Friday, July 31, 2009

VA not ready to back extra pay for lost quality-of-life

VA not ready to back extra pay for lost quality-of-life

By Tom Philpott, Special to Stars and Stripes
Pacific edition, Saturday, August 1, 2009
Monthly compensation that the Department of Veterans Affairs pays to veterans with service-connected disabilities is intended to replace average earnings loss due to their injuries or ailments.

But should VA also pay disabled veterans something extra for diminished quality of life? Two prominent commissions in 2007 said that it should. On Wednesday, however, a senior VA official told senators that the department isn’t prepared yet to endorse a qualify-of-life payment, or to make any other significant change to disability compensation.

“There’s more information that’s needed, and…more discussion that needs to take place with many experts, before we are prepared to say yes or no on any of those recommendations,” said Patrick W. Dunne, under secretary for benefits in VA’s Veterans Benefits Administration.

Sen. Richard Burr (N.C.), ranking Republican on the veterans’ affairs committee, raised the issue in a hearing on a different topic: What VA is doing to speed the processing of a rising number of disability claims.

Burr noted that VA just last year commissioned a study, by Economic Systems Inc., of Falls Church, Va., on appropriate levels of disability pay to compensate for loss of earning capacity and quality of life as a result of service-related disabilities. This six-month study was to follow up on recommendations from both the Veterans’ Disability Benefits Commission and the Dole-Shalala Commission in 2007 to reform disability compensation.

The benefits commission, in its comprehensive report, concluded that VA disability pay was too low for three categories of veterans: those who suffer from mental disabilities; those severely injured while young, and those deemed unemployable (i.e., rated IU or Individual Unemployability) by VA.

The commission also said current disability pay should reflect the “adverse impact…on quality of life” of veterans’ disabilities. Commissioners recognized that some severely injured veterans are paid a Special Monthly Compensation too on top of VA disability pay. But they said the VA rating schedule still should be revised to compensate many more veterans for diminished quality of life. In the interim, the commission said, Congress should increase VA disability compensation immediately by 25 percent.

The Dole-Shalala panel focused its recommendations on wounded warriors and veterans who were in service after the attacks of 9/11. It recommended restructuring their VA disability compensation into three parts: transition payments to cover short-term living expenses for disabled vets and their families; earning loss payments until veterans become eligible for social security, and a quality-of-life payment to compensate for non-work-related effects of permanent “combat-related” injuries.

The study by Economic Systems, Inc. (EconSys), delivered last August, looked at VA disability compensation with regard to earnings loss, loss of quality of life, transition benefits and other areas raised by the two commissions. To ensure that VA didn’t ignore the findings, the Veterans' Benefits Improvement Act of 2008 directed VA to evaluate the EconSys study and, in a report to Congress, give a timeline and a list of legislative changes needed to make any worthy disability pay reforms.

VA’s assessment of the EconSys study arrived on Capitol Hill July 22.

“But I don’t see any planned actions or timelines laid out in the VA’s report,” Burr told Dunne a week later. “Could you clarify whether VA plans to take any actions in response to that study?”

Dunne said EconSys did a “good job” considering its six-month deadline, but much more information and debate is needed before VA can back changes. For VA or Congress to act based on the “truly national policy recommendations” found in the EconSys study, which relied on insufficient cost and earnings data, “would not be serving our veterans properly,” Dunne said.

In reading VA’s evaluation of the $3.2 million EconSys study, it’s easy to see why VA officials are cautious. It’s a mixed bag for veterans. Some options are quite costly but might help many veterans. Others, like one calling for IU compensation eligibility to end in old age, would save VA money but anger many veterans. VA calls some of the recommendations “inconsistent with the nation’s obligations to its wounded warriors.”

EconSys presented three options for compensating for loss of quality of life. The easiest to understand would create a standard additional payment based on a veteran’s combined degree of disability. Payments would be set by assigning a quality-of-life score to the degree of disability.

