Healthcare
Panel urges VA to plan now for vets care
Apr 1st
Excerpt: Based on a review of disability claims from past wars, the report says the number of disability claims from recent veterans should peak around 2040.
By Kimberly Hefling – The Associated Press–
WASHINGTON — Looking decades ahead, the Institute of Medicine is urging the Veterans Affairs Department to begin planning now for the long-term health care needs of the estimated 1.9 million veterans of the Iraq and Afghanistan wars.
Specifically, the institute says in a report released Wednesday, not enough is known about what works best in the long term to treat veterans with traumatic brain injuries, often caused by roadside bombs.
While a multitude of public and private programs is available to help the men and women who have served in the recent conflicts, there is little coordination and sparse information about which ones are effective, the report said.
A 16-member panel coordinated by the Institute of Medicine instigated the review of the readjustment needs of troops, veterans and their families at the request of Congress. The institute is part of the National Academies, an independent organization chartered by Congress to advise the government on scientific matters.
Dr. Victoria Cassano, the VA’s liaison to the institute, said many of the report’s recommendations are “right on.” Cassano said it covers important issues the VA is either already working on or will consider.
The report urged Congress to direct the VA to produce more detailed annual projections of the needs of veterans and their families, so more thorough planning can be done to prepare for an uptick in disability claims and health needs in the decades ahead as the veterans age.
Based on a review of disability claims from past wars, the report says the number of disability claims from recent veterans should peak around 2040.
“It’s going to get worse before it gets any better,” said Ryan Edwards, an economics professor from the City University of New York, who served on the panel. “We’re going to see a larger burden … and it will continue to expand.”
The report praised the VA’s work to establish rehabilitation services for those with traumatic brain injury, which is often called the signature wound of the Iraq war. But it said the VA should sponsor research into protocols for long-term care for those with traumatic brain injury because little research is available.
“It’s an evolving area, and it’s going to need to evolve more to keep up with the patient population,” said Dr. George Rutherford, the panel chairman, who is a professor of epidemiology and biostatistics at the University of California, San Francisco.
Overall, the report said, the VA and Defense Department should better coordinate services available to veterans. It held up as a successful model Military OneSource, a one-stop online and telephone information source for military personnel and their families.
The study said the Defense Department needs to better address troops’ reluctance to report mental health problems and should review how it handles confidentiality when a service member seeks help. It also encouraged the Defense Department and VA to hire more mental health professionals.
It could be helpful for service members returning home from war if there’s an interim place they can go following time in combat to rest and prepare for the adjustment back to the U.S., the report said.
Navy Capt. Edward Simmer said the Defense Department is already looking for ways to address some of the problems discussed in the report. “The things we need to work on, we’ll definitely get started with,” Simmer said.
Simmer is the senior executive for psychological health at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Rosslyn, Va.
Next month, the panel starts a second, two-year examination of veterans’ health issues.
Popularity: 26% [?]
Eric K. Shinseki’s VA budget proposal aimed to transform the VA into a 21st century organization
Feb 5th
(Media-Newswire.com) – WASHINGTON – White House Seeks $125 Billion for Veterans in 2011 to expand health care to a record-number of Veterans, reduce the number of homeless Veterans and process a dramatically increased number of new disability compensation claims, the White House has announced a proposed $125 billion budget next year for the Department of Veterans Affairs.
“Our budget proposal provides the resources necessary to continue our aggressive pursuit of President Obama’s two over-arching goals for Veterans,” said Secretary of Veterans Affairs Eric K. Shinseki. “First, the requested budget will help transform VA into a 21st century organization. And second, it will ensure that we approach Veterans’ care as a lifetime initiative, from the day they take their oaths until the day they are laid to rest.”
The $125 billion budget request, which has to be approved by Congress, includes $60.3 billion for discretionary spending ( mostly health care ) and $64.7 billion in mandatory funding ( mostly for disability compensation and pensions ).
“VA’s 2011 budget request covers many areas but focuses on three central issues that are of critical importance to our Veterans – easier access to benefits and services, faster disability claims decisions, and ending the downward spiral that results in Veterans’ homelessness,” Shinseki said.
