SpinalColumnBlog

[originally published in KCN, March 2001]

“The Department of Defense is on record [regarding the commissioning of Doctors of Chiropractic in the Armed Forces to provide chiropractic care] as opposing such action….  To employ chiropractors, who have a limited and narrowly focused  scope of practice, is believed to be a manpower and financial expenditure that would be of little benefit to the beneficiaries of the military health care system.”  Besides, as the statement points out, “The treatment of musculoskeletal ailments…is currently well covered by physicians and physical therapists.”

So goes a statement that’s all too common to the ears of our profession — this one was issued in 1991 by the then Secretary of Defense, Richard Cheney’s Deputy Assistant Secretary, Edward Martin, M.D.

I wonder if our dedicated troops of Desert Storm felt the same way when they graciously lined up outside a make-shift chiropractic tent, amongst the sand dunes of Saudia Arabia, to have Registered Nurse, R. Jay Wipf, adjust their aching backs and necks.  Or perhaps the same thoughts came to mind when our uniformed men and women deployed to Macedonia and Kosovo, who oftentimes were required to put in hours around the clock six to seven days a week, received chiropractic adjustments from Sergeant Christopher Tarrant.  Possibly the elite soldiers of the Special Forces/Rangers felt the same way, while engaged in a physically and mentally demanding mission in Kuwait,  when they sought the services of spinal alignment by Radiologic Technologist, Lynn Grosvenor.  Or do you suppose our men in World War II shared the same sentiments when they requested Sergeant Joe Corcoran, a side gunner on a B-29, to adjust their stressed out spines?

Something tells me no.  For these grateful soldiers, sailors, and airmen who were treated by these men recognized something that the Department of Defense is refusing  to:   these men, while duly trained in their specialties, were also chiropractors.  And yet, this is but  a small sampling of the thousands of chiropractors that have proudly served our country, despite having their credentials ripped from their names.  Apparently this has been but a minor deterrent for our well-trained troops seeking the chiropractic care they want.  For as soon as they learn of the extra skills possessed by their fellow nurse, pharmacist mate, physical therapist, orthotist, or corpsman, they are quick to besiege him with requests for care.  In some instances these happenings are covert, and in others, they given a grateful nod by the military physicians on duty during  wartime efforts.

The nurse mentioned above, Dr. Wipf, tells that he quickly developed a “two-way informal referral arrangement” with the camp medical doctor.  Dr. Wipf’s great results on some of the more challenging cases seen by the medics (lumbar radiculitis, pelvic torsion, and old disc injuries) endeared the medical personnel to him as he relieved them of the responsibility of sending those patients out of the area for more intensive medical therapies and thus losing manpower resources. Another very valuable aspect of having Dr. Wipf’s services available was that he was able to relieve the allopathic practitioners of many of their musculoskeletal complaint  patients so they could focus their talents on the acute and traumatically injured cases.  Incidentally, the camp medical doctor also became a patient of Dr. Wipf’s.

A similar story of medical approval came from the sergeant “chiropractor,” Dr. Christopher Tarrant, stationed in Kosovo and Macedonia.   He explained that he began using his skills as a chiropractor when one of the medical doctors in the clinic found out who he was and asked for his help with some of the patients he was having slow progress with.  So impressed with his work, the medical doctor logged a personal recommendation that Dr. Tarrant be allowed to continue his volunteer chiropractic work when he returned to his post in Germany.  In a June 2000 letter,  Dr. Tarrant wrote, “By the end of January this year, I was in the clinic giving the gift of chiropractic care, not only to army service members but to their families as well, and to this day I am continuing that work”

It’s unfair that he has to do it on a volunteer basis.  It’s also unfair that our nation’s men and women of the armed forces, who fight to protect our freedoms, are not granted the simple freedom of health care choice themselves.  During peace time efforts, many willingly, albeit somewhat bitterly, step away from their all-expense paid health care benefits and seek the chiropractic care they really want on their own dime.

