RAOBULLETIN15 January 2016

HTML Edition

THIS BULLETIN CONTAINS THE FOLLOWING ARTICLES

Pg Article Subject * DOD * .

04 == RP~China Dispute [14] --------- (US/RP EDCA Ruled Constitutional)05 == DoD ID Cards --------------------------- (Obtainment in the Philippines)06 == Traumatic Brain Injury [48] ---------------- (DoD New TBI Campaign)08 == Commissary Funding [25] ------------ (Budget Neutral Plan Deadline)08 == Commissary/Exchange Future ------------ (New Store Pricing Models)09 == Commissary Improvement - (Goal | Stronger, Securer, More Modern)10 == Commissary Prices ----------------------- (Pacific Area Price Increases)11 == AAFES Online Pricing ------------------------ (Big Glitch on Furniture)12 == DoD Fraud, Waste, and Abuse --------- (Reported 1 thru 15 Jan 2016)13 == DoD-VA Pharmacy [02] ---- (PTSD/Prescription Monitoring Differs)14 == POW/MIA Recoveries ------------------ (Reported 1 thru 15 Dec 2016)

* VA * .

15 == Commission on Care ----- (VA Direct Provider Status under Review)16 == VA Claims Processing [14] --- (Lawmakers Balk at $1.3B Price Tag)17 == VA Aid & Attendance [18] ----------------- (Eligibility Rule Changes)18 == VA Facility Safety [01] -------- (Texas Open Carry Gun Law Impact)18 == Non-VA Facility Care [02] ------------------ (Over Estimated Budgets)19 == VA Claims Backlog [151] ------------ (Rep Millers VBMS Concerns)20 == VA Privacy Violations ---------- (On the Rise at Minnesota Facilities)21 == VA HIPAA Violations -------- (Confidential Patient Info Disclosures)22 == VA VistA [07] ------------------------------- (EHR Enhancement Effort)23 == Home Based Primary Care ---- (Multiple Discipline Team Approach)24 == VA Pharmacy [06] ----------------- (Copay Change Proposal for 2017)25 == VA Health Care Access [28] --- (Embattled Phoenix VA Exec Status)26 == VA Fraud, Waste & Abuse ------------ (Reported 1 thru 15 JAN 2016)26 == VAMC West Haven CT [02] ------- (PTSD Patient Death Questioned)27 == VAMC Oklahoma City --- (Diagnoses/Poor Patient Care Allegations)29 == VAMC Oklahoma City [01] ------ (Conflict of Interest in Care Probe)31 == VA HCS San Diego -------- (Botched Marine Vet Jeremy Sears' Care)33 == VA HCS Phoenix [19] -------- (Alleged Scandal Ringleaders Rehired)33 == VARO St. Petersburg [02] --------------- (Claim Processing Problems)35 == VARO Oakland [01] ---------- (Alleged Unprocessed Claims | 13,184)

* Vets * .

36 == Arlington National Cemetery [54] -------- (WASP Internment Denied)38 == World War I Memorial [07] ------------------- (Final Designs Selected)39 == Stolen Valor [100] ---------------------- (Reported 160101 thru 160114)39 == Vet Jobs [182] ------------------------------- (Solar Ready Vets Program)40 == Vet Unemployment [05] --------------------------- (2015 Ended at 4.8%)41 == Vet Suicide [08] ----------------------- (Daily Average of 22 Continues)43 == Homeless Vets [71] ----------------------- (Veterans on Patrol | Tucson)44 == USS Pueblo [03] ------------------------- (Crew Compensation Pending)45 == WWII Vets 98 ------------------------------------------------ (Boe~ONeil)46 == Obit: Katherine McFarland ----------------------------------- (1 Jan 2016)47 == Retiree Appreciation Days --------------------------- (As of 14 Jan 2016)48 == Vet Hiring Fairs ------------------------------ (16 JAN thru 14 Mar 2016)49 == Vet State Benefits & Discounts ----------------------- (Mississippi 2016)

* Vet Legislation * .

50 == Tricare: Amend it But Don't End it! ---------------------- (Take Action!)50 == Asbestos Litigation Reform [01] ------------ (Lawsuit Double Dipping)51 == Vet Bills Submitted to 114th Congress ---------- (151216 thru 151231)

* MILITARY * .

53 == Burn Pit Toxic Exposure [34] ------------------ (Pits Still in Use | Iraq)55 == Military Acquisition Reform -- (HASC Hearing | DMSP-F20 Fiasco)56 == Army Combat Action Badge [04] ------ (No Eligibility Rule Change)56 == Space Available Mail --------------------------------------- (Limitations)56 == USN/USMC Job Titles - (Review to Remove Any man Reference)58 == Medal of Honor [15] ---- (1100 Awards Poised for Upgrade Review)59 == Confederate Graves Vandalized - (Oakwood Cemetery Raleigh, NC)59 == Women in Combat [04] ------ (225,000 Job Openings under Review) 60 == Combat Awards ----------- (Pentagon Changing Recognition Criteria)62 == DWM [07] ------------------------- (Replaced by New Remote Device)63 == Military Enlistment Standards 2015 [10] --------- (Sexual Preference)63 == Military Enlistment Standards 2015 [11] - (Height/Weight Standards)64== Medal of Honor Citations ----------------------- (Hibbs~Robert J | VN)

* MILITARY HISTORY * .

65 == Aviation Art --------------------------------------------- (Roarin' 20s, The)66 == CSS Georgia --- (16,600 of 30k Recovered Relics Returned to River)67 == USS Oklahoma [02] -------------------------------- (5 Sailors Identified)68 == Military Trivia 117 ----------------- ('Don't Shoot, We're Republicans!)71 == Military History -------------------------- (Korea | The Forgotten War 2)73 == Military History Anniversaries -------------------------- (16 thru 31 Jan)74 == WWII Ads ------------- (Kolynos Dental Cream & Gold Medal Flour)74 == D-Day ---------------------------------------------- (Invasion Preparations)75 == WWII Prewar Events - (1934 Thanksgiving Celebration of the Reich)75 == WWII PostWar Events ---------- (1945 Buchenwald Camp Survivors)76 == Spanish American War Image 81 -- (USS Raleigh in Action in 1898) 76 == WWI in Photos 105 ------- (Ottoman Turk Machine Gun Corps 1917)77 == Faces of WAR (WWII) ---------- (General Douglas MacArthur 1947)77 == Ghosts of Time ------------ (Then & Now Photos of WWII Sites (08)

* HEALTH CARE * .

78 == TRICARE Prescription Refills ----- (MO, AL, NM, TX until 27 JAN)78 == Right of First Refusal [01] ------ (Saves TRICARE & Patients Money)79 == PTSD Prescriptions ---------------------- (Army Monitoring Questioned)79 == Cold Weather Exercise ---------------------------------------- (Guidelines)80 == TRICARE Nurse Advise Line [03] ---------------- (Patient Availability)81 == TRICARE Overseas Program [19] -------------- (Secure Claims Portal)81 == Sleep [02] ----------------------------- (Army Health of the Force Report)83 == TRICARE Help --------------------------------------------- (Q&A 160115)

* FINANCES * .

84 == Life Insurance [01] -------------------------------- (Need to Know Terms)85 == Social Security Outlook [01] ---------------- (Debt Limit Battle Impact) 86 == IRS Form 1095 -------------- (ACA Submission Requirement for 2015)86 == Saving Money --------------------- (Making Stuff Last Longer | 20 Tips)87 == Government Grant Scam ---------------------------------- (How it Works)88 == Smartphone for Ransom Scam --------------------------- (How it Works)89 == Tax Burden for Arizona Retired Vets ------------------ (As of Jan 2016) 91 == Tax Burden for Maine Residents ------------------------ (As of Jan 2016) 92== Thrift Savings Plan 2016 -------------------- (Returns as of 13 Jan 2016)

* GENERAL INTEREST .

94 == Notes of Interest ------------------------------------ (1 thru 15 Jan 2016) 94 == USCG Cable Issue ------- (Explosion Potential | 48 Sites in 12 States) 96 == North Korea Nuclear Bomb (4th Test | 7 Key Questions Answered) 98 == NEO Guide | Korea ------------------------ (Noncombatant Evacuation) 99 == ROKs Nuclear Test Response ----- (Propaganda Blasts Resumption)100 == Immigrant Children Housing ------- (Maxwell-Gunter AFB Opposed)101 == Photos That Say it All ----------------------------- (A Long Days Work)101 == Most Creative Statues ------------------ (Onesti, Romania | Tree Image)102 == Interesting Inventions ----------------------------------- (Compact Boots) 102 == Moments of US History ----------------- (Muhammad Alis fists 1963)102 == Parking ----------- (Revenge Tactic #11 against Inconsiderate Parkers)103 == Brain Teaser ----------------------=-------------------- (Puzzling Prattle 1)104 == Have You Heard? -------------------------------- (Engineer Goes to Hell)104 == Have You Heard? ----------------------------------- (Indian Want Coffee)104 == Help!!! -------------------------- (Things that might make you say it (04)105 == Brain Teaser Answer --------------------------------- (Puzzling Prattle 1)

Note: 1. The page number on which an article can be found is provided to the left of each articles title2. Numbers contained within brackets [ ] indicate the number of articles written on the subject. To obtain previous articles send a request to raoemo@sbcglobal.net.

