From: Director, RAO Baguio [raoemo@sbcglobal.net]
Sent: Wednesday, October 31, 2007 8:27 PM
Subject: RAO Bulletin Update 1 Nov 2007
Attachments: Veteran House Legislation Update 07-10-29.doc; Veteran
Senate Legislation Update 07-10-29.doc
RAO Bulletin Update
1 November 2007
THIS BULLETIN CONTAINS THE FOLLOWING ARTICLES
-- Medicare Part D [17] ...........................= . (New Legislation)
-- VA Budget 2008 [09] ............................= .. (New Approach)
-- VA Diverting Patients .................... (Nati= onwide Problem)
-- VA Guardian ........................................................ (Policy)
-- VA Tidbits ............................................. (Did you know?)
-- Biotape Refunds ........................ ($2.5 M= illion Available)
-- VA Flag-folding Recitation Ban ............. ( -- VA Flag-folding Recitation Ban [01] ....... (Ban
Clarified) -- Agent Orange Lawsuits [10] ....................
(Ramifications) -- VA Flu Shots [01] ....................... (48% D=
eath
Reduction) -- Tricare Flu Immunization
.............................. (Get it now) -- VA Secretary [03] ..........................
(Nomination Needed) -- VA Secretary [04] ..................... (Bush
Nominates Peake) -- DOD Disability Eval System [07] .... (Pilot/Futu=
re
Plans) -- Pennsylvania Vet Agency .......... (Separate Exi=
sting
Dept) -- VA MRSA Testing [01] ...... (Combating Staph
Infection) -- USAF Retiree Funerals ..........................
(Policy Changes) -- Reserve GI Bill [07] ....................... (Gu=
ard GI
Bill Snafu) -- Medicare Pmt Rule .............. (Preventable
Complications) -- DoD Retiree Pay Offset ......................
(Benefits Program) -- VA MRSA Testing [01] ...... (Combating Staph Inf=
ection) -- VA Comp Pmt Disparity [09] .............. (House
Examines) -- Grayhound Discounts .......... (Honoring
Servicemembers) -- Tricare UF [22] ......................... (Change
Announcement) -- COLA 2008 [08] ..................... (2.3% effec=
tive 1
DEC 07) -- Pneumonia Vaccination .................... (Prot=
ection
for Life) -- Veterans Day Free Meals [01] ........... (Restau=
rant
Offers) -- Windows -- Tricare Breast Cancer MRI’s ...............
(Coverage Added) -- Saluting the Flag [01] .........................=
...
(Status of S1877) -- VA Cemetery -- Veterans Mental Health Bill ................
(Hearing’s Result) -- VA Pain Care ...................................=
......
(Bill to Enhance) -- VA Claim Backlog [12] ............... (Cut Waiti=
ng
Time 2/3) -- Army Combat Action Badge ........... (Stuck in
Committee) -- VA Budget 2008 [08] ..... (Rhetorical Firefight
Escalates) -- Cell-phone Scare Message .......................=
. (FTC
debunks) -- Remote Infrared Audible Signs ............ (VA
hospital use) -- Alzheimer’s [04] ............... (Progress=
Cited
in Diagnosis) -- VA Fraud [02] ......................... (Conceal=
ed 2nd
Marriage) -- VA Cancer Reporting Policy ........ (Hampering
Research) -- FTC Fraud Survey ........... (30.2 million Adults
defrauded) -- Veteran Legislation Status 29 Oct 07 ... (Where =
We
Stand) Note: Tricare
initiated coverage for the Shingles vaccine effective 19 OCT 07. MEDICARE PART “D” UPDATE 17: Three lawmakers have introdu=
ced
legislation in the House and Senate to establish a Medicare-administered dr=
ug
benefit that would compete with private plans currently offered under Part =
D.
The law’s introduction was announced by Representatives Marion Berry
(D-AR) and Jan Schakowsky (D-IL) at an 23 OCT press call scheduled to publi=
cize
both the legislation and a report by the Medicare Rights Center (MRC) and
Consumers Union assessing the shortcomings of private Part D plans and the
advantages of providing a public option. The Medicare Prescription Drug Sav=
ings
and Choice Act of 2007, sponsored by Senator Richard Durbin (D-IL) in the
Senate and co-sponsored by Representatives Schakowsky and Berry in the Hous=
e, would
offer a public drug plan administered by Medicare with a nationally uniform
premium, formulary (list of drugs covered) and cost-sharing requirements. T=
he
legislation would require the Secretary of the Department of Health and Hum=
an
Services to use the breadth of the nationwide formulary to negotiate lower =
drug
prices from pharmaceutical companies. =
According to the MRC & Consumers Union report, The Best Medicine=
: A
Drug Coverage Option Under Original Medicare, the privatized delivery of
Medicare drug coverage has resulted in coverage gaps created by inconsistent
formularies and an ineffective appeals process. Changing formularies and
premiums has meant instability in coverage for people with Medicare,
particularly those with low incomes, according to the report. In a related
development, the House of Representatives Committee on Oversight and Govern=
ment
Reform released a report showing the high administrative costs associated w=
ith
using insurance companies to deliver Part D coverage. Total administrative
costs for Part D amounted to 9.8% of the total cost of the program. In
comparison, overhead and administrative costs amount to only 1.7% of the co=
st
of original Medicare. =
In testimony given at an 16 OCT hearing held by the House of Represe=
ntatives
Committee on Ways and Means Subcommittees on Health and Oversight it was
revealed that private Medicare plan benefit packages are not adequately
regulated by the federal government, resulting in inadequate financial
protections for plan enrollees and unpredictable cost-sharing requirements =
for
expensive health services. The subcommittees were convened in response to a=
JUL
07 report by the GAO, Required Audits of Limited Value, which found that the
Centers for Medicare & Medicaid Services had not met the legal requirem=
ent
to audit at least one-third of private Medicare plans. Instead, the proport=
ion
of companies audited decreased from 23.6% in 2001 to 13.9% in 2006. Paul
Precht, deputy policy director at the VA BUDGET 2008 UPDATE 09: In a risky change of strategy, Dem=
ocrats
are pursuing a plan that would dare President Bush to veto a massive bill t=
hat
combines spending for veterans care, education and the Pentagon. The packag=
e,
which combines three bills into one, would total almost $675 billion in
discretionary spending for the fiscal year that began 1 OCT. Of this, more =
than
70% is defense-related. The rest is expected to incorporate about $14 billi=
on
more for domestic priorities than Mr. Bush has requested. The plan is a
significant tactical change. Democrats had been expected to treat the three
bills individually and send them to the White House in a sequence that allo=
wed
the party to spell out its priorities. Supporters of the new, more-unified
approach say it better serves the party's political message by melding nati=
onal
security and domestic issues. But they also concede it could prove a
confrontational, gamble that risks alienating Republican moderates whose
support is vital if Congress is to convince the White House to negotiate ov=
er
domestic spending. Education, veterans' health care and medical-research
programs would most benefit from the added $14 billion. That is about a thi=
rd
of the growth in defense spending over 2007 -- a contrast Democrats will tr=
y to
draw in the unified bill. =
At the same time, the leadership wants to showcase a commitment to
fiscal discipline by cutting special spending projects for lawmakers known =
as
"earmarks" by 40% from 2006 levels, when Republicans controlled
Congress. House-Senate negotiators hope to agree on the individual pieces b=
y 31
OCT, after which a final decision must be made on assembling the package. H=
ouse
Appropriations Committee Chairman David Obey (D-WI) appears to be leaning
toward the new option in hope of combining enough popular interests to over=
ride
any veto. White House officials say the inclusion of defense spending in the
bill won't alter Mr. Bush's willingness to use his veto power, however. The
recent fight over child health insurance suggests that if Democrats are see=
n as
being too political, they won't win over the moderate Republicans they need=
to
prevail. Just last week, for example, House Democrats failed for the third =
time
to get a veto-proof majority for their health bill. Moderates complained
Speaker Nancy Pelosi (D-CA) failed to include them adequately in shaping the
newest version. =
The same could happen in the budget fight now. In an interview last =
week
Sen. Thad Cochran (R-MS), senior Republican on the Senate Appropriations
Committee, signaled a willingness to intercede with the White House to try =
to
reach some compromise on spending. But when told yesterday of the new propo=
sal
to bundle bills together, he was much cooler. "The Democrats are not g=
oing
to win my support by packaging the bills together," Mr. Cochran said. =
The
fact that Democrats are still debating their legislative strategy this far =
into
the fiscal year reflects the extraordinary confusion surrounding the budget
debate this fall. No one predicts a government shutdown, but the Democratic
majority faces a lame-duck president who has interpreted the 2006 elections=
as
a call to vigorously exercise his veto power against spending. As a result,
none of the 12 annual spending bills has been approved and most of the
government has been left to operate under a stopgap spending resolution due=
to
expire 16 NOV. =
The heart of the dispute lies in about $22 to $23 billion that would=
be
added to Mr. Bush's requests for domestic programs such as veterans' care,
education, medical research and law enforcement. The $14 billion in the
proposed package constitutes about two-thirds of this money, and Democrats =
hope
to draw a contrast between the increases they want and the much larger
increases Mr. Bush will get for his defense priorities. The big exception is
funding for the VA DIVERTING PATIENTS: James A. Haley VA Medical Ce=
nter
in =
The VA says it cannot assess how the “It’s like putting your finger in a dik=
e,
actually,” said Dr. Edward Cutolo, Haley’s chief of staff. Bay
Pines treated 49,800 patients in 2000 and tallied 516,000 outpatient visits=
. In
2006, the numbers increased to 95,000 and 1.1 million. The problem is not specific to VA
hospitals. About 36% of all hospitals reported going on diversion, a survey=
by
the American Hospital Association shows. “It’s a crisis across =
VA GUARDIAN:
Payment of benefits to a duly recognized fiduciary may be made on be=
half
of a person who is mentally incompetent or who is a minor; or, payment may =
