The information about the veteran is scant, clinical in tone, yet disturbing.
The veteran is identified as “Patient 1.” He
was “hospitalized twice for suicidal ideation and a reported suicide
attempt.” But only later, in a case of a buried lead, does the report
say another attempt was successful — “suicide caused by toxic levels of
sertraline, morphine, and gabapentin.”
This veteran — one of 20 who kill themselves every day,
a frightening figure — received medical care from the Department of
Veterans Affairs (VA) and a non-VA doctor who prescribed opioids for his
While psychological factors were the reasons
and drugs were the tools, the suicide was facilitated by a hole in a
system designed to give vets the choice, in same cases, to obtain
outside medical care at government expense. With Patient 1, “there is no
evidence in the medical record that any of his VA providers were aware
of the new opioid prescriptions,” according to the inspector general.
That gap in coordination, added to differing
clinical standards among VA and non-VA community providers, can be
deadly. Health professionals outside VA are not required to follow
Veterans receiving opioid prescriptions from
private clinics “may be at greater risk for overdose and other harm
because medication information is not being consistently shared,”
Inspector General Michael J. Missal said when the report was released
Tuesday. “That has to change. Health-care providers serving veterans
should be following consistent guidelines for prescribing opioids and
sharing information that ensures quality care for high-risk veterans.”
His office recommended that VA:
- “Require non-VA providers to submit opioid prescriptions directly to a VA pharmacy for dispensing.”
- Ensure those providers have “a complete up-to-date list of medications and medical history.”
- Require community providers to review VA opioid guidelines.
that if community facilities don’t meet VA opioid standards that
“immediate action is taken to ensure the safety of all veterans
receiving care from the non-VA provider.”
VA agreed, at least in principle, with all the recommendations.
“With America facing a looming doctor
shortage and demand for veterans health care outpacing VA’s ability to
provide it in-house, better coordination between VA and non-VA providers
is absolutely essential,” said VA press secretary Curt Cashour.
It’s absolutely essential considering that
about 142 Americans die daily from a drug overdose, “a death toll equal
to September 11th every three weeks,” said a report by the President’s Commission on Combating Drug Addiction and the Opioid Crisis issued
the day before Missal’s. Declaring opioids “a prime contributor to our
addiction and overdose crisis,” the commission called on President Trump
to declare a national emergency empowering the government to take “bold
steps” against drug abuse.
In response to the report, VA Secretary David J. Shulkin issued a statement noting that “recent studies and stories have pointed to VA’s success in its approach to pain management and responsible use of opioids with our Veteran patients.”
Since launching the Opioid Safety Initiative
in 2013, VA says, the number of its patients receiving opioids fell by
27 percent and the number on long-term opioid therapy dropped 33
percent. Shulkin said VA is widely sharing its eight best practices to
balance pain management and opioid use under the acronym S.T.O.P. P.A.I.N.
Missing from that list is cannabis. It could
be an ally in the fight against opioid abuse, as the nation’s largest
veterans’ service organization recognizes, except for Uncle Sam’s
outdated and repressive view of marijuana. Citing data showing that
states permitting medical marijuana have an opioid mortality rate almost 25 percent below that of
other states, the American Legion has urged the government to
acknowledge the potential medical value of cannabis and to reclassify it
to expand research into its use for patients.
“We also want to point out that the increased
focus on addiction is, in some cases, hurting veterans who suffer with
chronic pain and have been on long-term narcotic-based pain relievers,”
said Louis J. Celli Jr., veterans’ affairs and rehabilitation division
director at the American Legion. “For some patients, lifelong pain
management through prescription medications is all they have that allows
them to function. For some, removing these medications can lead to
depression, decreased ability to care for themselves, and, in some
While supporting flexibility in care,
veterans’ groups are cautious about the department’s Choice program,
which funds private-sector health services for vets. On Tuesday,
Congress approved $2.1 billion for Choice to help VA build Shulkin’s
vision for “an integrated system that allows veterans to receive the
best health care possible.”
