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WASHINGTON (AP) -- Two years after a scandal over long wait times for veterans seeking health care, the Department of Veterans Affairs still has "profound deficiencies" in delivering health care to millions of veterans, a congressional commission says in a new report. The Commission on Care says in a report to be released Wednesday that the VA delivers high-quality health care but is inconsistent from one site to the next, and problems with access remain. The panel says the VA needs to improve its service to veterans, adding that the VA's health care operations "require urgent reform. America's veterans deserve a better organized, high-performing health care system." Congress created the 12-member commission in 2014 after approving a landmark law overhauling the VA in the wake of the wait-time scandal, which also revealed that VA employees were covering up chronic delays with false paperwork and secret waiting lists. As many as 40 veterans died while awaiting care at the Phoenix VA hospital, according to an investigation by the VA's inspector general. President Barack Obama said in a statement late Tuesday that the commission's report includes a number of specific proposals that he will review closely in the coming weeks. In the meantime, "We will continue to work with veterans, Congress and our partners in the veteran advocacy community to further our ongoing transformation of the veterans' health care system," Obama said. "Our veterans deserve nothing less for their sacrifices and their service." VA Secretary Bob McDonald also hailed the report and said he was pleased to see that many of the panel's recommendations are in line with ongoing efforts to transform the VA into what McDonald calls a "veteran-centric organization." Work on that effort has been underway for two years and has resulted in increased access to health care and a better experience for veterans, McDonald said. In March, the VA set a new record for completed appointments: 5.3 million in VA hospitals and clinics, 730,000 more than in March 2014. The VA also issued twice as many authorizations for government-paid, private care than in a comparable period two years ago, McDonald said. Nearly 97 percent of appointments are now completed within 30 days of the veteran's preferred date, McDonald said, a huge improvement over past performance. But the report said the VA has a long way to go and singled out a "Choice Program," authorized by Congress to make it easier for veterans to get private care, as significantly flawed. The report recommends replacing the program with community-based delivery networks that it said should improve access, quality and cost-effectiveness. The commission also found that the long-term viability of VA health care is threatened by problems with staffing, facilities, capital needs, information systems and other problems. Rep. Jeff Miller, R-Fla., chairman of the House Veterans Affairs Committee, said the 292-page report "makes it abundantly clear that the problems plaguing Department of Veterans Affairs medical care are severe. Fixing them will require dramatic changes in how VA does business, to include expanding partnerships with community providers in order to give veterans more health care choices." BY MATTHEW DALY

WASHINGTON (AP) -- A White House campaign to help military families has hit a new milestone: All 50 states have eased the requirements for military spouses whose careers require a professional license. Michelle Obama said just three states accepted licenses from other states when she and Vice President Joe Biden's wife, Jill, launched a broader initiative in 2011 to help military families. Military spouses seek new employment every one to three years, on average, and more often than civilians, based on when their enlisted husbands or wives are deployed to new posts in a new state, the White House said Saturday in a fact sheet. About one-third of military spouses have careers that require a professional license, such as nursing or teaching. Each move often required these spouses to spend time and money getting re-licensed in their new home state for jobs they already qualified for. Mrs. Obama and Jill Biden asked the nation's governors in 2011 to act to streamline state licensing requirements for the military community. Nearly half of the states had addressed the issue by 2012, the first lady told the Military Times newspaper in an interview released Saturday. The administration then issued a report to help officials in the remaining states, she said. Despite the new milestone, Mrs. Obama said states can do even more on the issue, including having employers come up with creative solutions to offering temporary or expedited licenses to spouses. The first lady and Jill Biden marked this year's fifth anniversary of their Joining Forces initiative by announcing that more than 1.2 million veterans and military spouses had been hired. "Our military is an all-volunteer force, and we need to show our young people that serving in the military allows you to have a great career, both in and out of uniform," she told the newspaper. "So we need even more employers to step up and hire our veterans, and we need companies to provide more flexible work environments so that military spouses who are moving every few years can keep moving up the career ladder."

