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RAO Bulletin
15 November 2008

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THIS BULLETIN CONTAINS THE FOLLOWING ARTICLES

== Vet Jobs [06] ----------------------------------- (OPM Changes)
== Tricare After Hours Care ------------- (Emergency & Urgent)
== RACHAP/RHAPP [01] --------------- (Retiree Hearing Aids)
== Tricare PI Fee Schedule ----------------------- (New 1 NOV 08)
== Barcode Basics ----------------------------- (Country of Origin)
== Mobilized Reserve 11 NOV 08] --------------- (192 Increase)
== VA Funding [17] ------ (Obama Supports Advance Funding)
== Vet Jobs [05] --------------------- (Federal Government 2007)
== Hypertension [01] -------------------------- (Blacks vs. Whites)
== VA/DoD Resume Review ------------------------- (Peake/Chu)
== VA Interim Benefit Lawsuit --------- (Excessive Delay Pmts)
== Changing Medicare Health Plans ------------ (When Allowed)
== DFAS 1099R for 2008 ------------------------ (Viewing Dates)
== Express Scripts Data Breach -------------- (Ransom Demands)
== Medicare Reimbursement [01] ------------- (Payment Delays)
== Medicad Funding [01] ------------------- (Bush Strikes Again)
== Missing in America Project [01] -------- (11 Found in Idaho)
== Tomb of the Unknowns [02] ------------ (Repair or replace?)
== Disability Evaluation System --------------- (Pilot Expansion)
== Arizona Memorial ------------------- (Visitor's Center Sinking)
== Tricare Pharmacy Policy [03] --------------------- (Walgreens)
== VA Category 8 Care [07] --------------- (Campaign Promises)
== TSP [11] --------------------------------------- (Slide Continues)
== Immunizations [01] ----------------------------- (Fainting Stats)
== VA Radiation under Dosing --------- (Program Suspensions)
== NPRC Scam ------------------------------------------- (Potential)
== Warts -------------------------------------- (Cause & Treatment)
== Warts [01] ----------------------------------------- (Cancer Link)
== TFL Need-to-Knows ----------------------------------- (Top 10)
== Uniform Wearing [01] ----------------------------- (Halloween)
== VA Presumptive Atomic Vet Diseases [01] -- (Updated List)
== DoD PDBR [02] ------------ (Applications Available DEC 08)
== VA Claim Shredding [01] ------------- (Policy Under Review)
== VA Tinnitus Care --------------------------- (NCRAR Research)
== VA Diabetes Mellitus Care [04] -------------------- (Nam Vets)
== Uniform Wearing [02] -------------------- (Service’s Position)
== Veteran Legislation Status 13 NOV 08 --- (Where we Stand)

===============================

VET JOBS UPDATE 06:    OPM also announced that they are moving forward
 with President Bush’s Military Spouse Hiring Authority. In the next few
 weeks the proposed regulations will be published in the Federal
 Register for public comment. This has been incorrectly reported in the press
 to be a hiring preference. It is not. It is a “non-competitive
 authority to hire.”  They also announced that the new Time in Grade regulations
 were just published. They will take effect on 9 MAR 09. What this
 change means is that someone who is hired into a federal job does not have
 to wait 52 weeks in that job before a promotion. This should be a great
 help for some new veterans and retirees who are being hired. Their
 superior can take into account their military experience to move they up
 in pay grade. It does not remove job qualification standards which often
 still require 1 year in the previous job.  [Source: TREA Washington
 Update 11 Nov 08 ++]

===============================

TRICARE AFTER HOURS CARE:   Accidents happen. Babies get sick.
 Complications occur. And it seems they never happen at a convenient time.
 Certainly not always during the typical 9 a.m. to 5 p.m. work day. Tricare
 knows this, which is why it’s important to know your options for
 after-hours care.

Emergency Care:  Of course, if you are having an emergency, always call
 911 or go to the nearest emergency room. Tricare defines emergency
 care as the care you receive for a medical, maternity or psychiatric
 condition that would lead a "prudent lay person" (someone with average
 knowledge of health and medicine) to believe that a serious medical
 condition exists, or that the absence of immediate medical attention would
 result in a threat to life, limb or eyesight, or when the person has
 painful symptoms requiring immediate attention to relieve suffering.  This
 includes situations where a person is in severe pain or is at immediate
 risk to self or others. What’s important is to know what you must do
 following your visit. In general, take a look at these steps:

- Tricare Standard/Extra: If you have Tricare Standard/Extra, you
 manage your own care. However, you should contact your regional contractor
 if you are admitted due to a psychiatric emergency. The notification
 should be made within 24 hours of admission or the next business day. In
 general, the admission should be reported within 72 hours.
- Tricare Prime: In most cases, if you have Tricare Prime (including
 Tricare Prime Remote, Tricare Prime Overseas or Tricare Global Remote
 Overseas) you need to contact your primary care manager within 24 hours or
 the next business day after receiving emergency care, so that ongoing
 care can be coordinated and to ensure you receive proper authorization
 for care, if necessary.
- Tricare For Life (TFL): In the case of an emergency, Tricare For Life
 beneficiaries should go to the closest emergency room or call 911. TFL
 comes into play when the covered services have been exhausted under
 Medicare or are otherwise not a Medicare benefit.  To remain eligible for
 TFL, you must have Medicare Part B and follow the Medicare rules.

Since there are so many variables to consider within Tricare’s options,
 it is a good idea to visit the informative beneficiary Web site and
 enter your profile to determine your covered services, and what steps you
 need to take before an emergency arises.
 
Urgent Care:  Tricare defines urgent care as the care you receive for
 an illness or injury that would not result in further disability or
 death if not treated immediately, but does require professional attention
 within 24 hours.  Urgent care has the potential to develop into an
 emergency if treatment is delayed longer than 24 hours. Again, with the
 number of variables to consider, we recommend visiting the beneficiary Web
 site to learn exactly what you need to do before the need for urgent
 care arises. In general, the following information applies:

- Tricare Standard/Extra: As mentioned above, when using Tricare
 Standard and Extra, you manage your own health care.  While you'll never
 require referrals for any type of care, some services may require prior
 authorization.  It’s also important for you to understand the type of
 provider you are seeing.  You can visit any Tricare-authorized provider,
 network or non-network, but the type of provider you see determines your
 out-of-pocket costs.
- Tricare Prime:  You may schedule an appointment with your primary
 care manager (PCM) for URGENT care, for conditions such as a sprain, sore
 throat or rising temperature, by making a "same-day" appointment.  If
 you are a registered user on the Tricare Online Web Portal, you may be
 able to schedule some appointments at military treatment facilities
 online.  Active duty service members should obtain care in accordance with
 service guidance.  You should be able to receive an urgent care
 appointment within 24 hours (one day), even if you are traveling. If you do
 not coordinate urgent care with your PCM, the care will be covered under
 the point of service option, resulting in higher out-of-pocket costs.
 If you are away from home, contact your regional contractor for
 assistance in obtaining urgent care:   West Region:  TriWest, 1-888-874-9378;
 North Region:  Health Net, 1-877-TRICARE;  South Region:  Humana,
  1-800-444-544.
- Tricare For Life:  When using TFL, you manage your own health care.
 To get your urgent care, simply make an appointment with your Medicare
 provider.  To remain eligible for TFL, you must have Medicare Part B and
 follow the Medicare rules.

Overseas: There are a number of resources available for beneficiaries
 living or traveling overseas who encounter an emergency or need urgent
 care. Check out the Tricare passport for detailed information on how to
 proceed with your health care needs while overseas.  Also, Tricare has
 been working to expand emergency and urgent care options for our
 overseas active duty service members and their family members. For example,
 all active duty service members and active duty family members enrolled
 in Tricare Prime are now able to access the Tricare Global Remote
 Overseas (TGRO) Alarm Center for assistance.  Previously, only beneficiaries
 enrolled in TGRO had access to these services. For more updates, refer
 to : http://www.tricare.mil/pressroom/news.aspx?fid=399 and
 http://www.tricare.mil/pressroom/news.aspx?fid=468.
[Source: The Tricare Blog Major General Elder Granger article 10 Nov 08
 ++]

===============================

RACHAP/RHAPP UPDATE 01:    The Retiree-At-Cost Hearing Aid Program
 (RACHAP) for Air Force and/or Retiree Hearing Aid Purchase Program (RHAPP)
 are available to military retirees from active duty, Guard, and Reserve
 units who have hearing loss and/or tinnitus. Retired Commissioned
 Officers of the US Public Health Service are also eligible for this
 program. This is not a Tricare benefit. Advances in technology now make
 hearing aids into high-tech medical devices. The best hearing aids ever made
 are now in production. Retirees can obtain hearing aids at significant
 savings by using the programs. Two hearing aids can usually be
 purchased for less than $2,000. Exact costs are variable and subject to change
 at any time without notice. Contact your nearest audiology clinic for
 further details. Not every medical facility is able to provide these
 programs. Care of active duty members takes precedent at all MTFs. It is
 recommended that you contact the appropriate facility before incurring
 significant travel expenses. A list of stateside and overseas facilities
 currently participating with telephone numbers can be found at
 http://militaryaudiology.org/site/rachaprhapp-locations/ . Facilities
 may discontinue this program for any reason without notice. Retirees can
 use any facility which will accept them; you don't need to return to
 your service affiliation to participate. Dependents of military retirees
 are ineligible to participate in this program throughout the US.
 Overseas travel is required.  [Source: NAUS Weekly Update 14 Nov 08 ++]

===============================

TRICARE PI FEE SCHEDULE:    A new Tricare provider fee schedule for
 medical services and procedures is in effect in the Philippine Islands.
  Tricare officials expect the new fee schedule to better reflect actual
 medical costs.  There are no changes in payments for laboratory,
 radiology, pathology services and procedures. Tricare beneficiaries and
 providers in the Philippines who filed Tricare claims during the past two
 years are receiving letters from Tricare Management Activity (TMA)
 notifying them of the fee schedule change, which went into effect 1 NOV 08.
 The new allowable charges and inpatient per diem rates are available on
 the Tricare Web site at http://www.tricare.mil/CMAC. Tricare Standard
 deductibles and cost-shares will not change for beneficiaries in the
 Philippines under the new fee schedule.  Annual out-of-pocket caps for
 active duty family member costs will continue at $1,000 and $3,000 for
 retirees and their eligible family members.  Tricare beneficiaries living
 in, or traveling to, the Philippines should be aware that they must use
 Tricare certified providers to receive claims reimbursement.  A list of
 certified providers for the Philippines is available on the Pacific
 Area Office page in the TMA portal at http://www.tricare.mil. [Source:
 Tricare News Release 13 Nov 08 ++]

===============================

BARCODE BASICS:   A European Article Number (EAN) is a barcoding
 standard which is a superset of the original 12-digit Universal Product Code
 (UPC) system developed in North America. Check the barcode if you are
 interested in knowing the country that the item you are considering
 purchasing came from. The first two or three digits of an EAN-13 barcode
 identify the country in which the manufacturer's identification code was
 assigned.  For example the EAN: 4 710088 412539 is assigned to Taiwan.
  This may or may not be the country in which the goods were
 manufactured but in many cases is.  Following are some EAN identifiers of
 countries consumers might want to consider prior to making their decision
 whether to buy or not.  For a complete listing refer to
 http://www.makebarcode.com/specs/ean_cc.html:

00 to 13 (USA & Canada)
400 to 440 (Germany)
45 + 49 (Japan)
460 to 469 (Russian Federation)
471 (Taiwan)
480 (Philippines)
489 (Hong-Kong) 
626 (Iran)
690 - 695 (China)
867 (North Korea) 
880 (South Korea)
893 (Vietnam)
[Source:  The Barcode Software Center, Inc Nov 08 ++]
 
===============================

MOBILIZED RESERVE 11 NOV 08:   The Army, Air Force and Marine Corps
 announced the current number of reservists on active duty as of 11 NOV 08
 in support of the partial mobilization. The net collective result is
 192 more reservists mobilized than last reported in the Bulletin for 1
 NOV 08. At any given time, services may mobilize some units and
 individuals while demobilizing others, making it possible for these figures to
 either increase or decrease. The total number currently on active duty
 in support of the partial mobilization of the Army National Guard and
 Army Reserve is 96,023; Navy Reserve, 6,041; Air National Guard and Air
 Force Reserve, 10,399; Marine Corps Reserve, 6.946; and the Coast Guard
 Reserve, 848. This brings the total National Guard and Reserve
 personnel who have been mobilized to 120,257 including both units and
 individual augmentees. A cumulative roster of all National Guard and Reserve
 personnel, who are currently mobilized, can be found at
 http://www.defenselink.mil/news/Nov2008/20081111ngr.pdf . [Source: DoD
 News Release 948-0811 NOV 08 ++]

===============================

VA HEALTH CARE FUNDING UPDATE 17:    President-elect Barack Obama
 promised days before the 4 NOV election that his administration would
 support the idea of approving veterans’ funding one year in advance in an
 effort to avoid disruptions in critical programs. His pledge, made in a 28
 OCT letter to the American Federation of Government Employees, puts
 him on record as supporting what a coalition of veterans organizations
 sees as the answer to a perennial problem: funding for veterans programs
 that comes in fits and starts — and, in the process, diminishing the
 quality of health care.“First and foremost, the way our nation provides
 funding for VA health care must be reformed,” Obama says in the letter.
 “My administration will recommend passage of advance appropriation
 legislation for the [fiscal] 2010 appropriations cycle, instead of yearly
 continuing resolutions that lead to delays in hiring and facility
 construction. I will also work to fully fund veterans care.” Nine veterans’
 groups, united in what they call the Partnership for Veterans Health
 Care Budget Reform, have been calling for reform because only twice in the
 last 14 years — and only three times in the last 20 — has the Veterans
 Affairs Department budget been approved by the start of the fiscal
 year on Oct. 1. This has been one of the years when the budget passed on
 time.

