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All across America and around the world, this is Veterans Radio.

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This is Veterans Radio.

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Welcome to Veterans Radio.

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I am Jim Fausone.

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I'm the officer of the deck today.

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We've got some great programs for you.

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I think you'll find very interesting.

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We always want to remind you you can find more about Veterans Radio at its Facebook site

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or at the web.

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VeteransRadio.org is our new URL, VeteransRadio.org.

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Where we're on the web 24-7, you can find a lot of our podcasts there as well.

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We post new ones every Tuesday, so you can get a new story, a new interview, something

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you didn't know before by going to VeteransRadio.org.

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And before we get started, we want to thank our sponsors.

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First up, we want to thank National Veteran Business Development Council, NVBDC.org.

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It was established to certify both service disabled and veteran owned businesses.

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You'll find out how they can help your business by going to NVBDC.org.

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We want to thank Legal Help for Veterans.

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Legal Help for Veterans fights for veterans disability rights all across the nation.

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You can reach them at 800-693-4800 or on the web at LegalHelpForVeterans.com.

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You want to welcome to VeteransRadio today the Assistant Undersecretary for Health for

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Dentistry, Dr. Christine Lamar.

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Dr. Lamar, welcome to VeteransRadio.

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Thank you.

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Thank you so much for inviting me.

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I'm really excited to talk to you today.

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Well, we're really looking forward to getting some information out to our veterans about

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the VA's dental policies and those benefits.

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But let me set this up a little bit.

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You completed your general practice residency at the VA Long Beach Health Care System in

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California in 1998.

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In 2002, you became Chief of Dental Services.

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You've also served at Visin 22 as the lead dentist for seven years and the Office of

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Dentistry Infection Control Consultant for six years.

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You were appointed the Director of Operations in the Office of Dentistry for 2021 and the

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Acting Undersecretary in 2023.

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So you have a long history with the VA and you're an active member of the American Dental

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Association and a fellow in the International College of Dentists.

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And we're going to ask you some questions about some ADA information later.

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But you bring a real focus on dental health care with veterans.

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How did that become of such interest to yours?

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And tell us a little bit about your career.

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Yeah, great.

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Thank you for asking.

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So I first started off, my first love was to work with communities.

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Prior to coming to the VA, I ran a Ryan White clinic, which was a dental clinic for individuals

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with HIV and AIDS and kind of fell in love with that sector of the community outreach.

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And I had always, I loved my residency.

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I did it at the VA and when an opportunity opened up, I looked into it and I thought,

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this is the perfect place for me.

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My grandfather was a World War II 100% service-connected veteran.

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My father's a Vietnam veteran.

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So I always felt like I've been a caretaker, so to speak, of veterans throughout my life.

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We often find when we ask that question that back in the family history somewhere, there

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are family members who have been veterans and certainly both your father and your grandfather

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obviously had an impact on your career choices, I think.

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Yeah, no, definitely with my grandfather, especially with him being a 100% service-connected

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veteran, he got all his care through the VA and he even lived in a veteran community

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in Florida.

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And I used to spend my summers down there.

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My parents, we were in Michigan and my parents would, I know kind of the opposite right of

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a snowbird, but I would go down to Florida for the summer and spend it with my grandparents

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down there in Florida.

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Let's turn to veteran dental care because I think a lot of people struggle with understanding

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how one qualifies for this benefit.

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You shed some light?

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Yeah, absolutely.

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That's probably the most common question we get, right, is who's eligible for VA dental

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care?

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And this question most often refers to VA-provided dental care.

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In order to qualify for the VA-provided dental care, a veteran would need to meet certain

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criteria set by law.

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And some veterans may have a limited eligibility and others are eligible for what we call comprehensive

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dental benefits.

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I actually have a, I'm going to go into it a little bit for you, but I actually have

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a fact sheet that I can send you.

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If you have a website, we could put up for folks to look at as well to help with this.

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Oh, absolutely.

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I'll give it to you later and we'll put that up on veteransradio.org as well as its social

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media pages.

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Okay, perfect.

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Thank you.

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So for comprehensive dental benefits, there's about four categories a veteran would need

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to, or criteria, excuse me, a veteran would need to meet to go into that.

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One is they would need to have a service-connected, compensable, dental disability or condition,

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be a former POW, have a non-compensable dental condition or disability resulting from combat

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wounds or service trauma, or, and this is our most common category that we see in our

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clinics, is they have a service-connected disability rated at 100% or unemployable and

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paid at the 100% rate due to their service-connected conditions.

