NEW REGULATION FOR TBI
Talking Points for Traumatic Brain Injury

• Traumatic Brain Injury is a signature injury of Operations Enduring Freedom and Iraqi Freedom

• Nearly 30 percent of all patients with combat-related injuries seen at Walter Reed Army Medical Center from 2003 to 2005 sustained a TBI. An estimated 5.3 million Americans live with chronic disabilities associated with TBI.

• Traumatic Brain Injury is classified as Mild, Moderate or Severe based on classification at, or close to, the time of initial injury using either the Glasgow Coma Scale (GCS); length of loss of consciousness; or length of post-traumatic amnesia.

• The VA Rating Schedule for Disabilities (VASRD) evaluation criteria for TBI was based on material dating back to at least 1961.

• A Final Regulation updating the VASRD evaluation criteria for TBI will be published in the Federal Register Tuesday, September 23rd.

• The new regulation incorporates the latest scientific and medical knowledge on this subject and incorporates input received from the military services prior to publication.

• The new evaluation criteria provides for disability evaluations of 0, 10, 40, 70 or 100 percent depending on the level of severity of symptoms and residual functional loss.

• Mild TBI can be evaluated up to 40 percent for subjective complaints, alone. This replaces criteria that limited decision-makers to a 10 percent evaluation based solely on subjective complaints.

• Veterans who are currently 10 percent are not "automatically" entitled to a higher 40 percent evaluation unless the evidence supports the new evaluation as considered under the new rating schedule provisions. Therefore, if a veteran calls and thinks they deserve a higher evaluation then they should be encouraged to file a claim for increased evaluation under the new regulation. They should also be encouraged to submit any new evidence in support of their claim.

• The regulation consolidates evaluation criteria under one diagnostic code with a matrix describing cognitive impairment and subjective symptoms.

• The new regulation clarifies how to evaluate coexisting mental disorders such as depression and PTSD.

• The new regulation stipulates that a veteran may ask for a review under the new regulation, whether or not their disability has worsened since the last review. VA will review the disability rating to determine whether the veteran may be entitled to a higher rating.

• VA estimates the increased costs for the first year following introduction to be $3.6 million.

VA-NIH Study Offers Hope for Parkinson's Patients
Study Says Deep-Brain Stimulation Has Benefits

WASHINGTON (January 13, 2009) -- Electrical stimulation of the brain -- a treatment in which a pacemaker-like device sends pulses to electrodes implanted in the brain -- is riskier than drug therapy but may hold significant benefits for those with Parkinson's disease who no longer respond well to medication alone.

That is the conclusion of researchers from the Department of Veterans Affairs (VA) and National Institutes of Health (NIH) who conducted a six-year study comparing deep-brain stimulation (DBS) to medication, along with speech, physical or occupational therapy, given as needed. The results of the trial, the largest of its kind to date, appear in the January 7 Journal of the American Medical Association (JAMA).

"Deep-brain stimulation offers hope for a large number of patients with advanced Parkinson's disease who suffer from complications of long-standing medication therapy," said Secretary of Veterans Affairs Dr. James B. Peake. "This finding could mean improved quality of life for some of our patients."

The study included 255 Parkinson's patients at seven VA medical centers and six university hospitals. The VA sites were Portland, Ore., Seattle, San Francisco, Los Angeles, Houston, Richmond, Va., and Philadelphia, all members of VA's network of Parkinson's Disease Research, Education and Clinical Centers.

The JAMA article also noted VA's nationwide system of hospitals and specialized centers of excellence make the Department uniquely capable of conducting such large, multi-site trials of new therapies and medical devices. VA's patient population is especially suited for trials of treatments for chronic disease in the elderly.

Patients who took part in the study were on medication but are no longer seeing improvements in symptoms such as tremors or stiffness. Many were also developing side effects from the drugs, such as involuntary face, arm or leg movements.

