Tuesday, September 30, 2014

VA Updates Disability Claims Application Process for Veterans, Survivors

SOURCE:  U.S. Department of Veterans Affairs, press release, Sep. 24, 2014



September 24, 2014

VA Updates Disability Claims Application
Process for Veterans, Survivors
New Process Will Reduce Processing Times and Improve Quality

WASHINGTON – The Department of Veterans Affairs (VA) today announced that it is introducing a uniformed disability claims form to better serve Veterans, families and survivors. Standardizing the process by which Veterans file claims and initiate appeals will make it easier for Veterans and their survivors to clearly state what benefits they are seeking from VA and provide information that is necessary to process their claims and appeals. The new forms eliminate applicant guesswork, which often leads to delays in decisions and ultimately delays in receiving benefits. The new regulations go into effect in late March 2015.
“We must do everything that we can to make it as fast and easy as possible for Veterans and their survivors to file for and receive an accurate decision on their claim,” said VA Secretary Robert McDonald. “Our Veterans and survivors will know, at the outset of the claims process, what is needed, which removes subjective interpretation from the process. We want to eliminate any barriers that make it difficult for our Veterans or survivors to receive benefits to which they are entitled.”
In the past, a Veteran or survivor did not have to use a certain form to seek compensation or other benefits from VA.  Claims or appeals (Notice of Disagreement) could be submitted on any piece of paper which caused delays due to missing information.  
By using standard forms for all disability claims, VA can more quickly and accurately identify what the Veteran is claiming or appealing. This will allow VA to immediately move on to next steps in the evidence-gathering and decision-making process, which saves administrative processing time and speeds the delivery of earned benefits.  The existing process is also inconsistent with most, if not all, other government and non-government application processes, such as applying for social security, applying for a driver’s license, applying for a job or filing for an income tax refund. 
“These days, government agencies and private businesses rely on standard forms to deliver faster and more accurate customer service,” said Under Secretary for Benefits Allison A. Hickey.  “VA’s ability to deliver better customer service requires the use of standard forms as well. That is why we worked extensively with our partners in the Veterans community to streamline the way we process claims while  preserving the effective date rules concerning informal claims through the creation of a new intent to file a claim process.”
The updated process also includes standardizing the traditional informal claims process by employing a new “Intent to File a Claim” process which affords the Veteran or survivor one year to compile the necessary documentation or evidence to support the claim while preserving an effective date of claim.
More information about VA Forms 21-526EZ, 21-527EZ, 21-534EZ or VA Form 21-0958, Notice of Disagreement, may be found at www.ebenefits.va.gov or www.va.gov/vaforms/.


Saturday, September 27, 2014

Gulf War Advisory Committee Letter Expresses Grave Concerns to New VA Secretary

The letter below was shared with 91outcomes.  Included with the letter were these comments:  
"I ask you to please post on 91outcomes this letter RAC members sent to Secretary McDonald after the RAC meeting this week.  VA staff now controls what is posted to the RAC website, so this may never see the light of day otherwise.  The new Secretary should be cleaning house with the staff, not the committee.   So much for promises to fix VA's lack of integrity.  -- Joel Graves, Gulf War veteran member of the Research Advisory Committee, being replaced."

SOURCE:  Research Advisory Committee on Gulf War Veterans' Illnesses (RAC), September 23, 2014

Research Advisory Committee on Gulf War Veterans’ Illnesses

September 23, 2014

The Honorable Robert A. McDonald
Secretary of Veterans Affairs
United States Department of Veterans Affairs
Washington, DC

Dear Mr. Secretary,

We greatly appreciate your meeting with us yesterday and asking our views. We look forward to working with you to advance research to improve the health of Gulf War veterans.

Yesterday’s meeting showed the need for this advisory committee to provide you the full story on Gulf War veterans’ health. Despite twelve years of work, the committee just yesterday, through its independent review process, noted:

1. VBA staff said that VA recognizes that chronic multisymptom illness and undiagnosed illnesses are presumed to be service-connected for Gulf War veterans. But their data show that eighty percent of these claims are denied.

2. OPH staff reported on a new review of diagnoses received by Gulf War veterans who use VA facilities, which appears to show their health problems are no different from veterans of the same period who did not deploy, but the review does not include 75,000 Gulf War veterans who served after March 1, 1991, the most toxic period, when oil well fires burned and the demolition of the Khamisiyah nerve agent depot occurred, and does not state that VA doctors were not trained to consider the illness a serious physical illness. The non-deployed also include veterans who were deployed later in other operations in the same theater and have received many of the same exposures.

3. OPH staff reported on a new survey of Gulf War veterans that shows higher rates of stress and depression than previous surveys, without mentioning that the survey was overweighted with questions on mental health and that people suffering from chronic health problems often become depressed due to their illness after 23 years, but it is not the cause  of their illness.

