PIH received its first reimbursements beginning last week from the outpatient claims we submitted to WPS on 4/22 and 4/29, which is not a bad turnaround time.  75% of them were allowed.  Not a lot of money involved, and most of the allowed amounts went to deductible.  Several claims for the patients receiving one specific treatment were denied as “service not covered,” which we will have to investigate and appeal.  The good news is that our claims were processed and most of them were allowed at the amounts we billed.  As an aside, I have had similar success with personal claims which I have submitted myself, mostly for pharmaceuticals.

You may recall early this year that we provided HCFAs to many patients to be signed for submission of claims.  Those were claims that had been processed by our contracted company in Las Vegas.  We still have a large backlog of claims for the last 12 months, many of which require patient signatures.  We will be contacting patients to arrange to have them signed.  Your cooperation and assistance will be most appreciated.

Rumors attributed to “the veterans” continue to abound about PIH closing or already being closed.  We’re still here!  There is also a complaint that we charged an HVC patient P57,000 for an operation.  True.  The surgery was deemed not medically necessary, but the patient elected to have it done regardless.  So, in line with our cost cutting measures announced late last year, he paid and can submit his own claim.

Jack McDonald
Administrator 

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Hi All My Veteran Friends,

Some of you probably are aware of this and some of you might not be. Anyway, here is a link where you can apply for one if you want one:

https://www.hrc.army.mil/site/active/tagd/coldwar/default.htm

It's administered by the Army, but we won't hold that against them!

Take care,
Tom

++++++++++ General INFORMATION ++++++++++++
From: Lisa Bogle, Disabled American Veterans
To: Joe Godfrey
Sent: Tuesday, June 28, 2005 5:16 AM
Subject: Swift Action Urged to Cover Veterans Budget Shortfall

FOR IMMEDIATE RELEASE
June 24, 2005
 
Swift Action Urged to Cover Veterans Budget Shortfall
 
WASHINGTON—The Disabled American Veterans (DAV) is calling on Congress to act quickly to cover a critical shortfall in funding for veterans health care for the current fiscal year and make sure the Department of Veterans Affairs (VA) has the resources it needs in future.
 
 Following the disclosure yesterday by the VA that the agency faces a $1 billion shortfall this year, DAV National Commander James E. Sursely said, “Congress and the Administration must make veterans a top priority and fully fund medical care and other programs, which are a continuing cost of national defense.”
 
 The DAV raised the alarm earlier this year noting that VA medical facilities across the country were running out of money and face huge deficits. In April, the organization expressed its bitter disappointment that the United States Senate blocked an amendment to the $80 billion supplemental appropriation bill that would have provided $2 billion to cover the critical shortfall in funding for veterans medical care.
 
 “Congress must now act quickly to stem the flow of red ink that threatens health care for today’s veterans and thousands of men and women injured and disabled during the wars in Iraq and Afghanistan,” said Commander Sursely.
 
 Under legislation passed by the House, the VA would receive a total of $68.1 billion in fiscal year 2006. VA health care funding would be $28.8 billion. The Senate has yet to act on a bill funding the VA.
 
 “The DAV and other major veterans service organizations are united in calling on Congress to provide $31.2 billion for veterans medical care next year,” said Commander Sursely.
 
 “VA facilities in every region of the country have exhausted reserve funds to meet critical needs. Many have stopped hiring doctors and nurses because of shortfalls, while still others have cut back or even eliminated medical services. Health care for millions of today’s and tomorrow’s veterans is in limbo because Congress and the Administration have continually failed to adequately fund the VA,” Sursely said.
 
The 1.2 million-member Disabled American Veterans, a non-profit organization founded in 1920 and chartered by the U.S. Congress in 1932, represents this nation’s disabled veterans. It is dedicated to a single purpose: building better lives for our nation’s disabled veterans and their families. For more information, visit the organization’s Web site www.dav.org.

