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Both his grandfather and great uncle served in World War II, said Sen. Barack Obama, D-Ill., but only his great uncle entered a Nazi death camp as the war came to a close.

“According to the story my grandmother told,” said the senator in a phone interview, “when he got home he went up to his parents’ house, into the attic, and didn’t talk for about six months.”

It was an era, said Obama, in which many veterans struggled through the trauma of war, without counseling or disability pay.

Obama had several generations of veterans in mind, he suggested, when he joined with fellow Democrats Richard Durbin of Illinois, Patty Murray of Washington and Daniel K. Akaka of Hawaii on Sept. 22 on an amendment to block the Department of Veterans Affairs from reviewing case files of 72,000 veterans rated 100 percent disabled by post-traumatic stress disorder. The Senate, on a voice vote, adopted the amendment to the Military Construction and Veterans Affairs Appropriation Act (HR 2528).

The House version of the bill has no such language, so a House-Senate conference committee will decide its fate during final negotiations on the bill.

Rep. Steve Buyer, R-Ind., chairman of the House Veterans Affairs Committee, declined an interview but in a written statement said, “If a veteran’s claim is unfairly denied, that is a problem. If a claim is granted in error, that is money taken from another veteran.”

VA officials believe some PTSD claims have been decided for veterans without proper documentation. They announced their massive review only after the VA inspector general studied 2,100 randomly selected cases of PTSD disability awards and found 25 percent lacked documents to verify that a traumatic, service-connected incident occurred.

Given the poor staff work, VA said that in January it would begin to review paperwork for all 100 percent disabled PTSD cases decided over five years, from October 1999 through September 2004. In that period, the IG said, the number of veterans receiving compensation for PTSD rose by 80 percent and annual PTSD payments rose from $1.7 billion to $4.3 billion.

But the Senate’s amendment would bar the VA from conducting its case review until it justifies the program to Congress. It also would prohibit the VA from lowering PTSD awards except in cases of fraud.

“None of us wants to see any fraud or waste in government spending,” said Obama, who serves on the Senate Veterans Affairs Committee. “But nowhere should we be more willing to give people the benefit of the doubt than with the brave men and women who served our country.”

VA, he said, “is presuming significant fraud for people who have received 100-percent disability payments on PTSD claims. They are not conducting a comparable survey of people whose claims were denied. What that indicates, to me at least, is there is some bias against those who have received payments.”

He noted that the original IG investigation was launched because of veterans’ complaints of wide disparities in claim award between VA regions.

“There were a couple of ways the VA could have handled it. They could have said, ‘You know, this is troubling. It seems that some veterans are being short-changed. Let’s make sure all veterans are being treated fairly and generously.’”

Instead, the VA decided to “level down rather than up” on benefits.

He predicted House conferees will concede to the Senate on this issue.

“If you just think about the nature of PTSD, imagine the number of servicemen who come back and never even bother about making a PTSD claim, despite the fact that they’ve having significant trauma,” Obama said. “Think about those who maybe put in a claim but weren’t organized enough to have the paperwork, and now, potentially, are going to see benefits reduced.”

Obama said the rise in PTSD payments likely reflects greater knowledge today of the disorder rather than sloppy staff work or fraud.

Drug formulary changes?The Defense Department’s Pharmacy and Therapeutics Committee is recommending that several heart medicines and a drug to treat swollen prostates be moved off the military formulary, which would limit their availability on base and raise their price for beneficiaries who use the Tricare retail network or mail order program.

If Dr. William Winkenwerder, assistant secretary of defense for health affairs, approves the recommendations, more than 300,000 cardiac patients and 90,000 men with benign prostate enlargement will have to switch medicines within four to six months or face higher drug costs.

The committee said the following drugs should be listed “nonformulary” drugs:

ACE (angiotensin converting enzyme) inhibitors for treatment of hypertension: brand names Altace, Aceon, Accupril and Univasc;Calcium channel blockers for treatment of angina and other heart conditions: brand names Verelan, Verelan PM, Covera HS, Cardizem, Norvasc, DynaCirc, DynaCirc CR, Cardene (sustained release) and Nicardipine (immediate release); andAlpha blocker, to treat benign prostatic hypertrophy: brand name Flomax.Sydney Hickey, who chairs the beneficiary advisory panel, said she and colleagues disagreed with dropping Altace, an effective drug not only in preventing cardiovascular episodes but, trial data show, in preventing the onset of diabetes. About 115,000 military beneficiaries use Altace.

Nonformulary drugs are not dispensed routinely on base and beneficiaries are charged $22 per prescription, rather than $9, in the Tricare retail network and mail-order program.

Based on an earlier recommendation, erectile dysfunction drugs Viagra and Cialis will fall off the formulary Oct. 12. Levitra will remain.

To comment, write Military Update, P.O. Box 231111, Centreville, VA 20120-1111, e-mail milupdate@aol.com or visit www.militaryupdate.com.

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