Rao bulletin 1 June 2016 html edition this bulletin contains the following articles

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Military History Anniversaries 1 thru 15 JUN
Significant events in U.S. Military History over the next 15 days are listed in the attachment to this Bulletin titled, “Military History Anniversaries 1 thru 15 JUN”. [Source: This Day in History http://www.history.com/this-day-in-history | May 2016 ++]


WWII Battles Q&A (2) Answers
1. Answer: During WWII, Kharkov was the site of four major military engagements. The city was captured and recaptured by Nazi Germany on 24 October 1941; there was a disastrous Red Army offensive that failed to capture the city in May 1942; the city was successfully retaken by the Soviets on 16 February 1943, captured for a second time by the Germans on 15 March 1943 and then finally liberated on 23 August 1943. Seventy percent of the city was destroyed and tens of thousands of the inhabitants were killed.
2. Answer: The Guadalcanal campaign was a significant strategic combined arms victory by Allied forces over the Japanese in the Pacific theater. The Japanese had reached the peak of their conquests in the Pacific. The victories at Milne Bay, Buna-Gona, and Guadalcanal marked the Allied transition from defensive operations to the strategic initiative in that theater, leading to offensive operations, such as the Solomon Islands, New Guinea, and Central Pacific campaigns, that resulted in Japan's eventual surrender and the end of World War II.
3. Answer: The Allied forces were split in two by a German armored advance to the Channel coast at Calais after being taken by surprise at the speed of the advance. In one of the most widely-debated decisions of the war, the Germans halted their advance on Dunkirk, giving time for the Allies time to organize the Dunkirk evacuation and build a defensive line. Despite the Allies' gloomy estimates of the situation, with Britain discussing a conditional surrender to Germany, in the end over 330,000 Allied troops were rescued.
4. Answer: In World War II, during Operation Market Garden (September 1944), the British 1st Airborne Division and the Polish 1st Independent Parachute Brigade were given the task of securing the John Frost Bridge at Arnhem. The units were parachuted and glider-landed into the area on September 17th but the bulk of the force was dropped rather far from the bridge and never met their objective. A small force of British 1st Airborne managed to make their way all the way to the bridge but was unable to secure both sides. The British force at the bridge eventually ran out of ammo and were captured on September 21st, and a full withdrawal of remaining forces made on September 26th.
5. Answer: The Battle of Badung Strait was a naval battle of the Pacific campaign of World War II, fought on the night of February 19, 1942 in Badung Strait (not to be confused with the West Java city of Bandung) between the American-British-Dutch-Australian Command (ABDA) and the Imperial Japanese Navy. In the engagement, the four Japanese destroyers defeated an Allied force that outnumbered and outgunned them, escorting two transports to safety and sinking the Dutch destroyer Piet Hein.
6. Answer: Some sources claim the first kamikaze mission occurred on September 13, 1944 when a group of Japanese pilots on Negros Island decided to launch a suicide attack the following morning. Two 220 lb (100 kg) bombs were attached to two fighters, and the pilots took off before dawn, planning to crash into carriers however they never returned and there is no record of an enemy plane hitting an Allied ship that day. According to other sources, on October 14 1944, the USS Reno was hit by a deliberately crashed Japanese plane. Kamikaze tactics were undoubtedly used on October 17, 1944, at the beginning of the Battle of Leyte Gulf when the Japanese 1st Air Fleet was massively overwhelmed and purposefully resorted to suicide attacks.
7. Answer: Operation Battleaxe was a British Army operation in June 1941 to clear eastern Cyrenaica of German and Italian forces and raise the Siege of Tobruk. The British lost over half of their tanks on the first day and only one of the three attacks succeeded. They achieved mixed results on the second day, being pushed back on their western flank and repulsing a big German counter-attack in the center. On the third day, the British narrowly avoided complete disaster by withdrawing just ahead of a German encircling movement.
8. Answer: The Battle of Nancy in September 1944 was a 10-day battle in which the U.S. 3rd Army defeated German forces defending the approaches to Nancy, France and crossings over the Moselle River to the north and south of the city. When the 3rd Army began its attempt to capture Nancy, it had only recently recovered from a severe fuel shortage which had caused it to halt on the Meuse River for five days. During this time, German defenders in the area had reinforced their positions. The battle resulted in U.S. forces fighting their way across the Moselle and liberating Nancy.
9. Answer: His strategy of maneuver, air strikes and force avoidance meant that soldiers under his command faced relatively low casualties. Douglas MacArthur also managed the occupation of Japan from 1945 to 1951 and as the effective ruler of the country, he oversaw sweeping economic, political and social changes.
10. Answer: American losses for Operation Detachment during the Battle of Iwo Jima were a staggering 6,821 killed/missing and 19,217 wounded. During the struggle for the island, twenty-seven Medals of Honor were awarded, fourteen posthumously. A bloody victory, Iwo Jima provided valuable lessons for the upcoming Okinawa campaign. In addition, the island fulfilled its role as a waypoint to Japan for American bombers. During the final months of the war, 2,251 B-29 Superfortress landings occurred on the island. Due to heavy cost to take the island, the campaign was immediately subjected to intense scrutiny in the military and press
11. Answer: From the Normandy landings to the end of the war in Europe, Bradley had command of all U.S. ground forces invading Germany from the west. After the war, Bradley headed the Veterans Administration and became Army Chief of Staff. In 1949, Bradley was appointed the first Chairman of the Joint Chiefs of Staff, and the following year oversaw the policy-making for the Korean War, before retiring from active service in 1953. He was the last of only nine people to hold a five-star rank in the United States Armed Forces.
12. Answer: The Battle of Britain has been described as the first major campaign to be fought entirely by air forces. The primary objective of the Nazi German forces was to force Britain to agree to a negotiated peace settlement.
[Source: http://www.zoo.com/quiz/world-war-ii-battles | May 2016 ++]
Medal of Honor Citations Barrett~Carlton W | WWII
The President of the United States in the name of The Congress