4. The VA press release issued after the meeting stated that “nearly 800,000 Gulf War era Veterans are currently receiving compensation benefits for service-connected issues”, without clarifying that for benefits purposes, the “Gulf War era” extends from 1990 to the present, taking in all recent Iraq and Afghanistan veterans. 

This underscores the need for a continued independent ongoing review process. We recommend that, for the new members you plan to appoint to the committee, you choose scientists and veterans who are independent of VA staff and who understand that Gulf War illness is not a mental illness, that you continue to provide for the committee to have its own independent staff, and that you continue to welcome the committee’s comments on all aspects of VA’s Gulf War research program.


James Binns, chairman
James A. Bunker
Fiona Crawford, PhD
Beatrice Golomb, MD, PhD
Nancy Klimas, MD
James O’Callaghan, PhD
Lea Steele, PhD

Roberta White, PhD

VA to Evaluate Gulf War Biorepository's Continued Funding

According to a Federal Register notice, a special panel of the U.S. Department of Veterans Affairs (VA) is set to meet on November 4, 2014 to consider whether to continue funding for the Gulf War Biorepository.

The project has been fraught with challenges. Initially, the project was announced at a public meeting of the Research Advisory Committee on Gulf War Veterans' Illness (RACGWVI, or RAC) as a biorepository for Gulf War samples, but upon implementation was an ALS brain bank.  Eventually, this new project was announced, focused on Gulf War veterans, but only as a pilot project.

A portion of the November 4th meeting is open to the public, though VA will not allow any oral public comment.

For more information on this biorepository, see:  http://www.research.va.gov/programs/tissue_banking/gwvib/

Special thanks to Gulf War veteran and longstanding advocate Kirt Love for locating and sharing this Federal Register notice, which is posted in its entirety below.


SOURCE:  Federal Register, Sep. 29, 2014


[Federal Register Volume 79, Number 188 (Monday, September 29, 2014)]
[Pages 58431-58432]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-23160]


Biomedical Laboratory Research and Development Service, Special Emphasis Panel-Gulf War Veterans' Illnesses Biorepository, Notice of Meeting

The Department of Veterans Affairs (VA) gives notice under the Federal Advisory Committee Act, 5 U.S.C. App., that the Special Emphasis Panel—Gulf War Veterans' Illnesses Biorepository will meet on November 4, 2014, from 9:00 a.m. until 3:30 p.m. at the AAAE Conference Center, 601 Madison Street, Suite 400, Alexandria, VA. The panel meeting will be open to the public for approximately one-half hour at the start of the meeting to discuss the general status of the project. The remaining portion of the meeting will be closed to the public for the review, discussion, and evaluation of the research project to be performed for VA. The closed portion of the meeting involves discussion, examination, reference to staff and consultant critiques of the research proposal. As provided by subsection 10(d) of 92, as amended, closing portions of a panel meeting is in accordance with 5 U.S.C. 552b(c)(6) and (9)(B).
The purpose of this Special Emphasis Panel is to review the Veterans Affairs Gulf War Veterans' Illnesses Biorepository for its continued funding. The Gulf War Veterans' Illnesses Biorepository is a project of high programmatic importance to VA. The Special Emphasis Panel will review activities related to the Gulf War Veterans' Illnesses Biorepository including the significance of the biorepository, along with some other key areas such as innovation, environment, feasibility, and protection of human subjects.
No time will be allocated at this meeting for receiving oral presentations from the public. Those who plan to attend or would like to obtain a copy of minutes of the panel meeting and roster of the participants of the panel should contact Dr. Victor Kalasinsky, Designated Federal Officer, Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC, or by email at victor.kalasinsky@va.gov. Any member of the public wishing to attend the meeting or seeking additional information should contact Dr. Kalasinsky at (202) 443-5682.

Dated: September 24, 2014.
Rebecca Schiller,
Committee Management Officer.
[FR Doc. 2014-23160 Filed 9-26-14; 8:45 am]


SOURCE:  Federal Register

Thursday, September 25, 2014

NIH and VA address pain and related conditions in U.S. military personnel, veterans, and their families: Research will focus on nondrug approaches

The following is an NCCAM (NIH) press release regarding joint NIH-VA research on pain using psychological and other non-drug interventions.


SOURCE: Press Release, National Center for Complementary and Alternative Medicine (NCCAM), National Institutes of Health, September, 25, 2014



NIH and VA address pain and related conditions in U.S. military personnel, veterans, and their families: Research will focus on nondrug approaches 

NIH News
National Institutes of Health
National Center for Complementary and Alternative Medicine (NCCAM)
Thursday, September, 25, 2014

Thirteen research projects totaling approximately $21.7 million over 5 years will explore nondrug approaches to managing pain and related health conditions such as post-traumatic stress disorder (PTSD), drug abuse, and sleep issues. The effort seeks to enhance options for the management of pain and associated problems in U.S. military personnel, veterans, and their families.

