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Responding to PACT Act, VA Reducing Claims Backlog, Recruiting Rural Docs

Remember how Senator M. Michael Rounds tried to explain away his partisan resistance to the PACT Act by claiming that the Department of Veterans Affairs wouldn’t be able to handle the flood of claims it would receive from millions of veterans seeking treatment for exposure to toxic burn pits and other poisons during their military service?

Yeah, sure, the PACT Act is putting a lot more work on the VA’s plate:

The day after President Joe Biden signed the bill into law in August, veterans set an all-time record for benefits claims filed online and more than 136,000 have applied for benefits under the toxic exposure law as of mid-November. The VA expects the number of veterans and surviving family members applying could reach more than 700,000 in the coming months.

To address the surge in claims, VA is hiring more employees to provide health care and process applications, but officials do expect an increase in the backlog in the short term [Jennifer Shutt, “Thousands of Veterans Deluge VA with Claims for Toxic Exposure Benefits, Health Care,” South Dakota Searchlight, 2022.11.23].

But the VA is busting its chops to clear that backlog:

Joshua Jacobs, who is performing the delegable duties of the VA under secretary for benefits, said in mid-November that the VA is “in a better position to tackle this increased workload” than it was in 2013 when the agency was widely rebuked for letting the backlog swell to more than 600,000.

…Jacobs said the VA moving to a paperless system and hiring of thousands more people will help avoid a significant backlog in the months to come as hundreds of thousands of veterans likely apply for the health care and benefits that are part of the toxic exposure law, known as the PACT Act.

…Jacobs noted the VA has gotten the total backlog down to its lowest in years, below 150,000 claims as of this month [Shutt, 2022.11.23].

The VA’s hiring push includes extra attention to the challenges of recruiting and retaining health care providers in rural America:

While the PACT Act gives the VA plenty to implement, the agency’s fiscal 2023 budget request calls for additional pay incentives, such as raising the $400,000 salary cap for physicians in rural areas.

[Undersecretary for Health Shereef] Elnahal said the agency is also looking to raise pay caps on VA dentists and podiatrists.

“In order to recruit the right folks on the physician, dentist and podiatrist side, it’s becoming much more difficult, especially in rural areas, as salaries go up and the health care labor market becomes more difficult,” Elnahal said. “And we will be able to pay more innovatively as well to incent the right behavior among these clinicians, if we’re able to get that.”

Elnahal said the VHA is also on track to complete a national rural recruitment and hiring plan for healthcare professionals by early 2024.

“These are more difficult healthcare labor markets, it’s harder to get folks recruited for these critical positions. We are actually approaching this in, I think, an innovative way. We’re taking our experts in workforce management and human resources and combining them with our implementation science researchers to collate the data that is available to understand what a targeted outreach plan could look like and make that an actually an evidence-based effort,” he said [Jory Heckman, “VA Embarks on Year-End Push to Implement Workforce Elements of PACT Act,” Federal News Network, 2022.11.25].

The Veterans Health Administration is also bringing its new hires up to speed faster:

The VHA, through a national onboarding surge event last week, completed all the onboarding steps for more than 12,800 new employees — nearly double its goal.

…“My first priority is to hire faster and more competitively, because I know we need many more of those people. The more folks we have to be able to execute the mission, the more veterans we will be able to serve in a shorter time. And that means everything as we prepare for the historic expansion of benefits that the president signed into law this past August,” Elnahal said in a Nov. 23 interview [Jory Heckman, “VHA Nearly Doubles Goal of Onboarding Health Care Workers During ‘Surge’ Event,” Federal News Network, 2022.11.23].

Senator Rounds and other elected Republicans seem to think their job is to sit around complaining about how government can’t solve problems. Fortunately for veterans, the Biden Administration and the VA recognize that their job is to solve problems so we as a country can do what’s right for ailing veterans and other people who need help.

