A government study released in March shows that many painkillers given to war veterans suffering from post-traumatic stress disorder often lead to addiction.
Veterans who served in Iraq and Afghanistan and came back from war with PTSD were twice as likely to be given prescriptions for painkillers that have proven to be addictive compared to vets with only physical pain, according to the study.
Caregivers were approximately four times more likely to give the drugs to veterans with PTSD and a history of problems with substance abuse.
The study was paid for by the Department of Veterans Affairs and it was based on the VA’s data. It was published by the Journal of the American Medical Association.
All of the veterans of Afghanistan and Iraq who were diagnosed with physical pain between October of 2005 and December of 2010 were involved in the study, which equals 141,029 servicemen and servicewomen.
Vets with PTSD who were given morphine and other strong painkillers had a higher risk of suicide, alcohol and drug overdoses and self-inflicted injuries, according to the study. These consequences were rare, but still notable.
The study shows that it is a difficult task to treat painful injuries as well as painful memories. The study’s authors and other experts indicate other treatments including therapy and other drugs would be less risky, according to FoxNews.
Some doctors could be prescribing powerful, opium-based drugs like hydrocodone and morphine precisely because of their strength to potentially dull extreme physical pain or help reduce emotional distress. Opioids often make psychological problems worse, according to sources speaking to FoxNews.
In 2009, the VA adopted a pain management philosophy that requires opiate prescriptions be accompanied by non-drug mental health care. This came at the end of the study.
The VA distributed a press release about the study indicating that the agency’s pain management approach is a model of effective care, but “…we recognize that more work needs to be done.”
There were 15,676 veterans given opiate prescriptions in the study for physical pain. Those numbers included 18 percent of the vets with PTSD and about 12 percent of those with different mental health diagnoses. The opiate prescriptions were given to only about 7 percent of the veterans without those problems.
Since many veterans coming home from the wars in Iraq and Afghanistan are young, they are often struggling to find their place in civilian life, according to a Yale University teacher and doctor who spoke with FoxNews. Dr. William Becker works with veterans on substance abuse problems. The best treatment in that environment is therapy and behavioral management for the PTSD and separate chronic pain management for the physical injuries of war. He said the study “…brings much needed attention to the complexity of this problem.”
To learn more or to contact a Veterans disability lawyer, Veterans disability attorney, Veterans lawyer, or Veterans attorney call 1.800.693.4800 or visit Legalhelpforveterans.com
As part of a concentrated effort to help veterans find jobs, the Department of Veterans Affairs is sponsoring a contest for an entrepreneur to create a digital badge system that will help veterans translate their experience for prospective employers in civilian jobs.
Digital badges have taken on an increased importance recently as more people try to move into the civilian workforce after some time away in the military, taking online classes or even volunteering and doing charity work.
Badges are envisioned as supplements to a traditional resume that have a digital link where prospective employers can determine their authenticity. The MacArthur Foundation in Chicago is leading the badges revolution. The foundation gave a $1 million grant to the Mozilla Foundation to develop a consistent standard for badges that can be used across platforms.
The VA contest winner will design badges to help translate military experience into classroom credit or work-related training, according to a press release from the VA.
“We are looking for ways to make it easy for employers to see Veterans for who they are: highly qualified individuals in any job applicant pool,” Secretary of Veterans Affairs Eric Shinseki said in the release. “We want to help good jobs find Veterans and help Veterans find good jobs.”
Along with the VA, the “Badges for Vets” contest also is being sponsored by the U.S. Departments of Education, Labor and Energy. The contest is part of the larger MacArthur Foundation project called the Badges for Lifelong Learning Competition.
The VA Innovation Initiative announced three finalists in the competition in March.
• TopCoder Inc. is an IT consulting company that developed a way to issue badges representing military experience and training to help qualify veterans for a specific assignment.
• Western Governors University has a program to award transfer credit to veterans who have earned badges for corresponding training in the military.
• The Manufacturing Institute has a plan to use badges to help veterans find jobs on its jobs and talent matching platform online.
