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RAOBULLETIN

15 December 2016HTML Edition

THIS BULLETIN CONTAINS THE FOLLOWING ARTICLES

Pg Article Subject. * DOD * .

04 == Selective Service System [22] -- (Plan Dropped to Register Women)05 == Selective Service System [23] ----- (Obama on Female Registration)06 == Military Awards Review [03] ------------------------ (Navy Upgrades)07 == NDAA 2017 [22] -------------- (Draft Compromise Reached | $619B)08 == NDAA 2017 [23] ------------- (Senate Sends $618.7B Bill to Obama)09 == Commissary Reform ------- (DECA's Ability to Reform Questioned)10 == Commissary Private Label Products --------- (Coming in May 2017)10 == DoD Fraud, Waste & Abuse ------- (Reported 01 thru 15 DEC 2016)13 == POW/MIA Recoveries ------------ (Reported 1 thru 15 DEC 2016 | Five)

. * VA * .

15 == VA Emergency Care [10] -------------- (Vets Being Stiffed on ER Bills)

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15 == VA Nursing [06] ---- (Full Practice Authority Regulation Amended)16 == VA Secretary [50] ---------------- (Trump Urged to Keep McDonald)17 == VA OPC Medicine -------------------------- (New Copay Tier System)18 == VA Hepatitis C Care [16] -------- (High Cure Rates with New Drugs)19 == VA Medical Center Rating System ---------- (Heretofore Not Public)21 == VA Cemeteries [15] -- (PreNeed Eligibility Determination Program)22 == VA Privatization [08] -- (Make Everyone Pay for Health Insurance)22 == VA Project Funding ----------- (Money Needed for 24 Stalled Ones)23 == VA Prostate Cancer Program [13] ----------------- (PCF Partnership)24 == VA Home Loan [44] --------- (Usage Tripled After Mortgage Crisis) 24 == VA Blood Pressure Study ----- (ACC/Nam Vet Hypertension Links)25 == VACAA Constitutionality --------- (U.S. Court of Appeals Hearing)26 == Seasonal Affective Disorder [01] --------- (Winter Blues Treatment)26 == VA Digital Health Platform ---------- (Program Detailed Overview)27 == VA Burial Payment ---------------- (DVA Maryland Delays | $2.7M)28 == Vets.gov [03] ------------------ (Use to Manage Health Care & Benefits)29 == VA Fraud, Waste & Abuse ------------- (Reported 1 thru 15 DEC 2016)31 == Fisher House Expansion [16] --------------- (14 New Sites Proposed)32 == VAMC Tomah WI [17] ------------------------ (Dental Patient Recall)32 == VAMC New Orleans LA ---------- (New Facility Open for Business)33 == VAMC Phoenix AZ - (Whistleblowers Credited With Saving Lives)34 == VAMC McGuire VA [01] --------------------- (Pharmacy Violations)35 == VA HCS Bay Pines FL --------------- (Body Left 9 Hours in Shower)

. * Vets * .

36 == Enlistment Bonus Payback [06] ---- (NDAA Compromise Provision)36 == Wisconsin Veterans Homes [05] ----- (Immediate Jeopardy Citation)37 == GI Bill [215] ---------------------------- (Overseas College Utilization)38 == WWII Vets 123 ------------------------- (Ralph L. Rossman | Infantryman)39 == WWII Vets 124 ----------------- (Lauren Bruner | USS Arizona Survivor)41 == Famous Vets ---------------------- (Martha Raye | Honorary USA/USMC)42 == Vet Pain --------------- (More Prevalent and Severe than in Nonveterans)43 == Vet Jobs [203] ---------------------------------- (Virginia MMAC Program)44 == Vet Jobs [204] -------------------- (Health Care Employment on the Rise)45 == Vet Jobs [205] ---------------- (Post-9/11 vet Unemployment Rate Rises)46 == Vet Jobs [206] --------------------- (Lowe's Big on Vet with Service Dog)47 == Retiree Appreciation Days -------------------------- (As of DEC 14, 2016)48 == Vet Hiring Fairs ------------------------------- (16 DEC thru 15 JAN 2016)48 == Vet State Benefits & Discounts ---------------------- (South Dakota 2016)

* Vet Legislation * .

49 == Military Food Stamps [02] -------- (Military Hunger Prevention Act)50 == PTSD Punitive Discharges [05] --------------- (Fairness for Vets Act)51 == GI Bill [216] ----------------------- (S.1938/HR2360 Signed Into Law)

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51 == Congressional Gold Medal [07] ----------------- (Filipino WWII Vets)51 == OSS Congressional Gold Medal Act [01] - (House Approves S.2234)53 == VA Health Care Access [46] ------------------- (H.R.6407 Introduced)53 == VA Claims Processing [17] ---- (H.R.5166 | Streamlining Resistance)54 == Vet Health Care [03] ----------- (H.R.6416 | Omnibus Improvements)55 == Vet Legislative Issues 2016 [02] -- (Omnibus Reform Bill H.R.6416)56 == VA Employee Accountability [03] --- (Fire if Felony Convicted Bill)56 == House Vet Bill Progress --------------------------- (5 thru 9 DEC 2016)

. * MILITARY * .

57 == Civilian Run Military Importance ---------------- (SECDEF Nominee)58 == Discharge Review Boards [01] ---- (PTSD Must Now be Considered)58 == PowerWalk -------------------- (Army Strap On Battery Pack Charger)59 == DoD 2018 Budget ------- (Navy Says 'NO' to Shipbuilding $17B Cut)61 == Commissary Medical Clinics -------- (Navy Pilot Program in Florida)62 == Enlistment Bonus [07] --- (Public Faith Hurt by Recoupment Effort)62 == Ammunition ------------- (USA & USMC Rifle Ammo Requirements)63 == USCG Enlisted Rating Titles ---------------------- (Phase Out Not Likely)63 == Other than Honorable Discharge [06] --- (Wounded Soldiers Treatment)65 == USS Colorado (SSN-778) ------------------------------- (Christened 3 Dec)67 == U.S. Philippine Bases [13] -------------- (Freedom-of-Navigation Patrols)67 == U.S. Philippine Bases [14] ---------- (PHIBLEX and CARAT Cancelled)68 == Submarine Aircraft Carriers ----------------------- (The Ultimate Weapon)

. * MILITARY HISTORY * .

71 == WWII Speculation ---------------------- (What If No Pearl Harbor Attack)73 == Pearl Harbor Day ---------- (2016 | Joint Base Pearl Harbor-Hickam, HI)75 == Battle of Verdun Facts ------------ (10 Facts About Longest WWI Battle)75 == Military History Anniversaries --------------------------- (16 thru 31 DEC)75 == Medal of Honor Citations -------------------- (Elrod, Henry T | WWII)

. * HEALTH CARE * .

77 == NDAA 2017 [24] ---------------------- (Approved TRICARE Changes)78 == Navy Medicine ----------------------- (Surgeon General Reform Aims)80 == TRICARE Coverage [06] --------------------- (AOI & Urinary System)80 == Cancer Moonshot Initiative ----------------------- (VA's Involvement)81 == Dental Cost --------------------------------- (Avoid Crazy Dental Fees)83 == Dental Cost [01] ---------------------------------------- ( Delaying Care)84 == PTSD [224] -------------------------- (SGB Study Participants Needed)85 == PTSD [225] --------------------------------------- (Holiday Season Tips)86 == FLU Prevention [06] ------------------- (Staying Healthy This Season)87 == Traumatic Brain Injury [58] ------------ (DVBIC TBI Family Podcast)88 == Smoking [03] --------------------------------- (No Safe Level of Usage)88 == TRICARE Podcast 376 -- (Nurse Advice Line | ACA | Avoiding Fraud) 90 == TRICARE Podcast 377 ------ (Traveling | Tax Webinar | Handwashing)

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. * FINANCES * .

91 == Selfie Sextortion Scam --------------------------------- (How it Works)92 == Saving Money ----------------------------------- (Stocking Up Limitations)93 == Tax Burden for Mississippi Retired Vets ------------- (As of DEC 2016)

. * GENERAL INTEREST * .

94 == Notes of Interest ------------------------------------- (1 thru 15 DEC 2016) 96 == 114th Congress [05] ------------------------------ (What it Accomplished) 98 == WWII Merchant Marines ---- (Congressional Gold Medal Legislation) 98 == Air Force One ------------------------ (Replacement Cost Out of Control)100 == Have You Heard? ------------ (How to live like you're in the U.S. Navy)

Note: 1. The page number on which an article can be found is provided to the left of each article’s 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 - South Dakota Vet State Benefits & Discounts DEC 2016Attachment - Military History Anniversaries 16 thru 31 DECAttachment - WWI Battle of Verdun Facts

* DoD *

Selective Service System Update 22 ► Plan Dropped to Register Women

Lawmakers have officially dropped plans to make women register for the draft, instead opting for a review of the ongoing need for the Selective Service System. The controversial provision had been part of early drafts of the annual defense authorization bill, and narrowly passed a House Armed Services Committee vote last spring. A Senate panel followed suit a few months later. But conservatives in both chambers objected to the provision and

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stripped it out of the final legislative draft unveiled 29 NOV. Under current law, men ages 18 to 26 are required to register for possible involuntary military service with the Selective Service System. Women have been exempt, and past legal challenges have pointed to combat restrictions placed on their military service as a reason for their exclusion.

Early this year, Defense Secretary Ash Carter removed those restrictions, opening combat posts to women for the first time. In response, a collection of military leaders and women’s rights advocates said they would support requiring women to now register for the draft. Instead, the final authorization bill draft calls for a review of the entire Selective Service System, to see if the idea of a military draft is still realistic and cost-effective. The system has an annual budget of about $23 million, but watchdog groups have questioned whether the system could assemble a list of draftees if a national emergency were to arise. And military leaders have repeatedly insisted they have no desire to return to the draft to fill the ranks. No Americans have been pressed into involuntary military service since the last draft ended in 1973. Though Democrats are likely to renew debate on the issue next year, it’s unlikely to progress far with Republicans set to control both chambers of Congress and the White House. [Source: MilitaryTimes | Leo Shane | November 29, 2016 ++]

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Selective Service System Update 23 ► Obama On Female Registration

President Obama supports requiring women to register for Selective Service when they turn 18 — becoming the first president to endorse universal draft registration since Jimmy Carter. "As old barriers for military service are being removed, the administration supports — as a logical next step — women registering for the Selective Service," said Ned Price, a spokesman for Obama's National Security Council. The White House had previously expressed neutrality on the controversy, but took a position in a statement to USA TODAY on 1 DEC. But the timing of Obama's support makes it mostly symbolic, coming in the final weeks of his presidency and the day before the House voted on a defense policy bill that strips a Senate-passed provision to add women to Selective Service. Instead, the compromise version now calls only for a commission to study two related issues: Whether women should be included in Selective Service, and whether the Selective Service system itself should be abolished.

The White House made clear that Obama supports an all-volunteer force, and there are no plans to re-institute the draft. But Obama believes adding women to the draft would serve two purposes: showing a commitment to gender equality throughout the armed services, and fostering a sense of public service that comes from requiring draft registration as a ritual of adulthood. The Pentagon also expressed its support for a universal draft 1 DEC. "It makes sense for women to register for Selective Service just as men must," said spokesman Peter Cook. Defense Secretary Ash Carter opened all combat roles to women earlier this year, which "only strengthens our all-volunteer force by giving us access to 100% of America's population so we can recruit and retain the most qualified individuals," Cook said.

Removing the ban on women in all combat roles opened more than 200,000 jobs to women, most of them in Army and Marine infantry units. As a practical matter, women troops have been exposed to combat conditions for a long time. More than 280,000 women have served in Iraq and Afghanistan out of nearly 2.5 million troops. In those wars, 152 women have died in battle or from non-combat causes and more than 950 have been wounded in action. Sen. John McCain, the Arizona Republican who chairs the Armed Services Committee, had no comment on the White House announcement, said Dustin Walker, a spokesman. Kate Germano, chief operating officer of the Service Women's Action Network and a retired Marine officer, said her advocacy group views the White House announcement as a significant step toward improving national security. The draft would only be revived in time of a national emergency, and excluding women would mean lesser qualified men would be selected over women for the fight, she said. "That doesn't make sense," Germano said. "We support this wholeheartedly."

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Michael O'Hanlon, a defense analyst at the Brookings Institution, said the White House stand has value even it doesn't become policy. "It’s symbolic," O'Hanlon said. "But it’s a good statement." No one has been drafted into the military since 1973 — and indeed the last enlisted man drafted into the military retired years ago. But Selective Service can still have far-reaching consequences for young men and — under the policy change now supported by Obama — young women. Those who fail to register for the draft can be denied federal student aid and loans, security clearances, government employment and job training programs. For immigrants, failing to register can be a roadblock to citizenship. Three-quarters of states make Selective Service a requirement for driver's licenses and other government benefits. For Obama, adding women to the draft would also eliminate an inconsistency in the administration's policy on transgender status. The Education Department, for example, is pressuring schools to recognize a student's self-identified gender. But current Selective Service say the sex at birth determines whether someone is subject to the registration requirement.

Subjecting women to Selective Service has long made for intriguing politics, often fraught with ulterior motives. Rep. Charlie Rangel (D-NY) has introduced bills for years that would add women to the draft — but then also require a draft any time Congress declares war or authorizes military force for conflicts like Iraq and Afghanistan. His calculation: Requiring a draft would make Congress less likely to go to war in the first place. Senior military officials, over the years, say they prefer the volunteer force for its professionalism. On the other side of the spectrum is Rep. Duncan Hunter (R-CA), a hawkish conservative and member of the Armed Services Committee who proposed adding women to the draft earlier this year. But his proposal was essentially offered as a dare, attempting to force an election-year vote on a policy he opposes. Hunter blasted the White House announcement on Thursday as "purely politics, one last jab," given the action taken by Congress.

Hunter noted that the chairman of the Joint Chiefs of Staff, Marine Gen. Joe Dunford, had opposed opening Marine infantry units to women in his previous post as commandant. "The military doesn't support this," Hunter said. The incoming Trump administration is likely to review and potentially repeal allowing women to serve in ground combat units, Hunter said. The Senate version of the defense policy bill, which includes a provision requiring women to register for the draft, passed in June, 83-15. In July, the House voted 217-203 to remove the provision from its version of the bill. A conference committee hashed out a compromise bill this week.

It was President Franklin Roosevelt who first proposed drafting women in order to address a shortage of military nurses in World War II. "Since volunteering has not produced the number of nurses required, I urge that the Selective Service Act be amended to provide for the induction of nurses into the armed forces," he said in his 1945 State of the Union Address. "The need is too pressing to await the outcome of further efforts at recruiting." Two months later, the House passed a bill to draft nurses, 347 to 42, but the bill died in the Senate, and the war soon ended. In 1981, the U.S. Supreme Court ruled in Rostker v. Goldberg that an all-male draft was constitutional, with Justice William Rehnquist writing in a 6-3 decision that because Congress had excluded women from some combat roles, it was reasonable for Congress not require that they be subject to the draft. [Source: USA Today | Gregory Korte & Tom Vanden Brook | December 1, 2016 ++]

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Military Awards Review Update 03 ► Navy Upgrades

 Two Navy Cross recipients honored for acts of valor in Afghanistan or Iraq instead deserved the Medal of Honor for their actions and are being nominated for an upgrade, the Navy said 6 DEC. The announcement was part of a review of all Silver Stars and service crosses awarded since Sept. 11, 2001. As part of the review, the Navy has also determined that an unspecified number of Silver Stars will be upgraded to Navy Crosses. The department-wide medals review was directed by former Defense Secretary Chuck Hagel in 2014 after questions arose about how there appeared to be so few Medal of Honor recipients from

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more than a decade of combat in Iraq and Afghanistan. The Navy is the first to announce its findings.

To date, there have been four Medal of Honor recipients for actions in Iraq, all awarded posthumously. There have been 14 Medal of Honor recipients for actions in Afghanistan. Earlier this year, the services told Stars and Stripes that a total of 1,357 medals were being reviewed to determine whether they should be upgraded. The Army is reviewing 785 Silver Star and Distinguished Service Cross awards; the Navy, including the Marines, reviewed 425 Navy Cross and Silver Star medals, and the Air Force is reviewing 147 medals, including 135 Silver Stars and 12 Air Force Crosses. None of the medals under review would be downgraded, officials said. Capt. Patrick McNally, a spokesman for Navy Secretary Ray Mabus, said the secretary had “recommended that two Navy Cross recipients be considered for the Medal of Honor.”

Those recommendations would have to be approved by the president and the Pentagon might need to get a waiver from Congress depending on when the act of valor took place, because law stipulates Medals of Honor must be awarded within five years of the action. McNally also said the Navy has completed its review of potential Silver Stars that will be upgrades to Navy Crosses. Upgrading an award from Silver Star to a service cross only needs approval from the service secretary. “Those are complete and will be awarded in individual ceremonies,” McNally said. He could not say how many Navy Crosses would be awarded or when it will happen.  [Source: Stars & Stripes | Tara Cope | December 6, 2016 ++]

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NDAA 2017 Update 22 ► Draft Compromise Reached | $619B

Military personnel would see a 2.1% pay raise starting in January and a significant manpower boost within the Army, Air Force and Marine Corps as part of Congress' annual defense spending bill unveiled 29 NOV. The compromise measure also includes a massive overhaul of the military health care system, but it eliminates a controversial proposal to change troops' housing allowance, leaving the military's current stipend program largely unchanged. Totaling nearly $619 billion, the bill represents lawmakers' final offer to the White House, omitting several problematic provisions debated in recent months.

But that's still about $3.2 billion more than President Barack Obama's request, setting up a potential veto. Obama has said he won't accept an increase in defense spending without corresponding increases in nonmilitary programs. If the president intends to make good on that threat, he'll have to squash several measures that would benefit the military workforce at a time when many troops and their families feel their compensation and overall quality of life have slipped. That's because the extra money — tucked into overseas contingency funds, to get around defense spending caps — is used mainly to pay for additional pay and personnel costs. It pushes the 2017 military pay raise from the Pentagon-preferred rate of 1.6 percent to 2.1 percent, a mark equal to the projected rise in private sector wages. If it stands, 2017 will be the first time in six years that the military pay raise tops 2 percent.

Military budget planners had said that money would be better used to pay for training and modernization costs, but lawmakers have argued that three consecutive years of pay raise trims have begun to hurt military families' finances. Lawmakers also used the additional funds to reject Obama's plans to draw down Army and Marine Corps end strength, again to cut long-term personnel costs. Under the final authorization draft, Army end strength would be set at 476,000 soldiers, about 16,000 more than the White House had requested for fiscal 2017. The Marine

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Corps would be at 185,000 troops, an increase of about 3,000 over requested levels. The Air Force would go to 321,000 airmen, around 4,000 more than Obama wanted. The Navy would remain at 324,000 sailors. Other items in the final authorization draft included:

A defense health care overhaul that would transfer control of most military medical facilities to the Defense Health Agency and put in place new fees for enrollment in Tricare. But those fees would affect only new enlistees. All current troops and retirees in the system would not see any increases.

Mandating a reduction in flag and general officers in years to come, trimming about 12 percent of the total Dramatic changes in defense acquisition processes. A provision to deal with the recent California National Guard bonus recoupment scandal, shifting the

burden of proof for accusations of fraud or misuse to the Defense Department instead of individual troops. A hearing is scheduled on that issue next week.

Congressional staff touted the final product as one of the most significant pieces of reform legislation in years, touching on a variety of agencies and issues. But congressional negotiators did drop plans that would have changed even more.

A Senate-led plan to award Basic Allowance for Housing stipends based on individual troops’ rent costs, instead of flat-rates based on zip codes, was removed.

A provision to charge military families health care enrollment fees was similarly dismissed.

House lawmakers approved the bill 375 to 34 on 2 DEC and the Senate is expected to take up the legislation the week of 4 DEC. Whether Obama will veto the measure over the extra personnel funds will be among the last legislative decisions of his presidency.

The authorization bill sets defense policy and spending priorities for current fiscal year, but does not actually assign the money for those initiatives. The appropriations process, which distributes the money, has been stalled on Capitol Hill for months. Before they adjourn this year lawmakers will need to finalize plans for a continuing resolution to extend federal spending at fiscal 2016 levels into March. Republican leaders in both chambers have said that will allow incoming President Donald Trump to set his own budget priorities for federal programs, but Pentagon leaders have lamented the move as problematic for new purchases and program starts. Appropriations officials have already said they will adjust some budget items to provide for some increases above fiscal 2016 levels, including the military pay raise. That will go into effect on 1 JAN. [Source: MilitaryTimes | Leo Shane | November 29, 2016 ++]

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NDAA 2017 Update 23 ► Senate Sends $618.7B Bill to Obama

The US Senate has overwhelmingly passed the $618.7 billion defense policy bill (S.2943) that strips added jets and ships, but boosts military manpower above President Barack Obama’s budget. On 8 DEC, the Senate voted 92-to-7 to send the 2017 National Defense Authorization Act to the president's desk. Most Democrats backed the legislation even though it cost several billion more than the White House request. The bill includes a 2.1 percent pay raise for military personnel, set to take effect 1 JAN. That figure is greater than the president's request and, if approved, would mark the first time in five years that military pay has kept pace with project private sector wage growth.

The NDAA also orders major organizational changes for the Pentagon. Among them, it splits the job of the Pentagon’s top weapons buyer, slashes the number of general officers, caps the size of the National Security Council at 200 and extends the term of the Joint Chiefs chairman to four years. Congress is expected to pass a continuing resolution drafted to fund the federal government through April 28, 2017. GOP leadership abandoned regular order for all but one appropriations bills, expecting to give the new administration a chance to put its stamp on federal spending. Last week, before the House overwhelmingly passed the bill, White House spokesman Josh Earnest

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would not say whether Obama will follow through on past threats to veto any defense budget measures that work around statutory budget caps on military and non-military spending.

In the past, Democrats have insisted on parity between defense and non-defense spending. However Republican lawmakers inserted an unmatched $3.2 billion in temporary war funding to get around the caps. Nearly all the extra money is for additional personnel costs, including a larger pay raise for troops and boosts to troop numbers in the Army, Air Force and Marine Corps. The NDAA excludes an earlier House version’s provision for 14 more F/A-18E/F aircraft for the Navy and 11 more F-35 joint strike fighters across the services, and all but a fraction of the $2 billion plus-up to the Navy’s shipbuilding budget. Instead, the bill aims to roll back the Obama administration’s planned drawdown and adds related operations and sustainment funds to support the added manpower. Army end strength jumps to 476,000, from 460,000 in 2017, and the Marine Corps jumps to 185,000 from 182,000 in 2017.

The NDAA directs a reduction of 110 general and flag officers on active duty and requires a study that will identify another 10-percent cut. House Armed Services Chairman Mac Thornberry has said he hopes President-elect Donald Trump quickly asks Congress to pass supplemental defense spending to pay for jets and ships left out of the compromise defense policy bill. Earlier in the week Vice-President-elect Mike Pence said the new administration will request a defense supplemental within its first 100 days. Aimed at acquisition reform, the NDAA would split the duties of the Pentagon undersecretary for acquisition, technology and logistics (AT&L) between an undersecretary for acquisition and sustainment (AT&S), and create a new undersecretary for research and engineering (R&E) — a chief technology officer. Implementation is ordered for February 2018, though the Department of Defense isn’t precluded from implementing it sooner. [Source: NavyTimes | Joe Gould | December 8, 2016 ++]

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Commissary Reform ► DECA's Ability to Reform Questioned

As lawmakers are poised to agree to massive commissary reform, they've also sent a message to defense officials that they don't believe senior commissary agency management is capable of carrying out those reforms. Congressional negotiators stated they are concerned that the Defense Commissary Agency’s current senior management “may lack the necessary talent and skills to transform the commissary system into an efficient, high-performing purveyor of grocery products and services,” according to the explanatory statement with Congress’ annual defense spending bill, released 30 NOV. The bill represented the compromise reached between the House and Senate versions of the bills authorizing defense spending for fiscal 2017. Thus, the lawmakers “strongly urge” DoD to “engage experts in the commercial grocery industry” to help the Defense Commissary Agency carry out the reform.

The compromise bill authorizes the defense secretary to contract with an entity to get that expert commercial advice, assistance or other services. “The changes the commissary agency is being asked to make are different from anything DeCA has ever been asked to do. We echo their concern,” said Eileen Huck, deputy director of government relations for the National Military Family Association. “It’s something we’ve been saying for months.” The reforms being implemented are aimed at reducing the reliance of the commissary and exchange systems on taxpayer dollars, without reducing the benefit for commissary customers, or adversely affect MWR programs for service members. The commissary is the biggest spender, with an annual budget of about $1.4 billion in taxpayer dollars in order to sell groceries at a discount. That $1.4 billion pays for salaries and other operating expenses, so that groceries don't have to be marked up.

But that's about to change, as some prices will increase. Among other things, the reforms -- which were requested by defense officials -- will allow the commissary system to implement a “variable pricing” program in response to market conditions and customer demand. This will be a change from a system that sells groceries at cost plus a 5

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percent surcharge. If the new pricing system meets established benchmarks for success for at least six months, DoD is authorized to convert the commissary system to a nonappropriated fund system, the same type as that under which military exchanges and MWR programs operate. Huck said family advocates are pleased that oversight of the reform will be required to ensure the benefit is not adversely affected, but that advocates also hope that it will be enough to be able to reverse course on the reforms if they are affecting the benefit.

Sources in industry have also echoed lawmakers' concerns about the commissary agency leadership's ability to manage this massive reform. “No one at DeCA has any experience in the grocery business. They are bureaucrats. They manage a benefit,” said one source in the industry which sells items to commissaries and exchanges -- as well as to commercial stores. He said DeCA leaders' actions have contributed to lawmakers' concerns, such as failing to produce the baseline of savings information, which will be used as a benchmark to make sure the commissary benefit is not reduced in the future. Defense policy officials who oversee the commissary agency have been driving the reform movement. This follows several years of DoD's unsuccessful attempts to drastically cut the commissary's budget. [Source: MilitaryTimes | Karen Jowers | December 1, 2016 ++]

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Commissary Private Label Products ► Coming in May 2017

Commissary customers worldwide will start seeing private label products on their stores’ shelves in May 2017, with an initial assortment of about 400 items, officials announced today. Defense Commissary Agency officials announced they have selected MDV SpartanNash, a long-time distributor of products to commissaries and exchanges, to supply the private label products to commissaries. They conducted “a rigorous selection process” to identify the supplier for the products, according to the announcement. Private label products are sometimes referred to as “generic” products, usually costing less than national name brands. Many other grocer retailers offer private-label products, sold under their own, in-house brand or under a brand developed by their suppliers. That includes the military exchanges, who have developed their own lines of private label products.

Over the next few months the commissary agency will work with SpartanNash to decide on an initial assortment. That assortment of about 400 items will be available to commissaries worldwide in May 2017 and will continue to grow to about 1,000 items by the end of 2017, officials said. Over the next two years, they’ll add more products. “Our customers have been asking for private label for a long time,” said Joseph Jeu, DeCA’s director and CEO, in the announcement. He cited a DeCA patron survey in which 60 percent of respondents said they would like to see commissaries offer private label products. “They are smart, savvy shoppers who know that private label products are cost-effective alternatives to national brands,” Jeu said. “We’re excited to help them save more at our commissaries.”

Commissaries have long sold brands that are similar to private label brands, the same as are sold in some civilian stores, and offered a cost savings, but they were not developed by the commissary agency. Officials said key selection criteria included quality, cost savings, ease and efficiency of implementation and the ability to support and increase the program in the future. MDV SpartanNash, headquartered in Norfolk, Va., is a division of SpartanNash, a wholesale distributor that supplies more than 2,100 independent stores in 47 states. The Fortune 400 company is also a grocery retailer with more than 155 corporate supermarkets in 10 states. Previously, a DeCA spokesman said officials would use merchandising agreements for the process, not a contract, because these agreements are “traditionally used for resale acquisitions of this nature.” [Source: MilitaryTimes | Karen Jowers | December 8, 2016 ++]

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DoD Fraud, Waste & Abuse ► Reported 01 thru 15 DEC 2016

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Wright-Patterson Air Force Base, OH -- A security forces airman was arrested 29 NOV and charged with stealing government property, according to court documents. Senior Airman Zachary Sizemore, with the 88th Security Forces Squadron, allegedly sold at least 38 pieces of military equipment through eBay between 2013 and 2016 for a total value of about $50,000, according to the documents. The Defense Department’s Defense Criminal Investigative Service, Homeland Security Department and Air Force Office of Special Investigations are working together to investigate the unauthorized sale of the military-grade night-vision devices. Records from eBay and PayPal show that between July 14, 2013, and June 11, 2016, Sizemore created postings for at least 45 pieces of night-vision or thermal equipment, according to the court documents.

These items included 11 PAQ-4C infrared aiming lights, eight PVS-7 night-vision goggles, eight Aimpoint CompM4 Red Dot Sights, six PVS-14 night-vision goggles, four Insight Technology AN/PAS-23 Mini Thermal Monoculars with infrared laser, two AN/PEQ-2A target pointer/illuminating/aiming lights, and one Aimpoint CompM2 Red Dot Sight. Sizemore faced a hearing in federal court in Dayton, Ohio, and will report to the Eastern District of New York for his arraignment. According to a complaint and affidavit written by a DCIS agent, Sizemore’s Air Force duties include “serving as a liaison with civilian and military law enforcement, escorting munitions shipments, performing inspections, and controlling entry into restricted areas.” He also served as the security forces armorer, which means he was responsible for inventory control of military equipment, including night-vision devices, according to the affidavit. It also said Sizemore was responsible for ensuring the accountability of more than $2.9 million in weapons, ammunition and communications equipment.

His training as a Tactical Automated Security System operator gave him knowledge of an Air Force intrusion detection and surveillance system, the affidavit said. The military prohibits the sale of fully functional, military-issued night-vision equipment on websites such as eBay. Someone who steals government property costing more than $1,000 can be prosecuted as a felon and is subject to up to 10 years in prison, a maximum fine of $250,000, or both. Air Force officials said Sizemore entered active duty in 2010 and has received the Air Force Achievement Medal. A Wright-Patterson Air Force Base spokesperson referred queries to the U.S. Attorney's Office for the Eastern District of New York. [Source: AirForceTimes | Charlsy Panzino | December 1, 2016 ++]

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Singapore --A retired U.S. Navy official was sentenced 2 DEC to six years in federal prison after he admitted taking more than $350,000 in bribes and sexual favors from an Asian defense contractor. Paul Simpkins, a former contracting supervisor based in Singapore, is the sixth Navy official so far to receive prison time in a massive corruption scandal that has rattled the maritime service since the first defendants were arrested in 2013. Another half-dozen current and former Navy officers have pleaded guilty but are still waiting to learn their sentences. More arrests are expected; prosecutors have said 200 people have been placed under investigation. In exchange for the bribes, Simpkins, 61, of Haymarket, Va., steered multi-million-dollar Navy business deals to Leonard Glenn Francis, a Singapore-based contractor known as “Fat Leonard,” according to court records. Francis’s company, Glenn Defense Marine Asia, held contracts for more than 25 years to resupply and refuel Navy ships and submarines at ports across Asia.

Court records show that Simpkins and Francis met in a Singapore hotel bar in 2006 to discuss how to rig the awarding of lucrative contracts to service Navy vessels in Thailand. Prosecutors have said Francis first gave the Navy official an envelope stuffed with $50,000 in cash. In subsequent months, according to the plea agreement in the case, Francis wired another $300,000 in bribes to a Japanese bank account controlled by Simpkins’ wife. Prosecutors say that Simpkins received more money in bribes than any other Navy official charged in the scandal. “Simpkins valued and sold his office to Francis in the same manner as an automobile dealer sells used cars,” they wrote in a court filing. Besides steering contracts to Glenn Defense, Simpkins acted as a secret enforcer of the company’s interests. According to the plea agreement, he ordered other Navy officials to stop reviewing fraudulent

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invoices from the firm, and blocked the installation of special equipment that would have detected a scheme by Francis to overcharge the Navy for pumping wastewater from its ships. On another occasion, he overruled a recommendation from a junior officer to cancel one of Glenn Defense’s contracts for poor performance.

Simpkins also had a fondness for prostitutes that Francis exploited, court records show. After his retirement from the Navy, Simpkins returned to Singapore for a visit in 2012 and emailed the contractor with a request for “some clean, disease-free wome[n].” Francis replied that he would arrange for prostitutes, referring to them as “honeys and bunnys.” In a letter sent to the court for his sentencing, Simpkins said he took “total responsibility and accountability for my actions and offer no excuse[s]. There are not enough words to accurately and sincerely express my apology to the United States and my family.” He did not make any reference to Francis — who has also pleaded guilty and is in jail awaiting sentencing — or shed any more light on their actions. “Mr. Simpkins is sincerely remorseful and looks forward to putting this chapter of his life behind him,” his attorney, John Lemon of San Diego, said in an email. In addition to his prison term, Simpkins must pay $450,000 in restitution to the U.S. government.[Source: The Washington Post | Craig Whitlock | December 2, 2016 ++]

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Pentagon -- The Pentagon has kept quiet about an internal study that exposed $125 billion in administrative waste in its business operations according to interviews and confidential memos obtained by The Washington Post. The newspaper reported that senior defense officials moved to kill the study, issued in January 2015, by discrediting and suppressing the results. Initially, the study was requested to make operations more efficient. However, it found the Pentagon was more inefficient then suspected.  The report detailed a plan that could have avoided $125 billion in waste over five years without layoffs or reductions in military personnel. Some of the recommended action items were early retirements, reducing high-priced contractors and making better use of information technology.

Among other options, the study called for reallocating the $125 billion for troops and weapons. But  The Post reported that Pentagon leaders worried that Congress wouldn't provide more money and might decide to cut funds deeper. The Pentagon imposed secrecy restrictions on the data making up the study, which ensured no one could replicate the findings. A 77-page summary report that had been made public was removed from a Pentagon website http://dbb.defense.gov/Reports.

Among other options, the study called for reallocating the $125 billion for troops and weapons. But  The Post reported that Pentagon leaders worried that Congress wouldn't provide more money and might decide to cut funds deeper. The Pentagon imposed secrecy restrictions on the data making up the study, which ensured no one could replicate the findings. A 77-page summary report that had been made public was removed from a Pentagon website http://dbb.defense.gov/Reports. The White House press secretary on 6 DEC disputed claims that DoD swept under the rug noting that http://dbb.defense.gov/Portals/35/Documents/Meetings/2015/2015-01/CBP%20Task%20Group%20Out-brief%20Slides_FINAL.pdf was "available to anybody in the world that had a live Internet connection and a relatively modern Web browser."

Deputy Defense Secretary Robert Work, the Pentagon's second-highest-ranking official, initially ordered the survey. Work told The Post that $125 billion in savings was "unrealistic" and added "there is this meme that we're some bloated, giant organization ... I think it vastly overstates what's really going on." Work also said the Pentagon has adopted some of the study's recommendations and estimated those steps will save $30 billion by 2020. 

Sen. John McCain (R-AZ), the chairman of the Senate Armed Services Committee, and Rep. Mac Thornberry (R-TX), the chairman of the Senate Armed Services Committees, blistered the Pentagon in a joint statement issued 6 DEC. "The Defense Business Board's key findings ... are not a surprise. Nor are the problems identified by the board new. We have known for many years that the department's business practices are archaic and wasteful, and its inability to pass a clean audit is a longstanding travesty. The reason these problems persist is simple: a failure of leadership and a lack of accountability.  "That is why, over the past two years, the Senate and House Armed Services committees have mandated a 25 percent reduction to administrative support functions, a 25 percent

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reduction to bloated headquarters staffs, a 12 percent reduction to the number of general and flag officers, and a 12 percent reduction to the number of Senior Executive Service civilian employees."

The Senate’s No. 2 Democrat on 8 DEC asked the Pentagon to respond to $125 billion in waste-reduction proposals. In a letter to Defense Secretary Ash Carter, Sen. Dick Durbin, who is the Senate minority whip and ranking member on the Senate Appropriations Defense Subcommittee, voiced concern about runaway contractor costs in particular. Durbin's letter paralleled letters from other lawmakers to Carter asking for information about a 2015 Defense Business Board (DBB) report that recently surfaced in the news. The 31 members of the House Oversight and Government Reform Committee, in one such letter, focus on allegations that Pentagon leaders shelved the study. That letter questions "why learning about potential savings that would be enough to ‘cover the operational costs for 50 Army brigades, or 3,000 F-35 Joint Strike Fighters for the Air Force, or 10 aircraft-carrier strike groups for the Navy,’ would not also be a priority.”

Danielle Brian, executive director of the nonprofit Project on Government Oversight, called the Post story “a perfect illustration of the three biggest problems affecting the Defense Department: a contractor workforce that costs too much; a culture of secrecy; and a fear that exposing waste will lead to cuts in defense spending. It and other reports also show there are plenty of opportunities to cut Pentagon spending and the next administration should be skeptical of anyone who tells them otherwise.” [Source: NAUS/The Washington Post | Craig Whitlock & Bob Woodward | December 6, 2016 ++]

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POW/MIA Recoveries ► Reported 1 thru 15 DEC 2016 | Five

"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

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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/POW’s have been recovered, identified, and scheduled for burial since the publication of the last RAO Bulletin:

Vietnam

None

Korea

The Defense POW/MIA Accounting Agency announced the identification of remains and burial updates of four U.S. servicemen who had been previously listed as missing in action from Korea. Returning home for burial with full military honors are:

-- Army Master Sgt. Joseph Durakovich was a member of Company G, 5th Cavalry Regiment, 1st Cavalry Division. His unit was attacked by the Chinese forces while establishing a defensive position in Pongmyong-ni east of Kuni-ri, North Korea, on Nov. 28, 1950. After the battle, Durakovich could not be accounted for and was reported missing in action. Interment services are pending. Read more at: http://www.dpaa.mil/News-Stories/Recent-News-Stories/Article/1011976/soldier-missing-from-korean-war-identified-durakovich .

