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As printed in Hearing Health, volume 19:4,
Winter 2003
By Donna L. Schillinger, Assistant Editor
Dating from the earliest days of our nation, a series
of Congressional acts have formed the Department of
Veterans Affairs (VA) into a bureaucracy enormous in
scope and mission. In its present-day form, the VA provides
education, vocational rehabilitation and compensation
to disabled veterans and administers life insurance
benefits and the National Cemetery Program for all veterans.
Despite all of these other functions, the department
is perhaps most widely known for its healthcare system,
the Veterans Health Administration (VHA). Stretching
nationwide, it includes 171 medical centers, more than
350 clinics, 126 nursing homes and 35 residential care
facilities.
VHA assistance was available only for veterans with
disabilities until 1996 when the Veterans Health Care
Eligibility Reform Act changed its mission from treating
service-connected disabilities to developing a comprehensive
healthcare program for all veterans who are enrolled
with the VA. Veterans soon began to avail themselves
of this new treatment opportunity, spurred to do so
by rising medical costs and insurance premiums in the
private sector as well as the lack of Medicare coverage
for prescription drugs.
Although a welcome change for potential beneficiaries,
the transition has not been without complications. Now
the VA is nearing a crisis situation due to growing
demand for its healthcare services. Meeting the demand
with the current allotment of funds may be an impossible
task for the historic agency.
The situation is perhaps best described by the Presidential
Task Force to Improve Health Care Delivery for Our Nation’s
Veterans. Created in May 2001 by President George W.
Bush, the group was assigned to “identify ways
to improve healthcare delivery to VA and Department
of Defense beneficiaries.” As stated in its final
report released in May 2003, the task force’s
overriding conclusion is that there exists a basic “mismatch”
between demand for services and funding to provide them.
Calling the disparity “unacceptable,” the
report states that the imbalance “if unresolved,
will delay veterans’ access to care and could
threaten the quality of VA healthcare.”
A recent report by the Governmental Accounting Office,
the government’s internal watchdog agency, underscored
the VA’s current problems but noted that they
are not for lack of effort on the part of the department:
“VA has taken actions to address key challenges
in its healthcare and disability programs. However,
growing demand for healthcare and a potentially larger
and more complex disability workload may make VA's challenges
in these areas more complex.”
The realities of the number of VA enrollees further
define the dimensions of these challenges. Although
the veteran population in America has declined in recent
years, those being served by the department is rising
significantly. For example, a comparison of the number
of veterans who received a disability rating in 1998
(95,318) versus 2002 (147,686) reveals more than a 50
percent increase. This influx added to the more than
6.5 million veterans enrolled in VHA has created a service
delivery logjam. In January 2003, nearly a quarter of
a million veterans had spent over six months on a waiting
list for their first VHA visit or an initial follow-up.
Veterans needing audiology services fare better than
those seeking other forms of healthcare. Lucille B.
Beck, Ph.D., director of audiology and speech pathology
service for the department, reports that in 2003, 80
percent of VA audiology clinics had waiting times less
than 30 days, down from an average wait in 2002 of 32.3
days and significantly reduced from the year 2000 average
of 40.4 days. This drop in wait time is particularly
noteworthy because it indicates that VA audiology is
accommodating its own influx of new beneficiaries.
The mission change in 1996 qualified veterans with
certain levels of hearing loss – whether documented
as service-related or not – to receive hearing
aids or other hearing technology. A VHA directive dated
July 2002 clarified the current position by saying,
“It is VHA policy that hearing aids and eyeglasses
must be furnished to all eligible veterans,” including
“those with any compensable service-connected
disability.”
The same directive noted that qualifying criteria
related to hearing loss continues to differ between
service regions, stating that “facility policies
on the provision of eyeglasses and hearing aids indicate
a wide variation in prescribing practices and lack of
standardization, thus compromising equity of access
to these devices across the VHA healthcare system.”
These inconsistencies and other bureaucratic frustrations
notwithstanding, as the largest single purchaser of
hearing aids in the U.S., VA audiology clearly serves
up hearing healthcare in large portions. In the third
quarter of 2003, the service dispensed 80,000 hearing
aids, an all-time high. Veterans also receive care for
tinnitus and balance problems and are provided with
assistive and alerting devices, cochlear implant management
and auditory rehabilitation.
