Only weeks after the Toronto Star devoted a two-page spread to chiropractic, two articles published in the June 2009 issue of Military Medicine, the official monthly journal of AMSUS (Association of Military Surgeons in the United States), Society of the Federal Health Agencies, discussed chiropractic care and its inclusion in military and veterans administration health care environments.
One article, "Chiropractic in U.S. Military and Veterans' Health Care," authored by Drs. Bart Green, Claire Johnson and Anthony Lisi, provides an overview of chiropractic services within the Department of Defense and Department of Veterans Affairs (DVA). Dr. Lisi is director of chiropractic services for the VA.
A second article, "A Cross-Sectional Analysis of Clinical Outcomes Following Chiropractic Care in Veterans With and Without Post-Traumatic Stress Disorder,"reviews clinical outcomes in 130 veterans with neck or low back complaints at the VA Western New York Healthcare System. According to study findings, patients with PTSD had significantly poorer improvement on self-reported outcome measures (neck and low back disability) compared to patients without PTSD. Authors of this article include Drs. Andrew Dunn, Steven Passmore, Jeanmarie Burke and New York Chiropractic College student David Chicoine.
If the publication of two chiropractic articles in a military journal isn't encouraging enough, new legislation introduced in Congress on June 8 would expand the provision of chiropractic services to all DVA medical centers no later than Dec. 31, 2011. Washington Sen. Patty Murray (D), the first woman to serve on the Senate Veterans Affairs Committee and the daughter of a disabled World War II veteran, introduced the legislation (S. 1204). Rep. Bob Filner (R-Calif.), chairman of the House Committee on Veterans Affairs and longtime advocate of chiropractic care, introduced similar legislation in the House in February (H.R. 1017), requiring all VA medical centers to have a doctor of chiropractic on staff no later than Dec. 31, 2012.
For the past several years, Congress has entertained the notion of mandating an implementation date for full chiropractic inclusion in the VA health care system. In 2006, Rep. Filner and Rep. Jeb Bradley (R-N.H.) co-sponsored H.R. 5202, legislation that would have amended the Health Care Programs Enhancement Act to require 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. A year later, Rep. Filner introduced H.R. 1470 with essentially the same stipulations as the 2006 legislation, but with implementation dates adjusted by one year.
Both years, the congressional session ended before the legislation could be passed by the full Congress and signed by the president. The closest either of the Filner bills came to adoption was in 2007, when H.R. 1470 was passed by the House by an overwhelming margin (421-1) in May. A review of the bill's history and congressional actions reveals that following passage by the House, H.R. 1470 was read twice in the Senate and referred to the Senate Committee on Veterans Affairs, but never proceeded to a vote.
However, in 2008, Congress passed and President Bush signed the National Defense Authorization Act for Fiscal Year 2009, which calls on the Secretary of Defense to expand delivery of chiropractic services. According to Section 704 of the act, "Not later than Sept. 30, 2009, the Secretary of Defense shall provide chiropractic services to active-duty military personnel at 11 additional military treatment facilities that do not currently provide chiropractic services."
That leaves us with an obvious question: What will happen to the pro-chiropractic VA legislation this year? And will the Secretary of Defense expand the provision of chiropractic services to 11 additional military treatment facilities by Sept. 30, as mandated? As of press time, S. 1204 has been referred to the Senate Committee on Veterans Affairs, while H.R. 1017 has been referred to the House Subcommittee on Health. To track the status of these important bills, visit www.thomas.gov. In the "Legislation in Current Congress" section, enter the complete bill number in the "Search Bill Summary and Status" box. Make sure you are searching by bill number, not by word/phrase.
For information on the current status of chiropractic in the VA, read Dr. Lisi's recent DC articles, "Giving Our Veterans the Care They Deserve" (Jan. 29, 2009 issue) and "Chiropractic Training at VA Medical Facilities" (June 3, 2009 issue). These articles are part of an ongoing series by Dr. Lisi on chiropractic in the VA.
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.
