Health News

Top 5 My HealtheVet Articles of 2017

Parasites can be living your body from Vietnam


Prescription copay rules are changing effective February 27, 2017. The “Medication Copayment” attachment gives a quick summary and will be provided to veteran patients. The current VA medication copay is $8 for a 30 day supply of any medication when the veteran is eligible for a copay.

Copays for the new tiered system:
1)      Tier 1 generic medications will be $5 per 30 day supply (See second attachment titled “Tier copay” for list of Tier 1 medications)
2)      Tier 2 “non-preferred” generic medications will be $8 per 30 day supply
3)      Tier 3 Brand drugs will be $11 per 30 day supply

***Veterans that currently do not have medication copays will NOT be affected. Eligibility standards are still the same, the copays are changing only for those veterans that currently qualify for copays***

The new annual maximum for medication copays for veterans is $700 compared to $960 previously.
Supply items such as diabetic test strips, bandages, etc. will not have copays as current practice (considered “Tier 0”).

Website for Tier Copay Look up by drug name (third link at the website below, only for VA employees):

Answers to some common questions.

*   When will tier copays start? The current date is 2/27/2017.
*   Won’t this cost Veterans money? Only for a small percentage. Approximately 94% of veterans will see no increase with 80% getting a savings. In addition copays were scheduled to increase to $11 dollars this year so if nothing was done there would have been an increase on all Veterans. The annual copayment cap will be reduced from $960 to $700 per calendar year which will further insulate Veterans from a cost increase.
*   Will service connected veterans be charged a copay? No, these changes apply only to those eligible for a copay as current practice.
*   Can a Veteran request a branded product and just pay the higher copay? No, FDA approved generics are still the formulary standard for utilization.
*   Will local sites be required make local modifications to complete this process? No. If a drug is matched to NDF the correct copay will be charged.
*   Will Birth Control Products, Nicotine Products, and Vitamin D be exempted from copay charges? No. Those exemptions are part of the Affordable Care Act (ACA), however the ACA does not apply to VA. VA works under a different set of copay rules and these rules do not exempt these products.

Retiree Checklist ► What your survivors should know


This checklist is designed to provide retirees and their loved ones with some help in preparing for the future. The checklist is not all-inclusive and should be used with other estate planning tools.

  1. Create a military file.

__ Retirement orders

__ DD 214

__ Separation papers

__ Medical records

  1. Create a military retired pay file.

__ Claim number of any pending VA claims

__ Address of the VA office being used

__ List of current deductions from benefits

__ Name, relationship and address of beneficiary of unpaid retired pay at the time of death

__ Address and phone number for DFAS:

Defense Finance and Accounting Service, U S Military Retirement Pay, Post Office Box 7130, London, KY 40742 7130 (800) 321-1080 option #3 (for deceased members)

  1. Create an annuities file, to include:

__ Information about the Survivor Benefit Plan (SBP).

__ Reserve Component Survivor Benefit Plan (RCSBP)

__ Retired Serviceman’s Family Protection Plan (RSFPP)

__ Civil Service annuity

Note:  (Additional information regarding SBP annuity claims can be obtained from the DFAS-Cleveland Center office at 1-800-321-1080.)

  1. Create a personal document file.

__ Marriage Records

__ Divorce decree

__ Adoptions and naturalization papers

 Create an income tax file.

__ Copies of state and federal income tax returns

  1. Create a property tax file.

__ Copies of tax bills

__ Deeds and any other related information.

  1. Create an insurance policy file.

__ Life Insurance

__ Property, accident, liability insurance

__ Hospitalization/Medical Insurance

  1. Maintain a listing of banking and credit information, in a secure location.

__ Bank account numbers

__ Location of all deposit boxes

__ Savings bond information

__ Stocks, bonds and any securities owned

__ Credit card account numbers and mailing addresses

__ 401K Accounts

  1. Maintain a membership listing of all associations and organizations.

__ Organization names and phone numbers

__ Membership fee information

  1. Maintain a list of all friends and business associates.

__ Include names, addresses and phone numbers

  1. Hold discussions with your next of kin about your wishes for burial and funeral services.

At a minimum the discussion should include cemetery location and type of burial (ground, cremation or burial at sea). This knowledge may assist your next of kin to carry out all of your desires.

  1. You could also pre-arrange your funeral services via your local funeral home. Many states will allow you to prepay for services.
  1. Investigate the decisions that you and your family have agreed upon. Many states have specific laws and guidelines regulating cremation and burials at sea. Some states require a letter of authority signed by the deceased in order to authorize a cremation. Know the laws in your specific area and how they may affect your decisions. Information regarding Burials at Sea can be obtained by phoning

Navy Mortuary Affairs at (866) 787-0081.

  1. Once your decisions have been made and you are comfortable with them, have a will drawn up outlining specifics.

 Ensure that your will and all other sensitive documents are maintained in a secure location known by your loved ones. Organizations to be notified in the event of a retiree death:

  1. Defense Finance and Accounting Service, London, KY (800) 321-1080
  2. Social Security Administration (for death benefits) (800) 772-1213
  3. Department of Veterans Affairs (if applicable) (800) 827-1000
  4. Office of Personnel Management (OPM) (724) 794-8690
  5. Any fraternal group that you have membership with (e.g., MOAA, FRA, NCOA, VFW, AL, TREA)
  6. Any previous employers that provide pension or benefits.



Though not listed as a “most prevalent disability” in the Veteran Benefits Administration’s Annual Benefits Report, disability compensation claims for veteran sleep apnea grew by 150 percent over the a five-year period ending in 2014. Here’s what you need to know.

Update, May 13, 2016: In an adjudication manual change published April 18, 2016, Department of Veterans Affairs rating officials evaluating disability compensation claims for sleep apnea are now looking to answer a key question: Is the use of a qualifying breathing assistance device required by the severity of the sleep apnea? Prior to this change a veteran only needed to provide medical proof of a sleep apnea diagnosis when filing for disability compensation.

Learn more: VA Updates Evaluation Criteria for Sleep Apnea Claims

According to a May 2014 news report, yearly compensation costs for sleep apnea are expected to cross the $1 billion mark. Four years earlier, in June 2010, it was reported compensation costs of over $500 million with a 61 percent increase in claims between 2008 and 2010.  VA officials reportedly attributed the surge in claims to greater awareness. More than 94 percent of the increase in claims were submitted by veterans of Gulf War I or the Afghanistan and Iraq wars.

Sleep apnea is one form of sleep disturbance. “Apnea” is defined as “transient cessation of respiration,” meaning the person has temporarily stopped breathing. Since breathing is an automatic process, the brain issues a command to wake up enough to unblock the air passage and breathe.  And with a gasp, breathing begins again. This stop/start cycle can happen many times during the night.   The adverse affects of sleep apnea range from feeling tired all day to having high blood pressure or experiencing a heart attack or stroke.

The VA National Center for PTSD has reported that 90 percent to 100 percent of veterans with PTSD experience sleep disturbances. Sleep disturbances are also one of the recognized signs or symptoms of undiagnosed illness and medically unexplained chronic multi-symptom illnesses — also known as Gulf War Syndrome or Gulf War Illness — experienced by Gulf War veterans with active duty service in the Southwest Asia theater of operations. However, sleep apnea is not confined to Gulf War veterans; other veterans can claim a service connection for sleep apnea as a direct or secondary condition.

If a veteran requires a CPAP machine, the disability rating for sleep apnea is set at 50 percent or above. With costs topping $1 billion, the rating schedule for sleep apnea is expected to be included in the VA’s review and overhaul of the rating schedule (38 CFR Part 4) — a change meaning closer scrutiny of sleep apnea claims and a tighter rating schedule.

