Chester Clinic

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Volume 20 • Number 2
March - April 2006
President
Report from the Hill
Submits 2007 As we reported in our last nel. As a result, patients were forced to
Advocate, the Department of use the more expensive private sector VA Budget
Defense has proposed signifi- medical providers. One part of the cant increases in TRICARE fees and analysis that is missing in this entire has imposed premiums for TRICARE discussion is a determination of the Standard for the first time in history. You proper proportion of contract-care to can see from the accompanying chart direct-care in MTFs. erans Affairs R. that the premiums and copays represent The problem with increasing care in major out of pocket expenses to retirees. the private sector is that it increases the Also, for the first time in the history military medical budget. The cuts were of the TRICARE Standard program made despite the fact that study after will seek a record or its predecessor -- CHAMPUS, study over a period of years showed $80.6 billion in up-front premiums would be im- that medical care can be delivered in posed on the Standard program. This MTFs at much less cost than buying 2007 budget for the Department of proposal has been sent to Congress the care from the private sector. Some Veterans Affairs (VA), with the over- where it will be considered by the studies showed that the savings were whelming majority of these resources Armed Services Committees in both more than 30 per cent. targeted for health care and disability houses and if passed, would be effec- Another problem with disman- compensation. The FY ‘07 proposal tive on 1 October 2006 (see chart on tling the direct care part of the Mili- represents an increase of $8.8 billion, tary Health System is that by reducing or 12.2 percent, above the budget for The White House Office of the number of major teaching hospi- Management and Budget (OMB) is tals and reducing the size and variety of "Veterans are a priority. That's why driving this issue by forcing budget Graduate Medical Education programs, the President is proposing this historic cuts on the military health system. It the programs that attract and keep top budget with a landmark increase to is truly outrageous to reduce benefits quality young doctors, nurses and other continue the best health care and vital during wartime when other options are medical professionals in the military benefits to those veterans who count on available and in this case, DoD poli- services are thereby also reduced. In VA the most," Nicholson said. "With cies of the past have helped create the addition, the shortage of medical the support of Congress, we can budget problem in the first place.
professionals has serious implications take care of the needs of our newest When the cold war ended, it made in time of war. For example, I spoke generation of combat veterans, while sense to deactivate combat units and recently with the commander of a major honoring our commitment to veterans air and naval forces as well as the forces hospital who stated that because of the of earlier eras." supporting them. Medical forces were small number of physicians in certain The FY '07 budget proposal calls reduced as well. However, the need for specialties, their frequent deployments for $38.5 billion in discretionary medical support did not drop as dramat- are causing many of them to leave the funding -- mostly for health care. This ically as the need for heavy armor, service. And of course, the fewer the budget contains the largest increase mechanised infantry, fighters, bombers, doctors the worse the problem. Over in discretionary funding for VA ever naval forces and other combat forces. time, this will have a negative impact requested by a President. For health In addition, Base Realignment and on the quality of doctors serving. care alone, the President's request is Closure Commissions were employed With constraints on the budget and an increase of $3.5 billion (or more to recommend closure of hundreds of end strength, military service chiefs than 11 percent) over the FY '06 bases including the closures of Military are faced with making tough choices level. The budget proposal also would Treatment Facilities (MTFs) and between the need for warfighters and further reductions in medical person- continued on page 3 continued on page 6

Doug Russell
Instead of my usual column this issue, I want to share Many forget that it is because of great sacrifice, that something that is very personal to me. Recently my has occurred many times in our nation's history, which grandson wrote an outstanding essay for his high allows us to live without tyranny and oppression taking school history class. The VFW sponsored a scholarship over our every day lives. We need not live in fear of a competition for the best essay and this is his entry into the secret police force breaking into our homes and arresting competition. Needless to say, I am very proud of him and I us in the middle of the night. We need not live in fear of hope you enjoy what he wrote as much as I do.
mass genocide taking place due to one's ethnic or religious backgrounds. We need not live in fear of a corrupt and Celebrating our Veterans' tyrannical government taking power and ruling every
aspect of our daily lives. These are the things our Veterans fought and died to prevent, and I am proud to say that I live in a land where so few would be willing to dedicate their An Essay by Chris Russell lives to the welfare and freedom of so many.
