Retiree & Veteran Affairs News 2 July 2013 

7/2/2013 

   

ARMY ANNOUNCES RESTRUCTURING PLANS

In response to the Army’s announcement that it is reducing end strength and reorganizing brigade combat teams, Chairman of the House Armed Services Committee, Rep. Howard P. "Buck" McKeon, R-Calif., said, “As damaging as they are, these cuts don't begin to reflect the crippling damage sequestration will do to our Armed Forces and National Security.  The Committee will carefully examine the implications of this initial restructuring, but we all must understand that this is only the tip of the iceberg, much deeper cuts are still to come.  America learned the hard way that our pre- 9/11 military was too small.  Now, even before sequestration, we are reducing the force to that same size and foolishly expecting history to teach us a different lesson.  What lessons will we learn when sequester doubles these cuts in just a few months' time?”

The Army plans to reduce the authorized endstrength of the Active Army from 570,000 to 490,000 and the Army National Guard from 358,000 to 350,000 and will inactivate a total of 12 BCTs. 

In a press conference last week, Army Chief of Staff Gen. Ray Odierno said, “The reduction of 80,000 Soldiers or 14% from the Active Component will be completed by the end of fiscal year 2017.  Let me be clear, we are taking these actions as a result of the Budget Control Act of 2011.  This endstrength and force structure reduction predates sequestration.  If sequestration continues into Fiscal Year 2014, Army reductions to endstrength, force structure and basing announced today will be only the first step.”

Later in the press conference, Odierno reiterated, “I want to emphasize that these reductions do not reflect reductions due to sequestration.  Full sequestration could require another significant reduction in Active, Guard, and Reserve force structure as much as 100,000 combined.”

AUSA President Gen. Gordon R. Sullivan said that “Congress must find an alternative to sequestration.  Everyone needs to be reminded of history’s lessons, of the dangers of a hollow Army that is called to fight the first battle of the next war – but without enough manpower, training or weaponry to do the job – of an Army which then pays the price of unreadiness in the blood of too many Soldiers killed or wounded while they train the hard way – during war not before it.”

 AN END TO THE DOC FIX?

Working with the House Committee on Ways and Means, leaders from the House Energy and Commerce Committee have unveiled draft legislation that would repeal the current Sustainable Growth Rate (SGR) system and replace it with a fair and stable system of physician payments in the Medicare program. 

Enacted in 1997 as part of the “Balanced Budget Act,” the SGR is a continued concern for physicians who serve Medicare beneficiaries and for the beneficiaries themselves.  Because payments to doctors who treat TRICARE beneficiaries are tied to Medicare, it also affects active duty, reserve, and retired military personnel and their families.  For years, Congress has implemented a temporary “doc fix” to prevent substantial Medicare reimbursement rate cuts, which could result in fewer physicians willing to serve Medicare/TRICARE patients.

The draft legislation would replace the current SGR with an enhanced fee-for-service system, while allowing providers to opt out and participate in alternative payment models.  A contractor would evaluate the alternative models through demonstration programs, and report on those that work best.

Although the draft legislation provides a clearer picture of the proposed new payment system, it does not address how to pay for the cost of repealing the current payment system.  The Congressional Budget Office estimates the cost of repeal would be $139.1 billion over 10 years.

What’s next:  Health Subcommittee Chairman Joe Pitts, R-Penn., said he plans to hold a markup of the legislation next month.

TRICARE PRIME LEGISLATION PASSES HOUSE

Legislation (H.R. 1971) that would require the Defense Department to offer the TRICARE Prime managed health care option in places where the department plans to discontinue the program was passed by the House as part of the defense authorization bill.

Due to a policy change, more than 170,000 veterans across the country who live outside 100 miles of a military treatment facility will lose access to TRICARE Prime on Oct. 1, 2013. 

Introduced by Rep. John Kline, R-Minn., the legislation would afford every affected veteran the opportunity to continue their enrollment in TRICARE Prime or move to TRICARE Standard, depending upon which plan best fits their needs.

Since there is no similar provision in the Senate’s version of the authorization bill, whether or not it is included in the final bill will have to be negotiated in the House-Senate conference committee. 

VA: DISABILITY CLAIMS BACKLOG REDUCED

The Department of Veterans’ Affairs announced that an initiative they launched in April to expedite disability compensation claims decisions for veterans who have a waited a year or longer has cleared more than 65,000 claims -- or 97 percent of all claims over two years old.

Allison A. Hickey, VA’s undersecretary for benefits, said the success of this phase of the effort was due in part to the implementation of mandatory overtime for the Veterans Benefits Administration’s claims processing staff, as well as the support of physicians from the Veterans Health Administration, who expedited exams to provide medical evidence needed to rate the pending claims.

