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2019 VISN 20 MIRECC Staff Research Articles and Presentations

VISN 20 MIRECC Staff Research Articles and Presentations

The findings of NW MIRECC research are disseminated through MIRECC Presents, lectures and presentations, and publications. Below is a list of publications and presentations by VISN 20 NW MIRECC researchers and fellowship program faculty that were published in 2019. 

Buck, B., Norr, A. M., Katz, A., Gahm, G., & Reger, G. (2019). Reductions in reported persecutory ideation and
psychotic-like experiences during exposure therapy for posttraumatic stress disorder. Psychiatry Research, 272, 190-195. doi:10.1016/j.psychres.2018.12.022

ABSTRACT: While psychotic-like experiences (PLEs), including persecutory ideation and auditory or visual hallucinations, are common in PTSD, questions remain about their relationships to core PTSD symptoms and responsiveness to treatment. This study examined data from a waitlist (WL) controlled clinical study of the effect of virtual reality (VR) and prolonged exposure (PE) in a sample of active-duty service members with deployment-related trauma (n = 161). PLEs were assessed and examined with regard to their responsiveness to trauma focused treatment (combining conditions) relative to the WL, as well as their relationships to PTSD symptoms.

Cheng, Z., Perko, V., Fuller-Marashi, L., Gau, J., & Stice, E. (2019). Ethnic differences in eating disorder
prevalence, risk factors, and predictive effects of risk factors among young women. Eating Behaviors, 32, 23-30. doi:10.1016/j.eatbeh.2018.11.004

ABSTRACT: Findings regarding ethnic differences in eating disorder diagnoses and risk factors have been mixed. This study evaluated whether there are ethnic differences in eating disorder prevalence, risk factors, and the predictive relations of the risk factors to future eating disorder onset. We used a large sample of young women followed longitudinally over three years to increase sensitivity to detect differences and to provide the first test of ethnic differences in the relation of risk factors to future onset of eating disorders.

Cross, D., Meabon, J., Cline, M., Richards, T., Stump, A., Cross, C., ... & Cook, D. G. (2019). Paclitaxel
reduces brain injury from repeated head trauma in mice. Journal of Alzheimer's Disease. Advance Online Publication. doi:10.3233/jad-180871

ABSTRACT: Repetitive mild traumatic brain injury (rmTBI) is known to disturb axonal integrity and may play an important role in the pathogenic cascades leading to neurodegeneration. One critical approach to reduce the future onset of neurodegeneration is to intervene in this process at an early stage following a brain injury. Previously we showed that direct application of the microtubule-stabilizing drug, paclitaxel, on the brain following controlled cortical impact improved motor function and reduced lesion size. Herein, we extended these findings to a model of mild brain injury induced by repeated closed-skull impacts.

Das, S., Ansel, K., Bitzer, M., Breakefield, X., Charest, A., Galas, D., … Zhang, H. (2019). The extracellular RNA
communication consortium: Establishing foundational knowledge and technologies for extracellular RNA research. Cell, 177(2), 231-242. doi:10.1016/j.cell.2019.03.023

ABSTRACT: The Extracellular RNA Communication Consortium (ERCC) was launched to accelerate progress in the new field of extracellular RNA (exRNA) biology and to establish whether exRNAs and their carriers, including extracellular vesicles (EVs), can mediate intercellular communication and be utilized for clinical applications. Phase 1 of the ERCC focused on exRNA/EV biogenesis and function, discovery of exRNA biomarkers, development of exRNA/EV-based therapeutics, and construction of a robust set of reference exRNA profiles for a variety of biofluids.

Karr, J., Rau, H., Shofer, J., Hendrickson, R. C., Peskind, E. R., & Pagulayan, K. F. (2019). Variables associated
with subjective cognitive change among Iraq and Afghanistan war Veterans with blast-related mild traumatic brain injury. Journal of Clinical and Experimental Neuropsychology, 41(7), 680-693. doi:10.1080/13803395.2019.1611740

ABSTRACT: This study investigated variables associated with subjective decline in executive function among Veterans of Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND) following a history of blast-related mild traumatic brain injury (mTBI).

Kumthekar, A., Shull, S., Lovejoy, T. I., Morasco, B. J., Chang, M., & Barton, J. (2019). Impact of hepatitis C
treatment on pain intensity, prescription opioid use and arthritis. International Journal of Rheumatic Diseases, 22(4), 592-598.

