02 Dec 2010
New research suggests a hidden epidemic of suicide among younger
women with military service. Researchers found a markedly
elevated risk for young women veterans, with elevated risks for
middle-aged and older women with current or past military
Study authors Bentson H. McFarland, M.D., Ph.D.; Mark S. Kaplan,
Dr.P.H., and Nathalie Huguet, Ph.D. suggest that clinicians
should inquire about military service among women and should
recognize that suicide prevention practices pertain to female as
well as male veterans.
"This study shows that young women veterans have nearly triple
the suicide rate of young women who never served in the
military. This finding is very alarming," said Mark S. Kaplan
Dr.P.H., co-author of the study and Professor of Community
Health at Portland State University. "The elevated rates of
suicide among women veterans should be a call-to-action,
especially for clinicians and caregivers to be aware of warning
signs and helpful prevention resources."
This study was the first general population study of current
suicide risk among women with U.S. military service and support
was provided by the American Foundation for Suicide Prevention.
The study is presented in the December issue of Psychiatric
Services, a journal of the American Psychiatric Association
along with several other studies addressing the topic of
Another study, also looking at suicide among military personnel,
sought to better understand the clinical care of veterans before
suicide. The retrospective study, by Lauren M. Denneson, Ph.D.,
and colleagues, looked at 112 veterans who completed suicide
between 2000 and 2005 in Oregon and who had contact with
Department of Veterans Affairs (VA) health care services in the
year prior to the suicide. The researchers examined Veterans
Affairs clinicians' assessment of suicide risk during health
care visits prior to the completed suicides.
In the year before their suicide, about half of the veterans had
mental health contacts and about two-thirds had primary care
contacts. Most were seen for routine medical care; common
diagnoses included mood disorders and cardiovascular disease. Of
the 18 veterans who had been assessed for suicidal ideation at
their last visit, 13 denied such thoughts.
Research presented in another article looked at a specific
aspect of suicide prevention - engagement in treatment. Previous
studies have shown that up to half of suicide attempters refuse
recommended treatment, and some 60 percent drop out of treatment
after one session. A review of 13 empirical studies by Dana
Lizardi, Ph.D., and Barbara Stanley, Ph.D., found that when
suicide attempters are discharged from the emergency room or the
hospital, postdischarge follow-up by phone, by letter, or in
person must be immediate, substantial, and multifaceted to be
even minimally effective in preventing future attempts.
Researchers in Austria looked at whether the availability of
mental health professionals had an effect on suicide rates. The
study authors, led by Nestor D. Kapusta, M.D., found that
socioeconomic conditions, which determined the distribution of
mental health professionals in the population, were stronger
predictors of suicide rates than access to care per se. The
authors recommended working to reduce financial barriers as well
as geographic barriers to care.
American Psychiatric Association
Military Retirees Resist Push to Cut Health
DECEMBER 3, 2010
Defense Secretary Gates, shown before the
Senate Thursday, wants to overhaul the military health-care system.
Greg Bishop joined the Army 21 years ago with
this promise from recruiters: Serve for two decades and you'll get
health care for life. Now, Mr. Bishop, who retired from active duty
in September, is worried the government may be "moving the goal
At issue are possible changes to the military
health-care system, known as Tricare. As part of a raft of
debt-reduction measures, President Barack Obama's bipartisan deficit
commission recommended a review of Tricare, part of an effort to
reduce top-to-bottom federal spending. Secretary of Defense Robert
Gates also wants to overhaul the military health system.
The Republicans' ascendancy after the midterm
elections and the size of annual budget deficits have focused minds
in Washington on U.S. fiscal woes. In that climate, the deficit
panel's report could lead to a grand bargain next year between the
White House and Congress.
Before that happens, a retinue of powerful
backers will fiercely defend targeted programs and tax benefits.
Realtors and the construction industry are rallying to protect tax
deductions on mortgage interest. Liberal activist groups and AARP
want to beat back Social Security changes.
Veterans groups and military retirees are among
those mobilizing to fight back, in anticipation that the Pentagon
will recommend higher Tricare premiums in the president's 2012
As part of the social contract between the
nation and the all-volunteer military, Tricare is one of the most
emotionally charged targets for spending cuts, particularly in a
time of war.
