All across America and around the world, this is Veterans Radio.
This is Veterans Radio.
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I am Jim Fausone.
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You want to welcome to VeteransRadio today the Assistant Undersecretary for Health for
Dentistry, Dr. Christine Lamar.
Dr. Lamar, welcome to VeteransRadio.
Thank you.
Thank you so much for inviting me.
I'm really excited to talk to you today.
Well, we're really looking forward to getting some information out to our veterans about
the VA's dental policies and those benefits.
But let me set this up a little bit.
You completed your general practice residency at the VA Long Beach Health Care System in
California in 1998.
In 2002, you became Chief of Dental Services.
You've also served at Visin 22 as the lead dentist for seven years and the Office of
Dentistry Infection Control Consultant for six years.
You were appointed the Director of Operations in the Office of Dentistry for 2021 and the
Acting Undersecretary in 2023.
So you have a long history with the VA and you're an active member of the American Dental
Association and a fellow in the International College of Dentists.
And we're going to ask you some questions about some ADA information later.
But you bring a real focus on dental health care with veterans.
How did that become of such interest to yours?
And tell us a little bit about your career.
Yeah, great.
Thank you for asking.
So I first started off, my first love was to work with communities.
Prior to coming to the VA, I ran a Ryan White clinic, which was a dental clinic for individuals
with HIV and AIDS and kind of fell in love with that sector of the community outreach.
And I had always, I loved my residency.
I did it at the VA and when an opportunity opened up, I looked into it and I thought,
this is the perfect place for me.
My grandfather was a World War II 100% service-connected veteran.
My father's a Vietnam veteran.
So I always felt like I've been a caretaker, so to speak, of veterans throughout my life.
We often find when we ask that question that back in the family history somewhere, there
are family members who have been veterans and certainly both your father and your grandfather
obviously had an impact on your career choices, I think.
Yeah, no, definitely with my grandfather, especially with him being a 100% service-connected
veteran, he got all his care through the VA and he even lived in a veteran community
in Florida.
And I used to spend my summers down there.
My parents, we were in Michigan and my parents would, I know kind of the opposite right of
a snowbird, but I would go down to Florida for the summer and spend it with my grandparents
down there in Florida.
Let's turn to veteran dental care because I think a lot of people struggle with understanding
how one qualifies for this benefit.
You shed some light?
Yeah, absolutely.
That's probably the most common question we get, right, is who's eligible for VA dental
care?
And this question most often refers to VA-provided dental care.
In order to qualify for the VA-provided dental care, a veteran would need to meet certain
criteria set by law.
And some veterans may have a limited eligibility and others are eligible for what we call comprehensive
dental benefits.
I actually have a, I'm going to go into it a little bit for you, but I actually have
a fact sheet that I can send you.
If you have a website, we could put up for folks to look at as well to help with this.
Oh, absolutely.
I'll give it to you later and we'll put that up on veteransradio.org as well as its social
media pages.
Okay, perfect.
Thank you.
So for comprehensive dental benefits, there's about four categories a veteran would need
to, or criteria, excuse me, a veteran would need to meet to go into that.
One is they would need to have a service-connected, compensable, dental disability or condition,
be a former POW, have a non-compensable dental condition or disability resulting from combat
wounds or service trauma, or, and this is our most common category that we see in our
clinics, is they have a service-connected disability rated at 100% or unemployable and
paid at the 100% rate due to their service-connected conditions.
So if I have what's commonly known as TDIU, which gets me rated at 100%, that would be
that fourth category?
Yes, yes.
And then we do have some limited categories of care.
So I'll give you one example of that.
For a veteran who's been recently discharged from the military, they would become eligible
for one-time dental care if at the time of discharge, they had, did not have all of their
dental treatment completed by the military and that was notated on their DD 214.
These categories are pretty clear.
I don't know why they're not so well known.
As you, as you explore this issue as the Assistant Undersecretary for Health for Dentistry,
why doesn't the message get out more, do you think?
