7 Most Common Conditions Affecting Women Veterans
Lindy Nash: Hi there! And welcome to another edition of Facebook Live, from Chisholm, Chisholm & Kilpatrick here in Providence Rhode Island. My name is Lindy Nash, and I’m an attorney here at the firm. And I’m joined today by my colleagues Kayla D’Onofrio, and Amy Odom.
Today we are going to be talking about the seven most common conditions affecting women veterans. So we’re very excited to get to this topic, and if you have any questions, please don’t hesitate to leave us a comment in the box below, and we’ll do our best to address it. But if we can’t get to it, feel free to check out our website, www.cck-law.com. We have so many great resources there, blog posts, graphics, really a ton of information. So don’t hesitate to check that out.
So with that set, I think we can get started. Let’s start with just some kind of general statistics about women veterans. Kayla, why don’t you start us off.
Kayla D’Onofrio: Sure. So the female population of veterans only takes up about ten percent of the total veteran population. So it is pretty small currently. We have seen increase in it over the past hundred or so years as certain laws and restrictions have been lifted. According to a 2015 study, it was anticipated that the numbers would increase by about 18,000 women veterans over the next ten years. And then the next 25 or 2 years, they’re expecting that number to look more like 16.3% of all living veterans. So, we are seeing a rapid and steady increase in the number of female veterans.
Another very interesting thing about female veterans is it’s very young population. Again, because we’re seeing an increase in the women that are joining the military, in the services. About 80% of the female population is between ages of 25 and 64 years old. So they are very young. And we’re also seeing that more than half of them are involved in the more recent war. So within the gulf war era, we’re seeing more than half our female veterans.
Lindy: Wow. Thank you. A ton of excellent information. Amy, why don’t you tell us a little bit about disabilities that affect women veterans and what they see kind of on a daily basis.
Amy Odom: Well, sure. As of 2018, approximately half a million disabled women veterans were in the United States. That’s about 23% of all veterans having service-connected disability. And that number rose about 30,000 in just 2018 alone. 54% of those women have a service-connected disability or disabilities that are rated 50% or above, which is pretty astounding when you think about it. Another pretty interesting statistic is that 3% more women veterans have a service-connected disability than do men.
Lindy: Wow, fascinating. Well, thank you very much. So now that we’ve touched on some of those statistics, why don’t we get into the main portion of our broadcast today, the Seven Most Common Disabilities for Women Veterans. So these top seven disabilities actually account for about 30% of all service-connected conditions in women. So that just shows how prevalent they are. So why don’t we start of with PTSD and I think Amy will tell us about that.
Amy: Sure. So PTSD is Post Traumatic Stress Disorder. It’s a mental health disability that affects people who have been exposed to a difficult stressor. And about 20% of women of the Gulf War veteran population have PTSD, and 12% of all women in all the population have PTSD. The way that we see it generally in the veterans’s context is that women experience some sort of stressor in service that might be combat, it might be a car accident, or some other very stressful experience. And a lot of times, it’s military sexual trauma. Which is a difficulty that women face disproportionately in the military.
It can be challenging to prove a claim for PTSD because you have to have credible supporting evidence of an in-service stressor. And for especially military sexual trauma, that’s not something that you wouldn’t– normally see documented in the treatment records. But for other types of stressors, such as like car accidents or perhaps something being fired upon in Iraq or something along those lines, you would normally find that in the service treatment records. And VA has recently, well as of 2008, has lowered the evidentiary requirement for showing that you had a stressor like something like being fired on. As long as you can show that you experience fear of a hostile military or a terrorist activity, VA will accept your statements.
It still remains a little more difficult to show that you suffer personal assault in service. In that case, VA will require something other than your own statements showing that there was a personal trauma in service. And that includes not only military sexual trauma but also something like physical abuse, like domestic abuse, or something like that that also affects women disproportionately. In order to prove your stressor in that case, you’ll need something more like perhaps a statement from a friend, saying that you shared some details with him or her around the time of the assault. But another way you can show it is by showing that there was some sort of behavioral change in service. That prior to this stressor, perhaps your performance was very good, you didn’t have many problems, you didn’t experience any type of depression or anything like that. But then after the stressor, you can see in your personal records that your performance started to deteriorate, and perhaps you started to show a little more depression or withdrawal after the stressor.
