"The Vet's Place" -Veteran Disability Issues


Department of Defense agrees to work with VA to cover budget shortfall

        By Terri  Lukach, American Forces Press Service

WASHINGTON, June 28, 2005 - The Defense Department will work with the Veterans Affairs Department to help cover a shortfall in VA funds due to increased dental benefits claimed by returning veterans of the global war on terror, a top DoD health official told Congress today.

“The Department of Defense is firmly committed to protecting the health of its servicemembers - before, during, and after deployment - and all our other health beneficiaries,” Dr. Stephen L. Jones said in testimony before the House Subcommittee on Military Quality of Life, Veterans Affairs and Related Agencies. Jones is principal deputy assistant secretary of defense for health affairs.

“DoD attempts to demobilize our Reservists as soon as possible so that they can return to their families and civilian life,” he said, “after ensuring that all health issues they face have been adequately addressed.”

However, because health care benefits entitle veterans either to space-available care in military dental treatment facilities or voluntary enrollment in the Tricare dental program, some Reservists have made increasing use of their VA benefit entitlement, Jones said. The result has been slightly increased costs to the VA for dental care.

“At a recent hearing before the House Committee on Veterans Affairs, our colleagues in the VA described a significant funding shortfall in their fiscal year 2005 health care budget. A small portion of this shortfall, stated as approximately $90 million, was attributed to dental care for deactivated or recently separated Reserve and National Guard personnel,” Jones said.

“We met with the VA staff to review this requirement and provide an independent estimate of the amount,” he continued. “As the result of our joint work, we believe the additional workload has resulted in a $54 million requirement above VA’s 2005 baseline.”

Jones said DoD is investigating various transfer mechanisms between the two departments to help the VA defray the remaining increase in dental care.

“The Department of Defense is committed to taking care of its own personnel who are put into harm’s way to defend our nation,” he said. “We provide the best possible care for our wounded servicemembers, and have been well- supported by the Congress in acquiring sufficient resources to perform our missions. Where appropriate, and only with their coordinated cooperation, we have entered into joint ventures with the VA as a part of this process.”


Dr. Stephen L. Jones [http://www.ha.osdmil/ha/StevenJones.cfm]

Related Sites:

Department of Veterans Affairs [http://www.va.gov/]

Tricare [http://www.tricare.osd.mil/]


VA Faces $2.6 Billion Shortfall in Medical Care
Agency Undercounted Size of Returning Force

By Thomas B.  Edsall

Washington Post Staff Writer
Wednesday, June 29, 2005; A19

The Bush administration disclosed yesterday that it had vastly underestimated the number of service personnel returning from Iraq and Afghanistan seeking medical treatment from the Department of Veterans Affairs, and warned that the health care programs will be short at least $2.6 billion next year unless Congress approves additional funds.

Veterans Affairs budget documents projected that 23,553 veterans would return this year from Iraq and Afghanistan and seek medical treatment. However, Veterans Affairs Secretary Jim Nicholson told a Senate committee that the number has been revised upward to 103,000 for the fiscal year that ends Sept. 30. He said the original estimates were based on outdated assumptions from 2002.

“The bottom line is there is a surge in demand in VA [health] services across the board,” Nicholson told the Senate Veterans Affairs Committee.

Just last week, the VA revealed that the rise in demand for VA health facilities had caused a $1 billion shortfall in operating funds for the current year. That would more than double in the coming year without congressional intervention.

Senate Republicans, embarrassed and angered over the revelations, yesterday announced plans to pass emergency legislation this morning to add $1.5 billion to the fiscal 2005 appropriation. The move is designed to appease angry veterans groups and preempt a Democratic proposal calling for $1.42 billion in increased VA spending.

The action represents a reversal of GOP policies toward the VA. For the past four months, House and Senate Republicans have repeatedly defeated Democratic amendments to boost VA medical funding.

Nicholson, a former chairman of the Republican National Committee, faced criticism from House and Senate committee chairmen at two hearings.

“I sit here having recently learned that the information provided to me thus far has been disturbingly inaccurate,” Senate Veterans Affairs Committee Chairman Larry E. Craig (R-Idaho) told Nicholson. House Appropriations Committee Chairman Jerry Lewis (R-Calif.) told Nicholson that the failure to alert Congress earlier about the VA’s money problems “borders on stupidity.”

“Somebody was hoping they could hide the ball for a while and talk about it later, and frankly in this arena you can’t afford to do that,” Lewis said.

As GOP House and Senate leaders scrambled to deal with the politically damaging shortfall and quell criticism from veterans’ advocacy groups, Democrats intensified charges that the Bush administration and the Republican congressional majorities are failing to care for those who put their lives on the line for the country.

Rep. Chet Edwards (Tex.), the ranking Democrat on the House Appropriations subcommittee on military quality of life and veterans affairs, said the administration and Republican leadership had been made aware of the problems as far back as 2004 when Reps. Christopher H. Smith (R-N.J.) and Lane Evans (Ill.,), then chairman and ranking Democrat on the Veterans Affairs Committee, called for major increases in spending.

Instead of dealing with the problem, Edwards said, the House Republican leadership “fired Smith,” forcing him out of the chairmanship.

The Democratic Senatorial Campaign Committee issued a news release declaring: “Republicans can’t hide from their record of neglecting our nation’s veterans.” The release cited repeated rejection by the Senate Republican majority of amendments sponsored by Sen. Patty Murray (D-Wash.) to boost spending.

The new efforts by Republican leaders to increase veterans spending may jeopardize administration and congressional efforts to reduce the budget deficit. The budget resolution already passed by Congress calls for $31 billion for VA health care in fiscal 2006, a limit that now appears virtually certain to be broken.

The House yesterday rejected an Edwards move to boost 2005 VA spending on a party-line vote, 217 to 189.