You know, that's a great question and something we absolutely are pondering as well.
And it's just a lack of awareness.
And so I think that folks are not really sure, dental's kind of that area of the hospital
that maybe they're not as familiar with and they are not just aware of that.
You know, sometimes people have their own dental insurance and so they think, oh, well,
I have a dental insurance.
I can't use the VA dental.
Well, that's actually not true.
You can use your own insurance and you can use the VA dental benefit, but we want every
veteran to use all of their earned benefits, especially their dental benefit.
Absolutely.
They earned them through their service and they shouldn't be shy about using them.
I saw in some research that VA provides medical care for about 9 million veterans, but only
about 1.8 million are eligible for dental care and only about 40% of those who are eligible
actually use the care.
So there's a big gap between those who are entitled to and those who actually use the
care.
One of the questions I guess I'd have, and this seems awfully naive on my part, but does
every VA hospital have access to a dental clinic?
So every hospital except for one has a dental service associated with it.
So when I say that, what I mean is, you know, you might have a hospital in a location and
then in the CBOC, they have dental clinic or it could be in the hospital, but we do have
dentistry associated with every hospital except for one in the country.
And so the dental services might be provided, you mentioned a CBOC, which is a community
based outreach clinic.
So it might be in the clinics versus in the hospitals.
Is that what you're saying?
It could be.
Absolutely.
We have many, many in the hospital, but you know, depending on the region and the access
and where the veterans live, we do have them in different locations.
Now I saw a report from some researchers at the American Institute of Dental Public Health
and CareQuest Institute.
I don't even know who all those people are, but they say that veterans have a higher rate
of dental problems than the civilian population, including issues with tooth decay and gum
disease.
Does that sort of track what you have found in your role as assistant undersecretary for
health for dentistry?
We have.
We do see.
I'll be honest, I haven't looked at the literature exactly what you're referencing, but we do
see our veterans have a high rate of periodontal disease and dental caries.
I think though, when you look at some factors such as the age of the population we're treating
and other things, it might be closer to the norm with that.
But we definitely make sure we're focusing because we know that is very important to
our veterans.
So there's a couple of things we really look at.
We have some quality indicators in place to make sure we're getting patients in for
recalls.
We have fluoride interventions and all these different preventive things that we focus
on because we do want to make sure that their oral health is optimized.
Yeah, I think there's general recognition nowadays that your oral health does relate
to your overall physical health, doesn't it?
Yes, absolutely.
Aral health is part of whole health and we've had some articles out there that absolutely
do not necessarily it's cause and effect, but it can have different, you know, we know
it can affect those chronic diseases.
So what services, Dr. Lamar, are actually available?
Is it just cavities and pollen teeth or is it cleanings and X-rays?
I mean, when we talk about available dental services, broaden that out for us a little
bit.
Yeah, so we offer the full gamut of dental services outside of maybe a couple of things
and I'll get into those as well, but we offer everything from exams and X-rays, fillings,
all the way up to implants.
So we have a full gamut of services.
I think what is maybe sometimes difficult to understand about the VA versus just going
into your private dentist is that we don't have a list of things that it says you can
have these things.
We create a customized treatment plan for every veteran that comes in.
That's a big difference because in the private sector, it's what is your insurance allow
and we'll do this?
Exactly.
And that's where we focus on what is going to get you to the optimized oral health.
So that is our focus and sometimes we might say, this is what we are going to do today.
Let's get your oral health up to that and then let's move on to that next step and see
what we can do then.
But we sometimes take a, we really take a long-range approach where our focus is on,
let's get you up to that optimized oral health with this customized treatment plan.
So as somebody who's not a big fan of dentists and who's had root canals and crowns, I assume
your treatment services include those sorts of things and maybe even dentures?
Yes, absolutely.
We include crowns, partials, dentures, root canals.
You name it, we have all of those things and we even have in some of those areas, we have
residency programs teaching people how to become specialists in some of those arenas.
