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VA AND DoD CONSIDER EXPANSION OF STREAMLINED
DISABILITY RATING SYSTEM -- Pilot program has VA
doctors conducting one set of physical exams and
VA specialists determining one set of disability
ratings which both departments use.
For a previous story about this pilot program,
click here...
http://www.vawatchdog.org/07/nf07/nfJUL07/nf072807-3.htm
Story here...
http://www.govexec.com/dailyfed/0708/071808nj1.htm
Story below:
-------------------------
Pilot program may overhaul treatment of
veterans
By Sydney J. Freedberg Jr.
National Journal
The influx of wounded troops from Afghanistan and Iraq has burst the seams
of the military health care system.
The much-publicized scandal in 2007 at Walter Reed Army Medical Center,
which kick-started reforms, has proved to be only the tip of a large and
ugly iceberg.
The problem is not just about organizations and processes, but about
mind-sets.
Although most people in the Defense Department go above and beyond to take
care of their wounded, others can still lapse into an attitude of "shut
up, shape up, and soldier on"--especially toward those troops who suffer
subtle but deeply disabling
 mental
problems rather than obvious physical wounds. Yet it is precisely the
hard-to-diagnosis cases of post-traumatic stress disorder and "mild"
traumatic brain injury that have become the distinctive injuries of this
war.
This fall, however, the departments of Defense and Veterans Affairs will
decide whether to expand a pilot program that has the potential to
dramatically change the treatment of those disabled in the line of duty.
Started in November and currently limited to the Washington metropolitan
area, the program takes aim at a bureaucratic redundancy that has long
bedeviled injured troops leaving the armed forces. This is the double take
in which--before discharge--the Army, Navy, or Air Force first conducts an
exit exam of a departing service member to assess any conditions that
might trigger military disability benefits, and then--after discharge--the
VA conducts its own entry exam of the same individual for the same
conditions to determine eligibility for VA benefits.
Rarely do the two departments agree on just how disabled a departing
service member is. Even when they do, they pay compensation at different
rates set by different statutes. What's more, under federal laws banning
"concurrent receipt" of both benefits by the same person, a disabled
veteran will often discover his monthly check from the Defense Department
is reduced by an amount equal to some or all of the value of his VA
benefit. Because the VA is usually more generous, this offset can cut the
payment from Defense to nothing. The whole system is a source of endless
confusion and complaint.
"The biggest criticism was the redundancy, the complexity," said Samuel
Retherford, a retired Army colonel who oversees the pilot program as the
Pentagon's deputy director for personnel management policy. "They had to
re-explain their case, fill out forms over and over, and [re]state the
same thing."
So, in the pilot program, the Defense Department is essentially
subcontracting much of its disability assessment system to the Veterans
Affairs Department. VA doctors will conduct one set of physical exams, and
VA specialists will determine one set of disability ratings, which both
departments will then use. This reform should go a long way toward
eliminating the disparity in which the military has historically rated the
exact condition in the exact same patients as less disabling, and
therefore worthy of fewer benefits, than has the VA.
"There's this presumption of guilt that has pervaded the [military] system
for years," said a veteran who works on Capitol Hill. "Good soldiers got
screwed. The system never worked. It was dysfunctional in peacetime--but
now it's an absolute disaster."
Last August, a government-ordered study by CNA, a nonprofit research
group, compared 31,473 individuals who had been assessed by both systems
for the same condition. According to the study, the VA ratings were, on
average, 8.6 percentage points (out of 100) higher than the Defense
Department's. On mental disorders, the military rated disabilities much
lower than did the VA: 11.9 percentage points lower for traumatic brain
injury, 24.5 points lower for severe depression, and 32.8 points lower for
PTSD.
Mental problems have been a major focus for the VA since Vietnam. In the
military, they are still widely stigmatized or ignored--and given lowball
ratings from official disability assessment boards. Take Wendell McLeod,
an Army specialist mentally impaired after a 2005 accident in Kuwait. "He
has to be reminded to do the simple things in life," said his wife,
Annette, who has testified before Congress. "He hasn't started driving
yet." Even as a passenger, she said, "he grabs the steering wheel now at
the least little thing. He doesn't comprehend that just because there's a
bag in the road, that doesn't mean it's an IED [improvised explosive
device]."
