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  • Tricare provider

     

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

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

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

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

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

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

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

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

    Help spread the word

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

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

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

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

    Source

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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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  • Fix VA Nursing Homes

     

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

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

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

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

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

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

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

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

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

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

    VA 'striving to improve'

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

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

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

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

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

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

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

    Call for transparency

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

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

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

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

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

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

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

    Lawmakers demand answers

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

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

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

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

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

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

    Source

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  • 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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  • BWN Vets 43 Yrs Later

     

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

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

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

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

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

    Operation Ranch Hand

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

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

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

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

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

    VA: Too much money, not enough science

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

    Where the ships were located makes all the difference.

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

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

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

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

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

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

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

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

    Veterans and advocates say that's 'poppycock'

    The Veterans won't face this battle alone.

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

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

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

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

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

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

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

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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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  • 7 Investigates

     

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Full Statements

    From Sen. Tammy Baldwin:

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

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

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

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

    From Rep. Sean Duffy’s spokesperson Mark Bednar:

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

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

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

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

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

    VA Public Affairs statements

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

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

    Q: When are Veterans eligible for Staab Rule reimbursements?

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

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

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

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

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

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

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

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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."

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  • Vet Suicide Conv

     

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

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

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

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

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

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

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

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

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

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

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

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

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

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  • Donald Trump 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.

  • Robert Wilkie 10

     

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

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

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

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

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

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

    Wilkie takes charge

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

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

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

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

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

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

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

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

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

    Resisting outside influence

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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  • Dave Zielinski

     

    The Vietnam War has claimed another soldier.

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

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

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

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

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

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

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

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

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

    It didn’t. He became a police major.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Kelley is sure his will not be an unvisited grave.

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  • AO Ships Logs

     

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

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

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

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

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

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

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

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

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

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

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

    “Now I had the proof,” he said.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    The Navy did not answer questions for this story.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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  • 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."

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  • AZ Homeless Vets

     

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

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

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

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

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

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

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

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

    Source

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  • Antibiotic Resistance

     

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

    Antibiotic Resistance and Food Production

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

    Improving antibiotic use can help slow antibiotic resistance.

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

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

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

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

    What CDC is doing

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

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

    Protect yourself and your family

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

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

    Source

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  • 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.

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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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  • James Woods

     

    Updated: After actor James Woods used his Twitter account to call attention to a Veteran who sent a distressed tweet, authorities located the man who had tweeted he was contemplating death by suicide.

    "After numerous attempts to locate (Andrew) MacMasters yesterday, several of our officers were able to make contact with him to verify his well-being as well as ensuring that the appropriate resources were made available to him in reference to his tweet," Maitland (Fla.) Police Department Lieutenant Louis Y. Grindle told USA TODAY.

    The "Salvador" actor, 71, alerted the Orlando Police Department Monday night and asked authorities to perform a wellness check on MacMasters, a former Marine.

    "A man named Andrew MacMasters just said on @Twitter that he is sitting in a parking lot and is going to kill himself," Wood tweeted to his nearly 2 million followers. "He’s sitting with his dog, a black lab, possibly in a WalMart parking lot."

    Woods' plea for help included a screenshot from MacMasters' Twitter account, which has since been deleted.

    "I'm on Twitter every day, I retweet all the time but this is the first tweet I've ever written," user @macmasters_a tweeted Thursday. "I'm (a) good guy, I'm a Veteran, I love America. I'm gonna kill myself tonight. I've lost everything I have nobody, nobody cares."

    Woods responded to MacMasters' cry for help in a series of tweets, initially asking the Veteran to "tell me where you are."

    "We can talk. I don’t care what anybody thinks. Do you? Let’s have a conversation. Just you… and I," Woods said in one tweet to MacMasters, adding in another, "I’m following you now, so you can DM me. We can talk privately. Or we can talk openly right here. Lot of people worried about you right now."

    The actor tried to engage the distraught Veteran: "Someone said you’re Andrew. In Orlando? Im not trying to trap you. Let’s just talk. You also have your dog. Your little schnoot. Boy or girl?"

    "So think about this. A lot of Vets, I understand, have come to where you are tonight," Woods continued. "If you could just push this decision off tonight, at least, maybe you would also inspire another Vet to seek help. You could save another man, too. By waiting to do this."

    In 2016, the most recent data available, the Department of Veterans Affairs said about 20 Veterans a day take their own lives, a suicide rate 1.5 times greater than Americans who never served in the military. And Veterans accounted for 14 percent of all adult suicide deaths in the U.S. in 2016, even though only 8 percent of the population has served.

    In a last-ditch effort, the actor tried to comfort MacMasters. "I’m driving cross country. Sitting in a motel room. I have all night. I know that sounds dorky, but here I am! I would love to talk. Just talk. I won’t push you into anything," he said.

    Once it was clear the suicidal Veteran could no longer be reached on Twitter after deleting his social media account, Woods turned to his followers to gather information on MacMasters' location.

    The "Casino" actor learned his home address and forward it to authorities in Maitland, Florida, who promptly checked his residence. MacMasters was not there.

    "If only Andrew could see the THOUSANDS of fellow Americans who are pulling for him. It’s like he’s lost behind enemy lines and we are cheering him home, willing him to survive," Woods tweeted. "Andrew, do this for the 'other 21' Vets a day who don’t make it home from the darkness. Stay alive!"

    Woods continued to update the search on Twitter, sharing tweets from people who notified MacMasters' family, including the Veteran's mother and brother.

    Maitland Police Public Information Officer Lt. Louis Y. Grindle informed USA TODAY Tuesday morning that authorities were able to reach MacMasters, though his whereabouts are unknown.

    "Our agency was able to make contact with him by phone earlier this morning, where he advised he was OK but did not wish to have contact with law enforcement," the emailed statement read. "Our officers are still working to try and physically locate him to determine his well-being."

    Woods, who frequently uses his Twitter page to share his conservative political views, recently used his account to help link people together with family members following the California wildfires.

    Source

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  • 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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  • Robert Wilkie 13

     

    U.S. Veterans Affairs Secretary Robert Wilkie doesn’t want any sunlight on his agency’s “shadow rulers.” By blowing off a recent congressional document request, Wilkie is blocking the public from determining whether a secretive trio of outsiders is calling the shots at the VA.

    Wilkie was just confirmed by the Senate in late July. His handling of the data request from the House Veterans’ Affairs Committee raises serious questions about his judgment so early in his tenure. After the scandal involving clinic wait times, public faith in the VA is lagging. Yet Wilkie’s stunning refusal last month to turn over the documents undermines trust even further, creating the damning perception that his priority isn’t Veterans but protecting the three outsiders, all of whom belong to President Donald Trump’s glitzy Mar-a-Lago club.

    The Pulitzer Prize-winning ProPublica news organization first reported about the behind-the-scenes decisionmakers in a story published Aug. 7. E-mails and other documents obtained through the Freedom of Information Act revealed that the three have “leaned on VA officials and steered policies affecting millions of Americans.” They weighed in on high-level staffing changes, meddled with a major software contract and pushed the agency to make a seismic and expensive push — outsourcing care to private providers.

    One of the three also wanted the agency to bring in his son to develop an app. Despite this access to agency inner circles, none of three men ever served in the military. Nor is their expertise relevant. The three men are: Marvel Entertainment Chairman Ike Perlmutter, attorney Marc Sherman and Bruce Moskowitz, a doctor who runs a company catering to wealthy medical patients.

    The congressional request for additional documents, filed on Aug. 8 by Rep. Tim Walz, the Veterans’ Affairs Committee’s ranking member, is sensible. The documents obtained by the reporters may have been redacted. The congressional request would also go beyond the correspondence the reporters were able to obtain through the Freedom of Information law. A thorough review is a must, especially when Veterans sense that “an ideological war is being waged within the VA below the radar of the media and of the public,’’ said Paul Rieckhoff, founder and director of the Iraq and Afghanistan Veterans of America advocacy group. “Veterans’ healthcare, benefits and general well-being are ending up as collateral damage.”

    Yet on Sept. 15, Wilkie tersely declined the House committee’s document request. His reasons do not hold up to scrutiny. He said the documents are the subject of ongoing litigation. Yet that lawsuit was filed after the congressional committee’s data request. And its existence does not exempt the agency from complying with the committee’s request.

    Walz, who is also the Minnesota DFL gubernatorial candidate, gave a deadline extension — until Oct. 31 — in a forceful letter this month. It is Wilkie’s best interest to meet that. Failure will sour the VA’s relationship with a key oversight committee and will only accelerate the public trust deficit in him and the agency.

    A noncommittal response this week from a VA spokesman about whether Wilkie will release the documents did not inspire confidence. Wilkie made a mistake saying no once. He owes it to his agency and more important, to the 9 million Veterans served by VA medical facilities, to correct course.

    Source

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  • 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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  • VA Qtrly Research

     

    Dr. Steve Martino is chief of psychology at the VA Connecticut Healthcare System and professor of psychiatry at Yale School of Medicine. He specializes in the treatment of patients with substance use disorders, including those with co-occurring conditions. He also does research in the area of implementation science and how to move best practices into real-world clinical settings.

    Dr. Marc Rosen is an addiction psychiatrist at the VA Connecticut Healthcare System and professor of psychiatry at Yale School of Medicine. He is the director of addiction recovery services at VA Connecticut, and conducts research on substance use disorders and related problems for affected Veterans.

    KEY POINTS:

    • Dr. Rosen and his team conducted a pilot study that used the VA compensation and pension exam to engage Veterans who were applying for a service-connected disability because of musculoskeletal pain.
    • The pilot study showed that Veterans assigned to brief counseling were more likely to obtain pain treatment at a VA facility than those receiving the usual compensation and pension exam without additional counseling.
    • The pilot study also showed that when Veterans with risky substance use were assigned to counseling, they were significantly less likely to engage in risky use than those not assigned to this counseling.
    • The new study involves delivering the counseling by phone from a single hub site to Veterans having compensation exams throughout New England.

    VARQU spoke with the two researchers about their work on chronic pain management among Veterans.

    The Department of Defense, National Institutes of Health, and VA have just co-funded a large grant to study non-drug approaches to pain management. What is the significance to the VA health system?

    Dr. Rosen: This project has the potential to engage Veterans early in non-opioid pain treatment, and interrupt what can really be a harmful and dangerous course.

    How did VAConnecticut become part of the larger grant?

    MR: There are about 600,000 post-9/11 Veterans who are service-connected for back or neck pain. We had a developmental grant to intervene with people who were applying for service connection for musculoskeletal disorders. In the pilot study, most of the Veterans applying for service-connection for musculoskeletal disorders had considerable pain and impairment, and a high proportion were engaged in risky substance use. We found that they were amenable to intervention and that it helped them engage in VA pain-related treatment.

    Dr. Martino: In addition, we also found that as a result of the early intervention, Veterans reduced their risky substance use, as well. So we thought that this was a very promising approach to bring forward to the grant application.

    Can you tell us about your study, "Screening, Brief Intervention, and Referral to Treatment for Pain Management"?

    MR: That's the title of the study, actually; it’s not the title of the grant. I like the title of the grant better, it's more descriptive. The title is actually a pretty good summary: "Engaging Veterans Seeking Service Connected Payments in Pain Treatment."

    So why is that a good point in time to have this discussion with Veterans? Why not in the clinician's office?

    SM: Well one of the main reasons is these Veterans may not be in the health service system of the VA. They are reporting problems they are experiencing, and may not be aware of the services they could avail to help themselves. There's traditionally been a limited amount of information provided to Veterans at the point at which they are seeking a disability compensation exam, just because the nature of the exam is really determination for disability, not a clinical assessment.

    Marc's work has been fairly innovative in trying to use this as a point to provide Veterans who are seeking disability evaluations an opportunity to learn more about what is available to them and try to engage them in various services. And so that's why we think this is a great opportunity to work with Veterans who are experiencing chronic pain and who may have risky substance use—to try and get them engaged in services that they currently are not participating in.

    Can you walk us through a brief description of this intervention?

    MR: We talk to the Veterans a little bit about their claim: We ask them about their pain and inform them of the variety of services available at the VA health care system. We explain that pain treatment can involve not only medication, but also attending to other aspects of whole-body health. We then allow that many people in pain drink or use drugs to relieve their pain, and ask the Veteran about the extent of his or her substance use.

    There's a format for this type of brief substance use counseling that Dr. Martino is an expert in. We follow that format to engage Veterans in reducing their substance use. That style of working with people is based on motivational interviewing. And so a large part of what we are doing is to motivate Veterans to participate in non-drug treatments, and commit to reducing or stopping their risky substance use. And engaging in specialized addiction services if that makes sense and they are willing to do so.

    Part of the counseling involves not giving people exactly what they are expecting. The Veterans are coming for a compensation claim, and we are trying to say, "Hey, there are also some treatments available here that you are entitled to—that you've earned." We are also taking Veterans whose presenting complaint is pain and saying, "Substance use is something that could make your pain worse. Here are some ways you might want to think about that." We think that Veterans who have filed a claim are at a teachable moment.

    How is motivational interviewing different from a traditional doctor/patient interaction?

    SM: Motivational interviewing has been around for several decades. It began in the risky alcohol use field, and then has cut across all types of behavioral problems where motivation is part of the issue—particularly in the medical field. So the style of interaction really involves being very patient-centered, being empathic, collaborative, being compassionate to the needs of patients, and in particular being attentive to the ways in which patients speak about their problems that might support them making a change.

    So what people do when using motivational interviewing as a framework is try to illicit or draw out people's reasons for change and get people to elaborate more about those matters, such that they talk themselves into changing based on their own motivation. It's a way of helping people talk themselves into changing based on what is unique about their own experiences.

    You mentioned whole-body wellness earlier. Many studies show that opioids are not effective for long-term pain. What are some of the other treatments that might help patients deal with their pain?

    MR: There are non-opioid medications. There are various physical treatments like physical therapy, exercise and activity, chiropractic services. There are mind-body based treatments like yoga and mindfulness. And there are psychological treatments like cognitive behavioral therapy and relaxation techniques. And finally, treating other issues that make pain worse: poor sleep makes pain worse, depression makes pain worse. Treating conditions that we know how to treat well can make a big difference.

    SM: The mantra is that people need multi-modal pain care, and that the idea of medication as the sole form of treatment for chronic pain relief is misguided. We are trying to help people find a variety of ways in which they can approach pain treatment in order to get the best possible outcomes.

    MR: There is a vicious cycle that people in pain can get into, in which they become less active, which is depressing. They don't sleep well which worsens their overall physical condition, which worsens their pain. A lot of these treatments involve interrupting that vicious cycle.

    Can you tell us about the different phases of your study?

    SM: For all of these grants, there is an initial preparation phase where we have to meet certain milestones to prepare for the pragmatic trial. That's a two year process. And at the end of the two years, those grantees who are successful in meeting their milestones presumably will continue to be funded for a four-year pragmatic trial. And we fully expect to be successful and be funded for pragmatic trial.

    We have several things that we will be doing in phase one. First because we will be moving from the pilot trial which was done at VA Connecticut to all eight medical centers in VISN 1, we will get a grip on how pain care services and addiction services are delivered at each of those medical centers.

    We will be doing semi-structured interviews and qualitatively analyzing them, to appreciate the various factors that are at play at each medical site. We'll be talking with community medical providers and administrators and primary care folks, including nurse care managers, and anyone else who can tell us what's unique about their medical center.

    We will also be pilot testing this early intervention with five Veterans at each of the medical centers. The original trial was done face-to-face, in person. For this trial we will be using a hub-and-spoke model—so they'll be clinicians based in VA Connecticut who will be delivering the intervention entirely by phone. We want to see how that goes and if there are any adjustments that we need to make before we go to the full trial.

    Another key feature of the two-year preparation phase is it is very hard to characterize Veterans' use of non-drug treatments. There aren't codes for many of these treatments in the electronic medical record. So we have partnered with investigators from George Washington University to use what's called natural language processing, to develop algorithms that will basically use computer programs to screen CPRS (Computerized Patient Record System) for Veteran's use of non-drug treatment modalities.

    Another important piece of this study is the cost-effectiveness. How much is this all going to cost? And what kind of impact will this have on the budgets of medical centers, if they wanted to implement this if we were to be successful? So we also have a health economic component to this, and we will also be devising our methods for costing out everything for the trial.

    If this all works, would it be something that the clinicians could provide at the different medical centers, or would it be delivered through telehealth?

    SM: One of the reasons why we decided to do this within a VISN is because the VA is organized in regions—networks of medical centers organized together. Our hope would be if we could demonstrate this hub-and-spoke model, centered in a VISN, is effective, then it could be replicated in many other VISNs across the country. So we would be advocating for a telehealth means of administering this, which would provide greater access to people who may not be able to physically get to a medical center or who receive most services at rural sites across the country.

    MR: One feature of the VA that would facilitate the adoption of this is that VA regions receive capitated payments for each Veteran, but the amount of payment is based on what services the Veteran receives. So if a Veteran comes to a hospital and only has a compensation and pension exam, that region gets a limited amount of money. If providers engage the Veteran in treatment, the region gets more money for that Veteran. So unlike in some other healthcare systems, the region doesn't lose money by providing more comprehensive care.

    What are your long-term goals for this study?

    MR: Our first goal is to test the intervention as proposed. We tested this at a single site: It was done through face-to-face encounters, and it was promising. This next study is needed to see if it works in a setting in which we are treating many more people by phone, which is likely going to be less expensive and more easily spread throughout the region.

    So the first goal is to evaluate the cost and benefits of this intervention, and see what works in the real world, not just in a research setting.

    If it does works, then we would like to see it rolled out nationwide. We are not testing in some super complicated, super expensive form that couldn't be done anywhere else. We are testing it as a relatively simple phone call and evaluation and referral. The hope is, if the results merit it, that this will be adopted in other regions.

    SM: That last point I think is very important. The way we are studying this is consistent with the way that services are often delivered in VA. So we are hoping that this will make it attractive to the broader health care system because they will be able to relate to it. From an implementation standpoint, it won't be discrepant with what is commonly done here.

    MR: Sometimes it is hard to get health care systems to do things that will bring long-term benefits because the problems are subtle or the harms are long term. The harm from the opioid epidemic isn't subtle, and there's a real consensus that we need to treat pain better, and intervene early. In this case, I don't think it will be hard to convince decision makers that early, better pain treatment is necessary; this is a cause that people have embraced.

    SM: The other feature of this study that I think will be attractive to providers is we are creating a model where the providers are not going to be asked to do much more than what they are already doing. We are creating a system that complements what they are doing. One of the things that you hear constantly when you try to bring more behavioral interventions into medical centers is "We are too busy." They are very taxed. Asking them to do one more thing that is often seen as outside of their usual scope of practice is a difficult ask. So this is something that we think clinicians have not only embraced as a goal, but have embraced because it is not taxing all the other duties and responsibilities that they have.

    Source

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  • Burn Pit Widower

     

    It was in 2009 when Brian Muller first met his wife, Amie.

    "We actually met at a music venue. And at the time I was playing music in a band and she had some friends there that were at the event," Muller, 45, from Woodbury, Minn., recalls in a recent interview with Fox News. "Her friends forced her to go out. I forced myself to go out and just to see some music."

    He remembers how they discussed her service with the Minnesota Air National Guard.

    "We ended up talking about what she does with the military," he says, "and at that time, she was doing a project to make video memorials for gold star families. Families that lost loved ones in Iraq or Afghanistan or any type of war."

    "She asked me to write a song for those videos. And that's how we kind of started our relationship, as-- friends, and then it developed from there."

    Brian has never served in the military but was impressed by Amie's service -- including her two tours in Iraq.

    "She wanted to fly, and she joined the Air Force. And she got deployed and had her life kind of uprooted there for a while."

    Amie was stationed at the Iraqi air base in Balad during both of her tours in 2005 and 2007. While her active service was already behind her, the effects from her time on that base still lingered.

    "She didn't really want to talk about her time over there," Brian says. "Anytime a door would slam or a loud noise, she'd get startled very easily. She had a lot of PTSD [episodes] from just little things."

    A decade after returning from Iraq, Amie's physical health also suffered. She was diagnosed with Stage III Pancreatic Cancer.

    "I still remember Amie getting the call, and she looked at me," Muller says about the day they found out about her diagnosis back in April 2016.

    "We walked around the corner just to make sure the kids didn't see. I could tell by the look in her face how scared she was. And I just kind of listening in to the call. And we just started shaking.

    Both she and Brian believed it was related to her exposure to open-air burn pits used to destroy trash generated on the base. Nearly every U.S. military installation in Iraq during the war used the crude method of burn pit disposal, but Balad was known for having one of the largest operations, burning nearly 150 tons of waste a day.

    The smoke generated from these pits hung above Amie's barracks daily.

    "She talked about the burn pits even before she got cancer," Muller recalls, "and how the fact that they would change the filters on these ventilation systems quite frequently. And every time they'd change it would just be this black soot, so thick that you would think you'd have to change it every hour."

    "After she told me what they were burning, you know, all I thought about is all the campfires that we had in our backyard. You don't burn Styrofoam. You don't burn plastic. We all know that, but they were burning all those things. Highly toxic."

    As early as Operation Desert Storm in 1991, burn pits were used at U.S. military bases in Iraq. At the height of the Iraq War in 2005, more than 300,000 troops were stationed there and potentially exposed to the smoke and fumes from burn pits.

    Thousands of Veterans and former contractors returned from the Middle East and have developed rare cancers, respiratory problems, and blood disorders from what they claim are their exposure to toxins from the flaming pits. More than 140,000 active-service members and retirees have put their names on a Burn Pit Registry created by the Department of Veterans Affairs.

    After Amie was diagnosed and her treatment began, she and her family went public with her story in the hopes that it would bring awareness to the dangers she and countless Veterans faced after what they believe was a result of burn pit exposure.

    Amie succumbed to her illness just nine months after she first diagnosed.

