Chiropractic in the Military

Proposed Legislation Would Expand the Chiropractic Benefit Worldwide

By Michael Devitt

Dynamic Chiropractic examines House Resolutions 5122 and 5202, two important pieces of legislation that would significantly impact the provision of chiropractic services to U.S.

military personnel and veterans around the world.

H.R.5202 Mandates Chiropractic at Every VA Medical Center by 2010

Providing chiropractic benefits to the nation's veterans has been a goal of the chiropractic profession for decades. B.J. Palmer first promulgated the idea of making chiropractic a health benefit for veterans as early as 1937, and even succeeded in having a bill introduced in Congress that would have given veterans access to chiropractic services. While Dr. Palmer's original efforts were unsuccessful, the profession finally reached its goal in January 2002, when President George W. Bush signed into law the Department of Veterans Affairs Health Care Programs Enhancement Act, which established a permanent chiropractic benefit within the Veterans Affairs health care system.

Among other things, the Health Care Programs Enhancement Act authorized the hiring of doctors of chiropractic in the VA health system, and mandated that chiropractic care be available in at least one VA medical center of each geographic service area of the Veterans Health Administration. It also called for the creation of an advisory committee, designed to assist the Secretary of Veterans Affairs in the development and implementation of the chiropractic health program.

In November 2003, the chiropractic advisory committee submitted a list of 38 recommendations to Sec. Anthony J. Principi that covered numerous aspects of chiropractic's involvement in the VA system. Included in the list were recommendations that doctors of chiropractic be "integrated into the VHA health care system as a partner in a health care team," and that chiropractic care be provided "at each of the major VHA facilities in each of the Veterans Integrated Service Networks, consistent with the VHA distance and time standards for specialty access."

In March 2004, based in part on the advisory committee's recommendations, Sec. Principi issued an order that the VA begin the inclusion of chiropractic care into the veterans health system. At the time he issued the order, Principi stated that one of his goals was "to ensure that chiropractic care is ultimately available and accessible to veterans who need it throughout the DVA system."

Unfortunately, in some instances, actually making chiropractic benefits both available and accessible to veterans has been easier said than done. While chiropractic is offered in at least one facility in each of the nation's 23 Veterans Integrated Service Networks, less than one-fifth of the nation's major VA medical centers currently have a chiropractor on staff.

"In the more than 120 facilities without a chiropractor on staff, the chiropractic care benefit that Congress authorized for America's veterans remains virtually nonexistent," said American Chiropractic Association President, Richard Brassard, DC. "Detroit, Denver and Chicago are a few examples of major metropolitan areas without a doctor of chiropractic available at the local VA facility. Without a congressional directive, further expansion to these facilities and to other major metropolitan facilities will be on a case-by-case basis and will be terribly slow."

To help remedy that situation, Reps. Jeb Bradley (R-NH) and Bob Filner (D-CA) have co-sponsored House Resolution 5202. The legislation, introduced April 26, 2006, amends the Health Care Programs Enhancement Act by requiring that chiropractic benefits be provided at not fewer than 75 VA medical centers by the end of 2008, and at every VA medical center by the end of 2010.

Both Filner and Bradley are longtime supporters of the chiropractic profession. Rep. Bradley played an instrumental role in the passage of House Resolution 5122, which would expand the provision of chiropractic services to all members of the armed services at military treatment facilities worldwide. (Editor's note: see "HR 5122 Would Extend the Chiropractic Benefit to All U.S. Military Personnel" on page 1.) Rep. Filner, meanwhile, introduced the Better Access to Chiropractors to Keep Our Veterans Healthy Act in 2004, which would have provided eligible veterans with direct access to chiropractic care at DVA hospitals and clinics, and would have prohibited health care providers from discriminating against chiropractors when determining what types of services a patient needs. While the bill failed to make it out of committee, Rep. Filner was presented with the ACA's "Veterans Health Care Leadership Award" for his efforts.

