November 2010 Archives

Military veterans with psychiatric illnesses are at increased risk for suicide, says a new study.
Nov. 1

The greatest risk is among males with bipolar disorder and females with substance abuse disorders, according to the researchers at the U.S. Department of Veterans Affairs and Healthcare System and the University of Michigan.

Overall, bipolar disorder (the least common diagnosis at 9 percent) was more strongly associated with suicide than any other psychiatric condition.

The researchers examined the psychiatric records of more than three million veterans who received any type of care at a VA facility in 1999 and were still alive at the beginning of 2000. The patients were tracked for the next seven years.

During that time, 7,684 of the veterans committed suicide. Slightly half of them had at least one psychiatric diagnosis. All of the psychiatric conditions included in the study -- depression, schizophrenia, bipolar disorder, substance abuse disorders, post-traumatic stress syndrome (PTSD) and other anxiety disorders -- were associated with increased risk of suicide.

"In men, the risk of suicide was greatest for those with bipolar disorder, followed by depression, substance abuse disorders, schizophrenia, other anxiety disorders and PTSD," the researchers wrote. "In women, the greatest risk of suicide was found in those with substance abuse disorders, followed by bipolar disorder, schizophrenia, depression, PTSD and other anxiety disorders."

Since bipolar illness was most likely to be associated with suicide, "this makes bipolar disorder particularly appropriate for targeted intervention efforts or attempts to improve medication adherence," the researchers wrote.

The study found that many veterans with psychiatric conditions weren't identified by the VA health system.

"This could be owing to stigma, which may have made individuals less likely to report their mental health symptoms to physicians, an effect that could be more pronounced among men with military experience," the researchers wrote. "These findings highlight the importance of improved identification, diagnosis and treatment of psychiatric diagnoses (particularly bipolar disorder, depression, substance use disorders and schizophrenia) of all health care system users."

The study appears in the November issue of the journal Archives of General Psychiatry.

The U.S. Department of Veterans Affairs has more about veterans' mental health.

-- Robert Preidt

SOURCE: JAMA/Archives journals, news release, Nov. 1, 2010

Hope for the Journey - Diabetes Research at VA
Washington, DC, November 01, 2010 /PRNewswire

Group visits, telemedicine, peer counseling, and Internet-based education and case management are among the innovative strategies Department of Veterans Affairs (VA) researchers are studying to increase access to care and improve the health outcomes of Veterans and others with diabetes.

VA researchers are seeking better ways to prevent and treat diabetes, especially in special populations including the elderly, minorities, those with amputations or spinal cord injuries, and those with kidney or heart disease.

Diabetes is a serious chronic disease in which the body cannot produce or properly use insulin. The disease affects about 16 million Americans, including more than 800,000 Veterans receiving care from VA.

Much of VA’s research focuses on controlling the risk of cardiovascular disease in patients with type 2 diabetes, which is by far the most common type. For example, researchers at the Atlanta VA Medical Center are working to stave off progression of the condition before it reaches a full-blown stage. “I think (this project has) extended my life,” says Veteran Roger Parton, a participant in this research study.

In another important area of diabetes-related study—vision health—VA and its research partners have demonstrated that Veterans could be accurately tested for an eye disease called diabetic retinopathy using a method not requiring eye dilation. This new efficient and accurate eye test is helping reduce the risk of blindness in Veterans with diabetes throughout VA’s health care system, and the program is now being expanded to evaluate some other important causes of vision loss.

In yet another study that changed the face of diabetes care, researchers at the Miami VA Medical Center looked at whether glucose control affected the rate of cardiovascular disease in those with the disease. This seven-year trial found little reduction in the risk of stroke, heart attack, and other cardiovascular complications, compared with standard treatment. In light of the results of this study and others, major health organizations such as the American Diabetes Association issued new treatment guidance for doctors and patients.

Additional recent advances in VA diabetes research include:

·         Promising studies on the connection between insulin resistance—the hallmark of type 2 diabetes—and Alzheimer's disease.

·         A determination that, in some people, chromosome 12p is a likely site of genes associated with high triglycerides (a condition closely linked to diabetes, as well as obesity and heart disease).

·         Studies finding that walking on a treadmill can prevent and even reverse diabetes in chronic stroke patients.

“This kind of diabetes research is advancing the type of care we’re able to give Veterans,” notes Jennifer Marks, MD, chief of endocrinology at the Miami VA Medical Center and the VA Diabetes Trial’s principal investigator. “The care we provide gets better because of research.” For additional information on diabetes for Veterans, their families, and providers, go to For more information on how VA research is improving Veterans’ lives, go to

Media Contact:

Katie Roberts

Press Secretary

VA Office if Public and Intergovernmental Affairs

(202) 461-4982

Medicare Advantage Plans May Compliment VA Benefits
Nov 3, 2010

WOODLAND HILLS, Calif., Nov. 2, 2010 /PRNewswire/ -- The nation pauses to honor its veterans on November 11 for their patriotism, love of country, and willingness to serve and sacrifice for the common good. Naturally, we want our veterans to be taken care of, especially when it comes to their health. Those who have served their country through the United States military have several options when it comes to their health care coverage.

Qualifying veterans receive care at VA facilities. Additionally, those 65 years old and older – and those with certain disabilities – may qualify for Medicare. "Many veterans don't know about their Medicare rights," said Krista Bowers, president of senior business at Anthem Blue Cross. "Most have earned access to the Medicare system, just as they've earned their VA benefits. They shouldn't lose the opportunity, especially since some of these benefits may be offered at low or no cost. VA and Medicare offer different, yet valuable, benefits to veterans."

Through the VA, eligible veterans have access to a full range of preventive outpatient and inpatient services as long as they stay within the VA health care system, which includes hospitals, clinics, nursing homes, pharmacies and doctors nationwide. VA co-payments and deductibles, including the costs of prescription drugs, are generally less than Medicare. Eligibility for benefits is based on a priority system. According to the United States Department of Veterans Affairs website, there are more than 8 million people covered by the VA Health Care System.

Medicare has four parts – A, B, C and D. Part A covers inpatient services, including hospital, skilled nursing facility, home health and hospice care. Part B covers outpatient medical services, such as doctor visits, preventive care and durable medical equipment. Part C, also known as Medicare Advantage (MA), combines Parts A and B into one plan that is run by private insurance company, like Anthem Blue Cross, rather than the government. These plans may also include Part D, which is drug coverage.

Most people, including veterans, don't pay a premium for Part A. In most cases, these costs have been covered by payroll taxes. In contrast, Part B generally requires a monthly payment. Some companies offer Medicare Advantage plans (Part C) that cover everything included in Parts A and B, and more, including preventative services, at no additional cost. These are known as "zero premium plans." Some of these plans could also include dental, vision and hearing coverage. Other plans provide the same services, but require a monthly premium.

Enrollment processes and eligibility differ for VA and Medicare. Veterans can choose to participate in one program or the other or both. Enrollment in a Medicare plan does not affect an individual's VA eligibility.

On its website the VA recommends veterans not decline Medicare based solely on their VA coverage. The VA says there is no guarantee funds will continue to be appropriated for medical care for all enrollment priority groups. This could leave some veterans, especially those enrolled in one of the lower priority groups, with no access to care. For this reason, having a secondary source of coverage, like Medicare, may be in a veteran's best interest, the VA says.

Additionally, people who decline Medicare Part B when they are first eligible to receive it face substantial financial penalties if they decide to enroll later. The initial enrollment period typically occurs in the three months before the person's 65th birthday, their birthday month and the three subsequent months. There is no similar penalty for veterans who delay Part D enrollment because the VA's drug coverage is deemed equal to or better than Medicare.

Other benefits of Medicare for veterans include having access to doctors, hospitals and pharmacies outside the VA network and potentially having a larger list of covered drugs. Wider access could be important in case of an emergency or if a veteran needs a second opinion or specialized care.

There are additional benefits to having a Medicare Advantage plan. They vary by insurer, but may include some or all of the following:

  • Limits to total out-of-pocket costs
  • Fitness programs, such as free gym memberships
  • Preventive dental and vision care
  • Programs that help people with chronic diseases, such as diabetes and asthma.
  • Discounts on non-covered health-related products
  • Chiropractic and podiatry services


It's important to remember that Medicare cannot generally pay for the same service paid for by the Department of Veterans Affairs (VA). Nor can the VA generally pay for the same service paid for by Medicare

"Obviously, this can get very complicated," said Bowers. "There are many things for veterans to consider when selecting health care, including premiums, copayments and access. At Anthem Blue Cross we provide health benefits to many veterans and are happy to answer their questions to help them understand their options. After all, they deserve the absolute best health care coverage they can get."

For more information about veterans and Medicare, visit the Department of Veterans Affairs Web site at and click on "Medicare Information for Veterans."

About Anthem Blue Cross

Anthem Blue Cross is the trade name of Blue Cross of California.  Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross names and symbols are registered marks of the Blue Cross Association.

SOURCE Anthem Blue Cross


A recent study conducted by researchers at the Stanford University School of Medicine and the Veterans Affairs Palo Alto Health Care System indicates that Dabigatran, an anti-coagulant drug which recently received approval from the U.S. Food and Drug Administration (FDA) to be used as an alternative drug to warfarin in the treatment of atrial fibrillation, may also provide patients with a more cost-effective way of preventing strokes, as well as offering better health outcomes, when compared to warfarin.

Mintu Turakhia, MD, MAS, who is a Cardiac Electrophysiologist, an Instructor of Medicine at the Stanford University School of Medicine, a Veterans Affairs Investigator, as well as the senior author of this research, issued the following comment about the study: “Dabigatran is the first new drug in 20 years to be approved for stroke prevention in atrial fibrillation, and we wanted to see if it could be cost-effective even before it made its debut in the United States. We now have sufficient efficacy and cost-effectiveness data to help inform policy on this drug in the United States.”

Turakhia, who specializes in the treatment and research of atrial fibrillation, also commented on the need for a more effective drug for the treatment of atrial fibrillation: “Among my patients, I get asked about alternatives to warfarin a dozen times a week. Many of them are just unhappy with the need for regular, often lifelong blood testing.”

VA: Long Term Care Benefits Through Department of Veterans Affairs
Nov 4 2010

A quick little history lesson for you:

The veterans assistance program goes back to 1636 when Pilgrims of Plymouth Colony fought with the Pequot Indians. The Pilgrims enacted a law from English law that reads, “If any man shall be sent forth as a soldier and shall return maimed, he shall be maintained competently by the colony during his life.” In 1789 U. S. congress passed as law that pensions were to be provided to disabled veterans and their dependents and in 1811 the first domiciliary and medical facility for veterans was completed.

