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Racial disparities in electroconvulsive therapy Illustration: National Institute of Mental Health (01/14/2019) Racial disparities exist in the use of electroconvulsive therapy to treat depression in older adults, found a study including a Houston VA health Care System researcher. ECT involves applying electrical current to the brain to treat mood disorders. It has proven effective in treating major depressive disorder when medication does not work. The researchers looked at nearly 700,000 patients older than 65 in a national health care database. They found that black and Hispanic patients were nearly half as likely to receive ECT, compared with white patients. While the research team acknowledges that patient preference may have played some role, they assert that efforts are needed in any case to ensure that minority groups have equal access to care. (American Journal of Geriatric Psychiatry, Nov. 29, 2018) Barriers to medication treatment for opioid use disorder (01/14/2019) VA Palo Alto Health Care System researchers explored the barriers to using medication to treat opioid use disorder within VA. Evidence shows that medications such as methadone, buprenorphine, and naltrexone care be effective at treating opioid use disorder. However, only 21 percent of patients with the disorder in VA residential treatment are on these medications. According to patient and staff surveys, barriers to this type of treatment include program philosophy against medication use, lack of coordination with other treatment settings, and perceived low patient interest. Having prescribers on staff, education and support for patients and staff, and support from leadership would help facilitate medication treatment, according to survey responses. (Journal of Studies on Alcohol and Drugs, November 2018) Survey: Most Vets OK with curbing gun access during times of high suicide risk (01/14/2019) Veterans receiving mental health care were in favor of voluntary programs to reduce firearm access during high-risk periods for suicide, in a VA Ann Arbor Health Care System survey. Veterans in mental health care have high rates of firearm-related suicide. Of Veterans surveyed receiving mental health care at one VA facility, 93 percent were in favor of health system interventions to limit firearm access. Of those, 75 percent were in favor of substantially limiting firearm access during times of crisis. While Veterans with household firearms were less likely to be in favor of interventions, 50 percent of the group that owns firearms still said they would participate in an intervention to limit firearm access during high-risk periods. The results suggest that VA and other health systems should consider more intensive efforts to voluntarily limit firearm access during high-risk periods, say the researchers. (General Hospital Psychiatry, Nov.-Dec. 2018) Risk factors for transition from suicidal thoughts to attempts (01/03/2019) A team co-led by a VA San Diego Healthcare System researcher identified characteristics that differed between service members who contemplated suicide and those who went on to make a suicide attempt. As part of the Army STARRS study, researchers surveyed more than 10,000 soldiers. They found that, compared with soldiers without suicidal thoughts, those with suicidal thoughts had higher rates of interpersonal violence, relationship problems, major depressive disorder, PTSD, and substance use disorder. Soldiers with combat trauma in the past 12 months, intermittent explosive disorder, or any college education were less likely to have suicidal thoughts. Of those with suicidal thoughts in the past 30 days, those with PTSD had higher risk of suicide attempt. Those with intermittent explosive disorder or some college education were less likely to have attempted suicide. The results show that PTSD, intermittent explosive disorder, and education should be considered when studying what makes suicidal ideation transition into suicide attempts. (Depression and Anxiety, Dec. 14, 2018) Carpal tunnel syndrome treatment varies widely in VA (01/03/2019) Nonsurgical therapy use for carpal tunnel syndrome varies widely within the Veterans Health Administration, according to a study by VA Ann Arbor and Palo Alto researchers. Of nearly 80,000 patients diagnosed with carpal tunnel syndrome, 8 percent had surgery. Across different facilities, between 0 and 93 percent of surgical patients received physical therapy, occupational therapy, or an orthotic. Between 1 and 67 percent of nonsurgical patients received these types of therapy. Between 0 and 100 percent of surgical patients had electrodiagnostic studies (such as X-rays or CT scans), while between 0 and 55 percent of nonsurgical patients had diagnostic scans. The results suggest that clinical practice guidelines are needed to improve the uniformity and efficiency of carpal tunnel care, say the researchers. (Journal of Hand Surgery, Dec. 19, 2018) Probing the evidence for probiotics (01/03/2019) Evidence suggests that several probiotics are effective to treat various conditions, found a study by an Edward Hines, Jr. VA Hospital researcher and colleagues. Probiotics are live bacteria and yeast that promote a healthy microorganism balance in the digestive tract. While many probiotics are on the market, evidence is lacking on their effectiveness. Researchers reviewed the current medical literature and consulted experts in the field about which probiotics have been shown to be effective. They found enough evidence to suggest that 22 different types of probiotics are effective at treating different conditions. Some probiotics had strong evidence for treatment of conditions such as antibiotic-associated diarrhea, pediatric acute diarrhea, and inflammatory bowel disease. The researchers stress that it is important to pick the correct strain, formulation, and dose of a probiotic to match a specific disease. (PLoS One, Dec. 26, 2018) Intimate relationships may buffer against suicide (12/26/2018) Strong intimate relationships could help protect service members from suicide, according to a VA Ann Arbor Health Care System study. Researchers surveyed 712 National Guard members after they returned home from deployment. The found that lower relationship satisfaction and more depressive symptoms at six months after deployment were linked to greater risk of suicide 12 months after deployment. Couple satisfaction was related to suicide risk for service members with PTSD, depression, and anxiety. The results show that the strength of an intimate relationship could serve as a buffer against suicide for patients who have these conditions, say the researchers. (Suicide and Life-Threatening Behavior, Dec. 3, 2018)