takes pleasure in presenting the

Medal of Honor

Rank and organization: Private, U.S. Army, 18th Infantry, 1st Infantry Division

Place and date: Near St. Laurent-sur-Mer, France, 6 June 1944

Entered service: October 29, 1940 at Albany, N.Y.

Born: November 24, 1919 in Fulton N.Y.
For gallantry and intrepidity at the risk of his life above and beyond the call of duty on 6 June 1944, in the vicinity of St. Laurent-sur-Mer, France. On the morning of D-day Pvt. Barrett, landing in the face of extremely heavy enemy fire, was forced to wade ashore through neck-deep water. Disregarding the personal danger, he returned to the surf again and again to assist his floundering comrades and save them from drowning. Refusing to remain pinned down by the intense barrage of small-arms and mortar fire poured at the landing points, Pvt. Barrett, working with fierce determination, saved many lives by carrying casualties to an evacuation boat lying offshore. In addition to his assigned mission as guide, he carried dispatches the length of the fire-swept beach; he assisted the wounded; he calmed the shocked; he arose as a leader in the stress of the occasion. His coolness and his dauntless daring courage while constantly risking his life during a period of many hours had an inestimable effect on his comrades and is in keeping with the highest traditions of the U.S. Army.
Carlton William Barrett enlisted voluntarily in the United States Army about one month before his twenty-first birthday. In civilian life, Barrett had left school after his sophomore year in high school and had been working as a cook. Little information is available about Barrett’s military experience prior to being part of the 18th Regimental Combat Team, 1st Infantry Division on D-Day, June 6, 1944. The 18th RCT was the second of the 1st Division’s regiments to hit the beach, beginning their landing at about 1000 hours. They landed amidst a carnage of shredded landing craft and vehicles, mounting casualties from the 16th RCT that had landed before them, and a gigantic fight remaining to get off the beach and attack inland. Barrett’s assigned role during the landing was as a guide; assisting other soldiers ashore. He became one of three 1st Division soldiers to earn the Medal of Honor on D-Day.
The motto of the 18th Infantry Regiment is “In Omina Paratus” – “Prepared For All Things”. Carlton Barrett certainly was when liberty needed him the most. He survived World War II and remained in the Army until retiring in June 1963 as a Staff Sergeant. Carlton Barrett passed away on May 3, 1986. He rests in peace in the Napa Valley Memorial Park, Napa, California. [Source: http://www.history.army.mil/moh/wwII-a-f.html May 2016 ++]

