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It may very well have been the largest American Legion Walk for Veterans yet. An estimated 220 Legion family members and veterans walked alongside a series of memorials adjacent to the National Infantry Museum and Soldier Center in Fort Benning, Ga., on May 14. Part of the success can be attributed to the home field advantage of National Commander Dale Barnett. And in the spirit of a hometown hero, Barnett began the event with a pre-game pep talk to the large group of walkers. “This really is a welcome home,” Barnett said, pointing out that his daughter Michelle was born at the local hospital. “I deployed for Desert Shield/Desert Storm from Columbus, Georgia, with the 2nd Battalion, 18th Infantry. I chose (to visit) Columbus, Georgia, Fort Benning and Callaway Gardens because this truly is a homecoming.” He explained the rationale for the gold T-shirts given to registered walkers. “We are wearing these funky shirts because they stand out," he said. "When people look at us and ask why are we here with our families and why are we here as veterans and why do we do what we do, I want you to tell your story about why you are an American Legion member. I’m proud that my family is part of this journey with The American Legion. I hope you can be visible in your community to raise awareness of veterans. God bless you for being with us." The morning festivities began with a reading of a proclamation issued by Columbus mayor and city council, declaring May 14 as “Commander Dale Barnett Day.” U.S. Rep. Sanford Bishop, D-Ga., also attended the walk. “I want you to know that The American Legion is very, very special. It is the number one veterans service organization,” Bishop said. “As your member of Congress for the Second Congressional District, I can tell you firsthand that because of The American Legion, the issues that matter to veterans and their families are first and foremost on the table in Congress. And whenever (legislation) gets screwed up, The American Legion shows up, just like the cavalry, and gets it straight.” The walk raised $14,811 for Barnett's primary fundraiser, the National Emergency Fund (NEF). The NEF provides financial grants to qualified posts and Legion family members affected by declared natural disasters to help with out-of-pocket expenses, such as temporary housing, food and clothing. “Everything we’ve done for the past few years has been for Dale, our commander, our favorite son," said Department of Georgia Commander Thom Mash. "Our membership reflected that last year, and you’ll see it reflected again this year. We do it for Dale. We’re proud of him.” While Barnett frequently reminds the public of the estimated 22 veterans a day that commit suicide, Mash added a few additional reasons why The American Legion needs to "walk for those who marched for us." “A lot of thought went into that message,” Mash said. “It’s simple and right to the point. People from around the country tell me that they are in anti-veteran or anti-military states. Georgia is lucky in that sense. I think that the VA claims list and VA wait times need to be shortened, although it is going in the right direction.” During an evening homecoming banquet, Barnett reflected on highlights of the more than 30 awareness walks that he has participated in from Florida to California. “I will tell you, my Georgia American Legion family, it would have never happened if you hadn't stood behind me and allowed me to have these wonderful adventures and raise awareness about our great organization.” By John Raughter for American Legion News
Newswise — A University of Iowa researcher is working with the Veterans Administration on a pilot program to help female veterans suffering from postpartum depression. MomMoodBooster is an online intervention tool that helps mothers who live in rural areas cope with their depression. “Women in rural areas often don’t seek out or have access to mental health care,” saysMichael O’Hara, professor and Starch Faculty Fellow in the UI Department of Psychological and Brain Sciences. “Reaching out in particular to rural veteran women seemed to me like it was just something important to do.” Each year, about 300,000 new mothers in the United States suffer from postpartum depression, experiencing low moods, loss of interest in normally enjoyable activities, insomnia, appetite disturbances, difficulty concentrating, and suicidal thoughts—and O’Hara says this estimate is low. So far, about 40 women from across the country have taken part in MomMoodBooster with positive results. Over a six-week period, women participate in six sessions that target managing mood, increasing pleasant activities, managing negative thoughts, increasing positive thoughts, and planning for the future. Phone coaches also call to check in with the women, tracking progress, answering questions, and providing encouragement. O’Hara says it seems possible, given the combat experience of many female veterans, that they may be more at risk for depression, though that has not been quantified. “I was in the Navy for four-and-a-half years, and it’s not an easy life,” O’Hara says. “These are women who have served our country, and we have a way of contacting them. You put that together, and it’s sort of a winning combination.” Treating postpartum depression is important not only for mothers, but also for the well-being of their children. A depressed parent often pays less attention to the baby’s cues, either interacting less and neglecting the child or working so hard to interact that the baby becomes overwhelmed, leading to developmental problems. The self-focus caused by depression can be harmful to children in other ways as well. For example, when parents choose whether to make a meal or drive to a fast food restaurant, depression can influence them to make the easier choice. “Any time a parent is distracted by mental health concerns, this can lead to problems with the children,” O’Hara says. “We know that inconsistent parenting often makes it harder for children to internalize societal rules, a situation that often sets the stage for behavior problems. Having parents who are emotionally stable is quite a benefit to the child.” For some women, postpartum depression represents a recurrence of depression at a stressful time in their lives. For others, it stems from issues surrounding the marriage, finances, or simply the challenge of caring for an infant. Biologically, there is increasing evidence that pregnancy hormones may the set the stage for low mood, which, when combined with environmental factors, may cause postpartum depression. “The most dominant things I see are poor social support systems and conflict with the partner,” O’Hara says. The program will continue at least through the end of September, when the VA will determine whether to continue funding, and O’Hara expects to write a research study based on the results of the pilot. The MomMoodBooster project is funded by the VA Office of Rural Health and the VA Office of Women’s Health Services.