"ACA offers its gratitude to Reps. Jeb Bradley and Bob Filner for their steadfast support of America's veterans," said Dr. Brassard. "Veterans want, need and deserve access to chiropractic care, and it is ACA's goal to ensure that chiropractic is ultimately available and accessible at every major VA health care facility."

As of press time, H.R.5205 has been referred to the House Committee on Veterans Affairs for further consideration, and has garnered a third co-sponsor, Iowa Rep. Leonard Boswell. Look for an update on the status of H.R.5205 in a future issue of Dynamic Chiropractic.

Note: For a more in-depth look at the background and current status of chiropractic in the Veterans Health Administration, please read Dr. Anthony Lisi's article in the next (July 4) issue. In October 2004, Dr. Lisi became the first staff chiropractor appointed to the VA Connecticut Healthcare System. In January 2006, he was appointed to a three-year term as chairperson of the Veterans Health Administration's National Chiropractic Field Advisory Committee.

Resources

1. Devitt M. VA to offer chiropractic at 26 sites nationwide. Dynamic Chiropractic, July 29, 2004. www.chiroweb.com/archives/22/16/11.html.
2. Edwards JD. Fathers of success. Journal of the American Chiropractic Association, April 2002.
3. Chiropractic celebrates - Bush signs VA bill. Dynamic Chiropractic, Feb. 25, 2002. www.chiroweb.com/archives/20/05/18.html.
4. Legislation introduced to expedite expansion of chiropractic care to veterans. American Chiropractic Association press release, May 8, 2006.
5. Veterans get chiropractic care. Dynamic Chiropractic, May 6, 2004. www.chiroweb.com/archives/22/10/16.html.

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H.R.5122: Guaranteeing Chiropractic Care to All U.S. Military Personnel

On Oct. 30, 2000, President Bill Clinton signed into law the National Defense Authorization Act for Fiscal Year 2001, which included a historic provision requiring access to chiropractic services, including "care for neuromusculoskeletal conditions typical among military personnel on active duty." It also required full implementation of chiropractic benefits be over a five-year period throughout all phrased in service branches of the military, and mandated that the Department of Defense develop an "implementation plan" to ensure adequate provision of chiropractic benefits.

Building on the requirements of that provision, the U.S. House of Representatives has passed new legislation that would expand access to chiropractic care not just to active-duty military personnel in the United States, but also to all members of the armed services at U.S. military treatment facilities worldwide.

"The passage of this language is a victory for our men and women in uniform, as they are one step closer to accessing the chiropractic care they need and deserve," remarked ACA President Richard Brassard, DC. Dr. Brassard thanked several members of the House Armed Services Committee, including chair Duncan Hunter (R-CA), ranking member Ike Skelton (D-MO), and Reps. Jeb Bradley (R-NH), John McHugh (R-NY) and Mike Rogers (R-AL), whom he called "instrumental" in moving the legislation forward.

According to a report issued by the U.S. Government Accountability Office in September 2005, of the more than 230 military treatment facilities worldwide, only 42 facilities in the military health system offer chiropractic health care services, all of which are located within the continental United States. The Fiscal Year 2006 Department of Defense Authorization Act mandated that the U.S. Air Force make chiropractic services available at an additional 11 Air Force bases no later than Sept. 30, 2006, which, when fully operational, would expand the number of military treatment facilities offering chiropractic care to 53.

The new legislation is contained in House Resolution 5122, the National Defense Authorization Act for Fiscal Year 2007, which passed the House by a vote of 396-31 on May 11, 2006. Of particular importance to the chiropractic profession is Section 712, which calls for the Secretary of Defense to formulate a "study and plan" relating to the provision of chiropractic health care services for all active-duty military personnel, reservists, retirees and eligible dependents, and to submit a report to the House and Senate Armed Services Committees by March 31, 2007. The full text of Section 712 is as follows:

Sec. 712. Study and Plan Relating to Chiropractic Health Care Services.