    In her absence, Brian continued Amie's work in raising awareness by sharing her story. He also worked closely with Sen. Amy Klobuchar, D-Minn., toward getting "The Helping Veterans Exposed To Burn Pits Act" -- a bipartisan bill recently presented in Washington and signed by President Trump -- passed.

    The bill will help fund a new center by the Department of Veterans Affairs that will study the effects of burn pit exposure and eventually assist with treatment plans. He also started the Amie Muller Foundation, which helps other Veterans who were diagnosed with pancreatic cancer.

    "I just hope that our Vets are going to get the help they need," Brian says, "and it's not going bring back Amie, my wife, but it's going to get Veterans the help they need."

    But recent findings show that the Pentagon was aware of the dangers of burn pits during the height of the war in Iraq.

    Fox News recently obtained a series of memos drafted by top officials at Balad during the same years that Amie served at the base. The authors of the documents -- which include commanding officers as well as environmental officials -- stated that the operation of burn pits was a danger to those stationed there and that precautions needed to be taken urgently to improve conditions.

    "In my professional opinion, there is an acute health hazard for individuals," reads a line from one memo written by a Bioenvironmental Engineering Flight Commander and the Chief of Aeromedical Services at Balad in 2006. "There is also the possibility for chronic health hazards associated with the smoke."

    The memo also includes an assessment of the pits in Balad where one environmental inspector said that Balad's burn pit was "the worst environmental site I have personally visited."

    After inquiries by Fox News regarding the memos, Officials for the Department of Defense said that they would look into the matter and explained their procedural policy and that open-air burn pits are to be operated in a manner that prevents or minimizes risk.

    "DOD does not dispose of covered waste in open-air burn pits during contingency operations except when the combatant commander determines there are no feasible alternative methods available," reads the statement provided by a Defense Department spokeswoman. "DOD minimizes other solid waste disposal in open-air burn pits during contingency operations. Generally, open-air burn pits are a short-term solution. For the longer term, we use incinerators, engineered landfills, or other accepted solid waste management practices whenever feasible."

    Muller finds the memos troublesome.

    "I don't understand why they didn't do something," he says after being shown a copy of the memos. "These are people that volunteered to serve our country, and it just disgusts me to see memos like that, from high ranking officers that expressed this concern."

    Muller adds that the underlying issue is a lack of accountability.

    "The issue is they were doing something they shouldn't have done, that they constantly warned was an environmental hazard," he says. "And our Vets are getting sick. Our Vets are dying."

    "You know, there was a fellow that did a video--'Delay, Deny and Hope You Die.' And that's kind of what's been going on. They're delaying this as long as possible so that they won't have to deal with as many claims, because most of them will die before they do anything about it."

    Muller also believes that Amie would have never fallen ill if it wasn't for the fact that she was stationed at Balad.

    "I don't think she would have gotten cancer. I really don't. Maybe she would have later in life. Maybe it would have been some other type of cancer. I don't know," he says. "But something caused inflammation -- for something to grow in her body for a long period of time before it was ever seen and diagnosed. There was something going on with all of the Vets when they got back."

    In a recent interview with Fox News, Gen. David Petraeus, the former commander of U.S. Central Command and Multi-National Force-Iraq in 2007, offered an explanation when asked about why burn pits were used on military bases, conceding that the realities of war kept concerns about how to dispose of waste a low priority at that time.

    "At that time we weren't worried about burn pits," The general said back in September. "We were worried about just getting enough water for our troops in the really hot summer. We were looking forward to the time where we might get some real food, real rations, as opposed to MREs and so forth."

    The general also expressed that the U.S. has a commitment toward helping those Veterans.

    "It's a sacred obligation," Petraeus said. "But comparing what our VA does to any other country's care of Veterans... this is the gold standard. Certainly, a gold standard that can always improve, without question. This is an issue, though, where we have a sacred obligation, and we need to meet that obligation."

    Muller believes the general's recent comments to be a sign of a move in the right direction.

    "When you start seeing men in uniform, or women in uniform, people higher up in the military starting to voice their concerns, you know we're making progress."

    Source

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  • Wait Times 002

     

    The VA Debt Management Center just announced it reduced call wait times by over 75 percent while also increasing calls taken by 40 percent from 2016 to 2018.

    As part of the agency’s Veteran-focused initiatives, they agency reduced call wait times from 21 minutes in 2016 to under 5 minutes during 2018. The initiatives include increasing staff levels, improving technology, and driving better employee development.

    “The team at the DMC has enhanced services to our Veterans,” said VA Secretary Robert Wilkie. “It’s our mission to take care of our Veterans, no matter what their needs are. DMC is in concert with our priority of improving customer service and will continue to gather customer feedback through direct feedback, surveys and outreach in FY19 to further enhance the Veterans’ experience.”

    According to the press release:

    For the past three years, DMC received around 1 million calls annually with an average call wait time of about 21 minutes. In FY 2017, DMC launched a series of internal efficiencies and process improvements to enhance contact center capabilities.

    Initiatives included enhancing staffing levels to meet demand, enhancing contact center technology, focusing on employee development and engagement, and implementing an automated 12-month payment plan.

    These Veteran-focused initiatives represent a 79 percent reduction over two years to the average time for waiting and a 40 percent increase of actual calls taken. These are all indicators of successful initiatives providing a better experience for Veterans and VA employees.

    The DMC’s inbound contact center serves as the central point for Veterans and their family members to make payment arrangements, or receive guidance regarding the collection process on overpayments which could include debts created from education or pension payments.

    Debt counselors at the DMC work with callers in a professional and service-oriented manner to help them understand their options to address overpayments with Veterans either through extended repayment plans, the dispute process, compromise process or waiver process

    DMC’s contact center provides debt counseling for the Veterans Benefits Administration, and consolidated collection services of non-health care debt for Veterans Health Administration and National Cemetery Administration, enabling these entities to focus resources on accomplishing their core missions.

    DMC has provided centralized debt collection programs of Veteran benefit overpayments since 1975 and became a fee-for-service Enterprise Center in 1996.

    This is great news for Veterans trying to deal with the agency as a debt collector.

    LACK OF INFORMATION

    What is not great is the amount of information the agency publishes for Veterans dealing with the Debt Management Center for the first time. The agency gives us little information about how to advocate for yourself and what elements of your fact set to focus on when creating your argument – – whether for a waiver or to plainly dispute the alleged debt in full.

    They instead focus on how to pay and how to submit a waiver with no limited discussion of disputing the alleged debt in full.

    Ever have a run in with DMC? If you have a debt story, I would like to hear it below.

    Any idea how the Fair Debt Collection Practices Act might apply to VA or one of its contractors attempting to collect an illegitimate debt from a disabled Veteran?

    Source

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  • Unsterile Tools

     

    When the Department of Veterans Affairs released the annual ratings of its hospitals this fall, the facility in Atlanta dropped to the bottom, while the one in West Haven, Conn., shot to the top. It was something of a mystery as to why.

    The Atlanta hospital was downgraded to one star from three on the agency’s five-star scale, even though there had been only a “trivial change” in its quality data from the year before, according to the department. The Connecticut hospital climbed to five stars from three, even though numerous operations had to be performed elsewhere or canceled at the last minute because of problems with sterilization of surgical tools, according to an internal assessment and other accounts cited by Senator Richard Blumenthal in a letter to the agency.

    Veterans Affairs set up the rating system in 2012 in the hope of pushing its hospitals to improve, and it has been increasingly aggressive in using the ratings to hold hospital managers accountable. Leaders with low ratings can be ousted, as happened last week in Atlanta, where the chief of staff and heads of the emergency department, primary care and clinical access services were removed because of low scores.

    But former senior officials at the agency and experts in health care metrics say the system can be confusing, and so arbitrary that hospitals may gain and lose stars based only on statistical error. More than a dozen hospitals improved care but lost stars; another did not improve and gained one.

    What is most worrisome to some experts is the role that the star ratings now play in grading performance of hospitals and their managers. They say it creates an incentive to conceal problems rather than grapple with them, in order to collect bonuses or sidestep penalties.

    “It’s a big mistake,” said Dr. Ken Kizer, a former under secretary for health at Veterans Affairs who is widely credited with pioneering the use of health care quality metrics at the agency.

    Dr. Kizer said that it made sense to track quality measures when the goal was improving patient outcomes, and the agency had made important strides in that way. But he said that using the data to single out hospitals for discipline could lead to problems like the 2014 wait-time scandal, when managers who could not meet goals for prompt scheduling of patient appointments started keeping secret off-the-books waiting lists.

    “It’s the same pathology that perverted things then,” Dr. Kizer said. “As soon as you tie metrics to pay or performance, they become subject to gaming.”

    The gaming can put patient care on the line. At the hospital in Roseburg, Ore., administrators turned away some of the sickest patients to keep them from affecting the facility’s scores, doctors there have said.

    The chief of surgery at another Veterans’ hospital in a major metropolitan area said in an interview that administrators discussed whether the hospital should not perform certain operations because they could impact the hospital’s quality statistics.

    “That kind of thinking is driven by these ratings,” said the surgeon, who spoke on the condition of anonymity, adding that he feared being fired if he spoke publicly. “My life right now is continuously filling out reports and going to meetings, trying to figure out how to improve the numbers.”

    There is broad consensus in health care that quality should be tracked and reported, but little agreement on the best way to do it. As in education and law enforcement, a drive to collect data and use it to direct strategy has led to both improvements and frustrations. Often, experts say, the way care is measured can alter the care itself, and not always for the better.

    The Department of Veterans Affairs defended its hospital rating system, saying in a statement that it “has been successful in moving systemwide performance upward.” But the department declined to make key officials available to discuss the system.

    The ratings may soon take on even more importance. A law signed in June may allow more Veterans to get care from private providers if Veterans’ hospitals fall short of performance standards.

    Veterans Affairs has been tracking hundreds of health care metrics for decades, but it had no overall performance gauge for its 146 hospitals until 2012, when it started using a process called Strategic Analytics for Improvement and Learning, or Sail, to combine many of the metrics into a single score. Executive performance and pay were tied to Sail scores in 2015 in the wake of the wait-time scandal.

    The department has reported steady improvement in Sail scores, noting in September that 71 percent of Veterans’ hospitals did better this year than in 2017. But experts say some of that improvement may exist only on paper.

    The former quality director of a large Veterans’ hospital with a five-star rating, who spoke on the condition of anonymity to avoid harming a continuing relationship with the agency, said the hospital employed two analysts whose full-time job was to find ways to improve the Sail data. Some of their work focused on spotting ways that services could be improved, but much of it focused on finding ways to improve the numbers, such as by changing how patients’ conditions were entered in hospital records. “We learned how to take the test,” the director said.

    Sail was designed by Dr. Peter Almenoff, a longtime hospital administrator who was moved to a quality control post in the department in 2008 despite questions about his track record. This spring he was also put in charge of the team that revamps hospitals that get low ratings.

    The department refused multiple requests to interview Dr. Almenoff, and he did not respond to direct inquiries seeking comment.

    Veterans Affairs now relies on Sail to warn about failing hospitals. But Dr. Stephan Fihn, who was the department’s chief quality and performance officer before he retired this year, says the system is not reliable.

    “It has serious flaws and always has,” Dr. Fihn said. “The first is statistical: The numbers may not be mathematically sound. Second, it’s not transparent and lacks independent oversight.”

    A draft internal evaluation in 2014 found that combining dozens of metrics into a single Sail score was “akin to adding apples and oranges and trying to express the total as the number of pineapples.”

    An outside audit in 2015 found that many of the score’s ingredients had “never been assessed to see if they were actually valid measures of quality,” and that hospitals could gain or lose a star solely from statistical error.

    According to the report, 70 percent of Veterans’ hospital directors interviewed by the auditors with a promise of anonymity said Sail scores did not accurately reflect the quality of their hospitals.

    The New York Times contacted eight Veterans’ hospitals, including those in Atlanta and West Haven, asking to interview their directors about Sail. None were willing.

    “A lot of people don’t like this system, but they won’t speak up because they are afraid of what will happen,” Dr. Fihn said.

    Problems in measuring health care quality are not confined to Veterans’ hospitals. A 2015 comparison of four popular commercial systems used by private hospitals found their ratings so inconsistent that not one of the 844 hospitals examined earned a top rating from all four.

    Medicare tried to institute a five-star hospital grading system, but postponed releasing the latest results indefinitely in July after several hospitals threatened to sue, saying the grading method was inaccurate.

    Veterans’ hospitals, however, do not have that option, nor can they choose among commercial rating systems.

    The department says its star ratings help keep Veterans informed. But Dr. David Shulkin, who was President Trump’s first secretary of Veterans affairs, says the stars are not much help in gauging progress from year to year or in making comparisons with nearby civilian hospitals, because Sail grades Veterans’ hospitals on a national curve.

    “It’s not useful for our patients. It’s confusing. I wanted to move away from Sail,” said Dr. Shulkin, who clashed with political appointees in the department and was dismissed by Mr. Trump in March.

    Agency employees say that only Dr. Almenoff and a few members of his staff know exactly how the system weighs and adjusts the 60 publicly available measures that go into a score.

    “That’s the problem with Sail — what happens to make the scores is invisible,” Dr. Fihn said. “A person could move the stars arbitrarily, and you would have no way of knowing.”

    That lack of transparency became a problem for Lisa Nashton, who is in charge of tracking quality at the Veterans’ hospital in Columbia, S.C.

    After the hospital received one star, Dr. Almenoff visited the facility in 2016 to brief the staff on ways to improve. While he was there, Ms. Nashton said, she took him out to dinner to talk more about quality metrics.

    The effort seemed to pay off. The hospital got its rating up to three stars that year, and it looked forward to a similar rating in 2017, Ms. Nashton said, because it had sustained its quality measures at basically the same level.

    So when the word came that the hospital had actually lost a star, “it was a gut punch,” she said. “I kept going over the numbers again and again. I compared us to other hospitals. The math didn’t make sense.”

    Ms. Nashton said she then alerted the department’s Office of Accountability and Whistleblower Protection that Sail was statistically unsound and open to gaming, and submitted a lengthy paper showing how a host of problems made the system a “credibility crisis waiting to happen.”

    The reply came nearly a year later: The department planned to take no action.

    Source

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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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  • Disabled Vets

     

    What's Not Talked About?

    Throughout the history of warfare, service members have been placed in unimaginable situations, often situations in which they have to make difficult decisions. Frequently, decisions made during deployment have lifelong consequences. Many Veterans have expressed a desire to be the person they were before they experienced trauma, and they often try to suppress or avoid memories of the trauma they have lived through. However, the use of avoidant coping strategies has been found to be counterproductive in the long run. By attempting to avoid the traumatic events service members have experienced, they end up exacerbating the intensity and frequency of their trauma memories and the sequelae and symptoms of those memories over time.

    Some Veterans are able to move past trauma with minimal dysfunction in their lives; however, for others, the traumatic event creates havoc and chaos. Trauma symptoms can become so problematic that they result in family discord, divorce, social dysfunction, significant substance use, employment difficulty, physical health difficulties, legal problems, and more. And the disruption of service members’ lives as a result of trauma symptoms is hardly uncommon. Due to the dysfunction and negative impact of trauma and its symptoms in the lives of service members, the VA has recognized and developed the VA disability rating system. The disability rating system considers both physical and mental health-related conditions. The more areas of a Veteran’s life that are impacted (i.e. social and occupational difficulty or physical limitation and/or pain), the more financial compensation that Veteran potentially could be warranted. I am a firm believer that Veterans are entitled to every dollar that they are afforded and then some...Many can argue that the lifelong implications and symptoms that Veterans have to endure cannot be quantified or compensated with a dollar amount. The VA does its best to equitably compensate Veterans based on their level of dysfunction. However, if the Veteran could eliminate the disabling experience that initiated their impairing symptoms, it is possible that they could exceed the amount of their VA compensation by functioning optimally in the civilian sector. Essentially, they would be able to have a greater positive economic impact and earn a higher living wage if they did not experience disabling symptoms. Given the high level of training military members receive, the values, discipline, and structure instilled by military training and service often lead most Veterans to make dependable, hard-working, and effective employees.

    Disability Rating System

    According to the VA Disability Rating System, in the year 2000, the average compensation provided to Veterans through the disability rating system was about $20 billion for 2.3 million Veterans. In 2013, that number rose to 3.5 million Veterans receiving $54 billion in compensation. This number has continued to rise over the last several years and will hopefully continue to do so, enabling Veterans to receive the compensation they deserve. A major reason for the spike in Veterans receiving compensation is the continued 14-year wars in Iraq and Afghanistan. When service members are sent to war and later return home, there are often significant consequences to service—economics being one of them. Unfortunately, many Veterans who are still in need of services and compensation for VA benefits have not taken advantage of the services offered. Many factors impact Veterans’ decisions not to seek care— a main one being stigma. Two examples of stigma are: one, a Veterans’ hesitation to seek mental health services due to being perceived as “weak” or “vulnerable;” and, two, the possibility of having negative career or job implications as the result of potentially impairing symptoms. As I have said in a previous blog, it takes a nation to build a military and go to war. And, it takes a nation to welcome them home. Compensating our Veterans for their service is the first of many steps that should be afforded to Veterans for their sacrifice. If we send people to war, it is a fundamental imperative that we take care of them when they come home. The tide is changing, and the VA has gone to great lengths to decrease wait times for compensation and pension evaluations so that Veterans are streamlined through the process. There is no perfect system, and the pendulum has and is continuing to shift in the right direction so that our brothers and sisters in arms are taken care of.

    To specify the rating system with an example, if a Veteran diagnosed with PTSD has a 50 percent service-connected disability rating and they have a spouse and one child, they would receive $978.64 each month. Yearly, that is roughly $11,745. The pay for a Veteran that is 100 percent serviced-connected increases significantly. They would approximately $3200 monthly. Although this money is not taxed, many Veterans still struggle to make ends meet. Anecdotally, there is a misconception that if a Veteran receives a 100 percent service connection, they will be able to live a “lavish” lifestyle. That is simply not true. This money can definitely help decrease financial distress, however, many Veterans still struggle to pay for things they and their families need.

    Once a Veteran receives a disability rating and compensation is provided, there can be fear that the disability rating might be decreased or taken away if the VA finds evidence the Veteran’s symptoms have improved to a more manageable level. Once Veterans receive a service-connected percentage of disability, it is not a fixed rate for life—although it could be. The VA has the right to decrease the compensation rate if the Veteran shows material improvement in their ability to function in daily life whether that be in relation to a physical or mental health-related condition. According to the Department of Veteran’s Affairs Service Connected Disability website (2017), if a Veteran has less than a 100 percent disability rating, has been receiving compensation for less than five years, and has shown medical and social improvement, the VA can reduce the percentage of disability and compensation based on the evidence found. However, if a Veteran has been receiving benefits for longer than 20 years, it is considered a continuous rating and the VA cannot lawfully reduce the rating. At 10 years, a Veteran’s rating cannot be terminated, but it can be reduced. If a Veteran’s disability rating is reduced, a Veteran has the option of requesting a reexamination, and they should contact a Veterans’ Service Organization representative to advocate on their behalf.

    The VA provides great and well-needed services, and they save lives every day. Unfortunately, some Veterans walk away from the VA dissatisfied and displeased. There is no perfect mental health and medical system, and the disability rating scale is not perfect either. There is no one program that provides a “fix all” solution. What it will take is public and private partnerships moving forward in order to maximize reach and expand access, frequency, and quality of care.

    Many Veterans who receive benefits fear their benefits may be taken away at any point in time. Unfortunately, this fear of disability ratings potentially being lowered if there is substantial evidence that the Veteran has made improvement deters people from seeking and fully engaging in well-needed treatment. For instance, if a service-connected Veteran engages in an evidenced-based trauma-focused treatment for PTSD that has been shown to reduce symptoms upon full completion, and as a result of that treatment their overall dysfunction decreases, that Veteran could be at risk of decreased disability ratings if that improvement is documented and gathered during a medical evaluation. Veterans who know the disability rating system may be deterred from seeking care at the VA because of that potential. The more dysfunction one has, the more money they receive; so increased symptomology is incentivized and reinforced. If Veterans struggle with employment and optimal functioning, it makes sense that those Veterans may not want to show improvement. This is one lens to look through.

    Unfortunately, there is no perfect solution to this problem. However, there has been plenty of debate about possible solutions. One solution discussed would be to extend the time period between the rating system from the initial evaluation and reevaluation. This solution could assist with decreasing stigma and reducing the fear of losing a percentage rating with the potential benefit of encouraging people to fully engage in well-needed treatment. This would allow Veterans to seek a high standard of care, receive benefits, and practice their skill-sets learned with a longer time to adjust for life stressors that may continue to exacerbate symptoms. If there is no reoccurrence of symptoms, then one may experience a reduction in compensation. If there continues to be notable impairment, then the percentage of disability rating could stay the same or increase. Another potential solution is to continue the private-public partnership so that Veterans can receive care outside of the VA. If Veterans fear that making progress would jeopardize their disability rating when seeking care at the VA, those concerns are potentially lessened with treatment in the private sector. These issues about disability ratings and improvement in functioning are only a few of the many issues debated in the current Veterans’ issues climate. Although they are hotly debated, the pendulum is moving in the right direction by placing our Veterans first.

    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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  • Congressman Wants Answers

     

    ST. PETERSBURG, Fla. (WFLA) - Alarmed by an 8 On Your Side investigation of a Veteran mistreated by the VA, Florida Congressman Gus Bilirakis made a beeline to his home state to get answers and offer help.

    The Pinellas County Representative wants to know why VA doctors couldn't figure out what is wrong with Veteran Mike Henry.

    "This is a Veteran, we've got to give him the best possible treatment you can get," Congressman Bilirakis stated.

    Last week, 8 On Your Side revealed Henry languished in pain for months under VA care.

    That changed quickly when Henry visited Tampa General Hospital, where he was diagnosed with a neurological disorder within an hour.

    Henry suffers from a condition in which nerve cells in his brain trigger uncontrollable muscle contractions in his face, neck and shoulder.