19 Comments

  1. larry kurtz 2022-11-26

    Our neighbor, Penny did three tours in Iraq and is a burn pit victim but she needs to visit the VA in Albuquerque three times a week for therapy and it’s just too far from out here in the boonies especially in the winter.

    If the United Snakes was a whole nation the funding for Obamacare, TRICARE, Medicare, the Indian Health Service and the Veterans Health Administration would be rolled together then Medicaid for all would enable Penny to just go into any hospital for her treatment.

  2. All Mammal 2022-11-26

    Way to go for the improvements in the administration and just the huge sense of movement that is happening is incredible. I really hope this is also looked at from the point of innocent bystanders. If our soldiers are so negatively impacted by burn pits, what about the folks who live where these nasty pits are occurring? Shouldn’t we maybe not have such toxic crap burning, polluting the environment and innocent people down-wind? This is happening in people’s homeland. That is unacceptable.

  3. larry kurtz 2022-11-26

    Democratic Montana Senator Jon Tester has been a veterans advocate since before he even went to Congress. His VA Medicinal Cannabis Research Act directs the VA to begin clinical trials to test the effects of cannabis as therapy for chronic pain and to treat the symptoms of Post-Traumatic Stress Disorder (PTSD).

  4. Mark Anderson 2022-11-26

    Cory, Senator Rounds is proof that Republican government doesn’t work.

  5. DaveFN 2022-11-26

    larry kurtz

    Sen. Tester introduced that legislation four years ago.

    Here is what the VA says about cannabis use and PTSD among veterans:

    “Epidemiology of Cannabis Use and Cannabis Use Disorder (CUD) Among Veterans

    Cannabis use in the general population has increased over the past decade. From 2013 to 2018, the number of Americans over the age of 12 reporting past month cannabis use rose from 19.8 million to 27.7 million (1,2). Likewise, daily use has increased 60% in the prior decade (1,2). Cannabis use among U.S. military Veterans has also increased. In 2014, 9% of Veterans in the U.S. reported using cannabis in the past year (3). In 2019-2020, the prevalence of past-6-month cannabis use among Veterans was 11.9%, and was over 20% among Veterans aged 18-44 (4).

    A number of factors are associated with increased risk of cannabis use, including diagnosis of mental health problems such as PTSD (5), anxiety disorders, mood disorders and other substance use disorders (6).

    Cannabis use disorder (CUD) which is an extended problematic use of cannabis is also common. At the start of 2020, lifetime prevalence of CUD among Veterans was 9.2% and the prevalence of past-6-month CUD diagnoses among Veterans was 2.7% (7). However, rates of current CUD are considerably higher among the subset of Veterans with co-occurring PTSD (12.1%), as well as among Veterans with other psychiatric and substance use problems (8.9%-13.0%; 4)…

    Cannabis as a Treatment for PTSD

    The belief that cannabis can be used to treat PTSD is primarily based on anecdotal evidence from individuals with PTSD who report that cannabis helps with their symptoms or improves their overall life and functioning. Randomized controlled trials (RCTs), which are a necessary “gold standard” for determining safety and efficacy, are needed to test the use of whole plant cannabis to treat PTSD. There has only been 1 RCT comparing whole plant cannabis and placebo for treating PTSD (23). This trial included 2 phases. The first phase compared effects of 3 active cannabis preparations (high THC, high5 CBD, balanced THC+CBD) and placebo on PTSD symptoms in 80 U.S. military Veterans. Results showed no significant difference in PTSD symptom reduction between placebo and any of the active cannabis preparations. In the second phase, 74 Veterans were re-randomized to receive 1 of 3 active cannabis preparations. Results showed a significant reduction in PTSD symptoms in the THC+CBD group only; however, because there was no placebo group in this phase, it is not possible to draw conclusions about the efficacy of cannabis to treat PTSD from these results.