Reducing Claims Backlog
The president’s budget proposal includes an increase of $460 million and more than 4,000 additional claims processors for Veterans benefits. This is a 27 percent funding increase over the 2010 level.
The 1,014,000 claims received in 2009 were a 75 percent increase over the 579,000 received in 2000. Shinseki said the Department expects a 30 percent increase in claims – to 1,319,000 – in 2011 from 2009 levels.
One reason for the increase is VA’s expansion of the number of Agent Orange-related illnesses that automatically qualify for disability benefits. Veterans exposed to the Agent Orange herbicides during the Vietnam War are likely to file additional claims that will have a substantial impact upon the processing system for benefits, the secretary said.
“We project significantly increased claims inventories in the near term while we make fundamental improvements to the way we process disability compensation claims,” Shinseki said.
Long-term reduction of the inventory will come from additional manpower, improved business practices, plus an infusion of $145 million in the proposed budget for development of a paperless claims processing system, which plays a significant role in the transformation of VA.
Automating the GI Bill
The budget proposal includes $44 million to complete by December 2010 an automated system for processing applications for the new Post-9/11 GI Bill. VA also plans to start development next year of electronic systems to process claims from other VA-administered educational programs.
The Post-9/11 GI Bill authorizes the most extensive educational assistance opportunity since the passage of the original GI Bill in 1944. Over $1.7 billion in regular Post-9/11 GI Bill benefit payments have been issued since the implementation of the program on Aug. 1, 2009. In 2011, VA expects the number of all education claims to grow by 32 percent over 2009, going from 1.7 million to 2.25 million.
“To meet this increasing workload and process education claims in a timely manner, VA has established a comprehensive strategy to develop industry-standard technologies to modernize the delivery of these important educational benefits,” Shinseki said.
Eliminating Homelessness
The budget proposal includes $4.2 billion in 2011 to reduce and help prevent homelessness among Veterans. That breaks down into $3.4 billion for core medical services and $799 million for specific homeless programs and expanded medical care, which includes $294 million for expanded homeless initiatives. This increased investment for expanded homeless services is consistent with the VA secretary’s established goal of ultimately eliminating homelessness among Veterans.
On a typical night, about 131,000 Veterans are homeless. They represent every war and generation, from the “Greatest Generation” to the latest generation of Veterans who served in Iraq and Afghanistan. To date, VA operates the largest system of homeless treatment and assistance programs in the nation.
Targeting Mental Health, Preventing Suicides
“The 2011 budget proposal continues the department’s keen focus on improving the quality, access and value of mental health care provided to Veterans,” Shinseki said.
The spending request seeks $5.2 billion for mental health, an increase of $410 million ( or 8.5 percent ) over current spending, enabling expansion of inpatient, residential and outpatient mental health services, with emphasis on making mental health services part of primary care and specialty care.
The secretary noted that one-fifth of the patients seen last year in VA’s health care facilities had a mental health diagnosis, and that the department has added more than 6,000 new mental health professionals since 2005, bringing to 19,000 the number of employees dedicated to mental health care.
The budget request will enable the department to continue expanding its programs for post-traumatic stress disorder ( PTSD ) and traumatic brain injury ( TBI ), along with the diagnosis and treatment of depression, substance abuse and other mental health problems. Shinseki called PSTD treatment “central to VA’s mission.”
The proposed spending will continue VA’s suicide prevention program. Since July 2007, the department’s suicide prevention hotline has received nearly 225,000 calls from Veterans, active-duty personnel and family members. The hotline is credited with saving the lives of nearly 7,000 people.
Reaching Rural Veterans
For 2011, VA is seeking $250 million to strengthen access to health care for 3.2 million Veterans enrolled in VA’s medical system who live in rural areas. Rural outreach includes expanded use of home-based primary care and mental health.
A key portion of rural outreach – which shows promise for use with Veterans across the country – is VA’s innovative “telehealth” program. It links patients and health care providers by telephones and includes telephone-based data transmission, enabling daily monitoring of patients with chronic problems.
