Warrior Care Webhall

The Military Health System will host a Web town hall on Nov. 19 from 2 to 4 p.m. Eastern time on www.health.mil as part of the ongoing dialog between senior military leaders and service members and their families about the Defense Department’s medical care programs and services for its wounded, ill and injured troops.
 
Providing care to wounded, ill, and injured service members is a top priority of the Defense Department and MHS. Senior Defense leaders are committed to ensuring service members, families and care providers are continually informed about the latest transformation of warrior care news and improvement of services.
 
“We want to share with service members and their families about the progress we’ve made to find solutions that work,” said. Dr. S. Ward Casscells, assistant secretary of defense for Health Affairs.  “We want to hear from you directly, so please join us online on November 19.”
 
The online event will feature a live Web discussion with senior leadership and subject matter experts on warrior and family and veterans issues. It will provide participants with the opportunity to interact with an array of service members and families who have been touched by warrior care. 
 
Town hall participants may submit questions starting today (Nov. 14) and throughout the live program on Nov. 19. Send your questions to mhswebcontent@tma.osd.mil. Click here to obtain instructions on how to participate in the event. For privacy reasons, we ask that participants limit discussions to broad issues and lessons learned, and to not disclose personal information. When possible, service members should contact their chain of command to resolve issues.
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Comments (66)
SSG Sharon Collins at 2008-11-14 19:04:14 wrote:

Why is it so hard to get a truthful answer about what is going on for the Reserve and Guard in regards to the MEB? You get a different answer from every person instead of them admitting they don't know the answer because they don't understand or know they rules concerning the Reserve and Guard. It seems all we get is lip service.
COL Jimmie Keenan at 2008-11-19 14:27:29 wrote:

There is only one Medical Evaluation Board process. Active Component, ARNG and USAR soldiers are treated equally by the Medical Evaluation Board and the MEB process is the same for all three components. I encourage you to work closely with your PEBLO and MEB physician in the MEB process. They are the two most experienced personnel in the process.
Sharon Collins at 2008-11-14 19:08:23 wrote:

If healing is our priority why is it some think if we aren't able to work because of our medical condition we should sit in a room all day where we may be kicked out for a meeting and have no other place to go because we are banned from the orderly room without a Cadre? Why can't we heal where we are staying so we can be comfortable and stress free? I was told to my face since I was drawing a paycheck from the Army I should be at work and if I couldn't work or take a class I should have to sit all day at the unit.
COL Jimmie Keenan at 2008-11-19 14:29:26 wrote:

The triads of care and leadership are committed to a holistic approach to healing. It is proven that people heal better with a medical, occupational and educational approach. I and we encourage you to commit yourself to your comprehensive transition plan, holistic rehabilitation and progress in your transition back to duty or active citizenship.
william schuyler at 2008-11-15 10:50:11 wrote:

With a new administration, what plans are being considered if a cut in the military occurs? What impact on TRICARE will this have? I know it is early but everyone can see the hand writing on the wall.
Francine Forestell at 2008-11-19 14:44:14 wrote:

At this time, Congress has fully funded the 2009 Defense budget so there is no anticipated impact on TRICARE. TRICARE is a congressionally mandated program and exists to administer the benefit in accordance with existing statutes and regulations. We eagerly wait to see what the next adminstration brings to the Defense Health Care program.
Tracy Hejmanowski, Ph.D. at 2008-11-18 08:27:22 wrote:

I would like to submit three comments from a clinical perspective (I will be
unavailable during the town hall):

1. Recommend that clinical / mental health resource summits are held within
regions that aim to simply connect regional providers of care with each
other so as to minimize both gaps and redundancies in the coordination of
care. Awareness is key to utilization and provision of services. The wheel
need not be reinvented unnecessarily at the expense of cutting edge and
timely care.
2. Clinicians need to be aware that the PDHRA process may yield minimization
of symptomatology and medical/mental health concerns and follow-up the
post-deployment health assessments with a focused clinical interview, even
if brief.
3. Providers outside of the military treatment facilities should be provided
with ongoing "cultural competency" training if they are to work with active
duty (MilOneSource), Reserve/NG or veterans (Tricare, private providers,
etc.). The military is not unlike other special populations requiring
specialized clinical training. Post-deployed service members need providers
who are savvy about military life and deployment-related stress in order for
treatment to be successful.

Thank you for your consideration of these items. I look forward to hearing
about lessons learned from this initiative.

V/r,
Dr. Hejmanowski
Francine Forestell at 2008-11-19 14:40:07 wrote:

Thank you for your question. In response to your 3rd comment we can tell you a little about what TRICARE is doing to educate civilian providers about military healthcare. TRICARE Management Activity along with its contractors conduct a number of outreach activities to the civilian provider community. Staff provides educational seminars, online resource tools and a monthly provider newsletter. Currently we've posted a new Civilian Provider Portal pilot through MHSLearn that provides training on Traumatic Brain Injury and Post Traumatic Stress Disorder. Providers earn 17 Continuing Medical Education units with the course. We also publish and distribute a provider handbook to all network civilian providers. TRICARE contractors provide ready resources for civilian providers to gain information on TRICARE benefits and understanding military culture.
Meghan E. Malloy at 2008-11-18 08:28:49 wrote:

I was excited to see the concept of the Warrior Transition Unit come to fruition. I can't agree more that combat wounded troops deserve the best that we can give them. However, we've gone too far. Soldiers straight out of Basic Training and AIT, that have never seen combat, are being given same day priority medical care. Yet Soldiers that have deployed multiple times and have sustained injuries and illnesses that may not take them to the WTU, are made to wait days, weeks, and sometimes months to see a physician, much less in a specialty clinic. Typically our only option is sick call, where we wait in line for hours to speak with a PA that spends less than 10 minutes with their patient and often neglects or refuses to request needed tests such as labs or MRIs. Yet for the AIT Soldier that has never deployed that belongs to the WTU, the best care is given and no expense is spared.

