BACK

RAO Bulletin Update
15 July 2005
Lt. James "EMO" Tichacek, USN (Ret)
 

RAO Bulletin Update
15 July 2005

THIS BULLETIN UPDATE CONTAINS THE FOLLOWING ARTICLES:

== BRAC [11] ............................................ (Cost savings estimate questioned)
== VA Comp Payment Disparity [04] …… (PTSD 2nd review cancelled)
== Agent Orange & Diabetes ……………. (Relationship reinforced)
== Afghanistan, Iraqi Campaign Medals ... (AF approves wearing)
== TRICARE Third Tier Rx …………….. (Standby for some higher copays)
== Tricare Pharmacy Rates [03] ………… (Impotency drugs included in 3Rx)
== CRSC [30] …………………………… (Electronic statement delivery initiated)
== Pseudoephedrine Products …………… (AF removal from exchange shelves))
== Death Gratuity [01] …………………... (Increases effective 1 SEP 05)
== Atomic Veterans Relief Act ………….. (Bill proposes VA eligibility change)
== VA Budget 2006 [08] ……………….... (Shortfall impact on vets)
== VA Budget 2006 [09] ………………… (Bush stops opposing increase)
== Florida Veterans Homes ……………… (Lake City home renovation ++)
== Senior’s Discounts Website ………….. (Could save you some money)
== Colon Cancer Detection ……………… (2nd highest U.S. cancer killer)
== Mouse for Shaky Hands ……………… (Filter out shaky hand movement)
== VA Claim Filing Sources …………….. (You may be eligible)


NOTE: I have relocated to the Philippines. Although my email addee raoemo@sbcglobal.net is still good and you will see the Bulletin being sent from that addee via my Mailing List Provider in Europe, I must go on the web to access email sent to me at this addee. With no DSL available to me at this location it is a lengthy and time consuming process to open email sent to this addee. Until further notice request all email be sent to me be via raoemo@mozcom.com.


BRAC UPDATE 11: Military health officials concede that some retirees will see higher costs if the Base Realignment and Closure Commission accepts a plan to downsize nine stateside hospitals to outpatient clinics and to refer patients needing hospitalization to civilian facilities. However, according to the Air Force surgeon general. most of these patients will still be treated by military physicians under facility-sharing arrangements with local communities. The hospital downsizing plan, if accepted by the commission, will impact 148 inpatients a day, 6% of all inpatients treated in military stateside hospitals. Even if patients are treated off base by military physicians, their out-of-pockets costs will rise because TRICARE fees and co-payments for off-base care will apply. Some lawmakers and military associations have criticized the move as an attempt by the Bush administration to deny on-base medical care to more service beneficiaries, particularly retirees and their families. However, the military contends the actual goals are to create a more cost-efficient medical system, improve patient care and enhance medical staff skills and combat readiness.

Hospitals slated to downsized to clinics or outpatient surgery centers are at the: Air Force Academy, Colo.; MacDill AFB, Fla.; Great Lakes Naval Training Center, Ill.; Scott Air Force Base, Ill., Andrews Air Force Base, Md.; Keesler AFB, Miss.; Marine Corps Air Station Cherry Point, N.C., Fort Knox, Ky., and Fort Eustis, Va. The estimated cost-savings is $62 million a year. Two medical centers also will lose their inpatient mission but to nearby military facilities. Wilford Hall Medical Center at Lackland AFB, Texas, will send inpatients to Brooke Army Medical Center, 16 miles away. Brooke will be renamed the San Antonio Regional Medical Center. Walter Reed Army Medical Center in Washington D.C. will close. Its patients will be treated at Bethesda Naval Medical Center, six miles away, which will be renamed the Walter Reed National Military Medical Center at Bethesda. Whether treated in military or civilian hospitals, active duty family members enrolled in Tricare Prime, the managed care network, pay no hospital charges. If not enrolled, they pay $13.90 a day at a civilian hospital. Enrolled retirees and their dependents under age 65 pay $11 day. But under-65 retirees who rely on Tricare Standard, the military’s fee-for-service plan, pay $250 a day in civilian hospitals, or 25% of negotiated charges plus 20% of negotiated professional fees, whichever is less. Older retirees sent to civilian hospitals typically have Medicare and Tricare for Life coverage which covers almost all their costs.

Congressional auditors found in a report released on 2 JUL the Defense Department’s process for deciding which military bases to shutter was “logical, reasoned and well-documented,” but questioned some of the Pentagon’s cost savings estimates. The Government Accountability Office (GAO) review of the Pentagon’s base realignment and closure process, mandated by law, concluded that Defense officials had varying success in achieving their 2005 BRAC goals of reducing surplus infrastructure to create savings, furthering the department’s transformation and encouraging greater cooperation among the military services. The 273-page report O-05-785 raised some questions about Defense’s projection of $50 billion in savings from this BRAC round, noting that the closure and realignment process requires an upfront investment of an estimated $24 billion. Much of the savings would result from the elimination of jobs held by military service personnel. But Defense officials have said people in these positions will be reassigned to other positions without recognition that these are not dollar savings that can be readily applied elsewhere. The GAO noted that this could create a false sense of savings available for other purposes. GAO auditors also expressed heightened concern about savings projections resulting from the transformation of business processes at Defense were not well-defined. GAO recommended, and the Pentagon agreed, that Defense Secretary Donald Rumsfeld develop a method for tracking and updating savings estimates as the BRAC recommendations are implemented. In May, Rumsfeld unveiled a list of 222 BRAC recommendations, including 837 closures and realignments. The GAO report will be used by the independent Defense Base Closure and Realignment Commission in completing its review of Rumsfeld’s recommendations and putting together the final BRAC list. Those recommendations will be submitted to President Bush Sept. 8 and he must approve or disapprove them by Sept. 23. Congress then must either reject the list or allow it to become official within 45 days of presidential endorsement. [Source: Military.com Tom Philpott article 29 JUN 05, GOVEXEC.com Daily Briefing 1 JUL 05 ++]