The budget provides an increase of $42 million for VA’s home telehealth program. The effort already cares for 35,000 patients and is the largest program of its kind in the world.
Serving Women Veterans
The 2011 budget provides $217.6 million to meet the gender-specific health care needs of women Veterans, an increase of $18.6 million ( or 9.4 percent ) over the 2010 level. Enhanced primary care for women Veterans remains one of the Department’s top priorities. The number of women Veterans is growing rapidly and women are increasingly using VA for their health care.
Shinseki said the expansion of health care programs for women Veterans will lead to higher quality care, increased coordination of care, enhanced privacy and dignity, and a greater sense of security among women patients.
Among the initiatives for women in the 2011 budget proposal are expanded health care services in Vet Centers, increased training for health care providers to advance their knowledge and understanding of women’s health issues, and implementing a peer call center and social networking site for women combat Veterans. This call center will be open 24 hours a day, 7 days a week.
Delivering World-Class Health Care
During 2011, VA expects to treat 6.1 million patients, who will account for more than 800,000 hospitalizations and 83 million outpatient visits.
The total includes 439,000 Veterans who served in Iraq and Afghanistan, for whom $2.6 billion is included in the budget proposal. That’s an increase of $597 million – or 30 percent – from the current budget.
The proposed budget for health care includes:
- $6.8 billion for long-term care, an increase of $859 million ( or 14 percent ) over 2010. This amount includes $1.5 billion for non-institutional long-term care;
- Expanding access to VA health care system for more than 99,000 Veterans who were previously denied care because of their incomes;
- $590 million for medical and prosthetic research; and
- Continuing development of a “virtual lifetime electronic record,” a digital health record that will accompany Veterans throughout their lives.
VA is requesting $54.3 billion in advance appropriations for 2012 for health care, an increase of $2.8 billion over the 2011 enacted amount. Planned initiatives in 2012 include better leveraging acquisitions and contracting, enhancing the use of referral agreements, strengthening VA’s relationship with the Defense Department, and expanding the use of medical technology.
Preserving National Shrines
“VA remains steadfastly committed to providing access to a dignified and respectful burial for Veterans choosing to be buried in a VA national cemetery,” Shinseki said. “This promise requires that we maintain national cemeteries as shrines dedicated to the memory of those who served this nation in uniform.”
The requested $251 million for cemetery operations and maintenance will support more than 114,000 interments in 2011, a 3.8 percent increase over 2010. In 2011, the department will maintain 8,441 acres with 3.1 million gravesites. The budget request includes $37 million to clean and realign an estimated 668,000 headstones and repair 100,000 sunken graves.
Building for the Future
$1.15 billion requested for major construction for 2011 includes funding for medical facilities in New Orleans; Denver; Palo Alto, Calif.; Alameda, Calif.; and Omaha, Neb. Also budgeted for 2011 are major expansions and improvements to the national cemeteries in Indiantown Gap, Pa.; Los Angeles; and Tahoma, Wash., and new burial access policies that will provide a burial option to an additional 500,000 Veterans and enhance service in urban areas.
A requested budget of $468 million for minor construction in 2011 would fund a wide variety of improvements at VA facilities.
Popularity: 44% [?]
Morphine found to help stave off PTSD in wounded troops
Jan 15th
By David Brown–Washington Post–
More than 200 years after it was isolated from poppies, morphine remains one of medicine’s best painkillers. But that isn’t its only use.
Physicians sometimes include the drug in a cocktail of medications given to people having heart attacks. It can relieve the breathlessness of pulmonary edema. It decreases diarrhea. A famous physician of the early 20th century, William Osler, once called morphine “God’s own medicine.”
Research published this week suggests that the compound might have at least one more use.
In a study of about 700 troops who were wounded in Iraq, those who received morphine soon after being injured were about half as likely to develop post-traumatic stress disorder as those who did not get the drug.
It is not known whether morphine’s apparently protective effect arises directly from the relief of traumatic pain or indirectly by blocking the brain circuits that lay down traumatic memory.
