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Agent Orange Update


Introduce

VETERAN LEGISLATION

 Senate Bills


TRICARE Rx Fee Hike Planned for February and Other Info

TRICARE Rx Fee Hike Planned for February, CRSC 'Glitch,' Enhanced SERB,
 Time-In-Grade Waivers, and Compensation Commission
Tom Philpott December 20, 2012

   House-Senate conferees have agreed to the more modest House-passed plan for raising drug co-payments on military family members and retirees who fill prescriptions at TRICARE retail outlets or through mail order.

  The fee increases are scheduled to take effect Feb. 1, TRICARE officials said as the fiscal 2013 defense authorization bill, with many other provisions impacting the military community next year, moved toward final passage.

  The new pharmacy fee plan includes a requirement that beneficiaries 65 and older have all maintenance drugs for chronic conditions refilled, for at least one year, through TRICARE mail order or at base pharmacies, rather than through retail outlets where the cost to TRICARE is a third higher.
TRICARE likely will need to publish a draft regulation, solicit public comment and launch an education effort for elderly beneficiaries before it begins to enforce home delivery for seniors. That could delay starting that portion of the pharmacy plan until April or later.

   It is a matter "under review and as yet we do not have an implementation time frame established," said Kevin J. Dwyer, deputy chief of benefit information and outreach for the TRICARE Management Activity.

   Conferees were persuaded to embrace the House plan, supported by advocates for military beneficiaries, over more aggressive fee hikes sought by the Obama administration. The Senate version of the defense bill was silent on the issue, which was a nod for the administration to proceed.
But over the past two weeks, a House-Senate conference ironed out differences between separate versions of the defense bill and the House plan prevailed. So after January, at TRICARE retail outlets, the current $12 co-pay for brand name drugs on the military formulary will rise to $17. The $25 co-pay for non-formulary drugs will jump to $44. The co-pay for generic drugs at retail will stay at $5. Drugs will stay free at military pharmacies.r />  
   For mail order, the current $9 co-pay for brand names on formulary will increase to $13. The $25 co-pay for brand names off formulary will jump to $43. Generic drugs will continue to be dispensed by mail at no cost. For fiscal 2014 and beyond, the plan directs that drug fees be raised annually by the same percentage as retiree cost-of-living adjustments. In years when a COLA increase applied to pharmacy fees would total less than a dollar, it will be delayed a year and combined with the next adjustment. So that drug fee increases, when executed, are always a dollar or more. The administration wanted drug fees reset substantially higher in 2013 and to grow by $2-a-year through 2016. It then wanted annual adjustments to match medical inflation, not retiree COLAs. Mail order users of brand name drugs save two-thirds on co-pays automatically because refills are for 90 days versus 30 days at retail. Given those savings and the convenience of home delivery, backers of the House plan expect most elderly beneficiaries, once forced to use mail order, to stay with it, saving TRICARE hundreds of millions of dollars year after year.

  The projected savings allowed the House to roll back the drug fee increases sought by the administration without raising the budget's top line. In fact, so many TRICARE dollars will be saved that conferees used some of that money to fix a "glitch" in Combat-Related Special Compensation (CRSC).

  CRSC 'GLITCH' -- Effective Jan. 1, several thousand retirees forced from service short of 20 years due to combat-related disabilities will see their compensation pop by an average of a few hundred dollars a month. These folks became eligible for CRSC in 2008 when Congress expanded the program to cover these so-called "Chapter 61" retirees. But the formula for calculating payments had a flaw, which some disabled retirees noticed when the VA raised their disability rating but their take home pay didn't change.

  Whether and how individuals are impacted depends on a mix of factors including original service disability rating, length of service, rank and the VA rating for combat-related conditions. ENHANCED SERB -- Other personnel-related provisions in the defense bill (HR 4310) will give the services new authority to hold Enhanced Selective Early Retirement Boards for paring ranks of retirement-eligible officers during the force drawdown.

  The enhanced SERB allows the services to be more selective in retiring senior officers. It was used effectively after the Vietnam War. Current SERB authority is more limited. For example, an officer now can be screened for early retirement only every five years. It also is difficult to target specific year groups or job specialties when services need to pare a sizable number of officers in grades O-5 and O-6.
  TIME-IN-GRADE WAIVERS - The defense bill also will double the number of time-in-grade waivers the services can use to reduce excess senior officers. These waivers lower from three years to two the time O-5s and above must serve in current grade to retire at that rank. It's another force shaping tool sought by the services as force strength falls.

  COMPENSATION COMMISSION - The bill establishes a special nine-member commission to review military pay and retirement changes that will preserve "viability of the all-volunteer force," starting with a package of reforms being drafted by the Department of Defense. The commission is to deliver a report to Congress within 15 months, recommending any changes to the DoD or "president's" plan that at least five commissioners support. The commission, by law, will not propose changes to retirement for the current force. But it can propose enticements to current serving members to switch retirement plans voluntarily. Presumably the offer would include some lower-value package with earlier vested and portable benefits, which also would deliver long-term retirement savings to the government. Conferees rejected the president's request that recommendations from the pay commission have the sanctity of recommendation from base closing commissions, which Congress could accept or reject but not modify them.

 

Legislative Update 29 Oct 2010

VA Disability Evaluation System:

The Department of Veterans Affairs' Advisory Committee on Disability Compensation met this week in Washington and heard from the VA's Executive Director of the VA-DoD Collaboration Service, Mr. John Medve, who announced that the Disability Evaluation System (DES) pilot program will be expanded worldwide to replace the existing DoD legacy program over the next twelve months. The pilot program came about as a result of the Walter Reed scandal in 2007 that uncovered wounded and disabled service members were receiving "low-balled" ratings as a result of the DES process. Several commissions that investigated Walter Reed and the DES process recommended eliminating dual VA and DoD disability evaluations, but using one medical exam and having DoD use the VA disability ratings in evaluations by the Services' Physical Evaluation Boards. The pilot, which has proven to improve the speed, effectiveness, and transparency of the DES review process, will expand from the current 27 sites to an additional 28 sites during this year's first phase. The system will be expanded to cover all remaining sites in additional three phases, with a target completion of October 2011.

LTG James Terry Scott (USA-Ret.), Chairman of the VA Advisory Committee, also announced that the committee plans to delve deeper into VA philosophy in assessing individual unemployability and the methodology behind presumptions. Scott made the announcement at the two-day meeting where the committee received progress reports on the VA Schedule of Rating Disability re-write project and VA's roll-out of on-line Disability Benefits Questionnaires. The DoD efforts are being led by Deputy Under Secretary of Defense for Personnel and Readiness John R. Campbell, a Vietnam-era veteran and Purple Heart recipient recently appointed to this position after leading organizational change at several fortune 500 companies. [Source: MOAA Legislative Update 29 Oct 2010 ++]

NPRC Military Records Update 03:

The National Archives and Records Administration's National Personnel Records Center (NPRC) will relocate more than 100 million records to a new $112 million modernized facility. Crews broke ground on the 474,000 square-foot facility on 16 NOV 09. According to the St. Louis County Economic Council, the project is expected to pump $435 million into the local economy and involve more than 300 construction jobs. NARA will lease the facility for twenty years from The Molasky Group of Companies through the General Services Administration (GSA). Located in North St. Louis County, the facility will open its doors in MAY 2011, which is also when the workforce of 800 will start moving in. The entire move of personnel and records will take about seventeen months. The new location will store approximately 2.3 million cubic feet of records currently housed at three different St. Louis area facilities. The building will be certified under the Leadership in Energy and Environment Design (LEED) program and will also be compliant with the stringent Federal standards for archival and non-archival records. Records will be housed in climate-controlled stack areas designed for long-term preservation. As well, archival storage bays will have particulate and ultraviolet filtration. Paint, sealants, caulking and the powder-coated finishes for the shelving will be certified for minimal off-gassing of volatile organic compounds. The facility will also offer new research rooms, meeting rooms equipped with the latest video-conferencing technology and tenant office space for other area Federal agencies.