VA COMP PAYMENT DISPARITY UPDATE 04: The VA pulled back a week-old policy that required the most seriously disabled veterans to wait for a second review on their cases before the agency would pay any money. The VA decided it needed to revise their JUN 05 directive that was issued to all 57 regional VA offices through a memo (a copy of which was obtained by the Chicago Sun-Times) that required two approving reviews for veterans to be granted disability for post-traumatic stress disorder or to be deemed 100% disabled or unemployable. A point of contention among many veterans was that the directive had not required a second review to deny such cases. Senators Dick Durbin and Barack Obama also thought the policy "ignored" the possibility that denials could be wrong. The two Illinois senators sent VA Secretary Jim Nicholson a letter calling the policy "disturbing" and demanding that denials for PTSD claims receive extra scrutiny. The VA inspector general's investigation last month showed that PTSD and mental disabilities were among the most highly subjective cases in the nation. That report also showed that states where VA offices pay the most disability also have the largest percentage of veterans who are 100% disabled for PTSD. Only 2.8% of Illinois' veterans are rated 100% disabled for PTSD and Illinois is last in the nation for disability pay. Durbin and Obama cited the inspector general's report as one more reason denials should be included in the extra reviews. In their letter, the senators also asked that the VA send notices to all Illinois veterans who have filed claims over the last several decades. Nicholson sent a special squad to the Chicago VA in June to re-evaluate denied claims of Illinois veterans but no formal procedure has been set up to review those claims and veterans have not been informed that they can ask that their claims to be re-evaluated. [Source: Chicago Sun-Times 22 JUN 05]


AGENT ORANGE AND DIABETES: The DoD released 8 JUL 08 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. The Ranch Hand Study was named after the operation responsible for spraying herbicides in Vietnam between 1962 and 1971 to deny cover and destroy crops of the North Vietnamese Army. 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. 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.

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 to onset of the disease is decreased. A 166% increase in diabetes requiring insulin control was seen in those with the highest levels of dioxin. This is consistent with the strong evidence found in animal studies. Cardiovascular disease findings were not consistent, but separate studies have found an increased risk of cardiovascular death in Ranch Hand enlisted ground crews, the subgroup with the highest average serum dioxin. Overall, Ranch Hand pilots and ground crews examined in 2002 had not experienced a statistically significant increase in heart disease relative to the comparison group. Associations between measures of cardiac function and history of heart diseases and herbicide or dioxin exposure were not consistent or clinically interpretable as adverse. Other findings included an increase in the frequency of reported acne after service in Southeast Asia in Ranch Hand enlisted ground crew members, but the lack of corresponding patterns of skin lesions observed at the physical examination rendered this finding difficult to interpret. Finally, several blood tests regarding liver function and blood lipids were elevated and did tend to increase with dioxin level. However, these tests which may be elevated for many reasons, do not constitute a disease by themselves and cannot be explained by other findings in the study. At the end of the 20 years of follow-up, Ranch Hand pilots and ground crews as a group exhibited no statistically significant increase in the risk of cancer relative to comparisons. Differences by military occupation were inconsistent. Most importantly, the Ranch Hand enlisted ground crews, the subgroup with the highest dioxin levels and presumably the greatest herbicide exposure, exhibited a 14% decreased risk of cancer. These results do not suggest that herbicides or dioxin exposure are related to cancer in these veterans.

The report emphasizes three major limitations to the study. First, the results cannot be generalized to other groups, such as all Vietnam veterans or Vietnamese civilians, which have been exposed in different ways and to different levels of herbicide. Second, the size of the study makes it difficult to detect increases in rare diseases, thus small increases in rare diseases may be missed by the study. Third, other variables that were not considered in this report could be confounding factors influencing the results. The report is available on the Air Force Health Study Web site at: www.brooks.af.mil/AFRL/HED/hedb/default.html [Source: DoD News Release No. 682-05 dtd 8 JUL 05]


AFGHANISTAN, IRAQI CAMPAIGN MEDALS: The Air Force has approved the wearing of the Afghanistan, Iraqi campaign medals. These DoD campaign medals apply to active duty, Reserve and Guard personnel deployed on or after 24 OCT 04 for Operation Enduring Freedom and 19 MAR 03 for Operation Iraqi Freedom. Airmen must have been assigned, attached or mobilized to units operating in Afghanistan or Iraq for 30 consecutive days or 60 nonconsecutive days to be eligible. The ACM is awarded for service for all land areas and all airspaces above Afghanistan. The ICM is for service covering all land areas of Iraq, all adjoining water areas out to 12 nautical miles and all airspaces above those areas.
Service members are not entitled to more than one campaign and/or expeditionary medal for the same action, achievement, or period of service. In addition, there are no devices for the ACM, ICM, and Global War on Terrorism Medal. A period of service is defined as an area of deployment, and includes the number of days criteria outlined above. Members begin a second period of service when they forward deploy or return to home station and then redeploy later. Airmen deployed to Afghanistan or Iraq, who have 30 consecutive or 60 nonconsecutive days, between the eligibility period and 30 APR 05 may elect to wear either the appropriate campaign medal or the GWOT-E medal, but not both. Those who deployed to Afghanistan or Iraq, who have 30 consecutive or 60 nonconsecutive days, after 30 APR can only earn the respective campaign medal for the area they served in. The Air Force Personnel Center will do a mass system update in August to convert GWOT-E medals to ACMs or ICMs, for Airmen now eligible for one of the campaign medals. Airmen who do not want the GWOT-E medal converted should notify their commander's support staff or military personnel flight. The ACM shall be positioned below the Kosovo Campaign Medal above the ICM, and the ICM shall be positioned below the ACM and above the GWOT medal. For more information, contact the local CSS or MPF. [Source: AFPC Release No. 056 dtd 27 JUN 05]


