Frequently Asked Questions

How do I know if I am eligible to be seen at WRIISC?

Any veteran who served in a theater of combat operations from World War II through Operations Enduring Freedom and Iraqi Freedom and received the corresponding campaign medal is eligible to be seen at WRIISC. Specific eligibility criteria for the National Referral Program are described in the VA Undersecretary for Health’s Information Letter.

How do I obtain a referral if I am interested in the WRIISC clinical program?

• Veterans must be referred to WRIISC by their VA primary care provider.

• Clinicians interested in making referrals to the National Referral Program should contact Helen Malaskiewicz at 202-273-8463.

• A prescreening WRIISC referral application must be completed to confirm combat eligibility status and sent to Helen Malaskiewicz either by fax (202-273-9080) or by e-mail to helen.malaskiewicz@med.va.gov.

• Once eligibility is established, the referring physician is asked to complete the electronic WRIISC referral template in CPRS to provide background medical information. The title of this CPRS note is WRIISC Assessment and was distributed in patch TIU*1.0*159.

The WRIISC evaluation is a fairly intense 5-day program. Consequently, referring physicians need to verify in the electronic CPRS WRIISC referral note that the veteran is physically and mentally stable for travel and participation in the program. Once this template is completed, Ms. Malaskiewicz will forward the referral to either the East Orange, NJ, or Washington, DC, WRIISC based on geographical location. The WRIISC clinical team that receives the application will conduct a thorough review to determine whether the veteran is likely to benefit from an inpatient WRIISC evaluation or if some other mechanism, such as a Telehealth Consult, would be more appropriate. Seriously ill patients with well-established diagnoses, even if they are not responding to recommended therapy, usually are not appropriate candidates for WRIISC referral. Once a veteran has been approved for the WRIISC National Referral Program, an evaluation date will be finalized and confirmed with the veteran and referring provider. Additionally, detailed logistical information (to include contact information, maps, and a program description) will be mailed to the veteran.

How do I find out more information on depleted uranium and its health effects?

In 1998, the Institute of Medicine (IOM) began a series of congressionally-mandated studies to examine the scientific and medical literature on the potential health effects of chemical and biological agents related to the Gulf War. The first study reviewed the scientific literature on depleted uranium, chemical warfare agents (sarin and cyclosarin), pyridostigmine bromide, and vaccines (anthrax and botulinum toxoid) and published their findings in the report, Gulf War and Health Volume I: Depleted Uranium, Pyridostigimine Bromide, Sarin, Vaccines. The report is available from the IOM Web site.

For VA clinicians, Veterans Health Administration (VHA) Directive (VHA HANDBOOK 1303.1) outlines the procedures for evaluating Gulf War veterans with possible exposure to depleted uranium (DU).

How do I find out if the illness that I have is related to Agent Orange exposure?

(Note: The following information is provided in Agent Orange General Information Brochure, July 2003.) The number of diseases that the VA has recognized as associated with (but not necessarily caused by) Agent Orange exposure has expanded considerably during the 1990s. The following conditions are recognized for service connection for veterans: Agent Orange (a skin disorder), chloracne (a skin disorder), porphyria cutanea tarda, acute or subacute peripheral neuropathy (a nerve disorder), type 2 diabetes, and numerous cancers (non-Hodgkin’s lymphoma, soft tissue sarcoma, Hodgkin’s disease, multiple myeloma, prostate cancer, respiratory cancers [including cancers of the lung, larynx, trachea, and bronchus]) and chronic lymphocytic leukemia. Several time-limited conditions are recognized as associated with Agent Orange exposure. These conditions are chloracne (must occur within 1 year of exposure to Agent Orange), prophyria cutanea tarda (must occur within 1 year of exposure), and acute and subacute transient peripheral neuropathy (must appear within 1 year of exposure and resolve within 2 years of date of onset). In addition, Vietnam veterans’ children with the birth defect spina bifida are eligible for certain benefits and services. Furthermore, VA now provides certain benefits, including health care, for children with birth defects who were born to female Vietnam veterans.

Are there services available for combat veterans who experience symptoms of posttraumatic stress disorder (PTSD)?

(Note: The following information is provided in A National Center for PTSD Factsheet)

The Department of Veterans Affairs Medical Centers provide a network of more than 100 specialized programs for veterans with PTSD and work closely with the Vet Centers operated by VA's Readjustment Counseling Service. Each specialized PTSD program offers veterans education, evaluation, and treatment conducted by mental health professionals from a variety of disciplines (such as psychiatry, psychology, social work, counseling, and nursing).

