RAO Bulletin Update 15 July 2008

This bulletin contains the following articles:
== VA Voter Registration Ban ————————- (Criticism)
== VA Drug Testing on Vets [02] ——————— (Hearings Held)
== GI Bill [25] ————————————- (20% Increase)
== VA Claim Backlog [16] ———————- (Status)
== VA Claim Backlog [17] ———————— (Law Slows Claims)
== Family Film Festival ————————– (No Cost Movies)
== Medicare Reimbursement Rates 2008 [11] —- (Sent to President)
== VA Third-Party Insurers ————————- (Billing Problems)
== Adventure Excursions for OEF/OIF Vets ——— (Fully Funded)
== Vet Job [02] —————————– (Trucking Business)
== Mobilized Reserve 9 JUL 08 ——————— (2,267 Decrease)
== VA Vet Centers [05] —————————– (39 More by 2009)
== Ohio Vet Tuition —————————— (New Policy)
== Medicare Fraud [08] —————————— ($92 million)
== Medicare Part B Premiums [03] ——— (Medically Retired Vets)
== Tricare Back Surgery ——————————- (Policy Change)
== Vet Cemetery Arkansas [01] ———————— (Cross County)
== Rhode Island State DVA ——————- (Proposal Fails Again)
== Tricare Overseas Programs [01] ————– (PI Satellite Office)
== Enlistment Waivers [01] —————— (Process Standardized)
== VA Brachytherapy Treatments ——— (Some Improperly Done)
== DoD PDBR ———————————————– (New Board)
== DoD PDBR [01] —————————- (Anticipated Problems)
== VA Fraud [11] ————————– (Hines IL CMOP Director)
== Veterans’ Benefit Expiration [01] ————————- (Update)
== Atrial Fibrillation ————————- (What it Is)
== Forgotten Military Orphans ————– (Adverse Impact of Law)
== Legal Residency —————————– (Guidelines)
== SSA International Agreements ——— (Totalization Agreement)
== Veteran Legislation Status 13 JUL 08] ——– (Where we Stand)

VA VOTER REGISTRATION BAN: The U.S. Department of Veterans Affairs is facing mounting criticism over its national ban on voter registration drives on its property with Florida Secretary of State and chief election’s officer Kurt Browning being the latest to join the chorus of criticism. Two states — Connecticut and Washington — have joined California in asking the VA to do away with its policy. And Browning, while saying he is legally powerless to force the VA’s hand, nonetheless thinks their stand is wrong. Browning, Florida’s, said in an interview that he is yet to receive a complaint from either a veteran or a group complaining that the VA is preventing the registration of voters in Florida. The agency has previously said it allows its official volunteers to assist residents of VA nursing homes, hospitals and shelters in registering when they ask for help. Tom Bowman, VA chief of staff, told the St. Petersburg Times in May that the VA needed to control access to its property so patient care would not be affected. On 10 JUL U.S. Sen. Daniel Akaka, chairman of the Senate’s Veterans Affairs Committee, joined senators John Kerry and Dianne Feinstein in writing a letter to VA Secretary James Peake asking him to allow voter registration on VA property. The trio also said the VA’s insistence that the Hatch Act prevents voter registration drives on federal property is simply a misreading of the law, saying it simply prevents federal employees from engaging in political activity on VA time. They said the act doesn’t prevent employees from assisting veterans in registering and said the act doesn’t prevent any third party from a voter registration drive. Washington attorney Scott Rafferty has sued the VA over its policy. [Source: St. Petersburg Times William R. Levesque article 10 JUL 08 ++]

VA DRUG TESTING on VETS UPDATE 02: In a congressional hearing this week, Secretary of Veterans Affairs James B. Peake, M.D., discussed the actions taken in the wake of published reports in the Washington Times about a VA research program on smoking cessation involving veterans with post-traumatic stress disorder (PTSD). Secretary Peake emphasized the research project was not a drug study, but an examination of the most effective way to treat heavy smokers who have PTSD, using medications approved by the Food and Drug Administration (FDA). None of the medications used in this study are investigational or experimental, all are FDA approved, and the drug that made headlines, Chantix, is in fact considered to be the most effective medication available for smoking cessation with six million prescriptions written.

Peake noted any veterans receiving Chantix in the study or anywhere in the VA had been put on the drug by their doctors as an individual doctor-patient decision, with continued monitoring the health status. As information within the VA and by the FDA suggested potential psychological side effects were being seen in some patients taking Chantix, clinical providers were notified promptly. Not only were letters sent by researchers to members of the study, but, additionally, a letter has been sent to every veteran prescribed Chantix by the VA discussing possible side-effects, encouraging them to contact their provider immediately if they experience side effects and assuring them that the VA will help them find another way to quit smoking if they are concerned about Chantix or are having side effects. Secretary Peake has directed four internal investigations:
• A comprehensive review of the smoking cessation study within 30 days.
• A review of all PTSD drug protocols in the VA system within 45 days.
• A full review of our adverse event reporting system for pharmaceuticals within 20 days.
• A review of VA’s medication notification system to ensure the system’s policies support timely communications to our patients and providers within 20 days.

Chantix has been linked to at least 40 suicides and 400 suicide attempts in the population at large according to the FDA, which published its first alert about the potential dangers of the drug on 20 NOV 07. A second warning was issued by the FDA and one from the drug’s maker, Pfizer, before the VA finally began to warn veterans in the study on 29 FEB 08. Even then the word “suicide” was not mentioned in the letter sent to veterans. House Veterans’ Affairs Committee Chairman Rep. Bob Filner asked Secretary Peake “Why don’t you just stop if you know the drug induces suicidal thoughts?” No response was reported by this source. [Source: NAUS Weekly Update 11 Jul 08 ++].

GI BILL UPDATE 25: The Department of Veterans Affairs recently announced that the Montgomery GI Bill will soon be increased by 20% — a total increase of nearly $220 a month increase over last year’s rate. The increased full-time student payment rate of $1,321 multiplied by the 36-month brings the GI Bill total payout to over $47,500. If you are GI Bill eligible and have benefits remaining, you get this increase no matter when you became eligible or begin using it. This is increase that will help pay college costs until the new GI Bill goes into effect in AUG 09. [Source: NAUS Weekly Update 11 Jul 08 ++]

VA CLAIM BACKLOG UPDATE 16: As of two years ago, the Department of Veterans Affairs had a backlog of about 400,000 disability claims according to Iraq and Afghanistan Veterans of America, an advocacy group. Despite efforts to speed up the claims process, the backlog remains at about the same number now, VA officials said. In the week ending 5 JUL 08 there were a total of 637,000 rating and non-rating cases pending of which 23% were over 6 months old, in addition the VA has over 172,000 cases on appeal. To make matters worse, the Department of Defense and the VA have lagged at making the transition to civilian life easy for soldiers. According to a report issued in April by the GAO, the departments still haven’t developed a “one-stop shopping process” for soldiers that would provide standard discharge examinations, help with filing discharge claims, and assurances that vets don’t get lost in a sea of paperwork. The departments also don’t have a joint system to make it easier to keep track of soldiers’ medical histories. The system, the report said, was supposed to have been in place three years ago. “They’ve treated our veterans like stepchildren,” said U.S. Rep. Patrick Murphy, who in 2006 became the first Iraq veteran elected to Congress. A number of legislative and bureaucratic steps have been taken to improve the transition process: The VA announced an effort this year to track down 550,000 veterans and remind them of the benefits to which they are entitled, and Murphy helped pass legislation that allowed the VA to add 1,800 disability-claims processors. But more needs to be done, he said. “We had to change the philosophy first and start making our vets a real priority,” Murphy said.