"The heavy lifting [for this nation] is being
done by the military," said Norbert Ryan, a retired Navy admiral who
is president of the Military Officers Association of America. "They
should be the last ones to give. Don't ignore the service and
sacrifice that has earned them that benefit. Don't confuse it with
Social Security. Don't confuse it with Medicare and Medicaid."
Tricare includes plans that cover uniformed
service members, retirees and their dependents, in the U.S. and
overseas. Coverage for active-duty troops is largely free. The
Department of Veterans Affairs, which provides care for wounded
veterans no longer on active duty, or who have service-related
disabilities, has a separate budget.
The deficit panel report issued Wednesday was
short on specifics, but a series of draft recommendations called for
raising Tricare fees for retirees, a move that would save the
Pentagon about $6 billion in 2015. They noted that around 57% of the
people who use Tricare are retirees and their dependents, not
active-duty service members.
The cost for a military retiree to enroll his
family in Tricare Prime, which is similar to a health maintenance
organization, is $460 a year, a rate that hasn't changed since 1995.
According to the Kaiser Family Foundation, the average annual
premium currently paid by private-sector workers is around $4,000 a
Mr. Bishop, a partner in Musa Entertainment
Consulting Inc., a veteran-owned business in Los Angeles that helps
entertainment companies secure Pentagon cooperation, said access to
Tricare "was a major factor in my decision to go off on my own" in a
small business. Without that, "it would have been a tougher
In the past decade, the military's health-care
budget has more than doubled, ballooning from $24 billion a year to
more than $50 billion. Mr. Gates has complained health-care costs
are "eating the department alive."
In 2008, medical care ate 6% of the Department
of Defense's funding, according to the Congressional Budget Office.
By 2026, these costs are expected to more than double to 13% of
Tricare took a shot across the bow in August,
when retired Marine Corps Maj. Gen. Arnold Punaro decried "GM-style
fringe benefits" in a speech at the Center for Strategic and
International Studies in Washington. Mr. Punaro singled out
health-care costs for retired personnel as the primary culprit.
The speech rippled through the retired military
world. In an interview, Mr. Punaro joked that he was "probably
burned in effigy five or six times."
The Defense Department has previously attempted
moderate increases in premiums and co-pays, but has been met with a
furious response from Congress and veterans groups.
The Pentagon couldn't be reached for comment
Thursday on its current plans for Tricare.
That coalition of Congress veterans groups may
be on less solid ground now. The arrival in Congress of lawmakers
with a mandate to rein in spending has some veterans' advocates
nervous, especially after key pro-military members of Congress lost
their seats in November.
"A lot of people who understood our issues, who
are our biggest champions…are gone," said Steve Strobridge, the
director of government relations for the Military Officers
Association of America.
For Mr. Bishop, Tricare isn't simply an
employee benefit, but something earned in return for service. "I
understand the fiscal situation our country is in," he said. "I
understand that everyone needs to do their share." But, he added: "I
feel that veterans have already given something."
To direct the Secretary of Veterans Affairs to display in each
facility of the Department of Veterans Affairs a Women Veterans Bill
Rep. Filner, Bob
November 30, 2010
111th Congress, 2nd Session
H.R. 5953 is expected to be considered on
the floor of the House on Tuesday, November
30, 2010, under a motion to suspend the
rules, requiring a two-thirds majority vote
for passage. H.R. 5953 was introduced on
July 29, 2010 by Rep. Bob Filner (D-CA) and
referred to the Committee on Veterans
H.R. 5953 incorporates language from H.R.
5428, which was introduced on May 27, 2010
by Rep. Bob Filner (D-CA) and referred to
the Committee on Veterans Affairs.