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So if I have what's commonly known as TDIU, which gets me rated at 100%, that would be

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that fourth category?

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Yes, yes.

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And then we do have some limited categories of care.

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So I'll give you one example of that.

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For a veteran who's been recently discharged from the military, they would become eligible

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for one-time dental care if at the time of discharge, they had, did not have all of their

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dental treatment completed by the military and that was notated on their DD 214.

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These categories are pretty clear.

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I don't know why they're not so well known.

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As you, as you explore this issue as the Assistant Undersecretary for Health for Dentistry,

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why doesn't the message get out more, do you think?

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You know, that's a great question and something we absolutely are pondering as well.

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And it's just a lack of awareness.

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And so I think that folks are not really sure, dental's kind of that area of the hospital

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that maybe they're not as familiar with and they are not just aware of that.

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You know, sometimes people have their own dental insurance and so they think, oh, well,

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I have a dental insurance.

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I can't use the VA dental.

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Well, that's actually not true.

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You can use your own insurance and you can use the VA dental benefit, but we want every

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veteran to use all of their earned benefits, especially their dental benefit.

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Absolutely.

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They earned them through their service and they shouldn't be shy about using them.

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I saw in some research that VA provides medical care for about 9 million veterans, but only

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about 1.8 million are eligible for dental care and only about 40% of those who are eligible

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actually use the care.

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So there's a big gap between those who are entitled to and those who actually use the

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care.

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One of the questions I guess I'd have, and this seems awfully naive on my part, but does

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every VA hospital have access to a dental clinic?

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So every hospital except for one has a dental service associated with it.

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So when I say that, what I mean is, you know, you might have a hospital in a location and

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then in the CBOC, they have dental clinic or it could be in the hospital, but we do have

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dentistry associated with every hospital except for one in the country.

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And so the dental services might be provided, you mentioned a CBOC, which is a community

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based outreach clinic.

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So it might be in the clinics versus in the hospitals.

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Is that what you're saying?

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It could be.

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Absolutely.

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We have many, many in the hospital, but you know, depending on the region and the access

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and where the veterans live, we do have them in different locations.

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Now I saw a report from some researchers at the American Institute of Dental Public Health

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and CareQuest Institute.

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I don't even know who all those people are, but they say that veterans have a higher rate

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of dental problems than the civilian population, including issues with tooth decay and gum

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disease.

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Does that sort of track what you have found in your role as assistant undersecretary for

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health for dentistry?

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We have.

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We do see.

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I'll be honest, I haven't looked at the literature exactly what you're referencing, but we do

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see our veterans have a high rate of periodontal disease and dental caries.

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I think though, when you look at some factors such as the age of the population we're treating

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and other things, it might be closer to the norm with that.

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But we definitely make sure we're focusing because we know that is very important to

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our veterans.

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So there's a couple of things we really look at.

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We have some quality indicators in place to make sure we're getting patients in for

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recalls.

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We have fluoride interventions and all these different preventive things that we focus

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on because we do want to make sure that their oral health is optimized.

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Yeah, I think there's general recognition nowadays that your oral health does relate

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to your overall physical health, doesn't it?

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Yes, absolutely.

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Aral health is part of whole health and we've had some articles out there that absolutely

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do not necessarily it's cause and effect, but it can have different, you know, we know

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it can affect those chronic diseases.

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So what services, Dr. Lamar, are actually available?

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Is it just cavities and pollen teeth or is it cleanings and X-rays?

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I mean, when we talk about available dental services, broaden that out for us a little

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bit.

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Yeah, so we offer the full gamut of dental services outside of maybe a couple of things

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and I'll get into those as well, but we offer everything from exams and X-rays, fillings,

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all the way up to implants.

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So we have a full gamut of services.

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I think what is maybe sometimes difficult to understand about the VA versus just going

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into your private dentist is that we don't have a list of things that it says you can

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have these things.

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We create a customized treatment plan for every veteran that comes in.

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That's a big difference because in the private sector, it's what is your insurance allow

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and we'll do this?

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Exactly.

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Exactly.

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And that's where we focus on what is going to get you to the optimized oral health.

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So that is our focus and sometimes we might say, this is what we are going to do today.

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Let's get your oral health up to that and then let's move on to that next step and see

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what we can do then.

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But we sometimes take a, we really take a long-range approach where our focus is on,

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let's get you up to that optimized oral health with this customized treatment plan.

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So as somebody who's not a big fan of dentists and who's had root canals and crowns, I assume

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your treatment services include those sorts of things and maybe even dentures?

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Yes, absolutely.

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We include crowns, partials, dentures, root canals.

