A 21st Century System for Evaluating Veterans for Disability Benefits (2007) / Chapter Skim
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6 Medical Criteria for Ancillary Benefits
6 Medical Criteria for Ancillary Benefits
Pages 201-231
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From page 201... ...
breaks down veterans benefits into two categories -- ancillary and special. The Veterans' Disability Benefits Commission asked the committee to focus on the appropriateness of medical criteria for five specific ancillary benefits available to veterans with disabilities: vocational rehabilitation and employment (VR&E)
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, the veteran or serviceperson must be entitled to disability compensation for ankylosis of one or both knees or hips based on: • the establishment of service connection, or • entitlement under 38 U.S.C. 1151 as the result of − VA treatment or examination, − compensated work therapy, or − vocational training under 38 U.S.C.
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Perhaps the most important benefit provided to veterans with serviceconnected disabilities is priority access to free health care for all medical care needs from the Veterans Health Administration (VHA)
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• Service-disabled veterans' insurance (maximum of $10,000.00 coverage) , must file within 2 years of date of new service connection • 10-point civil service preference (10 points added to civil service test score)
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based on individual percent (in unemployability (applies to veterans who are unable to obtain or maintain addition to substantial gainful employment due solely to the service-connected the above) disability)
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Veterans with service-connected conditions rated at any percentage, from zero percent and higher, receive care for the condition(s) that are service connected, without requiring a copayment.
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5 • Veterans receiving VA pension benefits or eligible for Medicaid programs • Nonservice-connected veterans and noncompensable, zero percent service connected veterans whose annual income and net worth are below the established VA means-test thresholds 6 • Veterans of the Mexican border period or World War I • Veterans seeking care solely for certain conditions associated with exposure to radiation or exposure to herbicides while serving in Vietnam • For any illness associated with combat service in a war after the Gulf War or during a period of hostility after November 11, 1998 • For any illness associated with participation in tests conducted by the Department of Defense (DoD) as part of Project 112/Project SHAD • Veterans with zero percent service-connected disabilities who are receiving disability compensation benefits 7 Nonservice-connected veterans and noncompensable, zero percent service connected veterans with income above VA's national means-test threshold and below VA's geographic means-test threshold or with income below both the VA national threshold and the VA geographically based threshold, but whose net worth exceeds VA's ceiling ($80,000 in 2006)
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From page 208... ...
; • supportive rehabilitation services and additional counseling; and • for veterans whose disabilities are so severe they cannot currently consider employment, a program of services to assist in achieving independence in daily living.2 To be eligible for VR&E services, a veteran must have a serviceconnected disability of at least 20 percent with an employment handicap or at least 10 percent service-connected disability with a serious employment handicap, and be discharged or released from military service under other than dishonorable conditions.3 Servicemembers pending medical separation VA's Compensation and Pension Adjudication Procedure Manual, M21-1MR, Part 9, Subpart i, Ch. 1, Topic 1; and VA (2006a)
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38 CFR §21.52. VA's Compensation and Pension Adjudication Procedure Manual, M21-1MR, Part 9, Subpart i, Ch.
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However, veterans, when separating from active duty, are not systematically evaluated and given information to make informed career and employment decisions based on their vocational abilities at the time of the initial service-connected disability decision or subsequent disability decisions. If they are rated 20 percent or higher, they are informed of possible eligibility for VR&E services, but it is left to the veteran to initiate an application for services and be evaluated by a counselor.
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From page 211... ...
. As a near-term priority, the task force recommended the design and implementation of pilot formal vocational assessment projects, and suggested that VBA program and technical capabilities be leveraged by colocating the pilot project office with VBA's C&P Examination Program (CPEP)
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212 EVALUATING VETERANS FOR DISABILITY BENEFITS The tracks include • reemployment services to help a veteran return to a former civilian job and assistance in understanding rights under the Uniformed Services Employment and Reemployment Act; • rapid access to employment, which entails assistance in finding a job with government agencies and private corporations that have positions reserved for veterans (e.g., Department of Labor ReaLifeLines, Army Materiel Command, Army Wounded Warrior Program, Marine For Life Injured Support Program, Military Severely Injured/Disabled Operations Center, Home Depot Initiative, YMCA & Armed Forces YMCA Initiative, Helmets to Hardhats Initiative, VA Coming Home to Work Initiative) ; • employment through long-term services, such as specialized training and/or education, on-the-job training, apprenticeships, internships, job shadowing, higher education (about 80 percent of veterans in a current VR&E plan to attend college)
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213 MEDICAL CRITERIA FOR ANCILLARY BENEFITS In response to written questions submitted at a 2005 congressional hearing on the IU program, the following data on the VR&E program were provided: • The average number of days from the point of entering the evaluation/planning phase to the determination that the veteran has achieved rehabilitation is 933 days • The top five occupational categories veterans are rehabilitated into are professional, technical, or managerial; clerical; services; structural (building trades) ; and machine trades • The average salary of a suitably employed rehabilitated veteran in FY 2005 was $39,600 • As of September 30, 2005, the VR&E program had a total of 625 vocational rehabilitation counselors and counseling psychologists • The average workload per counselor was 150 cases • In FY 2005, 34,038 veterans received favorable VR&E entitlement determinations.