The most current disability rating and severity of symptoms can be found in the Code of Federal Regulations at 38 CFR 4.97 Schedule of ratings—respiratory system:

  • 100 percent: chronic respiratory failure with carbon dioxide retention or cor pulmonale; or requires tracheostomy
  • 50 percent: requires use of breathing assistance device such as continuous airway pressure (CPAP) machine
  • 30 percent: persistent daytime hypersomnolence
  • 0 percent: asymptomatic, but with documented sleep disorder breathing

The diagnosis for sleep apnea must be confirmed by a sleep study for compensation rating purposes.

Read More: Sleep apnea on the rise as veterans’ disability

Have sleep apnea or sleep disturbances? Here are five tips

  1. If you suffer from any sleep disturbances, consult your medical provider.
  2. If a diagnosis of sleep apnea is suggested, make sure that a sleep study is the basis of that diagnosis.
  3. If you believe that sleep apnea or any other sleep disturbance has been caused or aggravated by your military service, file a claim for disability compensation.
  4. To bolster the credibility of your disability compensation claim or strengthen an appeal of a denied service connection claim, consider submitting a Physician Medical Statement and a completed VA Form 21-0960L-2 Sleep Apnea Disability Benefits Questionnaire (DBQ). The Sleep Apnea Disability Benefits Questionnaire (DBQ) form can be found here, and the Physician Medical Statement can be downloaded here
  5. If you have already been granted a disability rating by the VA, and your symptoms have worsened, consider filing for an increased rating.

Veterans should appeal any denied claims for service connected sleep apnea or other sleep disturbances. Decisions from two successful appeals to have sleep apnea granted as secondary to service-connected PTSD can be found here ( and here (


VA Medical Foster Homes ► Nursing Home Alternative

A Medical Foster Home (MFH) can serve as an alternative to a nursing home. It may be appropriate for Veterans who require nursing home care but prefer a non-institutional setting with fewer residents. MFHs are private homes in which a trained caregiver provides services to a few individuals. Some, but not all, residents are Veterans. VA inspects and approves all Medical Foster Homes. The Homes have a trained caregiver on duty 24 hours a day, 7 days a week. This caregiver can help the Veteran carry out activities of daily living, such as bathing and getting dressed. VA ensures that the caregiver is well trained to provide VA planned care. You will continue to receive Home Based Primary Care services in the Medical Foster Home. You may also receive the following services from the Medical Foster Home caregiver.

  1. For Veterans:

 Help with your activities of daily living (e.g., bathing and getting dressed)

 Help taking your medications

 Some nursing assistance, if the caregiver is a registered nurse

 All of your meals

 Planned recreational and social activities

  1. For Caregivers:

 Peace of mind when Home and Community Based Services can no longer meet the Veteran’s needs at home

 A place to enjoy spending time with the Veteran

You can use the below Shared Decision Making (SDM) Worksheet to help you figure out what long term care services or settings may best meet your needs now or in the future. There’s also a Caregiver Self-Assessment (CSA) worksheet. It can help your caregiver identify their own needs and decide how much support they can offer to you. Having this information from your caregiver, along with the involvement of your care team and social worker, will

help you reach good long term care decisions.

 SDM:

 CSA:

Your physician or other primary care provider can answer questions about your medical needs. Some important questions to talk about with your social worker and family include:

 How much assistance do I need for my activities of daily living (e.g., bathing and getting dressed)?

 What are my caregiver’s needs?

 How much independence and privacy do I want?

 What sort of social interactions are important to me?

 How much can I afford to pay for care each month?

Medical Foster Homes are not provided or paid for by VA. To be eligible for a MFH you need to be enrolled in Home Based Primary Care, and a Home needs to be available. Your VA social worker or case manager can help you with eligibility guidelines for Home Based Primary Care and Medical Foster Home care. Also, with locating one and assist with making the arrangements. You will have to pay for the MFH yourself or through other insurance. The charge for a MFH is about $1500 to $3000 each month based on your income and the level of care you need. The specific cost is agreed upon ahead of time by you and the MFH caregiver. Talk with a VA social worker/case manager to find out if you are entitled to additional VA benefits that will help pay for a Medical Foster Home.  If a Medical Foster Home seems right for you, your VA social worker can help you locate one and assist with making arrangements.

Also, at you can use the Locate Services and Resources page to help you locate Medical Foster Homes. [Source: Geriatrics and

Extended Care Feb 2016 ++]


VA Claim DBQ ► Disability Benefit Questionnaire Submission

You will need to use a Disability Benefits Questionnaire (DBQ) as part of your application to the U.S. Department of Veterans Affairs (VA) for disability benefits. With Disability Benefits Questionnaires (DBQs) Veterans now have more control over the disability claims process For VA exams, a VA clinician will fill out the DBQ. If you prefer you have the option of visiting a private health care provider instead of a VA facility to complete their disability evaluation form. Veterans can have their providers fill out any of the more than 70 DBQs that are appropriate for their conditions and submit them to us.

You can locate a DBQ appropriate for your condition by downloading it at

For VA to use a DBQ to process your claim, your licensed healthcare professional must provide all requested medical information. Note that VA will not pay or reimburse any expenses or costs incurred in the process of completing and/or submitting a DBQ. VA reserves the right to confirm the authenticity of all DBQs completed by private health care providers. There are four steps to submit a DBQ:

Step1: Find the appropriate DBQ based on your claimed disability.

 Go to

 Select the appropriate DBQ by using the “List by DBQ Form Name” or “List by Symptoms” web pages.

 Either download the DBQ so the licensed healthcare professional can complete it or print the DBQ for your licensed healthcare professional to complete it by hand.

Step 2: Take the DBQ to your licensed healthcare professional and have your licensed healthcare professional complete the form.

 Your licensed healthcare professional must follow all instructions carefully.

 Legibility is important! Therefore, VA prefers that your licensed healthcare professional completes the DBQ electronically. If your licensed healthcare professional completes it by hand, please ask him to make sure VA can read the information.

 Ensure your licensed healthcare professional completes the last section of the DBQ by providing his or her name, signature, and contact information. VA will only accept a DBQ signed by a licensed healthcare professional. A licensed healthcare professional completing an electronic DBQ must print it to sign it.

 For a video on provider instructions go to

Step 3: Obtain a copy of the completed DBQ for your records.

Step 4: Submit the completed DBQ to VA.

 You or your licensed healthcare professional can fax, mail, or personally deliver the DBQ to the VA Regional Office (RO) responsible for handling you claim.

To find the RO’s mailing address and fax number go to

 DBQs also help support VA’s Fully Developed Claims (FDC) Program. DBQs are valuable for claims processing because they provide medical information that is directly relevant to determining a disability rating. When submitted with a fully developed claim, DBQs ensure VA’s rating specialists have precisely the information they need to start processing the claim.

For more information go to, call 1-800-827-1000 or use the Ask us a Question site

[Source: January 8, 2016 | ++]


Planning for Getting Older ► It’s Never too Early

Over half of America’s Veterans are over 65. It’s estimated 70% of them will eventually need long term care.


Why Plan for Getting Older? It’s so easy to get comfortable with the “I’m going to live forever” mentality. But the reality is that we all get older. We can’t predict the future. But we may be able to influence future decisions. The VA can help – with Shared Decision Making and Advance Care Planning. Many of us work hard to protect our money – how we spend it, where we keep it and who will get anything that’s left over after we die. But a lot more Americans, including Veterans, leave many other issues related to getting older and elder care to chance. They don’t realize that 70 percent of us will need long-term care at some point. Most say they want to stay in their own home, but fail to plan for changes that will make “aging in place” much easier. They stop focusing on wellness habits, even though research shows that staying active, eating healthy, and sleeping well makes a difference.


A Veteran’s Story – It Was Time So, what can you do?