A winner from among those three will be announced after Memorial Day, according to the release.
The contest calls for $25,000 in prizes for the winners in five categories for companies to design and deliver badges that are representative of veterans’ transferable skills from the battlefield to the cubicle.
Other industries using badge systems to help bridge people’s skillsets with potential employers include NASA, Disney and the library and manufacturing industries.
To learn more or to contact a Veterans disability lawyer, Veterans disability attorney, Veterans lawyer, or Veterans attorney call 1.800.693.4800 or visit Legalhelpforveterans.com
The Social Security Administration recently added 13 new conditions to the Compassionate Allowances program that fast-tracks disability decisions within the agency.
The new conditions were introduced in December as part of an ongoing effort to innovate and streamline the agency’s work, according to Social Security Commissioner Michael J. Astrue.
The conditions that were added to the list mostly are immune system, mental and neurological disorders, according to a press release from the agency. They include the following:
• Malignant Multiple Sclerosis
• ALS or Parkinsonism Dementia Complex
• Pulmonary Kaposi Sarcoma
• Angelman Syndrome
• Paraneoplastic Pemphigus
• Multicentric Castleman Disease
• Progressive Supranuclear Palsy
• Lewy Body Dementia
• Primary Effusion Lymphoma
• Corticobasal Degeneration
• Lowe Syndrome
• Primary Central Nervous System Lymphoma
• Multiple System Atrophy
The SSA’s Compassionate Allowances program spots conditions that always meet the standard of disability for the purpose of Social Security Disability Insurance. This way, once an individual is diagnosed with the specific condition, their case can be moved more quickly through the system.
“We need to keep innovating and making our work more efficient,” Astrue said in a press release. “With our Compassionate Allowances program, we quickly approved disability benefits for more than 60,000 people with severe disabilities in the past fiscal year. We have made significant improvements, but we can always do more.”
The Compassionate Allowances program began in 2008 with only 50 conditions. The original list included cancers, rare genetic disorders, adult brain disorders and early-onset Alzheimer’s disease. With the addition of 13 in December, the program now lists 113 conditions that can be moved through the agency with less stress for the individual, according to the release.
New technologies made available to the agency allow for faster identification of individuals with Compassionate Allowances so that quick decisions can be made.
The agency is committed to the relatively young program as an efficient upgrade of protocol. In the fall, the Social Security Administration launched a grant program available to graduate students to help the agency improve its list. The agency already awarded a grant worth $1.5 million over the course of five years to a group called Policy Research Inc.
The Disability Determination Process Small Grant Program is designed to improve the disability process. The program is actively looking for graduate students to apply for grant stipends for relevant research that is innovative in the field of disabilities.
The agency also recently upgraded the disability application online for individuals with conditions on the Compassionate Allowances list.
Robert Alston is with Alston & Baker, PA. To contact a Zephyrhills Social Security Disability Insurance attorney or Zephyrhills Social Security lawyer, call 1.888.500.5245 or visit http://www.alstonbakerlaw.com.
Four U.S. cities are in line to get new VA Hospitals during the next few years including Denver, Las Vegas, Orlando and a hospital in New Orleans. The new VA hospital in the Big Easy will replace the one destroyed by Hurricane Katrina in 2005.
The Department of Veterans Affairs has earmarked about $792 million of the fiscal year 2012 budget toward the final stages of completion for the new hospitals. That is less than one half of a percent of the VA’s massive $140 billion budget.
The new VA Hospital in New Orleans is under construction in the mid-city area of town. Congress appropriated funds for a new VA hospital in New Orleans in 2006 after Hurricane Katrina destroyed the city’s former facility.
The Replacement Medical Center in New Orleans is a 1.5 million square foot hospital with 120 inpatient beds and 60 beds for transitional care. The new VA hospital is being built to withstand hurricanes like the one that shut down its predecessor. It will be able to run for a week without resupply, it has a heliport and boat docks for evacuations and all mission-critical technologies are stored 20 feet above ground, according to the VA.
