FORUM translating research 

into quality health care 

for veterans

A publication of the VA Office of Research 

& Development, Health Services Research 

& Development Service, Center for 

Information Dissemination and Education 

Resources, in conjunction with AcademyHealth 

Special Supplement 

September 2005 

Contents 

Director’s Letter 2 

Response to Commentary 3 

Research Highlights 4 

Organizational Profile 7 

VA Health Services Research & Development Service 

New Veterans and New Challenges 

By Michael J. Kussman, M.D., M.S., M.A.C.P., Deputy Under Secretary for Health 

The conflicts in Iraq and Afghanistan have the processes we have put into place to serve 

brought a renewed sense of mission to Veterans Operation Iraqi Freedom (OIF) and Operation 

Health Administration (VHA) employees, as we Enduring Freedom (OEF) veterans. 

begin to see more and more young men and 

women with war-related wounds and trauma at One lesson we’ve learned is that the best 

our health care facilities. While we are all sad­ mechanism to coordinate care and benefits fo

dened by their injuries and illnesses, the good new veterans is to reach out early and often 

news is that modern military medicine has before they have separated from military service

brought better care than ever to the front lines— We have stationed VA employees at major mil

saving lives, increasing the numbers of service tary treatment facilities as a resource to those 

members that can be returned to combat, and requiring information about VA benefits, and 

improving the prognosis of many who must be to facilitate coordination with our health care 

returned home for further medical treatment. system. These employees have unsnarled red 

tape, improved communications, and generall

VA employees have excelled at finding new made the transition from service member to 

ways to cut through red tape and to operate as veteran a far simpler task than their parents o

teams to ensure that discharged service mem­ older siblings faced. 

bers are seamlessly transitioned from active 

duty to veteran status—and that they receive To improve this transition further, hospital 

the timely benefits and medical care they are directors and other senior leaders should rouentitled to. I am particularly proud of our out­ tinely reach out to nearby military facilities an

standing efforts to help the heroes whose care offer to speak about VA benefits and services. 

has been entrusted to us by the Department of Current service members are, in many cases, 

Defense (DoD), even before their discharge our future clients—even those who select 

from service. Many of these badly wounded Tricare as their option for care when they 

men and women have received personalized return to civilian life. And our health services 

care on a level that VHA has never before pro­ researchers should begin to look at non-tradivided to veterans of any war. tional means for collaborating with DoD to 

produce not only healthier soldiers by creating 

Now, however, is the time to apply the lessons strategies to improve short-term health outlearned from the Seamless Transition process comes, but also healthier veterans through 

to all of the heroes it is our privilege to serve. strategies that will improve long-term outOur efforts should no longer be differentiated comes for active duty service members. 

by periods of service—or limited to those 

recently returned from combat. To be of value, Once OIF and OEF veterans have separated 

VA must provide exemplary care to all who are from service, the Secretary of Veterans Affairs 

entitled to our care, whenever it is needed. We 

must now begin to institutionalize and expand continued on page 
2 ■ Forum/September 2005 

sends each one a letter, thanking them for 

their service to our Nation, and providing 

information on VA benefits and health care. 

Nearly 300,000 such letters have been sent; 

it is now time to extend this program to all 

newly separated veterans, whether or not 

they served in a theater of combat operations. Non-combat veterans, too, may be 

eligible for our care and we need to reach 

out to them at our earliest opportunity. 

“VHA is committed to growing 

and learning from our experiences 

in serving our newest generation 

of veterans. There is much we can 

be proud of in our performance 

thus far.” 

Another lesson we have learned is that the 

expectations of this new generation of service members and veterans are different 

from those who have come before them. 

Today’s armed services embrace and enfold 

members and their families in a blanket 

of service and support. This approach 

allows service members to focus on their 

assignments and the military’s explicit 

missions. OIF and OEF patients and their 

families have made it clear they expect the 

same level of service and support from VA, 

as they transition to VA health care. We 

must listen to those needs and determine, 

as an organization, the best ways to 

respond to those expectations for all of the 

veterans we serve. 

