7/25/2019 Bulletin 160214 (HTML)

1/144

RAO

BULLETIN14 February 2016

HTML Edition

THIS BULLETIN ONTAINS THE FOLLO!IN" ARTILES

#$ Arti%&e Sub'e%t

( )O) ( *

05 == DoD Lawsuit ~ Edgewood [07] ------- (Vet Victory in Testing Appea!

05 == DoD Lawsuit ~ "u#an Vet $ension ------------ (%einstate&ent 'ougt!

07 == DoD )0*7 +udget [0*] ------------ ($entagon %e,uesting 5./ +iion!

0. == "o&&issary unding [)7] --------- (DoD )001 +udget "ut $roposa!

02 == "o&&issary $rices [0)] -------------------------------- (3ncrease in )0*7!

*0 == DoD raud4 aste4 and A#use ---------- (%eported * tru *6 e# )0*!

** == $8913A %eco:eries ------------------- (%eported * tru *6 e# )0*!

( +A ( *

*) == VA Accounta#iity [*7] -------- (;udges 'ay s De&otions!

*6 == VA Accounta#iity [*.] ------------- (

7/25/2019 Bulletin 160214 (HTML)

2/144

/* == VA eart eat 1ont ----------------------------------- (1a@e A Date!

/* == VA +ood +io#an@ ---- (To $ay 1aFor %oe in "on,uering Diseases!

// == VA %o#otic Legs [0*] ----------- (VA1" Den:er Tests Donated 'uit!

/6 == VA %o#otic Legs [0)] --------------- (*0-person4 6-year 'tudy 'ated!

/6 == VA Vet "oice $rogra& [).] ----------------- (BA8 to Audit $rogra&!

/5 == VA Vet "oice $rogra& [)2] ---- (3&pe&entation G 'yste&ic aiure!

/5 == VA Vet "oice $rogra& [/0] ------------ (%uining 'o&e Vet>s "redit!

/7 == VA 'ecretary [6/] ----- ($oitica "aenges Touger Tan Epected!

/2 == VA epatitis " "are [0.] --------- (ouse earing on Treat&ent "ost!

60 == VA epatitis " "are [02] --- (VA %e:iewing %igts to 1irace Drug!

60 == $T'D [)0)] ------------------- ('tudies %e:ea Acceerated Aging Lin@!

6) == $T'D Drugs ---------------------------------------------- ($T'D 1eds *0*!

6/ == VA A8 +eneits -------- ($oicy %eassess&ent "o&pete G

7/25/2019 Bulletin 160214 (HTML)

3/144

76 == 'eecti:e 'er:ice 'yste& [*6] ----- (Drat A&erican>s Daugters Act!

75 == 'eecti:e 'er:ice 'yste& [*5] ----------- (Ei&ination ''' G ?%?65)/!

75 == A"T Act ------------------ ('?/57 G $uts Vets at %is@ o 3dentity Tet!

7 == A"T Act [0*] ------------------- (*st earing Triggers 'trong De#ate!

77 == VA Appeas [*7] ------------- (?%?6** G Epress Appea 8ption +i!

77 == VA Appeas [*.] ------------- (VA 'ecretary on )0*7 +udget %e,uest!

77 == Vet 'uicide [02] ------------ (e&ae Veterans 'uicide $re:ention Act!

7. == VA o&e Loan [6)] --- ($roposed %e&o:a o Loan Buarantee "aps!

72 == Vet +is 'u#&itted to **6t "ongress ---------- (*0)0* tru *0)*6!

( MILITAR- ( *

.* == 'eecti:e 'er:ice 'yste& [*/] M---- (C'A9C'1" ant e&ae Drat!

.) == Cnior&s [05] --- (s i Acco&&odate +igger +u@ier 'aiors!

./ == Detect -------------------------------- (DA%$A $oton Detection $roFect!

.6 == -/5 igter ;et ------- (500N to #e +uit #eore "oat Test is %eady!

.6 == 1iitary %etire&ent 'yste& [))] ----- (+ig Decision or 1any Troops!

.7 == C'1" Tuition Aid [0)] ------ ("oege *0* "ourse %epaced #y E$!

.. == Arsena $anes ---------------------- ('oution to C'A ;et igter Bap!

.2 == 1iitary Enist&ent 'tandards )0*5 [*/] M (1isceaneous $ro:isions!

2* == 1eda o onor "itations -------------------------- (ooper~;oe % G V

( MILITAR- HISTOR- ( *

26 == A:iation Art ----------------------------------------------- (Lone 'ur:i:or!

26 == 1iitary istory 'ites - (Airpanes-'ips-eapons-Aces H $ioneers!

25 == 1iitary istory Anni:ersaries ------------------------- (*5 tru )2 e#!

25 == 1iitary istory ------------------------------------ (1a@e Do and 1end!

2 == D-Day ---------------------------------------- (Tird %eic Atantic a!

27 == 33 Ads -------------------- ("ryser +uid or te s $ersona +odyguard!

2. == 33 $ostar E:ents --- (*26 E&press o ;apan 8rpanage Visit!

22 == 'panis A&erican ar .6 --- ('panis "ruiser %eina "ristina "rew!

22 == 3 in $otos */7 --------- (Aeria View o estern ront ca? *2*2!

*00 == +atte o 8@inawa ------------- (ana %idge

7/25/2019 Bulletin 160214 (HTML)

4/144

*02 == 'uper&ar@et 'e-"ec@out ------ (+eware 'ca&&ers wit '@i&&ers!

*02 == %etire&ent $an "ontri#ution Li&its -------------------- ()0* "anges!

*** == 3%' Baing Ta --------------------------- (at Jou a:e to %eport!

**) == '+$ G or&er 'pouse [0*] --------------------------- (Deat A&end&ent!

**/ == 'a:ing 1oney --------------------------- (Cseu 'ayings a#out Doing 3t!

**6 == $uppy 'ca& ------------------------------------------------- (ow it or@s!

**5 == 8nine 'aes 'ca& ----------------------------------------- (ow it or@s!

** == Ta +urden or 1innesota %esidents ------------------- (As o ;an )0*!

**7 == Ta +urden or "oorado %etired Vets ---------------- (As o e# )0*!

**2 == %etiree 'tate Taes ----------- (at to Epect in 'out Da@ota G )0*!

**2 == Trit 'a:ings $an )0* -------------------- (%eturns as o *) e# )0*!

( "ENERAL INTEREST ( *

*)* == s Day ----------------------------------------------- (e#ruary *5!

*)/ == 8:erseas Voters [0)] -------------------- (Easy 'teps to Voting in )0*!

*)6 == $orts&out "onederate 1onu&ent -------------------- (%e&o:a 3ssue!

*) == Eected 8icias "ontact Data ---------------------------- (ere to Bo!

*)7 ==

7/25/2019 Bulletin 160214 (HTML)

5/144

)o) La.,uit / Ed$e.ood Udate 0 +et +i%tory in Te,tin$ Aea&

S'e:en years ago4 in an unprecedented ega action4 Vietna& Veterans o A&erica4 aong wit 'an rancisco-#ased

:eterans organiIation 'words to $owsares4 Foined wit a a doIen :eterans wo :ounteered> to participate in

eperi&ents tat tested ce&ica and #ioogica agents4U said ;on %owan4

7/25/2019 Bulletin 160214 (HTML)

6/144

o is &onty pension o 0 W a arge su& or "u#a4 were saaries today a:erage a#out )5 a &ont? Te C?'?

agency ne:er epained te cuto4 #ut te a&iyXs A&erican awyer says eXs certain it was #ecause o te Cnite

'tatesX trade eargo on "u#a?

In ti, oto5 Otto Ma%ia, ,it, at i, o3e durin$ an interie. in Haana5 uba

7/25/2019 Bulletin 160214 (HTML)

7/144

8#a&a ad&inistration to sow te "u#ans tat itXs serious a#out u&an rigts and cange?Y ['ourceK Associated

$ress G 1icae eissenstein G e#ruary 24 )0* NN]

)o) 201 Bud$et Udate 01 #enta$on Re7ue,tin$ 89:; Bi&&ionTe $entagon on 2 E+ wi un:ei a 5./ #iion #udget re,uest or )0*7 tat see@s a &odest pay raise or ser:ice

&eers4 new adFust&ents to te uture &iitary retire&ent syste& and a&iiar W i unpopuar W canges to te

&iitary eat care syste&4 according Deense Depart&ent docu&ents sated or oicia reease Tuesday aternoon?

Te #udget re,uest or isca year )0*74 wic #egins * 8"T4 aso outines incre&enta reductions or te go#a

acti:e-duty orce as we as depoy&ent o &ore tan 4000 troops to Aganistan and a#out /4550 troops to 3ra,?

Te re,uest or a *? percent pay raise woud a #eow te oicia uptic@ in ci:iian-sector wages4 &ar@ing te

ourt consecuti:e year tat te Deense Depart&ent as sougt to cut ong-ter& costs #y curtaiing te growt in

#asic pay? Te *? percent raise in #asic pay4 i appro:ed #y "ongress4 woud ta@e eect in ;anuary )0*7? 3t as a

a percentage point #eow te deaut raise o )?* percent4 wic is pegged to te recent E&poy&ent "ost 3nde4 a

go:ern&ent &etric tat trac@s te rise in pri:ate-sector pay? Te *? percent raise pencied in or net year is iger

tan te *?/ percent #u&p tat troops recei:ed tis year?

8:era4 te #udget re,uest or&ay sent to "apito i contains ew surprises or &iitary personne accounts

and reiterates te $entagon>s priorities and stated pans ro& te past se:era years? Tota spending on &iitary

personne woud re&ain essentiay at at */5 #iion? ie te detais are su#Fect to cange #eore it #eco&es

aw4 te tota #udget o 5./ #iion trac@s wit a #roader spending agree&ent tat aw&a@ers reaced ast year so it

&ay a:oid te partisan #attes o:er top-ine spending tat a:e #eco&e co&&on since te #udget caps @nown as

se,uestration too@ eect in )0*/? Te #udget proposa is as@ing "ongress to &a@e so&e @ey canges to te

sweeping &iitary retire&ent reor& tat #eca&e aw ast year? Te $entagon supports te unda&enta canges tat

wi srin@ &iitary pensions or uture troops #y )0 percent yet aso oer cas contri#utions to indi:idua

in:est&ent accounts or a troops regardess o weter tey ser:e a u )0-year career? +ut deense oicias are

as@ing or S&odiications now to ensure tat4 wen te new syste& goes into eect [in ;anuary )0*.]4 it #est &eets

te retention needs o te ser:ices and our &en and wo&en in unior&4U according to #udget docu&ents o#tained #y

1iitary Ti&es? Tose proposed canges incudeK

%aising te current cap on go:ern&ent contri#utions to indi:idua in:est&ent accounts to percent o #asic

pay? "urrent aw i&its tat to 5 percent?

Deaying te start o go:ern&ent &atcing contri#utions to indi:idua in:est&ent accounts to te it year

o &iitary ser:ice? Te current aw #egins &atcing contri#utions at te tird year o ser:ice?

Etending te go:ern&ent>s &atcing contri#utions to an indi:idua ser:ice &eerXs actua retire&ent

date? "urrent aw cuts o go:ern&ent &atcing contri#utions at ) years o ser:ice?

%e&o:ing te new retire&ent syste&>s &andatory &ini&u& continuation pay or a troops reacing *)

years o ser:ice4 and gi:ing eac o te ser:ices ei#iity to set continuation pay #ased on teir indi:idua

7

7/25/2019 Bulletin 160214 (HTML)

8/144

needs? "urrent aw ensures tat a troops reacing *) years o ser:ice recei:e continuation pay e,ua to )?5

&onts #asic pay?

