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november/december 2008

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A New Day Dawning

No matter who won the election for President, there would have been a new hand dealt to the veterans’ community in regard to those in decision-making positions at the VA and on the Domestic Policy Council at the White House

As VVA President John Rowan notes in his column on page 5, we reached out to both Sen. McCain’s staff and Sen. Obama’s staff before the election, and we attended both conventions.

We were impressed that Sen. McCain began to speak about accountability in his remarks after some of these discussions. We were also pleased to hear Sen. Obama commit to mandatory funding for veterans health care.

Now it is time to follow up with the transition team to urge them to take action. As one of the first orders of business at the VA, the Obama administration must insist that VA obey all laws at VA, including completing the National Vietnam Veterans Longitudinal Study, seeking funds to increase long-term care for veterans, and taking steps to improve transparency of decision-making at the VA, especially with decisions about the shape of medical care in general and fiscal decisions that supercede best clinical judgment, such as the overly restricted formulary for pharmaceutical medications and contracting out care wholesale from VA Medical Centers to essentially gut them.

We need the VA to start taking a complete military history as part of the computerized patient treatment file, and to train its own clinicians and other staff properly in the wounds, injuries, maladies, diseases, and conditions that result from military service.

We need much greater accountability up and down the line in every area of the VA. We need advanced funding. We need an increase in Dependency and Indemnity Compensation, and an end to the “widows’ tax.” We call for an end to the exclusion of veterans and veteran advocates from the decision-making process at VA and other agencies that make key decisions that affect the lives and well-being of veterans, such as decisions on employment assistance and veterans preference.

We need a VA that will keep faith with every generation, and will not attempt to throw away Vietnam veterans by not having a single research study funded at or by VA that deals with the long-term adverse health impact of Agent Orange and other toxins prevalent in the war-time environment.

As President-elect Obama noted in his victory speech and in his first press conference, this is a challenging time because of two wars and an economy that continues to weaken. Some commitments, such as mandatory funding, may have to give way to enactment of advanced funding this year, and revisiting assured funding as the economy improves.

VVA notes that many of the recommendations that President Rowan has made to the President-elect cost little or no money, and others, such as increasing accountability and fixing a broken procurement process, will save significant funds that can then be channeled to enhanced medical care and other vital services.

At Vietnam Veterans of America, we will continue to pursue justice for veterans and their families of every generation, and we will seek support from both sides of the aisle in our efforts.

The veterans’ spending bill signed into law by the President has provided VA with the largest increase in the 77-year history of the Department of Veterans Affairs and its predecessor agency, the Veterans Administration. This year’s bill provides some $4.5 billion more in discretionary spending over last year’s level, nearly $3 billion more than the Bush administration had requested.

One of our primary jobs as veterans’ advocates is to ensure that this significant increase is properly spent.

Here is a breakdown:

Department of Veterans Affairs: $47.6 billion, $4.5 billion above 2008 and $2.8 billion over the President’s request, for veterans’ medical care, claims processors, and facility improvements. Some notable provisions include:

• Veterans Health Administration: $41 billion, $1.8 billion over the President’s request and $4.1 billion above 2008, for veterans medical care. The VHA estimates it will treat more than 5.8 million patients in 2009, including more than 333,000 veterans of Iraq and Afghanistan, 40,000 more than in 2008.

• Medical Services: $30.97 billion, $1.2 billion above the President’s request and $2.9 billion above 2008, to improve access to medical services for all veterans.

• Mental Health Care and Substance Abuse: A minimum of $3.8 billion, $900 million more than 2008, to specialty mental health services for veterans with mental illness, PTSD, and for suicide prevention.

• Priority 8 Veterans: $375 million to increase enrollment of Priority 8 (low-to middle-income) veterans by 10 percent.

• Mileage Reimbursement: $133 million above the President’s request to increase funding to raise the gas mileage reimbursement rate from 28.5 cents to 41.5 cents per mile for veterans traveling for care, and a freeze on the associated deductible.

• Claims Processors: Increased funding to hire 2,000 additional claims processors to work on the backlog of 390,000 benefits claims and to reduce the six-month time to process new claims.

• Rural Veterans: $250 million to begin a rural health initiative to improve access to medical services for veterans living in rural areas.

• Prosthetics: $1.6 billion, $250 million above 2008, and $116 million above the President’s request, to provide veterans with appropriate prosthetic support and sensory aids using recent advances in technology.

• Homeless Veterans: $130 million to provide additional case workers and medical services needed for homeless veterans, including $30 million to hire additional personnel for the HUD-Veterans Affairs Supportive Housing Program.

