A 21st Century System for Evaluating Veterans for Disability Benefits (2007) / Chapter Skim
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4 The Rating Schedule
4 The Rating Schedule
Pages 92-138
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From page 92... ...
It should be noted that, although the practice of providing pensions for veterans with disabilities began in the English colonies in North America, the first national pension law in the United States was adopted by the Continental Congress on August 26, 1776. A number of amendments, consolidations, and veterans acts followed, leading up to the current Rating Schedule used in the determination of eligibility for disability compensation.
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From page 93... ...
. The English set a precedent for providing benefits to men disabled in the military service (President's Commission, 1956b:5)
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From page 94... ...
. The War of 1812 and the Mexican War, which intervened between the Revolutionary and the Civil Wars, did not reflect significant developments regarding the nature or scope of veterans benefits; compensation for service-connected disability was provided for veterans of these wars at their onset (President's Commission, 1956b:10)
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From page 95... ...
. Some changes in detail were made, and more liberal benefit provisions for widows, children, and dependent relatives came about, but it continued the same provisions and philosophy: The claimant must show that his disability was the result of his military service, or, if it did not arise until after his separation from service, he must show that it arose from causes which could be directly traced to injuries Fordebates on the measure, see Annals of Congress, 15th Cong., 1st Sess., 1, pp.
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From page 96... ...
. The Arrears Act was passed in 1879, and it applied to claims filed prior to 1880.
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From page 97... ...
These disabilities due to disease, however, were very difficult to establish service connection for, and brought about much of the demand for pensions, par ticularly following the Civil War and the Spanish-American War. Confused and incomplete records of all kinds gave rise to much difficulty in estab lishing the facts of service and the facts of medical records on the basis of which to establish service connection of disabilities.
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From page 98... ...
Veterans injured in service were retrained for new jobs. An average earnings impairment disability rating schedule was introduced and, for the first time, service-connected "aggravation" of preexisting conditions applied (Gosoroski, 1997)
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From page 99... ...
It also provided for presumption of service connection for tuberculosis and neuropsychiatric conditions,6 and for creation of local rating boards around the country instead of a single rating board in Washington, D.C.
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From page 100... ...
This schedule provided a disability rating based on assumptions about the skills and functions needed for specific occupations. For example, a veteran with a disability resulting from an ocular disorder would receive a higher disability evaluation if the individual worked as an accountant as opposed to a laborer with the same disability.
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From page 101... ...
However, a rating could be reduced if Legislation in 1919 established temporary and permanent disability compensation rates, payable based on the degree of reduction in earning capacity resulting from the disability (Economic Systems Inc., 2004a)
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From page 102... ...
According to a July 1954 General Accounting Office (GAO) report: The disability ratings provided in the rating schedules are not based on an actual determination of the effect of the various disabilities on the average earning capacity of individuals in civil occupations.
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From page 103... ...
The Rating Schedule contains about 700 diagnostic codes. If the veteran has a condition that is not listed in the Rating Schedule, the rater uses an analogous condition listed in the Rating Schedule to evaluate it.
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From page 104... ...
At that time, medical specialists were asked to review the Rating Schedule and respond to the following questions: • (K) Are the disability ratings in accord with present-day accepted medical principles?
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From page 105... ...
opinion, agreed with the minority that numerous disability ratings and items in the schedule need revision in the light of changes in modern treatment, both surgical and medical, as disability ratings are changed when residuals of injuries and diseases are improved by operations, prostheses, and other mechanical aids, and particularly in the light of the new dug and surgical treatment of pulmonary tuberculosis. A large number of disability ratings do not properly take into account recent advances in medical rehabilitation, improved prostheses, reconstructive orthopedic surgery, and improved plastic surgery procedures" (p.
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From page 106... ...
. (See Appendix Table 4-1 for more detailed information about the changes that have occurred, including those in the descriptive text that accompany the diagnostic codes, which revise the criteria for assigning rating levels.)