By all accounts, there have been dramatic improvements in VA health care, and its accessibility, over the past 15 years. In addition, the current co-payment on prescription drugs is $7, far lower than that of private plans and the new drug benefit under Medicare.

Nicholson said the VA and its actuarial advisers based their calculations for the patient load in 2005 on data from 2002, before the Iraq and Afghanistan conflicts were fully engaged. The revised projection of 103,000 new enrollees this year includes some of the 13,700 veterans wounded in action in Iraq and Afghanistan, as well as others who served overseas seeking medical care.


Congress Must Act to Change Method
of Funding Veterans Health Care

[right]June 30, 2005* *No. 05-009
Mokie Porter
(301) 585-4000 Ext. 146
(301) 996-0901

(Washington, D.C.) – “The flurry of activity this week as Congress scrambled to contain the fallout from the failure to properly fund veterans health care highlights what the veterans service organizations have been saying for years: The method of funding veterans health care needs surgery to regain its health," said Thomas Corey, national president of Vietnam Veterans of America (VVA).

“Beyond the hasty supplemental appropriation Congress saw fit to pass, leaders from both parties now have to fix the system to provide sufficient resources to meet the healthcare needs of more than 100,000 recently returned veterans and the 5 million other veterans who use the VA’s health-care facilities,” Corey said.

“As we testified before the House and Senate Veterans’ Affairs Committees in April, the federal budget cannot and should not be balanced by taking away what veterans have earned by virtue of their service to our nation,” Corey said. “If it is the will of the American people to constrict the benefits to which veterans are statutorily eligible, then VVA challenges Congress here and now: Propose, introduce, hold public hearings, and debate the question of whether Americans want to limit access for ‘certain’ veterans who fulfilled their military duty to our country yet are now deemed unworthy of access to VA health care.

“We have said this before, and we’ll say it again: The cost of caring for those who served in the military is an integral part of the cost of the national defense …. Caring for veterans is not a Democratic cause. It is not a Republican effort. It is an American issue, one that cuts across political affiliations.”

Corey concluded: “VVA applauds those in Congress, including Sen. Larry Craig (R-Idaho), chair of the Senate Committee on Veterans’ Affairs, and Sen. Patty Murray (D-Wash.), who serves on that committee, as well as Rep. Lane Evans (D-Ill.) and Rep. Chet Edwards (D-Tx.). Their outrage at the apparent duplicity exhibited by VA officials who repeatedly assured them that the Administration had requested enough funding to care for the VA’s caseload has finally led to action.

“VVA estimates that $31.4 billion is needed in FY06 just to maintain the current level of the VA’s medical operations,” Corey concluded. “This is $2.6 billion more than Congress has appropriated. We urge Congress to appropriate these additional funds and take measures to establish a new mechanism that will guarantee sufficient and consistent funding for veterans health care – and ensure that such a ‘budget gap’ does not occur again.”


TRICARE For Life, TRICARE and Medicare Part A and B (Part 1)

 Updated July  1, 2005


TRICARE and Medicare Part A and B

When TRICARE beneficiaries become entitled to Medicare Part A and B on the basis of age, disability or end-stage renal disease they are eligible for TRICARE for Life. TRICARE For Life <http://www.tricare.osd.mil/tfl/default.cfm> (TFL) is TRICARE’s Medicare-wraparound coverage available worldwide to TRICARE beneficiaries that are also entitled to Medicare. If a beneficiary entitled to Medicare Part A declines Medicare Part B coverage, he/she will lose TRICARE coverage (with the exception of active duty family members).


TFL is available to all TRICARE and Medicare dual-eligible Uniformed Services beneficiaries, regardless of age including retired members of the National Guard and Reserve who are in receipt of retired pay, family members, widows/widowers and certain former spouses.

Uniformed Services beneficiaries entitled to Medicare Part A are required by law to have Medicare Part B coverage to retain their TRICARE benefits with one exception. Active duty family members entitled to Medicare Part A are not required to have Medicare Part B coverage. When the active duty service member retires, family members must have Medicare Part B coverage to avoid loss of TRICARE benefits.

Dependent parents and parents-in-law are not eligible for TFL.

Cost to Beneficiaries

There are no enrollment fees for TFL.

Medicare Part B

The Department of Defense (DoD) strongly encourages beneficiaries to purchase Medicare Part B when they are first eligible. Although a beneficiary may delay Medicare Part B sign up for up to eight months in certain circumstances, the beneficiary will not be covered by TRICARE until Part B coverage begins.

Beneficiaries who do not sign up for Medicare Part B when first eligible will pay a 10 percent surcharge for each 12 month period that they delayed signing up.

Beneficiaries should confirm that their Medicare status is current in the Defense Eligibility and Enrollment Reporting System (DEERS). Beneficiaries may go to the TRICARE DEERS <http://www.tricare.osd.mil/deers/update-info.cfm> information page to see a full list of contact options.

Beneficiaries may sign up for Medicare Part B during their initial enrollment period, which begins three months before the month a beneficiary turns 65 and ends three months after the month the beneficiary turns 65. NOTE: Although the eligibility age for full Social Security benefits is changing, the eligibility age to get Medicare is not changing.

If a beneficiary does not sign up for Medicare Part B when first eligible, he or she can sign up for Part B during the general enrollment period that occurs January 1 through March 31 of each year. When a beneficiary enrolls in Part B during the general enrollment period, Part B and TFL coverage begin July 1 of that year.

Employer Group Health Plan Coverage

Beneficiaries with group health plan coverage based on their current employment or that of a family member are not required by Medicare to sign up for Part B. They may sign up for Medicare Part B without paying the surcharge for late enrollment anytime while they are still covered by an employer group health plan or they may delay sign up for up to eight months after employment or health plan coverage ends, whichever comes first. Although Medicare does not require beneficiaries with group health coverage to sign up for Part B, TRICARE coverage will not begin until Medicare Part B coverage begins.