The Department may have reached a turning point in its long battle to process a huge backlog of benefits claims — for the first time in years, the VA is processing more claims than it is receiving. Sen. Daniel Akaka (D-HI) called this “gratifying news,” but expressed concern that faster processing may cause more errors on claims. “Timelines cannot take precedence over accuracy,” Akaka said at a 9 JUL senate hearing. While pleased with the VA’s progress, Akaka said, “It is far too soon to declare victory in the claims battle. Processing an initial disability claim takes an average of 185 days, about two months longer than the VA’s goal. Getting a handle on incoming claims is important because the workload will only increase because of a combination of new Iraq and Afghanistan combat veterans with service-connected disabilities and an aging population of veterans whose health and disabilities worsen with age.” Retired Rear Adm. Patrick Dunne, acting VA undersecretary for benefits, acknowledged that the workload is growing. The VA expected to get 855,000 claims this year but now projects it will receive 883,000, a 5% increase over 2007, Dunne said. But even with the increased volume, “we are now completing more claims than we receive,” Dunne said. “As a result, the pending inventory at the end of May was reduced to 390,000.” [Peninsula Daily News David Gambacorta & Army Times Rick Maze articles 30 Jun & 8 Jul 08 ++]

VA CLAIM BACKLOG UPDATE 17: In the last decade, the Department of Veterans Affairs has doubled the number of disability claim processors on staff, and yet the average time to process a claim has climbed during that period from four months to six. From JAN 07 through JUN 08, as VA added 2,700 claim processors to its inventory of 8,000, the average time to process a claim still fell unimpressively, from 183 days to 181. “Something’s going on here that isn’t right, that needs to be fixed. I don’t know what the hell it is,” said a frustrated Sen. Jon Tester (D-MT) during a hearing 9 JUL of the Senate Veterans Affairs Committee. “In the 1990s you were at 120 days” to process a claim. “Was there something in the process that changed,” Tester asked Michael Walcoff, deputy undersecretary for benefits for the Veterans’ Benefits Administration. Yes, Walcoff said. Congress in 2000 passed the Veterans Claims Assistance Act. Since then, two-thirds of the time required to process a claim is committed to blocks of time set up to develop evidence to support the claim. A recent study of VA claims processing, conducted by IBM, confirmed that compliance with the VCAA has created bottlenecks for processors. “It’s good law … set up to guarantee that veterans have certain rights and they are protected. It’s something we all agree with,” Walcoff said. But courts have interpreted that law “in various ways that have made it very difficult to administer and have added time to the process.”

Passage of the VCAA, in effect, overturned a 1999 decision by the Court of Appeals for Veterans Claims that veterans had to submit a “well grounded” claim for VA officials to be required to help them obtain further evidence — such as doctor files or witness statements — to prove their claim. While the VCAA lowered evidentiary standards for veterans, it also spelled out in great detail what actions VA had to take, and what deadlines it had to set, to help veterans develop evidence to support claims. When a claim is filed, the VCAA mandates that claim processors carefully analyze it and send a letter to the veteran explaining evidence on file and evidence still needed. The letter also must explain that VA will help obtain evidence if names and addresses of doctors or witnesses are provided and that VA will obtain government records pertinent to the claim. But the VCAA letter also tells a veteran that he or she has 60 days to submit the required evidence. And if the claim is to be based on the medical findings of a private physician, the doctor too is given a 60-day deadline to submit medical records. The process can be delayed further if their original claim fails to include a signed privacy form required for VA to request medical records from private physicians. “We then have to go back to the veteran to get the privacy form,” Walcoff said. All of this, he said, is required by VCAA.

Some veterans’ service organizations and lawmakers have criticized VA for implementing the VCAA, and follow on court rulings, like a lumbering bureaucracy rather than like a dynamic agency bent on speeding up the claims process. VA officials told senators they soon will implement some of the IBM report recommendations to speed the claims process. The study said, for instance, that the VA should reduce the 60-day period given veterans to provide evidence supporting their claim. “We are shortening that to 30 days so we can act faster,” said retired Navy Rear Adm. Patrick W. Dunne, acting undersecretary for benefits for the Veterans Benefits Administration. VA also will make the VCAA letter more understandable for veterans and make it available electronically in November after a software update.

VA disability claims have climbed by 5% from last year, to 883,000, the result of Iraq, Afghanistan and an aging veteran population. The claims backlog is still a hefty 390,000. Though decision timeliness remains a concern, said Sen. Daniel Akaka (D-HI) committee chairman, decisions finally are being handed down faster than claims are being filed. But North Carolina Sen. Richard Burr, ranking Republican on the committee, said claim timeliness remains very frustrating for veterans and their families. “Simply drawing more money and more personnel to the problem clearly — clearly — has not been the solution,” Burr said. It’s time “to seriously explore other options” including conversion to paperless claims and overhauling VA’s overly complex disability rating system. Howard Pierce, chief executive officer of PKC Corp., testified that his company in 2001 was tasked to set up a computerized decision model that could be used by VA disability raters and claim adjudicators. PKC analysts were stunned by the complexity of the decisions. “What a rater is asked to do on a day-to-day basis is extraordinarily complicated. We live in a world of complexity in my company. We work with very challenging science. We have never seen anything more complex” than the VA claims system, Pierce said. But Kerry Baker, with Disabled American Veterans, suggested other ways for VA to speed claim decisions and be fairer too. He said most claims still hinge on medical opinions, and VA should be more willing, as is the Social Security system, to accept well documented private medical opinions. VA also should be required, “as a matter of fairness,” to inform claimants on basic elements that render a private medical opinion adequate for rating disabilities. “VA relays this exact information to its own doctors when it seeks medical opinion,” Baker said. Source: Stars & Stripes Tom Philpott article 12 Jul 08 ++]

FAMILY FILM FESTIVAL: While school’s out, kids and their parents can visit selected Regal theatres around the country for their no charge Family Film Festival for nine weeks of movies. Regal has provided this service to the community since 1991. Selected G & PG movies start at 10AM each TUE and WED during the festival. First-come, first-served seating is limited to theatre capacity. The Family Film Festival is safe, lots of fun and a great way for kids to spend a weekday morning in the summer. To see if the no charge movies are playing in your city go to www.regmovies.com/ nowshowing/ familyfilmfestivalschedule. aspx and use the drop down box to find your state. It will then display the local theaters, movies, show times, etc. [Source: EANGUS Minuteman Update 10 Jul 08 ++]

MEDICARE REIMBURSEMENT RATES 2008 UPDATE 11: The Senate sent President Bush a controversial Medicare bill H.R.6331 passed by an unexpectedly wide margin 9 JUL. However, the President has threatened to veto it. The Senate cleared it by voice vote after voting 69-30 to overcome a final procedural hurdle. That tally is more than the two-thirds majority needed to override a presidential veto. Similarly, the House passed the bill by a vote of 355-59 on 24 JUN. The legislation would stop a 10.6% cut to doctors’ Medicare payment rates, replacing them with steady payments for the next 18 months. After that, more cuts would go into effect. The cuts technically went into effect on 1 JUL, but the administration has put a freeze on payments until 15 JUL, extending the deadline for work to be completed. Tricare provider payments are tied to Medicare payment rates. If the Senate had not passed the bill, Tricare payment rates would have been cut, which may have meant that doctors and dentists would no longer take Tricare patients, existing or new, having a significant effect on the military community. By passing the bill, the rate cuts are averted (if the President signs the bill) and rates will actually rise a bit.

The bill also would make cuts in privately administered Medicare Advantage plans to pay for the decreases in provider payments, and it was those cuts that the White House and Senate Republicans had objected to most vigorously. Republicans who initially had voted against the bill joined Democrats at the last minute, after Senator Ted Kennedy made his surprise appearance on the Senate floor. A senior Senate aide said Kennedy had been following the issue closely from Massachusetts and that he personally called Majority Leader Harry Reid on 7 JUL to say he would likely come back for the vote. The aide said Kennedy would return to work in the Senate in September. Kennedy is recovering from a brain tumor. The bill does a lot more than roll back a drastic Medicare pay cut to doctors. Following is a list of reforms a number of which the Medicare Rights Center has advocated for years:

• New preventive services of proven benefit will be covered by Medicare.
• Patient coinsurance for mental health services will be lowered from 50% to 20, the same rate that now applies to other doctor visits.
• A life insurance policy or in-kind help from friends and family (e.g. with groceries, heating bills) will no longer disqualify people from help with their drug costs.
• Bureaucratic obstacles that prevent low-income people from receiving help with their drug and medical costs will be eliminated.
• The Centers for Medicare & Medicaid Services will be required to rein in the exorbitant broker commissions that have fueled aggressive and fraudulent marketing of Medicare private health plans.
• Medicare private health plans will be required to provide care coordination and other services that meet the special needs of the enrollees they are designed to serve.
• All Medicare private health plans will be required to implement programs to improve the quality of care they provide.
• Fewer Medicare private health plans will be exempt from requirements that they have networks that guarantee access to specialists and other local providers.
• The Part D drug benefit will cover benzodiazepines, a class of drugs used to treat seizure disorders and anxiety disorders, which are now excluded from coverage.
• Part D coverage for anticancer drugs will be expanded to encompass more treatments that have been shown in respected medical journals to be effective.
[Source: EANGUS Minuteman & Asclepios Updates 10 Jul 08 ++]

VA THIRD-PARTY INSURERS: According to a report released on 10 JUL by the Government Accountability Office (GAO) a sample of medical centers managed by the Veterans Affairs Department failed to follow proper billing procedures on about $1.7 billion in uncollected payments to check if private insurance companies owed money to the department, In a study of 18 VA medical centers, GAO found that delays, billing mistakes or a lack of oversight led to the centers failing to check if $1.7 billion in fiscal 2007 should have been billed to third-party insurance companies. The medical centers have valid reasons for not billing for certain medical procedures, such as treatment received during military service, services covered by Medicare and a patient not having private health insurance. But “medical center management did not always validate the reasons for these unbilled amounts,” said the report which can be viewed at www.gao.gov/new.items/ d08675.pdf. “VA still has significant weaknesses in their controls in billing, follow-up and collection,” said Kay Daly, GAO’s acting director for financial management and assurance and the one of the report’s authors. “They could be obtaining hundreds of millions in revenue from third-party insurers if they addressed these weaknesses.”

