October 2010 Archives

VA Extends Coverage for Gulf War Veterans

By Donna Miles
American Forces Press Service

WASHINGTON, Sept. 29, 2010 – Veterans of the first Gulf War as well as current operations in Iraq and Afghanistan now have a smoother path toward receiving health-care benefits and disability compensation for nine diseases associated with their military service, Secretary of Veterans Affairs Eric K. Shinseki announced today.

A final regulation published in today’s Federal Register relieves veterans of the burden of proving these diseases are service-related: Brucellosis, Campylobacter jejuni, Coxiella Burnetii (Q fever), Malaria, Mycobacterium tuberculosis, Nontyphoid Salmonella, Shigella, Visceral leishmaniasis and West Nile virus.

Shinseki added the new presumptions after reviewing a 2006 National Academy of Sciences Institute of Medicine report on the long-term health effects of certain diseases suffered among Gulf War veterans.

He also extended the presumptions to veterans of Afghanistan, based on NAS findings that the nine diseases are prevalent there as well.

The new presumptions apply to veterans who served in Southwest Asia beginning on or after the start of Operation Desert Shield on Aug. 2, 1990, through Operation Desert Storm to the present, including the current conflict in Iraq. Veterans who served in Afghanistan on or after Sept. 19, 2001, also qualify.

For Shinseki, who pledged to honor the 20th anniversary of the Gulf War by improving health-care access and benefits for its 697,000 veterans, the new presumptions represent a long-overdue step in addressing the medical challenges many face.
“This is part of historic changes in how VA considers Gulf War veterans’ illnesses,” he said. “By setting up scientifically based presumptions of service connection, we give these deserving veterans a simple way to obtain the benefits they earned in service to our country.”

The new presumptions initially are expected to affect just under 2,000 veterans who have been diagnosed with the nine specified diseases, John Gingrich, VA’s chief of staff, told American Forces Press Service. He acknowledged that the numbers are likely to climb as more cases are identified.

With the final rule, a veteran needs only to show service in Southwest Asia or Afghanistan during the specified time periods to receive disability compensation, subject to certain time limits based on incubation periods for seven of the diseases.

“It gives them easier access to quality health care and compensation benefits,” Gingrich said. “The message behind that is that the VA is striving to make access to health care easier for our veterans who have served in our combat zones.”

He expressed hope that by providing quick, easy access, VA will help veterans get the care they need early on, without having to fight the bureaucracy.

“When we find these presumptions and we reach out and get the veterans into our system, we can help them and give them the proper medical care they need, and maybe keep their disease from getting worse or getting it to go away altogether,” he said.

It also will help eliminate the piles of paperwork and long claims adjudication process veterans had to go through to prove their cases to receive care and benefits. “This will help break the back of the backlog in the long run, while sending a reassuring message to veterans that the VA is there for them,” Gingrich said.

He called the new presumptions part of Shinseki’s effort to “create a culture of advocacy” within VA that builds trust as it reaches out to veterans.

For Gingrich, a Gulf War veteran himself, the effort is very personal. He remembers being deployed as a 1st Infantry Division field artillery battalion commander during Operation Desert Storm, when one of his officers became very sick with an illness nobody could diagnose.

“The medics couldn’t diagnose it. We called in the doctors and they couldn’t diagnose it. And eventually, he had to be medevaced back,” he recalled. “And now here we are, 20 years later, and I saw him in Dallas in August, and he is still sick. You can’t identify all the reasons and symptoms, but he is sick.”

Veterans deserve better, Gingrich insisted. “I believe that our veterans that served in uniform for our country deserve the absolute best care and benefits that we can provide,” he said.

VA provides compensation and pension benefits to more than 3.8 million veterans and beneficiaries, and received more than 1 million claims last year alone, VA officials reported. Veterans without dependents receive a basic monthly compensation ranging from $123 to $2,673.


VA Publishes Final Regulation on “Presumptive” Illnesses for Gulf War and Iraq, Afghanistan Veterans


WASHINGTON – Secretary of Veterans Affairs Eric K. Shinseki today announced the publication of a final regulation in the Federal Register that makes it easier for Veterans to obtain Department of Veterans Affairs (VA) health care and disability compensation for certain diseases associated with service in Southwest Asia (including Iraq) or Afghanistan.

“This is part of historic changes in how VA considers Gulf War Veterans’ illnesses,” said Secretary Shinseki. “By setting up scientifically based presumptions of service connection, we give these deserving Veterans a simple way to obtain the medical and compensation benefits they earned in service to our country.”

The final regulation establishes new presumptions of service connection for nine specific infectious diseases associated with military service in Southwest Asia beginning on or after the start of the first Gulf War on Aug. 2, 1990, through the conflict in Iraq and on or after Sept. 19, 2001, in Afghanistan.