Lindy: And those are known as markers, right?
Amy: That’s right. They’re called behavioral changes or markers. And veterans who file PTSD claims based on a military sexual trauma or other personal assault will likely be afforded a VA examination. The regional office will ask the veteran to attend an examination with a mental health professional from the veteran’s benefits administration who will take the veteran’s history, review the claims file, and will look for those types of markers in the claims file in the service treatment records.
Lindy: Right. And sometimes markers aren’t always really clear, right? So it can be even starting substance abuse problems, or good behavior and bad behavior in service.
Amy: That’s right.
Lindy: And even locations of pregnancy test or STD test can be markers. Anything along those lines to show that maybe some sort of assault happened.
Amy: That’s right. Or request to transfer your duty station is one thing.
Lindy: Right. Yes. Definitely.
Amy: So basically anything that shows that there was some sort of change in the veteran’s life following the stressor.
Lindy: And I know there was a period of time where proper protocol wasn’t always followed in military sexual trauma cases. And so maybe, you could touch on the history of that and kind of how that’s evolved.
Amy: Yes, absolutely. We had just talked about military sexual trauma and other types of personal assaults are not usually documented in the service treatment records. And VA adjudicator are generally always looking for some sort of documentation of the in-service injury. So, these claims were being disproportionately denied. In November 2013, the American Civil Liberties Union and SWAN, the Service Women’s Action Network, published a study that showed that there was this– that VA was denying a PTSD based on MST, Military Sexual Trauma claims, at significantly lower rates every year from 2008 to 2012. And there were 10 percentage points between the denial rate of PTSD claims for men and for women which is a pretty staggering difference.
Shortly after that study was published, VA did make some internal changes to their training and claims processing procedures, and it was looking up like these claims were going to be handled better. But unfortunately in 2018, VA’s own office of inspector general found that there were still a lot of problems with the processing of these particular claims based on military sexual trauma. The OIG found that half of MST claims were improperly processed. And it was for things like the adjudicators not being specialized or trained on MST claims which is what part of the initiative was following the ACLU and SWAN report.
VA was just marking claims as contradictory without doing any type of clarification or follow up. So that there seem to be still problems in this area, and hopefully they’ll be resolved soon.
Lindy: Great. And then to kind of wrap up the discussion of PTSD and military sexual trauma cases, as an advocate, do you have any advice as to how best to go through your PTSD claim or MST claim? Maybe certain pieces of evidence that are really helpful. I know you kind of touched on maybe buddy statements or things along those lines. But any advice to someone who is filing one of these claims.
Amy: Yes. My advice would be to give the VA as much information as possible about the circumstances surrounding the assault in terms of any type of changes in your behavior following the assault, anybody you might have told, if you can find somebody that you told about it, and get a statement from that person, that would be great. Just think about ways in which your life may have changed following the assault and that would be helpful evidence to prove your stressor. Also, if you are currently seeking treatment and have been seeing somebody about any current residuals of the assault, perhaps getting an opinion from that person to asking your therapist or your doctor to write a letter confirming that you suffer from symptoms that are related to a personal assault, will be actually really great evidence.
Lindy: Awesome. Thank you. So why don’t we move on to the next disability, which would be back concerns and back issues. So I believe in 2015, back conditions were actually the most commonly diagnosed concern in the VA system. So Kayla, why don’t you walk us through some information about musculoskeletal conditions in the back.
Amy: Yes. So about 58% of women were treated from musculoskeletal conditions in the back in 2015, according to that study. Whereas only about 47% of men were actually being treated. So the number of women being treated for back conditions is actually a little bit higher. There are three different disabilities that are most commonly seen in women. The first is cervical or lumbosacral strain, which is basically caused by overuse and it’s a microscopic tearing of the muscles in the tendons. Which is really the most common cause of back pain that we see. VA will rate this sort of condition based on a range of motion testing. So when you do to go exams, they’ll be looking at things like how much you can bend forward, or backwards, or side to side. And that’s how they’re going to rate the condition. And I’ll get a little bit more into sort of how the examinations do work a little bit later for all the back conditions.