American Legion National Commander Brett Reistad has designated the week leading up to the organization’s 100th birthday, March 10-16, as “Buddy Check National Week of Calling.” He’s asking departments, districts and posts to put together teams to call expired members and those who have yet to renew, and to check in with current members and let them know that “we are a better American Legion with their involvement,” Reistad said during The American Legion’s National Membership and Post Activities Committee meeting in Indianapolis, Jan. 11-12. “A phone script could be something I close meetings with … ‘Thank you for your service to our country and thank you for your continued service to our communities, our veterans and youth through your membership in the American Legion Family.’” A “Buddy Check National Week of Calling” toolkit was talked through during the meeting with committee members and members of the Legion’s 21st Century Ad Hoc Committee. The toolkit will be released soon and will contain several items such as introduction letters to departments, districts and posts detailing what the week of engagement is and their role; sample phone scripts; a buddy-check poster; ways to access expired lists through MyLegion.org; specifics to share about what The American Legion does from the national, department and post level; and incentives for conducting the week of calling. “This is coming from our commander. When he says he wants a week of calling, we’re going to do that. This is very important,” said Membership & Post Activities Committee Chairman Rev. Daniel J. Seehafer of Wisconsin. “I really, truly believe that this will be the basis for our retention. It has to start somewhere.” Past National Commander David Rehbein stressed that “this is important enough that we need to stop everything else (during March 10-16) and concentrate on contacting our members.” When Paul Dillard of Texas, the national commander’s representative on the National Legislative Commission, called on former Legionnaires who had let their membership expire he had an 85 percent success rate. “Call on those expires, and they will rejoin,” he said. A message Seehafer said that can be shared with expired members is, “Thank you for your service. Help us celebrate The American Legion’s 100th birthday and lead us into our second century strong by becoming a part of our family.” In addition to the call for members to make personal contact in their communities, Reistad reiterated his new Team 100 recruitment and retention awards. A post that signs up a former Legionnaire whose membership expired in 2014, 2015 or 2016 can receive $5 each for every one of those members who rejoins in the 2019 membership year. American Legion departments worldwide can receive $2,500 in reward bonuses by hitting their 100 percent membership goals by May 8, 2019. Those departments who hit 105 percent by June 30, 2019, will receive an additional $5,000 each. Seehafer shared that a department who has been reaching out by phone to expired members said a response they are hearing is, “'Now you call?’ It says something doesn’t it? The intention is for this to be an annual thing. And so when we talk about a national week of calling, it’s not just those who are expired. We want to call every single member of the American Legion Family. Every single member … ‘How’s it going? Just want to thank you for being a member.’ “We want to take this message … the why. Why we belong and take that to the next level.”
In the aftermath of experiencing war, some VFW members have returned to their previous passion — art — to manage post-traumatic stress disorder (PTSD) symptoms and bring hope to others. VFW Life member Pete Damon is one of them. He was in Iraq for only a few weeks when everything changed. On Oct. 21, 2003, Damon, who served with the Army’s 3rd Assault Bn., 158th Aviation Regt., was working on the wheel of a helicopter at Balad Air Base when the rim “exploded.” The blast severed Damon’s arms and killed Spc. Paul J. Beuche, 19, of Daphne, Ala. “I don’t remember much,” Damon said. “It was just flashes of horror of realizing my arms were gone.”   Dave Rogers, a Gulf War veteran and VFW member, displays his artwork at his studio in Artspace Patchogue Lofts. Rogers is the commander of VFW Post 2913 in Patchogue , N.Y. and, in addition to being an artist himself, has created an art program for his fellow veterans. Photo courtesy of Dave Rogers. Damon lost his right arm above the elbow and left arm below the elbow. He spent 15 months at Walter Reed Army Medical Center — three as an inpatient and 12 as an outpatient. In the following weeks, he underwent “multiple surgeries.”   “I was pretty optimistic, I guess — as far as you can be in that situation,” said Damon, a member of VFW Post 697 in Middleboro, Mass. It was at Walter Reed, after transitioning to outpatient status, that Damon regained his appreciation for art — something he used “to ward off homesickness” while in Iraq and Kuwait (June 2003). He started re-learning how to write with his non-dominant hand and an idea emerged. “The thought just occurred to me sort of like a light bulb going off in your head — if I could draw simple shapes to make up letters, I could also draw pictures,” Damon said. “For some reason, this was a big spiritual boost to me.”