Consider Vietnam Veteran Larry Smith’s story. Larry lives in Salem, OR. and often travels to the Portland VA Medical Center to receive care for his diabetes, vascular degeneration, neuropathy and a few other ailments. He chooses to focus on living and not on his illnesses. “I know the day could come when I cannot make decisions for myself.” Nonetheless, he knew it was time to make plans for the future. “I went to the VA’s website, , to check out my options.” Larry feels better knowing what his options are for long-term services and supports. “Nobody is ever ready to deal with this stuff, but the doctors have told me what I’ll likely have to deal with. I know the VA can provide palliative care, which is what I want to help deal with my symptoms and whatever it can do for my quality of life.” He’s not particularly close to his family. “I know the day could come when I cannot make decisions for myself. I chose a close friend, Paige, who is about 15 years younger than I am to be my health care agent. I talked over my wishes with her and filled out paperwork I downloaded from the Internet that took about 20 minutes to complete. I’m confident that she’ll advocate for me, if needed.”


Know Your Options

More than half our nation’s Veterans are over age 65. Many Veterans do not know about all of their options if or when the time comes. VA’s website for elder Veterans and their family caregivers details home and community based services, residential settings, and nursing homes. It provides valuable Worksheets for Veterans and family members to guide them in the process of making shared decisions with their VA health care providers and social workers.      The website also has helpful sections on paying for long term care and well-being. Refer to:


Shared Decision Making and Advance Care Planning Can Help


The goal of shared decision making is for you to get the services and supports that best meet your long term care needs and preferences. You can use more than one service at a time. And you can change the mix of services and supports you receive as your needs and preferences change. Advance care planning is the process where you identify your values and wishes for your health care at a future time if you are no longer capable of making choices for yourself. Part of the process is filling out a VA advance directive This is a legal form that helps your loved ones and doctors understand your wishes about medical and mental health care. At can be found VA’s one-stop website for aging Veterans provides a Values Worksheet to help you get started as well as resources ( for talking with family members and your health care provider. We all get older – it’s never too early to plan.


[Source: Veterans Health | Sheri Reder & and Taryn Oestreich |November 3, 2015 ++]


VA Health Care Eligibility ► Net Worth No Longer a Factor

The Department of Veterans Affairs is updating the way it determines eligibility for VA health care, a change that will result in more Veterans having access to the health care benefits they’ve earned and deserve. Effective 2015, VA eliminated the use of net worth as a determining factor for both health care programs and copayment responsibilities. This change makes VA health care benefits more accessible to lower-income Veterans and brings VA policies in line with Secretary Robert A. McDonald’s MyVA initiative which reorients VA around Veterans’ needs. “Everything that we do and every decision we make has to be focused on the Veterans we serve,” said VA Secretary Robert A. McDonald. “We are working every day to earn their trust. Changing the way we determine eligibility to make the process easier for Veterans is part of our promise to our Veterans.”

Instead of combining the sum of Veterans’ income with their assets to determine eligibility for medical care and copayment obligations, VA will now only consider a Veteran’s gross household income and deductible expenses from the previous year. Elimination of the consideration of net worth for VA health care enrollment means that certain lower-income, non-service-connected Veterans will have less out-of- pocket costs. Over a 5-year period, it is estimated that 190,000 Veterans will become eligible for reduced costs of their health care services.

In March 2014, VA eliminated the annual requirement for updated financial information. VA now uses information from the Internal Revenue Service and Social Security Administration to automatically match individual Veterans’ income information which reduces the burden on Veterans to keep their healthcare eligibility up to date. That change better aligned VA’s health care financial assessment program with other federal health care organizations. Veterans may submit updated income information by visiting their nearby VA health care facility or at For more information call VA toll-free at 1-877-222-VETS (8387) or visit [Source: VA News Release | March 17, 2015 ++]



VA Claim Filing Update 04 ► New Laws Require Standard Form Use

The days of being able to informally start disability claims with the Department of Veterans Affairs by writing a simple statement on a sheet of paper are over. That will no longer secure an effective date for the evaluation of an award. New laws going into effect 24 MAR will require claimants to use specific forms for claims and appeals. The new laws require that all claims to the VA be filed on standard forms, regardless of the type. The VA states that abolishing the longtime practice of informally initiating veterans’ disability claims will be one way of improving the quality and timeliness of processing. “These new processes will leave no doubt as to the effective dates of claims,” said National Service Director Jim Marszalek. “Of course, our 3,815 National, Department and Chapter Service Officers, including County Veteran Service Officers accredited by DAV, are ready to help everyone get through and understand these new requirements.”

The new law eliminates the practice of using reports of hospitalizations, examinations and other medical records to serve as the start of informal claims for increase or to reopen while retaining the retroactive effective dates. The change also affects appeals. Under the new laws, the VA will accept an expression of dissatisfaction or disagreement with its decision as a Notice of Disagreement (NOD) only if it is submitted on a standardized form. There are three major components to these changes:

First. The traditional informal claims process is being standardized with a new standard form, VA Form 21-0966, Intent to File a Claim for Compensation and/ or Pension, Survivors Pension, or Other Benefits. The form is designed to capture information necessary to identify and support compensation, pension and other benefit claims. An individual or their representative can submit this form in order to establish a potential effective date for benefits and then take up to a year to gather the evidence necessary to support the claim. The form may be submitted electronically, on paper or over the phone. The form is electronically available through eBenefits. The form can be submitted there or in hard copy by mailing it to a DAV National Service Office. The form can also be completed by a VA call center representative over the phone or by a DAV National Service Officer (NSO).

These new processes will leave no doubt as to the effective dates of claims. Individuals seeking compensation or pension benefits will have a full year to gather and submit evidence necessary to support their claim. The new rule does not require that evidence necessary to support a claim be submitted in order for the claim to be recognized as complete and for the VA to take action. The new regulations allow the VA to award increased benefits retroactive to the date of medical treatment, as long as the form is filed within one year of the treatment and the required claim form is filed within a year after that.

Second. If veterans want to file for compensation, they can do so online. If that is not possible or desirable, use of the EZ forms becomes mandatory under the new regulations.

· VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, is needed for paper submissions.

· Pension claims must be filed on VA Form 21-527EZ, Application for Pension.

· Survivors’ claims for dependency and indemnity compensation (DIC), survivors’ pension and accrued benefits must be filed on VA Form 21-534EZ, Application for DIC, Death Pension, and/or Accrued Benefits.

The EZ forms were previously available on an optional basis. Under the new regulations, the VA will mandate their use. Veterans and survivors do not have to file fully developed claims (FDCs) when using these mandatory forms, but the VA encourages FDC participation because it can expedite delivery of benefits through the FDC program.

Third. The changes mandate use of a standardized notice of disagreement form when a claimant wishes to initiate an appeal of a VA decision. Claimants will initiate the appeal of a decision with which they disagree by explaining their disagreement on VA Form 21-0958, Notice of Disagreement. DAV NSOs are being trained in these new laws and forms, and this will be a key topic in this year’s Department and Chapter Service Officer Certification Training Program.

Veterans, family members and survivors should always feel free to contact their local DAV National Service Office with any questions about claims, appeals and compensation. Contact information for those offices can be found online at veterans/find-your-local. [Source: DAV Magazine | Mar/April Edition 2015 ++]


VA Benefits ► How to Apply Online

To apply for VA Benefits online go to and click on the benefit(s) you want to apply for. Need help preparing your claims? You can request for an attorney, claims agent, or Veteran Service Organization (VSO) to help prepare and submit your claims for VA benefits. For more information on how to do this refer to If you are not seeking assistance you can select one of the below highlighted Benefits listed on .


Disability Compensation. Submit a claim for disabilities that you believe are related to your military service.
Add or Remove Dependent. Apply to have a new child or spouse added to or removed from your compensation award.