TRICARE THIRD TIER Rx: DoD has announced the start of the uniform formulary program, placing three medications on the third tier (more expensive) “non-formulary” category. Starting 17 July, the following medications will require a $22 copayment:
- Nexium for stomach problems and ulcers,
- Teveten and Teveten HCT for high blood pressure.
Depending on where the prescription is filled, beneficiaries will pay $22 for a 30-day supply of these medications from a TRICARE Retail Pharmacy (TRRx) or a 90-day supply from the TRICARE Mail-Order Pharmacy (TMOP). In non-network retail pharmacies, the copayment will be $22 or 20% of the cost, whichever is higher. Third-tier drugs will not be stocked in military treatment facility (MTF) pharmacies, but can be special-ordered if an MTF physician (or a non-MTF physician to whom the patient was referred) determines they are medically necessary for a particular patient. Beneficiaries who are taking Nexium, Teveten, or Teveten HCT should check with their doctors to see if a less-costly medication would be equally effective. Providers who believe there is a valid medical reason why a patient must take the non-formulary third tier medication can request a medical-necessity determination. Beneficiaries who already have established medical necessity for Nexium with the TMOP system must get another medical-necessity determination by July 17 to continue receiving the medication at the $9 copayment. Beneficiaries without an updated medical-necessity determination will have to pay the $22 cost share. Beneficiaries can expect more drugs to be added to the third tier category in DoD’s attempt to cut overall medical cost. [Source: MOAA JUN 05]


TRICARE PHARMACY RATES UPDATE 03: The DoD Beneficiary Advisory Panel (BAP) met in June to review the recent recommendation of the DoD Pharmacy and Therapeutics Committee (P&T) to move Viagra and Cialis used by more than 128,000 military beneficiaries, to third tier non-formulary status. The P&T committee concluded that none of popular impotency drugs is more clinically effective but Levitra is cheaper to stock. Only 10% of military patients with erectile dysfunction use Levitra whreas 77% use Viagra and 13% use Cialis. This status would raise the co-pay for these drugs to $22, vs. the normal $9 charged for brand-name drugs in the DoD formulary. If the change is approved, members currently taking those drugs would need to switch to the one remaining ED drug in the formulary (Levitra) if they want to keep the $9 co-pay. Also, this would effectively put two-thirds of the drugs in this class (representing 96% of ED prescriptions) in non-formulary status. The BAP panel composed of representatives from the DoD contractors, the US Family Health Plan, and an independent physician was split four and four in their votes for and against supporting the P&T committee's recommended plan. The tie vote on the main issue means that Levitra probably will end up being the only ED drug available through TRICARE at the $9 copay. The BAP did recommend delaying implementation until 120 days after final approval, to give more time to notify members currently taking those medications.

The BAP concurred with P&T's recommendations to move several less-frequently prescribed antifungal drugs to the third tier: Spectazole, Oxistat, Ertaczo, Exelderm, and Loprox. Seven other drugs in this class will remain on the formulary, giving patients and providers multiple prescription choices. The BAP also concurred with the P&T recommendation to retain all Multiple Sclerosis drugs (Avonex, Rebif, Betaseron, Copaxone) on the DoD formulary. Since individuals can vary widely in their reactions to the drugs, both panels felt it was essential to preserve the full range of drug options for beneficiaries afflicted by this serious disease. Dr. William Winkenwerder, Assistant Secretary of Defense (Health Affairs), will now review the two panels' recommendations before issuing a final decision regarding the drugs and implementation periods. For more details on the Uniform Formulary, visit TRICARE's website at www.tricare.osd.mil/pharmacy/unif_form.cfm. [Source: Military.com Tom Philpott article 29 JUN 05 ++]


CRSC UPDATE 30: The Defense and Finance and Accounting Service (DFAS) has begun electronic delivery of Combat Related Special Compensation (CRSC) account statements for military retirees. For those retirees who qualify to receive CRSC, the statements will be available on a monthly basis starting 1 JUL on the DFAS online pay account site at https://myPay.dfas.mil. The account statements provide detailed information regarding continuing monthly CRSC payments, including disability ratings, unemployability, Purple Heart indicators, as well as other entitlement data. Retirees may continue to contact the Retired and Annuitant Contact Center by phone at 1(800) 321-1080, but DFAS officials say the statement should answer most, if not all, questions regarding computation of CRSC payments. Officials note that the current monthly statements will only contain data concerning a retiree’s continuing monthly payment. Details about retroactive payments will be available through myPay by the end of the year. The myPay Web site is the only means of retirees receiving a CRSC monthly statement. The Web-based myPay system delivers personal pay information and provides the ability to process pay-related transactions timely, safely and securely for all its members. The online system eliminates the risks associated with hard-copy documents by allowing members to access their electronic1099R, Retiree Account Statement (RAS) and other financial information. Individuals who do not yet have a myPay account or who already have a myPay PIN, but have forgotten their number can call DFAS at 1(800) 390-2348 to get a Personal Identification Number (PIN) for an account or request one online at the myPay site. [Source: NavyTimes staff 1 JUL 05]