So we definitely provide all of those services.
I'll go back because I realize I didn't mention the couple of things that we don't do.
We don't do dentistry purely for cosmetic purposes and then orthodontia is not something
we offer unless you need orthodontia as a result of a CERNUS trauma condition.
Certainly, yeah.
One of the challenge, I'll come to the challenge in a minute, but you mentioned residency and
I always like to take a minute to remind people and I assume it's true in your area because
you did your residency, general practice residency at VA Long Beach.
I think people forget how much training the VA does.
Can you, and this is medical doctors and nurses and PAs and everybody else, I never thought
about the training, the teaching it does in the area of dentistry.
Can you elaborate on that a little bit?
Yeah, we have incredible training programs.
We have general dentistry residencies, we have specialty residencies in the VA.
We even have dental hygiene, we even have some dental assisting programs that come in
to our clinics.
What's great about this is it becomes our program where people get to know about the
VA and then they want to come work for the VA.
When I go and post for positions, I've got folks who've come into my service who know
already about the veterans and our mission and want to be part of that.
I have to say when I was the chief, I think almost all of my dental staff had done a residency
at a VA.
No, that's excellent.
Again, I think one of the great unsung stories to the general public is how much the VA does
in research and training and that's a benefit to the whole community, not just the community
of veterans.
Let me ask about the challenge though.
I suspect like many VA services, there may be challenges about staffing and having enough
personnel and budget to meet the need.
Can you talk about the challenges?
Yeah, absolutely.
So last year, VA dental clinics, we provided 5.5 million procedures to more than 560,000
veterans and that still didn't meet all of our need.
In addition to that, we spent $1 billion in the community because we needed to make sure
our veterans had access to care for the Mission Act.
I'm sure you're familiar with the Mission Act.
Those standards apply to dentistry.
Okay, I was going to ask that.
That's good to know.
Yeah, yeah.
So, for example, when I talked about veterans in Vermont, we're not just letting veterans
in Vermont go without dental care.
We still serve them through community care and that would be one area where you would
see that.
So if we can't provide that care in-house, we will provide that care in the community
or if that veteran meets that drive time standard as well.
So that's the challenge.
So originally going back to your question, our challenge is, I would say our challenge
is more having space, having dental treatment rooms is really the challenge we're facing
right now to get all of our eligible veterans in, especially in where we're seeing these
areas of the country with large growth.
And that is a very complicated question because it takes congressional dollars to build out
all those rooms and add all that equipment before you can even get to the personnel issues,
isn't it?
Right, exactly.
You know, that's exactly right.
You have to have that space to treat that veteran and then we're bringing in folks.
I have to say because of those training programs we have and things like that, we've done fairly
well with being able to recruit dentists.
The area right now, and this is true not just in VA, but across all of dentistry, the American
Dental Association has spoke about it, but we're seeing a nationwide shortage of dental
assistants and dental hygienists.
Help the uneducated out like myself.
What's the difference between an assistant and a hygienist?
Sure, absolutely.
So a dental assistant is that person who you usually see helping the dentist when you're
getting your treatment.
The dental hygienist is the person you see when you go in for your cleanings.
And those would be, you know, every six months when you go in for those cleanings in your
dental office.
Usually you see a dental hygienist.
Right, right.
So let me go on to another area that may become a challenge and there's been some articles
written on because of the 2022 promise to address Comprehensive Toxic Act, better known as the
PACT Act, that we're going to see a lot more veterans qualifying for dental benefits.
Is that something you're thinking about now in the office there?
Oh, absolutely.
We have absolutely, that's one of the areas, the strengths of our office is Dr. Trapp,
who I think you read about in that ADA article you mentioned at the beginning.
We have a dental resource model that is a data-driven model along with geospatial information
that looks at and predicts where our veterans be, where do we need to build our clinics
for that.
In addition to that, we are looking at, one of the wonderful things the PACT Act did was
give us these different authorities to expand.
