VA chief touts proposal to make it easier to fire executives (Military.com)
Veterans Affairs Secretary Bob McDonald on Wednesday discussed a budget proposal designed to make it easier to discipline senior executive service employees for wrongdoing. The proposal is included in the department’s $182 billion budget for fiscal 2017, which begins Oct. 1, among other policy and benefits changes intended in part to streamline agency operations. The bid to place medical center directors and other SES-level employees under Title 38 — the same job category as doctors and nurses — was spurred by recent administrative judges’ decisions vacating VA disciplinary actions against two senior executives. “It seemed to us that [the Merit System Protection Board] judges didn’t understand the intent of Congress” in giving the department greater power to discipline employees,” McDonald told lawmakers. A Title 38 employee demoted or fired for cause by the VA secretary would not be able to appeal to the board. “[This] gives us more flexibility to pay them more competitively,” McDonald said, “but it also gives us more flexibility in disciplinary matters without all the things that happened with the SES employees.” McDonald met on Tuesday night to discuss the planned bill with House Veterans Affairs Committee Chairman Rep. Jeff Miller, a Republican from Florida, and ranking member Rep. Corrine Brown, a Democrat from Florida, as well as the chair and ranking member of the Senate veterans committee, Sens. Johnny Isakson, a Republican from Georgia, and Richard Blumenthal, a Democrat from Connecticut. A legislative provision based on the VA proposal will immediately be incorporated into current and ongoing negotiations between the two committees as part of package of veterans’ legislation, a source familiar with the action told Military.com. VA is also asking Congress for legislation to end a longstanding appeals process that allows veterans to continue pushing claims for years after they have been denied, McDonald said. In one case, he said, the Board of Appeals has been working on a case continuously appealed for 25 years. Under the current law, a veteran may appeal any number of times if not satisfied with a VA ruling. The proposed legislation would end — with very limited exceptions — the requirement that the department continue to accept new evidence in an appeal once an initial decision is issued. It would also transfer continued appeals to the Board of Veterans Appeals and eliminate optional board hearings before veterans’ law judges. “Without the change,” McDonald said, “pending appeals will soar to 2.2 million by 2027.”
Panel to VA: Stop studying causes of Gulf War illnesses, focus on treatment (Military Times)
A scientific panel has concluded that the Veterans Affairs Department should stop searching for links between environmental exposures in the 1991 Persian Gulf War and veterans’ illnesses and instead focus on monitoring and treating those who have health problems related to deploying 25 years ago. In a report released Thursday, Institute of Medicine researchers said Gulf War veterans are at increased risk for developing some physical and psychological health conditions like post-traumatic stress, anxiety, Gulf War illness and chronic fatigue syndrome, but other diseases like cancer, respiratory illnesses and most neurodegenerative conditions do not appear to occur at higher rates in these former troops. Without concrete information on each Gulf War veteran’s exposure and the unlikely prospect of ever having the data, VA should focus instead on following this group as members age and treat illnesses that develop, panelists said. According to the report, the federal government has spent more than $500 million since 1994 to study Gulf War veterans’ health but “there has been little substantial progress in our overall understanding of the health effects” from the 1990-1991 deployments. Thus, “without definitive and verifiable individual veteran exposure information, further studies to determine cause-and-effect relationships between Gulf War exposures and health conditions in Gulf War veterans should not be undertaken,” wrote the panel of researchers, including experts in environmental health, epidemiology and medicine. Future research, they added, should focus on personalized care for veterans, follow-up assessments and treatment. The panel’s top recommendation also said VA should thoroughly study the “mind-body” connection of disease. “Any future studies of Gulf War illness should recognize the connections and complex relationships between brain and physical functioning and should not exclude any aspect of the illness with regard to improving its diagnosis and treatment,” panelists noted. The new report has outraged advocates for veterans who suffer from illnesses stemming from their service in the 1990-1991 operation. They argue the report reflects a bias among the panel toward VA and panelists were selective in choosing which studies they reviewed for the study, “Gulf War and Health, Volume 10: Update of Health Effects of Serving in the Gulf War, 2016.” … “The science is unequivocal, if viewed honestly and in its totality: Toxic exposures were responsible,” said Dr. Beatrice Golomb, a professor of medicine at the University of California-San Diego and former scientific director for the VA’s Research Advisory Committee on Gulf War Illness. “But the IOM doesn’t look at all relevant studies. This ‘don’t look, don’t find’ practice has been a consistent problem in IOM Gulf War reports.” The report examined studies on myriad diseases and their prevalence in Gulf War veterans as well as those who did not deploy. The panel then categorized these illnesses on a spectrum ranging from the strongest link — “sufficient evidence of a causal relationship” — to “inadequate or insufficient evidence to determine an association.” Post-traumatic stress disorder was the only condition the panel found to be caused by Gulf War deployment. The group also found sufficient evidence of an association for generalized anxiety disorder, depression, substance abuse, gastrointestinal symptoms, chronic fatigue syndrome and Gulf War illness, a catch-all term used to describe undiagnosed symptoms in Gulf War veterans. According to the report, there also is “limited but suggestive” evidence that amyotrophic lateral sclerosis, or ALS, fibromalygia and chronic pain and self-reported sexual dysfunction are related to Gulf War deployment. But it found little or no evidence that cancer, skin conditions, birth defects, musculoskeletal system diseases, multiple sclerosis and other illnesses were related. … About a quarter of the war’s 700,000 veterans developed symptoms after deployment that include chronic headaches, widespread pain, memory loss, persistent fatigue, gastrointestinal problems, skin conditions and mood disturbances. Researchers have determined that environmental factors, such as chemical exposures in the region, including sarin gas, pesticides and anti-nerve-agent pills, may have played a role in development of diseases among some troops. Anthony Hardie, a Gulf War veteran and director of Veterans for Common Sense, said the new report refutes earlier studies and is insulting to those who served as well as widows of those who have died from diseases like brain cancer and ALS. “It’s the same old government theme from the 1990s to deny what happened and deny care and benefits — just when research to understand the illness and identify treatments is finally making real progress,” Hardie said.