VHA is committed to growing and learning 

from our experiences in serving our newest 

generation of veterans. There is much we 

can be proud of in our performance thus 

far. But we must now use our new-found 

knowledge to improve our ability to care for 

all veterans, from every era, who entrust us 

with the awesome responsibility of providing them with the world-class health care 

their service and sacrifices for our Nation 

have entitled them to. ■ 

About the Author 

Brig. Gen. Michael J. Kussman, M.D., (U.S. 

Army Ret.) was recently appointed Deputy 

Under Secretary for Health. In this capacity, 

he has broad responsibility for the clinical poli

cy and programs within the VA system. He 

brings to his position the pragmatism of an 

experienced executive with the compassion 

and acumen of a seasoned clinician. 

Dr. Kussman became the Army Surgeon 

General’s chief consultant in internal medicin

and governor for the Army Region of the 

American College of Physicians in 1988. 

Dr. Kussman went on to command Walter 

Reed Health Care System in Washington, 

D.C., where he was promoted to brigadier 

general. He later served as commander of the 

Europe Regional Medical Command, command surgeon for U.S. Army Europe, and 

TRICARE lead agent for Europe. In this 

capacity, he was responsible for Army health 

care throughout Europe, the Middle East, 

and Africa. 

Dr. Kussman received many military decorations, including the Distinguished Service 

Medal (the highest award given in peace 

time). Dr. Kussman received the prestigious 

“A” designator from the Army Surgeon 

General, which identifies professorial rank, 

and the Laureate Award from the American 

College of Physicians/American Society of 

Internal Medicine, as well as being selected as 

a Master of the College. He is board certified 

in internal medicine and serves on the faculty 

of the Uniformed Services University of Healt

Sciences. 

This past spring, HSR&D released new 

research priorities for funding through 

fiscal year 2006. These priorities are 

intended to address the needs and challenges of all veterans that we have the privilege to serve, including our new veterans 

with unique needs. For full details about 

these funding priorities, visit the HSR&D 

Web site at www.hsrd.research.va.gov/ 

for_researchers/funding/solicitations. 

Director’s Letter 

We are pleased to welcome Joel 

Kupersmith, M.D., as our new Chief 

Research and Development Officer 

(CRADO). Dr. Kupersmith brings years of 

experience as a cardiologist, researcher, 

policy expert, and academic leader to the 

position. We look forward to working 

closely with Dr. Kupersmith on health services research and in support of the full 

spectrum of research across the Office of 

Research and Development. 

At the same time, we express our heartfelt 

appreciation to Stephan D. Fihn, M.D., 

who demonstrated extraordinary dedication and leadership as Acting CRADO 

since July 2004. In June, Jonathan B. 

Perlin, M.D., Ph.D., presented Dr. Fihn 

with the VHA Exemplary Award for his 

outstanding service. 

We also are delighted that both Dr. Perlin 

and Michael J. Kussman, M.D., M.S., 

M.A.C.P., have been confirmed as Under 

Secretary for Health and Deputy Under 

Secretary for Health, respectively. Both 

have been extremely supportive of health 

services research, and we look forward to 

continuing a productive relationship as we 

strive to improve the cost, quality, and 

effectiveness of health care for veterans. 

In this special supplement, we turn our 

attention to the challenges presented by 

our newest generation of veterans, those 

who have served or are now serving in 

Afghanistan and Iraq. Many of these 

young men and women are returning 

from combat with severe injuries that 

require extensive hospitalization and rehabilitation. VA is a leader in providing the 

specialized care needed by these veterans 

and in offering the support needed by 

their families. In this issue, we discuss 

just some of the recent and ongoing 

research and activities that will help VA to 

better understand and meet the important 

challenges presented by these new veterans and improve the care and outcomes 

for all veterans that we serve. 

Shirley Meehan, M.B.A., Ph.D. 

