TOP ENLISTED LEADERS TO CONGRESS:  BUDGETS “CUT TO THE BONE"In a hearing before the House Military Construction and Veterans’ Affairs Appropriations Subcommittee, the services’ top enlisted leaders said that service budgets have been "cut to the bone" by limits imposed by sequestration.  "We may have to tell good soldiers to go home," said Sergeant Major of the Army Dan Dailey. His counterpart in the Air Force agreed.  "Thirty years ago, if you were a good airman and worked hard, you could serve for 20 years. I'm not sure you can say the same today," said Chief Master Sergeant of the Air Force James Cody, who added that budget uncertainty "is curtailing the ability to serve." The leaders told the panel members that they are concerned about the growing anxiety among troops about what continuing budget threats will mean to their readiness, pay and career options.  The leaders also said that service members are increasingly worried about changes in benefits such as health care and family programs."In my four deployments … never once did a soldier say, 'I'm worried about my family.' I'm concerned that someday that will be an issue," Sergeant Major Dailey told the lawmakers.  While many in Congress have expressed their concern about the effects sequestration is having on the Defense Department, they have not been able to find a permanent solution.   Army officials already have said they'll have to trim their service's ranks to about 420,000 soldiers — if not more — by the end of the decade if the sequestration cuts aren't repealed. In addition to the dire warnings from Defense leaders of the consequences of sequestration, military personnel are also hearing about sweeping changes to pay, compensation, health care and retirement packages contained in the president’s budget request for fiscal 2016 and the recently released report from the Military Compensation and Retirement Modernization Commission.   None of the leaders provided their specific views on the reforms proposed by the commission, but did stress that the quality of family programs — especially health care — can sway a service member's decision to stay in or leave the military. AUSA President Gen. Gordon R. Sullivan, USA, Ret., agrees with the leaders and is very troubled by the uncertainty caused by the message that is being sent to our military and their families.  The demand for land forces, especially U.S. Army forces, seems to grow every day. At the same time, budget threats continue to squeeze military service member compensation and benefits. The subliminal message that the troops “cost too much” and that they, by their mere presence, are somehow contributing to an Army that is increasingly unready to meet the complex challenges the United States faces, is creating a level of uncertainty.  This message must change.  We need sequestration to be taken off the table, and we need it done quickly and permanently for the good of our soldiers, their families and our nation.  We also need to ensure military personnel are rewarded appropriately for their service and sacrifice.   CHANGES AHEAD FOR MILITARY HEALTHCARE?  In another hearing this week, members of the Military Compensation and Retirement Modernization Commission (MCRMC) outlined their proposals that would make sweeping changes to the military’s TRICARE healthcare system.   Testifying before the Senate Armed Services Personnel Subcommittee, Commission Chairman Alphonso Maldon, Jr., said that while a high-quality health benefit is essential for all military constituencies, the current TRICARE program is “beset by several structural problems that hinder its ability to provide the best health benefit to active duty families, reserve component members, or retirees.  It has weak health care networks because it reimburses providers at Medicare rates or lower.  It limits access to care with a frustrating referral process.” Among the Commission recommendations are those that would: ·     Continue to provide health care to active‐duty service members through their units or military treatment facilities to ensure the services maintain control of medical readiness of the force.·     Establish a new DoD health program to offer a selection of commercial insurance plans to active‐duty families members, members of the reserve components and families, non‐Medicare‐eligible retirees and families, survivors and certain former spouses.·     Provide active duty family members with a Basic Allowance for Health Care (BAHC) to fund insurance premiums and expected out‐of‐pocket costs.  BAHC would be based on the costs of median plans available in the family’s location, plus average out‐of‐pocket costs.·     Establish a program to assist active duty families that struggle with high‐cost chronic condition(s) until they reach catastrophic cap of their selected insurance plan.·     Allow reserve component members to purchase a plan from the DoD program at varying cost shares.·     Reduce cost share for selected reserves to 25 percent to encourage health and dental readiness and streamline mobilization of personnel.·     Allow mobilized reserve component members receive to BAHC for dependents; select a DoD plan or apply BAHC to a current (civilian) plan.·     Increase cost contributions for Non‐Medicare‐eligible retirees 1 percent annually over 15 years. Following the MCRMC witnesses, a panel of leaders from several of AUSA’s counterparts in The Military Coalition outlined their positions on the proposed changes.   All acknowledged that there are problems with the current TRICARE system; however, they cautioned against completely overhauling the system without thoughtful and careful consideration.   AUSA strongly agrees with this approach and will not support the changes without specific details and the second and third order effects.  We also agree with one of the Association leaders who said, “Service members, whether in garrison, down range, or anywhere in the world, should not have to worry if they have selected the appropriate health care coverage for their families.” We, along with our TMC counterparts, are particularly concerned about the potential premiums working-age retirees will pay.  A 20 percent premium cost share for retirees is too high, regardless of the length of the phase-in period.   