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Military Update

Disability evaluation reforms seen falling short

By TOM PHILPOTT | | Published: March 31, 2011

After a three-year effort by the departments of Defense and Veterans Affairs to improve the process, ill and injured military members still endure a long, complex and often contentious evaluation system when seeking disability ratings and compensation for service-related health conditions.

The process has been made more convenient and even shortened by an average six to eight months under a pilot program jointly run by the two departments and which continues to be expanded to more military bases.

Yet the Defense Department’s personnel chief and the Army’s surgeon general both have concluded, and said publicly, that the “integrated” disability evaluation system, or IDES, remains a disappointment.

More dramatic changes, they suggest, have to occur or else wounded warriors and other disabled service members still will be saddled with a process not befitting their sacrifices to serve the country.

Clifford L. Stanley, under secretary of defense for personnel and readiness, first revealed the depth of his concern to the annual Military Health System conference in January.  Stanley said he had been “raising Cain” over the time that injured and ill members still spent in “limbo” awaiting medical appointments and medical review board decisions.

Lt. Gen. Eric B. Schoomaker, Army’s top medical officer, told the House military personnel subcommittee in March that the pilot run by the two departments since late 2007, called IDES or the Integrated Disability Evaluation System, “remains complex and adversarial.”

 Soldiers, he said, “still undergo dual adjudication where the military rates only unfitting conditions and the VA rates all service-connected conditions.”  That produces separate ratings “confusing to soldiers and leaves a serious misperception about Army’s appreciation of wounded and injured soldiers [and their] medical and emotional situation.”

 Interviewed in his Pentagon office last Tuesday, Stanley said he agrees with that criticism of IDES, though the pilot continues to be improved as it replaces, base by base, the far more flawed legacy DES.

The legacy system, still used for 40 percent of members seeking disability ratings, requires each service to conduct its own medical evaluation to identify only “unfitting” conditions and award them a rating.  If the rating is 30 percent or higher, the member is retired and draws a lifetime annuity and other retiree benefits including access to military medical care.

If the rating is below 30 percent, the member is separated, usually with a lump sum severance payment.  Veterans then go to VA where a new evaluation process begins, this time of every service-related condition found.  VA ratings and compensation usually are higher than the service allowed.

Back in 2007, it took an average of 540 days to clear both DES processes.  The pilot program to integrate them uses one set of medical examinations done by VA doctors to VA standards.  It has honed the total process time down to an average of just over 300 days.  Members leave service with both their military and VA ratings set and with their compensation, usually based on the VA, starting immediately.

 Stanley and Schoomaker agree that IDES, where it operates, has been an improvement.  Yet both leaders say it doesn’t go far enough to simplify and accelerate the process for the 26,000 members moving through it at any given time.  Stanley has had a working group studying its weaknesses.  Recommendations to improve it will be presented to Defense Secretary Robert Gates and VA Secretary Eric Shinseki at the end of April.

The ideal system, Stanley said, would produce  “a single evaluation based upon one medical record,” and over which Defense and VA officials “have joined hands and made a decision: ‘Here’s the disability rating. Period.’  That’s what we’re looking for…That’s nirvana.”

But such a change, presuming the one and only rating were set by VA, would make many more military members eligible to be disabled “retirees” thus driving up DoD retirement and medical costs.  Neither Stanley nor Schoomaker have addressed, at least publicly, the possible cost consequences of their vision.

What both appear to be embracing is a key recommendation of the 2007 Dole-Shalala Commission, which Congress and the Department of Defense choose to ignore because of the costs involved.  Dole-Shalala, formerly called the President’s Commission on Care for America’s Returning Wounded Warriors, was formed after the scandal involving neglected wounded warriors on the campus at Walter Reed Army Medical Center.

It recommended getting “DoD completely out of the disability business” by giving VA sole responsibility for setting disability ratings and awarding compensation.  It urged replacing “confusing parallel systems” of DoD and VA ratings with a single simple and more generous system.

Congress instead passed more modest reforms to partially integrate the two processes.  In the pilot, DoD and VA use the same set of exams.  Both rating occur while members remain on active duty.  But IDES still allows the military to rate only “unfitting conditions” for determining retirement eligibility and the VA to rate all conditions.

Stanley, in our interview, said this dual adjudication process keeps the system too long and complex, and shakes the bond of trust members should have with their service branch as they leave for civilian life.

Disability evaluation shouldn’t be something that the private first class, or even the general has to briefed on for hours “to understand,” Stanley said.  It should just be there to serve them well and fairly.

Stanley isn’t persuaded, as some DES experts are, that the law would have to be changed to allow the services to use more than just “unfitting conditions” to set disability ratings for determining retirement eligibility.

While that debate continues internally, Stanley is pressing IDES officials to take more steps to cut down wait times for members, and at the same time ensure that their rights to due process are protected.

“At no time in this process are we talking about going faster than they want to go,” Stanley said.  “We’re not trying to rush people out.  We’re talking about respecting them [and] giving them an opportunity to go through a process that is not dehumanizing.”

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