Acting Director, HSR&D 
Forum/September 2005 ■ 

Response to Commentary
 

VA Research: Meeting the Challenge of a New 

Generation of Veterans 

By Stephan D. Fihn, M.D., Director, Seattle HSR&D Center of Excellence 

During its transformation over the past departments, and recognition that these vetdecade from a collection of loosely orga­ erans have sustained injuries and developed 

nized and inefficient hospitals to a tightly problems that are unique to this war. 

integrated network of 157 hospitals, 869 

outpatient clinics, and 134 nursing homes, For the first time in history, relatively large 

VA has become a far more responsive and numbers of soldiers are surviving with mulnimble organization. Once a provider of tiple amputations, in part due to protection 

mainly episodic inpatient care, the VA system of vital organs by body armor and the availnow emphasizes coordinated primary care ability of prompt, effective medical and surguided by explicit performance measures. gical care in the field. These injuries are 

occurring mainly in fit, young soldiers who 

Far from the lethargic bureaucracy that are highly motivated to resume functional, 

many critics once derided, VA is constantly fulfilling lives. Severe blast injuries caused 

evolving in an attempt to provide better by improvised explosive devices induce 

and more efficient health care. The return severe disabilities that may include blindof thousands of wounded veterans from ness, deafness, and/or cognitive impairthe ongoing conflicts in Iraq and ment. Prolonged rotations, arduous duty, 

Afghanistan has created a powerful imper­ and omnipresent danger have resulted in 

ative for further change and improvement. an incidence of post-traumatic stress synAnd as Dr. Kussman elucidates in his com­ drome that is at least as high as in previous 

mentary, VA has rapidly undertaken a major wars and perhaps higher. Led by Dr. 

number of ambitious initiatives to meet Kussman and his staff, VA has aggressively 

this challenge. set out to address these problems and to 

establish new standards for identification, 

intake, and care of patients entering the Active Outreach Characterizes Response health care system. 

It might seem relatively straightforward to 

cope with this influx of new patients. New Approach Offers Generalizable 

Hasn’t VA been receiving large numbers of Model 

wounded veterans for more than half a 

century? And isn’t the number of ill veter­ Health services investigators should view 

ans who have returned from the Gulf rela­ the influx of new veterans in the context of 

tively small in relation to the more than 5 VA’s ongoing transformation. As a health 

million veterans who currently receive care care system, we need to become more 

in the VA system? Although the answer to proactive, both in identifying prospective 

both questions is yes, Dr. Kussman patients and in anticipating their medical 

describes a response that is very different problems. This approach contrasts with the 

from the manner in which VA provided “old” passive system of simply waiting for 

care to returning veterans in the past. The patients to show up and reacting to their 

VA’s response to the newest generation of needs. Moreover, this new approach is a 

returning combat veterans involves active generalizable model and one that relies 

outreach, coordination of care with other upon surveillance of prospective patients. 

One could readily envision applying this 

approach to patients already in the system 

as well as those entering the system. These 

evolutionary changes will provide invaluabl

opportunities for research and, to exploit 

them, we need to continue to widen our 

vision as to what constitutes the VA health 

care system. 

We have moved from inpatient to outpatien

settings and now we need to think beyond 

those settings into the home and the community. Potential sites of care should include 

residential facilities, homes, and communit

centers, among others. The increasingly 

ubiquitous Internet, sophisticated but inexpensive wireless devices, and wearable mon

itoring equipment will provide exciting cha

lenges to rethink how health care is delivered. At this very moment, My HealtheVet 

is being deployed nationally and will provid

an unparalleled opportunity to reach a 

broad audience, to communicate with 

patients outside of the usual hospital and 

clinic settings, and to engage patients more 

fully in their own health care. 

There has, however, been regrettably little 

involvement by health services researchers 

in designing or evaluating potential applica

tions for this bold innovation. As with our 

clinical leaders, investigators must refashio

their notions about the very nature of health 

services. As the world changes, we should no

only keep up, but we must help set the pace. ■ 

HSR&D encourages our investigators to 

remain veteran-focused in their research 

and to provide early notification of manuscripts accepted for publication. Timely 

notification enables HSR&D to brief VA 

senior leaders and others about your 

valuable contributions and will help keep 

our programs vibrant despite budget constraints. For the notification process, see 

www.hsrd.research.va.gov/for_researchers/ 

pub_notice.cfm#a. 
4 ■ Forum/September 2005 

Research Highlights
 

Post-Traumatic Stress Disorder in Primary Care: 

Barriers to Care 

By Kathryn M. Magruder, M.P.H., Ph.D., Ralph H. Johnson VA Medical Center 

In a recent study of 746 randomly selected 

VA primary care patients from four VA hospitals, we found the prevalence of posttraumatic stress disorder (PTSD) to be 11.5 

percent.1 In addition to examining the 

prevalence of PTSD, we set out to determine 

the extent to which providers recognize 

PTSD symptoms in their patients. We used 

the Clinician Administered PTSD Scale, or 

CAPS, and a trauma assessment interview 

as our PTSD diagnostic assessment tools. 