‘BRUSH WITH DEATH’Damon said he started having panic attacks about one year after the incident, not knowing that he was experiencing PTSD symptoms. He was diagnosed in 2014. “I felt that saying I had, or being diagnosed with, PTSD would be something  that only someone going through something much more stressful like combat [would experience],” Damon said. “But I’ve come to realize that any trauma can cause PTSD. So painting helps me deal with that a lot.” Damon also opened True Grit Art Gallery in Middleborough, Mass., in 2015. “[Running the gallery helps] keep my mind pristine, occupied and healthy,” Damon said. Before being injured, Damon said, he viewed drawing as a “novelty.” But his outlook has changed. “I guess having a brush with death kind of wakes you up in a lot of ways [and] makes you focus on different things in life,” Damon said. “You get a different way of looking at life, and focusing on important things, and art helps me to do that.” He said he is inspired by “simple American scenes,” architectural subjects and how “light affects objects or the world around us.” “I paint by inspiration,” Damon said. “These are just little dramas in the universe that affect me in some way.” Because he cannot grip utensils as he did before his injury, Damon said it takes a “little finesse” to paint.  But he developed his own style to accommodate his prosthetics. “[My style has] sort of evolved because of my limitations,” Damon said. “If you look at my paintings, there are a lot of broken lines because I don’t have a lot of force in my brush strokes. It’s sort of a light touch.”GROUND ZERO ‘WORSE THAN ANYTHING’Another veteran, Dave Rogers, commander of VFW Post 2913 in Patchogue, N.Y., initially planned to study forensic psychology and join the FBI. But a broken neck put him on a different path. Rogers, also a first responder with the 1st Bn., 69th Infantry (New York Army National Guard) at the World Trade Center after the Sept. 11, 2001, terrorist attack, said he learned to “turn things off” while serving in the Army. But his experience at Ground Zero “opened all the flood gates.” “It was worse than anything I’ve ever experienced,” said Rogers, who served in the Army’s 224th Military Intelligence Bn., 24th Infantry Division, (Hunter Army Airfield) in Iraq (1990-91) and Headquarters Co., V Corps in Bosnia (1997) as an infantryman and utility supply specialist.‘STRUGGLE EVERY DAY’On Sept. 13, 2001, at Ground Zero, he was involved with search and rescue operations when the front of Building 7 started to fall. “I was helping people get out when I was knocked over and hit my neck and head,” Rogers said. “I then had to jump on a boat by the dock to get out of the area until all was clear. The jump was about 10 feet down, and I hit my back in the landing.” From there, Rogers said, “everything went to mush, basically.” With help from a therapist, he rediscovered his passion for art. Being an artist has helped him release frustrations and “get back into the world.” “When I got out, I was lost for a while,” said Rogers, who was medically discharged from the Army in 2005. “I didn’t know what I was going to do with my life. Art basically brought me back.” He was working in China as an English and art professor with WuYi University in Jiangmen, where he had his first art show. Since then, Rogers’ work has been seen in 11 countries. “I still struggle every day,” said Rogers, who was diagnosed with PTSD in 2007, “but going to the shows — like when they’re my shows and I know I have to go — has basically forced me to come out of my shell. I would say my art is kind of like my service dog…It forces me to get out in the world.” Rogers said one of the “great” aspects of art is that it’s a vehicle for “releasing a story” — whether or not those viewing the final piece fully understand what it’s about. “If I paint the World Trade Center, obviously [people know I’m] talking about the World Trade Center,” Rogers said, “but I can do paintings that relate to me and my life, and people may not understand that I’m talking about my PTSD or my struggle. But to me I am.”VETERANS ‘OPEN UP’ THROUGH ARTIn rekindling his own passion, Rogers gained a desire to create an art program for veterans, which he did in 2012. Classes are held four to five times per year either at the Post itself, or Long Island University (LIU), where Rogers earned a master’s degree in fine arts. The workshops draw about a dozen veterans, according to Rogers, who range from the Vietnam and Korean wars to Iraq, Afghanistan and Gulf wars. LIU professors and art therapy students volunteer to teach the workshops. Classes also are offered to veteran family members. “[One veteran has] really opened up a lot because he’s in a setting with other veterans,” Rogers said. “The art therapy students are so helpful. The professors are very understanding and helpful. He now feels comfortable.”‘PAINT WHAT I FEEL’And while that’s exactly what Rogers aimed for, his mission is two-fold — he also hopes to attract the next generation of veterans. “A lot of the younger veterans are really looking for new avenues and new things to do,” Rogers said. “The traditional fundraisers that we did many years ago, they’re still good, but they’re not everything. You’ve got to look for other ways to reach people.” Serving in the Army has allowed Rogers to view his art from a different perspective. “I used to paint what I saw,” Rogers said. “Now I more paint what I feel.” He allows the colors he puts on the canvas to represent his emotions. “I’ve learned that certain colors represent part of who I am,” Rogers said. “When I use a lot of red in a painting, I’m talking about my anger.” Additionally, the authors of “Art Therapy for Combat-Related PTSD: Recommendations for Research and Practice” state that art therapists have reported “remarkable results” in their work with combat veterans.  Kate Collie and David Spiegel, of Stanford University; Amy Backos, of the San Francisco VA Medical Center; and Cathy Malchiodi, of the American Art Therapy Association, note that previous research has found that art therapy “provided pleasurable distraction in conjunction with exposure to difficult content and thus allowed traumatic material to be processed without the negative short-term side effects of verbal introspective interventions.”  As a self-proclaimed “old-school artist,” Rogers said he makes his own paint. That, and his artwork in welding and sculpting, provides what he calls a “physical-ness,” that improves his mental health. “It’s kind of like veterans who go running because running will not just clear their head, but it kind of breaks you down a little bit,” Rogers said. “And you feel better after running because you’ve gotten that energy that was building up inside of you out. And the same thing with art.”
