February 15, 2016

DoD Lawsuit ~ Edgewood Update 07 ► Vet Victory in Testing Appeal

“Seven years ago, in an unprecedented legal action, Vietnam Veterans of America, along with San Francisco-based veterans organization Swords to Plowshares, joined with half a dozen veterans who ‘volunteered’ to participate in experiments that tested chemical and biological agents,” said John Rowan, National President of Vietnam Veterans of America. “We wanted to establish the ongoing responsibility of government to care for veterans whose health had been impacted because of their participation in the testing of more than 400 chemical and biological substances, including hazardous agents such as sarin and mustard gas and mind-altering drugs, including LSD.”

“Our concerns have now been validated,” said Rowan, in response to the news that the U.S. Court of Appeals for the Ninth Circuit has agreed with the trial judge, affirming an injunction ordering the U.S. Army to provide all former test subjects with any newly acquired information about the substances to which they were exposed and which might impact their health. The three-member appeals panel also concluded that the military still has an obligation to provide the test subjects with medical care.

“Under its own regulations,” said Rowan, “the Department of the Army has an ‘ongoing duty . . . to provide former test subjects with newly available information relating to their health’ and an ongoing duty to provide medical care to the test subjects ‘for injury or disease that is a proximate result of their participation in research.’ And, importantly, the full court denied the government’s petition for rehearing the appeal.’ ”

“This decision is a clear victory for veterans,” noted Rowan. “It reaffirms our position that caring for veterans is part of the continuing cost of war. It is a testament to the convictions of the late Gordy Erspamer, who took on this case pro bono for his law firm, Morrison & Foerster, that the government cannot ride roughshod over its own regulations and the rights of veterans. And this case has succeeded in exposing the breadth and scope of some of the top-secret experimentation that the military first denied and then acknowledged had been conducted to the potential detriment of the health of thousands of test subjects.

“VVA owes a debt of gratitude to Morrison & Foerster for their unwavering support of veterans in this case,” Rowan said. “And we can hope that the military takes to heart the essential message of this decision, that they have a ‘duty to warn’ future human subjects of any potential health effects associated with any testing in which they may participate.” [Source: VVA Press Release | January 22, 2016 ++]

******************************** DoD 2017 Budget Update 01 ► Pentagon Requesting $583 Billion

The Pentagon on 9 FEB will unveil a $583 billion budget request for 2017 that seeks a modest pay raise for service members, new adjustments to the future military retirement system and familiar — if unpopular — changes to the military health care system, according Defense Department documents slated for official release Tuesday afternoon. The budget request for fiscal year 2017, which begins 1 OCT, also outlines incremental reductions for the global active-duty force as well as deployment of more than 6,000 troops to Afghanistan and about 3,550 troops to Iraq.

The request for a 1.6 percent pay raise would fall below the official uptick in civilian-sector wages, marking the fourth consecutive year that the Defense Department has sought to cut long-term costs by curtailing the growth in basic pay. The 1.6 percent raise in basic pay, if approved by Congress, would take effect in January 2017. It falls a half percentage point below the default raise of 2.1 percent, which is pegged to the recent Employment Cost Index, a government metric that tracks the rise in private-sector pay. The 1.6 percent raise penciled in for next year is higher than the 1.3 percent bump that troops received this year.

Overall, the budget request formally sent to Capitol Hill contains few surprises for military personnel accounts and reiterates the Pentagon’s priorities and stated plans from the past several years. Total spending on military personnel would remain essentially flat at $135 billion. While the details are subject to change before it becomes law, the total budget of $583 billion tracks with a broader spending agreement that lawmakers reached last year so it may avoid the partisan battles over top-line spending that have become common since the budget caps known as sequestration took effect in 2013. The budget proposal is asking Congress to make some key changes to the sweeping military retirement reform that became law last year. The Pentagon supports the fundamental changes that will shrink military pensions for future troops by 20 percent yet also offer cash contributions to individual investment accounts for all troops regardless of whether they serve a full 20-year career. But defense officials are asking for “modifications now to ensure that, when the new system goes into effect [in January 2018], it best meets the retention needs of the services and our men and women in uniform,” according to budget documents obtained by Military Times. Those proposed changes include:

 Raising the current cap on government contributions to individual investment accounts to 6 percent of basic pay. Current law limits that to 5 percent.  Delaying the start of government matching contributions to individual investment accounts to the fifth year of military service. The current law begins matching contributions at the third year of service.  Extending the government’s matching contributions to an individual service member's actual retirement date. Current law cuts off government matching contributions at 26 years of service.  Removing the new retirement system’s mandatory minimum continuation pay for all troops reaching 12 years of service, and giving each of the services flexibility to set continuation pay based on their individual needs. Current law ensures that all troops reaching 12 years of service receive continuation pay equal to 2.5 months basic pay.

The Defense Department also is asking Congress to approve changes to the military health care system, a move many experts believe will become a focus for Congress as it looks to continue reducing military personnel costs. The new budget seeks to add some new fees for military troops and families that see doctors in the civilian sector. That’s designed to incentivize the use of less-costly military health care facilities. And the budget request seeks a new law reorganizing the current Tricare health benefit into two programs: Tricare Select, a health maintenance program like Tricare Prime that is limited to military hospitals; and Tricare Choice, an unmanaged care option like Tricare Standard but with higher fees for many.

Also under next year's proposed budget, the total size of the force is slated to drop by almost 20,000 troops — leaving an active-duty force of 1.28 million service members. That's down almost 10 percent from a peak of 1.42 million in 2010, defense department data shows. Among those troop reductions would be some 15,000 soldiers, reflecting the Army’s previously announced plans to continue its drawdown from about 475,000 this year to 460,000 next year. The Army’s long-term plans call for reducing the size of its force to 450,000. The Navy would cut about 4,400 sailors, bringing its total size down to about 333,000 for 2017. The size of the Air Force and Marine Corps would remain unchanged under the 2017 budget request.

The budget offers some insight into plans for overseas deployments. It pencils in a force level of about 6,217 troops for Afghanistan, reflecting current goals to keep force levels near 10,000 into the fall and reduce them to 5,500 by January 2017. And the budget plans for about 3,550 troops in Iraq, slightly fewer than the current authorized force of about 3,800. The budget request also includes a significant spike in spending for an "increased presence" in Europe, primarily in response to Russian aggression and an effort to reassure European allies. That will include an increase in rotational forces in the U.S. European Command, but the precise number of troops remains unclear. [Source: Military Times | Andrew Tilghman | February 9, 2016 ++]

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Commissary Funding Update 27 ► DoD $200M Budget Cut Proposal

Defense officials have proposed cutting about $200 million from the commissary operating budget, Military Times has learned. But it is not clear whether that will affect the operations of commissary stores. In the Defense Department budget for fiscal 2017 being submitted to Congress on Tuesday, officials call for $1.2 billion to operate the 240 commissary stores worldwide in fiscal 2017, down from the $1.4 billion appropriated by Congress to operate the stores in the current fiscal year. Officials made a similar proposal in 2015, to reduce the commissary budget to $1.15 billion, which would have required cutting operating days and hours at most commissaries. But lawmakers instead added $281 million for a total operating budget of $1.44 billion.

The DoD fiscal 2017 budget request decrease of about $200 million is driven by “the lower commissary operating support request,” according to budget documents obtained by Military Times. One source familiar with commissary operations said the $200 million reduction may be the result of various savings in operating costs that the Defense Commissary Agency has implemented. One example is the change in the way the commissary agency provides produce to stores in the Pacific, reportedly saving more than $40 million a year. "As long as it's not affecting the benefit and they've made some efficiencies that reduce the [amount of taxpayer dollars required], we wouldn't have any problem. But we'd like to see where the money is coming from," said the source. Lawmakers also gave DoD leeway this year to test proposals for saving money in commissary operations while delivering the same savings and same benefit. DoD is considering options for pilot programs.

Those taxpayer dollars, which cover commissary operating costs, enable the stores to sell groceries at cost, giving military patrons an average of about 30 percent savings over civilian stores outside the gates. Lawmakers were concerned that focusing on cutting taxpayer dollars would directly result in a cut to the commissary benefit — the savings customers enjoy. Defense officials will “look for efficiencies first and let efficiencies drive the budget, rather than the other way around,” said Peter Levine, DoD’s deputy chief management officer, in an 27 OCT speech. Levine is leading the efforts to find taxpayer savings in DoD’s resale operations. One proposal explored was the merger or consolidation of the commissary and exchange systems, but Levine said officials determined that is not necessary. “We believe we can get efficiencies without consolidation,” Levine said. [Source: Military Times | Karen Jowers | February 9, 2016 ++]

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Commissary Prices Update 02 ► Increase in 2017

Congress will seek to raise commissary prices while lowering others under a “variable pricing” plan as part of upcoming 2017 legislation governing the Defense Department, one lawmaker told Military.com. "I do expect there to be additional commissary provisions within the National Defense Authorization Act, some of which are to give the Defense Commissary Agency the authorities and flexibility they need to move forward with some of the things they've already said they would like to do," Rep. Joe Heck (R-NV), who oversees the House Armed Services subcommittee on personnel, which sets commissary legislation, told Military.com in a recent interview. "We think we've got to move the variable pricing," he added.

Under current law the Defense Commissary Agency sells goods at-cost, plus a 1-percent price bump to cover loss and spoilage and a 5-percent surcharge on shoppers' final bill. An ongoing push by Congress, however, looks to institute "variable pricing," a move that would allow commissary officials to raise or lower prices regardless of what those items cost the system. Since store sales only cover the cost of goods, the commissary currently receives $1.3 billion a year in taxpayer funding, which largely pays for employee costs and store operations worldwide. Lawmakers and the Pentagon have sought for several years to cut that funding and move the commissary to a self-sustaining model, but advocates warn that raising prices to pay for the system's operation will drive away customers and eliminate the benefit, seen by many as a non-monetary form of military pay.

While a variety of price-setting schemes have been floated, Heck said he expects a push for a rule that would set commissary prices on a region-by-region basis. That plan would set prices at a yet to be determined percentage below the regional average of goods outside the gate. For example, if a gallon of milk costs an average $2.50 in civilian stores in the Washington, D.C., area and the commissary were to set all prices at 15 percent below local averages, that milk at the commissary would cost $2.12. But coming up with what that average savings over the civilian marketplace should be is likely to be a sticking point. Heck said that any savings number has to be above the breakpoint where shoppers will no longer bother making a trip to the commissary. "We know that there's a break point, we know that if the savings is less than 'X' people will say 'well I'll just go to the Walmart superstore,'" he said. "So we want to make sure that the savings is adequate to allow the commissary shopper to remain a commissary shopper so they see it as a valued benefit."

As part of that process lawmakers have asked the commissary to produce a "market basket" of products that could be compared in each region against prices outside the gate. But military family advocates and industry representatives say there are major problems with that plan, including determining what products should be compared, how often a survey should be done and what kinds of stores should be included in the comparison. Military family advocates also warn that unless such a change is paired with increased cost of living allowances, a bump lawmakers are unlikely to give, families stationed in high-cost regions will be paying more out of pocket for groceries and, in effect, be punished for going where the military sends them. And no data has shown that such a model would actually result in savings. "It puts at a disadvantage families living in locations where already they are dealing with a high cost of living," said Eileen Huck, a deputy government relations director at the National Military Family Association. "I haven't seen numbers that demonstrate how adopting this model would make the commissary more efficient and allow it to operate at a lower appropriation." [Source: MilitaryTimes | Amy Bushatz | February 8, 2016 ++]

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DoD Fraud, Waste, and Abuse ► Reported 1 thru 14 Feb 2015

MCLB-Albany — A Florida man has pleaded guilty to bribing a public official at a Georgia military base. The Department of Justice announced 3 FEB that 60-year-old Ivan Dwight Brannan of Jupiter, Florida, pleaded guilty to paying bribes at the Marine Corps Logistics Base in Albany, Georgia. Brannan is a former agent for a large national trucking company. Details of Brannan's sentence were not given. Brannan admitted from 2006 to 2012 that he provided cash and other items of value to Mitchell, a former traffic office supervisor for the Defense Logistics Agency at MCLB-Albany. He said he directed truck driver David Nelson to provide cash and other things of value amounting $120,000 to Potts and Jeffrey Philpot, another official in the DLA Traffic office. Potts was sentenced to 10 years and Philpot was given seven years in prison. Nelson pleaded guilty to bribery and awaits sentencing. [Source: The Gazette | February 3, 2016 ++]

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San Diego CA — A federal judge on 29 JAN sentenced a Navy officer to 40 months in prison for providing ships and submarine schedules to a Malaysian contractor in exchange for cash, the services of a prostitute and luxury hotel stays in Singapore, Hong Kong and the island of Tonga. Lt. Cmdr. Todd Dale Malaki told Judge Janis L. Sammartino that he regretted his actions before he was sentenced Friday in San Diego. Malaki is among nine defendants who have pleaded guilty to bribery charges including the case's central figure, Singapore-based executive Leonard Francis. The gregarious businessman bribed Navy officials with extravagant gifts to obtain information that helped his Glenn Defense Marine Asia bilk the Navy out of at least $20 million, according to the criminal complaint. Francis is awaiting sentencing. Only one defendant is still fighting the charges. Prosecutors have suggested there still could be arrests in the ongoing investigation that has rocked one of the world's largest Navy fleets.

Sammartino told the court that a more significant sentence was warranted because of Malaki's long- term corruption over more than seven years. She said Malaki's case was "one of the most serious offenses the court has seen in its tenure in the Southern District of California." She ordered Malaki, 44, to pay a $15,000 fine and $15,000 in restitution to the Navy. Malaki's defense attorney, Jeremiah Sullivan, said his client has taken responsibility for what he did. "He dedicated 26 years of his life to serving the Navy and his country and he let everyone down," Sullivan said. "It pains him that he hurt so many." Malaki had faced a maximum of five years in prison. He is the second defendant to be sentenced. Last week, Navy Petty Officer First Class Daniel Layug was sentenced to 27 months in prison for conspiracy to commit bribery.

Malaki's sentencing comes a day after Navy Cmdr. Michael Misiewicz, one of the highest ranking officers charged in the ‘Fat Leonard” bribery case, pleaded guilty to one count each of conspiracy to commit bribery and bribery of a public official. He faces up to 20 years in prison if sentenced to the maximum amount for both charges. Prosecutors say he and Francis moved ships like chess pieces, diverting them to Pacific ports with lax oversight where GDMA submitted fake tariffs and other fees. In 2010, Misiewicz caught the world's attention when he made an emotional return as a U.S. Naval commander to his native Cambodia, where he had been rescued as a child from the violence of the Khmer Rouge and adopted by an American woman. His homecoming was widely covered by international media. His sentencing hearing was set for April 29. [Source: The Associated Press | Julie Watson | January 29, 2016 ++]

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VA Accountability Update 17 ► Judges Say No to Exec’s Demotions

Congress has repeatedly criticized for infrequent firings within the department, even in the wake of nationwide scandals regarding patient wait times and records manipulations. Last month, VA Secretary Bob McDonald told members of the Senate Veterans’ Affairs Committee that “we have enough authority to fire people” and that dismissing more employees would not improve services throughout the department. But he has also repeatedly promised to punish individuals found guilty of mismanagement and incompetence, a promise that lawmakers have repeatedly called into question. [Source: Military Times | Leo Shane | February 2, 2016 ++]

Veterans Affairs Deputy Secretary Sloan Gibson is promising new disciplinary action against a pair of senior executives accused of gaming the department’s internal promotion system, after appeals panels have rejected plans to demote the pair. “We have charges that have been sustained, but with no punishment,” Gibson told reporters 2 FEB. “I don’t believe that reflects the intent of Congress in passing (new accountability) laws.” He’ll also launch an investigation into whether other high-ranking officials should also face punishment for a series of “judgment errors” that amounted to a revolving door of leadership moves which cost more than $400,000 in relocation expenses, money lawmakers have insisted should be recovered from the employees.

That investigation will include interviews with Acting Undersecretary for Benefits Danny Pummill, and possible disciplinary action for his role in the cases. “If there is evidence that supports misconduct that was not available for my review previously, I will take action,” Gibson said. Gibson would not say whether the new proposed punishments would leave the two embattled executives — Diana Rubens, Philadelphia Regional Office director, and Kimberly Graves, a Minnesota regional office director — in their current jobs. Rubens and Graves are at the center of a months-long controversy that has pitted VA leaders against the department’s inspector general, congressional critics and their own employees.

An inspector general report released in late September charged Rubens and Graves with abusing their authority to reassign other directors to jobs elsewhere within VA, then moving into the vacant positions themselves. Investigators said the moves carried with them fewer responsibilities but no salary reductions, plus generous relocation payouts. Graves, who makes nearly $174,000 a year, got more than $129,000 to move from Philadelphia to Minnesota. Rubens, who makes $181,000, received more than $288,000 to move from Washington, D.C., to Philadelphia. Lawmakers have repeatedly called for their firings. But Gibson and other senior VA leaders have blasted the IG findings as politically motivated and baseless, and recommended demotions instead.

In two separate rulings over the last week, appeals judges denied those demotions, saying the mistakes made by the executives don’t warrant that level of punishment. Part of the justification for that decision is that other equally culpable executives weren’t disciplined at all for similar mistakes. Gibson said those comments and new evidence uncovered in the appeals process prompted him to look into whether Pummill — who oversaw both women — and others should face punishment. He also noted that neither judge refuted VA’s assertion that the women made errors in judgement in involving themselves in job transfers that could be self-beneficial, which he called a validation of the department’s moves so far. The new punishment could involve relocating both women to other jobs, but not demoting them from the senior executive service.

Gibson said he still has confidence in both of them as managers, but felt the moves were necessary because of the appearance of impropriety they created. He also dismissed the idea that his department needs more tools to handle employee accountability, noting that new rules approved by Congress in 2014 may have over-complicated this case. The appeals judge in Rubens’ case noted that he would have preferred to “mitigate” punishment for the executive, but under current law he was allowed only to reverse the decision. The law passed by lawmakers was designed to speed the firing process by simplifying the notification and appeals process. Gibson called it “the pitfalls associated with a patchwork quilt of processes and legal standards.” A decision on new punishment for Rubens and Graves, and possible punishment for other executives, is expected next week.

Congress has repeatedly criticized VA for infrequent firings within the department, even in the wake of nationwide scandals regarding patient wait times and records manipulations. Last month, VA Secretary Bob McDonald told members of the Senate Veterans’ Affairs Committee that “we have enough authority to fire people” and that dismissing more employees would not improve services throughout the department. But he has also repeatedly promised to punish individuals found guilty of mismanagement and incompetence, a promise that lawmakers have repeatedly called into question. [Source: Military.com | Leo Shane| February 2, 2016 ++]

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VA Accountability Update 18 ► New Top Exec Punishment Idea

The Department of Veterans Affairs bosses have come up with a new idea on how to punish top executives at the agency – one that would keep control in the hands of VA leadership and exclude involvement of an outside appeals board, VA Secretary Bob McDonald said 10 FEB. The idea was floated by Deputy Secretary Sloan Gibson after suffering a bruising blow from the mandated appeals board that overturned three VA punishments in a row in the past few weeks. The actions by the Merit Systems Protection Board embarrassed the agency and frustrated Gibson, who said the board had taken away his ability to hold senior executives accountable.

Secretary of Veterans Affairs Bob McDonald and other top VA officials testify at a House Veterans' Affairs Committee hearing on Capitol Hill, Feb. 10, 2016.

McDonald, appearing Wednesday before the House Veteran’s Affairs Committee to discuss the proposed VA budget for 2017, said Gibson’s idea was to put all senior executives under the regulatory Title 38 statute – the same one used for VA medical professionals -- which would allow the agency to fire executives at will. “It gives us the ability to pay them more competitively and gives us more flexibility in punishing them,” McDonald said. He said Gibson introduced the idea during a meeting Tuesday between the VA leadership and the House and Senate oversight committee leaders. The announcement marked the first time that the lawmakers and VA officials appeared to agree on accountability issues at an agency that has been plagued by scandal. For nearly two years, lawmakers on the oversight committees have been critical of VA leadership for failing to take executives to task, after details emerged of huge appointment and benefits wait times and of cover-ups that left veterans dying while languishing on hidden wait lists.

Rep. Jeff Miller (R-FL), the House Veterans’ Affairs Committee, has been pressing VA leaders to agree to legislative reform of the civil service system that would allow for greater accountability. Until now, McDonald and Gibson have said they had the tools they needed. Miller reiterated his concerns Tuesday, saying he would be remiss if he didn’t mention the frustrations he and other members of the panel felt following the MSPB reversals. “We’ve got to have an honest conversation about what’s happening in the civil service system,” he said. Other groups also railed against the system after the MSPB rulings. Last week, the board reversed the VA’s attempt to fire Linda Weiss, the director of the Albany Stratton VAMC following revelations of mismanagement of patient care. That reversal came on the heels of earlier decisions by the board to undo disciplinary actions in high-profile cases against executives Diana Rubens and Kimberly Graves, for their actions involving their reassignments to different positions while collecting hundreds of thousands of dollars in relocation incentives. Gibson vowed last week that despite the board’s reversal, he would not return Weiss to any position where she would be responsible for patient care.

American Legion National Commander Dale Barnett issued a statement 9 FRB, saying it was impossible to restore accountability to the VA when the board kept reversing its attempts to punish poor performers. “By tolerating bad behavior without even allowing a slap on the wrist, the MSPB is risking the lives of veterans,” Barnett said. “The American Legion is calling on Congress, the Department of Veterans Affairs and the MSPB to work together to reform the procedures needed to finally bring accountability to a department that desperately needs it.” Gibson’s proposal will be incorporated into negotiations between the House and Senate oversight committees over a package of veteran’s legislation that will go up for a vote later this year. The proposal could face some resistance, particularly from Sen. Bernie Sanders (D- MA) who was instrumental in ensuring that the appeals board had the final say on disciplinary cases against VA executives when the legislation was passed last year.

McDonald also outlined other issues he hopes Congress will consider for legislation this year, including 40 new proposals. Among them: allowing McDonald the authority to transfer up to 2 percent of discretionary funding across accounts; allowing for greater flexibility in job hours and pay for top medical staff so the VA can be more competitive in hiring, and restructuring the current process for benefits appeals, in which some cases have taken years or even decades to resolve. McDonald said he believed by restructuring the appeals process rather than just adding more staffing, the VA could ultimately cut the number of staff and expenditure while streamlining process and ending the backlog. “If we are serious about changing the VA and better serving veterans, we can’t keep kicking the can down the road,” McDonald said. Miller welcomed the proposal.

During two hours of testimony, McDonald faced down what has become routine criticism about accountability issues in other areas as well. Rep. Doug Lamborn (R-CO) grilled McDonald on why nobody was punished after an inspector general report last year found long wait times at the VA in Colorado Springs. McDonald said the report found bad training, not intentional malfeasance, and the VA has addressed the issue. Lamborn wasn’t appeased. “Whether it was malicious or not, I think the records were falsified and someone needs to be fired,” he said. Rep. Mike Coffman, another Republican from Colorado, picked up the mantle, pressing McDonald on why the VA wouldn’t get behind a legislative effort that would enable them to take back bonuses from executives who were found to have acted badly to get the money and why the VA wasn’t getting rid of more executives who’d been found guilty of wrongdoing. Coffman assailed McDonald for “saying great things” but “not attacking the heart of the problem” and allowing bad behavior to continue. “You can’t fire your way to excellence,” McDonald said. “It might be a good start,” Coffman replied. [Source: Stars and Stripes | Dianna Cahn | February 10, 2016 ++]

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VA Secretary Update 44 ► Sen. Isakson Wants McDonald to Stay

An influential member of the U.S. Senate wants Veterans Affairs Secretary Bob McDonald to stay on in that role next year, no matter who becomes president. “Everything I’ve seen with Bob McDonald over the last 16 months, I’ve been very pleased with,” said Sen. Johnny Isakson (R-GA) in an interview for C-SPAN's “Newsmakers” taped 11 FEB. Isakson chairs the Senate Veterans Affairs Committee. “I would certainly hope he would stay for continuity purposes, or the next president would pick him to stay. “The main thing we need at VA is continuity and commitment. Bob McDonald is a veteran, he ran a large business, he’s committed to the I-CARE program at VA. I want to make sure that goes through, and I would recommend him.”

