SCI Parking Signs

by Brent Follas, Senior NSO

As you may be aware the parking area in the Kansas City, MO VAMC for veterans with Spinal Cord Injury and Dysfunction (SCI/D) in the parking lot by the Patriot Store and Physical Medicine and Rehabilitation (PM&R) does not exist anymore. The new parking spots are located across from the Freedom Tower Entrance. There are four spots and you will need a Red Placard like before. If you don’t have one then you can get one from Ann Culver, SCI/D Nurse in PM&R or Carrie Duncan, Neurology Nurse. Please display the Red Placard when you park in those spots. If you see a vehicle that does not have a Red Placard please report it to the VA Police. Some people still mistake them for regular handicapped spots and they are strictly 24 hour parking spots for veterans with SCI/D.

Also, please let your local National Service Officer know if you are having any issues with your VA Medical Care. For the past few years it appears that the spinal cord clinic has migrated to veterans with SCI/D have a regular Primary Care Doctor. I want to advise that if you have any concerns related to your SCI/D then to contact your Specialty Clinic, such as, the Spinal Cord Clinic Nurse or Social Worker or Neurology Nurse to address any specialty needs.

The Pact Act

by Rodney Harris, Senior Health and Benefits Specialist

The PACT Act is a new law that expands VA health care and benefits for Veterans exposed to burn pits, Agent Orange, and other toxic substances.

The PACT Act adds to the list of health conditions that VA will assume (or “presume”) are caused by exposure to these substances. This law helps VA provide generations of Veterans—and their survivors—with the care and benefits they’ve earned and deserve.

The PACT Act will bring these changes:

•Expands and extends eligibility for VA health care for Veterans with toxic exposures and Veterans of the Vietnam, Gulf War, and post-9/11 eras

•Adds 20+ more presumptive conditions for burn pits, Agent Orange, and other toxic exposures

•Adds more presumptive-exposure locations for Agent Orange and radiation

•Requires VA to provide a toxic exposure screening to every Veteran enrolled in VA health care

•Helps us improve research, staff education, and treatment related to toxic exposures VA has added more than 20 burn pit and other toxic exposure presumptive conditions based on the PACT Act. This change expands benefits for Gulf War era and post- 9/11 Veterans.

These cancers are now presumptive:

•Brain cancer

•Gastrointestinal cancer of any type

•Glioblastoma

•Head cancer of any type

•Kidney cancer

•Lymphatic cancer of any type

•Lymphoma of any type

•Melanoma

•Neck cancer of any type

•Pancreatic cancer

•Reproductive cancer of any type

•Respiratory (breathing-related cancer of any type

These illnesses are now presumptive:

•Asthma that was diagnosed after service

•Chronic bronchitis

•Chronic obstructive pulmonary disease (COPD)

•Chronic rhinitis

•Chronic sinusitis

•Constrictive bronchiolitis or obliterative bronchiolitis

•Emphysema

•Granulomatous disease

•Interstitial lung disease (ILD)

•Pleuritis

•Pulmonary fibrosis

•Sarcoidosis

Based on the PACT Act, VA has added 2 new Agent Orange presumptive conditions:

•High blood pressure (also called hypertension)

•Monoclonal gammopathy of undetermined significance (MGUS)

Toxic exposure screenings are available at VA health facilities across the country. Every Veteran enrolled in VA health care will receive an initial screening and a follow-up screening at least once every 5 years. Veterans who are not enrolled and who meet eligibility requirements will have an opportunity to enroll and receive the screening.

The screening will ask you if you think you were exposed to any of these hazards while serving:

•Open burn pits and other airborne hazards

•Gulf War-related exposures

•Agent Orange

•Radiation

•Camp Lejeune contaminated water exposure

•Other exposures

VA will then give you information about any benefits, registry exams, and clinical resources you may need. Ask about the screening at your next VA health care appointment. If you don’t have an upcoming appointment, or if you want to get the screening sooner, contact your local VA health facility. Ask to get screened by the toxic exposure screening navigator. Ask your local PVA service officer for assistance in filing any new claims with VA. PVA NSOs will work with you to get the benefits you are entitled to due to your exposure.

For further information go to:

https://www.va.gov/resources/the-pact-act-and-your-vabenefits/utm_source=bing&utm_medium=paid_search&utm_campaign=ar_pact_fy22_veterans

ALS Walk and Introduction of New Drug for ALS

by Brent Follas, Senior National Service Officer

I attended the ALS Walk on October 1, 2022 and joined Anthony Vicks group. He is a Member of the Gateway Chapter and he and his family are very active in spreading awareness for ALS. I see him in the KU Medical Center Clinics frequently. His wife, Karen, Father, Mother-in-Law and many of his other family and friends were there. It was a beautiful day at Kauffman Stadium and there were hundreds of signs posted from people that suffer(ed) from ALS. Some I recognized. One was a personal friend and many I represented and helped with their claims along with the survivors.

There was something else mentioned at the Walk about a new drug called Relyvrio (marketed as Albrioza in Canada). Hopefully, soon, the VA will have it on its formulary list. It was mentioned that, because of the Ice Bucket Challenge in 2014, it helped streamline the research and production of this drug due to the extraordinary monetary donations provided from the challenge.

History and Birth of Relyvrio

The U.S. Food and Drug Administration approved Relyvrio (sodium phenylbutyrate/taurursodiol) to treat patients with amyotrophic lateral sclerosis (ALS), commonly referred to as Lou Gehrig’s disease.

“This approval provides another important treatment option for ALS, a life-threatening disease that currently has no cure,” said Billy Dunn, M.D., director of the Office of Neuroscience in the FDA’s Center for Drug Evaluation and Research. “The FDA remains committed to facilitating the development of additional ALS treatments.” ALS is a rare disease that attacks and kills the nerve cells that control voluntary muscles. Voluntary muscles produce movements such as chewing, walking, breathing, and talking. ALS causes the nerves to lose the ability to activate specific muscles, which causes the muscles to become weak and leads to paralysis. ALS is a progressive disease that continues to get worse over time. Most cases will result in death from respiratory failure, usually within three to five years from when the symptoms first appear. Approximately 5,000 individuals in the United States are diagnosed with ALS annually, and approximately 20,000 Americans are currently living with the disease.

