VA mental health care update: Veterans who have trouble getting timely mental health care from Veterans Affairs hospitals and clinics should also have access to thousands of health care providers who care for military personnel and their families, says the Republican chairman of the House Committee on Veterans Affairs. The proposal by Rep. Jeff Miller (R-FL) borrows from the playbook of Republican Mitt Romney, who raised the idea of tapping into the military’s Tricare network of doctors during the course of the presidential campaign.

“We can double overnight the number of providers for those who are in need,” Miller said in an interview. “Eighteen veterans a day commit suicide in this country. Nobody thinks that is acceptable.”

The VA has beefed up its mental health staff over the years to try to keep up with the needs of soldiers returning from Iraq and Afghanistan, but a critical inspector general’s report last year found that about half of those seeking care for the first time waited about 50 days before getting a full evaluation. The VA had been reporting that the vast majority of those patients were getting care within 14 days.

Shortly before that report was released, the VA announced it would be adding 1,900 mental health professionals to its staff. VA officials said the department has made good progress on the hires, but they couldn’t provide specific numbers yet. Miller says tapping into Tricare’s network of psychologists and psychiatrists would allow many veterans to get care closer to home, particularly those who live in rural communities. He doesn’t have an estimated price tag yet, but says that whatever it is, that’s part of the cost of war. His proposed expansion would only apply to mental health care. Still, even a modest increase in spending could make Miller’s proposal a tough sell at a time when Congress is focused on cutting the federal debt and dealing with the threat of across-the-board spending cuts to defense and discretionary programs.

Asked about Miller’s proposal, VA spokesman Josh Taylor said the department is “committed to providing high-quality, comprehensive care directly to veterans, instead of leaving veterans to navigate complex, unconnected providers who might not be experts in veterans’ unique healthcare needs.”

Miller acknowledged that veterans groups are traditionally wary of relying on health professionals outside the VA system because they view it as the first step to tearing it down. The congressman said he agrees veterans get excellent care from the VA — when they can access it.

“We simply want to expand a very capable system,” Miller said. In some instances, the VA already contracts with local doctors in rural settings to treat VA patients, but that represents a tiny fraction of the patient visits that occur each year. The number of veterans getting mental health treatment from the VA has been steadily rising: from 927,052 in 2006 to more than 1.3 million in the fiscal year that ended Sept. 30. Nearly 22 million veterans live in the United States, but fewer than half are enrolled in the VA system. It’s generally reserved for those who have a disability or illness stemming from their service. Also, all returning Iraq and Afghanistan veterans are eligible for VA care during their first five years back from deployment.

The Tricare program serves those currently in the military, their families and those who retire from the military. The two health systems are quite different. The doctors at VA-run facilities are government employees paid a fixed salary for the work they do. Doctors in Tricare agree to participate in a managed care program and are reimbursed at a rate set by the insurer. Under Miller’s proposal, the VA would pay that rate without additional costs to the veteran.

Days after Romney proposed giving veterans access to Tricare for mental health treatment, President Barack Obama issued an executive order that requires the VA to set up a minimum of 15 pilot projects focused on contracting with local providers to meet the mental health needs of veterans. Miller’s proposal is more sweeping. Sen. Bernie Sanders, an independent and the new chairman of the Senate Committee on Veterans’ Affairs, said he’s open to the idea.

“While we must do everything that we can to greatly expand the VA’s mental health capabilities, I am open to exploring options outside of the VA for contracting services with public and private mental health providers, including Tricare,” Sanders said.

Veterans groups are noncommittal at this early stage. They traditionally prefer beefing up the VA’s capacity rather than going outside the system.

“It’s a fantastic system,” Joe Davis, a spokesman for Veterans for Foreign Wars, said of the VA. “For contracted-out care, we will only concede to that for extremely rural areas, or for specialized care, when that type of care is not readily available at the VA.” With that caveat, Davis said the suggestion is worth a look. Dr. James Tuorila, a clinical psychologist in St. Cloud, Minn., who also advises the VFW on mental health issues, said he’s afraid many of the doctors who see Tricare patients still don’t have the specialized training the VA offers its psychiatrists and psychologists for treating such illnesses as post-traumatic stress disorder. “Being a veteran myself, there was an affinity to working with other veterans. The VA needs to step up on training and on offering internships so it can hire more of these professional veterans in the mental health area,” Tuorila said. [Source: Associated Press article 29 Jan 2013]

Sequestration update: The Pentagon has given managers authority to start firing some of its 46,000 temporary workers now in anticipation of across-the-board spending cuts set to take effect in March according to Deputy Defense Secretary Ashton Carter. By mid-February, the Defense Department also is likely to begin notifying its 800,000 civilian employees that they face mandatory unpaid leave one day per week starting in April unless Congress and President Barack Obama agree on a way to avert the spending cuts aimed at reducing the federal deficit, Carter told reporters in a briefing at the Pentagon today.

“There will be 800,000 people subject to furlough all over the country who will not be getting a fifth of their paycheck” if the cuts take effect, he said. Carter’s briefing was the latest in the Pentagon’s continuing campaign to prod Congress for action to block the spending cuts, which would trim $45 billion from defense programs in the current fiscal year that ends Sept. 30.

The mandatory leaves may run through the fiscal year and would save as much as $5 billion, Carter said. “It’s unfair and unreasonable,” he said.

The notices are required to be sent about 45 days before mandatory leave takes effect, Carter said. Almost 86 percent of those affected are employed outside the Washington area, he said. Military personnel are exempt from the budget reductions known as sequestration. Sequestration also would hurt defense companies, he said.

“It’s going to affect their business, affect their financial standing,” Carter said. “It’s going to affect their stock market positions. It’s going to affect their employees.”