Of those patients diagnosed with PTSD, a 

12-month medical record review indicated 

that providers identified only 46.5 percent 

and only 47.7 percent had used mental 

health specialty services. Patients who suffered from PTSD and who had used mental 

health care in the past 12 months were 

more apt to be identified as having PTSD 

than non-mental health service users (78.0 

percent vs. 17.8 percent). 

Since 1980, when the diagnosis of PTSD was 

first codified in the American Psychiatric 

Association’s Diagnostic and Statistical 

Manual III, VA has been a leader in all 

aspects of treatment for and research on 

PTSD. Why, then, did we find that fewer 

than half of the patients who met criteria 

for a research diagnosis of PTSD had been 

either recognized as having PTSD by their 

providers or used mental health services? 

Many factors affect the quality of care and 

service use for mental health conditions 

encountered in primary care settings. 

Patients may feel reluctant to discuss mental 

health problems—especially PTSD—with 

primary care providers. Some symptoms of 

PTSD are more somatic than psychological 

in nature (e.g., sleep disturbance, arousal); 

patients may report these symptoms to 

their providers as medical problems as 

opposed to a mental disorder. Patients may 

not understand that they have a mental 

health condition, or, they may understand 

they are suffering from a disorder but not 

know that it is appropriate to discuss their 

symptoms with a primary care provider. 

“We need a better understanding 

of the barriers to treating PTSD, 

including patients’ and providers’ 

knowledge, attitudes, and perceptions of PTSD and its treatment.” 

Furthermore, patients may feel that mental 

illness is a stigmatized condition—a sign of 

weakness, inability to cope, or embarrassment. It may also be difficult to talk about 

the traumatic events that contributed to 

PTSD. As a result, many patients feel reluctant to discuss PTSD (and other mental 

health issues) with their primary care 

providers and would be reluctant to see a 

mental health provider. 

From the primary care providers’ point of 

view, their training emphasizes medical illness rather than psychiatric disorders. They 

may not know how to interpret symptoms 

of PTSD—especially when patients emphasize somatic symptoms. They, too, may feel 

uncomfortable in addressing mental health 

issues and traumatic events, and may have 

concerns about losing their patient’s trust 

by bringing up the topic of mental illness. 

Or, primary care providers may have doubts 

about the effectiveness of mental health 

treatments. Finally, many patients in the VA 

have multiple medical problems, and 

providers may find themselves needing to 

prioritize and make decisions about which 

problems to address in a single visit. PTSD 

and other mental disorders simply may not 

make it to the top of the list. 

Last, system factors may also serve as barri

ers to identifying and treating PTSD. The 

primary care visit is typically not long 

enough to address both the medical and 

psychological problems that veterans have 

(not to mention preventive health issues). I

a patient is suspected of having PTSD, it 

takes time to investigate the symptoms mor

thoroughly, educate the patient about the 

diagnosis, and outline the choices of therapy 

(including referral to mental health). 

Furthermore, even if a patient is willing to 

accept a referral, many facilities have 

lengthy wait times for mental health 

appointments; providers may be reluctant 

to burden the specialty care system. 

A number of advances in treatment of PTSD 

have led to the development of treatment 

guidelines, including one jointly developed 

by VA and DoD that includes recognition and 

treatment of PTSD in primary care settings.

Guidelines, however, will not be successful i

patients and providers avoid addressing 

PTSD. We need a better understanding of 

the barriers to treating PTSD, including 

patients’ and providers’ knowledge, attitudes, and perceptions of PTSD and its trea

ment. Understanding these barriers will pro

vide a framework for developing patientand system-level interventions that can 

improve the timeliness and appropriatenes

of PTSD treatment, as well as acceptance o

that treatment by VA patients. ■ 

References 

1 Magruder KM, Frueh BC, Knapp RG, et 

al. Prevalence of posttraumatic stress disor

der in Veterans Affairs primary care clinics

General Hospital Psychiatry 27 (2005) 169­

179. 

