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Veterans Benefits Information

Bright spots of innovation: Q&A with past Innovation Award winner Nigel Bush

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Innovation is vital as the Military Health System (MHS) continues to strive for better care for service members, retirees and their families. To highlight innovation in care delivery, we are featuring award winners from last year’s Innovation Awards presented at the Association of Military Surgeons of the United States conference. More information, including application guidance, for the second annual Innovation Awards to be held at the beginning of December 2015. Applications are due by Oct. 9, 2015.

Nigel Bush is a research psychologist and program manager for the Research, Outcomes and Investigations program at the National Center for Telehealth & Technology, a part of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. He and his colleagues were recognized at last year’s Innovation Awards hosted by the MHS Innovation Office for their Virtual Hope Box. The mobile app helps to regulate emotions and reduce stress via personalized supportive audio, video, pictures, games, mindfulness exercises, activity planning, inspirational quotes, coping statements and other tools.

What inspired your team to develop the Virtual Hope Box?

Our team was familiar with the concept of a Hope Box, and we worked with clinicians who found it useful, but somewhat limited. Given our expertise with mobile technologies, the advantages of a smartphone tool seemed obvious. We kept hearing from clinicians that patients need a customizable accessory to care.

What do you feel makes the Virtual Hope Box innovative?

While our content has been proven, the variety of effective tools in a comprehensive multimedia suite that’s constantly and privately accessible makes it innovative. Clinicians appreciate that the content can be tailored to the unique needs of each patient or user.

Can you provide us with an update on where the Virtual Hope Box is now?

In addition to a successful pilot that demonstrated Virtual Hope Box as a practical clinical and general use tool for stress management and emotional regulation, we received several hundred testimonials from users and clinicians describing how they used Virtual Hope Box to cope with stress. Also, the app has now been downloaded over 50,000 times by service members and civilian users alike. Next, to build even more use, we are broadening our promotion of this app from one specialist clinic to an entire regional Department of Veterans Affairs behavioral health system.

What has been the impact of Virtual Hope Box on military health and readiness?

Personal cellphone use is extremely high among active and recently retired military personnel. And service members are highly mobile. When a patient is away from the clinic, we recognized that a mobile application could complement the care of a provider. Also, if there is ever a reluctance to seek care due to stigma or inaccessibility, patients can take advantage of the privacy a mobile app provides. Anecdotally, we know Virtual Hope Box is helping support emotional regulation and stress coping amongst service members.

Why do you think it’s so important for the MHS to recognize and reward innovation?

We work hard to develop health tools that we strongly believe will benefit service members and providers. But, it’s also natural for us to wonder at times whether everyone sees the same value we do. The MHS Innovation Awards reinforces our mission and helps legitimize our products.

How do you think the MHS could continue to support innovation?

First, awards such as the Innovation Awards are great. In my opinion, it’s also important to encourage risk taking and leaps of faith. Removing obstacles to imaginative and speculative endeavors to allow for failure alongside success will enable the MHS to keep innovating.


MHS Innovation redefines the pace of service, process and technology innovation aligned with MHS strategic priorities by empowering individuals, sharing best practices and collaborating with strategic partners. Learn more about MHS Innovation. 

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Deal Orders Flags to Half-Staff in Honor of Fallen Soldier

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Governor Nathan Deal has ordered flags in Georgia lowered to half-staff in honor of SPC Kyle E. Gilbert.

Flags are to remain lowered through sunset on October 2. 

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Trauma team delivers critical care, saves lives in Afghanistan

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BAGRAM AIR FIELD, Afghanistan – On the combat frontier, the ability to deliver advanced medical care usually means the difference between life and death for injured service members.

In Afghanistan, that lifesaving capability is delivered by a highly specialized team of medical professionals at the Craig Joint Theater Hospital.

According to U.S. Air Force Maj. Stephen Varga, 455th Expeditionary Medical Group trauma czar, the hospital provides surgical capabilities in trauma, general surgery, orthopedics, neurosurgery, urology, vascular surgery and otolaryngology, all of which are critical to helping 98 percent of patients who come to the hospital survive their injuries.

“CJTH provides surgical care for all troops, coalition forces, contractors, civilians and local nationals here in Afghanistan,” said Varga, who is on his first deployment and whose home station is the San Antonio Military Medical Center at Ft. Sam Houston, Texas. “As trauma czar, my role is organizing care for complex surgical patients, many of whom have wounds requiring not only immediate lifesaving surgery, but additional surgeries by specialty teams such as orthopedics and neurosurgery.”

Varga said he takes care of a patient from the moment he or she is wheeled into the trauma bay, throughout surgery, while they recover in the intensive care unit and until the patient is transferred out of theater as safely and efficiently as possible.

“Penetrating trauma like gunshot wounds, shrapnel injuries and the like are a surgical disease. The only way to fix hemorrhagic shock from penetrating trauma is to get patients into an operating room as quickly as possible,” said Varga. “Most combat related injuries are from gunshot wounds or IED (improvised explosive devices).”

According to U.S. Air Force Col. Jacqueline Mudd, 455TH EMDG chief nurse and surgical services flight commander, it’s important to have surgical and operation room capabilities here because it dramatically increases patients’ survival rate while minimizing morbidity and mortality.

“If we weren’t here, patients would be subject to risky travel out of the AOR (area of responsibility) before receiving medical care, which can increase morbidity and mortality,” said Mudd, who is on her sixth deployment and whose home station is the David Grant Medical Center at Travis Air Force Base, California. “We deliver world-class quality surgical care and capability here at Bagram.”