Te Deense Depart&ent aso is as@ing "ongress to appro:e canges to te &iitary eat care syste&4 a &o:e

&any eperts #eie:e wi #eco&e a ocus or "ongress as it oo@s to continue reducing &iitary personne costs? Te

new #udget see@s to add so&e new ees or &iitary troops and a&iies tat see doctors in te ci:iian sector? Tat>s

designed to incenti:iIe te use o ess-costy &iitary eat care aciities? And te #udget re,uest see@s a new awreorganiIing te current Tricare eat #eneit into two progra&sK Tricare 'eect4 a eat &aintenance progra& i@e

Tricare $ri&e tat is i&ited to &iitary ospitasZ and Tricare "oice4 an un&anaged care option i@e Tricare

'tandard #ut wit iger ees or &any?

Aso under net yearXs proposed #udget4 te tota siIe o te orce is sated to drop #y a&ost )04000 troops W

ea:ing an acti:e-duty orce o *?). &iion ser:ice &eers? TatXs down a&ost *0 percent ro& a pea@ o *?6)

&iion in )0*04 deense depart&ent data sows? A&ong tose troop reductions woud #e so&e *54000 sodiers4

reecting te Ar&y>s pre:iousy announced pans to continue its drawdown ro& a#out 6754000 tis year to 604000

net year? Te Ar&y>s ong-ter& pans ca or reducing te siIe o its orce to 6504000? Te

7/25/2019 Bulletin 160214 (HTML)

9/144

concerned tat ocusing on cutting tapayer doars woud directy resut in a cut to te co&&issary #eneit W te

sa:ings custo&ers enFoy? Deense oicias wi Soo@ or eiciencies irst and et eiciencies dri:e te #udget4 rater

tan te oter way around4U said $eter Le:ine4 DoD>s deputy cie &anage&ent oicer4 in an )7 8"T speec?

Le:ine is eading te eorts to ind tapayer sa:ings in DoD>s resae operations? 8ne proposa epored was te

&erger or consoidation o te co&&issary and ecange syste&s4 #ut Le:ine said oicias deter&ined tat is not

necessary? Se #eie:e we can get eiciencies witout consoidation4U Le:ine said? ['ourceK 1iitary Ti&es G aren

;owers G e#ruary 24 )0* NN]

o33i,,ary #ri%e, Udate 02 In%rea,e in 201

"ongress wi see@ to raise co&&issary prices wie owering oters under a S:aria#e pricingU pan as part o

upco&ing )0*7 egisation go:erning te Deense Depart&ent4 one aw&a@er tod 1iitary?co&? Y3 do epect tere

to #e additiona co&&issary pro:isions witin te

7/25/2019 Bulletin 160214 (HTML)

10/144

said? Y'o we want to &a@e sure tat te sa:ings is ade,uate to aow te co&&issary sopper to re&ain a

co&&issary sopper so tey see it as a :aued #eneit?Y

As part o tat process aw&a@ers a:e as@ed te co&&issary to produce a Y&ar@et #as@etY o products tat

coud #e co&pared in eac region against prices outside te gate? +ut &iitary a&iy ad:ocates and industry

representati:es say tere are &aFor pro#e&s wit tat pan4 incuding deter&ining wat products soud #e

co&pared4 ow oten a sur:ey soud #e done and wat @inds o stores soud #e incuded in te co&parison?1iitary a&iy ad:ocates aso warn tat uness suc a cange is paired wit increased cost o i:ing aowances4 a

#u&p aw&a@ers are uni@ey to gi:e4 a&iies stationed in ig-cost regions wi #e paying &ore out o poc@et or

groceries and4 in eect4 #e punised or going were te &iitary sends te&? And no data as sown tat suc a

&ode woud actuay resut in sa:ings? Y3t puts at a disad:antage a&iies i:ing in ocations were aready tey are

deaing wit a ig cost o i:ing4Y said Eieen uc@4 a deputy go:ern&ent reations director at te

7/25/2019 Bulletin 160214 (HTML)

11/144

'a&&artino tod te court tat a &ore signiicant sentence was warranted #ecause o 1aa@iXs ong-ter&

corruption o:er &ore tan se:en years? 'e said 1aa@iXs case was Yone o te &ost serious oenses te court as

seen in its tenure in te 'outern District o "aiornia?Y 'e ordered 1aa@i4 664 to pay a *54000 ine and *54000

in restitution to te

7/25/2019 Bulletin 160214 (HTML)

12/144

+ietna3

None

@orea

Te Depart&ent o Deense $8913A Accounting Agency (D$AA! announced today tat te re&ains o a C?'?

ser:ice&an4 &issing ro& te orean ar4 a:e #een identiied and wi #e returned to is a&iy or #uria wit u

&iitary onors? Ar&y "p? @ennet R* Stu%>4 )04 o u&&estown4 $ennsy:ania4 wi #e #uried ;an? /0 in is

o&etown? 8n s unit

was part o a screening orce deending a witdrawa route wen ene&y orces attac@ed? 8n s re&ains4 scientists ro& D$AA and te Ar&ed orces D Aairs "o&&ittee tat Swe a:e enoug autority to ire peopeU and tat

dis&issing &ore e&poyees woud not i&pro:e ser:ices trougout te depart&ent? +ut e as aso repeatedy

*)

http://www.dpaa.mil/http://www.dpaa.mil/

7/25/2019 Bulletin 160214 (HTML)

13/144

pro&ised to punis indi:iduas ound guity o &is&anage&ent and inco&petence4 a pro&ise tat aw&a@ers a:e

repeatedy caed into ,uestion? ['ourceK 1iitary Ti&es G Leo 'ane G e#ruary )4 )0* NN]

Veterans Aairs Deputy 'ecretary 'oan Bi#son is pro&ising new discipinary action against a pair o senior

eecuti:es accused o ga&ing te depart&ent>s interna pro&otion syste&4 ater appeas panes a:e reFected pans

to de&ote te pair? Se a:e carges tat a:e #een sustained4 #ut wit no punis&ent4U Bi#son tod reporters )

E+? S3 don>t #eie:e tat reects te intent o "ongress in passing (new accounta#iity! aws?U e> aso aunc anin:estigation into weter oter ig-ran@ing oicias soud aso ace punis&ent or a series o SFudg&ent errorsU

tat a&ounted to a re:o:ing door o eadersip &o:es wic cost &ore tan 6004000 in reocation epenses4

&oney aw&a@ers a:e insisted soud #e reco:ered ro& te e&poyees?

Tat in:estigation wi incude inter:iews wit Acting Cndersecretary or +eneits Danny $u&&i4 and possi#e

discipinary action or is roe in te cases? S3 tere is e:idence tat supports &isconduct tat was not a:aia#e or

&y re:iew pre:iousy4 3 wi ta@e action4U Bi#son said? Bi#son woud not say weter te new proposed

punis&ents woud ea:e te two eatted eecuti:es W Diana %u#ens4 $iadepia %egiona 8ice director4 and

iery Bra:es4 a 1innesota regiona oice director W in teir current Fo#s? %u#ens and Bra:es are at te center

o a &onts-ong contro:ersy tat as pitted VA eaders against te depart&ent>s inspector genera4 congressiona

critics and teir own e&poyees?

An inspector genera report reeased in ate 'epteer carged %u#ens and Bra:es wit a#using teir autority to

reassign oter directors to Fo#s esewere witin VA4 ten &o:ing into te :acant positions te&se:es? 3n:estigators

said te &o:es carried wit te& ewer responsi#iities #ut no saary reductions4 pus generous reocation payouts?

Bra:es4 wo &a@es neary *764000 a year4 got &ore tan *)24000 to &o:e ro& $iadepia to 1innesota?

%u#ens4 wo &a@es *.*40004 recei:ed &ore tan )..4000 to &o:e ro& asington4 D?"?4 to $iadepia?

Law&a@ers a:e repeatedy caed or teir irings? +ut Bi#son and oter senior VA eaders a:e #asted te 3B

indings as poiticay &oti:ated and #aseess4 and reco&&ended de&otions instead?

3n two separate ruings o:er te ast wee@4 appeas Fudges denied tose de&otions4 saying te &ista@es &ade #y

te eecuti:es don>t warrant tat e:e o punis&ent? $art o te Fustiication or tat decision is tat oter e,uay

cupa#e eecuti:es weren>t discipined at a or si&iar &ista@es? Bi#son said tose co&&ents and new e:idence

unco:ered in te appeas process pro&pted i& to oo@ into weter $u&&i W wo o:ersaw #ot wo&en W and

oters soud ace punis&ent? e aso noted tat neiter Fudge reuted VA>s assertion tat te wo&en &ade errorsin Fudge&ent in in:o:ing te&se:es in Fo# transers tat coud #e se-#eneicia4 wic e caed a :aidation o

te depart&ent>s &o:es so ar? Te new punis&ent coud in:o:e reocating #ot wo&en to oter Fo#s4 #ut not

de&oting te& ro& te senior eecuti:e ser:ice?

Bi#son said e sti as conidence in #ot o te& as &anagers4 #ut et te &o:es were necessary #ecause o te

appearance o i&propriety tey created? e aso dis&issed te idea tat is depart&ent needs &ore toos to ande

e&poyee accounta#iity4 noting tat new rues appro:ed #y "ongress in )0*6 &ay a:e o:er-co&picated tis case?

Te appeas Fudge in %u#ens> case noted tat e woud a:e preerred to S&itigateU punis&ent or te eecuti:e4

#ut under current aw e was aowed ony to re:erse te decision? Te aw passed #y aw&a@ers was designed to

speed te iring process #y si&piying te notiication and appeas process? Bi#son caed it Ste pitas associated

wit a patcwor@ ,uit o processes and ega standards?U A decision on new punis&ent or %u#ens and Bra:es4 and

possi#e punis&ent or oter eecuti:es4 is epected net wee@?

"ongress as repeatedy criticiIed VA or inre,uent irings witin te depart&ent4 e:en in te wa@e o

nationwide scandas regarding patient wait ti&es and records &anipuations? Last &ont4 VA 'ecretary +o#

1cDonad tod &eers o te 'enate Veterans> Aairs "o&&ittee tat Swe a:e enoug autority to ire peopeU

and tat dis&issing &ore e&poyees woud not i&pro:e ser:ices trougout te depart&ent? +ut e as aso

repeatedy pro&ised to punis indi:iduas ound guity o &is&anage&ent and inco&petence4 a pro&ise tat

aw&a@ers a:e repeatedy caed into ,uestion? ['ourceK 1iitary?co& G Leo 'aneG e#ruary )4 )0* NN]

*/

7/25/2019 Bulletin 160214 (HTML)

14/144

+A A%%ountabi&ity Udate 1: \ Ne. To Ee% #uni,3ent Idea

Te Depart&ent o Veterans Aairs #osses a:e co&e up wit a new idea on ow to punis top eecuti:es at te

agency M one tat woud @eep contro in te ands o VA eadersip and ecude in:o:e&ent o an outside appeas

#oard4 VA 'ecretary +o# 1cDonad said *0 E+? Te idea was oated #y Deputy 'ecretary 'oan Bi#son ater

suering a #ruising #ow ro& te &andated appeas #oard tat o:erturned tree VA punis&ents in a row in te

past ew wee@s? Te actions #y te 1erit 'yste&s $rotection +oard earrassed te agency and rustrated Bi#son4

wo said te #oard ad ta@en away is a#iity to od senior eecuti:es accounta#e?