It’s high time that the Department of Defense recognize the “Chiropractic Elephant” that’s been faithfully sitting in their infantries since World War I.  Furthermore, they need to realize that the  men and women they employ like  the elephant.  It makes little sense that the Department of Defense has no problem commissioning doctors of medicine, osteopathy, dentists, optometrists, podiatrists, pharmacists, psychologists, veterinarians, physical therapists, occupational therapists, dietitians, and physicians assistants — yet when it comes to doctors of chiropractic, we are strangely absent from the list.  In many instances, our educational requirements meet or exceed those on the list, and it’s been pointed out that we are the last of the post graduate health professions to not have commissioning status in the military.

And to insinuate that the conditions we would help treat are already well covered is, well, ignorant.   There are a multitude of jobs that, by the military’s own statements, are not to be done while under the influence of medication (including over-the-counter medications).  A pilot of an F-14, for example, taking Ibuprofen for a stiff and aching neck, brought on by his last high G-force maneuver, could potentially be taken off of flight status — a needless loss of valuable manpower.  Because of our drugless approach to treating  aches and pains, an adjustment  delivered by a chiropractor might be just the treatment this pilot needs to effectively relieve his pain and keep him in the air.  Makes sense to me, but is apparently beyond the AMA’s understanding.  This was the case in 1992 when they sent Dr. Jacott to testify in a House of Representatives hearing on commissioning DC’s — stating on their  behalf that they were strongly opposed to the bill, as DC’s are not trained in surgical techniques and can’t dispense drugs. (Huh?)

To add insult to injury, chiropractic is approved for veterans’ training under the G.I. bill.  Ironically, once their training is completed, they are unable to offer their newly acquired skills in the military as commissioned officers.

So what are we doing about it?  All that we can.  The chiropractic profession has virtually been at war with the “higher-ups” of our nation’s military to try and resolve this unfair issue laden with long-standing biases.  My research efforts located a bill that was introduced to Congress regarding the commissioning of chiropractors as early as 1944.  It was turned down —  as was a similar one in 1957.  However, it appeared that we received somewhat of a break in 1984 when President Reagan requested in his budget to include chiropractic in the military.  This was followed by a  directive from Congress to the Department of Defense (DoD) to undertake a two-year demonstration project to determine the cost effectiveness of adding chiropractic into the military’s health insurance, known as CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) at the time.  It wasn’t until 1990 that this CHAMPUS project finally got underway.

Around the same time Senator Strom Thurmond of South Carolina introduced a bill to have doctors of chiropractic commissioned in the military. It was referred on to the Senate Armed Forces Services Committee for further study and deliberation — only to have it almost immediately tabled, and rightfully so, as Desert Storm came into play.

Flash back to the CHAMPUS project.  With the project  nearly half complete,  serious flaws in the data collection method were cropping up.  Attempts to salvage what they could and move on were made.  The project ended a little over a year later.  It then took over an additional year and a half and strong legislative prompting for the “final” report to come out.  Needless to say, the results of the project were a bit “wishy-washy” but were clearly delivered with an unfavorable tone.   While patient satisfaction was notably higher for chiropractic services, questions as to whether it would be cost-effective were difficult to determine and appeared that they might be a little higher than the DoD would have liked, especially since the demonstration project didn’t take place in a managed care setting.  Which begs the question:  if the military was geared to achieving cost controls via managed care, why didn’t they conduct their study in a similar atmosphere? The report went on to say, “Given the current  crises in health care costs, and fiscal constraints within the military health care system, DoD does not favor inclusion of a benefit which cannot be justified with compelling evidence.  To date, chiropractic studies have not produced such evidence.”

An interesting statement to make when roughly six months prior to the release of the finalized project results, the infamous “Manga Report” on the effectiveness and cost-effectiveness of chiropractic care for lower back pain was released out of Ontario, Canada. In the words of the author, it was a  “voluminous testimony to the extensive and growing literature and clinical research in this area.”   Not only did his team’s research findings show that spinal manipulation by chiropractors was more effective for the treatment of lower back pain than other means, but that there was also “an overwhelming body of evidence indicating that chiropractic management of low back pain was more cost-effective than medical management.”