The CJTH surgical services flight is made up of three elements: operating room, including the sterile processing department; anesthesia element; and, surgeon element. Since April, the more than 20 surgeons, nurses and technicians have supported 264 cases, executing 474 procedures over 1,500 hours of surgery, including three mass casualty events and 70 trauma cases.

According to Varga, maintaining a Role 3 hospital in Afghanistan and the surgical capability it brings is vital to ensuring that the men and women who continue the fight against terrorism have the best chance of making it back home.

“The fatality rates of military members involved in this conflict are the lowest in history, and we aim to reduce those numbers even further,” said Varga. “Complex, traumatically injured patients require a multi-disciplinary approach to provide the best outcome and it’s essential someone is here to organize that approach.

“In a combat environment where moments can mean the difference between life and death for a military member, coalition force or local child, trauma surgeons are trained to evaluate multiple injuries very quickly and prioritize those surgeries necessary to save lives, and then to continue care and schedule follow-up surgeries in a way to best preserve quality of life and recovery,” said Varga.

As the team wraps up their deployment, Mudd shared her highlights of the team saving lives in the operating room.

“Memorable cases including saving the life of a (Service member) who had shrapnel pierce his heart, and another who had a gunshot wound to the brain that is now walking and talking with minimal residual deficit,” said Mudd. “There was also the young 8-year old girl who was caught in crossfire, and the patient who required multiple days of surgery to restore his face to normal.”

Varga said the skill and capabilities of the team resulted in some truly incredible saves in the past six months.

“One solider suffered a GSW to his chest and abdomen and his excessive blood loss caused his heart to stop while he was transported to CJTH. The moment he arrived, we rushed him immediately to the OR, restarted his heart and proceeded to repair multiple complex injuries to his liver and kidney along with major vascular repairs,” said Varga. “He survived and will soon be going home to his family.”

Varga also remembered the Service member who had shrapnel pierce his heart.

“The survival rate with this type of injury, even in a Level 1 Trauma Center in the U.S. with full surgical and cardiac capabilities, is less than three percent. I was able to get him into the OR and operated directly on his heart without the use of cardiopulmonary bypass-- in other words, I repaired his heart while it continued beating in his chest,” said Varga. “We stabilized the patient and very quickly coordinated a complex transfer to a cardiac surgeon in Germany who had the infrastructure to repair the multiple injuries to the valves in his heart.

“This required a truly awe-inspiring coordination of care from recognition of a rare and complex injury to medical transport across borders for an imminently necessary surgery,” said Varga. “That patient is now fully recovered and home with his family.”

Varga said the entire CJTH team wants nothing more than to provide the best care possible and save the lives of fellow service members who are on the front lines serving his or her nation.

“We’re delivering health care equal to the care found in the best trauma centers in the U.S., a feat that can only be managed because of the extensive medical, security, administrative, supply and airlift support of the joint U.S. military services,” said Varga.

“Our mission is to continue improving the historically high survival rates currently seen in combat medicine despite severe and complex injuries suffered by our military and NATO members and our Afghan partners,” said Varga. “Our goal is make sure every service member we see in this hospital recovers and makes it home to the family he or she loves and the country he or she protects.”

For Col. Gianna Zeh, 455th EMDG commander, she enjoys working with the joint medical team at CJTH and watching their efforts to save life, limb and eyesight of all the patients who come through the hospital.

“I’m humbled to lead this incredibly talented group of medics,” said Zeh. “They’ve answered their nation’s call and served with compassion.”

Disclaimer: Re-published content may have been edited for length and clarity. Read original post.

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Department of Puerto Rico holds Scouting ceremony

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On Sept. 12, the Department of Puerto Rico held an Eagle Scout Award ceremony at El Museo de Los Próceres in Cabo Rojo. A total of four Eagle Scouts, as well as a master, were honored.

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New Autism Care Demonstration Updates

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In an effort to continually improve the benefit, the Comprehensive Autism Care Demonstration (ACD) was recently updated to reduce the potential financial burden of applied behavior analysis (ABA) services for non-active duty families.  

As of October 1, 2015, all ACD cost-shares will match TRICARE PrimeA managed care option available in Prime Service Areas in the United States; you have an assigned primary care manager who provides most of your care.TRICARE Prime and Standard cost-shares for all ABA services provided by authorized ABA supervisors, assistant behavior analysts, and behavior technicians. This change will allow cost-shares to contribute to the annual catastrophic cap for families and eliminates the 10 percent cost-share for assistant behavior analyst and behavior technician services, also known as “tiered” services, significantly reducing the potential financial burden of ABA services for our non-active duty families.

Revisions were also made to enhance the quality and safety of ABA services.  All ABA providers will become trained in Basic Life Support (BLS) by December 31, 2015. Many beneficiaries diagnosed with autism spectrum disorder (ASD) typically have other medical conditions, and in the rare event that BLS would be needed to save a life, all ABA providers will be trained.  All behavior technicians (BT) are also now required to obtain BT certification from an accredited organization.  BT certification ensures these providers are consistently well-trained in ABA services. 

The TRICARE ACD covers all TRICARE eligible beneficiaries diagnosed with ASD under a single benefit. There are currently almost 13,000 beneficiaries receiving ABA through the ACD which runs through December 31, 2018. 

For more information about the changes to this benefit, visit the Autism Care Demonstration page on the TRICARE website.

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Did you know?

Military Funeral Honors ceremonies must be scheduled in advance.

The law requires that every eligible veteran receive a military funeral honors ceremony, which includes the folding and presentation of the United States flag and the playing of “taps,” upon the family’s request. This Department of Defense program calls for the funeral director to request military funeral honors on behalf of the veteran’s family.