Since that time the Department of Veterans Affairs has opened a multitude of care facilities nationwide. An article from the US Department of Veterans Affairs website states:

“VA’s health care system has grown from 54 hospitals in 1930 to 157 medical centers in 2005, with at least one in each state, Puerto Rico and the District of Columbia . More than 5.3 million people received care in VA health care facilities in 2005, a 29 percent increase over the 4.1 million treated just four years earlier.
VA operates more than 1,300 sites of care including nearly 900 ambulatory care and community-based outpatient clinics, 136 nursing homes, 43 residential rehabilitation treatment programs, nearly 90 comprehensive home-care programs, and more than 200 Veterans Centers.”

The National Care Planning Council has a piece on nursing homes available to veterans: 

Veterans Nursing Homes are generally available to active duty veterans but some states have beds for people who served with the reserves or National Guard and the spouses of veterans. The majority of these homes offer nursing care but some may offer assisted living or domiciliary care. Generally there is no income or asset test. Most veterans in most states would qualify. Many states have waiting lists of weeks to months for available beds. Each facility has different eligibility rules and there is an application process. You cannot simply walk in the door and arrange for nursing care on the spot. You must contact the veterans home you are interested in to find out the availability of beds and the application process. There are other veteran benefits which make money available that may be a better solution to your care needs.

In my experience in the in home care industry, I’ve noticed that many seniors who are eligible for veteran’s benefits do not completely understand exactly what they qualify for.  As the benefits relate to in home care, often times you must have served during a time of war to qualify for an in home care benefit. 

The good news is if you find yourself needing to access an in home care benefit, many professionals will know how to help you out.  For instance, a social worker, in home care provider, discharge planner, or other senior provider can either educate you or find the right resource for VA benefits.  You can also find many answers to your questions in the healthcare section of the VA website.

Senior Life Care Planning, LLC

A fact sheet issued by VA Health Care states that all veterans stationed at Camp Lejeune from 1957-1987 should have been contacted through a mail campaign initiated by the Department of the Navy.

A fact sheet issued by VA Health Care states that all veterans stationed at Camp Lejeune from 1957-1987 should have been contacted through a mail campaign initiated by the Department of the Navy.

Capt. Brian Block, a spokesman for the U.S. Marine Corps, said veterans are encouraged to register if notified.

"As a registered member, veterans will be sent updates on ongoing health studies related to PCE exposure, and they can use that information when determining their next step," he said. "We leave it up to the individual to file a claim for health benefits, but we certainly encourage all veterans to seek medical attention if they are ill.”

Camp LeJeune’s water contamination stems from PCE exposure.

Veterans Affairs Scrambles To Serve Female Veterans
November 7, 2010

by Frank Morris

November 7, 2010

Audio for this story from Weekend Edition Sunday will be available at approx. 12:00 p.m. ET

·         Transcript


Map: Women Veterans By State

The number of women serving in the military has mushroomed in recent decades to more than 200,000 active duty, not counting National Guard and reservists. This growing population faces many of the same problems as men — but also health and mental issues that are unique to female veterans.

In a wide hallway at a junior college in Kansas City, Mo., veterans — many of them homeless — drift from table to table. They're collecting everything from clothes and soap to legal advice.

The recent event, hosted by the Women's Bureau of the Labor Department, was designed specifically for female veterans.

Air National Guard Lt. Col. Connie Johnson-Cage smiles at the sight of so many of them.

"What do we typically see on TV? We see men fighting in the war. We see men veterans," Johnson-Cage says. "We never hear about the women in the back supporting the men. Now that we have women on the battlefield as well, we need to understand that we are all inclusive, and we are all veterans."

When Johnson-Cage's mother served in Vietnam, women made up about 3 percent of the military. Now women hold 15 percent of active-duty roles, according to the Department of Veterans Affairs.

But, the military, and the veterans system, was originally built by and for men.  That legacy frustrates Kim Rushing, a 20-year veteran of the Navy. From her wheelchair, she scoffs at tables piled with olive drab long johns.

"All this stuff, is all men's stuff," she says. "I'm a woman and I served my country, and that's what I get, is men's stuff."

Gender-Specific Treatment

Veterans Affairs lags behind the surge of women joining the military. Though, Patricia Hayes, the VA's national director of women's health services, says it's come a long way in the past couple of decades.

Eli Reichman

Even though she has served for a decade, Army Reserve Sgt. Miesha Wooten-Carr says she didn't know the VA provides comprehensive health care for women until last year.

"First of all, the woman might say that when she walked in she felt like she was walking a gauntlet," Hayes says. "There'd be a lot of men sitting in the waiting room. No images of women veterans. And the clerk may have said, 'Gee, are you here for your husband?'"

As recently as three years ago, only about a third of VA hospitals and clinics offered women's care. Hayes says that soon all of them, more than 1,000 facilities, will provide gender-specific treatment.

"So we're having this cultural change throughout the VA, which is also based on meeting their medical and health needs," she says.

Hayes says the VA is committed to getting the word out to women like Army Reserve Sgt. Miesha Wooten-Carr.

In her living room in Kansas City, Mo., Wooten-Carr is going over spelling words with her lively 6-year-old daughter.  Although, Wooten-Carr has served for a decade, it was only on her way home from Iraq last year, when she learned that the VA provides comprehensive health care for women.

"Wow. Head to toe, really? As a woman, you're going to take care of everything in this one clinic?  Uh, yeah, I was so amazed! And so far, the services have been really good," she says.

1 In 5 Faces Sexual Assault

The VA is also addressing women's psychological trauma. According to the agency, more than 1 in 5 military women reports being raped or severely harassed in the service.

Eli Reichman

Army veteran Hannah Jones says she spiraled into drugs, alcoholism and prostitution after being raped by a superior officer. She was homeless for years before getting help through the VA.

Army veteran Hannah Jones, 49, lives in a subsidized apartment in Kansas City. There she recounts being raped by a superior officer as a young recruit.

"If I tell anyone, he said, he'll know, and he will kill me," she says. "Every day, I saw him. Several times a day. I was so scared. I was 19."

Jones she says never reported the incident. She spiraled into drugs, alcoholism and prostitution. She was homeless for years before getting counseling, full medical benefits, and even housing, through the VA.

"I just, I love the VA — all this help they've given me, I can't help but love them," she says.

Jones says the range of mental and physical care the VA provides keeps her off the streets.

And that could be true of many more women after her: The VA expects the number of women seeking its services to double in the next decade.


VA Health System Shines in Quality-of-Care Study
November 8, 2010

A report in the November issue of the national publication Medical Care finds that the Department of Veterans Affairs (VA) health system generally outperforms the private sector in following recommended processes for patient care.

"This report is strong evidence of the advancements VA continues to make in improving health care over the past 15 years," said Secretary of Veterans Affairs Eric


K. Shinseki. "The systems and quality-improvement measures VA actively uses are second to none, and the results speak for themselves."

A research team with VA, RAND Corp. (a non-profit research institution) and two universities reviewed 36 studies published between 1990 and 2009. While the review did not include studies of surgical care, it did cover a range of studies of diseases common among Veterans, such as diabetes, heart disease and depression.

The study authors, led by Dr. Amal Trivedi of the Providence, R.I., VA Medical Center and Brown University, cite possible reasons for VA´s more positive performance, including integration of health care settings, use of performance measures with an accountability framework, disease-management practices and electronic medical record or health information technology. Among the specific findings of the review were.

- Nine studies comparing VA and non-VA care in general showed greater adherence to accepted processes of care-or better health outcomes-in VA.

- Five studies of mortality following a heart attack or other coronary event found similar survival rates in VA and non-VA settings.

- Three studies of care after a heart attack found greater rates of evidence-based drug therapy in VA; one found lower use of clinically appropriate angiography (blood vessel imaging) in VA.

- Three studies of diabetes care found VA to have better adherence to guidelines.

- Three studies found higher rates of vaccination against flu and pneumonia for the elderly in VA.

To gain greater insight into differences between VA and non-VA care and to also identify ways to improve VA care even further, the authors recommend continuing research with even more recent data. They also say there´s a need for studies that compare VA specifically to high-performing private health care systems, rather than to a broad cross section of non-VA facilities.

Collaborating with Trivedi on the review were co-authors affiliated with RAND, the University of California-Los Angeles and the Greater Los Angeles VA Medical Center.

For more information about VA health care, visit :
To learn more about VA research, go to :

U.S. Department of Veterans Affairs Office of Public Affairs Media Relations 202-461-7600

When the battle never ends - Military suicides and homelessness
November 11, 2010

By Donna Carbone, West Palm Beach Women's Issues Examiner


·         Earlier this year, I wrote a post entitled “The Military, Mental Health and Suicide Statistics,” which detailed the horrifying fact that 18 veterans kill themselves each day. Each day! If that is true, the total per year is 6,570 men and women dying because mental health care is failing them.

A 2008 study by the Rand Corporation estimated that more than 620,000 veterans who had served in the Middle East would need long term care for traumatic brain injuries. According to that study, one in five soldiers returning from the Middle East display symptoms of PTSD, putting them at a higher risk for suicide. Now consider that in 2008 over 22,000 veterans called a suicide hot line begging for help.

A few months ago, I wrote a follow up post entitled, “Incompatible: Military Macho and the Mind.” This was my attempt to understand why death was more appealing than life to so many of our brethren in uniform. Suicide is often described as a permanent solution to a temporary problem, but that philosophy fails to take into consideration that “temporary” can be an endless time frame.

Soldiers are expected to be brave in the face of all danger, unwavering in their allegiance to their country; following orders blindly even knowing that death will be their reward. Should they not be able to perform to these standards, shame is their only companion. Is it possible that the “shame” of not being able to re-enter society and behave “normally” weighs so heavily on their minds that eternal darkness is the only solution. Are we shaming our soldiers to death?

It is now 2010 – nearly 2011 – and the Veterans’ Administration is still at a loss for answers.

As if the deficiencies in health care aren’t enough, statics for veterans living on the streets are mind-boggling. The Department of Veterans Affairs estimates that approximately 107,000 soldiers are homeless. Last year, 92,000 veterans applied for help through the VA’s specialized programs. Another 100,000 reached out to churches and charities for food, shelter and clothing.