Outpatient PTSD programs include three basic types of clinics in which veterans meet with a PTSD specialist for regularly scheduled appointments. PTSD Clinical Teams (PCTs) provide group and one-to-one evaluation, education, counseling, and psychotherapy. Substance Use PTSD Teams (SUPTs) offer outpatient education, evaluation, and counseling for the combined problems of PTSD and substance abuse. Women's Stress Disorder Treatment Teams (WSDTTs) provide women veterans with group and one-to-one evaluation, counseling, and psychotherapy.

Day Hospital PTSD programs include two basic approaches to providing a "therapeutic community." Veterans with PTSD can attend these community programs several times a week for social, recreational, and vocational activities as well as for counseling. Day Treatment PTSD Units provide one-to-one case management and counseling, group therapy, education, and activities in order to help clients live successfully with PTSD. Treatment and socialization activities are scheduled for several hours each day during the day and evening hours. Residential (Lodger) PTSD Units also offer one-to-one case management and counseling, group therapy, education, and activities for several hours each day. While enrolled in daytime and evening PTSD treatment, lodger clients may live temporarily in secure quarters that do not have 24-hour nursing supervision.

Inpatient PTSD programs include four basic types of service and are conducted while veterans reside in hospital units that provide 24-hour nursing and psychiatric care. Specialized Inpatient PTSD Units (SIPUs) provide trauma-focused evaluation, education, and psychotherapy for a period of 28 to 90 days of hospital admission. Evaluation and Brief Treatment of PTSD Units (EBTPUs) provide PTSD evaluation, education, and psychotherapy for a briefer period ranging from 14 to 28 days. PTSD Residential Rehabilitation Programs (PRRPs) provide PTSD evaluation, education, counseling, and case management that focus on helping the survivor resume a productive involvement in community life. PRRP admissions tend to range from 28 to 90 days. PTSD Substance Use Programs (PSUs) provide combined evaluation, education, and counseling for substance use problems and PTSD. PSU admissions range from 14 to 90 days.

Are there suggestions for simple steps that veterans and their loved ones can take to make readjusting to life after a combat experience easier?

There are a number of tips that counselors, family, and friends can take to ease the readjustment process. Capt. Hugh Reusser offers his suggestions in a recent edition of Vet Center Voice, a publication of the Readjustment Counseling Service.

I have a medical problem that is due to my military service. What compensation and benefits am I entitled to?

VA benefits and services fall into these major categories:

• Disability Benefits

• Education and Training Benefits

• Vocational Rehabilitation and Employment

• Home Loans

• Burial Benefits

• Dependents’ and Survivors’ Benefits

• Life Insurance

• Health Care

The mission of the Veterans Benefits Administration is to provide benefits and services to the veterans and their families in a responsive, timely, and compassionate manner in recognition of their service to the Nation.

The WRIISC program is not directly involved in the compensation and pension program for combat service veterans. However, the WRIISC-DC program will provide veterans with information on available resources that may help to answer questions regarding compensation and pension.

Where can clinicians go to learn more about caring for combat veterans?

The Veterans Affairs Employee Education System and the Office of Public Health and Environmental Hazards sponsored an independent study module, "Caring for War Wounded," as a part of the Veterans Health Initiative (VHI). The VHI is a comprehensive program of continuing education that recognizes the connection between certain health effects and military service and emphasizes better military medical histories for those wounded during Gulf War II.

Learning objectives of the independent study include

1. Define the VA/DoD Contingency Back-Up System

2. List the environmental and endemic hazards of deployment to Southwest Asia

3. Explain the purpose of DoD predeployment screening and the Force Health Protection Program

4. List the VA healthcare benefits after combat deployment

5. Describe the specific combat-related injuries, including wounds from traditional weapons and high-velocity weapons

6. Identify injuries associated with chemical warfare agents

7. Identify injuries associated with pesticide agents

8. Identify injuries associated with biological warfare agents

9. Identify injuries associated with radiological warfare

10. Explain the effect of combat on mental health

11. Describe the family support programs for veterans and their families

This independent study is primarily designed for Department of Veterans Affairs clinicians and other interested VA staff. Other healthcare providers, especially those in VA healthcare facilities, also are encouraged to complete the study. This program is available in booklet form and on the Web at http://www.va.gov/vhi. CEUs and CME credit is available.

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