As reported in USA Today, the Pentagon’s top uniformed officer has called for all returning combat troops, from privates to generals, to undergo screening for post-traumatic stress with mental health professionals, a move aimed at stemming an epidemic of psychological issues among veterans.

Adm. Michael Mullen, chairman of the Joint Chiefs of Staff, said there is a reluctance to acknowledge psychological problems for fear of showing weakness. Troops now fill out questionnaires after combat tours that help determine if they have suffered psychological damage. They’re examined by medical professionals for physical injuries, but not by mental health experts.

“I’m at a point where I believe we have to give a [mental health] screening to everybody to help remove the stigma of raising your hand,” Mullen said. “Leaders must lead on this issue or it will affect us dramatically down the road.”

About one in five combat veterans from Iraq and Afghanistan suffer from post-traumatic stress or depression, according to a study by the RAND Corp. In all, RAND estimates that 300,000 veterans have been affected and it could cost more than $6.2 billion to treat them.

“The PTSD issue is something we just all have to focus on,” Mullen said. “I think it’s a bigger problem than we know.”

Adm. Mullen delivered the keynote address at the U.S. Chamber of Commerce Hiring Our Heroes conference the day after Veterans Day. He noted that finding a decent-paying, challenging job was the biggest need for most active-duty veterans, Reservists, and members of the National Guard. He and others in the military are seeking the help of private business and business organizations in this effort.

If he has his way, freshman Rep. Joe Sestak will introduce legislation to adjust income-level requirements to allow a much greater number of veterans to receive VA care.

“We have a moral obligation to ensure that the men and women who put nation before self to serve in our armed forces receive the best possible health care,” he said. “As one critical part of attaining this objective, I am introducing a bill that will reverse income limits that have prevented more than 273,000 veterans from receiving health care. With this legislation, we will cover many of these vets through the VA, rather than forcing them to use more expensive private insurance plans.”

Rep. Sestak’s legislation focuses on improving benefits for veterans in two categories: Priority 7, veterans whose injuries are not service-related and whose income is more than $24,644 but less than 80 percent of the community’s median income; and Priority 8, veterans whose injuries are not service related and whose incomes are higher than Priority 7 veterans.

Since 2000, the number of uninsured veterans has increased by more than 235,000, to 1.8 million nationwide. Many were prevented from receiving care through the VA health system because of policies enacted in 2003 when the administration began banning so-called Priority 8 veterans from the VA health system. However, while Priority 8 veterans’ incomes are deemed too high to qualify for VA health care by the administration, they are often too low for the veterans to purchase private health insurance.
“Thousands of troops are returning from Iraq and Afghanistan with post-traumatic stress disorder and other mental health issues, and more veterans of the current wars are falling into homelessness faster than we have seen in any prior conflicts,” Sestak said. “It is imperative that we continue to devote as many resources as possible to combating these serious problems.”

Veterans with amyotrophic lateral sclerosis (ALS), popularly known as Lou Gehrig’s Disease, may receive badly needed support for themselves and their families after the VA announced that ALS will become a presumptively compensable illness for all veterans with 90 days or more of continuously active service in the military.

“Veterans are developing ALS in rates higher than the general population, and it was appropriate to take action,” Secretary of Veterans Affairs James B. Peake

Peake based his decision primarily on a November 2006 report by the National Academy of Sciences’ Institute of Medicine (IOM) on the association between active-duty service and ALS.

The report, entitled “Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature,” analyzed many studies on the issue and concluded that “there is limited and suggestive evidence of an association between military service and later development of ALS.”

“ALS is a disease that progresses rapidly, once it is diagnosed,” the Secretary explained. “There simply isn’t time to develop the evidence needed to support compensation claims before many veterans become seriously ill. My decision will make those claims much easier to process, and for them and their families to receive the compensation they have earned through their service to our nation.”

ALS is a neuromuscular disease that affects 20,000 to 30,000 people in the United States, is often relentlessly progressive, and is almost always fatal.

ALS causes degeneration of nerve cells in the brain and spinal cord that leads to muscle weakness, muscle atrophy, and spontaneous muscle activity. The cause of ALS is unknown, and there is no effective treatment.
While VVA is grateful for this step by the Secretary to give some measure of justice to veterans with ALS, we were disappointed with his negative decision on making hypertension service connected as well, based on the latest report from the Institute of Medicine. Many among us wonder about the possible hand of the Office of Management & Budget and cannot help but think that only the diseases that affect very few people, and hence have little fiscal impact, seem to move forward to service-connected presumptive status.



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