Tamara Jackson, administrative officer for acute care, suggested Thompson also apply for benefits and suggested the Sandersville, Ga. resident consider recreation therapy. It wasn’t long before recreational therapist Charlene James urged Thompson to try adaptive sports and in 2011, he attended his first NVWG.

    When he’s not practicing for the games, Thompson spends time with his wife of 17-years, Janice, and managing his medical transportation service, 3D Enterprises.

    Keith Thompson is no stranger to life’s challenges. However, he is an example all people can emulate when striving for something that seems unobtainable.

    Source

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  • Maine VA helps Vets

     

    Veterans at the 3rd Annual Community Reintegration Outing at the Dew Haven Maine Zoo and Rescue pictured above. It’s not often you get to tear yourself away from the trials and tribulations of life to just take a break and have fun. More so, it’s difficult to reach outside of ourselves and connect to others. Just ask Veteran Dan Martins, peer support specialist for VA Maine Healthcare System.

    “I was a hermit myself for two years after the Navy. I just wanted to be left alone. But it’s amazing what happens when you leave your four walls and get out there.”

    Dan Martins and Pete Cayouette started a community reintegration program three years ago. They are two of five peer support specialists whose mission is to help Veterans get back into the community.

    Community groups like Bread of Life Ministries and Volunteers of America have joined VA in this effort, providing resources, socialization and basic human necessities to Veterans who have lost their way.

    Veteran George: “I up and left New York because I had to leave the environment there. My buddies were all overdosing and I knew I just had to get away from the situation. This is my seventh day in Maine.”

    George and 31 other Veterans came out for the 3rd Annual Community Reintegration Outing at the Dew Haven Maine Zoo and Rescue to have fun, build camaraderie, network, make new friends, and to just spend some time outdoors.

    Dave Anderson, a member of the Waterville Elks lodge #905 since 2006, along with his team from the Elks’ Veterans Committee, cooked up some barbeque before the tour started.

    “I’m proud to be one of the supporters of the Veterans Committee and help Veterans who are down and out or with anything they need.”

    The Elks Lodge has been supporting Veterans since the First World War, from putting in the first field hospital to making sure a Veteran mother of six has furniture and appliances after being displaced.

    “Today we brought a bunch of Veterans out here from the Togus VA, the homeless shelter and Bread of Life Ministries, to develop more camaraderie between the Veterans. I’ve met most of them over the years. Some of them are in and out of homelessness and some have already found housing they stay with.

    “But once they develop a relationship with each other, through VA and through the Elks, we like to treat them to a barbecue, and this is the day for this year. We’ve been doing it a few years now and I think we will keep on doing it,” said Anderson.

    Source

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  • Male Breast Cancer

    Mike Partain got the shock of his life five years ago when he was diagnosed with breast cancer at the age of 39. That he got breast cancer at all is surprising. It's so rare that for every 100 women who get it, just one man will.

    “Five years ago I was just an ordinary father of four, husband of 18 years. And one night, my then-wife gave me a hug and she felt a bump on my chest,” he said in an interview with Dr. Nancy Snyderman airing tonight at 10pm/9CT on NBC News’ Rock Center with Brian Williams. 

    When his doctor delivered the devastating news in a phone call, Partain’s first thought was, “What contest in hell did I win to deserve this?”

    After his diagnosis, Partain was desperate to answer the question, “why”? He said, “I don't drink. I don't smoke. I've never done drugs. There is no history of breast cancer in my family.” 

    But everything changed after he saw a news report, where a former Marine drill instructor named Jerry Ensminger told Congress how his 9-year-old daughter Janey died of leukemia, and that he believed her death was caused by drinking water at Camp Lejeune contaminated with chemicals.

    “My knees buckled,” Mike said, “I grabbed the back of the couch and I sat there.  I was like, ‘Oh my God, this is what happened.’”

    The son of a Marine, Partain was born at Camp Lejeune in North Carolina. He soon learned that there had been a long history of suspicion about the water at Camp Lejeune.

    “The entire time my mother was pregnant with me, we were drinking high levels of tetrachloroethylene, trichloroethylene, and benzene in our water” he said. Partain believes these chemicals caused his breast cancer.

    The Center for Disease Control and Prevention (CDC) estimates that between 500,000 and 1 million people were exposed to the contaminated water from 1953 to 1987, when the last of several contaminated wells were closed.

    Partain has found 83 other men who lived or served at Camp Lejeune who have also been diagnosed with male breast cancer.

    Peter Devereaux, a 50-year-old a former Marine, is one of them. He was diagnosed in 2008.

    Devereaux remembers when his doctor first let him know he had breast cancer.

    “I was just like, whooo. Even now I've said that so many times, it still takes your breath away,” he said.

    Dr. Katherine Ruddy, a medical oncologist at Dana Farber Cancer Institute in Boston, is Devereaux’s doctor.

    “When Peter was first diagnosed, he had a stage III cancer.  And approximately a year later, we did find that he had distant metastases to his bones,” said Ruddy.  She says his cancer is terminal.

    Click here for more of Peter Devereaux's story.

    Like Devereaux, most men tend to get diagnosed at later stages than women do, which decreases their survival, according to Ruddy. Devereaux needed a mastectomy and hormone treatment, both of which are common for men with male breast cancer.  But the side effects of hormone treatments affect men differently than women, according to Ruddy.

    “Men are not used to hot flashes and I think it is a particularly challenge for men to deal with the side effects of our treatments, including the hot flashes from our endocrine therapies that just are not something that they went into this expecting to feel,” Ruddy said.

    It is not just the disease that upsets the men from Camp Lejeune. They are angry because of how they believe they got cancer.

    Click here to read the Marine Corps’ full response to NBC News regarding water contamination at Camp Lejeune

    A Lab reports from 1980 show that the United States Marine Corps started routinely testing tap water back in 1980. Testing eventually revealed one sample that contained 280 times the acceptable standard of Trichloroethylene (TCE), a chemical which can cause cancer.

    For more on Camp Lejeune and its drinking water, click here.

    Some of the chemicals were linked to a dry cleaner off base that has since closed. But a recently-released report found that the worst contamination came directly from the Marine Corps, because of its industrial waste practices and from leaking fuel storage tanks. One document, released by the CDC in December 2012, details how over 1 million gallons of fuel seeped into the ground from underground storage tanks, contaminating the camp’s well water.

    Officials say that while testing of the tap water began in 1980, it took them four years to determine exactly which wells were contaminated, and that once those wells were identified, they were shut down immediately. Partain says the Marine Corps should have closed the wells earlier. “They chose to keep those wells on for whatever reason and did not begin shutting the wells down until 1984,” he said.

    As for any connection between the chemicals in the water and cancer, Marine Corps officials maintain that "reliable scientific evidence is lacking" to prove one way or another whether the water contamination caused any illness. But Dr. Richard Clapp, one of the nation’s most respected experts in cancer and the environment, disagrees.

    “The level [of contamination] in the drinking water was the highest that I've ever seen,” said Clapp, an epidemiologist at the University of Massachusetts, Lowell. “I've been working on this kind of thing for 30 years. I have never heard of a community that's had the levels of contaminants that they had at Camp Lejeune.”

    He has examined the data from Camp Lejeune and says he believes the contamination and the cancers are related. “The cluster of disease-- for example, male breast cancer-- may also turn out to be the highest that's been seen anywhere. “

    Click here to read the Marine Corps’ full response to NBC News regarding water contamination at Camp Lejeune

    Though the Marine Corps has not acknowledged a link between the bad water and any illness, Congress felt there was enough evidence to act to help the Veterans who believed the water at Camp Lejeune made them sick. In 2012 the president signed a law providing health benefits to Camp Lejeune Veterans and their families who can prove the contamination made them sick.

    The law lists several types of diseases that may be related to the poisoned water at Camp Lejeune, including childhood leukemia as well as cancers of the kidney, lung, bladder and breast. But it has been hard for the male breast cancer patients who believe they’re cancer was caused by contaminated water at Camp Lejeune to get benefits, which are managed through the Veteran’s Administration.

    One former Camp Lejeune Marine, Tom Gervasi, says he has been denied benefits several times. He says that for him, time is of the essence.

    “I've got stage 4 terminal cancer. My survival is minimal. What I worry about is my wife, and her being taken care of by the VA and the Marine Corps, if at all possible,” Gervasi said.

    The men are waiting on a report due out this year from the CDC's Agency for Toxic Substances and Disease Registry (ATSDR) that they believe may help them prove it was the water that made them sick, and that the Marine Corps is, in fact, responsible.

    Partain and Camp Lejeune families say the CDC analysis, which began more than 20 years ago, is taking too long. Dr. Christopher Portier, the director of the ATSDR told NBC News “I think we are late on this one.” Now he says he is pushing his staff to finish quickly. “Our responsibility for these people is to do the absolute best science, make sure we get it exactly right so nobody can challenge any of our results when we're done.”

    As everyone waits for the report, Partain and his men want the Marine Corps and the Veterans Administration to step up and take care of their Marines and their families. Partain asks, “When is the leadership of the Marine Corps going to stand up and say we made a mistake?”

    For more on Camp Lejeune and its drinking water:

    Register to receive notifications regarding Camp Lejeune Historic Drinking Water, by clicking here or call (877) 261-9782.

    Click here to visit the Agency for Toxic Substances and Disease Registry (ATSDR) 

    Source

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  • DVA 002

     

    Department of Veterans Affairs officials say they strongly oppose passage of the Blue Water Navy Vietnam Veterans Act (HR 299), which would extend Agent Orange disability benefits and health care to between 70,000 and 90,000 Veterans who served aboard ships in territorial waters off Vietnam during the war, and today suffer ailments associated with herbicides sprayed across its jungles for years.

    The Blue Water Navy bill passed the House unanimously in late June and seemed certain to fly through the Senate, given reports of close coordination on the bill between Veterans’ affairs committees, and the House having negotiated a plan to pay for the benefits with major Veteran service organizations.

    On Wednesday, however, with Robert Wilkie installed two days earlier as VA secretary, his undersecretary for benefits, Paul R. Lawrence, delivered a blistering attack on the Blue Water Navy bill, and on a proposal to test providing routine dental care to Veterans, during a Senate Veterans Affairs Committee hearing.

    Lawrence testified that there’s still no credible scientific evidence to support extending Agent Orange-related benefits to shipboard personnel who never went ashore in Vietnam or patrolled its rivers. Without such evidence, he said, it would be wrong, and would create a disastrous precedent, to award VA benefits.

    “This committee set the standard to use science to be fair and consistent in cases such as this,” said Lawrence, referring to the Agent Orange Act of 1991. “Once that standard is removed from the equation, it becomes nearly impossible to adjudicate a claim of this type on the merits. The resulting lower threshold sets in motion the prospect of uncontrolled demands for (VA) support.”

    Lawrence, who took charge of Veteran benefit programs in May, warned if HR 299 is enacted, it will “be referenced when other exposure claims are presented to this committee. At that point, Congress will be under greater pressure to accommodate these requests too, regardless of the evidence.”

    It wasn’t immediately clear what damage Lawrence and his top official on post-deployment health issues, Dr. Ralph Erickson, inflicted on the popular Blue Water Navy bill. A majority of senators on the committee still spoke in favor.

    But the Trump administration has reversed signals of support that a beleaguered VA Secretary, David Shulkin, gave Blue Water advocates in March.

    The VA for years had opposed the legislation. The usual hardline softened a year after Shulkin became President Trump’s first VA Secretary when he told Rep. David Valado, R-Ga., lead sponsor of the House bill, “that these Veterans have waited too long and this is a responsibility that this country has.”

    Shulkin noted that the VA lacked scientific evidence that shipboard personnel were exposed to dioxin. But he said his staff was “working hard to look at offsets” — cuts to other parts of the VA budget — to pay for Blue Water Navy benefits.

    “And it is a high priority for us,” he added.

    Two weeks later, Shulkin was fired, deepening a leadership vacuum at VA caused by political chaos at the White House. Trump initially nominated his White House physician, a Navy admiral, to replace Shulkin. The choice soon fell victim to controversy. The House, meanwhile, passed its Blue Water Navy bill after the Veterans affairs committee negotiated with major Veterans organizations a way to pay for it, by raising user fees modestly on VA guaranteed home loans.

    Robert Wilkie became VA Secretary this past Monday. By Wednesday, there was no trace of the accommodating tone on the Blue Water Navy issue that Shulkin had expressed months earlier. Lawrence scorched the bill and its “pay for” plan.

    “VA is opposed to paying for the provisions of this bill by increasing the cost that some Veterans must pay to access their (home loan) benefits. Veterans will either have to finance the VA funding fee with interest, or pay up front with cash. This means fewer Veterans will buy homes or (will) buy homes using non-VA options, potentially opening them to predator lenders,” Lawrence said.

    He further argued that opening Agent Orange benefits to thousands more Veterans would stunt ongoing efforts to reduce the backlog of compensation claims on appeal, adding time and cost to claim processes.

    In written testimony, Lawrence gave fresh estimates on the cost of the Blue Water Navy bill, at total of almost $7 billion over the first 10 years. Some senators pushed back at his attack on the bill, arguing it wouldn’t be needed if VA didn’t set a high bar for these Navy Veterans to gain benefits for conditions on VA’s list of 14 ailments linked to Agent Orange.

    Erickson told senators most of the ailments presumed to be caused by Agent Orange also are tied to aging, therefore VA needs evidence of dioxin exposure for ships at sea. He said a Blue Water Navy review conducted by the Institute of Medicine in 2011 failed to find sufficient evidence of dioxin exposure.

    He and Lawrence dismissed an oft-cited Australian study that was the scientific foundation for that government to award Agent Orange-related benefits to its shipboard Veterans. That study, said Lawrence, was based on an experiment involving distillation of water with presumed levels of dioxin near to shore. It was U.S. Navy policy to take on water for shipboard use more than 12-miles out to sea, to avoid contaminants, Erickson explained.

    Rick Weidman, with Vietnam Veterans of America, made the strongest case in support of Blue Water Veterans. VA officials have misinterpreted the 2011 study, which did find it plausible that shipboard Veterans were exposed to dioxin. Given that Congress already presumes Veterans who served anywhere in Vietnam were exposed, and doesn’t try to calculate level of exposure, that benefit of the doubt should be applied to shipboard personnel too, Weidman said.

    “How much (exposure) makes no difference,” he said. “You don’t know (the) difference for folks who served in the delta versus the central highlands where I served. Who knows? And you can’t put it together 40 years later.”

    VA’s hardline appears to leave Senate Committee Chairman Sen. Johnny Isakson, R-Ga., in a tough spot. Veteran service organizations and leaders of the House Veterans Affairs Committee thought Isakson was set to endorse the bill and shepherd it swiftly toward enactment.

    At the hearing, however, Isakson said “we have more work to do on these issues.” He promised the committee would work “deliberately” to understand all facets of the Blue Water bill, including whether the House plan to raise VA home loans fees was enough to pay for it. Isakson asked Lawrence whether charging non-disabled Veterans an extra $250 on every $100,000 in loan value would cover the cost of extending Agent Orange benefits to Blue Water Navy Veterans.

    “Not in our opinion, no,” said Lawrence. Isakson nodded agreement.

    “I did real estate sales my entire life,” Isakson said. “A lot of VA loans, FHA loans. You can make those numbers look like a lot of things. That is not a lot of money” if VA home loan fees are raised, as the House voted, from 2.25 percent of loan amounts to 2.4 percent, for Veterans with active duty service. “It’s variable too, and depends on number of loans that actually are closed” in any year, he said.

    It seems the Blue Water Navy bill will be adrift in uncertainty for at least several more months, its future dependent on how Senate leaders react to stiffened resistance from the Trump administration.

    Source

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  • Transition to DHA

     

    JACKSONVILLE, Fla. — Naval Hospital Jacksonville, including its five branch health clinics in Florida and Georgia, will be the first Navy military medical treatment facility (MTF) to transition to the Defense Health Agency (DHA) on Oct. 1, 2018.

    The change in administration will be transparent to patients — service members, family members, and retirees — with little or no immediate effect on their experience of care. For patients, their facility, physicians, and coverage will all remain the same. They will continue to receive the same exceptional level of care and service.

    “Naval Hospital Jacksonville is honored to be selected as the first Navy facility to make this transition,” said Naval Hospital Jacksonville Commanding Officer Navy Capt. Matthew Case. “It’s a testament to our track record as an innovator.”

    To achieve Congress’s requirements in the 2017 National Defense Authorization Act, the DHA will assume administration and management of all MTFs. This transition will increase efficiency by eliminating duplication, and enhancing standardization and consistency across the military services.

    Naval Hospital Jacksonville’s staff of more than 2,300 active duty, civilians, and contractors across six locations stands ready to make this a seamless transition for patients. Where and how patients access care will not change, and they will continue to have full access to care and convenience care options. All phone numbers will remain the same. Additionally, the facilities’ names will not change, and will maintain their Navy affiliation.

    Over time, these reforms will drive better integration and standardization of care across all MTFs, which means patients should have a consistent, high-quality health care experience, no matter where they are.

    While DHA will be responsible for health care delivery and business operations, Navy Medicine will retain principal responsibility for operational readiness of the medical force.

    To complement Naval Hospital Jacksonville’s transition, Navy Medicine is establishing a co-located Navy Medicine Readiness and Training Command (NMRTC). Navy Medicine, through the NMRTC, retains command and control of the uniformed medical force, and maintains responsibility and authority for operational readiness. This includes the medical readiness of Sailors and Marines, as well as the clinical readiness of the medical force.

    The Jacksonville NMRTC will improve the ability of Naval Hospital Jacksonville to meet the needs of operational commanders. Survivability of Navy and Marine Corps personnel in the future warfighting environment requires a medical force that’s ready to immediately deploy and save lives.

    Case will serve as both the MTF director under the DHA, and the NMRTC commander under Navy Medicine.

    “This transformation offers an opportunity to enhance what we already do. We ensure the medical readiness of active duty. We take care of patients — active duty, retired, and families. And we partner with private-sector health systems to maintain our clinicians’ advanced life-saving skills,” explained Case.

    Naval Hospital Jacksonville’s priority, since its founding in 1941, is to heal the nation’s heroes and their families. The command is the Navy’s third largest medical treatment facility, comprising a hospital and five branch health clinics across Florida and Georgia. Of its patient population (163,000 active and retired sailors, soldiers, Marines, airmen, guardsmen, and their families), about 84,000 are enrolled with a primary care manager and Medical Home Port team at one of its facilities.

    Source

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  • RX

     

    WILMINGTON, Del., Dec. 27, 2017 /PRNewswire/ -- NeuroRx, a clinical stage biopharma company developing the first drug regimen to treat severe bipolar depression in patients with Acute Suicidal Ideation and Behavior (ASIB), announced that it has signed a Cooperative Research and Development Agreement (CRADA) with the U. S. Department of Veterans Affairs, as represented by the Michael E. DeBakey VA Medical Center in Houston, TX and the Houston VA Research & Education Foundation, Inc. The collaboration also includes Baylor College of Medicine, in Houston, TX. NeuroRx is developing a sequential treatment regimen of NRX-100 (ketamine) and NRX-101 (a proprietary formulation of d-cycloserine / lurasidone), for the treatment of severe bipolar depression in patients with Acute Suicidal Ideation & Behavior (ASIB). The FDA awarded FAST TRACK designation to this investigational drug regimen in September, 2017. NeuroRx has now signed agreements with three clinical trial centers, including one with the University of Alabama, Birmingham.  Patient enrollment will begin shortly. The company is in active discussions with additional sites with which it expects to form contracts in early 2018.

  • Patient Rxs

     

    System works to identify drugs to ‘deprescribe,’ better aid person, save money

    By the time Dr. Sara Swathy Battar sees patients at the Veterans Affairs hospital in North Little Rock, they often have long lists of medications.

    It struck Battar, the associate chief of staff for geriatrics and extended care for the Central Arkansas Veterans Health Care System, that there was no standardized medical tool for taking patients off their medications.

    After some time, the same drugs that once saved someone's life are no longer needed and can have unpleasant or dangerous consequences.

    "Every medicine is a poison with a desirable side effect," Battar said.

    In 2016, Battar and her team developed a "deprescribing" method, which has saved the central Arkansas VA millions in cost avoidance and is now beginning to be implemented across the country.

    The tool, called VIONE, uses five categories to help health care providers, patients and families work together to identify medications that are necessary and helpful and those that are not needed, which should be "deprescribed" -- stopped or decreased.

    Battar's collaborators on the project were academic detail pharmacist Kim Dickerson and Tim Cmelik, chief of pharmacy for the central Arkansas VA.

    The V in VIONE stands for vital, lifesaving medications that a patient should continue taking, such as diabetes medication. The I stands for important -- quality-of-life medications that improve the way a patient feels, such as those that treat pain and constipation. Those should also be continued, Battar says.

    The O stands for optional, representing medications that don't make any difference in how a patient feels and could be discontinued.

    "It's a chemical in your body," Battar said.

    The N is for not indicated -- medications that do more harm than good and should be stopped.

    Every medication has a reason to be taken -- that's the E, and one of Battar's mantras. If a patient or his family isn't sure why the patient is taking something, he should consider getting off it, Battar says.

    Since VIONE was implemented at the central Arkansas VA about 2½ years ago, the method has saved the system an annualized cost of about $2.5 million. The team reviewed more than 8,000 Veterans' medical regimens and "deprescribed" more than 14,000 medications -- an average of 1.7 medications per person reviewed, Battar said.

    It's a simple approach, but it's something patients and families often don't think about, Battar said. Hot Springs resident Kim McCraw said she hadn't.

    THE SPARK

    McCraw had cared for her husband, Tom, by herself for eight years. The Air Force Veteran had been diagnosed with early-onset Alzheimer's disease at age 55. The disease had transformed "a man who had the patience of Job" into someone who was constantly agitated and unable to communicate, she said.

    He was prescribed low doses of antipsychotic drugs, then hospitalized. The illness, along with the four medications he was taking, eventually put him in a fog, nearly sedating him, she said.

    Then Battar proposed taking him off one drug at a time to see if it would make a difference.

    "The same medication that helped fix this man -- maybe he didn't need it anymore," McCraw said.

    Later, when VA staff members called her to say that her husband was up and walking, she thought they were talking about the wrong patient. Her husband hadn't walked in months.

    As the Alzheimer's took its toll, McCraw said her husband wasn't always verbal, but going off some of his medications during his last months of life returned the "spark" of who he was previously. He died in April.

    Because of that, she said, her memories of the visit the day before he died are ones where he was mentally present and loving. She remembers his joy while listening to music, him telling her that her purple shirt looked beautiful, him telling her that he loved her.

    "It didn't save his life, but it gave him a quality of life in his last months that he would not have had otherwise," McCraw said. "They brought a piece of him back."

    THE RIPPLES

    Many of her patients are elderly or frail, Battar said. They can have a plethora of ailments, ranging from long-term illnesses to past injuries, with prescriptions to match.