“The report used several factors in coming up with the score, but also found that the overall quality of life varies greatly among veterans with the same disability rating, depending on the body system involved,” VA warned.

A second option would create a separate pay scale for loss of quality of life, based on a veteran's combined degree of disability and primary disability. Certain disabilities would be associated with greater quality-of-life loss than others. That might result in veterans with a lower combined degree of disability getting a higher quality-of-life payment, VA said.

A third option would have VA conduct individual clinical and rating assessments and establish separate, empirically-based rates for loss of earnings and loss of quality of life. The VA medical exam would have to be expanded to include a rater to assess a wide range of quality-of-life criteria.

EconSys estimated the annual cost of each of its quality of life payment options would be in a range of between $10 billion to $30 billion.

Burr urged Dunne to consult with VA Secretary Eric Shinseki, and then tell Congress “what the next step should be.” Burr noted that both major commissions saw a need to “move to a system that compensates for the loss of quality of life.” That course was favored too, for a time, within VA and Congress. That momentum to help veterans shouldn’t be lost, Burr said.

To comment, e-mail, write to Military Update, P.O. Box 231111, Centreville, VA, 20120-1111 or visit:


The Veterans Disability Benefits Commission turned in it's report in 2007, then we had the Dole /Shalala Report after the Walter Reed fiasco. Which many people then decided that Veterans Hospitals and Walter Reed were all part of the same medical system and the media did not do a very good job at explaining the difference.

Walter Reed is an active duty medical center, it has NOTHING to do with the VA medical care.

Dole/Shalala advocate a 2 tier pay system for the new war vets of Iraq and Afghanistan the VDBC advocated a 25% pay raise for all compensation payments to disabled veterans to compensate them for loss of quality of life besides just a check to replace their loss of earning power as has been the way the government has been setting compensation pay since 1776. They have never paid any extra money for the loss of a disabled veterans quality life, not being able to play with your kids or grand kids, bowling as a family, take your spouse dancing etc, the 25% would enable the disabled veteran to afford a few nice extras in life to help offset the losses they are experiencing.

This is not a hard decision, either the disabled veterans and their families should get the extra funds as a quality of life payment or not it is about the money and the veterans and their families deserve it. Spend a day or a week with a family of a disabled veteran and you wouldn't deny them the extra compensation I promise you.

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Thursday, July 30, 2009

Initial List of Compassionate Allowance Conditions

See list of illnesses’
Compassionate Allowances

Social Security has an obligation to provide benefits quickly to applicants whose medical conditions are so serious that their conditions obviously meet disability standards.

Compassionate allowances are a way of quickly identifying diseases and other medical conditions that invariably qualify under the Listing of Impairments based on minimal objective medical information. Compassionate allowances allow Social Security to quickly target the most obviously disabled individuals for allowances based on objective medical information that we can obtain quickly.

Commissioner Astrue has held three Compassionate Allowance public outreach hearings. The hearings were on rare diseases, cancers, and traumatic brain injury (TBI) and stroke. The Commissioner will hold the fourth public outreach hearing in Chicago on July 29, 2009. The subject of the hearing is Early-Onset Alzheimer’s Disease and Related Dementias.

The initial list of Compassionate Allowance conditions was developed as a result of information received at public outreach hearings, public comment on an Advance Notice of Proposed Rulemaking, comments received from the Social Security and Disability Determination Service communities, and the counsel of medical and scientific experts. Also, we considered which conditions are most likely to meet our current definition of disability.

A modest 50 conditions were selected for the initiative's rollout. The list which follows will expand over time.

Initial List of Compassionate Allowance Conditions

Additional information about how compassionate allowances are processed

Quick disability info


IF this works the way it is intended, this will be one of the best things the government has done in decades......

