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The United States is more likely to use force in a military dispute when the president is a Southerner, according to a new study coauthored by a Yale political scientist.
The study, published this month in the journal World Politics, argues that “Southern honor” — an ethical code that emphasizes a reputation for resolve — pervasively shapes Southern presidents’ approach to disputes with other nations, making those presidents less willing than their peers from northern states to back down during international disputes. Consequently, Southern presidents have been more likely to use military force, resist withdrawal, and ultimately achieve victory, the study finds.
“Our study provides evidence that a president’s concern for reputation directly influences how they approach international conflicts,” said Allan Dafoe, an assistant professor of political science at Yale and coauthor of the study. “It is something for voters to consider when they go to the polls in the fall — how a candidate’s worldview could affect decisions regarding the use of force.”
Dafoe and his coauthor, Devin Caughey '04, assistant professor of political science at MIT, analyzed the behavior of U.S. presidents during international conflicts from 1816 to 2010 that involved either the threat of force, a show of force, or the use of force.
Their analysis shows that when militarized disputes occurred under Southern presidents, they were twice as likely to result in the use of force, lasted on average twice as long, and were three times as likely to result in an American victory.
“Our findings are consistent with Southerners being more concerned with demonstrating a reputation for resolve,” said Dafoe. “They provide evidence of the powerful influence that concern for reputation has on international conflicts.”
The dataset includes 36 presidents and 215 disputes between the United States and another country, as well as 296 disputes between multiple countries in which the United States was an originator of the conflict. Presidents were labeled as “Southern” if they were born and raised in the South, or were either born or raised in the South and had spent their pre-presidential political career there. Eleven of the 36 presidents in the study met these criteria: James Madison, James Monroe, Andrew Jackson, John Tyler, James Polk, Andrew Johnson, Woodrow Wilson, Lyndon Johnson, Jimmy Carter, Bill Clinton, and George W. Bush.
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University of Chicago Booth School of Business alumnus Eric Gleacher has made a $10 million gift to his alma mater to fund a groundbreaking scholarship program for U.S. veterans seeking a Chicago Booth MBA.
The Gleacher Veteran Scholars Fund will provide a permanent source of scholarship support to help veterans bridge the gap between the benefits they have earned from the government and the remaining costs associated with receiving their MBA degrees from Booth.
The number of veteran students in Booth’s programs has increased substantially over the past several years, and currently, there are 78 veterans enrolled.
“My experience in the Marine Corps gave me a boost in self-confidence, and my Booth education gave me direction, helping me decide which area of business I wanted to pursue,” Gleacher said.
“It was a winning combination, and I want to make it possible for those who have served our country to have the same opportunity.”
Booth has built a reputation for providing veteran support through participation in the Yellow Ribbon Program, a voluntary program that allows universities to enter into an agreement with the U.S. Department of Veterans Affairs to fund tuition and fee expenses that exceed the established thresholds under the Post 9/11 GI Bill.
The Gleacher Veteran Scholars Fund will serve as a permanent source of scholarship support, allowing Booth to sustain and expand its financial support for veterans.
“Military veterans bring a great deal to the Chicago Booth community in terms of their experience, commitment to service, and maturity. I’m delighted we have significantly increased the number of veterans in our programs,” said Sunil Kumar, Booth Dean and George Pratt Shultz Professor of Operations Management. “Eric’s gift will make pursuing an MBA at Booth significantly more affordable for many of these veterans, and thus will have a substantially positive impact on the Booth community as a whole.”
After completing his undergraduate work at Northwestern University in 1962, Gleacher served as an infantry officer in the U.S. Marine Corps for three years prior to earning his MBA at Booth in 1967.
Gleacher joined Lehman Brothers in 1968 in New York. He became a partner in 1973 and founded the firm's mergers and acquisitions business. He went on to head the mergers and acquisitions practice at Morgan Stanley, where he played a pivotal role in some of the highest-profile business deals of the 1980s: Revlon, Texaco, Union Carbide, and RJR Nabisco, among others. With others, Gleacher is credited with creating the business of merger advice.
In 1990, he founded Gleacher and Company, a successful mergers and acquisition boutique which he ran and developed until 2009 when he sold it and retired as CEO.