* ATTACHMENTS * .

Attachment - Veteran Legislation as of 15 Jan 2015Attachment - Mississippi Vet State Benefits & Discounts JAN 2016Attachment - Military History Anniversaries 16 thru 31 JanAttachment - Retiree Activity\Appreciation Days (RAD) Schedule as of 14 Jan 2016

TO READ and/or DOWNLOAD THE ABOVE ATTACHMENTS REFER TO:

-- http://www.nhc-ul.com/rao.html (PDF Edition w/ATTACHMENTS)-- http://www.veteransresources.org (PDF & HTML Editions w/ATTACHMENTS)-- http://frabr245.org (PDF & HTML Editions in Word format)-- http://veteraninformationlinksasa.com/retiree-assistance-office.html (HTML Edition)

* DoD *

RP~China Dispute Update 14 US/RP EDCA Ruled Constitutional

The Philippine Supreme Court on 12 JAN declared as constitutional a defense pact that allows American forces, warships and planes to temporarily base in local military camps, in a boost to U.S. efforts to reassert its presence in Asia as China rises to regional dominance. Ten of the 15 members of the high court also ruled that the Enhanced Defense Cooperation Agreement, which was signed by U.S. and Philippine officials in 2014 and has a 10-year lifespan, is an executive agreement that does not need Senate approval, court spokesman Theodore Te said. "EDCA is not constitutionally infirm as an executive agreement," Te said at a news conference after the justices' long-awaited vote.

The ruling will bolster U.S. efforts to reassert its presence in Asia and dovetails with Philippine efforts to harness America's help in addressing China's aggressive acts in the disputed South China Sea. Washington immediately welcomed the court's decision, saying the defense pact is a mutually beneficial accord that will bolster both countries' ability to respond to disasters and strengthen the Philippines' military. Left-wing activists said they would consider filing an appeal, adding that U.S. military presence won't solve the country's worries over China in the disputed waters. "This is another sad day for Philippine sovereignty," said left-wing activist Renato Reyes, who was one of those who challenged the legality of the defense accord before the high court. "We maintain that the EDCA is not the solution to the problems of China's incursions."

The Foreign Affairs Department said that with the court's decision, the Philippines and the U.S. can finalize the full implementation of an agreement that is a critical component of efforts to strengthen national security and disaster relief capabilities. "This decision bodes well for deepening our defense cooperation with a key ally," and will "redound to improving our capability to perform our mandate to protect our people and secure the state," said armed forces chief Gen. Hernando Iriberri. The Philippines has turned to Washington as it scrambles to strengthen its military, one of the most ill-equipped in Asia, to deal with an increasingly assertive China in the South China Sea. Presidential spokesman Herminio Coloma said the court's ruling boosts the ongoing military modernization program, and will introduce the armed forces to the "most modern equipment," which will allow "a generational leap in our abilities."

The long-simmering disputes involving China, the Philippines, Vietnam, Taiwan, Malaysia and Brunei have escalated in recent years. Tensions have been especially high since Beijing transformed seven disputed reefs into islands on which it is now constructing runways and facilities that rival claimants say can be used militarily in an already tense region. Nearly a century of U.S. military presence in the Philippines ended in 1992 when Americans shut their bases, including the largest military facilities outside the U.S. mainland, after Filipino senators voted a year earlier not to renew the lease on the bases amid a tide of nationalism. A resurgent territorial dispute with China in the mid-1990s, however, prompted Manila to reach out to Washington. In 1998, the U.S. and the Philippines signed the Visiting Forces Agreement, allowing large numbers of American forces to return to the country for joint military exercises each year.

The 2014 defense pact allows the Americans to stay in facilities within Philippine military camps, where they can also station warships and fighter jets in a presence that Filipino officials hope will serve as a deterrent against Chinese aggression in disputed territories. At least eight local camps have been designated as harboring areas for the Americans, including some located near the South China Sea and in areas prone to natural disasters, according to the Philippine military. [Source: Associated Press | Teresa Cerojano | January 12, 2016 ++]

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DoD ID Cards Obtainment in the Philippines

RENEWALS: Renewals, Disenrollments and Full Time Student Extensions will be processed via mail. You may find the procedures by following the link: Steps for processing mail in ID card renewals which can be found at http://photos.state.gov/libraries/manila/19452/pdfs/STEPS%20FOR%20PROCESSING%20MAIL%20IN%20ID%20CARD%20RENEWALS%20%20030615.pdf. For regulatory guidance refer to Air Force Instruction 36-3026_IP, Para 11-12

NEW ENROLLMENTS: New Defense Enrollment Eligibility Reporting System (DEERS) Enrollments will be processed by appointment only at the U.S. Embassy Manila. This includes enrolling new spouses and children for the first time. For processing go to NOX 1 Window 24, US Embassy Manila JUSMAG, Philippines. Appointments are very limited and given on a first come first served basis. You will NOT be seen without an appointment. Those without an appointment will be turned away.nYou may make appointments by clicking the link below: https://rapids-appointments.dmdc.osd.mil/appointment/building.aspx?BuildingId=185. If you are unable to make an appointment in a timely manner, you may search alternate locations outside the Philippines at: https://rapids-appointments.dmdc.osd.mil/appointment/default.aspx.

PROCEDURES: You must arrive 30 minutes prior to your appointment. You only need one appointment per family. (NOTE: The U.S. Embassy is closed all U.S. and Philippine Holidays. A list of holidays can be viewed at http://manila.usembassy.gov/wwwholidays.html. In addition there is always the possibility of unannounced closures due to mission requirements or system failure. We will contact you via the email address or phone number you listed during appointment scheduling when possible.)

WHAT TO BRING TO THE APPOINTMENT: All Adults Must Have 2 Forms of ID. The first form of ID Must be Picture ID. The following are acceptable: DoD ID Card, Passport Postal Card, Drivers License, NBI Clearance with picture, Philippine SSS Card with Picture, or Other Government issued ID with Picture 2nd form of ID. The following are acceptable: Birth Certificate, US Social Security card. Or Other government issued ID without picture

FAMILY MEMBERS - DUE TO THE PRIVACY ACT, THE SPONSOR/SERVICE MEMBER MUST BE PRESENT TO AUTHORIZE ALL DEERS/ID CARD ACCESS AND/OR TRANSACTIONS. A REPRESENTATIVE MUST PRESENT A CURRENT GENERAL OR SPECIAL (ID CARD/DEERS) POWER OF ATTORNEY AND A CURRENT PHOTO ID. COPIES OF POWERS OF ATTORNEY WILL NOT BE ACCEPTED. FAMILY MEMBERS MUST BE ENROLLED IN DEERS BEFORE AN ID CARD CAN BE ISSUED. FAMILY MEMBERS ARE NOT REQUIRED TO BE PRESENT FOR ENROLLMENTS.

In order for dependents to receive an ID card the sponsor must be present, if not, the dependent must meet one of the following conditions: The dependent must bring along a DD Form 1172 signed by the sponsor and notarized from a DEERS/RAPIDS workstation validating them as a dependent, along with a valid national ID (such as a Filipina/US passport, drivers license, NBI report, voters card, etc.) - OR - The dependent must bring along a valid Power of Attorney notarized by a U.S. notary which gives her the power to act on the sponsors behalf, along with a valid national ID as stated above. - OR - If the sponsor is deceased, the un-remarried spouse or unmarried former spouse may act on their own behalf.

It is advised that they should bring all documentation that verifies their relationship with the sponsor such as marriage certificates, birth certificates, and previous DOD ID cards.

SPOUSE ENROLLMENT: Initial Enrollment/ Issuance: Certified marriage certificate (shows where marriage was registered/recorded/returned and filed). If either sponsor or spouse was previously married, ALL final divorce decrees, annulments and/or death certificates are required. Two forms of identification (at least one being a photo ID).

NEWBORN CHILD ENROLLMENT: You must provide an original document establishing the childs relationship to the Sponsor. This may be one or more of the following: NSO Birth Certificate or Consular Report of Birth Abroad (FS-240) with Sponsor listed as one parent; Proof of Paternity; Marriage Certificate for Step Children; Adoption Decree; Court order appointing the sponsor as ward for the child.

[Source: U.S. embassy Manila | http://manila.usembassy.gov/dodcardsver2.html | January 2016 ++]

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Traumatic Brain Injury Update 48 DoD New TBI Campaign

A new campaign is underway to get service members and veterans with brain injuries to seek help. The new initiative is being launched by the Department of Defense and is being led by the Defense and Veterans Brain Injury Centers (DVBIC). Traumatic brain injury (TBI) is a significant health issue which affects service members and veterans during times of both peace and war. The Defense Department reports more than 330,000 service members have been diagnosed with TBI since 2000, but they know there are some who still need treatment to deal with lasting impacts from their injury.

