July 25, 2003


Military retirees living overseas who are eligible to receive mail through the Military Postal Service can now receive prescription drug shipments weighing more than 16 ounces. Previously, such shipments had to be in multiple packages each weighing less than 16 ounces. The MPS exception to policy allows contracted suppliers for the Tricare Mail Order Pharmacy program to mail a 90-day supply of prescription drugs that would have exceeded the 16-ounce limit. The exception is limited to prescription medication shipments made by Express-Scripts, Inc., which is the only authorized TMOP-contracted supplier.

July 25, 2003


Defense Department officials are seeking to resolve two issues involved with Combat Related Service Compensation: (1) whether CRSC will be paid based on the retiree's actual VA disability rating or a VA determination that the same veteran is 100-percent unemployable; and (2) the level of CRSC payable to retirees who are drawing both VA disability compensation and Special Monthly Compensation. The draft policy decision would allow higher CRSC payments for unemployability only if the combined combat-related disabilities meet threshold requirements for unemployability. If a finding of unemployability rests in part on non-combat-related injuries or illnesses, CRSC payments would not be raised. Issue: CRSC, SMC or Both?Under the draft plan being circulated by DoD officials, if retirees are drawing Special Monthly Compensation for severe disabilities in addition to VA compensation, the CRSC board would determine whether the disabilities are combat-related. For example, if a retiree had lost a foot from enemy fire,ny reduction in retired pay from receipt of SMC might be payable as CRSC. If, however, the loss occurred because of a power-mower accident at home, any reduction of retired pay from receipt of SMC might not be restored by higher CRSC. Even if the entire SMC payment is combat-related, CRSC wouldn't necessarily equal the sum of a retiree's SMC payment plus VA compensation because the purpose of CRSC is only to restore lost retired pay. Thus CRSC would not exceed the amount of retired pay offset.

July 25, 2003


"Totally unacceptable"said AMVETS (American Veterans) commander W.G. "Bill"Kilgore concerning legislation proposed by a House subcommittee for funding veterans' healthcare and related services. He added that the recommendation by the House Subcommittee on Appropriations is $2 billion below the nearly $30 billion that the congressional budget resolution had called for in April. "Coming at a time when our military personnel are putting their lives on the line in Iraq, Afghanistan and other places around the world, the FY 2004 VA-HUD appropriations bill is unconscionable."Kilgore said that adequate funding is absolutely essential if the Department of Veterans Affairs is to deliver quality health care to "the men and women who have sacrificed in the service of their country."He concluded that the subcommittee's proposal is just another reason why mandatory funding for veterans health care is "a must."

July 25, 2003


President Bush has proposed legislation that would improve benefits for short-term former POWs. "What we're proposing is to eliminate the current requirement in federal law that a former POW must be detained for at least 30 days in order to qualify for full POW benefits," said Secretary of Veterans Affairs Anthony J. Principi. The VA currently presumes that certain medical conditions in former POWs who were held at least 30 days are related to their captivity. Using this presumption, such veterans may obtain financial benefits without providing evidence directly linking a medical problem to captivity. "That may have made sense years ago for some conditions linked to nutritional deficiencies, but even a few days enduring terror at the hands of enemy captors may lead to other conditions," Principi said. The VA proposal also would improve dental care eligibility and exempt former POWs from copayments for medications for non-service connected conditions.

August 22, 2003

Fifty-two retired Army and Air Force general officers representing 1500 years of service to the nation have signed a letter to President Bush asking him to support congressional legislation for concurrent receipt. The letter says that last year the 107th Congress passed legislation "with overwhelming majorities in both houses" for concurrent receipt, but killed it because of White House opposition over costs, and substituted Combat Related Special Compensation. The writers state that CRSCcovers less than five percent of disabled military retirees. With a similar situation this year, the generals wrote, "We urge you as Commander-in-Chief to speak for the thousands of disabled GIs who faithfully served their country for an entire career, were disabled in service to their country and now find their retired pay taxed at a rate of 100 percent of their disability compensation." 

Update on Concurrent Receipt Letter
Currently, most military retirees forfeit one dollar of retired pay for every dollar of disability compensation awarded by the Veterans Affairs department. Congressional legislation to correct this inequity by authorizing "concurrent receipt" has been stalled in Congress by threats of a presidential veto because of costs. The sponsor of the letter from the retired general officers, retired Army Lieutenant General Billy M. Thomas stated, "It is really sad that our troops are giving it all they have in Iraq and doing a wonderful job, yet the President and his advisers would take the retired pay away from those who are disabled in Iraq should they make it to retirement." 

