DOD and VA Single examination Pilot

Jason Perry

Benevolent Leader
Site Founder
Staff Member
PEB Forum Veteran
Registered Member
Press Release from the VA:


VA and DoD Pilot Single Physical
November 7, 2007

One Exam Used for “Fitness for Duty” and Disability Pay
WASHINGTON – In a landmark agreement to simplify life for service members with medical problems as they leave the military and return to the civilian world, the Department of Veterans Affairs (VA) and the Department of Defense (DoD) signed a memorandum to pilot a single physical examination to be used by both Departments.
“This agreement commits VA and DoD to develop a single process to assess the medical conditions of wounded, injured or ill service members,” said Acting Secretary of Veterans Affairs Gordon H. Mansfield. “We will make it easier for these heroes to go back to their homes, with the key questions about their eligibility for VA compensation already decided.”
The agreement, signed Nov. 6 by Mansfield and Dr. David S.C. Chu, Under Secretary of Defense for Personnel and Readiness, calls for a pilot program to evaluate a single physical examination that would be used by DoD to determine the medical fitness of injured personnel to remain in uniform and by VA for awarding disability compensation.
Today’s announcement continues progress on the recommendations of the President’s Commission on Care for America’s Returning Wounded Warriors, co-chaired by former Sen. Robert Dole and former Health and Human Services Secretary Donna Shalala.
The pilot, which begins late this month, involves VA and DoD facilities in Washington, D.C. Service members from the Walter Reed Army Medical Center, the National Naval Medical Center in Bethesda, and the Air Force’s Malcolm Grow Medical Center at Andrews Air Force Base will participate in the pilot.
Medical evaluations will be performed by VA, although the agreement notes the physicals could actually take place in VA medical centers, military installations, VA contracted examination centers or other facilities.
The memorandum says the process “lays the foundation for building a network of qualified providers and resources that will meet both DoD and VA requirements and ease the transition of members from military service to veteran status.”
The evaluations will be based upon VA’s system for disability examinations and include an examination of medical conditions identified by military physicians that call into question a service member’s fitness for duty, as well as other applicable medical conditions identified by the service member together with VA. "

It will be interesting to see how this plays out. There is still a lot of controversy over what reform will look like. Dole-Shalala recommendations have a lot of supporters, however, VDBC has come up with different recommendations. With Chairman of Senate Committee on Veterans Affairs, Sen, Akaka voicing doubts on Dole-Shalala, I think it is still in up in the air how this plays out.

This is just a pilot program, so most cases are going to be processed normally. One interesting question will be if there will be a relationship between a challenge to the exam on the VA side impacting a rating or an appeal on the DOD side. I would think that if both systems use the same exam, a succesful challenge to the sufficiency of the exam in one system should impact the decision in the other system. Not necessarily so, but it will be interesting how this is dealt with.
 

brianwl

PEB Forum Veteran
Key question I have yet to see answered is how they are going to address the Ch61 and concurrent receipt issues. Not to mention the issue of those put out with less than Ch61 retirement.
 

Jason Perry

Benevolent Leader
Site Founder
Staff Member
PEB Forum Veteran
Registered Member
No legislation on this

Been thinking about this some more. Though Dole-Shalala recommendations suggest that DOD get out of the rating process and only perform the fit vs. unfit determination, there will need to be some major legislative overhauls to implement this. It seems strange to me that they are doing this pilot program when Chapter 61 clearly still requires a full and fair hearing (including rating determination). Unless there are BIG changes, someone is going to have to provide this hearing. I don't see the VA providing hearing that is binding on DOD. Anyway you cut it, there are huge hurdles to overcome in changing the system this drastically. H.R. 1538 and S.1601 discussed in another thread seem much more workable.
 

maparker

Staff Member
PEB Forum Veteran
Registered Member
Jason,

I am already hearing there are problems. For instance, the Army does not want to accept the VA decisons on service connections and ratings for certain herditary diseases. You probably now first hand how the Army throws over board anyone with a geneitic component for their disability even if military service provided the environmental trigger that mainfested the condition. Conversely, the military will rate a bonefide EPTS condition with 8 years active duty while the VA will not but that can be fixed with simple coordination.

Of course if the Dole/Shalala plan passes of if unfit and separate, then compensate with retireement based on rank and years of service, then all of this is moot and the system becomes simple and fair. No rating needed for DoD compensation and the VA rates only for VA compensation.