The new VA Southern Nevada Healthcare System in Las Vegas is scheduled to open this year. The Vegas VA hospital will have 201 beds in both inpatient and nursing home/extended care. It will be more than 1 million square feet on about 150 acres at 6900 N. Pecos Road in Las Vegas.
The new hospital will have a diagnosis and treatment building, an ambulatory care building, a community center and a mental health building, according to the VA.
In Orlando, Fla., the new VA Medical Center will be co-located with the University of Central Florida College of Medicine, the Nemours Children’s Hospital, the Burnham Institute and the University of Florida College of Medicine in an area known as Medical City.
The 314-bed Orlando VA will have 1.2 million square feet and cost about $665 million. The beds will be split between inpatient services, a community living center and a domiciliary. The Orlando VA hospital is expected to open in 2012.
Finally, the new VA hospital development in Denver, known as Project Eagle, is a $580.2 million facility on the site of the former Fitzsimmons Army Medical Center. The 180-bed Denver VA Medical Center will include a 30-bed center for spinal cord injuries and disorders. Project Eagle is expected to finish in early 2015.
The next four cities on the VA’s list for new medical centers are Seattle, St. Louis, Dallas and Palo Alto, Calif., according to the VA’s 2013 fiscal year budget proposal. All of these centers will be dedicated to the treatment and care of America’s 22 million veterans and more than a million new veterans expected to leave active duty during the next five years.
To learn more or to contact a Veterans disability lawyer, Veterans disability attorney, Veterans lawyer, or Veterans attorney call 1.800.693.4800 or visit Legalhelpforveterans.com
There will be about 1 million new veterans added to the 22 million American veterans as active-duty service members leave the military over the next five years.
This increase in veterans to serve means a larger budget for the Department of Veterans Affairs. President Barack Obama’s proposed budget includes $140.3 billion for the VA to cover the 2012 fiscal year beginning Oct. 1.
The budget proposal now must be approved by Congress. It is about a 10 percent increase over the last VA budget.
The VA must balance their budget while caring for the needs of soldiers returning from more than 10 years of war in the Middle East with the agency’s commitments to veterans from previous conflicts.
The requested budget includes $76 billion for mandatory spending, mostly for pensions and disability compensation. It also includes $64 billion in discretionary funds, most of which goes into medical care, according to the VA.
The VA’s budget supports a health care system with 8.8 million beneficiaries and its programs service 12 million veterans, families and servicemembers. It also supports home loan guarantees, education benefits, the eighth largest program for life insurance in the country, and America’s largest cemetery system.
The VA expects almost 6.5 million patients will use the agency for their health care during the next fiscal year. The President’s budget includes a medical care increase of about 4.1 percent over last year to $52.7 billion. These increases include upgrades in funding for mental health care and gender-specific health care for female veterans coming home from war, according to the VA.
The health care budget also includes $792 million to activate new health care facilities in Orlando, Fla., New Orleans, Denver and Las Vegas. Almost $400 million is flagged for continued construction on medical units in St. Louis, Dallas, Seattle and Palo Alto, Calif.
The proposed VA budget also includes funding for a new jobs program called the Veterans Jobs Corps. This new initiative is designed to leverage skills that veterans attained during military service for a variety of jobs in the United States. The Veterans Jobs Corps could put as many as 20,000 veterans to work here rebuilding or restoring public lands.
The budget also funds efforts to combat veteran homelessness issues. There is almost $1.4 billion set aside for efforts that will treat or prevent homelessness among veterans in the FY 2013 budget. This 33 percent increase represents a commitment to end veteran homelessness by 2015.
To learn more or to contact a Veterans disability lawyer, Veterans disability attorney, Veterans lawyer, or Veterans attorney call 1.800.693.4800 or visit Legalhelpforveterans.com
MECHANICS OF THE LOAN
Since a lawsuit itself is essentially the collateral to secure the finance company’s advances, the lending company will obtain information from the personal injury attorney concerning the case. They will follow these steps to offer the monies:
- Evaluation. The pre-settlement lending company evaluates the case and determines the likelihood of success. If the company is satisfied that there is a strong likelihood of a favorable settlement or verdict, then a cash advance will be approved.
