By Rick Maze - Staff writer
Posted : Wednesday Oct 3, 2007 6:01:24 EDT
A presidential commission will call Wednesday for an immediate 25 percent increase in veterans’ disability compensation while awaiting a larger overhaul of disability and transition benefits.
The Veterans’ Disability Benefits Commission will say the current compensation system is outdated and fails to consider the complete impact that a service-connected disability has on the life of veterans and their families.
The current system also is unnecessarily cumbersome to the point that it discourages veterans from getting the help they deserve, says the commission report, a copy of which was obtained Tuesday by the Military Times.
The 562-page report will be released Wednesday afternoon, although what happens next is unclear. Most of the recommendations, including the proposed 25 percent benefits boost, would require congressional action before they could take effect.
With the Bush administration already balking at the $4 billion increase in veterans’ health care and benefits programs being pushed by Congress, it is unlikely that administration officials would support further increases.
However, an overhaul of the veterans’ disability rating system, streamlined claims processing and an easier transition from military to veterans programs are all issues under consideration by Congress, and could end up included in the Wounded Warrior Assistance Act that lawmakers expect to pass later this year. An overhaul of the military’s complicated disability retirement and physical evaluation process is expected to be part of that bill.
The report by the 13-member commission, led by retired Army Lt. Gen. James Scott, caps more than two years of work, including several precedent-setting studies of disabled veterans and their compensation that looked at their total income and compared military and veterans’ benefits to those received by disabled workers who never served in the military.
In calling for an overhaul of the military and Department of Veterans Affairs rating systems, the commission said a revised system needs to be fair so that people who have experienced similar losses receive similar compensation. Veterans with mental disorders, including post-traumatic stress disorder, are particularly poorly served by the current rating system, the report says.
The VA ratings schedule that sets disability levels has not been changed in 62 years, and needs to be updated, the commission says, with top priority going to revising the ratings for PTSD, traumatic brain injury and other mental health and neurological body systems says. This could be done quickly, in time to help Iraq and Afghanistan war veterans, while leaving a review of the rest of the ratings to roll out over five years.
The commission comes down squarely on the side of veterans on several controversial issues. For example, it supports allowing disabled retirees to receive full veterans’ disability compensation and military retired pay when they are eligible for both, and to allow survivors to receive their full veterans’ and military survivors’ benefits.
On both of those issues, the Pentagon has resisted efforts in Congress to allow both payments in full, although in recent years lawmakers have been phasing out the mandatory offsets in one pay or the other that had been on the books for decades.
One recommendation that may not please veterans calls for periodic reviews of case in which disability pay is based, in part, on the fact that a veteran’s disability prohibits him or her from holding a job.
When former VA Secretary R. James Nicholson made a similar recommendation several years ago, veterans went wild about the government trying to cut their payments.
The commission calls for periodical and comprehensive evaluations of disabled veterans’ employability status, and a way to slowly wean veterans off benefits if it is possible for them to return to work at some point.
http://www.armytimes.com/news/2007/10/m ... t_071002w/
Veterans of PTSD
A look at war veterans and post-traumatic stress. Are they getting the help they need?
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SPECIAL NOTE ON PSYCHOGENIC SEQUELAE OF PERCEIVED EXPOSURE TO BIOCHEMICAL WARFARE AGENTS This report deals primarily with the biological health challenges engendered by the agent that is the subject of the report. Nevertheless, this report also incorporates, by reference and attachment, a supplement entitled "Psychogenic Effects of Perceived Exposure to Biochemical Warfare Agents".
The supplement addresses and describes a growing body of health effects research and interest centered upon the psychogenic sequelae of the stress experienced personally from actual or perceived exposure to chemical and biological weaponry. Because awareness of exposure to agents in Project SHAD logically includes the exposed person also possessing a perception of exposure to biochemical warfare agents, the psychogenic health consequences of perceived exposure may be regarded as additional health effects arising from the exposure to Project SHAD agents. This reasoning may also apply to simulants and tracers.
Therefore, a general supplement has been created and submitted under this contract to address possible psychogenic effects of perceived exposure to biological and chemical weaponry. Because such health effects are part of a recent and growing public concern, it is expected that the supplement may be revised and expanded over the course of this contract to reflect the actively evolving literature and interest in the issue.