ABSTRACT: A retrospective cohort study of Veterans with hepatitis C virus who were seen in a rheumatology clinic at least once while receiving direct acting anti‐viral (DAA) therapy between January 1, 2010 and December 31st 2016. This research assessed the impact of direct acting anti‐viral (DAA) therapy for hepatitis C virus (HCV) infection on changes in pain intensity and prescription opioid use among Veterans. Read full research article: Impact of hepatitis C treatment on pain intensity, prescription opioid use and arthritis

Leith, W. M., Lambert, W. E., Boehnlein, J. K., Freeman, M. D. (2019). The association between gabapentin and
suicidality in bipolar patients. Int Clin Psychopharmacology 34:27-32.

ABSTRACT: The aims of this study were to assess the association between gabapentin and suicidality in patients diagnosed with bipolar disorder (BD) and to determine whether the risk is greater relative to patients prescribed lithium. Read full research article: The association between gabapentin and suicidality in bipolar patients

Logsdon, A., Meabon, J., Yagi, M., Cook, D. G., & Banks, W. (2019). Abstract #2065 Markers of peripheral
immune cells are increased in regions of blood-brain barrier disruption after repetitive blast injury. Brain, Behavior, and Immunity, 76, e7. doi:10.1016/j.bbi.2018.11.193

ABSTRACT: Cycles of blood-brain barrier (BBB) disruption have been observed in a variety of rodent brain injury models. Changes in BBB permeability are correlated with pro-inflammatory cytokine production and brain infiltration of peripheral leukocytes. Whether the influx of peripheral leukocytes through a permeable BBB affords prolonged neuroprotection, or promotes detrimental changes to the anatomical site of entry remains to be elucidated. In a mouse model of blast-induced traumatic brain injury (TBI), we observed brain-region specific BBB permeability to radiolabeled albumin at 72 h. Moreover, we measured an increase in pro-inflammatory tumor necrosis factor alpha (TNF protein expression and mRNA abundance in brain regions vulnerable to BBB disruption.

Merlin, J. S., Long, D., Becker, W. C., Cachay, E. R., Christopolous, K. A., Claborn, K., ... & Liebschutz, J. M.
(2019). Marijuana use is not associated with changes in opioid prescriptions or pain severity among people living with HIV and chronic pain. Journal of Acquired Immune Deficiency Syndromes, 81, 231-237. doi:10.1097/QAI.0000000000001998

ABSTRACT: People living with HIV (PLWH) commonly report marijuana use for chronic pain, although there is limited empirical evidence to support its use. There is hope that marijuana may reduce prescription opioid use. Our objective was to investigate whether marijuana use among PLWH who have chronic pain is associated with changes in pain severity and prescribed opioid use (prescribed opioid initiation and discontinuation).

Montgomery, L., McClure, E. A., Tomko, R. L., Sonne, S. C., Winhusen, T., Terry, G., ... & Gray, K. M. (2019).
Blunts versus joints: Cannabis use characteristics and consequences among treatment-seeking adults. Drug and Alcohol Dependence, 198, 105-111. doi:10.1016/j.drugalcdep.2019.01.041

ABSTRACT: Despite the high prevalence of blunt smoking among cannabis users, very few studies examine the clinical profile of blunt smokers relative to those using more common methods of cannabis use, such as joints. The current study uses baseline data from the ACCENT (Achieving Cannabis Cessation-Evaluating N-acetylcysteine Treatment) study, a multi-site randomized pharmacotherapy clinical trial within the National Drug Abuse Treatment Clinical Trials Network, to predict the association between blunt and joint use frequency and cannabis use characteristics (e.g., grams of cannabis used) and consequences (e.g., withdrawal) among past-month cannabis users (N = 377) who were screened for study participation.

Morasco, B., Dobscha, S. K., Hyde, S., & Mitchell, S. H. (2019). Exploratory study examining associations between
prescription opioid dose and delay discounting in patients with chronic pain. Journal of Opioid Management, 15, 19-25. doi:10.5055/jom.2019.0482

ABSTRACT: Although some research has identified correlates of high-dose opioid prescriptions, relatively little is known about factors that lead to higher doses. Delay discounting (DD), defined as the subjective value of a reward declining as a function of the delay to that reward, is an objective measure of impulsivity. DD is commonly studied in the context of addictive behaviors, and findings consistently demonstrate greater DD among individuals with opioid use disorders. The authors conducted a preliminary investigation to examine the extent to which DD is associated with prescription opioid dose among patients with musculoskeletal pain.