The second most common one that we see is intervertebral disc syndrome which is when the disc between the vertebrae start to break down. It’s usually made worse when there is prolonged sitting and standing and bending down. And this is rated a little bit differently than the normal lumbosacral strain or the cervical strain. This is rated based in incapacitating episodes. So they’re looking at really bed rest, which has it’s own set of problems. Bed rest can actually worsen IVDS for a lot of veterans. It’s really not prescribed by doctors. But that is how VA physicians and VA adjudicators are going to be looking at that condition. However, if range of motion testing would result on a higher rating, VA will rate it based on range of motion.
The third most common one that we see is the degenerative arthritis of the spine, excuse me. Which is just when the cartilage between the joints and the discs in the neck in the back start to break down. Again, just caused by overuse, repetitive stress on the back, and it’s another very common cause for pain.
Lindy: And this might be kind of self-explanatory, but why do you think that these types of orthopedic conditions are so frequent in veterans in general. In women but and in general.
Amy: I think just the nature of what military service is. A lot of it is very physical, it’s very demanding on the body. So it does cause a lot of breakdown. We also see it secondary to a lot of conditions. Specifically, if you’re looking at maybe foot or knee conditions where the veteran now needs to walk with a limp, it could cause secondary issues with the back and the spine.
Lindy: Great. And I know you touched on this briefly, but could you walk us through a VA exam. Like your schedule for an exam for your back. How would that normally go? And maybe any advice to someone who is scheduled for one of these exams.
Amy: Right. Like I said, VA does largely rate back conditions based on range of motion testing. So they’re going to be asking you to do a lot of physical testing. How many degrees you can move forward, backward, side to side. They should also be looking at things like how severe your condition is during flare-ups, or with repetitive use over time. So they shouldn’t just be looking at sort of objectively what’s going on that day. They should be asking you questions about how it affects your daily life and how severe it is on a day to day basis. As well as what causes flare-ups, what sort of things will trigger it.
The other thing to keep in mind is that there’s a lot of secondary conditions for back, so if you are at an examine, you do have some secondary conditions like radiculopathy or in severe cases, incontinence. That’s something that you do want to honest with your examiner about. And it’s always really important to be honest about your symptoms. So, don’t over exaggerate them, but don’t diminish what you’re experiencing either, because it’s what VA really does rely on when they’re making decisions on these claims.
Lindy: Definitely, yes. During exams is definitely not the time to be your most tough self. Be honest and explain to them what you’re experiencing and even if something you may not really love to talk about, it’s really important that you’re honest with the VA examiner, because as Kayla said, VA exams are often found very probative, and they rely on those very frequently.
Okay. So any last pieces of advice to someone who is filing a claim for an increased rating for their back condition? Any pieces of advice for what to submit to be most helpful?
Amy: Yes. So like any normal service connection claim, VA’s going to be looking for three things. One is evidence that the condition exists. So in most cases, a diagnosis of the condition, or at least evidence of pain. They’re going to be looking at something that happened in service, and then they’re looking for a nexus opinion linking that condition to whatever happened in service. So medical records showing treatment for a back condition especially if they show continuous treatment from service, can be super helpful. lay evidence can also be very helpful, especially if you’re looking at things like incapacitating episodes, how long are you really on bed rest, how often are you kind of confined to a recliner or a bed because your back is so severe that you can’t move. So lay evidence from you as well as family members or friends who can witness how severe it is can be really helpful.
Lindy: Great. Okay. Let’s move on to number three. The most common disability, major depressive disorder. So I believe that women actually experience this 1.7 times, or they’re more likely to experience it than men. Is that right?
Amy: That’s true.
Lindy: Okay. So why don’t you tell us more about MDD.
Amy: So, major depressive disorder’s actually the second most common service-connected disability among female veterans.
Amy: Right now, there are 26,500 cases of depression among women. And it makes sense that depression is something that is associated with military service. Because a lot of times, people are separated from their families for long periods of time, they’re, especially– in the more recent conflicts, there have been multiple deployments. People have been expected to deploy several times. But also, women face disproportionately again, issues with harassment from their peers and sometimes superiors. And a lot of times too, depression can be the result of some other service-connected disability.
So for example, if a veteran hurts her knee in service and is unable to do the types of things that she once enjoyed as a result of the knee, oftentimes that can lead to a diagnosable depressive disorder.
Lindy: Great. And then I know, we touched on this earlier when talking about PTSD. But we mentioned that you do need a stressor for PTSD cases. Do you need a stressor in these case? With MDD?