In addition, Soldiers that are currently coming back are screened and re-screened for every type of ailment. The first time we returned, in 2003 from Iraq, there was no such thing as a PDHA or a PDHRA. How many Soldiers that deployed then were missed and will never recieve treatment? I returned again from Iraq in 2006 after being deployed as a medic, attached to an infantry unit and an EOD unit. When I got back and couldn't sleep, I was told at my PDHRA that I was addicted to caffeine, so I should stop drinking soda. At that point, I lost all faith in the Army medical system.

V/R,

Meghan E. Malloy
SSG, USA
COL Jimmie Keenan at 2008-11-19 14:23:11 wrote:

*We treat the severity of acuity of injuries or illness Soldiers with 6 or more months of complex medical management regardless of where they are coming from (combat vs. non combat).

*WTs have an enhance care standards vs. regular beneficiaries care standards.

*Regular beneficiaries may have to wait for weeks to see specific specialty but not for months and if this is the case then the patient needs to see the patient representative at the MFT.

*PDHA does happen in theater since 2003; however, it is manually input/review with hard paper copy. PDHA automation was introduced since OIF 2 (2004). If the line PA/DOC does not tend to the need of his/her individual Soldier during the PDHRA process then the Soldier needs to see their commander through open door policy.
William H Hoesen Sr at 2008-11-18 08:30:51 wrote:

When is our Tricare for life Health care system, going to be made to work for us.

We the patients do not get to contact the doctors that are assigned to Us, there are numerous Departments that we have to try to go through, we say try, because that is all we can do.

We are send from one department to another because the one department can not or is not able to satisfy our question for help, Information or advice.
The other department we are send to, is nine times out of ten, not able to get us any further than, to send us to the next department, and so on and on, until we finally are send back to the first department we started out with, in each case of course we have to leave a message and wait and wait for a reply that more than some times never comes.

We like to Inform you that this, is known to us as the Governments system, outside the Military, that stands between us and our top Commander, that likes to create jobs for people in these, boxed in restricted departments, that are set up to accomplish nothing, nor produce anything, their Job description is made up that way, this is called the ultimate example of Job protection.

Now that we made this clear, when Is the Military System going to wake up to this fact, which has been to the Military like our Enemy, for now more than a half a Century.???????

Lets accomplish, do something to correct this, once and for all, now that we know, that this outside the Military System has proven itself to be Undependable, untrustworthy, and undeserving, rid yourself of it and do the job ourselves, with a system, over which we have Quality control, and that works, we know how to do that, and have proved it in the Past!

William H Hoesen Sr 83+, Ret:WWII Mil:
MHS Webmaster at 2008-11-19 14:12:01 wrote:

Mr. Hoesen,

TRICARE for Life was established as a benefit program in 2001 to reduce the out-of-pocket costs for those beneficiaries who are Medicare-TRICARE reliant.

As you know, Medicare is health insurance for people age 65 or older, as well as for people under age 65 who have qualified for Social Security disability insurance. By law, TRICARE beneficiaries eligible for premium-free Medicare Part A must have Medicare Part A and Medicare Part B coverage to remain TRICARE-eligible.

When you talk about being assigned doctors, and having to go through various departments, it would seem like you are trying to access care through a military hospital or clinic. When beneficiaries become Medicare eligible, access to care within a military facility it typically on a space available basis. Beneficiaries should be establishing themselves with Medicare providers in the local community, for both access and continuity purposes. Once you see a Medicare-certified provider, TRICARE acts as second payer on those claims for services covered by Medicare and TRICARE. You are entitled to the Medicare benefit and to supplementation of the cost of the benefit by TRICARE. There is no intent to restrict services, but to maximize use of your entitlements.

With the reduction of the military system due to rightsizing of the force and of the military medical infrastructure, TRICARE is able to serve the needs of active duty family members and retirees and their family members. When a beneficiary becomes Medicare eligible, Medicare is there to serve their health care needs and TRICARE supplements that benefit with its own.
Jace BADIA at 2008-11-19 13:33:02 wrote:

I was injured 2 years ago and still have several surgeries to go on my right leg. Doctors have estimated a 12-18 month window left in surgeries alone not including rehab after so stated surgeries. Why was my med-board started 10 months ago and disability rating already being discussed if there are still ongoing factors which will change the end result? It seems redundant if I'm just going to have to continue to update my med-board file. Why not just wait until all surgeries are over with and do the med-board during the final rehab process?

