Chiropractic Care for Veterans: Why Doctors of Chiropractic Should be on the Front Lines of the Integrated Care Team

Apr 3rd, 2018   /  A+ | a-
Military life requires many physical challenges. The physical stresses of carrying heavy loads, running with body armor and jumping out of planes can often have a long-term impact on a person’s body. It shouldn’t come as a surprise that many Veterans suffer from chronic pain from the lingering effects of active duty.

Of the millions of patients served annually in the Department of Veterans Affairs (VA) facilities, more than half experience chronic pain. Much of the chronic pain reported by Veterans is musculoskeletal pain, with around 25 percent consistently reporting low back pain (LBP). The prevalence of severe pain is more common in Veterans with LBP than in non-Veterans. Chiropractic care – a safe, effective and non-pharmacological approach to manage pain, as well as general health and wellness - should be an increased part of the integrated care that Veterans receive for LBP.

Luckily there is hope. A Department of Veterans Affairs policy enforces that Veterans have access to chiropractic care, but this service is dependent on the availability of doctors of chiropractic (DC) on staff at VA facilities. The VA now provides chiropractic care at approximately 75 major VA treatment facilities within the U.S. Unfortunately, most of America's Veterans still do not have access to chiropractic care because the VA has yet to provide DCs at a vast number of its medical facilities. The Veterans Health Administration is the largest integrated health care system in the United States, providing care at 1,243 health care facilities, including 170 VA Medical Centers and 1,063 outpatient sites of care of varying complexity (VHA outpatient clinics), serving more than 9 million enrolled Veterans each year.

There is currently an effort to require the VA to provide chiropractic care to all its medical treatment centers by the end of 2020. Efforts to expand chiropractic care to Veterans has recently gained new steam as ranking members of the Veterans Subcommittee on Health have thrown their support behind H.R. 103, the Chiropractic Care Available to All Veterans Act. The bill would require chiropractic services to be offered at all VA medical centers and include chiropractic care as a standard benefit for Veterans using the VA. Companion legislation is in the Senate.

Furthermore, chiropractic care in the VA is expanding beyond just spinal manipulation. Recently, President Trump signed into law the Job for Our Heroes Act, which includes a provision allowing DCs working within the VA to perform physical exams on Veterans needing a medical certificate to operate a commercial motor vehicle. Prior to the legislation, only 25 medical doctors within the entire VA healthcare system were qualified to perform the Department of Transportation (DOT) physical exams. Providers in the National Registry of Certified Medical Examiners—including more than 3,500 DCs—were excluded from providing the exams to truck drivers who receive their care through the VA health care system. Consequently, the drivers were burdened with limited access and were forced to look outside the VA for eligible health professionals to perform the required physical.

As additional proof that chiropractic care is vital to Veterans, a consensus-based, integrated care pathway was recently designed for DCs, primary care providers and mental health professionals who manage Veterans with LBP within VA healthcare facilities. The purpose of this chiropractic integrated care pathway was to define the parameters of an appropriate approach incorporating mental health and chiropractic considerations in the primary management of patients with LBP. Since mental health conditions are common among VA patients, DCs, while providing LBP care, may identify changes in a patient’s mental health status that could require additional follow-up. Although this care pathway focuses on LBP management, it also includes an overview of common mental health issues that a patient may present while receiving chiropractic care.
Through providing treatment for LBP, physical exams and as another touchpoint for mental health, DCs are in a perfect position to help Veterans and should be included as part of the integrated care team.
Doctors of chiropractic, who receive a minimum of seven years of higher level education, are specifically trained to diagnose, evaluate and provide non-pharmaceutical care and rehabilitation to individuals suffering from acute and chronic back, low back and neck pain, headaches, neuro-musculoskeletal and other related conditions
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