World Chiropractic Alliance
White Paper on Veteran’s Affairs
HR 2116
President Clinton signed the Veteran’s Millennium Health Care Act (HR 2116) into law on November 30, 1999. This legislation requires the Veterans Administration (VA) to develop a policy on chiropractic care within 120 days.
Chiropractic in the United States
There are two major schools of thought in the chiropractic profession. The first considers chiropractic to be a limited medical specialty for the treatment of certain musculoskeletal disorders. Proponents of this position embrace a broad array of therapeutic interventions including manipulation and physical therapy modalities. This necessarily encroaches on the practice of medicine and physical therapy.
The second school of thought is committed to positioning chiropractic as a separate and distinct discipline in the healing arts, which does not duplicate existing medical services. It is directed toward the correction of vertebral subluxations, which interfere with the function of the nervous system.
Chiropractic in Medicare
Chiropractic has been included as a Medicare benefit for over 25 years. 42 USC 1395x (5)
provides for chiropractic services limited to manual correction of spinal subluxations. The Medicare benefit does not include physical therapy services. The only “condition” covered is spinal subluxation.
This position is consistent with the school of thought which positions chiropractic as a separate and distinct profession.
Chiropractic in the VA
The Chiropractic Health Care Demonstration project, created by the 1995 National Defense Authorization Act, attempts to position chiropractic as a treatment for neuromusculoskeletal conditions, and embraces a broad scope of therapeutic interventions. Many of these services, particularly physical therapy modalities, are already available through existing providers.
Furthermore, the Demonstration Project employs obsolete clinical practice guidelines which include expensive and/or questionable procedures. These include homeopathy, acupuncture, and passive physical therapy modalities.
The Demonstration Project also inappropriately excluded persons under 17 years of age, and those who were pregnant.
Recommendation
Our recommendation is that the policy promulgated by the VA provide for the following:
1. Chiropractic examination and adjustment to correct vertebral subluxations.
Rationale: Physical therapy and rehabilitation services are already available within the VA system; chiropractic examination and adjustment to correct vertebral subluxations are not. This provides consistency with the other existing Federal program, is the more cost-effective approach, and satisfies legislative intent.
2. Direct access to chiropractic care.
Rationale: Only a chiropractor is qualified to determine the appropriateness of chiropractic care. Direct access would also eliminate the costs associated with a screening process by other providers.
3. Adoption of Council on Chiropractic Practice Clinical Practice Guideline Number 1 — Vertebral Subluxation in Chiropractic Practice.
Rationale: This evidence-based guideline is current, and was distributed to US chiropractors in 1999. It was produced by an interdisciplinary expert panel, and underwent peer review by 195 chiropractors in 12 countries. The Guideline is included in the AHCPR National Guideline Clearinghouse .
The World Chiropractic Alliance
The World Chiropractic Alliance (WCA) is an international, non-profit professional membership organization. The WCA is concerned with health promotion, wellness, and quality of life issues. It is committed to positioning chiropractic as a separate and distinct discipline in the healing arts. WCA’s vision of chiropractic is directed toward the correction of vertebral subluxations, which interfere with the function of the nervous system. WCA was accredited as an NGO (non-governmental organization) by the Department of Public Information of the United Nations in late 1998. The World Chiropractic Alliance urges the Veteran’s Administration to promulgate a policy which provides for chiropractic care to correct vertebral subluxations.
