Proposed Joint Physical Disability Evaluation System

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From the Army Times:

Pentagon proposes joint disability system

By William H. McMichael- Staff writer
Posted : Thursday Jul 19, 2007 20:03:29 EDT
The Defense Department is proposing a joint disability rating system that would give seriously injured troops one physical exam and one review board while still on active duty — an effort to unify and shorten the current process some troops must endure with both the military and Veterans Affairs Department.
If successful, said Bill Carr, deputy undersecretary for military personnel policy, “we will have cured many of the major maladies of the system.”
Carr also announced during a hearing of the Veterans’ Disability Benefits Commission in Washington July 19 that the Pentagon will soon launch a pilot medical evaluation program in the Washington area. The idea, Carr said, is to adopt a mindset along the lines of, “Let’s create a new disability system.”
Together, the moves could help refute widespread criticism of the Defense Department, and the Army in particular, following the scandal several months ago at Walter Reed Army Medical Center, where injured outpatient combat troops faced a disturbing tangle of red tape during their treatment and medical evaluation process that highlighted what critics have said are broader gaps in the system.
Among other issues, the Pentagon was criticized for having allowed the services to establish and run their own decentralized disability review systems, which led to charges that the Army, the service with by far the largest number of injured troops, has downplayed the severity of soldiers’ injuries and disability ratings in an effort to hold down budget costs. Defense and Army officials have denied that charge.
The 13-member commission supports the Pentagon initiative, said retired Army Lt. Gen. Terry Scott, the chairman.
“The problems at Walter Reed and many other places were essentially generated by bottlenecks” in the current process, Scott said. “Too many people hanging around for too long without the decisions they should have had.”
But, he told Carr and the VA representatives on the panel, “I hope that while you’re designing a good future system, that all concerned are working hard to keep that backlog from building up at Fort Sam [Houston] or Walter Reed or wherever.”
The Pentagon hopes to send to Congress by Thanksgiving a package of proposed legislation that would codify what Carr termed an “ideal system.” The effort will commence in August with a multi-week tabletop exercise, with actual physicians and service rating panels using test cases “well-crafted to bring out concerns each of us might have about the system ... we’ll actually run them through as if they were real cases.
“Rather than running people through the pilot, we want to run paper through it,” Carr said. “But not in some wish-the-problem-away fashion. It’s going to be a very tough drill.”
Currently, if doctors suspect an injured service member might have difficulty continuing to serve, he or she is sent to a medical evaluation board made up of active-duty physicians not actively involved in the member’s care. If the board decides the member’s condition might warrant ending his or her service, the case is forwarded to a physical evaluation board.
The PEBs, run by a service’s personnel department and usually composed of a line officer, personnel officer and a medical officer, is a formal military fitness-for-duty and disability determination board that can recommend:
• Placement on the temporary disabled retired list, or TDRL, if there is a chance the condition might improve with time.
• Separation from active service, possibly with a one-time, lump-sum severance payment.
• Placement on permanent medical disability retirement, with lifetime retired pay, military health care and other benefits.
• A return to duty, with or without assignment limitations.
If the board decides a service member is unfit for duty, it determines whether he or she should receive compensation. If so, the PEB rates it on a scale from zero to 100 percent. The rating determines the nature and amount of Defense Department disability benefits.
A rating of at least 30 percent is required for permanent medical disability retirement.
Regardless of whether members are medically retired or simply separated, they can go on to seek VA compensation and benefits if they choose. But that requires a new physical evaluation and a forced weave through yet another bureaucratic maze — not to mention waiting for a decision from the VA, which currently has a backlog of hundreds of thousands of pending benefits claims that it has been unable to contain.
Carr said he understands the frustration that all this causes.
“Clearly, if we can do [it] all in one step, all the better,” he said.
But while the Pentagon’s plan might bring uniformity to the system within the Defense Department, it won’t help remedy what critics say is a major flaw in the system — that the Defense Department and VA often give different ratings for the exact same medical condition.
Military personnel experts say that’s because the systems look at disabilities from different perspectives; the services focus on fitness for military duty, while the VA measures potential loss of future earnings.
With that in mind, a single evaluation along the lines of what the Pentagon is proposing, Carr said, would allow for two possible appeals: an “unfit for duty” finding could be appealed to the Defense Department, and/or the disability rating could be appealed to VA.
A retired Army officer who closely follows the debate and has testified before the commission says the Pentagon’s proposal is a major step forward.
“The joint disability rating board is a very good and long-overdue idea,” said Michael Parker. “It will go a long way towards ensuring consistent disability evaluation policies and ratings. Having the VA rate the unfitting conditions will not only lead to more consistent and accurate ratings, it will also give the disabled service member a much-needed head start on his VA disability ratings and benefits.”
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