Newswise — Over the last decade, repair of the mitral valve (MV) has become widely favored over its replacement. Data available from such sources as the Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD) have documented this trend at non-governmental hospitals, but there is little known about mitral surgery practice in the largest federal health system in the US - the Veterans Affairs (VA) Health System. In a presentation at the 96th AATS Annual Meeting, Faisal G. Bakaeen, MD, presents data from more than 4,100 mitral valve surgeries showing that mitral valve operations are performed with low mortality in the VA and that the percentage of repair vs. replacement surgeries has increased significantly since 2001. However, despite the survival advantage for mitral repair in primary mitral regurgitation, the rate of valve repair was quite variable among the VA centers and offers an opportunity for system-wide quality improvement. Baltimore, MD, May 17, 2016 – Little is known about mitral valve (MV) surgical outcomes within the largest US federal health system – the Veterans Administration (VA) Health System. At the 96th AATS Annual Meeting, data presented from 40 VA cardiac surgery centers reveal that although MV repair rates increased from 48% in 2001 to 63% in 2013, a wide variability exists in repair rates among medical centers. This is especially important because MV repair mortality rates were significantly lower in patients with primary degenerative disease. “This large multi-center study adds further evidence to support the use of MV repair over replacement in patients with degenerative MV disease. Despite the benefits associated with MV repair, the rate of valve repair utilization varied widely among centers and presents an opportunity for education and quality improvement”, explained lead author Faisal G. Bakaeen, MD, Department of Surgery, Baylor College of Medicine, The Michael E. DeBakey VA Medical Center (Houston, TX), and the Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic (Cleveland OH). The investigators found that between 2001 and 2013, 4,165 mitral valve surgeries were performed, including 2,408 MV repairs and 1,757 MV replacements at 40 VA centers. The overall MV repair rate increased from 48% of the total number of MV surgeries to 63% in 2013. “The increased rate of MV repairs in VA hospitals mirrors the trend revealed by analyses of the STS ACSD,” commented Dr. Bakaeen. “These findings indicate that the introduction and adoption of novel surgical procedures occur in tandem at VA and non-VA facilities. This is expected because all VA cardiac programs are affiliated with academic centers and some share faculty and educational programs with their university affiliates.” The study highlighted other advantages of MV repair compared to MV replacement, including fewer complications around the time of surgery and shorter hospital stays. MV repair also showed some survival advantage. While some differences between surgical groups were sometimes not statistically significant (e.g. unadjusted and adjusted 30-day operative mortality rates), mortality rates for MV repair were significantly lower at both 180 days (2.5% vs. 5.0%) and 365 days (3.0% vs. 5.7%) in patients with primary degenerative disease. After 10 years, mortality was marginally lower for MV repair. When the investigators examined annual MV procedural volume per medical center, they found it varied widely: from 0 to 29, with a median of 7. The median number of annual MV repairs ranged from 0 to 21, with a median of 4 per center. Other studies have suggested that MV surgery volume is a significant predictor of greater MV repair use and better mitral surgery outcomes. In fact, some reports have specified that 40 MV repairs per year should be the minimum number performed annually to maintain a high level of care. This report, however, found that none of the VA centers met this 40 case per year threshold and, in fact, center volume accounted for only 19% of the total variation in facility-level MV repair. Dr. Bakaeen noted that the 40 case per year threshold may not be applicable to the VA system. “VA hospitals are not typical low-volume community hospitals. The shared-faculty model and educational collaboration that exists between some VAs and their academic affiliates may help mitigate these hospitals’ low-volume status, which would explain their good MV outcomes.” Nevertheless, he suggests that determining why MV repair rates are very low in some VA hospitals presents an opportunity for quality improvement.