Mike
 

Jason Perry

Benevolent Leader
Site Founder
Staff Member
PEB Forum Veteran
Registered Member
It's a trade off

Mike,

If the system goes to annuity based on years of service/rank after unfit finding, there will be winners and losers. I have been grappling with this one, it is of course a policy decision, arguable that there is no right or wrong answer. But, a PFC with serious injuries (rated currently at more than 30%) will get much less under such a new system than under the current one. If the VA compensation were to also increase, then the concern about reduced benefits would be addressed. On the whole, I see the annuity based system to be fair at first glance. But factor in the fact that lower ranking Servicemembers disproportionately are more grievously injured, then I am not sure this is something that is a boon to young Servicemembers.

Interesting that the Army is balking at determinations. Not surprising, but interesting. All of this will take a lot of ironing out. Please post any developments you hear on this.
 

maparker

Staff Member
PEB Forum Veteran
Registered Member
Jason,

I think the Dole Shalala system is theoretically fair. That is DoD compensates you for the career lost which has nothing to do with the degree of disability and the VA compensates you for the disability which has everything to with the disability.

Quantifying the value of the career lost is infinitely easier than quantifying the amount of earnings loss and quality of life loss across a wide range of disabilities. That is where they challenge lies.

MOAA did a study on this issue and found that the vast majority of service members came out way ahead under Dole Shalala. The greatest difference it terms of losers was junior officers who got a 70% rating from DoD and the VA. However, VDBC studies showed that this rarely happens and the VA ratings are usually much higher than DoD ratings due to DoD low balling and DoD rating only unfitting conditions. I think while one can demonstrate scenarios where one comes out behind under Dole Shalala, it takes a “perfect storm” of the conditions that rarely happens.

This can be fixed by offering both methods of calculation and the service member takes the method that pays the greater amount.

Mike
 

brianwl

PEB Forum Veteran
Jason,

"But, a PFC with serious injuries (rated currently at more than 30%) will get much less under such a new system than under the current one."

Assuming the annuity as proposed by the Dole-Shalala commission includes Tricare, I can see a definite advantage to it, especially for the young PFC you mention in my quote above.
 

Jason Perry

Benevolent Leader
Site Founder
Staff Member
PEB Forum Veteran
Registered Member
Assume 2.5%

Brian and Mike,

I guess I should have qualified my statement. What I meant was that if the annuity the Dole-Shalala Report discuses is set at 2.5% of base pay times years of service (which, by the way has been reported on but is not actually in the report...it makes sense that this is the rate used though given that many retirement calculations use this rate), the young PFC will do worse under the compensation for a career cut short (whether administered by DOD or VA).

Example: Under current rates, that PFC with 2 yrs has a base pay of $1,301.40. Under the current system, if placed on PDRL with 30% rating he will get $390.42 per month (this is a close approximation because of HI-3 averaging, which I did not calculate, either for this or for the annuity example).

Example: Same PFC is found unfit under Dole Shalala report recommendations. This time, his base pay of $1301.4 multiplied by 2.5% times his two years of service will result in a payment of $65.07 per month.

So, it is clear that from the compensation for career cut short, the PFC does better now. What about the Tricare? Well, Dole-Shalala recommend that if injuries are incurred as a result of combat/combat-related he gets health coverage for himself and dependents. He doesn't if his injuries are not combat-related. So there are potential huge disparities in the benefits from current system to proposed Dole-Shalala.

Of course, this does not end the inquiry. Dole Shalala proposes three other payments a short term transition payment, a loss of quality of life payment and a longer term earnings loss payment. And what ends up happening now is that this PFC, as a less than 20 yrs retiree, will offset all or some of his monthly DOD pay for VA compensation. If he is rated the same by DOD and VA at 30% he will get either $342,$376, $389, or $420 (for vet alone, vet plus child only,vet plus spouse only, or vet plus spouse and child).

Where does all this leave us? Well, if the purpose of the payments are as stated, presumably there will be no offset. So, except for the non-combat wounded PFC, in my example, it certainly seems that the vet will do better under Dole-Shalala. However, if this is so, the main fix seems to me to be the elimination of offset, which is the same as opening concurrent receipt to all. To me, all the gymnastics, uncertainties, etc along with the differentiation of combat/non=combat related injuries, gives me pause. Why not just eliminate prohibition of concurrent receipt if that really is the underlying fix? All that said, Mike, do you have the MOAA study? I may be missing something here and would like to see that before passing further judgment. I do agree, however, that the basic idea is fair (different types of compensation for different losses). I just worry that the details or final implementation ends up being more convoluted, puts up barriers, or lowers some class of persons benefits. Offering the greater of the two benefits (proposed versus current system) is a possible fix, though.
 
data-matched-content-ui-type="image_stacked" data-matched-content-rows-num="3" data-matched-content-columns-num="1" data-ad-format="autorelaxed">
Top