A 21st Century System for Evaluating Veterans for Disability Benefits (2007) / Chapter Skim
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2 Veterans with Disabilities in the 21st Century
2 Veterans with Disabilities in the 21st Century
Pages 36-68
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The numbers and types of claims submitted to the Department of Veterans Affairs (VA) for disability compensation depend on a number of variables, some of which are demographic.
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As protective equipment, frontline emergency medicine, and medical evacuation techniques improve, more seriously injured servicemembers will survive at a higher rate. For example, the average time to evacuate a wounded servicemember from the battlefield to stateside care is 3 days, compared with 10 to 14 days during the Persian Gulf War in 1991 and 45 days during the Vietnam War (U.S.
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. Of the first 433 traumatic brain injury patients seen at Walter Reed Army Medical Center between January 2003 and April 2005, 89 percent had closed-head brain injuries rather than penetrating wounds (Warden, 2006)
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This means that individuals who served in OEF/OIF are counted as Gulf War veterans if they separate from service before 2008 and as Post Gulf War veterans if they separate in 2008 or later.
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. 2-02 VA does not forecast the number of veterans it expects to apply for or be granted disability benefits beyond the next few years, but experience has shown that more recent veterans tend to apply at higher rates, and that the percentage of veterans service connected for disability compensation has been increasing accordingly.
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. As a result, Gulf War veterans will constitute 29 percent of service-connected beneficiaries in 2008, compared with 14 percent in 2000.
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Conditions can be rated 0 percent when they have been determined by VA to be service connected and disabling, but not to the extent that they would affect an average veteran's ability to work.11 If a veteran has more than one rated condition, VA calculates a combined percentage intended to represent the net impact of the multiple conditions on the veteran. For example, a 40 percent rating and a 20 percent rating result in a combined rating of 50 percent.
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Of the total of 7.7 million conditions, the largest number is rated 10 percent, followed by conditions rated at 0 percent. Only 3 percent are rated 100 percent (Figure 2-6)
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In FY 2005, posttraumatic stress disorder (PTSD) was the major diagnosis for the largest number of veterans, or 203,000, followed by diabetes mellitus and tinnitus, each with 102,000 (left half of Table 2-1)
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The most numerous service-connected conditions in FY 2005 were defective hearing (354,000 ratings) , tinnitus (340,000 ratings)
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220,532 weakness (5295) 9 Defective hearing 70,915 Hypertensive vascular 193,055 (6100–6110)
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Conditions by Period of Service Prevalence and distribution of disabling conditions vary somewhat by service period, reflecting age and other differences, such as attitudes about The Millennium Cohort is a longitudinal study of the health effects of military service. It will follow more than 100,000 servicemembers for 22 years through 2025 using standardized instruments (Ryan et al., 2007)
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.15 Hearing impairments are very prevalent among veterans of all periods of service. In FY 2005, tinnitus ranked among the top five most prevalent service-connected conditions for all periods of service, and defective hearing ranked among the top five in all periods except the Gulf War (Appendix Table 2-2)
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Musculoskeletal conditions are the most prevalent disorders among Gulf War and peacetime veterans, along with hearing impairment. Women Veterans Between 1990 and 2000, the population of women veterans increased by one-third, from 1.2 to 1.6 million.
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Most (84 percent) of the grants to women for disability compensation made during 2004–2006 were to women younger than age 50, and 78 percent were to Gulf War veterans (the comparable figures for men granted disability compensation were 41 and 45 percent, respectively)
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Gulf War 1,896,602 924,089 (49%)
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. The conditions that were granted service connection or higher rating were the same five, in different order: tinnitus, defective hearing, 60% 50% 2004 2005 2006 Percent of Total Annual Grants 40% 30% 20% 10% 0% WWII Korea Vietnam Peacetime Gulf War Period of Service FIGURE 2-9 Percent of conditions granted service connection or higher rating, by period of service, CY 2004–CY 2006.
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Five conditions accounted for almost half (48 percent) of the 58,000 conditions that were service connected and rated 100 percent during CY 2004–CY 2006: malignant neoplasms of the genitourinary system (prostate cancer)
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All diagnostic codes 58,326 All diagnostic codes 6,185 NOTE: The counts in this table are of diagnoses, not of individual veterans. Grants of higher ratings of already service-connected disabilities are not included in this table.
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The most numerous conditions service connected and rated 100 percent among Gulf War veterans were (in descending order) PTSD, loss of use of both feet, malignant neoplasms of the genitourinary system, major depressive disorder, and impairment of sphincter control (right side of Table 2-4)
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. VA reported only the 10 most numerous disability conditions at all combined rating degrees; the most numerous conditions rated 100 percent are unknown.
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Congress, Senate and House of Representatives, Com All the differences between the blast-injured and non-blast-injured cited above are statistically significant. Another VA document says, "Through December 2005, the Polytrauma Rehabilitation Centers provided inpatient rehabilitation treatment to 245 OEF and OIF service members with severe traumatic brain injury" (VA, 2007b)
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. Another source of information on the potential disability status of OEF/ OIF veterans is the types of conditions for which they seek health care at the Veterans Health Administration (VHA)
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, and the same percentage of those who have left active service apply for disability compensation as did veterans of the first Gulf War as of September 30, 2001 (about 33 percent) , VA can expect to receive about 290,000 claims from veterans of OEF/OIF.
