Veterans' Advocate Jim Strickland provides regular columns for VA Watchdog dot Org.
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http://www.yourvabenefits.org/sessearch.php?q=nexus&op=and
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by Jim Strickland
Your claim for a Veterans Benefits Administration (VBA) disability compensation award must be based on irrefutable evidence. If your claim leaves any doubt in the mind of the ratings specialist who makes that award decision, you'll be denied.
If you can't prove it, it didn't happen.
This is often the case when you allege that an injury or illness that occurred in service has worsened over the years. While the condition may have been relatively minor then, it's significantly disabling today.
An example might be a back injury. It's there in your service medical record (SMR) that you received treatment and you were assigned to light duty for a week or two. Later you might have had some complaints but nothing serious and you went on living your life. Today your back is knotted with crippling pain and you're facing a big surgery and a long recuperation. You file your claim and you're quickly denied. The VBA doesn't agree that your condition today is related to the event in your past. They explain to you that they think your earlier injury wasn't chronic, that it was temporary and that you must have done something else to injure yourself since then.
Another example could be an injury to a leg. You were shot by a sniper, your thigh was shattered and you spent months in a hospital healing. You were young, you wanted to get up out of that bed and you did heal. Within a year you were working again albeit with a limp. You raised your family, worked hard at being a great American and had a good life until last year. Your gait had become steadily more awkward as you grew older and you had been thinking that leg was weaker than ever and finally it happened. You took a bad fall and injured your knees, your lower back and you fractured a forearm.
It's clear to you that the old injury was the cause of your fall and you filed for additional compensation. Those recent injuries have kept you out of work and now you need financial help. The VARO takes 14 months to adjudicate your claim and denies you any additional compensation. They don't agree that your old wound was the cause of your new problems. Maybe you slipped. Maybe you were drinking. The VBA doesn't have to say what has caused your recent predicament, all they need do is tell you that they've concluded it wasn't connected to your military service.
It's possible you were exposed to Agent Orange, carbon tetrachloride or any one of the hundreds of lethal chemicals, biohazards or radioactive substances that we took for granted back in the day.
Now you have a cancer, your lungs have scarred with emphysema, cataracts have blinded you or you have Type 2 Diabetes and you've become dependent on insulin many times each day. You well remember the barrels of chemicals you loaded on those ships, you were bathed in the stuff. You know that the exposure to all of that is at the root of your health problems today, you are confident that you'll qualify for help from your VBA and you seek out a Veterans Service Officer to help you file a claim.
A year later you receive the letter from your Veterans Affairs Regional Office (VARO) denying your claim. They explain to you that your military service doesn't qualify you for benefits because you don't fit the established criteria that would fit you on to a presumptive list for an award. The VBA doesn't deny that you were exposed to the hazards that could have caused your illness. All they are required to do is determine whether your exposure meets the strict criteria of timing or geography and that ends the game. Your problems aren't their problems.
Now what?
Let's back up a minute and review the regulation that sits at the heart of all this;
Title 38: Pensions, Bonuses, and Veterans' Relief
PART 3—ADJUDICATION
Subpart A—Pension, Compensation, and Dependency and Indemnity Compensation
Ratings and Evaluations; Service Connection
§ 3.303 Principles relating to service connection.
(a) General. Service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. This may be accomplished by affirmatively showing inception or aggravation during service or through the application of statutory presumptions. Each disabling condition shown by a veteran's service records, or for which he seeks a service connection must be considered on the basis of the places, types and circumstances of his service as shown by service records, the official history of each organization in which he served, his medical records and all pertinent medical and lay evidence. Determinations as to service connection will be based on review of the entire evidence of record, with due consideration to the policy of the Department of Veterans Affairs to administer the law under a broad and liberal interpretation consistent with the facts in each individual case.
In plain language that regulation means that the VBA must consider all the evidence you've submitted. That includes all of your military service and the conditions under which you served, where you served, your current condition, and all medical and lay evidence. For the discussion today, we'll assume that your claim was well documented as to the nature of your service, when and where you served and your health then and now.
The disagreement between you and your VBA may be seen as a simple one. You claim cause and effect, your VBA denies that. A solution to the disagreement often lies in a nexus letter. A simple definition of nexus is: Tie; bond; link; connection or interconnection.
