VA Care for Women found lacking…

Study sees discrepancies in VA care for men, women

By KIMBERLY HEFLING – 1 day ago

WASHINGTON (AP) — Health care for female military veterans lags behind the care offered to male vets at many VA facilities, an internal agency report says, even as women are serving on front lines at historic levels.

There are clear needs for more physicians trained in women’s care and more equipment to meet women’s health needs, said Friday’s review by the Department of Veterans Affairs.

It did add that strides are being made, such as creating onsite mammography services and establishing women’s clinics at most VA medical centers. The department also is attempting to recruit more clinicians with training in women’s care.

For now, female veterans aren’t getting the same quality of outpatient care as men in about one-third of the VA’s 139 facilities that offer it, the report said. That appeared to validate the complaints of advocates and some members of Congress who have said more emphasis needs to be placed on women’s health.

Women make up about 5 percent of the VA’s population, but that is expected to nearly double in the next two years.

Paul Rieckhoff, founder of the Iraq and Afghanistan Veterans of America, said women veterans have complained about the lack of women’s restrooms and private changing areas in some VA centers. Others have complained about the scarcity of women-only group counseling options.

“There’s a definite feeling of isolation,” Rieckhoff said. “There’s a definite feeling that they’re a minority and that big Army and big VA are still trying to understand their issues.”

Any discrepancies in care are unacceptable and the agency is aggressively addressing the issue, said Dr. William E. Duncan, associate deputy undersecretary at the Department of Veterans Affairs.

“We’re striving to understand the reason for these health disparities and to eliminate differences in veterans health care based on personal characteristics,” Duncan said.

Delphine Metcalf-Foster, 65, an Army veteran from the Persian Gulf War, still laughs when she recalls the first day she stepped into a VA waiting room in 1991 and the physician called out for “Mr. Metcalf.”

“I knew he was talking about me, but I wouldn’t move,” said Metcalf-Foster, a member of the nonprofit Disabled American Veterans in Vallejo, Calif. “Of course, they weren’t used to women there.”

Despite that, Metcalf-Foster said, she thinks the VA has listened to the concerns of women like her, and has adapted as more women have sought care.

Silva Royer, 64, a Vietnam-era veteran who volunteers at the VA center in Biloxi, Miss., said she would like to see the VA reach out to more women veterans and encourage them to take advantage of the health care — particularly mental health help — to which they are entitled.

“I still think they still look at the VA as, that’s where my grandpa went,” Royer said.

Overall, women make up about 14 percent of the U.S. Armed Forces. Of the 1.7 million troops who have deployed in support of the wars in Iraq and Afghanistan, more than 190,000 — or about 11 percent — are women.

The VA’s review noted that other studies have found better surgical outcomes and decreased mortality for women at VA hospitals compared to women who receive care under the Medicare Advantage Program or under private care. And, performance of breast and cervical cancer screening exceeds that of commercial and some government plans.

Data were not available to compare the inpatient quality of care between men and women.

Sen. Patty Murray, D-Wash., who is on the Senate Veterans Affairs Committee, said in a statement that the findings confirm what she has been hearing from women veterans for years.

She encouraged passage of legislation that would, among other things, force the agency to do comprehensive studies of women veterans’ care and conduct a pilot program providing child care for veterans seeking mental health care.

Among the other findings of new report:

_Older and younger veterans appear to be receiving the same quality of care;

_About 86 percent of homeless veterans seen by VA received primary care, mental health care and/or substance abuse services;

_About 98 percent of appointments were completed within 30 days in primary care clinics and about 97 percent were completed during that period at specialty clinics;

_Overall quality of care appears to be good when reviewed using commonly accepted health care benchmarks;

_Minority veterans surveyed were generally less satisfied with inpatient and outpatient care than white veterans, but it wasn’t clear if the quality of care offered was different. A more comprehensive study of care for minority veterans is expected to be complete this summer.

• Disabled American Veterans: http://www.dav.org/
• Iraq and Afghanistan Veterans of America: http://www.iava.org/

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Official Urged Fewer Diagnoses of PTSD

It’s all about money unfortunately, not about what is right. Vote this year make your Vote count. Don’t be sheep actually look at what is going on.–D/C

By Christopher Lee
Washington Post Staff Writer
Friday, May 16, 2008

A psychologist who helps lead the post-traumatic stress disorder program at a medical facility for veterans in Texas told staff members to refrain from diagnosing PTSD because so many veterans were seeking government disability payments for the condition.

