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DEMS SAY VA DISABILITY RATING SYSTEM IN NEED OF

COMPREHENSIVE AND IMMEDIATE REPAIR -- And, GAO

testimony shows new VA / DoD joint disability evaluation pilot

program can't measure timeliness or accuracy of decisions.

We have two pieces of information.  First is a Democratic press release from the House Committee on Veterans' Affairs.  Second is GAO testimony.

Press release here... http://www.vawatchdog.org/08/hcva08/hcva022608-2.htm

Press release below: 

-------------------------

DEMOCRATIC PRESS RELEASE

VA Disability Rating System in Need of Comprehensive and Immediate Repair

House Veterans’ Affairs Subcommittee Holds Third Hearing in a Series to Address Necessary Improvements to the VA’s Claims Processing System

Washington, D.C. - On Tuesday, the House Veterans’ Affairs Disability Assistance and Memorial Affairs Subcommittee, led by Chairman John Hall (D-NY), conducted the third in a series of hearings on the benefits claims backlog at the Department of Veterans Affairs (VA). The hearing examined the issues surrounding the VA Schedule for Rating Disabilities (VARSD), which is used to determine compensation for veterans who experienced injuries and disabilities as a result of their military service.

The basis for the current VARSD has not been significantly updated since its development in 1945. Ratings range from 0 to 100 percent and are in increments of 10. The VASRD is divided into fourteen body systems, which incorporate approximately 700 codes that describe illness or injury symptoms and levels of severity. The VA uses a completely different system for rating disabilities than standard diagnostic codes and tools that are currently used by non-military governmental agencies, private sector disability plans, and medical providers. The VARSD, however, is not only used by the VA to determine a veteran’s disability benefits, but also by the Department of Defense (DoD) to determine whether a service member is fit or unfit to perform their military duties.

“Our nation’s service members and disabled veterans deserve to have a system that is based on the most available and relevant medical knowledge,” said Chairman Hall. “It is imperative that out-of-date and archaic criteria are replaced with current medical and psychiatric evaluation instruments for determining and understanding disabilities. The current system is simply not in sync with modern disability concepts.”

Panel discussions focused on a series of recent studies that have been conducted examining various aspects of the VA disability claims rating system, including the comprehensive report from the Veterans’ Disability Benefits Commission, a study on post-traumatic stress disorder from the Institute of Medicine, and research from the Center for Naval Analyses Corporation on compensation for loss of average earning and degradation of quality of life resulting from service-connected disabilities. A second panel comprised of representatives from the medical community provided testimony on standards and guides published by the American Medical and Psychiatric Associations and used by states and the private sector to evaluate levels of impairment and determine compensation. They advocated for VA to apply those same models and internationally recognized tools in evaluating veterans for disability.

Recommendations to improve the VASRD included updating and modernizing the ratings schedule, implementing technology to evaluate disabilities, and including criteria for quality of life loss issues that arise with experiencing disability. It was also recommended that VA raters use vocational assessments, not simply medical evaluations, when granting Individual Unemployability (IU) benefits to those unable to work due to their service-connected disabilities. Panelists proposed improving criteria for traumatic brain injury and expanding criteria for psychiatric disabilities including post-traumatic stress disorder.

“We must learn the lessons of past wars and prepare for the long-term health implications faced by current service members and veterans of today’s and yesterday’s wars,” stated Bob Filner (D-CA), Chairman of the House Committee on Veterans’ Affairs. “We can never adequately repay our veterans for their service and sacrifice, but we owe them our best efforts to provide for their future needs – and we must do better.”

Witness testimony also focused on how best to approach presumptive decisions for veterans who experience health conditions that arise long after completion of military service when specific evidence is unavailable or incomplete. The Institute of Medicine issued a report that called for a more evidentiary based approach to evaluating presumptive conditions. However, Ronald Abrams, Joint Executive Director of the National Veterans Legal Service Program responded, “Any move away from the ‘benefit of the doubt’ standard would have a negative impact on all veterans. If we send our troops into dangerous places, and if we put our service members into dangerous situations, our nation must make certain to at least maintain the non adversarial nature of the VA claims process and protect the ‘benefit of the doubt’ standard. The cost of compensating veterans who suffer from disabilities that are presumptive in nature is a cost of war.”

Brad Mayes, Director of the VA Compensation and Pension Service, provided testimony on a VA plan to improve the current rating schedule and compensate for quality of life losses, which should be completed by August 2008.

“I know there is a lot to be done to improve the VA claims processing system, but after review of the Rating Schedule, it seems that the centerpiece is in need of immediate comprehensive repair,” concluded Chairman Hall. “VA needs the correct tools to do the right thing, so our nation’s disabled veterans get the right assistance.”

