Solution Recommendations
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- Fay Gibbs
- 5 years ago
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2 About us BurnPits 360 is a national veterans service organization. Our mission is to provide resources, information, research, and legislative action as a pathway of advocacy for those affected by the effects of deployment airborne related hazards and toxic exposure. In an effort to create awareness after meeting an online community of individuals affected and receiving a recommendation to collect data to prove a correlation between the exposures and the illnesses and deaths, we formed BurnPits 360. Currently, we are educating service members, veterans, and their families for a boots on the ground outreach campaign to advocate and educate their healthcare providers, legislators, and community.
3 The Challenges National registry does not capture true symptoms or diagnosis due to lack of category in which veteran or service member can self report their exposures and health problems. National registry is not user friendly resulting in high non-completion rate according to the data reported by IOM and VA. Registry does not allow families of the fallen to self-report a death entry. Veterans and service members not familiar with medical terminology. Currently outreach and awareness is non-existent according to veterans and service members. Data captured in the registry does not allow us the opportunity for specialized healthcare or compensation benefits. Currently, Veterans have to travel to access care through private insurance providers, and at few VA s that acknowledge the association between exposure and diseases.
4 Solution Recommendations Revise registry to include an open category where true symptoms can be self-reported. Allow a section for families of the fallen to report a death entry. Capturing symptoms and illnesses will justify legislative action for specialized healthcare, presumptive list of illnesses for compensation, and benefits. Conduct an effective national and state outreach marketing campaign to include private organizations, VSOs, and community stakeholders.
5 Registry Data Burnpits 360 registry contains approximately 4,000 self reported entries of service members, soldiers, and families of fallen heroes. Of those 4,000 entries over 90% suffer from respiratory symptoms or disease. Other symptoms reported are headaches, GI issues, memory loss, cancer, rashes, and many others. Our registry indicates a high percentage of individuals who have undergone lung biopsies and received a zero compensation rating due to constrictive bronchiolitis being a new disease that is not listed as a category in the VA/DOD CFRs (code of federal regulation).
6 Widow Of A Fallen Hero (testimonial) To Whom it may concern, My daughter and I lost my husband 2yrs ago to cancer from exposure to burn pits while serving in Iraq. By this point the registry was not available. We hope that his passing and suffering was not in vain. That those who have passed still can make a difference and be allowed in the registry. Thank you for your time. Sincerely Maria Matic
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12 Burn Pit Victim Name Age Telephone Number Address Military Service Branch ARMY MARINES NAVY AIR FORCE COAST GUARD Military Status Active Duty Retired Reservist Military Base/FOB Where Did You Live On Base (miles or meters) Active Duty Tour Year (LIST START & SEPARATION DATES FOR ALL TOURS) MOS During Tour In Iraq Military Contractor Federal Employee Civilian Did You Work Directly At The Burn Pits Yes No Were You Given A Mask Yes No
13 Where did you work (miles or meters) Lung Biopsy Performed Yes Open Lung No Physician & Facility That Performed Lung Biopsy Other Symptoms of Illnesses (Please list anything not already included) Current Health Care Providers/Facilities Are You On Oxygen Yes No How Often Are You On Oxygen 24 hours a day As Needed Other Legal Representation Yes No Are You Receiving Service Connected Compensation For Burn Pit Exposures? Yes No Services Needed Cancer Diagnosis Yes No Active Remission Deceased
14 Cancer Type Of AML Acute Myeloid Leukemia Anaplastic Astrocytoma Large Cell Lymphoma Renal Cell Carcinoma Squamous Cell Mouth Cancer Hepatoid Adenocarcinoma Hodgkins Lymphoma Soft Tissue Sarcoma Acute Lymphoblastic Lymphoma Neuroendocrine Carcinoma Gastro esophageal Carcinoma Aplastic Anemia Dysgerminoma (Ovarian Cancer) Lymphatic Cancer Meningioma (Brain Tumor) Testicular Cancer Breast Cancer Glioblastoma Aggressive Aplastic Anemia Synovial Sarcoma CML Gastro esophageal Adenocarcinoma Non Hodgkins Diffuse Large Cell Lymphoma Brain Neoplastic Astrocytoma
