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November/December Issue

red star bulletThe Veteran Departments : Featured Stories / Letters / President's Message / VVAF Report / Government Relations / Veterans Benefits Update / PTSD Substance Abuse Committee Report / AVVA Report / SHAD/Project 112 Task Force Report / Veterans Against Drugs Task Force Report / Constitution Committee Report / Convention Resolution Report / Healthcare Budget Reform / NamJam / South Korean Veterans / Arts of War / Book Review / Books / Membership Notes / Locator / Reunions / 4 Chaplains /

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GOVERNMENT AFFAIRS

BY JOHN MITERKO, CHAIR, VVA GOVERNMENT AFFAIRS COMMITTEE, WITH VVA GOVERNMENT AFFAIRS STAFF

“Privatization” is a byword of the Bush administration. Just as vendors provide food services and potable water to our troops in Iraq, the Department of Veterans Affairs contracts out certain so-called fee-basis services to veterans. This is entirely understandable: There is no reason why a veteran who needs physical therapy has to travel 150 miles to a VA medical center when the service can be performed in the veteran’s home town.

Through Project HERO, the VA is testing the expansion of its privatization efforts in a quartet of VISNs. The eventual goal: Integrate Project HERO in all 21 VISNs. VVA believes this threatens the underpinning of the VA health care system. There is the very real danger that services integral to treating veterans, such as oncology and cardiac care, might be farmed out. Rather than trying really hard to attract top-flight medical personnel, a VAMC will have few constraints if it decides to take the easy path and provide key services on a fee-basis.

Why are we suspicious of the ulterior motives behind this initiative? Because we believe that if the VISNs find that it is fiscally advantageous to outsource more and more of their services, they will close outpatient clinics as well as medical centers.
The evidence is right in the explanation by VA honchos for this untenable idea. One of the “key features of Project HERO business model,” as noted in a VA powerpoint presentation, is “Current cost of fee basis care is escalating and Medicare pricing is not consistently obtained.” So Project HERO will come to the rescue “by leveraging market volume [so] VA can assure consistent, competitive pricing.” Somehow we don’t see much leveraging of physical therapy services in Finesville.

In rethinking this scheme, the VA did narrow its parameters a bit, but the explanations for the “revised scope” of the contract requirements are little more than exercises in bureaucratese, such as “improve the management of long-term care services for eligible veterans to ensure that veterans receive the best care for the best price.”

This is not the way to provide health care for veterans, especially now that the VA health care system has transformed itself into a smooth-running machine. Sure, there are parts of the machine that need oiling, and some that need replacing, but the machine is humming along quite nicely. Why fix what isn’t broken?

TRACKING MENTAL HEALTH DOLLARS

As our battles on the Global War on Terror and in Iraq continue to create veterans, the VA could cite the good work done at its 209 Vet Centers, places for readjustment counseling in a decidedly un-VA atmosphere. Yet many Vet Centers “have been forced to ration services, create waiting lists, and limit individual counseling sessions due to significant increases in demand for services from returning Iraq and Afghanistan war veterans,” according to a recent House Committee on Veterans’ Affairs Democratic staff report.

The report found that in nine months, from October 2005 through June 2006, the number of returning OEF and OIF veterans who have turned to Vet Centers for Post-traumatic Stress Disorder (PTSD) services and readjustment concerns has more than doubled, from 4,467 to 9,103 veterans.

The report found that the surveyed Vet Centers have seen a significant increase in outreach and services to these veterans. For half of these centers, this increase has affected their ability to treat the existing client workload; and 40 percent have directed veterans for whom individualized therapy would be appropriate to group therapy. More than one in four has limited or plans to limit veterans’ access to marriage or family therapy. Almost one in five has or plans to establish waiting lists
What is even more egregious is the failure of VA managers to insure that monies dedicated to mental health services in fact were spent on those services. The Government Accountability Office recently reported (GAO-06-1119T) that the administration failed to fund $300 million in resources that it had previously touted for veterans’ mental health services in 2005 and 2006. This is further evidence that rhetoric is divorced from reality in the Nation’s Capital. At a time when so many new veterans are returning to our shores with many of the same mental health issues that have plagued veterans from previous generations, the VA is failing in its obligation to provide timely, quality care for these women and men.

And in a war in which American women soldiers and marines are being seared by combat for the first time, the system that is supposed to help them—while not on life support—is reeling under the strain.

We call on Secretary Nicholson to ask hard questions of those senior managers responsible for insuring that the Vet Centers are adequately staffed and funded. Before newly minted veterans can show their pride, as the Secretary would like, the government entities charged with meeting the needs of these men and women must do their part.

VDBC SHELVES LUMP-SUM OPTION

At their meeting in October here in Washington, the commissioners of the Veterans’ Disability Benefits Commission discarded the concept of a lump-sum payment program.