According to the National Coalition for Homeless Veterans, the majority of “old soldiers” without a roof over their heads are men (5% female). They are single and suffer from mental illness and substance abuse. A staggering 50% served during the Vietnam War, which ended in 1975. Am I to assume these wounded warriors have been tucking themselves into cardboard boxes for 35 years?

By now you have realized that the recurring theme in all these scenarios is mental illness. Obviously, post-traumatic stress disorder and traumatic brain injuries are not a recent side effect of battle. Veterans of yesteryear are homeless as a result of these conditions. Today’s veterans choose suicide.

Why is it taking so long to find solutions to problems that that began with the cavalry somewhere on the open plains of the wild, wild west? Three years are all that was needed to develop the hydrogen bomb. Can nuclear fission really been easier to understand than the human mind?

Napoleon Bonaparte said, “Death is nothing, but to live defeated and inglorious is to die daily.”

Let’s not let that sentiment be the thanks we give to our veterans for their service to our country.

How electronic records transformed care for veterans
November 11, 2010

By D

Rod Mickleburgh

From Friday's Globe and Mail
Published Thursday, Nov. 11, 2010 10:14PM EST
Last updated Friday, Nov. 12, 2010 9:17AM EST

Ken Kizer is the miracle man of U.S. health care. Mr. Kizer brought in bold reform that transformed the vast and woeful Veterans Health Administration into an efficient, effective model institution with sky-high patient satisfaction. Starting in 1994, it took him five years to reduce costs and increase quality of care, while nearly doubling the number of patients.

The measurable results included a reduction in medication errors and patient deaths.

“What's wrong with expecting the government to do a good job?” he would ask those professing amazement at the change.

Key to the VHA's stunning improvement was the implementation of easily accessible electronic health records (EHRs).

What's so great about electronic health records?

It allows you to have all the information you need when you're actually face to face with the patient. It allows you to track and monitor performance and what should be done. Instead of sitting there and reciting a bunch of numbers to a patient, you can show them a single coloured graph that shows – for a diabetic, say – all their hemoglobin A1c readings for the last three years. And so much more. It changes the dialogue. It changes the way health care is provided.

What happened when you instituted them at VHA?

... It would be less than honest to say that it wasn't stressful and there wasn't some fallout. We lost between five to 10 per cent of our physicians.

Are there any downsides?

There are obviously risks of information leakage, although there are technical ways to prevent that happening. And you have to remember that EHR is just a tool. The real way it improves care is by making you focus on improving the process of care. If you automate a bunch of lousy processes, then you just get automated lousy processes.

How difficult was it to do this in a country where many people believe health care should be left to the private sector?

People said there was no way it could work, because it was government. But the number one lesson of the VHA is that governments can provide efficient, patient-centred, high-quality health care.

Where is the United States at now in terms of EHRs?

There's a lot of activity and a lot of money pouring in, but I'm not sure we're any better than you are in Canada.

You have headed a company that promoted “open-source” software for EHR, instead of a pricier proprietary system. Why do you think open source is better?

I believe the solution to health-care information technology lies in the open-source world that basically gives away the code. That is then adapted to local circumstances. With the proprietary model, you are always going back to the vendor for changes, and they decide whether to do them and how much they will cost. In Europe, open source EHR software is zooming. It's the most widely deployed EHR system in the world, but not here.

Why not?

... We have this very established and influential, private software industry that has done a good job of dissing the open-source system we put in at VHA. And people don't understand the conceptual difference between the two systems.

Blood-Thinning Pills Work with Either Home or Clinic Testing
November 11, 2010

VA Study Finds Similar Results

WASHINGTON (Nov. 4, 2010)-- Patients taking warfarin, a widely used blood-thinning pill that requires careful dose monitoring, have similar outcomes whether they come to a clinic or use a self-testing device at home, according to a recent Department of Veterans Affairs (VA) study.

The findings, published in the Oct. 21 issue of the New England Journal of Medicine, are good news for heart patients who live far from clinics or are homebound.

"This study helps answer an important question for cardiologists, primary care physicians and other health providers, and will lead to improved care for their patients," says VA Chief Research and Development Officer Joel Kupersmith, MD, himself a cardiologist. "The results are significant for a great number of Veterans currently receiving care through VA."

Traditionally, doctors, pharmacists and nurses monitor patients who are taking warfarin, sold as Coumadin, over several clinic visits. They test how fast the blood clots and adjust the dose accordingly: Too low a dose will not prevent dangerous blood clots and blood flow to the heart, brain or other areas of the body could be inadvertently blocked. Too high a dose could lead to dangerous internal bleeding.

Patients have the option of tracking their own blood response at home, using blood analyzers known as international normalized ratio (INR) monitors. Patients do a finger stick, apply a small amount of blood to a test strip and feed the strip into the device.  The procedure resembles the one used by people with diabetes to check their blood sugar.

Patients can then call in the results to their provider and get advice on dose adjustments without coming to the clinic. In some cases, they can even set the proper dose of warfarin on their own.  

The authors of the VA study expected home monitoring to work better than clinic monitoring, partly because self-testing can be done at home more frequently-weekly, compared with the typical monthly schedule of the best clinic-based monitoring.  As a result, off-target INR values can be adjusted more regularly and more quickly. 

However, the VA study found little difference between weekly self-testing and monthly testing by clinic-based care teams in the measured outcomes, which are strokes, major bleeding incidents and death.

The study did find, though, that self-testing at home may offer advantages in other areas: It moderately boosted patients' satisfaction with the medication and slightly increased the length of time they were in the appropriate dose range.

Study co-leaders were Dr. David Matchar, M.D., an internist with the Durham, N.C., VA Medical Center, Duke University School of Medicine and Duke-NUS Graduate Medical School, and Dr. Alan Jacobson, M.D., a cardiologist and researcher with VA and Loma Linda, Calif., University School of Medicine.  They said the main message of the study is that patients who are systematically monitored-no matter by what means-are likely to have good outcomes.


The study was sponsored by VA's Cooperative Studies Program, part of the VA Office of Research and Development. 

Armed Forces News
November 11, 2010

TRICARE to Beneficiaries: Use Mail Order


TRICARE, the managed health-care plan for members of the armed forces, says it could greatly curtail expenses if more beneficiaries used the mail-order option when filling or refilling prescription medication. Roughly 9.7 million beneficiaries have used mail order to fill 10.5 million prescriptions last year – encouraging numbers, particularly when compared to the 9 million prescriptions filled similarly in 2008, according to TRICARE. But the 9.7-million figure still represents only about eight percent of all prescriptions filled in 2009. While most beneficiaries fill their prescriptions at retail pharmacies, that option remains the most expensive – for the agency as well as patients themselves, according to TRICARE. Prescription costs are lowest when beneficiaries pick their prescriptions up at pharmacies located on military treatment facilities. But often, distance and logistics can make that impossible. In those cases, the agency says, mail order is the best option, with patients paying a third of the price for their medications as they would at civilian pharmacies.

Armed Forces News
November 11, 2010

Veterans Warned of False Email


Veterans who receive an e-mail touting a piece of legislation that would double their disability pay should not pay any attention to it, advocates advise. The e-mail is wrong. The bill mentioned in the e-mail – the Veterans' Compensation Cost-of-Living Act of 2010, is real, the Fleet Reserve Association

(FRA) notes. But the e-mail's claim about the increase in the payable amount of disability compensation from the Department of Veterans Affairs (VA) is not. Rather, as always, any cost-of-living adjustments

(COLAs) for disabled veterans, retired military members, or Social Security recipients will be pegged to the Consumer Price Index (CPI), a calculation of out-of-pocket expenses produced by the U.S. Labor Department's Bureau of Labor Statistics. The Veterans' Benefits Act of 2010 (H.R. 3219), which has cleared Congress and awaits President Obama's signature, does include some increased allowances and improved benefits, FRA says.

Mesothelioma Awareness In the Spotlight This Veterans Day
November 12, 2010

in Mesothelioma

Veterans Day, held every November 11 in the United States, honors veterans past and present through events and remembrance across the nation. Raising mesothelioma awareness is important on Veterans Day since so many veterans were exposed to asbestos during service and subsequently developed mesothelioma cancer.

The association between veterans and mesothelioma traces back to exposure that occurred during service. According to the United States Department of Veterans Affairs, thousands of military veterans have suffered from the asbestos-related illness mesothelioma. Many veterans from each division were exposed to the fibrous mineral asbestos during service, and on naval vessels where it was used as the main form of insulation.

All divisions of U.S. Armed Forces used asbestos, but the Navy found more uses than other sectors. More than 300 asbestos-containing products were used through the 1970s, where it appeared on most ships used by the Navy and in the shipyards where vessels were built.

The Navy issued a ban on asbestos-contaminated materials on new ships in 1973, but then violated its own ban for the next five years. In 1983, the Navy Asbestos Control Program was created to help facilitate compliance with asbestos-related regulations set by the U.S. Department of Labor’s Occupational Safety and Health Administration. Despite these actions, many veterans continued to be exposed to high levels of asbestos even after the Navy began to replace contaminated ships.

Asbestos, a toxic mineral, was commonly used as insulation in piping, boilers, sleeping quarters and navigation halls aboard vessels. The mineral’s innate resistance to fire and highly durable qualities made it an ideal choice for use in all sectors of the military, where it was also used for aircraft, vehicles and buildings.

Mesothelioma typically develops decades after moderate to heavy exposure to asbestos. When toxic asbestos fibers are inhaled, they may become lodged in organs or body cavities, causing inflammation or infection. Approximately 2,000 to 3,000 new mesothelioma cases are reported every year in the United States. Military veterans who suffer from mesothelioma may apply for Veteran Affairs (VA) benefits.

Today’s annual National Veterans Day Ceremony will be held at Arlington National Cemetery in Arlington, Va., commencing with a wreath laying at the Tomb of Unknowns, the day’s events include a concert, parade and remarks from dignitaries.

Additional information on mesothelioma and asbestos exposure among veterans may be found through the Mesothelioma Center.

America's Veterans: The Collateral Damage of War
November 12, 2010

The current situation for veterans is not new, just different. This Veterans Day, HBO is debuting a documentary entitled Wartorn: 1861-2010. Through interviews, personal letters and journals of soldiers, photos and archival footage, the 68-minute film traces post-traumatic stress disorder (PTSD) back to the Civil War. -

Marcia G. Yerman at the Huffington Post

It is a given that before a person is equipped to be part of a military fighting machine, he or she must be trained — physically and mentally. What is not explicit is that upon a return to civilian life, there is no preparation for reentry into the previous rhythm of life.