PSEUDOEPHEDRINE PRODUCTS: The Army & Air Force Exchange Service (AAFES) will remove products containing the solid form of pseudoephedrine from all store shelves effective 31 JUL 05. These items include Advil Flu & Sinus, Aleve Cold & Sinus, Claritin D and Tylenol Allergy Sinus. The affected items will be replaced with products containing phenylephrine, an acceptable substitute for pseudoephedrine, as a relief for sinus congestion. To date, 16 states have passed legislation restricting the availability of cough and cold medicines containing the drug pseudoephedrine in solid form. AAFES has decided that removal of these products from all of its stores is in the best interest of all military communities. Pseudoephedrine and ephedrine, are highly coveted by drug traffickers who use them to manufacture methamphetamine, a controlled substance, for the illicit market. The diversion of over-the-counter pseudoephedrine containing products is one of the major contributing factors to the methamphetamine situation in the U.S. Inappropriate retail level purchases by individuals attempting to procure pseudoephedrine for the illicit manufacture of methamphetamine have been documented as a source of much of the pseudoephedrine found in clandestine methamphetamine laboratories. [Source: Air Force Retiree News 1 JUL 05 & www.deadiversion.usdoj.gov Notice]


DEATH GRATUITY UPDATE 01: The Department of Defense announced 1 JUL 05 a significant increase in the death gratuity for the survivors of service members killed in action and the Servicemembers’ Group Life Insurance (SGLI) coverage for service members deployed to designated combat zones. The Emergency Supplemental Appropriations Act for Defense, the Global War on Terror and Tsunami Relief Act 2005 (Public Law 109-13) increases this immediate cash payment from $12,420 to $100,000 for survivors of those whose death is as a result of hostile actions and occurred in a designated combat operation or combat zone or while training for combat or performing hazardous duty. The supplemental also increases the maximum amount of SGLI coverage from $250,000 to $400,000 for all service members effective 1 SEP 05 and provides that the department will pay or reimburse the premiums to service members, who are deployed in a designated combat zone for $150,000 of SGLI coverage. Until the effective date for the SGLI increase, the supplemental provides for a special death gratuity of $150,000, retroactive to 7 OCT 01, for survivors of those whose death is in a designated combat operation or combat zone or occurred while training for combat or performing hazardous duty. The Secretary of Defense has designated all areas where service members are in receipt of the combat zone tax exclusion as qualifying combat zones and all members deployed outside the United States on orders in support of Operation Enduring Freedom or Operation Iraqi Freedom as participating in qualifying combat operations.

Effective immediately, survivors of service members, who die in these qualifying zones or operations, will receive the increased benefits. The services will also identify eligible survivors of service members who died in these designated zones and operations since 7 OCT 01 and begin making the retroactive payments within a few days. The process of identifying all eligible beneficiaries and completing these retroactive payments will take several months. Survivors of members who did not die in a designated combat operation or combat zone, but were training for combat or performing hazardous duty, will also qualify for the increased benefits. Circumstances that qualify include: aerial flight, parachute duty, demolition duty, diving duty, war games, practice alerts, tactical exercises, leadership reaction courses, grenade and live fire exercises, hand-to-hand combat training, confidence and obstacle courses, accident involving a military vehicle or military weapon, exposure!
to toxic fumes or gas and explosion of military ordnance. No amount of monetary compensation or level of assistance can replace a human life. However, it is our country’s duty to recognize the loss of a service member with dignified and appropriate support for the family members left behind. These death benefit enhancements recognize the direct sacrifice of life of those service members placed in harm’s way and in service to the nation. All beneficiaries for retroactive payments will be contacted by mail or telephone. If someone is not contacted, but thinks he may be entitled to added benefits, he may inquire at the following addresses or telephone numbers:

--- Army: Department of the Army Casualty Operations at 1(800)626-3317.
--- Navy: Navy Personnel Command (PERS-62), 5720 Integrity Drive, Millington, TN 38055-6200 or call 1(800) 368-3202.
--- Air Force: Air Force Personnel Center Casualty Services Branch at AFPC/DPFCS, 550 C Street West, Suite 14, Randolph AFB TX 78150-4216 or call 1(800) 433-0048.
--- USMC: HQMC Casualty Office, 3280 Russell Road, Attn: MRPC, Quantico, VA
22134 or call 1(800) 847-1597.
--- USCG: _ Coast Guard Personnel Services Center, 444 SE Quincy St., Topeka KS 66683-3591; Phone 785-339-3570.
[Source: DoD News Release1 JUL 05]


ATOMIC VETERANS RELIEF ACT: H.R.2962 introduced by Representative Neil Abercrombie (D-HI) will revise the eligibility criteria for presumption of service-connection of certain diseases and disabilities for veterans exposed to ionizing radiation during military service, and for other purposes. For years atomic veterans have not received adequate consideration on their claims for exposure to ionizing radiation. Since the 1980s, claims for Department of Veterans Affairs (VA) benefits by atomic veterans for radiogenic diseases, which are not currently on the presumptive list of diseases, have required an assessment to be made by DTRA (Defense Threat Reduction Agency) as to the nature and amount of the veteran’s radiation doses. The accuracy of the Government’s radiation dose reconstruction program has been questioned and doubted for a long time. The National Research Council’s most recent review of the DTRA Dose Reconstruction Program confirmed that dose estimates have been miscalculated and often based on arbitrary assumptions resulting in grossly underestimating the actual radiation exposure. H.R. 2962 would correct injustice by revising the eligibility criteria for presumption of service connection for radiogenic diseases and remove the uncertainties related to dose quantification, often constructed years after all service records have been retired or destroyed. To ask your Congressional representatives to cosponsor and actively support this bill you can send them a preformatted message at http://capwiz.com/usdr [Source: USDR Action alert 1 JUL 05]