Relyvrio can be taken orally by combining one packet in 8 ounces of room temperature water. It can also be administered through a feeding tube. The recommended dosage for the first three weeks is one packet (3 grams sodium phenylbutyrate and 1-gram taurursodiol) daily. After three weeks, the dosage increases to one packet twice a day. The medication can be taken before a snack/meal.

The efficacy of Relyvrio for the treatment of ALS was demonstrated in a 24-week, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. In the trial, 137 adult patients with ALS were randomized to receive either Relyvrio or placebo. The patients treated with Relyvrio experienced a slower rate of decline on a clinical assessment of daily functioning compared to those receiving a placebo. Additionally, longer overall survival was observed in a post hoc, long-term analysis of patients who originally received Relyvrio versus those who originally received placebo. The most common adverse reactions experienced with Relyvrio were diarrhea, abdominal pain, nausea and upper respiratory tract infection. Relyvrio contains taurursodiol, a bile acid, which may cause worsening diarrhea in patients with disorders that interfere with bile acid circulation.

These patients should consider consulting with a specialist before taking Relyvrio. The prescribing information includes additional information on risks associated with Relyvrio. The FDA granted this application Priority Review designation.

It also received orphan drug designation, which provides incentives to assist and encourage the development of drugs for rare diseases. The FDA granted the approval of Relyvrio to Amylyx Pharmaceuticals Inc.

In March, the Peripheral and Central Nervous System Drugs Advisory committee concluded that the Amylyx study did not provide “substantial evidence” that its drug was effective. Then in September, during a rare second meeting to consider a drug, the panel reversed course and voted in favor of approval.

The second vote came after Dr. Billy Dunn, director of the FDA’s Office of Neuroscience, encouraged the committee to exercise “flexibility” when considering a drug that might help people facing certain death. A much larger study of Relyvrio, the Phoenix Trial, is under way. But results are more than a year off.

A negative result from that study would be a major blow to Amylyx and ALS patients.

“If you’ve got a drug that’s extending life by five months,” Rind says, “you ought to be able to show that in a larger trial.”

In the meantime, he says, perhaps Amylix should charge less for their drug.

Relyvrio (marketed as Albrioza in Canada) is the only product made by Amylyx, a company founded less than a decade ago by Joshua Cohen and Justin Klee, who attended Brown University together.

Klee defends the drug’s price, saying it will allow the company to develop even better treatments. “This is not a cure,” he says. “We need to keep investing until we cure ALS.”

Klee and Cohen have also promised that Amylyx will re-evaluate its drug based on the results of the Phoenix trial.

“If the Phoenix trial is not successful,” Klee says, “we will do what’s right for patients, which includes taking the drug voluntarily off the market.”

But that the decision would require support from the company’s investors, and its board of directors.

Neurologists and Spinal Cord Physicians should be well aware of this new drug so when it is available inside the VA, you can inquire about it and they can place a consult for Relyvrio. Reference: https://www.fda.gov/news-events/press-announcements/fda-approves-new-treatment-option-patients-als.

Purchased Home Health Care Services Procedures

by Rodney Harris, Senior Benefits Advocate

I am asked by many veterans and caregivers, what services will VA provide for care of a veteran that would like to stay in his/her own home? If a veteran is enrolled in VHA’s health care, they are eligible for a comprehensive array of medically necessary in home services as identified in the medical benefits package described under 38 CFR 17.38. VHA has shifted from an episodic treatment of illness, to a greater commitment to home and community based options for short and long term care. VHA is committed to the provisions of clinically appropriate home health care services as an important component of medical care. VHA has a long history of coordinating care across settings and payer sources to ensure health care continuity for veterans. Types of VHA purchased care include, Purchased Skilled Home Health Care (PSHC), Home and/or Home Health Aide (H/HHA), Respite Care and Palliative care (also known as Hospice).

The eligibility and determination of the need for home health services is done through a interdisciplinary assessment and the veteran is determined to have the following clinical conditions:

(a) Three or more ADL (activities of daily living) dependencies, or

(b) Significant cognitive impairment, or

(c) Require H/HHA services as adjunct care to community hospice services, or

(d) Two ADL dependencies, and two or more of the following conditions:

1. Has dependency in three or more IADLs (instrumental activities of daily living);

2. Has been recently discharged from a nursing facility, or has an upcoming nursing home discharge plan contingent on receipt of home and community-based care services;

3. Is seventy-five years old, or older;

4. Has had high use of medical services defined as three or more hospitalizations in the past year or has utilized outpatient clinics or emergency evaluation units twelve or more times in the past year;

5. Has been diagnosed with clinical depression;

6. Lives alone in the community.

When a veteran who does not strictly meet the preceding criteria and nevertheless is determined by the clinical care team to need H/HHA services, the services may be ordered, but the reason for the variance from these standards must be documented in the patient’s record. This interdisciplinary team must complete an appropriate assessment and VA Form 10-0415, Geriatrics and Extended Care (GEC) Referral. This determination of need must be completed before a veteran is referred for service. The receipt of Aid and Attendance (A&A) is not to be considered when placing veterans into home health care services.

Another question then arises “What are the costs for these programs and who pays?” Remember home health care is a covered benefit for all enrolled veterans, on par with all other medical services included in the medical benefits package. A veteran who is dually eligible for both VA care and Medicare may elect to have home care services paid for under the Medicare benefit. Veterans who choose Medicare retain their eligibility for VA care and benefits. Veterans should to be notified that VA has no authority to pay for any balances or co-payments that may be due after Medicare or any other non-VA source makes payment for care. The total monthly VHA cost of an individual veteran’s home and community-based care services, to include skilled home health care, H/HHA services, community adult day health care, and non-institutional respite services, should not exceed 65 percent of the monthly cost per patient in the nearest VA Nursing Home Care Unit (VANHCU). Processes for purchasing home health care and hospice services must be jointly developed by Acquisition and Materiel Management Services (A&MMS) and appropriate clinical staff at each VISN or VA health care facility level.

The purchasing options ensure that a broad array of home and community-based care options are accessible to veterans, and that the veteran’s preference for specific resources is considered when facilitating referrals. All VA health care facilities must integrate into their overall quality management program a system of oversight and monitoring for VA-purchased home health care services. All veterans receiving VA-purchased home health care services have their need for service reviewed at least every six months for the first year of placement and annually thereafter.