1. Study Required
   1. Groups Covered - The Secretary of Defense shall conduct a study of providing chiropractic health care services and benefits to the following groups:
      1. All members of the uniformed services on active duty and entitled to care under section 1074(a) of title 10, United States Code.
      2. All members described in subparagraph (A) and their eligible dependents, and all members of reserve components of the uniformed services and their eligible dependents.
      3. All members or former members of the uniformed services who are entitled to retired or retainer pay or equivalent pay and their eligible dependents.
   2. Matters Examined
      1. For each group listed in subparagraphs A, B, and C of paragraph 1, the study shall examine the following with respect to chiropractic health care services and benefits:
         1. The cost of providing such services and benefits.
         2. The feasibility of providing such services and benefits.
         3. An assessment of the health care benefits of providing such services and benefits.
         4. An estimate of the potential cost savings of providing such services and benefits in lieu of other medical services.
         5. The identification of existing and planned health care infrastructure, including personnel, equipment, and facilities, to accommodate the provision of chiropractic health care services.
      2. For the members of the group listed in subparagraph A of paragraph 1, the study shall examine the effects of providing chiropractic health care services and benefits -
         1. on the readiness of such members; and
         2. on the acceleration of the return to duty of such members following an identified injury or other malady that can be appropriately treated with chiropractic health care services.
   3. Space Available Costs - The study shall also include a detailed analysis of the projected costs of providing chiropractic health care services on a space available basis in the military treatment facilities currently providing chiropractic care under section 702 of the Floyd D. Spence National Defense Authorization Act of Fiscal Year 2001 (as enacted by Public Law 106-398; 10 U.S.C. 1092 note).
   4. Eligible Dependents Defined - In this section, the term "eligible dependent" has the meaning given that term in section 1076a(k) of title 10, United States Code.
2. Plan Required - Not later than March 31, 2007, the Secretary of Defense shall revise the plan required under section 702 of the Floyd D. Spence National Defense Authorization Act of Fiscal Year 2001 (as enacted by Public Law 106-398; 10 U.S.C. 1092 note), including a detailed analysis of the projected costs, to provide chiropractic health care services and benefits as a permanent part of the Defense Health Program (including the TRICARE program) as required under that section.
3. Report Required - Not later than March 31, 2007, the Secretary of Defense shall submit a report on the study required under subsection a, together with the plan required under subsection b, to the Committees on Armed Services of the Senate and the House of Representatives.

According to a press release from the ACA, similar language had been inserted into the House version of the 2006 National Defense Authorization Act, but that language was not included in the final version signed into law by President Bush. As of press time, the Senate has yet to act on its own version of the legislation. However, both the ACA and the Association of Chiropractic Colleges have expressed their support for the bill and are working to ensure that the Senate version of H.R.5122 contains the pro-chiropractic language.

"I am proud that ACA and ACC spearheaded the advocacy efforts in support of each of the chiropractic provisions in H.R.5122," asserted Dr. Brassard. "Passage of this legislation by the House is a major first step. The ACA and ACC lobbying teams will be working with our chiropractic allies in the Senate to ensure that the accelerated chiropractic care directive remains in the legislation when it is considered for final passage."

"The progress that has been achieved to date with the inclusion of doctors of chiropractic in both the DoD and veterans' health care systems could not have been achieved without the grassroots assistance of chiropractic state associations, colleges, doctors and chiropractic students," added ACC President Frank Zolli, DC.

"Thank you for this critical support."

An update on the status of H.R.5122 will be available in an upcoming issue of Dynamic Chiropractic. For more information on the bill, visit http://thomas.loc.gov and enter "H.R.5122" on the site's "search bill text" field.

Resources

1. Devitt M. DoD's implementation of chiropractic benefit inadequate. Dynamic Chiropractic, Oct. 24, 2005. www.chiroweb.com/archives/23/22/06.html.
2. Edwards J. Congress mandates chiropractic at 11 Air Force bases. Dynamic Chiropractic, Feb. 13, 2006. www.chiroweb.com/archives/24/04/04.html.
3. More Air Force bases adding chiropractic services. Dynamic Chiropractic, Jan. 14, 2003. www.chiroweb.com/archives/21/02/02.html.
4. U.S. House passes legislation to expand military access to chiropractic. American Chiropractic Association press release, May 18, 2006.