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BY JOHN MITERKO, CHAIR, GOVERNMENT AFFAIRS COMMITTEE, WITH
GOVERNMENT AFFAIRS STAFF
Everyone except the President, elected or appointed to an
office of honor or profit in the civil service or uniformed
services, takes the following oath: “I, AB, do solemnly
swear (or affirm) that I will support and defend the Constitution
of the United States against all enemies, foreign and domestic;
that I will bear true faith and allegiance to the same; that
I take this obligation freely, without any mental reservation
or purpose of evasion; and that I will well and faithfully
discharge the duties of the office on which I am about to
enter. So help me God.”
This is the actual public officer’s
oath that every federal official since the time of President
Lincoln has taken. While it may be implicit in the oath,
nowhere in the wording does it say that the person taking
the oath pledges to obey, uphold, and faithfully execute
the law of the land. Upon checking further in Title 38, it
turns out that none of the job descriptions for any of the
main offices at the Department of Veterans Affairs state
that the individual holding that office must uphold the law.
What is the point?
The
point is that VA officials seem to choose and pick the laws
they uphold, as well as how rigorously. This is not new with
the current administration, but we hope that it will end
here.
Nowhere is this more at issue—and of
key concern to Vietnam veterans and their families—than
with the VA’s
refusal to obey Public Law 106-419 and language in the current
2009 Appropriations Act, and move to complete the replication
of the National Vietnam Veterans Readjustment Study (NVVRS),
which was completed more than 20 years ago.
The law calls
for the VA to use the same study sample of individuals, thereby
making it a true longitudinal study that would be a robust
mortality and morbidity study of the last large generation
of veterans prior to the current generation fighting in Iraq
and Afghanistan. This is the law, not some cute idea advanced
by the Congress.
Unfortunately, this refusal
by the VA is part of what is clearly a decision to discard
the Vietnam generation of veterans. One illustration of this
is that there is not one single study currently funded by
the federal government on the long-term health impact of
dioxin, other herbicides, and the other toxins used in the
Vietnam War—not at the VA, not at
the Defense Department, not at the Environmental Protection
Agency, not at the National Institutes of Health, nowhere.
It is clear that this is by design since there is a good
deal of research into the long-term health consequences of
exposure to these chemicals going on in other countries.
VVA
National President John Rowan repeatedly has asked VA officials
what happened to the more than 1.2 million Vietnam-era veterans
who have died since 1975. How many of them served in Southeast
Asia or the adjacent waters? What was the cause of death?
Is the fact that more than one out of eight of us who survived
the war is now dead “normal”?
Any reasonable person would expect that such basic epidemiological
questions would have been answered by now.
Since it is clear
that current VA officials intend to continue their refusal
to obey the law in regard to completing the NVVLS and in
other instances where it suits them, it would seem that a
requirement to obey the law needs to be written into the
statutory job description of each top VA appointed official,
as well as a requirement that the officials uphold all statutes
within their span of control.
Any reasonable
person would think that such a step would not be necessary.
But, then again, any reasonable person would have expected
the completed National Vietnam Veterans Readjustment Study
to have been delivered to the Congress on October 1, 2005,
when it was due.
(For more on this issue, see “NVVLS” on www.vva.org)
REACHING
OUT TO VETERANS
Maybe Congress is finally acknowledging the fact that a lot
more must be done to inform veterans and their families about
the benefits veterans have earned by virtue of their service
in uniform.
Back in June, the Senate Veterans’ Affairs
Committee included in the Veterans Health Care Authorization
Act an effort by Sens. Russ Feingold (D-Wisc.) and Bernie
Sanders (I-Vt.) to improve outreach to veterans. The Feingold-Sanders
language, based on Feingold’s Veterans Outreach Improvement
Act, would expand a grant program for community-based organizations
to include state and local entities, including the National
Guard and veteran service officers who conduct outreach for
veterans. The measure would also require coordination between
grant recipients and the VA.
“Nearly every day I learn of veterans in my state who
are not aware of services and benefits they have earned through
their service to our country, including wounded veterans
who fall through the cracks as they transition out of the
military,” Feingold said. “Conducting outreach
is more important than ever as we welcome home and prepare
to enroll into the VA system the tens of thousands of dedicated
military personnel who are serving in Afghanistan, Iraq,
and other places around the globe.”
“This legislation expands on a model program the VA
and National Guard have used in Vermont to help service members
returning from Iraq and Afghanistan,” Sanders added. “We
can have the best health care services in the world for our
veterans and their families, but if they do not know about
them or cannot access them, what good do they do? This legislation
will provide resources to organizations so that they can
reach out to returning service members, veterans, and their
families.
“With as many as 300,000 U.S. military personnel who
have served in Iraq or Afghanistan suffering from PTSD or
major depression and as many as 320,000 having suffered a
traumatic brain injury of some kind, we need these outreach
services more than ever.”
Our only quibble with this
is that it does not include veterans’ service
representatives of the veterans’ service organizations.
In
a related development, the Subcommittee on Oversight and
Investigations of the House Committee on Veterans’ Affairs
held a hearing in July on the implementation of the recent
decision by the VA to use television advertising and marketing
in its outreach to veterans.