Are there waiting lists for home health care services? In some VISNs within VHA “yes”, check with your local social worker. It is current VHA policy in utilizing an electronic waiting list (EWL) of veterans in need of home health care services when budget resources are not sufficient to meet all identified home health care needs of veterans. For eligible veterans who are determined to be in need of H/HHA, VA gives priority to veterans who are in receipt of, or are in need of, nursing home care primarily for the treatment of a service-connected disability, or who have a service-connected disability rated at 50 percent or more. A waiting list process for hospice care services is not to be utilized, as VA must provide or purchase needed hospice services without delay.

So, if you are in need of home health care services and are enrolled in the VHA system of care, speak with your primary care team. They will determine your needs and get the process started, to keep you in your home or community, close to your family and friends, to get the support you need to achieve your health care goals. Your local NSO or SBA can also give you insight into these programs provided by the VA.

Interim Final Rule-Presumptive Service Connection for Rare Respiratory Cancers Due to Exposure to Fine Particulate Matter

The Department of Veterans Affairs (VA) announced the addition of nine rare respiratory cancers to the list of conditions presumed to be service-connected due to military environmental exposure to fine particulate matter.

VA determined through a focused review of scientific and medical evidence there is biological plausibility between airborne hazards, specifically particulate matter, and carcinogenesis of the respiratory tract, and that the unique circumstances of these rare cancers warrant a presumption of service connection.

Based on these findings, VA published an interim final rule establishing presumptions of service connection for several rare respiratory cancers for certain Veterans. These cancers include:

•             Squamous cell carcinoma of the larynx;

•             Squamous cell carcinoma of the trachea;

•             Adenocarcinoma of the trachea;

•             Salivary gland-type tumors of the trachea;

•             Aden squamous carcinoma of the lung;

•             Large cell carcinoma of the lung;

•             Salivary gland-type tumors of the lung;

•             Sarcomatoid carcinoma of the lung; and

•             Typical and atypical carcinoid of the lung.

The rarity and severity of these illnesses, and the reality that these conditions present a situation where it prompted us to take action. We are utilizing a new approach, one that takes all available science into account, with one goal in mind— getting today’s Veterans—and Veterans in the decades ahead—the benefits they deserve, as fast as possible. We are fulfilling our promises to provide more care, more benefits and more services to more Veterans than ever before.

VA focused its rule on the rare respiratory cancers above for Veterans who served any amount of time in the Southwest Asia theater of operations and other locations. VA invited and will consider public comments as part of this process.

VA focused its rule on the rare respiratory cancers for Veterans who served any amount of time in the Southwest Asia theater of operations and other locations. VA invited and will consider public comments as part of this process.  VA will contact impacted Veterans and survivors to inform them about potential eligibility.

https://www.regulations.gov/document/VA-2022-VBA-0014-0001

VA Foreign Medical Program

Are you, planning a trip outside of the United States anytime soon? If so, are you service connected? Do you know about the VA’s Foreign Medical Program (FMP)?

The FMP is a health benefits program for U.S. veterans who are residing or traveling abroad sand have a VA rated service connected condition/disability. VA assumes responsibility of payment for certain necessary health care services associated with treatment for those service connected disabilities or any disability associated with and held to be aggravating a service-connected condition. (Veterans living in Canada are under the jurisdiction of FMP; however, inquiries and claims must be directed to the Foreign Countries Operations in Canada.) Additionally, VA may authorize necessary foreign medical services for any condition of a Veteran participating in the VA Vocational Rehabilitation Program (38 U.S.C. 31).

How do I know if I am eligible for FMP?

The eligibility requirements are different for veterans outside the U.S. than for those within the U.S. VA may authorize foreign medical services for veterans only for a VA rated service connected condition, or a condition associated with and aggravated by a VA rated service connected disability. Disability percentage has no bearing on determining eligibility for FMP.

Should I notify FMP if I am traveling abroad?

Pre-registration for eligible Veterans is not necessary. However, Veterans who are permanently relocating to a country under the FMP Office’s jurisdiction are encouraged to notify the FMP Office upon establishing a permanent foreign mailing address (address and telephone number). At that time, arrangements will be made for FMP registration and the mailing of detailed program material. Included in the program material will be an FMP Program Guide which provides detailed information on benefit coverage and limitations, how to select health care providers and claim filing instructions. Veterans who are simply traveling abroad need not bother with notification. However, program information is available upon request. Please use VA Form 10-7959f-1 when registering with FMP.

What is/is not covered under FMP?

Unlike typical health benefit/insurance plans, where the range of benefits is standard among all enrolled beneficiaries/subscribers, FMP benefits are limited to services that are medically necessary to treat a VA-rated, service-connected disability or for a condition that is associated with and held to be aggravating a service-connected disability. Supporting medical documentation is always required. The FMP does not pre-authorize services. A copy of the medical documentation must be submitted to determine if the care was related to a service connected disability. Claims filed under the FMP should be submitted no later than 2 years from the date of services or in the case of inpatient care, within 2 years of discharge date.

Covered benefits include:

• Durable medical equipment

• Emergency services

• Hospitalization

• Skilled nursing care

• Outpatient services

• Physical therapy, when under the direct supervision of a licensed physician

• Prescription drugs (including insulin) that are FDA approved

• Emergency ambulance services to the nearest medical facility for a VA rated service connected disability

• HISA-Home Improvement and Structural Alteration grant (must be preauthorized)

There are a number of exclusions to FMP, so before relocating contact the Health Administration Center in Denver, CO. at 303-331-7950 for help. For more information visit the PC@HAC website at www.va.gov/hac or contact your local PVA NSO for assistance.

Military Environment Exposure

As part of the Veterans Benefits Administration’s (VBA) six-month campaign on Military Environmental Exposure, they are gearing up to raise awareness and encourage Veterans of all eras to file compensation claims if they believe they were exposed to hazardous materials while serving in the military.

The campaign includes one 30-second television (TV) spot and one 30-second radio Public Service Announcement that will begin airing in late January through national and local outlets across the country.

In May 2021, VA started implementing provisions of P.L. 116-283, the William M. Thornberry National Defense Authorization Act for Fiscal Year 2021 (NDAA), adding bladder cancer, hypothyroidism and Parkinsonism to the list of medical conditions presumptively associated with exposure to Agent Orange for Vietnam Veterans.

https://www.publichealth.va.gov/exposures/publications/agent-orange/agent-orange-2021/presumptions.asp

Just a few months later, VA added asthma, rhinitis and sinusitis (to include rhinosinusitis) on a presumptive basis based on particulate matter exposures during military service in Southwest Asia and other areas.

https://www.va.gov/durham-health-care/news-releases/disability-claims-for-asthma-sinusitis-rhinitis-for-veterans-who-served-in-southwest-asia/

With the addition of six exposure-related presumptive conditions over the course of the last year, VBA believes campaigns like this are critical to inform Veterans of the benefits available to them and Paralyzed Veterans of America (PVA) supports this. Therefore, we encourage to share this information and the link to watch the Public Service Announcement. The Public Service Announcement can be found and distributed by using this link:

https://www.youtube.com/watch?v=fhCi8QKb_EU.