    It causes intense pain and swelling.

    "It actually feels like somebody has a knife, a steak knife in here, and they're just slowly twisting," Henry said as he pointed to his temple.

    According to Henry, one Bay Pines doctor called him a faker and accused him of being after drugs.

    "Then he grabs me right here, my neck was swollen and he's shaking me around. And then I said, 'what are you doing? Are you crazy?' He goes, 'oh you're talking normal now, you're just a faker, I told you that's what you were,'" Henry recalled.

    Henry explained what he experienced at the VA's C. W. Bill Young Medical Center at Bay Pines to Congressman Bilirakis.

    "We want to help them. I told them I'll help them, whether they want to stay with the VA at Bay Pines or transfer possibly to Haley or get private care, I'm here to help," Congressman Bilirakis said.

    The home visit left Mike and Shelly hopeful, especially since Bilirakis offered one of his staff to accompany Mike.

    "He would like to go with Mike to his next VA appointment and he's going to follow up with us," Shelly Henry added.

    Henry has a medical background. He hopes to sit with the VA to discuss mistakes he thinks the Bay Pines made.

    "Then maybe that would let them know, 'ah ha, maybe this is something we need to look at,'" Henry explained.

    The Henrys are thankful someone is watching out for them.

    "I will be forever grateful for you guys for doing this and hopefully you guys aren't just covering my case, you'll help some of the other Veterans and let the people know they have a voice," Henry added.

    "You have been wonderful," Shelly Henry said. "Thank you so much, I really hope this helps other Veterans.

    Now that a Congressman is watching over Mike Henry's case, he is hopeful a more meaningful dialogue will take place with Bay Pines about his care and treatment.

    Source

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  • Vet went without diagnosis

     

    ST. PETERSBURG, Fla. (WFLA) - An 8 On Your Side investigation into why the Department of Veterans Affairs failed a Pinellas County Veteran has two Congressman demanding answers.

    Rep. Gus Bilirakis (R) FL and Rep. Charlie Crist (D) FL want to know why doctors at the C.W. Bill Young VA Medical Center couldn't figure out what was wrong with Mike Henry.

    They also want to know if this Veteran was mistreated while he was a patient at Bay Pines.

    Mike Henry told 8 On Your Side that one VA doctor called him a faker and drug seeker and even grabbed and shook him.

    The VA says it investigated that allegation but can't confirm it.

    After months of tests it also couldn't confirm what was wrong with Mike Henry.  

    Congressman Gus Bilirakis labels it VA incompetence.

    "It's inexcusable for the Veteran to have that type of pain," Rep. Bilirakis said.

    Following 8 On Your Side's Thursday report detailing the inability of Bay Pines to diagnose Henry's problem, Congressman Crist is reaching out "to ensure he is receiving the medical care, support and assistance he needs."

    So is Bilirakis.

    "I'll go over to his house and talk to him personally," explained the congressman.

    "That way I get a better understanding of what happened and I hear directly from him and his wife and then we'll go to work for him."

    Henry's medical issues flared up in June.

    Severe swelling in his shoulder, neck, and face, caused excruciating pain.

    Why couldn't VA doctors figure it out?

    In an email Bay Pines told us, "The symptoms Mr. Henry presented....were evaluated...laboratory tests and imaging results were not conclusive."

    Nonetheless a VA doctor concluded, "This patient has no active neurological disease to require further attention from our neurology service."

    "I'm thinking I'm going to sit here and die," Henry stated.

    He left Bay Pines and went to Tampa General Hospital.

    Within an hour, doctors quickly determined a neurological problem triggered uncontrollable muscle contractions.

    According to Henry, one VA doctor called him a faker and a drug seeker.  

    "Then he grabs me right here, my neck was swollen, and he's shaking me around and then I said, 'what are you doing? Are you crazy?' He goes, 'oh you're talking normal now, you're just a faker, I told you that's what you were,'" Henry explained.

    The VA contends it investigated the allegation and could not substantiate it.

    His wife Shelly says Henry suffered tremendously at the VA.

    "It breaks my heart to see that happen to anybody, especially him and especially Veterans," Shelly explained.

    "The way Veterans are treated, they're treated like garbage. They're treated like garbage in this country, especially by the VA. It's really sad."

    An email from Bay Pines claims it offered to refer Henry to outside specialists but he declined.

    He contends that is just not true. He says the VA did not approve visits its doctors recommended.

    An email sent to the Bay Pines Chief of Staff by Shelly pointed out they ran up medical costs of close to $200,000 visiting outside specialists.

    The VA states Henry left the hospital against medical advice.

    Nursing notes show his attending physician said, "they've tried everything, now they will try nothing and see how bad it gets."

    At that point, Henry decided it was time to leave.

    Source

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  • Bad Paper Vets

     

    For an estimated 500,000 Veterans, being put out of the military with an other than honorable discharge is a source of shame and an obstacle to employment. "Bad paper," in most cases, means no benefits or health care from the Department of Veterans Affairs — even when the problems that got them kicked out were linked to PTSD, traumatic brain injury or military sexual assault.

    But last month, Connecticut opened state VA resources to Vets who can show that one of those conditions is linked to their discharge. For Veterans like Thomas Burke, now a youth minister at Norfield Congregational Church, it's part of a long path to recovery.

    "When I first started looking for jobs, I did not want to be a youth minister to kids, because my PTSD stems from a traumatic event where I failed children," says Burke.

    Burke did two combat deployments with the Marine Corps within the space of one year. After a rough tour in Iraq, he found himself in southern Afghanistan, based in a tiny village, living close to civilians. Burke had been trained in the local language, and he connected with the village kids. In one photo, Burke is in combat gear, playing with 15 laughing boys on a dusty road. He says local boys helped out — they would tell them where IEDs were. He grew to love them and they loved him back.

    "They'd bring us bombs," he says. "On one of those occasions they were bringing us [a rocket-propelled grenade], and it ended up exploding on them."

    When Burke heard the blast, he and other Marines rushed out to find eight of the kids from that photo dead.

    That sent him into a spiral — the local hashish was plentiful and many soldiers used it. Burke started smoking heavily and got caught.

    Suddenly a promising young Marine was getting kicked out with an other than honorable discharge — a sort of scarlet letter for a Veteran, which many say is worse than never having served at all.

    Burke was flown to his home base in Hawaii, where a mix of prescriptions and street drugs made things worse. Then, he flew back home.

    "I took a plane to Connecticut and slit my wrists in a state park," he says.

    Veterans with an other than honorable discharge have higher rates of suicide. They're at higher risk of homelessness. Mental health issues can snowball with economic ones: When employers ask about military service, they also ask about discharge status — so for job prospects, it is worse than never having served.

    "These individuals up till now were denied clinical support services and other programs and benefits, and we believe in many cases may have resulted in a worsening of their conditions," says Thomas Saadi, Connecticut's commissioner for Veterans affairs.

    Saadi says it makes both moral and practical sense to help these Vets before they're in crisis. And that's what Connecticut is now doing, thanks in part to the efforts of Veterans like Burke.

    After Burke's failed suicide attempt, the VA made a rare exception, and he was able to get services. He started down a different path — to become a pastor.

    And he joined a push to change the law around other than honorable discharge. He found allies in the state Legislature, like Republican Rep. Brian Ohler, also a combat Vet.

    "When we testified before the Veterans Affairs Committee, [Thomas] and I were sitting right next to each other," says Ohler. "And I said the only difference between Thomas and I is a piece of paper — one that says honorable discharge and the other that says other than honorable."

    It took years of lobbying, but as of last month, Connecticut Veterans whose other than honorable discharge is linked to PTSD, brain injury or sexual assault will qualify for state health care and benefits, including tuition to state schools.

    The national VA is changing too — earlier this year Sen. Chris Murphy, D-Conn., pushed through legislation that makes VA mental health care available nationwide to Veterans with other than honorable discharges, though it has been slow to roll out.

    For Burke, helping get recognition and treatment for other bad-paper Vets has been part of feeling whole again. When he hears kids laughing, it still triggers memories of Afghanistan, but he can smile through them now.

    "The opportunity to work with children fills me with the spirit and life and joy in a way that I can't even explain, because it also makes me recognize how far I've come from the person who got back from war," says Burke.

    Source

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  • Vet Pensions

     

    VIRGINIA BEACH, Va. (WAVY) -- 10 On Your Side is helping Veterans prepare for a new rule that goes into effect on Thursday, Oct. 18.

    According to the U.S. Department of Veterans Affairs, pensions will change beginning Thursday for those of you using long-term care services.

    Shannon Laymon-Pecoraro, a lawyer with Hook Law Center, says failing to plan is planning to fail when it comes to these changes.

    "In a region like ours that is home to so many military Veterans, we think it’s important to tackle this issue head-on so people can start to address these changes before they take effect," Laymon-Pecoraro said.

    Laymon-Pecoraro is referring to Veterans like Frank Rough, a retired senior chief who served in Vietnam.

    "I planned all my life for retirement and to have that possibly taken away so I could have Veterans benefits is crazy," said Rough.

    Rough is talking about changes that could make it more difficult to qualify for certain important benefits, according to Hook Law. That's why Rough and other Veterans attended a Hook Law seminar regarding the changes.

    The VA pension program is a needs-based benefit for wartime Veterans who served at least 90 days active duty service, who have limited or no income, who are 65 and older and who may have a permanent and non-service connected disability.

    What's at risk? According to Hook Law, aid and attendance pension up to $2,170 per month for a Veteran and spouse -- which is money that could be used for long-term care.

    With the new rules, assets cannot exceed $123,600 to get the long-term benefits.

    According to the seminar presentation, gifts that you made in the past 36 months -- either to a family member or to an irrevocable trust and an investment in an annuity -- would be penalized with the new rules.

    This means you could be prohibited from qualifying for VA pension benefits for up to five years, depending on the amount of the gift.

    "I'm getting older and I may need long-term care and if I go into long term care and they start taking the money I've saved - that's awful," said Rough.

    So, what should you do between now and Oct. 18?

    Laymon-Pecoraro said, "Assess are there any significant transfers you want to make or any assets you want protected so that you can then qualify for this benefit if you think you may need within the next 3 to 5 years."

    It is important to note this change does not affect all Veterans.

    According to Hook Law, if you are receiving VA service-connected disability or compensation payments, your benefits will not be affected.

    Source

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  • Salathiel Gaymon Sr

     

    More than a year after her father died in his car in the parking lot of the Wilmington Veterans Administration Medical Center, Shelatia Dennis still struggles to understand why.

    Salathiel M. Gaymon Sr.'s body was found April 25, 2017, more than 17 hours after he walked out of the facility after his regular treatment in the Hemodialysis Unit.

    Dennis believes her father shouldn't have been discharged without having his condition assessed more closely.

    Gaymon's death prompted an investigation by the Department of Veterans Affairs Office of Inspector General, which published a report in September that judged the VA harshly but didn't place blame.

    The unit nursing staff did not appropriately monitor the patient's medical status, the report said, but could not "substantiate" that the care contributed to his death.

    An autopsy indicated that Gaymon had cardiovascular and kidney disease and "probably" suffered a fatal cardiac arrhythmia.

    The report did say that based on the available information and review of the electronic health record, quality of care concerns were identified related to Gaymon's clinical management while in the dialysis unit.

    Changes at the VA

    Wilmington VA Medical Center Director Vincent Kane said a day doesn't go by that he and his staff don't think about the events leading up to the tragedy. He was appointed shortly after Gaymon's death.

    The OIG report and internal analyses sparked changes in staffing and procedures, including many within the dialysis unit and police department.

    "If we could go back in time and know what we know now, I'm confident this wouldn't happen," Kane said. "We're committed to never letting something like this happen again."

    Chief among the 14 recommendations from the OIG was having the proper number of staff members in the Hemodialysis Unit and providing continuous education in all areas of the unit.

    According to Kane, that has happened and is now ongoing.

    "We've added a tremendous amount of staff since my arrival," said Kane. "We want to make sure we have processes and staffing in place to prevent tragedies moving forward."

    The police department has a new chief and those involved in the Gaymon tragedy were disciplined.

    Appointed rounds directed by VA policy were not done, meaning no one noticed Gaymon.

    "Those rounds should have happened. It's devastating to us," Kane said. "We've added more cameras and a training officer to make sure officers are compliant."

    A man of principles

    Dennis described her father as a man whose love of family was matched only by his love of God.

    She said he had no problem expressing the love and pride for his family and was an affectionate man who couldn't encourage his kids and grandchildren enough.

    But Dennis said her father also was all about advocacy and justice and often spoke out against injustices in the world. That is why one of his favorite musicians was Bob Marley, she said.

    Dennis believes what happened to her father was an injustice.

    "The quality of care that he was given was very poor," Dennis said recently from her Dover home on what would have been her father's 64th birthday. "It seems like anything that could have gone wrong did go wrong. It makes me so angry that they could get away with this."

    Questionable discharge

    Dennis said her father's blood glucose readings were through the roof that day in the Hemodialysis Unit, he was administered the wrong medication at the wrong time, his blood pressure was critically high and he was allowed to be discharged.

    "He was not OK," she said. "How could they not see something was wrong? If they had, maybe we wouldn't have had to have a funeral in May."

    Gaymon had been a regular patient at the Wilmington VA Medical Center since 1997 after he was diagnosed with diabetes. His medical records indicate he was often "noncompliant" in his treatment regimen and his diabetes was "uncontrolled" from 1997 to 2017.

    Dialysis was initiated in early 2016, and a few months later a kidney specialist ordered a blood sugar reading prior to each of his dialysis treatments.

    Critical to Gaymon's treatment were differences of opinions about unit policies concerning the patient's finger-stick blood sugar check.

    Gaymon's blood sugar was obtained 38 minutes after starting dialysis and it was shown to be critically high.

    According to the OIG report, a unit registered nurse believed it was acceptable to test the blood sugar within an hour of beginning treatment.

    The Office of Inspector General staff found no such policy.

    The OIG determined that the combination of the timing of the blood glucose test, which found Gaymon's blood sugar critically high and sparked a "routine" call for insulin rather than "stat," or immediately, resulted in more than a two-hour difference in treatment.

    The OIG report said the nursing staff did not check Gaymon's blood glucose before releasing him.

    Contributing issues

    Policies regarding treatment of Gaymon's critically high blood pressure also were called into question by the report.

    Gaymon was given medication to bring down his high blood pressure and then released 18 minutes thereafter.

    The medication given reduces blood pressure within 30 to 60 minutes, with the maximum decrease occurring within two to four hours, the report said.

    The report also said there was no evidence that staff conducted a full clinical assessment or provided Gaymon with instructions regarding the effects of the medication, including drowsiness and a recommendation not to drive.

    Dennis said video from the facility showed an unsteady, unhealthy individual in medical distress as her father walked out of the dialysis unit and fell on the hood of his car before getting in it.

    "The report was more confirmation," she said. "We already had a gut feeling that there was very poor quality of care and that there was definitely negligence on their part. We just didn't understand to what extent."

    Undignified death

    Dennis believes that even though the nurses and doctors failed her father, the Department of Veterans Affairs Police had an opportunity to "pick up the slack had they been doing their job."

    If police had done timely rounds in the parking lots as policy requires, they would have noticed Gaymon sitting in his car in a no-parking zone in valet parking.

    A hospital volunteer came across Gaymon in his car and alerted police.

    "If they would have noticed him within an hour, that might have been enough time to alert the doctors and get some help," Dennis said. "There was no dignity in the way he died."

    The officers were supposed to walk or drive the facility every hour, "so long as they are not on another call or doing a report.”

    The report said the facility's police officers violated policies by leaving the patient’s car in a visible illegal parking spot for more than 17 hours.

    Dennis recognizes her father's death affected changes, but said she will forever hold the facility accountable for taking her father away "too soon."

    "There were so many opportunities for people to make decisions that would have supported his life being sustained," Dennis said. "The healthcare was obviously the first misstep. But if the police force would have been doing its job, my father might still be alive today."

    Source

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  • 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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  • Depression awareness

     

    Behavioral health experts say frequent deployments and other aspects of military life can contribute to clinical depression, a condition that negatively impacts mood and behavior. Depression may be more common in the armed forces community than among the civilian population, but it seems to me we still have a culture that may prevent service members from seeking help.

    If depression is something you don’t want to talk about, then let me tell you about my brother. Army Sgt. 1st Class Ruben Leal joined the Army in 1975 and became a tanker, a year after I enlisted and became a Special Forces medic. Ruben always had a smile on his face. He was outgoing and athletic, and also technically and tactically proficient on the job. He was a highly respected and decorated soldier, selected to participate in elite fraternal organizations such as the Sergeant Audie Murphy Club.

    Ruben considered me, his older brother, to be his hero. But truthfully, Ruben was mine. Both of us had come a long way from our troubled childhood.

    By December 1991, I was a senior ROTC instructor in San Antonio, and Ruben was a platoon sergeant at Fort Hood. He’d returned from a deployment in the Gulf War several months earlier. We were less than 200 miles apart, but it might as well have been 2,000. We were both so busy that we didn’t see each other as often as we should have.

    During our telephone conversations, my brother never talked about struggling with depression. Ruben was a proud man, and back then, it wasn’t really the Army’s way to focus on behavioral health issues after deployment – or really, ever.

    Still, I was a trained medic, and Ruben was my brother. When he died by suicide Dec. 4, 1991, I felt tremendously guilty. I realized the signs of depression were there, and I had missed them. I’d missed all of them.

    I don’t blame the military for Ruben’s death. I recognize his combat deployment experiences may have been a contributing factor in triggering a clinical depression that had roots in our dysfunctional upbringing. Since his death, I’ve struggled with depression, too. But I’ve gotten help, and I want to encourage others to do so as well.

    Three years after my brother’s death, I retired from the Army and used my GI benefits to earn accreditation as a licensed vocational nurse. Then I completed a two-year registered nurse program. I’ve dedicated the past eight years of my career to helping patients in the Warrior Transition Unit. A lot of injuries we’re seeing today aren’t only physical injuries, they’re also behavioral health injuries.

    This is my mission now: to encourage everyone to recognize the signs of clinical depression so they can get help -- for themselves or for others. Those signs include feeling negative, worthless, or guilty; loss of interest in previously enjoyable activities; sleeping too little or too much; or feeling restless or anxious.

    Today, my eyes and ears are open to people who are struggling. I ask them, “Do you want to talk to me about it? If you do, I’m ready to listen. But if you don’t, let’s find someone for you to talk to, now. I’ll walk with you. I’m here to help.”

    I tell people with depression that there’s hope. There are a lot of things we can do as health care providers, as senior leaders, as clergy. We can help you, we can get you to the right people. Please let us help you. Opening up is the first step.

    We’re all in this together. I ask you to reach out to help someone else. I ask you to reach out to help yourself.

    Source

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  • Memphis VAMC

     

    The Department of Veterans Affairs is standing by its decision to fire a top doctor at the Memphis VA Medical Center last year, despite recommendations from officials to reinstate the former chief of surgery as a general surgeon, records show.

    Darryl Weiman was fired last October by Director David Dunning for “failure to lead and act.” The move came during sweeping changes by administrators aimed at improving the hospital that received a one-star rating by the VA for its death and infection rates, among other factors.

    But Weiman’s firing at the time — along with the firing of Susan Calhoun, former head of anesthesiology — led to allegations that VA administrators were using the hospital’s doctors as scapegoats for ongoing issues.

    The same independent examiner who conducted a review of Weiman’s appeal, looked into the grievance filed by Calhoun. And though a similar recommendation that Calhoun be granted relief in her reinstatement, along with compensation, VA MidSouth Healthcare Network Director Cynthia Breyfogle upheld Calhoun’s termination.

    Source

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  • Hill and Ponton Logo

     

    When it comes to VA disability compensation, the goal for most Veterans is getting a 100 percent rating. The road to a 100 percent rating can be long and confusing. There are also different ways to get to a 100 percent rating. Below we will discuss the different types of 100 percent disability ratings.

    Total disability based on 100 percent scheduler rating: This is when a Veteran’s single service-connected disability or alternatively, the Veteran’s combined service-connected disabilities total to 100 percent.

    Total Disability/Individual Unemployability:

    Better known as TDIU or IU is a type of rating that can be a bit more complicated than just a regular 100 percent scheduler rating. TDIU is considered once a Veteran has made a request to be paid at the 100 percent rate even though his or her disabilities do not combine to 100 percent. A Veteran may file a claim for this rating when he or she is unable to maintain substantially gainful employment because their service-connected disability keeps them from doing so. Substantially gainful employment for VA purposes is defined by the amount of earned from an employed position. The total amount of earnings from a job is considered gainful if they are above the poverty level. It is also defined as competitive employment where a non-disabled individual may ear a comparable income to the particular occupation in the same area.

    In order to qualify for TDIU or IU, a Veteran must have one disability rated at 60 percent or one disability rated at 40 percent with enough additional disabilities that combine to a rating of 70 percent or above. It is important to keep in mind that just because the initial criteria for IU are met, does not mean that a 100 percent disability rating will be awarded. A Veteran will need to provide medical evidence that shows that they are unable to work in both a physical and a sedentary work environment.

    Temporary 100 Percent Disability Rating:

    This rating is given to Veterans who have been hospitalized for 21 days or longer or had surgery for a service-connected disability that requires at least a 30 day convalescence period. The VA will pay the Veteran at the 100 percent rate for the extent of the hospital stay or convalescence period.

    Permanent and Total Rating:

    The permanent and total rating is given when the VA recognizes that a Veteran’s service-connected disabilities have no probability of improvement. This means that the Veteran will remain at the 100 percent rating permanently without the need for future examinations.

    Veteran often times make the mistake of requesting a permanent and total rating because they want the Chapter 35 educational benefits for their dependents. It is important to keep in mind that whenever a permanent and total rating is requested, all service-connected disabilities will be subject for re-evaluation. If improvement is noted during a re-examination, a reduction from the 100 percent rating may be proposed. It is important to note that most ratings are not considered permanent and are subject to future review.