Several move teams are working to ensure that each and every record is accounted for when moved and that NPRC's important services to veterans continue with little delay. Many of the records are currently stored on 10-high shelving units in an old 1950s facility at 9700 Page Avenue in Overland, Missouri. This location was ravaged by a 1973 fire that was one of the worst in U.S. history. The fire destroyed the building's sixth floor and an estimated 16 - 18 million individual military personnel records. The records lost include those of Army personnel discharged between November 1, 1912 and December 31, 1959, and Air Force personnel discharged between September 25, 1947 and December 31, 1963 with names alphabetically following Hubbard, James. Some records were salvaged from the disaster; these fire-damaged records have been stored in a climate-controlled area where specially trained preservation technicians treat the records for mold and delicately piece together whatever they can save. Despite the very fragile state of the burned records, preservationists have been able to retrieve valuable information in an effort to reconstruct portions of a service member's personnel file. At the current Page facility the Preservation Branch also treats several thousand records that have been exposed to the harmful rays of the sun and to other contaminants that shorten a record's life span. In the new building, all of the records will be housed in climate-controlled record storage bays.

NPRC is comprised of three organizational divisions:

Civilian Records, Military Records and Archival Programs. Visiting researchers are encouraged to schedule an appointment prior to making a research visit. With headquarters in Washington, DC, the National Archives at St. Louis' NPRC is one of 44 NARA facilities located throughout the United States. Unlike other collections, however, the records held in St. Louis impact nearly every family in the United States. These holdings represent a priceless piece of history and are a critical source of information for genealogists, family members, scholars, veterans and researchers in many fields of knowledge. [Source: St. Louis Economic Council News Release 26 Oct 2010 ++]

Patriot Guard Riders:

As the U.S. Supreme Court contemplates whether protestors at military funerals are protected under First Amendment free-speech rights, a motorcycle group that travels the country attending those funerals as a show of support and respect rides on, undeterred by the political fray. About 200,000 members of the Patriot Guard Riders attend military funerals to honor those who died for or served their country and to support their grieving families. They also escort the bodies of fallen servicemembers as they arrive from Dover Air Force Base, Del., for burial in their hometowns across America. The riders take part in these events only at the family's request and regardless of whether protestors are expected says Bill Richart, national president of the group's board of11directors. "What we do is never about the protestors," he said. "We are not a counterprotest group. We don't go anywhere because of them, and we don't not go anywhere because they are not there. ... It's about being there for the families, recognizing their loss and ensuring they know that people care."

Richart emphasized that the riders have no political agenda and take no official position on the pending Supreme Court decision. In that case, Albert Snyder, father of Marine Corps Lance Cpl. Matthew Snyder, who was killed in Iraq in 2006, sued the Westboro Baptist Church of Topeka, Kan., for emotional distress after church members demonstrated and carried offensive signs at his son's funeral in Westminster, Md. A lower court ruled in Snyder's favor. However, the church appealed the decision, arguing to the Supreme Court earlier this month that the protests are protected speech under the First Amendment. As the issue plays out in the courts, the Patriot Guard Riders continue their missions around the country. Richart, an Air Force veteran who deployed to Dharan, Saudi Arabia, during Operation Desert Storm, said he and his fellow riders feel a special connection to the grieving families they support. "If you go out there and you give a couple hours of your time and show families that people care and share their loss, it's very touching to them and to us," he said. For additional information on this organization refer to http://www.patriotguard.org. [Source: AFPS Donna Miles article 28 Oct 2010 ++]

VA Claims Backlog Update 45:

The Department of Veterans Affairs (VA) has released three new disability benefits questionnaires for physicians of Veterans applying for VA disability compensation benefits. This initiative marks the beginning of a major reform of the physicians' guides and automated routines that will streamline the claims process for injured or ill Veterans. "This is a major step in the transformation of VA's business processes that is yielding improvements for Veterans as we move to eliminate the disability claims backlog by 2015," said Secretary of Veterans Affairs Eric K. Shinseki. These new questionnaires are the first of 79 disability benefits questionnaires that will guide Veterans' personal physicians, as well as VA physicians, in the evaluation of the most frequent medical conditions affecting Veterans. Accurate and timely medical evaluations are a critical element of VA's continued commitment to high-quality and prompt decisions about the nature and degree of conditions afflicting Veterans. Streamlining this process by directly involving Veterans' treating physicians in providing specific information needed to evaluate their claims will lead to completeness in the examination and faster compensation decisions.

VA's goal is to process all claims in fewer than 125 days with a decision quality rate no lower than 98%, a mark Secretary Shinseki has mandated by 2015. The physician questionnaire project is one of more than three dozen initiatives actively underway at VA, including a major technology modernization that will lead to paperless claims processing. The disability benefits questionnaires are part of VA's automated health records system which prompts VA physicians conducting disability examinations to include precise information in a standardized way to assist claims adjudicators in ensuring Veterans receive the benefits they deserve as quickly as possible. These VA examination results are electronically available to claims adjudicators in VA regional offices. For Veterans who receive their care from private physicians, VA has placed the disability benefits questionnaires on its Internet site at www.vba.va.gov/disabilityexams with instructions for physicians to submit examination results on Veterans' behalf.

The first three questionnaires cover B-cell leukemia (such as hairy-cell leukemia), Parkinson's disease and ischemic heart disease. VA recently published a final regulation to be implemented 30 OCT that will establish the presumption of eligibility to VA disability compensation benefits for Veterans with one of these three conditions who were exposed to Agent Orange, a herbicide agent used extensively in Vietnam. In practical terms, Veterans who served in Vietnam during the war who have a "presumed" illness do not have to prove an association between their illnesses and their military service. This "presumption" establishes eligibility to VA compensation if their condition is disabling to a compensable level. For additional information on the VA disability compensation program or additional presumptive disabilities for Veterans exposed to herbicide agents, contact VA at 800-827-1000 or visit www.vba.va.gov/bln/21/AO/claimherbicide.htm. [Source: VA News Release 26 Oct 2010 ++]

VA Post-Surgical Mortality:

Studies have shown that nearly one-third of patients develop psychiatric problems after having a major surgery. But what about patients who have poor mental health before they go under the knife? Does it affect their chances for a full recovery? According to a study published in the October issue of Archives of Surgery, surgical patients with a preexisting psychiatric comorbidity (presence of one or more disorder) have a greater 30-day post-surgical mortality risk.. Thad E. Abrams, M.D., of the University of Iowa Carver College of Medicine in Iowa City, and colleagues conducted a retrospective cohort study of 35,539 surgical patients admitted to Veterans Health Administration hospital intensive care units. The purpose of the study was to assess the effect of five psychiatric comorbidities on post-surgical mortality. A preexisting psychiatric diagnosis of depression, anxiety, posttraumatic stress disorder, bipolar disease, or schizophrenia was identified in 25.1% of admitted surgical patients. The patients – 97% of them men – had an average age of 65, though the patients with a psychiatric problem were four years younger, on average. The researchers found the adjusted 30-day post-surgical mortality to be 21% higher in the psychiatric comorbidity group than in the group of surgical patients without preexisting comorbidity. Individually, patients with anxiety and depression, but not the other comorbidities, had significantly greater odds of 30-day mortality. The researchers offered several theories on why depression and anxiety make a patient more vulnerable?

Among them:

  • Depressed patients don’t take as good a care of themselves, so when they go in for surgery, they may have underlying conditions that complicate their recovery.
  • Patients with mental health problems may settle for lower-quality hospitals and surgeons.
  • Patients with depression or anxiety may put off going to the doctor, so by the time they have their surgery, their physical condition is worse. [Source: Los Angeles Times Karen Kaplan article 21 Oct 2010 ++]



22 JUL 2010

Vet Jobs Update 21:

On 22 JUL leaders from the NAUS, Disabled Veterans of America, the American Legion, VFW, Purple Heart and Blinded Veterans met with Department of Homeland Security Secretary Janet Napolitano to discuss advancement in the hiring of veterans and other matters. All were pleased to hear the Secretary say that nearly 25% of the department's employees are veterans—47,000 out of 230,000. The Secretary asked the associations to help her develop a stronger hiring process, called Direct Authority, for blanket authority t increase veterans employment in the multi-mission department from the current mark to the goal of 50,000.
[Source: NAUS Weekly update 23 Jul 2010 ++]


Sept 09

VA DISABILITY COMPENSATION Update 05:

Approximately 3 million veterans—about 2 million of whom are under age 65—receive compensation from the Department of Veterans Affairs (VA) for their serviceconnected disabilities. The amount is based on a rating of an impairment’s effect on a veteran’s earnings capacity, on average; disability ratings range from zero to 100%. Additional allowances are paid to veterans whose disabilities are rated 30% or higher and who have dependent spouses, children, or parents. Veterans with disabilities may also qualify for cash payments from other sources, including workers’ compensation; private disability insurance; means-tested program benefits, such as Supplemental Security Income; and, for veterans under 65, the Social Security Disability Insurance (DI) program. About 146,000 veterans who receive disability compensation from VA also receive DI payments. When Social Security beneficiaries are eligible for disability benefits from more than one source, ceilings usually limit combined disability benefits from public sources to 80% of a recipient’s average pre-disability earnings. Those DI payments—after any reduction—are adjusted periodically to reflect changes in the cost of living and in national average wages. Veterans’ compensation payments for disabilities are not considered for that purpose, however, and thus do not apply toward limits. That same exclusion applies to means-tested benefits and to some benefits that are based on public employment.