In response to the VA’s statement, Rep. Jeff Miller, Chairman of the House Veterans’ Affairs Committee, said “Any progress toward eliminating the backlog is welcome news. But we cannot forget that the department is still far short of its own backlog performance benchmarks for 2013. Additionally, one can’t help but question how the department was able to process most of its two-year-old claims in just 60 days. If two months was all VA needed to adjudicate these claims, why did the department let them sit for two years or longer? Furthermore, what will happen to the backlog once VA employees are taken off of mandatory overtime and returned to regular duties? Nevertheless, when it comes to evaluating VA’s success in combatting the backlog, the two most important numbers are zero and 2015. In other words, this problem won’t be solved unless the backlog is at zero by 2015, just as VA leaders have promised.”

Miller's statement echoed what many lawmakers have been saying.  A bi-partisan letter from 160 House members to President Obama urged that he become more involved in resolving the disability claims backlog.  Sixty-seven Senators sent their own letter to the President. 

The remaining two-year-old claims will be finalized in the coming days, officials said, except for those that are outstanding due to unique circumstances, such as the unavailability of a claimant for a needed medical exam, military service, vacation or travel overseas.

AMENDMENT WOULD CREATE JOBS FOR FORMER SERVICEMEMBERS

An amendment to the Senate’s immigration reform bill that encourages the Department of Homeland Security (DHS) to recruit servicemembers and veterans to serve in border security positions was adopted by a voice vote.

Introduced by Sens. Mark Pryor, D-Ark., and Mike Johanns, R-Neb., the amendment would offer bonuses and incentives including the repayment of student loans to members of the National Guard and  reserve as well as veterans who take border security jobs with the DHS.

Unfortunately, the amendment’s outlook is uncertain.  It is not clear whether or not the Senate has the 70 votes needed to pass the immigration bill.  Even if they do pass it, it will still need action by the House. 

RETIREE DENTAL PROGRAM CONTRACT EXTENDED

The Defense Department announced last week that they have extended the TRICARE Retiree Dental Program (TRDP) contract through Dec. 31, 2013.

Authorized by Congress in the fiscal 1997 National Defense Authorization Act, the current TRDP contract was scheduled to run from Oct. 1, 2012 through Sept. 30, 2013.  The contract extension will bring it in-sync with the other healthcare contracts on a calendar year versus fiscal year basis.

The contract extension brings no change in premiums or scope of benefits.  However, the annual maximum for enrollees in the Enhanced program will be increased to $1,500 for this period.  Those in the Basic program will see their maximum increase to $1,250. 

These changes were implemented April 1.  If beneficiaries have already reached the maximum for the year, they should have their dental provider resubmit any claims that were not made due to exceeding the maximum.

Delta Dental also will serve as administrator of the new five-year TRDP contract, which will begin Jan. 1, 2014.

Supreme Court Rules Defense of Marriage Act Unconstitutional

In a 5-4 ruling, the Supreme Court overturned the Defense of Marriage Act (DOMA). Secretary Hagel released a statement, saying:
 
“The Department of Defense welcomes the Supreme Court's decision today on the Defense of Marriage Act.  The department will immediately begin the process of implementing the Supreme Court's decision in consultation with the Department of Justice and other executive branch agencies.  The Department of Defense intends to make the same benefits available to all military spouses -- regardless of sexual orientation -- as soon as possible.  That is now the law and it is the right thing to do. Every person who serves our nation in uniform stepped forward with courage and commitment.  All that matters is their patriotism, their willingness to serve their country, and their qualifications to do so.  Today's ruling helps ensure that all men and women who serve this country can be treated fairly and equally, with the full dignity and respect they so richly deserve.”

We will continue to provide updates on what this ruling will mean for same-sex military families as the story continues to develop.

Army Initiates Collaborative Effort on TBI, PTSD

At a National Post Traumatic Stress Disorder Day event held in Washington, DC, BG Cho, deputy chief of staff with Army Medical Command stressed that the invisible wounds of war were not just issues specific to the military community, and as such, should be included in the national dialogue about identification and treatment. As part of its collaborative effort, the Army is participating in a $60 million research study for TBI, and $700 million has been allocated toward both PTSD and TBI as the result of a White House executive order for a renewed effort in collaboration with the Veterans Affairs Department and other organizations. Additionally, the Army has set up seven "restorative centers" in Afghanistan, where TBI can be identified and treated, often allowing soldiers to stay in theater as they improve. Read the full article on the measures being taken to advance TBI and PTSD study, and the organizations working to support the military’s efforts.

DoD Training Prepares Care Coordinators to Support Service Members, Families and Caregivers

Quarterly training for Recovery Care Coordinators, Advocates, Non-Medical Case Managers and other non-medical care coordinators with standardized DoD-level training to prepare them for their mission of supporting recovering Service members, families and caregivers throughout the continuum of care. Topics covered during training included Office of Warrior Care Policy programs such as the Integrated Disability Evaluation System (IDES), the Education and Employment Initiative (E2I), Operation Warfighter (OWF) and the Military Adaptive Sports Program (MASP).

