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FEDERAL HEALTH UPDATE

October 12, 2007

Produced by Kate Connelly Theroux in collaboration with the U.S. Medicine Institute for Health Studies (USMI)

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Congressional Schedule

  • The Senate is in recess until Oct. 15, 2007.
  • The House Veterans Affairs Subcommittee on Disability Assistance and Memorial Affairs held a field hearing in Windsor, N.Y., on Oct. 9, 2007, to examine the personal costs of the VA claims backlog.
  • The House Veterans Affairs Committee held a hearing on Oct. 10, 2007, to examine the findings of the Veterans Disability Benefits Commission.  Commission Chairman James Terry Scott, Lt. Gen. USA (Ret.), testified before the committee about the Commission’s recommendations.
  • Representative Jo Ann Davis, Republican of Virginia, died on Saturday after a two-year battle with breast cancer, her office said. She was 57.

    Ms. Davis represented southeastern Virginia in the House. Ms. Davis, who was first elected to Congress in 2000, was a member of the House Armed Services Committee and the Foreign Affairs Committee.

    Her first piece of legislation, passed by the House in 2001, increased the life insurance benefit paid to survivors of military members killed on duty.

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Military Health Care News

  • TRICARE Management Activity announced that the Departments of Defense (DoD) and Veterans Affairs (VA) have agreed to exchange Chief Information Officers (CIOs). This exchange is an effort to increase joint understanding and communication between the two agencies.

    In what Dr. S. Ward Casscells, assistant secretary of defense for health affairs, called the “Chuck swap,” Charles “Chuck” Hume went to the VA and Charles “Chuck” Campbell returned to the MHS to, “Walk a mile in the other man’s shoes.”

    Coming full circle, Campbell has returned to DoD to serve as CIO for the Military Health System (MHS), serving as principal advisor to Dr. Casscells and other DoD medical leaders on all matters related to information technology (IT) and protection, enterprise architecture, IT capital investment and strategic planning.

    Hume recently left his post as deputy CIO for the MHS to go to the VA as deputy CIO for health for the Veterans Health Administration. Hume was the deputy CIO for the MHS since July 2006.  His new position at the VA is the one Campbell held most recently before returning to the MHS. In his last assignment before retiring from the Air Force as a colonel in May of 2006, Campbell was acting MHS CIO and then deputy MHS CIO. http://www.tricare.mil/pressroom/news.aspx?fid=324

  • The Military Health System was one of the 2007 GCN Award winners for its Electronic Surveillance System for the Early Notification of Community-based Epidemics, which provides early warning of potential disease outbreaks, or attacks, worldwide

    ESSENCE is a Web-based application integrated into the Defense Department’s Military Health System (MHS) that records instances of viruses and other diseases and tracks those reports in search of trends. Public health is a matter of national security. Regardless of whether it’s a relatively commonplace occurrence such as viral gastroenteritis, or potentially life-threatening, such as influenza or SARS, any disease outbreak in the military can put entire units out of action if not quickly detected and checked. And the threat of a biological attack, both at home and abroad, has become much more tangible since the letter-borne anthrax attacks of 2001.

    The ESSENCE system links medical data with geographic information systems, allowing DoD public health investigators to track the spread of symptoms, drilling down to a specific military unit or ZIP code. Analysis of the data can help medical personnel move quickly and early to treat affected individuals before an illness becomes an epidemic — and before it becomes potentially life-threatening. ESSENCE is the product of the merger of two projects — one in DoD and the other at Johns Hopkins University’s Applied Physics Laboratory in coordination with the Maryland Department of Health and Mental Hygiene and Maryland Emergency Management Agency.

    Based on its success in a trial tracking cases in the National Capitol Region, in 2001, DoD expanded it beyond the NCR and brought in data from the entire military health system.  ESSENCE has become an essential tool in helping DoD deal with not just the threat of major infectious diseases but also other public health issues in the military population that affect units’ readiness.

    In the case of influenza-like illness, the early-detection capabilities of ESSENCE are important in helping medical facilities move quickly to prevent a larger outbreak.