Isakson’s comments stem from questions about the presidential candidates’ VA reform proposals. While on the campaign trail, several have labeled the department a failure and a disgrace, and called for a massive downsizing and outsourcing of VA programs. Isakson said his committee is looking at ways to expand outside care programs so veterans have quick access to treatment, but he rejected calls for privatization of key department functions and dismantling the system. “The preponderance of veterans I talk to love their VA care and want to keep it,” he said. “They don’t want it to be replaced or taken away from them. I don’t find a lack of enthusiasm for VA among veterans.” When asked about specific candidates, Isakson said committee activities under his predecessor, Sen. Bernie Sanders, I-Vermont., were “not as active as they should have been” in oversight on a host of department problems but credited him with helping push through the massive Choice Card legislation in 2014.

He also called VA criticisms from Republican frontrunner Donald Trump off-base and misinformed. “I don’t know that he has served or used any VA services, so I think he is regurgitating what he’s hearing in the press,” he said. “A lot of the things being reported are things that happened before I came along or Secretary McDonald came along. … The VA is making substantial changes.” Isakson said he expects that work to continue with a new veterans omnibus package, rolling together a host of proposed health and benefits reform proposals. Whether that legislation will include VA plans to overhaul the benefits appeals process remains to be seen. Isakson said he supports working on changes to that system, but is not sure there will be enough time to reach compromise on a new plan this year. [Source: Military Times | Leo Shane | February 11, 2016 ++]

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VA SAH Update 09 ► Grant Processing Delays Due to Understaffing

The Veterans Affairs Department needs more staff to handle its program that helps disabled veterans to purchase or modify homes to improve their independent living, according to advocates. In many areas of the country, inadequate staffing contributes to delays in processing Specially Adapted Housing program grants and results in poor customer service to veterans, said Heather Ansley, associate general counsel for corporate and government relations for Paralyzed Veterans of America, testifying before the House Veterans’ Affairs Committee’s panel on economic opportunity.

Investments in staffing are needed, she said, because staff members are not able to handle the large work load, including the influx of veterans with amyotrophic lateral sclerosis. “Veterans with ALS are critical users of the SAH grant program and the housing adaptation assistance it provides,” she said. The system is not responsive enough to those with more rapidly changing disorders like ALS, she said. PVA recommends expediting the process for veterans who are terminally ill, including those with ALS, she said. According to service officers with PVA, veterans are having trouble reaching their SAH agents. This is not only unfair to the veterans, but to the agents who are trying to serve them despite too many tasks and too few resources, Ansley said. While it’s understood that application reviews need to be complete, said Rep. Ryan Costello (R-PA), “we must strive to improve the timeliness of service for all veterans.”

VA is working to free up other staff to assist with the grants, said Mike Frueh, director of loan guaranty service for the VA’s Veterans Benefits Administration. Frueh said the VA looks at efficiency and effectiveness across the board, and that these staff members need to be located around the country, but staffing can be adjusted if there’s a spike in need in one area. VA requires in-home interviews be conducted with veterans within 30 business days of eligibility determination, and the typical SAH process requires numerous communications and in-person meetings with the veteran. VA implemented streamlined policies and procedures for the SAH grant process in February 2014, Frueh said. He noted that there has been an overall increase in the number of veterans eligible for the program, citing expansions in the program, the military drawdown and VA’s reductions in the disability compensation claims processing time. In fiscal 2015, VA approved more than 1,800 grants totaling $96 million, he said, an increase of about 44 percent over 2014, and an increase of 65 percent over 2013. [Source: Military Times | Karen Jowers | February 11, 2016 ++]

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VA Medical Foster Homes ► Nursing Home Alternative

A Medical Foster Home (MFH) can serve as an alternative to a nursing home. It may be appropriate for Veterans who require nursing home care but prefer a non-institutional setting with fewer residents. MFHs are private homes in which a trained caregiver provides services to a few individuals. Some, but not all, residents are Veterans. VA inspects and approves all Medical Foster Homes. The Homes have a trained caregiver on duty 24 hours a day, 7 days a week. This caregiver can help the Veteran carry out activities of daily living, such as bathing and getting dressed. VA ensures that the caregiver is well trained to provide VA planned care.

You will continue to receive Home Based Primary Care services in the Medical Foster Home. You may also receive the following services from the Medical Foster Home caregiver.

1. For Veterans:  Help with your activities of daily living (e.g., bathing and getting dressed)  Help taking your medications  Some nursing assistance, if the caregiver is a registered nurse  All of your meals  Planned recreational and social activities

2. For Caregivers:  Peace of mind when Home and Community Based Services can no longer meet the Veteran's needs at home  A place to enjoy spending time with the Veteran

You can use the below Shared Decision Making (SDM) Worksheet to help you figure out what long term care services or settings may best meet your needs now or in the future. There's also a Caregiver Self-Assessment (CSA) worksheet. It can help your caregiver identify their own needs and decide how much support they can offer to you. Having this information from your caregiver, along with the involvement of your care team and social worker, will help you reach good long term care decisions.

 SDM: http://www.va.gov/geriatrics/guide/longtermcare/Shared_Decision_Making_Worksheet.pdf  CSA: http://www.va.gov/geriatrics/guide/longtermcare/Caregiver_Self_Assessment.pdf

Your physician or other primary care provider can answer questions about your medical needs. Some important questions to talk about with your social worker and family include:

 How much assistance do I need for my activities of daily living (e.g., bathing and getting dressed)?  What are my caregiver's needs?  How much independence and privacy do I want?  What sort of social interactions are important to me?  How much can I afford to pay for care each month?

Medical Foster Homes are not provided or paid for by VA. To be eligible for a MFH you need to be enrolled in Home Based Primary Care, and a Home needs to be available. Your VA social worker or case manager can help you with eligibility guidelines for Home Based Primary Care and Medical Foster Home care. Also, with locating one and assist with making the arrangements. You will have to pay for the MFH yourself or through other insurance. The charge for a MFH is about $1500 to $3000 each month based on your income and the level of care you need. The specific cost is agreed upon ahead of time by you and the MFH caregiver. Talk with a VA social worker/case manager to find out if you are entitled to additional VA benefits that will help pay for a Medical Foster Home

If a Medical Foster Home seems right for you, your VA social worker can help you locate one and assist with making arrangements. Also, at http://www.va.gov/GERIATRICS/Guide/LongTermCare/Locate_Services.asp you can use the Locate Services and Resources page to help you locate Medical Foster Homes. [Source: Geriatrics and Extended Care http://www.va.gov/geriatrics/guide/longtermcare/medical_foster_homes.asp# Feb 2016 ++]

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VA Hospital Quality of Care Update 02 ► 2010-2013 Study Results

Veterans' hospitals compare pretty favorably with others when it comes to treating older men with three common conditions — heart attacks, heart failure and pneumonia, according to a study on death rates and readmissions. Chances for dying or being readmitted within 30 days of treatment for those conditions varied only slightly for patients hospitalized within the VA system versus at outside hospitals, the 2010- 2013 study found. The results contrast with longstanding concerns about challenges facing veterans and the VA health system, including quality questions and long waits for care. They suggest that VA hospitals "are still able to deliver high-quality care for some of the sickest most complicated patients," Dr. Ashish Jha, a Harvard health policy expert, said in an editorial published 9 FEB with the study in the Journal of the American Medical Association.

The study analyzed claims for men aged 65 and older treated at 104 VA hospitals and for male Medicare patients treated at 1,513 non-VA hospitals nationwide. Each comparison involved at least 7,900 patients. At VA hospitals, death rates were marginally lower after a heart attack — 13.5 percent vs 13.7 percent; and for heart failure — 11.4 percent vs 11.9 percent. They were slightly higher for pneumonia — 12.6 percent vs. 12.2 percent at non-VA hospitals. Readmission rates ranged from about 17 percent to 25 percent for the three conditions and were highest at VA hospitals, but only by about 1 percentage point or less. "Both groups are now working on quality in ways they didn't a decade ago and the levels of good performance are quite comparable" for the conditions studied, said lead author Dr. Harlan Krumholz, a Yale University cardiologist and researcher.

The efforts include online sites allowing consumers to compare patient outcomes for the three conditions studied at VA hospitals and others nationwide, and growing use of pilot-style checklists during hospital procedures to verify appropriate treatment. Still, Krumholz said the overall results aren't ideal. "Readmissions are still way too high and we haven't made enough progress there," he said. Lower readmission rates at non-VA hospitals may partly reflect the impact of financial penalties the Medicare system introduced in 2012 to reduce readmissions. But also, VA patients tend to be sicker and travel farther for care, which could lead to more readmissions, the researchers said.

Dr. David Shulkin, the VA's undersecretary for health, said the results are not surprising and they debunk "the impression that the VA has fallen behind. This really is validation" that VA employees "are really doing a very good job and keeping focused on doing what's right for veterans." Krumholz noted that the study doesn't address quality of care for young patients, women and those with conditions other than those studied. Jha, the editorial author, said other important questions about VA hospitals remain, including timeliness of care and whether veterans perceive that they are treated with respect. [Source: ABC News | Lindsey Tanner | February 9, 2016 ++]

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VA Appeals Update 19 ► Regional Office Appeals Process

Most Veterans are aware that claims are rated at the VA regional office (RO), usually in their state. However, a lot of Veterans are not aware that appeals are also reviewed at the regional office before they go to the Board of Veterans’ Appeals (Board). Following addresses the RO’s appeal process, your role in the process, and the things you can do to help expedite your appeal.

Appeals at the local regional office level. Once a VA office issues its decision on your claim, you have one year from that date to file an appeal. Read the decision letter closely: it will tell you why VA made the decision it did. If you are unsure why or how VA made its decision, ask a Veterans service officer for help. You can also call VA or go to your regional office. If you disagree with VA’s decision for any reason – the effective date of your award, the rating percentage you were given or the reason you were denied – you should file a Notice of Disagreement (NOD). If VA included VA Form 21-0958, Notice of Disagreement, with its decision, you must use that form to file your NOD – it is mandatory. At http://www.vba.va.gov/pubs/forms/VBA-21-0958-ARE.pdf you can access one if necessary. The NOD is the start of your appeal.

Appeal Life Cycle. Once you file your NOD, you have several rights: you can submit new evidence, ask for a de novo review where a decision review officer (DRO) takes a “fresh look” at the claim, reviewing the entire claims file and/or ask to testify and present evidence at a telephone or in-person hearing. VA encourages Veterans who choose to have a hearing to opt for an informal teleconference hearing, since these can be scheduled much faster. Many appeals are favorably resolved at these early stages. Make sure you file your NOD on time: your right to appeal ends a year from the date of VA’s decision. When you file your NOD, you have a choice: either select a traditional review or a de novo review by a DRO. You can make this choice right on your NOD when you start your appeal. If you don’t make a decision, VA will mail you a notice of this right, and you’ll have 60 days to respond, so answer right away. Thus:

 If you are dissatisfied with the decision on your claim, file your appeal right away  When you file your NOD, submit any new evidence you have; waiting until later on in the process can delay your appeal  Also, when you file your NOD, state if you want a DRO review or a traditional review – this will also save you time on your appeal

Traditional Review. If you opt for a traditional review, a member of the RO appeals team reviews the decision on your claim to determine if it was processed correctly; if it was, the RO will issue you a Statement of the Case (SOC). An SOC lists the applicable laws and regulations related to that decision, all the evidence that was considered in making the decision and a detailed explanation of the decision VA made.

De novo Review. A de novo review is your other option. de novo, which means “new,” or “fresh look,” is a Latin term used by lawyers. In a de novo review, a DRO, who is a senior-level, highly experienced claim processor, looks at all the evidence of record (your entire claims file, including any new evidence you’ve submitted). The DRO can grant your appeal, deny your appeal and issue an SOC, or order additional development (such as a new medical exam or a request for additional medical records), if warranted. Unless the RO grants the full benefit you are seeking, you will receive an SOC. This means EVEN if the RO grants your claim, you may receive an SOC, allowing you to continue the appeal. For instance:

 If you were appealing service connection for tinnitus (ringing in the ears) and the RO granted this on appeal at 10 percent, the RO appeals team will ONLY issue a rating decision since 10 percent is the highest rating you can receive for tinnitus. This means the appeal has been granted in full. You will not receive an SOC.  If you were appealing VA’s 10-percent rating for arthritis in your lower back because you believe you should be rated higher, but the RO appeals team disagrees and continues your 10-percent rating, you will  If you were appealing VA’s 10-percent rating for arthritis in your lower back because you believe you should be rated higher, and the RO appeals team agrees and increases your rating to 20 percent, you will receive BOTH a new award decision explaining why VA increased your disability rating AND an SOC detailing how VA arrived at its decision, including why you were not entitled to a rating higher than 20 percent.

You have 60 days from the date the SOC is mailed to you to file a VA Form 9, Appeal to the Board of Veterans’ Appeals, if you wish to continue your appeal to the Board. At http://www.va.gov/vaforms/va/pdf/VA9.pdf it can be completed online and downloaded for mailing. Any time you submit more evidence after the SOC or before the Form 9, VBA must conduct another review of the case and issue another SOC – this one called a supplemental statement of the case (SSOC) that includes the additional evidence – or a rating decision, if the additional evidence allows VBA to grant the appeal. This must be done each time you submit new evidence after the SOC. I have seen appeals with four or five SSOCs. Keep in mind, each time you submit new evidence it triggers a new review. It’s like starting all over again in the appeals process. Each new SSOC can add up to 400 days to the appeal, so my best advice is, submit all available evidence to support your appeal when you file your NOD.

On the Form 9, you can request an optional hearing before a judge at the Board, who will decide your appeal. A hearing is not required and will delay a final decision, but if you want a hearing, you can choose a video-teleconference hearing, a travel board hearing at your local RO, or an in-person hearing in Washington, D.C. If you want a hearing, your best bet is to opt for the video-teleconference hearing, since it can be scheduled much quicker than other types of hearings. This is because you don’t have to travel to Washington, D.C. and you don’t have to wait for a judge to travel to your RO. You still get the benefit of representation and talking to a judge face-to-face – though virtually, like on Skype or on FaceTime. Once you submit your Form 9, the RO appeals team reviews your appeal to ensure all actions were completed and that it is ready to go to the Board. Once ready, the local RO will certify and transfer your appeal to the Board in Washington, D.C. [Source: VAntage Point | Catherine Trombley | February 10, 2016 ++]

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VA Budget 2017 ► $182.3B Proposed

In his FY 2017 budget, President Obama is proposing $182.3 billion for the Department of Veterans Affairs (VA). Funding will continue to support the largest transformation in VA history; expand access to timely, high-quality health care and benefits; and advance efforts to end homelessness among Veterans. “VA has before it one of the greatest opportunities in its history to transform the way it cares for our Veterans who nobly served and sacrificed for our Nation,” said VA Secretary Robert A. McDonald. “As we work to become a more efficient, effective and responsive, Veteran-centric Department, we can’t do it alone; we need the help of Congress. This year, VA submitted over 100 legislative proposals, including 40 new proposals to better serve Veterans. Our goal is provide the best care to our Veterans while removing obstacles or barriers that prevent them from getting the care they deserve.”

The FY 2017 budget includes $78.7 billion in discretionary funding, largely for health care and $103.6 billion for mandatory benefit programs such as disability compensation and pensions. The $78.7 billion for discretionary spending is $3.6 billion (4.9 percent) above the 2016 enacted level, including over $3.6 billion in medical care collections from health insurers and Veteran copayments. The budget also requests $70.0 billion, including collections, for the 2018 advance appropriations for medical care, an increase of $1.5 billion and 2.1 percent above the 2017 medical care budget request. The request includes $103.9 billion in 2018 mandatory advance appropriations for Compensation and Pensions, Readjustment Benefits and Veterans Insurance and Indemnities benefits programs in the Veterans Benefits Administration.

Health Care - With a medical care budget of $68.6 billion, including collections, VA is positioned to continue expanding health care services to its millions of Veteran patients. Health care is being provided to over 922,000 Veterans who served in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn/Operation Inherent Resolve (OIR) and Operation Freedom’s Sentinel (OFS). Major spending categories within the health care budget are:

 $12.2 billion for care in the community;  $8.5 billion for long-term care;  $7.8 billion for mental health;  $1.6 billion for homeless Veterans;  $1.5 billion for Hepatitis-C treatments;  $725 million for Caregivers;  $601 million for spinal cord injuries; and  $284 million for traumatic brain injuries.

Expanding Access - The President’s Budget ensures that care and other benefits are available to Veterans when and where they need them. Among the programs that will expand access under the proposed budget are:

 $12.2 billion for care in the community compared to $10.5 billion in 2015, a 16 percent increase;  $1.2 billion in telehealth funding, which helps patients monitor chronic health care conditions and increases access to care, especially in rural and remote locations;  $515 million for health care services specifically designed for women, an increase of 8.5 percent over the present level;  $836 million for the activation of new and enhanced health care facilities;  $900 million for major and minor construction projects, including funding for seismic corrections, two new cemeteries, and two gravesite expansions; and  $171 million for improved customer service by providing an integrated services delivery platform.

Improving the Efficiency of Claims Processing - The President’s Budget provides for continued implementation of the Veterans Benefits Administration’s (VBA) robust Transformation Plan -- a series of people, process, and technology initiatives -- in 2017. This plan will continue to systematically improve the quality and efficiency of claims processing. Major claims transformation initiatives in the budget invest $323 million to bring leading-edge technology to claims processing, including:

 $180 million ($143 million in Information Technology and $37 million in VBA) to enhance the electronic claims processing system – the Veterans Benefits Management System (VBMS); and  $143 million for Veterans Claims Intake Program (VCIP) to continue conversion of paper records, such as Veterans’ medical records, into electronic images and data in VBMS.

In addition, the President’s Budget supports increasing VBA’s workforce to address staffing needs so it can continue to improve the delivery of benefits to Veterans. As VBA continues to receive and complete more disability compensation rating claims, the volume of non-rating claims correspondingly increases. The request for $54 million for 300 additional full-time equivalent employees (FTE) and claims processing support will allow VBA to provide more timely actions on non-rating claims.

Appeals Reform - The current appeals process is complicated and ineffective, and Veterans on average are waiting about 5 years for a final decision on an appeal that reaches the Board of Veterans’ Appeals, with thousands waiting much longer. The 2017 Budget proposes a Simplified Appeals initiative – legislation and resources – to provide Veterans with a simple, fair, and streamlined appeals process in which they would receive a final appeals decision within one year from filing an appeal by 2021. The Budget requests $156 million and 922 FTE for the Board, an increase of $46 million and 242 FTE over 2016, as a down payment on a long-term, sustainable plan to improve services to Veterans.

Ending Veterans Homelessness - The Administration has made the ending of Veteran homelessness a national priority. The Budget requests $1.6 billion for programs to prevent or reduce Veteran homelessness, including:

 $300 million for Supportive Services for Veteran Families (SSVF) to promote housing stability;  $496 million for the HUD-VASH program, wherein VA provides case management services for at-risk Veterans and their families and HUD provides permanent housing through its Housing Choice Voucher program; and  $247 million in grant and per diem payments that support temporary housing provided by community-based organizations.

MyVA - The 2017 budget continues the largest Department-wide transformation in VA’s history through the MyVA initiative, which is changing VA’s culture, processes, and capabilities to put the needs, expectations and interests of Veterans and their families first. MyVA has developed five objectives fundamental to the transformation of VA: 1) improving the Veterans’ experience; 2) improving the employee experience; 3) improving support service excellence; 4) establishing a culture of continuous performance improvement; and 5) enhancing strategic partnerships. To aid in this transformation, the Department established the Veterans Experience Office (VEO). The VEO will represent the voice of Veterans and their families in Departmental governance; design and implement customer-centric programs to make interactions with VA easier; and support VA’s “mission owners” in carrying out MyVA improvements across the system.

Veterans Choice Act - The Veterans Choice Act provides $5 billion to increase Veterans' access to health care by hiring more physicians and staff and improving the VA’s physical infrastructure. It also provides $10 billion through 2017 to establish a temporary program (the Veterans Choice Program) to improve access to health care by allowing eligible Veterans who meet certain wait-time or distance standards to use eligible health care providers outside of the VA system. In 2017, VA will use the Choice Act funds in concert with annual appropriations to meet VA staffing and infrastructure needs and expand non-VA care to Veterans who are eligible for the Veterans Choice Program. VA plans to spend $1.4 billion in 2016 and $853 million in 2017 to support more than 9,700 new medical care staff hired through the Choice Act; $980 million in 2016 and $116 million in 2017 to improve VA facilities.

Other Key Services for Veterans -

 $286 million to administer VA’s system of 134 national cemeteries, including additional funding for operations of new cemeteries and the National Shrine program to raise and realign gravesites;  $4.3 billion for information technology (IT), including investments to strengthen cybersecurity, modernize Veterans’ electronic health records, improve Veterans’ access to benefits, and enhance the IT infrastructure; and  $125 million for state cemetery grants and state extended care grants.

Enhanced Oversight of VA’s programs - The 2017 budget requests an additional $23 million and 100 FTE for the Office of Inspector General (OIG) to enhance oversight and assist the OIG in fulfilling its statutory mission and making recommendations that will help VA improve the care and services it provides.

-o-o-O-o-o-

VA operates the largest integrated health care system in the country; the tenth largest life insurance program in the Nation, with $1.3 trillion in coverage; monthly disability compensation, pensions, and survivors benefits to 5.3 million beneficiaries; educational assistance or vocational rehabilitation benefits and services to nearly 1.2 million students; mortgage guaranties to over 2 million homeowners; and the largest cemetery system in the Nation. Information about VA’s 2017 budget submission and links to related documents may be found at www.va.gov/budget/products.asp. .Information about the President’s budget may be found at https://www.whitehouse.gov/omb. [Source: VA Press Release | February 9, 2016 ++]

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VA Budget 2017 Update 01 ► Lawmakers Eye Ever-Growing Budget

Lawmakers warned Veterans Affairs officials 10 FEB not to assume they’ll continue to see their budget grow unchecked, especially in light of recent criticisms of department spending. The department has seen budget increases each of the last 16 years, even as funding of other government programs has held steady or been reduced. When lawmakers passed spending caps on federal programs in 2011, Veterans Affairs programs were exempt. In fiscal 2001, the VA budget totaled $45 billion. The president’s budget request for fiscal 2017 is four times that, topping $177 billion, with $75 billion for discretionary funding alone.

Administration officials have said the increases reflect the growing demands on the department in the wake of the wars in Iraq and Afghanistan, and are designed to correct longstanding shortfalls in the department. But congressional leaders warned that those cost corrections may be coming to an end. “This budget request is almost double the VA budget in 2009, and since then, the VA has been plagued by scandals and mismanagement and has consistently proven its inability to use its existing resources,” Senate Veterans' Affairs Committee Chairman Johnny Isakson (R-GA) said in a statement. “The solution to fixing a broken agency is not simply giving it more money.”

In a VA budget request hearing across Capitol Hill, House Veterans' Affairs Committee Chairman Jeff Miller (R-FL) promised to “fight to ensure VA has the resources it needs, but given recent problems, this budget request will receive every bit of the scrutiny it is due.” He referenced a billion-dollar cost overrun for plans to build a new VA hospital near Denver and related budget shortfalls last year that caused Congress to pass emergency legislation to keep the department’s programs operating. “But in classic VA fashion, I’m not aware of a single employee that has been held accountable for these unprecedented failures,” he said. Other committee members lamented lingering problems with veterans' access to health care appointments, disability benefits claims and middle management mistakes.

VA Secretary Bob McDonald said the budget proposal does include a host of efficiencies and reforms, including proposals to simplify the management structure within the department and close excess facility space. “We’re providing more care, more access to care,” he said of the budget increases. “We’re dealing with more disability claims. We’re serving a customer that has more demands.” The annual budget process is expected to last well into the fall, although leaders from both chambers have expressed hope that appropriations work could be completed before the November presidential election. [Source: Military Times | Leo Shane | February 10, 2016 ++]

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VA Claim DBQ ► Disability Benefit Questionnaire Submission

You will need to use a Disability Benefits Questionnaire (DBQ) as part of your application to the U.S. Department of Veterans Affairs (VA) for disability benefits. With Disability Benefits Questionnaires (DBQs) Veterans now have more control over the disability claims process. For VA exams, a VA clinician will fill out the DBQ . If you prefer you have the option of visiting a private health care provider instead of a VA facility to complete their disability evaluation form. Veterans can have their providers fill out any of the more than 70 DBQs that are appropriate for their conditions and submit them to us. You can locate a DBQ appropriate for your condition by downloading it at http://www.benefits.va.gov/COMPENSATION/dbq_ListByDBQFormName.asp

For VA to use a DBQ to process your claim, your licensed healthcare professional must provide all requested medical information. Note that VA will not pay or reimburse any expenses or costs incurred in the process of completing and/or submitting a DBQ. VA reserves the right to confirm the authenticity of all DBQs completed by private health care providers. There are four steps to submit a DBQ:

Step1: Find the appropriate DBQ based on your claimed disability.