-- Army Cpl. Louis A. Damewood was a member of Headquarters Company, 3rd Battalion, 38th Infantry Regiment, 2nd Infantry Division, operating near Hoengsong, South Korea. He was declared missing after his unit attacked an opposition road block on Feb. 13, 1951. Interment services are pending. Read more at: http://www.dpaa.mil/News-Stories/Recent-News-Stories/Article/1011982/soldier-missing-from-korean-war-identified-damewood

-- Army Cpl. David T. Nordin, Jr., 23, of Los Angeles, will be buried in Kent, Washington, on Dec. 16. Nordin was a member of Company K, 3rd Battalion, 35th Infantry Regiment, 25th Infantry Division. He was declared missing Nov. 28, 1950, after his unit was attacked by Chinese forces while establishing a position near Unsan, North

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Korea, as part of a United Nations Command offensive. Read more at: http://www.dpaa.mil/News-Stories/News-Releases/Article/1024527/soldier-killed-in-korean-war-accounted-for-nordin .

-- Army Sgt. Stafford L. Morris was a member of Battery A, 503rd Field Artillery Battalion, 2nd Infantry Division. His unit was operating just north of Kujang-dong, North Korea, when it was attacked by overwhelming Chinese forces and was forced to withdraw through an area referred to as “The Gauntlet.” Morris was declared missing on Dec. 1, 1950. Interment services are pending. Read more at: http://www.dpaa.mil/News-Stories/Recent-News-Stories/Article/1024636/soldier-missing-from-korean-war-identified-morris/.

World War II

The Defense POW/MIA Accounting Agency announced the identification of remains and burial update on oneU.S. servicemen who had been previously listed as missing in action from World War II. Returning home for burial with full military honors are:

-- Navy Fireman 1st Class Jim H. Johnston, 23, will be buried in his hometown of Wesson, Miss., on Dec. 7. Johnston was assigned to the USS Oklahoma, which was moored off Ford Island, Pearl Harbor, when Japanese aircraft attacked his ship on Dec. 7, 1941. Johnston was one of 429 crewmen to be killed in the attack.  Read more at: http://www.dpaa.mil/News-Stories/Recent-News-Stories/Article/1010134/airman-missing-from-world-war-ii-identified-moessner/.

[Source: http://www.dpaa.mil | December 15, 2016 ++]

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VA Emergency Care Update 10 ► Vets Being Stiffed on ER Bills

South Dakota U.S. Senator Mike Rounds (R) is blasting the VA for still refusing to pay for emergency care for veterans at non-VA medical facilities. In his U.S. Senate floor speech on 30 NOV, Rounds highlighted the case of 90-year-old Korean War Veteran Alfred Dimmick of Rapid City. He said Dimmick was twice taken to non-VA facilities for possible heart attacks, because emergency responders didn't want to take a chance with the longer drive to a VA facility. Rounds said Dimmick still owes thousands of dollars because the VA refuses to cover the bills. "His daughter writes to me that even as frail and ill as Mr. Dimmick is, he wants to know before he dies that his bills are covered, so that he can have peace," said Rounds. Rounds urged the Department of Veterans Affairs to comply with the Veterans' Emergency Care Fairness Act.

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On February 1, 2010 the Veterans’ Emergency Care Fairness Act (P.L. 111-137) was signed into public law. The Act amends 38 U.S.C. 1725 by changing the definition of personal liability. It removes the disqualifying factor of payment in part by a third party payer and removes one’s own automobile reparations coverage from the definition of a health plan contract.

This law is intended to make certain that veterans with private health insurance are covered by the VA if their outside insurance does not cover the full amount of non-VA emergency care. Despite a court case this year, originally brought by a Minnesota veteran, ruling that the VA must pay in such emergency situations, Rounds claimed that it is still refusing to do so. In fact, the VA is appealing the court decision. Over 100,000 claims are now pending on the outcome of that appeal. Go to https://youtu.be/yf8_FTohdMw to view Sen. Rounds Senate floor speech. [Source: KELO-AM |Military Times Mark Russo | November 30, 2016 ++]

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VA Nursing Update 06 ► Full Practice Authority Regulation Amended

The Department of Veterans Affairs (VA) on 14 DEC announced that it is amending provider regulations to permit full practice authority to three roles of VA advanced practice registered nurses (APRN) to practice to the full extent of their education, training, and certification, regardless of State restrictions that limit such full practice authority, except for applicable State restrictions on the authority to prescribe and administer controlled substances, when such APRNs are acting within the scope of their VA employment. “Advanced practice registered nurses are valuable members of VA’s health care system,” said VA Under Secretary for Health Dr. David J. Shulkin. “Amending this regulation increases our capacity to provide timely, efficient, effective and safe primary care, aids VA in making the most efficient use of APRN staff capabilities, and provides a degree of much needed experience to alleviate the current access challenges that are affecting VA.”

In May 2016, VA announced its intentions, through a proposed rule, to grant full practice authority to four APRN roles. Though VA does have some localized issues, we do not have immediate and broad access challenges in the area of anesthesia care across the full VA health care system that require full practice authority for all Certified Registered Nurse Anesthetists (CRNAs). Therefore, VA will not finalize the provision including CRNAs in the final rule as one of the APRN roles that may be granted full practice authority at this time. VA will request comment on the question of whether there are current anesthesia care access issues for particular states or VA facilities and whether permitting CRNAs to practice to the full extent of their advanced authority would resolve these issues.

APRNs are clinicians with advanced degrees and training who provide primary, acute and specialty health care services; they complete masters, post-masters or doctoral degrees. There are four APRN roles: Certified Nurse Practitioner, Clinical Nurse Specialist, Certified Registered Nurse Anesthetist, and Certified Nurse Midwife. “CRNAs provide an invaluable service to our Veterans,” Under Secretary for Health Shulkin continued. “Though CRNAs will not be included in VA’s full practice authority under this final rule, we are requesting comments on whether there are access issues or other unconsidered circumstances that might warrant their inclusion in a future rulemaking. In the meantime, we owe it to Veterans to increase access to care in areas where we know we have immediate and broad access challenges.”

All VA APRNs are required to obtain and maintain current national certification. The final rulemaking establishes professional qualifications an individual must possess to be appointed as an APRN within VA, establishes the criteria under which VA may grant full practice authority to an APRN and defines the scope of full practice authority for each of the three roles of APRN. Certified Registered Nurse Anesthetists will not be included in VA’s full practice authority under this final rule. VA is the nation’s largest employer of nurses; as of July 2016 its workforce of approximately 93,500 nurses (RNs, LPNs, NAs) includes approximately 5,769 APRNs For more

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information about openings for nurses or other health care positions at VA, visit Vacareers@va.gov. [Source: VA News Release | December 14, 2016 ++]

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VA Secretary Update 50 ► Trump Urged to Keep McDonald

The nation’s largest veterans groups are urging President-elect Donald J. Trump to keep President Obama’s secretary of veterans affairs, Robert A. McDonald, out of concern that his rumored candidates’ inexperience and ideological leanings could cripple the massive veterans health care system. On the campaign trail, Mr. Trump was relentless in his criticism of the Department of Veterans Affairs, calling it “the most corrupt agency in the United States.” Some of the candidates mentioned to head the department have called for sweeping changes to make it easier to fire federal workers and privatize veterans’ health care. But the major veterans groups, which together represent hundreds of thousands of veterans, said they favor the incremental reform they have seen under Mr. McDonald.

On 9 DEC, leaders of the American Legion, Disabled American Veterans, Veterans of Foreign Wars, Vietnam Veterans of America and Amvets told members of Mr. Trump’s transition team that they would not support other candidates that have been mentioned. “We all want McDonald,” said Joe Chenelly, the executive director of Amvets. “He has a good business mind, he is experienced and we feel we can trust him.” It is unclear whether the Trump team is considering Mr. McDonald, and whether the secretary has met with Mr. Trump. The Trump transition team did not respond to requests for comment. A spokeswoman for Mr. McDonald, Victoria Dillon, said she was not aware if he had spoken to Mr. Trump.

Mr. McDonald, 63, a former Army officer who rose to become the chief executive of Procter & Gamble, was tapped to lead the department in 2014, amid a scandal over long waits for veterans seeking care. Mr. McDonald, who had regularly contributed to Republican candidates, was seen as a business-savvy reformer who could cultivate private-sector efficiency while appealing to both sides of the aisle. Veterans groups credit him with making smart and steady improvements, while also acknowledging that progress has been slow. Though morale has risen and the health care system has completed millions more appointments each year than it did before Mr. McDonald took over, they say, wait times at many hospitals have yet to improve.

In a meeting with Mr. Trump’s transition team on Friday, veterans groups raised concerns with the names mentioned so far for secretary: Sarah Palin, the onetime vice-presidential candidate; Jeff Miller, the retiring chairman of the House Committee on Veterans Affairs; Scott Brown, the former Massachusetts senator; and Pete Hegseth, who was until recently the chief executive of Concerned Veterans for America, a group funded by the conservative billionaire industrialists Charles G. and David H. Koch.

Veterans groups oppose Ms. Palin and Mr. Miller in part because neither served in the military, Mr. Chenelly said, adding that they think Mr. Brown lacks the experience to run a nationwide health care and benefits system with 350,000 employees.

The groups particularly oppose Pete Hegseth, an Army veteran and Fox News commentator who for years worked for Republican-funded activist groups and think tanks that have portrayed veterans health care as feckless and corrupt. Currently, about a third of veterans’ health care is provided by private doctors. Mr. Hegseth advocates giving all veterans the choice to seek care in the private sector. Veterans groups say this would siphon billions of dollars away from veterans hospitals, causing the system to collapse. “If Trump picks Hegseth, it’s going to be war,” said Paul Rieckhoff, the executive director of Iraq and Afghanistan Veterans of America. “He would be a radical departure from what the V.A. has been for generations.”

On the campaign trail Mr. Trump echoed many of Mr. Hegseth’s positions, saying he would give every veteran the choice to see a private doctor. A recent bipartisan study found such a program could cost more than $100 billion

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over the next decade. “These guys are like the dog who caught the car,” Mr. Rieckhoff said of Mr. Trump’s transition team. “They suddenly realize how big the machinery really is and that privatization isn’t financially viable. So they are testing names, looking for different ideas.” Mr. Rieckhoff said the current secretary is a natural fit with Mr. Trump’s vow to bring in outsiders and make business-friendly reforms. “If he wasn’t already the secretary, he would be at the top of his list. He’s a Washington outsider. He’s a C.E.O. of a major company. He’s a Republican. He’s everything Trump would look for.”

Some Republicans and conservative media outlets oppose Mr. McDonald, saying he has been an apologist for the failures of veterans health care, and has not taken needed steps to fire more workers accused of hiding delays and other malfeasance. Chief among the critics is the small but well-funded Concerned Veterans for America, which Mr. Hegseth left in January. Created by a network of conservative donors organized by the Koch brothers, it sends out regular emails blasting the agency for every failure and misstep. “Under Secretary McDonald, problems at the V.A. have worsened,” Dan Caldwell, the group’s vice president for policy, said in an email. He said Mr. McDonald has fired far fewer employees for manipulating wait times than he has indicated in public, and increased employee bonuses, even as the veterans’ health care system has struggled to meet goals. “The V.A. needs an overhaul,” he said. “Not an extension of the dysfunctional status quo. McDonald’s legacy is one of lies and incompetence.” [Source: The New York Times | Dave Philipps | December 12, 2016 ++]

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VA OPC Medicine ► New Copay Tier System

The Department of Veterans Affairs (VA) is amending its regulation on copayments for Veterans’ outpatient medications for non-service connected conditions. VA currently charges non-exempt Veterans either $8 or $9 for each 30-day or less supply of outpatient medication, and under current regulations, a calculation based on the medication of the Medical Consumer Price Index (CPI-P) would be used to determine the copayment amount in future years. “Switching to a tiered system continues to keep outpatient medication costs low for Veterans,” said VA Under Secretary for Health Dr. David J. Shulkin. “Reducing their out-of-pocket costs encourages greater adherence to prescribed outpatient medications and reduces the risk of fragmented care that results when multiple pharmacies are used; another way that VA is providing better service to Veterans.”

This new regulation eliminates the formula used to calculate future rate increases and establishes three classes of outpatient medications identified as Tier 1, Preferred Generics; Tier 2, Non-Preferred Generics including over-the-counter medications; and Tier 3, Brand Name. Copayment amounts for each tier would be fixed and vary depending upon the class of outpatient medication in the tier. These copayment amounts will be effective February 27, 2017:

$5 for a 30-day or less supply - Tier 1 outpatient medication $8 for a 30-day or less supply - Tier 2 outpatient medication $11 for a 30-day or less supply - Tier 3 outpatient medication

These changes apply to Veterans without a service-connected condition, or Veterans with a disability rated less than 50 percent who are receiving outpatient treatment for a non-service connected condition, and whose annual income exceeds the limit set by law. Medication copayments do not apply to former Prisoners of War, catastrophically disabled Veterans, or those covered by other exceptions as set by law. Copayments stop each calendar year for Veterans in Priority Groups 2-8 once a $700 cap is reached. More information on the new tiered medication copayment can be found at www.va.gov/opa/pressrel/pressrelease.cfm?id=2843#sthash.Fydtpgj3.dpuf. [Source: VA News Release | December 12, 2016 ++]

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VA Hepatitis C Care Update 16 ► High Cure Rates with New Drugs

A VA database study shows that new drug regimens for hepatitis C have resulted in “remarkably high” cure rates among patients in VA’s national health care system. Of the more than 17,000 Veterans in the study, all chronically infected with the hepatitis C virus at baseline, 75% to 93% had no detectable levels of the disease in their blood for 12 or more weeks after the end of treatment. The therapy regimens lasted 8 to 24 weeks, depending on patient characteristics.

“This promising news comes as VA is dedicating significant funds to help greater numbers of patients with hepatitis C,” said David Shulkin VA Under Secretary for Health. “In March, we announced our ability to fund care for all Veterans with hepatitis C for fiscal year 2016 regardless of the stage of the patient’s liver disease. VA has long led the country in screening for and treating hepatitis C. As of mid-September 2016 alone, the Department treated more than 100,000 Veterans infected with the virus. More than 68,000 of these patients had been treated with these new highly effective antivirals.”

The VA researchers analyzed data from four subgroups of patients infected with hepatitis C—genotypes 1, 2, 3, and 4—and found that genotype 1 patients showed the highest cure rates and genotype 3 the lowest. Genotype 1 was by far the most common type of infection among the four subgroups. The study group of more than 17,000 Veterans included more than 11,000 patients with confirmed or likely cirrhosis, a liver disease that can result from hepatitis C, among other causes. The study team found “surprisingly high” response rates of around 87% in this group. The overall results were consistent with those from earlier clinical trials that led to FDA approval of the three new drug regimens in the study: sofosbuvir (SOF), ledipasvir/sofosbuvir (LDV/SOF) and paritaprevir/ ritonavir/ ombitasvir and dasabuvir (PrOD).

The drugs, introduced in 2013 and 2014, have been credited with revolutionizing hepatitis C treatment, which means a cure is now in reach for the vast majority of patients infected with the virus. Previously, using earlier drug regimens, most patients could expect, at best, only a 50% chance of a cure. “Our results demonstrate that LDV/SOF, PrOD and SOF regimens can achieve remarkably high SVR [sustained virologic response] rates in real-world clinical practice,” VA researchers wrote. The new drug regimens examined in the study do not contain interferon, which has troublesome side effects such as fever, fatigue, and low blood counts. The newer drugs are considered far more tolerable than the older interferon-based antiviral regimens, although they are far more expensive. The researchers extracted anonymous data on all patients in VA care who received HCV antiviral treatments between January 2014 and June 2015 using the VA Corporate Data Warehouse, a national, continually updated repository of data from VA’s computerized patient records.

The study’s optimistic finding is a source of optimism for Veterans and others infected with the hepatitis C virus, according to coauthors Dr. Lauren Beste and Dr. George Ioannou, specialists in internal medicine and hepatology, respectively, with the VA Puget Sound Health Care System in Seattle. According to the researchers, modern, direct-acting antiviral drugs for hepatitis C far outperform our older options in terms of efficacy and tolerability. With older drugs, most patients could not undergo antiviral treatment because they had contraindications or medication side effects. With newer options, almost anyone can safely undergo treatment for hepatitis C. V

A research continues to expand knowledge of the disease through scientific studies focused on effective care, screening, and health care delivery. Some studies look at particular groups of hepatitis C patients—for example, female Veterans, or those with complicated medical conditions in addition to hepatitis C.For more information on VA care for hepatitis C, visit www.hepatitis.va.gov and www.hepatitis.va.gov/patient/hcv/index.asp. Information about the database study may be found in the September 2016 issue of the journal Gastroenterology. [Source: VA News Release | December 13, 2017 ++]

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VA Medical Center Rating System ► Heretofore Not Public

The Department of Veterans Affairs has for years assigned star ratings for each of its VA medical centers (VAMCs) based on the quality of care and service they provide, but the agency has repeatedly refused to make them public, saying they are meant for internal use only. USA TODAY has obtained internal documents detailing the ratings, and they show the lowest-performing medical centers are clustered in Texas and Tennessee. VA hospitals in Dallas, El Paso, Nashville, Memphis and Murfreesboro all received one star out of five for performance as of 30 JUN, the most recent ratings period available. Many of highest-rated facilities are in the Northeast — in Massachusetts and New York — and the upper Midwest, including in South Dakota and Minnesota. Those medical centers scored five out of five stars.

The VA determines the ratings for 146 of its medical centers each quarter and bases them on dozens of factors, including death and infection rates, instances of avoidable complications and wait times. USA TODAY Network has publishing the ratings in full for the first time so that members of the public — including patients and their families — can see how their local VA medical centers stack up against others across the country. You can review your Medical Centers rating at http://www.usatoday.com/story/news/politics/2016/12/07/internal-report-details-secret-quality-ratings-veterans/94811922.

Some lower-ranking medical centers have remained poor performers despite high-profile crises and years of attention and resources from Washington. For instance, the Phoenix VA was a one-star medical center in 2014 when news broke that veterans had died awaiting care there while schedulers kept secret wait lists masking how long veterans were waiting for appointments. The revelations triggered a national scandal, hearings on Capitol Hill and the replacement of the VA secretary. Phoenix remained a one-star facility in the most recent ratings. VA Undersecretary for Health David Shulkin cautioned against using the star ratings as a “ranking tool” and said they are considered an internal improvement tool. “It is essentially a system within VA to see who’s improving, who’s getting worse, so we can identify both,” Shulkin said.

The documents obtained by USA TODAY list star ratings for every facility for the fourth quarter of 2015. The VA subsequently agreed to provide a list of one- and five-star facilities for the quarter that ended June 30, the most recent ratings available, but declined to identify those with two to four stars. Shulkin said he was apprehensive about any ratings becoming public. “My concern is that veterans are going to see that their hospital is a 'one' in our star system, assume that’s bad quality and veterans that need care are not going to get care,” he said. “And they’re going to stay away from hospitals and that’s going to hurt people.” But without the star ratings, members of the public — including patients, members of Congress and others outside the agency who could hold it accountable — have no way of knowing whether VA medical centers are improving or declining, except to plow through a dizzying array of hundreds of spreadsheets on the agency’s website. “The data’s there, but you’d have to be an expert to get through it,” Shulkin conceded.

He said 120 of the 146 medical centers that the VA rates on the star scale have shown improvement since he began overseeing the Veterans Health Administration in July 2015. He said all of the one-star facilities have shown improvement except for the VA medical center in Detroit, which has declined. Pamela Reeves, director of the Dingell VA Center in Detroit, said that officials there are "working closely with our performance improvement teams in the development and oversight of action plans to address the opportunities identified by the … data.” In Phoenix, VA officials appointed a new director in October and are pumping millions into the effort to improve the medical center. Shulkin said that nationwide, medical centers where performance has declined are getting extra scrutiny and help from national VA officials. If they still don’t show sufficient progress, hospital management could be replaced. That’s what happened in Wilmington, Del., where the VA ousted the medical center’s director in October after months of deteriorating quality. Wilmington was among several hospitals placed on a “high-risk” watch list earlier this year because of declining performance, according to the internal VA documents. Also on the list were hospitals in Tomah, Wis., and Oklahoma City, Okla. The Tomah VA Medical Center made national

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headlines nearly two years ago after a veteran died there when he was prescribed a fatal cocktail of narcotics. A USA TODAY investigation published last December revealed gaping lapses in care at the Oklahoma City VA.

Rep. Jeff Miller (R-FL), chairman of the House Veteran's Affairs Committee, said the VA should immediately release all the ratings and quality data and do so on a continuing basis. He argued that the status quo — “in which VA officials often attempt to downplay and sometimes mislead the public about serious problems until it's too late” – is unacceptable. "The secrecy with which VA treats these quality ratings is alarming,” Miller told USA TODAY. “Veterans seeking care at VA hospitals deserve to know exactly what they are walking into. Additionally, Congress, taxpayers and other stakeholders need to have a quick and efficient means of comparing the performance of various VA medical centers in order to identify facilities in need of improvement.” Alex Howard, senior analyst at the Sunlight Foundation, a nonpartisan transparency advocate in Washington, said there’s “no rationale that I see for withholding that from veterans, much less the general public.” “I would think the only entity that wouldn’t want that data public would be the facilities themselves, which is not sufficient cause,” he said.

The VA also rarely releases nationwide averages showing overall improvements or declines in agency performance measures, so it can be hard to determine exactly what’s changed since the scandal in 2014, when President Obama tapped Bob McDonald, a former Procter & Gamble CEO, to take over as secretary and overhaul the agency. The documents obtained by USA TODAY detail those averages, and when asked about them, VA officials agreed to provide updated statistics. Overall, the data show something of a mixed bag, with improvements in some areas and declines in others. On average, veterans are dying at lower rates and contracting fewer staph and urinary tract infections from catheters in VA medical centers since 2014. Veterans are not staying as long in VA hospitals and they are being readmitted within 30 days at lower rates. At the same time, veterans are experiencing higher rates of preventable complications during hospital stays, on average, than they did in 2014. Those on ventilators suffered more problems, such as catching pneumonia, and the rate of turnover for nurses has increased.

The VA has also seen increases in the percentage of veterans who have to wait longer than 30 days for appointments when they are new patients. Overall, more than 500,000 veterans were still waiting longer than 30 days to be seen as of Nov. 15. More than 125,000 of them were waiting longer than two months, and 46,000 were waiting more than six months. Shulkin said half of the 500,000 appointments are for more minor needs such as dental, hearing, vision and diet consultations. “I can sleep at night,” he said. “The ones I worry about are the ones who can’t wait or shouldn’t be waiting, so that’s where our entire focus of our system is right now. I don’t care about you waiting for eyeglasses, I mean that’s poor customer service, I understand, but I do care if you have a lung nodule. I mean, that matters.” Shulkin said the number of veterans waiting longer than a month for urgent care has decreased from 57,000 to 600 since he took over last year. And he says he is working to ensure that veterans get same-day care — if they have urgent needs — at VA medical facilities across the country by the end of the year. “If you have an urgent care problem, your wait should be zero,” he said. [Source: USA TODAY | Donovan Slack | December 7, 2016 ++]

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VA Cemeteries Update 15 ► Pre-Need Determination of Eligibility Program

The Department of Veterans Affairs announced 8 DEC it now provides eligibility determinations for interment in a VA national cemetery prior to the time of need. Through the Pre-Need Determination of Eligibility Program, upon request, individuals can learn if they are eligible for burial or memorialization in a VA national cemetery. Secretary of Veterans Affairs Robert A. McDonald said, “MyVA is about looking at VA from the Veterans’ perspective, and then doing everything we can to make the Veteran Experience effective and seamless. This new program reaffirms our commitment to providing a lifetime of benefits and services for Veterans and their families.”

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Interested individuals may submit VA Form 40-10007, Application for Pre-Need Determination of Eligibility for Burial in a VA National Cemetery, and supporting documentation, such as a DD Form 214 (if readily available) to the VA National Cemetery Scheduling Office by: toll-free fax at 1-855-840-8299; email to Eligibility.PreNeed@va.gov ; or mail to the National Cemetery Scheduling Office, P.O. Box 510543, St. Louis, MO 63151. Form 40-10007 can be completed on line and downloaded at http://www.va.gov/vaforms/va/pdf/VA40-10007.pdf. VA will review applications and provide written notice of its determination of eligibility. VA will save determinations and supporting documentation in an electronic information system to expedite burial arrangements at the time of need. Because laws and personal circumstances change, upon receipt of a burial request, VA will validate all pre-need determinations in accordance with the laws in effect at that time.

 VA operates 135 national cemeteries and 33 soldiers’ lots in 40 states and Puerto Rico. More than 4 million Americans, including Veterans of every war and conflict, are buried in VA’s national cemeteries. VA also provides funding to establish, expand and maintain 105 Veterans cemeteries in 47 states and territories including tribal trust lands, Guam, and Saipan. For Veterans buried in private or other cemeteries, VA provides headstones, markers or medallions to commemorate their service. In 2016, VA honored more than 345,000 Veterans and their loved ones with memorial benefits in national, state, tribal and private cemeteries.

Eligible individuals are entitled to burial in any open VA national cemetery, opening/closing of the grave, a grave liner, perpetual care of the gravesite, and a government-furnished headstone or marker or niche cover, all at no cost to the family. Veterans are also eligible for a burial flag and may be eligible for a Presidential Memorial Certificate. Information on VA burial benefits is available from local VA national cemetery offices, from the Internet at   http://www.cem.va.gov, or by calling VA regional offices toll-free at 800-827-1000.  To make burial arrangements at any open VA national cemetery at the time of need, call the National Cemetery Scheduling Office at 800-535-1117.  [Source: VA News Release | December 8, 2016 ++]

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VA Privatization Update 08 ► Make Everyone Pay for Health Insurance

A health policy expert at the libertarian Cato Institute is offering a radical idea to help reform the Department of Veterans Affairs and prevent future wars at the same time: Make troops and veterans pay for their own medical insurance. In an online essay last week, institute Director of Health Policy Studies Michael Cannon recommends dropping the idea of free health care for veterans and instead offering better pay for current troops and vouchers for current veterans to buy their own coverage on the open market. He also calls for privatizing the Veterans Health Administration -- something the major veterans groups have all argued against -- with shares of the new publicly-run company to be given to veterans and servicemembers based on time in service.

“Privatization would improve the quality of veterans’ benefits immeasurably,” he wrote. “The federal government promises veterans’ benefits to military personnel once they leave active duty. Only it’s not an explicit promise. And Congress doesn’t fund it. “As a result, Congress can -- and does -- renege on that commitment.” Cannon also argues that since the government would have to front the costs for insurance stipends and vouchers, it would also make the costs of war clearer before the first shots are fired. “Veterans benefits are one of the largest financial costs of any armed conflict,” he wrote. “Yet Congress does not pre-fund those obligations. It only funds them once they come due. “(In the event of war), the added risk of deaths and injuries would cause premiums to rise, which would increase the amount of added pay Congress must provide each service member. The result is that future Congresses and presidents would have to confront this enormous cost of war at the moment they decide to send U.S. troops off to war, and every day they decide to keep them there.”

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The idea is as radical as it is theoretical. While Republicans including President-elect Donald Trump have argued in favor of expanding private care options for veterans, none have offered plans to completely dismantle veterans benefits and hospital management. Meanwhile, Democrats and veterans groups have warned against even small steps towards privatization of VA functions, arguing that many outside hospitals and physicians lack the expertise or motivation to handle the most difficult service-connected injuries. But Cannon argued that without radical changes, any reform effort is doomed. “If Trump retains the VA’s basic structure, he will join a long line of presidents who have failed our nation’s veterans,” he wrote. You can read the full report online at the Cato web site. https://www.cato.org/blog/how-president-trump-can-fix-veterans-benefits-once-all. [Source: MilitaryTimes | Leo Shane | November 26, 2016 ++]

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VA Project Funding ► Money Needed for 24 Stalled Ones

With President-elect Donald Trump eying an overhaul in veterans health care, 18 senators are urging quick action from the lame duck Congress on two dozen stalled VA projects, including a major one in Hampton Roads. Virginia Sens. Mark R. Warner and Tim Kaine joined 16 of their colleagues 1 DEC in calling for Congress to set aside funding for a list of health care centers, outpatient clinics and research facilities proposed throughout the Veterans Affairs system. It asks Senate leaders to authorize the money “in the December funding bill, or another appropriate vehicle, to be signed into law this year.” If Congress doesn’t act, it is unclear how these proposed projects would fare under a President Trump and a new Congress come January. Trump has talked about improving veterans health care, but in the context of providing more private-sector choices, not building more VA facilities.

The list of 24 projects includes a proposed 155,000 square-foot care center planned for South Hampton Roads, a project considered the top priority for the fast-growing Hampton VA Medical Center. Congress has delayed approving these projects because the Congressional Budget Office has changed how it rates the financial impact. Before 2012, CBO scored these projects -- which result in signed leases, even the project results in new construction -- as equal to the annual lease payment. But then it switched, saying Congress should consider the full cost up front. Because many of these leases run for 20 years, it made it more difficult for these projects to move forward.

The proposed South Hampton Roads center would offer primary and specialty care, day surgery, an eye clinic, a pharmacy and a radiology services. A location has not been specified, but putting it in South Hampton Roads would relieve pressure on the Hampton VA, where patient visits grew more than three times the national average between 2011 and 2014. Medical center officials have worked to create more space on the Hampton campus, converting administrative areas into exam rooms and adding floors. But that will not solve the problem, said Michael Dunfee, the center’s director. “A lot of the changes we've made space-wise are short-term solutions for what is becoming a long-term problem," Dunfee recently told the Daily Press. "At some point, we're going to reach the end of our limit to be creative." Warner has openly expressed frustration at the lack of progress on the proposed center. He has attempted different strategies this year, only to be stymied at every turn.

In September, the senator co-sponsored legislation to authorize funding. It has been referred to the Veterans Affairs Committee.

In June, he tried to amend the National Defense Authorization Act to include the project, but that fizzled. That same month, a House bill to fund the centers died without a vote because it drew money from veterans benefits.

Thursday’s plea comes as Trump is contemplating who will head the Department of Veterans Affairs.

Supporters say a plan that leans more on private hospitals would give veterans additional choices. Critics fear it marks the first step toward privatization of veterans health care and abandonment of long-held promises for retired service members.

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CVA’s report, “Fixing Veterans Health Care,” is a 102-page document that describes a dramatic shift in veterans health care. Under the plan, the Veterans Health Administration would be split in two -- one entity responsible for medical centers and another handing health insurance oversight. Essentially, it’s a division between provider and payer, which supporters say would offer veterans more options to seek private care. VA hospitals could concentrate on military-specific areas for which it has expertise, such as traumatic brain injuries, spinal cord injuries, and post-traumatic stress disorder. Supporters say this would not lead to a dismantling of the VA health system. The federal government would still bear responsibility for veterans health care. Not all agree. Sherman Gillums Jr., executive director of the Paralyzed Veterans of America, told Military Times: “A fragmented and less coordinated care environment is not optimal for veterans whose health issues are often too complex and hard to treat for providers who do not specialize in them.” [Source: The Daily Press | Hugh Lessig | December 1, 2016 ++]

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VA Prostate Cancer Program Update 13 ► PCF Partnership

The VA announced it is partnering with the Prostate Cancer Foundation (PCF) to prevent, screen and promote research to speed the development of treatments and cures for prostate cancer among veterans. The announcement was made during Launch Pad: Pathways to Cancer InnoVAtion, a joint VA/PCF summit that brings together world-class oncology experts, corporate and nonprofit partners to discuss research, big data, technology and clinical solutions to advance screening, diagnostics and care coordination for cancer and to promote the implementation of best practices across the VA health care system.

As part of the summit, PCF announced a $50-million precision oncology initiative to expand prostate cancer clinical research among veterans to speed the development of new treatment options and cures for prostate cancer patients. The agreement is the first partnership between PCF and VA, and it comes at a time when an estimated 12,000 veterans each year are diagnosed with prostate cancer, making it the most frequently diagnosed cancer among Veterans. In particular, African-Americans are 64 percent more likely to develop prostate cancer compared to any other race or ethnicity and 2.4 times more likely to die from the disease. The goals of the PCF partnership are to increase the number of Veterans Health Administration (VHA) investigators applying to PCF for funding; increase the number of VHA facilities involved in precision medicine/prostate cancer clinical trials; increase the number of veterans enrolled in studies, providing veteran specimens or data used in studies as well as increase the number of minorities enrolled in PCF studies; and increase the number of early career scientists working on prostate cancer research. For more information about the Launch Pad event visit the VA website http://www.blogs.va.gov/VAntage/33183/launch-pad-event-brings-together-greatest-minds-in-cancer-care. [Source: NAUS Weekly Update | December 1, 2016 ++]

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VA Home Loan Update 44 ► Usage Tripled After Mortgage Crisis

Home loans through the Department of Veterans Affairs more than tripled in the wake of the 2007-2009 mortgage crisis, providing a critical line of lending credit to tens of thousands of veterans trying to buy a house, according to a report released 29 NOV. Researchers say those numbers show the quiet importance of the VA program, a benefit used by million of veterans but often getting less attention than initiatives like health care coverage and education stipends. “This is a stable, accessible form of credit that has helped a lot of families,” said Keith Wiley, a research associate at the Housing Assistance Council and co-author of the report. “And over the years it has been expanding.” The report, funded in part by the Home Depot Foundation, found nearly 9 percent of all home mortgages in America in 2014 were backed by VA, up from 2 percent a decade earlier.

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Before the recession, those loans totaled around 140,000 a year. Today, those numbers are closer to 510,000, making them the third-largest home loan type in the country (behind conventional commercial mortgages and loans backed by the Federal Housing Administration). That’s still far from the peak of importance for the loans, which began in 1944 as part of the original GI Bill. Just two years after the program was created, more than 40 percent of all mortgages in America were VA-guaranteed loans. But researchers for the HAC report said that the benefit is often overlooked by lawmakers and public planners, even if it still receives significant use from veterans. “There has been a VA home loan in nearly every county in America,” said Moises Loza, HAC executive director, in a statement. “There are more than 100 counties where VA loans make up 20 percent of the loan population. … The military community truly relies on the VA Home Loan program to provide a home for their families.”

Researchers said they did not see a significant drop in the rejection rate of loan applications as the total mortgage count rose in recent years, another sign they say indicates stability and accessibility for veterans. VA officials said nearly 40 percent of the loans approved in recent years were issued free of service charges, since the applicants qualified for disabled veteran status. HAC officials said they hope the new report will be used as part of broader planning efforts on veterans homelessness and financial health, and to drive national policies on those issues. [Source: Military Times | Leo Shane | November 29, 2016 ++]

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VA Blood Pressure Study ► ACC/Nam Vet Hypertension Links

VA researchers found a link between service-related occupational exposure to herbicides and high blood pressure (hypertension) risk among U.S. Army Chemical Corps (ACC) Veterans, a group of Veterans assigned to do chemical operations during the Vietnam War. Researchers also found an association between military service in Vietnam and hypertension risk among these Veterans.

Researchers at VA’s Post Deployment Health Services Epidemiology Program, Office of Patient Care Services, conducted the Army Chemical Corps Vietnam-Era Veterans Health Study, a three-phase study of nearly 4,000 Veterans who served in the U.S. Army Chemical Corps between 1965 and 1973. The study included a survey that requested information on these Veterans’ exposure to herbicides, whether they were ever diagnosed with hypertension by a physician, and their health behaviors such as cigarette smoking and alcohol use. To confirm self-reported hypertension, researchers conducted in-home blood pressure measurements and a medical records review for a portion of study participants.

ACC Veterans were studied because of their documented occupational involvement with chemical distribution, storage, and maintenance while in military service.This study follows a request by former Secretary of Veterans Affairs Eric K. Shinseki for VA to conduct research on the association between herbicide exposure and hypertension to learn more about if hypertension is related to military service in Vietnam. The research was originally designed and led by Han Kang, Dr.P.H., former director of VA’s Epidemiology Program (now retired). Yasmin Cypel, Ph.D., M.S., another researcher with VA’s Epidemiology Program, is currently the principal investigator on this study, which extends prior research on these Veterans. “This study expands our knowledge of the relationship between hypertension risk and both herbicide exposure and service in Vietnam among Veterans who served during the War by focusing on a specific group of Vietnam era Veterans who were occupationally involved in chemical operations,” said Dr. Cypel.

Self-reported hypertension was the highest among Veterans who distributed or maintained herbicides (sprayers) in Vietnam (81.6%), followed by Veterans who sprayed herbicides and served during the Vietnam War but never in Southeast Asia (non-Vietnam Veterans) (77.4%), Veterans who served in Vietnam but did not spray herbicides (72.2%), and Veterans who did not spray herbicides and were non-Vietnam Veterans (64.6%). The odds of

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hypertension among herbicide sprayers were estimated to be 1.74 times the odds among non-sprayers, whereas the odds of hypertension among those who served in Vietnam was 1.26 times the odds among non-Vietnam Veterans.

The researchers would like to extend their thanks to all those Army Chemical Corps Vietnam Era Veterans who participated in this study for their contribution to the research. Without their input there would be no findings to report and no additions to existing findings on the health consequences of military service during the Vietnam War. VA will review the results from this research, along with findings from other similar studies and recommendations from the recent National Academies of Science report on Veterans and Agent Orange, when considering whether to add hypertension as a presumptive service condition for Vietnam Veterans. To read more about the Army Chemical Corps Vietnam-Era Veterans Health Study, go to http://www.publichealth.va.gov/epidemiology/studies/vietnam-army-chemical-corps.asp. To read the published article containing findings from this study, go to https://www.ncbi.nlm.nih.gov/pubmed/27820763. [Source: VAntage Point | Stephanie Green | November 29, 2016 ++]

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VACAA Constitutionality ► U.S. Court of Appeals Hearing

The U.S. Court of Appeals for the Federal Circuit ordered oral argument 5 DEC in the Helman v. Department of Veterans Affairs case -- in which the constitutionality of the Veterans Accountability, Choice, and Access Act will be defended. NAUS (National Association for Uniformed Services) and a number of other VSOs got involved in this case as intervenors to defend both the Constitution and the rights of veterans nationwide who rely on VA facilities for their medical care. The Court accepted NAUS's petition to intervene and has now givrn them the opportunity to present oral argument in defense of this critical statute. Michael T. Morley, a Washington, D.C., attorney who specializes in appellate and election law, was scheduled to argue NAUS's position.