I attended the WWII Memorial dedication on Memorial When one thinks of how to celebrate our Veterans' Day in Washington, D.C., and it was definitely one of the service and sacrifice, one almost instinctively turns to the most fulfilling experiences I have ever had the opportunity several monuments we have erected to honor such people. to be present at. It was made even more so because I The Vietnam Memorial, the Korean Memorial, the WWII attended it with my grandfather, who served both in WWII Memorial and the statue of the Marines raising the flag and in Vietnam, retiring as a Command Sergeant Major. on Iwo Jima all make us think of what these valiant souls I felt it extremely important that something be left accomplished and sacrificed for their country and for each behind to remember him and all who fought in the defining war of the twentieth century, so that future generations may We also have several holidays that recognize the very not forget what great sacrifice those men and women went same thing as the monuments, most notably Memorial Day through to preserve our freedoms and liberties. and Veterans' Day. When we visit these Memorials, and on While I was there, though, I realized that a Monument these holidays, we reflect on how our Veterans' service to was not needed to remind us of that. Every time we speak our country has impacted our lives and how it has made our out for something we believe in we are reminded of our rights. Every time we vote for our town mayors, our state When one views these moving Memorials, images may representatives and senators, and the President of the be conjured up in one's mind of war, death, struggle and United States we are reminded of our democracy. sacrifice. It is here that people are again reminded, although Every time we wake up in the morning and have the they will soon forget, that many Veterans died over the ability to pursue what we want to do with our lives, we are history of our nation so that we may live as we do today.
reminded of our freedom. All these things would not have What about all the other days of the year however? Why been possible, however, without the service and sacrifice do we celebrate our Veterans' service only a couple times of our Veterans, and because of that I say thank you, for a year, and even then why is it only viewed by many as a making it possible for me to live a better life.
long weekend? This is because Americans have enjoyed One must always remember that freedom is most such instrumental and natural rights as freedom of speech, certainly not free.
religion, press, assembly and the ability to live in a free and democratic nation ever since America's birth that we take Chris Russell is a sixteen year old high school student in them for granted.
We do not fully realize the importance of these liberties, and therefore do not properly pay homage to those who made them possible. These freedoms have been paid for in blood ever since America was a country, in the Revolutionary War, and all the way up to today in Iraq. DoD to Restrict Cell Phone
VA Warns of
Use on Military Bases
Defense Department installations violation of the rules, have begun implementing he said. new cell phone restrictions for As the installations implement the drivers on military bases. The new restrictions, they have a responsibility The VA is warning veterans not
to give credit card numbers regulation states that anyone driving to notify the public by putting up signs over the phone to callers a motor vehicle on a DoD installation or putting notices in base newspapers, claiming to update VA prescription cannot use a cell phone unless the Seibert said. Many installations are information. The VA does not call
vehicle is safely parked or the driver is allowing a grace period in which veterans and ask them to provide using a hands-free device. motorists in violation of the rule will be personal financial information.
Many installations already have warned and not ticketed. The latest scam involves callers implemented the new restrictions, This regulation was developed who say they're working for the and the rest will implement the rules based on information from the National "Patient Care Group." They claim on their own schedule, said John Highway Traffic Safety Administration, that VA recently changed procedures Seibert, assistant for safety, health and which studied driving distractions as for dispensing prescriptions and ask fire protection for DoD. There is no the cause of motor vehicle accidents, for the veteran's credit card number. deadline for installations to implement Seibert said. The study found that cell This is not true.