 Go to http://benefits.va.gov/COMPENSATION/dbq_disabilityexams.asp  Select the appropriate DBQ by using the "List by DBQ Form Name" or "List by Symptoms" web pages.  Either download the DBQ so the licensed healthcare professional can complete it or print the DBQ for your licensed healthcare professional to complete it by hand.

Step 2: Take the DBQ to your licensed healthcare professional and have your licensed healthcare professional complete the form.

 Your licensed healthcare professional must follow all instructions carefully.  Legibility is important! Therefore, VA prefers that your licensed healthcare professional completes the DBQ electronically. If your licensed healthcare professional completes it by hand, please ask him to make sure VA can read the information.  Ensure your licensed healthcare professional completes the last section of the DBQ by providing his or her name, signature, and contact information. VA will only accept a DBQ signed by a licensed healthcare professional. A licensed healthcare professional completing an electronic DBQ must print it to sign it.  For a video on provider instructions go to https://www.youtube.com/watch?v=Ij3kmGLYndo.

Step 3: Obtain a copy of the completed DBQ for your records.

Step 4: Submit the completed DBQ to VA.

 You or your licensed healthcare professional can fax, mail, or personally deliver the DBQ to the VA Regional Office (RO) responsible for handling you claim. To find the RO's mailing address and fax number go to http://www.va.gov/directory/guide/Allstate_flsh.asp?dnum=3&divName=Veterans%20Benefits% 20Administration 

DBQs also help support VA's Fully Developed Claims (FDC) Program. DBQs are valuable for claims processing because they provide medical information that is directly relevant to determining a disability rating. When submitted with a fully developed claim, DBQs ensure VA's rating specialists have precisely the information they need to start processing the claim. For more information go to http://www.benefits.va.gov/COMPENSATION/dbq_FAQS.asp, call 1-800-827-1000 or use the Ask us a Question site https://iris.custhelp.com/app/. [Source: January 8, 2016 | http://www.benefits.va.gov/compensation/dbq_disabilityexams.asp ++]

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VA Mustard Agent Claims Update 01 ► VA Failure to Help Exposed Vets

Sen. Claire McCaskill (D-MO) had strong words for Department of Veterans Affairs Secretary Robert McDonald on 4 FEB regarding the VA's failure to compensate thousands of World War II veterans who were exposed to mustard gas. McCaskill has been requesting information from the agency ever since NPR reported the VA's mishandling of disability benefits for the veterans, some of whom are now in their late 80s and early 90s, and still waiting. McCaskill said the VA has "blown past deadlines for briefings and documents" and "shown no urgency in addressing 70 years of appalling mistreatment of these men, many of whom have already passed away." In a statement to NPR, the VA says it is conducting "extensive research to collect and validate the data and information Senator McCaskill has requested. VA is also looking to conduct additional outreach to any veterans newly identified as a result of this research."

Last summer, NPR revealed that despite promises made in the early 1990s, the VA failed to contact more than 3,000 veterans who were exposed to large amounts of mustard gas in secret military experiments and that the agency denied the veterans compensation based on a lack of documentation, even though such documentation was not available to them. Since the report was published, more than two dozen members of Congress have written to McDonald demanding an explanation for the failures and calling for the swift disbursement of benefits for veterans who are still living. In her letter Thursday, McCaskill wrote: "I am trying to help the remaining veterans before time runs out. This makes the VA's refusal to provide answers in a timely fashion all the more unacceptable." [Source: NPR | Caitlin Dickerson | February 4, 2016 ++]

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VA Mustard Agent Claims Update 02 ► Missouri Vet’s Claim Denied

In the final days of World War II, an 18-year-old Army private from Missouri named Arla Wayne Harrell was sent to Camp Crowder in the southwest corner of the state, where he said he was twice exposed to mustard gas. He didn't talk about it for years. When he finally did, he told his family that the Army warned him he'd be thrown in jail if he ever disclosed the experiments. Harrell, known as "Arlie," has been rejected three times by the Department of Veterans Affairs for claims to help treat a lung disorder and skin cancer that his family believes are connected to that exposure, Harrell, who turns 89 next month, is in a nursing home in Macon, Missouri, 180 miles northwest of St. Louis, unable to walk or talk. But his family hopes his final appeal to the VA will get him the recognition from the government they believe he deserves.

The VA has said he needs more documentation — "new and material evidence," as a 2006 rejection letter describes it — to prove the claim. Harrell's family said that's impossible. He was 18 at the time and had been warned to never talk. At the time, Harrell was new in the military and didn't know or doesn't remember the names of other men exposed with him. His children think he purposely blocked out the experience. But 55 pages of military records in his family's possession show that right after Arlie Harrell said he was twice tested with mustard gas, in late July 1945, he was hospitalized at Camp Crowder with a high fever and a sore throat. The Army diagnosed it as nasopharyngitis — an inflammation of mucous membranes between the nose and throat — along with tonsillitis and severe gum disease. He served three years, mostly in postwar Germany. Ever since, his children say, he has suffered persistent breathing problems.

Harrell and his wife, Betty, raised three daughters and two sons in a Kansas City suburb, and later, in the town of Bevier, Missouri, a three-hour drive northwest of St. Louis. Harrell was a truck driver and mechanic; his wife worked as a nurse. "He was always short of breath," said a son, Ray Harrell, of Sarasota, Florida, who served in the National Guard. "Something was not quite right. I worked side by side with him a lot, and when he'd push it, he'd just have to stop sometimes and catch his breath." According to the Centers for Disease Control and Prevention, exposure to mustard gas, though not usually fatal, can cause short-term sinus pain, shortness of breath and other respiratory ailments. Long-term health effects of mustard gas exposure can include "chronic respiratory disease, repeated respiratory infections" and other symptoms, according to the CDC.

"I never knew a healthy dad growing up," said Trish Ayers, a daughter who lives in Berea, Kentucky "Dad worked the whole time, but Dad struggled with his breathing. We girls could not use perfume, we could not use hairspray, anything in the house" because of his ailment. Daughter Beverly Howe, a nurse trained in chemical, biological and radiological treatment from Thomasville, Georgia, said she interviewed her father for a school paper in the early 1970s, and he disclosed the gassing reluctantly to her for the first time. As a nurse, she recognized the symptoms from her training. "He said it was secret and they weren't supposed to talk about it," she said. "If they did, they'd be in big trouble." Then, while visiting a Veterans Administration hospital in Columbia, Missouri, in the late 1980s or early 1990s, a VA X-ray technician who had seen Arlie Harrell's records asked if he had ever been exposed to mustard gas. "I was mostly horrified when I saw the look of terror in my dad's eyes," said Ayers, who was with her father at that appointment. "The man told him it was OK, you can talk about it now. He said, 'Yes,' and that was about it."

His children say he suffers from frequent pneumonia and bronchitis and from the aftermath of a stroke. Despite his inability to talk, he is still cognizant and understands visitors, including his wife, who visits him almost every day. The children say their parents are spending down savings on his care and that $500-a- month drug costs for Harrell put a serious drain on their mother's state pension. VA benefits that would come if he was recognized as a victim of the mustard gas exposure would help. But what matters most now, the children say, is that in the time their father has left the government acknowledges the secret he kept for so long, and that the VA has for so long denied — that "my father could understand that somebody finally believes him," Howe said.

In November, National Public Radio reported that it had uncovered about 3,900 World War II veterans who had been exposed to mustard gas in Army experiments, six times the number the VA had recognized. Harrell may be the only World War II veteran from Missouri on that list who is still alive. VA Secretary Robert McDonald said his agency would try to square the two lists. "We have to find the veterans who suffered through this," he told reporters in November. Arlie Harrell's children helped file a new claim in November, but they say they feel they are again being stonewalled by the VA. Now Sen. Claire McCaskill is pressuring the Pentagon and the VA to expedite the investigation of the NPR claims. More importantly for Harrell, McCaskill's investigators point to a 2012 Army Corps of Engineers document proving mustard gas was present at Camp Crowder. "All of the soldiers who underwent the experiments with mustard gas in World War II have been treated reprehensibly by the VA and by the Department of Defense," said McCaskill (D-MO). "These should have been handled decades ago, and this shouldn't be a fight to get help."

A Veterans Administration spokesman said the agency could not talk about Harrell's claim because of privacy concerns, but that it is working with the family on it. "VA appreciates the service and sacrifices of World War II veterans who may have been subject to mustard gas testing," a statement released by the agency said. It said that "we are working with all stakeholders to do right by these veterans to ensure they receive the benefits and services to which they are entitled." Arlie Harrell told his family he was exposed during his training as a field medic and cook. The war in Europe was over, but the atomic bombs had not yet fallen on Japan. He could not remember names of the men whom he said locked him in a gas chamber at Camp Crowder and filled it with mustard gas, nor did he take names of other men he said were herded in with him. He told family members some screamed or beat on the door in panic, or passed out.

The government acknowledged in that 2012 Corps of Engineers document that there was testing of gas masks and chemical weapons suits at Camp Crowder, but the family said Harrell told them he was not wearing a gas mask. Trish Ayers said her father always talked of "breathing it in." Nor did Harrell remember the name of the man whom, he says, directly applied mustard gas to his arm. As a medic in training, he was told, he needed to know the symptoms of exposure in case the enemy ever used mustard gas in combat. It had been widely used in World War I. "I personally think he just blocked it out as much as he could," Trish Ayers said. After the war, a get-on-with-it resolve came home with the Greatest Generation. "He was always proud of the service he had done, but there always was this reluctance to talk about it," Beverly Howe said.

What weighed on Harrell was the VA denials, his children, now all in their 50s and 60s, said. After each rejection, he'd be depressed and worried, their mother angry, the children said. After the 2006 rejection, "You could see visibly that it is still very disturbing to him," said another daughter, Betty Agan, of Salisbury, North Carolina "It's like, 'Dad, what is going to happen to you?' Nothing. Nothing." McCaskill said: "I think this family is much more interested in this veteran feeling that he is going to be acknowledged for what he did on behalf of his country than any money that would go into his pocket."

That 2012 U.S. Corps of Engineers report says that soldiers at Camp Crowder were exposed to "chemical warfare training" and tests of "gas mask proficiency" in three rooms it refers to as "gas chambers." Soldiers were also trained in the "safe identification, handling, and decontamination of chemical agents and industrial chemicals used in chemical warfare," the corps document says. The corps report says that in 1986, a man on a bulldozer clearing land for development on the Camp Crowder site suddenly had difficulty breathing and watery eyes after a "white gaseous cloud filled the air" after the bulldozer unearthed "several vials of unidentified liquid and metallic material of military nature." Three vials contained mustard gas. None of that conclusively proves that Arlie Harrell was exposed to mustard gas, but it is evidence the family didn't know about until informed by a reporter proving that mustard gas was used at Camp Crowder in gas chambers like the one he described to his family. "This even makes me angrier," said Howe, the nurse, when told of the corps document. "All of these years, they could have been helping my dad with these medical issues. We could have known what it was definitely, and then we could have had treatment with that knowledge." [Source: St. Louis Post Dispatch | Chuck Raasch | February 7, 2016 ++]

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Presumptive AO Diseases Update 23 ► New VA Fact Sheet

The Department of Veteran Affairs on February 4, 2016 released a new Agent Orange and Presumptions of Service Connection: Inland Waterways and “Blue Water” Navy Veterans Fact sheet. A copy is available in the attachment to this bulletin titled, “VA Fact Sheet- AO & SC Presumptions”. [Source: FRA | Charley Randall | February 6, 2016 ++] VA

Gulf War Syndrome Update 36 ► New Analysis Pinpoints Cause

Exposure to pesticides and other toxins appears to be the cause of Gulf War illness in U.S. veterans, a new analysis states. The Boston University researchers reviewed studies on Gulf War illness, and said their findings "clearly and consistently" show a link between the disorder and exposure to pesticides and taking pyridostigmine bromide (PB) pills, which were meant to protect troops against the effects of nerve gas. There's also evidence of a connection between Gulf War illness and exposure to the nerve gas agents sarin and cyclosarin, and to oil well fire emissions, according to the findings published in the January issue of the journal Cortex. These toxins damaged troops' nervous and immune systems, and reduced the amount of white and gray matter in veterans' brains, said study leader Roberta White in a news release from the university. White is a professor of environmental health at Boston University's School of Public Health.

The main causes of Gulf War illness are like so-called "friendly fire," said study co-author James Binns. "We did it to ourselves," he said in the news release. "Pesticides, PB, nerve gas released by destroying Iraqi facilities -- all are cases of friendly fire. That may explain why government and military leaders have been so reluctant to acknowledge what happened," Binns said. About 700,000 U.S. troops fought in the first Gulf War 25 years ago, and as many as 250,000 veterans of that conflict have Gulf War illness, the researchers said. It is a debilitating disorder that features symptoms such as fatigue, joint and muscle pain, headaches, concentration and memory difficulties, gastrointestinal problems and skin rashes.

For years, Gulf War veterans have claimed that the U.S. Department of Veterans Affairs did not take Gulf War illness seriously. In 2008, a committee created by Congress and directed by the White House released a report that said Gulf War illness is a real disorder that's distinct from stress-related syndromes. The report from the Research Advisory Committee on Gulf War Veterans' Illnesses called for research into the causes and treatments of the illness. Binns was chairman of that committee. Efforts to find effective treatments for Gulf War illness have been unsuccessful, but recent research has started to offer promising leads, the researchers added. [Source: HealthDay News | February 1, 2016 ++]

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VA Caregiver Program Update 31 ► Monthly Stipend Removals

There are a growing number of families around the country who are raising questions about why the VA has been removing them from a caregiver program it launched in 2010. For three years Sarah Jenkins’ family received a monthly stipend of $1,275 from the federal Department of Veterans Affairs. This gave Sarah the freedom to care for her husband without having to worry about resuming her career. That let her keep a calm home and respond instantly if her veteran husband experienced one of the mood swings that have characterized his behavior since a group of mortars landed close to him on an Iraqi air field. The checks abruptly stopped in August when the VA declared her family no longer needed them. Jenkins is still trying to figure out why. “How am I going to keep him still feeling safe? That’s what the caregiver program has enabled me to do — to keep him feeling safe,” said Jenkins, 39, whose family recently moved to their hometown in North Idaho after spending the previous 17 years in Roy and Yelm.

The program delivers extra compensation to caregivers of badly wounded Iraq and Afghanistan veterans in the interest of keeping them out of expensive, long-term treatment facilities. Most of the caregivers are spouses or close family members of veterans. That program still is growing at a rate of 400 patients a month, but the VA has been taking a closer look at the veterans it initially enrolled to see whether they still meet standards to continue receiving checks. So far, about 7,000 veterans who once were enrolled in the program no longer are getting stipends. About a third were cut because VA staff members determined they did not meet medical criteria for the support.

From the beginning, the money was not intended to be a permanent benefit and the program’s creation stipulated that the VA occasionally would reassess patients. The trouble was, the VA badly underfunded the program and fell behind in oversight, according to a September 2014 study from the Government Accountability Office. What’s different now is that the VA only last year published an article laying out how the program should be administered and it might finally have enough employees to manage it as it was designed. The idea is to provide stipends to families as long as the veteran’s health meets criteria laid out by the law, VA officials said. If the veteran’s health improves, the VA might remove a patient from the financial part of the program. “What you’re seeing today is based on our (GAO) findings nationwide that have helped us refocus the program and make sure we’re following the guideline set by the law,” said Rocco Bagala, the assistant chief for social work at VA Puget Sound.

Veteran support organizations around the country have been hearing scattered reports of caregiver families raising concerns about losing their stipends. They don’t have enough information yet to decide whether they want to press the VA for reforms or to know for certain that the VA is removing patients from the program who genuinely no longer need the stipends. “The spirit of the law is that you go with the veteran, you go with the caregiver,” said Adrian Atizado, the deputy national legislative director for. “The purpose of this program is to provide support and services to the caregivers because they are taking part in personally discharging this nation’s responsibilities to this nation’s veterans,” he said.

Congress in 2010 called for the creation of a robust caregiver program for Iraq and Afghanistan veterans, pointing to studies that showed families missing work to care for wounded loved ones. A Rand Corp. study in 2014 estimated the work of those families was worth about $3 billion a year, money that otherwise might be spent by the government on veteran support services. Staff for U.S. Sen. Patty Murray (D-WA) have received several complaints from families cut from the program in recent weeks. She’s been one of the program’s main supporters, promoting it at events with the Wounded Warrior Project and the Elizabeth Dole Foundation. She has been advocating for its expansion to include veterans of all conflicts instead of just the most recent wars. “We know that our military caregivers sacrifice their careers, their time, even their own health to take care of our veterans, and they absolutely deserve our support,” Murray said. “I want to make sure VA is a good partner in that effort.”

The GAO showed the VA initially estimated about 4,000 veterans would qualify for the stipend. Instead, more than 15,600 had enrolled by 2014. Last year, more than 24,700 people received caregiver stipends, according to the VA. Spending on the program has swelled to the $555 million budgeted for 2016 from $350 million in 2014, according to VA documents. Staffing has increased, too. At the time of the GAO report, VA Puget Sound had two caregiver case managers overseeing 331 patients. It was one of the highest workloads in the VA. Now, VA Puget Sound has four case managers working with 287 veterans. The program is bigger than just the financial stipends. It also provides coaching and networking to help caregiver families learn from each other. Those benefits are provided to all veterans, not just people who served in Iraq and Afghanistan. “We take a lot of pride in making sure that we are providing services for veterans and family members,” Bagala said. “We want to make sure the hard work the caregivers are doing to support the veterans is recognized.”

Some veterans who recently lost caregiver stipends took the decision as a sign the VA did not value them. They’re also unaware of the non-financial services the program provides. “The recognition of all my hard work, that was important,” said Alisha McNulty, 32, of Olympia. “Now it’s like they’ve said, Never mind.” She and her husband have received caregiver stipends since 2012. They were abruptly cut from the stipends in December after a short meeting with a psychologist at the Seattle VA hospital in November. It was a conspicuously quick decision to the McNultys. “The VA doesn’t do anything that fast,” said Jared McNulty, 33, a former infantry staff sergeant who has struggled with post-traumatic stress since his deployment to Iraq with a Joint Base Lewis-McChord Stryker brigade in 2004-05 He works part-time for the Timberland Regional Library system and Alisha spends much of her life making a home that feels safe for him. They rarely have friends over, don’t go out often and have cut down trees so Jared McNulty can have a clear view of approaches to their house. “I told the VA over and over. I don’t know if they’re not writing it down, if they don’t think it’s issue or what the deal is, but (Jared’s post-traumatic stress) has never been addressed,” Alisha McNulty said. The McNultys are appealing the VA’s decision to cut their stipends.

Sarah Jenkins in Bonners Ferry, Idaho, is out of appeals. Her family lost its stipend in August when a VA psychologist determined her husband, who has held a job has an X-ray technician despite his head injuries, did not need additional support at home. The psychologist’s summary of his condition describes her husband — who did not want to be identified in this story — as needing “minimal assistance” to overcome a hyper-alert state and incidents in which he becomes startled Otherwise, it characterized him as generally able to care for himself while Sarah performs typical “household duties.” That’s not how Sarah Jenkins describes her life.

She had been struggling with her husband’s mood swings since he deployed to Iraq as a medical technician with a JBLM Stryker brigade in 2004. She didn’t know he’d been exposed to close mortar blasts until she stumbled on medical records almost three years later. He goes to the doctor less than he used to, but she worries that will change when she has less time to give him if she returns to work. She wrote a six-page appeal to the VA’s Northwest regional headquarters asking to retain the stipend. In it, she wrote that her husband still experiences nightmares, insomnia, memory loss and a quick temper. They were the same conditions that led her enroll in the program four years ago. “They don’t see what I see in front of me,” she said. [Source: The News Tribune (Tacoma, Wash.) | Adam Ashton | January 30, 2016 ++]

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VA Vet Choice Program Update 28 ► GAO to Audit Program

Thanks to the bipartisan efforts of three members of Congress, the Government Accounting Office (GAO) will audit the VA’s Veterans Choice program, which has been plagued by countless complaints from veterans and health care providers alike. In an effort to help veterans, Congresswoman Louise Slaughter (D-NY), Senator Johnny Isakson (R-GA), and Senator Richard Blumenthal (D-CT) have convinced the GAO to conduct a comprehensive audit of the Veterans Choice program.

The program was created in response to the tragic wait time scandal, in which at least 40 veterans died while waiting for appointments at the Phoenix Veterans Affairs Health Care system. When Congress passed the Veterans Choice and Accountability Act and President Obama signed it into law in August 2014, the idea was to expand the availability of hospital care and medical services for veterans. In May 2014 Secretary of Veterans Affairs Eric Shinseki had to resign because of the wait time scandal. Then, in November 2014, Sharon Helman was fired by the VA. Helman had been the VA executive who was in charge of the Phoenix VA Health Care System at the time of the scandal and the subsequent attempt to cover it up. At the time, many people thought that the problem was solved because of Shinseki’s resignation and Helman’s firing. However, CNN was perceptive enough to ask, But will that improve things at VA hospitals? The answer seems to be an emphatic no. In fact, there is ample evidence that that the Veterans Choice program is a disaster.

Senator Isakson is the chair of the Senate Veterans Affairs Committee, and Senator Blumenthal is the ranking member of that committee. During a committee hearing held on 28 JAN, Isakson asked VA Secretary Robert McDonald how the VA plans to address the many issues the VA has faced during its implementation of the Veterans’ Choice Program. McDonald had no answers. For example, Isakson pointed out that earlier this month a large health care provider in New Hampshire announced that it would no longer participate in the Choice Program because the VA has failed to provide payment for services rendered. Despite the best efforts of Congress and the President, the VA has found another way to make sure that veterans get the short end of the stick. NPR reports that the New Hampshire pain management company, PainCare, has notified its patients that as of February 1st, it will no longer accept Veterans Choice. PainCare spokesman Tom Barnes told NPR, “Of course we want to continue with these patients. The thing is, we’re doing a lot of work, but we’re not getting any reimbursement for it.”

Congresswoman Louise Slaughter represents the Rochester area in Western New York. She explains the situation this way in her press release. “In summer 2014, more than 120,000 veterans were waiting more than 125 days for health care services. In response, Congress passed the Veterans Access, Choice and Accountability Act, which established the VCP. Two third-party administrators—Health Net and Tri- West—were awarded $5 billion and $4.3 billion, respectively, to implement the program.” Health Net is responsible for the non-payments to PainCare. However, Health Net could not tell NPR what percentage of claims it had paid on time or even how many claims have been paid on time. PainCare finally got its first payment from the Veterans Choice program in December, but it is still owed about $70 thousand dollars.

But that is only part of the problem. Barnes says that dealing with the Veterans Choice bureaucrats is a nightmare. “Even just receiving a phone call; if they call us, they require us to recite our company name, our address, our phone number, and fax. And that’s when they call us. Same thing when you call them.” Barnes also says that according to the VA, it has to schedule the veteran’s first appointment, and that visit must fall within an authorization period determined by the VA without consulting the health care provider. Moreover, there have been many times when the VA hasn’t called to make the appointment before the authorization period expired. When that happens, the veteran has to start all over again trying to get an appointment for medical care. How ironic is that, when you consider that this kid of time delay was the exact reason why the Veterans Choice program was created in the first place? [Source: Examiner.com | Thomas Mangan | January 24, 2016 ++]

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VA Vet Choice Program Update 29 ► Implementation | Systemic Failure

Sen. Mark Kirk (R-IL) wants to know how the Department of Veterans Affairs (VA) will fix a key health program, calling its implementation a systemic failure. "I consistently hear reports that the Department of Veterans Affairs is delaying the process of veterans’ requests to use the Choice Act, delaying the approval of provider participation in Choice, and delaying payments to participating providers," he wrote in a letter to VA Secretary Bob McDonald released 5 FEB. Under the Choice Act, veterans who can't get an appointment within 30 days are supposed to be able to use the Veterans Choice List, which gives them access to private non-VA care. But Kirk pointed to a VA OIG report released 4 FEB on a Colorado Springs, Colo., facility.

The report found that out of 288 veterans who had wait times of more than 30 days at the facility, all 288 were either not added to the Veterans Choice List or were added later than they should have been. Kirk said that he wants to know "how the VA plans to address these issues and ensure that all veterans have access to the Choice Act envisioned by Congress with a comprehensive provider network," including addressing reports that the VA isn't providing "timely payments" to healthcare providers under the Choice program. The VA noted in the OIG report that it's taken steps to address the findings.