Due to the importance of the case, the court extended oral argument time to a full hour; arguments usually are only thirty minutes. Moreover, as intervenors, NAUS will be presenting their own argument opposing both Helman and the Government, both of whom are asking the Court to strike down the VACAA. Following the argument, the Court will likely take 4-6 months, and possibly longer, to rule. Without the participation of the intervening military and veterans groups, the Court likely would already have invalidated the VACAA at the joint request of Helman and the Government, and, in consequence, Helman, the former director of the scandal ridden Phoenix VA hospital, might be on her way to once again administering her style of care to sick and disabled veterans at the Arizona VA hospital. [Source: NAUS Weekly Update | December 2 , 2016 ++]

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Seasonal Affective Disorder Update 01 ► Winter Blues Treatment

While it may be just a temporary case of “winter blues” for most people, for others the long cold days of winter can be a serious psychological problem. It’s called Seasonal Affective Disorder — and never has an acronym been more apropos: SAD. According to Dr. Joseph V. Pace, Chief of Psychiatry at the Alaska VA Medical Center, SAD is defined as “recurring depression with seasonal onset and remission.” Two seasonal patterns of SAD have been described: the fall-onset SAD and the summer-onset SAD. The fall-onset type, also known as “winter depression,” is most recognized. In this subtype, major depressive episodes begin in late fall to early winter and decrease during summer months. Dr. Pace adds that some of the symptoms of SAD include increased appetite, weight gain, sleep loss, decreased energy and lack of motivation. He notes that, “Usually, we do not see pure seasonal depression, but seasonal worsening of pre-existing depression. Also, low vitamin D levels are common in our Alaskan vets and can

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correlate with depression. We screen for that and treat it.” One of the treatments he recommends is aerobic exercise, “which can sometimes help.”

The cause of SAD is not well understood. It is believed that the decreasing daylight available in fall and winter triggers a depressive episode in people predisposed to develop the disorder. However, no studies have established a causal relationship between decreasing daylight and the development of winter SAD. One of the most effective remedies for dealing with the condition is light therapy. Light therapy has proven effective in a limited number of small, placebo-controlled studies. The usual dose is 10,000 lux (the intensity of light that hits or passes through a surface) beginning with one 10-to-15 minute session per day, usually in the morning, gradually increasing to 30-to-45 minutes per day, depending upon response. It may take four- to- six weeks to see a response, although some patients improve within days. Therapy is continued until sufficient daily light exposure is available through other sources, typically from springtime sun.

Light therapy is considered first-line therapy in patients who are not severely suicidal, have medical reasons to avoid antidepressant drugs, have a history of a positive response to light therapy, or if the patient specifically requests it. Medication is also an option in some cases. Drugs may be a better option in patients with significant functional impairment or who are at high suicide risk, for patients with a history of moderate to severe recurrent depression and for patients who have had a prior positive response to antidepressants or mood stabilizers or who have failed other therapies. Dr. Pace recommends that any Veterans experiencing unusual depression during the winter months should see their VA doctor as soon as possible. [Source: VAntage Point Blog | December 1, 2016 **]

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VA Digital Health Platform ► Program Detailed Overview

The Department of Veterans Affairs has launched a new website to raise awareness of the agency’s Digital Health Platform (DHP) – a cloud-based approach to integrating veterans health data to produce what the agency calls real-time, analytics-driven, personalized care. The  new site at http://www.oit.va.gov/specialreports/dhp/index.html provides a detailed overview of how the DHP will work, the emerging technologies it will leverage, and provides user case studies to show how veterans will benefit from a comprehensive dashboard that can enable customized care.

VA’s Digital Health Platform is the agency’s vision for moving beyond a system centered on a specific electronic health record, or EHR. VA’s current EHR platform, known as VistA, is a 40-year-old system that the agency continues to modernize while it debates a potential commercial replacement. “Much has changed at VA since VistA was first introduced,” states a fact sheet provided to MeriTalk by a VA spokesperson. “The average age of a Veteran has increased from 46 to 60, VA serves 500% more female Veterans, and the suite of specialty services the Department provides, like prosthetics and mental health care, has continued to expand.”

Announced earlier this year, VA’s Digital Health Platform is a 25-year strategy that goes well beyond the choice of an EHR, including financial management, CRM, supply chain management, and human resources. According to the new website, “DHP provides a comprehensive dashboard spanning a veteran’s complete health record. DHP is a cloud-based technology platform integrating Veteran data from VA, military and commercial electronic health records (EHRs), applications, devices and wearables to a Veteran’s healthcare team in real-time.”

During a Senate hearing in July, VA Chief Information Officer LaVerne Council described the Digital Health Platform as a system of systems. “It is not dependent on any particular EHR, and VA can integrate new or existing resources into the system without sacrificing data interoperability. One of the digital health platform’s defining features will be systemwide cloud integration, a marked improvement over the more than 130 instances of VistA that we have today,” Council said. “A decision on the EHR component of DHP will be decided by the department

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after the business case and cost analysis is complete–as several EHR options are being evaluated,” a VA spokesman said. “DHP is agnostic to an EHR, and during the proof of concept, DHP was shown to work with VistA,  Cerner, and Regenstrief GOPHER (a European EHR).” The VA spokesman said the agency is working toward completing the business case and a rough cost estimate for the DHP later this month.

Digital Health Platform Case Study: Byron https://youtu.be/Lqjq1OBWRY4

[Source: MeriTalk | Dan Verton | December 8, 2016 ++]

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VA Burial Payment ► DVA Maryland Delays | $2.7M

Delays in dispersing money at the U.S. Department of Veterans Affairs left Maryland on the hook for $2.7 million in costs for burying veterans, state auditors found. Some of the federal payouts were delayed more than three years, the Office of Legislative Audits said in a report published 8 DEC. The VA is in the process of paying the state back. The VA told the auditors that the delays were caused by staff turnover in the department that handles the payouts. Peter Pantzer, the finance director at the state Department of Veterans Affairs, told The Baltimore Sun that the federal authorities had made a "specific effort to clean this up." In the six months since the end of the audit period, the VA has paid off a year's worth of the backlog, Pantzer said. The agency is now processing two months' worth of claims every month to eliminate the rest.

The delays are the latest problem at the VA. The department has faced criticism in recent years that it has been too slow to award benefits to veterans and had a huge backlog of cases. At one point the Baltimore benefits office was among the worst performing in the country. The burial benefits are separate from those disability payouts. When a veteran is buried in a state cemetery, the state can apply for about $730 from the federal government, auditors said. They found that state officials were slow in applying for the money — sometimes submitting requests almost six months late — and the VA was slow in making payouts. The state had to step in to cover the gap, auditors said. Thomas J. Barnickel III, the auditor, said no veterans' families were directly affected by the problems.

A VA spokesman said officials are taking steps to address the problems. "The Baltimore VA Regional Office has established a working relationship with the state office to address these burial benefits and put a process in place to expeditiously pay all overdue burial benefits," he said. The auditors found other problems at the state Department of Veterans Affairs. The auditors said the department overpaid contractors that run a veterans nursing home in St. Mary's County by $180,000 after they didn't fill vacant positions. Pantzer said the payments were within the department's discretion, and that the contractor was actively looking to hire staff, not holding the positions open merely to reap the extra money.

In another case, the auditors said the department held on to $126,000 in credits from utilities companies that it should have returned to the state's general fund and the end of the year. Pantzer attributed that to a delay in getting advice from another state agency, and said the money was ultimately paid back. Pantzer said that before he was hired about two years ago, the team responsible for overseeing the department's finances had "frankly fallen apart."

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"We had to rebuild from scratch," he said. "We built up a unit." The department has made progress, Pantzer said, and he was generally pleased with the audit's findings. "We're not perfect but we're getting better," he said. "I was personally quite happy frankly with what this audit reported." [Source: The Baltimore Sun | Ian Duncan | December 8, 2016 ++]

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Vets.gov Update 03 ► Use to Manage Health Care & Benefits

Veterans can now access and manage their health care and benefits more easily and securely online through a single sign-on on the https://www.vets.gov website, the Department of Veterans Affairs announced in early DEC. The portal, operated through an API from veteran-owned digital identity-management company ID.me, meets the National Institute of Standards and Technology's Level of Assurance 3, which confirms a veteran is who they say they are online to the highest degree of certainty currently available. The VA claims it is the first federal agency to meet that LOA 3 standard.

Using a multi-factor authentication process from ID.me on the recently launched Vets.gov website, veterans can now access several services that were spread across several websites, like checking on a benefits claim, communicating with a health care provider and ordering prescription refills. “This move is just the latest step in VA’s effort to improve Veterans’ access to VA services and information,” VA CTO Marina Martin said in a statement. “Protecting Veterans’ privacy and personal information is central to our mission, and these improvements keep that commitment while making communication with VA more convenient and accessible.”

Before the partnership with ID.me, veterans had to verify their identity in person with the VA to access services online, ID.me CEO Blake Hall said. “Now, Veterans can easily verify their identity at Vets.gov from their own home or on the go," he said. "The net result is a substantial improvement in access and customer experience.” ID.me was chosen in May as a subcontractor for Maryland-based Ad Hoc LLC's $12.9 million contract to support the iterative development of Vets.gov, which the VA launched on Veteran's Day 2015 as a consolidation of the department's many websites and services into one central, vet-friendly portal. [Source: Fed Scoop | Billy Mitchell | December 8, 2016 ++]

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VA Fraud, Waste & Abuse ► Reported 1 thru 15 DEC 2016

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Chesapeake, VA — William E. Grobes, IV, 45, of Chesapeake, pleaded guilty 30 NOV to charges of conspiring to commit wire fraud and money laundering. According to the statement of facts filed with the plea agreement, Grobes owns the College of Beauty and Barber Culture (CBBC), located in Chesapeake. CBBC was purportedly a barber and cosmetology school approved by the Department of Veterans Affairs to provide education and training to military veterans, including veterans who received tuition assistance under the Post-9/11 GI Bill. Grobes represented to the VA that CBBC provided full-time schooling to hundreds of veteran students beginning in October 2011. In reality, the school was a sham. Most veterans enrolled in CBBC courses received few, if any, hours of instruction from CBBC employees, and there were no tests, exams, or practical exercises given. Rather, students were directed to simply sign in and out of the school each day so that Grobes could report to the VA that they were enrolled and attending.

In exchange, CBBC received Post-9/11 GI Bill tuition payments for each veteran from the VA. Based on Grobes’ provision of false information to the VA concerning the number of hours of instruction and the manner and quality of the instruction provided to veteran students, CBBC received over $4.5 million in Post-9/11 GI Bill tuition payments between October 2011 and September 2016. Grobes was charged by criminal information on 16 NOV, and faces a maximum penalty of 20 years in prison when sentenced on March 8, 2017. The maximum statutory sentence is prescribed by Congress and is provided here for informational purposes, as the sentencing of the defendant will be determined by the court based on the advisory Sentencing Guidelines and other statutory factors. [Source: DOJ US Attorney's Office | Eastern Dist of VA | November 30, 2016 ++]

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Council Bluffs, IA — A southwest Iowa woman has been imprisoned for using a veteran's name and military service information to falsely obtain a Department of Veterans Affairs home loan. Prosecutors say 34-year-old Mandy Whipple was sentenced 2 DEC to 18 months in federal prison. She'd pleaded guilty in June to mortgage fraud for falsifying loan papers to buy a house in Fremont County. Prosecutors say a report of delinquent payments led to the discovery that Whipple had falsified the loan documents, using information about a military veteran who employed her. The judge ordered Whipple to make restitution of nearly $42,000 to the VA, nearly $29,000 to a mortgage company and nearly $6,000 to another lender. [Source: The Associated Press | December 6, 2016 ++]

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Lynn, MA —A Lynn man has been sentenced to a year of probation for stealing nearly $80,000 in federal veterans' benefits that were erroneously sent to his dead neighbor. Prosecutors say 73-year-old John Ladd was sentenced 1 DEC to spend the first six months of the probationary period in home confinement and was ordered to pay full restitution to U.S. Department of Veterans Affairs. He pleaded guilty in August to stealing public money. Prosecutors say Ladd was a caretaker for the woman who died in 2009. But the U.S. Department of Veterans Affairs was not properly notified of the death and continued to deposit her benefits into her bank account each month. Ladd wrote 70 checks to himself from the neighbor's account, forging her signature, and deposited them into his own account. [Source: The Associated Press | December 7, 2016 ++]

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Mandeville, LA — Ricky P. Templet, 54, was sentenced 8 DEC to nine months in prison for his involvement in a scheme to fraudulently obtain benefits from the federal Department of Veterans Affairs. He was also ordered to pay $16,760 in restitution to the VA and must report to Northlake Behavioral Hospital for drug treatment within 24 hours of his release from prison, authorities said. According to court records, the Department of Veterans Affairs' Office of Inspector General determined that Templet had become his mother's fiduciary the day before she died in 2013. As fiduciary, Templet was required to notify the VA when his mother passed away, but failed to do so, according to a news release from U.S. Attorney Kenneth Polite's office. After his mother's death, Templet

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received and deposited 15 U.S. Treasury checks totaling approximately $16,673, according to the release. He was indicted 3 MAR for theft of government funds and aggravated identity theft. Templet was sentenced by U.S. District Judge Eldon E. Fallon, who was appointed to the bench by President Bill Clinton. Assistant U.S. Ricky P. Templet is not the same person as Jefferson Parish Council member and former state Legislator Ricky J. Templet. [Source: The New Orleans Times-Picayune | Kim Chatelain | December 8, 2016 ++]

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Council Bluffs, Ia — On December 2, 2016, Mandy Lea Whipple, formerly Mandy Lea Johnson, a 34 year-old resident of Page County, Iowa, was sentenced by United States District Court Judge Stephanie M. Rose, to 18 months in prison followed by five years of Supervised Release for Mortgage Fraud, announced United States Attorney Kevin E. VanderSchel. Whipple entered a guilty plea on June 9, 2016, to Mortgage Fraud for falsifying mortgage loan papers to purchase a house in Fremont County, Iowa. The investigation began with a report of delinquent payments on the purchased Fremont County residence, leading to the discovery that Whipple had falsely obtained a Veteran Administration’s loan to purchase the home, using the name and identifiers of a military veteran that employed her. As part of the sentence, the Court ordered Whipple to make restitution to the Veteran’s Administration in the amount of $41,675.00; to J.G. Wentworth Mortgage Home Lending, LLC, in the amount of $28,904.27; and to Discover Financial Services in the amount of $5,780.04. [Source: DOJ US Attorney's Office | Southern Dist of IA | December 5, 2016 ++]

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Boston, MA — Several pharmaceutical executives and managers, formerly employed by Insys Therapeutics, Inc., were arrested today on charges that they led a nationwide conspiracy to bribe medical practitioners to unnecessarily prescribe a fentanyl-based pain medication and defraud healthcare insurers. The indictment alleges that Michael L. Babich, 40, of Scottsdale, Ariz., the former CEO and President of the company; Alec Burlakoff, 42, of Charlotte, N.C., former Vice President of Sales; Richard M. Simon, 46, of Seal Beach, Calif., former National Director of Sales; former Regional Sales Directors, Sunrise Lee, 36, of Bryant City, Mich. and Joseph A. Rowan, 43, of Panama City, Fla.; and former Vice President of Managed Markets, Michael J. Gurry, 53, of Scottsdale, Ariz., conspired to bribe practitioners in various states, many of whom operated pain clinics, in order to get them to prescribe a fentanyl-based pain medication. The medication, called “Subsys,” is a powerful narcotic intended to treat cancer patients suffering intense episodes of breakthrough pain. In exchange for bribes and kickbacks, the practitioners wrote large numbers of prescriptions for the patients, most of whom were not diagnosed with cancer. The indictment also alleges that the now former corporate executives charged in the case conspired to mislead and defraud health insurance providers who were reluctant to approve payment for the drug when it was prescribed for non-cancer patients. They achieved this goal by setting up the “reimbursement unit” which was dedicated to obtaining prior authorization directly from insurers and pharmacy benefit managers.

The defendants were arrested 8 DEC in their respective states and will appear in U.S. District Court in Boston at a later date. Babich is charged with conspiracy to commit racketeering, conspiracy to commit wire and mail fraud and conspiracy to violate the Anti-Kickback Law; Burlakoff, Simon, Lee and Rowan are charged with RICO conspiracy, mail fraud conspiracy and conspiracy to violate the Anti-Kickback Law; Gurry is charged with RICO conspiracy and wire fraud conspiracy. The indictment also alleges that the conspiracy to bribe practitioners and to defraud insurers generated substantial profits for the defendants, their company, and for the co-conspirator practitioners. On the charges of conspiracy to commit RICO and conspiracy to commit mail and wire fraud, the charging statute provides a sentence of no greater than 20 years in prison, three years of supervised release and a fine of $250,000, or twice the amount of pecuniary gain or loss. On the counts of conspiracy to violate the Anti-Kickback Law, the charging statute provides a sentence of up to five years in prison, three years of supervised release and a $25,000 fine. Actual sentences for federal crimes are typically less than the maximum penalties.

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Sentences are imposed by a federal district court judge based upon the U.S. Sentencing Guidelines and other statutory factors. [Source: DOJ US Attorney's Office | Dist of MA | December 8, 2016 ++]

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Shreveport, LA — United States Attorney Stephanie A. Finley announced 8 DEC that a Bossier City woman was sentenced to 12 months in prison for fraudulently taking more than $90,000 in federal benefits that were payable to her deceased mother. Gloria Lynn Perry, 67, of Bossier City, La., was sentenced by U.S. District Judge S. Maurice Hicks Jr. on one count of theft of government property.  She was also sentenced to three years of supervised release and ordered to pay $ 88,915.15 restitution. According to the July 24, 2015 guilty plea, Perry stole $90,000 of her mother’s Veteran’s Affairs Dependency and Indemnity Compensation benefits from April 1, 2008 until July 1, 2014. Her mother died in 2008 and was no longer entitled to the benefits. In addition, Perry filed for Chapter 13 bankruptcy in 2014, but she did not report the existence of the bank account where her mother’s benefits were deposited nor the income she received as a result. [Source: DOJ US Attorney's Office | Dist of MA | December 8, 2016 ++]

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Fisher House Expansion Update 16 ► 14 New Sites Proposed

The Fisher House offers unique accommodations when a family member is receiving treatment at a VA medical center or military hospital. Located near the medical center or hospital, Fisher Houses offer the comforts of home at no cost to families while treatment is underway. To enable Fisher Houses to expand their good work, Department of Veterans Affairs’ Secretary Robert A. McDonald recommended 14 VA medical centers become priority sites for future Fisher Houses. “Fisher House is simply one of those best-in-class organizations and we want to do everything that we can to support their important and noble mission,” said Secretary McDonald. “Their goal is selfless: to serve the families of Veterans who served our nation.” The 14 recommended sites are:

James J. Peters VA Medical Center, Bronx, N.Y. VA Hudson Valley Health Care System, Montrose, N.Y. Southeast Louisiana Veterans Health Care System, New Orleans Kansas City VA Medical Center, Kansas City, Mo. VA Ann Arbor Healthcare System, Ann Arbor, Mich. White River Junction VA Medical Center, White River Junction, Vt. Huntington VA Medical Center, Huntington, W.Va. William Jennings Bryan Dorn VA Medical Center, Columbia, S.C. Bay Pines VA Healthcare System (second house), Bay Pines, Fla. Hunter Holmes Maguire VA Medical Center (second house), Richmond, Va. Harry S. Truman Memorial Veterans' Hospital, Columbia, Mo. Perry Point VA Medical Center- VA Maryland Health Care System, Perry Point, Md. South Texas Veterans Healthcare System (second house) San Antonio Overton Brooks VA Medical Center, Shreveport, La.

Following the Secretary’s recommendations, a timeline for construction will be completed by the Fisher House Foundation based on VA and Department of Defense construction priorities. In 2016, Fisher Houses accommodated over 23,000 families, saving guests over $3 million in lodging expenses. The addition of 14 VA Fisher House sites will support access to care for thousands of additional Veterans traveling to VA facilities for treatment. The Fisher House Foundation has built and donated 31 Fisher Houses to VA and 40 Fisher Houses to the Department of Defense. VA has 16 Fisher House sites in various stages of construction planning, with the newest being built in Charleston, S.C., Houston and Orlando, Fla. With the additional locations, VA will expand to at least 61 houses over

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the next several years. Go to http://www.socialwork.va.gov/fisher.asp for more information on Fisher Houses. [Source: VA News Release | December 12, 2016 ++]

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VAMC Tomah WI Update 17 ► Dental Patient Recall

The health of hundreds of veterans is in question because a dentist at the Tomah Veterans Affairs Medical Center failed to meet proper cleaning standards. Tomah VA acting medical director Victoria Brahm said 29 NOV 592 veterans that received care from the dentist can receive free screenings for Hepatitis B, Hepatitis C and HIV. At a news conference, Brahm said a dental assistant reported last month that the dentist had not properly cleaned equipment, so an investigation was launched. Brahm says the dental equipment may have been cleaned, but it didn't meet VA standards. Fifty-four veterans that had bridge and crown work done received phone calls about the problem. The others affected will receive letters. Brahm said "I pray no one has an infection," but added the risk is low. [Source: Associated Press | November 29, 2016 ++]

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VAMC New Orleans LA ► New Facility Open for Business

Department of Veterans Affairs Under Secretary for Health Dr. David Shulkin acknowledged the long wait southeastern Louisiana veterans have endured since Hurricane Katrina obliterated the 1951-built former VA medical center in downtown New Orleans 11 years ago. “People have been waiting a long time, but I think no one has been waiting longer than a gentleman I got to meet this morning,” Dr. Shulkin said, pointing to a World War II Army veteran seated in the front row of the 25 NOV dedication ceremony of the new Southeast Louisiana VA Medical Center. “Mr. Lawrence Brooks started to get his care here in 1945. He has been waiting a long time. He is 107 years young.”

“This is great – a long time coming,” Brooks said with a proud smile as veterans, families, politicians, health-care providers and others cheered his service in the shadows of a shimmering new VA hospital of 1.6 million square feet now in operation between Canal Street and Tulane Avenue, near the heart of a city that looked like an atomic bomb hit it in 2005. “We did this for you, Mr. Brooks,” Dr. Shulkin said. “Thank you for your service. Thank you for waiting this long.”

The storm and its aftermath, which damaged or destroyed about 80 percent of the city, shut down all but the top two floors of the old VA medical center on Perdido Street. Hospitalized veterans had to be evacuated to facilities in surrounding areas and even other states, if they could get there, after the storm. VA quickly established triage care stations, some in tents and one in a vacant department store, to care for patients. A circuit of leased clinics around the metropolitan area was soon wired together as the city and region began the long, costly ordeal of rebuilding. More than 1,500 are estimated to have lost their lives. Property damage is calculated in the tens of billions of dollars, the costliest natural disaster in U.S. history.

From out of the crisis, as $600,000 in federal disaster-relief funding was appropriated immediately after the storm to get started on the new VA hospital, which was ultimately a $1 billion project, an opportunity arose. Opportunity became reality on when officials, including VA Secretary Robert McDonald and American Legion Past National Commander William Detweiler, cut the ribbon on the new Southeast Louisiana VA Medical Center, a centerpiece in an emerging biomedical corridor that has already shifted the city’s long-term economic outlook. “This is the culmination of 11 years of a lot of work, a lot of time and a large team of people that believed in the vision of bringing veterans health care back to southeast Louisiana,” said Detweiler, who has fought for the new hospital since before the flood waters had subsided from his own home in New Orleans. “It’s a spectacular facility. It

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provides cutting-edge medicine to veterans of this area, and it’s going to be a destination facility for a number of different major medical interests, such as neurology, orthopedics and mental health care.”

“It means a lot,” said Jay Walsh, a former American Legion department service officer who has been immersed in the VA medical center journey since the hurricane struck; his New Orleans home was nearly destroyed, as well, by the floods. A member of American Legion Post 175 in Metairie, La., which donated the U.S. flag that flies above the new medical center, Walsh said the facility is already having a positive ripple effect in a part of the city that had fallen into serious disrepair even before the storm. “Now, look at it. It’s a thriving place where veterans will be treated, and it’s gotten rid of the crime, and it’s going to employ a lot more than the 2,500 they said they were going to have.”

The facility, with 120 acute-care beds, occupies a 29-acre campus adjacent to a year-old University Medical Center teaching hospital staffed by Louisiana State University and Tulane University medical faculty, researchers, interns and students. University Medical Center health-care providers will augment more than 2,500 VA employees through an affiliation relationship that fully resumes now that both facilities are up and running after the storm. [Source: American Legion | Jeff Stoffer | November 18, 2016, ++]

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VAMC Phoenix AZ ► Whistleblowers Credited With Saving Lives

Two counselors at the Phoenix, Ariz., veterans hospital who blew the whistle on lapsed suicide-prevention procedures prompted changes that are saving lives, the Office of Special Counsel said on 5 DEC. In letters to the White House and Congress, the independent investigative agency said it verified disclosures from Brandon Coleman and Jared Kinnaman that the staff’s monitoring of veterans with mental health and substance abuse problems was not being done in compliance with a VA directive requiring that at least one qualified hospital employee observe each potentially suicidal patient at all times.

“The Emergency Department lacked safeguards preventing elopement, a situation where a patient is not permitted to leave, because they pose a danger to themselves or others, but intentionally does so,” the whistleblower protection agency said in a statement. “As a result of these deficiencies, Mr. Coleman and Mr. Kinnaman reported to OSC that 10 suicidal patients deemed 'high risk for suicide' eloped from the Emergency Department from October 2014 and February 2015. “Although these issues had been recognized by Phoenix VA leadership prior to the investigation, only after Mr. Coleman made his disclosures to OSC and went public in the press did the hospital come into compliance with the VA’s directive and move the rooms for these patients farther from the exit door,” OSC added. The facility also installed a delayed release on the door.

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Since these changes were implemented, the VA has reported no further cases of elopement from the Emergency Department. But a later report confirmed the whistleblower’s accounts that since February 2015, some potentially suicidal veterans treated elsewhere in the hospital have left the premises, as have veterans with substance abuse issues in the Emergency Department. The VA hospital has since improved interdepartmental communication and training in suicide prevention, OSC said.

In a related matter, OSC this spring facilitated resolution of a claim of whistleblower retaliation filed by Coleman through an Alternative Dispute Resolution program, moving him to a new position as an addiction therapist at nearby clinic. “Mr. Coleman and Mr. Kinnaman likely saved lives by speaking up for the veterans in the Phoenix VA’s care,” said Special Counsel Carolyn Lerner. “They prompted long-overdue changes to better protect veterans who are seeking help for their mental health and substance abuse issues. However, based on recent reports suggesting continuing problems, I urge the Phoenix VA to keep working with whistleblowers to improve veterans’ care.” [Source: GovExec.com | Charles S. Clark | December 6, 2016 ++]

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VAMC McGuire VA Update 01 ► Pharmacy Violations

A Union president is calling for a federal investigation of McGuire VA Medical Center. She says the hospital did not immediately fire its Assistant Chief of Pharmacy even though his license was suspended for fraudulently filling prescriptions. Did the delay jeopardize the care of the veterans it serves? he Assistant Chief of Pharmacy is Stuart Beasley. In a seven-page order, which he signed, it details numerous violations including filling prescriptions for himself using a false profile he created.

The order of consent reads Beasley filled 15 prescriptions for 1140 tablets of hydrocodone for personal and unauthorized use. It goes on to state he created a false prescription profile under the name "Stuart Beazley" using the letter "z" instead of "s" in the last name and using different addresses than his own. The order says he filled 23 prescriptions for himself for powerful drugs used to treat PTSD. All violations outlined by the Virginia Board of Pharmacy took place when Beasley was working a part-time job at Colonial Pharmacy on Mechanicsville Turnpike between 2012 and 2015. A representative there said when the DEA came into the pharmacy almost two years ago, Beasley was put on leave. When it all came to light, he was let go January 2015.

During all of this, Beasley was also working at McGuire, and the Union President says the hospital should have removed him long ago. "One of the requirements of being Assistant Chief of Pharmacy Service is to have a pharmacy license," said Union President Jennifer Marshall. "He does not have a pharmacy license. Therefore, he should not be getting paid at all." Beasley's license status - suspended indefinitely by the Virginia Board of Pharmacy. Marshall says McGuire did nothing until now. "He continued to hold a job at McGuire Assistant Chief, earning $160,000 a year," said Marshall. How? Why? Marshall suspects preferential treatment of top managers. "Theft of control substances, fraud, anybody else would in jail," said Marshall. "He's been allowed to get salary for four months even after the consent order suspending his license. He's there until Dec. 10. Now all the other people that are whistle blowers, they're detailed out of their position of record, openly humiliated but this guy they didn't take his badge. They didn't escort him off the property."

WWBT-12 Investigators reached out to hospital Director John Brandecker for answers about Beasley's license suspension and how it may have impacted his work with veterans who are patients at McGuire. All we got back was a one-line response from his Public Relations Officer: "The medical center is unable to discuss personnel issues." A year ago, WWBT-12 investigated a whistle blower's complaint about trash bags of unused medicines that should have been restocked. Marshall says that needs to be looked into. "He was around narcotics. Our taxes go to support veterans to help provide their care," said Marshall. The Union President says McGuire terminated Beasley effective

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10 DEC, 2016. McGuire calls it a personnel matter and will not comment. [Source: NBC WWBT-12 | Diane Walker | December 8, 2016 ++]

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VA HCS Bay Pines FL ► Body Left 9 Hours in Shower

Staff at a Veterans Affairs hospital in Florida left the body of a veteran in a shower for nine hours after the veteran died and proper pickup procedures to the morgue weren't followed. The Tampa Bay Times on Sunday reported that an internal investigation concluded that staff at the Bay Pines VA Healthcare System failed to provide appropriate post-mortem care to the veteran's body. The investigative report said that leaving the body unattended for so long increased the chance of decomposition. The unnamed veteran died in February after spending time in hospice care. The hospital's Administrative Investigation Board ordered retraining for staff. Hospital spokesman Jason Dangel said hospital officials view what happened as unacceptable but have implemented changes to make sure it doesn't happen again. "We feel that we have taken strong, appropriate and expeditious steps to strengthen and improve our existing systems and processes within the unit," Dangel said. "It is our expectation that each veteran is transported to their final resting place in the timely, respectful and honorable manner. America's heroes deserve nothing less."

The investigation found that once the veteran died, hospice staff members requested a staffer known as a "transporter" to get the body moved to the morgue. The transporter told them to follow proper procedures and notify dispatchers, but that request was never made, so nobody showed up to take the body away. Instead, it was moved to a hallway in the hospice and then to the shower room where it was unattended for more than nine hours. Some hospice staff "demonstrated a lack of concern, attention and respect" for the veteran, according to the investigative report. The investigation also found that staff failed to check a 24-hour nursing report that would indicate whether the death was reported properly, and staff failed to update a nursing organizational chart that hampered efforts to determine who was in charge. [Source: ABC-13 Eyewitness News | December 12, 2016 ++]

* Vets *

Enlistment Bonus Payback Update 06 ► NDAA Compromise Provision

House and Senate negotiators announced a compromise 29 NOV that would permit the Pentagon to forgive debts owed by thousands of California National Guard soldiers who received improper bonuses during the height of the wars in Iraq and Afghanistan. The agreement, included in the National Defense authorization Act (NDAA) due to be voted on by the House on 2 DEC and the Senate the following week, seeks to strike a balance between the Pentagon’s concerns about fraud in the bonus system and lawmakers’ attempts to resolve a scandal that has hurt thousands of military veterans and sparked a public furor. The compromise calls on the Pentagon to forgive the

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enlistment bonuses and student loan benefits unless the soldier who received the money “knew or reasonably should have known” that he or she was ineligible for it.

The provision stops short of requiring the Pentagon to forgive debts owed by all California Guard soldiers as long as they fulfilled the terms of their enlistment contracts and did not commit fraud — a far more sweeping waiver that members of the California delegation had proposed. But by placing the burden on the Pentagon to contact the soldiers and prove that each was ineligible, the compromise provision is likely to result in forgiveness of the debts for most of the 9,700 soldiers ordered to repay some or all of their reenlistment incentive payments from 2004 to 2015, according to lawmakers.

“This largely meets the needs of the soldiers who accepted their bonuses in good faith, as the vast majority of them did,” said Rep. Adam B. Schiff (D-Burbank). “It should give these soldiers peace of mind during the holidays that the Pentagon won’t claw them back.” Under the compromise, if the Pentagon forgives a soldier’s debts, it would have to inform credit agencies to correct any adverse effect on credit scores that could affect applications for car loans, mortgages and other debts. [Source: Los Angeles Times | David Cloud| November 28, 2016 ++]

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Wisconsin Veterans Homes Update 05 ► Immediate Jeopardy Citation

Democratic Senator Tammy Baldwin is calling on the Centers for Medicare and Medicaid to explain why it failed to post a serious citation it issued to the Wisconsin Veterans Home at King on its website for nearly eight months. Baldwin wrote a letter on 17 NOV to the agency's acting administrator, Andrew Slavitt, asking why a federal "immediate jeopardy" citation that was given to Olson Hall at the King home in March, following a resident's death, was not posted to the CMS Nursing Home Compare website until November. "Immediate jeopardy" is the most serious citation a nursing home can receive and could lead to a nursing home losing its license. According to the Centers for Medicare and Medicaid, immediate jeopardy is given to a situation that has “caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.”

The Wisconsin Department of Veterans Affairs, which runs the home, disputed the citation and appealed it, but emails from the CMS obtained by the Cap Times show that the federal agency has upheld its citation with no changes. According to the citation, a male resident at King died after he was not given CPR or any other lifesaving measures shortly after staff discovered he was not breathing. The resident had requested that CPR and other lifesaving measures be given when he was admitted to King, according to the CMS inspectors. "I ask to be provided a detailed account as to why the March 2016 immediate jeopardy citation was not posted on Nursing Home Compare in a timely fashion and what action is being taken to ensure such error or delay does not occur again," Baldwin wrote. She also asked for Olson Hall's quality rating to be reviewed to "ensure that it is accurate based on all available data," according to the letter.

In October, while the citation was still missing from the CMS website, Olson Hall received a five-star quality rating, the highest rating a nursing facility can receive. The three other residence halls on King's campus, Ainsworth, Stordock and MacArthur, also received five-star ratings — the first time every hall at King received five stars, according to the Wisconsin Department of Veterans Affairs. Outgoing WDVA Sec. John Scocos and Gov. Scott Walker have touted the CMS rating system as a rigorous and accurate metric of quality at its veterans homes, using its consistently high ratings to dispute employee and resident accounts of problems there. State lawmakers from both parties approved an audit of the King veterans' home in September. Baldwin agreed that the reputation of the CMS rating system is one of quality and fairness, and said she is troubled by the delay in posting the citation. "I am particularly alarmed that serious health and safety citations are not being accurately reported to, or timely captured by, the CMS database," she wrote.

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Last week, Olson Hall's rating was downgraded from five stars to four. The health inspection rating dropped to two stars as a result of the citation in March, but the overall rating is four stars because of high scores in other areas, according to CMS. Emails from a CMS official obtained by the Cap Times show that the federal agency upheld its citation against Olson Hall with no changes, and that the appeal process has ended. According to the CMS, when a facility appeals a citation, that particular deficiency is omitted from the five-star system until the appeal is complete. When it is done, the information is uploaded and incorporated into the Nursing Home Compare website. The nursing home compare survey data is updated on a monthly basis, the fourth Wednesday of each month, according to the CMS.

According to emails from the agency, the delay in uploading the citation promptly was due to an upload and data entry issue. Typically, complaints from the past three years and the three most recent and annual recertification surveys are included on the CMS site for a nursing facility. But the site does not show the most recent state inspections from September that detail citations at Olson Hall and MacArthur Hall, which are both part of the King home. In that report, state health inspectors found more than three dozen instances of medical errors at MacArthur Hall, which were a part of 14 total federal citations issued to the home following a two-week inspection in September. Among those errors, residents were found to be given the wrong medication, incorrect dosages or never received needed medicine. Olson Hall received 10 citations, which included more than 70 instances of food safety violations, according to inspectors. Neither report from Olson or MacArthur Hall are publicly available on the CMS website. [Source: The Capital Times | Katelyn Ferral | November 29, 2016 ++]

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GI Bill Update 215 ► Overseas College Utilization

From the Philippines to Iceland, an increasing number of U.S. military veterans are heading overseas to complete degrees at global universities, thanks to the Post-9/11 GI Bill. Many veterans say appealing aspects of studying at an overseas college include learning another language and receiving cheaper tuition, thanks in part to the exchange rate. The VA's list of approved international colleges now includes around 1,800 universities or training schools in more than 100 countries, says Curtis L. Coy, VA deputy undersecretary for economic opportunity. Countries include Colombia in South America, Romania in Europe and New Zealand. According to VA statistics, 2,007 Post-9/11 GI Bill students pursued either undergraduate or postgraduate degrees overseas in fiscal year 2015 compared with 806 in fiscal year 2010. Popular countries included the Philippines, Australia, the United Kingdom, Germany and various other countries in Europe.