VA BUDGET 2006 UPDATE 08: The VA claimed that through their ongoing program of shifting funds dedicated to replace old equipment and conduct maintenance the department could address its budget shortfall and meet veterans’ demand for timely, high quality health care. In the interim the House agreed to a $3,100 pay raise for Congress next year bringing their annual salaries to $165,200. Ranking Democrat on the House Veterans Affairs Committee, Congressman Lane Evans (D-IL), and his staff conducted research to determine the impact on veterans from how VA was coping with the shortfall resulting from Congress' approval of a budget that was $1 billion less than what was needed. The following snapshots from across the nation reflect the stark reality of the budget shortfall on veterans’ access to safe, high quality care:

-- The 3 surgical operating rooms at the White River Junction VAMC in Vermont had to be closed on June 27 because the heating, ventilation, and air conditioning system was broken and had not been repaired due to the siphoning of maintenance funds to cover the budget shortfall.
-- The VAMC in San Antonio could not provide a paraplegic veteran with a special machine to help clean a chronic wound because the facility did not have the equipment dollars.
-- The VAMC in Lebanon, Pennsylvania, closed its Geriatric Evaluation and Management Unit which does extensive case management to help elderly veterans increase their functioning and remain at home.
-- The Community Based Outpatient Clinics (CBOCs) needed to meet veterans’ increased demand for care in the North Florida/South Georgia VA Healthcare System have been delayed due to fiscal constraints. The Gainesville facility has made progress in reducing its wait lists, but as of April there were nearly 700 service-connected veterans waiting for more than 30 days for an appointment.
-- VA Medical Centers in VISN 16, which includes Arkansas, Oklahoma, Mississippi and Louisiana and part of Texas, have stopped scheduling appointments for many veterans who are eligible for care, pending available resources.
-- Even though the VA Palo Alto, California, Health Care System has used $3 million in capital funds for operating needs, as of March 1 more than 1,000 new patients had to wait more than 30 days for a primary care appointment. A third of these new patients had to wait more than 3 months. More than 5,000 patients had to wait more than 30 days for a specialty care appointment. Roughly 1,400 had to wait more than 3 months.
-- The replacement of the fire alarm system at the Loma Linda VAMC in California won’t be done this year because the facility is using most of its capital funds to cover operating expenses.
-- The White River Junction VAMC in Vermont is struggling with a $525,000 shortfall in its prosthetics budget. Because the FY 2005 budget is inadequate, the facility has not been allowed to hire 3 additional mental health care staff and 3 additional Registered Nurses for the ICU. Nurses in the ICU have been forced to work double shifts, which this Committee has found to be an unsafe patient practice.
-- Even though the San Diego VAMC expects to exceed its goal in medical care cost collections, it will divert $3.5 million of non-recurring maintenance funds to partially cover operating expenses, and has delayed filling 131 vacant positions for 3 months. The facility has a waiting list for patients of 750 veterans.
-- Because the Iowa City VAMC had to shift maintenance funds and equipment funds to cover a FY 2004 million shortfall of $3.2 million in medical care expenses in FY 2004, the facility is facing severe infrastructure problems and a larger shortfall of $6.8 million in FY 2005 that puts patient care and safety at risk. The facility wanted to spend $950,000 in non-recurring maintenance funds last year to prevent a mechanical failure of the electrical switcher, which would close the facility, but was required to use those funds to cover a budget shortfall in medical care last year. As a result in FY 2005, the VA must divert $1.5 million of medical care funds to maintain the key electrical switchgear for the hospital.
-- Recently, a motor failed on a hospital bed, which the VA planned to replace but couldn’t because of the shortfall, causing a fire with the patient on the bed. Fortunately the patient was able to get out of the bed safely, but the facility was forced to expend $700,000 of medical care dollars to replace all the beds, which thanks to the diligence of VA staff lasted 7 years beyond their life expectancy. The facility could not use capital funds to replace the very old beds because the money had already been siphoned off to cover medical care. To bring the shortfall down to $6.2 million the facility has delayed hiring staff for 4 months. deliberately short staffing nurses on the psychiatric ward as a means to correct the budget shortfall. This has forced the VA to cut the beds available for treatment in half.
-- As a result of cost cutting measures to make up for the shortfall in FY 2005, the Portland, Oregon, VAMC is delaying all non-emergent surgery by at least six months. For example, veterans in need of knee replacement surgery won’t be treated because of the budget shortfall.
-- Since FY 2002, the Portland VAMC has had to use its equipment and non-recurring maintenance funds to cover medical care expenses. For FY 2005 the facility needed $13 million for medical and clinical equipment but only received $2 million. The facility is reducing staff as a cost-cutting measure and is now short at least 150 hospital staff, including nurses, physicians, and social workers. As a result of budget cuts for staffing, the VA has cut the number of medical beds available to care for veterans. Veterans in need of outpatient psychiatric treatment at the Portland facility are on a waiting list because of the budget shortfall.
-- The Biloxi, Mississippi, VAMC has diverted maintenance dollars to meet operating expenses for the past two years but the facility will not be able to balance its budget without reducing staffing levels at a time when the Gulf Coast Veterans Health Care System has approximately 100 new veterans seeking enrollment each week.
-- Fifty percent of all the veterans receiving home health care through the San Antonio VAMC will now have to fend for themselves. This cost-cutting measure means that some 250 veterans, including those with spinal cord injuries, will no longer be provided this care.
-- The VA Connecticut Healthcare System is facing a major budgetary challenge of sending veterans to non-VA facilities for hospitalizations because the VA has a shortage of beds to care for veterans and staff.
-- Due to the budget shortfall, the VA facility in Bay Pines, Florida, has been forced to put veterans who have a service-connected illness or disability rating of less than 50% on a waiting list for primary care appointments. As of late April, some 7,000 veterans will be waiting longer than 30 days for a primary care appointment.
[Source: Veteran & Retiree News report from Democratic_Leader_Pelosi@mail.house.gov dtd 30JUN 05]