The final regulation reflects a determination of a positive association between service in Southwest Asia or Afghanistan and nine diseases and includes information about the long-term health effects potentially associated with these diseases: Brucellosis, Campylobacter jejuni, Coxiella Burnetii (Q fever), Malaria, Mycobacterium tuberculosis, Nontyphoid Salmonella, Shigella, Visceral leishmaniasis and West Nile virus. With the final rule, a Veteran will only have to show service in Southwest Asia or Afghanistan and that he or she had one of the nine diseases within a certain time after service and has a current disability as a result of that disease, subject to certain time limits for seven of the diseases. Most of these diseases would be diagnosed within one year of return from service, through some conditions may manifest at a later time.

For non-presumptive conditions, a Veteran is required to provide medical evidence to establish an actual connection between military service in Southwest Asia or Afghanistan and a specific disease. The decision to add these presumptives was made after reviewing the 2006 report of the National Academy of Sciences Institute of Medicine (NASIOM), titled, “Gulf War and Health Volume 5: Infectious Diseases.” The 2006 report differed from the four prior reports by looking at the long-term health effects of certain diseases determined to be pertinent to Gulf War Veterans. Secretary Shinseki decided to include Afghanistan Veterans in these presumptions because NAS found that the nine diseases are also prevalent in that country.

The 1998 Persian Gulf War Veterans Act requires the Secretary to review NAS reports that study scientific information and possible associations between illnesses and exposure to toxic agents by Veterans who served in the Persian Gulf War. While the decision to add the nine new presumptives predates VA’s Gulf War Veterans’ Illnesses Task Force (GWVITF), the overarching responsibility of the GWVI-TF is to regain Gulf War Veterans’ confidence in VA’s health care, benefits, and services and reconfirm VA is 100 percent committed to Veterans of all eras. The GWVI-TF began in fall 2009 and is not a static, one-time initiative but will continue to build on its work with annual reports issued every August. The group’s focus centers on unanswered Gulf War Veterans’ health issues, improving access to benefits, ensuring cutting edge research into treatments, and to make sure Veterans’ concerns are heard and addressed. This includes continuing to solicit Veterans, experts, advocates and stakeholders to share their views to better inform the important work of the GWVI-TF.

The GWVI-TF Report can be found at www.VA.gov
Disability compensation is a non-taxable monetary benefit paid to Veterans who are disabled as a result of an injury or illness that was incurred or aggravated during active military service.

Last year, VA received more than one million claims for disability compensation and pension. VA provides compensation and pension benefits to over 3.8 million Veterans and beneficiaries.

Currently, the basic monthly rate of compensation ranges from $123 to $2,673 for Veterans without any dependents. For information about health problems associated with military service in Southwest Asia and Afghanistan, and related VA programs, go to www.publichealth.va.gov/exposures/gulfwar/ and http://www.publichealth.va.gov/exposures/oefoif/index.asp.

For information about how to apply for disability compensation, go to www.va.gov
or http://www.publichealth.va.gov/exposures/gulfwar/compensation_benefits.asp.


VA Awards Contract to Austin Clinic
New Construction Will Triple Size of Medical Facility
Oct 3, 2010


WASHINGTON (Oct. 5, 2010) -- The Department of Veterans Affairs (VA) awarded a $224 million contract to Cullinan Properties, Ltd., for the construction of a new state-of-the-art medical clinic in Austin. The VA clinic will be the largest of its type in the country.

"This new clinic will allow more Veterans to receive the timely, compassionate, high- quality care they have earned and will serve as a model for patient-centered care, said Secretary of Veterans Affairs Eric K. Shinseki. President Obama is committed to increasing access to Veterans' benefits and services, and this clinic will help us do that.

It is good for Austin and good for Central Texas.

Thomas C. Smith III, director of the Central Texas Veterans Health Care System, who oversees the Austin Outpatient Clinic, said the new 185,000-square-foot clinic will be three times as large as the existing clinic with almost twice the clinic staff. The clinic is scheduled to open in 2012 off Highway 71 on 35 acres near the intersection of Metropolis and Metlink, commonly called MetCenter. The location is very close to the existing VA outpatient clinic, making access easy for Veterans.

The existing clinic opened in 1990 and was expanded in 1997. In 2008, VA leased 15,000 additional square feet in the Southgate Building to serve the growing number of patients.

Expanded services at the new clinic will include oncology, chemotherapy, cardiac rehabilitation, ear, nose and throat (ENT) services, orthopedic services, minor surgeries, urology and gastroenterology. It will include space for an endoscopy suite, a computerized tomography (CT) scanner and a magnetic resonance imaging (MRI) machine, as well as more space for all the services provided at the current Austin VA location.

The clinic will employ about 315 people, up from the current staff of 182. The Central Texas VA Health Care System serves more than 80,000 Veterans.