Supporting Tasks for Compensation

Upload supporting documents for a submitted claim. Upload additional documents to support your submitted compensation claim.
Request a representative for VA claims. Need someone to help you prepare and submit claims for benefits? Request an attorney, claims agent, or Veteran Service Organization (VSO) representative.
Release medical records to VA. Give non-VA medical facilities permission to release your medical information to VA.

Pension – Pension Benefits. Apply online for pension benefits.


Specially Adapted Housing (SAH) Grant. Apply for financial help to make changes to your home, based on your disabilities.
Certificate of Eligibility for VA Home Loan. Get a certificate of eligibility (COE) to help with getting a VA home loan.

Education and Training

Education Benefits. Planning to go to school? Apply online for education benefits.
Vocational Rehabilitation and Employment Benefits. Need help getting back into the workforce? Apply online for vocational rehabilitation and employment benefits.

Health Care

VA Health Care. Apply online for health benefits.
Purchased Care Health Benefits. Apply for non-VA health care benefits and services for yourself and your family through the Purchased Care program.
TRICARE® Health Plans. Find and enroll in a TRICARE® health plan based on your eligibility.

Insurance – Veterans’ Group Life Insurance (VGLI). Enroll for low-cost, term life insurance, or make changes to your existing VGLI policy.

Burial – Burial Benefits. Apply for burial and funeral benefits.

View Open/Submitted Application.

Manage Your Existing Benefits. Go to

Intent To File A Claim

If you need additional time to file a claim for disability compensation, pension, or survivors’ benefits and wish to preserve a date of claim while you gather evidence and complete the application, you should use one of the four following methods to communicate an intent to file a claim to VA:

Appointing a Veterans Service Organization (VSO) or state or county representative to help initiate an intent to file a claim electronically via the Stakeholder Enterprise Portal (SEP). VSOs and representatives can also assist you throughout the claims process. VSOs can access SEP by going to

Starting the claims process online. This is the fastest and easiest way to express intent to file a claim. Simply begin the online application process, and your intent is documented once you select “save.” Access eBenefits via

Completing and mailing VA Form 21-0966, Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC. Complete and download at

Over the phone with a VA call center representative or in person with a VA public contact representative. Locate phone number or office at

[Source: U.S. Department of Veterans Affairs | March 20, 2015 ++]


VA Vet Choice Program Update 10 ► 40 Mile Limit Calculation Changed

More veterans will be able to access health care outside of the Veterans Affairs medical system under a change the department announced on 24 MAR. VA has tweaked one of the Choice program’s eligibility requirements — the criterion related to a vet’s distance from the nearest VA facility — under pressure from veterans, lawmakers and veteran advocates. Instead of calculating geographic distance based on a straight line or, “as the crow flies,” the department will determine eligibility based on the actual driving distance between the veteran’s home and the nearest VA medical facility. The department anticipates that the change will double the number of vets eligible for the Choice program, which allows certain vets to receive health care temporarily outside the VA, if the department is unable to schedule an appointment for the vet within 30 days, or the vet lives more than 40 miles from a VA facility.

The department plans to publish an interim rule soon in the Federal Register making the revision official, and will notify vets via letter about the revised mileage calculation. The department will determine driving distance as calculated with commercial mapping tools that are “consistent with VA’s long-established beneficiary travel program.” Coincidently, the Senate Veterans’ Affairs Committee scheduled a 24 MAR hearing on the Choice program’s 40-mile rule. The program is a key component of the 2014 Veterans Access, Choice and Accountability Act, which President Obama signed into law last summer. The department began sending Choice cards to eligible veterans at the end of last year, mailing them out in three phases. But the roll-out created confusion, and many vets who believed they were eligible for the Choice program were turned away. Since the Choice program took effect in November, more than 45,000 medical appointments have been scheduled, according to the VA. “We’ve determined that changing the distance calculation will help ensure more veterans have access to care when and where they want it,” said VA Secretary Bob McDonald in a 24 MAR statement, adding the change was based on “constructive feedback” from veterans and other stakeholders. “VA looks forward to the ongoing support of our partners as we continue to make improvements to this new program,” he said.

The Choice program runs through Aug. 7, 2017, or until the $10 billion fund is “exhausted,” according to the Nov. 5, 2014, interim rule published in the Federal Register on the program’s implementation and eligibility. The administration’s fiscal 2016 budget proposal recommended shifting any potential excess money from the Choice program into other areas, but lawmakers quickly shot down that idea in February saying it could end the program prematurely. House Veterans’ Affairs Committee Chairman Rep. Jeff Miller, (R-FL) called the proposal a “non-starter.” As of 17 MAR, nearly 46,000 vets have sought to receive care using the Choice program, according to VA data.

Miller on Tuesday praised the department for the distance calculation change, calling it “common sense.” But he also said it would take more to ensure VA implements the program successfully, citing a new survey from the Veterans of Foreign Wars that found VA didn’t offer Choice program enrollment to more than 80 percent of eligible vets who participated in the survey. “Veterans deserve more choices when it comes to their health care decisions, and it’s up to VA to start providing them, just as Congress and the president intended,” Miller said. Many others have criticized the Choice program and its implementation so far, including this clip–2015—ayaan-hirsi-ali from Jon Stewart’s 23 MAR The Daily Show. [Source: | Kellie Lunney | March 24, 2015 ++]


Agent Orange ► Ten Things Every Vet Should Know

The Vantage Point blog at the Department of Veterans Affairs website has some very useful information that most veterans should be aware of. They report:

1. Agent Orange was a herbicide and defoliant used in Vietnam. Agent Orange was a blend of tactical herbicides the U.S. military sprayed from 1962 to 1971 during the Vietnam War to remove the leaves of trees and other dense tropical foliage that provided enemy cover. The U.S. Department of Defense developed tactical herbicides specifically to be used in “combat operations.” They were not commercial grade herbicides purchased from chemical companies and sent to Vietnam. More than 19 million gallons of various “rainbow” herbicide combinations were sprayed, but Agent Orange was the combination the U.S. military used most often. The name “Agent Orange” came from the orange identifying stripe used on the 55-gallon drums in which it was stored. Heavily sprayed areas included forests near the demarcation zone, forests at the junction of the borders of Cambodia, Laos, and South Vietnam, and mangroves on the southernmost peninsula of Vietnam and along shipping channels southeast of Saigon.

2. Any Veteran who served anywhere in Vietnam during the war is presumed to have been exposed to Agent Orange. For the purposes of VA compensation benefits, Veterans who served anywhere in Vietnam between January 9, 1962 and May 7, 1975 are presumed to have been exposed to herbicides, as specified in the Agent Orange Act of 1991. These Veterans do not need to show that they were exposed to Agent Orange or other herbicides in order to get disability compensation for diseases related to Agent Orange exposure. Service in Vietnam means service on land in Vietnam or on the inland waterways (“brown water” Veterans) of Vietnam.

3. VA has linked several diseases and health conditions to Agent Orange exposure. VA has recognized certain cancers and other health problems as presumptive diseases associated with exposure to Agent Orange or other herbicides during military service. Veterans and their survivors may be eligible for compensation benefits.

· AL Amyloidosis. A rare disease caused when an abnormal protein, amyloid, enters and collects tissues or organs.

· Chronic B-cell Leukemias. A type of cancer which affects a specific type of white blood

Cell.Chloracne (or similar acneform disease). A skin condition that occurs soon after exposure to chemicals and looks like common forms of acne seen in teenagers. Under VA’s rating regulations, it must be at least 10 percent disabling within one year of exposure to herbicides.

· Diabetes Mellitus Type 2. A disease characterized by high blood sugar levels resulting from the body’s inability to produce or respond properly to the hormone insulin.

· Hodgkin’s Disease. A malignant lymphoma (cancer) characterized by progressive enlargement of the lymph nodes, liver, and spleen, and by progressive anemia.