Researchers followed the patients for six months, finding:
* Patients who received DBS gained an average of 4.6 hours per day of good motor control and few or no involuntary movements, compared with no gain for those on medical therapy alone;
* 71 percent of DBS patients showed significant gains in motor function, compared with only 32 percent of drug therapy patients; and
* Serious adverse side effects were nearly four times more common in the DBS group, but almost all of these effects in both groups were resolved during the six-month study. The most common side effects from DBS were infections, falls, depression, gait and balance problems, and pain.

Lead authors and study co-chairs were Frances Weaver, PhD, a researcher with the Center for Management of Complex Chronic Care at the Hines VA Hospital near Chicago, and Dr. Kenneth Follett, a neurosurgeon at the Omaha VA Medical Center and University of Nebraska. They emphasize that besides the higher likelihood of serious side effects with DBS compared with drug therapy, another drawback of the procedure is that, although it generally improves movement, it does little to help other Parkinson's symptoms such as depression, decline in mental ability, gait and balance problems, and trouble with gastrointestinal, urinary or sexual function.

"The results of the study should not be over- or under-stated," said Dr. Michael Kussman, VA's Under Secretary for Health. "Still, there are many good candidates for DBS among patients with Parkinson's disease whom we treat in VA."

The trial was sponsored by VA's Cooperative Studies Program and the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health. Additional support came from Medtronic, which makes the DBS system used in the study.

Parkinson's disease, a progressive neurological disorder, affects some 1.5 million Americans, with 50,000 new cases diagnosed annually. VA treats at least 40,000 veterans with the disorder each year. Most patients are over age 50, but some forms of the disease can strike younger adults.

VA, DOT, DOD Steer Vets toward Safe Driving
Deadly Toll from Post-Deployment Car Crashes

WASHINGTON (Jan. 12, 2009) - With motor vehicle crashes being a leading cause of deaths among combat veterans during the first years after their return home, the Department of Veterans Affairs (VA), the Department of Transportation (DOT) and the Department of Defense (DOD) are working together to reduce these accidents.

Today, Secretary of Veterans Affairs Dr. James B. Peake, Deputy Under Secretary of Defense for Installations and Environment Wayne Arny, and Acting Administrator of the National Highway Traffic Safety Administration David Kelly announced the creation of a new program designed to identify needed research involving recently returned veterans from Iraq and Afghanistan and to increase awareness of the importance of safe driving among newly-demobilized veterans.

"VA is committed to helping our returning heroes with world-class health care and educational benefits, home loans, job training and now with a specific safe-driving program," said Secretary Peake. "Together with our partners at DOT and DOD, we will be able to collect and analyze data that will be used to develop a comprehensive outreach initiative to target veterans with specific needs -- and ultimately to save lives."

Experts in transportation safety, veterans' health and medical care, and public health are identifying gaps in current knowledge and developing a strategic plan for addressing key research questions, in fields ranging from epidemiology to psychology and biomechanics.

Participants in the strategic planning process include scientists and policy officials from VA, DOT, DOD and Department of Health and Human Services, as well as non-governmental experts. The resulting strategic plan will lay out research needs and identify priorities for the initiative.

"Our returning combat veterans have already put themselves in harm's way to protect our way of life. Now it's our turn to take action," said David Kelly, Acting Administrator of the National Highway Transportation Safety Administration (NHTSA). "NHTSA can offer knowledge and expertise to address challenges such as these. Working side-by-side with the Department of Veterans Affairs, we are committed to tackling this problem and reducing the number of veterans killed and injured on our nation's roadways."

The safe-driving initiative strives to increase awareness of motor vehicle crashes among veterans and the importance of safe driving, seatbelt and helmet usage, and other measures. To reach out to veterans and their families, VA will create a national educational program using the Department's network of medical centers, community clinics, drop-in counseling centers (Vet Centers), and veterans benefits offices.