The bottom line:  Subcommittee Chairman Sen. Lindsay Graham, R-S.C. said, “Change is coming.”  What that change will be is a long way from being known.   Graham also acknowledged that under-65 retirees would be the hardest hit under the MCRMC’s plan.  He said that if couldn’t look those retirees in the eye and tell them they were getting a better benefit for their money, he wouldn’t go along with the plan.    We will continue to follow developments closely and will take immediate action as needed. - See more at: http://www.ausa.org/legislation/newsletter/Pages/26February2015Update.a…KEEPING THE PAY GAP CLOSED For years, the Association of the U.S. Army has been in the forefront of the campaign to close the pay gap.  We believe that a nation who sends its sons and daughters into the world’s hotspots has an obligation to ensure they are adequately compensated and that their families enjoy a standard of living comparable to that of their counterparts in the private sector. Once again, the president’s budget request for fiscal 2016 calls for a 1.3-percent pay raise for military personnel, instead of the 2.3-percent raise mandated by law.  The budget also includes a plan for four additional years of pay caps.The 2015 raise is the same percentage amount as the 2014 pay increase, which DoD and the Obama administration sold to a reluctant Congress as a modest bit of belt-tightening needed to make sure there was enough money to pay for other military priorities.  To make the sacrifice of a smaller raise seem more palatable, Congress adopted a provision that gave flag and general officers no raise in 2015. This was the second consecutive year when basic pay increases were less than called for under the Federal Employees Pay Comparability Act of 1990, which creates a formula for military and federal civilian raises linking them to the Employment Cost Index, a measurement of average private-sector increases.  If followed—and it frequently isn’t—the 2014 and 2015 raises would have been 1.8 percent each year instead of 1 percent.How much to pay troops has been a subject of extended debate from the earliest days of the Army.  In the Continental Army, only officers were paid in the beginning, with troops receiving food and forage, but by 1775, privates were earning $6.66 monthly, although they were required to find their own weapons and clothing.  By 1790, there was a formal system of pay plus allowances, similar to the current concept.Over the decades, there were several revisions in compensation as the military’s needs changed, with one of the biggest revisions resulting from recommendations from the Gates Commission, a body appointed in 1969 to come up with a plan for ending the military draft.  The commission recommended a 45 percent increase in total entry-level compensation, along with improvements in living and working conditions, as a way of getting people to volunteer for military service.  The $437 monthly pay was based on an estimate of how much money it would take to get 18-year-olds to sign up and not on any comparison of private-sector wages.Until 1980, pay raises rose at an uneven clip, with money distributed between basic pay received by everyone and housing and subsistence allowances received by a few.  In fiscal year 1981, with the services warning about problems recruiting and retaining quality people, an 11.7 percent pay increase was approved.  It was followed in fiscal year 1982 by an average 14.3 percent increase in an adjustment believed at that point to have made military pay scales equal with the private sector.That equality was short-lived, as military pay raises fell below average private-sector raises for nearly all of the next 16 years.  By 1999, this resulted in what was perceived as a cumulative 13.5 percent gap between military and civilian.  The so-called pay gap was measured by comparing military and private-sector pay increases, and not by any measure of comparable or competitive pay.Congress got involved and for 13 consecutive years approved pay raises meeting or exceeding private-sector salaries.  This shaved the perceived pay gap to about 2 percentage points, although DoD declared the gap—if it ever existed—had closed by 2007, and the nonpartisan Congressional Budget Office estimated in 2010 that military pay was 10.3 percent ahead of the private sector.The 2011 edition of the Military Compensation Background Papers, a DoD document explaining the complicated array of pays and benefits, says that setting military raises involves a controversial principle of comparability and competitiveness.  This requires comparing salaries of soldiers to those of civilians who have substantially similar work, experiences and education.  It is often a judgment call because there are very few military skills with a civilian equivalent in terms of responsibility, danger and other military-unique factors.The RAND Corporation declared in a 2012 report that military pay was doing very well in comparison with the civilian sector as a result of a combination of a 45 percent increase in basic pay over a decade while civilian pay had dropped by 4 to 8 percent in much of the private sector.  “Also, the cost of health care has increased rapidly in the civilian sector but remains at zero for service members and at quite low cost for their families,” the report said about the possibility of limiting future pay increases.  In terms of being competitive, RAND found total military compensation ranked high in comparison to civilians of comparable age and education, especially 23- to 27-year-olds who had a high school diploma but no college.Unlike in the 1970s, when DoD was trying to adjust pay scales to get volunteers to fill the military at the end of conscription, the Army now is cutting troops and scaling back on recruiting, reducing the risk to the force from pay caps.“A more attractive compensation system does not necessarily translate into improved recruiting and retention,” wrote Todd Harrison, a senior fellow for defense budget studies at the Center for Strategic and Budgetary Assessments in a 2012 study called “Rebalancing Military Compensation: An Evidence-Based Approach,” which looked at options for soldier pay and benefits.  “Compensation is an important factor for many people serving in the military, but it is by no means the only factor.  