5 percent boost to VA spending in 2017 might not be enough (Federal News Radio)
The Veterans Affairs Department could see a 5 percent bump in funding for fiscal 2017, if Congress gives the department everything it’s asked for in the President’s new budget proposal. The request totals $78.7 billion in discretionary funding, including $7.2 billion in discretionary funding for veterans’ care in the community programs under the Veterans Access, Choice and Accountability Act. But spending on the Choice Program is unsustainable, VA executives said, and funding for the program will likely dry up by the end of 2017. … The Choice Program helps veterans look for care outside the VA when certain conditions are met. Congress created it in 2014, when it learned that some VA clinics cooked the books to hide delays in patient care. The VA will continue to spend more on the Choice program because more veterans are tapping into the department’s health care options. The average veteran uses VA services for about 34 percent of his care, VA Secretary Bob McDonald told the committee. If that estimate rises just one percentage point, the VA will have to spend nearly $1.5 billion more. … The budget also includes more than 40 new legislative proposals that could give the VA secretary more flexibility to shift funding to areas of emerging need and address some of these challenges. Among the proposals are a complete overhaul of the department’s appeals process and its community care program, compensation reforms for VA medical professionals and congressional authority to terminate leases on 18 under-utilized properties. The President’s budget proposal includes an ambitious request for more funding in nearly every facet of VA operations. The VA would receive $65 billion for medical care in 2017, a 6.3 percent increase in funding over enacted 2016 levels. Medical care programs would receive $66.4 billion in advance appropriations in 2018. Its homelessness programs could receive $1.6 billion. More than $7 billion could go to VA mental health initiatives. The department is also asking for $4.2 billion in IT spending, which VA Chief Information Officer LaVerne Council said will support its broader modernization goals. … The size of the department’s workforce could increase by nearly 4.8 percent next year, according to the President’s budget request. Many of those positions would come from the $2.6 million the department is requesting to improve its customer service and MyVA initiatives. But applications for available positions within the VA are down nearly 75 percent, McDonald told the committee. He said the department has difficulty recruiting new talent — particularly skilled doctors, nurses and health care specialists — in light of recent public personnel scandals. … Ultimately, the committee didn’t reach any concrete decisions on the VA’s fiscal future.
Legislation to help veterans with PTSD passes House (The Logan Daily News)
The Veterans Dog Training Therapy Act, sponsored by Congressman Steve Stivers (R – OH) and Congressman Tim Walz (D – MN), passed the House of Representatives Tuesday as part of a larger veterans health services bill. This legislation would establish a therapeutic dog training and handling pilot program for veterans struggling with Post-traumatic Stress Disorder (PTSD). … The pilot program would be established at three to five V.A. facilities, as selected by the V.A. Secretary. These facilities would connect veterans to local therapeutic dog training organizations, which would be responsible for the dogs’ housing and care. Veterans would learn useful occupational skills while training the dogs, and after training, each dog would be provided to a disabled veteran – thereby enabling veterans to help other veterans. Once the program is started, it would be studied and considered for expansion to additional facilities. This is nearly identical to the service dog training program conducted by the non-profit organization Warrior Canine Connection at several Department of Defense medical facilities and one V.A. Hospital location. Many veterans who have participated in the Warrior Canine Connection have seen significant improvements in both PTSD and Traumatic Brain Injury symptoms. Additionally, preliminary research from Kaiser Permanente has shown that veterans who have these service dogs show fewer symptoms of PTSD and depression, have better interpersonal relationships, a lowered risk of substance abuse and better overall mental health. The Veterans Dog Training Therapy Act, originally introduced on January 15, 2015, was included as part of H.R. 3016, the Veterans Employment, Education and Healthcare Improvement Act.