The initiative will also include outreach to mobilize national veterans service organizations; the nation's governors and state police, safety officers, and state highway safety officials; and the private sector - including employers; automobile, motorcycle and sports vehicle dealers and manufacturers; the motor vehicle insurance industry; and driving and motorcycle racing enthusiasts' organizations. NASCAR legend and safe driving advocate, Richard Petty, will also be an active partner in the initiative.

"Richard Petty Driving Experience (RPDE) is thrilled to be working with VA, DOT and DOD on such a worthwhile project to save veterans' lives," said NASCAR legend Richard Petty. "We want to bring more attention to the continuing problem of veteran drivers and their safety through our involvement. Last year alone, RPDE operated over 1,100 event days, ran almost 1 million miles on track and had a staff of professional drivers. We have the commitment, the knowledge to teach, and the infrastructure to take this initiative to many markets."

According to the Department of Transportation, motor vehicle crashes are the leading cause of death for all Americans between the ages of eight through 34. Men constitute about 70 percent of all traffic deaths. In the past decade, both deaths and injuries from motor vehicle crashes have gone down in the United States, due to increases in seat-belt use and decreases in alcohol involvement, among other factors.

Nonetheless, motor vehicle accidents remain a major concern in the military and among veterans as the greatest cause of accidental fatalities. Several studies have reported an increase in post-deployment deaths among military personnel who served in a combat zone compared to their non-deployed counterparts, who are in the military but not deployed to a war, after both the Vietnam War and the 1991 Gulf War. Preliminary evidence also indicates this is the case with veterans from the Global War on Terror.

For more information regarding the Department of Veterans Affairs and the Department of Transportation's safe driving initiative for veterans, please visit www.safedriving.va.gov .

VA Announces $22 Million for Rural Veterans
Peake: Down Payment on Expansion of Services

WASHINGTON (January 9, 2009) -- The Department of Veterans Affairs (VA)has provided $21.7 million to its regional health care systems to improve services specifically designed for veterans in rural areas.

"This special allocation is the latest down payment on VA's commitment to meet the needs of veterans living in rural areas," said Secretary of Veterans Affairs Dr. James B. Peake. "VA will take to our rural veterans the health care services they have earned."

Within the last year, VA has launched a major rural health initiative. The Department has already created a 13-member committee to advise the VA secretary on issues affecting rural veterans, opened three rural health resource centers to better understand rural health issues, rolled out four new mobile health clinics to serve 24 predominately rural counties, announced the opening of 10 new rural outreach clinics in 2009 and launched a fleet of 50 new mobile counseling centers.

The extra funding is part of a two-year VA program to improve the access and quality of health care for veterans in geographically isolated areas. The program focuses on several areas, including access to health care, providing world-class care, the use of the latest technology, recruiting and retaining a highly educated workforce and collaborating with other organizations.

More specifically, the new funds will be used to increase the number of mobile clinics, establish new outpatient clinics, expand fee-based care, explore collaborations with federal and community partners, accelerate the use of telemedicine deployment, and fund innovative pilot programs.

The new funds will be distributed according to the proportion of veterans living in rural areas within each VA regional health care system, called VISNs, for "Veterans Integrated Service Networks."

VISNs with less than 3 percent of their patients in rural areas will receive $250,000. Those with population of rural veterans between 3 percent and 6 percent will receive $1 million each. And VISNs with more than 6 percent of their veterans population in rural areas will receive $1.5 million.

Special VA Funding for Rural Health
(By VISN number and VISN Headquarters)

#1. Bedford, Mass., $1 million
#2. Rochester, N.Y., $1 million
#3. New York, N.Y., $250,000
#4. Wilmington, Del., $1 million
#5. Baltimore, Md., $250,000
#6. Durham, N.C., $1.5 million
#7. Atlanta, Ga., $1.5 million
#8. Bay Pines, Fla., $1 million
#9. Nashville, Tenn., $1.5 million
#10. Cincinnati, Ohio, $1 million
#11. Ann Arbor, Mich., $1 million
#12. Chicago, Ill., $1 million
#15. Kansas City, Mo., $1.5 million
#16. Jackson, Miss., $1.5 million
#17. Arlington, Texas, $1 million
#18. Mesa, Ariz., $1 million
#19. Denver, Colo., $1 million
#20. Vancouver, Wash., $1 million
#21. Palo Alto, Calif., $1 million
#22. Long Beach, Calif., $250,000
#23. Lincoln, Neb., $1.5 million