The desire to serve one’s country has been and will continue to be an important part of what motivates people to join the military.”Harrison’s study asked people to weigh the value of one military benefit against another, revealing that an increase in basic pay was the most important part of military compensation for junior enlisted personnel, who make up about half of the military.  For other ranks, basic pay increases rated behind retirement collection age, time to qualify for retirement and active duty dependent health care in relative importance, according to the study.Harrison’s study raised questions about the value of across-the-board pay increases in which everyone receives the same percent increase.  “Increasing basic pay for junior enlisted has more than six times the impact per dollar than increasing basic pay for senior officers,” he wrote.  “This finding calls into question the wisdom of across-the-board pay raises.”The study also shows there is no harm to DoD from freezing pay scales for generals and admirals, as they are unlikely to leave the military because they did not get a pay raise.  For senior officers, Harrison’s study showed the most important part of military compensation was the ability to collect retirement pay as soon as they retire.There is harm, in terms of recruiting and retention, of capping pay, according to the study.  Four out of five troops who responded to Harrison’s online questionnaire said they would be willing to delay receiving their first military retirement check until age 50 in return for an immediate 1 percent pay raise.  The average age for beginning to receive retired pay is 47 for officers and 43 for enlisted members. The continued drive to cap military pay below the Employment Cost Index along with other “modest” cost-cutting proposals amounts to balancing the budget through the wallet of servicemembers and families and we must push back.  Please add your voice to ours.  Click on the “Contact Congress” link on our webpage, www.ausa.org, enter your zip code and then click on the letter titled, “Keep the Pay Gap Closed.” - See more at: http://www.ausa.org/legislation/newsletter/Pages/19February2015Update.a…A DRAFT PROPOSAL sent from the White House to Congress asks for authorization to use military force against the terror group, ISIL.The proposal states, “The so-called Islamic State of Iraq and the Levant (ISIL) poses a threat to the people and stability of Iraq, Syria, and the broader Middle East, and to U.S. national security. It threatens American personnel and facilities located in the region and is responsible for the deaths of U.S. citizens James Foley, Steven Sotloff, Abdul-Rahman Peter Kassig, and Kayla Mueller. If left unchecked, ISIL will pose a threat beyond the Middle East, including to the United States homeland.”It goes on to state that the draft proposal “would not authorize long-term, large-scale ground combat operations like those our Nation conducted in Iraq and Afghanistan.” Rather, the administration seeks to “authorize the use of U.S. forces in situations where ground combat operations are not expected or intended, such as intelligence collection and sharing, missions to enable kinetic strikes, or the provision of operational planning and other forms of advice and assistance to partner forces.”Some in Congress will say that the language in the proposal which would authorize the use of military force for only three years (unless re-authorized) is too vague while others believe the measure should empower the military to fight Syria’s president as well as ISIL.Senate Majority Leader Mitch McConnell said that the Senate will carefully consider the proposal and will consult with military leaders. Expect a vigorous debate on the authorization request in the coming days.IN: ASH CARTER. OUT: CHUCK HAGEL. Shortly after the Senate Armed Services Committee unanimously voted to confirm Ash Carter to be the next Secretary of Defense, the full Senate is expected follow suit. The vote is scheduled for today.Committee Chairman Sen. John McCain, R-Ariz., said that Carter is “one of America’s most respected and experienced defense professionals. “I have known him, and members of the committee have known him, to be an honest, hardworking and committed public servant.”BACK IN 2011, nationally syndicated columnist William Hamilton wrote a piece on military retirement and the plans to change it.In his column, Hamilton, who served 20 years on active duty, recalled a conversation he had with his personnel officer shortly after going on active duty about what he could expect from a 20-year career in the military.The personnel officer told him, “You can expect to live abroad for about 10 years, much of it in disease-ridden, Third World countries you would never ever want to visit on vacation. You will be moved 15 to 20 times. You can expect your household goods to be lost at least once. Off and on, you can expect to be separated from wife and family for about six years. You can expect to be wounded at least once. Or, killed. But that only happens once.”Not much has changed with respect to military life since Hamilton wrote his column. If anything it has become even more complicated because of the fallout of sequestration, downsizing, and the seemingly constant attacks on military pay and compensation.AUSA’s leadership is carefully studying the proposals released by the Military Compensation and Retirement Modernization Commission and the proposals contained in the president’s budget request for 2016.Keeping in mind that DoD’s review and Congress’ debate on the merits of the proposals is still in the early stages, AUSA’s President Gen. Gordon R. Sullivan, USA, Ret., is struck by the uncertainty caused by the message that is being sent to our military and their families.The demand for land forces, especially U.S. Army forces, seems to grow every day. At the same time, military servicemember compensation and benefits continues to be squeezed.The subliminal message that the troops “cost too much” and that they, by their mere presence, are somehow contributing to an Army that is increasingly unready to meet the complex challenges the United States faces, is creating a level of uncertainty.That uncertainty and concern about the future of retirement benefits and pensions