The Congressional Budget Office (CBO) has provided to Congress an option to reduce government spending that would limit disability compensation for veterans who receive VA disability benefits and DI payments. The option would reduce VA’s disability compensation by the amount of the DI benefit. Applying that change to current and future recipients of veterans’ compensation would affect an estimated 153,000 recipients in 2010, saving almost $1.8 billion that year and approximately $9.6 billion between 2010 and 2014. Applying the change only to veterans who are newly awarded compensation payments or DI payments would affect an estimated 3,000 recipients in 2010, saving about $40 million in outlays that year and about $1.1 billion through 2014. A rationale in favor of this option is that it would eliminate duplicate public compensation for a single disability. An argument against it is that the change would subject veterans’ disability benefits to a form of means-testing (VA benefits are considered entitlements). Moreover, to the extent that this option applied to current DI recipients, some disabled veterans would have their income reduced. [Source: CBO Budget Options Vol 2 Aug 09 ++]

KENTUCKY VET CEMETERY Update 01

Secretary of Veterans Affairs Eric K. Shinseki has announced Veterans living in northeastern Kentucky will soon have a final resting place that honors their service to the nation. The Department of Veterans Affairs (VA) has awarded a $6,187,799 grant to establish the Kentucky Veterans Cemetery Northeast in Greenup. The grant covers 100% of the costs associated with building the cemetery. The grant will fund construction of a committal shelter, pre-placed crypts, standard burial areas, a columbarium for cremation remains, in-ground cremation burial areas, a main entrance, roads, a maintenance facility, an assembly area and supporting infrastructure. Interment areas will include approximately 3,000 standard burial sites, 1,200 pre-placed crypts, 882 in-ground cremation burial sites and 713 columbarium niches. The cemetery will serve nearly 77,000 Kentucky Veterans and their families. The nearest national cemetery is VA’s Camp Nelson National Cemetery in Nicholasville, approximately 160 miles away. The nearest state cemetery is Kentucky Veterans Cemetery North in Williamstown, 159 miles away.

The 75-acre site is in the northeastern part of the state. The first phase of the project will develop approximately 18 acres. VA's State Cemetery Grants Program is designed to complement VA’s 130 national cemeteries across the country. These state cemeteries provided nearly 25,000 burials in 2008. Kentucky residents who are Veterans with a discharge issued under conditions other than dishonorable, their spouses and eligible dependent children can be buried in the Kentucky Veterans Cemetery Northeast. For more information about Kentucky state Veterans cemeteries, contact the state Department of Veterans Affairs by phone at (800) 572-6245 or visit its Web site at http://veterans.ky.gov/cemeteries/. Information on VA burial benefits can be obtained from national cemetery offices, from VA’s Web site on the Internet at http://www.cem.va.gov or by calling VA regional offices toll-free at 800-827-1000. Since 1980, the program has awarded grants totaling more than $368 million to establish, expand or improve 74 Veterans cemeteries in 38 states and territories. [Source: VA News Release 4 Sep 09 ++]

If you are enrolled in Tricare Prime at an MTF and live at least 30 minute drive from the MTF you should have received, or will be receiving soon, a letter from the MTF command concerning a travel waiver. If you want to remain enrolled in the MTF you will need to send back a form saying you wish to waive the Tricare Prime distance requirement that all enrollees live within a 30 minute drive of the Primary Care Provider (PCP). If you don’t get a waiver you will need either to be assigned a PCP in the civilian network (if possible), move into the allowed Tricare Prime distance requirement, or disenroll from Prime and start using Tricare Standard/TFL. Only approximately 30% of enrollees who have been sent the waiver letter have replied. If you have received a letter you need to answer it (whatever the answer is). If you have not received one and live at least 30 minutes driving time from your PCP make sure to call your MTF and ask them for one. [Source: TREA Washington Update 4 Sep 09 ++]

STROKE Update 04

If you have symptoms of a stroke, seek emergency medical care.  Time is of the essence and it is imperative that medical assistance is provided immediately.   Do not ignore the warning signs of a stroke and remember not all of them occur with every stroke.  When you arrive at the hospital make sure you let them know you think you are having a stroke.  If possible, pay attention to the time the symptoms started and let them know that as well.  There is a drug that can save critical brain tissue after a stroke, but it only works well if patients get to the emergency room within a certain period of time. General symptoms of a stroke include:

  • Sudden numbness, paralysis, or weakness in your face, arm, or leg, especially on only one side of your body.             
  • New problems with walking or balance.
  • Sudden vision changes.
  • New problems speaking or understanding simple statements, or feeling confused.
  • A sudden, severe headache that is different from past headaches.

Symptoms vary depending on whether the stroke is caused by a clot or bleeding. The location of the blood clot or bleeding and the extent of brain damage can also affect symptoms.

Symptoms of an ischemic stroke (caused by a clot blocking a blood vessel) usually occur in the side of the body opposite from the side of the brain where the clot occurred. For example, 9a stroke in the right side of the brain affects the left side of the body. Symptoms occur suddenly, within seconds.

Symptoms of a hemorrhagic stroke (caused by bleeding in the brain) can be similar to those of an ischemic stroke but may be distinguished by symptoms relating to higher pressure in the brain, including severe headache, nausea and vomiting, neck stiffness, dizziness, seizures, irritability, confusion, and possibly unconsciousness. Symptoms of a stroke may progress over minutes, hours, or days, often in a stepwise fashion. For example, mild weakness may progress to an inability to move the arm and leg on one side of the body.

When an artery that is narrowed by atherosclerosis becomes blocked, stroke symptoms usually develop gradually over minutes to hours, or (in rare cases) days. If several smaller strokes occur over time, the person may have a more gradual change in walking, balance, thinking, or behavior (multi-infarct dementia). It is not always easy for people to recognize symptoms of a small stroke. They may mistakenly think the symptoms can be attributed to aging, or the symptoms may be confused with those of other conditions that cause similar symptoms.[Source: Yahoo Health Monica Rhodes article 1 JAN 09 ++

STROKE Update 05:


Prompt treatment of stroke and medical problems related to stroke, such as high blood sugar and pressure on the brain, may minimize brain damage and improve the chances of survival. Starting a rehabilitation program as soon as possible after a stroke increases your chances of recovering some of the abilities you lost.

Initial treatment for a stroke varies depending on whether it's caused by a blood clot (ischemic) or by bleeding in the brain (hemorrhagic). Before starting treatment, your doctor will use a computed tomography (CT) scan of your head and possibly magnetic resonance imaging (MRI) to diagnose the type of stroke you've had. Further tests may be done to find the location of the clot or bleeding and to assess the amount of brain damage. While treatment options are being determined, your blood pressure and breathing ability will be closely monitored, and you may receive oxygen. Initial treatment focuses on restoring blood flow for an ischemic stroke or controlling bleeding for a hemorrhagic stroke. As with a heart attack, permanent damage from a stroke often occurs within the first few hours. The quicker you receive treatment, the less damage will occur.

