RAO Bulletin Update 1 September 2006
THIS BULLETIN UPDATE CONTAINS THE FOLLOWING ARTICLES:
== Agent Orange Lawsuits [04] -------------- (Offshore Eligibility)
== VA Presumptive AO Illnesses [Vets] ---- (AO Impact on Vets)
== VA Presumptive AO Illnesses [Kids] ---- (AO Impact on Kids)
== Alzheimer’s [01] --------------------------- (Early Treatment)
== TFL Claim Processing [02] ---------------- (Opt-out Providers)
== Recruiters ----------------------------- (Increase in Wrongdoing)
== Recruiters [01] ------------------------ (Sexual Misconduct)
== Social Security Name Change ------------ (New Rules)
== DFAS Contact Info [01] -------------------- (Keep Current)
== Computer Tip -------------------------------- (Email Print Size)
== American Amicable Refunds -------------- (70,000+ Vets Due)
== Expeditionary Warfare Pin [USN] ------- (Approved 31 JUL 06)
== Air Force Enlistment -------------------- (Recruits Still Needed)
== Service Members’ Rights Website ------ (New Website)
== Walter Reed Army Medical Center ------ (Closing in 2011)
== Medicare Part D [07] ----------------- (TFL Mistaken Enrollment)
== Medicare Part D [08] ----------------------- (Excluded Medicines)
== VA New York Hospitals: ---------------- (Will Remain Open)
== COLA 2007 [05] ---------------------------- (3.4% to Date)
== TMOP [05] ------------------------- (Prescription Savings)
== Captioned Telephone: ------------- (Hearing Impaired Vets)
== VA Claim Representation [03] ----------- (DAV Opposes S.2694)
== VA Data Privacy Breach [24] ------------- (Data to be Encrypted)
== FDA Assessment --------------------------- (Lower Enforcement)
== SBP Open Season [03] -------------------- (Last Chance)
== Tricare Allowable Charges: -------------- (New Executive Order)
== Disabled Retiree Back Pay [02]----------- (Some in OCT)
== Medicare Physical Therapy Payments --- (Limited in 2007)
== Health Care Quality and Price ------------ (Medical Data Sharing)
== USMC Involuntary Recall --------- (Individual Ready Reserve)
== AHLTA Update [01] ---------------------- (Problem for VA)
== Beer Belly Control ------------------------- (1-2 beers a day OK)
== PI Tricare Provider Certification --------- (How to)
== Military Legislation Status ---------------- (Where we stand)
AGENT ORANGE LAWSUITS UPDATE 04: Veterans who patrolled the waters
off Vietnam can now claim disability benefits for exposure to Agent
Orange under an appeals court ruling that opens the door for
thousands of servicemen to seek medical coverage. The ruling was
handed down by the U.S. Court of Appeals for Veterans Claims in the
case of Haas v. VADC-Nicholson by a former sailor who served on an
ammunition ship during the Vietnam War but never stepped foot on
land. The court’s order, issued 16 AUG, reverses the Veterans Affairs
Department’s denial of benefits for Jonathan L. Haas, who blamed his
diabetes, nerve damage and loss of eyesight on exposure to Agent
Orange. Haas, represented by the National Veterans Legal Services
(NVLS) argued that clouds of the toxic defoliate, which the U.S.
sprayed on Vietnamese jungles, drifted out to sea, englfing his ship
and landing on his skin. Veterans officials said that to qualify for
coverage, Haas was required to have docked in Vietnam and come
ashore.
The three-judge panel said regulations governing the benefits
were unclear. The court said it made no sense for veterans who
patrolled Vietnam’s inland waterways and those simply passing through
the country to receive medical coverage while those serving at sea do
not. “Veterans serving on vessels in close proximity to land would
have the same risk of exposure to the herbicide Agent Orange as
veterans serving on adjacent land, or an even greater risk than that
borne by those veterans who may have visited and set foot on the land
of the Republic of Vietnam only briefly,” Judge William A. Moorman
wrote. The Court did not actually award a disability to Haas, but
sent his case back to the Board for that determination. If the Board
rules in his favor, the Court directed that his other Agent
Orange-related medical conditions also must be compensated. The
Veterans Affairs Department said Friday that it was reviewing the
opinion and was not sure how many veterans would be affected or how
much the added coverage would cost.