- Agreement. The pre-settlement lending company will expect the plaintiff and the plaintiff’s attorney to sign an agreement. The agreement will require that the attorney release confidential information to the pre-settlement lending company to enable the company to make its evaluation of the request for an advance. The agreement will also require that the personal injury attorney notify the pre-settlement lending company of all settlement offers and execute an acknowledgement obligating the attorney to pay the lender directly from proceeds recovered from the suit.
USURY
Since the loan is structured as a non-recourse loan, most states have held that usury laws do not apply.
PUBLIC BENEFITS ISSUES
If the client is receiving means-tested public benefits such as SSI and/or Medicaid, does receipt of the funds pursuant to the terms of the LLA disqualify the client from means-tested public benefits such as SSI and Medicaid? If the funds are received by parents of a child under 18 receiving such benefits, do the funds received under the LLA deemed to the child so as to disqualify the child from those benefits? This becomes a tricky issue. If the funds are considered a loan and there is a reasonable expectation of repayment, then the funds are not considered income in the month received. However, funds kept into the next month will be considered a resource.[1] The issue then becomes whether the transaction is characterized by Social Security and Medicaid as a loan, subject to a reasonable expectation of repayment, or whether it is characterized as a cash advance, which is the categorization made by the pre-settlement lending company to avoid the usury statute. The lawsuit funding company contends that the transaction is non-recourse and therefore not subject to state usury laws. This is clearly an issue that needs to be taken into consideration.
BEST PRACTICES
The best practice with respect to pre-settlement lending is to refer the client to a reputable third party to perform the following:
- Identify Lender. The third party would identify the pre-settlement lender after thorough due diligence respecting reasonable rates for the industry and the lender’s reputation for honest dealing.
- Custody Funds. The loan proceeds should be custodied with the third party, who would make disbursements as appropriate.
- Recordkeeping. The third party would keep accurate and detailed records of expenditures from the loan proceeds and maintain receipts for each expenditure.
Best practices dictate that the litigation attorney engages the services of a third party to identify a reputable pre-settlement lender and supervise all aspects of the transaction.
CONCLUSION
Pre-settlement lending is appropriate if the injured person is unable to work, has reduced income, or has expenses associated with care or disability as a result of the injury. Because of the high fees associated with pre-settlement lending, it should be a last resort. Alternatives to pre-settlement lending might be:
- Personal loans from a relative
- Cash advances on a credit card
- Home equity loans
- Working with client’s creditors to forebear in collection activity until the suit is settled
The Begley Law Group, PC has counseled individuals and families on their financial and legal choices for more than 75 years. Thomas D. Begley Jr., Esquire, CELA, has extensive experience in personal injury, disability law, special needs trusts, Medicaid planning and elder law. He is a member of the New Jersey Bar Association, all relevant state and local affiliates, and the National Academy of Elder Law Attorneys.
For more information:
Begley Law Group
509 S. Lenola Road, Building 7
Moorestown, NJ 08057
Tel: 800.533.7227
Fax: 856.273.1062
There is an ever-growing cottage industry of investors ready, willing and able to make the equivalent of a loan to an individual who is the plaintiff in a personal injury case. These transactions, also known as pre-settlement lending, are a growing trend for those in need. In order to avoid usury statutes, these transactions are characterized not as loans but as non-recourse cash advances. If the plaintiff loses the lawsuit, then no repayment is due. If the plaintiff receives less than the outstanding balance of the loan, then only the amount that the plaintiff receives need be repaid. Because of the high risk associated with these transactions, the equivalent of an interest rate is fairly high.
A number of issues arise in connection with these loans including legal, ethical, Medicaid and practical concerns that must be considered in determining whether applying for such a loan is appropriate.
PURPOSE OF THE LOAN
The purpose of pre-settlement lending is usually to enable the injured party and/or his family to meet their living expenses during the period of time when the lawsuit is pending.