Care coordinators will also be trained to recognize and respond to issues commonly faced by recovering Service members and families, including traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), suicide prevention and sexual assault prevention and response. In addition to receiving information and training for knowledgeable agencies and organizations, trainees also benefitted from hearing first-hand accounts from those familiar with their experience. Read more about this training event here.

Army Cuts Brigades in Effort to Begin Total Force Reduction

The Army recently announced cuts to 10 brigade combat teams at US installations and two abroad, in an effort to meet the previously announced goal of an 80,000 soldier reduction by 2017.  The major force structure cuts are a result of looming budget restraints, and will reduce the number of brigade combat teams from 45 to 33. By 2017, brigades will deactivate from the following locations:  Fort Bliss, Texas; Fort Bragg, N.C.; Fort Campbell, Ky; Fort Carson, Colo.; Fort Drum, N.Y.; Fort Hood, Texas; Fort Knox, Ky.; Fort Riley, Kan.; Fort Stewart, Ga., and Joint Base Lewis-McChord, Wash.  Two brigades in Germany will deactivate by the end of the fiscal year, leaving just two brigade combat teams in Europe to fulfill strategic commitments. 

The reduction of 80,000 soldiers from the force represents a 14 percent reduction across the active component force. The specific impacts of these decisions on individual installations are being provided to affected Congressional delegations and will be presented prior to taking any irrevocable actions to implement these decisions.  We will continue to monitor this story and the trickledown effect it will have for Army families. Read the full release here.

2013 AUSA Annual Meeting and Military Family Forum Registration Open

Registration is now open for the 2013 AUSA Annual Meeting, October 21-23, along with the Military Family Forums. These forums within the Annual Meeting are designed to engage and inform both the military community and the greater civilian community around them. We are excited to connect with military families, share resources, and gain insight from our scheduled speakers and panelists. Our forums this year will feature the Army’s top leaders and in depth discussions about holistic approaches to self-care, outside the installation community resources, and the rapidly expanding world of military community and family support via social networking and online outreach.

AUSA Family Programs Attends MFRI Symposium

The Military Family Research Institute, housed at Purdue University, recently held their fourth annual International Research Symposium for Military Families in Indianapolis. Researchers and policy experts presented on important military family issues and discussed new approaches and ideas for support. The Symposium brought together leading military and civilian scholars who study issues relevant to military families, and presentations focused on deployment, caregiver issues, parenting, and marriage stressors. In small- and large-group settings, participants offered feedback and commentary, which previously helped to form the basis for chapters in previous editions of MFRI’s research text, Risk and Resilience in U.S. Military Families. Click here to read more about the Symposium.

DoD Extends TRDP Contract

The TRICARE Management Activity (TMA) of the Department of Defense has extended the current TRICARE Retiree Dental Program (TRDP) contract – which runs from October 1, 2012 through September 30, 2013 – to continue through December 31, 2013.The contract extension brings no change in premiums or scope of benefits. However, the annual maximum for enrollees in the Enhanced program will be increased to $1,500 for this period.

Those in the Basic program will see their maximum increase to $1,250. And, although the maximums are being INCREASED for the extended period, enrollees will NOT be asked to pay a higher deductible. These changes were implemented April 1. If you had already reached your maximum for the year, please have your dentist resubmit your claim(s) that were not made due to exceeding the maximum. Delta Dental also will serve as administrator of the new five-year TRDP contract, which will begin January 1, 2014.The TRDP, authorized by Congress as part of the National Defense Authorization Act for fiscal year 1997, offers affordable dental benefits as a voluntary option to the nation's 5 million-plus Uniformed Services retirees and their family members. With current enrollment of more than 1.3 million, the TRDP is the nation's largest voluntary, all-enrollee-paid dental programs.

The TRDP will continue as a worldwide, combined fee-for-service/preferred provider program that offers enrollees access to any licensed dentist in all 50 states, plus the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, the Commonwealth of the Northern Mariana Islands, Canada and overseas. If you have any questions you can visit their web site www.trdp.org.

37 Overseas Commissaries to Remain Open During Furloughs

As suggested previously, nearly 40 stores in Europe and the Pacific will remain open with local national employees during furloughs, said the director and CEO of the Defense Commissary Agency. Because of international agreements, local national employees are exempt from furlough. Store staffs overseas include a mix of U.S. and local national employees, and 37 of DeCA’s 66 overseas stores have enough local national staff to remain operational.

The Department of Defense announced those commissaries would remain open during furloughs. This includes stores in the U.K., Belgium, Italy, Turkey, Japan, and more. As sequestration continues, commissary customers can quickly find out about any changes to their local store’s operating schedule here on commissaries.com by clicking on the “Locations” tab on the home page, then “Alphabetical Listing”; after finding your store, click on “Local Store Information.” To read the full press release and the list of overseas commissaries remaining open, visit the DeCA news page.

