On January 23, 2001, President Bush signed legislation establishing a permanent chiropractic benefit within the Department of Veterans Affairs (DVA) health care system.1 The law (P.L. 107-135) is the result of almost 65 years of political effort. The law authorizes the hiring of doctors of chiropractic in the DVA health system, sets a broad scope of chiropractic practice, and allows the chiropractic profession to oversee the development and implementation of the new benefit through an "advisory committee," partially composed of representatives of the chiropractic profession. The agreement is similar to legislative language that became law last year requiring the Department of Defense to establish a permanent chiropractic benefit for active-duty military personnel.
Key provisions of the law include:
Sadly, this lack of unity created a golden opportunity for those overseeing the administration of the chiropractic veterans' benefit to choose an advisory committee that would be most detrimental to the chiropractic profession and still appear representative.
Secretary of Veterans Affairs Anthony Principi announced the appointments to the Chiropractic Advisory Committee on August 12. The committee is comprised of 11 members: six doctors of chiropractic, two medical doctors, an osteopath, a physical therapist and a physician's assistant:
Charles Duvall, Jr.,DC - Dr. DuVall, of Akron, Ohio, is a well-know detractor of the chiropractic profession, he is the president of the National Association of Chiropractic Medicine. He is on the board of directors of the National Council Against Health Fraud, is a co-founder of the Ohio Council Against Health Fraud, and is a member of several other "anti-health fraud" organizations. Dr. DuVall is a Navy veteran, and was a combat medic in Vietnam.
Ronald Evans,DC,FACO,FICC - Dr. Evans, of Urbandale, Iowa, was a member of the Department of Defense Chiropractic Oversight Committee4,5 representing the Foundation for Chiropractic Education and Research (FCER) He was also on the united slate of DCs that was supposed to be nominated by the four organizations. Dr. Evans is a Navy veteran.
Reed Phillips,DC,DACBR,PhD - Dr. Phillips is chairman of the committee. He, like Dr. Evans, was a member of the Department of Defense Chiropractic Oversight Committee, but represented the Council on Chiropractic Education (CCE). He is the president of the CCE and president of Southern California University of Health Sciences. Dr. Phillips served in the Utah National Guard.
Cynthia Vaughn,DC - Dr. Vaughn, of Austin, TX, is president and executive director of the Texas Board of Chiropractic Examiners. She has served on the computerization committee for the National Board of Chiropractic Examiners (NBCE).
Michael McLean,DC,FICA - Dr. McLean, of Virginia Beach, VA, is the ICA's legislative committee chairman, and a member of the ICA Board of Directors. Dr. McLean served in the Navy Reserve.
Leona Fisher,DC - Dr. Fisher, of Elmhurst, IL, is a member of the WCA International Board of Governors. She is also a certified emergency medical technician, and a massage therapist. She is a Navy veteran.
Paul Shekelle,MD,PhD - Dr. Shekelle, of Los Angeles, CA, is best know by the chiropractic profession as the primary investigator of the RAND study, "The Appropriateness of Spinal Manipulation for Low-Back Pain."6,7 He is a research associate at the West Los Angeles Veterans Affairs Medical Center, and a senior natural scientist at RAND.
Warren Jones,MD - Dr. Jones is a clinical professor of family medicine at the University of Mississippi Medical Center in Jackson, and a former medical director at the Defense Dept. He was a captain in the Navy Medical Corps. He is president of the American Academy of Family Physicians, the first African American to hold the post.
The AAFP opposed the primary care designation for DCs in the VA, and in March of 2002, the VA agreed. The USVET, a publication of the National Veterans Organization of America, quoted Dr. Jones at the time of the VA's decision: "We believe there is a role for chiropractors in the VA system. We just don't believe they are trained to serve as primary care providers at this time." He added: "Chiropractors are not trained to make differential diagnosis like a primary care physician. Physicians will refer to chiropractors for low back pain if warranted."
Mike Murphy,DO - Dr. Murphy, of Pikeville, KY, is the executive director of the Appalachian Osteopathic Postgraduate Training Institute Consortium, and professor of family medicine at Pikeville College School of Osteopathic Medicine. He is a retired Navy captain and liaison to the DoD Chiropractic Health Care Demonstration Oversight Advisory Committee.
Bryan Murphy,PT - Dr. Murphy, of Salt Lake City, UT, is the clinical manager of rehabilitation at VA Salt Lake City Healthcare System, and an instructor at the University of Utah.
Michael O'Rourke,PA - Michael O'Rourke, of Washington, D.C., is the assistant director of Veterans Health Policy with the Veterans of Foreign Wars. He is a Marine Corps veteran, served in Vietnam, and was later commissioned as a physician assistant.
A simple review of the committee members chosen by the DVA reveals that the 6-5 margin of chiropractors over other providers is skewed against chiropractic, if one considers the history of Dr. DuVall.
The inaugural meeting of the advisory committee is in September. The committee will have just over two years to make recommendations before the committee is dissolved on December 31, 2004.
References
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
On Feb. 1, 2024, two more legislators – John R. Carter (R-Texas) and Robert “Bob” Good (R-Va.) – co-sponsored the Chiropractic Medicare Coverage Modernization Act of 2023, bringing the co-sponsor total to 155, two more than the total achieved over the entire two-year congressional cycle in which identical legislation last appeared (2021-22).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