· Ischemic Heart Disease. A disease characterized by a reduced supply of blood to the heart, that can lead to chest pain (angina).

· Multiple Myeloma. A cancer of plasma cells, a type of white blood cell in bone marrow.

· Non-Hodgkin’s Lymphoma. A group of cancers that affect the lymph glands and other lymphatic tissue.

· Parkinson’s Disease. A progressive disorder of the nervous system that affects muscle movement

· Peripheral Neuropathy, Early-Onset. A nervous system condition that causes numbness, tingling, and muscle weakness. Under VA’s rating regulations, it must be at least 10 percent disabling within one year of herbicide exposure.

· Porphyria Cutanea Tarda. A disorder characterized by liver dysfunction and by thinning and blistering of the skin in sun-exposed areas. Under VA’s rating regulations, it must be at least 10 percent disabling within one year of exposure to herbicides.

· Prostate Cancer. Cancer of the prostate; one of the most common cancers among older men.

· Respiratory Cancers (includes lung cancer). Cancers of the lung, larynx, trachea, and bronchus.

· Soft Tissue Sarcomas (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma). A specific group of malignant of cancers in body tissues such as muscle, fat, blood and lymph vessels, and connective tissues

4. Veterans who want to be considered for disability compensation must file a claim. Veterans who want to be considered for disability compensation for health problems related to Agent Orange exposure must file a claim. During the claims process, VA will check military records to confirm exposure to Agent Orange or qualifying military service. If necessary, VA will set up a separate exam for compensation.

5. VA offers health care benefits for Veterans who may have been exposed to Agent Orange and other herbicides during military service. Veterans who served in Vietnam between January 9, 1962, and May 7, 1975, are eligible to enroll in VA health care. Visit VA’s health benefits explorer to check your eligibility and learn how to apply.

6. Participating in an Agent Orange Registry health exam helps you, other Veterans and VA. VA’s Agent Orange Registry health exam alerts Veterans to possible long-term health problems that may be related to Agent Orange exposure during their military service. The registry data helps VA understand and respond to these health problems more effectively. The exam is free to eligible Veterans and enrollment in VA health care is not necessary. Although the findings of your exam may be used to inform your subsequent care, they may not be used when applying for compensation as a separate exam is required. Contact your local VA Environmental Health Coordinator about getting an Agent Orange Registry health exam.

7. VA recognizes and offers support for the children of Veterans affected by Agent Orange who have birth defects. VA has recognized that certain birth defects among Veterans’ children are associated with Veterans’ qualifying service in Vietnam or Korea.

· Spina bifida (except spina bifida occulta), a defect in the developing fetus that results in incomplete closing of the spine, is associated with Veterans’ exposure to Agent Orange or other herbicides during qualifying service in Vietnam or Korea.

· Birth defects in children of women Veterans are associated with their military service in Vietnam but are not related to herbicide exposure.

The affected child must have been conceived after the Veteran entered Vietnam or the Korean demilitarized zone during the qualifying service period. Learn more about benefits for Veterans’ children with birth defects at

8. Vietnam Veterans are not the only Veterans who may have been exposed to Agent Orange. Agent Orange and other herbicides used in Vietnam were used, tested or stored elsewhere, including some military bases in the United States. Other locations/scenarios in which Veterans were exposed to Agent Orange may include:

· Korean Demilitarized Zone. Exposure along the demilitarized zone in Korea between April 1, 1968 and August 31, 1971

· Thailand Military Bases. Possible exposure on or near the perimeters of military bases between February 28, 1961 and May 7, 1975

· Herbicide Tests and Storage Outside Vietnam. Possible exposure due to herbicide tests and storage at military bases in the United States and locations in other countries.

· Agent Orange Residue on Airplanes Used in Vietnam War. Possible exposure of crew members to herbicide residue in c-123 planes flown after the Vietnam War

9. VA continues to conduct research on the long-term health effects of Agent Orange in order to better care for all Veterans. VA and other Federal government Departments and agencies have conducted, and continue to conduct, extensive research evaluating the health effects of Agent Orange exposure on U.S. Veterans. An example is the Army Chemical Corps Vietnam-Era Veterans Health Study designed to examine if high blood pressure (hypertension) and chronic obstructive pulmonary disease (COPD) are related to herbicide exposure during the Vietnam War. Researchers have completed data collection and aim to publish initial findings in a scientific journal in 2015. Learn more about Agent Orange related studies and their outcomes at

10. VA contracts with an independent, non-governmental organization to review the scientific and medical information on the health effects of Agent Orange. VA contracts with the Institute of Medicine (IOM) of the National Academy of Sciences every two years to scientifically review evidence on the long-term health effects of Agent Orange and other herbicides on Vietnam Veterans. The IOM uses a team of nationally renowned subject matter experts from around the country to gather all the scientific literature on a topic, identify peer-reviewed reports, and then examine the studies to determine the most rigorous and applicable studies. The IOM looks for the highest quality studies. The IOM then issues its reports, including its conclusions and recommendations to VA, Congress, and the public.

[Source: Beaufort Observer | George Schryer | March 16, 2015 ++]


Sleep ► How Much is Enough?

On 3 FEB the National Sleep Foundation released new guidelines, serving to clarify the meaning of “enough” in the tedious rejoinder, “Most people don’t get enough sleep.” The sleep-advocacy foundation convened a panel of experts, led by Harvard professor Charles Czeisler, to review hundreds of studies, reminding us that too little sleep can lead to weight gain, depression, and relative deficits of attention—and that too much sleep is, likewise, inadvisable. The recommended sleep allotments are:

 Newborns (0-3 months): 14-17 hours (previously 12-18)

 Infants (4-11 months): 12-15 hours (previously 14-15)

 Toddlers (1-2 years): 11-14 hours (previously 12-14)

 Preschoolers (3-5): 10-13 hours (previously 11-13)

 School-age children (6-13): 9-11 hours (previously 10-11)

 Teenagers (14-17): 8-10 hours (previously 8.5-9.5)

 Younger adults (18-25): 7-9 hours (new age category)

 Adults (26-64): 7-9 hours (previously the same)

 Older adults (65 and older): 7-8 hours (new age category)

These new recommendations do little in the way of upsetting the old, with minor variations and clarifications for older adults and young children. And the numbers may vary among people with medical conditions, and among the few outliers who still function optimally outside of these ranges. But these are the amounts that the panel wants people to consider “rules of thumb.” The issuance of new guidelines, however familiar they are, serves at least in an effort toward awareness amid an ongoing public-health effort to rebrand sleep deprivation as less of a testament to mettle and more of a serious medical hazard. The evidence against too much sleep is not as strong as the evidence against too little, though getting too much sleep has been linked with increased risk of near-term mortality. Still some experts argue that it’s unclear if sleeping beyond nine hours is inherently dangerous to adults. In relation to poor health and failure to thrive, deviating from these sleep ranges can either be a cause or an effect. In practical terms, the panel also reminds people, familiarly, of the benefits of avoiding caffeine and alcohol in the hours before bed, exercising as a means to better sleep, and the reprehensibility of bringing a phone into bed. Because ultimately, the National Sleep Foundation implores us today, evoking the scythe:

“Humans, like all animals, need sleep, along with food, water, and oxygen, to survive.” [Source: The Atlantic | James Hamblin, MD | Feb. 03, 2015 ++]


