When Your Doctor Joins a New Practice – Consumer Reports

For most people, including fellow military retirees, veterans and their families, healthcare is second only to our income, in importance. While this blog has offered insight into military retirement (pay) issues, there are questions a beneficiary or family member may have about healthcare. The Reserve or Guard member, and family may be covered by one plan, if still serving in the military, another once that member reaches “gray-area retiree” status, and a third option once the member reaches 60 years of age. And then, at full retirement (Social Security/ Medicare-eligible) age, yet another healthcare transition occurs. For many who are employed after military service, they likely have a private -or public (government) employer offering a subsidized healthcare option. Often the most straightforward approach is to visit a website, which may then require a call to the physician’s office, which may be directed to the health group switchboard, and then to a department versed in many questions a beneficiary might have. At times, that approach may not be satisfactorily answered, so second website visit (https://tricare.mil), which may then lead to a call to the Tricare manager, which for West Coast residents is https//www.tricare-west.com (Humana Federal services) .

With all the changes nationally to healthcare in the last dozen years, it is prudent to be aware of how your healthcare may change. What, if anything, may interrupt your health maintenance, prescriptions, treatments or attending physicians when your doctor joins a new practice? This is my first question of the year, as my “primary care manager” went from private practice, to a new group practice. Read here about questions you should have for your physician and insurer, and be prepared for any, or more likely inevitable, interruption in your care plan.

The information in the linked post, was published by Orly Avitzur, M.D., in the February 10, 2017 online Consumer Reports

A new year and re-commitment time

The First of January is a great time to assess my contributions to a blog devoted to things of interest to veterans and their families. I want to publish more sea-stories; however, to be a resource for military families and veterans I need, or rather, I must provide better content in 2020.

patience only goes so far when a veteran wants what was earned

For many veterans, myself counted among them, hold a cynical attitude of the amount of support that the State and Federal Government actively provides to veterans. Some of that is deserved due to standards of individual personnel hired to serve the veteran population, volume of work relying on undermanned office staff, and incompetence. However, the remedy for delays and ineffective support to veterans – customers and taxpayers – is an informed – and resolute veteran seeking redress. In my own situation, five months in determined pursuit of Navy retirement pay once eligible to receive it (a full year after initially applying) resulted in receiving up to date payment. This took letters to elected representatives, waiting hours on hold to speak to pay clerks, making visits to offices, and bringing in social media attention. The “squeaky wheel”, or irritable retired Senior Chief, gets the grease.

some benefits you may not know

Some of the benefits that veterans have now:

Perks offered by public companies

Some of this information comes via Military Times and Military OneSource, with links to the originating Government agency or other. -ed.

Ask the Chief: getting help with substance abuse

As a veteran, retired Navy Senior Chief, parent, and member of my church community, I have seen friends, shipmates, comrades-in-arms, and family members struggle with mental illness and substance abuse. While the social ignorance and stigma Post-Traumatic Stress sufferers once faced is fading, the number of veterans suffering PTSD, TBI (Traumatic Brain Injury), and ailments from exposure to toxics in the combat theater is a huge problem. In addition, every other condition that veterans encounter from financial issues, divorce, job losses and health problems exacerbated by their service, can compound depression, feelings of isolation and a tendency to substance abuse. Even with a support network of friends, pastoral counseling, and veterans community organizations, professional help in the form of treatment centers and follow-up care, is available for those who are ready to be helped.

One potential source of professional help is found in south Florida. The Recovery Village (844-359-9732) offers a full range of behavioral health treatment and support, for veterans as well as the civilian community. From their website, the following are their core beliefs:

  1. Anyone can recover from addiction
  2. Each client deserves respect and compassion
  3. Addiction is a disease that deserves evidence-based care backed by research
  4. The physical and mental causes of addiction should be addressed simultaneously
  5. Recovery is a lifelong journey that requires daily commitment

Additional information on addiction, substance abuse, questions and help a veteran’s friends and family may wish to provide can be found here.

