Disability Reforms Bring Higher Ratings, Faster Pay

The pilot for a new, jointly-developed DoD-VA disability evaluation system (DES), set to expand from five to 22 military bases by May, does much of what proponents hoped it would.

It allows more injured or ill service members to win higher disability ratings, to see VA payments start faster and, through greater transparency in the process, to feel they have been treated more fairly by government.

But there have been enough kinks and challenges uncovered by the pilot to persuade designers in the departments of Defense and Veterans Affairs not to expand so quickly that the program outpaces the additional staff that needs to be hired and trained, particularly at the largest military bases.

Sam Retherford, director of officer and enlisted personnel management in DoD, has overseen phase-in of this landmark disability reform, starting in November 2007 in the Washington D.C. area, including Walter Reed Army Medical Center and Bethesda Naval Medical Center.  He said nearly 900 disabled service members have been through the improved DES.  As many as 700 a month will process through the expanded pilot.

The aim is to end the wasteful, time-consuming and confusing practice of DoD and VA both conducting their own disability evaluations, one before and one after discharge or retirement.  Under the pilot, VA conducts the single, comprehensive physical examination while members are on active duty, and prepares a single disability evaluation used by each department.

The military service uses the findings to determine fitness for duty.  Those members found unfit are separated or retired.  But the service continues to base its decision and disability rating only on medical conditions that make the member unfit for duty.  A rating for unfitting conditions of 20 percent or less qualifies for a lump sum severance payment.  A rating of 30 percent or higher on those conditions qualifies a member for military disability retirement, which means a lifetime annuity, access to military health care and base stores and facilities.

The VA simultaneously awards an overall rating based on all service-related conditions to set its compensation payment.  The member then can choose, before leaving service, between the DoD or VA outcomes.

In a report to Congress on the pilot, DoD and VA officials last month said the “initial reviews…are favorable,” citing improved “outcomes” on level of ratings, timeliness and the transparency of the process.

With VA doctors using VA protocols to evaluate and rate disabilities, pre-discharge rating have risen 10 to 20 percent, Retherford said.  VA doctors, he said, are trained to document conditions more thoroughly with an eye toward long-term effect.  Military doctors, by contrast, focus their evaluations on diagnosis and treatment.

The pilot will expand to 17 bases outside the D.C. area over the next five months.  They are: for Army, Fort Carson, Colo., Fort Drum, N.Y., Fort Stewart, Ga., Fort Richardson, Alaska, Fort Wainwright, Alaska, Brooke Army Medical Center, Texas, and Fort Polk, La; for Navy: Naval Medical Center (NMC) San Diego and Camp Pendleton, Calif., NMC Bremerton, Wash., NMC Jacksonville, Fla., and Camp Lejeune, N.C.; for Air Force: Vance Air Force Base, Okla., Nellis Air Force Base, Nev., MacDill Air Force Base, Fla., Elmendorf Air Force Base, Alaska., and Travis Air Force Base, Calif.

Retherford said these bases will provide more diverse data to better judge the effect of the new DES.  The D.C. area processes a high number of severely wounded members leaving service from Walter Reed or Bethesda.

The pilot imposes a heavy document workload on facilities and on Physical Evaluation Board Liaison Officers (PEBLOs) or case managers.  But a consensus among all involved affirms “this is a good thing,” Retherford said.

Randy Reese, national service director for Disabled American Veterans, both praised and criticized the DES pilot.  To have VA conduct physicals and awarding ratings for DoD is “a marriage made in heaven,” he said.  “The results of the decisions are better.  They are definitely more consistent,” Reese said, and ratings awards before discharge have “definitely improved.”

Also VA compensation begins immediately after discharge, eliminating a huge hassle and long waits for disabled veterans to receive first payments.

The pilot doesn’t address a need that disabled members have for advocacy counseling, either by trained JAG officers or by veteran organization representatives, from the start of the DES, Reese said.

“The PEBLO will provide information but they are not an advocate.”

Army SFC James F. Babin of Arlington, Va., went through the pilot after recovering from surgery last February for a deteriorated leg injury first sustain in combat in 2003.  Babin said he didn’t get his ratings — a combined 30 percent for leg and head injuries from VA or 20 percent from Army – until late October.  Babin, 31, said he was surprised that it took eight months.

He was more disappointed that his PEBLO had left documents out of the packet evaluated by VA which likely resulted in a lower rating.  The mistake was caught by a DAV advisor at Walter Reed, and the PEBLO was reprimanded.  Babin didn’t find her “very knowledgeable or very useful in this process,” reinforcing Reese’s worry of a counseling gap in the pilot DES.

The issue of lost compensation by administrative error was voided in Babin’s case when the Army approved his request to stay on activity duty.  A medic, he will retrain to a more sedentary specialty like intelligence analyst.