The National Academies Press

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Pages 1-20

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From page 1... ... VA should dedicate staff to maintaining the Rating Schedule and reestablish an external advisory committee of medical and other disability experts to assist in the updating process. The report also recommends that the current statutory purpose of VA's disability compensation program -- to compensate for average loss of earning capacity -- should be expanded to compensate for nonwork disability and loss of quality of life as well as average loss of earning capacity. Read the entire page →
From page 2... ... The report also addresses a number of other topics, for example, use of computer-based templates to improve disability examina tions; better training of examiners and raters; adoption of com monly used diagnostic classification systems; comprehensive needs assessment of veterans separating from military service for health care, vocational rehabilitation, educational, and other benefits and services provided by VA; involvement of vocational expertise in determining individual unemployability; and research to improve the rating process (e.g., analyze the validity and reliability of the Rating Schedule, evaluate training and certification programs, and assess the extent to which compensation and ancillary benefits meet the needs of veterans) Read the entire page →
From page 3... ... . The statutory purpose of disability benefits is to compensate veterans for "the average impairments of earning capacity resulting from such injuries in civil occupations." VA program policies clearly reflect a grateful nation. Read the entire page →
From page 4... ... The veterans disability compensation program should compensate for three consequences of service-connected injuries and diseases: work disability, loss of ability to engage in usual life activities other than work, and loss in quality of life. (Specific recommendations on approaches to evaluating each con sequence of service-connected injuries and diseases are in Chapter 4.) Read the entire page →
From page 5... ... In practice, the best proxy for earning capacity is actual earnings. There is no current evidence on the relationship between the Rating Schedule's severity ratings and average loss of earnings of veterans with disabilities. Read the entire page →
From page 6... ... VA should compensate for nonwork disability, defined as functional limitations on usual life activities, to the extent that the Rating Schedule does not, either by modifying the Rating Schedule criteria to take account of the degree of functional limitation or by developing a separate mechanism. Read the entire page →
From page 7... ... THE MEDICAL EXAMINATION AND DISABILITY RATING PROCESS Medical Evaluation Process Nearly every veteran applying for disability compensation is examined by a physician or other clinician (e.g., audiologist) working for or under contract to VA. Read the entire page →
From page 8... ... The Rating Process Quality of Rating Decisions VBA's quality assurance program, STAR, implemented in 1998, has improved the accuracy rate from 80 percent in FY 2002 to 88 percent in FY 2006. The sample is only large enough to determine the aggregate accuracy rate of regional offices. Read the entire page →
From page 9... ... Recommendation 5-6. Educational and training programs for VBA rat ers and VHA examiners should be developed, mandated, and uniformly implemented across all regional offices with standardized performance objectives and outcomes. Read the entire page →
From page 10... ... However, it is not possible to judge their appropriateness because the thresholds that have been set for ancillary benefits requirements were not based on research on who benefits or who benefits most from the services in terms of rating level. Recommendation 6-2. Read the entire page →
From page 11... ... 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. INDIVIDUAL UNEMPLOYABILITY Individual unemployability (IU) Read the entire page →
From page 12... ... Recommendation 7-3. VA should conduct research on the earnings histories of veterans who initially applied for individual unemploy ability benefits past the normal age of retirement for benefits under the Old Age, Survivors, and Disability Insurance Program under the Social Security Act. Read the entire page →
From page 13... ... VA should implement a gradual reduction in compensation to individual unemployability recipients who are able to return to substantial gainful employment rather than abruptly termi nate their disability payments at an arbitrary level of earnings. OTHER DIAGNOSTIC CLASSIFICATION SYSTEMS AND RATING SCHEDULES Alternative Diagnostic Classification Codes Having the same diagnostic categories for the disability compensation program as VHA and other health-care providers -- International Classification of Diseases (ICD) Read the entire page →
From page 14... ... This system should apply to all applications, including those that are denied. During the transition to ICD and DSM codes, VA can continue to use its own diagnostic codes, and subsequently track and analyze them comparatively for trends affecting veterans and for program planning purposes. Read the entire page →
From page 15... ... The disability compensation evaluation process provides an opportunity to assess the needs of veterans with disabilities for the other services VA provides, such as vocational rehabilitation, employment services, and specialized Read the entire page →
From page 16... ... The purpose of the current veterans disability compensation program as stated in statute currently is to compensate for average impairment in earn ing capacity, that is, work disability. This is an unduly restrictive rationale for the program and is inconsistent with current models of disability. Read the entire page →
From page 17... ... In addition to medical evaluations by medical professionals, VA should require vocational assessment in the determination of eligibility for individual unemployability benefits. Raters should receive training on how to interpret findings from vocational assessments for the evaluation of individual unemployability claims. Read the entire page →
From page 18... ... Recommendation 7-3. VA should conduct research on the earnings histories of veter ans who initially applied for individual unemployability benefits past the normal age of retirement for benefits under the Old Age, Survivors, and Disability Insurance Program under the Social Security Act. Read the entire page →
From page 19... ... VA should guide clinical evaluation and rating of claims for secondary service connection by adopting specific criteria for determining causation, such as those cited above (e.g., temporal relationship, consistency of research findings, strength of association, specificity, plausible biological mechanism) Read the entire page →
From page 20... ... Appendix D The Role of Medical Personnel in Selected Disability Benefit Programs. Read the entire page →

From page 1...

... VA should dedicate staff to maintaining the Rating Schedule and reestablish an external advisory committee of medical and other disability experts to assist in the updating process. The report also recommends that the current statutory purpose of VA's disability compensation program -- to compensate for average loss of earning capacity -- should be expanded to compensate for nonwork disability and loss of quality of life as well as average loss of earning capacity.

Summary Pages 1-20

Summary
Pages 1-20