A 21st Century System for Evaluating Veterans for Disability Benefits (2007) / Chapter Skim
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3 Impairment, Disability, and Quality of Life
3 Impairment, Disability, and Quality of Life
Pages 69-91
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From page 69... ...
"impairment in earnings capacity." This chapter begins with a section that provides a model of disability and defines our understanding of quality of life and impairment in earning capacity, as well as other concepts used in the model, including medical impairment and limitations in the activities of daily living. A MODEL OF DISABILITY AND DEFINITIONS The most useful model for purposes of this report was developed by an earlier Institute of Medicine (IOM)
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70 EVALUATING VETERANS FOR DISABILITY BENEFITS FIGURE 3-1 The four domains of disablement (IOM, 1991:Figure 4)
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From page 71... ...
It may be a secondary consequence of yet another impairment, as when a person has a shorter leg from an injury and later develops arthritis in the hip because the abnormal gait resulting from the short leg causes trauma in the joint. Disability compensation systems, such as VA's or workers' compensation programs, generally determine the amount of compensation by rating the severity of the permanent impairment -- the sequelae or residuals of a disease or injury.
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From page 72... ...
actual loss of earnings resulting from the injury or disease and (2) presumed loss of earning capacity [or impairments of earning capacity]
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From page 73... ...
These include range of motion of limbs and decreased capacity of an organ (loss of breathing capacity of the lung has already been described above) : • Thigh, limitation of flexion of (5252)
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. The Veterans Health Administration (VHA)
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From page 75... ...
Work disability refers to the loss of earning capacity (or impairment in earning capacity) or the actual loss of earnings resulting from an injury or disease.
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The current role of these broader measures of outcomes such as HRQOL is to expand the scope of evaluation research and the scope of policy making. More research is needed to better understand how HRQOL relates to work disability, including loss of earning capacity.
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From page 77... ...
77 IMPAIRMENT, DISABILITY, AND QUALITY OF LIFE increases in the incidence and prevalence of morbidity and accompanying disabilities (IOM, 1997)
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From page 78... ...
The term domain is used to describe the physical, psychological, and social aspects of an individual's activities. For example, measures of physical impairments, which might include anatomical or physiological abnormalities, are thought to contribute to overall function and quality of life.
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From page 79... ...
7 IMPAIRMENT, DISABILITY, AND QUALITY OF LIFE • The information age has educated individuals about what is possible • The public has higher expectations about what can be achieved by an individual following illness and injury • The Americans with Disabilities Act has identified regulations about the need to remove environmental barriers and increase opportunities for people with disabilities • Medical practice and health services have advanced such that amelioration of disability and restoration of function is feasible with greater frequency In general, the health-care establishment is committed to helping reduce the burden of disease, but has become increasingly aware of patient priorities, which include the desire to be independent, to maintain valued activity, and to have a sense of well-being in all aspects of daily life -- in short, to achieve a good quality of life. The Centers for Disease Control and Prevention (CDC)
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From page 80... ...
These include scars, minor hearing loss, and loss of a procreative organ. The Canadian veterans disability compensation program and some provincial workers' compensation programs compensate for loss of QOL.
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Although intended to compensate for losses suffered despite ability to work, Sinclair and Burton's study of the Ontario workers' compensation program found that impairment ratings based on the AMA Guides did not well predict loss of quality of life (Sinclair and Burton, 1995)
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From page 82... ...
The second approach pays permanent partial disability benefits after a determination of the worker's loss of earning capacity, based on the extent of permanent impairment and other factors, such as his or her age and previous work experience. A few states pay permanent partial disability benefits based on the worker's actual wage losses, which is much more complicated to administer.
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From page 83... ...
, chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events) .10 Although the veterans disability compensation program borrowed the ideas of a schedule of monthly benefits for particular impairments and loss of earning capacity from workers' compensation, some significant changes were made.
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From page 84... ...
benefit and, further, allowing individuals who do not meet the minimum schedular rating degree to quality for IU to appeal to the administrator for total disability benefits. Perhaps because earning capacity is not the same as actual earnings, successive VA Rating Schedules, including the current one, have not been based on empirical comparisons of the actual earnings of veterans at the various rating levels with veterans who are not rated for disability.
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From page 85... ...
PURPOSE OF SERVICE-CONNECTED DISABILITY COMPENSATION Compensation for average loss of earning capacity is the official statutory purpose of the veterans disability compensation program. The concept of average loss dates from the War Risk Insurance program amendments of 1917: 11 The ECVARS is also discussed in Chapter 4 and in Appendix C
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From page 86... ...
The statutory purpose is clearly economic: To compensate veterans for "the average impairments of earning capacity resulting from such injuries in civil occupations." The intent may not have been to compensate for each individual's actual loss 12 The Bureau referred to in the law is the Bureau of War Risk Insurance, a predecessor agency of today's VA.
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From page 87... ...
. Another view of the purpose of the disability compensation program is that it is in part an indemnification against enduring losses, such as blindness, amputation, or PTSD, and other permanent effects, such as pain, and it includes losses that do not seem likely to affect a veteran's earning capacity or ability to work.
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From page 88... ...
These expansions of the conditions covered by the Rating Schedule have been ad hoc, however, and may not address the full range or extent of nonwork impacts of injuries and diseases suffered while in military service. A clear legislative statement of the purpose or purposes of the veterans disability compensation program would be tremendously helpful in evaluating and updating the Rating Schedule and the procedures for its application, which would include the appropriateness of the rating criteria, which tests and examinations should be used, and determination of the appropriate types and amounts of expertise needed for implementation, such as using medical rather than vocational experts.
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From page 89... ...
The purpose of the current veterans disability compensation program as stated in statute currently is to compen sate for average impairment in earning capacity, that is, work dis ability. This is an unduly restrictive rationale for the program and is inconsistent with current models of disability.
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1997. VA disability compensation: Disability ratings may not reflect veterans' economic losses.
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Presentation to the IOM Committee on Medical Evaluation of Veterans for Disability Compensation, Washington, DC, May 25. Perlin, J., L
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