VA Ramps Up Job Search for Injured Vets

WASHINGTON (Dec. 30, 2008) - Thirty percent of employees of the Department of Veterans Affairs (VA) are veterans - the second highest ranking among cabinet departments after the Department of Defense -- and nearly 8 percent of VA employees are service-connected disabled veterans. But the VA intends to increase the number of disabled veterans who obtain employment in its workforce.

"I am proud of this effort," said Secretary of Veterans Affairs Dr. James B. Peake. "VA knows the true quality of our men and women, and we should be a leader in employing them."

Peake said all severely injured veterans of the wars in Iraq and Afghanistan will be contacted by VA's Veterans Employment Coordination Service to determine their interest in -- and qualifications for -- VA jobs. So far, that office has identified 2,300 severely injured veterans of those wars, of whom 600 expressed interest in VA employment.

The coordination service was established a year ago to recruit veterans into VA, especially those seriously injured in the current wars. It has nine regional coordinators working with local facility human resources offices across the country not only to reach out to potential job candidates but to ensure that local managers know about special authorities available to hire veterans. For example, qualified disabled veterans rated by the Defense Department or VA as having a 30 percent or more service-connected disability can be hired non-competitively.

"Our team is spreading the message that VA is hiring, and we want to hire disabled veterans," said Dennis O. May, director of VA's Veterans Employment Coordination Service.

VA coordinators participate in military career fairs and transition briefings, and partner with veterans organizations, the Department of Labor's Veterans Employment and Training Service, as well as VA's Vocational Rehabilitation and Employment Service, the Marine Corps' Wounded Warrior Regiment and the Army's Warrior Transition Units.

Some Veterans to See Another Travel Reimbursement Increase

WASHINGTON (Dec. 29, 2008) - Service-disabled and low-income veterans who are reimbursed for travel expenses while receiving care at Department of Veterans Affairs (VA) facilities will see an increase in their payments beginning January 9.

A recently passed law allows VA to cut the amount it must withhold from their mileage reimbursement. The deductible amount will be $3 for each one-way trip and $6 for each round trip -- with a calendar cap of $18, or six one-way trips or three round trips, whichever comes first. The previous deductible was $7.77 for a one-way trip, and $15.54 for a round trip, with a calendar cap of $46.62.

"I'm pleased that we can help veterans living far from VA facilities to access the medical and counseling help they deserve, especially in the current economic climate," said Secretary of Veterans Affairs Dr. James B. Peake. "Together with the increased mileage rate approved last month, we can further reduce the financial hardship some veterans undergo to use our superior health care."

In November, Peake announced VA's second increase in the mileage reimbursement rate during 2008, from 28.5 cents to 41.5 cents a mile.

Service-disabled and low-income veterans are eligible to be reimbursed by VA for the travel costs of receiving health care or counseling at VA facilities. Veterans traveling for Compensation and Pension examinations also qualify for mileage reimbursement. VA can waive deductibles if they cause financial hardship.

Nearly 11,000 Survivors to Receive Retroactive Payments by New Years Search for Other Eligible Survivors Continues

WASHINGTON (Dec. 24, 2008) -- The Department of Veterans Affairs (VA) has identified nearly 11,000 surviving spouses of deceased veterans who will receive a lump-sum payment before the New Year to correct an error in their VA benefits. Also documented were more than 73,000 who had been previously paid. VA officials are still tracking down eligible survivors.

"I am pleased that our task force working to correct this problem has been able to identify this first group this week," said Secretary of Veterans Affairs Dr. James B. Peake. "We understand the difference these funds can make for these surviving spouses, especially during the holiday season."

