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Berta
Article published Dec 17, 2006,
http://www.news-record.com/apps/pbcs.dll/a...ID=200661216004
From: DALE PETERS
Sent: Sunday, December 17, 2006 2:04 PM
To: colonel-dan@sbcglobal.net
Inconsistency skews vets' disability pay
By Lex Alexander
Staff Writer
David Best of Fayetteville developed knee pain while serving in the Army in
Korea during the Vietnam War.
That pain turned out to be a symptom of osteoarthritis in his hip. But the
Department of Veterans Affairs has denied Best's disability claim, saying he
had suffered no knee injury while in service and knee X-rays taken then were
negative.
But the doctor who found Best's arthritis several years ago took one look at
his hip X-rays and told him, "Wow, they should have found this 25 years
ago."
"The VA is obligated to choose the diagnostic code that will yield the
highest disability rating," says Best's attorney, Craig Kabatchnick of
Greensboro, who defended the department against disability claims in the
early 1990s. "In fact, the VA is doing the opposite: They're finding ways to
give the lowest rating possible. They're finding excuses to do it. That's a
tactic we used to use."
Best's case illustrates a long-standing problem with the department's
disability system: Inconsistent or inaccurate disability ratings threaten
the financial and medical security of the nation's veterans. The issue
particularly concerns North Carolina because more service members are
discharged here than in almost any other state.
The department's disability rating system has remained essentially the same
since World War II, despite rapid change in everything from the labor market
to prosthetic limbs.
But the problem is magnified by inconsistency and inaccuracy despite
congressional investigators' repeated recommendations for improvements.
As a result, not only could veterans be denied money to which they're
entitled, they also could be pushed farther back in line for VA-supplied
health care. That's because disability ratings determine eligibility and
priority for many treatments.
At the other extreme, the inconsistencies leave the department vulnerable to
fraud.
The problems are so bad that in January 2003 the Government Accountability
Office, the investigative arm of Congress, designated the department's
disability compensation and pension program as "high risk." That designation
identifies programs either vulnerable to waste, fraud, abuse and
mismanagement or facing major problems with their economy, efficiency or
effectiveness.
The department has not responded to e-mailed questions about the disability
program.
Says Kabatchnick, "It's a real mess."
The ratings system for disabilities, in place with only minor changes since
1945, aims to compensate for the average impairment of earning capacity in
civil occupations caused by an injury or disorder.
It is based on the nature and extent of a veteran's physical injuries or
dysfunctions, or how well or poorly the veteran functions with a mental
disorder. The rating scale runs in increments of 10 from 0 (no disability)
to 100 (totally impaired or disabled). The rating translates into monthly
disability payments of between $115 and $2,471 - more if a veteran supports
a spouse or children.
The static and subjective nature of the system has drawn criticism for
decades, but the most significant alarm might have been sounded in 1997 by
the nonprofit National Academy of Public Administration. That group called
on the department to set consistency standards and to test how well
standards were being met, either through its quality-review process or by
sending identical test cases to regional offices for rating.
But in August 2002, the GAO noted that the VA still wasn't grappling with
the differences among regional offices or inconsistent decisions on
particular types of disability ratings. It recommended that the department
begin doing so. The VA said it would; however, the GAO noted, it "did not
describe how it will measure consistency and evaluate progress in reducing
any inconsistencies it may find."
The VA has resisted other recommendations from the GAO, as noted in the
January 2003 "high-risk" report. There, the GAO again called on the VA to
update its disability ratings. But Anthony J. Principi, then secretary of
veterans affairs, refused, saying the existing standards were "equitable."
The VA also has struggled with rating accuracy, which is assessed through
reviewing randomly selected cases.
Kabatchnick, the attorney, said certain types of errors are common, and most
work to the detriment of veterans.
For example, a VA employee may require a veteran's case to meet all criteria
for a particular disability rating, even though the rating schedule requires
him to meet only one.
"A vet with asthma can get a lower rating because he uses an inhaler, even
though all that does is relieve the symptoms," Kabatchnick said.
The VA also frequently will assign lower disability ratings based on
criteria that aren't part of the official rating system, he said.
"The VA takes the liberty to deny rating increases on the grounds that the
vet has not taken medicine for his condition or hasn't been hospitalized
recently for his disabilities," Kabatchnick said. "These criteria aren't
part of the rating schedule."
Beginning in fiscal 2002, the VA focused its assessment of quality on
whether benefits were correctly granted or denied, rather than on technical
issues that might not affect a ruling on benefits. Despite that more lenient
standard, the department's accuracy rate fell from 89 percent to 81 percent.
The inconsistencies in rating gained national attention in December 2004,
when the Chicago Sun-Times published VA data showing that the average annual
payment per disabled veteran varied from $6,710 in Ohio to $10,851 in New
Mexico.
The report came just weeks after the GAO had recommended that the VA use
computerized records to identify inconsistencies in disability ratings and
identify medical conditions most likely to result in those variations.
In October 2005, the GAO told Congress that the VA had taken neither action.
And there is no record in subsequent GAO or inspector-general reports that
those changes have been made.
Contact Lex Alexander at 373-7088 or lalexander@news-record.com
News & Record . 200 East Market Street . Greensboro NC 27401
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