VA BUDGET 2006 UPDATE 09: The Senate, after a series of angry partisan exchanges, unanimously approved 29 JUN $1.5 billion in emergency funds for the Department of Veterans Affairs' health care programs. The action is the first step in what now appears to become a total increase of at least $2.5 billion in fiscal 2005 and 2006. Hours before the Senate's 96 to 0 vote, the last opponents in the House and Bush administration to boosted VA spending told reporters that they have abandoned their resistance. House Veterans Affairs Committee Chairman Steve Buyer (R-Ind.) and Veterans Affairs Secretary Jim Nicholson, who had both argued that the department could get through this year without additional cash, held a joint news conference to announce "immediate action" to fill a fiscal 2005 shortfall of at least $1 billion, and another shortfall of at least $1.5 billion in the House-passed appropriation for VA health care in fiscal 2006. Nicholson told lawmakers that the administration had vastly underestimated the number of service personnel returning from Iraq and Afghanistan who would seek VA medical treatment. The estimates had been based on outdated assumptions from 2002. The developments marked the failure of the administration and GOP congressional leaders to force tough spending constraints on the department, which is backed by some of the most influential lobbies in the capital.

With the 2006 midterm elections approaching and President Bush's favorability ratings at low levels, Republicans in the House and the Senate clearly had no stomach for risking the wrath of former service members in the cause of deficit reduction. Virtually all veterans groups -- including the American Legion, the Disabled American Veterans and the Veterans of Foreign Wars -- have complained bitterly that the administration and the Republican leadership have abandoned a commitment to treat VA health care as an integral "cost of war." The commander in chief of the VFW, denounced Bush's spending proposals for the department as "especially shameful during a time of war." The Senate vote was on a bill sponsored by Sen. Rick Santorum (R-PA.), who had opposed a past Democratic amendment to raise VA spending. He was given the honor of becoming lead sponsor because he faces one of the toughest reelection fights next year among incumbent Republicans. The VA department had been planning to make up for the $1 billion shortfall in medical care money for 2005 by transferring just under $400 million from a special reserve fund and more than $600 million from a fund for maintenance and equipment purchases. Many lawmakers voiced concern over these planned transfers, contending that critical repairs would be postponed. [Source: Washington Post Staff Writer Thomas Edsall article 30 JUN 05]


TSP UPDATE 02: The restrictions of having only two open seasons each year for civilian and military members to sign up for, stop, resume or change their Thrift Savings Plan contributions has ended.
Public Law 108-469 goes into effect 1 JUL 05, eliminating restrictions on contribution elections that have always been tied to TSP open seasons. The elimination of open seasons affects civilian and military members who are eligible to contribute to TSP in the following ways:
-- Gives people more flexibility in managing their TSP contribution amounts depending on their personal situations.
-- Civilians can now make 26 or 27 TSP contribution elections per year (based on pay periods) and service members 24 per year.
-- Contribution elections submitted on or after 1 JUL will be effective at the beginning of the pay period following the one in which the election is submitted.

The contribution limits set for 2005 have not changed. Employees may continue to contribute to TSP based on the system they are currently under for 2005 -- Civil Service Retirement System, 10%; Federal Employees' Retirement System, 15%; or the military pay system, 10%. The law eliminating open seasons does not eliminate the waiting period that newly hired or rehired FERS employees not previously eligible must serve before they can begin to receive agency contributions. Participants who make an in-service financial hardship withdrawal may not make TSP contribution elections for a six-month period following the withdrawal. Information on the overall TSP is also available at www.tsp.gov. [Source: Air Force Retiree News 29 JUN 05]


FLORIDA VETERANS HOMES: The Department of Veterans Affairs (VA) announced a grant of more than $713,000 to renovate the Robert H. Jenkins Veteran's Domiciliary. The grant will pay up to 65% of the cost for renovations at the State Veteran's Domiciliary in Lake City. The overall cost of the project is over $1 million. Florida provides the following assisted living and/or skilled nursing facilities to veterans:
• Robert H. Jenkins Jr. Veterans' Domiciliary Home of Florida, 751 SE Sycamore Terrace, Lake City, Florida 32025 Tel: (386)758-0600
• Douglas T. Jacobson State Veterans' Nursing Home, 21281 Grayton Terrace, Port Charlotte, FL 33954 Tel: (941) 613-0919 or FAX: (941) 613-0935
• Clifford Chester Sims State Veterans' Nursing Home, 4419 Tram Rd, Springfield, FL 32404 Tel: (850) 785-1678 or Fax: (850) 785-2237
• Emory L. Bennett Memorial State Veterans' Nursing Home, 1920 Mason Avenue, Daytona Beach, FL 32117 Tel: (386)274-3460/61 or FAX: (386) 274-3487
• Baldomero Lopez State Veterans' Nursing Home, 6919 Parkway Blvd, Land-o-Lakes, FL 34639 Tel: (813) 558-5000 or FAX (813) 558-5021
• Alexander “Sandy” Nininger State Veterans’ Nursing Home, 8401 West Cypress Drive, Pembroke Pines, FL 33025 Tel: (954) 985-4824 or FAX (954) 985-4866