Military OneSource Spouse Education and Career Opportunities Program

The Spouse Education and Career Opportunities Program provides education and career guidance to military spouses worldwide. SECO offers comprehensive resources and tools ranging from initial career exploration to education and training to employment readiness to career connections.

Using the tools and assessments on MySECO, you can begin to explore your interests, skills, passions and personality type to determine the best fit for education and career choices for building a portable and meaningful career path. To create an account and log in visit the MySECO portal.

2013 AUSA Annual Meeting and Military Family Forum Registration Open

Registration is now open for the 2013 AUSA Annual Meeting, October 21-23, along with the Military Family Forums. These forums within the Annual Meeting are designed to engage and inform both the military community and the greater civilian community around them. We are excited to connect with military families, share resources, and gain insight from our scheduled speakers and panelists.  Take a look at our forum descriptions below.
 
• Military Family Forum I- Our Military Community: Voices from the Top: This forum will feature town hall style presentations from the top Army leaders. 
• Military Family Forum II- The Performance Triad: A Holistic Approach to Self-Care: This forum will explore holistic approaches to caring for one’s self and family. New and innovative programs from the Department of the Army and the Department of Defense will be discussed. 
• Military Family Forum III- Community Resources: A Beautiful Day in the Neighborhood:This forum will showcase the growing support of military families by civilian organizations through private /public partnerships with the military community. 
• Military Family Forum IV- Expanding Our Reach: Our Neighborhood Knows No Bounds: This forum will explore innovative uses of social media and advanced technology in the military family communications arena. Featured speakers will share techniques and successful approaches to building a virtual support community. 

We look forward to seeing you in October. Register today!

Senate Committee Not Happy with VA on Burn Pit Registry

Last week the Senate Appropriations Committee, chaired by Senator Barbara Mikulski (D-MD), took action to ensure that the Veterans Affairs Department establishes a registry for troops exposed to potentially toxic fumes from open-air burn pits in Iraq and Afghanistan on time and in compliance with existing law.

Noticing that VA has moved rather slowly to establish the registry as mandated by the 2012 Dignified Burial and Veterans Improvement Act, the committee approved an amendment to the $158 billion military construction and veterans appropriations bill that recommends VA inform veterans and family members about the registry and work with the Defense Department to educate troops on the possible health consequences of exposure.

The amendment would require the VA to give Congress a report on its planned timeline and communications strategy for reaching veterans and informing its own personnel about the registry. This has been a goal for the claims backlog as well, so applying it to the Burn Pit Registry is a step in the right direction as well.

The Airborne Hazards and Open Burn Pit Registry is supposed to be up and running by January 2014. It is meant to track troops who served in areas where burn pits were used for waste disposal and notify participants of significant developments in treatment and research on environmental exposure-related diseases. Participation is voluntary.

The VA finally posted its proposed rules setting up the registry in the Federal Register. As we told you two weeks ago this is the time for all of us to tell them our opinions. The open comment period on the burn pit registry began June 5 on regulations.gov as required by law. In the first two weeks, more than 120 people commented, providing information ranging from what was tossed into the pits, illnesses and symptoms, to privacy concerns. Again, please consider going to https://www.federalregister.gov/articles/2013/06/05/2013-13224/proposed-information-collection-open-burn-pit-registry-airborne-hazard-self-assessment-questionnaire to study their proposed rules and comment on the plan.

The VA had opposed the creation of the registry, saying that it already tracks service members through an injury and illness surveillance system.

VA documents estimate the project will cost roughly $2.2 million in fiscal 2013: $600,000 in contract costs, $1.5 million for information technology and $70,000 for outreach to veterans.

As with other organizations, the $70,000 budget for outreach to veterans seems like it might be on the low end of what is required to accomplish the mission. TREA will keep you updated on any developments, and make sure you submit your input to the Federal Register on this issue.  

Immediate Release

June 27, 2013

Cartwright Introduces Legislation to Improve Veterans’ Access to Mental Health Care

WASHINGTON — Today U.S. Rep. Matt Cartwright introduced the Expedited Hiring for VA Trained Psychiatrists Act, legislation that would create a fast track hiring process for psychiatrists who train at Veterans Affairs facilities. The legislation was introduced with the support of Republican and Democratic Representatives: Dr. Bill Cassidy (LA-06), Steve Chabot (OH-01), Lynn Jenkins (KS-02), Marcy Kaptur (OH-09), Tom Rooney (FL-17), Tim Ryan (OH-13), and Carol Shea-Porter (NH-01).

The legislation aims to reduce the wait times for veterans seeking to access mental health services by reducing the time it takes to fill these critical positions.