Currently, the VA does not use
national media campaigns to advertise benefits and services
it provides. As part of its long-range planning, the VA was
prohibited from using television advertising to notify veterans
about services offered at VA hospitals, Community-Based Outpatient
Clinics, and Vet Centers. Following the introduction of legislation
from Reps. John Boozman (R-Ark.) and Stephanie Herseth Sandlin
(D-S.D.), the VA has changed its policy and is in the process
of implementing a plan to begin mass advertising.
“The VA clearly needs to enter the 21st century when
it comes to notifying veterans about services available to
these American heroes,” said subcommittee Ranking Member
Ginny Brown-Waite (R-Fla.). “It is mind-boggling to
me that it has taken until 2008 for the VA to even consider
television advertising and has yet to even contemplate using
e-mail as a way to quickly and cheaply communicate with veterans.
It was heartening that Secretary Peake has removed the prohibition
on television advertising, but very distressing that they
aren’t even collecting e-mail addresses for veterans.”
In
the past, VA policy barred purchasing paid media to advertise.
On June 16, Secretary Peake issued a memorandum rescinding
the 20-year VA-imposed policy restriction on the purchase
of paid media advertising.
“Getting the word out about veterans’ benefits
to our nation’s heroes should be a high priority for
the Department of Veterans Affairs,” Brown-Waite said. “Printing
brochures and handbooks in this day of the Internet and instant
messaging is still a very expensive option, but 21st century
technology needs to be explored.
The VA needs to quickly move beyond snail
mail and television and embrace e-communication as a way
to reach veterans. This would create new efficiencies, save
taxpayer funds, and provide information and resources veterans
are seeking.”
We couldn’t agree more.
VICTORY FOR VETERANS WITH DIABETES
Back in March, the Veterans Health Administration quietly
added the therapeutic category “long-acting insulin” to
the VA Formulary. The addition of these newer therapeutic
categories of drugs, for which VVA has long advocated, brings
the VA more in synch with treatment for diabetes in the rest
of the country.
Of the 5.5 million veterans who receive VA
health care services, approximately 20 percent—well
over one million—are
diabetic. By comparison, the American Diabetes Association
estimates that approximately 7 percent of the U.S. population
has diagnosed or undiagnosed diabetes. The prevalence of
diabetes among veterans can be attributed to the average
age of the veteran population, the predominance of men in
the system, and a higher rate of smoking than the population
overall, but most of all, service in or around the Southeast
Asia theater of operations during the Vietnam War, whether
in Vietnam, Thailand, or in the waters off of the coast.
A
recent study by the VA Pharmacy and Therapeutics Society
on the implementation of new insulin glargine for patients
with diabetes revealed significant differences in implementation
between VA regions and treatment facilities. The addition
of long-acting insulin to the Formulary should help improve
care across the VA system.
The evidence is overwhelming that
poor diabetes care results in drastically increased costs,
a poorer quality of life, and worse clinical outcomes—including
increased blindness, cardiovascular diseases, amputations,
and kidney problems.
The
connection between exposure to the use of defoliants, especially
in Vietnam, and a higher than normal subsequent development
of type II diabetes, is well established.
New
insulin products can be used with an insulin pump or auto-injector
pen. Patients with diabetes, or those who believe they may
have diabetes, should consult their physicians. The conditions
that lead to diabetes include overweight (especially abdominal
fat), hypertension, raised cholesterol and lipids levels,
and smoking. The characteristic symptoms of diabetes are
excessive urine production due to high blood glucose levels,
excessive thirst and increased fluid intake to compensate
for increased urination, blurred vision due to high blood
glucose effects on the eyes’ optics, unexplained weight
loss, and lethargy.
McCAIN REVERSAL
Sen. John McCain (R-Ariz.), the presumptive GOP nominee for
President, has seemingly reversed field on his voucher concept
for veterans health care. His new-and-improved VA Card would
only go to certain veterans in special circumstances. This
announcement was made in an address to the DAV convention
on August 9, according to VA Watchdog Larry Scott.
McCain
says the card would be a choice for “veterans
with illness or injury incurred during military service,
as well as low-income veterans,” not every veteran
as previously promised.
The card could only be used if the
VA could not provide care under the following conditions: “No
more than an hour’s
drive for care, routine care within a week, urgent care within
24 hours, and specialty care within a month.”
McCain
said that the card would be a “supplement to
ordinary VA care, which would not replace or privatize existing
programs.” And that’s the rub.
As Scott noted, for every veteran who opts for private health
care, that means there is one less veteran using the VA.
The inevitability is obvious: The VA would receive less funding.
But
keep in mind that one out of every ten health-care dollars
goes out of the VA system already in what is known as fee-basis
care. This is, one can argue, very much like what Sen. McCain
is proposing.
We maintain, however, that the old adage remains
true: If it ain’t broke, don’t fix it.
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©2006-
2008, Vietnam Veterans of America. All Rights Reserved. 8605 Cameron
Street, Silver Spring, MD 20910