Press Release: Arlington, VA— March 17, 2023

The TreatNOW Coalition, in association with Americas Mighty Warriors, BurnPits360, the HOW Foundation, KOTERRA, 135 Coalition clinics, and the International Hyperbaric Medical Foundation, today announced the release of the revised version of Veteran Eric Koleda’s Report: The Veteran Diabetic Foot Ulcer (DFU) Epidemic: A U.S. Department of Veterans Health Administration (VHA) Hyperbaric Oxygen Therapy (HBOT) Services Review.

The increase in the Worldwide Diabetic Patient population at risk for Lower Limb Amputation (LLA) is growing exponentially. The Diabetic Foot Ulcer (DFU) epidemic increase in US Veteran Diabetes population is due to poor clinical management is substantially greater than the civilian Medicare population resulting in an alarming LLA rate which is largely unnecessary.

The US Veteran’s Administration continues to mismanage the clinical evaluation and timely care of the estimated 2.2 million diabetic Veteran population at risk for Diabetic Foot Ulcer limb amputation. This failure on the part of the VHA has resulted in substantially higher Lifetime costs, morbidity, mortality and a tragic reduction in Veteran length and quality of life that is well below that of the Medicare civilian population statistical comparators as reflected in this report.

The underlying tragedy is that the VHA is arbitrarily withholding services to conserve contract expenditures when expending six times the cost in treatments, amputations, surgical, and after care cost. HBOT contract services will provide fewer capital expenditures long-term by including existing hospital-based civilian Community Care Providers in the Diabetic Foot Ulcer Veteran population. This will reduce the Veteran morbidity and mortality statistics to realign with the comparable U.S. civilian Medicare population. The VHA delays or refusals to provide HBOT to DFU Veterans for outside treatment referrals is essentially sentencing DFU LLA Veterans to early deaths.

Here are the highlights of the revised Report:

  • 796,340 Veterans have died from Diabetic Foot Ulcer (DFU) and Lower Limb Amputation (LLA) in the past 22-years, more than all the Veterans KIA in all the U.S. Wars (623,982) since the beginning of World War I, approximately 94% were not offered HBOT treatments.
  • The current VHA DFU Lower Limb Amputations (LLA) Veteran mortality rate is 64-71 percent within 3-years post-LLA surgery.
  • 79.4 percent of VHA Veteran DFU LLA’s are diabetic with an average age of 66.2 years, the majority over 65 CMS eligible and HBOT covered indication.
  • The VHA provides HBOT treatment to approximately 46 Veterans per month versus amputating on average 3,016 lower legs per month, a 66 to 1 ratio.
  • The industry average is 74 percent heal rate for DFU cases when treated with aggressive Wound Care to coincide with HBOT treatments.
  • Veterans are NOT being provided the doctrine of “Informed Consent” on HBOT under the Code of Medical Ethics Opinion 2.1.1 by VA medical staff.
  • The VA does not operate HBOT chambers in any of the 1,298 VA facilities nationwide. There are 1,156 medically qualified, trained, and certified HBOT treatment facilities in US not including the private clinics treating with HBOT.
  • On 20-year average 93.7% of the 2.2 million diabetic Veterans do NOT receive HBOT
  • The 20-year average annual DFU LLA’s is 8,624 of which 6,123 die on average post 3-year LLA surgery.
  • The VHA contracts to less than 32 percent of existing HBOT wound care facilities in the U.S.
  • An estimated annual $2.7 billion spend for Veteran DFU and Lower Limb Amputation in surgical, hospitalization, aftercare, prosthesis, wheelchair, and disability costs.
  • All 2021 DFU 9,542 Veterans could have been treated with CMS, FDA, and Tricare approved HBOT for approximately $115 million, 4% of the estimated amputation cost.
  • HBOT for DFU Veterans has been CMS approved since 2002, Tricare approved since 2008 but on average 94% of diabetic Veterans are NOT provided or informed about HBOT.
  • Under H.R. 5674, The VA Mission Act of 2018. Title I, Caring for our Veterans, Subtitle A, Chapter 1, Section 101, The Secretary shall not limit the types of hospital care, medical services, or extended cares services covered veterans may receive under this section if it is in the best medical intertester of the veteran to receive such hospital care, medical services, or extend services, as determined by the veteran and the veteran’s health care provider”. The Department does not offer the care or service the veteran requires. Veterans are not being provided the option for HBOT services.
  • The VA is violating federal law under The VA Mission Act of 2018, The Veteran Access to Care Act of 2014, and the Code of Medical Ethics 2.1.1 by denying routine access to HBOT.
  • The U.S. Diabetic and Stroke Belts reside entirely within the Humana Military Tricare East geographic region and its cohorts may generate the most Veteran DFUs and Lower Limb Amputations for the entire national Tricare network (Figure 1 and Table 2)
  • North Carolina is in the middle of both the diabetic and stroke belts and accounts for 8 percent of 2019 CDC-reported diabetic deaths (3,124/38,599) in the diabetic state belt. Approximately 40.7 percent (7,400,081/18,204,166, Table 2 and Appendix 1) of all US Veterans are in this Diabetic Belt and North Carolina accounts for approximately 7.5 percent (83,767/1,115,456) of the total diabetics in the belt (Table 2).
  • “They can’t say, ‘No, you don’t get the care,’ and they can’t say, ‘Yes, you will get the care,’” she said. “They’ll just say, ‘It is processing.” As a result of these delays and denials, DFU Veterans who normally would receive limb-saving treatments are instead having amputations and 70.9 percent are dying within 3 years post-surgery.


The TreatNOW Coalition’s pro bono Mission is to end service member suicides. Service members suicides have once again increased, continuing a fifteen year trend. Coalition clinics have demonstrated 100% safety and over 90% success in treating over 21,000 service members, Special Operators, first responders, athletes, and citizens with TBI/PTSD/Concussion. Veterans with DFUs are invited to visit the website and register their condition.

The information provided by does not constitute a medical recommendation. It is intended for informational purposes only, and no claims, either real or implied, are being made. If you or anyone you know is contemplating suicide, please immediately contact the new ###: 988 or the old Veterans Crisis Line: 1-800-273-8255 (Press 1)