Was the fight for the VA worth the effort?

For years, the chiropractic profession lobbied and fought for the right to provide chiropractic services to U.S. Armed Forces veterans through the Veterans Affairs health care system. After VA Secretary Anthony Prinicipi, acting on the recommendations of the chiropractic advisory committee, put a "by consultation only" restriction on chiropractic care, however, many DCs questioned whether the result was worth the effort.

In all, only 26 facilities will permit a doctor of chiropractic to offer services, either as employees or through contracted services. The other facilities are supposed to allow veterans to obtain chiropractic care on a "fee‑based" system.

Veterans, however, must first receive permission for chiropractic care from their medical provider, via a "consultation." This gatekeeper provision was vehemently protested by two members of the VA Advisory Committee: Leona Fischer, DC, of the World Chiropractic Alliance (WCA) and Michael McLean, DC, of the International Chiropractors Association (ICA). Voting for the consultation provision were the three members affiliated with the American Chiropractic Association: Cynthia Vaughn, DC; Rick McMichael, DC; and Reed C. Phillips ‑‑ and Charles DuVall, DC, president of the National Association of Chiropractic Medicine.

In their minority argument, Drs. Fischer and McLean argued that the Veterans Health Administration "has had the ability to refer to doctors of chiropractic for years, but has seldom made such referrals in the past. It is doubtful such an ingrained institutional culture will be altered from within by directives."

Their concern was that medical doctors, out of ignorance about or prejudice against chiropractic, would refuse to allow patients to have chiropractic care except on rare occasions. E‑mail correspondence between Steven Lindner, DC, of New York and Susan Stickevers, MD, Chief of Physical Medicine and Rehabilitation Service, Northport VAMC/Program Director, SUNY Stony Brook Physical Medicine and Rehabilitation Residency Program, showed that their concerns were justified.

Dr. Lindner wrote to Stickevers for information on how veterans who are currently his patients could qualify for chiropractic services through the new outpatient fee‑basis program. Her response was: "AS A POINT OF INFORMATION, WHEN IT IS DEEMED APPROPRIATE FOR A PATIENT TO RECEIVE SPINAL MANIPULATION, THERE ARE OSTEOPATHS, PHYSICAL THERAPISTS, LICENSED ACUPUNCTURISTS, AND PHYSIATRISTS ON STAFF AT THIS VA FACILITY WHO ALREADY PROVIDE THIS SERVICE. WE ARE AFFILIATED WITH NYCOM, THE NY COLLEGE OF OSTEOPATHIC MEDICINE. IF YOUR VETERAN PATIENTS COME HERE FOR TREATMENT, WE WILL BE HAPPY TO PROVIDE THEM WITH SPINAL MANIPULATION AND ACUPUNCTURE. THANKS FOR THE REFERRALS." (Note: message is reprinted verbatim, capitalized as in original.)

In a subsequent e‑mail, Lindner tried to educate Stickevers, explaining to her that, "Your last e-mail supports the misconception of chiropractic: That is, that a DO, DC, and PT do the same thing... I agree manipulations of joints can be done by DOs, and PTs, but adjustments are very, very different. Our methods of analysis are very different."

He went on to explain the critical differences between the three approaches and provide additional information about the book, "Somatovisceral Aspects of Chiropractic ‑‑ An Evidence‑Based Approach" for her reference. At press time, Lindner had not received a response from Stickevers.

Ironically, the American Chiropractic Association (ACA) continues to boast about its role in the "success" of the VA program. A recent press release noted that the organization "applauds Secretary Principi and the DVA for this quick, decisive action to ensure that the nation's veterans receive the chiropractic care they need and deserve."

"In the end, the only thing that matters is whether our veterans are able to get much‑needed chiropractic care, both for specific neuromusculoskeletal conditions and for subluxation correction," stated Terry A. Rondberg, DC, president of the World Chiropractic Alliance. "I have yet to hear any reports of veterans being referred to DCs by their VA medical providers. Probably no more than two dozen chiropractors in the entire country -- out of the 50,000+ licensed doctors -- will be hired to work full‑time in the VA facilities and veterans will have to get through a medical gatekeeper to see them. That kind of situation is not one to win applause from WCA members."