++++++++++ General INFORMATION ++++++++++++
http://www.dcmilitary.com/navy/tester/10_25/national_news/35478-1.html

The Veterans Health Care Act of 2005!
June 21, 2005
 
S. 1182, the Veterans Health Care Act of 2005, contains a provision that would eliminate the requirement that the Department of Veterans Affairs (VA) maintain its staffing and extended care services at levels provided nationally in 1998.  The current law, which requires VA to maintain its nursing home bed capacity recognizes the importance of long-term care services as a major component in VA’s total health care mission.  In addition, this law reflects the vulnerability of these high-cost services in an under funded system.  Continued budget shortfalls have forced VA to cannibalize long-term care programs in order to fund what they see as other priorities.
       
The number of aging veterans is increasing rapidly.  Veterans who are 85 years and older, who have a greater need for nursing home care, are expected to increase from 870,000 to 1.3 million over the next decade.  This in not the time for reducing VA nursing home capacity with increased veteran demand looming on the horizon. 
       
The Senate Veterans Affairs Committee will mark-up S. 1128 in mid-July.   Please contact your Senators and request they do not support this provision to eliminate the current capacity requirements for long-term care.

++++++++++ General INFORMATION ++++++++++++
Differences between VA disability
and Social Security Disability
http://www.disabilitysecrets.com/the-va-and-disability.html

Disabled veterans will usually find themselves dealing with the social security administration, at some point or another. And this is only to be expected. However, many vets may end up very surprised when they learn how different the two systems really are. In this article, we’ll discuss the principle aspects of the SSA system as well as a couple of differences that exist between the two systems.

To begin with, how does social security disability work? Basically, like this: a person who feels that he or she is disabled contacts the social security office that is closest to them. They inquire into how a disability application can be filed and an appointment is set, either for an in-office interview, or an over-the-phone interview. This is for the purpose of filing what is called an initial claim.

Once the paperwork for the initial claim is complete, the claimant’s file is transferred to a state agency known as DDS, which stands for disability determination services. At DDS, the claimant’s file is assigned to a Disability Examiner, a specialist who will gather the claimant’s medical records and, then, in consultation with a physician and/or a psychologist who is assigned to the examiner’s unit, make an approval decision or denial decision. Unfortunately, the decision that is made is typically a denial. In fact, denials occur roughly seventy percent of the time at the initial claim level.

After the initial claim is denied, the claimant may file a new claim (a mistake) or may follow the appeal process and file what is known as a request for reconsideration.

The reconsideration works exactly as the initial claim. The paperwork is filed at the social security office which, once more, sends the claimant’s file off to disability determination services. When the reconsideration (or recon, for short) is received at DDS, it is assigned to a reconsideration-level examiner … who does exactly what the initial examiner did. He or she gathers whatever medical evidence is thought to be needed and then makes a decision. Typically, this is also a denial. And, in fact, recons are denied at an even higher rate: about eighty-five percent of the time.

After a recon denial, a claimant may elect to follow the appeal process again and file a request for hearing before an administrative law judge.

Fortunately, this is where most claimants will have the best chance of winning their claims. Unfortunately, because the system is so backed up, it may take an extremely long time to have a hearing date set. Depending on which part of the country the claimant resides in, and how backlogged their local hearing office is, it may take a year or longer to have a hearing date set.

In a nutshell, this is how the disability process plays out for most individuals (this is an abbreviated version, of course). Now, how is the federal social security disability system different from the the VA system?

Primarily, the SSA system is different from the VA system in that there are no percentages of disability. While the system that exists for vets allows the veterans administration to conclude that a vet is 40% disabled and then receive benefits based on that determination (and potentially have that percentage upgraded over time to a full 100% rating), in the social security system it is all or nothing.

With the social security disability system, a claimant is either awarded 100% of their eligible benefits, or zilch. Without a doubt, the SSA system is fairly draconian. In fact, the definition of disability used by the social security system stipulates that not only must your condition have kept you out of work … (from the ssa.gov website) “Your disability must also last or be expected to last for at least one year or to result in death.”

The percentage approach is the greatest single difference between the ssa and va disability systems. However, there are other aspects regarding social security disability that veterans should probably know about.

First of all, if your primary source of treatment is a VA medical center, don’t assume that the DDS examiner who is assigned to your case will be successful in obtaining your VA medical records. The VA is notorious in some areas for not supplying needed medical records. And for this reason, it’s never a bad idea for vets to personally obtain their medical records themselves so they may turn these records in when they apply for disability, or file an appeal. One word of caution, though: never submit anything to social security without making a copy first since the social security administration is fairly notorious itself for loosing things that have been sent to them.

