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What’s the Latest Problem with Veteran Benefit Claims?

“VA.gov has gaps, and veterans are falling into them,” said Rep. Matt Rosendale, R-Mont., who chairs the House Veterans Affairs subcommittee on technology, during a hearing recently. “This is a situation where the VA is badly in need of independent oversight.”

Military Times’ recent article, “Lawmakers demand accountability after VA loses track of vets’ claims,” reports that in August, VA leaders announced they’d found roughly 32,000 veterans’ disability claims delayed. Some of these cases date back years because of technical flaws in the department’s VA.gov filing systems. Two weeks later, officials acknowledged 57,000 more similarly delayed cases involving veterans trying to add dependents to their accounts.

VA officials said they would backdate veterans’ pay as soon as possible. However, the errors may have delayed potentially thousands of dollars in monthly payouts to individuals suffering from military-related illnesses or injuries.

Veterans Affairs Chief Information Officer Kurt DelBene noted that the errors are just a small portion of the more than seven million cases filed since early 2018. However, he also acknowledged that any mistake that causes financial harm to veterans is unacceptable.

“VA will resolve these issues, prevent them from happening again, and address them more quickly when needed,” he told lawmakers. “And most importantly, we’ll make sure that all impacted veterans get the benefits and services that they deserve as quickly as possible.”

However, several lawmakers said those promises aren’t enough.

“I think we have a problem with addressing the major issues in leadership and officials not being held accountable for things that they do or do not do in upholding their responsibilities to veterans,” said Rep. Morgan Luttrell, R-Texas. “My concern is that no one is holding [anyone] responsible for this.”

Earlier this month, in a letter to VA leadership, committee Chairman Mike Bost, R-Ill., commented that the problems are “just the latest in a string of electronic filing issues that continue to plague the department.”

Reference: Military Times (Sep. 26, 2023) “Lawmakers demand accountability after VA loses track of vets’ claims”

How to Pay for Hearing Aids

Untreated hearing loss has been linked to a higher level of depression, cognitive decline, dementia, falls, visits to the emergency room, and hospital stays. Despite this, says an article from ncoa Adviser, “Financial Assistance for Hearing Aids: A Complete Guide for Older Adults,” fewer than 15% of adults who need hearing aids use them, and the average person takes nearly nine years to go about getting a pair after being told they have hearing loss.

Part of the reason for the delay is financial. Resources for getting hearing aids vary from state to state, and even county to county, which can be confusing. Here’s how to get started.

First, check with your health insurance company to see what’s covered and ask about additional services. You’re not just buying an appliance. Hearing aids require activation and fitting, and other unexpected out-of-pocket costs may occur. Sometimes the easiest way to verify insurance is to have a hearing aid clinic check into it.

Except in five states—Arkansas, Connecticut, Illinois, New Hampshire, and Rhode Island—insurance providers are not required to cover hearing aids as part of health care for adults. Medicare Parts A and B don’t cover the cost of hearing aids or fitting exams. Still, Medicare Part B covers hearing and balance exams ordered by a doctor and an annual audiology appointment to evaluate hearing loss. Whether or not Medicare Advantage, aka Medicare Part C, provides coverage depends upon the plan.

Medicaid coverage varies by state and plan. Many people with Medicare and Medicaid can sign up with select insurance companies and get coverage at no additional cost, but the coverage varies. Also, the quality of the hearing aids may differ.

Active duty military service members and family members diagnosed with hearing loss meeting the coverage criteria may be eligible to receive hearing aids through a TRICARE-approved provider. For veterans, the VA has hearing aid benefits. They should reach out to their local office or representative. The VA website has information on how to apply for VA hearing health care and find the nearest provider.

Federal employees of the American Federation of Government Employees (AFGE) have access to discounted hearing aids, including a free hearing exam, discounted hearing aids, and aftercare support.

Those with mild to moderate hearing loss can now consider over-the-counter hearing aids. Note that the cost of the device you are buying is a third of the price. The rest of the costs are services, so be sure what services are bundled into the offerings. Instead of relying on online reviews, research trusted sources. You’ll want to clearly understand the return policy, warranty coverage for damage and loss, and customer service.

Reference: ncoa Adviser (July 2, 2023) “Financial Assistance for Hearing Aids: A Complete Guide for Older Adults”

How is the VA Handling Aging Veterans?

The Department of Veterans Affairs and veterans organizations across the country are working to care for a new generation of older veterans who are apt to have greater expectations for longevity and independence than earlier generations, yet also may struggle with more complex medical conditions, reports Military Times’ recent article entitled, “America faces a tidal wave of aging military veterans.”

“We’re kind of compounding multiple variables, in the sense that not only are people living longer, but … many of them survived something that wasn’t survivable,” says Scotte Hartronft, the director of geriatrics and extended care at VA. “A lot of veterans have survived significant injuries over the last couple of conflicts that [they] wouldn’t have survived in previous wars.”

In California, the most populous state and home to the highest number of vets, the State Department of Veterans Affairs, known as CalVet, the state’s veterans department, is working to create a modern facility that centers the needs and dignity of older veterans. Like VA facilities across the country, people charged with caring for veterans must address the same question: How do we best care for those who have served on our behalf as they grow old?

Other states also have issues: between 2021 and 2041, the number of veterans older than 85 is expected to increase by 31%. That’s partially because the overall number of veterans nationwide is actually decreasing. Between 2000 and 2018, the number of veterans in the country declined by a third — the bulk of Americans who have served in the military served decades ago.