Newswise — In a Veterans Affairs study of more than 300 enlisted Army National Guard and Army Reserve members who had deployed to Iraq or Afghanistan, a majority reported symptoms consistent with a condition known as chronic multisymptom illness (CMI). The data were collected a year after the soldiers returned home. The results suggest that deployment to these conflicts could trigger symptoms consistent with CMI. The ailment presents as a combination of medically unexplained chronic symptoms, such as fatigue, headache, joint pain, indigestion, insomnia, dizziness, breathing problems, and memory problems. The study, by researchers with VA's War-Related Illness and Injury Study Center (WRIISC) in New Jersey, appeared online Feb. 22, 2016, in the Journal of Rehabilitation Research and Development. "As a whole, CMI can be challenging to evaluate and manage," said lead author Dr. Lisa McAndrew. "CMI is distinct from PTSD or depression. It contributes to significant disability." McAndrew is also with the University at Albany. In the veteran community, chronic multisymptom illness has previously been associated mainly with service during the Persian Gulf War in the early 1990s. At least a quarter of those veterans are affected. Experts aren't sure, though, if that condition is the same one that has emerged among more recent veterans, as documented in the newest WRIISC study and one or two earlier ones. Last year, for example, researchers with the Millennium Cohort Study reported that about a third of combat veterans who served in Iraq and Afghanistan had CMI symptoms. "This condition appears to be similar to that experienced by many Gulf War veterans, in terms of the symptoms, but we don't really know if it's the same condition," says McAndrew. "That still requires study." McAndrew and her colleagues surveyed 319 soldiers about their overall health before they deployed and one year after they returned. The VA team found there were 150 soldiers who did not report many symptoms before they deployed but who reported symptoms of CMI one year after deployment, suggesting a link between deployment to Iraq or Afghanistan and CMI. In total, nearly 50 percent of the overall group met the criteria for mild to moderate CMI, and about 11 percent met the criteria for severe CMI, one year after deployment. The most common symptoms reported were trouble sleeping, moodiness or irritability, joint pain, fatigue, difficulty remembering or concentrating, headaches, and sinus congestion. Not surprisingly, the researchers found that veterans who screened positive for CMI scored significantly lower on measures of physical and mental health function. Of the 319 veterans in the study, 166 had chronic pain, lasting more than three months. Almost all of those with chronic pain--90 percent--also met the criteria for CMI. Similarly, 82 percent of those with CMI reported chronic pain. The finding underscores the strong link between chronic pain and CMI, say the researchers. The study also found that almost all veterans with PTSD symptoms also showed signs of CMI--about 98 percent. Only seven patients had PTSD and did not meet the criteria for CMI. In contrast, though, about 44 percent of the veterans with CMI did not have PTSD. In other words, the link between PTSD and CMI was not as robust as that between chronic pain and CMI. The authors caution that the study looked only at pain and PTSD as factors tied in with CMI. It did not document other conditions that could possibly account for the symptoms of CMI, such as depression, traumatic brain injury, and substance abuse. At the same time, they say these other conditions are unlikely to completely account for the frequency of symptoms seen in the study. By the same token, other conditions not examined in the study, such as arthritis or multiple sclerosis, could cause symptoms similar to those of CMI. More research is needed to tease out those variables. Another limitation of the study: The research team used a definition of CMI, established by the Centers for Disease Control and Prevention (CDC), that is based on Gulf War Veterans. They say it might not exactly fit the symptoms of veterans of the more recent conflicts. Also, it's unclear whether the Guard and Reserve members surveyed in the study are representative of the larger veteran or military cohort who deployed to Iraq and Afghanistan. All in all, the research team advises that the results be interpreted with caution. "We're taking the approach that an abundance of caution is necessary in the clinical implications of the findings," says McAndrew. "Respondents self-reported symptoms on pen and paper surveys. The symptoms were not confirmed or evaluated by a clinician. While the CDC case definition is fairly clear-cut, in clinical practice there is a lot of gray area around applying the label of CMI. We used the term 'symptoms consistent with CMI' to indicate the uncertainty due to the self-reported, clinician-unverified nature of the classification." Pending further research on the topic, McAndrew's group says clinicians in VA or other settings should consider CMI when evaluating Iraq and Afghanistan Veterans, especially those with chronic pain. Once the condition is identified, clinicians in VA and the Department of Defense do have a clinical practice guideline for managing the condition. "Acknowledging the presence of multiple symptoms and taking a holistic approach to achieving patient goals is critical in managing CMI," says McAndrew. For example, pain management may need to be tailored to account for other symptoms of CMI. The WRIISC study notwithstanding, McAndrew says not enough attention has been focused on the issue to date. "There have been few studies of CMI among Iraq and Afghanistan veterans. Our findings suggest this could be an overlooked problem." ### Senior researcher on the WRIISC study was Dr. Karen Quigley, now at the Edith Nourse Rogers Memorial Veterans Hospital and Northeastern University.