The legislation would direct the Secretary
of Veterans Affairs to ensure that the Women
Veterans Bill of Rights is displayed
prominently in each VA facility and
distributed widely to women veterans. The
bill would enumerate women veterans health
care “rights” such as the right to the
(1) Coordinated, comprehensive, primary
women's health care at every VA medical
(2) Be treated with dignity and respect;
(3) Innovative care delivery;
(4) Treatment by clinicians with specific
training and experience in women's health
(5) Enhanced capabilities of medical
providers to meet unique needs; and
(6) Gender equity in access to and the
provision of clinical health care services;
The bill would also require the Secretary of
Veterans Affairs to establish and display
prominently an Injured and Amputee Veterans
Bill of Rights to include such “rights” as
(1) Access the highest quality prosthetic
and orthotic care;
(2) Continuity of care in the transition
from the Department of Defense health
program to the Department of Veterans
Affairs health care system; and
(3) Select the practitioner that best meets
their prosthetic and orthotic needs,
including a private practitioner with
Some members may be concerned that,
according to testimony from the VA, this
legislation would confer special rights upon
a limited group of veterans, leading to
inconsistent and inequitable patient care
provided to veterans as a group.
Additionally, some members may be concerned
that the “right” to seek private medical
treatment could mislead veterans to believe
they are entitled to receive services from a
non-VA practitioner, which could preclude VA
quality assurance and result in personal
financial liability for the veteran if the
VA is not authorized to incur the expense of
The bill would also require the Secretary of
Veterans Affairs to conduct employee
education regarding the Women Veterans Bill
of Rights and the Injured and Amputee
Veterans Bill of Rights, in addition to
requiring the Secretary to conduct outreach
to relevant groups of veterans.
There is no CBO cost estimate for this
TRICARE, Medicare Cuts Delayed Again
December 10, 2010
Congress acted again to delay plans to cut
reimbursement rates paid to health-care providers under TRICARE and
Medicare by 23 percent. Both the House and Senate approved H.R. 5712
shortly after Thanksgiving, which sets the implementation date of
the change at Jan. 1, 2011. The cuts had been slated to take effect
Dec. 3. The Fleet Reserve Association reports that two key lawmakers
Max Baucus, D-Mont., and Charles Grassley,
R-Iowa – are working on a plan to extend the delay for a full year.
Baucus chairs the Senate Finance Committee; Baucus is the
committee’s ranking minority member.
VisualDx Selected by the Department of Veterans Affairs for
Dec 11, 2010
Rochester, NY, December 11, 2010 --(PR.com)--
Logical Images announced today that their diagnostic decision
support system, VisualDx, has been selected by the Department of
Veterans Affairs as a new clinician resource to be deployed
nationally throughout the Veterans Health Administration’s (VHA)
medical centers and clinics, which treat more than 5.5 million
veterans on an annual basis.
VisualDx is the only diagnostic decision support system to
combine the power of a comprehensive library of over 19,000
medical images with specialist-developed clinical information.
The system aids primary care providers in the identification,
diagnosis, and management of over 1,000 visually identifiable
diseases, drug reactions, and infections.
“We are proud that our product supports the care of the men and
women who bravely serve in our armed forces,” said Richard Cohan,
CEO of Logical Images, Inc. “By implementing health IT resources
like VisualDx, the VHA continues to be a leader in our nation’s
movement to improve quality and care throughout our health
Via the Web and mobile devices, VHA clinicians now have
immediate point-of-care access to this diagnostic and
educational resource covering both common conditions they may
see on a daily basis, and rare diseases they may not. Clinicians
will be able to enter observations, symptoms, medical histories,
international travel locations, and other key findings about
their patient to return a pictorial list of diagnostic
possibilities they can then compare with their patient’s
presentation to more accurately identify the diagnosis. VisualDx
empowers the primary care clinician to manage a greater level of
care for their patients with dermatologic conditions – providing
more timely treatments, better patient understanding, and more
appropriate referrals to dermatologists.
VisualDx has been nationally deployed throughout the VHA with
the assistance of the Veterans Affairs Library Network (VALNET).
About Logical Images
Based in Rochester, NY, Logical Images develops visual health
care tools to elevate diagnostic accuracy, enhance medical
education, and heighten patient knowledge. Logical Images is a
company of digital imaging experts, leaders in computer-based
design and knowledge management, skilled image archivists, and
practicing physicians. The company’s products include VisualDx,
a visual clinical decision support system for diagnostic
accuracy, and Skinsight, the Web’s leading consumer skin health
and wellness resource. Logical Images has developed the most
comprehensive digital medical image library including over
70,000 images representing all ages and skin types. This
extensive collection is the foundation for all of the company’s
Web and mobile applications – designed to speed disease
recognition for faster, more accurate decision making and
Troops booted for pre-existing mental issues
Kelly Kennedy - Staff writer
Posted : Sunday Dec 12, 2010 12:57:38 EST
From 2003 to 2008, more people were separated from the military
within their first year of service for “pre-existing” psychiatric
conditions than for any other reason, according to a military
Those discharges do not qualify a service member for medical
benefits or medical retirement pay after leaving.