The National Institutes of Health's National Center for Complementary and Alternative Medicine (NCCAM) and National Institute on Drug Abuse (NIDA) and the U.S. Department of Veterans Affairs (VA) Health Services Research and Development Division provided funding for this initiative. The research projects are located at academic institutions and VA medical centers across the United States.

“Pain is the most common reason Americans turn to complementary and integrative health practices,” said Josephine P. Briggs, M.D., Director of NCCAM. “The need for nondrug treatment options is a significant and urgent public health imperative. We believe this research will provide much-needed information that will help our military and their family members, and ultimately anyone suffering from chronic pain and related conditions.”

A 2011 Institute of Medicine (IOM) report states that nearly 100 million American adults suffer from chronic pain at a cost of $635 billion per year and notes a need for a cultural transformation to change this problem. Chronic pain disproportionately affects those who have served or are serving in the military. [An August] 2014 report in JAMA Internal Medicine showed an alarmingly high rate of chronic pain—44 percent—among members of the U.S. military after combat deployment, compared to 26 percent in the general public.

“Unless the 'cultural transformation' called for by the IOM begins in earnest, our nation faces additional crises in the future. Many service members and veterans with pain also have comorbid conditions such as posttraumatic stress syndrome or traumatic brain injury,” a commentary in the journal said. “Many of them are at risk for a lifetime progression of increasing disability unless the quality, variety, and accessibility of evidenced-based 'self-management' skills are improved. Without more effective and less costly approaches to pain management, the estimated costs of care and disability to the country will approach $5 trillion.”

One co-author of the commentary is Eric B. Schoomaker, M.D., Ph.D., a retired U.S. Army lieutenant general who is a scholar-in-residence and Distinguished Professor of Military and Emergency Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Maryland, and is a member of NCCAM's Advisory Council. The other is Wayne B. Jonas, M.D., a retired U.S. Army lieutenant colonel who is president of the Samueli Institute, a nonprofit organization in Alexandria, Virginia, with a mission that includes applying academic rigor to research on healing, well-being, and resilience; and translating evidence into action for the U.S. military and large-scale health systems.

Pain is not the only issue. According to the JAMA Internal Medicine report, 15 percent of U.S. military post-deployment use opioids, compared to 4 percent of the general public. Drugs such as opioids that are available to manage chronic pain are not consistently effective, have disabling side effects, may exacerbate pain conditions in some patients, and are often misused. According to NIDA, an estimated 52 million people (20 percent of those aged 12 and older) have used prescription drugs for nonmedical reasons at least once in their lifetimes.

“Prescription opioids are important tools for managing pain, but their greater availability and increased prescribing may contribute to their growing misuse,” said Nora D. Volkow, M.D., Director of NIDA. “This body of research will add to the growing arsenal of pain management options to give relief while minimizing the potential for abuse, especially for those bravely serving our nation in the armed forces.”

The thirteen new studies under this initiative are:

       Jeffrey Borckardt, Ph.D., Medical University of South Carolina, Charleston. The project will evaluate the efficacy of combining transcranial direct current stimulation (constant low current delivered to specific brain areas via small electrodes placed on the scalp) with cognitive behavioral therapy (a type of psychotherapy that helps patients understand thoughts and feelings that influence behaviors) for the treatment of pain, opioid use, and related health issues. (NIDA-funded).

       Helen Burgess, Ph.D., Rush University Medical Center, Chicago. The pilot study will use and test the feasibility of a morning bright light treatment to reduce and help manage chronic low-back pain and improve post-traumatic stress disorder (PTSD) symptoms, mood, and sleep in veterans. (NCCAM-funded).

       Eric Elbogen, Ph.D., University of North Carolina, Chapel Hill. Dr. Elbogen has a joint appointment at the Durham VA Medical Center. This project will test the feasibility, acceptability, utilization, and effectiveness of using mobile devices that display real-time brain activity that veterans with PTSD and traumatic brain injury can use to induce relaxation and reduce pain symptoms. (NCCAM-funded).

       Christine Goertz, D.C., Ph.D., Palmer College of Chiropractic, Davenport, Iowa. The project will develop an innovative and collaborative treatment model between chiropractors, primary care providers, and mental health providers for veterans with spine pain and related mental health conditions. (NCCAM-funded).