Meanwhile, moving back in time a bit, seven months after the conclusion of the CHAMPUS project (finalized findings yet to be seen) President Bush (George W’s father), on the momentum of Strom Thurmond’s bill, signed a law on October 23, 1992, which marked a historic day for chiropractic.  It was the bill that his former boss most likely had visions of signing back in 1984 — a bill which appointed chiropractors as commissioned officers in the armed forces to provide chiropractic care within the military health care system.  What wasn’t so apparent, however, amidst our victory parties was one little word:  “may.”  That’s right, there was a loop hole in the legislative language.  The language simply gave the military the authority  to commission chiropractors, by stating that chiropractors may  be appointed;  it did not mandate  them to act.  Consequently not much happened at first, and it did not appear anything ever would,  as the Navy Times  speculated, despite an April 1993 deadline.

The 1993 deadline came and went.  Because of the DoD’s resistance to integrate chiropractic into the military health care system, the Secretary failed to commission any doctors of chiropractic.  As a result of the DoD’s inaction, Congress created a Chiropractic Pilot Program which would determine the “feasibility and advisability” of providing military beneficiaries with chiropractic care.  That legislation passed Congress in 1995.  It was further modified in 1998 and resulted in chiropractic care being offered on a test basis at 13 military treatment facilities within the United States.  In March of 2000, the DoD released a final report on the results of the program.  Data contained in the report clearly demonstrated 1) higher levels of patient satisfaction with chiropractic care; 2) superior outcomes for patients receiving chiropractic care vs. traditional medical care; 3) fewer hospital stays resulting from chiropractic care; and 4) significant improvements in military “readiness” due to chiropractic care vs. traditional care because of a large reduction in lost duty time.  Yet with all this compelling evidence, the DoD still said, “No” — opposing chiropractic integration on a permanent basis, citing a high dollar “cost-estimate.”

Not backing down without a fight, chiropractors on the Pilot Project’s Oversight Committee, along with the American Chiropractic Association, the Association of Chiropractic Colleges, and the ACA’s consulting firm, Muse & Associates, did their own independent cost analysis and found that the integration of chiropractic care into the military would actually save  the DoD money — to the tune of 25 million dollars per year.  With this information in hand, the group appealed to Congress, who in light of the clear evidence before them, usurped the DoD’s decision and authorized a permanent chiropractic benefit for all active duty personnel.  President Clinton signed the bill into law on October 30, 2000.

The law specifically requires:  “Not later than March 31, 2001 [that’s this month!], the Secretary of Defense shall complete development of a plan to provide chiropractic health care services and benefits as a permanent part of the Defense Health Program (including the TRICARE program), for all members of the uniformed services who are entitled to care under section 1074(a) of title 10, United States Code.”  The law requires that full implementation of the chiropractic benefit be phased in over a five-year period, starting October 1, 2001, throughout the three military services.

This law represents a major step forward in our long-standing effort to deliver chiropractic care to our deserving men and women in uniform.  While the law falls a bit short of what we’d like to ultimately achieve (mandating military commissions for doctors of chiropractic, guaranteeing direct access to chiropractic services, and providing chiropractic benefits for military dependents and retirees), it is promising.  Once in the system, we’ll have a better chance to prove ourselves.  During the Chiropractic Pilot Project, Donald Baldwin, D.C. encountered a very cautious orthopedist who was very blunt about his concerns.  Appreciating his candor, he decided to be very up front in return and told him, “All we ask to do is what we say we can do, and if we can’t, we’re out of here.”  For now, we’ll stand at attention watching the calendar for March 31st.

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2010 Update:

Since I published this article back in March 2001, much has happened, and much hasn’t happened with regards to chiropractic in the military.  Chiropractors still are not eligible to be commissioned officers in the military — we have tried.  Back in 2008 a House resolution was introduced urging the Secretary of Defense to take immediate steps to appoint doctors of chiropractic as commissioned officers in the military health care system — a statutory authority that he possesses but has not acted upon.