VA secretary grilled over Colorado Springs clinic’s woes (The Gazette)
Department of Veterans Affairs Secretary Bob McDonald was grilled about problems at the Colorado Springs VA clinic during a House budget hearing Wednesday. The VA leader worked to blunt calls for discipline for workers at the Fillmore Street facility in the wake of last week’s report that found the clinic wasn’t delivering timely care and had falsified appointment days. “Firing does not lead to excellence in an organization,” McDonald said during an exchange with U.S. Rep. Mike Coffman over discipline in Colorado Springs. During the hearing, VA officials revealed that the supervisor responsible for the scheduling flap was reassigned within the clinic, but kept their VA job. “I am not aware that there was a specific disciplinary action for that individual,” McDonald said. The secretary downplayed the inspector general report, which revealed that 68 percent of veterans sampled waited more than a month for care and that employees falsified appointment dates. To make it seem like veterans were more quickly seen, 28 veterans were shown to have same-day appointments when they actually waited an average of 76 days. McDonald attributed the trouble in Colorado Springs to poorly trained workers. “The IG report does not call out anyone for malfeasance,” McDonald said. “What it does is indicate is, No. 1, we didn’t train the people properly.” Coffman, R-Aurora, and Colorado Springs Republican U.S. Rep. Doug Lamborn said the report uncovered a culture of corruption that persists at the Colorado Springs clinic. During the hearing, Coffman claimed the VA scheduling woes can be tied to an employee bonus scheme that gave workers cash for improving the clinic’s wait times. He told McDonald that VA needs to be more aggressive in disciplining workers, including firing those responsible for the trouble. McDonald said VA has removed 2,600 workers under his tenure, and dismissed arguments over past misconduct within the agency by saying he was “looking to the future.” Coffman said the agency still needs to address the root causes of past trouble. “I think firing incompetent people would be a good start,” Coffman told the secretary.
VA struggles to fill medical center positions (Cronkite News)
Veterans Affairs Secretary Robert McDonald told lawmakers Wednesday that his agency is having trouble filling vacancies at VA medical centers around the country, which has led to “critical staffing problems” at the facilities. McDonald said applications to the VA are down as much as 75 percent since problems uncovered at the Phoenix VA two years sparked probes that revealed systemic problems at the agency nationwide, leading to the resignation of a secretary. It also comes as the health care industry as a whole faces shortages of medical personnel and struggles to fill openings. … VA reports showed that 12.1 percent of jobs at agency medical centers nationwide were unfilled in late January. The numbers were even higher in Arizona, where an average of 14.9 percent of the jobs at the three medical centers in the state were vacant. When employment at Veteran Health Administration offices was included, those vacancy rates jumped to 12.9 percent and 16 percent, respectively. The VA emphasized that vacancy numbers are fluid, changing every month. But, as of Jan. 22, Phoenix had the 15th-highest job vacancy rate of the 130 VA medical centers in the country, at 19 percent. McDonald told the House Veterans Affairs Committee that he has personally visited dozens of colleges to recruit medical students, but that the people he talked to had the perception that the agency was intent on firing its employees. The VA also struggles to recruit medical personnel away from the private sector to come to the agency where they are likely to have a lower salary and be posted to a less desirable, rural locations. … In a separate interview Wednesday, Sen. John McCain, R-Arizona, conceded that there has been “upheaval” in the VA, especially in Phoenix. But he said Congress has also given the agency the tools to get out from under its problems, pointing to 2014 legislation that allowed for rapid hiring by the VA. … The VA hired 41,000 new employees last year, but that represented a net increase of only about 14,000 staff, or 4.7 percent of the Veterans Health Administration payroll, according to McDonald’s prepared statement for the committee. The department said in an emailed statement last week that the VA has about a 9 percent turnover rate – which it said is better than an 18 percent turnover rate in the private sector. VA officials said the current staffing shortage mirrors national trends in health care, where a study by the Association of American Medical Colleges predicted that the shortage of physicians could range from 46,000 to 90,000 in the next 10 years. Lawmakers on Wednesday also urged the VA to focus on recruiting mental health care providers, with which both McDonald and VA Under Secretary for Health David Shulkin agreed.
