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INSULT TO INJURY: CHEATING OUR VETS - HOW THE
PENTAGON IS SHORTCHANGING WOUNDED SOLDIERS --
The U.S. military appears to have dispensed low
disability
ratings to wounded service members with serious
injuries and thus avoided paying them full
military disabled retirement benefits.
Story here...
http://www.usnews.com/
usnews/health/articles/070408/16va.htm
Story below:
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Insult to Injury
New data reveal an alarming trend: Vets'
disabilities are being downgraded
By Linda Robinson
In the middle of a battle in Fallujah in April 2004, an M80 grenade
landed a foot away from Fred Ball. The blast threw the 26-year-old
Marine sergeant 10 feet into the air and sent a piece of hot shrapnel
into his right temple. Once his wound was patched up, Ball insisted on
rejoining his men. For the next three months, he continued to go on
raids, then returned to Camp Pendleton, Calif.
But Ball was not all right. Military doctors concluded that Ball was
suffering from a traumatic brain injury, post-traumatic stress disorder
(PTSD), chronic headaches, and balance problems. Ball, who had a 3.5
grade-point average in high school, was found to have a
sixth-grade-level learning capability. In January of last year, the
Marine Corps found him unfit for duty but not disabled enough to receive
full permanent disability retirement benefits and discharged him.
Ball's situation has taken a dire turn for the worse. The tremors that
he experienced after the blast are back, he can hardly walk, and he has
trouble using a pencil or a fork. Ball's case is being handled by the
Department of Veterans Affairs-he receives $337 a month-but while his
case is under appeal, he receives no medical care. He works 16-hour
shifts at a packing-crate plant near his home in East Wenatchee, Wash.,
but he has gone into debt to cover his $1,600 monthly mortgage and
support his wife and 2-month-old son. "Life is coming down around me,"
Ball says. Trained to be strong and self-sufficient, Ball now speaks in
tones of audible pain.
Fred Ball's story is just one of a shocking number of cases where the
U.S. military appears to have dispensed low disability ratings to
wounded service members with serious injuries and thus avoided paying
them full military disabled retirement benefits. While most recent
attention has been paid to substandard conditions and outpatient care at
Walter Reed Army Medical Center, the first stop for many wounded
soldiers stateside, veterans' advocates say that a more grievous problem
is an arbitrary and dysfunctional disability ratings process that is
short-changing the nation's newest crop of veterans. The trouble has
existed for years, but now that the country is at war, tens of thousands
of Americans are being caught up in it.
Now an extensive investigation by U.S. News and a new Army inspector
general's report reveal that the system is beset by ambiguity and
riddled with discrepancies. Indeed, Department of Defense data examined
by U.S. News and military experts show that the vast majority-nearly 93
percent-of disabled troops are receiving low ratings, and more have been
graded similarly in recent years. What's more, ground troops, who suffer
the most combat injuries from the ubiquitous roadside bombs, have
received the lowest ratings.
One counselor who has helped wounded soldiers navigate the process for
over a decade believes that as many as half of them may have received
ratings that are too low. Ron Smith, deputy general counsel for the
Disabled American Veterans, says: "If it is even 10 percent, it is
unconscionable." The DAV is chartered by Congress to represent service
members as they go through the evaluation process. Its national service
officers are based at each rating location, and there is a countrywide
network of counselors. Smith says he recently asked the staff to cull
those cases that appeared to have been incorrectly rated. Within six
hours, he says, they had forwarded him 30 cases. "So far," Smith says,
"the review supports the conclusion that a significant number of
soldiers are being fairly dramatically underrated by the U.S. Army."
Magic number. In an effort to learn how extensive the problem is, U.S.
News spent six weeks talking to wounded service members, their
counselors, and veterans advocacy groups and reviewing Pentagon data. At
first glance, the disability ratings process seems straightforward. Each
branch of service has its own Physical Evaluation Boards, which can
comprise military officers, medical professionals, and civilians. The
PEBs determine whether the wounded or ill service members are fit for
duty. If they are, it's back to work. Those found unfit are assigned a
disability rating for the condition that makes them unable to do their
military job. The actual rating is key, and here's why: Service members
who have served less than 20 years-the great majority of wounded
soldiers-who receive a rating under 30 percent are sent home with a
severance check. Those who receive a rating of 30 percent or higher
qualify for a host of lifelong, enviable benefits from the DOD, which
include full military retirement pay (based on rank and tenure), life
insurance, health insurance, and access to military commissaries.