be
made directly to the beneficiary or to a relative or other person for the u=
se
of the beneficiary, regardless of legal disability, when it is determined t=
o be
in the best interest of the beneficiary by the VA’s Veterans Service
Center Manager. Unless otherwise contraindicated by evidence of record, pay=
ment
will be made direct to the following classes of minors without any referral=
to
the Veterans Service Center Manager: • Those
who are serving in or have been discharged from the military forces of the =
• Those
who qualify for survivors benefits as a surviving spouse. Unless otherwise contraindicated by evidence of rec=
ord,
immediate payment of benefits may be made to the spouse of an incompetent
veteran having no guardian for the use of the veteran and his or her depend=
ents
prior to referral to the Veterans Service Center Manager under the following
circumstances: • When
payments have been discontinued or withheld from a fiduciary, benefits may =
be
temporarily paid to the person having custody of the minor or incompetent.<=
/p>
• Where
a child is in the custody of a natural, adoptive or stepparent, benefits
payable on behalf of such child may be paid to the parent as custodian of t=
he
child. • Benefits
due a minor or incompetent adult Indian who is a recognized ward of the
Government, for whom no fiduciary has been appointed, may be paid to the pr=
oper
officer of the Indian Service designated by the Secretary of the Interior to
receive funds for said person. Guardians are allowed to keep a percentage of the VA
payments if the state in which they reside allows it. In VA TIDBITS: =
• The
law provides a grant not to exceed $5,500 for certain disabled veterans tow=
ard
the purchase of an automobile. If a veteran received this grant when the am=
ount
was lower, he cannot use the difference toward the purchase of another
automobile. A veteran with a qualifying service-connected disability or dis=
abilities
may receive only one VA automobile grant. • There
is no limit to the number of times VA can furnish specially adapted equipme=
nt
for a veteran's automobile. For qualifying veterans, VA will pay for the
purchase, repair, replacement, or reinstallation of adaptive equipment need=
ed
for the safe operation of a vehicle. • A
veteran does not have to be rated 100% in order to be eligible for an
automobile grant. If he or she has lost the use of a limb and that injury is
service-connected, he or she meets the eligibility requirements. • Divorce
terminates all eligible for a spouse to receive any part of a veterans
disability compensation when it becomes final. • Under
the improved pension plan all other VA compensation and/or pensions are cou=
nted
as income. The VA will not accept an election of improved pension unless it=
is
to your advantage. • The VA
audits the periodic guardianship accountings that are required by the Proba=
te
Court. If discrepancies are discovered, the Probate Court is notified and a=
sked
to take corrective action. The welfare and needs of disabled veterans under
guardianship are monitored by VA Field Examiners who make periodic visits w=
ith
these veterans. Unattended needs or adverse conditions are reported to the
guardian or, if necessary to the Probate Court for required action. • If a
veteran dies in a VA hospital, for confidentiality reasons the VA does not =
put
a death notice or obituary in the local newspaper or newspaper from where t=
he
veteran lived. Such notices are at the discretion of the veteran's family or
guardian and are handled either by the funeral home with the family's guida=
nce,
or by the family itself. [Source:
www.va.gov Oct 07 ++] BIOTAPE REFUNDS:&n=
bsp;
Smart Inventions, Inc. and Jon Nokes have entered into a settlement
agreement that will provide up to $2.5 million in consumer refunds to
purchasers of the Biotape, an adhesive product that was falsely claimed to
relieve pain when applied to the skin. In addition, a federal district court
has ruled that Darrell Stoddard, the tape’s inventor who appeared in a
nationally televised infomercial, must give up the $86,000 he received from
infomercial sales. The FTC had charged that all three defendants deceptively
claimed that Biotape provided significant, permanent relief from severe pain
and was superior to other pain-relief products. The infomercial claimed that
Biotape was “a space age conductive mylar that connects the broken
circuits that cause . . . pain.” The agency will contact consumers
regarding refunds. For more information refer to
http://www.ftc.gov/opa/2007/09/biotape.shtm. [Source: FTC news release 18 Sep 0=
7 ++] VA FLAG-FOLDING RECITATION BAN: Complaints about religious content=
have
led to a ban on flag-folding recitations by Veterans Administration employe=
es
and volunteers at all 125 national cemeteries. It all started because of one
complaint about the ceremony at =
Veterans and honor detail volunteers, including Bobby Castillo, 85, =
and
Rees Lloyd, 59, are furious. "That the actions of one disgruntled,
whining, narcissistic and intolerant individual is preventing veterans from
getting the honors they deserve is truly an outrage. These are decisions th=
at
should be made by the families of our deceased veteran comrades and not by
Washington bureaucrats" Lloyd said. "This is another attempt by
secularist fanatics to cleanse any reference to God." Lloyd, who is a
California civil rights attorney, says he and his allies at the Alliance
Defense Fund are considering their legal options. World War II Navy veteran
Castillo said it's "a slap in the face to every veteran. When we got b=
ack
from the war, we didn't ask for a whole lot," Castillo said. "We =
just
want to give our veterans the respect they deserve. No one has ever complai=
ned
to us about it. I just don't understand." Lloyd and Castillo are part =
of a
16-member detail that has performed military honors at more than 1,400
services. They were preparing to read the flag-folding remarks at the River=
side
cemetery when graveyard staff members stopped them. =
Charlie Waters, parliamentarian for the American Legion of Californi=
a,
said he's advising memorial honor details to ignore the edict. "This is
nuts," Waters told the Riverside Press-Enterprise by telephone from
Fresno. "There are 26 million veterans in this country, and they're not
going to take us all to prison." An American Legion commander in
California says he and other veterans will defy the new ban. VA spokesman N=
acincik
said that though the flag-folding narrative includes references to God that=
the
government does not endorse, the main reason for the new rules is uniformit=
y.
"We are looking at consistency," Nacincik said. "We think th=
at's
important." Rabbi Yitzhak Miller of Temple Beth El said he understands=
the
ban. "It is a perfect example of government choosing to ignore religio=
n in
order to avoid offending some religions," Miller said. "To me,
ignoring religion in general is just as problematic as endorsing any one re=
ligion." [Source: AP OneNewsNow.com article 26 Oct 0=
7 ++] VA FLAG-FOLDING RECITATION BAN UPDATE 01: To ensure burial services at the 1=
25
national cemeteries operated by the Department of Veterans Affairs (VA) ref=
lect
the wishes of veterans and their families, VA officials have clarified the
Department’s policy about recitations made while the U.S. flag is fol=
ded
at the gravesite of a veteran. “Honoring the burial wishes of veteran=
s is
one of the highest commitments for the men and women of VA,” said Wil=
liam
F. Tuerk, VA’s Under Secretary for Memorial Affairs. “A family may request the
recitation of words to accompany the meaningful presentation of the American
flag as we honor the dedication and sacrifice of their loved ones.”
Traditional gravesite military funeral honors include the silent folding and
presentation of an American flag, a 21-gun rifle salute, and the playing of
“Taps.” The clarification includes the following: • Volunteer
honor guards are authorized to read the so-called “13-fold” fla=
g recitation
or any comparable script; • Survivors
of the deceased need to provide material and request it be read by the
volunteer honor guards; and • Volunteer
honor guards will accept requests for recitations that reflect any or no
religious traditions, on an equal basis. Veterans with a discharge other than dishonorable, =
their
spouses and eligible dependent children can be buried in a national
cemetery. Other burial benefi=
ts
available for all eligible veterans, regardless of whether they are buried =
in a
national cemetery or a private cemetery, include a burial flag, a President=
ial
Memorial Certificate and a government headstone or marker. [Source: VA News
Release 30 Oct 07 ++] AGENT ORANGE LAWSUITS UPDATE 10: The Haas vs. Department of Veterans
Affairs case is going to be argued on 7 NOV at the US Court of Appeals for =
the
Federal Circuit. This case has implications far beyond the payment or
continuing non-payment of Agent Orange related benefits to Blue Water Navy
sailors who never set foot on the ground.&=
nbsp;
If the lower court (the US Court of Appeals for Veterans Claims) is
upheld in tissue 06 decision, the DVA will be forced to begin processing cl=
aims
for, and paying benefits to US Navy, Coast Guard, and Marine Corps, [and
possibly Merchant Marine] veterans who served off the coast of Vietnam duri=
ng
the war, but never set foot on the ground.=
In essence, the decision reverts to the policy of granting presumpti=
ve
eligibility to anyone who was rewarded the Vietnam Service Medal, or the Ar=
med
Forces Expeditionary Medal for service in Vietnam, a policy which was in ef=
fect
from the enactment of the Agent Orange Act of 1991 until the DVA erroneously
and unilaterally stop paying benefits to Blue Water Navy Veterans in 2002. =
But,
the case, once it is upheld, will also, by dint of the presumptive service
connection, create a new class of potential litigants in lawsuits against t=
he
chemical companies that manufactured the dioxin based defoliants, but also =
the
United States Government, which specifically demanded the chemical composit=
ion
to be delivered by the chemical manufacturers. It i=
s the
reason cited in the paragraph above on which the decision in Haas rests. One of the
things being looked at is the cross reference of spray maps and the locatio=
ns
of ships off shore vs. AO conditions in veterans who were on those ships at
that time. The association has
already begun collecting data.