Thank you
COL Jimmie Keenan at 2008-11-19 14:07:27 wrote:

Without the full details, they would start the MEB if they believed there was nothing further treatment wise that would change the outcome. If you can provide me with what Army Warrior Transition Unit you are assigned to or if you are not a contact email, I will have my doctor contact you.
Thanks for your service to our country.
COL Keenan
Chief of Staff
Warrior Care and Transition Office
MHS Web at 2008-11-19 13:47:54 wrote:

Welcome! The Webhall is now open for your questions and comments.
Karen Boeve at 2008-11-19 14:06:30 wrote:

I am interested in particpating in the Webhall. Thank you.
Arash Habibzadeh at 2008-11-19 13:52:47 wrote:

Interested in the topic!
Michael A. Parker at 2008-11-19 14:02:08 wrote:

November being warrior care month, DoD and the Services have posted much about their successes in improving wounded warrior care and benefits. Credit is certainly due for these improvements. However, I need to point out where DoD and the Services are still egregiously failing the wounded warrior.

You can about many of the remaining problems in a brief here: http://www.usni.org/assets/stories/woundedwarriorforumbrieffinalappt19972003.ppt

Some key, remaining problem areas are:

1. Medical evaluation boards are refusing to cover all current medical conditions as required by DoDI 1332.38. This coupled with inadequate documentation and substandard work ups for the conditions that are addressed leads to bad MEB’s. Bad MEB’s lead to bad PEB’s and that results in wounded warriors being denied their full and legally due disability benefits.

2. The Services are still administratively discharging members for medical conditions that are required to evaluated and compensated by the Disability Evaluation System. Most egregiously, the Navy and Marines continue to administratively discharge members due to medical conditions the PEB found not to be unfitting. This is nothing more than a scam to avoid paying legally due disability benefits.

3. The review board process has been bastardized by DoD and the Services to keep appeals and benefits down. While DoD and the services have made progress to fix the present and future, they are turning a blind eye and have even sabotaged efforts and methods to correct past disability cases.

The last Item I will discuss in detail on this post and I hope to have other post on the other two issues.

For years and years, DoD and the Services ignored the law and rated service members’ unfitting disabilities how they wanted instead of per the VASRD, a requirement that is well established in statute and case law. This is one of the key scandals revealed in the Walter Reed story and it was addressed by the various commission findings. DoD and the Services also used many other techniques to keep ratings low, like cherry picking which conditions to deem unfitting and declaring that conditions existed prior to service without overcoming the presumption that the condition is service connected.

Congress acted swiftly and reinforced the VASRD rating requirement. They also established the Physical Disability Board of Review (PDBR). Congress stated the PDBR was required to review the “Disability Determination” given by the PEB to make sure it was compliant with law, regulation and policy. DoD immediately redefined the law and stated they would only look at the rating determination. DoD also “decided” they would not address the other problems in the PEB’s “Disability Determination”, such as cherry picking, or improper MEB’s; issues that led to so many service members being denied legally disability benefits. Then DoD had the nerve to state the PDBR only had to follow the VASRD rating standards for cases adjudicated by the PEB since January 2008. For cases prior to that, DoD will follow DoDI 1332.39, a document that lead to lower ratings by illegally substituted DoD rating criteria for VASRD rating criteria. Since at least 1949, the law has specifically required DoD to rate unfitting disabilities per the VASRD criteria. DoD further “decided” that those who seek relief from their Service’s Board for the Correction of Military records cannot have access to the PDBR despite the fact that Congress made no such limitation in the PDBR law. (Doesn’t it make sense to allow members to resolve the issue at the Service level boards before appealing to the DoD level PDBR?) Finally, DoD “decided” that if the PDBR determined that the PEB “erred” in the rating, they would not make retroactive payments based on the correct rating. This is an absolutely incredible disregard for the needs of the wounded warrior to save bucks for their other “priorities”.

Please note what DoD’s own regulation states as it is verbatim from what PDBR law states:

From DoDI

5. SECRETARIES OF THE MILITARY DEPARTMENTS. The Secretaries of the Military Departments shall:



g. Correct the military records of individuals covered by section 2 of Enclosure 3 in accordance with a recommendation made by the PDBR, as outlined in section 6 of Enclosure 3, if the recommendation is accepted by the Secretary concerned.

(1) Any such correction may be made effective as of the effective date of the action taken on the report of the Military Department PEB to which such recommendation relates.



Despite Congress allowing the Service secretaries to pay benefits retroactively, DoD has decided to remove that authority from the Service secretaries and prohibit retroactive payments for DoD’s past actions that denied disability benefits. This coupled with the fact that DoD was required by Congress to have the PDBR operational by 28 April 2008, show DoD’s true benfits denying colors. They have stacked the deck do that the longer they delay getting the PDBR up and running, the less benefits they will have to pay to wounded warriors. How convenient and how despicable is that?

DoD cannot honestly state wounded warrior is their second highest priority when they pull crap like this. They have gotten away with years and years of illegally denying disability benefits and, despite promises of reform, the old “budget first, soldier last, culture remains alive and well.

On 26 October I wrote about this issue here: http://www.health.mil/Press/Release.aspx?ID=388

I was promised a response would be posted. It is now three plus weeks later and nothing. Why won’t DoD address these issue openly and honestly?

Agian, I encourage you to read my brief at http://www.usni.org/assets/stories/woundedwarriorforumbrieffinalappt19972003.ppt

to understand how much more DoD must do before they can honestly state they are doing everything they can for the wounded warrior. I have given this brief and related information to DoD time and time again and yet they refuse to act or even respond to the points raised. They have proven time and time again that they are really not acting in the best interest of wounded warriors.