The VA's Veterans Health Administration has been repeatedly under the congressional spotlight since the department faced a months-long scandal over allegations that VA officials manipulated appointment wait time data to downplay how long veterans were waiting for healthcare. "Given the VHA's demonstrated inability to provide even basic care, let alone comprehensive services, I find it particularly disappointing that VHA continues to stymie the private sector's attempts to address veteran patient needs," he added in his letter to McDonald. Kirk is the latest lawmaker who supported the Choice Act — formally known as the Veterans Access, Choice and Accountability Act — but has voiced concern about its implementation. [Source: The Hill | Jordain Carney | February 5, 2016 ++]

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VA Vet Choice Program Update 30 ► Ruining Some Vet’s Credit

Some veterans are seeing their credit ruined by using the Veterans Choice health program because the Veterans Affairs Department is not reimbursing participating physicians promptly, forcing them to bill their veteran patients who often can’t pay. Veterans advocates and House lawmakers said 11 FEB that veterans using the community care program face long delays in treatment and bad credit because physicians are waiting up to six months for reimbursements from VA and are demanding payment from patients, often forwarding the bills to collection agencies.

 Rep. Raul Ruiz (D-CA) said one of his constituents sought care for pain and orthopedic problems through the Veterans Choice program, but VA did not reimburse the specialists in a timely manner, forcing the veteran to reschedule needed surgeries and deal with aggressive collection agents. “Now this veteran has damaged health and damaged credit due to the VA,” Ruiz said during a House Veterans' Affairs subcommittee hearing. “This damage that veterans suffer due to the VA’s reimbursement system is irreparable and unacceptable.”

 In another case, a veteran in Saginaw, Michigan, needed follow-up care for an eye appointment through Veterans Choice. But while the initial appointment was approved, the needed sight-saving treatment was not. Since approval and payment were delayed, the providing clinic stopped treatment and demanded money from the patient before they would continue, Veterans of Foreign Wars senior legislative associate Carlos Fuentes said. To solve the issue, VFW contacted the Veterans Choice contractor Health Net Federal Services but was told that treatment could not be approved retroactively. The group then appealed to VA for help, Fuentes said. “It shouldn’t require our involvement to have this paid,” Fuentes told House committee members.

The Veterans Choice program was launched in November 2014 to give veterans who face lengthy wait times for care or live 40 miles or more from a VA facility the option to see a private physician. It has come under fire for failing to improve veterans' access to medical treatment since patients continue to face challenges making appointments or receiving approval for care. Providers have complained about the program as well, citing long delays in payments and disparate reimbursement rates. According to VA officials, the department paid less than 70 percent of its claims to providers within 30 days. In contrast, 99 percent of Tricare and Medicare claims from community providers are processed within 30 days.

In fiscal 2012, VA spent $4.5 billion on care for veterans outside VA hospitals and clinics. That figure rose to $10 billion in fiscal 2015, and the Obama administration has requested $12 billion for community care programs in fiscal 2017. But despite vast sums of money appropriated for the programs, systemwide problems persist. Earlier this month, the VA Office of Inspector General found that for 64 percent of 450 appointments reviewed at a VA clinic in Colorado Springs, Colorado, veterans waited more than 30 days for care and none were offered a faster appointment through Veterans Choice.

The VA inspector general also found that in Tampa, Florida, eligible veterans were not offered care through Veterans Choice and VA medical center staff “inappropriately removed" veterans from the Choice eligibility list. "VA needs to improve program controls. Without adequate controls, VA's consolidation plan is at increased risk of not achieving its goal of delivering timely and efficient health care to veterans," said Gary Abe, deputy assistant inspector general for audit and evaluations. VA officials say they are working to solve the problems, starting with the late payments, by:

 Changing requirements of providers to furnish medical documentation along with the bills.  Hiring more claims processing staff and establishing new productivity standards, said Dr. Baligh Yehia, Veterans Health Administration assistant deputy undersecretary for health for community care. "There should be no administrative burden that stands in the way of veterans getting care,” Yehia said.  Seeking to consolidate its private care programs into a single initiative, the New Veterans Choice program, and has asked Congress for legislative authority to implement the changes needed to jump-start the new program.  Writing letters to credit bureaus to help restore former service members' credit ratings.  Providing a toll-free number, 877-881-7618, for veterans to call if they have problems with adverse credit reports related to the Veterans Choice program.

Rep. Dan Benishek, a surgeon who chairs the House Veterans' Affairs personnel subcommittee, said the VA must fix the problem or risk losing willing program participants. "The overly bureaucratic, highly manual claims process … does not meet the standards. Community providers continue to report millions of dollars in past-due, unpaid claims and my office continues to hear regularly from providers who would like to serve veterans but they hesitate to take referrals from the VA because it is so difficult to get paid for their services," Benishek said.

Rep. Mark Takano (D-CA) said the VA is not entirely at fault for the problems with provider reimbursement. "A lot of the beating up on the department needs to be put into context," Takano said. "VA was never set up to be an insurer/payer. This is a revolution of sorts. The mindset has been that VA is a provider organization but now we are looking at other approaches, including a permanent program for care in the community, which means setting up a system to do both — a provider and payer organization. Let's make that a distinction." [Source: Military Times | Patricia Kime | February 11, 2016 ++]

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VA Secretary Update 43 ► Political Challenges Tougher Than Expected

Bob McDonald, now in his last year as secretary of Veterans Affairs as President Obama wraps up his administration, expected that there would be challenges when he took the job. He assumed the position 18 months ago amidst a major scandal involving long patient wait times and veterans dying while waiting for appointments. At the same time, there was the widely known backlog of disability claims applications -- with some veterans waiting years for a decision -- and persistent delays and cost overruns with a major VA medical center in Colorado

What the former head of international consumer giant Procter & Gamble, one-time airborne soldier and West Point grad did not expect was unrelenting political attacks from Congress and elsewhere -- including, he believes, a veterans group backed by billionaire brothers Charles and David Koch. "I think the biggest surprise was the politics," he told Military.com during a recent interview at the VA Medical Center in Boston's Jamaica Plain neighborhood. "Remember, I was confirmed 97 to zero. I thought I would focus on just getting better care for veterans, so the politics has been surprising to me. I don't like politics, I'm not going to be a politician, I’m not running for anything." But McDonald's dislike for politics and lack of political ambition, coupled with a comfortable, stable life made possible by a successful career with P&G, provides him "the freedom to do what is right" regardless of whatever pressure is exerted, he said. "I don't need the money. I don't need the position," he said. "I'm sacrificing, in a sense, to do this, but it's not a sacrifice because it's for my brothers and sisters who served. I've got no other agenda."

McDonald was in Boston recently to tour a unique veterans' blood repository that is expected to boost medical research across the country. The Million Veterans Program will provide blood samples and DNA for research into myriad health problems, especially those plaguing veterans, but also for the wider population. That's a point he raised during another part of his Boston visit, a recruiting talk he gave to more than 200 healthcare workers in training at the VA facility.

Making the Pitch for the VA

McDonald makes the pitch at pretty much every VA hospital he visits. He offers a bit of VA history, including the fact that the VA has earned three Nobel Prizes for its work, seven Lasker Awards -- known as the Nobel Prize of the U.S. -- and pioneered medical advances and development now common around the world: the first liver transplant, first kidney transplant, the shingles vaccine, the nicotine patch. A VA nurse came up with the idea of using barcodes to link patients with their records. The electronic health record itself was pioneered at the VA, he said. To the social workers and mental health providers in the room, he touted the VA's work in post-traumatic stress disorder and traumatic brain injury. "We need you [at the VA] because we are on the cutting edge of [this research] and not surprisingly what we're learning applies to policemen, firemen, EMT [emergency medical technician] workers, NHL players, NFL players -- and we're on the cutting edge of this," he said.

The VA spends about $1.8 billion a year on research. McDonald notes the VA's total budget runs about $190 billion, so he believes it can afford to put more money into medical research, especially since the VA has the wherewithal and the mission to look at medical problems that others, especially for-profit institutions, would shy away from. "Talk about the necessity of the VA. Well, as a former CEO of a large company, I can only imagine if I was running a for-profit hospital if someone came to me and said, 'We'd like you to do research on spinal cord injuries.' I'd say, 'Well, how many people have spinal cord injuries?' " The discussion that would follow would deal with the scale and the rate of return on the research investment, McDonald said, with the bottom line being there would "be no rate of return." "But yet we do that research [at the VA] because we have veterans who have been injured in combat [or] in training who have traumatic spinal cord injuries and we have to be one of the world's leaders in spinal cord injury" treatment and prevention, he said.

Fielding Slings and Arrows

Despite that, the VA has taken multiple hits in recent years over its care -- or in some cases failure to care -- for veterans. This includes the wait-times scandal that came to light with the VA Medical Center in Phoenix, Arizona, but was found to be systemic across the VA. Like the claims backlog, chronic veteran homelessness and cost overruns in VA construction, the major problems all preceded McDonald's arrival. His nomination, in fact, was made possible by the scandals, which led to President Obama asking for the resignation of the prior chief, Secretary Eric Shinseki. "We're in a political environment. We're in a presidential election," he told a VA employee in the audience who wondered at all the bad press. But, he said, there is "a group of people who want the VA to go away."

McDonald identified the group as Concerned Veterans for America, an organization widely reported to be funded by the Koch brothers. McDonald said the group's former chief executive officer, Peter Hegseth, was recorded "speaking at a Koch convention saying, 'Listen, we've got to point out everything bad going on at the VA, because if we kill the VA, we can kill Obamacare, and if we kill Obamacare, we'll kill nationalized medicine.' " The recording, first reported and posted online by The Nation magazine in 2014, does not include those phrases, though the speaker does say that exploiting the VA's failures had "created a new line of defense against the march toward socialized medicine, educating veterans and Americans in the process. Veterans have had government-run healthcare for decades. We've had the preview of Obamacare, and the scandal has exposed the inevitable result of central planning for all Americans: massive wait times, impenetrable bureaucracy, de facto rationing, wasted tax dollars. It goes on and on."

In a statement to Military.com, Concerned Veterans for America said McDonald "is making false and baseless attacks on CVA's reform proposals."

"Concerned Veterans for America has never advocated 'destroying' the VA," spokesman John Cooper said. "In our Fixing Veterans Health Care Task Force report, which lays out our comprehensive VA reform plan, we very clearly state that we want to preserve and reform the VA health care system as opposed to completely dismantling it, as some have proposed. In fact, the recent Independent Assessment of the Veterans Health Administration, mandated by Congress and funded by the VA, cited CVA's proposed reforms as a credible way forward in making the VA work for veterans."

Taking on Congress

McDonald also criticized the tone of debate with Congress, in particular the House Veterans Affairs Committee, over VA problems and operations. Given how well he was received in 2014, he said, McDonald believed he would be allowed to do the job he was brought in for -- to improve delivery of health care to veterans. But the continuing, oftentimes confrontational questioning of VA officials on the Hill did not start with his tenure. Shinseki and his senior leaders -- some of whom McDonald inherited -- were grilled, as well. McDonald believes that even if a lawmaker is genuinely concerned for veterans, the tone on the Hill is so much political posturing. He recalled taking part in a Disabled American Veterans event in Denver last summer with Rep. Jeff Miller, the Republican chairman of the House Veterans Affairs Committee. Miller has been dogged in digging into failings at the VA and demanding accountability for incompetence or corruption. In numerous hearings, he has castigated the VA and senior leaders over scandals, demanded reports and threatened to issue subpoenas to get testimony.

But when the two appeared together in Colorado, McDonald said, it was a far different Miller, who said at one point that "knowing that Bob McDonald is the Secretary of Veterans Affairs, I could not have a better feeling for where the department is going in the future." Says McDonald: "Juxtapose that [appearance] with some of the drivel that you [hear in Washington]. Two different people." Miller, in a statement to Military.com, said that if not for his committee's work investigating and exposing VA problems, "McDonald would not have the job he holds today and thousands of veterans would still be stuck on secret waiting lists." Miller said the committee will continue to put the spotlight on VA problems because it's the only way to get the department to address them effectively. That will be the case "regardless of who's serving as VA secretary," Miller said. [Source: Military.com | Bryant Jordan | Jan 22, 2016 ++]

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VA Hepatitis C Care Update 08 ► House Hearing on Treatment Cost

Congress is looking into why veterans are being denied a cure for a deadly form of hepatitis. In a CBS News investigation, we told you the cure was developed by a doctor working for the Department of Veterans Affairs. The doctor got rich, but at $1,000 a pill, the VA can't afford it. Much of the anger at the 3 FEB House hearing was directed at someone who wasn't even in the room. "If I were you, I would be outraged," Rep. Mike Coffman (R-CO) said. "Certainly the taxpayers should be outraged," Rep. Ralph Abraham (R-LA) added. Their target is Dr. Raymond Schinazi, who played a leading role developing a drug that cures hepatitis C. When he sold his company to pharmaceutical giant Gilead in 2012, he made over $400 million. And he did it all while working seven-eighths of his time for the VA.

"So, I'm not full time -- what I do with my remaining time is up to me," Schinazi told CBS News in December. We asked him if anyone has ever questioned the arrangement that allowed him to become very wealthy while working most of his time for the government. "Nobody has questioned anything yet," he said. That changed Wednesday as House members including Rep. Tim Huelskamp (R-KS) grilled David Shulkin, the VA's undersecretary for Health. "But he just sold a company for $400 million. Did anybody know about that?" Huelskamp asked. "I'm not aware of who knew what three or four years ago," Shulkin responded. Coffman wanted to know why Schinazi got rich, but the VA got nothing for a drug that one of its own doctors helped develop. "Is it bureaucratic incompetence or is it corruption, or is it a combination of the two?" Coffman asked. "This wasted resource is why this nation is unable to take care of the men and women who have served this country in uniform."

Others were upset that Schinazi wasn't there to be questioned. The VA says Schinazi retired just two days ago. "The person that's responsible always seems to retire before the investigation starts," Coffman said. The VA did approve Schinazi's part-time arrangement and told CBS News part-time employees are allowed to invest in private companies, so long as all conflict of interest rules are followed. The VA said there will be both internal and outside investigations. Refer to http://www.cbsnews.com/news/congress- outraged-over-hepatitis-c-treatment-va-cant-afford/ to view the CBS News report. [Source: CBS News | Chip Reid | February 3, 2016 ++]

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VA Hepatitis C Care Update 09 ► VA Reviewing Rights to Miracle Drug

The Veterans Affairs Department is attempting to learn if it has a financial right to a Hepatitis C drug it says was developed under the leadership of a former agency senior scientist. Pressed by lawmakers in Congress, department officials are also trying to find out if the former scientist with the VA Medical Center in Atlanta unfairly benefited from his work there by developing the drug with agency resources and then sold it and his company in 2011 for $11 billion. "We are going to make sure that we get to the bottom o of this with all the fact with the external reviews we set in place and the internal reviews," VA Under Secretary for Health Dr. David Shulkin told the House Veterans Affairs Committee Chairman on 2 FEB.

Committee Chairman Rep. Jeff Miller, a Republican from Florida, last week accused the company that now owns the drug -- Gilead Sciences of California -- of price gouging the country. During Wednesday's hearing, however, Miller and other lawmakers focused on Dr. Raymond Schinazi, the recently retired senior VA scientist in Atlanta who they believe discovered the drug and possibly failed to go through the proper steps to ensure the department could assert a financial interest in its commercial sale. "If, in fact, it is found that it was a [VA] employee that did, in fact, discover the drug … I think it's important that this committee … really try to get to the bottom of it," Miller said. Schinazi worked for the VA part time for 33 years before retiring on Feb. 1. He also works for Emory University in Georgia and has owned several companies.

Shulkin called the drug, alternately called Sofosbuvir and Solvaldi, "truly a miraculous new drug" for treating Hepatitis C, which afflicts thousands of veterans, especially those who served in Vietnam. By law, the VA has the right to assert a financial interest in science and technology developed by its employees and using VA resources and funding. When it does, commercial sales of a product or medicine put money back into the VA budget. The Hepatitis C drug is estimated to be worth billions annually on the commercial market. At the same time, the VA is currently paying an estimated $40,000 for an eight or nine week course of the drug for veterans, even though in other counties, including Egypt, the same treatment cost about $900. [Source: Miliary.com | Bryant Jordan | February 04, 2016 ++]

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PTSD Update 202 ► Studies Reveal Accelerated Aging Link

We've all heard of people "aging overnight" after a traumatic event. Scientists actually have a word for this phenomenon: "Marie Antoinette Syndrome," named for the French queen. When she was captured after fleeing Paris and sentenced to death by guillotine, observers claimed her hair turned white from shock. While accounts of the queen's hair may just be legend, scientists have long suspected that chronic psychological stress—triggered by events like war, abuse, or imprisonment—may accelerate aging, leading to early onset of age-related disease or even premature death. Now, two studies from researchers at the Boston University School of Medicine (MED), jointly funded by the US Department of Veterans Affairs (VA) and the National Institute of Mental Health, report significant links between post-traumatic stress disorder (PTSD) in veterans and accelerated aging. Many vets with PTSD are aging too fast, at a surprisingly young age.

 "We're seeing evidence, on multiple levels, of accelerated aging among very young veterans— people in their early 30s," says Erika Wolf, a MED assistant professor of psychiatry and clinical research psychologist at the US Department of Veteran Affairs' National Center for PTSD, who is lead author on the two studies. "These could snowball into major health problems down the road."  "The idea that traumatic events can have a physical effect on people has been around for a long time," says Mark Miller, associate professor of psychiatry at MED and senior author on the two studies. "Observations suggest that traumatic stress starts a cascade of biological consequences that can produce visible signs of aging. More recent research shows how this is happening on a cellular level, and for the first time we have the methods to actually see it in a person's DNA."

The first study, published online on September 30, 2015, in the journal Psychoneuroendocrinology, used new tools for examining DNA for signs of aging and comparing it to a person's actual age. The tools, developed in 2013 by scientists at the University of California, Los Angeles, and the University of California, San Diego, look at specific areas of a person's genome and note how they are methylated—tagged with a tiny molecule of one carbon and three hydrogen atoms, known as a methyl group. Methylation is one of the primary ways that the body switches genes on and off, and certain patterns of DNA methylation correlate to a person's chronological age.

For the Psychoneuroendocrinology study, Wolf, who is also funded by the VA Clinical Science Research & Development Career Development Award, examined data from 281 veterans, studied at the VA's Translational Center for TBI and Stress Disorders (TRACTS) database. TRACTS has collected health information—including brain scans, blood tests, and the results of comprehensive psychological exams— from 450 veterans who have been exposed to trauma. She found small but significant evidence that veterans with PTSD had accelerated aging of their DNA. "As we age, what we see in the DNA is a lot of 'flip-flopping'—regions that are methylated become unmethylated, and vice versa," says Wolf. This pattern appears across genes involved with cell death, cardiac function, neurogeneration, and other cellular processes. "There's a lot of variability, but it makes sense that they are involved with aging."

The second study, published online in January 2016 in the journal Biological Psychiatry, examined broader, age-related health consequences of PTSD. Specifically, Wolf looked at metabolic syndrome—a constellation of symptoms including obesity, high blood pressure, abnormal blood lipids, and high blood sugar that can contribute to Type 2 diabetes, coronary artery disease, and even neurodegenerative diseases like Alzheimer's. Metabolic syndrome is elevated among veterans, says Wolf, with an estimated 25 percent affected. That number may be as high as 40 percent among people with PTSD. Wolf wondered exactly how PTSD correlated to metabolic syndrome, and whether the two together led to reduced cortical thickness—a shrinking of specific brain areas responsible for things like emotional regulation and memory. Again using data from TRACTS, Wolf examined health information from 346 military veterans who had deployed to Iraq or Afghanistan. She found that PTSD was directly associated with metabolic syndrome, and that metabolic syndrome was strongly associated with reduced cortical thickness.

Wolf hopes to continue the research looking at longitudinal data, so she can see how this accelerated aging proceeds over a decade or more. She also wants to expand the research to include Vietnam veterans, who could provide an even longer-term view. The findings are significant, says Wolf, because they highlight a problem—metabolic syndrome—that is not usually considered in treating PTSD and is "ripe for intervention." Furthermore, says Miller, they suggest that clinicians may need to expand their repertoire of treatments for PTSD to target sleep, diet, and exercise. "A lot of research is looking at the causes and risk factors of PTSD," says Miller. "Our research is looking at the other side of the PTSD puzzle— what are the consequences for the body?" "Traditionally, treatment for PTSD involves psychotherapy that focuses on the memory of traumatic events," adds Miller. "That's an undeniably relevant and important part of treatment. But these studies are suggesting that the clinical picture of PTSD is much bigger than a problem with somebody's memory. The profound biological changes that accompany it affect not just the mind and memory, but the whole body." [Source: Medical Express | Barbara Moran | February 3, 2016 ++]

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PTSD Drugs ► PTSD Meds 101

Since the syndrome was first officially acknowledged by psychiatrists in 1980, treatments for post- traumatic stress disorder have grown in number — both for civilians and for troops with combat traumas. But medications continue to be a go-to treatment, usually in conjunction with talk therapy. While these drugs may help ease suffering, some people complain that they don’t feel like themselves while taking them. And families voice concerns about a loved one’s long list of pills. So, what are the classic PTSD drugs, and what are their side effects?

Dr. Tonya Masino, a psychiatrist at the VA’s La Jolla hospital and a veteran of the PTSD clinic there, said it’s typical for a patient to get a small cocktail of drugs to temper anxiety and sleep issues. PTSD patients with moderate to severe symptoms are going to be offered an antidepressant, specifically an SSRI (selective serotonin reuptake inhibitor). It will probably be Zoloft or Paxil, as they are the only two Food and Drug Administration-approved antidepressants specifically for PTSD, Masino said. The San Diego VA commonly prescribes five SSRIs for PTSD, including Prozac, Celexa and Lexapro. If Zoloft or Paxil don’t work, one of the others can be tried. Another popular antidepressant option is an SNRI (serotonin– norepinephrine reuptake inhibitor,) such as Effexor. If the patient is suffering from nightmares, it’s common to prescribe an alpha-blocker medication.

 Why the drugs? Because the antidepressants modulate neurotransmitters in the anxiety and fear centers of the brain, Masino said. The desired result: A reduction in the classic PTSD symptoms, which are hyper-vigilance, intrusive thoughts and memories, irritability, trouble with sleeping, depression and difficulty feeling close to others. Also why: Some patients won’t be able to engage well in therapy until their symptoms are under control. PTSD patients with sleep issues may commonly get trazadone, brand name Desyrel, which is also an antidepressant. These are the VA’s frontline drugs for PTSD. If they don’t work, Plan B can involve mood stabilizers, such as Depakote for anger, or anti-seizure medications that smooth out moods.

Masino said research has changed the way VA psychiatrists treat PTSD. Doctors used to prescribe anti- anxiety medicines known as benzodiazepines, such as Xanax or Ativan. But in the past five to 10 years, research has shown they don’t work for PTSD over the long haul. Also, these medications can cause problems with memory, and they are habit-forming, Masino said.

 What about side effects? The complaint of feeling “like a zombie” on PTSD meds is probably a dosing problem, Masino said. Common side effects of antidepressants are nausea, trouble sleeping, constipation, loss of appetite, tiredness and dizziness. Another commonly reported outcome is sexual dysfunction. Any of the above might make some PTSD patients want to stop taking their medications. But most people need to take antidepressants for at least a year before they consider tapering off, Masino said. Otherwise, risk of relapse is high.  What about the rare but possible side effect of suicidal thoughts while on antidepressants? All of the VA’s top PTSD antidepressants were on the list in 2004 when the FDA required drug makers to update the “black box” warning on their products. The new warning reflected the possibility of increased risk of suicidal thinking and behavior in young adults ages 18 to 24.  How does Masino handle the risk? She notes there’s a difference between thinking about suicide and suicidal behavior. “A number of patients with PTSD and depression will come in with suicidal thoughts. I advise patients that any medication we prescribe for mental health may affect your mood. We hope that happens in a positive way,” she said. “But if there’s any worsening of symptoms, or you’re not liking the way you feel, or if you have suicidal thoughts that weren’t there before, let your doctor know right away.” Masino calls an upswell of suicidal thoughts a “very remote possibility,” but added that it’s an important thing for patients to be aware of. “I think people are savvy enough to say, ‘OK, I’m having this now and I wasn’t before.’ Or, ‘I was having this, and I’m feeling much worse.’”