“The Marines taught me a great deal about leadership, which is crucial to the success of every business,” Gleacher said. “Most veterans have learned those same leadership skills, which can be successfully applied in a variety of business contexts. A Booth MBA can inspire veteran students as future business leaders, preparing them for successful careers as entrepreneurs and executives in major companies.”
In 1996, Gleacher gave $15 million to Booth to help finance its downtown Chicago riverfront Gleacher Center, which houses Booth’s evening and weekend programs, as well as its North American executive program.
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Veterans’ access to timely, quality healthcare was the focus of a rally held today on the west lawn of the U.S. Capitol by approximately 500 nurse anesthetists from around the country.
Certified Registered Nurse Anesthetists (CRNAs) have been outspoken in their support of a plan proposed by the Veterans Health Administration (VHA) to expand veterans’ access to healthcare by allowing advanced practice registered nurses (APRNs), including CRNAs, to practice to the full extent of their education and licensure. The policy, recommended by a major Independent Assessment of the VHA as well as by the Institute of Medicine and already in place in America’s military and Indian health systems, would help eliminate the dangerous wait times for needed care that America’s veterans currently endure.
By updating its regulations to include APRN/CRNA full practice authority, the VHA will make use of an already existing workforce that ensures veterans have access to essential surgical, obstetric, emergency, and pain management healthcare services without needless restrictions or having to travel long distances for care.“Because more veterans need care today, long wait times for appointments or procedures—sometimes a month or more just to receive basic health services—are the unacceptable norm veterans routinely encounter,” says American Association of Nurse Anesthetists (AANA) President Juan Quintana, DNP, MHS, CRNA. “Delays are not justified after these honorable men and women have already put their lives on the line while serving our country.”
This was the second year in a row that CRNAs and student registered nurse anesthetists have rallied on Capitol Hill in support of patient care improvements. The rally was organized by the AANA, which represents more than 49,000 nurse anesthetists nationwide. More than 6,000 APRNs, including 900 CRNAs, work in VHA facilities across the country.
In addition, the AANA’s National Health Leadership Award was presented during the rally, honoring Senators Jeff Merkley (D-OR) and Mike Rounds (R-SD). Merkley and Rounds are co-sponsors of Senate legislation (S. 2279) which expands veterans' access to care by supporting APRN full practice authority in VHA facilities. Both senators spoke at the rally.
Also speaking were AANA President Quintana; President-elect Cheryl Nimmo, DNP, MSHSA, CRNA; and AANA Senior Director of Federal Government Affairs, Frank Purcell, BS.
Caring for America’s active-duty and reserve military personnel, as well as military veterans, has long been a hallmark of the nursing community at large, and nurse anesthetists in particular. Nurses first gave anesthesia to wounded soldiers on the battlefields of the American Civil War, predating physician anesthesiologists by decades.
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Prescription opioid abuse and a nationwide heroin epidemic are claiming the lives of tens of thousands of Americans each year. To help address this problem in addition to supporting our service members who may struggle with prescription misuse associated with chronic pain, the F. Edward Hebert School of Medicine at the Uniformed Services University of the Health Sciences (USU) has implemented a new pain management curriculum – the first medical school in the nation to do so.
Focusing on standardized pain care practices, USU’s extensive pain management curriculum teaches clinical pain assessment, pain assessment tools, pharmacologic and psychological approaches to pain management, and behavioral management of chronic pain. It also highlights evidence-based alternative modalities for chronic pain management, and pain as it relates to specific pain conditions, and substance use disorder.
USU is the first medical school to fully incorporate each of the elements included in the Joint Pain Education Program (JPEP), set forth by the USU Defense & Veterans Center for Integrative Pain Management (DVCIPM). Committed to training providers, and building a new model of pain care, the JPEP is a collaborative effort between the Department of Defense and Department of Veterans Affairs to standardize pain management curriculum.
“The Joint Pain Education Program integrated into the USU curriculum follows more than five years of close work with the Veterans Administration and Federal and civilian pain experts through the USU Defense & Veterans Center for Integrated Pain Management (DVCIPM),” said retired Army Col. (Dr.) Chester “Trip” Buckenmaier, DVCIPM program director. “We are very proud of this work and immensely pleased that our own university is the first adopter of this valuable program.”
To continue optimizing care for warriors and their families, USU will also require its students to take some form of prescriber education beginning in fall 2016, in order to graduate, in line with the newly released Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain.
