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Wounding Warriors

How Bad Policy Is Making Veterans Sicker and Poorer.

Shamrock Reins, a nonprofit specializing in equine-assisted therapy for veterans, sits across more than 20 acres of land in Bucks County, Pa., just north of Philadelphia. Inside a dirt pen on a bright August morning, Andrew, a tall Iraq War vet in blue jeans and a loose white T-shirt, led his horse in small circles. The sun was already beating but the summer heat had not yet set in.

“That’s it, Emerald,” Andrew said in a loud, relaxed drawl. “Come, Emerald. Come. Good.”

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A Pennsylvania native, Andrew joined the Air Force Reserve after high school and trained as a flight medic. When his unit mobilized he deployed to Iraq. After separating from the military, he applied for disability benefits. “It took me almost four years of fighting to get my compensation,” he said over lunch, gazing out at the fields from an outdoor picnic table. “I have big-time issues with the VA [Veterans Affairs].”

Wounded_Warrior
This article is excerpted from “Wounding Warriors: How Bad Policy is Making Veterans Sicker and Poorer,” by retired Army Lt. Col. Daniel Gade and Daniel Huang. The book can be ordered at www.woundingwarriors.com.

Public criticism of the Department of Veterans Affairs is common, but in the case of the VA’s disability benefits system, the facts tell a more complex story. As a percentage of the total veteran population, more vets today are compensated for disabilities than ever before in the agency’s history. VA spending on disability compensation has more than tripled since 2000 and is now the organization’s largest expenditure. The VA is projected to spend more than $105 billion on disability benefits in 2021—more than six times the budget of the U.S. Space Force. It is spending more on veterans’ disability today than it is spending on rehabilitation programs, on education and retraining, or on all veteran-related health care services. 

WORKING THE SYSTEM

Andrew initially filed his claims through Disabled American Veterans [DAV], a national veterans service organization with more than a million members. The VA rejected his claim. He tried again, working with different DAV officers, getting the same unsuccessful result for two years. Then he met someone who took pity on him. “I’m not supposed to tell you this but contact this guy,” the man said, sliding a business card across the table. “If anyone asks, I don’t know who this person is. I didn’t give you his name.”

The card named a civilian therapist who had been assisting vets with VA benefits since the Vietnam War. “I hired him, and I paid him cash, and I didn’t go to see him for therapy,” said Andrew. “I went to see him to fight for me.” The therapist reviewed Andrew’s records and wrote a long letter detailing the afflictions Andrew sustained in service, including sinusitis (“I was in sandstorms on the regular,” Andrew said. “You breathe all that junk in and I lost my smell.”); hearing loss (“not because of any traumatic event but you hear the vibration from the airplane floor and it damages those bones in your inner ear”); and PTSD from multiple deployments. In just three weeks, Andrew’s claim was finally approved.

Individual Unemployability bumps a claimant’s disability rating all the way to 100 percent if
the veteran is deemed “unable to hold a job as a result of service-connected disabilities.” Department of Veterans Affairs

Some of the earliest pension programs for American veterans were beset by grifters and opportunists even in the early decades of the republic, notes George Mason University Professor James T. Bennett in his 2017 book, “Paid Patriotism? The Debate Over Veterans’ Benefits.” Performing private disability examinations is lucrative—several hundred dollars per evaluation—and not all do so ethically. One examiner in Puerto Rico charges $200 for a 10-minute phone consultation, before supplying veterans with the evidence they need to get their claims approved, a VA compensation and pension examiner told us via Google Groups in 2017. In some cases, the examiners or those who hire them on behalf of veterans take a commission on future benefits as payment. Other firms, such as militarydisabilitymadeasy.com and vaclaimsInsider.com market themselves as education providers, delivering online courses designed to help “you maximize the disability benefits you’ve earned” or to help vets “get the VA Disability Rating they DESERVE.”  These operations coach veterans on how to increase their disability rating.

Following the advice of the therapist he hired, Andrew continued to press for a ratings increase. “I contacted my senator and did a senatorial inquiry on [my VA examiners],” he said. Within two weeks, his disability rating was raised to 100 percent—retroactively. Andrew received three years of back pay.

  • According to the VA, veterans whose claims are turned down or reduced have three ways to appeal: 
  • File a supplemental claim to add new and relevant evidence; 
  • Ask for a senior reviewer to examine the case; and Appeal to a Veterans Law Judge. If his appeal is denied, the veteran can appeal further to the U.S. Court of Appeals for Veterans Claims.

The VA has no limit on the number of claims or appeals a veteran may file, nor a time span in which vets must file their claims, factors that contribute to the clogged and overworked VA disability system. Combat-wounded veterans must compete with opportunists for time and attention. For every new disability claimant, there are almost twice as many veterans seeking increased compensation. 