Witnesses:

Panel 1

· Dennis Vincent McGinn, VADM, USN (RET.), Member, Veterans’ Disability Benefits Commission

· Lonnie Bristow, MD, Chair, Committee on Medical Evaluation of Veterans for Disability Compensation, Institute of Medicine

· Dean Kilpatrick, PhD, Member, Committee on Veterans’ Compensation for Posttraumatic Stress Disorder, Institute of Medicine

· Jonathan Samet, MD, Chair, Committee on Evaluation of the Presumptive Disability, Decision-Making Process for Veterans, Institute of Medicine

· Joyce McMahon, PhD, Health Care Operations and Policy Research Center, Center for Naval Analyses Corporation

Panel 2

· Mark Hyman, MD, American Academy of Disability Evaluating Physicians

· Sidney Weissman, MD, Member, American Psychiatric Association

· Ronald Abrams, Joint Executive Director, National Veterans Legal Service Program

Panel 3

· Dean Stoline, Assistant Director, National Legislative Commission, The American Legion

· Kerry Baker, Associate National Legislative Director, Disabled American Veterans

· Gerald T. Manar, Deputy Director, National Veterans Service, Veterans of Foreign Wars

Panel 4

· Brad Mayes, Director, Compensation and Pension Service, Veterans Benefits Administration, U.S. Department of Veterans Affairs

Accompanied by

· Tom Pamprin, Deputy Director for Policy and Procedures, Veterans Benefits Administration, U.S. Department of Veterans Affairs

· Steven H. Brown, MD, MS, Director, Compensation and Pension Exam Program (CPEP), Veterans Health Administration, U.S. Department of Veterans Affairs

· Patrick Joyce, MD, Chief Occupational Health Clinic, Veterans Health Administration, U.S. Department of Veterans Affairs

· Richard Hipolit, Assistant General Counsel, U.S. Department of Veterans Affairs

· Joseph Kelley, MD, Deputy Assistant Secretary of Defense for Clinical and Program Policy (Health Affairs), U.S. Department of Defense

Accompanied by

· Horace Carson, MD, Senior Medical Advisor, Air Force Review Boards Agency, (SAF/MRB), U.S. Department of Defense


Prepared testimony for the hearing and an audio recording of the hearing is available on the internet at this link: http://veterans.house.gov/hearings/hearing.aspx?newsid=197.

-------------------------

Full GAO testimony here... http://www.gao.gov/new.items/d08514t.pdf

Highlights here... http://www.gao.gov/highlights/d08514thigh.pdf

Summary here... http://www.gao.gov/docsearch/abstract.php?rptno=GAO-08-514T

Summary below:

-------------------------

DOD and VA: Preliminary Observations on Efforts to Improve Care Management and Disability Evaluations for Servicemembers

GAO-08-514T

In February 2007, a series of Washington Post articles about conditions at Walter Reed Army Medical Center highlighted problems in the Army's case management of injured servicemembers and in the military's disability evaluation system. These deficiencies included a confusing disability evaluation process and servicemembers in outpatient status for months and sometimes years without a clear understanding about their plan of care. These reported problems prompted various reviews and commissions to examine the care and services to servicemembers. In response to problems at Walter Reed and subsequent recommendations, the Army took a number of actions and DOD formed a joint DOD-VA Senior Oversight Committee. This statement updates GAO's September 2007 testimony and is based on ongoing work to (1) assess actions taken by the Army to help ill and injured soldiers obtain health care and navigate its disability evaluation process; and to (2) describe the status, plans, and challenges of DOD and VA efforts to implement a joint disability evaluation system. GAO's observations are based largely on documents obtained from and interviews with Army, DOD, and VA officials. The facts contained in this statement were discussed with representatives from the Army, DOD, and VA.

Over the past year, the Army significantly increased support for servicemembers undergoing medical treatment and disability evaluations, but challenges remain. To provide a more integrated continuum of care for servicemembers, the Army created a new organizational structure--the Warrior Transition Unit--in which servicemembers are assigned key staff to help manage their recovery. Although the Army has made significant progress in staffing these units, several challenges remain, including hiring medical staff in a competitive market, replacing temporarily borrowed personnel with permanent staff, and getting eligible servicemembers into the units. To help servicemembers navigate the disability evaluation process, the Army is increasing staff in several areas, but gaps and challenges remain. For example, the Army expanded hiring of board liaisons to meet its goal of 30 servicemembers per liaison, but as of February 2008, the Army did not meet this goal at 11 locations that support about half of servicemembers in the process. The Army faces challenges hiring enough liaisons to meet its goals and enough legal personnel to help servicemembers earlier in the process. To address more systemic issues, DOD and VA promptly designed and are now piloting a streamlined disability evaluation process. In August 2007, DOD and VA conducted an intensive 5-day exercise that simulated alternative pilot approaches using previously-decided cases. This exercise yielded data quickly, but there were trade-offs in the nature and extent of data that could be obtained in that time frame. The pilot began with "live" cases at three treatment facilities in the Washington, D.C. area in November 2007, and DOD and VA may consider expanding the pilot to additional sites around July 2008. However, DOD and VA have not finalized their criteria for expanding the pilot beyond the original sites and may have limited pilot results at that time. Significantly, current evaluation plans lack key elements, such as an approach for measuring the performance of the pilot--in terms of timeliness and accuracy of decisions--against the current process, which would help planners manage for success of further expansion.

-------------------------

posted by Larry Scott
Founder and Editor
VA Watchdog dot Org

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