Se%retary oD +eteran, ADDair, Bob M%)ona&d and oter to +A oDDi%ia&, te,tiDy at a Hou,e +eteran, ADDair, o33ittee

earin$ on aito& Hi&&5 Feb* 105 2016*

1cDonad4 appearing ednesday #eore te ouse Veteran>s Aairs "o&&ittee to discuss te proposed VA

#udget or )0*74 said Bi#son>s idea was to put a senior eecuti:es under te reguatory Tite /. statute M te sa&e

one used or VA &edica proessionas -- wic woud aow te agency to ire eecuti:es at wi? S3t gi:es us te

a#iity to pay te& &ore co&petiti:ey and gi:es us &ore ei#iity in punising te&4U 1cDonad said? e said

Bi#son introduced te idea during a &eeting Tuesday #etween te VA eadersip and te ouse and 'enate

o:ersigt co&&ittee eaders? Te announce&ent &ar@ed te irst ti&e tat te aw&a@ers and VA oicias appeared

to agree on accounta#iity issues at an agency tat as #een pagued #y scanda? or neary two years4 aw&a@ers on

te o:ersigt co&&ittees a:e #een critica o VA eadersip or aiing to ta@e eecuti:es to tas@4 ater detais

e&erged o uge appoint&ent and #eneits wait ti&es and o co:er-ups tat et :eterans dying wie anguising onidden wait ists?

%ep? ;e 1ier (%-L!4 te ouse Veterans> Aairs "o&&ittee4 as #een pressing VA eaders to agree to egisati:e

reor& o te ci:i ser:ice syste& tat woud aow or greater accounta#iity? Cnti now4 1cDonad and Bi#son

a:e said tey ad te toos tey needed? 1ier reiterated is concerns Tuesday4 saying e woud #e re&iss i e

didn>t &ention te rustrations e and oter &eers o te pane et oowing te 1'$+ re:ersas? Se>:e got to

a:e an onest con:ersation a#out wat>s appening in te ci:i ser:ice syste&4U e said? 8ter groups aso raied

against te syste& ater te 1'$+ ruings? Last wee@4 te #oard re:ersed te VA>s atte&pt to ire Linda eiss4 te

director o te A#any 'tratton VA1" oowing re:eations o &is&anage&ent o patient care? Tat re:ersa ca&e

on te ees o earier decisions #y te #oard to undo discipinary actions in ig-proie cases against eecuti:es

Diana %u#ens and iery Bra:es4 or teir actions in:o:ing teir reassign&ents to dierent positions wie

coecting undreds o tousands o doars in reocation incenti:es? Bi#son :owed ast wee@ tat despite te #oard>sre:ersa4 e woud not return eiss to any position were se woud #e responsi#e or patient care?

A&erican Legion

7/25/2019 Bulletin 160214 (HTML)

15/144

o :eteran>s egisation tat wi go up or a :ote ater tis year? Te proposa coud ace so&e resistance4 particuary

ro& 'en? +ernie 'anders (D-1A! wo was instru&enta in ensuring tat te appeas #oard ad te ina say on

discipinary cases against VA eecuti:es wen te egisation was passed ast year?

1cDonad aso outined oter issues e opes "ongress wi consider or egisation tis year4 incuding 60 new

proposas? A&ong te&K aowing 1cDonad te autority to transer up to ) percent o discretionary unding across

accountsZ aowing or greater ei#iity in Fo# ours and pay or top &edica sta so te VA can #e &oreco&petiti:e in iring4 and restructuring te current process or #eneits appeas4 in wic so&e cases a:e ta@en

years or e:en decades to reso:e? 1cDonad said e #eie:ed #y restructuring te appeas process rater tan Fust

adding &ore staing4 te VA coud uti&atey cut te nuer o sta and ependiture wie strea&ining process

and ending te #ac@og? S3 we are serious a#out canging te VA and #etter ser:ing :eterans4 we can>t @eep @ic@ing

te can down te road4U 1cDonad said? 1ier weco&ed te proposa?

During two ours o testi&ony4 1cDonad aced down wat as #eco&e routine criticis& a#out accounta#iity

issues in oter areas as we? %ep? Doug Laorn (%-"8! gried 1cDonad on wy no#ody was punised ater an

inspector genera report ast year ound ong wait ti&es at te VA in "oorado 'prings? 1cDonad said te report

ound #ad training4 not intentiona &aeasance4 and te VA as addressed te issue? Laorn wasn>t appeased?

Seter it was &aicious or not4 3 tin@ te records were asiied and so&eone needs to #e ired4U e said? %ep?

1i@e "o&an4 anoter %epu#ican ro& "oorado4 pic@ed up te &ante4 pressing 1cDonad on wy te VAwoudn>t get #eind a egisati:e eort tat woud ena#e te& to ta@e #ac@ #onuses ro& eecuti:es wo were

ound to a:e acted #ady to get te &oney and wy te VA wasn>t getting rid o &ore eecuti:es wo>d #een ound

guity o wrongdoing? "o&an assaied 1cDonad or Ssaying great tingsU #ut Snot attac@ing te eart o te

pro#e&U and aowing #ad #ea:ior to continue? SJou can>t ire your way to eceence4U 1cDonad said? S3t &igt

#e a good start4U "o&an repied? ['ourceK 'tars and 'tripes G Dianna "an G e#ruary *04 )0* NN]

+A Se%retary Udate 44 Sen* I,a>,on !ant, M%)ona&d to Stay

An inuentia &eer o te C?'? 'enate wants Veterans Aairs 'ecretary +o# 1cDonad to stay on in tat roe

net year4 no &atter wo #eco&es president? SE:eryting 3>:e seen wit +o# 1cDonad o:er te ast * &onts4

3>:e #een :ery peased wit4U said 'en? ;onny 3sa@son (%-BA! in an inter:iew or "-'$A

7/25/2019 Bulletin 160214 (HTML)

16/144

o&ni#us pac@age4 roing togeter a ost o proposed eat and #eneits reor& proposas? eter tat egisation

wi incude VA pans to o:erau te #eneits appeas process re&ains to #e seen? 3sa@son said e supports wor@ing

on canges to tat syste&4 #ut is not sure tere wi #e enoug ti&e to reac co&pro&ise on a new pan tis year?

['ourceK 1iitary Ti&es G Leo 'ane G e#ruary **4 )0* NN]

+A SAH Udate 0 "rant #ro%e,,in$ )e&ay, )ue to Under,taDDin$

Te Veterans Aairs Depart&ent needs &ore sta to ande its progra& tat eps disa#ed :eterans to purcase or

&odiy o&es to i&pro:e teir independent i:ing4 according to ad:ocates? 3n &any areas o te country4 inade,uate

staing contri#utes to deays in processing 'peciay Adapted ousing progra& grants and resuts in poor custo&er

ser:ice to :eterans4 said eater Ansey4 associate genera counse or corporate and go:ern&ent reations or

$arayIed Veterans o A&erica4 testiying #eore te ouse Veterans> Aairs "o&&ittee>s pane on econo&ic

opportunity?

3n:est&ents in staing are needed4 se said4 #ecause sta &eers are not a#e to ande te arge wor@ oad4

incuding te inu o :eterans wit a&yotropic atera scerosis? SVeterans wit AL' are critica users o te 'A

grant progra& and te ousing adaptation assistance it pro:ides4U se said? Te syste& is not responsi:e enoug to

tose wit &ore rapidy canging disorders i@e AL'4 se said? $VA reco&&ends epediting te process or :eterans

wo are ter&inay i4 incuding tose wit AL'4 se said? According to ser:ice oicers wit $VA4 :eterans are

a:ing trou#e reacing teir 'A agents? Tis is not ony unair to te :eterans4 #ut to te agents wo are trying to

ser:e te& despite too &any tas@s and too ew resources4 Ansey said? ie it>s understood tat appication re:iews

need to #e co&pete4 said %ep? %yan "osteo (%-$A!4 Swe &ust stri:e to i&pro:e te ti&einess o ser:ice or a

:eterans?U

VA is wor@ing to ree up oter sta to assist wit te grants4 said 1i@e rue4 director o oan guaranty ser:ice

or te VA>s Veterans +eneits Ad&inistration? rue said te VA oo@s at eiciency and eecti:eness across te

#oard4 and tat tese sta &eers need to #e ocated around te country4 #ut staing can #e adFusted i tere>s a

spi@e in need in one area? VA re,uires in-o&e inter:iews #e conducted wit :eterans witin /0 #usiness days o

eigi#iity deter&ination4 and te typica 'A process re,uires nu&erous co&&unications and in-person &eetings

wit te :eteran? VA i&pe&ented strea&ined poicies and procedures or te 'A grant process in e#ruary )0*64

rue said? e noted tat tere as #een an o:era increase in te nuer o :eterans eigi#e or te progra&4

citing epansions in te progra&4 te &iitary drawdown and VA>s reductions in te disa#iity co&pensation cai&s

processing ti&e? 3n isca )0*54 VA appro:ed &ore tan *4.00 grants totaing 2 &iion4 e said4 an increase o

a#out 66 percent o:er )0*64 and an increase o 5 percent o:er )0*/? ['ourceK 1iitary Ti&es G aren ;owers G

e#ruary **4 )0* NN]

+A Medi%a& Fo,ter Ho3e, \ Nur,in$ Ho3e A&ternatie

A 1edica oster o&e (1! can ser:e as an aternati:e to a nursing o&e? 3t &ay #e appropriate or Veterans

wo re,uire nursing o&e care #ut preer a non-institutiona setting wit ewer residents? 1s are pri:ate o&es

in wic a trained caregi:er pro:ides ser:ices to a ew indi:iduas? 'o&e4 #ut not a4 residents are Veterans? VA

inspects and appro:es a 1edica oster o&es? Te o&es a:e a trained caregi:er on duty )6 ours a day4 7 days

a wee@? Tis caregi:er can ep te Veteran carry out acti:ities o daiy i:ing4 suc as #ating and getting dressed?

VA ensures tat te caregi:er is we trained to pro:ide VA panned care?

*

7/25/2019 Bulletin 160214 (HTML)

17/144

Jou wi continue to recei:e o&e +ased $ri&ary "are ser:ices in te 1edica oster o&e? Jou &ay aso

recei:e te oowing ser:ices ro& te 1edica oster o&e caregi:er?

*? or VeteransK

ep wit your acti:ities o daiy i:ing (e?g?4 #ating and getting dressed!

ep ta@ing your &edications

'o&e nursing assistance4 i te caregi:er is a registered nurse A o your &eas

$anned recreationa and socia acti:ities

)? or "aregi:ersK

$eace o &ind wen o&e and "o&&unity +ased 'er:ices can no onger &eet te VeteranXs needs at

o&e

A pace to enFoy spending ti&e wit te Veteran

Jou can use te #eow 'ared Decision 1a@ing ('D1! or@seet to ep you igure out wat ong ter& care

ser:ices or settings &ay #est &eet your needs now or in te uture? TereXs aso a "aregi:er 'e-Assess&ent ("'A!

wor@seet? 3t can ep your caregi:er identiy teir own needs and decide ow &uc support tey can oer to you?

a:ing tis inor&ation ro& your caregi:er4 aong wit te in:o:e&ent o your care tea& and socia wor@er4 wiep you reac good ong ter& care decisions?