    The thought of someone on so many medications toward the end of his life makes her squirm, Battar said.

    Some might have seen a private specialist for aches, pains and other complaints, while others might have a health condition such as diabetes. Some might get over-the-counter medications for constipation, headaches, stomachaches, coughs, colds and other conditions that go away in a few days.

    "They do not realize that all of those medicines can fight with each other," Battar said.

    Additionally, some patients may not consistently take all of the medications they are prescribed, but get refills anyway, which is costly for the VA. Lots of prescriptions can also result in opioid addiction and abuse, Battar said, which is something else her system can address.

    Nationally, about 40 percent of adults aged 65 and older were taking five or more medications in 2010, compared with about 13 percent in 1998, according to a 2010 study from researchers at Oregon State University.

    VIONE was identified as a "gold status" practice in a Shark Tank-style competition encouraging innovative practices in the national VA system in 2017. It was selected for national dissemination in May by the U.S. Department of Veterans Affairs Diffusion of Excellence office.

    Battar has shared the method with 26 other VA hospitals across the nation, at their request, she said. Some have already started implementing it. She said she hopes VIONE will become a household name in the medicine world.

    "We have created some small ripples, and now we are seeing some huge tidal waves," Battar said.

    Source

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  • One Star Rating

     

    WASHINGTON – The number of one-star Veterans Affairs hospitals has dropped from 14 to nine since last year, according to star rankings the VA released Wednesday.

    Five VA hospitals remain at the bottom of the rankings for the third straight year, including in Big Spring and El Paso, Texas; Loma Linda, California; and Phoenix, where a wait-time crisis in 2014 triggered a national scandal.

    Also among the one-star hospitals for the third year in a row is the VA medical center in Memphis, Tennessee, where USA TODAY reported patient safety problems have soared in recent years.

    Overall, 40 VA hospitals dropped one star or more, 68 stayed the same and 38 improved in the rankings. The largest improvement was in Hot Springs, South Dakota, which went from two stars to five.

    “With closer monitoring and increased medical center leadership and support, we have seen solid improvements at most of our facilities,” VA Secretary Robert Wilkie said in a statement. “Even our highest performing facilities are getting better, and that is driving up our quality standards across the country.”

    The VA regularly scores 146 of its medical centers based on dozens of quality factors, including death and infection rates, instances of avoidable complications and wait times. The agency uses a five-star scale on which one is the worst and five the best.

    The rankings compare VA hospitals against each other, but the number of one-star hospitals is not constant. Medical centers in that bracket can be elevated to two stars based on quality-of-care factors.

    The agency did not start releasing the ratings until USA TODAY obtained and published them for the first time in 2016. The VA then committed to posting them annually.

    The VA also rates 133 agency nursing homes on a one-to-five star scale and kept those ratings from the public until learning this year that USA TODAY and The Boston Globe planned to publish them.

    Those ratings, unlike the hospital rankings, take private-sector nursing home averages into account. As of March 31, nearly half of VA nursing homes – 58 – received the lowest one-star rating.

    Use the column heads below to sort by city, state or star rating or to see how this year’s hospital ratings compare with last year.

    Source

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  • Worst Ranking Hosp

     

    WASHINGTON – The number of one-star Veterans Affairs hospitals has dropped from 14 to nine since last year, according to star rankings the VA released Wednesday.

    Five VA hospitals remain at the bottom of the rankings for the third straight year, including in Big Spring and El Paso, Texas; Loma Linda, California; and Phoenix, where a wait-time crisis in 2014 triggered a national scandal.

    Also among the one-star hospitals for the third year in a row is the VA medical center in Memphis, Tennessee, where USA TODAY reported patient safety problems have soared in recent years. Montgomery dropped from three stars in 2017 to one star in 2018.

    Overall, 40 VA hospitals dropped one star or more, 68 stayed the same and 38 improved in the rankings. The largest improvement was in Hot Springs, South Dakota, which went from two stars to five.

    “With closer monitoring and increased medical center leadership and support, we have seen solid improvements at most of our facilities,” VA Secretary Robert Wilkie said in a statement. “Even our highest performing facilities are getting better, and that is driving up our quality standards across the country.”

    The VA regularly scores 146 of its medical centers based on dozens of quality factors, including death and infection rates, instances of avoidable complications and wait times. The agency uses a five-star scale on which one is the worst and five the best.

    The rankings compare VA hospitals against each other, but the number of one-star hospitals is not constant. Medical centers in that bracket can be elevated to two stars based on quality-of-care factors.

    The agency did not start releasing the ratings until USA TODAY obtained and published them for the first time in 2016. The VA then committed to posting them annually.

    The VA also rates 133 agency nursing homes on a one-to-five star scale and kept those ratings from the public until learning this year that USA TODAY and The Boston Globe planned to publish them.

    Those ratings, unlike the hospital rankings, take private-sector nursing home averages into account. As of March 31, nearly half of VA nursing homes – 58 – received the lowest one-star rating.

    Use the column heads below to sort by city, state or star rating or to see how this year’s hospital ratings compare with last year.

    City

    State

    2017

    2018

    Change

    Big Spring

    Texas

    1

    1

    0

    Decatur

    Ga.

    3

    1

    -2

    El Paso

    Texas

    1

    1

    0

    Loma Linda

    Calif.

    1

    1

    0

    Memphis

    Tenn.

    1

    1

    0

    Montgomery

    Ala.

    3

    1

    -2

    Phoenix

    Ariz.

    1

    1

    0

    Tucson

    Ariz.

    3

    1

    -2

    Washington

    D.C.

    2

    1

    -1

    Albuquerque

    N.M.

    2

    2

    0

    Augusta

    Ga.

    3

    2

    -1

    Battle Creek

    Mich.

    2

    2

    0

    Beckley

    W.V.

    3

    2

    -1

    Biloxi

    Miss.

    1

    2

    1

    Cheyenne

    Wyo.

    3

    2

    -1

    Columbia

    S.C.

    2

    2

    0

    Dallas

    Texas

    3

    2

    -1

    Denver

    Colo.

    2

    2

    0

    East Orange

    N.J.

    3

    2

    -1

    Fayetteville

    N.C.

    2

    2

    0

    FortHarrison

    Mont.

    3

    2

    -1

    Fort Wayne

    Ind.

    3

    2

    -1

    Fresno

    Calif.

    1

    2

    1

    Hampton

    Va.

    2

    2

    0

    Harlingen

    Texas

    1

    2

    1

    Honolulu

    Hawaii

    2

    2

    0

    Jackson

    Miss.

    2

    2

    0

    Kansas City

    Mo.

    2

    2

    0

    LakeCity

    Fla.

    2

    2

    0

    Las Vegas

    Nev.

    2

    2

    0

    Long Beach

    Calif.

    3

    2

    -1

    Marion

    Ill.

    2

    2

    0

    Martinsburg

    W.Va.

    3

    2

    -1

    Murfreesboro

    Tenn.

    1

    2

    1

    Muskogee

    Okla.

    2

    2

    0

    Nashville

    Tenn.

    1

    2

    1

    Oklahoma City

    Okla.

    3

    2

    -1

    Palo Alto

    Calif.

    2

    2

    0

    Pineville

    La.

    2

    2

    0

    Prescott

    Ariz.

    2

    2

    0

    Roseburg

    Ore.

    1

    2

    1

    San Juan

    P.R.

    3

    2

    -1

    Seattle

    Wash.

    2

    2

    0

    Walla Walla

    Wash.

    1

    2

    1

    Albany

    N.Y.

    3

    3

    0

    Anchorage

    Alaska

    3

    3

    0

    Ann Arbor

    Mich.

    4

    3

    -1

    Baltimore

    Md.

    3

    3

    0

    Bay Pines

    Fla.

    3

    3

    0

    Boise

    Idaho

    4

    3

    -1

    Brooklyn

    N.Y.

    2

    3

    1

    Chicago

    Ill.

    3

    3

    0

    Columbia

    Mo.

    3

    3

    0

    Danville

    Ill.

    3

    3

    0

    Dayton

    Ohio

    4

    3

    -1

    Detroit

    Mich.

    2

    3

    1

    Dublin

    Ga.

    1

    3

    2

    Durham

    N.C.

    3

    3

    0

    Fayetteville

    Ark.

    4

    3

    -1

    FortMeade

    S.D.

    4

    3

    -1

    Gainesville

    Fla.

    2

    3

    1

    Hines

    Ill.

    3

    3

    0

    Houston

    Texas

    4

    3

    -1

    Indianapolis

    Ind.

    3

    3

    0

    Iowa City

    Iowa

    2

    3

    1

    Little Rock

    Ark.

    2

    3

    1

    Los Angeles

    Calif.

    3

    3

    0

    Louisville

    Ky.

    3

    3

    0

    Manchester

    N.H.

    4

    3

    -1

    Mather

    Calif.

    2

    3

    1

    Miami

    Fla.

    4

    3

    -1

    Milwaukee

    Wis.

    3

    3

    0

    Montrose

    N.Y.

    4

    3

    -1

    New Orleans

    La.

    3

    3

    0

    Northport

    N.Y.

    4

    3

    -1

    Orlando

    Fla.

    3

    3

    0

    PerryPoint

    Md.

    3

    3

    0

    Philadelphia

    Pa.

    3

    3

    0

    Poplar Bluff

    Mo.

    4

    3

    -1

    Portland

    Ore.

    3

    3

    0

    Providence

    R.I.

    4

    3

    -1

    Reno

    Nev.

    3

    3

    0

    Salisbury

    N.C.

    4

    3

    -1

    Salt Lake City

    Utah

    3

    3

    0

    San Antonio

    Texas

    3

    3

    0

    San Diego

    Calif.

    3

    3

    0

    San Francisco

    Calif.

    3

    3

    0

    Shreveport

    La.

    3

    3

    0

    Spokane

    Wash.

    3

    3

    0

    St. Louis

    Mo.

    2

    3

    1

    Syracuse

    N.Y.

    4

    3

    -1

    Temple

    Texas

    3

    3

    0

    Tomah

    Wis.

    3

    3

    0

    Topeka

    Kan.

    3

    3

    0

    Tuscaloosa

    Ala.

    4

    3

    -1

    W Palm Beach

    Fla.

    2

    3

    1

    WhiteCity

    Ore.

    1

    3

    2

    White River Junction

    Vt.

    3

    3

    0

    Wilkes-Barre

    Pa.

    3

    3

    0

    Wilmington

    Del.

    2

    3

    1

    Altoona

    Pa.

    5

    4

    -1

    Amarillo

    Texas

    3

    4

    1

    Birmingham

    Ala.

    4

    4

    0

    Boston

    Mass.

    5

    4

    -1

    Bronx

    N.Y.

    3

    4

    1

    Buffalo

    N.Y.

    3

    4

    1

    Canandaigua

    N.Y.

    3

    4

    1

    Charleston

    S.C.

    5

    4

    -1

    Chillicothe

    Ohio

    3

    4

    1

    Clarksburg

    W.V.

    3

    4

    1

    Columbus

    Ohio

    5

    4

    -1

    Des Moines

    Iowa

    3

    4

    1

    Fargo

    N.D.

    5

    4

    -1

    Grand Junction

    Colo.

    4

    4

    0

    Huntington

    W.V.

    4

    4

    0

    Leavenworth

    Kan.

    2

    4

    2

    Lexington

    Ky.

    5

    4

    -1

    Minneapolis

    Minn.

    5

    4

    -1

    Mountain Home

    Tenn.

    4

    4

    0

    New York

    N.Y.

    2

    4

    2

    North Chicago

    Ill.

    4

    4

    0

    Omaha

    Neb.

    5

    4

    -1

    Pittsburgh

    Penn.

    5

    4

    -1

    Richmond

    Va.

    4

    4

    0

    Sheridan

    Wyo.

    3

    4

    1

    Sioux Falls

    S.D.

    5

    4

    -1

    Tampa

    Fla.

    4

    4

    0

    Wichita

    Kan.

    3

    4

    1

    Asheville

    N.C.

    4

    5

    1

    Augusta

    Maine

    3

    5

    2

    Bath

    N.Y.

    5

    5

    0

    Bedford

    Mass.

    5

    5

    0

    Butler

    Pa.

    5

    5

    0

    Cincinnati

    Ohio

    4

    5

    1

    Cleveland

    Ohio

    5

    5

    0

    Coatesville

    Pa.

    5

    5

    0

    Erie

    Pa.

    5

    5

    0

    Hot Springs

    S.D.

    2

    5

    3

    IronMountain

    Mich.

    5

    5

    0

    Lebanon

    Pa.

    3

    5

    2

    Leeds

    Mass.

    5

    5

    0

    Madison

    Wis.

    4

    5

    1

    Saginaw

    Mich.

    4

    5

    1

    Salem

    Va.

    4

    5

    1

    St Cloud

    Minn.

    5

    5

    0

    West Haven

    Conn.

    3

    5

    2

    Source

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  • VA Sucker Punch BWN

     

    TAMPA, Fla. (WFLA) - Sucker-punched, blind-sided and betrayed.

    Vietnam War Navy Veterans claim the new head of the Department of Veterans Affairs, Robert Wilkie, stabbed them in the back by promising to meet with them and instead, fired off a letter trying to kill a bill that grants them Agent Orange benefits.

    Wilkie sent a letter to Sen. Johnny Isakson (R)-Georgia claiming, "science does not support extending Agent Orange benefits to Blue Water Navy Veterans."

    "When I met with Secretary Wilkie at his confirmation hearing, he promised me a meeting on this subject," said John Wells, Executive Director of Military Veterans Advocacy, Inc.

    Instead of a face-to-face, John Wells accuses Robert Wilke of betrayal.

    Wilkie sent the letter to Isakson, the chairman of the Senate Committee on Veterans Affairs, which is now considering the legislation.

    The letter claims the bill will cost more than anticipated and create a bigger claims backlog.

    According to John Wells, Wilkie is distorting the facts.

    "He's come out with inaccurate and inflammatory material designed to convince Senate Chairman Johnny Isakson to not move this bill forward," Wells said.

    For years, the VA opposed extending benefits to Veterans who served on ships in the harbors, bays and territorial waters of Vietnam.

    In June, the house unanimously passed the bill granting them benefits long denied.

    Blue Water Navy Veterans contend Agent Orange seeped from rivers and streams into harbors, bays and territorial waters.

    Ships unknowingly pulled in contaminated water, desalinating it for drinking, bathing and cooking.

    As a result, Navy Veterans contend, Agent Orange-related illnesses are crippling and killing them, yet because they did not set foot on Vietnam soil, the VA will not presume those diseases are connected to herbicide exposure.

    "They're not worried about taking care of the Veteran or spouse," Wells explained.

    Wells charges, Secretary Wilkie is cutting out Veterans exposed to the deadly weed killer and cutting off support for their children born with impairments.

    "Look, if Secretary Wilkie wanted to meet with me and say, 'I'm sorry, I don't buy this,' that's fair," said Wells.

    "But the man promised to meet with me and he refused to meet with us. He broke his promise. That to me is a betrayal."

    According to Wells, despite widespread support in the senate, this bill is being stalled by one person, Senator Johnny Isakson of Georgia, who calls himself the "Veterans' Senator."

    Isakson's Georgia office telephone number is 770-661-0999.

    Source

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  • New Vet Clinic

     

    After several years of uncertainty, the Department of Veterans Affairs has decided on a location for a permanent medical clinic.

    According to an announcement from U.S. Rep. John Rutherford’s office, the VA has awarded a contract to build a St. Augustine Community Based Outpatient Clinic at 207 Stratton Rd. in St. Augustine — off of State Road 207.

    The clinic will offer primary care, mental health services and specialty care to the more than 9,000 Veterans in St. Johns County who currently receive services at the interim clinic. The facility, which will be leased for 20 years at the outset, will be 16,595 square feet and is set to begin construction this winter with an estimated completion date of spring 2020.

    “This is welcome news for Veterans in St. Johns County,” Rutherford said in an email statement. “We must always ensure that our nation’s Veterans receive access to timely and quality medical care, so I am pleased that this facility will expand services in Northeast Florida.”

    It’s been a long wait securing a permanent home. The VA used to have its clinic at 1955 U.S. 1 South, but that property, which also housed the county health department, was purchased by Lowe’s for a new store.

    After that, the VA built a temporary clinic at Southpark Boulevard and Old Moultrie Road that opened in 2015. VA spokesman Daniel Henry said that clinic will remain open as long as needed to accommodate patients.

    “At no point will we ever stop serving Veterans,” Henry said. “We’ve been working very closely with the community to upgrade our ability to take care of Veterans there.”

    According to St. Johns County Veterans Council chairman Bill Dudley, it’s good for Veterans to know they are going to have a place to go for care for years to come.

    “We’re happy that we finally have a location for a permanent home for our Veterans’ health care services,” Dudley said.

    The location itself is not exactly what Dudley was pushing for when he met with VA representatives during the bidding process. He said he advocated for a site close to the relocated health department facility on San Sebastian View. That’s also close to the other county administration offices, including the Veterans Services office.

    Dudley said that might have made things easier for Veterans because so many services would have been clustered together.

    In the end, the site near S.R. 207 was chosen. It’s close to the current clinic and also fairly close to Flagler Hospital.

    “The bottom line is that, for the most part, the Veterans were anxious to just get a permanent home location selected, so that has now been achieved,” Dudley said.

    It’s unclear what will happen with the temporary clinic since it will remain operational for about another year and a half. Henry said there are no definite plans yet.

    Dudley and others in the Veteran community obviously would have preferred a permanent solution right after the previous location was sold. However, he said the temporary clinic was a much better option than having to travel out of town for care.

    “We did not want to see any interruption in our health care services for our Veterans in the county,” Dudley said. “In that respect, we were happy with the interim solution.”

    The new clinic will be entirely a VA project. The county government has no financial obligation in the new clinic.

    Source

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  • Noise impact

     

    DAYTON, Ohio — Protecting service members from noise-induced hearing loss is an ongoing focus of the Department of Defense as hearing loss is the number one disability among Veterans. Noise exposure in the military can occur 24 hours a day, such as during flight operations, even in off-duty areas. For example, noise measurements in berthing areas of aircraft carriers have been found to exceed current hearing protection standards during flight operations, bringing into question what constitutes acceptable noise levels during off-duty periods following occupational noise exposures. More research is needed to understand what level of noise is sufficient during daily “effective quiet” periods that would allow for auditory recovery and prevent permanent hearing loss.

    Researchers from Naval Medical Research Unit - Dayton’s Environmental Health Effects Laboratory are evaluating the impact of military-relevant 24 hour noise exposures on hearing loss.

    A project funded by the Navy In-House Laboratory Independent Research Program is studying the effects of elevated steady noise levels during a recovery period (simulating the off-duty shipboard environment) after an eight hour high noise exposure at the occupational limit of 85 decibels time-weighted average. These noise exposures would not be expected to cause damage on their own, but in combination could impede auditory recovery and lead to permanent hearing loss after four weeks of exposure.

    A separate study funded by the Defense Health Agency is focusing on the effects of steady and impulse noise exposures during the daily recovery period following occupationally relevant exposures to combined noise and inhaled chemical exposures.

    There are many factors that can complicate risk assessment when it comes to noise exposure. Noise exposure itself is often complex and may consist of brief high-level noise impulses, in addition to steady elevated noise levels. Additionally, breathing in certain chemicals, such as the volatile organic compounds (VOCs) present in jet fuel, may worsen noise-induced hearing loss. It is unknown how these complex noise and chemical exposures will impact permanent changes in hearing, especially taking into account elevated noise levels during the auditory recovery period.

    NAMRU-Dayton is currently developing a system that can study steady and impulse noise exposure for 24 hours a day with or without chemical exposure for a portion of that time. A noise generation system had been developed for prior studies at the lab, but the system was limited to use with short-term exposure chambers and could only generate steady noise. EHEL toxicologist, Dr. Andrew Keebaugh, is working with Air Force Capt. Lester Morales, a student at the Air Force Institute of Technology, to design and construct a noise exposure system capable of generating high-decibel impulse noise for use in these studies.

    The research team at EHEL is committed to protecting service members from noise-induced hearing loss by using our unique facilities to support the effort.

    Source

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  • Natl Hearing Month

     

    Take steps to protect your hearing

    Did you know that sounds that are too loud for too long can damage your hearing permanently? The louder the noise, the faster it can damage your hearing. This October, during National Protect Your Hearing Month, the National Institute on Deafness and Other Communication Disorders (NIDCD) encourages everyone to learn about noise-induced hearing loss (NIHL) and steps you can take to prevent it.

    Very loud noise, such as using firearms, can cause you to lose your hearing almost instantly. You can damage your hearing in less than 15 minutes at loud sporting events or concerts or when listening to music through headphones at high volume. If the noise is not as loud but lasts a long time, such as when using noisy yard or farm equipment, hearing damage can build more slowly.

    NIHL can happen to anyone at any age. Up to 24 percent of American adults under age 70 may have hearing loss due to noise exposure in one or both ears. Other studies have suggested that 13 to 18 percent ofU.S. teens have signs of possible hearing loss from noise.

    When sounds are too loud for too long, tiny bundles of hair-like structures that sit on top of hair cells in the inner ear are damaged. When hair cells are damaged, they cannot respond to sound, causing NIHL. In humans, hair cells cannot be fixed or replaced, so the hearing loss is permanent. Because NIHL can build slowly over time, you might not notice the early signs of hearing loss.

    The good news is that you can take steps to protect your hearing:

    • Lower the volume. Know which noises can cause damage: those at or above 85 decibels. If you use headphones or earbuds, keep the volume low.
    • Move away from the noise. If you cannot lower the volume, put some distance between you and the source.
    • Wear hearing protectors, such as earplugs or earmuffs, when you’re involved in a noisy activity, whether it’s mowing the lawn, using power tools, playing loud music, or attending a concert or loud sporting event. Activity-specific earplugs and earmuffs are available online and at hardware, sporting goods, and other stores.
    • Protect the ears of children who are too young to protect their own.
    • Tell family, friends, and colleagues about noise hazards.
    • Help spread the healthy hearing message to your family and community with these resources:
    • October is Protect Your Hearing Month shareable image (also available in Spanish).
    • It's a Noisy Planet. Protect Their Hearing.® is a public education campaign that teaches preteens and their parents and communities about noise-induced hearing loss.
    • How Loud is Too Loud bookmark
    • Noise-Induced Hearing Loss fact sheet
    • Do You Need a Hearing Test?

    Source

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  • Veterans with Services Supplies

     

    Knitted inside every pair of Bombas socks, there’s a message that reads, “Bee better.” Bombas’ slogan serves as a reminder to the company’s customers that for every purchase they make, another pair of socks is donated to someone in need. Since 2013, Bombas has donated more than 5 million pairs.