But the integration isn’t as good as it needs
to be, which is a danger when care is fragmented among VA and private
providers, said Garry Augustine, executive director of the Disabled
The outside providers might not know all they
need to know about a patient or share their records with VA.
Coordination is key, he said, but not always present.
“Under the current Choice program, it isn’t as tight as it should be,” Augustine added. “That should be addressed.”
And soon — before another vet, like Patient 1, falls through the gap.
Expanded college program zips through Congress, but a healthcare battle awaits.
AUGUST 8, 2017 — 9:52PM
Minnesota Democratic U.S. Rep. Tim Walz played a key role in pushing
the largest expansion to veterans' education benefits in a decade — a
measure that President Trump is expected to sign after lawmakers
recently pulled together in a rare bit of unity.
is hoping the passage of the "Forever GI" bill is a lesson that getting
something done in Congress requires building a coalition of broad,
"Otherwise, [such efforts] just become messaging," he said.
polarizing debates over health care and the budget, the House and
Senate approved a revamped GI bill that would allow veterans to go to
college at any time in their lives, instead of losing the option after
15 years. The measure has won widespread praise from veterans
organizations after nearly collapsing in the spring.
Walz, the ranking member of the House Veterans Affairs Committee,
cautions that lawmakers will have to address more controversial
veterans' health care issues when they return from break in September.
Lawmakers approved emergency funding to the Veterans Choice Program last
month, and they must agree on a longer-term solution that will raise
larger issues of privatization that have dominated Republicans' agenda
program allows veterans to see private doctors on the government's
dime, but it was on the verge of running out of money as patient visits
skyrocketed. The new six-month extension buys lawmakers more time to
debate improvements to the multibillion-dollar program.
Veterans for America has already launched ads criticizing Walz for
initially voting against the extension of the stopgap funding in July,
among other votes. The conservative organization says it's targeting
Walz because he is a critical member of the committee.
will play a role in the future discussion around reforming community
care and the choice program for the VA," said Dan Caldwell, the
organization's director of policy. "We think it's important to highlight
his votes to send a message not just to him but to other members on the
committee that we are going to point out when you do the wrong thing."
Stakeholders raise questions
became the ranking member on the veterans' affair panel in January, and
efforts soon intensified over the scope of an expanded GI bill. Walz is
the highest-ranking enlisted soldier in Congress, having retired after
24 years in the Army National Guard as command sergeant major.
when veterans support organizations opposed plans for how to pay for
the legislation, it "went up in flames," Walz recalled. Some
stakeholders raised questions about a proposal to pay for the future
benefits by imposing the cost on veterans currently receiving benefits.
Walz said he asked Republican leaders on the panel for a little more
time to build consensus and find another way.
parties agreed to pay for the $3 billion expansion by reducing housing
allowance increases for future GI bill recipients. The legislation
broadens benefits to include reservists, Purple Heart recipients and
spouses and children of fallen soldiers. It would also provide funds for
veterans to pursue careers in science, technology, engineering and
At a July hearing on the measure, John Kamin of the American Legion said the past few months had not been easy.
public disagreements dividing us, many believed it would be impossible
to get anything done this year for veterans' education," Kamin
the last decade and a half, we've been sending reservists into harm's
way at an unprecedented level … this is the least we can do as a country
for those who put their bodies on the line for our freedom," said
Patrick Murray of Veterans of Foreign Wars (VFW).
biggest benefit to Minnesota? The National Guard troops deployed from
Mankato to the Sinai Peninsula will now be eligible for schooling under
the GI bill, according to Walz. The legislation expands education for
several hundred Minnesota troops deployed overseas under a mobilization
code that wasn't eligible for the benefits, even as they served
alongside many officers who were.