2 VA/DoD Clinical Practice Guideline for 

the Management of Post-traumatic Stress: 

www.oqp.med.va.gov/cpg/cpg.htm. 
Forum/September 2005 ■ 

Evaluation of Combat Veterans: Lessons Learned 

from the War Related Illness and Injury Study 

Center—Washington, D.C. 

By Mitchell T. Wallin, M.D., M.P.H., and Julie C. Chapman, Psy.D., both from the 

Washington, D.C., VA Medical Center 

Wars have long affected the health of veterans in multiple ways. From the Civil War to 

the Gulf War (GW), a variety of physical and 

psychological stressors have placed military 

personnel at high risk for adverse health 

effects.1 DaCosta syndrome, effort syndrome, 

combat stress reaction, post-traumatic 

stress disorder, and GW illness are some of 

the war-related illnesses that have been 

described during the past two centuries. 

Veterans of these wars frequently complain 

of similar symptoms, including fatigue, 

memory and concentration difficulties, 

headaches, gastrointestinal complaints, and 

sleep disorders. These complaints are nonspecific and are also commonly documented in patients who present to general medical facilities.2 Historically, however, there 

has never been an identified physiological 

illness related to combat exposure that does 

not also have a psychological contribution. 

VA introduced two War Related Illness and 

Injury Study Centers (WRIISC) by a competitive peer reviewed process in 2001 to 

address the health issues of veterans who 

have returned from the combat theater 

(please visit www.va.gov/WRIISC-DC). The 

centers focus on four topic areas: 1) clinical 

care, 2) education, 3) research, and 4) risk 

communication. The clinical program at the 

WRIISC-DC has evaluated more than 400 

veterans who have served in military conflicts 

through its outpatient and inpatient referral 

program. A number of conferences and multimedia products have been produced to educate health care providers, veterans, and their 

families about combat-related health issues. 

With its emphasis on epidemiologic studies, 

the WRIISC-DC has provided a new catalyst 

for collaborative research on deploymentrelated illness and injuries. Members from 

our center have addressed morbidity and 

mortality in GW veterans through a number 

of studies. Preliminary data from veterans 

serving in Operation Iraqi Freedom and 

Operation Enduring Freedom reveal high 

rates of mental disorders and post-traumatic 

stress disorder.3 

“With its emphasis on epidemiologic studies, the WRIISC-DC has 

provided a new catalyst for collaborative research on deploymentrelated illness and injuries.” 

In reviewing the research experience of GW 

veterans, many studies have used highly 

selective samples of patients that present to 

referral programs. The participants in these 

studies may not be representative of the 

deployed troops. Bias introduced through 

the selection process limits the accuracy and 

generalizability of results. Consequently, we 

would argue that population-based epidemiologic data is the preferred source for 

assessing the health of veterans. 

The current authors and colleagues were 

funded by VA Health Services Research and 

Development Service to evaluate the cognitive health of a population-based sample of 

GW veterans. Cases were deployed to the 

GW theater and met Centers for Disease 

Control and Prevention criteria for multisymptom illness. Controls were also 

deployed to the GW theater, but did not 

meet criteria for multisystem illness. All 

subjects completed a day of neuropsychological evaluation, including measures of 

premorbid ability and effort. The case and 

control groups did not differ significantly 

on demographic variables. Interim analysis 

revealed that cases differed from controls 

primarily on self-reported measures of 

symptoms. Specifically, on self-reported 

measures of physical, emotional, and socia

functioning, the case group endorsed significantly poorer functioning than the contro

group. None of the primary neuropsychological outcome variables differed significantly between groups. Final analysis is 

under way and results will be forthcoming. 

In order to continue to meet the needs of 

combat veterans, future research studies 

will require careful attention to the specific 

questions asked and the appropriateness of 

the population and methods used. The 

WRIISC-DC serves as a resource for VA 

investigators interested in the health outcomes of combat veterans. ■ 

References 

1 Hyams KC, Wignall FS, Roswell R. War 

syndromes and their evaluation: from the 

US Civil War to the Persian Gulf War. 