Morasco, B. J., Krebs, E. E., Adams, M. H., Hyde, S., Zamudio, J., & Dobscha, S. K. (2019). Clinician response to
aberrant urine drug test results of patients prescribed opioid therapy for chronic pain. Clinical Journal of Pain, 35(1), 1-6.

ABSTRACT: Urine drug testing (UDT) is recommended for patients who are prescribed opioid medications, but little is known about the various strategies clinicians use to respond to abnormal urine drug testing results. We sought to examine changes in opioid prescribing and implementation of other risk reduction activities following an aberrant UDT. Read full research article: Clinician Response to Aberrant Urine Drug Test Results of Patients Prescribed Opioid Therapy for Chronic Pain

Morasco, B., Smith, N., Dobscha, S., Deyo, R., Hyde, S., & Yarborough, B. (2019). (142) Outcomes of prescription
opioid dose escalation for the treatment of chronic pain: Results from a prospective cohort study. Journal of Pain, 20, S12.

Norr, A. M., Bourassa, K., Stevens, E., Hawrilenko, M., Michael, S., & Reger, G. (2019). Relationship between change
in in-vivo exposure distress and PTSD symptoms during exposure therapy for active duty soldiers. Journal of Psychiatric Research, 116, 133-137. doi:10.1016/j.jpsychires.2019.06.013

ABSTRACT: The current study sought to examine the relationship between changes in distress for items on in-vivo exposure hierarchies and posttraumatic stress disorder (PTSD) symptom change over the course of exposure therapy. Active duty army soldiers (N = 108) were recruited from a military base in the U.S. and were enrolled in a randomized clinical trial comparing Prolonged Exposure (PE), Virtual Reality Exposure (VRE), and a wait-list control for the treatment of PTSD stemming from deployments to Iraq or Afghanistan.

Reger, G., Bourassa, K., Smolenski, D., Buck, B., & Norr, A. M. (2019). Lifetime trauma exposure among those with
combat-related PTSD: Psychiatric risk among U.S. military personnel. Psychiatry Research, 278, 309-314. doi:10.1016/j.psychres.2019.06.033

ABSTRACT: Research has described the association between lifetime trauma exposure and psychiatric symptoms among various cohorts, but little is known about the effect of lifetime trauma histories on the symptom expression of active-duty military personnel diagnosed with combat-related posttraumatic stress disorder (PTSD). Active-duty soldiers ( N = 162) were diagnosed with PTSD from deployments to Iraq or Afghanistan using the Clinician Administered PTSD Scale.

Reger, G., Smolenski, D., Edwards-Stewart, A., Skopp, N., Rizzo, A., & Norr, A. M. (2019). Does virtual reality
increase simulator sickness during exposure therapy forPost-Traumatic Stress Disorder? Telemedicine and e-Health, 25(9), 859-861. doi:10.1089/tmj.2018.0175

ABSTRACT: Measurement of simulator-related side effects (SSEs) is an integral component of competent and ethical use of virtual reality exposure (VRE), but common SSEs may overlap with symptoms of anxiety. Limited research exists about the frequency of SSEs during VRE treatment for post-traumatic stress disorder (PTSD) and no research compares self-reported SSEs for those undergoing VRE with those participating in exposure therapy without virtual reality. This study compared the SSEs of active duty soldiers with PTSD randomly assigned to exposure therapy through traditional prolonged exposure or VRE.

Reger, G., Smolenski, D., Norr, A. M., Katz, A., Buck, B., & Rothbaum, B. (2019). Does virtual reality increase
emotional engagement during exposure for PTSD? Subjective distress during prolonged and virtual reality exposure therapy. Journal of Anxiety Disorders, 61, 75-81. doi:10.1016/j.janxdis.2018.06.001

ABSTRACT: Prolonged exposure (PE) is a treatment for posttraumatic stress disorder (PTSD) based on emotional processing theory. According to this theory, emotional engagement during imaginal exposure is critical to clinical outcome. One rationale for virtual reality exposure therapy (VRE) is the ability of trauma-relevant, multi-sensory stimuli to increase emotional engagement. This study compared the subjective distress of active duty soldiers (N = 108) during exposure via PE or VRE.