To show that there exists a connection between your documented service event (exposure to CBR elements, wounding, illness) and your condition today (cancer, worsening of original injury, etc.) requires that you present the favorable opinion of an expert who agrees with your thought process. This is known as a nexus letter.
To be effective, your nexus letter must fulfill a number of obligations.
The author must be an expert. This is most often a medical doctor who is board certified in the area of health that's at issue. If a cancer is the condition, an oncologist is preferred. If an old injury to a bone is in question, an orthopedic surgeon is the obvious choice. PTSD has become more controversial in recent years and it's accepted today that a clinical psychiatrist or psychologist is the gold standard for opinions related to the condition. It helps if your doctor will provide a curriculum vitae (CV) stating the areas of their expertise and education.
The expert who signs your nexus letter must have thoroughly reviewed all available and pertinent medical records and state that fact in the letter. If your expert can't reasonably verify that all records were reviewed, the letter won't be of much value.
Although it may not always be an absolute requirement, it will lend a lot of weight if the writer of your nexus letter has recently examined you.
When writing a nexus letter, a few points to remember are in order. The letter should be as brief as possible while stating facts. The doctor who writes your letter does not have to use absolutes or conclusions in his or her statements. Opinions are made based on conjecture of observing facts and possibilities arising from those facts.
This means that the author isn't required to say that one thing definitely caused another, only that it might have or is likely to have led from point A to point B.
The preferred language to describe an expert's opinion should express whether "it is more likely than not (i.e., probability greater than 50 percent), at least as likely as not (i.e., probability of 50 percent), or less likely than not (i.e., probability less than 50 percent) that (the condition) was incurred or aggravated during active service.
A complete rationale for all opinions should be expressed. For example, your doctor might point out that you have no family history of diabetes or cancer and that you have no known risk factors that might have otherwise precipitated your condition. This leads to the conclusion that your known exposure to a carcinogenic chemical during your military service is more likely than not the cause of your current condition.
The same might apply to that earlier back problem. Your physician could state that as it is recognized in medical literature and in his own personal experience that a leg injury that causes an alteration of a person's gait often progresses on to issues with one's back. Your doctor should point out that between the time of the original injury and today, there is no other know injury that could account for your condition today. Thus, it is reasonable to assume that it is more likely than not that your original injury is the cause of the condition at issue today.
In each of the above examples, the clinical nexus is established. There was a causation in military service and an effect today.
In determining whether service connection is warranted for an alleged disability, VA is responsible for considering evidence both for and against the claim. If the evidence, as
a whole, supports the claim or is about evenly balanced, the veteran prevails. If the preponderance of the evidence is against the claim, then it is denied.
However, the adjudication of the claim by the VBA includes the responsibility of determining the weight to be given to the evidence of record, and this responsibility includes the authority to favor one medical opinion over another. The probative value of a medical opinion is generally based on the scope of the examination or review, as well as the relative merits of the expert's qualifications and analytical findings, and the probative weight of a medical opinion may be reduced if the examiner fails to explain the basis for an opinion.
If private clinical reports are not accompanied by the same kind of specific clinical and laboratory findings as is the case with the VA clinical evidence of record, nor are they supported by any convincing medical findings or rationale, weight of the VBA evidence may exceed that of the nexus letter and the claims for service connection may be denied.
Let's now take a look at the basics of a good nexus letter;
DATE
Reference: YOUR NAME
YOUR ADDRESS ETC.
To Whom It May Concern;
I am Dr. Quack. I am board certified to practice in my specialty. A CV is included.
Mr. John Doe is a patient under my care since DATE. His diagnosis is YOUR CONDITION, etc.
I have personally reviewed his medical history (NAME DOCUMENTS) and I've also reviewed his history of the (EVENT OR EVENTS YOU CLAIM ARE THE CAUSE OF YOUR CONDITION) while he served during his military service.
I am familiar with his history and have examined Mr. Doe often while he has been under my care. (SPECIFY LAB WORK, X-RAYS, ETC.)
Mr. John Doe has no other known risk factors that may have precipitated his current condition.
