A 21st Century System for Evaluating Veterans for Disability Benefits (2007) / Chapter Skim
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D The Role of Medical Personnel in Selected Disability Benefit Programs
D The Role of Medical Personnel in Selected Disability Benefit Programs
Pages 362-373
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From page 362... ...
Appendix D The Role of Medical Personnel in Selected Disability Benefit Programs This appendix describes some of the major features of five major disability benefit programs: 1. Veterans disability compensation 2.
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From page 363... ...
363 APPENDIX D Program Administration The Veterans Benefits Administration within the Department of Veterans Affairs administers the veterans disability compensation program. Program References Program rules and operating procedures are primarily contained in 38 U.S.C 1100ff; 38 CFR Parts 3 and 4; VA's Compensation and Pension Adjudication Manual M21-1MR; and various program guides and worksheets.
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364 EVALUATING VETERANS FOR DISABILITY BENEFITS a rating veterans service representative (RVSR) , a layperson trained in rating principles and VA's Schedule for Rating Disabilities (Rating Schedule)
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365 APPENDIX D education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy, regardless of whether such work exists in the immediate area in which he lives, or whether a specific job vacancy exists for him, or whether he would be hired if he applied for work.2 Health-Care Professional Role SSA's rules require that the existence of a "medically determinable impairment" (in other words, a diagnosis) be established by evidence from an "acceptable medical source," generally a physician or, for specific kinds of impairments, a psychologist, optometrist, podiatrist, or speech-language pathologist.
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366 EVALUATING VETERANS FOR DISABILITY BENEFITS Appeals Council, a panel of judges that reviews administrative law judge decisions. After exhausting these administrative appeals, claimants may seek further relief in the federal courts.
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367 APPENDIX D Health-Care Professional Role The military services rely on a multistep process, referred to as the DoD Disability Evaluation System, to evaluate fitness for duty when there has been an illness or injury that may affect a servicemember's ability to perform his or her job. The process begins with a referral to a medical evaluation board (MEB)
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BENEFITS UNDER FECA FECA provides for workers' compensation benefits to civilian federal employees who are not covered by state-run workers' compensation programs for work-related illnesses and injuries. Benefits include cash compensation, medical coverage, and vocational rehabilitation.
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36 APPENDIX D Claimants are rarely found to have total disability, which is considered only in catastrophic injuries or long-standing chronic conditions after all attempts at rehabilitation have failed. This is true even for impairments that the law states are "prima facie" evidence of permanent total disability (loss of both hands, arms, feet, or legs, or the loss of sight of both eyes)
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370 EVALUATING VETERANS FOR DISABILITY BENEFITS Health-Care Professional Role OWCP administers the FECA program nationally through a network of 12 district offices, each of which has a significant medical staff: • The district medical director is a physician7 employed by OWCP who has administrative oversight of the medical functions of the district office, and also serves as liaison with the medical community and federal employers within the district office's jurisdiction. The district medical director administers the district office's network of district medical advisors (discussed below)
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371 APPENDIX D by the American Board of Medical Specialties. Consequently, most referee examiners are board certified, although this is not a requirement.
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372 EVALUATING VETERANS FOR DISABILITY BENEFITS TABLE D-1 Summary of the Role of Medical Personnel in Selected Disability Benefit Programs VA SSA Treating physiciana Treating physicians are a Treating physicians are provides medical evidence? source of evidence.
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From page 373... ...
373 APPENDIX D DoD CSRS, FERS FECA Treating physicians are a Treating physicians are Treating physicians are source of evidence. usually the main source of usually the main source of evidence.
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