     The nine groups proposed that Congress pass a budget for veterans
 programs a full year ahead of time, which would mean that in 2009
 lawmakers would need to pass both a fiscal 2010 budget and a fiscal 2011
 budget. Obama’s letter indicates support for that idea. Delayed budgets
 hurt veterans because they make it harder for VA to plan capital
 improvements and buy major medical equipment, and also delays hiring, said
 Joseph Violante, national legislative director of Disabled American
 Veterans. Another benefit to advanced funding is that veterans programs would
 get a first slice of the federal budget, without having to directly
 compete with other federal programs, Violante said. The day after his
 election, Obama pledged as president to fully fund VA and establish a
 “world-class VA planning division” so that future budgets were more
 accurate, according to a transition agenda that was briefly placed on the
 president-elect’s transition Web site. The transition agenda has since been
 removed. [Source: NavyTimes Rick Maze article 12 Nov 08 ++]

===============================

VET JOBS UPDATE 05:   The number of veterans working for the federal
 government rose slightly in fiscal 2007, according to a new report from
 the Office of Personnel Management. Between fiscal 2006 and 2007, the
 number of veterans in the civilian workforce increased by 4,779, or 0.1
 percent. In fiscal 2007, there were 462,744 veterans working for Uncle
 Sam, accounting for 25.5% of the total government workforce. Those
 figures represent a 0.5% gain from fiscal 2003. Disabled veterans also
 boosted their ranks in government between fiscal 2003 and 2007, growing 1.3%
 during that time to 103,180. In fiscal 2007, the number of disabled
 federal employees fell to 0.92%, down from 1.2% in fiscal 1996, according
 to the Equal Employment Opportunity Commission. The disability
 categories that cover veterans are determined by VA, and can include
 conditions like burns, post-traumatic stress disorder and traumatic brain
 injury. Civilians who apply for federal employment are considered to have
 targeted disabilities if they suffer from deafness, blindness, paralysis,
 amputation, mental illness, retardation, convulsive disorders, and
 spine or limb distortion, among a number of other conditions. Some veterans
 who are considered disabled by VA might not be considered to have
 targeted disabilities.

     The report said veterans overall made up 22.9% of new federal
 hires in fiscal 2007, up from 22.1% in fiscal 2006. In the 43 departments
 and agencies that OPM studied, 52,452 of the new hires in fiscal 2007
 were vets. Despite the modest hiring gains, veterans were
 underrepresented slightly in promotions, OPM found. While vets comprise 25.5% of the
 workforce, they received 23.2% of the 290,855 promotions granted to
 federal employees in fiscal 2007. Disabled veterans received 5.5 % of all
 promotions, while they make up 5.7% of the workforce. And 30% disabled
 veterans received 3% of promotions, though they are 3.1% of the overall
 workforce. OPM also found that agencies used their special hiring
 authority -- for veterans who are more than 30% disabled -- less in fiscal
 2007 than in fiscal 2006. Agencies hired 1,265 of veterans in that
 category with that authority in fiscal 2006; in fiscal 2007, the government
 took advantage of the special provision to hire 1,068 veterans deemed
 30% or more disabled, 197 less than the previous year. Disability
 advocates have said agencies must do more for all disabled employees if they
 hope to accommodate disabled veterans and help them to succeed.
 [Source: GovExec.com Alyssa Rosenberg article 11 Nov 08 ++]

===============================

HYPERTENSION UPDATE 01:  The lives of nearly 8,000 black Americans
 could be saved each year if doctors could figure out a way to bring their
 average blood pressure down to the average level of whites, a surprising
 new study found. The gap between the races in controlling blood
 pressure is well-known, but the resulting number of lives lost startled some
 scientists. The study, released 10 NOV in the Annals of Family
 Medicine, is being called the first to calculate the lives lost due to racial
 disparities in blood pressure control. The lead author, Dr. Kevin
 Fiscella of the University of Rochester School of Medicine & Dentistry said
 he believes steps can be taken to erase that gap. But a second article
 in the same journal found that racial differences in blood pressure
 treatment persisted in England despite a national health system that
 provides equal access to care. Doctors may not be providing proper care, but
 some black patients may not be taking prescribed medicines or following
 medical advice, said Christopher Millett of the Imperial College of
 London.

     High blood pressure -- often called the "silent killer" because it
 has no symptoms -- increases a person's chances for heart disease,
 stroke and other serious problems. But it's easy to check for and usually
 can be controlled through exercise, diet and medication. For decades,
 doctors have noted that a higher percentage of black Americans have high
 blood pressure than whites. The reasons for that include poverty and
 cultural habits. Both can prevent people from exercising, eating healthy
 foods and getting in to see a good doctor. The study suggesting 8,000
 black lives are lost because of uncontrolled blood pressure is based on
 earlier research that finds that about 40% of black adults have high
 blood pressure, compared with about 30% of whites. Fiscella and his
 colleague, Kathleen Holt, made a series of calculations. They took
 estimates of how each point of increased blood pressure affects the likelihood
 of death, and put it in a formula that included the difference in black
 and white blood pressure readings. Those differences caused about
 5,500 extra deaths from heart disease and about 2,200 deaths from stroke
 each year. The second study, done in England, looked at the electronic
 medical records of about 8,900 patients in southwest London, who are
 covered by that country's national health insurance system. Researchers
 found black patients with high blood pressure had significantly higher
 readings than white or Asian patients, even though blacks were prescribed
 more medications.

     The researchers also looked at patients who were sick with one or
 more conditions like heart disease, kidney disease and diabetes. They
 found that blood pressure control was much worse in blacks than whites.
 Patients' failure to regularly take their medicine may be one factor.
 Another may be that certain medications work better for blacks, but some
 doctors may be overlooking that difference, said Millett, a consultant
 in public health for Imperial College. Former U.S. Surgeon General Dr.
 David Satcher said changes need to be made to make sure minority
 patients can get good medical care when they need it. But there also needs
 to be more done to make sure patients understand medical directions and
 feel comfortable asking questions when they don't. "It's very clear we
 need to target our efforts to differences in" how well patients follow
 medical advice, said Satcher, who is now an administrator at Atlanta's
 Morehouse School of Medicine.

     Once hypertension develops, it becomes a lifetime condition.
 Hypertension is an increased pressure on the walls of the arteries when the
 heart pumps blood to the different part of the body. A sphygmomanometer
 is the instrument used in measuring the blood pressure aided by a
 stethoscope to check the sound from the arteries. A blood pressure is
 measured in "biphasic" number-e.g.  120/80. There are two phases when taking
 blood pressure readings. One is the systolic pressure in which the
 heart pumps blood from the left side of the heart to the major arteries.
 The other phase is the diastolic pressure or the pressure in filling up
 of blood in the chambers of the heart (ventricles).  A normal blood
 pressure is below 140/90 millimeter per mercury (mm/hg) in a
 sphygmomanometer reading. An increase in blood pressure connotes hypertension.
 Anything more than 140/90 mm/hg but less than 160/90 mm/hg is diagnosed as
 "borderline hypertension." If the reading is more than 160/90 mm/hg, it
 is considered as "definite hypertension."  Being hypertensive can
 greatly affect the normal condition of the heart and circulation of the
 blood. There is still no known reason why this mechanism fails.  [Source:
 CNN.com/Health article 10 Nov 08 ++]

===============================

VA/DOD RESUME REVIEW:    Following is an excerpt taken from an
 editorial written by Bruce Coulter, editor of the Burlington Union and a
 retired, disabled veteran. He may be reached at 978-371-5775, or by e-mail at
 bcoulter@cnc.com.  Reproduction in the Bulletin is to provide insight
 into some of the president elect's options related to veterans and
 should not be considered an endorsement of the content:

"During the course of a 21- month presidential campaign,
 President-elect Barack Obama said he would derail the amount of legislation passed on
 behalf of Washington, D.C. lobbyists, many of whom are former
 government officials. Although he’s taken a step back from that posture, he
 hopes to limit the role and influence of special interest groups. Still,
 jobs, according to Politico.com, would still be available to lobbyists,
 but not within the sphere of their private practice. In other words, an
 energy industry lobbyist would not likely be hired to work for the
 Department of Energy. Given that position, Obama should take a hard look
 at Department of Veterans Affairs Secretary James Peake, who earlier
 this year proposed outsourcing the administration of new Post-9/11 G.I
 Bill benefits. The VA has since reversed course, announcing last month it
 would rely upon its own workforce to set up the information technology
 programs needed to implement the educational benefits of the G.I. Bill.
 The plan was not well received by veterans’ groups, who loudly
 protested against the proposal. Peake was an executive with California-based
 QTC Management, Inc, a private corporation that provides compensation
 and pension examinations for the VA. The chairman of QTC is former VA
 secretary Anthony Principi.

     If Obama is serious about limiting the influence of special
 interests, he should consider nominating Tammy Duckworth, a decorated and
 disabled veteran of the Iraq War, and now, the director of the Illinois
 Department of Veterans Affairs. Duckworth was serving as co-pilot of a
 Black Hawk helicopter in Iraq that was struck by a rocket-propelled
 grenade. As a result of the attack, she lost both legs and partial use of
 one arm. Despite what could have been a major personal setback, Duckworth
 has moved forward with her life, making an unsuccessful bid for
 Congress in 2006 and still serving as a major in the Illinois National Guard,
 despite being offered a medical retirement.  Duckworth may also be a
 sentimental favorite as a “hometown” pick given that she, like Obama,
 represents the Land of Lincoln. John Raughter, a spokesman for the
 American Legion, when asked for a comment regarding Duckworth’s possible
 nomination, said the group’s bylaws do not allow endorsements for any
 offices. “So we always focus on positions, rather than personalities,” he
 said. ... Other candidates being considered for the position is the
 incumbent, Peake, and Max Cleland, a former U.S. Senator from Georgia and a
 disabled veteran of the Vietnam War.

