April 27 Veterans News

April 27 Veterans News

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A possible link between gut bacteria and PTSD (Neuroscience News)
Dr. John Bienenstock and Dr. Paul Forsythe–who work in The Brain-Body Institute at McMaster University in Ontario, Canada, are investigating intestinal bacteria and their effect on the human brain and mood. “This is extremely important work for U.S. warfighters because it suggests that gut microbes play a strong role in the body’s response to stressful situations, as well as in who might be susceptible to conditions like PTSD,” said Dr. Linda Chrisey, a program officer in ONR’s Warfighter Performance Department, which sponsors the research. The trillions of microbes in the intestinal tract, collectively known as the gut microbiome, profoundly impact human biology; digesting food, regulating the immune system and even transmitting signals to the brain that alter mood and behavior. ONR is supporting research that’s anticipated to increase warfighters’ mental and physical resilience in situations involving dietary changes, sleep loss or disrupted circadian rhythms from shifting time zones or living in submarines. Through research on laboratory mice, Bienenstock and Forsythe have shown that gut bacteria seriously affect mood and demeanor. They also were able to control the moods of anxious mice by feeding them healthy microbes from fecal material collected from calm mice. Bienenstock and Forsythe used a “social defeat” scenario in which smaller mice were exposed to larger, more aggressive ones for a couple of minutes daily for 10 consecutive days. The smaller mice showed signs of heightened anxiety and stress–nervous shaking, diminished appetite and less social interaction with other mice. The researchers then collected fecal samples from the stressed mice and compared them to those from calm mice. “What we found was an imbalance in the gut microbiota of the stressed mice,” said Forsythe. “There was less diversity in the types of bacteria present. The gut and bowels are a very complex ecology. The less diversity, the greater disruption to the body.” Bienenstock and Forsythe then fed the stressed mice the same probiotics (live bacteria) found in the calm mice and examined the new fecal samples. Through magnetic resonance spectroscopy (MRS), a non-invasive analytical technique using powerful MRI technology, they also studied changes in brain chemistry. “Not only did the behavior of the mice improve dramatically with the probiotic treatment,” said Bienenstock, “but it continued to get better for several weeks afterward. Also, the MRS technology enabled us to see certain chemical biomarkers in the brain when the mice were stressed and when they were taking the probiotics.” Both researchers said stress biomarkers could potentially indicate if someone is suffering from PTSD or risks developing it, allowing for treatment or prevention with probiotics and antibiotics. Later this year, Bienenstock and Forsythe will perform experiments involving fecal transplants from calm mice to stressed mice. They also hope to secure funding to conduct clinical trials to administer probiotics to human volunteers and use MRS to monitor brain reactions to different stress levels. Gut microbiology is part of ONR’s program in warfighter performance. ONR also is looking at the use of synthetic biology to enhance the gut microbiome. Synthetic biology creates or re-engineers microbes or other organisms to perform specific tasks like improving health and physical performance. The field was identified as a top ONR priority because of its potential far-ranging impact on warfighter performance and fleet capabilities.