“We have a responsibility to do all we can to make sure the brave men and women who served get the care they need and deserve when they return,” said Cartwright. “This legislation simply speeds up the process for recruiting trained, talented mental health professionals into a career caring for the invisible wounds of our nation’s veterans.”

“When I meet with veterans in Washington and back home, mental health continues to be a top concern. Post-traumatic stress disorder (PTSD) is a silent, deadly affliction many of our brave veterans are dealing with every day,” said Jenkins. “This bill is just one step toward quickly getting these brave men and women the help they need, and I am proud to be an original cosponsor.”

According to the Department of Veterans Affairs, 29% of OEF/OIF veterans within the VA healthcare system have PTSD, and a similar proportion of Vietnam veterans are believed to be affected. VA policy requires that new patients requesting or referred for mental health services receive an initial assessment within 24 hours and a full evaluation within 14 days. Yet congressional testimony has raised questions about the extent to which these policies are implemented in practice.

“It’s fitting that we introduce this straightforward legislation on Post-Traumatic Stress Disorder Awareness Day,” Shea-Porter said. “This bill would help decrease the wait time for veterans seeking mental health care and requires no additional spending. It’s good for our veterans, and it’s the right thing to do.”

“Today, on Post-Traumatic Stress Disorder Awareness Day, we’re reminded of how many American troops and veterans are suffering from invisible wounds like PTSD,” said Rooney. “While we’ve made tremendous progress in recent years to expand screenings, encourage treatment seeking and improve access to care, we know that the VA simply does not have enough mental health professionals to meet the needs of our veterans. This bipartisan bill will help cut through the red tape and make it easier for the VA to hire qualified psychiatrists, so that our veterans can get the treatment they need.”


“I started the Military Mental Health Caucus to focus on how to provide veterans with the best mental healthcare possible. The mental health of our veterans is as important as their physical health, and it is our duty to ensure that they receive the care they need—when they need it,” said Ryan. “This bill takes major steps in ensuring that the Department of Veterans Affairs is prepared to offer the best mental health services possible. Our veterans deserve nothing less.”

The Blinded Veterans Association (BVA) announced their support for Congressman Cartwright’s legislation yesterday. BVA Government Relations Director Tom Zampieri said his organization "supports the changes to expedite the hiring of these mental health providers instead of the current slow VA credentialing process for individuals who have already treated veterans as residents in numerous clinics."

 “Ensuring timely access to quality mental health care for all veterans should be a priority for everyone, regardless of party,” said Cartwright. “I am grateful to my colleagues on both sides of the aisle for their support of this important legislation.”

Dempsey and Winnefeld Renominated

On Wednesday President Obama announced that he was nominating General Martin E. Dempsey to be chairman of the Joint Chiefs of Staff and Admiral James A. Winnefeld, Jr. to be vice chairman of the Joint Chiefs of Staff for second terms. If confirmed by the Senate they both will serve second two year terms.

The Fund Raising For The U.S. Army Continues

For the last several years the Army Historical Foundation has been planning and raising money for a U.S. Army Museum. It is to be located on a 41 acre campus just outside of Washington DC on land donated by Ft. Belvoir, Virginia. It is going to be a state of the art 185,000 square foot facility and is expected to attract more than 750,000 visitors a year when it is completed. To see much more about the plans and the fund raising you can go to:
www.armyhistory.org/the-national-museum-of-the-united-states-army/

Army Announces Planned Slashing of Number of Active Duty Brigades

The U.S. Army announced dramatic (but expected) plans to cut the number of active duty combat brigades from 45 to 33 and the size of the Army by 80,000. The Army says that by 2017 they plan to eliminate 2 brigades in Germany and others in Texas, Kentucky, Georgia, Colorado, North Carolina, New York, Kansas and Washington.
These cuts have been expected for over one year.

“Under the plan set to be announced Tuesday, the Army will increase the size of its infantry and armor brigades by adding another battalion, which is between 600-800 soldiers. Adding the battalion was a recommendation from commanders in Iraq and Afghanistan who said it would beef up the fighting capabilities of the brigades when they go to war.
A brigade is usually about 3,500 soldiers, but can be as large as 5,000 for the heavily armored units.”

These announcements will not affect National Guard brigades.

PTSD May Contribute to Heart Disease

Below please find a press release from the National Institute of Health (NIH) which outlines new and very interesting medical findings linking PTSD and heart disease. This is a matter of deep concern. TREA willfollow any additional findings and pass them on to you.

EMBARGOED FOR RELEASE                        Contact:
June 25, 2013                                    NHLBI Communications Office
3:30 p.m. ET                                     301-496-4236
 NHLBI_news@nhlbi.nih.gov

Vietnam vets with PTSD more than twice as likely to have heart disease
NIH-funded study finds PTSD is a risk factor for heart disease among Vietnam vets

Male twin Vietnam veterans with post-traumatic stress disorder (PTSD) were more than twice as likely as those without PTSD to develop heart disease during a 13-year period, according to a study supported by the National Institutes of Health.