     And while he’s taking applications Obama should consider sending
 David Chu, the undersecretary of defense for personnel and readiness
 packing. Chu, a career federal service employee, is no friend of veterans.
 In a 2005 interview with the Wall Street Journal, Chu said Congress
 had gone too far in expanding military retiree benefits. "The amounts
 have gotten to the point where they are hurtful. They are taking away from
 the nation's ability to defend itself,” said Chu. Now he’s at it
 again. The Department of Defense has instituted a policy, based on a
 memorandum written by Chu, according to Disabled American Veteran Magazine,
 “Limits the number of injured and disabled servicemembers who would not
 have to repay their military disability severance pay before they could
 receive disability compensation from the Department of Veterans
 Affairs.”Chu’s memo redefines what qualifies as a combat-related injury,
 despite the intent of Congress’s passage of the 2008 Defense Authorization
 act, which allows combat-related special compensation for injuries
 received in a combat zone or duty performed in combat-related operations. In
 his memo, Chu defined combat-related injuries as “a disease or injury
 incurred in the line of duty as a direct result of armed conflict.” In
 short, by changing Congress’s policy, Chu has cheated a large group of
 veterans out of compensation they earned the hard way, including many
 who would be eligible for combat-related special compensation. By the
 way, the pensions earned by veterans after 20 or more years of service
 are likely to be dwarfed by the federal pension Chu will receive. It’s
 time for him to update his resume..."
[Source: Concord MA Burlington Union editorial 10 Nov 08 ++]

===============================

VA INTERIM BENEFIT LAWSUIT:  Two veterans’ groups have filed a suit in
 an effort to get a federal court to order interim benefits for veterans
 if a claim for disability compensation takes longer than 90 days to be
 processed. Vietnam Veterans of America and Veterans of Modern Warfare
 want an interim payment equal to what is paid for a 30 percent
 disability rating — between $356 and $497 a month, depending on the number of
 dependents — if an initial claim takes more than 90 days or an appeal of
 a denied claim takes longer than 180 days. The suit, filed 10 NOV in
 the U.S. District Court for the District of Columbia, is an attempt to
 use the federal court system to tackle the Department of Veterans
 Affairs claims processing bureaucracy, said Robert Cattanach, one of the
 attorneys handling the case. VA officials had no immediate comment.
 Spokesman Phil Budahn said VA officials learned about the suit only after it
 was filed, and are working on a response. “Veterans need prompt action
 and they need it now,” Cattanach said. “The Department of Veterans
 Affairs is failing miserably.”

     It is no coincidence that the suit was filed one day before
 Veterans Day. John Rowan, president of the Vietnam Veterans of America, said
 more than half a million veterans “will wake up on Veterans Day still
 awaiting their benefits” because VA takes, on average, 182 days to
 process an initial claim and 4½ years or more to an appeal. “These
 unacceptable and excessive delays cause veterans and their families irreparable
 harm,” he said. “Financial hardship can become extremely dire while
 waiting.” Donald Overton, Veterans of Modern Warfare’s executive director,
 called it a “terrible irony” that today’s military has sophisticated
 weapons of war but the VA claims system remains antiquated. “All of us
 should be outraged,” Overton said. The lawsuit asks the court to require
 the VA to present a plan within 30 days for speedier claims
 processing. If the VA fails to come up with such a plan, the suit asks the court
 to order an “equitable remedy,” which the veterans’ groups believe
 would be interim payments equal to what someone would receive if they had a
 30% disability rating. The interim payments would continue until the
 claim is resolved. Cattanach said interim payments “are not a lot of
 money” but would be enough for “basic support.”

     The 90-day and 180-day standards sought by the lawsuit are the
 groups’ estimates of what is reasonable. Federal law does not include any
 specific requirement about how long claims processing can take.
 Providing interim benefits while awaiting claims decisions is an idea that has
 bounced around veterans’ groups and Congress for several years as the
 backlog of pending claims has grown. There has been some reluctance to
 endorse the idea because of concern that the promise of quick payments
 might encourage veterans to file unsubstantiated claims and
 deliberately make them complicated so they would take longer than 90 days to
 complete. Cattanach said faster claims processing is more important now than
 ever. “Disabled vets have a very difficult time finding jobs,
 especially in this economy,” Cattanach said. While veterans eventually received
 backdated payments if claims are decided in their favor, veterans
 suffer in the meantime. “Providing back pay whenever the VA gets around to
 it” does not make up for the hard times, he said. “Under the law,
 excessive delays amount to the same thing as benefits denied.” [Source:
 NavyTimes Rick Maze article 10 Nov 08 ++]

===============================

CHANGING MEDICARE HEALTH PLANS:    You are limited as to when you can
 change your Medicare health plan during the year (this is known as
 lock-in).  Changes can only be made during ACEP, OEP, or SEP
 periods/circumstances:

Annual Coordinated Election Period (ACEP): You can switch once during
 the ACEP which runs from 15 NOV thru 31 DEC of every year. Your new
 coverage will start 1 JAN. During this period you can change your choice of
 health coverage, and add, drop or change Medicare drug coverage.  You
 can make as many changes as you need during this period, but only your
 last coverage choice will take effect on 1 JAN. To avoid enrollment
 problems, it is best to make as few changes as possible.  If you are
 changing plans to join a Medicare Medical Savings Accounts (MSA), you can
 only do so during the ACEP. If you are enrolling in the Medicare drug
 benefit for the first time, you may face a penalty if you had not
 previously had coverage as good as Medicare’s

Open Enrollment Period (OEP): You can switch once during the OEP which
 runs from 1 JAN through 31 MAR of every year. Your new coverage starts
 the first of the month after you make your selection. During the OEP
 you cannot decide to add or drop Medicare drug coverage (Part D).  Your
 options are:

- If you have a Medicare private health plan with drug coverage you can
 switch to another Medicare private health plan with drug coverage or
 original Medicare and a stand-alone drug plan.
- If you have Original Medicare and a stand-alone drug plan you can
 switch to a Medicare private health plan with drug coverage.
- If you have a Medicare private health plan without drug coverage you
 can switch to another Medicare private health plan without drug
 coverage or original Medicare alone (no stand-alone drug plan).
- If you have original Medicare alone (no stand-alone drug plan) you
 can switch to a Medicare private health plan without drug coverage.
- If your Medicare private health plan leaves your area or you move out
 of your plan's service area, you can switch to another private health
 plan or to Original Medicare.

Special Enrollment Period (SEP): Under certain circumstances, you may
 be eligible for a SEP to change your drug coverage and/or health plan.
 If you get an SEP, your new coverage will start the first of the month
 after you sign up for or disenroll from a Medicare private health plan.
 If you do not enroll in the Medicare drug benefit (Part D) when you are
 first eligible, and you do not have other drug coverage that is at
 least as good as Medicare’s (i.e. creditable) for 63 days or more, you
 will likely have to pay a premium penalty if you later enroll in a
 Medicare drug plan. Most SEPs allow you to enroll in the drug benefit outside
 a standard enrollment period, but you will still owe a premium penalty.
 You can get the penalty waived if you qualify for Extra Help—a federal
 program that helps pay for most of the costs of the Medicare drug
 benefit—and enroll in a Medicare drug plan in 2007 or 2008 if you show that
 you received inadequate information about the creditability of your
 drug coverage. SEP eligibility could apply if:

1. You lose creditable  drug coverage through no fault of your own or
 you want to disenroll from Medicare drug coverage to keep or enroll in
 other creditable coverage programs such as VA, TRICARE or a state
 pharmaceutical assistance program (SPAP) that offers creditable coverage.
 This does not include losing your drug coverage because you do not pay, or
 cannot afford, your premiums.
2. You join or drop employer/union drug coverage regardless of whether
 it is creditable. Employer coverage may be current or former (retiree
 plan).
3. You are institutionalized. i.e. You move into, reside in, or move
 out of a qualified institutional facility: a skilled nursing facility,
 nursing home, psychiatric hospital or unit, Intermediate Care Facility
 for the Mentally Retarded—ICF/MR, rehabilitation hospital or unit,
 long-term care hospital, or swing-bed hospital
4. You are enrolled in a qualified State Pharmaceutical Assistance
 Program (SPAP), or lose SPAP eligibility.
5. You have Extra Help whether you applied or automatically qualified
 because you have Medicaid, a Medicare Savings Program or receive
 Supplemental Security Insurance.
6. You want to disenroll from your FIRST Medicare private health plan
 with drug coverage (MA-PD).
7. You enroll in/disenroll from PACE.
8. You move (permanently change your home address).
9. You have had Medicare eligibility issues.
10. You are eligible to join a Special Needs Plan (SNP) or you lose SNP
 eligibility.
11. You experience contract violations, misleading marketing or
 enrollment errors.
12. Your plan no longer offers Medicare coverage.
13. You experience an exceptional circumstance not covered in the
 foregoing.
[Source: Medicare Rights Center 10 Nov 08 ++]

===============================

DFAS 1099R FOR 2008:   Below is the schedule for viewing your tax
 statement on myPay for the tax year 2008:
December 10, 2008           Retiree Account Statement        
December 15, 2008           Retired 1099R
December 15, 2008           Annuitant Account Statement
December 15, 2008           Annuitant 1099R
[Source: DFAS Newsletter 13 Nov 08 ++]

===============================

EXPRESS SCRIPTS DATA BREACH:    One of the nation's largest processors
 of pharmacy prescriptions said this week that extortionists are
 threatening to disclose personal and medical information about millions of
 Americans if the company fails to meet payment demands. St. Louis-based
 Express Scripts said 6 NOV that in early OCT it received a letter that
 included the names, birth dates, Social Security numbers and, in some
 cases, prescription data on 75 of its customers. The authors threatened to
 expose millions of consumer records if the company declined to pay up,
 Express Scripts said in a statement. Chief executive George Paz said
 in the statement that Express Scripts has no intention of paying and
 that his company is working with the FBI to track down those responsible
 for the scam. Express Scripts is the third-largest U.S. pharmacy benefit
 management firm, which processes and pays prescription drug claims.
 Working with more than 1,600 companies, it handles roughly 500 million
 prescriptions a year for about 50 million Americans. 

     Express Scripts has notified its clients of the threat. Fairfax
 County Public Schools yesterday sent a letter to employees alerting
 health-plan participants who use Express Scripts to the breach.  The letter
 was delivered by mail, said company spokesman Steve Littlejohn. He
 declined to say how much money the extortionists were demanding. He added
 that the company is trying to determine how the data were stolen. "We
 know where the data came from by looking at it, but precisely how it was
 accessed is still part of the investigation," Littlejohn said. The
 company last week set up a Web site to give consumers tips on how to
 protect their identity. While Express Scripts does not interact with
 consumers directly, the company's name is printed on prescription cards of
 health-care plans that use its services, Littlejohn said. The 75 people
 listed in the letter have been notified. Billy Cox, special agent for the
 FBI's St. Louis field office, confirmed that the bureau was contacted
 by Express Scripts, but declined to comment on the case. ESI has offered
 a $1 million reward for information leading to the arrest and
 conviction of the perpetrator and is offering free identity restoration
 services if any customer becomes a victim of identity theft because of this
 incident. A dedicated website has been established at
  www.esisupports.com which members and beneficiaries can use for further information and
 guidance

     Alan Paller, director of research for the SANS Institute, a
 Bethesda-based computer-security training group, said many companies,
 especially in the financial industry, have already paid to keep their
 customers' data from being released. Some receive more than one extortion
 threat a day. Paller said that in some ways, the health-care industry is the
 perfect target. "Nobody is going to want to go to a health-care
 provider if they think their private medical history is going to be revealed
 to the world online," he said. "Hospitals wouldn't have to think too
 hard about that before paying off an extortion demand." Last month, the
 FBI arrested an Indiana man accusing him of stealing 900,000
 policyholder records from a medical provider and trying to extort $208,000 from
 its parent, American International Group. Graham Cluley, a senior
 technology consultant for Sophos, a British computer security company, said
 Express Scripts was right to go to the FBI. "Data extortion is not like
 if your daughter gets kidnapped: Even if something is returned to you,
 you can never be sure they're not going to carry on taking advantage of
 the situation," Cluley said. "The bad guys can always just make a copy
 of what they've stolen, and they can keep on coming back and asking for
 money, or they can still go and sell the data online." [Source:
 Washington Post Brian Krebs article 8 Nov 08 ++]

===============================

MEDICARE REIMBURSEMENT UPDATE 01:   Doctors across California, Nevada,
 and Hawaii are owed millions of dollars in backlogged Medicare
 reimbursements, leading some physicians to turn away elderly patients and
 pushing others to the brink of bankruptcy. In the most extreme cases,
 doctors have not been paid since FEB 08. Others are owed hundreds of
 thousands of dollars. Doctors who serve high numbers of Medicare patients say
 they are defaulting on rent, laying off staff and begging drug suppliers
 not to stop shipments. One cardiologist said she's even resorted to
 doing the office laundry to cut costs.  The holdup is twofold. By May,
 doctors were supposed to be using a new universal identification number
 assigned by the Centers for Medicare and Medicaid Services. Without the
 new number, which is like a Social Security number, doctors can't get
 reimbursed. Then, as scores of doctors still waited for those numbers,
 in September the federal agency switched to a new claim processor for
 its 90,000 California providers. The move to Palmetto GBA in South
 Carolina, part of a national effort to reform Medicare contractors,
 compounded the billing issues and left even doctors who had their universal
 identification numbers waiting months for reimbursement.