has many wondering whether it is still worth staying in the service for a full career or leaving early (after the military has invested in training and education to the tune of up to $600,000 per soldier over their first 10 years of service).With no clearly identified bottom for the Army’s endstrength reductions, Soldiers and their families are living under the constant specter of involuntary separations and early retirements. This is extremely discomfiting for a generation of Soldiers who voluntarily signed up to serve their country and to make the military their lifelong career.The bottom line: Clearly, pay and other compensation and benefits always can be refined. But this should not be the first place to look for savings, it should be the last. If we are not careful, the Soldiers who depart our ranks today – voluntarily or involuntarily – will be the leaders missing when we next need them.Is the compensation package military personnel receive after they complete their careers rich? You better believe it. It should be. If it is such an easy, undemanding career, then why do only less than 1 percent of the population sign up for it?We are not setting a welcome tone for America’s military who have done so much for so long.- See more at: http://www.ausa.org/legislation/newsletter/Pages/11February2015Legislat…Pulmonary Diseases Related to Environmental Deployment Exposures, or STAMPEDEArmy medical researchers looking for soldiers who deployed to Iraq and Afghanistan to help investigate possible long-term health effects of exposure to dust, smoke and other airborne contaminants. The project is known as the Study of Active Duty Military for Pulmonary Diseases Related to Environmental Deployment Exposures, or STAMPEDE. About 300 volunteers will be studied, each of whom must have developed respiratory problems while deployed, and still have some symptoms but be able to take treadmill tests. What to watch: There is no doubt that some soldiers have deployment-related breathing problems, but researchers are hoping to investigate specific causes and to also find what treatments, if any, have been most effective. AUSA's Military Family ForumsAUSA Family Readiness is taking their Military Family Forums series on the road! First stop: Joint Base Lewis-McChord on March 11, with a forum focused on education for the entire family. Registration is open to the entire JBLM community and includes free childcare to those who need it. To register, please visit http://www.eventbrite.com/e/jblm-ausa-family-forum-tickets-15336582130- See more at: http://www.ausa.org/resources/familyprograms/Pages/default.aspx#sthash.gsqRfebm.dpufArmy Hospitals in a 'Death Spiral'Retired Army Gen. Peter Chiarelli, a former Army Vice Chief, is an advocate for overhauling military medicine. "I think we are in a death spiral right now in our MTFs," he said of Military Treatment Facilities, because they are not treating enough people to "keep their doctors up to standard. ...We need well trained doctors, not only to treat patients in hospitals but to be ready to deploy wherever we send them and provide that same kind of treatment on day one of the conflict," he told the Senate Armed Services Committee.What to watch: A health care reform initiative that includes changes in health insurance for soldiers' families and retirees includes a push to get boost care at military hospitals for medical issues that would improve combat medical readiness. What happens depends on whether Congress is ready for a medical reform package that could replace Tricare health insurance and could raise out-of-pocket expenses for some military retirees and their families. The Role of the Community in Rural Veterans' Health and Well-beingThis issue of The Rural Connection focuses on the relationship between community and health, and highlights some of the many efforts underway that support rural communities—and ultimately the Veterans who reside there. This issue is the second in a four-part series on the impact that the social determinants of health have on Veterans in rural communities. In case you missed it, last quarter’s issue featured the impact of employment on health and well-being.In this issue:Message from the Director of the VHA Office of Rural HealthVA Employee and My HealtheVet “SAVE” Veterans’ Time and Improves ServiceNew Program Enables Veterans to Share Health Information with Community ProvidersMental Health and Housing Barriers Addressed through Community Collaboration Efforts in Rural IowaVeteran Transportation Service “Drives” Access to Health Care for Veterans10 Things Rural Veterans Should Know About the Veterans Choice ActVA and Mississippi State University Polytrauma Partnership: A Unique CollaborationA Collaboration for Improved Veteran Care in Rural CommunitiesOpportunities for Tomorrow’s Veteran Farmers“Take a Closer Look at VA” Recruits Health ProfessionalsVHA Builds Valuable Community PartnershipsSpotlight On: Community Support for American Indian VeteransGeriatrics at Your FingertipsAs you will read throughout these articles, ORH and its partners are committed to make a healthy difference in the communities in which Veterans work and live. Our ultimate vision remains: America’s Veterans thrive in rural communities.Gina Capra, MPADirector, Office of Rural HealthGAO: TRICARE Likely Missing Mistakes Mistakes involving claims payments that are too high or too low are being missed by the TRICARE audit system, according to a report by the Government Accountability Office. The report was the subject of an article in Stars and Stripes last week. According to the GAO study, TRICARE does not routinely examine records to determine if a bill was accurate. Because of that, TRICARE reported "improper payments" of $68 million in 2013, an error rate of 0.3 percent. GAO pointed out that Medicare reported improper payments at a rate of 10.1 percent for the same time. Many of the same providers use both programs. And coverage and payment policies are often the same. The difference, GAO reported, is that TRICARE does not perform the same review process of medical records that Medicare does. The report says TRICARE's method of reviewing claims has not changed in 20 years and is likely missing mistakes that would be found by a more rigorous review process.Defense Experts: End Sequestration NowEighty men and women with expertise in national security have signed an open letter to House and Senate leaders to end the spending limits required by the Budget Control Act and adequately fund the military so it can address threats around the globe. Former defense secretaries, retired generals, former senators and House members and other defense experts, including one governor, released their letter today. It is addressed to Rep. John Boehner, R-Ohio, the House speaker, Sen. Mitch McConnell, R-Ky., the Senate majority leader, Sen. Harry Reid, D-Nev., the Senate minority leader, and Rep. Nancy Pelosi, D-Calif., the House minority leader. The letter is signed by former Defense Secretary Robert M. Gates, former Defense Secretary Melvin Laird, and others with backgrounds in defense. The letter is the product of the Foreign Policy Initiative, a nonprofit organization promoting U.S. engagement in the world. The letter says, "The trillion dollars of defense spending cuts required by the Budget Control Act and sequestration present a grave and growing danger to our national security. Even as threats intensify across the globe, these cuts are undermining the readiness of our forces today and investment in the critical capabilities they will need tomorrow." It asks Congress to adopt a budget for fiscal 2016 that is "significantly greater" than what the president has requested. The signers of the letter support the recommendation of the National Defense Panel to repeal the Budget Control Act. The panel was created by Congress and warned last year of a "hollow force." The letter continues, "You have each expressed your opposition to the needless harm that the Budget Control Act and sequestration are inflicting on our Armed Forces. You now have an opportunity to end it."Base Closing Threat Hidden in BudgetThree consecutive years of rejection have not stopped the Defense Department and services from asking, again, for Congress to authorize a 2017 round of base closing and realignment. "Department must eliminate unneeded infrastructure; it already has more infrastructure than needed, and the excess will increase as DoD reduces its end strength. The best way to eliminate unneeded infrastructure is through the Base Realignment and Closure process," according to Pentagon budget documents.  What to watch: Odds are pretty good Congress won't approve another round of base closings, but what happens next isn't clear. There is a threat, of sorts, in the budget documents: "In the absence of authorization of a new round of BRAC, the administration will pursue alternative options to reduce this wasteful spending." That could include leaving a base open but removing units and workers.Army's 25 Most WantedA little different than the Uncle Sam Wants You posters, the Army has a poster of its 25 Most Wanted fugitives, a collection of murderers, child molesters and rapists who have pending warrants for their arrest. Five of the 25 have been captured. The most recent was Elvis Ramon Garcia, captured on Feb. 7, a former vehicle mechanic wanted for indecent acts with children and other charges. What to watch: While some have been on the wanted list since the 1980s, the most recent addition is Dion Omar Hawkins, at large since Feb. 8, who is wanted for aggravated assault and kidnapping. If you know someone on the list, you can email army.cid.crime.tips@mail.mil VA Releases Veterans Choice Program VideoYesterday, VA released an informational video on the Veterans Choice Program, an initiative that allows enrolled veterans who live farther than 40 miles from the closest VA facility, or who must wait longer than 30 days for an appointment to receive care from community doctors. The video covers basic program eligibility requirements, as well as the appointment scheduling process. The VFW strongly supported the establishment of the Veterans Choice Program as a provision of the Veterans Access, Choice and Accountability Act. Watch the video. Roundtable on Undiagnosed PTSD and OTH DischargesOn Friday, the House Veterans Affairs Subcommittee on Disability Assistance and Memorial Affairs held a roundtable to discuss the use of administrative discharges in the military and the process for upgrading such discharges if veterans feel they were wrongly discharged because of mental health conditions.  the Committee was . informed of the adverse effects administrative discharges have on veterans’ ability to access health care and the challenges  faced when trying to upgrade their erroneous discharges.Fertility RoundtableThe House Veterans Affairs Subcommittee on Health held a roundtable to discuss fertility counseling and treatments available to veterans who have lost their ability to conceive as a result of their military service. DOD and VA discussed the range of fertility services available to veterans and their non-veteran spouses. The Committee was urged to authorize VA and DOD to provide assisted reproductive technology treatments and other non-assisted reproductive technology services, such as adoption, to severely wounded, ill and injured veterans. To read more about infertility treatments offered at VA and DOD medical facilities, click here or hereService Members Due Recompense for Mortgage ScamSome 952 service members and their co-borrowers are eligible to receive more than $123 million in settlements from some of the nation's largest mortgage bankers, who illegally foreclosed their mortgages. The banks – JP Morgan Chase, Wells Fargo, Citi Residential Lending, Citibank, CitiMortgage, GMAC Mortgage, Ally Financial, Residential Capital, and BAC Home Loans Servicing (formerly Countrywide Home Loans Servicing) – conducted the non-judicial foreclosures between Jan. 1, 2006, and April 4, 2012. Their actions violated the Service Members Civil Relief Act, which prohibits such foreclosures against eligible service members as long as they originated their mortgages before their period of military service began. "These unlawful judicial foreclosures forced hundreds of service members and their families out of their homes. While this compensation will provide a measure of relief, the fact is that service members should never have to worry about losing their home to an illegal foreclosure while they are serving our country," said Acting Associate Attorney Gen. Stuart F. Delery.   