And so we've gone into agreements with, or lease agreements with the Department of Defense.
We're seeing more and more joint DOD VA clinics.
We're looking at leases in private, you know, a dental office that maybe is vacant.
And we lease that space and use it as well as traditional expansion.
So all of those things are being put into place.
Well, that's one of the things that I think, again, the VA does a pretty good job of it,
which is trying to think ahead about where is this going?
What do I need to be doing?
I, meaning VA, what does VA need to be doing to address these future set of complexities?
There is another benefit I wanted to talk about with you, and that is the VA Dental Insurance
Program.
I'm sure that if I had 100 veterans in the room now, okay, I'll say one of them might
have ever heard of this.
I'm not even sure if one has.
Can you talk to us about this?
Yes, absolutely.
So the VA Dental Assurance Program, if a veteran does not qualify for VA dental care, or maybe
they only get limited care and they're enrolled in VA health care, they have the option to
enroll in a Veterans Affairs Dental Insurance Program.
And what that is, that's administered by Delta Dental and MetLife, and you can, it's similar
to what I as a VA employee can choose for my own personal dental insurance.
And you can, there's different programs, different levels, different geography.
So for example, you can do a Veteran-Only Program plan with maybe, you know, it gives
you your traditional cleaning exams, and then would cover maybe some work at 50% for maybe
$20 a month.
And it also can offer extensive programs where it covers more extensive procedures, maybe
those root canals and crowns you were talking about.
And you can also sign up with a Veteran and Spouse, and that could maybe be about $60 a
month for that more extensive plan, depending of course on your geographic location, it
varies.
And this is available because I have my Veteran status.
I don't have to be a member of a union or part of this company or that company.
I can sign up for this because I'm a Veteran.
That's correct, but you do have to be enrolled in VA healthcare.
Yes, absolutely.
We remind everybody that even if you aren't entitled to healthcare under any of these
various circumstances, you should still be enrolled in VA healthcare for the, when that
day comes that maybe you need it.
So we...
Exactly.
I have this argument with my father.
And that's one of the great things the PACTAC did was I actually got him to sign up for
VA healthcare when the PACTAC came out.
And I used, you know, look at during COVID, he could have access to different services.
The VA was at the forefront of offering if he'd been in part of healthcare, signed up.
And as I say, the dental benefits aren't really widely known and the dental healthcare insurance.
Boy, that was a first for me.
Before we close up here, I want to give you the chance to cover anything that I've not
mentioned where you go, well, people don't know about this either.
That's why he can't ask.
What did I not cover that you think I want to get out to the wider Veteran audience?
Yeah.
No, thank you for doing that.
You know, I think that VA dentistry is...
I mean, we're here for the Veteran's Oral Health.
That's why we're here.
And our providers, we have a dental patient satisfaction survey.
And people who come in and see our dental providers are nine times out of 10 most of the time,
they're rating our providers in the care they received very highly.
And that's very important to us.
And like you said, you're not a huge fan of the dentist.
The best way to make sure you don't have to come in is through prevention.
Absolutely.
Yeah.
Even though you don't want to see us, see us before you have to.
Absolutely.
And we want to thank Dr. Christine Lamar, Assistant Under Secretary for Health for Dentistry at
the VA for coming in and talking to us today to spread the word about the services that
are available, the amazing work that the dentists do, both in terms of training and research,
and help get the word out on something that maybe people didn't know about, which is the
VA Dental Insurance Program.
Dr. Lamar, thank you for your time today.
Thank you for inviting me on and letting me get the word out to veterans about VA dentistry.
And I want to thank everybody for listening to Veterans Radio today.
I am Jim Fossone.
It's been a pleasure to be your host.
I'm a Veterans Disability Lawyer at Legal Help for Veterans, and you can reach us at
800-693-4800 or legalhelpforveterans.com on the web.
You can follow Veterans Radio on Facebook and listen to its podcasts and internet radio
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