Newswise —  Veterans of the Gulf War are more than twice as likely to have medically unexplained symptoms known as "multisymptom illness" (MSI), compared to Iraq/Afghanistan War veterans, according to an updated research review in the July Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine (ACOEM). "Gulf War deployment continues to be strongly associated with increased MSI, affecting a considerable proportion of Gulf War veterans," write Stella M. Gwini and colleagues of Monash University, Melbourne, Australia. Multisymptom illness refers to chronic, unexplained symptoms affecting several body systems, such as fatigue, mood or cognitive (thinking) problems, and joint and muscle pain. The researchers analyzed data from seven previous studies evaluating the prevalence of MSI among veterans of the 1990-91 Gulf War as well as the Afghanistan and Iraq Wars. In addition to including some more recent, higher-quality studies, the review added an Australian study to previous data from the United States and the United Kingdom. Although estimates varied widely, MSI prevalence was substantially higher in Gulf War veterans: 26 to 65 percent, compared with 12 to 37 percent in Iraq/Afghanistan War veterans. On pooled data analysis, the odds of MSI were 2.5 times higher in Gulf War veterans versus other military groups.The odds were slightly lower in higher-quality studies. Veterans who were deployed to Iraq or Afghanistan were more likely to have MSI than nondeployed personnel—but their risk was still not as high as in deployed Gulf War veterans. The study provides "updated and more robust estimates" of the risk of MSI in Gulf War veterans, compared to other military personnel. Ms. Gwini and coauthors conclude that their results "highlight the continuing problem and magnitude of MSI in Gulf War veterans, calling for ongoing awareness of the need for timely health assessments and health care." ###

Newswise — UNLV sociology professor Georgiann Davis has racked up thousands of web hits with personal essays exploring how intersex and LGBTQ people fit into American society. Since 2008, Davis, who was born with complete androgen insensitive syndrome — meaning she has an outward female appearance, but possesses XY chromosomes — has studied how the intersex community deals with everything from the medical community to marriage to young child/parent relationships. Davis’ work has appeared in publications ranging from Ms. Magazine to the American Journal of Bioethics. She is past president of one of the largest support groups in the country for intersex people, their families, and allies. Regarding the Pentagon order allowing transgender people to openly serve in the military, she says: "Lifting this ban is symbolic more than anything else, for thousands of trans folks who have served, or are serving, in our military. It's the right move, but the masculine culture of the military may prevent trans folks affiliated with the military from comfortably and openly identifying as trans."

Newswise — Post-traumatic stress disorder (PTSD) and alcohol dependence (AD) are two of the most common and debilitating disorders diagnosed among American military veterans. AD and PTSD often occur together, and this co-occurrence has a worse prognosis than either disorder alone. Alcohol craving is related to relapse, but the relationship between PTSD symptoms, craving, and relapse is not well understood. This study is the first to explore the effects of trauma-induced and stress-induced imagery on alcohol craving, affect, and cardiovascular and cortisol responses in a laboratory setting. Researchers examined 25 veterans who had been diagnosed with AD and PTSD and were participating in a randomized treatment trial. At baseline, participants’ PTSD symptoms and drinking quantity and frequency during the three-month pretreatment period were assessed. During the session, the participants were exposed to neutral, stressful, and traumatic imagery in random order. The main outcomes included craving, anxiety, mood states, salivary cortisol, and cardiovascular responses. Both stress and trauma cues produced greater increases in craving, negative affect (anxiety, fear, anger), and cardiovascular reactivity when compared to neutral cues. Traumatic images produced significantly stronger craving for alcohol and greater cardiovascular reactivity than stressful images. Also, trauma-induced but not stress-induced craving was positively correlated with baseline levels of drinking. These findings are consistent with prior observations of a relationship between PTSD symptoms and alcohol relapse.