Twenty-two percent of soldiers who were given “existed prior to
service,” or EPTS, discharges had psychiatric conditions, while 42
percent of Marine Corps EPTS discharges fell under that category.
The figures for the Navy and Air Force were 24 percent and less than
1 percent, respectively.
Whether the Marine Corps is not screening its new recruits for
mental health issues as well as the other services, or whether other
factors are at work, is not clear.
According to the 2010 Accession Medical Standards Analysis &
Research Activity Report, the Army approved 1,231 waivers for
anxiety, dissociative and somatoform disorders from 2004 until 2009,
and another 522 for depressive disorder.
The Marines gave out 766 waivers during the same period for
neurotic, mood, somatoform, dissociative or fictitious disorder, and
230 for “disturbance of emotions specific to childhood and
But discharges for pre-existing mental health conditions far
exceed recruitment waivers for those conditions. Psychiatric
discharges are the top diagnosis for pre-existing discharges for
Marines and soldiers. From 2004 to 2009, 4,359 soldiers and 3,636
Marines were discharged during their first year of service for
pre-existing psychiatric conditions.
Many, if not most, of those service members probably did not see
combat because they were discharged while still in training.
The second-most common disability discharge for soldiers from
2004 to 2009 was for “affective and nonpsychotic mental disorders.”
In 2009, 2,798 soldiers left the Army on such discharges. The Marine
Corps discharged 528 people for those disorders. The Air Force and
the Navy’s rates are far lower.
The Marines “have more guys in combat, so they have more cases of
PTSD than the Navy,” said retired Army Lt. Col. Mike Parker, a
veterans advocate who helps troops get correct disability retirement
discharge ratings. “There aren’t too many sailors doing combat
deployments — just the docs and SEALs. The Marine Corps is all
Parker said that while most of the discharges for pre-existing
conditions are among service members who have been in uniform only a
short time, some are still being diagnosed with pre-existing
psychiatric conditions after they’ve been in for several years and
have served in combat — even more worrisome to veterans advocates
who say that combat experience may play a role in their mental
“I’m working with several Marines in that situation right now,”
Two years ago, Congress refined the rules for discharging people
for “personality disorder” as a pre-existing condition after it
became clear that many of troops really had PTSD or symptoms of that
disorder that was caused by their combat experience. Discharges for
personality disorder have subsequently declined, but Parker noted
that discharges for other mental conditions have jumped since
pre-existing personality disorder “became verboten” as a diagnosis
for troops with combat experience.
According to the Armed Forces Health Surveillance Center report,
adjustment disorder diagnoses rose from 35,774 in 2006 to 51,545 in
2009. Over the same period, anxiety disorder diagnoses rose from
14,140 to 23,609 and PTSD diagnoses rose from 8,416 to 14,193.
Personality disorder diagnoses decreased from 7,459 to 5,020.
Four senators wrote a letter to Defense Secretary Robert Gates in
October asking him to address a “new loophole” that allows the
military to discharge service members for “adjustment disorder” or a
similar condition when they actually have PTSD.
Service members discharged specifically for PTSD are entitled to
an automatic disability rating of 50 percent, which comes with
health care and other benefits. Adjustment disorder discharges do
not bring the same benefits.
“While it is a good thing that the Pentagon has moved away from
unfairly discharging combat troops by erroneously claiming a service
member had a personality disorder rather than addressing the harmful
effects of combat stress, we need to ensure a new method is not
being used to deny combat veterans the care and benefits they
deserve,” the senators wrote. “Unfortunately, the recent drop in
discharges for personality discharges has been accompanied by a
disturbing rise in discharges ‘for the convenience of the
government’ for ‘other physical or mental discharges not amounting
to disability.’ ”
The letter was signed by Sens. Kip Bond, R-Mo.; Chuck Grassley,
R-Iowa; Patrick Leahy, D-Vt.; and Sam Brownback, R-Kan.