'D1K ttpK99www?:a?go:9geriatrics9guide9ongter&care9'ared^Decision^1a@ing^or@seet?pd

"'AK ttpK99www?:a?go:9geriatrics9guide9ongter&care9"aregi:er^'e^Assess&ent?pd

Jour pysician or oter pri&ary care pro:ider can answer ,uestions a#out your &edica needs? 'o&e i&portant

,uestions to ta@ a#out wit your socia wor@er and a&iy incudeK

ow &uc assistance do 3 need or &y acti:ities o daiy i:ing (e?g?4 #ating and getting dressed!P

at are &y caregi:erXs needsP

ow &uc independence and pri:acy do 3 wantP

at sort o socia interactions are i&portant to &eP

ow &uc can 3 aord to pay or care eac &ontP

1edica oster o&es are not pro:ided or paid or #y VA? To #e eigi#e or a 1 you need to #e enroed in

o&e +ased $ri&ary "are4 and a o&e needs to #e a:aia#e? Jour VA socia wor@er or case &anager can ep you

wit eigi#iity guideines or o&e +ased $ri&ary "are and 1edica oster o&e care? Aso4 wit ocating one and

assist wit &a@ing te arrange&ents? Jou wi a:e to pay or te 1 yourse or troug oter insurance? Te

carge or a 1 is a#out *500 to /000 eac &ont #ased on your inco&e and te e:e o care you need? Te

speciic cost is agreed upon aead o ti&e #y you and te 1 caregi:er? Ta@ wit a VA socia wor@er9case

&anager to ind out i you are entited to additiona VA #eneits tat wi ep pay or a 1edica oster o&e

3 a 1edica oster o&e see&s rigt or you4 your VA socia wor@er can ep you ocate one and assist wit

&a@ing arrange&ents? Aso4 at ttpK99www?:a?go:9BE%3AT%3"'9Buide9LongTer&"are9Locate^'er:ices?asp you

can use te Locate 'er:ices and %esources page to ep you ocate 1edica oster o&es? ['ourceK Beriatrics and

Etended "are ttpK99www?:a?go:9geriatrics9guide9ongter&care9&edica^oster^o&es?aspOe# )0* NN]

+A Ho,ita& Gua&ity oD are Udate 02 \ 2010

7/25/2019 Bulletin 160214 (HTML)

18/144

"ances or dying or #eing read&itted witin /0 days o treat&ent or tose conditions :aried ony sigty or

patients ospitaiIed witin te VA syste& :ersus at outside ospitas4 te )0*0-)0*/ study ound? Te resuts

contrast wit ongstanding concerns a#out caenges acing :eterans and te VA eat syste&4 incuding ,uaity

,uestions and ong waits or care? Tey suggest tat VA ospitas Yare sti a#e to dei:er ig-,uaity care or so&e

o te sic@est &ost co&picated patients4Y Dr? Asis ;a4 a ar:ard eat poicy epert4 said in an editoria

pu#ised 2 E+ wit te study in te ;ourna o te A&erican 1edica Association?

Te study anayIed cai&s or &en aged 5 and oder treated at *06 VA ospitas and or &ae 1edicare patients

treated at *45*/ non-VA ospitas nationwide? Eac co&parison in:o:ed at east 74200 patients? At VA ospitas4

deat rates were &arginay ower ater a eart attac@ W */?5 percent :s */?7 percentZ and or eart aiure W **?6

percent :s **?2 percent? Tey were sigty iger or pneu&onia W *)? percent :s? *)?) percent at non-VA

ospitas? %ead&ission rates ranged ro& a#out *7 percent to )5 percent or te tree conditions and were igest at

VA ospitas4 #ut ony #y a#out * percentage point or ess? Y+ot groups are now wor@ing on ,uaity in ways tey

didnXt a decade ago and te e:es o good peror&ance are ,uite co&para#eY or te conditions studied4 said ead

autor Dr? aran ru&oI4 a Jae Cni:ersity cardioogist and researcer?

Te eorts incude onine sites aowing consu&ers to co&pare patient outco&es or te tree conditions studied

at VA ospitas and oters nationwide4 and growing use o piot-stye cec@ists during ospita procedures to :eriy

appropriate treat&ent? 'ti4 ru&oI said te o:era resuts arenXt idea? Y%ead&issions are sti way too ig andwe a:enXt &ade enoug progress tere4Y e said? Lower read&ission rates at non-VA ospitas &ay party reect te

i&pact o inancia penaties te 1edicare syste& introduced in )0*) to reduce read&issions? +ut aso4 VA patients

tend to #e sic@er and tra:e arter or care4 wic coud ead to &ore read&issions4 te researcers said?

Dr? Da:id 'u@in4 te VAXs undersecretary or eat4 said te resuts are not surprising and tey de#un@ Yte

i&pression tat te VA as aen #eind? Tis reay is :aidationY tat VA e&poyees Yare reay doing a :ery good

Fo# and @eeping ocused on doing watXs rigt or :eterans?Y ru&oI noted tat te study doesnXt address ,uaity

o care or young patients4 wo&en and tose wit conditions oter tan tose studied? ;a4 te editoria autor4 said

oter i&portant ,uestions a#out VA ospitas re&ain4 incuding ti&einess o care and weter :eterans percei:e tat

tey are treated wit respect? ['ourceK A+"

Appeas (+oard!? oowing addresses te %8>s appea process4 your roe in te process4 and te tings you can do

to ep epedite your appea?

*.

7/25/2019 Bulletin 160214 (HTML)

19/144

Aea&, at te &o%a& re$iona& oDDi%e &ee&* 8nce a VA oice issues its decision on your cai&4 you a:e one year

ro& tat date to ie an appea? %ead te decision etter coseyK it wi te you wy VA &ade te decision it did? 3

you are unsure wy or ow VA &ade its decision4 as@ a Veterans ser:ice oicer or ep? Jou can aso ca VA or go

to your regiona oice? 3 you disagree wit VA>s decision or any reason M te eecti:e date o your award4 te

rating percentage you were gi:en or te reason you were denied M you soud ie a

Appeas4 i you wis to continue your appea to te +oard? At ttpK99www?:a?go:9:aor&s9:a9pd9VA2?pdit can #e

*2

http://www.vba.va.gov/pubs/forms/VBA-21-0958-ARE.pdfhttp://www.vba.va.gov/pubs/forms/VBA-21-0958-ARE.pdfhttp://www.va.gov/vaforms/va/pdf/VA9.pdfhttp://www.va.gov/vaforms/va/pdf/VA9.pdfhttp://www.vba.va.gov/pubs/forms/VBA-21-0958-ARE.pdfhttp://www.va.gov/vaforms/va/pdf/VA9.pdf

7/25/2019 Bulletin 160214 (HTML)

20/144

co&peted onine and downoaded or &aiing? Any ti&e you su#&it &ore e:idence ater te '8" or #eore te

or& 24 V+A &ust conduct anoter re:iew o te case and issue anoter '8" M tis one caed a suppe&enta

state&ent o te case (''8"! tat incudes te additiona e:idence M or a rating decision4 i te additiona e:idence

aows V+A to grant te appea? Tis &ust #e done eac ti&e you su#&it new e:idence ater te '8"? 3 a:e seen

appeas wit our or i:e ''8"s? eep in &ind4 eac ti&e you su#&it new e:idence it triggers a new re:iew? 3t>s

i@e starting a o:er again in te appeas process? Eac new ''8" can add up to 600 days to te appea4 so &y #est

ad:ice is4 su#&it a a:aia#e e:idence to support your appea wen you ie your t a:e to

wait or a Fudge to tra:e to your %8? Jou sti get te #eneit o representation and ta@ing to a Fudge ace-to-ace M

toug :irtuay4 i@e on '@ype or on aceTi&e? 8nce you su#&it your or& 24 te %8 appeas tea& re:iews your

appea to ensure a actions were co&peted and tat it is ready to go to te +oard? 8nce ready4 te oca %8 wi

certiy and transer your appea to te +oard in asington4 D?"? ['ourceK VAntage $oint G "aterine Troey G

e#ruary *04 )0* NN]

+A Bud$et 201 81:2*;B #roo,ed

3n is J )0*7 #udget4 $resident 8#a&a is proposing *.)?/ #iion or te Depart&ent o Veterans Aairs (VA!?

unding wi continue to support te argest transor&ation in VA istoryZ epand access to ti&ey4 ig-,uaity

eat care and #eneitsZ and ad:ance eorts to end o&eessness a&ong Veterans? SVA as #eore it one o te

greatest opportunities in its istory to transor& te way it cares or our Veterans wo no#y ser:ed and sacriiced

or our

7/25/2019 Bulletin 160214 (HTML)

21/144

3nerent %eso:e (83%! and 8peration reedo&>s 'entine (8'!? 1aFor spending categories witin te eat care

#udget areK

*)?) #iion or care in te co&&unityZ

.?5 #iion or ong-ter& careZ

7?. #iion or &enta eatZ

*? #iion or o&eess VeteransZ

*?5 #iion or epatitis-" treat&entsZ

7)5 &iion or "aregi:ersZ

0* &iion or spina cord inFuriesZ and

).6 &iion or trau&atic #rain inFuries?

Eandin$ A%%e,, < Te $resident>s +udget ensures tat care and oter #eneits are a:aia#e to Veterans wen

and were tey need te&? A&ong te progra&s tat wi epand access under te proposed #udget areK

*)?) #iion or care in te co&&unity co&pared to *0?5 #iion in )0*54 a * percent increaseZ

*?) #iion in teeeat unding4 wic eps patients &onitor cronic eat care conditions and increases

access to care4 especiay in rura and re&ote ocationsZ

5*5 &iion or eat care ser:ices speciicay designed or wo&en4 an increase o .?5 percent o:er tepresent e:eZ

./ &iion or te acti:ation o new and enanced eat care aciitiesZ

200 &iion or &aFor and &inor construction proFects4 incuding unding or seis&ic corrections4 two new

ce&eteries4 and two gra:esite epansionsZ and

*7* &iion or i&pro:ed custo&er ser:ice #y pro:iding an integrated ser:ices dei:ery pator&?

I3roin$ te EDDi%ien%y oD &ai3, #ro%e,,in$ < Te $resident>s +udget pro:ides or continued

i&pe&entation o te Veterans +eneits Ad&inistration>s (V+A! ro#ust Transor&ation $an -- a series o peope4

process4 and tecnoogy initiati:es -- in )0*7? Tis pan wi continue to syste&aticay i&pro:e te ,uaity and

eiciency o cai&s processing?1aFor cai&s transor&ation initiati:es in te #udget in:est /)/ &iion to #ring

eading-edge tecnoogy to cai&s processing4 incudingK

*.0 &iion (*6/ &iion in 3nor&ation Tecnoogy and /7 &iion in V+A! to enance te eectroniccai&s processing syste& M te Veterans +eneits 1anage&ent 'yste& (V+1'!Z and

*6/ &iion or Veterans "ai&s 3nta@e $rogra& (V"3$! to continue con:ersion o paper records4 suc as

Veterans> &edica records4 into eectronic i&ages and data in V+1'?

3n addition4 te $resident>s +udget supports increasing V+A>s wor@orce to address staing needs so it can

continue to i&pro:e te dei:ery o #eneits to Veterans? As V+A continues to recei:e and co&pete &ore disa#iity

co&pensation rating cai&s4 te :ou&e o non-rating cai&s correspondingy increases? Te re,uest or 56 &iion

or /00 additiona u-ti&e e,ui:aent e&poyees (TE! and cai&s processing support wi aow V+A to pro:ide

&ore ti&ey actions on non-rating cai&s?

Aea&, ReDor3 < Te current appeas process is co&picated and ineecti:e4 and Veterans on a:erage are

waiting a#out 5 years or a ina decision on an appea tat reaces te +oard o Veterans> Appeas4 wit tousandswaiting &uc onger? Te )0*7 +udget proposes a 'i&piied Appeas initiati:e M egisation and resources M to

pro:ide Veterans wit a si&pe4 air4 and strea&ined appeas process in wic tey woud recei:e a ina appeas

decision witin one year ro& iing an appea #y )0)*? Te +udget re,uests *5 &iion and 2)) TE or te

+oard4 an increase o 6 &iion and )6) TE o:er )0*4 as a down pay&ent on a ong-ter&4 sustaina#e pan to

i&pro:e ser:ices to Veterans?

Endin$ +eteran, Ho3e&e,,ne,, < Te Ad&inistration as &ade te ending o Veteran o&eessness a nationa

priority? Te +udget re,uests *? #iion or progra&s to pre:ent or reduce Veteran o&eessness4 incudingK

)*

7/25/2019 Bulletin 160214 (HTML)

22/144

/00 &iion or 'upporti:e 'er:ices or Veteran a&iies (''V! to pro&ote ousing sta#iityZ

62 &iion or te CD-VA' progra&4 werein VA pro:ides case &anage&ent ser:ices or at-ris@

Veterans and teir a&iies and CD pro:ides per&anent ousing troug its ousing "oice Voucer

progra&Z and

)67 &iion in grant and per die& pay&ents tat support te&porary ousing pro:ided #y co&&unity-

#ased organiIations?