Adding staff audiologists to help fulfill all of these
functions became easier recently, thanks to passage
of The Department of Veterans Affairs Long-Term Care
and Personnel Authorities Enhancement Act of 2003. Provisions
of the act increase the VA's ability to compete with
the private sector in hiring within certain professions,
audiology among them, as the budget allows.
Direct consumer healthcare is only one of three mission
areas for the VA’s audiology service. Within the
hearing healthcare arena, it is renowned for its leadership
in research and its strong influence in the field of
audiology. The Hearing Journal (Feb. 2000) reported,
“ ... the VA has a goal of making a difference
in audiology and advancing the profession.” To
that end, the department funds approximately $5 million
annually in research initiatives, requires vendors to
earn ISO 9000 certification – the “Good
Housekeeping Seal” equivalent for hearing device
manufacturers – and offers innovative instruction
for audiology students at its National Center for Rehabilitative
Auditory Research in Portland, Ore., all efforts designed
to make a positive impact on the health and lives of
veterans.
VA audiology research presently underway in conjunction
with the National Academy of Sciences could in fact
add to the burgeoning demand for hearing healthcare.
The Veteran’s Benefits Improvements Act of 2002
authorized these entities to work together to establish
a presumption that hearing loss is associated with certain
military skills and activities. It further authorizes
compensation for veterans who participated in the activities
presumed to cause hearing loss and now experience impaired
hearing.
Prior to the change in disability requirements allowed
by this law, many veterans presented with hearing loss
claiming it was service-related but they lacked the
necessary documentation in their military records to
receive a disability rating and thus benefit payments.
Once parameters for presumption of hearing loss associated
with military
service have been set, however, the VA may face a rush
of claims for disability compensation for “impaired
auditory acuity.”
At the base of the VA’s present and potential
future problems is lack of sufficient funding, a reality
addressed by the Presidential Task Force with a definitive
call to action. In addition to warning of a potentially
dire situation presented by an inequity in healthcare
services demand and supply, the panel exhorted the Congress
and the Executive Branch to work together to provide
full funding to address the needs of all veterans. If
citizen advocates, including those of hearing healthcare,
reinforce this appeal to our elected officials, additional
budget appropriations may remedy the present crisis
and thwart another in the future.
Watch for upcoming Hearing Health updates on VA disability
benefits for hearing loss and trends in hearing loss
among veterans and active military personnel.
VA Resources
Department of Veterans Affairs, www.va.gov
VA Audiology, www.washington.med.va.gov/Audio-speech/index.htm
VA Benefits, 800.827.1000
Health Benefits, 877.222.8387 V, 800.829.4833
TTY
Health Eligibility Center, 800.929.8387
Advocacy and Service Organizations
Veterans of Foreign Wars, www.vfw.org,
816.756.3390. VFW assists
veterans and dependents in obtaining federal or state
entitlements and helps vets seek discharge upgrades,
record corrections, education benefits,
disability compensation and pension eligibility.
Disabled American Veterans, www.dav.org,
859.441.7300. DAV represents over two million disabled
veterans and survivors. Nationwide network of
free services includes VA advocacy and is supported
by membership dues
and contributions. Publishes bimonthly online DAV Magazine,
http://www.dav.org/news/magazine/index.html.
Vietnam Veterans of America, www.vva.org,
800.VVA.1316 (800.882.1316). VVA, dedicated to Vietnam-era
veterans and their families, supports issues for more
than 50,000 members through government relations advocacy
and assistance to vets seeking benefits/services from
the government.
The Veterans Alliance Service Center,
http://vets.com. VASC
helps veterans find answers to questions about benefits,
pay or dealing with the VA, get records, find friends
and get face-to-face help.
House Committee on Veterans’ Affairs,
http://veterans.house.gov.
Reviews veterans’ programs, examines current laws
and reports on bills on veterans and the VA for healthcare,
disability compensation, GI bill education and job training,
home loan guarantees, life insurance policies and more.
Website links to recommendations of the President’s
Task Force to Improve Health Care Delivery for Our Nation’s
Veterans.
General Accounting Office, www.gao.gov.
Audit, evaluation and investigative arm of Congress.
To view decisions, follow the link to GAO Reports.
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