15 Symptoms & Diagnosis Shortness Of Breath (MILD) JOGGING Shortness Of Breath (SEVERE) ONE ROOM TO OTHER Nausea Muscle Pain Joint Stiffness Abdominal Pain Chronic Cough Memory Loss Chronic Cough GI Bleeding Low Testosterone Level Intestinal Parasite Infections Headaches Weight Loss Paralysis Lupus Blurred Vision Polyps Shortness Of Breath (MODERATE) WALK ONE BLOCK High Blood Pressure GI Bleeding Muscle Twitching Joint Pain Stomach Distention/Bloating Chest Pain Fatigue Choking Spasms Low Vitamin D Level Infertility Skin Lesions Gallbladder Removal Dyspnea Diarrhea Acid Reflux Fibromyalgia
16 Was Pre Deployment Health Exam Normal Yes No Have You Had A PFT (Pulmonary Function Test) Yes No Have You Ever Smoked Yes No If Yes How Many Packs Per Day How Many Years Since You Stopped Smoking If Yes How Many Years Did You Smoke Do You Still Smoke Yes No
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20 Financial hardship Loss Of Civilian/military employment Suicide(result of combat & toxic exposure) Compensation Specialized Healthcare Develop Centers Of Excellence Develop medical protocol/program within DOD/VA Systems. Research Benefits Legislative Medical Scientific Death Healthcare Social Security (Compassionate Allowance)
21 For more information on BurnPits 360 Rosie Torres Retired Captain Leroy Torres
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NEW PATIENT INFORMATION
NEW PATIENT INFORMATION Personal Mr. Ms. Mrs. Miss Dr. Other Last Name First Name MI Home Address City State Zip Mail Address City State Zip Is This a Nursing Home? Facility Name Telephone # Cell Phone
Corinna Mosher, M.D. A Medical Corporation 415 E. Rolling Oaks Drive Suite #280 Thousand Oaks, CA (805) Fax (805)
Patient Registration: Corinna Mosher, M.D. A Medical Corporation 415 E. Rolling Oaks Drive Suite #280 Thousand Oaks, CA 91361 (805) 496-8522 Fax (805) 496-0469 Last Name: First Name: MI: Address: City:
Social Security No. Date of Birth Sex Male Female Height Weight lbs Occupation Marital Status
Workers Compensation Intake Form File Number (Office Use) Patient Information: Today s Date Home Phone Name Cell Phone I prefer to be called Preferred Contact Home Cell Email Social Security No. Date of
Please fill in all bubbles completely! Patient Name: Date: Date of Birth: Referring Doc: Family Doc: I. What are you being seen for today?
Gregory H. Tchejeyan, M.D., Inc. Please fill out this form in its entirety. Please complete every line item, as it is necessitated by regulations from the government (Health Care Finance Administration
PATIENT DATA SHEET GENERAL INFORMATION DATE ( ) ( ) ( ) HOME PHONE WORK PHONE CELL PHONE
PATIENT DATA SHEET GENERAL INFORMATION / / DATE LAST NAME FIRST NAME MIDDLE INITIAL ADDRESS CITY STATE ZIP CODE ( ) ( ) ( ) HOME PHONE WORK PHONE CELL PHONE EMAIL ADDRESS SEX MALE FEMALE (PLEASE CIRCLE)
New Patient Information Form
New Patient Information Form Patient Label Dear Patient: Please take a few minutes to complete this form. Your answers will help the doctors and staff plan and provide your care. If you are unsure of any
NEW PATIENT QUESTIONNAIRE
NEW PATIENT QUESTIONNAIRE PLEASE PRINT Full name: Age: Preferred Contact number: Email address: Why are you here today? To establish primary care Annual exam Consultation from another doctor If consultation,
MONTEFIORE MEDICAL CENTER TRANSPLANT PROGRAM LIVING DONOR EVALUATION FORM History Questionnaire
MONTEFIORE MEDICAL CENTER TRANSPLANT PROGRAM LIVING DONOR EVALUATION FORM History Questionnaire Donor s Name: Today s Date: Social Security #: Date of Birth Age Sex Address: Telephone #: (home) (work)
Please have your health insurance card(s), a valid picture ID, and any applicable copayment ready when you check-in.
Please have your health insurance card(s), a valid picture ID, and any applicable copayment ready when you check-in. We have enclosed a questionnaire for you to complete and bring to the visit. Please
Name: Date: Sex: Male Female Date of Birth(DD/MM/YY): Address: City: Postal Code: Phone #: (Home) (Work) (Cell) (Other) Address:
Name: Date: Sex: Male Female Date of Birth(DD/MM/YY): Address: City: Postal Code: Phone #: (Home) (Work) (Cell) (Other) Email Address: Emergency Contact Name and Phone Number: Family Doctor Name and Address: