First Steps to Overhaul the Department of Veterans Affairs

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Dr. David Shulkin continues to impress by tackling some rather entrenched “special interest” groups within the Department of Veterans Affairs (“the VA”):

– Personnel;

– Infrastructure

Earlier this week, VA Secretary Shulkin informed a Congress that he was considering closing some 1,100 underutilized VA facilities.  The Associated Press reports that:

Shulkin said the VA had identified more than 430 vacant buildings and 735 that he described as underutilized, costing the federal government $25 million a year. He said the VA would work with Congress in prioritizing buildings for closure and was considering whether to follow a process the Pentagon had used in recent decades to decide which of its underused military bases to shutter, known as Base Realignment and Closure, or BRAC.

“Whether BRAC is a model that we should take a look, we’re beginning that discussion with members of Congress,” Shulkin told a House appropriations subcommittee. “We want to stop supporting our use of maintenance of buildings we don’t need, and we want to reinvest that in buildings we know have capital needs.”

Last week, President Trump signed an Executive Order protecting VA whistleblowers from retaliation in a quest by the VA to shed incompetent employees.

Department of Veterans Affairs

While these measures may seem rather insignificant given the overall size and reach of the VA, they could mark an important change in the direction of the VA to help respond to the needs of Veterans.

The VA has evolved into a mammoth organization intent on serving the needs of all Veterans and their families.  Roughly 60% of the VA’s $180 billion budget (2017 budget) is allocated to mandatory benefits programs.

The VA’s discretionary budget of $78.7 billion is allocated to a variety of Veteran services,  but by far, is the the $65 billion allocated to medical care facilities.   Despite regular reports of shortcomings at VA facilities, the Rand Corporation recently (2016) reported that “the Veterans Affairs health care system generally performs better than or similar to other health care systems on providing safe and effective care to patients.”

While it appears that many Veterans – quite possibly the vast majority – receive quality health services from the VA, many Veterans complain about the timeliness and quality of service provided to them.

Like other healthcare providers in the private sector, the VA has determined what health events are covered, the type of coverage provided and where the health services are administered.

One program that has come under particular attack is the Choice Program, which gives Veterans access to medical services in the private sector if the VA can’t dispense services within 30 days or a VA facility is not located within 40 miles of the Veteran.

At his confirmation hearings, now VA Secretary David Shulkin, requested that Congress expand the coverage of the Choice program and eliminate many of its administrative constraints.  Needless to say, changes in the Choice program would certainly provide a greater number of Veterans with access to private sector care.

In cases of emergency, even minor improvements to the Choice program could be of major benefits to Veterans.

Nevertheless, these changes do not provide Veterans with access to alternative therapy programs not currently approved by the VA.  As SFTT has reported on numerous occasions, PTSD is currently treated with demonstrably ineffective “approved” treatment procedures while far better and less-intrusive programs like hyperbaric oxygen therapy (HBOT) are widely used with success throughout the world.

In effect, there are a number of activities within the VA that can best be performed by third-party services.  In fact, integrating these services with community resources may prove to be more of a long term benefit to the Veteran and his or her family.

Stand for the Troops remains hopeful that Secretary Shulkin and the dedicated employees of the VA will find the right balance in helping Veterans recover their lives.

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SFTT Military News: Week Ending May 5, 2017

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Found below are a few military news items that caught my attention this past week. I am hopeful that the titles and short commentary will encourage SFTT readers to click on the embedded links to read more on subjects that may be of interest to them.

If you have subjects of topical interest, please do not hesitate to reach out. Contact SFTT.

Is China Reconsidering Its Relationship with North Korea?
When North Korea’s founder Kim Il-Sung visited Beijing to sign a mutual defense pact with China in 1961, he was comforted by the military protection promised by his fellow communist neighbors. But half a century and a few North Korean nuclear tests later, the agreement is beginning to look like a musty Cold War relic that China would rather forget. Despite their alliance in the 1950 – 1953 Korean War, analysts questioned whether Beijing would now rush to Pyongyang’s defense in a military confrontation with the US and South Korea.  Read more . . .

Questions on Efficacy of “MOAB” bombing in Afghanistan
But a new investigation by independent analysts casts doubt on the efficiency of the bomb, suggesting it inflicted far less damage than initially reported – and raising questions again over why the bomb was dropped. Using satellite imagery, ground footage and 3D visualization, Alcis, an institute for geographical analysis, surveyed the targeted area in Nangarhar province. It found 38 buildings and 69 trees destroyed within a 150-metee radius, challenging statements from locals who told reporters the bomb had damaged houses up to two miles away. Alcis was also skeptical of the Afghan government’s assessment that the bomb killed 94 Isis militants. “I’m staggered by that,” said Richard Brittan, the institute’s managing director. “I simply don’t understand where they can get that number from.”  Read more . . .

Pituitary gland

Can Brain Concussion Injury be Properly Evaluated?
In an effort to fill that technology gap, Timothy Bentley, and his team at the Office of Naval Research’s Warfighter Performance Department in Arlington, Virginia, have engineered new sensor technology that could give medics on the battlefield a clearer idea of whether or not an injury actually occurred after a blast. The coin-sized sensors, placed in service members’ helmets and tactical gear, detect the impact of a blast wave—which moves faster than the speed of sound—and assign it a number, a measure of blast strength. The number is then run through an algorithm that computes how a service member was hit by a blast, which sensors were activated based on their placement, and then tells medics if the service member needs to get off the field immediately or not.   Read more . . .