Vietnam and Gulf War-era veterans represent a different slice of the population than veterans who fought in World War II and Korea: the number of women veterans over 65 is expected to increase by 237% between 2021 and 2041. Racial diversity is also increasing, and the geographic distribution of veterans is shifting. As a result, veterans’ care must change. Women, for example, have a greater life expectancy than men do. Women veterans will generally need more support to continue to live independently as they age for longer — a fact compounded by the fact that women, who tend to be informal caregivers to friends and family, often have more difficulty than men finding their caregivers when needed.

In addition to higher rates of post-traumatic stress and other conditions affecting mental health, veterans are more likely to be exposed to risk factors, such as traumatic brain injuries or toxic exposure, for Alzheimer’s and other dementias. Vets also have a higher chance of being diagnosed with certain types of cancer, like lung and skin cancer. Roughly 50,000 new cancer cases among veterans are reported annually; that number is expected to rise as veterans age.

Every VA medical center will offer veteran-directed care within the next two years. This popular program provides qualified veterans with a stipend to hire local caregivers to assist them with daily living or even companionship. VA is expanding home-based primary care — which provides health care to veterans at home, many of whom are housebound — to 75 new sites and expanding its Medical Foster Care program. This lets some vets live in a private home with a caregiver rather than in a nursing home. They’re also piloting a program using predictive analytics to help determine which veterans are at the highest risk of nursing home care in the coming years to connect them with preventive services.

Reference: Military Times (June 2, 2023) “America faces a tidal wave of aging military veterans”

What’s the Latest on VA’s Coverage of New Alzheimer’s Drug?

The VA has announced that it will cover Leqembi, a monoclonal antibody therapy made by pharmaceutical companies Eisai and Biogen, for veterans in the disease’s early stages. This makes the VA the first and largest health program in the country to endorse the treatment, reports’ military.com in its recent article entitled, “VA to Cover New Drug for Early Stage Alzheimer’s Disease.”

In January, the FDA granted accelerated approval for Leqembi, also known as lecanemab, when research showed that the medication slowed the physical and mental decline in some patients with early Alzheimer’s by as much as 27%. Although research is ongoing on the treatment’s effectiveness, the drug is among the first to show that it reduces beta amyloid — the toxic protein that contributes to the development of Alzheimer’s — in the brain.

“This treatment option is the latest therapy to target and affect the underlying disease process of Alzheimer’s instead of only treating the symptoms of the disease,” said Dr. Billy Dunn, director of the Office of Neuroscience in the FDA’s Center for Drug Evaluation and Research, during the accelerated approval announcement.

The VA treats about 168,000 veterans with Alzheimer’s, some of whom are in the early stages. Leqembi has an estimated cost of $26,500 a year, and a two-milliliter dose at the VA will cost the department $194.63. A five-milliliter dose will cost $486.57, according to the department’s National Acquisition Center Contract Catalog.

According to VA Press Secretary Terrence Hayes, the drug will be available only at the request of a provider to vets who “most closely align with” patients who meet the selection criteria for clinical trials. This means that the VA patients must meet the same demographic and health history standards as those studied by the manufacturers.

“Each dose of the medication administered for each patient will be tracked and monitored for safety and appropriateness of use, in real-time, by VA’s Center for Medication Safety,” Hayes said in an email to Military.com. “VA will continue to monitor the clinical evidence and safety data for this agent and adjust the criteria for use as appropriate. VA also has capabilities and safeguards in place that are very different from the private sector, such as the ability to conduct real-time medication-use evaluations that will allow for continued safe use of the medication.”

Leqembi is approved for use only in patients with early Alzheimer’s with a “confirmed presence,” via a brain scan, of beta amyloid.

Reference: military.com (March 14, 2023) “VA to Cover New Drug for Early Stage Alzheimer’s Disease”

How Do Healthcare Professionals Help Aging Veterans Cope?

As our veteran population grows older, some will require mental health professionals to help them continue to live their best lives. Daily Nurse’s recent article entitled “Help Aging Veterans Cope with a Geriatric Mental Health Career” says that when it comes to providing for our aging veterans’ mental health, geriatric psychiatrists bring unique expertise to our team.

They focus on the prevention, evaluation, diagnosis and treatment of mental and emotional disorders in the elderly. However, the big difference for geriatric professionals is their experience with older adults who have multiple medical issues and take multiple medications.

Aging vets may have depression, anxiety, distressing memories from their military service, or stress related to health concerns. This may present as pain, trouble sleeping, or memory issues.

“Having access to a specialist who not only understands psychiatric medicine but the pharmacological goals of the elderly we care for has made a tremendous difference in our ability to keep our Veterans stabilized and safe in our memory care unit,” explained Edith Emerson, who works in the memory care unit at the Togus Maine VA.

The VA has a number of programs to support older veterans and their families and caregivers, both online and in-person at their facilities. They also provide specialized geriatric services for veterans and families to help them cope with complex mental health conditions in later life. However, the need for geriatrics professionals throughout the country is growing.

There are more than 11 million people aged 60 and older alive today who have served in the military, representing the largest population of veterans in the nation.

“Nationwide, there’s a shortage of geriatric services, in particular geriatric psychiatry,” said Dr. Isis Burgos-Chapman, a geriatric psychiatrist who provides community living center and outpatient consultation services through one of VA’s Clinical Resource Hubs.

With telehealth services, inpatient care positions and outpatient care support opportunities, there are many ways a mental health professional with a focus on geriatrics can reach out to aging veterans and demonstrate our core values—integrity, commitment, advocacy, respect, and excellence

Reference: Daily Nurse (Jan. 27, 2023) “Help Aging Veterans Cope with a Geriatric Mental Health Career”

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