The Slow March Toward Full Inclusion

The chiropractic profession achieved another well-deserved victory in its quest to make chiropractic available to all members of the armed forces on Sept. 27, 2008, when Congress passed the National Defense Authorization Act (NDAA) for Fiscal Year 2009. Included in the massive piece of legislation is a provision that calls on the Secretary of Defense to expand delivery of chiropractic services within the next year. Section 704 of NDAA 2009 states the following relative to chiropractic care: "Not later than September 30, 2009, the Secretary of Defense shallprovide chiropractic services to active-duty militarypersonnel at 11 additional military treatment facilities that do not currently provide chiropractic services."

"Despite opposition by chiropractic competitors and an all-too-often unreceptive bureaucracy within the Department of Defense (DoD) health care system, we are making strides to increase the number of active-duty personnel with access to much-needed chiropractic care," said Glenn Manceaux, DC, president of the American Chiropractic Association (ACA). "Certainly, we are concerned that many of our brave men and women - particularly at overseas locations - are still without adequate access to chiropractic care, but we are heartened at the continued support we receive in Congress." The ACA and the Association of Chiropractic Colleges (ACC) lobbied extensively to include the pro-chiropractic stipulation inthe bill.

"Given the DoD's unsympathetic attitude, it is remarkable that any pro-chiropractic provision survived the legislative process and was included in the final version of this year's controversial NDAA," added ACC President Carl Cleveland III, DC. "Some at the DoD would like to limit the chiropractic program to its current plateau of49 bases, but Congress continues to support program expansion and for that, we are very grateful."

By "unsympathetic attitude," Dr. Cleveland may well be referring to the fact that 49 bases falls well short of full implementation of chiropractic benefits in all service branches of the military, as stipulated in the National Defense Authorization Act for Fiscal Year 2001. That historic legislation mandated implementation over a five-year period and required the Secretary of Defense to develop a plan to ensure adequate provision of those benefits.

Why chiropractic care for our military personnel? As a doctor of chiropractic, certainly you know why, but for legislators, third-party payors, patients and others who may ask, two examples from the recent literature make the rationale crystal clear: 

1. Results of an observational study of soldiers who were medically evacuated from Operation Iraqi Freedom showed that the most common pain complaint was radicular or axial low back pain (53% of subjects), with nonradicular extremity pain accounting for an additional 23 percent of complaints. Lumbar herniated disc was the most common diagnosis, accounting for almost 25 percent of all pain disorders. The study authors noted that "the major cause of attrition in recent wars has not been battle-inflicted injuries, but more ordinary conditions such as accidents and musculoskeletal complaints." The study, "Presentation, Diagnoses, Mechanisms of Injury, and Treatment of Soldiers Injured in Operation Iraqi Freedom," by Dr. Steven Cohen, et al., appeared in the journal Anesthesia & Analgesia in 2005.
2. A 2006 report from the Veterans Health Administration Office of Public Health and Occupational Hazards cited musculoskeletal complaints, primarily joint and back disorders, as one of the three most common possible health problems affecting war veterans. The VA report, "Analysis of VA Health Care Utilization Among U.S. Southwest Asian War Veterans," evaluated nearly 200,000 soldiers who sought health care from Fiscal Year 2002 to the third quarter of 2006. Nearly 42 percent of veterans who sought health care services through the VA after returning from Iraq or Afghanistan were diagnosed with a musculoskeletal condition.

According to a often-quoted report issued by the U.S. Government Accountability Office in late 2005, the U.S. maintains more than 230 military treatment facilities worldwide. That means even if the Secretary of Defense complies with the latest congressional mandate, more than 70 percent of facilities, and hundreds of thousands of active-duty military personnel, will still not have access to chiropractic care as of September 2009. For that reason, the ACA and ACC anticipate renewing efforts to expand access when a new Congress - and a new president - begin work in January.