In my personal experience and in the medical literature it is known, ETC.
It is my opinion that it is more likely than not that Mr. John Doe's condition ETC.
SIGNED
Dr. Quack, M.D.
The nexus letter should be as detailed and complete as your circumstances dictate.
Many physicians, both civilian and VA docs, are reluctant to write such a letter. Sometimes, they are concerned that there are legal pitfalls that can arise from writing disability letters and they want to avoid such. While there probably are some legal issues to consider, I'm not aware of any physician ever suffering any repercussions from writing a truthful, factual nexus letter.
In my experience, the physician is most often simply too busy to write such letters or isn't sure of the proper statements to make.
I recommend that you write the letter for your doctor. If you elect to do this you must carefully construct every word to ensure that there is nothing in the letter that the doctor could disagree with. Keeping it simple is most likely to lead to your doctor signing the letter.
Your best bet to have your doctor agree with you and write the letter onto his letterhead is to approach him or her directly. Don't hand it off to a receptionist or nurse to do for you.
If your personal doctor won't write such a letter, you'll have to seek out a physician who specializes in Independent Medical Examinations or IME's. These doctors are relatively scarce and they are often paid by the Social Security Administration, insurance companies and businesses to evaluate the extent of injuries of claimants. The IME doctor is a good choice for you to turn to and I highly recommend that you do so if you believe that an independent review of your case would help you. The doctor who is a specialist in Independent Medical Examination is usually thought to be above reproach as their living depends on their reputation as an impartial reporter of facts. They will often know the language that's needed very well and they spend a lot of time examining you and reviewing your records.
The IME doctor may be expensive and you must pay your bill up front and out of your own pocket. These IME opinions may cost from $600.00 to $1500.00 or more. There is no guarantee that the IME doctor will agree with your thinking and if the report you receive is not in agreement with you, you don't get your money back.
In practical terms, the nexus letter is a powerful tool for the Veteran to use to establish a claim. Often enough the VA will recognize that the physician who writes your nexus letter is better trained, better experienced or spent more time examining you than a VA Compensation and Pension (C&P) examiner did. In many cases at the VARO level as well as the Veterans Board of Appeals and in higher courts, the expert opinion expressed in a nexus letter has been the deciding factor that wins a Veteran those well deserved benefits.
The nexus letter may require a lot of effort on your part and an investment of money that you can hardly afford.
It may also be the single best investment of time and money you'll make. Don't give up on your claim until you've tried it.
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Monday, January 7, 2008
Jim Strickland of VA Watchdog explains Nexus letters
Handbook for wounded soldiers and families
Handbook outlines benefits, bureaucracy for wounded vets
By Karen Jowers - kjowers@militarytimes.com
Posted : January 14, 2008
http://www.armytimes.com/issues/stories/0-ARMYPAPER-3281855.php
A new handbook designed to help wounded warriors and their families navigate the bureaucracy to get the benefits they have earned is now available.
The 149-page “A Handbook for Injured Service Members and Their Families” was prepared free by a New York-based law firm for two nonprofit charities — the Wounded Warrior Project and the Intrepid Fallen Heroes Fund. It can be downloaded for free at http://www.woundedwarriorproject.org and http://www.fallenheroesfund.org/.
“This answers the questions you have,” said Army Spc. James O’Leary, who received multiple injuries in a mortar attack in Iraq in 2004. “I didn’t know what I was eligible for. I didn’t know about the vocational rehabilitation program, which is much better than the GI Bill and pays for all your tuition and books. I didn’t know about the evaluation system. I figured if [the Veterans Affairs Department] gave me a certain rating, that’s what I would be eligible for.”
Davis Polk & Wardell donated about $500,000 worth of time, with hundreds of attorneys combing through government laws, regulations and other information, said Bill White, president of the Intrepid Foundation, which operates the Intrepid Fallen Heroes Fund.
“They tried to simplify and put the information in layman’s terms, so that if you’re 19 years old and haven’t gone to law school, ... you can understand it,” White said, adding that the senior lead partner on the project is a retired Marine.
The handbook is divided into sections dealing with issues that come up during the process wounded service members go through, said Jeremy Chwat, vice president for policy and public affairs for the Wounded Warrior Project.