VA Patient Centered Care: The Story of Health for LifeVeterans Health Administration (VHA) is undertaking one of the most significant changes in the philosophy and practice of health care ever embarked upon by an organized health care system. The mission of VHA is “to honor America’s Veterans by providing exceptional health care that improves their health and well-being.”  VHA declared its number one strategic priority to provide whole health care to Veterans that is personalized, proactive, and patient-driven.To deliver this care, VHA is working to enhance both the experience and practice of health care.  The foundation of an optimal “experience of care” is the healing relationship, where providers can use the power of their words and the strength of their caring to support healing, even when physical curing is not possible. The experience of care also includes physical environments with attention to making the spaces feel safe, comfortable, and peaceful.  VHA leaders across the country have made this cultural transformation a priority and national training programs that improve the way care is practiced and delivered. VHA’s “practice” of care” model is personalized, beginning with the Veteran and exploring their values and goals and their vision of health. To this end, the VHA Office of Patient Centered Care & Cultural Transformation has created the Story of Health for Life. This narrative report details many achievements and aspects of how VA is improving the health care experience and practice for Veterans. You can explore more of what VA is doing by visiting the VHA Office of Patient Centered Care & Cultural Transformation website. Last week, a group of at least six military spouses were the target of online threats made by ISIS, or possibly sympathizers. The words and pictures are nearly identical to those used a month ago when Central Command's Twitter and YouTube accounts were hacked: "American soldiers, we are coming, watch your back, ISIS." "We know everything about you, your wives, and children." The common link between the spouses targeted in the Tweets is this CNN article in which each of them was quoted.We have heard from a number of spouses who say they are now re-evaluating the information they share on social media and a few who question whether or not to close their blogs or social media accounts altogether. While making that decision, a number of them decided to delete Army Wife or Military Spouse from their bio or “about” section but still wonder if that’s enough to keep them from being the next target.While each family has to do what they feel is right for them, most spouses I’ve talked to won’t be scared into hiding. In fact, the hashtag #NoFear has been used in online discussions on the topic. However, this may be a good time to rethink your social media settings. 

• Not sharing when your spouse will be away. Deployments and TDYs are tough and it’s nice to reach out to our online friends when our spouse isn’t home, but posting that your spouse is gone lets people know you are home alone.

• Not checking in places. It’s fun to let your friends know you are out and about having a great time, but this lets people know you aren’t home. Checking in at your own house can give people your exact location.

• Clean up your friends list. Do you know everyone on your friends list? Maybe it’s time to clean it up. Even if you do know the person, make sure it’s not a duplicate profile or a brand new one. It’s very easy to take someone’s picture and create a new profile.

• Talk to your children about online safety. If you have children with social media profiles, make sure they know what information is OK to share. It also may be helpful to set rules that your family is comfortable with about accepting new friends, what they should do if a stranger messages them, and what the consequences are if these rules are broken. OnGuardOnline.gov has great information if you don’t know where to start.

These threats aren’t a reason to live in fear and some people won’t change their social media use at all, but they do provide a good opportunity to double-check our online security and start or continue an open dialogue with our family about the unique situations military families can face. What suggestions do you have for military families to help them stay safe online?VA's Veterans Crisis Line Saves Lives Every DayVeterans Crisis Line connects Veterans in crisis with qualified, caring responders.By Hans Petersen, VA Staff WriterThursday, February 19, 2015Caring, Confidential Responders Always ThereVA’s Veterans Crisis Line has answered over 1,625,000 calls.That’s more than a million-and-a-half times a Veteran has felt suicidal or depressed or lost and decided to call for help…and the Crisis Line was there.It’s a crisis too many of our wounded warriors face.The Crisis Line has sent over 45,000 rescues to assist callers with emergency services. That means that when our trained responders know the caller is in a serious crisis and they can’t calm them down or convince them to go to a VA hospital and see a Suicide Prevention Coordinator, they call the closest local emergency personnel to go to that Veteran’s home and help them.And that has happened 45,000 times.That saves lives and helps Veterans on the road to recovery. And since 2007, the Crisis Line has been there non-stop: 24 hours a day, 7 days a week, and 365 days a year. Mental Health problems do not take a holiday and neither do we.VA’s Veterans Crisis Line connects Veterans in crisis and their families and friends with qualified, caring responders through a confidential toll-free hotline, online chat, and text services.The Crisis Line has provided over 261,000 referrals to local facility Suicide Prevention Coordinators. It is an essential component of VA’s overall effort to prevent suicide.Mental Health problems do not take a holiday and neither do we.Goal: Immediate Crisis InterventionOur goal is to provide immediate crisis intervention and then connect the Veteran with local Suicide Prevention Coordinators. The mission is to reduce the number of suicides by reducing immediate stress, offering callers options, and referring them to the appropriate VA or community resources nearest their homes.We encourage all Veterans