Feel free to review the above links for Agent Orange and Southwest-Asia Exposures and contact your local National Service Office for any questions.

Veteran Readiness and Employment and other Education and Employment Opportunities

by Brent Follas, Senior NSO

You may receive Chapter 31 benefits, also known as, Veteran Readiness and Employment (VR&E) (Formerly known as Vocational Rehabilitation and Employment) services to help with job training, employment accommodations, resume development, and job seeking skills coaching. Other services may be provided to assist Veterans and Servicemembers in starting their own businesses or independent living services for those who are severely disabled and unable to work in traditional employment. VA’s Education and Career Counseling program is a great opportunity for Veterans and Servicemembers to get personalized counseling and support to help guide their career paths, ensure the most effective use of their VA benefits, and achieve their goals. If you have a service-connected disability that limits your ability to work or prevents you from working, this can help you explore employment options and address training needs. In some cases, your family members may also qualify for certain benefits.

Eligibility

You may be eligible for VR&E benefits and services if you’re a Veteran, and you meet all of the requirements listed below.

All of these must be true. You:

•Didn’t receive a dishonorable discharge, and

•Have a service-connected disability rating of at least 10% from VA

Depending on your needs and goals, services may include:

•A complete evaluation to determine your abilities, skills, and interests for employment

•Professional or vocational counseling and rehabilitation planning for employment services

•Employment services such as job training, resume development, and other work-readiness support

•Help finding and keeping a job, including the use of special employer incentives and job accommodations

•On-the-job training (OJT), apprenticeships, and non-paid work experiences

•Post-secondary training at a college, vocational, technical, or business school

•Supportive rehabilitation services including case management, counseling, and medical referrals

•Independent living services if you’re unable to work due to the severity of your disabilities

You can apply by mail, in person at a VA Regional Office or with a trained professional, such as, a Paralyzed Veterans of America, National Service Officer. Fill out an Application for Vocational Rehabilitation for Claimants with Service-Connected Disabilities (VA Form 28-1900).

After you apply, a meeting will be scheduled for you with a Vocational Rehabilitation Counselor (VRC) to find out if you have an employment handicap and if you’re eligible for VR&E benefits and services. You have an employment handicap if your service-connected disability limits your ability to prepare for, obtain, and maintain suitable employment (a job that doesn’t make your disability worse, is stable, and matches your abilities, aptitudes, and interests).

After an entitlement decision is made, you and your counselor will work together to develop a rehabilitation plan. This plan outlines the rehabilitation and other services that VR&E will provide.

If you disagree with a decision on your application for VR&E services and benefits, you can request a decision review. You can also manage any review requests or appeals you already filed.

VR&E Independent Living track

If your service-connected disability limits your ability to perform activities of daily living (like bathing, dressing, accessing the community, and interacting with others) and you can’t return to work right away, you may qualify for independent living services through the Independent Living track. You may also receive these services as you work to find a job if that’s a goal you and your Vocational Rehabilitation Counselor (VRC) have created. In both cases, your VRC can help you restore your daily-living activities.

Special Note: If you are entitled to the Specially Adaptive Housing Grant (SAH) or other housing grant you can apply for VR&E and use the Independent Living Grant together, as long as you are eligible.

All of these must be true:

•You have a serious employment handicap (SEH), and

•Your disabilities prevent you from looking for or returning to work, and

•You’re in need of services to live as independently as possible

Please note: Having an employment handicap means your service-connected disability limits your ability to prepare for, obtain, and maintain suitable employment (a job that doesn’t make your disability worse, is stable, and matches your abilities, aptitudes, and interests).

Depending on your needs, services may include:

•Evaluation and counseling to identify your needs and goals

•Referral to support resources

•Evaluation to see if you’re eligible for the VR&E home adaptation grant. This grant is part of your rehabilitation plan to improve accessibility features in your home.

•Guidance to help you understand if you’re eligible for our adaptive-housing programs. These programs can help you make changes to your home—like widening doorways or adding ramps—so you can live more independently.

These services generally last up to 24 months. In some cases, you may be able to use services for longer than this.

Veterans Career Program

Don’t forget Paralyzed Veterans of America’s Veterans Career Program, formerly known as PAVE, program which provides FREE employment support and vocational counseling assistance to ALL veterans, transitioning service members, spouses, and caregivers.

Leveraging a high-touch approach, our Employment Analysts and Vocational Rehabilitation Counselors will work with you on your path toward a meaningful career. Our team also has expertise in helping veterans overcome employment barriers and other obstacles at all stages.

Whether you need help with job search and networking strategies or with obtaining necessary accommodations at work, the Veterans Career Program is always a click or a phone call away. Go to www.pva.org or contact your local National Service Officer for more information. We are a partner for life.

Summertime Blues

by Rodney Harris, Senior Benefits Advocate

When summer roles around the relief from the “Winter Blues” is sometimes replaced by “Summertime Blues.” With the change in the weather it brings about different issues that can cause people to dread the heat and humidity of the Midwest and become depressed and isolated from friends and family. This is referred to as a Reverse Seasonal Affective Disorder or (SAD). Symptoms of Reverse (SAD) include feelings of hopelessness, irritability, loss of interest in activities, insomnia, decreased appetite and weight gain or loss.

During the summer, there are additional factors that may contribute to Reverse SAD such as:

• Changes in regular schedules as children are out of school, routines are varied, and there are disruptions in eating and sleeping patterns

• Because of the heat, people wear less clothes which can lead to body image issues

• Summer activities including camp and vacations can lead to increased financial worries

• Isolation where people tend to stay indoors to beat the heat leading to decreased socialization

• Not meeting social expectations to relax and enjoy the summer

The causes of Summertime Blues are unclear but it is thought that the extra sunlight and higher temperatures affect serotonin and melatonin levels which regulate sleep and moods. This is more prevalent in the south where the days are longer but it can be a factor anywhere during the summer months due to how each of us react to the changes in the seasons.

