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Tuesday, November 1, 2005

Military Update: Veterans’ disability panel to avoid debating genetics

By Tom Philpott, Special to Stars and Stripes

Pacific edition, Thursday, October 27, 2005

The Veterans’ Disability Benefits Commission unanimously has voted that a veteran’s genetic makeup, which might show predisposition to certain illnesses before entering service, is not a reasonable topic for the commission to study in its review of “service connection” and disability payments.

During an Oct. 14 public hearing in Washington, the commission also rejected, on a 10-1 vote, a proposal to study whether veterans’ disability benefits should be reduced at some “normal” retirement age to reflect the typical income drop of most American workers as they retire.

The two votes came as commissioners shaped research questions they want answered by staff or through contracted studies to be conducted by the Institute of Medicine of the National Academies of Science and by the Center for Naval Analyses over the next year or more.

“If you cannot determine at time of entry into service what the genetic makeup of the potential serviceman is, how can you, when the serviceman leaves in two years, three years or 20 years, base disability benefits on the genetic issue?” asked retired Army Lt. Gen. James T. Scott, commission chairman, in summing up the panel’s decision not to delve into genetics.

Some critics contend that the veterans’ disability compensation system is overly generous because it assumes that any disease or ailment that surfaces while a service member is on active duty is “service-connected” and, therefore, compensable, even if family history is suspected to be a factor.

“We’re not going there,” said Commissioner Rick Surratt, a Vietnam combat veteran and deputy legislative director for Disabled American Veterans, after the vote, which he agreed was significant for veterans.

The IOM says it needs 15 months to apply its medical expertise, which the commissioners concede they lack, to review and analyze the Schedule for Rating Disabilities used by the Department of Veterans Affairs and the Department of Defense for setting disability compensation levels.

The IOM will judge how well the rating schedule reflects current medical understanding of the link between impairment and disability; advances in technology and treatments for disabilities; gains in function realized through vocational rehabilitation, environmental adaptations or other special-purpose benefits. The IOM also will review possible weaknesses in the rating schedule that require “additional disability designations such as Individual Unemployability” in order to compensate veterans adequately.

Congress chartered the 13-member commission to conduct a comprehensive review of federal disability benefits for veterans and their survivors. Lawmakers set a tentative deadline for the commission to deliver a final report to the president and Congress within 17 months of its first meeting, which was held May 16 this year.

But Ray Wilburn, the commission’s executive director, said that a final report might be delayed at least a year, until fall 2007, to allow the IOM and CNA time to complete their studies, integrate their work and inform commissioners.

The CNA will study the appropriateness of current compensation levels for veterans, tapping various data sources and fresh surveys. It also will analyze the effectiveness of the rating schedule in meeting the original intent of Congress that compensation be sufficient to replace “average impairment in earning capacity resulting from such injuries in civil occupations.”

Given the law’s emphasis on earning capacity, Commissioner John H. Grady, an actuary with Mellon Financial Corp. in Dallas, included among research questions for the CNA this: Would disability benefits be more appropriate if the level of payment was higher before some normal ‘retirement age’ and lower thereafter?

On a motion from Surratt that the research question be dropped, Grady defended it, saying the commission needs at least to consider whether disability benefits should follow earnings and income patterns of civilian occupations, which routinely fall as they retire.

Surratt argued that disabled veterans don’t have normal working careers. Some cannot build a nest egg for their retirement years like able-bodied counterparts. Also, he said, a veteran who becomes a double amputee from fighting in Iraq won’t grow his limbs back in retirement. The disability is permanent and continues to affect quality of life.

Surratt’s motion to strike such research was approved, with only Grady dissenting among 11 commissioners present.

Another commissioner, Marine Corps Major Gen. James E. Livingston, a Medal of Honor recipient, challenged draft guidance that CNA study the issue of “disabilities that occur as part of genetics” in reviewing standards for defining ailments as service connected.

Livingston said recruits who clear entrance physicals are presumed to be fit for duty, and that presumption shouldn’t be altered even if advances in genetics now can show that veterans were predisposed to certain illnesses. The entire panel, on a voice vote, agreed to strike the genetics question.

Chairman Scott, in an interview afterward, said the commission isn’t abandoning its responsibility to weigh other issues regarding the definition of “service-connected” disabilities. He pointed to research still planned into whether age should be a factor in determining entitlement to service-connected compensation, whether the “benefit-of-the-doubt rule,” which guides raters to favor the veteran in deciding close calls on service connection, should be changed, and whether service connection on a “secondary” or an “aggravation” basis should be redefined.

But Scott also said he also agreed with a concern expressed by Commissioner Joe Wynn that final recommendations reflect the opinions of commissioners and not be driven by “subject matter experts” at IOM or CNA.

To comment, write Military Update, P.O. Box 231111, Centreville, VA 20120-1111, e-mail milupdate@aol.com or visit www.militaryupdate.com.

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