Emergency treatment for an ischemic stroke depends on the location and cause of the clot. Measures will be taken to stabilize your vital signs, including giving you medicines. If your stroke is diagnosed within 3 hours of the start of symptoms, you may be given a clot-dissolving medicine called tissue plasminogen activator (t-PA), which can increase your chances of survival and recovery. But t-PA is not safe for everyone. If you have had a hemorrhagic stroke, use of t-PA would be life-threatening. Your eligibility for t-PA will be quickly assessed in the emergency room. You may also receive aspirin or aspirin combined with another antiplatelet medicine. But aspirin is not recommended within 24 hours of treatment with t-PA. Other medicines may be given to control blood sugar levels, fever, and seizures. In general, high blood pressure won't be treated immediately unless systolic pressure is over 220 millimeters of mercury (mm Hg) and diastolic is more than 120 mm Hg (220/120, which is also called 220

Initial treatment for hemorrhagic stroke is difficult. Efforts are made to control bleeding, reduce pressure in the brain, and stabilize vital signs, especially blood pressure. There are few medicines available to treat hemorrhagic stroke. In some cases, medicines may be given to control blood pressure, brain swelling, blood sugar levels, fever, and seizures. You will be closely monitored for signs of increased pressure on the brain, such as restlessness, confusion, difficulty following commands, and headache. Other measures will be taken to keep you from straining from excessive coughing, vomiting, or lifting, or straining to pass stool or change position. Surgery generally is not used to control mild to moderate bleeding resulting from a hemorrhagic stroke. But if a large amount of bleeding has occurred and the person is rapidly getting worse, surgery may be needed to remove the blood that has built up inside the brain and to lower pressure inside the head. If the bleeding is due to a ruptured brain aneurysm, surgery to repair the aneurysm may be done. Repair may include using a metal clip to clamp off the aneurysm to prevent renewed bleeding. Another procedure (Endovascular coil embolization) involves inserting a small coil into the aneurysm to block it off. Whether these surgeries can be done depends on the location of the aneurysm and your condition following the stroke.

After emergency treatment for stroke, and when your condition has stabilized, treatment focuses on rehabilitation and preventing another stroke. It will be important to control your risk factors for stroke, such as high blood pressure, atrial fibrillation, high cholesterol, or diabetes. Your doctor will probably want you to take aspirin or other antiplatelet medicines. If you had an ischemic stroke you may need to take anticoagulants to prevent another stroke. You may also need to take medicines, such as statins, to lower high cholesterol or medicines to control your blood pressure. Medicines to lower high blood pressure include Angiotensin-converting enzyme (ACE) inhibitors, Angiotensin II receptor blockers (ARBs), Beta-blockers, Diuretics, and/or Calcium channel blockers. Your doctor may also recommend carotid endarterectomy surgery to remove plaque buildup in the carotid arteries. This procedure is much like coronary angioplasty, which is commonly used to open blocked arteries in the heart. During this procedure, a doctor inserts a metal tube called a stent inside your carotid artery to increase blood flow in areas blocked by plaque. The doctor may use a stent that is coated with medicine to help prevent future blockage.

Early aggressive rehabilitation may allow you to regain some normal functioning. Your rehabilitation will be based on the physical abilities that were lost, your general health before the stroke, and your ability to participate. Rehabilitation begins with helping you resume activities of daily living, such as eating, bathing, and dressing. If you get worse, it may be necessary to move you to a care facility that can meet your needs, especially if your caregiver has his or her own health problems that make it difficult to properly care for you. It is common for caregivers to neglect their own health when they are caring for a loved one who has had a stroke. If your caregiver's health declines, the risk of injury to you and your caregiver may increase. [Source: Yahoo Health Monica Rhodes article 1 JAN 09 ++]

Camp Jejeune Toxic Exposure Update 07:

North Carolina's senior U.S. senator introduced a bill 28 JUL calling for the Department of Veterans Affairs to provide health care to veterans and their relatives who were exposed to contaminated water at Camp Jejeune. Sen. Richard Burr's bill, "Caring for Camp Jejeune Veterans Act of 2009 (S.1518)," would grant care at a VA facility to any veteran or family member who was based at Camp Jejune and suffers from adverse health effects. Burr's office did not specify what kind of health problems, only that they are connected to exposure to contaminated water. A Marine Corps spokesman, 1st Lt. Brian Block, said the service would study the bill before making a statement. "As far as pending legislation, it is something we'd be very interested in seeing because anything that impacts our former residents and Marines is very important to us," he said. "Our first concern is taking care of our Marines and their family members." Department of Veterans Affairs spokeswoman Katie Roberts said the VA can't comment on pending legislation. Water was contaminated by dry cleaning solvents and other sources at the base's major family housing areas: Tarawa Terrace and Had not Point. It is impossible to know how many people would qualify, Burr's office said. Health officials believe as many as 1 million people may have been exposed to the toxins trichloroethylene (TCE) or perchloroethylene (PCE) before the wells were closed 22 years ago.

Camp Jejune veterans and their families deserve closure on this tragic situation," Burr said in a statement. He is a member of the Senate Armed Services Committee and is the ranking member of the Veterans Affairs Committee. Jerry Ensminger, a retired Marine master sergeant who lived at the base, applauded the bill. He said veterans from the base are being diagnosed with cancer and the VA is turning down their claim because it is not service connected. "At least this is a start. We haven't had that up to this point," said Ensminger, whose daughter was conceived at Camp Lejeune and died of childhood leukemia in 1985 at age 9. "This legislation is great for providing help to those who need it but it does not by any means exonerate the Department of the Navy and Marine Corps of their culpability on this issue." He would still like to see a hearing on the issue in front of the full Senate Armed Services Committee. It was not immediately clear how the care offered in Burr's bill would be funded. Burr's office said the bill will offer veterans and their families some relief while the problem is studied. "This is kind of a first step in providing the care these folks need," said David Ward, a Burr spokesman.

People who lived at the base have claimed everything from child leukemia to skin lesions and rashes. A report released earlier this month by the National Academy of Sciences said there are severe challenges in trying to connect the contaminants to any birth defects, cancer and many other ailments suffered by people who lived and worked on base. The 341-page report reviewed past studies of the base's water and called into question the value of further studies. Burr's office stressed that the National Research Council report is not the final word on the issue, and he looks forward to seeing the results of the ongoing study of water by the Agency for Toxic Substances and Disease Registry. Burr and Sen. Kay Hagan (D-NC) have also asked the Navy for details about gaps in information. Hagan plans to meet with Navy Secretary Ray Mabus in September, according to her office. Veterans who have not already done so should register on the official Camp Lejeune Historic Drinking Water Registry at https://clnr.hqi.usmc.mil/clwater if they believe there is a possibility they or their family were exposed to the toxins.

Source: AP article 28 Jul 09

On 16 JUL the Veteran Affairs Disability Assistance and Memorial Affairs approved several veterans’ bills. All the bills will now go to the full Veteran Affairs Committee for their consideration. The bills were:


*H.R.2379 to provide certain veterans an opportunity to increase the amount of Veterans' Group Life Insurance.

*H.R.2774 to make permanent the extension of the duration of Service members' Group Life Insurance coverage for totally disabled veterans.

* H.R.2968 to eliminate the required reduction in the amount of the accelerated death benefit payable to certain terminally-ill persons insured under Service members' Group Life Insurance or Veterans' Group Life Insurance.


Source:TREA
WashingtonWeekly17Jul09

Burn Pit Toxic Emissions Update 10: When epidemiologist Shira Kramer first saw data about some 400 service members who say they were sickened by open-air burn pits in Afghanistan and Iraq, she said she was shocked to see how well their symptoms matched up with symptoms associated with toxic exposure. "I was appalled but not surprised to learn that there were so many serious adverse health effects," she said. "We know open pit burning is very dangerous." Kramer, who has a doctorate in epidemiology and co-authored a textbook about it, was invited by lawyer Elizabeth Burke to research the burn pits to compile evidence for several class-action lawsuits against military contractor KBR. The military typically disposes of waste in burn pits during contingency operations, but KBR took over burn-pit operations for the largest of the pits at Joint Base Balad, Iraq. In a memo dated 20 DEC 06, Air Force Lt. Col. Darrin Curtis, former bioenvironmental flight commander at Balad, said the chemicals to which troops there may have been exposed include: dioxin, the same chemical that made Agent Orange so toxic; benzene, an aircraft fuel known to cause leukemia; arsenic; dichlorofluoromethane, or Freon; carbon monoxide; ethyl benzene; formaldehyde; hydrogen cyanide; nitrogen dioxide; sulfuric acid; and xylene.