Securing a 100 percent rating qualified Andrew for more than $3,000 in disability compensation each month. By then, he hadn’t worked in more than two years, and soon, his veteran friends were advising him to apply for Social Security Disability as well. He contacted the civilian therapist again. “I paid him more money and said, ‘Will you represent me for Social Security?’ He said, ‘Absolutely.’”

The additional benefits arrived so quickly they caught Andrew off guard. “I called my sister and I’m like, ‘Did you make a large deposit in your account last night that was accidentally put in mine?’ Because I’m loaded overnight. It was all the back pay. You don’t know it’s coming in. You turn around and there’s $50,000 in your account.”

Andrew found himself guarding his windfall like a secret, as if it would vanish if anyone found out. “Suddenly, I felt like I have to keep this to myself,” he said. “I kept thinking I was going to wake up and this was all a bad dream. It didn’t really happen.”

His suspicions weren’t entirely wrong. His increased benefits from the VA had come through a mechanism called Individual Unemployability, which bumps a claimant’s disability rating all the way to 100 percent if he is deemed “unable to hold a job as a result of service-connected disabilities.” 

The bigger monthly checks gave Andrew an immediate thrill, but the long-term repercussions of his new designation began to sink in. “I went from being able to do everything—[to the VA] telling me I’m unemployable—that I should basically go home and sit around and lick my wounds,” he said. 

Andrew called the civilian therapist again. “I don’t want to be unemployed for the rest of my life. What am I going to do?”

The therapist warned him not to rock the boat. “You can’t challenge this because you’ll lose everything that you fought for,” Andrew recalls being told.

“I didn’t like that but what was I to do?” he said. “It took me about a year to make peace with the decision.” He lifted his shoulders, sitting a little taller. Lunch was over and he had decided to take a dip in the pool. “I realized I should count this as a blessing,” he said. “I shouldn’t feel bad about this.”

PAID TO BE SICK

Andrew’s story is not uncommon. Though he freely admits that he is “able to do everything,” he fought to earn a 100 percent disability rating workforce. Once there, he is trapped. Yet reforming the VA’s disability compensation system is crucial to ensuring that veterans lead lives of meaning, purpose, and value. The existing system too often treats veterans as victims rather than placing them in the driver’s seat of their own transitions from Active service to civilian life. Among the challenges are the powerful, organized, and motivated interest groups that work to support veterans. Some of these veterans service organizations (VSOs) are explicitly chartered by the VA and have a quasi-official national role. The economist Randall G. Holcombe, quoted in “Paid Patriotism,” calls veterans “the first organized interest group that was able to use the political process to systematically transfer large sums of money to themselves through the political system.”

Then-U.S. Army Capt. Daniel Gade at an undisclosed
location. Gade became an amputee in 2005 while serving as a company commander in Ramadi, Iraq. Daniel Gade/courtesy
U.S. Senate candidate Daniel Gade addresses the crowd in Harrisonburg, Va., on Aug. 18, 2020. Mark Klosinski/Gade For Virginia Facebook

The military is consistently one of the most respected sectors of American life, ranking just behind doctors, scientists, and firefighters in the public eye, and non-veterans view military service with deference. 

Terminology is also a factor. The term “service-connected disabled veteran” describes both members seriously maimed in training or combat and those with minor conditions, like tinnitus or diabetes, that were diagnosed during or at the conclusion of service and thus attributed to service. Yet to the uninformed casual observer, the “disabled veteran” license plate signifies something greater than tinnitus or limited knee flexion. The political parties are also complicit in the beatification of veterans. The right ties veteran status to patriotism and rarely opposes veteran-related spending; the left views veterans as victims of the system. 

After the Washington Post’s exposé of conditions at Walter Reed Army Medical Center in 2007, the President’s Commission on Care for Returning Wounded Warriors—co-chaired by former Sen. Bob Dole and former Secretary of Health and Human Services Donna Shalala, and called the Dole-Shalala Commission—proposed major reforms. First, it proposed that disability pay be separated into two parts: loss of earnings and quality-of-life. Given the agency’s legal purpose to compensate for average loss of earnings, this proposal recognized the absurdity of parts of the disability “system.” The Dole-Shalala recommendation would have given a substantial payment for the veteran whose sexual function was a casualty of war and returned the program to its legal foundation. Among the changes, only the quality-of-life payment would continue after the veteran began to receive Social Security, reducing double-dipping. (Some veterans even “triple dip” by getting Social Security disability, military retirement, and VA compensation.) Despite the bipartisan credibility and Washington clout of the co-chairs, however, the Dole-Shalala report went nowhere, except for one small recommendation to assign recovery coordinators to assist the most seriously injured.

