The Schedule For Rating Disabilities For Vietnam Veterans

Once a veteran has achieved service connectionMental Disorders (DSM). See 38 C.F.R. 4.125(a).
for his or her disability, the next question to beThe DSM recognizes the differences among the
addressed is somehow evaluating (or rating) thevarious psychiatric disorders (e.g., psychoses, like
severity of the symptoms to determine theschizophrenia, and neuroses, like PTSD). Some
appropriate level of compensation. The VA usespsychiatric disorders are organic in natures, some
what has evolved from a 1945 Schedule forare acquired and some are congenital. Some are
Rating Disabilities, which is codified at 38 C.F.R. Partchronic, some are intermittent and acute. Yet the
4 (known as the "rating schedule"). The ratingrating schedule completely ignores such
schedule is designed to compensate veteransdifferences. Instead, it lumps all psychiatric
based on the average impairment of theirdisorders together and evaluates them under the
industrial (or earning) capacity. Explained simply,exact same list of symptoms. See 38 C.F.R.
the rating schedule is a collection of disabilities,§ 4.130. This is both inherently inconsistent
grouped by body systems that delineate a groupand illogical. The DSM diagnostic criteria are
of different symptoms in an increasing order ofexpressly adopted, but fundamental differences
severity. Percentages of disability are assigned toamong various psychiatric disorders are virtually
each level of symptoms from zeroignored.
(non-compensable disabling) to one hundredConsequently, the VA should initially undertake a
percent (totally disabling) in ten percentcomprehensive review of the rating schedule in
increments. Each disorder is assigned an identifyingconcert with medical, psychiatric and vocational
diagnostic code. If a particular disorder is notexperts. New rating criteria should be developed
listed, it is rated by analogy to a listed disorderthat take into account not only impairment in
that most closely approximates it. See 38 C.F.R.industrial capacity, but also the psychiatric effects
§ 4.20. Multiple disability ratings are combinedof physical disability and the effect of physical and
according to a complex tabulation matrix, ratherpsychiatric disability on the veteran's quality of life.
than added together, to produce a combinedVVA often advocates for a "Veterans' Health
rating of all service-connected disabilities. See id,Care System", rather than a health care system
§ 4.25. Essentially, the adjudicator reviewsfor veterans, based on the unique nature of
the medical evidence of record, finds theveterans' disabilities. Such disabilities are incurred in
compatible diagnostic code and compares theunique ways and have unique consequences. It is
clinical evidence of the severity of the veteran'sthe very "veteran-ness" of a veteran's disability
current symptoms with the list of symptomsthat demands a system of evaluating disabilities
under that diagnostic code. The commensuratethat keeps pace with technology, current medical
rating percentage is assigned. Each year, Congressstandards and practices, socioeconomic factors
sets the monetary level of compensation forand individual self-esteem.
each percentage level.Once the rating schedule has been adequately
Anyone would be hard pressed to say that therevised, it may be utilized just as it is today. It
VA's rating schedule even approaches perfection.works logically, the documented symptomology is
It is antiquated, imprecise, and vulnerable to greatcompared with the diagnostic criteria and a
subjectivity and does not take into account thecommensurate rating results. As long as Congress
diminution of a disabled veteran's quality of life.sets adequate payment levels for the various
However, given the uniqueness of the veterans'ratings (which, in equity, should be higher than
benefits system, the rating schedule, in principle,they currently are), veterans should receive
does serve its essential purpose. With certainadequate compensation.
refinements, the rating schedule may be able toMeaningful Accountability and Training of VA
live up to its original expectations.Adjudication Personnel
Part of the current problem with the ratingIt is axiomatic that a system is only as good as
schedule is that it was formulated at a time whenthe people who run it. The VA disability
disabled veterans were returning home fromcompensation system can be flawlessly designed;
World War II. Veterans were universally admiredhowever, if the personnel who operate it not are
and their disabilities were, for the most part,not adequately trained, supervised and held
clear-cut. Orthopedic injuries, amputations,accountable for repeated errors, the system will
psychiatric disorders; these are known quantities.grind toward disaster.
Since World War II, however, veterans haveIn a recent rather disturbing press conference,
returned with more insidious illnesses. DiseasesVA Secretary R. James Nicholson, Inspector
such as hepatitis C and HIV (which were unknownGeneral Richard Griffin and Under Secretary for
until decades later), diseases as the result ofBenefits Daniel Cooper, announced a May 19,
exposure to chemical, biological and/or radiological2005, VA Inspector General's (IG) Report, entitled
agents, mysterious syndromes such as Gulf War"State Variances in VA disability Payments". The
Illness and chronic fatigue syndrome, were notreport was generated following newspaper
contemplated by the framers of the original ratingreports of low disability compensation payments
schedule.for Illinois veterans as compared to veterans in
In the 1940s, the United States was more of another states. In response, several Illinois
industrial society. Quite naturally, the emphasisRepresentatives requested the VA investigate
within the VA disability compensation scheme wasthe disparity. Following the investigation, the IG
on the impairment of a veteran's earning capacity.conceded that variances in average disability
However, times have changed. Advances incompensation payments by states have existed
medicine have allowed for qualitatively greaterfor decades, and stated that "[p]ayments by
treatment, cures and rehabilitation. Medicalstate are affected by legislated pay increases, an
knowledge has increased exponentially in the lastantiquated rating schedule, veteran demographics
five decades, diagnostic tools have been refinedand inconsistent rating decisions [including] claims
and today's medical professionals are practicingprocessing practices, disability examinations,
medicine in ways that could not have beentimeliness pressures, staffing levels, rate
envisioned by doctors even two generations ago.experience and training, and fraud." Executive
Yet the rating schedule remains static. While newSummary and Management Comments of State
disorders have been added from time to time andVariances in VA Disability Compensation
the symptoms listed in the diagnostic codes havePayment¸ IG Report No. 05-00765 (May 19,
been updated here and there, it is long past time2005) at x. The IG further concluded that "some
for a wholesale revision of the rating schedule todisabilities are inherently prone to subjective rating
bring it in synchronization with the state ofdecisions, especially for conditions such as PTSD
modern medicine and American society.where much of the information needed to make
One example of the inadequacy of the currenta rating decision is not physically apparent and is
rating schedule is rather glaring. VA regulationsmore susceptible to interpretation and judgment
have historically adopted the nomenclature and[which] leads to inconsistency in rating decisions."
diagnostic criteria of the American PsychiatricId.
Association's Diagnostic and Statistical Manual of