     Kramer said the mix of chemicals, and their combination with particulates such as ash and sand, may have made the problem worse. "You have a toxic brew that is...much more dangerous than individual chemicals alone," she said. "The absorption onto particulate matter then allows these chemicals not only to deeply penetrate into the lungs, but also to have a dwell time in the lungs." Air Force officials say the burn pit at Balad has been cleaned up the 90,000 water bottles a day that were being burned are now recycled, and hazardous materials are no longer making their way to the pit. But even if the pit burned only wood and paper, the troops would still be at risk, Kramer said, noting that burning wood produces dioxin. "Uncontrolled, open burning of any of these materials represents a hazard. The symptoms can be signs of acute respiratory problems and blood cancers… Troops stationed near burn pits who began coughing and spitting up black stuff..."plume crud," they call it...should have served as a warning to military officials. The acute effects are a tip-off that something quite troubling is going on. Military data showing that chronic obstructive pulmonary disease cases have risen by 12,000 a year since the wars in Iraq and Afghanistan began are especially troubling. You would not expect to see COPD in a young, healthy population…in this age range," she said. "It's extremely unusual and unexpected."

Source: NavyTimes Kelly Kennedy article 13 Jul 09

VA Foreclosed Homes:

The Department of Veterans Affairs (VA) acquires properties as a result of foreclosures on VA-guaranteed and VA-financed loans. These acquired properties are marketed for sale through a property management services contract that was awarded to BAC Home Loan Servicing, LP. Properties are listed for sale at

https://va.reotrans.com/index.cfm?

and through local Multi Listing Systems (MLS) by local listing agents. By clicking a state on the site's map the search will return every property in that state. When you have your list, select view to see price and details of the properties selected. You may then email questions directly to the listing agent that is managing the property. You may also contact the real estate broker of your choice to see the property.

     The VA has re-opened Vendee Financing to purchasers of Vendee eligible VA REO Properties. Vendee financing offers very reasonable down payment requirements, with an interest rate established by the VA based on market conditions. Any prospective purchaser who requests VA financing to purchase a VA-owned property must have sufficient income to meet the loan payments, maintain the property and pay all taxes, insurance, utilities and other obligations, as well as be an acceptable credit risk. The purchaser must also have enough funds remaining for family support. Any purchaser can apply for Vendee Financing. You do not have to be a Veteran. Vendee financing is a loan product offered to help finance the purchase of VA REO Properties for either owner or non-owner occupied properties. It offers low interest rates, 2.25% VA funding fee, no pre-payment penalties, and no appraisal requirement for underwriting. Some of the guidelines for VA Vendee Financing are:

* Seller may contribute up to 6% of the contract sales price to pay for funding fee, closing costs, prepaid and other expenses.

*   Vendee mortgages are assumable by qualification.

* Vendee Financing is not a credit score driven product.

* There are two available terms, a 15 and 30 year fixed rate.

* Owner Occupied Purchase can be financed with as little as 0% down. The loan amount may be increased up to 2% to finance closing costs, prepaids or other expenses. Funding fee may not be financed.

* Non-Owner Occupied Purchase can be financed with as little as 5% down. Investors may use 75% of anticipated rent based on appraiser's estimate to offset against the subject property monthly payment. Investors must have experience managing rental properties to include anticipated rent on subject property in underwriting. There is no maximum number of investment properties one can acquire.   

     For additional info or for a no cost pre-qualification call (800) 816-4346 to speak with a qualified Vendee Representative.

[Source:
http://www.homeloans.va.gov Jul 09 ++]

VA Women Vet Programs Update 06:

Citing problems large and small, female veterans say they often feel that the Veterans Affairs Department is not for them. Two days of hearings before the Senate and House Veterans’ Affairs committees revealed a host of hurdles for women seeking benefits and health care from VA. The testimony could be a sign that VA isn’t ready for the flood of women seeking help...and that women aren’t ready to trust VA. A report by the Government Accountability Office, the investigative arm of Congress, says that women often find that not all services are available at all sites, scarce child care makes it hard to keep appointments and privacy isn’t always a priority. And out of 19 VA hospitals and outpatient clinics surveyed in the report, 17 had no sanitary napkins or tampons in their restrooms. Retired Army Capt. Dawn Hal­faker of the Wounded Warrior Pro­ject, wounded in Iraq in 2004, said many female veterans are unaware VA has a women’s health plan or that they are eligible for benefits. Some view VA as being for older veterans...the average male veteran is 61, while the average female vet is 48, and of the 102,000 women who served in Iraq and Afghanistan, almost all are younger than 40.

Former Marine Capt. Anuradha Bhagwati, executive director of the Service Women’s Action Net­work, called VA treatment for women who have suffered sexual trauma “inconsistent at best.” She said there is a shortage of female doctors and counselors, high turnover of residents and often a “poorly trained, apathetic and unprofessional medical staff.” Getting disability compensation for sexual trauma also can be difficult because there are rarely official records to back up such claims, she said. VA health and benefits officials said they expect a 30% increase in the next five years in women seeking VA services. “We recognize more needs to be accomplished,” said Dr. Lawrence Deyton, the VA’s chief public health officer. Some of the problems faced by women in the VA health care system that were cited at the 16 JUL hearing were:



* Some gynecological exam tables in rooms with no privacy curtains face doors that open to waiting rooms or busy hallways.

* A female Iraq veteran in an inpatient psychiatric ward was forced to share a bathroom with male veterans, including one who was a Peeping Tom.

* A female veteran receiving an annual pap smear from a male gynecologist says she asked to have a female staff member present, at which point the doctor left the room and yelled down the hall, “We’ve got another one!”

* Clinic hours for women are often less than for men, with no evening or weekend hours convenient for those who work.

* On-site child care is rarely available, and some clinics refuse to treat women who bring children with them.

[Source: NavyTimes Rick Maze article 27Jul09++]   

Chapter 61 Disability Pay Update 05: This information is based on the H.R.2990 proposed legislation at this point. Everything is subject to change until the draft is signed into law. Based on conversations with potentially affected military members, it helps to start with a few ground rules to make this program easier to understand:

     First, forget all you know about your Service pay and concurrent receipt AKA Concurrent Retirement and Disability Pay (CRDP). If you start with a clean slate it’s easier to comprehend. The barracks lawyers are putting out misinformation.


Next, you have to understand the definition of CRDP. This is critical. CRDP only restores Service pay based on your service time. That’s all it has ever restored. It does not restore Service disability pay. The law prohibiting two disability checks is still in force.


Third. Your Chapter 61 Service pay, for CRDP purposes, has two components. Part disability pay and part Service longevity pay; the part based on your years of service. The part based on your service time is figured like any retiree’s retired pay; 2.5% times years of service.


Fourth. Depending on your personal situation under this proposal you may already be getting what CRDP would provide you (in other words, you get nothing extra, no CRDP) or you may get something extra.

Based on the above and the proposed bill here are some examples of how it would impact vets:

*

Example 1
Member with 3 years of service, Service disability rating of 60%, and VA rating of 80%.
Service pay based on $1800 base pay per month at retirement.
60% Service rating provides disability retirement of $1080 ($1800 x 60%).
80% VA rating pays $1400 a month.
Currently, member’s entire Service pay docked due to VA comp at a greater amount.
Under CRDP the member will receive retired pay for years served.
3 years multiplied by a 2.5 percent is 7.5%.
7.5% times the $1800 base pay is $135 a month in retired pay for years served.
Member will get VA comp of $1400 plus $135 Service pay (CRDP).

*

Example 2
Member with 10 years of service, 90% Service rating, and 90% VA rating.
Base pay of $6500.
$6500 base pay at 90% Service rating equals $5850.
VA comp at 90% $1600.
Member is receiving $1600 from VA and $4250 from Service ($5850 – $1600).
Under CRDP there is no change—no CRDP payment since you already receive all of your Service longevity retired pay.
10 years of service times 2.5% equals 25% of base pay or $1625; this is the only amount CRDP restores.
You’re receiving Service pay of $4250 so the VA comp is only docking your Service disability pay and by law the CRDP proposal doesn’t change that.