Instructions for enrollment in the association are available via the
BlueWaterNavy Forum at http://bluewaternavy.org/phpBB2/index.php. Interested veterans and their wive=
s,
widows, and/or children are invited to register and log in to the forum. VA FLU SHOTS UPDATE 01: To safeguard the health of
America’s veterans, the Department of Veterans Affairs (VA) is urging=
all
veterans, especially those enrolled in VA’s health care system, to
receive flu vaccinations this season. Walk-in clinics, even drive-in clinics
for the vaccinations— which are free for veterans enrolled in VA̵=
7;s
health care system—are being offered at many of VA’s 153 hospit=
als
and more than 900 outpatient clinics.
Veterans should check with their nearest VA health care facility to
learn about local vaccination programs. “Vaccination is a simple way =
of
preventing serious health care problems, especially among the elderly, thos=
e with
compromised immune systems and veterans with spinal cord injuries,” s=
aid
Acting Secretary of Veterans Affairs Gordon H. Mansfield. “Part of VA’s health c=
are
service is ensuring veterans get their flu shots.” Veterans should
discuss flu vaccinations with their primary health care provider. Physicians recommend flu vaccinati=
ons
for pregnant women, people with chronic medical conditions, those at least =
50
years of age, patients in long-term care facilities, and people who live wi=
th
those at high risk for complications from flu. A recent study by Dr. Kristin
Nichol, a nationally recognized expert on the flu and chief of medicine at =
the
Minneapolis VA Medical Center, found dramatic reductions in deaths and sick=
ness
after getting a flu shot.
Vaccination reduced hospitalizations for pneumonia or influenza by 2=
7%,
and there was a 48% reduction in deaths. In addition to information about f=
lu
vaccines available in VA’s medical centers and clinics, VA maintains
information for consumers on its Web site at: http://www.publichealth.va.go=
v/flu/. [Source: VA Media Relations 25 Oct 07 ++]
TRICARE FLU IMMUNIZATION: Fall is the best time to get the f=
lu
vaccination in the United States, according to health officials. This gives the body a chance to bu=
ild up
immunity before the winter flu season. “Tricare beneficiaries should
check with their local military treatment facility or primary care manager =
to
find out when and where they are offering the flu vaccine,” said Army
Major General Elder Granger, Deputy Director, Tricare Management Activity
(TMA). “All beneficiari=
es are
encouraged to protect themselves against this potentially deadly virus.R=
21;
Influenza kills about 36,000 Americans each year, and leads to about 200,000
hospitalizations, according to the Centers for Disease Control and Preventi=
on.
It is strongly recommended that the following people get vaccinated each
year: all children aged six m=
onths
to their fifth birthday; adults aged 50 years and older; persons with
underlying chronic medical conditions; pregnant women; health care workers
involved in direct patient care; child care and elderly care workers; and
persons at high risk for severe complications from influenza. Tricare will
cover the Flu shots administered in a civilian pharmacy or drugstore are not
covered by Tricare. For Trica=
re for
Life beneficiaries, Medicare covers flu vaccinations and Tricare would pay =
as
second payer, if needed. Tricare covers two types of vaccinations; the
inactivated vaccine containing a killed virus and given with a needle, and =
the
nasal-spray flu vaccine made with live, weakened flu viruses that do not ca=
use
the flu. For more information about influenza refer to www.cdc.gov/flu/. For
more information about your Tricare benefits refer to www.Tricare.mil. [Source: TMA Press Release 07-76 d=
td 25
Oct 07 ++] VA SECRETARY UPDATE 03: The Secretary of Veterans A=
ffairs
presides over the U.S. government's second largest Cabinet department, after
Defense. It is a politically sensitive job, especially of late, with new
studies showing that the Bush administration has vastly underestimated the =
cost
of providing health care to the more than 750,000 soldiers who have returned
home from the wars in Iraq and Afghanistan. But three months ago, former secre=
tary
James Nicholson resigned abruptly after a difficult tenure and tension among
vets is rising because the White House still hasn't nominated a replacement.
Some veterans advocates say the VA is in such disarray that the White House=
has
been unable to find a top-notch candidate willing to take the job, much les=
s go
through a confirmation hearing. "Who wants to come in for 15 months and
take over a department that has been left in shambles?" asks Paul
Sullivan, a former VA official who now heads Veterans for Common Sense. Whi=
te
House spokeswoman Emily Lawrimore declined to comment on particular candida=
tes,
but says, "We are working hard to nominate a highly qualified
individual." She adds that the White House hopes to announce a nominee
"soon." =
In response to criticism over the issue, President Bush has unveiled=
new
proposals to revamp the health-care and disability system for vets, partly =
by
streamlining the bureaucracy. Days later, USA Today reported the results of=
a
new internal VA study showing that the number of Iraq and Afghanistan vets
diagnosed with post-traumatic-stress disorder is rising rapidly, from 29,04=
1 a
year ago to 48,559 this year. Few of these soldiers are even counted in the
Pentagon's official tally of 27,753 wounded in Iraq. Yet a Pentagon task fo=
rce
recently concluded that the number of mental-health professionals available=
to
vets is woefully inadequate, and the average wait time for disability claim=
s is
six months. Linda Bilmes, a policy analyst at Harvard who will testify befo=
re
Congress this week, calculates that over the next decade, the disability co=
sts
for vets will be at least $60 billion—more than six times the
administration's official projections. The numbers coming out of government
budget offices, she says, are significantly underestimating the reality. All
this has angered some vets and their families. "I would love to have t=
he
president live my life for one week to see how difficult it is," says
Annette McLeod, wife of Army specialist Wendell McLeod, who is suffering fr=
om
PTSD after serving in Iraq. "How do you fund a war but not fund the
casualties?" [Source: Newsweek magazine Michael Isikoff and Jamie Reno
article 29 Oct Issue ++] VA SECRETARY UPDATE 04: President Bush on 30 OCT
nominated retired Army Lt. Gen. James Peake to direct the embattled Departm=
ent
of Veterans Affairs, which is strained by the influx of wounded troops
returning from Iraq and Afghanistan. "He will work tirelessly to elimi=
nate
backlogs and ensure that our veterans receive the benefits they need to lead
lives of dignity and purpose," Bush said. Peake, 63, is a physician who
spent 40 years in military medicine and was decorated for his service in
Vietnam. He retired from the Army in 2004 after being lead commander in sev=
eral
medical posts, including four years as the U.S. Army surgeon general. The
nomination comes as the administration and Congress struggle to find clear
answers to some of the worst problems afflicting wounded warriors, such as
adequate mental health treatment and timely payment of disability benefits.=
=
Peake currently is chief medical director and chief operating office=
r of
QTC Management Inc., which provides government-outsourced occupational heal=
th,
injury and disability examination services. If confirmed by the Senate, Pea=
ke
would lead the government's second-largest agency with 235,000 employees in=
the
waning months of the Bush administration. In his new post, Peake, the son o=
f a
medical services officer and Army nurse, would manage the VA, criticized for
poor coordination in providing medical treatment and disability benefits to
millions of veterans. Earlier this year, a presidential commission chaired =
by
former Sen. Bob Dole, R-Kan., and Donna Shalala, former Health and Human
Services Secretary during the Clinton administration, proposed sweeping cha=
nge
that could add to the VA's backlogged system by shifting most of the
responsibility in awarding disability benefits from the Pentagon to the VA.=
The
VA's backlog is between 400,000 and 600,000 claims, with delays of 177 days=
. Former Secretary Nicholson in May
pledged to cut that time to 145 days, but little headway has been made with
thousands of veterans from Iraq and Afghanistan returning home. "There=
is
a lot of work to be done as we move forward on implementing the Dole-Shalala
commission recommendations," Peake said. "The disability system is
largely a 1945 product, 1945 processes around a 1945 family unit. About
everybody that has studied it recently said it is time to do some
revisions." Sen. Patty Murray, D-Wash., a member of the Senate Veterans
Affairs Committee, said Peake will have to prove he is up to the task of
improving the beleaguered veterans care system. =
Peake, a graduate of the U.S. Military Academy at West Point, was
awarded the silver star and purple heart for his service in Vietnam as a
platoon leader with the 101st Airborne Division. He was wounded twice in ba=
ttle
and received his acceptance letter to Cornell University Medical College wh=
ile
in the hospital recovering from injury. As surgeon general of the U.S. Army=
, he
commanded 50,000 medical personnel and 187 army medical facilities across t=
he
world. He also was commanding general of the U.S. Army Medical Department
Center and School. From 2004 to 2006, Peake was executive vice president and
chief operating officer of Project HOPE, a nonprofit international health
foundation. While at HOPE, he helped organize civilian volunteers aboard the
Navy hospital ship Mercy as it responded to the tsunami in Indonesia and ab=
oard
the hospital ship Comfort which responded to Hurricane Katrina. Joe Davis, a
spokesman for Veterans of Foreign Wars, said Peake appeared to be a strong
nominee who will nevertheless face many difficult challenges at the VA.