The researchers and outside experts agreed that the effect would have to be proved virtually beyond a doubt before morphine would be routinely given to prevent the mental disorder.
“I would be very reluctant to suggest any change in clinical practice,” said Troy Lisa Holbrook of the Naval Health Research Center in San Diego, who headed the study published in the New England Journal of Medicine. “We need to understand a great deal more how this appears to work.”
Morphine has been used for pain relief from battle wounds as far back as the Civil War. Since World War II, medics and hospital corpsmen have carried small injectors filled with the drug.
Popularity: 12% [?]
Is U.S. prepared to care for more casualties from troop buildup?
Dec 7th
WASHINGTON — As the Obama administration ramps up the war in Afghanistan, veterans advocates say the government must develop a better plan to handle the wounded when they come home.
Eight years of war have overtaxed the health care systems that treat service members and veterans, several said, and President Barack Obama’s decision to deploy 30,000 to 35,000 more troops in Afghanistan will compound the stress.
Treatment at medical facilities that the military and the Department of Veterans Affairs operate is viewed as world class despite its well-publicized lapses. However, both often struggle to care for large numbers of soldiers and Marines with devastating physical and mental injuries.
Coordination between the military and the VA is often slow, veterans groups say, and waiting times to see doctors and process benefit claims are long. A recent VA investigation found that 11,000 claims filed at offices around the country were still unresolved after more than a year.
More disturbing still is that suicides by combat veterans are at record levels.
“A war plan has to include the care of vets on the back end,” said Paul Rieckhoff, the executive director of Iraq and Afghanistan Veterans of America. “What was lacking in the Iraq war was a plan for all the resources. We’re going to encourage them to not just think about bombs and bullets, but social workers and hospital beds.”
A spokesman for the U.S. Army Medical Command couldn’t be reached for comment. A VA spokeswoman declined to speak on the record, but said the Obama administration already had taken several steps to improve the delivery of health care to veterans.
Read the rest of this entry »
Popularity: 14% [?]
Illinois: Inquiry at Veterans Hospital
Nov 5th
Veterans Affairs Secretary Eric Shinseki ordered a high-level, quality-management team to assess problems at a troubled Veterans Affairs hospital in Southern Illinois, lawmakers said. Mr. Shinseki met with members of the state’s Congressional delegation and Gov. Patrick J. Quinn two days after the Veterans Affairs inspector general issued a report outlining serious problems at the Marion V.A. Medical Center, where major surgeries were halted in 2007 because of a spike in deaths. A review of the hospital found inconsistencies with reporting deaths and problems with patient safety, including surgeons performing procedures they were not authorized to do. The hospital has been under scrutiny since 2007, when a former surgeon resigned three days after a patient bled to death after gall bladder surgery. The administration found that at least nine deaths between October 2006 and March 2007 resulted from substandard care at the hospital.
Popularity: 9% [?]
Gates: injured troops face too much bureaucracy
Oct 27th
By KIMBERLY HEFLING–Associated Press–
Defense Secretary Robert Gates said Monday that troops injured in combat in Iraq and Afghanistan continue to face too many bureaucratic hurdles.
Paperwork alone for them can be “frustrating, adversarial, and unnecessarily complex,” Gates said.
Gates spoke at a mental health summit with Veterans Affairs Secretary Eric Shinseki. By appearing publicly together, they sought to reinforce their commitment to tackling veterans’ health issues and the stigma associated with seeking mental health care.
Earlier this year, they pledged with President Barack Obama to create a system that would make it easier for the Pentagon and VA to exchange information so there is less of a wait for veterans to get disability benefits. The VA is struggling with a backlogged disability claims system with hundreds of thousands of claims that need to be processed.
Among U.S. troops who have fought in the recent wars, Gates says brain injuries and mental health ailments are “widespread, entrenched and insidious.” He noted that a RAND Corp. study last year estimated that there could be more than 600,000 service members with traumatic brain injuries or mental health issues.
Gates said there have been positive changes such as the doubling of the budget for mental health and traumatic brain injuries to almost $1.2 billion from last year, but other challenges remain such as filling a shortage of therapists in and near military installations.
