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

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VA Fertility Services Wounded Vets Press for Services
Three months into a deployment in June 2012, Army Sgt. Kevin Jaye was on foot patrol in Afghanistan when he triggered the pressure plate of an improvised explosive device. The blast tore off his right leg and caused significant damage to his left leg and lower torso. Jaye spent two years at Walter Reed National Military Medical Center, enduring more than 30 surgeries and countless physical therapy sessions. Now medically retired from the military, he continues to need health services from the Veterans Affairs Department. Nearly all Jaye’s combat-related conditions are covered by VA, except for one: Infertility.
The explosion “destroyed my reproductive system,” according to Jaye, leaving him with low testosterone and a negligible sperm count that makes it impossible for Jaye to father children without medical assistance. The VA provides assessments and some treatment, such as surgeries and medications, to increase a veteran’s odds of creating a baby, but it does not provide in vitro fertilization and other advanced reproductive treatments for the 1,800 to 2,000 injured post-9/11 troops who need help to start a family. Jaye and his wife, Lauren, were able to access fertility treatments through Lauren’s employer-provided health insurance. But without a change to the 1992 law that prohibits VA from covering in vitro fertilization, their baby girl, due in August, likely will be their only child, since the couple has maxed out their $30,000 insurance cap on fertility treatments. “We have fought so hard to have a child. … VA covers everything else, why not this? It’s heartbreaking,” Kevin Jaye said during a visit to Congress to press for the law to be overturned.
Sen. Patty Murray (D-WA) has tried for more than five years to pass legislation requiring the VA to cover in vitro fertilization and other specialty fertility services. She recently sponsored an amendment to the Senate military construction and Veterans Affairs appropriations bill that would allocate $88 million to the VA to cover fertility treatments and counseling for these wounded veterans and their spouses. According to Murray, paralyzed veterans, those with groin injuries, and former service members who have suffered head trauma that affects their hormones have a right to start a family and shouldn’t be forced to pay out of pocket. “This is just so wrong to me. … People in America need to stand up and say this is a wound of war and this country needs to pay for it,” Murray said.
Earlier this year, the Pentagon announced it would create a pilot program that will cover the cost of freezing the sperm or eggs of active-duty troops to provide more family planning options and preserve a service member’s fertility prior to deployment. The Defense Department also covers in vitro fertilization and other fertility services for severely wounded troops while they are on active duty. But once they medically retire, the coverage stops. And, according to these troops, the recovery period before they leave active duty is the worst time to think about having babies. “We were in the process of saving his leg. What a terrible time, as responsible people, to start a family,” Lauren Jaye said. “We wanted to get him healed and then think about it.”
“We had a lot to get through,” said Tracy Keil, wife of retired Army Staff Sgt. Matt Keil, who was paralyzed by a sniper’s bullet in Iraq. “We were adjusting to the wheelchair, we both lost our jobs. Matt lost his whole career — he need time figure out what he wanted to do when he grew up. It wasn’t a good time to think about children.” The Keils did not take DoD up on the offer and paid $32,000 of their savings for treatment. Their twins are now 5 years old. “I felt betrayed, forgotten. I don’t want other veterans to have to go through the heartache I went through. Why should any of us have to beg for something like this?” Matt Keil said.
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Matthew Keil give twins Matthew Jr. and Faith a ride around the house at their home near Parker, Colo. Keil and his wife, Tracy were among a group of veterans this week on Capitol Hill pressing for VA coverage.

Murray has made several attempts to get legislation passed to expand coverage for veterans. A bill proposed last year was pulled before a committee vote when Sen. Thom Tillis (R-NC) added amendments that questioned the funding of the initiative and prohibited the VA from working with Planned Parenthood and other organizations that provide abortion services in addition to fertility treatments. A 2012 bill was approved by the Senate but failed in the house over funding concerns. Murray said 10 MAY she believes her most recent proposal has the support of lawmakers from both sides of the aisle and funding shouldn’t be an issue. “I want to make sure that nothing happens in the middle of the night that takes it out of the bill. People say they object to it because of its cost. But this is a cost of war,” she said. During a hearing last year, an assistant VA deputy undersecretary told the Senate Veterans' Affairs Committee that the department largely supports Murray’s proposals, provided that money was available for the services. “VA supports doing all we can to restore to the greatest extent possible a veteran's quality of life, including the ability to have a family,” Dr. Rajiv Jain said. Still, the legislation faces an uphill battle.