Vietnam vets push VA to link bladder cancer to Agent Orange (ProPublica)
Alan Eller has spent more than a decade trying to convince the Department of Veterans Affairs that his bladder cancer was the result of exposure to Agent Orange almost 50 years ago in Vietnam. The Army vet has filed three claims with the agency, most recently in 2014, since a doctor told him the cancer was likely tied to the toxic herbicide. Each time, even as he found additional doctors to vouch for the link between his cancer and his service, the VA rejected Eller’s claim, arguing there was no proof. But a report last month by a prominent committee of scientists said there’s now research suggesting otherwise. As a result, the VA is studying whether it should reverse its position and add the condition to the list of illnesses it presumes to be linked to Agent Orange, which the U.S. sprayed across Vietnam during the war. The VA has no legal obligation to do this and has previously declined to cover other conditions despite research supporting a connection. But if it does this time, the shift could mean thousands of dollars a year for some vets, and even more for those like Eller, who filed claims years ago. In such cases, the agency is required to pay disability benefits retroactively, dating back to the day a veteran first applied. Eller, a retired welder from Indiana, could receive up to 13 years of back payments. Depending on how severe the VA rated his disability, that lump sum could reach six figures. … The VA began its review last month, following the release of findings by the Institute of Medicine, part of the National Academies of Sciences, Engineering and Medicine. A panel of VA scientists and health experts is studying the report to recommend whether the government should begin providing disability benefits to thousands more veterans exposed to Agent Orange who suffer from bladder cancer, under-active thyroid, Parkinson’s-like symptoms or high blood pressure. Those ailments aren’t currently on the VA’s Agent Orange presumptive list, but the Institute of Medicine found evidence of a link for each of them. A final decision could come by late summer, VA officials said. … The new evidence linking Agent Orange to bladder cancer demonstrates how much work remains to understand its effects on vets, said Kenneth Ramos, chairman of the Institute of Medicine committee and an associate vice president at University of Arizona Health Sciences. For years, the committee had concluded the evidence suggested no connection to bladder cancer. But Ramos and his colleagues changed their stance after reviewing a 2014 study that found Korean veterans who were exposed to Agent Orange while serving in Vietnam were twice as likely to die of bladder cancer as vets who weren’t exposed. … It’s not clear how many Vietnam veterans have suffered from bladder cancer, which is the fourth-most common cancer among men in the U.S. In a recent one-year period, the VA said it provided medical care to nearly 5,500 Vietnam vets with the disease, though that isn’t a complete accounting since many vets received medical care outside the VA. It also doesn’t count those who were treated successfully in earlier years and have no further signs of the cancer. To receive disability payments from the VA for conditions not on its Agent Orange list, a Vietnam veteran must produce evidence, such as a doctor’s opinion, proving that the illness was as likely as not connected to his service. As of last month, only 44 vets had persuaded the VA to compensate them for bladder cancer related to their Agent Orange exposure, sometimes after years of appeals. Many more have been denied. … Even with the new research, there’s no guarantee the VA will begin compensating vets for bladder cancer or any other condition newly linked to Agent Orange. Since 2007, the Institute of Medicine has flagged evidence that Agent Orange exposure could cause or worsen hypertension, better known as high blood pressure, which affects a third of adults in the U.S. But the VA has repeatedly declined to add the condition, saying that the research isn’t strong enough. The agency also has declined to act on research suggesting that Agent Orange exposure could lead to increased risk of stroke. … Still, adding new conditions to the Agent Orange presumptive list wouldn’t be unprecedented. In 2010, prompted by the Institute of Medicine, the VA added three: Parkinson’s disease, ischemic heart disease and a certain type of leukemia.

More Information on Agent Orange Including IOM Reports

Among Vietnam vets, a rare few score Agent Orange benefits for bladder cancer (The Virginian-Pilot)
It’s rare, but sick Vietnam War veterans occasionally wring disability benefits from the government even if their illnesses aren’t among those recognized by the Department of Veterans Affairs as being caused by Agent Orange. In 2013, Yale Law School professor Michael Wishnie led a group of law students who persuaded a veterans appeals board in Philadelphia to grant disability benefits to Daniel Dewey. The 72-year-old Vietnam War veteran had spent a decade fighting to get the VA to pay for his bladder cancer, which researchers have said might be caused by Agent Orange but isn’t on the list of illnesses the agency automatically covers. The key, Wishnie said, was finding doctors willing to cite studies linking Agent Orange to the cancer, and then helping those doctors translate their conclusions into terms recognized by the VA. Dewey got a boost from a Yale legal scholar and a renowned bladder cancer expert who personally examined him and wrote in support of his appeal. “What I did is tough for most guys to do,” said Dewey, a former Marine who endured seven surgeries before doctors finally determined his bladder needed to be removed. “I got one of the finest experts in the world, and it was still a long, hard battle.” Reporters for ProPublica and The Virginian-Pilot examined every case over the past eight years in which a Vietnam veteran appealed to the VA after being denied compensation for bladder cancer. Of the 157 appeals reviewed, only 12 vets were awarded compensation. The vast majority were denied outright by the Board of Veterans’ Appeals. About 50 cases were sent back to a VA regional office because the agency had failed to perform a required medical examination before denying the claim. “Most people lose, but a few people can win,” Wishnie said. “If you have enough lawyers, doctors and evidence – and if the veteran is driven and determined to fight.” Veterans must convince the VA that Agent Orange “as likely as not” caused an illness, as opposed to genetics or some other environmental factor. Scientific studies on their own, detached from the veteran’s specific diagnosis and health history, do not count for much during a VA benefits review. It’s not always clear why some Agent Orange claims are accepted and others denied. Like Dewey, some veterans have won appeals by presenting several supportive doctor opinions. Others have succeeded by arguing their illness was caused by a combination of Agent Orange and diesel fuel exposure during their service. A veteran in Oakland, Calif., won despite the fact he’d been smoking more than a pack of cigarettes a day for 40 years (smoking is the top cause of bladder cancer). Yet numerous veterans who have used similar approaches have had their appeals denied. The fact that so many vets have to appeal in the first place is part of the problem, said Matthew Hill, a veterans lawyer in Florida. At least some Agent Orange benefits should be awarded when veterans first file claims, he said, especially if they present supportive medical opinions. “It is extremely frustrating,” Hill said. “I’ve never won a case like that at the regional office. They reject it every time.”

