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Honoring the Call to Duty: Veterans' Disability Benefits in the 21St Century

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Honoring the Call to Duty: Veterans' Disability Benefits in the 21St Century Honoring the Call to Duty: Veterans’ Disability Benefits in the 21st Century Veterans’ Disability Benefits Commission October 2007 Veterans’ Disability Benefits Commission Established Pursuant to Public Law 108-136 1101 Pennsylvania Avenue, NW, 5TH Floor Washington, DC 20004 www.vetscommission.org (202) 756-7729 (Voice) (202) 756-0229 (Fax) James Terry Scott, LTG, USA (Ret.), Chairman Ken Jordan, COL, USMC (Ret.) Nick D. Bacon, 1SG, USA (Ret.) William M. Matz, Jr., MG, USA (Ret.) Larry G. Brown, COL, USA (Ret.) James Everett Livingston, MG, USMC (Ret.) Jennifer Sandra Carroll, LCDR, USN, (Ret.) Dennis Vincent McGinn, VADM, USN (Ret.) Donald M. Cassiday, COL, USAF (Ret.) Rick Surratt (Former USA) John Holland Grady Joe Wynn (Former USAF) Charles “Butch” Joeckel, Jr., USMC (Ret.) Ray Wilburn, Executive Director October 3, 2007 Transmittal to: The President of the United States The President of the Senate Honorable Harry Reid, Majority Leader, United States Senate Honorable Mitch McConnell, Minority Leader, United States Senate Honorable Daniel K. Akaka, Chairman, Committee on Veterans’ Affairs, United States Senate Honorable Richard Burr, Ranking Member, Committee on Veterans’ Affairs, United States Senate Honorable Carl Levin, Chairman, Committee on Armed Services, United States Senate Honorable John McCain, Ranking Member, Committee on Armed Services, United States Senate Honorable Nancy Pelosi, Speaker, U. S. House of Representatives Honorable Steny Hoyer, Majority Leader, U. S. House of Representatives Honorable John A. Boehner, Minority Leader, U. S. House of Representatives Honorable Bob Filner, Chairman, Committee on Veterans’ Affairs, U. S. House of Representatives Honorable Steve Buyer, Ranking Republican Member, Committee on Veterans’ Affairs, U. S. House of Representatives Honorable Ike Skelton, Chairman, Committee on Armed Services, U. S. House of Representatives Honorable Duncan L. Hunter, Ranking Member, Committee on Armed Services, U. S. House of Representatives The Veterans’ Disability Benefits Commission is pleased to submit to you our report, Honoring the Call to Duty: Veterans’ Disability Benefits in the 21st Century. The Commission’s recommendations aim to ensure that disability benefits fairly compensate service-disabled veterans and their families, and help them live with dignity as they rehabilitate and reintegrate into civilian life. The Commission was created to study the benefits and services intended to compensate and assist veterans and their survivors for disabilities and deaths attributable to military service. To accomplish this undertaking, the Commission embarked upon a thorough, comprehensive, and objective analysis of the full range of benefit programs. The Commission engaged the analytical support of two well-established research organizations, the Institute of Medicine (IOM) of the National Academies and CNA Corporation (CNAC) to provide a data-driven, evidence-based foundation for the findings and recommendations in this report. With contributions from IOM and CNAC, the Commission addressed the appropriateness and purpose of the benefits, the benefit levels and payment rates, and the processes and procedures used to determine eligibility. Special attention was given to the care of the severely injured, treatment and compensation for posttraumatic stress disorder, transition from military service to civilian life, the rating schedule used to assess disability, the methodologies applied to establishing presumptive service-connection for disabilities, individual unemployability, and the timeliness of claims processing. The Commission also conducted fact-finding visits to eight cities around the country, held public hearings, carried out surveys, and reviewed studies and research regarding programmatic and organizational improvements to the veterans’ disability benefits system. As part of the public hearings, the Commission heard extensive testimony from veterans, advocates, and family members regarding the current veterans’ disability system, as well as from directors, program managers and staff from the Department of Veterans Affairs, the Department of Defense, and other federal and state agencies and private sector experts. After more than two years of study, the Commission found that improvements are needed, in both the benefits received and the management and operation of the benefit programs. The recommendations of this report offer a way forward and practical solutions so that disabled veterans and their families receive appropriate, equitable, and consistent benefits honoring their service and sacrifices. Sincerely, Back row, left to right: Commissioners Rick Surratt, Jim