     In some cases, the problem is as simple as a change of address not
 being processed. Dr. Daniel Marcus moved from Suite 404 to 414 in his
 Marina del Rey office and as a result has not been paid since May.
 "This is just a complete disaster," said Dr. Dev Gnanadev, medical director
 and chairman of the Department of Surgery at Arrowhead Regional
 Medical Center in Colton and president of the California Medical Assn. "I
 know people who have turned down their office to minimal size. Some are
 even considering closing temporarily. If you don't get paid, then you're
 in deep trouble." Rep. Henry Waxman (D-Beverly Hills), whose office was
 contacted by at least two dozen doctors, called the transition to the
 new contractor "marred by missteps." Palmetto has also been the subject
 of complaints from doctors in Nevada, which switched to the processing
 firm in August. The state has the fastest-growing Medicare population
 in the nation. So far, Medicare patients have been largely insulated
 from the reimbursement fight, though they may have difficulty making new
 appointments. Some doctors, particularly those with specialties that
 get minimal Medicare reimbursements, say this could be the tipping point
 that makes them abandon their participation in Medicare altogether.
  This could have a ripple effect on TFL and Tricare Standard users

     Mike Barlow, a Palmetto vice president who oversees California,
 Nevada and Hawaii, said company officials are aware of the issues and
 have acted to address them. The company has hired and trained more people
 to field calls. Teams are in place to fast-track the most severe cases.
 Palmetto has taken the brunt of the doctors' ire. The cover of
 Southern California Physician magazine that hit mailboxes this week features a
 huge picture of a cockroach, also called a Palmetto bug, with the word
 "INFESTATION!" stripped across the front. The article opens with one
 doctor telling Barlow, "I wish I had a tomato," as he stood before an
 angry crowd at a California Medical Assn. meeting last month. Critics of
 the switch say the federal Medicare agency is also to blame for
 undertaking two major transitions within months of each other. In an effort to
 cut costs, the agency picked a contractor that was not equipped or
 prepared to handle California's Medicare providers, they contend. But
 federal officials defend the choice. Torris Smith, an associate regional
 administrator for the agency, said Palmetto has more than 40 years of
 experience as a Medicare contractor and was selected after a "full and
 open competition."
     Officials of both Palmetto and the federal agency said they expect
 the backlog of applications will be eased by 31 DEC. Claims,
 meanwhile, are being paid, they said. Medicare's regional office is also trying
 to assist doctors with serious problems, Smith said, and Palmetto will
 advance emergency payments. But change isn't coming soon enough for
 doctors and their staffs, who have wasted hours on hold with no relief.
 The California Medical Assn. has fielded calls from more than 1,000
 doctors seeking help with delayed reimbursements. Palmetto officials said
 they receive about 4,500 calls per day -- that's down from the 45,000
 calls on the first day when they had been expecting only 2,500. Through
 SEP, callers were met with a busy signal 90% of the time. With added
 phone lines, only 10% of the callers should be getting busy signals now,
 Barlow said. Dr. Sally Davis of Walnut Creek-based Cardiology Associates,
 who is doing the office laundry along with her two partners, said,
 "It's unbelievably embarrassing that we've reached that point." Dirty
 linens, though, is the least of her problems.  Roughly 80% to 85% of her
 patients are on Medicare, and the practice is owed more than $700,000.
 [Source:  Los Angeles Times Kimi Yoshino article 8 Nov 08 ++]

===============================

MEDICAD FUNDING UPDATE 01:   In the first of an expected avalanche of
 post-election regulations, the Bush administration on 7 NOV narrowed the
 scope of services that can be provided to poor people under Medicaid’s
 outpatient hospital benefit. The new rule conflicts with efforts by
 Congressional leaders and governors to increase federal aid to the states
 for Medicaid as part of a new economic action plan. President-elect
 Barack Obama has endorsed those efforts. At a news conference he said
 that legislation to stimulate the economy should include “assistance to
 state and local governments” so they would not have to lay off workers or
 increase taxes. In a notice published 7 NOV in the Federal Register,
 the Bush administration said it had to clarify the definition of
 outpatient hospital services because the current ambiguity had allowed states
 to claim excessive payments. “This rule represents a new initiative to
 preserve the fiscal integrity of the Medicaid program,” the notice
 said. But John W. Bluford III, the president of Truman Medical Centers in
 Kansas City, Mo., said: “This is a disaster for safety-net institutions
 like ours. The change in the outpatient rule will mean a $5 million hit
 to us. Medicaid accounts for about 55% of our business.”

     Alan D. Aviles, the president of the New York City Health and
 Hospitals Corporation, the largest municipal health care system in the
 country, said: “The new rule forces us to consider reducing some outpatient
 services like dental and vision care. State and local government
 cannot pick up these costs. If anything, we expect to see additional cuts at
 the state level.” Carol H. Steckel, the commissioner of the Alabama
 Medicaid Agency, said the rule would reduce federal payments for
 outpatient services at two large children’s hospitals, in Birmingham and Mobile
 AL. Richard J. Pollack, the executive vice president of the American
 Hospital Association, said these concerns were valid. “The new
 regulation,” Mr. Pollack said, “will jeopardize important community-based
 services, including screening, diagnostic and dental services for children,
 as well as lab and ambulance services.” Herb B. Kuhn, the deputy
 administrator of the Centers for Medicare and Medicaid Services, defended the
 rule. “We are not trying to deny services,” Mr. Kuhn said. “We want to
 pay for them more accurately and appropriately. Payments for some
 services were way higher than they should be.”

     The rule narrows the definition of outpatient hospital services to
 exclude those that could be provided and covered outside a hospital.
 In May, the White House said it wanted to avoid the rush of “midnight
 regulations” that had occurred at the end of other administrations. But
 Bush administration officials said this week that they still intended to
 issue, or relax, many economic, environmental, health and safety rules
 before they leave office on 20 JAN. Medicaid, financed jointly by the
 federal government and the states, provides health insurance to more
 than 50 million low-income people. Services can often be billed at a
 higher rate if they are performed in the outpatient department of a
 hospital rather than in a doctor’s office or a free-standing clinic. Hospitals
 generally have higher overhead costs. Matt D. Salo, a health policy
 specialist at the National Governors Association, said, “The new rule is
 consistent with the administration’s effort to squeeze, shrink and
 flatten Medicaid spending.” In a recent letter, the governors urged
 Congress to increase the federal share of Medicaid for at least two years.
 With state tax revenues plunging, many governors are considering cuts in
 Medicaid and other programs. Such cuts, they say, would further depress
 economic activity.

    Ann Clemency Kohler, the executive director of the National
 Association of State Medicaid Directors, said: “The new rule is a pretty
 sweeping change from longtime Medicaid policy. Since the beginning of the
 program, states have been allowed to define hospital outpatient services.
 We have to question why the rule is being issued now, three days after
 the election, with a new administration coming in.” The rule was
 proposed in SEP 07. It takes effect on 8 DEC, six weeks before Mr. Bush
 leaves office. Ms. Kohler said the rule would cut “money going to the
 states, to safety net providers, at a time when states are really being
 stressed. More and more people are coming onto Medicaid. People are losing
 their jobs and running out of unemployment benefits. Some employers can
 no longer afford to provide health insurance to their workers.” In the
 last 18 months, Congress has imposed moratoriums on six other rules
 that would have cut Medicaid payments. But the administration says
 Congress did not block this rule. Larry S. Gage, the president of the
 National Association of Public Hospitals, said, “We will urge Congress to
 extend the moratorium to this rule, and we will ask the Obama
 administration to withdraw it.”  [Source: New York Times Robert Pear article 7 Nov
 08 ++]

===============================

MISSING IN AMERICA PROJECT UPDATE 01:   Eleven veterans from three
 branches of the military were laid to rest 7 NOV at a state veterans
 cemetery, thanks to the efforts of a project that matches records of those
 who served their country with unclaimed remains in funeral homes. In this
 case, the cremated remains of all 11 came from a single funeral home
 in north Idaho. The veterans had served in three different wars. One of
 them, Sgt. James Overton, served in World War I and died Nov. 14, 1939.
 "It's sad to think they were lost in some funeral home," said Sharon
 Bowman, a 57-year-old state employee with the Idaho Department of Health
 and Welfare in Nampa. Bowman was among a small crowd that gathered at
 the Idaho State Veterans Cemetery to honor the veterans, who were
 identified through the Missing in America Project, a nonprofit organization
 that locates the unclaimed remains of veterans with assistance from
 state and federal agencies. The unclaimed remains of 50 service members
 have been found since 2005 in Idaho, where efforts at the state veterans
 cemetery inspired the creation of the nationwide Missing in America
 Project, Fred Salanti, a 60-year-old Vietnam veteran and director of the
 organization, said in a telephone interview.

     Nationwide, the Missing in America Project has coordinators in 45
 states who have identified the cremated remains of nearly 500 solders.
 About 350 have been laid to rest in veterans cemeteries. "We are their
 family," Salanti said. "We stand in and sign documents at the national
 cemeteries and the state cemeteries so they can receive those honors."
 The 11 veterans honored in Boise were from Idaho, California and
 Washington state, said Zach Rodriguez, director of the Idaho State Veterans
 Cemetery. The servicemen have been identified as veterans from the U.S.
 Army, Air Force and Marine Corps. They served in the Vietnam War, World
 War I and World War II. The remains were identified earlier this year
 at a Lewiston funeral home. "Once they've been abandoned for more than
 a year, there's a state statute that allows us to go recover the
 remains," Rodriguez said. Members of the Missing in America Project
 crosscheck data on U.S. service members from a national data center with names
 and birthdates on unclaimed remains at funeral homes.  For more info on
 the Missing in America Project refer to www.miap.us.  [Source: AP
 Jessie L. Bonner article 7 Nov 08 ++]
===============================

TOMB OF THE UNKNOWNS UPDATE 02:   A proposal to replace the cracked and
 weathered white marble monument that crowns the Tomb of the Unknowns
 at Arlington National Cemetery has stirred up a years-long controversy.
 The always-guarded tomb to the nation’s war dead is a potent symbol of
 sacrifice and patriotism and the above-ground monument, which has
 cracks running 48 feet around it, is the most visible part of it. Congress
 authorized the tomb in 1921 as a memorial to honor the unknown dead of
 World War I, which had ended three years earlier. On 11 NOV that year —
 then known as Armistice Day and now Veterans Day — an unidentified
 American soldier from the war was interred in an underground vault. For
 years, Army officials have studied the idea of building a replica because
 of concerns that the damage, which is getting worse despite repairs, is
 distracting from the monument’s solemn appearance. Moreover, officials
 say, replacement marble is becoming scarce and should be secured now.
 An August report said the Army would again repair the monument while a
 final decision is being made. The repairs would cost about $65,000, and
 a replica monument would cost about $2.2 million. “The importance of
 preserving that tomb as long as possible is paramount,” said Tom
 Sherlock, the cemetery historian. “The decision has been made to repair as
 much as possible and to only ultimately replace it if that becomes a
 necessity in the future.”    

     Preservationists and others argue that repairs should continue
 since the authentic monument conveys a symbolism that a replica cannot
 duplicate. The sarcophagus-shaped monument is a solid block of marble,
 weighing 36 tons and topped with a 12-ton cap and resting on a 16-ton
 base, according to the U.S. Army Military District of Washington. Four
 other pieces of marble are used in the sub-base. In the years since 1921,
 unknown service members from World War II, the Korean War and Vietnam
 were added, with their tombs marked by marble slabs in the tomb’s plaza.
 The Vietnam soldier’s remains were later exhumed and identified, and
 that tomb remains vacant, although a new plaque was added to honor the
 nation’s missing service members from 1958 to 1975. The Army’s new report
 said the cracks are not compromising the stone’s structural integrity
 and are repairable, but the monument’s condition will continue to
 deteriorate. Repeated repairs will leave the monument looking “patched, worn
 and shabby,” counter to the cemetery’s purpose of maintaining a
 dignified memorial to the nation’s war dead, the report said. The Army has
 support for its position of repairing the monument now but keeping the
 option open to replace it in the future. The Veterans of Foreign Wars and
 American Legion also support the Army’s strategy. [Source: Gannett
 News Service Dennis Camire article 7 Nov 08 ++]

===============================

DISABILITY EVALUATION SYSTEM:    Wounded service members leaving the
 military will have easier, quicker access to their veterans benefits due
 to the expansion of a pilot program that will offer streamlined
 disability evaluations that will reach 19 military installations, representing
 all military departments. The Department of Veterans Affairs (VA)
 announced 7 NOV the expansion of the Disability Evaluation System (DES)
 pilot which started in the National Capitol Region in coordination with
 Departments of Defense (DoD).  The pilot is a test of a new process that
 eliminates duplicative, time-consuming and often confusing elements of
 the two current disability processes of the departments. The initial
 phase of the expansion started on 1 OCT with Fort Meade, Md. and Fort
 Belvoir , Va.   The remaining 17 installations will begin upon completion
 of site preparations and personnel orientation and training, during an
 8-month period from NOV 08 to May 09.  “The decision to expand the
 pilot was based upon a favorable review that focused on whether the pilot
 met its timeliness, effectiveness, transparency, and customer and
 stakeholder satisfaction objectives,” said Sam Retherford, Director, officer
 and enlisted personnel management, Office of the Under Secretary of
 Defense for Personnel and Readiness.  “This expansion extends beyond the
 national capital region, so that more diverse data from other geographic
 areas can be evaluated, prior to rendering a final decision on
 worldwide implementation.” 
 
    The remaining installations to begin the program are: Army: Fort
 Carson, Colo.; Fort Drum, N.Y.; Fort Stewart, Ga.; Fort Richardson,
 Alaska; Fort Wainwright, Alaska; Brooke Army Medical Center, Texas; and Fort
 Polk, La.  Navy: Naval Medical Center (NMC) San Diego and Camp
 Pendleton, Calif. ; NMC Bremerton , Wash. ; NMC Jacksonville , Fla. ; and Camp
 Lejeune , N.C.   Air Force: Vance Air Force Base, Okla.; Nellis Air
 Force Base, Nev.; MacDill Air Force Base, Fla.; Elmendorf Air Force Base,
 Alaska.; and Travis Air Force Base, Calif. In November 2007 VA and DoD
 implemented the pilot test for disability cases originating at the
 three major military treatment facilities in the national capitol region.
  To date, over 700 service members have participated in the pilot over
 the last ten months.  The single disability examination pilot is
 focused on recommendations from the reports of the Task Force on Returning
 Global War on Terrorism Heroes, the Independent Review Group, the
 President’s Commission on Care for America’s Returning Wounded Warriors (the
 Dole/Shalala Commission), and the Commission on Veterans’ Disability
 Benefits. [Source: VA Media relations 7 Nov 08 ++]

===============================

ARIZONA MEMORIAL:    Aging, frail survivors of the 1941 Japanese attack
 on Pearl Harbor gingerly sifted dirt as they helped to break ground on
 a new visitor’s center for the Arizona Memorial. The current visitor’s
 center — across the harbor from the submerged battleship — is sinking
 because it was built on reclaimed land, causing water to seep into its
 basement. Engineers estimate the building will last only a few more
 years. The center is where visitors board ferries taking them to the white
 memorial straddling the sunken hull of the Arizona. It’s also where
 they learn about the attack through exhibits and films, making it vital
 for conveying the history of the day that launched the U.S. into World
 War II. The National Park Service, which runs the memorial, and the
 Arizona Memorial Museum Association, which supports it, have spearheaded
 the effort to build a replacement visitor’s center so they can continue
 to tell the story of Pearl Harbor.

     Sen. Daniel K. Inouye, D-Hawaii, a World War II veteran, told the
 several hundred people gathered for the groundbreaking 5 NOV that
 walking through the visitor’s center exposes people to the devastation and
 despair Americans felt during the attack. It also instills in them
 unwavering resolve, he said. “We must always remember our history. While
 there were painful lessons learned, it is also the source of our inner
 strength and our spirit,” Inouye said. “We must never allow that torch to
 flicker out.” Inouye, 84, witnessed Japanese fighter planes flying over
 Oahu on Dec. 7, 1941, when he was a 17-year-old high school student
 living in Honolulu. He served as a first-aid volunteer, helping to treat
 civilians wounded when misfired U.S. anti-aircraft shells fell on homes
 and businesses. In 1943, he joined the 442nd Regimental Combat Team, a
 highly decorated unit of mostly Japanese-Americans. In 2000, President
 Clinton presented him with the Medal of Honor.

     Herb Weatherwax, a 91-year-old attack survivor, said the new
 visitor’s center would help survivors and the park service tell the story of
 the attack. “I just hope that I live long enough for it,” he said. The
 building is due to be completed by December 2010. The Pearl Harbor
 Memorial Fund has raised nearly $54 million of the estimated $58 million
 cost of the center. Donations from individuals will cover more than $22
 million of it, while the federal government is putting up $29.6 million
 and the state of Hawaii is paying $2 million. The current center,
 built in 1980, was designed to accommodate about 2,000 visitors a day. But
 more than 4,000 people have been visiting daily on average since the
 1980s, straining its resources. The Arizona sank nine minutes after a
 being hit by an aerial bomb dropped by a Japanese plane. It is an
 underwater grave for more than 1,000 sailors and Marines unable to escape.
 There were 1.4 million gallons of fuel on the USS Arizona when she sank.
 Over 60 years later, approximately two quarts a day still surfaces from
 the ship. Some Pearl Harbor survivors have referred to the oil droplets
 as "Black Tears."

     There is no charge for admission to the memorial.  Complementary
 tickets are distributed on a first-come, first-served basis (these
 tickets are not reservable) for timed programs to the memorial. Timed
 programs include a 23-minute documentary film about the attack on Pearl
 Harbor and the boat trip to the USS Arizona Memorial. Programs begin at 7:45
 a.m. The last program each day begins at 3:00 p.m. Tickets are issued
 on a first-come, first-served basis. The wait time for a program may be
 as much as three hours depending on the season. There is a female and
 male restroom facility on-site. Visitors may want to use restroom
 facilities in the parking lot or at the Bowfin Submarine Memorial and Museum
 during busy times. Both restrooms have diaper changing tables. There
 is no shower or locker room. The minimum dress attire for the USS
 Arizona Memorial is footwear, shorts and shirt. Sandals and Flip Flops are
 permissible, but bathing suits or profane T-shirts are not allowed
 on-site. The minimum dress attire for military personnel is dress whites or
 better, or service equivalent. BDU'S are not allowed on the memorial.
 There are no age restrictions at the national memorial. Pets are not
 permitted. Service animals are not considered pets and are allowed.
 [Source: AP Audrey McAvoy article 6 Nov 08 ++]

===============================

TRICARE PHARMACY POLICY UPDATE 03:   When Express Scripts (ESI) was
 chosen to administer the Tricare pharmacy benefit, they committed to doing
 their part to provide a quality benefit that DOD beneficiaries can
 count on for years to come. One way they do this is by effectively
 managing their retail pharmacy networks.  Recently, Walgreens had been unable
 to reach a contractual agreement with Express Scripts, the Tricare
 Pharmacy Contractor. Therefore, as of 1 JAN 09, Walgreens would have no
 longer be in the network used by the Tricare pharmacy plan.  That meant
 that if any beneficiary filled a prescription at Walgreens after 31 DEC
 08, they would have had to pay 100% of the cost and then file a paper
 claim for non- network benefit reimbursement. For more information on
 cost shares when using a non-network pharmacy refer to:
 http://member.express-scripts.com/dodCustom/benefitSummary.do#3. There
 are three easy ways to transfer your prescriptions:

1. Have the medications you take on an ongoing basis safely and
 conveniently delivered through Home Delivery from the Tricare Mail Order
 Pharmacy (TMOP). Visit www.express-scripts.com/Tricare to switch your
 eligible prescriptions to Home Delivery today.
2. Transfer the prescriptions you take on an ongoing basis to TMOP by
 asking your doctor to fax your eligible prescription(s) to
 1-877-895-1900. This fax number is for healthcare providers only.
3. Have your prescription bottles ready and call or visit the network
 pharmacy of your choice. You may fill your prescriptions at other major
 pharmacies and independent drug stores that remain part of the network
 used by Tricare.  For a complete list of local pharmacies in the
 network used by the Tricare pharmacy plan, refer to
 www.express-scripts.com/Tricare.  If you have questions, call Express Scripts anytime at
 1-877-425-1139.

There are 756,000 Tricare beneficiaries who use Walgreens that were
 sent letters advising them of this change.  ESI was hopeful that Walgreens
 would ultimately decide to continue their service to Tricare
 beneficiaries and strike a deal after the beneficiary letters had been sent.
  That is exactly what happened.  Beneficiaries who received letters from
 Express Scripts concerning Walgreens will receive another letter from
 Express Scripts stating that Walgreens is still a viable retail option in
 2009.  ESI exceeds all Tricare Pharmacy contractual access and size
 requirements. The current network has 60,149 stores. Access standards
 are:
a. Urban (1 pharmacy in 2 miles) 96.1%
b. Suburban (1 pharmacy in 5 miles) 99.8%
c. Rural (1 pharmacy in 15 miles) 99.0%
[Source:  EANGUS Minuteman Update 6 & 13 Nov 08 ++]

===============================

VA CATEGORY 8 CARE UPDATE 07:   President-elect Barack Obama has vowed
 to reverse or sharply modify many of the Bush administration's
 policies. Based on his campaign promises he wants to expand VA health care for
 veterans. Congress voted in 1996 to do that, but the agency has
 exercised its authority to suspend enrollments as needed. Obama has said that
 led to 1 million veterans being turned away, and he has promised to
 reverse the policy. He also said he would improve screening and treatment
 for mental health conditions and traumatic brain injury; expand the
 number of housing vouchers and start a program to help veterans at risk of
 being homeless; add more rural veterans centers; create an electronic
 system to transfer medical records from the military; and improve
 preventative health options. The Senate Veterans Affairs Committee is also
 expected to push for changes at the VA. CongressionaL Quarterly
  reports, "As the new president moves to bring troops home from Iraq and
 fortify" the US presence in Afghanistan, the Senate Veterans Affairs
 Committee "will be spurring" the VA to "ramp up its capacity to provide
 medical, readjustment, disability and housing benefits to veterans and their
 families." The committee "is likely to try to rebuild the VA
 compensation system from the ground up. That could include creating a uniform
 information technology system to manage VA claims and figuring out what
 should be included in claims notification letters." [Source: AP Kimberly
 Hefling & GC Jonsom articles 6 Nov 08 ++]

===============================

TSP UPDATE 11:   The Thrift Savings Plan weathered another difficult
 month in October as every fund except the government securities option
 lost ground.

• The G Fund -- the plan's most stable offering -- rose 0.31% in OCT,
 following a 0.31% increase in SEP. The fund is up 3.18% since JAN and
 3.95% since OCT 07. It is the only offering that has posted positive
 returns in 2008, and one of only two funds to make gains during the past 12
 months.
• The F Fund is the only other fund that is up since OCT 07.   It is a
 portfolio of fixed-income bonds. That offering has grown 0.52% in the
 past 12 months, though it fell 2.4% in OCT and is down 1.59% for 2008.
• The S Fund, which invests in small- and mid-size U.S. companies and
 tracks the Dow Jones Wilshire 4500 Index, posted the largest OCT loss:
 its value fell 20.99%. The fund is down 33.69% since the beginning of
 2008, and 37.69% for the past 12 months.
• The I fund, which invests in European, Asian and Australian companies
 and suffered the largest losses of any TSP fund in SEP, was close
 behind the S Fund in OCT, falling 20.59%. The I Fund has dropped 42.67% in
 2008 and 46.05% since OCT 07. Those are the largest 2008 and 12-month
 losses of any TSP offering.
• The C Fund, which tracks Standard & Poor's 500 Index, was down 16.83%
 in October, and 32.84% since the beginning of 2008. The fund has
 fallen 36.08% since OCT 07.