soldiers … [were] contacting their congressmen and letting them know
how this disparity personally affected them. … That provision is what we
in the Minnesota National Guard have had our eye on," said Capt. Mindy
Davis, education services officer for the Minnesota National Guard.
said many have been surprised that the bill moved so quickly — it
sailed through both chambers with no opposition. But addressing the
Choice program at the Department of Veterans Affairs could be another
matter, as debate renews about how to best serve veterans who face long
wait and travel times to receive medical care at government facilities.
lawmakers return to Washington after the August recess, Walz said he's
preparing for a "candid and very, very challenging discussion on the
capacity and the vision of what veterans' health care looks like." For
some stakeholders, "this is a proxy fight for privatization."
added: "We're going to have to get beyond the overly simplistic
arguments … that it should be all privatization or all in the VA. We've
always had a hybrid model."
has advocated for more veterans to have access to private doctors. Yet
Veterans Affairs Secretary David Shulkin wrote in an op-ed for USA Today
last month that the department's services would not become privatized
under his watch.
He said the VA is ramping up private and internal services to address increasing patient visits.
"That is going to test this bipartisan resolve," Walz said.
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WASHINGTON – Less than half of the
bombers President Donald Trump would rely upon to be “locked and loaded”
against North Korea could launch today if needed, according to the
latest Air Force figures available.
That’s not a surprise to the bomb
squadrons who have seen firsthand the combined effects of aircraft age,
the demand of 15 years of air war operations and reduced budgets. But
the numbers can be stark. Of the nation’s 75 conventional and nuclear
B-52s, only about 33 are ready to fly at any given time, according to
Air Force statistics. Of the 62 conventional B-1s, only about 25 are
ready. With the 20 nuclear B-2 stealth bombers, the number drops
further. Seven or eight bombers are available, according to the Air
“On a nominal basis you don’t have more
than single digits of B-2s available to do anything,” said retired Air
Force Lt. Gen. Dave Deptula, currently the dean of the Mitchell
Institute of Aerospace.
“If anything good comes out of the North Korea crisis,” it should be a wake-up call, he said.
“It’s not just the nation’s bomber
force,” that is so stretched, Deptula said. “It’s the military writ
large. The U.S. Air Force is the smallest and least ready it’s ever been
in history – that should get people’s attention.”
Despite the reduced numbers, the
bombers can still meet the president’s call if needed, said Col. Robert
Lepper, chief of the combat aircraft division at Air Force Global Strike
“All three of our bomber fleets are
capable of meeting their missions – they’ve always dealt with reduced
bombers,” Lepper said. “Specifically with the B-2 fleet – we make
decisions every day how to best utilize the aircraft … and meet the
requirements that are there for us in that given day.”
The B-2’s primary mission is nuclear
deterrence. It made a rare conventional run against Islamic State forces
in Libya in January. But the B-2 is largely held back from a
conventional role; otherwise there would not be enough available
aircraft to keep its pilots fully trained and not enough fully ready
bombers to meet national security requirements.
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Overall, there are 20 B-2s in the Air
Force arsenal. While the B-2 is the youngest bomber in service, it is
still a 21-year-old airframe, and it’s undergoing modernization. At any
given time, two are in programmed depot maintenance and another two are
in long-term modernization overhaul, leaving a fleet of 16. At least one
B-2 is dedicated to research and testing, Col. Michael Lawrence, chief
of the Air Force’s maintenance division, said in an interview this
But even fewer than that - only 38
percent on average, meaning seven or eight of the 20 B-2s - are
available at any given time, both Lawrence and Lepper said. Worse, the
Air Force reports that on average, only 51 percent of those available
aircraft are mission capable.
Three B-2s deployed to Andersen Air
Force Base in Guam in 2016, but there are limited facilities there to
support their advanced maintenance needs. In other shows of force to
North Korea, the bombers have deployed from their home at Whiteman Air
Force Base in Missouri.