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Tuesday, July 28, 2009

Our national myth is that we honor and take care of our war veterans

Our national myth is that we honor and take care of our war veterans

New veterans need America's compassion
Our national myth is that we honor and take care of our war veterans
Garry Trudeau, who draws Doonesbury at the bottom of this page, is one of few in the media who has paid consistent, long-term attention to the disabled veterans of the Iraq and Afghanistan wars. Trudeau had help from the Department of Veterans Affairs, which wisely offered the cartoonist firsthand experience with amputees and other veterans bearing long-term injuries.

One of our national myths is that America cares for its veterans. Through several wars, that is not the case. In this war, however, the Department of Veterans Affairs as well as the military services themselves are giving more attention to psychiatric services.

As the director William Wyler depicted in his 1946 The Best Years of Our Lives, the war veteran returns to a world that has changed in his absence and he is seldom acknowledged or appreciated for his service.

San Diego's recent Stand Down, described in last Sunday's edition of The New York Times is a heartening example of a community responding to the needs of its veterans. In its third annual incarnation, this three-day beckoning to veterans is starting to see homeless vets from the Iraq and Afghanistan wars, and female veterans with children.

We must not underestimate the physical and mental damage of our current wars. Reported Erik Eckholm, "In an ominous harbinger, a recent study found that more than one-third of Iraq and Afghanistan war veterans who enrolled in the veterans health system since 2001 had already displayed post-traumatic stress disorder, depression or other mental health problems."

The Obamas' focus on military families is a very good thing. Senators such as Oregon's Ron Wyden and Jeff Merkley have the opportunity to insure that the health and economic issues of the veterans of these two wars are handled intelligently. After more than two centuries of armed conflicts, America knows enough to do that. Let's show the will to have compassion for these wounded men and women.

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Monday, July 27, 2009

52 percent of U.S. soldiers wounded in Iraq, Afghanistan diagnosed with TBI

52 percent of U.S. soldiers wounded in Iraq, Afghanistan diagnosed with TBI

WASHINGTON -- Some 52 percent of soldiers severely injured in Iraq and Afghanistan who have come to the U.S. Army's largest hospital for treatment have been diagnosed with traumatic brain injuries (TBI), an internal study has found.

The results of the study, carried out by Defense and Veterans Brain Injury Center (DVBIC) at Walter Reed Army Medical Center, also showed a steep increase -- from 33 percent -- in TBI cases since the end of 2008.

Diagnoses of TBI are rising steadily as arrangements for TBI checks improve, while at the same time improvised explosive device (IED) attacks -- the primary cause of TBI -- in Afghanistan are intensifying, with 46 U.S. soldiers killed by the homemade bombs so far this year. Casualties from these attacks flow into Walter Reed, which provides treatment to badly wounded soldiers unavailable anywhere else.

According to DVBIC at Walter Reed, since January 2003 -- just before the beginning of the Iraq War -- 52 percent of soldiers wounded in Iraq and Afghanistan by bombs and treated at the hospital have been diagnosed with TBI. According to figures uncovered by the Mainichi, this would mean the number of diagnosed TBI cases has risen to well over 10,000 since the end of 2008, when the figure stood around 9,100. Furthermore, in more than 90 percent of those diagnosed with TBI, the patient had no visible head injuries.

On the battlefield, TBI is caused by the supersonic shockwave produced by an explosion -- often from an IED -- which damages or destroys brain cells. A soldier caught in the blast may not even know he or she has been injured.

The U.S. Department of Defense began conducting cognitive ability tests on all military personnel to be deployed to Iraq or Afghanistan in November 2007. The servicemen and women who took the tests began returning from their combat tours early this year, allowing for greater chances of discovering a TBI and probably leading to the increased numbers of diagnosed cases.

The Department of Defense estimated in March this year that the final tally of TBI cases would reach 10 to 20 percent of all personnel deployed to Iraqi and Afghani battlefields.


More than half? My question is do the soldiers in Afghanistan have the new padding kits for the Kevlar helmets that reduce TBI injuries, or is the cost of 100 dollars each to expensive for DOD or the Army to fund them? With injuries rates this high common sense says the 100 dollars would be money well spent......

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