This VCAA decision could eventually expand to cover more
veterans than the decision appears to now cover. During Vietnam
was a short time frame where military service within the Theater of
Operations within the Vietnam War justified the Vietnam Service
Medal. This included waters off the coast {so called brown water},
deep waters for air operations {so called blue water operations},
Thailand based Operations for USAF and other types of operations
which included loading the Agent Orange aircraft. Most Vietnam
combat veterans receive some medical benefits, but if their illnesses
are related to their service, they could receive full coverage and
their families might be eligible for benefits. David Houppert,
director of veteran’s benefits for the Vietnam Veterans of America,
said the ruling could allow thousands of veterans to seek coverage
for service-related illnesses. Most are Navy veterans, he said, but
some Marines and Army veterans could be affected. Houppert said his
group was encouraging these veterans to seek coverage quickly because
the ruling left it up to government officials whether to change
federal regulations in a way that could deny coverage. Vets can
refer to www.vba.va.gov/bln/21/benefits/herbicide/#bm04 to review
what benefits they could be eligible for.
As of 20 AUG the VADC-legal office had not filed a request for a
stay order pending an appeal to the Supreme Court. The Board of
Veterans' Appeals is sitting at the Phoenix VARO. The senior judge
has agreed to contact his office in Washington DC to get current
guidance on implementation of this decision. The VCAA ruling over
turned a BVA decision on Haas. If the VADC-Sec Nicholson's office
does not appeal they have no choice but to grant service connected
for Agent Orange Presumptive Disabilities with military service with
in the theater of Vietnam war for those with the Vietnam Service
Medal. This decision will mean a potential liability of millions of
dollars to the VA Medical budget and VA Administrative budget.
Potential claims from the wives of already deceased Vietnam veterans
could also mean considerable liability. This helps explain why the
VADC has been slow to provide positive guidance about this VCAA
decision. Haas is now the law of the land and therefore VA must
abide by it. However, it is possible that VA may amend their
regulations in such a way that it is adverse to veterans who
otherwise would have benefited from the court’s decision. Service
organizations are recommending that other veterans like Mr. Haas who
served offshore but did not set foot in Vietnam, and who suffer from
diseases or conditions that they believe to be caused by exposure to
Agent Orange should consider filing a claim for disability. Members
who have had such claims denied may wish to re-file based on the
Court's decision. Veterans are encouraged to seek the advice and
assistance of an experienced veterans' service organization before
proceeding. [Source: Associated Press article 18 Aug & Arizona
Department of Veterans' Services msg 23 Aug 06 ++]
VA PRESUMPTIVE AO ILLNESSES [VETS]: The following health conditions
are presumptively recognized for service connection. Vietnam vets
with any of these conditions do not have to show that the illness is
related to their military service to get disability compensation. A
current medical diagnosis of the condition and a DD Form 214 showing
Vietnam Service is normally all that is needed to accompany a
completed Veterans Application For Compensation or Pension VA Form
Number 21-526.
1. Chloracne (must occur within 1 year of exposure to Agent Orange).
Chloracne is a skin condition that looks like common forms of acne
seen in teenagers. The first sign may be excessive oiliness of the
skin. This is accompanied or followed by numerous blackheads. In mild
cases, the blackheads may be limited to the areas around the eyes
extending to the temples. In more severe cases, blackheads may appear
in many places, especially over the cheekbone and other facial areas,
behind the ears, and along the arms.
2. Non-Hodgkin’s lymphoma. A group of malignant tumors (cancers) that
affect the lymph glands and other lymphatic tissue. These tumors are
relatively rare compared to other types of cancer, and although
survival rates have improved during the past two decades, these
diseases tend to be fatal.