Hopefully, with voices demanding to be heard, the public, lawmakers, and other agencies will listen to the urgent calls to action that must be heeded.

The current situation for veterans is not new, just different. This Veterans Day, HBO is debuting a documentary entitled Wartorn: 1861-2010. Through interviews, personal letters and journals of soldiers, photos and archival footage, the 68-minute film traces post-traumatic stress disorder (PTSD) back to the Civil War. At that time, survivors were labeled as hysterical, melancholic, or insane. In fact, it is noted that “after the Civil War, over half of the patients in mental institutions were veterans.” In World War I, the condition was referenced as “shell-shock.” During World War II, the term “combat fatigue” was euphemistically employed. (Included in Wartorn is a scene with a group of World War II vets sharing their stories for the first time. One man explains, “I had no one to turn to. No one understood.” Another reveals, “You’re just not coming home the same guy you left.”)

We now have the terminology and psychological insights to recognize the problem. But are we doing any better? When interviewed, General Peter Chiarelli, the Vice Chief of Staff of the U.S. Army who is working to stem the rising tide of suicides states, “You’re fighting a culture that doesn’t believe that injuries you can’t see can be as serious as injuries you can see.” In reality, Chiarellli points out, “these are hidden wounds as serious as losing an arm or a leg.” He adds, “We’ve got to get them off the battlefield.”

Suicides among veterans expanded by 26 percent from 2005 to 2007. That doesn’t include the veteran deaths that were the result of high-risk behavior. More than 1,000 vets in California under the age of 35 died after returning home from Iraq and Afghanistan between 2005-2008. Author and journalist, Aaron Glantz, succinctly outlined this problem in his article, “After Service, Veterans Deaths Surge.” He wrote that the “figure is three times higher than the number of California service members who were killed in the Iraq and Afghanistan conflicts over the same period.” He drilled down on the lack of response from the government when he appeared on the “War and Peace Report” hosted by Amy Goodman of Democracy Now.

What’s actually being done in a nuts and bolts way to support veterans? I checked in with America Works of New York, which serves veterans by offering psychological and substance abuse counseling, health insurance guidance, interview and resume preparation, and ultimately job placement. America Works is a for-profit company that is 100 percent performance based. The staff saw an upsurge of veterans into their program approximately three years ago. In 2008, they applied to the federally funded entity “Homeless Veterans Reintegration Program,” and were contracted to place 160 homeless vets in jobs within a year. They reached their goal and got a follow up three-year contract.

The founders of America Works, Dr. Lee Bowes and Peter Cove, have taken their “work first” model, which originated in 1984, and tailored it to the needs of soldiers returning from Iraq and Afghanistan — at least one in 10 of whom are unemployed. In the 18-24 demographic the stats drop to one in five unemployed, as many enlistees join the service directly from high school — and are looking for a civilian job for the first time.

The facts put out by America Works explain that nationwide approximately 154,000 veterans are homeless each night. Foreclosure rates in military towns have been on the upswing of four times the national average. In 2008, more than 1.3 million vets were living in poverty. Almost one million were unemployed. More than a third of incarcerated veterans have screened for PTSD. In the New York City homeless vet population, approximately 85 percent is comprised of those who served in Vietnam and Korea. Many vets move to New York, looking for services and employment they couldn’t find at home.

While I was at the offices of America Works, I had the opportunity to dialogue with Retired Navy SEAL Captain Pete Wikul, vice president of America Works of Washington, D.C. Wikul served more than 39 years in the U.S. Navy and was the “Bullfrog” — a title given to the longest serving Navy SEAL on active duty. He shares the 1988 Nobel Peace Prize with all the Peacekeeping Forces who served in Lebanon from 1948-1988.

Outspoken, with lots of personality, Wikul was emphatic about the need to heal suicidal vets. “That’s what I want,” he told me. His figures related that 17 to 34 vets commit suicide daily. “It is estimated by veteran suicide counselors that perhaps as many as three times as many veterans have taken their own lives than the number who died in the Vietnam War.” He said, “The first greatest sin of this country was slavery. The second is how it treats its military vets.”

For Wikul, the problem lies with the individual’s separation from the service. He penned an op-ed with Bob Kerrey outlining the need to prepare vets for rejoining civilian life. Wikul had definitive opinions on the crisis. “The nation is responsible,” he said. “I fault our political leaders.” Referencing the lip service paid to the needs of veterans he emphasized, “I want to see the line item in the budget. It’s the lawmakers that hold the purse strings.” As a man used to accomplishing his mission, his frustration was palpable. “We need analysis, and then a cure for this social ill.” Wikul recommends the America Works mantra of “work first and a rapid attachment to work” as a great leveler, and the way for an individual to maintain his/her self-esteem.

Looking at the issues from another perspective is Ryan Berg, a 28-year-old, California-based vet, who spent seven years in the Marine Corps. He joined up because he chose not to be in an academic situation immediately after high school. He wanted to be a leader. He currently attends UC Berkeley on the GI Bill, where he is completing a four-year degree focusing on communications. He is the founding editor at, whose mission is to “help build lasting veterans’ communities across the United States.” In addition, they house a news and opinion blog dedicated to the movement of building “real community” among the returning veterans of Iraq and Afghanistan.

Berg has become proactive in seeking to build a “community” of veterans that is modeled on the support structure that was forged during time of service. He described how during deployment, there was a “life saving mechanism borne out of the group experience.” He believes that this core essence needs to be translated into a new language — to help vets adapt back into civilian life. “The important thing to remember,” he said, “is that there is a specific sensibility that needs to be connected between vets. We need support from those who are like us, people who have come out of the same experience. We’re learning what this new mission we are on is. We need to feel as influential in civilian society as we did in the military. We need the care of each other in order to start the new mission. The mission of coming home is a task we aren’t used to.”

For Berg, the most powerful prescription a veteran could receive is that of “community.” He qualified it as follows: “It’s when we have a group of people that hang out and speak to each other in a different way, because of our lives. Whatever stage we are at in our coming home process, life begins to matter more as we speak the same language to others who are like us.” He continued, “It’s kind of like a family. Thinking about what’s next. It’s about guys and girls talking to each other. It’s the platoon mentality. It’s everyone having each other’s back. Getting a veteran into a mental health appointment is nearly impossible without the encouragement of another vet.”

The need to connect to others who understand a shared history was repeatedly articulated in Wartorn. The common denominator pointed to was the refrain “No one except a soldier can understand what a soldier has to endure.”

In 1946, William Wyler directed The Best Years of Our Lives, which won the Academy Award for that year’s top picture. It told the story of three servicemen from the same small town trying to pick up the threads of their previous lives. Samuel Goldwyn decided to produce the film after he read an article about the difficulties experienced by men returning from World War II. The topics of familial disconnect, estrangement, and unemployment are captured in the scene below when former Army Air Force Captain Derry, who is afflicted with nightmares, wanders through an aircraft boneyard.

At the beginning of Wartorn, there is a visual quote by Homer from The Odyssey. It reads, “Must you carry the bloody horror of combat in your heart forever?”

1861, 1946, 2010.

The time to do something is now.

VA touts new study on its care, but report's data raise questions
November 13, 2010

By D


McClatchy Newspapers

The Department of Veterans Affairs has for years touted the achievements of its health care system, but a new study shows that its health outcomes are ... about like everybody else's.

The VA highlighted the study, published in the journal Medical Care, saying in a press release this week that "VA Health System Shines in Quality-of-Care Study."

"This report is strong evidence of the advancements VA continues to make in improving health care over the past 15 years," VA Secretary Eric Shinseki said in the release. "The systems and quality-improvement measures VA actively uses are second to none, and the results speak for themselves."

However, the study - which synthesized the results of three dozen other studies that compared VA health care to care provided by non-VA providers - concluded that the VA performed well on many measures of medical care, but also found that the VA had little impact on the key question of whether the patient lived or died.

Moreover, most of the research the study depended on to reach its conclusions dates to when Bill Clinton was president. One source for the study is dated 1991, when George H.W. Bush was in the White House.

The issue of how good is VA care is a hot topic among veterans' advocates and Congress. Some recent studies have been used to make the case that VA care is not only pretty good, it's also among the best in the country. That's a big turnaround from two decades ago, when the VA was widely derided for poor quality. Since then, the agency has transformed from a hospital-based system to an integrated network of hospitals and clinics that is commended for its emphasis on preventive care.

But the best care anywhere?

What the latest study shows is that the VA performs well on what are known as "process" measures - whether a certain test was ordered, for example. But studies that compare health outcomes - do patients in the VA system do better or live longer? - are equivocal.

Of 12 studies that compared mortality, for example, three showed a better outcome for VA patients, two showed a better outcome for non-VA patients, and seven showed no difference.

That's very different from the process measures, which showed an overwhelming VA advantage.

Researchers aren't sure what causes that disconnect. If veterans are taking their drugs and getting their tests done, the thinking goes, they should be living longer. But for the most part, the data don't show that.

"When it comes to mortality, we found that the VA does no better and does no worse," said study author Amal Trivedi, an investigator at a VA medical center in Providence, R.I.

It would be helpful to study other health outcomes - so-called "intermediate outcomes" that detail health status short of death - but those aren't often measured, Trivedi said.

There were some other caveats to the study. One is what's known as a "publication bias," since most of the studies researchers found were funded by the VA. But researchers weren't sure why that would show a VA advantage on process measure but not one on outcomes.

The lack of fresh data was a central problem with the study, Trivedi said.

"We need more recent data," Trivedi said. "There have been a number of efforts in the private sector to improve care." But those efforts wouldn't have shown up in this analysis.

Researchers initially combed through 175 VA quality studies, excluding most for a variety of design or other problems. They were left with 36.

Of those, about 60 percent included data gathered only during the Clinton administration. One included data from 1991.

The freshest data were five years old, collected from 2005.

Joseph Francis, the VA health system's chief quality and performance officer, said the relative age of the research "was kind of surprising to me."

Part of that has to do with the length of time it takes to complete and publish rigorous research. He also said the VA is working to complete more studies on health outcomes, which will show how VA patients fare compared with non-VA patients.

Other researchers have found it difficult to compare VA care to non-VA care, in part because so many veterans get care from different places.