GAO performed the case study as a follow-up to a 2004 report that also identified failures in VA’s ability to bill third-party insurers for care given at medical centers. The department often did not bill private insurance companies that covered patients treated at its facilities. The most recent report acknowledges VA has made some progress in correcting those shortcomings issue, but concludes many patient visits still are not billed to third-party insurers. “We found that VA didn’t have the full range of reports they needed to manage this at a high level perspective,” Daly said. “They didn’t have information on the billing and collection process or formal procedures to provide them with that information.” GAO found 10 medical centers took, on average, 109 to 146 days to bill third-party insurers. VA’s goal is 60 days. “We also found these centers had significant documentation, coding, and billing errors and performed little or no management oversight of the billing function,” the report stated. GAO said the lack of reporting was closely tied to problems in the design of VA’s computer systems.

The Veterans Health Information Systems Architecture, or VistA, a medical records system that includes accounts receivable, operates as a stand-alone system at each medical center. That prevents officials from directly accessing individual medical center data and requires officials to call each center to ask for information. To collect the data in one accessible location, VA developed the Performance and Operations Web-Enabled Reports System, which serves as a data warehouse for VistA data. GAO noted, however, that the system does not provide all the required standard management reports to conduct oversight and additional queries and data compilations are needed to collect the billing data. VA has undertaken initiatives to upgrade its systems. The Clinical Data Entry program will allow the department to capture clinical data automatically during a patient’s first visit. The system also will compile procedures that are expensive and conducted frequently but are not billed. VA wanted to complete the system in MAY 07 but so far the department has yet to set a deployment date. Another major driver in VA’s efforts to optimize revenue collection is the Patient Financial Services System, which will resolve business processes and technology issues in VA’s revenue collection and financial management systems. [Source: GovExec.com newsletters Gautham Nagesh article 14 Jul 08 ++]

ADVENTURE EXCURSIONS FOR OEF/OIF VETS: Outward Bound, an international non-profit outdoor education program, is offering fully funded outdoor adventure excursions to all OEF/OIF veterans. It doesn’t matter what your current military status is (active, inactive, discharged, retired) – you’re eligible to attend as long as you deployed in support of OEF/OIF combat operations while in the military. These five-day excursions offer adventure activities such as backpacking, rock climbing, canyoneering, canoeing, and dog sledding in wilderness areas in Maine, Texas, Colorado, California, and Minnesota. Scheduled courses from 8 SEP 08 thru 9 FB 09 are listed below, and future courses will be scheduled soon. All expedition costs for lodging, equipment, food, and instruction are completely funded by a multi-million dollar Sierra Club grant, including the participants’ round-trip transportation between home and the wilderness site. The excursion is offered at no cost to the participant. To sign up for one of the prescheduled courses, contact Doug Hayward at 1-866-669-2362, ext. 8387, or e-mail him at [email protected]. To learn more about the OEF/OIF program, visit the website at www.outwardboundwilderness. org/veterans.html. You can also contact two of their retired Judge Advocates, Joe and Amy Frisk, who are working for Outward Bound on this program at [email protected] , or at (303) 968-4420. The open enrollment course schedule is:

• Leadville CO – Backpacking and Rock Climbing in the Colorado Rockies: 3-7 SEP & 4-8 OCT 08.
• Newry ME – Backpacking and Canoeing: 7-11 & 19-23 OCT 08 .
• Big Bend TX – Back packing and Canyoneering: 2-6 & 15-19 NOV 08.
• Joshua Tree National Monument CA – Backpacking and Rock Climbing: December 3-7 & 14-18 DEC 08.
• Ely MN – Dog Sledding: February 3-7 FEB 09.
[Source: Student Veterans of America John D. Mikelson Notice 10 Jul 08 ++]

VET JOB UPDATE 02: Both Schneider National and Con-way Freight have implemented programs to attract former military personnel to the trucking business, helping train and prepare armed forces members for a life behind the wheel. The trucking industry needs good, quality workers. Former servicemen and women need a post-military career. It seems like a natural fit. Schneider National announced last week its Veterans Owner-Operator Program, which will give former military personnel the training, mentoring, financial incentives and purchasing power necessary to become an owner-operator, the carrier said. Schneider signed a Memorandum of Understanding with the U.S. Department of Veterans Affairs that will subsidize veterans’ commercial drivers’ license training through their GI Bill benefits. The carrier added that it will work closely with veterans to ensure they are able to become owner-operators six months sooner than prospective owner-operators without a military background. According to Schneider, more than 25% of the company’s employees have military backgrounds, and the carrier ranks sixth on G.I. Jobs’ Top Military-Friendly Employer list. Con-way Freight is also looking to attract armed forces personnel, launching last week a public-private partnership with the U.S. Army Reserve that will allow both organizations to recruit, train and employ those interested both in serving their country and joining the commercial freight transportation industry. According to Con-way, the agreement gives Army Reserve soldiers employment opportunities with Con-way Freight after they complete their military occupational training, formally creating a relationship between the armed forces and the private sector. [Source: Fleet Owner Online Justin Carretta article 7 Jul 08 ++]

MOBILIZED RESERVE 9 JUL 08: The Army, Air Force and Marine Corps announced the current number of reservists on active duty as of 9 JUL 08 in support of the partial mobilization. The net collective result is 2,267 fewer reservists mobilized than last reported in the Bulletin for 15 JUN 08. At any given time, services may mobilize some units and individuals while demobilizing others, making it possible for these figures to either increase or decrease. The total number currently on active duty in support of the partial mobilization of the Army National Guard and Army Reserve is 85,517; Navy Reserve, 5,757; Air National Guard and Air Force Reserve, 11,499; Marine Corps Reserve, 8238; and the Coast Guard Reserve, 787. This brings the total National Guard and Reserve personnel who have been mobilized to 111,799, including both units and individual augmentees. A cumulative roster of all National Guard and Reserve personnel, who are currently mobilized, can be found at www.defenselink.mil/ news/Jul2008/d20080709ngr.pdf . [Source: DoD News Release 576-08 9 Jul 08 ++]

VA VET CENTERS UPDATE 05: Combat veterans will receive readjustment counseling and other assistance in 39 additional communities across the country where the Department of Veterans Affairs (VA) will develop Vet Centers by fall 2009. The existing 232 centers conduct community outreach to offer counseling on employment, family issues and education to combat veterans and family members, as well as bereavement counseling for families of service members killed on active duty and counseling for veterans who were sexually harassed on active duty. Vet Center services are available at no cost to veterans who experienced combat during any war era. They are staffed by small teams of counselors, outreach workers and other specialists, many of whom are combat veterans. The Vet Center program was established in 1979 by Congress, recognizing that many Vietnam veterans were still having readjustment problems. The centers have hired 100 combat veterans who served in Iraq and Afghanistan as outreach specialists, often placing them near military processing stations, to brief servicemen and women leaving the military about VA benefits.

VA’s 2009 budget proposal seeks $20 million more than this year’s budget for Vet Centers, to include operating and leasing space for the new centers. Eighteen of the counties that will have new centers already have one or more; the other 21 do not. The communities receiving new VA Vet Centers will be: AL – Madison; AZ – Maricopa; CA – Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego; CT – Fairfield; FL – Broward, Palm Beach, Pasco, Pinellas, Polk, Volusia; GA – Cobb; IL – Cook, DuPage; MD – Anne Arundel, Baltimore, Prince George’s; MI – Macomb, Oakland; MN – Hennepin; MO – Greene; NC – Onslow; NJ – Ocean; NV – Clark; OK – Comanche; PA – Bucks, Montgomery; TX – Bexar, Dallas, Harris, Tarrant; VA – Virginia Beach; WA – King; and WI – Brown.
[Source: VA News Release 9 Jul 08 ++]

OHIO VET TUITION: In an effort to attract more veterans to Ohio’s public universities, Gov. Ted Strickland announced 8 JUL that the state would charge in-state tuition to all veterans attending college on the G.I. bill. The Ohio plan, the first of its kind in the nation, makes all veterans “honorary Ohioans” for the purpose of a college education. On 30 JUN, President Bush signed into law a new G.I. bill, doubling college benefits for eligible troops and veterans, essentially guaranteeing full scholarships at their in-state public colleges or universities, as well as providing monthly housing stipends. But generally, veterans can attend college under the law only in their home states. The Ohio plan, called the Ohio G.I. Promise, changes residence requirements at the state’s 36 colleges and universities to allow all veterans, their spouses and dependents to attend Ohio colleges and universities at in-state tuition rates. Ohio, which has about 47,000 students enrolled in its public institutions, recently adopted a 10-year strategic plan with a goal of enrolling about 230,000 more over the next decade.