3. Hodgkin’s disease. A malignant lymphoma characterized by
progressive enlargement of the lymph nodes, liver, and spleen, and by
progressive anemia.
4. Kaposi's sarcoma or mesothelioma
5. Soft tissue sarcoma other than osteosarcoma and chondrosarcoma. A
group of different types of malignant tumors (cancers) that arise
from body tissues such as muscle, fat, blood and lymph vessels, and
connective tissues (not in hard tissue such as bone or cartilage).
These cancers are in the soft tissue that occurs within and between
organs. The following conditions fall under the term "soft-tissue
sarcoma):
a. Adult fibrosarcoma
b. Dermatofibrosacoma protuberans
c. Malignant fibrous histicytoma
d. Liposarcoma
e. Leiomyosarcoma
f. Malignant granular cell tumor
g. Alveolar soft part sarcoma
h. Rhabdomysarcoma
i. Ectomesenchymoma
j. Malignant glomus tumor
k. Malignant hemangiopericytoma
l. Malignant Schwannoma
m. Malignant mesenchymoma
n. Epithelioid sarcoma
o. Extraskeletal Ewing's sarcoma
p. Congenital and infantile fibrosarcoma
q. Malignant ganglioneuroma
r. Epitheloid Leiomysarcoma (malignant meiomyblastoma)
s. Angiosarcoma (hemangiosarcoma and lymphagiosarcoma)
t. Proliferating (systemic) angioendotheliomatosis
u. Clear cell sarcoma of tendons and aponeuroses
v. Synovial sarcoma (malignant synovioma)
w. Malignant giant cell tumor of tendon sheath
6. Porphyria cutanea tarda (must occur within 1 year of exposure.)
Porphyria cutanea tarda is a
disorder characterized by liver dysfunction and by thinning and
blistering of the skin in sun-exposed areas.
7. Multiple myeloma. A cancer of specific bone marrow cells that is
characterized by bone marrow
tumors in various bones of the body.
8. Respiratory cancers, including cancers of the lung, larynx,
trachea, and bronchus. (Previously
these conditions must have manifested within 30 years of the
veteran's departure from Vietnam to qualify but this 30 year time
limit has now been eliminated.
9. Prostate cancer. A cancer of the prostate and one of the most
common cancers among men.
10. Peripheral neuropathy (transient acute or subacute. It must
appear within 1 year of exposure and
resolve within 2-years of date of onset.) A nervous system condition
that causes numbness, tingling, and muscle weakness. This condition
affects only the peripheral nervous system, that is, only the nervous
system outside the brain and spinal cord. Only the transient acute
(short-term) and subacute forms of this condition (not the chronic
persistent form) have been associated with herbicide exposure.
11. Diabetes mellitus: Often referred to as Type 2 diabetes: A
condition characterized by high blood
sugar levels resulting from the body’s inability to respond properly
to the hormone insulin.
12. Chronic lymphocytic leukemia (Final rule and regulations
pending). A disease that progresses
slowly with increasing production of and older) who live in areas
where it’s offered.
VA health care providers occasionally see combat veterans with
multiple unexplained symptoms or difficult-to-diagnose illnesses that
can cause significant disability. Two VA centers offer specialized
evaluations for combat veterans with disabilities related to these
difficult-to-diagnose illnesses. The War Related Illness and Injury
Study Centers - WRIISCs (pronounced “risks”) are at the VA Medical
Centers in Washington, DC, and East Orange, NJ. Veterans who were
deployed to combat zones, served in areas where hostilities occurred,
or were exposed to environmental hazards while on duty may be eligible
for services. [Source: NAUS Weekly Update for 22 AUG 03 & POVA VSO msg
28 JUL 04]
VA PRESUMPTIVE AO CONDITIONS [KIDS]: The following health conditions
are presumptively recognized in children of veterans for service
connection. Vietnam veteran’s children with any of these conditions
do not have to show that their illness is related to their parent’s
military service to get disability compensation. A current medical
diagnosis of the condition and a DD Form 214 showing the parent’s
Vietnam Service is normally all that is needed to accompany a
completed Veterans Application For Compensation or Pension VA Form
Number 21-526.