Beneficiaries may check with the Social Security Administration online at www.ssa.gov <http://www.ssa.gov/> , call toll-free at (800) 772-1213 or visit Medicare online at www.medicare.gov <http://www.medicare.gov/> for information about Medicare Part B.

How TFL Works with Medicare

For services received from a provider that accepts Medicare, the provider first files claims with Medicare. Medicare pays its portion and electronically forwards the claim to the TFL claims processor. TFL sends its payment for the remaining beneficiary liability directly to the provider.

Beneficiaries receive a Medicare summary notice from Medicare and a TFL explanation of benefits (EOB) from the TFL contractor indicating the amounts paid.

-For Medicare and TRICARE covered services, Medicare pays first and

the remaining beneficiary liability may be paid by TFL.

-For services covered by TRICARE but not by Medicare, such as care received overseas, TFL pays first and Medicare pays nothing. Beneficiaries are responsible for the TRICARE fiscal year deductible and cost shares.

-For services covered by Medicare but not by TRICARE, such as chiropractic services, Medicare is the first payer and TFL pays nothing. Beneficiaries are responsible for Medicare deductibles and coinsurance.

-For services not covered by Medicare or TRICARE, such as cosmetic

surgery, Medicare and TRICARE pay nothing. The beneficiary is responsible for the entire bill.

How TFL Works With Medicare and Other Health Insurance (OHI)

Beneficiaries with OHI, such as a Medicare supplement or employer-sponsored medical coverage, may use TFL. By law, TRICARE pays claims only after all OHIs have paid.

Typically, after Medicare processes a claim-either approving or denying it-the claim is automatically forwarded to the beneficiary’s OHI. Once the OHI processes the claim, the beneficiary needs to file a paper claim with TRICARE for any out-of-pocket expenses. TRICARE may reimburse the beneficiary if the services provided are covered by TRICARE.

Paper claims must be submitted to the TFL contractor using a CHAMPUS claim form (DD Form 2642 <http://www.tricare.osd.mil/claims/Dd_2642.pdf> ) along with a copy of the provider’s itemized bill, the Medicare summary notice and EOBs from all OHIs. TFL claims must be filed within one year from the date the care is received. Beneficiaries may receive assistance with claims filing procedures from the TFL contractor, a local Beneficiary Counseling and <http://www.tricare.osd.mil/bcac> Assistance Coordinator or from the TRICARE Web site at www.tricare.osd.mil/claims/default.htm.


TRICARE For Life, TRICARE and Medicare Part A and B (Part 2)
Canceling OHI

Beneficiaries must contact their OHI administrator if they wish to cancel their OHI. After canceling OHI, beneficiaries MUST mail a copy of the termination notice to Wisconsin Physician Services (WPS), the TFL contractor,



P.O. Box 7890

Madison, WI 53707-7890

TRICARE Overseas Program (TOP) TFL

Eligible beneficiaries living overseas may use TOP TFL &lt;[http://www.tricare.osd.mil/tfl/top.cfm](http://www.tricare.osd.mil/tfl/top.cfm)&gt; as long as they are entitled to Medicare Part A and Part B. TOP TFL coverage is the same as stateside TRICARE Standard. Medicare does not typically provide health care coverage overseas; therefore TOP TFL will be the primary payer and the beneficiary will be responsible for the fiscal year deductible and cost shares.

However, Medicare does pay for health care services received in U.S territories (Guam, Puerto Rico, the U.S. Virgin Islands, American Samoa, the Northern Mariana Islands and, for purposes of services rendered onboard ship, in the territorial waters adjoining the land areas of the United States). In these locations, TOP TFL acts as the second payer after Medicare, just as with the stateside TFL program.

When a beneficiary receives medical care from a provider that accepts Medicare in one of the U.S. territories, their provider may file the claim with Medicare; if so, no action is required by the beneficiary. Medicare then processes the claim and forwards the claim to TRICARE for payment of the remaining amount. TRICARE automatically sends payment to the beneficiary's provider. The beneficiary will receive a Medicare summary notice from Medicare and an EOB from the TFL contractor indicating the amounts Medicare and TRICARE paid.

When seeking reimbursement for care received in locations not covered by Medicare, beneficiaries must file their own claim(s). Paper claims are submitted to the TRICARE Overseas claims processor using a DD Form 2642 &lt;[http://www.tricare.osd.mil/claims/Dd_2642.pdf](http://www.tricare.osd.mil/claims/Dd_2642.pdf)&gt; , along with a copy of the provider's itemized bill and any EOBs from all OHIs; no Medicare summary notice is required. Beneficiaries are responsible for the TRICARE Standard deductible and cost shares. 

The TOP TFL claims filing address is:

TRICARE Overseas

P.O. Box 7985

Madison, WI 53707-7985

Beneficiaries may receive assistance with claims filing procedures from the TRICARE Overseas claims processor, a local TRICARE Service Center or Beneficiary Counseling and Assistance &lt;[http://www.tricare.osd.mil/bcac](http://www.tricare.osd.mil/bcac)&gt; Coordinator or from the TRICARE Web site at [www.tricare.osd.mil/claims/default.htm](http://www.tricare.osd.mil/claims/default.htm)

Services In Military Treatment Facilities

TFL beneficiaries may receive care in military treatment facilities on a space-available basis.  

For More Information:

For more information, beneficiaries may contact the TFL contractor, WPS/TFL, by telephone at 1-866-773-0404, or by mail at:  


P.O. Box 7890

Madison, WI 53707-7890

Beneficiaries may visit the TRICARE Web site at [www.tricare.osd.mil/tfl](http://www.tricare.osd.mil/tfl) or the TFL contractor Web site at [www.tricare4u.com](http://www.tricare4u.com/) &lt;[http://www.tricare4u.com/servlet/portal/?escmd=startup](http://www.tricare4u.com/servlet/portal/?escmd=startup)&gt; . 