NOTE: This information is provided without regard to the suitability or efficacy of the programs offered through Advanced Recovery Systems, floridarehab.com or drugrehab.com. No compensation was offered nor sought in providing these resources to veterans or the public through this blog.

Ask the Chief

“veteran” is gender-neutral

Some of my closest shipmates, friends, and mentors are female Sailors, officer and enlisted. Many, like me, are no longer on Drilling Reserve nor on Active Duty. Some have retired after long and distinguished military careers. Some have continued to support fellow veterans with active engagement with organizations such as Honor Flight. Some I served with are successful attorneys, realtors, and teachers. Some are corporate executives, software engineers, and human resource managers. Relatives who formerly served in the Marine Corps and others beginning careers serving in submarines.

Many of my peers in the years since the Gulf War served in war zones. Thirty-seven thousand female military served in the Gulf War, where many served in roles that exposed them to Scud attack and IEDs. Five female soldiers were killed in enemy action and two were taken prisoner. Since then, nearly a thousand female military members have been injured (843) or killed by hostile action from the USS COLE bombing in Yemen, to wars in Afghanistan and Iraq. [At the time of this writing, a female Chief Cryptologist, a linguist, was killed along with two other military members and one DOD civilian in a terrorist bombing in a Syrian town.] Women actually have been in combat, have come under fire, been injured and have been killed serving in the US military since the Revolutionary War. History documents that women disguised themselves as men in order to serve since the Revolution, in the Civil War, and until physical exams were instituted in the early 1900s. Nurses were recruited before the First World War.

Beginning in 1979, women graduated from the military academies. In 1994, female midshipmen augmented the male crew of a Spruance-class destroyer, the USS PETERSON, several summers while I was aboard. Since 9/11 I have known females serving year tours in Afghanistan and Iraq, providing intelligence, communications, logistics, and medical support. However, beginning in 1993, women began serving as combat pilots and flying sorties over Iraq. In 2013, Defense Secretary Panetta lifted the ban on women serving in combat roles. The impact of female veterans serving in increasing numbers and in more front-line occupations will increase the need for physical and mental health services, more VA female providers as well as gender-specific services. One statistic indicated that the number of female service members has quadrupled in the forty years since 1973. By the end of the first decade of the new Millennium, female veterans grew to 10 percent of the veteran population.

But the bureaucracy is slow to react. As recently as 2016, veterans seeking care at VA facilities reported being mistaken for caregivers, spouses, or questioned their veteran status. Additionally, in contrast with employer-provided health plans, the VFW survey reports respondents found the VA required co-pays for preventative-care prescriptions including contraceptives.

veterans helping veterans

In a recent program, “Returning the Favor”, Mike Rowe whom many may recognize from “Dirty Jobs” fame, featured a male Iraq War veteran who runs a gym in Austin Texas, and through Make a Vet Sweat helps fellow veterans overcome Post-Traumatic Stress Disorder through exercise. It was in the course of the show, one of the female veterans served discussed her career-ending injury resulting in her own PTSD. Since the Gulf War time, I have known that female servicemembers have been in combat, risking death and injury, from hostile fire, IEDs, and terrorist attacks just as their male servicemembers have. The availability of creative therapies for working through mental health issues helps each sufferer, whether it is animals, exercise, or outreach. And may help many veterans avoid prescription drug addictions.

veteran suicide has no gender

According to statistics compiled by the Veterans Administration, of veterans who attempt suicide, the numbers of female veterans were increasing from 14 per 100,000 in 2001 to 17 per 100,000 population by 2014. This may be due the increasing number of female service members since 2001. Studies report that suicide rate decreased between 2001 and 2014 for female veterans receiving mental health services. While in the overall population, male suicide is three times greater than female, men more often use firearms while females tend to poison or overdose. In a VA fact sheet published in August 2017, female veterans who reported military sexual trauma or harassment were more likely to commit suicide than other female veterans. And overall, female veterans are more likely to commit suicide than civilian women.