 


Scott Mendelson, M.D.
October 6, 2010

Another sad story in the press. There have been four more suicides at Fort Hood, Texas. Military suicide numbers keep climbing. The rates of depression, PTSD and suicide are reaching startling proportions among soldiers and veterans. New programs begun by the Department of Defense and the Veterans Administration are said to be designed to expand mental health care, and to make it more effective, palatable, and accessible to soldiers and veterans. They don't. As a psychiatrist employed by the VA who sees these broken soldiers on a daily basis, I find it infuriating and heartbreaking.

The new Mental Health programs, referred to by the Department of Defense as the acronym RESPECT-mil, and by the Veterans Administration as TIDES, are based on the Hamburger Helper model of health care. That is, if real care is too expensive, then dilute it with cheap care, fluff it up, advertise it well and make it look there is more there than there actually is. This brilliant new idea of the Veterans Administration and Department of Defense is intended to direct the psychiatric care of patients away from the people actually trained to provide this care, i.e., psychiatrists, psychologists, psychotherapists, and psychiatric nurse practitioners, and to place their care in the hands of less expensive people with weeks rather than years of training in mental health. This perspective includes the notion that mental health care is best provided away from stigma in the primary care setting, and that soldiers can be managed by primary care doctors helped by nurses with eight weekends of training to become what are called, "Champions."

The U.S. Government website says: "Welcome to the RESPECT-Mil Program. RESPECT-Mil stands for Re-Engineering Systems of Primary Care Treatment in the Military. It's a system of primary care designed to enhance the recognition and high-quality management of Post-Traumatic Stress Disorder (PTSD) and depression." It is in this opening statement that the intention to focus the treatment of mental health issues in primary care rather than the mental health clinic is noted.

The website goes on to state: "RESPECT-Mil is a treatment model designed by the United States Department of Defenses' Deployment Health Clinical Center (DHCC) to screen, assess and treat active duty Soldiers with depression and/or PTSD. This program is modeled directly after a program that's proven effective in treating civilian patients with depression."

Unfortunately, the evidence for this type of program being effective is some of the weakest data I have ever seen in my professional life. The evidence is derived almost entirely from a 2006 paper by psychologist Simon Gilbody and associates titled, "Collaborative Care for Depression" (Archives of Internal Medicine 166:2314-2312, 2006). This paper reviewed a series of studies of what is referred to in the "civilian" literature as the Collaborative Care for Depression Model. In this model, nurses are trained in roughly eight weekend training sessions to become "Depression Care Managers" or, in the military's more Pollyannaish term, "Champions." These Champions call regularly, report back to the primary care doctor, and if necessary, inform the primary care doctor that things are not going well and more help is needed. Admittedly, these are all good things. I was, however, astonished to hear at a Veterans Administration conference for the related TIDES program, that these Champions are also expected to advise the doctors as to when and if medication should be adjusted.

In Gilbody's paper, 35 studies in which the Collaborative Care model was compared against "standard care" in the primary care setting were reviewed. What is so disturbing and completely unacceptable about these studies, and Gilbody's paper, is that "standard care" in the primary care setting was never described. In fact, it was admitted that "standard care" varied from place to place, from fairly good care in some sites to virtually no care in other clinics. In Gilbody's meta analysis, the Collaborative Care model faired quite well against "standard care." Unfortunately, due to the lack of definition of "standard care," all that can really be said about the Collaborative Care model that the Department of Defense and the Veterans Administration has sunk it's hopes and resources into, is that it is almost certainly better than nothing!

The Collaborative Care model has not been compared against the mental health care provided by trained mental health professionals in mental health clinics. I do believe that contact and communication from "Champions" can be very supportive and beneficial to soldiers and veterans. However, this would be if it were in addition to competent mental health care, not in lieu of it! I have heard the argument that "specialty" behavioral health, i.e., real mental health professionals, is still available in the system. However, I believe that if the money being devoted to RESPECT-mil and TIDES were diverted to hiring real mental health professionals, there might be a better chance of actually improving things.

Finally, the addition of the new, highly touted, "Resiliency Training" as a method to avert depression, PTSD and suicide completes the recipe for inadequacy, incompetence, and disaster in the treatment of mentally ill soldiers and veterans. The 10 hour course on resiliency is taught by "Master Trainers" who themselves are soldiers who have had 10 days of training to become skilled enough to encourage resiliency and strength, and to prevent suicide in their charges. What are these people thinking?

The Department of Defense and the Veterans Administration need to take steps now to hire a sufficient number of competent, well trained mental health professionals, not Champions or cheerleaders, to treat the soldiers and veterans now suffering from military related illnesses. These must include psychiatrists, psychologists, psychotherapists and psychiatric nurse practitioners. There are no shortcuts. As a psychiatrist who sees and treats our veterans of World War II, Korea, and Vietnam on a daily basis, I can guarantee you that this problem will not go away any time soon.


VA expands program to bring EHRs to the home

By Mary Mosquera
Wednesday, October 13, 2010

The Veterans Affairs Department plans to expand its use of information technology and telecommunications – including  mobile and landline phones and video conferencing – to deliver health care to aging veterans and others who suffer from chronic conditions, according to senior telehealth official.