Can Putin and Trump “Broker” Syrian Deal with No-Fly Zone?
Once again it appears Vladimir Putin has seized the strategic high ground and initiative in Syria, as he declared yesterday that he has broad agreement for humanitarian safe zones across Syria after discussions with Donald Trump, Turkey and Iran. He claims he can enable the ceasefire brokered in Astana some weeks ago, which currently is an abject failure, by creating no-fly zones with the Russian, Turkish, Iranian and US militaries protecting safe zones on the ground. He also, thankfully, acknowledges that UN troops might be required.  Read more . . .

Antibiotic Doxycycline May Reduce the Risk of Developing PTSD
Doxycycline, a common antibiotic, appears to disrupt the formation of negative memories in the brain. According to a study in the journal Molecular Psychiatry, this could help prevent post traumatic stress (PTSD). The study suggests blocking matrix enzymes—proteins located outside nerve cells—may interfere with the ability to form memories. Doxycycline blocks these enzymes.  Read more . . .

VA Secretary Ponders Closing Up to 1,000 VA Facilities
Veterans Affairs Secretary David Shulkin says his department is seeking to close perhaps more than 1,100 VA facilities nationwide as it develops plans to allow more veterans to receive medical care in the private sector. At a House hearing Wednesday, Shulkin said the VA had identified more than 430 vacant buildings and 735 that he described as underutilized, costing the federal government $25 million a year. He said the VA would work with Congress in prioritizing buildings for closure and was considering whether to follow a process the Pentagon had used in recent decades to decide which of its underused military bases to shutter, known as Base Realignment and Closure, or BRAC.  Read more . . .

Drop me an email at info@sftt.org if you believe that there are other subjects that are newsworthy.

Feel you should do more to help our brave men and women who wear the uniform or our Veterans? Consider donating to Stand For The Troops

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Whistleblowers and the Department of Veterans Affairs

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On April 27th, President Trump signed an Executive Order to create the Office of Accountability and Whistleblower Protection within the Department of Veterans Affairs (“the VA”).

According to the AP, VA Secretary David Shulkin said the office will help identify “barriers” that make it difficult for the department to fire or reassign bad employees. Another function of the office will be to help shield whistleblowers from retaliation.

To many, it may seem surprising that a new office within the VA is required to protect “whistleblowers,” since private and public whistleblowers have long been afforded protection under the Whistleblower Protection Act of 1989.

Clearly, additional protection is needed if doctors like Dr. Dale Klein can be relegated to an empty room for bringing VA abuse to the attention of the Inspector General.  Found below is a report for Fox News:

Dr. Dale Klein may be the highest-paid U.S. government employee who literally does nothing while he’s on the clock. A highly rated pain management specialist at the Southeast Missouri John J. Pershing V.A., Klein is paid $250,000 a year to work with veterans, but instead of helping those who served their country, he sits in a small office and does nothing. All day. Every day.

“I sit in a chair and I look at the walls,” the doctor said of his typical workday. “It feels like solitary confinement.”

A double board certified physician and Yale University fellow, Klein said the Department of Veterans Affairs (V.A.) took away his patients and privileges almost a year ago after, he alleges, he blew the whistle on secret wait-lists and wait-time manipulation at the V.A. in Poplar Bluff, Mo., as well as his suspicion that some veterans were reselling their prescriptions on the black market.

While one would like to be optimistic that the new “Whistleblower Office” within the VA would help improved efficiency within the VA, I suspect that there are far too many institutional barriers to be overcome in this mammoth organization.

Department of Veterans Affairs

Size Matters at the Department of Veterans Affairs

The VA’s simple mission laid down by President Abraham Lincoln is “to care for him who shall have borne the battle, and for his widow, and his orphan.”

Needless to say, each person has his or her interpretation of what that VA mission entails, but over time the VA has laid on layers of responsibility to fulfill that mission.   In the military, we often refer to that as “mission creep.”

In effect, the VA – whether pressured by Congress, the President or their own Administration – have taken on responsibilities that may or may not be what was originally intended under President Lincoln’s promise.

More importantly, the VA has centralized most functions under its umbrella to administer to the needs of Veterans.

Employing some 350,000 people and many outside consultants, the VA administers health and benefit programs to millions of Veterans.  In economic terms, one might characterize the VA as a monopoly.

While many of the services provided by the VA are excellent, it would be unrealistic to expect that ALL services are effective.

In fact, the IG, internal VA audits and the IG have reported many irregularities at the VA.  Unmanned Crisis Call Centers, unacceptable patient “wait times” and the heavy reliance on prescription drugs all contribute to public wariness and distrust of the VA.   More importantly, many Veterans reject the services provided by the VA.

SFTT has long argued that the VA is far too large to succeed on every front without compromising their main mission.  Shortly after Dr. David Shulkin was appointed Secretary of the VA, we wrote:

NO AMOUNT OF MONEY or CHANGE IN LEADERSHIP or ENACTMENT OF NEW LEGISLATION will bring about A MORE RESPONSIVE VA.

The VA has become a bureaucracy that answers only to itself and is not responsive to the needs of Veterans.  Frankly, the VA has lost its way and very little will change unless the VA is broken down into far smaller manageable components.

While smaller components of the VA will invariably fail, A SMALLER AND LESS CENTRALIZED VA WON’T COMPROMISE THE FULL MISSION.  

VA Whistleblowers and David Cox

Dr. Shulkin and others clearly realize that there are serious problems of accountability within the VA.  The April 27, 2017 Executive Order is designed to help “weed out” waste and inefficiencies within the VA.