Eric D. Fingerhut, chancellor of the Ohio Board of Regents said, “We have for years had a net out-migration, not only for the state generally, but for people with college degrees. So one of our goals, specifically delineated in the strategic plan, is to reverse the out-migration of people with degrees. In order to achieve that, we have to graduate more students and keep them here, and also attract more from out of state.” Mr. Fingerhut said the veterans plan will work in tandem with other new programs to encourage students to stay in Ohio. “If we are able to attract veterans to Ohio, we can link them and their families to internships, co-op and other opportunities, and if they get good jobs here, we’ll have Ohioans. We want veterans to know Ohio wants them to come here, and that we think they’re incredibly valuable high potential students. We already have a number of very good programs, which we’ll be expanding, to provide the type of counselors, advisers, and mentors who can work one on one with veterans to help them make the transition to civilian life and navigate the academic environment.” Currently, out-of-state students make up about 7.2% of those enrolled in Ohio’s state colleges and universities. [Source: New York Times Tamar Lewin article 9 Jul 08 ++]

MEDICARE FRAUD UPDATE 08: Congressional investigators said 8 Jul 08 that Medicare has paid as much as $92 million since 2000 to medical suppliers who billed the government for wheelchairs and other home equipment purportedly prescribed by physicians who, according to records, were dead at the time. The Centers for Medicare and Medicaid Services (CMS) honored about 500,000 such claims despite pledging six years ago to correct the problem, which was identified by the Health and Human Services Department’s inspector general in 2001. In more than half the cases studied, the doctor listed as having ordered the equipment had died more than five years earlier, said a report by the Senate Homeland Security and Governmental Affairs Committee’s permanent subcommittee on investigations. The report is part of the committee’s ongoing investigations into waste, fraud and abuse in the fast-growing federal health program, which serves more than 43 million elderly and disabled Americans. Medicare pays annually more than $400 billion in benefits and is a fixture on the Government Accountability Office’s “high-risk” list of troubled programs.

The Medicare program’s durable medical equipment component, in particular, has been a frequent target of companies seeking to bilk the government. The subcommittee has scheduled a hearing on the problem. When the system works properly, a physician writes a prescription for home medical equipment for a Medicare beneficiary. He takes the order to a supplier, who sells or rents the equipment to him. The supplier, in turn, submits a claim for payment to a Medicare contractor for processing. The claim includes a number issued by Medicare that identifies the prescribing physician. Senate investigators obtained from the American Medical Association a computer file of physicians who had died between 1992 and 2002. They selected 1,500 at random and asked Medicare officials to turn over medical-equipment claims filed with those doctors’ Medicare ID numbers between 2000 and 2007. During that time, the review said, ID numbers for 734 deceased doctors were used to file 21,458 claims that totaled $3.4 million. Investigators counted the claims only if the equipment was bought more than a year after the doctor’s death.

Extrapolating from the sample, investigators estimate that 384,730 to 572,238 such fraudulent claims were submitted during that period, and Medicare paid an estimated $60 million to $92 million. There are still active ID numbers in Medicare’s system for as many as 2,895 dead physicians, investigators said. They examined separate data for Florida, home to many retirees and a perennial leader in Medicare fraud. They found that more than a quarter of deceased Medicare doctors there still have active ID numbers in Medicare’s system. Medicare officials had promised to do a better job screening claims after the 2001 inspector general’s report found that the agency had paid $91 million for medical supply claims with invalid or inactive physician ID numbers in 1999. Medicare officials said several new steps should help, including a plan to match monthly Social Security Administration data about U.S. deaths against a revamped Medicare provider-identification system. They also pointed to new accreditation requirements for suppliers under a new program, opposed by the industry, that sets some equipment prices through competitive bidding. [Source: Washington Post Christopher Lee article 9 Jul 08 ++]

MEDICARE PART B PREMIUMS UPDATE 03: Some military retirees disabled in the wars in Iraq and Afghanistan pay more for health care than other retirees, and a new report recommends waiving their insurance premiums to correct the inequity. The report 8 JUL by inspectors general of the Department of Defense and the Department of Veterans Affairs suggests waiving for life the Medicare Part B premiums for service members who have been medically retired and are unlikely to get another job. Service members judged unfit for continued service after a service-related injury or illness are called “medically retired” and are eligible to continue receiving care through the military health care system. But those who don’t live near VA facilities can enroll in Medicare and go to civilian providers, the report said. Such retirees pay roughly $1,160 annually in monthly premiums until reaching the age of 65, while other retirees remain in the military health care system and don’t need the Medicare plan. The proposed change is among recommendations made after a review of services available for troops injured in Afghanistan and Iraq as they transition from active duty in the military to the responsibility of the VA.

The review, started two years ago, didn’t study the quality of medical care or individual cases, but rather efforts to improve the transition process. Release of the report was delayed to take into account legislation passed or proposed since the study started — as well as recommendations by more than a half-dozen commissions and task forces that have looked at veteran and troop health care in recent years. Those other studies made more than 400 recommendations — now in varying stages of review or implementation. “Since 2005, DOD and VA made significant progress modifying, updating and improving the systems supporting injured service members and veterans,” the report said. “The final step will be to ensure implementation.” Some veterans have complained about falling through the cracks of the bureaucracy as they leave the Pentagon’s care and transition to the VA. Some have complained about long waits to get appointments or about being discharged at a fraction of their pay, then waiting for months before their full disability payments arrive. Cynthia O. Smith, a Pentagon spokeswoman, said that among other efforts, the two departments have provided coordinators to guide wounded warriors and their families through medical recoveries and have set up a pilot program to simplify what was two exhaustive medical exams into one at the start of the disability process. [Source: Air Force Times AP Pauline Jelinek article Posted 9 Jul 08 ++]

TRICARE BACK SURGERY: A policy change is retroactive to 1 MAR 07 will allow beneficiaries with pain from fractured vertebrae to now seek surgery under Tricare. Percutaneous vertebroplasty and kyphoplasty, two minimally invasive back surgeries, are now covered. Either may replace spinal fusion, an invasive surgical procedure, for treatment of fractured vertebrae. Usually occurring in patients with osteoporosis, many vertebral fractures heal on their own with bed rest and anti-inflammatory medication in approximately three months. It is only when pain persists beyond three months that surgery is recommended. The traditional treatment was spinal fusion surgery which requires up to 12 hours in the operating room with days of hospitalization afterward. Percutaneous vertebroplasty and kyphoplasty are outpatient surgeries which have patients back to relative normality in 24 hours. Although minimally invasive, all surgeries come with risk and decisions need to be consulted with a doctor. Approval must be obtained from a provider for either surgery. Beneficiaries with questions about this procedure and its coverage under Tricare should contact their primary care manager. Check www.tricare.mil for this and other healthcare benefit information. [Source: Tricare News Release No. 08-64 dtd 8 Jul 08 ++]

VET CEMETERY ARKANSAS UPDATE 01: Officials say a fifth veterans cemetery for Arkansas will be established by the state on 99 acres near this Cross County community. Of the four current veterans cemeteries in Arkansas, only three are open for new burials — national cemeteries at Fayetteville and Fort Smith and a third being developed by the state at Camp Robinson in North Little Rock. The Little Rock National Cemetery has no more room for gravesites. The new veterans cemetery, to be a state operation, will be developed on land bought from the Maurice Smith family of Birdeye, near the intersection of Arkansas 42 and Arkansas 163, northeast of Wynne and east of Cherry Valley. The Smith family sold the land for $150,000, but that is only a small part of the cost. Jerry Bowen, a former undersecretary in the federal Veterans Affairs Department Bowen said that, in addition to the land, the estimated cost of developing the cemetery will be $5.6 million. The state Legislature has appropriated $1.3 million to start the project. According to Bowen, 46% of all veterans in the state live in central Arkansas, 34% in northwest Arkansas, 16% in northeast Arkansas, 4% in southeast Arkansas and 5% in southwest Arkansas. The cost of development will be paid for by the federal government through the state. David Fletcher, director of the Arkansas Department of Veterans Affairs, said the need for a new veterans burial ground was made apparent by the large pool of World War II veterans living in the region. The cemetery will have a full-time staff of five and an estimated annual operating budget of $250,000. Officials estimate the first burial could be as early as Memorial Day or Veterans Day in 2010. [Source: Arkansas Democrat Gazette AP article 7 Jul 08 ++]