My+A < Te )0*7 #udget continues te argest Depart&ent-wide transor&ation in VA>s istory troug te

1yVA initiati:e4 wic is canging VA>s cuture4 processes4 and capa#iities to put te needs4 epectations and

interests o Veterans and teir a&iies irst? 1yVA as de:eoped i:e o#Fecti:es unda&enta to te transor&ation

o VAK *! i&pro:ing te Veterans> eperienceZ )! i&pro:ing te e&poyee eperienceZ /! i&pro:ing support ser:ice

eceenceZ 6! esta#ising a cuture o continuous peror&ance i&pro:e&entZ and 5! enancing strategic

partnersips? To aid in tis transor&ation4 te Depart&ent esta#ised te Veterans Eperience 8ice (VE8!? Te

VE8 wi represent te :oice o Veterans and teir a&iies in Depart&enta go:ernanceZ design and i&pe&ent

custo&er-centric progra&s to &a@e interactions wit VA easierZ and support VA>s S&ission ownersU in carrying out

1yVA i&pro:e&ents across te syste&?

+eteran, oi%e A%t < Te Veterans "oice Act pro:ides 5 #iion to increase VeteransX access to eat care #y

iring &ore pysicians and sta and i&pro:ing te VA>s pysica inrastructure? 3t aso pro:ides *0 #iion troug)0*7 to esta#is a te&porary progra& (te Veterans "oice $rogra&! to i&pro:e access to eat care #y aowing

eigi#e Veterans wo &eet certain wait-ti&e or distance standards to use eigi#e eat care pro:iders outside o te

VA syste&? 3n )0*74 VA wi use te "oice Act unds in concert wit annua appropriations to &eet VA staing

and inrastructure needs and epand non-VA care to Veterans wo are eigi#e or te Veterans "oice $rogra&? VA

pans to spend *?6 #iion in )0* and .5/ &iion in )0*7 to support &ore tan 24700 new &edica care sta

ired troug te "oice ActZ 2.0 &iion in )0* and ** &iion in )0*7 to i&pro:e VA aciities?

Oter @ey Seri%e, Dor +eteran, s syste& o */6 nationa ce&eteries4 incuding additiona unding or

operations o new ce&eteries and te er, Eye Eer

7/25/2019 Bulletin 160214 (HTML)

23/144

Law&a@ers warned Veterans Aairs oicias *0 E+ not to assu&e tey> continue to see teir #udget grow

uncec@ed4 especiay in igt o recent criticis&s o depart&ent spending? Te depart&ent as seen #udget increases

eac o te ast * years4 e:en as unding o oter go:ern&ent progra&s as ed steady or #een reduced? en

aw&a@ers passed spending caps on edera progra&s in )0**4 Veterans Aairs progra&s were ee&pt? 3n isca

)00*4 te VA #udget totaed 65 #iion? Te president>s #udget re,uest or isca )0*7 is our ti&es tat4 topping

*77 #iion4 wit 75 #iion or discretionary unding aone?

Ad&inistration oicias a:e said te increases reect te growing de&ands on te depart&ent in te wa@e o te

wars in 3ra, and Aganistan4 and are designed to correct ongstanding sortas in te depart&ent? +ut

congressiona eaders warned tat tose cost corrections &ay #e co&ing to an end? STis #udget re,uest is a&ost

dou#e te VA #udget in )0024 and since ten4 te VA as #een pagued #y scandas and &is&anage&ent and as

consistenty pro:en its ina#iity to use its eisting resources4U 'enate VeteransX Aairs "o&&ittee "air&an ;onny

3sa@son (%-BA! said in a state&ent? STe soution to iing a #ro@en agency is not si&py gi:ing it &ore &oney?U

3n a VA #udget re,uest earing across "apito i4 ouse VeteransX Aairs "o&&ittee "air&an ;e 1ier (%-

L! pro&ised to Sigt to ensure VA as te resources it needs4 #ut gi:en recent pro#e&s4 tis #udget re,uest wi

recei:e e:ery #it o te scrutiny it is due?U e reerenced a #iion-doar cost o:errun or pans to #uid a new VA

ospita near Den:er and reated #udget sortas ast year tat caused "ongress to pass e&ergency egisation to

@eep te depart&ent>s progra&s operating? S+ut in cassic VA asion4 3>& not aware o a singe e&poyee tat as

#een ed accounta#e or tese unprecedented aiures4U e said? 8ter co&&ittee &eers a&ented ingering

pro#e&s wit :eteransX access to eat care appoint&ents4 disa#iity #eneits cai&s and &idde &anage&ent

&ista@es?

VA 'ecretary +o# 1cDonad said te #udget proposa does incude a ost o eiciencies and reor&s4 incuding

proposas to si&piy te &anage&ent structure witin te depart&ent and cose ecess aciity space? Se>re

pro:iding &ore care4 &ore access to care4U e said o te #udget increases? Se>re deaing wit &ore disa#iity

cai&s? e>re ser:ing a custo&er tat as &ore de&ands?U Te annua #udget process is epected to ast we into

te a4 atoug eaders ro& #ot caers a:e epressed ope tat appropriations wor@ coud #e co&peted

#eore te

7/25/2019 Bulletin 160214 (HTML)

24/144

co&peting and9or su#&itting a D+? VA reser:es te rigt to conir& te autenticity o a D+s co&peted #y

pri:ate eat care pro:iders? Tere are our steps to su#&it a D+K

Ste1 ind te appropriate D+ #ased on your cai&ed disa#iity?

Bo to ttpK99#eneits?:a?go:9"81$E

7/25/2019 Bulletin 160214 (HTML)

25/144

!!II %o3bat et denied +A beneDit, oer &a%> oD I)

Li&pert said e waited unti now to appy or #eneits #ecause e is down to noting? e and is wie i:e in an

assisted-i:ing aciity outside 't? Louis? Se got rid o our car4 we got rid o our ouse4U e said? S3 got rid o

&oney 3 ad in #onds and stoc@s and now 3 need ep?U is appication incuded penty o docu&entation4 incuding

discarge papers4 te na&es o is ooe pas and te -ray o is wounded eg? Te proo aso incuded is $urpe

eart and two +ronIe 'tars e recei:ed in te $aciic? o ) reported te VA etter as@s Li&pert to su#&it aida:its

ro& eow ser:ice &eers4 &ost o wo& are dead4 or te ocation o te ospita were e was originay

treated? STere ain>t no ospita4U e tod te station? Se were in te Funges?U Te station reported tat Li&pert>s

&iitary records were apparenty a&ong te &iions destroyed in a &assi:e ire in 8:erand4 1issouri4 in *27/? Te

station aso reported tat it sougt co&&ent ro& te VA in asington witout success? Li&pert as now turned tois oca senator or ep in te &atter? ['ourceK o

7/25/2019 Bulletin 160214 (HTML)

26/144

ta@ a#out it or years? en e inay did4 e tod is a&iy tat te Ar&y warned i& eXd #e trown in Fai i e

e:er discosed te eperi&ents? arre4 @nown as YArie4Y as #een reFected tree ti&es #y te Depart&ent o

Veterans Aairs or cai&s to ep treat a ung disorder and s@in cancer tat is a&iy #eie:es are connected to tat

eposure4 arre4 wo turns .2 net &ont4 is in a nursing o&e in 1acon4 1issouri4 *.0 &ies nortwest o 't?

Louis4 una#e to wa@ or ta@? +ut is a&iy opes is ina appea to te VA wi get i& te recognition ro& te

go:ern&ent tey #eie:e e deser:es?

Ar&a !ayne Harre&&

Te VA as said e needs &ore docu&entation W Ynew and &ateria e:idence4Y as a )00 reFection etter

descri#es it W to pro:e te cai&? arreXs a&iy said tatXs i&possi#e? e was *. at te ti&e and ad #een warned

to ne:er ta@? At te ti&e4 arre was new in te &iitary and didnXt @now or doesnXt re&eer te na&es o oter

&en eposed wit i&? is cidren tin@ e purposey #oc@ed out te eperience? +ut 55 pages o &iitary records

in is a&iyXs possession sow tat rigt ater Arie arre said e was twice tested wit &ustard gas4 in ate ;uy

*2654 e was ospitaiIed at "a&p "rowder wit a ig e:er and a sore troat? Te Ar&y diagnosed it as

nasoparyngitis W an ina&&ation o &ucous &eranes #etween te nose and troat W aong wit tonsiitis and

se:ere gu& disease? e ser:ed tree years4 &osty in postwar Ber&any? E:er since4 is cidren say4 e as suered

persistent #reating pro#e&s?

arre and is wie4 +etty4 raised tree daugters and two sons in a ansas "ity su#ur#4 and ater4 in te town o+e:ier4 1issouri4 a tree-our dri:e nortwest o 't? Louis? arre was a truc@ dri:er and &ecanicZ is wie

wor@ed as a nurse? Ye was aways sort o #reat4Y said a son4 %ay arre4 o 'arasota4 orida4 wo ser:ed in te

7/25/2019 Bulletin 160214 (HTML)

27/144

is cidren say e suers ro& re,uent pneu&onia and #roncitis and ro& te ater&at o a stro@e? Despite

is ina#iity to ta@4 e is sti cogniIant and understands :isitors4 incuding is wie4 wo :isits i& a&ost e:ery

day? Te cidren say teir parents are spending down sa:ings on is care and tat 500-a-&ont drug costs or

arre put a serious drain on teir &oterXs state pension? VA #eneits tat woud co&e i e was recogniIed as a

:icti& o te &ustard gas eposure woud ep? +ut wat &atters &ost now4 te cidren say4 is tat in te ti&e teir

ater as et te go:ern&ent ac@nowedges te secret e @ept or so ong4 and tat te VA as or so ong denied W

tat Y&y ater coud understand tat so&e#ody inay #eie:es i&4Y owe said?

3n

7/25/2019 Bulletin 160214 (HTML)

28/144

coud ied te airY ater te #udoIer unearted Yse:era :ias o unidentiied i,uid and &etaic &ateria o

&iitary nature?Y Tree :ias contained &ustard gas? s success in #uiding an

integrated poytrau&a care progra& or wounded and inFured 'er:ice&eers and Veterans?U said Dr? Da:id ;?

'u@in4 VA Cnder 'ecretary or eat? SVA>s dedicated poytrau&a care tea&s recogniIe te i&portance o ta@ing

care o te woe person and coordinating pysica4 &enta and rea#iitati:e care or Veterans suering te &ost

dra&atic inFuries o te war?U

VA e&poyees created $'" to address te need or a co&preensi:e &uti-discipinary syste& o care to ep

Veterans suering wit two or &ore inFuries considered disa#ing pysica and psycoogica i&pair&ents4 suc as

#ast inFuries and trau&atic a&putations? $'" patients a:e sustained inFuries aecting &utipe #ody parts tat

resut in pysica4 cogniti:e4 psycoogica4 and unctiona disa#iities? re,uenty4 Trau&atic +rain 3nFury (T+3!

occurs in $oytrau&a patients4 as does $osttrau&atic 'tress Disorder ($T'D!4 and oter &enta eat pro#e&s?