J. David Cox

J. David Cox

Despite much needed reform within the largely ungovernable VA, I suspect that  J. David Cox, President of the American Federation of Government Employees, will continue to run a destabilizing campaign to block any meaningful reform.

We admire the courage of “whistleblowers,” but Veterans shouldn’t expect great changes considering the entrenched positions of David Cox and his henchmen.

It is reassuring to see Dr. Shulkin take action to confront the serious problems within the VA.  We wish him success in his endeavors and hope that he receives much needed support from our elected leaders to bring radical reform to the VA.

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SFTT Military News: Week Ending Apr 28, 2017

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Found below are a few military news items that caught my attention this past week. I am hopeful that the titles and short commentary will encourage SFTT readers to click on the embedded links to read more on subjects that may be of interest to them.

If you have subjects of topical interest, please do not hesitate to reach out. Contact SFTT.

Israeli Airstrike at Syrian Airport Confirmed
An Israeli missile strike has caused a large explosion and fire at a military site near Damascus international airport, Syrian state media report. A fuel tank and warehouses were damaged, the Sana news agency said. But Syrian rebel sources said an arms depot run by Lebanon’s Hezbollah movement, which is fighting in Syria as an ally of the government, was hit. Israel said the explosion was “consistent” with its policy to prevent Iran smuggling weapons to Hezbollah.  Read more . . .

Brain Shock Therapy by US DARPA Army Research Group
The US military is working with seven American universities to see if electrically stimulating the brain will increase the ability to learn new skills. The Targeted Neuroplasticity Training (TNT) program is focused on synaptic plasticity, the ability of the brain to build new neural pathways to absorb knowledge. By stimulating the nerves that connect neurons in the brain and spinal cord to organs, skin and muscles, the Defense Advanced Research Projects Agency (DARPA) is hoping that the brain can be trained to learn new skills more quickly.  Read more . . .

Rethinking the US Military Health System
During Operations Enduring Freedom and Iraqi Freedom (2001 – 2014), the United States’ military health system completely transformed its approach to casualty care, achieving the highest rate of survival from battlefield wounds in the history of warfare. It is one of the most remarkable accomplishments in the history of US medicine. Ironically, the same health care system that worked miracles “down range” in Iraq and Afghanistan faces mounting criticism at home. How can this be? In part, it is because the military health system has two distinctive missions: support combat and humanitarian assistance missions overseas and provide comprehensive health services to millions of service members, their families, and military retirees at home.   Read more . . .

North Korean Military Strength Overrated?
North Korea’s soldiers mostly carry fake weapons during their mass-scale parades, a former US intelligence officer has said. Michael Pregent believes many of the arms flaunted by menacing-looking North Korean troops during their displays are dummies, and claims even their sunglasses wouldn’t be fit for combat. Pregent was asked to look at photographs from an April 15 military parade in the North Korean capital of Pyongyang.  Read more . . .

Taliban

 Taliban Announces Spring Offensive
Afghanistan’s Taliban announced the start of their annual spring offensive Friday, promising to build their political base in the country while focusing military assaults on coalition and Afghan security forces. Taliban spokesman Zabihullah Mujahid announced the launch of the offensive in an email statement that boasted Taliban control over more than half of the country, referencing a February report issued by Washington’s special inspector general for Afghan reconstruction. That report said that the Afghan government had control or influence over only 52 percent of Afghanistan’s 407 districts last year, down from 63.4 percent previously.  Read more . . .

Brainwave Study to Help Fight PTSD
The new study was led by researchers at Wake Forest Baptist Medical Center in Winston-Salem, N.C. The investigators sought to tackle PTSD from another angle, through the patients’ own brainwaves. The study involved 18 patients who completed an average of 16 successive, daily sessions of what the researchers called “noninvasive closed-loop acoustic stimulation brainwave technology.” During the sessions, the patients’ brain activity was monitored and certain brain frequencies were translated into acoustic tones that were then relayed back to the patients via earbuds.  Read more . . .

 Whistleblower Protection Executive Order for VA
President Donald Trump, as part of his dash to rack up wins before the end of his first 100 days, signed an executive order Thursday that creates a new office devoted to protecting whistleblowers at the Department of Veterans Affairs.Before signing the order at the Department of Veterans Affairs, Trump said the new office will help provide veterans with the “health care they need and the health care they deserve.””We are not going to let them down,” Trump said, arguing that the order “makes it clear that we will never tolerate substandard care for our great veterans” and ensure that those who report problems at the veterans affairs are protected.  Read more . . .

Drop me an email at info@sftt.org if you believe that there are other subjects that are newsworthy.

Feel you should do more to help our brave men and women who wear the uniform or our Veterans? Consider donating to Stand For The Troops

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Hyperbaric Oxygen Therapy (HBOT) to Treat Veterans with PTSD

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Veterans and casual observers continue to be mystified why the Department of Veterans Affairs (the “VA”) continues to insist on failed therapy programs to treat Veterans with PTSD.

Dr. David Cifu, the senior TBI specialist in the Department of Veterans Affairs’ Veterans Health Administration, argues that Veterans treated with Cognitive Behavioral Therapy and Prolonged Exposure Therapy are receiving the best therapy possible to treat PTSD.   There is no reliable third-party verification to support Dr. Cifu’s bold assertion.

More to the point, Dr. Cifu dismisses  other treatment alternatives arguing that there is no scientific basis to support them.  In particular, Hyperbaric Oxygen Therapy (HBOT) has been singled out for particular disdain by Dr. Cifu.

