Why The VA Is Buried In Disability Claims

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From Wall Street Journal today

But the biggest issue by far is how the current system defines "disability." The average American may picture a disabled veteran as a wartime amputee, burn patient or wheelchair user. Fortunately, this isn't the case. The number of major amputations from Iraq and Afghanistan combined is less than 2,000, and the number of serious burns is around 2,500.

The reality is that the majority of veterans' disability claims are for post-traumatic stress disorder, depression or minor physical conditions, including common age-related ailments such as hearing loss, lower-back pain and arthritis. Furthermore, 62% of the claims in the backlog of unprocessed claims are not first-time claimants, but are from veterans reapplying for increased benefits.

The financial structure of the claims process gives veterans further incentive to make claims. By getting a disability adjusted upward to 90% from 70%, a veteran will gain an additional $500 per month. It should come as no surprise, then, that many veterans will appeal or refile their claims in hopes of getting a higher disability rating. There are so many conditions that the VA dubs disabilities that the average veteran in the system now claims more than eight conditions as "disabling." The average during the post-World War II era was one or two.

By categorizing minor conditions as disabilities, the process threatens to become a kind of stealthy welfare system, where those with minor conditions might feather their nests at the expense of both taxpayers and truly disabled veterans trapped behind them in a line that stretches over the horizon. This also harms the veterans who are being told the lie that they are "disabled" and being paid to believe it. Sadly, this process can decrease veterans' work incentives and dull their ability to contribute to society after military service

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Lt. Col. Gade is an assistant professor at the U.S. Military Academy. In 2005, he lost his right leg in combat in Iraq. His views do not reflect those of the Defense Department, Army or the U.S. Military Academy. This essay is adapted from an article in the upcoming Summer 2013 issue of National Affairs.
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True and true and a little false.

It isn't all the VA, it's also DOD (and CG... kind of). As separating or retiring service members get out, they go through TAPS. There, representatives tell them, as you're getting out, make sure you have everything documented, especially for your medical.

So that's what you do. As you go down the long, disconnected path of separation you say anything that has happened to you while you served (and if you're active duty, that's pretty much everything).

While I was in I had oral surgery (tooth implant), shoulder surgery and back pain from a hockey injury at CGA in practice (hit from behind into the boards). So I listed these things and had my physical. The forms float off to VA Never Never land and after about a year I was told my back issue was covered. Not HUGE money, maybe $100 a month, but it was covered. I didn't push for it or advocate for it. I just listed everything that was wrong with me. You get out once, and it's not east to go back after everything is in.

Anyway, yes, there are people with far better, more complete claims out there, missing limbs, eyes etc. That doesn't change the fact that you HAVE to do this as you separate/retire and that it's coordinated with your separation physical.

It's an issue with the system, not the people in it. And in the end, the most damaged suffer the most, in no small part because of increased claims, but not because the less damaged members want it that way.
 
The VA compensation process cannot begin without a Veteran filing a claim. You must allege which disabilities (in reality, which symptoms) you attribute to your military service.

If the military is now mandating that separating people file VA claims, that is a pretty new thing.

The article is pretty spot-on. When most people think of VA benefits, they think of the guy who had limbs removed by a combat explosion. They don't think of a guy who was diagnosed with diabetes at age 60, but because he spent a day in Vietnam in 1968, he now gets service connection for it. They don't think of a guy who has hemorrhoids in service and now collects 10% because of it. All of these are good claims according to the law.

And Veterans absolutely should file for benefits. The law is very pro-Veteran, and there is no reason not to collect a benefit you've earned.

By the way, the rating schedule initially came out in 1946, so this is nothing new. It's been revised many times since then, and maybe claims have increased with younger generations, but the system has been around for a while. Also, service-connected disabilities are rated as being noncompensable (0% disabling) to 100% disabling depending on their severity. Different conditions carry different maximum ratings, and it all contributes to the combined overall disability rating. This is all based on occupational impairment associated with the specific service-connected disabilities, and the criteria for each rating are published in 38 CFR (the rating schedule). Someone who is 10% disabled by a sole service-connected disability is 90% able to function normally (or, if there is other disablement, it is due to nonservice factors). This is very different from say, SSA, where you are either "disabled" (i.e. unable to work) or not. Plenty of Veterans receive compensation and can still work.
 