STe $oytrau&a 'yste& o "are sets VA apart ro& oter eat care syste&s4U said Dr? ;oe 'coten4

7/25/2019 Bulletin 160214 (HTML)

29/144

+A #re,u3tie AO )i,ea,e, Udate 2; Ne. +A Fa%t Seet

Te Depart&ent o Veteran Aairs on e#ruary 64 )0* reeased a new Agent 8range and $resu&ptions o 'er:ice

"onnectionK 3nand aterways and S+ue aterU

7/25/2019 Bulletin 160214 (HTML)

30/144

/24 wose a&iy recenty &o:ed to teir o&etown in s

dierent now is tat te VA ony ast year pu#ised an artice aying out ow te progra& soud #e ad&inistered

and it &igt inay a:e enoug e&poyees to &anage it as it was designed? Te idea is to pro:ide stipends to

a&iies as ong as te :eteran>s eat &eets criteria aid out #y te aw4 VA oicias said? 3 te :eteran>s eat

i&pro:es4 te VA &igt re&o:e a patient ro& te inancia part o te progra&? Sat you>re seeing today is #ased

on our (BA8! indings nationwide tat a:e eped us reocus te progra& and &a@e sure we>re oowing te

guideine set #y te aw4U said %occo +agaa4 te assistant cie or socia wor@ at VA $uget 'ound?

Veteran support organiIations around te country a:e #een earing scattered reports o caregi:er a&iies

raising concerns a#out osing teir stipends? Tey don>t a:e enoug inor&ation yet to decide weter tey want to

press te VA or reor&s or to @now or certain tat te VA is re&o:ing patients ro& te progra& wo genuiney no

onger need te stipends? STe spirit o te aw is tat you go wit te :eteran4 you go wit te caregi:er4U said

Adrian AtiIado4 te deputy nationa egisati:e director or? STe purpose o tis progra& is to pro:ide support and

ser:ices to te caregi:ers #ecause tey are ta@ing part in personay discarging tis nation>s responsi#iities to tis

nation>s :eterans4U e said?

"ongress in )0*0 caed or te creation o a ro#ust caregi:er progra& or 3ra, and Aganistan :eterans4

pointing to studies tat sowed a&iies &issing wor@ to care or wounded o:ed ones? A %and "orp? study in )0*6

esti&ated te wor@ o tose a&iies was wort a#out / #iion a year4 &oney tat oterwise &igt #e spent #y te

go:ern&ent on :eteran support ser:ices? 'ta or C?'? 'en? $atty 1urray (D-A! a:e recei:ed se:era co&paintsro& a&iies cut ro& te progra& in recent wee@s? 'e>s #een one o te progra&>s &ain supporters4 pro&oting it

at e:ents wit te ounded arrior $roFect and te EiIa#et Doe oundation? 'e as #een ad:ocating or its

epansion to incude :eterans o a conicts instead o Fust te &ost recent wars? Se @now tat our &iitary

caregi:ers sacriice teir careers4 teir ti&e4 e:en teir own eat to ta@e care o our :eterans4 and tey a#soutey

deser:e our support4U 1urray said? S3 want to &a@e sure VA is a good partner in tat eort?U

Te BA8 sowed te VA initiay esti&ated a#out 64000 :eterans woud ,uaiy or te stipend? 3nstead4 &ore

tan *5400 ad enroed #y )0*6? Last year4 &ore tan )64700 peope recei:ed caregi:er stipends4 according to te

VA? 'pending on te progra& as sweed to te 555 &iion #udgeted or )0* ro& /50 &iion in )0*64

according to VA docu&ents? 'taing as increased4 too? At te ti&e o te BA8 report4 VA $uget 'ound ad two

caregi:er case &anagers o:erseeing //* patients? 3t was one o te igest wor@oads in te VA? re aso unaware o te non-inancia ser:ices te progra& pro:ides? STe recognition o a &y ard wor@4 tat

was i&portant4U said Aisa 1c:e said4

7/25/2019 Bulletin 160214 (HTML)

31/144

us#and a:e recei:ed caregi:er stipends since )0*)? Tey were a#rupty cut ro& te stipends in Deceer ater a

sort &eeting wit a psycoogist at te 'eatte VA ospita in

7/25/2019 Bulletin 160214 (HTML)

32/144

+A B&ood Bioban> To #&ay Ma'or Ro&e in on7uerin$ )i,ea,e,

s condition4 Ds #ood sa&pe or te progra&? A :eterans &ust :ounteer to participatein te 1iion Veterans $rogra&4 agreeing to sare teir &edica records and eperiences? Te identities o a

donors are @ept secret ro& researcers? 'a&pes are stored in a secure data#ase and a#eed wit a code rater tan

a :eteran>s na&e4 and no identiying inor&ation is attaced to te data accessed #y researcers4 according to te

VA? Te progra& aready as *?. &iion :ias o #ood co&ponents ro& :eterans4 incuding red #ood ces4 wite

#ood ces and pas&a? Te #iorepository currenty recei:es a#out *004000 new sa&pes a year4 and VA oicias

ope a partnersip wit te Deense Depart&ent coud increase te nuer o donors to reac te &iion-:eteran

&ar@ #y )0)04 BaIiano said? Te sa&pes are stored at te VAXs #iorepository at VA 1edica "enter +oston? VA

/)

7/25/2019 Bulletin 160214 (HTML)

33/144

oicias are oping to #uid a second storage site e,uipped wit te sa&e state-o-te-art syste& or D,o Bioni%,

Ro,e .a, in'ured .en an IE) e&oded under i, tru%> in AD$ani,tan*

//

7/25/2019 Bulletin 160214 (HTML)

34/144

Tan@s to 'odier'trong4 a nonproit dedicated to pro:iding ad:anced &edica tecnoogies to :eterans4 te

Den:er VA got te ree eos@eeton suit to study weter it can ep #rains as we as #odies? Te co&puter-dri:en

wa@ing &acine nor&ay costs *504000 to *..4000? Te eos@eeton4 or&ay te E@so BT de:ice4 wi #e tried

on a#out /0 :eterans in weecairs at irst4 and te VA opes to a:e data #y su&&er on its potentia psycoogic

#eneits? Y3 see te psycoogica and pysica as #eing connected4Y said Lisa +renner4 a VA researc psycoogist

and &enta iness cinic director? Te progra& wi e:auate Ywat itXs i@e or peope to stand4 ta@ to peope eye to

eye4 participate in ie e:ents4Y se said? YTe wordXs set up or peope wo are standing?Y %ose re&eers one

draw#ac@ a#out standing again or te irst ti&e in is o&e? e coud see te top o is rerigerator co:ered in dust?

['ourceK Den:er $ost G Da:id 8inger G ;anuary )04 )0* NN]

+A Roboti% Le$, Udate 02 \ 160s resignation and e&an>s iring? owe:er4 "

/6

7/25/2019 Bulletin 160214 (HTML)

35/144

"oice $rogra&? 1cDonad ad no answers? or ea&pe4 3sa@son pointed out tat earier tis &ont a arge eat

care pro:ider in re,uests to use te "oice Act4 deaying te appro:a o pro:ider participation in

"oice4 and deaying pay&ents to participating pro:iders4Y e wrote in a etter to VA 'ecretary +o# 1cDonad

reeased 5 E+? Cnder te "oice Act4 :eterans wo canXt get an appoint&ent witin /0 days are supposed to #e

a#e to use te Veterans "oice List4 wic gi:es te& access to pri:ate non-VA care? +ut ir@ pointed to a VA 83B

report reeased 6 E+ on a "oorado 'prings4 "oo?4 aciity?

Te report ound tat out o ).. :eterans wo ad wait ti&es o &ore tan /0 days at te aciity4 a ).. were

eiter not added to te Veterans "oice List or were added ater tan tey soud a:e #een? ir@ said tat e wants

to @now Yow te VA pans to address tese issues and ensure tat a :eterans a:e access to te "oice Acten:isioned #y "ongress wit a co&preensi:e pro:ider networ@4Y incuding addressing reports tat te VA isnXt

pro:iding Yti&ey pay&entsY to eatcare pro:iders under te "oice progra&? Te VA noted in te 83B report tat

itXs ta@en steps to address te indings?

Te VAXs Veterans eat Ad&inistration as #een repeatedy under te congressiona spotigt since te

depart&ent aced a &onts-ong scanda o:er aegations tat VA oicias &anipuated appoint&ent wait ti&e data

to downpay ow ong :eterans were waiting or eatcare? YBi:en te VAXs de&onstrated ina#iity to pro:ide

e:en #asic care4 et aone co&preensi:e ser:ices4 3 ind it particuary disappointing tat VA continues to sty&ie

/5

7/25/2019 Bulletin 160214 (HTML)

36/144

te pri:ate sectorXs atte&pts to address :eteran patient needs4Y e added in is etter to 1cDonad? ir@ is te atest

aw&a@er wo supported te "oice Act W or&ay @nown as te Veterans Access4 "oice and Accounta#iity Act

W #ut as :oiced concern a#out its i&pe&entation? ['ourceK Te i G ;ordain "arney G e#ruary 54 )0* NN]

+A +et oi%e #ro$ra3 Udate ;0 \ Ruinin$ So3e +etC, redit

'o&e :eterans are seeing teir credit ruined #y using te Veterans "oice eat progra& #ecause te Veterans

Aairs Depart&ent is not reiursing participating pysicians pro&pty4 orcing te& to #i teir :eteran patients

wo oten can>t pay? Veterans ad:ocates and ouse aw&a@ers said ** E+ tat :eterans using te co&&unity care

progra& ace ong deays in treat&ent and #ad credit #ecause pysicians are waiting up to si &onts or

reiurse&ents ro& VA and are de&anding pay&ent ro& patients4 oten orwarding te #is to coection

agencies?

%ep? %au %uiI (D-"A! said one o is constituents sougt care or pain and ortopedic pro#e&s troug

te Veterans "oice progra&4 #ut VA did not reiurse te speciaists in a ti&ey &anner4 orcing te

:eteran to rescedue needed surgeries and dea wit aggressi:e coection agents? Ss reiurse&ent syste& is

irrepara#e and unaccepta#e?U

3n anoter case4 a :eteran in 'aginaw4 1icigan4 needed oow-up care or an eye appoint&ent troug

Veterans "oice? +ut wie te initia appoint&ent was appro:ed4 te needed sigt-sa:ing treat&ent was

not? 'ince appro:a and pay&ent were deayed4 te pro:iding cinic stopped treat&ent and de&anded

&oney ro& te patient #eore tey woud continue4 Veterans o oreign ars senior egisati:e associate

"aros uentes said? To so:e te issue4 V contacted te Veterans "oice contractor eat

7/25/2019 Bulletin 160214 (HTML)

37/144

inspector genera or audit and e:auations? VA oicias say tey are wor@ing to so:e te pro#e&s4 starting wit te

ate pay&ents4 #yK

"anging re,uire&ents o pro:iders to urnis &edica docu&entation aong wit te #is?

iring &ore cai&s processing sta and esta#ising new producti:ity standards4 said Dr? +aig Jeia4

Veterans eat Ad&inistration assistant deputy undersecretary or eat or co&&unity care? YTere

soud #e no ad&inistrati:e #urden tat stands in te way o :eterans getting care4U Jeia said?

'ee@ing to consoidate its pri:ate care progra&s into a singe initiati:e4 te

7/25/2019 Bulletin 160214 (HTML)

38/144

at te or&er ead o internationa consu&er giant $rocter H Bae4 one-ti&e air#orne sodier and est

$oint grad did not epect was unreenting poitica attac@s ro& "ongress and esewere -- incuding4 e #eie:es4 a

:eterans group #ac@ed #y #iionaire #roters "ares and Da:id oc? Y3 tin@ te #iggest surprise was te

poitics4Y e tod 1iitary?co& during a recent inter:iew at te VA 1edica "enter in +ostonXs ;a&aica $ain

neig#orood? Y%e&eer4 3 was conir&ed 27 to Iero? 3 tougt 3 woud ocus on Fust getting #etter care or

:eterans4 so te poitics as #een surprising to &e? 3 donXt i@e poitics4 3X& not going to #e a poitician4 3>& not

running or anyting?Y +ut 1cDonadXs disi@e or poitics and ac@ o poitica aition4 couped wit a

co&orta#e4 sta#e ie &ade possi#e #y a successu career wit $HB4 pro:ides i& Yte reedo& to do wat is

rigtY regardess o wate:er pressure is eerted4 e said? Y3 donXt need te &oney? 3 donXt need te position4Y e said?