As outlined by President Barak Obama through the CDC, USU’s new pain management curriculum stresses non-drug solutions first and non-opioid drugs when pharmacological supplementation is needed, said retired Army Lt. Gen. (Dr.) Eric Schoomaker, professor and vice-chair for Leadership, Centers and Programs, Department of Military and Emergency Medicine, USU.
“The root of our national opioid problem is poorly managed chronic pain,” Schoomaker added. “Proactive pain education is a major step forward for USU and the Military Health System. It educates new uniformed health professionals about a team-focused, multi-professional and multi-modal approach to pain management that places the patient at the center of the plan.”
Newswise —
Among military veterans identifying as transgender, 90 percent have at least one mental health diagnosis, such as posttraumatic stress disorder (PTSD) or depression, and nearly 50 percent had a hospitalization after a suicide attempt or suicidal thoughts. These study findings, from a single veterans’ hospital, will be presented Friday at The Endocrine Society’s 98th annual meeting in Boston.
“As more of our active military returns from deployment and transitions to veteran status, the health care system will be faced with treating more transgender veterans who have mental health issues,” said principal investigator Marissa Grotzke, MD, an endocrinologist at Salt Lake City Veterans Affairs Medical Center (VAMC), Salt Lake City.
Compared with the general U.S. population, the military and its veterans have a fourfold higher rate of gender dysphoria, according to Grotzke. Formerly called gender identity disorder, gender dysphoria is substantial distress associated with nonconformity to one’s assigned sex.
Patients with gender dysphoria have unique health care concerns, Grotzke said. In general, they have high rates of depression, anxiety and suicidal thoughts. Past research also has shown high rates of mental health disorders in military veterans, including PTSD and depression. Less is known, however, about the mental health of veterans with gender dysphoria, she noted.
By examining medical records at Salt Lake City VAMC between January 1, 2014, and October 1, 2015, Grotzke and her colleagues found 39 patients who had a diagnosis of gender dysphoria. Eight transgender patients identified as transitioning from female to male, and the other 39 as male-to-female. They included both combat and noncombat veterans and ranged in age from 21 to 68 years.
The researchers then searched the medical records for mental health conditions that coexisted with the gender dysphoria. They found that PTSD was the most commonly identified mental health diagnosis, affecting 46 percent of these veterans, followed by depression in 41 percent. Tobacco use disorder reportedly occurred in one-third, and anxiety was present in 15 percent. Nine patients (23 percent) had other substance abuse, bipolar disorder or schizotypal personality disorder.
Eighteen patients (46 percent) carried two or more mental health diagnoses, according to the researchers. Only four patients (10 percent) with gender dysphoria had no additional mental health problem.
“These findings highlight the need to improve the quality of care for our transgender veterans,” Grotzke said.
To address these concerns, the Salt Lake City VAMC formed a multidisciplinary gender dysphoria team composed of an endocrinologist, mental health professional, pharmacist, speech therapist and vocational rehabilitation providers. Team members meet together twice a month to discuss patients and treatment plans, which Grotzke said already has been “very beneficial” for patients.
Probably multiple reasons exist for the increased rates of mental health disorders they observed in transgender veterans. Grotzke said that traumatic brain injuries sustained in combat, military sexual abuse, and stigma related to gender struggles are common in this population.
Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.
Newswise —
A study in military veterans finds that explosive blast-related concussions frequently result in hormone changes leading to problems such as sleep disturbances, fatigue, depression and poor quality of life. The research, to be presented Saturday at the Endocrine Society’s 98th annual meeting in Boston, evaluated hormone levels in 41 male veterans who had been deployed to Iraq or Afghanistan.
“Some of these hormone deficiencies, which mimic some symptoms of post-traumatic stress disorder, may be treated successfully with hormone replacement if correctly diagnosed,” said the study’s leader, Charles Wilkinson, PhD, a researcher with the Veterans Affairs (VA) Puget Sound Health Care System, Seattle.
Wilkinson wants to raise awareness of this hormonal problem in light of the high frequency of head injuries from improvised explosive devices in modern warfare. Concussion, also called mild traumatic brain injury (TBI), represents 80 percent of TBI diagnoses among U.S. military service members, according to government estimates in 2010.
“Although studies in civilians indicate a 25 to 50 percent prevalence of hormonal deficiencies resulting from brain injuries, surprisingly there are limited data on their prevalence and symptoms in military veterans,” Wilkinson said.