    Your browser may not support display of this image. Initially, the application wasn’t designed with security in mind — the data were anonymized, and only aggregated data were available to users.  To comply with the regulations set forth by the Health Insurance Portability and Accountability Act governing security and privacy of medical records, DoD had to extend the program.

    In addition, there were many enhancements to the software made to include e-mail, text message or pager alerts when a situation that may require investigation is detected, asking them to log in for an investigation. Part of the advantage of complete integration with the MHS architecture was the ability to drill down to the specific medical records involved in a possible outbreak.

    The speed with which new information is processed has also been increased. New data from around the world is submitted around the clock, and the system now does full detection cycles on the data it receives six times a day, so users worldwide are constantly getting the latest data.  
    For the complete list of the 2007 GCN Award winners, click here

  • To address the behavioral health care needs of the thousands of Minnesota National Guard members throughout the state, Blue Cross and Blue Shield of Minnesota (Blue Cross), along with TriWest Healthcare Alliance and the Minneapolis VA Medical Center (VAMC), is hosting the first-ever Combat Stress Conference.

    The Minnesota National Guard consists of more than 13,000 members who live in nearly every corner of the state. Since 2001, more than 80 percent of the members have been mobilized for active duty, serving in 33 different countries. In addition, nearly 2,600 Minnesota National Guard members completed their deployments to Iraq and returned home in August.

    Nearly 350 community-based physicians, nurses, psychiatrists and other health care professionals that care for the troops have been invited to attend the conference on Oct. 17, 2007, at the Earle Brown Heritage Center from 7:30 a.m. to 5 p.m. It is intended to help providers identify deployment-related symptoms such as combat stress, anxiety, depression, post-traumatic stress disorder (PTSD) and traumatic brain injury, as well as providing treatment methods.

    In addition, the Minnesota Army National Guard has reached an agreement with TriWest Health Care Alliance to put mental health services at 22 Minnesota National Guard armories around the state. This agreement will allow the 2,600 members of the Minnesota National Guard who returned from extended deployment to Iraq to have greater access to mental health services.

    Mental health professionals will do onsite consultations and make referrals to any Guard member. Minnesota Army National Guard Chaplain John Morris says the goal is to encourage married and single soldiers to get help.

    The program will also consult with military commanders on mental health issues. Mental health professionals will also participate in monthly unit training.  

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Veterans Health Care News

  • A unique health care facility combining the resources of the Department of Veterans Affairs (VA) and the Department of Defense (DoD) will be named in honor of a local native, Navy veteran and astronaut James A. Lovell.

    The new James A. Lovell VA-DoD Federal Health Care Facility, scheduled to open in 2010, will care for nearly 100,000 veterans, sailors, retirees and family members.  The new facility will result from the merger of the North Chicago VA Medical Center and the Great Lakes Naval Hospital.  

    This joint $130 million initiative marks the first totally integrated federal health care facility in the country.  

    Jim Lovell, a Chicago native, naval aviation veteran of the Korean War and former astronaut, was command pilot of Apollo 8, the first Apollo mission to enter lunar orbit.  He also commanded Apollo 13, which suffered an explosion in route to the moon and was brought back safely to earth by the efforts of its crew and mission control.  Lovell is a recipient of the Congressional Space Medal of Honor and the Presidential Medal of Freedom. http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1392

  • Lilly Endowment Inc awarded a $9.9 million grant to the Richard L. Roudebush VA Medical Center to support a new clinic for injured service members returning from Iraq and Afghanistan and other projects.  This grant will also allow the VA to build a "comfort home" serving families of hospitalized service members while their loved ones undergo rehabilitation.

    The grant will provide $5.8 million for a 24,000-square-foot Seamless Transition Integrated Care Clinic where returning troops will receive comprehensive multidisciplinary health care.  Another $3.5 million will be used to build a 28-suite comfort home that will provide accommodations for veterans’ families during extended periods of care.

    In addition, the endowment is funding retreats at which veterans and their spouses or loved ones can reunite and learn to work through readjustment issues typically associated with returning from deployment.

    Another $500,000 is designated for rehabilitation events, including the National Veterans Golden Age Games, which the Roudebush VA Medical Center will host in the summer of 2008.  This senior adaptive rehabilitation program is designed to improve the quality of life for older veterans, including those with a wide range of abilities and disabilities.