Craig Schroeder, who was injured in 2006 while serving with the Marines in Iraq, suffers from traumatic brain injury and pain, for which he has been on a steady regimen of opioids. (Ted Richardson/For The Washington Post)   New federal rules that make it harder to get narcotic painkillers are taking an unexpected toll on thousands of veterans who depend on these prescription drugs to treat a wide variety of ailments, such as missing limbs and post-traumatic stress. The restrictions, adopted last summer by the Drug Enforcement Administration to curb a national epidemic of opioid abuse, are for the first time, in effect, forcing veterans to return to the doctor every month to renew their medication, although many were already struggling to get appointments at overburdened VA health facilities. And even if patients can get appointments, the new rules pose an additional hardship for many who live a good distance from the health centers. Although the tighter regulation applies to everyone on opioid painkillers, it’s hitting veterans especially hard because so many are being treated for horrific injuries sustained during the long wars in Iraq and Afghanistan and have become dependent on the Department of Veterans Affairs’ beleaguered health-care system for medical care. The rules come at a time of turmoil for VA. The agency’s widespread problem with patient backlogs burst into view last year with revelations that employees had covered up how long veterans had to wait for care, even for such pressing matters as cancer and suicide prevention. In dramatically curtailing access to the highly addictive painkillers, the government is trying to roll back what the Centers for Disease Control and Prevention has termed “the worst drug addiction epidemic in the country’s history, killing more people than heroin and crack cocaine.” The rules apply to “hydrocodone combination products,” such as Vicodin. More than half a million veterans are now on prescription opioids, according to VA. Pain experts at VA say that in hindsight they have been overmedicating veterans, and doctors at the Pentagon and VA now say that the use of the painkillers contributes to family strife, homelessness and even suicide among veterans. A study by the American Public Health Association in 2011 also showed that the overdose rate among VA patients is nearly double the national average. But some veterans say they have come to depend on these painkillers to function and now, unable to get a timely renewal of the prescription, are suffering withdrawal symptoms that feel like a panic attack and the flu at the same time. Craig Schroeder was injured in a makeshift-bomb explosion while serving as a Marine corporal in the “Triangle of Death,” a region south of Baghdad. He suffers from traumatic brain injury, which has affected his hearing, memory and movement, and from pain related to a broken foot and ankle and a herniated disc in his back. He has been on a steady regimen of opioids. But after the DEA regulations were put in place, he was unable to get an appointment to see his doctor for nearly five months, he said. He stayed in bed at his home in North Carolina much of that time. “It was a nightmare. I was just in unbearable, terrible pain,” he said. “I couldn’t even go to the ER because those doctors won’t write those scripts. ”His wife, Stephanie Schroeder, said getting him a VA appointment turned into a part-time job and her “main mission in life.” While part of the problem was a shortage of doctors, she said she also noticed that VA had become hostile toward patients who asked for painkillers. “Suddenly, the VA treats people on pain meds like the new lepers,” she said. “It feels like they told us for years to take these drugs, didn’t offer us any other ideas, and now we’re suddenly demonized, second-class citizens. ”Officials at Disabled American Veterans, a veterans service organization, said VA needs to be more compassionate and help veterans through the changes. “We’re hearing from veterans with lifelong disabilities, who never had a problem with addiction issues. They have been on these drugs for decades, and then all of a sudden it was boom, a total change in attitudes,” said Joy Ilem, the group’s deputy national legislative director. Gavin West, a clinical operations chief at VA, said there has been a systematic effort since autumn to contact veterans to explain the new rules, broader concerns about opioid use and alternative options for treatment. At the same time, he said, the agency is working to ensure that veterans get the access to medical care that’s required. “The DEA did a good thing here for opioid safety,” he said. But he added, “How do you balance the sensitivity of patients and the new rules when all of a sudden a veteran, who’s been treated with this medication for 15 years or 20 years, has everything change?” To help patients adjust to the changes, Rollin Gallagher, VA’s national director for pain management, said staff members are meeting personally with veterans. “There is the real anxiety of being in pain and losing control of that pain. We are aware of the fact that we need to pay attention to this,” he said. The agency recently set up a Choice Card program for veterans, which would allow those facing long wait lists or who live more