In this Department of Veterans Affairs-funded study, the researchers took blood samples from 27 veterans with one or more blast concussions sustained at least one year earlier and from 14 previously deployed veterans with no history of blast exposure. They measured 11 hormones in the blood related to the pituitary systems. The pituitary gland, located at the base of the brain, is called the master gland because it affects almost all parts of the body.
They found that 12, or 44 percent, of blast-concussed veterans had irregular hormone levels indicating an underactive pituitary gland—also known as hypopituitarism. In contrast, only one (7 percent) of the 14 study participants without blast injuries had abnormal hormone levels, he said.
To try to relate specific hormone problems with particular symptoms, the researchers administered questionnaires and tests about sleep, fatigue, depression, social isolation, memory, PTSD and quality of life.
Wilkinson said he was surprised that on every test, participants who had mild TBI and hypopituitarism had more problems than did participants with mild TBI but no hypopituitarism and those with no blast exposure. Veterans with mild TBI with hormonal abnormalities had significantly poorer overall sleep quality, more depressive symptoms and were more easily fatigued than were veterans with mild TBI and normal hormone levels, he noted.
“The value of screening for hormonal abnormalities after concussions, particularly in the presence of chronic symptoms, is currently a matter of debate,” Wilkinson said. “Yet, if the possibility of hormone deficiencies in our veterans is not considered, appropriate treatment may not occur.”
Co-author Elizabeth Colasurdo from VA Puget Sound Health Care will present the study results.
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The Institute for Veterans and Military Families (IVMF) announced it received a $450,000 grant from Sam’s Club to support women veteran entrepreneurs through its business management training program V-WISE, Veteran Women Igniting the Spirit of Entrepreneurship.
The Sam’s Club grant helps IVMF to launch the first V-WISE Alumni Chapters in key regions around the nation, in addition to hosting the inaugural V-WISE Graduate Conference. The conference will bring more than 300 V-WISE program graduates together to further cultivate their professional network and learn key business concepts required to take their ventures to the next level.
The grant comes at a critical time for women veterans who face employment challenges in today’s economy. While the U.S. Bureau of Labor Statistics reports improvements to the job market, the unemployment rates of female post-9/11 veterans is worsening, increasing from 4.4 percent in March to 7.8 percent in April. Nonetheless, women veterans are interested in business opportunities. A study by Waldman Associates and REDA International found that nearly 27 percent of female veterans were interested in starting or purchasing a business.
In recognition of the unique challenges female veteran and military spouse entrepreneurs face, the IVMF launched the V-WISE program in cooperation with the U.S. Small Business Administration. The V-WISE program is tailored to help this distinguished population navigate the complexities of business ownership. The success of the program hinges on the strong entrepreneurial skillset inherent in female veterans and military spouses – strong self-efficacy, a high need for achievement, comfort with autonomy and uncertainty, and effective decision-making in the face of dynamic environments. In June, the program will embark on its 10th iteration, growing its graduate population to nearly 1,500 female veterans.
“In developing the graduate level training program, we know that business ownership is not something that happens at a moment in time, but evolves over time,” said IVMF Founder and Executive Director J. Michael Haynie, “V-WISE graduates are at a critical time in their entrepreneurial journey. Now is the time to help these female veterans build and activate a network of business owners and mentors that spans the nation.”
The support from Sam’s Club allows IVMF to offer the V-WISE conference at no in-house expense to program graduates, with all lodging and food cost covered. In addition, the launch of the V-WISE Alumni Chapters will help the IVMF further its local strategy and formalize organic meetings of graduates. This combined effort will support the long-term sustainability of the ventures launched by V-WISE graduates.
“We are pleased to support all women- and veteran-owned small businesses and entrepreneurs, and to expand the distinguished V-WISE network that helps female veterans grow and prosper,” said Jason Kidd, senior vice president of Sam’s Club South Division. “Sam’s Club welcomes V-WISE alumnae to San Antonio this November and encourages new alumnae chapters to engage Sam’s Club for further small business training, savings and community support.”