Michael Parker
MHS Webmaster at 2008-11-19 14:12:55 wrote:

Thanks for your participation today. Unfortunately, we don't have a DES expert here today to answer this exact question. We will forward your question to the appropriate office today and hope to have an answer tomorrow. It will be posted on this page as soon as we receive it.
Lynn Peters APRN at 2008-11-19 14:02:34 wrote:

This is my first Webhall...are we supposed to call in for audio or just keep refreshing the page to see new comments?
MHS Webmaster at 2008-11-19 14:03:35 wrote:

This is not an audio-enabled event. Please keep refreshing the screen to see new comments.
Candy Wright at 2008-11-19 14:03:48 wrote:

I am signing on to participate in the town hall discussion.
Joan McLeod at 2008-11-19 14:05:28 wrote:

How can we participate in this program, listen to others without asking a formal question?
MHS Webmaster at 2008-11-19 14:09:44 wrote:

You're welcome to follow along with the comments and questions, but we welcome any questions, comments, lessons learned, etc. Please hit refresh on your web page or the F5 key. Thanks for joining us.
Virginia Paganelli at 2008-11-19 14:05:44 wrote:

How does one access the meeting. I can only find the comment section but not the meeting.
MHS Webmaster at 2008-11-19 14:06:44 wrote:

Please continue to refresh your page and submit any questions or comments on Warrior Care. Welcome to the Webhall
Carolyn Stoehr at 2008-11-19 14:07:01 wrote:

I don't have a question but want to view the Web Hall. Not sure I know how to do that. I am one of the newly hired MEB Outreach attorneys.
MHS Webmaster at 2008-11-19 14:08:11 wrote:

Please continue to refresh your page. Thanks for your participation.
Jim Rice at 2008-11-19 14:15:45 wrote:

AW2 is on line
Michael Parker at 2008-11-19 14:22:49 wrote:

Why do DoD and the Services refuse to allow service members who were discharged due to disability to have access to the discharge review board provided under 10 USC 1553?

The discharge review board allows the service members to appear at an actual hearing and DoDI 1332.28 requires that issues raised by the service member must be addressed in the board’s decision. Detailed and complete answers to issues are rarely ever provided given by other appeal boards. Also, service members can apply for discharge review boards up to 15 years after the discharge. The BCMR’s are limited to three years after the discovery of the error or injustice. This board can also retroactively restore benefits; a power DoD stripped away in the new 10 USC 1554a Physical Disability Board of Review.

Congress stated that the discharge review board was:

“to review the discharge or dismissal (other than a discharge or dismissal by sentence of a general courtmartial) of any former member of an armed force under the jurisdiction of his department upon its own motion or upon the request of the former member”

How is it DoD and the Services can tell those discharged for medical reasons that they cannot have access to this board? I thought DoD and the Services wanted to do everything possible for wounded warriors.

See 10 USC 1553 below:

10 USC 1553. Review of discharge or dismissal
(a) The Secretary concerned shall, after consulting the Secretary of Veterans Affairs, establish a board of review, consisting of five members, to review the discharge or dismissal (other than a discharge or dismissal by sentence of a general courtmartial)
of any former member of an armed force under the jurisdiction of his department upon its own motion or upon the request of the former member or, if he is dead, his surviving spouse, next of kin, or legal representative. A motion or request for review must be made within 15 years after the date of the discharge or dismissal. With respect to a discharge or dismissal adjudged by a court-martial case tried or reviewed under chapter 47 of this title (or under the Uniform Code of Military Justice (Public Law 506 of the 81st Congress)), action under this subsection
may extend only to a change in the discharge or dismissal or issuance of a new discharge for purposes of clemency.

(b) A board established under this section may, subject to review by the Secretary concerned, change a discharge or dismissal, or issue a new discharge, to reflect its
findings.

(c) A review by a board established under this section shall be based on the records of
the armed forces concerned and such other evidence as may be presented to the board. A witness may present evidence to the board in person or by affidavit. A
person who requests a review under this section may appear before the board in person or by counsel or an accredited representative of an organization recognized by the Secretary of Veterans Affairs under chapter 59 of title 38.
MHS Webmaster at 2008-11-19 14:43:10 wrote:

Thank you again for your question on this very important subject. The last NDAA requires DoD to establish this appeals board and that effort is in progress. We will refer your question to the individuals running that process and post their response here as soon as we receive it. Thank you.
Michael Parker at 2008-11-19 14:49:32 wrote:

Please refer this question to those who are responsible for the 10 USC 1553 Discharge Review Board, not the 10 USC 1554a Physical Disabilty Board of Review.

