Montana Legislative Issues
November 11th Hungry Horse Veterans Memorial Bridge Dedication
HUNGRY HORSE: Veterans’ Memorial Bridge Dedication – South Fork Bridge, 2 – 4pm
Please join Senator Dee Brown and local Veterans’ organizations to unveil the Veterans Memorial in Hungry Horse, MT and dedicate the South Fork Bridge to county veterans Killed in Action. It dedicates the new bridge to Flathead County Veterans and establishes a memorial with names of individual veterans killed in action.
Public notice was published in your local newspaper regarding the Veterans’ Memorial Bridge Dedication scheduled November 11th at 2:00 pm in Hungry Horse. In an effort to ensure that the whole community is aware of the dedication, and that every individual has an opportunity to attend, and have his or her questions, comments, or concerns answered and addressed, we are asking you to partner with us in sharing information regarding the Veterans’ Memorial Bridge Dedication.
Honor and Remember Medallion
During the 2017 Legislative Session, Gov. Bullock signed into Montana state law the Honor and Remember Act, which authorizes the Honor and Remember Medallion (HRM) for family members of servicemen or women who have passed in the service of their country while engaged against hostile military forces. The Medallion – its appearance and presentation criteria – is based upon the Department of Defense and U.S. Congress’ determination of the Gold Star Family standard, and as adopted by Montana state statute. As such, specific family relationships are authorized the Honor and Remember Medallion – as designated on its application form. The Medallion’s presentation criteria honors previously relevant state laws that allowed for a Medallion, at no charge, for one family member; as well as, the recently passed legislation which expands the Medallion’s availability to all authorized family members (per Gold Star Family standards). Expanding the availability was the right thing to do, but it also significantly increased the cost of the program; therefore, there is a cost of $20 for any additional family member to receive the Medallion. While there was apprehension to include a fee, it was necessary for the greater good of the Honor and Remember Medallion program in that it could be, long-term, as financially self-sustaining as possible. While the $20 does not cover all the costs of the Medallion, its presentation case, the engraving and other expenses; it does – as augmented by donations – ensure its perpetual availability. Please visit the Montana Veterans Affairs Division website at mt.gov to obtain the application and instructions.
National Legislative Issues
Stay informed about the issues that affect Vietnam Veterans.
VA Health Care Data for iPhone
In honor of Veterans Month this November, the U.S. Department of Veterans Affairs (VA) is rolling out nationwide access for Veterans to their VA health data, alongside their health records from other health care providers in one place, in the Health Records section of the Health app for iPhone.
Now, patients will be able to see their medical information from various participating institutions, including VA, organized into one view. The view covers allergies, conditions, immunizations, lab results, medications and procedures and vitals. Veterans will also receive notifications when their data is updated.
“We have delivered Veterans an innovative new way to easily and securely access their health information,” said VA Secretary Robert Wilkie. “Veterans deserve access to their health data at any time and in one place, and with Health Records on the Health app, VA has pushed the Veterans experience forward.”
This capability was developed through VA’s Veterans Health Application Programming Interface (Veterans Health API), first revealed in February, and has topped 2,000 users. The Veterans Health API allows private sector organizations to create and deploy innovative digital applications that help Veterans access their health records in new ways. Health Records data is encrypted and protected with the user’s iPhone passcode, Touch ID, or Face ID.
Beyond this effort with Apple, VA plans to partner with other organizations to bring similar capabilities to other mobile platforms.
Senate Passes Veterans Benefits and Transition Act
The United States Senate passed Ranking Member Jon Tester’s 21st bipartisan bill, capping off a landmark Congress with numerous victories for America’s veterans.
Tester’s Veterans Benefits and Transition Act contains 18 bipartisan bills, including the following six bipartisan Tester-authored bills to honor Native American veterans, better protect student veterans, and increase the transparency and accountability of the VA’s historic electronic health records transition.
The Servicemembers Improved Transition through Reforms for Ensuring Progress “SIT-REP” Act:Forces schools that receive G.I. Bill benefits to adopt a policy that it will not impose a late fee, restrict a student veterans’ access to campus facilities, or otherwise punish a student veteran due to a late payment of tuition or fees from the VA.
Tribal Veteran Burial Benefits Act:Authored by Tester and Senator Dean Heller (R-Nev.), the VA can now provide headstones or burial markers to a Native American veteran’s spouse and dependents who wish to be buried alongside their loved one in a tribal veterans’ cemetery.
Veteran Debt Fairness Act:Following reports that the VA had been forcing veterans to repay benefits to the VA, Tester authored legislation with Senators Sherrod Brown (D-Ohio) and Richard Blumenthal (D-Conn.) to require the VA to update its information technology systems so that affected veterans are able to review and revise information about their dependents electronically.
Veterans Fair Debt Notice Act:Tester authored this legislation with Senator Deb Fischer (R-Neb.) to require the VA to notify veterans with a straightforward, easy-to-understand electronic or standard mail notification of any debt that veteran owes to the VA and the steps they can take to dispute that debt.
Veterans’ Electronic Health Record Modernization Oversight Act:As the VA undertakes the largest electronic health records change in history, Tester and Blumenthal authored legislation to make the modernization program’s key planning and implementation efforts more transparent and hold the VA accountable by requiring the VA to notify Congress in the event of any significant cost increase, schedule delay, loss of veteran health data or breach of privacy.
Veterans’ Dental Care Eligibility Expansion and Enhancement Act:The VA is required to report on the possibility of expanding veterans’ access to dental care. By analyzing access and affordability through VA dental care, oral health needs of eligible veterans, and the number of providers needed to provide such care.