See also:  &lt;[http://www.tricare.osd.mil/Factsheets/index.cfm](http://www.tricare.osd.mil/Factsheets/index.cfm)&gt; [www.tricare.osd.mil/Factsheets/index.cfm](http://www.tricare.osd.mil/Factsheets/index.cfm) Fact sheet on Eligibility and DEERS. &lt;[http://www.tricare.osd.mil/Factsheets/viewfactsheet.cfm?id=299](http://www.tricare.osd.mil/Factsheets/viewfactsheet.cfm?id=299)&gt; [http://www.tricare.osd.mil/Factsheets/viewfactsheet.cfm?id=299](http://www.tricare.osd.mil/Factsheets/viewfactsheet.cfm?id=299)


DoD Committed to Veteran Health Care****

The Defense Department will work with the Veterans Affairs Department to help cover a shortfall in VA funds due to increased dental benefits claimed by returning veterans of the global war on terror, a top DoD health official told Congress last week. “DoD attempts to demobilize our Reservists as soon as possible so that they can return to their families and civilian life after ensuring that all health issues they face have been adequately addressed.” said Dr. Stephen L. Jones said in testimony before the House Subcommittee on Military Quality of Life, Veterans Affairs and Related Agencies. Jones is principal deputy assistant secretary of defense for health affairs. However, because health care benefits entitle veterans either to space-available care in military dental treatment facilities or voluntary enrollment in the Tricare dental program, some Reservists have made increasing use of their VA benefit entitlement, Jones said. The result has been slightly increased costs to the VA for dental care. [color=black]Click here for more information.[/color]


VA Budget Shortfall, House of Representatives

July 5, 2005

The Department of Veterans Affairs (VA) recently revealed to Congress its budget shortfall having failed to account for a surge in veterans’ health care costs relating to the war. The shortfall is expected to be about $1 billion this year and could reach $2.7 billion in fiscal 2006, which begins October 1, 2005.

As a follow-up to the July 1, 2005 alert, please contact your member of Congress to urge them to ensure VA receives the additional funding needed to treat sick and disabled veterans. Moreover, we ask that you call upon them to ensure the $1.5 billion increase remains in the conference agreement and that they support increased funding to meet VA’s fiscal year 2006 budget gap. Take Action!

       [right][Take Action!](http://capwiz.com/dav/utr/1/MJHEEVRSLM/NLLJEVRSPY/)



Senate Okays $1.5 Billion for Veterans

An amendment to add $1.5 billion dollars to the 2005 budget for the U.S. Department of Veterans Affairs was adopted by the U.S. Senate on June 29. It received a unanimous vote and is now a part of the Interior Appropriations bill. “America’s 25 million veterans received a solid vote of support from the U.S. Senate today and I am pleased that we truly had a bipartisan show of support for this measure. The VA will now be able to purchase the equipment and provide the care that veterans need,” said Senator Larry Craig, Chairman of the U.S. Senate Committee on Veterans’ Affairs. At the same time that I am pleased for veterans, I am not happy to be placed in this situation of having to add $1.5 billion as an emergency measure. We need a better budget model so that we don’t have to pass emergency funding measures like the one we passed today. This cannot and should not happen again." The money the Senate approved will replace funding that the VA has taken from its capital investment fund and from funds it had anticipated to carry in to 2006. Click here for more details.


DoD Committed to Veteran Health Care

The Defense Department will work with the Veterans Affairs Department to help cover a shortfall in VA funds due to increased dental benefits claimed by returning veterans of the global war on terror, a top DoD health official told Congress last week. “DoD attempts to demobilize our Reservists as soon as possible so that they can return to their families and civilian life after ensuring that all health issues they face have been adequately addressed.” said Dr. Stephen L. Jones said in testimony before the House Subcommittee on Military Quality of Life, Veterans Affairs and Related Agencies. Jones is principal deputy assistant secretary of defense for health affairs. However, because health care benefits entitle veterans either to space-available care in military dental treatment facilities or voluntary enrollment in the Tricare dental program, some Reservists have made increasing use of their VA benefit entitlement, Jones said. The result has been slightly increased costs to the VA for dental care. Click here for more information.


Bill** Aims to Connect Vets, Benefits**

Officials in the Department of Veterans Affairs and major veterans’ advocacy groups recently threw their weight behind a bill that would boost efforts to find veterans who are not getting disability and other benefits due them. The legislation would require the VA to detail its plans to identify veterans who are not enrolled for VA benefits or services. It also would require the VA to coordinate with veterans’ groups and state officials who conduct such outreach. Click here for more information.******


Qualifying for ‘Aid and Attendance’ Funds

One VA benefit veterans and their caretakers may be unaware of is the “Aid and Attendance” benefit. For those veterans and their widows who are eligible, the benefit can be a blessing for an incapacitated individual who wants to avoid going to a nursing home. Included as a part of the veteran’s pension program as well as the compensation program, the benefit is available to a veteran who is not only disabled, but needs the aid and attendance of a caretaker. A veteran is eligible for this program if he or she has served at least one day during wartime; has at least 90 days or more of active duty; is found to be permanently or totally disabled; and makes an annual income of $10,162 or less. An unmarried widow does not have to be disabled to receive the benefit. He or she must have been married to the veteran for at least one year before the death unless they had a child, then benefits can be received regardless of length of marriage. The widow’s income cannot exceed $6,814. A person’s medical expenses can be used to offset income. To see if you or a loved one is eligible for the benefit, contact your local veterans’ office.******


This information is from Bruce Whitaker, Chair, Veteran Affairs Committee. (Part 1)

Honorable Lane Evans

Ranking Democratic Member
House Committee on Veterans Affairs
Report and Recommendations
Department of Veterans Affairs
Veterans’ Disability Benefits Commission
May 10, 2005

Thank you for the opportunity to present my views to the Commission. I hope that your efforts will improve and not diminish the benefits and services provided to those who have been disabled in service to our Nation and the survivors of those who have paid the ultimate price. 