After receiving informal comments from federal stakeholders and veterans service organizations, retired Gen. James Terry Scott, who chairs the commission, said that “despite some surface attractions, there is no evident benefit [of a lump-sum program] either to the veteran, the VA, or the government.” The commission noted the steep up-front costs associated with any lump-sum program. The commissioners then shelved the concept as an option to recommend to Congress and the President.

Gen. Scott was very clear regarding the intent of the commission he heads. “It doesn’t matter who appointed us,” he said. “What matters is where we are going. And we are not here to take away benefits from veterans.”

He also explained the commission’s eight-step process for developing, evaluating, refining, and finalizing each of the issue papers that will be included in the commission’s report to the President and Congress next October:

  1. Staff will prepare an initial draft issue paper using research and legal analyses information.
  2. The commissioners will review, comment, and revise the initial draft issue paper at a public meeting.
  3. Program and legal experts will conduct a technical review to insure the thoroughness and accuracy of the analyses.
  4. Staff will then revise the draft issue paper to incorporate input from steps 2 and 3.
  5. The commissioners will release the document for posting on the VDBC web site www.vetscommission.org and dissemination to stakeholders.
  6. Stakeholders and the public provide written or verbal comment via e-mail, letters, statements, and testimony before the commission.
  7. The commissioners will then deliberate and tentatively approve an option on each of the 31 research questions at a public meeting.
  8. The commissioners will review and finalize issue papers after consideration of appropriate information and data from the Center for Naval Analysis, the Institute of Medicine, and other sources. New information may result in a reevaluation of findings and options.

GENOMIC MEDICINE COMING TO VA

The Department of Veterans Affairs has received many kudos of late. Major media outlet U.S. News & World Report is the latest to have reported that the VA, the largest integrated health care system in the nation, does a highly commendable job caring for 5.3 million veterans. It’s a managed-care success story at a time when steeply rising health care premiums are causing the drums to beat again for systemic reform in the private sector.

The VA justifiably has much to be proud of. Cognizant of the stunning advances in genomic medicine, Secretary Nicholson asked the VA to form a Genomic Medicine Program Advisory Committee. This panel of distinguished scientists, physicians, and academicians and veterans will be charged with making recommendations to the secretary that will keep the VA at the cutting edge in the emerging era of personalized medicine.

At the committee’s inaugural meeting in October, the Acting Undersecretary for Health, Dr. Michael Kussman, called the field of genomics “a work in progress.” Secretary Nicholson praised “this extraordinarily accomplished group of people” who will “help us shape a new venture, a genomic medicine program that will help move us from where we are to where we should be.”

The committee chair, Dr. Wayne Grody, professor of pathology and laboratory medicine and pediatrics at UCLA, expressed confidence that the group will have much influence in meeting its mandate: to “assist the VA in adapting the advances in genomics and genomic medicine to provide the best care to our veterans [as] a model for the entire U.S. health care system.”

The committee and the VA will be sailing in uncharted waters. Because genomics can have predictive value, a natural concern of veterans is: If an individual is shown to have a genetic susceptibility to a particular disease, like diabetes, and he comes down with the disease, can this be attributed to genetic causes or exposure during military service? Will this in some way jeopardize his veterans’ benefits?

Vowing to keep veterans’ service organizations apprised of the progress made in adapting genomics to the practice of everyday medicine in VA facilities, Dr. Joel Kupersmith, the VA’s Chief Research and Development Officer, promised that the VA would collaborate with the VSOs to form focus groups to get veterans to understand the promise and the potential pitfalls of this brave new world.

After these introductory remarks, the group quickly embarked on an intensive, wide-ranging intellectual discussion about various what-ifs of the task that lay before them. One of the many vexing ethical questions that were touched upon: If a veteran is at risk for a genetic cancer, can the VA system pay for testing of a member of his or her family? Indeed, what is the VA’s obligation, if any, to family members who are being treated by other health care professionals? Another key question: To what extent should the VA provide veterans with access to raw genetic data (as opposed to interpretive information)?

At future gatherings, at subcommittee meetings, and in focus groups, these issues and many others will be aired out and haggled over. And maybe they will reach a consensus that will be a boon to veterans and their families and will solidify the VA’s position as a prime deliverer of quality health care to a population that has earned such care by virtue of its service.

ANTHRAX VACCINATIONS, REDUX

American soldiers will once again be forced under threat of court martial to submit to anthrax vaccinations without their voluntary informed consent. The National Vaccine Information Center (NVIC) warns that one-size-fits-all mandatory vaccinations are dangerous for those with genetic and other biological risk factors. They may be vulnerable to brain and immune system dysfunction following the vaccination.

The anthrax vaccinations are part of DoD’s biodefense against the potential use of bacillus anthraxix and other bioweapons. Veterans and active-duty troops who want to learn more about this should visit a new web site of the National Vaccine Information Center, www.military-biodefensevaccines.org The website is part of a project dedicated to providing the public with information on the research, development, regulation, policymaking, legislation, and government promotion of military and biodefense vaccines that may be mandated for mass use in both military and civilian populations.