* Health Care *

TRICARE Reform Update 02 House/Senate Committee Proposals
The House and Senate concur that the military health system should be overhauled starting in fiscal 2017; they just disagree on how to reach their similar vision for a system that serves more than 9 million beneficiaries. The draft defense policy bill rolled out last week by the Senate calls for consolidating Tricare into two plans — the current Tricare Prime and Tricare Choice, a meld of Tricare Extra and Standard — and adds a Tricare supplement for beneficiaries with other health insurance. The proposal is similar to the House’s draft bill, but the two bodies disagree on who should pay for revised benefits, with the House proposing to charge new beneficiaries, including active-duty families, an enrollment fee for all plans after Jan. 1, 2018.
The Senate version does not include any enrollment fees for active-duty personnel, and it phases in Tricare Choice fees more slowly than requested by the Pentagon in its proposed budget. “We came to similar conclusions, but we didn’t go about it in similar ways,” a Senate Armed Services staff member said 16 MAY. “[The House version] would implement for the first time ever enrollment fees for active-duty family members. This is not a place our senators wanted to go.” Under both the Senate and House proposals, military retirees not eligible for Medicare will pay more for health care, regardless of which plan they choose.
The Senate has proposed that enrollment fees for Tricare Prime increase for these retirees by $68 per year for an individual and $135 for families starting in 2018 and increase each year by the same formula now used. Retirees electing Tricare Choice would pay $150 for an individual and $300 for a family, increasing over five years to $450 per year for an individual and $900 per year for a family. The idea, Senate staffers said, is to make “modest increases” to ensure that the Pentagon can sustain its health budget while improving quality. “We get input ... every year, and their biggest issue was if we are going to tinker with the system, we had to increase the quality of care,” a staff member said.
The House bill also reorganizes Tricare, into the existing Tricare Prime and Tricare Preferred, similar to the Senate's "Choice." The House version has the same fee structure for those enrolled before 2018 until 2020, if the Defense Department meets certain standards for patient access and care. After that, if DoD has proven it has met standards, retirees using Tricare Preferred would start paying an annual enrollment fee: $100 for an individual and $200 for a family. And anyone enlisting after Jan. 1, 2018, would pay an annual fee, including the active-duty family members, of either $180 for an individual and $360 for a family for Tricare Prime, or $300 for an individual or $600 for a family for Tricare Preferred, under the House version.
Both legislative proposals also make changes to the military health system to "ensure medical readiness and streamline administrative structure," staff said. The House would place oversight of the military medical facilities under the Defense Health Agency. The Senate has not released its specifics on the structural overhaul but hinted at creating a unified medical command, eliminating the service medical “stove pipes” and “realigning the DoD medical command structure” while shrinking headquarters staff. For the first time, the Senate Armed Services Committee is proposing to fine beneficiaries who miss medical appointments. According to staff members, military beneficiaries missed 1.7 million appointments last year, including 700,000 active-duty or active-duty family member appointments. Staff members did not say how much DoD would charge for the missed appointments; the bill language is expected to be released this week.
Pharmacy fees also would rise, under the Senate plan, mainly at retail pharmacies and for brand-names ordered by mail. The Senate supports the DoD’s nine-year cost table, which has prescription co-pays for brand-name medications rising incrementally to more than $45 per 30-day prescription by 2026. But, staff pointed out, prescriptions would remain available at no cost through the military treatment facility, and generics also would be available at no cost through mail. “Ninety-two percent of active duty live within a service area of a military hospital and clinic. ... What does that tell you? They can get free health care,” the staff said. Agreeing with a Pentagon budget proposal to raise the catastrophic cap, the Senate version would increase the cap for active-duty families to $1,500 for network care, up from $1,000, and for retiree families, from $3,000 to $4,000. Participation fees would not count toward the caps. Both drafts must be approved by their respective legislative bodies and reconciled before becoming law. [Source: Military Times | Patricia Kime | May 16, 2016 ++]
TRICARE Reform Update 03 Senate Package Highlights
The Senate Armed Services Committee is embracing some TRICARE fee increases proposed by the Obama administration, particularly for working age retirees and their families. But it links those fee hikes to some surprising and long overdue improvements in patient access and quality of care. This is a far different and seemingly less strained approach than adopted by the House, which would delay most TRICARE fee increases for a generation so they impact only persons who enter the military after 2017 and begin to retire 20 or more years later. On TRICARE fees alone, military beneficiaries almost certainly would prefer that the House provisions prevail when a conference committee meets to iron out differences in the two versions of the fiscal 2017 defense authorization bill. But Democrats charge that the House only was able to defer hard decisions on military compensation by voting to fund just seven months of Iraq and Afghanistan war operations next year.
The threat of a presidential veto if the House budget blueprint prevails, and the attraction of Senate initiatives to expand patient access, seem to give the Senate’s approach to reform better odds of becoming law, though the outcome isn’t near certain. Steve Strobridge, director of government relations for Military Officers Association of America, said MOAA opposes the TRICARE fee increases but the Senate committee does deserve credit for following through on a promise to link them to concrete steps to improve care access and care quality.
Here are highlights of the fee increases and system improvements endorsed by senators:
TRICARE for Life – No fee increases for disabled retirees or for retirees and family members age 65 and older who rely on TRICARE for Life, the military’s prized supplement to Medicare coverage.

