| Once a veteran has achieved service | | | | (DSM). See 38 C.F.R. 4.125(a). The DSM |
| connection for his or her disability, the | | | | recognizes the differences among the various |
| next question to be addressed is somehow | | | | psychiatric disorders (e.g., psychoses, like |
| evaluating (or rating) the severity of the | | | | schizophrenia, and neuroses, like PTSD). Some |
| symptoms to determine the appropriate level | | | | psychiatric disorders are organic in natures, |
| of compensation. The VA uses what has evolved | | | | some are acquired and some are congenital. |
| from a 1945 Schedule for Rating Disabilities, | | | | Some are chronic, some are intermittent and |
| which is codified at 38 C.F.R. Part 4 (known | | | | acute. Yet the rating schedule completely |
| as the "rating schedule"). The rating | | | | ignores such differences. Instead, it lumps |
| schedule is designed to compensate veterans | | | | all psychiatric disorders together and |
| based on the average impairment of their | | | | evaluates them under the exact same list of |
| industrial (or earning) capacity. Explained | | | | symptoms. See 38 C.F.R. § 4.130. This is |
| simply, the rating schedule is a collection | | | | both inherently inconsistent and illogical. |
| of disabilities, grouped by body systems that | | | | The DSM diagnostic criteria are expressly |
| delineate a group of different symptoms in an | | | | adopted, but fundamental differences among |
| increasing order of severity. Percentages of | | | | various psychiatric disorders are virtually |
| disability are assigned to each level of | | | | ignored. |
| symptoms from zero (non-compensable | | | | |
| disabling) to one hundred percent (totally | | | | Consequently, the VA should initially |
| disabling) in ten percent increments. Each | | | | undertake a comprehensive review of the |
| disorder is assigned an identifying | | | | rating schedule in concert with medical, |
| diagnostic code. If a particular disorder is | | | | psychiatric and vocational experts. New |
| not listed, it is rated by analogy to a | | | | rating criteria should be developed that take |
| listed disorder that most closely | | | | into account not only impairment in |
| approximates it. See 38 C.F.R. § 4.20. | | | | industrial capacity, but also the psychiatric |
| Multiple disability ratings are combined | | | | effects of physical disability and the effect |
| according to a complex tabulation matrix, | | | | of physical and psychiatric disability on the |
| rather than added together, to produce a | | | | veteran's quality of life. VVA often |
| combined rating of all service-connected | | | | advocates for a "Veterans' Health Care |
| disabilities. See id, § 4.25. Essentially, | | | | System", rather than a health care system for |
| the adjudicator reviews the medical evidence | | | | veterans, based on the unique nature of |
| of record, finds the compatible diagnostic | | | | veterans' disabilities. Such disabilities are |
| code and compares the clinical evidence of | | | | incurred in unique ways and have unique |
| the severity of the veteran's current | | | | consequences. It is the very "veteran-ness" |
| symptoms with the list of symptoms under that | | | | of a veteran's disability that demands a |
| diagnostic code. The commensurate rating | | | | system of evaluating disabilities that keeps |
| percentage is assigned. Each year, Congress | | | | pace with technology, current medical |
| sets the monetary level of compensation for | | | | standards and practices, socioeconomic |
| each percentage level. | | | | factors and individual self-esteem. |
| | | | |
| Anyone would be hard pressed to say that the | | | | Once the rating schedule has been adequately |
| VA's rating schedule even approaches | | | | revised, it may be utilized just as it is |
| perfection. It is antiquated, imprecise, and | | | | today. It works logically, the documented |
| vulnerable to great subjectivity and does not | | | | symptomology is compared with the diagnostic |
| take into account the diminution of a | | | | criteria and a commensurate rating results. |
| disabled veteran's quality of life. However, | | | | As long as Congress sets adequate payment |
| given the uniqueness of the veterans' | | | | levels for the various ratings (which, in |
| benefits system, the rating schedule, in | | | | equity, should be higher than they currently |