“There’s one specific hangar that can meet all the B-2 needs” at Guam, Lepper said. “But they have to share.”
There are 62 remaining B-1 bombers, and
like the B-2 they also require modernization. About six are undergoing
programmed depot maintenance at any given time – long-term overhauls
that take the aircraft offline. Another six or so are unavailable
because of the Air Force’s upgrade program, where each of the now
30-year-old airframes will eventually get modern cockpit features to
improve the B-1’s situational awareness, communications and network
capabilities, Lawrence said.
The depot time means the Air Force on
average has about 50 available B-1s. According to the fiscal year 2016
numbers, the latest statistics available, 51.6 percent of the available
B-1s are mission capable. Those statistics align with what the B-1 fleet
has experienced for the last several years.
The nation’s B-1s are split between
Dyess Air Force Base in Texas and Ellsworth Air Force Base in South
Dakota, and are easier to deploy overseas than the B-2.
The defense of Guam and South Korea is
now partially in the hands of six Ellsworth B-1s and 350 airmen from the
37th Expeditionary Bomb Squadron who rotated to Andersen in late July.
They relieved Dyess’ departing 9th Expeditionary Bomb Squadron,
according to the Air Force.
Those six forward deployed B-1s will
“face a large number of the same problems that we face at home,” Lepper
said, including demand for spare parts, scheduled maintenance and
However, forward-deployed B-1s are sent
with “a robust maintenance team and have the top priority for parts
across the Air Force,” Lepper said.
The Dyess unit that just returned from
Guam was able to maintain a 74 percent mission capable rate during the
six months it was overseas, Lepper said.
The oldest bomber in the fleet, the
B-52, actually has the highest mission capable rates of all three
bombers. Over the last several years 60 percent of the B-52s have been
available to fly, meaning about 45 airframes. Those B-52s are an average
54 years old apiece, yet the fleet was also reporting 74 percent
mission capable rate.
The B-52 has a conventional and nuclear
role. To meet the requirements of the new Strategic Arms Reduction
Treaty (START) non-proliferation treaty, the Air Force began converting
29 of its remaining B-52s in 2015 to a conventional-only role, and
finished that process in 2017, the Air Force said in a statement. The
remaining B-1 fleet still can support both a conventional and nuclear
The B-52s higher rate of mission
capability is the result of an extensive overhaul the aircraft went
through over the last several years and the fact that there were
previously hundreds of B-52s, so there are plenty of spare parts
remaining, Lepper said.
Despite the challenges facing all three airframes, Lepper was confident.
“The bomber fleet is ready,” he said.
By: Staff report 20 hours ago
U.S. service members were killed and five others were injured Sunday
while conducting combat operations in northern Iraq, officials with
Combined Joint Task Force-Operation Inherent Resolve said in a
reports indicate the incident was not due to enemy contact, officials
said. But no additional information was publicly released Sunday
The incident is under investigation.
entire counter-ISIS Coalition sends our deepest condolences to these
heroes’ families, friends and teammates,” said Lt. Gen. Stephen
Townsend, commander of Combined Joint Task Force-Operation Inherent
Resolve, in a statement. “I hope there is some small solace in knowing
their loss has meaning for our country and all the nations of the
Coalition as the fallen service members were fighting to defeat a truly
evil enemy and to protect our homelands.”
08/13/2017 09:50 AM EDT
National security adviser H.R. McMaster
said Sunday that the U.S. is "taking all possible actions" to resolve
the nuclear threat from North Korea without resorting to military
action, but he declined to rule out responding to another threat from
the country with force.
President Donald Trump was criticized
last week for warning that North Korea, which has been in conflict with
the United States since the start of the Korean War in 1950, would face
“fire and fury” if it issued any more threats to the United States. The
comments were interpreted by some as threatening a preemptive nuclear
attack and overheated.
Story Continued Below
Asked on ABC's "This Week" to clarify
whether threats alone would provoke a military response from the U.S.,
McMaster said it "depends on the nature of the threat."