and Military Servicemembers to connect with the Veterans Crisis Line by calling 1-800-273-8255 and press 1.You can chat with someone who understands by visiting our website at www.veteranscrisisline.net or you can text us at 838255.The caring professionals at the Veterans Crisis Line are specially trained and experienced in helping Veterans of all ages and circumstances. Many of the responders are Veterans and understand what Veterans and their families and friends have been through and the challenges Veterans of all ages and service eras face.Working the phone lines is a team of a responder and a health technician. The responder, a trained crisis intervention specialist, takes the call and speaks with the Veteran and tries to understand the situation. The health technician takes the information the Veteran provides to the responder and tries to pinpoint their location. Once a location is established, emergency services in that area can be contacted either for immediate attention in response to a suicide attempt or to provide follow-up care.Call and talk to them about anything you are struggling with — the death of a loved one, relationship break-up, loss of job or unemployment, money problems, losing your home or anything else that might be contributing to how you are feeling.Crisis Can Come from a Wide Range of SituationsIt is not unusual to face disappointments, frustrations, loss and the wear and tear of daily stress. People experience emotional and mental health crises in response to a wide range of situations — from difficulties in their personal relationships to the loss of a job. For Veterans, these crises can be heightened by their experiences during military service. When emotional issues become overwhelming, it’s time to call on the Veterans Crisis Line for support.It’s helped thousands of Veterans and it can help you.The Veterans Crisis Line works in partnership with the Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) National Suicide Prevention Lifeline.One suicide is one too many, and in our efforts to try and prevent any suicide, we are working hard to make the Crisis Line even better. We’re working to improve our processes and systems to allow for earlier intervention through better identification of Veterans in crisis and proactive engagement.The Crisis Line is working. A million-and-a-half phone calls later, we are still here to help. Call!Veterans Crisis Line: 1-800-273-8255 and press 1- See more at: http://www.va.gov/HEALTH/NewsFeatures/2015/February/VAs-Veterans-Crisis-Line-Saves-Lives-Every-Day.asp#sthash.zwhKYdBP.dpuf     New Pentagon Boss Rips SequestrationDefense Secretary Ash Carter took the reins of the military Tuesday at the White House and immediately addressed an issue that impacts all corners of the agency he leads. In a letter to military members and Defense Department civilians, he called sequestration, the automatic budget cuts imposed by Congress, "a wasteful uncertainty and risk to our nation's defense." Carter was confirmed last week by the Senate as the nation's 25th defense secretary. He follows Defense Secretary Chuck Hagel, who took the job in 2013. Carter pointed out in his letter that he has served for three decades in the Pentagon and has worked for 11 defense secretaries under both Republican and Democratic administrations. But he concentrated on the budget, which is likely to be as challenging as the enemies he faces abroad. "We must balance all parts of our defense budget so that we continue to attract the best people—people like you; so that there are enough of you to defend our interests around the world; and so that you are always well-equipped and well-trained to execute your critical mission," he said. He continued, "To win support from our fellow citizens for the resources we need, we must show that we can make better use of every taxpayer dollar. That means a leaner organization, less overhead, and reforming our business and acquisition practices. It also means embracing the future—and embracing change. "We must be open to change in order to operate effectively in an increasingly dynamic world; to keep pace with advances in technology; and to attract new generations of talented and dedicated Americans to our calling." VA Boss: Few Veterans Use Private Care The head of the Department of Veterans Affairs wants flexibility in how he can use $10 billion marked for the Choice Card program, which allows qualified veterans to seek health care from providers outside the VA. Secretary Robert McDonald said only 27,000 veterans have used the program since it started in November, a small fraction of the 9 million people who use VA health care. He wants to use the money for other priorities, such as hiring more claims officers to address the backlog of claims within his agency, according to The Washington Post. The Choice Card program was created last fall in the wake of reports that veterans wait inordinately long times for appointments with the VA. The card allows veterans who wait more than 30 days for an appointment or who live more than 40 miles from a VA facility to seek care from a private doctor or clinic and the government will pay the bill. But the VA says it has hired more doctors and nurses and cut the waiting time for appointments. It says the money approved for the Choice Card can be used elsewhere. Lawmakers have rejected the idea, which was revealed in the president's budget released three weeks ago. Rep. Jeff Miller, R-Fla., the chairman of the House Committee on Veterans' Affairs, says the VA's idea is a "complete nonstarter."  VA Seeks to Close Facilities Nationwide The Department of Veterans Affairs has hundreds of facilities that are underutilized or not being used at all, the VA secretary told lawmakers last week, and he wants to close them. Secretary Robert McDonald told the House Committee on Veterans' Affairs that the VA has 336 buildings less than half-occupied or unused, according to Military Times. "VA cannot be a sound steward of the taxpayers' resources with the asset portfolio that we're currently carrying," he said in his testimony. "No business would carry such a portfolio. Veterans deserve much better. It's time to close the VA's old substandard and underutilized infrastructure." The VA has more than 1,300 facilities that are at least 70 years old, but Military Times noted that members of Congress are reluctant to close military facilities because that often means lost jobs in their districts or states. The same is true of VA buildings. Rep. Corrine Brown, D-Fla., joked that "we support closing some of the VA facilities . . . just as long as you don't close any in Florida." She added that communities affected by closures should have input in the process if any VA facilities are closed.  