VA chiropractic clinics saw a greater percentage of female and younger patients compared with the national VA outpatient population. This demographic tendency is consistent with the cohort of veterans from the recent conflicts in Iraq and Afghanistan, which is known to have a high prevalence of musculoskeletal conditions.

There has been only one change in the types of on-station chiropractic services over time: a trend of decreased frequency of physical modality codes and an increased frequency of exercise/active care codes. This could be explained by changes in coding and/or practice patterns among existing VA DC's or the addition of new DC's with new coding and/or practice patterns over time. It is interesting to note that the change is consistent with current evidence on the management of low back pain.

Consistent with VA policy for all health care services, delivery of chiropractic services occurs through a combination of care provided on-station at VA facilities as well as care purchased from community chiropractors. Purchased care may be used to supplement on- station chiropractic care at a given facility (for instance, to meet demand that exceeds current on-station capacity), or it may be the only mechanism whereby that care is delivered (for instance, at a facility that does not have an on-station DC). The Department of Veterans Affairs’ use of purchased chiropractic care began slowly at first and then grew more parallel with its use of on-station chiropractic care starting in 2005.

Presented as a service to the community by: Union County Chiropractic Clinic, 110 Skyline Drive, Maynardville, TN (865) 992-7000 www.unioncountychiropractic.com.