    Furthermore, evidence about the relationship over time between whole plant cannabis use and PTSD symptoms is mixed. One recent study comparing cannabis users to non-using controls found that cannabis users reported greater improvements in PTSD symptoms when observed over the course of a year. However, this study recruited individuals who endorsed already using cannabis to treat their PTSD symptoms before enrolling in the study. Because these individuals were not initiating cannabis as a novel treatment, it is somewhat surprising that their PTSD symptoms abated at the initiation of the study, rather than earlier in the course of their cannabis use. It is possible that including individuals who believed cannabis to be helpful for their PTSD may have selected for participants who were more likely to report greater symptom improvement related to their cannabis use. In addition, the study did not control for other variables that could explain differences in symptom reduction between the groups, leading to a high risk of bias (24). Meanwhile, another study found that medical cannabis users with self-reported PTSD experienced short-term symptom relief when using cannabis but no long-term changes in PTSD symptoms, suggesting that cannabis may not effectively treat PTSD (25). In addition, other research shows that chronic cannabis use might worsen trauma-related symptoms over time (26).”

    https://www.ptsd.va.gov/professional/treat/cooccurring/marijuana_ptsd_vets.asp

  6. leslie 2022-11-26

    rounds sure wants to keep out of sd “farmers and ranchers’ way, who know how to care for their land better than big government” but has no problem complaining that Biden has had “680 days to fix the southern border” and failed. All he has learned in all his decades in big government is Republican obstructionism. And get fat, and force his whole brood of 20 relatives to shoot shotguns chasing around little birds. (recent twitter) You would think he would have learned something at the seat of power. Every advantage at his fingertips.

  7. Mark Anderson 2022-11-26

    Come on Leslie, the Republican’s don’t want to fix the border. It’s their bread and butter.

  8. O 2022-11-26

    Senator Rounds forgets that the Senate is a legislative body and not a performance art center. All he ever needs to do is write a solution to ANY problem down, get 51 (or 60) of his closest friends in the Senate to agree that it is a good idea, and we are well on out way to fixing that problem. Really, I saw a cartoon about this very process between Saturday morning cartoons during my youth.

    By the way, Sen. Rounds has not fixed the broken southern border since his election in 2014 — far longer than 680 days.

  9. grudznick 2022-11-26

    Mr. O points out interesting facts. Mr. Rounds is, of course, strung up by his ham by Mr. Biden.

    Mr. O also fails to realize that the Senate is, in fact, and in deed, a performance art center.

  10. Richard Schriever 2022-11-26

    Jeez Dave – very simple research design problem is demonstrated in those two different iterations of the cannabis RCTs. One treatment, vs 2 other treatments shows some significant impact of the one treatment vs. the two others. However, when that one treatment that did show some is COMBINED with the two that didn’t, and compared to NO treatment, – can’t tell the difference. Do you see the simple “averaging” issue here that is sort of spun to make it appear as if “nothing” works?? A single stand-alone study, especially one like this that has an obvious flaw, is no better to anecdote. I.E., don’t rely on this ONE flawed study to form an opinion. Basic science and critical thinking stuff. Yeppers, more studies are needed.

  11. Richard Schriever 2022-11-26

    grudz, The administrative branch has ZERO control over the congressional branch. Zipp, nada, none. The congress critters are absolutely free to do as they choose.

  12. larry kurtz 2022-11-27

    The goal of the bill – which passed the House of Representatives in July by a strong bipartisan vote of 325-95 under the leadership of Representatives Earl Blumenauer (D-Ore.) and Andy Harris (R-Md.) – is to facilitate research on marijuana and its potential health benefits. The bill will accomplish this by streamlining the application process for scientific marijuana studies and removing existing barriers for researchers that frequently slow the research process. In addition to Feinstein, Grassley and Schatz, the Senate bill is cosponsored by Senators Dick Durbin (D-Ill.), Amy Klobuchar (D-Minn.), Thom Tillis (R-N.C.), Tim Kaine (D-Va.), Joni Ernst (R-Iowa), Kevin Cramer (R-N.D.), Jon Tester (D-Mont.) and Lisa Murkowski (R-Alaska).

    https://www.feinstein.senate.gov/public/index.cfm/press-releases?id=F72220B0-7431-4762-9ED9-0DFF7A8EB66A

  13. Cory Allen Heidelberger Post author | 2022-11-27

    Right, O: we need more senators who view their jobs as problem-solving, not performance. But the easy re-election of Thune, Johnson, and especially Noem demonstrate our view of elected office as an actual job with expected civic results is the minority view.