Annals of Internal Medicine 1996; 125:5:398

405. 

2 Kroenke K, Arrington ME, Mangelsdorff 

AD. The prevalence of symptoms in medical outpatients and the adequacy of therapy. Archives of Internal Medicine 1990; 

150:1985-1989. 

3 Kang HK, Hyams KC. Mental Health 

Care Needs among Recent War Veterans. 

New England Journal of Medicine 2005; 

352:1289. 
6 ■ Forum/September 2005 

Weinberger Receives John 

M. Eisenberg Excellence 

in Mentorship Award 

Morris Weinberger, Ph.D., a VA 

Health Services Research and 

Development Service (HSR&D) 

Career Scientist Awardee and a 

faculty member of the School of 

Public Health at the University of 

North Carolina at Chapel Hill 

(UNC), has won the 2005 John M. 

Eisenberg Excellence in 

Mentorship Award from the 

Agency for Healthcare Research 

and Quality (AHRQ). The award 

recognizes faculty serving in a 

mentoring capacity at institutions 

participating in training programs 

of the National Research Service 

Award (NRSA). AHRQ awards 

NRSA fellowships and training 

grants to foster health services 

research training opportunities 

across the country. 

“Morris is interested in the growth 

of students as researchers and as 

professionals,” said Timothy Carey, 

M.D., director of UNC’s Cecil G. 

Sheps Center for Health Services 

Research and the AHRQ fellowship 

at the University of North Carolina. 

“His legacy will not just be the 

papers he has authored or the 

research he has led, it will be the 

generations of researchers whose 

work he has supported.” 

The award was named for the late 

John M. Eisenberg, M.D., who 

directed AHRQ from 1997 to 2002. 

Research Highlights
 

Evidence-Based Research Priorities to Improve the 

Health and Health Care of Women Veterans 

By Elizabeth M. Yano, Ph.D., M.S.P.H., Sepulveda HSR&D Center of Excellence for the Study of 

Healthcare Provider Behavior, and Linda R. Lipson, M.A., HSR&D Central Office 

Women now comprise 20 percent of new mili­ depression. Similarly, the literature synthesis 

tary recruits, 15 percent of active duty forces, demonstrated knowledge gaps regarding 

and 17 percent of reserve and National Guard women veterans’ specific health risks and qual

forces. They are among the fastest growing ity of care, as well as limited data on efficaciou

segment of new users in the VA health care treatments for key high-prevalence conditions. 

system and represent new challenges to the 

design and delivery of health care that has tra­ Achieving Consensus on Priorities ditionally focused on men. The VA’s research 

enterprise provides a valuable opportunity to The resulting gap analysis provided a foundation improve our understanding of women veterans’ for an agenda-setting conference among VA and special health care needs and to foster research non-VA women’s health researchers. Workgroup

that acts on priority areas. As a result, the 

Department of Veterans Affairs tasked the VA generated priorities for biomedical, clinical, 

Office of Research & Development with devel­ rehabilitation, and health services research, and 

recommendations for improving the capacity oping the first women’s health research agenda for conducting VA women’s health research. designed to map research priorities to the needs 

of women veterans and to position VA as a ■ The Biomedical Workgroup emphasized the 

national leader in women’s health research. need for research on sex-based influences on 

prevention, induction, and progress of diseases 

relevant to women veterans, with special Developing the Evidence Base emphasis on: 1) mental health (especially 

PTSD, stress, addiction, sexual trauma, and To build an evidence base that aligns VA depression), 2) military occupational hazards research priorities with the needs of women (especially injury/rehabilitation, wound heal- veterans, we capitalized on VA’s extensive data ing/tissue remodeling, vaccine development, repositories to obtain gender-focused analyses and biological/chemical exposures), 3) chronic that would frame a portrait of their needs. We diseases, 4) cancer, focused on etiology and then partnered with the Southern California response to treatment for exposure-related can