Reforms since the late-2000s have been spotty and anemic. I [Daniel Gade] worked as a “Special Government Employee” on the VA’s Advisory Committee on Disability Compensation (ACDC) from late-2008 to around 2013. The ACDC’s mandate, springing out of federal law, is: “To provide advice to the Secretary of Veterans Affairs on establishing and supervising a schedule to conduct periodic reviews of the VA Schedule for Rating Disabilities (VASRD).”

In reality, it soon became clear, the ACDC was largely focused on supervising a revision of the disability rating system that would simply clear out a few obsolete diagnoses—diseases which no longer occur or have been folded into other diseases from a diagnostic perspective—while rubber-stamping increases in a variety of other disability diagnoses and ensuring that claims were processed accurately and quickly. In the backroom conversations to which I was personally privy, leaders acknowledged the disability system was a one-way ratchet: Only higher payments and increased ratings were to be recommended.

In this context, accuracy meant that the veteran was awarded compensation in accordance with the schedule, not that his condition was severe. The word “quickly” meant precisely that; the VA soon adopted an informal policy of approving claims with limited oversight. A former VA undersecretary for benefits told the advisory committee and staff that the “backlog” was the primary concern, not whether there were undeserving veterans in the queue. For that reason, claims processors were pressured to put as many claims through the system as they could.

President George W. Bush’s (center) bi-partisan Presidential Commission on Care for America’s Returning Wounded Warriors, co-chaired by Democrat Donna Shalala and Republican Bob Dole, recommended separating payments for loss of quality of life from payments for lost earnings. The proposal, like most of the commission’s recommendations, was never adopted. Eric Draper /White House

The VA has made marginal changes, such as allowing veterans denied claims to choose their route of appeal, but the basics remain the same: Veterans are paid to be sick. This is a powerfully negative force in the lives of many veterans. The VA system robs veterans of vitality and then looks everywhere else for reasons to explain the veteran suicide crisis.

CONCLUSION

The durability of this system is a testament to its political viability and strength rather than to its moral value. In political science, such durability is attributed to so-called “iron triangles”—alliances between politicians, the bureaucracy, and interest groups. In the end, any reform that’s implemented will be, like the current system, subject to political pressure. For that reason, we offer not concrete policy proposals, but instead a series of principles that should guide the resulting policy: 

  • First, the goal of any system of veterans benefits and care should be to return the veteran as closely as possible to the life situation in which he would have found himself but for the service rendered. This requires an approach customized to the individual veteran. Since employment is a social good, we believe that employment should be the goal of any system of benefits—hopefully to a level that results in the veteran being weaned off whatever temporary assistance might be required. This is true even in cases of high-level spinal cord injury, multiple amputations, or devastating mental illness, as there are treatments that can result in a more positive life course than that which would be available in their absence. Our system must reject the idea that any veteran is unemployable or permanently and “totally” disabled. The only veterans for whom employment is not a reasonable goal are those few whose brain injuries are devastating and impossible to overcome. For them, virtually any amount of benefits is morally sustainable.
  • Second, the system should incentivize desired outcomes by linking treatment for an illness with the compensation associated with it. If you don’t get treatment for your PTSD, then you have no right to taxpayer-funded support. This approach has a dual benefit: those who are faking symptoms to get paid would begin to drop out of the system, freeing up mental health providers to see those who are truly ill, and those who are being compensated and in treatment are more likely to eventually become better and graduate from treatment to a lower level of need. Critically, we must recognize that they will be better off with their health restored than if it were not. 
  • Third, the system needs total reform in the nature and types of disabilities compensated. Those injuries not directly caused by military service might be good targets for treatment rather than compensation. In the current regime, someone diagnosed with Parkinson’s Disease or diabetes during military service will be compensated as if the disease resulted from military service. The veteran receives medical care, plus a disability payment. Instead, that person should be treated by the VA but not compensated—unless the cause of the illness can be tied directly to service. This would allow the VA to spend more on the veteran whose brain is damaged due to a gunshot wound and less on veterans with lifestyle or aging-related conditions. The entire disability rating system could be rewritten in a few dozen pages rather than thousands.

Our nation’s 19 million veterans deserve to live lives they can be proud of, just as they are proud of their military service. They do not need or deserve to be trapped in a well- intentioned but demonstrably harmful system as they are today.                                                                                                           

This article is excerpted from “Wounding Warriors: How Bad Policy Is Making Veterans Sicker and Poorer” by retired Army Lt. Col. Daniel Gade and Daniel Huang. Gade was twice wounded in combat in Iraq, where his wounds resulted in the amputation of one of his legs. He was a professor at West Point until his retirement from the Army in 2017 and now works as a consultant in Northern Virginia. Daniel Huang is a freelance journalist whose work has appeared in The New Republic, Foreign Affairs, and The Wall Street Journal.