Colonel Sidney Hinds, Director of the DVBIC, says whether the TBI is mild or severe, the cause is clearly defined. A traumatic brain injury is the result of any blow or jolt to the head that causes an alteration in consciousness or an impairment of memory. said Hinds. Colonel Hinds is a medical doctor, who is board certified in neurology and nuclear medicine. He says one of the biggest myths about TBI among service members is that they mostly occur in combat zones as the result of a blast. He says the truth is that motor vehicle collisions account for the majority of of traumatic brain injuries in the military. The vast majority of those head injuries are actually diagnosed, back in garrison, back in home environmentsnot in the deployed environments and theyre caused by similar events that cause civilian traumatic brain injuries. Hinds said. Symptoms of a TBI can be physical, cognitive, and emotional.

For veterans and service members, reporting lasting effects of a TBI seems to be a low priority. TBI sufferer Randy Gross says theres a mentality that the individual can tough it out. Were used to, if you fall off the bike, get back on and youll be fine..ya know, when we grew up it was rub some dirt on it, youll be fine. Maybe, take an aspirin to it if youre in football, but thats not, I mean, we cant expect people to do that. Gross said, adding that the message behind the new campaign to get more people like him to get help is needed. The problem is that when individuals go so long without actually recognizing the symptoms, you know, the recovery is gonna be that much more difficult. said Gross. Colonel Hinds says symptoms vary with the severity of the TBI, but in general, lasting effects can be physical, cognitive, and even emotional.

The impacts of TBI are felt within each branch of the service and throughout both the Department of Defense (DoD) and the Department of Veterans Affairs (VA) health care systems. In the VA, TBI has become a major focus, second only to recognition of the need for increased resources to provide health care and vocational retraining for individuals with a diagnosis of TBI, as they transition to veteran status. Veterans may sustain TBIs throughout their lifespan, with the largest increase as the veterans enter into their 70s and 80s; these injuries are often caused by falls and result in high levels of disability. Active duty and reserve service members are at increased risk for sustaining a TBI compared to their civilian peers. This is a result of several factors, including the specific demographics of the military; in general, young men between the ages of 18 to 24 are at greatest risk for TBI. Many operational and training activities, which are routine in the military, are physically demanding and even potentially dangerous. Military service members are increasingly deployed to areas where they are at risk for experiencing blast exposures from improvised explosive devices (IEDs), suicide bombers, land mines, mortar rounds and rocket-propelled grenades. These and other combat related activities put our military service members at increased risk for sustaining a TBI.

Although recent attention has been intensively focused on combat-related TBI, it should be noted that TBI is not uncommon even in garrison and can occur during usual daily activities. Service members enjoy exciting leisure activities: They ride motorcycles, climb mountains and parachute from planes for recreation. In addition, physical training is an integral part of the active duty service members everyday life. These activities are expected for our service members and contribute to a positive quality of life; but these activities also can increase risk for TBI.

DVBIC was founded in 1992, largely in response to the first Persian Gulf War, under the name Defense and Veterans Head Injury Program. At that time, its goal was to integrate specialized TBI care, research and education across military and veteran medical care systems. Twenty years later they are a network of 16 centers, operating out of 11 military treatment facilities and five VA polytrauma hospitals. The specific activities vary at each site and include research, helping service members, veterans and their families find and use the right services for their needs, providing education in military and civilian settings, providing direct care to service members, and assessing TBI injury data. [Source: NBC WSAV 3 & http://dvbic.dcoe.mil | Martin Staunton | January 12, 2016 ++]

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Commissary Funding Update 25 Budget Neutral Plan Deadline

The new year may bring more clarity to the future of the commissary benefit, following a year in which the system came under perhaps its most intense scrutiny ever. Actions to be completed in the first half of the year are expected to further define how money can be saved in the commissary budget. Proposals from Defense Department officials over the past two years to gradually cut $1 billion from the roughly $1.3 billion annual commissary budget were perceived as being driven by a need for money, rather than the need for reform and were rejected by lawmakers. Congress recently passed a provision that some say forces the Pentagons hand, by requiring defense officials to come up with a comprehensive plan to make the commissary benefit, as well as the military exchanges, budget neutral. In other words, the stores would operate with zero taxpayer dollars, while also sustaining their traditional hefty discounts to customers. A plan must be submitted by 1 MAR, with a target implementation date of Oct. 1, 2018. DoD is authorized to conduct pilot programs to test different ideas for achieving the targets again, while maintaining customer discounts.

Defense officials say the most that can be cut out of the commissary budget by that time is $300 million, a little over 21 percent of the current annual operating budget. The only way to get the additional billion-plus in budget cuts would be to reduce savings, close stores or both, Peter Levine, DoDs deputy chief management officer, said recently. My message is that we cant take that drastic step and expect to maintain the benefit, he said. Indeed, DoD recently has been moving away from its own more drastic cost-cutting proposals. Now, officials will look for efficiencies first, and let efficiencies drive the budget rather than the other way around, Levine said. The Military Retirement and Compensation Modernization Commission and an outside consultant both completed reviews in 2015 that recommended consolidation of the military commissary and exchange systems to some degree. But defense officials continue to believe that is not necessary. [Source: The Associated Press | Susan Haigh | December 27, 2015 ++]

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Commissary/Exchange Future New Store Pricing Models

Defense officials have begun charting a new course for the future of commissaries and exchanges, laying out their plans in a fact sheet provided to some military service organizations. But at this point, details are minimal, and military advocates are calling for the process to be fully transparent to commissary and exchange customers. Officials established a new board, the Defense Resale Business Optimization Board, which includes the leaders of the commissary and exchange systems. According to the DoD fact sheet, the board has begun its work. It is unclear whether the separate boards that traditionally have overseen the commissary and exchange systems have disbanded. The first order of business is to firmly define tangible and intangible benefits across the resale enterprise and establish a current baseline against which optimization results will be evaluated, states the fact sheet. The goal is to maintain current benefits while finding more efficient ways to operate, in order to achieve significant savings for the taxpayer.

These definitions and benchmarks are critical, said Joyce Raezer, executive director of the National Military Family Association. How do they define the benefit, so they can measure whether or not theyre reducing it? How will they determine the tangible and intangible benefits? How will they determine the benchmarks? she said. And whos speaking for the people who need the commissaries? It has to be transparent to the customer. The fact sheet is not clear as to how much of the current system were changing, and to what end, Raezer said. We think theyre going to continue to look for ways to chip away at the benefit, and theres a mood in Congress to let them, Raezer said. We dont see the strong understanding in Congress that the benefit is the savings. Thats why these benchmarks are so important. Defense officials did not immediately respond to a Military Times request for comment.

This fiscal year, $1.4 billion in taxpayer funds will go to the Defense Commissary Agency to operate stores and allow goods to be sold at cost. A 5 percent surcharge paid at the register by customers covers store construction and renovation. The DoD fact sheet refers to using at least two pricing pilots to test various recommendations for reducing the amount of taxpayer dollars needed to operate the commissary system. As part of the fiscal 2016 National Defense Authorization Act, Congress gave DoD the flexibility to try such pilot programs. Concurrently, lawmakers showed their support for commissaries by adding $281million back into the systems budget in spite of DoDs request to reduce that funding.

The NDAA requires defense officials to develop a plan to operate the military resale system with no taxpayer dollars by fiscal 2019. That plan would have to be submitted to Congress and evaluated before it is approved. DoD recognizes that there are significant barriers to meeting the budget neutrality challenge without reducing the patron benefit, closing commissaries, and affecting system synergies, which would likely threaten the viability of the exchanges and [morale, welfare and recreation] programs, the fact sheet noted.

Defense officials also propose legislative changes for fiscal 2017 that would make permanent this temporary flexibility. These proposals, if accepted, could also lay the groundwork for converting the defense commissary system to operating within a nonappropriated fund business framework, the fact sheet says. Raezer said officials may be looking at a regional pricing model, as well as at the possibility of a true commissary private label brand. We do know savings vary depending on geographic area, she said. Do people in higher-cost areas need more savings? Do we settle for 30 percent savings everywhere [compared to local prices], or 15 percent savings everywhere? As far as a private label program, DoD officials still dont get that military families are getting name-brand goods at private label prices, Raezer said.

The military exchange stores offer a variety of products through their own private label program. Such programs require funding and staff to develop and manage. The idea is that while these private label brands cost less for the customers than comparable national brands, stores could mark up prices on the items and use any profits toward operating costs. But under current law, all items in commissaries must be sold at cost from the manufacturer or distributor. So it does the Defense Commissary Agency no good to offer a private label program under its current pricing system, said Peter Levine, DoDs deputy chief management officer, in an Oct. 27 speech to the American Logistics Association. Levine also made it clear in that October speech that DoD does not believe a merger of the commissary and exchange systems is necessary in order to achieve savings out of the resale operations.