Evidence-based Practice Center to commission cers, and 5) reproductive health. a literature review. For secondary analyses, we 

sought to determine high-prevalence, high-cost ■ The Clinical Sciences Workgroup found the 

and/or high-impact conditions, as well as con­ lack of high-quality epidemiological data on 

ditions with disproportionate burden among women veterans, prior to and through military 

women (e.g., osteoporosis) or with distinct exposures to their status post-discharge, to be a 

clinical presentations in women (e.g., coronary hindrance to clinical research. Priority recomartery disease). More than 15 research centers mendations included creating VA/Department 

responded to our requests, demonstrating both of Defense data-use agreements to capitalize on 

the capacity and commitment to furthering the their inception cohorts. Barring that, researchVA women’s health research agenda. Top diag­ ers should create a prospective cohort of women 

noses included post-traumatic stress disorder upon discharge from the military, modeled after 

(PTSD), arthritis, chronic low back pain, the Nurses’ Health Cohort Study. 

hypertension, chronic lung disease, and continued on page 
Forum/September 2005 ■ 

Organizational Profile
 

Seamless Transition in VA 

By Jennifer Perez, LICSW, Office of Seamless Transition, VA Central Office 

Like never before, the Department of strategies, policies, and programs to provide 

Veterans Affairs (VA) is collaborating with timely, appropriate services to returning 

the Department of Defense (DoD) to provide service members and veterans. The cornera seamless transition for the health care stone of this initiative is the assignment of 

and delivery of benefits to returning service full-time VA staff at DoD Military Treatment 

members from Military Treatment Facilities Facilities to provide onsite education and 

to Veterans Health Administration (VHA) counseling about VA services. Social workers 

facilities and Veterans Benefits and benefits counselors are assigned to eight 

Administration (VBA) Regional Offices. major Military Treatment Facilities, including Walter Reed Army Medical Center and 

In August 2003, VA’s Under Secretary for the National Naval Medical Center-Bethesda. 

Benefits and Under Secretary for Health They collaborate closely with Military Treatcreated a Taskforce for the Seamless ment Facility treatment teams to provide 

Transition of Returning Service Members. consultation for complex patient care needs 

The Taskforce was charged with: and to coordinate the transfer of active duty 

service members and recently discharged ■ improving communication, coordina­ veterans to appropriate VA health care facilities. tion, and collaboration, both within VA and 

Benefits counselors provide early counsel­ between VA and DoD, in providing health ing and assist with applications for benefits care and benefits to returning veterans to which a service member may be entitled. from Operation Iraqi Freedom/Operation 

Enduring Freedom (OIF/OEF); To ensure that seamless transition is a reality 

■ ensuring that VA staff is educated about at the hometown VA Medical Center and VBA 

the needs of OIF/OEF veterans, particularly Regional Office, OIF/OEF Points of Contact 

those severely ill or injured as result of mili­ at VHA facilities and OIF/OEF Coordinators 

tary service; and at VBA Regional Offices have been identi­

■ ensuring that policies and procedures fied to expedite and coordinate the transfer 

are in place to enhance access to health care of health care and benefits information iniand benefits. tiated at the Military Treatment Facility. This 

role also includes coordinated outreach 

In January 2005, VA established a perma­ efforts to the National Guard and Reserve 

nent Seamless Transition Office to assume Units as they return from military service. 

the duties of the Taskforce. Composed of 

representatives from VHA and VBA, the In a further collaborative effort, Uniformed 

Seamless Transition Office coordinates Army Liaisons have been assigned to VA’s 

departmental activities related to the transi­ four regional Traumatic Brain Injury Lead 

tion of returning service members. The VA Rehabilitation Centers that address the 

is partnering with DoD to enhance the unique conditions faced by the multi-trauma 

activities of the Seamless Transition Office. combat injured patient. The Army Liaisons 

To aid in this effort, an active duty Marine assist in the transfer of active duty service 

colonel has been assigned to the Seamless members who have sustained severe 

Transition Office. injuries (e.g., traumatic brain injury, spinal 

cord injury, loss of limbs, visual impairIn providing high-quality health care and ment) and in expediting the flow of inforaccess to benefits, VA has established mation and communication between Military 

Treatment Facilities, the VA, service members, and family members. In that spirit, an 

active duty Marine Liaison Officer has been 

assigned by the Marine Corps Marine For 

Life Program to the Seamless Transition 

Office. This officer assists with the transition needs faced by Marines or sailors and 

their families during the transfer of care 

from the Marine Corps or Navy to the VA. 