As for PTSD patients taking an assortment of medications, Macino said the long list is sometimes due to them being treated for several conditions. For example, it’s common for a veteran to get PTSD care while also recovering from a surgery or dealing with long-term back pain. “They see different doctors ... and they can end up on a number of medications,” Macino said. “The really important thing is they need to make sure all of the doctors are talking to each other and get all (the prescriptions) filled at the same pharmacy.” A danger is that one drug might affect how another works, rendering one useless, said Susan Leckband, a clinical pharmacist at the VA in La Jolla. Macino said the patient is somewhat responsible to know what he or she is taking and what its effect is supposed to be.

She also said a long prescription list may look worse than it really is. “With some conditions, and this is true in mental health, it’s better to use a combination of medicines at lower doses than just one medication at a high dose, where you run the risk of increased side effects,” said the psychiatrist, a recent Navy veteran herself. “Sometimes, the number seems alarming, but there may be a rationale for it. Some medications are meant to be taken just when you need them, not all the time.”

NON-MEDICATION TREATMENTS FOR PTSD

Prevention - Early intervention after a trauma may prevent the development of post-traumatic stress disorder. A brief stretch of therapy, group interventions and social support may provide benefits.

 Exposure therapy: Repeated exposure to targeted thoughts, feelings and situations helps reduce their ability to cause distress.  Cognitive therapy: Tries to provide a new way to handle distressing thoughts. Patients learn how going through a trauma changed them and their view of the world.  Stress inoculation: Emphasizes breathing retraining and muscle relaxation. May also include cognitive approaches and exposure techniques.  Eye movement desensitization and reprocessing: Uses rapid eye movements while addressing memories of trauma. It’s believed that this leads the patient to process the memory and disturbing feelings in better ways.  Imagery rehearsal: Believed to be effective in reducing nightmares. In this therapy, PTSD patients “rescript” the endings of their nightmares while they are awake to make them less debilitating.

Complementary and alternative medicine. The Defense Centers for Excellence recommends these techniques as possible secondary treatments: acupuncture, meditation or mindfulness, yoga, body manipulation and various energy techniques.

[Source: San Diego Union Tribune | Jeanette Steele | February 5, 2016 ++]

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VA Agent Orange Benefits ► Policy Reassessment Complete | No change

A federal court had ordered the VA to reassess its policy denying Agent Orange benefits to Navy sailors who served in the Vietnam War. The VA’s conclusion: They still don’t qualify. The U.S. Department of Veterans Affairs has once again turned down an effort by Navy veterans to get compensation for possible exposure to Agent Orange during the Vietnam War. In a document released 5 FEB, the VA said it would continue to limit benefits related to Agent Orange exposure to only those veterans who set foot in Vietnam, where the herbicide was sprayed, and to those who were on boats in inland rivers. The VA compensates these veterans for a litany of associated illnesses, including diabetes, various cancers, Parkinson’s Disease, peripheral neuropathy and a type of heart disease.

Advocates for some 90,000 so-called Blue Water Navy veterans who served off the coast of Vietnam have been asking the VA for more than a decade to broaden the policy to include them. They say that they were exposed to Agent Orange because their ships sucked in potentially contaminated water and distilled it for showering, drinking, laundry and cooking. Experts have said the distillation process could have actually concentrated the Agent Orange, which contained the toxic chemical dioxin and was used to kill vegetation and deny enemy cover. ProPublica and the Virginian-Pilot profiled their effort to gain coverage in September as part of an ongoing project to chronicle the impact of Agent Orange on vets and their families.

The U.S. Court of Appeals for Veterans Claims last April struck down VA rules that denied compensation for sailors whose ships docked at certain harbors in South Vietnam, including Da Nang. Those ports, the court determined, may have been in the Agent Orange spraying area. The court ordered the VA to review its policy. But on Friday, the VA largely stood by its old policy and once again asserted that there’s no scientific justification or legal requirement for covering veterans who served off the coast. “Environmental health experts in VA’s Veterans Health Administration have reviewed the available scientific information and concluded that it is not sufficient to support a presumption that Blue Water Navy Veterans were exposed to Agent Orange,” the VA said in a fact sheet.

U.S. Sen. Richard Blumenthal (D-CT), the ranking member of the Senate Veterans’ Affairs Committee, criticized the VA’s decision. “Rather than siding with veterans, VA is doubling down on an irrational and inconsistent policy,” he said in a statement. “Young sailors risked their lives during the Vietnam War, unaware that decades later, they and their children and grandchildren would still feel the toxic effects of exposure. Veterans who served offshore and in the harbors of Vietnam were exposed and deserve the presumption of service connection for Agent Orange-related diseases.” Blumenthal and others are seeking adoption of the Blue Water Navy Vietnam Veterans Act, which would ensure that all vets exposed to Agent Orange are compensated. The VA opposes the legislation, as it has several previous iterations dating back to 2008.

The VA’s new review rejecting benefits relied on a 2011 report by the respected Institute of Medicine, as well as other published research, according to the agency’s fact sheet. The Institute of Medicine report said there was no way to prove Blue Water vets were exposed to the chemicals, but it identified plausible routes that Agent Orange could have traveled out to sea and into a ship’s distillation system. Although military policy at the time recommended against distilling water closer than 10 miles to shore — where the chemical concentration would have been highest — veterans said doing so was often unavoidable, and their commanding officers routinely ordered it. The VA said it is working with veterans groups to “initiate a groundbreaking study of Blue Water Navy Veterans health outcomes. We hope to have data gathered and analyses published in 2017.”

Veterans called the VA’s decision a betrayal. John Wells, a Louisiana lawyer who has spent more than a decade advocating for Blue Water veterans, said his group would continue challenging the VA and push for legislation that would mandate coverage for the Blue Water veterans. “It wasn’t completely unexpected. We’re used to being betrayed by the VA,” Wells said. “We’re going to fight this thing until we’re done or dead.” Jim Smith, who served aboard the ammunition ship Butte, has been diagnosed with prostate cancer and believes that Agent Orange exposure may have played a role. “My feeling is the VA is thumbing their nose and sending the middle finger back to the Blue Water people,” he said. “It’s like nobody at the VA has any kind of science background whatsoever.” Blue Water vets — so named to set the sailors apart from their Brown Water Navy counterparts, who patrolled the murky rivers of South Vietnam — were initially deemed eligible for compensation under the Agent Orange Act of 1991, only to have the VA change its interpretation a decade later. [Source: ProPublica | Charles Ornstein and Terry Parris Jr. | February 8, 2016 ++]

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VA Whistleblowers Update 40 ► Disclosure Surge Attributed to McDonald

A report by Government Executive last month highlighted the fact that in year two of Secretary of the Department of Veterans' Affairs Bob McDonald's tenure, the Office of Special Counsel (OSC) has seen a surge in whistleblower disclosures in FY 2015, in large part due to an onslaught of new cases from VA employees. According to Government Executive, OSC, which is tasked with protecting whistleblowers and federal employees from improper personnel actions, received 755 whistleblower disclosures in fiscal 2015, a 56 percent increase over the previous year. The agency received nearly 2,000 disclosures from employees across government last fiscal year, a 27 percent increase from FY 2014.

It seems that at the very least Secretary McDonald has been successful in creating a culture in which whistleblowers feel comfortable reporting inappropriate behavior. VA’s contribution to OSC’s workload has not just come from whistleblowers. Employees at the VA filed 1,400 claims of prohibited personnel practices against their supervisors last fiscal year, a 41 percent increase over 2014. Eight of every 10 favorable actions OSC won for federal employees last year involved reprisal.

OSC is a small, independent agency of about 140 employees, and it is having a tough time handling its mandate with current funding levels. Congress increased its budget in the recent omnibus spending bill by 5 percent to $24.1 million, but the agency said that boost does not keep pace with inflation or the inundation of new cases. Schwellenbach said the agency plans to hire more staffers to take on the backlog of cases, which has ballooned in recent years but remained stagnant in fiscal 2015. [Source: TREA Update | February 9, 2016 ++]

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VA Clinic Colorado Springs CO ► Care Delays Irk Lawmakers

Angry lawmakers are calling for a probe of misconduct at the Department of Veterans Affairs in light of a report that found that hundreds of veterans faced care delays at a Colorado Springs clinic, even as an agency spokesman disputed the findings. Colorado U.S. Reps. Doug Lamborn and Mike Coffman were joined by House VA committee head Rep. Jeff Miller in calling for a congressional review of the Floyd K. Lindstrom Clinic, where VA’s inspector general found 68 percent of 450 veteran cases reviewed faced delays of more than 30 days for care. What angered lawmakers the most was the use of phony dates in a scheduling system for some cases that investigators said made it appear the appointment wait time was less than 30 days. “This report documents blatant dishonesty and corruption, and the sad truth is that this same sort of behavior is routinely tolerated across the department,” Miller said.

The report, released 4 FEB, found that 28 patients’ records were manipulated to show they had same- day appointments when they actually waited and average of 76 days. “I reject the notion that anywhere in this report it says we falsified data,” Denver VA spokesman Dan Warvi said. Warvi contends that the records, including those that falsely showed same-day appointments, were correct according to a “local standard” in place until 2015. While he denied that workers falsified reports, he couldn’t explain the discrepancies for the 28 patients. Lamborn said VA waits in Colorado Springs have claimed a life. In a letter to VA Secretary Bob McDonald, Lamborn said a veteran in Colorado Springs was deemed a suicide risk during an April visit to the Lindstrom Clinic, but wasn’t referred for care. The former Marine killed himself six weeks later, Lamborn wrote. “I am infuriated that your department continues to intentionally delay the medical care our nation’s veterans have earned,” the Colorado Springs Republican wrote. Warvi said he couldn’t comment on Lamborn’s allegations because of patient privacy concerns.

Patient waits at the clinic remain among the longest in the country, VA records show. For the month ending Jan. 15, 5,036 veterans were waiting more than a month for appointments — 31 percent of all appointments scheduled at the facility that opened in August 2014. Retired Air Force Maj. Gen. Wes Clark said he and other leading local veterans’ advocates were told when the new clinic opened that waits for care would drop. “We were assured at the beginning that this was going to be one of the best-run clinics in the country,” Clark said. “Just look at it now, only a few months after opening. Should be some criminal penalties for this.” Warvi said VA is working to shorten waits in Colorado Springs, but is struggling to keep up with growing demand. The number of appointments there in 2015 rose to 170,000, up from 143,000 the previous year. Warvi said the number of veterans seeking care in Colorado Springs is a sign that clients like the service they’re getting. [Source: Tribune News | Tom Roeder | February 7, 2016 ++]

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VA Fraud, Waste & Abuse ► Reported 1 thru 14 Feb 2016

AKRON, Ohio — A Virginia architect convicted of conspiring with the former head of the Louis Stokes Cleveland VA Medical Center admitted 2 FEB to using inside information to gain contracts from the VA. Mark Farmer will spend 21 months to six years in prison under the terms of a post-jury-conviction deal with prosecutors. In exchange for his admission, prosecutors agreed to seek no new charges against Farmer. Under the deal, Farmer admitted that he knew about $3.9 million in illicit deals gained by using inside information from William Montague, the former head of the Cleveland VA who later became director of the Dayton VA Medical Center. Other high-ranking officials within Farmer's former company, Cannon Design, used inside information from Montague that would have resulted in up to $20 million in projects, the agreement says. "High-ranking officials at Cannon Design knew about and approved of the payments to Montague and received confidential documents and information that Montague provided from the VA," the agreement says. No one else from Cannon Design has been charged.

A 28 SEP letter between prosecutors and Farmer's defense team helped lay the groundwork for the agreement. The letter had to do with investigators gathering more documents and issuing more subpoenas to other Cannon Design employees, Assistant United States Attorney Antoinette Bacon said during Tuesday's hearing. U.S. District Judge Sara Lioi ordered that letter sealed from the public at the attorneys' request. Farmer, 55, was convicted in August of conspiracy, racketeering, embezzlement, bribery, theft of public money, mail fraud and wire fraud. He'll remain in federal custody until he's sentenced 29 MAR. The agreement calls for Farmer to forfeit $70,801 in ill-gained money. He also faces fines between $10,000 and $250,000.

The scheme occurred during a four-year period from 2010 to 2013. Montague, of Brecksville, resigned from the Dayton VA in 2011 to run the consulting firm House of Montague. Montague admitted during Farmer's trial that he sent along confidential information so Cannon Design could have an advantage when submitting bids on upcoming projects. Cannon Design then used the confidential information to prepare proposals that resulted in the company being chosen to design a veterans' hospital in West Los Angeles, California. Farmer and Cannon Design used Montague as a "double agent" because of his access, particularly in 2011 when he served as an interim director at the VA in Dayton. Farmer's primary role at the firm was to get VA projects across the country. He was the firm's man contact with Montague and paid Montague's firm for insider information.

Montague, 64, pleaded guilty in September 2014. The deal states that he could spend as little as 4 1/2 years in federal prison in exchange for his cooperation. He has yet to be sentenced. Farmer's deal also stipulates that prosecutors wanted to make a deal for Farmer since there was a "significant unwarranted sentencing disparity" between Farmer's and Montague's expected sentences. Prosecutors wrote there was a lack of evidence of the scope of the deals at the time Montague entered his guilty plea. [Source: Cleveland.com | Adam Ferrise | February 02, 2016 ++]

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Blythewood, SC — United States Attorney Bill Nettles stated 26 JAN that Dennis Paulsen, age 45, of Blythewood was convicted of stealing more than $1.5 million from the United States Department of Veteran’s Affairs and the Social Security Administration following a seven-day jury trial in federal court in Columbia. Mr. Nettles stated the maximum penalty Paulsen faces is imprisonment for up to 20 years and fines of $500,000, along with forfeiture of the more than $1.5 million. Senior United States District Judge Margaret B. Seymour of Columbia presided over the trial and will impose sentence after she has reviewed the presentence report which will be prepared by the U.S. Probation Office.

In conducting one of the largest fraudulent single disability compensation claims in VA history, Paulsen substantially feigned and exaggerated the impairment resulting from his multiple sclerosis (MS) diagnosis. After being diagnosed and discharged from the Navy in the early 1990s, Paulsen began receiving a monthly VA benefit as a result of his diagnosis. Unsatisfied with the amount he was receiving, Paulsen began a pattern of malingering by claiming his MS rendered him unable to use his hands or feet in any respect. Still unhappy with the money he was awarded, Paulsen ramped up his claims, lying to his doctors, presenting himself as house- and wheelchair- bound, and making false claims that he required daily professional medical care to live until his benefits were increased to the maximum disability payments available to a Veteran. At the same time, Paulsen used the same feigned impairments to convince the Social Security Administration that he was entitled to SSA disability benefits.

Despite his feigned claims of impairments and presenting himself in a wheelchair to his doctors, Paulsen lived in a non-handicap accessible residence and was able to ride his motorcycle and jet skis plus play baseball and golf on a regular basis. In 1999, Paulsen met his ex-wife at the gym where he exercised and worked training others. In 2004, Paulsen sold their 5,000 square foot house for more than half of a million dollars and moved from Virginia to Blythewood, SC. In Blythewood, Paulsen purchased a two-story brick house that was not handicapped accessible and stopped going to neurologists for his MS. Illustrating his lack of impairment, Paulsen was active in several gyms, joined a baseball league from 2006 until 2014, and lived an active lifestyle, including playing pool, swimming in his backyard pool, playing on the beach, and driving his Escalade and manual shift Mini-Cooper.

In 2014, a concerned citizen reported Paulsen to the VA and explained how Paulsen lacked the impairments that he claimed. Upon learning that the VA was looking into his actual impairment from MS, Paulsen immediately quit his baseball league and began appearing at the VA again in his wheelchair, claiming to be unable to walk or use his hands. The extensive investigation by the VA and SSA included undercover agents, surveillance, and photographs and video footage from banks, stores, and the Columbia Metropolitan Airport. Family photographs kept by Paulsen’s ex-wife were also obtained showing Paulsen’s many activities with his family, playing baseball, and participating in a Marine Mud Run. Paulsen testified, in a wheelchair, for four hours and called three doctors as expert witnesses in an attempt to support his claim that he was and had been totally disabled. The guilty verdict reflects that the jury did not find this testimony credible. [Source: DOJ - Dist of South Carolina Press Release | January 26, 2016 ++]

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Sacramento CA — John Cal Howe II, 42, of Lakehead, pleaded guilty t8 FEB to 23 misdemeanor counts in a scheme to obtain thousands of dollars in veterans’ benefits to which he was not entitled, United States Attorney Benjamin B. Wagner announced. According to court documents, Howe pleaded guilty to one count of theft in connection with a healthcare program, 20 counts of theft of government property, one count of making a fraudulent demand against the United States, and one count of making a fraudulent representation about the receipt of military decorations or medals. According to the superseding information filed on January 14, 2016, between February 2012 and April 2015, Howe obtained health care benefits from the Veterans Affairs Health Benefits Program. He also obtained fraudulent travel reimbursements from the VA, and applied for a VA pension. He falsely claimed he was a decorated United States Marine Corps veteran and the recipient of three Purple Heart medals, although he had never enlisted or served in the armed forces of the United States. Howe is scheduled to be sentenced on April 25, 2016, by United States Magistrate Judge Edmund F. Brennan. Howe faces a maximum statutory penalty of one year in prison, a $100,000 fine, and a one-year term of supervised release on each count. The actual sentence, however, will be determined at the discretion of the court after consideration of any applicable statutory factors and the Federal Sentencing Guidelines, which take into account a number of variables. [Source: Springfield News-Leader | Jackie Rehwald | January 19, 2016 ++]

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Oakdale CA — A Veterans Affairs contracting official has been sentenced for accepting gifts in relation to his job duties, which included influencing the award of construction contracts for the Sacramento VA Medical Center. Anthony Castaneda, 45, of Oakdale in Stanislaus County, was sentenced 11 FEB by U.S. District Judge Morrison C. England Jr. to five months of house arrest and two years of probation for receipt of a gratuity by a public official, according to a U.S. Attorney’s Office news release. According to court documents, while working as a contracting official for the Department of Veterans Affairs, Castaneda was in a position to influence the award of construction contracts at VA facilities, including the VA hospital at the former Mather Field. In 2010, Castaneda received from a construction contractor a prepaid vacation package at a theme park worth approximately $2,250. Castaneda and his family traveled to the theme park for five days in October 2010. At the time he accepted the gift, authorities said, Castaneda was in a position to influence the award of contracts by making recommendations about which contractors should be given VA business. Court records also show that Castaneda received a second vacation package from the same contractor worth approximately $1,440 in 2008. Castaneda pleaded guilty in federal court in Sacramento in August. In addition to his period of house arrest, Castaneda was ordered to forfeit the value of the 2010 vacation and to pay a $2,000 fine. The contractor involved, Jacobo Tadeo Herrera, pleaded guilty to providing a gratuity to a public official. He was sentenced in December in federal court in San Jose to three years probation. [Source: The Sacramento Bee | Cathy Locke | February 11, 2016 +]

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VA HCS So. Arizona ► New Cardiovascular Clinic for Women

Women veterans in southern Arizona have a new resource at the Southern Arizona VA Health Care System. It's a cardiovascular clinic for women, and it's the first one of its kind in the entire VA system. According to the American Heart Association, heart disease is the No. 1 killer of women. Many women, including those who have served the United States, do not know the risks or the symptoms.

Vicky McManaman is an Air Force veteran whose family has a history of heart disease. She lost a younger brother, and the disease has also affected her father and her uncles. Still, McManaman was surprised when her doctor found a blocked artery. "I was scared," she said. She underwent treatment and continues to take care of herself. McManaman found out in time, but many women have no idea until it is too late.

"I have a really good friend who died from sudden heart attack death. I mean she was just washing dishes and she died," she said. McManaman is now a patient at the Southern Arizona VA Women's Health Clinic's new cardiovascular clinic, and is also an employee of the Southern Arizona VA.

Mary Kaye Pierce, nurse practitioner in cardiology, runs the new clinic. "I think it's a way of recognizing women veterans now and the contributions they're making, and trying to bring it more to the forefront that the VA is here to serve women," Pierce said. "We're trying to make it clear what we have to offer them and to sort of step up the services for them." Everything from diagnosing heart disease to the heart attack itself can be very different for a woman than it is for a man. Pierce said research is underway to find the best ways to diagnose women. Many health care providers are learning to become aware that women do not always come in with chest pain. "Being more cognizant of how they present, that it's atypical. It may just be fatigue, shortness of breath. So don't blow that off. It's another problem. They should be worked up for cardiovascular disease also," Pierce said.

Anxiety and depression are also risk factors for heart disease. According to the American Heart Association, women with heart disease are often diagnosed later, when the condition is severe. More women than men will die within a year of the first heart attack, no matter their ages, and fewer women are prescribed cardiac rehabilitation after a heart attack. The organization also said women have longer hospitalizations, great chances of dying in the hospital and more bleeding complications. In a new report, women will see up to 30 percent more re-admissions within a month after going home from the hospital. "Make people more aware of women and heart disease. Get early treatment, early recognition and, yes, we hope to save lives with this [clinic] ultimately," Pierce said. "Prevention is probably the most important thing we can do for women. So controlling things like diet, diabetes, hypertension, their cholesterol levels, health lifestyle, exercise."

Pierce said the clinic is open one day a month. As the need grows, she said she hopes to be open at least two days a month. She said the VA's cardiology clinic continues to be available to all veterans. For her part, McManaman said she makes sure she always asks her health care provider questions important for her health. She eats right, exercises, takes her medication and follows up. "So, yes, it's important because I want to be here for my three grandchildren," McManaman said. [Source: Tucson News Now | Barbara Grijalva | February 1, 2016 ++]

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VAMC Albany NY Update 01 ► Director Wins Removal Appeal

Linda Weiss, who until November was director of the Stratton VA Medical Center, won an appeal challenging her removal from that post, according to a final decision of the U.S. Merit Systems Protection Board released 5 FEB. She will not, however, be allowed to return to the Albany VA or be placed at any other VA facility in a position charged with overseeing patient care, according to a statement from VA Deputy Secretary Sloan Gibson. “I do not intend to return the director of the Albany Stratton VA Medical Center to any position, in Albany or elsewhere, where she would be responsible for patient care or safety,” Gibson said. Weiss, who assumed the post as the Albany VA’s chief in 2010, did not return phone calls seeking comment.

The decision regarding Weiss’ appeal was bereft of details on the board’s findings, which it said would be forthcoming in a separate, formal statement to be released by 16 FEB. The decision does provide the first official confirmation that Weiss was removed from her post last month, rather than choosing not to return after a two-month paid administrative leave that began in November. Gibson removed her from the position, he said Friday, because she did not take timely, appropriate action to ensure that veterans received safe medical care. Weiss did not hold her employees accountable for actions that led to inappropriate care, he said. “In my judgment, a medical center director who fails to proactively address patient safety concerns or fails to be an advocate for vulnerable Veteran patients has no place in the VA,” Gibson said. Gibson also did not provide details about the specific patient safety issues considered by himself or the MSPB.

The Times Union has reported that in the last year, two male nurses at Stratton were accused in separate incidents of stealing medicine intended for patients. One of them was charged with federal crimes; the other, found incoherent with a used syringe nearby, was let go from his job but not charged criminally even though it was the second incident involving his illicit drug use. Another nurse remained on duty despite complaints from co-workers that he was sleeping on duty, including in the bed of a patient who had died the night before. And a former nurse has alleged that patients in a geriatric unit with “treatable” conditions were instead being given morphine, hastening their deaths. A hospital spokesperson has denied this allegation. Complaints are known to have been filed with federal overseers regarding the alleged inaction of Albany VA officers after a patient was unnecessarily held in restraints for hours in 2013 and a nurse stole vials of morphine, instead giving salt-and-water mixtures to patients who were in pain.

Gibson strongly criticized the MSBP for overriding his concerns about Weiss in reversing his decision to remove her from her post. “Under the Choice Act, my judgment is owed considerable deference by the MSPB,” Gibson said. “Yet based on this and other recent decisions, it appears the MSPB does not agree with the Congress’s or the VA’s interpretation of the extent of my authority and has, once again, substituted its judgment for mine and demonstrated a willingness to second guess the VA’s application of legitimate high standards for accountability.” Appeals such as the one that Weiss made are intended to insure the VA is not abusing its authority. [Source: Times Union | Claire Hughes | February 5, 2016 ++]

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VAMC Omaha Update 01 ► Vet Billed $15k for VA Misdiagnosis

An elderly Fremont veteran claims Omaha’s VA Health System admitted to misdiagnosing him with a serious heart condition which led to unnecessary and expensive treatment. That veteran tells WOWT 6 News he’s now stuck with the bill. Larry Brown contacted Six On Your Side to help him make sense of a growing stack of medical bills; bills Omaha's VA Health System refuses to pay even though Brown, who is 72 years old, is a Navy veteran who served in Vietnam and Japan. “I don't think I let people down when I was serving. And I don't expect the VA to let me down either, but I feel like they have,” said Brown.