In fiscal year 2010, VA recorded 300,000 health care encounters in 36 specialty areas with the assistance of telehealth technologies, according to Dr. Adam Darkins, VA’s chief consultant for telehealth services, who spoke at an Oct. 12 conference on telehealth sponsored by West Wireless Health Institute, a medical mobile technology researcher.

The VA has now begun to analyze data from these programs as part of a long-term goal to  change the location of care from the hospital to where the patient is, he said. The plan is ultimately to, “extend the electronic health record into the home.”

“No evidence suggests that the best way to manage chronic conditions is in the hospital or office because they return again,” Darkins said. Prime treatment targets include diabetes and hypertension in older veterans or traumatic brain injury suffered in battle by younger veterans in Iraq and Afghanistan.

Among the VA’s major telehealth programs, the Care Coordination Home Program, which has 48,000 participants nationwide, enables senior veterans to continue to live at home instead of in an assisted living facility unless symptoms demand that a physician intervene.

So far, the program has reduced by 47 percent the number of days of facility provided medical care, Darkins said. The technology has also lowered costs by reducing or avoiding the time spent in assisted living facilities. Over the next two years, VA plans to increase participation in this program by 100 percent.

A companion effort, the VA’s Clinical Video Tele-health Program, uses video conferencing so patients can consult with a specialist from the office of their primary physician in VA community clinics. This program has 75,000 participants, most of whom reside in rural areas and have mental health conditions and need rehabilitation support.  VA is about to pilot Internet video conferencing in the patient’s home as part of this effort.

The Defense Department is also testing mobile health applications to extend patient management of healthcare for active service members.

One of its findings is that patients prefer to use their own phones as telehealth devices. Forty percent of the participants in a recent test of an application to send patients messages about their diabetes management did not even use the smart phone provided  to them.

“We early on decided that we’re going to do mobile health on patients’ preexisting cell phone,” said Dr. Col. Ronald Poropatich, deputy director of the U.S. Army Medical Research & Materiel Command and Telemedicine & Advanced Technology Research Center.  “If you give them an extra device, they’ll leave it at home.”

Many current veterans are under 30 years old and have grown up engaging with friends and family over the Internet, said Tom Tarantino, legislative associate for the Iraq and Afghanistan Veterans of America.  “It’s jarring to be thrown into an industry when they come for health care that’s not anywhere near in patient engagement to what they’re used to,” he said.


IRS ruling will keep thousands of veterans from using Health Savings Accounts

·         October 13th, 2010 10:01 am ET

·         By Susy Raybon, Military Community Examiner

http://tags.bluekai.com/site/1932

It’s time for open enrollment on insurance plans for thousands of companies and their employees across America. 

Many corporations are changing health care insurance options available to their employees; much of that change is cost-shifting in response to the new Health Care Plan recently passed by the government.

Some employers are now offering only high deductible health plans (HDHP) with the options being $1500 or $3000 annual deductibles.

To help defray some of the out-of-pocket expenses on those HDHPs, companies are giving their employees a Health Savings Account.  The HSA accounts are "seeded" or partially funded by the employer.  Employees are eligible to continue adding funds to the account with monthly pre-tax contributions; that is unless you are a veteran who also uses the VA. 

By law, only employees who have a high deductible plan are eligible to use health savings accounts.

Why would this hit the radar of the National Military Examiner? 

Because due to a 2004 IRS law there is an unintended consequence for military veterans who would otherwise benefit from employer funded health savings accounts.

A veteran who has used the Veterans’ Administration three months prior to enrollment is NOT eligible to make Health Savings Account (HSA) contributions or receive HSA funds contributed by their employer, even if that service was for a war-related injury or illness. 

Additionally, military (or retired) personnel who use TRICARE or the Veterans' Administration hospital are not eligible to use an HSA because coverage options do not meet the minimum annual deductible requirements.

In a nutshell, this IRS ruling means work-force veterans will not be able to use millions of dollars in employer funded Health Savings Accounts that are made available to their non-veteran co-workers.  Many of these veterans have recently served combat tours.  

This IRS law is an obvious oversight with an unintended consequence by lawmakers. 

U.S.Senators and Representatives need to have this IRS ruling called to their attention for immediate revision.

Examiner’s Note:  Being perfectly clear, this is an IRS ruling and has nothing to do with employers, other than the fact they have chosen to offer only high deductible plans to their employees.

The following is an excerpt from the IRS ruling:

Q-5.  If an otherwise eligible individual under section 223(c)(1) is eligible for medical benefits through the Department of Veterans Affairs (VA), may he or she contribute to an HSA? 

A-5.  An otherwise eligible individual who is eligible to receive VA medical benefits, but who has not actually received such benefits during the preceding three months, is an eligible individual under section 223(c)(1). An individual is not eligible to make HSA contributions for any month, however, if the individual has received medical benefits from the VA at any time during the previous three months.