“We wanted to make sure service members understand their benefits and rights and that it’s not lost in legislative speak,” Chwat said.
Chapters include “Immediate Concerns,” with details on important documents, financial aid sources and information on service members’ continuing salaries.
For families traveling to be at their service member’s bedside, information is included about the military’s invitational travel orders, per diem rates for family members, and a listing of contacts for all Fisher House homes.
Extensive information about the disability evaluation systems, education and employment benefits, health benefits, legal rights and legal assistance, and other federal benefits is provided.
The handbook has a glossary and a state-by-state list of resources for the wounded. Other resources are sprinkled throughout, such as Disabled American Veterans and the Army’s Wounded Soldier and Family Hotline.
__._,_.___
Pay in Vets' Work Program Ruled Tax-Free
Pay in Vets' Work Program Ruled Tax-Free
Ruling on Compensated Work Therapy Retroactive Three Years
WASHINGTON (January 7, 2008) -- Payments provided to veterans under two
specific programs of the Department of Veterans Affairs (VA) -- the
Compensated Work Therapy (CWT) and Incentive Therapy (IT) programs --
are no longer taxable, according to the Internal Revenue Service.
Veterans who paid tax on these benefits in the past three years can
claim refunds.
Recipients of CWT and IT payments no longer receive a Form 1099
(Miscellaneous Income) from VA. Veterans who paid tax on these benefits
in tax years 2004, 2005 or 2006 can claim a refund by filing an amended
tax return using IRS Form 1040X. Nearly 19,000 veterans received CWT
benefits last year, while 8,500 received IT benefits.
The IRS agreed with a U.S. Tax Court decision earlier in 2007 that CWT
payments are tax-free veterans benefits. In so doing, the agency
reversed a 1965 ruling that these payments were taxable and required VA
to report payments as taxable income.
The CWT and IT programs provide assistance to veterans unable to work
and support themselves. Under the CWT program, VA contracts with
private industry and the public sector for work by veterans, who learn
new job skills, strengthen successful work habits and regain a sense of
self-esteem and self-worth. Veterans are compensated by VA for their
work and, in turn, improve their economic and social well-being.
Under the IT program, seriously disabled veterans receive payments for
providing services at about 70 VA medical centers.
Helping injured troops get trauma pay
Helping injured troops get trauma injury pay
By Tom Philpott Special to Stars and Stripes Pacific edition, Saturday, January 5, 2007
Too many severely injured troops and their families haven’t been getting the bedside help they need in preparing applications to qualify for up to $100,000 in traumatic injury insurance. But that is going to change, says Army Col. John Sackett.
Sackett heads the Traumatic Servicemembers’ Group Life Insurance (TSGLI) branch within the U.S. Army Human Resources Command in Alexandria, Va. More than 6,600 claims for TSGLI have been filed by wounded or injured soldiers since the program began Dec. 1, 2005.
But only 2,700 Army claims, about 40 percent of the total, have been approved.
Many more wounded members from all services would be found eligible for TSGLI if servicemembers, family caregivers and especially medical staff were better informed on the kind of detailed documentation TSGLI requires, Sackett said.
To increase their knowledge, and boost the number of claims approved, the Army is assigning Soldier Family Support Specialists to 10 military treatment facilities critical in the treatment of trauma patients.
These specialists already are deployed and holding TSGLI training sessions at a number of military medical facilities, and more of these counselors are being trained to deploy soon.
Every member covered by Servicemembers’ Group Life Insurance also pays an extra $1 a month for traumatic injury protection. TSGLI pays $25,000 increments, up to $100,000, to help severely injured members and families handle the extra expense and the strain of adjusting to life-altering injuries.
The Department of Veterans Affairs, which administers TSGLI, lists 44 types of losses that can qualify a member for payment. Conditions not difficult to document involve the loss of body parts or bodily functions, severe burns, or severe brain and spinal chord injuries.
A far bigger and more complex problem in preparing TSGLI claims, however, involves members who suffer severe wounds to limbs that are saved or have mild traumatic brain injury. The trauma can leave them dependent on others to perform “activities of daily living” for extended periods.
