Military Update: Congress looks at consistency in veterans' disability claims
More than two years after congressional auditors scored it as a problem, the Department of Veterans Affairs still has no way to assess whether its 57 regional offices are consistent in deciding disability claims for veterans suffering from the same type and severity of impairment.
The Government Accountability Office, in recent briefings for two House subcommittees, said, “VA cannot provide reasonable assurance that similarly situated veterans who submit claims for the same impairment to different regional offices receive reasonably consistent decisions.”
In other words, where veterans live and file disability claims could impact disability ratings and thus their compensation.
The report urged VA to use data collected through a newly implemented information system, called RBA 2000, to identify “indications” of inconsistencies among regional offices in award and denial of benefits. Then, where inconsistency even appears to exist for specific impairments, VA should conduct “systematic studies” of claim decisions for the specific ailments. The auditors indicated this process could take several years.
GAO said it first raised this issue in an August 2002 report. And though “VA acknowledges that veterans are concerned about consistency, VA has not taken any action to assess consistency.”
This fiscal year VA will pay $25 billion in disability compensation to 2.7 million disabled veterans. VA regularly audits the overall accuracy of disability decisions. But those reviews don’t measure the consistency of claim decisions overall or for specific impairments.
Randy Reese, national service director for Disabled American Veterans, said individual veterans can only guess whether they’ve been treated equitably by the claim adjudicators in comparison to peers. But DAV, with national service officers in every state, confirms that inconsistencies in VA decision-making exist between regions and sometimes within regions, between individual disability rating boards, Reese said.
The greatest inconsistencies occur with mental disorders such as post-traumatic stress disorder, said Randy Reese, national service director for Disabled American Veterans.
“A lot of that has to do with how they interpret information,” Reese said. “Some grant PTSD very liberally, using a broad and liberal interpretation of the law, a requirement” under Code of Federal Regulations guidelines. “In another region, it will be construed very narrowly.”
The inconsistencies aren’t just between regions, however.
“If they have more than one rating board, there could be variations between rating boards. And at the highest level of appeal in the [Veterans Benefits Administration], there are inconsistencies amongst the Board of Veterans Appeals’ staff. That’s even been pointed out by the courts. There are different sections and different judges that rate cases differently.”
Appeal judges, he said, have “unilateral ability to interpret law.”
Inconsistency in decision-making over PTSD is of particular concern now with so many soldiers and Marines exposed to trauma in Iraq. Mental health experts estimate that 15 to 17 percent of personnel serving tours there will return with symptoms of post-traumatic stress.
A study published in July in the New England Journal of Medicine, written by Dr. Charles W. Hoge and five medical colleagues, found “a significant risk of mental health problems” for ground forces in Iraq. It also found “important barriers” to their receiving mental health services, “particularly the perception of stigma among those most in need.”
The study found lower incidence of PTSD among servicemembers sent to Afghanistan where combat has been less intense and troops are exposed to fewer bombings and ambushes by insurgents.
The VA had no immediate comment on the GAO finding but was preparing a statement for Congress. VA does not keep statistics on number of veterans receiving disability compensation for PTSD or other mental illnesses. It does keep data on users of VA health care.
Through last June, of 195,000 separated veterans who had served in Iraq or Afghanistan, 16 percent — almost 30,300 — had sought VA health care for a wide range of medical and psychological ailments. Nineteen percent of hospitalizations and outpatient visits involved care for mental disorders. More common ailments, however, were musculoskeletal, diseases of the nervous or digestive systems and dental problems.
Through June, the VA had diagnosed 1,743 cases of PTSD among recently returned combat veterans.
The GAO, in its 2002 report, blamed inconsistencies involving disability claim decisions on the need for reviewers to use their own judgment. VA acknowledges, the report said, “that in many cases two adjudicators of equal competence could review the same evidence but render different decisions, due to the difficult judgment often required.”
An example GAO used was a PTSD case from a claimant who served in Vietnam as a supply specialist but said he was subject to enemy mortar attacks. Because he was vague about the number of attacks, one adjudicator might turn to unit reports, conclude the claimant was engaged in combat and award a PTSD disability rating.
Another might decide the claimant isn’t credible and require more supporting evidence of exposure to enemy fire.
Reese said VA officials are very aware of the inconsistency issue. Indeed, two recent VA task forces, one of which Reese served on, recommended corrective steps. None will take effect for a few more years.
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