Any person interested in residency can be referred through a VA Medical Center. Candidates must be veterans with qualifying war or peacetime service, be a resident of Florida for one year immediately prior to applying for admission and must require long-term care in a skilled nursing facility. For admission information contact the nearest Florida County Veterans Service Office which can be located at www.floridavets.org/organization/cvso.asp or Florida Department of Veterans Affairs Office www.floridavets.org/organization/where.asp#medical. Veterans with service-connected disabilities or veterans unable to afford nursing home care will be considered first for residency. You are welcome to contact the Admissions Coordinator for the Home in which you are interested for additional information. Tours are always available. At www.floridavets.org/nursing/nursing.asp a virtual tour of a State Veterans’ Nursing Home can be found. The tour includes ten 360 degree fully interactive pictures that require no additional software to view.
VA’s State Home Program is a partnership with the states to acquire, construct or renovate nursing homes, domiciliaries and adult day health-care facilities for veterans. The states own and operate the homes, but VA can provide up to 65% percent of the cost of approved projects. When construction is complete and inspections are satisfactory, the facilities qualify for per diem payments from VA. In fiscal year 2004, VA spent over $4.6 billion in Florida to serve more than 1.7 million veterans who live in the state. VA operates six medical centers in Florida with outpatient clinics and Vet Centers in many communities. Information about Florida’s Veterans Homes can be found on the Web at www.floridavets.org/nursing/nursing.asp or by calling (850) 487-1533.[Source: FDVA e-florida Newsletter 17 JUN 05]


SENIOR’S DISCOUNTS WEBSITE: If you don’t mind telling people that you qualify for senior discounts, www.seniordiscounts.com can be a good resource for saving on thousands of products and services including airlines, car rentals, travel, sports, recreation, shopping, restaurants, national parks, medical services, pharmacies, museums, and much more. The Web site also offers a free weekly newsletter that focuses exclusively on senior discounts. When you log onto the Web site, search by your zip code or city & state, and the category you’re interested in. You will see a list that includes names and addresses, the amount of the senior discount, and the minimum age requirement. It doesn’t promise the best deals available, but the site is a good place to start. When you contact any company, don’t hesitate to ask about special offers, closeouts, or additional senior discounts that may be available. [Source: www.seniordiscounts.com May 05]


COLON CANCER DETECTION: Cancer of the colon or rectum (Colorectal cancer) is the second leading cancer killer in the United States after lung cancer. About 135,000 new cases are diagnosed each year and 55,000 deaths occur each year. More than one-third of colorectal cancer deaths could be avoided if people over 50 had regular screening tests. Screening tests can help prevent colorectal cancer by finding pre-cancerous polyps so they can be removed before they turn into cancer. Most colorectal cancers begin as polyps. Polyps are growths on the inner wall of the colon or rectum. People who have polyps or colorectal cancer do not always have symptoms, especially at first. Screening tests are important because they can find colorectal cancer early, when treatment works best. When colorectal cancer is detected in the earliest stage of the disease (Stage 1), the survival rate is 96%. The risk of developing colorectal cancer increases with age. In fact, 92% occur in people 50 and older. Both sexes may develop this cancer. Several different screening tests can be used to test for polyps or colorectal cancer. Each can be used alone. Sometimes they are used in combination with each other. Medicare Part B and TFL cover the following:

1. Fecal Occult Blood Test (FOBT) or Stool Test - Covered once every 12 months. You pay no coinsurance and no Part B deductible. This a test you do at home using a test kit you get from your health care provider. You put stool samples on test cards, then return the cards to the doctor or a lab. This test checks for occult (hidden) blood in the stool.
2. Flexible Sigmoidoscopy (Flex Sig) - Covered once every 4 years. You pay 20% of the Medicare approved amount after the yearly Part B deductible. If the flexible sigmoidoscopy or colonoscopy is done in a hospital outpatient department, you pay 25% of the Medicare-approved amount after the yearly Part B deductible. This is a test in which the doctor puts a short, thin, flexible, lighted tube into your rectum. The doctor checks for polyps or cancer in the rectum and lower third of the colon. Sometimes a flexible sigmoidoscopy is used in combination with a Fecal Occult Blood Test (FOBT).
3. Colonoscopy High Risk Individuals - If you are at high risk for colorectal cancer, Medicare covers a colonoscopy or a barium enema every 2 years. You pay 20% of the Medicare approved amount after the yearly Part B deductible. Your risk for colorectal cancer may be higher than average if you or a close relative had colorectal polyps or cancer, or if you have inflammatory bowel disease.
4. Average Risk Individuals - If you are at average risk (i.e., not at high risk) for colorectal cancer, Medicare will cover a colonoscopy every 10 years. You pay 20% of the Medicare approved amount after the yearly Part B deductible. However, if you are at average risk and have had a covered flexible sigmoidoscopy, you must wait 4 years to be eligible for Medicare coverage of a colonoscopy. This test is similar to a flexible sigmoidoscopy, except the doctor uses a longer, thin, flexible, lighted tube to check for polyps or cancer in the rectum and the entire colon. During the test, the doctor can find and remove most polyps and some cancers.
5. Double Contrast Barium Enema - This test can substitute for a flexible sigmoidoscopy or for a colonoscopy. This test is covered every 24 months if you are at high risk for colorectal cancer and every 48 months if you aren't at high risk. You pay 20% of the Medicare approved amount after the yearly Part B deductible. A test in which you are given an enema with a liquid called barium. The doctor takes x-rays of your colon. The barium allows the doctor to see the outline of your colon, to check for polyps or other abnormalities.