"He will inherit a department that continues to face significant
challenges, ranging from the influx of a new generation of disabled veterans
and an uncontrollable claims backlog, to not having an on-time budget for e=
ight
consecutive years," Davis said. "He will walk into tremendous
challenges on day one." [Source: Associated Press Deb Riechmann articl=
e 30
Oct 07 ++] DOD DISABILITY EVALUATION SYSTEM UPDATE 07: The Defense Department will soon u=
nveil
a new, streamlined disability evaluation system that, in tandem with the
Department of Veterans Affairs, will replace the current cumbersome process
with a single exam and single disability rating. According to a copy of the
plan obtained by Military Times and confirmed by Pentagon officials, vetera=
ns
medically retired from service will be able to apply for, and get, VA benef=
its
immediately. Overall, the time spent in the system, from the point a service
member is found unfit for duty until he begins receiving VA disability
payments, will be cut “by about half,” said to Bill Carr,
undersecretary of defense for military personnel policy. The plan is the
Pentagon’s best effort to make some fixes to the system immediately,
without having to seek congressional approval. A broader, longer-range plan
unveiled by the White House on 16 OCT, based on recent recommendations from=
a
blue-ribbon commission, will require congressional approval and will take
longer to implement. The Pentagon’s interim plan will be phased in wi=
th a
pilot program to be launched in late November at three military hospitals:
Walter Reed Army Medical Center in Washington , D.C.; National Naval Medical
Center in Bethesda , MD ; and Malcolm Grove Medical Center at Andrews Air F=
orce
Base, MD. The plan will expand to other facilities as officials evaluate its
effectiveness, with the emphasis on facilities that treat greater numbers of
troops wounded in the wars. Carr said expansion will take place as fast as =
it
can. =
The plan, a top priority of Defense Secretary Robert Gates, is the
Pentagon’s answer to the Walter Reed scandal earlier this year in whi=
ch
media reports described wounded troops caught in tangle of red tape during
their treatment and subsequent medical evaluations. The problems were
complicated by the slow-moving VA benefits process and poor coordination
between VA and the Pentagon — and exacerbated by the wars in Iraq and
Afghanistan, in which more than 28,000 troops have been wounded, more than
13,600 of them seriously. The new program will evaluate all service members
equally, regardless of how their condition developed. Each service now does=
its
own physical exam during the process leading to possible separation, and ea=
ch
service member is rated for his condition. A member medically separated or
retired who then seeks VA care faces another physical exam and yet another
rating. The single exam will be administered to troops as part of the stand=
ard
Medical Evaluation Board (MEB), which determines a member’s fitness f=
or
duty. But instead of a military doctor, a VA-qualified provider with access=
to
the member’s medical records will perform the exam. In addition to ev=
aluating
conditions that could make the member unfit for service, the doctor will al=
so
consider problems the member may say have been incurred in or aggravated by
military service. =
If the MEB, which also considers a commanding officer’s input,=
decides
the member does not meet retention standards, the case is referred to a
Physical Evaluation Board (PEB). This board decides whether to retain, sepa=
rate
or return the member to duty and, under the current system, can determine t=
he
nature and amount of military disability benefits. Troops will retain the r=
ight
to appeal this decision to a formal PEB. But if the original finding is
confirmed, the new system will allow troops to have any single condition or
rating reconsidered by a VA decision review officer while still on active d=
uty.
As it now stands, if a member is rated by the military as at least 30%
disabled, he is medically retired. Unless the member served more than 20 ye=
ars,
a rating below 30% calls for medical separation and, under some conditions,=
a
lump-sum, one-time payment. In the new plan, the military no longer will is=
sue
ratings; that will be solely the VA’s job. But until the law is chang=
ed,
the military will continue to base its disability ratings decisions only on
those conditions that make a member unfit for continued service. For exampl=
e,
if a member is rated as 20% disabled for a knee injury and 10% disabled for
hypertension, the military’s rating for the purpose of deciding wheth=
er
to keep or release the member would be 20%, since hypertension is treatable,
Carr said. In contrast, VA would use the total rating of 30% to calculate
disability compensation for that member, using its own formula. That dispa=
rity
would vanish if Congress adopts the plan announced 16 OCT by President Bush,
Carr said. But while that plan faces competition from separate wounded warr=
ior
legislation introduced in the House and Senate, Carr said the essence of the
new Pentagon plan likely will stand no matter what happens with follow-on
efforts. Carr agreed that the shock of the Walter Reed scandal and Gates=
217;
subsequent push to fix the problems sped the process along. But he said thr=
ee
congressionally mandated Pentagon executive groups had been looking at such
changes for the past two years. In
summary following is a summary of the current, pilot, and future plans: • Current
plan – DoD & VA run separate disability evaluation and ratings
systems, each with its own standards for medical exams and separate process=
es
for setting the level of disability, which in turn determines the military
disability retirement pay or severance pay from the Defense Department and =
the
amount of VA disability compensation. • Pilot
plan -- An interim program would eliminate the separate military and vetera=
ns
health exams and separate systems of awarding a disability rating. Injured
troops would undergo a single exam and get a single rating based on VA̵=
7;s
ratings schedule. DoD would continue paying disability retired pay and
severance pay, while the VA would continue paying disability compensation.<=
/p>
• Future
plan -- If Congress approves a White House plan, DoD’s role in disabi=
lity
decisions would be reduced to ruling on whether a person is fit to continue
military service. Those found unfit would get a pension based on their rank=
and
years of service. VA would then determine the level of disability. Based on
that rating, an individual would receive enhanced disability compensation
featuring several components — the basic disability payment, plus a
transition payment equal to a minimum of three months of basic pay, plus a
payment based on an assessment of how the disability has diminished the
veteran’s quality of life and the potential loss of future income. The
exact levels of pay would be determined by a proposed seven-month study. [Source: ArmyTimes William McMichael article 29 Oct=
07
++] PENNSYLVANIA VET AGENCY: A comprehensive study issued in OC=
T 07
supports state Sen. Richard A. Kasunic’s bill calling for separate st=
ate
government departments to serve the needs of Pennsylvania’s military
personnel and its veterans. Kasunic, who has served as Democratic chairman =
of
the Senate Committee on Veterans Affairs & Emergency Preparedness,
estimated the Keystone State is home to 1.3 million veterans. The 154-page Legislative Budget and
Finance Committee study’s first recommendation calls for a new
cabinet-level Department of Veterans Affairs. Kasunic has introduced this
measure in every legislative session dating to 1983. According to the study,
the federal government annually spends an average of $545 less on Pennsylva=
nia
veterans than on vets who reside in other states. Kasunic said that amounts=
to
$610 million fewer federal dollars, and $1.4 billion in lost economic activ=
ity.
Study recommendations include: • Establishing
a separate state Department of Veterans Affairs. • Funding
the new department with its share of assets from the current DoD & VA, =
and
supplementing the new agency with about $14 million annually. The study cla=
ims
that simply separating the department without providing supplemental dollars
would do little more than drain already existing program resources. • Establishing
a state or county Veterans’ Service Officer, as well as overseeing the
management and funding of the Governor’s Veterans Outreach and Assist=
ance
Centers. • Providing
at least $10 million in the next five years to refurbish the Scotland School
for Veterans’ Children in Franklin County. The new department would be
located at the facility. • Increasing
monthly benefits in the Educational Gratuity, Blind Veterans’ Pension=
and
Paralyzed Veterans’ Pension Programs. • Changing
the law, which excludes veterans younger than 60, to allow any honorably
discharged veteran to serve on the State Veterans’ Commission. • Transferring
the Governor’s Outreach Assistance Center to the new department. [Source:
VA MRSA TESTING UPDATE 01: Lately the news has been saturated= with stories on the increasing rates of methicillin-resistant staphylococcus aur= eus (MRSA) infections in the United States.&nb= sp; The VA wants veterans to know they have taken proactive steps to com= bat the infection at each of its 153 hospitals and are placing greater emphasis= on hygiene and screening procedures to help control spread of the disease. The= new disease control plan is based on a pilot program that reduced the worrisome staph infection rate by 70% at a VA facility earlier this year. “VA demonstrated that dramat= ic reductions in MRSA-related infections are possible,” said Acting Secretary of Veterans Affairs Gordon H. Mansfield. “VA’s completion of our national deployment of these serious prevention measures reinforces VA̵= 7;s stature as one of the safest health care environments nationally.” [Source: NAUS Weekly Update 19 Oct 07 ++]
= MRSA resists many antibiotics and is presently killing more people annually than AIDS, emphysema or homicide, taking an estimated 19,000 lives= in 2005, according to a study published in the Journal of the American Medical Association. The best defense against the potentially deadly infection is common sense and cleanliness. Community-acquired staph infections, or CA-MR= SA is primarily a skin infection. It often resembles a pimple, boil or spider bite, but it quickly worsens into an abscess or puss-filled blister or sore. Patients who have sores that won’t heal or are filled with pus should= see a doctor and ask to be tested for staph infection. They should not squeeze = the sore or try to drain it — that can spread the infection to other part= s of the skin or deeper into the body. The vast majority of MRSA cases happen in hospital settings, but 10 to 15% occur in the community at large among otherwise healthy people. Infections often occur among people who are prone= to cuts and scrapes, such as children and athletes. MRSA typically spreads by skin-to-skin contact, crowded conditions and the sharing of contaminated personal items. Others who should be watchful: people who have regular cont= act with health care workers, those who have recently taken such antibiotics as= fluoroquinolones or cephalosporin, homosexual men, military recruits and prisoners. Clusters= of infections have appeared in certain ethnic groups, including Pacific Island= ers, Alaskan Natives and Native Americans.