On 11 MAY Democrats on the House Veterans' Affairs Committee proposed amendments similar to Murray’s proposal. But the panel instead advanced legislation that would give $20,000 in new compensation payouts to veterans who suffered injuries to reproductive organs, with the goal of using the money to cover ensuing family planning costs. Republican supporters said the money could go toward adoption costs, fertility treatments or family expenses of the veterans’ choosing. Rep. Dina Titus(D-NV) however, noted that $20,000 may not be enough to cover even one full cycle of IVF treatments. "We should do the right thing and fulfill our promises to take care of these veterans," she said.
Crystal Black and retired Army Cpl. Tyler Wilson have spent $14,000 of their own money to have a baby. They are just in the early stages and hope that Crystal will be pregnant in the next few months. Wilson, paralyzed from the waist down by enemy gunfire, said in vitro fertilization is the only way they will have a complete family. But after this try, they won’t be able to afford future attempts. “The VA covers every other medical need he has, his medications, his wheelchair. But the VA is denying Tyler and every other service member in our situation, the right to have a family, the right that these men served for and already have given so much for,” Black said. [Source: Military Times | Patricia Kime | May 16, 2016 ++]
VA In Vitro Fertilization Update 08Passed Senate Bill Includes Funding
Veterans whose war wounds have rendered them infertile are one step closer to having their service-related condition covered by the Veterans Affairs Department. The Senate version of the Military Construction and Veterans Affairs funding bill, which passed 18 MAY in an 89-8 vote, included a provision that would require VA to cover fertility treatments for the estimated 1,800 to 2,000 post-9/11 troops whose combat or training-related injuries have affected their ability to have children. Sen. Patty Murray (D-WA) has lobbied for the change for more than five years. Thursday's vote marks the second time the measure has passed the Senate; the House must approve similar language before it becomes law.
"This issue shouldn’t be about politics. It shouldn’t be about partisanship. And we shouldn’t cut corners when it comes to our veterans and their families," Murray told her Senate colleagues just prior to the vote. The VA currently provides assessments and some treatment, like surgeries and medications, to increase a veteran’s odds of creating a baby, but it is barred by law from covering in vitro fertilization and other advanced reproductive treatments. The Defense Department covers in vitro fertilization and other fertility services for severely wounded troops, but only while they remain on active duty. Affected veterans were on Capitol Hill last week to tell lawmakers about the challenges facing them as they have recovered from horrific injures, only later discovering that the VA doesn't offer fertility services for service-connected wounds. “I felt betrayed, forgotten. I don’t want other veterans to have to go through the heartache I went through. Why should any of us have to beg for something like this?” said retired Army Staff Sgt. Matt Keil, who was paralyzed from the upper chest down by sniper fire in Iraq.
The last time the Senate approved Murray's proposal was in 2012, but the measure failed in the House over funding concerns. The current proposal would allocate $88 million over two years to VA to cover in vitro fertilization and other advanced reproductive treatments for injured personnel and their spouses. Last week, the House Veterans Affairs Committee rejected bills containing the same provisions as Murray's proposed amendment. Instead, the panel advanced legislation that would give $20,000 in new compensation payouts to veterans who suffered injuries to reproductive organs, paid out over two installments. The money could be used for fertility treatments, adoption or reproductive services but would not have to go toward family planning. [Source: Military.com | Patricia Kime | May 19, 2016 ++]
VA Hepatitis C Care Update 13 Get Tested at your VA Center
VA encourages Veterans to get tested and get treatment for viral hepatitis. If left untreated, hepatitis is life threatening, because it can lead to liver disease. Effective screening and treatment for hepatitis is available at your VA medical center. Testing for hepatitis C infection is recommended for all Veterans born between 1945 and 1965, regardless of perceived risk. May 19 was National Hepatitis Testing Day. Hepatitis C infections can go unnoticed for years, even decades. Effective treatment is available. Don’t let hepatitis C surprise you. Get the facts. Get tested. Get treatment. Learn more at www.hepatitis.va.gov/patient/hcv/testing/index.asp.
“Hepatitis” means inflammation of the liver. It can be caused by one of several viruses, which is why it is often called “viral hepatitis.” The most common types of viral hepatitis within the U.S. are hepatitis A, hepatitis B, and hepatitis C. Hepatitis B and hepatitis C can become chronic, life-long infections that can cause serious health problems including liver damage, cirrhosis, liver cancer, and even death. Veterans have unusually high rates of hepatitis C, especially those born between 1945 and 1965. Hepatitis C is generally spread through blood-to-blood contact. The disease begins with the swelling of the liver and can progress to liver damage such as cirrhosis and liver cancer if untreated.
Many are Unaware They Have Hepatitis C. Hepatitis C can persist for 10 to 30 years before there are any clear symptoms, which is why most people with chronic hepatitis C are unaware they are infected. There is no vaccine for hepatitis C, but effective treatments are now available. A blood test is the only way to diagnose a hepatitis C infection. Veterans with any of the following risks should be tested for hepatitis C:\