Veterans should also know that, unlike the VA system, you’re entitled to attorney representation from the very start. Yes, you are allowed to have an attorney with you if you appeal a VA claim denial, but since the VA only allows an attorney to be compensated $10.00 for this first appeal, most vets will find it difficult to get assistance from an attorney. In the social security system, an attorney works off a contingency-fee basis from the moment they represent a claimant. In other words, if they win the case, they get paid 25% of whatever backpay that SSA decides it owes the claimant. The corollary of this, of course, is that the attorney receives nothing if the case is not won.

Is an attorney always needed in a social security disability case? No. And, in fact, there are many outstanding disability representatives who are not attorneys at all and are referred to as “non attorney representatives” (many of these non attorney reps are former social security employees who put their experience to use representing disabled individuals).

The rule of thumb for getting an attorney (or non-attorney) is usually this. If you get denied on your initial claim, you might as well get an attorney. Because in most cases, the first appeal (the recon) will be denied and a claimant will have to request the second appeal:, a hearing before an administrative law judge. And, of course, to go before a judge without representation is never a good idea.

The SSA disability system can be exasperating and difficult. Most individuals who’ve gone through the system have, at some point, concluded that the system is rigged against them. And, to be honest, it would be difficult to argue completely against that conclusion.

However, the best advice any claimant can utilize with regard to filing for disability is simply to learn as much as possible about the system and use that information to avoid simple mistakes, and even costly ones.

++++++++++ HEALTH INFORMATION ++++++++++++
From: Sunshine Vet News

Like Vioxx, Ibuprofen May Up Heart Attack Risk
Study: 'Traditional' Painkillers May Carry Small but Serious Risk
http://my.webmd.com/content/Article/107/108459.htm
By Daniel DeNoon, WebMD Medical News
Reviewed By Michael Smith, MD on Thursday, June 09, 2005 

June 9, 2005 - Ibuprofen, naproxen, and similar pain relievers raise a person's risk of heart attack, a new study suggests.

Ibuprofen and naproxen - traditional anti-inflammatory pain relievers - have been considered more heart friendly than the new Cox-2 type of pain drugs. Two of the Cox-2 drugs, Vioxx and Bextra, have been pulled from the marketVioxx and Bextra, have been pulled from the market because they increase a person's risk of heart attack.

The new study, led by Julia Hippisley-Cox, MD, MRCP, of the University of Nottingham, England, did show that Vioxx increased the risk of heart attack by 32% when taken in the previous three months. But it also linked ibuprofen -- brand names include Advil and Motrin -- to a 24% higher risk of heart attack compared with people who had not taken any anti-inflammatory in the last three years.

Diclofenac (brand names including Arthrotec, Cataflam, and Voltaren) increased heart attack risk by 55%. Naproxen (brand names include Aleve) was also linked to a higher heart attack risk, although the finding was not as strong.

Previous research has shown no link between occasional use of painkillers and heart attacks. Patients taking over-the-counter anti-inflammatory painkillers should not take them for more than 10 days without checking with their doctor.

A second study by Canadian arthritis specialist Marie Hudson, MD, MPH, found that among elderly patients who already had heart disease, Celebrex - a Cox-2 drug still on the market - was safer than Vioxx and possibly even traditional anti-inflammatory drugs.

Both studies appear in the June 11 issue of the British Medical Journal.

Heart Attacks and Pain Pills

Hippisley-Cox and colleague Carol Coupland analyzed data collected from general practices across England, Wales, and Scotland. They analyzed data from 9,218 people with first-time heart attacks and compared them to 86,349 matched patients without heart attacks.

Those with heart attacks were much more likely to have used anti-inflammatory painkillers regularly, also known as nonsteroidal anti-inflammatory drugs (NSAIDs).

"The list of traditional NSAIDs seems to be comparable to the Cox-2 drugs in increasing heart attack risk," says Hippisley-Cox, "but when you put that into perspective, the vast majority of people taking these drugs will not be harmed by them."