“Given that we are having more and more compensation seeking veterans, I’d like to suggest that you refrain from giving a diagnosis of PTSD straight out,” Norma Perez wrote in a March 20 e-mail to mental-health specialists and social workers at the Department of Veterans Affairs’ Olin E. Teague Veterans’ Center in Temple, Tex. Instead, she recommended that they “consider a diagnosis of Adjustment Disorder.”

VA staff members “really don’t . . . have time to do the extensive testing that should be done to determine PTSD,” Perez wrote.

Adjustment disorder is a less severe reaction to stress than PTSD and has a shorter duration, usually no longer than six months, said Anthony T. Ng, a psychiatrist and member of Mental Health America, a nonprofit professional association.

Veterans diagnosed with PTSD can be eligible for disability compensation of up to $2,527 a month, depending on the severity of the condition, said Alison Aikele, a VA spokeswoman. Those found to have adjustment disorder generally are not offered such payments, though veterans can receive medical treatment for either condition.

Perez’s e-mail was obtained and released publicly yesterday by VoteVets.org, a veterans group that has been critical of the Bush administration’s policies in Iraq and Afghanistan, and Citizens for Responsibility and Ethics in Washington (CREW), a nonprofit government watchdog group.

“Many veterans believe that the government just doesn’t want to pay out the disability that comes along with a PTSD diagnosis, and this revelation will not allay their concerns,” John Soltz, chairman of VoteVets.org and an Iraq war veteran, said in a statement.

Melanie Sloan, executive director of CREW, said in a statement: “It is outrageous that the VA is calling on its employees to deliberately misdiagnose returning veterans in an effort to cut costs. Those who have risked their lives serving our country deserve far better.”

Veterans Affairs Secretary James B. Peake said in a statement that Perez’s e-mail was “inappropriate” and does not reflect VA policy. It has been “repudiated at the highest level of our health care organization,” he said.

“VA’s leadership will strongly remind all medical staff that trust, accuracy and transparency is paramount to maintaining our relationships with our veteran patients,” Peake said.

Peake said Perez has been “counseled” and is “extremely apologetic.” Aikele said Perez remains in her job.

A Rand Corp. report released in April found that repeated exposure to combat stress in Iraq and Afghanistan is causing a disproportionately high psychological toll compared with physical injuries. About 300,000 U.S. military personnel who have served in Iraq or Afghanistan are suffering from PTSD or major depression, the study found. The economic cost to the United States — including medical care, forgone productivity and lost lives through suicide — is expected to reach $4 billion to $6 billion over two years.

Ng said diagnosing PTSD often requires observing a patient for weeks or months because the condition implies a long, lingering effect of stress. “Most people exposed to trauma, in general, can get better,” Ng said. “You don’t want to over-diagnose people with PTSD. Whether it’s adjustment disorder is one thing. It’s usually a temporary disorder with severity that is not as bad as someone with full-blown PTSD.”

From National Veterans Foundation

Care Costs Rise as Veterans Population Declines.

All of our heroes from WWII and Korea are dying due to age. The VA is not receiving the savings they thought they would due to the Injured Vets from IRAQ & Afghanistan.

Care costs rise as veteran population declines

WASHINGTON — Increasing numbers of U.S. troops have left the military with damaged bodies and minds, an ever-larger pool of disabled veterans that will cost the country billions of dollars for decades to come — even as the total population of America’s veterans has begun to shrink.

Despite the decline in the total number of veterans — as soldiers from World War II and Korea die — the government expects to be spending $59 billion a year to compensate injured warriors in 25 years, up from today’s $29 billion, according to internal documents obtained by The Associated Press. And the Veterans Affairs Department concedes the bill could be much higher.

Why?

Worse wounds. More disabilities. More vets aware of the benefits and quicker to file for them.

Also, ironically, advanced medical care. Troops come home with devastating injuries that might well have killed them in earlier wars.

Time is also a factor when it comes to disability compensation costs. Payments tend to go up as veterans age, and an increasing number of soldiers from the Vietnam War will be getting bigger payments as they get older and are less able to work around their disabilities.

The number of disabled veterans has jumped by 25 percent since 2001 — to 2.9 million — and the cause really is no mystery.

“This is a cost of war,” says Steve Smithson, a deputy director at the American Legion. “We’re still producing veterans. We’ve been in a war in Iraq for five years now, and the war on terror since 9/11.”

VA and Census Bureau figures show the previous six-year period, before hostilities in Afghanistan and Iraq, saw a more modest increase of 4 percent in the number of disabled vets. Veterans can make claims for disability benefits long after their military service has ended.