  • Anyone born from 1945-1965,

  • Anyone with liver disease or who has had abnormal liver tests,

  • Anyone who has ever injected illegal drugs,

  • Anyone who had a blood transfusion or organ transplant before 1992,

  • Anyone who received a tattoo or body piercing in a non-regulated setting

  • Anyone with HIV or a weakened immune system.

Talk to your VA health care provider about testing and treatment. VA is the largest single provider of hepatitis care in the United States. For more information about hepatitis, please visit www.hepatitis.va.gov. According to the Hepatitis Foundation International, an estimated 4.4 million Americans are living with chronic hepatitis and about 80,000 new infections occur each year. [Source: Virage Point Blog | VAntage Point Blog | May19, 2016 ++]

VA Vet Choice Program Update 40 ► Mix-Ups at Fayetteville VAMC
Spring Lake veteran Wilbur Amos says he grows weaker by the day awaiting a surgery that would fix his three excruciating hernias. Some days are worse than others for Amos and the symptoms vary, and Amos said he's worried one day he'll inadvertently twist his bowels and die from septic shock if he's not treated with surgery soon. Amos' long and agonizing wait for surgery comes as a result of two mix-ups on the part of the Fayetteville VA Medical Center, and the national initiative for providing veterans' with timely medical care, the Veterans Choice Program. The program is well over a year old now, but veterans like Amos, a retired U.S. Army staff sergeant who served for 24 years and fought in the Vietnam War, are questioning if the program is really working as he is still suffering for months waiting for care, unsure of what the process is to find help faster.
http://cdn.abclocal.go.com/content/wtvd/images/cms/051916-wtvd-wilbur-amos-still-img.jpg http://cdn.abclocal.go.com/content/wtvd/images/cms/051916-wtvd-wilbur-amos-vietnam-1-img.jpg