But the system is hideously complicated in practice. The military
doctors who prepare the case for the PEBs pick only one condition for
the service member's rating, even though many of the current injuries
are much more complex. The PEBs use the Department of Veterans Affairs
ratings scale, which grades disabilities in increments of 10-a leg
amputation, for example, puts a soldier at between 40 and 60 percent
disabled. The PEBs claim they have the leeway to rate a soldier 20
percent disabled for pain, say, rather than 30 percent disabled for a
back injury. If rated at 20 percent or below and discharged, the soldier
enters the VA system as a retiree where he is evaluated again to
establish his healthcare benefits. Ball, for example, was found by the
VA to be 50 percent disabled for PTSD.
Since 2000, 92.7 percent of the disability ratings handed out by PEBs
have been 20 percent or lower, according to Pentagon data analyzed by
the Veterans' Disability Benefits Commission, which Congress formed in
2004 to look into veterans' complaints (Page 47). Moreover, fewer
veterans have received ratings of 30 percent or more since America went
to war in Afghanistan and Iraq, according to the Pentagon's annual
actuarial reports. As of 2006, for example, 87,000 disabled retirees
were on the list of those exceeding the 30 percent threshold; in 2000,
there were 102,000 recipients. Last year, only 1,077 of 19,902 service
members made it over the 30 percent threshold (chart, Page 49).
The total amount paid out for these benefit awards has remained roughly
constant in wartime and peacetime, leading disabled veterans like
retired Lt. Col. Mike Parker, who has become an unofficial spokesperson
on this issue, to allege that a budgetary ceiling has been imposed to
contain war costs. A DOD spokesperson, Maj. Stewart Upton, said that the
Pentagon "is committed to improving the Disability Evaluation System
across the board and to ... a full and fair due process with regard to
disability evaluation and compensation."
Other data reveal glaring discrepancies among the military services.
Even though most of those wounded in Iraq and Afghanistan have been
ground troops, the Army and Marine Corps have granted far fewer members
full disabled benefits than the Air Force. The Pentagon records show
that 26.7 percent of disabled airmen have been rated 30 percent or more
disabled, while only 4.3 percent of soldiers and 2.7 percent of marines
made the grade. Services engaged in close combat, experts say, could be
expected to find more members unfit for duty and meriting full
retirement benefits. Instead, the Air Force decided that 2,497 airmen
fall into that category while the much larger Army, with its higher
tally of wounded, has accorded those benefits to only 1,763 soldiers
since 2000.
How many of these veterans' cases have been decided incorrectly? Nobody
knows. These statistics show trends that are clearly at odds with what
logic would dictate, but there has been no effort to discover how many
of those low ratings were inaccurately conferred or to ascertain why the
number receiving full benefits has declined during wartime or why there
is such a discrepancy between the Air Force and the other services. But
there is abundant anecdotal evidence of a process cloaked in obscurity
and riddled with anomalies, and of ratings that are inconsistent and
often arbitrarily applied.
DAV lawyer Smith, for example, took on the case of a soldier whose
radial nerve of his dominant hand had been destroyed, the same
affliction former Sen. Bob Dole has. Like Dole, the soldier was unable
to write with a pen or to button his shirt. "There is one and only one
rating for that condition, which is 70 percent disability," says Smith.
The PEB gave the soldier 30 percent, the lawyer said, "which I found to
be fairly outrageous." Upon appeal to the Army Physical Disability
Agency, the entity that oversees that service's disability evaluation
process, the rating was raised to 60 percent. Smith recently took on
another case, that of Sgt. Michael Pinero, a soldier who developed a
degenerative eye condition called keratoconus that required him to wear
contact lenses. Army regulations prohibit wearing contacts in combat,
which should have made him ineligible for deployment and therefore unfit
to perform his specific military duties. But the PEB ignored the eye
condition, which Smith believes merited a 30 percent rating or more, and
rated Pinero 10 percent disabled for shin splints. Smith has asked the
Army to clarify whether it considers the regulation on contact lenses
binding or, as one board member alleged, merely a guideline. Disputes
over such distinctions are common in the Alice in Wonderland world of
disability ratings.
Controversy frequently surrounds decisions on which conditions make a
soldier unfit for duty. Smith took issue with a recent statement made by
the Army Physical Disability Agency's legal adviser, quoted in Army
Times newspaper. The official said that short-term memory loss would not
necessarily render soldiers unfit for duty since they could compensate
by carrying a notepad. "Memory loss is a common sign of TBI," Smith
said, using the abbreviation for traumatic brain injury, which has
afflicted many soldiers hit by the roadside bombs commonly used in Iraq.