By law, many of you have been asked to serve on this Commission by virtue of exemplary military service. As a result of that service, you may be unaware of the difficulty which confronts the average G.I. Joe or Jane who seeks compensation from the Nation for disabilities incurred or aggravated in military service. Veterans know when they are being treated unfairly by their government. The “Bonus March” of World War I veterans taught us that.

I fear that the goal of some who authorized this Commission is to diminish the responsibility of the Nation to adequately and fairly provide for our Nation’s disabled veterans, their families and survivors. I hope that your work will prove this fear to be unfounded.

**I.**The Commission Should Consider Whether the Nation Is Providing Adequately for All Those Who “Have Borne the Battle” and Their Survivors.

Veterans seeking service-connection for disabilities incurred or aggravated during military service continue to face a daunting challenge in receiving accurate and timely decisions from the Department of Veterans Affairs (VA). While attention is often focused on combat veterans, all those called to serve may suffer from disabling conditions. These include veterans who were told to “Suck it up soldier” after a training musculoskeletal injury which was not properly treated, and then develop an on-going musculoskeletal impairment.

They also include those who adapted so well in acquiring the survival skills needed for combat that their coping mechanisms got jammed in the “on position” resulting in the debilitating effects of post-traumatic stress disorder. *See, *Jonathan Shay, M.D., Ph. D., Odysseus in America: combat trauma and the trials of homecoming (Scribner, 2002).

Servicemembers released from the military after findings by a physical evaluation board often receive a rating which appears more appropriate to limiting the financial liability of the military service rather than correctly applying the criteria of the rating schedule. Veterans granted service-connection for similar disabilities may receive different ratings, depending upon the regional office in which their claim is decided and even the person making the decision in the same regional office.

The challenge of proving service-connection is particularly difficult for the following groups of veterans:

Those who file for compensation many years after military service;

Those whose claims are denied without obtaining and reviewing relevant military service and medical records;

Those who served in combat, but lack documentation of their specific combat activity;

Those who suffer from the effects of various environmental exposures associated with recent warfare; and

Those seeking compensation for mental disabilities, such as post-traumatic stress disorder or other psychiatric conditions.

For example:

Veterans who suffered musculoskeletal injuries during military service and who later develop traumatic arthritis often have difficulty establishing a connection between the military trauma and the later arthritis.

It is not uncommon to find claims for compensation, filed many years ago, denied on the grounds that there is no evidence that the disability was “incurred or aggravated” during military service without obtaining and reviewing all of the relevant records. For example, a veteran filed a claim for a service-connected back injury alleging that he was hospitalized during military service following an accident in 1953 in which he was pinned between two trucks. According to VA, the veteran’s physician had submitted a medical report stating that his “degenerative herniated lumbar disc was the result of trauma in 1953.”

The claim was denied because the physician’s opinion as to service-connection was based “solely upon the veteran’s report of the accident.” The rating decision stated, “Review of SR’s is negative for back injury.” However, the service medical records in the file clearly indicate that on March 10, 1953, he was seen as an outpatient and then admitted for hospital care after being “Trapped between two trucks. Px [Physical examination] Erythema over low abd[omen] & back. No obvious bone injury. No shock. Admit Wd. 8.” Although it is clear from the outpatient records that the veteran was admitted as an inpatient, there is no evidence that the veteran’s inpatient records were obtained by VA before rating the claim. Following hospitalization, the veteran received additional outpatient treatment with findings of tenderness over left sacroiliac joint with pain on pelvic pressure. He continued to complain of back and left leg symptoms and was treated with exercise and medication.” The claim was denied and the veteran continues to file new claims and appeals.

Combat veterans often have difficulty in establishing their specific combat activities for purposes of service-connection of post-traumatic stress disorder unless they received certain awards or decorations.

Veterans of the first Persian Gulf War are eligible for service-connection of “[a] medically unexplained chronic multisymptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs or symptoms.” 38 U.S.C. § 1117 (a)(2)(B). However, the Secretary of Veterans Affairs issued regulations which provided that only chronic fatigue syndrome, fibromyalgia and irritable bowel syndrome” and not other medically explained multi-symptom illnesses would be service-connected under the law. While this interpretation is likely to be overturned on appeal, it illustrates the difficulty veterans have in obtaining service-connection even when Congress has specifically spoken to the issue.

The rating schedule for mental disabilities is particularly problematic. For example, veterans with post-traumatic stress disorder who have reduced reliability and productivity due to symptoms associated with the disorder and who have impairment of short-term and long-term memory are rated at 50% (38 C.F.R. §4.130). Such veterans are unlikely to be able to obtain and retain gainful employment and are usually unemployed and unemployable without special assistance.

With the increased expected psychiatric disabilities associated with the current conflict in Iraq, it will be critical to provide disabled veterans with the benefits and services they need to function in civilian life.


This information is from Bruce Whitaker, Chair, Veteran Affairs Committee. (Part 2)
II. **Veterans Should Continue to Be Compensated for Disabilities Incurred or Aggravated by Military Service.

If during their military service, veterans are harmed, the Nation has an obligation to redress that harm. Because of the complexities of modern warfare and the variety of environmental exposures to which servicemembers are subjected during military service, I believe that servicemembers, who have disabilities in excess of those experienced by those who did not similarly serve, should be compensated on the basis of prevalence.

Some reports have suggested that certain disabilities, such as diabetes mellitus and osteoarthritis are unrelated to military service. I urge the Commission to be cautious in discounting associations between military service and disabilities which may occur in the general population.