• Spina bifida (except spina bifida occulta): A neural tube birth
defect that results from the failure of the bony portion of the spine
to close properly in the developing fetus during early pregnancy.
• Other (than spinal bifida) disabilities in the children of women
Vietnam veterans. Covered birth defects” means any birth defect
identified by VA as a birth defect associated with the service of
women Vietnam veterans in Vietnam from 28 FEB 61 to 7 MAY 75, and
that has resulted, or may result, in permanent physical or mental
disability. However, the term does not include a condition due to a
familial (this is, inherited) disorder; birth-related injury; or
fetal or neonatal infirmity with other well-established causes.
Covered birth defects include, but are not limited to, the following
conditions:
1) achondroplasia,
2) cleft lip and cleft palate,
3) congenital heart disease,
4) congenital talipes equinovarus (clubfoot),
5) esophageal and intestinal atresia,
6) Hallerman-Streiff syndrome,
7) hip dysplasia,
8) Hirschprung’s disease (congenital megacolon),
9) hydrocephalus due to aqueductal stenosis,
10) hypospadias,
11) imperforate anus,
12) neural tube defects,
13) Poland syndrome,
14) pyloric stenosis,
15) syndactyly (fused digits),
16) tracheoesophageal fistula,
17) undescended testicle, and
18) Williams syndrome.
** Not covered are conditions that are congenital malignant
neoplasms, chromosomal disorders, or developmental disorders. In
addition, conditions that do not result in permanent physical or
mental disability are not covered birth defects. All birth defects
that are not excluded under the language above are covered birth
defects. (Source: Extracted from Agent Orange Review, Vol. 19, No 2,
Dated July 2003)
ALZHEIMER’S UPDATE 01: If treatment to prevent Alzheimer's disease
is going to work, it may have to begin in middle age — or even
younger, new research by Seattle scientists suggests. The researchers
found that in people genetically prone to Alzheimer's, significant
amounts of a brain-clogging protein start moving from the spinal
fluid to the brain at about age 50 or younger. Previous research has
indicated that Alzheimer's begins years before symptoms appear. But
this latest work by Dr. Elaine Peskind, associate director of the
University of Washington Alzheimer's Disease Research Center at the
VA Puget Sound Health Care System in Seattle and her colleagues is
the first to look at early signs across a wide range of ages — from
21 to 88. The research is particularly significant because scientists
predict a dramatic increase in Alzheimer's in the decades ahead. About
4.5 million people in the United States have the disease, and
researchers say that could increase to 16 million by 2050.
Peskind and scientists from five other medical centers analyzed
the effects of aging and the presence of a gene connected to
Alzheimer's, APOE4, on 184 adult volunteers with an average age of 50
and all mentally normal. People with the APOE4 gene have a higher
Alzheimer's risk because it produces a sticky protein, called beta
amyloid, in the form of a plaque that is thought to damage brain
cells. Among the volunteers with the gene, the level of one
important form of the protein in the spinal fluid was dramatically
lower in participants 50 and older than in the younger ones. The
decline in levels possibly begins in young adulthood in those with
the gene, the scientists report in the July edition of the Archives
of Neurology. Among the volunteers without the gene, the protein
levels dropped slowly into old age. About a quarter of the population
has the APOE4 gene, though there are other physical factors that also
influence whether a person develops the disease.
Peskind said more research is needed to confirm the study's
findings. As part of that effort, the scientists will follow about
half of the participants, those older than 60, to see which ones
develop Alzheimer's and to analyze more spinal-fluid samples. She
predicts that spinal-fluid tests someday could help identify who will
develop Alzheimer's. Because there is no cure or vaccine for
Alzheimer's, such tests would be unwise now, because they could
affect whether someone could obtain health insurance or
long-term-care insurance, she said. The four prescription drugs now
available for Alzheimer's merely ease the symptoms for a few years.
