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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).
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[ This news release and report are available at http://national-academies.org ]
INSTITUTE OF MEDICINE
Board on Military and Veterans Health
Committee on Medical Evaluation of Veterans for Disability Compensation
Lonnie R. Bristow, M.D., M.A.C.P. (chair)
American Medical Association
Walnut Creek, Calif.
Gunnar B.J. Andersson, M.D., Ph.D.
Professor and Chairman
Department of Orthopedic Surgery
Rush University Medical Center
John F. Burton Jr., Ph.D., LL.B.
School of Management and Labor Relations
New Brunswick, N.J.
N. Lynn Gerber, M.D.
Director, Center for Chronic Illness and Disability, and
Professor of Rehabilitation Science
College of Nursing and Health Science
George Mason University
Sid Gilman, M.D., F.R.C.P.
William J. Herdman Distinguished Professor of Neurology
University of Michigan, and
Director, Michigan Alzheimer's Disease Research Center
Howard H. Goldman, M.D., Ph.D.
Professor of Psychiatry
School of Medicine
University of Maryland
Sandra Gordon-Salant, Ph.D.
Department of Hearing and Speech Sciences, and
Director, Doctoral Program in Clinical Audiology
University of Maryland
Jay S. Himmelstein, M.D., M.P.H.
Professor of Family Medicine and Community Health;
Director, Center for Health Policy and Research; and
Assistant Chancellor of Health Policy
University of Massachusetts
Ana E. Nunez, M.D.
Associate Professor of Medicine and Director
Center of Excellence in Women's Health and Women's Health Education Program
James W. Reed, M.D., M.A.C.P.
Professor of Medicine and Associate Chair of Medicine for Research
Morehouse School of Medicine, and
Chief of Endocrinology
Grady Memorial Hospital
Denise G. Tate, Ph.D., A.B.P.P., F.A.C.R.M.
Professor of Rehabilitation Psychology and Neuropsychology
Department of Physical Medicine and Rehabilitation
University of Michigan
Brian M. Thacker
U.S. Department of Veterans Affairs, and
Regional Director, Medal of Honor Society
Dennis Turk, Ph.D.
John and Emma Bonica Professor of Anesthesiology and Pain Research, and
Director, Fibromyalgia Research Center
University of Washington
Raymond John Vogel, M.S.
RJ Vogel and Associates
Mt. Pleasant, S.C.
Rebecca A. Wassem, R.N., D.N.Sc.
University of Utah College of Nursing
Salt Lake City
Edward H. Yelin, Ph.D.
Professor of Medicine and Health Policy;
Director, Arthritis Research Group;
Director, Multidisciplinary Clinical Research Center in Rheumatic Diseases; and
Director, Medical Effectiveness Review for the California Health Benefits Review Program
University of California School of Medicine