Spc. McLeod is being treated by the VA, which assessed him as 100 percent
disabled. But military raters initially declared his problems a case of
mental retardation that was unrelated to and pre-existed his military
service; they pointed to his receiving Title I remedial education in
elementary school and denied him benefits. Annette McLeod had that ruling
overturned through appeals, but she is still struggling to get a military
board to reconsider an interim rating of 50 percent. "Hopefully, this will
be the last battle with the Army," she told National Journal. Because of
their case's high profile, she said, "for us it's a little bit easier this
time around. But some people I've talked to, they're still bogged down in
the system."
Dubious ratings like those given to Spc. McLeod have become distressingly
common since the invasion of Iraq. "About a year and a half ago, we were
getting anecdotal evidence that the Army's system was severely underrating
cases," said Kerry Baker, a staffer who works on veterans appeals for the
1.4 million-member Disabled American Veterans. "What we found was just
atrocious." In one case, Baker went on, "we found a kid with several
penetrating skull injuries, a couple of different craniotomies, major
seizure disorder, major migraines on a daily basis, and a cognitive
disorder so severe his mother was appointed as his guardian." The VA rated
the young soldier as 100 percent disabled; the military, 10 percent.
The cause of such discrepancies goes back to the birth of the Republic.
Since the American Revolution, the military has had a medical corps to
keep troops healthy before battle and to patch them up after--focusing on
the collective fighting power of the force and discharging any individual
no longer fit to fight. By contrast, federal veterans
facilities--authorized by law in 1811--have always focused on care for
people who were no longer serving a military purpose, but whose injuries,
poverty, or both affected the conscience of a grateful nation.
Over time, however, the two systems have come to overlap in one area: the
population eligible for benefits from both--military retirees. Most of
these beneficiaries are commissioned officers and senior noncoms who
served a full 20 years, but they include those who were so disabled in
accidents or combat while in uniform that they were medically retired from
military service and therefore eligible to use military hospitals as well
as VA facilities for their care.
From 2003 through '07, the Pentagon medically retired more than 22,000
such disabled troops, who will receive military-subsidized medical care
and monthly pension checks for life. Another 57,000 troops have been
"medically separated," discharged as unfit to serve but with lesser
degrees of disability, which entitles them to only a onetime severance
payment. All 79,000, both the medically retired and the medically
separated, also count as disabled veterans who may qualify for VA health
care and disability checks. Because the law often entitles the same person
to two benefits, one from the Defense Department and one from the VA, each
department must determine a disability rating.
Ostensibly, the two departments have used the same standard schedule,
written by the VA, to rate each disabling condition, from 10 percent for a
bullet through the foot to 100 percent for blindness in both eyes. But for
years, the military "supplemented" the schedule with layers of regulations
that effectively altered it beyond recognition--until Congress banned the
practice last year. The 2007 "wounded warrior" reforms forced all military
disability raters to use the VA schedule, without alterations, and ordered
the pilot program combining the military and VA assessment systems.
Under the pilot program, the military uses not only the VA-written
schedule of ratings but also VA doctors and VA ratings specialists to
assess each service member. Military personnel still make the critical
decision on whether a given individual is unfit to serve or can return to
duty. The Defense Department and the VA provide different kinds of
benefits, determined by different laws and regulations, for the same
individuals. But the often-bizarre discrepancies in how the two
departments rated the same condition in the same individual will no longer
exist.
By the end of June, 461 service members had entered the pilot process, of
whom just 61 had been discharged from the military (13 medically
separated, 48 medically retired). The Washington area benefits from an
unusually rich cluster of military and veterans medical facilities, which
makes coordination easier here than elsewhere. In late August, the
Pentagon and the VA will begin considering a second location, probably an
underserved and relatively rural area where implementing the pilot program
will be distinctly harder.
Even if the expanded pilot program succeeds, wholesale adoption of the
reforms is at least a year away. As the casualties keep coming in, the
pressure on the disability system will continue to mount.
-------------------------
posted by Larry
Scott
Founder and Editor
VA Watchdog dot Org
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