The Congressional Budget Office, for example, recently reported that 79 percent of veterans in the VA system also had health coverage elsewhere, typically Medicare but also private health plans.

"I think we do have a challenge understanding the totality of care veterans receive - and that includes care rendered outside the walls of our system," Francis said.

In 2008, the VA treated 5.5 million people in its system of about 150 hospitals, 900 outpatient clinics and other facilities.

Posted on Fri, Nov. 12, 2010 04:37 PM

VA Launching New Personalized Veterans Health Benefits Handbook
Nov 18th

Recent VA News Releases

WASHINGTON (Nov. 18, 2010) - The Department of Veterans Affairs (VA) is piloting new, personalized Veterans Health Benefits Handbooks. The handbooks are tailored to provide enrolled Veterans with the most relevant health benefits information based on their own specific eligibility. In essence, each handbook will be written for the individual Veteran.

"These handbooks will give Veterans everything they need to know and leave out everything that doesn't apply to them," said Secretary of Veterans Affairs Eric K. Shinseki. "Our Veterans will now have a comprehensive, easy to understand roadmap to the medical benefits they earned with their service."

In addition to highlighting each Veteran's specific health benefits, the handbook also provides contact information for the Veteran's preferred local facility, ways to schedule personal appointments, guidelines for communicating treatment needs and an explanation of the Veteran's responsibilities, such as copayments when applicable.

"Enhancing access isn't just about expanding the kinds of services VA provides. It also includes making sure we do everything we can to ensure Veterans have a clear understanding of the benefits available to them so they can make full use of the services they have earned," Shinseki said.

The new handbooks will initially be available only to certain Veterans in Cleveland and Washington, D.C., areas. Following the pilot phase, full implementation is scheduled to begin in the fall of 2011 for across the county.

For additional information, go to or call VA's toll-free number at 1-877-222-VETS (8387).


Yale-Led Study to Examine Post-Combat Trauma Among Women Veterans
Nov 18th

By Michael Tsang
Epoch Times Staff Created: Nov 18, 2010 Last Updated: Nov 18, 2010

Related articles: United States > National News

NEW HAVEN, Conn.—A new nationwide study on the gender difference of how female and male military combat veterans readjust to civilian life is underway. The study was made possible by a $2.2 million grant from the U.S. Department of Veterans Affairs (VA) and represents one of the first empirical studies of its kind.

This nationwide investigation is headed by Rani Desai, a Mental Illness Research,
Education, and Clinical Care (MIRECC) investigator at the VA Connecticut Healthcare System, who is also associate professor of psychiatry at the Yale School of Medicine and director of the Women and Trauma research core of Women’s Health Research at Yale.

The study will be a collaboration that includes researchers from the VA, Women’s Health at Yale, and the
University of Connecticut.

Of the 2 million Americans who have served in Afghanistan and Iraq since 2001, approximately 12 percent or 240,000 have been women. This is an unprecedented number and represents the largest cadre of U.S. military women exposed to combat to date. This does not include approximately 40,000 who serve as contractor personnel—many of whom are women. The American Legion estimates the number of women active in duty will increase to 20-25percent in the new millennium.

California and Texas comprise the largest percentage (approximately 25 percent) of troops that have served in the Afghanistan and Iraq wars.

Although women veterans face the same, or many of the same transition issues as their male counterparts, studies indicate that they also face specific issues related to their gender.

One of the biggest difficulties is the culture change back to civilian life. They feel lost because they think that others around them do not have the same experiences. Women veterans also find the lack of respect and recognition for their military service, especially their combat experience, as their primary transition challenge.

And while male veterans may traditionally have been allotted down time to readjust to civilian life, women veterans are often expected to resume their roles as mothers or primary caregivers immediately. Women veterans are also twice as likely as male veterans to have reported mental health problems.

The study at Yale will for the first time investigate the speculation that women veterans are more susceptible than men to post-traumatic stress disorder (PTSD). The presupposition is that women on average enter military service having had more civilian trauma than men and as a result of military sexual trauma (MST), more than male veterans.

An article on an award-winning blog called “Healing Combat Trauma” indicates that of the 18 veterans who commit suicide every day, women veteran suicide is two to three times higher than nonveteran women.

MST affected roughly the same number of men and women, approximately 60,000 each, between 2002 and 2008, despite their disproportional numbers in service. The blog also cites a VA report that the prevalence of MST among Gulf and Afghanistan veterans is 15.1 percent among females, but anecdotally the figures are much, much higher, typically underreported because of shame and fear of reprisal.  

A 2006 report by the Journal of General Internal Medicine indicated that 41 percent of veteran women had experienced MST, and MST can lead to PTSD. Among Gulf War veterans, for example, women who suffered MST had a 5 times higher risk of suffering from PTSD.

A study out of the VA North Texas Healthcare System based on 270 veteran women found that compared with those without a history of sexual assaults, women veterans were nine times more likely to have PTSD if they had a history of military sexual assault, seven times more likely if they had childhood sexual assault histories, and five times more likely if they had civilian sexual assault histories.

The Pentagon in 2008 commissioned an estimated $300 million in research funding for a full-scale assessment of PTSD. The military has since embraced a slew of alternative treatment options, including pet therapy, acupuncture, and yoga. Many of these integrated
treatments have been used and there have been noted successes.

National clinic to assist vets coping with tinnitus
Nov 19th


Nov 19, 2010 07:24AM

PHOENIX, Ariz. -- Tinnitus, commonly known as noise or ringing in the ears, is a major health issue for soldiers returning from combat in Afghanistan and Iraq, Veterans Administration hospital official say.

The condition was the most-claimed service-connected disability for veterans receiving compensation in fiscal year 2009-10, according to the Veterans Affairs Health Care System.

The disorder can be the result of extreme noise exposure, such as that experienced by combat veterans, and is associated with hearing loss, also is a common complaint from veterans.

Because of increased patient demand, the audiology clinic at the Phoenix veterans hospital extended its daily hours from five to six days open each week. It also added staff.

In January, the hospital will launch a national tinnitus program called Progressive Tinnitus Management to help veterans with the disorder.

Audiologists and mental-health professionals will work together to help veterans manage their reaction to tinnitus.

The VA has been developing the program for five years using research literature, textbooks and clinical experience.

Tinnitus happens when hairs in the inner ear move in relation to entering sound waves. Then an electrical signal is sent from the ear to the brain.

Dr. Cathy Kurth, an audiology specialist at the Audiology and Hearing Aid Center in Scottsdale, said the brain interprets these signals as sound. If the hairs inside the inner ear are bent or broken, this could cause tinnitus. It involves the sensation of hearing sound when no external sound is present.

Kurth said there isn't an effective surgery for tinnitus, so management is the best way to treat the condition. This can be done through aural rehabilitation and hearing aids.

Busting Myths About VA Health Care
Nov 19th

The fol­low­ing post was orig­i­nally fea­tured on the VA’s VAn­tage Point blog.
By Alex Hor­ton

Rumor mills are per­ma­nent fix­tures in schools, offices and wher­ever peo­ple con­gre­gate, and most of the time they’re pretty innocu­ous.  But myths and rumors that deal with health–in this case Vet­er­ans health–are a seri­ous mat­ter that can pre­vent qual­i­fied Vets from seek­ing the care they both need and deserve.  Many have come up in the com­ments sec­tion, and oth­ers I hear from the guys in my old unit.  The myths won’t die unless they are addressed pub­licly and clearly, so we present you with the most com­mon we hear, and the straight­for­ward answers they need.

Five Myths About VA Health Care

Myth Num­ber One - I wasn’t injured in the ser­vice, so I’m not eli­gi­ble for VA health care.

Sta­tus: False -
One of the most com­mon myths revolves around eli­gi­bil­ity for health care at VA.  Many think that you have to first estab­lish a dis­abil­ity rat­ing before you can start to make appoint­ments, see doc­tors and receive med­ica­tion.  That is not the case.  If you served in the mil­i­tary, even dur­ing peace time, and were hon­or­ably dis­charged, you likely qual­ify for VA care.  Even if you don’t meet those require­ments, spe­cial cir­cum­stances might apply, like Viet­nam ser­vice, expo­sure to Agent Orange and house­hold income.  The best way to find out if you qual­ify is to sub­mit an appli­ca­tion for health ben­e­fits.  You can fill one out online or at a VA Med­ical Cen­ter.  If you are an Iraq or Afghanistan Vet­eran, there are spe­cial com­bat Vet­eran ben­e­fits from VA, like tem­po­rary access to den­tal care and guar­an­teed access to Pri­or­ity 6 for five years (unless you are eli­gi­ble for a higher pri­or­ity group).  See the pri­or­ity enroll­ment groups here.

Also, if new reg­u­la­tions are estab­lished regard­ing health ben­e­fits, VA will auto­mat­i­cally reassess your case if it’s on file.

Myth Num­ber TwoI can only receive care for ser­vice con­nected injuries.

Sta­tus: False -
You can receive care for any ail­ment, ser­vice con­nected or not, but the dif­fer­ence is pay­ing for med­ica­tion relat­ing to treat­ment.  For exam­ple, if a Vet­eran has a ser­vice con­nec­tion because of a bad knee, any treat­ment and med­ica­tion for the knee is free of charge. How­ever, if the same Vet goes into surgery to remove an appen­dix and it’s not ser­vice con­nected, he may be sub­ject to a co-pay depend­ing on the amount of his dis­abil­ity rat­ing. Famil­iar­ize your­self with co-pay guide­lines and rates.

A small num­ber of Vet­er­ans, such as Fil­ipino Vets and bad con­duct dis­charges, can only be treated for their ser­vice con­nected dis­abil­i­ties and noth­ing else.  If one of those Vets is ser­vice con­nected for their left foot, they can only use VA health care for their left foot and noth­ing else.

Myth Num­ber ThreeI make too much money to qual­ify for VA health care.

Sta­tus: It depends -
If you do not have a ser­vice con­nected dis­abil­ity, you must ver­ify your income with VA to see if you qual­ify for free med­ica­tion and travel ben­e­fits.  If you gen­er­ate too much income (a max­i­mum income level set every year by Con­gress), you may have to pick up the tab for trav­el­ing and receive your med­ica­tion using co-pay.  Recently, the rules have been changed for Pri­or­ity 8 Vet­er­ans who have income that exceeds the thresh­old and dis­al­lowed new enroll­ments.  Go here for more infor­ma­tion and an income cal­cu­la­tor to see if you qual­ify under the new rules.