marriage and divorce

Compared to civilian women, female veterans were more likely to be married while in the service, and at younger ages than their counterparts. Thirty percent of female military members were likely to be married between ages of 17 and 24, while eight percent of civilian women were. And the same veteran age group was more likely to be divorced compared to civilian women. In 2015, a study found that female veterans of all ages were more likely to be divorced than civilians, but civilians were more likely to have been divorced more than once.

healthcare and homelessness

The VFW has considerable resources and political clout engaged in support of female veterans. They commissioned a survey, from December 2015 to January 2016, with 2000 validated Active Duty, Reservist, retiree and vet respondents, on issues and challenges for women veterans. The survey found that the Veterans Administration needs to hire female healthcare providers to treat female veterans unique concerns. Lacking the personnel, the majority of the female veterans reported they were not given an option to request the gender of their VA healthcare provider.

The survey also sought information on female veteran homelessness. Four percent (72) of the respondents reported being homeless, and of these, 46 percent reported living in another person’s home (‘couch surfing’). Seventy percent of the homeless veterans had children; a third of them reported having children impacted their ability to receive care at a VA facility.

education and employment

Since the end of the Second World War, female veterans, who made up less than 9 percent of all veterans, like their civilian counterparts, who had worked in the defense industries during the war, were less likely than male veterans to use the GI Bill, or did not pursue college education due to social pressure (women in the home instead of the workplace). Studies in 2015 on the educational level and employment of female veterans indicates that they obtain a Bachelors or higher degree later in life than civilian women, are more likely to work in management, professional and technical occupations (49 versus 41 percent), and more work for local, state or federal agencies than their civilian counterparts. Twenty-nine percent of veterans work in sales or office occupations compared to thirty percent of non-veteran women. [statistics from: report, National Center for Veteran Analysis and Statistics, February, 2017, see va.gov/vetdata]

veteran groups

To inform veterans of their benefits, aid them with specific needs affecting them, provide networking for employment and business opportunities, and lobby on their behalf with lawmakers, service-providers, and the public, there are several organizations. One of the largest organizations specifically focused on women veterans is the Women’s Veteran Alliance. This national organization holds regional employment workshops, networking ‘mix and mingles’, conferences, and opportunities for businesses looking to hire veterans. See their link for female veteran “allies” (referrals and local organizations) More information is available on their Facebook page.

Since 1970, the National Veterans Foundation, its founder “Shad” Meshad, a Vietnam veteran, has been meeting the needs of veterans with mental health counseling, with three hundred offices across the country. Staffed by veterans of all periods – Vietnam, Cold War, Iraq and Afghanistan, they provide counseling and referral. All of these are located away from VA hospitals. (The reputation of VA hospitals in the last couple decades particularly among Vietnam veterans has suffered negative exposure, “new management” and political promises to fix internal problems). NVF’s counseling programs particularly with Post Traumatic Stress, according to their information webpage, were called upon after the attack on the World Trade Center in New York after September 11, 2001.

States each have their own Department of Veteran Affairs. In California, CALVET has a resource page for female veterans, from housing assistance, advocacy to employment and health. CALVET also provides resources for groups and agencies to provide support to the veteran.

The Veterans Administration has a directory of female-veteran service organizations here

FB make a vet sweat

Hollywood needs military vets

Transitioning from Active Duty? Like television and the movies, but wish the military-theme was more real-life? Have a skill and want to get into the high-tech industry?

When a friend, one-time co-worker, and fellow Navy Reservist told me of his experience acting, with minor parts in television and film, I was interested. He said Hollywood needs military veterans to consult and to help lend realism to the shows and movies. One of my favorite actors, R Lee Ermy did do that pretty well.

But what about off-camera? How do you find technical work with the studios, animators, and creative genius that create spectacular visual effects? I imagine that one way is through the active and popular employment search engines and services online. And there are apparently at least one organization that support and recruit veterans for many functions in Hollywood and the industry.