  • Donald Trump 026

     

    The U.S. Department of Veterans Affairs (VA) announced that it is ready to hire an additional 50 Veterans Justice Outreach (VJO) specialists following President Trump’s signing today of the Veterans Treatment Court Improvement Act of 2018, a new law shoring up support services to Veterans impacted by the justice system.

    The law requires VA, within one year of enactment, to hire 50 additional VJO specialists and place them at eligible VA medical centers (VAMCs); the VJO specialists will, either exclusively or in addition to other duties, serve as part of a justice team in a Veterans Treatment Court or other Veteran-focused court.

    “By signing this bill into law, President Trump is demonstrating VA’s commitment to supporting America’s Veterans, particularly those who may be navigating difficult chapters in their lives,” said VA Secretary Robert Wilkie. “Since incarceration is often linked to homelessness, mental health issues and substance abuse, the VJO specialists will help facilitate these Veterans’ access to numerous VA programs and resources.”

    Created in 2009, VA’s Veterans Justice Outreach (VJO) Program currently funds 314 VJO specialist positions across the U.S., including 53 added in fiscal year 2018. VJO specialists serve Veterans at earlier stages of the criminal justice process, with a three-pronged focus on outreach to community law enforcement, jails and courts.

    VJO specialists at each VA medical center work with Veterans in the local criminal justice system (including but not limited to Veterans Treatment Courts), conduct outreach in jails, and engage with law enforcement by delivering VA-focused training sessions and other informational presentations. VJO specialists have served more than 184,000 justice-involved Veterans since 2009.

    The first Veterans Treatment Court started in Buffalo, NY in 2008. There are now 551 Veterans Treatment Courts and other Veteran-focused courts operating in the U.S. VA is a critical partner for these courts, and VJO specialists serve as members of the courts’ interdisciplinary treatment teams.

    Veterans Treatment Courts are a Veteran-specific adaptation of the drug court model. Unlike traditional criminal courts, Veterans Treatment Courts are not adversarial; the judge, prosecutor, defense counsel, and others work together as a team to ensure that Veteran defendants access the treatment services they need and fulfill any other requirements imposed by the court.

    For more information about the Veterans Justice Outreach Program, visit www.va.gov/HOMELESS/VJO.asp.

    Source

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  • Prostate Cancer Awareness

    Prostate cancer is the most commonly diagnosed cancer among males, second only to skin cancer, and affects more than 3 million men in the United States, according to the National Cancer Institute. During Prostate Cancer Awareness Month, health care providers are encouraging men of all ages – especially those with a family history – to learn more about the disease.

    “Prostate cancer can impact all men,” said Army Col. Inger Rosner, director of the Department of Defense Center for Prostate Disease Research at Walter Reed National Military Medical Center in Bethesda, Maryland. “It’s important for men to know if they want to be screened, how and when to be screened, and what their treatment options are if diagnosed, so that they can be equipped to make decisions that are best for their health.”

    The National Institutes of Health estimates that nearly 165,000 men in the U.S. will be diagnosed with prostate cancer in 2018. Although the disease is the second leading cause of cancer death among men in the U.S., it’s a very slow-growing disease, NIH says. Nearly all of those who get prostate cancer – more than 98 percent – are alive five years after diagnosis.

    Symptoms can include weak or interrupted flow of urine, sudden urge to urinate, frequent urination, pain or burning while urinating, trouble starting the flow of urine, and trouble emptying the bladder completely. Pain in the back, hips, or pelvis, as well as blood in the urine or semen, can also be indicators.

    Rosner said prostate cancer is common in older men but can still affect younger men, particularly if they have a male relative with a history of the disease. Age is the most common risk factor, but other important risk factors include race, genetic factors, and family history. Men who have a relative with prostate cancer are twice as likely to develop the disease as those with no family history, Rosner noted.

    “If you have a positive family history, that puts you at a potentially higher risk for having prostate cancer, and you should bring that potential risk up with your primary care doctor,” she said, adding that patients can then decide with their providers whether or not to be screened for prostate cancer.

    Patients can be screened with a prostate-specific antigen blood test, also known as a PSA test. The test measures the level of PSA in the blood; an increased amount may indicate prostate cancer. But increased PSA levels alone do not diagnose the disease, which is confirmed through a biopsy.

    The American Urology Association encourages men age 55 to 69 to undergo a PSA test every year. The U.S. Preventive Services Task Force considers the decision to undergo periodic PSA screening to be an individual choice for men of that age group, stating that they should have the opportunity to discuss its potential benefits and drawbacks with a clinician. The task force said PSA screening offers a potential benefit of reducing the chance of death from the disease in some men, but also carries potential risks, such as false-positive results, over-diagnosis, and overtreatment.

    “The important thing with prostate cancer is educating patients about their disease and their options, and tailoring treatment very specifically to that individual,” said Rosner. “We want to educate and empower people about their disease and help them make the best choices for themselves in terms of treatment or active surveillance.”

    A majority of prostate cancer is treatable, explained Rosner. Since the disease advances slowly, not all cases require treatment, which can alter quality of life, she said. Men undergoing treatment can experience side effects, such as fatigue, pain, vomiting, or nausea as well as urinary, bowel, or erectile dysfunction.

    Patients with low-risk prostate cancer can discuss alternative options with their physician, such as monitoring the cancer – known as active surveillance. Treatment options can include radiation therapy, surgery, chemotherapy, and hormone therapy, among others. All treatment regimens must be balanced against quality-of-life concerns, considering the potential side effects of each treatment, the aggressiveness of the cancer, and the overall life expectancy of the patient, said Rosner.

    “It’s a very treatable disease, but the treatments can have a significant impact on quality of life,” she said. “For some low-risk or low-grade tumors, we tend to favor active surveillance, which is monitoring the disease but not necessarily treating it, because you can live with prostate cancer and not die from your prostate cancer.”

    “While there’s no definitive way to prevent prostate cancer, men can help decrease their risk by being physically active, maintaining a healthy weight, and eating a nutritious diet,” said Rosner.

    In addition to conducting research and clinical trials, the Uniformed Services University’s Center for Prostate Disease Research sees men for all prostate-related issues, including detection and treatment of prostate cancer. Open to active-duty servicemen and retirees, CPDR offers a weekly multidisciplinary clinic for newly diagnosed prostate cancer patients. For coverage details on prostate cancer screening, visit the TRICARE website.

    “Men’s health really comes down to having an open and honest conversation with your physicians or providers,” said Rosner. “The more that we educate and empower our patients, the better off their decision-making will be.”

    Source

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  • PTSD Key

     

    Post traumatic stress disorder (PTSD) is a recognized psychiatric disorder that a person may develop after exposure to a traumatic event. For many years, PTSD went widely undiagnosed or was not recognized as the serious condition it is. Thanks to advancements in research and the breakdown of social stigmas, we have more information about the condition than ever before. We know that the majority of people who are exposed to traumatic events do not develop PTSD, and we know that veterans of the U.S. military are disproportionately affected by PTSD when compared to American civilians.

    This blog post is intended to serve as a brief breakdown of the required criteria for a diagnosis of PTSD as defined by the fifth edition of the Diagnostic and Statistics Manual of Mental Disorders (DSM V), published by the American Psychiatric Association.

    Criterion A: Stressor

    In the context of PTSD, the stressor is the traumatic event that leads to the development of PTSD. The precise definition of “traumatic event” is contested, but the DSM V requires exposure to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. This exposure must have occurred in one of the following ways: direct exposure; witnessing the trauma; learning that a relative or close friend was exposed to the trauma; or indirect exposure to details of the trauma, often in the course of professional duties (for example, a paramedic treating victims of a serious motor vehicle accident would be indirectly exposed to the traumatic event of the motor vehicle accident even if she did not witness the accident herself).

    Criterion B: Intrusive symptoms

    Not everyone who is exposed to a traumatic event will develop PTSD. In order for a person to receive a diagnosis of PTSD, the DSM-V requires the person to show at least one intrusive symptom. Intrusive symptoms can manifest in sudden upsetting memories; nightmares or bad dreams; flashbacks to the traumatic event; emotional distress after reminders of the traumatic event; or physical reactivity following reminders of the traumatic event (for example, an increased heart rate after exposure to reminders of the traumatic event).

    Criterion C: Avoidance symptoms

    The third criterion for a PTSD diagnosis is avoidance of reminders of the trauma. This could be an avoidance of thoughts or feelings about the event or avoidance of trauma-related reminders altogether. A person who suffered sexual assault may display avoidance of thoughts and feelings of the assault and do their best to never think about the event. Someone who witnessed a person drowning may avoid trauma-related reminders and stay away from pools or bodies of water. For a diagnosis of PTSD, the presence of at least one of these symptoms is required.

    Criterion D: Negative alterations in cognition and mood

    A person who receives a diagnosis of PTSD must display at least two of the following symptoms following the stressor: inability to recall key features of the stressor; overly negative thoughts or assumptions about oneself or the world; exaggerated blaming of self or of others for causing the trauma; negative affect (having a flat or depressed mood); decreased interest in regular activities; feelings of isolation; or difficulty experiencing a positive effect (having a hard time feeling happy).

    Criterion E: Alterations in arousal and reactivity

    For a diagnosis of PTSD, at least two of the following symptoms that began or worsened after the stressor must be present: Irritability or aggression; risky or destructive behavior (for example, driving recklessly); hypervigilance (for example, not being able to relax for fear that something bad will happen); increased startle reaction; difficulty concentrating; or difficulty sleeping. These alterations in arousal and reactivity are a defense mechanism for preventing further trauma.

    Criterion F: Duration of symptoms

    Even if a person fulfills all the required criteria, a diagnosis of PTSD requires persistence of the symptoms for more than one month. A person may fulfill all criteria immediately following a traumatic event but two weeks after the event may display fewer or none of the required symptoms. Although the criteria were present for a time, the person would not meet the duration requirement.

    Criterion G: Functional significance

    The PTSD symptoms experienced by the person with the diagnosis must create distress or functional impairment in a person’s life. For example, a veteran who suffers from PTSD and currently works in an office setting may find that his job performance is impacted by difficulty concentrating or increased irritability with his coworkers. A college student who experienced sexual assault at a party may find that their friendships are affected by their negative affect, hypervigilance, and their avoidance of other social events.

    Criterion H: Exclusion

    In order to meet the criteria for a PTSD diagnosis, the symptoms must not be caused by medication, substance abuse, or any other illness.

    This is an extremely simplified discussion of PTSD intended to provide clarity to a frequently-discussed condition. Follow-up blogs will address specifications of the diagnosis as well as the issue of PTSD as it relates specifically to veterans seeking service connection.

    Source

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  • OIG 003

     

    The VA Office of Inspector General (OIG) reviewed Veterans Benefits Administration’s (VBA’s) statistics related to pending disability claims to determine if it accurately reported its claims backlog. For reporting, VBA defines its backlog as rating claims pending greater than 125 days. VBA reported it had reduced its claims backlog from a peak of 611,000 in March 2013 to 70,537 at the end of May 2018. However, in earlier reports, the OIG identified instances in which VBA created new policies that resulted in unreliable performance measures, or that VBA staff took incorrect actions that misrepresented workload statistics. In this review, the OIG found that VBA’s reported backlog did not include all claims from October 1, 2015, to March 31, 2016, that were awaiting rating decisions for more than 125 days. The OIG estimated VBA completed about 63,600 of these claims that were not counted as part of the backlog. As a result, the OIG estimated that, in its completed backlog, VBA only reported about 79 percent of the claims that required rating decisions that took over 125 days. Although VBA has reported significant reductions in its backlog, the OIG found that what the backlog represented was not always clearly defined, possibly resulting in significant understating. Also, VBA’s prioritization of its backlog resulted in delays in processing other claims, even if they were older and required rating decisions. Finally, inaccurate claims characteristics impaired VBA’s ability to manage its workload causing even further processing delays. The OIG recommended the Under Secretary for Benefits consider revising which claims are included in VBA’s reported disability claims backlog and provide a clear definition to all stakeholders. In addition, the OIG recommended the Under Secretary for Benefits implement a plan to provide consistent oversight and training of Claims Assistants through national performance and training plans.

    Source

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  • SD Housing Comm

     

    SAN DIEGO (CNS) - The National Association of Housing and Redevelopment Officials singled out the San Diego Housing Commission for its efforts to help house homeless military Veterans, city officials announced Monday.

    The commission received an Award of Excellence from the NAHRO -- which named 22 award recipients nationwide -- for the Housing Our Heroes program, which has helped more than 1,000 homeless Veterans find rental housing in San Diego. The city launched the program in March 2016 after the San Diego City Council unanimously approved funding for it.

    "The success of our innovative `Housing Our Heroes' program in getting over 1,000 Veterans off the street and into permanent homes is a testament to the creativity of city leaders, the San Diego Housing Commission and, most importantly, the landlords who stepped up to be part of the solution," said San Diego Mayor Kevin Faulconer.

    In order to house the city's homeless Veterans, the program gave incentives to property owners in certain ZIP codes in San Diego and National City who offered rental properties to homeless Veterans. The city also awarded vouchers from the U.S. Department of Veterans Affairs and made assistance payments for upfront move-in costs to homeless residents who were placed in housing via the program.

    The city received support from myriad organizations to fund and administer program services, including the San Diego Regional Chamber of Commerce, the California Apartment Association and the U.S. Department of Housing and Urban Development.

    "The Housing Our Heroes initiative proved what we can accomplish when government agencies, landlords and service providers work together. I thank the mayor and the City Council for their leadership and support of this effort, as well as our partners and the staff at the San Diego Housing Commission. This national recognition is well-deserved," said Housing Commission board Chairman Frank Urtasun.

    The NAHRO will present the Award of Excellence to the Housing Commission at the organization's annual conference on Oct. 26.

    Source

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  • TRICARE Logo

    By law, the TRICARE Retiree Dental Program (TRDP) will end on Dec. 31, 2018. New dental plan options for those enrolled in TRDP will be available through the Federal Employees Dental and Vision Insurance Program (FEDVIP). FEDVIP vision coverage will also be available for the first time.

    In case you missed the September webinar, join the TRICARE webinar on Oct. 11, from 2 to 3 p.m. ET, to learn about new dental and vision coverage under FEDVIP. The “New Dental and Vision Coverage Options for TRICARE Beneficiaries” webinar will discuss who is eligible for FEDVIP, as well as how and when to enroll.

    There’s no automatic enrollment into a new dental plan once TRDP ends. For 2019 dental coverage, retirees and their family members must take action to enroll in a FEDVIP plan. All beneficiaries eligible for TRDP are eligible for FEDVIP dental coverage. Visit the FEDVIP website for dental plan options.

    If you’re eligible, your first chance to enroll in FEDVIP is during the 2018 Federal Benefits Open Season. This runs from Nov. 12 through Dec. 10, 2018. Your coverage will then start Jan. 1, 2019.

    Retirees, retiree families, and active duty families are eligible for FEDVIP vision coverage. This year’s FEDVIP open season is also your first chance to enroll in a FEDVIP vision plan. If you enroll during open season, your coverage will start Jan. 1, 2019. Visit the FEDVIP website for vision plan options.

    Register to join us on Oct. 11 to learn more about the TRDP transition to FEDVIP and what the change means for you. A Q&A led by the presenters will follow the presentation.

    Keep updated on all of the TRICARE changes. For the latest on changes to TRICARE, visit TRICARE News and TRICARE Changes.

    Source

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  • Robert Wilkie 07

    Secretary of Veterans Affairs Robert Wilkie hosted his first State of VA Community Town Hall on September 27, 2018. The secretary and eight guest panelists highlighted the activity and direction of VA since his appointment to lead the department in July. “VA exists to make life easier for Veterans,” Wilkie recently told the crowd of Veterans at the AMVETS annual convention. “So my prime directive is customer service. When a Veteran comes in to VA, it is not up to him to get VA to say ‘yes.’ It is up to VA to give the Veteran tools.”

    The secretary and panelists discussed how VA is focused on becoming the leader in customer experience and improving services to our nation’s Veterans through various initiatives such as engagement with community partners, leaders, advocates, state/county VA departments, Department of Defense, Veteran Service Organizations, and community Veterans engagement boards. The secretary engaged Veterans directly during this webcast’s live question and answer session. All attendants were invited to submit questions during the webcast.

    Source

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  • Robert Wilkie 002

     

    LAS VEGAS (KSNV) — It’s veterans like Daniel Kaminski who United States Secretary of Veterans Affairs Robert Wilkie got to know Thursday.

    Kaminski is a United States Navy Veteran. He’s a well-known wheelchair athlete who’s not letting his spinal cord injury stop him from enjoying life.

    “It's like going around town really going over bumps and hills,” Kaminski said.

    Secretary Wilkie is making it his mission to connect with veterans on his cross-country tour of VA hospitals.

    “The growth here in this part of Nevada is astounding,” Secretary Wilkie said.

    He says the veteran population is getting bigger and younger.

    “It is astounding seeing the growth of this place. As an Air Force officer watching Nellis grow and then seeing the growth outside the gate and the changes in the population of veterans in America,” Secretary Wilkie said.

    He says big changes are coming to the Department of Veterans Affairs.

    At the VA Southern Nevada Healthcare System in North Las Vegas, President Donald Trump will make history Friday, signing an $86.5 billion appropriations bill that will provide funding for the Department of Veterans Affairs.

    “It also reflects the change in the direction of the department we are opening up the aperture for veteran’s choice we are keeping the VA at the center of that veteran’s experience,” Secretary Wilkie said.

    White House officials are calling it the largest dollar amount ever for veterans with $8.6 billion set aside for mental health services and $400 million towards preventing opioid abuse.

    Thursday's visit has Secretary Wilkie excited for what the future holds for veterans and their families.

    “Veterans want to be around people who speak their language and it's a unique language the language of service and being around people who understand those specific those particular experiences,” Secretary Wilkie said.

    Source

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  • Robert Wilkie 07

     

    LAS VEGAS (KSNV) — It’s Veterans like Daniel Kaminski who United States Secretary of Veterans Affairs Robert Wilkie got to know Thursday.

    Kaminski is a United States Navy Veteran. He’s a well-known wheelchair athlete who’s not letting his spinal cord injury stop him from enjoying life.

    “The growth here in this part of Nevada is astounding,” Secretary Wilkie said.

    He says the Veteran population is getting bigger and younger.

    “It is astounding seeing the growth of this place. As an Air Force officer watching Nellis grow and then seeing the growth outside the gate and the changes in the population of Veterans in America,” Secretary Wilkie said.

    He says big changes are coming to the Department of Veterans Affairs.

    At the VA Southern Nevada Healthcare System in North Las Vegas, President Donald Trump will make history Friday, signing an $86.5 billion appropriations bill that will provide funding for the Department of Veterans Affairs.

    “It also reflects the change in the direction of the department we are opening up the aperture for Veteran’s choice we are keeping the VA at the center of that Veteran’s experience,” Secretary Wilkie said.

    White House officials are calling it the largest dollar amount ever for Veterans with $8.6 billion set aside for mental health services and $400 million towards preventing opioid abuse.

    Thursday's visit has Secretary Wilkie excited for what the future holds for Veterans and their families.

    “Veterans want to be around people who speak their language and it's a unique language the language of service and being around people who understand those specific those particular experiences,” Secretary Wilkie said.

    Source

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  • Suicide Awareness

     

    Hello, I’m Robert Wilkie, Secretary of the Department of Veterans Affairs.

    I’m blessed with the opportunity to serve our nation’s 20 million Veterans. Until recently, I was also honored to serve more than 1.4 million dedicated service members, and their families, at the Department of Defense.

    Service members and Veterans who have defended our freedom have earned our enduring gratitude. They should have the opportunity to live meaningful, productive lives, in the same freedom and peace that their service and sacrifices made possible for so many other Americans.

    Unfortunately, the cost of defending freedom can be tragically high. On average, 20 American Veterans die by suicide each day. Of those, 14 do not seek health care within our VA.

    VA is committed to delivering the highest quality care to Veterans, providing some with access to specialized innovative care, that may be unavailable in the private sector. And more and more, Veterans are receiving care through VA.

    Ultimately, whether Veterans choose VA, or get care or support from a peer, or a community agency, there is no wrong door when it comes to saving lives. Preventing Veterans suicide is a top priority for VA, the Department of Defense and this administration. Our goal is to prevent suicide among all Veterans, including those who may not receive care from us.

    This September, during Suicide Prevention Month, we’re spreading awareness about the risk factors and warning signs for suicide, and helping people start the conversation around mental health and support for Veterans in their communities. During Suicide Prevention Month, and all year round, we encourage everyone to be there from Veterans and service members.

    Starting the conversation may be challenging, but reaching out to a Veteran who’s facing a tough time can make all the difference, and it may even save a life.

    As part of VA suicide prevention strategy, we deliver targeted support to different populations based on their suicide risk. And we know that service members transitioning to Veteran status face a higher risk of suicide, especially during the first year after separation from the military.

    That’s why, this past January, President Trump signed an executive order that created a task force to align the mental health and suicide prevention efforts of VA, the Department of Defense and the Department of Homeland Security. We’re working together, across departments, to expand mental health programs and other resources for Veterans during that critical first year after departing from uniformed service.

    Even one Veteran, or service member lost to suicide is too many. VA is working hard to prevent that, through efforts like this critically important executive order, and others. But we can’t do it alone.

    Visit: BeThereForVeterans.com for resources to help you be there for Veterans and the service members in your life.

    Ending service member and Veteran suicide will not be easy, but we can make a positive difference, if we work together to be there, for all those who have served.

    Thank you,

    Robert Wilkie

    Source

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  • Fired VA Employees

     

    The Veterans Affairs Department may soon have to reinstate many of the employees it fired over the last year, following a ruling from a third-party arbitrator that said the agency has violated a collective bargaining agreement in enforcing one of the key reforms signed into law by President Trump.

    The ruling, if upheld, would impact employees represented by the American Federation of Government Employees who faced adverse action under the 2017 VA Accountability and Whistleblower Protection Act. Trump, VA and lawmakers in both parties have heralded the law as a significant step in cracking down on malfeasant and poorly performing employees, but its enforcement has been mired in controversy since its passage.

    AFGE brought the case for mediation after VA issued a series of memoranda that said VA was no longer required to give employees 90 days to improve and performance improvement plans would not be used. The union said that violated specific clauses in its collective bargaining agreement requiring those steps for employees identified for poor performance.

    VA argued the memos do not affect performance improvement plans, and even if they did, the accountability law supersedes the requirements of the collective bargaining agreement.

    The arbitrator rejected that argument, saying the memos did affect performance improvement plans and the accountability law speaks only to the hastened timeline once the department decides to discipline an employee. It does not address what VA must do prior to firing someone, said Jerome Ross, the arbitrator, and therefore it cannot supersede the collective bargaining agreement. Ross noted that federal law requires that federal employees be afforded a “reasonable opportunity to demonstrate acceptable performance.”