    The Lilly Endowment was established in 1937 by members of the Lilly family as a vehicle to pursue their personal philanthropic interests. It is separate from the Eli Lilly and Co. pharmaceutical firm and is independently managed. http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1393

  • On Oct. 10, 2007, Humana Inc. announced that Humana Veterans Healthcare Services (HVHS) was awarded the Department of Veterans Affairs (VA) Project Hero demonstration contract to support healthcare delivery to veterans in Veterans Integrated Service Networks (VISNs) 8,16, 20 and 23. Under the terms of the award, HVHS will have the opportunity to serve veterans in Arkansas, Florida, Idaho, Iowa, Louisiana, Minnesota, Mississippi, Nebraska, North Dakota, Oklahoma, Oregon, South Dakota, Washington; and portions of Alabama, California, Georgia, Kansas, Illinois, Missouri, Montana, Texas, Wisconsin and Wyoming.

    HVHS will work with local VA officials to deliver timely access to high quality, cost-effective care, for the veteran population in the affected areas. The contract is comprised of one base period and four one-year option periods.

    HVHS will offer an extensive array of resources and services. Among the clinical offerings will be behavioral health, diagnostic, dialysis, medical and surgical services. Availability of these services is designed to improve the ability of VA’s patient-focused health care system for the Department’s enrolled veterans

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Health Care News

  • The Department of Health and Human Services (HHS) awarded contracts totaling $22.5 million to nine health information exchanges (HIEs) to begin trial implementations of the Nationwide Health Information Network (NHIN).  HIEs are networks that securely connect electronic health records for providers and patients.

    These contracts will connect the HIEs to form the “network of networks,” the NHIN. The NHIN trial implementations will leverage recent accomplishments of HHS, its contractors and partners, including: the Healthcare Information Technology Standards Panel (HITSP), the Certification Commission for Healthcare Information Technology (CCHIT), the Health Information Security and Privacy Collaboration (HISPC) and the National Committee on Vital and Health Statistics (NCVHS).

Awardees include the following organizations, representing broad-based state and regional health information exchanges:

    • CareSpark -- Tricities region of Eastern Tennessee and Southwestern Virginia
    • Delaware Health Information Network – Delaware
    • Indiana University -- Indianapolis Metroplex
    • Long Beach Network for Health -- Long Beach and Los Angeles, California
    • Lovelace Clinic Foundation -- New Mexico
    • MedVirginia -- Central Virginia
    • New York eHealth Collaborative -- New York
    • North Carolina Healthcare Information and Communications Alliance, Inc. -- North Carolina
    • West Virginia Health Information Network -- West Virginia

These contractors will participate in the NHIN Cooperative -- a collaborative to test and demonstrate the exchange of private and secure health information among providers, patients and other health care stakeholders.

HHS’ Centers for Disease Control and Prevention is expected to announce contract awards in December, 2007, that will complement these efforts to further develop the NHIN. This joint work will ensure that health information exchanges using the NHIN infrastructure can support the community-based activities of public health agencies.

Interim NHIN results will be shared through three public forums and other public demonstrations of real-time information exchange at the end of the first contract year (September 2008).

Once created, the NHIN health information exchanges’ specifications and related testing materials will be placed in the public domain to facilitate widespread participation in the developing the NHIN. http://www.hhs.gov/news/press/2007pres/10/pr20071005a.html

  • The Department of Health and Human Services (HHS) awarded contracts totaling $55.3 million to four companies for the advanced development of anthrax antitoxins, therapeutics and antibiotics for use against plague and tularemia.

    The new Biological Advanced Research and Development Authority (BARDA) and NIH’s National Institute for Allergy and Infectious Diseases (NIAID) provided funding for the new contracts. Through an agreement with BARDA, NIAID will manage the contracts.

   The companies receiving contracts are

    • Nanotherapeutics Inc. of Alachua, Fla. -- $20 million for a plague and tularemia antibiotic development;
    • Emergent BioSolutions Inc. of Rockville, Md. -- $9.5 million for anthrax immune globulin development;
    • PharmAthene Inc. of Annapolis, Md. -- $13.9 million for anthrax antitoxin development; and
    • Elusys Therapeutics Inc. of Pine Brook, N.J. -- $11.9 million for anthrax antitoxin development.