    Source

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  • Agent Orange 004

     

    GRAND RAPIDS, Mich. — A chemical sprayed on troops by the US military during the Vietnam War is continuing to impact the lives of Veterans and their families. One Michigan Vietnam Veteran is teaming up with the group Vietnam Veterans of America to do something about it.

    Philip Smith conducts meetings like this one Saturday in Grand Rapids throughout Michigan to warn Veterans about a silent killer many of them are unaware of Agent Orange.

    Smith serves as the director for Vietnam Veterans of America.

    “When Admiral Zumwalt was alive and he was the Admiral of the Navy.” “’He says don’t spray that stuff ‘well guess what we did and the ultimate factor is the disease that came down with it afterward,” he said.

    It was a herbicide used to eliminate forest cover and crops during the Vietnam War. Agent Orange is a toxic chemical that’s known to be associated with several illnesses and diseases. Many of them are considered deadly.

    “I’ve got a charcoal foot now because of it which went crooked. I had open heart surgery a little less than two years ago because of it,” said Jeron Hendricks, a Vietnam War Veteran.

    Hendricks served in Vietnam and says he now suffers from a number of illnesses impacting his legs and heart, but he was only able to receive compensation from the Veterans Administration four years after being able to prove his conditions were in fact related to the herbicide Agent Orange.

    “If things start happening to you, your family members, or relatives and nobody can figure it out well it’s a good chance if you were in service that this is part of that reason,” Hendricks said.

    And the chemical is just one of the Tactical Use rainbow herbicides impacting America’s Veterans. Information that the Vietnam Veterans of America are sharing by setting up presentations such as this in hopes of getting Veterans the knowledge they need to get the proper care and money that they deserve.

    “A lot of them are coming forward now saying ‘well I got some of these symptoms what do we do,” and that’s where Phil comes in he helps them get a claim into the VA and they get compensated for it and it also puts them on the record that they’re Agent Orange,” said Ken Rogge, the VVA Michigan first vice president.

    Over the last few years, more Veterans have come forward with claims about Agent Orange related illnesses and now signs of its impact are reaching past the Veterans to children, grandchildren and into further generations.

    To learn more about Agent Orange click here.

    Source

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  • Vet Benefits

     

    Different government programs have different Veteran criteria

    There is no standardized legal definition of "military Veteran" in the United States. Veteran benefits weren't created all at one time. They've been added one at a time for more than 200 years, and each time Congress passed a new law authorizing and creating a new Veteran benefit, it included eligibility requirements for that particular benefit.

    Whether or not one is considered a "Veteran" by the federal government depends upon which Veteran program or benefit one is applying for.

    Veterans' Preference for Federal Jobs

    Veterans are given preference when it comes to hiring for most federal jobs. However, in order to be considered a Veteran for hiring purposes, the individual's service must meet certain conditions.

    Preference is given to those honorably separated Veterans (this means an honorable or general discharge) who served on active duty in the Armed Forces. Retirees at or above the rank of major or equivalent are not entitled to preference unless they qualify as disabled Veterans.

    For more information about the Veteran's Preference Hiring Program, see the Federal Government's Veteran's Preference Web Page.

    Home Loan Guarantee

    Military Veterans are entitled to a home loan guarantee (within dollar limits) when they purchase a home. While this is commonly referred to as a "VA Home Loan," the money is not actually loaned by the government. Instead, the government acts as a sort of co-signer on the loan, and guarantees the lending institution that they will cover the loan if the Veteran defaults. This can result in a substantial reduction in interest rates, and a lower down payment requirement.

    For more information, see the VA's Home Loan Guarantee Web site.

    Burial in a VANational Cemetery

    To qualify as a Veteran for the purposes of burial in a VA National Cemetery also depends on the conditions and period of service. Any member of the Armed Forces of the United States who dies on active duty is obviously eligible.

    Any Veteran who was discharged under conditions other than dishonorable is usually eligible as well.

    Service beginning after September 7, 1980, as an enlisted person, and service after October 16, 1981, as an officer, must be for a minimum of 24 continuous months or the full period for which the person was called to active duty (as in the case of a Reservist called to active duty for a limited duration) to qualify for VA National Cemetery burial.

    Undesirable, bad conduct, and any other type of discharge other than honorable may or may not qualify the individual for Veterans benefits, depending upon a determination made by a VA Regional Office. Cases presenting multiple discharges of varying character are also referred for adjudication to a VA Regional Office.

    For more criteria for burial at Arlington National Cemetery can be viewed on the VA's National Cemetery's Web Site.

    Military Funeral Honors

    The Department of Defense (DOD) is responsible for providing military funeral honors. "

    Upon the family's request, every eligible Veteran receives a military funeral honors ceremony, to include folding and presenting the United States burial flag and the playing of Taps. The law defines a military funeral honors detail as consisting of two or more uniformed military persons, with at least one being a member of the Veteran's parent service of the armed forces.

    For more information, see the DoD's Military Funeral Honors Web site.

    Active DutyMontgomery GI Bill

    In all cases, the ADMGIB expires 10 years after discharge or retirement. To be eligible, one must have an honorable discharge. To retain MGIB benefits after discharge, in most cases, one must serve at least 36 months of active duty, if they had a four-year active duty contract, or at least 24 months of active duty, if they signed up for a two or three-year active duty contract (there are some exceptions to this rule).

    For complete details, see our ADGIB Article.

    Post-9/11 GI Bill

    If you have at least 90 days of aggregate active duty service after September 10, 2001, and are still on active duty, or if you are an honorably discharged Veteran or were discharged with a service-connected disability after 30 days, you may be eligible for this VA-administered program. See details.

    Service-Disabled VA Life Insurance

    To be eligible for basic Service-Disabled Veterans Insurance (S-DVI), a Veteran must have been released from active duty under other than dishonorable conditions on or after April 25, 1951. He/she must have received a rating for a service-connected disability and must be in good health except for any service-connected conditions. An application must be made within two years of the granting of service-connection for a disability.

    For complete details, see the VA Life Insurance Web site.

    VA Disability Compensation

    Disability compensation is a benefit paid to a Veteran because of injuries or diseases that happened while on active duty or were made worse by active military service. It is also paid to certain Veterans disabled from VA health care.

    The amount of basic benefit paid varies depending on the nature of your disability. Note: You may be paid additional amounts, in certain instances, if:

    • you have very severe disabilities or loss of limb(s)
    • you have a spouse, child(ren), or dependent parent(s)
    • you have a seriously disabled spouse

    For complete information, see the VA's Disability Compensation Web site.

    VA Disability Pension

    Disability Pension is a benefit paid to wartime Veterans with limited income who are no longer able to work.

    You may be eligible if:

    • you were discharged from service under other than dishonorable conditions
    • you served 90 days or more of active duty with at least 1 day during a period of wartime. (However, anyone who enlisted after September 7, 1980, generally has to serve at least 24 months or the full period for which a person was called or ordered to active duty in order to receive any benefits based on that period of service)
    • you are permanently and totally disabled, or are age 65 or older
    • your family income is below a yearly limit set by law

    VA Medical Care

    The Veterans Health Administration (VHA) provides a broad spectrum of medical, surgical, and rehabilitative care to eligible Veterans.

    If you have a discharge other than honorable, you may still be eligible for care. As with other VA benefits programs, the VA will determine if your specific discharge was under conditions considered to be other than dishonorable.

    The length of your service may also matter. It depends on when you served. There’s no length of service requirement for:

    • Former enlisted persons who started active duty before September 8, 1980, or
    • Former officers who first entered active duty before October 17, 1981

    The number of Veterans who can be enrolled in the health care program is determined by the amount of money Congress gives VA each year. Since funds are limited, VA set up priority groups to make sure that certain groups of Veterans are able to be enrolled before others.

    For more information, see the VA's Health Care Web site.

    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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  • Agent Orange 003

     

    For decades, the military and the VA have repeatedly turned to one man to guide decisions on whether Agent Orange harmed Vets inVietnam and elsewhere.

    His reliable answer: No.

    A FEW YEARS AGO, retired Maj. Wes Carter was picking his way through a stack of internal Air Force memos, searching for clues that might help explain his recent heart attack and prostate cancer diagnosis. His eyes caught on several recommendations spelled out in all capital letters:

    “NO ADDITIONAL SAMPLING …”

    “DESTROY ALL …”

    “IMMEDIATE DESTRUCTION …”

    A Pentagon consultant was recommending that Air Force officials quickly and discreetly chop up and melt down a fleet of C-123 aircraft that had once sprayed the toxic herbicide Agent Orange across Vietnam. The consultant also suggested how to downplay the risk if journalists started asking questions: “The longer this issue remains unresolved, the greater the likelihood of outside press reporting on yet another ‘Agent Orange Controversy.’”

    The Air Force, Carter saw in the records, had followed those suggestions.

    Carter, now 70, had received the 2009 memos in response to public records requests he filed after recalling the chemical stench in a C-123 he crewed on as an Air Force reservist in the years after the Vietnam War. He’d soon discovered that others he’d served with had gotten sick, too. Now it seemed he’d uncovered a government-sanctioned plan to destroy evidence of any connection between the aircraft, Agent Orange and their illnesses. And the cover-up looked like it had been set in motion by one man: Alvin L. Young.

    Carter had gotten his first glimpse of “Dr. Orange.”

    Young had drawn the nickname decades earlier as an Air Force expert on herbicides used to destroy enemy-shielding jungle in Vietnam. Since then — largely behind the scenes — the scientist, more than anyone else, has guided the stance of the military and U.S. Department of Veterans Affairs on Agent Orange and whether it has harmed service members.

    Young tested the weed killer for the Air Force during the war, helped develop a plan to destroy it at sea a decade later — a waste of good herbicides, he’d said — then played a leading role in crafting the government’s response to Veterans who believed the chemicals have made them sick. For a while, he even kept a vial of Agent Orange by his desk.

    Throughout, as an officer and later as the government’s go-to consultant, Young’s fervent defense hasn’t wavered: Few Veterans were exposed to Agent Orange, which contained the toxic chemical dioxin. And even if they were, it was in doses too small to harm them. Some Vets, he wrote in a 2011 email, were simply “freeloaders,” making up ailments to “cash in” on the VA’s compensation system.

    Over the years, the VA has repeatedly cited Young’s work to deny disability compensation to Vets, saving the government millions of dollars.

    Along the way, his influence has spawned a chorus of frustrated critics, including Vets, respected scientists and top government officials. They argue that Young’s self-labeled “investigations” are compromised by inaccuracies, inconsistencies or omissions of key facts, and rely heavily on his previous work, some of which was funded by Monsanto Co. and Dow Chemical Co., the makers of Agent Orange. Young also served as an expert for the chemical companies in 2004 when Vietnam Vets sued them.

    “Most of the stuff he talks about is in no way accurate,” said Linda S. Birnbaum, director of the National Institute of Environmental Health Sciences, part of the National Institutes of Health, and a prominent expert on dioxin. “He’s been paid a hell of a lot of money by the VA over the years, and I think they don’t want to admit that maybe he [isn’t] the end all and be all.”

    Birnbaum, whose agency studies how environmental factors affect health, questions how Young’s training in herbicide science qualifies him to draw some conclusions. “He is not an expert when it comes to the human health effects,” she said.

    Others complain that Young spent years using his government authority to discount or resist new research, then later pointed to a lack of research to undercut Vets’ health claims.

    “For really almost 40 years, there has been a studious, concerted, planned effort to keep any study from being done and to discredit any study that has been done,” said Jeanne M. Stellman, an emeritus professor at Columbia University. Stellman, a widely published Agent Orange researcher, has repeatedly clashed with Young and the VA.

    There’s a reason. In an era in which the military and the VA are facing a barrage of claims from Vets alleging damaging chemical exposures, from burn pits in Afghanistan to hidden munitions in Iraq, Stellman said Young provides a reliable response when it comes to Agent Orange: No.

    Anyone who set foot in Vietnam during the war is eligible for compensation if they become ill with one of 14 cancers or other ailments linked to Agent Orange. But Vets with an array of other illnesses where the connection is less well established continue to push for benefits. And those Vets who believe they were exposed while serving elsewhere must prove it — often finding themselves stymied.

    It’s not just the Vets. Some of their children now contend their parents’ exposure has led to their own health problems, and they, too, are filing claims.

    In recent years, Young, 74, has been a consultant for the Department of Defense and the VA, as well as an expert witness for the U.S. Department of Justice on matters related to dioxin exposure. By his own estimate, he’s been paid “a few million” dollars over that time.

    “He’s an outstanding scientist,” said Brad Flohr, a VA senior advisor for compensation, defending the agency’s decision to hire Young in spite of the controversy surrounding his work. “He’s done almost everything there is. He’s an excellent researcher into all things, not necessarily just Agent Orange.”

    In an interview and emails, Young defended his role. To date, he said, there’s no conclusive evidence showing Agent Orange directly caused any health problems, only studies showing a statistical association. It’s an important distinction, he says.

    “I’ve been blamed for a lot of things,” Young said. He likened the criticism he faces to Republican presidential nominee Donald Trump’s smearing of “Crooked Hillary” Clinton after 30 years of public service: “They say, ‘Crooked Young.’”

    Young said he believes most sick Vets are simply suffering from the effects of old age, or perhaps war itself, rather than Agent Orange. It’s a point even critics say has some validity as Vets have grown older during the benefits battle. His critics, he said, are as biased against the herbicide as he is accused of being for it. “Who’s an impartial expert? Name one for me, by all means.”

    When Carter came across Young’s name, he knew nothing of the controversy that surrounded him. He also had no need for benefits related to Agent Orange: He was already receiving full disability compensation from the VA for a back injury suffered during the first Gulf War.

    Reading the memos after his 2011 cancer diagnosis, it seemed clear there was a link between Agent Orange and illnesses plaguing those who’d flown aboard C-123s.

    But to get answers — and to help others get benefits — he’d have to take on Dr. Orange.

    IN THE SUMMER OF 1977, a VA claims worker in Chicago took a call from the sobbing wife of a Veteran claiming “chemicals in Vietnam” had caused his cancer. The woman mentioned a mist sprayed from above to kill plants on the ground. The claims specialist, Maude DeVictor, called the Pentagon and was transferred to Capt. Alvin Young, who knew more about the chemicals used in Vietnam than perhaps anyone.

    By then, Young, who’d gained an appreciation for herbicides on his family’s farm, had a doctorate in herbicide physiology and environmental toxicology and had spent nearly a decade studying defoliants for the Air Force. In 1961, the U.S. began spraying millions of gallons of herbicides across Vietnam’s thick jungles. Then, in 1971, it halted the effort after the South Vietnamese media reported a surge in birth defects in areas where the chemicals had been used — a political decision, according to Young, who didn’t believe the claims.

    DeVictor peppered Young with questions on the phone that day. Within weeks, she’d identified more than two dozen other Vets who believed their contact with Agent Orange had made them sick. DeVictor prepared a memo on what she had learned and shared her findings with a reporter, spurring national media attention on Agent Orange for the first time.

    “Dr. Young was very helpful. Without him, I wouldn’t have known anything,” said DeVictor. She was later fired by the VA; she claimed for speaking out about the herbicide.

    Young publicly refuted many of the comments attributed to him — especially those suggesting Agent Orange might have harmed Vets — and criticized media reports that he felt sensationalized the risks. But the episode was a turning point, moving Young from the Air Force’s internal herbicide expert to public defender of Agent Orange.

    Over the next decade, as concern grew about the effects of Agent Orange, Young was repeatedly promoted to positions of increasing influence, despite public clashes with prominent politicians and some federal health experts. In 1980, an exasperated Rep. Tom Daschle, D-South Dakota, who later became the Senate’s Majority Leader, challenged Young’s testimony before a House subcommittee by rattling off recent studies and media reports that suggested Vets had suffered because of Agent Orange. “I really find it somewhat interesting,” Daschle said, “that they are all wrong and he is correct.”

    Moments earlier, Young had said he didn’t doubt the competency of other authors, they just couldn’t match his 12 years of analyzing records. “It is a very complex issue,” he said.

    Young’s genial, almost folksy style belied a resolute confidence that while his listeners’ opinions might differ, no one knew Agent Orange as well as he did.

    In a 1981 Air Force research paper titled “Agent Orange at the Crossroads of Science and Social Concern,” Young questioned whether some Vets were using Agent Orange “to seek public recognition for their sacrifices in Vietnam” and “to acquire financial compensation during economically depressed times.” The paper earned him an Outstanding Research Award from the Air Force’s staff college.

    The same year, the Air Force assigned Young to serve as director of the VA’s new Agent Orange Projects Office, in charge of planning and overseeing initial research into emerging health claims. Here, too, he attracted congressional ire. Sen. Alan Cranston, R-California, warned the VA’s chief medical director in 1983 that Young’s dismissive comments about possible health risks might cause the public to doubt the “sincerity of the VA’s effort.”

    Soon after that, the White House tapped Young to serve as a senior policy analyst for its Office of Science and Technology Policy, giving him broad influence over the nation’s policy on dioxin. Over the next several years, the Reagan administration was accused of obstructing, stalling and minimizing research into Agent Orange.

    In 1986, another House committee faulted Young for undermining a planned study of chemical company workers exposed to dioxin. Young maintained that previous studies conducted by Monsanto and Dow of their workers “might have been enough,” the panel’s report said.

    Young recently denied interfering with that research but took credit for helping to shut down a major Centers for Disease Control and Prevention study of Vietnam Vets in 1987 that sought definitive evidence of a link between health issues and Agent Orange. Young said data on who had been exposed wasn’t reliable enough, though others argued that military records on spray missions and troop movements would have sufficed.

    In the end, answering the question of who was exposed was taken out of the hands of the scientists. Under pressure from Vets and their families, Congress passed the Agent Orange Act. Signed into law by President George H. W. Bush in 1991, it presumed that all Vets were exposed if they set foot in Vietnam during the war or traveled in boats on its rivers. And it provided compensation for them if they had certain conditions linked to exposure.

    In Young’s view, the Vets won; the science lost. By his final years at the White House, he was tiring of the battle. Young said emotions had risen so high he began “receiving threats to my family, threats to me.”

    CARTER DIDN’T SERVE IN VIETNAM and thus wasn’t covered by the Agent Orange Act. His connection to the herbicide began in 1974, when for six years he served as a crew member on a C-123 as part of his reserve duty at Westover Air Reserve Base in Massachusetts.

    During the war, C-123s criss-crossed southeast Asia, mostly ferrying troops and supplies. A few dozen were modified for spraying herbicides and insecticide. Back home, most were stripped of the spray gear, cleaned and put into service with the Air Force reserves.

    For Carter, the planes were an exhilarating break from his civilian marketing gig — even though when they flew through rain clouds, water seeped into the cabins and they were always too hot or too cold. He often flew on a C-123 that had been nicknamed “Patches” because it was hit almost 600 times by enemy bullets in Vietnam — then patched up with metal. Over the years, he served as an aeromedical evacuation technician, flight instructor and flight examiner.

    Even then, Patches’ former duties in Vietnam worried Carter and other reservists, who complained about the overpowering odor coming from it. But after an inspection, he said, “the wing commander assured us that the aircraft was as safe as humanly possible.”

    Patches was sent in 1980 to the National Museum of the Air Force near Dayton, Ohio, where it was displayed outside because of its chemical odor. Then, in 1994, during a restoration attempt, Air Force staff toxicologists said samples from the plane showed it was “heavily contaminated” with the dioxin TCDD, an unfortunate byproduct of manufacturing Agent Orange. Later, other planes were also found to be contaminated.

    But no one alerted Carter or any of the 1,500 to 2,100 reservists who’d flown them at least two weekends a month plus two weeks a year, often for years. Instead, most of the contaminated planes were quarantined in Arizona at Davis-Monthan Air Force Base, a sprawling airplane graveyard nicknamed “the Boneyard.” In 2010, at Young’s recommendation, they were destroyed.

    One year later, when Carter learned he had prostate cancer, his best friend from the reserves found out he did, too. With a few phone calls, Carter quickly tallied five from his old squadron with prostate cancer. The sixth he called had died. His squadron commanders and others tied to the planes also had Agent Orange-related illnesses.

    “Nearly two months into this project,” Carter wrote on a blog he kept, “it seems I have trouble finding crewmembers who don’t have AO-illnesses!”

    DECADES AFTER the last of the military’s Agent Orange was supposedly incinerated aboard a ship in the Pacific Ocean, Army Vet Steve House went public in 2011 with a surprising claim: He and five others had been ordered in 1978 to dig a large ditch at a U.S. base in South Korea and dump leaky 55-gallon drums, some labeled “Compound Orange,” in it. One broke open, splashing him with its contents. More than three decades later, House was suffering from diabetes and nerve damage in his hands and feet — ailments that researchers have associated with dioxin exposure.

    Around the same time House came forward, other ailing Vets recounted that they, too, had been exposed to Agent Orange on military bases in Okinawa, Japan.

    The Pentagon turned to a familiar ally.

    “I just heard back from Korea and the situation has ‘re-heated’ and they do want to get Dr. Young on contract,” one defense department official wrote to others in June 2011, according to internal correspondence obtained by ProPublica and The Virginian-Pilot through the Freedom of Information Act.

    By then, Young had established a second career. From his home in Cheyenne, Wyoming, he and his son ran a sort of Agent Orange crisis management firm. His clients: the federal government and the herbicide’s makers — both worried about a new wave of claims.

    In 2006, under contract for the Defense Department, Young had produced an 81-page historical report listing everywhere Agent Orange had been used and stored outside of Vietnam, and emphasizing that even in those places, “individuals who entered a sprayed area one day after application … received essentially no ‘meaningful exposure.’” Among the scholarly references cited were several of his own papers, including a 2004 journal article he co-authored with funding from Monsanto and Dow. That conflict of interest was not acknowledged in the Defense Department report.