What started out as an American Legion post resolution is now implemented in schools across the state of West Virginia as a required subject – patriotism and Americanism. “Veterans and wars have been overlooked in our educational system … it’s important that this history not be overlooked,” said Bob Post, commander of Frank B. Bartlett Post 7 in Buckhannon, W.Va. “The goal of doing this was to teach the love of country to our youth. You can’t have patriotism and Americanism without the love of God and country.” Post 7 wrote the resolution in 2008 requesting that West Virginia legislature pass legislation requiring the West Virginia Board of Education to mandate that a class on patriotism be taught in all West Virginia secondary schools, grades K-12. “We felt that if we could get this in to our school system, every student in our school system would understand how our country became the greatest country in the world,” Post said. The resolution was passed during the Department of West Virginia’s convention in 2010. And starting with the 2013-2014 school year, it was put into effect. Post said Legion membership didn’t have to go through the state legislature; instead, he met several times with the State Board of Education and the school superintendent at the time “liked what he heard.” Changes were made to the social studies class throughout the state in all public schools grades K-12 to incorporate patriotism education. What it is mandated for teaching depends on the age of the students. Examples include recognition of Veterans Day, Memorial Day, President’s Day, Martin Luther King Jr. Day, Flag Day and Patriot’s Day; reciting of the Pledge of Allegiance; singing patriotic songs; creating art that demonstrates patriotism; participating in community service project and parades; and how to show respect to the U.S. flag. Just this past school year it was mandated that at some point during grades 9-12, public school students through West Virginia must take the civics potion of the naturalization test used by the U.S. Citizenship and Immigrations Service. The results of the test may be reported in the aggregate to the county Board of Education for evaluation. “One of the most significant accomplishments of Post 7 was spearheading to get patriotism and Americanism as a required subject in the curriculum of our West Virginia Secondary School System,” Post said. “We hope as an organization that The American Legion Frank B. Bartlett Post 7 helps exemplify what patriotism, Americanism and love of country is all about. Everything we do is for these causes. “It is our hope that this can spread to other states throughout the country.”
With every passing year, more and more of Americans’ lives are lived online. Why drive to the bank or the DMV when you can deposit checks with your cell phone and renew your driver’s license from home? Adults socialize with friends, pay bills and file their taxes online. High school seniors average a whopping six hours a day online,1  texting, playing games, and on social media.  All this Internet activity means we’re safer in some ways—we can’t lose our wallet in our living room or get into a traffic accident at our desk. But the online world carries its own dangers, and cybercrime is unfortunately exploding. A September 2018 Forbes article2 listed these five statistics: Every minute, 1,861 people fall victim to cyber-attacks and $1.14 million is stolen. Over the next five years, 146 billion records will be breached—four times the current rate. Ransomware attacks are increasing 350% per year, and damage costs will be $11.5 billion in 2019. (This is when hackers gain control of a person’s or company’s computer, lock out the owners, and demand a ransom to let them have access again.) In a survey of IT decision makers, 56% cited phishing attacks as their biggest cybersecurity threat, and more than a million new phishing sites are created every month. Close to 60 million Americans have been victims of identity theft. These are alarming statistics, especially for those with lucrative careers and sizable assets. Fortunately, as a member of the VFW, you can protect your entire family with Identity Guard® with a 20 percent discount.3 Identity Guard is unique among identity protection solutions because it’s powered by the artificial intelligence of IBM Watson®. Watson is able to continuously scan the Internet to identify information that indicates you might be at risk. If it finds data relevant to you, you’ll receive an alert so you can take action quickly—hopefully before trouble begins. Watson will let you know if your: Personal habits put you at greater risk than the average person Bank, PayPal or iTunes account has announced a security alert Personal ISP, email provider, or streaming service has a security issue Car or home insurance company had a security breach Health care provider has announced a customer data breach Computer, tablet or phone has a security issue Teen appears to be bullied on social media Favorite dating website or app has been hacked Favorite online store has issued a phishing attack warning Favorite restaurant’s point of sale system has been compromised Identity Guard is the only personal cybersecurity solution powered by Watson. To learn more about Identity Guard or to enroll, go to: www.identityguard.com/vfw.    1 San Diego State University study, 20182 A Scoville Heat Scale for Measuring Cybersecurity, Forbes, Sept 20183 Maximum savings based upon Identity Guard Premier Family package. Savings range from 40-57%
(Stars & Stripes) WASHINGTON — A cost-saving proposal that sparked backlash from veterans in 2017 has resurfaced in a new Congressional Budget Office report as an option to help reduce the federal budget deficit. The report suggests removing approximately 235,000 disabled veterans from a Department of Veterans Affairs program called Individual Unemployability in 2020, projecting it could save $47.6 billion in the next 10 years. Veterans removed from the program would see their monthly incomes decrease by an average of $1,300, according to CBO estimates. One veterans group, AMVETS, is urging the White House and the VA to publicly disavow the proposal before it creates a groundswell of anger within the veteran community. “We want the White House to immediately make a statement saying this recommendation is out of line and will not be considered,” said Joe Chenelly, director of AMVETS. “We understand that the White House is looking to trim costs, but this cannot be an option in that.” The program applies to veterans who have disability ratings through the VA of between 60 percent and 100 percent and are unable to secure jobs because of their disabilities. It allows them to receive the highest compensation rate. The CBO suggested removing veterans from Individual Unemployability once they reach age 67, claiming those veterans would be eligible