    VA also tried to dismiss the grievance on the grounds that AFGE has filed another grievance demanding the department bargain over implementation of the accountability law, but Ross said the two claims were sufficiently distinct.

    The arbitrator ruled that VA must resume compliance with its CBA, rescind any adverse action against AFGE-represented employees who did not first receive a performance improvement plan and reinstate them at the department, including back pay, restored leave and other benefits. VA must also pay AFGE’s attorney fees.

    VA has 30 days to challenge the ruling before the Federal Labor Relations Authority. A spokesman said the department would review the decision and “determine an appropriate response.”

    AFGE originally brought the case to mediation on behalf of its employees at the Veterans Benefits Administration, but a spokesman said the union expects the ruling to apply across the department. He did not immediately have available a count of how many employees may now have their jobs reinstated and/or receive back pay, but public data posted by VA shows about 1,400 employees were fired outside of their probationary periods between the time the department issued the memos last August and June 30, 2018. It is unclear how many of those employees were denied opportunities to improve their performance and are represented by AFGE. The union represents more than two-thirds of the departments 383,000 workers.

    Lawmakers have for months accused VA of flouting congressional intent in implementing the accountability law. Earlier this year, a group of senators wrote a letter voicing concerns specifically about the elimination of performance improvement plans and lack of progressive discipline.

    The senators said new policies have led to employees being fired for “missing deadlines or moving slowly after an injury,” even on first offenses. Such actions “are not the types of offenses that rise to the level of immediate termination,” an authority provided in the 2017 law.

    “This is unacceptable and runs counter to congressional intent and your previous comments,” the lawmakers said. They noted then-VA Secretary David Shulkin had previously testified, “Every good manager works with their employees to make them better, to give them feedback,” a practice which the new policies do not allow.

    VA has also faced criticism for disproportionately firing low-level employees, such as housekeeping staff. A June letter asked VA’s inspector general to investigate the law’s enforcement, and while no Republican signed onto either letter, Republican leaders on the department’s oversight committee’s have voiced concerns. The IG is currently probing the law’s enforcement.

    The department has stood by its actions.

    “VA makes absolutely no apology for holding employees accountable when circumstances warrant," Curt Cashour, a department spokesman, said in June. "If former employees feel their removal from federal employment is improper, they have a number of appeal options under federal law."

    At a House hearing on the law last month, then-acting VA Secretary Peter O’Rourke defended the department’s policies, but acknowledged it still had work to do to ensure consistent enforcement.

    “Right now we’re dealing with the first year of implementation,” he said. “New rules, everyone’s trying to figure that part of it out.”

    Source

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  • Spartan Pledge

     

    To fight the suicide epidemic, Veterans vow to serve and be there for one another

    It started with a conversation about Veteran suicide and what is causing the “22 a day” epidemic.

    It continued with a promise, which became the Spartan Pledge.

    The Spartan Pledge is a commitment among Veterans to not take their own lives but rather stand for their fellow soldiers in times of despair. It was created almost accidentally by an Iraq Veteran, Boone Cutler, when he spoke with another Veteran, his friend “Nacho,” about a mutual friend’s suicide.

    “I said to him, ‘Have you ever thought about it?’” Cutler remembered. “And he said, ‘Yeah, I think about it every day.’ And it blew me away. We’d never discussed that—and we were tight. We covered each other.”

    Off the cuff, Cutler and his buddy made a promise.

    “You really can’t think too far ahead when you’re in that state of mind, so I said, ‘Just call. Just call me first. Don’t punk out. Don’t go without saying goodbye,’” Cutler told his friend. “And then we made an agreement to at least call each other first.”

    Other Veterans helped that evolve into what Cutler started calling the Spartan Pledge, which he said around a thousand Veterans have made. It’s just two lines, meant to give Vets a pause before they hurt themselves:

    “I will not take my own life by my own hand until I talk to my battle buddy first. My mission is to find a mission to help my warfighter family.”

    Veterans commit suicide at a 50-percent higher rate than those who did not serve in the military, according to a study published last year from the Department of Veterans Affairs. The 2015 DAV Veterans Pulse Survey found that 1 in 4 Veterans see suicide as one of the biggest challenges facing those who have served.

    “You don’t have to be suicidal to take the pledge,” said Steve “Luker” Danyluk, a retired Marine lieutenant colonel who’s also taken up the cause. “It’s finding a mission: Help your buddy. It’s reconnecting, re-establishing those relationships that seem to vanish once you leave the military.”

    When Danyluk and retired New York City Fire Department firefighter Danny Prince started talking about 25 pounds of steel recovered from the World Trade Center and the aftermath of the tragedy on 9/11, their conversation became about how they could use that powerful symbolism to bring attention to the terrible epidemic of Veteran suicide as well.

    Prince, a Coast Guard Veteran, visited injured Veterans at Walter Reed National Military Medical Center last fall. With him, he carried the 25 pounds of scrap metal.

    “It’s remarkable, the pieces of steel that we have. They’re so important, and you don’t want to waste anything,” said Prince.

    Danyluk had an idea to turn the steel remnants into a symbol for Veterans and first responders everywhere that could potentially open up the conversation and save Veterans’ lives. What evolved was nothing short of powerful. They started moving on a plan to gather Veterans and first responders together and forge the steel into a “Spartan Sword.”

    “The pure, almost religious nature of the steel from the World Trade Center was transformed into something about healing,” said Danyluk.

    The 9/11 attacks motivated a lot of people to join the military, Danyluk said, so the symbolism of the sword is important. “It’s about transformation—taking this twisted steel that was part of our nation’s greatest tragedy and turning it into something beautiful: a weapon of healing rather than a weapon of destruction.”

    Danyluk helped organize the Spartan Alliance, a collaboration of nonprofit Veteran organizations, and joined forces with Prince to create Spartan Weekend.

    DAV got on board early, realizing the impact such an event could have for our nation’s ill and injured Veterans.

    “DAV proactively fights this epidemic by providing services that connect Veterans with care and address their quality of life, but this was a chance for us to become involved in a way where we could directly see an impact,” said DAV National Adjutant Marc Burgess. “It was a new idea—nothing like this had been done before—so we knew we were in for something truly special.”

    Hundreds of Veterans, their families and caregivers attended the Spartan Weekend, held in Washington, D. C., in May. They gathered to raise awareness about Veteran suicide, a struggle many of them have faced head on.

    “I know too many people who have chosen suicide over life, including my own supervisor,” Air Force Veteran Sarah Bonner said. “That’s why I came. I will do anything—absolutely anything—to make sure other Veterans don’t choose that option. This weekend reminds us that we are not alone. We have our Veteran family. I could’ve been one of the 22, but I wasn’t because of support. So now I’m here to show other Veterans I support them.”

    The weekend included a bike ride, a concert at the Hard Rock Cafe headlined by Kristy Lee Cook and other events designed to bond participating Veterans and family members. It culminated on Mother’s Day with a nondenominational service at the American Veterans Disabled for Life Memorial.

    The Rev. Matt Pawlikowski, an Army chaplain from West Point, officiated a Mother’s Day service honoring Gold Star and Blue Star Mothers who have sons or daughters who are actively serving or have lost their lives in service.

    Margie Miller, from New York, came to the event eight months and seven days after her son, a 22-yearold Marine, fatally shot himself. She talked about how they spoke on the phone most days and how she had just heard all about his plans, seemingly happy as ever, to go boating with friends. Two days later, her husband told her, “There are three Marines in the living room.”

    “You took a solemn pledge to protect our country,” Miller told the audience of Veterans. “Take that same pledge, the Spartan Pledge, and protect yourself. Say, ‘I will reach out for help.’”

    The ceremony closed with dozens of Veterans taking an oath against suicide.

    Leading the pledge was Miller and DAV Past National Commander and Marine Vietnam Veteran Roberto “Bobby” Barrera.

    “Come over here,” Barrera said while reaching out to the sword with his prosthetic arm. “Gather around the sword with me; touch it. If you can’t touch the sword, grab ahold of someone who is touching it, so we can form an unbreakable connection. You are not alone. We are here. Your family, your Veteran family.”

    Everyone in attendance gathered around the sword and each other in an emotionally charged circle while they repeated the pledge.

    The evening before the pledge at the memorial, Barrera shared his personal story and told his fellow Veterans that, even recently, he himself had contemplated suicide after moving and experiencing a setback to his physical health. The fight against the epidemic is something that requires constant vigilance, he said. Nearly a half-century after being severely burned in combat, and after years of counseling and mentoring others, he was only recently diagnosed with post-traumatic stress disorder.

    “I realized I needed help. I thought about what it would mean to my family and my fellow Veterans if I had made that choice. I thought of all the people who had supported me, and that’s what got me through a very dark period,” said Barrera. “It’s not just recent-era Veterans who contribute to these statistics. To solve this problem, we need to make a commitment as a community to be there for one another.”

    The event also featured DAV Past National Commander Dennis Joyner, a Vietnam Veteran and triple amputee, who is the president of Disabled Veterans’ Life Memorial Foundation. “When the last bullet is fired, when the last man or woman steps off the plane or ship and comes home, for disabled Veterans, their struggles— those that are visible and the ones we can’t see—remain an everyday part of life,” said Joyner. “We as a community of Veterans and survivors must band together and ensure none of our own are left behind or forgotten.”

    Source

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  • GI Bill

     

    WASHINGTON — About 340,000 students attending school using the GI Bill received slightly smaller housing payments in August than they’re eligible for under federal law, according to the Department of Veterans Affairs.

    Monthly housing allowances help student Veterans pay for their housing costs, utilities and food. Veterans who started the 2018-2019 school year last month received incorrect payments caused by delays at the VA Office of Information and Technology with complying to new rules on how stipends are calculated.

    The VA is still working to fix the problem, and officials have not said whether this month’s payments will be corrected.

    In a letter this week to VA Secretary Robert Wilkie, 15 Veterans groups described it as “an organizational and customer service failure at the highest level.”

    “These incorrect payments are asking Veterans, their families, and schools to bear the burden of VA’s problems,” the groups wrote. “They have left students and schools confused, with improper payments, and absent a clearly articulated timeline for when these issues will be fixed.”

    Last year, Congress approved the Forever GI Bill, which included numerous changes to Veterans’ education benefits. One change calls for calculating Veterans’ housing allowances based on the ZIP codes of the campus where they attend classes, rather than defaulting to the main campuses.

    Because of technology problems, the VA failed to meet an Aug. 1 deadline to implement the change. VA officials told lawmakers that it would be done by mid-August, but that deadline came and went, too, without a fix.

    When the fall semester started, the VA sent student Veterans their housing allowances based on 2017 rates. For about 340,000 students, that means they received payments that didn’t account for cost-of-living increases in 2018. According to the VA, the incorrect housing stipends were an average of 1 percent less than they should have been.

    In Fort Collins, Colo., the difference between the amount Veterans received and the amount they are entitled to receive was $138 per student.

    Marc Barker, director of adult learner and Veterans services at Colorado State University in Fort Collins, said student Veterans are flooding his office with questions about the incorrect payments.

    About 1,400 students at Colorado State are Veterans who use VA education benefits. They’re adult students, and in some cases have mortgages and children, Barker said.

    “Many of them have outside responsibilities, and they’ve made the transition back to higher education in good faith that their benefits will be delivered to them on time and accurately,” he said. “They’re counting on that. When that’s not happening, it becomes a barrier to their success in the classroom. They’re focused and worried about these things they shouldn’t have to be concerned about.”

    The VA isn’t communicating with affected students, Barker said, and Colorado State hasn’t been able to receive concrete answers from the agency to share with students. If Veterans at Colorado State receive incorrect payments again when housing allowances are disbused at the end of September, the school is prepared to pay the difference to each affected student in October, he said.

    “They’re kicking the can down the road,” Barker said. “What we’re losing sight of is the impact on the students.”

    The 15 Veterans groups who wrote to Wilkie also charged the VA with not being upfront about the problems.

    “It took several weeks into the current semester before any communication was sent to students, and schools have received little information beyond, ‘wait and see,’” their letter reads. “Transparency on what to expect and when to expect it, from all levels of leadership at VA, is critical to helping students and schools make informed decisions.”

    On Wednesday, VA Press Secretary Curt Cashour said the VA is continuing to run tests on the new IT program that will be used to calculate housing stipends and will begin using it “as soon as possible.” Students who are underpaid will get that money back once the fixes are made, he said.

    Elsewhere, some Veterans are receiving payments that are too much because of cost-of-living changes from 2017. Cashour said the VA would not require students to pay back the excess amounts.

    The 15 groups that wrote to Wilkie want reassurance.

    “VA should strongly stress to students and schools that they will not bear any undue financial burden for [the VA Information Technology]’s delays,” they wrote.

    Source

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  • Spartan Pledge 002

     

    Taking the 'Spartan Pledge' Against Suicide

    To fight epidemic, Veterans vow to serve and be there for one another

    It started with a conversation about Veteran suicide and what is causing the "22 a day" epidemic.

    It continued with a promise, which became the Spartan Pledge.

    The Spartan Pledge is a commitment among Veterans to not take their own lives but rather stand for their fellow soldiers in times of despair. It was created almost accidentally by an Iraq Veteran, Boone Cutler, when he spoke with another Veteran, his friend "Nacho," about a mutual friend's suicide.

    "I said to him, ‘Have you ever thought about it?'" Cutler said during an interview with NPR reporter Quil Lawrence. "And he said, ‘Yeah, I think about it every day.' And it blew me away. We'd never discussed that -- and we were tight. We covered each other."

    Off the cuff, Cutler and his buddy made a promise.

    "You really can't think too far ahead when you're in that state of mind, so I said, ‘Just call. Just call me first. Don't punk out. Don't go without saying goodbye,'" Cutler told his friend. "And then we made an agreement to at least call each other first."

    Other Veterans helped that evolve into what Cutler started calling the Spartan Pledge, which he said around a thousand Veterans have made. It's just two lines, meant to give Vets a pause before they hurt themselves:

    "I will not take my own life by my own hand until I talk to my battle buddy first. My mission is to find a mission to help my warfighter family."

    Veterans commit suicide at a 50-percent higher rate than those who did not serve in the military, according to a study published last year from the Department of Veterans Affairs. A Veterans Pulse Survey released by the charity DAV (Disabled American Veterans) last Veterans Day found that 1 in 4 Veterans see suicide as one of the biggest challenges facing those who have served.

    "You don't have to be suicidal to take the pledge," said Steve "Luker" Danyluk, a retired Marine lieutenant colonel who's also taken up the cause. "It's finding a mission: Help your buddy. It's reconnecting, re-establishing those relationships that seem to vanish once you leave the military."

    When Danyluk and retired New York City Fire Department firefighter Danny Prince started talking about 25 pounds of steel recovered from the World Trade Center and the aftermath of the tragedy on 9/11, their conversation became about how they could use that powerful symbolism to bring attention to the terrible epidemic of Veteran suicide as well.

    Prince, a Coast Guard Veteran, visited injured Veterans at Walter Reed National Military Medical Center last fall. With him, he carried the 25 pounds of scrap metal.

    "It's remarkable, the pieces of steel that we have. They're so important, and you don't want to waste anything," Prince said in an interview with NPR reporter Quil Lawrence.

    Danyluk had an idea to turn the steel remnants into a symbol for Veterans and first responders everywhere that could potentially open up the conversation and save Veterans' lives. What evolved was nothing short of powerful. They started moving on a plan to gather Veterans and first responders together and forge the steel into a "Spartan Sword."

    "The pure, almost religious nature of the steel from the World Trade Center was transformed into something about healing," said Danyluk.

    The 9/11 attacks motivated a lot of people to join the military, Danyluk said, so the symbolism of the sword is important. "It's about transformation -- taking this twisted steel that was part of our nation's greatest tragedy and turning it into something beautiful: a weapon of healing rather than a weapon of destruction." Danyluk helped organize the Spartan Alliance, a collaboration of nonprofit Veteran organizations, and joined forces with Prince to create Spartan Weekend. The charity DAV got on board early, realizing the impact such an event could have for our nation's ill and injured Veterans.

    "DAV proactively fights this epidemic by providing services that connect Veterans with care and address their quality of life, but this was a chance for us to become involved in a way where we could directly see an impact," said DAV National Adjutant Marc Burgess. "It was a new idea -- nothing like this had been done before -- so we knew we were in for something truly special."

    Hundreds of Veterans, their families and caregivers attended the Spartan Weekend, held in Washington, D. C., in May. They gathered to raise awareness about Veteran suicide, a struggle many of them have faced head on.

    "I know too many people who have chosen suicide over life, including my own supervisor," Air Force Veteran Sarah Bonner said. "That's why I came. I will do anything -- absolutely anything -- to make sure other Veterans don't choose that option. This weekend reminds us that we are not alone. We have our Veteran family. I could've been one of the 22, but I wasn't because of support. So now I'm here to show other Veterans I support them."

    The weekend included a bike ride, a concert at the Hard Rock Cafe headlined by Kristy Lee Cook and other events designed to bond participating Veterans and family members. It culminated on Mother's Day with a nondenominational service at the American Veterans Disabled for Life Memorial.

    The Rev. Matt Pawlikowski, an Army chaplain from West Point, officiated a Mother's Day service honoring Gold Star and Blue Star Mothers who have sons or daughters who are actively serving or have lost their lives in service.

    Margie Miller, from New York, came to the event eight months and seven days after her son, a 22-year-old Marine, fatally shot himself. She talked about how they spoke on the phone most days and how she had just heard all about his plans, seemingly happy as ever, to go boating with friends. Two days later, her husband told her, "There are three Marines in the living room."

    "You took a solemn pledge to protect our country," Miller told the audience of Veterans. "Take that same pledge, the Spartan Pledge, and protect yourself. Say, ‘I will reach out for help.'"

    The ceremony closed with dozens of Veterans taking an oath against suicide.

    Leading the pledge was Miller and DAV Past National Commander and Marine Vietnam Veteran Roberto "Bobby" Barrera.

    "Come over here," Barrera said while reaching out to the sword with his prosthetic arm. "Gather around the sword with me; touch it. If you can't touch the sword, grab ahold of someone who is touching it, so we can form an unbreakable connection. You are not alone. We are here. Your family, your Veteran family." Everyone in attendance gathered around the sword and each other in an emotionally charged circle while they repeated the pledge.

    The evening before the pledge at the memorial, Barrera shared his personal story and told his fellow Veterans that, even recently, he himself had contemplated suicide after moving and experiencing a setback to his physical health. The fight against the epidemic is something that requires constant vigilance, he said. Nearly a half-century after being severely burned in combat, and after years of counseling and mentoring others, he was only recently diagnosed with post-traumatic stress disorder.

    "I realized I needed help. I thought about what it would mean to my family and my fellow Veterans if I had made that choice. I thought of all the people who had supported me, and that's what got me through a very dark period," said Barrera. "It's not just recent-era Veterans who contribute to these statistics. To solve this problem, we need to make a commitment as a community to be there for one another."

    The event also featured DAV Past National Commander Dennis Joyner, a Vietnam Veteran and triple amputee, who is the president of Disabled Veterans' Life Memorial Foundation. "When the last bullet is fired, when the last man or woman steps off the plane or ship and comes home, for disabled Veterans, their struggles -- those that are visible and the ones we can't see -- remain an everyday part of life," said Joyner. "We as a community of Veterans and survivors must band together and ensure none of our own are left behind or forgotten."

    The Spartan Pledge has caught fire in the Veteran community and continues to be a binding promise among suffering Veterans. While there can be no study of how effective the Pledge is, many say just having that "battle buddy" aware of what's going on inside can be the difference between suicide and life.

    Cutler and a charity called The Gallant Few have made this mission to combat Veteran suicide with his creation of The Spartan Pledge. Warfighters promise not to take their own lives, and instead vow to find a new mission to help one another.

    The newest data from the Department of Veterans Affairs states that 20 Veterans commit suicide every single day. Don't be one of the 20. Contact the Veterans Crisis Line – 1-800-273-8255 – or any medical professional if you're having thoughts of suicide.

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  • VA Report

    Jeff Sweeney and Galen Warman were not surprised by the findings. Any of them.

    Not by the first report issued by the Office of the Medical Inspector, or the second, or the third, released last week in an investigation into the Manchester VA Medical Center’s competency and procedures.

    “They’re notorious for covering things up,” said Sweeney, 40. “I am fed up for having to fight for everything and I’m fed up being in pain all the time, but I’m not surprised.”

    Their skepticism is easy to understand, since the Office of the Medical Inspector is the VA’s own investigative arm. That’s why they think the OMI essentially shouted, “Nothing to see here,” in its recent findings, when it ruled on a variety of issues, including suspected mistreatment, misdiagnosis and slow response times connected to Myelopathy, a compression of the spinal cord.

    Sweeney and Warman both live in Concord, were both injured while serving their country and both sought medical help for their severe back and neck pain. They’ve moved on, started new lives, learned to live with their pain, and the ongoing process of an organization investigating itself has dulled their senses.

    “It falls in line with what they’ve been trying to do,” Warman told me. “I expected this all along, so no one is plowing new ground.”

    Indeed, this is old ground. Warman suffered back and neck injuries in a construction accident 30 years ago and a car wreck in 2007. Sweeney’s truck was hit by an improvised explosive device in Iraq in 2011.

    They both have since gotten some relief through surgery, but years had passed before they received the proper care, and they still have plenty of aches and pains.

    That’s why the whistleblowers we’ve been hearing about since the summer of 2017, the ones with those medical and nursing degrees – the ones who documented incompetency and delays in treatment and immoral record keeping and a poor monitoring system on degenerative spinal conditions – won’t let this go.

    In fact, they remain fighting mad, complaining about the conflict of interest they’ve seen as part of the VA’s investigation and the lack of accountability since the story exploded in the Boston Globe.

    “It’s what they do, like a damage control system,” said whistleblower Dr. Ed Kois, head of the spinal cord clinic at the Manchester VA. “They say they’re going to investigate, bring in the OMI knowing they’ll do a lengthy investigation and then wash their hands.”

    The Office of Special Counsel, an independent entity that oversees the OMI, isn’t buying it. In a prepared statement emailed to me, the OSC’s special counsel, Henry Kerner, wrote that “clear discrepancies undermine the assertion that VA leadership was open to concerns and worked to ensure Veterans receive timely care.”

    Those words were golden to Kois and Stewart Levenson, the Manchester VA’s former Medicine Department chairman, who were the loudest whistleblowers among the 12 staff members who came forward.

    They want you to know they are not doctors with axes to grind, nor are they trying to further their careers, working as self-promoters, promised by an outside government entity to expose trouble at the VA.

    Kois says he hasn’t been promised a better parking spot, and Levenson insists he did not come aboard to boost his chances of winning a seat in the U.S. House of Representatives.

    Kois’s parking spot remains unchanged, and he’s still courting the press, trying to make as much noise as possible. And Levenson did not win in the primary election, yet he’s writing op-eds and calling columnists back so these problems don’t fade from view.