Today’s veterans — disabled or not — number nearly 24 million. That population is projected by the VA to fall under 15 million by 2033, mostly because of dying World War II and Korean War vets. But costs are expected to rise.

Inflation accounts for a big chunk of the increase. But even when the VA factors out inflation, the compensation for disabled veterans would still grow from $29 billion to $33 billion in today’s dollars — a more than 10 percent increase. And the department acknowledges the estimate could rise by 30 percent.

VA officials were not eager to talk about reasons for the increases. They declined several requests for interviews. In a written response to a handful of questions, the agency noted a few factors at play in the rising costs, such as the aging veterans population, an increase in the number of disabilities claimed and the severity of injuries sustained.

Outside experts provided more insight.

The American Legion’s Smithson says the Iraq and Afghanistan wars are resulting in more severe injuries — amputations and traumatic burns — the kind of injuries that troops in Vietnam and earlier wars would not have survived.

Smithson says today’s veterans also are filing claims for more disabilities.

“People are more aware of the benefits they are able to file for (because of) better outreach,” Smithson said. “It’s not like the WWII generation and Korean war generation where they weren’t aware of what they could file for, and they were also reluctant to file if they didn’t think they needed it.”

Iraq veteran Christopher Bain filed for about 10 disabilities after his tour in 2004. Bain came under mortar fire outside Baghdad and was hit several times. He successfully fought doctors who wanted to amputate his left arm. But 10 operations later, he still needs help getting dressed each day. An electrical stimulator implanted in his upper buttocks helps dull the pain from his injuries.

“It’s hard, you go through certain periods of remorse,” said Bain. “I am never going to be the man I once was.”

Bain suffers from tinnitus, post-traumatic stress disorder and serious injuries to his arms. He receives a check each month for $2,618 that helps the former Army staff sergeant pay the mortgage, food and clothing costs for his family of five in Williamsport, Pennsylvania.

Bain is one of about 755,000 veterans of the Iraq and Afghanistan wars. Of that group, the VA says more than 181,000 are collecting disability benefits.

Another factor driving up costs and the overall number of disabled veterans is Vietnam. Veterans from that era make up the biggest group of vets today receiving disability compensation. At the end of 2006, more than 947,000 Vietnam vets were getting monthly checks.

“You see an awful lot of Vietnam veterans over the course of the years have gone from a 30 percent to 40 percent disability rating up to 100 percent when their employment years start to wane a little bit,” said David Gorman, a Vietnam War veteran who is executive director at the Washington headquarters of Disabled American Veterans.

Conditions, such as a bad back or knee, can worsen with age and draw higher payments. A big concern for Vietnam vets is diabetes. Last year, more than 271,000 veterans were receiving disability benefits for diabetes. Most of the disabilities — 236,000 of them — were linked to Agent Orange exposure.

Veterans who are approved for disability receive monthly checks for injuries or illnesses sustained or aggravated while on active duty. Ratings are scaled from 0 to 100 percent in 10 percent increments. A rating of 10 percent, for example, is given to tinnitus, or ringing in the ears, which is increasingly common for troops returning from Iraq and Afghanistan because of roadside bombings. Ratings for post-traumatic stress disorder and traumatic brain injury can range from 0-to-100 percent, and 10-to-100 percent, respectively.

Former Army Sgt. Michelle Saunders was rated at 70 percent by the VA after being shot at during a 2004 convoy mission in Iraq. The bullet was caught in her flak jacket, but she sustained painful injuries, including two ruptured disks in her lower back and nerve damage to her right leg.

“It’s turned me from a really alive, pretty happy person into somebody who is numb. I don’t know how to feel anymore,” she said.

Saunders gets a disability check each month from the VA for just under $800.

Annual benefits run from $1,404 for a veteran rated at 10 percent to about $30,324 for those at 100 percent. Severe disabilities, such as the loss of a limb, draw additional compensation.

Ring Ring…. Ring Ring….VA to call Iraq, Afghanistan veterans

WASHINGTON — Iraq and Afghanistan veterans: Get ready for a phone call.

The Department of Veterans Affairs said Thursday that on May 1, it will start calling 570,000 recent combat veterans to make sure they know what services are available to them.

The first calls will go to about 17,000 veterans who were sick or injured while serving in the wars. If they don’t have a care manager, the VA says they will be given one.

