Can Secretary David Shulkin Fix the VA?

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Can Secretary David Shulkin fix the Department of Veterans Affairs (“the VA”)?  The answer is an emphatic NO!

Department of Veterans Affairs

This is not a commentary on Dr. Shulkin’s inspired leadership or his vision for a vastly improved VA, but a consequence of competing ideologies and a dysfunctional institution.

As Stand for the Troops has stated several times over the past year: “THE VA IS SIMPLY TOO LARGE TO SUCCEED IN ITS MISSION.”

As suggested in last week’s article by Maj. Ben Richards, the care provided by the VA is far different than the “happy talk” its administrators disseminate to a gullible public and Congress.   The disturbing suicide of Veteran Eric Bivins can clearly be laid at the doors of the VA, but does anyone in authority really care?

Will the desperate pleas Eric’s spouse Kimi resonate in the corridors of power in DC?  Probably not.  And yet, Kimi’s description of the troubling treatment provided by the VA is far more accurate than the self-serving assurances that VA “change agents” dispense to the press.

Veterans are giving up hope daily and seeking treatment outside the VA.  If Congress truly wanted to know the extent of the problems in the VA, they would surely spend far more time seeking out the views of Veterans than blindly accept the assurances of its administrators.  Will this occur? Not likely – and even if it were to occur, not much is likely to change.

The VA is like an old automobile that is falling apart.  Sure, we can try fixing it with the same failed strategies that have been used in the past OR how about trying a different approach? Scrap the dysfunctional VA and build a responsive institution that truly attends to the needs of most Veterans?

How Can the VA be Fixed?

With an annual budget of over $180 billion and nearly 350,000 employees, things can easily get off-track.  More to the point, impassioned administrator can run about putting their fingers in the holes of a leaking dyke, but another leak will surface almost immediately.

As I stated previously,

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.  

The public seems relieved that Veterans now have a choice of service providers because the Choice Program has been extended by Congress, but for many thousands of Veterans like Eric Bivins and his family, there really is NO CHOICE!

Where the VA is Today

Personally, I believe that Dr. Shulkin has done a remarkable job in addressing some of the more urgent problems at the VA.  While one can argue whether he has done enough, the task he has been given is like being assigned to captain the Titanic after it has hit the iceberg.

The speed with which the VA will sink further into disrepute may be slowed, but SINK it will.

How many more reports do we need from the Office of the Inspector General (the “IG”) that the VA lacks effective governance and oversight?

How many more times to we have to fire ineffective VA employees when the Labor Union intercedes to protect  employee “rights”?

How many more infection risks do Veterans need to overcome at VA facilities?

These are just the latest “issues” that Dr. Shulkin and his staff need to deal with.  Despite evidence of much needed progress to overhaul the VA, these problems are likely to persist.

In fact, every local incidence of inefficiency or incompetence becomes magnified into a matter of national concern and raises further doubts about the VA’s ability to reform itself from within.  Frankly, there are far too many competing mandates for it to do so.

Sadly, our Veterans and their loved ones will continue to suffer until we stop posturing and enact real reform.

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SFTT Military News: Highlights for Week Ending August 4, 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.

With Eye on Russia, US Military Focuses on Global Exercises
The U.S. military is moving toward more global exercises to better prepare for a more assertive Russia and other worldwide threats, a senior officer said in an interview with Reuters. Air Force Brigadier General John Healy, who directs exercises for U.S. forces in Europe, said officials realized they needed to better prepare for increasingly complex threats across all domains of war – land, sea, air, space and cyber. Some smaller-scale war games with a global focus had already occurred, but the goal was to carry out more challenging exercises by fiscal year 2020 that involved forces from all nine U.S. combatant commands – instead of focusing on specific regions or one military service, such as the Marines.  Read more . . .

Secretary of State Tillerson Seeks Talks with North Korea
In the Trump administration’s first serious attempt at a diplomatic opening to North Korea, Secretary of State Rex W. Tillerson has offered to open negotiations with Pyongyang by assuring “the security they seek” and a new chance at economic prosperity if the North surrenders its nuclear weapons.Mr. Tillerson’s comments came just hours before the United States on Wednesday tested an unarmed Minuteman III intercontinental ballistic missile, sending it 4,200 miles to a target in the Marshall Islands. The Pentagon said the test was not intended as a response to the North’s launch on Friday of a missile that appeared capable of reaching Los Angeles and beyond.But military officials said the test demonstrated that the American nuclear arsenal was ready “to deter, detect and defend against attacks on the United States and its allies.”  Read more . . .

Telehealth for Veterans Rolls Out To General Acclaim
American Telemedicine Association (“ATA”) has long supported the VA’s vision of expanding veterans’ access to telehealth services, facilitating high-quality encounters between veterans and providers, and ensuring that veterans are equipped with the best tools to monitor their health. This includes innovative models that facilitate cross-state practice and enable consumer choice such as the VETS Act (S. 295 and H.R. 2123). “We applaud Dr. Shulkin for demonstrating the value of telehealth today at the White House.” said Gary Capistrant, Chief Policy Officer, ATA. “We encourage President Trump to issue an Executive Order to eliminate the state-by-state licensure model for all federal and private-sector health professional employees servicing federal government programs—notably agencies (such as the VA and the Department of Health and Human Services), health benefit programs (such as Medicare and TRICARE), federally-funded health sites (such as community health centers and rural clinics), and during federally-declared emergencies or disasters.  Read more . . .