Other drugs are under investigation, including two at the UW. One is
to remove the plaque. The other is to prevent its production. But
Peskind predicts it will be many years before a major drug will be
available to prevent or control the disease but believes that within
10 years, it will definitely be possible. [Source: Seattle Times
medical reporter Warren King 11 JUL 06]
TFL CLAIM PROCESSING UPDATE 02: TRICARE For Life (TFL) beneficiaries
are strongly encouraged to find out what type of Medicare provider
they have prior to making an appointment with their health care
professional. If you don't, you may wind up paying more than you
think. Medicare currently has three types of providers:
- Opt-out providers: Opt-out providers have chosen to not see
Medicare patients and cannot submit claims to the Medicare program.
They are considered nonauthorized and nonparticipating. If you use a
nonauthorized provider, you will be responsible for the full bill,
including the portion TRICARE would have paid.
- Participating providers: Participating providers are
Medicare-authorized providers who agree to accept the
Medicare-allowable charge as payment in full, and who agree to file
claims.
- Nonparticipating providers: A nonparticipating provider does not
agree to accept the allowable charge as payment in full, and may or
may not file claims.
Beginning 5 JUN 06, a small number of TFL beneficiaries who were
treated by providers who "opted-out" saw their claims denied by both
Medicare and Tricare. This was incorrect. The TFL claims processor
will automatically reprocess those claims that were improperly
denied. No action by the beneficiary is necessary. Tricare will
continue to pay claims at the Tricare Standard rate for any
Medicare-eligible beneficiary who is treated by a provider who has
opted-out of Medicare only until 30 SEP 06. After that date, a TFL or
Dual Eligible beneficiary who seeks care from a provider who has opted
out of Medicare will be responsible for the entire bill.
About 93% of all doctors accept Medicare patients (and therefore
also accept Tricare for Life). Although your present providers might
be participating at the moment, come 1 JAN 07 many could decide to
opt out of Medicare because of the scheduled 5.1% reduction in fees
to be paid by Medicare after that date. When Medicare fees are cut,
TFL payments are also reduced thus making it less desirable for
providers to see a military retiree/spouse/surviving spouse. An AMA
survey of providers in early 2006 indicated that if the payment cuts
kick in, 45% of physicians plan to either stop accepting or decrease
the number of new Medicare patients and 43% will either stop
accepting or decrease the number of new Tricare patients. This
government action and the recently implemented Tricare third tier
pharmaceutical copay upgrades is making the lifetime medical care
benefit of retirees much more restrictive and costly to users. To
find out what type of health care provider you have, call Medicare
toll-free at 1(800) 633-4227. The November elections will give
veterans an opportunity to show Congressional incumbents what they
think of their actions that have allowed this erosion of our health
care benefit. [Source: MOAA News Exchange 16 Aug 06 ++]
RECRUITERS: As the military struggled to attract new troops to fill
its billets, instances of wrongdoing by recruiters skyrocketed
between fiscal 2004 and fiscal 2005, Government Accountability Office
(GAO) investigators concluded in a report released 14 AUG. Ongoing
operations in Iraq and Afghanistan, coupled with low U.S.
unemployment rates, have made lining up new enlistments a challenging
duty, compelling some recruiters to employ illegal or unethical
tactics to meet their quotas. Cases of wrongdoing vary widely,
ranging from paperwork errors to serious allegations, such as sexual
harassment, falsifying documents and concealing serious medical
conditions. In May, for instance, The Oregonian reported that the
Army had accepted an autistic recruit and signed him up to become a
cavalry scout. The recruit has since been discharged. The GAO
reported last year, allegations of wrongdoing among the military's
22,000 recruiters grew by 50% over fiscal 2004 claims, while
substantiated cases increased by more than 50%. Criminal violations,
meanwhile, jumped by more than 100%,
The actual number of cases of wrongdoing may be even higher
than the number provided by GAO, whose investigators concluded that
many of the services do not have an effective way to track complaints
and allegations. They contend DoD is not in a sound position to assure
the general public that it knows the full extent to which recruiter
irregularities are occurring. Its investigation follows two other
reports in 1997 and 1998 that recommended the military improve
performance among recruiters and reduce the number of violations by
rewarding recruiters for every enlistee's successful completion of
basic training rather than the number of enlistment contracts written
for applicants they attracted.