The DoD fact sheet states that the department does not intend to consolidate the commissary and exchange systems; reduce the resale benefits to meet artificial budget goals; or reduce the portion of exchange system profits that flow into other military MWR programs. The fact sheet noted that the two top defense officials with oversight of the resale system the undersecretary for personnel and readiness and the deputy chief management officer are jointly committed both to optimizing the system and preserving benefit levels and quality-of-life programs. Raezer said its critical for personnel officials to be involved in any discussions that may define or redefine military resale benefits. People with personnel in their title we like them to be advocates for personnel, she said. Defense Department officials are examining ways to reduce the taxpayer funds that support commissaries and exchanges, while maintaining the value of those benefits. [Source: NavyTimes | Karen Jowers | January 11, 2016 ++]

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Commissary Improvement Goal | Stronger, More Secure, More Modern

The Chairman of the House panel that oversees the commissary benefit said his message to the military community is that his panels goal is to improve the commissary system, not slash the benefit. The goal is to modernize commissary services that will preserve an important and expected benefit for customers, said Rep. Joe Heck (R-NV), chairman of the military personnel subcommittee of the House Armed Services Committee, in an interview 12 JAN. Among the panels responsibilities is the oversight of commissaries and other resale activities. [The Defense Department] is looking to squeeze the budget wherever they can. Thats not our approach, said Heck, a physician who is a brigadier general in the Army Reserve. Were looking to make the system better through modernization and long-term sustainability.

Rep. Joe Heck

At a hearing scheduled for 13 JAN, the subcommittee will hear feedback from beneficiaries and industry groups about potential changes to commissary operations. If the improvements result in savings, great. But thats not my driving force, said Heck, whose father was in the grocery business. The hearing is one of the efforts by the subcommittee to gather information related to commissary reform and whether to recommend any changes in law. DoD's plans for changes to the commissary system have not yet been outlined. The fiscal 2016 National Defense Authorization Act required defense officials to come up with a plan by 1 MAR to operate the commissaries without taxpayer dollars by fiscal 2018, while maintaining the customer benefit.

Over the last couple of years, DoD has proposed drastically reducing the amount of taxpayer dollars used to operate commissaries, but Congress has restored the funding, which has been about $1.4 billion per year. Taxpayer funding enables commissaries to sell items at cost, plus a 5 percent surcharge that is used primarily for construction and renovation of stores. While DoD must come up with a plan, Congress must approve it, as well as any pilot programs that will test different approaches. And although the requirement for the plan is in law, Heck said he doesnt think its possible to operate the commissary benefit without any taxpayer dollars. He said he's waiting to see whether DoD officials think they can get to zero funding without affecting the benefit. He said there could be a decrease in the amount of taxpayer dollars used, but is doubtful DoD could get to zero funds. The goal should be a stronger, more secure, more modern benefit, he reiterated.

Some of the ideas that have been floated by defense officials include a variable pricing system where there is flexibility in pricing items. Theoretically some items still could be sold at cost, while others are marked up to help pay for operating costs at the commissaries. Still, others might be decreased. Another idea is offering a commissary private brand with items possibly cheaper to customers a program that would generally be created and managed by commissary officials. But the subcommittee will also be monitoring these pilots, if they are approved, Heck said. The idea behind a pilot is to prove something can be effective, he said. Well monitor whether they can achieve X, Y, Z, without decreasing the benefit to the beneficiary. Theyll also make sure there are safeguards in place and monitor the pilot programs so the programs dont have adverse effects on other commissaries. The panel will review information from the hearing, from previous briefings and DoDs plan to brainstorm potential courses of action, Heck said. Theyll determine whether any changes in law are warranted. [Source: MilitaryTimes | Karen Jowers | January 13, 2016 ++]

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Commissary Prices Pacific Area Price Increases

A California congressman wants answers from defense officials about the increased prices of fruits and vegetables at some commissaries in the Pacific. The Defense Commissary Agency "has now embarked on a sourcing strategy that will force our military families to pay more for an inferior product," Rep. Duncan Hunter (R-CA) wrote in a 4 JAN letter to Brad Carson, acting undersecretary of defense for personnel and readiness. "I am dismayed your office, which is responsible for the health and morale of our soldiers, sailors, airmen and Marines, and which was aware of these concerns, did not prevent DeCA from implementing this counterproductive strategy," Hunter wrote. Families in Guam report that produce prices have doubled or tripled since new contracts went into effect 1 NOV. While there have been some trouble spots in Japan and South Korea, the problems have been more pronounced in Guam, sources said.

Hunter has asked for more details about the prices and about the quality of the produce. He asked Carson to review the new policy for sources of produce in Asia and the Pacific, "and consider whether changes are necessary to ensure that our military families have affordable, American-style produce at the commissary." "Please let me know your determination as soon as it is available so that I can let our military families know when they can expect to see low-cost, high-quality produce back on the shelves at the commissary," Hunter wrote.

Previously, DeCA used taxpayer dollars to pay for the cost of shipping produce to the Pacific, so that military customers would have access to produce of comparable cost, type and quality as commissary patrons in the U.S. Now, contractors either get produce from local sources in their overseas areas or bear the cost of shipping it from other countries, including the U.S. That cost is passed on to commissary customers in those areas in the form of increased prices. DeCA officials have said that in the long run, they expect the results of the new contracts to be positive, with fresher fruits and vegetables available to customers. Some prices will decrease, while others will increase, they added. The new contractors are MPG West for Japan and South Korea; and International Distributors for Guam. In a list of 20 items DeCA provided to Military Times comparing prices in Guam under the previous contract to prices during the week of 13 DEC, nine items saw price increases ranging from 2 percent to 30 percent, while 11 items saw price drops ranging from 9 percent to 42 percent.

At the beginning of the new contracts, store personnel were selecting the most expensive items, not realizing that a less costly item was available, according to DeCA. The less costly items were delivered by ship, rather than by air. In its bid for the contract, International Distributors proposed that savings would be 40.1 percent compared to the local Guam economy. DeCA's new benchmarks for savings under these contracts are comparisons with local foreign markets. Before the new contracts went into effect, the DeCA benchmark for produce prices in the Pacific was comparisons with produce prices in commercial stores in California. The previous contractor was Raymond Express International, based in Los Angeles. "We brought in savings, but we also had to pass on the freight [costs] to the customers," said Shana Guzman, president of International Distributors of Barrigada, Guam, in an interview 16 DEC. The added cost for items that are shipped by ocean is about 25 cents per pound; for items that are airlifted, added costs are about $4 per pound, Guzman said. IDI tries to provide as much local produce as possible, she said, but that's only about 1 percent of the overall produce provided to the commissaries.

She acknowledged that the quality of produce brought in by ship "won't match up to airlifted items, but it's a challenge we face being so far away." The quality of the produce is good, "just not great," although it's absolutely safe to eat, she said. She noted that IDI provides the same produce to commissaries that it provides to four-star hotels and restaurants on Guam. In his letter, Hunter expressed concern about quality, noting that DeCA gave a report to the House Armed Services Committee in October 2014 stating that one reason for the change was to increase the freshness and quality of fresh fruit and vegetable products. Hunter also noted that in November 2014, DeCA director Joseph Jeu wrote: "Incremental price increases will be widely accepted by our customers as they realize the improved quality derived from local purchase and shorter shipping times." Jeu added that fresh produce is one thing that draws customers to commissaries, regardless of location, and noted that quality is a major factor in their decision to buy. "Even at the time, I thought that DeCA's optimism sounded too good to be true, and it appears that I was justified in my skepticism," Hunter wrote in his new letter to Carson. [Source: MilitaryTimes | Karen Jowers | January 5, 2016 ++]

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AAFES Online Pricing Big Glitch on Furniture

Army and Air Force Exchange Service officials are trying to resolve a huge pricing glitch after an unknown number of military exchange shoppers ordered furniture from the Exchange website over New Years weekend, some of whom thought they were getting savings of upward of 80 percent. There were some inaccurate prices and were working on a solution, AAFES spokesman Chris Ward said. Some customers have been notified that their orders were canceled. But information was not readily available on how many people ordered the items (subsequently determined to be over 5,000), or whether AAFES will honor the cut-rate prices offered, some of which were picked up by other websites that promote deals for shoppers. Some examples of furniture with incorrect prices: An Ashley Signature Design Darcy two-piece sectional was listed for $199; the regular price is $939. A Hillsdale Monaco five-piece dining set was listed for $149.97; it regularly sells for $899. A Home Styles China Hutch and Buffet was listed for $199.97; it usually goes for $1,099.99, according to the Raining Hot Coupons website.