In 2014, Brown's VA doctors diagnosed him with atrial fibrillation, an irregular heart beat which can lead to blood clots, strokes, and heart failure. He was put on blood thinners to reduce his risk. Then, late last year, Brown checked himself into his local emergency room. “I just didn't feel right,” he told WOWT. Brown didn't know it at the time, but he was bleeding internally. Brown's local ER doctors called doctors at the Omaha VA to arrange a transfer, but the VA didn't have enough beds. Brown was sent by ambulance to Nebraska Medicine and stayed several days of treatment. He said he racked up a $15,000 bill. Shortly after he was discharged, Brown got a phone call from the VA asking him to attend a meeting with his VA doctors. “They had made an error with my heart monitor results. They had confused them with another patient,” said Brown.

This meant he was misdiagnosed in 2014 for atrial fibrillation and those blood thinners he was prescribed could be the cause of his internal bleeding. That bleeding which led to a giant medical bill that the VA won’t pay. Brown says the VA told him it can't pay the bill because Medicare is supposed to do it. He told WOWT 6 News he thinks it’s their responsibility. He said, “I feel the VA hospital was at fault and it should be their responsibility to cover that.” Brown also said this incident has forever changed the way he thinks about the VA Health Care system. “Now my trust and confidence level is down to about zero. I don't believe the doctors anymore. It’s just taken away the trust that I had,” said Brown.

WOWT contacted the Omaha VA about Brown's story, and in a statement, they said: “VA does not discuss patients’ health care situations publicly to respect their privacy in accordance with the Health Insurance Portability and Accountability Act of 1996. However, VA takes patient concerns very seriously, and has a process to look into complaints to ensure we are providing excellent health care that ensures the health and well-being of all enrolled Veterans.” [Source: WOWT NBC Omaha | Brandon Scott | February 9, 2016 ++]

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VAMC Martinsburg WV Update 02 ► Call Center Abandoned Calls

Veterans trying to reach their doctors, fill prescriptions or ask questions through the Martinsburg Veterans Affairs Medical Center and its clinics are finding it harder since a new phone call center was started up in November. Indeed, the medical center used some of its emergency procedures to address the thousands of “abandoned” phone calls that were occurring soon after the phone system started up. Under the medical center definitions, abandoned phone calls are those in which the caller hangs up before being connected with a human being, the call gets lost in a transfer, or the caller was disconnected somehow.

According to data from the medical center in West Virginia, which also handles Veterans Affairs patients in the Frederick area, the center receives tens of thousands of phone calls each month. The call center tracks phone calls as “presented,” “handled” or “abandoned.” In a “presented” phone call, a caller is connected to the call center system and uses the menu to get questions answered. In a “handled” phone call, a medical support assistant — a person — answers the presented phone call and helps the caller. In an “abandoned” phone call, the caller hangs up before being connected with a human being, the call gets lost in a transfer, or the caller was disconnected. Of 28,299 calls to Martinsburg’s hospitals and clinics in January, 85 percent were answered by a medical support assistant, but 4,171, about 15 percent, of calls were abandoned. Last week, from Feb. 1 to Feb. 5, about 720 of 7,293 received calls were abandoned, or about 10 percent, an improvement.

The Martinsburg Veterans Affairs Medical Center oversees several community clinics, including one in Frederick County at Fort Detrick. The new call center system was implemented in November 2015. “The new system is a substantial upgrade,” said Sarah M. Tolstyka, public affairs specialist at the Martinsburg Veterans Affairs Medical Center. Before the new system, veterans could call community clinics directly. Now, calls for services or physicians at community clinics are routed to the call center. Processing calls through the call center enables the medical center to track the number of calls, “abandoned” calls and length of hold time.

Under the new system, a medical support assistant at the call center helps the veteran schedule, change or cancel an appointment or relay a message to the veteran’s primary or specialty care provider. The assistants are staff members who work at Martinsburg or one of the community clinics. But staff and patients of the Martinsburg system have noted that the time between dialing the number and connecting with a medical support assistant can be more than 30 minutes, that using existing staff places an added demand on their limited time, and that the call center system has made it more difficult for physicians to talk to patients.

William J. Robinson, a veteran who lives in Hagerstown, regularly sees doctors at the Hagerstown clinic, but he also visits the Fort Detrick clinic to see a specialty care doctor and goes to the Martinsburg hospital for some medical procedures. Robinson is frustrated with the call center system. When he called to refill a prescription this week, he was directed to a medical support assistant, who then contacted the Hagerstown clinic. Robinson said he was put on hold for 20 minutes while the medical support assistant tried, unsuccessfully, to reach the clinic’s staff. “I have no other way of contacting them,” Robinson said of the Hagerstown clinic. The assistant took his number, tried to reach the clinic again, and called him back half an hour later to give him the information he needed. The call center system lengthened the amount of time it took to get a refill from his usual clinic. Robinson said he has no complaints about the Martinsburg hospital, but with the new call system, he has come to rely more on the Department of Veterans Affairs’ online messaging system to correspond with his doctors.

The Martinsburg medical center’s director activated its “Incident Command System” in November, soon after the launch of the call center, to address the number of abandoned primary care calls. Primary care calls are often from veterans contacting their primary care doctors. The “Incident Command System” is an internal method of coordinating a response to an emergency. In Arizona, the Phoenix Veterans Affairs Health Care System activated its Incident Command System in 2014 to address allegations regarding a waiting list for patients seeking appointments. At Martinsburg, in November, the Primary Care Division received 9,453 calls. About 27 percent of those, or 2,577 calls, were “abandoned.” In response to the percentage of abandoned calls, the medical center’s Incident Command System added medical support assistants to answer phones for primary care.

The Incident Command System was deactivated at the Martinsburg medical center on Jan. 8. In January, the proportion of abandoned primary care calls was 16.1 percent, out of about 12,100 received calls. The medical center has now assembled a work group to address the abandoned calls. Tolstyka said the work group will tackle: Reducing abandoned calls, technical and equipment issues, scripting of calls that do not relate to scheduling, including prescription renewals and test results, appropriate methods of transferring calls, and training. The “Primary Care Automatic Call Distribution System Review and Redesign” work group will meet 11 FEB. [Source: The Frederick-News Post | Sylvia Carignan | February 10, 2016 ++]

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Gulf War Syndrome Update 37 ► Should Focus on Treatment vice Causes

A scientific panel has concluded that the Veterans Affairs Department should stop searching for links between environmental exposures in the 1991 Persian Gulf War and veterans’ illnesses and instead focus on monitoring and treating those who have health problems related to deploying 25 years ago. In a report released 11 FEB, Institute of Medicine researchers said Gulf War veterans are at increased risk for developing some physical and psychological health conditions like post-traumatic stress, anxiety, Gulf War illness and chronic fatigue syndrome, but other diseases like cancer, respiratory illnesses and most neurodegenerative conditions do not appear to occur at higher rates in these former troops. Without concrete information on each Gulf War veteran’s exposure and the unlikely prospect of ever having the data, VA should focus instead on following this group as members age and treat illnesses that develop, panelists said.

According to the report, the federal government has spent more than $500 million since 1994 to study Gulf War veterans' health but “there has been little substantial progress in our overall understanding of the health effects” from the 1990-1991 deployments. Thus, “without definitive and verifiable individual veteran exposure information, further studies to determine cause-and-effect relationships between Gulf War exposures and health conditions in Gulf War veterans should not be undertaken,” wrote the panel of researchers, including experts in environmental health, epidemiology and medicine. Future research, they added, should focus on personalized care for veterans, follow-up assessments and treatment. The panel's top recommendation also said VA should thoroughly study the “mind-body” connection of disease. "Any future studies of Gulf War illness should recognize the connections and complex relationships between brain and physical functioning and should not exclude any aspect of the illness with regard to improving its diagnosis and treatment,” panelists noted.

The new report has outraged advocates for veterans who suffer from illnesses stemming from their service in the 1990-1991 operation. They argue the report reflects a bias among the panel toward VA and panelists were selective in choosing which studies they reviewed for the study, "Gulf War and Health, Volume 10: Update of Health Effects of Serving in the Gulf War, 2016." "IOM committees should not be made up of former VA officials and their friends," said Rick Weidman, executive director for policy and governmental affairs for Vietnam Veterans of America. “It's outrageous that the VA under secretary from the 1990s who began the policy of minimizing Gulf War illness was on this committee or that the committee chair was on record before she was appointed saying you can't say what caused it.”

"The science is unequivocal, if viewed honestly and in its totality: Toxic exposures were responsible,” said Dr. Beatrice Golomb, a professor of medicine at the University of California-San Diego and former scientific director for the VA's Research Advisory Committee on Gulf War Illness. "But the IOM doesn't look at all relevant studies. This 'don't look, don't find' practice has been a consistent problem in IOM Gulf War reports.” The report examined studies on myriad diseases and their prevalence in Gulf War veterans as well as those who did not deploy. The panel then categorized these illnesses on a spectrum ranging from the strongest link — "sufficient evidence of a causal relationship” — to "inadequate or insufficient evidence to determine an association.” Post-traumatic stress disorder was the only condition the panel found to be caused by Gulf War deployment. The group also found sufficient evidence of an association for generalized anxiety disorder, depression, substance abuse, gastrointestinal symptoms, chronic fatigue syndrome and Gulf War illness, a catch-all term used to describe undiagnosed symptoms in Gulf War veterans.

According to the report, there also is "limited but suggestive" evidence that amyotrophic lateral sclerosis, or ALS, fibromalygia and chronic pain and self-reported sexual dysfunction are related to Gulf War deployment. But it found little or no evidence that cancer, skin conditions, birth defects, musculoskeletal system diseases, multiple sclerosis and other illnesses were related. “In spite of a thorough literature search, [this] committee found little evidence to warrant changes to the conclusions made by [a previous IOM] committee regarding the strength of the association between deployment to the Gulf War and adverse health outcomes," they wrote.

About a quarter of the war's 700,000 veterans developed symptoms after deployment that include chronic headaches, widespread pain, memory loss, persistent fatigue, gastrointestinal problems, skin conditions and mood disturbances. Researchers have determined that environmental factors, such as chemical exposures in the region, including sarin gas, pesticides and anti-nerve-agent pills, may have played a role in development of diseases among some troops. Anthony Hardie, a Gulf War veteran and director of Veterans for Common Sense, said the new report refutes earlier studies and is insulting to those who served as well as widows of those who have died from diseases like brain cancer and ALS. “It’s the same old government theme from the 1990s to deny what happened and deny care and benefits — just when research to understand the illness and identify treatments is finally making real progress,” Hardie said. [Source: Military Times | Patricia Kime | February 11, 2016 ++]

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Gulf War Syndrome Update 37 ► Should Focus on Treatment vice Causes

A scientific panel has concluded that the Veterans Affairs Department should stop searching for links between environmental exposures in the 1991 Persian Gulf War and veterans’ illnesses and instead focus on monitoring and treating those who have health problems related to deploying 25 years ago. In a report released 11 FEB, Institute of Medicine researchers said Gulf War veterans are at increased risk for developing some physical and psychological health conditions like post-traumatic stress, anxiety, Gulf War illness and chronic fatigue syndrome, but other diseases like cancer, respiratory illnesses and most neurodegenerative conditions do not appear to occur at higher rates in these former troops. Without concrete information on each Gulf War veteran’s exposure and the unlikely prospect of ever having the data, VA should focus instead on following this group as members age and treat illnesses that develop, panelists said.

According to the report, the federal government has spent more than $500 million since 1994 to study Gulf War veterans' health but “there has been little substantial progress in our overall understanding of the health effects” from the 1990-1991 deployments. Thus, “without definitive and verifiable individual veteran exposure information, further studies to determine cause-and-effect relationships between Gulf War exposures and health conditions in Gulf War veterans should not be undertaken,” wrote the panel of researchers, including experts in environmental health, epidemiology and medicine. Future research, they added, should focus on personalized care for veterans, follow-up assessments and treatment. The panel's top recommendation also said VA should thoroughly study the “mind-body” connection of disease. "Any future studies of Gulf War illness should recognize the connections and complex relationships between brain and physical functioning and should not exclude any aspect of the illness with regard to improving its diagnosis and treatment,” panelists noted.

The new report has outraged advocates for veterans who suffer from illnesses stemming from their service in the 1990-1991 operation. They argue the report reflects a bias among the panel toward VA and panelists were selective in choosing which studies they reviewed for the study, "Gulf War and Health, Volume 10: Update of Health Effects of Serving in the Gulf War, 2016." "IOM committees should not be made up of former VA officials and their friends," said Rick Weidman, executive director for policy and governmental affairs for Vietnam Veterans of America. “It's outrageous that the VA under secretary from the 1990s who began the policy of minimizing Gulf War illness was on this committee or that the committee chair was on record before she was appointed saying you can't say what caused it.”

"The science is unequivocal, if viewed honestly and in its totality: Toxic exposures were responsible,” said Dr. Beatrice Golomb, a professor of medicine at the University of California-San Diego and former scientific director for the VA's Research Advisory Committee on Gulf War Illness. "But the IOM doesn't look at all relevant studies. This 'don't look, don't find' practice has been a consistent problem in IOM Gulf War reports.” The report examined studies on myriad diseases and their prevalence in Gulf War veterans as well as those who did not deploy. The panel then categorized these illnesses on a spectrum ranging from the strongest link — "sufficient evidence of a causal relationship” — to "inadequate or insufficient evidence to determine an association.” Post-traumatic stress disorder was the only condition the panel found to be caused by Gulf War deployment. The group also found sufficient evidence of an association for generalized anxiety disorder, depression, substance abuse, gastrointestinal symptoms, chronic fatigue syndrome and Gulf War illness, a catch-all term used to describe undiagnosed symptoms in Gulf War veterans.

According to the report, there also is "limited but suggestive" evidence that amyotrophic lateral sclerosis, or ALS, fibromalygia and chronic pain and self-reported sexual dysfunction are related to Gulf War deployment. But it found little or no evidence that cancer, skin conditions, birth defects, musculoskeletal system diseases, multiple sclerosis and other illnesses were related. “In spite of a thorough literature search, [this] committee found little evidence to warrant changes to the conclusions made by [a previous IOM] committee regarding the strength of the association between deployment to the Gulf War and adverse health outcomes," they wrote.

About a quarter of the war's 700,000 veterans developed symptoms after deployment that include chronic headaches, widespread pain, memory loss, persistent fatigue, gastrointestinal problems, skin conditions and mood disturbances. Researchers have determined that environmental factors, such as chemical exposures in the region, including sarin gas, pesticides and anti-nerve-agent pills, may have played a role in development of diseases among some troops. Anthony Hardie, a Gulf War veteran and director of Veterans for Common Sense, said the new report refutes earlier studies and is insulting to those who served as well as widows of those who have died from diseases like brain cancer and ALS. “It’s the same old government theme from the 1990s to deny what happened and deny care and benefits — just when research to understand the illness and identify treatments is finally making real progress,” Hardie said. [Source: Military Times | Patricia Kime | February 11, 2016 ++]

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Vet Unemployment Update 06 ► JAN Rate Remains Low

The strong veteran employment numbers charted throughout 2015 continued in the first month of the new year, government data indicate. The unemployment rate for post-9/11 veterans was 5.7 percent in January, according to the Bureau of Labor Statistics, equal to the previous month's rate and in line with the 5.8 percent average for all of 2015's unemployment reports. The unemployment rate was 4.9 percent in January, down a hair from December's 5 percent rate, with the U.S. tacking on 151,000 jobs. The January unemployment rate for the youngest generation of veterans is up a bit from the all-time low of 4.2 percent recorded in November. Still, 5.7 percent is the lowest unemployment rate ever recorded in a January report for this group, for whom unemployment data dates back to fall 2008. The next lowest January unemployment rates were more than 2 full percentage points higher: 7.9 percent in 2014 and 2015. [Source: Military times | George Altman | February 5, 2016 ++]

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Vet Hiring Fairs ► 15 Feb thru 31 Mar 2016

The U.S. Chamber of Commerce’s (USCC) Hiring Our Heroes program employment workshops are available in conjunction with hundreds of their hiring fairs. These workshops are designed to help veterans and military spouses and include resume writing, interview skills, and one-on-one mentoring. For details of each you should click on the city next to the date in the below list. To participate, sign up for the workshop in addition to registering (if indicated) for the hiring fairs which are shown below for the six weeks. For more information about the USCC Hiring Our Heroes Program, Military Spouse Program, Transition Assistance, GE Employment Workshops, Resume Engine, etc. visit the U.S. Chamber of Commerce’s website at http://www.hiringourheroes.org/hiringourheroes/events .

Fort Bliss, TX - Fort Bliss Transition Summit Details Register

March 23 - 4:00 pm to March 24 - 4:00 pm

Veterans Omnibus Bill ► Lawmakers May be Headed Towards One

Lawmakers could be headed toward a veterans omnibus bill covering a host of health, education and employment issues after House members passed a package of nine veterans-themed measures the evening of 9 FEB. The flurry of legislation came after a day of debate and discussion about veterans issues on the House floor. All of the measures were passed by voice vote without objection, but will need Senate action and the president's signature before they can become law.

House Majority Leader Kevin McCarthy (R-CA) said the moves were a needed push to help “our retired servicemen and women who have been neglected by a broken Department of Veterans Affairs.” He promised more focus on the issues in months to come. “It has been several years since the corruption and dysfunction at the VA was exposed, and quite frankly, it is appalling that we must continue to pass bills to fix the countless problems that have been ignored,” he said. “We continue to hear that change at the VA is on the way, but as the bureaucracy remains unchanged, our veterans continue to wait for care and benefits.” House Veterans' Affairs Committee Chairman Jeff Miller (R-FL) said the bills together help “rein in the incompetence that permeates VA’s construction efforts, end the egregious taxpayer abuse some unscrupulous and greedy schools are committing on a daily basis, and most importantly, honor our veterans while improving and expanding the benefits they have earned.”

The most controversial item on the legislative slate was a measure that would halve the housing stipend for children of troops attending college with transferred Post-9/11 GI Bill benefits. Veterans advocacy groups opposed that portion of the so-called Veterans Employment, Education, and Healthcare Improvement Act, which also included provisions to restrict GI Bill payouts for flight schools and increased eligibility for children of some veterans. Supporters of the measure did not address the issue on the House floor, but several Democrats said they hope the housing stipend cut is reconsidered in the Senate. Among the other bills approved Tuesday:

 The Construction Reform Act, which would require VA to hire an assistant inspector general for construction projects. Lawmakers have criticized lax oversight of those projects, several of which have faced multimillion-dollar cost overruns.  The American Heroes COLA Act, which would permanently tie veterans’ annual cost-of-living adjustments to Social Security and make their annual adjustments automatic.  The Career-Ready Student Veterans Act, which would require educational programs eligible for GI Bill payouts to meet state licensure and certification standards.  The Female Veteran Suicide Prevention Act, which would boost focus and oversight on suicide prevention programs targeted at women veterans.  The Failing VA Medical Center Recovery Act, which would require VA to assign special management teams to underperforming VA medical facilities to provide faster solutions for patients using those services.

Lawmakers in the House and Senate have discussed the possibility of crafting a larger veterans omnibus bill later this year, to include both the measures passed Tuesday and a host of other separate bills under consideration by both chambers. But no further details have been finalized on when that plan might be introduced.

[Source: Military Times | Leo Shane | February 10, 2016 ++]

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End of Service Physicals ► H.R.4251

On Dec. 16, 2015, Representative Mike Coffman (R-CO) along with 29 House colleagues, introduced H.R.4251, the Guard and Reserve Equal Access to Health Act. The American Legion-initiated bill was based upon the legislative mandate in Resolution 182, which requires the Department of Defense to provide end-of-service physical examinations to all retiring and separating servicemembers within 90 days of the end of their military service. If passed, the bill will ensure servicemembers of the Guard and reserve obtain an end-of-service physical at completion of military service. Today, both reservists and active-duty military are required to complete a physical examination when they are processed into the military. But under current law, only active-duty servicemembers are required to complete an end-of-service physical. Providing reserve component servicemembers with an end-of-service physical will document those health conditions that may be service connected to determine eligibility for VA health care. The end-of-service health records will also help expedite the disability compensation claims process for the veterans.

When he introduced the bill, Rep. Coffman, a Marine Corps combat veteran who was mobilized and deployed twice to the Middle East, said, "These reservists are often deployed and endure many of the hardships of war….citizen soldiers deserve the same consideration as their active-duty counterparts when they transition out of the military and this legislation is a further step in that direction." Rep. Coffman serves on both the House Armed Services and House Veterans’ Affairs committees, where he is the chairman of the Subcommittee on Oversight and Investigations. He is the only member of Congress to have served in both Iraq wars. Since the introduction of this legislation, the American Legion’s Legislative Division staff have held a number of face-to-face meetings with congressional staff, seeking additional cosponsors.

If your representative is a co-sponsor of this bill, you are requested to contact them and thank them for their support and encourage them to pass this legislation. If your representative is not a co-sponsor, contact them and ask them to become a co-sponsor by contacting the office of Rep. Coffman. Go to http://www.house.gov/legion representatives/find and enter your zip code if you are not aware of the contact number go to.

[Source: American Legion | Brett Reistad | February 2, 2016 ++]

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Selective Service System Update 14 ► Draft American’s Daughters Act

Two House Republicans introduced a bill 4 FEB requiring eligible women in the United States to sign up for the military draft, just days after it was recommended by the Marine Corps and Army. Rep. Duncan Hunter (R-CA), a Marine veteran, and Rep. Ryan Zinke R-MN), a retired Navy SEAL, filed the Draft American’s Daughters Act to stoke debate over the military’s historic move to fully integrate female troops into all combat roles. If passed, women from 18-26 years old would for the first time have to join men in registering with the Selective Service program and potentially be forced to fight in future wars. “If this administration wants to send 18, 20-year-old women into combat, to serve and fight on the front lines, then the American people deserve to have this discussion through their elected representatives,” Hunter said in a released statement.

Female Marine recruits practice rear hand punches during training at Parris Island, S.C., in July 2011

On 2 FEB, Marine Commandant Gen. Robert Neller and Army Chief of Staff Gen. Mark Milley testified to the Senate that they believe there no longer should be an exemption in the draft for half of the country’s population now that the military is all inclusive. The Marines and Army, along with the other service branches, were ordered by Defense Secretary Ash Carter to open about 225,000 combat jobs to women candidates – the last remaining occupational specialties that had barred female troops. The decision was made despite research and reservations from the Marine Corps and special operations community, and without adequate debate among lawmakers, according to the two congressmen sponsoring the bill. “My daughter is a damn good Navy diver. I know women play an invaluable role in war. Many times women can gain access to strategic sites that men never could,” Zinke said in a released statement. “However, this administration’s plan to force all front-line combat and Special Forces to integrate women into their units is reckless and dangerous.” The Marines completed a study last summer that found women get injured more often and perform below males in combat. During an oversight hearing in the Senate on Tuesday, lawmakers repeatedly referenced the study and said they are worried the military could lower standards to accommodate more women in combat occupational specialties.

Zinke said the decision now means the country must contemplate changes to the draft. His bill requires women to register beginning 90 days after it is signed into law. “This is a very important issue that touches the heart of every family in America, and I believe we need to have an open and honest discussion about it,” Zinke said. Men, who historically filled combat roles, are required to register with Selective Service when they turn 18 years old in case a draft is again needed. The Supreme Court had in the past backed the exemption for women, but only because they were not expected to fill crucial combat ranks. Millions of women might now suddenly and unexpectedly be required to register due to the Pentagon decision on combat roles. Neller, who initially requested exemptions for women in some combat positions, said he thinks it is fair that women now face being called up to wartime service. “Every American that is physically qualified should register for the draft,” said Neller, who had requested but was denied the exclusion of women in some Marine combat jobs. [Source: Stars and Stripes | Travis J. Tritten | February 4, 2016 ++]

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Selective Service System Update 15 ► Eliminate SSS | H.R.4523

As Congress begins debate on whether to force women to register for the draft, a bipartisan group of House lawmakers has a compromise solution: Get rid of it altogether. On 11 FEB, a group of four representatives — Mike Coffman (R-CO), Jared Polis (D-CO), Peter DeFazio (D-OR), and Dana Rohrabacher (R-CA) — introduced new legislation to abolish the Selective Service System (SSS), calling it an outdated and unneeded program. “Maintaining the Selective Service simply makes no sense,” Coffman, a Marine Corps veteran, said in a statement. “In 1973, the last draftee entered the Army and since then, despite the first Gulf War and subsequent wars in Iraq and Afghanistan, the Pentagon has never considered reinstituting the draft.” The idea comes amid dueling proposals from other lawmakers either requiring or continuing to exempt women from registering for the draft for the first time in U.S. history.