Since the 2001 law signed by President Clinton, chiropractors have been privately contracted by multiple military facilities to provide chiropractic care for “Active Duty Service Members”  Unfortunately, family members, retirees and their family members, unremarried former spouses and survivors are still not eligible.

All reports that I have read from chiropractors “on the inside” find that their services are well-received by the active duty military men and women.  The logistics of receiving chiropractic care, however, is not necessarily easy.  Care is controlled and overseen by the patient’s primary medical doctor and then, of course, the military facility has to offer chiropractic care.  And if they do, there is a good chance that there will be a wait, due to the program’s popularity, before one can actually obtain an appointment.

As of Fall 2009, eleven additional military treatment facilities added chiropractic t0 their arsenal — bringing the total up to 60 (two of which are overseas).  Still though, 60 falls considerably short of the initial law’s “full inclusion” language over a five year period, when you consider that the military has 230 treatment facilities.

In 2005 the journal of Anesthesia and Analgesia reported that the number one complaint of pain among soldiers during Operation Iraqi Freedom was low back pain.

To see a current list of the military facilities that have chiropractic care, as well as how the program works, visit TriCare’s website at www.tricare.mil/ChiropracticCare. Also, for those who are interested in learning more about the various ups and downs — and twists and turns — of this topic, I recommend that you visit Dynamic Chiropractic’s website and type “Chiropractic Military” into their search box.  Happy reading.   —Dr. TL

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One Additional Addendum: About two years after my original article was in print, my chiropractic colleague and classmate made front page news of our various chiropractic publications adjusting one of his men on the courtyard wall of what appears to be Saddam Hussein’s palace.  You see, much the same way the chiropractors I described in the article above rolled up their sleeves to help their fellow military comrades during wartime efforts, so too did Lieutenant Colonel Mark Losack of the United States Marine Corp during his deployment in Operation Iraqi Freedom — he happened to also be a Doctor of Chiropractic.  Read his story here.

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Sources used for this article:

Historical Perspectives

The chirons:  images from world war II and afterward.  Dynamic Chiropractic [http://www.chiroweb.com/archives/18/20/12.html]. 2000.

The chirons:  images from world war II and afterward — part II.  Dynamic Chiropractic. [http://www.chiroweb.com/archives/18/21/12.html]. 2000.

Peterson.  Chiropractic:  an illustrated history.  Mosby. St. Louis. 1995.

Wardwell, W.  Chiropractic:  history and evolution of a new profession.  Mosby.  St. Louis.  1992.

1991

ACA lobbies to commission DCs in the armed services.  Dynamic Chiropractic. [http://www.chiroweb.com/archives/09/04/01.html]. 1991.

Congress, the military, and the doctor of chiropractic.  Dynamic Chiropractic. [http://www.chiroweb.com/archives/09/05/32.html]. 1991.

DoD’s response to commissioning DC’s.  Dynamic Chiropractic. [http://www.chiroweb.com/archives/09/09/10.html]. 1991.

CHAMPUS:  pilot project crashing?  Dynamic Chiropractic. [http://www.chiroweb.com/archives/09/11/08.html]. 1991.

Chiropractic in Saudi Arabia.  Dynamic Chiropractic. [http://www.chiroweb.com/archives/09/12/26.html]. 1991.

1992

The honorable senator Strom Thurmond. Dynamic Chiropractic. [http://www.chiroweb.com/archives/10/07/17.html]. 1992.

Profession well represented at HR 608 hearing.  Dynamic Chiropractic. [http://www.chiroweb.com/archives/10/11/08.html]. 1992.

Fighter pilots and chiropractic — chiropractors in the military? Dynamic Chiropractic. [http://www.chiroweb.com/archives/10/15/10.html]. 1992.

Bill commissioning DCs in military passes full house and senate committee.  Dynamic Chiropractic. [http://www.chiroweb.com/archives/10/17/09.html]. 1992.