August 29, 2003

On August 15, the Centers for Medicare and Medicaid Services published the 2004 physician fee schedule, with another proposed reduction in fees. The amount of this reduction would be 4.2 percent, which opponents assert would reduce the number of doctors who take Medicare patients. (A recent study done by the American Academy of family Physicians indicated that 24 percent of their members all ready are no longer taking Medicare patients.) Such reductions affect not only Tricare-For-Life benefits, since TFL is secondary payer to Medicare, but also Tricare Standard and Prime beneficiaries, because Tricare reimbursement rates are tied to Medicare rates. In response, the House version of the Medicare Prescription Drug and Modernization Act would increase payments to doctors by 1.5 percent in both 2004 and 2005, and the Senate version calls for separate legislation to prevent the CMMS proposal. 

July 18, 2003

Retirees who are preparing applications for Combat-Related Service Compensation can ensure faster processing in three ways: (1) use VASRD (VA Schedule of Rating Disabilities) diagnosis codes; (2) submit original rating documents, because the most recent rating decisions may not contain the data needed; and (3) don't delay your adjudication by sending piles of unnecessary papers. Some retirees who tried to get VASRD codes in June were turned down, so they filed incomplete applications. Since then, VA officials have notified their regional offices to make the codes available. In addition, the VA is arranging for CRSC boards to have direct access to VASRD codes. So, what if your application included too much or too little? Don't apply again, which would only stall the adjudication longer, advises a Defense pay official who helped draft the CRSC regulations. Just wait, and your service's CRSC board will notify you of what, if anything, it needs. 

Olin E. Teague Veterans Center
1901 South 1st Street
Temple, Texas

July 16, 2003

I am Walter Schellhase, President of the Hill Country Veterans Council. The Council represents over 16,000 veterans in the Texas Hill Country. Thank you for the opportunity to speak to you reference the CARES initiative as the process relates to the Kerrville Division of the STVHCS. 

Members of your team have visited the Kerrville facility on at least two occasions. Therefore, you know the excellent condition of these facilities, the truly dedicated professional staff providing care to our veterans and the timeliness of service the veteran receives. Therefore, I will not go into telling you about the excellent facility we have in Kerrville. However, I will tell you about the desire of veterans through out South Texas choosing to make use of this facility as opposed to all others in the system. It is a well know fact that Veterans in South Texas will go the extra mile to obtain their medical health care in Kerrville when allowed to do so. Up until a few years ago, Kerrville was known as the very best in VA health care service. There had to been a reason for such desire on the part of the veteran to come to Kerrville.

Several years ago bad decisions were made reference acute beds, specialty services, surgery, and who will and who will not be entitled to VA service. The VA has a unique way of making the stagtistics reflect the numbers the system wants to see. As an example, this year you want the numbers to reflect usages. Therefore, service is extended to all categories of veterans. Next year you want to reflect a lack of usages. Therefore, you cut off service to a particular category. Lets face it, the VA is not providing the veterans with the service our veterans deserve and yet you cut or, in the case we are here today to discuss, enhanced realignment. Enhanced Realignment is NOT a bad term to use when you are trying to sale a product to congress. However, in real terms, it means reduced service to our Kerrville veterans, regardless of what you say. In fact at a recent briefing by one of your team members the statement was made, “we are not trying to close down anything, we are trying to justify keeping the small rural hospitals open”. We do not consider Kerrville a small rural hospital. The fact that the VA has selected to discontinue much of the services provided in the past, in the desire to achieve budget goals, does not mean these services are not still needed, it just means they are no longer available to the needing veteran in this particular area.