Payments will be released to these survivors on Dec. 29. The total value of the payments is about $24 million.

At issue is a 1996 federal law that makes a surviving spouse eligible to receive the veteran's VA compensation or pension benefit for the month of the veteran's death. VA failed to properly implement that law in all cases.

Most likely to have been affected by this problem are surviving spouses who never applied for VA survivors' benefits following the death of a veteran. Eligible for the payment are surviving spouses of veterans who died after Dec. 31, 1996. The Department doesn't have current addresses for many of them, which makes the process of contacting them difficult.

VA has established a special Survivor Call Center (1-800-749-8387) for spouses who believe they may be eligible for this retroactive benefit. The Call Center is open Monday through Friday from 7:00 a.m. to 7:00 p.m., Central Standard Time. Inquiries may also be submitted through the Internet at http://www.vba.va.gov/survivorsbenefit.htm.

WASHINGTON (Dec. 18, 2008) - The Department of Veterans Affairs (VA)today announced immediate actions to quickly identify and pay surviving spouses who are eligible to receive a one-time compensation or pension payment for the month of the veteran's death.

"This benefit payment is long overdue to many of our beneficiaries," said Secretary of Veterans Affairs Dr. James B. Peake. "In these difficult economic times, it is imperative that we take aggressive action to fix this situation for the families of our veterans."

Problems in VA's implementation of a change in law that was effective in 1997 resulted in some surviving spouses not receiving the veteran's compensation or pension payment for the month of death. This problem was recently brought to VA's attention by Sen. Daniel K. Akaka, chairman of the Senate Veterans' Affairs Committee.

Peake immediately directed the formation of a special task force to identify and pay the beneficiaries who never received the benefit or were inadvertently required to repay the money issued for the month of a veteran's death.

Surviving spouses most likely to be affected by this processing problem are those who never applied to VA for survivors' benefits following the death of a veteran.

The task force is in the process of reviewing VA's payment records for veterans who died after December 31, 1996, and who are survived by a spouse. The review will identify those to whom VA owes retroactive benefits for the month of the veteran's death. Current address information is being obtained for as many of these beneficiaries as possible.

VA will begin issuing retroactive payments to eligible surviving spouses at the end of this month. Payments will continue to be issued as additional unpaid beneficiaries are identified and VA is able to obtain current address information.

Because there are deceased veterans for whom VA does not have marital status information, a special Survivors' Call Center has been established for spouses who believe they may be entitled to this retroactive month-of-death benefit.

Surviving spouses are encouraged to contact the Survivors' Call Center at the toll-free telephone number, 1-800-749-8387. Call center agents will assist surviving spouses in providing VA with the information needed to determine their eligibility.

The Call Center is open Monday through Friday from 7:00 am to 7:00 pm central standard time. Inquiries may also be submitted through the Internet at http://www.vba.va.gov/survivorsbenefit.htm.

VA is aggressively changing its processing procedures to ensure this benefit is correctly paid to all surviving spouses in the future. VA's disability payment system will also be enhanced to automate the month-of-death payment for all eligible surviving spouses.

New Law Authorizes Veterans' Salutes during National Anthem
(Please also see addendum at the end of this)

WASHINGTON (Oct. 30, 2008) -- Veterans and active-duty military not in uniform can now render the military-style hand salute during the playing of the national anthem, thanks to changes in federal law that took effect this month.

"The military salute is a unique gesture of respect that marks those who have served in our nation's armed forces," said Secretary of Veterans Affairs Dr. James B. Peake. "This provision allows the application of that honor in all events involving our nation's flag."

The new provision improves upon a little known change in federal law last year that authorized veterans to render the military-style hand salute during the raising, lowering or passing of the flag, but it did not address salutes during the national anthem. Last year's provision also applied to members of the armed forces while not in uniform.

Traditionally, members of the nation's veterans service organizations have rendered the hand-salute during the national anthem and at events involving the national flag while wearing their organization's official head-gear.