LOANS INVOLVING MINORS AND INCAPACITATED PERSONS
If the lending agreement is made directly with the injured adult plaintiff, it is much easier than if the lending agreement is made with parents on behalf of a minor child or an incapacitated adult plaintiff whether acting as natural guardian or legally-appointed guardian of the plaintiff. In cases involving a minor or incapacitated plaintiff, many courts will refuse to enforce the terms of the lending agreement, unless it can be clearly demonstrated that the funds were used for the direct benefit of the injured minor or incapacitated person. Excellent recordkeeping is critical.
For example, if a parent misses considerable time from work superintending a catastrophically injured child and falls behind in mortgage payments, a court may question whether a pre-settlement lending agreement used by the parent to bring the mortgage payments current was for the direct benefit of the child and, therefore, enforceable. On the other hand, if the parent is the injured party, unable to work because of the injury, and assuming the pre-settlement lending was used to make mortgage payments, there should be no enforceability issue based on the fact that the “borrower” does have an interest in the lawsuit.
BORROWER’S CREDIT
In most situations involving a loan, the borrower’s credit is paramount. Even if the loan is secured by a real estate mortgage, most lenders will want to see that the borrower is credit-worthy because of today’s sensitive lending environment. In pre-settlement lending transactions, the borrower’s credit is immaterial, because the pre-settlement lending company is looking to the proceeds of the lawsuit as collateral for the loan.
The Begley Law Group, PC has assisted individuals and families with their legal and financial decisions for more than 75 years. They are highly respected for their successful track record and attention to their clients’ needs first and foremost. Thomas D. Begley Jr., Esquire and CELA, has extensive experience in personal injury, disability law, special needs trusts, Medicaid planning and elder law.
For more information:
Begley Law Group
509 S. Lenola Road, Building 7
Moorestown, NJ 08057
Tel: 800.533.7227
Fax: 856.273.1062
A joint study conducted by the U.S. Department of Veteran’s Affairs and Stanford University found that veterans with a mental health condition – especially posttraumatic stress disorder – tend to suffer from physical ailments, as well.
The study, conducted on the newest generation of veterans enrolled with the VA, is no surprise to researchers, who have known for years that there is a strong link between mental wellbeing and physical wellbeing.
“We need to ensure that veterans receive ample physical and emotional care,” said James G. Fausone, a lawyer who works for Legal Help For Veterans, PLLC. “The VA has been treating mental and physical injuries for a long time, but it needs to understand the link between the two when caring for veterans.”
The records of more than 90,000 Iraq and Afghanistan Veterans who used VA outpatient care in fiscal year 2006-2007 were involved in the study, the majority of whom had a diagnosed mental condition.
The study found that the link between PTSD and physical injuries was stronger among women than men. Women with PTSD had a median of seven medical conditions, while men had a median of five. Women without a mental health condition had a median of 4.5 medical conditions, while men without a mental health condition had four.
“Posttraumatic stress disorder is a very serious problem that veterans need to be aware of and the VA needs to examine,” Fausone said. “This study did not find that PTSD causes physical conditions or vice versa, but it did find that there is a link between the two. All veterans who suffered from minor to major physical injuries should be carefully screened for PTSD and treated appropriately.”
Susan Frayne, MD, MPH, with the VA Palo Alto Health Care System and Stanford University and the lead author of the study, suggested what the findings could mean.
She said that PTSD could increase the risk of medical conditions. “One way this could happen is that PTSD can cause changes in the neuroendocrine system in the body, which might affect other biological processes,” she said in a VA article.
She said another possibility is that “PTSD itself does not cause medical conditions, but that whatever caused the PTSD also simultaneously caused the medical condition.” A roadside bomb that injures a solider, for example, could simultaneously cause PTSD and a medical condition.
To learn more or to contact a Veterans disability lawyer or Veterans attorney call 1.800.693.4800 or visit http://www.legalhelpforveterans.com.
Researchers at the U.S. Department of Veterans Affairs and Healthcare System and the University of Michigan studied the records of more than three million veterans over the course of seven years – starting in 1999 – and found that 7,684 of them committed suicide. Approximately half of the veterans who committed suicide had a psychiatric disorder.