    “All these investigative bodies descended on Manchester and you would think more would have been done,” Levenson said by phone. “But how can you investigate yourself? It was garbage. You can’t explain it away.”

    Added Dr. Ted Daly, another reputable whistleblower: “I’m flabbergasted by their conclusions.”

    Levenson, Kois and the others cited dirty surgical instruments, flies in the operating room and mismanagement up top, but it was the mistakes made on patients with compressed spinal cord problems that were the most alarming and damaging.

    Kois called it a “perfect storm” of factors. The Manchester VA had no neurosurgeons, forcing patients to the Boston VA in West Roxbury, which was overworked and not able to give the proper care.

    Record keeping between Boston and Manchester failed to clearly show who needed surgery, and a doctor named Muhammad Huq, the former head of the spinal cord clinic at the Manchester VA, was found to be cutting and pasting notes in medical charts, meaning information remained unchanged for years.

    Some whistleblowers and staff felt that upper management was more concerned with ratings and budgets than actual care, which led to the ouster of top officials once the story broke.

    Caught in this perfect storm were nearly 100 patients with spinal cord problems, many of whom were never properly treated. Some ended up in wheelchairs, others were forced to use canes, and still others simply had to endure pain needlessly for years, for a condition that one doctor said often goes untreated in third-world countries like Nigeria.

    But certainly not here in the U.S.

    Try telling that to Warman, 67, an Army Veteran who later served in the Air National Guard. His back pain went undiagnosed for years at the Manchester VA, leading to an endless supply of painkillers and a drastic change in lifestyle.

    “They were not forthcoming on how to treat it,” Warman told me. “It was like, ‘Take two of these in the morning and have a nice day.’ I was addicted to painkillers.

    “I tried to have some kind of life and I kept asking for help and getting none,” Warman continued. “They said they were not responsible.”

    Kois, new to the facility, first examined Warman in 2015. His response after viewing an MRI was “Holy s---.”

    “It showed he had severe narrowing of the spinal canal,” Kois said. “I sent him for further evaluation and he had surgery and I saw him again and he was doing great.”

    Pain remains, but Warman is strong enough to work at Cumberland Farms and deliver newspapers.

    And then there’s Sweeney. After midnight, riding in the lead truck in a convoy of at least 30 vehicles, he heard a bang, saw a flash and, after running for cover and the adrenaline rush had worn off, awoke with his back “killing me.”

    The Manchester VA sent him for physical therapy, which did nothing. Neither did steroids. Surgery was performed in Boston, but Sweeney awoke in even more pain.

    He was told during subsequent checkups that the pain was a normal part of the recovery process, but the pain grew worse and he later was let go from his job with the Department of Transportation for missing eight months.

    Sweeney said the VA eventually stopped taking his calls. He contemplated suicide. He drank a lot of beer. Then he went to see Kois, who took a CAT scan and told Sweeney, “I want you in my office, now.”

    Sweeney pulled out his phone and showed me what Kois had shown him: a picture of his spine, with a screw inserted into bone, which was fine, and another screw penetrating a nerve, which was not.

    “Permanent nerve damage caused by the VA,” Sweeney said. “I didn’t put that screw in there myself.”

    But following 14-hour surgery to remove the misplaced screw at New England Baptist Hospital, Sweeney’s life changed.

    “I was shocked that I was walking,” Sweeney said. “I went for a walk with the nurse and I felt good walking around. I’ll have contact with Dr. Kois for the rest of my life, if I can. Dr. Kois saved my life.”

    There’s still pain, though. Sweeney has been taking steroid injections since January. He installs natural gas lines and hopes surgery in the future will return him to some sense of normalcy.

    And, soon, his story and that of five others from across the country will be told in a documentary called, The Care They’ve Earned, an unflinching look at flaws and holes in the VA system.

    Advanced screenings have been shown in selective theaters this summer. Sweeney didn’t know the film’s release date around here, and its producer, Justin Springer, was unavailable for comment.

    Sweeney showed me a trailer on his phone, which included that CAT scan, the one that clearly showed those two screws in his back.

    “I hope people see it,” Sweeney told me. “I lived it and it was still an eye-opener for me.”

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  • Tomah Whistleblower

     

    A Gulf War Veteran who blew the whistle on the prescription drug crisis at the Tomah Veterans Affairs Medical Center said he thinks it would be “immoral” to vote for Democratic Sen. Tammy Baldwin.

    The comments from Ryan Honl, a Libertarian, drew a sharp rebuke Thursday from Heather Simcakoski, the widow of Veteran Jason Simcakoski, who died in 2014 due to “mixed use toxicity” while being treated at Tomah.

    Baldwin’s reaction to the Tomah scandal has been an issue in her re-election campaign, with her Republican opponent Leah Vukmir saying she failed to adequately respond. Outside conservative groups have also attacked Baldwin on the issue.

    Baldwin has defended her reaction by pointing to the passage of a law she introduced named after Simcakoski and designed to increase oversight of opioid prescriptions issued at VA facilities.

    Honl, in comments first reported by the Milwaukee Journal Sentinel, said he felt compelled to speak out now after Heather Simcakoski and her in-laws cut a pair of campaign ads for Baldwin. Honl claimed that Baldwin “used” the Simcakoski family when she produced the ads.

    Honl, in an interview with The Associated Press, said he was surprised by the ads because Jason Simcakoski’s parents told him in 2016 they didn’t plan to get involved in politics. Marvin and Linda Simcakoski did not immediately return a message seeking comment.

    Heather Simcakoski told AP that Honl was lying and said his comments were “incredibly upsetting.”

    Honl said he didn’t want to argue with the family and he has no plans to cut an ad or do anything to help Vukmir’s campaign, even though he intends to vote for her.

    “My sole focus is calling out Tammy Baldwin,” he said.

    Honl is a 46-year-old West Point graduate who worked at Tomah as a secretary in the hospital’s mental health clinic before resigning in 2014 and filing a federal whistleblower complaint on his way out.

    He is a longtime critic of Baldwin and briefly considered running as a Republican against Democratic U.S. Rep. Ron Kind, of La Crosse. Honl said he’s since “buried the hatchet” with Kind and endorsed him for re-election this year.

    Heather Simcakoski and her in-laws praised Baldwin in the ads, saying it is “shameful” that Jason Simcakoski’s death was being used against Baldwin.

    She reiterated that on Thursday.

    “Either work with us to fix the VA like Tammy has or stop talking about my husband’s death,” she said.

    Vukmir seized on Honl’s statement, saying voters in November will hold Baldwin accountable for what happened at Tomah.

    “As a military mom, it pains me to know Baldwin knew about the opioid crisis at Tomah and refused to take action to help our Veterans because she had more concern for her political career,” Vukmir said.

    Baldwin has been criticized for not making public a report from the Department of Veterans Affairs’ inspector general that said physicians at Tomah were over-prescribing opioids.

    Baldwin later said her office made mistakes, leading her to fire one staffer, demote another and cut the pay of her chief of staff.

    There is no evidence that Baldwin took steps to cover up what was happening at Tomah and a Senate committee that investigated it determined she did not engage in a cover-up.

    “Veterans from across the state and the Simcakoski family have spoken out to stop the politicization of Veterans and support Tammy Baldwin for her work to hold the VA accountable and improve Veterans’ health care,” said Baldwin’s spokesman, Bill Neidhardt. “Senator Baldwin has worked with the Simcakoski family to craft and pass Jason’s Law, and she has worked across party lines to secure vital investments to support America’s Veterans.”

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  • Com Care Prgms

     

    WASHINGTON — Veterans Affairs officials announced Tuesday that TriWest Health Care Alliance will take over nationwide operations for the department’s main community care programs despite concerns raised last month about overpayments to the company.

    For the last five years, operations for the department’s primary two outside care programs — Patient-Centered Community Care and Veterans Choice Program — had been operated by TriWest and Health Net Federal Services.

    The new contract extends TriWest’s partnership and names them the sole provider until the two programs are replaced next year with a new overarching community care program mandated in the VA Mission Act, which President Donald Trump signed into law this summer.

    VA officials praised the contract as ensuring that Veterans will not see disruptions in their health care in the coming year.

    “Extending the time and reach of our partnership with TriWest will ensure Veterans get the care they need while the department transitions to delivering care under the Mission Act next year,” VA Secretary Robert Wilkie said in a statement.

    Last month, the VA inspector general found that over a one-year period, TriWest officials filed more than 111,000 duplicate claims for outside care services and made mistakes in nearly 300,000 others, resulting in department overpayments of more than $45 million dollars.

    Similar errors by Health Net officials resulted in $56 million in overpayments, investigators said.

    In response, VA officials implemented new payment controls and recovered about $40 million of that money. Additional reimbursements are being reviewed.

    Veterans’ cases currently being handled by Health Net will be transitioned to the new program in a way department officials promise will not disrupt care. Details of how other cases will be transferred from existing community care programs to future ones have yet to be finalized.

    On Friday, congressional staffers received a briefing from VA officials on the Mission Act implementation, laying out future timelines for new community care rules and parameters for that work.

    Last week, in an appearance before the Senate Veterans Affairs Committee, VA Secretary Robert Wilkie predicted the new community care rules will “revolutionize Veterans’ care” once implemented.

    “My view of Congress' trust and mission is to … give that Veteran choice and allow that Veteran to continue with the choice that he or she is most comfortable with,” he said.

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  • Largest VA Budget

     

    WASHINGTON — President Donald Trump signed the Department of Veterans Affairs fiscal 2019 budget into law on Friday, giving the department a funding boost of more than 6 percent and pushing the agency’s total spending over $200 billion for the first time.

    The president finalized the bill at a ceremony held in the North Las Vegas VA Medical Center, surrounded by federal officials and local Veterans. He praised the massive spending measure as another promise kept by his administration.

    “With this funding bill we have increased the VA’s budget to the largest ever,” he said. “We are delivering the resources to implement crucial VA reforms.”

    The bill includes $1.1 billion for the start of a VA electronic health records overhaul and $400 million for opioid abuse prevention within the department, both efforts touted by Trump in the past.

    The final deal also includes a $1.75 billion increase in money tied to the VA Mission Act, passed at the start of the summer. The legislation will rewrite the department’s community care programs, expanding Veterans ability to access private health care at taxpayer expense.

    That money had stalled negotiations on the budget bill for months, and Democrats said they still are not satisfied with the short-term spending plug to cover what is expected to be an even bigger financial hole next year.

    “The bill the president signed today leaves a funding gap in May of 2019, expected to grow to more than $8 billion in fiscal year 2020,” Sen. Patrick Leahy, D-Vt., the top Democrat on the Senate Appropriations Committee, said in a statement after the signing.

    “We do our Veterans no favors when we make promises we do not keep, and I will continue to fight in Congress to make sure they receive the care they deserve.”

    The VA funding legislation also includes $10.3 billion in military construction funding for fiscal 2019 as well as the full-year budgets for the legislative branch and federal energy programs.

    Trump’s signature came just a day after he blasted a similar sprawling budget package focused on the Department of Defense as a “ridiculous spending bill” because it omitted border wall funding he has demanded from Congress.

    The House is expected to finalize that legislation next week. If the president chooses to Veto it, most federal departments would face a partial government shutdown. VA would be exempted from those problems, however, since their fiscal 2019 funding is now in place.

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  • Evidence 002

     

    One of the major aspects of developing a disability claim with the VA is gathering and submitting relevant evidence to help support it. The VA has what is called a duty to assist, however, it can be extremely beneficial to also gather your own evidence during the claims process. By submitting various forms of evidence, you provide the VA with more information and different angles for them to view your case. The type of evidence you should consider submitting will depend greatly on the disabilities that you are experiencing and at what step of the process you are at.

    Types of Evidence

    Service Records/Service Medical Records

    When trying to initially get your claim service connected, you have to show an in-service event that led to your disability. The easiest way to prove this in-service event is with your service records and medical records, if the event is documented. Whether it is a physical injury, or a mental one, having it documented in your service records can be a huge stress reliever when it comes to managing your VA claim. If the in-service event is not documented in your service record, don’t give up on your claim! There are other pieces of evidence that can be used to help prove your claim.

    Service records can also be beneficial when you need to prove you were in a certain location during a specific time period. For example, for the VA’s presumptive illnesses, you may need to show that you were in Vietnam or Thailand between 1962 and 1975, or that you were stationed at Camp Lejeune between 1953 and 1987, or even possibly that you served in the Southwest Asia Theater during the Gulf War. Your service record should contain any documents that show what units you were assigned to and the location of each. These documents can include, but are not limited to, orders, travel vouchers, re-enlistment paperwork, and awards.

    Expert Medical Opinions

    Medical opinions can be useful, whether you are trying to show service connection for a disability, or if you are requesting an increased rating. Medical opinions allow for an outside doctor to review your claims file and meet with you to discuss your disabilities, symptoms, and the limitations you suffer because of it. They can provide the VA with a detailed medical account to show diagnosis and severity.

    Employment Information

    When filing for increased compensation based on unemployability, it is required to disclose your employers of the last five years that you actually worked. By giving the VA the employer’s name and address, it allows them to send the employer a form to verify when you worked there, your total income earned, the type of work you did, and anytime you lost due to illnesses. Basically, they are verifying all of the information that you included on the form 21-8940, but they want to hear it from the employer. You can expedite this step by sending your previous employers a form 21-4192 when you first file for individual unemployability.

    Buddy Statements

    Buddy statements can be helpful at any point in your process with the VA. If you are trying to get service connected or receive a higher rating, a buddy statement can prove to be your best piece of evidence. Generally, buddy statements will come from close family members or friends who have witnessed your disabilities and the change they have caused in your life. Buddy statements can also come from fellow service members, and can be beneficial if you are trying to prove a specific location or an event in service. They can help to corroborate the facts to the VA and provide an additional outlook on your situation.

    Deck Logs

    Deck logs can be vital to a Navy Veteran’s claim, especially when they need to show that they were part of the Brown Water Navy, serving within the inland waterways of Vietnam. For these Veterans, the deck logs for their ship during the time they were deployed to Vietnam can be requested and used to show on what days their ship was inland and what specific bay or waterway they were in. Deck logs can also be used to help prove a stressor that may have occurred on board on the ship. For example, if there was an active shooter on the ship and a Veteran developed PTSD and is now trying to get it service connected, the deck logs can be used to prove the incident occurred and provide the details of the situation.

    Dependent Benefits

    If you are trying to obtain additional compensation for your dependents, there is also evidence required for these benefits to be granted. When you file for dependents with the VA, you must complete a form 21-686c. With this form, you list any current and prior marriages, as well any prior marriages of your spouse. You also list any children who may qualify for benefits. To prove you have a spouse, you may be required to submit your marriage certificate and any prior divorce decrees. To claim children, you may be required to submit their birth certificate, so it is helpful to know where these documents are and have them ready to avoid further delay with the VA.

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  • Justice Appeal 001

     

    On Sept. 14, two weeks ahead of schedule, the U.S. Department of Veterans Affairs (VA) exceeded its goal to deliver 81,000 appeals decisions of disability benefits and services to Veterans in fiscal year 2018 — 28,000 more decisions than the previous year.

    In doing so, VA’s Board of Veterans’ Appeals provided thousands of Veterans with critical, life-changing decisions.

    “The Board’s historic achievement delivering results to Veterans and their families reflects VA’s hard work and commitment to getting it right for our Veterans under the leadership of President Trump,” said VA Secretary Robert Wilkie. “Together, we have achieved significant results for our nation’s Veterans, as each of the more than 81,000 decisions produced by the Board can make a real difference in their lives and for their families.”

    The achievements come amid focused Board efforts to prepare for the full implementation of the Veterans Appeals Improvement and Modernization Act of 2017, which is transforming a historically complex appeals process into a simple, timely and transparent process providing Veterans with increased choice and control. Veterans who disagree with the initial claim decision have three options under the Act:

    1. Higher Level Review at the office of original jurisdiction
    2. Supplemental Claim with the office of original jurisdiction
    3. Appeal to the Board

    Once a Veteran appeals to the Board, he or she remains in control of the process by choosing one of three docketsbest suited to the appeal:

    1. Direct Review Docket
    2. Evidence Docket
    3. Hearing Docket

    To support the various organizations preparing to help Veterans navigate the new appeals process, the chairman of the Board and her staff led numerous training sessions and panels held by national, state and local Veteran Service Organizations and private legal organizations.

    To maintain its momentum, the Board hired 186 new attorneys this fiscal year, and plans to add 30 more to the team by Sept. 30. Additionally, the Board is joining the Military Spouse Employment Partnership in October, and looks forward to participating in a program that helps bring the valuable insights and tremendous talent of military spouses to the Board.

    For more information about the Board and its progress on appeals modernization, visit www.bva.va.gov.

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  • Tracking Devices

     

    Investigators with the Department of Veterans Affairs have concluded that a half-billion-dollar contract to bring cutting-edge tracking technology to VA hospitals has been plagued by poor oversight and security lapses and has an uncertain future even after VA officials dramatically pared down its scope.

  • Removed from High Risk List

     

    WASHINGTON -- Five low-performing Department of Veterans Affairs hospitals have improved enough in the past six months to no longer qualify as high risk, the VA announced Tuesday.

    The VA hospitals in Dublin, Ga.; Harlingen, Texas; Roseburg, Ore., Nashville and Denver were removed from high-risk status based on new performance statistics released Tuesday.

    The statistics, called the Strategic Analytics for Improvement and Learning, or SAIL, score hospitals based on 25 categories, including patient satisfaction, overall efficiency and death rates. The scorecards are used to rank hospitals using a star system -- one star being the worst and five the best.

    Last year, 15 hospitals, including the facilities in Dublin, Harlingen, Nashville, Roseburg and Denver, received one-star ratings. The VA in February announced an "aggressive new approach" to improving those hospitals, which included more direct oversight from VA headquarters.

    At the 15 hospitals, 26 managers and senior leaders were removed -- a result of "close scrutiny of performance trends," said VA Press Secretary Curt Cashour.

    The five hospitals removed from the high-risk list are on track to rise to two stars when the new star ratings are released, Cashour said. The new star ratings are expected to be made public before Sept. 30, the end of the fiscal year.

    Nine other VA hospitals are still designated as high risk. Those facilities are located in Hampton, Va.; Big Spring and El Paso, Texas; Jackson, Miss.; Loma Linda, Calif.; Memphis and Mufreesboro, Tenn.; Walla Walla, Wash., and Phoenix.

    One hospital that made the high-risk list has gotten worse. The Washington, D.C., VA Medical Center was elevated to "critical" in July after a quarterly review found conditions had deteriorated.

    The D.C. hospital has been under scrutiny since last year, when the VA inspector general warned of widespread failures that put Veterans at risk. The warning prompted former VA Secretary David Shulkin to fire the hospital director. Since then, a series of temporary directors have led the facility.

    VA Secretary Robert Wilkie said Aug. 7 that he would soon announce a new, permanent leader for the hospital. As of Tuesday, he had yet to name a replacement.

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  • VA Oppose Spina Bifida Bill

     

    More than two years ago, in March 2016, the Department of Veterans Affairs received the latest in a series of scientific literature reviews from the National Academy of Medicine on Agent Orange-associated ailments.

    This one raised the possibility that VA might add as many as four new conditions — bladder cancer, hypothyroidism, Parkinson-like tremors and perhaps even hypertension — to its list of 14 illnesses it presumes have been caused by exposure to herbicides the U.S. military sprayed during the Vietnam War.

    The report delivered in 2016 moved bladder cancer and hypothyroidism from “inadequate or insufficient” evidence of association to herbicide exposure up to the “limited or suggestive” evidence of association. That’s the same level VA previously relied upon to award Agent Orange benefits for conditions including laryngeal cancer, cancers of the lung, bronchus or trachea, and prostate cancer.

    Hypertension (high blood pressure), the report said, remained in the “limited or suggestive evidence” category too, where it was placed in a previous study. That’s the same evidence level used to add ischemic heart disease to the Agent Orange presumptive disease list for near automatic award of benefits.

    The Academy also clarified that Vietnam Veterans with “Parkinson-like symptoms,” but without a formal diagnosis of Parkinson’s disease, should be considered eligible for presumption of exposure to Agent Orange, just as Parkinson’s disease previously was connected to service in Vietnam.

    At the same time, the birth defect spina bifida in the offspring of Vietnam Veterans was demoted by the Academy since its last report, from the “limited or suggestive” association category down to “inadequate or insufficient.”

    The Academy, previously called the Institute of Medicine, delivered this last report, Veterans and Agent Orange: Update 2014, after a panel of scientific experts spent two years reviewing the latest medical literature on health effects of dioxin and other harmful compounds in herbicides associated with certain diseases.

    VA officials promised to review the results and that then-VA Secretary Bob McDonald would act on the Academy report’s findings by July 2016. With this report, however, the secretary faced no timeline for reaching a decision. That’s because Congress had allowed a statutory 180-day deadline governing secretarial actions on Agent Orange scientific reviews to expire in 2015.

    The consequence has been that the Obama administration in its final year did nothing more than study the report. The same has been true with the Trump administration during its first 19 months. While Vietnam Veterans with, for example, bladder cancer await a decision on whether they will gain VA health care and compensation, VA has been silent on the 2016 Academy findings.

    That changed slightly on Aug. 1. During a hearing of the Senate Veterans’ Affairs Committee dominated by discussion of the House-passed Blue Water Navy Vietnam Veterans Act (HR 299), VA Undersecretary for Benefits Paul R. Lawrence and VA’s chief consultant on post-deployment health, Dr. Ralph Erickson, referred to the latest Academy report on Agent Orange. They did so not to propose that a disease be added to VA’s list of conditions presumed caused by Agent Orange. Instead they cited the report to urge senators to reject a House amendment to HR 299 that would extend Agent Orange benefits to certain Vietnam-era Veterans who served in Thailand and had children born with spina bifida.

    In his written testimony, Lawrence said VA “is concerned there is continued scientific uncertainty surrounding the association of spina bifida and exposure to Agent Orange. As found in the last relevant [Academy] report, an association between spina bifida and exposure to Agent Orange is no longer shown.”

    Erickson reinforced the point with Sen. John Boozman, R-Ark., after the senator said he was glad to see the House bill included a bill he had co-sponsored to provide Agent Orange benefits “to any child of a Veteran with covered service in Thailand who is affected by spina bifida.” If the Senate passed an identical bill, said Boozman, children of Thailand-service Veterans would get “the same health care, monetary allowance and vocational training” given children of Vietnam Veterans with spina bifida.

    “Are you all for or against that provision,” Boozman asked.

    Erickson noted that the Academy in 2016 “actually downgraded the evidence for there being an association of spina bifida and the children of Vietnam Veterans. That doesn’t mean VA withdrew that benefit. However, at the present time, extending the benefit further is a little tricky because the scientific foundation per the National Academy of Medicine has diminished remarkably.”