Less than 8 percent of veterans expelled from the military under the "don't ask, don't tell" policy have applied to upgrade their discharges to honorable or strip references to their sexual orientation from their record. In the nearly five years since the repeal of the policy that banned gays and lesbians from serving openly in the military, fewer than 1,000 people - out of the more than 13,000 people who were expelled - have sought corrections, according to data the military provided to The Associated Press. Many veterans simply don't know it's an option, said Scott Thompson, executive director of the Board for Correction of Naval Records. The boards have always existed without a lot of internal or external advertisement, he said. Veterans and the veterans' advocates agreed there's a lack of awareness but cited reasons why veterans wouldn't correct their record. They may be in jobs where they aren't affected by what the record says. Going to the board could open up old wounds. Or they may feel it's not worth the effort, or don't know where to start. For Danny Ingram, the reference to his sexual orientation on the form is a badge of honor. Ingram was given an honorable discharge from the Army in 1994 as one of the first to be expelled under "don't ask, don't tell." "I was victimized by that policy," said Ingram, of Atlanta, who is now 56. "I want that to remain so people in the future can see what was done to people, and that it was unjust." "Don't ask, don't tell" didn't require that people be dishonorably discharged. It varied case by case, but if their commanders weren't pushing for a lower category and there were no mitigating factors, such as misconduct, the service member could be given an other-than-honorable or honorable discharge. Honorably discharged veterans are entitled to benefits, such as medical care and a military burial, and can re-enlist if they meet eligibility requirements. Jeremy Brooks was given an honorable discharge from the Navy in 2007 under the policy. He re-enlisted in 2011 after the full repeal. Currently serving in the Navy Reserve, Brooks said he considered trying to change the narrative that states "homosexual admission" because of the risk of bias anytime anyone sees it. "You're handing it to them and telling them something about yourself without being able to choose when you're telling them," said Brooks, who is 39 and works in Washington, D.C. Brooks said the idea of tackling it was overwhelming. Like Ingram, he didn't want that part of history erased from his record, as if his service under "don't ask, don't tell" didn't happen, so he didn't pursue a correction. He thinks many veterans know about the process but were deeply wounded by their discharge and may be trying to forget that part of their lives. Since the 2011 repeal, the Navy has reviewed about 430 cases, including from the Marines, and upgraded slightly more than 300 of the discharges. The Army has received nearly 300 applications from soldiers discharged under "don't ask, don't tell" or its predecessor policies and granted about 200 requests. The Air Force reviewed about 150 similar cases and approved about 130 of the applications. The Coast Guard, which falls under the Department of Homeland Security, reviews far fewer cases, only eight since the repeal. Some applications were denied because there were "aggravating factors," such as misconduct. Some were incomplete. About 65 cases are pending among the boards. The Defense Department barred gays and lesbians from serving before "don't ask, don't tell." President Bill Clinton promised to lift the ban but compromised and authorized the policy in 1993. After that, they could serve but not be open about their sexual orientation, and personnel couldn't ask about it. The policy was widely criticized because thousands of people were discharged under it, and many others were forced into secrecy. A bill in Congress would streamline the paperwork for applying for a correction and codify the Defense Department policy in statute. It would require the historians of each military service to review the circumstances of the estimated 100,000 service members discharged for their sexual orientation prior to "don't ask, don't tell" to improve the historical record. Melvin Dwork was expelled from the Navy during World War II for being gay. He spent decades fighting what he called a "terrible insult" that had to be righted - a discharge characterized as "undesirable." In 2011, the Navy agreed to change it to honorable. It was believed to be the first time the Pentagon had taken such a step on behalf of a WWII since the repeal of "don't ask, don't tell." Dwork died last week at age 94.

DETROIT (AP) -- Dozens of military veterans have come to Detroit to rebuild neglected areas of the financially distressed city. It marks the latest - and largest - effort undertaken by St. Louis, Missouri-based The Mission Continues, a nonprofit that encourages and aids volunteerism by veterans to ease the post-military transition. Teams of volunteers fanned out Monday to three locations in a neighborhood on the northeast side of Detroit. At a park, Iraq and Afghanistan veteran Ben Eichel, 33, and others picked up trash and built benches. "When you're not part of something that's bigger than yourself, you lose that identity. You become isolated, and a lot of us tend to go to dark places," said Eichel, of Denver, taking a break from trying to remove a rusted-out fence. "So, The Mission Continues was there and got me involved in the community. It helped me reintegrate in civilian society effectively, because I learned that I'm not just a veteran." The Detroit deployment, which is known as Operation Motown Muster, got underway Saturday and will end Wednesday. In addition to park beautification, the volunteers will also convert a school classroom into an art gallery and clean vacant lots. "We believe very strongly that military veterans are really uniquely poised to help try to solve some of these community challenges all over the country," according to group official Mary Beth Bruggeman, who should know. She was a combat engineer with the U.S. Marines and was part of the force that invaded Iraq in 2003.