Exercise Impact on Death ► Lack of it Twice as Deadly as Obesity

Even a small amount of exercise, such as brisk daily 20 minute walk, reduces the risk of premature death. It seems more and more studies are showing that any level of activity has benefit. So begin today by doing something. Researchers estimated that 337,000 of the 9.2 million deaths amongst European men and women each year were attributable to obesity but twice this number of deaths could be attributed to physical inactivity. They found that even small amounts of exercise, such as brisk 20 minute walk each day which burns around 100 calories, had major health impacts, reducing the risk of premature death. Previous research has found that physical inactivity is linked to heart disease and cancer. “This is a simple message: just a small amount of physical activity each day could have substantial health benefits for people who are physically inactive,” said study leader Professor Ulf Ekelund, from the Medical Research Council (MRC) Epidemiology Unit at Cambridge University. ”

Although we found that just 20 minutes would make a difference, we should really be looking to do more than this – physical activity has many proven health benefits and should be an important part of our daily life.” The results were a ‘clear reminder’ that exercise was the best way to avoid an early death. June Davison, Senior Cardiac Nurse at the British Heart Foundation, said: “The research suggests that just a modest increase in physical activity can have health benefits. “Adults should aim to do at least 150 minutes of moderate intensity activity a week, carrying it out in sessions of 10 minutes or more. “Whether it’s going for a walk, taking a bike ride or using the stairs instead of the lift, keeping active every day will help reduce the risk of developing coronary heart disease.” [Source: Health-E-News | Dr Michael LoGiudice | February 2015 ++]



VA Staph Infections ► Initiatives Substantially Reduce MRSA

A Department of Veterans Affairs (VA) initiative targeting potentially life-threatening staph infections in hospitalized patients has produced significant positive results, according to recent statistics released by VA.

VA’s success in substantially reducing rates of health care-associated infection with methicillin-resistant Staphylococcus aureus (MRSA) serves as important confirmation that multifaceted intervention strategies

can achieve effective and sustained control of MRSA in U.S. hospitals. “VA has a well-earned reputation in successful prevention of MRSA,” said VA Secretary Robert McDonald. “Delivering high-quality care to

our Veterans when they are in our hospitals is a responsibility that we do not take lightly. The drop in MRSA rates shows that we are pursuing the right course for prevention and treatment. The results that we

have achieved mean better health care for our Veterans and that care ultimately benefits all Americans.”

Among VA patients in intensive care units (ICU) between 2007 and 2012, healthcare-associated MRSA infection rates dropped 72 percent—from 1.64 to 0.46 per 1,000 patient days. Infection rates dropped 66

percent—from 0.47 to 0.16 per 1,000 patient days—for patients treated in non-ICU hospital units. “These results are striking,” said Dr. Carolyn Clancy, VA’s Interim Under Secretary for Health. “Health care associated

infections are a major challenge throughout the health care industry, but we have found in VA that consistently applying some simple preventive strategies can make a very big difference, and that difference is being recognized.”

VA’s prevention practices consist of patient screening programs for MRSA, contact precautions for hospitalized patients found to have MRSA, and hand hygiene reminders with readily available hand

sanitizer stations placed strategically in common areas, patient wards, and specialty clinics throughout medical centers. Computerized reminders, online training, frequent measurement, and continual feedback

to medical staff reinforce such practices. VA has created a culture that promotes infection prevention and control as everyone’s responsibility. A major part of that commitment is a dedicated employee at each VA

medical center exclusively for the purpose of monitoring compliance with MRSA protection procedures, training staff, and working with Veteran patients and families.

MRSA infections are a serious global health care issue and are difficult to treat because the bacterium is resistant to many antibiotics. In a Centers for Disease Control and Prevention 2012 MRSA surveillance

report from its Active Bacterial Core surveillance (ABCs), the CDC cites that there were 75,309 cases of invasive MRSA infections and 9,670 deaths due to invasive MRSA in 2012. “The VA health care system is

able to implement and assess these prevention strategies,” said Dr. Martin Evans, director of VA’s MRSA control program. “What we’ve learned translates into better health care for the Veterans we serve.” With

over 8 million Veterans enrolled, VA operates the largest integrated health care delivery system in the United States conducting this type of large-scale, organized prevention program and documenting its


[Source: VA News Release Oct. 07, 2014 ++]



VA Telehealth Update 06 Programs Served 690,000+ in 2014

The Department of Veterans Affairs (VA) announced 10 OCT that its national telehealth programs served more than 690,000 Veterans during fiscal year 2014. That total represents approximately 12 percent of the

overall Veteran population enrolled for VA healthcare, and accounted for more than 2 million telehealth visits. Of that number, approximately 55 percent were Veterans living in rural areas with limited access to

VA healthcare. With more Veterans seeking health care, telehealth is rapidly becoming an attractive option, especially for those Veterans who don’t have a VA health care facility close to home. “We have to adapt to

meet Veterans wherever their needs are,” said VA Secretary Robert A. McDonald. “A brick-and-mortar facility is not the only option for health care. We are exploring how we can more efficiently and effectively

deliver health care services to better serve our Veterans and improve their lives. Telehealth is one of those areas we have identified for growth.”


Currently, there are more than 44 clinical specialties offered to Veterans through VA’s telehealth programs. One program at the Miami VA schedules close to 90 clinic connections every week for

dermatology, eye exams, the women Veterans program, podiatry, mental health and other clinical specialties. One tangible example of the success of VA’s telehealth program is its burgeoning

TeleAudiology program because of large population of Veterans living with hearing loss. The TeleAudiology program has grown from 1,016 Veterans in fiscal year 2011 to more than 10,589 in fiscal

year 2014. For more information about VA’s telehealth program, visit .


[Source: VA News Release Oct. 10, 2014 ++]



VA Hepatitis C Treatment Update 05 ► $1,000 Pill Budget Impact

The Department of Veterans Affairs has a new problem on its hands. While struggling to beef up its medical staff and sharply reduce the time it takes veterans to get appointments at health facilities, the staggering

cost of Sovaldi, a specialty drug to treat Hepatitis C, is threatening to blow a $1.3 billion hole in the agency’s budget in the next two years. It’s a fiscal crisis that could force deep agency cutbacks in other

areas. The issue first surfaced in July when the embattled VA gave the Senate Veterans Affairs Committee a $17.6 billion wish list of resources to begin delivering high quality and timely health care to veterans. VA

officials complained that the unexpectedly high cost of using Sovaldi was eating away at their budget. The VA is the largest provider of care in the U.S. for chronic Hepatitis C virus infections, which can destroy the

liver and require a liver transplant or result in death. The VA has 174,000 veterans under its care with documented HCV; another 42,000 could be added once they’re properly tested.


Congress subsequently approved $17.5 billion of new funding as part of VA reform legislation, but none of those funds was earmarked for the Sovaldi treatments. Made by Gilead Sciences of California and

approved by the Food and Drug Administration a year ago, the drug offers huge advances in the treatment of Hepatitis C and related liver problems – and guarantees a cure rate of 90 percent. Yet the medicine costs

$1,000 per pill – or $84,000 for the obligatory 12-week treatment. The 3.2 million Americans who are infected by Hepatitis C could benefit greatly from the treatment. Still, the total cost of covering those

people with the new drug would exceed the $300 billion the U.S. is spending annually on pharmaceuticals. Sovaldi is just the leading edge of a surge in specialty drugs that offer important advances in treating

cancer, multiple sclerosis and other serious illnesses but that threaten to saddle government, health insurers and consumers with huge unsustainable costs.


The VA spent about $220 million on the new drug in the fiscal year that ended 30 SEP, according to agency figures. Other HCV treatments will be coming on the market soon; the VA intends to use those as

well. Although Gilead and the VA negotiated down the price of a tablet from $1,000 to $543, according to one source, the long-term cost of Sovaldi to the VA could be staggering – and will eclipse the treatment

costs of most other diseases, including cancer. A spokesperson for Gilead declined to respond to questions from The Fiscal Times about the pricing controversy. In late July, Gilead was informed it is under

investigation by the Senate Finance Committee, whose members became interested in learning why Gilead had decided to more than double the price of the medication before it was put on the market, as The Fiscal

Times reported. Gilead claims the cost of developing Sovaldi was $11 billion. The Senate in an inquiry says the company’s cost between 2009 and 2011 was merely $62.4 million.