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If the military is now mandating that separating people file VA claims, that is a pretty new thing.

Not sure if I would have characterized it as "mandating". Instead, the tone was "if anything is wrong at all, just list it and let them decide if it applies."

I was under the impression that, 40 years down the road, when the implant fails, I needed documentation stating that it was done by the U.S. government. A VA doc later told my that wasn't the case. But before I knew that I listed my tooth. I didn't get any disability for that. I didn't get anything for my shoulder. I may have received 5% for my back.

It's not a process where you argue it. You just say, I was in for 9 years, here are the things that are wrong with me. Yes or no, they're at least on file for the future if anything comes up.

There are some big disability earners. Most people talk about sleep apnea (sp? sorry I can't check that spelling).

If you hit 30% disability, you are also get 10 points as a veteran when you apply for federal positions.
 
Not sure if I would have characterized it as "mandating". Instead, the tone was "if anything is wrong at all, just list it and let them decide if it applies."

I was under the impression that, 40 years down the road, when the implant fails, I needed documentation stating that it was done by the U.S. government. A VA doc later told my that wasn't the case. But before I knew that I listed my tooth. I didn't get any disability for that. I didn't get anything for my shoulder. I may have received 5% for my back.

It's not a process where you argue it. You just say, I was in for 9 years, here are the things that are wrong with me. Yes or no, they're at least on file for the future if anything comes up.

There are some big disability earners. Most people talk about sleep apnea (sp? sorry I can't check that spelling).

If you hit 30% disability, you are also get 10 points as a veteran when you apply for federal positions.

Service-connected sleep apnea with CPAP is 50 percent disabling.

38 CFR 4.97, DC 6847.
 
Service-connected sleep apnea with CPAP is 50 percent disabling.

38 CFR 4.97, DC 6847.

Not a doctor, but hard to imagine how serving in the military will cause someone to get sleep apnea?
 
Not a doctor, but hard to imagine how serving in the military will cause someone to get sleep apnea?

If it is first diagnosed in the military, or, if symptoms existed that are later linked to a period of service, benefits can be awarded. The "causal element" being that it arose in service.
 
Referencing LineInTheSand's back injury at CGA, can injuries sustained while at a service academy be used as the basis for a VA disability claim? My service academy medical file is neither included with my active duty medical records at the National Personnel Records Center nor has it been located at my service academy. Are these medical records retained? If so, where?

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Referencing LineInTheSand's back injury at CGA, can injuries sustained while at a service academy be used as the basis for a VA disability claim? My service academy medical file is neither included with my active duty medical records at the National Personnel Records Center nor has it been located at my service academy. Are these medical records retained? If so, where?

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Yes.... they can be used in your claim. I have no idea where each service retains those files, but my academy file followed me in the fleet. When I separated, documentation was included.

For most of the service academies, I believe, you are considered active duty. If I'm required by the service academy to participate in certain activities, and I'm injured during that activity, it's service related, and obviously not pre-existing.

During my TAPS session we were told provide documentation of everything and list everything that's wrong with you. Of course, when you consider injuries from war, you really start to think your issues aren't worthy. Maybe they aren't as much, but I listed them when I got out, did the typical physical you have to do (including the "SURPRISE" at the physical no one warned me about) and that's it. It's up to the VA to toss it or accept it.
 
Yes, thanks. I know by definition in Title 38 U.S. Code that members of the Service Academies are active duty. It would be useful to locate those medical records though.

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Its a system issue. And it seems to have changed.

30 years ago, I saw more than one Marine blow out his knee in training. No othroscopic surgery - they got the big zipper-like scar surgery. Once that happened, they were separated as they were never going to be the same. I remember very low disability scores - certainly less than 30%. They never got the golden ticket disability level despite never being able to walk normally again. We assumed you had to lose multiple limbs, an eye and hearing in both ears before you hit that threshold.