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From page 107... ...
373 (46.7%) aThis table does not include the number of diagnostic codes that have been dropped, or added and subsequently dropped, since 1945, although this number would provide additional information on how much each body system has been revised since the Schedule for Rating Disabilities was issued in 1945.
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From page 108... ...
Organs of special sense: Vision 05/11/99 Neurological conditions and convulsive (under disorders review) Digestive (under review)
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From page 109... ...
in the Federal Register prior to issuance of a Notice of Proposed Rulemaking (NPRM) for each body system revision, or for revision of a specific diagnostic code or explanatory note in a body system, to allow the public preliminary commentary on revisions VA is planning to propose.
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From page 110... ...
Also in 2005, VA contracted with the Institute of Defense Analyses to determine the major factors contributing to state and regional variation in disability compensation claims, ratings, and payments. VA expects the results to help in identifying corrective actions to increase consistency (IDA, 2007)
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From page 111... ...
. There are no clear criteria by which to evaluate neurological impairment and functional limitations related to SCI in the current Rating Schedule.
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From page 112... ...
assesses functional limitations on four dimensions (activities of daily living; social interaction; concentration, persistence, and pace; and adaptive functioning or decompensation) using an ordinal scale (none, mild, moderate, marked, and extreme)
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From page 113... ...
FINDINGS AND RECOMMENDATIONS The first order of business should be to ensure that the Rating Schedule is up to date medically. Up to date medically means that • the diagnostic categories reflect the classification of injuries and diseases currently used in health care, so that the appropriate condition in the Rating Schedule can be more easily identified and confirmed using the medical evidence; • the criteria for successively higher rating levels reflect increasing degrees of anatomic and functional loss of body structures and systems (i.e., impairment)
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From page 114... ...
We began the study with a careful review of a number of the medical conditions included in the current Rating Schedule and were very concerned by what we found. In many cases, the medical knowledge used in the Rating Schedule is inadequate, often because the information is obsolete or there has been inadequate integration of current and accepted diagnostic procedures.
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From page 115... ...
The committee considers it important for VA to be as up to date as possible in current medical approaches to diagnosis and terminology as pertains to the Rating Schedule in order to serve veterans with disabilities more effectively and help them integrate or reintegrate into a productive and meaningful civilian life. VA should undertake a comprehensive revision of the Rating Schedule now and make it a formal process to revise the schedule every 10 years thereafter.
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From page 116... ...
The Uses of the Rating Schedule The Rating Schedule should be based on the best current medical evidence, which was the topic examined in the previous portions of this chapter. The Rating Schedule should also be designed to serve the purposes of the veterans disability compensation program, which is the topic examined in the balance of the chapter.
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From page 117... ...
The essential point of the distinction between the purposes of the disability benefits and the operational basis for the benefits is this: While the purpose of the workers' compensation benefits and the current veterans disability compensation program is to compensate for work disability,
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From page 118... ...
The Rating Schedule and Work Disability One of the purposes of the veterans disability compensation program endorsed in Chapter 3 is to provide compensation for work disability resulting from service-connected injuries and diseases. For the Rating Schedule to support this purpose, several questions need to be resolved.
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From page 119... ...
The Rating Schedule should be evaluated by the ability of the ratings produced by the schedule to accurately predict the extent of actual losses of earnings for veterans with disabilities. The Relationship Study in Appendix C provides such evaluations for the Wisconsin and California workers' compensation programs and for the veterans disability compensation program as of 1967.
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From page 120... ...
The evidence indicates that the Rating Schedule in use in 1967, as well as the two workers' compensation programs, had serious deficiencies meeting this test. Each of the programs systematically treated some injuries or medical conditions differently than other injuries in terms of the extent of earnings losses associated with similar disability ratings (see Figures C-6, C-11 and C-12, and C-14 and C-15 in Appendix C for results from the Wisconsin workers' compensation, California workers' compensation, and VA disability compensation programs circa 1967, respectively)
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From page 121... ...