U.S. veterans interested in pursuing an international education can either use the GI Bill Comparison Tool at https://www.vets.gov/gi-bill-comparison-tool to review the VA's approved list of universities or search for a specific college through the Web Enabled Approval Management System Institution Search available at http://inquiry.vba.va.gov/weamspub/buildSearchCountryCriteria.do Both tools are available on the VA website. The GI Bill Comparison Tool also helps veterans determine which benefits package is most suitable for them, including whether the package will provide enough money to study overseas. Veterans will need to account for a country's exchange rate in their calculations. If a veteran's preferred college is not on the approved list, he or she can apply to have the school added, provided it meets the VA's eligibility requirements.

One of the main requirements is that any training at a foreign school must be at an institution of higher learning that will result in a college degree or equivalent, according to the VA's website. If eligible, the VA will issue the veteran a Certificate of Eligibility, which shows the quantity and duration of benefits; veterans should obtain this before enrolling at a foreign university. Xiangyu (Sheila) Wu, international enrolment services officer at Cambrian College in Sudbury, Ontario, Canada, says that once veterans know if the foreign university is VA-approved, they should complete the school's application process. She says, ideally, those applying to foreign colleges should submit applications for their GI Bill benefits between three to six months prior to school starting.

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Coy from the VA says the Post-9/11 GI Bill pays up to $21,000 in tuition per year at approved foreign colleges, about $1,500 per month for housing and $1,000 annually for books. The Post-9/11 GI Bill, which replaced the Montgomery GI Bill in 2009, has also opened up global education opportunities to eligible veterans' family members. Active-duty service members must plan to complete 10 years of service to be eligible to transfer some or all of the Post-9/11 GI Bill benefits to a spouse or children. Coy says that after the service members leave the military, they cannot transfer the benefits; as such, they need to make plans prior to leaving the military. If you are considering utilizing this benefit you should fist review the following:

http://www.usnews.com/education/best-global-universities/articles/2015/10/07/prepare-for-the-hidden- costs-of earning-a-degree-overseas to anticipate some of the hidden cost.

http://www.usnews.com/education/best-global-universities/articles/2014/10/28/calculate-the-cost-of- earning-an-overseas-degree for information on calculating the cost of earning a degree overseas.

http://www.usnews.com/education/best-global-universities to review the rankings of the best global universities.

[Source: U.S. News & World Report | Jodie O'Brien | December 8, 2016 ++]

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WWII VETS 123 ► Ralph L. Rossman | Infantryman

Flipping through photographs and telegrams and handling bits of artillery shrapnel that earned him a Purple Heart, Ralph L. Rossman took time on 24 NOV to recall his service during World War II. Rossman, 95, of Normal, was 21 years old when the Army drafted him in November 1942. "I served for three years, one month and 23 days," said Rossman, proving his sharp memory.

The seventh of eight siblings, Rossman left his home in rural Minonk shortly after his brother was drafted. He completed basic training at Camp Blanding in Florida and was in camps throughout the U.S., including posts in Tennessee, Indiana and Boston. "In February of 1944, I boarded the S.S. Argentina in Boston with 5,000 troops," said Rossman. "We left on Lincoln's birthday, Feb. 12, and landed in Scotland on Washington's birthday, Feb. 22." After a train ride from Scotland to Bognor Regis along the English Channel, Rossman's unit first stayed in civilians' houses because the barracks were full. "They were afraid Germany was going to cross the Channel, so they kept us there for a while," he said.

While there, the company commander told Rossman's unit it was going to maneuver with an incoming armored unit. When the trucks rolled in the next day, Rossman realized it was his brother Wilbert's unit. "I hadn't seen him for two years. I asked the driver right away if he knew where my brother was and he said he'd holler for him," said Rossman. Before he could even return to camp to set his tent for the night, Rossman said his brother had rushed to find him. "It was quite a reunion for us, being that far away from home for so long," he said. Rossman recalls Gen. Dwight Eisenhower and British Army Commander Bernard Montgomery visiting his camp to see if troops were prepared for their first round of combat. "They cheered us on a little bit," said Rossman.

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Rossman's Memorabilia including his shrapnel dented dog tag

His first action was the Battle of Normandy at Omaha Beach on June 14, 1944, eight days after D-Day. "They had soldiers on this British ship with small assault boats filled with a dozen people. They put troops down in the water," said Rossman. "We got in the water and could just wade in. Some guys just didn't stand a chance because the water was too high. We were lucky, being on land at the beach. It felt real, then." While fighting in St. Jean de Daye in Normandy, Rossman was hit in the crook of his right shoulder by shrapnel from an artillery shell. "All I can remember is a couple of tanks burning up and shrapnel flying everywhere," he said. "I was paralyzed from the waist down." He vaguely remembers a buddy, who he still speaks with today, lying him down and sprinkling sulfa powder in his wound to prevent infection.

He was retrieved by medics who dressed his wounds and flown back to England for surgery. The feeling returned to his body. The shrapnel had clipped through his dog tag chain and a holy metal chain he wore from his mother. "Here I am at 95. My mother probably wore out her rosary. Somebody up above was watching out for me," he said. Rossman received the Purple Heart for his efforts in Normandy. He still has the twisted pieces of shrapnel taken from his shoulder along with other WWII mementos from his service, including the telegram informing his mother he had been wounded, photos from down time, his uniform and foreign coins. After working in the 14th base Post Office in France, he returned to the U.S. in 1945. "I remember when we were landing in Brooklyn, flying right past the Statue of Liberty and thinking, 'Oh my God, we made it,'" he said.

Rossman began working for the Minonk Post Office, married his wife, Bernadette, and had two daughters before moving to Normal. The couple has been married 60 years. In 2012, he took the Land of Lincoln Honor Flight to Washington, D.C., with his daughter, Theresa Weldy. More than 70 years after his service, Rossman said being in WWII has affected his view of patriotism in a few ways. "You wonder. Why do we have all this fighting? Why can't we do good for people instead of finding more reasons to fight war? It's hard to say," he said. "It makes you feel proud that people still remember you on Veterans Day. It's a duty we all did back then." [Source: The Pantagraph via AP | Julia Evelsizer | November 29, 2016 ++]

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WWII VETS 124 ► Lauren Bruner | USS Arizona Survivor

In 1941 Lauren Bruner was getting ready for church on his battleship, the USS Arizona, when the alarm sounded. The Japanese attack on Pearl Harbor had begun, and Bruner, then 21, scampered up five stories by ladder to the enormous anti-aircraft guns he was responsible for manning. But bullets hit his left leg and explosions set off by the Sunday morning bombardment rocked his ship before he could get to the weapons. The ship sank just nine minutes later. Bruner escaped, but suffered severe burns.

Back then Bruner didn't know who was attacking until the planes got close enough for him to see the red Rising Sun Japanese insignia on their sides. The aircraft shot at "everything in sight," he said. Then an explosion tore

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through his battle station. "That's where the flames blew right through and cooked me right there," Bruner said in a telephone interview from his home in La Mirada, California. With "everything burning," Bruner tried to get off the ship as fast as he could. But the water in the harbor 80 feet below — infused with leaked oil — was on fire, too, so jumping wasn't an option. Bruner and a few fellow shipmates shouted to a sailor on the ship moored next to the Arizona to toss over some rope. The six of them tied the rope and carried themselves hand-over-hand across the 100-foot expanse to the USS Vestal. "You're like a chicken getting barbecued," he said. All of them made it, becoming six of the 335 sailors and Marines on the Arizona to survive. Another 1,177 shipmates died. Most are still entombed in the wreckage.

Due to his burns, Lauren spent 7 months in a hospital, where they would soak his hands in brine water and then peel off the dead skin and then soak them in alcohol. After recovering, Lauren was given orders to the USS Coghlan, DD-606 and participated in eight major engagements. The USS Coghlan was decommissioned in 1945. He was transferred to the USS Duluth, CL-87 in Shanghai, China where he served until his discharge in late 1946 at a rank of Chief Fire Controlman.

Lauren married Marcella Stapleton on 25 July 1943 in Los Angeles, California. After 12 years of marriage, Marcella died on 12 August 1955 from tuberculosis. Lauren remarried Betty Jean Bruner, a friend of his first wife. They were married about 20 years when she slipped in their house and fell into a glass mirror and broke her back. She lived for about two weeks in the hospital before she passed away on 26 August 1983. His third wife, a widow, was a lady who lived next door. His current girl friend was a music teacher to the kids next door, and now suffers from Alzheimer's disease and resides in a nursing home. Lauren continues to live by himself in the Los Angeles, California area. He plans to be cremated and his ashes buried with his shipmates on the USS Arizona, who weren't as fortunate as himself.

Bruner, now 96, recently visited the memorial over the Arizona's sunken wreckage attending the remembrance ceremony at Pearl Harbor on the 75th anniversary of the Dec. 7, 1941, attack. He has traveled from his Southern California home for the events many times, but doesn't know how long the Arizona's few remaining survivors will able to keep up the tradition. "It's getting close to being the end pretty soon. There's only five of us left now," Bruner said. [Source: The Associated Press | Audrey McAvoy | December 5, 2016 ++]

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Famous Vets ► Martha Raye | Honorary USA/USMC

Born to a peripatetic vaudeville couple, Maggie Reed joined her parents' act as soon as she learned to walk, stopping the show with an energetic rendition of "I Wish I Could Shimmy Like My Sister Kate." After touring in a double act

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with her brother Bud, she made her Broadway debut in the 1934 revue Calling All Stars, where she was billed for the first time as Martha Raye. While appearing as a singer/comedienne at Hollywood's Trocadero, she was selected to appear in Paramount's Rhythm on the Range (1936), in which she introduced her trademark song, "Mr. Paganini." For the next four years she was Paramount's favorite soubrette, overemphasizing her big mouth and gorgeous legs in a series of zany comedy roles. She also proved to be a convincing romantic lead for Bob Hope (a lifelong friend).

During World War II, she joined with actresses Carole Landis, Kay Francis, and Mitzi Mayfair to form a United Service Organizations (USO) troupe, performing shows — often under difficult and dangerous conditions — for U.S. soldiers across Europe, the South Pacific, and North Africa. Raye performed a similar service for G.I.s in two more wars, entertaining thousands and thousands of troops at U.S. military bases in Korea in the early 1950s and in Vietnam from 1965 to 1973. She is fondly remembered by generations of service members not just for her tireless efforts in staging shows for U.S. soldiers all over the world, but for uncomplainingly enduring the same conditions they did and for going far beyond the role of an entertainer by tending to troops in the field, including working with medivac units in Vietnam to pick up wounded Americans and assist in field hospitals. For example, an October 1966 Associated Press article reported the following account: 

Comedienne Martha Raye, a front-line trouper for 24 years, changed her routine last week. She donned fatigues and worked for two days in an Army field dispensary, cleansing wounds, changing bandages and comforting GIs wounded in a Mekong Delta battle. The twangy-voiced brunette, who has gone from outpost to tiny outpost throughout Viet Nam to entertain American servicemen, sang, danced and ribbed the men of two Army aviation helicopter companies stationed in the Mekong Delta town of Soc Trang. The next morning, the chopper pilots and their crews delivered Vietnamese soldiers to the paddy fields and marshlands of the delta to charge the entrenched Viet Cong. As the first helicopters settled into the landing zones, they were met by intense fire. The landing zones were in the stronghold of a Viet Cong battalion.

Additional troops were brought in, and in the battle that followed four American helicopters were shot down and 20 were damaged. American casualties began arriving by 8 a.m., at the small Soc Trang dispensary. Miss Raye, a former nurse, arrived about the same time, dressed in Army fatigues and volunteering for duty. "She worked all day — until 9 that night — doing everything she could," one corpsman said. One of the first things she did was donate a pint of blood to a badly wounded sergeant. Then it was hour after hour of scrubbing and preparing the wounded for surgery, helping the surgeons, changing bandages, and cheering up men awaiting evacuation to field hospitals in Vung Tau or Saigon. Miss Raye's show did not go on that night. The next morning she was back at the hospital in her stained fatigues, helping one doctor and eight corpsmen care for the patients. Shortly before noon, when the work eased, Miss Raye flew 80 miles north to Vinh Long and performed that night for another unit of Army chopper crews who fly Vietnamese troops into battle. "She did a lot for the morale of the men who'd been shot up, and she did a lot for ours, too," said a corpsman at the dispensary.

As recognition of her efforts on behalf of U.S. service members, Martha Raye was given several honorary military designations, including the honorary ranks of lieutenant colonel in the U.S. Army and colonel in the U.S. Marine Corps (leading to her being dubbed "Colonel Maggie" by troops in Vietnam). In 1993 she was awarded the Presidential Medal of Freedom by President Bill Clinton for her service to her country, with a citation reading as follows:

A talented performer whose career spans the better part of a century, Martha Raye has delighted audiences and uplifted spirits around the globe. She brought her tremendous comedic and musical skills to her work in film, stage, and television, helping to shape American entertainment. the great courage, kindness, and patriotism she showed in her many tours during World War II, the Korean Conflict, and the Vietnam Conflict earned her the nickname 'Colonel Maggie.' The American people honor Martha Raye, a woman who has tirelessly used her gifts to benefit the lives of her fellow Americans.

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Raye, who died in Los Angeles at age 78, requested several years [earlier] to be buried at Fort Bragg, home of the Green Berets. She was to get her wish in 1994 after a ceremony with a flag-draped casket and military pallbearers. Raye entertained troops in Vietnam for nine straight years, four months a year, spending much of the time with isolated Special Forces detachments in camps all over the country. Normally, only active duty and retired Army personnel are buried on post, but the Defense Department granted an exception for Raye, who was made an honorary lieutenant colonel in the Special Forces in 1966 by President Lyndon B. Johnson. Martha is the only woman buried in the SF (Special Forces) cemetery at Ft. Bragg, North Carolina, a singular honor for a civilian: [Source: Snopes.com | David Mikkelson | August 22, 2012 ++]

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Vet Pain ► More Prevalent and Severe than in Nonveterans

American veterans experience higher prevalence of pain and more severe pain than nonveterans, with young and middle-aged veterans suffering the most, according to a new analysis of the National Health Interview Survey (NHIS) by the lead epidemiologist at the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health. This survey provides the first national estimate of severe pain associated with painful health conditions in veterans and nonveterans and underscores the importance of sustaining efforts to monitor and manage pain among veterans. “Our analysis showed that veterans were about 40% more likely to experience severe pain than nonveterans,” said Richard L. Nahin, Ph.D., lead author of the analysis. “As well, younger veterans were substantially more likely to report suffering from severe pain than nonveterans, even after controlling for underlying demographic characteristics. These findings suggest that more attention should be paid to helping veterans manage the impact of severe pain and related disability on daily activities.”

The analysis is based on data from the 2010-2014 NHIS, in which 67,696 adults (6,647 veterans and 61,049 nonveterans) responded to questions about the persistence and intensity of self-reported pain during the three months prior to the survey. The majority of veteran participants were men (92.5%), while the majority of nonveteran participants were women (56.5%). The survey data did not identify any specific aspects of military service, including branch of the armed forces, years of service, or whether the veteran served in a combat role. Among the findings from this analysis:

More veterans (65.5%) than nonveterans (56.4%) reported having pain in the previous three months. A higher proportion of veterans (9.1%) reported having severe pain than nonveterans (6.3%). Younger veterans (7.8%) were substantially more likely to report suffering from severe pain than

nonveterans (3.2%) of similar ages, even after controlling for underlying demographic characteristics.

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Veterans were more likely than nonveterans to have any back pain (32.8%), back pain with or without sciatica (12.2%, 20.5%), or joint pain (43.6%), but less likely to have jaw pain (3.6%) or migraines (10%).

The prevalence of severe pain was significantly higher in veterans with back pain (21.6 percent), jaw pain (37.5%), severe headaches or migraine (26.4%), and neck pain (27.7%) than in nonveterans with these conditions.

For nonveterans, as age increased, the prevalence of any pain and severe pain also increased; however, for veterans, those aged 50 to 59 were most likely to have severe pain, while the youngest and oldest groups were least likely to have severe pain.

Veterans aged 18−39 and 50−59 were more likely than nonveterans of the same ages to have any pain. Veterans aged 18−39 were also more likely to have severe pain than nonveterans in the same age group. However, veterans aged 70 or older were less likely to have severe pain than similarly aged nonveterans.

Male veterans (9.0%) were more likely to report severe pain than male nonveterans (4.7%); however, no significant difference was seen between the two female groups.

“These findings show that we still have much more to do to help our veterans who are suffering from pain,” said Josephine P. Briggs, M.D., director of NCCIH. “This new knowledge can help inform effective health care strategies for veterans of all ages. More research is needed to generate additional evidence-based options for veterans managing pain. Over time this research may help nonveterans as well.” NCCIH is partnering with the Department of Veterans Affairs and Department of Defense on 13 grants to research military and veteran health with a focus on nonpharmacological approaches to pain and related conditions. If desired you can view the graphics on the above at https://nccih.nih.gov/health/pain/veterans. [Source: NIH News Release | Journal of Pain | December 13, 2016 ++]

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Vet Jobs Update 203 ► Virginia MMAC Program

The Virginia Military Medics and Corpsmen Program (MMAC) launched on 1 JUL 2016 will help open the door to jobs in the New Virginia Economy to former military medics and corpsmen. These personnel receive extensive medical training and experience while on active duty, but some have not yet had the opportunity to receive the civilian licenses or certifications needed to practice outside of the military medical system. MMAC is designed to help create opportunities for these individuals to apply their skills and training in civilian medical facilities. Eligible vets who want to participate in this program will:

Work with Virginia health care employers to explore ways they can hire former military medics and corpsmen

Help fill workforce gaps for employers and keep veterans’ clinical skills up-to-date Allow Virginia employers to recruit motivated employees from a pipeline of 11,000 medics and corpsmen

who transition out of the military every year; many of whom will go on to become licensed health care professionals

Former military Medics and Corpsmen who decide to participate in the program will be subject to the following Guidelines:

The Program is scheduled to terminate July 1, 2018. Participants must have served as a medic, medical technician or corpsmen in the military. Applicants are evaluated and approved by MMAC prior to referral to a Partner Healthcare Systems (PHS).

The required skills and timeframes will vary by PHS. If greater than six months has elapsed since discharge, candidates may be required to demonstrate skills proficiency.

All participants must follow Virginia's PHS’s standard employment process.

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Participant's position title will be Clinical Care Technicians (CCT). This title may vary depending upon the PHS.

CCTs will be under the supervision of a PHS physician and/or designated member of the PHS nursing staff. CCTs pay rate, full, part-time, hourly or PRN status and/or benefits will be at the discretion of the assigned

PHS. Applicants not qualified to participate in the program will be referred to the DVS Veterans Transition

Assistance Program (VTAP) team. They will offer a variety of employment services and support

Virginia is the first state to offer this kind of innovative pathway for this subset of highly-skilled veterans. To apply or for more information on MMAC, contact the Virginia Department of Veterans Services at (804) 786-0571 or (804) 482-8528, mmac@dvs.virginia.gov, or www.dvs.virginia.gov. [Source: MMAC Program Manager | Beverly VanTull | November 29, 2016 +]

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Vet Jobs Update 204 ► Health Care Employment on the Rise

According to U.S. News and World Report, health care employment is on the rise. As the Boomer population ages, the demand for health care professionals is ever-growing. The need for at-home health, residential caregivers, and long-term care facilities are expected to significantly grow as life expectancies rise. As medical technology increases the number of people who recover from serious illness or injury, the number of patients who will require long-term therapy and care are also on the rise.Here are the 25 fastest growing jobs in the health care field:

OrthodontistDentistNurse AnesthetistPhysician AssistantNurse PractitionerPsychiatristPediatricianAnesthesiologistObstetrician and GynecologistOral and Maxillofacial SurgeonOptometristPhysical TherapistPodiatristSurgeonPhysicianRegistered NurseOccupational TherapistAudiologistSpeech-language PathologistProsthodontistPharmacistRadiation TherapistDietitian and NutritionistChiropractorRespiratory Therapist

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And these aren’t the only roles on the rise. As health care systems grow, so does the need for corporate, operational, and administrative support. And as long as technology continues to evolve, IT professionals and digital technicians will also be in demand. If you’re interested in one of these growing career paths, search VA's new career listings in your area at http://www.vacareers.va.gov and connect with their recruiters to discover why a career in health care with VA is right for you at http://www.vacareers.va.gov/veterans/contact-veso.asp. [Source: VAntage Point | December 2, 2016 ++]

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Vet Jobs Update 205 ► Post-9/11 vet Unemployment Rate Rises

The unemployment rate for the latest generation of veterans jumped to 6.5 percent in November, a notable increase that brings the rate to its highest level of 2016, government data show. But even with November's high unemployment rate included, the average 2016 rate is on track for 5 percent, a lower level of unemployment than has ever been recorded annually for post-9/11 veterans, Military Times calculations of Bureau of Labor Statistics information indicate. On the national level, the economy added 178,000 jobs, while the unemployment rate dropped from 4.9 percent in October to 4.6 percent in November. The last time the national unemployment rate was that low was August 2007 — before the recession. While the November unemployment picture for post-9/11 veterans might not look quite as good, there is still plenty of reason for optimism.

Unemployment rate for post-9/11 veterans 2008 - 2016

The unemployment rate spike from October, when the rate charted by the Bureau of Labor Statistics was 4.7% for post-9/11 veterans, is large. But such spikes are far from rare and are often followed by similarly large drops. For example, the rate jumped from 4.7% this February to 6.3% in March and then tumbled to 4.1% in April. Because the post-9/11 unemployment data is based on a very small sample size, such volatility is common. Economists advise not to pay too much attention to any one month's results but rather to look at multi-month trends. Those trends have been toward lower post-9/11 veteran unemployment for years, with unemployment dropping lower in 2016 than it has ever been before. A single month's rate spike cannot change that. [Source: MilitaryTimes | George Altman | December 2, 2016 ++]

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Vet Jobs Update 206 ► Lowe's Big on Vet with Service Dog

Charlotte may not know the difference between latex and oil-based paint, but she is eager to please the customer at the southwest Abilene Lowe's store. She dresses like most of the other employees, easily identifiable by the red-and-

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blue vest that everyone wears. She's shaggier than most employees, and sits around a lot. She doesn't say much. She has a nice smile. Oh, and those eyes that draw you in. Charlotte, who was "hired" just this fall, is a 10-year-old golden retriever. She brings her pal, Clay Luthy, to work with her. Clay is an Air Force veteran, a former C-130 loadmaster, who officially was the one hired by Lowe's. He "blew out" not one but both knees, which since has required five surgeries. He cannot bend his left knee and can slowly work his way down on his right knee to get to items on lower shelves.

Tough stuff for an otherwise sturdy 35-year-old man, who has a wife and three kids to support. But Clay's story is not a sad one. He makes do, which is a theme at a home improvement center, right? Besides, who focuses on him? "Everyone loves Charlotte," he said of his constant companion, who's trained to help Clay get back on his feet should he fall prone to the floor. More often, she's the one sprawled on the floor. When observed on 6 DEC you could see now and then customers having to maneuver carts around Charlotte which from their smiles did not seem to be a problem for them. "How cute," one woman said, slowing her trek through the store to see Charlotte. Also seen was Tinley Farmer, 4, with her parents. They were not in too much of a rush, so Tinley got to spend quality time with Charlotte, who rolled over for some serious belly rubs.

"Everybody loves Charlotte. This definitely was not part of the job description," Clay said. When he was hired, no one thought that Charlotte would entertain kids in the tow of parents searching for the right light bulb or considering a new appliance. And when a child is unhappy, it's Charlotte to the rescue. She calms them just by being Charlotte, the dog. It's a ruff job that she's up to, though more slowly these days. She's 10, after all. Clay can do several jobs, including filling in at the register. "I can do pretty much everything. We grew up with nothing, so we fixed things and did it ourselves," he said. He's a flex team member, meaning he roves the store in search of customers who need help. If he can't help them specifically, he finds someone who can. "That way people don't have to wait," he said.

Charlotte follows Clay Luthy as he returns items to shelves (left) and provides companionship

for 4-year old while her parent shop (right).

Now, Charlotte is not just tagging along to the store when Clay works. She is a service dog, and when she's on duty, she knows it's all business. But when she wears her Lowe's vest, made from an apron that employees used to wear, she knows it's OK to wander up to customers, wag her tail and look all cute, which almost always induces customers to pet her. Charlotte went up to a woman in a motorized wheelchair, who was delighted to see her. Clay then helped her trio find what they needed.

Clay, who's from central California, shipped out for Air Force basic training Jan. 29, 2002. If you know your history, you know what had happened a few months before. "I joined because of 9/11," he said, another in his family to enter the military. He turned 21 during tech school. He was stationed at Dyess Air Force Base for three years but because of his bad knees, he could not re-enlist. His primary job after getting out of the military was as a handyman. He frequented Lowe's and one day asked the store manager whom he had gotten to know if someone like him could

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be hired. Sure, go ahead and apply, he was told. A job eventually came open and he, and Charlotte, were hired. Her paperwork as a service dog checked out, he said, smiling. Clay learned that Lowe's is fine with service dogs. In fact, customers who bring a dog on a leash or carry one are welcome. One reason is that Lowe's does not sell food or beverages, he said. But it just seems right to see dogs in a home improvement store. Maybe you're wanting to build a doghouse.

The chain also is big on hiring veterans and doing projects to help veterans, Clay said. Thus, he feels right at home after close to two months on the job. He hopes to keep this job a while. Charlotte, though, is nearing retirement. At home is a 6-month-old golden retriever named Lola. She is being trained to take Charlotte's job. Clay said Charlotte's "golden" years may be spent visiting folks in hospitals and homes. He has reason to be thankful, he said. He has a job that he likes and a wonderful family. He arranged with Lowe's to be off Fridays during football season this year so he could see his oldest daughter march in the Cooper High School band. "I made it here. I have my family, my wife and kids," he said, smiling.

Bottom line, if you are a vet with a services dog looking for a job, check out Lowe's. Nothing ventured, nothing gained.

[Source: Abilene Reporter-News | Greg Jaklewicz | December 6, 2016 ++]

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Retiree Appreciation Days ► As of 14 DEC 2016

Retiree Appreciation Days (RADs) are designed with all veterans in mind. They're a great source of the latest information for retirees and Family members in your area. RADs vary from installation to installation, but, in general, they provide an opportunity to renew acquaintances, listen to guest speakers, renew ID Cards, get medical checkups, and various other services. Some RADs include special events such as dinners or golf tournaments. Due to budget constraints, some RADs may be cancelled or rescheduled. Also, scheduled appearances of DFAS representatives may not be possible. If you plan to travel long distances to attend a RAD, before traveling, you should call the sponsoring RSO to ensure the RAD will held as scheduled and, if applicable, whether or not DFAS reps will be available. The current updated schedule for 2016 is available at:== HTML: http://www.hostmtb.org/RADs_and_Other_Retiree-Veterans_Events.html== PDF: http://www.hostmtb.org/RADs_and_Other_Retiree-Veterans_Events.pdf== Word: http://www.hostmtb.org/RADs_and_Other_Retiree-Veterans_Events.doc

This schedule has been expanded to include dates for retiree\veterans activity related events such as Seminars, Veterans Town Hall Meetings, Stand Downs, Resource\Career Fairs and Other Military Retiree & Veterans Related Events for all military services. To get more info about a particular event, mouseover or click on the event under Event Location. Please report comments, changes, corrections, new RADs and other military retiree\veterans related events to the Events Schedule Manager at milton.bell126@gmail.com.

(NOTE: Attendance at some events may require military ID, VA enrollment or DD214. "@" indicates event requires registration\RSVP.)For more information call the phone numbers indicated on the schedule of the Retirement Services Officer (RSO) sponsoring the RAD.

To quickly locate events in your geographic area just click on the appropriate State\Territory\Country listed at the top of the schedule. They will look like this:

AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY Belgium Germany Italy Japan Korea Netherlands Thailand

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[Source: RAD List Manager | Milton Bell | December 14, 2016 ++]

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Vet Hiring Fairs ► 16 DEC thru 15 JAN 2016

The U.S. Chamber of Commerce’s (USCC) Hiring Our Heroes program employment workshops are available in conjunction with hundreds of their hiring fairs. These workshops are designed to help veterans and military spouses and include resume writing, interview skills, and one-on-one mentoring. For details of each you should click on the city next to the date in the below list. To participate, sign up for the workshop in addition to registering (if indicated) for the hiring fairs which are shown below for the next month. For more information about the USCC Hiring Our Heroes Program, Military Spouse Program, Transition Assistance, GE Employment Workshops, Resume Engine, etc. visit the U.S. Chamber of Commerce’s website at http://www.hiringourheroes.org/hiringourheroes/events . Vet Job Fairs being conducted in the next 30 days in state order include:

Washington, DC NBC4 Health and Fitness Expo Hiring FairJanuary 06 - 8:30 am to 1:00 pm Details Register

San Antonio, TX Veterans Job Fair January 12 - 11:00 am to 3:00 pm Norris Conference Centers

Tampa, FL Veterans Job FairJanuary 12 - 11:00 am to 3:00 pm Straz Center for the Performing Arts

[Source: Military Times, U.S. Chamber of Commerce Assn, http://civilianjobs.com/careeradvice/jobfairs.aspx & https://events.recruitmilitary.com | December 2016 ++]

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State Veteran's Benefits & Discounts ► South Dakota 2016

The state of South Dakota provides several benefits to veterans as indicated below. To obtain information on these plus discounts listed on the Military and Veterans Discount Center (MCVDC) website, refer to the attachment to this Bulletin titled, “Vet State Benefits & Discounts – SD” for an overview of the below benefits. Benefits are available to veterans who are residents of the state. For a more detailed explanation of each of the below refer to http://vetaffairs.sd.gov & http://militaryandveteransdiscounts.com/location/south-dakota.html

Veteran Housing Benefits Veteran Financial Assistance Benefits Veteran Education Benefits

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Other State Sponsored Veteran Benefits Discounts

[Source: http://www.military.com/benefits/content/veteran-state-benefits/south-dakota-state-veterans-benefits.html December 2016 ++]

* Vet Legislation *

Military Food Stamps Update 02 ► Military Hunger Prevention Act

Congresswoman Susan Davis (D-San Diego) moved to aid military families being blocked from benefits that help them put food on the table. Rep. Davis, the Ranking Member of the Military Personnel Subcommittee, introduced the Military Hunger Prevention Act to ensure eligibility for food supplement benefits for servicemembers and their families. “Those who make great personal sacrifices in service to our country should not have to struggle to provide regular, nutritious meals to their families,” said Rep. Davis, a senior member of the House Armed Services Committee. “Unfortunately, an unintended policy barrier prevents military families struggling with food insecurity from getting help from available federal nutrition assistance programs.”

“For far too long, food insecurity among currently serving military families has been a real and painful reality,” says Abby J. Leibman, President and CEO of MAZON: A Jewish Response to Hunger (http://mazon.org). “Barriers to access of government safety net programs have left tens of thousands of military families struggling to put nutritious food on the table, turning for emergency assistance to food pantries on or near the military base. The MAZON organization believes that those who make great personal sacrifices in service to our country should not have to struggle to provide regular, nutritious meals to their families. MAZON recognizes the extraordinary leadership of Congresswoman Davis to address this issue with the legislation she introduced to remove a major barrier impacting military families.” MAZON has endorsed Davis’s bill.

Military families are able to access various federal nutrition assistance programs, and many rely on these programs to make ends meet and put nutritious food on the table. In practice, far too many military families find themselves ineligible for such assistance because the way military compensation and allowances are considered. The Basic Allowance for Housing (BAH), which is provided as a monthly, regionally adjusted allowance to servicemembers living off-base or in privatized housing, is currently counted as income for the purposes of determining eligibility for Supplemental Nutrition Assistance Program (SNAP, formerly known as Food Stamps). The Military Hunger Prevention Act would prevent housing allowances from being used to determine eligibility for SNAP.

The legislation comes as food pantries and other charities said they continue to encounter strong demand from military households for their services. Young servicemembers and their children are forced to resort to emergency assistance through community food pantries. There are emergency food distribution programs that operate throughout the San Diego region to serve the needs of military families stationed there. When GAO investigators

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visited Camp Pendleton late last year, they found four food pantries on base. One of those programs alone fed between 400 and 500 Marine families every month. In 2015, the Department of Defense determined that nearly a quarter of the children in Pentagon-run schools inside the continental United States qualified for free meals. Last year’s Blue Star Families Military Family Lifestyle Survey revealed that 6 percent of respondents sought emergency food aid through a food bank or other charity. Between September 2014 and August 2015, active-duty troops spent more than $21 million worth of food stamps at base commissaries, according to the Pentagon.

A 2013 Census Bureau study estimated that about 23,000 military families used food stamps during the previous 12 months — about 2 percent of the active-duty force. More troops would use them if they knew how to access the program and overcame the stigma of buying groceries with food stamps, the GAO determined. To help overcome the stigma of handouts, the San Diego Food Bank launched a program that discreetly distributes more than 1,600 backpacks stuffed with groceries to 33 schools every week. The initiative feeds chronically hungry students over the weekend, when they can’t eat a free cafeteria breakfast or lunch. The students are summoned to a school office — typically the nurse’s station — to receive backpacks that they can tote home. It’s a moment of charity replayed every Friday at Miramar Marine Corps Air Station’s Youth and Teen Center and two elementary schools located on Camp Pendleton, which is a key reason why Davis vows to reintroduce her bill in the next Congress if it fails this year.

H.R.6205 would amend title 37, United States Code, to exclude the receipt of basic allowance for housing for members of the Armed Forces in determining eligibility for certain Federal benefits. “It’s unconscionable to people that we have not solved this problem,” she said. Neither President Barack Obama nor President-elect Donald Trump has commented on Davis’ measure. [Source: Rep. Davis Press Release & The San Diego Union Tribune | Carl Prime | November 17 & 28, 2016 ++]

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PTSD Punitive Discharges Update 05 ► Fairness for Vets Act

An important amendment to the Fiscal Year 2017 National Defense Authorization Act (NDAA) made it through both the House and Senate and is expected to be signed by President Obama: it requires military record review boards to give liberal consideration to medical conditions like Post-Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI), and Military Sexual Trauma (MST) in the discharge review process. This is essentially the codification of the “Hagel Memo,” which was penned by former Secretary of Defense Chuck Hagel in early 2014 but that has been haltingly applied by the various military Departments. For instance, the Army only recently hired two mental health specialists to work full-time on military record reviews; previously doctors with specialties like orthopedics or obstetrics were given the ability to weigh in on things like PTSD, when they had no formal training on the subject. It should be pointed out that servicemembers who are discharged with “bad paper” discharges (which are General or Other-Than-Honorable discharges, NOT Dishonorables) have not been court-martialed, and are at vastly higher risk of developing substance abuse problems, unemployment and homelessness without access to the VA’s mental healthcare services. Allowing these veterans to be treated at the VA can head off much more serious, life-threatening issues with simple, cost-effective treatment once the servicemember leaves the service. Currently these “bad paper discharge” servicemembers suffer for years and eventually become a much bigger burden to society than they would have been if we had just stepped to the plate and gotten them the help they needed at the outset, so they can get their lives back on track and become productive members of society. [Source: TREA Update | December 13, 2016 ++]

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GI Bill Update 216 ► S.1938/HR2360 Signed Into Law

The short-term government funding bill that President Obama signed last week contained a provision that is intended to prevent student veterans from using their Post-9/11 G.I. Bill benefits on career programs that won't help them land a job. The Career Ready Student Veterans Act, which TREA: The Enlisted Association supported, would prohibit institutions from receiving GI Bill benefits if their programs don't meet the requirements needed for required licensing exams or certification in order to enter the chosen career field. A group called Veterans for Education Success conducted a study last year that found that 20 percent of about 300 approved programs to train veterans were improperly accredited and that, as a result, their graduates were not eligible to sit for licensing exams or certification in their fields of study. The report identified eight programs offered by 15 different institutions at 60 campuses that failed to meet employer or state requirements. The legislation was originally sponsored by Senator Thom Tillis (R-NC). [Source: TREA Update | December 13, 2016 ++]

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Congressional Gold Medal Update 07 ► Filipino WWII Vets

The House approved (S.1555), a bill that would honor Filipino and Filipino-American veterans of World War II. The VFW adopted Resolution 305 at the 116 th National Convention in 2015 supporting the Filipino veterans who served and fought to help defeat the Japanese and liberate the Philippines. Of the estimated 300,000 Filipino veterans of World War II, more than 57,000 would be killed in action during the four year battle to defend, then free, their homeland which was then sovereign U.S. territory. Filipino veterans were also present at the Bataan Death March which resulted in the loss of between 6,000 to 10,000 Filipino’s alongside 700 members of the United States Armed Forces during the 70 mile march. The bill previously passed the Senate in July and now heads to the president’s desk for his signature. [Source: VFW Action Corps | December 02, 2016 ++]

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OSS Congressional Gold Medal Act Update 01 ► House Approves S.2234

The Office of Strategic Services (OSS) Congressional Gold Medal Act (S. 2234) was passed by the House of Representatives 2 DEC. The OSS was the World War II predecessor to the CIA, the US Special Operations Command and the State Department’s Bureau of Intelligence and Research. It was created in 1942 by President Roosevelt who appointed Gen. William Donovan, a World War I Medal of Honor recipient, as its director. Donovan is the founding father of the US intelligence and special operations communities. The OSS played a critical role in America’s victory in World War II. It:

Gathered critical intelligence that led to the success of D-Day. America’s leading academics served in its Research and Analysis Branch.

It supported, trained and led resistance movements around the globe. It OSS created new technologies and devised innovative methodologies for gathering information. Its personnel went behind enemy lines on the most dangerous missions of World War II. It recruited ran one of the war’s most important spies, the German diplomat Fritz Kolbe. Its Morale Operations Branch pioneered the use of psychological operations.

The OSS drew its personnel from every branch of the military. Its Maritime Unit was a predecessor to the Navy SEALs. Its Jedburghs and Operational Groups were predecessors to the Green Berets, the US Army Special Forces. The 801st/492nd Bombardment Group (“Carpetbaggers”), and other elements of the US Army Air Corps, the air arm of the OSS, were predecessors to the Air Force Special Operations Command. The Marines who served in the

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OSS were predecessors to the Marine Corps Special Operations Command. It drew its operational swimmers from the US Coast Guard.