*

Example 3
Member with 18 years’ service, Service rating 50%, and VA rating 90%.
Base pay $4500 a month.
50% Service rating times base pay equals $2250.
VA comp at 90% is $1600.
Member receiving $650 from Service (2250 – 1600) and $1600 from VA.
Under CRDP you have to calculate Service longevity retired pay of 18 years times 2.5% for 45% times $4500 equals $2025. CRDP ensures the member receives this amount due to his vested service time.
Member is owed $2025 from the Service (CRDP) AND $1600 from the VA.
Finally, please keep in mind, everyone with less than 90% VA rating will be phased in over time. You will see your CRDP later. See our MOAA Legislative Update for the proposed phase in schedule.[Source: MOAA News Exchange 15 Jul 09 ++]

GI Bill Update 52:

On 6 JUL VA under Secretary for Benefits Patrick Dunne and Education Service Director Keith Wilson outlined their ongoing efforts to ensure a successful rollout of the Post-9/11 GI Bill on August. They said the VA is on track to issue the first checks for student-veterans and active duty participants on 3 AUG. Demand for VA "certificates of eligibility" has been heavy. As of early July, 98,000 applicants had submitted on-line applications. VA has issued 65,000 certificates and reports no problems resolving any application discrepancies. Also beginning this week, colleges and universities have been asked to submit student enrollment certifications to assure the VA that veterans had been approved to take college coursework this coming semester on their campuses. Under the Post-9/11 GI Bill, the VA reimburses colleges directly for tuition and fees for a full semester's coursework based on the highest in-state public college or university costs. The VA pays student-veterans a monthly housing stipend set at the DoD housing rate for an E-5 with dependents at the school's zip code, plus an annual book stipend of $1,000 for full-time study. Full-time distance (on-line) students are ineligible for the housing stipend.

The VA has accepted over 3,400 agreements from private colleges and universities and some public colleges under the Yellow Ribbon program. Yellow Ribbon schools agree to cover up to half the difference between the cost of attending a public college and the participating private school. The VA matches the amount pledged by the school. Veterans who withdraw from college may have to pay back some or all of their Post-9/11 GI Bill benefits, depending on the circumstances involved. The VA will use existing procedures to make recoupment determinations. MOAA recommends that service members who are entitled to Montgomery GI Bill (MGIB) benefits carefully review their situation before making an irrevocable election for the Post-9/11 GI Bill. For example, a MGIB participant who has used up a portion of MGIB entitlement might be better off sticking with that program and then converting to the Post-9/11 GI Bill after exhausting MGIB benefits. ‘Dual eligibility’ rules limit total entitlement to 48 months’ of benefits. But MGIB participants lose their remaining MGIB entitlement if they make an election for the new program. [Source: MOAA Leg Up 10 Jul 09 ++]


Prostate Cancer Update 11:

British doctors have developed a third way to treat prostate cancer that takes a middle road between radical treatment and watchful waiting. The procedure, which uses ultrasound to “melt” tumors, is said to be just as effective as radiotherapy or surgery but has a lower risk of causing incontinence, impotence, diarrhea, bleeding, and other side effects. The new technique is called high-intensity focused ultrasound, and men treated with it can be released from the hospital within several hours instead of several days, which is typical with surgery. The technique kills cancer cells by heating them to temperatures from 176 degrees to 194 degrees, which researchers at University College Hospital say can be tolerated by surrounding healthy tissue and also by nerves involved in sexual function. In the initial group of 172 men who took part in the trial, 159 were free of cancer one year later. This rate of cure is virtually the same as the cure rate following surgery and radiotherapy for early prostate cancer. The big difference between the ultrasound technique, surgery, and radiotherapy according to the findings of the study lies in improvement in side effects.

Only one of the 172 ultrasound patients became incontinent, none had bowel problems, and impotence was at a much-reduced rate of 30 percent to 40 percent. The usual rate for incontinence following surgery and radiotherapy is between 5 percent and 20 percent, and the impotence rate is usually 50 percent. When men are treated with radiotherapy, they also can expect bleeding and diarrhea. Lead researcher Dr. Hashim Ahmed said, “Men are being diagnosed earlier with prostate cancer because of increasing awareness with many patients in their fifties and sixties now. It means we are treating them more successfully, but the side effects are a big issue. Having to wear pads because of incontinence is not very nice and neither is sexual dysfunction, as a lot of these patients are still sexually active." The study suggests that high-intensity focused ultrasound some day might help treat men with early prostate cancer with fewer side effects. According to the most recent figures from the Centers for Disease Control, 185,895 men in the United States developed prostate cancer in 2005, and 28,905 died from it. Statistics show that one in six men will develop it at some point in their lifetime. [Source: Newswatch.com Health Alert 18 Jul 09 ++]

Medicare Rates 2010:

Medicare costs are expected to continue to escalate in 2010, but seniors won’t be getting any comparable increase in their annual cost-of-living adjustments (COLAs), government economists say. The Social Security Trustees recently forecast that there would be no COLA in 2010 and 2011 because of extremely low inflation. Due to a special “hold harmless” provision of law, the government estimates that about 30 million Medicare beneficiaries will have no change in their Medicare Part B premium, which is automatically deducted from most people’s Social Security benefits. The little-known provision protects the Social Security benefits of most seniors when the Part B premium increases more than a person’s COLA. If there is no COLA increase in 2010, then there is no Part B premium increase for beneficiaries protected by the hold harmless provision.

The hold harmless protection, however, does not cover about one-quarter of Part B enrollees, and does not apply at all to Part C Medicare Advantage or Part D plan premiums. The senior citizens League (TSCL) estimates that more than 6.8 million Social Security beneficiaries, about one in every seven, could see their Social Security checks (or direct deposits) reduced next year. If individuals have Medicare Advantage or drug plan premiums automatically deducted from their Social Security and the premium increases, then their benefits will be reduced to cover those rising costs. In addition millions of other seniors pay their plans directly. They would also have to pay a bigger portion of their Social Security to cover rising costs and would have less to live on. Medicare Trustees estimate that basic Part B premiums will rise by about $7.80 per month in 2010 (from $96.40 to $104.20), and would jump to $120.20 by 2011 for seniors subject to the increase. Nationwide Part D premiums climbed about 24% on average in 2009 for most beneficiaries, and have increased about 10% per year, on average, since 2006. [Source: TSCL Social Security and Medicare Advisor, Vol. 14, No. 6 dtd 27 Jul 09 ++]

Added 12/14/09

A Los Angeles-based law organization on 11 NOV launched a program to provide free legal assistance to veterans who hit bureaucratic roadblocks when filing claims for federal medical and mental health benefits. Public Counsel, a pro bono law firm, will offer the free service throughout Southern California and in partnership with other volunteer attorneys in more than 25 states. "Many veterans who return home to their families are facing a system that routinely rejects their benefit claims," Los Angeles Mayor Antonio Villaraigosa said at a Veterans Day news conference to announce the effort. "That's absolutely unacceptable. We can and must do more for our nation's heroes." Public Counsel President Hernan D. Vera said the effort would help the 1.7 million troops deployed to Afghanistan and Iran, many of whom have been denied benefits for post-traumatic stress disorder depression, traumatic brain injury, and other combat-related injuries. The program also will help the tens of thousands of homeless veterans living on the nation's streets to collect government assistance. "The veterans' homeless population is skyrocketing. Nearly one out of every four homeless individuals we see on the streets of Los Angeles wore the uniform protecting our country. But only one in 10 receive the government services that they're entitled to," Vera said. The legal program, called the Center for Veterans Advancement (CVA), will provide free legal representation in court as well as for administrative proceedings with the Department of Veterans Affairs, the Social Security Administration, all branches of the military, and with other local and national agencies. For additional info refer to www.publiccounsel.org

. Veterans seeking assistance can contact Public Counsel at:

·         Mailing Address: P.O. Box 76900, Los Angeles, CA 90076 Tel: (213) 385-2977

·         Office Address: 610 South Ardmore Avenue, Los Angeles, CA 90005 Fax: (213) 385-9089

 