These customers are being offered a one-time 30 percent discount off their next furniture order, and the offer code is being sent by email, said Julie Mitchell, a spokeswoman for AAFES. The Exchange website carries a disclaimer stating that although AAFES strives to provide accurate information on the site, typographical or omission errors occasionally may occur in pricing, disclaimers, special offers, product information or images. Such errors are subject to correction at any time, the disclaimer states. A similar glitch in 2011 on the AAFES websites resulted in some customers ordering laptop computers valued at about $1,000 for only $25. Those orders were canceled, and the purchases were not honored. The Exchange website has had other problems in the past. After the site was quietly relaunched more than 15 months ago in September 2014, customers reported a wide range of issues, including credit cards charged but items not shipped; inability to place orders; and rejection of all forms of payment. Officials reported they have worked out those glitches. [Source: MilitaryTimes | Karen Jowers | January 4, 2016 ++]

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DoD Fraud, Waste, and Abuse Reported 1 thru 15 Jan 2015

Seven soldiers were arrested 6 JANas part of the latest group of service members to face federal charges related to the National Guards troubled and now-defunct Recruiting Assistance Program. The soldiers, all members of the New York Army National Guard, are accused of scheming to obtain fraudulent recruiting bonuses, Preet Bharara, the U.S. attorney for the Southern District of New York, said in a statement. The soldiers arrested are: Staff Sgt. Evette Merced, 45. Sgt. 1st Class Darryl Harrison, 51. Staff Sgt. Siul Celeste, 29. Staff Sgt. Jeanette Arizaga, 41. Sgt. Yesenia Adames, 43. Sgt. Renetta Edwards, 40. Sgt. Jefferson Simbanamuzo, 41.

Those who join the National Guard nobly serve their fellow citizens, but, as alleged, these defendants used their positions in the National Guard to steal, Bharara said. The Army cannot discuss specific details of this or any other case associated with potential RAP fraud, Lt. Col. Joe Buccino, an Army spokesman, said in a statement. This is a criminal matter under investigation, he said. The Army is participating in a multi-agency task force to investigate and resolve fraudulent actions associated with the Recruiting Assistance Program and has had a sizable task force investigating other instances of RAP fraud for more than three years. Wednesdays arrests come less than three months after 25 current and former soldiers from the Puerto Rico National Guard were charged with similar offenses. Charges in that case included wire fraud, aggravated identify theft and participating in a conspiracy to defraud the United States and the National Guard Bureau of money and property.

The Guard Recruiting Assistance Program, also known as G-RAP, was launched in late 2005 as a way to boost sagging recruiting numbers during the height of the war in Iraq. Program participants, or recruiter assistants (RAs), could earn up to $2,000 for every new soldier they recruited into the Guard. The RA would receive the first $1,000 when the recruit enlisted and the rest of the money once the new soldier shipped to basic training. The program was highly successful, bringing in thousands of new soldiers into the Guard. It later came under scrutiny for widespread fraud and abuse, even drawing a hearing on Capitol Hill. The G-RAP was suspended in January 2012. Then-Army Secretary John McHugh terminated all recruiting assistance programs a month later.

Under the G-RAP, only RAs were eligible to receive referral bonuses for bringing in new recruits. The program required RAs to establish an online account in their name to record their referral and recruitment efforts. The RA would then input personal identifying information for each recruit into that account. Beginning in 2007, Merced and Harrison, who then served as full-time, salaried recruiters for the Army National Guard, abused their positions by providing the personal identifying information of potential soldiers to Celeste, Arizaga, Adames and Edwards in exchange for thousands of dollars in kickbacks, according to the U.S. attorneys office. Celeste, Arizaga, Adames and Edwards then used their respective online RA accounts to falsely claim that they were responsible for referring those soldiers to the New York Guard. The four received bonus payments worth more than $62,000 from the G-RAP and kicked back a significant portion of those payments to Merced and Harrison, according to the U.S. attorneys office.

In a similar but separate scheme, Simbanamuzo, a police officer in the New York Police Department, used his online RA account to falsely claim he was responsible for referring soldiers to the New York Guard. Charges against Merced and Harrison, the two full-time recruiters in the group, include conspiracy to commit bribery, solicitation and receipt of bribes, theft of government funds, and aggravated identity theft. Each charge carries anywhere from two to 10 years in prison. Celeste, Arizaga, Adames and Edwards were each charged with conspiracy to commit bribery, which carries a maximum sentence of five years in prison, and theft of government funds, which carries a maximum of 10 years in prison. Simbanamuzo is charged with theft of government funds, which can bring up to 10 years in prison. [Source: ArmyTimes | Michelle Tan | January 6, 2016 ++]

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DoD-VA Pharmacy Update 02 PTSD/Prescription Monitoring Differs

An effort to align the medications carried in both Defense and Veterans Affairs department pharmacies has exposed differences between the departments approaches to monitoring prescriptions and treating post-traumatic stress, a new government report has found. A Government Accountability Office investigation into DoD and VA prescribing practices for post-traumatic stress disorder and mild brain injury found that the VA closely monitors its physicians' practices in prescribing medications for PTSD, especially drug classes like benzodiazepines and anti-psychotics that are discouraged for use in PTSD patients. But the Defense Department largely relies on the military services to review medication-prescribing practices of their physicians and, while DoD monitors prescriptions, it does not track medication use in relation to PTSD diagnoses.

The Army issued a policy in 2012 requiring military hospitals to review their prescribing practices for atypical anti-psychotics, and according to the service, the percentage prescribed dropped by nearly half, from 19 percent in fiscal 2010 to 10 percent in fiscal 2014. The policy expired in 2014. Army doctors interviewed by GAO at one facility said they continue to monitor these prescriptions because they saw higher-than-expected prescribing rates for these drugs at their facility. Doctors at other Army facilities said, however, that they no longer monitored these prescriptions because they felt the awareness effort had been effective.

GAO Health Care Director Debra Draper said the military should improve its monitoring standards and align them with the VA's system to ensure that doctors are following recommended treatment guidelines for PTSD and concussions. Without such monitoring, the Army may be unable to identify and address practices that are inconsistent," Draper wrote. The fiscal 2016 National Defense Authorization Act required the DoD and VA to carry the same medications to treat mental and sleep disorders and pain. Lawmakers had raised concerns that veterans were suffering because they were unable to get the medicines they had been prescribed by DoD doctors after leaving the service. GAO found that VA largely has processes in place to ensure that transitioning veterans could get their medications at a VA facility, such as specialty request forms and a policy issued in 2015 instructing doctors not to discontinue patients' DoD-prescribed mental health medications due to formulary differences. A GAO survey of 729 veterans found that 24 of them, or 3 percent, had their medications changed at VA for "non-clinical" reasons.

While VA officials told GAO that cost is a factor in determining which medicine to include in its formulary, it also does not carry some medications out of safety concerns or differences in treatment approaches. For example, VA officials said they did not carry the pain medication piroxicam because it believes its formulary offers safer alternatives. It carries only two sleep medications, VA told GAO, because administrators have concerns about the appropriateness of prescribing some sleep medications to treat insomnia instead of treating the underlying condition for the sleeplessness.

GAO recommended that the DoD and the Army which it examined for the report because it had the largest number of troops serving in Iraq and Afghanistan implement processes to monitor prescriptions for PTSD. Draper also recommended VA clarify which types of medications are covered by the Veterans Health Administration 2015 policy on medical continuation. Both departments concurred with the GAO recommendations in written responses to the report. Assistant Secretary of Defense for Health Affairs Dr. Jonathan Woodson said the military services will continue focusing on education and training their providers, and the Defense Health Agency will monitor pharmacological prescribing practices when appropriate. VHA said it plans to publish a list of the medications covered in the 2015 policy. [Source: MilitaryTimes | Patricia Kime | January 5, 2016 ++]

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POW/MIA Recoveries Reported 1 thru 15 Jan 2016

"Keeping the Promise", "Fulfill their Trust" and "No one left behind" are several of many mottos that refer to the efforts of the Department of Defense to recover those who became missing while serving our nation. The number of Americans who remain missing from conflicts in this century are: World War II (73,515) Korean War (7,841), Cold War (126), Vietnam War (1,627), 1991 Gulf War (5), and Libya (1). Over 600 Defense Department men and women -- both military and civilian -- work in organizations around the world as part of DoD's personnel recovery and personnel accounting communities. They are all dedicated to the single mission of finding and bringing our missing personnel home. For a listing of all personnel accounted for since 2007 refer to http://www.dpaa.mil/ and click on Our Missing. If you wish to provide information about an American missing in action from any conflict or have an inquiry about MIAs, contact: Mail: Public Affairs Office, 2300 Defense Pentagon, Washington, D.C. 20301-2300, Attn: External Affairs Call: Phone: (703) 699-1420 Message: Fill out form on http://www.dpaa.mil/Contact/ContactUs.aspx

Family members seeking more information about missing loved ones may also call the following Service Casualty Offices: U.S. Air Force (800) 531-5501, U.S. Army (800) 892-2490, U.S. Marine Corps (800) 847-1597, U.S. Navy (800) 443-9298, or U.S. Department of State (202) 647-5470. The remains of the following MIA/POWs have been recovered, identified, and scheduled for burial since the publication of the last RAO Bulletin:

Vietnam

None

Korea

The Department of Defense POW/MIA Accounting Agency (DPAA) announced 8 JAN that the remains of a U.S. serviceman, missing from the Korean War, have been identified and will be returned to his family for burial with full military honors. U.S. Army Pfc. David S. Burke, 18, of Akron, Ohio, will be buried Jan.15, in Rittman, Ohio. On Nov. 25, 1950, Burke was assigned to Company C, 1st Battalion, 24th Infantry Regiment, 25th Infantry Division, when his unit was attacked by the Chinese Peoples Volunteer Forces (CPVF), near the border between China and North Korea. Under pressure, outnumbered and surrounded by CPVF roadblocks, they were unable to escape. After suffering heavy casualties, the unit was forced to surrender to the CPVF, and four officers and 136 enlisted soldiers were taken prisoner, including Burke. Following the attack, the U.S Army declared Burke missing in action.

