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September/october 2008

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Everyone except the President, elected or appointed to an office of honor or profit in the civil service or uniformed services, takes the following oath: “I, AB, do solemnly swear (or affirm) that I will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; that I take this obligation freely, without any mental reservation or purpose of evasion; and that I will well and faithfully discharge the duties of the office on which I am about to enter. So help me God.”

This is the actual public officer’s oath that every federal official since the time of President Lincoln has taken. While it may be implicit in the oath, nowhere in the wording does it say that the person taking the oath pledges to obey, uphold, and faithfully execute the law of the land. Upon checking further in Title 38, it turns out that none of the job descriptions for any of the main offices at the Department of Veterans Affairs state that the individual holding that office must uphold the law. What is the point?

The point is that VA officials seem to choose and pick the laws they uphold, as well as how rigorously. This is not new with the current administration, but we hope that it will end here.

Nowhere is this more at issue—and of key concern to Vietnam veterans and their families—than with the VA’s refusal to obey Public Law 106-419 and language in the current 2009 Appropriations Act, and move to complete the replication of the National Vietnam Veterans Readjustment Study (NVVRS), which was completed more than 20 years ago.

The law calls for the VA to use the same study sample of individuals, thereby making it a true longitudinal study that would be a robust mortality and morbidity study of the last large generation of veterans prior to the current generation fighting in Iraq and Afghanistan. This is the law, not some cute idea advanced by the Congress.

Unfortunately, this refusal by the VA is part of what is clearly a decision to discard the Vietnam generation of veterans. One illustration of this is that there is not one single study currently funded by the federal government on the long-term health impact of dioxin, other herbicides, and the other toxins used in the Vietnam War—not at the VA, not at the Defense Department, not at the Environmental Protection Agency, not at the National Institutes of Health, nowhere. It is clear that this is by design since there is a good deal of research into the long-term health consequences of exposure to these chemicals going on in other countries.

VVA National President John Rowan repeatedly has asked VA officials what happened to the more than 1.2 million Vietnam-era veterans who have died since 1975. How many of them served in Southeast Asia or the adjacent waters? What was the cause of death? Is the fact that more than one out of eight of us who survived the war is now dead “normal”? Any reasonable person would expect that such basic epidemiological questions would have been answered by now.

Since it is clear that current VA officials intend to continue their refusal to obey the law in regard to completing the NVVLS and in other instances where it suits them, it would seem that a requirement to obey the law needs to be written into the statutory job description of each top VA appointed official, as well as a requirement that the officials uphold all statutes within their span of control.

Any reasonable person would think that such a step would not be necessary. But, then again, any reasonable person would have expected the completed National Vietnam Veterans Readjustment Study to have been delivered to the Congress on October 1, 2005, when it was due.
(For more on this issue, see “NVVLS” on

Maybe Congress is finally acknowledging the fact that a lot more must be done to inform veterans and their families about the benefits veterans have earned by virtue of their service in uniform.

Back in June, the Senate Veterans’ Affairs Committee included in the Veterans Health Care Authorization Act an effort by Sens. Russ Feingold (D-Wisc.) and Bernie Sanders (I-Vt.) to improve outreach to veterans. The Feingold-Sanders language, based on Feingold’s Veterans Outreach Improvement Act, would expand a grant program for community-based organizations to include state and local entities, including the National Guard and veteran service officers who conduct outreach for veterans. The measure would also require coordination between grant recipients and the VA.

“Nearly every day I learn of veterans in my state who are not aware of services and benefits they have earned through their service to our country, including wounded veterans who fall through the cracks as they transition out of the military,” Feingold said. “Conducting outreach is more important than ever as we welcome home and prepare to enroll into the VA system the tens of thousands of dedicated military personnel who are serving in Afghanistan, Iraq, and other places around the globe.”

“This legislation expands on a model program the VA and National Guard have used in Vermont to help service members returning from Iraq and Afghanistan,” Sanders added. “We can have the best health care services in the world for our veterans and their families, but if they do not know about them or cannot access them, what good do they do? This legislation will provide resources to organizations so that they can reach out to returning service members, veterans, and their families.

“With as many as 300,000 U.S. military personnel who have served in Iraq or Afghanistan suffering from PTSD or major depression and as many as 320,000 having suffered a traumatic brain injury of some kind, we need these outreach services more than ever.”

Our only quibble with this is that it does not include veterans’ service representatives of the veterans’ service organizations.

In a related development, the Subcommittee on Oversight and Investigations of the House Committee on Veterans’ Affairs held a hearing in July on the implementation of the recent decision by the VA to use television advertising and marketing in its outreach to veterans.