Wilbur Amos
Amos said he's never had an issue before with the Fayetteville VA Medical Center in scheduling other appointments such as eye exams, but he said he's now absolutely fed up. "I have one outlook in life; that if I have to do someone else's work and they're getting paid for it, I don't think that's right. It angers me greatly," he said. "I have done everything I can do to make this work and it has not worked." Amos said he contacted the Fayetteville VA Medical Center in September of 2015 after he woke up in terrible pain one morning and went to an urgent care. He says a doctor at the VA diagnosed him with the three hernias, but the VA surgeon was unable to operate since it could not be done at the Fayetteville VA. In December, Wilbur says he was approved for surgery and he was scheduled with a Choice community provider to have the surgery in March.
When Amos arrived for his surgery, he says he was turned away at the reception desk. "I went to the appointment and was called back to the counter after I sat in the waiting room," he said. "I went up and she said I'm sorry there has been a problem. Your appointment has been canceled. We no longer accept Veterans Choice." Amos was left waiting in pain. Through the Veterans Choice Program, Wilbur was set up for the surgery in April with another provider. But upon arriving at the appointment, Amos discovered that provider couldn't do the surgery either, as it was an orthopedic clinic. "I don't know who would send a person for surgery at an orthopedic clinic," Amos said. "That strikes me as inept." Amos reached out to ABC 11 Eyewitness News Diane Wilson after he says he was unable to get the Fayetteville VA to set up another appointment. "If you can get them to move on this at all...I mean I'm at my wits end," Amos said. After Wilson reached out to the Fayetteville VA on Amos' behalf, they contacted him to schedule another appointment. He is now set up to see a correct surgeon at the end of May. Amos says he is relieved, and can't believe the quick action once the news media got involved
In a statement, the Fayetteville VA admitted to the fact that Health Net, the company that handles the Veterans Choice Program, mistakenly scheduled Amos with an orthopedic doctor, but said it had no record of the first mistake. Health Net also took responsibility and gave ABC11 this statement: "It is our honor and responsibility to serve the veteran community. We strive to provide excellent service to every veteran, every time. However, unfortunately, there are times when veterans may not get the care they need when they need it. For that, we take responsibility and apologize." You can read Health Net’s full statement at http://dig.abclocal.go.com/wtvd/docs/051916-wtvd-health-net-statement.pdf.
While Amos' troubles with the VA are undoubtedly distressing, they are not unique. In the months since the installation of the Veterans Choice Program, veterans tell Wilson they are still left facing many frustrations with the program. Government agencies such as the U.S. Government Accountability Office (GAO) and the VA's Office of Inspector General have brought to light some of the major issues with the Veterans Choice program. The Veterans Choice program was initiated in 2014. It was Congress' response to the discovery that the VA was concealing the wait times of some veterans needing prompt medical care. The program was meant to alleviate some of this wait time by setting veterans up with private providers. However, the $10 billion dollar program was implemented within a 90-day time-limit - a deadline that some say was too short for such a large and complex program.
According to data released by the VA, as of May 1, 2016, there are around 70,000 more appointments keeping a veteran waiting over a month to get care than there were last year. The Durham VA alone has seen that number increase by more than 1,800, while the Fayetteville VA has seen the number drop by about 900. Furthermore, an investigation conducted by the GOA found that data provided by the VA continues to be faulty, failing to measure veterans wait times in a comprehensive and transparent way. Instead, the VA's data measures wait time from the moment a veteran is contacted by the VA to schedule an appointment until the time when the veteran sees a provider - not from the day in which the veteran initially contacts the VA about his or her need to see a provider.
Since his first contact with the Fayetteville VA in September, Amos will have waited 9 months for surgery by the time he finally sees a provider at the end of May. He said that from the beginning he was warned that getting the care he needed from the VA would be a difficult process and until he reached out to Wilson, Amos said he hadn't been able to find an advocate who could help him. He says he's now thankful and relieved his surgery is scheduled as he just wants to stop suffering in pain. "Not only did you straighten out my situation with getting a surgery scheduled, but I know have better communication from the VA. Thank you." [Source: Spring Lake, N.C. (WTVD) | Diane Wilson | May 20, 2016 ++]
VA Vet Choice Program Update 41 ► VA Opposes Expansion Efforts
The Veterans Affairs Department opposes efforts to expand the Veterans Choice program and instead wants permission from Congress to roll several private care programs into the Choice benefit, VA Deputy Secretary Sloan Gibson said 24 MAY. Addressing members of the Senate Veterans Affairs Committee in a legislative markup, Gibson said a bill sponsored by Sen. John McCain (R-AZ) to let any enrolled veteran use the Choice program would “erode the VA’s ability to address the special needs of veterans.” “If veterans who currently do not use the VA health care system begin to seek community care through the Choice program, VA will have to divert resources from … internal VA care, dramatically undercutting our ability to provide care tailored to the unique needs of veterans,” Gibson said.
McCain's proposed bill would make permanent the Choice program, which is set to expire next year. It would allow any veteran who uses VA health services to use the program, which currently lets veterans get care at a private health facility if they live more than 40 miles from a VA facility or have to wait more than a month for an appointment. The proposed legislation also would require VA to expand pharmacy hours and let veterans be seen at commercial walk-in clinics without preauthorization or a co-payment. McCain said the legislation is needed because some doctors are refusing to see veterans under the Choice program, knowing it has an expiration date. “I’ve heard testimony from a number of veterans who have sat in the ER for 14 hours without being seen. Veterans would just like to see a provider on the same day. This legislation would do that,” McCain said.
A VA medical facility in California on 24 MAY began letting enrolled veterans get health care at walk-in clinics with a referral. Gibson said implementation of a similar program nationwide would be cost-prohibitive with the current VA budget. “This provision is too broad and does not include any feature such as the inclusion of copayments that would ensure it is used in a measured way that would not overrun the funds appropriated by Congress," Gibson said.