OSS personnel included the Hollywood actor Sterling Hayden; Fred Mayer, the real “inglorious bastard” who was nominated for the Medal of Honor: the “French Chef” Julia Child; Virginia Hall, the only American civilian woman to receive the Distinguished Service Cross in World War II; Supreme Court Justice Arthur Goldberg; Hollywood director John Ford; James Donovan, the OSS general counsel who was portrayed by Tom Hanks in “Bridge of Spies”; Ralph Bunche, the first person of color to receive the Nobel Peace Prize; Medal of Freedom recipients Moe Berg and Marlene Dietrich; four CIA directors (William Casey, William Colby, Allen Dulles and Richard Helms); Nobel Physics Prize recipient Jack Kilby, who invented the integrated circuit; and Pulitzer Price recipient and JFK aide Arthur Schlesinger Jr.

“For many years, the heroic contributions of the OSS – which included some of the most daring covert operations of World War II — remained shrouded in secrecy, their contributions largely unknown to the American public. Today, Congress is able to publicly recognize the members of the OSS for their remarkable heroism and many sacrifices,” said Sen. Mark Warner (D-VA), who cosponsored the Senate bill with Sen. Roy Blunt (R-MO). “As the predecessor to the modern CIA, other elements of the U.S. intelligence community, and U.S. special operations forces, the OSS once boasted nearly 13,000 members, but more than 70 years after they won the war, fewer than 100 are still with us. I know how much it means to the veterans of the OSS, as well as their families, that this legislation is finally making its way to the President’s desk to be signed into law. Today, Congress has ensured that their courage of spirit and their love of country will long live on in our nation’s memory.” Comments of others involved in passage of the bill included:

Sen. Roy Blunt said: “From establishing intelligence networks deep behind enemy lines to bolstering resistance organizations throughout Europe and Asia, the members of the OSS saved thousands of lives and played a critical role in securing the Allied victory in World War II.”

Bob Latta (R-OH), the bill’s House sponsor said: “Honoring veterans of the OSS with a Congressional Gold Medal will ensure that their heroic actions during one of our country’s most trying times will not be forgotten. The clandestine nature of the OSS often meant members had to operate behind enemy lines in situations calling for unquestionable bravery and unparalleled skill. Their actions played an important role in winning the war and saved countless American lives in the process.”

Rep. Marcy Kaptur (D-OH) said: "I was “deeply honored … to pay tribute to the patriotic and fearless soldiers of the OSS. Over 13,000 exceptional Americans comprised the Office of Strategic Services, formed clandestinely during World War II by President Roosevelt.”

Rep. Devin Nunes (R-CA), Chairman of the House Permanent Select Committee on Intelligence said: “The Office of Strategic Services was filled with patriots who honorably served their country while making an enormous contribution to the defeat of the Axis powers. It’s gratifying to see Congress recognize their heroism.”

Rep. Adam Schiff (D-CA), House Permanent Select Committee on Intelligence Ranking Member said: “The men and women who served our country in the Office of the Strategic Service are among the most deserving of the Congressional Gold Medal. The OSS, members of our “Greatest Generation,” were the faces and minds behind our modern intelligence community and helped vanquish some of the most malevolent enemies that our country, and indeed the world, has ever faced. We owe them a debt of gratitude that can never be repaid, and I am pleased the bill has finally been passed by the House and will hopefully soon be signed into law.”

Charles Pinck, president of The OSS Society, said: “General Donovan said OSS personnel performed ‘some of the bravest acts of the war.’ We are very grateful to the Majority Leader, the bills’ sponsors in the House and Senate, and the 393 cosponsors from both bodies for recognizing their bravery with a Congressional Gold Medal. We look forward to the presentation of this medal next year to coincide with the 75th anniversary of the OSS’ founding.”

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Dana Hudson, the daughter of Capt. James W. Hudson, Sr., said: “It is a great honor to see this important bill passed this year. My father and his OSS colleagues put their lives on the line, often alone, in enemy territory for one purpose: to preserve the freedom of our nation and the world. I only wish he were here to receive this honor himself.”

The Congressional Gold Medal is Congress’ highest civilian honor. The bill, which was passed by the US Senate earlier this year, now goes to President Obama for his signature. More information about the OSS Congressional Gold Medal Act, including photographs, are available at http://www.osssociety.org/goldmedalact.html. [Source: Veteran News | Donnie La Curan | December 2, 2016 ++]

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VA Health Care Access Update 46 ► H.R.6407 Introduced

Responding to a report released in October that found the Department of Veterans Affairs has been slow to make changes after the 2014 wait-time scandal, two lawmakers have introduced legislation to force the VA to speed up reform. Rep. Derek Kilmer (D-WA) and Rep. Dan Newhouse (R-WA) introduced the VA Management Alignment Act of 2016 to the House on 30 NOV. The measure would require the VA secretary to submit plans to the House and Senate veterans committees within 180 days after the bill goes into effect, detailing the roles and responsibilities of VA executives and spelling out how they would improve veterans’ access to treatment. “This would force action on persistent problems,” Kilmer said. “After the wait-time scandal, we saw a number of good proposals sent to the VA to fix things. As the [Government Accountability Office] report makes clear, a lot of those recommendations were ignored.”

Last year, Kilmer called on the Government Accountability Office to do a comprehensive study of management problems on the health care side of the VA. Investigators with the Office of Inspector General had previously discovered that some managers at VA hospitals instructed employees to falsify data about how long veterans were waiting for care. Since then, the agency has undergone internal and external reviews and inspections into its management practices, business processes, staffing levels and veterans’ access to care. The reviews came at a cost to taxpayers. One of the reviews cost $68 million to perform and it was mandated by the Veterans Access, Choice and Accountability Act, which included an assessment of all areas of the VA’s health care delivery system.

Answering Kilmer’s request, the GAO released its report in October, stating the VA doesn’t have a process for following through with the recommendations that it receives or to effectively make changes. The report also states without a process, there’s “little assurance” the deliver of health care will improve. It goes on to say the VA can’t confirm that it’s holding leaders accountable for making improvements. Kilmer said he’s hopeful the legislation can pass before the end of the busy, lame-duck session, which is scheduled to end in mid-December. “I don’t think there’s a reason to delay,” he said. “There’s bipartisan support for seeing systemic change happen within the VHA.” [Source: Stars & Stripes | Nikki Wentling | December 1, 2016 ++]

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VA Claims Processing Update 17 ► H.R.5166 | Streamlining Being Blocked

According to Representatives Ted Yoho (R-FL.) and Rodney Davis (R-IL), the Department of Veterans Affairs and Sen. Harry Reid (D-NV) are standing in the way of improving customer service for our nation’s veterans. The representatives introduced WINGMAN (H.R. 5166) in May of this year with broad bipartisan support - 137 of their colleagues in the House signed on as co-sponsors. The bill allows trained congressional caseworkers to check the status of a veteran’s claim and view relevant files within the VA’s claims system. Veterans often contact their

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offices as a last resort because they have already spent weeks or months waiting for the VA to respond to their request. This will streamline the claims process by eliminating the burdensome step of having to use the VA as a middle-man. WINGMAN will reduce the wait time for file requests by veterans, which can take weeks or even years.

This past week the House unanimously passed WINGMAN and sent it to the Senate. The Senate has the opportunity to hotline this commonsense bill so the government can begin to help frustrated veterans and their families before this Congress adjourns. Unfortunately, Sen. Reid and a few Democrats in the Senate are blocking these efforts seemingly to protect the VA. Two years ago, along with more than a hundred Representatives, VA was approached about changing the way constituent caseworkers could expedite the claims process. Months later, House representatives received a polite response explaining the VA was working to better serve veterans and looked forward to working with Congress moving forward. Representatives continued to write the VA and they continued to make politely vague comments while veterans who have contacted their offices for help continued to wait for answers.

The thing about VA management is, it does not like change, it fears transparency, and it has virtually no accountability unless Congress chooses to flex its muscle and hold them accountable. Throughout the process of moving WINGMAN through the House, the VA has attempted to thwart the bill. They have tried to stall progress by delaying responses and sending inflated figures to the Congressional Budget Office (CBO). Senate Democrats have reportedly said they are concerned with the cost but this bill does not create any new system nor does it authorize any additional spending. It simply grants congressional offices access to a system already in place. Additionally, the bill caps VA spending on implementation at no more than $10 million. In the long term, this bill has the potential to save the VA money by allowing congressional offices to help.

Less than a month ago, our nation celebrated Veterans Day. For a day, the nation was unified in a moment of remembrance and gratitude. Representatives passed this bill thinking of the faces of each veteran whose hand they shook that day, every medal ceremony they attended since being elected, and honor flight they have greeted at the World War II monument. But most of all they are thinking of the numerous heart wrenching stories they have heard from veterans and their families who feel abandoned by the agency whose sole mission it is to care for them.v The term “customer service” is too often forgotten in federal bureaucracies. And in lieu of the many scandals within the VA system, one would think any relief or improvement would be welcomed. Congress owes it to those veterans we represent to do our job and hold the VA accountable.

WINGMAN had the support of every member of the House VA Committee and received unanimous support by the 435 members of the U.S. House of Representatives. However, Sen. Reid stands in WINGMAN’s way. Does Sen. Reid know more than the 435 members of the House or the unanimous support of the House VA Committee? We will not forget the promises we made to our veterans. We will fight for them every day of every year that we are in office. We are deeply saddened that a few of our colleagues in the Senate cannot, or will not, do the same. [Source: The Hill | Reps. Ted Yoho & Rodney Davis | December 7, 2016 ++]

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Vet Health Care Update 03 ► H.R.6416 | Omnibus Improvements

On 6 DEC, the House of Representatives voted unanimously to pass HR 6416, the “Jeff Miller and Richard Blumenthal Veterans Health Care and Benefits Improvement Act of 2016.” This is a bipartisan bill sponsored in the House by Veterans Affairs Committee Chairman Rep. Jeff Miller (R-FL) and in the Senate by Sen. Richard Blumenthal (D-CT), the senior Democrat on the Senate Veterans Affairs Committee. This omnibus legislation included a long list of changes, including provisions to:

Require a GAO review of VA regional offices' claims processing performance,

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Award veteran status for all guard and reserve retirees, Expand Gunnery Sergeant John David Fry scholarship coverage for survivors of members who died in

service between 2001 and 2005, Authority to modify hours of work for VA physicians, Improve assistance for homeless vets; and Require studies of potential effects of veterans' toxic exposures on their children. Expedite payment of survivor benefits,

MOAA strongly supported this legislation, but was concerned whether or not the Senate would take it up as time was running out on the legislative year.  Fortunately they did and the bill is now awaiting the President's signature. [Source: MOAA Leg UP | December 8, 2016 ++]

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Vet Legislative Issues 2016 Update 02 ► Omnibus Reform Bill H.R.6416

Lawmakers passed a veterans omnibus bill in the waning hours of Congress’ legislative session last week, but without many of the most sweeping and controversial provisions the two chambers had struggled with in recent months. Instead, the measure heading to the president’s desk is a collection of mostly non-controversial items, including small changes in the benefits appeals process, an extension of education benefits to some war widows and increased access to benefits for homeless veterans.

It doesn’t include accountability provisions championed by critics of the Department of Veterans Affairs, who insist the bureaucracy does not have the ability to properly discipline criminal employees. It also omits a costly expansion of veteran caregiver benefits and proposed trims to the post-9/11 GI Bill, which several veterans groups had protested. And it doesn’t include an overhaul of the benefits appeals process or a consolidation of VA’s outside care programs, two priorities that department leaders had pleaded with lawmakers to approve before the end of the year. Still, House and Senate leaders hailed the passage as important steps forward in improving assistance for veterans, noting the changes should improve health care and benefits access. Senate Veterans’ Affairs Committee Chairman Johnny Isakson (R-GA) called it “a down payment on the promise and the debt that we owe to veterans.” Under the bill — named for retiring House Veterans’ Affairs Chairman Jeff Miller, R-Fla., and the Senate committee’s former ranking member Richard Blumentha (D-CT) —

The U.S. Court of Appeals for Veterans Claims will expand from seven to nine judges for the next three years, to help clear the backlog cases there.

A host of new reports ar mandated on the reasons behind that backlog, and would allow the VA to pay some survivor benefits to veterans’ family members even if they don’t formally apply for the payouts.

Burial at VA cemeteries would be expanded to include some reservists with service-connected illnesses and training accidents. Certain education benefits would be expanded to include spouses of troops killed between Sept. 11, 2001, and Jan. 1, 2006, who had previously been ineligible.

The health care provisions include new language allowing veterans who served in classified missions to seek mental health treatment without fear of security violations and to ease rules for hiring more mental health specialists.

New research is mandated on the potential health effects from toxic exposures on veterans’ children, with an eye toward possibly covering those illnesses in the future.

Union officials had voiced opposition to the bill over a measure changing how the department sets pay scales for some employees. VA leaders had backed dropping review panels required to set those salaries, and lawmakers ignored those concerns in their final passage. The full measure is available online through the Senate Veterans’ Affairs Committee’s website http://www.isakson.senate.gov/public/_cache/files/77a9a32f-a214-4edb-98a7-

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9c5c0880eaa2/HR6416%20Section%20by%20Section%20Summary.pdf The president is expected to sign the measure into law in the coming days. [Source: MilitaryTimes | Leo Shane | December 13, 2016 ++]

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VA Employee Accountability Update 03 ► Fire if Felony Convicted Bill

Sen. Jeff Flake (R-AZ) announced 8 DEC that he has introduced legislation that would force the Department of Veterans Affairs to fire employees with felony convictions. The bill, dubbed the Clean Up the Department of Veterans Affairs Act, also would mandate termination for VA employees whose medical licenses have been suspended or revoked. In a news release and conference call with The Arizona Republic, Flake listed examples of VA staffers who remain on the federal payroll despite criminal convictions for sexual offenses, robbery and firearms violations. Flake said some of those workers may have been retained due to cronyism, while others were not fired because VA administrators did not want to face the personnel-system hassles. Either way, he said, "They've kept people on who simply should not be there. ... If Congress wants to see improvements at the VA, it needs to put an end to the carousel of criminals passing through its doors. It’s time to clean up the VA so we can focus on recruiting the best and brightest to care for our veterans.”

Flake said the Phoenix VA is still failing in leadership nearly three years after it became the flash point for a national furor over veterans' health care. The VA has about 360,000 employees, only a handful with felony records. While legislation targeting criminal staffers may seem like picking "low-hanging fruit," Flake said, it is one step in a larger effort to impose accountability on a giant bureaucracy with $182 billion in funding. Flake added that he anticipates a surge of VA reform bills as President-elect Donald Trump takes office, and as Republicans assume control of Congress with majorities in both houses. He predicted major reforms if Rep. Jeff Miller (R-FL) becomes Trump's appointee as VA secretary because Miller ramrodded criticism of the agency for years as chairman of the House Committee on Veterans' Affairs. [Source: The Arizona Republic | Dennis Wagner | December 8, 2016 ++]

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House Vet Bill Progress ► 1 thru 15 DEC 2016

During the week of 5 thru 9 DEC House of Representatives passed nine bills, two of which have previously passed the Senate. The three that have passed both chambers of Congress and await the president’s signature are 

S. 3076, a bill to ensure that veterans with no next-of-kin or who lack the financial resources are provided with a casket or urn; and 

S. 3492,which will name a VA outpatient clinic in Michigan after Colonel Demas T. Craw. H.R. 6416, a veterans omnibus package bill that will, among other provisions, allow for toxic exposure

research, restore certain educational benefits for National Guard and Reservists and expand homeless veterans’ benefits.

The following House bills passed and are awaiting Senate action: H.R. 6435, a bill to allow independent investigations at VA medical centers;  H.R. 5099, a bill to allow VA to enter into five public-private partnerships to offset the cost of building VA

medical centers;  H.R. 4298, a bill to direct the Secretary of the Army to place a memorial at Arlington National Cemetery

honoring Vietnam era helicopter pilots and crews;  H.R. 5399, a bill to allow improve accountability of VA doctors;  H.R. 4150, a bill to allow VA to better schedule VA doctors’ work hours; 

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H.R. 4352, a bill that calls for a pilot program to allow veterans to self-schedule their appointments; and 

[Source: Various December 2016 ++]

* Military *

Civilian Run Military Importance ► SECDEF Nominee

Rep. Tammy Duckworth worries her congressional colleagues don’t fully appreciate the importance of a civilian-run military. As a combat-wounded Iraq War veteran and incoming Illinois senator, she finds that troubling. “I believe so strongly that the military is subservient to civilian leaders,” she said 7 DEC. “I went to fight in a war I didn’t believe was one we should be engaged in, but the president and Congress believed it was the right thing to do. So I’m proud of that. I would go back. “Every part of my being as a former military officer says what (Congress is) doing now is wrong.”

Duckworth (D-IL) is referring to legislation expected to be passed which would ease the confirmation process for retired Marine Corps Gen. James Mattis to become the next secretary of defense. Mattis, who retired in 2013, needs a waiver from lawmakers to step into the role because federal rules mandate a seven-year gap between military service and the top civilian military job. The requirement is designed to reinforce the principle of civilian control of the U.S. military and discourage a public image of a ruling military class in charge of national security decisions. But House Republicans inserted language into a must-pass budget extension bill, which would trigger automatic waiver legislation early in the next congressional session, potentially without any hearings or debate on the issue of granting such waivers.

Mattis would still need to undergo the normal Senate confirmation process, and both chambers would still need to pass the waiver, though with abbreviated debate and legislative review. But multiple Democrats have complained the language is poorly worded, too rushed and likely unnecessary given Mattis’ good reputation on Capitol Hill. The 66-year-old served 44 years in the Marine Corps, and few lawmakers have objected to the idea of him taking over Pentagon operations. Duckworth said she’s a fan, too. “I have high hopes for Gen. Mattis,” she said. “I was in Iraq when he was a commander. I have high hopes that maybe with him, we’ll be able to lift the Budget Control Act and work on the readiness issues that we need to make our military the strongest it can be. I admire him. I think he would be a good secretary of defense.”

But she sees the legislative language as potentially undermining his term as defense secretary if it's not proceeded by an open debate over the rules regarding civilian control of the military. “I think there is a lack of understanding of that division,” she said. “I think the American public has great respect for military leaders, as do I, but that does not mean that military leaders trump the American public. “I just think we need to proceed with caution. This really bothers me, that we’re talking about eroding a safeguard that was put in there and setting ourselves up in the future for this happening again and again.”

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A House vote on the issue was scheduled for 8 DEC, with Senate passage expected soon afterward. Duckworth has petitioned Republican leaders to drop the provision and Democratic leaders to fight to remove it, though she won’t say whether she’ll vote to shut down the government over the issue. Regardless the outcome, Mattis is expected to face numerous questions on the issue during his Senate confirmation hearing, likely to be held next month. President-elect Donald Trump has largely remained silent on the issue, simply calling Mattis the right fit for the role. Beyond the legislation, Duckworth wants her colleagues in both congressional chambers to think about the larger ramifications of the move and to develop a better appreciation for civilian control of the armed forces. “I feel like we are diminishing the voice of the American people, and we’re diminishing civilian oversight of the military,” she said. [Source: MilitaryTimes | Leo Shane | December 8, 2016 ++]

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Discharge Review Boards Update 01 ► PTSD Must Now be Considered

Inside the 2017 massive defense spending bill Congress passed 8 DEC, is small provision that could change the fate of tens-of-thousands of service men and women currently denied access to medical care. The Fairness for Veterans Act (https://www.congress.gov/bill/114th-congress/senate-bill/1567/text) is featured in the TEGNA investigative docu-series, Charlie Foxtrot (http://www.missioncharliefoxtrot.com). The bill requires military discharge review boards to consider post-traumatic stress disorder and traumatic brain injury. It reads: To provide for the treatment by discharge review boards of claims asserting post-traumatic stress disorder or traumatic brain injury in connection with combat or sexual trauma as a basis for review of discharge.

Charlie Foxtrot investigated how tens of thousands of service members are stripped of benefits, often without medical care. Many are not legally considered veterans anymore. According the VA data uncovered by a group of investigators from 11Alive News in Atlanta, since Sept. 11, 2001, about 28 percent of our troops are returning home with post-traumatic stress disorder, traumatic brain injury or both. Symptoms of post-traumatic stress disorder, traumatic brain injury often manifest as what appears to be questionable behavior, like fighting with others, substance abuse or even suicide attempts. But those actions can lead to a less than honorable discharge. As a result of the passage of this bill, the military will now be required to consider mental health conditions for troops who receive less than honorable discharges. If a service member does something the military considers undesirable, their mental health will now factor in to any discharge review. Now, thousands of veterans will now be eligible for at status upgrade and VA medical care.

More than 12,000 people felt compelled to signed a petition supporting the law after watching Charlie Foxtrot. Earlier this week, Charlie Foxtrot was shown on Capitol Hill as part of a discussion with participants of the docu-series, as well as several bills aimed at safeguarding veterans' mental health. The National Defense Authorization Act was sent to President Obama’s desk for a signature. The President is expected to sign the plan into law. [Source: WXIA-11 Atlanta | Jeremy Campbell & Erin Gutierrez | December 08, 2016 ++]

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PowerWalk ► Army Strap On Battery Pack Charger

The Army is looking for a way to lighten the load of batteries soldiers have to carry around to use their gadgets, and rising to the top of the heap is a tricked-out knee brace that absorbs the energy every time your feet hit the ground. The PowerWalk, also known as the bionic power knee harvester, looks like a very tactical knee brace, but it's wired to a battery pack that can power radios and other equipment with a weight of less than 7 pounds. "It's modeled after the HALO video game, which had a brace that was modeled after an old Natick prototype," Noel Soto, a project

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engineer at the Army Natick Soldier Research, Development and Engineering Center, told Army Times in a 23 NOV interview. The team took the futuristic-looking body armor and made it lighter and smaller, Soto said.

Back in 2012, NSRDEC began adapting a medical device designed to help with mobility, turning it into a tactical-looking knee brace that draws power from a soldier's footfalls and feeds it into a wearable battery or the existing power manager, which is hooked up to radios and other equipment. "When you step down, it adds to the body’s breaking motion, and at that point it generates power," Soto said. "The system adjusts to the user almost instantly – two or three steps." The system works with the Integrated Soldier Power and Data Distribution System, so that the knee brace charges a battery and the battery keeps the hub going.

PowerWalk is one of three leading soldier power-generation systems the Army is working on, next to a chargeable backpack and lightweight, wearable solar panels, out of hundreds of proposals. "In four years, the technology hasn’t changed. We’re the leading technology that can do this, that provides the most power for the weight," Soto said. "There’s nothing out there that has proven to be better. The state of the art just hasn’t advanced far enough with power generation." Last July, engineers tested the system for the first time, taking soldier feedback and calculating their movements. "The soldiers did perceive that there was a limited range of motion, but there really wasn’t," Soto said. "The effort to use them was perceived as very light effort ... Most forgot that they had it on after a few minutes."

The Marines have shown interest in the system and chipped in some money for its development, he added. Right now, a prototype can cost upward of $25,000. The PowerWalk might also lead to an innovation that the Navy has its eye on, as one of the brace's sensors could help locate someone on the ground in a GPS-denied environment. "There's a sensor in the knee that detects when to take power," Soto said. "Those same sensors can be used to tell range, azimuth, direction. They could actually use it to create an algorithm to tell where the user is without GPS." PowerWalk's next step is obstacle course testing. If all goes well, the system could be ready to deploy next summer, Soto said, though it's not yet part of an acquisitions program. [Source: ArmyTimes | Meghann Myers | December 1, 2016 ++]

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DoD 2018 Budget ► Navy Says 'NO' to Shipbuilding $17B Cut

The Navy is digging in its heels and rejecting billions in cuts from its 2018 budget as infighting has hit a boiling point at the Pentagon. The Navy has refused to submit a budget that incorporates $17 billion in cuts over the next five years that Defense Secretary Ash Carter ordered. It's a standoff that has been brewing for months since Carter told the Navy to begin cutting major shipbuilding programs and invest in weapons systems and aircraft, according to half a dozen defense officials who spoke to Navy Times. At issue is Navy Secretary Ray Mabus's insistence that budget cuts not be directed at the shipbuilding program, which he has long fought to shield from cuts as he attempts to rebuild the fleet to his goal of 308 ships.

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Mabus has long argued that cutting ships is the "least reversible" thing to cut from the budget because of the long timeline for shipbuilding programs and the damage to the industrial bases. The Navy had been developing budgets with the $17 billion in cuts that preserved shipbuilding, but the savings came overwhelmingly from operations and maintenance money needed to deploy ships and fix them when they get back — Navy leaders deemed those cuts intolerable. What's unclear is what impact the outgoing administration's fiscal year 2018 budget would have on the incoming Trump administration, which will be expected to roll out a defense budget this spring. Carter's office insists its going to hand over the best budget it can while keeping the Navy and all the other services within the caps mandated by the 2011 Budget Control Act.

"At Secretary Carter's direction, the Department of Defense is hard at work developing a FY18 budget proposal that will help guide the next administration and ensure a seamless transition," said top Pentagon spokesman Peter Cook. "All of the services were asked to develop specific budget plans that focus on improving readiness and developing capabilities that will allow the United States to defeat high-end adversaries while adhering to current budget limits. The Department is reviewing those plans to ensure they are balanced and maintain America's military edge." But the Navy, led by Mabus, insists it would be foolish to send over a budget that cuts ships when Trump has said he wants to grow the Navy.

"Whatever budget the Navy submits will have the half-life of a mayfly at noon on January 20th," said a senior defense official supportive of the Navy's plan, referring to the date of Donald Trump's inauguration. "So to some degree Secretary Mabus has tried to make that point over the past several weeks." The defense official said that Trump is "on the record" saying he wants 350 ships, so he is "unlikely to support a document that cuts ships. ... This is a nonsensical discussion that amounts to people on the third deck [OSD], substituting their judgement for the Navy's on what the Navy needs."

The budget battle is the latest in a string of brawls between Defense Secretary Ash Carter and Mabus which have spilled out into the public. Carter and Deputy Secretary of Defense Bob Work have pushed the Navy to cut its shipbuilding program in favor of investments in missiles and systems that will boost the current fleet's capabilities. "The games between Carter's team and Mabus's team have gone on for months," said another defense official familiar with the infighting. "This is just a small example." Carter's office is also preparing a letter to send to the Navy that will outline his priorities that will be sent to the Navy shortly, three sources confirmed. It would be the second such letter in the past 12 months. In December 2015, Navy Times sister publication Defense News reported that Carter had directed the Navy to cut the overall buy of the littoral combat ship from 52 to 40 and to pick just one ship variant — the current program produces both a trimaran version manufactured in Alabama and a mono-hull version built in Wisconsin.

The deadline for submitting 2018 budgets to OSD was 8 DEC, the senior defense official said, adding that the Navy's will not incorporate the cuts. Ultimately that means that Carter's budget wonks will have to do the cutting themselves and the Navy may not like what they decide to cut, said Bryan Clark, a retired submarine officer and analyst with the Center for Strategic and Budgetary Assessments. But the standoff between Mabus and Carter is emblematic of the Defense Departments struggle to come to terms with the budget constraints imposed by the 2011 cuts. "The SECNAV's decision is emblematic of the challenge the Navy faced since the BCA was enacted in 2011," Clark said. "Operational demands continue to grow while the fleet remains the same size or shrinks. Ships and their crews don't have time to train and maintain their ships, and they are increasingly reliant on supplemental funding which cannot be planned for in advance.

"SECNAV is essentially drawing a line in the sand that the navy will need to reduce its OPTEMPO and put resources toward capacity, instead of just working the fleet harder to support overseas operations." [Source: NavyTimes | David B. Larter | December 7, 2016 ++]

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Commissary Medical Clinics ► Navy Pilot Program in Florida

Need medical attention? You might be able to do some grocery shopping while you're there, if the Navy's planned test of putting medical clinics in some commissaries is successful. The test, which will take place in the Jacksonville, Florida, area, is in the planning phase. The clinics will be run by Navy corpsmen, said Vice Adm. Forrest Faison III, the Navy surgeon general, during a Dec.1 session at the conference of the Association of Military Surgeons of the United States, held just outside Washington, D.C.

“Those corpsmen who save lives on the battlefield need to be doing more than taking vital signs and pushing records in the records room,” Faison said. “We’re letting them run clinics in our commissaries to give them the clinical experience they need, to build confidence in patient care that they need.” Further information about the test – what types of care would be offered, whether appointments would be required, or the role (or interest level) of the Defense Commissary Agency or other service branches in the pilot, for instance – was not immediately available. Along with providing experience for military medical personnel, the clinics also would offer convenience, helping keep young service members connected to military health care. Faison noted that service members and their families have more choices now with their health plan, “so our challenge is to get them to choose us, in an environment and with a generation that’s driven by convenience.”

Major enterprises such as Walmart are getting into the health care business, he said. “Walmart is putting clinics in many of their stores over the next two years. Ninety percent of the U.S. population, to include our sailors, soldiers, airmen and Marines and their families, live within 10 miles of a Walmart.” Walmart Care Clinics are in Georgia, South Carolina and Texas, and their website lists Tricare first among the insurance plans they accept. “No appointment is required. …. [Walmart has] integrated health care into people’s day-to-day lives,” Faison said. “It’s a big deal to have to call up and navigate the phone tree to make an appointment, drive to the hospital, find a parking spot, which is challenging in some of our facilities, go and sit in the waiting room, see the doctor, go to the pharmacy, wait in the pharmacy. “It’s an all-day evolution. Why would you do that when you can just go to Walmart and pick up dinner on the way home?"

Advocates applaud the idea of testing clinics in commissaries. "Our association has been fighting for improved access to care for a long time, so we are thrilled to see the Navy embrace a new concept that seems to be working well in the civilian world," said Karen Ruedisueli, government relations deputy director for the National Military Family Association. "What makes this even more exciting is that Navy medicine is considering the needs of military families with this pilot. The whole idea is to make health care more accessible and convenient. We think the clinics in commissaries pilot is a great idea for improving access to care and would love to see the other services follow suit," she said.

Jacksonville Navy medical officials are testing ways to improve patients’ experiences overall, and part of that is looking at ways to provide care outside the hospital setting. The concept is “if they don’t have to come to the hospital, don’t make them come to the hospital,” Faison said. “Seventy percent of what goes into a primary care clinic doesn’t need to see a physician. So why are we making them do that?" The military medical system must fundamentally change how it approaches medical care for millennials in other ways, too, Faison said, noting that technology is an integral part of millennials’ lives. There are nearly 16,000 health-related apps in the iTunes store – none of which went through quality control, Faison said.

“All of them are being used by our service members and their families to make important health care decisions," he added. "That’s their primary source of information. It’s not us. ... We have to play in that environment or we will become irrelevant for their health care. We will lose visibility on the health of the force. "What happens when a unit commander comes to me as the doctor and says, ‘What’s going on with Seaman Smith? And I have to say, I don’t know sir, he’s getting his care from Walmart.” [Source: MilitaryTimes | Karen Jowers | December 6, 2016 ++]

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Enlistment Bonus Update 07 ► Public Faith Hurt by Recoupment Effort

California National Guard officials acknowledged their moves to recoup decade-old bonuses from troops has hurt public faith in their operations, but they believe military leaders are on the right path to fixing the problem. “We are going to have to re-establish trust with our military families and recruits,” said Maj. Gen. David Baldwin, Adjutant General of the California National Guard, in testimony on Capitol Hill Wednesday. “That burden will be on us.” The high-profile hearing comes almost two months after national attention over the bonus scandal, which involved up to 17,000 soldiers ordered to return thousands in payouts. Guard officials acknowledged 7 DEC that many of those cases did not involve wrongdoing by troops who accepted the money, but said Defense Department rules and regulations mandated recoupment efforts anyway.

Pentagon officials in October ordered a halt to all of the bonus clawbacks while the cases are reviewed and new appeals processes are established. Congress is also considering legislation that would force Guard officials to prove fraud before going after those payouts, instead of putting the burden of innocence on veterans. The bonus recoupments began following a series of fraud cases involving California Guard officials, where supervisors were found to be improperly (and in some cases illegally) awarding recruiting and retention bonuses at the height of the Iraq and Afghanistan wars. Guard leaders had told lawmakers they would seek repayment of those improper bonuses, but lawmakers said they were not informed of the scope or inefficient processes for that work. An investigation from the Los Angeles Times found numerous veterans forced to repay the bonuses later faced significant financial problems, including damaged credit reports and near bankruptcy. “These recruits put their lives in the hands of their recruiters,” said Rep. Paul Cook, R-Calif. “We betrayed the trust of these troops, and there is no excuse for that.”

Peter Levine, acting Undersecretary of Defense for Personnel and Readiness, told lawmakers that Pentagon officials were not involved in the initial decision, but “we missed this.” He said officials are working now to ensure that bonus mistakes are never again ignored for years. “Recoupment is an ordinary fact of life in the military, our pay systems are not as perfect as we’d like them to be,” he said. “But the California National Guard cases are particularly egregious cases.” Defense officials have not promised to waive the veterans’ debts, but have begun putting in place new appeals processes for individuals still facing recoupments. Levine said he expects fewer than 2,000 veterans to be required to repay bonuses once the review is complete.

They also have instructed defense finance officials to reach out on behalf of affected veterans, to help repair their financial histories. California Guard officials said they regret not better emphasizing the clawback issue in recent years, a move that left lawmakers unaware of the scope and seriousness of the problem. Pentagon officials are expected to report back on their review next summer. [Source: MilitaryTimes | Leo Shane | December 7, 2016 ++]

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Ammunition ► USA & USMC Rifle Ammo Requirements

The Marine Corps and the Army use different rifle ammo — and Congress is demanding a report explaining why. The final joint version of the Fiscal 2017 National Defense Appropriations Act, released Wednesday, includes a provision requiring the secretary of defense to submit a report to the House and Senate Armed Services Committees explaining why the two services are using different types of 5.56 mm ammunition for their M16A4 and M4 rifles. According to the provision, the report must be submitted within 180 days after the bill, which includes the entire defense budget for the coming year, is enacted. If the secretary of defense does not determine that an “emergency” requires the Army and Marine Corps to use the two different types of rifle ammo, they must begin using one standard kind within a year after the bill is passed, it states.

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This provision, introduced by the House of Representatives, addresses a longstanding difference in procurement strategies between the two services. The Marine Corps uses an M855 5.56 mm round, while the Army uses the M855A1. The Army moved away from the M855 in 2010 after finding that the M855A1 steel-and-copper round performed better. The Marine Corps planned to do the same, but the project was sidetracked in 2009 when some bullets did not follow their trajectory in testing. In 2015, Marine Brig. Gen. Joseph Shrader, then commanding general of Marine Corps Systems Command, told a congressional panel there were plans to test the M855A1 rounds again. “What we are pursuing in a new round … are three things — precision, lethality and reduced signature or muzzle suppression,” he said. [Source: Kit Up! | Hope Hodge Seck | November 30, 2016 ++]

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USCG Enlisted Rating Titles ► Phase Out Not Likely

With the Navy's decision to phase out ratings in favor of an alphanumeric job code system to create more career flexibility, the Coast Guard is the only service to continue using traditional ratings. Don't expect that to change anytime soon, Coast Guard Commandant Adm. Paul Zukunft said. Speaking to reporters following an address at the Brookings Institution in Washington, D.C., recently, Zukunft said the Navy's change had prompted a brief internal evaluation for the Coast Guard -- and one with a definite conclusion. "With the Master Chief Petty Officer of the Coast Guard [Steven Cantrell], we said, 'What would the workforce think about this,' and it would cause chaos," Zukunft said. "I cannot afford chaos when every person in the Coast Guard has a 24-by-7 job to do."

The Coast Guard, the smallest of the branches, has an active-duty force of about 40,000, compared to the Navy's nearly 324,000. It also has a smaller ratings system, with fewer than two dozen separate ratings compared with 89 for the Navy. The Navy and Coast Guard use the same naval rank system, which is different from that used by the Army, Air Force and Marine Corps. Coast Guardsmen are "very proud of the rating badge that they wear on their sleeve," Zukunft said, "so I've listened to my master chief and he's provided me the best advice. So that was a very easy question for me to say 'no' to." The Navy has also had to contend with pushback from sailors and Navy veterans who have strong attachments to the 241-year-old ratings system, with culture and community built around certain titles. [Source: NAUS Weekly Update | December 1, 2016 ++]

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Other than Honorable Discharge Update 06 ► Wounded Soldiers Treatment

An Army review concludes that commanders did nothing wrong when they kicked out more than 22,000 soldiers for misconduct after they came back from Iraq or Afghanistan – even though all of those troops had been diagnosed with mental health problems or brain injuries. The Army's report, ordered by Secretary Eric Fanning, seeks to reassure members of Congress that it's treating wounded soldiers fairly. But senators and military specialists say the report troubles them. "I don't think the Army understands the scope of this problem," says Sen. Chris Murphy (D-CT). "And I don't think they've conveyed the seriousness to get it right." The Army's report is "unbelievable," says

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psychiatrist Judith Broder. "It's just bizarre." Broder was awarded the Presidential Citizens Medal by President Obama for organizing the Soldiers Project, a network of hundreds of psychotherapists and others who help troops and their families.

NPR asked Fanning for an interview, but he declined and sent a statement: "Anyone who is injured while serving our nation deserves to be properly diagnosed and treated," it says, in part. "In cases where a Soldier is facing separation as a result of his or her conduct, the completion of a thorough medical review is a routine part of the Army's process." The Army didn't provide NPR an interview with other top officials, either. NPR and Colorado Public Radio revealed last year that the Army has separated more than 22,000 wounded soldiers for misconduct since 2009, stripping them of some or all of their benefits — often unfairly because they had mental health problems or brain injuries. As a result, 12 Democratic senators signed a letter asking Fanning to investigate and "rectify this grave offense to the men and women that serve in our armed forces."