Amy: No, you don’t. That’s the difficult thing about a PTSD claim is that the VA requires more corroboration of what happened to you in service if your diagnosed disability is PTSD, than it does if your diagnosed disability is anything other than PTSD. So even when we’re talking about military sexual trauma, technically under the law, if the thing that happened to you in service, has to do with a personal assault, but the resulting diagnosis associated with your residuals of that assault is major depressive disorder or generalized anxiety disorder as opposed to PTSD, technically VA under the law isn’t supposed to require that high level of corroboration that you need if you have PTSD. It’s unclear to me why VA treats these two topics so differently, but the court of veteran’s appeals, a couple of decades ago, agreed that it was appropriate and so that’s the state of the law.
Lindy: Okay. And then to wrap up our discussion on depression, again, any other pieces of advice or great pieces of evidence you could submit to help your claim?
Amy: Well, the best evidence is always documentation in the service treatment record. So if a veteran sought treatment or complained to a doctor in service that she was experiencing low feelings or even anxiety or anything like that, then that’s going to be your best evidence. But a lot of times, people don’t seek treatment for having the blues or something like that that can actually be indicative of major depressive disorder or turn in to something like that. So in those cases, the best evidence that you can submit is statements from yourself or anybody else who has personal knowledge of how you felt back then or how you acted back then, and an explanation for why you did not seek treatment which could be something as simple as “I didn’t realize I had a problem.”
Lindy: Great. Okay. Let’s move on to number four which would be migraine headaches. And Kayla, if you could explain to us a little bit about migraine headaches and how women develop those from service.
Amy: Sure. So migraine headaches are obviously very severe condition and they do come with a lot of residual issues. When someone experiences a migraine, they usually also experience things like photosensitivity or noise sensitivity, nausea, vomiting, lightheadedness. So it can be a really debilitating condition for a lot of women, and a lot of veterans in general.
So currently about 24,000 female veterans are receiving benefits for migraines. So, there’s a lot. Some of the most common reasons that we see it being related to service is actually secondary to other conditions. So we see it commonly with neck conditions for example when they have a lot of pain in their neck, it may cause issues with headaches. We also see it secondary to a lot of psychiatric conditions. So with increased stress, sometimes those will trigger migraines as well.
Lindy: Great. And again, how is it best to build a strong case for migraine headaches.
Amy: So when VA is rating migraine headaches, what they’re really looking at is how prostrating as they call it, the migraines are. Which really just means how debilitating it is.
Amy: So, I think lay evidence is probably going to be one of your most important pieces of evidence here. And describing how severe your symptoms are. It can be really helpful to talk specifically about the things that you’re not able to do when you do have a migraine. Because they’re looking at does it require to basically be in bed in a dark room with no noise. Or, does it affect you to the point where you can’t complete your normal activities of daily living like cooking or cleaning, or you have to call out of work. Some sort of economic inadaptability. So talking about how severe it is and how it prevents you from doing those day to day things, and how frequently that happens is I think going to be one of the most important pieces of evidence.
Lindy: Great. And I feel like this can probably set for all of the common disabilities we’re talking about, but when you are scheduled for that VA exam, again, be as honest as possible. If your headaches do– they are incapacitating, you have to lay down in a dark room for an hour, it affects your ability to work, you often miss work, you leave early, anything along those lines, be as honest as possible because that is all taken into account. It’s relied on extremely heavily by the VA and will be a crucial part of your case. So again, at all VA exams be as honest and forthright as possible.
Lindy: Great. Okay. So let’s move on to number five which will be gynecological conditions. And I believe 43% of all VHA diagnosed conditions for women involve at least one reproductive health condition. So, Amy, why don’t we discuss that?
Amy: So, the VA Schedule for rating disabilities recognizes a variety of conditions including like endometriosis, polycystic ovarian syndrome, those types of really pretty common diseases and disabilities among women, The problem though is that most of those disabilities are maxed out at 30%. In other words, you can’t get a rating higher than 30%. And that rating is available– disability rating is available after you’ve proven that the disability is somehow related to service. And it doesn’t have to be related to something that happened in service. So that’s a really important thing to remember especially with gynecological conditions. There doesn’t have to be some sort of like, service-related injury that you suffered in service in order to have gynecological condition, service-connected. Rather if the disease first began, first manifested in service, then that’s enough to get service connection.