“I hope the Congress understands it’s going to affect each and every state and district,” he said. The military services have been given a Feb. 8 deadline to outline specific steps they will take if sequestration occurs, Carter said. The across-the-board cuts would be in addition to a $10 billion decrease for operations and maintenance required by stopgap spending legislation that provides Pentagon funding through March 27. Carter said that if the temporary funding legislation is extended and sequestration takes effect as well, the military will face a “pervasive crisis” in readiness.

Two-thirds of the Army’s active-duty combat brigades will be at reduced readiness, Carter said. The service has directed a 30 percent reduction in base operations spending compared with fiscal 2012, he said. The Navy is planning to defer maintenance and repairs on 30 vessels later this year, he said, and the Air Force will do so for 250 aircraft. Carter said the Pentagon hopes to “protect the integrity” of the $4.9 billion fixed-price contract for Boeing’s KC-46 tanker. “We are working to make it the case that sequestration doesn’t force us to abandon that acquisition approach, but we are not sure we are going to be able to do that,” Carter said. Weapons and research development programs face about a nine percent across-the-board reduction under sequestration. Carter said it’s unlikely contracts already funded would be canceled because the automatic cuts don’t apply to “obligated funds.” “You have nine percent of your money gone and you have to work around that,” he said. “But there are examples where nine percent might make a critical difference. [Source: Bloomberg News | Tony Capaccio | 26 Jan 2013]

Gulf War syndrome update: Veterans of the wars in Iraq and Afghanistan may be suffering from the 20-year-old set of symptoms known as Gulf War Illness, according to a new report released Jan. 23 by the federal Institute of Medicine.

“Preliminary data suggest that (chronic multisymptom illness) is occurring in veterans of the Iraq and Afghanistan wars as well,” the report says. This may be the first time that the symptoms suffered by veterans of the 1991 Gulf War have been linked to veterans of the current wars, which started in 2001 and 2003, said Paul Rieckhoff, CEO of Iraq and Afghanistan Veterans of America. It also means the Department of Veterans Affairs’ definition of who qualifies for Gulf War veterans’ benefits should include those who served in Afghanistan, said Paul Sullivan, a 1991 Gulf War veteran and founder of Veterans for Common Sense. Because Wednesday’s report associates the symptoms with deployment, Sullivan said, the VA “should expand the geographical definition of the current Gulf War to include the ongoing conflicts in Iraq and Afghanistan.”

The researchers were to investigate treatments for Gulf War illness, including any existing research, to see what worked for veterans. Their research included traumatic brain injury, which is caused by blunt force to the head or proximity to an explosion; post-traumatic stress disorder, which must involve exposure to trauma; respiratory problems, fibromyalgia and chronic pain.

Chronic multisymptom illness was formerly called Gulf War Syndrome, the Institute of Medicine report said. It includes symptoms in at least two of six categories: fatigue, mood and cognition issues, musculoskeletal problems, gastrointestinal problems, respiratory difficulties and neurologic issues that last for at least six months. About one-third of Gulf War veterans — or 175,000 to 250,000 people — have Gulf War illness. The symptoms are too broad for any one treatment, the report said.

“Based on the voluminous evidence we reviewed, our committee cannot recommend using one universal therapy to manage the health of veterans with chronic multisymptom illness, and we reject a ‘one size fits all’ treatment approach,” said committee chair Bernard M. Rosof, chairman of the board of directors at Huntington Hospital in Huntington, N.Y., in a statement. “Instead, we endorse individualized health care management plans as the best approach for treating this very real, highly diverse condition.”

Researchers also said there may be no specific cause for the illness. “Despite considerable efforts by researchers in the United States and elsewhere, there is no consensus among physicians, researchers and others as to the cause of CMI,” the report states. “There is a growing belief that no specific causal factor or agent will be identified.”

Anthony Hardie, a Gulf War veteran and advocate, disagreed. “They’ve lumped together so many ill people that it’s impossible to come up with one treatment,” Hardie said. Other recent research has shown possible causes for some of the symptoms suffered by Gulf War illness. A large-scale study done by Robert Haley, chief of epidemiology at the University of Texas Southwestern Medical Center in Dallas, showed veterans have damage to their autonomic nervous system caused by exposure to nerve agents after the U.S. Air Force bombed a chemical factory. Beatrice Golomb of the medical school at the University of California-San Diego tested the value of giving doses of the coenzyme Q10 to Gulf War veterans and found that “every single” veteran found improvement from 20 symptoms.

For current war veterans, scientists have connected chronic obstructive pulmonary disorder and bronchiolitis to exposures in Iraq and Afghanistan, including to garbage pits that burned as much as 240 tons of waste in an open pit a day, as well as to dust proved to be laden with bacteria and heavy metals. Denise Nichols, also a Gulf War veteran and advocate, said she fears the report will add to Americans’ belief that the symptoms are “all in our heads” — even after numerous reports have come out saying the disease is physical and real.

“We need true treatment modalities,” Nichols said, “that address the physical brain damage and other body organ damage from the exposures we endured.” [Source: USA Today | Kelly Kennedy | 23 Jan 2013]

Flags: The American Legion Post 70 has on hand American flags, all of the military service flags, POW/MIA flags, and S.C. State flags. Contact a member of Post 70 to purchase flags; the cost is $5.

American Legion Post 70: Meeting at 1800 on the third Tuesday of the month. For more information, please contact Thomas Crisp at 940-2793.

American Legion Post 24 of Newberry’s meeting is on the second Tuesday of the month at 1830. The American Legion Auxiliary Unit 24 meets the same day at 3 p.m. at Post 24.