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org/sm/presentations/Feb07-B.ppt#293,1,Force Health Protection (accessed March 14, 2007)
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PowerPoint presentation by the Chief Research and Development Officer, Veterans Health Administration, VA. http://www.academyhealth.org/2006/kupersmith.pdf (accessed March 9, 2007)
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2001b. Veterans Benefits Administration annual benefits report for fiscal year 2000.
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2006b. Veterans Benefits Administration annual benefits report for fiscal year 2005.
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64 EVALUATING VETERANS FOR DISABILITY BENEFITS APPENDIX TABLE 2-1 Individual Service-Connected Conditions by Rating, FY 1995 and FY 2005 FY 1995 FY 2005 Number of Rated Percent of Number of Rated Percent of Rating Conditions Total Conditions Total 0% 1,775,993 34.9% 2,363,021 31.0% 10% 1,894,441 37.2% 3,052,872 40.0% 20% 476,706 9.4% 813,832 10.6% 30% 433,832 8.5% 593,025 7.7% 40% 145,030 2.9% 212,238 2.8% 50% 91,040 1.8% 166,344 2.2% 60% 88,745 1.7% 142,177 1.8% 70% 27,916 0.5% 97,526 1.3% 80% 9,008 0.2% 10,331 0.1% 90% 2,669 0.1% 3,202 * 100% 140,905 2.8% 221,219 2.9% Total 5,086,285 100.0% 7,675,787 100.0% *
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19,808 5.6% Scars, other 15,476 4.4% PTSD 10,994 3.1% Arthritis, due to trauma 10,030 2.8% Scars, superficial, tender and painful 7,147 2.0% Duodenal ulcer 6,825 1.9% Scars, disfiguring, head, face, or neck 5,758 1.6% Generalized (analogous to) musculoskeletal 5,552 1.6% conditions All 355,344 100.0% Vietnam Diabetes mellitus 190,199 6.9% PTSD 179,737 6.5% Defective hearing 129,323 4.7% Scars, other 121,850 4.4% Tinnitus 120,625 4.4% Generalized (analogous to)
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66 EVALUATING VETERANS FOR DISABILITY BENEFITS APPENDIX TABLE 2-2 Continued Percent Period of Number of of All Service Condition Conditions Conditions Gulf War Generalized musculoskeletal conditions 131,092 5.9% Tinnitus 104,039 4.7% Arthritis due to trauma 100,374 4.5% Other impairment of knee 81,677 3.7% Hypertensive vascular disease 64,558 2.9% Lumbosacral strain 61,658 2.8% Scars, other 60,350 2.7% Defective hearing 60,023 2.7% Arthritis, degenerative, hypertrophic, or 54,042 2.4% osteoarthritis Limited motion of ankle 53,002 2.4% All 2,233,479 100.0% Peacetime Generalized musculoskeletal conditions 78,233 4.9% Other impairment of knee 77,768 4.9% Arthritis due to trauma 68,068 4.2% Defective hearing 64,013 4.0% Tinnitus 60,278 3.8% Scars, other 54,823 3.4% Hypertensive vascular disease 50,247 3.1% Lumbosacral strain 44,736 2.8% Arthritis, degenerative, hypertrophic, or 39,646 2.5% osteoarthritis Intervertebral disc syndrome 37,103 2.3% All 1,602,697 100.0% SOURCE: VA (2006b)
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67 VETERANS WITH DISABILITIES IN THE 21ST CENTURY APPENDIX TABLE 2-3 20 Most Frequent Service-Connected Conditions Among Women and Men, 2004–2006 Women Men Number of Number of Condition Grants Condition Grants Lumbosacral or cervical strain 11,113 Tinnitus 161,090 Migraine 10,255 Defective hearing 135,394 Tinnitus 5,901 Diabetes mellitus 85,005 Scars, other 5,807 PTSD 74,491 Limitation of flexion of leg 5,566 Hypertensive vascular disease 51,033 Major depressive disorder 5,378 Lumbosacral or cervical strain 50,136 Tenosynovitis 5,155 Penis, deformity with loss of 38,719 erectile power Degenerative arthritis of the 4,997 Paralysis of sciatic nerve 38,356 spine Scars, superficial, tender, and 4,847 Degenerative arthritis of the 36,672 painful spine Allergic or vasomotor rhinitis 4,687 Limitation of flexion of leg 35,798 Hernia, hiatal 4,671 Scars, other 33,537 Eczema 4,443 Limited motion of the ankle 30,182 Limited motion of the ankle 4,258 Arthritis, due to trauma 29,306 Flatfoot, acquired 3,992 Hernia, hiatal 25,251 Hypertensive vascular disease 3,734 Scars, superficial, tender, and 24,924 painful Asthma, bronchial 3,534 Tenosynovitis 24,806 PTSD 3,313 Eczema 23,666 Hallux valgus 3,303 Paralysis of the median nerve 22,227 Arthritis, due to trauma 3,236 Intervertebral disc syndrome 20,929 Paralysis of the median nerve 2,988 Arteriosclerotic heart disease 19,854 SOURCE: VA (2007c)
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From page 68... ...
. APPENDIX TABLE 2-5 Frequency of Mental Diagnoses Among Recent Veterans of Iraq and Afghanistan Disease Category (ICD-9CM Code)
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