About 2 million troops have fought in the recent wars. Tens of thousands have been physically injured, while hundreds of thousands have entered the VA’s health care system.
Shinseki said veterans from the recent wars are coming homes with “invisible wounds” that are just as debilitating as physical traumas sustained on the battlefield.
“Who’s vulnerable? Everyone,” Shinseki said. “Warriors suffer emotional injuries as much as they do physical ones.”
Popularity: 12% [?]
Kayak therapy aids veteran in brain injury recovery
Oct 18th
By: Violeta Ikonomova –Washington Examiner–
Don Lange was serving in the Army in Afghanistan in 2004 when he sustained a traumatic brain injury that left him unable to communicate or feed himself.
He was sent to Walter Reed Army Medical Center for rehabilitation. He needed help completing simple everyday tasks he had forgotten how to do.
Brain injuries can result in a problems like memory loss, inattention, depression, distorted judgment and slow thinking. Lange suffered from them all. After a year at Walter Reed, doctors told Lange’s wife that he would never live independently again and she should consider hiring an in-home caregiver.
“That was too much for her, and she left,” Lange, now 53, recalled recently.
By the end of 2005, Lange had been moved to a Department of Veterans Affairs medical center. He had come a long way in his recovery, but he still couldn’t live independently. Lange then hit a plateau, and his doctors no longer saw improvement in his condition.
Popularity: 10% [?]
Post-Traumatic Stress May Raise Death Risks
Oct 18th
Veterans with disorder more likely to die within a year of major surgery, study finds 
(HealthDay News) — Veterans with post-traumatic stress disorder face an increased risk for dying after surgery, even if the surgery is performed years after they have completed their service, according to a U.S. study.
Researchers analyzed data on 1,792 male veterans who had major non-cardiac, non-emergency surgeries between 1998 and 2008. Of that group, 129 (7.8 percent) had been diagnosed with post-traumatic stress disorder (PTSD) before their surgery.
Men with PTSD were an average of seven years younger than those without PTSD — 59 versus 66 years old — but were much more likely to have cardiac risk factors, the study noted.
One year after surgery, the death rate among men with PTSD was 25 percent higher than for those without PTSD — 8.5 percent versus 6.8 percent. After the researchers adjusted for age and preexisting medical conditions — including heart disease, high blood pressure, diabetes, high cholesterol, smoking and depression — they found that veterans with PTSD were 2.2 times more likely to die within a year of surgery than those without PTSD.
More information
The U.S. National Institute of Mental Health has more about PTSD.
Popularity: 18% [?]
VA to ease way for vets to get stress disability
Oct 14th
WASHINGTON — Female soldiers and others who served behind front lines have long complained about how hard it is to prove their combat experience when applying for disability due to post-traumatic stress disorder.
That could soon change.
The Veterans Affairs Department has proposed reducing the paperwork required for veterans to show their experience caused combat-related stress. Even just the fear of hostile action would be sufficient, as long as a VA psychologist or psychiatrist agreed.
The VA says the change would streamline claims and recognize the “inherently stressful nature” of war service. The agency is accepting comment until Oct. 23.
Sen. Patty Murray, D-Wash., called it a significant shift in policy.
“Before, and for a long time, I’ve been fighting many times over for the VA not to discourage people from saying they have PTSD,” said Murray, who serves on the Senate Veterans’ Affairs Committee. “We’ve have many cases where veterans were told it’s all in your head.”
Post-traumatic stress disorder can affect anyone who is traumatized by an experience. From the Iraq and Afghanistan wars, more than 134,000 veterans have sought help at a VA facility for possible PTSD, the VA says. The symptoms include flashbacks and anxiety, and for some, it’s so debilitating that it makes it difficult to work after they leave the military.
While praising the VA’s effort, veterans service organizations have questioned the requirement for a VA psychologist or psychiatrist to agree the experience caused the disorder. Rep. John Hall, D-N.Y., who chairs a subcommittee with oversight over the disability claims system, said he’s concerned that the proposed rule isn’t comprehensive enough.
The debate is a reflection of the changing battlefield.