Q-6. May an otherwise eligible individual who is covered by an HDHP and also receives health benefits under TRICARE (the health care program for active duty and retired members of the uniformed services, their families and survivors) contribute to an HSA?

A-6. No. Coverage options under TRICARE do not meet the minimum annual deductible requirements for an HDHP under section 223(c)(2). Thus, an individual covered under TRICARE is not an eligible individual and may not contribute to an HSA

 


VA expands program to bring EHRs home

 October 15, 2010 | Mary Mosquera, Government Health IT

WASHINGTON – The Department of Veterans Affairs plans to expand its use of information technology and telecommunications - including  mobile and landline phones and video conferencing - to deliver healthcare to aging veterans and others who suffer from chronic conditions, according to senior telehealth officials.

In fiscal year 2010, VA recorded 300,000 healthcare encounters in 36 specialty areas with the assistance of telehealth technologies, according to Adam Darkins, MD, VA's chief consultant for telehealth services, who spoke at an Oct. 12 innovation conference sponsored by West Wireless Health Institute, a wireless medical technology nonprofit researcher.

The VA has now begun to analyze data from these programs as part of a long-term goal to  change the location of care from the hospital to where the patient is, he said. The plan is ultimately to, "extend the electronic health record into the home."

"No evidence suggests that the best way to manage chronic conditions is in the hospital or office because they return again," Darkins said. Prime treatment targets include diabetes and hypertension in older veterans or traumatic brain injury suffered in battle by younger veterans in Iraq and Afghanistan.

Among the VA's major telehealth programs, the Care Coordination Home Program, which has 48,000 participants nationwide, enables senior veterans to continue to live at home instead of in an assisted living facility unless symptoms demand that a physician intervene.

So far, the program has reduced by 47 percent the number of days of facility-provided medical care, Darkins said. The technology has also lowered costs by reducing or avoiding the time spent in assisted living facilities. Over the next two years, VA plans to increase participation in this program by 100 percent.

Help for rural areas

A companion effort, the VA's Clinical Video Tele-health Program, uses video conferencing so patients can consult with a specialist from the office of their primary physician in VA community clinics. This program has 75,000 participants, most of whom reside in rural areas and have mental health conditions and need rehabilitation support. VA is about to pilot Internet video conferencing in the patient's home as part of this effort.

The Defense Department is also testing mobile health applications to extend patient management of healthcare for active service members.

One of its findings is that patients prefer to use their own phones as telehealth devices. Forty percent of the participants in a recent test of an application to send patients messages about their diabetes management did not even use the smart phone provided  to them.

"We early on decided that we're going to do mobile health on patients' pre-existing cell phone," said Col. Ronald Poropatich, MD, deputy director of the U.S. Army Medical Research & Materiel Command and Telemedicine & Advanced Technology Research Center.  "If you give them an extra device, they'll leave it at home."

Many current veterans are under 30 years old and have grown up engaging with friends and family over the Internet, said Tom Tarantino, legislative associate for the Iraq and Afghanistan Veterans of America.  "It's jarring to be thrown into an industry when they come for healthcare that's not anywhere near in patient engagement to what they're used to," he said.


Agent Orange: Thailand Military Bases
October 18, 2010

 

Vietnam-era Veterans whose service involved duty on or near the perimeters of military bases in Thailand anytime between February 28, 1961 and May 7, 1975 may have been exposed to herbicides and may qualify for VA benefits.

U-Tapao Air Base, Thailand, 1972
The National Archives

The following Veterans may have been exposed to herbicides:

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*  U.S. Air Force Veterans who served on Royal Thai Air Force (RTAF) bases at U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhli, Korat, and Don Muang, near the air base perimeter anytime between February 28, 1961 and May 7, 1975.

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*  U.S. Army Veterans who provided perimeter security on RTAF bases in Thailand anytime between February 28, 1961 and May 7, 1975.

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*  U.S. Army Veterans who were stationed on some small Army installations in Thailand anytime between February 28, 1961 and May 7, 1975. However, the Army Veteran must have been a member of a military police (MP) unit or was assigned an MP military
occupational specialty whose duty placed him/her
at or near the base perimeter
.

To receive benefits for diseases associated with herbicide exposure, these Veterans must show on a factual basis that they were exposed to herbicides during their service as shown by evidence of daily work duties, performance evaluation reports, or other credible evidence.

Report on Defense Tactics in Thailand

A recently declassified Department of Defense (DoD) Report written in 1973 titled, “Project CHECO Southeast Asia Report: Base Defense in Thailand 1968-1972,” contains evidence that there was a significant use of herbicides on the fenced-in perimeters of military bases in Thailand to remove foliage that provided cover for enemy forces.

DoD determined that herbicides used on the Thailand base perimeters may have been tactical and procured from Vietnam, or a strong, commercial type resembling tactical herbicides.