1993

Commissions for DCs sought, and passage of landmark CHAMPUS bill.  Dynamic Chiropractic. [http://www.chiroweb.com/archives/11/13/14.html]. 1993.

We get letters:  Chiropractic — still locked out of the military.  Dynamic Chiropractic.[http://www.chiroweb.com/archives/11/13/35.html]. 1993.

Manga, et. al.  The effectiveness and cost-effectiveness of chiropractic management of low-back pain.  Ontario Ministry of Health.  1993.

CHAMPUS demonstration project report. Dynamic Chiropractic. [http://www.chiroweb.com/archives/11/26/05.html]. 1993.

1994

Hearing scheduled for chiropractic inclusion in CHAMPUS.  Dynamic Chiropractic. [http://www.chiroweb.com/archives/12/09/06.html]. 1994

Defense bill directs military to provide “detailed plans” for commissioning DCs; also expedites report on chiropractic CHAMPUS pilot project.  Dynamic Chiropractic. [http://www.chiroweb.com/archives/12/11/10.html]. 1994.

1995

Smith, J.C.  It’s time for chiropractic to crow.  Dynamic Chiropractic. [http://www.chiroweb.com/archives/13/03/17.html]. 1995.

DoD wants you:  DCs called to military demonstration project.  Dynamic Chiropractic. [http://www.chiroweb.com/archives/13/11/03.html]. 1995.

The military demonstration project — how will chiropractic be judged?  Dynamic Chiropractic. [http://www.chiroweb.com/archives/13/19/14.html]. 1995.

1996

Treating the troops in Eucador.  Dynamic Chiropractic. [http://www.chiroweb.com/archives/14/03/08.html]. 1996.

A moment of silence for…Dr. R. Jay Wipf.  Dynamic Chiropractic. [http://www.chiroweb.com/archives/14/09/24.html]. 1996.

Desperately seeking chiropractic in the military. Sgt. Lynn Grosvenor, DC, RT, US Army. Dynamic Chiropractic. [http://www.chiroweb.com/archives/14/24/24.html]. 1996.

1998

Chiropractic health care demonstration project:  an update — high marks for chiropractic in the military. Dynamic Chiropractic. [http://www.chiroweb.com/archives/16/07/16.html]. 1998.

1999

New military chiropractic demonstration project sites are thriving.  Dynamic Chiropractic. [http://www.chiroweb.com/archives/17/02/11.html]. 1999.

2000

DoD alert bulletin.  Email from the ACA.  May 19, 2000.

House committee approves inclusion of chiropractic in DoD.  ACA Today.  June 2000.

Letters to the editor:  Definitely officer material.  The Chiropractic Journal.  June 2000.

Letters to the editor:  Military D.C.’s restricted.  The Chiropractic Journal.  July 2000.

Historic legislation guarantees access to chiropractic for all active-duty military personnel.  ACA Today.  November 2000.

Congress passes historic chiropractic legislation.  Dynamic Chiropractic.  November 15, 2000.

106th Congress ends, leaving mixed record on chiropractic.  Dynamic Chiropractic.  November 15, 2000.

President Clinton signs 2001 national defense authorization act.  Dynamic Chiropractic.  November 30, 2000.

Permanent chiropractic benefit for military signed into law.  Plexus.  December 2000.

Life’s little adjustments:  three li’l words.  Dynamic Chiropractic. [http://www.chiroweb.com/archives/18/25/07.html]. 2000.

Unified action key to chiropractic role in armed forces.  The Chiropractic Journal.  December 2000.

President signs DoD bill; groups meet to discuss plan.  ACA Today.  December 2000/January 2001.

2001

We get letters & E-mail:  ACA response to “Three li’l words” editorial.  Dynamic Chiropractic. [http://www.chiroweb.com/archives/19/01/18.html] 2001.

Pioneering doctors:  demonstration participants clear the path for chiropractic in military.  JACA.  February 2001.