For example, because of the association between exposure to certain herbicides and diabetes mellitus, a Vietnam veteran who might have developed diabetes at age 60 may be severely disabled by the condition at age 40. Such veterans should be compensated for their diabetes. Often servicemembers are exposed to a variety of environmental toxins whose effects are not currently known and which may never be knowable.

Veterans who place excessive stress on certain joints during military activities or had musculoskeletal injuries not properly treated during military service, may develop osteoarthritis at a much earlier age than would be otherwise expected. Biomechanical stresses affecting the articular cartilage and subchondral bone are associated with osteoarthritis. See, “Recommendations for the Medical Management of Osteoarthrits of the Hip and Knee,” 43 Arthritis & Rheumatism 9 (September 2000) at 1905-1915.

In addition, servicemembers who are harmed as the result of improper medical care during military service are precluded from suing their medical providers under the *Feres *doctrine which bars suits by military personnel for injuries that “arise out of or are in the course of activity incident to service.” Feres v. United States, 340, U.S. 135, 146 (1950). As a result of the Feres doctrine, servicemembers whose medical treatment results in an on-going disability must look to the VA for any redress.

Efforts to divide and conquer veterans by treating similarly disabled veterans differently based on whether or not their disabilities were incurred or aggravated by combat, medical malpractice or other special circumstances should be avoided. All who served honorably deserve to be treated honorably.

III**.** The Commission Should Avoid Recommendations to Increase the Financial Burden on Servicemembers and Veterans.

There has been a disturbing pattern of increasing the financial liability of servicemembers and veterans for costs which should be borne by all American taxpayers. When women and men enter military service, they are serving all Americans. When servicemembers incur or aggravate disabilities in service to the Nation, the Nation should make them whole. Just as the costs of guns and bullets are borne by all taxpayers, the costs of mental health care, prosthetics and insurance for servicemembers and veterans should be borne by all taxpayers.

Examples of current efforts to shift the financial burdens of war to servicemembers and veterans include:

Requiring servicemembers who obtain Servicemembers Group Life Insurance (SGLI) to purchase mandatory traumatic injury protection insurance;

Proposals to more than double the co-payments for veterans receiving prescription medication from the Department of Veterans Affairs;

Charging service-disabled veterans three times the premium amount for comparable non-disabled persons in order to obtain Service-Disabled Veterans Insurance (S-DVI);

Congressional “pay-go” requirement that any improvements to benefits for service-disabled veterans or their survivors be paid for by charges to veterans or decreased benefits for other veterans and survivors.

IV. The Commission Should Consider Inconsistencies in Ratings Among Regional Offices and Between the Military Services and the VA.

Veterans in Ohio, Illinois and Michigan who receive service-connected compensation benefits receive approximately $4,000 - $5,000 per year less than veterans in Puerto Rico, Maine, and New Mexico for service-connected disabilities. (See, Veterans Benefits Administration Report Fiscal Year 2003 at pages 119-173.) While there will always be some variation in the judgments made concerning the degree of disability attributable to military service, such wide variations appear arbitrary and unfair. Without an analysis of the reasons for such disparities, such wide inconsistencies suggest a lack of fundamental fairness in decision-making.

Similarly, the differences in number of appeals to the Board of Veterans Appeals and the results of such appeals appear to vary significantly from regional office to regional office. Such wide variations should be further investigated and analyzed.

Recent newspaper reports have highlighted the difference between VA regional offices in rating claims. See, Chicago Sun Times articles and Knight Ridder Reports (

A study of disparities between the disability ratings by physical examination boards of the military services and the VA for similar disabilities might be instructive.

**V. **Military Retirees Who Have Earned Retirement Benefits Should Not Be Required to Pay for Disabilities Incurred or Aggravated by Military Service.

Recently, the Congress has made some efforts to recognize that servicemembers who have earned a military retirement benefit by reason of years of service should not be have their military retirements reduced because of VA benefits paid on the basis of service-connected disabilities. No such reduction occurs for those who after a brief period of military service earned federal retirement benefits in another governmental occupation. None should occur for military retirees whose retirement benefits are based upon years of service

VI. The Commission Should Recognize That the Failure to Care for Today’s Veterans Will Discourage Men and Women From Putting Their Lives on the Line in Tomorrow’s Military Service.

I strongly believe that if we are to put the men and women of this Nation at risk of harm in the service of the Nation, then all Americans must be willing to make veterans and their survivors’ whole when harm ensues. Failure to do so will discourage men and women from entering military service. At a time when our country is at war, when men and women are giving life and limb around the world, we must remember that war has costs, not only in dollars, but in the impact military deaths and disabilities have on the lives of those who suffer them. Those costs are a debt of the American people. They must be paid.

Thank you for the opportunity to consider these remarks. I hope that your work will be marked by sound judgment and compassion.


Subject: Administration to increase VA healthcare funding
From: “VVA Government Relations Department” <govtrelations@vva.org>
Date: Tue, 12 Jul 2005 19:02:08 -0400 (EDT)

Administration to increase VA healthcare funding

Congress Daily PM, Tuesday, July 12, 2005**


White House To Ask $2 Billion More For Vets’ Health Care**

The White House is preparing as early as Wednesday to formally ask Congress for nearly $2 billion more to cover unanticipated veterans’ healthcare costs, which is higher than earlier estimates yet still not enough to meet increased demands, according to critics. Part of the amended FY06 budget submission would provide an additional $300 million to offset increased utilization of healthcare services for this fiscal year, while the rest would go toward filling gaps in coverage anticipated for next year. The new aid request comes on top of a $975 million FY05 supplemental currently pending in the Senate. The House quickly approved the funds before adjourning for the July Fourth recess. At that time, House Democrats wrote to President Bush calling for a supplemental request of $1.3 billion, which they argued was necessary to cover the current year funding gap – and which the White House now acknowledges is the correct target.