Lets look at the Kerrville hospital. Ten years ago there was over 300 active beds, specialist for most needs, surgery and an excellent team approach to veterans health care. Today we have 5 ICU and 20 acute beds. Now you propose to change the 20 beds remaining from acute to transitional. Has anyone in the VA bureaucracy ever wondered where those 280 veterans, needing acute beds, have gone for medical care? 
In the STVHCS stagtistics plan presented to the Council last December there was projected a continuing decrease in veterans count from now until 2022. As a veterans group we challenged
these numbers as being grossly in accurate. I see in the data provided for this meeting today, VISN 17 show a substantial increase in requirements for primary care in South Texas from a 2001 base line of over 212,000 to nearly 278,000 in 2012 and then a slight decreasing to a little over 256,000 in 2022. At the same time, specialty care is expected to continue to increase over the years by 53% in the year 2022. I am not for sure why 17’s figures differ so much from those used by STVHCS in December. The interesting thing however is, how can STVHCS justify recommendation of Alternative A (Status Quo) with a projected decrease in patient load where VISN 17 recommends Alternative D with a substantial increase in patient count.
VA started closing beds in our area (both Kerrville and Audie Murphy) several years ago and opening clinics. Opening clinics through the catchment area of each VA facility provided a tremendous service for the veteran. Many veterans that have never used a VA facility started to receive medical care at one of these clinics. It is a well-known fact that local clinics provide an additional input to the requirements of acute beds. For roughly every 20 outpatients seen in a clinic at least one patient will require an acute bed. However, when that veteran is referenced to the hospital for an acute bed, the bed is not available. You can provide all the clinics you want, but if you do not maintain the hospitals to support the clinics, you have provided the veteran a disservice. 
STVHCS director has stated on more than one occasion that we have gone too far in closing acute beds. And now, if I read this proposal correctly, you want to open more clinics in the San Antonio area adding additional needs for acute beds and at the same time, provide for the 20 Kerrville beds in San Antonio. Based on data presented and being reviewed here today, it is obvious there is a need for more acute beds not less in the South Texas area. So the question I have to ask is, “why change acute to transitional in Kerrville”?
This is where it becomes difficult to understand VISN 17’s recommendation. At the current time, when Audie Murphy’s acute beds are full, the patient is sent to Kerrville and this is not unusual. When Kerrville acute beds are full, which is about 50% of the time, patients are sent to Audie Murphy. However, on at least three occasions in the past 60 days three patients were referred to Audie Murphy but no beds were available. One went to the local hospital at his own expense, one was sent to Methodist and the other was held at Kerrville until a bed opened up at Audie.
When you look at VISN 17’s recommendation under the comments column it notes: “Implement in coordination with San Antonio”. To date, it appears no one knows exactly what this means. Does it mean Audie Murphy is going to open up more acute beds to accept the Kerrville’s beds? Does it mean there is a building or expansion program planned for San Antonio? Does it mean long range more parking is going to be provided? Does it mean another large building project? “Implement In coordination with San Antonio” – just what does that mean: how does it effect Kerrville and how can we find out? 
It would be a shame for the VA to consider any sort of expansion in San Antonio where the facility is land locked, parking a serious problem now and gets worst every day, and cost/BDOC is extremely high. This would truly be an injustice to the American taxpayer, especially when you have a facility in Kerrville with over 70 acres available for expansion, unlimited parking capability, an operation cost/BDOC of only $870, a staff that is recognized as one of the best throughout the area, and a facility that the veteran is willing to drive through San Antonio, by passing Audie, to be treated at the Kerrville facility.

How can you possibly not recommend an increase of at least 40 more acute beds in Kerrville to relieve the pressure at Audie, save hundreds of thousands of dollars in construction cost, provide the American taxpayer a break they deserve, make complete use of an excellent existing facility, added back the needed specialist such as surgery (now must go to Audie), urologist (waiting of over 67 days), Orthopedic (now must go to Audie) and podiatry (appointments made February will be kept in September). 
There are a lot of changes that need to be made in Kerrville, but acute beds to transitional beds is not one of them.

Thank you.

July 11, 2003

The Defense Department has received over 12,000 applications for Combat-Related Special Compensation, and has offered three suggestions to help expedite action on future applications. First, classify disabilities by VASRD code (VA Schedule of Rating Disabilities). To get this information, contact the VA regional office and request a listing. Second, especially for Post-Traumatic Stress Disorder, submit a copy, if possible, of the first VA rating decision on the disability that shows the basis of the award. Third, submit only supporting documents that deal with qualifying conditions. Those eligible for CRSC are retirees with 20 years of service for retired pay computation and who either have disabilities related to a Purple Heart award or are rated at least 60 percent disabled because of armed conflict, hazardous duty, or military-related injuries. Applicants must submit DD form 2860, Application for Combat-Related Special Compensation, to their own branch of service. 