They cited Pentagon data showing discharges for “other physical
or mental discharges” have more than doubled, from 1,453 in 2006 to
3,844 in 2009.
“We fear the rise in this category of discharges could reflect a
failure to identify and treat troops for whom a deployment-related
disability board would be more appropriate,” the senators wrote.
They asked for the number of soldiers discharged for personality
disorders and “other designated physical or mental conditions.”
Retired Air Force Col. Mike Hayden, deputy director of government
relations for the Military Officers Association of America, said
MOAA believes all service members should receive a presumptive
disability of 30 percent if they have served in the war zone — and
there should be no argument that the problem was pre-existing.
That would mean lifetime medical benefits, which, in the case of
those with mental health issues intense enough to qualify for
discharge, can mean the difference between relationship problems,
homelessness, unemployability and a strong, stable, happy life.
Hayden cited a June 2008 memo from Gates stating, “Is there a reason
we could not change the disability rating presumption for wounded
warriors to a minimum of 30 percent service-connected disability?”
“We are of a similar belief that if a troop is healthy enough to
send into harm’s way, then they are vested with the department and
EPTS should no longer be an issue,” Hayden said.
The Armed Forces Health Surveillance Center has recognized mental
health as an issue and has launched a series of studies.
“This report very likely underestimates the true incidence and
prevalence of the disorders of incidence,” the report states.
“Studies that employed anonymous questionnaires have measured the
relatively high frequency with which service members have expressed
their reluctance to seek assessment and care for possible mental
health disorders. Those barriers include shortages of mental health
professionals in some areas, and the social and military stigmas
associated with seeking or receiving mental health care.”
The report noted that more male service members spend time in the
hospital for mental health issues than for any other reason. Mental
health issues were the number two reason female service members were
hospitalized, second only to pregnancy-related conditions.
VA program empowers veterans with home health care options
Dec 16, 2010
By MICHAEL DEAK • STAFF WRITER • December
— Township resident Evelyn Marrinan
did not know much about
so when her
husband John became debilitated with diabetes, she
found herself lost in a labyrinth of options and not
sure of what to do.
Directed Home and Community-Based Services
Program came to the rescue.
"I am so grateful," Marrinan said Wednesday
morning at the VA New Jersey Health Care System
during a presentation celebrating the program's
"They were unbelievable."
What Marrinan liked best about the program was the
"empowerment" that the program gave her and her
husband, who died in April, to determine the proper
care for him.
"We could find what was best for him," she said.
The program, developed in 2008 and scheduled to
be implemented nationwide in 2011, was designed
to give veterans more input into their long-term
care so they could avoid institutionalization.
In the program, explained Daniel J. Schoeps,
national director of the VA's Purchased Long Term
Care Group, the needs of veterans are assessed and
a care plan is developed. The veterans then are
given a flexible budget and they choose, with the
help of a counselor, how to implement the plan,
including hiring and firing home health aides and
how to manage their
The program had to overcome questions that it
varied from other VA programs, Schoeps said.
"It's so different for the VA to place so much
and decision making with veterans," he said.
"We've been aware for some time that veterans
wanted more options," Schoeps said. "They wanted
more control over the decision making."
One of the keys to the program's success is that the
veterans and their caregivers are given expert
advice, not only in health care but in
matters as well.
Another key is the partnerships in the program
between the VA and local agencies, such as the
Somerset County Office on Aging. The agencies
provide resources and support that compliment the
services of the VA, Schoeps said.
"It's all about connecting," said Kenneth Mizrach,
director of the VA New Jersey Health Care System.
"It's a program were all community services come
together. It's a very special program."
Poonam Alaigh, commissioner of the New Jersey
Department of Health and Senior Services, said the
program is "an example of how we can
health care." She said the program provides
alternatives to traditional long-term care by "getting
partners together to make sure veterans get the
New Jersey was selected to spearhead the program
because of its tradition of home-based services for
veterans, Schoeps said.