    The Pandemic and All Hazards Preparedness Act of 2007 directed HHS to establish the BARDA office and authorized the funding of advanced development of medical countermeasures. BARDA coordinates interagency efforts to define and prioritize requirements for public health medical emergency countermeasures, related research, and product development and procurement. BARDA also has responsibility for setting deployment and use strategies for medical countermeasures held in the Strategic National Stockpile. http://www.hhs.gov/news/press/2007pres/10/pr20071005c.html

  • On Oct. 4, 2007, Rear Adm. Kenneth P. Moritsugu, USPHS, acting surgeon general of United States and head of the Public Health Service Commissioned Corps, relinquished command to Rear Adm. Steven K. Galson. The ceremony also served as Rear Adm.  Moritsugu’s retirement ceremony after an illustrious thirty-seven year career.
  • The U.S. Department of Health and Human Services (HHS) and the Ad Council and the National Football League (NFL) will join to launch a new series of national public service advertisements (PSAs) designed to combat childhood obesity by encouraging physical activity among children. The new ads, which feature NFL players Reggie Bush (New Orleans Saints), Antonio Gates (San Diego Chargers) and Jason Witten (Dallas Cowboys), urge families to “get up and play an hour a day.” The PSAs will be unveiled this morning during the NFL’s United Way Hometown Huddle Event in New Orleans, part of the NFL’s national day of service.  The ads will also air during NFL games throughout the football season. 

    The “Be a Player” multimedia ad campaign is an extension of HHS’ Obesity Prevention campaign that launched in 2004 and the Ad Council’s Coalition for Healthy Children initiative. The campaign message is also an important part of the NFL’s “Play 60” youth health and fitness initiative, a multi-year campaign which launches today to encourage youth to achieve 60 minutes of activity a day. The PSAs are available in both English and Spanish and were created pro bono by the NFL and Curious Pictures.

    The PSAs are being distributed to media outlets nationwide this week. Per the Ad Council’s model, all of the new ads will air and run in advertising time and space donated by the media.

    The new PSAs aim to reach children ages 6-13 to communicate the message that physical activity is fun and easy, and that you don’t need to be an athlete or join organized sports to stay healthy. In addition to the NFL players, the ads introduce new animated NFL characters, Mike “Good Manners” McMannis (a referee who flags kids for “lazy penalties”) and Wanda (a superhero-like cheerleader), who join the players in urging children to “get up and play an hour a day.” The characters will be featured in upcoming NFL youth fitness initiatives throughout the season.

    The new PSAs encourage youth to visit www.NFLRUSH.com and www.smallstep.gov for fun and interactive experiences to get healthy and be active. Both sites include information to keep kids fit, including NFL player blogs, games, wallpapers, and activities.

    In addition to the new NFL spots, Ad Council continues to promote the “Be a Player” physical activity message, along with communications focused on portion control and energy balance, through its Coalition for Healthy Children. The coalition harnesses the combined strengths of major marketers, media, non-profit and government partners to combat childhood obesity through the dissemination of consistent, research-based messages to parents and children. This unique collaboration utilizes a national research study to evaluate progress and determine the effects of Coalition members’ initiatives.  http://www.hhs.gov/news/press/2007pres/10/pr20071009a.html

    AHRQ's EPCs conduct research syntheses and analyses of the scientific literature on clinical and other health care delivery issues and produce reports and technology assessments on the evidence. The resulting reports are used by Federal and State agencies, private-sector professional societies, health delivery systems, providers, payers, and others committed to evidence-based health care. Since the program was created in 1997, the EPCs have produced and published nearly 200 evidence reports on a variety of health care topics.