than 40 miles away from a VA hospital to use private clinic visits. Veterans say the initiative iscomplicated and confusing. VA officials acknowledged this month that veterans have been using this program at a lower rate than anticipated. [Veterans say new choice cards are causing more problems] DEA officials declined to comment on the specific challenges that the new rules pose for veterans. Barbara L. Carreno, a DEA spokeswoman, said in a statement that everyone, including “practitioners employed by the U.S. Veterans Administration,” have to follow the new regulations. The officials said the rules are a response to multiple medical studies that have showed that the opioid overdose rate is higher in the United States than anywhere else. DEA officials offer some flexibility, allowing doctors to write prescriptions for up to 90 days by post-dating them. But many VA doctors will not do that because of concerns over fraud or fatal overdoses; doctors are telling patients they need to come back every month, medical staff say. Half of all returning troops suffer chronic pain, according to a study in the June issue of the Journal of the American Medical Association. So a new generation of pain doctors is pushing for alternative ways to help veterans cope with chronic pain. Some alternatives are acupuncture, bright light therapy and medical marijuana. As part of a $21.7 million initiative with the National Institutes of Health, VA is looking for therapies that could substitute for opioids. “Our hospitals are doing some really exciting things to combat chronic pain and take care of our veterans. There are VA hospitals that are using alpha-stimulation devices to treat pain and depression,” VA Secretary Robert McDonald said. “That’s only going to continue and keep getting better. And we are getting there.” [Federal research seeks alternatives to addictive opioids for veterans in pain] In the meantime, however, veterans say they continue to bear the burden of the new restrictions on narcotic painkillers. A retired staff Army sergeant who served in Iraq, who spoke on the condition of anonymity for medical privacy reasons, said he can’t drive because of shrapnel in his femur and pelvis. He takes the bus nearly two hours for “a one-minute consult” to get his medications. He has been taking them for more than nine years and has never had an addiction problem, he said. Mike Davis, a retired Army corporal, said he shattered his left arm from the elbow to the fingertips when he fell off of a Pershing missile during maneuvers in Germany in 1979. Over the years, he has had six surgeries. After the last one, in 2003, he was prescribed opioids and said he has been on them since. Davis, who now works as a social worker in Illinois, said he feels lucky to have found a combination of painkillers that works for him. “It’s just insulting to the veteran to assume they are abusing these drugs,” said his wife, Linda Davis, who works as his personal patient advocate. “I’m fully aware that people doctor-shop, some docs overprescribe. But I think they need to realize that there’s a real difference between addiction and dependence. ”But Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing, called the new DEA rules “the single most important change that could happen. The best way to treat any disease, whether it’s Ebola or opioid addiction, is to stop creating more people with the disease.” At the same time, he said, VA needs to do far more to help veterans through the rocky transition. “Unfortunately, veterans are the victims here,” Kolodny said. “The VA created this mess by aggressively jumping onto pills as the solution. But it’s not something you can just abruptly stop.”    by Emily Wax-Thibodeaux
Veterans Can Now Receive Care from Ascension Doctors through the Veterans Choice Program  ST. LOUIS,  — Ascension, the nation’s largest nonprofit healthcare system and the world’s largest Catholic health system, announced a national partnership to provide care through the Veterans Choice Program, giving veterans the choice to receive care at Ascension locations across the country.  Now qualified U.S. veterans who face wait times in excess of 30 days at the Department of Veterans Affairs (VA) or have to travel farther than 40 miles from their home can receive care from Ascension doctors at 2,000 sites of care in 24 states and the District of Columbia.  “Ascension doctors, hospitals and clinics are humbled to be able to provide care to veterans through the Veterans Choice Program,” Anthony R. Tersigni, Ed.D., FACHE, Ascension President and Chief Executive Officer, said. “Just as veterans take an oath, our doctors are committed to providing quality care and services, particularly to those most in need.” The Veterans Access, Choice and Accountability Act of 2014 established funding to pay for healthcare services provided to veterans by private healthcare providers. Through the partnership, Ascension physicians and other caregivers are authorized to provide primary care, inpatient and outpatient specialty care, and mental health care for eligible veterans outside of VA.                                                   “As Ascension further integrates our systems of care nationwide, we are collaborating across healthcare to provide personalized, compassionate care to all, including our veterans,” Tersigni said. “We welcome veterans to visit our doctors and hospitals in their local community.”  Ascension has established a contractual agreement with TriWest Healthcare Alliance and national provider registration with Health Net Federal Services, LLC — both are federal contractors to the U.S. Department of Veterans Affairs. As Veterans Choice Program contractors, TriWest and Health Net are designated by VA to implement the Veterans Choice Program and provide eligible veterans access to care in their community when the local VA facility cannot readily provide care.  Nearly 9 million veterans received the Veterans Choice Card. Use of the card is strictly voluntary; veterans who qualify for VA healthcare can continue to receive care at a VA medical facility as they have in the past. The program will end when the allocated funds of $10 billion are used or no later than August 7, 2017.  Veterans can determine eligibility for the Veterans Choice Program at http://www.va.gov/opa/choiceact/ or by calling the number on their Choice Card, 1-866-606-8198. They can also contact the Ascension National Veterans Call Center at 1-844-623-3003, for more information about Ascension and the care we provide or for assistance scheduling an appointment with a local Ascension provider who is participating in the Veterans Choice Program.  U.S. veterans, Ascension patients and caregivers who are interested in learning more about the Veterans Choice Program are encouraged to visit www.ascension.org/veterans.  About Ascension   Ascension (www.ascension.org) is a faith-based healthcare organization dedicated to transformation through innovation across the continuum of care. As the largest non-profit health system in the U.S. and the world’s largest Catholic health system, Ascension is committed to delivering compassionate, personalized care to all, with special attention to persons living in poverty and those most vulnerable. In FY2015, Ascension provided nearly $2 billion in care of persons living in poverty and other community benefit programs. Approximately 160,000 associates and 36,000 aligned providers serve in 2,000 sites of care – including 137 hospitals and more than 30 senior living facilities – in 24 states and the District of Columbia. In addition to healthcare delivery, Ascension subsidiaries provide a variety of services and solutions including physician practice management, venture capital investing, investment management, biomedical engineering, clinical care management, information services, risk management, and contracting through Ascension’s own group purchasing organization.
ORLANDO, Fla. (AP) -- The Invictus Games closed four days of inspirational athletic performances in spectacular fashion Thursday night in Orlando. The Paralympic-style event for wounded and sick military members and veterans wrapped up with a star-studded concert including performances from Grammy-nominated hip-hop artist Flo Rida, country music group Rascal Flatts, pop star Rachel Platten, "American Idol" winner Phillip Phillips and "The Voice" Season 9 winner Jordan Smith. But the closing ceremonies belonged to the 454 participants from 14 nations who came to Disney's ESPN Wide World of Sports to compete in the name of their countries. "The competition has been fierce with performances of the highest international standard across a number of events," said Prince Harry, who created the Invictus Games to aid wounded service members and veterans from around the world. "But what inspired me was the courage to make it to the starting line, to take to the field or to dive into that pool motivated by the goal of giving it your all medal or no medal." During the Games, thousands who came in person and millions watching around world saw competition in 10 sports including wheelchair basketball, sitting volleyball, wheelchair rugby, indoor rowing, and track and field. "What an amazing night," said Dr. Jill Biden, who was part of the presidential delegation at the Invictus Games. "It's been an honor to be here with you the past couple of days. Congratulations to our competitors, all of their families and friends who have supported them on the road to Invictus. "For the past four days, the world has watched as some of the finest athletes and warriors in the world carried their countries flags in competition against others who truly understand the meaning of duty, loyalty and sacrifice," she said. "It has been a truly humbling experience for me to be a part of the Invictus Games." The Invictus Games were created by Prince Harry as a way to inspire and motivate wounded soldiers on their path to recovery. The first Invictus Games were held in London last year and the 2017 Games will be held in Toronto, which had a delegation on hand to accept the I Am flag. "Thank you to Prince Harry and Ken Fisher (chairman and CEO of the Invictus Games) for bringing the Invictus Games to the United States," Biden said. "I am so proud of all of the competitors. The spirit of the wounded warriors, the competitive drive and dedication defines what it means to be resilient."   BY TERRANCE HARRIS