Older patients are at the highest risk of heart attack and thus more vulnerable to the increased heart risk from pain drugs. Hippisley-Cox calculates that Vioxx would cause one extra heart attack for every 700 patients aged 65 and older taking the drug. Ibuprofen would cause one extra heart attack for every 1,000 patients taking the drug.

Pain vs. Side Effects

"Patients are taking painkillers because they are in pain," Hippisley-Cox says. "At the end of the day, we need to know the benefits and the risks. A young patient with arthritis has a low risk, so a 30% increase on that is quite small - whereas that person's dreadful pain is very likely to affect quality of life. So there is a trade-off of living without pain vs. the risk of side effects. The message to the consumer is not to panic and not to change treatment based on these study findings."

Interestingly, low-dose aspirin did not change a person's risk. Other studies have suggested that low-dose aspirin may offer some protection against the heart risks associated with pain drugs.

"The study suggests that the effects of NSAIDs are present whether or not patients are being prescribed aspirin," Hippisley-Cox says. "Aspirin does not cancel the risk out."

The British researcher is quick to note that her study does not prove anything. While it is a carefully done study, its findings are still preliminary. Only a well-designed clinical trial that randomly assigns patients to take one treatment compared to another can substantiate the findings.

Celebrex a Better Choice?

In a smaller observational study, Hudson and colleagues looked at data on more than 2,200 patients aged 66 and over with congestive heart failure. All the patients needed a pain reliever.

"We know that in these patients, traditional NSAIDs and Cox-2 drugs are not generally indicated," Hudson tells WebMD. "But the fact is that some of these patients still need these drugs. For those who need them, we wanted to see if there are some that are better or worse than others."

The bottom line: Risk of death and recurrent heart failure appeared slightly lower in patients taking Celebrex.

"I am telling my patients who have heart failure and arthritis that the first-line treatment is still acetaminophen [Tylenol]," Hudson says. "But this does not always offer relief. So if I have to go on to [another] drug, I explain the increased risks. If I have to choose, I have been prescribing Celebrex."

The Hippisley-Cox and Hudson studies did not receive funding from drug companies. Neither of the researchers reports financial connections with the makers of any of the drugs under study.

SOURCES:
Hippisley-Cox, J. British Medical Journal, June 11, 2005; vol 330: pp 1366-1372. Hudson, M. British Medical Journal, June 11, 2005; vol 330: pp 1370-1375. Julia Hippisley-Cox, MD, MRCP, MRCGP, DRCOG, professor of clinical epidemiology and clinical practice, University of Nottingham, England. Marie Hudson, MD, MPH, rheumatologist and postdoctoral student, McGill University.

©2005 WebMD Inc.

*************************************
Hypertension Serious in Young Men
High blood pressure is more common in younger men, and should be taken just as serious as in their older counterparts.
http://my.webmd.com/content/Article/106/108284.htm
By Leanna Skarnulis, WebMD Medical News
Reviewed By Brunilda  Nazario, MD on Tuesday, May 31, 2005 

You're under 35 and feel fine, yet the doctor says your blood pressure is high and you'd better come back to have it checked again. Being a red-blooded male, you figure five years will be soon enough. After all, isn't high blood pressure an old man's disease?

"Young men are less likely than older men to believe they have hypertension and less likely to go back to the doctor," says Daniel Lackland, DrPH, spokesman for the American Society of Hypertension. "Often these are patients whose blood pressure would respond to weight management and other lifestyle changes, but they're less likely to seek treatment."

Untreated hypertension damages the heart and other organs and can lead to life-threatening conditions that include heart disease, stroke, and kidney disease. It's called "the silent killer" because symptoms generally appear only after the disease has caused damage to vital organs.

"With treatment, we can truly prolong life," Lackland tells WebMD.

Understanding High Blood Pressure

If your blood pressure is 120/80, 120 represents systolic pressure, or the pressure of blood against artery walls when the heart beats. Eighty represents diastolic pressure, or the pressure between beats.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines categorize hypertension as follows:

 • Normal. Less than 120/80
 • Prehypertension. 120-139/80-89
 • Hypertension. 140/90 (130/80 for patients with diabetes or chronic kidney disease)
 • Stage 2 hypertension. 160/100

Hypertension, or high blood pressure (HBP), exists when either the systolic measurement is 140 or higher or the diastolic measurement is 90 or higher. However, in the majority of people, controlling systolic hypertension is a more important heart disease risk factor than diastolic blood pressure (except in young people under the age of 50).