"The rules of engagement are a seven-step process.... If a suicide
bomber is coming at you, you cannot stop and consult your notepad," he
added. "I find this demonstrative of the attitude that pervades the
Physical Disability Agency," which is in charge of reviewing evaluations
for accuracy and consistency.
Trying to overturn a low rating can be a full-time job-and an
exasperating one. Take Staff Sgt. Chris Bain, who lost the use of his
arms but not his sense of humor. "They call me T-Rex because I have a
big mouth and two hands and I can't do nothing with them," he jokes. He
left the Army in February, but he still has plenty of fight in him.
During an ambush in Taji, Iraq, in 2004, a mortar round exploded 2 feet
away from him, ripping through his left arm and hand. A sniper's bullet
passed through his right elbow. His buddies saved his life, throwing
Bain on the hood of a humvee and rushing him to a combat hospital. Once
transferred to Walter Reed, Bain refused to have his arm amputated and
underwent eight surgeries to save it. That choice cost him. While an
amputation would have automatically put him over the 30 percent
threshold, the injury to his left arm was rated at 20 percent even
though he cannot use the limb.
Bain was angry. A noncommissioned officer who had planned on 20 or 30
years in the Army, he knew his career was over, but he wasn't going to
go quietly. "I wanted to be an example to all soldiers," he said. "My
job was to take care of troops." He went to find Danny Soto, the DAV
representative at Walter Reed he'd heard so much about. "Danny is just
an awesome guy. He took great care of me, but he should not have had
to," Bain says. Soto is a patron saint to many soldiers at Walter Reed.
He walks the halls, finding the newly injured and urging them to collect
documents for their journey through the tortuous-and, to many,
capricious-system. Many soldiers are young, and after they have spent
months or years recuperating, they just want to get home and are
unwilling to argue for the rating they deserve. Even though he missed
his wife and three children, Bain decided: "I've already been here two
years, another one ain't going to hurt me. Too many people are getting
lowballed."
With Soto's help, Bain gathered detailed medical evidence of his
injuries and went to face the board. They gave him a 70 percent rating
for injuries related to the blast except for his hearing loss, which was
not considered unfitting since he had a hearing aid. Oddly enough,
however, the board put him on the temporary disabled retirement list
instead of the permanent list. "What do they think, that after three
years, my arm is going to come back to life?"
A lifetime of adjusting lies ahead for Bain. "I can't tie my shoes, open
bottles of water, or cut my own food," he says. "I have to ask for
help." The 35-year-old veteran has found a new sense of purpose. He's
decided to run for Congress in 2008, and fixing the veterans' system is
his top priority. "I do not want this s--- to happen again to anyone. No
one can communicate with each other. The paper trail doesn't catch up."
It's a tall order, but the soldier says that he has "100,000 fights"
left in him.
A systemic fix doesn't appear to be anywhere in sight. A March 2006
report by the Government Accountability Office found that Pentagon
officials were not even trying to get a handle on the problem. "While
DOD has issued policies and guidance to promote consistent and timely
disability decisions," the report concluded, "[it] is not monitoring
compliance." But the GAO report did spur Army Secretary Francis Harvey,
who was forced to resign last month in the wake of the Walter Reed
scandal, to order the Army's inspector general to conduct an
investigation of the disability evaluation system. After almost a year
of work, the inspector general's office last month issued a 311-page
report that begins to pierce the confusion and opacity surrounding the
process. While it does not determine how many erroneous ratings were
accorded to the nearly 40,000 soldiers rated 20 percent disabled or less
since 2000, it does make three critical points: 1) the ambiguity in
applying the ratings schedule should end; 2) wide variance in ratings is
indisputable, even among the three Army boards, and 3) the Army's
oversight body is not doing its job.
Way overdue. Army officials met with U.S. News to discuss the inspector
general's report. "This is something that has been near and dear to our
hearts for a long time, and it's probably way overdue as far as having
someone go and take a look at it," says a senior Army official. The
inspector general's team found that Army policy was not consistent with
the policies of either the Pentagon or the Department of Veterans
Affairs. It recommended that the Army "align [its] adjudication of
disability ratings to more closely reflect those used by the Department
of Veterans Affairs." For years, the Army has asserted that it has the
right to depart from VA standards on grounds that it is assessing
fitness for duty and compensating for loss of military career, not
decreased civilian employability.