     The CVA also provides training in VA representation and assists veterans in obtaining housing, employment, medical care, and supportive services. Public Counsel provides the opportunity for its volunteers to work on a wide variety of projects. Some of the casework is relatively simple, suitable for new attorneys seeking to develop new skills or more experienced attorneys seeking to expand their legal experience. Other cases are highly complex. In addition to work on litigation matters, Public Counsel volunteers can also assist with transactional and administrative matters as well as work in specialized areas such as bankruptcy and health care. Public Counsel’s speakers’ bureaus provide lawyers opportunities to educate their clients about the lawyer’s area of specialty. Volunteer opportunities are by no means limited to lawyers. Paralegals, legal assistants, law students, expert witnesses, and individuals employed in other professions are needed and welcomed (see Non-legal volunteer opportunities). For information about volunteering at Public Counsel, contact their volunteer coordinator, Ted Zepeda, at (213) 385-2977 x125 or tzepeda@publiccounsel.org. The Center for Veterans Advancement is being sponsored by grants from the Safeway and Vons foundations, as well as Northrop Grumman, the Oder Family Foundation, the Bettingen Foundation and other private donors. It does not receive city funding.Marine Corps veteran Aaron Huffman 27, who served in both Iraq and Afghanistan from 2000 to 2004, said he was forced to turn to Public Counsel last year when the Veterans Administration denied his claim for medical coverage after he injured his back when his Humvee hit a roadside bomb in Iraq. The Humvee flipped and loads of gear landed on Huffman, pinning him against the windshield. Huffman said he underwent spinal surgery for three herniated disks in his lower back. He said the Veterans Administration immediately denied his claim for compensation, telling him that he needed to provide more documentation that showed the injuries were suffered in combat. "When you're in the middle of combat, you don't always have time to pull over and say, 'Time out, I just got hurt, can you record this,' " Huffman said. "That's not the way combat works. That's some of the issues veterans are facing."  [Source: Los Angeles Times Phil Willon article 12 Nov 09 ++]

 

VA Women Vet Programs Update 08:

Secretary of Veterans Affairs Eric K. Shinseki announced the Department of Veterans Affairs (VA) is launching a comprehensive study of women Veterans who served in the military during the Vietnam War to explore the effects of their military service upon their mental and physical health. The study, which begins NOV 09 and lasts more than four years, will contact approximately 10,000 women in a mailed survey, telephone interview and a review of their medical records.

As women Vietnam Veterans approach their mid-sixties, it is important to understand the impact of wartime deployment on health and mental outcomes nearly 40 years later.

The study will assess the prevalence of post-traumatic stress disorder (PTSD) and other mental and physical health conditions for women Vietnam Veterans, and explore the relationship between PTSD and other conditions.

VA will study women Vietnam Veterans who may have had direct exposure to traumatic events, and for the first time, study those who served in facilities near Vietnam. These women may have had similar, but less direct exposures. Both women Veterans who receive their health care from VA and those who receive health care from other providers will be contacted to determine the prevalence of a variety of health conditions. About 250,000 women Veterans served in the military during the Vietnam War and about 7,000 were in or near Vietnam.

Those who were in Vietnam, those who served elsewhere in Southeast Asia and those who served in the United States are potential study participants. The study represents to date the most comprehensive examination of a group of women Vietnam Veterans, and will be used to shape future research on women Veterans in future wars.

Such an understanding will lay the groundwork for planning and providing appropriate services for women Veterans, as well as for the aging Veteran population today

Women Veterans are one of the fastest growing segments of the Veteran population There are approximately 1.8 million women Veterans among the nation's total of 23 million living Veterans.

Women comprise 7.8% of the total Veteran population and nearly 5.5% of all Veterans who use VA health care services.

VA estimates women Veterans will constitute 10.5% of the Veteran population by 2020 and 9.5% of all VA patients. In recent years, VA has undertaken a number of initiatives to create or enhance services for women Veterans, including the implementation of comprehensive primary care throughout the nation, staffing every VA medical center with a women Veterans program manager, supporting a multifaceted research program on women's health, improving communication and outreach to women Veterans, and continuing the operation of organizations like the Center for Women Veterans and the Women Veterans Health Strategic Healthcare Group. The study, to be managed by VA's Cooperative Studies Program, is projected to cost $5.6 million VA Family Caregiver Assistance

On 19 NOV the Senate passed Caregivers and Veterans Omnibus Health Services Act of 2009 (S.1963) an omnibus package of veterans bills. The bill had been held up for several days because of Senator Tom Coburn’s (R-OK) amendment calling for a cost offset. His amendment required an offset of the costs and would have ordered the State Department to transfer funds from its budget for supporting international organizations and peacekeeping activities. The amendment was defeated 32-66. The bill was then passed 98-0. It combined several different bills
        

S.801: Family Caregiver Program Act of 2009.
A bill to amend title 38, United States Code, to waive charges for humanitarian care provided by the Department of Veterans Affairs to family members accompanying veterans severely injured after September 11, 2001, as they receive medical care from the Department and to provide assistance to family caregivers, and for other purposes.

S.252: Veterans Health Care Authorization Act of 2009. A bill to amend title 38, United States Code, to enhance the capacity of the Department of Veterans Affairs to recruit and retain nurses and other critical health-care professionals, to improve the provision of health care veterans, and for other purposes.

S.597: Veterans Health Care Improvement Act of 2009. A bill to amend title 38, United States Code, to expand and improve health care services available to women veterans, especially those serving in operation Iraqi Freedom and Operation Enduring Freedom, from the Department of Veterans Affairs, and for other purposes.

S.498: Vet Dental Insurance. A bill to amend title 38, United States Code, to authorize dental insurance for veterans and survivors and dependents of veterans, and for other purposes.

S.246: Veterans Health Care Quality Improvement Act. A bill to amend title 38, United States Code, to improve the quality of care provided to veterans in Department of Veterans Affairs medical facilities, to encourage highly qualified doctors to serve in hard-to-fill positions in such medical facilities, and for other purposes.

S.772: Honor Act of 2009 A bill to enhance benefits for survivors of certain former members of the Armed Forces with a history of post-traumatic stress disorder or traumatic brain injury, to enhance availability and access to mental health counseling for members of the Armed Forces and veterans, and for other purposes.

Among other things It authorizes approximately $3.7 billion for programs to help caregivers for veterans from the Iraq and Afghanistan wars, improve health care in rural areas, focus on women veterans health care, provide VA dental care for some veterans and their families and survivors. Senator Coburn’s failed amendment would have also expanded the bill to cover all veterans rather than just those from the present wars. His hold caused a dramatic confrontation. Veterans’ Affairs Chairman Daniel K. Akaka (D-HI) said: “The cost of veterans’ health care is a true cost of war and must be treated as such. The cost of the underlying bill does not need to be offset. The price has already been paid, many times over, by the service of the brave men and women who wore our nation’s uniform.” Senator Coburn’s statement was: “I don’t have any opposition to veterans’ care. We’re supposedly anti-veteran because we think maybe we ought to pay for some things that we do around here. . . . I apologize to no one for having put a hold on this bill for a very good reason.” [Source: TREA Washington Update 20 Nov 09 ++]

VA Budget 2010 Update 05:

The Senate approved its version of the "2010 Military Construction and Veterans Affairs Appropriations" bill with a proposed budget of $133.9 billion on 17 NOV. The House version of the legislation was approved in July. The measure (HR 3082), passed 100-0, is now headed to conference committee, where negotiators will try to hammer out the differences between the Senate and House versions. Some items of interest to the veteran community in the Senate version include:

 ·        Both Senate and House bills include an information technology (IT) budget of $3.3 billion. However, the Senate bill puts hold on $1.1 billion in IT development funds until VA's Chief Information Officer Roger Baker completes a review of the department's IT systems and he and Secretary Eric Shinseki identify which projects should receive funding in fiscal 2010.

·         $3.2 billion nationally for health care and support services for homeless veterans, including $500 million in direct programs to assist homeless veterans.

·         $50 million for the VA to renovate unused, empty buildings on VA campuses to provide housing with supportive services, including rehabilitation and counseling, for homeless veterans.

·         $29 million for medical care for veterans in highly rural areas  

·         $44.7 billion for VA healthcare in fiscal 2010, which started 1 OCT 09

·         $48.2 billion for VA medical services for 2011 to end the cycle of the VA getting its funding late every year as Congress wrangles over the federal budget.

·         Gold Star parent admission to VA nursing homes.  

·         An amendment that directs VA to study how it addresses combat stress in women vets.

·         A provision that requires the National Cemetery Administration (NCA) to look Into creating a national cemetery In Montana.