Specifically, the VA concluded their trial “study” with the following observations:

“To date, there have been nine peer-reviewed publications describing this research,” Dr. David Cifu, VA’s national director for physical medicine and rehabilitation recently told the Oklahoman. “All the research consistently supports that there is no evidence that hyperbaric oxygen has any therapeutic benefit for symptoms resulting from either mild TBI or PTSD.”

Frankly,  there is voluminous scientific evidence that HBOT is both a viable and recommended treatment alternative for Veterans suffering from PTSD and TBI.

Hyperbaric Oxygen Therapy (HBOT)

Hyperbaric Oxygen Therapy or HBOT is available at many privately-owned hospitals in the United States and around the world.  There is compelling scientific evidence that HBOT reverses brain damage.

In fact, HBOT is the preferred therapy of  the Israeli Defense Forces (“IDF”) for service members with head injuries.  Frankly, this assertion alone trumps any argument to the contrary by Dr. Cifu.

In its most simple form, HBOT is a series of “dives” in a decompression chamber (normally 40) where concentrated oxygen is administered under controlled conditions by trained physicians.  There is clear and conclusive evidence that brain function improves through the controlled application of oxygen.  In effect, it stimulates and may, in fact, regenerate brain cells at the molecular level.

HBOT Brain Functionality Over Time

In addition, HBOT is far cheaper to administer than currently approved programs at the VA.   Maj. Ben Richards argues that all Veterans with PTSD and TBI could be treated with HBOT for less than 10% of the VA budget allocated for pharmaceuticals.

More to the point, the annual VA treatment costs for Veterans with PTSD and TBI are roughly $15,000. For this annual expense, many Veterans could receive HBOT.

Dr. Figueroa asks, What are we Waiting For?

Almost 3 years ago, Dr. Xavier A. Figueroa, Ph.D., in an article entitled “What the <#$*&!> Is Wrong with the DoD/VA HBOT Studies?!!” clearly sets forth a compelling scientific argument why Veterans with TBI and PTSD should be treated with HBOT.

Found below is a summary of Dr. Figueroa’s conclusions (footnotes removed):

A large fraction of the current epidemic of military suicides (22+ service members a day take their lives) are more than likely due to misdiagnosed TBI and PTSD. Although the DoD and VA have spent billions (actually, $ 9.2 billion since 2010) trying to diagnose and treat the problem, the epidemic of suicide and mental illness are larger than ever. Drug interventions are woefully inadequate, as more and more studies continue to find that pharmacological interventions are not effective in treating the varied symptoms of TBI or PTSD. In many cases suicide of veterans have been linked through prescribed overmedication.

HBOT is a safe and effective treatment with low-to-no side effects (after all, even the DOD accepted the safety of HBOT back in 2008). Access to HBOT is available within most major metropolitan centers, but the major sticking point is money. Who pays for the treatment?  Those that are willing to pay for it out-of-pocket and state taxpayers picking up the tab for brain-injured service members forced back into society without sufficient care (or forced out on a Chapter 10, when it should have been treated as a medical condition).

The continued reports of studies like the DoD/VA sponsored trials allow denial of coverage and provide adequate cover for public officials to claim that more study needs to be done. As we have seen, the conclusions of the authors of the DoD/VA sponsored studies downplay the results of effectiveness. There are sufficient studies (and growing) showing a strong positive effect of HBOT in TBI. More will be forthcoming.

The cardinal rule of medicine is “First, Do No Harm”. With HBOT, this rule is satisfied. Now, by denying or blocking a treatment that has proven restorative and healing effects, countless physicians and organizations, from the VA to DoD, Congress and the White House, could be accused of causing harm. Never mind how many experiments “fail” to show results (even when they actually show success). Failure to replicate a result is just that…a failure to replicate, not a negation of a treatment or other positive results. You can’t prove a negative and there are many clinical trials that do show the efficacy of HBOT.

The practice of medicine and the use of HBOT should not be dependent on the collective unease of a medical profession and the dilatory nature of risk adverse politicians, but on the evidence-based results that we are seeing. Within the VA, there are hard working physicians that are trying to change the culture of inertia and implement effective treatments for TBI and PTSD, using evidence based medicine. Unfortunately, evidence-based medicine only works when we accept the evidence presented to us and not on mischaracterized conclusions of a single study (or any other study). Our veterans, our citizens and our communities deserve better than what we are currently giving them: bad conclusions, institutions too scared to act in the interests of the people it serves and too many physicians unwilling to look at the accumulated evidence.

Indeed, it is time to for Dr. Shulkin to rid the VA of Dr. Cifu and embrace cost-effective treatment therapies which provide some hope for Veterans with PTSD and TBI.

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SFTT Military News: Week Ending Apr 21, 2017

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Found below are a few military news items that caught my attention this past week. I am hopeful that the titles and short commentary will encourage SFTT readers to click on the embedded links to read more on subjects that may be of interest to them.

If you have subjects of topical interest, please do not hesitate to reach out. Contact SFTT.

Kim - North Korea

Grim Military Options Available in Confrontation with North Korea
Three weeks before becoming president, Donald Trump weighed in on the threat of North Korea developing a nuclear warhead capable of reaching the U.S.: “It won’t happen,” he vowed on Twitter. Now planners are contemplating what a U.S. strike to prevent that development might look like, and the options are grim.Analysts estimate North Korea may now possess between 10 and 25 nuclear weapons, with launch vehicles, air force jets, troops and artillery scattered across the country, hidden in caves and massed along the border with South Korea. That’s on top of what the U.S. estimates to be one of the world’s largest chemical weapons stockpiles, a biological weapons research program and an active cyberwarfare capability.  Read more . . .