for Social Security by that time. The cut was one of 121 cost-saving proposals included in the CBO report, titled “Options for Reducing the Deficit: 2019 to 2028.” The CBO periodically compiles the list of policy options to help inform lawmakers. The CBO’s inclusion of the cut to Individual Unemployability in its report doesn’t mean the White House or Congress will consider the proposal. However, now that it’s public, it’s likely to trigger concern among veterans who would face substantial financial consequences if the idea ever became law, Chenelly said. AMVETS and other veterans’ groups said they heard from thousands of veterans in 2017 when the same cost-saving measure was included in President Donald Trump’s 2018 budget. Then-VA Secretary David Shulkin quickly backed off the proposal, but concerns have lingered. “We received hundreds of phone calls from veterans and emails and social media posts telling us how devastating this would be and how much anxiety and worry it was causing — and I’m talking about at dangerous levels,” Chenelly said. “We’re really worried since this became public again that the worry will come back. The White House can save these vets a whole lot of angst by being very clear and immediate in saying this is something we’re not going to ever consider again.” The White House did not respond Monday to a request for comment. The VA referred all questions about the report to Congress. Released Thursday, the CBO report comes as the White House prepares its budget recommendations for fiscal year 2020. The president’s budget is sent to Congress every February. In its report, the CBO offered an alternative option to allow veterans already enrolled in the Individual Unemployability program to keep their benefit while applying the age cutoff to veterans who enroll after December 2019. The CBO estimated that option would save $6.7 billion in the next 10 years. Cuts to other VA benefits also were included in the report. One option would stop disability compensation for seven medical conditions: arteriosclerotic heart disease, chronic obstructive pulmonary disease, Crohn’s disease, hemorrhoids, multiple sclerosis, osteoarthritis and uterine fibroids. Another option would reduce veterans’ disability compensation by 30 percent once they reach age 67. The CBO also suggested ending VA payments to veterans with disability ratings of 30 percent or lower. In an October meeting, Trump requested each Cabinet secretary present ideas to cut costs, citing an increase in spending in his first two years as president. He told them to “get rid of the fat” and suggested the cuts could be as much as 5 percent of each department’s budget. Despite that, VA Secretary Robert Wilkie said in November that he believed next year’s budget could be bigger than the last one. Congress appropriated more than $200 billion for the VA in fiscal 2019 — another in a series of budget increases during the past decade. “In the last presidential campaign, the president committed with everything he had to making sure the Department of Veterans Affairs was the most robust it’s ever been,” Wilkie said at the time. “I am convinced that the budget that gets through both chambers will replace this last budget as the largest in our history.”
Statement ofKayda Keleher, Associate DirectorNational Legislative ServiceVeterans of Foreign Wars of the United StatesFor the Record Joint Hearing Committees on Veterans’ AffairsUnited States Senate and United States House of RepresentativesWith Respect To “Tracking Transformation: VA MISSION Act Implementation” WASHINGTON, DC After four years of tireless work and development, the VA MISSION Act of 2018 was signed into law on June 6, 2018. The main prerogative of the VA MISSION Act of 2018 is perfectly stated as Title I –– Caring for Our Veterans. The Veterans of Foreign Wars of the United States (VFW) believes that to successfully implement this multifaceted portion of the law, the Department of Veterans Affairs (VA), Congress, and veterans service organizations (VSOs) must collaboratively work together, while maintaining its implementation as the top priority of the 116th Congress. The VFW thanks the committees for the continued oversight of this important law and leadership in ensuring VA has the resources to properly implement it. If the law is effectively implemented, veterans’ health care will enter a new era of timely access to high-quality care. However, if implementation strays from the overwhelming consensus reached by stakeholders involved in development of the law, VA health care could decline, resulting in negative consequences for the millions of veterans who rely on VA for their health care, and threaten the viability of VA’s teaching, world-class research, and emergency response missions. While there are groups that believe VA facilities should be downsized and that veterans should receive more care through private sector doctors, the VFW’s numerous surveys show veterans want VA to hire more doctors and increase internal capacity. In fact, our latest VA health care survey indicates nearly 60 percent of veterans who were offered community care elected to stay with VA. The main reason veterans prefer VA is they like the quality of care they receive, which a recently published peer-reviewed study entitled Veterans Health Administration Hospitals Outperform Non-Veterans Health Administration Hospitals in Most Health Care Markets found is better than the private sector. The law requires VA to develop regulations for new access and quality standards to replace the current arbitrary rule of a 30-day wait and 40-mile distance standards, by March 6, 2019.  This will be done by consolidating seven current community care programs, including the Veterans Choice Program, into one. This program will be the Veterans Community Care Program (VCCP), and will use local health care networks and academic affiliates to provide care to all eligible veterans. The VFW has serious concerns about the lack of collaboration and working communication from VA with VSOs to establish these new regulations. While VA has held consistent meetings between VSOs and the Office of Community Care, the majority of such meetings have been one-sided conversations. Without proper stakeholder input, VA will fail. For example, VA is considering up to 20 different access standard models, none of which have been shared with VSOs. The VFW understands Congress intended for VSOs to receive specific data and to work in cooperation with VA to develop these future regulations that will affect the lives of millions of veterans. The VFW also has concerns with the lack of participation at Office of Community Care meetings from VA’s Executive Steering Committee, which will ultimately assist the Secretary in choosing access standard models and how the law is implemented. The VFW is encouraged by this past week’s decision to