There are two types of hypertension: essential, which accounts for 90% to 95% of cases, and secondary. The cause of essential hypertension is unknown, although lifestyle factors such as obesity, sedentary lifestyle, and excessive alcohol or salt intake contribute to the condition. In secondary hypertension, the cause may be kidney disease; hormonal imbalance; or drugs, including cocaine or alcohol.

According to the JNC 7, half the adult population is prehypertensive or hypertensive, and because blood pressure increases age, most people will become hypertensive if they live long enough.

Younger vs. Older Men With High Blood Pressure

Younger men with high blood pressure typically have high diastolic pressure while older men have high systolic pressure. "In young men, the diastolic pressure rises because the heart is pumping harder," says Lackland. "In older men, the systolic pressure rises and stiffens arteries.

"Part of the problem with young men is increased body mass. Ten years ago we wouldn't have seen hypertension in the teens and 20s, but now it's increasing along with rising obesity rates. We're seeing the increase in particular in African-American men, but it affects men of all races."

Lackland, who is professor of epidemiology and medicine at the Medical University of South Carolina in Charleston, says that as with older men, treatment for younger men follows JNC 7 guidelines for lifestyle changes and medications.

The JNC 7 recommends the following lifestyle modifications for people with prehypertension as well as hypertension:

Weight reduction. Maintain a normal weight with a target body mass index (BMI) of 18.5 to 24.9.

This can result in an approximate reduction in systolic blood pressure of 5-20 points per 10 kilograms of weight loss, according to the JNC 7.

DASH (Dietary Approaches to Stop Hypertension) eating plan. Adopt a diet rich in fruits, vegetables, and low-fat dairy products. Reduce saturated and total fat. This can be expected to drop systolic blood pressure by 8-14 points.

Lower salt intake. Reduce dietary sodium to less than 2,400 milligrams or about 1 teaspoon a day. According to the JNC 7, a 1,600-milligram sodium DASH eating plan has effects similar to a single drug therapy. The approximate reduction in systolic blood pressure would be 2-8 points.

Aerobic physical activity. Engage in regular physical activity, such as brisk walking, at least 30 minutes per day most days of the week. This can decrease systolic blood pressure by 4-9 points.

Moderation of alcohol consumption. Men should limit alcohol to no more than two drinks per day. A standard drink is defined by the type of alcohol. For example, a standard drink, such as a 12-ounce bottle of beer, a 5-ounce glass of wine, or 1.5-ounce shot of 80-proof distilled spirits, has between 11 and 14 grams of alcohol. Limiting the amount of alcohol to this quantity is expected to result in a reduction in systolic blood pressure by 2-4 points.

When medications are indicated for younger men, one question is what will be the long-term effect? "We've had medications around since the 1970s, but with newer ARBs (angiotensin receptor blockers), we don't know," says Lackland. "But the benefit of keeping blood pressure to goal is so great. Without treatment, a man at [age] 30 could be facing end-stage renal disease, stroke, or heart attack."

Another Complication Worth Considering

If the threat of premature death from complications of untreated high blood pressure doesn't get your attention, perhaps this will: A recent study showed that men with high blood pressure were 2.5 times as likely as men with normal pressure to develop erectile dysfunction (ED). Men with prehypertension also had a higher incidence of ED than did men with normal pressure.

Michael Doumas, MD, of the University of Athens in Greece, presented the study at the American Society of Hypertension 20th Annual Scientific Meeting and Exposition. In order to assess the link between hypertension and erectile dysfunction, researchers excluded men who had a history of diabetes, heart disease, renal failure, or liver and vascular disease, which are associated with ED.

While the study of men aged 31 to 65 didn't compare younger vs. older men, the fact that more than one-third of the participants with high blood pressure had erectile dysfunction should be seen as another very good reason to seek treatment and follow doctor's orders.

