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INSTITUTE OF MEDICINE REPORT CALLS FOR COMPLETE
OVERHAUL OF VA DISABILITY RATING SYSTEM -- IOM
report:
"...the agency should make sure that the
[proposed] revised
Rating Schedule addresses the extent to which
veterans'
disabilities affect their quality of life and
limit any aspect
of their daily lives, not just their ability to
work..."
The Institute of Medicine (IOM) has released
their report on the VA disability rating system.
This report was done for the Veterans'
Disability Benefits Commission (VDBC or Vets' Commission).
Background on VDBC with backlinks here...
http://www.vawatchdog.
org/07/nf07/nfMAR07/nf031207-4.htm
This report calls for a complete overhaul of
the VA disability rating system.
The IOM feels disability should be rated not
just on inability to work but for noneconomic losses as well. From
the report: "Veterans who can and do work can be disabled in
other aspects of their lives, such as their ability to maintain their
family and other personal relationships or to engage in sports, hobbies,
or other activities they formerly pursued."
This report is excellent news for veterans.
Last month the IOM issued a report on how the
VA handles post-traumatic stress disorder (PTSD) evaluations and
ratings. The report was highly-critical of the VA and, basically,
told them to get it together and properly evaluate and rate veterans
with PTSD. That story here...
http://www.vawatchdog.
org/07/nf07/nfMAY07/nf050907-1.htm
Portions of the report are available for
reading online here...
http://www.iom.edu/CMS/26761/34247/43423.aspx
We have two pieces of information. First
is the IOM press release about the report...second is a story from the
AP.
IOM press release here...
http://www8.
nationalacademies.org/onpinew
s/newsitem.aspx?RecordID=11885
Press release below:
-------------------------
Date: June 7, 2007
Contacts: Christine Stencel, Media Relations Officer
Sarah Morocco, Media Relations Assistant
Office of News and Public Information
202-334-2138; e-mail <news@nas.edu>
FOR IMMEDIATE RELEASE
Overhaul of VA System for Evaluating and Rating Veterans' Disabilities
Needed to Ensure Appropriate Compensation for Both Work-Related and
Noneconomic Losses
WASHINGTON -- The U.S. Department of Veterans Affairs (VA) needs to
overhaul its Schedule for Rating Disabilities -- the tool it uses to
determine the degree of disability suffered during military service --
to ensure that veterans receive appropriate compensation and other
benefits, says a new report from the Institute of Medicine. The agency
also needs to establish a process for keeping the Rating Schedule up to
date; some of its elements have not been changed since 1945, and do not
adequately reflect current understanding of certain conditions that now
occur more frequently, such as traumatic brain injury.
In addition, the agency should make sure that the revised Rating
Schedule addresses the extent to which veterans' disabilities affect
their quality of life and limit any aspect of their daily lives, not
just their ability to work, which is the disability program's current
focus. If the revised schedule does not, the VA will need to develop new
tools to identify and compensate for these noneconomic losses, said the
committee that wrote the report. Written at the request of the Veterans'
Disability Benefits Commission, the report's recommendations are
intended to inform the commission's review of the benefits program and
its report to the president and Congress this fall.
"With troops being injured nearly every day, the VA's system for
evaluating and rating former service members' disabilities should be as
up to date as possible with current medical knowledge of impairment and
its effects on a person's functioning and quality of life," said
committee chair Lonnie R. Bristow, former president of the American
Medical Association. "Right now, the Rating Schedule is out of sync with
modern medicine and modern concepts of disability. This report details
ways the agency can more successfully carry out the goals of veterans'
benefits programs, which were created to recognize the nation's debt to
those who serve and compensate them for their sacrifices."
Veterans who have a service-connected disability can receive monthly
payments tied to their disability ratings, ranging from $115 a month for
a 10 percent rating to $2,471 per month for a 100 percent rating.
Clinical professionals medically evaluate claimants and provide their
assessments to another group of nonclinical professionals who use this
information to determine the applicants' degree of disability using the
Rating Schedule, a list of about 700 diagnostic codes, each with
criteria for determining the percentage of disability. According to
federal statute, the veterans' disability benefits program is supposed
to compensate for average loss of earning capacity, though Congress and
the VA also have recognized and compensated veterans for other,
noneconomic losses since the disability program was codified in the
1920s.
VA should immediately undertake a comprehensive revision of the Rating
Schedule, beginning with those conditions that have not been reviewed
within the last decade. This step should remove ambiguous criteria and
obsolete conditions and introduce current medical knowledge of the
effects of injuries and diseases such as traumatic brain injury,
diabetes, and hearing loss, the report says. The agency also should
reassess the Rating Schedule approximately every 10 years and revise it
as needed. Some conditions identified in recent years are not in the
Rating Schedule. In addition, VA should adopt new diagnostic codes based
on the International Classification of Diseases (ICD) codes and the
Diagnostic and Statistical Manual of Mental Disorders (DSM), which are
used widely by other health care providers and systems in the United
States and elsewhere and undergo regular revision, so they would help VA
keep up with advances in medical understanding.