Nonetheless, the aid request for FY06, which comes to nearly $1.7 billion, does not factor in an estimated $600 million in costs VA officials have told congressional staff would be incurred if lawmakers do not accept White House proposals for new user fees to pay for healthcare services. Since the White House proposals – unpopular with lawmakers because veterans would be paying more out of pocket – would essentially lower demand and thus long-term care and utilization costs, sources familiar with the discussions said the real FY06 funding gap is closer to $2.3 billion, since Congress will not go along with the increased user fees.

Senate Military Construction and Veterans Affairs Appropriations Subcommittee Chairwoman Kay Bailey Hutchison, R-Texas, said today the Senate should call up the House-passed bill and increase the amount to the $1.27 billion necessary for the FY05 shortfall while including the additional $1.7 billion or so for next year in the FY06 Military Construction measure her subcommittee will take up July 19. Senate Majority Leader Frist said the Senate would act on the matter this week, but he did not elaborate. On the floor, Democrats led by Sen. Patty Murray of Washington successfully added $1.5 billion to an unrelated Homeland Security spending measure on a 95-0 vote, as they did before the recess on the Interior spending bill. That money is intended to cover the FY05 shortfall and provide a cushion going into FY06. “Now the Senate has an opportunity before us to tell our veterans we will do all we can and all we’ve promised and we should not be nickel and diming them,” Murray said.

Meanwhile, Democrats are already sharpening their knives for Wednesday’s unveiling of OMB’s mid-session review of the FY05 deficit, holding press briefings today to show that even if OMB’s estimates are anything like CBO’s most recent estimate of a $325 billion or so deficit, it would still be the third worst in history in dollar terms. “That’s good news, no question about it, there is a question though as to how long that good news will continue,” said House Budget ranking member John Spratt, D-S.C. Reuters reported today that Ben Bernanke, chairman of the White House Council of Economic Advisers, told the American Enterprise Institute that the deficit estimate would come in “well below” previous projections because of higher-than-expected tax revenues.
– by Peter Cohn*


Subject: Veterans Health Care Funding
From: “VVA Government Relations Department” <govtrelations@vva.org>
Date: Tue, 12 Jul 2005 17:05:10 -0400 (EDT)

Veterans Health Care Funding

July 12, 2005

Administration Again Forced to Boost Request for Veterans’ Health Care

By Tim Starks, CQ Staff

Less than two weeks after seeking $975 million in supplemental funds for veterans’ health care in the current fiscal year, the administration is conceding substantially more money will be needed.

On June 29, the Senate unanimously voted to add $1.5 billion for veterans’ health care to the fiscal 2006 Interior spending measure (HR 2361).

One day later, the administration requested and the House passed a supplemental bill (HR 3130) totaling $975 million for fiscal 2005.

Tuesday, the Senate again unanimously adopted the $1.5 billion amendment * this time as part of the fiscal 2006 Homeland Security appropriations bill (HR 2360).

Sen. Kay Bailey Hutchison, R-Texas, who chairs the Appropriations Subcommittee on Military Construction and Veterans Affairs, said she now expects the Senate to call up the House-passed bill as soon as this week and amend it to provide about $1.27 billion in extra health care funds in fiscal 2005. She said appropriators are only waiting for the details of the latest VA request.

She said shealso expects the administration to ask for an extra $1.6 billion in fiscal 2006.

In the meantime, she said, she and other Senate Republicans will support continuing Democratic efforts to pressure the House into accepting the higher Senate spending figures.

“If we backtrack, if we walk away from $1.5 billion, our vets will be hurt,” said Sen. Patty Murray, D-Wash., lead sponsor of the amendment.

Growing Need

Congress last year appropriated $28.2 billion for the Veterans Health Administration. President Bush requested only a shade more for fiscal 2006.

Democrats in both the House and the Senate have been calling for higher VA health care spending all year. In the Senate, they have been joined by their Republican counterparts on both the Appropriations and Veterans Affairs committees.

VA officials did not reveal their funding shortfall to Congress until June 23, even though they discovered it in April, prior to the time House appropriators drafted their fiscal 2006 funding bill (HR 2528) for veterans affairs. The House passed that measure on May 26.

VA officials blamed rising health care costs in part on a surge in enrollment by returning veterans of the war in Iraq and Afghanistan, many of whom have suffered severe injuries that will require continuing medical care.

Hutchison said the Senate had already planned to add $1.3 billion for veterans’ health care to the administration’s original fiscal 2006 request. She said she expects the administration’s new request for fiscal 2006 to be another “$1.6 billion or so.”

Senate Veterans Affairs Chairman Larry E. Craig, R-Idaho, who said he spoke with VA Secretary Jim Nicholson on Monday, said that supplemental request could arrive later Tuesday.

Hutchison’s subcommittee is scheduled to consider the fiscal 2006 funding bill July 19, followed by full committee consideration July 21.

Source: CQ Today
Round-the-clock coverage of news from Capitol Hill.
© 2005 Congressional Quarterly Inc. All Rights Reserved.