All the life-cycle funds, which make riskier but more aggressive
 investments for younger workers and shift to more conservative allocations as
 employees approach retirement, lost more in OCT than in SEP. The L
 2040 Fund fell 15.4%, the L 2030 Fund lost 13.4%, the L 2020 Fund dropped
 11.1%, the L 2010 Fund slid 5.41% and the L Income Fund for investors
 closest to retirement fell 3.44%. Those losses deepened the overall
 declines for the life-cycle funds both in 2008 and for the past 12 months.
 The L 2040 Fund is down 29.82% in 2008 and 32.73% for the past year,
 the L 2030 Fund is down 26.11% in 2008 and 28.73% for the past 12 months.
 The L 2020 Fund has declined 21.83% since the beginning of the year
 and 24.06% since OCT 07. The L 2010 Fund is down 10.57% this year and
 11.77% from the same time a year ago, while the L Income Fund has fallen
 5.43% in 2008 and 5.78% during the past 12 months. [Source: GovExec.com
 Alyssa Rosenberg article 3 Nov 08 ++]

===============================

IMMUNIZATIONS UPDATE 01:    Feeling woozy after your latest round of
 immunization shots then you’re probably a male airman. Ten years of
 records showed that 2,612 service members passed out cold — and fell down —
 after a nurse slowly inserted a thin half-inch of steel into their
 biceps or buttocks. Data from the Armed Forces Health Surveillance Center
 shows that the rate of airmen who fell out was twice that of soldiers
 and sailors — Marines fall in between — and that twice as many men as
 women were among the fainthearted. The overall numbers also are rising;
 today’s service members are 2½ times more likely to faint from getting a
 shot than they were in 1998. Possibly worse than the risk of ridicule
 is the risk of injury, the report states, “particularly when collapse
 leads to forceful contact between the face or skull ... and a sharp or
 solid object nearby.” Researchers found 150 examples of fractures, brain
 injuries, open wounds, contusions, sprains and strains. Fainting occurs
 when blood vessels dilate and blood pressure decreases among people
 who stand for too long, don’t like the sight of blood or fear pain,
 experts say.  [Source: Navy Times Staff Report 3 Nov 08 ++]

===============================

VA RADIATION UNDER DOSING:    Nearly six months after a physicist at
 the Veterans Affairs Medical Center in Philadelphia discovered that a
 patient being treated for prostate cancer had received
 lower-than-prescribed radiation doses, inspectors with VA's National Health Physics
 Program have found more than 100 similar cases at four facilities. VA
 officials have declined repeated requests for information about the
 department's brachytherapy programs, in which radioactive seeds are implanted
 into the prostate. In October, the Nuclear Regulatory Commission, which
 licenses VA's radiation programs, announced that the department had
 suspended treatment at hospitals in Cincinnati; Jackson, Miss., and
 Washington. The Philadelphia program was suspended earlier. VA spokeswoman
 Laurie Tranter said on 15 OCT that officials would not discuss the program
 suspensions or any aspect of the investigation until the department
 issues a press release. VA still had not issued a release by 3 NOV. "It's
 not any particular person" delaying the statement, she said. "It's the
 process." Nonetheless, reports filed with NRC and recently made public
 shed some light on the investigation.

        VA is required by law to notify the commission whenever it
 discovers radiation dosing errors that vary by 20% or more from the
 prescribed dose. Reports filed through October show that VA investigators had
 found 92 cases of improper dosing at the Philadelphia center as of 2
 OCT. Nine cases had been identified at the Jackson Medical Center as of
 30 OCT; six cases at the Cincinnati Medical Center as of 7 OCT; and
 three at the Washington Medical Center as of 26 SEP. NRC records are made
 public within 30 days of filing. The initial discovery of under dosing
 at Philadelphia stemmed from a brachytherapy procedure that took place 5
 MAY. "Seeds of a lower apparent activity than intended were mistakenly
 ordered and implanted," according to the initial VA report to NRC on
 16 MAY. As the investigation unfolded, the Philadelphia report was
 updated as new cases of improper dosing were discovered. The most recent
 update was 2 OCT, when investigators reported the discovery of an
 additional 37 patients for whom "medical events" had been identified. That
 brought the total number of patients receiving incorrect doses at
 Philadelphia to 92.

     According to the report filed with NRC, "35 of the additional
 medical events involve doses to organs or tissues other than the treatment
 site." The other two newly identified patients received doses to the
 treatment site (the prostate) that were below 80% of what was prescribed.
 None of the reports filed with NRC is considered "emergency events,"
 but NRC has hired an independent consultant to assess the effect of the
 errors on patients' health. That assessment is ongoing. Viktoria
 Mitlyng, a spokeswoman with NRC's regional office in Lisle Illinois said the
 commission is monitoring VA's investigation of programs at 13 hospitals
 that perform brachytherapy, including the four whose programs were
 suspended. It is possible programs at other hospitals will be suspended,
 depending on what investigators find there, Mitlyng said. "We don't have
 a timeline" for the investigation of all 13 hospitals, she said. "We
 want to make sure it's done properly."  [Source: GovExec.com Katherine
 McIntire Peters article 3 Nov 08 ++]

===============================

NPRC SCAM:    The below email was received by myself and a number of
 other vets who are asking if it i legitimate. A review of the website
 provided in the message revealed that it contains a number of veteran
 related informational items but does not provide any information on who the
 owner/sponsors of this site are or any background that would attest to
 the legitimacy of the site.  Since this web site ends in dot.com vice
 dot.gov  it is not a government site and could possibly be a scam to
 get personal information.  Readers are advised to exercise caution before
 providing any personal information or records.
 
"HOUSTON , TX (October 21, 2008)  In order to alleviate the strain on
 the National Personnel Records Commission (NPRC), and Veterans Affairs
 (VA), U.S. Veteran Compensation Programs introduced today that veterans
 can permanently store their service medical records (SMR), legal
 records, or military records in their new, user-friendly, Records Archive
 Division (RAD). http://www.veteranprograms.com" 
[Source:  CA DVBE Advocate Ted Puntillo msg 3 Nov 08 ++]

===============================

WARTS:    Other than being a nuisance, most warts are harmless and go
 away on their own. They are normally non-cancerous skin growths caused
 by a viral infection in the top layer of the skin.  However, in some
 cases they can become cancerous.  Warts are usually skin-colored and feel
 rough to the touch, but they can be dark, flat and smooth. These skin
 infections, which are more common in kids than in adults, are caused by
 viruses of the human papillomavirus (HPV) family. They can affect any
 area of the body, but tend to invade warm, moist places, like small cuts
 or scratches on the fingers, hands, and feet. They are usually
 painless unless they're on the soles of the feet or another part of the body
 that gets bumped or touched all the time.  Kids can pick up HPV and get
 warts from touching anything someone with a wart has used, like towels
 and surfaces. The appearance of a wart depends on where it is growing.
 There are several different kinds of warts including:

• Common warts usually grow on the fingers, around the nails and on the
 backs of the hands. They are more common where skin has been broken,
 for example where fingernails are bitten or hangnails picked. These are
 often called "seed" warts because the blood vessels to the wart produce
 black dots that look like seeds.
• Foot warts are usually on the soles (plantar area) of the feet and
 are called plantar warts. When plantar warts grow in clusters they are
 known as mosaic warts. Most plantar warts do not stick up above the
 surface like common warts because the pressure of walking flattens them and
 pushes them back into the skin. Like common warts, these warts may have
 black dots. Plantar warts have a bad reputation because they can be
 painful, feeling like a stone in the shoe.
• Flat warts are smaller (about the size of a pinhead) and smoother
 than other warts. They tend to grow in large numbers - 20 to 100 at any
 one time. They may be pink, light brown, or yellow. They can occur
 anywhere, but in children they are most common on the face. In adults they
 are often found in the beard area in men and on the legs in women.
 Irritation from shaving probably accounts for this.
• Filiform warts. These have a finger-like shape, are usually
 flesh-colored, and often grow on or around the mouth, eyes, or nose.

 Warts are passed from person to person, sometimes indirectly. The time
 from the first contact to the time the warts have grown large enough
 to be seen is often several months. The risk of catching hand, foot, or
 flat warts from another person is small. Some people get warts
 depending on how often they are exposed to the virus. Wart viruses occur more
 easily if the skin has been damaged in some way, which explains the high
 frequency of warts in children who bite their nails or pick at
 hangnails. Some people are just more likely to catch the wart virus than are
 others, just as some people catch colds very easily. Patients with a
 weakened immune system also are more prone to a wart virus infection. In
 children, warts can disappear without treatment over a period of several
 months to years. However, warts that are bothersome, painful, or
 rapidly multiplying should be treated. Warts in adults often do not
 disappear as easily or as quickly as they do in children. Dermatologists are
 trained to use a variety of treatments, depending on the age of the
 patient and the type of wart.

• Common warts: Young children can be treated at home by their parents
 on a daily basis by applying salicylic acid gel, solution or plaster.
 There is usually little discomfort but it can take many weeks of
 treatment to obtain favorable results. Treatment should be stopped at least
 temporarily if the wart becomes sore. Warts may also be treated by
 "painting" with cantharidin in the dermatologist's office. Cantharidin causes
 a blister to form under the wart. The dermatologist can then clip away
 the dead part of the wart in the blister roof in a week or so. For
 adults and older children cryotherapy (freezing) is generally preferred.
 This treatment is not too painful and rarely results in scarring.
 However, repeat treatments at one to three week intervals are often
 necessary. Electrosurgery (burning) is another good alternative treatment. Laser
 treatment can also be used for resistant warts that have not responded
 to other therapies.
• Foot warts: Difficult to treat because the bulk of the wart lies
 below the skin surface. Treatments include the use of salicylic acid
 plasters, applying other chemicals to the wart, or one of the surgical
 treatments including laser surgery, electrosurgery, or cutting. The
 dermatologist may recommend a change in footwear to reduce pressure on the wart
 and ways to keep the foot dry since moisture tends to allow warts to
 spread.
• Flat warts: Often too numerous to treat with methods mentioned above.
 As a result, "peeling" methods using daily applications of salicylic
 acid, tretinoin, glycolic acid or other surface peeling preparations are
 often recommended. For some adults, periodic office treatments for
 surgical treatments are sometimes necessary.
• Laser therapy. Lasers are more expensive and require the injection of
 a local anesthesia to numb the area treated.
• Injection.  Each wart is injected with an anti-cancer drug called
 bleomycin. The injections may be painful and can have other side effects.
• Immunotherapy.  Attempts to use the body's own rejection system.
 Several methods of immunotherapy are being used. With one method the
 patient is made allergic to a certain chemical which is then painted on the
 wart. A mild allergic reaction occurs around the treated warts, and may
 result in the disappearance of the warts. Warts may also be injected
 with interferon, a treatment to boost the immune reaction and cause
 rejection of the wart.

 There are some wart remedies available without a prescription.
 However, you might mistake another kind of skin growth for a wart, and end up
 treating something more serious as though it were a wart. If you have
 any questions about either the diagnosis or the best way to treat a
 wart, you should seek your dermatologist's advice. Many people, patients
 and doctors alike, believe folk remedies and hypnosis are effective.
 Since warts, especially in children, may disappear without treatment, it's
 hard to know whether it was a folk remedy or just the passage of time
 that led to the cure. Since warts are generally harmless, there may be
 times when these treatments are appropriate. Medical treatments can
 always be used if necessary. Sometimes it seems as if new warts appear as
 fast as old ones go away. This may happen because the old warts have
 shed virus into the surrounding skin before they were treated. In reality
 new "baby" warts are growing up around the original "mother" warts. The
 best way to limit this is to treat new warts as quickly as they
 develop so they have little time to shed virus into nearby skin. A check by
 your dermatologist can help assure the treated wart has resolved
 completely. Research is moving along very rapidly. There is great interest in
 new treatments, as well as the development of a vaccine against warts.
 [Source:  Familydoctor.org May 08 ++]

===============================

WARTS UPDATE 01:   The U.S. Centers for Disease Control (CDC) and
 Prevention reported 3 NOV that the human wart virus HPV caused 25,000 cases
 of cancer a year in the United States between 1998 and 2003, including
 not only cervical cancer but also anal and mouth cancers. The study
 suggests a broad need for screening both men and women for human
 papillomavirus, or HPV. This virus category includes about 100 different
 viruses, and they are the leading cause of cervical cancer. The viruses,
 transmitted sexually and by skin-to-skin contact, can also cause anal and
 penile cancers, as well as cancers of the mouth and throat. Both Merck
 and Co. and GlaxoSmithKline make vaccines against some of the strains of
 HPV most strongly linked with cervical cancer. They are recommended for
 girls and young women who have not begun sexual activity. Dr. Maura
 Gillison of Johns Hopkins University in Baltimore, who has studied the
 link between HPV and oral cancers, said the findings suggest a wider use
 of the cervical cancer vaccines may be justified. "Currently available
 HPV vaccines have the potential to reduce the rates of HPV-associated
 cancers, like oral and anal cancers, that are currently on the rise and
 for which there is no effective or widely applied screening programs,"
 Gillison said in a statement. Last month researchers said their
 computer model indicated that vaccinating women as old as 45 could prevent
 some cases of cervical cancer, even though the vaccines do not protect
 anyone who has already been infected with one of the strains of HPV. An
 estimated 11,070 new cases of cervical cancer will be diagnosed in 2008
 in the United States, and 3,870 women will die of it. Cervical cancer is
 even more widespread globally where regular Pap smear and HIV tests
 are not available. An estimated 500,000 women globally are diagnosed with
 cervical cancer each year and 300,000 die of it. The CDC survey of 38
 states and Washington, D.C., found nearly 7,400 cancers of the mouth
 and throat that could be linked with HPV -- nearly 5,700 among men and
 about 1,700 among women. "There were more than 3,000 HPV-associated anal
 cancers per year -- about 1,900 in women and 1,100 in men," the CDC
 said. [Source: Reuters Maggie Fox article 3 Nov 08 ++]

===============================

TFL NEED-TO-KNOWS:    If you’re nearing retirement, transitioning
 health care coverage shouldn’t be a hassle. As you’re preparing to switch to
 TRICARE for Life (TFL), the following facts and tips will help you
 make a seamless transition to TRICARE for Life (TFL) coverage.