Treatments for Reverse (SAD) can include antidepressant medications, melatonin, and Cognitive Behavior Therapy which can be quite effective. Other helpful suggestions include exposing oneself for a few minutes to early morning sunlight, pushing yourself to go out and socialize, having consistent eating and sleeping routines, practicing meditation, yoga, and exercise, and remembering that Summertime Blues are temporary.

There are also other ways to deal with (SAD) such as:

• If you have SB, remember that it is temporary

• Plan ahead during spring so you will be prepared in the summer

• Be kind to yourself and don’t compare how you feel in the summer to others

• Expose yourself to early morning sunlight for a few minutes

• Set and maintain a consistent routine to feel more in control of goings on around you

• Plan fun events and activities to look forward to

• Keep a consistent exercise routine and regular eating and sleeping patterns

• Don’t isolate; push yourself to be around people and socialize

• If you are feeling overwhelmed, delegate tasks so you can have some “me” time

• Keep a journal of your feelings and experiences

• Pursue new interests or hobbies and volunteer for charitable work

• Practice yoga, meditation, and other relaxation activities

• Seek professional help to replace negative thoughts with positive ones

If you are feeling the lows of the summer remember to seek out treatment and remember that these symptoms are only temporary. Only you know your mind and body completely so when you are not feeling and acting like yourself ask for assistance from your VA psychologist or psychiatrist. Also reach out to your local PVA NSO for guidance to get the help you need to enjoy summer and not the blues (no knock to the St. Louis Blues). Parts of this article were taken from the Psychology Journal for reference and accuracy.

VA Debt Relief Extended

by Brent Follas, Senior National Service Officer

The Department of Veterans Affairs (VA) is extending debt relief for Veterans through September 30, 2021 due to the COVID-19 pandemic. VA will suspend collection of all Veteran benefit overpayments incurred between April 6, 2020 and September 30, 2021. No adverse actions or collection attempts will occur during this suspension period. Veteran medical care and prescription charges incurred from April 6, 2020 through September 30, 2021 will be cancelled and any payments for this time period will be refunded.

VA is committed to keeping Veterans informed about their debt and the expansive relief options available. VA may send subsequent letters providing details of the benefit debt and patient statements regarding medical care copayment debts. These letters and patient statements are for information only, unless Veterans choose to act before the suspension period ends. No adverse action will occur at this time.

WHAT WILL HAPPEN NEXT

With regards to benefit overpayments, Veterans will receive a letter from the VA Debt Management Center (DMC) showing current debt amount as well as available options. Subsequent letters will be sent showing updates to Veterans’ accounts. VA will resume mailing patient statements for medical care and prescriptions received prior to April 6, 2020 once all charges for medical care and prescriptions on and/or after April 6, 2020 are cancelled. However, no payments are required until at least October 2021.

WHAT VETERANS CAN DO NOW

For benefit overpayments, no action is required through September 30, 2021. That said, if Veterans would like to resolve debts sooner, there are options they can exercise now. VA can work with Veterans to determine what option is best.

Options include:
• Dispute the Debt
• Request a Waiver

WHOM TO CONTACT

For questions about VA benefit debt, including information on how to make voluntary repayment arrangements or for information about how to request a waiver, how to dispute a debt, or how to submit a compromise offer; call the DMC (800-827-0648) from 6:30 a.m. to 6 p.m. CT Monday through Friday. Visit https://iris.custhelp. va.gov/app/ask/ to submit your request online.

• For medical care copayment questions, please contact the Health Resource Center at (866-400-1238) from 7:00 a.m. to 7 p.m. CT Monday through Friday.
• If a Veteran’s debt was referred to the U.S. Department of the Treasury (Treasury), the debt is suspended through September 30, 2021. For questions on debts referred to Treasury, contact the Treasury Cross-Servicing Program (888-826-3127) or the Treasury Offset Program (800-304-3107).

Please follow the national and local guidelines to stay healthy and safe.

Preparation is the Key to Surviving Frigid Winter Days

by Jeremy Lile, National Service Officer II

Growing up in the Midwest, I was never a fan of all the snow and ice that comes with it. I did not see it as a beautiful winter wonderland, but more of an inconvenience accompanied with unpleasant and unsafe conditions. Then I went to Basic Training at Fort Knox (Kentucky) in January. As a result, I learned quickly that spending a lot of time out in frigid temperatures is never a good idea. Thus, implementing additional safety measures when the weather becomes dangerously cold will help us all survive the winter’s wrath.

According to the National Weather Service, more than 950 Americans died due to cold weather from 1989 to 2019. Prolonged exposure to bitterly cold conditions without proper clothing can increase the chances of frostbite and hypothermia. Practicing proper cold weather safety and understanding the warning signs can help decrease the dangers. Hypothermia (abnormally low body temperature) and frostbite (freezing of body parts) can occur when an individual is exposed to extremely cold temperatures. Symptoms of hypothermia and frostbite can vary based on age, health, diet, and amount of outdoor activity. These dangers can be avoided by practicing the following tips:

• Stay indoors as much as possible and try to minimize travel. If traveling cannot be avoided, create a vehicle emergency kit in case of accidents or becoming stranded.

• Follow the manufacturer’s instructions of any alternative-heating sources being used at home, such as space heaters. Always turn off alternative-heating sources before going to bed or leaving home.

• Take frequent breaks in a warm shelter while working outdoors. It also helps to drink warm (noncaffeinated) beverages and eat high-calorie foods during these breaks.

• Remember to never leave animals, especially pets, outside without adequate shelter.

Driving in the St, Louis area as well as in the rural areas is always an experience. Sometimes the roads are nice and clear, while other times they look as if they have not been touched. And so, if you must go out and drive somewhere, let someone know your destination, your route, and when you expect to arrive. Before leaving the house, listen to local weather reports, or call the state highway patrol for the latest road conditions. Lastly, be on the lookout for sleet, freezing rain, freezing drizzle, and dense fog, which can make driving even more hazardous.

If you know of people that have no where to go, there are warming centers all over Missouri. Here is a link that will help locate the warming centers in your area: https://www.stlouis-mo.gov/live-work/ warming-centers.cfm

As always, feel free to call your local NSO for any VA/PVA related questions.