http://www.iom.edu/Object.File/Master/4 ... SPHITE.pdf
Medical scholarship is increasingly accepting the idea that the simple awareness of being exposed to agents of chemical or biological warfare can pose significant health effects for an individual. "The threat or perceived exposure to chemical warfare agents has been shown to have a lasting and adverse impact on human health," write Col. James Riddle and his co-authors in a study published in the August 2003 issue of Military Medicine. The trauma of a perception of exposure may be sufficient to elicit stress-induced debilitation. "The [mere] belief that chemical weapons were being used," they observe, "may cause or exacerbate illness because of . . . maladaptive stress response." (Riddle) The authors of the study, whose affiliations span the Pentagon's Health Affairs office, the Department of Veterans Affairs, the Naval Research Center, and the U.S. Army Medical Research Institute of Chemical Defense, came to this determination after finding that mysterious poor health conditions of certain Persian Gulf War (1990-1991) veterans did not correlate with any demonstrated actual exposure to weapons of mass destruction, but nevertheless did seem to correlate with a subjective belief on the part of the veterans that they had in fact been so exposed. "Feelings of helplessness in the face of a ubiquitous and unseen killer can be overwhelming," Riddle et al. explain. Psychogenic effects can be short and long term. "The psychological impact of a potential or actual chemical attack can result in immediate casualties from acute stress disorder, grief, anger, scapegoating, and somatization disorders. Longer term effects include phobias, sleep disorders, post-traumatic stress disorder, substance abuse, and major depression." Specific studies on veterans who have undergone mustard-gas exposure in military tests compel the conclusion that psychogenic effects of the subjective awareness of exposure to biochemical weaponry are a major set of health effects. "The life threat inherent in . . . exposure," one such study concludes, "suggests that experimental mustard-gas exposure is a traumatic event that meets the Diagnostic and Statistical Manual of Mental Disorders (4th ed. DSM-IV) A.1 criterion for a diagnosis of PTSD [Post-traumatic stress disorder]." (Schnurr 2000) Authoritative acceptance of the existence of purely psychogenic health effects of perceived exposure appears to be increasingly firm. "The IOM [Institute of Medicine] Committee [on Health Effects Associated with Exposures during the Gulf War] recognized the impact on health from the threat of or perceived exposure to chemical and biological warfare agents," Riddle and his colleagues report. An IOM committee in
1993, also evaluating the effects on veterans of mustard-gas testing from five decades earlier, determined in a similar vein that "the best available evidence indicates a causal relation between the experiences of the subjects . . . and the development of psychological effects." (IOM) The Riddle study and review further argues that greater study of the psychogenic effects of perceived exposure needs to be a key concern for veterans' health.
In a statement directed primarily at the studies of the health condition of Persian Gulf War veterans but which clearly possesses validity in regard to the health effects of all veterans who havefelt exposed to biochemical weapons, the authors express a consensus that "theDepartment of Veterans Affairs and IOM should examine the health impact from . . . theperceived exposure to chemical warfare agents as an important health concern and cause of morbidity among . . . veterans." The practical importance is driven home in studies examining the psychological effects on military personnel of biochemical warfare agent testing. These studies consistently note significantly higher levels of long-term health
problems and long-term medical services use by veterans who have experienced
psychogenic effects from perceived chemical weapons exposure. (Schnurr 2000, Schnurr
1996, Friedman 1994)
VHA DIRECTIVE 2004-016
April 15, 2004
4. ACTIONS: Facility Directors are responsible for:
a. Ensuring that these veterans are enrolled in priority group 6, if they are not eligible for a higher enrollment priority based upon other eligibility factors. Accordingly, they are to receive needed hospital care, medical services, and nursing home care at no cost for any illness possibly related to their participation in these tests. However these veterans may be charged a co-payment for care of conditions found to have resulted from a cause(s) other than their participation in Project 112 tests.
(1) In making the determination if the illness or disability is possibly related to a veteran’s participation in Project 112/SHAD, the VA physician must consider that the following types of conditions are not ordinarily considered to be due to occupational or military activities:
(a) Congenital or developmental conditions, e.g., scoliosis.
(b) Conditions which are known to have existed before military service.
(c) Conditions having a specific and well-established etiology and that began after military service ceased, e.g., bone fractures occurring after separation from military service, a common cold, etc.
(2) Although the preceding types of conditions are not ordinarily considered to be due to military
service, if the staff physician finds that a veteran requires care under this provision for one or more of those conditions, the physician is to seek guidance from the facility Chief of Staff (COS) and the Registry Physician (RP) regarding the authorization for such treatment. The decision and its basis must be clearly documented in the medical record and chart by the RP.
b. Ensuring that Project 112/SHAD veterans who request either an examination or enrollment in the VA health care system, whether or not they have previously received health care from VA, are offered a complete “Primary Care New Patient History and Physical Examination,” using the standardized template for this examination, and that the results of the examination are documented in the patient’s health record.
(1) The Primary Care New Patient documentation template is one of several templates developed by a national task group to address the need to have medical record documentation that is appropriate, accurate, and supports coding for third-party billing, workload capture, research, and other clinical and administrative needs. It can be located at the following web address: http://vaww1.va.gov/health/him/VHACC/vaphyspage.htm.
The United States has not suffered significant psychosocial or medical consequences from the use of biological weapons within its territories. This has contributed to a "natural" state of denial at the community level.
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