Rep. Fortney Stark (D-CA) said in a statement 14 AUG that, “DoD
has twice ignored GAO recommendations on how best to account for and
limit recruiters' violations. This third inquiry confirms the two
prior reports' findings and demands immediate action." Stark, who
requested the report with House Armed Services Personnel Subcommittee
ranking member Vic Snyder (D-AR) urged the military to take overdue
steps to enforce the Uniformed Code of Military Justice and called on
the House Armed Services Committee to increase oversight on the
matter. In 2005, the Army, Army Reserve and Navy Reserve failed to
meet recruiting goals, however DoD reported last week that all
services met or exceeded their recruiting targets for JUL 06.
[Source: GOVEXEC.com Daily Briefing 14 Aug 06 ++]
RECRUITER MISCONDUCT UPDATE 01: More than 100 young women who
expressed interest in joining the military in the past year were
preyed upon sexually by their recruiters. Women were raped on
recruiting office couches, assaulted in government cars and groped en
route to entrance exams. A six-month Associated Press investigation
found that more than 80 military recruiters were disciplined last
year for sexual misconduct with potential enlistees. The cases
occurred across all branches of the military and in all regions of
the country. At least 35 Army recruiters, 18 Marine Corps
recruiters, 18 Navy recruiters and 12 Air Force recruiters were
disciplined for sexual misconduct or other inappropriate behavior
with potential enlistees in 2005, according to records obtained by
the AP under dozens of Freedom of Information Act requests. That’s
significantly more than the handful of cases disclosed in the past
decade. The AP also found:
• The Army, which accounts for almost half of the military, has had
722 recruiters accused of rape and sexual misconduct since 1996.
• Across all services, one out of 200 frontline recruiters - the ones
who deal directly with young people - was disciplined for sexual
misconduct last year.
• Some cases of improper behavior involved romantic relationships,
and sometimes those relationships were initiated by the women.
• Most recruiters found guilty of sexual misconduct are disciplined
administratively, facing a reduction in rank or forfeiture of pay;
military and civilian prosecutions are rare.
• The increase in sexual misconduct incidents is consistent with
overall recruiter wrongdoing, which has increased from just over 400
cases in 2004 to 630 cases in 2005, according to a General Accounting
Office report released this week.
The Pentagon has committed more than $1.5 billion to recruiting
efforts this year. Defense Department spokeswoman Lt. Col. Ellen
Krenke insisted that each of the services takes the issue of sexual
misconduct by recruiters very seriously and has processes in place to
identify and deal with those members who act inappropriately. In the
Army 53 of 8000 recruiters were charged with misconduct last year.
Recruiting spokesman S. Douglas Smith said the Army has put much
energy into training its staff to avoid these problems.
For this story, the AP interviewed victims in their homes and
perpetrators in jail, read police and court accounts of assaults and
in one case portions of a victim’s journal. A pattern emerged. The
sexual misconduct almost always takes place in recruiting stations,
recruiters apartments or government vehicles. The victims are
typically between 16 and 18 years old, and they usually are thinking
about enlisting. They usually meet the recruiters at their high
schools, but sometimes at malls or recruiting offices. Not all of the
victims are young women. A former Former Navy recruiter is serving a
12-year sentence for molesting three male recruits. One of the
victims is suing him and the Navy for $1.25 million. The trial is
scheduled for next spring. All of the recruiters the AP spoke with
said they were routinely alone in their offices and cars with girls.
Although the Uniform Code of Military Justice bars recruiters
from having sex with potential recruits, it also states that age 16
is the legal age of consent. This means that if a recruiter is caught
having sex with a 16-year-old, and he can prove it was consensual, he
will likely only face an administrative reprimand. But not under new
rules set by the Indiana Army National Guard. There, a much stricter