Thanks,

Michael Parker
Rear Admiral Karen Flaherty, Bureau of Medicine and Surgery, Deputy Chief for Wounded, Ill, and Injured at 2008-11-19 14:38:27 wrote:

Dr. Hejmanowski, thank you very much for your interest and care of our Wounded Warriors and their families. I appreciate your comments and would like to reach out to you directly from the Bureau of Medicine and Surgery, Wounded, Ill and Injured Directorate. I am confident that we can find comprehensive and innovative solutions to meet the care needs of our Warriors and their families. Please let me know of your contact information to arrange a conversation. Many thanks, for all that you do.
Marjorie Ingelsby at 2008-11-19 14:38:33 wrote:

A transcript of this discussion may be helpful. Will one be made available?
MHS Webmaster at 2008-11-19 14:57:40 wrote:

This is an online discussion, not an audio-enabled event, and thus the thread of questions and comments on the Webhall page will serve as a document of the Webhall event.
gail holley at 2008-11-19 14:40:42 wrote:

I retired last year with 22 years reserve time. When do I qualify for Tricare? One of my injuries was during weapons training, M-22 rifle, a bullet popped me in the eye from the Sgt's rifle who was laying/shooting his M22 on the ground next to me.
Francine Forestell at 2008-11-19 14:51:54 wrote:

Thank you on your time served. We are truly appreciative. Since you retired as a reservist, your TRICARE benefit begins when you start drawing your retirement pay, which is typically at age 60. At that time, you need to make sure your records are current in the Defense Enrollment Eligiblity Reporting System (DEERS) and I would suggest you contact your regional contractor to determine what TRICARE option is available to you. Be aware that if you get other employment and are covered under an employer-sponsored health care plan, TRICARE may become second payer to your medical and pharmacy benefits. Remember, dental is a separate purchased coverage and you may consider purchasing dental coverage upon establishment of your TRICARE eligibility.
Michael Parker at 2008-11-19 15:04:08 wrote:

Gail,

If the injury caused a condition that resulted in you not meeting retention standards, then you should have been referred to DES for MEB/PEB. From that process you may have been found unfit and medically retired with immediate TRIARE benefits and disability retired pay.

To many Guard/Reserve members have been denied access to the DES resulting in lost disability bebefits. Every SM, active guard and reserve is required to be entered into the DES if they do not meet retention standards.

Regardless, if this condition is service connected you can get VA compensation and care for it.

Mike
Smith, David Eugene at 2008-11-19 14:44:35 wrote:

I am a former US Navy carrier pilot, retired with pay, seven and 1/2 years active duty, WWII and Korea, 20 years Naval Reserve. My hearing has deteriated significantly, I flew Props and Jets fighters, 1800 hours and was frequently in a gut wrenching sound invironmentas as a pilot and maintenance officer. I shall need some hearing aid/assistance before long. Does VA offer any help in this regard? David E Smith
Gina Klaus at 2008-11-19 15:03:00 wrote:

Mr. Smith,

VA has extensive audiology assistance and provides hearing aides to our eligible veterans. If you are not currently receiving VA benefits or not enrolled in VA Healthcare, there are a number of ways you can become enrolled. VA can assist you with filing a claim for disability compensation, please contact 1-800-827-1000 or visit the local regional office or medical center. Our Veteran Service Representative or Health Care Eligibility Specialist would be happy to help you file your claim. Disability compensation is a benefit paid to a veteran because of injuries or diseases that happened while on active duty, or were made worse by active military service. You will need to establish your hearing loss as a result of military service. The benefits are tax-free. You can apply by filling out VA Form 21-526, Veterans Application for Compensation and/or Pension. If you have any of the following material, please attach it to your application:

Discharge or separation papers (DD214 or equivalent)
Dependency records (marriage & children's birth certificates)
Medical evidence (doctor & hospital reports)

Additionally, you may contact 877-222-8387 for help establishing health eligibility.

Thanks for your service to our great nation.

Gina Klaus
Michael Parker at 2008-11-19 14:52:29 wrote:

Why does DoD still allow the Navy and Marines to administratively discharge members for DES compensable conditions found fitting by their PEB’s? I brought this issue up in the April webhall and as a result, I was invited down to brief Dr. Casscells, Dr. Davis and Mrs. Darby on the problem. Some six month later the practice still continues resulting in disabled sailors and marines being denied legally due DoD disability benefits. In December of 2007, DoD issue a DTM that was aimed and curtailing this practice. Since that time none of the Services have implemented the change that allows the PEB’s to use non deployability as a sole reason for finding a member unfit. DoD, are you in charge of the DES or not? DoDD 1322.18 states you are in charge if that helps.

Michael A. Parker
MHS Webmaster at 2008-11-19 15:05:05 wrote:

Thanks for participating and re-addressing this issue. The subject matter experts available at this time are not able to provide a complete answer to your issues. We will forward this question to both the medical and personnel areas of the services, particularly the Navy and Marine Corps. As soon as we receive an answer, we will post it here. Thank you again.
Santiago Rodriguez 8687 at 2008-11-19 14:52:37 wrote:

I Turned 65 in June and waiting for forms to fill out for my Medicare, but I am told that I will taken care by Tri Care because I live in Germany. Is this true? Where can I get the forms to update my health care for Medicare or Tri care?
Francine Forestell at 2008-11-19 15:26:18 wrote:

It appears you currenlty don't have Medicare coverage. Regretfully, law requires that for you to continue TRICARE coverage when you turn 65, if you are entitled to Medicare Part A, you must have Medicare Part B. It appears you may not have purchased Part B when first becoming eligible. This means you may not have any health care coverage (Medicare or TRICARE), unless you use the German health care system. You need to submit your paperwork during Medicare's open enrollment period January through March and coverage will begin in July. Call Medicare for additional information at 1-800-633-4227. Since you are overseas you need to contact the Social Security Administration to purchase Part B. Contact information can be found at http://www/ssa.gov/foreign. Once your Medicare Part A&B status is confirmed in the Defense Enrollment Eligiblity Reporting System (DEERS), you will regain TRICARE coverage. You may want to confirm your TRICARE eligibility by visiting the nearest ID card issuing facility. Because Medicare does not provide benefits for medical care received overseas (except in U.S. Territories) TRICARE is the primary payer. You are responsible for TRICARE deductibles and cost shares. So you don't have to file your claims with Medicare, just with TRICARE. Since there may be a lapse in coverage, you may want to contact Veterans Affairs (VA) as VA will pay for medical services for service-connected disabilities and related conditions or medical services needed as part of a vocational rehbilitation program for veterans living or traveling outside the U.S. You can telephone the Foreign Medical Program toll free from these countries: Germany 0800-1800-011 for additional information.
Francine Forestell at 2008-11-19 15:51:50 wrote:

For more information about TRICARE For Life, our Medicare-TRICARE plan, the following link is specific to Germany
http://tricare.mil/mybenefit/ProfileFilter.do?uri=&step=4&status=Retired+Service+Member&country=Germany&zipCode=&plan=TRICARE+for+Life+%28TFL%29&x=14&y=13
NavyDoc at 2008-11-19 15:10:12 wrote:

I served as a psychiatrist in the Navy and towards the end of my career the Marine Corps submitted an Urgent Universal Needs request ("Urgent UNS") for 161 mental health related personnel. The intent was to establish an embedded/organic mental health capability across the Marine Corps. The Marine Corps was also working on creating billets for these personnel. I was curious if you heard anything or had any updates about this effort? I concluded the OSCAR program was a huge success and really was pulling for this effort.
SF//NavyDoc
Rear Admiral Karen Flaherty, Bureau of Medicine and Surgery, Deputy Chief for Wounded, Ill, and Injured at 2008-11-19 15:23:31 wrote:

Sir, thank you for your comments and thoughts. The OSCAR program has been a great success and has provided excellent support to those in need. The Navy and the Marine Corps are working together to determine the requirement for this growth and we expect this analysis and course of recommendations to be delivered in the very near future to our senior leaders. Thank you for your service and your continued support of our Sailors and Marines.
NavyDoc at 2008-11-19 15:17:32 wrote:

I'm a former Navy psychiatrist now at an academic medical center. The other day I had lunch with a couple surgeons here who are part of the C-STARS program for surgery. Do you think that the military could benefit from a C-STARS like program for psychiatry? Maybe we could help military physicians hone their psychiatry skills and get some mental health experience before a deployment.
SF//NavyDoc
Rear Admiral Karen Flaherty, Bureau of Medicine and Surgery, Deputy Chief for Wounded, Ill, and Injured at 2008-11-19 15:33:47 wrote:

Sir, great concept. I would welcome the opportunity to talk to you directly along with members of our Deployment Health Team to discuss this idea. Please let me know how best to contact you. We welcome all of our staff, active, reserve, and retired to be part of new solutions.
Michael Parker at 2008-11-19 15:30:17 wrote:

DoDI 1332.38 states:

E3.P1.2.3. Content. MEBs, TDRL physical examinations, and Reserve component Physical examinations shall document the full clinical information of all medical conditions the Service member has and state whether each condition is cause for referral into the DES. (See enclosure 4 of This instruction.) Clinical information shall include a medical history, appropriate physical examination, medical tests and their results, medical and surgical consultations as necessary or indicated, diagnoses, treatment, and prognosis. MEBs shall not state a conclusion of unfitness because of physical disability, assignment of disability percentage rating, or the appropriate disposition under Chapter 61 of 10 U.S.C. (reference (b)).

PEB’s can only rate the conditions the MEB indentifies and documents. If the MEB fails to list and evaluate all current medical conditions, the service member will likely be denied legally due disability benefits.

I recently assisted a soldier at Fort Lee whose MEB absolutely refused to address all of her medical conditions. As a result, the PEB only rated her at 20% and ordered her separated w/o disability retirement. (Dr. Lather at Fort Lee has repeatedly told soldiers the MEB will only cover the conditions that sent them to the WTU.) After a month of wrangling, the USAPDA finally returned her MEB to Fort Lee to be done correctly and the new MEB covered many conditions with full clinical information. As a result, this soldier was rerated by the PEB and awarded a 50% permanent disability rating and medically retired. I shudder to think of all the other wounded warriors who have been victims to this problem.

What will DoD do enforce their MEB content standard and what will DoD do to correct the cases of past victims of this problem?

Michael Parker
Dr. Jack Smith at 2008-11-19 15:51:27 wrote:

DoD and VA have been conducting a Disability Evaluation System Pilot in the National Capital Region, which uses a single comprehensive physical exam and provides the opportunity for the Service member to claim all known medical conditions. All Pilot cases are being adjudicated by the VA and accepted by DoD. This process will be expanded to selected military facilities over the next year. For Service members who have received PEB findings less than 30%, an appeals board is being established which will conduct a review. There is no representative of the PEB available at our session today, but we will forward your concerns to OSD disability experts and will post their response as soon as available.
Michael Parker at 2008-11-19 16:12:07 wrote:

The pilot program will help, but it is a long ways a way from being completed and implemented everywhere. What do we do about those screwed over in the meantime?