the restrictions, Seibert said, but he phone use is the fastest growing and Veterans with questions about expects most will do so this year. "We most visible distraction that leads to VA services should contact the have not issued an implementation accidents, he said. nearest VA medical center or call schedule," he said. "But it's definitely The DoD regulation follows suit 1-877-222-8387. ❧ getting everyone's attention." with many regulations that states and The law enforcement policy offices cities have already imposed. Currently for each military department are putting only Connecticut, New York, New Jersey together policies and procedures for and the District of Columbia ban hand-the implementation and enforcement held cell phones for drivers, but many of the restrictions, Seibert said. He cities have imposed their own rules, explained that this regulation is a according to the Governors Highway minimum requirement, and installation Safety Association. "We are in front of commanders still have the authority to put the majority, but we certainly are not the stricter rules in place. Each installation first ones to do this," Seibert said. ❧will determine the punishment for While AMS is generally pleased with the funding President Submits
request, we are troubled that the budget includes a proposal to charge an annual enrollment fee of $250 for veterans in 2007 VA Budget
Priority levels 7 and 8, who are enrolled in the VA system. continued from page 1 It also increases pharmacy co-pays from $8 to $15 for those same veterans. In addition, it proposes that veterans provide $42.1 billion in mandatory funding, mostly for receiving treatment for nonservice-connected disabilities compensation, pension and other benefit programs. be billed for the entire co-pay. This is the same proposal The budget request comes on top of a year of that AMS helped defeat in Congress last year, and we will embarrassments for the Department of Veterans Affairs in fight to kill it once again this year. While Priority level 7 2005 when Secretary Nicholson had to go to Congress and and 8 veterans do not have service-connected disabilities, ask for emergency funds after the Department admitted that they were invited by the VA to enroll in the VA health care the funding it had requested would fall far short of meeting system in 1996. Former VA Secretary Principi subsequently the needs of the nation's veterans. In addition, just a few days closed the door to further nonservice-connected veterans. before the new budget request was released, the Associated However, we believe that those who did enroll should be Press reported that the Government Accountability Office taken care of. There should be full funding for all enrolled had issued a report stating that the VA had used "misleading veterans, and these enrollment fees and increased co-pays accounting methods and lacked documentation to prove its should not be imposed upon them. ❧ ❧ claimed savings." 3 drug types added to formulary; 16 taken off
Three classes of medications used to treat benign Formulary drugs
prostatic hypertrophy (enlarged prostate) and Alpha Blockers for Benign Prostatic Hypertrophy:
cardiovascular disease have been added to the Doxazosin (Cardura®), terazosin (Hytrin®), and alfuzosin TRICARE Uniform Formulary and 16 medications in those (Uroxatral®) classes are being moved to non-formulary status. The drugs ACe inhibitors:
are listed below. Benazepril (Lotensin®), benazepril/hydrochlorothiazide The TRICARE Uniform Formulary (UF) is a list (Lotensin HCT®), captopril (Capoten®), captopril/ of medications approved by DoD for distribution in the hydrochlorothiazide (Capozide®), enalapril (Vasotec®), Military Health System. Drugs are grouped into three enalapril/hydrochlorothiazide (Vasoretic®), fosinopril tiers: formulary generic (tier one), formulary brand name (Monopril®), fosinopril/hydrochlorothiazide (Monopril- (tier two) and non formulary (tier three). Beneficiaries' HCT®), lisinopril (Prinivil®, Zestril®), lisinopril/ copayments are based on a medication's grouping within hydrochlorothiazide (Prinzide®, Zestoretic®), and trandolopril (Mavik®) Beneficiaries will pay $22 for up to a 30 day TRICARE Calcium Channel Blockers:
Retail Network Pharmacy (TRRx) or 90-day TRICARE Diltiazem immediate release (Cardizem®), diltiazem Mail Order Pharmacy (TMOP) supply for non-formulary sustained release (cardizem SR®), diltiazem extended medications. Beneficiaries will pay the higher of $22 or release (Cardizem CD®, Dilacor XR®, Cardizem CD®, 20% in retail non-network pharmacies. Cartiz XT®, Tiazac®, Taztia XT®), felodipine (Plendil®), Patients currently using the medications which are being nifedifine immediate release (Procardia®), nifedipine designated non-formulary may wish to ask their doctors extended release (Adalat CC®, Procardia XL®), nimodipine if switching to formulary alternatives or documenting (Nimotop®), nisoldipine (Sular®), verapamil sustained a medical necessity would be appropriate for them. If release (Isoptin SR®), and verapamil immediate release medical necessity for using non-formulary medications is (Isoptin®, Calan®, Calan SR®) established, patients may qualify for the $9 copayment for
up to a 30-day TRRx supply or up to a 90-day TMOP supply. Non-Formulary drugs
Military treatment facilities (MTF) will no longer carry Alpha Blockers for Benign Prostatic Hypertrophy:
these or other non-formulary medications on their local Tamsulosin (Flomax®) Implementation date: February 15
formularies. Non-formulary medications may be available ACe inhibitors:
at MTFs only when medical necessity is established and Quinapril (Accupril®), perindopril (Aceon®), ramipril
the prescription is written by an MTF provider. Medical (Altace®), and moexipril (Univasc®) Implementation date:
necessity forms are available at http://www.tricare.osd. February 15
mil/pharmacy/medical-nonformulary.cfm. Procedures for Calcium Channel Blockers:
completing and submitting medical necessity information Amlodipine (Norvasc®), isradipine (DynaCirc® and
may be found on these forms.
DynaCircCR®), nicardipine (Cardene® and Cardene SR®), Eligible beneficiaries may fill prescriptions for non- verapamil extended release (Verelan®), verapamil extended formulary and covered medications through the TMOP and release for bedtime dosing (Verelan PM®), and Covera TRRx pharmacies. Beneficiaries may reduce out-of-pocket HS®, and diltizem extended release for bedtime dosing expenses by filling prescriptions through the TMOP where (Cardizem LA®) Implementation date: March 15 ❧they may receive up to a 90-day supply of medicine for the same cost as a 30-day supply in the TRRx. For more information about TMOP, go to http://www.tricare.osd.mil/pharmacy/tmop_contact.cfm or call 1-866-DOD-TMOP, (1-866-363-8667). Beneficiaries may also contact the TRRx customer service line at 1-866-DOD-TRRX, (1-866-363-8779), or visit http://www.tricare.osd.mil/pharmacy/trrx_contact.cfm. For more information about medications, beneficiaries can go to http://www.tricareformularysearch.org/dod/medicationcenter/default.aspx.

CRSC – How to document your disability
Have you applied for Combat- records that document the injury? If free 1-866-272-6272 and press "4" to Related Special Compensation so, submit these documents and the be transferred .
(CRSC)? Or did you start to complete VA findings, decisions,
apply and stop because it was too reasons and basis with your CRSC Agency (NARA), located in 18 states,
difficult to document your combat- claim.
Recreating lost medical records is a my application?
daunting task. Make the process easier The following groups are helpful: Call 1-800-827-1000 or go to: by using this guidance to document your • County VA offices injuries when you apply for CRSC. • Major Veteran or Military address.htm or http://www.visn1.med.
CRSC is monthly, tax-free Service Organizations compensation for certain military • VA hospital counselors retirees that supplements their VA • The Army CRSC office in hospital after 1970 for my disability.  
disability pay and retired pay. To apply for CRSC, applicants must meet all the I lost my medical records.  How do I 
following criteria and have at least one recreate them?
VA-rated, combat-related disability: There are several resources: • Served at least 20 years active a) Contact a VA hospital or MTF Patient Administration Systems & duty or be a Reservist age 60 or and provide them the following records, Biostatistics Activity (PASBA), ATTN: older with 20 or more qualifying if available: Ms. Terri Amrhein, Analysis Branch, 1. Your current medical information 1216 Stanley Rd, Ste 25, Ft Sam • Are in retired status; documenting the injury.