    Following the hearing we asked if VA officials weren’t using the Academy report selectively now — ignoring it as a justification to add ailments to the Agent Orange presumptive list but citing it to try to block benefits to more Veterans with children born with spina bifida. The department challenged that view.

    “Citing a specific scientific report to discuss pending legislation (HR 299) is nothing other than a reasonable and relevant way to address specific legislative provisions under consideration,” said Curt Cashour, VA press secretary.

    “The issue of additional Agent Orange presumptive conditions is completely separate from HR 299, and the notion that the two issues must always be discussed together is contrary to what VA and the Senate committee were specifically examining at the August 1 hearing,” Cashour added.

    Carlos Fuentes, director of national legislation for Veterans of Foreign Wars, said the Academy’s downgrade of evidence associated with spina bifida means more research is needed. That’s why VFW “has pushed for passage of the Toxic Exposure Research Act to require the [Academy] to evaluate what research is needed to determine whether descendants of exposed Veterans are impacted,” he said.

    Meanwhile VFW is urging the VA secretary “to make a decision as soon as possible” on the other conditions reviewed in the last Academy report.

    Those decisions now pass to Robert Wilkie, the new VA secretary. We asked VA when Wilkie plans to announce decisions on these other ailments.

    “We have no announcements on Agent Orange presumptive conditions at this time,” said spokesman Cashour.

    After then-Secretary McDonald opted to leave those decisions for the Trump administration, Dr. David Shulkin became the new president’s first VA secretary. Shulkin had served as McDonald’s top health official during that period when teams of experts at VA spent months reviewing the Academy’s last report.

    By summer of 2017, Shulkin had promised a decision on adding new ailments to the presumptive list by Nov. 1. He later told the Senate Veterans’ Affairs Committee he had delivered his recommendations by that date to the White House’s Office of Management and Budget. But OMB had “asked for some additional data to be able to … get financial estimates for this. So, we are committed … to get this resolved in the very near future,” Shulkin said.

    Shulkin was fired in March this year before revealing which conditions, if any, he wanted added to the presumptive list. That his recommendations had costs that the OMB needed to assess suggests Shulkin wanted at least one more ailment to qualify for Agent Orange benefits.

    Source

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  • VA exceeds goals

     

    The Veterans Affairs Department said it has surpassed its goal this year of delivering more than 81,000 appeals decisions on claims for disability benefits and services.

    In doing so, VA said it delivered 28,000 more appeals decisions in fiscal 2018 than in fiscal 2017, a 52 percent increase.

    In a press release Tuesday, VA Secretary Robert Wilkie said the Board of Veteran’s Appeals had provided thousands of Veterans with critical, life-changing decisions.

    “The Board’s historic achievement delivering results to Veterans and their families reflects VA’s hard work and commitment to getting it right for our Veterans under the leadership of President [Donald] Trump,” Wilkie said.

    The achievement comes as the agency prepares for the full implementation of the Veterans Appeals Improvement and Modernization Act of 2017, which aims to make the appeals process an easier, more timely and transparent process that is designed to give Veterans increased choice and control. The new law takes effect February 2019.

    Getting ready for the rollout, VA said it has developed new IT capabilities and held numerous training sessions and panels for national, state, and local stakeholders. It also said 186 new attorneys have been hired this fiscal year to help the agency work through the new appeals program and address backlogged claims.

    While the VA perfects its new process, it is trying to prove itself to Veterans by encouraging those who have pending claims to opt into the Rapid Appeals Modernization Plan (RAMP) .

    VA sees RAMP as an opportunity for Veterans to get a faster decision on an appeal. Of the more than 50,000 Veterans participating in the program, VA said many are receiving decisions in an average of 100 days.

    Source

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  • DVA Logo 008

     

    The U.S. Department of Veterans Affairs (VA) recently updated regulations related to how it governs the oversight of beneficiaries, who, because of injury, disease, or age, are unable to manage their VA benefits, and the appointment and oversight of fiduciaries for these vulnerable beneficiaries.

    Managed by VA’s Veterans Benefits Administration (VBA), the new regulations, which took effect in August, update and reorganize fiduciary rules consistent with current law and VA policies, and clarify the rights of beneficiaries and the roles of VA and fiduciaries in the program.

    “These new regulations clarify the protections in place for Veterans and family members who apply for or are currently part of our fiduciary care program,” said VA Secretary Robert Wilkie. “This furthers our commitment to care for those who have given so much to our country.”

    Among other things, the new regulations clarify beneficiaries’ rights, including the right to appeal fiduciary appointments and other fiduciary decisions, the 4 percent limit on fiduciary fees, and the procedures to remove a fiduciary, for instance, when a beneficiary demonstrates the ability to manage their own funds or when VA determines that the fiduciary misused VA benefits.

    This is the first full revision of the Fiduciary Activities regulations since they were first published in 1975.

    Source

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  • Be There

     

    To mark Suicide Prevention Month this September, the U.S. Department of Veterans Affairs (VA) is shining a light on effective ways to prevent Veteran suicide with its Be There campaign.

    The campaign highlights the risk factors and warning signs for suicide, provides information about VA mental health and suicide prevention resources, and helps individuals and organizations start the conversation around Veteran mental health in their communities.

    “In our various communities, everyone is in a position to make a difference for a Veteran who may be at risk for suicide,” said VA Secretary Robert Wilkie, who recorded a video about VA’s strategies to prevent Veteran suicide. “A common misconception is that you need special training to talk safely about suicide risk or show concern for someone who is in distress. One simple act of kindness could help save a life. I encourage everyone this September, and beyond, to take the first step in acting as that support system.”

    Talking with a Veteran about mental health or suicide risk may be challenging, but VA encourages community leaders, colleagues, family and friends to simply “Be There” by sharing messages of support that can help show a Veteran you care. VA has also collaborated with community partners and is asking individuals across the country this month to share resources with Veterans in their lives via the BeThereForVeterans.com webpage.

    Veterans in crisis or having thoughts of suicide — and those who know a Veteran in crisis — can call the Veterans Crisis Line for confidential support 24 hours a day, seven days a week, 365 days a year. Call 800-273-8255 and press 1, chat online at VeteransCrisisLine.net/Chat or text to 838255.

    Source

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  • VA Ramps Up Hiring

     

    The Department of Veterans Affairs has begun hiring more job counselors to reduce caseloads in the Vocational Rehabilitation and Employment (VR&E) Program for disabled Veterans.

    The aim of the hiring effort is to get the counselor-to-caseload ratio down to one counselor for every 125 Veterans seeking employment, the VA said in a release Wednesday.

    According to the numbers provided by the VA in its release, the current ratio is roughly 1 counselor to 148 Veteran job-seekers.

    "The VR&E program is much more than a benefits program," VA Secretary Robert Wilkie said in a statement. "It's a vital support network, where VA's expert counselors work closely with Veterans on their personalized vocational rehabilitation goals."

    Funding from Congress allowed the VA "to expand our team of counselors who are on the ground across the country working tirelessly for Veterans, and we appreciate their support," he added.

    Currently, there are about 940 counselors working across VA's 56 regional offices and other satellite offices to advise Veterans with service-connected disabilities on transitions to the civilian workforce, the VA said.

    The plan is to hire an additional 172 vocational rehabilitation counselors (VRCs) to bring caseloads down to more manageable levels "and [provide] the resources needed to ensure Veterans are receiving thorough, quality services," the VA said.

    About 900 of the VRCs will work out of regional and satellite offices; others will work out of military installations and college campuses.

    The VA estimates that more than 56,000 Veterans have either completed a rehabilitation plan, found jobs or "achieved a greater independence in living through VR&E assistance" since 2014.

    The announcement of the job counselor expansion comes amid frequent charges by the American Federation of Government Employees and congressional Democrats of widespread staff shortages at the VA's more than 1,200 facilities.

    The AFGE, representing more than 230,000 VA employees, has cited figures from former VA Secretary Dr. David Shulkin that there are more than 33,000 unfilled positions at the VA.

    Source

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  • DVA 003

     

    Today the U.S. Department of Veterans Affairs (VA) released its figures on employment vacancies as of June 30, as mandated each quarter under the recently passed MISSION Act.

    VA reported the following vacancies:

    • 45,239 overall vacancies at the department, out of a total of 419,353 full-time authorized and budgeted positions. This overall number of vacancies includes:
    • 40,456 vacancies in the Veterans Health Administration, out of a total of 375,953 full-time authorized and budgeted positions
    • 1,978 vacancies in the Veterans Benefits Administration, out of a total of 25,560 full-time authorized and budgeted positions
    • 233 vacancies in the National Cemetery Administration, out of a total of 2,179 full-time authorized and budgeted positions
    • 2,572 vacancies in the department’s Staff Offices, out of a total of 15,661 full-time authorized and budgeted positions

    “President Trump has made it clear that achieving the optimal workforce at VA is a top priority as we look to provide the best care and benefits to our nation’s heroes,” said VA Secretary Robert Wilkie. “My priority has been to have a clear and accurate picture of our vacancies, and getting this information out publicly is an important step in transparency to Veterans and taxpayers.”

    With approximately 374,000 current employees, VA is the second largest federal organization in the United States. From the start of fiscal year (FY) 2014 to the end of FY 2017, VA achieved a growth rate of 12.5% and an average annual turnover (i.e., total loss) rate of 9.2%. VA turnover rates compare favorably with other large cabinet-level agencies, which averaged 11% in FY 2017. (1)

    Veterans Health Administration (VHA) Vacancies

    The Veterans Health Administration (VHA) is the largest administration within VA, accounting for approximately 335,000 of VA’s 374,000 employees. VHA turnover rates compare favorably with the healthcare industry, including for those occupations identified as mission critical. (2) In FY 2017, VHA’s annual turnover rate for full-time and part-time employees was 9.1%, which compares well to the healthcare industry turnover rate of 20-30%. (3)

    There is a consistent turnover of employees in large organizations such as VHA due to normal retirements and job changes. Vacancies represent current unencumbered positions due to turnover and new positions that are planned to meet an anticipated growth in services. VHA has approximately 40,000 vacancies, which is consistent with the historical annual 9% turnover rate and a 2-3% growth rate.

    Staffing plans consider normal rates of workforce turnover, retirement, and growth, and the expectation that there will always be vacant positions. Each year, VHA hires more employees than it loses to replace turnover and keep up with the growth in demand for services. The best indicators of adequate staffing levels include Veteran access to care and health care outcomes – not vacancies:

    • VA now provides same-day services for care needs right away at all primary care and mental health clinics.
    • In FY18 to date, 21% of all appointments have been completed the same day that the appointment was requested.
    • The average time it took to complete an urgent referral to a specialist has decreased from 19.3 days in FY14 to 3.2 days in FY17 and 2.0 days in FY18 – this number continues to improve now down to 1.3 days during July of 2018.
    • VA completed 95% of follow-up appointments no later than the provider recommended date for time sensitive appointments in FY to date.
    • According to a recent RAND Corp. study, Veterans receive the same or better care at VA medical centers as patients at non-VA hospitals.
    • For inpatient care specifically, VA hospitals performed on average the same or significantly better than non-VA hospitals on 21 of 26 measures.
    • VA performed significantly better than commercial and Medicaid Health Maintenance Organizations on 28 of 30 measures, with no difference on the other two.
    • Although there was variation in performance across VA, the variation was even wider among non-VA hospitals.

    VHA’s plans to fill vacancies

    VHA’s workforce challenges mirror those of the health care industry as a whole. There is a national shortage of healthcare professionals, especially for physicians and nurses. The American Association of Colleges of Nursing, Association of American Medical Colleges, and other national healthcare organizations have written about this workforce shortage at length.

    VHA remains fully engaged in a fiercely competitive clinical recruitment market. VA has been successful in this fight – it has increased its number of clinical providers including hard-to-recruit-and-retain physicians such as psychiatrists.

    VHA is taking a number of key steps to attract qualified candidates:

    • Mental Health and other targeted hiring initiatives;
    • Increased maximum physician salaries;
    • Utilization of recruitment/relocation and retention (3Rs) incentives and the Education Debt Reduction Program (EDRP);
    • Targeted nationwide recruitment advertising and marketing;
    • The “Take A Closer Look at VA” trainee outreach recruitment program;
    • Expanding opportunities for telemedicine providers;
    • DoD/VA effort to recruit transitioning service members; and
    • Exhibiting regularly at key healthcare conferences and job fairs.

    The Mission Act also provides additional authority that VA will leverage for recruitment and retention of medical professionals, including:

    • Initiating a pilot scholarship program targeted toward Veterans for medical school education;
    • Increasing the maximum award amount for the Education Debt Reduction Program (EDRP), and expanding program eligibility to additional mental health providers; and
    • Offering recent medical school graduates loan repayment opportunities in exchange for service in VA Medical Centers through the Specialty Education Loan Repayment Program (SELRP).

    Together, these tools expand VA’s already robust and aggressive staffing initiatives to retain high-quality providers for our Veterans.

    “Despite a challenging and ultra-competitive market for filling health care positions across the country, VA has worked with Congress and other key stakeholders to deploy a number of new and important tools to help us reduce our vacancies,” said Secretary Wilkie. “We are always looking for new ways to recruit high-quality talent, and will continue to do everything we can to provide the best quality care for our nation’s Veterans.”

    Applying for a position at VA

    VA is continuously recruiting for committed professionals who are dedicated to serving our nation’s Veterans. Employment at VA provides a good salary, comprehensive benefits and great work/life balance. Above all else, the highest honor in working at VA is the opportunity to serve the brave men and women who have served our country. Additional information regarding careers at VA can be found at www.vacareers.va.gov/.

    1. OPM Fedscope data retrieved in July 2018 www.fedscope.opm.gov/index.asp
    2. The annual “National Health Care Retention and RN Staffing Report” published byNSI Nursing Solutions Inc. in January 2017 identified turnover rates for nurses and other health professionals. VHA’s turnover rate for registered nurses, physician assistants, pharmacists, physical therapists, and occupational therapists was lower than the industry average reported for these occupations.
    3. BLS (Bureau of Labor Statistics) JOLT (Job Opening and Labor Turnover Survey), www.bls.gov/jlt/

    Source

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  • Artificial Lung

     

    U.S. Department of Veterans Affairs (VA) scientists at the VA Ann Arbor Healthcare System in Michigan recently announced that they are working to create a 3D-printed artificial lung that could potentially revolutionize treatment of Veterans affected by lung disease.

    Though still in its infancy, VA researchers hope to build what they call the first artificial lung that closely replicates the natural lung, resulting in compatibility with living cells and a very small size for portable or wearable short- and long-term respiratory support.

    In the near term, the device could be used as a temporary measure — a bridge to help patients waiting lung transplant or an aid for Veterans with recovering lungs. According to researchers, future versions could have longer-term applications.

    “Our Veterans deserve the highest quality of care and the latest breakthroughs in medical science,” said VA Secretary Robert Wilkie. “This exciting project is the latest in a long string of incredible research and medical advancements developed by VA researchers over the years. The results of this project could change millions of lives for the better.”

    Exposure to burn pits, sand, diesel exhaust and chemicals are some of the most commonly cited factors that lead to lung problems for active-duty military. About 20 percent of patients with severe traumatic brain injury also have acute lung injury.

    One lung disorder VA researchers hope to tackle someday with the 3D-printed artificial lung is chronic obstructive pulmonary disease (COPD), regarded as one of the most prevalent and costliest ailments in the Veteran population.

    COPD affects 5 percent of American adults and 16 percent of the Veteran population. Most people with COPD have emphysema, in which the air sacs of the lung are damaged and enlarged, and chronic bronchitis, a long-lasting cough caused by chronic inflammation of the bronchial tubes. The disease is characterized by an airflow limitation that is often linked to an abnormal response of the lungs to noxious particles or gases, such as those in cigarette smoke.

    For additional information about this study visit www.research.va.gov/currents/0818-Researchers-strive-to-make-3D-printed-artificial-lung-to-help-Vets-with-respiratory-disease.cfm.

    Source

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  • VA Rips BWN

     

    Department of Veterans Affairs officials say they strongly oppose passage of the Blue Water Navy Vietnam Veterans Act (HR 299), which would extend Agent Orange disability benefits and health care to between 70,000 and 90,000 Veterans who served aboard ships in territorial waters off Vietnam during the war, and today suffer ailments associated with herbicides sprayed across its jungles for years.

    The Blue Water Navy bill passed the House unanimously in late June and seemed certain to fly through the Senate, given reports of close coordination on the bill between the chambers’ Veterans’ Affairs committees, and the House having negotiated a plan to pay for the benefits with major Veteran service organizations.

    On Wednesday, however, with Robert Wilkie installed two days earlier as VA secretary, his undersecretary for benefits, Paul R. Lawrence, delivered a blistering attack on the Blue Water Navy bill, and on a proposal to test providing routine dental care to Veterans, during a Senate Veterans’ Affairs Committee hearing.

    Lawrence testified that there’s still no credible scientific evidence to support extending Agent Orange-related benefits to shipboard personnel who never went ashore in Vietnam or patrolled its rivers. Without such evidence, he said, it would be wrong, and would create a disastrous precedent, to award VA benefits.

    “This committee set the standard to use science to be fair and consistent in cases such as this,” said Lawrence, referring to the Agent Orange Act of 1991. “Once that standard is removed from the equation, it becomes nearly impossible to adjudicate a claim of this type on the merits. The resulting lower threshold sets in motion the prospect of uncontrolled demands for [VA] support.”

    Lawrence, who took charge of Veteran benefit programs in May, warned that if HR 299 is enacted, it will “be referenced when other exposure claims are presented to this committee. At that point, Congress will be under greater pressure to accommodate these requests too, regardless of the evidence.”

    It wasn’t immediately clear what damage Lawrence and his top official on post-deployment health issues, Dr. Ralph Erickson, inflicted on the popular Blue Water Navy bill. A majority of senators on the committee still spoke in favor.

    But the Trump administration has reversed signals of support that a beleaguered VA secretary, David Shulkin, gave Blue Water advocates in March.

    VA for years had opposed the legislation. The usual hard line softened a year after Shulkin became President Donald Trump’s first VA secretary when he told Rep. David Valado, R-Ga., lead sponsor of the House bill, “that these Veterans have waited too long and this is a responsibility that this country has.”

    Shulkin noted that VA lacked scientific evidence that shipboard personnel were exposed to dioxin. But he said his staff was “working hard to look at offsets” — cuts to other parts of the VA budget — to pay for Blue Water Navy benefits.

    “And it is a high priority for us,” he added.

    Two weeks later Shulkin was fired, deepening a leadership vacuum at VA caused by political chaos at the White House. Trump initially nominated his White House physician, a Navy admiral, to replace Shulkin. The choice soon fell victim to controversy. The House, meanwhile, passed its Blue Water Navy bill after the Veterans’ Affairs Committee negotiated with major Veterans organizations a way to pay for it, by raising user fees modestly on VA guaranteed home loans.

    Wilkie became VA secretary this past Monday. By Wednesday, there was no trace of the accommodating tone on the Blue Water Navy issue that Shulkin had expressed months earlier. Lawrence scorched the bill and its “pay for” plan.

    “VA is opposed to paying for the provisions of this bill by increasing the cost that some Veterans must pay to access their [home loan] benefits. Veterans will either have to finance the VA funding fee with interest, or pay up front with cash. This means fewer Veterans will buy homes or [will] buy homes using non-VA options, potentially opening them to predator lenders,” Lawrence said.

    He further argued that opening Agent Orange benefits to thousands more Veterans would stunt ongoing efforts to reduce the backlog of compensation claims on appeal, adding time and cost to claim processes.

    In written testimony, Lawrence gave fresh estimates on the cost of the Blue Water Navy bill, at total of almost $7 billion over the first 10 years. Some senators pushed back at his attack on the bill, arguing it wouldn’t be needed if VA didn’t set a high bar for these Navy Veterans to gain benefits for conditions on VA’s list of 14 ailments linked to Agent Orange.

    Erickson told senators most of the ailments presumed to be caused by Agent Orange also are tied to aging, therefore VA needs evidence of dioxin exposure for ships at sea. He said a Blue Water Navy review conducted by the Institute of Medicine in 2011 failed to find sufficient evidence of dioxin exposure.

    He and Lawrence dismissed an oft-cited Australian study that was the scientific foundation for that government to award Agent Orange-related benefits to its shipboard Veterans. That study, said Lawrence, was based on an experiment involving distillation of water with presumed levels of dioxin near to shore. It was U.S. Navy policy to take on water for shipboard use more than 12 miles out to sea, to avoid contaminants, Erickson explained.

    Rick Weidman, with Vietnam Veterans of America, made the strongest case in support of Blue Water Veterans: VA officials have misinterpreted the 2011 study, which did find it plausible that shipboard Veterans were exposed to dioxin. Given that Congress already presumes Veterans who served anywhere in Vietnam were exposed, and doesn’t try to calculate level of exposure, that benefit of the doubt should be applied to shipboard personnel too, Weidman said.

    “How much [exposure] makes no difference,” he said. “You don’t know [the] difference for folks who served in the delta versus the central highlands where I served. Who knows? And you can’t put it together 40 years later.”

    VA’s hard line appears to leave Senate Committee Chairman Sen. Johnny Isakson, R-Ga., in a tough spot. Veteran service organizations and leaders of the House Veterans’ Affairs Committee thought Isakson was set to endorse the bill and shepherd it swiftly toward enactment.

    At the hearing, however, Isakson said “we have more work to do on these issues.” He promised the committee would work “deliberately” to understand all facets of the Blue Water bill, including whether the House plan to raise VA home loans fees was enough to pay for it. Isakson asked Lawrence whether charging non-disabled Veterans an extra $250 on every $100,000 in loan value would cover the cost of extending Agent Orange benefits to Blue Water Navy Veterans.

    “Not in our opinion, no,” said Lawrence. Isakson nodded agreement.

    “I did real estate sales my entire life,” Isakson said. “A lot of VA loans, FHA loans. You can make those numbers look like a lot of things. That is not a lot of money” if VA home loan fees are raised, as the House voted, from 2.25 percent of loan amounts to 2.4 percent, for Veterans with active-duty service. “It’s variable too, and depends on number of loans that actually are closed” in any year, he said.

    It seems the Blue Water Navy bill will be adrift in uncertainty for at least several more months, its future dependent on how Senate leaders react to stiffened resistance from the Trump administration.

    Source

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  • Score Card

     

    Using a web-based report scorecard that measures, evaluates and benchmarks quality and efficiency at its medical centers, the U.S. Department of Veterans Affairs (VA) recently released data that showed significant improvements at the majority of its health care facilities.

    Compared with data from the same period a year ago, the July 2018 release of VA’s Strategic Analytics for Improvement and Learning (SAIL) report showed 103 (71 percent) VA Medical Centers (VAMCs) have improved in overall quality — with the largest gains seen in areas where there were VA-wide improvement initiatives, such as mortality, length of stay and avoidable adverse events. Seven (5 percent) VAMCs had a small decrease in quality.