VA Benefits

Veterans

Eligible Veterans may receive the following VA benefits:

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*  Health care benefits: A full range of medical benefits. Veterans who believe they were exposed to Agent Orange or other herbicides outside of Vietnam must show that they were exposed in order to receive health care benefits for diseases associated with Agent Orange exposure.

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*  Agent Orange registry health examination: A cost-free, comprehensive examination. Veterans who may have been exposed to herbicides during a military operation or as a result of testing, transporting, or spraying herbicides for military purposes may be eligible for an Agent Orange Registry health examination.

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*  Disability compensation benefits: A monthly payment for diseases associated with Agent Orange exposure. Veterans who believe they were exposed to Agent Orange or other herbicides outside of Vietnam must show on a factual basis that they were exposed in order to receive disability compensation for diseases associated with Agent Orange exposure.

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*  Other benefits: Home loans, vocational rehabilitation, education, and more

Children and Survivors

Surviving spouses, children and dependent parents of Veterans who were exposed to herbicides and died as the result of diseases associated with Agent Orange exposure may be eligible for benefits. These benefits include Dependency and Indemnity Compensation, education, home loan and health care benefits. Find out if you qualify for survivors’ benefits.

Need Help Determining Exposure or Eligibility?

Contact VA for help determining Agent Orange exposure and your eligibility for VA benefits.

By Telephone

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*  Toll-free Helpline: 1-800-749-8387 Press 3

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*  Health Care and Agent Orange Registry Health Exam: 1-877-222-8387 (Ask to speak to the Environmental Health Coordinator or Patient Care Advocate)

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*  Compensation and Other Benefits: 1-800-827-1000

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*  TDD (for hearing impaired): 1-800-829-4833

In Person

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*  Health Care and Agent Orange Registry Health Exam: Go to your nearest VA medical facility.

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*  Compensation Benefits and Other Benefits: Go to your nearest VA benefits office.


VA's 'Medical Team' Approach Reduces Operating Room Mortality Rates
October 21, 2010

WASHINGTON (Oct. 21, 2010)- A Department of Veterans Affairs (VA) study published October 20 in the Journal of the American Medical Association concludes that a concept called Medical Team Training (MTT) improves communication, teamwork, and efficiency in VA operating rooms, resulting in significantly lower mortality rates.

"Patients can suffer inadvertent harm at times, despite care from well-trained, experienced, and conscientious health care providers,"

noted Dr. Douglas Paull, a VA surgeon and co-director of the Medical Team Training program at VA's National Center for Patient Safety in Ann Arbor, Mich. "The cause in many such instances is faulty teamwork and communication.

"Fortunately, teamwork and communication skills --often referred to as non-technical skills-- can be measured, learned, practiced, and enhanced," Paull continued. "The MTT Program improves these non-technical skills among providers, delivering on the promise of a safer health care system."

VA's nationwide study involved the analysis of more than 100,000 surgical procedures conducted at 108 of its hospitals from 2006 to 2008.

MTT had been introduced at 74 of these hospitals. The study found that the decline in the risk-adjusted mortality rate was 50 percent greater in the MTT group than in the non-MTT group.

"MTT is all about communication," said Dr. Lisa Mazzia, who runs VA's Medical Team Training Program along with Dr. Douglas Paull. "MTT empowers every member of the surgical team to immediately speak up if they see something that's not right."

"When people talk and listen to each other, fewer errors occur in the operating room. That's the bottom line," Mazzia added.

`` Julia Neily, associate director of VA's National Center for

Patient Safety Field Office in Vermont and one of the study's nine authors, said conducting briefings prior to starting surgery, much like pilot and crew work through a pre-flight checklist, proved to be a key component in reducing mortalities because it gave the surgical team "a final chance" to correct potential problems.

Post-operative debriefings also proved valuable, the study found, because they led directly to the prompt resolution of glitches that occurred during surgery. Examples included fixing broken equipment or instruments, ordering extra back-up sets of instruments, and improving collaboration between the Operation Room and the Radiology Department --all of which led directly to less delays while future surgeries were in progress.

Pre-operative briefings and post-operative debriefings are a fundamental component of VA's MTT program, which VA's National Center for Patient Safety began developing in 2003-2004. VA began implementing a nationwide MTT program in 2006.

To find out more about Medical Team Training, contact VA's National Center for Patient Safety at 734-930-5884 or go to www.patientsafety.gov.


Drop in surgical deaths seen in hospitals with team-trained staff
October 25, 2010

 

Hospitals that had their operating room staff participate in a medical team training program showed a significantly lower surgical mortality rate than centers not involved in the program, according to the results of a study appearing in the Journal of the American Medical Association.

For their study, Julia Neily, RN, MS, MPH, of the National Center for Patient Safety, Department of Veterans Affairs, in Hanover, N.H., and colleagues compared the surgical mortality rates of hospitals which had staff who participated in the Veterans Health Administration’s (VHA) medical team training program with those that did not. The surgical care teams of the hospitals that underwent the training received 2 months of preparation and a day-long onsite learning session, according to a Journal of the American Medical Association (JAMA) and Archives Journals press release.