DoD has "decided" the new board (PDBR) cannot address issues of MEB's not covering all conditions as required. By law, the PDBR should indeed review the entire "disability determination" but DoD won't allow it.

This means a lot have already been screwed and many more will be screwed in the future by bad MEB's and without DoD doing anything about it.

How about enforcing your damned MEB content standard right now? DoD can do just as good a job on MEBs as the VA with the right leadership.

Michael Parker
Vanessa Keeslar at 2008-11-19 15:35:19 wrote:

My husband lost both of his legs in combat in 2006 and prior to that we had been stationed in Fairbanks Alaska. Upon our arrival here, if I had medical needs I made doctors appointments at WRAMC and had filled out what I understood to be the appropriate paperwork to be registered in this system. After being referred to a specialist outside of the system in April 2008 I started receiving medical bills from that care provider. After many months of clarification and follow-up, I have been told that I did not fill out the appropriate paperwork to transfer from Tri-Care West to Tri-Care North and that I will need to pay that bill. I thought that Tri-Care was Tri-Care and my husband was not in any condition to remember to tell me anything different. I have spoken with 4 different Tri-Care personnel who have essentially told me that this is my problem, which seems inappropriate to me. I have now filled out the correct paperwork to enroll in Tri-Care North and would like to know if I can get it back-dated to 2006 when I first started getting care in the Tri-Care North region. V/R
James Thur, Captain, USNR (Retired) at 2008-11-19 16:10:50 wrote:

I hope that someone steps forward to resolve this problem for this family and that you post a response on the webplog. Thank you.
Francine Forestell at 2008-11-19 16:16:01 wrote:

TRICARE has three stateside regions. When you move from one region to another, you need to find out what TRICARE options are available in your new location. If you move from one region to another, you need to complete a new Prime enrollment form and make sure you update your address in the Defense Enrollment Eligiblity Reporting System (DEERS). Check back with your regional contractor 5-10 days after submitting the form to make sure the transfer has taken effect. We suggest you keep a copy so that if you need care in the local area, the document will show you requested the transfer. If you are enrolled to a military treatment facility, your Primary Care Manager is responsible for submitting a referral for specialty care from a civilian provider. We recommend you don't make any appointments for care until you receive an authorization from the regional contractor (via phone or letter). Backdating your enrollment, at this time, shouldn't be necessary. I would suggest you contact the North Region contractor's toll free number at 1-877-874-2273 to find out how to get this claim processed if the care was authorized.
Frank Roth at 2008-11-26 09:08:01 wrote:

We were able to coordinate with the North Region office and adjust Ms. Keeslar's enrollment date and will be reprocessing her claim.
Cheryl Lynch at 2008-11-19 15:48:15 wrote:

I’m not too sure who is totally responsible for the new National Resource Directory, but I’d like to tell you that I find it very helpful and a great step in the right direction to offering one place to find resources for; injured service members, their families, caregivers and/or those who support them! I’m not too sure who is totally responsible for the new National Resource Directory (a.k.a. Wounded Warrior Resource Center), but I’d like to tell you that I find it very helpful and a great step in the right direction. Finally you’re offering one place to find resources for; injured service members, their families, caregivers and/or those who support them! https://www.nationalresourcedirectory.org
I look forward to seeing the expansion of this program and only hope that it continues on the current path and does not end up like other DoD or VA sites that lead people off into never, never-land.
MHS Webmaster at 2008-11-19 15:50:16 wrote:

Thank you for your comment. We're glad you find it helpful and hope others do, too.
MHS Web at 2008-11-19 15:55:36 wrote:

The live Webhall event will end shortly, at 4 p.m. We thank you for your questions and comments. Please feel free to continue submitting questions and comments. We will supply answers as soon as possible.
MHS Web at 2008-11-19 15:58:09 wrote:

The Warrior Care Webhall live event is now closed. You may, however, continue to submit questions and comments. We will provide answers as soon as possible.
Michael Parker at 2008-11-20 06:53:46 wrote:

10 USC 1207 states that in order for a service member to receive DoD disability compensation for a condition that undoubtedly existed prior to service (EPTS) and was not aggravated by service, the member must have eight years of active duty.

A DoD civilian only needs 18 months of service to get DoD disability compensation even for an clearly EPTS conditions.

If a DoD civilian is removed from service due to an EPTS condition then they get, for the first year, 60% of their High three salary. After one year they get 40% of their high three salary. “At age 62, the disability annuity is recomputed to an amount that represents the annuity received if the individual had continued to work until the day before the 62nd birthday, and retired under the FERS non-disability provisions. All FERS Cost of Living
Adjustments (COLA) that were effective during the time the annuitant was receiving the disability retirement will increase the high-3 average salary.” They also get to keep their TSP accounts to include the government contributions.

If a military member is dismissed due to an EPTS condition with 7 years and 364 days, they get nothing from DoD disability and nothing from the VA for an EPTS condition.

Should not our uniformed service members have the same level of disability protection and benefits as their civilian DoD counterparts?

Question: What can DoD do to change the law so that uniformed service members get the same level of DoD disability protection and benefits as their civilian counterparts?