If unable to independently perform two or more of these activities for 30 days, the member will qualify for $25,000 in TSGLI. If debilitated in this way for 120 days would qualify for the maximum award of $100,000.
Of nearly 3,700 Army TSGLI claims rejected by the VA, about 90 percent involve claims of members’ lost ability to perform activities of daily living. Sackett said they are being rejected because caregivers aren’t documenting what VA needs to see to prove loss of ability to perform activities.
“The way to resolve this is to put boots on the ground, so to speak, to help the individuals get the necessary documentation they need at the military treatment facility,” Sackett said.
In recent months the VA has relaxed the degree of debilitation that needs to be documented. It used to require evidence that members were “completely dependent” on others for two or more activities of daily living for 30 to 120 days. Now caregivers need only show that members were unable to “independently perform” these activities for the required periods of time.
From this change alone, said Christian Harris, program managers for the Army TSGLI outreach program, claim approval rates are starting to rise.
“We [also] are working with VA to try to adjust program guidance to include a wider array of debilitating injuries,” Harris said.
Wounded servicemembers and their families also need to understand how early application for TSGLI can cut off their eligibility for Combat Injury Pay and thus lower a member’s total compensation over time, Sackett said.
A year ago Congress decided it was unfair that servicemembers wounded in a war saw hostile fire pay, imminent danger pay and hazardous duty pay end within a month of being evacuated.
So since March 23, 2006, medical evacuees have been able to draw Combat Injury Pay which replaces war zone pays that stop during hospitalization or rehabilitation. CIP can total $430 a month.
But wounded servicemembers should be aware that CIP ends when a member is awarded TSGLI. Those facing long periods of convalescence could be denying themselves almost $5,200 a year if they apply too early for TSGLI, Sackett said. TSGLI specialists will include this in their briefings.
http://www.stripes.com/article.asp?section=104&article=58898&archive=true
Housing glut could help wounded
http://www.airforcetimes.com/news/2008/01/ap_warwounded_080103/
Housing glut could help war wounded
By Michelle Roberts - The Associated PressPosted : Friday Jan 4, 2008 12:44:58 EST
CIBOLO, Texas — The glut of unsold houses pocking the nation’s newer neighborhoods may be just what the doctor ordered for thousands of wounded service members facing homelessness and serious financial hardships since returning home from Iraq and Afghanistan, advocates say.
Operation Homefront, a nonprofit that aids the families of deployed and wounded service members, has launched what it says is a first-of-its-kind effort to match wounded soldiers with lenders and home builders to help them buy homes at prices they can afford in communities near Veterans Administration medical facilities.
“Especially with so much inventory, it seems like the perfect match,” said Meredith Leyva, co-founder of Operation Homefront.
The physical wounds suffered by the more than 30,000 service members injured in Iraq and Afghanistan are often followed by financial chaos as the families absorb extra travel and living expenses, forgo combat pay and transition to civilian life with a disability, Leyva said.
Her group, which helped 1,700 injured service members’ families pay utility bills or other living expenses last year, is seeing more families fall into bankruptcy and the threat of homelessness, she said.
A service member who is injured and decides to leave the military usually qualifies for disability payments. But oftentimes, it can take 18 months to get military, Veterans Administration and Social Security benefits determined, said Leyva.
Meanwhile, families — many of whom are young and had little savings — fall behind on bills at a time when travel expenses for medical treatment are climbing and they are least able to work, she said. Their credit is badly damaged, and they must move out of base housing when the service member is discharged from the military.
Veterans have access to VA loan guaranties. But the limits mean they don’t offer much help in many housing markets, and in any event, lenders still apply typical creditworthiness requirements to mortgages, Leyva said.
On average, it takes 6 months for VA to determine disability payments, and the lag can get longer if a veteran appeals to get a larger amount, said VA spokesman Jim Benson.
“That’s a tough amount of time to wait,” he acknowledged.
The agency has been working to decrease the wait, but the workload and paperwork requirements often bog down processing, he said.
The VA, which is primarily concerned with medical care and disability, doesn’t track bankruptcy among wounded veterans but has estimated that 195,000 veterans are homeless on any given night. As many as twice that number have been homeless within the last year, the agency said. Many of the homeless are Vietnam-era veterans.
