Help for Disabled Warriors
Certain injured US veterans would have their disability ratings reviewed and perhaps upgraded as part of a comprehensive set of “Wounded Warrior” reforms endorsed in June by the Senate Armed Services Committee.
The reform applies to those vets who have retired for disabilities since September 2001 and were given severance pay rather than retired pay when they separated from service.
The House had passed its own packet of Wounded Warrior initiatives a month earlier, focusing on steps to improve support services for members and families.
The two sets of initiatives must be reconciled before enactment, producing either a stand-alone bill, which could be enacted quickly, or becoming part of a final 2008 defense authorization bill.
The Senate committee’s bill (S 1606) is more ambitious and seeks to address a wider range of issues including disparities across the services in setting disability ratings and severance payments.
From 2000 through 2006, the Army awarded ratings of 30 percent or higher only to 13 percent of disabled soldiers being separated, the lowest rate among service branches. The Air Force’s proportion was twice as high.
Fixing Major Veteran Problems
The Dignified Treatment of Wounded Warriors Act, said Sen. Carl Levin (D-Mich.), chairman of the Armed Services Committee, would address not only problems with “inconsistent application of disability standards” but with substandard health facilities, less-than-seamless transition to VA care, inadequate levels of severance pay, and gaps in caring for traumatic brain injuries and post-traumatic stress.
More specifically, the bill would:
- Require the services to use VA standards for rating disabilities.
- Direct the Secretary of Defense to establish a board to review and, where appropriate, correct disability determinations of 20 percent or less for members separated as medically unfit for duty after the Sept. 11, 2001 start of the war on terrorism. Members would gain a chance to correct unwarranted or low ratings to ensure fairness.
- Require the services to use the same statutory presumptions that VA uses when determining whether a disability resulted from service or existed before signing up. The military now presumes an ailment or injury results from service if the member has been in eight or more years. The Senate bill would lower that threshold to six months’ active duty, barring some other compelling evidence the condition existed prior to service.
- Mandate two pilot programs to test the viability of using the VA to assess disability ratings for the Department of Defense.
- Increase minimum severance payments to a year’s worth of basic pay for disabilities incurred in a combat zone, and to six months for all others. Current payments vary by length of service. A member with two years’ service, for example, receives only four months of basic pay as severance. Also, severance pay is deducted from any VA disability compensation later received. The bill would end this offset.
The bill had 30 co-sponsors even before it cleared the Armed Services Committee. Other prominent backers include Sen. Daniel K. Akaka (D-Hawaii), the Veterans’ Affairs Committee chairman, Sen. John McCain (Ariz.), ranking Republican on armed services, and Sen. John W. Warner (R-Va.), former committee chairman.
Mental Health: Gaps and Solutions
The Department of Defense Task Force on Mental Health, reporting the results of a year-long study forced by Congress, urged a rapid and aggressive plan of action to address deficiencies in mental health services for service members and veterans affected by deployments to Iraq and Afghanistan.
Lawmakers mandated creation of the 14-member task force. Its work began in May 2006.
“Everyone realizes that the programs we now have are not adequate in terms of the number of providers, the amount of care that we need to give, and to whom we need to give it,” said Vice Adm. Donald C. Arthur, Navy surgeon general and co-chairman of the task force.
The report describes current mental health care staffing as “woefully inadequate” but doesn’t recommend specific increases in providers or mental health spending.
“We didn’t try to quantify the personnel or financial resources that would be required,” Arthur said, because that must vary by service.
“An infantry unit may need more services than, say, a logistics unit that’s farther rearward from the … battle. So we have asked the services to determine what their needs are,” Arthur said.
Data from post-deployment health reassessments completed by service members 90 to 120 days after deployment indicate that 38 percent of soldiers and 31 percent of Marine Corps personnel have symptoms of psychological illness. Other studies the task force cited show 17 percent of soldiers who deployed with brigade combat teams are at risk for developing “clinically significant symptoms” of post-traumatic stress disorder, major depression, or anxiety. And the task force suggests that’s a conservative estimate. Families are impacted, too, with post-deployment divorce plans rising among married members.
DOD’s 95 Recommendations
Defense Secretary Robert M. Gates said a plan is being formulated to address the many problems identified in the rising population of service members afflicted by post-combat stress disorder and traumatic brain injury, two signature conditions of current conflicts.
