By Sandra Basu
WASHINGTON—VA is moving faster than it “ever has” when it comes to making complementary and integrative health (CIH) services available to veterans but needs to accelerate those efforts, a top VHA official told a House committee.
“I think, if a treatment is helpful for people, then veterans should have access to it. … I don’t think we can afford to wait for all the research to be in, because I know from my own career it will be 20 years before we can say definitely what works and what doesn’t work,” Harold Kudler, MD, VHA acting assistant deputy under secretary for patient services, testified last month.
Kudler said that more than 90% of all VAMCs have at least one kind of CIH. “We have just about expanded in every direction—yoga, meditation. … So we are moving forward,” he pointed out.
Those comments were in response to lawmakers’ calls for the availability of more CIH treatments for veterans.
Rep. Julia Brownley (D-CA) noted that lack of evidence for some of those therapies keeps them from being offered by VA, even if they are widely used outside that healthcare system.
“Why aren’t we using evidence-based practices that have already been established outside of VA and say, ‘OK, we see the efficacy here.’? Brownley asked.
Rep. Jim Banks (R-IN) asked how long veterans in his state would have to wait for greater access to these types of therapies in VA.
“We are going to have to find ways to find providers who can provide them and ways of screening veterans to decide which way to go,” Kudler responded.
The discussion occurred during a House Committee on Veterans’ Affairs hearing on post-traumatic stress disorder (PTSD), with chairman Rep. Phil Roe, MD, (R-TN) noting that “suicide rates among veterans with PTSD are not declining.”
“Despite all the good, well-intentioned work that has been done, clearly we must do more to reduce stigma against seeking care,” Roe emphasized.
Calling treatment of PTSD a “top VA priority,” Kudler said that, since fiscal year 2010, the number of OEF/OIF/OND veterans receiving mental health services has more than doubled and PTSD services overall have grown by over 50%.
“In FY 2016, more than 1.6 million veterans received mental health treatment in a VA mental health specialty program,” Kudler further explained.
At the hearing, Kudler told lawmakers that a recent decision to expand provisions for urgent mental health care needs to former servicemembers with other-than-honorable (OTH) administrative discharges was a step in that direction. The announcement was made earlier this year by VA Secretary David J. Shulkin, MD, and the agency estimated that about 500,000 former servicemembers with OTH discharges could benefit.
As for bringing more alternative therapies to veterans, Kudler touted VA’s Center for Compassionate Innovation (CCI), which serves as a way for the private sector to share new treatments or therapies with the VA.
“CCI seeks to offer hope to a subset of veterans who struggle with their physical and mental health conditions after traditional, evidence-based treatments have failed to yield the desired or optimal outcome. CCI oversees a rigorous review process to answer whether it is advisable and feasible to offer therapies that have promising anecdotal evidence but lack significant structured scientific research to a population of veterans who have exhausted the evidence-based options,” he explained in written testimony.
Veterans who were on the panel shared their experiences. Brendan O’Byrne, said that, after serving in the Army from 2002-2008, he received a 70% disability rating from VA. O’Byrne said he has worked hard to no longer be 70% disabled but has received pushback for working to lower his rating from VA workers, other veterans and family members.
“What I have to ask is this, if our goal is not to get veterans off disability and to become active, contributing members of society, then what is our goal?” he asked.
Rep. Mike Bost (R-IL) told O’Byrne he was the first person he had encountered who would like to reduce the amount of benefits he is receiving.
O’Byrne also suggested that there are veterans who are “scammers” and are seeking a higher rating without real trauma.
“In the noble efforts to help veterans and clear the backlog of VA claims, we allowed a lot of fraud into the system and it is pushing away the veterans with real trauma and real PTSD,” he said.
O’Byrne was featured in a book written by journalist, author and filmmaker Sebastian Junger, who was also on the panel. Junger said that “many of our vets seem to be suffering from something other than trauma reaction.”
“One possible explanation for their psychological troubles is that, whether they experience combat or not, transitioning from the kind of close communal life of a platoon to the alienation of modern society is extremely difficult,” he said.
He further explained that, “when you collapse modern society—such as during the London Blitz or the attacks of 9/11—there is often an improvement in mental health. It is thought that the enforced communalism of a crisis actually buffers people from suicide and depression.”
A facility-specific survey found that 138 of 140 VA facilities reported shortages of medical officers, with psychiatry and primary care positions being the most frequently listed.
When Terrence O’Neil, MD, retired as chief of nephrology at the James H. Quillen VAMC in Johnson City in December 2016, he left in his wake decades of work treating kidney disease—nearly 35 years in the Air Force and DoD, plus 11 more at VA.