NEW ORLEANS (AP) — Air Force veteran Liz Skilbeck recently got a new license plate for her vehicle that identifies it as being driven by a female veteran. Before that, the license plate just identified it as being driven by a veteran, causing people to thank her husband for his service. "It was 'Thanks for your support. What did your husband do?' And my husband didn't," Skilbeck said. Skilbeck is one of 50 female veterans coming together this weekend in a conference put together by The Mission Continues, an organization that connects veterans with public service projects. The conference aims to bring together the women — all volunteers with The Mission Continues — to share their unique experiences, inspire them with some strong role models and help them learn new skills.   "I think no matter where we are, no matter what battles we've overcome it's just good to be around strong women," Skilbeck said.   The Mission Continues has been around since 2007, but this is the first time they've had an event just for women, said Laura L'Esperance, from the organization. She said they decided to do a women-specific conference after doing a study of their programs and noticing that while women make up about 15 percent of active duty troops, they made up roughly double that share of some of the organization's programs. But in a society that often equates the military with men, she said women vets often feel invisible when they leave the service. Hopefully through this conference the women will gain a new network and new skills to prepare them for whatever challenges they face next, she said. "Men and women join the military for the same reason," she said. "But culturally their experiences in the military and after service are very different." The women come from all over the country and a range of ages, although most are post-9/11 veterans. Skilbeck joined the Air Force in early 2001 and specialized in how to dispose of explosive ordnance. She left the service in March 2005 after multiple surgeries made it impossible to continue. Skilbeck said she struggled after leaving the Air Force. Working with The Mission Continues has given her a chance to contribute to society while working alongside veterans who understand what she's been through: "That's something I really missed." The conference comes at a time of immense change for women in the military. The Defense Department this year opened up all combat jobs to women. Some generals have raised the prospect of women registering for the draft. The defense department is also pushing family-friendly proposals such as doubling the fully paid maternity leave for female service members. The conference will feature speakers like Michele Flournoy, co-founder of the Center for New America Security whose name has been mentioned as the possible first woman to head the Pentagon, and sisters Betsy Nunez and Emily Nunez Cavness who confounded a company to repurpose military waste into bags and purses. Rachel Gutierrez, who joined the Army in 2000 and deployed to Iraq from 2004 to 2005, said she's looking forward to talking with one of the featured speakers, Brig. Gen. Helen Pratt, and connecting with other women. Like Skilbeck, she's run into multiple situations where she's not recognized as a veteran — for example, going to a veterans' hospital and people assuming she's a caretaker for a male veteran. "I think for a woman veteran that can become super alienating," she said. She's helped launch two platoons — teams of volunteer veterans — in the Phoenix area. "We are over 400 veterans strong and we are absolutely not male dominated." By REBECCA SANTANA
JACKSONVILLE, N.C. (AP) — Three veterans' groups have sued the Department of Veterans Affairs over its handling of claims about contaminated water at Camp Lejeune. Multiple media outlets report the lawsuit was filed by Vietnam Veterans of America; The Few, The Proud, The Forgotten; and the Connecticut State Council of Vietnam Veterans of America. The lawsuit says between 1953 and 1987 nearly one million Marines, sailors, civilian employees and family members unknowingly "drank, cooked with, and bathed in contaminated water" at Camp Lejeune.   Henry Huntley, a public affairs specialist with the Veterans Administration, told The Daily News of Jacksonville that he was not familiar with the lawsuit and could not comment. WNCT in Greenville, North Carolina, reports the lawsuit was filed in a federal court in Connecticut with assistance from a veterans legal service team at Yale Law School. The lawsuit challenges the department's system set up to handle claims stemming from the medical problems suffered by those exposed to the water. The groups say the claim approval rate has dropped from 25 percent to 8 percent since the program started in 2012. The lawsuit says a group of 30 doctors works under the agency's Subject Matter Expert Program and the veterans groups have not been able to determine the panel's credentials and qualifications. Those suing say they are also concerned about what they see as a selective implementation of the claims review panel. "Camp Lejeune veterans are the only veterans that have been subjected to this so-called subject matter expert program," said Master Sgt. Jerry Ensminger, a retired Marine and founder of The Few, The Proud, The Forgotten. All other veterans file normal claims, but the VA has a Camp Lejeune Task Force, Ensminger said he learned this week.  