The researchers found that many of the veterans who committed suicide were suffering from a mental health disorder. Among men, the most at-risk group was those afflicted with bipolar disorder. This was followed by followed by depression, substance abuse disorders, schizophrenia, other anxiety disorders and PTSD. Among females, substance abuse disorders were linked with higher suicide rates, followed by bipolar disorder, schizophrenia, depression, PTSD and other anxiety disorders.
In total, bipolar disorder was the psychiatric disorder most closely linked with suicide. Bipolar disorder accounts for nine percent of all psychiatric disorders suffered by veterans. However, all psychiatric disorders included in the study were linked to an increased risk of suicide, including depression, schizophrenia, bipolar disorder, substance abuse disorders, posttraumatic stress disorder, and other anxiety disorders.
The VA may be able to use the data to help prevent veteran suicides. Researchers wrote that bipolar disorder was “particularly appropriate for targeted intervention efforts or attempts to improve medication adherence” because of its prevalence. The study also found that the VA failed to recognize many of the psychological disorders that afflicted veterans, perhaps due to the fact that soldiers often hide their psychological problems for fear of harming their careers.
“This could be owing to stigma, which may have made individuals less likely to report their mental health symptoms to physicians, an effect that could be more pronounced among men with military experience,” the researchers wrote.
Beyond the estimated $1 trillion cost just to pay for the war, researchers believe that the costs to cover the medical benefits needed for veterans will be astronomical. In a 2008 study, RAND Corporation, a nonprofit research firm, found that one third of Iraq and Afghanistan veterans were suffering from posttraumatic stress disorder, a traumatic brain injury, or major depression.
James G. Fausone is a Veterans disability lawyer and Veterans attorney with Legal Help for Veterans, PLLC. Learn more at http://www.legalhelpforveterans.com
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A clinic in the Phoenix Veteran’s Affairs Health Care System is opening its doors to veterans nationwide who have suffered one of the most common afflictions faced by veterans – tinnitus.
Tinnitus – which is more commonly referred to as simply “a ringing in the ears” – is common among adults and a major health issue for veterans returning from Iraq or Afghanistan. Statistically, one in 10 adults have tinnitus, and the number is much higher among veterans. During the 2009-10 fiscal year, it was the most claimed disability connected to service, according to VA records.
For most soldiers, tinnitus results from exposure to extremely loud noises, often from improvised explosive devices or gunfire. Most sufferers describe it as an auditory sensation that comes from within the ear, sort of a constant ringing noise. Tinnitus results when tiny hairs inside the ear that normally create electrical signals in response to sound waves begin to produce signals without corresponding external sounds.
Loudness varies between patients. Those who describe theirs as a “soft” noise may be able to ignore it, but those who have extreme tinnitus often cannot. Many suffer from lack of concentration, difficulty sleeping and emotional reactions due to their tinnitus. It is also associated with hearing loss.
The auditory clinic in the Phoenix VA system previously added staff and hours because of the increased numbers of soldiers returning from Afghanistan and Iraq complaining of tinnitus. Starting in January, however, it will begin a national tinnitus program called Progressive Tinnitus Management to help all veterans suffering from tinnitus.
Hearing specialists and mental health specialists will work to treat soldiers. Tinnitus treatment can be complex to treat, as many react differently to the constant ringing tone. Some can be treated with special sounds, hearing aids and in-ear devices, while others will nee to undergo training and mental health sessions to help them deal with their tinnitus. The clinic also can suggest a variety of self-help techniques, which can be very helpful for those who are having trouble handling the constant noise.
There is currently no surgery available to treat tinnitus, so management is the only way to help those afflicted.
The VA had been conducting extensive research regarding tinnitus for five years before the opening of the clinic.
James G. Fausone is a Veterans disability lawyer and Veterans attorney with Legal Help for Veterans, PLLC. Learn more at http://www.legalhelpforveterans.com.
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April 20, 2012 in