TRICARE Users Must Report Coverage to IRSAs tax season begins, Defense Department officials want to remind TRICARE beneficiaries of changes in the tax laws, which require all Americans to have health insurance or potentially pay a tax penalty. For the first time since the Affordable Care Act passed in 2010, all U.S. citizens, including service members, military retirees and their family members, must report health-care coverage on their 2014 taxes, said Mark Ellis, a Defense Health Agency health care operations program analyst. For this year only, taxpayers will "self-attest" on their 2014 tax forms to each month in which they had health care coverage, he said. The act mandates that health care must meet minimum essential coverage, and TRICARE coverage meets that criteria for the majority of service members and their families. TRICARE Prime, TRICARE Standard, TRICARE for Life, TRICARE Overseas, TRICARE Remote and the Uniformed Services Family Health Plan meet the minimum essential coverage criteria, he added. When purchased, premium-based plans such as TRICARE Reserve Select or TRICARE Retired Reserve also fulfill the act's requirements. Uniformed service members who have questions about TRICARE, the act and the individual coverage mandate can visit the TRICARE website to download a fact sheet on TRICARE and the act, with TRICARE plans compared to minimum essential coverage, Ellis said. The TRICARE and ACA fact sheet is available at www.tricare.mil/~/media/Files/TRICARE/Publications/FactSheets/ACA_FS.pdf.Sparks Fly At VA Budget Request HearingLast week the House Veterans’ Affairs Committee held a hearing of the full committee to consider the Department of Veterans’ Affairs’ budget request for the 2016 fiscal year. Some substantive information was disclosed, but the most newsworthy event from the hearing was a clash between Congressman Mike Coffman (R-CO) and VA Secretary Bob McDonald.The most substantive part of the hearing came at the beginning, when the Chairman of the House Veterans’ Affairs Committee, Jeff Miller (R-FL) pushed back against the VA’s request that $10 billion from the Veterans’ Choice Access and Accountability Act be reprogrammed so that VA can hire doctors within its system, instead of allowing veterans to receive care in the private sector at VA’s expense.Chairman Miller’s position is that it hasn’t even been a year since the law took effect, so any attempt to move money away from the Choice program would be premature. Until VA healthcare access issues are solved through the normal budget process, it would be inappropriate to eviscerate the program that Congress set up just six months ago.The real fireworks came when Congressman Coffman began questioning Secretary McDonald in a rather accusatory tone about the debacle surrounding the construction of the VA Medical Center in Denver, Colorado. Congressman Coffman was entirely right to ask the Secretary why the budget seemed to suggest that defending against the lawsuit brought by the project’s prime contractor was a “success” by the VA’s Office of General Counsel when the VA had lost in court on all counts.But raising his voice and suggesting that this proved that nothing had changed at the VA was a step too far in the opinion of the Secretary, who pushed back by saying “I’m offended by your comments,” McDonald said. “I’ve been here six months. You’ve been here longer than I have. If there’s a problem in Denver I think you own it more than I do.” View the whole exchange here.The mess at the VA Medical Center in Denver, as well as the problems with construction management in Las Vegas, Orlando, and numerous other locations is well documented, but casting a judgment on the tenure of a VA Secretary who has been on the job less than six months seems to be over reach on the part of Congressman Coffman. We hope that this exchange serves to light a fire under the VA leadership team and that they continue to show great resolve in getting a handle on these mismanaged construction projects that waste taxpayer money as well as fail to deliver needed care to veterans.VA and Community Partners Release West Los Angeles Homeless PlanOn January 28, 2015, U.S. Department of Veterans Affairs (VA) Secretary Robert A. McDonald and attorneys representing homeless veterans in Los Angeles announced a historic agreement that dedicates the West Los Angeles VA campus to serving veterans in need. The agreement is an important step forward in carrying out President Obama's commitment that no veteran should live on the streets, or forego available medical and psychological services.SAV Act Now Law President Obama sign the Clay Hunt Suicide Prevention for American Veterans (SAV) Act into law. The new law allows the VA to hire more psychiatrists, collaborate with local non-profit mental health organizations, and expand its successful peer support networks. It strengthens and expands the mental health programs and services currently available to service members and veterans. What the SAV Act doesn’t do is go far enough, dropped provisions from the final bill would have improved mental health partnerships between the VA and the Reserve Components, and required DOD to review less-than-honorable discharges that may have been associated with undiagnosed PTSD.  VA Announces $300 Million in Grants to Community Partners Working to End Veteran HomelessnessBuilding on President Obama's commitment to end Veteran homelessness, the Department of Veterans Affairs is announcing the availability of $300 million in grants to non-profit organizations and other groups that serve Veterans through VA's Supportive Services for Veteran Families (SSVF) program. The SSVF program assists very low-income Veteran families who are homeless or at risk of becoming homeless. The $300 million grants are available to current grantees seeking renewals.