In September 1953, as part of a prisoner of war exchange known as Operation Big Switch, returning American soldiers who had been held as prisoners of war reported that Burke had died between March and May 1951 from malnutrition. A military review board later amended his status to deceased. Between 1990 and 1994, North Korea returned to the United States 208 boxes of commingled human remains, which when combined with remains recovered during joint recovery operations in North Korea, account for the remains of at least 600 U.S. servicemen who fought during the war. North Korean documents included in the repatriation indicated that some of the remains were recovered from the area where Burke and other members of his unit were held at POW Camp 5. To identify Burkes remains, scientists from DPAA and the Armed Forces DNA Identification Laboratory used circumstantial evidence, three types of DNA analysis, including mitochondrial DNA analysis, Y-chromosome Short Tandem Repeat DNA analysis, as well as autosomal DNA analysis, which matched his brothers, and dental analysis, which matched Burkes records.

World War II

None

[Source: http://www.dpaa.mil | January 15, 2015 ++]

* VA *

Commission On Care VA Direct Provider Status under Review

Public Law 113-146, the Veterans Access, Choice, and Accountability Act (VACAA) of 2014, established a "Commission on Care" to examine the Department of Veterans Affairs (VA) health care system and make recommendations for change. The Commission is composed of membership selected coequally by the President and House and Senate leadership. The Commission has completed its fourth meeting and has issue a statutorily required interim report. As a partner organization in the Independent Budget, DAV has been invited to meet with the Commission on Care staff and to submit our views on the future of VA to the Commission. In its public sessions, some members of the Commission have made statements about the advisability of moving VA from its current status as a direct provider of care to that of insurer. Meanwhile, VA has released its plan to consolidate all community care programs into one plan for referral and payment. These existing seven programs, including the "choice" provisions from the VACAA, operate using different rules and procedures related to both eligibility and utilization. In order to consolidate these programs, VA will need authorizing legislation. Congress is considering VA's proposal at this time DAV is closely monitoring these events to ensure that the rights and benefits of wounded, injured and ill veterans are protected. [Source: DAV National Cdr | Moses A. McIntosh | December 30, 2015 ++]

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VA Claims Processing Update 14 Lawmakers Balk at $1.3B Price Tag

The Department of Veterans Affairs may finally have good news to share, but lawmakers are balking at the price tag. Total costs for a digital system used to process veterans disability claims that officials say has been key to slashing a massive VA backlog are nearly double the initial estimates. And VA, which has continued to make upgrades to the system under an agile software development methodology, still cant say how much the system will end up costing, according to auditors. VA has spent more than $1 billion developing and maintaining the Veterans Benefits Management System, or VBMS, since 2009. The agency has requested an additional $290 million this year for continued tweaks to the system, which was initially projected to cost $579 million.

At a House VA committee hearing 12 JAN, the agencys deputy inspector general, Brent Arronte, warned lawmakers the agency cannot ensure its getting a return on its billion-dollar investment and that costs will continue to spiral upward. First, the good news: The Web-based application replaced a largely paper-based process used to track veterans disability benefits. The longstanding backlog of disability claims at the agency is down from a high of 600,000 in 2013 to about 80,000 currently, the lowest in VAs history. And in contrast to other big-budget IT projects that fail upon launch or get canceled after wasting millions before ever getting off the ground, VAs initial system launched ahead of schedule in June 2013 -- albeit with some early glitches.

Initially, the system was designed to act simply as an electronic claims repository. "We didn't stop there, said Beth McCoy, VAs deputy undersecretary for field operations. We went on to add in automation, because that made sense and that was the right thing to do for veterans and for our employees." Following the agile method, VA has been rolling out new features and functionality every three months, McCoy told Congress, delivering 17 major software releases and 56 more minor updates over the past four years. But watchdogs -- including the IG and the Government Accountability Office -- say VA lacks clear goals for further development of the system. VA has yet to produce a plan that identifies when VBMS will be completed, testified Valerie Melvin, director of information management at GAO. "Thus, the department lacks an effective means to hold management accountable for meeting a timeframe and demonstrating progress on completing the system, Melvin testified.

Republican lawmakers, who have fiercely criticized VA management in recent years, are impatient with VA's approach to improving the system. You're going to go through the appropriations process this year and say, 'We want more money, but we don't know when this will end and what the final cost will be for a very specific project?" said Rep. Tim Huelskamp (R-KS). Thats the nature of agile development, VA officials said. VBMS is different because we use what we refer to as agile, said Dawn Bontempo, director of the Veterans Benefits Management System program management office. And that means that we can release software every three months and bring high-value functionality to the field as quickly as possible to serve our veterans."

Traditionally, the federal government has used a waterfall approach when developing and implementing large IT projects. Agency planners exhaustively gather system requirements upfront. Those are then turned over to the IT development shop, which builds the system. And years later, the agency may have a functioning system. We did not go down that path, Bontempo said. We used something called agile, which allowed us to take and build requirements as we were going along. However, GAO, which has identified incremental development as a best practice that could help agencies stay on top of failure-prone IT projects, also agrees VA needs reliable cost estimates for completing the system or risks flying blind. Without such an estimate, management and stakeholders have a limited view of the system's future resource needs and the program risks not having sufficient funding to complete the system," Melvin testified. [Source: Nextgov.com | Jack Moore | January 12, 2016 ++]

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VA Aid & Attendance Update 18 Proposed Eligibility Rule Changes

Proposed changes to the eligibility rules regarding Aid & Attendance Pension benefits from the Department of Veterans Affairs will take effect in early 2016, probably February or March. The proposed changes impact the following:

Net Worth: For the first time, a definitive limit on the countable net worth an applicant can have and still qualify for benefits is given. The proposed limit is $119,220 (equal to the current maximum community spouse resource allowance for Medicaid purposes); The net worth limitation would increase each year with the Social Security cost-of-living increase; and The net worth limitation will apply regardless of whether the applicant is single or married (or has other qualifying dependents), and without consideration of any excess care costs the applicant may have.

Countable Assets for Net Worth Purposes: Assets are defined as fair market value of all property that an individual owns, including all real and personal property, unless considered an excluded asset, less the amount of mortgages or other encumbrances specific to the mortgaged or encumbered property. The primary residence (Homestead) of the applicant is still excluded from the asset calculation, whether the applicant resides there or not, as long as it remains a residence (e.g. sale or lease of the premises can be problematic); but the reasonable lot area that the residence sits on will now be limited to 2 acres (previously, there was no such limitation.) Annual income will be considered an asset for net worth purposes. For example: if the applicant has Social Security of $1,500 per month, this would correspond to $18,000 in assets (which could result in the applicant being over the net worth limit described above).

Transfers of Assets and Penalties: Assets that would otherwise be countable for eligibility purposes which are transferred within the lookback period will result in a period of ineligibility. Penalty periods may also be assessed for the purchase of an annuity or transfer of assets to a trust (revocable or irrevocable). The ineligibility period is limited to 10 years, regardless of the size of the transfer; In order to cure the transfer by returning the funds to the applicant, the return of funds must be done within 30 days of submission of the VA Pension application; The lookback period will be the 36 months immediately preceding the date of application for benefits; and The only exception to the presumption of a penalized transfer is evidence that the transfer was a result of fraud, misrepresentation or other bad act in the marketing or sale of a financial product.

The VA has not stated whether the new rules will apply retroactively, however, the potential application of the proposed regulations underscores the importance of consulting a qualified Elder Law attorney before submitting an application. Additionally, despite the promulgation of regulations that restrict the ability of many to receive VA Pension benefits, there are options available for restructuring of finances to allow qualification without first having to spend all of your heard-earned savings. If you have questions, do not hesitate to contact a qualified Elder Law attorney. Do not let the newly restrictive regulations or the worries or opinions of others keep you from exploring your options. There may still be strategies available to achieve eligibility, and VA Pension benefits may allow you to receive care in your own home instead of a facility. [Source: Florida Today | Stephen Lacey | January 12, 2016 ++]

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VA Facility Safety Texas Open Carry Gun Law Impact

Open carry is now the law of the land in the Lone Star State, but the federal government is reminding Texan veterans that guns still are not allowed on VA property. In a reminder posted to the Central Texas Veterans Health Care System website, the U.S. Department of Veterans Affairs made clear that firearms will remain prohibited at all of the federal agency's sites. "Texas concealed and open carry handgun laws DO NOT apply to VA property," the alert stated. "No firearms or weapons are allowed on our VA controlled property. Any confiscated firearms will be destroyed and offender will appear before Federal Court. Only certified police officers in the commission of his or her duties may bring a firearm onto VA property."

