Posted on: Monday, December 6, 2004

MILITARY UPDATE

By Tom Philpott

More than two years after congressional auditors identified the problem, the Department of Veterans Affairs still has no way to assess whether its 57 regional offices are consistent in deciding disability claims for veterans suffering from the same type and severity of impairment.

The Government Accountability Office, in recent briefings for two House subcommittees, said that where veterans live and where they file disability claims could affect disability ratings and so their compensation.

The report urged the VA to use data collected through a newly implemented information system, called RBA 2000, to identify "indications" of inconsistencies among regional offices in award and denial of benefits. Then, where inconsistency even appears to exist for specific impairments, the VA should conduct "systematic studies" of claim decisions for the specific ailments. The auditors indicated that this process could take several years.

This fiscal year the VA will pay $25 billion in disability compensation to 2.7 million disabled veterans. The VA regularly audits the overall accuracy of disability decisions. But those reviews don't measure the consistency of claim decisions overall or for specific impairments.

Randy Reese, national service director for the Disabled American Veterans, said individual veterans can only guess whether they've been treated equitably by the claim adjudicators in comparison to peers. But the DAV, with national service officers in every state, confirms that inconsistencies in VA decision-making exist between regions and sometimes within regions, between individual disability rating boards, Reese said.

The greatest inconsistencies occur with mental disorders such as post-traumatic stress disorder, he added said.

"A lot of that has to do with how they interpret information," Reese said. "Some grant PTSD very liberally, using a broad and liberal interpretation of the law, a requirement" under Code of Federal Regulations guidelines. "In another region, it will be construed very narrowly."

Inconsistency in decision-making over PTSD is of particular concern now with so many soldiers and Marines exposed to trauma in Iraq. Mental health experts estimate that 15 percent to 17 percent of personnel serving tours there will return with symptoms of post-traumatic stress.

A study published last July in the New England Journal of Medicine, written by Dr. Charles W. Hoge and five medical colleagues, found "a significant risk of mental health problems" for ground forces in Iraq. It also found "important barriers" to their receiving mental health services, "particularly the perception of stigma among those most in need."

The study found lower incidence of PTSD among service members sent to Afghanistan, where combat has been less intense and troops are exposed to fewer bombings and ambushes by insurgents.

Through last June, of 195,000 separated veterans who had served in Iraq or Afghanistan, 16 percent — almost 30,300 — had sought VA healthcare for a wide range of medical and psychological ailments.

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