Veterans groups that testified, including the Veterans of Foreign Wars, Paralyzed Veterans of America, Disabled American Veterans and American Legion, also said they oppose McCain’s bill, adding they believe issues must be fixed with the current program before it is expanded. "The Choice Program ... has yet to achieve what Congress envisioned when it passed the Veterans Access, Choice and Accountability Act," said Carlos Fuentes, senior legislative associate with the VFW.

McCain urged the Senate Veterans Affairs Committee to consider the bill, which he said will improve the original legislation co-written in 2014 by McCain and then-Senate Veterans Affairs Chairman Sen. Bernie Sanders (I-VT). [Source: Military Times | Patricia Kime | May 25, 2016 ++]
Vets First Act Update 02 Federal Employee Group Blasts Act
A group of 12 federal employee unions and associations are voicing their displeasure with several provisions in the Veterans First Act. The group—which includes the Senior Executives Association, National Active and Retired Federal Employees Association and Federal Managers Association—penned a 18 MAY letter to Sen. Mitch McConnell (R-KY) and Sen. Harry Reid (D-NV) outlining three sections in the omnibus reform bill that the coterie said undermine employee rights. “If enacted, these provisions would undermine constitutionally-guaranteed protections available to Department of Veterans Affairs employees who are subject to discipline for misconduct or performance,” the letter said. “Moreover, these provisions would fail to protect the integrity of services to our nation’s veterans by permitting the VA’s workforce to become vulnerable to undue political influence.”

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Sen. Richard Blumenthal (D-CT)
The Veterans First Act was introduced on 28 APR as a bipartisan reform bill shepherded by Sens. Johnny Isakson, (R-GA) and Richard Blumenthal (D-CT), the chairman and ranking member of the Senate Committee on Veterans’ Affairs (SEA). Acting SEA president Jason Briefel said the bill, if passed, could face a challenge in the courts for its sweeping discipline changes, but could also usher in a spate of political favoritism and reprisals. “There're a couple of different levels here,” he said. “One is should this become law, the immediate on the VA. By the read of the SEA and other signatories to the letter, [there are] potential unconstitutional deprivation of rights and due process for public employees, whether they are senior executives or otherwise. “But I think the bigger picture is kind of the precedent that policies of this nature would set for the government.” The letter takes issue with the following sections of the bill:

  • Section 112 (e) and Involuntary Reassignment Abuse. The section allows the VA to decrease the pay of an agency director who has been involuntarily reassigned as the result of a disciplinary action and prohibits it from being appealed. The employee groups said that such a move would open the door to political reprisals on government employees.

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