Newswise — WASHINGTON D.C.  – At the midpoint of the public comment period, professional nursing and veterans’ organizations held a press conference today to demonstrate support and highlight the need for a proposed rule by the Veterans Administration(VA) to provide veterans with direct access to Advanced Practice Registered Nurses (APRNs) practicing to the top of their education and training in VA facilities. As of June 28 at 9 a.m., more than 44,000 people had submitted comments on the proposed rule, which is by far the highest number of comments for a VA rule since online comment submission was instituted in 2006 – more than six times the total number of comments previously submitted. Over the last ten years, a combined total of 6,030 comments have been posted during more than 150 VA comment opportunities. The news conference, which was held at the National Press Club in Washington D.C., provided in-depth analysis of the proposed rule and included first-hand accounts of how it will benefit veterans and the Veterans Healthcare Administration (VHA) by increasing veterans’ access to health care provided by APRNs. The organizations that participated in the news conference included the American Association of Nurse Anesthetists (AANA), American Association of Nurse Practitioners (AANP), American Nurses Association (ANA) and the American Association of Colleges of Nursing (AACN), along with the Air Force Sergeants Association (AFSA) and the Military Officers Association of America (MOAA). “It’s time for evidence to trump politics when it comes to the health of our veterans. And there’s no evidence for the arguments of the groups opposing the rule – all baseless rhetoric,” said Juan Quintana, DNP, MHS, CRNA, president, American Association of Nurse Anesthetists, who also served in the Air Force Reserves. “Our initial review of the comments submitted thus far indicates wide-reaching support for the rule from veterans and health care providers alike - roughly two-thirds of the comments submitted - and we want to encourage others to submit comments and let their voices be heard.” “Throughout my career, I have been honored to care for this extraordinary population,” said AANP President Cindy Cooke, DNP, FNP-C, FAANP, on behalf of the 222,000 nurse practitioners in the U.S. today. “Our veterans have given so much to our nation and deserve to have us stand with them. The proposed rule is zero risk. Zero delay. And a zero cost solution to ensuring veterans have access to needed health care. We applaud the VA for taking this important action, which will immediately improve veterans’ access to care. And we are doing everything we can to support its proposal.” Dr. Cooke has provided primary care to patients for 18 years, more than 12 of those exclusively to active duty and retired military members and their families. The Department of Defense (DoD) already provides active duty personnel direct access to APRNs. Nurse anesthetists first provided healthcare to wounded soldiers on the battlefields of the American Civil War, and have been the main providers of anesthesia care on the front lines of every U.S. military conflict since World War I. CAPT (Ret) Kathryn Beasley, USN, PhD, FACHE, served alongside nurse practitioners, nurse anesthetists and other APRNs as a Navy Nurse for 30 years. She supports the proposed rule on behalf of the 390,000 members of the Military Officers Association of America. Said CAPT Beasley: “In the Navy we would never train a sailor ten skills, then limit them to using only three. It makes no sense. No one would do that. But that’s what illogical and wasteful practice limitations on highly skilled advanced practice nurses do. Our Veterans need all the skills Advanced Practice Registered Nurses can provide them.” “Health care is one of the things our veterans were promised when they raised their right hands to serve their country,” said CMSGT Robert L. Frank, USAF (ret.), chief executive officer of the Air Force Sergeants Association. “More than 80 percent of those who served in the military were enlisted, and many rely on VA healthcare to take care of them. The waiting is unacceptable. We’re excited about this rule to allow the 6,000 APRNs currently employed by the VHA to be used to their full potential. Let them serve our veterans.” Prior to becoming the CEO of the American Nurses Association, Marla J. Weston, PhD, RN, FAAN, worked at the VHA as deputy chief officer. “I personally know the value and contribution that APRNs can make to serve our country’s veterans,” said Weston. “Our veterans deserve the best care that this country can provide and that requires having APRNs practicing to the full extent of their education and training. We know that when there are not enough nurses, patient mortality goes up.” The proposed rule impacts future care of our veterans as well. Many APRNs complete clinical rotations in the VA, gaining additional exposure to the unique needs of the veteran population. “When the more than 70,000 APRN students enrolled in AACN member nursing schools enter the workforce, allowing them to practice to the full extent of their education and training will serve as a strong incentive for these highly skilled providers to seek employment at VA facilities,” said Jane M. Kirschling, PhD, RN, FAAN, dean and professor, University of Maryland School of Nursing, and director of interprofessional education, University of Maryland. More than 60 organizations support this policy change, including veterans’ groups such as the Military Officers Association of America and the Air Force Sergeants Association. The policy is also supported by AARP (whose membership includes 3.7 million veteran households), and 80 Democratic and Republican members of Congress. The public comment period on the proposed rule is currently underway and expires July 25. Comments can be submitted tohttps://www.regulations.gov/document?D=VA-2016-VHA-0011-0001. About the Veterans Access to Quality Healthcare AllianceThe Veterans Access to Quality Healthcare Alliance is an initiative of advanced practice registered nurse (APRN) organizations and others dedicated to providing and promoting the access to care Veterans need and deserve. These groups are joined in their goal of ensuring Veterans’ access to APRN services by other nursing groups, veterans’ organizations, individual veterans, patient advocacy groups, congressional leaders, and others that together represent millions of individuals and healthcare providers across the country.