RHODE ISLAND STATE DVA: A renewed proposal to establish a state Department of Veterans Affairs has been defeated again. Rep. Kenneth Carter, a North Kingstown Democrat and chairman of the House Committee on Veterans Affairs, resubmitted the measure that last year was passed by the Rhode Island General Assembly but vetoed by Governor Carcieri. This time, the bill won House passage but died in a Senate committee. Currently, veterans issues are dealt with by a division of the state Department of Human Services. [Source: Veterans Journal George W. Riley article 7 Jul 08 ++]

TRICARE OVERSEAS PROGRAMS UPDATE 01: TRICARE Area Office Pacific (TAO PAC) has announced they will be establishing a Philippines Satellite Office with a target opening date by the end of 2008. Negotiations with JUSMAGPHIL and the Department of State for space in the Embassy compound are currently ongoing. Once the office is set up Tricare users will be able to call or visit the office for help with their Tricare issues and problems. In the interim, Philippine support will continue from the TAO PAC Okinawa office which can be reached via [email protected] , or Commercial Tel: 81-611.743.2036 or DSN: 315.643.2036 or DSN FAX: 315.643.2037 or no cost Tel: 888-777-8343 Menu Option # 4. Within the month all Philippine Tricare users will be sent a letter from Wisconsin Physician Services (WPS) to inform them about the new Philippines rates that have been established to pay for inpatient (hospital) and outpatient care. If you do not receive a letter either you have not updated your current local address or you are still registered under a Tricare region in the states. The new rates will begin on 1 OCT 08. They were developed by the Tricare Management Activity (TMA) office to replace the Puerto Rico caps that are currently used for outpatient services and for the inpatient daily rates in the Philippines. TMA used the World Bank International Comparison Program index for the Philippines to establish more reasonable rates to reflect costs in the Philippines. Generally the new rate caps will be lower than the current caps, so it is important that users know what these rates are in order to avoid significant out of pocket costs. These rates will be published on the TRICARE website: www.tricare.mil/tma/ foreignfee/ . Inpatient rates are already listed on the site and below. Outpatient rates will be listed soon.

Philippines Inpatient Allowed Daily Per Diem Rates:
Group # Description Current 1 OCT 08
01 Infectious Disease …………… $1,847 $1,144
02 Cancer ……………………….. $2,136 $1,196
03 Endocrine …………………… $2,119 $1,141
04 Mental Health …………….. $909 $395
05 Nervous System …………… $1,906 $1,027
06 Circulatory ………………… $3,044 $1,769
07 Respiratory ………………… $1,828 $916
08 Digestive …………………… $1,888 $1,009
09 Genitourinary …………….. $1,980 $1,152
10 Pregnancy and birth ………. $1,076 $555
11 Musculoskeletal and Skin .. $3,079 $1,998
12 Congenital anomalies …. $2,916 $1,657
13 Perinatal ……………………. $731 $333
14 Symptoms, signs, etc. ….. $1,950 $1,080
15 Injuries ……………………… $2,246 $1,249
16 Poisoning …………………… $1,801 $1,069
17 Complications ……………. $2,333 $1,403
18 V-codes …………………….. $1,640 $966
[Source: TAO PAC Notice 1 Jul 08 ++]

Editors Note: The above rates changes will result in significant out-of-pocket medical care expense for Philippine users if they do not take steps to plan their health care in advance. It also sets the precedent to take similar steps in other overseas countries in which retirees reside. The revised rate structure for 1 OCT will result in all users in PI having to effectively pay higher Tricare fees than those in CONUS. By lowering the allowed amounts that can be reimbursed to providers the net result is that in addition to the 25% copay, retirees will also have to pay their providers the difference between what Tricare allows and what is charged to Philippine citizens. PI Tricare users should confirm that their current providers will accept the reduced rates before care is needed and, if not, attempt to locate alternate providers who will. At present less than 10% of the providers in the PI will accept direct reimbursement from Tricare. Since almost all PI provider’s require payment in advance, it would be prudent to set aside funds to make these payments as needed. Readers are encouraged to write their legislators and request they either conduct a congressional inquiry or hold hearings to justify why DoD has taken steps for Tricare users overseas to pay more than those in CONUS.

ENLISTMENT WAIVERS UPDATE 01: This week the Department of Defense (DoD) and the nation celebrated the 35th Anniversary of the All Volunteer Force (AVF). Since its inception, our volunteer military has upheld the traditions of strong and selfless service to the nation. Presently, more than 1.4 million men and women choose to serve on active duty, along with nearly 1.1 million members of the National Guard and Reserves. DoD announced changes 27 JUN to improve the enlistment screening process by standardizing enlistment criteria and generating uniform reporting of waiver types across all services. The most noticeable change to the policy is in the area of conduct waivers. Previously, each service categorized offenses differently, making it impossible to provide reliable comparisons across services, over time. Under the new policy all conduct offenses will be classified into one of four different categories. The most severe offenses will be classified as “major misconduct,” while less severe offenses will be considered “misconduct,” “non-traffic,” or “traffic” offenses. Also new is a coding system allowing services to track the level of the misconduct and the specific offense in question. Recent research suggests patterns of smaller offenses such as underage drinking and curfew violations are often more problematic over a career than a single major youthful offense such as burglary, which is the most common offense in the “major misconduct” category.

About one in five recruits receives exceptional admission to the military by means of a waiver. About one third are for medical waivers- most frequently for high body fat – and nearly two thirds involve youthful misconduct waivers. The standardization of data will allow the department to better analyze the relationship between offenses or categories of offense on the one hand, and attrition or performance concerns on the other. This new policy, will go into effect on 1 OCT 08, does not prohibit further changes in the management of the military’s screening for service in the armed forces, but it does represent another affirmative step in sustaining the pattern of success that has come to characterize AVF. Today’s AVF is highly educated with nearly 95%t of recruits holding a high school diploma, compared to about 75% of contemporary youth. Moreover, two thirds are drawn from the top half of American youth in math and verbal aptitude. The new policy can be viewed online at
www.defenselink.mil/ news/d20080627DTM08-018% 20Final%20Signed%20compressed. pdf .
[Source: DoD News release No.560-08 dtd 2 Jul 08 ++]

VA BRACHYTHERAPY TREATMENTS: On 2 JUL VA notified the major veteran service organizations about a medical treatment problem at the VAMC in Philadelphia. Specifically, VA had discovered that a specific treatment for prostate cancer, called brachytherapy, had not been conducted properly in a number of cases from 2002 to 2008. At this time this problem is known to exist at the Philadelphia VAMC only. Actions are underway to contact all patients who have received brachytherapy treatment at the Philadelphia VAMC during this time frame by mail. These letters will provide information on the error in treatment, information on obtaining follow-up care, a contact number for additional information, an apology, and assurances that any co-pays for additional testing will be waived. All other veterans who are concerned should call the VA hospital where they were treated. Following are responses to some anticipated questions from those who have received brachytherapy:

• What will happen next to me? In order to determine which patients have a problem, VA will be performing repeat CT scans on some patients. Using these scans, they will then calculate the dose to the prostate and determine whether it was adequate. If it is determined that the dose was adequate, VA will inform you, and nothing further will be done except for routine follow-up. If it turns out that the dose was inadequate, see items 4 and 5 below.
• What does inadequate dosage mean? Prostate brachytherapy is based on the delivery of a certain dose of radiation to the entire prostate gland using radioactive seeds. Based on a review of dosing to the prostate gland, VA determined that some doses may have been lower than optimal. Patients whose prostate gland received lower than optimal doses have a higher chance of their cancer returning than patients who received higher doses.
• Will additional tests be required, and if so what tests? VA is requesting a repeat CT scan on patients who they suspect may have been under dosed. They will also be obtaining PSA levels on our patients, which is something which would be done even if there were no suspicion of under dosing. If there is a rising PSA, VA may obtain a bone scan. In some cases, a prostate biopsy might be recommended.
• If it turns out that I received an inadequate dose, does it mean that I will have a relapse of my prostate cancer? Not necessarily. Properly delivered brachytherapy cures early stage prostate cancers in 90-95% of patients meaning that there is a 5-10% chance of the cancer returning. If it turns out that you received an inadequate dose, your risk is higher. However, it is still possible that it will never return.
• If it is determined that I was under dosed, will I require more treatment? We is reviewing your case to determine whether to recommend further treatment at this time and if so what that therapy should be. This is an individualized decision based on many factors, including how long ago your implant was performed and your current and past PSA levels. If it is felt that your risk of relapse is high, VA may recommend further treatment such as a second implant. Alternatively, VA may recommend no further treatment and may continue to follow your PSA levels.
• If no further treatment is recommended but only follow-up, how long do I need this? Prostate cancer can be very slow growing and may relapse many years later. For this reason, it is recommended follow-up at least every six months for a minimum of five years following treatment and preferably for ten years.
• If I do have a relapse what further treatment could be given? After radiation therapy to the prostate has been given, most urologists are unwilling to perform surgery. The most likely course of action would be to place you on hormonal therapy (injections given every 3 months and oral pills).
• Do I have the right to sue? Yes; for more information about filing a claim contact the Office of Regional Counsel (Mr. Jose Lopez). He may be reached by telephone at (215) 823-7811, or by mail at Jose H. Lopez, Regional Counsel, Office of Regional Counsel (642/02), Department of Veterans Affairs Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104 .
[Source: NVS Weekly Updates 2 July 08 ++]

DOD PDBR: Former servicemembers who disagree with the disability ratings they received when they were discharged as unfit for military duty can now apply to have those ratings reviewed by a new Physical Disability Board of Review (PDBR). The Defense Department announced formation of the new board to reassess the accuracy and fairness of disability ratings assigned to discharged troops. Several task forces and studies cited inconsistencies in the way the military departments assigned disability ratings for similar conditions. The Army tended to assign the lowest ratings, according to the studies. The findings were enough to warrant the creation of a PDBR. The board won’t second-guess service determinations of fitness for continued service; it will only review the combined disability ratings associated with the specific unfitting conditions cited by the service Physical Evaluation Board. Their recommendations will be final and won’t be reviewable by a service Board for Correction of Military Records. Any servicemember who meets eligibility qualifications (or the surviving spouse, next of kin, or legal representative) can submit a written request to the parent service to have his or her case considered by the PDBR if the servicemember:

1) Was separated from the Armed Forces between 11 SEP 01 and 09 due to a disability that made him or her unfit for continued military service; and
2) Received a combined disability rating of 20% or less from the parent service; and
3) Was not eligible for retirement.

The new board could potentially affect almost half the 20,000 servicemembers processed through the Disability Evaluation System each year. Of these, about 10% have combat- or training-related injuries. Disability ratings have a significant financial impact, determining if the servicemember qualifies for retired pay and military benefits such as health care and base privileges for life, or a one-time severance pay with no additional benefits. Those who receive 30% or higher disability ratings — 1,296 during fiscal 2007 — are medically retired. In addition, more than 4,200 servicemembers were put on a temporary disability retired list last year, a status they can retain for up to five years. If the combined rating is 20% or lower, troops are typically discharged with severance as unfit for duty. During fiscal 2007, almost 4,000 servicemembers processed through the Disability Evaluation System were returned to duty. Of those separated as no longer fit for duty, more than 9,200 received a severance. Another 1,150 did not receive a severance, typically because their disabilities were due to misconduct or pre-service conditions. Not all were happy with their disability rating findings. About 10% appealed their cases. Now, under the PDBR troops will have one additional method of recourse. Retherford said he anticipates the board will review about 900 cases per year, all by request. Former servicemembers separated from the military after 11 SEP 01, must apply to have their case reviewed.

The Defense Department plans to launch an awareness campaign to ensure people who qualify for a records review know about the new board and how to apply. The Defense Department designated the Air Force to operate and manage the new board, but it will include representatives from each military department. Board members will include line officers as well as medical experts, who will review documentary evidence. No former servicemember will appear in person before the board. The board can recommend that the appropriate service secretary increase a disability rating, uphold the previous finding, or issue a disability rating when the previous board did not assign one. However, the board cannot recommend a lower rating. Undersecretary of Defense for Personnel and Readiness David S. C. Chu called the board an important step in ensuring affected servicemembers are treated fairly. “The PDBR has no greater obligation to our wounded, ill and injured servicemembers and former servicemembers than to offer fair and equitable recommendations pertaining to the assignment of disability ratings,” he said. [Source: AFPS Donna Miles article 1 Jul 08 ++]

DOD PDBR UPDATE 01: The Defense Department announced formation of the new Physical Disability Board of Review (PDBR) to reassess the accuracy and fairness of disability ratings assigned to discharged troop. The Air Force is to recommend someone to lead the PDBR immediately, and then the other services will determine who will represent them on the board. According to the legislation, the new board was supposed to be in place by the end of April. David S.C. Chu, undersecretary for personnel and readiness, in a memo dated 27 JUN wrote, “The purpose of the [board] shall be to reassess the accuracy and fairness of the combined disability ratings assigned service members who were discharged as unfit for continued military service. The [board] shall operate in a spirit of transparency and accountability, and shall impartially readjudicate cases upon which review is requested or undertaken on its own motion.” One sentence of the new directive already has veterans service organization representatives concerned: “Only the medical condition(s) determined to be specifically unfitting for continued military service, as previously determined by the Military Department [physical evaluation board], will be subject to review by the [board].” The legislation makes no such limitations. Retired Army Lt. Col. Mike Parker, who has worked as an advocate for service members going through the physical evaluation board process, said there are at least two categories of veterans who could be hurt by this limitation:

• He gave an example of a sergeant who was originally sent to the medical evaluation board because of a congenital cornea condition that caused his vision to be distorted. According to the surgeon general of the Army’s policy, soldiers may not wear hard contact lenses to the field, as this soldier was required by his doctor to do. But when he went to the board, he was found fit for his cornea condition, which would have brought him a rating of at least 30%, and found unfit for two other lesser conditions and given a total rating of 10%. “They’ve been cherry-picking which unfitting condition to use,” Parker said. The new board would not be allowed to make sure the ‘fit’ determination for the soldier’s cornea problem was fair.
• The Physical Evaluation Board is required to include all current medical conditions, but the Walter Reed scandal showed that often, medical records were lost or not included in board packets. If that happens, the Physical Evaluation Board doesn’t get a chance to rate for all conditions, but those cases would not be covered by the new board.

Pentagon Spokesman Lt. Col. Les Melnyk said in an e-mail, “Conditions that were not identified as unfitting are not within the scope of this board. A determination of unfitting is generally unique to the demands of the service member’s military department. These decisions are best made by the military departments.” However, he said conditions that were not rated because they were determined to be pre-existing, as was the case of thousands of service members discharged with no benefits for personality disorders, would be eligible for review by the new board. Parker said the new board needs to address all situations that can lead to a combined disability rating of less than 30% — otherwise, service members may have to take their cases to several boards to try to correct specific errors in their cases. “If the new board does not address all of these factors, I fear a service member may have to spend years going to multiple review boards to fix all the issues that led to an erroneous rating,” Parker said, which is exactly the kind of bureaucratic quagmire the Wounded Warrior legislation sought to correct. Melnyk said a different board should, in fact, look at those other issues. “Service members may appeal those issues to the Military Department Board of Corrections for Military Records or the Discharge Review Boards,” he said. But that could also cause a problem: After they receive a recommendation from the new review board, service members will not be eligible for review by the Board for the Correction of Military Records, according to Chu’s directive and the legislation. [Marine Corps Times Kelly Kennedy article 8 Jul 08 ++]

VA FRAUD UPDATE 11: The Department of Justice announced 30 JUN that the director of the Hines IL Department of Veterans Affairs Consolidated Mail Outpatient Pharmacy (CMOP) has agreed to plead guilty to participating in a conspiracy that allowed a subordinate to make contracting decisions regarding a company owned by the subordinate’s spouse. The director also has agreed to plead guilty to accepting illegal gratuities. In a plea agreement filed in U.S. District Court in Chicago , Joel M. Gostomelsky , admitted to conspiring with a subordinate between 2000 and 2007 to allow the subordinate to be involved in the hiring and supervising of temporary pharmacist employees supplied to the CMOP by a company owned by the subordinate’s spouse. Among other actions, Gostomelsky falsely represented to VA officials that the subordinate had no role at the CMOP in the ordering of these services, and that the subordinate would be removed from making decisions affecting the employees of the temporary staffing company. He also agreed to plead guilty to receiving illegal gratuities from 1998 through approximately 2005 from another vendor that provided supplies to the CMOP acknowledging that because of the gifts he received, he helped steer orders for mailing supplies to the vendor. According to the terms of the plea agreement, which is subject to court approval, he has agreed to cooperate in the government’s ongoing investigation. His sentence will be determined by the court.