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You name it, we have all of those things and we even have in some of those areas, we have

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residency programs teaching people how to become specialists in some of those arenas.

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So we definitely provide all of those services.

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I'll go back because I realize I didn't mention the couple of things that we don't do.

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We don't do dentistry purely for cosmetic purposes and then orthodontia is not something

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we offer unless you need orthodontia as a result of a CERNUS trauma condition.

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Certainly, yeah.

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One of the challenge, I'll come to the challenge in a minute, but you mentioned residency and

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I always like to take a minute to remind people and I assume it's true in your area because

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you did your residency, general practice residency at VA Long Beach.

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I think people forget how much training the VA does.

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Can you, and this is medical doctors and nurses and PAs and everybody else, I never thought

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about the training, the teaching it does in the area of dentistry.

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Can you elaborate on that a little bit?

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Yeah, we have incredible training programs.

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We have general dentistry residencies, we have specialty residencies in the VA.

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We even have dental hygiene, we even have some dental assisting programs that come in

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to our clinics.

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What's great about this is it becomes our program where people get to know about the

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VA and then they want to come work for the VA.

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When I go and post for positions, I've got folks who've come into my service who know

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already about the veterans and our mission and want to be part of that.

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I have to say when I was the chief, I think almost all of my dental staff had done a residency

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at a VA.

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No, that's excellent.

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Again, I think one of the great unsung stories to the general public is how much the VA does

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in research and training and that's a benefit to the whole community, not just the community

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of veterans.

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Let me ask about the challenge though.

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I suspect like many VA services, there may be challenges about staffing and having enough

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personnel and budget to meet the need.

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Can you talk about the challenges?

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Yeah, absolutely.

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So last year, VA dental clinics, we provided 5.5 million procedures to more than 560,000

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veterans and that still didn't meet all of our need.

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In addition to that, we spent $1 billion in the community because we needed to make sure

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our veterans had access to care for the Mission Act.

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I'm sure you're familiar with the Mission Act.

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Those standards apply to dentistry.

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Okay, I was going to ask that.

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That's good to know.

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Yeah, yeah.

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So, for example, when I talked about veterans in Vermont, we're not just letting veterans

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in Vermont go without dental care.

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We still serve them through community care and that would be one area where you would

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see that.

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So if we can't provide that care in-house, we will provide that care in the community

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or if that veteran meets that drive time standard as well.

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So that's the challenge.

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So originally going back to your question, our challenge is, I would say our challenge

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is more having space, having dental treatment rooms is really the challenge we're facing

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right now to get all of our eligible veterans in, especially in where we're seeing these

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areas of the country with large growth.

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And that is a very complicated question because it takes congressional dollars to build out

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all those rooms and add all that equipment before you can even get to the personnel issues,

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isn't it?

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Right, exactly.

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You know, that's exactly right.

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You have to have that space to treat that veteran and then we're bringing in folks.

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I have to say because of those training programs we have and things like that, we've done fairly

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well with being able to recruit dentists.

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The area right now, and this is true not just in VA, but across all of dentistry, the American

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Dental Association has spoke about it, but we're seeing a nationwide shortage of dental

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assistants and dental hygienists.

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Help the uneducated out like myself.

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What's the difference between an assistant and a hygienist?

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Sure, absolutely.

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So a dental assistant is that person who you usually see helping the dentist when you're

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getting your treatment.

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The dental hygienist is the person you see when you go in for your cleanings.

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And those would be, you know, every six months when you go in for those cleanings in your

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dental office.

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Usually you see a dental hygienist.

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Right, right.

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So let me go on to another area that may become a challenge and there's been some articles

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written on because of the 2022 promise to address Comprehensive Toxic Act, better known as the

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PACT Act, that we're going to see a lot more veterans qualifying for dental benefits.

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Is that something you're thinking about now in the office there?

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Oh, absolutely.

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We have absolutely, that's one of the areas, the strengths of our office is Dr. Trapp,

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who I think you read about in that ADA article you mentioned at the beginning.

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We have a dental resource model that is a data-driven model along with geospatial information

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that looks at and predicts where our veterans be, where do we need to build our clinics

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for that.

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In addition to that, we are looking at, one of the wonderful things the PACT Act did was

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give us these different authorities to expand.

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And so we've gone into agreements with, or lease agreements with the Department of Defense.

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We're seeing more and more joint DOD VA clinics.

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We're looking at leases in private, you know, a dental office that maybe is vacant.

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And we lease that space and use it as well as traditional expansion.

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So all of those things are being put into place.