Myth Num­ber FourI can’t use VA health care if I have pri­vate health insur­ance.

Sta­tus: False -
From VA’s Health Eli­gi­bil­ity Cen­ter Direc­tor Tony Guagliardo:

“We strongly encour­age Vet­er­ans to receive all your health care through VA.   How­ever, if you choose to receive treat­ment from pri­vate doc­tors, VA will work with them to meet your health care needs and coor­di­nate effec­tive treat­ment.  We call this Co-managed Care or Dual Care — which means that your VA and pri­vate doc­tors will work together to pro­vide safe, appro­pri­ate, and eth­i­cal med­ical care.”

Myth Num­ber FiveIf I’m 100 per­cent dis­abled, that means I’m per­ma­nently dis­abled

Sta­tus: False -
You could have a 100 per­cent dis­abil­ity rat­ing as a tem­po­rary sta­tus while you undergo surgery, and have it reduced to its pre­vi­ous rat­ing after you heal.  100 per­cent doesn’t nec­es­sar­ily stay with you.

My hope is that this infor­ma­tion sheds a lit­tle light on the some­times con­fus­ing realm of VA med­ical care.  These myths and answers are very gen­eral, but we hope to receive more spe­cific ques­tions in the com­ment sec­tion. We look for­ward to dis­pelling myths about other parts of VA as well.

Veterans: Traumas resurface at end-of-life
Nov 20

U.S. researchers have tailored a program to help veterans whose traumas resurface at end-of-life.

Researchers led by Dr. Joshua Hauser of Northwestern University Feinberg School of Medicine in Chicago and Dr. Amos Bailey of the University of Alabama at Birmingham have developed a program they say is tailored to meet veterans' end-of-life needs.

"Many veterans, at the end of their lives, struggle with issues related to a traumatic event they had during their time in service," Bailey says in a statement. "They may have had a physical or emotional disability related to their time in service."

In addition to dealing with battle experiences, the new program -- Education on Palliative and End-of-Life Care for Veterans Project -- addresses sexual trauma and substance abuse during service, as well as how the particular war in which a veteran served affects both emotional and physical care, and other issues.

"Because these war memories come up more frequently near the end of life, palliative care providers need to be alert for these issues," Hauser says. "We want to show healthcare professionals how someone's individual war memories come up and how those can be talked about."

The program, which began in October, is scheduled to be introduced in 170 Veterans Administration Medical Centers around the country during the next 12 months.

Physician assistants working in the Department of Veterans Affairs

Denni J. Woodmansee, PA-C; Roderick S. Hooker, PhD, PA-C

November 25 2010


There is broad consensus among medical workforce analysts that the demand for physician assistants (PAs), physicians, nurses, allied health, and other medical providers has substantially increased since the late 1990s. While researchers tend to examine the deployment of various providers in private medical offices, they often overlook federally-employed PAs. Since the late 1980s, the Department of Veterans Affairs (VA) has been a major employer of PAs. The demand for services is projected to increase by 30% over the next decade as the VA undergoes expansion.

We examined the characteristics of PAs in the Veterans Health Administration (VHA), the medical arm of the VA. In 2010, 1,878 PAs were employed in 153 VA medical centers and many of the more than 900 community-based outpatient clinics. The majority work full time, and 49% are female. VHA PAs are distributed broadly across medical services (38%), surgery (47%), mental health (11%), and other services (4%). Thirty-one percent of PAs have prior military experience. The average years of VHA PA employment is 10.5, and the average age of a VHA PA is 49 years (range 23-74 years); one-third (34%) are within 5 years of retirement eligibility. Annual attrition for PAs is 9%, consistent with doctors, nurses, and pharmacists in the VHA. Projected demand for PA services in the VHA is expected to grow to 2,550 by 2018. Strategies are under way to improve the PA workforce in the VA.

Near the end of the last century, the Veterans Health Administration (VHA) in the Department of Veterans Affairs (VA) initiated a medical workforce re-engineering effort to improve its quality of care.1,2 The VHA is vertically integrated and comprehensive.3 Admired for its ability to deliver services in both urban and rural areas, it has also been a leader in advance medical record integration technology and safety.4 Additionally, the VHA is a major employer of physician assistants (PAs).

The VHA is notable for its commitment to primary care, and this specialty serves as the entry point for beneficiaries to access the health system. It is also a model of a managed health system that relies heavily on electronic record access to all aspects of care. Because of a commitment to improve all aspects of care to veterans, the VHA boosts its efforts to improve quality through performance measurement.5 However, an increasing transition of active duty military members to VA status and new policies on beneficiary enrollment over the past decade have created backlogs in access to medical care and processing claims.6 Furthermore, the VA takes care of a different population than the civilian sector; predominantly male, elderly, vulnerable, and burdened with significant chronic diseases. The profile of this beneficiary structure produces large differences in patterns of practice within the VA, and as a result, more care is inpatient-based and specialist-oriented with higher per capita expenditures than in private practices. These veterans, many with service-connected disabilities and without any other means of medical care, consume resources at different rates than a non-VA population. Nonetheless, the VA is challenged to make systematic improvements while at the same time implementing economy of scale measures of cost-effectiveness. Because the VA is vertically organized with most of the care produced under one roof, it serves as a model institution to study optimal delivery of health care services.

Since the late 1990s, the VHA has increasingly turned to PAs to improve access and maintain continuity of care. Employment criteria include graduation from an accredited PA program and a passing score on the PA National Certification Examination (VA policy). Each of the 153 VA medical centers or the more than 900 community-based outpatient centers employs providers according to its need. As a result, the utilization of PAs is irregular across the nation. Some locations have no PAs, and other regions make very high use of PAs.

Administration is hierarchical; each medical officer (MO) and PA reports to the service chief. The service chief reports to the medical director of the facility. A director of PA services reports to the chief patient care services officer. In turn, a VHA physician assistant field advisory committee advises the PA director on policy matters.

PAs employed in federal institutions often bypass state control of provider services. For example, state PA practice laws tend to have little bearing on whether a VA facility permits PAs to perform medical or surgical procedures. PAs practice under federal authority, and states do not have jurisdiction over federal health care facilities. If the facility approves a scope of practice that includes performing colonoscopy (or any other procedure), it can be granted by that facility under federal law.

The VA also supports PA education. For example, a VA Medical Center in Durham, North Carolina, has provided clinical education sites dating back to the first PA students at Duke University in the 1960s. The St. Louis University PA program was partially funded by the VA in 1971. In 1972, the VA standardized the role of PAs, defined the areas of the hospital in which PAs could be utilized, and specified the type and level of tasks assigned to them.

Implementing and using team delivered care has been a major goal of the VHA, and PAs are part of this effort. In one study of 32 VHA medical centers, 84% of operating room (OR) and 75% of intensive care units had implemented team concepts to improve care. As a result, efficiency improvements were reported by 94% of OR implementation teams. Almost all facilities (97%) reported a success story or avoiding an undesirable event.7

A major goal of the VA is to enlarge the medical workforce to meet the needs of an increasing enrollment of veteran beneficiaries. One of the VHA's stated goals is to grow PA services to 2,550 by 2018. Increased recruitment is part of a larger goal to expand the size and capacity of the VA. This expansion will necessitate an increase in the number of doctors, nurses, and other personnel during the same time period. This investment in human resources requires more information to be made available both internally and in the public domain.

We undertook an organizational examination of PAs in the VA because their role in the federal workforce has been described only broadly.8 There is growing interest in understanding the PA workforce and the extent it is used in this institution. Our aim was to establish historical data for medical workforce planning purposes and to contribute to the growing body of literature on the US medical system of care.


A descriptive study of PAs in the VHA was undertaken using existing administrative files from the VA Central Office. One author (DW) is the manager of PA medical workforce data and advisor to the under secretary for health. Administrative files were probed for pertinent information on employment trends, gender, age, role, and pay. The data were aggregated, descriptive statistics were used, and no individual employee was identifiable in the analysis. The study was approved by the VA Central Office.


As of 2010, the VHA was composed of 1,878 PAs; 49% were female. The mean age was 49 years (median 54 years; range 24-74 years) (Figure 1). During the period 1992 to 2009, the cadre of PAs in the VA grew by 55% (on average, an additional 45 PAs were added each year) (Figure 2). The percentage of PAs in the VHA workforce who will be of retirement age or older (65 years or older) within the next 5 years is 16.24%; 35% of PAs in the VHA are older than 55 years. The turnover rate from 2000 to 2009 is shown in Figure 3.


The national VA system is composed of 21 integrated service networks (VISNs), and the deployment of PAs is spread over these VISNs. The ratio of medical officers to PAs and nurse practitioners (NPs) differs widely depending on the VISN. In 2010, the ratio of PA/NP to MO was 3:7, with approximately 1.5 times as many NPs as PAs (Figure 4). Overall PAs were grouped broadly under medical services (38%), surgery (47%), mental health (11%), and other services (4%, including anesthesia/pain clinic, radiology, rehabilitation, and administration).


The wage for VHA-employed PAs is structured through the General Schedule (GS) system of the US Office of Personnel Management and is the pay structure for most federal workers. PA salary ranges from GS-9 to GS-13 (92% of PAs are GS-12 or GS-13). Most pay is assigned a locality adjustment for cost of living differences across the country ( In 2010, a GS-13 who had topped out in pay scale steps earned an annual salary of around $110,000. The benefit structure in the federal compensation system is about 25% on top of the wage and includes 4 weeks vacation, holidays, health insurance, and education. Once a PA is a government employee, transfers are possible both within a VA health facility and across the nation (including other federal services) depending on need and supply.

Approximately 50 PA programs used the VA System for clinical rotation. More than 250 PA students rotated through VHA facilities in 2010, and 58 qualified for a stipend. Institu­tional agreements are usually on the local level, and arrangements of PA students who are provided clinical sites for training may exceed this estimate.

All new employees are surveyed for their reasons for joining the VA. In 2009 and 2010, 48 respondents cited the benefit structure and loan repayment as the two leading reasons for accepting employment within the VA as a PA.