[Source: 25CNBC | Eric Pianin | Oct. 08, 2014 ++]



VA Caregiver Program Update 26 ► Program Expansion Unlikely

For older generations of spouses, mothers and other family caregivers of severely disabled veterans, the startling feature of the Family Caregiver Program that Congress enacted in 2010 was its exclusivity. The

unprecedented package of caregiver benefits includes training to help to ensure patient safety; cash stipends to partially compensate for caregiver time and effort; caregiver health coverage if they have none, and

guaranteed periods of respite to protect against burn out. The comprehensive package, however, isn’t available to most family members who are primary caregivers to severely ill and injured veterans. To

control costs, Congress opened the program only to caregivers of veterans severely “injured,” either physically or mentally, in the line of duty on or after Sept. 11, 2001. It is not open to families of severely

disabled vets injured before 9/11. It also is not open to post-9/11 veterans who have severe serviceconnected illnesses, rather than injuries.


Advocates for these forgotten families had hoped a successful launch of a limited program would spur Congress to expand eligibility and end the obvious inequity it created. That hope is set back by a new

Government Accountability Office report on the three-year-old Family Caregiver Program, which finds its under resourced and, for the most part, in disarray. For starters, officials woefully underestimated the

number of veterans eligible for the program, for which Congress set aside $1.5 billion to fund it through fiscal 2015. VA forecast 4000 approved caregivers by September this year. Instead, by last May, 15,600 had

been approved out of an applicant pool of 30,400. Roughly 500 more are being approved monthly, GAO said, with no slowdown in sight. Eight of every 10 approved caregivers are spouses of veterans. Ninety-two

percent of them care for veterans with mental health diagnoses, mostly post-traumatic stress disorder (63 percent) or traumatic brain injury (26 percent). Stipends, based on local hourly caregiver wages, are set at

three levels.


Caregivers providing a maximum of 40 hours of care per week receive an average of $2320 a month, or $27,830 annually. About 6000 caregivers qualify for this level. An equal number provide a maximum of 25

hours’ care per week and draw an average $1470 a month. And 3,600 caregivers provide 10 hours of care weekly and receive on average $600 a month or $7200 a year. Because VA “significantly underestimated

caregivers’ demand for services,” GAO reports, VA medical centers were unprepared to meet program demands, particularly the work load on primary care physicians and nurses who must form into teams and

visit homes of applicants to assess health needs and determine appropriate levels of caregiver support. GAO also found that the computer system hastily adopted to track caregivers and workloads is inadequate

and must be replaced if officials are to have data needed to monitor and resource the program effectively.


As the program now operates, a mandate to complete application reviews within 45 days is routinely missed. Also, some physicians and nurses have rebelled against the extra work, declining to visit homes to

assess caregiver skills, veterans’ eligibility and proper level of support. VA regional health officials told GAO, the report says, “that their facilities do not have sufficient medical staff to effectively manage the

additional workload” from the program, “which they view as collateral duty.” There are funds for medical centers to hire more Caregiver Support Coordinators who run the program locally by providing stipends

and support services, and arranging CHAMPVA medical coverage for eligible caregivers. But GAO found some medical centers reluctant to hire enough CSCs for fear that funds available now to support caregivers

will dry up in time, forcing medical centers to pinch spending on more critical priorities.


As a result, GAO reports, the ratio of coordinators to caregivers varies widely across the VA medical system. For example, there is one coordinator for six caregivers in Fayetteville, Ark., and also only one to

support 251 caregivers at the Atlanta VA medical center in Decatur, Ga. The workload on some CSCs is so heavy that caregivers can’t get their phone calls returned. One caregiver said she became desperate to learn

how to manage a veteran with increasingly severe symptoms of traumatic brain injury. Her coordinator finally said her request was one of many and the program was too taxed to provide counseling. So the

caregiver had to turn to an outside non-profit organization for help. “There are just not enough people to run the program,” said Adrian Atizado, assistant legislative director for Disabled American Veterans, who

has monitored the caregiver program since its start. “There are not enough support coordinators, not enough interdisciplinary providers and nurses to do the home visits. Also, keep in mind this program doesn’t exist

anywhere else. This is the first of its kind so it’s going to have problems.” All of the research and the studies that Congress relied to shape the program, Atizado added, had focused on caregiver needs for the

elderly, not for a younger generation of veterans struggling to reengage with society.


Atizado noted that most caregivers of severely disabled veterans, including most represented by DAV, aren’t eligible for the comprehensive caregiver benefit, although they want to be and should be. “We have

always asked that eligibility include illness so if you come down with multiple sclerosis or ALS, a prevalent disease for the veteran population that served in Southwest Asia for whatever reason,” Atizado

said, “that should be covered. Now, it is not allowed.” Caregivers of older vets also should be covered, he said. Most caregivers of severely disabled Vietnam and Korean War veterans “are spending their estates to

support their veterans at home. They haven’t worked in 20 to 30 years. They have no Social Security or retirement. These are the veterans and caregivers we’re fighting to get expansion for.” Problems with the

current program don’t help, he agreed. VA concurred with GAO recommendations to fix the program so eligible caregivers get the services they need. How long it will take is not yet clear.


[Source: Tom Philpott | Sept. 25, 2014 ++]




VA Vaccination Program ► New Partnership with Walgreens

In a first-of-its-kind partnership, the Department of Veterans Affairs (VA) announced 2 OCT that it will join forces with retailer Walgreens to provide greater access to Centers for Disease Control and Preventionrecommended

vaccinations to Veterans across the country. This partnership grew out of a successful pilot program that began in Florida to provide flu vaccines to Veterans throughout the state. Based on those results, VA is expanding the pilot nationwide. Through its nearly 8,200 locations nationwide, Walgreens will offer flu and other recommended vaccinations to Veterans. Pharmacists can administer vaccinations to Veterans and will leverage eHealth Exchange, through its Walgreens Cloud Electronic Health Records platform, to securely share immunization records with VA to help ensure complete patient medical records.


Vaccinations are available daily during all pharmacy hours with no appointment necessary and are subject to availability.


“VA is proud to partner with Walgreens to provide needed vaccines to our nation’s Veterans,” said VA Secretary Robert A. McDonald. “This partnership is a great example of how government and the private sector can work together to effectively and efficiently provide Veterans the care and benefits that they’ve earned.” Walgreens President and Chief Executive Officer Greg Wasson said, “Walgreens is committed to supporting our Veterans, and we are proud to work with the Department of Veterans Affairs to provide convenient access to vaccines,” said “This is an excellent opportunity for our pharmacists to help VA educate Veterans about the importance of vaccinations, to improve immunization rates through greater access and to contribute to helping veterans get, stay and live well.” Interim Under Secretary for Health, Dr. Carolyn Clancy said, “The VA-Walgreens partnership gives Veterans greater choice in time and location for getting their flu shots without having to complete any other VA forms,” said “With this program, the Veteran patient’s record is integrated, and VA maintains a complete immunization record that allows us to more effectively provide patient-centered care.”