= The risk of contracting MRSA can be lowered by bathing regularly and washing hands before meals as a start. Wash your hands often or use an antibacterial sanitizer after you’ve been in public places or have touched handrails and other highly trafficked surfaces. Make sure cuts and = scrapes are bandaged until they heal. Wash towels and sheets regularly, preferably = in hot water, and leave clothes in the dryer until they are completely dry. Re= mind kids and teenagers that personal items shouldn’t be shared with their friends. This includes brushes, combs, razors, towels, makeup and cell phones. The bacteria may be f= ound on the skin and in the noses of nearly 30% of the population without causing harm. Experts believe it survives on surfaces in 2 to 3% of homes, cars and public places. But the bacteria are evolving, and the statistics may already underestimate the prevalence of MRSA. Be especially vigilant in health clubs and gyms — staph grows rapidly in warm, moist environments. The risks= of infection and necessary precautions should be explained to student athletes, particularly those in contact sports who often suffer cuts and spend time in locker rooms. When working out at the gym, make sure you wipe down equipment before you use it. And if you have a scrape or sore, keep it clean and band= aged until it heals. Minor cuts and scrapes are the way MRSA takes hold. For more info on MRSA refer to www.Mayoclinic.com.&= nbsp; [Source: NAUS Weekly Update 19 Oct & NY Times article 23 Oct 07 ++]
USAF RETIREE FUNERALS: Manpower cuts and a high operations tempo, plus more retiree funerals than ever in Air Force history, mean base honor guards Air Force-wide will change the way they perform reti= ree funerals starting 1 NOV 07. T= he formal 10-person funeral will no longer be authorized for retiree funerals. The funeral detail = will now consist of seven people who will serve as pall bearers, flag folders, f= lag presenter, bugler, spare, and firing party. This is to provide a 30% manpower = relief for retiree funeral details, and 21% manning relief for overall funeral details, according to Pentagon air staff officials. "The main concern people had = in the change of the funeral procedures was that we wouldn't be keeping with past traditions," said Staff Sgt. David Little, U.S. Air Force Honor Guard course supervisor for base honor guards.&n= bsp; "Originally, the number of (Airmen) was going to be lowered to five, but we didn't want to lose the pall-bearing aspect so we determined t= hat seven people would still be able to carry on all aspects of the funeral.&qu= ot;
This new f=
uneral
sequence has three major differences:
the noncommissioned officer in charge of pall bearers also will be t=
he
NCO in charge of the funeral, the number of firing party members will be
reduced to three, and a spare position will be added. The new sequence begins with the N=
CO of
pallbearers assuming the position of NCO in charge to ensure the casket and
flag are situated properly in the hearse.&=
nbsp;
He or she will then join the pallbearers and call commands to carry =
the
casket to gravesite, and finally present the flag to the family while the o=
ther
team members assume their roles as either the bugler, spare or firing
party. The final sequences ar=
e the
same. A video was released 24=
SEP
documenting the new funeral, and is available on the Air Force Honor Guard =
Web
site. Sergeant Little noted,
"Another concern we've heard is that people think we're taking away the
'21-gun salute' by having only three people fire. But what people don't rea=
lize
is that we've never done a 21-gun salute during military funeral honors.
Overall, t= he reaction has been positive, Sergeant Little said. "Retirees are gratef= ul; they knew the Air Force was going to make changes, so they're happy we kept= all aspects," he said. "= ;The bases have been having a hard time supporting the 10-person funeral so this eases their personnel strain, and the base honor guards are happy with the = new sequence. Training for the new sequence is not difficult either. We've had a lot of phone calls about the video, but what is important to remember is th= at all the manuals are the same. It's what you've already been trained on. The only differences are the sequences, and those are narrated to he= lp each person understand (his or her) role.&= nbsp; We're not teaching movements, we're teaching the sequence. The order of events is the same as= the 10-person; the only real differences are the addition of the spare and the sequence at the back of the hearse."&= nbsp; For more information or questions regarding funeral policy or protoc= ol, call the Pentagon air staff at (703) 604-4928. [Source: Air Force Retiree N= ews Service Madelyn Waychoff article 23 Oct 07 ++]
RESERVE GI BILL UPDATE 07: In the 18 OCT hearing before the H=
ouse
Veterans Affairs Economic Opportunity Subcommittee on the Montgomery GI Bill
(MGIB) the dominant subject was education benefits for returning combat
veterans from the Minnesota National Guard. The 34th Brigade combat team serve=
d a
grueling 16-month tour in Iraq and a total of 22 months on active duty. More than half of the unit served =
on
two-year orders that qualified them to apply for active duty MGIB
benefits. But orders for the =
rest
of the unit were for one year and 364 days - one day short of two years.
MEDICARE REIMBURSEMENT RULE (NEW): To defuse physicians' and hospitals' opposition to the creation of Medicare back in 1965, the program= 's congressional architects selected payment mechanisms designed to preserve t= he status quo. But as Medicare h= as expanded and problems of affordability and quality of care have grown, such= an approach has become untenable. Recently, the Centers for Medicare and Medic= aid Services (CMS) announced its decision to cease paying hospitals for some of= the care made necessary by "preventable complications" — condit= ions that result from medical errors or improper care and that can reasonably be expected to be averted. This rule, which implements a congressionally manda= ted change in hospital reimbursement, is the latest in a series of steps that h= ave rendered Medicare's payment policy far less passive than it once was. The starting point for current Med= icare payments for inpatient care is the system based on diagnosis-related groups (DRGs) that was adopted in 1983 by CMS's predecessor, the Health Care Finan= cing Administration. That system is considered prospective, in that the amount p= aid to a hospital for a patient is fixed in advance and depends only on the diagnoses and major procedures reported at discharge (which, in turn, map t= o a specific DRG).
= In reality, payments under this system have never been completely prospective, being influenced to some degree by what happens to an individu= al patient during a hospitalization. For example, higher payments are made on behalf of patients in whom clinically significant complications develop aft= er admission than for those with the same diagnosis who have no such complications. There are also so-called outlier payments that partially compensate hospitals for the additional expenses incurred for very-high-cost cases. With regard to preventable complications, these retrospective featur= es of the DRG payment system have harbored a perverse incentive: hospitals that improved patient safety and ameliorated problems such as nosocomial infecti= ons saw their Medicare revenues — and sometimes their profits — reduced.
Believing that this counterproductive incentive sho= uld be eliminated, Congress instructed the Secretary of Health and Human Services = in 2005 to select at least 2 conditions that are
(a) High cost or high volume or both,
(b) Result in the assignment of a case to a DRG tha= t has a higher payment when present as a secondary diagnosis, and
(c) Could reasonably have been prevented through the application of evidence-based guidelines.&= nbsp;
After issuing a proposed set of measures and consid= ering comments from stakeholders and experts, CMS decided to disallow incremental payments associated with eight secondary conditions that it sees as prevent= able complications of medical care. These conditions, if not present at the time= of admission, will no longer be taken into account in calculating payments to hospitals after October 1, 2008.
The new rule will result in hospitals seeing substa= ntial reductions in payment for the care of individual patients with preventable complications. For example, if a patient were admitted to a Boston-area hospital with pneumonia and developed a urinary tract infection or bed sores during the hospitalization, the hospital would currently be paid $6,253.58, under DRG 89 ("pneumonia with complications"); under the new rule= , if there were no other complications, the hospital would be paid only $3,705.3= 8, under DRG 90 ("simple pneumonia") — a difference of $2,548.= 20 (a reduction of approximately 40%). The policy, however, is unlikely to change= the total Medicare payments to hospitals substantially, because the payment wil= l be "reduced" only for instances in which preventable complications w= ere the only factors causing a case to be reclassified under a more expensive D= RG.