  14. Rob D. 2022-11-27

    I’m not sure I buy that the backlog is getting addressed. I’ve been working a claim for my Mom that’s over a year old, covered by the PACT Act, and has just been sitting on VA bureaucratic hell.

  15. DaveFN 2022-11-27

    Richard Schriever

    Re the Bonn-Miller publication [ref 23 in the VA link]: Take a bad study and piggy-back it on a good study: ie, a study without a placebo showing significant effect piggy-backed onto a placebo-controlled RCT which latter showed no benefit. Pretty twisted from the get-go, but package the two into a publication with the exculpatory and provisional conclusion “This study provides evidence that the types of cannabis available in recreational and medical cannabis dispensaries might hold promise as an alternative treatment for PTSD,” “might” being the operant word.

    Yet note the additional caveat in the conclusion: “Randomized placebo-controlled trials are needed to assess safety and determine how different preparations of cannabis impact PTSD and functioning,” highlighting the author’s recognition of the limitation of their own study, namely, the failure to employ a placebo in the second aspect of the study.

    The VA statement is merely pointing out the facts of the matter of the Bonn-Miller publication and is not in any way “spinning” them.

    The same is also reiterated in a 2022 publication which says of the Bonn-Miller study:

    “The only randomized controlled trial to date found cannabis had no greater effect on PTSD symptoms than placebo.”

    [Bedard-Gilligan M, Lehinger E, Cornell-Maier S, Holloway A, Zoellner L. Effects of Cannabis on PTSD Recovery: Review of the Literature and Clinical Insights. Curr Addict Rep. 2022 Sep;9(3):203-216. doi: 10.1007/s40429-022-00414-x. Epub 2022 Jun 15. PMID: 36385902; PMCID: PMC9648847.]

    Incidentally, five of the seven authors of the Bonn-Miller publication have a COI. Two authors were employees of Canopy Growth Corporation—in 2019 the world’s largest cannabis company—and both those authors received stock options in the course of their employment. Another author was a consultant for Canopy Growth Corporation. A fourth author was on the scientific board for a firm with cannabis interests, while a sixth author was an employee of Jazz Pharmaceuticals (which in 2021 bought GW Pharma for $7.2 billion adding Epidiolex®, aka cannabidiol, to its portfolio) which sixth author in the course of employment with Jazz also received stock options. As Donald Pay is fond of saying, “Follow the money.”

    I see no “research design problem” afoot as you indicate but the obvious and transparent omission in the second phase to use a placebo.

    Any spin appears to come in the form of the notion that there is some “simple ‘averaging’ issue here that is sort of spun to make it appear as if “nothing” works,” as you say.

    Also, the lead author of the above Bonn-Miller study published a study two years later for PTSD on smoked cannabis which form was not utilized in the previous study. Note the conclusion again: “The present study is the first randomized placebo-controlled trial of smoked cannabis for PTSD….**no active treatment statistically outperformed placebo in this brief, preliminary trial.** Repeat: “…no active treatment statistically outperformed placebo…”

    [Bonn-Miller MO, Sisley S, Riggs P, Yazar-Klosinski B, Wang JB, Loflin MJE, Shechet B, Hennigan C, Matthews R, Emerson A, Doblin R. The short-term impact of 3 smoked cannabis preparations versus placebo on PTSD symptoms: A randomized cross-over clinical trial. PLoS One. 2021 Mar 17;16(3):e0246990. doi: 10.1371/journal.pone.0246990. PMID: 33730032; PMCID: PMC7968689.]