July 5, 2003 
by Tom Philpott

If you're among tens of thousands of military retirees who still intend to apply for the new Combat-Related Special Compensation, below are tips from officials for filing a "good" CRSC application. If you're one of 15,000 retirees who already applied for CRSC, you might learn here that you provided too little or too much information. But don't apply again, says Tom Tower, a Defense Department pay expert who helped to draft CRSC regulations. Be patient and your service's CRSC board will notify you if it needs more information to determine eligibility. The tips presented here reflect a month's experience by the services in reviewing CRSC applications, and in working with the Department of Veterans Affairs to gain quicker access to VA disability codes and files.

Though the first CRSC applications were filed in early June, only about 1000 were reviewed and 100 approved in time for payments to begin July 1. Given the volume of applications, waits of two to three months will be commonplace for a while. But when CRSC payments do begin for current retirees, they will be retroactive to June 1. 

Congress enacted CRSC to cut or eliminate for a select group of disabled military retirees an offset in retired pay that occurs when they begin receiving VA disability compensation. Qualified retirees are those who were awarded Purple Hearts for these disabilities or had serious injuries or illnesses from combat, combat training, or "instrumentalities of war" such as Agent Orange.

An estimated 710,000 military retirees receive some VA compensation for "service-connected" disabilities. Only 35,000 to 40,000, said Tower, are expected to be found eligible for CRSC.

Monthly CRSC for most of them will range from $104 to $2193, matching the retired pay offset caused by their VA compensation. But CRSC, as interpreted by Defense officials, will not restore retired pay offsets resulting from VA compensation to retirees for spouse and dependents.

Tower described the volume of applications reaching CRSC Boards as "huge." About 60 percent are Army retirees, as expected. Only the Army is using a private contractor to help with the administrative burden. Volume is the big obstacle to timely decisions, Tower said. At least 50,000 total applications are expected, but the number could double. New applicants can ensure faster processing in three ways, he said:

1. Use VASRD Codes

The third page of the application asks retirees to itemize disabilities using diagnosis codes, known as VASRD or VA Schedule of Rating Disabilities. CRSC boards need the four-digit codes to verify that a disability is combat-related. Many applications filed so far lack these codes, often because the VA didn't provide them to retirees. Some retirees who tried to get them from the VA in June were turned down, so they filed incomplete applications.

Since then, VA officials have notified their regional offices to cooperate with CRSC applicants by running something called an M-13 screen to produce a list of diagnosis codes for each retiree and each VA disability. Meanwhile, VA is arranging for CRSC boards to have rapid access to such data on their own to allow quick verification of disability codes. That has taken "a little longer than we had hoped," said Tower. But in time, he said, applicants won't have to provide codes. "But we would still like them to do that, at least for a while…so their applications make good sense."

2. Provide Original Rating Documents

Another problem with many applications is that retirees provided copies of the most recent disability rating decisions, an increase perhaps of the rating from 40 to 60 percent, but did not provide the original rating decision. Only the original explains the basis for the disability. It is particularly important, Tower said, for applications involving "presumptive" diseases to prove a relation to combat.

For example, Tower said, the VA presumes that veterans suffering post-traumatic stress disorder have a service-connected illness. The CRSC board has to look behind that presumption to see if the stress is combat-related. Was the stress caused, for example, by an accident during weapons training or a house fire, which likely would not qualify for CRSC.

3. Avoid 'Kitchen Sink' Syndrome

July 4, 2003


When Congress took its Independence Day recess, the discharge petition on Rep. Mike Bilirakis' (R-Fla.) H.R. 303 (full concurrent receipt, to end the disabled veterans tax) had 201 signatures. This was 17 short of the 218 needed to move the bill to the House floor for debate and vote. Only one of the 201 signers is a Republican, Rep. Tom Tancredo of Colorado. Not even Rep. Bilirakis has signed the petition. Does this make it a partisan issue? The Military Officers Association of America says no, stating that it is only a partisan issue if politicians choose to make it so. Indeed, H.R. 303 has wide co-sponsorship, with 171 Republicans, 173 Democrats, and one Independent signed on. A MOAA official says, "We have to remind legislators that their first duty is to their constituents and not to their party leaders."