Expensive Hepatitis C drug helping Arkansas veterans (THV11)
A recent CBS News investigation uncovered alarming statistics on how thousands of veterans aren’t getting access to what’s being called a “miracle drug” in the treatment of hepatitis C. The drug claims to cure up to 99 percent of hepatitis C patients, but the retail price for a 12-week treatment rings up at $84,000. Gilead, the company that owns and sets the price on the drug, has since drawn the attention of lawmakers in Washington. “Using Gilead’s own documents,” said U.S. Senator Ron Wyden, “the evidence shows that the company pursued a calculated scheme for pricing and marketing its hepatitis C drug based on one goal… maximizing revenue regardless of the human consequences.” According to a 2013 trade journal, the cost of making the drugs comes to less than two percent of its retail price. While the VA gets a 50 percent discount, it still pays $42,000 per treatment. That same treatment costs $900 in some developing countries. But in spite of the extremely high cost of the drugs, the Central Arkansas Veterans Healthcare System says it has had an amazingly high success rate in treating veterans with hepatitis C, and as more veterans get screened and seek help, they hope those numbers will continue to improve. “Hepatitis C affects a large proportion of veterans,” said Dr. Casey Barnett, a Clinical Pharmacy Specialist for the Central Arkansas Veterans Healthcare System. “Certainly the cost of the medication, it’s been a hot topic, but the VA has done everything possible to expand treatment… It’s no question that the therapy is expensive, however, the VA offers treatment solely on the basis of clinical benefit without consideration of cost.” Barnett said the VA’s goal is to treat every veteran with hepatitis C, and that it has the capability to treat many more here in central Arkansas right away. “We’ve expanded the treatment team to involve several members who are treating hepatitis C. We have availability in clinics and we’re ready to evaluate veterans and patients,” added Barnett. “Taking them through to the end where their virus is eradicated and watching the burden lifted off of their shoulders. It’s a really powerful thing, and something I’m very proud to be a part of.” Barnett said there are about 180,000 veterans in the U.S. who are known to have hepatitis C, and many more who have the virus and don’t even know it. She encourages veterans, especially Vietnam-era veterans, to get screened.
How video games are helping American veterans (CNBC)
When Army veteran Stephen Machuga returned to the U.S. about a decade ago after deployment in Iraq, he didn’t like trash day. In Iraq, insurgents embedded explosives in refuse. “You just got used to looking for wires coming out of piles of trash,” he recalled. Back in the U.S., Machuga’s mind would start twitching on Tuesdays, when large bags and bins dotted his Pittsburgh neighborhood. This is what civilian life can sometimes be like for a returning veteran. You try to engineer a new normal. But your brain can’t stop imagining dangerous scenarios about your surroundings. And you miss your military buddies. … His mind itching, Machuga eventually found mental relief in a lifelong hobby — playing video games. … Last November, Machuga used his personal experience and founded Stack-Up.org, a Pittsburgh-based nonprofit that supports veterans through a shared loved of gaming. And last month, Oculus VR founder Palmer Luckey revealed on Twitter he was joining Stack-Up’s advisory board. Machuga, an occasional gaming blogger — had met Luckey years ago, when he was developing prototype VR goggles. Some veterans can face serious mental health issues on their return including post-traumatic stress disorder. Gaming isn’t meant to be an easy fix for veterans, but it can encourage members of the military — regardless of rank — to enjoy camaraderie through a shared hobby, which helps them relax their minds. Video games allow “friendly competition and coordination between people who generally might not talk with one another,” Machuga said. When you’re deployed, you can be patrolling or doing dangerous tasks like transporting fuel and other supplies for several hours. But then there’s the other 18 hours in a day in which you’re pretty much eating, sleeping, lifting weights and waiting for the next assignment. Any way to decompress and pass time is welcome. And unlike movies, gaming requires interactivity and a higher level of engagement. “Gaming offers a unique opportunity to relieve the stresses, tensions, and social challenges of being separated from your friends and family while on deployment,” said Dean Hall, a game developer and military veteran. Hall created DayZ, a survival game in which players scavenge for food, water and weapons. Originally from New Zealand, Hall served in New Zealand’s army and air force. He has also joined Stack-Up’s advisory board. … Beyond video games, some groups are using 360 VR to help veterans. n 2015, the Veterans United Foundation announced an immersive, VR collaboration called “Honor Everywhere 360.” The foundation is the philanthropic division of Veterans United Home Loans. Veterans unable to travel were given VR goggles to watch the film, and be virtually transported to veteran memorials in Washington, D.C. The video was produced with partners including Jaunt Studios and Google. The U.S. loses around 500 World War II veterans each day, and many die before getting the chance to travel to Washington to see the WWII Memorial. “Technology has given our veterans a real chance to see their memorials while confined to their homes, hospital rooms or even beds,” said Steve Paulsell, flight director of Central Missouri Honor Flight. His group helps transport veterans to Washington. Looking ahead, VR could potentially be used to help deployed men and women connect virtually with families back home.