New Russian Military Base in the Arctic
Visitors to the Russian defense ministry website can now take a “virtual tour” of a new military base in a remote region of the Arctic. The Arctic Trefoil permanent base is in Franz Josef Land, a huge ice-covered, desolate archipelago. The Russian military sees the resource-rich Arctic as a key strategic region. President Vladimir Putin visited the new base, on Alexandra Land, last month. It is built on stilts – to help withstand the extreme cold – and will house 150 personnel on 18-month tours of duty. Winter temperatures typically plunge to minus 40C.  Read more . . .

Head Injuries Can Alter Hundreds of Genes
Head injuries can adversely affect hundreds of genes in the brain that put people at high risk for diseases including Alzheimer’s, Parkinson’s, post-traumatic stress disorder, stroke, ADHD, autism, depression and schizophrenia, life scientists report. The researchers have identified for the first time potential master genes which they believe control hundreds of other genes that are linked to many neurological and psychiatric disorders.  Read more . . .

Veterans with PTSD

New Study Suggests “Post-Traumatic Growth” after PTSD
A new study of military veterans who went through trauma finds that those veterans who have related post-traumatic stress disorder (PTSD) are also more likely to experience ‘post-traumatic growth’ — such as an increased appreciation of life, awareness of new possibilities and enhanced inner strength.   Read more . . .

New Bill May Provide Veterans with Greater Private Care Health Options
President Donald Trump signed a bill Wednesday to temporarily extend a program that lets some veterans seek medical care in the private sector, part of an effort by the president to deliver on a campaign promise. The extension will give Veterans Affairs Secretary David Shulkin time to develop a more comprehensive plan to allow veterans to more easily go outside the VA health system for care. Under the bill Trump signed into law, the VA will be allowed to continue operating its Choice Program until the funding runs out, which is expected early next year. The program was scheduled to expire on Aug. 7 with nearly $1 billion left over.  Read more . . .

New VA Facility in Waco, Texas Targets Brain Injuries
Waco’s Doris Miller Department of Veterans Affairs Medical Center now can provide the gold standard in research and treatment for brain injuries suffered on the battlefield with Thursday’s opening of a 53,000-square-foot facility for the VISN 17 Center of Excellence for Research on Returning War Veterans that sprawls across three floors of Building 93. More than 150 people attended a grand-opening ceremony to mark the occasion, and U.S. Rep. Bill Flores said the Waco VA will become a hub for dealing with the invisible wounds of post traumatic stress disorder and traumatic brain injury that have become part of this country’s global war on terror.  Read more . . .

Drop me an email at info@sftt.org if you believe that there are other subjects that are newsworthy.

Feel you should do more to help our brave men and women who wear the uniform or our Veterans? Consider donating to Stand For The Troops

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Opioid Abuse: Department of Veterans Affairs Culpability?

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While many families will be celebrating Easter today, I am quite sure that their thoughts will turn to a family member or friend who were among the 52,000 that died of a drug overdose last year.

By comparison, there were only 33,000 traffic fatalities over the same period.  These statistics suggest that substance abuse plays a far greater threat to our society than careless driving.

In an excellent 5-part series by FOX News entitled “Drugged, Inside the Opioid Crisis,” the network explores the devastating impact of opioid abuse in towns across the United States.

In fact, the FOX network claims that 4 out of 5 overdose fatalities can be traced to the initial use of prescription drugs for pain medication.   It is clear that prescription painkillers have caused many innocent victims to become dependent on more lethal drugs like heroin.

Temazepam_10mg_tablets-1

As Stand for The Troops (“SFTT”) has been reporting for several years, Veterans suffering from PTSD have been regularly over-served with a concoction of drugs – primarily opioids – to allow them to cope with pain and other issues.

If there was any doubt about the culpability of the Department of Veterans Affairs (“the VA”) in addicting our Veterans to painkillers rather than treat them, I suggest that you watch the video below:

With 20-20 hindsight most everyone can be on the “right side of history,”  but our Veterans, the VA and Congressional oversight committees have known that opioids was not the proper way to treat Veterans suffering from PTSD and TBI.

Dr. David Cifu:  A State of Denial at the VA

Unfortunately, VA protocols to treat PTSD as articulated by Dr. David Cifu, the senior TBI specialist in the Department of Veterans Affairs’ Veterans Health Administration, have resulted in few lasting benefits for Veterans with PTSD.  Paraphrasing Dr. David Cifu,  “the worse thing you can do for someone with PTSD is not to press them back into action as quickly as possible.  At the VA, we prescribe drugs for those in pain or suffering trauma.”

Indeed, there is no compelling evidence that the VA has improved the lives of Veterans suffering from PTSD or TBI.  

The VA continues to push its stale and failed agenda that states that the only two effective treatment therapies offered by the VA are:

– Cognitive Behavioral Therapy and,

– Prolonged Exposure Therapy.

To see how badly the VA has failed our Veterans, one only needs to listen to a detailed explanation by Maj. Ben Richards citing his experience with the VA and a summary of failed patient outcomes at the VA. Watch the first two minutes to see Maj. Richards refute all VA claims that they are dealing with the problem effectively.