SOMERSET – They were heroes for our country, and they are heroes again for New Jersey’s former service members; the seven NJHA veteran health navigators were honored Tuesday morning as winners of the Education Hero- Organization award by NJBIZ at the 10th annual Healthcare Heroes awards program. New Jersey is home to more than 428,000 veterans. For many, accessing primary and mental health care can be a great challenge. To address this, the New Jersey Hospital Association (NJHA) and several other organizations have called upon members of our veteran community to assist those who are not receiving the care they need. They served in war zones and in peacetime. They include Purple Heart recipients and PhDs. The navigators assist fellow veterans in getting the appropriate care as well as social supports, and have spent the spring touring South Jersey providing outreach at clinical screening events. In addition to linking former service members and their families to care, the navigators are also working with clinicians around the state to better inform them about the military culture and the unique challenges veterans face when seeking healthcare. “These veterans are not only educating other veterans about opportunities for better health, but they are educating our state’s healthcare systems on how to better serve those who have served us,” said NJHA President and CEO Betsy Ryan. The navigators are: * Francis “Bud” Funk, of Edgewater Park, Marine Corps; * Norman F. “Norm” Glover, Jr., of East Windsor, Army; * Vernon Hall, PhD, of Asbury Park, Army; * Michael Mimms, EdD, of Sicklerville, Marine Corps; * Edward “Ed” Sadowski, of Winslow Township, Army; * Don Sanford, of Pennsauken, Air Force; and * Jaye Silver, PhD, of Pennsauken, Air Force. Their work is funded by grants from the New Jersey Department of Health, United Health Foundation and the Centers for Medicare and Medicaid Services’ Hospital Engagement Network. NJHA first engaged with the veteran community through the Affordable Care Act; unemployed veterans were hired to help screen and enroll uninsured persons for the Health Insurance Marketplace or Medicaid. The success of the collaboration led to the three additional grant programs using veteran navigators to improve access to appropriate care. More information on the veteran navigators program is available on Facebook, at www.Facebook.com/ServingThoseWhoServed.

DENVER (AP) -- Fort Logan National Cemetery honored 30 veterans whose remains have gone unclaimed with a funeral ceremony Saturday in Denver, including veterans' whose cremated remains were left at funeral homes and others who had no next of kin. Maj. Gen. H. Michael Edwards, the service's guest speaker, said remains also may go unclaimed because families forgot about them, or don't know their relatives are eligible for a military burial. "In my mind, (they're) almost MIA, because they just sat there," Edwards said. "Each of them has a story. I only wish we knew their full story." A crowd of about 80 people showed up. The names of the dead were read, followed by the rank, branch and war in which they served, going back as far as World War II. Service members located the veterans' urns on a table and declare them "present," and a bell would ring, the Denver Post reported (http://tinyurl.com/zjq9fws ). The remains were marked with engraved marble plates. Stan Paprocki, president of Chapter 1071 of the Vietnam Veterans Association, said it took the chapter more than a year to assemble the remains for the service. He said the U.S. Department of Veterans Affairs helped identify the remains. Paprocki said another 36 veterans would be honored at another service in two months. The ceremony was part of the Missing In America Project, a national nonprofit that works with veterans groups to inter unclaimed veterans' remains. Jose Gonzales, a 67-year-old Vietnam veteran, said it took him a long time to heal after he returned home. After several decades, Gonzales started to go to memorial services for veterans. "I (hadn't) attended before because it took some 40 years to break out of that shell and honor the vets," Gonzales said. "It's healing to the soul, you know."