If anyone knows others, is member of, or would like to be featured, contact me. It would be fascinating to learn more about careers and opportunities for transitioning military and experienced veterans.

Mesothelioma-affected veterans

The Mesothelioma Center provides the following information for veterans and their families to get educated and find support for veterans affected by mesothelioma. Thanks to Samatha Litten of the Public Outreach Department of the Mesothelioma Center for providing this information:

Countless veterans are currently suffering from life-threatening illnesses that are a result of exposure to asbestos, a material that was commonly used in hundreds of military applications, products, and ships because of its resistance to fire. Veterans who have been diagnosed with mesothelioma even qualify for special benefits from the U.S Department of Veteran Affairs.

We recently published an educational guide about mesothelioma prognosis:

Combat-era vet support

Veteran Service Organizations

World War II

  1.   http://www.benefits.va.gov/persona/veteran-world_war_ii.asp

Any Era

Wartime Veterans’ Pension and Survivor’s Pension

Wartime veteran’s pension

ask the Chief

disability compensation questions

Becoming an expert in any specialty in the military takes time.  The nature of military assignments is such that individuals transfer and often take that expertise with them!   This is particularly aggravating in the specialties that relate to service members career and health administration.  Because the military is a large bureaucracy, with volumes of policies, regulations and procedures for virtually everything,  obtaining answers to specific situations is very difficult. 

military service and service-connected disabilities

 If you are on Active Duty getting close to your EAOS, a veteran with health issues possibly connected to your military service, or transitioning or enlisting in the Reserve as a veteran of Active Duty, you may find the following example from actual experience helpful.  This example is from a family member, a former soldier, who in the last year and a half of his Active Duty enlistment was plagued with shin splints, and an injury that incurred during training in a military culture that treats infirmity as a lack of physical and mental toughness. In most respects an excellent soldier, medical complications and the command climate influenced him to not consider re-enlisting.

From the author’s experience, the process of post-enlistment transition is much improved since the 1990s. The Army referred the soldier for transitional job training, and recommended him for a re-enlistment eligible discharge at his End of Active Obligated Service (EAOS). But there is some ambiguity in that transition. Whether assumptions made or questions went unasked, the service member knew that an initial enlistment contract in the military was a commitment to eight years of total service. Three, four or six years of an Active Duty service and the balance served in the Active or Inactive component of the Reserve. But it is apparent that the soldier was not aware that inactive or IRR service was the default to serve out the balance of the contract. In an inactive status, the service member does not drill nor receive compensation, but annually is only required to inform the military of any changes in status or address.

evaluation by the VA for disabilities

However, as part of the soldier’s transitional assistance he was recommended to go to the Veterans Administration off-post to be evaluated for the medical conditions resulting from, or aggravated by, military service. Once processed out of the Army and possessing a DD214, the official record of military service for veterans, the Veterans Administration determines he has a service-connected disability.    Further,  the severity of the disability finding is such that the veteran receives a 100 percent rating and compensation for injuries and illness sustained while in the military service.   

Can a disabled veteran still serve?

There are different categories of service-connected disability, and either the service branch or the Veterans Administration may determine a disability exists. Unless the member or his command requests a Medical Review Board prior to the service member’s discharge, and the service branch makes a determination, the veteran can go to the Veterans Administration for a medical evaluation. Either may result in a finding of service-connected disability which may be eligible for compensation.

the DD214 is key to benefits and reenlistment

There is no prohibition on its face, for a veteran receiving compensation from the VA for a disability to reenlist in the Reserve component. For the military branch, the re-enlistment code on the DD214  is the clearest indicator of eligibility. Getting a clear answer from the military service representative is difficult. As any veteran can attest, expertise is a rare commodity. Rumor, half-answers and lack of knowledge dominates. The individual affected or a specialist, like a service-organization (VFW, DAV, or AL) representative, may find the answers more readily.