Michael Deak: 908-243-6611;
VA's Standard Rates for Non-VA Care
Dec 17, 2010
Recent VA News Releases
To view and download VA news release, please visit the following
VA Announces Use of Standard Payment Rates for Some Non-VA Care
WASHINGTON (Dec. 16, 2010) - The Department of Veterans Affairs (VA)
announced today it will begin using Medicare's standard payment rates
for certain medical procedures performed by non-VA providers on Feb. 16,
"This regulation will have no impact on the Veterans we care for," said
VA Under Secretary for Health Dr. Robert A. Petzel. "VA will now have
the ability to better plan budgets and place more money into access to
health care for the Veterans that VA is honored to serve."
The new adjustment was made in federal regulations and will affect the
following treatments VA provides to Veterans through contracted care:
ambulatory surgical center care, anesthesia, clinical laboratory,
hospital outpatient perspective payment systems, and end stage renal
Veterans who are eligible for care will continue to receive the
uninterrupted care they need and have earned. Non-VA doctors and
facilities will still get paid for services they provide to eligible
Veterans but at rates set by the Centers for Medicare and Medicaid
Services (CMS) Prospective Payment Systems (PPS) and Fee Schedules.
Existing contracts will not be affected and the rule allows for new
contracts using the new rates.
Savings of approximately $1.8 billion over five years will allow VA to
continue to invest in such innovative programs as a wearable artificial
kidney, home dialysis and expanding access through stand-alone clinics.
"Adopting CMS pricing methodology for these schedules and services will
allow VA medical centers to use their resources more efficiently to meet
Veterans' needs," said Gary Baker, VA's health administration chief
business officer. "The adoption of Medicare rates will help ensure
consistent, predictable medical costs, while also helping to control
costs and expenditures."
The pricing methodology changes are a result of a rule change to 38 CFR
17.56, the federal regulation that governs VA when paying medical claims
for Veterans treated in community facilities. The proposed rule was
published on Feb. 18, 2010 and was opened for public comment April 19,
2010. The congressional review period for the final rule begins Dec. 17
and lasts 60 days.
VA is providing written notifications to Veterans and non-VA providers.
As additional information becomes available, it will be posted to the
VA's "Non-VA Purchased Care" Web site, www.nonvacare.va.gov.
VA Processing Claims for New Agent Orange Presumptives
Dec 18, 2010
VA Processes First Claims for New Agent Orange Presumptives New Program
Speeds Approval for Vietnam Veterans
WASHINGTON (Dec. 17, 2010) - The Department of Veterans Affairs (VA) has
decided more than 28,000 claims in the first six weeks of processing
disability compensation applications from Vietnam Veterans with diseases
related to exposure to the herbicide Agent Orange.
"With new technology and ongoing improvements, we are quickly removing
roadblocks to processing benefits," said Secretary of Veterans Affairs
Eric K. Shinseki. "We are also conducting significant outreach to
Vietnam Veterans to encourage them to submit their completed application
for this long-awaited benefit."
VA published a final regulation on Aug. 31 that makes Veterans who
served in the Republic of Vietnam and who have been diagnosed with
Parkinson's disease, ischemic heart disease, or a B-cell (or hairy-cell)
leukemia eligible for health care and disability compensation benefits.
With the expiration of the required 60-day congressional review on Oct.
30, VA is now able to process these claims.
Vietnam Veterans covered under the new policy are encouraged to file
their claims through a new VA Web portal at www.fasttrack.va.gov
<http://www.fasttrack.va.gov/> . Vietnam Veterans are the first users of
this convenient automated claims processing system.
If treated for these diseases outside of VA's health system, it is
important for Veterans to gather medical evidence from their non-VA
physicians. VA has made it easy for physicians to supply the clinical
findings needed to approve the claim through the new Web portal. These
medical forms are also available at www.vba.va.gov/disabilityexams.
The portal guides Veterans through Web-based menus to capture
information and medical evidence required for faster claims decisions.
While the new system currently is limited to these three disabilities,
usage will expand soon to include claims for other conditions.
VA has begun collecting data that recaps its progress in processing
claims for new Agent Orange benefits at www.vba.va.gov/VBA/agentorange/reportcard/index.html.