Roggenkamp, H., Abbass, A., Town, J., Kisely, S., & Johansson, R. (2019). Healthcare cost reduction and
psychiatric symptom improvement in posttraumatic stress disorder patients treated with intensive short-term dynamic psychotherapy. European Journal of Trauma and Dissociation. Advance Online Publication. doi:10.1016/j.ejtd.2019.100122

ABSTRACT: Posttraumatic stress disorder (PTSD) is associated with significant psychiatric morbidity and high healthcare costs. The aim of this pilot study was to evaluate changes in healthcare costs and general psychiatric symptom severity in patients with PTSD following intensive short-term dynamic psychotherapy (ISTDP).

Schindler, A., Meabon, J., Baskin, B., Cooper, E., Yagi, M., Simon, B., ... & Cook, D. G. (2019). Non-invasive
vagus nerve stimulation for the prevention/treatment of comorbid mild traumatic brain injury and PTSD. Brain Stimulation, 12(2), 418-419. doi:10.1016/j.brs.2018.12.356

Seal, K. H., Borsari, B., Tighe, J., Cohen, B. E., Delucchi, K., Morasco, B. J., … Midboe, A. (2019). Optimizing
pain treatment interventions (OPTI): A pilot randomized controlled trial of collaborative care to improve chronic pain management and opioid safety—rationale, methods, and lessons learned. Contemporary Clinical Trials, 77, 76–85.

ABSTRACT: Veterans seeking care in VA medical facilities have high rates of chronic pain, which often co-occur with mental health and substance use disorders, including prescription opioid misuse. The overall goal of the Optimizing Pain Treatment Interventions (OPTI) study was to pilot a 12-week Collaborative Care intervention to improve opioid safety, chronic pain disability, and use of non-pharmacological pain management strategies in veterans in VA primary care. Read full research article: Optimizing pain treatment interventions (OPTI): A pilot randomized controlled trial of collaborative care to improve chronic pain management and opioid safety

Shaffer, R., Sheppard, L., Peskind, E. R., Zhang, J., Adar, S., & Li, G. (2019). Fine particulate matter exposure
and cerebrospinal fluid markers of vascular injury. Journal of Alzheimer's Disease, 71(3), 1015-1025. doi:10.3233/JAD-190563

ABSTRACT: Cerebrovascular diseases play an important role in dementia. Air pollution is associated with cardiovascular disease, with growing links to neurodegeneration. Prior studies demonstrate associations between fine particulate matter (PM2.5) and biomarkers of endothelial injury in the blood; however, no studies have evaluated these biomarkers in cerebrospinal fluid (CSF). We evaluate associations between short-term and long-term PM2.5 exposure with CSF vascular cell adhesion molecule-1 (VCAM-1) and e-selectin in cognitively normal and mild cognitive impairment (MCI)/Alzheimer's disease (AD) individuals.

Stewart, T., Shi, M., Mehrotra, A., Aro, P., Soltys, D., Kerr, K., ... & Zhang, J. (2019). Impact of Pre-
Analytical Differences on Biomarkers in the ADNI and PPMI Studies: Implications in the Era of Classifying Disease Based on Biomarkers. Journal of Alzheimer's Disease, 69(1), 263-276. doi:10.3233/JAD-190069

ABSTRACT: Neurodegenerative diseases require characterization based on underlying biology using biochemical biomarkers. Mixed pathology complicates discovery of biomarkers and characterization of cohorts, but inclusion of greater numbers of patients with different, related diseases with frequently co-occurring pathology could allow better accuracy. Combining cohorts collected from different studies would be a more efficient use of resources than recruiting subjects from each population of interest for each study.