Central Texas VA spokesperson Deborah Meyer said the prohibition on firearms extends to all federally-controlled property in the state, not just the VA, but said the posting was simply a reminder to Texans. There was no incident that led to the alert, she confirmed. The VA operates several dozen hospitals, clinics and centers in Texas. "We wanted to remind everybody that it still remains the same. Concealed carry is the same as open carry, there's still no firearms on federal property," Meyer said. The new open carry law allows Texans with a license to carry to openly tote handguns in shoulder or hip holsters. Certain areas, such as public schools, courthouses and polling places, remain off-limits to all weapons, including knives, clubs and brass knuckles. Open carry of long arms -- rifles and shotguns -- is legal in Texas and does not require an owner to have a license to carry. [Source: Houston Chronicle | Lauren McGaughy | January 12, 2016 ++]

The Michael E. DeBakey VA Medical Center in Houston, Texas

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Non-VA Facility Care Update 02 Over Estimated Budgets

An audit of the Veterans Health Administrations private health care program books finds the department failed to spend $1.9 billion or 40 percent of the $4.8 billion designated for non-VA care in fiscal 2013. Also, from Oct. 1, 2013, through March 31, 2015, medical center administrators overestimated the funds they needed to pay for outside care for veterans by $543 million, leaving that amount unavailable for patient care, according to a new Veterans Affairs Office of Inspector General report. The finding follows numerous reports that VA has mishandled disciplinary actions against administrators involved in scandals, a slow rollout of its $10 billion to provide care in the private sector through the Veterans Choice program and a nationwide problem involving long waits for medical care.

The VA IG said the failure occurred because VA administrators have not provided medical directors with the tools they need to estimate costs and that medical center staff were not required to adjust estimated costs routinely to reflect actual costs. We recommended that the Under Secretary for Health improve cost estimation tools, update system software to ensure unused funds can be deobligated,' require facilities to adjust cost estimates and monitor VA medical facility obligation estimates, wrote Gary Abe, acting assistant general for audits and evaluations. VA Secretary Robert McDonald asked Congress last year to allow the department to shift money from the Veterans Choice program to other VA programs, saying administrators needed flexibility in spending money on VA and private or community health care. Congress agreed to allow VA to use about $3.3 billion in Choice program funds to cover other account shortfalls.

Rep. Jeff Miller, chairman of the House Veterans Affairs Committee said the audit indicates that the department has a management problem, not a money problem. If VAs job was mismanaging money, it would have a near-perfect record of achievement," Miller said. "Yet despite this and other high-profile budgetary failures, all too often the departments knee-jerk response to challenges is to ask taxpayers for more money." A veterans advocacy group that has been pressing for a complete overhaul of the VA health system, including partial privatization, said 12 JAN that the IG audit shows the department is not truly invested in giving veterans more options. This report makes clear that in addition to relying on faulty budget projections, the VA failed to provide oversight for the program, to the likely detriment of nearly 80,000 veterans, Concerned Veterans for America press secretary John Cooper said.

In a response to the audit, Under Secretary for Health Dr. David Shulkin said he concurred with the recommendations made by the auditors, and he attached a plan of action. Veterans issues have been a focus of the administration -- transitions from military service, employment and homelessness. On 13 JAN, McDonald will travel to Boston to highlight several notable VA research efforts and collaboration on VA mental health. McDonald will visit the Million Veteran Program, an initiative designed to study service-related conditions, the VA Brain Bank and the Jamaica Plain VA Medical Center, where hell present an award to VA National Center for PTSD behavioral science director Terence Keane for his work in the field of traumatic stress. [Source: MilitaryTimes| Patricia Kime | January 12, 2016 ++]

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VA Claims Backlog Update 151 Rep Millers VBMS Concerns

The Department of Veterans Affairs is scaling up an IT system to help benefits administrators reduce a backlog of veteran claims. But the VA's top watchdog in the House of Representatives is worried that the system is over budget, behind schedule and not working as advertised. The Veterans Benefits Management System was developed to overcome the massive backlog of disability claims by digitizing claims forms and expediting claims decisions. According to Rep. Jeff Miller (R-FL), chairman of the House Veterans Affairs Committee, VBMS is making a dent in the claims backlog, but could be doing a lot better. The agency's own internal watchdog thinks that VA could be manipulating data to make their performance seem better on paper than it is in fact. By the VA's accounting, VBMS has greatly reduced the backlog, although the agency did not meet its self-imposed goal of eliminating backlogged claims completely by the end of 2015.

According to Beth McCoy, the VA's deputy undersecretary for field operations, who testified at a 12 JAN hearing of the House panel, backlogged claims (defined as claims older than 125 days) have dropped from a peak of over 611,000 in March 2013 to about 80,000 today. McCoy credited the reduction of nearly 90 percent in part to department's work on the electronic system. However, Brent Arronte, the VA's deputy assistant inspector general for audits and investigations, questioned the integrity of the VA's numbers, saying the data had been manipulated. "We don't believe all the [backlog] numbers are reliable," Arronte said. "We want to see how they count their numbers." He added, "There may be a systemic issue across the nation, so we're going to test their data reliability,"

The exact impact of the VBMS has also attracted the attention of the Government Accountability Office. In a Sept. 2015 report, the GAO expressed concern that the system wasn't completed, and that the agency hadn't put in place a way to collect user feedback to generate improvements. Miller recognized the 'department's progress, but made clear that he felt not enough has been done. "As of Jan. 1, 2016, there were over 360,000 disability claims pending, over 75,000 of which were [backlogged]," he said. "This is despite Congress devoting substantial taxpayer resources -- including significantly increasing VBA's workforce by approximately 7,300 full-time employees between 2007 and 2014." Miller said that "The projected cost of the program has jumped to $1.3 billion, and there is no guarantee that VA will not need more money for VBMS in the future."

Legislators were visibly displeased by those vagaries. But the moment that most frustrated committee members was when they were presented a picture from a January GAO report of a VA storage facility with boxes containing about 41,000 un-scanned claims; all claims are supposed to be scanned and uploaded to the VBMS within five days of receipt. "If veterans saw that [picture], they would be livid," said Rep. Phil Roe (R-TN). "That looks worse than my garage." McCoy told lawmakers that she believed the claims backlog could be eliminated in fiscal year 2018. [Source: Federal computer Week | Chase Gunter | January 12, 2016 ++]

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VA Privacy Violations On the Rise at Minnesota Facilities

Since 2011, there have been 240 cases of reported privacy violations at VA facilities in St. Paul, Minneapolis, St. Cloud and various clinics around the state. From 2011 to 2015, the number of violations has more than doubled. The violations include one veteran receiving a photo in the mail of another veterans colonoscopy, one provider discussing a patients diagnosis with the patients real estate agent, VA workers snooping into the records of patients whose names have appeared in the news, and some widows receiving discharge papers and awards belonging to unrelated vets.

The disclosures are contained in a database built by the investigative journalism organization ProPublica and shared with the Star Tribune. Working with data obtained through the Freedom of Information Act, ProPublicas national investigation found that employees and contractors at VA medical centers, clinics, pharmacies and benefit centers commit thousands of privacy violations each year and have racked up more than 10,000 since 2011. The VA said the challenges it faces in keeping patient information secure are similar to those experienced by others in the private and public sectors. It said it takes its patients privacy seriously and its policies and guidelines go beyond what is required by law. Inappropriate access of patient health records, either during or post treatment, is absolutely unacceptable and in violation of privacy laws and regulations, VA policies and procedures, and our principles, the VA said in a prepared statement.

But the disclosures indicate the VAs handling of its cases differs from those of other health care providers. The VA remains embroiled in scandals over manipulated appointment wait times and from revelations that the medical information of whistleblowers sometimes has been accessed by the VA in an apparent attempt to discredit them. Last year, the head of the office that investigates VA whistleblower complaints told a Senate committee that systematic changes were needed in how the VA keeps records. It is too easy right now for a mischief-minded employee to enter the medical record system and access information on his or her co-workers, Carolyn Lerner said in written testimony. The Minnesota cases run the gamut, from simple clerical errors to outright maliciousness:

In 2013, one veteran opened his mail to discover a picture of the inside of another veterans colon, taken during the veterans colonoscopy at the St. Cloud VA. A nurse did not clear the camera to set up for the next patient and when the system printed the photos it included the veterans name, birth date, Social Security number and date of the procedure, along with the providers name. In 2014, a former VA supervisor in Minneapolis called a retired VA employee and claimed she knew about his health problems from another VA supervisor. In 2011, an employee of the Minneapolis VA snooped in the chart of a vet who had been in the news, even though it wasnt part of the employees official duties. The worker admitted looking in the chart out of curiosity and was written up for disciplinary action. The following year, a research contract worker accessed the chart of another high-profile patient who was in the news. In another 2011 case in Minneapolis, clerks in a clinic were overheard by a patient and his daughter discussing a veteran enrolled at the clinic who had been identified in the local news media after being charged with a crime.

