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INCONSISTENCY SKEWS VETERANS' DISABILITY PAY -- "The VA is

obligated to choose the diagnostic code that will yield the highest

disability rating. In fact, the VA is doing the opposite. They're

finding ways to give the lowest rating possible."

 

 

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Inconsistency skews vets’ disability pay

By Lex Alexander
Staff Writer

David Best of Fayetteville developed knee pain while serving in the Army in Korea during the Vietnam War.

That pain turned out to be a symptom of osteoarthritis in his hip. But the Department of Veterans Affairs has denied Best’s disability claim, saying he had suffered no knee injury while in service and knee X-rays taken then were negative.

But the doctor who found Best’s arthritis several years ago took one look at his hip X-rays and told him, "Wow, they should have found this 25 years ago."

"The VA is obligated to choose the diagnostic code that will yield the highest disability rating," says Best’s attorney, Craig Kabatchnick of Greensboro, who defended the department against disability claims in the early 1990s. "In fact, the VA is doing the opposite: They’re finding ways to give the lowest rating possible. They’re finding excuses to do it. That’s a tactic we used to use."

Best’s case illustrates a long-standing problem with the department’s disability system: Inconsistent or inaccurate disability ratings threaten the financial and medical security of the nation’s veterans. The issue particularly concerns North Carolina because more service members are discharged here than in almost any other state.

The department’s disability rating system has remained essentially the same since World War II, despite rapid change in everything from the labor market to prosthetic limbs.

But the problem is magnified by inconsistency and inaccuracy despite congressional investigators’ repeated recommendations for improvements.

As a result, not only could veterans be denied money to which they’re entitled, they also could be pushed farther back in line for VA-supplied health care. That’s because disability ratings determine eligibility and priority for many treatments.

At the other extreme, the inconsistencies leave the department vulnerable to fraud.

The problems are so bad that in January 2003 the Government Accountability Office, the investigative arm of Congress, designated the department’s disability compensation and pension program as "high risk." That designation identifies programs either vulnerable to waste, fraud, abuse and mismanagement or facing major problems with their economy, efficiency or effectiveness.

The department has not responded to e-mailed questions about the disability program.

Says Kabatchnick, "It’s a real mess."

The ratings system for disabilities, in place with only minor changes since 1945, aims to compensate for the average impairment of earning capacity in civil occupations caused by an injury or disorder.

It is based on the nature and extent of a veteran’s physical injuries or dysfunctions, or how well or poorly the veteran functions with a mental disorder. The rating scale runs in increments of 10 from 0 (no disability) to 100 (totally impaired or disabled). The rating translates into monthly disability payments of between $115 and $2,471 — more if a veteran supports a spouse or children.

The static and subjective nature of the system has drawn criticism for decades, but the most significant alarm might have been sounded in 1997 by the nonprofit National Academy of Public Administration. That group called on the department to set consistency standards and to test how well standards were being met, either through its quality-review process or by sending identical test cases to regional offices for rating.

But in August 2002, the GAO noted that the VA still wasn’t grappling with the differences among regional offices or inconsistent decisions on particular types of disability ratings. It recommended that the department begin doing so. The VA said it would; however, the GAO noted, it "did not describe how it will measure consistency and evaluate progress in reducing any inconsistencies it may find."

The VA has resisted other recommendations from the GAO, as noted in the January 2003 "high-risk" report. There, the GAO again called on the VA to update its disability ratings. But Anthony J. Principi, then secretary of veterans affairs, refused, saying the existing standards were "equitable."

The VA also has struggled with rating accuracy, which is assessed through reviewing randomly selected cases.

Kabatchnick, the attorney, said certain types of errors are common, and most work to the detriment of veterans.

For example, a VA employee may require a veteran’s case to meet all criteria for a particular disability rating, even though the rating schedule requires him to meet only one.

"A vet with asthma can get a lower rating because he uses an inhaler, even though all that does is relieve the symptoms," Kabatchnick said.

The VA also frequently will assign lower disability ratings based on criteria that aren’t part of the official rating system, he said.

"The VA takes the liberty to deny rating increases on the grounds that the vet has not taken medicine for his condition or hasn’t been hospitalized recently for his disabilities," Kabatchnick said. "These criteria aren’t part of the rating schedule."

Beginning in fiscal 2002, the VA focused its assessment of quality on whether benefits were correctly granted or denied, rather than on technical issues that might not affect a ruling on benefits. Despite that more lenient standard, the department’s accuracy rate fell from 89 percent to 81 percent.

The inconsistencies in rating gained national attention in December 2004, when the Chicago Sun-Times published VA data showing that the average annual payment per disabled veteran varied from $6,710 in Ohio to $10,851 in New Mexico.

The report came just weeks after the GAO had recommended that the VA use computerized records to identify inconsistencies in disability ratings and identify medical conditions most likely to result in those variations.

In October 2005, the GAO told Congress that the VA had taken neither action.

And there is no record in subsequent GAO or inspector-general reports that those changes have been made.

Contact Lex Alexander at 373-7088 or lalexander@news-record.com

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Larry Scott