= Medicare will continue to make outlier payments for cases with costs substantially exceeding the average for the appropriate DRG, even when these costs are the consequence of preventable complications — and the likelihood of incurring such outlier payments will actually be increased by= the new policy, because cases in which there are complications will more easily exceed the threshold associated with the lower-paying DRG. Moreover, preventable complications including the eight that CMS identified for exclu= sion may continue to result in higher Medicare payments to hospitals, because th= eir downstream consequences may place cases in entirely different and very-high-cost DRGs, such as DRG 483 (tracheostomy with mechanical ventilat= ion for 96 hours or more). The new approach does not attempt to unravel these m= ore complex clinical scenarios.
= Conditions for which Medicare will no longer pay more if acquired du= ring an inpatient stay, number of incidents in FY 2006, and average Medicare pay= ment for admissions in which condition was present are:
• Object left in patient during surgery – 764 - $61,962
• Air embolism – 45 - $66,007
• Blood incompatability – 33 - $46,492
• Catheter-associated urinary tract infection – 11,780 - $40,347
• Pressure ulcer - 322,926 - $40,81
• Vasculat-catheter associated infection – Unknown
• Mediastinitus after coronary-artery bypass grafting – 108 - $304,747
• Fall from bed -2,591 - $24,962
[Source: The New England Journal of Medicine Meredi= th B. Rosenthal article 18 Oct 07 ++]
programs designed to reduce the reduction in retire= d pay due to receipt of Veteran Administration compensation, for certain disabled retirees. Concurrent Retirement and Disability Payments (CRDP) provides a 1= 0-year phase-out of the offset to military retired pay due to receipt of VA disabi= lity compensation for members whose combined disability rating is 50% or greater= . Members retired under disability provisions must have 20 years of service.<= span style=3D'mso-spacerun:yes'> Combat-Related Special Compensation (CRSC) pays added benefits to retirees who receive VA disability compensati= on for combat-related disabilities and have 20 years of service. To find out if either of this programs apply to you and to obtain the appropriate paperwor= k to apply refer to the following:
• New Retired Benefit Programs general information paper at http://www.defenselink.mil/prhome/docs/concurrent_retire_07a.pdf
• CRSC Information paper Updated NOV 06 at http://www.defenselink.mil/prhome/docs/crsc_nov06.pdf
• Revised CRSC guidance effective 1 JAN 04 at http://www.defenselink.mil/prhome/docs/CRSC_Guidance_104.pdf
• CRSC Application (DD FORM 2860) at http://www.dtic.mil/whs/directives/infomgt/forms/eforms/dd2860.pdf or http://www.dtic.mil/whs/directives/infomgt/forms/forminfo/forminfopage2483.= html
Veterans must apply to their own branch of Service = for Combat-Related Special Compensation (CRSC) benefits. Applicants are urged to contact their own branch of Service for additional information. Link to your Service web site:
• Army at https://www.hrc.army.mil/site/crsc/index.html
• Navy & Marine corps at http://www.donhq.navy.mil/corb/crscb/combatrelated.ht= m
• Air force at http://ask.afpc.randolph.af.mil/crsc/default.asp?prods3=3D2039&prods2= =3D39&prods1=3D1&cats1=3D144&p_cats=3D144
For more info refer to http://www.defenselink.mil/prhome/mppcrsc.html. [Source: Under Secretary of Defense Personnel & Readiness notice 28 Mar 07 ++]
VA MRSA TESTING UPDATE 01: Lately the news has been saturated= with stories on the increasing rates of methicillin-resistant staphylococcus aur= eus (MRSA) infections in the United States.&nb= sp; The VA wants veterans to know they have taken proactive steps to com= bat the infection at each of its 153 hospitals and are placing greater emphasis= on hygiene and screening procedures to help control spread of the disease. The= new disease control plan is based on a pilot program that reduced the worrisome staph infection rate by 70% at a VA facility earlier this year. “VA demonstrated that dramat= ic reductions in MRSA-related infections are possible,” said Acting Secretary of Veterans Affairs Gordon H. Mansfield. “VA’s completion of our national deployment of these serious prevention measures reinforces VA̵= 7;s stature as one of the safest health care environments nationally.” [Source: NAUS Weekly Update 19 Oct 07 ++]
VA COMP PAYMENT DISPARITY UPDATE 09: On 17 OCT, the House Veterans̵= 7; Affairs Subcommittee on Oversight and Investigations held a hearing to revi= ew the disability claims rating process and assess the causes of disparities in disability ratings that are administered by the Department of Veterans Affairs. Variances in VA disa= bility compensation rates range from an average of $12,000 per veteran in New Mexi= co to less than $8,000 per veteran in Ohio. Among the actions under review are= six recommendations from the Institute for Defense Analyses (IDA) on providing improved consistency in VA disability ratings and claims payments:
1.) Standardize training for rating specialists;
2.) Standardize the medical evaluation reporting pr= ocess;
3.) Increase oversight and review of rating decisio= ns;
4.) Consolidate rating activities to a central loca= tions;
5.) Develop metrics to monitor consistency in adjudication results; and,
6.) Improve and expand data collection and retentio= n.
The hearing marks what will hopefully be the contin= uation of a more rigorous effort to modernize and improve the way we evaluate disabilities and award compensation for injured service members, exactly as= the Veterans’ Disability Benefits Commission and a number of other blue-ribbon panels have also recommended. [Source: NAUS Weekly Update 19 Oc= t 07 ++]
GRAYHOUND DISCOUNTS:
Military Discount:= Active duty and retired military personnel and their dependent famil= y members may receive a 10% discount off the Greyhound walk-up (unrestricted) fare. Another option for military personnel is to travel on Greyhound for a maxim= um fare of $198 round trip anywhere in the continental United States. The following restrictions apply:<= /p>
1. Fares are valid on Greyhound schedules and those= of participating interline carriers. Not available on Greyhound Canada routes.=
2. This fare applies only to active and retired mem= bers of the United States Armed Forces, which includes the U.S. Air Force, Army, Coast Guard, Marines, and Navy; members of the National Guard, reservists a= nd bonafide identifiable spouses and dependents of the above. A valid military picture identification card must be presented upon request.
3. A 40% discount for children of military personnel referenced above is available. Discount not available with $198 maximum military fare. No other discounts apply.
4. Only totally unused tickets may be refunded to t= he location of the original purchase. A 15% penalty fee applies upon refund. No refund will be allowed if any portion of the ticket has been used.
5. Departure date and time may be changed for a cha= rge of $10 per ticket provided that the advance purchase requirement is not violat= ed.
6. Advance purchase tickets purchased over the phone require a minimum of ten days for delivery by mail and for online orders. <= /p>
7. Casino, commuter, Discovery Pass, student or oth= er special military fares do not qualify for the military discount.
8. Fares are subject to change until purchase and m= ay be higher during peak holiday travel periods.
9. Ten-percent discount may not be used in conjunct= ion with the $198 maximum fare.
Veterans Discount: With the Veterans Advantage Disc= ount Card, members can save 15% on walk-up fares at the terminal or online. Vete= rans Advantage is available for U.S. Military Veterans, active duty, National Gu= ard & Reservists, and their family members. Membership is good for discount= s on travel, dining, entertainment, clothing, and many more services and product= s. To become a member and get this discount, apply online at the Veterans Advantage Web site, or call 1(866) 838-7392. A Veterans Advantage 30-day fr= ee trial offer is currently available for Greyhound riders to thank you for yo= ur service. Full memberships are available for as low as $59.95 for one year, = plus $4.95 to process enrollment.
VA Patient Discount: A 25% discount on applicable one-way fares also is available to pati= ents of U.S. Veterans Administration Hospitals, patients assigned by the U.S. Veterans Administration to Army, Navy, Air Force, or military hospitals, or patients assigned by the U.S. Veterans Administration to civil and state institutions when traveling at their own expense. To qualify, the patient must prese= nt a completed original Veterans Administration Request for Reduced Rate Transportation Form (VA-Form 3068) to the ticket agent at time of purchase.= No copies, facsimiles, or other forms will be accepted for this discount.