“Using the crew resource management theory from aviation adapted for health care, clinicians were trained to work as a team; challenge each other when they identify safety risks; conduct checklist-guided preoperative briefings and postoperative debriefings; and implement other communication strategies such as recognizing red flags, rules of conduct for communication, stepping back to reassess a situation, and how to conduct effective communication between clinicians during care transitions,” the researchers wrote.

Morality rates

Neily and her colleagues used data from the VHA Surgical Quality Improvement Program and interviews conducted between 2006 and 2009. The researchers analyzed 182,409 procedures performed at 108 VHA hospitals.

The researchers found a baseline risk-adjusted mortality rate of 17 per 1,000 procedures at the trained hospitals vs. 15 per 1,000 procedures at the non-trained centers. Both types of centers showed mortality rates of 14 per 1,000 procedures at the end of the study.

Impact of training

“After controlling for baseline differences, the 74 trained facilities experienced a significant decrease of 18% in observed mortality,” the researchers noted. “Mortality decreased by 7% in the non-trained facilities.”

After adjusting the results for surgical risk and volume, the researchers discovered that the morality rate dropped 0.5 per 1,000 procedure deaths for every quarter of training. In addition, they found that the rate was reduced by .6 per 1,000 procedures for each increase in the degree of debriefings at the centers.

"It is our hypothesis that conducting preoperative briefings is a key component in reducing mortality because it provides a final chance to correct problems before starting the case,” the researchers wrote. “The use of conducting briefings and debriefings requires a more active participation and involvement than sometimes occurs when a checklist is used by itself. During follow-up interviews, facilities provided specific examples of having avoided adverse events because of the briefing.”

Reference:

Neily J, Mills PD, Young-Xu Y, et al. Association between implementation of a medical team training program and surgical mortality. JAMA. 2010;304(15):1693-1700.


Veterans Affairs agency shows pitfalls of single-payer health system
Published: October 25, 2010

During the legislative fight over new federal health care legislation, a number of opponents warned the program would be the first step toward a government-run system, that Washington would slowly absorb all medical services while incrementally killing private insurance along the way.

Obamacare supporters denied such a scenario, but too many — including President Obama — already were on the record as favoring a so-called "single-payer” system,” that single payer being Uncle Sam.

It remains to be seen whether Obamacare plays out that way. Already we know the program will cost more than advertised, and its mandates will force individual insurance premiums higher, as nonunion workers at Boeing now can affirm.

Frequently, the Canadian and British health programs are cited as single-payer examples. But there's an even closer illustration: the Veteran's Administration medical system. In an article for National Review Online, the Cato Institute's Michael Tanner depicts a system stressed by heavy patient demand that has little choice but to ration care.

The VA controls costs by limiting how much it can spend on care in a given year, Tanner writes. "When resources can't meet demand in a given year, the VA does what other single-payer systems do: it rations.”

Psychiatric and pharmaceutical services, for example, are constrained by resources, not based on patient need. The system is highly bureaucratized and when problems surface, "no one takes responsibility for fixing them,” Tanner writes.

Is this the future for all Americans? Maybe the distant future but, thanks to Obamacare, you can see it from here.



Read more: http://newsok.com/ration-all-va-shows-pitfalls-of-single-payer-system/article/3507742#ixzz13QRySUiy


Editorial: Limbaugh takes conservative health care to logical conclusion
Oct 26 2010

"What is wrong with privatizing the VA? What’s wrong with privatizing? Somebody tell me where it’s working! ... Would a Veterans Administration hospital that is run by the private sector be better run than by the public sector? In my view, yes."

There, he said it. And it wasn’t just anybody who said it -- it was a radio commentator no Republican in Congress dares criticize

The quote was from Rush Limbaugh during his Oct. 15 radio broadcast. Give Limbaugh credit. While most politicians dance around the contradiction between opposition to government-run health care and the existence of government-run hospitals for military veterans, Limbaugh took conservative health care philosophy to its logical conclusion. If government-run health care really leads to shoddy care, rationing, inefficiencies, death panels, etc., then the VA should be privatized. The system could be turned over to a private vendor, or the whole system could be scrapped and veterans could be given a voucher similar to what Wisconsin Congressman Paul Ryan (R-Janesville) envisions to replace Medicare.

Limbaugh’s approach is consistent with conservative free-market philosophy. Whether it’s in the best interests of veterans is another issue. Veterans generally prefer the system as it exists. In a 2005 independent survey, 81 percent of VA hospital patients expressed satisfaction with the care they receive, compared to 77 percent of Medicare and Medicaid patients. Wisconsin Congressman Ron Kind (D-La Crosse) told the Tomah Journal last week, “I have yet to have a veteran come up to me and say, ‘Ron, please privatize the VA.’”