VA Beneficiary Travel Self Service System

by Brent Follas, Senior National Service Officer

In 2020 the VA Beneficiary Travel Program offers eligible Veterans, caregivers, and other beneficiaries greater peace of mind and ease of submitting travel reimbursement claims through a new online claims reimbursement tool called the Beneficiary Travel Self Service System (BTSSS). Eligible Veterans and caregivers receive mileage reimbursement for travel to and from VA health care, or VA authorized non-VA health care. Veterans and Caregivers can submit claims and supporting documentation for reimbursement of costs incurred from use of a privately-owned vehicle (POV), common carrier, pre-approved meals and/or lodging, and other travel related expenses such as tolls, parking, and luggage. BTSSS implementation began on July 2020 and will be expanded across the country in three subsequent phases through November 2020. With deployment of BTSSS, Veterans can submit, and track beneficiary travel reimbursement claims online from a computer or mobile device 24/7, 365 days a year through the secure, AccessVA website. AccessVA can be accessed at https://access.va.gov/ accessva/, using a DS Logon Level 2 account or VA PIV card to authenticate the identity of the user. A DS Logon is an ID issued by DoD that will allows Veterans and caregivers to access many VA and DoD sites with one user username and password. BTSSS ensures timely processing and payment of travel reimbursements and reduces manual intervention and improper claim payments through automated features and it replaces the kiosk method and reduces the need for completing hard copy claim and in-person claim submissions. For questions, you can visit https://www.va.gov/ health-care/get-reimbursed-for-travel-pay/, reach out to your local VA Travel Department or the Paralyzed Veterans of America National Service Office in your area.

A New Bill Proposes to Add to the Agent Orange Exposure List - Jeremy Lile

The exposure to Agent Orange in Vietnam and coastal waters has affected countless soldiers. For many, the health-related issues did not show up until several years later. While some issues and/or illnesses have not officially been recognized, there are currently fourteen conditions the VA presumes to have been caused by Agent Orange exposure. Those current issues are Chronic B-cell Leukemia, Hodgkin’s Disease, Multiple Myeloma, Non-Hodgkin’s Lymphoma, Prostate Cancer, Respiratory Cancers, Soft Tissue Sarcomas, AL Amyloidosis, Chloracne, Diabetes Mellitus Type 2, Ischemic Heart Disease, Parkinson’s Disease, Early Onset Peripheral Neuropathy, and Porphyria Cutanea Tarda. However, there is a pending bill to amend title 38 of the United States Code. As part of the Fair Care for Vietnam Veterans Act of 2020 (S. 3444), there are four proposed additions to the Presumptive Agent Orange Conditions. The bill was introduced to the Senate as part of the 116th Congress in March of 2020. Recent reports suggest about one-third of all U.S. Senators are backing the referendum, which could add four new conditions to the present Agent Orange conditions list. The new issues being considered are Bladder Cancer, Hypothyroidism, Parkinson’s-like tremors, and Hypertension. As of July 22, the Senate passed the amendment with a vote of 94-6. According to sources, if the bill is signed into law, the provision would expand VA health care and compensation benefits to approximately 22,000 affected veterans. However, the proposal that passed the Senate did not include hypertension. Lawmakers state hypertension is common among the elderly. Plus, it could have added more than two million veterans to VA’s ever-growing list of veterans receiving compensation. The more obvious reason is due to money. By including hypertension, it would have added an estimated cost of $11.2 billion to $15.2 billion. There is no indication of when the new additions will officially become law. Once it becomes law, veterans can file an Agent Orange /Blue Water Navy claim for one of the approved issues. Proof of official diagnosis and treatment will be necessary to support a claim. As always, contact your local NSO with any questions or concerns.

VA Letters and Downloads

by Rodney Harris, Senior Benefits Advocate

I get calls all the time for a needed letter or income verification from VA for tax purposes or personal use. You can also request medical records and needed records from your service in the US military. You can easily download these needed documents at this VA website https://www.va.gov/records/ download-va-letters/.

The following is important information from the VA website:

Download VA benefit letters - To receive some benefits, Veterans need a letter proving their status. Access and download your VA Benefit Summary Letter (sometimes called a VA award letter) and other benefit letters and documents online. Please sign in to get your VA benefit letters. Try signing in with your DS Logon, My HealtheVet, or ID.me account. If you don’t have any of those accounts, you can create one.

What types of VA letters can I download using this tool? You can download a variety of VA letters that include information about your benefits and service history.

How do I download a VA letter?

Before you download your VA letter, we’ll ask you to review the address we have on file for you. This address will be listed on your letter. If this address isn’t correct, you can update it. But your letter will still be valid even with the incorrect address. Please note to download a letter, you’ll need the latest version of Adobe Reader. It’s free to download.

What if I want to download a letter or document that isn’t available from this tool?

Right now, you can only download the VA letters you see listed when you sign in.

Use these links on the website to get access to other common VA letters and documents you may be eligible for:

View and print your Post-9/11 GI Bill statement of benefits

Sign in to eBenefits to request a Certificate of Eligibility for home loan benefits

Sign in to eBenefits to request a copy of your discharge or separation papers (DD214)

What if I have trouble downloading a VA letter?

Call MyVA311 for help: 844-698-2311. If you have hearing loss, call TTY: 711. If you have any issues or concerns please contact your local PVA National Service Office. Some VA regional offices will not print these letters for you so this link will be helpful the next time you need documentation from VA.

Maintaining and Enhancing Your Mental Health and Well-Being During the Novel Coronavirus Disease (COVID-19) Outbreak

by Brent Follas, Senior National Service Officer

Taking care of your well-being, including your mental health, is essential during this time. Everyone reacts differently to stressful situations. Many people may experience stress, fear, anxiety, or feelings of depression. This is normal. There are things that you can do to manage your stress and anxiety:

•Exercise regularly, try to eat well-balanced meals, and get plenty of sleep.

•Take showers and get dressed as you would normally do during a regular day.

•Limit alcohol.

•Practice breathing exercises and/or meditation. VA has many free mental health apps for Veterans.

•Take breaks from the news (see below for tips).

•Stay connected with others while practicing social distancing (see below for tips).

•Participate in activities or hobbies that you enjoy, or learn a new one.

•Keep your current mental health appointments. VA offers both video and phone telemental health options that do not require you to go to your closest facility in-person should you have a medical concern or need to follow specific social distancing guidelines in your community.