[Source: Military.com 18 Oct 07 ++]
TRICARE UNIFORM FORMULARY UPDATE 22: On 26 OCT DoD officials announced =
the
reclassification of nine additional medications as non-formulary. The nasal corticosteroid Veramyst =
and
growth stimulants Genotropin, Genotropin Miniquick, Humatrope, Saizen and O=
mnitrope
will be changed to non-formulary status on 9 DEC 07. Allergy medications Clarinex, Clar=
inex-D
and the asthma medication Zyflo will be reclassified as non-formulary
medications on 19 JAN 08. Medications not on the Uniform Formulary are not
available at military treatment facility (MTF) pharmacies unless medical
necessity has been established and an MTF provider writes the
prescription. Beneficiaries t=
aking
non-formulary medications may want to consult with their health care provid=
er
about changing to a less costly alternative. Beneficiaries can also ask provide=
rs if
establishing medical necessity for the third-tier medication is
appropriate. If medical neces=
sity is
established for a third-tier medication, the co-payment is reduced to $9.
www.tricareformularysearch.org/dod/medicationcenter= /default.aspx. [Source: NAUS Weekly Update 26 Oct= 07 ++]
COLA 2008 UPDATE 08: The Department of Labor announced that next year’s COLA (Cost = of Living Adjustment) be 2.3%. The increase will apply to military retirees and their survivors, as well as Social Security annuities and certain other fed= eral payments. Civilian federal retirees will receive a COLA of 2.0%. This is the lowest increase since 2004. T= he cost of living increase was 2.7 % in 2004, 4.1% in 2005 and 3.3% in 2006. C= OLAs are set by comparing the change in the consumer price index for wage earners and clerical workers from the third quarter of one year to the third quarte= r of the next year. The COLA is lower this year than last due to a drop in energy costs in August and September. Counterbalancing the COLA for Medicare beneficiaries will be a rise in Medicare premiums of $2.50, to $96.40 a mon= th. The COLA is effective on 1 DEC 07 and will appear in your JAN checks. [Sour= ce: NAUS Weekly Update 19 Oct 07 ++]
PNEUMONIA VACCINATION: The Army Medical Department is lau= nching a concerted effort to reduce the needless suffering, death, and waste of medical resources that stem from widespread failure by older beneficiaries = to get their pneumonia vaccinations. Military medical facilities are being pre= ssed to stay on their toes about offering the shots to all their older patients. Also known as the pneumococcal shot or Pneumococcal Polysaccharide Vaccine = or PPV, the pneumonia vaccine is safe and highly effective, according to medic= al authorities—provided it gets out of the bottle and inside somebody’s body. To encourage that to happen more often, military med= ical leaders are stressing these facts:
• Pneumococcal disease can kill you. It is the sixth leading cause of death in the U.S. (40,000 deaths annually).
• It can make you miserably and expensively ill. There are 100,000 -130,000 hospitalizations annually in the U.S.
• It can affect your lungs, blood, and brain. It usually causes fever, cough, and shortness of breath.
• Pneumococcal disease can affect people of all ages, but older adults ages 65 and over ar= e at higher risk for complications from both the flu and pneumococcal disease. T= he shot can help protect you from getting a serious infection in your lungs, b= lood and brain.
• Getting the shot when you’re age 65 or older should protect you for the rest = of your life. You can get it any time of the year. The shot is safe and most people have no side effects. For maximum safety, medical officials also encourage beneficiaries to take the flu vaccine annually.
Anyone can get pneumococcal disease, but some peopl= e are at greater risk from the disease. These include people 65 and older, the ve= ry young, and people with special health problems. The pneumonia vaccine prote= cts you from getting serious infection in your blood or brain that can cause dangerous health problems, hospitalization, and death. Pneumococcal disease= can lead to serious infections of the lungs (pneumonia), the blood (bacteremia), and the covering of the brain (meningitis). About 1 out of every 20 people = who get pneumococcal pneumonia dies from it, as do about two people out of 10 w= ho get bacteremia and three people out of 10 who get meningitis. People with t= he special health problems are even more likely to die from the disease. Drugs such as penicillin were once effective in treating these infections; but the disease has become more resistant to these drugs, making treatment of pneumococcal infections more difficult. This makes prevention of the disease through vaccination even more important. Those who should get the pneumococcal shot are:
• All adults 65 years of age or older.
• Anyone over 2 years of age who has a long term health problem such as: heart disea= se, lung, disease, sickle cell disease, diabetes, alcoholism, cirrhosis, or lea= ks of cerebrospinal fluid.
• Anyone over 2 years of age who has a disease or condition that lowers the bodyR= 17;s resistance to infection, such as: Hodgkin’s disease, lymphoma, leukem= ia, kidney failure, multiple myeloma, nephrotic syndrome, HIV infection or AIDS, damaged spleen, or no spleen, organ transplant.
• Anyone over 2 years of age who is taking any drug or treatment that lowers the body’s resistance to infection, such as: long-term steroids, certain cancer drugs, radiation therapy.
• Alaskan Natives and certain Native American populations.
For more info on immunizations Ask your doctor or n= urse, refer to the National Immunization Program
website http://www.cdc.gov/nip/default.htm (Departm= ent of Health And Human Services Centers for Disease Control and Prevention Nation= al Immunization Program, or go to http://www.cdc.gov/nip/vaccine/pneumo/pneumo-pubs.htm#top. [Source: Army News Service Harry N= oyes article 18 Oct 07 ++]
VETERANS DAY FREE MEALS UPDATE 01: In their annual = salute to all veterans McCormick & Schmick's Seafood Restaurants will again provide free meals in honor of Veterans Day. All veterans can receive a free lunch or dinner entrée at McCormick & Schmick's Seafood Restaura= nts nationwide on Sunday, 5 NOV 06. Vets should show proper identification (VA card, VFW card, veterans ID, discharge papers, etc.) Reservations are stron= gly encouraged! In a show of thanks to our nation's veterans, Bill McCormick an= d Doug Schmick offer to serve those who've served at their McCormick & Schmick= 's Seafood Restaurants. Last year the company served nearly 15,000 vets nationwide. This year's event is taking place on the Sunday before Veterans= Day so that families can participate. McCormick & Schmick's annual veterans program began as a small effort in just one restaurant in 1999. Due to its overwhelming popularity and positive response received from veterans the program has expanded nationwide. A complete list of participating restauran= ts may be found at www.McCormickandSchmicks.com .
Also thanking active duty and veterans, the Golden Corral restaurants will be ha= ving their annual salute to the military on Monday 13 NOV from 17-2100. Military Appreciation Monday (First Monday after Veteran's Day) is set aside for Golden Corral to honor all act= ive duty and retired military personnel with a free "thank you" dinner and beverage at any Golden Corral restaurant. No identification is required. Since 2001, Golden Corral has served 1,230,960 free meals to active duty and retired military personnel. For more info go to their website http://www.goldencorral.net/. [Source: The Veterans Voice http://www.theveteransvoice.com/Hero.html Oct 07 ++]
WINDOWS VISTA BOYCOTT: The Consumers’ Associa=
tion
(Consumentenbond) has called on consumers when purchasing a new computer to
explicitly ask for the operating system Windows XP. New PCs come standard w=
ith
Windows XP’s successor Windows Vista but there are many complaints ab=
out
this system. The organization=
has
also called on shops to provide free Windows XP packages to clients who are
having problems with Vista. The Consumers’ Association took this deci=
sion
on 18 OCT after a meeting with Microsoft to discuss the problems with
Vista. After a survey conduct=
ed by
the Consumers’ Association showed that the performance of
Microsoft’s latest operating system was very poor, the Association se=
t up
a registration centre for complaints about Vista. In less than five weeks 5=
,000
users filed complaints about the functioning of the system. "The produ=
ct
has many teething problems, it is just not ready," a spokesperson for =
the
association said. Printers and other hardware reportedly failed in combinat=
ion
with Vista, computers crash regularly and the peripherals are very slow.
TRICARE BREAST CANCER MRI’S: Recognizing the importance of early detection, the Tricare Management Activity (TMA) recently changed its policy adding coverage for Magnetic Resonance Imaging (MRI) screening for women at high risk of developing breast cancer.&nbs= p; The American Cancer Society has clear guidelines defining high risk which doctors can use to determine who qualifies for the coverage. If any qualified beneficiary recei= ves this care in the near future and it is denied, they can resubmit their clai= m for reimbursement. “An MRI is a clearly superior tool for screening the highest risk women for breast cancer,” said Army Major General Elder Granger, Deputy Director, and Tricare Management Activity. “We want these women to have= every chance to detect any cancer at the earliest possible stages.”