“These systems are superbly designed to deal with medical issues,” Leyva said. “They are not designed to deal with the messy lives of these service people.”
To launch what it hopes will be a model for other wounded service members, Operation Homefront helped Spc. Austin Johnson and his wife buy a home in Cibolo, northeast of San Antonio. They moved in Thursday.
Johnson suffered a traumatic brain injury from a blast in Iraq last August. While he was being treated in San Antonio for stuttering, memory loss and other symptoms, his wife and three children were in a rollover accident while driving from El Paso.
On a windy desert stretch of interstate, their sport utility vehicle rolled over. All three children, ages 2, 5 and 9, were killed.
Physical and emotional wounds were then followed by financial ruin. Johnson and his wife, Monalisa, had to file bankruptcy, crushed by the extra expenses of travel and other unanticipated costs at a time when paying bills seemed unimportant.
“We’re trying to take it day by day,” Monalisa Johnson said Thursday.
The Johnsons’ case is an extreme example, but Leyva said financial woes and even bankruptcy are common.
For the Johnsons, Operation Homefront raised the down payment from donors, and USAA, an insurer and financial services company for service members and their families, helped secure a lender that would buy the Johnsons’ mortgage. Homebuilder KB Home donated furnishings.
But Amy Palmer, Operation Homefront’s executive vice president, said the group, which has a $13 million annual budget, is trying to convince builders with unsold homes to sell the houses at a substantial discount to wounded service members.
The group has approached major home builders and lenders, asking them to look at a wounded veteran’s pre-injury credit rating and consider selling at a substantial discount. The nonprofit will pay mortgage points and closing costs to help make the deals workable, Palmer said.
So far, they’ve been able to work out a few individual deals but hope to get a more widespread program launched.
Karen Mawyer, USAA’s executive director of secondary marketing, said the skittish credit market makes finding banks to offer mortgages to folks like the Johnsons especially difficult.
“We won’t be able to help all of them,” she said.
But looking at a wounded veteran’s pre-injury creditworthiness helps, and the historical performance of other veterans can help convince banks to lend to wounded veterans, Mawyer said.
Soldiers Opine on Wounded Warrior Program at Fort Bragg
http://www.armytimes.com/news/2008/01/ap_woundedwarriors_080107/
Soldiers slam Wounded Warrior Program at Bragg
By Kevin Maurer - The Associated PressPosted : Monday Jan 7, 2008 7:58:02 EST
FORT BRAGG, N.C. — It took Jay Erwin two months to find the U.S. Army Wounded Warrior Program at Fort Bragg.
When he finally found the program’s representative — Clyde Foster — he was told that he might not be injured enough.
“I’m not sure if your injuries are significant enough to become a member,” Erwin said Foster told him without seeing his medical records.
Erwin was hit in September 2006 by a mortar that peppered his leg, neck and knee with shrapnel during a mission in Iraq.
“I have all my parts, but they just don’t work right,” Erwin said. He still can’t use some of his fingers.
Foster denies telling Erwin that he wasn’t injured enough.
“I would never tell a soldier he wasn’t injured enough,” Foster said. “[The program] is there for them. We alleviate the bureaucracy so that they can concentrate on their recovery.”
But three Fort Bragg paratroopers from the 325th Airborne Infantry Regiment tell a different story. The Army Wounded Warrior Program they experienced was difficult to get into and provided no support, they said.
Erwin, Matthew Bushong and Staff Sgt. Bryan McNees all were injured when a mortar landed near them while on a mission in September 2006. Bushong lost the use of his right hand because of nerve damage, and McNees’ right leg was shattered. Doctors rebuilt it at Walter Reed Army Medical Center. He spent several months bedridden and in a wheelchair, but he now walks with a slight limp.
Erwin and Bushong are both medically retired.
Almost 2,400 injured soldiers — 34 at Fort Bragg — are enrolled in the Wounded Warrior Program. The program has existed since 2004, initially under the name Disabled Soldiers Support System. The Wounded Warrior Program was created to ensure that wounded soldiers and their families receive all the benefits and support they are entitled to.
It took a year for Erwin to get into the program.