    In an interview, Young said the companies’ financial support essentially paid the cost of publishing, but did not influence his findings. He and his co-authors, he said, “made it very clear” in the journal that Dow and Monsanto had funded the article. “That doesn’t mean that we took the position of the companies.”

    The Pentagon also hired Young to write a book documenting its history with herbicides. Published in 2009, the book made Young Agent Orange’s official biographer.

    In 2011, facing the new claims involving South Korea and Okinawa, the Defense Department asked Young and his son to search historical records and assess the evidence. In both cases, they concluded that whatever the Vets thought they’d seen or handled, it wasn’t Agent Orange. Young’s son did not respond to a request for comment.

    Alvin Young dismissed the claims of House and other Vets from Korea, saying he found no paperwork that showed the herbicide had been moved to their base. “Groundless,” Young told the Korea Times newspaper in 2011.

    In Okinawa, Young was similarly dismissive, even after dozens of barrels, some labelled Dow Chemical Co., were found buried under a soccer field. The barrels were later found to contain high levels of dioxin. But Young told the Stars and Stripes newspaper, they were likely filled with discarded solvents and waste.

    Young never spoke to the Vets in either case.

    “Why would I want to interview the Veterans, I know what they’re going to say,” Young told ProPublica, saying he focused on what the records showed. “They were going to give the allegation. What we had to do is go and find out what really happened.”

    In 2012, Young’s firm was hired again, this time by the VA, in part to assess the claims of other groups who believed they’d been sickened by their exposure to Agent Orange. One was led by Carter, a man whose determination appeared to match Young’s.

    “Mr. Carter,” Young recalled recently, “was a man on a mission.”

    FROM ALMOST THE MOMENT Carter came upon Young’s name in the Air Force documents, he’d been consumed by the scientist’s pivotal role. He began documenting Young’s influence on a blog he’d set up to keep fellow C-123 reservists informed. “Memo after memo from him showed exquisite sensitivity to unnecessary public awareness … what he calls ‘misinformation’ about Agent Orange. Best to keep things mum, from his perspective,” Carter wrote in a July 2011 post.

    An Agent Orange activist who heard about Carter’s efforts sent him an email exchange between Young and a Veteran named Lou Krieger. Krieger had been corresponding with Young about herbicide test sites in the United States and had mentioned that he believed the controversy over the C-123 aircraft represented “another piece of the puzzle.”

    In a flash of anger, Young had written back, “The only reason these men prepared such a story is that they are hoping they can cash in on ‘tax free money’ for health issues that originate from lifestyles and aging. There was no exposure to Agent Orange or the dioxin, but that does not stop them from concocting exposure stories about Agent Orange hoping that some Congressional member will feel sorry for them and encourage [the VA] to pay them off.

    “I can respect the men who flew those aircraft in combat and who made the sacrifices, many losing their lives, and almost all of them receiving Purple Hearts,” Young wrote, “but these men who subsequently flew them as ‘trash haulers,’ I have no respect for such freeloaders. If not freeloading, what is their motive?”

    Young’s response offended Carter. He pressed his Freedom of Information Act campaign with renewed vigor, requesting a slew of new records from the Air Force and the VA. He later filed lawsuits, with the help of pro-bono lawyers, against the agencies for withholding documents. The government eventually gave him the records and paid his lawyers’ fees.

    Carter worked the non-military world as well, soliciting letters from doctors, researchers and government officials who had expertise with toxic chemicals, some of whom had clashed with Young in the past. Several responded with letters supporting his cause, even a few who worked for federal agencies.

    The head of the Agency for Toxic Substances and Disease Registry, a part of the CDC, wrote in March 2013 that based on the available information, “aircrew operating in this, and similar, environments were exposed to TCDD [dioxin].”

    And a senior medical officer at the National Institute for Environmental Health Sciences wrote, “it is my opinion that the scientific evidence is clear” that exposure to dioxin is not only possible through the skin but has been associated with a number of health conditions, including cancer, heart disease and diabetes.

    Carter also found support in Congress from Sen. Richard Burr, R-North Carolina, and Sen. Jeff Merkley, D-Oregon, who began writing the VA regularly to advance Carter’s cause.

    He sent missive after missive filled with his findings and the letters of support he’d received to the prestigious Institute of Medicine, a congressionally chartered research organization hired by the VA to assess the science behind the claims of Carter and other C-123 Vets. If the VA was going to grant them benefits, Carter realized, he had to first convince this group of researchers that he was right.

    “It didn’t take long to realize that the VA had a lot of resources working against us and we found none working for us,” he said.

    One of those resources was Young, whom the agency had given a $600,000 no-bid contract to write research reports on Agent Orange.

    Young had approached the VA in 2012, offering to assess Vets’ claims that they’d been exposed to herbicides outside of Vietnam and weren’t covered by the Agent Orange Act.

    Over the next two years, Young and his son wrote about two-dozen reports examining issues such as whether Vets who served in Thailand, Guam or aboard Navy ships off the coast of Vietnam could have been exposed. In most cases, they concluded exposure was unlikely. The reports buttressed the VA’s rejection of claims by members of those groups, just as Young’s Pentagon reports were cited to deny those of individual Vets.

    In November 2012, Young turned in the first of several reports discounting the claims of Carter and his group. “All the analytical and scientific studies suggested that if they were exposed, that exposure was negligible,” he wrote. Although some samples taken from the C-123s showed minimal traces of dioxin, it was nothing to be concerned about, Young wrote, since dioxin sticks to surfaces and was unlikely to affect anyone who came in contact with the planes.

    Though Young dismissed the Vets’ claims, Carter’s campaign clearly bothered him. In a June 2013 email to a VA staffer, Young criticized the Air Force for releasing all of his correspondence to Carter.

    A couple months later he wrote: “You and I knew that the preparations of these investigative reports were going to show that in most cases the allegations are without any evidence. We can expect much more media interest as more and more Veteran claims are rejected on the basis of the historical records and science.”

    Young’s contract with the VA and emails were later disclosed to Carter as a result of his FOIA requests and a lawsuit against the VA. The emails showed that Young had also discounted the opinions of other experts, including the VA’s own researchers when they linked Agent Orange to prostate cancer.

    “It is clear the VA researchers do not understand what really occurred in Vietnam,” he wrote in May 2013 to several VA leaders, “and that the likelihood of exposure to Agent Orange was essentially negligible.”

    FOR THREE YEARS, Carter and Young had circled each other. Carter in his blog and in at least one intemperate email; Young in dismissive reports and notes to the VA. Finally in June 2014, they were face to face in Washington D.C. where an Institute of Medicine panel would weigh the evidence to determine which man was right.

    They lived just 45 minutes apart — Young in Wyoming and Carter in Colorado — but had never met. Now they sat next to each other to deliver testimony.

    Carter, who was now in a wheelchair, told panel members that their task should be straight-forward: Did the evidence show — more likely than not — that he and his crewmates had been exposed? “I’m probably the only bachelor’s degree person in this room, but I know the airplane,” he said.

    Young, who followed him, gave a rundown on the planes’ uses during the Vietnam War and their return to this country. He then defended the destruction of the planes, leaving out his role as the consultant who told the military to do it.

    “Those aircraft had been out there for almost 25 years. How long do you maintain an aircraft?” he said, adding later, “Those aircraft had a stigma.”

    Young had been at odds with the IOM before. An earlier panel had embraced a method to estimate troop exposure to Agent Orange, angering Young and his allies who didn’t believe it was possible.

    But the hours-long hearing on C-123s, in which an array of experts spoke, ended with no hint of which way the panel was leaning. As the months wore on without a decision, Carter began to wonder if he had wasted the past few years of his life. “I wasn’t a grandpa or a retiree or a hobbyist or a churchman, the things that usually follow in retirement,” he said. “I was ill and I was tired. It’s a lot of money. Every time I went back to Washington, there goes another fifteen hundred bucks.”

    Finally, on a crisp January morning in 2015, the IOM was ready to announce its decision. Carter and his wife Joan had flown in and now they sat holding hands in a conference room. Joining them were VA and Air Force officials, members of the IOM staff and journalists. Four lawyers who had helped him showed up too, as well as supportive congressional aides. Young, the man who’d fueled his quest, wasn’t there.

    At the front of the room, Emory University’s nursing school dean began to deliver the results of the institute’s report. Carter heard the words “could have been exposed,” and knew he’d won. “That was the moment that I really understood.” Carter and his wife squeezed hands, then hugged with happiness and relief when the meeting ended.

    The committee had rejected Young’s position that the dioxin residue found on interior surfaces of the C-123s would only have come off with a chemical wipe, dismissing that claim as “conjecture and not evidence-based.” His argument that dioxin wouldn’t be absorbed through a crew member’s skin was also wrong, the committee determined, and appeared to be based on an irrelevant Dow-funded study of contaminated soil. Further, Young’s overall description of the chemical properties and behavior of TCDD, a dioxin contaminant, were “inaccurate.”

    Joan Carter said it was her husband’s most meaningful mission, “a kind of a legacy of some good work, some definitive good work that he could leave behind.” It allowed him to help “a far greater circle of fellow Veterans, most of whom he never met.”

    Within weeks, Young protested to the IOM that it had “ignored important historical and scientific information … some material was misinterpreted, and there was a failure to focus on the science instead of who or what agency provided the information.”

    The IOM stood by its findings, and several months later, the VA approved disability benefits for the ailing C-123 Veterans. In a statement, VA Secretary Robert McDonald called it “the right thing to do.”

    In an interview, Young said the IOM panelists got it wrong — a retort he’s used for decades whenever his findings have been challenged.

    “Unfortunately,” he said, they “did not have a good handle on the science.”

    THE IOM’S DISMISSAL of Young’s findings has not dampened the military’s reliance on him.

    The Pentagon once again has signed Young on as a consultant, this time to track where herbicides were used at bases in the United States.

    Pentagon officials declined to answer detailed questions about Young’s work, including how much he’s been paid. Spokesman Lt. Col. James B. Brindle would only say that Young is the “most knowledgeable subject matter expert” on Agent Orange and that his personal views “are not relevant to the historical research he was contracted to perform.”

    While the VA didn’t renew Young’s contract when it expired in 2014, a VA official said the department wouldn’t hesitate to hire him again if he was the most qualified person. Flohr, the VA senior advisor, said Young was chosen for his expertise — not his position on the Vets’ exposure. “It was purely scientific, the research he did,” he said, “no bias either way on his part or our part.”

    In a subsequent statement, the VA said it makes decisions on Agent Orange “only after careful and exhaustive reviews of all the medical/scientific evidence. … Our obligation remains to the Veterans we serve.”

    Young’s continued work for the government comes as a surprise to those who squared off against him a generation ago. “As a physician, as a dioxin scientist, as an Agent Orange researcher, as a Vietnam-era Veteran, I’m just appalled by that personally,” said Dr. Arnold Schecter, who has written a major textbook on dioxin and who has feuded with Young.

    Today, despite his loss to Carter, Young is unwavering in his belief that his research is “great.” Among his few regrets: Putting controversial opinions — such as calling C-123 reservists freeloaders — in emails that could be obtained through public records requests.

    Young said he, too, was exposed to Agent Orange while testing the chemicals over the years, and in that way has a deeply personal interest in the research.

    “Give me some credit,” Young said. “Hell, I’ve got 40 years working out there on these issues. I have a great deal of experience. … Am I wrong? I could be wrong. I’ve always said I don’t understand it all.”

    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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  • PTSD Vet Lied

     

    A Veteran from Fairport pleaded guilty to lying about suicides he says he witnessed overseas in order to claim disability benefits and claim tens of thousands of dollars.

    Michael Pecka, 33, filed a claim for VA Disability Benefits in 2011 claiming that he had Post Traumatic Stress Disorder (PTSD) from witnessing the suicide of two fellow soldiers while deployed to Kuwait in 2004-2005 with the Army Reserve.

    But investigators with the Department of Veterans Affairs determined that Pecka "lied about being present for either suicide, lied about observing either suicide, lied about being involved in the investigation of either suicide, and in the case of one of the soldiers, was not even in the same country at the time he committed suicide," according to the office of U.S. Attorney James P. Kennedy, Jr.

    Due to the high disability rating that Pecka received because of his PTSD claims, he received more than $92,000 in tax free disability benefits that he wasn't legally entitled to.

    Pecka filed the initial claim while he was an inmate in federal prison for an unrelated bank fraud conviction. Investigators said he repeated his false claims about observing the suicides on government forms in 2011 and 2014.

    He faces five years in prison, a fine of up to $250,000, or both. Pecka is scheduled to be sentenced on January 24, 2019.

    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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  • VA Nursing Home

     

    BOSTON – Staffers at the Department of Veterans Affairs nursing home in Brockton, Massachusetts – rated among the worst VA nursing homes in the country – knew this spring that they were under scrutiny and that federal investigators were coming to visit, looking for signs of patient neglect.

    Still, when investigators arrived, they didn’t have to look far: They found a nurse and a nurse’s aide fast asleep during their shifts. One dozed in a darkened room, the other was wrapped in a blanket in the locked cafeteria.

    The sleeping staffers became a focal point of a new, scathing internal report about patient care at the facility, sparked by a nurse’s complaint that Veterans were getting substandard care, according to a letter sent late last month to President Donald Trump and Congress by the agency that protects government whistleblowers.

    “We have significant concern about the blatant disregard for Veteran safety by the registered nurses and certified nurse assistants,” agency investigators wrote in a report about the 112-bed facility. The Brockton facility is a one-star nursing home, the lowest rating in the agency’s own quality ranking system.

    VA spokeswoman Pallas Wahl said officials took “immediate corrective action,” and the employees caught sleeping no longer work there.

    The problems at the Brockton nursing home are the latest to surface in a review of VA nursing home care by USA TODAY and The Boston Globe.

    In June, the news organizations revealed the VA’s secret quality ratings showed that care at more than 100 VA nursing homes across the country scored worse than private nursing home averages on a majority of key quality indicators last year.

    In response to questions from USA TODAY and the Globe, the VA released nursing home ratings that had been kept secret for years, potentially depriving Veterans and their families of crucial health care information.

    At the time, the VA said it was releasing inspection reports the agency withheld from the public for nearly a decade. Five months later, none has been released.

    VA spokesman Curt Cashour told USA TODAY that the agency is working with an outside contractor to remove patient information from reports. He said the VA expects to release "publicly redacted versions of the most recent reports" around Christmas.

    That's not good enough for Leslie Roe, whose husband of 38 years walked out of a supposedly secure unit at the VA nursing home in Tuskegee, Alabama, last year and was never found.

    Roe, who had Navy Veteran Earl "Jim" Zook declared dead this year, wants the VA to immediately release three years' worth of inspection reports – the standard for private-sector nursing homes whose reports are posted on a federal website, NursingHomeCompare. 

    "It's just a shame the way the VA is," she said. "It can't help Jim, but maybe it can help just one other person."

    The reports can include incidents of poor care and conditions that can be a tip-off to prospective or current residents and their families about problems with staffing or neglect at a facility.

    "What are they hiding? Why wouldn’t you release it?" asked Amy Leise, whose uncle, Vietnam Veteran Don Ruch, suffered from malnutrition and bedsores last year at a VA nursing home in Livermore, California.

    "It feels like the government is immune from accountability and responsibility, where in other settings that wouldn't be the case," she said.

    VA releases new nursing home ratings

    The VA released an updated set of star ratings. They show 45 of its nursing homes received the lowest one out of five stars for quality as of June 30. That’s down from 58 in March. The VA has 133 nursing homes that serve 46,000 infirm Veterans each year across the country.

    At the nursing home in Brockton, residents were, on average, more likely than residents of other VA nursing homes to deteriorate, feel serious pain or suffer from bedsores, according to agency data. They were nearly three times as likely to have bedsores than residents of private nursing homes.

    Licensed practical nurse Patricia Labossiere said she complained to the Office of Special Counsel, a federal whistleblower agency, this year after supervisors in Brockton ignored her alerts.

    “I am a no-nonsense nurse who took a vow to take care of patients,” said Labossiere, who quit in July. “We are there to be kind and treat others as we would want to be treated. I could not believe that this was how we treat the people that fought for our country.”

    Labossiere said she saw instance after instance of poor patient care at the facility within days after she started working there last December. She told the federal whistleblower agency that nurses and aides did not empty the bedside urinals of frail Veterans. Nurses failed to provide clean water at night and didn’t check on the Veterans regularly, as required, she said. They often slept when they were supposed to be working.

    She offered some specific examples: One patient had trouble breathing because his oxygen tank was empty. Another fell – his feeding tube got disconnected, and the liquid splashed onto the floor – and didn’t appear to have been monitored by staffers for hours.

    The VA investigators did not substantiate those allegations, saying the patient with the empty oxygen tank suffered no ill effects. Investigators couldn’t confirm that the patient who fell had been neglected because the records were shredded “in accordance with the local policy.”

    'Routinely receiving substandard care'

    Wahl, the VA spokeswoman, noted that the investigators “did not find evidence of Veteran harm or neglect.” She said the facility’s one-star rating is undeserved and not an “accurate reflection of the quality of care delivered to our patients."

    The Office of Special Counsel ordered the VA’s Office of Medical Inspector to investigate Brockton after Labossiere’s complaint. The office turned over its report in September to special counsel Henry Kerner, who sent the findings to Trump and Congress on Oct. 23.

    “Because a brave whistleblower came forward, VA investigators were able to substantiate that patients at the Brockton (nursing home) were routinely receiving substandard care,” Kerner said in an emailed statement.

    This is not the first time the Brockton facility has come under fire by the Office of Medical Inspector.

    In 2014, a doctor at the nursing home alleged that three Veterans with significant mental health issues received “inappropriate medical and mental health care.”

    Two of them went years, he alleged, without appropriate treatment. A third allegedly received psychotropic drugs for more than two years against written instructions.

    Investigators largely substantiated the allegations, finding that two Veterans with significant psychiatric issues did not receive adequate treatment for years. They did not substantiate the allegation that a third received improper medication.

    Source

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  • DVA

     

    A retired Marine makes it his mission to get former homeless Veterans on track.

    WASHINGTON — In a White House press conference Wednesday, amid a host of other topics, President Donald Trump stated that because of his leadership “our Vets are doing better than they’ve ever done.”

    Yet his critics contend that over the last eight months, the Department of Veterans Affairs has never been in more disarray, with a confusing series of leadership scandals and management overhauls further diminishing public faith in the institution.

    They both may be right.

    “It really is the tale of two VAs right now: It’s the best of times, it’s the worst of times,” said Melissa Bryant, chief policy officer for Iraq and Afghanistan Veterans of America.

    “We’ve had major legislative victories years in the making. But a lot of what we have seen in 2018 has been political theater, unfortunately.”

    This Veterans Day, VA leaders once again find themselves at a critical moment for the department. Trump just signed into law the largest VA budget ever, topping $200 billion. Congress has given him nearly every major piece of legislation on Veterans policy he has requested, including new rules that make it easier to fire poorly performing VA workers and reforms that aim to speed up the benefits claims process.

    But as deadlines loom for implementing numerous health care and management initiatives, Democrats in the House are already preparing new scrutiny over how policy decisions are being made inside VA and what unplanned side effects those changes will have.

    It’s a stark change from a year ago, when VA was arguably the most stable and successful part of Trump’s Cabinet.

    On Veterans Day 2017, at Arlington National Cemetery in Virginia, then VA Secretary David Shulkin lauded the president for “strengthening our ability to provide high quality care and benefits while also improving outcomes for Veterans.” Trump in a separate event lauded Shulkin for “doing an amazing job” caring for America’s former military members.

    Within five months, Shulkin was fired.

    Ongoing leadership woes

    Shulkin’s dismissal in March set off months of leadership confusion at VA. The former secretary to this day insists he was fired because of his opposition to plans to privatize portions of VA health care that were advanced by political operatives in the Trump administration. The White House has said Shulkin resigned after the president lost faith in his leadership.

    The day Shulkin’s departure was announced — on Twitter, by the president, with little advance warning to the secretary — Trump also announced his pick to replace him: White House physician Rear Adm. Ronny Jackson. The Navy officer had never worked in the department before, and his lack of experience raised concerns among Veterans advocates.

    Within a month, Jackson was also gone. Reports of unprofessional behavior at the White House medical office (including drinking, improper medication distribution and hostile management practices) forced him to withdraw his name from consideration.

    It took Trump four months to get his next full-time VA secretary in place. During that span, key decisions on electronic medical records systems and VA health care programs were met with legal challenges asserting that Trump’s interim appointments were in violation of federal law.

    When VA Secretary Robert Wilkie — a career bureaucrat with experience on Capitol Hill and at the Pentagon — was confirmed, he promised to bring stable and calm leadership to the department.

    But just a few weeks after he began work, a ProPublica report detailed how three of Trump’s business associates (all members of his exclusive Mar-a-Lago country club) were influencing a host of department plans and policies without any public scrutiny.

    In the last few months, Wilkie has worked to dismiss assertions that his leadership is already undermined by the same officials who sparred with Shulkin and those outside influences. At a Senate Armed Services Committee hearing in September, Wilkie described the department as “calm” now. He promised lawmakers he is “the sole person” leading VA.

    Democratic lawmakers remain unconvinced. They’ve asked — unsuccessfully — for more information on potential outside influencers.

    Meanwhile, Veterans groups thus far have reported little interaction with the new secretary, a break in typical protocols for the department’s top official. While Wilkie has made numerous appearances on the topic of homelessness and drug abuse prevention in recent weeks, the new secretary maintains a significantly lower profile than Shulkin.

    Privatization or choice?

    Amid the leadership turmoil, lawmakers on Capitol Hill have continued to churn out a host of major bills related to Veterans policy, including this summer’s VA Mission Act. The measure has the potential not only to define Trump’s legacy regarding Veterans but also radically reshape the department for years to come.

    Among other sweeping changes, the Mission Act calls for an overhaul to VA’s community care programs, which allow Veterans to get medical appointments with private-sector doctors at the federal government’s expense. Trump has repeatedly referred to it as giving Veterans “choice” in their medical care.

