Vha Directive 2009-047 Project 112-Shad Testing

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This Directive will eventually end up completed in the VA Training & Fast Letters .....Forum, this website. However, since this is specific to this section, I am posting it here also. fanaticbooks

Department of Veterans Affairs

Veterans Health Administration

Washington, DC 20420

September 30, 2009

VHA DIRECTIVE 2009-047

PROVISION OF HEALTH CARE SERVICES TO VETERANS INVOLVED IN PROJECT 112-SHIPBOARD HAZARD AND DEFENSE (SHAD) TESTING

1. PURPOSE: This Veterans Health Administration (VHA) Directive provides Department of Veterans Affairs (VA) policy for providing Project 112-Shipboard Hazard and Defense (SHAD) Veterans a thorough clinical evaluation and enhanced access to enrollment in the VA Health Care System. This Directive describes the type of care for which these Veterans are eligible from VA at no cost; notwithstanding there is insufficient medical evidence to conclude their conditions are attributable to such testing.

2. BACKGROUND

a. Public Law 110-387, Section 803, the Veterans’ Mental Health and Other Care Improvements Act of 2008, permanently provides for Veterans, who participated in Project 112, (see subparagraph 2b) to be enrolled in Priority Enrollment Category 6, and as such, are eligible for VA health care at no cost for any illness related to their participation in that project. Veterans who participated in Project 112-SHAD are eligible for enrollment in Priority Group 6, unless otherwise eligible for placement in a higher enrollment priority based upon other eligibility factors. Accordingly, they are to receive needed hospital care, medical services, and nursing home care at no cost for any illness possibly related to their participation in these tests. VA waives first and third-party billing for services related to Project 112-SHAD exposure.

b. Project 112 is the name of the overall program for both shipboard and land-based biological and chemical testing that was conducted by the United States (U.S.) military between 1962 and 1973. Project SHAD was the shipboard portion of these tests, which were conducted to determine:

(1) The effectiveness of shipboard detection of chemical and biological warfare agents;

(2) The effectiveness of protective measures against these agents; and

(3) The potential risk to American forces posed by these weapons.

c. The Department of Defense (DOD) estimates that about 6,000 Veterans may have been involved in Project 112-SHAD. DOD has provided VA with the names of approximately 5,000 Veterans who participated in the tests. Currently, it is known that these tests involved low levels of a variety of biological and chemical warfare agents, simulants (thought to be less hazardous substitutes), and decontamination chemical substances.

d. Veterans, Members of Congress, Veterans Service Organizations, and the public have been interested in Project 112-SHAD and any potential long-term health effects to Veterans who participated in these tests.

e. DOD has collected, reviewed, and declassified relevant documentation regarding the testing. As the tests were declassified, DOD provided VA with:

(1) Test name, date, location, and, if a SHAD test, the names of ships involved in these tests;

(2) Names and service numbers of individual Veterans involved; and

(3) The materials to which the participants may have been exposed.

NOTE: Information about the specific ships involved and the known health effects from exposures to agents that were used in Project 112-SHAD tests is available along with other relevant background information at: http://vaww.va.gov/hec/Access/. This is an internal VA Web site and is not available to the public. Another source of information regarding Project 112 tests, is DOD's Web site at:

http://fhp.osd.mil/CBexposures/shad.jsp.

f. All Veterans identified by DOD as having participated in Project 112-SHAD were notified by letter from the Veterans Benefits Administration (VBA) in May 2002.

3. POLICY: It is VHA policy that Project 112-SHAD Veterans are offered: a thorough clinical evaluation by a knowledgeable VA primary care provider; enhanced priority for enrollment in the VA Health Care System; and pertinent information about Project 112-SHAD exposures and possible related adverse health effects.

4. ACTIONS: Facility Directors are responsible for:

a. Ensuring Project SHAD Veterans are enrolled in priority enrollment group 6, if they are not eligible for a higher-enrollment priority based on other eligibility factors; however, Project SHAD Veterans are not exempt from the requirement to complete a Financial Assessment (Means Test) and may be charged a copay for care for conditions found to have resulted from a cause(s) other than their participation in Project 112-SHAD tests.

b. Ensuring VA physicians consider the following types of conditions, that are not ordinarily considered to be due to occupational or military activities, when making the determination if the illness or disability is possibly related to a Veteran’s participation in Project 112-SHAD:

(1) Congenital or developmental conditions, e.g., scoliosis.

(2) Conditions which are known to have existed before military service.

(3) Conditions having a specific and well-established etiology and that began after military service ceased, e.g., bone fractures occurring after separation from military service, a common cold, etc.

(4) Although the preceding types of conditions are not ordinarily considered to be due to military service, if the staff physician finds that a Veteran requires care under this provision for one or more of those conditions, the physician is to seek guidance from the facility Chief of Staff (COS) and the Registry Physician (RP) regarding the authorization for such treatment. The decision and its basis must be clearly documented in the Veterans electronic health record and chart by the RP.

c. Ensuring that Project 112-SHAD Veterans who request either an examination or enrollment in the VA health care system, whether or not they have previously received health care from VA, are offered a complete "Primary Care New Patient History and Physical Examination," using the standardized template for this examination, and the results of the examination is documented in the Computeriezed Patient Record System (CPRS).

NOTE: Templates are located at the following Web site:

http://vaww.vhaco.va.gov/him/natldoctemplates.html. This is an internal VA Web site not available to the public

d. Designating appropriate knowledgeable staff (like the "Environmental Agents Clinicians and Coordinators" who routinely deal with military deployment exposure questions) to provide information about Project 112-SHAD exposures and possible adverse affects on Veteran health. This staff must document provision of such information in the patient's electronic health record.

e. Ensuring that facility intake, eligibility and clinic scheduling staff are knowledgeable of the Project 112-SHAD indicator in Veterans Health Information Systems and Technology Architecture (VistA) on the Registration screen 7.

NOTE: The Project 112-SHAD information entered in this indicator field is also available in other VistA applications to enable other users (e.g., clinicians) to view it.

f. Ensuring facility intake, eligibility and clinic scheduling staff contact Health Eligibility Center (HEC) staff to make any needed changes to SHAD status since they cannot edit the Project 112-SHAD indicator. NOTE: Staff may contact the VHA HEC Alert mail group using Outlook or by fax to (404) 982-3060 or telephone at (404) 828-5257.

g. Ensuring the name of the specific Project 112-SHAD test or tests in which the Veteran participated, while in military service, and possible exposures are recorded in the patient's electronic health record. This data must be obtained from the patient or from the notification letter the Veteran received from VBA (see subpara. 2f).

h. Identifying one clinical application coordinator at the VA facility to import the template using the Text Integrated Utility template editor in (CPRS Graphic User Interface (GUI)). The template must be imported into the test account prior to placing into production.

5. REFERENCES: Title 38 U.S.C. § 1710(e)(1)(E).

6. FOLLOW-UP RESPONSIBILITY: The Chief Business Office (16) is responsible for the contents of this Directive. Questions about patient care and possible adverse health effects related to Project 112-SHAD maybe addressed to the Environmental Health Strategic Health Care Group (13A) at (202) 461-1020. Questions concerning enrollment and eligibility maybe referred to the Chief Business Office at (202) 461-1589.

7. RESCISSIONS: VHA Directive 2004-016 is rescinded. This VHA Directive expires

September 30, 2014.

Gerald M. Cross, MD, FAAFP

Acting Under Secretary for Health

DISTRIBUTION:

E-mailed to the VHA Publication Distribution List 10/5/09