    The VA link cites 37 references. It does not rely on “a single stand-alone study” as you have indicated.

    As far as critical thinking, one can be critical and entirely without thought other than the thought to spin. So, jeez Richard: “C’mon man!” You’re better than this.

  16. All Mammal 2022-11-27

    Perhaps the fact that all the studies conducted on long term effects with psychotropic drugs show declines in mental health, compounded with the complete lack of predictable empirical scientific understanding of what is actually happening to the patient’s mental hardwiring is enough evidence to convince the critical thinker to avoid the risk of losing your mind and stick with the tried and true au natural cannabis plant. Works on mice. No synthetic can replace the chemical compound our thc receptors love to smash.

    Sometimes, when science puts nature’s perfect wonders under the microscope, it kills all the magic and you can’t get that back.

  17. Richard Schriever 2022-11-28

    Dave – more study is needed. Again – you cite the previous paper, and admit (as do some of the cites included and the paper’s authors) that they have flaws. Then you cite ONE additional study (more properly-done from what I can see) that reaches the same conclusion to the initial one’s with self-admitted problematic conclusions. So now we essentially have two anecdotes. When we get to 100 or so that would be pretty conclusive IMO. But using what we have so far as a justification for denigrating further study as useless —- well, there you have Roundish thinking.

  18. Richard Schriever 2022-11-28

    Dave – my question here is did you post the first “summary” of the VA’s paper in support or in opposition of more – and better – research? My conclusion, from reading that post was you are opposed, having concluded that a definitive conclusion has already been achieved.

  19. DaveFN 2022-12-01

    Richard Schriever

    You are misreading my comments and criticisms. As far as “denigrating further study” I am doing nothing of the kind (although I have plenty of criticisms when it comes to massive wasted taxpayer money by the military and government agencies which support earmarks and certain kinds of space travel as well as the Sanford Underground Research Facility; but that’s another topic for another time).

    The point is that there is currently insufficient evidence from clinical trials supporting cannabis to treat PTSD. This, in spite of the fact that “U.S. military Veterans have high rates of posttraumatic stress disorder (PTSD) and are especially likely to report using cannabis for medical purposes, including the management of PTSD symptoms” as per the September 2022 report by Hill and Norman, “Cannabis and Posttraumatic Stress Disorder in Veterans.” Self-reporting is fraught with problems, as I’m certain you must realize, and does not rise to the level of evidence required by rigorous science.

    Again, the conclusion of the above report:

    “There is currently insufficient evidence from clinical trials supporting cannabis to treat PTSD. Some patients with PTSD may report experiencing short-term symptom relief when using cannabis, but PTSD symptom reduction did not differ between Veterans randomized to cannabis versus placebo in the only extant RCT. The long-term effects of cannabis use in Veterans with PTSD remain unclear. Some Veterans may experience worsening PTSD symptoms with chronic cannabis use and/or difficulty stopping cannabis use.”

    https://www.cannabisevidence.org/wp-content/uploads/2022/11/Cannabis-and-Posttraumatic-Stress-Disorder-in-Veterans.pdf

    Anything to the contrary falls outside the domain of evidence-based, scientific research.

    The origins of such unscientific bias? One can but speculate, myself as well as anyone. One might suppose some unconscious, pseudo-theological elucubrations similar to the ancient “argument from design for God” which contends “we find things in the world which cannot plausibly be explained as the product of blind natural forces, but are moch more reasonably to be regarded as evidence of a beneficial purpose.” (I quote Bertrand Russell here as he puts it so well).

    In other words, enter the “miracle” of “natural” marijuana and personal anecdote as entirely shoddy “evidence” for treatment of PTSD. Wishful thinking. Not at all unlike individuals who find evidence of a pedophile ring at Comet Ping Pong, or claim “evidence” for a host of conspiracy theories.

    https://en.wikipedia.org/wiki/List_of_conspiracy_theories

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