    Wilkie and other department leaders are now in a year-long process now of hammering out the details for who will be eligible for the outside care, how much involvement in those decisions VA doctors will have, and how the pay structures will work.

    “The hardest question at the heart of the Mission Act is how much should the private sector do for VA?” said Phil Carter, a senior policy researcher at the RAND Corporation who specializes in military and Veterans issues. “That influences everything else.”

    About one-third of all VA medical appointments today are already conducted by physicians outside the department’s system. Supporters of further increasing outside care options argue Veterans shouldn’t have to wait in VA lines for basic care they could receive in the private sector.

    But critics, including federal unions, argue the that real goal of these moves is to siphon federal money into outside companies, providing less specialized care while crippling the existing VA hospitals’ ability to meet Veterans’ needs. They’ve labeled many of Trump’s proposals as a “privatization” of the department’s mission.

    Wilkie, in his confirmation hearing this summer, said he wholeheartedly opposes privatizing VA services, but left ambiguity in that definition.

    “If we believe that the Veteran is central, we can also make the argument that as long as VA is at the central node in his care, and that that Veteran has a day-to-day experience with the VA … that reinforces the future of VA,” he told senators. “That’s what I believe in.”

    The debate over where to draw those lines was already contentious before the midterm elections. Now, with Democrats set to take over the House Veterans’ Affairs Committee agenda, the issue of private-sector care is likely to dominate much of the conversation in months to come.

    In September, Rep. Mark Takano, D-Calif. and the leading candidate to be chairman of the Veterans committee in January, promised in a letter to colleagues to “make necessary reforms to the Veterans Health Administration … while rejecting conservatives’ calls to privatize health care.”

    Other fights ahead

    That’s not the only Trump administration priority in the crosshairs.

    Several lawmakers from both parties have expressed concerns over VA’s planned move to a shared electronic health record with the Department of Defense, hailed by Trump and Shulkin as a game-changer for Veterans care.

    If successful, the multi-year project would more easily allow Veteran patients to access and share their medical history, from the first day they enlist to their geriatric appointments. But while praising the idea, lawmakers have questioned whether the effort is properly funded and managed.

    The same goes for VA staffing. Trump has promised to bring in more doctors and oust staffers who are performing poorly. Democrats have charged that Trump’s VA has instead used accountability legislation from 2017 to fire low-level employees without filling other much-needed positions.

    “Everything is in the air right now,” said Joe Chenelly, national executive director at AMVETS. “We don’t know what the Mission Act will look like. We don’t know how health records are going to be. We don’t know about these budget cuts that Trump has talked about for federal departments.

    “There are just a ton of questions unanswered.”

    Trump’s 2016 campaign pledge to start a new hotline for Veterans complaints has earned some goodwill from the community, but individuals using the service have reported mixed results with getting answers on their problems.

    His VA has received harsher reviews for its opposition to paying benefits to “blue water” Veterans who served in Vietnam and claim toxic exposure to chemical defoliants. And in recent months, dissatisfaction has risen among student Veterans as another round of benefits payouts issues has plagued the post-9/11 GI Bill system.

    In the September 2018 Military Times poll of active-duty troops, more than 40 percent said they had an unfavorable view of VA. Only 20 percent described their feelings as favorable.

    Wilkie has acknowledged that along with his policy priorities, rebuilding public trust in the institution is a critical part of his work ahead.

    “The state of VA is better,” he told senators at the September hearing. “I didn’t say good or excellent. It is better. And I do think we’re headed in the right direction.”

    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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  • Claims Process

     

    What Is a Fully Developed Claim?

    The Fully Developed Claims (FDC) program is an optional initiative that offers Veterans and survivors faster decisions from VA on compensation, pension, and survivor benefit claims.

    Veterans and survivors simply submit all relevant records in their possession, and those records which are easily obtainable, such as private medical records, at the time they make their claim and certify that they have no further evidence to submit. VA can then review and process the claim more quickly.

    Many Types of Claims

    There are many types of claims for disability compensation. For example, if you're filing a VA claim for the very first time, you have an original claim. A reopened claim means you have new and material evidence and you want VA to reconsider a claim it once denied. There are also new claims, secondary claims, and special claims.

    To learn more about which type of claim you may have and the evidence and forms you need with your submission, view the Claims and Evidence page. Your claim must meet all the applicable requirements listed to be considered for the FDC program.

    Who Can File anFDC?

    Veterans may file an FDC for disability compensation for the following reasons:

    • An injury, disability, or condition believed to have occurred or been aggravated by military service.
    • A condition caused or aggravated by an existing service-related condition.

    Veterans and their families and survivors may also file pension or dependency and indemnity compensation (survivor) claims at these pages:

    Why Use theFDC Process?

    FDC puts you in control, and it's faster and risk-free.

    By filing an FDC, Veterans and survivors take charge of their claim by providing all the evidence at once. By then certifying that there is no more evidence, VA can issue a decision faster.

    File an FDC without risk. Participation will not affect the attention your claim receives from qualified VA rating staff or the benefits to which you're entitled. If VA determines other non-federal records exist and are required to decide a claim, VA will simply remove the claim from the FDC program and process it through the traditional claims process. Once you initiate your FDC, you'll have up to one year to complete it. Should VA approve your claim, you'll be paid back to the day you initiated your claim.

    What's theBest Way to File anFDC?

    • The best way to file an FDC is electronically at eBenefits.va.gov. Once you log on to your account, VA recommends you appoint an accredited Veterans Service Officer to help you initiate your claim, gather the required medical records and evidence, and submit your claim. If you don't yet have an eBenefits.va.gov account, register today.
    • If you prefer to file your FDC by paper, complete VA Form 21-526EZ and visit your local regional office. You can appoint an accredited Veterans Service Officer to help you prepare and submit your claim. You can also appoint your accredited Veterans Service Officer online at eBenefits.va.gov.

    How Should I Prepare MyFDC?

    • Register for an eBenefits.va.gov account.
    • Next, appoint an accredited Veterans Service Officer who can provide free, expert assistance.
    • Gather relevant documents, such as private medical records. While VA will obtain Federal records on your behalf, such as your DD-214 or service medical records, submitting them, if you have them will save time. If you believe there is not a notation in your service record describing your disability, submit letters from friends or those you served with that tell us about the facts of your claim ("buddy statements").
    • Initiate your claim at eBenefits.va.gov or call 1-800-827-1000 for assistance.

    Source

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  • GAO 001

     

    WASHINGTON — The Department of Veterans Affairs doesn’t have the tools to track whether private-sector medical providers are accurately giving exams that help determine whether Veterans are eligible for VA benefits, a government watchdog agency found.

    Disability compensation exams are key in determining whether Veterans have injuries or illnesses connected to their military service and deserve compensation. Because of legislation passed in 2014 that allows the VA to outsource more services, an increasing number of Veterans are receiving their exams outside of the agency.

    The Government Accountability Office reported last week that the VA lacks the data to determine whether the private-sector providers are meeting standards for quality, timeliness and accuracy. Based on analysis by the GAO, the contractors are falling short with the exams.

    “As VA continues to rely on contracted examiners, it is important that the agency is well positioned to carry out effective oversight of contractors to help ensure that Veterans receive high-quality and timely exams,” the GAO report states.

    The report is expected to be the subject of a House subcommittee hearing Thursday.

    Rep. Phil Roe, R-Tenn., the chairman of the House Committee on Veterans’ Affairs, asked the GAO to conduct the investigation.

    “If Congress is without data on the quality and timeliness of these examinations, we have no way of knowing if this is wise use of taxpayer funds,” Roe said Friday in a statement. “I remain just as committed as I was when I first became chairman to ensuring that Veterans are receiving timely and quality examinations and that taxpayer money is well spent.”

    The VA awarded contracts in 2016 to five private firms to conduct the exams, totaling up to $6.8 billion for five years. The firms are: VetFed Resources, Inc., in Alexandria, Va.; Logistics Health Inc., in La Crosse, Wisc.; Medical Support Los Angeles in Pasadena, Calif.; QTC Medical Services, Inc., in Diamond Bar, Calif., and Veterans Evaluation Services, Inc., in Houston, Texas.

    When awarding the contracts, then-VA Secretary Robert McDonald said it was good news for Veterans who were waiting for the VA to determine whether they were eligible for VA benefits – a process that can take years.

    “For these Veterans, we want the process to be smoother – from beginning to end,” McDonald said in a statement at the time.

    The GAO focused its investigation on 2017, when contractors conducted 767,000 disability compensation medical exams – about half of the total exams that year. The cost of the exams by contractors totaled $765 million.

    The VA set standards for the outside contractors to meet, including for 92 percent of exam reports to contain no errors. In the first half of 2017, only one contractor met that target, the GAO found.

    Most contractors fell into the “unsatisfactory performance” category, meaning 10 percent or more of their reports contained errors. The worst-performing contractor had errors in 38 percent of their exam reports.

    The VA doesn’t have data for the second half of 2017, but the agency said it hired more staff to review the quality of the reports.

    The department had even less information about how quickly the exams are being performed. Contractors are supposed to send their exam reports to the VA within 20 days after they accept a Veteran’s exam request. The VA lacked the tools to determine whether they met that mark.

    Using VA data, the GAO investigators themselves analyzed the timeliness of 646,005 exams that contractors completed between February 2017 and January 2018. Of those exams, 306,479 – just more than half – were completed within 20 days. Twelve percent, 69,748 claims, took 40 days – double the targeted time.

    Contractors gave various reasons for the delays, including severe weather, Veterans’ availability and challenges finding medical specialists in rural areas.

    As of June 2018, there were more than 87,000 exams pending with contractors. Of those exams, 37,077 had already lapsed beyond the 20-day target, the GAO reported.

    “Tracking these exams is important because a large volume of such exams could ultimately increase the amount of time Veterans have to wait for their claims to be processed,” the report states.

    The GAO made four recommendations to better track and analyze the contractors’ performance. Investigators also recommended the VA improve its training for the providers who conduct disability compensation exams.

    In response to the report, VA Secretary Robert Wilkie wrote the VA was developing a new system to capture and analyze data from the exams, which is expected to be completed by the end of the year.

    The department is also trying to hire employees who could implement a new training plan for outside medical providers.

    The House subcommittee on disability assistance and memorial affairs is scheduled to meet at 10:30 a.m. Thursday to discuss the report.

    “It is time to delve into the details,” Roe said.

    Source

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  • Justice 002

     

    Company and owner fraudulently misused “service-disabled Veteran-owned small business” status to defraud the Department of Veterans Affairs and Army Corps of Engineers

    NEWS RELEASE SUMMARY – November 21, 2018

    SAN DIEGO, CA – A federal jury today convicted Andrew Otero and his company, A&D General Contracting, Inc. (“A&D”), on charges that they fraudulently obtained $11 million in federal contracts specifically set aside for service-disabled Veteran-owned businesses.

    The evidence demonstrated that Otero had no military experience. Yet Otero (on behalf of A&D) and Veteran Roger Ramsey (on behalf of Action) participated in a conspiracy to defraud the government by forming a joint venture (“the JV”) – and falsely representing that Action and the JV qualified as service-disabled Veteran-owned small businesses (“SDVOSB”). Based on the false claim to SDVOSB eligibility, the conspirators fraudulently obtained approximately $11 million in federal government construction contracts or task orders with the Department of Veterans Affairs (“VA”) and the Army Corps of Engineers (“ACE”).

    As proven at trial, the fraudulent conspiracy involved set-aside contracts that could only be bid upon by legitimate service-disabled Veteran-owned small businesses – a designation that did not apply to Otero or A&D. To appear qualified, Otero and Ramsey initially executed an agreement to create the JV (“the JV Agreement”), which stated that Ramsey’s company (Action) would be the managing venturer, employ a project manager for each of the set-aside contracts, and receive the majority of the JV’s profits.

    However, as proved at trial, six months later, Otero and Ramsey signed a secret side agreement that made clear the JV was ineligible under the SDVOSB program. For example, the side agreement said the parties created the JV so that A&D could simply “use the Disabled Veteran Status of Action Telecom” to bid on contracts. The side agreement also stated that A&D – not Action – would run the construction jobs. They also agreed that “A&D will keep 98% of every payment; Action Telecom will receive 2% of every payment.”

    In addition to the secret side agreement, the evidence demonstrated several ways in which the JV did not operate as a legitimate SDVOSB, but was essentially controlled by Otero and A&D. For example, although Ramsey (a service-disabled Veteran) nominally served as president of Action and the JV, he actually worked full-time for another telecommunications company. Otero and A&D, not Ramsey, controlled the day-to-day management, daily operation and long-term decision making of the JV. Among other things, Otero and A&D appointed an A&D employee as the project manager for every contract and task order.

    “Our nation strives to repay the debt of gratitude we owe to our Veterans by setting aside some government contracts for Veterans with service-related disabilities,” said United States Attorney Adam Braverman. “These unscrupulous contractors abused this program through a cynical and illegal ‘rent-a-Vet’ scheme. They are now being held fully accountable for robbing truly deserving Vets of important economic opportunities.”

    All four defendants are also facing civil charges in United States v. Otero, et al., Case No. 15CV0441-JAH, a case alleging violations of the false claims act based on the similar misconduct.

    The defendants were ordered to appear before U.S. District Judge John Houston for sentencing on February 19, 2019 at 10:30 a.m.

    This case is being prosecuted by Assistant United States Attorneys Rebecca Kanter and Aaron Arnzen.

    CORPORATE DEFENDANTS

    A&D General Contracting, Inc., Santee, California

    INDIVIDUAL DEFENDANTS                                        

    Andrew Otero                                           El Cajon, CA

    Criminal Case No. 17CR0879-BEN

    SUMMARY OF CHARGES

    Count 1:                                 Conspiracy to defraud and commit offenses (18 U.S.C. § 371)

    Maximum penalties: 5 years’ imprisonment; 3 years’ supervised release; a fine of $250,000 or twice the gross gain or gross loss resulting from the offense, whichever is greatest; and a mandatory special assessment of $10

    Count 2-4:                               Major fraud against the United States (18 U.S.C. § 1031)

    Maximum penalties: 10years’ imprisonment; supervised release; a fine of $1,000,000 per count ($5,000,000 total); and a mandatory special assessment of $100

    Counts 5-7:                             Wire fraud (18 U.S.C. § 1343)

    Maximum penalties: 20 years’ imprisonment; a fine of $250,000 or twice the gross gain or gross loss resulting from the offense, whichever is greatest; and a mandatory special assessment of $100

    10, 14:                                     False statements (18 U.S.C. § 1001)

    Maximum penalties: 5 years’ imprisonment; a fine; and a mandatory special assessment of $100

    AGENCIES

    Department of Veterans Affairs, Office of Inspector General

    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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  • Justice 004

     

    HUNTINGTON, W.Va. – A Huntington man pled guilty yesterday to embezzling over $80,000 of his brother’s Veteran’s benefits. The case was investigated by the United States Department of Veteran’s Affairs Office of Inspector General and the Federal Bureau of Investigation.

    David Washington, 55, was appointed his brother's fiduciary to receive and manage benefits from the Department of Veteran's Affairs. Washington failed to submit accounting reports, which led investigators to question his management. Washington later admitted to mismanagement, including spending his brother's benefits for his own personal expenses. The total amount misappropriated was over $81,000.

    “Our Veterans have sacrificed enough and have earned every dollar this country provides them through benefit programs,” said United States Attorney Mike Stuart. “It’s despicable to think that anyone, much less a family member, would steal benefits from a Veteran for their own personal use.”

    Washington faces up to 5 years imprisonment and a fine of up to $250,000 when he is sentenced in February 2019. United States District Court Judge Robert C. Chambers presided over the plea hearing. Assistant United States Attorneys Gabe Wohl and R. Gregory McVey handled the prosecution.

    Source

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  • Hypertension 001

     

    WASHINGTON – The latest in a series of congressionally mandated biennial reviews of the evidence of health problems that may be linked to exposure to Agent Orange and other herbicides used during the Vietnam War found sufficient evidence of an association for hypertension and monoclonal gammopathy of undetermined significance (MGUS). The committee that carried out the study and wrote the report, Veterans and Agent Orange: Update 11 (2018), focused on the scientific literature published between Sept. 30, 2014, and Dec. 31, 2017.

    From 1962 to 1971, the U.S. military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, destroy crops that those forces might depend on, and clear tall grass and bushes from the perimeters of U.S. bases and outlying encampments. The most commonly used chemical mixture sprayed was Agent Orange, which was contaminated with the most toxic form of dioxin. These and the other herbicides sprayed during the war constituted the chemicals of interest for the committee. The exact number of U.S. military personnel who served in Vietnam is unknown because deployment to the theater was not specifically recorded in military records, but estimates range from 2.6 million to 4.3 million.

    Hypertension was moved to the category of “sufficient” evidence of an association from its previous classification in the “limited or suggestive” category. The sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association. A finding of limited or suggestive evidence means that epidemiologic research results suggest an association between exposure to herbicides and a particular outcome, but a firm conclusion is limited because chance, bias, and confounding factors could not be ruled out with confidence. The committee came to this conclusion in part based on a recent study of U.S. Vietnam Veterans by researchers from the U.S. Department of Veterans Affairs (VA), which found that self-reported hypertension rates were highest among former military personnel who had the greatest opportunity for exposure to these chemicals.

    The committee concluded that there was sufficient evidence of an association between exposure to at least one of the chemicals of interest and MGUS, a newly considered condition. This finding is based on a recent study in which investigators found a statistically significant higher prevalence of MGUS in Vietnam Veterans involved in herbicide spray operations than in comparison Veterans. MGUS is a clinically silent condition that is a precursor to the cancer multiple myeloma, but only an estimated 1 percent of MGUS cases progress to multiple myeloma each year.

    While some new studies suggest an association might exist between exposure to the chemicals of interest and Type 2 diabetes, the committee could not come to a consensus on whether this and the other available evidence continued to be limited or suggestive, or merited elevation to sufficient. Both newly and previously reviewed studies consistently show a relationship between well-characterized exposures to dioxin and dioxin-like chemicals and measures of diabetes health outcomes in diverse cohorts, including Vietnam Veteran populations. The risk factors for diabetes, such as age, obesity, and family history of the disease, were controlled for in the analyses of most studies reviewed. However, some members of the committee believed that the lack of exposure specificity and the potential for residual uncontrolled confounding influences complicated attribution of the outcome to the chemicals of interest.

    In addition, VA asked the committee to focus on three health outcomes: possible generational health effects that may be the result of herbicide exposure among male Vietnam Veterans, myeloproliferative neoplasms, and glioblastoma multiforme. The evidence of association for exposure to the chemicals of interest and glioblastoma (and other brain cancers) remains inadequate or insufficient, the committee concluded. While it is appropriate for VA be mindful of the concerns raised about the possible association between Vietnam service and glioblastoma, the outcome is so rare and the information concerning herbicide exposures so imprecise, that it is doubtful that any logistically and economically feasible epidemiologic study of Veterans would produce meaningful results regarding the association between exposures and the disease. For this reason, the committee recommended that VA should focus on fostering advancements to inform improved glioblastoma treatment options.

    There are relatively few studies on the health effects of paternal chemical exposures on their descendants, and none address Vietnam Veterans specifically. Therefore, the committee recommended further specific study of the health of descendants of male Vietnam Veterans.

    Myeloproliferative neoplasms and myelodysplastic syndromes are diseases of the blood cells and bone marrow. The committee’s search of epidemiologic literature yielded only one relevant paper on these diseases -- a study of these cancers in Vietnam Veterans that was reviewed in a previous update. Given this paucity of research, the committee recommended that investigators should examine existing databases on myeloid diseases to determine whether there are data available that would allow for an evaluation of myeloproliferative neoplasms in Vietnam Veterans and others who have been exposed to dioxin and the other chemicals of interest.

    Although progress has been made in understanding the health effects of military herbicide exposure and the mechanisms underlying these effects, significant gaps in knowledge remain. The committee restated recommendations for research activities outlined in previous updates in this series, including toxicologic, mechanistic, and epidemiologic research. Such work should include efforts to gain more complete knowledge through the integration of information in existing U.S. Department of Defense and VA databases.

    The committee noted that the difficulty in conducting research on Vietnam Veteran health issues should not act as a barrier to carrying out such work. There are many questions regarding Veterans’ health that can only be adequately answered by examining Veterans themselves, thereby properly accounting for the totality of the military service experience.

    The study was sponsored by the U.S. Department of Veterans Affairs. The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln. For more information, visit nationalacademies.org. A committee roster follows.

    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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  • VA Qtrly Research

     

    Dr. Joseph Frank is a primary care physician at the VA Eastern Colorado Health Care System in Denver. He is also a health services researcher at the HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care. His research is focused on improving the safety and effectiveness of chronic pain care for Veterans. As a physician, he is particularly interested in how VA can provide chronic pain care in primary care settings.

    VARQU spoke with Frank about the work he is doing to help Veterans who are living with chronic pain.

    KEY POINTS:

    • Tapering or stopping long-term opioid medications in Veterans who have chronic pain can be a challenging process.
    • The scientific evidence guiding the assessment of the risks and benefits of long-term opioid therapy and/or dose reduction or discontinuation for individual patients is limited.
    • A team-based approach to multimodal pain care could help both physicians and their patients.
    • Further research is needed to identify the systems and resources that are necessary to adequately support physicians and patients as they consider opioid tapering.

    Welcome, Dr. Frank. Can you tell us about the three different lines of research that you are pursuing?

    The first of those is for patients who are taking opioid medications long term. For these patients, the process of stopping or reducing those medications—sometimes referred to as opioid tapering—can be very challenging. We need to understand how to deliver high-quality pain care during and after opioid tapering.

    The second line of research focuses on who delivers this care. As with many chronic conditions, primary-care physicians are most effective when working as part of a team. I am interested in how we should design teams in primary care to deliver pain care that is patient-centered and effective.