Y3X& sacriicing4 in a sense4 to do tis4 #ut itXs not a sacriice #ecause itXs or &y #roters and sisters wo ser:ed? 3X:e

got no oter agenda?Y

1cDonad was in +oston recenty to tour a uni,ue :eteransX #ood repository tat is epected to #oost &edica

researc across te country? Te 1iion Veterans $rogra& wi pro:ide #ood sa&pes and Din$ te #it% Dor te +A 1cDonad &a@es te pitc at pretty &uc e:ery VA ospita e :isits? e oers a #it o VA istory4 incuding te

act tat te VA as earned tree

7/25/2019 Bulletin 160214 (HTML)

39/144

Yspea@ing at a oc con:ention saying4 XListen4 weX:e got to point out e:eryting #ad going on at te VA4 #ecause i

we @i te VA4 we can @i 8#a&acare4 and i we @i 8#a&acare4 weX @i nationaiIed &edicine?X Y Te recording4

irst reported and posted onine #y Te

7/25/2019 Bulletin 160214 (HTML)

40/144

par&aceutica giant Biead in )0*)4 e &ade o:er 600 &iion? And e did it a wie wor@ing se:en-eigts o

is ti&e or te VA?

)r* Ray3ond S%inaKi

Y'o4 3X& not u ti&e -- wat 3 do wit &y re&aining ti&e is up to &e4Y 'cinaIi tod "+'

7/25/2019 Bulletin 160214 (HTML)

41/144

'u@in caed te drug4 aternatey caed 'oos#u:ir and 'o:adi4 Ytruy a &iracuous new drugY or treating

epatitis "4 wic aicts tousands o :eterans4 especiay tose wo ser:ed in Vietna&? +y aw4 te VA as te

rigt to assert a inancia interest in science and tecnoogy de:eoped #y its e&poyees and using VA resources and

unding? en it does4 co&&ercia saes o a product or &edicine put &oney #ac@ into te VA #udget? Te epatitis

" drug is esti&ated to #e wort #iions annuay on te co&&ercia &ar@et? At te sa&e ti&e4 te VA is currenty

paying an esti&ated 604000 or an eigt or nine wee@ course o te drug or :eterans4 e:en toug in oter

counties4 incuding Egypt4 te sa&e treat&ent cost a#out 200? ['ourceK 1iiary?co& G +ryant ;ordan G e#ruary 064

)0* NN]

#TS) Udate 202 Studie, Reea& A%%e&erated A$in$ Lin>

eX:e a eard o peope Yaging o:ernigtY ater a trau&atic e:ent? 'cientists actuay a:e a word or tis

peno&enonK Y1arie Antoinette 'yndro&e4Y na&ed or te renc ,ueen? en se was captured ater eeing $aris

and sentenced to deat #y guiotine4 o#ser:ers cai&ed er air turned wite ro& soc@? ie accounts o te

,ueenXs air &ay Fust #e egend4 scientists a:e ong suspected tat cronic psycoogica stressWtriggered #y

e:ents i@e war4 a#use4 or i&prison&entW&ay acceerate aging4 eading to eary onset o age-reated disease or e:enpre&ature deat?

7/25/2019 Bulletin 160214 (HTML)

42/144

Te second study4 pu#ised onine in ;anuary )0* in te Fourna +ioogica $syciatry4 ea&ined #roader4 age-

reated eat conse,uences o $T'D? 'peciicay4 o oo@ed at &eta#oic syndro&eWa consteation o

sy&pto&s incuding o#esity4 ig #ood pressure4 a#nor&a #ood ipids4 and ig #ood sugar tat can contri#ute to

Type ) dia#etes4 coronary artery disease4 and e:en neurodegenerati:e diseases i@e AIei&erXs? 1eta#oic syndro&e

is ee:ated a&ong :eterans4 says o4 wit an esti&ated )5 percent aected? Tat nuer &ay #e as ig as 60

percent a&ong peope wit $T'D? o wondered eacty ow $T'D correated to &eta#oic syndro&e4 and

weter te two togeter ed to reduced cortica tic@nessWa srin@ing o speciic #rain areas responsi#e or tings

i@e e&otiona reguation and &e&ory? Again using data ro& T%A"T'4 o ea&ined eat inor&ation ro&

/6 &iitary :eterans wo ad depoyed to 3ra, or Aganistan? 'e ound tat $T'D was directy associated wit

&eta#oic syndro&e4 and tat &eta#oic syndro&e was strongy associated wit reduced cortica tic@ness?

o opes to continue te researc oo@ing at ongitudina data4 so se can see ow tis acceerated aging

proceeds o:er a decade or &ore? 'e aso wants to epand te researc to incude Vietna& :eterans4 wo coud

pro:ide an e:en onger-ter& :iew? Te indings are signiicant4 says o4 #ecause tey igigt a pro#e&W

&eta#oic syndro&eWtat is not usuay considered in treating $T'D and is Yripe or inter:ention?Y urter&ore4

says 1ier4 tey suggest tat cinicians &ay need to epand teir repertoire o treat&ents or $T'D to target seep4

diet4 and eercise? YA ot o researc is oo@ing at te causes and ris@ actors o $T'D4Y says 1ier? Y8ur researc is

oo@ing at te oter side o te $T'D puIIeWwat are te conse,uences or te #odyPY YTraditionay4 treat&ent

or $T'D in:o:es psycoterapy tat ocuses on te &e&ory o trau&atic e:ents4Y adds 1ier? YTatXs an

undenia#y ree:ant and i&portant part o treat&ent? +ut tese studies are suggesting tat te cinica picture o

$T'D is &uc #igger tan a pro#e& wit so&e#odyXs &e&ory? Te proound #ioogica canges tat acco&pany it

aect not Fust te &ind and &e&ory4 #ut te woe #ody?Y ['ourceK 1edica Epress G +ar#ara 1oran G e#ruary /4

)0* NN]

#TS) )ru$, #TS) Med, 101

'ince te syndro&e was irst oiciay ac@nowedged #y psyciatrists in *2.04 treat&ents or post-trau&atic stress

disorder a:e grown in nuer W #ot or ci:iians and or troops wit coat trau&as? +ut &edications continueto #e a go-to treat&ent4 usuay in conFunction wit ta@ terapy? ie tese drugs &ay ep ease suering4 so&e

peope co&pain tat tey don>t ee i@e te&se:es wie ta@ing te&? And a&iies :oice concerns a#out a o:ed

one>s ong ist o pis? 'o4 wat are te cassic $T'D drugs4 and wat are teir side eectsP

Dr? Tonya 1asino4 a psyciatrist at te VA>s La ;oa ospita and a :eteran o te $T'D cinic tere4 said it>s

typica or a patient to get a s&a coc@tai o drugs to te&per aniety and seep issues? $T'D patients wit &oderate

to se:ere sy&pto&s are going to #e oered an antidepressant4 speciicay an ''%3 (seecti:e serotonin reupta@e

ini#itor!? 3t wi pro#a#y #e oot or $ai4 as tey are te ony two ood and Drug Ad&inistration-appro:ed

antidepressants speciicay or $T'D4 1asino said? Te 'an Diego VA co&&ony prescri#es i:e ''%3s or $T'D4

incuding $roIac4 "eea and Leapro? 3 oot or $ai don>t wor@4 one o te oters can #e tried? Anoter popuar

antidepressant option is an 's co&&on to prescri#e an apa-#oc@er &edication?

!y te dru$,+ecause te antidepressants &oduate neurotrans&itters in te aniety and ear centers o

te #rain4 1asino said? Te desired resutK A reduction in te cassic $T'D sy&pto&s4 wic are yper-

:igiance4 intrusi:e tougts and &e&ories4 irrita#iity4 trou#e wit seeping4 depression and diicuty

eeing cose to oters? Aso wyK 'o&e patients won>t #e a#e to engage we in terapy unti teir

sy&pto&s are under contro? $T'D patients wit seep issues &ay co&&ony get traIadone4 #rand na&e

Desyre4 wic is aso an antidepressant? Tese are te VA>s rontine drugs or $T'D? 3 tey don>t wor@4

6)

7/25/2019 Bulletin 160214 (HTML)

43/144

$an + can in:o:e &ood sta#iiIers4 suc as Depa@ote or anger4 or anti-seiIure &edications tat s&oot

out &oods?

1asino said researc as canged te way VA psyciatrists treat $T'D? Doctors used to prescri#e anti-aniety

&edicines @nown as #enIodiaIepines4 suc as ana or Ati:an? +ut in te past i:e to *0 years4 researc as sown

tey don>t wor@ or $T'D o:er te ong au? Aso4 tese &edications can cause pro#e&s wit &e&ory4 and tey

are a#it-or&ing4 1asino said?

!at about ,ide eDDe%t, Te co&paint o eeing Si@e a IoieU on $T'D &eds is pro#a#y a dosing

pro#e&4 1asino said?"o&&on side eects o antidepressants are nausea4 trou#e seeping4 constipation4

oss o appetite4 tiredness and diIIiness? Anoter co&&ony reported outco&e is seua dysunction? Any

o te a#o:e &igt &a@e so&e $T'D patients want to stop ta@ing teir &edications? +ut &ost peope need

to ta@e antidepressants or at east a year #eore tey consider tapering o4 1asino said? 8terwise4 ris@ o

reapse is ig?

!at about te rare but o,,ib&e ,ide eDDe%t oD ,ui%ida& tou$t, .i&e on antidere,,ant, A o te

VA>s top $T'D antidepressants were on te ist in )006 wen te DA re,uired drug &a@ers to update te

S#ac@ #oU warning on teir products? Te new warning reected te possi#iity o increased ris@ o

suicida tin@ing and #ea:ior in young aduts ages *. to )6?

Ho. doe, Ma,ino and&e te ri,> 'e notes tere>s a dierence #etween tin@ing a#out suicide andsuicida #ea:ior?SA nuer o patients wit $T'D and depression wi co&e in wit suicida tougts? 3

ad:ise patients tat any &edication we prescri#e or &enta eat &ay aect your &ood? e ope tat

appens in a positi:e way4U se said?S+ut i tere>s any worsening o sy&pto&s4 or you>re not i@ing te

way you ee4 or i you a:e suicida tougts tat weren>t tere #eore4 et your doctor @now rigt away?U

1asino cas an upswe o suicida tougts a S:ery re&ote possi#iity4U #ut added tat it>s an i&portant

ting or patients to #e aware o?S3 tin@ peope are sa::y enoug to say4 84 3>& a:ing tis now and 3

wasn>t #eore?> 8r4 3 was a:ing tis4 and 3>& eeing &uc worse?>U

As or $T'D patients ta@ing an assort&ent o &edications4 1acino said te ong ist is so&eti&es due to te&

#eing treated or se:era conditions? or ea&pe4 it>s co&&on or a :eteran to get $T'D care wie aso reco:ering

ro& a surgery or deaing wit ong-ter& #ac@ pain? STey see dierent doctors ??? and tey can end up on a nuer

o &edications4U 1acino said? STe reay i&portant ting is tey need to &a@e sure a o te doctors are ta@ing toeac oter and get a (te prescriptions! ied at te sa&e par&acy?U A danger is tat one drug &igt aect ow

anoter wor@s4 rendering one useess4 said 'usan Lec@#and4 a cinica par&acist at te VA in La ;oa? 1acino said

te patient is so&ewat responsi#e to @now wat e or se is ta@ing and wat its eect is supposed to #e?