       Mark Jensen, Ph.D., University of Washington, Seattle. The project will compare the efficacy of self-hypnosis and mindfulness meditation to education for reducing pain and improving quality of life in veterans. The project will also test biological, psychological, and social factors such as brain activity, expectation, and physician-patient relationships that could explain the impact of the effects of the interventions. (NCCAM-funded).

       Robert Kerns, Ph.D., Yale University, West Haven, Connecticut. Dr. Kerns has a joint appointment at the VA Connecticut Healthcare System. This study will use novel approaches to gather data from electronic health records to examine the assessment and treatment of veterans with chronic pain, particularly in regard to use of complementary/integrative health approaches. The methods developed will facilitate assessment of an approach to pain management called a stepped care model, which starts with lower intensity, less costly, and less invasive treatments and, if needed, steps up to more intensive or complex treatments. (VA- and NCCAM-funded).

       Mary Jo Larson, Ph.D., Brandeis University, Waltham, Massachusetts. The project will expand data collection and conduct additional analyses of data from the Substance Use and Psychological Injury Combat Study (SUPIC). This can determine the prevalence of post deployment chronic pain for active duty and reserve component Army members, how complementary/nonpharmacologic health approaches are used to manage chronic pain, and outcomes associated with use of complementary/nonpharmacologic approaches. (NCCAM-funded).

       Donald McGeary, Ph.D., University of Texas Health Science Center, San Antonio. This project will evaluate the effectiveness of an integrated program to improve physical function/reduce disability and decrease rates of chronic opioid use of combat-injured veterans with multiple traumatic injuries. The approach integrates relaxation, biofeedback, guided exercise, imagery, mindfulness meditation, cognitive-behavioral therapies, and weekly team meetings with physical therapy and medical care. (NCCAM-funded).

       Shari Miller, Ph.D., Research Triangle Institute, Research Triangle Park, North Carolina. The pilot project will test the acceptability and practicality of an interactive mindfulness meditation training program—using Web-based platforms and mobile apps—with active duty soldiers being treated for chronic pain. (NCCAM-funded).

       Melissa Polusny, Ph.D., University of Minnesota, Minneapolis. Dr. Polusny has a joint appointment at the Minneapolis VA Health Care System. The study will use medical health records and survey data to develop a model for understanding chronic pain outcomes, use of complementary health approaches and other nonpharmacologic approaches, and use of opioids for chronic pain as well as gain a deeper understanding of veterans' preferences and attitudes towards pain management. (NCCAM-funded).

       Barbara Rakel, Ph.D., University of Iowa, Iowa City. The pilot project's aim is to reduce post-surgical pain and opioid use among veterans at risk due to pre-operative stress. The study will test feasibility and explore outcomes of an innovative delivery format of Acceptance and Commitment Therapy (ACT), a type of psychotherapy that is based on acceptance and awareness of difficult emotions, as an addition to usual care. (NCCAM-funded).

       Stephanie Taylor, Ph.D., Sepulveda Research Corporation, North Hills, California. Dr. Taylor has a joint appointment at the VA Greater Los Angeles Healthcare System. This research will study the extent and cost-effectiveness of complementary and alternative medicine use among veterans being treated at the VA for musculoskeletal disorder-related pain and related conditions. (VA-funded).

       Kevin Vowles, Ph.D., University of New Mexico, Albuquerque. The aim of this study is to determine the feasibility of integrating two psychotherapeutic interventions: ACT for chronic pain; and Mindfulness Based Relapse Prevention. The mindfulness training teaches patients how to become aware of emotional or physical states that might provoke a relapse for substance use and misuse. (NCCAM-funded).

This work is supported by the following grants: DA038971, AT008347, AT008399, AT008427, AT008336, AT008448, AT008404, AT008422, AT008423, AT008387, AT008349, HX001704, AT008398.

Related Topics

       Complementary Health Practices for U.S. Military, Veterans, and Families

       Director's Message: Exploring Nondrug Approaches to Managing Pain and Related Conditions in the Military

       Research Blog: New Studies Address Pain and Related Problems in Military Personnel

       Infographic: Fighting Pain in the U.S. Military, Veterans, and Their Families

VA Research has been contributing to improvements in the lives of veterans and all Americans since 1925. The program, part of the nationwide VA health care system, is unique because of its focus on health issues that affect U.S. veterans. To learn more about VA Research, visit www.research.va.gov.

The National Center for Complementary and Alternative Medicine’s mission is to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care. For additional information, call NCCAM’s Clearinghouse toll free at 1-888-644-6226, or visit the NCCAM Web site at nccam.nih.gov. Follow us on Twitter, Facebook, and YouTube.

NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to inform policy and improve practice. Fact sheets on the health effects of drugs of abuse and information on NIDA research and other activities can be found on the NIDA home page at www.drugabuse.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.