“VA is committed to providing 

a seamless transition from DoD 

to VA for returning OIF/OEF 

veterans. VA is reaching out to 

new combat veterans in unprecedented ways and has no more 

important mission than to provide 

the highest quality health care and 

benefits to our Nation’s veterans.” 

The Marine Liaison Officer has been called 

upon to provide service member contact 

information to expedite the delivery of VA 

benefits and health care when such information has been previously unavailable. As 

the subject matter expert on Marine Corps 

issues, this officer provides detailed information and education in resolving complex 

issues for the service member, family, and 

VA staff. Such issues may include the 

nature of military discharge and/or retirement, coordination of military benefits, and 

assistance with military orders. 

VA is committed to providing a seamless 

transition from DoD to VA for returning 

OIF/OEF veterans. VA is reaching out to new 

combat veterans in unprecedented ways and 

has no more important mission than to 

provide the highest quality health care and 

benefits to our Nation’s veterans. ■ 
Yano continued from page 6 

■ The Rehabilitation Workgroup established 

six priority conditions/diseases: 1) arthritis, 

2) chronic pain, 3) obesity, 4) osteoporosis 

and fall-related injuries, 5) amputation, and 

6) reproductive challenges for disabled 

women veterans. Priority areas include 

prosthetics research adapting to menstrual 

cycle variability in limb volume and rehabilitation engineering focused on genderappropriate assistive devices for women with 

disabilities and gender-specific technologies 

for urinary incontinence. 

■ The Health Services Workgroup recommended evaluations of women veterans’ 

health care delivery models. Priority recommendations focused on assessments of 

women’s chronic illness care needs, including the combined impact of their physical 

and mental health conditions on utilization 

and outcomes, as well as analyses of gender-specific barriers to access. 

■ The Infrastructure Workgroup recommended improved networking and mentoring of interested researchers, establishment 

of multi-site collaborative arrangements capable of recruiting adequate samples of 

women veterans, focused statistical expertise and training, and creation of Web-based 

dissemination tools. Building bridges to 

research partners at agencies with longstanding commitments to advancing 

women’s health and improving gender equity also will continue to invigorate the VA 

research process. 

The resulting VA women’s health research 

agenda has yielded a comprehensive set of 

research priorities for the future, while new 

partnerships hold promise for creating collaborative synergy that will advance the field. 

The agenda-setting process itself has created a foundation for fostering new research 

designed to accelerate the translation of 

research from the bench to the bedside that 

meets women veterans’ needs. Since most 

of the 1.7 million women veterans currently 

living in the United States obtain all or 

most of their medical care outside VA, 

where their veteran status is likely unrecognized, all researchers and clinicians have 

the potential to benefit from this investment in establishing evidence-based 

research priorities for improving the health 

and health care of women veterans. ■ 

Conference proceedings and other updates on 

VA women’s health research are available at 

www.va.gov/resdev/programs/womens_ 

health/conference/default.cfm. Also look fo

the upcoming Journal of General Internal 

Medicine special issue on VA women’s health 

care. 

FORUM 

Geraldine McGlynn, Editor-in-Chief 

Margaret Trinity, Editor 

Editorial Board 

Martin P. Charns, D.B.A., Director, VA HSR&D 

Center of Excellence, Boston, MA 

Phil Crewson, Ph.D., Assistant Director, 

VA HSR&D, Central Office 

Joseph Francis, M.D., M.P.H., Director, HSR&D 

QUERI, Central Office 

Rodney A. Hayward, M.D., Director, VA HSR&D 

Center of Excellence, Ann Arbor, MI 

Shirley Meehan, M.B.A., Ph.D., Acting Director, 

VA HSR&D, Central Office 

Laura Miller, Deputy Under Secretary for Health 

for Operations and Management, Washington, DC 

Michael J. Miller, M.D., Ph.D., Chief Medical 

Officer, VA Network #1, Bedford, MA 

Eugene Z. Oddone, M.D., M.H.Sc., Director, 

VA HSR&D Center of Excellence, Durham, NC 

Alan S. Perry, M.H.A., FACHE, Director, 

VA Medical Center, Fresno, CA