“That whole year, I was just floating,” he said.
Foster said there is always room for improvement.
“Sometimes the process doesn’t work as fast as we’d like,” Foster said. “Nothing can happen fast enough for the soldiers and their families.”
Erwin, McNees and Bushong say drastic improvements are needed. They came forward because they worry about the more severely injured paratroopers who are too injured to fight for their benefits.
Foster said the paratroopers’ requests were delayed because it took time to determine the extent of their injuries and how they would respond to treatment. Wounded soldiers must meet a 30 percent disability threshold to get into the program. Thirty percent disability allows the soldiers to keep their medical insurance even after they are retired.
In order to get a 30 percent rating, a soldier usually suffers from a loss of vision or a limb, paralysis or other permanent injuries. The rating is based on the Physical Disability Evaluation System.
Foster, who served 26 years in the military, said he doesn’t determine who gets into the program. When a soldier comes in, Foster said he starts the intake process. Once the soldier is in the system, his file is sent to U.S. Army Human Resources Command in Alexandria, Va. Human Resources Command determines if the soldier is eligible.
The process can take anywhere from a few days to a few months to determine, Foster said. But Foster said he doesn’t wait.
“When I do an intake, I start providing a service at that time,” he said.
His caseload is about 35 soldiers. His four-person office — located on the fifth floor of Womack Army Medical Center — takes care of the 102 wounded soldiers statewide. Foster said he helps with veterans benefits and provides information about programs and job placement.
McNees said he got very little information after his first meeting. After several e-mails to Foster went unanswered over a three-month period, he sent an e-mail to the program’s office in Washington. The next day, McNees was in the program.
“If I hadn’t pestered him, it might not have happened at all,” McNees said. Everybody seemed to get into the program after McNees’ October e-mail. Bushong and Erwin were admitted soon after.
“Nobody was getting in, and now everybody is getting in,” Bushong said.
Foster said the program is trying to empower wounded soldiers but will be around for the long haul if the soldiers ever need assistance. Foster said the program contacts soldiers who are just out of the Army once a month.
After six months, they only contact them quarterly and after two years only semiannually.
All three paratroopers say they’ve never been contacted. Erwin left Fort Bragg this summer and lives in Kansas.
“As soon as I left the Army, I didn’t hear from them,” Erwin said. “It is kind of an ongoing mess.”
McNees is still at Fort Bragg and hasn’t heard from Foster or the Wounded Warrior Program.
“This is something that is supposed to provide care and resources,” McNees said. “I don’t have very good faith in receiving much help from them.”
Military Medical Retirements
On the mendhttp://www.armytimes.com/issues/stories/0-ARMYPAPER-3284742.php
Army disability retirement system better
By Kelly Kennedy - kellykennedy@militarytimes.comPosted : January 14, 2008
When Lt. Col. Chip Pierce served as troop commander at Tripler Army Medical Center in Hawaii, he said he was “frustrated” by some of the issues he saw his injured soldiers face as they made their way through the bureaucracy of the Army’s military disability retirement system.
“At Tripler, we didn’t have the same volume [of soldiers] as Walter Reed [Army Medical Center], so we didn’t have the same level of problems,” he said. “But nearly every problem they had, we had a little of it.”
In some cases, he didn’t know where to turn to solve a problem, he said. And he “wasn’t satisfied” with the troops’ living quarters.
So when the Army offered Pierce the opportunity to lead its new Warrior Transition Unit, a brigade designed specifically to address the administrative needs of injured soldiers, “I couldn’t get here fast enough,” Pierce said.
That was last spring. Already, he said, he’s seen progress.
In February, Army Times reported that soldiers languished for months — even years — in the medical hold system, facing bureaucratic tangles as they worked their way toward the physical evaluation board to determine their disability rating for retirement pay.
The stories, as well as reports from the Pentagon Inspector’s General and Government Accountability Office and testimony of injured soldiers before Congress, brought about a series of investigations and planned changes. And the new Warrior Transition Unit meant officials could immediately put some of those changes into effect.
“Before, folks didn’t feel they had the power to make change,” Pierce said, referring to a stifling set of 50-year-old policies and procedures. “Now, everyone is an advocate for change. If something isn’t working, they can fix it.”