    And finally, as a primary care physician, I know it's critical that we help patients get involved in and lead their own plans for pain management. As a researcher, I believe this means we must also help patients get involved in pain research; therefore, I am very interested in how we can better involve patients in all phases of the research process.

    You have received a VA Career Development Award to study tapering opioid medications for patients on long-term therapy. What areas will you be investigating as part of this award?

    We will be investigating several different areas. The first of those is a national survey of Veterans who are on long-term opioid medications to learn more about their perceptions of and experiences with opioid tapering. We know that opioid prescribing rates are decreasing over recent years within VA. But we don't know how these changes are affecting Veterans who have been on these medications long-term. And we don't know what their goals are as it relates to their own use of opioid medications.

    The second aspect of this work is to engage Veterans in the development of a primary care-focused program to support opioid tapering. We will be gathering Veteran stakeholders as well as VA provider stakeholders to conduct a series of meetings and incorporate their perspectives in the development of a program to provide patient-centered opioid-tapering support.

    And finally, the long-term goal is to pilot this intervention and understand what it means for Veterans. As I mentioned, pain care is changing rapidly in the VA. So I think a challenge in the years ahead will be to continue to learn quickly from research that is ongoing and to make sure that the intervention that we are developing will take advantage of the latest science in this area. With our approach to engaging Veterans early in the process, we will have a unique opportunity to incorporate both the latest science as well as Veterans’ experiences to come up with something that is valuable to the Veterans that we serve.

    What is the VA policy for tapering or reducing opioid use in Veterans?

    VA policy is guided by the most recent guidelines released by the departments of Veterans Affairs and Defense. The guideline was released just last year, in 2017. The guideline recommends that for patients who are on long-term opioids, it is important to assess the risks and benefits of ongoing treatment with opioid medications for the individual Veteran. That guideline also notes that it is important to assess the risks and benefits of tapering. This is challenging currently because we don't have much evidence to help providers assess those risks and benefits. So the decision-making is challenging, but importantly should focus on the individual Veterans and their unique needs.

    Importantly, what that policy does not include is a recommendation to reduce opioid dose based on dose alone or without attention to individual risks and benefits. I think a place where we risk getting beyond the evidence, beyond the VA guidelines, and other related guidelines is by unilaterally making changes to medications that don't take into consideration an individual patient's unique needs.

    Can you tell me about the benefits and limitations of using opioid medications long-term for chronic pain?

    I think the goal of using medications, any medications, particularly opioids long-term for a condition like chronic pain, is that they improve function and quality of life. I think we are moving away from measuring pain severity on a simple zero to 10 scale, and trying to think more broadly about individual patients’ long-term goals, especially as it relates to their ability to do the things they want to do. So I think when they are beneficial, it is because they are helping patients function well and improve their quality of life.

    I think important risks often travel alongside those benefits. We have seen in prior studies that people may take these medications with some ambivalence, as they experience both benefits and some side effects. Side effects differ based on the individual patient, but can include decreased energy, cognitive impairment, and some other meaningful side effects that they experience day to day.

    And then I think the risk of serious harms such as overdose or a new opioid use disorder diagnosis are front and center in the minds of policymakers and providers. In our prior work talking with patients, they told us that the pain they experience day to day is more salient than the more abstract risks for future harms. And so it can be a real challenge for physicians and providers to get on the same page prioritizing goals and concerns about potential future harms.

    You published a paper that discussed the scientific evidence on strategies to safely taper opioid medications. Can you tell us what you found?

    This was a systematic review conducted by a great team of VA researchers doing work on this topic. Together, we identified 67 studies that examined opioid tapering and came to three key conclusions. First, the quality of evidence was very low for each of our key questions. Health care systems and health care providers are working to take urgent action to prevent opioid-related harms. However, for patients taking these medications long-term, it's important that we balance this urgency with caution, because we have so little evidence to guide opioid tapering currently.

    I think the second key point is that we found very few studies that addressed the effect of opioid tapering on important adverse events such as overdose. We want to find effective strategies to prevent harms such as overdose, and we need to learn more about how tapering affects this risk.

    And third, we found that opioid tapering may improve pain, function, and quality of life for some patients. Importantly, the fair-quality studies that showed these positive results examined voluntary tapering in the context of multidisciplinary pain management programs. More work is needed to better understand the effects of tapering when it occurs in primary care, which is where most of our pain management is happening in VA.

    In a different study, you interviewed a group of primary care physicians to find out about their experiences with tapering opioid therapy. What did they say are their greatest challenges?

    We conducted focus groups with 40 providers across three health care systems here in Denver, Colorado. We identified three key themes related to their perceived barriers to opioid tapering. First, providers that we spoke with described discussions of opioid tapering with their patients to be uniquely emotionally charged, and at times, exhausting. Health care systems are asking providers to have these conversations more often these days, and it's important that we recognize the impact on providers as well as the impact on patients.

    Second, providers described a sense that they had inadequate resources to support opioid tapering, specifically, but also chronic pain care generally. They described a lack of training specific to this process, as well as a lack of other team members and resources in their clinics and communities.

    And third, they reported that opioid tapering did not go well when there was a lack of trust between their patient and themselves.

    You also mentioned in that study that you identified several best strategies that would help primary care physicians safely taper opioids. What are they?

    In addition to barriers, the primary care physicians that we spoke with also identified strategies that they found helpful. They noted the importance of empathizing with their patients' experiences—both their experience of pain and their concern about making medication changes. We have learned from patients that this process can be very anxiety-provoking. And so providers noted the importance of acknowledging that anxiety.

    Providers also described opioid tapering as a long-term process that benefits from planning and preparation. They described ways in which working with individual patients to think long-term about goals as it relates to the medication was a productive process.

    And finally they reported feeling supported by guidelines and local policies that sought to standardize care processes related to opioid prescribing and opioid tapering.

    What types of strategies would you like to see developed to help primary care physicians work with chronic pain patients and assist them in tapering opioids?

    That's an important question. I think first it takes a team. And in a system like the VA, it will take guidance to help teams develop effective processes in their own local sites. Primary care providers, nurses, psychologists, pharmacists—the list goes on. Each provider has a unique expertise that may be helpful to patients during opioid tapering. The challenge ahead is to create systems that connect each patient with the right team at the right time during opioid tapering and chronic pain management generally.

    The VA is leading in this area with some very interesting work to compare different types of teams and to understand which Veterans benefit from which team structure. It will be important that we learn from those ongoing studies and as researchers try and help leaders in VA integrate those lessons into routine care as quickly as we can.

    I'll mention two other resources that I think are potentially impactful in VA. The first is an important role for peer support. While I as a primary care physician try to help my patients know what to expect during opioid tapering, I think a fellow Veteran who has been through the process can provide practice insights and support that I just can't match.

    And finally, as we discussed, opioid medications are just one tool in the chronic pain toolkit. I think it's important that we continue to improve Veterans' access to the full range of treatments and continue to improve the quality of evidence that guides our approach to multimodal pain care.

    Source

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  • Vets with TBI

     

    Traumatic brain injuries, a frequent consequence of the wars in Iraq and Afghanistan, can lead to such debilitating symptoms as irritability, depression, insomnia, memory deficits—and post-traumatic headaches, which are similar to migraine headaches.

    Migraine is a potentially disabling disorder, causing severe headaches that can last days at a time and pose huge health care costs to the patient and society. A key component of migraines is photophobia, an extreme sensitivity to light. Photophobia can be so harmful that it may force people to wear sunglasses indoors.

    Enter Dr. Levi Sowers, a principal investigator in the Center for the Prevention and Treatment of Visual Loss at the Iowa City VA Health Care System.

    Sowers is leading a study aimed at learning more about regions of the brain that may play a role in migraines and photophobia. He and his team have been focusing mostly on the posterior thalamus. It’s just above the brain stem between the cerebral cortex and the midbrain.

    The main function of the posterior thalamus is to relay motor and sensory signals to the cerebral cortex. It’s also a hub for light and headache pain. Sowers and his colleagues are taking things a step further by zeroing in on a molecule that’s produced in nerve cells of the brain and spinal cord called calcitonin gene-related peptide (CGRP). It plays an important role in triggering migraine headaches.

    The goal of the study is to understand more about how CGRP acts and to apply that knowledge to brain-stimulation techniques, which involve activating and deactivating areas of the brain with electrical, magnetic, or light stimulation. The hope is that precise targeting with stimulation will lower CGRP in the brain and thereby also ease photophobia and headaches.

    Migraine headaches are a neurological disorder

    Currently, nearly 40 million people suffer from migraines, which usually involve a severe throbbing pain on one side of the head. The dilation and constriction of blood vessels were once thought to be the main source of migraine pain. Now, migraine headaches are believed to be one symptom of a greater neurological disorder involving nerve pathways and brain chemicals that is called migraine.

    The Department of Defense and the Defense and Veterans Brain Injury Center estimate that 22 percent of combat casualties from Iraq and Afghanistan involve brain injuries, compared with 12 percent of Vietnam combat casualties. Up to 80 percent of service members who have other blast injuries may also have traumatic brain injuries.

    In the future, Sowers plans to pursue research that explores the level of migraines in Vets with mild, moderate, and severe traumatic brain injury (TBI).

    Current treatments for post-traumatic headache and photophobia are inadequate due to a poor understanding of where CGRP acts in the body to induce headaches, Sowers says. Therapies don’t reduce photophobia between episodes of headache. Successful reduction of light sensitivity in patients with post-traumatic headache may lessen patient discomfort between and during headache attacks, he adds.

    “One of the big questions remaining in the headache field is where CGRP is acting to contribute to migraines,” says Sowers, who is also a research scientist at the University of Iowa. “We hypothesized that CGRP in the posterior thalamus may play an important role in headache-related photophobia. We’re also looking at other regions controlled by CGRP that could be involved with light-aversive behavior. These regions can be targeted by stimulation techniques.”

    He adds: “Every day, targeted brain stimulation methods are getting better and better. This could one day help Veterans. We’re excited about what this holds for the future.”

    In addition to the posterior thalamus, Sowers and his team are looking at the amygdala, the hippocampus, and the cerebellum in relation to photophobia. Any of those regions could be targets for brain stimulation techniques, he says.

    “We believe if we can identify critical areas involved in photophobia, then any of these targeted approaches could one day be effective in treating migraine,” Sowers says. “However, we need to first understand how these brain areas work during states of migraine or post-traumatic headache.”

    The Food and Drug Administration (FDA) has approved certain types of brain stimulation to treat such disorders as anxiety, depression, epilepsy, obsessive-compulsive disorder, Parkinson’s disease, and insomnia. But the FDA hasn’t approved brain stimulation techniques for the treatment of TBI and PTSD.

    Researchers stimulate nerve cells in mice

    Thus far, in lab research, Sowers’ team has identified brain regions that may be critical to photophobia in mice and has found pain and light sensitivity in the rodents that mimic migraines based on similar characteristics in humans. That knowledge could apply to photophobia in people, Sowers says, noting that there are correlates between the brain regions in humans and mice.

    The researchers begin by subjecting the mice to blast-related injuries, the most common type of TBI in Veterans who have served in Iraq and Afghanistan. The team then measures the rodents’ sensitivity to light through use of a light and dark box. The mice are allowed to move freely between a well-lit side of the box and a dark side of the box. The ones more sensitive to light spend more time on the dark side.

    In the mice that are more light-sensitive, Sowers and his team are using a combination of genetic manipulation and light to affect the firing of neurons, or nerve cells. That process is known as optogenetics, a biological technique that involves the use of light to control cells in living tissue, typically neurons. It allows the researchers to target specific brain regions that they believe are involved in triggering post-traumatic headache and to change the firing of nerve cells in those regions. The process also gives the researchers “pinpoint control over the time when we stimulate the nerve cells and which ones we’re stimulating in the brain,” Sowers says.

    The researchers are trying to learn what neurons in a region like the posterior thalamus are doing. They stimulate the neurons by shining a light on that region via a fiber-optic probe that’s inserted into the mouse’s head.

    Both peripheral and central neurons produce CGRP.

    Sowers explains that the investigators have thus far discovered axonal injury, or nerve damage, after blast-induced mild TBI in the posterior thalamus of the mice.

    “Axonal damage means the neurons are damaged, which can cause them to be easily excited,” he says. “In theory, it could lead to light sensitivity in that particular brain region, or heightened sensitivity to pain and other sensory signals in that brain region.”

    Sowers hopes he and others in the medical community can someday use optogenetics to target human brain regions that are involved in triggering post-traumatic headache.

    “That would be really cool,” he says. “In fact, this optogenetic technique has already been used in non-human primates. We’re still many years away from being able to do specific targeting in people. But the goal is when we stimulate these brain regions that correlate with a human then we can go back and possibly target these regions with what we now have to hopefully treat migraine or post-traumatic headache.”

    He and his team hope to publish results later this year.

    Work could also yield insights on PTSD, epilepsy

    Sowers’ work falls under the umbrella of an RR&D grant that has multiple aims related to understanding post-traumatic headache and migraines in Veterans with TBI. In another phase of the grant, he’ll be a senior co-author on a paper in which scientists probed a preclinical model of pain induced by CGRP. They specifically looked at how the molecule is playing a role in spontaneous headache pain in mice, which is facial grimacing, and whether or not that pain can be treated with anti-migraine drugs.

    In an extension of that research, the scientists are injecting CGRP into mice with brain injuries to learn if such trauma makes them more susceptible to migraines and if TBI increases the amount of CGRP in a mouse. The researchers are then testing an antibody that is supposed to attack the CGRP and control light-sensitivity.

    The antibody is similar to a new class of anti-migraine drugs called the CGRP monoclonal antibody. The FDA recently approved the first in this series called erenumab (sold as Aimovig).

    “The drugs we are using look very promising in mice,” Sowers says. “It’s possible that they could be very promising to treat the pain of post-traumatic headache.”

    In addition to post-traumatic headache and migraines, Sowers believes his research may ultimately lead to a better understanding of mental health disorders, such as PTSD, and neurological diseases, such as epilepsy.

    “Veterans with migraine headaches have a strong correlation with PTSD,” Sowers says. “So perhaps insights that we find in our studies of migraines and post-traumatic headache in mice could translate to PTSD research. Also, a number of the brain regions we’re looking at are important for epileptic seizures. So if we understand what CGRP is doing in migraines, perhaps we can use that knowledge to treat or understand other neurological or mental health disorders.”

    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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  • VA Qtrly Research

     

    Thirteen articles based on outcomes and policy recommendations from VA's Health Service Research and Development state-of-the-art conference on "Non-pharmacologic Approaches to Chronic Musculoskeletal Pain Management" were published in a special supplement of the Journal of General Internal Medicine. The conference brought together experts from VA, the Department of Defense, and the National Institutes of Health to discuss the existing knowledge base on non-opioid therapies for chronic pain.

    The thrust of the SOTA was to review the effects of complementary and integrative health (CIH) on pain and opioid use; discuss the different approaches to chronic pain; and share ideas on the larger topic of non-opioid therapies.

    "Evidence clearly shows that no single therapy is the best approach for a majority of patients with chronic musculoskeletal pain," Drs. Robert Kerns, Erin Krebs, and David Atkins wrote in the introduction. "Like analgesic medication, non-pharmacologic therapies generate meaningful clinical improvement in only a subset of patients."

    Because there is no one best therapy for chronic pain, they recommend that health systems and payers offer multiple options for pain management to patients. CIH therapies like yoga, massage, or mindfulness-based stress reduction are equally as important as structured exercise or cognitive behavioral therapy, they point out.

    It is also important for clinicians to use a multimodal, stepped model of care that allows individual Veterans to try different kinds of therapy, if the first one doesn't work. The researchers suggest that type of multimodal care can be best implemented by primary care physicians who don't just treat patients for pain, but also for other contributing conditions like diabetes.

    Because VA is an integrated health system that provides comprehensive care, wrote the authors, it is well-suited to offer the type of multimodal care that is best for chronic pain patients.

    Source

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  • PTSD Vets Sue

     

    A federal judge in Connecticut ruled Thursday in favor of thousands of Veterans seeking to sue the federal government alleging they were discharged due to infractions related to untreated mental illnesses and denied Veterans Affairs benefits as a result.

    The Associated Press reports that Senior U.S. District Judge Charles Haight Jr. ruled Thursday that the Veterans, who were given less-than-honorable discharges after service in Iraq and Afghanistan, could move forward with a lawsuit against Navy Secretary Richard Spencer.

    The less-than-honorable discharges, the Veterans allege, made it harder for Veterans who were discharged to receive care for their mental illnesses developed as a result of their service in America's wars.

    The lead plaintiff in the case, Marine Veteran Tyson Manker, sharply criticized the Department of Defense in a statement Thursday following the initial ruling.

    “The fact that the Court has now recognized this class of Veterans is further evidence of the Department of Defense’s disgraceful violation of the legal rights of the men and women who have served their country," Manker said in a statement obtained by the AP.

    “This decision is a victory for the tens of thousands of military Veterans suffering from service-connected PTSD and TBI (traumatic brain injury),” added Manker, who says he was dishonorably discharged after serving in Iraq due to a single use of an illegal drug.

    Students from Yale Law School are reportedly representing the Veterans and have filed a similar suit against the Army, according to the AP.

    Connecticut-based Veterans group National Veterans Council for Legal Redress, another plaintiff in the suit, celebrated the judge's decision in a statement Thursday.

    “We filed this lawsuit to make sure that the Iraq and Afghanistan Veterans with service-connected PTSD do not suffer the same injustices as the Vietnam generation,” group director Garry Monk told the AP.

    “We are thrilled with the court’s decision and look forward to creating a world where it doesn’t take years of wading through unlawful procedures for these Veterans to get relief.”

    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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  • Homeless Vet Finds Kindness

     

    BEDFORD — At 2 a.m. on a chilly May morning, Norman Franks sat slumped in a chair in a TV lounge at the Department of Veterans Affairs medical center, fighting for snatches of sleep under the glare of ceiling lights, he said.

    A Navy Veteran of the late 1970s, Franks had led a troubled life. His addiction to crack cocaine led to a long series of armed robberies, which led to 15 years in prison. Now, he found himself homeless.

    Franks wanted a clean start, but first he needed a place to live. With no good options, he made his way to the Bedford Veterans complex, an outpost of a sprawling federal agency that takes its motto from Abraham Lincoln’s promise “to care for him who shall have borne the battle.”

    They had to take him in, Franks thought.

    Instead, he spent the night in the woods, shivering under a tarp. He stayed there for four of the next five nights, then spent the next four months in a cramped tent in a campsite on the grounds of Hanscom Air Force Base.

    As the weeks passed, Franks fell deeper into despair. But slowly, unexpectedly, he was reclaiming some of his life, thanks to a devoted group of strangers — members of an American Legion post, volunteers from a Catholic parish, even from a congressman’s staff — who felt obliged to aid a Veteran in need.

    “We had to help this man,” said Catherine Giorato, an auxiliary member at American Legion Post 221 in Bedford. “If we turn away a Veteran at the American Legion, we should be ashamed of ourselves.”

    Franks, 58, is angry at how the VA handled his case, arguing that he never should have been turned away that May night when the temperature fell into the 40s, or to have lived at a campground for so long.

    When he arrived at the hospital that May evening, Franks said, he was told by a VA social worker that he might be able to sleep undisturbed in the TV lounge. But in the middle of the night, Franks said, he was awoken by a rap on the chair and ordered to leave.

    “I don’t have any place to go,” he mumbled.

    “I don’t give a [expletive]. You’re out,” the VA security officer answered, according to Franks.

    Wearing only a T-shirt and shorts, Franks stumbled into the night and dropped to the ground at the half-hidden edge of the VA property, resting against a tree and wrapped in the tarp he had taken from a small VA dump truck.

    VA officials said they have no record of an encounter that night between Franks and VA security officers. Under the Bedford VA’s policy, any Veteran who turns up homeless can be sheltered in the urgent-care area if no other beds are available, agency officials said.

    Franks did contact the VA by phone three days later and discuss housing options, officials added. The next day, Franks declined an offer to be placed in a Haverhill facility affiliated with the VA, according to Ken Link, chief of social work services at the Bedford VA.

    “Mr. Franks was offered multiple shelter options, but he did not care for the shelter options we were offering him,” Link said.

    Those options included transportation to the New England Center and Home for Veterans in Boston and other facilities closer to Bedford. But Franks said he declined because posttraumatic stress from his years in the Navy and prison have made living in close quarters nearly impossible.

    As it turned out, Franks was not on his own. Help came from the American Legion, where Franks’s first, desperate call in the following days was answered by Giorato, a Massachusetts Institute of Technology locksmith who tends bar at the post.

    “He explained he had no place to stay, and he asked if we could do anything,” Giorato said. “So, I spoke with everybody at the bar. People started taking $20 bills out of their wallets, and we probably raised $200” for a night’s stay in a hotel across the street.

    A few days later, Franks called again.

    “It was pouring rain. It was terrible. He had no food,” Giorato said. “I picked him up and took him to Stop & Shop, where we bought about $120 of food. I kept saying, ‘Get this, get this, get this.’ He was very proud and very embarrassed and kept saying, ‘That’s too much money.’ ”

    The post also pitched in with blankets and other basic comforts.

    “I found him very sincere, a nice man, and down on his luck,” Giorato said. “He couldn’t have been more apologetic.”

    Franks said he soon was directed to the Hanscom campsite and helped by a local chapter of the St. Vincent de Paul Society, a Catholic organization that assists people in need. Its members took him shopping for camping equipment, bought him gift cards for groceries, and paid the $18 daily fee charged by FamCamp, the Air Force campsite, Franks said.

    Through it all, Franks said, he regularly called VA officials and caseworkers. In the summer, he was approved for placement at Bedford Green, a VA-linked development of 69 furnished apartments for older Veterans who are homeless or at imminent risk of becoming so.

    But that approval was suspended after the VA determined Franks had behavioral issues that might affect other residents at the complex, Link said.

    “He was not ready, and there was concern it would not be conducive to the overall health of the environment,” according to the social work chief.

