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Monday, April 09, 2007

U.S. News & World Report: More Evidence That Military Downgrading Disability Ratings

The evidence keeps piling up:

U.S. military appears to have dispensed low disability ratings to wounded service members with serious injuries and thus avoided paying them full military disabled retirement benefits. While most recent attention has been paid to substandard conditions and outpatient care at Walter Reed Army Medical Center, the first stop for many wounded soldiers stateside, veterans' advocates say that a more grievous problem is an arbitrary and dysfunctional disability ratings process that is short-changing the nation's newest crop of veterans. The trouble has existed for years, but now that the country is at war, tens of thousands of Americans are being caught up in it.

Now an extensive investigation by U.S. News and a new Army inspector general's report reveal that the system is beset by ambiguity and riddled with discrepancies. Indeed, Department of Defense data examined by U.S. News and military experts show that the vast majority-nearly 93 percent-of disabled troops are receiving low ratings, and more have been graded similarly in recent years. What's more, ground troops, who suffer the most combat injuries from the ubiquitous roadside bombs, have received the lowest ratings.

One counselor who has helped wounded soldiers navigate the process for over a decade believes that as many as half of them may have received ratings that are too low. Ron Smith, deputy general counsel for the Disabled American Veterans, says: "If it is even 10 percent, it is unconscionable." The DAV is chartered by Congress to represent service members as they go through the evaluation process. Its national service officers are based at each rating location, and there is a countrywide network of counselors. Smith says he recently asked the staff to cull those cases that appeared to have been incorrectly rated. Within six hours, he says, they had forwarded him 30 cases. "So far," Smith says, "the review supports the conclusion that a significant number of soldiers are being fairly dramatically underrated by the U.S. Army."

In educational interest, article(s) quoted from extensively.


At first glance, the disability ratings process seems straightforward. Each branch of service has its own Physical Evaluation Boards, which can comprise military officers, medical professionals, and civilians. The PEBs determine whether the wounded or ill service members are fit for duty. If they are, it's back to work. Those found unfit are assigned a disability rating for the condition that makes them unable to do their military job. The actual rating is key, and here's why: Service members who have served less than 20 years-the great majority of wounded soldiers-who receive a rating under 30 percent are sent home with a severance check. Those who receive a rating of 30 percent or higher qualify for a host of lifelong, enviable benefits from the DOD, which include full military retirement pay (based on rank and tenure), life insurance, health insurance, and access to military commissaries.

But the system is hideously complicated in practice. The military doctors who prepare the case for the PEBs pick only one condition for the service member's rating, even though many of the current injuries are much more complex. The PEBs use the Department of Veterans Affairs ratings scale, which grades disabilities in increments of 10-a leg amputation, for example, puts a soldier at between 40 and 60 percent disabled. The PEBs claim they have the leeway to rate a soldier 20 percent disabled for pain, say, rather than 30 percent disabled for a back injury. If rated at 20 percent or below and discharged, the soldier enters the VA system as a retiree where he is evaluated again to establish his healthcare benefits.

Some stats:

Since 2000, 92.7 percent of the disability ratings handed out by PEBs have been 20 percent or lower, according to Pentagon data analyzed by the Veterans' Disability Benefits Commission, which Congress formed in 2004 to look into veterans' complaints (Page 47). Moreover, fewer veterans have received ratings of 30 percent or more since America went to war in Afghanistan and Iraq, according to the Pentagon's annual actuarial reports. As of 2006, for example, 87,000 disabled retirees were on the list of those exceeding the 30 percent threshold; in 2000, there were 102,000 recipients. Last year, only 1,077 of 19,902 service members made it over the 30 percent threshold (chart, Page 49).

The total amount paid out for these benefit awards has remained roughly constant in wartime and peacetime, leading disabled veterans like retired Lt. Col. Mike Parker, who has become an unofficial spokesperson on this issue, to allege that a budgetary ceiling has been imposed to contain war costs.

One soldier's story:

Trying to overturn a low rating can be a full-time job-and an exasperating one. Take Staff Sgt. Chris Bain, who lost the use of his arms but not his sense of humor. "They call me T-Rex because I have a big mouth and two hands and I can't do nothing with them," he jokes. He left the Army in February, but he still has plenty of fight in him. During an ambush in Taji, Iraq, in 2004, a mortar round exploded 2 feet away from him, ripping through his left arm and hand. A sniper's bullet passed through his right elbow. His buddies saved his life, throwing Bain on the hood of a humvee and rushing him to a combat hospital. Once transferred to Walter Reed, Bain refused to have his arm amputated and underwent eight surgeries to save it. That choice cost him. While an amputation would have automatically put him over the 30 percent threshold, the injury to his left arm was rated at 20 percent even though he cannot use the limb.

Bain was angry. A noncommissioned officer who had planned on 20 or 30 years in the Army, he knew his career was over, but he wasn't going to go quietly. "I wanted to be an example to all soldiers," he said. "My job was to take care of troops." He went to find Danny Soto, the DAV representative at Walter Reed he'd heard so much about. "Danny is just an awesome guy. He took great care of me, but he should not have had to," Bain says. Soto is a patron saint to many soldiers at Walter Reed. He walks the halls, finding the newly injured and urging them to collect documents for their journey through the tortuous-and, to many, capricious-system. Many soldiers are young, and after they have spent months or years recuperating, they just want to get home and are unwilling to argue for the rating they deserve. Even though he missed his wife and three children, Bain decided: "I've already been here two years, another one ain't going to hurt me. Too many people are getting lowballed."

With Soto's help, Bain gathered detailed medical evidence of his injuries and went to face the board. They gave him a 70 percent rating for injuries related to the blast except for his hearing loss, which was not considered unfitting since he had a hearing aid. Oddly enough, however, the board put him on the temporary disabled retirement list instead of the permanent list. "What do they think, that after three years, my arm is going to come back to life?"

A lifetime of adjusting lies ahead for Bain. "I can't tie my shoes, open bottles of water, or cut my own food," he says. "I have to ask for help." The 35-year-old veteran has found a new sense of purpose. He's decided to run for Congress in 2008, and fixing the veterans' system is his top priority. "I do not want this s--- to happen again to anyone. No one can communicate with each other. The paper trail doesn't catch up." It's a tall order, but the soldier says that he has "100,000 fights" left in him.

A DAV national service officer at Walter Reed sums it up:

Meanwhile, people like Danny Soto want to know who is going to stop the military boards from giving out ratings like the 10 percent given to one soldier for a skull fracture and traumatic brain injury, when the VA later assigned a 100 percent rating. Soto is also frustrated by a recent case in which a soldier whose legs had been severely injured in a blast in Iraq was given only a 20 percent disability rating for pain and by the treatment of a man who has a bullet hole through his eye and suffers from seizures. As Soto sat with that soldier in front of the board, he asked why he had been placed on the temporary list. "At what point do you think he is going to fall below 30 percent?"

Soto is unsparing in his criticism of the bureaucracy. "This system," he says, " is so broke." Old soldiers say the root of the problem is an Army culture that preaches a "suck it up" attitude. "If you ask for what you are due, you are perceived to be whining or trying to pad your pocket," says a retired command sergeant major. "If you're not bleeding, you're not hurt. That's what we were taught."

We have a lot of work ahead of us, folks.

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