"This is why what Kim Jong Un is doing is
very, very dangerous," McMaster said, referring to the North Korean
dictator. "Of course any response that we have we do in close
cooperation with our allies in the region. As you know, we have been
prepared for an escalation on the Korean Peninsula since the armistice
"The difference between then and now is
the danger is much greater," he added. "And it's growing every day, with
every missile test, with the ... nuclear tests. And so what we can no
longer do is afford to procrastinate. And President Trump has made it
very clear, he cannot tolerate, will not tolerate, a threat to the
United States from North Korea involving nuclear weapons."
But despite the escalating rhetoric from
Trump, McMaster said the threat of war with North Korea has not
dramatically increased over the past few days, though he underscored the
seriousness of the problem.
"We're not closer to war than a week ago.
But we're closer to war than we were a decade ago," McMaster said.
"And, as Dr. [Henry] Kissinger made clear in a great op-ed this weekend,
this has been a problem that we have procrastinated on for a long
period of time, and now it's coming to a head. Where the threat from
North Korea, not only to the United States but to the world, is very,
very clear. And it demands a concerted effort by the United States, but
with our allies and all responsible nations."
CIA Director Mike Pompeo similarly said
Sunday that there is no “imminent” threat of North Korea attacking the
U.S. with a nuclear weapon, though he still expects the country to
continue developing its missile program even as other countries call on
it to stop.
“There's nothing imminent today,” Pompeo
told Chris Wallace on “Fox News Sunday,” when asked what kind of threat
the U.S. is facing. “But make no mistake about it, the continuation, the
increased chance that there will be a nuclear missile in Denver is a
very serious threat, and the investigation is going to treat it as
Asked whether that meant that he does not
expect any future missile tests, Pompeo said he is “quite confident”
that Kim “will continue to try to develop a missile program, so it
wouldn't surprise me if there was another missile test.”
“What I'm talking about is I've heard
folks talking about being on the cusp of a nuclear war,” he clarified.
There is “no intelligence that would indicate that we’re in that place
today,” he added.
Pompeo also defended Trump’s "fire and fury" comment.
“The president has made it very clear to
the North Korean regime how America will respond if certain actions are
taken,” Pompeo said. “We are hopeful that the leader of that country
will understand them in precisely the way they are intended, to permit
him a place to get where we can get the nuclear weapons off the
“It's that straightforward,” he
continued. “What we need from an intelligence perspective, what is most
important is that our communications are clear that the fella who
intends to inflict pain on the United States of America understands the
U.S. position in an unambiguous way. That's the best message you can
deliver to someone who's putting America at risk.”
Pompeo also said the intelligence
community was not surprised by the recent news that North Korea is now
capable of fitting a nuclear warhead on a missile.
By: The Associated Press 19 hours ago
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ALBUQUERQUE, N.M. — A Veterans Affairs
office in New Mexico during the 2015 fiscal year denied more than 90
percent of benefit claims related to Gulf War illnesses, marking the
ninth-lowest approval rating among VA sites nationwide, according to a
The U.S. Department of Veterans
Affairs’ Albuquerque office denied 592 of 640 Gulf War illness claims in
2015, which is the latest yearly data available, The Albuquerque Journal
reported earlier this week.
The report released in June from the
Government Accountability Office found approval rates for Gulf War
illness claims are one-third as high as for other disabling conditions.
The Gulf War illness claims also took an average of four months longer
Gulf War illness was first identified
in troops returning home from Operation Desert Storm and Operation
Desert Shield in the early 1990s. But it has been found to afflict
troops who have served in other parts of the Middle East since then as
The illness includes a wide variety of
symptoms and conditions, from fatigue and skin problems to insomnia and
indigestion. It is believed the conditions may be the result of exposure
to burn pits, oil well fires or depleted uranium weapons during
The report concluded that instituting
required training for medical examiners, clarifying claim decision
letters sent to veterans and developing a single definition for the
illness would increase consistency in approval rates and reduce
confusion among staff and veterans.