Since then, the Army has added staff, improved training for counselors and lawyers, and ensured every soldier has someone overseeing his or her progress through the system.
And Building 18 — Walter Reed’s dilapidated symbol of the breakdown in the system — no longer houses wounded soldiers.
“I’ve been fortunate to be able to see the frustrations and bring them up to this level,” Pierce said. “It’s been very satisfying to be in this position.”
Increase in medically retired
While the number of soldiers medically retired — meaning they received a disability rating of 30 percent or higher or had at least 18 years of service when they went through the disability process — declined from 2005 to 2006, it increased by several hundred in 2007, according to figures provide by Col. Carlton Buchanan, deputy commander of the Army’s Physical Disability Agency.
Moreover, Buchanan said, while 270 fewer soldiers were medically retired in 2006 than in 2005, the percentage of those completing the evaluation process who were medically retired went up over that time, and has continued to rise in 2007:
• In 2005, 13,048 soldiers went through the process and 2,232 were medically retired, about 17.1 percent.
• In 2006, 10,460 soldiers went through the process and 1,956 were medically retired, about 18.7 percent.
• And in 2007, 10,400 soldiers went through the process and 2,397 were medically retired — about 23 percent.
The 8,003 soldiers who weren’t medically retired in 2007 either were found fit and remained in the Army, were awarded a lump-sum severance payment based on rank and years of service, or were separated without benefits if their condition was found to be pre-existing and they hadn’t been in the military for at least seven years.
Pierce said about 8,900 soldiers remain in the Warrior Transition Unit waiting for their final disability evaluation board.
Tracking individuals
Things still aren’t perfect; Pierce said it’s hard to judge how soldiers feel about the improvements because they weren’t in the system a year ago. And there are still cases taking longer than they should to go through the process.
But now, rather than justifying a months-long quagmire, as had been done by other officials in the past, Pierce said his office tracks, by name, every soldier whose transition takes longer than 60 days. Prior to the 60-day mark, soldiers’ squad leaders in the Warrior Transition Units are responsible for making sure soldiers move through as quickly as possible.
The GAO reported in the fall that some transition units are only at half staffing, but Pierce said the necessary ratio of staff to injured soldiers is at the right levels. In some cases, he said, the GAO report called for staffing for 100 injured soldiers when there may have only been 25 soldiers in the unit.
The Marine Corps also stood up a Wounded Warriors regiment last spring to keep track of Marines and sailors going through the disability retirement system. Though the Navy and the Marine Corps have a better track record for getting service members through the process, there have been worries about the equity of their ratings system.
An Army Times investigation last spring found that enlisted Marines lag far behind enlisted sailors and airmen in the size of the average disability payments they are awarded.
Soldiers, Marines still lag
The 2006 data released by the Defense Department’s Office of the Actuary show Marines and soldiers continue to lag, even though they have higher injury rates and could be expected to have a greater proportion of serious injuries because of the wars in Iraq and Afghanistan than do sailors or airmen. Their ranks and times in service were also comparable.
The average monthly disability payments for all enlisted members receiving disability pay from the military in 2006:
• Air Force: $963
• Navy: $845
• Army: $792
• Marine Corps: $774
Officers had similar discrepancies:
• Air Force: $2,668
• Navy: $2,392
• Marine Corps: $2,336
• Army: $2,067
According to the Office of the Actuary, the number of Marines medically retired in 2006 went up by about 200 compared with the previous year — far more than any other service. The Marine Corps did not comment on the figures by press time.
The Air Force and Navy also saw increases in permanent disability retirements from 2005 to 2006 of 125 airmen and 36 sailors.
Buchanan said part of the reason for the Army’s increase of more than 400 disability retirements in 2007 was that combat-related injuries rose to 18 percent from about 15 percent the year before.
Among soldiers going through the military disability evaluation process, more than half of those with combat-related injuries are retired, Buchanan said.
Another reason for the increase, he said, is “increased training of physicians and adjudicators, coupled with greater precision in describing injuries, such as scars, muscle and nerve injuries, as well as mental disorders.”
That gives medical boards better information to determine proper disability percentages, he said.
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