And the rationale behind that is that VA benefits are kind of a form of worker’s comp benefits, to keep it simple. And a service member’s workday never ends. So everything that happens to the service member while she is in the military is considered service connection. So if you have endometriosis and it was first diagnosed in service, then you are entitled to benefits, even though there wasn’t any type of injury that caused the endometriosis. But once you have established service connection, then you go on to well, what’s the disability rating. And as we were just discussing, for a disease like endometriosis, that maximum rating is 30%. It doesn’t matter if it’s so severe that you are laid up in bed for a week with cramps and are totally debilitated by it, or if you have cramps occasionally that are moderate and don’t keep you debilitated for a week, as long as it’s not controlled by medication, you get 30%. So that is I think a major flaw in the schedule for rating gynecological problems.
Lindy: And just really quick, why do you think that is? That it maxes out at 30%.
Amy: So I think that part of the reason is that–
Lindy: Not to get too political.
Amy: It’s been around for a while, it was probably written and developed by men. Which is not to say that men, there are no men in this world who understand gynecological conditions. There are many, many fine gynecologists out there who are men. But another issue with it too is that VA hasn’t had a ton of experience relatively with these types of issues. Because women have not been in the VA benefit system based on their own service in the numbers that they have more recently. My hope is that this area will continue to develop and grow and to become a little bit more representative of the wide array of severity of these types of disabilities.
Lindy: Great. I know you touched on this briefly. But just to be clear about it. What are some ways that your gynecological condition could start from service, or some common examples that we see?
Amy: Well, certainly a veteran could experience a traumatic injury that results in an injury to the ovaries or the uterus.
Amy: And not to circle back to this, but one way that that might happen is through personal assaults. So that’s an important thing to remember in pursuing and reviewing these claims as well. I would wager to guess that most of these disabilities, it’s just that they began while the veteran was in service, and it has nothing to do with anything that actually happened in terms of injuries, but it just was a disability that began that.
Another thing to keep in mind is that Gulf War veterans and by Gulf War mean both the first Persian Gulf War and Iraq and more recently and even today. Gulf war veterans who experience unexplained gynecological issues, in other words, symptoms that can’t be attributed to a known diagnosis, those veterans are also entitled to service connection for those problems, because the law will presume that since it can’t be explained, it has to do with something that you were exposed to in the gulf, in the Persian gulf.
Lindy: I think we even have a couple of clients who maybe had children during service. And then certain secondary issue stem from maybe something that went wrong during labor, or anything kind of after that. And you can get service-connected that way. So even things that you may not think, “Oh, it’s not directly due to service.” But if you were in service and you had a child or anything along those lines, that will count for service connection.
Amy: That’s true.
Lindy: Great. And then did you want to touch on– I know IVF treatments have kind of been brought up recently. And so can you discuss anything about IVF treatment for service-connected conditions stemming from gynecological conditions.
Amy: Yes. So just recently, VA has approved paying for in vitro fertilization for veterans who suffer from infertility as a result of a service-connected gynecological condition. That’s really a major breakthrough because a lot of women suffer and previously couldn’t find any help from the VA in starting a family.
Lindy: That’s great. Okay. Thank you. Why don’t we move on to our next common disability? That would be bronchial asthma. So, Kayla, I believe that over 10,000 veterans are diagnosed with bronchial asthma and actually receive VA benefits. Is that right?
Lindy: Great. And so, can we discuss maybe why that’s so common among women veterans.
Amy: Yes. So like we had talked about earlier and like Amy just mentioned, more than half of our female veterans have served in the Gulf War.
Amy: So I think a majority of the reason we’re seeing these issues is that they’re exposed to things in the Persian Gulf that are causing respiratory symptoms. So, under the law, you are presumed to be entitled to service connection for respiratory conditions. If they have that unexplained etiology or pathophysiology like Amy had just previously talked about a little bit more. We also see related to burn pit exposure. So if you served post 9/11 in the South West Asia theater of operations, you may have been exposed burn pits. So you’re inhaling all sorts of toxins and carcinogens and smoke and particulate matter which can cause a lot of other respiratory issues as well.
Lindy: Okay. And so what are some good ways to be able to prove exposure or to prove that you were around burn pits or what can people submit as evidence to demonstrate that?