Williams, P., Cribbet, M., Tinajero, R., Rau, H., Thayer, J., & Suchy, Y. (2019). The association between
individual differences in executive functioning and resting high-frequency heart rate variability. Biological Psychology, 148, 107772. doi:10.1016/j.biopsycho.2019.107772

ABSTRACT: Both resting high-frequency heart rate variability (HF-HRV) and executive functioning (EF) are individual differences implicated in vulnerability to a wide range of adverse outcomes. The overlapping set of associations, along with theoretical models positing connections between the brain regions subserving the executive functions and the parasympathetic nervous system, suggest that the two factors should be correlated. Seeking to address limitations in prior research, the current study examined the association between EF, measured comprehensively with individually-administered neuropsychological tests and controlling for lower-order cognitive processes, and resting physiology, measured with impedence cardiography, in healthy, community participants (68% female; mean age = 27, SD = 6.5).

Wyse, J. J., Ganzini, L., Dobscha, S. K., Krebs, E. E., & Morasco, B. J. (2019). Setting expectations, following orders,
safety, and standardization: Clinicians' strategies to guide difficult conversations about opioid prescribing. Journal of General Internal Medicine. Advance online publication. doi: 10.1007/s11606-019-04983-y

ABSTRACT: Evidence has continued to accumulate regarding the potential risks of treating chronic pain with long-term opioid therapy. Clinical practice guidelines now encourage clinicians to implement practices designed to reduce opioid-related risks. Yet how clinicians implement these guidelines within the context of the patient encounter has received little attention. This secondary analysis aimed to identify and describe clinicians’ strategies for managing prescription opioid misuse and aberrant behaviors among patients prescribed long-term opioid therapy for chronic pain. Read full research article: Setting Expectations, Following Orders, Safety, and Standardization: Clinicians' Strategies to Guide Difficult Conversations About Opioid Prescribing

NW MIRECC Research Articles:   In Press | 2019 | 2018 | 2017 | 2016 | 2015 | 2014

NW MIRECCVeterans Integrated Service Network 20 (VISN 20) serves 135 counties in Alaska, Idaho, Oregon, Washington, and extending into Del Norte County California and Lincoln County Montana. VISN 20 is the largest geographic region of VA and home to 273 federally recognized American Indian and Alaskan Native tribes, 229 of which are located in Alaska. Encompassing 23% of the US land mass, VISN 20 spans three time zones over 817,417 square miles. VA Puget Sound Health Care System (VAPSHCS) and the Portland VA Health Care System (VAPORHCS) were commissioned by Congress and the U.S. Department of Veterans Affairs (VA) as one of the first three Mental Illness Research, Education, and Clinical Centers (MIRECCs) in the United States. VAPSHCS serves Veterans from a five-state area in the Pacific Northwest with two main divisions: American Lake VA Medical Center and Seattle VA Medical Center. VA Outpatient Clinics and Vet Centers in Washington are located in Bellingham, Bellevue, Bremerton, Chehalis, Edmunds, Everett, Federal Way, Lacey, Mount Vernon, Olympia, Port Angeles, Puyallup, Richland, Renton, Silverdale, Seattle, Spokane, Union Gap, Vancouver, Walla Walla, Wenatchee, and Yakima. Veterans in Washington are also served by VA Medical Centers in Spokane, Vancouver, and Walla Walla. VAPORHCS serves Veterans in Oregon and Southwest Washington with two main divisions: Portland VA Medical Center and Vancouver VA Medical Center. VA Outpatient Clinics and Vet Centers in Oregon are located in Bend, Boardman, Brookings, Enterprise, Eugene, Fairview, Grants Pass, Hines, Hillsboro, Klamath Falls, LaGrande, Lincoln City, Newport, Portland, Salem, The Dalles, Warrenton, and West Linn. Veterans in Oregon are also served by VA Medical Centers in Roseburg, White City, and Vancouver, Washington.

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VA provides health care for Veterans from providers in the local community outside of VA. Veterans may be eligible to receive care from a community provider when VA cannot provide the care needed. VA launched its new and improved Veterans Community Care Program (VCCP) on June 6, 2019, implementing portions of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (MISSION Act), which both ended the Veterans Choice Program and established VCCP. Types of care under the new VCCP include General Community Care, Urgent Care, Emergency Care, Foreign Medical Care, Home Health and Hospice Care, Indian and Tribal Health Services, In Vitro Fertilization, State Veterans Home, and Flu Shots. Veterans work with their VA health care provider or other VA staff to see if they are eligible to receive community care based on new criteria. The VA Community Care Network (CCN) is VA’s direct link with community providers to ensure Veterans receive timely, high-quality care.

