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American Legion News Clips – August 14, 2017


 
By Joe Davidson | Columnist August 7 

The information about the veteran is scant, clinical in tone, yet disturbing.
 
“At the time of his death, the patient was a male in his forties with a past medical history significant for PTSD, chronic low back pain, obstructive sleep apnea, obesity, and depression,” the Department of Veterans Affairs inspector general reported.
 
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 chronic pain.
 
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 departmental guidelines.
 
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.
  • Ensure 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 cases, suicide.”
 
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 American Veterans.
 
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. 
By Maya Rao Star Tribune
 
AUGUST 8, 2017 — 9:52PM
WASHINGTON – 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.
 
Walz is hoping the passage of the "Forever GI" bill is a lesson that getting something done in Congress requires building a coalition of broad, bipartisan support.
"Otherwise, [such efforts] just become messaging," he said.
Amid 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.
But 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 in Washington.
The 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.
Concerned 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.
"He 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
Walz 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.
But 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.
The 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 math.
At a July hearing on the measure, John Kamin of the American Legion said the past few months had not been easy.
"With public disagreements dividing us, many believed it would be impossible to get anything done this year for veterans' education," Kamin acknowledged.
"For 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).
The 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.
"The 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.
Hurdles remain
Walz 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.
When 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."
He 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."
Trump 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.
 
 
By: Tara Copp   1 day ago
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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 Force. 
“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 Command.
“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 spring.
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 unscheduled maintenance.
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 role.
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
 
Two 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 statement.
Initial reports indicate the incident was not due to enemy contact, officials said. But no additional information was publicly released Sunday morning. 
The incident is under investigation.
“The 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.
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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 in 1953."
"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 such.”
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 peninsula.”
“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 federal report.
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 to process.
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 well.
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 service.
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 the report.
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 taken.”
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 officials say.
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.”