Conversation with a Veteran Drug Abuse Specialist

Several years ago, I had the opportunity to visit a Community Center in northern New York that was working with high-risk Veterans suffering from PTSD and TBI.  During this visit, I encountered a Drug Abuse Specialist, who had been rescued from addiction through the Veteran Court System.

What he told me shocked me.

– Well over 90% of Veterans returning from Iraq and Afghanistan suffer from substance abuse issues;

– Veterans are well aware that opioids don’t work and have major side-effects (i.e. suicidal thoughts) when combined with other prescription drugs provided by the VA;

– Rather than flush prescription drugs down the toilet, the drug of choice, OxyContin, was pulverized into powder and sold on the black market to civilian drug users;

– A leading supplier of OxyContin to the VA had its sales of the drug fall by more than 60% when Congress forced them to repackage the pills in a gel composite so it couldn’t be sold as a powder on the black market;

– This same pharmaceutical company petitioned Congress to reinstate OxyContin in pill form citing that “it is more effective than gel;”

– VA prescribed drugs don’t provide Veterans with a meaningful road to full recovery.

Sadly, I don’t believe the situation has changed significantly in recent years.

Opioid Abuse in the United States

The magnitude of the addiction problem in the United States can’t be underestimated.  Consider these staggering statistics from the American Society for Addiction Medicine (ASAM):

– Drug overdose is the leading cause of accidental death in the US, with 52,404 lethal drug overdoses in 2015. Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015.

–  The overdose death rate in 2008 was nearly four times the 1999 rate; sales of prescription pain relievers in 2010 were four times those in 1999; and the substance use disorder treatment admission rate in 2009 was six times the 1999 rate.

– In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills.

– Four in five new heroin users started out misusing prescription painkillers.

– 94% of respondents in a 2014 survey of people in treatment for opioid addiction said they chose to use heroin because prescription opioids were “far more expensive and harder to obtain.

Opioids for Veterans: Deja Vu All Over Again

It’s often said that the definition of insanity is doing the same thing over and over again and expecting a different outcome.  As previous articles from SFTT have argued, the VA is in a rut and will continue to pursue well-meaning but demonstrably ineffective procedures to help Veterans with PTSD.  Most tragic.

While one would think that there is compelling evidence for the VA to follow in a different tack, I read a few days ago that OxyContin is again being tested to treat PTSD and substance abuse.

How much longer to our Veterans need to suffer from the VA bureaucracy and autocratic controls that remains largely unresponsive to their very real needs?   Based on the evidence, it seems that the VA management philosophy of benign neglect will continue to persist.  How sad!

Easter Advice from Veteran Wives Who Care

On Facebook, I recently came across this wonderful advice from Wives of PTSD Vets and Military.  I quote this useful advice below:

“If there is anything you have learned from your experience that you would tell those who are new to PTSD and the VA, what would it be?

Just A FEW of mine would be:

1. Staying on top of the VA and the veteran’s care is a full time job by itself. It is important to stay on top of it or they will fall through the cracks. Don’t wait for the VA to call. You call the VA.
2. Always research the severe side effects, and interactions of ALL medications including over the counter.
3. Always be aware of their moods, anniversaries (if possible), and seek help if you see them slipping downward.
4. Have a safety plan.
5. Find ways to communicate with your spouse. Use of code words, safety words etc are extremely helpful for us. Our new one is trust tree, which means either one of has something important to say, and the other one can’t judge, flip out, or start an argument. So far, it’s working. I’ll make a post later for it.

These are only a few off the top of my head. I have a lot more in depth ones that I will write about after while. What things have you learned or did you wish you knew when starting this roller coaster ride called PTSD?”

While one can only hope that this pragmatic spouse finds a sympathetic ear at the VA, “effective treatment” still seems out of reach.

In summary, may our brave Veterans and their families and friends get the HONEST SUPPORT THEY DESERVE.

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SFTT Military News: Week Ending Apr 14, 2017

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Found below are a few military news items that caught my attention this past week. I am hopeful that the titles and short commentary will encourage SFTT readers to click on the embedded links to read more on subjects that may be of interest to them.

If you have subjects of topical interest, please do not hesitate to reach out. Contact SFTT.

Military Revamping Retirement System to Attract Millennials
In a bid to lure millennials, the U.S. military is making the most sweeping changes to its retirement program since World War II. Gone are the days when only a 20-year veteran leaves the service with a nest egg. Going forward, those who serve as little as two years will return to civilian life with retirement savings. The new system introduces 401(k)-type savings for military personnel while downsizing the traditional pension benefit—a trade the corporate world has been making for 35 years. The new design also comes with a stepped-up effort to provide service members with the education they will need to make the most of a system that demands more individual involvement.  Read more . . .

Expanded U.S. Military Push in Yemen?
Amid reports President Trump is considering more American military help for the Saudi-led fight in Yemen, U.S. lawmakers are urging caution, if not an about-face. Four U.S. senators have offered legislation to limit arms sales to Riyadh over its troubled Yemen campaign. Fifty-five members of the U.S. House called on Trump in a letter to end both U.S. refueling for Saudi coalition warplanes and logistical assistance for the Saudi-led bombings in Yemen — and they said Trump must seek congressional approval before he deepens U.S. military involvement.  Read more . . .

Department of Veterans Affairs

Another VA Hospital Criticized by the Inspector General
In a scathing report, the Inspector General for the Department of Veterans Affairs listed a range of overlooked and long-standing problems at the Washington, D.C., VA Medical Center “sufficient to potentially compromise patient safety.” The risk to the 98,000 vets served by medical center in the nation’s capital was so high that the office of Inspector General Michael Missal took the unusual step of issuing a preliminary report to alert new VA Secretary Dr. David Shulkin to the danger.  Read more . . .