VA Vet Center LogoVet Centers in the VISN 20 Health Care Network are community-based counseling centers that provide a wide range of social and psychological services, including professional readjustment counseling to eligible Veterans, active-duty Army, Navy, Marine Corps, Coast Guard, Air Force, and Space Force service members, including National Guard and Reserve components, and their families. 1-877-WAR-VETS is an around the clock confidential call center where Veterans, service members and their families can talk about their military experience or any other issue they are facing in transitioning after military service or trauma and get connected to their nearest Vet Center.

Vet Centers in VISN 20

Vet Centers provide counseling to make a successful transition from military to civilian life or after a traumatic event experienced in the military. Individual, group, marriage and family counseling is offered in addition to referral and connection to other VA or community benefits and services. If you can’t make it to a nearby Vet Center, VA offers satellite Vet Center locations and Mobile Vet Centers that may be closer to you.


Anchorage Vet Center (Anchorage, AK)

Anchorage Satellite Vet Centers in Anchor Point and Homer

Fairbanks Vet Center (Fairbanks, AK)

Fairbanks Satellite Vet Centers in Fort Greely and Fort Wainwright

Kenai Vet Center Outstation (Soldotna, AK)

Wasilla Vet Center (Wasilla, AK)


Central Oregon Vet Center (Bend, OR)

Eugene Vet Center (Eugene, OR)

Eugene Satellite Vet Centers in Florence and Reedsport 

Grants Pass Vet Center (Grants Pass, OR)

Grants Pass Satellite Vet Center in Cave Junction and Grants Pass Mobile Vet Center

Portland, OR Vet Center (Portland, OR)

Portland Satellite Vet Centers in Oregon City, St. Helens, and Vancouver, Washington

Salem Vet Center (Salem, OR)

Salem Mobile Vet Center


Boise Vet Center (Boise, ID)

Boise Satellite Vet Center in Ontario, Oregon and Boise Mobile Vet Center

Spokane Satellite Vet Centers in Couer d'Alene, Kootenai, Post Falls, Fairchild AFB, and Newport, Washington


Bellingham Vet Center (Bellingham, WA)

Everett Vet Center (Everett, WA)

Federal Way Vet Center (Federal Way, WA)

Lacey Vet Center Outstation (Lacey, WA)

Seattle Vet Center (Seattle, WA)

Spokane Vet Center (Spokane, WA)

Spokane Satellite Vet Centers in Fairchild AFB, Newport, Post Falls and Couer d'Alene, Idaho

Spokane Mobile Vet Center

Tacoma Vet Center (Tacoma, WA)

Tacoma Mobile Vet Center

Vancouver Vet Center - Washington State University, Clark County (Vancouver, WA)

Walla Walla Vet Center (Walla Walla, WA)

Yakima Valley Vet Center (Yakima, WA)

Yakima Satellite Vet Center in Ellensburg

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VA has a variety of mental health resources, information, treatment options, and more — all accessible to Veterans, Veterans’ supporters, and the general public. Explore the pages below to learn more about a specific mental health topic. Each of these pages includes resources, information on treatment options, and more.

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In 1946, Veterans Canteen Service (VCS) was established by law to provide comfort and well-being to America’s Veterans. With our many retail stores, cafés and coffee shops across the country, we serve those who have served our country. Our Canteens are whole health spaces for Veterans to connect, relax, share and care for themselves in an environment that is their benefit. We are proud to Serve America’s Veterans and those who provide for their care.

VCS operates over 200 Patriot Stores in Veterans Administration (VA) Medical Centers nationwide. Many of our stores have been recently updated and expanded to provide our customers with a modern, clean and comfortable shopping experience. Our stores welcome our customers with wider aisles, wood-like floors, enhanced lighting and directional signage. PatriotStores have expanded hours of operation to provide service for customers on weekends at most locations.

The Patriot Cafe is the best place in the VA Medical Center to enjoy delicious, freshly prepared breakfast or lunch served hot or cold each weekday. Providing Veterans, their families, VA employees, volunteers and visitors a place to relax and enjoy a meal or take-out for their convenience. With a wide variety of food from traditional comfort food, specialized menu selections and a large assortment of healthy choices; there is something for everyone's taste buds.

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