Michael Parker
Michael Parker at 2008-12-08 13:08:06 wrote:

Any estimation on when questions raised in the Webhall will be answered as promised? It has been nearly a month. If the entities that received they questions are not going to answer them, please say so.

Michael Parker
Cristapher Zuetlau at 2009-01-11 05:09:19 wrote:

WOW we are looking at almost 2 months now. Does anyone even remember these questions are here?

MR.PARKER, I THINK YOU HAVE THEM STUMPED!
MHS Webmaster at 2009-01-12 12:23:45 wrote:

Please know that the Health.mil staff has not forgotten these questions and continues working to receive the answers they deserve.
MHS Web at 2009-01-15 16:44:59 wrote:

Mr. Parker,

These are complex and important issues, and the MHS understands that the concerns of Service members and their families extend beyond their medical care and treatment when an individual becomes ill or injured. As your questions pertained to MEB and DES policy, they were forwarded to the Personnel and Readiness office, which supplied the following reply:

Due to pending litigation, it is inappropriate to comment on DoD and Service policies toward service members who were discharged due to disability having access to the discharge review board provided under 10 USC 1553.

Below is the DoD policy on medical evaluation boards including all current medical conditions (DoDI 1332.38) and using the VASRD to rate disabilities.

Department of Defense Policy for the Disability Evaluation System (DES):

--The standards for referring and determining unfitness because of physical disability or medical disqualification and the compensability of unfitting disabilities shall be uniform between components within an individual Service.

--In making a determination of a member's disability rating, the Military Department shall take into account all medical conditions, whether individually or collectively, that render the member unfit to perform the duties of the member's office, grade, rank or rating.

--The Secretaries of the Military Departments may not deviate from the schedule or any interpretation of the schedule, including any applicable interpretation of the VASRD by the United States Court of Appeals for Veterans Claims. The Secretary concerned may utilize in lieu of the VASRD such criteria as the Secretary of Defense and the Secretary of Veterans Affairs may jointly prescribe if utilization of such criteria will result in a greater percentage of disability than would be otherwise determined through the utilization of the schedule. (National Defense Authorization Act for Fiscal Year 20008, section 1642).

The MHS remains committed to assuring that Service members and their families and our retirees and their families have access to the health care they need and deserve. Since the delivery of that care is by the military Services, they are best positioned to answer concerns related to specific individuals being treated at specific facilities.
Michael Parker at 2009-01-22 09:14:56 wrote:

Thanks for posting this partial response to the issues I raised. I look forward to further responses on the issues I raised involving the Physical Disability Board of Review (PDBR), the Navy/Marine Corps’ fit but unsuitable problem and DoD actions to ensure all medical conditions are covered by all medical evaluation boards.

Unfortunately the response DoD provided has a serious error that relates directly to issues I have raised. The response DoD provided states:

The standards for referring and determining unfitness because of physical disability or medical disqualification and the compensability of unfitting disabilities shall be uniform between components within an individual Service.

The actual standard comes from paragraph 3.7 of DoDD 1332.18 which states:

3.7. The standards for determining unfitness because of physical disability or medical disqualification and the compensability of unfitting disabilities shall be uniform "among the Services" and between components within an individual Service.

DoD’s response left out the critical words “among the Services”. Why?

Uniformity among the Services is absolutely required yet it has been this lack of uniformity that has created a great deal of the problems with the equity of the DES. For example, the “fit but unsuitable” issue I raised where the Navy and the Marine Corps administratively separate individuals without disability benefits due to compensable medical conditions covered under the DES. Identical cases in the Army and Navy result in the awarding of disability benefits or retention on active duty. Why is it no one from DoD will address this issue? I have been asking this question of DoD for years now.

The Physical Disability Board of Review issue is another example. DoD has recently stated that the PDBR will be able to use Service specific rating criteria to uphold previous PEB decisions. First and foremost, Service (and DoD) rating criteria violates the law which clearly, and for decades, has required DoD to assign disability ratings per the VA Schedule for Rating Disabilities ( VASRD):


10 USC 1201

“the disability is at least 30 percent under the standard schedule of rating disabilities in use by the Department of Veterans Affairs at the time of the determination”

10 USC 1203

“the disability is less than 30 percent under the standard schedule of rating disabilities in use by the Department of Veterans Affairs at the time of the determination”

All DoD disability ratings that are not compliant with the criteria of the VASRD are, in fact, illegal. This was the fundamental issue disclosed in the aftermath of the Walter Reed Scandal and key reason why Congress created the PDBR. However, DoD recently announced that the PDBR will continue t o use illegal, non VASRD rating criteria:


For disability cases adjudicated after the effective date of section 1643, only the VA standard should have been used and thus will be used in the PDBR process to reach the recommendation to raise the disability rating (where appropriate). For separation cases prior to the effective date of section 1643, the rating will be upheld if the rating was fair and accurate using the Services' (or DOD) supplemental guidance to the VA rating. If that guidance was not correctly applied, the PDBR will make a recommendation based upon the correct interpretation of the guidance.

DoD is specifically stating it is still permissible for the PDBR to use Service specific rating criteria and policies in defiance of the law and even there DoDD 1332.18 paragraph 3.7 above.

DoD, you just don’t get it. Is it any wonder why you have lost the faith of disabled service members? Stop screwing them and follow the law and your own long established policies.


Michael Parker

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