Fanning responded by ordering Assistant Secretary for Manpower Debra Wada "to conduct a thorough, multidisciplinary review," of how the Army handles misconduct separations for troops with mental health problems or brain injuries. Army auditors and the inspector general took part. The report is dated 14 APR but Army officials released it only recently. The report's conclusion: "The Army remains confident in the administrative processes that define misconduct separation procedures." The report supports that statement by arguing that the Army has followed the letter of a 2009 law. But senators say the report focuses too narrowly on precise legal wording instead of examining a widespread problem that started coming to light more than a decade ago.

The nation's leaders had become increasingly troubled by widespread media reports that commanders were kicking out wounded combat soldiers instead of helping them. So Congress passed a law requiring commanders to evaluate two issues whenever they're considering dismissing a soldier for misconduct: whether that soldier has been diagnosed with traumatic brain injury or post-traumatic stress disorder, and whether he or she deployed during the previous two years in a war zone or other "contingency operation." If so, the commanders must decide if those injuries "constitute matters in extenuation" that helped trigger the soldier's behavior. The law does not specifically mention other mental health disorders.

The Army's report states that only 3,327 of the more than 22,000 soldiers who had been kicked out met that legal test. As a result, investigators ignored the rest of the soldiers — roughly 19,000 of them — who had mental health problems or brain injuries. Broder says that by focusing on the fine print in the law, Army officials are missing the big picture. If Army officials genuinely want to help wounded troops, their new report makes no medical sense. "It's mind boggling to exclude people because they don't have one of those two diagnoses," Broder says. "Our experience at the Soldiers Project is that at least half, maybe more than that, of the people who call us with mental health problems following their service have anxiety, depression, drug and alcohol problems, all of which directly flow from their experiences in combat." But, she says, they have not been diagnosed with PTSD or TBI.

Army records, which NPR and CPR obtained under the Freedom of Information Act, reinforce the Soldiers Project's findings. Those records show that most of the 22,000-plus troops whom the Army kicked out for misconduct had been diagnosed with illnesses such as "anxiety disorder," "adjustment disorder" or "mood disorder," which includes depression. Murphy says he's also troubled that the Army report suggests that soldiers' mental health injuries don't matter if they didn't serve in the wars within two years of their diagnosis. "What we know is that PTSD and other disorders and conditions that arise from military service often don't rear their ugly heads until two or three or four years later," he says. The federal government's studies of Vietnam veterans show that mental health problems linked to combat sometimes take many more years to show up and be diagnosed. "What a moral injustice it continues to be to have so many soldiers with mental illnesses and brain injuries connected to their service who are being discharged and made ineligible [for benefits]," says Murphy.

The Army report also seeks to rebut another finding by NPR and CPR: Many, if not most, of the soldiers with mental health disorders or TBI who were kicked out for misconduct lost some or all of their benefits. The new Army report states that 88 percent of the soldiers they examined "were separated under honorable conditions and were

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immediately eligible for medical care through the Veterans Administration." The report's wording sounds as if those soldiers got a coveted honorable discharge, which conveys all the benefits the Army has to offer. But in response to questions by NPR, the Army disclosed that actually, 96 percent of those troops received a "general under honorable conditions" discharge — which denies some crucial benefits. The Army's report does not disclose that fact. It's "completely misleading," says Colby Vokey, a former top attorney in the Marine Corps who's now in private practice. "A general discharge has a very negative effect on soldier. It often carries a stigma."

Soldiers who receive a general discharge get access to medical care at the VA, but they lose their education benefits under the GI Bill – one of the main incentives for people to join the service. In addition, a general discharge can hurt their chances of getting good jobs. "I have a client right now who's a soldier," Vokey says. "He wants to get into law enforcement or corrections. He's applied to a number of police departments and because of the general discharge, they won't hire him." The Army's report acknowledges that investigators did find some problems with the ways commanders have been separating soldiers for misconduct. It states, for instance, that they couldn't find evidence in more than one third of the cases they examined that commanders had considered soldiers' mental health before they kicked them out. But, the report adds, "that finding alone does not mean the [commanders] did not review it or that the Army was non-compliant" with the law. Fanning told each of the 12 senators in a letter that from now on, the Army will require commanders to document in writing that they reviewed the soldier's medical files.

Fanning wrote in the letter that investigators found 73 cases in which soldiers might have been kicked out unfairly, and that the Army will review those cases "to determine if the Soldier's discharge should be upgraded." When Murphy read that finding, he laughed. "No, the number is clearly not 73. The problem is much bigger than that." Sen. Ron Wyden (D-OR) says , "The bottom line for me is that the Congress still has work to do to ensure that our soldiers who are facing mental health challenges, and have been kicked out of the Army, get a fair shake" Both Wyden and Murphy told NPR that they are trying to figure out their next steps. That could include calling for congressional hearings and pushing for a tougher law to protect soldiers with mental health problems and brain injuries.

But Andrew Pogany, a soldiers' rights advocate who has helped trigger federal investigations of alleged mistreatment of soldiers, says that's not enough. "The only way we can really find out how the Army is treating wounded soldiers is by forming an independent third-party commission and conducting a genuine investigation," says Pogany, CEO of the Uniformed Services Justice and Advocacy Group. "As long as Army officials investigate themselves, we'll just hear what those officials want to tell us." [Source: NPR | Daniel Zwerdling | December 1, 2016 ++]

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USS Colorado (SSN-778) ► Christened 3 DEC

With two whacks of a bottle of sparkling wine from a vineyard in the capitol of the ship's namesake state, which was chilled in a bucket of Colorado River water, a daughter of the secretary of the Navy christened the future submarine Colorado in a ceremony 3 DEC. Annie Mabus was 19 when, in the kitchen of her family's Mississippi home, her dad, Ray Mabus, told her she'd be the ship's sponsor. Then the Colorado was a plan on a piece of paper, she said, and she had no concept of what a sponsor was. "Hundreds, if not thousands, of hands have transformed her from an idea into an awe-inspiring presence behind me," she said.

For the christening, the 370-plus-foot submarine was in the main assembly hall of Electric Boat's Groton shipyard — as opposed to floating in the water, as is tradition — to allow for it to be in the right spot at the right time to finish testing, according to EB's Chief Operating Officer Kurt Hesch. Hundreds of people gathered around the submarine in the frigid, open-air building, bundled up in jackets and wrapped in blue and white scarves — with

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the words "USS Colorado SSN-788" and the state's symbol — given out by the commissioning committee. Seven World War II veterans, all around the age of 90, of the battleship USS Colorado (BB-45), attended the ceremony and presented the crew with pens made out of teak wood from the battleship's deck. One of the veterans said the pens had been baptized with the blood of their fallen shipmates. Their ship — which had a crew of more than 2,000 and saw heavy action in the Pacific theater — was vastly different from the new submarine, which has a crew of 132. "I had 130 in the boiler division," said Chuck Johnson, 91, of Indiana.

Hundreds gather as General Dynamics Electric Boat hosts the christening ceremony for the 15th Virginia-class, fast-attack submarine Colorado at Electric Boat in Groton on Saturday, Dec. 3, 2016

Ray Mabus, who is wrapping up his time as secretary of the Navy, as he not expected to be re-appointed under President-elect Donald Trump, called the crew of the submarine Colorado "the rightful heirs to the sailors who crewed the USS Colorado in World War II." The previous submarine named Colorado was decommissioned nearly 70 years ago. The sailors of the new Colorado "will be spending years of their lives unseen," Ray Mabus said. "You won't know about it. But they will be there, standing the watch. They will be there protecting us. They will be there when their families are back here celebrating birthdays and other holidays. As he has in the past, Ray Mabus pointed to the number of ships under contract doubling during his tenure compared to the number of ships under contract in the seven years before he took office. His other daughter, Elisabeth Mabus, is the ship sponsor for the future submarine Washington, Colorado's sister ship, which was christened earlier this year. It also took two hits to break the bottle.

Electric Boat and Newport News Shipbuilding in Virginia, which build Virginia-class submarines together under a teaming agreement, are poised to deliver 18 more of these submarines, EB President Jeff Geiger said. U.S. Rep. Joe Courtney [D-CO-02] in his remarks, noted the "rapid fire succession" in which these events are happening. While the christening was the last for Ray Mabus, it won't be the last christened submarine of his legacy, Courtney said. Virginia-class submarines are "technological wonders," U.S. Sen. Richard Blumenthal (D-CT) said, noting their ability to fire Tomahawk land-attack missiles, put special operation forces on the ground and conduct surveillance.

Construction on the Colorado began in March 2012, and the ship is expected to be delivered to the Navy in summer 2017, capping off the five years it takes to build Virginia-class submarines, which EB and Newport News have been building at a rate of two a year since 2011. After all was said and done Saturday, Electric Boat employees

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got back to work on the submarine that afternoon. The employees will be testing the submarine's steam propulsion system. About 800 employees currently are working on the submarine, according to the Hesch, the company's COO. Annie Mabus had just one question for the crew before christening the submarine: "How high?" "Mile high," they replied. [Source: \The Day | Julia Bergman | December 5, 2016 ++]

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U.S. Philippine Bases Update 13 ► Freedom-of-Navigation Patrols

The Philippine defense secretary said 8 DEC it is highly unlikely his country will allow the U.S. military to use it as a springboard for freedom-of-navigation patrols in the disputed South China Sea. Delfin Lorenzana said U.S. ships and aircraft could use bases in Guam or Okinawa or fly from aircraft carriers to patrol the disputed waters. Under President Rodrigo Duterte's predecessor, Benigno Aquino III, some U.S. aircraft and ships stopped in the Philippines on the way to patrolling the disputed waters to challenge China's territorial claims. Duterte, who took office in June, has taken steps to mend ties with China and became hostile toward the Obama administration after it raised concerns over Duterte's deadly crackdown on illegal drugs.

Asked if the Philippines will continue to host U.S. ships and aircraft patrolling the disputed waters, Lorenzana said Duterte will not likely allow that to happen "to avoid any provocative actions that can escalate tensions in the South China Sea. It's unlikely." "We'll avoid that for the meantime," Lorenzana said. "Anyway, the U.S. can fly over there coming from other bases." U.S. officials did not comment immediately. The commander of U.S. forces in the Pacific, Adm. Harry Harris, said last month that despite Duterte's rhetoric, military cooperation with Manila has not changed. Duterte has publicly threatened to scale back the Philippines' military engagements with the U.S., including scuttling a plan to carry out joint patrols with the U.S. Navy in the disputed waters, which he said China opposes. U.S.-Philippine annual combat exercises have been reduced and will be redesigned to focus on disaster response and humanitarian missions. Among the maneuvers to be dropped starting next year are amphibious landing exercises and beach raids aimed at enhancing the country's territorial defense, military officials said.

Duterte's actions have become a hindrance to U.S. efforts to reassert its presence in Asia, although the U.S. military has vowed to continue patrolling one of the world's busiest commercial waterways. After Duterte met Chinese President Xi Jinping in Beijing in October, China allowed Filipinos to fish at disputed Scarborough Shoal. China took control of the rich fishing area in 2012 after a tense standoff with Philippine government ships. Philippine coast guard ships have also resumed patrols at the shoal. Aside from the easing of tensions at Scarborough, Chinese coast guard ships are no longer blocking Philippine resupply ships from Second Thomas Shoal, farther south in the Spratlys, Lorenzana said.

Lorenzana said he and his Chinese counterpart agreed in October, during Duterte's trip to China, to resume exchanges of defense observers and students under a 2004 agreement. The exchanges were suspended in 2012 when the Philippines brought its territorial disputes with China to international arbitration under Aquino's presidency, angering Beijing, he said. China has also inquired if it can supply armaments to the Philippines, he said. China can further expand its influence in the region if U.S. President-elect Donald Trump pursues an isolationist foreign policy, former Philippine Foreign Secretary Albert del Rosario said. "If the U.S. relinquishes (its) leadership posture in terms of the region, that vacuum will be quickly filled by our northern neighbor," del Rosario said. [Source: The Associated Press | Jim Gomez | December 8, 2016++]

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U.S. Philippine Bases Update 14 ► PHIBLEX and CARAT Cancelled

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For the first time in 34 years, the U.S. and Philippines will not hold the annual amphibious joint exercise PHIBLEX in 2017, the latest sign of strain in the two countries’ relationship since Philippine President Rodrigo Duterte was elected in May. More than 1,400 Okinawa-based Marines and sailors from the 3rd Marine Expeditionary Brigade, and 500 Philippine troops participated in the 33rd annual PHIBLEX this October. The annual exercise involved live-fire events, as well as training for amphibious landings. But in 2017, the two countries will hold a different training exercise, one that is more limited in scope and focused on amphibious operations in response to natural and man-made disasters, officials said. “PHIBLEX included a wider range of capabilities, ranging from command and control, mobility, maneuver, logistics, and territorial defense to humanitarian assistance and disaster relief missions,” said Chuck Little, a spokesman for Marine Corps Forces, Pacific.

The exercises slated for 2017 will include training for cybersecurity, maritime security and counter terrorism, said Capt. Rachel Nolan, a liaison officer for the U.S. in Manila. “We reached a mutually agreed upon plan for 2017, which ensures that U.S.-Philippine military training activities and engagement remain robust and substantial,” Nolan said. Relations between the U.S. and the Philippines have been strained since Duterte was elected in May. He has ordered a crackdown on alleged drug users and dealers that has resulted in thousands of deaths. President Obama canceled a meeting with Duterte after the Philippine president vowed to swear at Obama if he expressed concerns about those killed. Duterte initially vowed to end all military training exercises with the U.S., but the two countries so far have agreed to cancel only a small number of them — including PHIBLEX and CARAT, a Navy exercise. The shift is driven by the Filipino president's desire not to appear confrontational towards China, said Carl Baker a defense analyst with the Center for Strategic and International Studies.

“They’ve said: ‘We don’t want to do patrols in the South China Sea and we don’t want to do maritime-based exercises that focus on assault and amphibious landings," said Baker, director of programs at Pacific Forum CSIS in Honolulu. But, Baker added, "“The fact is there is still a deep engagement with the Philippines,” The U.S. military relationship with the Philippines is shifting back to its original focus on being prepared for humanitarian assistance and disaster relief missions, Baker said. “That’s what we always used to do, and that’s what we do with Balikatan, and that’s why they didn’t cancel Balikatan,” he said, referring to another joint military exercise between the two countries. In September, Defense Secretary Ash Carter called the relationship between the U.S. and the Philippines ““ironclad;” however, Philippine Defense Minister Delfin Lorenzana told reporters on Dec. 8 that his country would likely not allow U.S. ships and planes to use his country for patrols in the South China Sea. The rough patch between the U.S. and the Philippines may turn out to be short-lived. Duterte seems to enjoy a much warmer relationship with President-Elect Donald Trump, who has reportedly invited Duterte to the White House.

It is important to weigh what Duterte says in public with what he actually orders his military to do, said retired Army Special Forces Col. David Maxwell, associate director at the Center for Security Studies at Georgetown University. “If he is allowing exercises to continue, albeit with a new name and a new concept, I think it indicates he wants to sustain the military alliance,” Maxwell said. The U.S. military alliance with the Philippines expanded significantly under Duterte’s predecessor, In March, the two countries announced plans for a permanent American military presence and five military bases that will support rotational deployments of U.S. forces near the contested South China Sea. Military leaders view the Philippines as a key ally for containing China and its territorial ambitions in the South China Sea. [Source: MilitaryTimes | Jeff Schogol | December 11, 2016 ++]

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Submarine Aircraft Carriers ► The Ultimate Weapon

If submarines possessed the high vision and quick speed of aircraft, they could dramatically extend their reach. If aircraft took off and landed from underwater platforms, their staging and strikes would be stealthier and more secure. But combining the two epoch-making weapons has proved difficult. Only one country really pulled it off—and too late to win a war. But the tremendous potential of the aircraft-sub combo may make an historic comeback

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thanks to drones and Special Operations Forces. The underwater stealthiness of submarines comes with a great downside—blindness. Subs rely on a few sensors—and help from other military assets—to comprehend their environments. By carrying and deploying a small airplane, a submarine could dramatically expand its ability to look around itself. But even a small sub-launched plane needs a large and heavy pressure-proof hangar to ride in while the sub submerges. Early on, only the largest subs had room for such bulky hangars.

After World War I, the British replaced an M-class sub’s 12-inch gun with an aircraft hangar. The sub-carrier sank when the hangar flooded. The French “submarine cruiser” Surcouf, the largest undersea boat in the world in the 1930s, carried a small folding plane for spotting targets for its twin eight-inch guns. A Soviet designer came up with a submersible airplane. Though never built and full of technical loose-ends, U.L. Ushakov’s 1934 design featured a thick, manta-ray-style wing and narrow fish-like body, complete with a conning tower. Ushakov did not specify how he would seal the three radial engines against saltwater. The machine supposedly would have flown out to sea, landed on its pontoons like a normal seaplane then flooded spaces within its wings and hull to sink. Approaching its target under electrical power while submerged, the flying sub could observe using its periscope or fire its two torpedoes.

We have no idea how well Ushakov’s clever concept would have worked in combat because the Soviets never built it. But we do have a good idea of how the Japanese would have used their submarine aircraft carriers, because they almost actually used them in battle. Adm. Isoroku Yamamoto, who led Japan’s raid on Pearl Harbor, believed Japan had to carry the war to the American mainland. Japanese subs had already launched individual aircraft over U.S. shores. Bigger submarine carriers could get past U.S. defenses to launch air strikes on strategic targets like the Panama Canal. Yamamoto’s vision drove Japan to create the largest non-nuclear subs ever. The Sen-Toku subs carried three Seiran bombers and enough fuel to steam around the planet. Ace crews could surface, load and launch the Seirans at night in just 45 minutes. But the emperor’s broadcast surrender decree in August 1945 stopped the five giant subs of SubRonOne from attacking the huge U.S. Navy anchorage at Ulithi Atoll. The Americans seized the Sen-Tokus, studied them and subsequently sank them to prevent the Soviets from discovering their secrets.Drone Daydreams:

In the 1950s both Soviet and American engineers explored the idea of submarine aircraft carriers. Between 1958 and 1964 the U.S. Navy installed Regulus nuclear-armed cruise missiles aboard specially-equipped subs, including USS Halibut, pictured. Regulus was essentially a drone with a three-megaton warhead and a 500-mile range. Like the Sen-Tokus, a Regulus missile sub had to surface to launch the big drones, potentially exposing it to detection.Guided missile submarines like Halibut and later ballistic-missile boats successfully melded the undersea and aerospace realms. But they were essentially very-long-range naval artillery rather than aircraft carriers. The sub-launched missiles were one-shots, not recoverable aircraft.

Regulus nuclear-armed cruise missiles

The “Flying Sub” became one of the pop icons of the 1960s when Irwin Allen introduced the craft on his TV show Voyage to the Bottom of the Sea. Even 50 years later, the manta-shaped sub looks incredibly futuristic, but it’s

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possible it drew inspiration from a real concept. In 1962, Convair pitched the Navy a submersible aircraft design. Like the Ushakov plane, the Convair design would fly to a search area then land on water and submerge to continue its mission. Convair released some details from the study in 1965. Like the Ushakov, the High Density Seaplane had pressure-proof compartments, floodable voids and three engines with watertight doors. Also like the Ushakov, there is no sign it was ever built. Allen’s research assistant and librarian Elizabeth Emanuel compiled an impressive archive for her boss, who developed a passion for underwater adventures. The archive so impressed undersea explorer Jacques Cousteau when he visited the TV producer that he tried to hire her away. It’s possible Emanuel had found and brought news of Convair’s San Diego-based research to Allen, providing the basis of the fictional Flying Sub.

In the late 20th century, the Navy perfected the Regulus concept by developing the sub-launched Tomahawk cruise missile. A cross between a drone and a flying torpedo, the jet-powered Tomahawk is the Pentagon’s long-range strike weapon of choice. The submarine USS Florida launched scores of cruise missiles to destroy Libya’s coastal air defenses in the opening hours of the 2011 assault on Muammar Gaddahfi’s regime. But at almost $2 million a shot and with no return capability, a Tomahawk makes an expensive spotter plane or comm relay.

In 2003, the Pentagon’s fringe-science Defense Advanced Research Projects Agency launched a study of reusable submersible aircraft. In 2006, Lockheed Martin evolved this Multi-purpose Unmanned Aerial Vehicle into the Cormorant project, named for the seabird which can dive to astonishing depths. The Cormorant engineers solved the storage problem by fitting their plane into a missile sub’s existing launch tube. The 19-foot-long drone would make up for the seven Tomahawks it replaced with its endurance and reuseability. To minimize detection risk while the Cormorant launched, the sub would release the drone underwater then sail away. Compressed gas would then drive the plane to the surface where its rocket motors would fire and loft it into the sky.

Cormorant mock-up.

Once in the air with its wings unfolded and its jet engine breathing, the Cormorant would range as far as 500 miles and as high as 35,000 feet. At the end of its mission, the drone would return to the sub’s vicinity, deploy a parachute and splash into the sea a short distance away. The vessel’s crew would send a swimming robot to tow the aircraft back to the waiting submarine. Tucked away in the patent application for the drone is a hint of an unexpected side capability. A drawing shows a Cormorant launching from a small surface ship, thus making any vessel a potential drone seaplane tender. The Cormorant fell victim to budget cuts in 2008, it seems. But it’s hard to believe such a useful idea truly just went away.

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Carderock flying sub

Submarines now deploy small drones from mast-mounted launchers and buoys. But sending out bigger payloads at longer ranges demands bigger aircraft. Not long after the Cormorant project ended, engineers at the Naval Surface Warfare Center at Carderock designed a submersible aircraft for special operations. Like Ushakov’s pioneering design, it’s a flying wing on pontoons, full of hollow spaces and a pressure compartment. Thirty-four to 36 feet long with a wingspan of between 90 and 110 feet, the Carderock flying sub might carry six Special Operations Forces troops and two pilots some 800 miles in the air and up to 12 miles underwater. Fantastic as the notion is, flying subs and sub carriers still beckon. Drone technology and advances in material science could finally make these fantastical weapons feasible. [Source: The National Interest | Steve Weintz | November 24, 2016 ++]

* Military History *

WWII Speculation ► What If No Pearl Harbor Attack

Few events in World War II were as defining as the Japanese assault on Pearl Harbor on Dec. 7, 1941. The "date which shall live in infamy" — as President Franklin D. Roosevelt famously put it — prompted the American entry into the war, subdued an entrenched isolationist faction in the country's politics and, in the long run, prefigured Washington's assumption of the role of global superpower. 2,403 Americans died and 19 vessels were either sunk or badly damaged in the attack, which involved more than 350 warplanes launched from Japanese carriers that had secretly made their way to a remote expanse of the North Pacific. It caught the brass in Hawaii by surprise and stunned the nation. "With astounding success,” Time magazine wrote, “the little man has clipped the big fellow.”

But the big fellow would hit back. Japan's bold strike is now largely seen as an act of "strategic imbecility," a move born out of militarist, ideological fervor that provoked a ruinous war Japan could never win and ended in mushroom clouds and hideous death and destruction at home. Admiral Isoroku Yamamoto, the Japanese naval commander, hoped his plan to attack on Pearl Harbor would deliver a fatal blow to American capabilities in the Pacific and persuade Washington to push for a political settlement. Otherwise, he knew that his country stood no chance against the United States in a protracted war, according to Steve Twomey, author of a new book on the tense

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build-up to Pearl Harbor. Twomey documents Yamamoto's initial opposition to engaging the United States: "In a drawn-out conflict, 'Japan’s resources will be depleted, battleships and weaponry will be damaged, replenishing materials will be impossible,' Yamamoto wrote on September 29 to the chief of the Naval General Staff. 'Japan will wind up 'impoverished,' and any war 'with so little chance of success should not be fought.'"

But with war a fait accompli, Yamamoto conceived of a raid that would be so stunning that American morale would go "down to such an extent that it cannot be recovered," as he put it. Unfortunately for him, the United States was galvanized by the assault — and had its fleet of aircraft carriers largely unscathed. A plane carrying the Japanese admiral would be shot down over the Solomon Islands by American forces in 1943 with the U.S. counter-offensive already well underway. Could it have gone differently? No modern conflict has spawned more alternative histories than World War II. In the decades since, writers, Hollywood execs and amateur historians have indulged in all sorts of speculation: What the world would look like if the Axis powers triumphed, or if the Nazis crushed the Soviets, or if the United States had not deployed nuclear weapons, or if Roosevelt had chosen not to enter the war at all. But even if Japan had not attacked Pearl Harbor, it's quite likely that the two sides would have still clashed.

Japan's will to power

For imperial Japan, the United States posed a fundamental obstacle to its expanding position in the Pacific. Here was a resource-hungry island nation eager to assert itself on the world stage in the same way European powers had done in centuries prior. By the summer of 1941, it had seized a considerable swath of East Asia, from Manchuria and Korea to the north to the formerly French territories of Indochina further south, and was embroiled in a bitter war in China. American sanctions attempted to rein in Tokyo: Washington slapped on embargoes on oil and other goods essential to Japan's war machine. The price to have them lifted — a Japanese withdrawal from China, as well as the abandonment of its "tripartite" alliance with Germany and Italy — proved too steep and humiliating. So Japan calculated further expansion in order to access the resources it needed. "Our increasing economic pressure on Japan, plus the militaristic cast of the government ... and their partial loss of face in China, spelled a probable resumption of their policy of conquest," mused a lengthy essay in the Atlantic, published in 1948. "In what direction would the Japanese strike, and against whom?"

Japan opted not to venture into Soviet Siberia; in 1939, Japanese troops had suffered a chastening defeat at the hands of a combined Soviet and Mongolian army and its forces were already bogged down on various fronts in China. The decision was made to target the vulnerable British and Dutch colonies in Southeast Asia — what's now the independent nations of Burma, Singapore, Malaysia and Indonesia. The Japanese knew this would likely spur a greater response from the United States, which then controlled the Philippines and other scattered island possessions in the Pacific. "Unwilling to give up what it wanted — greater empire — in return for the restoration of lost trade, unwilling to endure the humiliation of swift withdrawal from China, as the Americans wanted, Japan was going to seize the tin, nickel, rubber, and especially oil of the British and Dutch colonies," wrote Twomey.

The rest is history. Some observers, though, reckon that American policy could have forced imperialist Japan's hand. "Never inflict upon another major military power a policy which would cause you yourself to go to war unless you are fully prepared to engage that power militarily," wrote American historian Roland Worth Jr., in "No Choice But War: The United States Embargo against Japan and the Eruption of War in the Pacific." "And don't be surprised that if they do decide to retaliate, that they seek out a time and a place that inflicts maximum harm and humiliation upon your cause."

Roosevelt's battle with the isolationists

Meanwhile, in the United States, President Roosevelt faced widespread public opposition to entering the war. The memory of World War I — a struggle many Americans believed wasn't worth fighting — still loomed large in the political imagination. Roosevelt faced off a 1940 election challenge by pandering to anti-war voters. "I have said this before, but I shall say it again and again and again," he declared on the campaign trail in Boston in October 1940. "Your boys are not going to be sent into any foreign wars." But Roosevelt was steadily trying to engage in the

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conflicts abroad, no matter his rhetoric. He was an avowed anti-fascist and was preoccupied more by Nazi aggression in Europe than Japanese inroads in Asia. His political opponents fretted that he would push toward a greater confrontation. This included figures from the America First movement, a big tent coalition of isolationists, nationalists, pacifists and, indeed, some anti-Semites, who wanted the United States to cling to a policy of neutrality and weren't that bothered by an ascendant fascism in Europe.

Charles Lindbergh, the legendary aviator, was one of the more prominent champions of the America First cause. “The pall of the war seems to hang over us today. More and more people are simply giving in to it. Many say we are as good as in already. The attitude of the country seems to waver back and forth,” Lindbergh wrote in his diary on Jan. 6, 1941. “Our greatest hope lies in the fact [that] eighty-five percent of the people in the United States (according to the latest polls) are against intervention.” In March 1941, Roosevelt persuaded Congress to pass the Lend-Lease Act, which "loaned" arms and ships to the beleaguered Allies in Europe. U.S. warships engaged Nazi submarines in the Atlantic and protected convoys bearing relief supplies to the British. Months of secret diplomacy with British Prime Minister Winston Churchill already bound Roosevelt's administration to the Allied cause, but the United States was not yet formally in war.

The attack on Pearl Harbor in December gave Roosevelt all the ammunition he needed. Germany, in alliance with Japan, declared war on the United States four days later, saving Roosevelt the trouble of having to do it himself. The isolationists were defeated. “I can see nothing to do under these circumstances except to fight. If I had been in Congress, I certainly would have voted for a declaration of war,” Lindbergh lamented. Other politicians in Congress, mostly Republicans, would soon lose elections and become an irrelevant wing of the party. Without the American entry into World War II, it's possible Japan would have consolidated its position of supremacy in East Asia and that the war in Europe could have dragged on for far longer than it did. The U.S.'s role in the war forced Nazi Germany to commit a sizeable troop presence in Western Europe that it would have otherwise diverted to the withering invasion of the Soviet Union. It helped turn the tide of battle.

For decades since, though, conspiracy theories have surrounded Roosevelt's role in the build-up to Pearl Harbor, with a coterie of revisionist historians alleging he deliberately bungled military coordination and obscured intelligence in order to provoke the crisis that led to war. Most mainstream historians dismiss these claims. "He was totally caught off guard by it," Roosevelt biographer Jean Edward Smith told NPR this week. "The record is clear. There was no evidence of the Japanese moving toward Pearl Harbor that was picked up in Washington."

[Source: The Washington Post | Ishaan Tharoor | December 7, 2016 ++]

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Pearl Harbor Day ► 2016 | Joint Base Pearl Harbor-Hickam, Hawaii

Dozens of Pearl Harbor survivors and World War II veterans gathered 7 DEC for a commemoration recognizing their valor on Dec. 7, 1941, when Japanese aircraft decimated America’s mighty fleet of battleships moored in the harbor. Simultaneous attacks on Army and Marine Corps airfields across Oahu wiped out most of the fighter planes on the island.For some of these veterans, it was their first return to Hawaii in 75 years. For many – the youngest in their mid-90s and a few more than a century old – it will likely be the last time they return to Pearl Harbor, first-hand witnesses to one of America’s greatest military disasters.

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An audience of roughly 1,000 people filled a covered pier that overlooks the USS Arizona Memorial. At one point the throng of visitors rose and gave the veterans long and thunderous applause. Countless others watched the event being live-streamed by the National Park Service. “To America’s World War II patriots here and watching at home: we will never forget your courage under considerable fire and seemingly insurmountable odds,” said Adm. Harry Harris, U.S. Pacific Command commander. “Because of you, our future remains bright. We owe you an immeasurable debt, and we can’t thank you enough for answering the call to duty when lady liberty needed it the most.” Harris garnered his own minute-long standing ovation with an allusion toward San Francisco 49ers quarterback Colin Kaepernick, who began going down on one knee during the national anthem this season as a protest to racial injustice. “You can bet that the men and women we honor today and those that died that fateful morning 75 years ago never took a knee and never failed to stand whenever they heard our national anthem being played,” Harris said.

Survivors from the USS Arizona, which was destroyed and sunk during the Dec. 7, 1941, surprise attack by the Japanese, chat with guests before the start of a ceremony commemorating the 75th anniversary of the disaster, Wednesday, Dec. 7, 2016, at Joint Base Pearl Harbor-Hickam, Hawaii

The “110-minute chaotic attack” left 2,403 dead and almost 1,200 more wounded, he said. All eight of the Navy’s battleships moored in Pearl Harbor just off Ford Island were damaged, with four sunk. Six were repaired and entered the Pacific war. Only one, the USS West Virginia, was present at Tokyo Bay when Japan formally surrendered on Sept. 2, 1945. None of the sailors, Marines and soldiers on Oahu that day “knew it would be the last moment of peace for almost four years,” Harris said.

Among the many caught by surprise was Cecil Hollingshead, 96, a former Marine who watched the ceremony from wheelchair near the front row. He was stationed at Kaneohe, on the opposite side of the island from Pearl Harbor. “I stepped out of the barracks on my way to breakfast at the PX,” he said. “When I looked to my left, there was a young man walking down the sidewalk and an airplane strafing him, with bullets spitting at his feet. That was my introduction to war.” Hollingshead headed to the armory and equipped himself with a submachine gun, taking a position at the edge of the runway tarmac. “When the second [wave] came through, we fired at them,” he said. “After that was over with, we tried to set up a machine gun emplacement and so forth for any following attack, but that didn’t come.”

Another Marine, Gordon C. Sage, 95, was shining his shoes aboard the USS Maryland in Battleship Row. He’d planned to go ashore that sunny Sunday. “I felt the movement of the ship, and it was the attack on Pearl,” Sage said. When he got to a window to look out, “there was the Oklahoma rolling over on its side.” A recent transfer to the Maryland from the West Virginia, Sage did not yet have a designated battle station. “I went out and joined the gun crew and passed ammunition to the gun crew,” he said.

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The scars of that momentous day remain 75 years later, Harris said. “We see them all around us. The battleships USS Arizona and USS Utah are still entombed in the waters behind me. The USS Oklahoma Memorial. The bullet holes in the buildings at Ford Island and Hickam Field. And on the bodies and in the minds of the veterans with us here today. These scars remind us of our history and how America responded with conspicuous valor. “Today we have a precious opportunity to reflect on what it means to be a patriot, to reflect on what it means to be a nation tested by war and to reflect on both the cost and the blessings of liberty." [Source: Stats & Stripes | Olsen Wyatt | December 7 2016 ++]

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Battle of Verdun Facts ► 10 Facts About Longest WWI Battle

The morning of February 21, 1916, marked the beginning of one of the longest, bloodiest and costliest battles in WWI and history. For about 300 gruesome days, the French and German armies exchanged a brutal cycle of attacks, counterattacks and bombardments. The battle plunged the region around the Meuse River, not even 10 km radius, into what was later called the “Hell of Verdun”. Hundreds of thousands of German infantries, heavy artillery, and bombardments were unleashed upon French armies positioned around forts and inside the fortified city of Verdun. Although the Germans planned for their attack to bleed France to death, the battle pulled both of them into a long and expensive impasse. By December 19th, the French were able to get the upper hand and regained their territory, but not before sustaining heavy causalities. The French and German armies suffered 800,000 men or more between them. To read these facts on the battle refer to the attachment to this Bulletin titled, "Battle of Verdun Facts". [Source: Frontiers of Freedom Newsletter | December 9, 2016 ++]

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Military History Anniversaries ► 16 thru 31 DEC

Significant events in U.S. Military History over the next 15 days are listed in the attachment to this Bulletin titled, “Military History Anniversaries 16 thru 31 DEC”. [Source: This Day in History http://www.history.com/this-day-in-history | December 2016 ++]

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Medal of Honor Citations ► Elrod, Henry T | WWII

The President of the United States in the name of The Congress

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takes pleasure in presenting theMedal of Honor posthumously

to

HENRY TALMAGE ELROD

Rank and organization: Captain, U.S. Marine Corps.Place and date: Wake Island, Dec. 23, 1941Entered service: Ashburn GA in Dec. 1927

Born: Sept. 27, 1905, in Turner County

Citation

For conspicuous gallantry and intrepidity at the risk of his life above and beyond the call of duty while attached to Marine Fighting Squadron 211, during action against enemy Japanese land, surface and aerial units at Wake Island, 8 to 23 December 1941. Engaging vastly superior forces of enemy bombers and warships on 9 and 12 December, Capt. Elrod shot down 2 of a flight of 22 hostile planes and, executing repeated bombing and strafing runs at extremely low altitude and close range, succeeded in inflicting deadly damage upon a large Japanese vessel, thereby sinking the first major warship to be destroyed by small caliber bombs delivered from a fighter-type aircraft. When his plane was disabled by hostile fire and no other ships were operative, Capt. Elrod assumed command of 1 flank of the line set up in defiance of the enemy landing and, conducting a brilliant defense, enabled his men to hold their positions and repulse intense hostile fusillades to provide covering fire for unarmed ammunition carriers. Capturing an automatic weapon during one enemy rush in force, he gave his own firearm to one of his men and fought on vigorously against the Japanese. Responsible in a large measure for the strength of his sector's gallant resistance, on 23 December, Capt. Elrod led his men with bold aggressiveness until he fell, mortally wounded. His superb skill as a pilot, daring leadership and unswerving devotion to duty distinguished him among the defenders of Wake Island, and his valiant conduct reflects the highest credit upon himself and the U.S. Naval Service. He gallantly gave his life for his country.

Elrod enlisted in the Marine Corps in December 1927, and was appointed a Marine second lieutenant in February 1931. He attended the University of Georgia and Yale University prior to his entry into the Marine Corps. Following over a year at the Marine Corps Basic School in Philadelphia as a student aviator, Lieutenant Elrod was ordered to the Naval Air Station Pensacola, Florida. There he served as a company officer and as student aviator. In February 1935, he earned his wings and was transferred to Marine Corps Base Quantico, where he served as a Marine Aviator

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until January 1938. In addition to his other duties, he was his squadron’s school, personnel, and welfare officer. In July 1938, Elrod was ordered to a squadron in San Diego and served as their material, parachute, and personnel officer until January 1941, when he was detached to the Hawaiian area. On December 4, 1941, Captain Elrod flew to Wake Island with twelve aircraft, twelve pilots, and the ground crew of Major Paul A. Putnam's fighter squadron, VMF-211. Hostilities in the air over Wake Island commenced on December 8, 1941.

Captain Elrod was posthumously promoted to Major on November 8, 1946, and his widow was presented with the Medal of Honor for his heroic actions during the defense of Wake Island. His widow is also a former commissioned officer in the United States Marine Corps. He was initially buried on Wake Island, but was reinterred in Arlington National Cemetery in October 1947. His grave can be found in Section 12, Grave 3246. Henry Talmage "Hammerin' Hank" Elrod was the first aviator to receive the Medal of Honor during World War II, for his heroism in the defense of Wake Island.