Livingston, Ken Jordan, Jennifer Carroll, Don Cassiday, Nick Bacon and John Grady; front row, left to right: Commissioners Butch Joeckel, Larry Brown, Joe Wynn, James Terry Scott (Chair), Dennis McGinn and Bill Matz Staff of the Veterans’ Disability Benefits Commission Mr. Ray Wilburn, Executive Director Mr. Robert Epley, Consultant Ms. Jacqueline Garrick, Senior Policy Analyst Mr. Mark Goodin, Copyeditor Ms. Kathleen Greve, Senior Policy Analyst Mr. Keith Hancock, Senior Policy Analyst Mr. Michael McGeary, Consultant Mr. Stephen Riddle, Senior Policy Analyst Ms. Laura Sivitz, Senior Editor Mr. James Wear, Senior Policy Analyst Mr. Edward Andersen, Administrative Officer Ms. Dietra Shepherd, Administrative Assistant Mr. Donald Zeglin, Legal Consultant Mr. Conrad Anderson, Legal Assistant Mr. John Harlepas, Research Assistant Mr. Paul Stepnowsky, Research Assistant Mr. Kurt von Tish, Research Assistant Mr. Victor Soto, Intern Ms. Kimberlie Neal, Intern Contents Acknowledgements xiii Preface xv Abbreviations xvii Executive Summary 1 1 Introduction 15 2 Guiding Principles 23 3 Veterans’ Past, Present, and Future 29 4 Rating Process and System 55 5 Policies for Determining Eligibility for Benefits 89 6 Appropriateness of Benefits 161 7 Appropriateness of the Level of Benefits 203 8 Survivors and Dependents 283 9 Disability Claims Administration 303 10 Transition 345 11 The Way Forward: Findings and Recommendations 373 Appendix A: Commission Statutes and Charter 397 Appendix B: Commissioners’ Biographical Sketches 405 Appendix C: Commission’s Research Questions 423 Appendix D: Site Visit Summary 429 Appendix E: Legal Analysis 437 xi xii Honoring the Call to Duty: Veterans’ Disability Benefits in the 21st Century Appendix F: Executive Summary of The CNA 457 Corporation’s Final Report to the Commission: Compensation, Survey Results, and Selected Topics Appendix G: Comparison of VA Disability Ratings with 475 DoD Disability Ratings for the Same Conditions Appendix H: Summary of IOM Medical Evaluation of 483 Veterans for Disability Appendix I: Summary of IOM Presumptions 501 Appendix J: Summary of IOM PTSD Diagnosis 519 Appendix K: Summary of IOM PTSD Compensation 525 Appendix L: Statement of Alternative Views by 537 Commissioner John Grady Acknowledgements The Veterans’ Disability Benefits Commission wishes to acknowledge first and foremost all of the veterans who participated in our open public meetings, site visits, and panels, and who sent us correspondence. We are grateful for their dedication to assisting fellow veterans by sharing their perspectives. We also appreciate the representatives from veterans service organizations who diligently provided us with important information. In particular, the Commission would like to thank Steve Smithson of The American Legion, Joe Violante of Disabled American Veterans, Gerald Manar of Veterans of Foreign Wars, Rick Weidman of Vietnam Veterans of America, Mike Hayden of the Military Officers Association of America, Edith Smith of Gold Star Wives, and Barbara Cohoon and Kathleen Moakler of the National Military Family Association. Brad Snyder from Armed Forces Services Corporation was extremely helpful at clarifying complex cost analyses and issues regarding benefits for veterans and their families. The Commission was honored to be included by COL William O’Brien in the Severely Injured Marines and Sailors (SIMS) pilot study working group; we learned from the group’s research. The Commission is also grateful to all of the expert witness who appeared before us from the Department of Veterans Affairs, Department of Defense (DoD), Department of Labor, and the Social Security Administration. In addition, the Commission could not have completed its site visits to eight locations if not for the assistance of all of the personnel at the Veterans Benefits Administration, Veterans Health Administration, and DoD who participated in the planning and execution. The cooperation and coordination that made these visits possible was paramount and appreciated, especially the efforts of Beth McCoy and LTC Melissa Applegate. The VA facility directors, military installation commanders, and their staffs were vital in ensuring productive visits. The Commission is also grateful to the local veterans service organizations and state veterans’ departments who took time to meet with us and promote attendance at the town hall meetings. We learned a great deal from those organizations. xiii xiv Honoring the Call to Duty: Veterans’ Disability Benefits in the 21st Century Key aspects of the Commission’s work could not have been completed without the assistance and analyses of our two contractors: the CNA Corporation (CNAC) and the Institute of Medicine (IOM). Dr. Joyce McMahon, Laurie May, Eric Christensen, Dan Harris, and Ted Jaditz from CNAC gave us the data and analyses we needed on the issues surrounding
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