The report makes 95 recommendations. One urges relief from the stigma of mental health care pervasive in the military. Gates promised swift action to remove a question on past mental health care found on security clearance applications, a signal to members that careers are at risk if they seek the counseling that so many need.
“This is something that we can, must, and will get fixed,” Gates told a group of Pentagon reporters soon after the report’s release.
The task force’s mental health experts, six of whom still serve in the military, delivered a blunt assessment of the psychological health threat facing US fighting forces, their families, and survivors.
“A single finding underpinning all others,” the report said, is that the military health system lacks sufficient money and fully trained personnel to support a psychological health mission in peacetime, much less the enhanced requirements imposed by war. The health system “must be restructured” to become more adept at preparing warriors for psychological trauma, at preventing and assessing mental illness and brain-related injuries, at early health care intervention, and at building an “easily accessible continuum of treatment” both for members and families whether active duty or with reserve components.
Defense officials have six months to develop a plan to implement the recommendations.
Tricare Savings Claim Inflated
Congressional auditors have confirmed what critics have contended since December 2005, when defense officials unveiled their plan for hefty increases in Tricare fees for retirees under age 65: The projected cost savings of $9.8 billion over five years is clearly too high.
The savings still would be “significant,” said the Government Accountability Office in a 44-page report requested by the Armed Services Committees. But only $2.3 billion of the five-year saving estimate is solid. Much of the rest relied on a shaky assumption that 500,000 retirees and dependents under 65 would either leave Tricare or choose not to enroll. It was also wrongly assumed that these “avoided users” would save Tricare an amount equal to what a typical current beneficiary now costs.
But in fact, GAO said, “older and sicker individuals” are less likely to drop Tricare, and that’s a population with above average health expenses.
GAO also called “unlikely” the department’s projection of $1.5 billion saved in pharmacy costs over five years, from raising beneficiary co-payments for Tricare’s retail pharmacy option. Data used to calculate that estimate came from the experience of non-DOD employer-sponsored insurance programs, which was “not analogous to DOD’s situation,” GAO reported. Far fewer military beneficiaries would stop using the retail network if co-payments were raised from $9 for a 30-day supply up to $22.
VA System, Payments Criticized
The Veterans’ Disability Benefits Commission, another creation of Congress, received two reports in June that could shape their recommendations this fall on issues important to disabled veterans.
The first report from Institute of Medicine (IOM), which Congress established to advise the government on medical issues, says the current VA disability ratings and compensation schedule, devised following World War II, is outdated now and in need of reform. They don’t reflect advances in medicine or the storehouse of knowledge gained over the decades on how specific disabilities or medical conditions affect the body.
The IOM report calls for an updated rating schedule with regular adjustments as required. It urges VA and DOD to move to a combined and comprehensive medical and vocational evaluation of separating members. It says disability compensation should take account of the impact on quality of life and not just earning capacity, the sole yardstick for current payments.
A second report prepared for the commission finds a generational imbalance in current levels of VA disability compensation because that lost-earnings-capacity yardstick is based on averages among recipients. Payments now don’t differentiate between the relative earnings loss of a younger veteran returned from war and that of an aged veteran whose working life is over when he or she applies for benefits.
This report, prepared by CNA Corp., a research and analysis firm, found that disability compensation for veterans severely wounded in Iraq and Afghanistan is set too low, creating a lifetime earnings gap with their nondisabled peers. The same study found disability pay probably is set too high for veterans who first begin drawing payments at age 65 or older, having already retired from post-service careers.
CNA also examined how well disability pay levels reflect the “implied intention” of Congress that payments also compensate veterans in some way for their decline in quality of life as a result of service-connection disabilities. Not at all, CNA concluded. Basic VA payments do not recognize diminished quality of life, a fault also identified by the IOM study.
But when age is considered, veterans disabled at a younger age don’t receive enough VA compensation even to replace lost earning capacity, which deepens the decline in qualify of life compared with nondisabled peers.
CNA noted, for example, that a 25-year-old veteran who returned from war 100 percent disabled from physical wounds and rated as unemployable by the VA, received $28,352 a year in disability compensation, using 2005 rates. That was more than $11,000 short of the $39,447 needed to keep average income even with nondisabled peers.