Vaccines are subject to availability. Age, state and health related restrictions may apply. Many immunizations may be covered by commercial insurance plans, Medicare Part B or Medicare Part D. As part of this launch and under the agreement, VA funding can provide approximately 75,000 flu shots for enrolled veterans. Patients are encouraged to check with their health plan for specific coverage details. To find the nearest Walgreens, veterans can call 1-800-WALGREENS or visit For more information about VA’s immunization program, visit


[Source: VA News Release Oct. 02, 2014 ++]



Vet Charity Watch Update 50 Wounded Warrior Project Under Fire


Over the past decade, the Wounded Warrior Project has emerged to become one of the celebrated charities in the country—but with its prominence comes deeper scrutiny and criticism. It’s a broad but closely held sentiment within the veterans’ advocacy community: grumbling and critiques about the fundraising behemoth WWP has become, and whether it has been as effective as it could be. In interviews, critical veterans’ advocates and veterans charged that the Wounded Warrior Project cares more about its image than it does about helping veterans; that it makes public splashes by taking vets on dramatic skydiving trips but doesn’t do enough to help the long-term wellbeing of those injured in combat. These criticisms come from a broad cross-section of veterans and their advocates, the vast majority of whom refused to speak on the record due to the sway the Wounded Warrior Project carries.


“They are such a big name within the veterans’ community. I don’t need to start a war in my backyard,” a double-amputee veteran who served in Iraq told The Daily Beast. But granted anonymity, the vet gave voice to what is at the very least a perception problem for the WWP: “They’re more worried about putting their label on everything than getting down to brass tacks. It’s really frustrating.” The same veteran spoke of waking up in the hospital after an IED hit his supply truck—WWP, he said, had given him only trivial merchandise: a backpack, a shaving kit and socks. “Everything they do is a dog-and-pony show, and I haven’t talked to one of my fellow veterans that were injured… actually getting any help from the Wounded Warrior Project. I’m not just talking about financial assistance; I’m talking about help, period,” he said.


Some gripe in interviews with the Beast about how the charity has become more of a self-perpetuating fundraising machine than a service organization. WWP certainly is successful at fundraising: It had revenues of more than $300 million, according to its most recent audited report, up from approximately $200 million the year before. “In the beginning, with Wounded Warrior, it started as a small organization and evolved into a beast,” said Sam, an active-duty Army soldier who works with Special Forces. It’s “become so large and such a massive money-maker,” he says, that he worries the organization cares about nothing more than raising money and “keeping up an appearance” for the public with superficial displays like wounded warrior parking spots at the Walmart. Sam said he’s not interested in becoming involved with the Wounded Warrior Project after he leaves active-duty service—he prefers small nonprofits that are “just trying to survive” with a smaller budget and narrower mission. “They’re laser-focused on making money to help vets, but forgetting to help vets,” said one veterans’ advocate. “It’s becoming one of the best known charities in America—and they’re not spending their money very well.”


The organization also engages in branded partnerships for everything from ketchup to paper towels to playing cards—something that rubs other veterans’ groups the wrong way. “It’s more about the Wounded Warrior Project and less about the wounded warrior,” said a second veterans’ advocate. “You have an organization that is spending God knows how many millions of dollars saying that they’re helping people, but they’re not,” said Davis, an Iraq War veteran. Here are the charity’s self-reported results: As of September, the Wounded Warrior Project said it was serving more than 56,000 wounded vets and nearly 8,000 family members. To date, the WWP’s benefits team has helped 6,600 veterans submit benefit claims, and their Warriors to Work program helped place 1,900 veterans in jobs. The organization offers peer mentoring, employment assistance services, physical health and wellness activities, and long-term support initiatives.


But of the more than 56,000 veterans the group counts as “alumni,” meaning that they have been registered with the organization, many don’t directly engage with WWP. Less than two-thirds (62 percent) of alumni participated in at least one WWP activity or service in the past year, according to a survey of alumni the group shared with the Beast. But according to their internal database, 78.9 percent of alumni have been involved with “engagements and interactions” with WWP this year. The Wounded Warrior Project has also gotten mixed results from charity watchdogs: Charity Watch gave Wounded Warrior a C+ in 2013, up from a D two years prior. Charity Navigator gave it three out of four stars. WWP claims to currently spend 80 percent of its budget on programs for veterans. But their formulation includes some solicitations with educational material on it as money spent on programs. A 2013 collaboration between the Tampa Bay Times and the Center for Investigative Reporting reported that the charity spent just 58 percent of donations directly on veterans’ programs. That year, the figure WWP self-reported was 73 percent. In contrast, a veterans’ charity like Fisher House, which received four stars from Charity Navigator and an A+ from Charity Watch, spent close to 95 percent of its budget on its programs.


There is also a distinct bitterness, especially from smaller advocacy groups, about the level of executive compensation doled out to the group’s leadership: For example, CEO Steven Nardizzi makes an annual salary of $375,000, according to their most recent tax report. WWP counters that its volunteer Board of Director studies similar organization to determine executive compensation, and that their CEO’s compensation is approximately one-tenth of 1 percent of its budget. Nardizzi himself has dismissed charity ratings as unhelpful in the past.


Ken Davis, a veteran who served in Iraq before being injured, is considered among the “alumni” of the Wounded Warrior Project—even though he said he no longer wants to be associated with it. “I receive more marketing stuff from them, [and see more of that] than the money they’ve put into the community here in Arizona,” he told the Beast. “It’s just about numbers and money to them. Never once did I get the feeling that it’s about veterans.” He could have used a ride to a VA facility for health care, he said. But rather than receive practical assistance from the WWP, he got a branded fleece beanie. “They’re marketing, they’re spending money—but on what?” Davis asked.



Outside defenders of the Wounded Warrior Project, in interviews with the Beast, suggested that critics were merely jealous of the charity’s success, and that the disapproving criticisms were merely a function of fear that WWP was eating up their donor dollars. “There’s a certain level of jealousy, that [WWP] have such cachet, and on a daily basis people will associate [other prominent veterans’ groups] as Wounded Warrior. That rubs people the wrong way,” said one such defender in the nonprofit sphere. As for the administrative costs of the charity, the nonprofit worker continued, “There is a fundamental misunderstanding in the public sphere about what it really costs to run an effective nonprofit.”


For its part, the Wounded Warrior Project dismisses much of the criticism. The branding of products will “help to create awareness of the challenges and needs of this generation of veteran… help fund the 20 free programs and

services we provide to injured veterans, their families and caregivers, and inform veterans of the programs and services we provide so that they can register as Alumni to take part in them,” their spokeswoman said.


As for the comfort packages and merchandise, Roberts notes that it reflects the group’s origins: WWP started with just six friends packing backpacks to provide items to wounded services warriors at Walter Reed Medical Center. And the group also says employees are empowered to provide direct assistance to veterans such as rent, utilities, food, and emergency repairs. The Wounded Warrior Project is certainly not a scam, nor an ill-meaning charity. Even its fiercest detractors admit that WWP has the right motives, even if they believe WWP can be a lot more effective. But as the Wounded Warrior Project has grown to become one of the nation’s most prominent veterans’ groups, it still has room for improvement. Can it claim to serve 56,000 vets when at least one-third haven’t engaged with the group in the past year? Or claim to be maximally effective if it spends more of its budget on administrative costs than the top-ranked charities in the field do? At the very least, the Wounded Warrior Project has a perception problem among a broad group of fellow veterans advocates and vets themselves. “You have an organization that is spending God knows how many millions of dollars saying that they’re helping people, but they’re not,” said Davis, an Iraq veteran.


[Source: The Daily Beast | Tim Mak | Sept. 26, 2014 ++]





It is almost 2 years since the cancer he developed while in Vietnam took him.

I want to get the word out:  Any Vietnam veteran who ate raw or undercooked fish, drank the water or even swam in it,

needs to be tested for Cholangiocarcinoma.  It is a silent killer.  It is cancer of the internal liver bile ducts caused by the Southeast Asian Liver Fluke.  

Lots of men have mild symptoms that the doctors chalk up to routine liver conditions in “middle aged” men, and not the cancer.  Please pass the word along.  More and more men are dying every day from this little known “gift” from ‘Nam.  If we can save just one vet from my husband’s fate, it will serve as a fitting memorial for his passing.