The 2011 to 2015 data provided to ProPublica for their investigation included the outcome of the breaches but does not indicate whether any employee was disciplined. Asked whether workers were disciplined in the Minnesota cases, officials from Minnesota VA facilities referred all questions to a VA spokesman in Washington and provided a fact sheet on the VAs response to protect the privacy of its patients. The VA spokesman in Washington did not respond to a request for information. While the VA has indicated it will pursue discipline, it said in its fact sheet that it relies heavily on workers admitting their own mistakes. Self-reporting is more consistent when punishment is de-emphasized over training and clear incident response, the VA said. When an individuals medical record is accessed, it generates a report, which shows who has accessed the information and when. Additional audit records for the electronic health record are reviewed for signs of any inappropriate or suspicious activity or suspected violations.

The VA requires annual privacy and information security training of all employees and contractors. An Incident Response Team assesses any reported risk and arranges credit monitoring for the individual whose information is involved. While HIPAA violations can carry economic penalties, its virtually impossible to sue the VA over other privacy breaches because a prospective plaintiff would need to prove real economic damage, Krause said. They dont have the same kind of fear of God like some normal Joe Schmo, where they are held personally accountable, Krause said of the VA. These individuals in the federal government are above the law, and its the taxpayer that has to foot the bill every time there is a mistake. [Source: Star Tribune | Mark Brunswick | January 12, 2016 ++]

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VA HIPAA Violations Confidential Patient Information Disclosures

Every time you turn around there is another scandal at the Department of Veterans Affairs. They just keep coming one after another. This time it is the revelation that the VA is disclosing confidential patient information that it is supposed to keep private. That is a violation of the Health Insurance Portability and Accountability Act (HIPAA), the federal patient privacy law enacted to protect Americans from having their medical records made public. The incidents at the VA include the disclosure of veterans Social Security Numbers, addresses and telephone numbers, as well as their medical history, and prescription medications. VA medical facilities are not the only hospitals that have been caught disclosing private patient information. However, the Department of Health and Human Services' Office for Civil Rights, the agency responsible for enforcing HIPPA, has cited the Department of Veterans Affairs for HIPPA violations more frequently than any other health provider in the entire country.

According to the Department of Veterans Affairs, the mission of the VA is to fulfill President Lincoln's promise To care for him who shall have borne the battle, and for his widow, and his orphan by serving and honoring the men and women who are Americas Veterans. It doesnt seem that the VA is fulfilling that mission. To care for him who shall have borne the battle and for his widow, and his orphan, as noted in Lincolns Second Inaugural Address. Some of the incidents at VA hospitals were accidental, the result of sloppy work by VA employees. But other incidents were deliberate attempts by VA employees to punish co-workers who had reported some of the terrible conditions at VA hospitals to Congress or the media. The story was published simultaneously by National Public Radio (NPR) and ProPublica, an independent, non-profit news service that produces investigative journalism in the public interest.

Sloppy work by VA employees has led to the private medical data about deceased veterans being sent to the wrong widows. There are many cases where one veteran received medications meant for another veteran, or where one veteran received another veteran's refill slip at the pharmacy window. In some cases the veterans address was changed incorrectly, which resulted in medications being mailed to the wrong address. There are also cases where one veteran received a package from the VA that contained the medication that the veteran used, but the label on the medication bottle contained personal information about another veteran who took the same medicine. Veterans also reported that they had received copies of their confidential medical records in the mail in an unsealed envelope. One VA employee mistakenly mailed documentation that contained a veterans personally identifiable information to an outside organization.

But some of the incidents are much more serious. VA employees have snooped on the records of patients who have committed suicide, and whistleblowers within the VA told NPR and ProPublica that their own medical privacy has been violated. The whistleblowers are veterans, who are also VA employees, and they reported that other VA employees had accessed protected health information (PHI) in their veteran medical record without authorization and then disclosed that protected health information to another VA employee without authorization.

And the violations are not confined to one or two VA hospitals. They are happening at VA hospitals across the country. For example, a six-month long investigation by WREG in Memphis found hundreds of privacy violations by employees at the Memphis VA Medical Center. In April of 2014, WREG filed a Freedom of Information (FOIL) request with the Department of Veterans Affairs. They wanted to know how the Memphis VA Medical Center was investigating and resolving privacy complaints. In September 2014, after months of wrangling with the VA, WREG obtained a report about privacy violations at the Memphis VA hospital. The report covered a three-year period and documented more than 200 complaints, reports, and investigations into privacy breaches at the Memphis VA Medical Center. There are similar stories at other VA hospitals. In the two year period 2013 2015, there were 21 reported violations of patient privacy at the Canandaigua VA Medical Center, near Rochester, New York, including incidents at the VA Outpatient Clinic on Westfall Road in Rochester. [Source: Rochester Independent Examiner | Thomas Mangan | December 30, 2016 ++]

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VA VistA Update 07 EHR Enhancement Effort

Congress has provided $233 million in its final fiscal year 2016 omnibus bill for continued modernization of the Department of Veterans Affairs VistA electronic health record system. However, the appropriationsigned into law by President Obamacomes with restrictions. The EHR enhancement effort, called the VistA Evolution program, calls for the addition of an Enterprise Health Management Platform (eHMP)a set of new modular-based componentsto replace the Computerized Patient Record System, which is the existing user interface that clinicians use while delivering care. Among other capabilities, the new eHMP platform will enable the VA to meet many of the 2014 Edition Meaningful Use certification criteria for HIT components.

However, legislative language restricts the use of congressional funding until VA demonstrates functional improvements in the interoperability of the system to seamlessly exchange veterans medical data among the VA, Department of Defense and the private sector. Not more than 25 percent of the funds can be obligated or spent until the VA Secretary submits a report to both House and Senate appropriations committees providing specifics on the scope and functionality of projects within the VistA Evolution program, including proposed changes to the program as well as the milestones and timeline associated with achieving interoperability. Lawmakers are particularly interested in the definition being used for interoperability between DoD and VA EHR systems, the metrics to measure the extent of interoperability, and the progress toward developing and implementing all components and levels of interoperability including semantic interoperability.

Although DoD and VA have committed to achieving interoperability between their separate EHR systems, the two departments continue to miss important deadlines and have yet to establish outcome-oriented goals and metrics for measuring their progress toward interoperable EHRs, according to an August 2015 audit by the Government Accountability Office. According to GAO, DoD and VA missed an Oct. 1, 2014, deadline established by Congress in the National Defense Authorization Act (NDAA) for Fiscal Year 2014 to certify that all healthcare data in their systems complied with national standards and were computable in real time. Auditors also revealed that a number of key activities in the departments system modernization plans will be implemented beyond Dec. 31, 2016, the deadline established in the NDAA for DoD and VA to deploy modernized EHR software to support clinicians while ensuring full standards-based interoperability. [Source: Health Data Management | Greg Slabodkin | January 4, 2016 ++]

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Home Based Primary Care Multiple Discipline Team Approach

In Connecticut, there are 209,882 veterans, according to the most-recent U.S. census data, and 29.4 percent are over the age of 75. This group forms the core of veterans with chronic medical issues who are targeted by a VA program to treat them in their own homes. Most of the patients in the VAs Home Based Primary Care (HBPC) program are like US Army veteran Bob Swirsky, who is bed-bound and not able to easily get to the West Haven VA Hospital. He enrolled in the HBPC program in August. Swirskys daughter, Mindy Hart, said, It is tremendously tiring for him to get into a car, or even just to move around.

U.S. Army veteran Bob Swirskys face lights up when home health care nurse Jeanette Hutchinson enters his room to check his blood pressure and attend to his body to prevent bedsores. Its going to be 120 over 60, Swirsky says, as Hutchinson inflates the cuff on the meter on his left arm. Close, she said, 124 over 60.

Home Based Primary Care, is a team approach in which we have multiple disciplines that come out to the house and visit our veterans who typically have a difficult time getting into the hospital to see their provider on a regular basis, Hutchinson said. The team comprises the program director, physicians, psychiatrists, nurses, social workers, registered dieticians, physical therapists, clinical pharmacists, and program support staff. Prospective patients are veterans who are already registered in the VA health care system. Veterans are referred to HBPC by the hospital, or their doctors, or sometimes veterans request the service themselves, said Aileen OConnell, HBPC program director. A registered nurse assesses referrals. Swirsky, 96, lives just a few miles from the West Haven VA and falls within the territory HBPC covers. Across the state, the general guideline is 30 miles or 30 minutes from the VA facilities in West Haven or Newington, or from one of the community-based outpatient clinics, located in New London, Winsted and Waterbury.

August Palmer, of Stratford, was recommended