According to the NVIC, more than 1,200 anthrax vaccine-injured soldiers have been treated at the congressionally mandated Vaccine Healthcare Centers, which DoD, to its shame, has attempted to close.

Some background: The Pentagon’s mandatory anthrax vaccine program was halted in October 2004 when a federal district judge in Washington issued a permanent injunction directing DoD to stop giving the experimental anthrax vaccine to military personnel without their voluntary, informed consent. In December 2005, the Food and Drug Administration issued a new Final Order declaring the vaccine safe and effective, but it failed to provide evidence that the vaccine was effective against inhalation (weaponized) anthrax or to address published research studies and 5,000 adverse events reports received by FDA demonstrating that the anthrax vaccine causes serious health problems. The NVIC filed an amicus brief in support of soldiers seeking to stop DoD from forcing anthrax vaccinations without informed consent.

DEFENSE AUTHORIZATION ACT

Among the highlights of the $532 billion FY’07 Defense Authorization bill are the following provisions:

An appropriate amount of compensation should be paid to each living Bataan Death March survivor in recognition of their captivity during World War II. In the case of a Bataan Death March survivor who is deceased but who has an unremarried surviving spouse, such compensation should be paid to that spouse.

The Secretary of the Air Force shall notify the participants of the Air Force Health Study that the study as currently constituted ended as of September 30. In consultation with the Medical Follow-up Agency of the Institute of Medicine of the National Academy of Sciences, the Secretary of the Air Force shall request the written consent of the participants to transfer their data and biological specimens to the agency during fiscal year 2007 and written consent for the agency to maintain the data and specimens and make them available for additional studies.

Custodianship of the Air Force Health Study shall be completely transferred to the agency on or before September 30, 2007. Assets to be transferred shall include electronic data files and biological specimens of all the study participants.
This is the course of action that VVA has strongly advocated for the last three years. Now we must ensure that the funds for maintaining this data and materiel, as well as adequate research dollars, are contained in future DoD authorizations and appropriations acts.

The Secretary of Defense, in consultation with the Secretaries of Veterans Affairs and Health & Human Services, shall conduct a comprehensive study of the health effects of exposure to depleted uranium munitions on uranium-exposed soldiers and on children of uranium-exposed soldiers who were born after the soldiers’ exposure to depleted uranium.

The Secretary of Defense shall conduct a longitudinal study on the effects of traumatic brain injuries incurred by members of the Armed Forces serving in Operation Iraqi Freedom or Operation Enduring Freedom and the impact of those injuries on their families.

As part of the assessment required by the Defense Authorization Act of 2006 of the efficacy of mental health services provided to members of the Armed Forces by the Department of Defense, a task force shall consider the specific mental-health needs of members who were deployed in Operation Iraqi Freedom or Operation Enduring Freedom upon their return.

The Secretary of Defense shall carry out not less than three pilot projects to evaluate various approaches to improving the capability of the military and civilian health care systems to provide early diagnosis and treatment of Post-traumatic Stress Disorder and other mental health conditions. One of the pilot projects under this section shall focus on members of the National Guard or Reserves who are located more than 40 miles from a military medical facility and who are served primarily by civilian community health resources.

FEDERAL EMPLOYMENT of VETERANS

The Office of Personnel Management (OPM) released the annual report on veterans’ employment just before Veterans Day. The figures show an upward trend of veterans and disabled veterans being hired into federal employment, particularly among younger veterans of Iraq and Afghanistan. However, the overall numbers are still low, and not nearly enough to make up for the Vietnam veterans who already have retired or will do so in the next few years. While OPM is doing more than it has in the past, the overall federal effort to recruit these bright, disciplined, and capable younger veterans into the federal workforce is just not enough to meet the need.

High marks do go to the VA, which is making a significant effort to recruit younger veterans, particularly disabled veterans. Credit goes to Secretary Nicholson, who had made hiring more veterans, particularly disabled veterans, a main Department of Veterans Affairs goal. Significant credit also goes to W. Allen Pittman, who was wounded while serving as a Navy Corpsman with the Marines in Vietnam, for spearheading this effort within the VA.

VETERANS PREFERENCE

A ruling by the federal Merit Systems Protection Board, which hears appeals in personnel disputes, has reaffirmed the government’s obligation to abide by Veterans’ Preference laws and give preference in hiring to veterans even when federal agencies use the Outstanding Scholar program. This program, which permits agencies to bypass civil service hiring procedures, is oriented to quickly fill federal jobs with applicants who have a high grade-point average. The federal Office of Personnel Management’s appeal of this ruling failed, reaffirming the hiring preference for veterans who seek civil service jobs. As a general practice, veterans who meet minimum qualifications have 5 or 10 points added to their numerical rating when competing for civil service positions.

 

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