Learn More about Agent Orange Presumptive Diseases

Commentary: More must be done to help female vets (The Gazette)
Christina Dieters: Daughter, mother, wife, these are just some of the titles women have, but to women veterans these titles not only look, but can feel different when they transition back into civilian lives. There are approximately 214,098 women serving in the military, and a total of 1,853,690 women veterans as of 2013. Female veterans experience challenges as a result of their military service, including readjustment issues, post-traumatic stress disorder, military sexual trauma, trouble sleeping and physical injury. Females when coming home have a 9 percent chance of unemployment, they have more child care responsibilities, and they often have a hard time fitting into the social norms. A large issue is that the civilian population is failing to understand the increase of females in the military and female veterans. There have been several instances of female veterans being ridiculed when they park in a veterans only or wounded warrior parking spot. The ridicule that these female soldiers and veterans are experiencing affects their depression, PTSD, and adds doubt about the service they provided for their country. … In 2010, the Department of Veterans Affairs, Mental Health Services, and Suicide Prevention Program published a report providing data, and according to 21 states, 22 veterans commit suicide every day. A Veterans Affairs study showed that female veterans’ suicide rates were a third of male veterans. Female veterans have an increased risk of suicide compared the U.S. female population – actually higher than when the male veterans were compared to the U.S. male population. Why is there an increase in female veteran suicides? This is the issue. There is not enough research among women veterans to know exactly why the increase. The thoughts among the veteran community are that women suffer from gender-specific issues, such as sexual trauma from rape, or sexual harassment during their military service. There is an estimated 10 percent of active duty women who are raped during their time in service. Other causes could be post-traumatic stress disorder that can be caused from combat and multiple deployments. What can be done to help these female veterans? There have been some improvements from Capitol Hill, but without specific tools to help female veterans, the VA cannot do everything that is needed. The Female Veteran Suicide Prevention Act will require the VA to collect data and best practices for treating female veterans, in hopes to find the best, and most effective mental health and prevention programs for female veterans. The hope is that the VA can find the right fit for female veterans, get them into the right programs that work for them, and get them the help they need in time. What can you do to help? Reach out to your congressmen, do letter writing campaigns, if you know a veteran who needs assistance please help them reach out. The Veterans Crisis Line can be reached online or by calling 800-273-8255.

Study: Majority of California vets who need mental health care receive inadequate or no treatment (Sierra Sun Times)
Seventy-six percent of California veterans in need of mental health care from 2011 to 2013 either didn’t receive treatment or received inadequate care, according to a new study by the UCLA Center for Health Policy Research. But the share of veterans who needed mental health care was no greater than that of the general population, despite common perceptions that veterans are more likely than others to need care. Using data from the California Health Interview Survey for 2011 to 2013, researchers found that 90,000 California veterans who had served in the military for at least a year, or 3.5 percent of the state’s veterans, needed mental health care. For nonveterans in California, the figure is 3.9 percent. Linda Diem Tran, lead author of the policy brief, said the CHIS survey covers a broader swath of the veteran population than studies that draw their data from the U.S. Department of Veterans Affairs. Only about 40 percent of veterans are enrolled in VA programs, and VA data on mental health tends to include more severe cases. “Much of the data that exists is not representative of the total population of veterans,” Tran said. “Our study is one of the few to make estimates based on all the veterans in California, and it finds that the stereotype that veterans have more mental health needs than everyone else may not be true.” However, the UCLA study did find that veterans are more likely to contemplate suicide than nonveterans. The research found that 9.1 percent of California veterans had seriously considered suicide, compared to 5.6 percent of nonveterans. (Veterans are also disproportionately likely to kill themselves; a previous study by the VA reported that more than 20 percent of suicides in the U.S. from 2009 to 2012 were veterans.) Thoughts of suicide and the need for mental health assistance are measured differently in the study’s methodology. Among those veterans with mental health needs, 68.8 percent reported visiting a health professional for their mental or emotional health. Among nonveterans who needed mental health care, 50.1 percent went without treatment. But the study found that nearly 46 percent of all veterans with mental health needs did not receive adequate care, which the study authors defined as four or more visits with a health professional and use of prescription medication for mental health within the previous year. California’s 2 million veterans made up an average of 7.2 percent of the state’s population between 2011 and 2013. … The study recommends increasing California veterans’ access to mental health services and identifying strategies to help veterans sustain their treatment. Other suggestions include standardizing mental health screenings by integrating them with physical health services, which would take advantage of the fact that 88 percent of veterans see a primary care doctor; reducing the stigma associated with mental health by educating veterans and their families about mental health; supporting long-term suicide prevention efforts; and continuously evaluating veterans’ mental health status throughout their lives, not just when emergencies arise. Because of the small number of women veterans, women were not included in the study. The authors note that their mental health needs will need to be examined and addressed in future studies.