The next round of calls will target 555,000 veterans from the wars who have been discharged from active duty, but have not reached out to the VA for services. For five years after their discharge from the military, Iraq and Afghanistan veterans have access to health care at the VA.

The effort will cost about $2.7 million and will be handled by a government contractor.

The agency has faced complaints that a backlog in claims and bureaucratic hurdles have prevented some recent veterans from getting proper mental and physical care. Earlier this week, two Democratic senators accused the VA’s top mental health official of trying to cover up the number of veteran suicides and said he should resign.

Per The VA’s own letter.. Keith Olbermann Countdown.

This is just downright disgusting. It’s almost like the Vietnam era when our Vets then fell through the cracks.. This is just plain nuts.. Please contact your elected officials. We have friends and family who are in crisis and need help.

120 OIF/OEF Vets Committing Suicide a Week

This article is from the San Francisco Chronicle.  I am not sure I agree with all of it, but they are quoting emails that have been discovered from the VA.  Read below.. Post what you think in the forums.
D/C

VA stalling on care, judge told at S.F. trial

Bob Egelko, Chronicle Staff Writer

Tuesday, April 22, 2008

He said veterans are committing suicide at the rate of 18 a day - a number acknowledged by a VA official in a Dec. 15 e-mail - and the agency’s backlog of disability claims now exceeds 650,000, an increase of 200,000 since the Iraq war started in 2003.

Justice Department lawyer Richard Lepley countered that the VA runs a “world-class health care system.” He said the changes the plaintiffs seek in their lawsuit - better and faster mental health care, and more rights for veterans appealing denials of benefits - are beyond the judge’s authority.

“Of course we’re obliged to provide health care,” Lepley said, but “the court does not have standards to determine the speed or the scope or the level of that care.”

U.S. District Judge Samuel Conti is presiding over the nonjury trial, scheduled to last two weeks. Conti, a conservative jurist and World War II veteran appointed to the bench by former President Richard Nixon, ruled in January that the case could go to trial. In doing so, he rejected the government’s argument that civil courts have no authority over the VA’s medical decisions or how it handles grievances.

If the advocates can prove their claims, Conti said in his ruling, they would show that “thousands of veterans, if not more, are suffering grievous injuries as the result of their inability to procure desperately needed and obviously deserved health care.”

He also ruled that veterans are legally entitled to five years of government-provided health care after leaving the service, despite federal officials’ argument that they are required to provide only as much care as the VA’s budget allows in a given year.

But at a later hearing, Conti indicated he was uncertain about his authority to require spending on particular types of health care. The lawsuit plaintiffs - Veterans for Common Sense in Washington, D.C., which claims 11,500 members, and Veterans United for Truth, a Santa Barbara group with 500 members - want him to order the VA to provide immediate treatment for suicidal veterans and prompt care for those suffering from post-traumatic stress.

The trial follows publication of a Rand study last week that estimated 300,000 U.S. troops returning from Afghanistan and Iraq, or 18.5 percent of the total, suffer from major depression or post-traumatic stress.

The lawsuit is a proposed class action on behalf of 320,000 to 800,000 veterans or their survivors. The advocacy groups say the VA arbitrarily denies care and benefits to wounded veterans, forces them to wait months for treatment and years for benefits, and gives them little recourse when it rejects their medical claims.

“The time delays are staggering,” Erspamer, the plaintiffs’ lawyer, told Conti on Monday. Although the VA says it decides the typical claim for benefits in six months, he said, the agency takes far longer to review post-traumatic stress claims, and four years or more for the government to hear veterans’ appeals of denied treatment.

Veterans who seek benefits within the VA’s grievance system have no right to a lawyer and no right to demand records or question opposing witnesses, Erspamer said. The plaintiffs want Conti to grant those rights and to require the agency to set a timetable for deciding claims.

Lepley, the government’s lawyer, said the VA has undertaken a “huge staff increase” - 20 percent in mental health, 25 percent in claims processing - and now provides one mental health staff member around the clock at every VA center, as well as a suicide-prevention hot line.

For those who do not need immediate care, he said, the agency has a policy of scheduling a mental health appointment within two weeks, and has reached that goal at 80 percent of its facilities.

“These kinds of medical decisions are not something that this court can inject itself into,” Lepley said. He referred to the plaintiffs as “single-interest groups” and said the legal rights they seek in the VA benefit system, such as the involvement of lawyers, are “not in the patients’ interest.”

E-mail Bob Egelko at begelko@sfchronicle.com.

 

 

http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/04/22/MNQK109AA7.DTL