    Franks said he became increasingly distraught.

    “I was thinking about going back to my old ways, robbing somebody,” Franks said. “But I couldn’t do it. People were taking care of me. They were stepping up. They’ve been unbelievable.”

    Yet with cold weather only a few months away, Franks wondered anew where he would live. Help arrived once more, this time from the office of US Representative Seth Moulton of Salem, a Marine Corps Veteran whose staff made calls on his behalf, Franks said.

    Finally, Franks found a federally subsidized apartment on his own in Acton, where he moved Sept. 26. The VA provided a tenant voucher for the new apartment, helped with the application, and referred him to movers.

    “We really do want to help homeless Veterans, and we want homeless Veterans to feel encouraged to come here,” Link said.

    When Franks moved to his new apartment, following a stop at a furniture bank that helps the poor and homeless, the two-bedroom unit felt like a palace. Giorato, the post auxiliary member who answered his plea, said she is thrilled.

    “I hope we continue to keep in touch,” Giorato said. “I still want to help him with whatever he needs — dishes, glasses. Between all of us girls, we have extra things in our basements.”

    For his part, Franks said he hopes to be licensed soon to operate heavy equipment in Massachusetts. He has been trained for the job, he said, and wants to move ahead and leave his past behind.

    “I did my time. I’m not going back. I’m focused on going forward,” Franks said.

    He also does not want to be homeless again.

    “If I can help just one other Vet from being in this position, then this has been worth it,” Franks said. “No one should be living in the woods for four months.”

    Source

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  • Privitization Protest

     

    ST. CLOUD-- A group of Veterans, union members, and St. Cloud VA employees protested VA privatization in the rain Thursday evening.

    After the passing of the Veteran Access Choice and Accountability Act in 2014 and the VA Mission Act in 2018, the group is concerned that government and special interest groups looking to privatize will lessen the quality of care provided to Veterans.

    Gregg James, Vice President for District 8 of the American Federation of Government Employees says the biggest problem with the VA today is understaffing.

    "[The VA is] still considered the number one single-source health provider in the country. Nintey-two percent of Veterans like the care that they get. The issue is with getting them in and getting their appointments, and that's hard to do when you're down 35,000 people across the country."

    Should the VA system become privatized locally or nationwide, the group believes an influx of Veteran patients will place extra stress on private healthcare companies and impact all citizens trying to access care. James says the VA is still best equipped to handle the wounds of war.

    "They're the number one provider for folks that have prosthetics. Nobody is better equipped to deal with the wounds of war than the VA."

    Nationwide, there is a shortage of about 35,000-40,000 VA employees and growing concerns that the current system is not as successful as it used to be.

    Source

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  • Low rating Atlanta VAMC

     

    ATLANTA - Huge developments in the leadership at Atlanta VA Health Care System. The Department of Veterans Affairs announced temporary changes to the top brass in Atlanta after receiving low ratings.

    “As Secretary Wilkie has said, Veterans deserve the best healthcare possible, and the steps we are taking today are designed to ensure that’s exactly what the Atlanta VAMC is providing,” Veterans Integrated Service Network 7 Director Leslie Wiggins was quoted as saying in a release sent to FOX 5 News.

    The VA launched an investigation following the drop in ratings. It will be conducted by the department’s Office of Accountability and Whistleblower Protection and the Veterans Health Administration’s Office of the Medical Inspector.

    “To be clear, this is not an indication of misconduct on the part of any Atlanta VAMC employee. Rather, we are making these changes out of an abundance of caution so that Veterans can have the utmost confidence in the facility’s commitment to quality of care,” Wiggins was quoted as saying.

    The changed include the following moves:

    • Chief of Staff David Bower has decided to retire, and Dr. Ashley Slappy will serve as acting chief of staff
    • Deputy Chief of Staff Sanjay Ponkshe will be detailed to a staff position in primary care
    • Emergency Department Chief Robert Forster will be detailed to a staff position in Tele-Urgent Care, and Dr. Melissa Stevens will serve as acting emergency department chief
    • Clinical Access Services Chief Lee Singleton will be detailed to the Veteran Experience Office and Ms.Tammy Robinson will serve as acting clinical access services chief
    • Primary Care Chief Raman Damineni voluntarily stepped down to a primary care staff position, and Dr. Cedrella Jones-Taylor will serve as acting primary care chief

    “Upon the conclusion of the OAWP and OMI investigations, which are expected to take approximately 30 days, we will reevaluate the Atlanta VAMC’s leadership needs,” Wiggins said.

    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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  • Justice 005

     

    A Pennsylvania man pled guilty recently to defrauding a disabled Veteran in the VA Fiduciary program of $316,360.

    The man, Jason Ehrhart, will serve out a sentence for his role in misappropriation of the Veteran’s disability benefits as well as health care fraud. Ehrhart swindled the Veteran, suffering from multiple sclerosis, of his VA and Social Security disability payments for years.

    I wrote about this previously during the prosecution and wanted to follow up now that Ehrhart pled guilty to further highlight the dangers of VA Fiduciary and how it can be abused.

    VA FIDUCIARY FRAUD

    According to the SSA IG press release, in italics below:

    In August of 2006, the Veteran was deemed by the VA to be incompetent to handle his own financial affairs. As a result, on October 2, 2006, Jason Ehrhart applied to serve as the Veteran’s VA Fiduciary and Legal Custodian. Under the terms of a Fiduciary Agreement, Jason Ehrhart agreed to use all of the Veteran’s VA disability benefits exclusively for the Veteran’s benefit. The agreement warned him that the funds were not for his personal use. The Fiduciary Agreement also required Jason Ehrhart to submit an annual accounting to the VA with respect to the amount of money spent on the Veteran’s behalf.

    While Jason Ehrhart served as the Veteran’s VA Fiduciary and Legal Custodian, all of the Veteran’s VA benefits, plus most of his Social Security disability checks, were deposited into a checking account Jason opened at The Orrstown Bank. Altogether, $476,260 in federal benefits ($422,828 in VA disability, $48,187 in Social Security disability, and $5,244 in VA clothing allowance) were deposited into the account between January 2009 and August 2016.

    According to Jason Ehrhart’s criminal information and Laurie Ehrhart’s indictment, at least $316,360 of the $476,260 was misappropriated by Jason and Laurie Ehrhart and converted to their own use between October 2006 and August 2016. Checks totaling $218,832 ($96,202 payable to Jason Ehrhart and $122,630 payable to Laurie Ehrhart), were drawn against the account. Of the $218,832, $157,742 was deposited into Jason and Laurie Ehrhart’s joint checking account at the Juniata Valley Bank (JVB) and at least $23,496 was converted to cash. Thereafter, the funds in the joint JVB account were employed by Jason and Laurie Ehrhart to pay their personal expenses.

    Another $7,174 in checks were made payable to Jason and Laurie Ehrhart’s two minor children. According to the charges Jason Ehrhart instructed the children to take the checks to the bank, cash them, and to surrender the cash to him.

    Another $19,890 in checks were made payable to another couple who were Jason and Laurie Ehrhart’s best friends. According to the charges Jason Ehrhart regularly treated the couple and their children to dinners out and at least two, all-expense paid vacations to Disney World in Florida, purchased two automobiles for the family, and paid for the wife’s dental work.

    To conceal his embezzlements, Jason Ehrhart submitted eight false annual accountings to the VA in which he falsely claimed he spent $402,408 on the Veteran’s behalf between October 2006 and October 2015. The itemized expenditures in the accountings were grossly inflated. For example, Jason Ehrhart claimed he paid the mortgage on the Veteran’s residence ($1,631 per month) plus the Veteran’s share of the mortgage on his mother’s residence ($881) after she died in May 2011. However, the lenders against both properties obtained judgments and they were eventually foreclosed and sold.

    Jason Ehrhart also falsely claimed in the annual accountings that he spent thousands on miscellaneous expenditures for the Veteran, including storage unit rentals, vehicle maintenance bills, state and local taxes, life and auto insurance, and credit card bills. However, in 2016 the Veteran’s specially equipped wheelchair van, for which Jason Ehrhart claimed he spent approximately $32,395 for vehicle maintenance, was found broken down and abandoned along a Perry County roadside.

    The Veteran died at the Lebanon VA Hospital on July 30, 2018.

    Jason Ehrhart agreed to make full restitution of the monies owed to the Veteran’s estate. No date was set by Chief Judge Conner for Jason Ehrhart’s sentencing pending preparation of a presentence report. Laurie Ehrhart is currently scheduled for trial on January 8, 2019.

    Source

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  • Justice 002

     

    Charleston, South Carolina ---- United States Attorney Sherri A. Lydon announced today that Keith R. Hudson, 71, of Charleston, South Carolina, was sentenced to six months in federal prison and six months of home confinement for receiving $197,237 in benefits from the Department of Veterans Affairs (VA) after falsely claiming to be a Veteran.

    Evidence presented to the court showed that Hudson falsely claimed that he was entitled to VA benefits because he was a Veteran who had been in combat in Vietnam. He even went so far as to claim that he had received two Purple Hearts and a Bronze Star.

    Hudson has committed the same crime in the past. In 2005, he was prosecuted in Connecticut for the falsely claiming to be a Veteran in order to claim VA benefits. He was placed in pretrial diversion. He moved to Charleston, South Carolina, and in 2012 he applied to the VA in Charleston for benefits. He used the same falsified form from the Department of Defense, (a DD-214, “Report of Separation from Active Duty”) and claimed that he was in the Navy and saw combat as a medic, suffering wounds and other trauma. He claimed that he served from August 1, 1967, through October 31, 1971.

    This was all a fraud. Hudson was never in the military. He never served in the United States Navy, nor did he ever see combat in Vietnam.

    Hudson asked for a probationary sentence, claiming poor health and noting his age, previous bypass surgeries, and cancer. United States District Judge Richard M. Gergel denied Hudson’s motion for probation and instead sentenced him to 1 year of confinement, in a split sentence. Six months of the confinement is to be served in federal prison, and six months is to be served as home confinement. Hudson was also ordered to pay $297,237 in restitution.

    U.S. Attorney Lydon emphasized the importance of this case for our country and for our community. “This is an egregious crime,” she said. “This Defendant trampled on the memory of those who have bravely served our country and suffered harm protecting us. Hudson not only stole from the taxpayers by taking benefits he did not earn, he also stole directly from Veterans who served our nation and protected our freedom. Every minute of time he spent with a VA doctor or a staff member is a minute he stole from a real Veteran. He took resources that the VA just cannot afford to spare. We are grateful to the Veterans Affairs Office of Inspector General for their investigative work on this case.”

    Kim Lampkins, the Special Agent in Charge for the Veterans Administration Office of Investigations Criminal Investigations Division, said, "Those who defraud the VA harm all Veterans. VA benefits are intended solely for those who have protected this nation’s freedoms. We investigate individuals who commit fraud against the VA and are dedicated to defending Veterans who genuinely earned our support."

    The case against Hudson was investigated by the VA Office of Inspector General and prosecuted by Assistant United States Attorney Sean Kittrell of the Charleston office.

    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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  • Afghan Vet

     

    As a caregiver of a catastrophically disabled Veteran, I'm in a lifelong battle to support my husband. Too often, the VA forces me into battle alone.

    Eight years ago, my husband stepped on an improvised explosive device in Afghanistan. He lost his left leg and much of his left arm, and barely survived.

    Mike's war was over. But mine would be fought on the home front. I was going to have to battle for him.

    Sometimes that battle takes place in the hospital, as I help my husband through another surgery — 119 and counting. Sometimes it's in our home, as I try to juggle three young kids, a plumbing issue and a health care bill, all while trying not to burn dinner.

    Caregivers like me are supporting catastrophically wounded Veterans all over the country. All too often, we're carrying out that mission alone, with insufficient help from the very government that sent our husbands, wives, sons and daughters off to war. My husband proudly volunteered to serve and wanted to go to the front lines. Never did we think that the greatest fight would occur once he came home.

    An army of caregivers on the home front

    Our nation — federal officials and civilians alike — must take more concrete action to care for Veterans and their families.

    As many as 5.5 million caregivers struggle to care for disabled Veterans like my husband. These wounded warriors, especially the catastrophically disabled, need round-the-clock assistance because they have a hard time completing the tasks associated with daily living — such as going to the bathroom or getting out of bed.

    In our case, my husband needs assistance to complete all his daily tasks, from dressing, to getting cleaned and ready, to planning the day. Every day, I am constantly thinking for two people.

    Catastrophically wounded Vets also require lots of medical care. In addition to his surgeries, my husband has gone through years of speech, visual, physical and occupational therapy.

    The Department of Veterans Affairs offers caregivers support for coordinating these services as well as a stipend. Caregivers could receive $7,800 to $30,000 in any given year. To calculate caregiver stipends, the VA looks at a typical home health aide's hourly wage in a Veteran's geographic location, as well as the number of hours of care that Veteran needs. The VA caps the hours of care at 40 per week.

    That's almost insulting. I am a caregiver every second of every day. One-fifth of caregivers report caring for their Veterans 80 hours a week.

    Securing caregiver status can be a nightmare. VA guidelines dictate that the maximum wait for approval should be 45 days. But according to a recent investigation from the Office of Inspector General at the VA, more than half of Veteran caregivers wait three to six months. One West Virginia couple waited almost three years for approval.

    The VA has also been known to drop caregivers from support programs without explanation. Between 2014 and 2017, the Seattle and South Texas VAs cut the number of caregivers they recognized by almost 50 percent. Portland, Oregon, made a 66 percent cut. The VA in Charleston, South Carolina, reduced the number of caregivers supported by 94 percent — from about 200 to 11.

    VA's caregiver red tape needs reform

    Fortunately, federal officials are beginning to take action. As part of the recently passed VA MISSION Act, Congress will expand caregiver support to all Veterans — not just those injured after 9/11.

    But there's more to be done. The VA must approve applications for official caregiver status more quickly and better tailor its resources to the neediest families, especially those of catastrophically disabled Vets.

    One concrete thing the VA can do is give family members of catastrophically wounded Veterans a permanent caregiver designation. Today, in order to maintain caregiver status, I am re-evaluated every single year to make sure that Mike still has his injuries and still requires a caregiver — as though amputated limbs could somehow grow back.

    Further, every three months, in the midst of an already hectic life, I have to speak to my caregiver coordinator to check in and comply or risk being dropped from the program.

    Any casual observer can see that my battle is lifelong. The VA shouldn't need periodic check-ins to make sure of that.

    There's a role for the average civilian, too. My advice? Don't ask how you can help — just do it. Help with transport for Veterans, bring over a home-cooked meal, or drop off basic essentials — caregivers are in survival mode and receiving help without having to ask for it is the biggest gift. Search for nonprofits in your area that can help you connect with local Veterans and caregivers.

    My husband paid a huge price in service of his country. It is the honor of my lifetime to take care of him. But the caregivers now waging the war at home must be remembered, too.

    Source

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  • JD Williams

     

    A triple amputee Veteran will have his full-time caregiver services reinstated after the Tennessean reported Wednesday that the Nashville VA initially decided to deny the level of his caregiver's benefits.

    Staff Sergeant J.D. Williams lost his right arm and both legs while deployed with the 101st Airborne Division in Afghanistan in 2010.

    He was discharged and sent home, where his wife, Ashlee Williams, was assigned and paid by the VA to be his caregiver.

    But after six years, she wrote on Facebook on Nov. 17, the VA decided to lower her husband to the lowest tier of the program, determining that he no longer needs a full-time caregiver.

    She claimed that the VA assumed that the care she provided her husband, including helping her husband with applying prosthetics and lifting him into a wheelchair about 10 times a day, was part of her "spousal duty."

    "...should have been included on the marriage certificate according to the VA," Ashlee Williams wrote in a post that was shared more than 25,000 times on Facebook by Wednesday morning.

    Williams wrote in a separate post that while she still has caregiver designation, being dropped to the lowest tier in the program has been a "pattern" she has seen in other VA caregiver cases.

    "I'm just a minuscule part of this MUCH Larger problem," she wrote.

    Nashville VA is part of the Tennessee Valley Healthcare System. When asked by the Tennessean to comment on the case, the VA said they will reverse their action Wednesday.

    "In this case, the reassessment process was handled incorrectly, and VA is taking steps today to reinstate Mr. Williams’ caregiver benefits to their original level," said Chris Vadnais, a TVHS spokesman.

    He said Williams' occupational therapy assessment responses were not fully considered by the team assessing his benefits, leading to an "improper reduction."

    "The goal of all VA health care programs is to help Veterans achieve their highest level of health, quality of life and independence," said Vadnais.

    The Williams did not respond to requests for comment.

    Caregiver details the VA's process

    According to Ashlee Williams, when a caregiver is dropped to the lowest tier, they're given an opportunity to appeal. But the appeal is reviewed by the same clinical eligibility team that made the decision to change caregivers' status, and the appeals are most often denied.

    Then the caregiver is removed.

    The practice of dropping the caregiver's to a lower tier before the appeal and dismissal helps ensure the VA pays the cheapest rate, Williams said.

    "The VA now only has to pay them the 3 months at the lower tier. It is a SIGNIFICANT difference," she wrote. "THIS is why I'm speaking out. No-one deserves this. I will appeal my decision to be lowered and fight for every other caregiver going through this too."

    Williams noted that she had made six attempts to reach the VA Caregiver Support Coordinator on Friday before posting, but ultimately went public due to the VA’s inaction.

    An OB-GYN at the VA hospital made the decision, according to her post.

    Vadnais said the provider was a primary care physician who works in a women's clinic, not an OB-GYN.

    VA to establish clearer assessment

    The VA MISSION Act gives the VA the ability to make these changes to participants of the Program of Comprehensive Assistance for Family Caregivers, while expanding the program to those who care for Veterans.

    The VA, Vadnais said, periodically reassesses participants to ensure that Veterans and caregivers have everything they need to continue progressing toward improved health and wellness.

    "Eligibility for VA’s caregivers program is complex, and determinations are often made by multidisciplinary teams, including primary care doctors, rehab professionals and mental health clinicians," he said.

    The VA, he said, is working to establish clearer, more objective eligibility criteria for consistency in these determinations.

    "In the meantime, VA is ensuring that all facilities understand better how to differentiate Veterans undergoing positive changes in their needs and capabilities from those who require a consistent or greater level of care," he said.

    'A hundred ways I could have died'

    J.D. Williams was on his second tour in Afghanistan when he led a small six-person team into a village "that had a great deal of resistance," he wrote in a blog post for Retiring Your Boots.

    As they approached, an IED detonated directly beneath him.

    "My whole life started flashing through my head and I could feel an ice-cold tingling sensation all over my body," he wrote.

    When he checked himself for injuries, he saw that his right arm and legs were gone.

    "I (laid) back down and started thinking about life. Chaos going on all around me, I’m laid there thinking I may never see my family, friends, or Montana ever again," he wrote.

    Williams said his team risked their own lives to get him to safety and get him a medical evacuation within 20 minutes, all while exchanging gunfire with the Taliban.

    "As soldiers, we faced the horrors of war and never backed down... I take pride in our country and the brave men and women who defend it. I can honestly say that I would do it all again. I can think of a hundred ways I could have died the day I stepped on that IED but I’m here and I’m extremely thankful for that," he wrote.

    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.

  • Vet with HBP

     

    WASHINGTON — New research linking Veterans’ high blood pressure with wartime exposure to chemical defoliants could dramatically expand federal disability benefits for tens of thousands of Vietnam-era troops.

    The findings, from the National Academies of Sciences, Engineering and Medicine, conclude that “sufficient evidence” exists linking hypertension and related illnesses in Veterans to Agent Orange and other defoliants used in Vietnam, Thailand and South Korea in the 1960s and 1970s.

    They recommend adding the condition to the list of 14 presumptive diseases associated with Agent Orange exposure, a group that includes Hodgkin’s Disease, prostate cancer and Parkinson’s Disease. That’s an upgrade from past research that showed a possible but not conclusive link between the toxic exposures and high blood pressure problems later in life.

    If Veterans Affairs officials follow through with the recommendation, it could open up new or additional disability benefits to thousands of aging Veterans who served in those areas and who are now struggling with heart problems.

    Veterans who struggle with high blood pressure issues are eligible for health care at VA facilities. But the illness is eligible for disability benefits in only select cases.

    Adding an illness to VA’s presumptive list means that Veterans applying for disability benefits need not prove that their sickness is directly connected to their time in service. Instead, they only need show that they served in areas where the defoliant was used and that they now suffer from the diseases.

    That’s a significant difference, since proving direct exposure and clear health links can be nearly impossible for ailing Veterans searching for decades-old paper records.

    A change in the designation of hypertension by VA could also add significant new costs to the department’s disability payout expenses.

    In 2010, when then Veterans Affairs Secretary Eric Shinseki expanded the list of presumptive illnesses for Agent Orange exposure to include ischemic heart disease and Parkinson's, the department estimated additional costs of more than $42 billion over a decade.

    It’s unclear how many Veterans suffer from high blood pressure and would be eligible for disability payments if the change is made. In a statement, VA spokesman Curt Cashour said the department “is in the process of evaluating this report and appreciates the work” of the group.

    Regardless the cost, officials from the Veterans of Foreign Wars are already calling for VA officials to move ahead with adding hypertension to the list.

    “There is no doubt in anyone’s mind that Agent Orange made Veterans sick, it made their children sick, and it brought pain and suffering and premature death to many,” VFW National Commander B.J. Lawrence said in a statement. “Even though it’s been a half century since they were exposed, the results of that exposure is something they continue to live with daily.”

    Over the last year, advocates for “blue water” Navy Veterans — sailors who served in ships off the coastline of Vietnam — have been fighting with department officials over a decision to deny them presumptive status in Agent Orange related claims.

    VA officials have insisted that scientific evidence does not exist linking their illnesses to exposure to the defoliant miles away from the Vietnam mainland.

    The new study is available at the National Academies Press website.

    Source

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  • 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