Since 1967, the VHA has been an employer of PAs (personal communication Vic Germino, PA, July 2010); a trend to employ more has been under way since 1992. As of 2010, 1,872 PAs were working in most of the 153 VA medical centers and 976 community-based outpatient clinics. The majority work full time, and half are female. These VHA PAs are distributed broadly across medicine and surgery, and their diverse roles are known only broadly. Less than 1% of PAs are in senior administrative roles. This distribution among the rank and file of clinical PAs is analogous to the military in the late 1900s, when there was a dearth of senior officers in PA ranks. Only when PAs began moving into senior command levels did policy improvements in the utilization and career focus of PAs in uniform change.9 We suggest that similar senior administrative VA positions need to be filled by PAs who can provide a representative voice in organizational change and policy decisions.

An important observation about the PA in the VA is the age distribution. The average age of a VHA PA is 49 years, but the age curve shows that more than half are older than 50 years. Furthermore, about one-third of PAs (34%) are within 5 years of retirement eligibility. The average years of VHA PA employment is 10.5, and the annual attrition rate of PAs is 9% (consistent with doctors, nurses, and pharmacists in the VHA). These observations suggest that the pool of older, more experienced PAs are eligible to depart in large numbers over the next few years, producing recruitment and retention challenges ahead. Not only does the VA want to expand its corps of PAs (along with all other clinicians), but it will need to replace at least 100 PAs a year to stay even and more than 200 PAs per annum to reach full complement by decade's end. Retention and recruitment are significant issues for the VHA, as competition from the private sector vies for scarce human resources in health. Pay disparity leads this list of challenges because compensation tends to be high on the priorities list of graduates wishing to pay off loans acquired in training. In addition, older males with decades of procedural experience are being replaced with younger females with newer knowledge of medicine and technology. Such generational changes also present challenges for managers.

Strategies to help cope with challenges for recruitment and retention are being developed. Policy makers are proposing new initiatives that will permit those in government service to have their accrued education costs repaid if they extend their federal career for a period of time. Contracting with retirees to return as part-time clinicians is an option in some locations. Increasing the PA student's experience in VA settings may provide the needed contact for recruitment. Developing postgraduate traineeships for physician assistants may be another option.


Medical workforce research relies on surveys such as censuses or secondary data such as administrative files. Both have their advantages and limitations. Administrative data capture all workers employed but sacrifice candid responses that help shape attitudes, roles, and relationships. Research on public organizations reveals a substantial and growing body of empirical evidence relevant to many international issues in political economy and organization theory, such as the privatization of public services. However, certain assumptions are made that may mislead goals. While the institutional data we obtained have a great deal of integrity due to accurate compensation and benefit structure, the data do not capture the role delineation of PAs employed in federal service. As a result of policy, specifics had to be set aside to avoid identifying characteristics such as age and gender co-variables or PA density in certain VISNs. Also missing are qualitative studies needed to probe the organizational issues concerned with job satisfaction in the VA and how federally employed PAs compare to those in the private sector.


The re-engineering of the VHA that began in the 1990s has resulted in an unprecedented enrollment of American veterans. Along with this came a broad mix of providers: one that mirrors the diversity of medical care clinicians in American society. Included in this mix are PAs, many of whom are veterans themselves. Several principles adopted by the VA in its quality-improvement projects include an emphasis on the use of PAs to expand services to veterans. This integration of provider services, designed to achieve high-quality, effective, and timely care, has been embodied by the architects of VA service change and delivery.2

Our findings suggest that initiatives based on principles that improve the quality of care in the VA are being carried out with PA involvement on many levels. This trend in task transfer and integrated skill mix using PAs in the VA is consistent with the changing pace of health care in America. However, the VHA may be challenged by social changes where demand for PAs is high and compensation is increasing in the private sector. On top of this is an impending loss of human intellectual capital over the next few years. Improving the representation of PAs with managerial skills in the hierarchy of the VHA is a critical piece needed to achieve a dynamic, integrated health care system that is highly prized by social system advocates. JAAPA

Denni Woodmansee is the acting director of physician assistant services in the US Department of Veterans Affairs. Roderick Hooker is a physician assistant in the Department of Veterans Affairs, Dallas, Texas. The authors have indicated no relationships to disclose relating to the content of this article.


1. Iglehart JK. Reform of the Veterans Affairs health care system. N Engl J Med. 1996;335:1407-1412.

2. Jha AK, Perlin JB, Kizer KW, Dudley RA. Effect of the transformation of the Veterans Affairs health care system on the quality of care. N Engl J Med. 2003;348(22):2218-2227.

3. Oliver A. The Veterans Health Administration: an American success story? Milbank Q. 2007;85(1):5-35.

4. Oliver A. Public-sector health-care reforms that work? A case study of the US Veterans Health Administration. Lancet. 2008;371(9619):1211-1213.

5. Fisher ES. Medical care—is more always better? N Engl J Med. 2003;349(17):1665-1667.

6. Asch SM, McGlynn EA, Hogan MM, et al. Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample. Ann Intern Med. 2004;141(12): 938-945.

7. Neily J, Mills PD, Lee P, et al. Medical team training and coaching in the Veterans Health Administration; assessment and impact on the first 32 facilities in the programme. Qual Saf Health Care. 2010;19(4):360-364.

8. Hooker RS. Federal employed physician assistants. Mil Med. 2008;173(9):895-899.

9. Hooker RS, Cawley JF, Asprey DP. Physician Assistants: Policy and Practice. 3rd ed. Philadelphia, PA: FA Davis Co; 2010.

TOM PHILPOTT: A Positive Historical Perspective on Caring for Our Nation's Veterans

Posted November 26, 2010 at 8:07 p.m.

Some of us, when we see a proposal to raise VA health care fees for a category of veteran in a report on ways to curb federal budget deficits, jump to the conclusion that veteran benefits are under fresh attack.

Bernard Rostker, former undersecretary of defense for personnel and now a senior fellow at the RAND Corp., has a more optimistic perspective on how, over time, America cares for and compensates its wartime veterans.

For more than a year Rostker has been researching what will be a two-volume study on the treatment of veterans and their survivors, going back to before the Revolutionary War, with a special focus on wounded warrior care.

His original working premise, as he explained it in a phone interview, was that veterans’ care and benefits today reflect a deeper attachment to the force, the result of moving away from a military of conscripts, after the Vietnam War, to a more professional force comprised entirely of volunteers.

But as he completed volume one of his study, covering the Colonial era through World War II, Rostker said he found the working premise to be wrong. Much of what’s being done today for veterans of the all-volunteer force is “rediscovering” what’s been done before.

One glaring exception, he said, is the focus today on treating mental wounds of war, post-traumatic stress disorder. Resources aimed at the invisible wounds are unprecedented, reflecting more medical knowledge, the nature of current wars and an attitude shift, even since the Persian Gulf War.

“Today it’s remarkably different. Much more willing to deal with issues of stress than what came out of the Gulf War,” said Rostker. In the late 1990s he was the defense secretary’s special assistant on Gulf War Illness.

Otherwise the infusion of money and staff for veterans’ care and benefits today fits an historical pattern, Rostker said, the nation’s deep appreciation for those who fight for country and suffer wounds or illness.

Other patterns emerge, Rostker said. Government support tends to deepen with budget surpluses. Benefits tend to improve as veterans age, their ranks thin out, and enhancements become more affordable.

Wars bring change too. The Department of Veterans Affairs budget has more than doubled since U.S. troops invaded Afghanistan in October 2001 -- from $51 billion then to $114 billion in the fiscal years that ended Sept. 30. VA spending is set to climb another 10 percent this year, to $125 billion.

Vet groups laud a 25 percent rise in VA spending since President Obama took office. Some contrast that largess to the Bush administration difficulty in June 2005 when it had to request $2 billion supplemental for VA to meet pressing health care obligations. Some veterans groups had called the original budget that year “tightfisted, miserly” and “woefully inadequate.”

Rostker avoids such comparisons. But his research might inform cost-conscious politicians about the perils of scrimping on veterans.

President Franklin Roosevelt made such a misstep, he said, while trying to pull the nation out of the Great Depression. At his urging, Congress in 1933 passed the Economy Act, which cut deeply into veterans’ benefits. Roosevelt told the American Legion convention “the mere wearing of a uniform” in war should not entitle a veteran, and later his survivors, to a pension for disabilities incurred after he left service.

The backlash was strong enough that the following March, Congress had enough votes to override Roosevelt’s veto and it restored almost all of the benefits it had cut a year earlier.

The Continental Congress in 1776 first recognized responsibility for wounded veterans, voting to authorize half pay for life to anyone who lost a limb or their ability to earn a living due to the revolution. By 1805 Congress approved pay for disabilities developed years after a veteran left service.

Support for lifetime “half pay,” particularly for officers, drew criticism. Funds to pay it sometimes could not be found. Yet Congress extended the same pension rights to disabled veterans from the War of 1812 and other wars.

By 1818, with federal coffers flush with tariff money, the Department of War gave pensions to anyone who served in wartime, not just disabled.

Ten years later Congress settled complaints of Revolutionary War veterans by granting 850 surviving officers and soldiers full pay for life.

Rostker noted too that in 1833 Congress first approved “concurrent receipt” — payment of both an “invalid pension” and service pension. In 1836, Congress extended pension eligibility to widows and children of Revolutionary War veterans, adding enormously to the cost. The last spouse eligible for that Revolutionary War pension died in 1906, Rostker said.

The Civil War Pension Law of 1862 was viewed as the most generous any government had ever adopted, Rostker said, allowing disability payments for injuries or ailments incurred as a direct result of service. It even set up a medical screening system, though reliance on hometown doctors led to rampant fraud and soon a purging of the rolls, Rostker said.

Payments to surviving spouse and children could exceed what veterans got. The last Civil War pensioners lived well into the 20th Century, all the while drawing payments.

Our conversation provided just a glimpse of how America has cared for veterans long ago. The study will span newer, more controversial periods including Gen. Omar Bradley’s reform of the VA after World War II, Korea and Vietnam and Gulf War Syndrome.

Given the history, I asked, what might be ahead for the newest generation of war veterans. More effective help, Rostker suggested. The nation knows now that not all wounded have missing limbs or physical scars.

Through history, he said, “you see the generosity in many ways. You see it in the amount of money given, in the change of eligibility standards. And recently in the understanding of the mental aspects of conflict.”



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Weiner, vets decry proposed health care cuts
Nov 27th

By Joe Anuta
Friday, November 26, 2010 11:10 AM EST


Rep. Anthony Weiner (c.) speaks out with war veterans against a proposed cut to veterans' health care outside the American Legion post in Forest Hills. Photo by Joe Anuta

A Forest Hills congressman said proposed cuts to the federal budget went too far last week when they targeted health care for veterans, especially since Queens is home to so many.