In December, Defense Secretary Ash Carter announced plans to open all infantry and combat-unit positions to women, provided they meet gender-neutral job standards. The military’s past prohibition on women serving in those roles also provided a legal backing for excluding women from registering for the draft. Coffman said re-opening of that debate provides a timely opportunity to get rid of the Selective Service System. Agency activities cost taxpayers roughly $23 million each year, and a 2012 Government Accountability Office report questioned whether the system could even provide a viable list of draftees to the Defense Department if needed. Military officials have repeatedly said that reverting to the draft from the current all-volunteer system would have significant negative impact on troop training, readiness and quality.

DeFazio noted that young men who fail to register for the draft face penalties, including denial of federal student loans and potential criminal punishment. “Not only will abolishing the Selective Service save the U.S. taxpayers money, it will remove an undue burden on our nation’s young people,” he said in a statement. “We need to get rid of this mean-spirited and outdated system and trust that if the need should arise Americans — both male and female — will answer the call to defend our nation.” Defense Department officials have said they are reviewing draft rules and regulations, and expect to issue recommendations in coming months. The issue is expected to be a key point of controversy in the annual defense authorization bill debate. It has also become a talking point on the Republican presidential campaign trail. Former Florida Gov. Jeb Bush and Florida Sen. Marco Rubio have both offered support for having women register, while Texas Sen. Ted Cruz has voiced strong opposition to the idea. [Source: Military Times | Leo Shane | February 11, 2016 ++]

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VA Appeals Update 17 ► H.R.4116 | Express Appeal Option Bill

A bipartisan group of senators is offering legislation aimed at cutting down the amount of time it takes for the Department of Veterans Affairs (VA) to handle a disability claim. Sens. Dan Sullivan (R-AK), Bob Casey (D-PA), Dean Heller (R-NV) and Jon Tester (D-MT) have introduced legislation to create a five-year pilot program that would serve as a voluntary alternative to the VA's current appeals process for disability claims. Under their proposal, veterans would be able to file an "express" appeal after the VA hands over a decision on a disability claim, which the lawmakers suggested could cut hundreds of days of wait time out of the current appeals process. Veterans can appeal the VA's original decision for a myriad of reasons, including disagreeing with the department about the severity of their disability.

According to weekly VA data released 1 FEB, the VA's Veterans Benefits Administration (VBA) currently has more than 300,000 appeals pending. A fiscal year 2014 report found that on average it can take more than 1,000 days between the time an appeal is filed and when the Board of Veterans' Appeals (BVA) makes a decision. Sullivan said that he hopes the Senate legislation will "create a less-bureaucratic appeals express lane" for the VA to handle appeals, adding that it is "astounding" that veterans can wait almost three years for a decision. Casey added that the current timeline is unacceptable. "It is crucial that we work to ensure that veterans get timely and accurate decisions on their appeals," he said.

As part of the legislation, if a veteran decided to opt for an "express" appeal but later changed their mind, they would be able to go back to the current appeals process without being negatively impacted. To help save time, the "express" process would skip over a current step in the appeals process when VA officials collect additional evidence after a veteran files an appeal. The legislation comes after lawmakers have pushed the VA for years to reduce the number of pending appeals from veterans. VA Secretary Bob McDonald called for a "simplified appeals process" while testifying before the Senate Veterans Affairs Committee. [Source: The Hill | Jordain Carney | February 1, 2016 ++]

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VA Appeals Update 18 ► VA Secretary on 2017 Budget Request

A few weeks ago during a hearing on VA’s transformation strategy, I made clear that we would need the help of Congress and our Veterans Service Organization partners in legislating a fair, streamlined and comprehensive process for new appeals, as well as providing much-needed resources to address the current pending inventory of appeals. We have also engaged with Veterans and their representatives, and have heard them loud and clear that the experience they expect is a simple and understandable process with a personal touch that is capable of responding to their changing needs.

This week’s budget request represents a down payment toward that effort. Our budget proposes legislation to simplify the appeals process that will enable VA to provide most Veterans with an appeals decision within one year by 2021. The $156 million request, which is $46 million more than last year, and the 242 additional full-time appeals employees we requested are a down payment on a long-term, sustainable plan to provide Veterans with timely decisions. The appeals process we have in current law is failing Veterans—and taxpayers. Over the years, laws have been changed to add layers of process, which, at the time, was perceived as being necessary to protect the interests of Veterans. Those perceived protections have crippled the system to the point where it is now broken. Most importantly, it is now so antiquated that it no longer serves Veterans well. Many find it confusing and are frustrated by the endless process and the length of time it can take to get an answer.

Veterans deserve an appeals process that is simple, timely, fair and transparent, and one that preserves their rights. We look forward to working with the Congress, Veterans Service Organizations, our state and federal partners and other key stakeholders to accomplish this important goal for Veterans and for American taxpayers. [Source: VA Secretary message | February 11, 2016 ++]

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Vet Bills Submitted to 114th Congress ► 160201 thru 160214

Refer to this Bulletin’s “House & Senate Veteran Legislation” attachment for a listing of Congressional bills of interest to the veteran community introduced in the 114th Congress. The list contains the bill’s number and name, what it is intended to do, it’s sponsor, any related bills, and the committees it has been assigned to. Support of these bills through cosponsorship by other legislators is critical if they are ever going to move through the legislative process for a floor vote to become law. A good indication of that likelihood is the number of cosponsors who have signed onto the bill. Any number of members may cosponsor a bill in the House or Senate. At https://beta.congress.gov you can review a copy of each bill’s content, determine its current status, the committee it has been assigned to, and if your legislator is a sponsor or cosponsor of it by entering the bill number in the site’s search engine. To determine what bills, amendments your representative/senator has sponsored, cosponsored, or dropped sponsorship on go to: https://beta.congress.gov/search?q=%7B%22source%22%3A%5B%22legislation%22%5D%7D, Select the ‘Sponsor’ tab, and click on your congress person’s name. You can also go to http://thomas.loc.gov/home/thomas.php.

Grassroots lobbying is the most effective way to let your Congressional representatives know your wants and dislikes. If you are not sure who is your Congressman go to https://beta.congress.gov/members. Members of Congress are receptive and open to suggestions from their constituents. The key to increasing cosponsorship support on veteran related bills and subsequent passage into law is letting legislators know of veteran’s feelings on issues. You can reach their Washington office via the Capital Operator direct at (866) 272-6622, (800) 828-0498, or (866) 340-9281 to express your views. Otherwise, you can locate their phone number, mailing address, or email/website to communicate with a message or letter of your own making at either: http://www.senate.gov/general/contact_information/senators_cfm.cfm http://www.house.gov/representatives

FOLLOWING IS A SUMMARY OF VETERAN RELATED LEGISLATION INTRODUCED IN THE HOUSE SINCE THE LAST BULLETIN WAS PUBLISHED

 H.R.4477 : Be Responsive to all Veterans Expeditiously Act of 2016. A bill to amend title 38, United States Code, to require voice mail for certain telephone lines paid for by the Secretary of Veterans Affairs, and for other purposes.  H.R.4513 : VA Mental Health Program State Grants. A bill to authorize the Secretary of Veterans Affairs to make grants to State and local entities to carry out peer-to-peer mental health programs.  H.R.4519 : Special Survivor Indemnity Allowance 5-Year Extension. A bill to amend title 10, United States Code, to provide a five-year extension of the special survivor indemnity allowance provided to widows and widowers of deceased members of the uniformed services affected by required Survivor Benefit Plan annuity offset for dependency and indemnity compensation received under section 1311(a) of title 38, United States Code.  H.R.4523 : Eliminate Selective Service System. A bill to repeal the Military Selective Service Act, and thereby terminate the registration requirements of such Act and eliminate civilian local boards, civilian appeal boards, and similar local agencies of the Selective Service System.  H.R.4527 : Military Retiree Employment Act. A bill to temporarily authorize recently retired members of the armed forces to be appointed to certain civil service positions, require the Secretary of Defense to issue certain notifications, and for other purposes.

FOLLOWING IS A SUMMARY OF VETERAN RELATED LEGISLATION INTRODUCED IN THE SENATE SINCE THE LAST BULLETIN WAS PUBLISHED

 S.2487 : Female Veteran Suicide Prevention Act. A bill to direct the Secretary of Veterans Affairs to identify mental health care and suicide prevention programs and metrics that are effective in treating women veterans as part of the evaluation of such programs by the Secretary, and for other purposes.  S.2493 : Senior Vet (75+) Hospital Care and Medical Services. A bill to expand eligibility for hospital care and medical services under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 to include veterans who are age 75 or older, and for other purposes.  Medal of Honor Surviving Spouses Recognition Act of 2016. A bill to amend title 38, United States Code, to provide payment of Medal of Honor special pension under such title to the surviving spouse of a deceased Medal of Honor recipient, and for other purposes.  S.2520 : Newborn Care Improvement Act. A bill to amend title 38, United States Code, to improve the care provided by the Secretary of Veterans Affairs to newborn children.  S.2521 : Military SAVE Act. A bill to amend the Veterans Access, Choice, and Accountability Act of 2014 to improve the treatment at non-Department of Veterans Affairs facilities of veterans who are victims of military sexual assault, and for other purposes.  S.2527 : Sergeant Daniel Somers Classified Veterans Access to Care Act. A bill to amend title 38, United States Code, to improve the mental health treatment provided by the Secretary of Veterans Affairs to veterans who served in classified missions.  S.2545 : VA Reimbursement Modification for Health Care Providers. A bill to modify the requirements of the Department of Veterans Affairs for reimbursing health care providers under section 101 of the Veterans Access, Choice, and Accountability Act of 2014, and for other purposes.  S.2554 : VA Employee Removal/Demotion. A bill to amend title 38, United States Code, to provide for the removal or demotion of employees of the Department of Veterans Affairs based on performance or misconduct, and for other purposes.

[Source: https://beta.congress.gov & http: //www.govtrack.us/congress/bills February 13, 2016 ++]

Selective Service System Update 13 ► USA/USMC Want Female Draft

The Army and Marine Corps' top uniformed leaders both backed making women register for the draft as all combat roles are opened to them in coming months, a sweeping social change that could complicate the military’s gender integration plans. Both services, along with the Navy, have begun work to open all military jobs to any service member after a decision by Defense Secretary Ash Carter in December to lift all gender-based restrictions on combat and infantry roles. On 2 FEB, Army Chief of Staff Gen. Mark Milley and Marine Corps Commandant Gen. Robert Neller told senators during a Capitol Hill hearing that full integration of those jobs will likely take a few years, to overcome logistical and cultural issues.

One of those complications will be how to handle the Selective Service System, which requires all men ages 18 to 26 to register for possible involuntary military service. Women have always been exempt, and past legal challenges have pointed to the battlefield restrictions placed on them. With that reasoning moot, lawmakers will need to determine what becomes of the system. Navy Secretary Ray Mabus Jr. said there needs to be “a national debate” over what the changes mean, balancing social concerns over the idea of drafting women with the reality of national security and military readiness. But the uniform leaders were blunter in their assessment. “It's my personal view in light of integration that every American physically qualified should register for the draft,” Neller said. Milley echoed those remarks, saying “all eligible men and women” should be required to register.

The comments drew support from some Democratic lawmakers — “I agree with you,” said Sen. Claire McCaskill, (D-MO) — but concerned looks from Republicans on the Senate Armed Services Committee, who spent most of the hearing criticizing how abruptly the decision to drop gender restrictions was made. Several pressed military leaders over whether job standards would be lowered to allow women into combat roles, a charge officials repeatedly refuted. Milley and Neller said no quotas for positions have been set. Mabus said that watering down physical standards is “unacceptable under the law, and unacceptable to me and every other senior leader in the Pentagon, because it would endanger not only the safety of Marines, but also the safety of our nation.”

But committee chairman Sen. John McCain (R-AZ) said military officials still have not provided enough study or implementation plans to justify the rapid changes laid out by military leaders. “I am concerned that the department has gone about things backward,” he said. “This consequential decision was made and mandated before the military services could study its implications, and before any implementation plans were devised to address the serious challenges raised in studies.” Sen. Joni Ernst (R-IA) — the only female veteran on the Senate committee — said she fully supported the changes “as long as standards are not lowered” to boost the number of women in combat jobs or force them to meet quotas. “We need to ensure we don’t set up men or women for failure,” she said. “It’s clear we need to ensure that we’re taking into account the impact this could have on women’s health.

Marine Corps officials had requested to leave some of their infantry and combat jobs closed to women, citing a service study showing concerns about unit effectiveness. Carter denied those requests. For many advocates, the controversy over women in combat jobs is an outdated debate. Army leaders noted at the hearing that more than 9,000 women have already earned the Combat Action Badge for actions in the wars in Iraq and Afghanistan. More than 1,000 women have been killed or wounded in that fighting. [Source: Military Times | Leo Shane | February 2, 2016 | ++]

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Military Retirement System Update 22 ► Big Decision for Many Troops

Hundreds of thousands of service members face a critical decision during the next year that could have a huge impact on their future financial security: Whether to opt into the new military retirement system or stick with the traditional one. Signed into law in November, the new retirement benefit will mean smaller pension checks but include cash contributions to the individual investment accounts of all troops. It's the biggest change in decades for military compensation. For the first time, the military will offer some limited retirement benefit, similar to 401(k) contributions, to troops who separate before reaching 20 years of service. Historically those non-career service members — more than 80 percent of the force — received no retirement benefit.

Officially the new retirement system takes effect Jan. 1, 2018. After that, all troops coming out of boot camp will be automatically enrolled in the new benefit as the traditional pension plan is phased out. Yet for today’s troops, and anyone who joins during the next two years, the new law includes a grandfather clause that will allow them to choose to remain under the traditional all-or-nothing retirement system. The Defense Department plans to roll out a forcewide education program later this year to give troops the details on the new benefits and also provide financial literacy training to help them make key decisions like how much personal basic pay to allocate to retirement savings accounts and where to invest it.

Despite years of skepticism, the new benefit looks like a potentially good deal for many of today’s younger troops and the Pentagon expects thousands of service members to voluntarily waive their right to stick with the traditional system. There’s an immediate incentive: Troops who opt in will begin receiving matching contributions — ranging from 1 percent to 5 percent of monthly basic pay — into their portable individual investment account that they own outright after just two years of service. The new system caps years of heated debate over the future of military retirement. And the final outcome is vastly different from the initial proposals that would have eliminated the fixed-income pension entirely and gutted the real value of the benefit. Those proposals sparked outrage and were ultimately rejected by the Pentagon as a major risk to retention and readiness.

In fact, the new system does not really save much money for the Defense Department. Most of the reduced spending on smaller pensions will be offset by the cash contributions for the vast majority of the rank-and-file force. “It’s an incredibly generous deal,” said Mackenzie Eaglen, a military personnel expert at the American Enterprise Institute. “By and large this is the establishment of a generous new benefit for a wide swath of people who were never going to get it in the past,” she said. Offering a side-by-side comparison of the two retirement systems is difficult because it hinges on big variables, such as future stock market returns and the extent to which individual service members contribute their own pre-tax money to their retirement account and are in turn able to draw on the matching government contributions. Troops who entered military service before 2006 are not eligible for opting into the new system and, generally speaking, for those troops who have already clocked many years in uniform and are well on their way to reaching the 20-year retirement threshold, the new system is not very attractive because they have far fewer years to accrue monthly cash contributions and let those grow over time.

Yet for troops who are early in their careers, especially the several hundred thousand who are first- term enlistees or junior officers, the question is more complex, experts say. “This decision likely will depend on service members’ answers to several questions. First, and most importantly, what is the likelihood that the service member will make the military a career and stay at least 20 years?” said Jim Grefer, a military personnel expert at the Center for Naval Analyses. “Service members who are unlikely to stay to 20 years of service clearly would be better off under the new system,” he said. For individuals who strongly believe they will remain in uniform for 20-plus years, exercising the grandfather clause and staying with the traditional benefit package might make more sense, he said. They should focus on several key questions: Are they willing to sacrifice current spendable income by making contributions to their TSPs from their own pockets? And, are they willing to accept the market risk inherent in TSP-type retirement accounts?” Grefer said. “If the answers are no, then they likely should stay in the current retirement system,” he said. Here are the details:

 Under the new retirement system, military pensions will shrink by 20 percent, but otherwise will function the same as the current system, with the pension earned after 20 years of active-duty service and checks payable immediately upon separation.  Troops will receive a “continuation pay” upon reaching 12 years of service if they agree to a new four-year service agreement. Continuation pay will vary by career field but will be at minimum equal to 2.5 months of basic pay. These funds will be paid as cash, so service members can spend it — or invest it — as they wish.  The Defense Department will create an individual investment account, known as a Thrift Savings Plan, for all recruits showing up at boot camp. Troops will automatically receive monthly deposits equal to 1 percent of their basic pay. They can select an investment fund and hope to accumulate market gains and interest over time as financial markets grow.  Ownership of the TSP accounts will be handed off to the individual troops after reaching two years of service. Troops will be given incentives to contribute their own money to the retirement account. Specifically, the Defense Department will offer a dollar-for-dollar match to individual contributions up to an additional 3 percent of pre-tax basic pay.  For troops opting to contribute 3 percent of basic pay, the Pentagon will contribute 4 percent, which would be the initial 1 percent automatic contribution plus a 3 percent match. That means troops contributing 3 percent would sock away monthly pre-tax contributions equal to 7 percent of basic pay.  Additionally he Defense Department will match at 50 cents on the dollar troop contributions beyond 3 percent, up to 5 percent. So to receive the maximum possible retirement benefit, troops should contribute 5 percent of their own basic pay and receive a 5 percent matching contribution from the government. Troops are permitted to contribute more of their own money, but the government match is capped at 5 percent.  For those contributing to a TSP, there is the added benefit of reducing their taxable income. However, because the TSP offers investment funds, not specific stocks, standard maintenance fees apply, and they will vary from fund to fund.  Money deposited into a TSP is generally subject to a 10 percent penalty if withdrawn before the owner reaches age 59½. Taxes are deferred on contributions, payable upon withdrawal of funds.

Deadline. It all kicks off Jan. 1, 2018. That's when the Defense Department will begin distributing monthly retirement account contributions to recruits arriving at boot camp as well as to troops already in the ranks who opt into the new system. Opting in will require signing some basic paperwork. Those troops who joined the military before January 2018 will automatically remain under the current system unless they seek the authorization forms for opting in. Current plans call for giving current troops a 12-month window for opting in, so the last chance to sign up to participate in the new benefit will be late December 2018.

Old bonuses. The law that fundamentally changes the retirement benefit is intended to dovetail with the longstanding system of special and incentive pays. Re-enlistment bonuses for specific career fields, combat pays and special incentives for high-demand skills such as proficiency in foreign languages or medical specialties will continue to be a key device for the services to retain talent and shape the force. “The new system isn’t meant to dislodge the existing ‘S & I’ pays,” said James Hosek, a military personnel expert with the Rand Corp. whose research contributed to the development of the new retirement system. Despite the pension’s reduction, its total value will continue to serve as an incentive for midcareer service members to stay in uniform. “The retirement benefit at 20 years of service is still substantial. It’s still a major draw,” Hosek said.

Lump sum. Among the biggest changes to the retirement benefit is a new option for troops leaving after 20 years of service to receive part of their pension benefit in the form of a “lump sum” cash payout. Retiring service members will have the option of receiving their retirement benefit in the traditional form of monthly pension checks. Or, they can opt to receive 25 percent or 50 percent of that benefit in a cash payout upon separation in exchange for future years of reduced pension payments. (The lump-sum option reduces monthly pension checks only through the traditional retirement age, typically age 67, at which time all retirees will receive the full monthly pension benefit). The lump-sum option in some ways will resemble today’s “Redux” retirement option, in which troops can receive a $30,000 cash payment in exchange for reduced lifetime pensions. In most cases, the lump-sum payout will, after taxes, be worth less than $100,000. Yet the precise amount of the lump-sum payments remains unclear. They won’t be calculated by simply adding up the face value of pension payments. Rather, the calculations can rest upon a "discount rate," a device that financial professionals use to measure the current value of future payments.

Discount rates assume money today is more valuable than money tomorrow — akin to reverse interest rates, shaving money from the current value of a future benefit. The higher the discount rate applied, the lower the value of the lump sum payment today. The law Congress passed leaves the details up to the Pentagon, which will face a big decision to make in setting that discount rate, one that will add or cut hundreds of thousands of dollars from individual troops' lump-sum options. “That is going to be the largest point of contention. It’s rife with missteps,” said one defense official. A key question is whether different service members will be offered different rates. Studies show enlisted troops are more eager to get money up front and therefore will accept a much bigger hit from the discount rate. But does that mean the DoD will take advantage of that and offer a better discount rate to officers? If, hypothetically, studies show that the “grunts” in the combat arms career fields are willing to take the lump sum with a higher discount rate, will the Pentagon use that to craft the formal retirement benefits program and offer those troops smaller lump-sum retirement payouts? “Do you split it by age? By pay grade By MOS?” the official said.

Critics of the lump-sum payout plan compare it to “pay-day lenders” and say it exploits individuals’ desire to have cash now at the expense of long-term financial benefit. An independent panel on military compensation initially floated the idea in a report to Congress in January 2015. The panel suggested it was a good option for retiring troops who want to buy a home, start a business or help send a child to college. Last year the Defense Department officially opposed the idea of a lump-sum cash payout, saying it was not a good deal for troops in most scenarios. The idea was first floated by the Military Compensation and Retirement Modernization Commission in a report to Congress last year. Defense Department officials can kick that can down the road for a few years because it’s unlikely that anyone will be completing their career and actually retiring under the new system for at least another 10 years. Some defense officials are quietly hoping that Congress will revisit the new retirement law and eliminate that piece of the benefit package before any troops have an opportunity to exercise it. “If we can get rid of it at some point it would be ideal,” the defense official said.

-o-o-O-o-o-

Troops who opt into the new retirement system will face an array of new variables and decisions. What are the best investment fund options for a TSP account? How will financial markets impact the growth of retirement accounts? How much will the 12-year continuation pay actually be? Is the lump-sum option worth considering? “It can be very complicated. But it can also come down to some very simple decisions, like contributions,” said Beth Asch, a personnel expert with RAND. “There are certain rules of thumb," she said. "Like if there is a match, do it." [Source: Military Times | Andrew Tilghman | February 8, 2016++]

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Military Enlistment Standards 2015 Update 13 ► Miscellaneous Provisions

In general, the following additional conditions will render one ineligible for enlistment, and waivers will not normally be granted:

1. Intoxicated or under influence of alcohol or drugs at time of application, or at any stage of processing for enlistment.

2. Having history of psychotic disorders or state of insanity.

3. Questionable moral character.

4. Alcoholism.

5. Drug dependence.

6. Sexual perversion.

7. History of antisocial behavior.

8. History of frequent or chronic venereal disease.

9. Previously separated for unfitness, unsuitability, unsatisfactory performance, misconduct or bar to reenlistment, with 18 or more years of active Federal service completed.

10. Military retirees (can be waived in some cases).

11. Persons unable to present written evidence (official documents) of prior service claimed, until such service has been verified.

12. Persons whose enlistment are not clearly consistent with interests of national security.

13. Last discharged or separated from a component of a U.S. Armed Force, with an other than honorable or general administrative discharge.

14. Criminal or juvenile court charges filed or pending against them by civil authorities.

15. Persons under civil restraint, such as confinement, parole, or probation.

16. Subject of initial civil court conviction or adverse disposition for more than one felony offense.

17. Civil conviction of a felony with any one of the following:

 Three or more offenses (convictions or other adverse dispositions) other than traffic.  Applicants with juvenile felony offenses who have had no offenses within five years of application for enlistment may be considered for a waiver in meritorious cases.

18. Subject of initial civil court conviction or other adverse dispositions for sale, distribution, or trafficking (including "Intent To:) of cannabis (marijuana), or any other controlled substance.

19. Prior Service with a RE-Code of "4." (Note: The Army will sometimes waive a re-enlistment eligibility code of "4" when that code was issued by another service, and the individual's discharge characterization is "uncharacterized," or "honorable."