Amy: Service records can be really helpful. So if you have service records that do put you in a location where you might be presumed entitled to these benefits, those are always going to be helpful. Lay evidence, again, is something that can be really important in these cases. Particularly if you were exposed to burn pits, having lay evidence discussing how you were exposed to those burn pits, how frequently, how close you were to them. Those can be really helpful for VA adjudicators.
Lindy: Great. Okay. So let’s move on to our last condition. Number seven, this is tinnitus, or tinnitus, depending on how you pronounce it. But it is a hearing condition, so I often think of it as kind of that constant ringing in your ears. It often comes along with service-connection for hearing loss claim. So we usually see them kind of claimed at the same time. Or if service connection for hearing loss has been granted, usually tinnitus would be granted as well. It kind of depends, but you usually see them hand in hand. And I believe it’s the most commonly claimed condition in all of VA benefit system which is fascinating.
So Amy, why don’t you discuss tinnitus– do you use tinnitus, or tinnitus.
Lindy: Tinnitus. Okay.
Amy: Yes. I say tinnitus.
Lindy: So, why is tinnitus most commonly rated at 10%? And maybe discuss the diagnostic code for it.
Amy: Well, it’s most commonly rated at 10% because that’s the only rating you can get with it. There are of course exceptions to every rule, and in really extraordinary circumstances, it’s possible that you can get more than 10%. But that’s really difficult to prove and unlikely to succeed in most cases. So that’s why the VA ratings will only recognize at a 10% rating for tinnitus.
But something to keep in mind is that, sometimes when the tinnitus is– I just said tinnitus, now [cross talking]–
Lindy: I’m messing you up.
Amy: Sometimes, the tinnitus is so extraordinary that it leads to depression or anxiety. Difficulty communicating with others. And then in that case, there’s always the possibility of secondary service connection for the anxiety or depression.
Lindy: And in terms of proving your claim for tinnitus, I know– I feel like in our practice, we see all the time that maybe tinnitus would be denied because perhaps the veteran didn’t start experiencing it until many years after service. Is that a good reason to deny like any hearing loss claim?
Amy: Not in every case. The first thing about proving claims for tinnitus is that tinnitus is a little bit unique in that you don’t need a diagnosis. Because just like you are competent to say, “My knee hurts,” in other words, you have enough– you don’t need medical training to be able to say, “My knee hurts.” You don’t need medical training to say that “I have ringing in my ears.” And that is enough to have a diagnosis of tinnitus. So that’s something unique about it.
But the other thing that’s unique about it is that VA, and VA examiners often say that if it didn’t begin in service, then it can’t possibly be related to the type of hearing– or I’m sorry, the type of acoustic trauma or noise exposure that veterans are subject to. And that’s not necessarily true in all cases. There is a lot of emerging research out there that says that it is possible that the type of noise exposure that veterans receive in service can affect the nerves inside the ear in such a way that it doesn’t actually register until many years later. So if you’re a veteran who has been denied service connection for tinnitus, tinnitus, or hearing loss, simply because it didn’t begin in service, you are best bet is to get on the internet, track down those articles and send them to the VA for reconsideration. And especially important one called Noise in Military Service from the Institute of Medicine. It’s available, I believe even on VA’s website.
Lindy: Yes. I think we cite to that sometimes and I was just reading it earlier today. So it is definitely available. I would probably just Google it. Okay, great. So we have gone through the seven most common disabilities that affect women veterans. And so I guess in closing, Amy and Kayla, do you have any last pieces of advice or words of wisdom for any female veterans out there looking for help or guidance? Did we hit on everything?
Amy: Well, you had– yes. I would just say, if you need help with your claims, you can contact us. Or you can contact your local disabled American veterans representative. There are a lot of new rules coming in to play now. And the VA system, the claims adjudication system is supposed to be veteran-friendly and very helpful to veterans. But it’s actually very difficult system to navigate. So don’t be afraid to ask for help.
Lindy: Definitely. Yes, we are here for you if you need anything and as our colleagues at the DAV, and it’s always great to reach out for help. And don’t be afraid to do so. So with that, I think we are wrapping up our Facebook Live today. Again, if you have any questions, feel free to call us or leave a message on our Facebook Live. You can check on our website again, www.cck-law.com. Again, a ton of information on there with blogs, graphics, really helpful information. So with that, we’ll see you next time. Thanks.
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