Learn more about TRICARE for Life.

TRICARE Prime – The enrollment fee to use military managed care would be raised only for non-disabled retirees under age 65 and their families. For family coverage, retirees would pay $700 a year versus the current $565. Individual retirees would pay $350, up from $282.

Learn more about TRICARE Prime.

TRICARE Choice (Standard) – TRICARE Standard, the military fee-for-service insurance option, would see a name change, to TRICARE Choice. This would underscore that users get to pick their providers. But that freedom to choose would become more costly. Active duty family members or retirees and families would pay a first ever annual enrollment fee. Senators rejected the administration’s call for the fee in fiscal 2018 to be set at $450 for individuals and $900 for families. It opted for a lower fee to start, with a climb to $450/$900 over five years.
TRICARE Supplemental – Working spouses and military retirees would be offered a new lower-cost Choice option if they have alternative health insurance through civilian employers. TRICARE Supplemental would cover costs that alternative insurance wouldn’t pay. And so beneficiaries would pay only half of the annual enrollment fee of full Choice coverage.
Deductibles – The bill accepts the administration’s proposal to establish an annual deductible for Choice beneficiaries who use out-of-network providers. For family members of pay grades E-4 and below, the deductible would be $100 for individuals and $200 for families. For dependents of higher grades and for retirees, the deductible would be $300 per individual or $600 for families.
Outpatient Cost Shares – The Senate bill largely embraces the administration’s call to replace existing co-shares for Choice (Standard) with flat cost-shares for active duty family members and retirees who use healthcare providers outside the network. The aim is to incentivize patients to use TRICARE network contractors and base facilities more efficiently.
Pharmacy Co-Payments – The bill largely accepts the administration’s plan to phase in higher co-pays for off-base pharmacy benefits to spur greater use of generic drugs and mail order. The administration wanted co-pays for brand name drugs at retail outlets or by mail order to climb from $24 this year to $46 by 2026. Instead, co-pays for generic drugs at retail would stay at $10 through 2018 and then climb to $14 by 2025. Generic drugs filled by mail order would have no co-pays through 2019, but rise thereafter to reach $14 by 2025. Brand names not on TRICARE’s drug formulary would be unavailable at retail outlets. Through mail order, non-formulary brand drugs would cost beneficiaries $54 per prescription in 2017, and climb to $92 by 2026. Prescriptions would continue to be filled on base at no charge.
Health Fee Indexing – Senators reject the administration’s call to index TRICARE fees and co-pays to the annual rise in health care costs as measured by the National Health Expenditures (NHE) index. They found a different index to use that that should keep fee increases somewhere between the NHE index and annual retiree cost-of-living adjustments.
Here are highlights of Senate package aimed at ensuring the military health system delivers better value:
Commercial Insurance for Reservists – DoD would have authority to test a program to offer drilling Guard and Reserve members access to the commercial health insurance plans for federal civilian employees. The benefits and premiums might be more attractive than those offered under the TRICARE Reserve Select program, which would not be changed.
End Pre-Authorization Requirement – TRICARE beneficiaries no longer would need pre-authorization from TRICARE managers to seek urgent or special care. This is expected to vastly expand timely access to care.
Appointment Schedules – Military treatment facilities would be required to adopt a single standardized appointment system.
Improved Dental/Vision Coverage – Military retirees would be allowed to enroll in the same dental and vision insurance plans offered to federal civilian retirees. The dental benefits, in particular, are seen as an improvement over the plan now offered to military retirees.
Value-Based Co-Payments – DoD would gain authority to lower beneficiary co-pays on health services and drugs critical to health care outcomes, and to raise them elsewhere. This should encourage wiser choices in use of health resources, replacing a one-size-fits-all approach to fees.
No-show appointment fees – Beneficiaries would be charged a “no-show” fee if they fail to appear for scheduled appointments at military treatment facilities, a move to curb current widespread abuse that limits patient access to care and leads to system-wide inefficiencies.
Telemedicine Expansion – The healthcare system would be required to offer a full range of telehealth services to military beneficiaries.
[Source: NCOA Advocate | Tom Philpott | May 19, 2016 ++]
CMI Chronic Multisymptom Illness | Iraq/Afghanistan Vets
A majority of veterans returning home from Iraq and Afghanistan are reporting symptoms of a condition known as chronic multisymptom illness (CMI), according to a new Veterans Affairs study of more than 300 enlisted Army National Guard and Army Reserve troops. The data was collected one year after their return. The condition presents itself as a combination of chronic symptoms, including memory problems, insomnia, fatigue, headache, dizziness, joint pain, indigestion, and breathing problems. “As a whole, CMI can be challenging to evaluate and manage,” said lead author Dr. Lisa McAndrew from the University at Albany. “CMI is distinct from PTSD or depression. It contributes to significant disability.”