Currently, a 90-minute training course
on Gulf War illness is voluntary. Only about 10 percent of the VA’s
4,000 medical examiners had completed it as of February, according to
Sonja Brown, acting associate director
of the New Mexico VA Health Care System, did not say how many of the
Albuquerque medical examiners have completed the course.
“The Gulf War Examination training is
currently on the curriculum for our medical examiners with a due date of
8/10/2017 to complete,” Brown wrote in an email. “While I don’t have a
percentage of those completed, I can tell you that the training is being
The VA plans to make training mandatory, with all medical examiners expected to complete the program by October.
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HARTFORD, Conn. — The recent exhumation
of an Army Vietnam veteran’s body from the Connecticut State Veterans
Cemetery was a rare invocation of federal laws aimed at keeping
murderers and rapists out of veterans burial grounds, federal and state
The remains of Guillermo Aillon were
disinterred from the Middletown cemetery July 3, after state veterans’
affairs officials learned that he had been serving a life prison
sentence for stabbing to death his estranged wife and both her parents
in North Haven in 1972. It’s not clear where the remains were taken.
Only one other person appears to have
been exhumed from a U.S. veterans’ cemetery under a 2013 federal law
that gave the federal Department of Veterans Affairs the authority to
dig up the remains of murderers and rapists, according to the VA.
In 2014, the body of Army veteran
Michael LeShawn Anderson was removed from the Fort Custer National
Cemetery in Augusta, Michigan. Authorities said Anderson killed Alicia
Koehl, wounded three other people and killed himself in a 2012 shooting
in Indianapolis. The 2013 law, named after Koehl, specifically
authorized the exhumation of Anderson.
Burying convicted murderers and rapists
at veterans’ cemeteries was banned by a 1997 federal law, which was
aimed at preventing Oklahoma City bomber and Army veteran Timothy
McVeigh from being interred at Arlington National Cemetery.
The law prohibits people sentenced to
life in prison or death on convictions for federal or state capital
crimes and certain sexual offenses from being buried in national
veterans cemeteries and other veterans burial grounds — such as the
Connecticut cemetery — that receive federal funding.
But exhumation authority didn’t exist
until the 2013 law, which also was made to apply to people who committed
murders and rapes but were not available for trial and not convicted.
The law applies only to veterans buried after it took effect on Dec. 23,
2013, with the exception for Anderson.
The remains of another veteran
convicted of murder, Russell Wayne Wagner, were removed from Arlington
National Cemetery under an order approved by Congress in 2006 as part of
a veterans’ bill. Wagner killed an elderly couple in Hagerstown,
Maryland, in 1994.
Connecticut officials did not know
about Aillon’s convictions because he was transferred from prison to a
hospital before he died in 2014 and his death certificate listed the
location as the hospital, said Thomas Saadi, spokesman for the Veterans
Affairs Commissioner Sean Connolly.
“It’s a very rare occurrence,” Saadi said of exhumation. “The Aillon situation was very unique.”
Saadi said the state has since required
funeral directors to attest that veterans whose families have applied
for them to be buried in the state veterans’ cemetery were not convicted
of murder or rape.
Relatives of Aillon did not return
messages seeking comment. They previously have said they were unaware of
the burial restrictions and were upset with the exhumation plans.
At the Michigan cemetery, Anderson was buried with full military honors, despite Koehl’s killing.
“It was just a total insult,” Koehl’s father-in-law, Frank Koehl, told the Detroit Free Press.
Anderson’s mother, Debra Graham, said her son’s remains were relocated to another cemetery.
“I couldn’t believe it. It hurt so
bad,” she told The Associated Press, referring to the exhumation. “A lot
of pain and grief. I try not to think about it. I try to think about
the good times we had.”