Breast cancer is the t= hird most common cancer among Tricare beneficiaries and the second most common c= ause of cancer death for women in the United States. An individual’s level of ris= k can be impacted by a number of factors including age, family history and race.<= span style=3D'mso-spacerun:yes'> Doctors can advise their patients = of their individual risk factors, but even women of average or low risk should= be vigilant. “The availability of MRI screenings does not reduce the importance of regular examinations,” Major General Granger stressed.<= span style=3D'mso-spacerun:yes'> “All women over 39 years old= need to get those annual mammograms. The key to dealing with cancer is early detection.” Anyone who meets the criteria for a breast MRI will be covered by Tricare, retroactive to 1 MAR 07. If any qualified benefici= aries received this care on or after March 1, 2007 and it was denied, they can resubmit their claim for reimbursement. For more information about b= reast cancer refer to http://www.Tricare.mil/pressroom/doctor_is_in.aspx?fid=3D60. [Source: Tricare Press Release 07-71dtd 17 OCT 07 ++]
SALUTING THE FLAG UPDATE 01: S1877, introduced by Senator Inhofe of Oklahoma, to amend Title 4, United States Code, to prescribe those members of the Armed Forces and veterans out of uniform may render the mili= tary salute during hoisting, lowering, or passing of the flag. The bill was sent= to the House Judiciary Committee for consideration. The Committee, to date, has not set the bill for review. They have a huge backlog of issues currently u= nder consideration. The staff reports that the concern with this bill is that th= ere is no way to determine when people are in civilian clothes who is and who is not a veteran. The staff also said that there currently is in the law an appropriate method for rendering honors and that is to place one's hand over one's heart. It is not known at this point whether or not this bill will be= come law, but it is expected to be mired in legal wrangling and constitutional l= aw review for quite some time. The Air Force Association (AFA) in the interim = is suggesting that veterans render honors in a way they deem appropriate. If t= he situation warrants, place your hand over your heart - if you'd rather salut= e, do that. No law is going to change the way you feel about rendering honors.= You earned the privilege to do as you choose. [Source: AFA Update 17 Oct 07 ++]=
VA CEMETERY TEXAS UPDATE 01: The numbers are deceiving fo= r the Ft. Sam Houston National Cemetery. Since 31 JUL 07 the total internments have reached 116,766 and occup= ied gravesites number 92,980. Jus= t five years ago, the cemetery added 40 new acres that were expected to give Fort = Sam enough gravesites to last through 2010. But that section already is 90% ful= l. There are just 5,256 gravesites left, which could run out in less than a ye= ar. Those running the cemetery say they’re utilizing the space they have left better, and are mapping plans to open one last section that could keep it in business through 2035. Run by the Veterans Affairs Department, the cemetery acquired 169.8 acres from Fort Sam Houston that is bordered by Salado Creek. Cemetery director William Trower said at least 100,000 veterans and their spouses are to be buried there before space runs out. Burials are done in concrete-lined crypts that can hold both a veteran and his or her spouse. The "lawn crypt," as it’s called, allows five graves to be placed in the s= ame space that four once used. The headstone, set in a concrete containment box, won’t move the way others do that rest on the earth. All headstones in American veteran= ’s cemeteries stand as soldiers do before mustering to war. But those here won’t rise and fall, creating a "wave" of marble in a sea of well-manicured grass. That will spare Fort Sam’s maintenance workers = from having to occasionally straighten the markers. [Source: San Antonio Express-News 15 Oct 07= ++]
VETERANS MENTAL HEALTH BILL: U.S. Senator Daniel K. Akaka (D-HI= ), Chairman of The Committee on Veterans’ Affairs, has introduced comprehensive mental health legislation.&n= bsp; The bill, inspired by an 25 APR Committee hearing on mental health c= are, would address the immediate needs of veterans by ensuring high quality ment= al health services at VA facilities and in their communities. In testimony at the hearing, veter= ans and their family members told heart-wrenching stories of substance abuse, P= TSD, and suicide, which exposed flaws in the current mental health care system f= or veterans. “Servicemen and women return from war suffering from invisi= ble wounds that are complicated and wide-ranging,” Akaka said. “The solutions put forth in t= his legislation will help lead to proper mental health care for our veterans.” In his floor statement Akaka noted:
• A MAR
07 study published in the Archives of Internal Medicine reported that more =
than
one-third of war veterans who have served in either Iraq or Afghanistan are
suffering from various mental ailments including post-traumatic stress
disorder, anxiety, depression, substance use disorder and other problems.
• One in five Iraq War veterans are likely to develop PTSD, as studies have estimate= d, and this is but one aspect of the mental health challenges faced by veteran= s.
• We also know that veterans suffering from physical and mental wounds use drugs= and alcohol to assuage their pain. Experts believe that stress is the number one cause of drug abuse, a= nd of relapse to drug abuse. Six= ty to eighty percent of Vietnam veterans who have sought PTSD treatment have alco= hol use disorders. VA has been de= aling with substance abuse issues for decades, but much remains to be done.
• This bill addresses the immediate needs of veterans by ensuring high quality men= tal health services at VA facilities and in their communities.
The bill also looks to the future through a number core provisions. The legislation would:
• Require VA medical centers to offer a minimum range of services for veterans in nee= d of help to overcome their substance use disorders.
• Require programs to prevent relapse and to provide medical treatments to reduce cravings for alcohol and drugs, among others.
• Require that the confluence of substance use disorders and other mental hea= lth disorders be treated by a well-qualified team of health professionals who w= ould treat the disorders concurrently.
• Create grants to enhance programs and fill holes.= VA facilities would compete for grants for various purposes, from increasing weekend and evening hours to creating programs which encourage u= rgent care physicians - who are often gateways for new patients - to quickly refer those whom they believe may have a mental health disorder.
• Require the VA Secretary to designate six inpatient facilities to provide recovery services for veterans with comorbid PTSD and substance use disorders.
• Require a comprehensive review of VA's residential mental health facilities.
• Restate an existing law which allows families to have access to care which will aid= in the effective treatment and rehabilitation of a veteran by clarifying the t= ype of services to which family members should have access.
• Set up a mental health research program based on the successful pediatric oncology model. It proposes a network = of sites with adequate patient flow and clinical and research expertise with a goal of promoting rapid progress from research to therapeutic advancement a= nd effective treatments for PTSD and PTSD in the presence of a substance use disorder.
• Authorize the creation of new programs and expansion of existing ones.
The Veterans Affairs Department on 24 OCT announced= its opposition to the mental health care legislation, contending that it duplic= ates efforts already under way. Dr. Michael J. Kussman, the VA's undersecretary for health, "said the substance abuse segment of the bill was 'overly prescriptive and attempts to mandate the type of treatments to be provided to covered veterans, the treatment settings and the composition of treatment teams.' Kussman also sa= id the contracted care sections of the bill are duplicative of currently exist= ing authorities. [Source: SCVA Ne= ws Release 15 Oct 07 ++ ]
VA PAIN CARE: On 15 OCT Senator Daniel K. Akaka (D-HI), Chairman of the Veterans’ Affairs Committee, and fellow Committee member Senator Sher= rod Brown (D-OH), introduced legislation that would enhance the Department of Veterans Affairs’ pain management program. The Veterans Pain Care Act of 2007= would assist in focusing attention on pain management as a new generation of vete= rans suffering from pain enter VA’s health care system. This legislation seeks to signific= antly bolster VA’s existing pain management efforts and bring them up to pa= r at a national, system-wide level. This bill, among others, is scheduled to be reviewed at the Committee’s 24= OCT 07 hearing on pending legislation. It has been endorsed by the Pain Care Forum, a consortium representi= ng over 75 health care and health advocacy organizations from across the count= ry. Sen. Akaka noted in introducing the legislation that:
• It is estimated that nearly 30% of Americans – that’s some 86 million people – suffer from chronic or acute pain every year. A recent study conducted by VA researchers in Connecticut found that nearly 50% of veteran patients that a= re seen at VA facilities reported that they experience pain regularly.
• While pain increases in severity with age, it is also a growing problem among you= nger veterans who have been injured in the wars in Iraq and Afghanistan. Many of these veterans are coming = home with severe injuries – often traumatic brain injuries – that require intensive rehabilitation. In some cases, these younger veterans will have to live with the long-term effects of their injuries, of which pain is a large and debilitat= ing part.
• Pain management is an area of health care that by many accounts is not yet to up= to par, in both the private and public sectors. The legislation being introduced w= ould enhance VA’s pain management program on a national, system-wide level= , by requiring VA to establish a pain care initiative at every VA health care facility. Every hospital and = clinic would be required to employ a professionally recognized pain assessment too= l or process, and ensure that every patient who is determined to be in chronic or acute pain is treated appropriately.
• The profile of a veteran in pain is often times different than that of his or h= er counterpart in the private sector. For example, veterans suffering from chronic pain are more likely to= be receiving treatment for other problems including depression, substance abus= e, alcoholism, or post traumatic stress disorder. Understanding and treating t= heir pain must be a priority, and this bill will help VA enhance the department’s existing pain management program.
• VA’s current pain management efforts are worthwhile, but are unfortunately not adequate to meet all of the needs of veterans. Pain management in VA continues to= be relatively decentralized and unstandardized. Some VA medical centers have adopt= ed successful approaches and procedures to deal with pain, while others have b= een less active. Fortunately, VA = has begun the work of identifying professional talent and developing ideas that provide the groundwork of an effective pain management program. This bill would build upon that foundation and help ensure that these ideas become practice.
[Source: SCVA News Release 15 Oct 07 ++]
VA CLAIM BACKLOG UPDATE 12: On 9 OCT at a field hearing of the= House Veterans Affairs Subcommittee on Disability Assistance and Memorial Affairs, Chairman John Hall (D-NY-19) called on the VA to reduce the waiting time for veterans stuck in its overwhelming claims backlog by two-thirds. He pointed= out that these veterans have mortgages, medical bills, and tuition bills for th= eir children’s education and that bill collectors don’t wait 6 mont= hs, 2 years, or 5 years to collect—you have to pay them every month. The VA must meet the same standard= . He is asking that the VA cut the w= aiting time from six months to two months, and someday even be able to turn around= a claim in 30 days. The VA currently maintains a backlog of over 600,000 cases. Due to funding shortfa= lls over the past five years, the backlog and waiting times became exacerbated = to the point of unmanageability. The current average waiting periods at all levels in the VA disability benefits system are staggering:
• 177 days at the Regional Office
• 751 days at the Board of Veterans Appeals
• 240 days at the Court of Appeals for Vetera= ns Claims
Hal said, “This backlog is simply unacceptabl=
e and
the VA has shown little ability or interest in reducing the number of claims
pending a decision. These veterans stood up for our country when asked, and=
now
it’s our turn to stand up for them.” The backlog New York veter=
ans
face is even worse than that suffered by the average veteran in the U.S.