Gostomelsky was the Director of the CMOP in Hines from 1995 until April 2007 . The CMOP in Hines is one of seven such pharmacies throughout the nation, and currently processes and sends more than 100,000 prescriptions to veterans daily. The conspiracy charge carries a maximum penalty of five years of imprisonment and a fine of $250,000 and the acceptance of illegal gratuities charge carries maximum sentence of two years of imprisonment and a fine of $250,000. The maximum fine for each of these violations may be increased to twice the gain derived from the crime or twice the loss suffered by the victims of the crime, if either of those amounts is greater than the statutory maximum fine. George J. Opfer, Inspector General of the Department of Veterans Affairs said, “The VA Office of Inspector General investigates every credible allegation against VA employees who betray the trust of our veterans and taxpayers by acts of bribery, graft, and criminal conflict of interest. Former managers of two other VA Consolidated Mail Outpatient Pharmacies currently serving multi-year prison sentences for similar, yet unrelated, criminal acts have learned just how seriously we take these allegations.” Anyone with information concerning bid rigging, fraud, kickbacks, bribery or other crimes relating to violations of federal procurement laws meant to foster competition concerning any of the VA’s CMOP’s should contact the Chicago Field Office of the Antitrust Division at 312-353-7530 or the VA Office of Inspector General at 1-800-488-8244. [Source: U.S. Department of Justice News Release 30 Jun 08 ++]

VETERANS’ BENEFIT EXPIRATION UPDATE 01: Many of your benefits have an expiration date. Below are a few important federal ones to remember so you don’t lose out. Most veterans are not aware, that their benefits can expire. For more detailed information of these programs go to www.military.com/ benefits/veteran-benefits/ veterans-benefit-expiration- dates or: www.va.gov:

Education, Training, and Employment Programs: 10 years from date of last discharge or release from active duty.

Veterans Education Assistance Program (VEAP): 10 years from last discharge or release from active duty.

Montgomery GI Bill for Selected Reserve (MGIB-SR): 14 years from the date of eligibility for the program, or until released from the Selected Reserve or National Guard. (Some extensions available if activated.)

Reserve Educational Assistance Program (REAP): No time limit, while remaining in the same level of the Ready Reserve.

Vocational Rehabilitation and Employment (VocRehab): Generally, 12 years of separation from service or within 12 years of being awarded service-connected VA disability compensation.

VA Insurance Programs:
• Servicemembers’ Group Life Insurance (SGLI): Coverage ends 120 days after separation or Can be extended up to 1 year for totally disabled veterans.
• Family Group Life Insurance (FGLI): Coverage ends 120 days after separation or Can be extended up to 1 year for totally disabled veterans after separation.
• Veterans Group Life Insurance (VGLI): Within 120 days of separation.
• Service Disables Veterans Insurance (SDVI): Within 2 years from the date of being notified of service-connected status.
• Veterans Mortgage Life Insurance (VMLI): Must apply before age 70

Veterans Health Care Administration (VHA) PROGRAMS:
• Veterans Health care: No Time Limit
• Combat Veterans Health Care: 5 years from release from active duty.
• Dental Treatment: Within 90 days of separation.

VA Pension And Compensation Programs:
• Disability Compensation: No Time Limit.
• Disability Pension: No Time Limit.
• VA Home Loan Guaranty Program: No Time Limit.
[Source: CFVI Newsletter Jun 08 ++]

ATRIAL FIBRILLATION: This subtle condition can have serious consequences for your health. Fortunately, diagnosis is easy and treatment reduces long-term effects. To understand this condition you need to know how the heart works. It has four chambers – two atria on top and two ventricles below them – that subsequently fill with blood and contract to circulate blood throughout the body. The timing and sequence of the contractions are crucial and are controlled by the heart’s own internal cardiac pacemakers. Normally each chamber contracts about 70 times am minute, allowing it to fill with blood and empty, thus moving the blood efficiently. Atrial fibrillation occurs when the top two chambers of the heart flutter or quiver, rather than contracting rhythmically. These quivers are so fast and erratic that the atria does not have time to fully fill or empty. This means the ventricles, in turn, cannot fully fill or pump enough oxygenated blood throughout the body. As the heart’s internal pacemakers try to regulate atrial fibrillation, the heart might beat too quickly or slowly. If too slowly there is not enough oxygenated blood circulated to meet the body needs and too quickly there is not enough time for the ventricles to fill between beats causing a similar reduction in oxygenated blood availability. In addition, if blood pools in the atria, clots can form and then travel to the brain causing a stroke.

Though atrial fibrillation can have serious consequences, for many people it goes unnoticed for years. A doctor often will recognize the irregular irregularity of the atrial fibrillation heartbeat when he or she takes a patient’s pulse or listens to the heart with a stethoscope during a physical examination. An EKG will show the altered electrical pathways and the irregular irregularity of the heart rate and confirm diagnosis of atrial fibrillation. Treatment depends on many factors. A doctor will look for predisposing conditions, such as hypoglycemia (low blood sugar), hypoxia (low oxygen) from lung disease, abnormal thyroid function, alcohol or drug use, etc. and treat them first. If the heart is beating too fast medication such as digoxin or propanolol can be used to slow ventricular rate. These medications may be needed for years. If too slow an antrioventicular sequential pacemaker can be inserted to signal the atria and ventricles so they will contract more normally and improve circulation and oxygenation. Anticoagulants such as aspirin or warfarin can reduce clots and the risk of stroke in chronic atrial fibrillation. If atrial fibrillation is of relatively recent onset, the heart is normal, and a patient is otherwise healthy, cardioversion can be used to electrically shock the heart back to its normal rhythm. Although this is the best procedure for some patients, it has serious risks and should be considered carefully. Almost 20% of people over 80 years of age have (or have had) atrial fibrillation. For more information click on “arrhythmias” on the American Heart Association’s web site www.americanheart.org. [Source: Military Officer Ask the Doctor article Apr 05]

FORGOTTEN MILITARY ORPHANS: There are some statutory and regulatory problems that adversely effect many of the orphans of deceased military personnel. The problems are the result of how current Federal laws are written and thus need Congressional action to fix them.
1. Orphans (the children of a deceased military person) who are not the children of the deceased and his or her current spouse do not receive any of the death gratuity (DG).
2. Where there are minor children, but no spouse, the guardian of the minor child must go into state court and be declared the Guardian of the Minor’s Estate in order for the Defense Finance and Accounting Service (DFAS) to pay the DG out.
3. Minor orphans who do not live in the deceased’s household at the time of death do not usually get commissary and exchange shopping privilege.

The original purpose of the death gratuity was to off set extra expenses that one’s loved ones incur when there is a death and to bridge the gap between the military pay stopping and the other long term benefits such as social security, dependency indemnity compensation (DIC), and survivor’s benefits starting up in a month or two. If one has a spouse and dies in the military, the DG is directed first to go to the surviving spouse. This is not a problem if the children of the deceased are all from the current spouse. The deceased’s children only get the DG if there is no spouse. It is not uncommon for a deceased serviceman to have children from relationships with other people. Upon death of the serviceman the child support these other children are receiving stops. Thus, they suffer the same income interruption as the spouse but do not get any stopgap DG payment. A solution would be to change the current law at Sec. 1477 (a) (1) to give all the DG to the spouse if the deceased does not have children fathered or mothered from people other than his or her current spouse. If there are children that are not issue from the current spouse, then the widow or widower gets half the DG and the deceased’s children from relationships other than with the current spouse equally share the other half of the DG.

Death Gratuity (DG) money that is paid out for the benefit of minor children must be paid into a trust account which usually requires the hiring of an attorney to set up a “Guardianship of the Child’s Estate” which is needed for them to set up a trust account at a bank in the child’s name. DFAS does not recognize the mere fact that the natural parent or someone else has custody of the child, even if from a divorce or other legal proceeding. DFAS requires an adult member, usually the person with physical custody of the minor child, to have a state court name them as the guardian of the minor child’s assets/estate. After this is done, the guardian then must open up a trustee bank account in the child’s name. Only then will DFAS send a check on the child’s behalf payable to the child’s trust account. In many cases, this requires the guardian/trustee to spend $1000 or more in legal fees to get the DG. This often takes months to do which tends to defeat the original purpose of the DG, help with immediate expenses. A solution would be for Congress to add new wording to Title to Title 10 US Code Sections 1475 to 1477 stating the person with physical custody of the minor child would have the right to go to Legal Aide or the closest military operated legal assistance office for help. The legal services would include not only preparing the paperwork, but also appearing in state court if necessary on that matter.