include VSOs in VA MISSION Act workgroup meetings with VA leadership. We hope such meetings will be more productive, and look forward to working with VA to ensure this important bill is implemented in the best interest of the veterans VA was created to serve. The VFW has made clear time and time again that VA must back away from setting arbitrary standards for when patients using VA are given the option to use community care. VFW members have made clear the many negative unintended consequences of not upholding the decision to use community care as a clinical decision made between a patient and their provider. It is optimistic to hear VA working toward solutions in overcoming this range of arbitrary barriers, such as when a patient lives within close proximity to a VA facility based on miles, but must overcome geographical difficulties such as mountains. VA must adapt lessons learned from the Veterans Choice Program and study recommendations from industry experts, such as the Transforming Health Care Scheduling and Access: Getting to Now independent review conducted by the National Academy of Medicine, formerly known as the Institute of Medicine, to establish access standards that are appropriate for the users of the VA health care system. The VFW warns VA against adopting arbitrary standards which would fail to address the uniqueness of the VA health care system and the needs of our nation’s veterans. It is important for VA to establish access standards that define objective criteria for access to VA community care networks. Unless these standards are pragmatic and clinically appropriate, both veterans and VA will suffer negative consequences. VA must establish standards that are sensible for VA’s capacity, and comparable to measures of local health care systems outside VA. As with access standards, quality standards must balance the need to maintain the unique features of VA that effectually serve veterans, but are different than those in the private sector. The VFW also has concerns with feedback from facilities that veterans are being automatically placed into community care based on arbitrary guidelines without discussion or input from their providers. The VFW continues to oppose patients being involuntarily placed into community care simply because their appointments may not be scheduled within 30 days. First and foremost, veterans and their providers must remain part of this process to ensure patient understanding and continuity of care. Second, many of these patients would prefer to stay with VA. Finally, not every appointment must be fulfilled within the 30 days. If the appointment is not medically necessary in that timeframe, veterans must be able to choose whether to wait for VA or seek care through the community care networks.  The VFW also urges VA to account for how the implementation of a new electronic health care record impacts productivity. In partnership with the Defense Health Agency (DHA), the VFW has kept a keen eye on the implementation of the Military Health System GENESIS electronic health care record, which is the same system VA has elected to adopt for the VA health care system. While the VFW hopes VA adopts lessons learned from DHA to ensure a more seamless implementation, we are certain VA medical facilities will experience a temporary reduction in productivity that comes with change management. However, military treatment facilities report an eventual increase in productivity after full implementation. The VFW suspects VA medical facilities will experience a similar trend in productivity, which will lead to a temporary increase in demand for community care.  This and other temporary spikes in demand for community care, such as snowbirds, will require VA to adjust its community care networks and VA medical facility capacities to ensure veterans can receive the care they need where they need it. VA must make certain that temporary increase in demand for community care does not jeopardize the long-term viability of capacity at VA medical facilities. That is why the VFW urges VA and Congress to consistently evaluate whether VA should be expanding its community care networks or increasing internal capacity. This must be done by hiring more doctors or having VA deploy a quick reaction force of VA doctors to areas facing temporary spikes in demand for care. VA facilities with service lines that fail to meet established quality standards will undergo remediation. Patients who rely on the 36 service lines that fall under the quality standards will have the opportunity to choose if they would rather stay with a VA doctor or use private sector doctors in their community. It is important that VA take into account what options veterans use and where they would prefer to go when developing remediation plans. VA must also take into account the ability for VA medical facilities to provide severely disabled veterans, such as those in spinal cord injury centers or polytrauma network sites, a full continuum of care. Simply closing such service lines in favor of community care would fail veterans who prefer to see a VA doctor and those who are unable to use community care.  To ensure access and quality standards are fully vetted and understood, the VFW urges VA to issue notice of proposed rulemaking in the Federal Register to allow sufficient time for public comments. It would be unacceptable for VA to issue an interim final rule, which does not allow for public input, specifically if stakeholders were not incorporated in developing it. Aside from stakeholders who must be consulted in the development of these rules, veterans and individuals who will be impacted by them must have their voices heard and considered through public comment. Doing so may mean that VA will not meet the deadlines established in the law. To the VFW, it is more important that VA produce high-quality and accurate regulations than it is for VA to rush the decision-making process and repeat previous mistakes in order to meet such deadlines. Also, there must be an organized outreach campaign for veterans who use VA once these regulations are finalized. Since the VA MISSION Act became law, VA has worked with VSOs to design pamphlets and other educational materials to share with patients when the law is ready to be implemented. This must be done so thoroughly and on multiple platforms, while also promising that all VA employees who will be involved in this transition completely understand the program and are able to explain it to patients.  As the regulations for the VA MISSION Act continue to be planned and implemented, the VFW looks forward to continuing to prioritize the remaining sections of the law. This includes working with VA and Congress to perfect billing, market assessments, expansion of the caregiver program, provider education and training programs, and the asset and infrastructure review.  