Houston, TX 78234; (210) 295-8938. • Are entitled to retired pay 2. Your personnel records proof such Only verifies hospital stays in an Army that is offset by VA disability as: unit assigned, date assigned, location hospital after January 1971 and is to be payments; and injured (e.g., 21st Tank Maintenance used only after requesting records from • Have at least a 10% VA disability BN, Jun 1967-Sep 1968, RVN).
the National Personnel Records Center 3. Your signed statement, claiming or the VA if those sources to not have Combat-related disabilities are how the injury occurred. the medical records. those incurred, with documented 4. A signed buddy statement, saying Once I have documented my combat-
how the injury occurred.
• In the performance of duty under b) Ask a doctor, physician's steps?
conditions simulating war (e.g., assistant, nurse, or an officer for a copy Obtain a CRSC claim form or exercises, field training); of your written medical consultation get questions answered by going to • While engaged in hazardous visit on signed letterhead that states http://www.crsc.army.mil or by calling service (e.g., flight, diving, "how" you got each injury.
1-866-281-3254. Complete your claim and send it with the appropriate • Through an instrumentality documents?
documentation to the address on the of war (e.g., combat vehicles, Center form. Make sure to include all of your weapons, Agent Orange); or for Research of Unit Records DD 214s with the application. ❧ • As a direct result of armed (USAFCRUR), 7779 Ciena Rd., Springfield, VA 22150; (703) 428-6801. To approve your claim, the CRSC NOTE: Can still get Purple Heart Office must know how your injury awards via records from USAFCRUR.
happened. You need to document Verifies combat activity from WWII
your combat-related disability. How? forward by Morning Reports.
The CRSC Office has supplied the Where can I get my personnel 
following advice: 
Center (NPRC-MPR), 9700 Page Ave., Do you have VA records that St. Louis, MO 63132-5100; http:// document your combat-related disability www.archives.gov/st-louis/military-or military treatment facility (MTF) personnel; (314) 801-0800 or call toll- Report from the Hill
continued from page 1 dod Proposed increase in triCAre enrollment
the need for medics. They often solve the Fees, Co-pays and deductibles for under age-65
problem by converting military medical spaces to warfighters and then opting retirees and Prescription drug Co-pay increases for
to use contract medical services, which all retirees
generally results in higher costs. A better solution would be to exempt a certain number of military medical spaces from Summary of Proposed Changes to TRICARE Benefit
end-strength ceilings so that the service Enrol ment Fee and Deductible Changes * chiefs are not faced with this choice. Two Year Phase-In (FY07-08) A white paper completed several years ago indicated that approximately 40% of TRICARE Prime Annual medical spaces could be removed from Annual Enrol ment the end strength ceilings and accounted for in a separate medical personnel Retireed Junior Enlisted (E-6 and Below) account. This would allow the Assistant Secretary of Defense (Health Affairs) and the service Surgeons General to make decisions as to the proper mix of uniformed personnel, civilian employees and contract support needed to accom- plish the medical mission within the Retired Senior Enlisted (E-7 and Above) budget allocation without arbitrary end strength limitations. The Joint Staff is currently considering the formation of a medical command which would facili-tate adopting this proposal. While we realize this explanation tends to involve a lot of minutia, the main thing to remember is that there is a viable alter-native to what is now being done, and it is an alternative that would be good for retirees, good for the military, and good for the taxpayer.
While we believe this proposal may be a viable long term solution, the problem right now is the current effort to * Applies ONLY to eligible retirees under age 65; no changes to active duty, active duty shift medical costs to military retirees. family members, or TFL AMS, the National Military and Veterans Changes in Pharmacy Co-payments *, ** Alliance and The Military Coalition are fighting this attempt to push these costs onto the backs of retirees, their families and survivors. Congressional hearings on the Defense budget have already begun. We ask you to contact both of your sena- tors and your representative and let them know you oppose this effort. The only Co-pays in FY07 and after way we are going to beat this is with overwhelming opposition from military retirees and their families.
Chuck PartridgeGovernment Relations * 100% co-pay for a few certain medications ** Applies to ALL eligible beneficiaries, except active duty American Military society Membership Application Form
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