New Worries About VA Budget Shortfall

Associated Press | July 15, 2005
WASHINGTON - A budget proposal that could push thousands of military veterans out of state nursing homes is causing new worries in light of recently disclosed shortfalls in the Veterans Affairs budget…


Possible Link: Agent Orange and Diabetes

The Department of Defense released recently the latest report of the Air Force Health Study on the health effects of exposure to herbicides in Vietnam, which includes the strongest evidence to date that Agent Orange is associated with adult-onset diabetes. This supports the findings from earlier reports in 1992 and 1997. The Air Force Health Study summarizes the results of the 2002 physical examination of 1,951 veterans, which is the final examination of the 20-year epidemiological study. Since the first examination in 1982, the Air Force has tried to determine whether long-term health effects exist in the Ranch Hand pilots and ground crews, and if these effects can be attributed to the herbicides used in Vietnam, mainly Agent Orange and its contaminant, dioxin. Results from the 2002 physical examination support adult-onset diabetes as the most important health problem seen in the Air Force Health Study. They suggest that as dioxin levels increase, not only are the presence and severity of adult-onset diabetes increased, but the time until the onset of the disease is decreased. The report, along with many other studies on herbicide and dioxin exposure, will be reviewed by the National Academy of Sciences. Based upon this review, the Secretary of Veterans Affairs can ask Congress for legislation on disability compensation and health care. The report is available on the Air Force Health Study website.


Various links of Interest:
DoD Contracts for Service-Disabled Vets **
Hospice Access for Nursing Home Residents**
Possible Nursing Home Budget Cuts
Featured Job: Homeland Security/Marketing
Vet Lifestyles Can Lead to Diabetes
Theater Workshop for Disabled Veterans
VA Hospital to Get $20 Million **
The Vietnam Wall Experience**


Veterans Report for July 25, 2005

Record Funding Approved for Veterans
U.S. Sen. Larry Craig, Chairman of the Committee on Veterans’ Affairs, said veterans should be pleased with a $2 billion emergency supplemental approved last week. More

Deal of the Week: Special Pricing on Steiner Binoculars
Binocular Source will gladly quote volume pricing on any Steiner Binoculars, ship free to APO, FPO and AE addresses and accept government credit cards. More

Veteran Groups: VA Funding Formula Change
Recent announcements that the Department of Veterans Affairs had underestimated its fiscal 2005 and 2006 health care budgets by billions came as no surprise to four veterans’ service organizations. More

Casting Call for Cable Channel Show
A call has been put out for former servicemembers with experience or knowledge of high-tech weapons to audition for the host position for a major cable channel show on weapons. More

Scholarship Spotlight: Horatio Alger Military Veterans Scholarship
The Horatio Alger Association is accepting applications from June 1, 2005 through September 1, 2005 for its Horatio Alger Military Veterans Scholarship. More

Featured Job: Regional Security Agent
Southern California Edison has open position for Regional Security Agent. The position requires a minimum of five years experience. More

Subcommittee Proposes $1.98B for VA
A Senate subcommittee injected $1.98 billion last week into a spending bill to cover a Veterans Affairs shortfall projected in next year’s budget. More

VA’s 75th Anniversary Celebrated
Vice President Richard B. Cheney joined Secretary of Veterans Affairs R. James Nicholson in Washington, D.C. to kick off a yearlong celebration of the VA Department’ 75th anniversary. More

VA Improves ‘My HealtheVet’ Website
The Department of Veterans Affairs (VA) recently improved its Web-based system for providing health care information to its patients. Veterans will be able to update personal information and record medical data such as prescriptions. More


Subject: House Veterans Affairs Committee
From: “VVA Government Relations Department” <govtrelations@vva.org>
Date: Tue, 26 Jul 2005 13:18:55 -0400 (EDT)

** House Veterans Affairs Committee**

Press Advisory
Committee on Veterans’ Affairs
Steve Buyer, Chairman, 335 Cannon House Office Building, Washington, DC 20515
Immediate Release: July 26,2005 Contact: Brook Adams (202) 225-3664


Washington, D.C.- Chairman of the House Committee on Veterans Affairs Steve Buyer today expressed concern over findings in a recent report on outpatient scheduling procedures, issued by the Department of Veterans Affairs inspector general. The findings reinforced evidence of rising waiting times for health care appointments that was discussed at a Committee hearing on VA health care funding shortfalls Thursday.

The July 8 report, “Audit of the Veterans Health Administration’s Outpatient Scheduling Procedures,” used survey data gathered by VA’s IG in eight VA medical facilities for the week of June 21-27, 2004. Initiated by Secretary of Veterans Affairs Jim Nicholson, it found that VA health care schedulers often failed to correctly schedule appointments. It also found that facility directors did not have accurate data on patient waiting lists.

“To provide the best care possible to veterans, VA must more efficiently handle the basics,” Buyer said. “I want VA to resolve these problems with appointment scheduling, eliminate these waiting lists, and improve access.”

Chairman Buyer, responding to evidence of growing waiting lists at many VA facilities, last week directed VA to fully report its patient waiting times to Congress. As of July 15, the number of new enrollees and established patients waiting more than 30 days for appointments in Cleveland was 1,638; in San Diego, 621; in Indianapolis, 287; and in Tampa, 2,650. Buyer informed the VA of these numbers at the hearing, and intends to return to the matter.

VA policy requires that any veteran with a service-connected disability rating of 50 percent or more and veterans who need care for any service-connected disability will be scheduled for care within 30 days of the desired appointment time. If they cannot be, VA must provide for their care at another VA facility or through a non-VA provider at VA expense.

However, misreporting has caused VA medical facilities to understate waiting times. Veterans were consequently kept on waiting lists past 30 days without referral for treatment at another VA facility or at a non-VA facility. VA health care facility directors were unaware of thousands of such cases and thus could not ensure correct procedure.

Seven percent of survey respondents said “managers or supervisors directed or encouraged them to schedule appointments contrary to established procedures,” raising concerns about the system’s accountability and reliability.

VA Under Secretary for Health Dr. Jonathan Perlin agreed to enact IG recommendations, including increased emphasis on following procedure, better training, and better oversight of scheduling staffs.

Perlin noted in his reply that VA has already launched a program called Advanced Clinic Access, designed to more efficiently schedule and manage appointments system-wide.

Read the VA IG report at: http://www.va.gov/oig/52/reports/2005/VAOIG-04-02887-169.pdf