About Sam's Club
Sam's Club, the nation's eighth largest retailer and a leading U.S. membership club, offers savings and surprises to millions of members in 635 U.S. club locations and at SamsClub.com. The Sam's Club Giving Program, established by the Walmart Foundation in 2008, is dedicated to micro- and small business prosperity and committed to investing $32 million over the next five years to U.S. programs dedicated to improved training, education and increased access to capital for small business owners. For more information on national or local giving, visit SamsClub.com/giving.
About the Institute for Veterans and Military Families at Syracuse University
The IVMF is the first interdisciplinary national institute in higher education focused on the social, economic, education and policy issues impacting veterans and their families post-service. Through our focus on veteran-facing programming, research and policy, employment and employer support, and community engagement, the institute provides in-depth analysis of the challenges facing the veteran community captures best practices and serves as a forum to facilitate new partnerships and strong relationships between the individuals and organizations committed to making a difference for veterans and military families.
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Military Officers Association of America (MOAA) and the Institute for Veterans and Military Families at Syracuse University (IVMF) announce the results of a national study focused on military spouse employment.
A major finding was 90% of responding female spouses of active duty service members report being underemployed, meaning they possess more formal education/experience than needed at their current or most recent position. Additionally, the 2012 American Community Survey (ACS) data show military spouses make an average of 38% less total personal income and are 30% more likely to be unemployed than civilian counterparts.
“The results of the Military Spouse Employment Survey demonstrate a need for concerted efforts to improve the employment issues currently faced by military spouses,” MOAA President Vice Adm. Norb Ryan said.
“This critical research effort examined the range of economic impacts facing military spouses as a result of Permanent Change of Station (PCS) moves, licensure constraints, and lack of career enhancing opportunities which come as a result of their spouse’s service,” said IVMF Director of Research, Rosalinda Maury. “Through this project and our partnership with MOAA, we hope that this work will inform the national discussion, helping to create new programs, policies and initiatives that provide resources which will help this community to overcome challenges they face in the pursuit of economic empowerment. The results of this study demonstrate that these challenges are significant and pervasive.”
While ACS data consistently show noticeable gaps in income and unemployment between armed forces spouses and their civilian counterparts, this survey discovered there is not a lack of desire to work that is causing these gaps; over 55% of respondents indicated they “need” to work, while 90% indicated they “want” to work. However, active duty military spouses are more likely to have moved within states, across states, and abroad, compared to their civilian and veteran counterparts. The increased likelihood of moving from one geographic location to another further compounds economic issues for these families. According to survey results, other factors affecting their unemployment or underemployment include relocating to geographic locations with limited employment opportunities, employer perceptions of military spouses, inability to match skills and education to jobs, inflexible work schedules and high childcare costs.
Other study highlights:
• In 2012, 18-24 year-old Armed Forces female spouses had the highest unemployment rates at 30 percent (which is almost three times higher than their civilian counterparts at 11 percent). 25-44 year-old Armed Forces female spouses had the second highest unemployment rates at 15 percent (almost three times higher than their civilian counterparts at 6 percent).
• Over 50% of respondents indicated their chosen career field requires licensing or certification and 73% requires renewal/reissuing after a PCS move, costing an average of $223.03.
• Respondents reported being underemployed with respect to education (33%), experience (10%), or both (47%).
• Income significantly differs based on educational attainment and whether the military spouse is working in their preferred career field.
These and other findings, including recommendations to address the issues of military spouse employment are detailed in a summary report entitled, “The Military Spouse Employment Report”. Infographic highlights of the report findings can be found here.
“MOAA is very honored to be able to present statistically reliable and informative data about military spouse employment that will help provide the basis for future decision and policy making regarding the well-being of military families,” MOAA President Vice Adm. Norb Ryan said
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The fact that many veterans ultimately leave their initial post-military job is well known, but the reasons behind this attrition and the ways employers can best increase retention have yet to be quantified. In order to gather the necessary data, VetAdvisor® and the Institute for Veterans and Military Families at Syracuse University (IVMF) today launched a nationwide Veterans Job Retention Survey.
The Veterans Job Retention Survey focuses on determining the reasons why veterans leave their initial post-military jobs. Because this data has not been previously captured, the survey will provide insight into how organizations can best structure their veteran-centric employee programs. All interested veterans and service members are encouraged to participate in the survey.
“Better understanding the causes for veteran attrition, and programs and policies that can improve retention, aligns with the mission of IVMF,” states James Schmeling, IVMF Managing Director and Co-Founder. “Our goal is to develop employment-focused programs in collaboration with industry, government, NGOs and the veteran community, to address the primary economic and public policy concerns of our nation’s servicemen and women such as employee retention and career development.”