1.  Enroll in Medicare Part B when first eligible. TFL enrollment
 hinges on enrollment in Medicare Part B. You must remain enrolled in
 Medicare Part B (medical care) in order to maintain TRICARE eligibility.

2. Keep DEERS up to date. Although Medicare provides data to DEERS, you
 must maintain your TRICARE eligibility by keeping DEERS up to date any
 time there is a life changing event, like becoming eligible for
 Medicare. Contact DEERS online at www.dmdc.osd.mil/rsl or call toll-free
 1-800-538-9552.

3. Enrollment in TFL is seamless. If you are receiving Social Security
 benefits, you will transition smoothly to TFL upon your 65th birthday;
 if you are not receiving Social Security benefits at the time of your
 65th birthday, you will need to visit the nearest Social Security office
 and enroll in Medicare.

4. Medicare authorized providers are also TRICARE authorized. You can
 visit any Medicare provider for care since all Medicare providers are
 also TRICARE authorized. Simply show your Medicare card and Uniformed
 Services ID card at your appointment.

5. Claims are paid automatically between Medicare and TFL. As a TFL
 beneficiary, you will not need to submit a paper claim when you have a
 doctor’s visit (in most cases). The provider will submit the claim to
 Medicare. Medicare will then submit the claim to TRICARE once the Medicare
 portion is paid.

6. TFL is considered a second payer to Medicare. For services covered
 by Medicare and TRICARE, Medicare will pay its portion of the claim and
 TRICARE will pay the remainder. For services that are covered by
 Medicare and not by TRICARE (such as chiropractic care) TRICARE will not make
 a payment and the beneficiary will be responsible. Services covered by
 TRICARE but not Medicare (such as overseas claims) may be billed
 directly to Wisconsin Physicians Services (WPS) and TRICARE will pay as
 primary insurer. You will be responsible for any cost shares. Payments for
 services that are not covered by either program remain your sole
 responsibility.

7. Other health insurance (OHI) coordinates differently with TFL and
 Medicare. TFL beneficiaries who have OHI need to submit their Medicare
 Summary Notice with a paper claim and OHI explanation of benefits (EOB)
 to Wisconsin Physician Services. The paper claims may be sent to:
 Wisconsin Physician Services, TRICARE for Life, P.O. Box 7890, Madison, WI
 53707-7890

8. Enrollment in Medicare Part D is not necessary. The TRICARE pharmacy
 benefit is considered creditable coverage and pays equally to
 Medicare.

9. TFL beneficiaries may continue to use any of the TRICARE pharmacy
 programs. You may fill prescriptions at any military treatment facility
 pharmacy, through the TRICARE Mail Order Pharmacy or through any TRICARE
 network or non-network pharmacy.

10. TRICARE coverage continues for eligible family members after the
 death of a sponsor.
Surviving spouses remain eligible for TRICARE unless they remarry. If
 they remarry, they lose TRICARE eligibility and cannot regain
 eligibility later, even in cases of divorce or death of the new spouse. Unmarried
 surviving children remain eligible for TRICARE until their 21st
 birthday (or 23rd birthday if enrolled in college full time and if at the
 time of the sponsor’s death, the sponsor provided more than 50 percent of
 the child’s financial support.) For more information on TRICARE for
 Life, please visit www.tricare4u.com or call Wisconsin Physicians Services
 toll-free at 1-866-773-0404.
[Source: USDR Action alert 30 Oct 08 ++]

===============================

UNIFORM WEARING UPDATE 01:   On October 31st of each year, small
 children (and some not-so-small "children") dress up in costumes and go
 door-to-door begging strangers for candy. Some of these folks, both small
 and tall will be wearing replicas of United States Military Uniforms. Is
 that legal? Can you dress up your little Rambo to look like a United
 States Army Officer? What about your big Rambo? It would seem, on the
 surface, that the law is pretty plain, right? None of the categories of 10
 USC, Subtitle A, Part II, Chapter 45, Sections 771 and 772 state cover
 Halloween. Or, do they? Section 772 (f) allows the uniform to be worn
 in a theatrical production. Is Trick or Treat a "theatrical
 production?" Nobody knows, because no court has ever defined this. The closest a
 court has come is the Supreme Court, who used a very liberal
 interpretation of "theatrical production" in SCHACHT v. UNITED STATES, 398 U.S. 58
 (1970). In this case, the court said:

"Our previous cases would seem to make it clear that 18 U.S.C. 702,
 making it an offense to wear our military uniforms without authority is,
 standing alone, a valid statute on its face. See, e. g., United States
 v. O'Brien, 391 U.S. 367 (1968). But the general prohibition of 18
 U.S.C. 702 cannot always stand alone in view of 10 U.S.C. 772, which
 authorizes the wearing of military uniforms under certain conditions and
 circumstances including the circumstance of an actor portraying a member of
 the armed services in a "theatrical production" 10 U.S.C. 772 (f). The
 Government's argument in this case seems to imply that somehow what
 these amateur actors did in Houston should not be treated as a "theatrical
 production" within the meaning of 772 (f). We are unable to follow
 such a suggestion. Certainly theatrical productions need not always be
 performed in buildings or even on a defined area such as a conventional
 stage. Nor need they be performed by professional actors or be heavily
 financed or elaborately produced. Since time immemorial, outdoor
 theatrical performances, often performed by amateurs, have played an important
 part in the entertainment and the education of the people of the world.
 Here, the record shows without dispute the preparation and repeated
 presentation by amateur actors of a short play designed to create in the
 audience an understanding of and opposition to our participation in the
 Vietnam war. Supra, at 60 and this page. It may be that the
 performances were crude and [398 U.S. 58, 62] amateurish and perhaps unappealing,
 but the same thing can be said about many theatrical performances. We
 cannot believe that when Congress wrote out a special exception for
 theatrical productions it intended to protect only a narrow and limited
 category of professionally produced plays. Of course, we need not decide
 here all the questions concerning what is and what is not within the
 scope of 772 (f). We need only find, as we emphatically do, that the
 street skit in which Schacht participated was a "theatrical production"
 within the meaning of that section.”

     Notable is in making this decision, the Supreme Court also struck
 the words, "if the portrayal does not tend to discredit that armed
 force," from the statute as unconstitutional. The court said:  “This brings
 us to petitioner's complaint that giving force and effect to the last
 clause of 772 (f) would impose an unconstitutional restraint on his
 right of free speech. We agree. This clause on its face simply restricts
 772 (f)'s authorization to those dramatic portrayals that do not "tend
 to discredit" the military, but, when this restriction is read together
 with 18 U.S.C. 702, it becomes clear that Congress has in effect made
 it a crime for an actor wearing a military uniform to say things during
 his performance critical of the conduct or [398 U.S. 58, 63] policies
 of the Armed Forces. An actor, like everyone else in our country, enjoys
 a constitutional right to freedom of speech, including the right
 openly to criticize the Government during a dramatic performance. The last
 clause of 772 (f) denies this constitutional right to an actor who is
 wearing a military uniform by making it a crime for him to say things
 that tend to bring the military into discredit and disrepute. In the
 present case Schacht was free to participate in any skit at the
 demonstration that praised the Army, but under the final clause of 772 (f) he could
 be convicted of a federal offense if his portrayal attacked the Army
 instead of praising it. In light of our earlier finding that the skit in
 which Schacht participated was a "theatrical production" within the
 meaning of 772 (f), it follows that his conviction can be sustained only
 if he can be punished for speaking out against the role of our Army and
 our country in Vietnam. Clearly punishment for this reason would be an
 unconstitutional abridgment of freedom of speech. The final clause of
 772 (f), which leaves Americans free to praise the war in Vietnam but
 can send persons like Schacht to prison for opposing it, cannot survive
 in a country which has the First Amendment. To preserve the
 constitutionality of 772 (f) that final clause must be stricken from the section.”
 

     So, is it illegal for your kid to dress up as an Air Force officer
 for Halloween? Unknown for sure, but very probably not. Separate from
 technical legality is whether or not it really matters. If your kid
 wears the uniform, would that result in arrest and prosecution? Almost
 certainly not. Under our legal system, district attorneys have are given a
 wide latitude of what law violations to prosecute and which ones to
 ignore. [Source:  About.com: US military 28 Oct 08 ++]

===============================

VA PRESUMPTIVE ATOMIC VET DISEASES UPDATE 01:   The Department of
 Veterans Affairs presumes that specific disabilities diagnosed in certain
 veterans were caused by their military service. If one of these
 conditions is diagnosed in Vietnam Vet, VA presumes that the circumstances of
 his/her service (i.e. exposure to agent Orange) caused the condition, and
 disability compensation can be awarded. This includes DIC education
 and CHAMPVA for spouses of veterans rated 100% or surviving spouses
 late-veterans that died from discussed medical problems. The following
 disabilities may be presumed for those who participated in atmospheric
 nuclear testing; occupied or was a POW in Hiroshima or Nagasaki; service
 before 1 FEB 92 at a diffusion plant in Paducah, KY, Portsmouth, OH, or
 Oak Ridge, TN; or service before 1 JAN 74 at Amchitka Island, AK:
• All forms of leukemia (except for chronic lymphocytic leukemia)
• Cancer of the thyroid, breast, pharynx, esophagus, stomach, small
 intestine, pancreas, bile ducts, gall bladder, salivary gland, urinary
 tract (renal pelves, ureter, urinary bladder and urethra), brain, bone,
 lung, colon, ovary
• Bronchiolo-alveolar carcinoma
• Multiple myeloma
• Lymphomas (other than hodgkin's disease)
• Primary liver cancer (except if cirrhosis or hepatitis B is
 indicated)
[Source: County of Humboldt Veterans Service office 12 Oct 08 ++]

===============================

DOD PDBR UPDATE 02:    Service members who have been medically
 separated since 11 SEP 01 will have the opportunity to have their disability
 ratings reviewed to ensure fairness and accuracy. The new Physical
 Disability Board of Review (PDBR) will examine each applicant's medical
 separation, compare DoD and VA ratings, and make a recommendation to the
 respective Service Secretary (or designee).  A disability rating cannot be
 lowered and any change to the rating is effective on the date of final
 decision by the Service Secretary. To be eligible for PDBR review, a
 service member must have been medically separated between 11 SEP 01  and
 31 DEC 09 with a combined disability rating of 20% or less, and not
 found eligible for retirement. There are significant differences between
 this new PDBR review and a Board for Correction of Military (or Naval)
 Record (BCMR/BCNR) review. These differences are outlined at
 http://www.health.mil/Content//docs/COMPARISON.pdf and will also be on
 the application.

