The World Chiropractic Alliance launched a massive grass roots campaign to modify a Congressional proposal which could have defined the role of chiropractic in the Veterans Affairs (VA) health services system as a method of treating "neuromusculoskeletal conditions."

In addition, on October 3, the WCA submitted testimony to the House Committee on Veterans Affairs, supporting the concept of direct and full access to chiropractic but objecting to its categorization as a quasi-medical treatment for specified conditions.

At press time, the WCA lobbyist in Washington D.C., reported that both the House and Senate Committees removed the chiropractic language altogether from the bill, giving the chiropractic profession time to reach a consensus on the language prior to review next session.

The House hearing was the final chapter in a long and at times controversial attempt by the World Chiropractic Alliance to ensure a meaningful role for chiropractors in the VA system.

In February, WCA representatives met with officials of the Veterans Health Administration to assist in the development of its chiropractic utilization policy. At that time, it filed a position paper explaining chiropractic as a unique service focused on the detection and correction of vertebral subluxation.

In contrast, the American Chiropractic Association (ACA) submitted a report to the VA in which it quoted from its "Master Plan" that chiropractic is defined as "a branch of the healing arts that is concerned with human health and disease processes."

The ACA report also referred repeatedly to chiropractic's role in treating low back pain. At one point, it cited the Mercy Conference guidelines as the basis of the clinical practice guidelines on low back pain released by the Agency for Healthcare Policy and Research.

The word "subluxation" was not used once in the ACA's 50-page report, and the word "adjustment" was used only when coupled with the term "spinal manipulation."

From this input, a proposal was developed by the VHA and submitted to Congress which categorized chiropractors as non-primary providers, along with therapists and dieticians.

In September, the ACA -- working with the Association of Chiropractic Colleges (ACC) and the International Chiropractors Association (ICA) -- drafted an amendment to a House bill relating to chiropractic in the Department of Veterans Affairs Health services system. They refused to include other groups in their deliberation and did not seek input from the profession.

Their new wording -- although allowing for full and direct access to chiropractic -- specified that the VA plan for chiropractic shall include "care for neuromusculoskeletal conditions typical of those affecting all age groups within the eligible veterans population..."

There was no mention of subluxation care in the ACA/ICA/ACC wording and the proposal could have been used to exclude subluxation-based chiropractic from the VA.

"We have seen in the past that, when the unique character of chiropractic is excluded, it is viewed as a medical treatment," stated WCA President Terry A. Rondberg, D.C. "Yet, as we all know, when a medical treatment is required, chiropractors are passed over in favor of medical doctors. Unless we present ourselves as providing a needed service which cannot be provided by medical doctors we will always be left out of the process."

The WCA supported many provision of the proposal, including direct access to chiropractors as primary care doctors. However, the lack of any reference to subluxation care made the proposal unacceptable and, on September 17, information was disseminated to the chiropractic profession asking them to contact members of Congress.

The model letter provided to doctors by the WCA specified that the wording should allow for direct access as well as permit D.C.s to perform subluxation correction to all veterans.

Despite the WCA's clear support of the direct access portion of the proposal, some detractors were quick to disseminate inaccurate reports stating that the WCA fought the bill because of that provision.

In addition, Michael Pedigo, D.C, of the ACA, said in an article for the online version of Dynamic Chiropractic that, "I can't prove it, but I suspect the last-minute letter writing campaign by the WCA to legislators to muddy the waters about what chiropractors do confused some members of Congress, causing them to back away from their prior support."

When told of this comment, Dr. Rondberg reacted with surprise. "Muddy the waters? We explained to the legislators that the purpose of chiropractic was to detect and correct subluxation in order to increase health," he stated. "If that muddied the waters, I hate to think what the ACA has been telling them all this time."

In another widely distributed press release, issued September 22, the ACA referred to the WCA as a "fringe chiropractic group" and said "irresponsible actions by Rondberg group threaten pro-chiropractic initiatives in Congress."

Rondberg said he was used to such tactics by the ACA.

"They claim to be the most powerful organization in the profession, yet they blame the WCA for every failure," he chided. "If we are such a 'fringe' group, how is it that we were able to stop them? The truth is, it was a badly worded proposal which would have hurt chiropractic severely and doctors around the country knew it. That's why they rose up and spoke out. That's why they were able to stop the ACA from pushing through this bill. If the only way the ACA can accomplish something in Washington is to have the profession remain silent, then maybe they should set up shop somewhere else."

The ACA press release was published in several chiropractic publications, without independent verification of the facts involved and without soliciting any response from the World Chiropractic Alliance. One publication, the Palmer Beacon added an inadvertent note of irony to the situation by printing the press release along with a boxed quote from B.J. Palmer which read "Adjustment is the Issue."

Upon seeing the article, Rondberg stated, "That's just the point the WCA was making -- the adjustment is the issue. For the ACA to try to sneak in wording which completely ignores both the adjustment and the subluxation goes against everything B.J. stood for ... and that's something the WCA won't stand for!"

On September 20, just days after the WCA began its campaign, the ICA issued a press release stating that it "rejects amendments offered to Veteran's Legislation." In its testimony for the October 3rd hearing, it included information on the chiropractic premise of subluxation correction.

During the hearing, legislators faulted the Department of Veterans Affairs for failing to incorporate chiropractic into its health services system. "Congress, as early as 1978, authorized VA to provide chiropractic services to eligible veterans," stated Rep. Cliff Stearns subcommittee chairman. "But over the period of its existence, VA has never employed its first chiropractor as a VA staff practitioner in this professional field; has never developed, without prodding from Congress, any meaningful policy on chiropractic care; and until this hearing, has never had to defend its decisions to severely restrict or deny chiropractic care to veterans.

"In this member's opinion," Stearns continued, "if a health care service is licensed and fully legitimate in all 50 states and abroad, if millions of Americans are willingly paying for this service every day, if health insurers -- and even the federal Medicare program -- approve reimbursements for the service as a routine activity of doing business...then VA needs to better articulate why VA seems to deny these services to eligible veterans."

Representatives from the American Medical Association and the American Osteopathic Association opposed chiropractic inclusion in the VA system.

"One reason for their opposition," stated Rondberg, "was that chiropractic was being presented as a duplication of medical services. It is very possible that, had it been presented in a realistic manner as providing specific and unique service, they might have felt less threatened."

WCA board member Christopher Kent, D.C., agreed. "If we represent ourselves as one of many purveyors of 'manipulative therapy,' he pointed out, "we have no claim to direct access, and we'll be relegated to the role of therapist."

"Consider the dentist," he continued. "Dentists don't do full body diagnosis, yet they have direct access. Why? Because they provide a unique service, which medicine does not and which is not competitive with the existing medical system. Subluxation correction is a unique service, which medicine does not provide, and which is not competitive with the existing medical system.

Dr. Kent concluded, "Manipulation and physical medicine for treating musculoskeletal disorders already is provided in the VA."

While the ACA and its allies lamented the defeat of the proposal and tried to blame the WCA for their failure, the WCA was already working to ensure that a properly worded provision could be developed for the next Congressional Congress.

"I, too, am disappointed that we weren't able to secure a meaningful role in the VA system," stated Dr. Rondberg. "But we cannot and should not settle for being a second-rate provider of musculoskeletal treatment. Chiropractic is greater than that and we have so much more to offer our veterans.