The IVMF is committed to forging enduring partnerships with stakeholders like VetAdvisor® that are committed to supporting transitioning service members, veterans and their families. “We’re thrilled to partner with the IVMF in conducting this nationwide survey of veterans and employers,” says VetAdvisor® CEO Dan Frank. “Developing programs in support of veteran employees is crucial both for organizations interested in retaining the talent they have invested in recruiting, but also for enhancing the career development paths of veterans entering the workforce.”
The Veterans Retention Work Survey is part of a continuing effort by VetAdvisor® to develop programs to support veterans as they transition to civilian life. As part of its though leadership in the reintegration issues faced by veterans, VetAdvisor® partnered with the Johns Hopkins School of Medicine in 2012 to conduct the National Veteran Sleep Survey in order to better understand the underlying causes of and possible treatments for veteran sleep disorders.
The Veterans Job Retention Work Survey will be conducted online at www.retainingvets.org with a goal of recruiting 5,000 participants.
Credit Newswise —
The U.S. Senate has approved legislation that will improve the delivery of benefits to America's veterans, bringing them one step closer to gaining further access to the essential services provided by doctors of chiropractic (DCs) at major Department of Veterans Affairs (VA) medical centers. S. 1203, the 21st Century Veterans Benefits Delivery Act, passed under unanimous consent and has been referred to the U.S. House of Representatives, where it awaits action. Section 102 of the Act, titled "Expansion of Provision of Chiropractic Care and Services to Veterans," calls for the chiropractic benefit to be carried out at a minimum of two additional medical centers or clinics per Veterans Integrated Service Network (VISN) no later than two years after enactment of the bill, with the program being implemented at no less than 50 percent of all medical centers in each VISN within three years of enactment. There are nearly 160 VA treatment facilities nationwide. Currently, DCs serve at 66 treatment facilities across the country. Especially important to note in the bill is the further integration of chiropractic services available to veterans, which was broadened to include services provided by DCs under the Preventive Health Services and Medical categories in addition to the existing coverage area of Rehabilitative Services, placing DCs in service categories previously closed to them. "For the past several years, veterans have enjoyed only limited access to the essential services provided by doctors of chiropractic throughout the VISN," said American Chiropractic Association (ACA) President Anthony Hamm, DC. "ACA has worked closely with our congressional allies, such as Sens. jerry Moran and Richard Blumenthal, on behalf of our nation's heroes and in support of this important bill." "I am especially proud that the member institutions that comprise the Association of Chiropractic Colleges (ACC) will play a pivotal role in preparing the next generation of DCs to serve our military veterans throughout the United States and overseas," said David O'Bryon, JD, CAE, ACC president. "It is important for us to assist with veterans care."The provision comes after a VA report published in June 2015, stated that more than 61 percent of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans who sought health care from the VA over a 13-year period were treated for musculoskeletal ailments.
Sen. Moran (R-Kansas), a senior member of the Senate VA Committee, and Sen. Blumenthal (D-Conn.), ranking member of the committee, championed this provision, after introducing S. 398, the "Chiropractic Care Available to all Veterans Act of 2015," from which the pro-chiropractic provisions of the recently passed legislation were derived. Sens. Moran and Blumenthal have been strong supporters of further integrating the essential services provided by DCs to veterans and worked closely with ACA in securing support for this provision in the Senate.ACA believes that the inclusion of services provided by DCs in the VA health care system will speed the recovery of many veterans, especially those returning from operations in Iraq and Afghanistan. The services provided by DCs have been proven to be a cost-effective and beneficial treatment option. In fact, a 2010 study published in Clinical Rehabilitation found that spinal manipulation provided better short- and long-term functional improvement and more pain relief in follow-up assessments than other physiotherapy interventions. Furthermore, a 2003 study published in the medical journal Spine found that manual manipulation provides better short-term relief of chronic spinal pain than a variety of medications.Prior to congressional intervention over a dozen years ago, no DCs served on the staff of any VA treatment facility. The availability of chiropractic care for eligible veterans was limited to VA "referrals" to DCs serving in private practice outside the VA system. Such referrals were so rare that chiropractic care was essentially non-existent within the VA system.