The most recent change, authorizing hand-salutes during the national anthem by veterans and out-of-uniform military personnel, was sponsored by Sen. Jim Inhofe of Oklahoma, an Army veteran. It was included in the Defense Authorization Act of 2009, which President Bush signed on Oct. 14.

The earlier provision authorizing hand-salutes for veterans and out-of-uniform military personnel during the raising, lowering or passing of the flag, was contained in the National Defense Authorization Act of 2008, which took effect Jan. 28, 2008. CUSTOMS AND TRADITIONS

Date Signed: 12/17/2008
ALMAR Number: 052/08
R 161950Z Dec 08
UNCLASSIFIED//
ALMAR 052/08
MSGID/GENADMIN/CMC WASHINGTON DC CMC//
SUBJ/CUSTOMS AND TRADITIONS//
REF/A/DESC:DOC/CMC WASHINGTON DC/05MAY2003//
AMPN/REF A IS MCO P5060.20, MARINE CORPS DRILL AND CEREMONIES MANUAL.
//
GENTEXT/REMARKS/
1. THIS ALMAR REINFORCES THE IMPORTANCE OF OUR CUSTOMS AND TRADITIONS AND AMPLIFIES THE PROVISIONS OF THE REFERENCE FOR RENDERING SALUTES AND HONORS TO THE NATIONAL FLAG; THE PROPER CONDUCT OF THE MARINE CORPS BIRTHDAY CAKE CUTTING CEREMONY; AND THE PLAYING OF THE MARINES' HYMN.

2. CUSTOMS AND TRADITIONS PROVIDE A LINK TO THE PAST; THEY BOND MARINES WHO HAVE GONE BEFORE WITH MARINES WHO WILL CARRY THE TORCH THROUGH THE FUTURE. ANY LOSS OF TRADITION OR IMPROPER OBSERVATION OF CUSTOM BLURS OUR IDENTITY AND WEAKENS US AS AN INSTITUTION. THROUGH THE FAITHFUL ADHERENCE BY COMMANDERS AND EACH INDIVIDUAL MARINE, WE PRESERVE OUR IDENTITY AND REPUTATION AS A UNIQUE AND ELITE FIGHTING ORGANIZATION.

3. SALUTING. A RECENT CHANGE TO THE LAW HAS AUTHORIZED ACTIVE DUTY AND RETIRED SERVICEMEMBERS TO SALUTE THE NATIONAL COLORS, WHETHER COVERED OR UNCOVERED, INDOORS OR OUT. BY CUSTOM AND TRADITION, MARINES DO NOT RENDER THE HAND SALUTE WHEN OUT OF UNIFORM OR WHEN UNCOVERED. LET THERE BE NO CONFUSION; THAT HAS NOT CHANGED. DURING THE PLAYING OF THE NATIONAL ANTHEM, OR THE RAISING, LOWERING, OR PASSING OF THE NATIONAL FLAG, MARINES WILL CONTINUE TO FOLLOW NAVAL TRADITIONS AND THE POLICY / PROCEDURES CONTAINED IN REFERENCE (A). SPECIFICALLY, MARINES NOT IN UNIFORM WILL FACE THE FLAG, STAND AT ATTENTION, AND PLACE THE RIGHT HAND OVER THE HEART. IF COVERED, MARINES NOT IN UNIFORM WILL REMOVE THEIR HEADGEAR WITH THE RIGHT HAND AND PLACE THEIR RIGHT HAND OVER THEIR HEART. WHEN THE FLAG IS NOT PRESENT, MARINES WILL ACT IN THE SAME MANNER WHILE FACING IN THE DIRECTION OF THE MUSIC. IN CASES SUCH AS INDOOR CEREMONIES, WHEN MARINES ARE IN UNIFORM AND UNCOVERED, THEY WILL FACE THE FLAG, OR THE DIRECTION OF THE MUSIC WHEN THE FLAG IS NOT PRESENT, AND STAND AT ATTENTION.