    “This is a major step in the right direction to improving our quality of services for our Veterans,” said VA Secretary Robert Wilkie. “Over the past year, we were able to identify our problems and implement solutions to fixing the issues at 71 percent of our facilities. I’m extremely proud of our employees and the progress they have made to raise VA’s performance for our nation’s heroes.”

    Additionally, of the 15 medical centers placed under the Strategic Action for Transformation program (StAT), an initiative that monitors high-risk medical centers and mobilizes resources to assist the facilities, 33 percent (five medical centers) are no longer considered high-risk and 73 percent (11 medical centers) show meaningful improvements since being placed under StAT in January 2018.

    The quarterly SAIL report, which has been released publicly since 2015, assesses 25 quality metrics and two efficiency and productivity metrics in areas such as death rate, complications and patient satisfaction, as well as overall efficiency and physician capacity at 146 VAMCs. It is used as an internal learning tool for VA leaders and personnel to pinpoint and study VAMCs with high quality and efficiency scores, both within specific measured areas and overall. The data is also used to identify best practices and develop strategies to help troubled facilities improve.

    Source

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  • Wilkie Las Vegas

     

    Secretary of Veterans Affairs Robert L. Wilkie, visited the VA Southern Nevada Healthcare System Sept. 20 to meet with hospital administrators, speak with Veterans and employees, and talk about the way forward for the VA.

    Since being sworn in, July 30, the new VA secretary has visited sites across the nation to learn and assure both Veterans and VA employees that his focus is on ensuring the department has the resources necessary to provide Veterans the care and benefits they’ve earned.

    “In five weeks in office, this is the 10th hospital I’ve been to,” Secretary Wilkie said. “Part of my job, is getting outside of the nation’s capital, walking the post, listening, and trying to learn as much as I can so I can be a better advocate for our Veterans and employees.”

    During his inaugural visit, Secretary Wilkie remarked on the positive things he saw – both within the VA and the Southern Nevada military and Veterans community as a whole. “Here in Las Vegas we see what the VA will become,” the secretary said. “The growth here is astounding. More than 1,000 Veterans come in to our VA facilities for care here every day. We also have a relationship between the VA and Nellis Air Force Base and I believe it’s a model for the future as we need to be better joined at the hip with the Department of Defense. [The community] is also moving forward with getting a new medical school here, which I think is the other prong of the VA’s future — being tied to academic and research institutions.”

    While at the North Las Vegas VA Medical Center, Secretary Wilkie visited a prosthetics laboratory and wheelchair repair, and also had the opportunity to tour a Mobile Vet Center. He also met with several Veterans, including Red Coat Ambassadors as well as state and local Veterans service leaders. “What I saw are volunteers who are excited to be here,” the secretary said. “That’s an unsung part of the VA experience… Veterans want to be around people who speak their language. And it’s a unique language… It’s the language of service.”

    Since taking office, one of Secretary Wilkie’s most important objectives is ensuring that each Veteran’s visit is a positive experience. “When a Veteran comes to the VA, nine times out of 10, he or she is very happy with the care,” he said. “What I emphasize is importance of every encounter or experience, which really is customer service.”

    Part of improving the experience comes with funding and the secretary’s trip is part of a two-day visit that will see President Donald J. Trump sign the 2019 Veteran Affairs appropriation. “It’s the largest bill in the history of the VA, but it also reflects a change in the direction of the department,” Secretary Wilkie said, adding that one of the biggest changes within the VA going forward will involve an expansion of stipends for family home care. “We recognize family caregivers as the coming trend in health,” he said. “The greatest number of Veterans in this area are from the Vietnam era…and for those who served prior to May 7, 1975, this provides their families with stipends to provide care at home for their Veterans.”

    As an Air Force officer, Secretary Wilkie wrapped up his visit stating that he appreciates the dedication of America’s service members. “I am soldier’s son. My military service, compared to my ancestors’, is modest. But being a part of an organization of folks whose very existence ensures that their fellow citizens sleep soundly at night is as great an honor as I can have. I am proud to be part of America’s obligation to those who have sacrificed so much.”

    Source

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  • VA Social App

     

    Motorcycles – retired Navy – fuel exposures. Sonja Skinner says those are three items she added to her profile on VA DoD Veteran Link, a new social networking app just for Veterans and current service members. The app creates a secure, closed community where users can connect and feel comfortable talking about common interests and life circumstances – including any health concerns they may have.

    After retiring from the Navy in 2005, Skinner began her second career at VA. Today, she works at the Olin E. Teague Veterans’ Medical Center in Temple, Texas, as a My HealtheVet Coordinator, a VA Online Scheduling Manager and a Virtual Lifetime Electronic Record (VLER) Representative. She’s busy, but not too busy to help test new VA technologies and apps. She tested VA DoD Veteran Link this past spring.

    “I think it’s a good program,” she says. “I’m really excited and hope it takes off.”

    Those who engage in the Veteran Link community start by creating a secure profile and sharing as much or as little personal information as they want. The profile then lets users search for other Veterans and service members with similar self-reported diagnoses, military backgrounds or interests.

    “You definitely want to fill out your profile. That will help you connect with other people,” Skinner explains. “It would be so cool to find people who were stationed in the same places where I was stationed. Maybe if they’re nearby and like motorcycles, too, we could meet up and go for a ride. Or, because I worked with fuels, maybe I could find someone and see if we’re experiencing the same things.”

    The benefit of “shared experiences” is exactly the reason why Dr. John Hixson, a neurologist at the San Francisco VA Medical Center, says he pursued the development of VA DoD Veteran Link.

    “I personally believe that the unique value of the Veteran experience is in their community. We know a lot of Veterans come to VA because of the Veteran community, to share stories and socialize with peers. For rural or disabled Veterans, or anyone who cannot easily travel, we have identified a need for, and see the value in, this type of technology.”

    How to Sign Up

    VA DoD Veteran Link is available through the VA App Store. Veterans can access it from internet-connected desktops, laptops and mobile devices. To join and create a profile, users must have a My HealtheVet Premium Account, DS Logon Level 2 (Premium) Account or ID.me credentials.

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  • Suicide Data

     

    The suicide rate among Vets has not improved and remains a deeply disturbing problem, despite work by the VA and others, according to a VA analysis and statistics obtained by Fox News.

    Last week, the VA released findings from a years-long investigation into Veteran suicide data from 2005-2015 in all 50 states and the District of Columbia. The findings are clear: the suicide rate is constant.

    Veterans are more than twice as likely to die by suicide as non-Veterans, according to the VA report. Additionally, VA researchers found the number of Vets who take their own lives each day “remained unchanged at 20.” And even more-recent data obtained by Fox News suggests things may not be much better in 2018.

    Even for the mother of a U.S. Marine who took his own life after battling PTSD, and who has since dedicated her own to preventing Veteran suicides, the numbers are stunning.

    “I had no idea it was that bad,” said Janine Lutz. “That’s really lighting a fire under my butt to work harder."

    The Veterans Crisis Line provides 24/7 support to Veterans in distress, as well as concerned friends and family members. Staffers are available by phone at 800-273-8255 (Press 1), online at VeteransCrisisLine.net/Chat, and via text at 838255.

    The volume of phone calls the Crisis Line receives is staggering. The VA told Fox News that since October 31, 2017, the Veterans Crisis Line has fielded approximately 222,000 calls from Veterans who are having thoughts of suicide. That is in addition to the 49,000 calls from family members or friends who are concerned about a Veteran who is considering suicide.

    That breaks down to nearly 950 calls from Veterans (or nearly 40 calls per hour) every day since Halloween, and more than 200 calls a day from friends and family.

    "The mother of all battalions"

    Lutz, who lives in Florida, is affectionately referred to by many in the Veterans' community as “the mother of all battalions” for her efforts to bring Veterans of all stripes together, and prevent more Veteran suicides, via the LCpl Janos V Lutz Live To Tell Foundation.

    Lutz started Live To Tell to honor the memory of her son “Jonny,” a Marine who took his own life while under the influence of a cabinet’s worth of medication for his PTSD. Since then, she has sued the government for her son’s death, eventually winning a settlement out of court, but her work didn’t stop there.

    “About five months after [Jonny’s] death, I woke up one day and I was mad,” Lutz told Fox News. “I was mad knowing that my son wasn't the first to die like this. And I said why didn't somebody tell me… why aren't we doing more as a community? And it was then I decided that I was gonna be the voice, and fight for those who fought for us.”

    It was only a year after her son’s death that Lutz made her first foray into advocacy, organizing a motorcycle rally that brought out an unexpectedly large number of people from across the country. She was excited about the hundreds of supporters who turned out, but unsure of what to do next.

    That was until Lutz’s niece played a song for her that she says “grabbed me by the chest,” and inspired a plan to save the lives of Veterans across the country:

    Buddy Up

    “It’s time to buddy up ‘cause yup, this is wrong.

     

    Surviving battle, but die when we’re home.

    Yeah it hurts, that’s why I made this song.

    It’s time to see the signs, like the lights when it’s on.”

    Those lyrics are from the song “Red Flags” by Soldier Hard, an artist whose real name is Jeff Barillaro and who also happens to be an Army combat Veteran. Barillaro dedicated himself to creating music that gives a voice to Veterans, and the issues they experience along with their friends and families. When Lutz heard the lyrics to his song, she says she knew immediately what she had to do.

    “He said ‘you all need to buddy up’… and he was talking to the Veterans out there,” Lutz says. “When I heard that, I said that's it. I'm gonna get these guys together, build local communities, facilitate – I don’t know how, but that’s what I’m gonna do.”

    Using Soldier Hard’s song as inspiration, Lutz has since established two “Lutz Buddy Up” social clubs, one in Florida and one in Massachusetts, and this summer she’s touring the country in the hopes of establishing even more. The concept is simple: bringing Veterans together (and even first responders) so they can support one another while sharing a meal, playing a game or two, or just chatting.

    “We welcome our Veterans just as they are, wherever they are,” Lutz says. “Whatever mindset they're in, we welcome them. All we want to do is connect them with their peers, and it's just been a great success. Dozens and dozens of success stories.”

    Lutz says membership has skyrocketed from just a handful back in 2014, to well over 500 in 2018 – including Veterans from every U.S. armed conflict since the Korean War.

    Asked what she would tell Veterans who might be suffering in silence, or friends and family who might be concerned about a Veteran they know, Lutz says to remember that connecting with peers is the key.

    “They need to speak to their peers, someone who has walked in their shoes,” Lutz says, before pointing out that this is the exact philosophy soldiers employ on the battlefield.

    “That's what they fight for, to keep the guy next to them alive… Yeah, they have a mission, but the biggest part is making sure the guy right next to you is alive and well,” Lutz says. “You're watching each other, and that’s what they have to continue when they get home…

    “So if you don’t have any local buddies you know, find some in your community because they're everywhere, and they're looking for help too,” Lutz says. “Reach out to other Veterans in your communities because that is your best medicine - your peer who has walked in your shoes.”

    If you are a Veteran in crisis or having thoughts of suicide, or if you are someone who knows a Veteran in crisis, call the Veterans Crisis Line for confidential support 24 hours a day, seven days a week, 365 days a year at 800-273-8255 and press 1. You can also chat online at VeteransCrisisLine.net/Chat, or send a text message to 838255.

    Source

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  • Rusty Surgical Instruments

     

    At the Manchester, New Hampshire, VA Medical Center last year, surgeries were canceled when debris that appeared to be "rust and blood" was found on instruments doctors were about to use.

    At the Washington, D.C., VA Medical Center last year, the staff ran out of sterilized instruments, and even bone marrow, and had to borrow them from neighboring hospitals.

    At the Cincinnati VA Medical Center in 2016, inspectors found that the system was failing to provide doctors with equipment that was "free of bioburden [bacteria], debris, or both."

    At the West Los Angeles VA Medical Center, 83 surgeries were cancelled in 2016 because of fly infestations in operating rooms.

    Rep. Phil Roe, R-Tennessee, a medical doctor and chairman of the House Veterans Affairs Committee, said he found it amazing that the Veterans Health Administration within the VA was struggling to fulfill the "most basic function" of its hospitals: "to make sure you have sterile equipment."

    "It's astonishing to me," Roe said at a hearing Wednesday before the Subcommittee On Oversight and Investigations.

    Roe, who served two years in the Army Medical Corps, said he had performed or assisted in thousands of surgeries.

    "I never even thought about it, was the equipment going to be sterile that I'm using today?" he said.

    In response, Dr. Teresa Boyd, the VA's assistant under secretary for Health for Clinical Operations, acknowledged the problem but pointed to mitigating data on the surgical site infection rate.

    Of the more than 424,000 surgeries scheduled at the VA in the past year, only 0.8 percent had to be cancelled because of concerns with equipment sterility, Boyd said. At the Washington, D.C., VA Medical Center, the rate was 1.09 percent.

    That compared with surgical site infections rates of 1.41 percent nationally, and 1.9 percent in industry, she said.

    However, Dr. John Daigh, Jr., assistant inspector general for Healthcare Inspections at the VA's Office of Inspector General, said there was still cause for concern regarding the VA's protocol for sterile equipment and ensuring the same standards across all its facilities.

    The sterile equipment issue at the VA has been a recurring problem dating back to at least 2009 and has been documented in numerous reports from the Government Accountability Office, the VA's Office of Inspector General, the VHA's Office of Medical Inspector, and verified whistleblower complaints.

    In 2009, more than 10,000 Veterans at VA facilities in Florida, Georgia and Tennessee were put at risk for hepatitis because of concerns over the sterility of instruments used for colonoscopies.

    Hospital officials at the time reported that tubing for endoscopes used repeatedly in the procedures had been rinsed but not disinfected.

    At the hearing, Rep. Jack Bergman, R-Michigan, the subcommittee's chairman and a retired Marine lieutenant general, charged that failures in VA leadership allowed "safety protocols to go unnoticed and uncorrected."

    He said the VHA's central office was unaware that medical centers were failing to submit timely Sterile Procedure Services reports, "suggesting that blame goes all the way to the top."

    Boyd said the issue was being addressed at all levels of the VA. She also concurred with the findings of recent GAO reports, and said that a shortage of SPS staff was a contributing factor.

    Last week, the VA reported that there were about 40,000 job vacancies at the VHA.

    "It is imperative that we have not only trained and experienced front line staff" but also the leadership to direct them, Boyd said.

    Beth Taylor, a registered nurse and the VA's deputy assistant under secretary for Health and Clinical Operations, also stressed the need for more staff in Sterile Procedure Services. She said a report on hiring would be filed by December and a plan should be ready in about six months.

    "[The] current governance structure [at the VA] is simply not getting the job done," Bergman said.

    He cited the Washington, D.C., VA Medical Center as the "poster child" for what has gone wrong at the VA in ensuring the provision of sterile equipment and operating rooms at its facilities.

    The Washington VA center has been the subject of two scathing reports from the VA Office of Inspector General, released in 2017 earlier this year.

    The latest IG report found "a culture of complacency among VA and Veterans Health Administration leaders at multiple levels who failed to address previously identified serious issues" at the Washington hospital and its two clinics.

    "Veterans were put at risk because important supplies and instruments were not consistently available in patient care areas," the IG report said.

    It added that equipment rooms where supplies were kept were filthy.

    In his second week on the job in early August, VA Secretary Robert Wilkie visited the Washington facility, where he was told that plans were in place for "assuring reliable availability and sterilization of instruments for surgical procedures."

    "We had a good visit today, and I appreciated hearing from facility and regional leadership on the important work that has been done to address the Inspector General's concerns, as well as plans for resolving all its remaining recommendations," Wilkie said in a statement following his visit.

    Source

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  • DVA Logo 006

     

    Today the U.S. Department of Veterans Affairs (VA) announced it will fund a new center of excellence to expand the department’s capacity to deliver innovative, data-driven and integrated approaches to improve services for Veterans and their caregivers.

    Managed by VA’s Office of Health Services Research & Development (HSR&D), the first of its kind center will be named for Sen. Elizabeth Dole in recognition of her national leadership and advocacy on behalf of the nation’s 5.5 million military and Veteran caregivers, and her support for the landmark RAND Corp. research on their challenges.

    The Elizabeth Dole Center of Excellence for Veteran and Caregiver Research will serve as the model for excellence in peer-reviewed research on innovation, training, evaluation, implementation and the dissemination and adoption of best practices in supporting the caregivers of Veterans across VA, the federal government and private and nonprofit sectors.

    “Given Senator Elizabeth Dole’s significant impact on, and dedication to, military and Veteran caregivers, it is only fitting that VA names this center of excellence in her honor,” said VA Secretary Robert Wilkie. “The creation of the Elizabeth Dole Center of Excellence for Veteran and Caregiver Research is a firm example of VA’s ongoing commitment to improving services and outcomes for the families, friends and neighbors who tirelessly care for our nation’s Veterans.”

    The center of excellence consists of a multidisciplinary team that takes advantage of HSR&D’s virtual network of nationally recognized VA investigators and their university affiliates to ensure that their state-of-the-art research will have the greatest possible impact on Veterans and the caregivers who support them. The team of VA investigators will be led by Dr. Luci Leykum of the South Texas Veterans Health Care System.

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  • Wont Turn Over Documents

     

    WASHINGTON — Veterans Affairs officials are declining to give members of Congress documents related to accusations that outside businessmen are unduly influencing department policy, citing legal ongoing disputes over the issue.

    In response, the ranking member of the House Veterans Affairs Committee blasted the move as “an attempt to stonewall not only a member of Congress, but the American public.”

    At issue are concerns raised by a ProPublica report this summer that identified three businessmen — Marvel Entertainment CEO Ike Perlmutter, primary care specialist Dr. Bruce Moskowitz, and attorney Marc Sherman — as key architects of a host of Veterans policy decisions by Trump’s administration.

    None of the men hold official government positions, but all three are confidants of Trump and members of his exclusive Mar-a-Lago resort in Florida. Documents released by the news organization show frequent contact between the men and top VA officials last year, including discussions on policy matters and personal favors.

    Last month, at a Senate Veterans’ Affairs Committee hearing, VA Secretary Robert Wilkie told lawmakers he has only met with the men once, as a courtesy during a trip to Florida, and that they have no role in crafting department policy.

    But after House Democrats in August requested correspondence between the men and VA officials, Wilkie refused, citing “ongoing litigation alleging violations of the Federal Advisory Committee Act” making them “not appropriate for release at this time.”

    The claim appears to be connected to a lawsuit filed by the left-leaning advocacy group VoteVets, to block the men from contact with VA leadership on official matters.

    Minnesota Rep. Tim Walz, the top ranking Democrat on the Veterans’ panel, called Wilkie’s excuse for not releasing the documents “unacceptable” and without legal merit.

    “We have received nothing from VA except excuses,” he said in a statement. “The reports of corruption and cronyism are serious and we cannot allow VA to sweep this under the rug. This issue will remain a top concern of the committee until all our questions have been answered.”

    Walz is demanding the documents be turned over to the committee before the end of the month.

    In his Senate appearance, Wilkie told lawmakers he believes that VA “has calmed down” in the first few weeks of his tenure as secretary.

    Wilkie was nominated for the post after former VA Secretary David Shulkin was fired by Trump over Twitter in March, and after Trump’s other replacement nominee, Rear. Adm. Ronny Jackson, withdraw from the process amid reports of unprofessional behavior while working as the White House physician.

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  • TBI Vets

     

    James. A. Haley Veterans’ Hospital (JAHVH) in Tampa, Florida, has been designated a Headache Center of Excellence (CoE) by VA. JAHVH is one of seven facilities throughout the Veterans Health Administration to receive the designation.

    “We’re very lucky because we probably wouldn’t have it if we didn’t have this awesome Polytrauma Center,” Dr. Georgia Kane said. “It means we can offer so much more to our patients. Everybody’s highly excited.”

    Kane, a neurologist and head of the Chronic Headache Management Program (CHAMP), said the designation was due in large part because of the hospital’s Polytrauma program.

    Veterans with a history of polytrauma or traumatic brain injury commonly experience headaches. Headache management for Veterans with TBI and multiple co-morbid conditions is challenging and is best managed by an interdisciplinary team. That’s precisely what CHAMP has been doing for several years.

    “We started an interdisciplinary team about four years ago,” Kane said of the five-week outpatient program. “We noticed that with people with headaches, it’s difficult to treat just the headache, so occupational therapy, psychology and me, we all work together and we meet weekly on patients to maximize their care.”

    Program participants are required to keep a diary, noting the time a headache starts, what they were doing, what they were eating and other aspects of their lives that can be critical to understanding what might be triggering the headaches.

    Options other than medications

    “The number one thing is education. Once you know more about what is affecting your situation, we can then teach options that are other than medications,” Kane said. “Medication will do a certain percentage, but if you only relied on medications to help your situation, then you would be discounting the fact that you’re not sleeping well, or to distract yourself with relaxation techniques or biofeedback that we do to try and get your mind to think of something else.”

    CHAMP participants meet once a week for lectures and other forms of treatment that includes recreation therapy, Botox injections and precise injections in the neck if needed. Botox is used to relax muscles that, when tensed, can cause headaches. The treatment is very effective, Kane said.

    About 60 people are in CHAMP at any given time, including those patients who are followed after discharge.

    While many of the TBI patients with headaches tend to be younger, chronic headaches are non-discriminatory, affecting men and women, young and old, and the additional funding that comes with the Center of Excellence designation will allow the CHAMP staff to add additional treatments for them.

    They hope to work with the lighting in the treatment areas since lighting can affect headache sufferers. Equipment for neck injections, electrical stimulators, and virtual reality equipment are a few of the items Kane said she hopes to procure for the program. Headache treatment is offered to all Veteran patients at all VA medical centers. Patients can get referred to any Center of Excellence but because not all centers offer the same thing Veterans should confirm with their VA health care team and the Center of Excellence that they will receive the specific treatment they need.

    Patients should keep in mind that this is an outpatient program. Patients come once a week for five consecutive weeks – plus the follow-up after they complete the treatment – which is not always easy if referred from a distance.

    “Becoming a Headache Center of Excellence means that we can expand and do more, to be able to offer more things, more physical therapies, recreational therapies, art therapies,” Kane said. “When we were presented with this, it was one of those truly amazing moments.”

    Source

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  • Mare Island Cemetery

     

    The Department of Defense has approved an application by the City of Vallejo to begin planning initial repairs to the Mare Island Naval Cemetery, U.S. Rep. Mike Thompson announced Thursday.

    Work will include repairing or replacing fencing, installing a flagpole, and repairing the damaged drainage system, according to the announcement.

    These improvements will be done through the DOD’s Innovative Readiness Training (IRT) program, which is designed to provide training for reserve forces while also bettering local communities through medical or engineering support, Thompson’s office said.

