THE NEWLY PASSED PACT ACT AMOUNTS TO INADEQUATE VETERANS LEGISLATION ON A FEW DIFFERENT POINTS
Providing just treatment doctors or just research doctors is a non-starter for many veteran patient groups. It's the point of failure that has to be fixed.
Most of the people who are seated as Congressperson or Senator on both the House and Senate Veteran’s Committees; are civilians with no military background at all. Even worse, most of them are not even former medical workers. Those who are, either have no background in military medicine or in environmental medicine. Straight off the legislative drafting table, the bills are coming out with language that needs urgent correction by those veterans who are insiders to the process. Bills often flourish at face value without this needed correction, and such was the case with the PACT Act. The Fort McClellan Veterans group was omitted from their own legislative process.
Additionally, the VA usually remains silent on any medical industry mistakes that often lurk inside the bills. If you add in the misplaced interferences of veteran’s social membership clubs and new generation veterans who have no idea about what is “supposed” to be happening in the environmental medicine process, then this is what the public actually saw in the news stories and TV. The PACT Act passed with no environmental medicine doctors backing it. By itself, this speaks volumes about the integrity of the bill. The actual medical patients in the bill look for that important sign, which is almost always never there.
The McClellan Vets group has been advocating toxic exposure bills inside the legislative system for eighteen years now. This story is about their experience with it. What happens inside of bills can be best explained by simply saying that the VA doesn’t even hire doctors who are licensed in the specialized practice of environmental medicine or health. The PACT Act went whizzing past public eyes with no obvious fix to that part of the crisis. None of the VA doctors are “board certified” by the American Board of Environmental Medicine1. Both Congress and the VA have been repeatedly asked by the veterans for this point to be the centerpiece of fixes in any new bills. It wasn't. (A list of VA unskilled clerical offices2 is posted instead.) They do nothing for the veterans who have tried this.
The use of tricky legislative language found in the PACT bill tends to keep VA problems in place instead of solving them. The PACT Act was a preferential patient treatment bill for the burn pit veterans while leaving the McClellan Vets in the dust. Here is one way it does that. Inside the VA processing system for environmental medical patients, there are four categories of doctors that medical patients need, but can't find or use. Veterans say that understanding what the differences are between these categories, is critical to judging the quality of a bill. For some veterans who are not in the burn pits group, the PACT Act has done nothing at all to remedy this part of their national processing crisis.
1. Toxic exposure declaration doctors, either for individual cases or at the patient population level. These absolutely DO have to be board certified and specialized in their medical practice. They should be situated either inside the VA disability claims process or in the VA hospital system at the open clinic level. Right now, they are not. The medical patient access to environmental declaration experts is limited to GAO Office reports & the Agency for Toxic Substances, which is not part of the VA.
2. Treatment doctors. These are NOT the same as toxic exposure declaration doctors. The VA likes to confuse onlookers by saying that all doctors are the same when they really aren't. Any specialized treatment doctor can treat a toxic exposure case that's within their medical specialty. A doctor who normally treats diabetes cases can also treat a toxic exposure case just fine if the patient has diabetes. But making a toxic exposure determination is outside their practice level unless they consult with an environmental medicine doctor. At the VA, this is never done.
3. Disability exam doctors for VA Comp and Pen benefits. These are very often general medicine doctors who have only had a VA “workshop” level of training for certain toxic exposure patient groups such as the Gulf War Veterans. Veterans know this internally because they receive a copy of their workshop list. Other exposure veterans who are not on their workshop list are blocked from a toxic exposure exam. These doctors should technically recuse themselves from the exam, but they don't.
4. Research doctors are mostly for numerical patient studies and are a lot more like statisticians. These are only available through legislation. Also as a side note, the age of certain patient groups is disqualifying from this approach if only a numerical study is used all by itself. This point is widely known throughout the industry, and the VA has told the veterans as much at meetings with them.
The VA and Congress take their turns using wordplay in medical legislation bills to trick supporters. The veterans actually need four different categories of doctors to be in place as they move through the various parts of the toxic exposure process. Among other things, the PACT Act is a miserable failure in solving this need.
Susan Frasier
Toxic Exposure Army Veterans of Fort McClellan
ft_mcclellan_vets1@yahoo.com
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1 https://coem.com/about-us/faqs/american-board-of-environmental-medicine/
2 https://www.publichealth.va.gov/exposures/coordinators.asp#NewYork
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