Future of the US Military Health System
Three components are needed for a high-performing military. First, the health of military personnel affects “readiness and battlefield performance.” So, health is not only a personnel matter, but also a national security issue. Second, maintaining the health of service members requires “everything from nutritious meals to medical services.”  Third, health care benefits help to attract and retain men and women in the armed services.  Nevertheless, the Military Health System “is a major cost” to the federal government, and the growth of that system “threatens other defense priorities” and attracts “criticism and proposals to reform military health care.”  Read more . . .

Oxycontin and PTSD

Oxycontin Being Tested (Again) for Treatment of PTSD
Nightmares. Obsessive thoughts. Avoiding particular places. Sudden outbursts. Fearing you’re in danger. Survivor guilt. These experiences – manifestations of post-traumatic stress disorder (PTSD) – are part of life for up to 1 in 3 U.S. combat veterans and active military personnel. That’s more than triple the prevalence of PTSD in the population at large. About two-thirds of those with PTSD struggle with alcohol abuse. A new trial may hold new hope for these military personnel through treatment with oxytocin, sometimes referred to as the “love hormone.”  Read more . . .

Tonix Drug PTSD Study Enters Phase 3
Tonix Pharmaceuticals Holding Corp. announced today that it has enrolled the first participant in the Phase 3 HONOR study of TNX-102 SL 5.6 mg, for the treatment of posttraumatic stress disorder (PTSD). “Enrolling the first participant in the HONOR study is an important event not only to Tonix, but potentially to millions who suffer worldwide from both civilian and military-related PTSD,” said Seth Lederman, M.D., Tonix’s president and chief executive officer. “The HONOR study is designed to confirm the clinical benefit of TNX-102 SL to improve PTSD symptoms across several measures as demonstrated in our Phase 2 AtEase study in military-related PTSD.”   Read more . . .

VA Launches New “Quality of Care” Website
The Department of Veterans Affairs unveiled a new website Wednesday aimed at providing information on the quality of care at VA medical centers, touting new accountability even as it grappled with fresh questions of patient safety in its beleaguered health system. The VA website, www.accesstocare.va.gov, is a work in progress. It provides preliminary data on the VA’s 1,700 health facilities, along with more than a dozen private-sector hospitals and national averages. Three years after a wait-time scandal at the Phoenix VA medical center, the website offers comparative data on wait times as well as veterans’ satisfaction ratings in getting timely appointments.  Read more . . .

 

Drop me an email at info@sftt.org if you believe that there are other subjects that are newsworthy.

Feel you should do more to help our brave men and women who wear the uniform or our Veterans? Consider donating to Stand For The Troops

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VA Secretary David Shulkin: Glass Half Full?

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Department of Veterans Affairs (“the VA”) Secretary, Dr. David Shulkin means well, but it is not surprising that his leadership is being undermined by the same chronic conditions that have plagued other VA Secretaries.

Dr. David Shulkin, VA Secretary

THE VA IS SIMPLY TOO LARGE TO SUCCEED IN ITS MISSION

This week brings yet three more examples of the chronic problems facing the VA:

The VA still can’t FIX the Suicide Hotline

Secretary Shulkin Needs Senate Approval to Fire VA Employees

VA Dropping Veteran Caregivers from Their Rolls

Indeed, this litany of weekly crises is not dissimilar from scandals that have surfaced under the leadership of other VA secretaries.

What follows is a well-choreographed skit designed to reassure the public and Veterans that all is well in the Music Man’s River City.

“New Crisis” at the VA attracts national media;

VA Secretary assures Congressional subcommittee that problem will be fixed;

Congressmen get public facetime preaching to the converted;

– VA Secretary Shulkin sulks back to his office to prepare for next week’s Congressional hearing;

VA Labor Union blocks any constructive legislation that would allow the Secretary Shulkin to implement much-needed change within the VA.    Why?  Just ask J. David Cox, President of the American Federation of Government Employees, who once threatened a VA Secretary with “physical violence” for suggesting a change to the status quo.

For those who have followed this same tragic charade for many years, it is clearly evident that the VA is too big to succeed.  In the words of Nassim Taleb, the VA is fragile.

In my opinion, NO AMOUNT OF MONEY or CHANGE IN LEADERSHIP or ENACTMENT OF NEW LEGISLATION will bring about A MORE RESPONSIVE VA.

The VA has become a bureaucracy that answers only to itself and is not responsive to the needs of Veterans.  Frankly, the VA has lost its way and very little will change unless the VA is broken down into far smaller manageable components.

While smaller components of the VA will invariably fail, A SMALLER AND LESS CENTRALIZED VA WON’T COMPROMISE THE FULL MISSION.  

Will “change you can believe in” actually take place?  I think not, considering the entrenched political interest in maintaining the status quo and the patronage of a large block of voters represented by J. David Cox.

As presently configured, there is no possible way that the VA can fulfill President Abraham Lincoln’s promise: “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s Veterans.

As argued on several other occasions, the VA should be reconfigured to concentrate on those Veteran functions which require centralization.  All other activities should be assigned to smaller VA components or outsourced (with supervision) to the private sector.

For instance, the VA centralized suicide crisis line makes little sense.   Aside from the fact that the crisis line is currently non-responsive (and has been for a long period of time), it seems evident that we should allocate responsive resources far closer to a high-risk Veteran.