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214 EVALUATING VETERANS FOR DISABILITY BENEFITS • 7 veterans have been hired directly by their work experience employers upon discharge from active duty (U.S. Congress, House of Representatives, Veterans' Affairs Subcommittee on Economic Opportunity, 2007:4-5)
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215 MEDICAL CRITERIA FOR ANCILLARY BENEFITS Another joint effort with DOL is the Disabled Transition Assistance Program (DTAP) , which involves intervening on behalf of servicemembers who may be released because of a disability or who believe they have a disability qualifying them for VR&E services.
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To assist VBA in its efforts to contact servicemembers eligible to apply for disability compensation, VA and DoD are collaborating to ensure that VA is notified of servicemembers referred to the physical evaluation board and who may be medically separated or retired. Partnerships with private and not-for-profit sectors are being promoted by VA to provide veterans with early access to competitive career opportunities and training (U.S.
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217 MEDICAL CRITERIA FOR ANCILLARY BENEFITS employees or entered into independent living arrangements. For this same time period, veterans were provided VR&E services for graduate school (2,117)
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These veterans, including those with amputations, hearing and vision losses, and other conditions, are returning home and are in need of both medical and vocational attention. Modern medicine and assistive technologies both can improve their health outlook and enable them to find gainful employment of various kinds.
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reported: More than 10,000 U.S. military servicemembers, including National Guard and Reserve members, have been injured in the conflicts in Afghanistan and Iraq.
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.10 The payment must be made to the seller. To receive automobile assistance, a veteran must have acquired one of the following service-connected disabilities as a result of injury or disease incurred or aggravated during activity military service, or as a result of medical treatment or examination, vocational rehabilitation, or compensated work therapy provided by VA: • loss, or permanent loss of use, of one or both feet; or • loss, or permanent loss of use, of one or both hands; or • permanent impairment of vision in both eyes with a central visual acuity of 20/20 or less in the better eye with corrective glasses, or central visual acuity of more that 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field has an angular distance no greater than 20 degrees in the better eye; and • ankylosis (immobility)
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From page 221... ...
To be eligible to receive only adaptive equipment (as opposed to the automobile allowance) , the veteran or serviceperson must be entitled to disability compensation for ankylosis of one or both knees or hips based on the establishment of a service connection, or entitlement under 38 U.S.C.
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2101(a) , 38 CFR § 3.809, and VA's Compensation and Pension Adjudication Procedure Manual, M21-1MR, Part 9, Ch.
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2101(a) , 38 CFR §3.809, and VA's Compensation and Pension Adjudication Procedure Manual, M21-1MR, Part 9, Ch.
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1151, veterans injured while receiving medical care or training and rehabilitation services from VA are eligible as if service connected.
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The Task Force made 15 process and 10 outreach recommendations (Task Force, 2007) .22 Of particular interest for this report are Recommendations P-1 (develop a joint process for disability determinations)
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The transition for a veteran leaving military service and reentering civilian life can be difficult for a number of reasons, but it is further complicated when a veteran has become disabled in the course of his or her military service. Disability compensation is one part of the benefits package aimed at increasing the ability of veterans to succeed in the civilian world and, if they have impairments, to compensate them for their loss of earning capacity (defined as the average loss of earnings of those with the same degree of impairment)
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A broader, integrated approach to assist veterans in their transition from military to civilian life was recommended through the coordination of VA's health, VR&E, and compensation programs. An even more individualized approach was suggested by the task force, including • continuing and systematic medical examinations of veterans for better informed career and employment decisions; • early, routine functional capacity assessments by vocational experts for both disability compensation and rehabilitation decisions; and • a change from a sequential series of required steps to a more individualized sequence taking into consideration the person's education, vocational rehabilitation, and compensation needs.
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• Should age, an issue that has been raised in individual unemployability, be a factor in determining eligibility? Certainly, the cost-benefit ratio is lower (more favorable)
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22 MEDICAL CRITERIA FOR ANCILLARY BENEFITS disabilities succeed in civilian life. These include specialized research and rehabilitation centers for vision impairment, spinal cord injury, traumatic brain injury, polytrauma, and difficult-to-diagnose war-related illnesses.
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VA should develop and test incentive models that would promote vocational rehabilitation and return to gainful employment among veterans for whom this is a realistic goal.
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. VBA (Veterans Benefits Administration)
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