“This legislation is the product of hard work, compromise and bipartisanship,” said Tester, Ranking Member of the Senate Veterans’ Affairs Committee. “Sending another VA reform bill to the President’s desk sends a clear message to our nation’s veterans: Serving our men and women in uniform is a responsibility that we should all take very seriously. I have been honored to work with Chairman Isakson this Congress to accomplish so much for our nation’s veterans.”
News from National Academies of Sciences, Engineering and Medicine
Nov. 15, 2018
FOR IMMEDIATE RELEASE
Hypertension Upgraded in Latest Biennial Review of Research on Health Problems in Veterans That May Be Linked to Agent Orange Exposure During Vietnam War
WASHINGTON — The latest in a series of congressionally mandated biennial reviews of the evidence of health problems that may be linked to exposure to Agent Orange and other herbicides used during the Vietnam War found sufficient evidence of an association for hypertension and monoclonal gammopathy of undetermined significance (MGUS). The committee that carried out the study and wrote the report, Veterans and Agent Orange: Update 11 (2018), focused on the scientific literature published between Sept. 30, 2014, and Dec. 31, 2017.
From 1962 to 1971, the U.S. military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, destroy crops that those forces might depend on, and clear tall grass and bushes from the perimeters of U.S. bases and outlying encampments. The most commonly used chemical mixture sprayed was Agent Orange, which was contaminated with the most toxic form of dioxin. These and the other herbicides sprayed during the war constituted the chemicals of interest for the committee. The exact number of U.S. military personnel who served in Vietnam is unknown because deployment to the theater was not specifically recorded in military records, but estimates range from 2.6 million to 4.3 million.
Hypertension was moved to the category of “sufficient” evidence of an association from its previous classification in the “limited or suggestive” category. The sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association. A finding of limited or suggestive evidence means that epidemiologic research results suggest an association between exposure to herbicides and a particular outcome, but a firm conclusion is limited because chance, bias, and confounding factors could not be ruled out with confidence. The committee came to this conclusion in part based on a recent study of U.S. Vietnam veterans by researchers from the U.S. Department of Veterans Affairs (VA), which found that self-reported hypertension rates were highest among former military personnel who had the greatest opportunity for exposure to these chemicals.
The committee concluded that there was sufficient evidence of an association between exposure to at least one of the chemicals of interest and MGUS, a newly considered condition. This finding is based on a recent study in which investigators found a statistically significant higher prevalence of MGUS in Vietnam veterans involved in herbicide spray operations than in comparison veterans. MGUS is a clinically silent condition that is a precursor to the cancer multiple myeloma, but only an estimated 1 percent of MGUS cases progress to multiple myeloma each year.
While some new studies suggest an association might exist between exposure to the chemicals of interest and Type 2 diabetes, the committee could not come to a consensus on whether this and the other available evidence continued to be limited or suggestive, or merited elevation to sufficient. Both newly and previously reviewed studies consistently show a relationship between well-characterized exposures to dioxin and dioxin-like chemicals and measures of diabetes health outcomes in diverse cohorts, including Vietnam veteran populations. The risk factors for diabetes, such as age, obesity, and family history of the disease, were controlled for in the analyses of most studies reviewed. However, some members of the committee believed that the lack of exposure specificity and the potential for residual uncontrolled confounding influences complicated attribution of the outcome to the chemicals of interest.
In addition, VA asked the committee to focus on three health outcomes: possible generational health effects that may be the result of herbicide exposure among male Vietnam veterans, myeloproliferative neoplasms, and glioblastoma multiforme. The evidence of association for exposure to the chemicals of interest and glioblastoma (and other brain cancers) remains inadequate or insufficient, the committee concluded. While it is appropriate for VA be mindful of the concerns raised about the possible association between Vietnam service and glioblastoma, the outcome is so rare and the information concerning herbicide exposures so imprecise, that it is doubtful that any logistically and economically feasible epidemiologic study of veterans would produce meaningful results regarding the association between exposures and the disease. For this reason, the committee recommended that VA should focus on fostering advancements to inform improved glioblastoma treatment options.
There are relatively few studies on the health effects of paternal chemical exposures on their descendants, and none address Vietnam veterans specifically. Therefore, the committee recommended further specific study of the health of descendants of male Vietnam veterans.
Myeloproliferative neoplasms and myelodysplastic syndromes are diseases of the blood cells and bone marrow. The committee’s search of epidemiologic literature yielded only one relevant paper on these diseases — a study of these cancers in Vietnam veterans that was reviewed in a previous update. Given this paucity of research, the committee recommended that investigators should examine existing databases on myeloid diseases to determine whether there are data available that would allow for an evaluation of myeloproliferative neoplasms in Vietnam veterans and others who have been exposed to dioxin and the other chemicals of interest.
Although progress has been made in understanding the health effects of military herbicide exposure and the mechanisms underlying these effects, significant gaps in knowledge remain. The committee restated recommendations for research activities outlined in previous updates in this series, including toxicologic, mechanistic, and epidemiologic research. Such work should include efforts to gain more complete knowledge through the integration of information in existing U.S. Department of Defense and VA databases.
The committee noted that the difficulty in conducting research on Vietnam veteran health issues should not act as a barrier to carrying out such work. There are many questions regarding veterans’ health that can only be adequately answered by examining veterans themselves, thereby properly accounting for the totality of the military service experience.
The study was sponsored by the U.S. Department of Veterans Affairs. The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln. For more information, visit nationalacademies.org.