This is the first long-term study to measure the association between PTSD and heart disease using objective clinical diagnoses combined with cardiac imaging techniques.

Computer-generated map of the heart of a twin without PTSD (left) and with PTSD (right). Image credit Viola Vaccarino, M.D., Ph.D.

“This study provides further evidence that PTSD may affect physical health,” said Gary H. Gibbons, M.D., director of the NIH's National Heart, Lung, and Blood Institute (NHLBI), which partially funded the study. “Future research to clarify the mechanisms underlying the link between PTSD and heart disease in Vietnam veterans and other groups will help to guide the development of effective prevention and Treatment strategies for people with these serious conditions.”

The findings appear online today in the Journal of the American College of Cardiology and in the September 10 print issue.

Researchers from the Emory University Rollins School of Public Health in Atlanta, along with colleagues from other institutions, assessed the presence of heart disease in 562 middle-aged twins (340 identical and 222 fraternal) from the Vietnam Era Twin Registry. The incidence of heart disease was 22.6 percent in twins with PTSD (177 individuals) and 8.9 percent in those without PTSD (425 individuals). Heart disease was defined as having a heart attack, having an overnight hospitalization for heart-related symptoms, or having undergone a heart procedure. Nuclear scans, used to photograph blood flow to the heart, showed that individuals with PTSD had almost twice as many areas of reduced blood flow to the heart as individuals without PTSD.

The use of twins, identical and fraternal, allowed researchers to control for the influences of genes and environment on the development of heart disease and PTSD.

“This study suggests a link between PTSD and cardiovascular health,” said lead researcher Viola Vaccarino, M.D., Ph.D., professor in the department of medicine at Emory University and chair of the department of epidemiology at the Rollins School of Public Health. “For example, repeated emotional triggers during everyday life in persons with PTSD could affect the heart by causing frequent increases in blood pressure, heart rate, and heartbeat rhythm abnormalities that in susceptible individuals could lead to a heart attack.”

When researchers compared the 234 twins where one brother had PTSD and the other did not, the incidence of heart disease was almost double in those with PTSD compared to those without PTSD (22.2 percent vs. 12.8 percent).

The effects of PTSD on heart disease remained strong even after researchers accounted for lifestyle factors such as smoking, physical activity level, and drinking; and major depression and other psychiatric diagnoses. Researchers found no link between PTSD and well-documented heart disease risk factors such as a history of hypertension, diabetes or obesity, suggesting that the disease may be due to physiologic changes, not lifestyle factors.

Affecting nearly 7.7 million U.S. adults, PTSD is an anxiety disorder that develops in a minority of people after exposure to a severe psychological trauma such as a life-threatening and terrifying event. People with PTSD may have persistent frightening thoughts and memories of their trauma, may experience sleep problems, often feel detached or numb, and may be easily startled. According to a 2006 analysis of military records from the National Vietnam Veterans Readjustment Study, between 15 and 19 percent of Vietnam veterans experienced PTSD at some point after the war.

The study used state-of-the-art imaging scans with positron emission tomography, which measures blood flow to the heart muscle and identifies areas of reduced blood flow, at rest and following stress.

The study was supported by grants from NHLBI (K24HL077506), (R01 HL68630), and (R21HL093665), the National Institute on Aging (R01 AG026255), the National Institute of Mental Health (K24 MH076955), and by the American Heart Association. Support also was provided by the National Center for Advancing Translational Sciences (UL1TR000454) and the National Center for Research Resources (MO1-RR00039).

For additional information or to arrange an interview with Susan M. Czajkowski, Ph.D., program officer in the NHLBI’s Clinical Applications and Prevention Branch, please contact the NHLBI Office of Communications at 301-496-4236 or nhlbi_news@nhlbi.nih.gov. To arrange an interview with Dr. Vaccarino, please contact Melva Robertson at the Emory School of Medicine at 404-727-5692 or melva.robertson@emory.edu.  
Resources

Line of Duty Care for National Guard and Reserve Members

 From TRICARE
Understanding TRICARE health care options for National Guard and Reserve members can be confusing as it varies based on their duty status. When a member suffers or aggravates an injury, illness or disease while in a qualifying duty status, they may be eligible to receive care at the government’s expense.

When activated for more than 30 days, Guard and Reserve members are eligible for TRICARE Prime. If a Guard or Reserve member gets injured or aggravates an existing injury or illness as a direct result of his or her duties during a period of activation less than 30 days, that Guard or Reserve member may be covered under line of duty (LOD) care or notice of eligibility (NOE) care for members of the Coast Guard. Weekend drill, summer training exercises and/or national disaster response are examples of activations for less than 30 days. For care received from a civilian provider, the Military Medical Support Office (MMSO) reviews the LOD/NOE case. For care received at a military hospital or clinic, the facility where care is received reviews the LOD/NOE case.