The Japanese destroyer Kisaragi and Wreckage of Wildcat 211-F-11, flown by Capt Elrod

[Source: http://www.history.army.mil/moh | December 2016 ++]

* Health Care *

NDAA 2017 Update 24 ► Approved TRICARE Changes

The 2017 National Defense Authorization Bill passed by both chambers of Congress includes the following changes to TRICARE for active duty and retirees:

TRICARE enrollment costs and use fees for currently serving troops and existing retirees escaped congressional reform efforts unchanged, according to the final draft of the NDAA. But future retirees who join the military in 2018 or thereafter will pay higher fees for all TRICARE plans.

TRICARE reforms proposed over the last year had included a parade of fee increases, many of which put the greatest burden on military retirees. But after months of negotiations, lawmakers produced a toned-down set of reforms that focuses change on the incoming military force instead of those who entered service under current health care plans.

For those currently in the TRICARE system, including TRICARE Reserve Select and TRICARE for Life users, reform focuses primarily on program title change, back end management and limited expansions. For example, the law eliminates the "TRICARE Standard" and "TRICARE Extra" options, swapping them out

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with the newly minted "TRICARE Select." But for those who serve before 2018, nothing about the cost structure under the new plan differs from what users pay today under Standard or Extra.

Under expansions in the legislation, TRICARE Prime users will be able to access civilian-based urgent care without prior authorization, a program that is currently capped at two visits per year. Military treatment facilities also will expand their primary care business hours and implement a standard appointment scheduling system across all services and facilities nationwide while increasing the number of available appointments.

The legislation allows the Defense Department to sell durable medical equipment, such as hearing aids, to beneficiaries at cost. Currently, TRICARE does not cover hearing aids for retirees.

Those new to the military in 2018 will see new cost structures once they hit retirement, including annual enrollment fees of at least $900 per family for the new "TRICARE Select" option and $700 for TRICARE Prime. Active-duty family users new to the force in 2018 or after will be charged fees for the "Select" plan similar to those charged for active-duty families on Standard today, according to the legislation.

[Source: NAUS Weekly Update | December 9, 2016 ++]

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Navy Medicine ► Surgeon General Reform Aims

Nearly a year into his job as the Navy’s top doc, Vice Adm. C. Forrest Faison III wants to make wide-ranging reforms designed to better heal millions of sailors, Marines, military retirees and their families. The 38th surgeon general of the Navy wants to wage war against complacency on three fronts — making health services more convenient for troops and their families; ensuring positive, “friction-less experiences” with Navy medical providers; and using technology to connect troops with the best physicians. But he doesn’t want his reforms to bear unacceptable costs, like destroying a medical culture that saved 97% of America’s wounded service members during the wars in Iraq and Afghanistan — the highest survival rate in military history — or adopt private-sector practices that won’t work in a military constantly churning with new recruits coming aboard and veterans returning to their hometowns.

Vice Admiral C. Forrest Faison III, the 38th Navy surgeon general

“There’s a great temptation to look at Navy medicine through a civilian lens,” Faison, 58, said during an interview last week with The San Diego Union-Tribune. “We have a 28% turnover rate because people move every three years to support the Navy. People also deploy. Unlike one of the marquee civilian health-care institutions in the nation — (where) they’re not going to empty their hospital and send that staff into harm’s way — I am. And I’m going to do it on a moment’s notice.”

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The Navy is younger than the U.S. civilian population, which is why Faison’s proposals focus on a millennial generation of Marines and sailors that he believes is “fundamentally changing health care.” Three out of every four sailors and their families were born after 1986. They’re digital natives — more than 80 percent of them fall asleep with their mobile phones — and their fingers can choose from 16,000 apps related to health care, few of which have been tested for accuracy by the Navy or linked to the service’s physicians. They demand convenience, and the federally subsidized health system — called Tricare — lets them choose “minute clinics” and urgent-care providers outside the traditional military medical system. But their need for speed has unintended consequences: When sailors and Marines desert the traditional sick bay system for off-base care, Navy medical teams lose both “visibility on the health of the force” and proficiency in their craft because they have fewer patients to practice on, Faison said.

He wants to fix that by pushing Navy medicine onto smartphones and integrating that health care more seamlessly into service members’ daily lives, wooing sailors and their families back to direct military treatment while taking advantage of technology already in the fleet to make their experiences better than they would find in most private-sector clinics. Faison points to early efforts that promise to use high-tech “virtual medicine” to link patients with his 63,000 physicians, nurses, corpsmen, dentists, government civilians and contractors.

“We’re in the early stages of discussing a pilot program that would develop corpsmen-led clinics that might be in our commissaries or in our exchanges, connected by telemedicine to doctors at the hospital,” he said. “So if you’re a patient, while you’re in the commissary you can get your health-care needs met by a corpsman, and that corpsman is getting the opportunity to keep his skills up. “More importantly, because he’s the guy there, he’s developing the confidence he’s going to need to save lives on the battlefield — but in a structured way that we’re providing good, safe health care using telemedicine links to experienced physicians in the rear.” For example, the Navy’s new hospital in Guam links to specialists in Hawaii and San Diego. Similar systems connect to warships at sea or surgical teams saving Marines on remote battlefields.

More than 70% of clinical care doesn’t require a trip to the doctor, so putting a corpsman in the commissary could very well be a smarter and cheaper option for taxpayers than pushing patients into emergency rooms or physicians’ offices. Controlling expenses is important in a Navy that spends $9.6 billion annually on health care — about a fifth of the Department of Defense’s overall medical budget. Accounting for inflation, military health costs rose 130% between 2000 and 2012, according to the Congressional Budget Office. In 2000, medical care consumed 6% of the Pentagon’s base budget. A dozen years later, it gobbled up a tenth of all military spending. It could reach 11% by 2028, the federal analysts warned. Rising expenses are mostly tied to Tricare. In the past two decades, Congress has expanded Tricare access to growing numbers of military retirees, active-duty service members’ families, National Guardsmen and reservists.

Today, the Navy directly treats or funds the health care of 2.8 million beneficiaries, but three out of every four patients aren’t active-duty sailors or Marines. They’re mostly military spouses, children and working-age retirees. Federal lawmakers have been reluctant to force military families to share a larger portion of health-care expenses by significantly hiking co-pays, enrollment fees and other charges — even in Tricare Prime, the managed-health-care option that’s designed to contain costs. In 2010, the typical Tricare Prime enrollee garnered $4,800 in yearly federal subsidies, according to the Congressional Budget Office analysis. With low out-of-pocket costs, Tricare Prime beneficiaries use 50% more outpatient services than civilians of the same age who are enrolled in health-maintenance organizations.

But beyond the financial savings for military enrollees, Tricare surveys have shown that many service members and their families believe they get seen faster, and by better physicians, in the private sector. Marines are the most disgruntled. In the 2015 Military Compensation and Retirement Modernization Commission report, 54% of them expressed dissatisfaction with their overall health-care experiences and 56% said they didn’t like their choice of medical providers. The Navy is using a customer-service surveying system modeled on Delta Airlines’ to get rapid feedback from those dissatisfied Marines so Navy medicine can respond nimbly to their needs.

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But in general, Faison said military care suffers from a perception problem. “Our access for primary care and specialty care is well below the civilian average. So when people are sick, we take it to heart to get them in quickly and get them seen,” he said. Faison believes private-sector health networks artificially boost satisfaction rates by offering valet parking, gourmet meals and other non-medical perks that taxpayers wouldn’t tolerate for the Navy. “It’s very easy to confuse the experience of care with the quality of care,” he said. “So you see nice waterfalls and pavilions and that sort of stuff and you say, ‘Well, that place has all of this so it must be high-quality care.’”

The one program Faison won’t revamp is the Navy’s cutting-edge medical research. Faison’s teams are experimenting with a potential malaria vaccine in the jungles of northern Thailand, exploring the cause of sepsis in an Egyptian hospital and working to unravel the mysteries of the Zika and other epidemics — medical breakthroughs that could save millions of lives worldwide, help preserve stability in troubled places and safeguard American service members from disease if they’re deployed overseas. “Look at the force you can say confidently will get out the door tonight to save lives, wherever called upon, that can build strategic partnerships and alliances around the world and that’s leading the nation — and sometimes the world — in battling infectious diseases in our research labs. That’s a pretty darned good investment,” he said. [Source: San Diego Union Tribune | Carl Prine | December 11, 2016 ++]

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TRICARE Coverage Update 06 ► AOI & Urinary System

Effective early December, TRICARE coverage expanded to include the care and treatment of beneficiaries requiring an auditory osseo-integrated implant (AOI) to non-active duty family members. In addition, TRICARE announced future coverage of the services and supplies needed to diagnose and treat illness or injury of the urinary system. AOI is a prosthetic device implanted in the skull to transmit sounds to the inner ear. They are used when needed for significant hearing conditions resulting from trauma, birth defects or disease. Injuries to the urinary system can include a blunt force, e.g., most commonly motor vehicle crashes, falls, or sports injuries or a penetrating force, e.g., most commonly gunshot or stab wounds, or surgery. Injuries to the urinary tract often occur together with injuries to other organs, especially abdominal organs. Illnesses can include bladder disease or cancer, urinary tract infections and chronic kidney disease. These additions to coverage are on the heels of our recently expanded preventive services and care for congestive heart failure under the TRICARE cardiac rehabilitation benefit. [Source: NAUS Weekly Update | December 2, 2016 ++]

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Cancer Moonshot Initiative ► VA's Involvement

During his State of the Union address on January 12, 2016, President Barack Obama announced the establishment of a Cancer Moonshot to accelerate cancer research. The initiative—led by Vice President Joe Biden—aims to make more therapies available to more patients, while also improving our ability to prevent cancer and detect it at an early stage. To ensure that the Cancer Moonshot's goals and approaches are grounded in the best science, President Obama directed the Cancer Moonshot Task Force to consult with external experts, including the presidentially appointed National Cancer Advisory Board (NCAB). A Blue Ribbon Panel of experts was established as a working group of the NCAB to assist the board in providing this advice. The panel's charge was to provide expert advice on the vision, proposed scientific goals, and implementation of the Cancer Moonshot.

In early DEC, Vice President Joe Biden stopped by the Late Show with Stephen Colbert and talked about progress made with the Cancer Moonshot Initiative over the last year. Talking personally about his own family’s connection to the cancer crisis, Vice President Biden quickly turned to the power of big data to change what we

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know about cancer. Pointing out that hundreds of thousands of genomes have been sequenced, Biden specifically noted the power of big data and its ability to make tremendous progress in expediting the search for a cancer cure. He particularly noted the strategic partnerships efforts by the VA, the largest hospital system in the world, to work with private entities to expand the knowledge base around cancer. Earlier this year as a part of VA’s Cancer Moonshot commitments, VA collaborated with IBM Watson on a precision medicine program to bring top tier access to innovative genomic treatment options to cancer patients within the VA. Over the next two years, the VA hopes to treat 10,000 American Veterans with targeted cancer therapies.

“The biggest thing [will be] changing the culture of sharing data and sharing information,” Biden said. “We’re beginning to break down these silos and barriers and I think we’re going to make enormous progress.” In mid-NOV VA convened more than 200 cancer experts with that same focused goal – to foster collaborative partnerships to advance cancer cures (http://www.blogs.va.gov/VAntage/28796/va-enlists-watson-health-technology-war-cancer). Launch Pad: Pathways to Cancer InnoVAtion celebrated VA strategic partnership efforts supporting the Cancer Moonshot Initiative, and propelled the discussion into the future, with two new partnership announcements with the Prostate Cancer Foundation and Stanford University.

“For an area like cancer research, strategic partnerships are a force multiplier,” said Matthew S. Collier, senior advisor to the secretary for strategic partnerships. “The work we can do together far outweighs the work we do individually. With the VA’s position as the largest medical research institution in the country, the discoveries made to improve cancer care for Veterans will go on to advance the national public health landscape with regards to cancer care for all Americans.” To learn more about VA’s efforts to support the Cancer Moonshot Initiative go to http://www.blogs.va.gov/VAntage/33183/launch-pad-event-brings-together-greatest-minds-in-cancer-care. [Source: VAntagePoint blog | December 13, 2016 ++]

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Dental Cost ► Avoid Crazy Dental Fees

Keeping your teeth and gums healthy isn’t just a question of vanity. Sure, fresh breath and a sexy smile are great social assets. But oral health also has a lot to do with overall wellness. According to the Mayo Clinic, dental disease may be linked to such health issues as premature birth and low birth weight, cardiovascular disease, diabetes, endocarditis (infection of the inner lining of the heart), osteoporosis and even Alzheimer’s disease. A twice-annual cleaning and exam can help you stay healthy — and that ounce of prevention will help save you far more costly work — but even a cleaning can run up a bill of several hundred dollars. So, the question is, how to stay on top of it without breaking the bank? Dentists often advertise some super deals through social buying sites such as Groupon and LivingSocial, local “shopper” newspapers and even the ubiquitous blue envelope from Valpak. Potential users should keep in mind the following:

Read such deals carefully, and take note of expiration dates. If a voucher expires, you can still redeem it for the amount paid but you won’t get the same price on the deal. Suppose you spent $29 on a Groupon deal for cleaning and X-rays but forgot to book the appointment in time. You can still apply the $29 toward those services, but it’ll cost a lot more than $29.

Deep discounts, whether through social buying networks or a coupon in a local paper, are generally for new customers. You won’t get nearly as good a price on future visits.

The office on the coupon might not be the most cost-effective game in town for later work. If the exam turns up a problem, write down the specific treatment recommended and the total cost, then say you’ll get back to them regarding future appointments.

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Use a list of average dental costs compiled by Consumer Reports to see if the charges seem reasonable. If not, ask friends and co-workers which dentists they use and call to compare fees for the same service.

Beware Costly Extra Procedures. Teeth whitening is just one of the unnecessary treatments offered at many offices. Nancy Metcalf of Consumer Reports says, “Many dentists are trained to push for procedures, both cosmetic and non-cosmetic, that will boost their bottom line.”

Nearly a half of [readers surveyed] who had a cosmetic procedure had been prompted to do so by their dentist.

In-office whitening will cost, on average, about $650, according to the Consumer Guide to Dentistry. If you’re concerned about stains on your teeth, you can instead purchase whitening strips or bleaching kits over-the-counter for a fraction of the cost.

Among the procedures that could be unnecessary are teeth whitening, amalgam filling replacement, X-rays precautionary removal of wisdom teeth and temporomandibular joint (TMJ) disorder surgery.

Regarding X-rays: Most adults don’t need them at every dentist visit. According to www.WebMD.com , you might need them only every two to three years depending on your age and the current state of your mouth. If your dentist wants X-rays at every visit, ask why.

Consider a Second Opinion. Suppose the dentist says you need deep treatment for serious gum disease plus a crown to fix serious upper-molar decay. You’ll probably reject the idea, wondering just how your teeth could have gotten that bad even though it’s been a year since your last checkup. It could be you’re rationalizing. But it could also be that you need a second opinion. Although most dentists aren’t out to rob you, consider a second opinion if things just don’t feel right. And if you do need additional care? Prioritize the procedures, i.e., take care of pain and/or infection immediately lest things get worse. Schedule any other work to be done over a period of months or even a couple of years, so you won’t go over the maximum annual allowance on your dental insurance.

Don’t have dental insurance? Spacing out the treatment might mean you can pay as you go versus charging it. Here’s a tip that could help: Use a site like www.FairHealthConsumer.org or Healthcare Blue Book http://www.healthcarebluebook.com to learn the insurance reimbursement rates offered in your region. Ask whether a dental practice will accept that rate, paid in cash, each time you go in for treatment. If you need a lot of work done, maybe you can negotiate an additional price break. Or look for discount dental plans such as New Dental Choice https://www.newdentalchoice.com and Dental Plans http://www.dentalplans.com . An annual membership fee of $80 to $150 qualifies you for discounts of up to 60% from a group of dentists who have agreed to lower rates. With regard to these plans, Consumer Reports warns once more against “pricey add-ons and extra procedures (you) don’t need.” A few more free or low-cost options possibilities are:

Children’s Health Insurance Program (CHIP): Designed for families who don’t qualify for Medicaid assistance but can’t afford private insurance, CHIP dental coverage is good for children up to age 19. Coverage varies from state to state. To find out more, call 877-543-7669 or visit the CHIP website http://www.insurekidsnow.gov/state.

Clinical trials: According to the National Institute of Dental and Craniofacial Research, you may qualify for studies that include your specific dental situation. This means free or low-cost care. To learn more, visit the NIDCR website http://www.nidcr.nih.gov and click on “Clinical Trials.”

Dental schools: The American Dental Association (http://www.ada.org/267.aspx) has a list of such schools; maybe you’re lucky enough to live near one. Don’t worry, dental students’ work is supervised.

Dental hygiene schools: You may be able to get low-cost cleanings at some dental hygiene schools. Check the American Dental Hygienists’ Association website (http://www.adha.org/dental-hygiene-programs) to find the nearest school.

Federally funded health centers: These operate on a sliding-scale basis. The U.S. Department of Health and Human Services website (http://findahealthcenter.hrsa.gov/Search_HCC.aspx) has a health care finder tool.

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Medicaid: Another state-run program that may cover dental benefits for low-income residents. Visit http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Dental-Care.html or call 877–267–2323 to learn about benefits in your state.

Online searches: Click around and you might find regional dentistry events. For example, the Fox Valley area of Illinois has at http://www.dentistwithaheartonline.org/index.html an annual “Dentist With a Heart” day of free care. Aspen Dental (https://www.aspendental.com/about/healthy-mouth-movement) has a mobile dental clinic that travels around the country providing free dental work through their Healthy Mouth Movement program.

Remember, dental problems won’t go away on their own. Allow them to get worse, and you’re looking at major pain, greater expense and a longer course of treatment. A crisis situation makes it difficult to make the best decision — you’ll just be looking for someone, anyone, who can make it stop hurting. Also, prevention is easier (and cheaper!) than repair. If you haven’t seen a dentist lately, start looking for one. [Source: MoneyTalksNews | Y Donna Freedman | November 28, 2016 ++]

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Dental Cost Update 01 ► Delaying Care

The biggest reason for delaying dental care is cost, according to a 2012 Consumer Reports survey that asked readers to describe the dental health and cosmetic treatments they received in the last 5 years. CR subscribers tend to have better insurance coverage than Americans on average, but cost was still cited as a barrier by 43% of readers who delayed. The survey also revealed that only a third of readers are brushing and flossing when they should and some patients might be paying for cosmetic treatments they don’t need. The report is available online at www.ConsumerReports.org.

“Consumers worry about pain when it comes to the dentist, but the financial burden of yet another medical expense is the greatest concern of all. It’s worrisome that so many people are putting off dental care due to cost constraints,” said Nancy Metcalf, senior program editor, Consumer Reports. “Because cost is an issue, consumers need to be clear about the line between dental care that is necessary and the procedures they can live without. Many dentists are trained to push for procedures, both cosmetic and non cosmetic, that will boost their bottom line,” said Metcalf. “We were struck by the finding that nearly a half of those who had had a cosmetic procedure had been prompted to do so by their dentist.” Some examples of treatments that might not be necessary include teeth whitening, amalgam filling replacement, unnecessary restorations, precautionary removal of wisdom teeth, x-rays, and temporomandibular joint disorder (TMJ) surgery.

The survey report revealed that 17% of respondents who had a dental procedure for health reasons said they had delayed it. That’s a much lower percentage than in nationally representative surveys. Even readers with insurance put off a treatment they needed; 23% did so because insurance wouldn’t cover the procedure, and 24% because they had already used up the maximum that their insurance plan would cover for the year. According to Metcalf, there are several ways consumers can keep costs down or get by without insurance:

Shop around and bargain. Look up typical insurance paid rates in your area at FairHealthConsumer.org and HealthCareBlueBook.com, then ask providers to accept that amount, or less, as a cash payment.

Consider Free and low-cost clinics and health centers. Some community health centers offer dental care with fees based on the ability to pay. Consumers should call their local health department to find one nearby. But they should expect to encounter waiting lists in some locations.

Look into dental and dental-hygienist schools. Consumers who are willing to be treated by supervised students can avail themselves of schools that offer free or discontinued care to the public. A list of schools is available at www.ada.org/267.aspx.

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Investigate dental discount plans. For an annual membership fee of around $50 to $100, one can get access to a network of dentists who have agreed to discounted rates. But Consumer Reports recommends that consumers watch out for pricey add-ons and extra procedures they don’t need.

The report noted that having dental insurance is better than not having it, especially if an individual’s insurance is job based. But don’t expect free or nearly-free care. Consumer Reports’ survey found that of the 71% of respondents who had dental insurance, 90% received some sort of coverage. But only 46% said it covered more than half of the cost. Here’s what subscribers with and without insurance paid for some common dental procedures. The costs are based on average out-of-pocket payments.

Procedure Insured (average cost) Uninsured (average cost)Filling $141 $288Filling repair $149 $265Extraction $317 $501Crown $563 $1,018Root canal $593 $1,201Gum treatment $598 $972Bridge $1,479 $2,698Implant $2,825 $3,938

[Source: Consumer Reports National Research Center | January 3, 2012 ++]

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PTSD Update 224 ► SGB Study Participants Needed

It only takes about a minute for Dr. Michael Bartoszek to inject a local anesthetic into a bundle of nerves in a patient's neck. But the relatively simple procedure can have a big impact on troops suffering from post-traumatic stress. Bartoszek, a doctor at Womack Army Medical Center, said the treatment - known as a stellate ganglion block - can reduce anxiety, halt nightmares and stop the hyper-vigilance associated with PTSD. The effects are near instantaneous, he said. And they can be long-lasting. But while Bartoszek is sold on the procedure - he's performed 350 for Womack since 2013 - the larger medical and scientific community is not.

That's where a new clinical trial, underway at Womack and two other military hospitals, comes in. At Fort Bragg, Tripler Army Medical Center in Hawaii and Landstuhl Regional Medical Center in Germany, officials are hoping to gather data on at least 240 patients to provide the first scientific proof of the procedure's efficacy as a PTSD treatment. The trial involves two procedures, spaced two weeks apart, and two months of monitoring, which includes assessments and focus groups for the patient and family members. The bulk of the trial participants are expected to come from Fort Bragg, which has one of the busiest and largest military medical centers. "This is where the soldiers are," Bartoszek said. "Fort Bragg is very important for Army medicine and the Army as a whole. That makes us the prime site for this."

Since the trial opened in June, not all has gone as expected. Bartoszek said the hospital has had trouble recruiting participants. Many are concerned, he said, that they will be among the one-third of participants to receive a placebo. "The study itself has been fine," Bartoszek said. "The biggest challenge is convincing folks to participate. Soldiers are hesitant to risk not getting the treatment they believe might calm their symptoms." Bartoszek has accounted for roughly half of all stellate ganglion block procedures done at Womack since 2011, when a predecessor introduced the treatment to local troops suffering from PTSD. Over that time, the hospital has treated many PTSD sufferers, repeating injections as needed. Bartoszek said the results have been extremely positive. "It's continued to do well," he said. "People notice the difference."

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A previous study conducted with 166 patients at Womack found more than 70 percent "had a clinically significant improvement" to their symptoms that persisted for months. Officials believe that by administering anesthetic to the stellate ganglion - a cluster of nerves related to the sympathetic nervous system found in the neck - they can affect the part of the body that helps control pain, body temperature and the manifestations of post-traumatic stress. In effect, the procedure reduces nerve growth, limiting the body's "fight or flight" response. Bartoszek has described the treatment as helping to bring veterans back to a normal range of alertness. Veterans suffering from post-traumatic stress may always be on high alert, he said. A stellate ganglion block doesn't remove their alertness. But it resets the range. That can often make veterans feel less agitated and less likely to be quick to anger. And that, in turn, can open them up to more traditional treatments.

The lack of a prior extensive clinical trial is part of the reason the procedure has yet to gain wide acceptance as a treatment for PTSD. Womack has been an early adopter of the procedure. But it's still only offered in four military hospitals - Womack, Tripler, Landstuhl and Walter Reed National Military Medical Center in Bethesda, Maryland. "We've done it a bunch of times, hundreds of times," Bartoszek said. "In the retrospective, it's safe. But in the world of science, that's not enough." If successful, the doctor said he expects to see more use of the treatment, in and out of military hospitals. "Insurance companies will have a hard time saying 'No' if there is medical evidence," Bartoszek said. "If the study shows that it's helpful, there are very few barriers to improving access."

A stellate ganglion block itself is not new to the medical community. But it is typically used to treat pain, specifically a disorder known as chronic regional pain syndrome, an uncommon form of chronic pain that usually affects an arm or a leg. It wasn't until 2007 that a Chicago anesthesiologist made the first link between the procedure and PTSD. The trial is being conducted with the help of RTI International in Research Triangle Park, using a $2 million Department of Defense grant. But its success depends on attracting participants. "The DOD is interested, but if we can't meet our quota, it would be for naught," Bartoszek said. The doctor said he couldn't discuss exact numbers of current trial participants, but did say the trial is falling short of its goals. "We're not doing as well as we'd like," he said. Participants must meet a minimum threshold in their PTSD symptoms, and have no deployments, separations or change of stations within the two-month length of their participation. They also must be on active duty and not have received a stellate ganglion block previously nor be facing military judicial punishment.

Carol Sheff, research coordinator for the study, said the participants do not need to be Fort Bragg soldiers. They can be from any military branch, and come from any installation. "If people can get here, they can get the treatment," Sheff said. Officials said they hoped service members from Camp Lejeune, Seymour Johnson Air Force Base and military installations in Virginia and other surrounding states would be willing to participate. "It's a chance for them to make a difference," Bartoszek said. "Those that are participating are doing it to help soldiers of the future. That sacrifice can occur now for the soldiers that come after them." For more information on the trial, contact Sheff at 919- 407-1093 or csheff@sgb.rti.org, or go to https://sgbstudy.rti.org . [Source: The Fayetteville Observer | Drew Brooks | December 5, 2016 ++]

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PTSD Update 225 ► Holiday Season Tips

The holiday season is often difficult for people with PTSD, but there are healthy ways to cope and manage stress. Here are some tips from VA's clinicians that can help you manage your PTSD symptoms over this holiday season:

Don't overschedule. Leave time for yourself. Make a plan to get things done. Set small, doable goals. When stressed, remind yourself of what has helped in the past. Use the tools from PTSD Coach app http://www.ptsd.va.gov/public/materials/apps/PTSDCoach.asp or

PTSD Coach Online http://www.ptsd.va.gov/apps/ptsdcoachonline/default.htm to help you manage stress.

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Reach out for support if you need it. Know you can rely on for help. If your symptoms are getting worse or you feel down, reach out to your provider or

Call the Crisis Line (https://www.veteranscrisisline.net) 1-800-271-8255 and press 1.

If you know someone with PTSD, there are things you can do to make sure the holiday season is pleasant and enjoyable for everyone.

Educate yourself: Downloadhttp://www.ptsd.va.gov/public/understanding_ptsd/booklet.pdf and read Understand PTSD and PTSD Treatment (PDF) , to learn more about how PTSD affects your loved one.

Talk to your family member about what they need to feel comfortable during the holidays. If your loved one needs services, call Coaching into Care (http://www.mirecc.va.gov/coaching) 1-888-823-7458 for advice in talking to them about treatment.

Keep important resources at hand, such as the Veterans Crisis Line https://www.veteranscrisisline.net , a confidential toll-free hotline, online chat, or text. Veterans and their loved ones can call 1-800-273-8255 and Press 1, chat online, or send a text message to 838255 to receive confidential support 24 hours a day, 7 days a week, 365 days a year.

[Source: PTSD Monthly Update | December 2016 ++]

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FLU Prevention Update 06 ► Staying Healthy This Season

Flu season is here, and TRICARE wants you to stay healthy this winter. Each year approximately 5% to 20% of the U.S. population get the flu and some are even hospitalized as a result. It is important for you to know how to prevent the flu and what is covered under your TRICARE® pharmacy benefit.

What is the flu?Influenza, commonly known as the flu, is a highly contagious, viral infection easily spread from person-to-person. Adults can infect others 1 day before even showing symptoms and as long as 5 days after getting sick. Symptoms range from mild to severe.

When is flu season? Flu season typically starts in the fall and peaks in January or February.

Who is considered high risk for flu-related complications?While everyone is at risk of getting the flu, some people are at an increased risk for flu-related complications, including:

Young children Pregnant Women People with asthma, diabetes or heart and lung disease People aged 65 or older People with compromised immune systems

How does the flu spread?The flu is spread person-to-person by sneezing, coughing or contact with saliva. You can also get the flu by touching surfaces with germs on them and then touching your eyes, nose and mouth.

How to prevent the flu:There are several different ways you can prevent getting the flu. Follow these guidelines to stay healthy this flu season.

Get vaccinated – The flu shot is the first and most effective way to prevent infection. While there are many types of flu viruses, the flu shot protects against 3 or 4 types identified to be common each season. You

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can., visit http://www.tricare.mil/HealthWellness/Preventive/FluResources.aspx for information on getting vaccinated at no cost to you.

Who should get the flu shot?Everyone 6 months or older should be vaccinated against the flu as soon as the shot is available in your area. It’s important for you to be vaccinated if you live with or care for high risk people. Infants who are younger than 6 months old are considered high risk, but are too young to receive the flu vaccination. Getting the flu shot can reduce flu illness, visits to the doctor, missed school or work, as well as the possibility of a hospital stay. A flu shot can also lessen the severity of the illness if you do become infected.

Preventing the flu through every day actions. Practice good health habits to help build your body’s resistance to infection. These are a few ways build your immunity:

Drink plenty of water. Eat a healthy diet. Exercise regularly. Get enough rest and sleep.

In addition to keeping your body’s immunity levels strong, you can follow these common sense actions to help prevent the spread of germs:

Wash your hands frequently with soap and water or an alcohol-based hand sanitizer. Avoid contact with sick people. Avoid touching your eyes, nose and mouth. Cover your nose and mouth with tissues when you sneeze or cough. Don’t have a tissue? Sneeze or cough

into the crook of your elbow. Stay home from school or work when sick.

Preventative antiviral medicationsAntiviral medication is available if:

You currently have the flu. These medications, such as Tamiflu, can make your illness milder and shorter. They are most effective if taken within two days of getting sick, but can still help if taken later, especially if you are at high risk for complications.

You have been exposed to someone with the flu or are caring for someone with the flu to help prevent you from becoming infected.

Your TRICARE pharmacy benefit covers the following antiviral influenza medications: Amantadine Rimantadine HCL Oseltamivir (generic for Tamiflu)

Caring for someone with the flu. If someone you live with or care for has the flu you’ll want to: Make sure that person follows all instructions given to them by their health care provider and takes all

medications prescribed to them. Place the sick person in an area separate from other members of the household. Ensure everyone in the household washes their hands frequently with soap and water or an alcohol-based

hand sanitizer.

[Source: Express Scripts | December 9, 2016 ++]

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Traumatic Brain Injury Update 58 ► DVBIC TBI Family Podcast

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Defense and Veterans Brain Injury Center (DVBIC) launched 9 DEC a new podcast for family caregivers of service members and veterans with traumatic brain injuries. The podcast, called “The TBI Family” van be accessed at http://dvbic.dcoe.mil/about-dvbic. It focuses on providing information about TBI, sharing resources for caregivers and telling caregiver stories. According to a recent study by Rand Corp., there are 5.5 million military family caregivers in the United States and 29% of them are helping someone who experienced a TBI. The study found that the term “family caregiver” can be misleading as well. Nearly a quarter of military caregivers are friends and neighbors. DVBIC serves active-duty military, their beneficiaries, and veterans with traumatic brain injury through state-of-the-science clinical care, innovative clinical research initiatives and educational programs, and support for force health protection services. For more information on DVBIC go to http://dvbic.dcoe.mil/about-dvbic. [Source: Health.mil | November 17, 2016 ++]

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Smoking Update 03 ► No Safe Level of Usage

People who consistently smoked an average of less than one cigarette per day over their lifetime had a 64% higher risk of earlier death than never smokers, and those who smoked between one and 10 cigarettes a day had an 87% higher risk of earlier death than never smokers, according to a new study from researchers at the National Cancer Institute (NCI). Risks were lower among former low-intensity smokers compared to those who were still smokers, and risk fell with earlier age at quitting. The results of the study were reported Dec. 5, 2016, in JAMA Internal Medicine. NCI is part of the National Institutes of Health.

When researchers looked at specific causes of death among study participants, a particularly strong association was observed for lung cancer mortality. Those who consistently averaged less than one cigarette per day over their lifetime had nine times the risk of dying from lung cancer than never smokers. Among people who smoked between one and 10 cigarettes per day, the risk of dying from lung cancer was nearly 12 times higher than that of never smokers. The researchers looked at risk of death from respiratory disease, such as emphysema, as well as the risk of death from cardiovascular disease. People who smoked between one and 10 cigarettes a day had over six times the risk of dying from respiratory diseases than never smokers and about one and half times the risk of dying of cardiovascular disease than never smokers.

Smoking has many harmful effects on health, which have been detailed in numerous studies since the U.S. Surgeon General’s 1964 report linking smoking to lung cancer. The health effects of consistent low-intensity smoking, however, have not been well studied and many smokers believe that low-intensity smoking does not affect their health. To better understand the effects of low-intensity smoking on mortality from all causes and for specific causes of death, the scientists analyzed data on over 290,000 adults in the NIH-AARP Diet and Health Study. Low-intensity smoking was defined as 10 or fewer cigarettes per day. All participants were age 59 to age 82 at the start of the study. Participants were asked about their smoking behaviors during nine periods across their lives, beginning with before they reached their 15th birthday until after they reached the age of 70 (for the older participants). Among current smokers, 159 reported smoking less than one cigarette per day consistently throughout the years that they smoked; nearly 1,500 reported smoking between one and 10 cigarettes per day.

The study relied on people recalling their smoking history over many decades, which introduced a degree of uncertainty into the findings. Also, despite the large number of people surveyed, the number of consistent low-intensity smokers was relatively small. Another limitation of the study is that the participants were mostly white and in their 60s and 70s, so the smoking patterns collected in the study reflect only a particular set of age groups in the

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United States. Future studies among younger populations and other racial and ethnic groups are needed, particularly as low-intensity smoking has historically been more common among racial and ethnic minorities in the US. The study also lacked detailed information about usage patterns among participants who reported smoking less than one cigarette per day. Hence, the researchers could not compare the effects of smoking every other day, every few days, or weekly, for example.

“The results of this study support health warnings that there is no safe level of exposure to tobacco smoke,” said Maki Inoue-Choi, Ph.D., NCI, Division of Cancer Epidemiology and Genetics, and lead author of the study. “Together, these findings indicate that smoking even a small number of cigarettes per day has substantial negative health effects and provide further evidence that smoking cessation benefits all smokers, regardless of how few cigarettes they smoke.” [Source: NIH News Release | December 5, 2016 ++]

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TRICARE Podcast 376 ► Nurse Advice Line | ACA | Avoiding Fraud

Nurse Advice Line -- When an urgent health problem arises, it’s hard to know whether you should tough it out or seek medical care. Try calling the nurse advice line for advice on health care questions first. Registered nurses can help you decide whether you should go to an urgent care center. Calling the nurse advice line before seeking care can save time and money. When you call, you’ll be asked several medical questions based on your symptoms. These questions were developed by physicians to help the nurses assess your medical problem accurately. If you’re not calling for yourself, please make sure that the family member in question is present so you can assess their condition as the nurse asks questions. The nurse may want to talk to your family member directly if the person is over 13 years old. Your nurse may give you advice on home treatments and remedies if self-care is recommended. But if you need urgent care, the nurse will help you with next steps.

If you have TRICARE Prime and are enrolled at a military hospital or clinic, the nurse will try to schedule a same or next-day appointment for you. If you can’t get an appointment at your military hospital or clinic and need to see a civilian provider, the nurse will make sure your urgent care referral is submitted. If you’re a Prime beneficiary who gets care through the civilian network, and you need urgent care, you should contact your primary care manager for care or an urgent care referral. Access the nurse advice line at 1-800- 874-2273 and select option 1. Get more information about the nurse advice line at www.TRICARE.mil/nal .

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Affordable Care Act -- With the implementation of the Patient Protection and Affordable Care Act in 2010, TRICARE beneficiaries have been asking how it will affect them. TRICARE and the ACA are governed by different pieces of legislation so changes in one have no effect on the other. There are some other key differences between the two. Health care reform provides everyone with affordable healthcare options. TRICARE on the other hand, is not health insurance. It’s a federal health care entitlement program that’s only for eligible uniformed service members, retirees and their families. The Affordable Care Act created laws for minimum essential benefits that commercial health insurance must provide. TRICARE already provided most of these benefits, including free screenings, vaccinations, and counseling before the Act was passed. For more information about TRICARE, the Affordable Care Act or minimum essential coverage, visit www.TRICARE.mil/aca. 

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Avoiding Fraud -- Don’t wait for fraud against TRICARE beneficiaries to be in the news. Always protect your personal information! Never share your uniformed service identification card, or personal or family information with someone you don’t know. Protecting your personal information is vital to your privacy. Fraudsters often target TRICARE beneficiaries.

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Sometimes they conduct fake surveys so they can collect your personal information, or They may call saying they know you have TRICARE and that you qualify for a free or low cost knee brace

or walker. Then they bill TRICARE for services or supplies you don’t need and never receive. No one from TRICARE will ever recommend a particular product or medicine. If someone claims to be from TRICARE and does, don't share any personal information. If you think you’re the victim of TRICARE-related fraud, report it to the Defense Health Agency. Also, report when you think a provider or company is trying to defraud TRICARE. For example, if your TRICARE explanation of benefits shows a charge for services you didn’t get, tell your TRICARE regional contractor. TRICARE also won’t call you or email you asking for personally identifiable information, like your uniformed service ID number, Social Security number, or Defense Department benefits number. This information should only be given to a trusted person or office, like your doctor, a TRICARE claims officer or regional contractor. For more information about fraud, visit www.health.mil/fraud.