     While the Air Force is the lead for the PDBR process, case
 tracking and reporting, a joint service board will conduct the evaluation and
 review of each case. Applicants will not be able to appear in person,
 but may
include any statements, briefs, medical records or other supporting
 documents with their application. After the document review is completed
 and a final decision is made, each applicant will be notified of the
 decision and any further information regarding a change of rating. Pending
 final approval, the application form should be available on the MHS
 Web Site (http://www.health.mil/) on or about1 DEC 08. Applications will
 be accepted immediately thereafter. For more information about the PDBR
 refer to the FAQ document at.
http://www.health.mil/Content//docs/PDBR%20Question%20and%20Answers.pdf.
 You can contact the PDBR intake unit at SAF/MRBR, 550 C Street West,
 Suite 41,  Randolph AFB, Texas 78150-4743. Keep in mind that this office
 cannot discuss the merits of your application. You may wish to contact
 your local veterans' service organization for advice or guidance. The
 DoD Instruction on the PDBR process is available at:
 http://www.dtic.mil/whs/directives/corres/pdf/604044p.pdf . [Source:
 DoD Military Health System News 3 Nov 08 ++]

===============================

VA CLAIM SHREDDING UPDATE 01:    The Department of Veterans Affairs is
 finalizing a sweeping new records policy to prevent the destruction of
 claims documents in benefits offices around the nation. The policy
 comes as the VA continues to investigate improper shredding at a St.
 Petersburg veterans benefits office and 56 other regional offices in nearly
 every state. It calls for the appointment of a records control team in
 Washington, D.C., to oversee the handling of documents. It also would
 lead to the hiring of records officers in each benefits office to do the
 same on a local level. And before shredding any document, two VA
 employees, including a supervisor, would have to sign off, according to a
 draft of the policy obtained by the St. Petersburg Times. The VA said it
 also notified members of Congress on 28 OCT about the pending policy;
 parts of which the agency said have already been implemented.

     The new policy came about after the discovery last month of nearly
 500 veterans' claims documents improperly set aside for shredding in
 41 VA benefits offices. The documents, which had no duplicates in VA
 files, could have been crucial in deciding if an individual veteran
 received a pension or disability payment. That total includes 13 documents
 found in shredding bins in the VA's busiest benefits office at Bay Pines
 in St. Petersburg, where the agency's inspector general is still
 conducting an audit. Bay Pines is the home benefits office for Florida's
 1.8-million veterans and the 330,000 who live in the Tampa Bay area.  The
 total also includes 95 records which were erroneously dumped in a
 shredder bin at the VA office in Columbia SC. Forty-six of the records -- or
 about half discovered in the shredder bin at the Columbia office --
 were either new claims for benefits or supporting documents. Other claims
 included burial and death benefits, notices of clients' disagreements
 with VA rulings, and documents for education benefits.   Veterans
 Affairs officials are investigating why and an unidentified employee at that
 office is under investigation for mishandling the documents, which
 include new benefits claims and other personal files. On 28 OCT VA leaders
 met with representatives of the largest veterans’ service groups in the
 nation Friday and told them they expect to enact this new policy
 within 10 days, perhaps with minor revisions. In the meantime, a national
 ban on all shredding in VA benefits offices remains in effect.

    Some veterans’ representatives’ question if the policy will go
 beyond the shredding bin to assure paperwork is not lost or destroyed in
 other ways, such as when workers bring documents home. "This solves a
 problem," said Dave Autry, a spokesman for Disabled American Veterans.
 "I'm not sure it solves the entire problem." A VA spokeswoman said she
 could not comment on the new document policy because she had not yet been
 told about it. Improper shredding is "a big problem, and we've got to
 take care of it," said Alison Aikele, a VA spokeswoman. "Even one
 document is too many." The chairman of the House Committee on Veterans
 Affairs plans to hold a hearing later this month to examine the destruction
 of veterans claims documents. In some cases, the VA says, employees may
 have deliberately and improperly set aside claims documents for
 shredding.

     Two VA employees, neither in St. Petersburg, have been placed on
 paid leave pending further investigation. At one of the VA's busiest
 benefits office in New York City, four VA management employees have been
 placed on administrative leave, the VA has confirmed. That office's
 director and assistant director also have been transferred. The VA first
 denied any of these leaves were related to shredding but reversed itself
 when presented with information obtained by the Times. The agency now
 says one of those suspensions was because of shredding allegations. The
 VA said other suspensions were because employees may have doctored
 records indicating they more timely process claims than they actually did.
 Veterans with concerns about their files and claims are asked to call
 the U.S. Department of Veterans Affairs, (800) 827-1000. [Source: St.
 Petersburg times William R. Levesque article 1 Nov 08 ++]

===============================

VA TINNITUS CARE:   Hearing loss is presently the most common veterans’
 disability with tinnitus (i.e. persistent ringing in the ear) ranking
 second. In fiscal 2007, VA dispensed nearly 350,000 hearing aids to
 veterans.  Nearly 850,000 veterans receive compensation for
 service-connected hearing disabilities.  Tinnitus is the number one service-connected
 health condition for Iraq and Afghanistan veterans, with nearly 70,000
 diagnoses.  Defective hearing ranks third, with almost 60,000 cases.
 One of VA’s 14 Centers of Excellence, the National Center for
 Rehabilitative Auditory Research (NCRAR) at the Portland OR VA Medical Center,
 conducts research to support hearing rehabilitation, education,
 professional training, and technology development. NCRAR researchers are working
 on more than 30 hearing loss and tinnitus projects, including the
 connection between traumatic brain injuries and hearing loss.  Researchers
 are also working with engineers to develop a portable ototoxicity
 measuring device. The hope is that this device will improve the ability to
 detect and monitor hearing loss among soldiers in the field and that
 resulting from treatment with some medications. [Source: VCFL Michael Isam
 article 30 Oct 08 ++]

===============================

VA DIABETES MELLITUS CARE UPDATE 04:   The occurrence of Type 2, or
 adult onset, diabetes is increasing, particularly for the Vietnam Era
 veteran. For veterans of Vietnam, there is a statistically higher incidence
 of Type 2 diabetes. Because of this, the Veterans Affairs Department
 declared a link between Vietnam service and the disease. This means that
 if you have served in Vietnam and now have Type 2 diabetes, you are
 eligible for service-connected disability compensation and health care
 connected with this condition through the VA. The term "service in
 Vietnam" means that at some time between 9 JAN 62, and 7 MAY 75, you were in
 Vietnam. Service in the waters offshore or in the air does not qualify
 you unless during that time you set foot in Vietnam and have some way
 to prove it. For most veterans who served in Vietnam, their service is
 clearly shown on their separation papers, the DD-214.

     If you have qualifying service, you should obtain a statement from
 your treating doctor that you are currently being treated for the
 disease. The more detail you provide, the easier it will be for the VA to
 handle your claim, so try to get a copy of your treatment records for
 the past year. A successful claim could entitle you to monetary
 compensation and treatment for your diabetes. The evaluation will be assessed
 through a VA examination, during which a VA doctor will evaluate your
 current condition. The VA will then assign an evaluation through the
 rating process. The evaluation could be as little as zero percent disabling
 to 100% disabling, which would result in monthly compensation for your
 condition. Service connection can also be granted for secondary
 conditions directly related to the diabetes, for example, diabetic
 retinopathy. Once service connection has been established, you can reopen your
 claim if the condition progresses or other secondary conditions are
 discovered. In addition, if service connection is established, you are
 entitled to care for this condition at any VA medical facility. Medical care
 includes prescription drugs required to treat the condition. Both the
 medical care and prescription drugs are provided without cost for
 veterans service connected for the condition. If you've never filed a claim
 with the VA before, or you know someone who may benefit from this
 information, contact your local Veterans Service office. [Source:  The
 trasure coast Palm Paul Hiott article 1 Nov 08 ++]

===============================

UNIFORM WEARING UPDATE 02:  The military services do care if civilians
 wear the uniform or parts of the uniform. Although district attorneys
 have are given wide latitude of what law violations to prosecute and
 which ones to ignore the military might they be willing to persuade a
 local district Attorney to prosecute. Some of the services have gone out of
 their way to include restrictions in their dress and appearance
 regulations (which are not enforceable against civilians, but tend to show
 that service's view on the subject). Army Regualtion 670-1, paragraph 1-4
 states: d. In accordance with chapter 45, section 771, title 10,
 United States Code (10 USC 771), no person except a member of the U.S. Army
 may wear the uniform, or a distinctive part of the uniform of the U.S.
 Army unless otherwise authorized by law. Additionally, no person except
 a member of the U.S. Army may wear a uniform, any part of which is
 similar to a distinctive part of the U.S. Army uniform. This includes the
 distinctive uniforms and uniform items listed in paragraph 1–12 of this
 regulation.

     Paragraph a.1–12 goes on to define Distinctive uniforms and
 uniform items: The following uniform items are distinctive and will not be
 sold to or worn by unauthorized personnel:
(1) All Army headgear, when worn with insignia.
(2) Badges and tabs (identification, marksmanship, combat, and special
 skill).
(3) Uniform buttons (U.S. Army or Corps of Engineers).
(4) Decorations, service medals, service and training ribbons, and
 other awards and their appurtenances.
(5) Insignia of any design or color that the Army has adopted.
[Source:  About.com: US military 28 Oct 08 ++]

===============================

HAVE YOU HEARD:  The Company Commander and the First Sergeant were in
 the field. As they hit the sack for the night, the First Sergeant said,
 "Sir, look up into the sky and tell me what you see?"
        The CO said, "I see millions of stars."
        1st Sgt.: "And what does that tell you, sir?"
        CO: "Astronomically, it tells me that there are millions of
 galaxies and potentially billions of planets. Theologically, it tells me
 that God is great and that we are small and insignificant.
 Meteorologically, it tells me that we will have a beautiful day tomorrow. What does
 it tell you, Top?"
        1st Sgt.: "Well sir, it tells me that somebody stole our tent."

===============================

VETERAN LEGISLATION STATUS 13 NOV 08:   Congress will reconvene 17 NOV
 for a lame duck session and most likely adjourn by 21 NOV.  This will
 be their last session prior to the start of the 111th Congress in JAN
 09. Refer to the Bulletin’s House & Senate attachments for or a listing
 of Congressional bills of interest to the veteran community that have
 been introduced in the 110th Congress. Support of these bills through
 cosponsorship by other legislators is critical if they are ever going to
 move through the legislative process for a floor vote to become law.  A
 good indication on that likelihood is the number of cosponsors who have
 signed onto the bill. A cosponsor is a member of Congress who has
 joined one or more other members in his/her chamber (i.e. House or Senate)
 to sponsor a bill or amendment. The member who introduces the bill is
 considered the sponsor.  Members subsequently signing on are called
 cosponsors. Any number of members may cosponsor a bill in the House or
 Senate. At http://thomas.loc.gov you can also review a copy of each bill’s
 content, determine its current status, the committee it has been
 assigned to, and if your legislator is a sponsor or cosponsor of it.  To
 determine what bills, amendments your representative has sponsored,
 cosponsored, or dropped sponsorship on refer to
 http://thomas.loc.gov/bss/d110/sponlst.html.  The key to increasing
 cosponsorship on veteran related bills and subsequent passage into law is
 letting our representatives know of veteran’s feelings on issues.  At
 the end of some listed bills is a web link that can be used to do that.
 You can also reach his/her Washington via the Capital Operator direct
 at (866) 272-6622, (800) 828-0498, or (866) 340-9281 to express your
 views. Otherwise, you can locate on http://thomas.loc.gov who your
 representative is and his/her phone number, mailing address, or email/website
 to communicate with a message or letter of your own making.  Refer to
 http://www.thecapitol.net/FAQ/cong_schedule.html for future times that
 you can access your representatives on their home turf.  [Source: RAO
 Bulletin Attachment 13 Nov 08 ++] 

===============================

Lt. James “EMO” Tichacek, USN (Ret)
Director, Retiree Assistance Office, U.S. Embassy Warden & IRS VITA
 Baguio City RP
PSC 517 Box RCB, FPO AP 96517
Tel: (951) 238-1246 in U.S. or Cell: 0915-361-3503 in the Philippines.
Email: raoemo@sbcglobal.net Web:
 http://post_119_gulfport_ms.tripod.com/rao1.html
AL/AMVETS/DAV/FRA/NAUS/NCOA/MOAA/USDR/VFW/VVA/CG33/DD890/AD37 member

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