VA should regularly assess whether the Rating Schedule accurately
predicts loss of potential earnings and adjust it as needed. Such
assessments would ascertain if veterans with higher disability ratings
indeed earn less on average and ensure that average earnings at each
rating level are the same for all disabling conditions. But the
committee concluded that work disability alone is an unduly restrictive
rationale for VA's disability program. Veterans who can and do work can
be disabled in other aspects of their lives, such as their ability to
maintain their family and other personal relationships or to engage in
sports, hobbies, or other activities they formerly pursued.
The agency should develop or adapt a scale to measure specific
noneconomic effects and loss of quality of life and determine whether
the updated Rating Schedule adequately compensates for these negative
consequences. If it does not, VA should either modify the Rating
Schedule criteria or develop separate mechanisms to do so, the report
says.
Additional staff and resources will be needed to update the Rating
Schedule and implement other recommendations, the committee noted. VA
would benefit from guidance provided by an external advisory committee
made up of medical professionals as well as vocational experts and
representatives of the veteran community. Likewise, the agency personnel
who rate the severity of veterans' disability should have ready access
to health care professionals who can provide guidance on medical and
psychological issues that may only become apparent during the rating
process. Few raters have medical backgrounds, and they do not have
medical experts on staff to consult on complex cases.
VA and the U.S. Department of Defense should give every veteran applying
for disability compensation a thorough evaluation of all their medical,
psychosocial, and vocational abilities and needs at the time of
separation from service, rather than conducting such evaluations
piecemeal. Veterans may be eligible for additional benefits such as job
training meant to help them achieve their full potential in civilian
life, but currently before they can even be considered for these
services, they first must establish their disability, a process that can
take months or even years.
The study was sponsored by the Veterans' Disability Benefits Commission.
Established in 1970 under the charter of the National Academy of
Sciences, the Institute of Medicine provides independent, objective,
evidence-based advice to policymakers, health professionals, the private
sector, and the public. The National Academy of Sciences, National
Academy of Engineering, Institute of Medicine, and National Research
Council make up the National Academies. A committee roster follows.
Copies of A 21st Century System for Evaluating Veterans for Disability
Benefits are available from the National Academies Press; tel.
202-334-3313 or 1-800-624-6242 or on the Internet at
http://www.nap.edu . Reporters may
obtain a copy from the Office of News and Public Information (contacts
listed above).
-------------------------
AP story here...
http://www.forbes.com
/feeds/ap/2007/06/07/ap3799457.html
Story below:
-------------------------
Better Vets Disability System Needed
By RANDOLPH E. SCHMID
U.S. military personnel returning from Iraq and Afghanistan with
disabling wounds are still being evaluated by a system set up decades
ago and which urgently needs upgrading, the Institute of Medicine said
Thursday.
"With troops being injured nearly every day, the VA's system for
evaluating and rating former service members' disabilities should be as
up to date as possible," said Lonnie R. Bristow, former president of the
American Medical Association.
"Right now, the rating schedule is out of sync with modern medicine and
modern concepts of disability," said Bristow, chairman of the IOM
committee that looked at the issue.
In 2006 about 2.7 million veterans were receiving $26.5 billion in
disability compensation from the Department of Veterans Affairs. The
agency estimates that compensation payments to veterans will increase to
about $32.4 billion in 2008, when there are expected to be about 2.9
million beneficiaries.
Injured veterans are rated for their degree of disability based on their
ability to hold a job. They can receive monthly payments ranging from
$115 a month for a 10 percent disability rating to $2,471 per month for
a 100 percent rating.
The IOM called for the VA to update the rating system, parts of which
haven't been changed since 1945, particularly focusing on new
understanding of conditions such as traumatic brain injury.
Also, the report said, a new rating system should consider how much
veterans' disabilities affect their quality of life and limit any aspect
of their daily lives, not just their ability to work.
The committee pointed out that veterans who can and do work can still be
disabled in other ways, such as the ability to maintain their family and
other personal relationships or to engage in sports, hobbies, or other
activities they formerly pursued.
The report was prepared at the request of the federal Veterans'
Disability Benefits Commission. The IOM is an arm of the National
Academy of Sciences, a private organization chartered by Congress to
advise the government on scientific matters.
In addition to brain injury, the rating system needs to be updated with
new understanding of conditions such as diabetes and hearing loss, the
report said.
And the system should be updated every 10 years or as needed, it said.
The report suggested the VA establish an external advisory committee
including medical professionals, vocational experts and representatives
of the veteran community.
-------------------------
Larry Scott --