About two decades after Dee Fulcher left the Marine Corps, in which she served for nearly a dozen years, she came out as a transgender woman. “From the age of probably six I knew that I was different,” says the 54-year-old from Louisiana, who once worked on helicopter hydraulics systems. “Part of the reason I joined the service was I wanted to be the macho man everybody wanted me to be.” But now Fulcher is on another path and believes that her healthcare provider, the Department of Veterans Affairs, is holding her back because of a blanket prohibition on providing surgical care to transgender veterans, which she can’t afford out of pocket. Along with a Army veteran who identifies as a transgender man, she is one of two named individuals seeking to have that rule rewritten through a petition submitted to the Department on May 9. “When people are denied care or care is delayed, it can lead to significant psychological distress, depression and even suicide,” says Sasha Buchert, staff attorney at the Transgender Law Center. That organization, along with Lambda Legal, filed the petition on behalf of those individuals and the Transgender American Veterans Association, an organization with approximately 2,268 members around the country. Fulcher says this is about her mental well-being. “I’ve had good times here and there just like anybody else, but the majority of the time it was the unhappiness and uncertainty about who I am and not liking who I am, physically. You get sick from looking at yourself in the mirror,” she says. “Now I’ve found my answers … [but] I just feel like I’m not fully being able to be a woman.” The V.A. has not yet responded to a request for comment. In the petition, the legal team essentially makes four arguments. The first is that the V.A. already provides transition-related healthcare for transgender people, such as hormone replacement therapy and mental health services, so the ban is “arbitrary,” says Lambda Legal’s Dru Levasseur. (The V.A. issued a directive in 2011 indicating that staff must provide such care “without discrimination.”) The second is that the V.A. covers the same procedures that transgender people are seeking, such as mastectomies, for non-transgender and intersex veterans. The third, says Levasseur, is “the V.A. created this exclusion without examining any relevant data,” ignoring the “medical consensus” on the topic. On that point, the legal team has gathered materials to point to, such as a statement from the American Medical Association that “an established body of medical research demonstrates the effectiveness and medical necessity of mental health care, hormone therapy and sex reassignment surgery” in treating people with gender dysphoria. That’s not to say that every transgender person needs or wants surgery, and having had more surgery does not make someone more transgender, cautions the Transgender Law Center’s Buchert, but those procedures can be “life-saving” for those who do want them. The fourth argument is the same one that the U.S. Attorney General is making to oppose a controversial law passed in North Carolina, one that seeks to ban transgender women from the women’s room and transgender men from the men’s: that discriminating against transgender people is a form of sex discrimination, which is prohibited by the Civil Rights Act. Though there is no federal law that explicitly prohibits discrimination based on gender identity, advocates have increasingly been relying on the sex discrimination ban to win cases in federal courts and through administrative bodies like the Equal Employment Opportunity Commission. Buchert says the legal team is confident that appealing to the V.A. to rewrite this rule will work but that they’re willing to file a lawsuit if it does not. Blanket bans on surgery for transgender people, which Medicare lifted in 2014, are based on “outdated” modes of thinking, she says, such as the belief that such surgery is “experimental” or “cosmetic,” rather that a medically effective treatment for people who feel a severe incongruence between their bodies and innate sense of self. “I’m just not comfortable in my own skin,” says Gio Silva, the Army veteran named in the petition. “Since I was little kid I thought I don’t belong in this body.” Silva says he wants a mastectomy not just for transition-related reasons but also because he has large breasts that cause physical pain, a reason that non-transgender women seek such surgery. “I hurt every single day,” he says. “I did my time in the military and I was told, ‘Hey, if anything does happen, we got you. This is a brotherhood.’ And I don’t feel that.” Silva is currently living on unemployment benefits—transgender people as a demographic experience much higher rates of poverty and unemployment than the general public—so the notion of paying for such surgery himself seems impossible. The surgeries in question could cost anywhere from several thousand dollars to $50,000, but while that kind of bill can be crippling for individuals, the legal team says, several studies have found that those costs are often negligible for big insurers. And, says Levasseur, the cost of surgery is often smaller than the bills taxpayers will foot when transgender people turn to more destructive means of coping, such as substance abuse or attempting suicide. In 2013, the Department of Veterans Affairs treated more than 2,500veterans for gender dysphoria, with the exception of providing surgical care. A study by UCLA’s Williams Institute estimates that 150,000 transgender Americans have or are currently serving in the military. Though a ban on their open military service is under review, it remains in place. Fulcher says that while she opposes the ban on surgery, the V.A. has been generally very supportive of her in an upending, stressful time. She attends a support group for transgender veterans organized by the V.A., goes there for counseling and gets hormone therapy from a V.A. healthcare site. “It’s sort of funny,” she says, “that they’ll provide you all the hormones and everything else to go halfway but they won’t finish the job.” by Katy Steinmetz