[Source: Various 19 Nov ++]

 

Gray area military retirees who were promised health care coverage under Tricare may have to wait a year or longer for benefits to begin, Tricare officials are warning. Reserve retirees, who have had to wait until age 60 before military health coverage begins, had been promised they could sign up for Tricare Reserve Select under a provision of the 2010 National Defense Authorization Act, which was signed by President Barack Obama on 28 OCT 09. Tricare coverage for the reserve retirees — called “gray area” retirees because they are eligible for, but not yet receiving, retirement benefits — was authorized effective 1 OCT, but everyone expected it would take six to eight months to implement, based on the amount of time it has taken for other Tricare changes. But military and veterans associations were surprised 17 NOV when a Tricare official said it could take 11 to 18 months before enrollment is allowed.

One group thinks the delay might be driven by the budget. “I suspect the Pentagon is slowing implementation to coincide with the next generation of a Tricare contract to avoid change order costs,” said Marshall Hanson, a retired Navy captain who is legislative director for the Reserve Officers Association. Hanson’s group has launched an effort with other military associations to try to push the Defense Department to move faster by getting congressional leaders involved. Congressional aides working on military health care issues said they already have heard complaints about the slow implementation and were trying to determine the reason. The Tricare statement warning of the delay says the new program requires Tricare to come up with “complex operational procedures, negotiate significant modifications to existing contracts and introduce changes in the Code of Federal Regulations.” The statement from Thomas E. Broyles, a Tricare Management Activity spokesman, was sent to several military and veterans groups that were inquiring about when the new benefit would begin. [Source: MarineCorpsTimes Rick Maze article 18 Nov 09 ++]

Tricare Reserve Select Update 15:

By law, Tricare Reserve Select (TRS) Premiums are now based on the actual cost of delivering care to Guard and Reserve families. Previously, the Defense Department developed TRS premiums based on federal civilian health costs. When military associations and Congress questioned that, the Government Accountability Office did a study and determined that TRS premiums were significantly higher than actual costs would indicate. So Congress directed a substantial premium reduction, implemented in JAN 09, and required that 2010 premiums would be 28% of the average of actual cost of delivering care to Guard and Reserve eligibles in 2007 and 2008. The Defense Department has announced that:

The TRS member-only premium for 2010 will be $49.62 per month - a $2.11 (4.4%) increase from 2009. The TRS family premium for 2010 will be $197.65 per month - a $17.48 (9.7%) increase. Current enrollment in the program is approximately 30% of those eligible. Enrolling in Tricare Reserve Select (TRS) is a 2-step process: Times New Roman Qualify - Log on to the Guard and Reserve Web Portal https://www.dmdc.osd.mil/appj/trs/; Follow the instructions; Print and sign the TRS Request Form (DD Form 2896-1)

2.Purchase

- You may purchase the plan at any time throughout the year, there are no tiers or open seasons. Mail or fax your completed TRS Request Form along with the first month's premium payment to your regional contractor within the specified deadline.  [Source: NGAUS & MOAA Leg Up 20 & 24 Nov 09 ++]

Aid & Attendance Update 03:   This Special Pension (part of the VA Improved Pension program) allows for Veterans and surviving spouses who require the regular attendance of another person to assist in eating, bathing, dressing, undressing or taking care of the needs of nature to receive additional monetary benefits.  It also includes individuals who are blind or a patient in a nursing home because of mental or physical incapacity.  Assisted care in an assisted living facility also qualifies. This most important benefit is overlooked by many families with Veterans or surviving spouses who need additional monies to help care for ailing parents or loved ones.  This is a "pension benefit" and is not dependent upon service-related injuries for compensation.  Most Veterans who are in need of assistance qualify for this pension.  Aid and Attendance can help pay for care in the home, nursing home or assisted living facility.  For 2009 a single veteran is eligible for up to maximum benefit of $1,645 per month ($19,736 annually), while a surviving spouse is eligible for up to $1,057 per month ($12,681 annually).  A couple is eligible for up to $1,950 per month ($23,396 annually).  To be eligible the veteran must have served during one of the following periods:

·         World War II: December 7, 1941 through December 31, 1946

·         Korean War: June 27, 1950 through January 31, 1955

·         Vietnam War: August 5, 1964 (February 28, 1961, for veterans who served “in country” before August 5, 1964), through May 7, 1975

Gulf War

: August 2, 1990, through a date to be set by law of Presidential Proclamation

The VA must determine that your net worth is such that it will probably not support you through the remainder of your life. The VA does not include primary residence or vehicles when determining net worth. To qualify you must have a “countable income” of less than the pension amount to be eligible for all or a portion of the pension. Countable Income is the amount of income a veteran or surviving spouse receives each year including rollover interest, AFTER deducting all unreimbursed, and recurring health care expenses. This includes assisted living costs, home health care, insurance & Medicare premiums, on-going pharmacy costs and more. If you have dependents, their health care costs can also be used to reduce your countable income. However, their income must also be added into the equation.Refer to www.vba.va.gov/bln/21/pension/vetpen.htm#3 for additional details on the Aid & Attendance pension.



Application to the VA for this benefit can be made by any of the following methods: On line at

or http://www4.va.gov/vaforms download and fill out VA Form 21-526, Veteran's Application for Compensation and/or Pension  Send the completed application and any copies of other documents to the VA regional office that serves your area of residence. Make sure you download all parts of the application as well as the instructions for filling out the forms.  If available, attach copies of dependency records (marriage & children's birth certificates).

Contact a Veterans Service Officer (VSO) from a veterans service organization.    To locate call 1-800-827-1000, for the location of the nearest VSO nearest you.  Also, you can refer tohttp://www1.va.gov/vso for a list of the nationally recognized Veterans Service Organizations.

There are three levels to the Improved Pension program: Basic Pension, Housebound, or Aid & Attendance. Each tier has its own level of benefits and qualifications.  If you or your loved one does not qualify for Aid and Attendance, you may want to check to see if you qualify for another level of the Pension. For example the following would apply for eligibility to receive the Basic Pension:

·         A veteran receives $14,000 per year from Social Security. His wife earns $9,000 per year. The veteran also earns $5,000 per year from a small company pension giving the couple a total annual income of $28,000, and;

·         The couple have $38,000 in net worth in CDs and savings (not enough to support them for the rest of their lives) and they still live in the home they bought in 1954, and;

The veteran pays $1,800 per month for his wife’s home health care, they each pay a monthly Medicare premium of $96.40 (x 2 = $192.80/mo), and he also pays $149 per month for supplemental insurance. Thus, their total medical monthly expenses come to $25,702 per annum.

Symbol·         ! When you subtract the medical expenses from their total income, you get a “countable income” of only $2,368. The maximum basic benefit amount of $15,493 minus the countable income amount of $2,298 equals $13,195 ($1100 per month) which would be paid by the VA if the veteran applies for it..

[Source: Various Nov 09 ++]

Cholesterol Update 01:

Results of a new study suggest that the cholesterol lowering drug Zetia, manufactured by Merck maybe dangerous. Millions of Americans take Zetia to control their cholesterol, but study results indicate that they maybe at increased risk of heart problems. In the study, researchers analyzed health records of people who took Zetia, comparing them to people taking a rival drug, Niaspan. Those people on the Merck drug did not see a reduction in their cholesterol build up and were also at a greater statistical risk of suffering a heart attack. Zetia “has been on the market for about seven years and we still haven’t proven that it improves clinical outcomes,” said Dr. Roger Blumenthal, preventive cardiology chief at Johns Hopkins University. The new results will be “very influential” in getting more doctors to turn to Niaspan, he said. The study will be published in the 16 NOV issue of the New England Journal of Medicine. [Source:www.DbTechNo.com Nov 09 ++]

VA Burial Benefit Update 08:

VA offers the following benefits and services to honor our Nation's deceased Veterans.  For detailed information about all VA benefits and services, refer to www.va.gov

Headstones and Markers:

VA can furnish a monument to mark the grave of an eligible Veteran.

Presidential Memorial Certificate (PMC): VA can provide a PMC for eligible recipients.

Burial Flag: VA can provide an American flag to drape an eligible Veteran's casket.

Reimbursement of Burial Expenses: Generally, VA can pay a burial allowance of $2,000 for Veterans who die of servicer elated causes. For certain other Veterans, VA can pay $300 for burial and funeral expenses and $300 for a burial plot.

Burial in a VA National Cemetery: Most Veterans and some dependents can be buried in a VA national cemetery.

Time Limits: There is no time limit to claim reimbursement of burial expenses for a service related death. In other cases, claims must be filed within two years of the Veteran's burial.

[Source: VA Pamphlet 21-00-1 JUL 09 ++]

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