While the Department of Wisconsin American Legion Family – led by its District 8 American Legion Riders – were leading an effort that placed more than 7,200 wreaths on one of the state’s veterans cemeteries, American Legion posts across the nation were either leading or taking part in Wreaths Across America events in their own communities. The following are just a sampling of the American Legion Family’s involvement in the 27th annual Wreaths Across America day. Colorado • American Legion Post 9 of La Junta conducted Wreaths Across America events at both Fairview and Calvary cemeteries in La Junta. • Colorado’s District 7 Legionnaires helped support an event at Memorial Gardens in Colorado Springs. According to KOAA-TV, Joseph Schmidt – historian at Post 209 in Colorado Springs – said it’s important to remember those buried at the cemetery. “You die twice. Once when you breathe your last breath, and then the second time when they forget your name,” Schmidt said. “So, we always make sure to say the name of each veteran out here at the cemetery so that they know that they’re remembered.” Connecticut • American Legion Post 50 put its own stamp on Wreaths Across America, placing wreaths on veterans memorials across Ansonia. “In our own mini-version of Wreaths Across America, we mean to capture the essence of its spirit, which is to remember our deceased comrades during the Christmas and holiday season,” Post 50 Adjutant Pat Henri told the New Haven Independent. • In Meriden, approximately 50 people attended a Wreaths Across America ceremony at Walnut Grove Cemetery sponsored by American Legion Post 45. Auxiliary Unit 45 member Georgetta Sharpe led a short memorial service before people began decorating veterans’ graves. “We are here not only to remember their deaths but also their lives,” said Sharpe, according to the local Record-Journal. Florida Hundreds turned out for the fifth annual Wreaths Across America Cemetery at Highlands Memorial Park in Ocala. The event was organized by Eddie Jaworski, a member of Al Krietemeyer Memorial Post 284, while fellow Post 284 members assisted with the ceremony. Jaworski told the Ocala Star-Banner that 2,038 wreaths were sponsored this year, the largest number to date locally. State Sen. Dennis Baxley was one of the speakers at the ceremony, which included a ceremonial wreath laying at the flags of each branch of the military. The Post 284 Honor Guard gave a gun salute before volunteers began placing wreaths. Iowa Dozens of volunteers took part in the wreath-laying effort at Graceland Cemetery. Baty-Tucker Post 168 in Knoxville was able to gather more than 210 wreaths to place on the graves. Wreaths with miniature American and service flags were also put at the base of the flag poles, along with the banners of all the branches of the service. Maryland Joseph L. Davis American Legion Post 47 in Havre De Grace conducted a wreath-laying ceremony at Angel Park. Families, volunteers and members of the U.S. Marine Corps, U.S. Navy, U.S. Coast Guard, U.S. Air Force and U.S. Merchant Marines participated in the wreath laying. Wreaths for POWs and MIAs were presented by Post Commander 47 Bud Lilly. Massachusetts American Legion Post 144 and other community members placed wreaths at the graves of veterans at Cudworth Cemetery. A wreath was also tossed to the North River from the Sgt. Michael J. Kelley Bridge to honor the Army National Guardsman killed June 8 when his helicopter landing zone came under enemy fire in Shkin, Afghanistan, in 2005. Oklahoma American Legion Post 141 in Claremore organized a community Wreaths Across America event that placed 1,000 wreaths on the graves of veterans buried at Woodlawn Cemetery. Guest speakers included State Rep. Mark Lepak, County Commissioner Ron Burrows and Mayor Bill Flanagan, while Post 41 Legionnaire Ray Watts presented a specially decorated wreath to a local Gold Star Mother and her sons. According to the Claremore Daily Progress, Watts wrapped an arm around the older son’s shoulder and asked all the veterans present to raise their hands. He told the boys that while these men didn’t know their brother personally, their shared oath to the United States meant they were all brothers, so if the boys ever needed anything, they need only call on one of those men. South Carolina American Legion Post 45 in Inman helped organize a community event that places more than 80 wreaths on veterans’ graves at Inman Cemetery. According to the Spartanburg Herald-Journal, members of Trail Life USA Troop 2331 also helped place wreaths, including on the graves of World War II veterans Arthur E. Turner and James Wilbur Woodfin, who served in the U.S. Air Force and U.S. Coast Guard. Virginia American Legion Post 242 in Sandston raised over $9,000 to buy the wreaths so each of the 1,244 graves at the Seven Pines National Cemetery would have a wreath for the holidays.