Let’s face it, few jumpers have been talked down off the ledge by a Call Center.  If you want to deal with high-risk Veterans in urgent need of support, get human resources to them as quickly as possible.  THINK LOCAL and COMMUNITY-BASED SERVICES.

While this more decentralized approach may not resolve the current Crisis Center problems, it would be far easier to manage and control at a local level.  Better yet, high-risk Veterans will benefit from a far more responsive human touch by local communities that truly care.

For Veterans, BIG IS NOT BEAUTIFUL!   Many Veterans see a largely unresponsive institution that seems more preoccupied with statistical adherence to protocol than positive patient outcomes. Wouldn’t it be wonderful if we could turn that perception around?

From the perspective of the VA, it is a lot easier to say that “we need more resources to deal with current shortcomings,” rather than face the reality that the VA has become a dysfunctional bureaucracy.

The Titanic

The ability to turn around the “Titanic” VA was lost many years ago.  Going forward, we must chop down the VA into far smaller component “passenger ships”  with accountability and leadership that can truly effect meaningful change.

Sure, one or more of these smaller components may fail, but not ALL Veterans will be held hostage by the continued failure in leadership of an INSTITUTION THAT IS TOO BIG TO SUCCEED.

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SFTT Military News: Week of April 7, 2017

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Found below are a few military news items that caught my attention this past week. I am hopeful that the titles and short commentary will encourage SFTT readers to click on the embedded links to read more on subjects that may be of interest to them.

If you have subjects of topical interest, please do not hesitate to reach out. Contact SFTT.

US Military Options in Syria
Trump said that Tuesday’s attack “crossed a lot of lines” for him and that his “attitude towards Syria and Assad has changed very much.” And Trump told some members of Congress that he’s considering military action in Syria in response, a source familiar with the calls told CNN on condition of anonymity. Trump has not yet spelled out what his administration will do, if anything. But inevitably, speculation is focused on whether he might embark on military action where former US President Barack Obama did not. So what are the possible military options for the US in Syria?  Read more . . .

Budget Gridlock Could Harm Military
Lawmakers must finalize a budget for the remainder of fiscal 2017 by the end of April or trigger a partial government shutdown. In recent days, talk of a continuing resolution to fund the government through the end of September has slowly built in the halls of Congress, raising concerns among defense officials who say that would cause tremendous funding headaches for the military.  Army Chief of Staff Gen. Mark Milley warned that with the U.S. facing foreign threats and wars against terrorism, it is no time to risk national security by closing the year with a continuing resolution or returning to statutory budget caps.  Read more . . .

sftt_soldier

Being a Military Advisor in the Middle East is Not Easy
Americans are currently advising Iraqi troops in a vicious fight against ISIS in Mosul, and the United States has almost doubled, to nearly 1,000, the number of U.S. soldiers and Marines on the ground in northern Syria just in the past month. But training local fighters is a risky job that’s hard to do right, especially in the Middle East, which is splintered into groups with conflicts that go back centuries. Those divisions can be religious (Sunni vs. Shiite), ethnic (Arab vs. Kurd) and national (Turkey vs. Syria). An advisor’s job is made all that much harder by the fact that the divisions overlap.  Read more . . .

Taliban to Focus on Vulnerable Provinces in 2017
“There will be an increase in attacks in those provinces that are on the verge of collapse,” Taliban spokesman Zabihullah Mujahid told Stars and Stripes. While in the past the group had single units covering several provinces, Mujahid said: “This year, we have a unit for every province in the country.” The ability to control the capitals of Afghanistan’s 34 provinces appears to be the barometer that U.S. and NATO forces use to measure success in the Afghan conflict. Occupying a capital has been a top priority of the Taliban, and some fear this could be the year they finally succeed.  Read more . . .

Common Antibiotic Helps Inhibit Fear Memories
Researchers from University College London and the University of Zurich recently discovered a startling side-effect of the common antibiotic doxycycline – it can disrupt and suppress the formation of fear memories in the brain. This fascinating discovery could not only lead to novel treatments for PTSD, but also offers scientists a clue to how the brain forms lasting fear and threat memories.  Read more . . .

Can Ayahuasca Reduce Dependence on Addictive Drugs?
Combat-related PTSD is notoriously difficult to treat and in theory ayahuasca can work as a form of drug-assisted exposure therapy. When traumatised people repeatedly avoid fear-inducing situations this only serves to maintain and reinforce the deeply ingrained conditioning that underlies their illness. The idea is that by dredging up traumatic memories and exposing them to conscious awareness within a safe, controlled environment, ayahuasca allows the brain to reassess and extinguish conditioned fear responses.  Read more . .

J. David Cox

J. David Cox

Legislation Needed to Fire Incompetent Employees at the VA
A bill to give Department of Veterans Affairs Secretary David Shulkin authority to quickly fire incompetent employees faces a major battle in the Senate, although it has his backing and has already passed the House. Shulkin came out in favor of the legislation after realizing he couldn’t immediately fire an employee caught watching pornography at work.  While the VA Accountability First Act of 2017 passed the House, only 10 Democrats voted in support.  The ranking member of the House Committee on Veterans Affairs, Democratic Rep. Tim Walz, voted against the bill.  Read more . . .

Drop me an email at info@sftt.org if you believe that there are other subjects that are newsworthy.

Feel you should do more to help our brave men and women who wear the uniform or our Veterans? Consider donating to Stand For The Troops

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