   The EPCs will develop reports of the scientific literature in the following focus areas:

    • U.S. Preventive Services Task Force, where they will conduct systematic reviews of the evidence on specific topics in clinical prevention and provide technical support that will serve as the scientific basis for Task Force recommendations.
    • AHRQ's Technology Assessment Program, where they will assess the clinical utility of medical interventions to assist the Centers for Medicare & Medicaid Services make informed decisions regarding its Medicare program.
    • The Generalist Program, for which they will continue producing numerous reports each year with private and Federal partners on a range of clinical, behavioral, economic, and health care delivery topics.
    • The Effective Health Care Program, for which they will provide high-quality, reliable data in the form of comparative effectiveness reviews to help patients, clinicians, and policymakers make the best health care decisions.
    • The Scientific Resource Center, through which they will provide scientific and methodologic technical support to the Generalist and Effective Health Care programs.

   The EPCs and their directors are as follows:

    • Blue Cross and Blue Shield Association Technology Evaluation Center; Naomi Aronson, Ph.D.
    • Duke University; Douglas C. McCrory, M.D.
    • ECRI Institute; Karen M. Schoelles, M.D., S.M.
    • Johns Hopkins University; Eric B. Bass, M.D., M.P.H.
    • McMaster University; Parminder Raina, Ph.D.
    • New England Medical Center Hospitals; Joseph Lau, M.D.
    • Oregon Health & Science University; Mark Helfand, M.D., M.S., M.P.H.
    • RAND Corporation; Paul Shekelle, M.D., Ph.D.
    • RTI International; Meera Viswanathan, Ph.D.
    • University of Alberta; Terry P. Klassen, M.D., M.Sc., and Brian Rowe, M.D., M.Sc.
    • University of Connecticut, C. Michael White, Pharm.D.
    • University of Minnesota; Robert L. Kane, M.D. and Timothy J. Wilt, M.D., M.P.H.
    • University of Ottawa, David Moher, Ph.D.
    • Vanderbilt University Medical Center, Katherine Hartman, M.D., Ph.D. 

   http://www.ahrq.gov/news/press/pr2007/epcnextpr.htm 
 

  • The U.S. Food and Drug Administration (FDA) approved the first generic versions of Trileptal (oxcarbazepine), an anticonvulsant drug. Generic oxcarbazepine is FDA-approved for use alone or in combination with other medications in the treatment of partial seizures in adults and children aged 4 years and above.

    Oxcarbazepine tablets in three strengths (150 milligrams, 300 milligrams and 600 milligrams) are manufactured by Roxane Laboratories Inc., Glenmark Pharmaceuticals Limited, and Sun Pharmaceutical Industries Limited.

    The labeling of the generic products may differ from that of Trileptal because parts of the Trileptal labeling are protected by patents and/or exclusivity.

  • The Centers for Medicare and Medicaid Services (CMS) announced that the vast majority of the nation’s hospitals are meeting the quality reporting goals about the quality of the care they provide to Medicare beneficiaries and will receive a full payment rate increase of 3.3 percent next year.  Of the nation’s 3,506 acute care hospitals eligible to participate in the RHQDAPU program in FY 2007, 93 percent participated and met requirements; 6 percent failed to meet requirements; and 1 percent chose not to participate

    Under the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program, hospitals that reported certain quality measures and met other requirements are entitled to receive the full market basket update for FY 2008.  Although participation in the program is voluntary, hospitals that don’t participate are subject to a 2.0 percent reduction in payment.

    The reporting of hospital quality data under the RHQDAPU program is part of a program-wide effort to transform Medicare from being a passive payer of health care services to a prudent purchaser of high quality care for people with Medicare.  The program was originally authorized under section 501(b) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and was launched by CMS in FY 2005 with 10 reportable measures and a 0.4 market basket percentage point reduction for IPPS hospitals that did not meet program requirements.

    CMS has continued to refine the quality measures since it launched the RHQDAPU program.  For FY 2008, hospitals will be required to report on 27 quality measures, including 24 processes of care measures for discharges on or after Jan. 1, 2007. The new quality measures for FY 2008 include mortality data, as well as data collected from patient surveys about their perceptions of the care they received during an inpatient stay. 

    CMS implemented the patient satisfaction survey, known as the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, as part of the RHQDAPU program for FY 2008.  The survey asks about consumer perceptions of the care they have received during a hospital stay, such as responsiveness of hospital staff, cleanliness and the overall rating of the hospital.  Beginning with discharges on or after July 1, 2007, this survey will be one of the quality measures that must be reported by IPPS hospitals in order to receive the full update. CMS NR 10-11-2007

  • On Oct. 11, 2007, drug makers voluntarily pulled children's cold medicines off the market, less than two weeks after the government warned of potential health risks to infants.