But you can't fault the guys who follow the rules. If you are to report everything that happened to you and every injury - you should. Its a system/ process thing. I don't fault them for doing that. But I am surprised that sleep apnea, etc would warrant such a high disability rating.
 
But I am surprised that sleep apnea, etc would warrant such a high disability rating.

You would have to laugh if you saw the number of soon to be separating members who all the sudden didn't have sleep apnea symptoms when I told them they would have to cancel their terminal leave plans to complete a sleep study prior to leaving the service since they had all the sudden developed sleep issues after attending TAPS class.

It was to the point where I seriously considered filing a complaint against the TAPS instructors.

I have other stories of people trying to "set up" future VA disability claims by coming to medical to report deployment exposures that are tenuous at best.

On another note disability claims also open doors to other financial incentives to include some states providing tuition, etc based on any disability rating at all. So it's not just Healthcare that is involved when it comes to VA disability ratings.

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I know by definition in Title 38 U.S. Code that members of the Service Academies are active duty.

I do not believe students at the U.S. Merchant Marine Academy are active duty.... just to avoid any future confusion.
 
I do not believe students at the U.S. Merchant Marine Academy are active duty.... just to avoid any future confusion.

To clarify
Title 38 USC 101

(21) The term “active duty” means—


(D) service as a cadet at the United States Military, Air Force, or Coast Guard Academy, or as a midshipman at the United States Naval Academy; and
 
Yes, thanks. I know by definition in Title 38 U.S. Code that members of the Service Academies are active duty. It would be useful to locate those medical records though.

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True for all but USMMA.
 
Its a system issue. And it seems to have changed.

30 years ago, I saw more than one Marine blow out his knee in training. No othroscopic surgery - they got the big zipper-like scar surgery. Once that happened, they were separated as they were never going to be the same. I remember very low disability scores - certainly less than 30%. They never got the golden ticket disability level despite never being able to walk normally again. We assumed you had to lose multiple limbs, an eye and hearing in both ears before you hit that threshold.

But you can't fault the guys who follow the rules. If you are to report everything that happened to you and every injury - you should. Its a system/ process thing. I don't fault them for doing that. But I am surprised that sleep apnea, etc would warrant such a high disability rating.

Not for nothing, but as the article mentions, there is no time limit to file claims with VA. In the most general terms, if someone did get service connection for a disability many years ago, and it is now worse, they should file for an increase. Probably will require a new exam, but it's the current symptoms that are at issue with respect to such a claim (as opposed to what happened in service). VA just needs to see how bad the disability is now, and if it meets the higher criteria, the evaluation will increase. If the person disagrees with the Regional Office's rating, he/she should appeal to the Board in DC. The RO people are good, but you get two attorneys reviewing the claim at the Board (Board Counsel and the signing Veterans Law Judge). It costs nothing…the vet just has to be patient (which, I know, is frustrating). Anyone with such an issue might consider getting in touch with DAV, The American Legion or another VSO. They exist to help vets with this stuff.
 
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You would have to laugh if you saw the number of soon to be separating members who all the sudden didn't have sleep apnea symptoms when I told them they would have to cancel their terminal leave plans to complete a sleep study prior to leaving the service since they had all the sudden developed sleep issues after attending TAPS class.

It was to the point where I seriously considered filing a complaint against the TAPS instructors.

I have other stories of people trying to "set up" future VA disability claims by coming to medical to report deployment exposures that are tenuous at best.

On another note disability claims also open doors to other financial incentives to include some states providing tuition, etc based on any disability rating at all. So it's not just Healthcare that is involved when it comes to VA disability ratings.

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The disability percentage for a service-connected disability is, primarily, a basis for a rate of compensation paid to a veteran. The combined total rating determines the monthly entitlement. Now, you can be service-connected for something at a noncompensable rate, which means that it doesn't pay anything. 10% is the first level where a vet gets a monthly tax-free payment for his disorder.

VHA (the hospital part of VA) does use disability ratings in determining their priority system, and having a service-connected disability can mean the difference between being a 5-point or 10-point veteran for federal hiring purposes under OPM rules. So, yes, you're right that it matters in more than the monthly check.
 
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