Colorado veterans speak out against VA health care system (WesternSlopeNow)
The National American Legion Office held a town hall meeting, Tuesday evening, in Palisade to give local veterans a chance to speak out. This is part of the National American Legion Office’s review of the VA health care system– one the Grand Junction VA Medical Center says is “worth saving.” More than a hundred veterans were in attendance, along with the Grand Junction VA Medical Center’s director Marc Magill and representatives from Senator Michael Bennet and Scott Tipton’s office. “They [Grand Junction VA Medical Center] have treated me for 25 years and I would not be here tonight. If it had not been for the compassionate, professional care I received,” veteran, Bruce Jones said. While some in attendance praised the VA health care system, others were up in arms. “There was a veteran, just last month in New Jersey, that couldn’t get care at his local VA so he went outside, doused himself in gasoline and lit himself on fire. He died. Is that reallt a system worth saving,” veteran, Chris Kornkven asked. Speaking out in frustration, Kornkven says since his knee replacement surgery at the Grand Junction VA Medical Center he has had to deal with longer than usual appointment wait times and issues with reimbursement for his private insurance. “I’ve been fighting for quite a few months in order to get my insurance company reimbursed from charges that the VA had erroneously billed them,” Kornkven said. From waking up during surgery only to see doctors pounding into his leg to being discharged without a nurse, nor wheelchair, in sight, Kornkven adds that the quality of care he’s has received from the VA is unacceptable. “They refuse to provide a physical therapy machine because they would have to pay an outside contractor for it.. but then they paid $142 million in bonuses to their employees in 2014,” Kornkven adds. But Kornkven wasn’t the only one frustrated, several others voiced their concerns over the Veteran’s Choice Program and having to wait, sometimes up to six months, to receive an appointment. “Everywhere is going to have it’s problem but their is always stuff that comes down form the politicians that messes everything up. They just don’t understand our problems,” veteran, Rick Avery said. In response to many of the veteran’s concerns, including appointment wait times being over 30 days, as well as the Choice program, Magill says he is aware of their frustration but that it is beyond his “local control.” “There are problems with it.. yes. One of the reasons we are here tonight is to try to resolve that,’ the American Legion’s, Ralph Bozella said. Bozella says a report with the information from Tuesday night’s meeting, will be submitted to American Legion members, Congress and Senior VA officials in Washington D.C, including the president. On Wednesday, The National American Legion will tour the Grand Junction VA Medical Center to further review the facility’s administrative and clinical procedures.

VA replaces director of Cincinnati medical center (bizjournals.com)
The Cincinnati VA Medical Center is getting a new chief executive less than a year after the top spot was last filled. John Gennaro, who became executive director of Cincinnati’s seventh-largest hospital in July, has been reassigned to lead the Erie VA Medical Center in Pennsylvania. He got his start with the VA system in 1997 as a budget analyst in the research program at the Cincinnati medical center. Replacing him in Cincinnati will be Glenn Costie, who is now director of the VA Medical Center Director in Dayton. Costie is expected to serve as acting director of the hospital in Corryville until a permanent chief executive is hired. A nationwide search has begun, the VA said today. Costie will oversee an annual budget of $387 million and a staff of 2,000 at the Cincinnati VA Medical Center, which treats more than 43,000 veterans who live in 17 counties in Southwest Ohio, Northern Kentucky and Southeast Indiana. The hospital operates a medical center in Fort Thomas as well outpatient clinics in Bellevue, Florence, Lawrenceburg, the city of Hamilton, Clermont County’s Union Township and the Brown County village of Georgetown. Costie has more than 30 years of experience in health care. He previously worked at VA medical centers in Cleveland, Chicago, Baltimore, West Haven, Conn., and Poplar Bluff, Mo. The Cincinnati VA Medical Center was previously led by Linda Smith, who had been director of the hospital since 2005 before stepping down in December 2015. I reported in January that officials with two local unions that represent many of the more than 2,000 employees at the hospital complained that nurses and others were pushed to their limits because of understaffing. That could jeopardize care for veterans, the federal workers said. Bob McDonald, an Indian Hill resident who became secretary of the VA in 2014, has vowed to correct problems throughout the nation’s largest health care system. He was CEO of Cincinnati-based Procter & Gamble Co. from 2009 to 2013. Earlier this month, the Cincinnati VA Medical Center named a doctor who spent 12 years in the Army as its next chief of staff. Dr. Elizabeth Brill, who is board certified in obstetrics and gynecology, will join the hospital on May 2. Dr. Barbara Temeck was removed Feb. 25 as acting chief of staff pending disciplinary action over allegations of wrongdoing. Temeck had been acting chief of staff at the Cincinnati VA since July 2013.

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