Currently, the VA does not use national media campaigns to advertise benefits and services it provides. As part of its long-range planning, the VA was prohibited from using television advertising to notify veterans about services offered at VA hospitals, Community-Based Outpatient Clinics, and Vet Centers. Following the introduction of legislation from Reps. John Boozman (R-Ark.) and Stephanie Herseth Sandlin (D-S.D.), the VA has changed its policy and is in the process of implementing a plan to begin mass advertising.

“The VA clearly needs to enter the 21st century when it comes to notifying veterans about services available to these American heroes,” said subcommittee Ranking Member Ginny Brown-Waite (R-Fla.). “It is mind-boggling to me that it has taken until 2008 for the VA to even consider television advertising and has yet to even contemplate using e-mail as a way to quickly and cheaply communicate with veterans. It was heartening that Secretary Peake has removed the prohibition on television advertising, but very distressing that they aren’t even collecting e-mail addresses for veterans.”

In the past, VA policy barred purchasing paid media to advertise. On June 16, Secretary Peake issued a memorandum rescinding the 20-year VA-imposed policy restriction on the purchase of paid media advertising.

“Getting the word out about veterans’ benefits to our nation’s heroes should be a high priority for the Department of Veterans Affairs,” Brown-Waite said. “Printing brochures and handbooks in this day of the Internet and instant messaging is still a very expensive option, but 21st century technology needs to be explored.

The VA needs to quickly move beyond snail mail and television and embrace e-communication as a way to reach veterans. This would create new efficiencies, save taxpayer funds, and provide information and resources veterans are seeking.”

We couldn’t agree more.

Back in March, the Veterans Health Administration quietly added the therapeutic category “long-acting insulin” to the VA Formulary. The addition of these newer therapeutic categories of drugs, for which VVA has long advocated, brings the VA more in synch with treatment for diabetes in the rest of the country.

Of the 5.5 million veterans who receive VA health care services, approximately 20 percent—well over one million—are diabetic. By comparison, the American Diabetes Association estimates that approximately 7 percent of the U.S. population has diagnosed or undiagnosed diabetes. The prevalence of diabetes among veterans can be attributed to the average age of the veteran population, the predominance of men in the system, and a higher rate of smoking than the population overall, but most of all, service in or around the Southeast Asia theater of operations during the Vietnam War, whether in Vietnam, Thailand, or in the waters off of the coast.

A recent study by the VA Pharmacy and Therapeutics Society on the implementation of new insulin glargine for patients with diabetes revealed significant differences in implementation between VA regions and treatment facilities. The addition of long-acting insulin to the Formulary should help improve care across the VA system.

The evidence is overwhelming that poor diabetes care results in drastically increased costs, a poorer quality of life, and worse clinical outcomes—including increased blindness, cardiovascular diseases, amputations, and kidney problems.

The connection between exposure to the use of defoliants, especially in Vietnam, and a higher than normal subsequent development of type II diabetes, is well established.

New insulin products can be used with an insulin pump or auto-injector pen. Patients with diabetes, or those who believe they may have diabetes, should consult their physicians. The conditions that lead to diabetes include overweight (especially abdominal fat), hypertension, raised cholesterol and lipids levels, and smoking. The characteristic symptoms of diabetes are excessive urine production due to high blood glucose levels, excessive thirst and increased fluid intake to compensate for increased urination, blurred vision due to high blood glucose effects on the eyes’ optics, unexplained weight loss, and lethargy.

Sen. John McCain (R-Ariz.), the presumptive GOP nominee for President, has seemingly reversed field on his voucher concept for veterans health care. His new-and-improved VA Card would only go to certain veterans in special circumstances. This announcement was made in an address to the DAV convention on August 9, according to VA Watchdog Larry Scott.

McCain says the card would be a choice for “veterans with illness or injury incurred during military service, as well as low-income veterans,” not every veteran as previously promised.

The card could only be used if the VA could not provide care under the following conditions: “No more than an hour’s drive for care, routine care within a week, urgent care within 24 hours, and specialty care within a month.”

McCain said that the card would be a “supplement to ordinary VA care, which would not replace or privatize existing programs.” And that’s the rub.
As Scott noted, for every veteran who opts for private health care, that means there is one less veteran using the VA. The inevitability is obvious: The VA would receive less funding.

But keep in mind that one out of every ten health-care dollars goes out of the VA system already in what is known as fee-basis care. This is, one can argue, very much like what Sen. McCain is proposing.

We maintain, however, that the old adage remains true: If it ain’t broke, don’t fix it.



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