The minor children of a deceased’s current spouse or those who were living in the deceased’s household automatically get full commissary and exchange privileges. Other orphans only qualify for these two privileges if they can establish at the time of death that the deceased was providing the residence they were living in and over 50% of their support. This unfairly penalizes the minor children from prior marriages and those born out of wedlock. These same children qualify for all other Federal benefits automatically. A solution would be to change current Federal law and DoD policies to state that all minor children of deceased military personnel receive full commissary and exchange privileges. There would be no need to establish any level of support being provided prior to the death of the military member. [Source: CDR Wayne Johnson, JAGC, USN (Ret) 5 Jun 05 [email protected] ]

LEGAL RESIDENCY: What follows is aimed at active duty military personnel who are covered under the Servicemembers Civil Relief Act (SCRA) of 2003. As to whether their nonmilitary spouses and dependent children get the same protections; one must look at state law. Most states allow the family members to maintain the same state of legal residence as the military spouse, but do not assume this to be so. Check with a legal assistance office. Under the Act (formerly known as the Soldiers’ and Sailors’ Civil Relief Act of 1940), a military member’s state of legal residence (Home State) does not change every time they are transferred. If one is a legal resident of Ohio when one comes on full time active duty, that person stays an Ohio citizen so long as they are on active duty, even if they spend 20 years on active duty and never step foot in Ohio during the who period. This means they stay a legal resident of their home state for such things as their driver’s license, car registration, income taxes, personal property taxes, and voting. Even if a service member no longer has any form of address in their home state, the member stays a legal resident. In some counties, for voting purposes, if you no longer have a physical address there the county makes your address the local courthouse. This is contrary to what happens to the average civilian or retiree who gets transferred or moves to another state since, by operation of law, they become a citizen/legal resident of the new state.

Another effect of the Act is that a military member may obtain a state drivers license and/or register his or her car in the state in which he or she is assigned under orders. Under the Act doing either or both of these things does not automatically make one a legal resident of the state one is assigned to. You probably know someone who has kept a state’s plates on their car after transferring to another state even though they are a legal resident of a third state. The danger is a person who keeps the plates or license of the host state they had been residing in after they transfer. Doing so could be used by the host state to argue you now owe them income taxes since keeping your license with them after you left the state shows that you are now a legal resident of that state. It could also lead to a traffic citation and fine. Remember, your registration and license can only be from your home state or where you are currently stationed/residing pursuant to military orders.

If a military member wants to become a legal resident of the state they are physically present in due to PCS orders, they may do so by avowing that, for the foreseeable future, he or she desires to make that state their legal residence for the rest of their life. Thus, you must have both physical presence and the intent at the same time in order to make this change. You must also actually be living there for more than just a few weeks. If one decides to change their legal residence, one would do certain things to reflect this change to the rest of the world. DEFINITE INDICATORS are where one votes and where one files their state income tax returns as to one’s military pay if the home state has a tax. Even if a return is not required, it is frequently a good idea to file a return and have a paperwork trail reaffirming your state of legal residence/home state. MAYBE INDICATORS are your driver’s license and vehicle registrations. Some states, such as Florida, have a written affidavit one can file at the local courthouse that attests to a person becoming a legal resident of that state. If one does that, get a few certified copies from the court clerk of the newly filed affidavit and send one copy to your old home state with your income tax return for that year so they will know why you have quit filing with them.

Legal residence or Home State is not to be confused with “Home of Record” which is a purely military term. Usually they are one in the same but “Home of Record” cannot be changed during one’s enlistment. The main purpose of “Home of Record” is that it sets the limit the distance the government is willing to pay to move you when you get off of active duty. Retirees, however, get to move anywhere in the country when they retire compliments of the military. Retirees do not get the protections of the Act and must file taxes and do everything else that the state they are living in requires. Having said that, anyone who is, or has been in the military, should check with their state of residence to see if under state law they are entitled to any perks. Most states give military, veterans, retirees, and in some cases their family members some sort of special treatment when it comes to taxes and licenses. This is particularly true for wounded, disabled, or deceased personnel. Many states exempt all or part of a military pension from state income tax. Every state has its own “state” veterans affairs office which can provided such information. Do not confuse it with the local federal Department of Veterans Affairs office, which is a separate entity.

The SCRA covers other matters The major areas the SCRA covers include the stay of legal actions, rent, installment contracts, mortgages, liens, assignment, leases, life insurance, taxes and public lands, powers of attorney, professional liability protection, health insurance reinstatement, guarantee of residency for military personnel, and business or trade obligations. To review the Servicemembers Civil Relief Act of 2003refer to www.servicemembers.gov/ scratext.htm and legalassistance.law.af. mil/content/legal_assistance/ cp/scratext.pdf. Some useful web sites containing Summaries and “How To” Guides are:
www.abanet.org/ legalservices/lamp/downloads/ SCRAguide.pdf.
www.justice.gov/usao/ az/rights/Servicemembers_ Civil_Relief_Act.pdf.
www.abanet.org/family/ military/ scrajudgesguidecklist.pdf.
legalassistance.law.af. mil/content/content.php? qrylvl=3&lvl1id=1&lvl1folder= yes&lvl2id=11&lvl2folder=yes
[Source: Cdr Wayne Johnson, JAGC,USN (Ret) MAY 2008 [email protected]

SSA INTERNATIONAL AGREEMENTS: In today’s global environment people often relocate from one country to another, either permanently or on a limited time basis. This presents challenges to businesses, governments, and individuals seeking to ensure future benefits or having to deal with taxation authorities in multiple countries. To that end, the Social Security Administration has signed treaties, often referred to as Totalization Agreements, with other social insurance programs in various foreign countries. Overall, these agreements serve two main purposes. First, they eliminate dual Social Security taxation, the situation that occurs when a worker from one country works in another country and is required to pay Social Security taxes to both countries on the same earnings. Second, the agreements help fill gaps in benefit protection for workers who have divided their careers between the United States and another country. Normally, non-resident aliens of foreign countries without a Totalization Agreement are taxed by the U.S. at a rate of 30% on all income derived in the U.S. To ensure payment the tax is normally withheld at source from payments forwarded to a SSA beneficiary overseas. The following countries with effective dates have signed Totalization agreements with the SSA:

Australia (October 1, 2002)
Austria (November 1, 1991)
Belgium (July 1, 1984)
Canada (August 1, 1984)
Chile (December 1, 2001)
Finland (November 1, 1992)
France (July 1, 1988)
Germany (December 1, 1979)
Greece (September 1, 1994)
Ireland (September 1, 1993)
Italy (November 1, 1978)
Japan (October 1, 2005)
Luxembourg (November 1, 1993)
Netherlands (November 1, 1990)
Norway (July 1, 1984)
Portugal (August 1, 1989)
South Korea (April 1, 2001)
Spain (April 1, 1988)
Sweden (January 1, 1987)
Switzerland (November 1, 1980)
United Kingdom (January 1, 1985)
[Source: Wikipedia Online Encyclopedia 1 Jul 08 ++]

HAVE YOU HEARD: Think what you will of Ronald Regan and his politics but most cannot dispute the following comments of his regarding our government:
• ‘Here’s my strategy on the Cold War: We win, they lose.’
• ‘The most terrifying words in the English language are: I’m from the government and I’m here to help.’
• ‘The trouble with our liberal friends is not that they’re ignorant; it’s just that they know so much that isn’t so.’
• ‘Of the four wars in my lifetime, none came about because the U.S. was too strong.’
• ‘I have wondered at times about what the Ten Commandments would have looked like if Moses had run them through the U.S. Congress.’
• ‘The taxpayer: That’s someone who works for the federal government but doesn’t have to take the civil service examination.’
• ‘Government is like a baby: An alimentary canal with a big appetite at one end and no sense of responsibility at the other.’
• ‘The nearest thing to eternal life we will ever see on this earth is a government program.’
• ‘It has been said that politics is the second oldest profession. I have learned that it bears a striking resemblance to the first.’
• ‘Government’s view of the economy could be summed up in a few short phrases: If it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it.’
• ‘Politics is not a bad profession. If you succeed, there are many rewards; if you disgrace yourself, you can always write a book.’
[Source: Words of wisdom by Margaret Gee 2001 ++]

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

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