    Over-the-counter medications aimed at children under the age of 2 are being removed from store shelves because of rare instances of parents overdosing young children.

    The Consumer Healthcare Products Association agreed with government officials that use of the drugs should be restricted, but had previously stopped short of pulling the products from the market.

    Cold medicines being withdrawn include: Johnson & Johnson Pediacare Infant Drops and Tylenol Concentrated Infants Drops, Wyeth's Dimetapp Decongestant Infant Drops, Novartis' Triaminic Infant & Toddler Thin Strips and Prestige Brands Holdings' Little Colds Decongestant Plus Cough.

    Late last month the Food and Drug Administration tentatively recommended adding the words "do not use in children under 2 years" to products' labeling. Current labeling directs parents to consult a doctor before administering the drugs to infants and toddlers.

    FDA will formally consider revising labeling next week. After reviewing reports of side effects over the last four decades, FDA found 54 child fatalities from over-the-counter decongestant medicines. The agency found 69 reports of children's deaths connected with antihistamines, which are used to treat runny noses.

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Reserve/Guard

  • The total number of Guard and Reserve currently on active duty has decreased by 587 from the last report to 90,822. The totals for each service are Army National Guard and Army Reserve, 70,228; Navy Reserve, 5,926; Air National Guard and Air Force Reserve, 7,553; Marine Corps Reserve, 6,823; and the Coast Guard Reserve, 292. www.defenselink.mil

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Reports/Policies

  • The Institute of Medicine (IOM) released “The State of Quality Improvement and Implementation Research: Expert Views, Workshop Summary,” on Oct. 5, 2007.  The report examines what works in quality improvement; what methods are currently being used to assess and identify best practices; and what programs and methods should be pursued in the future.  The IOM invited experts both from within and outside of health care to provide a better understanding of what is known about quality improvement and implementation research.  http://www.iom.edu/CMS/3809/38607/46844.aspx
  • The GAO issued “Prescription Drugs: Trends in Usual and Customary Prices for Drugs Frequently Used by Medicare and Non-Medicare Health Insurance Enrollees,” (GAO-07-1201R) on Sept. 7, and released on Oct. 10, 2007.  This report provides information on trends in retail prices--known as usual and customary prices--for prescription drugs frequently used by Medicare enrollees and non-Medicare health insurance enrollees. The GAO focused on usual and customary price trends from January 2004 through January 2007; and usual and customary price trends from January 2000 through January 2007 for the subset of drugs that were included in both our 2005 report and the current report. http://www.gao.gov/new.items/d071201r.pdf
  • The GAO issued “Global Health: U.S. Agencies Support Programs to Build Overseas Capacity for Infectious Disease Surveillance,” (GAO-08-138T) on Oct. 4, 2007.  The report examined the obligations, goals, and activities of these programs; and the U.S. agencies' monitoring of the programs' progress. http://www.gao.gov/new.items/d08138t.pdf
  • The Institute of Medicine (IOM) released: “Informing the Future: Critical Issues in Health. Fourth Edition,” on Oct. 10, 2007.  This report highlights the groundbreaking reports released by the IOM over the past two years and explores the policy areas that will be critical to the nation's well-being in years to come. http://www.iom.edu/CMS/28312/47034.aspx

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Legislation

  • No legislation was proposed this week.

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Hill Hearings

  • The Senate Veterans Affairs Committee will hold a hearing on Oct. 17, 2007, to examine Departments of Veterans Affairs and Defense collaboration, focusing on the report of the President's Commission on Care for America's Returning Wounded Warriors, the report of the Veterans Disability Benefit Commission, and other related reports.
  • The House Veterans Subcommittee on Health will held a hearing on Oct. 18, 2007, to examine the impact of health care on recruitment and retention.
  • The Senate Veterans Affairs Committee will hold a hearing on Oct. 24, 2007, to consider pending legislation.
  • The Senate Veterans Affairs Committee will hold a hearing on Oct. 31 2007, to examine vocational rehabilitation.   

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Meetings / Conferences

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