U.S. Rep. Anthony Weiner (D-Forest Hills) and about 25 veterans stood outside the Forest Hills American Legion, at 107-15 Metropolitan Ave., Friday to denounce the proposed cuts to military health-care programs they believe the government is obligated to provide.

“When these veterans went to serve our country,” Weiner said, “the implicit contract was that we’ll be here for them when they get back. [Veteran health care] is less a benefit than an obligation, particularly in Queens, where we have a lot of vets.”

The proposal was released by two co-chairmen of the National Commission on Fiscal Responsibility and Reform Nov. 10 and contains only a list of suggestions to rein in the $13 trillion national deficit. Three of those suggestions caused concern for Weiner.

First, the proposal suggests that premium prices increase for TRICARE, the health-care plan for military members. The now free enrollment would cost $120 and a premium membership would increase by seven times from $230 to $1,750.

Also, the co-chairs proposed to increase the amount of money that low-income veterans — those who make less than $30,000 — have to pay to see a doctor. In addition, a veteran would not become eligible for benefits until the age of 60 instead of becoming eligible at any age. But to receive the benefits, soldiers would only have to serve 10 years instead of 20, according to a spokesman for the congressman.

The proposed cuts left many borough veterans feeling betrayed by the government, such as Gene Burch, who served in the Vietnam War.

“One of the benefits [of serving] was that we’d get free hospitalization for the rest of our lives,” Burch said. “Ever since then, [the government] has been cutting back. We feel it’s not fair — we have freedom because of us.”

But Burch is not only concerned for himself. He points to the morale of soldiers currently fighting in two overseas wars.

“Stop and think about our fighting troops,” Burch said. “They read about this stuff in the papers, how [the government] is cutting their benefits before they even get out.”


Instead of cutting health care, Weiner suggested curbing several other areas of government with bloated budgets such as farm subsidies or the Defense Department.

“This is a debt of a different kind,” Weiner said. “There are smart cuts and there are dumb cuts, and I think cutting veterans’ health care is not only dumb, but immoral.”

The co-chairmen’s deficit reduction proposal also suggested tax reform, a Social Security overhaul and other cuts to slash the deficit by $4 trillion by 2020.

The National Commission on Fiscal Responsibility and Reform could not be reached for comment.

Reach reporter Joe Anuta by e-mail at or by phone at 718-260-4566.

Gates Seeking to Contain Military Health Costs
Nov 28th


Published: November 28, 2010

WASHINGTON — Francis Brady enjoys a six-figure salary and generous benefits at the consulting firm Booz Allen Hamilton, but as a retired Marine lieutenant colonel he and his family remain on the military’s bountiful lifetime health insurance, Tricare, with fees of only $460 a year. He calls the benefit “phenomenal.”  

“It is so cheap compared to what Booz Allen has,” Colonel Brady said in a recent interview, acknowledging that premiums called for by private employers can run many times greater.

Of nearly 4.5 million military retirees and their families, about three-quarters are estimated to have access to health insurance through a civilian employer or group. But more than two million of them stay on Tricare. As the costs of private health care continue to climb, their numbers are only expected to grow.

Now, as part of a broad offensive to cut Pentagon spending, that group is once again in the sights of Defense Secretary Robert M. Gates, who is seriously considering whether to ask for Tricare fee increases in next year’s budget — and perhaps start one of the last fights of his public career.

Already, he has met with the chairmen of President Obama’s bipartisan fiscal commission, which faces a deadline this week for getting an agreement on a plan to address the federal budget deficit.

The battle over Tricare pits the efforts of the Pentagon to contain the exploding cost of health care for nearly 10 million eligible beneficiaries against the pain and emotions of those who say they have already “paid up front” with service in uniform, particularly those who deployed to America’s two current wars. The 10 million figure includes active-duty personnel, retirees, members of the National Guard and Reserves and their families.

The arguments reflect the broader debate over the huge Pentagon budget that will intensify next year when Mr. Gates, who says he will step down in 2011, continues his campaign to cut off what he calls the “gusher” of defense spending. Total health care costs for the Pentagon, which is the nation’s single largest employer, top $50 billion a year, a tenth of its budget and about the same amount that it is spending this year on the war in Iraq. Ten years ago, health care cost the Pentagon $19 billion; five years from now it is projected to cost $65 billion.

But Tricare fees have not increased since 1995.

“Health care costs are eating the Defense Department alive,” Mr. Gates said in a much-noticed speech in May. Defense budget analysts say that rising health care costs will make less money available for new weapons, repairs to a worn-out arsenal and quality-of-life programs like schools on military bases.

“In the long run, it could actually limit our ability to field a military of sufficient size,” said Todd Harrison, a senior fellow for defense budget studies at the Center for Strategic and Budgetary Assessments in Washington.

Veterans groups and military officers’ lobbies have responded by going on high alert. One of the most powerful of them, the Military Officers Association of America, is preparing a public relations campaign that will focus on what it calls the broken promise between the nation and the people who defend it.

“Don’t ask the folks who have done so much more for this country, who have been called to act since 9/11, to be the first in line to give some more,” said Norbert R. Ryan Jr., a retired vice admiral and president of the military officers’ group. As for Tricare’s generous benefits, Admiral Ryan said that anyone “can get this good deal — go over to a recruiting office and sign up for Iraq and Afghanistan.”

Defense officials point out that Mr. Gates is weighing only whether to increase the cost of health insurance for retirees and their families, not those on active duty, who receive Tricare at no cost. Any fee increases would also not affect military retirees 65 and older, who use a free program called Tricare for Life that supplements Medicare. It is not possible to estimate the exact savings without knowing what rate increase might be proposed, but analysts say even a modest rise could recoup billions of dollars annually for the Pentagon.

If the past is any guide, veterans groups are expected to point out that any fee increases could affect those disabled by the wars in Iraq or Afghanistan who do not use the free services available to them at veterans’ hospitals, either because they choose not to or because they live too far away.

Mr. Gates has included proposals to increase Tricare fees for retirees in three of his past four Pentagon budgets. In 2008, when he held the same job under the Bush administration, Mr. Gates proposed a five-year phased increase of the annual $460 family fee for Tricare Prime, the popular H.M.O.-like option offered to military retirees, to a maximum of $1,260 to $2,460, depending on a retiree’s income, according to an analysis by the Congressional Budget Office.

Tricare refers to the $460 payment as an “enrollment fee,” not a premium. With $12 co-pays per doctor visit, some drug prescription payments and other costs, the current annual out-of-pocket expense for a family on Tricare Prime is estimated at $1,200 per year, still substantially less than what is available from private employers.

Congress, unwilling to be seen as inflicting any kind of pain on the military or veterans, rejected the increases. Mr. Gates said he got the message — “The proposals routinely die an ignominious death on Capitol Hill,” he said in May — and he did not try again in 2010. But in shaping that budget proposal, Obama administration officials also told the Pentagon not to raise it, lest it distract from Mr. Obama’s overhaul of the nation’s health care system earlier this year.

Some Pentagon officials and military advocacy groups have suggested alternatives to raising fees that could cut costs. One idea is to renegotiate the lucrative Tricare packages with the insurance companies, hospitals and drug companies that actually operate the programs. Another is to promote a cost-saving mail-order pharmacy.

Defense officials say that Mr. Gates has to make up his mind about any health care fee increases in the next weeks, in time for the Pentagon to submit its 2012 spending plans to the White House budget director in December. Defense analysts who spoke to Mr. Gates over the summer said he told them that he did not know if it was realistic to try to increase military health care costs while troops were at war.

But Defense Department officials have since said they see a window of opportunity in the growing alarm over the federal debt, the focus of two bipartisan panels that are proposing deep cuts in government spending.

Mr. Gates met in recent weeks with the leaders of one of the panels, former Senator Alan K. Simpson, a Republican, and Erskine B. Bowles, a Democrat and the former chief of staff to President Bill Clinton. They are the co-chairmen of Mr. Obama’s fiscal commission, which has proposed raising Tricare fees. The panel is trying to deliver a final report to the White House on Wednesday, if the members can reach a consensus that fast.

The panel is considering proposals to increase fees for military retirees working for civilian companies, but it would also require employers to reimburse the government for a share of the health insurance costs of those on their payroll who opt for Tricare. That measure alone, described as an effort to make civilian employers pay “a normal business expense,” could recoup $3 billion annually for the Pentagon.

In the meantime, Colonel Brady, 51, said he did not want to be overly dramatic about what was at stake. Although he spent 22 years in the Marines, six of them deployed, including to the 1991 Persian Gulf war, he said he could not buy the argument about a broken promise.

“Tricare is a very good deal for me, and if it costs some more, well, O.K.,” he said. Raising Tricare fees would be a financial burden for many retirees, he acknowledged, but he could not honestly say it would be for him.

“Not that I want to pay a ton of money,” he said.

VA Testing Quicker Access to Medical Records
Nov 29th

WASHINGTON (Nov. 29, 2010) - The Department of Veterans Affairs (VA) is working to significantly reduce the average time needed to obtain health-care records from private physicians with the help of a private contractor and the Internet to speed claims decisions.

"Innovations that will speed, simplify or improve our services to Veterans are receiving rigorous tests at VA," said Secretary of Veterans Affairs Eric K. Shinseki. "We are committed to harnessing the best technology and the brightest minds in the government and private sector to ensure Veterans receive the benefits they have earned."

One innovation is using a private contractor to assist VA in collecting health-care records. When private medical records support a Veteran's application for benefits, a contractor will quickly retrieve the records from the health-care provider, scan them into a digital format and send the material to VA through a secure transmission.

This pilot project hopes to validate initial estimates that a specialized contract can yield records required to process Veterans'
disability compensation claims in seven to 10 days instead of VA's average 40 days. In addition, the additional contract frees VA staff to focus on core duties to process claims more quickly.

Exploring economical contract support for time savings is one of more than three dozen initiatives supporting VA's claims transformation plan, which aims to ensure that by 2015, Veterans' claims are decided within
125 days.

VA officials emphasize that in all cases Veterans must sign documents approving the release of their medical records to the department from private health-care providers.

The test is expected to involve about 60,000 records requests among regional benefits offices in Phoenix; New York City; St. Louis; Portland, Ore.; Chicago; Anchorage, Alaska; Indianapolis, and Jackson, Miss. At the conclusion of the test, VA officials will decide whether to cancel, modify or expand any changes in procedures nationwide.