There’s good reason for their satisfaction. Take, for example, laptop medicine. The VA pioneered computerized administration of prescription drugs, which reduced the number of wrongly administered drugs and dosages to almost zero.

All of this is a powerful argument against privatization, but at least Limbaugh has the courage of his convictions. He believes the horror stories of public-sector medicine in Europe and doesn’t flinch from opposing such arrangements as they exist in the United States. His philosophy is clear and consistent. And that’s more than can be said for almost anyone else who raises the bogeyman of socialized medicine.


VA Going to World Series
October 29

Department Will Use Mobile Vet Centers for Outreach at Game Four

ARLINGTON, Texas (Oct. 29, 2010)- The Department of Veterans Affairs

(VA) is partnering with the Texas Rangers and Major League Baseball to provide outreach and readjustment counseling to Veterans attending game four of the World Series Oct. 31.

"VA's mobile Vet Centers improve access by providing counseling and outreach services where Veterans are going to be," said VA Secretary Eric K. Shinseki. "With thousands of Lone Star Veterans on hand to see the Rangers try for their first World Series championship, this will be a great venue to reach out. VA is thankful to Major League Baseball for this opportunity."

The mobile Vet Centers will be located on Nolan Ryan Boulevard between the Home Plate and First Base gates on the west side of Rangers Ballpark and will be on site the entire day of the game for Veterans and their families to stop in for confidential counseling or to inquire about other VA services.

VA has a fleet of 50 mobile Vet Centers to support readjustment counseling for combat Veterans and their families throughout the U.S.

where area facilities may not be close by. The mobile Vet Centers complement 270 Vet Centers across the Nation that exist as walk-in support centers, providing counseling and connection to local services for Veterans adjusting to civilian life after combat. The mobile Vet Centers are customized vehicles outfitted to house two mental health counseling offices and a small waiting room. They can also be converted with portable exam tables to provide basic medical care and are outfitted with litters, a wheelchair lift and rear doors to provide emergency patient evacuation capabilities.

Three mobile Vet Centers responded to the Fort Hood shooting tragedy Nov. 5, 2009. With augmented staff, more than 8,200 Veterans, active duty Servicemembers and families were provided readjustment counseling.


VA Begins Paying Benefits for New Agent Orange Claims
Oct 30 2010

VA Encourages Affected Vietnam Veterans to File Claims

WASHINGTON - The Department of Veterans Affairs (VA) has begun distributing disability benefits to Vietnam Veterans who qualify for compensation under recently liberalized rules for Agent Orange exposure.

"The joint efforts of Congress and VA demonstrate a commitment to provide Vietnam Veterans with treatment and compensation for the long-term health effects of herbicide exposure," said Secretary of Veterans Affairs Eric K. Shinseki.

Up to 200,000 Vietnam Veterans are potentially eligible to receive VA disability compensation for medical conditions recently associated with Agent Orange. The expansion of coverage involves B-cell (or hairy-cell) leukemia, Parkinson's disease and ischemic heart disease.

Shinseki said VA has launched a variety of initiatives - both technological and involving better business practices - to tackle an anticipated upsurge in Agent Orange-related claims.

"These initiatives show VA's ongoing resolve to modernize its processes for handling claims through automation and improvements in doing business, providing Veterans with faster and more accurate decisions on their applications for benefits," Shinseki said.

Providing initial payments - or increases to existing payments - to the 200,000 Veterans who now qualify for disability compensation for these three conditions is expected to take several months, but VA officials encourage all Vietnam Veterans who were exposed to Agent Orange and suffer from one of the three diseases to make sure their applications have been submitted.

VA has offered Veterans exposed to Agent Orange special access to health care since 1978, and priority medical care since 1981. VA has been providing disability compensation to Veterans with medical problems related to Agent Orange since 1985.

In practical terms, Veterans who served in Vietnam during the war and who have a "presumed" illness do not have to prove an association between their illnesses and their military service. This "presumption"

simplifies and speeds up the application process for benefits.

The three new illnesses - B-cell (or hairy-cell) leukemia, Parkinson's disease and ischemic heart disease - are added to the list of presumed illnesses previously recognized by VA.

Other recognized illnesses under VA's "presumption" rule for Agent Orange are:

* Acute and Subacute Transient Peripheral Neuropathy

* Chloracne

* Chronic Lymphocytic Leukemia

* Diabetes Mellitus (Type 2)

* Hodgkin's Disease

* Multiple Myeloma

* Non-Hodgkin's Lymphoma

* Porphyria Cutanea Tarda

* Prostate Cancer

* Respiratory Cancers

* Soft Tissue Sarcoma (other than Osteosarcoma, Chondrosarcoma,

Kaposi's sarcoma, or Mesothelioma)

* AL Amyloidosis

Veterans interested in applying for disability compensation under one of the three new Agent Orange presumptives should go to www.fasttrack.va.gov <http://www.fasttrack.va.gov/> or call 1-800-827-1000.

 

 

 

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