For emergency room visits, prior authorization is not needed. However, if the service member is admitted to a hospital or if additional care is needed, he or she must get authorization from the MMSO or the military hospital or clinic, preferably before admission, or as soon as possible after admission. For ongoing care, service members who live or work near a military hospital or clinic Prime Service Area should seek LOD/NOE care from that facility. For those who do not, the service member’s command or medical unit requests an authorization for civilian medical care by submitting and LOD/NOE determination to the MMSO.

To continue receiving LOD/NOE care once the period of activation ends, service members must stay in the Guard or Reserve, continue to need TREAtment, and care must be authorized. Guard and Reserve members should make sure their command or medical unit has a copy of the LOD/NOE document before being released from active service. Prescription medications must be paid for out-of-pocket, but members can file a claim for reimbursement.

Guard and Reserve members activated less than 30 days do not show as TRICARE-eligible in the Defense Eligibility Enrollment Reporting System (DEERS). Because of this, it is extremely important all paperwork and documentation is complete – like the LOD/NOE document and active service orders – when seeking Treatment. For more information on LOD/NOE care or to download the TRICARE Treatment of Line of Duty Conditions Fact Sheet, please visit www.tricare.mil/LOD.  

DoD to Move Quickly on Same-Sex Benefits

The Department of Defense will move quickly to extend the same benefits to same-sex married couples as it does to heterosexual married couples, from factoring in the spouse for housing allowance to burial at Arlington National Cemetery, the Pentagon said on Wednesday.

Defense Secretary Chuck Hagel’s announcement followed the Supreme Court’s decision striking down a 1996 federal law that recognizes marriages only between a man and a woman, and President Obama’s subsequent order to have all current federal statutes put in compliance with the ruling.

Hagel, who once opposed allowing gays to serve openly in the military, said in his statement he “welcomes the Supreme Court’s decision today [overturning] the Defense of Marriage Act and that DoD “intends to make the same benefits available to all military spouses – regardless of sexual orientation – as soon as possible.”

Gen. Martin Dempsey, chairman of the Joint Chiefs of Staff, told reporters during an afternoon joint press conference with Hagel that “the Joint Chiefs have made it clear, we’ll follow the law of the land, and the law of the land just changed.”

Neither Hagel nor Dempsey offered much in the way of specifics – either a timeline, the additional costs to be incurred by extending benefits to same-sex military families or even whether the Pentagon can guaranty that same-sex married troops serving in states that have laws defining marriage as an intuition between a man and a woman will be able to get federal benefits. The Pentagon also said it is looking at what same-sex married troops will mean for overseas tours to countries that don't recognize same sex relationships, let alone marriages.

Allyson Robinson, an Army veteran and executive director of OutServe-Servicemembers Legal Defense Network, acknowledges that reworking Status of Forces Agreements to accommodate the new reality of same-sex married troops will be “a challenge.” The U.S. military has bases all across the world, and some host countries have laws against same-sex relationships.

“While we recognize these challenges would expect that married gay and lesbian service members would have the same opportunity for these accompanied overseas tours as any other married service member,” she said in a telephone interview on Wednesday. “That’s the standard DoD has already set for itself.”

Hagel told reporters at the Pentagon that there is still much research and work to be done to know how the end of DOMA will play out in every area.

“I have read the basic [Supreme Court] opinion. I have not talked to any lawyers about it,” Hagel said. “I’ve got a responsibility to carry out the law of the land, the decisions the Supreme Court made today … obviously we’re going to deal with the Justice Department and all the other executive offices to comply that law of the land, which we’re very pleased to do and will do and do it expeditiously, but beyond that I don’t know. I don’t want to go any further than that because I don’t know.”

Dempsey defended the Defense Department against the impression, held by some, he said, that the military “will find a way to fight this or fight that” when it comes to gays serving in the military.

“We actually have done what I think is a very credible job of ensuring as much equality as we can possibly provide to the men and women who serve this country in uniform voluntarily,” he said, “and we will do what we can for them within the limits of the law, but we haven’t had time to figure out what is yet.”

What the Pentagon has said, however, is that it will make available to same-sex spouses all the benefits currently extended to opposite-sex spouses, including with-dependent Basic Allowance for Housing, medical and dental care, and interment at Arlington National Cemetery.

While a U.S. Senator Hagel supported the Don’t Ask, Don’t Tell policy that allowed gays and lesbians to serve in the military as long as they were not open about their sexuality. His opposition to repealing the law came back to haunt him when gay rights groups initially came out in opposition his nominated to be Secretary of Defense.

Hagel successfully overcame the opposition with a commitment to ensuring gays would be fully welcome in the military. That sentiment was also expressed in his prepared statement on Wednesday.