Colonoscopy is an effective procedure to identity and remove polyps in the colon before they become cancerous. It is often recommended if there is a change in bowel habits, unexplained chronic diarrhea, constipation, abdominal pain, blood in stools, anemia, or suspicion of colon polyps or cancer. Your colon must be clean during the procedure to give the physician clear view. Typically, bowel prep involves drinking a gallon of a special flavored laxative solution the night before. An intravenous sedative and pain medication is given before the procedure begins. Your doctor inserts a flexible fiber-optic tube called a colonoscope into your rectum. It is about half an inch in diameter, as long as the colon, and has a micro camera at the tip. Because of the medication, it is practically painless. A small amount of air is used to expand the colon and make it easier to see the colon wall. If polyps, other small growths, or abnormally inflamed tissue is found thy often can be removed during the procedure for further examination. A complete procedure takes about 45 minutes. “Virtual” colonoscopies use CT scanning to get a visual image. They are faster and do not require any sedative or pain medication. However, they require the same bowel prep and involve the insertion of a tube into the rectum to blow in air to expand the colon. They are expensive and cannot identify many smaller polyps. If any are found a regular Colonoscopy is required for removal. Additional information can be found at www.acg.gi.org. [Source: Military Officer Nov 04 & MEDICARE web site www.medicare.gov/Health/ColonCancer.asp]


MOUSE FOR SHAKY HANDS: Tremors that cause shaky hands is common in our retiree community. The International Essential Tremor Foundation (IETF) reports that nearly 10 million people in the United States are affected by Essential Tremor, the most common form of hand tremors. Parkinson's disease and several other conditions can also cause tremors. When people with tremors try to use a computer, their involuntary hand movements wreck havoc with the standard mouse which interprets each movement as a planned event. A device call the Assistive Mouse Adapter is now available to help computer users with shaky hands. This adapter is a small rectangular device that is plugged in between the computer and the mouse. The adapter functions like the stabilization in some camcorders to filter out the shaky movements and is designed to work with any PC. The device compensates for shaky movements and has a sensitivity setting that can be adjusted according to tremor severity. It can also eliminate the multiple clicks that a shaky hand might produce. For more information and a picture of the device refer to www.montrosesecam.com. [Source: AARP News 22 Apr 05]


VA CLAIM FILING SOURCES: If you are a retiree with any injury or medical condition that first manifested itself during military service and causes you to be at least 10% disabled, you might be entitled to disability compensation from the Department of Veterans Affairs. In addition, wartime retirees and veterans with low incomes who are permanently and totally disabled, unable to work and over age 65 may be eligible for monetary support through VA’s pension program. In 2003, VA provided $26 billion in disability compensation, death compensation and pension to 3.4 million people. About 2.8 million veterans received disability compensation or pensions from VA. Also receiving benefits were 568,146 spouses, children and parents of deceased veterans. It s relatively easy to file a disability claim; you can do it at any VA office or medical center. Many cities also have Vet Centers where claims may be filed. Once approved, veterans with service-connected disabilities receive priority access to care for outpatient and hospitalization care. VA’s Readjustment Counseling Service has operated its Vet Centers since 1979. It provides psychological counseling for war-related trauma, community outreach, case management and referral activities, plus supportive social services to veterans and family members. There are now about 206 Vet Centers, and the system has served about 1.7 million veterans since its inception. If you don’t live anywhere near a VA office, medical center or Vet Center, you can file a disability claim online at http://vabenefits.vba.va.gov/vonapp/main.asp. VA also offers comprehensive information about all its disability compensation and pension benefits on its Web site at www.vba.va.gov/bln/21. If you do not have computer access, you can call VA toll free at (800) 827-1000 for more information.

Your DD214 discharge papers are the key to unlocking your veterans’ benefits. Without them, you are virtually shut out until you can get an official copy from the National Records Center, which can take weeks or months. If you plan to retire from the military soon, you should ensure that your medical records, personnel file and other important papers are updated with all the proper documentation of any incurred injuries, illnesses or ongoing medical conditions. Representatives of veterans’ service organizations are on duty at all VA offices or clinics and can help you with disability claims. They can ensure that your enrollment and claims forms are correctly filled out and that your claims are processed right the first time. Many veterans’ service organizations are federally chartered, recognized or approved by the secretary of Veterans Affairs. These groups include the Veterans of Foreign Wars, Disabled American Veterans and the American Legion, to name just a few. Representatives of these organizations may prepare, present and prosecute VA claims. Each VSO’s service officer will help prepare and manage your claims for benefits at no cost to you. It’s their job and they have the expertise to assist. These service officers also can function as advocates for you and your family in any appeals you make with VA. And they will help you and your family in filing claims for rehabilitation and education programs, pension and death benefits, employment and training programs, Social Security disability benefits and many other programs. If you plan to file a VA claim of any kind, make sure you keep copies of everything that might be related to your claim inclusive of all your correspondence and evidence. Remember, this is the government, and the government needs its paperwork. VA review boards can only award veterans claims based upon the documentation and evidence presented to them. It is your responsibility as a veteran to ensure that your case has been thoroughly reviewed. Laws change and if you are not eligible
to receive compensation today, you may be one day. There is no deadline for applying for disability benefits, but approved VA claims are usually awarded back to the date of filing, so it is important to file as soon as possible. [Source: Navy times Alex Keenan article 25 JAN 05]


Lt. James "EMO" Tichacek, USN (Ret)
Director, Retiree Assistance Office, VITA & U.S. Embassy Warden Baguio City RP
PSC 517 Box RCB, FPO AP 96517-1000