many iraq, afghanistan vets reporting chronic illness symptoms

CMI has previously been associated with service during the Persian Gulf War in the early 1990s with at least a quarter of those veterans affected. Experts are unsure, however, if that condition is the same one that is emerging with such force among recent veterans. Last year, for example, researchers with the Millennium Cohort Study reported that about one-third of combat veterans who served in Iraq and Afghanistan had CMI symptoms. “This condition appears to be similar to that experienced by many Gulf War veterans, in terms of the symptoms, but we don’t really know if it’s the same condition,” says McAndrew. “That still requires study.”

For the new study, the researchers surveyed 319 soldiers about their overall health before they deployed and one year after they returned. The findings show there were 150 soldiers who did not report many symptoms before they deployed but who reported symptoms of CMI one year after deployment, suggesting a link between deployment to Iraq or Afghanistan and CMI. Overall, nearly 50 percent of the overall group met the criteria for mild to moderate CMI, and about 11 percent met the criteria for severe CMI, one year after deployment. The most common symptoms reported were trouble sleeping, moodiness or irritability, joint pain, fatigue, difficulty remembering or concentrating, headaches, and sinus congestion. Not surprisingly, veterans who screened positive for CMI scored significantly lower on measures of physical and mental health function.
In total, 166 of the veterans suffered from chronic pain, lasting more than three months. Almost all of those with chronic pain — 90 percent — also met the criteria for CMI. Similarly, 82 percent of those with CMI reported chronic pain. The finding underscores the strong link between chronic pain and CMI, say the researchers. Furthermore, nearly every veteran with PTSD symptoms also showed signs of CMI — about 98 percent. Only seven patients had PTSD and did not meet the criteria for CMI. In contrast, though, about 44 percent of the veterans with CMI did not have PTSD. In other words, the link between PTSD and CMI was not as robust as that between chronic pain and CMI. The authors caution that the study looked only at pain and PTSD as factors associated with CMI. It did not document other conditions that could possibly account for CMI symptoms, such as depression, traumatic brain injury, or substance abuse. However, they say that these other conditions are unlikely to completely account for the frequency of symptoms seen in the study.
All in all, the research team advises that the results be interpreted with caution. “We’re taking the approach that an abundance of caution is necessary in the clinical implications of the findings. Respondents self-reported symptoms on pen and paper surveys. The symptoms were not confirmed or evaluated by a clinician,” says McAndrew. “While the CDC case definition is fairly clear-cut, in clinical practice there is a lot of gray area around applying the label of CMI. We used the term ‘symptoms consistent with CMI’ to indicate the uncertainty due to the self-reported, clinician-unverified nature of the classification.”
McAndrew’s group says clinicians should consider CMI when evaluating Iraq and Afghanistan Veterans, especially those with chronic pain. Once the condition is identified, clinicians in VA and the Department of Defense do have a clinical practice guideline for managing the condition. “Acknowledging the presence of multiple symptoms and taking a holistic approach to achieving patient goals is critical in managing CMI,” says McAndrew. The WRIISC study notwithstanding, McAndrew says not enough attention has been focused on the issue to date. “There have been few studies of CMI among Iraq and Afghanistan veterans. Our findings suggest this could be an overlooked problem.”

The findings are published in the Journal of Rehabilitation Research and Development. [Source: VVA Web Weekly | Traci Pedersen | | May 24, 2016 ++]

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