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The above is from the TRICARE Beneficiary Bulletin, an update on the latest news to help you make the best use of your TRICARE benefit. [Source: http://www.tricare.mil/podcast | December 1, 2016 ++]

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TRICARE Podcast 377 ► Traveling | Tax Reporting Webinar | Handwashing

Traveling With TRICARE -- There’s no place like home for the holidays, but how will you get medical care if you’re travelling to see your family? Rules for getting care depend on your plan and travel destination.

If you’re using Prime, get routine care from your Primary Care Manager before you travel. You’ll need a referral from your Primary Care Manager if you need urgent care, but should seek any emergency care at the nearest emergency room.

Standard and Extra beneficiaries can visit any TRICARE-authorized provider anywhere for care. If you’re overseas, you may need to pay up front and file a claim with the overseas claims processor for

reimbursement. If you’re in the TRICARE Dental Program and need dental care, then you can visit any licensed dentist for

treatment anywhere. If you’re in the TRICARE Retiree Dental Program, then you can search for a stateside dentist, or if you’re

overseas, you can call Delta Dental’s international dentist referral service. Visit www.TRICARE.mil/dental for more information.

You also have several options for filling your prescriptions including military hospitals or clinics, network pharmacies, home delivery and non-network pharmacies. And if you’re travelling in the United States and are unsure of your care options, then call TRICARE’s Nurse Advice Line at 1-800-TRICARE, Option 1. Learn more about TRICARE’s travel options at TRICARE.mil/travel.

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Tax Reporting Webinar -- TRICARE and Military OneSource cohosted a webinar to educate TRICARE beneficiaries about tax reporting and the Patient Protection and Affordable Care Act. Unless you’re exempt, all Americans must have minimum essential coverage or pay a monthly “individual shared responsibility” tax penalty on their federal tax returns. TRICARE fulfills Minimum Essential Coverage requirements of the Affordable Care Act under certain conditions. The webinar took place on December 12, 2016, from Noon to 1:00 p.m. Eastern Standard Time. Registration was on a first-come, first-served basis and was limited due to system capacity. Sign up was at www.TRICARE.mil/mecwebinar.

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Handwashing -- Keeping your hands clean helps you avoid getting sick and spreading germs to others. In honor of Handwashing Awareness Week, here are some tips from the Centers for Disease Control to help you wash your hands as effectively as possible.

First, get your hands wet with clean running water. Then turn off the tap and apply soap. Washing your hands in standing water could get them dirty again. And always use soap. Water alone will not remove dirt and microbes from the skin. People also tend to scrub more when they are using soap. Make sure to wash the back of your hands, between your fingers, and under your nails.

Scrub your hands for at least 20 seconds. This is about the length of singing the entire “Happy Birthday” song twice.

Finally, rinse your hands well under clean running water and dry them using a clean towel or let them air dry.

Taking these steps will help you prevent the spread of illness. If you do happen to get sick, and don’t know what type of care you need, contact TRICARE’s Nurse Advice Line. Learn more at www.TRICARE.mil/nal .

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The above is from the TRICARE Beneficiary Bulletin, an update on the latest news to help you make the best use of your TRICARE benefit. [Source: http://www.tricare.mil/podcast | December 1, 2016 ++]

* Finances *

Selfie Sextortion Scam ► How it Works

You're scrolling through Facebook like any other day, when a friend request pops up from a pretty girl. You accept, and she sends you a naughty picture. You send one back, just to be polite, or maybe because she asked nicely. But then she asks for money. She wants hundreds of dollars, or she'll send your naked photo to your friends, your family and - worst of all - your command. Hundreds of troops every year are falling directly into this trap, and many of them are handing over thousands of dollars to try to make the problem go away, to no avail, experts warn of this increasingly common ploy to extort U.S. service members.

"She's like, you know, 'I'm angry. You don't want to make me angry. Here's how not to make me angry,' " recalled one junior sailor, who exchanged sexy Skype videos with someone he met online. Minutes later, the scammer threatened to ruin his reputation and career unless he forked over cash. "If these individuals pay at all, [the scammers] will ask for more money," Naval Criminal Investigative Service division chief Megan Bolduc told Military Times in a phone interview.

Law enforcement officials have dubbed the scam "sextortion," and it happens all over the world. Service members are particularly vulnerable, experts say. They have a steady income, and their conduct is regulated. Four

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services have put out guidance about the problem, counting several dozen reports to several hundred reports since the scam first surfaced in 2012. Victims and special agents said troops are often targeted by criminals overseas and offered some tips so they could protect themselves from this scam, which has netted as much as $10,000 from individual service members.

Many of the victims in the Navy and Marine Corps are in the E-1 to E-4 range, according to NCIS intelligence specialist Katherine McDonald. Many of them are away from home for the first time and trying to create connections in the world. "These perpetrators know that they have a steady income by being military. They know they get paid on the 1st, they get paid on the 15th," Bolduc said. "These perpetrators also know that they're held to a higher standard. Threatening that their career may go down the drain is terrifying to a young service member." Despite outreach efforts, the problem continues to grow. The number of cases has shot up in recent years, McDonald said, from 60 in fiscal 2014 to more than double that in FY 2016.

"Part of that, too, is that we have gotten the word out in so many different ways and encouraged reporting," Bolduc added. "I think people are more willing to come forward, but incidents are also increasing." Still, for all of the reports, NCIS hasn't been able to prosecute a single perpetrator. So the only thing to do is warn troops to not send compromising photos or videos to strangers on the internet. And if you do, absolutely do not pay them, experts say. [Source: NavyTimes | Meghann Myers | December 12, 2016 ++]

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Saving Money ► Stocking Up Limitations

Stocking up at low prices can be a smart financial move, but only if you can use what you buy before it goes bad. If you have a bathroom full of old cosmetics, a pantry full of cleaning supplies, or a garage filled with paint and oil, it may be time to purge and be a little more mindful about what you buy in the future. While stocking up can seem like a smart move, not everything can be stored indefinitely. Following are some items that might be about to go bad in your stockpile.

Anti-acne products — Products containing Benzoyl peroxide will only be effective for 3 months, other products can last up to a year however products with retinol, glycolic acid and vitamin C break down quicker.

Anti-aging products — 6 months to a year depending on ingredients (products with retinol, glycolic acid and vitamin C break down quicker)

Antiperspirant— can last for three years. Check package for expiration date Battery shelf life — ultimate lithium batteries 15 years, advanced lithium batteries 10 years, rechargeables 1%

each day. Bleach — 6 months. If you use bleach in homemade cleaners, be aware it can lose its effectiveness quickly

once diluted. A 10% bleach solution is potent for only a day. Body bleach cream — six months if opened, two years unopened Body wash/lotion — can last for 3 years Boxed wine — starts degrading one year after packaging Car seats — six to 10 years depending on manufacturer. Check label Caulk — two months opened, one year unopened Cleaners with antibacterial ingredients — one year Cleanser — two years Deodorant — three years Depilatory cream —six months if opened, up to two years unopened Dish soap — 12 to 18 months Dishwasher detergent — three months Disinfectants — two years

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Eye cream — 6 to 12 months (6-9 months for products in a jar) once opened Fabric softener — one year Face cream — 6 to 12 months (6-9 months for products in a jar) Face powder — can last for 2 years Glazing compounds — one year opened, two years unopened Hair styling product — can last for one to five years, products containing alcohol tend to last longer Latex or oil based paint — unopened 2 years Laundry detergent — six to 12 months Lipstick — two to three years Liquor — unopened indefinitely, opened will start losing potency. Best to use up in one year Mascara — three months Moisturizer — Can last for 2 years (if in a pump) or one year (if in a jar), if product contains SPF, check for

expiration date on package Motor oil — Some oils have additives that can break down over time. In addition, open or unsealed bottles can

absorb moisture. The shelf life may vary depending on the manufacturer. Mouthwash — Can last for three years. Bottle should contain an expiration date Multisurface cleaners — two years Nail polish — one to 2 years. If you shake the bottle and the formula won’t mix up, the polish is no good Nail polish remover — does not expire Oil-based stains — one year opened, two to three years unopened Oil-based varnishes — one year, opened or unopened Oil-free foundation — one year Perfume — can last for up to two years. Store in a cool and dark place Rubbing alcohol —three to five years Shampoo/conditioner — three years unopened Shaving cream — Can last for two years Soap, bar and liquid — Can last for three years Sunscreen — One year (federally regulated) Toothpaste — Can last two years, always check the expiration date, since the product contains fluoride Water-based stains — one year opened, two years unopened

[Source: MoneyTalksNews | Maryalene Laponsie | December 8, 2016 ++]

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Tax Burden for Mississippi Retired Vets ► As of DEC 2016

Many people planning to retire use the presence or absence of a state income tax as a litmus test for a retirement destination. This is a serious miscalculation since higher sales and property taxes can more than offset the lack of a state income tax. The lack of a state income tax doesn’t necessarily ensure a low total tax burden. States raise revenue in many ways including sales taxes, excise taxes, license taxes, income taxes, intangible taxes, property taxes, estate taxes and inheritance taxes. Depending on where you live, you may end up paying all of them or just a few. Following are the taxes you can expect to pay if you retire in Mississippi:

Sales TaxesState Sales Tax: 7% (prescription drugs, residential utilities, motor fuel, newspapers, healthcare services, and payments made by Medicare and Medicaid are exempt).Gasoline Tax: 37.18 cents/gallon (Includes all taxes)

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Diesel Fuel Tax: 42.8 cents/gallon (Includes all taxes)Cigarette Tax: 68 cents/pack of 20

Personal Income Taxes Tax Rate Range: Low – 3%; High – 5%Income Brackets: Three.  Lowest – $5,000; Highest – $10,000Personal Exemptions:  Single – $6,000; Married – $12,000; Dependents – $1,500  For detail reefer to http://www.dor.ms.gov/info/faqs/IndividualIncomeFAQs.htmlAdditional Exemption: 65 or older – $1,500Standard Deduction: Single – $2,300; Married filing jointly – $4,600; $1,200 per dependentMedical/Dental Deduction: PartialFederal Income Tax Deduction: NoneRetirement Income Taxes: Qualified retirement income is exempt from state income tax.  Social Security is not taxed, regardless of total income.  Retirement income from IRAs, 401s/403s, Keoghs and qualified public and private pension plans is not taxable.  Interest income from federal securities and obligations of Mississippi and its political subdivisions are all exempt.Retired Military Pay: Retired pay is exempt. The exemption is also available to the spouse or other beneficiary upon the death of the primary retiree. Widows’ pensions received from the VA are not taxable.Military Disability Retired Pay: Retirees who entered the military before Sept. 24, 1975, and members receiving disability retirements based on combat injuries or who could receive disability payments from the VA are covered by laws giving disability broad exemption from federal income tax. Most military retired pay based on service-related disabilities also is free from federal income tax, but there is no guarantee of total protection.VA Disability Dependency and Indemnity Compensation: VA benefits are not taxable because they generally are for disabilities and are not subject to federal or state taxes.Military SBP/SSBP/RCSBP/RSFPP: Generally subject to state taxes for those states with income tax. Check with state department of revenue office.

Property TaxesProperty and automobiles are both subject to ad valorem taxes – meaning that the tax is assessed in relationship to the value of the property.  Single family residential property is taxed at 10% of its assessed value.  All other personal property is assessed at 15% of its value.  Motor vehicles are taxed at 30% of their value.  The state offers a homestead exemption to all eligible taxpayers.  Eligible homeowners should make application with the Tax Assessor in the county where the home is located.  This application must be filed between January 1 and April 1.  The maximum exemption for regular homeowners is $300.  For homeowners 65 years of age or totally disabled, there is an exemption on the first $75,000 true value.  You do not have to apply for homestead exemption each year.  You should reapply if there were changes in your homestead status (marital, property, ownership, etc.). For additional information, call 601-923-7631 or http://www.dor.ms.gov/Pages/default.aspx.

Inheritance and Estate TaxesThere is no inheritance tax.  An estate tax is imposed on the value of a decedent’s estate when the total gross estate exceeds the federal exemption of $1,000,000.  The exemption amount will follow the federal exclusion under 26 USC 2010.

For further information, visit the Mississippi Department of Revenue site http://www.dor.ms.gov or call 601-923-7000 [Source: http://www.retirementliving.com/taxes-kansas-new-mexico#MISSISSIPPI DEC 2016 ++]

* General Interest *

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Notes of Interest ► 1 thru 15 DEC 2016 TRICARE pharmacy network. As of 1 DEC, CVS and CVS pharmacies in Target stores are no longer

part of the TRICARE pharmacy network; but Walgreens now is, so beneficiaries need to transfer all prescription fills or refills from CVS pharmacy to another TRICARE pharmacy to avoid paying the full retail prices. Read more at http://capwiz.com/vfw/utr/1/HLWWYYOATP/JHLZYYOAXY/11357317151

Army Recruiting. Army Recruiting Command chief Maj. Gen. Jeffrey Snow said the Army needs 80,000 new troops this fiscal year, but it's having trouble meeting that goal because only 3 in 10 of today's youths meet the requirements, and officials don't want to lower standards just to make the target. He said, "I don't think the American public would like us to lower the quality of those joining the Army if they knew it's going to impact our ability to perform the very functions our nation expects us to do".

PTSD. The Food and Drug Administration has given the go-ahead for clinical trials of the club drug ecstasy as a potential treatment for post-traumatic stress disorder. In earlier research, the drug showed promise in reducing symptoms of PTSD.

USS Zumwalt. The largest and most expensive destroyer built for the U.S. Navy has resumed its voyage after a breakdown in the Panama Canal.  The Navy said 1 DEC that the dhip departed Panama after repairs to the propulsion system by the ship's crew and a team from General Electric and the Naval Sea Systems Command.  The 610-foot destroyer was in the Panama Canal when it lost propulsion on 21 NOV. 

USAF Pilot Shortage. The United States Air Force is reporting a shortage of pilots of fighter airplanes. The lack is so severe that some generals say it may affect the service’s ability to carry out operations as soon as next year.

Retiree Firearms. The Pentagon's new policy for carrying firearms on base is intended for uniformed service members and civilians working for the U.S. military -- not for retirees, Defense Department officials maintain.

Federal Workforce. Veterans make up almost one-third of the federal workforce, up 5 percentage points since President Obama took office, according to new data released by OPM on Veterans Day. That translates into more than 623,000 veterans working in civilian federal posts, 31% of the 2 million individuals working in civilian government jobs. 

Grocery Shopping. Amazon is doing away with checkout lines and cashiers in concept 'Go' grocery stores. To see how they will do it go to https://youtu.be/NrmMk1Myrxc  First store in Seattle will be open to the public in early 2017.

Okinawa. The U.S. and Japan announced 6 DEC that Washington will give back to the Japanese government nearly 10,000 acres of land on Okinawa that U.S. Marines use for jungle warfare training.

Nuclear Waste. The Navy and U.S. Department of Energy have announced that they'll build a $1.65 billion facility at a nuclear site in eastern Idaho that will handle fuel waste from the nation's fleet of nuclear-powered warships.

Fidel Castro. Castro’s ashes were put inside a rock. The funeral procession was halted when the jeep carrying his ashes broke down and soldiers had to push it. Kind of a mini analogue of communism right there for all to see.

Foundation for American Vets. A Michigan fundraiser (Associated Community Services Inc) that targeted veterans and seniors will be banned from operating in Minnesota and has agreed to pay $200,000 to settle a lawsuit that accused it of engaging in deception and failing to provide required disclosures about what it

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does. ACS was allegedly sending out false “pledge reminders” and making other deceptive statements to solicit donations for the Foundation for American Veterans, 

Obama Vacation Costs. Judicial Watch announced 10 DEC that it obtained records from the U.S. Secret Service revealing that its travel expenses for the First Family’s 2015 Hawaiian vacation cost taxpayers $1.2 million, which bring the total cost of the vacation trip to at least $4.8 million. This was the Obamas’ eighth Hawaiian family vacation. The trip has become an annual event for the Obamas. To date, Obama’s and his family’s travel expenses total at least $85,029,819.

Senate Last Seat filled. Louisiana voters Saturday chose to send Republican state Treasurer John Kennedy to the U.S. Senate, filling the nation’s last Senate seat and giving the GOP a 52-48 edge in the chamber when the new term begins in January. 

VAMC Denver. The Justice Department is considering whether to investigate allegations that Veterans Affairs Department executives lied to Congress to conceal massive cost overruns at a $1.7 billion VA hospital under construction outside Denver.

RP President. Philippines' President Rodrigo Duterte has admitted he personally killed criminal suspects as mayor of Davao. Speaking to business leaders at the presidential palace on 12 DEC he stated, "In Davao I used to do it personally. Just to show to the guys [police] that if I can do it why can't you."

Kirk Douglas. Former movie star Kirk Douglas celebrated his 100th birthday on 9 DEC.

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114th Congress Update 05 ► What it Accomplished

Congress wrapped up the 114th session on 10 DEC, a tumultuous two years marked by the resignation of a House speaker, a fight over a Supreme Court vacancy, bipartisan bills on health care and education and inaction on immigration and criminal justice. The new Congress will be sworn-in 3 JAN 2017. Following is what this Congress passed or approved:

A hard-fought budget and debt agreement that provided two years of relief from unpopular automatic budget cuts and extended the government’s borrowing cap through next March.

The end of a 40-year-old ban on crude oil exports. A rescue package for financially strapped Puerto Rico, creating an oversight board to supervise some debt

restructuring and negotiate with creditors. A sweeping biomedical bill that would help drug and medical device companies win swifter government

approval of their products, boost disease research and drug-abuse spending and revamp federal mental health programs. It would also include money for preventing and treating abuse of addictive drugs like opioids.

The first overhaul of the Toxic Substances Control Act since it was approved in 1976.

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A sweeping rewrite of education law, giving states more power to decide how to use the results of federally mandated math and reading tests in evaluating teachers and schools.

An aviation bill that attempts to close gaps in airport security and shorten screening lines. Five-year, $305-billion highway legislation to address the nation’s aging and congested transportation

systems. An extension of a federal loan program that provides low-interest money to the neediest college students. The USA Freedom Act, which extends some expiring surveillance provisions of the USA Patriot Act

passed after the 9/11 attacks. A bipartisan measure that recasts how Medicare reimburses doctors for treating over 50 million elderly

people. Legislation reviving the federal Export-Import Bank, a small federal agency that makes and guarantees

loans to help foreign customers buy U.S. goods. $1.1 billion to combat the threat of the Zika virus. Defense legislation rebuffing President Barack Obama’s attempts to close the prison at Guantanamo Bay,

Cuba, and blocking the Pentagon from starting a new round of military base closings. Food labeling legislation that will require most food packages to indicate whether they contain genetically

modified ingredients. Legislation authorizing hundreds of water projects, including measures to help Flint, Michigan, rid its water

of poisonous lead, and to allow more of California’s limited water resources to flow to Central Valley farmers hurt by the state’s lengthy drought.

Expanded law enforcement tools to target sex traffickers. Legislation that would tighten several security requirements of the visa waiver program, which allows

citizens of 38 countries to travel to the U.S. without visas. Cybersecurity legislation that would encourage companies to share cyber-threat information with the

government. A renewal of health care and disability payments to 9/11 first responders who worked in the toxic ruins of

the World Trade Center. A bill allowing families of Sept. 11 victims to sue Saudi Arabia in U.S. courts for its alleged backing of the

attackers, enacted in Obama’s first veto override. A permanent ban on state and local government Internet taxes. A bill that boosts government suicide prevention efforts for military veterans. Confirmation of Eric Fanning to be Army secretary, making him the first openly gay leader of a U.S.

military service. The election of a new House speaker, Republican Rep. Paul Ryan of Wisconsin.

Here is what Congress did not pass or approve: Confirmation of Obama’s pick for the Supreme Court, Merrick Garland. Confirmation of 51 federal judges nominated by Obama, including 44 district court nominees and seven

appeals court nominees. Gun control legislation. Bills that would have halted federal payments to Planned Parenthood, after secretly recorded videos of

Planned Parenthood officials discussing tissue donations fueled an uproar among congressional Republicans and abortion opponents.

Comprehensive or incremental changes to immigration law. $1 trillion worth of agency budget bills that will be kicked into next year, complicated by a familiar battle

over the balance between Pentagon spending and domestic programs and a desire by Republicans to get a better deal next year from the Trump administration. Congress passed a four-month extension of current spending instead.

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A bipartisan criminal justice bill that would have reduced some mandatory sentences for low-level drug offenders and increased rehabilitation programs.

The first comprehensive energy bill in nearly a decade, which would speed exports of liquefied natural gas and create a new way to budget for wildfires.

War powers for Obama to fight Islamic State militants. A bill forcing the president to allow construction of the Keystone XL oil pipeline from Canada. Obama

rejected the pipeline in 2015 after seven years of indecision. The Trans-Pacific Partnership, a multinational trade agreement involving 11 other Pacific Rim countries.

Congress did give the president Trade Promotion Authority, allowing Congress to ratify or reject trade agreements negotiated by the executive branch, but not change or filibuster them.

Child nutrition bills that would have scaled back the Obama administration’s standards for healthier school meal

[Source: Associated Press | Mary Clare Jalonick | December 10, 2016 ++]

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WWII Merchant Marines ► Congressional Gold Medal Legislation

The House passed a bipartisan measure (H.R.2992) on 30 NOV to award World War II Merchant Marines the Congressional Gold Medal. More than 250,000 mariners were pressed into service in 1942 to ferry troops and supplies across submarine-infested seas to battle zones. Around 9,000 were killed in the war. Roughly 5,000 of the mariners are still alive and several expressed their gratitude over the House effort, FoxNews reported. “We’re always working for some recognition,” former merchant mariner Morris Harvey told FoxNews.com. Harvey expressed concern the award would not pass in the Senate during this session, but said he is hoping to receive the award next year along with financial compensation (H.R.563) outgoing California Rep. Janice Hahn has attempted to secure for the mariners.

The financial plan would give those who served during the war one payment of $25,000. “These men put their lives on the line in defense of their country during one of the darkest periods of human history,” Hahn said 30 NOV. “For decades, their service went unrecognized, and many of them died without the appreciation they deserved. In awarding these men the Congressional Gold Medal, we may finally express to them our gratitude as a nation for their incredible sacrifices.” Congress passed legislation Wednesday to award World War II spies who served behind enemy lines the Congressional Gold Medal, the Associated Press reported. [Source: Roll Call | Christina Flom | December 1, 2016 ++]

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Air Force One ► Replacement Cost Out of Control

The government should cancel its multibillion-dollar order for new Air Force One presidential planes, Donald Trump declared 6 DEC, serving notice he's ready to jump in and start making decisions six weeks before his inauguration. Costs for the two Boeing 747s are "totally out of control," Trump told reporters in the lobby of his New York skyscraper. The government has contracted with Boeing to build the planes, which would go into service around 2024. That means Trump wouldn't fly on the aircraft, which carry U.S. presidents around the globe, unless he pursued and won a second term. But the Air Force has pressed for a faster schedule, saying the current version is becoming too expensive to repair and keep in good flying shape.

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The contract for the planes was to be about $3 billion, but costs have been reported to be rising. Trump tweeted early 6 DEC, "Boeing is building a brand new 747 Air Force One for future presidents, but costs are out of control, more than $4 billion. Cancel order!" Later, he said the costs are ridiculous: "I think Boeing is doing a little bit of a number. We want Boeing to make a lot of money, but not that much money." The price of Boeing stock dipped after his comments but not drastically. Trump had tweeted in 2013 that he owned Boeing stock, but a spokesman said he sold all of his stocks in June.

Boeing's President and Chief Executive Officer said it will be up to members of the transition team who are versed in defense acquisitions to explain to the president-elect the complex requirements of the future Air Force One, and why these airplanes cost far more than commercial passenger planes. Presidential airplanes are nuclear-hardened, outfitted with highly advanced communications technology and come with security features that would be unthinkable for any other airplane. Compared to the average Heavy Private Jet, the original Boeing 747-200B (Air Force One):

Is $252,500,000 more expensive at $325 million Can fly 953 nautical miles farther at 6,778 nautical miles Can cruise 4,100 ft higher at 45,100ft Can reach a 4.5 knot (5 mph) higher max. cruise speed at 481 knots (553 mph) Outputs 172,200 more lbf of thrust at 226,800 lbf Is 652,050 lbs heavier at 833,000 lbs Has a 1.03 ft taller cabin at 8.33ft

Trump now uses his own plane, a Boeing 757, which he has outfitted with white leather and gold, a large flat-screen television and a bedroom. But as president it is expected that he would travel aboard the Air Force jet, which is equipped with special safety, defensive and communications equipment. Air Force One also has seating for reporters; Trump generally does not allow the press on his own plane.

On 7 DEC the president elect vowed to "negotiate" the price pledging to cancel the order if costs don't come down. He spoke with Boeing President and CEO Dennis Muilenburg by phone 6 DEC just hours after tweeting that the U.S. Air Force should cancel the planned replacement for Air Force One, rattling not just Boeing but the entire aerospace and defense industry. The next morning Trump praised Muilenburg, calling him a "terrific guy" and saying the two will "work it out," but doubled down on his promise to cancel the order if he can't get a better price. "That's what I'm here for, I'm going to negotiate prices," Trump told Matt Lauer 7 DEC on the Today Show. "The planes are too expensive and we're going to get the prices down and if we don't get the prices down, we're not going to order them and we’re going to stay with what we have."

It's important to note that Boeing does not actually have a production contract for the new Air Force One. The Air Force has estimated it will spend $2.87 billion in research and develop funds through fiscal 2021 on the project, and the Government Accountability Office projects the total cost will be $3.2 billion. But right now Boeing is on

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contract for just $170 million for risk reduction and other preliminary work, meaning that the Trump administration could cut its losses with minimal cost to the taxpayer, and without penalties for breaking a massive development contract. Trump could choose to simply change the requirements, perhaps settling on a smaller airframe with fewer specialized systems onboard to get a lower price. As requirements stand today, however, a heavily-modified Boeing 747-8 widebody is the only airframe that fits the bill. Boeing will work with the new administration to control costs on Air Force One as they establish requirements for the program, a company official told Aviation Week.

Cancelling the new Presidential Aircraft Replacement program would be bad news for Boeing, as the company is already struggling to maintain production of the iconic 747-8 widebody. Boeing is in the midst of design and development of at least two new aircraft to replace the current VC-25A aircraft that currently ferry the President around the world. A day before President-elect Donald Trump threatened one of Boeing’s most high-profile defense procurements, the deal to build the new Air Force One, the company had finalized a deal to pledge $1 million for his inaugural festivities, the company said 8 DEC. Boeing has a long history of helping defray the costs of inaugurations, and the company gave the same amount for Obama’s second inauguration in 2013. [Source: The Associated Press & ARES | Jonathan Lemire & Lara Seligman | December 6 & 7, 2016 ++]

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Have You Heard? ► How to live like you're in the U.S. Navy

1.. Buy a dumpster, paint it gray and live in it for 6 months straight. 2.. Run all of the piping and wires inside your house on the outside of the walls. 3.. Pump 10 inches of nasty, crappy water into your basement, then pump it out, clean up, and paint the basement "deck gray."

4.. Every couple of weeks, dress up in your best clothes and go to the scummiest part of town, find the most run down, trashy bar you can, pay $10 per beer until you're hammered, then walk home in the freezing cold. 5.. Perform a weekly dis-assembly and inspection of your lawnmower. 6.. On Mondays, Wednesdays, and Fridays turn your water temperature up to 200 degrees, then on Tuesday and Thursday turn it down to 10 degrees. On Saturdays, and Sundays declare to your entire family that they used too much water during the week so all showering is secured. 7.. Raise your bed to within 6 inches of the ceiling. 8.. Have your next-door neighbor come over each day at 5am, and blow a whistle so loud that Helen Keller could hear it and shout "Reveille, Reveille, all hands heave out and trice up." 9.. Have your mother-in-law write down everything she's going to do the following day, then have her make you stand in the back yard at 6am and read it to you. 10.. Eat the raunchiest Mexican food you can find for three days straight, then lock yourself out of the bathroom for 12 hours, and hang a sign on the door that reads "Secured-contact OA division at X-3053." 11.. Submit a request form to your father-in-law, asking if it's ok for you to leave your house before 3pm.

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12.. Invite 200 of your not-so-closest friends to come over and then board up all the windows and doors to your house for months. After the 6 months is up, take down the boards, wave at your friends and family through the front window of your home...you can't leave until the next day you have duty. 13.. Shower with above-mentioned friends. 14.. Make your family qualify to operate all the appliances in your home (i.e. Dishwasher operator, blender technician, etc.). 15.. Walk around your car for 4 hours checking the tire pressure every 15 minutes. 16.. Sit in your car and let it run for 4 hours before going anywhere. This is to ensure your engine is properly "lighted off." 17.. Empty all the garbage bins in your house, and sweep your driveway three times a day, whether they need it or not. (Now sweepers, sweepers, man your brooms, give the ship a clean sweep-down fore and aft, empty all trashcans over the fantail) 18.. Repaint your entire house once a month. 19.. Cook all of your food blindfolded, groping for any spice and seasoning you can get your hands on. 20.. Use eighteen scoops of budget coffee grounds per pot, and allow each pot to sit 5 hours before drinking. 21.. Have your neighbor collect all your mail for a month, read your magazines, and randomly lose every 5th item. 22.. Spend $20,000 on a satellite system for your TV, but only watch CNN and the Weather Channel. 23.. Avoid watching TV with the exception of movies, which are played in the middle of the night. Have the family vote on which movie to watch and then show a different one. 24.. Have your 5-year-old cousin give you a haircut with goat shears. 25.. Sew back pockets to the front of your pants. 26.. Spend 2 weeks in the red-light districts of Europe, and call it "world travel." 27.. Attempt to spend 5 years working at McDonalds, and NOT get promoted. 28.. Ensure that any promotions you do get are from stepping on the dead bodies of your co-workers. 29.. Needle gun the aluminum siding on your house after your neighbors have gone to bed.

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30.. When your children are in bed, run into their room with a megaphone, and shout at the top of your lungs that your home is under attack, and order them to man their battle stations. ("General quarters, general quarters, all hands man your battle stations") 31.. Make your family menu a week ahead of time and do so without checking the pantry and refrigerator. 32.. Post a menu on the refrigerator door informing your family that you are having steak for dinner. Then make them wait in line for at least an hour, when they finally get to the kitchen, tell them that you are out of steak, but you have dried ham or hot dogs. Repeat daily until they don't pay attention to the menu any more so they just ask for hot dogs. 33.. When baking a cake, prop up one side of the pan while it is in the oven and spread the icing on real thick to level it off. 34.. In the middle of January, place a podium at the end of your driveway. Have you family stand watches at the podium, rotating at 4-hour intervals. 35.. Lock yourself and your family in your house for 6 weeks. Then tell them that at the end of the 6th week you're going to take them to Disneyland for "weekend liberty." When the end of the 6th week rolls around, inform them that Disneyland has been canceled due to the fact that they need to get ready for Engineering-certification, and that it will be another week before they can leave the house. 36.. Sleep on the shelf in your closet. Replace the closet door with a curtain. Have your wife whip open the curtain about 3 hours after you go to sleep. She should then shine a flashlight in your eyes and mumble "Sorry, wrong rack." 37.. Renovate your bathroom. Build a wall across the middle of your bathtub, move the shower head to chest level. When you take showers, make sure you shut off the water while you soap down. 38.. When there is a thunderstorm in your area, find a wobbly rocking chair and rock as hard as you can until you become nauseous. Have a supply of stale crackers in your shirt pocket. 39.. Put lube oil in your humidifier and set it on high. 40.. For ex-engineering types: leave the lawn mower running in your living room eight hours a day. 41.. Once a week, blow compressed air up your chimney, making sure the wind carries the soot onto your neighbor's house. Ignore his complaints. 42.. Lock-wire the lug nuts on your car. 43.. Buy a trash compactor, but use it only once a week. Store the garbage on the other side of your bathtub. 44.. Get up every night around midnight and have a peanut butter and jelly sandwich on stale bread.

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45.. Set your alarm clock to go off at random during the night, jump up and get dressed as fast as you can making sure you button up the top button on your shirt, stuff you pants into your socks. Run out into the backyard and uncoil the garden hose. 46.. Once a month, take every major appliance apart and put them back together again. 47.. Install a fluorescent lamp under the coffee table and then get under it and read books. 48.. Raise the thresholds and lower the top sills of your front and back doors so that you either trip or bang your head every time you pass through one of them. 49.. Every so often, throw the cat in the pool and shout, "Man overboard, starboard side" Then run into the house and sweep all the pots and dishes off the counter. Yell at the wife and kids for not having the kitchen "stowed for sea." 50.. Put on the headphones from your stereo set, but don't plug them in. Hang a paper cup around your neck with string. Go stand in front of your stove. Say...to no one in particular "Stove manned and ready" Stand there for three or four hours. And say again to no one in particular "stove secured." Roll up your headphones and paper cup and place them in a box.

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FAIR USE NOTICE: This newsletter may contain copyrighted material the use of which has not always been specifically authorized by the copyright owner. The Editor/Publisher of the Bulletin at times includes such material in an effort to advance reader’s understanding of veterans' issues. We believe this constitutes a 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material in this newsletter is distributed without profit to those who have expressed an interest in receiving the included information for educating themselves on veteran issues so they can better communicate with their legislators on issues affecting them. To obtain more information on Fair Use refer to: http: //www.law.cornell.edu/uscode/17/107.shtml. If you wish to use copyrighted material from this newsletter for purposes of your own that go beyond 'fair use', you must obtain permission from the copyright owner.

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Notes: 1. The Bulletin will be provided as a website accessed document vice direct access until further notice. This was necessitated by SPAMHAUS who alleged the Bulletin’s size and large subscriber base were choking the airways interfering with other internet user’s capability to send email. SPAMHAUS told us to stop sending the Bulletin in its entirety to individual subscribers and to validate the subscriber base with the threat of removing all our outgoing email capability if we did not. To avoid this we notified all subscribers of the action required to continue their subscription. This Bulletin notice was sent to the 20,358 subscribers who responded to that notice and/or have since subscribed. All others are in the process of being deleted from the active mailing list.

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3. Bulletin recipients with interest in the Philippines, whether or not they live there, can request to be added to the RAO's Philippine directory for receipt of notices on Clark Field Space 'A', U.S. Embassy Manila, and TRICARE in the RP.

4. New subscribers and those who submit a change of address should receive a message that verifies their addition or address change being entered in the mailing list. If you do not receive a message within 7 days it indicates that either I never received you request, I made an error in processing your request, or your server will not allow me to

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send to the email addee you provided. Anyone who cannot reach me by email can call (858) 432-1214 to ask questions or confirm info needed to add them to the directory.

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7. The Bulletin is normally published on the 1st and 15th of each month. To aid in continued receipt of Bulletin availability notices, recommend enter the email addee raoemo@sbcglobal.net into your address book. If you do not receive a Bulletin check either http://www.nhc-ul.org/rao.html (PDF Edition), http://www.veteransresources.org (PDF & HTML Editions), http://veteraninformationlinksasa.com/emos-rao.html (PDF & HTML Editions), or http://frabr245.org (PDF & HTML Editions) before sending me an email asking if one was published.   If you can access the Bulletin at any of the aforementioned sites it indicates that something is preventing you from receiving my email. Either your server considers it to be spam or I have somehow incorrectly entered or removed your addee from the mailing list. Send me an email so I can verify your entry on the validated mailing list. If you are unable to access the Bulletin at any of these sites let me know.

8. Articles within the Bulletin are editorialized information obtained from over 100 sources. Provided at the end of each article is the primary source from which it was obtained. The ++ indicates that that the information was reformatted from the original source and/or editorialized from more than one source. Because of the number of articles contained in each Bulletin there is no why that I can attest to their validity other than they have all been taken from previously reliable sources. My staff consist of only one person (myself) and it is a 7/10-12 endeavor to prepare and publish. Readers who question the validity of content are encouraged to go to the source provided to have their questions answered. I am always open to comments but, as a policy, shy away from anything political. Too controversial and time consuming.

== To subscribe first add the RAO email addee raoemo@sbcglobal.net to your address book and/or white list. Then send to this addee your full name plus either the post/branch/chapter number of the fraternal military/government organization you are currently affiliated with (if any) “AND/OR” the city and state/country you reside in so your addee can be properly positioned in the directory for future recovery. Subscription is open at no cost to all veterans, dependents, military/veteran support organizations, and media.== To change your email addee or Unsubscribe from Bulletin distribution click the “Change address / Leave mailing list” tab at the bottom of the Bulletin availability notice that advised you when the current Bulletin was available. == To manually submit a change of email addee provide your old and new email addee plus full name.

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RAO Bulletin Editor/Publisher: Lt. James (EMO) Tichacek, USN (Ret) Tel: (858) 432-1214 Email: raoemo@sbcglobal.netBulletin Web Access: http://www.nhc-ul.org/rao.html, http://www.veteransresources.org, http://frabr245.org , and http://veteraninformationlinksasa.com/emos-rao.html [PDF & HTML Editions w/ATTACHMENTS]

RAO Baguio Director: SMSgt Leonard (Len) D. Harvey, USAF (Ret) PSC 517 Box 4036, FPO AP 96517-1000, Tel: 63-74-442-3468; Email: lenharvey@live.com.ph

RAO Baguio Office: Red Lion Inn, 35 Leonard Wood Road, Baguio City, 2600 Philippines FPO Mail Pickup: TUE & THUR 09-1100 --- Outgoing Mail Closeout: THUR 1100

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Warning:DELETE the end-paragraph of the Bulletin before you forward it to others. The end-paragraph following this warning is required by law and offers the recipient an opportunity to “UNSUBSCRIBE”, if they choose to. However, the “unsubscribe” link contains your email address and whoever receives your re-distribution has the opportunity, whether purposely or inadvertently, to terminate your future receipt of Bulletin messages.