Unless a veteran is in receipt of a classification of 100 percent disability / unemployable, a veteran receiving compensation for 100 percent disability, may serve in the Active Reserve, unless the Reserve determines that the member needs to be medically evaluated and screened for enlistment. This apparently can become, unintentionally,  bureaucratically cumbersome, where the member cannot receive military pay and a VA compensation. Suspending ones compensation, or a finding by the military branch that the members disability rating is less than what the VA has determined, can be confusing at best.   

U.S. military veterans of past conflicts have the same opportunity to receive care and compensation for disabilities incurred or aggravated by military service. While some medical and service records have been damaged or lost from a several decades-old fire (1973) at the national archive when records were stored on paper, most veterans have access to records that assist them when requesting benefits. Current policies evaluate a list of symptoms, dates and locations stationed with compensation – or medical-treatment- eligible illnesses.

Even a finding by the Veterans’ Administration of a Service-Connected Disability, rated at 0 (Zero) Percent, allows the veteran to obtain benefits for herself or her family. It can be reviewed and re-evaluated based on additional evidence, including civilian medical records documenting conditions a physician attests to military service. Many times, a veteran has received benefits that retroactively are granted back to the period of the veteran’s discharge.

If there is one piece of advice that any service member or veteran should heed, it is to get evaluated. Physical and emotional ailments can be treated before they cause further disabilities. Suicide among veterans, homelessness, PTSD, and drug addiction are among the most severe problems affecting men and women who

no substitute for becoming informed

Visiting or becoming a member of a veterans’ service organization is the best source for information to support a veteran of the armed forces. (Spouses can also become auxiliary members of these organizations.) The Veterans of Foreign Wars (VFW), American Legion and the Disabled American Veterans (DAV) are the most well-known. Vietnam veterans and Iraq-Afghanistan veterans have service organizations as well. They have expertise, first-hand experience and the resources to assist veterans with claims to the VA and benefits the veteran may be unaware of. And personally becoming educated is no less important. The following links are reference material to support obtaining a medical discharge,  supporting a veteran’s request to change military status and official records (DD214), and understanding the policies and options for a veteran. The veteran in this example is still working through the bureaucracy, though VA compensation has continued uninterrupted.

Guide to Obtaining a Medical Discharge (unofficial)

Medical Evaluation Board (PowerPoint)

Requesting a change to your military discharge (DD214)

Family Support: Dealing with Anxiety, Depression, Addiction, PTSD

“Before you can break out of prison, you must realize you are locked up.”  – www.healthyplace.com

Everyone is affected by a terminal condition called “life”.   In every family, there are emotional or physical Illnesses that affect one member – the sufferer – yet also affect others – spouses or partners, parents, children, or siblings.   To a lesser degree, friends, co-workers, or neighbors may also be affected.   Disease and genetic disorders like  Lyme disease, asthma, Parkinson’s, muscular dystrophy or cancer are chronic conditions and are lifelong disabilities physically but emotional disorders, many linked to genetic predispositions, traumatic physical events or lifestyle choices can can radically change the family dynamics no less permanently.

In most cases, there is no preparation. no schooling or a “recommended reading list” in one’s formative years, for family members when a loved one has a mental illness like anorexia, depression, bipolar or anxiety disorders like agoraphobia.  These can also accompany or be elevated by an addiction to alcohol, prescription drugs, or other substances.  A casual relationship may not reveal the extent of a sufferer’s condition.   But in a long-term relationship, marriage or one with frequent connection or intimacy, between spouses, or parents and children,  clues early in a person’s life may exist.  Of course, everyone experiences an illness, accident, depression or difficult circumstances that are temporary.  It takes long-term observation to note patterns that may indicate unhealthy behavior.