'e aso said a ong prescription ist &ay oo@ worse tan it reay is? Sit so&e conditions4 and tis is true in

&enta eat4 it>s #etter to use a coination o &edicines at ower doses tan Fust one &edication at a ig dose4

were you run te ris@ o increased side eects4U said te psyciatrist4 a recent

7/25/2019 Bulletin 160214 (HTML)

44/144

Eye &o:e&ent desensitiIation and reprocessingK Cses rapid eye &o:e&ents wie addressing &e&ories o

trau&a? 3t>s #eie:ed tat tis eads te patient to process te &e&ory and distur#ing eeings in #etter

ways?

3&agery reearsaK +eie:ed to #e eecti:e in reducing nigt&ares? 3n tis terapy4 $T'D patients

SrescriptU te endings o teir nigt&ares wie tey are awa@e to &a@e te& ess de#iitating?

o3&e3entary and a&ternatie 3edi%ine*Te Deense "enters or Eceence reco&&ends tese tecni,ues aspossi#e secondary treat&entsK acupuncture4 &editation or &induness4 yoga4 #ody &anipuation and :arious energy

tecni,ues?

['ourceK 'an Diego Cnion Tri#une G ;eanette 'teee G e#ruary 54 )0* NN]

+A A$ent Oran$e BeneDit, #o&i%y Rea,,e,,3ent o3&ete J No %an$e

A edera court ad ordered te VA to reassess its poicy denying Agent 8range #eneits to s concusionK Tey sti don>t ,uaiy? Te C?'? Depart&ent o Veterans Aairs as once

again turned down an eort #y s Disease4 peripera neuropaty and a type o eart disease?

Ad:ocates or so&e 204000 so-caed +ue ater

7/25/2019 Bulletin 160214 (HTML)

45/144

+ietna3 eteran i3 S3it a, been dia$no,ed .it ro,tate %an%er and be&iee, A$ent Oran$e eo,ure 3ay ae

&ayed a ro&e* My Dee&in$ i, te +A i, tu3bin$ teir no,e and ,endin$ te 3idd&e Din$er ba%> to te B&ue !ater eo&e5

e ,aid* ItC, &i>e nobody at te +A a, any >ind oD ,%ien%e ba%>$round .at,oeer*

C?'? 'en? %icard +u&enta (D-"T!4 te ran@ing &eer o te 'enate Veterans> Aairs "o&&ittee4 criticiIed

te VA>s decision? S%ater tan siding wit :eterans4 VA is dou#ing down on an irrationa and inconsistent poicy4U

e said in a state&ent? SJoung saiors ris@ed teir i:es during te Vietna& ar4 unaware tat decades ater4 tey andteir cidren and grandcidren woud sti ee te toic eects o eposure? Veterans wo ser:ed osore and in

te ar#ors o Vietna& were eposed and deser:e te presu&ption o ser:ice connection or Agent 8range-reated

diseases?U +u&enta and oters are see@ing adoption o te +ue ater s new re:iew reFecting #eneits reied on a )0** report #y te respected 3nstitute o 1edicine4 as we as

oter pu#ised researc4 according to te agency>s act seet? Te 3nstitute o 1edicine report said tere was no

way to pro:e +ue ater :ets were eposed to te ce&icas4 #ut it identiied pausi#e routes tat Agent 8range

coud a:e tra:eed out to sea and into a sip>s distiation syste&? Atoug &iitary poicy at te ti&e

reco&&ended against distiing water coser tan *0 &ies to sore W were te ce&ica concentration woud a:e

#een igest W :eterans said doing so was oten una:oida#e4 and teir co&&anding oicers routiney ordered it?Te VA said it is wor@ing wit :eterans groups to Sinitiate a ground#rea@ing study o +ue ater s decision a #etraya? ;on es4 a Louisiana awyer wo as spent &ore tan a decade

ad:ocating or +ue ater :eterans4 said is group woud continue caenging te VA and pus or egisation tat

woud &andate co:erage or te +ue ater :eterans? S3t wasn>t co&petey unepected? e>re used to #eing

#etrayed #y te VA4U es said? Se>re going to igt tis ting unti we>re done or dead?U ;i& '&it4 wo ser:ed

a#oard te a&&unition sip +utte4 as #een diagnosed wit prostate cancer and #eie:es tat Agent 8range

eposure &ay a:e payed a roe? S1y eeing is te VA is tuing teir nose and sending te &idde inger #ac@

to te +ue ater peope4U e said? S3t>s i@e no#ody at te VA as any @ind o science #ac@ground watsoe:er?U

+ue ater :ets W so na&ed to set te saiors apart ro& teir +rown ater

7/25/2019 Bulletin 160214 (HTML)

46/144

super:isors ast isca year4 a 6* percent increase o:er )0*6? Eigt o e:ery *0 a:ora#e actions 8'" won or

edera e&poyees ast year in:o:ed reprisa?

8'" is a s&a4 independent agency o a#out *60 e&poyees4 and it is a:ing a toug ti&e anding its &andate

wit current unding e:es? "ongress increased its #udget in te recent o&ni#us spending #i #y 5 percent to )6?*

&iion4 #ut te agency said tat #oost does not @eep pace wit ination or te inundation o new cases?

'cween#ac said te agency pans to ire &ore staers to ta@e on te #ac@og o cases4 wic as #aooned inrecent years #ut re&ained stagnant in isca )0*5? ['ourceK T%EA Cpdate G e#ruary 24 )0* NN]

+A Te&eea&t Udate 0: Ne. #i&ot #ro$ra3

A new piot progra& announced 5 E+ #y te nationXs 'ecretary o Veterans Aairs ai&s to ep :eterans in so&e o

te &ost rura parts o 1ississippi? edera oicias aso ope te new initiati:es -- incuding a syste&atic o:erau

o te depart&entXs sceduing and &anage&ent syste&s -- wi sow positi:e cange in te wa@e o tat )0*6

scanda in:o:ing wait ti&es nationwide? Y3n te sa&e way :eterans use teir ce pones or ta#ets to :iew teir

#an@ state&ents or aceTi&e wit a a&iy &eer4 we @now tat tereXs a way or te& to recei:e eat care in

tis &anner4Y VA 'ecretary %o#ert 1cDonad said to a crowd o neary one undred? Ye a:e wor@ to do to

#aance pri:acy and con:enience? ere in 1ississippi is were weXre going to try tat out irst?Y

Dr? '@ye 1cDouga4 recenty appointed to o:ersee VA ospitas in 1ississippi and oter 'outern states (V3' records were &anipuated to sow tey ad sa&e-day

appoint&ents wen tey actuay waited and a:erage o 7 days? S3 reFect te notion tat anywere in tis report it

says we asiied data4U Den:er VA spo@es&an Dan ar:i said? ar:i contends tat te records4 incuding tose

tat asey sowed sa&e-day appoint&ents4 were correct according to a Soca standardU in pace unti )0*5? ie

e denied tat wor@ers asiied reports4 e coudn>t epain te discrepancies or te ). patients? Laorn said VA

waits in "oorado 'prings a:e cai&ed a ie? 3n a etter to VA 'ecretary +o# 1cDonad4 Laorn said a :eteran in

"oorado 'prings was dee&ed a suicide ris@ during an Apri :isit to te Lindstro& "inic4 #ut wasn>t reerred or

care? Te or&er 1arine @ied i&se si wee@s ater4 Laorn wrote? S3 a& inuriated tat your depart&ent

continues to intentionay deay te &edica care our nation>s :eterans a:e earned4U te "oorado 'prings%epu#ican wrote? ar:i said e coudn>t co&&ent on Laorn>s aegations #ecause o patient pri:acy concerns?

$atient waits at te cinic re&ain a&ong te ongest in te country4 VA records sow? or te &ont ending ;an?

*54 540/ :eterans were waiting &ore tan a &ont or appoint&ents W /* percent o a appoint&ents scedued at

te aciity tat opened in August )0*6? %etired Air orce 1aF? Ben? es "ar@ said e and oter eading oca

:eterans> ad:ocates were tod wen te new cinic opened tat waits or care woud drop? Se were assured at te

#eginning tat tis was going to #e one o te #est-run cinics in te country4U "ar@ said? S;ust oo@ at it now4 ony a

ew &onts ater opening? 'oud #e so&e cri&ina penaties or tis?U ar:i said VA is wor@ing to sorten waits in

"oorado 'prings4 #ut is strugging to @eep up wit growing de&and? Te nuer o appoint&ents tere in )0*5

rose to *7040004 up ro& *6/4000 te pre:ious year? ar:i said te nuer o :eterans see@ing care in "oorado

'prings is a sign tat cients i@e te ser:ice tey>re getting? ['ourceK Tri#une

7/25/2019 Bulletin 160214 (HTML)

48/144

;udge 'ara Lioi ordered tat etter seaed ro& te pu#ic at te attorneysX re,uest? ar&er4 554 was con:icted in

August o conspiracy4 rac@eteering4 eeIIe&ent4 #ri#ery4 tet o pu#ic &oney4 &ai raud and wire raud? eX

re&ain in edera custody unti eXs sentenced )2 1A%? Te agree&ent cas or ar&er to oreit 704.0* in i-

gained &oney? e aso aces ines #etween *04000 and )504000?

Te sce&e occurred during a our-year period ro& )0*0 to )0*/? 1ontague4 o +rec@s:ie4 resigned ro& te

Dayton VA in )0** to run te consuting ir& ouse o 1ontague? 1ontague ad&itted during ar&erXs tria tat esent aong conidentia inor&ation so "annon Design coud a:e an ad:antage wen su#&itting #ids on upco&ing

proFects? "annon Design ten used te conidentia inor&ation to prepare proposas tat resuted in te co&pany

#eing cosen to design a :eteransX ospita in est Los Angees4 "aiornia? ar&er and "annon Design used

1ontague as a Ydou#e agentY #ecause o is access4 particuary in )0** wen e ser:ed as an interi& director at te

VA in Dayton? ar&erXs pri&ary roe at te ir& was to get VA proFects across te country? e was te ir&Xs &an

contact wit 1ontague and paid 1ontagueXs ir& or insider inor&ation?

1ontague4 64 peaded guity in 'epteer )0*6? Te dea states tat e coud spend as itte as 6 *9) years in

edera prison in ecange or is cooperation? e as yet to #e sentenced? ar&erXs dea aso stipuates tat

prosecutors wanted to &a@e a dea or ar&er since tere was a Ysigniicant unwarranted sentencing disparityY

#etween ar&erXs and 1ontagueXs epected sentences? $rosecutors wrote tere was a ac@ o e:idence o te scope

o te deas at te ti&e 1ontague entered is guity pea? ['ourceK "e:eand?co& G Ada& errise G e#ruary 0)4)0* NN]

7/25/2019 Bulletin 160214 (HTML)

49/144

is #ase#a eague and #egan appearing at te VA again in is weecair4 cai&ing to #e una#e to wa@ or use is

ands? Te etensi:e in:estigation #y te VA and ''A incuded underco:er agents4 sur:eiance4 and potograps

and :ideo ootage ro& #an@s4 stores4 and te "ouia 1etropoitan Airport? a&iy potograps @ept #y $ausen>s

e-wie were aso o#tained sowing $ausen>s &any acti:ities wit is a&iy4 paying #ase#a4 and participating in

a 1arine 1ud %un? $ausen testiied4 in a weecair4 or our ours and caed tree doctors as epert witnesses in

an atte&pt to support is cai& tat e was and ad #een totay disa#ed? Te guity :erdict reects tat te Fury did

not ind tis testi&ony credi#e? ['ourceK D8; - Dist o 'out "aroina $ress %eease G ;anuary )4 )0* NN]

7/25/2019 Bulletin 160214 (HTML)

50/144

o&en :eterans in soutern AriIona a:e a new resource at te 'outern AriIona VA eat "are 'yste&? 3tXs a

cardio:ascuar cinic or wo&en4 and itXs te irst one o its @ind in te entire VA syste&? According to te A&erican

eart Association4 eart disease is te

7/25/2019 Bulletin 160214 (HTML)

51/144

A&bany +A )ire%tor Linda !ei,, D