Mackenzie Wolf American Legion Deputy Director of Claims Services Greg Nembhard testified Nov. 29 before the House Committee on Veterans' Affairs Subcommittee on Disability Assistance and Memorial Affairs. Nembhard’s testimony focused on reports published by Department of Veterans Affairs Office of Inspector General (VAOIG) on unwarranted medical examination for disability benefits, processing inaccuracies involving veterans’ intent to file submissions for benefits and trauma, denied post-traumatic stress disorder (PTSD) claims related to military sexual trauma (MST), and The American Legion’s System Worth Saving program. The VAOIG reports cite inaccuracies, inadequate training, lack of specialization and poor quality of VA examinations done by contracted medical examiners. “The American Legion wants to protect veterans from these, and other inadequacies, and urge the VBA (Veterans Benefits Administration) to take swift corrective action," Nembhard testified. “We believe that a variety of factors cause these shortfalls. Including a lack of funding, understaffed VA facilities, and contracting companies solely focused on their bottom line —at the veterans’ expense.” VA often denies victims of MST benefits based on a claim of PTSD — despite MST being a cause of PTSD — because they cannot produce evidence of the assault. MST victims often do not report the assault for varying reasons including “concerns about negative implications for performance reports, worries about punishment for collateral misconduct, and the perception of an unresponsive military chain of command.” A total of 169 MST-related claims that were denied were reviewed. The review concluded the VBA did not correctly process veterans’ denied MST-related claims in 82 of 169 cases. VAOIG estimated 1,300 of 2,700 MST-related claims denied were processed incorrectly during the review period. “Veterans should not experience additional harm in the process — especially when processing MST-related claims,” Nembhard said. “Finding ways to ensure these veterans receive the services they deserve is one of the highest priorities of The American Legion. "The growing diversity of veterans means that a system which primarily provided care to male enrollees must now evolve — and adapt — to meet the needs of all veterans and to provide them the best possible care.” The mission of The American Legion's System Worth Saving program is to “assess the quality and timeliness of veterans’ health care, the claims process at VA Regional Offices (VARO), and provide feedback from veterans about the care and services offered.” Reports from these site visits are then compiled into a publication that is distributed to the president, members of Congress and VA officials. “We believe in quality of care at VA facilities, we remain committed to a strong VA, and we believe that VA is a system worth saving,” Nembhard said. The American Legion “remains committed to a VA that is appropriately funded, staffed, trained and empowered to conduct internal quality reviews and oversight,” he concluded.   American Legion Deputy Director of Claims Services Greg Nembhard testified Nov. 29 before the House Committee on Veterans' Affairs Subcommittee on Disability Assistance and Memorial Affairs. Nembhard’s testimony focused on reports published by Department of Veterans Affairs Office of Inspector General (VAOIG) on unwarranted medical examination for disability benefits, processing inaccuracies involving veterans’ intent to file submissions for benefits and trauma, denied post-traumatic stress disorder (PTSD) claims related to military sexual trauma (MST), and The American Legion’s System Worth Saving program. The VAOIG reports cite inaccuracies, inadequate training, lack of specialization and poor quality of VA examinations done by contracted medical examiners. “The American Legion wants to protect veterans from these, and other inadequacies, and urge the VBA (Veterans Benefits Administration) to take swift corrective action," Nembhard testified. “We believe that a variety of factors cause these shortfalls. Including a lack of funding, understaffed VA facilities, and contracting companies solely focused on their bottom line —at the veterans’ expense.” VA often denies victims of MST benefits based on a claim of PTSD — despite MST being a cause of PTSD — because they cannot produce evidence of the assault. MST victims often do not report the assault for varying reasons including “concerns about negative implications for performance reports, worries about punishment for collateral misconduct, and the perception of an unresponsive military chain of command.” A total of 169 MST-related claims that were denied were reviewed. The review concluded the VBA did not correctly process veterans’ denied MST-related claims in 82 of 169 cases. VAOIG estimated 1,300 of 2,700 MST-related claims denied were processed incorrectly during the review period. “Veterans should not experience additional harm in the process — especially when processing MST-related claims,” Nembhard said. “Finding ways to ensure these veterans receive the services they deserve is one of the highest priorities of The American Legion. "The growing diversity of veterans means that a system which primarily provided care to male enrollees must now evolve — and adapt — to meet the needs of all veterans and to provide them the best possible care.” The mission of The American Legion's System Worth Saving program is to “assess the quality and timeliness of veterans’ health care, the claims process at VA Regional Offices (VARO), and provide feedback from veterans about the care and services offered.” Reports from these site visits are then compiled into a publication that is distributed to the president, members of Congress and VA officials. “We believe in quality of care at VA facilities, we remain committed to a strong VA, and we believe that VA is a system worth saving,” Nembhard said. The American Legion “remains committed to a VA that is appropriately funded, staffed, trained and empowered to conduct internal quality reviews and oversight,” he concluded.  
Make sure your senators support its immediate passage and encourage their colleagues to do the same Urge Your Senators to Support the Blue Water Navy Bill Now Take Action! Background: Congress is very close to passing H.R. 299, the Blue Water Navy Vietnam Veterans Act of 2018, which would end the injustice of denying Vietnam, Korean DMZ, and Thailand veterans who suffer from life-threatening health conditions the care and benefits they deserve. Unfortunately, this important bill is now in jeopardy. Make sure your senators support its immediate passage and encourage their colleagues to do the same. Take Action: Call your senators to demand support for immediate passage of H.R. 299. The Senate cannot continue to delay passage of this important bill while Blue Water Navy veterans sicken and die from diseases related to exposure to Agent Orange. Take action now!