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Well, that's one of the things that I think, again, the VA does a pretty good job of it,

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which is trying to think ahead about where is this going?

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What do I need to be doing?

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I, meaning VA, what does VA need to be doing to address these future set of complexities?

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There is another benefit I wanted to talk about with you, and that is the VA Dental Insurance

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Program.

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I'm sure that if I had 100 veterans in the room now, okay, I'll say one of them might

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have ever heard of this.

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I'm not even sure if one has.

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Can you talk to us about this?

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Yes, absolutely.

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So the VA Dental Assurance Program, if a veteran does not qualify for VA dental care, or maybe

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they only get limited care and they're enrolled in VA health care, they have the option to

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enroll in a Veterans Affairs Dental Insurance Program.

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And what that is, that's administered by Delta Dental and MetLife, and you can, it's similar

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to what I as a VA employee can choose for my own personal dental insurance.

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And you can, there's different programs, different levels, different geography.

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So for example, you can do a Veteran-Only Program plan with maybe, you know, it gives

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you your traditional cleaning exams, and then would cover maybe some work at 50% for maybe

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$20 a month.

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And it also can offer extensive programs where it covers more extensive procedures, maybe

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those root canals and crowns you were talking about.

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And you can also sign up with a Veteran and Spouse, and that could maybe be about $60 a

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month for that more extensive plan, depending of course on your geographic location, it

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varies.

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And this is available because I have my Veteran status.

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I don't have to be a member of a union or part of this company or that company.

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I can sign up for this because I'm a Veteran.

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That's correct, but you do have to be enrolled in VA healthcare.

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Yes, absolutely.

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We remind everybody that even if you aren't entitled to healthcare under any of these

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various circumstances, you should still be enrolled in VA healthcare for the, when that

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day comes that maybe you need it.

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So we...

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Exactly.

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Exactly.

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I have this argument with my father.

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And that's one of the great things the PACTAC did was I actually got him to sign up for

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VA healthcare when the PACTAC came out.

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And I used, you know, look at during COVID, he could have access to different services.

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The VA was at the forefront of offering if he'd been in part of healthcare, signed up.

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And as I say, the dental benefits aren't really widely known and the dental healthcare insurance.

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Boy, that was a first for me.

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Before we close up here, I want to give you the chance to cover anything that I've not

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mentioned where you go, well, people don't know about this either.

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That's why he can't ask.

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What did I not cover that you think I want to get out to the wider Veteran audience?

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Yeah.

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No, thank you for doing that.

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You know, I think that VA dentistry is...

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I mean, we're here for the Veteran's Oral Health.

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That's why we're here.

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And our providers, we have a dental patient satisfaction survey.

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And people who come in and see our dental providers are nine times out of 10 most of the time,

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they're rating our providers in the care they received very highly.

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And that's very important to us.

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And like you said, you're not a huge fan of the dentist.

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The best way to make sure you don't have to come in is through prevention.

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Absolutely.

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Absolutely.

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Yeah.

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Even though you don't want to see us, see us before you have to.

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Absolutely.

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And we want to thank Dr. Christine Lamar, Assistant Under Secretary for Health for Dentistry at

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the VA for coming in and talking to us today to spread the word about the services that

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are available, the amazing work that the dentists do, both in terms of training and research,

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and help get the word out on something that maybe people didn't know about, which is the

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VA Dental Insurance Program.

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Dr. Lamar, thank you for your time today.

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Thank you for inviting me on and letting me get the word out to veterans about VA dentistry.

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And I want to thank everybody for listening to Veterans Radio today.

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I am Jim Fossone.

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It's been a pleasure to be your host.

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I'm a Veterans Disability Lawyer at Legal Help for Veterans, and you can reach us at

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800-693-4800 or legalhelpforveterans.com on the web.

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You can follow Veterans Radio on Facebook and listen to its podcasts and internet radio

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shows by visiting us at veteransradio.org.

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That's veteransradio.org.

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And until next time, you are dismissed.

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If you have a VA claim denied by the Board of Veterans Appeals, contact Legal Help for

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00:25:37,840 --> 00:25:42,080
Veterans at 1-800-693-4800.

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They're experts in handling cases before the U.S. Court of Appeals for Veterans Claims.

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Their number again, 1-800-693-4800.

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Council, NVBDC.org, VA Ann Arbor Health Care System, the Vietnam Veterans of America, Charles

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00:26:04,920 --> 00:26:13,600
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the American Legion Press Corn Post 46 also in Ann Arbor.

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Click on the sponsor level and continue to support keeping veteransradio on the air.

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And until next time, you are dismissed.