“Every person who serves our nation in uniform stepped forward with courage and commitment,” he said. “All that matters is their patriotism, their willingness to serve their country and their qualifications to do so. Today’s ruling helps ensure that all men and women who serve this country can be treated fairly and equally, with the full dignity and respect they so richly deserve.”

GI Bill Transfer Rules Changes

Stars and Stripes reports that beginning Aug 1, all active-duty military personnel who opt to transfer their Post-9-11 G>I> Bill benefits to a family member will be obligated to four more years of service, including troops who are eligible for retirement. The rule change mostly affects senior officers and enisted personnel who are nearing retirement. The four years does not begin until the servicemembers executes the actual transfer. to transfer Post-9/11 G.I. benefits, a servicemember must have a minimum of six years in the military; to be eligible to receive those benefits, adependent, whether a spouse or child, must be enrolled in the Defense Enrollment Eligibility Reporting System (DEERS) computerized database.

Troops to Teachers

Transitioning military personnel looking to serve in a different way will find assistance from the Department of Defense program Troops to Teachers. Since 1994, Troops to Teachers has assisted more than 6,000 military personnel looking to begin a career in the education sector. To be eligible for the program, individuals must register with Troops for Teachers within three years of separation from the military. An exception will be made for people with service-connected injuries and candidates who have completed 20 years of military service. They can join the program at any time. For more information, visit the Troops to Teachers website at www.proudtoserveagain.com.

TRICARE and State of Emergency in Colorado

Due to the Black Forest, Royal Gorge and Klickus wildfires, the Governor of Colorado has issued a State of Emergency in the Colorado counties of El Paso, Fremont, and Huerfano. TRICARE beneficiaries who live in these counties can obtain emergency prescription refills through July 11, 2013. To obtain an emergency refill, take your prescription bottle to any TRICARE retail network pharmacy. To find a network pharmacy call Express Scripts at 1-877-363-1303 or search the network pharmacy locator at the TRICARE Pharmacy Program website at www.express-scripts.com/TRICARE/pharmacy/. If possible, visit the pharmacy where the prescription was filled.  

DoD Brain Tissue Repository

The Department of Defense established the world's first brain tissue repository to help researchers understand the underlying mechanisms of traumatic brain injury (TBI) in servicemembers. The new repository is part of a military health care system initiative to bring all the resources it can to better understand how to prevent, diagnose and treat traumatic brain injuries. Defense Department researchers will look at the brain tissue samples to characterize the neuropathologic features of TBI in servicemembers. For further information on donation to the brain tissue repository for traumatic brain injury, email the repository team or call 855-DON-8TBI (855-366-8824).  

Identity Theft Prevention

Here are some tips to protect military personnel and retirees from identity theft: (1) safeguard vulnerable information like Social Security numbers, passwords, and account numbers in properly secured containers; (2) never recite sensitive information over the phone or send it in an e-mail; (3) sensitive data like ATM and account pin numbers and passwords should be memorized instead of written down; (4) select passwords that offer strong protections against identity theft; (5) use paper shredders to destroy documents; (6) diligently monitor credit reports; (7) keep receipts of purchases and regularly check them against billing statements; and (8) remain in contact with creditors and contact them if bills are not arriving as they should. If identity theft does occur, the FTC offers guidance on its Identity Theft webpage at www.consumer.ftc.gov/features/feature-0014-identity-theft  

Advice on Providing Long-Term Care

When you think of caregiving, odds are you think of the courageous families who care for our wounded warriors. But, some servicemembers themselves may one day face the challenge of another type of caregiving: helping a family member who is aging, sick, or has a disability and needs full-time care. Holly Petraeus from the Office of Servicemember Affairs recently offered advice to help you prepare for the financial and emotional strain that this responsibility. 

AAFES Salute to Clean Sweepstakes

The Army and Air Force Exchange Service will award gift cards to 15 lucky shoppers during the Unilever "Salute to Clean" sweepstakes. Each winner will be awarded a $1,000 gift card, redeemable at any Exchange location worldwide or online at www.shopmyexchange.com. Customers can fill out and drop off entry forms at any Exchange location through July 11. To find an Exchange location near you, visit www.shopmyexchange.com/ExchangeStores. No purchase is required to enter. Entrants must be 18 or older with a valid driver's license. 

Some Commissaries to Remain Open

Thirty-seven military commissaries in Europe and the Pacific will remain open with local national employees while U.S. Civilian employees are affected by furloughs. Most Defense Department civilian employees will be off work for up to 11 unpaid furlough days from July 8 to Sept. 30. Because of international agreements, local national employees are exempt from furlough. A list of the commissaries that will remain open is available. Because the budget situation is fluid, DeCA officials said, plans for the furlough period are subject to change. Commissary customers can quickly find out about any changes to their local store's operating schedule by going to the Commisaries.com website at www.commissaries.com, clicking on the "Locations" tab, then "Alphabetical Listing," finding their store and clicking on "Local Store Information."