    “This is an exciting announcement that provides a plan to begin repairs on the Mare Island Cemetery and an important step toward giving our fallen heroes the final resting place they deserve,” Thompson (D-St. Helena) said. “It also highlights the work still to be done to fully restore the cemetery and I will continue fighting for every possible avenue that will allow us to complete this important task.”

    The City of Vallejo applied for assistance with these engineering projects through the IRT program and was approved through support by Thompson, who has been championing restoration of the cemetery, including with a bill to transfer the cemetery’s control to the Department of Veterans Affairs. Thompson’s bill to help restore the cemetery has more than 70 Democrat and Republican cosponsors and is supported by five major Veterans service organizations, his staff says.

    A companion bill by Sen. Dianne Feinstein is also working its way through the senate.

    The IRT work wouldn’t likely begin until late 2019, subject to the availability of the IRT unit, further cost negotiations with the city, and other necessary advance work, including environmental reviews, Thompson’s office said.

    Those months during which the cemetery can further deteriorate is the bad news portion of this announcement, said Ralph Parrott, the retired Virginia-based retired Navy captain whose chance day trip to the island sparked the effort to get it restored and maintained.

    It was then that Parrott, having found the cemetery to be in a condition unfit to be the final resting place of the more than 800 service members and their families, including three Medal of Honor recipients buried there, launched an effort to rectify the situation. Through some investigation, Parrott learned that when the Mare Island Naval Shipyard closed in 1998, the Navy transferred the property to the City of Vallejo, with no mechanism in place for its upkeep. A cadre of inadequately funded volunteers have been fighting a losing battle to maintain the site for 20 years.

    “They’re going to put in a flagpole and do something about drainage, but with the caveat that the city must pay for materials,” Parrott said of the IRT effort. “But, it’s not going to start ‘till next year, and our chances of getting the bill passed this year (suffered) with the objections from the VA.”

    A VA spokesman recently testified in a Congressional committee hearing that transferring the MINC to his department’s care would set a bad precedent, and possibly encourage other jurisdictions to abdicate their responsibilities to local military graveyards.

    Parrott and local effort champion retired U.S. Army Col. Nestor Aliga said they’re redoubling their efforts to get more California lawmakers to sign on to the bill to try to get it passed this year.

    “We need to get everyone nationwide to sign our online letter that urges their representatives and senators to urgently cosponsor H.R.5588 and S.2881, today,” Aliga said.

    “We need your urgent help. The House Subcommittee on Disability Assistance and Memorial Affairs (House Committee on Veterans’ Affairs) will hold a Legislative Hearing on Wednesday, Sept. 5, 2018 and unfortunately our H.R.5588 — to transfer the Mare Island Naval Cemetery to the Veterans Affairs — is NOT yet on their list,” according to a letter Aliga sent out to as many Veterans organizations as he could. “Note that (this week), only 26 out of our 53 California Representatives have cosponsored H.R.5588. It is possible that (they) have NOT even heard about H.R.5588. We especially need to contact House Majority Leader Kevin McCarthy (R-CA-23), and House Minority Leader Nancy Pelosi (D-CA-12) because they can quickly mobilize their colleagues to cosponsor.”

    The letter urges Veterans to call or write their Representatives and “to urge the House Subcommittee on Disability Assistance and Memorial Affairs to include H.R5588 on their Legislative Hearing on Sept. 5, 2018.”

    He suggested they be asked to “please cosponsor today H.R.5588 to transfer the dilapidated Mare Island Naval Cemetery, the oldest military cemetery on the west coast, to the Veterans Affairs and please urge the House Subcommittee on Disability Assistance and Memorial Affairs to include H.R5588 on their Legislative Hearing on Sept. 5.”

    He included the following links for that purpose: www.votervoice.net/NavyLeague/Campaigns/59972/Respond and www.govtrack.us/congress/members/CA#representatives

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  • Grps Fight BWN AO

     

    Sen. Sherrod Brown (D-Ohio) met Tuesday with Robert Wilkie to try to coax the new VA secretary out of his department’s newly stiffened opposition to a House-passed bill that would extend VA health care and compensation to tens of thousands of former sailors and Marines with Agent Orange-associated ailments.

    “We haven’t convinced him yet,” Brown said in a next day phone interview.

    Without support from the Department of Veterans Affairs, Sen. Johnny Isakson (R-Ga.), chairman of the Senate Veterans Affairs Committee, faces a difficult decision on whether to allow a committee vote this fall on the Blue Water Navy Vietnam Veterans Act (HR 299).

    “Johnny pays a lot of attention to what the VA thinks, as he should [as] chairman,” Brown said.

    The Ohio senator has had several conversations with Isakson on the Blue Water bill and said he “is about as fair-minded and bipartisan a chairman as there is in the Senate.” But Brown declined to guess what Isakson will decide on HR 299 if the VA secretary continues to oppose the bill.

    “If we get the VA on board, it will make this a lot easier, I’ll just answer it that way,” Brown said of prospects for the bill. “Otherwise, I think it will be hard.”

    We tried polling all 15 senators on the committee to learn what impact VA opposition to HR 299 has had on their support for the bill. A spokesman for Isakson said only that he “is actively working” with the VA, outside stakeholders and his committee “on a path forward on this legislation.”

    Sens. John Boozman (R-Ark.) and Mike Rounds (R-S.D.), noted they are original co-sponsors of a near identical Senate bill. Sen. Bernie Sanders (I-Vt.) said the bill should be passed and signed into law “without delay.” A “disappointed” Sen. Dean Heller (R-Nev.) said he wrote to Wilkie, urging him to reconsider his opposition. And Sen. Bill Cassidy (R-La.) said he still is reviewing HR 299 and working with colleagues to do “what is best” for Veterans.

    Meanwhile, pressure on Isakson builds. Every major Veterans’ group and most military associations urged him this week to move the bill out of committee. Their volley of letters responded to Wilkie’s own Sept. 6 letter to Isakson expanding on why VA opposes extending benefits to Veterans who served on ships off Vietnam and have ailments associated with exposure to dioxin in Agent Orange.

    Wilkie noted again that the latest review of available scientific evidence by the Institute of Medicine (IOM), from 2011, concluded that exposure of shipboard personnel to defoliants sprayed over Vietnam “cannot reasonably be determined.” Also, he said, Navy ships were required to draw seawater for conversion to shipboard potable water 12 miles from any river, making the presence of Agent Orange “highly unlikely” and the “dilution factor would have been significant.”

    He also criticized how the House-passed bill would pay part of the cost of expanding benefits to Blue Water Vets by ending an exemption from VA home loan funding fees for certain disabled Veterans, those not rated fully and permanently disabled and seeking jumbo loans. The amount of such loans can start as low $453,100, or as high as $679,650, depending on local housing market prices.

    If HR 299 becomes law, Wilkie wrote, on a home loan of $500,000 “a disabled Veteran could be required to pay $12,000 to the VA in funding fees (plus interest if rolled into the life of the loan) rather … $11,725 as a down payment, which results in home equity.”

    Advocates for Blue Water Veterans argue Wilkie and staff have fallen into a previous pattern of “cherry-picking” information from scientific reports to conclude there is no scientific basis to support extending Agent Orange-related benefits. They also criticize a fresh VA estimate on the cost of HR 299 — $5.5 billion over 10 years — as wildly high and claim VA exaggerates the impact on home-buying Veterans of planned funding fee increases, particularly for disabled Veterans.

    Former surface warfare officer, retired Navy commander and lawyer John B. Wells, who has served as general counsel to the Blue Water Navy Vietnam Veterans Association, considers himself the technical expert on the science and shipboard practices that, he argues, support extending Agent Orange benefits.

    The Slidell, Louisiana, attorney also is executive director of a nonprofit corporation that litigates and advocates for Veterans and trains other attorneys on Veterans’ law. Wells complained to Wilkie that VA staff for Blue Water issues have no naval operational experience or expertise in hydrology, thermodynamics and other relevant sciences for determining how Agent Orange reached sailors at sea.

    “The VA consistently cherry picks through the (IOM) reports taking phrases out of context to support their position,” Wells wrote.

    A conclusion VA ignores from a 2008 IOM report is that the evidence its research committee “reviewed makes limiting Vietnam service to those who set foot on Vietnamese soil seem inappropriate.”

    The same report said: “Given the available evidence, the committee recommends that members of the Blue Water Navy should not be excluded from the set of Vietnam-era Veterans with presumed herbicide exposure.”

    Regarding the 2011 report finding that Agent Orange exposure by Blue Water Veterans “could not reasonably be determined,” it needs context, Wells said.

    “What [IOM] actually said was: This lack of information makes it impossible to quantify exposures for Blue Water and Brown Water Navy sailors and, so far, for ground troops as well,” Wells wrote. Therefore, IOM couldn’t “state with certainty whether Blue Water Navy personnel were or were not exposed to Agent Orange.”

    While the IOM was told Navy ships did not typically make potable water within 12 miles of shore, Wells said it also was told that in exceptional circumstances a ship might take up water for distillation close to the coastline.

    Mike Yates, national commander of Blue Water Navy Vietnam Veterans Association, wrote separately to Isakson. Among points he made was that naval gunfire support data show many ships operated within three nautical miles of the Vietnam coast for periods long enough to mandate water distillation. Also, some Navy ships were provided potable water from barges operating from shore, a practice not known to the IOM before it produced its 2011 report.

    More arguments are made in two joint letters to Isakson in mid-September. One is from The Military Coalition, a consortium of 27 Veterans groups and military associations, and another from Veteran service organizations: Disabled American Veterans, Veterans of Foreign Wars, The American Legion and Paralyzed Veterans of America.

    The second letter reflects a consequential shift of position. The four large Vet groups all now agree they do not support imposing new fees on any service-connected disabled Veteran, even for jumbo home loans. Disabled Veterans “have already paid with their service, and we therefore urge the Committee to strike this provision from HR 299 before passing the legislation.”

    If the senators embrace that change, they would have to find other budget offsets to cover the cost of the bill, which VA contends already were woefully inadequate in the House bill to satisfy balanced-budget law requirements. Also, any change to HR 299 would require the bill’s return to the House to be voted on again, increasing the risk that the 115th Congress will run out of time to pass a Blue Water Navy bill.

    In that case, advocates would have to restart their quest in 2019 with a mix of lawmakers significantly altered by November’s election.

    Source

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  • 10 year battle

     

    KANSAS CITY, MO (KCTV) -- There may finally be some hope for veterans battling appeals with the V.A.

    “RAMP”, or the Rapid Appeals Modernization Program, started about a year ago.

    Steve Fisher is a veteran who began his battle for benefits back in 2007. He has spent a decade fighting a bureaucratic paperwork war with the U.S. Department of Veterans Affairs.

    To put it in perspective, his fight for benefits lasted longer than the war he served in.

    Fisher served three tours in Iraq and has survived three roadside bombs.

    “I heard a big boom, lots of smoke, ringing," he recalled. "Everyone was rushing to get us out of there."

    One roadside bomb was the worst one.

    “It separated the entire truck in half,” he said. “Luckily, everyone survived, but we were all knocked unconscious and medevacked to Fallujah Medical.”

    He suffers from PTSD, a traumatic brain injury, hearing and vision loss, and nerve damage -- especially in his back.

    Fisher said his life changed after that blast. So, he applied for benefits when he finished his tours.

    The V.A. approved some, but not all, of his claims. He has been in appeals since 2009.

    “This has all been going on since then,” he said. “Here it is -- 2018.”

    He first applied in 2007. It took two years for the V.A. to approve some of the claims. Then, that kicked off the long appeals process as his file bounced from Washington back to the regional level twice. As time passed, his medical reports became outdated.

    “I had to go to new exams,” he explained, “do all the exams again.”

    Fisher describes a frustrating, bureaucratic, never-ending process.

    “Every time I get a new letter from the V.A., it’s a sinking feeling,” he said. “My heart drops and then I open it. Every time I opened it, it hasn’t been a positive outcome; it's been a nightmare.”

    He’s not alone. Many veterans across the nation report similar problems.

    Last year, KCTV5 News reported on Phil Nash who is battling the V.A. for benefits, as well as cancer.

    “We have to fight for the compensation we are entitled to,” Nash said.

    In pictures from his service, one can see planes spraying Agent Orange.

    The V.A. originally approved his disability benefits because his cancer was directly connected to his exposure to Agent Orange.

    Then, he had surgery and was considered cured, so the benefits stopped.

    However, when his prostate cancer came back, the benefits did not. Since then, the cancer has spread.

    Nash’s case is on appeal. It has taken years, it is still not resolved, and he is losing hope.

    “I’ll probably be dead,” he said.

    “I have several friends who have given up and these are friends in heavy combat,” Fisher said. “They are missing limbs, organs from mortar attacks. They are having the same issues I’m having.”

    The V.A. has promised things will improve and, for Fischer, he’s finally seeing results.

    KCTV5 News first spoke to Fischer when he was concerned the new rapid appeals process wasn’t working. We followed his story and the program did resolve his claim in the promised time frame.

    “I’m just glad it’s over,” he said. “It still hasn’t hit me yet. It’s still really new to me, definitely. When I wake up in the morning, now I have a smile. This is great!”

    However, one has to remember this was a 10-year battle that lasted through three presidencies. So, only time will tell how well the program will work overall for veterans across the nation.

    Source

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  • Vet Finds Salvation

     

    Randy Elston graduated from VA San Diego Healthcare System’s Aspire Center on Sept. 4 after six months of care at the facility, which assists Veterans from Iraq and Afghanistan recover from wounds of war. For the 38-year-old Marine Veteran, the thought of completing the program fills him with something that has been absent from his life as of late – hope.

    Hope in Randy’s life means the promise of seeing his two young daughters again, the chance of getting on his feet with a place to live and a future career, and having something to look forward to with each day. Not very long ago, none of these things were possible and the burden almost ended his life on several occasions.

    Elston’s troubles began with difficulties in his immediate family long before he joined the military. They continued in his service, with deployments and experiences that led to symptoms of post-traumatic stress disorder (PTSD). After being honorably discharged, Randy faced a strained marriage, which eventually ended in divorce.

    “When my marriage imploded, I didn’t know how the court was going to look at me and say I’m able to take care of my kids,” Randy said. “I just tried to check out.”

    One night when talking to his ex-wife, she ran out to take her kids to her brother and Randy tried to end his life with a bottle of pills.

    She came back to find him on the floor and barely managed to save his life. Randy woke up in intensive care at his local hospital, broken in many ways and without a path forward. After recovering, Randy went through several programs to help treat his mental health. While they did help move him forward, he needed something more. He was out of money, homeless and living on the streets.

    “When he came to us, he was a lost individual.”

    “After completing a program in Louisiana, I got an opportunity to come to the Aspire Center,” Randy said. “It took a while but I was finally accepted and came into the program last February.”

    Among the treatment modalities offered at the Aspire Center are: case management, vocational rehabilitation, psychotherapy, education classes, medication management, complementary/alternative therapies, social and recreational activities, and post-traumatic stress disorder treatment. In addition, Veterans are given the tools to thrive when they leave, such as help with vocational, financial, and mental health resources.

    “When Randy came to us, he was a lost individual. He had lost so many things leading to his admission into the program, his wife, contact with his children, no home and no care,” said Dr. Lu Le, staff psychiatrist at the Aspire Center. “He was a very appropriate candidate for our program, being very heavily exposed to combat and had post-traumatic stress. I thought he would be a good fit. The initial phase of his care, I felt like, was a challenging transition. There’s definitely a transitional period where Veterans are dealing with a new way of doing things.”

    “When I came here, I had given up on myself again,” Randy said. “I didn’t want help but knew I needed it. I didn’t know what I needed. After about three or four days, I fled.”

    “In talking and building rapport, he didn’t seem open to it,” Dr. Le said. “He was still preoccupied with the stress at hand and got up and left the building.”

    “I jumped the fence behind the building and ran into oncoming freeway traffic,” Randy said. “I was running into traffic for 30 minutes trying to get people to hit me. I would run into both lanes of traffic and everyone would swerve around me or hit their brakes.”

    When he saw police helicopters in the air and police sirens approaching, he left the area. Again, he tried to end his life through several methods, all unsuccessful. In his last attempt, he was found before completing the act and eventually came back to the Aspire Center.

    “That was my turning point in my recovery,” Randy said. “I knew that I was sick, but I had a fight-or-flight instinct. I was fighting for my way of dealing with things…alone. I didn’t have an honest way of dealing with problems, so I broke down and fell apart. It all happened in the worst way.”

    Randy ended up in the mental health inpatient unit at the San Diego VA Medical Center to receive a higher level of care for what he was going through at that moment. It was restrictive but stripped down the layers and allowed him to focus on what was going on in his head and in his life. In the context of that environment, he could see what an opportunity the Aspire Center was in supporting his recovery. Randy realized his mistake and wrote letters to the Aspire Center staff, pleading for readmission.

    “I haven’t had that kind of care my whole life.”

    In the meantime, he had ASPIRE staff and Veterans visit him on a regular basis at the inpatient unit, which felt reassuring in an odd way. “I’m from Arizona, and here I am in California, and people are checking in on me. Nobody knows me. Why would someone care about me? I haven’t had that kind of care my whole life,” Randy said.

    After careful consideration and monitoring of his progress to see if it was appropriate for Randy to return, the Aspire Center staff invited him back. “It was a big decision as a team because we had uncertainties based on his past,” Dr. Le said. “Through medication management to target his impulsivity, intensive psychotherapy and amazing staff support, the rest is history in terms of his growth and progress acquiring the tools to integrate back into society,” he added.

    Now with support from the Aspire Center, Randy plans on attending a trade school. He has helped with housing through social work’s HUD/VASH program and is volunteering heavily in the community. He’s also continuing with meetings and further care to help him transition. “Here is an individual who was lost and now has found meaning and purpose to his life,” Dr. Le said.

    Most importantly in his recovery, Randy has made progress in getting to see what gives him the most hope: his daughters. When he entered the program, Randy had doubts on whether he would ever see them again. Through a new attorney, he now has increased access by phone and visitation, a process he hopes will evolve as time goes on.

    September 9 – 15 was Suicide Prevention Week. If you know a Veteran who may be having an emotional crisis, get them the help they need by calling 1-800-273-8255, press 1 for Veterans.

    Source

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  • VA Delays Nearly Kill

     

    TEMECULA, Calif. (KABC) -- Brian Tally is a military Veteran, a husband, a father of four - and until a few years ago - a successful small business owner. Now, he spends much of his day in a beat-up recliner chair, the only relief he says from unrelenting pain.

    "There's not a day that goes by that I'm not in pain," Tally said. "This is the only thing that takes the pressure off my spine."

    Brian served four years in United States Marine Corps, but now he's in what he calls the fight of his life.

    Brian's downward spiral began in January 2016. Severe back pain, night sweats - he made urgent phone calls to his primary care doctor through the Department of Veterans Affairs. She prescribed painkillers over the phone.

    The pain only got worse. He went to the VA's emergency room in Loma Linda twice. Both times - he did not get to see a doctor. And twice - no one ordered a simple blood test.

    "I was on the floor, I was in traumatic pain...I was literally in tears," Brian recalled. "They gave me an X-ray and the VA ER in Loma Linda diagnosed me with having a low back sprain and told me to go stretch."

    He was seen by a nurse practitioner both times, but again - no doctor.

    Brian followed up, as instructed, with his primary care physician at the VA clinic in Murrieta.

    "She looked at the two ER reports and she agreed with the original diagnosis - the two diagnoses the ER nurses gave me," Brian said. "She told me to stretch. She ordered more pills."

    His primary care doctor did request a consult with orthopedics, but Brian said he was unable to get an appointment. Scared and in debilitating pain, Brian and his wife paid out of pocket for their own MRI.

    "My wife made the decision," he said. "She goes - you're down 40 pounds, you have these crazy night sweats, you can't use the bathroom properly - there's something wrong. This doesn't happen to a 39-year old guy."

    The MRI revealed "severe spinal stenosis" - a narrowing of the spinal canal - and edema - a swelling of the spinal canal. Once Brian gave VA doctors the MRI that he paid for himself - the VA finally agreed this was more than just a back sprain - Brian needed surgery.

    But again there were more delays. The VA could not fit Brian in for surgery for nine long months.

    "If I would've went another month and a half, I would've died," Brian said. "I would've died in my chair."

    A nine-month wait was unacceptable to Brian and his wife Jenny. They pushed for an earlier surgery date and the VA agreed to pay for a surgeon outside of the VA system.

    SURGERY REVEALSLIFE-THREATENING INFECTION OF THE SPINE

    "So, had you waited another six months, that would have been disastrous to his bone," said orthopedic surgeon Dr. Jean-Jacques Abitbol of the California Spine Group in San Diego.

    Abitbol performed Brian's surgery and said that MRI combined with other symptoms, including difficulty urinating, were an ominous sign and should have been a red flag to VA medical practitioners.

    "The bone at the very bottom could've collapsed down, he could have had permanent neurological problems - he could have been paralyzed," Abitbol told Eyewitness News.

    On the operating table, the news went from bad to worse. An aggressive staph infection was eating away at Brian's spine.

    "This kind of bacteria, if not taken care of, can get into the blood and cause what's known as sepsis - and ultimately result in system-wide failure of the organs and ultimately death," Abitbol said. "A term we sometimes use is 'moth-eaten.'"

    Abitbol told Eyewitness News a blood test by the VA likely could have spotted the infection before Brian suffered permanent injury. But, again - that never happened. Severe damage to Brian's nerves led to erectile dysfunction, urinary incontinence and bowel issues - along with herniated discs in his neck, causing constant pain.

    "It's like you've got an ice pick that's being driven through your neck," Brian said.

    JUSTICE DELAYED... THEN DENIED. LEGAL LOOPHOLE SHIELDS VA'S INDEPENDENT CONTRACTORS

    Once Brian realized the damage was permanent, he filed a medical malpractice - or tort claim - against the VA.

    But suing the federal government, or one of its agencies, is not the most straightforward process. First you have to file a claim under the Federal Tort Claims Act - and then wait six months for a response or an offer to settle your claim out of court. Only then, can you file an actual lawsuit.

    "They misdiagnosed me not once, not twice, but three times," Brian said.

    Brian followed the rules and filed a tort claim against the VA in March 2017. He then waited the required six months, before learning his claim had been shuffled to a different office as part of a "realignment" and staff reduction at the VA's general counsel office.

    Still, Brian was hopeful because he said the new VA attorney handling his tort claim told him that a financial settlement was likely - and that an expert for the VA concluded his primary care physician had failed the standard of care.

    "She used these exact words - the VA failed to meet the standard of care and there was a breach - and that there's liability involved and the VA is looking to settle your case," Brian said.

    But eight months after he filed the claim, that same VA attorney dropped a bombshell. It turns out that Brian's physician was NOT a VA employee - she's an independent contractor for the VA, and under federal law the VA is not legally responsible for negligence by its contractors.

    The VA attorney told Brian there would be no settlement even though their expert agreed the primary care physician had failed the standard of care.

    "She has a VA