Veterans' advocates argue that federal law requires the military to use
the Veterans Affairs Schedule for Rating Disabilities as the standard
for assigning the ratings. But over the years, Pentagon directives on
applying the schedule have opened up a whole new gray area by saying the
schedule is to be used only as a guide. And the services have
interpreted them in different ways, engendering further discrepancies.
Soto, the DAV national service officer at Walter Reed, says that
inconsistencies are especially prevalent in complex cases of traumatic
brain injury and post-traumatic stress disorder. "There is a saying
going around the compound here," Soto says, "that if you are not an
amputee, you are going to have to fight for your rating."
The inspector general's report calls for ending the ambiguities. "What
we're saying is it shouldn't be left to interpretation; it should be
clearly defined," says one Army official. "If there were a way to cut
down on that ambiguity, I think that variance would decrease."
Finally, the report bluntly concludes that the system's internal
oversight mechanism is not functioning. "The Army Physical Disability
Agency's quality assurance program does not conform to DOD and Army
policy," it says-the same conclusion the GAO came to a year ago. The
inspector general's report adds evidence of just how little the watchdog
is doing to ensure that cases are correctly decided. The agency is
supposed to send cases to either of two review boards when soldiers
rebut their rating evaluations, but from 2002 through 2005, the agency
sent only 45 out of 51,000 cases to one of the boards. The other review
board has not been used at all.
The inspector general's team made 41 recommendations in all, finding
among other things that the Army lacks a formal course for training the
liaison officers who are supposed to guide soldiers through the PEB
process, that the disposition of cases lags badly, that the computerized
information systems are antiquated, and that the two key medical and
personnel databases are not integrated and cannot communicate with each
other. The report has been forwarded to the action team that Army Vice
Chief of Staff Richard Cody convened-one of many official groups formed
since the revelations of substandard conditions and bureaucratic delays
at Walter Reed.
Veterans' advocates are skeptical that the administration or the
military bureaucracy will make major changes anytime soon. In testimony
to Congress last month, Veterans for America director of veterans'
affairs Steve Robinson recommended taking the entire ratings process
away from the Pentagon and giving it to the Department of Veterans
Affairs. "It's hard to ignore the fact that in time of war they are
giving out less disability," he says. "Is it policy? I don't know. But
it is a fact."
Congress has not responded to this problem. Says Rep. Vic Snyder, the
Arkansas Democrat who chairs the House Armed Services subcommittee on
military personnel: "This whole issue of disability ratings is very
complex. It is not well understood by many people, including many in
Congress. That is why we set up the [ Veterans' Disability Benefits]
Commission in 2004. We are hoping it will help us sort this out."
A lot is riding on the commission. Its chairman is Lt. Gen. Terry Scott,
who retired in 1997 and ran Harvard's Kennedy School of Government's
National Security Program until 2001. After the Pentagon data on the
disability process were presented to the commission last week, Scott
said "we still don't understand the whys and wherefores" of the skewed
ratings. The core problem, he believes, is that "the military was not
designed to look after severely wounded people for a long time." The
commission has not yet decided what changes it will recommend, but he
said there is a general sense that "one physical exam at the end of
service should be enough for both agencies, DOD and VA."
Cash and staff. Any solutions that call for transferring more
responsibility to the Department of Veterans Affairs will have to be
matched by enormous infusions of cash and staff. Already, the VA is
reeling under a backlog of over 600,000 claims from retired veterans,
which the agency predicts will grow by an additional 1.6 million in the
next two years. Harvard Prof. Linda Bilmes, an economist who has
published two studies on the costs of the Iraq war and the associated
veterans' costs, projects that as much as $150 billion more will be
required to deal with the wounded returning from Iraq and Afghanistan.
Meanwhile, people like Danny Soto want to know who is going to stop the
military boards from giving out ratings like the 10 percent given to one
soldier for a skull fracture and traumatic brain injury, when the VA
later assigned a 100 percent rating. Soto is also frustrated by a recent
case in which a soldier whose legs had been severely injured in a blast
in Iraq was given only a 20 percent disability rating for pain and by
the treatment of a man who has a bullet hole through his eye and suffers
from seizures. As Soto sat with that soldier in front of the board, he
asked why he had been placed on the temporary list. "At what point do
you think he is going to fall below 30 percent?"
Soto is unsparing in his criticism of the bureaucracy. "This system," he
says, " is so broke." Old soldiers say the root of the problem is an
Army culture that preaches a "suck it up" attitude. "If you ask for what
you are due, you are perceived to be whining or trying to pad your
pocket," says a retired command sergeant major. "If you're not bleeding,
you're not hurt. That's what we were taught."
With Edward T. Pound
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Larry Scott --