| principle, does serve its essential purpose. | | | | are), veterans should receive adequate |
| With certain refinements, the rating schedule | | | | compensation. |
| may be able to live up to its original | | | | |
| expectations. | | | | Meaningful Accountability and Training of VA |
| | | | Adjudication Personnel |
| Part of the current problem with the rating | | | | |
| schedule is that it was formulated at a time | | | | It is axiomatic that a system is only as good |
| when disabled veterans were returning home | | | | as the people who run it. The VA disability |
| from World War II. Veterans were universally | | | | compensation system can be flawlessly |
| admired and their disabilities were, for the | | | | designed; however, if the personnel who |
| most part, clear-cut. Orthopedic injuries, | | | | operate it not are not adequately trained, |
| amputations, psychiatric disorders; these are | | | | supervised and held accountable for repeated |
| known quantities. Since World War II, | | | | errors, the system will grind toward |
| however, veterans have returned with more | | | | disaster. |
| insidious illnesses. Diseases such as | | | | |
| hepatitis C and HIV (which were unknown until | | | | In a recent rather disturbing press |
| decades later), diseases as the result of | | | | conference, VA Secretary R. James Nicholson, |
| exposure to chemical, biological and/or | | | | Inspector General Richard Griffin and Under |
| radiological agents, mysterious syndromes | | | | Secretary for Benefits Daniel Cooper, |
| such as Gulf War Illness and chronic fatigue | | | | announced a May 19, 2005, VA Inspector |
| syndrome, were not contemplated by the | | | | General's (IG) Report, entitled "State |
| framers of the original rating schedule. | | | | Variances in VA disability Payments". The |
| | | | report was generated following newspaper |
| In the 1940s, the United States was more of | | | | reports of low disability compensation |
| an industrial society. Quite naturally, the | | | | payments for Illinois veterans as compared to |
| emphasis within the VA disability | | | | veterans in other states. In response, |
| compensation scheme was on the impairment of | | | | several Illinois Representatives requested |
| a veteran's earning capacity. However, times | | | | the VA investigate the disparity. Following |
| have changed. Advances in medicine have | | | | the investigation, the IG conceded that |
| allowed for qualitatively greater treatment, | | | | variances in average disability compensation |
| cures and rehabilitation. Medical knowledge | | | | payments by states have existed for decades, |
| has increased exponentially in the last five | | | | and stated that "[p]ayments by state are |
| decades, diagnostic tools have been refined | | | | affected by legislated pay increases, an |
| and today's medical professionals are | | | | antiquated rating schedule, veteran |
| practicing medicine in ways that could not | | | | demographics and inconsistent rating |
| have been envisioned by doctors even two | | | | decisions [including] claims processing |
| generations ago. Yet the rating schedule | | | | practices, disability examinations, |
| remains static. While new disorders have been | | | | timeliness pressures, staffing levels, rate |
| added from time to time and the symptoms | | | | experience and training, and fraud." |
| listed in the diagnostic codes have been | | | | Executive Summary and Management Comments of |
| updated here and there, it is long past time | | | | State Variances in VA Disability Compensation |
| for a wholesale revision of the rating | | | | Payment¸ IG Report No. 05-00765 (May 19, |
| schedule to bring it in synchronization with | | | | 2005) at x. The IG further concluded that |
| the state of modern medicine and American | | | | "some disabilities are inherently prone to |
| society. | | | | subjective rating decisions, especially for |
| | | | conditions such as PTSD where much of the |
| One example of the inadequacy of the current | | | | information needed to make a rating decision |
| rating schedule is rather glaring. VA | | | | is not physically apparent and is more |
| regulations have historically adopted the | | | | susceptible to interpretation and judgment |
| nomenclature and diagnostic criteria of the | | | | [which] leads to inconsistency in rating |
| American Psychiatric Association's Diagnostic | | | | decisions." Id. |
| and Statistical Manual of Mental Disorders | | | | |