First, the earnings of a particular person are affected by a myriad of factors, and the workers' compensation programs that have used the actual wage loss approach have generally abandoned it because it was found to be unworkable.10 Second, as discussed in Appendix C, the direct link between disability ratings (and the accompanying disability benefits) and the actual loss of earnings can create incentive problems for active participation in the labor force.11 The more relevant issue is whether the predictions of actual loss of earnings (IIIB in Figure 4-1)
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From page 122... ...
The study in Appendix C provides examples of how certain medical conditions may consistently have more (or less) earnings losses than predicted by the disability rating systems used in the workers' compensation programs and VA's disability compensation program as of 1967.
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From page 123... ...
George's Respiratory Questionnaire; Guyatt's Chronic Respiratory Questionnaire; the University of California at San Diego's Shortness of Breath Questionnaire for chronic obstructive pulmonary disease; and the Diabetes Health Profile. Some veterans disability benefits programs assess and compensate for functional limitations under certain circumstances.
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From page 124... ...
The Rating Schedule and Losses in the Quality of Life One of the purposes for the veterans disability compensation program endorsed in Chapter 3 is to provide compensation for loss in QOL resulting from service-connected injuries and diseases. For the Rating Schedule to support this purpose, several questions need to be resolved.
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From page 125... ...
An example of QOL research is the noneconomic loss survey of approximately 12,000 injured workers who received benefits from the Ontario, Canada, workers' compensation program, plus 300 individuals from the general population of Ontario who served as a control group. Seventy-eight medical conditions covering a wide range of impairments were selected as subjects for videos.
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From page 126... ...
These research results can be used in at least two possible ways to improve the accuracy of the Rating Schedule. First, the disability ratings assigned to a particular medical condition can be increased (or decreased)
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From page 127... ...
Although the committee was not asked to consider costs in recommending improvements in medical evaluation of veterans for disability benefits, it was cognizant of the magnitude of the changes recommended and aware that its recommendations for updating and improving the system for evaluating veterans for disability benefits would entail additional short- and long-term administrative costs and probably benefit costs. Phase 1 Recommendation 4-1 calls for updating the Rating Schedule immediately.
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From page 128... ...
. After the measures are validated in the disability compensation population, VA would conduct a study of functional capacity among applicants to see how well the revised Rating Schedule compensates for loss of functional capacity.
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From page 129... ...
. In addition, VA could use the results of disability evaluations in making decisions on individual unemployability, particularly if a VR counselor or other vocational specialist is involved in the multidisciplinary assessment (see Chapter 7)
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From page 130... ...
2004b. VA Disability Compensation Program: Literature review.
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From page 131... ...
2005. Review of state variances in VA disability compensation payments.
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From page 132... ...
27, 2003, with the creation of a number of new diagnostic codes under which previous codes were subsumed. Diagnostic codes 5285–5295 were therefore deleted.
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From page 133... ...
19, 1988. Diagnostic codes in this section were revised: anatomical loss of both eyes (6061)
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From page 134... ...
• Diagnostic codes 7343–7345, 7351, and 7354 were revised at 66 FR 29486, May 31, 2001. Genitourinary • The entire body system was revised at 59 FR 2523, Jan.
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From page 135... ...
was added. • The diagnostic codes for secondary anemia (7701)
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From page 136... ...
• Correcting amendments were made at 57 FR 24363, June 9, 1992, to reinstate diagnostic codes 8510–8730, which had been inadvertently omitted at 54 FR 49754, Dec.
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From page 137... ...
• The category of psychophysiologic skin reaction was removed, including diagnostic codes 9500–9511 based on DSM-IV guidelines that preclude the need for a separate code and evaluation criteria for this disorder. • A category for eating disorders was added, with new diagnostic codes for anorexia nervosa (9520)
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From page 138... ...
18, 1994. Conditions • New diagnostic codes for loss of more than half of the maxilla (9914)
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