20. Persons with a Bad Conduct or Dishonorable punitive (court-martial) discharge.

21. Persons with prior service last discharged from any component of the Armed Forces for drug or alcohol abuse, or as rehab failure during their last period of service.

22. Three or more convictions or other adverse dispositions for driving while intoxicated, drugged, or impaired in the 5 years preceding application for enlistment.

23. Confirmed positive drug test at MEPS. (Note: The Navy, Marine Corps, and Army may waive this, after a waiting period. The Coast Guard and Air Force never waive this).

24. Persons with convictions or other adverse dispositions for five or more misdemeanors preceding application for enlistment.

25. Alien without lawful admittance or legal residence in the United States.

26. Permanently retired by reason of physical disability.

27. Individuals receiving disability compensation from the VA (may be waived in some cases, as long as the member agrees to give up the disability compensation).

28. Officers removed from active or inactive service by reason of having attained maximum age or service.

29. Discharged by reason of conscientious objection.

[Source: About.com Newsletter | Rod Powers | June 02, 2015 ++]

TRICARE Enrollment Fee ► FY 2017 Budget Proposal

All retired service members would pay an annual TRICARE enrollment fee under a new, simplified version of the military’s main health care program outlined in President Obama’s fiscal 2017 budget. TRICARE would consist of two options under the proposal, instead of the several different choices available to beneficiaries now. Enrollees could choose a lower-cost plan called TRICARE Select, similar to an HMO, and centered on military treatment facilities, or TRICARE Choice, a more expensive plan that would operate like a PPO. Retired enrollees in both plans would pay participation fees, which is not the case now for beneficiaries with TRICARE Standard coverage, or those military retirees age 65 or older who have TRICARE-for-Life. Enrollees who choose not to pay an annual participation fee would forfeit their TRICARE coverage for that year under the White House proposal. The changes would not affect active-duty service members.

The proposed participation fees for TRICARE Select beneficiaries in 2018, based on Defense estimates, would be $350 for individuals and $700 for families. Under the Choice option, the Pentagon budget estimated $450 for the individual fee, and $900 for families. Right now, for example, TRICARE Prime retirees pay $282.60 annually for individual coverage, and $565.20 per year for family coverage through Sept. 30, 2016. Under the new system, co-pays would depend on which plan beneficiaries enrolled in, and where they obtained their prescription drugs. Military treatment facilities would not charge co-pays. The fiscal 2017 budget also recommends creating an enrollment fee for TRICARE-for-Life beneficiaries, which would be tied to retired recipients’ income – a proposal that has cropped up in previous Obama Defense budgets. Fees and drug co-payments would be indexed at the National Health Expenditures per capita.

The Select/Choice options under the fiscal 2017 proposal are reminiscent of the Pentagon’s previous attempts to streamline TRICARE, and save money by requiring beneficiaries to pay more for their health care. When TRICARE took effect in 1996, a working age retiree’s costs were approximately 27 percent of the total health care price tag, according to Defense. Today, the beneficiary’s share is less than 9 percent. “While health care costs have doubled or tripled over this time frame, a family’s out-of-pocket expenses, including enrollment fees, deductible and cost shares, have grown by only 30 to 40 percent,” the Defense budget said. Military pay and benefits, including TRICARE costs, amount to 34 percent of the overall Defense base budget in fiscal 2016.

The Pentagon framed the changes as part of a larger reform effort to improve TRICARE while also reining in costs. “Simply revising the cost-sharing structure of TRICARE will not meet beneficiaries’ concerns or resolve access to care issues,” said the fiscal 2017 Defense budget. “Instead, the department must commit to institutional health care reform and implement targeted solutions to solve the variety of issues facing its beneficiaries.” Congress has resisted the Obama administration’s more aggressive TRICARE proposals so far, opting instead for more modest increases in TRICARE enrollment fees and prescription drug co-payments. But Defense is hoping that lawmakers’ willingness to overhaul the military retirement system in 2015 will translate into more significant reforms to TRICARE this budget season. For a more detailed look at the Pentagon’s TRICARE reform proposals, go to the following FY2017 Budget Request Overview Book website and scroll down to the section “Take Care of Our People.” http://comptroller.defense.gov/Portals/45/Documents/defbudget/fy2017/FY2017_Budget_Request_Overview_Book.pdf

NAUS Note: NAUS does not see the President’s recommendations as the best way forward and will press Congress to improve, protect and preserve access to world-class health care for those who wear and have worn the uniform and who earned these benefits through service to country. NAUS is especially concerned with fees for TRICARE Standard and TRICARE for Life, which are unprecedented. It appears that all these initial proposals are only a way for DoD to get more money from those the benefits are supposed to help. Nowhere is there any mention of improving the benefits as House and Senate Armed Services Committee Chairmen, Rep. Mac Thornberry (R-TX) and Sen. John McCain, have said are part of their agenda.

[Source: GovExec.com | Kellie Lunney | February 9, 2016 ++]

TRICARE Standard Claims Update 02 ► Submitting Your Own Claim

As a TRICARE Standard beneficiary, you may have to submit your own claims. When doing so, keep the following in mind to help avoid late or denied payments. If you get care in the U.S., submit claims to the claims processor in the region where you live, not where you got care. For care you get overseas or in the U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands), submit claims to the TRICARE Overseas Program claims processor, regardless of your home region. In the United States and U.S. territories, claims must be filed within one year from the date of service or date of inpatient discharge. Overseas, claims must be filed within three years, and you must submit proof of payment. For more information, visit www.tricare.mil/proofofpayment .

To file a claim, fill out a TRICARE DoD/CHAMPUS Medical Claim—Patient’s Request for Medical Payment form (DD Form 2642). You can download DD Form 2642 at www.tricare.mil/claims or from your regional contractor’s website. Beneficiaries age 18 or older, spouses, parents or guardians may sign the initial claim form. Forms needed later to process a claim must be signed by the patient, or parent or guardian if the patient has not yet reached age 18.

Items To Include. When filing a claim, attach a readable copy of the provider’s bill to the claim form, making sure it contains the following:

 Patient’s name  Sponsor’s Social Security number (SSN) or Department of Defense Benefits Number (DBN); eligible former spouses should use their own SSN or DBN and not the sponsor’s  Provider’s name and address; if more than one provider’s name is on the bill, circle the name of the person who provided the service for which the claim is filed  Date and place of each service  Description of each service or supply furnished  Charge for each service  Diagnosis; if the diagnosis is not on the bill, complete block 8a on the form

You may have to pay up front for services if you see a TRICARE-authorized non-network provider who chooses not to accept TRICARE’s payment as payment in full on the claim. In this case, TRICARE reimburses you for the TRICARE-allowable charge, minus any amount toward your annual deductible and cost-shares. A deductible is the amount you pay out of pocket before your health care benefit begins cost-sharing. A cost-share is the percentage of the cost of care that you are responsible for paying when you visit a health care provider. You are responsible for the annual deductible and cost-shares under TRICARE Standard.  Nonparticipating non-network providers may charge up to 15 percent above the TRICARE- allowable charge in addition to your deductible and cost-shares. You are responsible for this cost. Visit www.tricare.mil/costs for more information.  Outside the U.S. and U.S. territories, there may be no limit to the amount that nonparticipating non-network providers may bill, and you are responsible for paying any amount that exceeds the TRICARE-allowable charge. Visit www.tricare.mil/overseas for more information.

Remember, when you visit a TRICARE network provider, you are using TRICARE Extra (not available overseas), and your provider files the claim for you. With TRICARE Extra, you also have lower out-of-pocket costs. For additional claims information, visit www.tricare.mil/claims.

Regional Claims-Processing Information

TRICARE North Region - Send claims to: Health Net Federal Services, LLC, c/o PGBA, LLC/TRICARE, P.O. Box 870140 Surfside Beach, SC 29587. Check the status of your claim at www.myTRICARE.com or www.hnfs.com.

TRICARE South Region - Send claims to: TRICARE South Region, Claims Department, P.O. Box 7031, Camden, SC 29021. Check the status of your claim at www.myTRICARE.com or http://humanamilitary.com.

TRICARE West Region - Send claims to: TRICARE West Region, Claims Department, Health Net Federal Services, LLC, c/o PGBA, LLC/TRICARE, P.O. Box 870140 Surfside Beach, SC 29587.

TRICARE Overseas Region

Active Duty Service Members (ADSMs) (all overseas areas) - Send claims to: TRICARE Active Duty Claims, P.O. Box 7968, Madison, WI 53707 USA

Non-ADSMs Eurasia-Africa - Send claims to: TRICARE Overseas Program, P.O. Box 8976, Madison, WI 53708 USA

Non-ADSMs Latin America, Canada, and Pacific - Send claims to: TRICARE Overseas Program, P.O. Box 7985, Madison, WI 53707 USA

[Source: TRICARE Standard Health Matters | Annual 2016 Pub ++]

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TRICARE Cost Share 2016 ► Standard & Extra

You can use both TRICARE Standard and TRICARE Extra to get care. The option you use determines your out-of-pocket costs. The costs that follow are for care you get from civilian providers. These costs are for fiscal year (FY) 2016 (Oct. 1, 2015 thru Sept. 30, 2016), and may change each year on 1 OCT. You are required to meet an annual deductible each FY for outpatient services before cost-sharing begins. For more information on costs, visit www.tricare.mil/costs.

Active Duty Family Members (Costs for families of National Guard and Reserve members called or ordered to active service for more than 30 consecutive days are the same as for active duty family members)

 TRICARE Standard (Non-Network Provider) – Outpatient: 20% of the allowable charge. Inpatient: $18 per day ($25 minimum charge)  TRICARE Extra (Network Provider) – Outpatient: . 15% of the negotiated rate. Inpatient: $18 per day ($25 minimum charge)

Retired Service Members, Their Families and All Others

 TRICARE Standard (Non-Network Provider) – Outpatient: 25% of the allowable charge. Inpatient: $810 per day or 25% for institutional services, whichever is less, plus 25% for separately billed professional charges.  TRICARE Extra (Network Provider) – Outpatient: 20% of the negotiated rate. Inpatient: $250 per day or 25% for institutional services, whichever is less, plus 20% for separately billed professional

[Source: TRICARE Standard Health Matters | Annual 2016 Pub ++]

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GI Bill Myths ► Don’t Miss Out Because of These Four

Part of the original GI Bill of 1944, VA home loans — mortgage loans guaranteed by the U.S. Department of Veterans Affairs (VA) — have soared since the housing crash. During a time of tight credit and tough lending, this long-cherished program backed a record 631,151 loans in fiscal year 2015. VA loans aren’t just grabbing market share — they’re snagging headlines, too, from talk of their industry-low interest rates to their surprising safety. But countless veterans and military families are still missing out, in part because of longstanding myths and misconceptions. A perception of red tape and bureaucracy is something Department of Veterans Affairs officials continue to combat. Mike Frueh, the head of the loan program, calls it the ‘myth of my father’s VA.’ “It’s the myth that the loan takes too long to get, it’s too cumbersome, it’s difficult,” Frueh said. “We can counter that through education, and through constantly addressing our program to make it better.” To that end, let’s take a look at four pervasive VA loan myths that can keep veterans from exploring their hard-earned home loan benefits.

Myth 1: You need perfect credit - This one is almost laughably wrong. VA loans were created to help level the playing field for veterans and military members who’ve sacrificed for our country. More flexible and forgiving credit guidelines are a key part of the benefit. While the VA doesn’t require a certain credit score, the private lenders ultimately making these loans certainly will. The good news is, many are looking for a minimum 620 FICO score to qualify. That’s considered just “Fair” credit, a step below “Good” and two beneath “Excellent.” VA loans also typically feature shorter waiting periods than conventional loans following negative credit events like a bankruptcy or foreclosure.

Myth 2: VA loans cost more - These $0 down loans come with a host of big-time benefits that have made homeownership possible for millions of veterans and service members who might otherwise be left on the sidelines. They also don’t inherently cost more than other loan types. The VA limits what lenders can charge in closing costs, and these no-down-payment loans also come with no mortgage insurance. The latter can prove especially costly and eat into a veteran’s buying power. Conventional buyers without a 20-percent down payment usually need to pay for private mortgage insurance. FHA buyers face both upfront and annual mortgage insurance charges. Compared to FHA, the VA estimates its 2015 buyers will save $44 billion in mortgage insurance costs over the life of their loans.

VA buyers do have to contend with an upfront funding fee, which can be paid in cash at closing or rolled on top of the loan. The VA Funding Fee varies depending on your down payment, your service history and whether it’s your first use of the benefit. For most first-time buyers, it’s 2.15 percent of the loan amount. Veterans who receive compensation for a service-connected disability don’t have to pay this fee.

Myth 3: VA loans take forever to close - VA loans have long fought a reputation for being slow and choked with red tape. Some of that reflects old truths, but the program has become considerably more efficient over the past 15 years. Long a sore spot for buyers and real estate agents, VA appraisals now come back in under 10 business days on average, which is on par with the other loan types, Frueh said. Wait times can be longer in more remote parts of the country. There’s also little difference between VA and conventional loans in terms of getting to the finish line. The average VA purchase in December closed in 51 days, which was a day longer than the typical conventional loan, according to mortgage software provider Ellie Mae. VA loans also had a higher closing success rate than conventional loans throughout all of 2015.

Myth 4: No down payment makes VA loans risky - This is one of the surprising — and surprisingly neglected — stories of the housing recovery. These $0 down loans have had the lowest foreclosure rate of any mortgage on the market for most of the past eight years, according to data from the Mortgage Bankers Association. That success is partly due to the VA’s common-sense guideline for discretionary income, which helps ensure buyers can weather financial hiccups and stay current on their mortgage. But the VA’s foreclosure prevention team deserves a lot of credit, too. Foreclosure specialists get regular updates on each of the 2.5 million active VA loans, and they can reach out to homeowners at the first sign of danger. The foreclosure team also encourages lenders and mortgage servicers to offer foreclosure alternatives to borrowers in jeopardy. Those efforts helped more than 90,000 veterans avoid foreclosure last year alone.

-o-o-O-o-o-

“There’s not many times that a government agency is leading the industry in something, and in something as important as housing,” Frueh said. “I want our children’s VA to be better than it is today, and we’re doing everything we can in our power to get there.” [Source: Fox Business | Chris Birk | February 04, 201 ++]

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IRS Data Breach Update 04 ► 101,000 e-file PINs Disclosed

Identity thieves tricked an Internal Revenue Service system into issuing them PINs under the names of other taxpayers so they could file for their victims' refunds, according to the tax agency. The so-called e- file PINs are required to file federal returns electronically, if you are missing other acceptable types of identification such as your adjusted gross income. The incident shows hackers are undeterred by stronger ID verification controls that organizations from Twitter to the Justice Department have activated. On 9 FEB, the IRS disclosed that a "bot," essentially an automatic malicious program, entered Social Security numbers (stolen elsewhere) into the IRS system that generates e-file PINs. The malware successfully obtained 101,000 PINs last month using this maneuver. Whoever was behind the manipulation possessed a total of 464,000 stolen Social Security numbers but not all of them worked in the system, according to the IRS.

Agency officials said they have stopped the malicious usage of the system. But at a 10 FEB congressional hearing, the Senate Finance Committee chairman questioned IRS Commissioner John Koskinen about whether the hackers might still have access to the affected system. "How can the IRS be sure it has fully identified and contained this attack and other attacks that may come?" asked Sen. Orrin G. Hatch, R-Utah, at a session on the agency's 2017 funding request. "Attacks of this nature can often result in malware or a virus being embedded in a compromised system even after an event is known." Koskinen called the possibility of malware that can evade detection a serious question. "The caliber of the enemy we are facing is increasingly more sophisticated and more global," he said. "We're dealing with organized crime syndicates all around the world."

No networks or systems were compromised in this instance or a similar gambit ID thieves perpetrated last filing season, however. "None of those attacks breached our system itself -- in the sense that our database was accessed,” Koskinen said. The most recent case "was simply an attempt by criminals to get a filing PIN to allow them to in fact use information that they have stolen already to try to file a false return." About a year ago, criminals gamed an online service called "Get Transcript" to view 334,000 taxpayers' records for similar ends. The latest episode “is not connected or related to last week’s outage of IRS tax processing systems," IRS officials said in a statement, referring to a suspected hardware failure Feb. 4 that knocked agency computers offline, bringing e-filing to a halt.

The agency is notifying the affected taxpayers to inform them that someone else used their Social Security numbers. In addition, the IRS says it is flagging their accounts to counter tax-related ID theft. The stolen E-file PINs are valid for a year. Koskinen on 11 FEB thanked the lawmakers for allocating $290 million this year to reduce phone wait times for customer service, bolster network security and combat ID theft. In the 2017 budget proposal, the IRS is asking for $90 million in additional funding to further deter fraud and reduce improper payments. The money would cover extra staffing and technology to, among other things, move away from relying on SSNs as an identifier and more quickly obtain W-2 employment tax forms from the Social Security Administration. [Source: NextGov | Aliya Sternstein | February 11, 2016 ++]

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SBP | Former Spouse Update 01 ► Death Amendment

The National Defense Authorization Act of Fiscal Year 2016 amended the Survivor Benefit Plan (SBP) statute to allow members to elect to cover their current spouse coverage following the death of their former spouse. The legislation also permits members who before Nov. 25, 2015 (the date the law was enacted), had a former spouse beneficiary under the SBP/Reserve Component SBP (RCSBP) program who died before that date; and who on Nov. 25, 2015, are married, to provide spouse coverage for their eligible spouse. A member who married after the date of death of their former spouse (or in the one year period preceding the date of the death of the former spouse) the effective date is the first day of the first month after the first anniversary of the marriage. Any such election may only be made during the one-year timeframe which began on Nov. 25, 2015. The new law does not permit members to reduce their current base amounts when electing spouse coverage. The Defense Finance and Accounting Service is currently creating a template that retired members can use to enroll their spouses during this open season. Substantiating documentation will include a copy of the former spouse’s death certificate and a copy of the members’ marriage certificate. [Source: Shift Colors | Navy Casualty Office | Winter-Spring 2016 ++]

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Elected Officials Contact Data ► Where to Go

Federal Elected Officials

 President, Vice President, and White House https://www.whitehouse.gov/contact. Contact the white House by submitting your comments or questions online or by phone/Fax.  Members of the U.S. Congress ~ Senators http://www.senate.gov/general/contact_information/senators_cfm.cfm ~ Representatives http://www.house.gov/representatives. Find the website and contact information for your representative in the U.S. House of Representatives.

State Elected Officials

 State Governors - https://www.usa.gov/state-governor  State Legislators - http://thomas.loc.gov/home/state-legislatures.html. Find the names and current activities of your state legislators.

Local Elected Officials

 U.S. Mayors: http://www.usmayors.org/meetmayors/mayorsatglance.asp. Locate mayors by name, city, or population size. Also provides Mayor’s photo.  County Executives: http://www.naco.org/counties. A county executive is the head of the executive branch of government in a county. The county executive may be an elected or an appointed position.  Other Local Government Officials: https://www.usa.gov/local-governments. This directory can help you find contact information for your city, county, and town officials in your state.

Other Ways to Contact Government

 By topic https://www.usa.gov/contact-by-topic. If you need assistance with a particular issue, anything from food stamps to vaccines.  By agency https://www.usa.gov/federal-agencies/a. A-Z index of U.S. Government Departments and Agencies

Bottom line? The reason they’re called “representatives” is because they represent us. They can’t do that if they don’t know what we think. So tell them. But as with all communication, the more effectively you do it, the more likely you are to get the result you want. [Source: MoneyTalksNews | Stacy Johnson | February 5, 2016 ++]

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Doomsday Clock ► Remains at Three Minutes to Midnight

The Doomsday Clock remains at three minutes to midnight, the closest to the brink of global destruction since the height of the Cold War, representatives of the Bulletin of the Atomic Scientists announced 26 JAN. Constructed in 1947 as an indicator of an oncoming nuclear catastrophe, the Doomsday Clock now factors in climate change and other threats to humanity as well in its projections of global safety. The clock, which counts down to an apocalypse at midnight, has moved some 21 times since it was put in place.

Last year, the clock was moved forward to just three minutes to midnight, largely because of climate change and what was seen as unchecked nuclear proliferation. Scientists from the Bulletin cited many of the same reasons this year, but noted that there were bright spots such as the Iran deal and the climate talks in Paris. “That decision is not good news, but an expression of dismay that world leaders continue to fail to focus their efforts and the world’s attention on reducing the extreme danger posed by nuclear weapons and climate change,” The Bulletin of the Atomic Scientists Science and Security Board wrote in a statement. “When we call these dangers existential, that is exactly what we mean: They threaten the very existence of civilization and therefore should be the first order of business for leaders who care about their constituents and their countries.”

The last time the clock remained at 3 minutes to midnight was in 1984, a moment in the Cold War where communications had gone dark between the United States and the Soviet Union. Several years later the clock reached its safest point in history, 17 minutes to midnight, after an agreement between America and the Soviets to reduce their numbers of nuclear weapons. [Source: Time | Daniel White | January 26, 2016 ++]

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Passwords ► Common and Easily Guessable

It should really come as no surprise that using “password” or “123456” for your online password is not a good idea. Unfortunately, many people still do it. But according to password management company SplashData, there’s a whole host of password choices that are nearly as risky to use because they’re so common and easily guessable. Nine newcomers joined veterans “123456” and “password” on SplashData’s annual list of the 25 worst passwords for 2015, including three passwords inspired by a galaxy far, far away — “starwars,” “solo” and “princess.” (Apparently “the force” is not enough to protect your data from hackers). A few longer password combinations also made their debut on SplashData’s latest worst passwords list, including “qwertyuiop” and “1234567890.” “We have seen an effort by many people to be more secure by adding characters to passwords, but if these longer passwords are based on simple patterns they will put you in just as much risk of having your identity stolen by hackers,” SplashData chief executive Morgan Slain said in a statement. Here are SplashData’ biggest losers of 2015:

1. 123456 2. Password 3. 12345678 4. qwerty 5. 12345 6. 123456789 7. Football 8. 1234 9. 1234567 10. Baseball 11. Welcome 12. 1234567890 13. abc123 14. 111111 15. 1qaz2wsx 16. .dragon 17. Master 18. Monkey 19. Letmein 20. Login 21. Princess 22. Qwertyuiop 23. Solo 24. passw0rd 25. starwars

If your password is on this list, do yourself a favor and change it now. SplashData’s worst passwords for last year are based on leaks of more than 2 million passwords in 2015. If you’re driving yourself crazy trying to remember all your online passwords, you may want to use one of these five password managers to help keep your secret passwords organized and always at your fingertips.

1. LastPass https://lastpass.com

 Price: Free for your computer, $12 a year for mobile access  Supported operating systems: Windows, Apple, Linux  Supported browsers: Chrome, Firefox, Opera, Safari, Internet Explorer  Supported mobile devices: Apple, Android, Windows, BlackBerry

2. RoboForm http://www.roboform.com

 Price: Free for up to 10 logins, $29.95 for the desktop version, $39.95 for USB access or a $9.95 yearly subscription for unlimited use across all devices and platforms.  Supported operating systems: Windows, Apple, Linux.  Supported browsers: Chrome, Firefox, Opera, Safari, Internet Explorer.  Supported mobile devices: Apple, Android, Windows

3. Dashlane https://www.dashlane.com

 Price: Free for one device or $39.95 per year to sync across all devices.  Supported operating systems: Windows, Apple.  Supported browsers: Chrome, Firefox, Safari, Internet Explorer.  Supported mobile devices: Apple, Android, Nook

4. Keeper https://keepersecurity.com

 Price: Free for one device, but backup service cost $9.95 per year for a single device or $29.99 per year for unlimited devices.  Supported operating systems: Windows, Apple, Linux, Unix.  Supported browsers: Chrome, Firefox, Safari, Internet Explorer.  Supported mobile devices: Apple, Android, Windows, BlackBerry

5. PasswordBox https://www.passwordbox.com

 Price: Currently offering free premium access to new and existing customers.  Supported operating systems: Windows, Apple.  Supported browsers: Chrome, Firefox, Safari, Internet Explorer and Opera.  Supported mobile devices: Apple, Android, Kindle

Go to http://www.moneytalksnews.com/5-password-managers-keep-all-your-secrets-safe/?all=1 for comparison information on the above . For more ideas, check out http://www.moneytalksnews.com/are- emoji-based-passwords-the-key-hampering-hackers. [Source: MoneyTalksNews | Krystal Steinmetz & Stacy Johnson | January 23, 2016 ++]

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