A World War II-era law established that veterans who “engaged in combat with the enemy” receive special treatment when they seek disability compensation, so it’s less burdensome to prove an injury was from war service.
Troops from an infantry or special forces unit are awarded a badge that makes it easier to prove they engaged in combat.
Truck drivers, cooks and others in support roles aren’t eligible for the badge but can use other types of documentation or medals, such as a Purple Heart, to prove they were in combat.
But veterans and service organizations that work with them have said doing so is often incredibly difficult, in part because of the lack of paperwork kept by many units. About half of all post-traumatic stress disability claims filed by veterans are denied — with the majority of denials coming because the veteran lacks sufficient documentation, the VA has said.
The VA said it does not have an estimate of the number of veterans who would likely fall under the policy change, nor does it have a cost estimate.
In 2008, a Congressional Budget Office estimate, on legislation that would have made a similar change, concluded it would cost billions over a nine-year period. Based on 2006 figures, it said the average payout for a PTSD claim was $543 a month.
Natalie MacLeod, 51, a mother of five from Lowell, Mass., who served in Iraq is among the veterans hopeful that the proposed rule change will help her. She said she’s been denied PTSD disability benefits because of a lack of documentation, even though she’s been diagnosed with PTSD.
“The VA will diagnose you with the PTSD and then the VA will turn you down, which is what I’m fighting right now,” said MacLeod, who said she was a cook and did administrative work for her Army Reserves unit.
At a hearing last week on the issue, representatives from veterans service organizations testified that many veterans go to private mental health providers for treatment. They said the law requires the VA to consider private medical evidence when considering claims, and asked the VA to allow that in these types of cases.
Hall said he thinks that in addition to fear, if veterans could show feelings of helplessness or horror while at war caused their PTSD, they should also be eligible under the new rule.
Bradley G. Mayes, director of compensation and pension service at the Veterans Benefits Administration, who attended the hearing, said the VA is considering all meaningful comments.
Christina Roof, national deputy legislative director for advocacy group AMVETS, said while the rule change isn’t perfect, “it’s a step forward. It’s not a cure-all, but we need to so something now.”
Popularity: 26% [?]
Door Opens to Health Claims Tied to Agent Orange
Oct 13th
By JAMES DAO–NY TIMES–
Under rules to be proposed this week, the Department of Veterans Affairs plans to add Parkinson’s disease, ischemic heart disease and hairy-cell leukemia to the growing list of illnesses presumed to have been caused by Agent Orange, the toxic defoliant used widely in Vietnam.
The proposal will make it substantially easier for thousands of veterans to claim that those ailments were the direct result of their service in Vietnam, thereby smoothing the way for them to receive monthly disability checks and health care services from the department.
The new policy will apply to some 2.1 million veterans who set foot in Vietnam during the war, including those who came after the military stopped using Agent Orange in 1970. It will not apply to sailors on deep-water ships, though the department plans to study the effects of Agent Orange on the Navy.
The shift underscores efforts by the secretary of veterans affairs, Eric Shinseki, a retired Army chief of staff and a Vietnam veteran himself, to reduce obstacles to sick or disabled veterans’ receiving benefits. The department has come under sharp criticism from Congress and veterans groups for long delays in processing disability claims.
“Since my confirmation as secretary, I’ve often asked why, 40 years after Agent Orange was last used in Vietnam, we’re still trying to determine the health consequences to our veterans who served in the combat theater,” Mr. Shinseki said in a statement. “Veterans who endure a host of health problems deserve timely decisions.”
The veterans department already recognizes more than a dozen conditions as being presumptively connected to Agent Orange exposure in Vietnam, including Hodgkin’s disease, prostate cancer and Type 2 diabetes.
But for diseases not on that list, veterans are required to provide evidence directly relating their service in Vietnam to their illness, a requirement that often leads to application rejections and prolonged appeals.
Veterans department officials estimate that about 200,000 veterans might seek benefits under the proposed change in policy. But they said they could not estimate the cost of the change until the policy underwent public review and was published in final form, which could take several months.
Popularity: 16% [?]
