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PL 102-484
President Bush signed the Defense Authorization Bill (HR 5006) into law on October 23, 1992. Section 505 authorizes the Secretary of Defense to “appoint chiropractors as commissioned officers in the armed forces to provide chiropractic care within the military health system.”
On May 27, 1993, an Army Information Paper indicated that chiropractors would be commissioned as officers in the Medical Services Corps.
As of January 2000, no chiropractor has been commissioned as a chiropractor in any branch of the military.
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(r)(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.
Recommendations
Our recommendation is that the military be directed to immediately commence commissioning chiropractors as officers in all branches of the military. This should include:
1. Create a Chiropractic Corps providing chiropractic examinations and adjustments to correct vertebral subluxations.
Rationale: A separate Dental Corps exists, recognizing that dentistry is a service separate and distinct from medicine. Chiropractic does not belong in the Medical Specialist Corps. Physical therapy and rehabilitation services are already available within the military 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 military to promulgate a policy which provides for the creation of a Chiropractic Corps. Furthermore, there should be no further delay in commissioning chiropractors as officers.