Veteran Choice Options Expanded
Thank bipartisan support for helping veterans, or lingering anger over the previous scandals at the Department of Veterans Affairs, but whatever the reason, Congress is managing to get legislation passed addressing veterans’ needs. First, Congress finally worked out a deal on funding for Veterans Choice. If you believe that veterans should be able to seek out and get the best care wherever they prefer, whether it’s within the VA or from a private health care provider, Veterans Choice is a nice half-step, but hardly a sweeping change. (The booming demand for treatment through the program can be interpreted in veterans’ interest in exploring other treatment options.)  Read more . . .

Brain and PTSD Studies

No Surprise Here:  PTSD May Be More Physical than Psychological
The part of the brain that helps control emotion may be larger in people who develop post-traumatic stress disorder (PTSD) after brain injury compared to those with a brain injury without PTSD, according to a study released today that will be presented at the American Academy of Neurology’s Sports Concussion Conference in Jacksonville, Fla., July 14 to 16, 2017. “Many consider PTSD to be a psychological disorder, but our study found a key physical difference in the brains of military-trained individuals with brain injury and PTSD, specifically the size of the right amygdala,” said Joel Pieper, MD, MS, of University of California, San Diego. “These findings have the potential to change the way we approach PTSD diagnosis and treatment.” In the brain there is a right and left amygdala. Together, they help control emotion, memories, and behavior. Research suggests the right amygdala controls fear and aversion to unpleasant stimuli.  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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SFTT News: Highlights for Week Ending Jul 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.

New Russian AK-12 Assault Weapon Passes Field Tests
The AK-12 assault rifle has passed military field tests and meets all of the Russian armed forces’ design and operational standards, gunmaker Kalashnikov Concern says, according to Jane’s 360. The AK-12’s success in military trials sets it up to become the standard weapon for soldiers in Russia’s Ratnik — or Warrior — future weapon system. Work on the AK-12 began in 2011 with the AK-200 as a base model. Kalashnikov Concern presented prototypes in early 2012, and the first generation of the weapon was also successful in military tests.  Read more . . .

AK-12 Kalashnikov

Russia May Deploy Military in Syria Buffer Zones
Russia may deploy its military to police the borders of planned de-escalation zones in Syria within two to three weeks after finalizing an agreement with Turkey and Iran, Russian negotiator Alexander Lavrentyev said on Tuesday. Moscow hopes to sign the final documents with Ankara and Tehran on Wednesday, he told reporters after a series of meetings in the Kazakh capital, Astana.  Read more . . .

DIA Analysis on Russian Military Capabilities
The Pentagon’s Defense Intelligence Agency has released a new assessment of Russian military power—reviving a Cold War-era practice. The agency concludes that the modern Russian military builds upon its Soviet heritage but has modernized its capabilities and doctrine for the present day. “The Russian military has built on the military doctrine, structure, and capabilities of the former Soviet Union, and although still dependent on many of the older Soviet platforms, the Russians have modernized their military strategy, doctrine, and tactics to include use of asymmetric weapons like cyber and indirect action such as was observed in Ukraine,” the DIA report states.  Read more . . .

VA “Choice Funding” Requires Congressional Action
When they return from legislative recess next week, lawmakers will have only a few days to address financial problems with the Veterans Affairs Choice program before users start to see significant problems.  Last month, in testimony before the Senate, VA Secretary David Shulkin warned lawmakers that money in the Choice program funds was being spent at a faster rate than officials expected, threatening to bankrupt the program before the end of the fiscal year. Available funds dropped from about $2 billion to less than $850 million in three months.  Read more . . .

VA “TBI Model” to Determine Long Term Care Policy
“The VA TBI Model System is uniquely positioned to inform policy about the health, mental health, socioeconomic, rehabilitation, and caregiver needs following TBI,” write Guest Editors Risa Nakase-Richardson, PhD, of James A. Haley Veterans’ Hospital, Tampa, Fla., and Lillian Stevens, PhD, of Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va. The special issue presents initial reports from a Department of Veterans Affairs (VA)-specific database of patients representing all traumatic brain injury (TBI) severity levels. The findings will play a critical role in VA’s efforts to meet the long-term needs of veterans with TBI.  Read more . . .

5 Common Misconceptions about PTSD
June 27 is National PTSD Awareness Day, an opportunity to bring to light a disorder that affects millions of Americans every day. The distinction of this day was granted by the United States Senate in 2010. In 2014, the Senate upgraded the cause by designating the full month of June toward raising awareness for PTSD. These efforts are critical to providing opportunities to educate the public about PTSD and how it affects those with the disorder.  Read more . . .

Electromagnetic Brain Pulse Study Underway for PTSD
A study by the Consortium to Alleviate PTSD will test whether PTSD can be treated with electromagnetic pulses to the brain. The study, beginning this summer, will treat 100 military members and veterans with PTSD at the Laurel Ridge Treatment Center in San Antonio. There, a robot will guide an electromagnet pulse across each subject’s scalp during 20 days of treatment. If it seems like science fiction, the therapy, known as transcranial magnetic stimulation (TMS), has a genealogy going back all the way to Galvani’s frogs, said Peter Fox of UT Health, the study’s primary investigator.  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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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 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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