When a participant (an active observer, or even a co-dependent personality type) is not a professionally-trained counselor, experience, level of empathy and often spiritual foundation are the only tools available.  Behavior that later manifests in addiction,  mania and depression mood swings,  obsessive-compulsive activity, hyperactivity, sleeplessness or its opposite, and emotional disconnection may be subtle at first or have sudden onset.   With PTSD,  post-traumatic stress disorder, a life event such as death of child, a combat experience, a severe accident, sexual assault or abuse can severely damage a formerly healthy individual and ripple emotionally through a family. Triggering events may be a tone of voice, a certain time, a season, a smell, sounds or a characteristic that one person displays.   For someone in a relationship with another who experienced a traumatic event -even years in the past – “walking on eggshells” becomes normal.  Often in hindsight to a failed relationship, injury or death of the sufferer, particularly when a victim was unwilling or unable to seek help, guilt may emotionally affect those in the victim’s circle for years.   Yet PTSD is not a terminal condition, but requires compassion, professional treatment, cooperation, and ongoing engagement on the part of the sufferer and her close personal relationships.

For many, when it is a close family member, in late adolescence or early adulthood, it is a natural response to think the behavior  including addiction, is just a “phase” he or she is “going through”.   From the outside looking in,  the addict, when rational and sober, seems to be functioning individual – but it is a ruse.   Some are able to hold a job for a time.  They may frequently change jobs due to work stress or the addiction’s toll on a person’s performance.  It is a natural self-defense mechanism or social response for people not to ‘get involved’,  or to overlook indicators, but these are not compassionate responses of family and close friends.   However, an addict can also mask his or her  problems by being outgoing but shallow, and very reserved (personal details) to coworkers, family members or others in his or her circle of acquaintances.  One sort of behavior that may be due to embarrassment,  or pride is a need  to appear to be “holding it together”.   Limited engagement,  that is,  keeping visits short with family and family friends at holidays or other gatherings.

When the sufferer is an adult, who arguably is not a “danger to themselves or others”, there is little one can do more than to suggest, advise, or urge the sufferer to seek professional help.  The longer the addiction continues, the more the addict does damage to themselves physically and emotionally.   Hospitalization and treatment of the symptoms may give the addict an opportunity to be sober for a short time.

Treating the problem – the addiction – without a sustained, professional program to treat the emotions or physical underpinnings, is a temporary measure.   In the meantime,  the family and close friends have to endure their own emotional pain to partner in their loved one’s recovery.   For some,  replacing the destructive addiction with a positive one particularly through physical activity can be successful when partnered with professional counseling.  It may well be a lifelong activity. A new ‘normal’.

For those who are willing to consider a spiritual component to ongoing wellness,  study of the Bible offers examples of successful lives though suffering from illness, depression or anxieties.  The Bible offers hope in illustrations of several figures who suffered from depression.  King David is lauded as one of the most devout leaders in the Old Testament, but his Psalms are full of outpouring his anxieties, fears, troubles, and anger to God.

11 Why, my soul, are you downcast?
    Why so disturbed within me?
Put your hope in God,
    for I will yet praise him,
    my Savior and my God  – Psalm 42:11

Elijah, one of the greatest prophets in the Old Testament is another.  In 1 Kings 19:4

while he himself went a day’s journey into the wilderness. He came to a broom bush,(A) sat down under it and prayed that he might die. “I have had enough, Lord,” he said. “Take my life;(B) I am no better than my ancestors.”

the passage illustrates his depression.  Job also battled depression.  Examples:  Job 3: 26

26 I have no peace,(A) no quietness;
    I have no rest,(B) but only turmoil

and Job 10: 1:

“I loathe my very life;(A)
    therefore I will give free rein to my complaint
    and speak out in the bitterness of my soul.

While these figures went on to have great impact in the Bible and to adherents for thousands of years, there is no indication that they were freed from the emotional and physical ailments that people still endure today.

One of those who has been successful in ongoing recovery from anorexia, BeautyBeyondBones, offers her personal experience and resources that are instructive for eating disorders and other communities who are seeking support with emotional and physical disorders.

In the following article, there are some good tips for families dealing with the various demons affecting their loved ones.   But it is only a starting point.

Family Support: Dealing with Anxiety, Depression, Addiction, PTSD