Risk Factors

Young men with hypertension often have what's called "metabolic syndrome," which is known to contribute to heart disease and diabetes. It includes a cluster of risk factors found in an individual and include excess body fat (especially around the waist and chest), high cholesterol, and insulin resistance. Studies have also shown that early vertex baldness can be associated with HBP. In addition, obstructive sleep apnea and snoring are linked to HBP in men in general.

Family history plays a role, but whether its importance varies with age of onset is unknown. "From epidemiological and twin studies, estimates range from 10% to 40%," says Ulrich Broeckel, MD, who is researching the role of genetics in hypertension. The goal of research is to subcategorize hypertension in order to improve diagnosis and treatment. "We're not ready for a diagnostic test, but ultimately we'll treat patients better based on their genetic makeup."

Learn to Manage Anger

Managing anger may be more important for younger men than older men, says Charles Spielberger, PhD, professor of psychology at the University of South Florida in Tampa. "I don't know of studies that look only at men under age 35, but a young man is dealing with a lifelong habit of anger," he tells WebMD.

He says anger involves feelings ranging from annoyance to rage and causes psychological and biological changes. Spielberger developed the widely used STAXI (State Trait Anger _Expression Inventory) to assess anger and has studied the role of anger in hypertension. "Research shows it is people who are boiling inside but don't show it who are more likely to develop hypertension."

Anger can also be a personality trait. "Some people feel anger more often across a wider variety of situations. People who do this and hold it in, they're the ones in danger of hypertension."

Spielberger tells WebMD that a good anger management program can help someone lower or normalize blood pressure. It's a three-step process.

First, learn to recognize the anger and the situations that cause it. "A lot of people who feel anger frequently might not recognize it, especially low to moderate levels."

Second, analyze the situation. "If your supervisor frequently makes you and other employees angry, tell yourself 'It's not me. This person is supercritical. I'll listen to what he says, but I'm not going to blame myself for his bad disposition.'"

Third, reduce the anger. "Counting to 10 will distract you, or try muscle relaxation. If possible, avoid the situation."

What About 'White Coat Hypertension?'

If you have a physical exam that shows elevated blood pressure, your doctor might say it could be "white coat hypertension," meaning the stress of seeing the doctor caused the high reading.

White coat hypertension was once thought to be benign, but that may not be the case, says Ulrich Broeckel, who is assistant professor of medicine at the Medical College of Wisconsin in Milwaukee. He co-authored a study of 1,677 patients aged 25 to 74. The study, reported in the British Medical Journal, measured structural changes in the heart, which Broeckel says were probably related to stress and the response to stress. "We found a significant difference between people who had white coat hypertension and those who didn't. It suggests that if people have these increases in blood pressure when they see a doctor, they have them in other stressful situations," says Broeckel.

Don't Wait 5 Years

"The longer you have untreated hypertension, the more complications you get," says Broeckel. "We also know patients who had early onset hypertension and developed diabetes at an early age. It makes early diagnosis and treatment very important."

SOURCES:
American Society of Hypertension 20th Annual Scientific Meeting and Exposition, San Francisco, May 14-18, 2005. British Medical Journal, August 1998. Merck Manual of Medical Information, Home Edition. National Institutes of Health. National Heart, Lung, and Blood Institute. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Ulrich Broeckel, MD, assistant professor of medicine, Medical College of Wisconsin, Milwaukee. Daniel Lackland, DrPH, professor of epidemiology and medicine, Medical University of South Carolina, Charleston; spokesman, American Society of Hypertension. Charles Spielberger, PhD, professor of psychology, University of South Florida, Tampa.

©2005 WebMD Inc.

++++++++++ General INFORMATION ++++++++++++

http://p203.ezboard.com/fvetbenefitsfrm152.showMessageRange?topicID=46.topic&start=61&stop=89

Websites for doing your VA Claim research.

United States Code Title 38 (the big enchillada): straylight.law.cornell.edu/uscode/html/uscode38/

Link to 38 CFR (VA regs) Concentrate on Part 3 and 4.
link to 38 CFR

Board of Veterans Appeals:
www.va.gov/vbs/bva/

U. S. Court of Appeals for Veterans Claims:
www.vetapp.gov/

VA WARMS site index (how it all gets done):
www.warms.vba.va.gov/sitemap.htm