•Learn ways to connect with VA providers using telehealth options and schedule or reschedule your appointment online. If you are requesting a new mental health appointment, please call your local VA and they will work to arrange an appointment for you. If you need same day access for mental health services, call your local VA to request this and you will be connected to care.

Also, see these great resources on managing stress and anxiety related to COVID-19:

•Moving Forward

•National Center for PTSD Guidance on Managing Stress

•CDC Guidance on COVID19 Mental Health Support

Sometimes it is wise to take breaks from watching, reading, or listening to news stories. It can be upsetting to hear about the crisis and see images repeatedly. If you feel anxious or stressed from the information, struggle to turn off the TV or log off of social media, or have trouble sleeping, you might want to limit the amount and type of news you are viewing. Try to do enjoyable activities, return to normal life as much as possible, and check for updates between breaks.

It is important to realize that during times of social distancing, it is normal to have increased feelings of loneliness, sadness, fear, or anxiety. It is imperative for everyone to stay connected. Seek support from family, friends, mentors, clergy, and those who are in similar circumstances. While face-to-face communication may be difficult, be flexible and creative using phone, email, text messaging, and video calls. Sign up or join a virtual social network that includes service members and Veterans.

Additionally, keep in touch with fellow Veterans and assist them in navigating this new environment if they are having a hard time. Teach them how to use VA Video Connect through the VA mobile app store as VA increases virtual health and mental health appointment availability. As a Veteran, you have been uniquely trained in emergency response situations. Your resilience and strength can assist others during these times. Connection can also happen when you give back to your community by sharing your expertise and support with family, friends, and neighbors through acts of kindness and volunteer opportunities which will arise.

Moreover, stay engaged with VA information as it becomes available so you can continue to maintain your health. VA's Novel Coronavirus Disease (COVID-19) webpage has the most current information and VA's Coronavirus FAQs page provides answers to many important questions. Stay connected of Coronavirus information as it becomes available by visiting the CDC's Coronavirus page. Finally, stay up-to-date on what the federal government is doing in response to the pandemic at the USA.gov page.

Remember, we are all in this together. We are struggling together; we will triumph together. As veterans, we are trained leaders and we have overcome many different obstacles, as well as, sacrificed our lives to protect our country. Although, this is an adversity unlike our generations have ever seen, we will be victorious because of our strength, resolve, passion and because, we are Americans. God bless America!

Be Kind, Be Safe and Be Healthy.

New Changes to Commissary, Exchange, and MWR Benefit Programs

For many years, access to Commissaries, Exchanges and Morale/Welfare/Recreation benefits were limited to active duty military, their families, and military retirees. As of 01/01/2020, new changes has expanded Commissary, Exchange and MWR privileges for veterans. Installation access is now granted to all service connected disabled Veterans, Purple Heart recipients, and former Prisoners of War. This benefit also includes individuals designated as the primary family caregivers of eligible veterans under the VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC).

A valid Veteran Health Identification Card must be presented to gain access to both the installation and commissary/exchange. The card must also display the veteran’s eligibility status (i.e., Purple Heart, Former POW or Service Connected). Veterans cannot be issued a VHIC without first enrolling in the VA Health Care System.

Eligible caregivers will receive an eligibility letter from VA’s Office of Community Care. If a primary family caregiver under PCAFC loses their eligibility letter, it is necessary to call 1-877- 733-7927 and request a replacement letter. You can also visit www.va.gov/health-care/familycaregiver- benefits/comprehensive-assistance for more information regarding the PCAFC.

This new access to Commissaries, Exchanges, and MWR activities is for installations in all 50 states, Washington, D.C., and the participating U.S. territories and possessions. Access at installations overseas in foreign countries is subject to status of forces agreements, international laws, and other agreements with host countries. MWR benefits include access to golf courses, bowling centers, recreational lodging, RV campgrounds, movie theaters, marinas and kennels.

Some veterans may not have a service connected disability, or meet the Purple Heart/POW criteria. And so, all honorably discharged veterans and reservists do have the opportunity to shop through the online Exchanges. The first step to gain online Exchange privileges is to verify eligibility. Go to VetVerify.org and submit a verification form. Veterans are required to submit verification of their military service. Veterans will also be asked to provide their full name, last four digits of their Social Security Number, date of birth, and a contact email.

Authorized veterans can utilize any of the four (AAFES, NEXCOM, MCX and CGX) military Exchanges. These Exchanges can be found at shopmyexchange.com, mynavyexchange.com and ShopCGX.com. Additionally, veterans can use all of the online Exchanges mentioned regardless of their branch of service. Online shopping privileges exclude the purchase of uniforms, alcohol and tobacco products.

Contact your local NSO for any questions or visit: https://www.military.com/dailynews/ 2020/01/01/your-questions-answered-new-commissary-access-vets-and-caregivers.html

Christmas Cheer - Rodney Harris

Christmas time is here again and the holiday season gatherings of family and friends begins. The hustle and bustle of shopping, fighting crowds and getting that perfect gift for someone can create undue panic and anxiety. We get so caught up in trying to make every detail perfect (or as near as possible) that we forget to relax and enjoy Christmas and what it really means. Hours of planning, shopping and wrapping comes down to the sounds of gift wrap being torn and thrown about which may only last minutes. Christmas is celebrated in many ways throughout our country and no matter how it is celebrated there are certain things that make the season brighter when you give a little of yourself to others.

Christmas cheer can be defined as “Food and Drink, especially alcoholic beverages consumed around the Christmas holiday.” We all know the feeling food and drink can bring when enjoyed during the holidays. We eat or drink too much and then we have to either nap or loosen a belt buckle a notch or two. Christmas cheer is also defined as the “Joyful and generous attitude expected of people at Christmas.” Now this definition is obvious when you watch Christmas movies on Hallmark but is it present everywhere?

You may also feel Christmas cheer when you hear your favorite Christmas song. Whether it is “Silent Night” or “Jingle Bells” we all get that feeling of the season singing along. This feeling can be described as the Christmas Spirit that fills you up with happiness and joy. This Spirit can help to remove any unhappy thoughts of the past year and replace them with hope and a brighter outlook for the New Year that approaches.

Many people will be staying in a hospital or nursing home this holiday season. Whether they are veterans or not most will miss out on sharing with family and friends. Some may have lost loved ones this year and could be struggling to hold the thoughts of them close. They will not get that hug or kiss that always makes things better for them.

So remember that Christmas time is about spreading happiness and joy to our fellow women and men. Begin by filling yourself with the Christmas Spirit (not the locally made “Spirits”) which will help you to spread the Christmas cheer to those who need it most this season. A joyful and generous attitude may just be contagious. Merry Christmas and Happy New Year!

Five Things You Need to Know about sharing your health information - Brent Follas

1. The VA MISSION Act allows VA to now share your health information with participating community care providers for your care and treatment as permitted by federal privacy laws. You do not have to take any action unless you choose not to share your health information electronically.

2. Rest assured. Your health information is safe and secure as it moves from VA to participating community care providers. VA uses a secure network called the Veterans Health Information Exchange (VHIE) to protect and easily share in real-time your health information.

3. Sharing your health information saves you time, and improves your health. By having all of your information available, your providers will have a more complete picture of your health history to better inform treatment decisions.

4. You can always opt out of sharing your information. If you don’t want to share your health information electronically, complete and return VA Form 10-10164 (Opt Out of Sharing) to the Release of Information (ROI) Office at your VA Medical Center or by mail. If a community care provider requests your records in an emergency, information will be shared even if you have opted out of sharing. Traditional paper forms of health information sharing will remain available regardless of your preference to share or not share electronically. If you opted out of sharing, but change your mind, you can opt back in and authorize VA to share your health information by completing and returning VA Form 10-10163 (Opt In for Sharing) to your ROI Office or by mail.

5. There is no deadline to submit your Form 10-10164. You can submit your Form 10-10164 at any time. If you submitted Form 10-0484 before September 30, 2019, you do NOT need to submit Form 10-10164.

Blue Water Claims Welcomes a New Wave of Claims - Jeremy Lile

Claims for service connection due to Agent Orange exposure require two things. First, a veteran must be diagnosed with one of the fourteen illnesses listed in 38 CFR 3.309 (e) – (AL Amyloidosis, Chronic B-cell Leukemias, Chloracne, Diabetes Mellitus Type 2, Hodgkin's Disease, Ischemic Heart Disease, Multiple Myeloma, Non-Hodgkin's Lymphoma, Parkinson's Disease, Peripheral Neuropathy, Early-Onset, Porphyria Cutanea Tarda, Prostate Cancer, Respiratory Cancers, and Soft Tissue Sarcomas).

Secondly, veterans must meet certain geographic service requirements. Up until this year, veterans were required to prove they set foot in Vietnam or somewhere near the Korean Demilitarized Zone. Simply flying over Vietnam does not meet the service requirement.

However, the Blue Water Navy Vietnam Veterans Act of 2019 has expanded the area of possible exposure. The new law was signed on 6/25/2019, and takes effect on 1/1/2020. Per Public Law 116-23, veterans who served aboard a vessel on the inland waterways, or on a vessel operating not more than 12 nautical miles seaward from the demarcation line of the waters of Vietnam and Cambodia may be eligible for compensation benefits.

Eligible Navy veterans must provide evidence to support that they served on a ship that was in the specified territory waters. The needed information may be found by searching Navy Deck Logs and/or Carrier Reports. The National Archives has digitized a sizable number of deck logs for Navy ships. The digitized deck logs are available on this site: https://www.archives.gov/ research/military/logbooks/navy-online. The list of ships are presented in chronological order. Each ship can be selected in order to review more in depth historical information.

The Blue Water Navy Association has also prepared a series of reports presenting information on when Aircraft Carriers entered the territorial seas off Vietnam within the required 12 nautical miles of the baseline.

For any veterans that had their claim for an Agent Orange issue previously denied can file a new claim based on the recent change in the law. If the claim gets approved, some veterans may get a retropayment back to the date when the original claim was submitted. Since the law doesn’t go into effect until 1/1/2020, any Blue Water claims submitted before that date will be held by the VA. Contact your local NSO for any questions or to file a claim.

VA Launches New Health Care options under MISSION Act - Brent Follas

The U.S. Department of Veterans Affairs (VA) launched its new and improved Veterans Community Care Program on June 6, 2019, implementing portions of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (MISSION Act), which both ends the Veterans Choice Program and establishes a new Veterans Community Care Program.

The MISSION Act will strengthen the nationwide VA Health Care System by empowering Veterans with more health care options. “The changes not only improve our ability to provide the health care Veterans need, but also when and where they need it,” said VA Secretary Robert Wilkie. “It will also put Veterans at the center of their care and offer options, including expanded telehealth and urgent care, so they can find the balance in the system that is right for them.” Under the new Veterans Community Care Program, Veterans can work with their VA health care provider or other VA staff to see if they are eligible to receive community care based on new criteria. Eligibility for community care does not require a Veteran to receive that care in the community; Veterans can still choose to have VA provide their care. Veterans may elect to receive care in the community if they meet any of the following six eligibility criteria:

1. A Veteran needs a service not available at any VA medical facility.

2.A Veteran lives in a U.S. state or territory without a full-service VA medical facility. Specifically, this would apply to Veterans living in Alaska, Hawaii, New Hampshire and the U.S. territories of Guam, American Samoa, the Northern Mariana Islands and the U.S. Virgin Islands.

3. A Veteran qualifies under the “grandfather” provision related to distance eligibility under the Veterans Choice Program.

4. VA cannot furnish care within certain designated access standards. The specific access standards are described below:

• Drive time to a specific VA medical facility

• Thirty-minute average drive time for primary care, mental health and noninstitutional extended care services.

• Sixty-minute average drive time for specialty care. Note: Drive times are calculated using geomapping software.

• Appointment wait time at a specific VA medical facility

• Twenty days from the date of request for primary care, mental health care and noninstitutional extended care services, unless the Veteran agrees to a later date in consultation with his or her VA health care provider.

• Twenty-eight days for specialty care from the date of request, unless the Veteran agrees to a later date in consultation with his or her VA health care provider.

5. The Veteran and the referring clinician agree it is in the best medical interest of the Veteran to receive community care based on defined factors.

6. VA has determined that a VA medical service line is not providing care in a manner that complies with VA’s standards for quality based on specific conditions.

In preparation for this landmark initiative, senior VA leaders will visit more than 30 VA hospitals across the country to provide in person support for the rollout.

The VA MISSION Act:

• Strengthens VA’s ability to recruit and retain clinicians.

• Authorizes “Anywhere to Anywhere” telehealth across state lines.

• Empowers Veterans with increased access to community care.

• Establishes a new urgent care benefit that eligible Veterans can access through VA’s network of urgent care providers in the community.