STATEMENT FOR THE RECORD
JIM VALE, DIRECTOR
VETERANS BENEFITS PROGRAM
VIETNAM VETERANS OF AMERICA
THE SUBCOMMITTEE ON DISABILITY ASSISTANCE
AND MEMORIAL AFFAIRS
COMMITTEE ON VETERANS AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
REGARDING "RATING THE RATING SCHEDULE-
THE STATE OF VA DISABILITY RATINGS IN THE 21ST CENTURY"
JANUARY 30, 2012
Chairman Runyan, Ranking Member McNerney and Members of the Committee, Vietnam Veterans of America (VVA) thanks you for the opportunity to present our statement for the records on "Rating the Rating Schedule- The State of VA Disability Ratings in the 21st Century." We would also like to thank you for your overall concern about the VA Rating System that is impacting our troops and veterans, especially the current generation of war fighters returning home today who are suffering from Post-Traumatic Stress Disorder (PTSD).
We are deeply concerned with the state of our VA Disability Rating System, and share many of the same concerns as our fellow Veteran Service Organizations regarding the need to compensate disabled veterans for their loss of "Quality of Life" and other economic losses in addition to compensating for "average impairments of earning capacity." Rather than repeating what has already been said, we would like to focus our comments on the problems with the VA Disability Rating System when the VA rates claims for Post-Traumatic Stress Disorder (PTSD).
The Current VASRD Is Grossly Inadequate For Rating PTSD Because It Ignores Fundamental Differences Among Various Psychiatric Disorders. VA regulations have historically adopted the nomenclature and diagnostic criteria of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM recognizes the differences among the various psychiatric disorders (e.g., psychoses, like schizophrenia, and neurosis, like PTSD). Some psychiatric disorders are organic in nature, some are acquired and some are congenital. Some are chronic, some are intermittent and acute. Yet the rating schedule completely ignores such differences. Instead, it lumps all psychiatric disorders together and evaluates them under the exact same list of symptoms. This is both inherently inconsistent and illogical. The DSM diagnostic criteria are expressly adopted, but fundamental differences among various psychiatric disorders are virtually ignored.
The VA Should Initially Undertake A Comprehensive Review Of The Rating Schedule In Concert With Medical, Psychiatric And Vocational Experts. New rating criteria should be developed that take into account not only impairment in industrial capacity, but also the psychiatric effects of physical disability and the effect of physical and psychiatric disability on the veteran's quality of life. VVA often advocates for a "Veterans' Health Care System", rather than a health care system that happens to be for veterans, based on the unique nature of veterans' disabilities. Such disabilities are incurred in unique ways and have unique consequences. It is the very nature of a veteran's disability that demands a system of evaluating disabilities that keeps pace with technology, current medical standards and practices, socioeconomic factors and individual self-esteem.
VA Does Not Follow Their Own Procedures. As mentioned by previous VVA Veterans Benefits Program Directors in prior VVA testimony, local Veterans Health Administration (VHA) officials routinely do not provide adequate training, materials, or time to examining clinicians to let them do their job correctly in performing C&P exams. An excellent example is the "Best Practices Manual for Adjudication of PTSD Claims." VA examiners should be trained in these "Best Practices" and given sufficient time by their clinic directors to successfully complete their job. We frequently hear complaints from veterans that their C & P exam lasted only 20 minutes. This is inadequate per IOM standards:
"It is critical that adequate time be allocated for this assessment. Depending on the mental and physical health of the veteran, the veteran's willingness and capacity to work with the health professional, and the presence of comorbid disorders, the process of diagnosis and assessment will likely take at least an hour or could take many hours to complete…..Unfortunately, many health professionals do not have the time or experience to assess psychiatric disorders adequately or are reluctant to attribute symptoms to a psychiatric disorder.."
Examiners are required by law to review a claimant's entire claims file and medical record. Unfortunately, it is common for veterans to appear for a C & P exam and discover their examiner has not reviewed or even been provided their claims folder.
If VA properly used their own manual, policy, procedures, rules, trained their employees properly, gave them proper tests, and let their professionals do their job correctly; almost all VA staff would get it right the first time. This would obviate the need to "churn" claims back and forth in the system. Add to this effective supervision and VA would greatly increase their accuracy and output.
VA Should Use The Best Medical Science To Accurately Diagnose And Assess PTSD. The Institute of Medicine (IOM) report of June 16, 2006 presented the best medical science as to how to accurately diagnose and assess PTSD. Unfortunately, VA does not follow these recommendations, even though VA commissioned and paid for this study. If VA were to use the PTSD assessment protocols and guidelines as strongly suggested by the Institutes of Medicine back in 2006 , our veteran warriors would receive the accurate mental health diagnoses needed to assess their PTSD.
International Classification of Diseases (ICD) 9/10. VVA at this time does not support the adoption of ICD9/10 to replace the VASRD and DSM codes for mental health disabilities. There are too many differences that would increase the confusion and complexity for VA raters trying to rate PTSD claims. For example, ICD9/10 lacks DSM-IV criterion A2 for PTSD.
Diagnostic And Statistical Manual Of Mental Disorders (DSM)-IV. We are waiting for the revision of the DSM-IV (scheduled to be revised by 2013). Preliminary evidence suggests there will be further separation of some mental health classifications. We feel the VASRD should reflect these latest medical advancements in classification of mental health conditions and follow the revised DSM standards.
Disability Benefit Questionnaires (DBQ). VA describes DBQs as "…streamlined medical examination forms designed to capture essential medical information for purposes of evaluating VA disability compensation and/or pension claims from Veterans or Servicemembers." DBQs are designed to closely follow the VASRD, and increase consistency and accuracy of VA rating decisions by replacing traditional C & P medical opinions with "Turbotax-like" questionnaire for doctors to quickly point and click when evaluating veterans. This potentially reduces the amount of reading a VA rater must do when rating a claim. VVA supports the use of DBQs, but cautions DBQs are only as good as the VASRD they are based on.
In closing, on behalf of VVA National President John Rowan and our National Officers and Board, I thank you for your leadership in holding this important hearing on this topic that is literally of vital interest to so many veterans, and should be of keen interest to all who care about our nation's veterans. I also thank you for the opportunity to speak to this issue on behalf of America's veterans.
James R. Vale, Esq.
Mr. Jim Vale is the Director of Veterans Benefits Programs for Vietnam Veterans of America. He is a licensed attorney (State of Washington) and oversees VVA’s network of over 700 service officers and six appellate attorneys.
Mr. Vale is a past-presenter at the National Organization of Veterans Advocates, has written an article in the National Veterans Legal Services Program, The Veterans Advocate, and has a column in VVA’s Magazine, The Veteran.
He is a former Government Relations Intern with the Blinded Veterans Association, and a former David Isbell Summer Law Clerk with the Veteran Pro Bono Consortium. He has been an accredited service officer since 2004 and has represented veterans for VA claims at the VA Seattle Regional Office and the Board of Veterans Appeals.
Mr. Vale is a disabled Navy Gulf War-era Veteran and is legally blind. He earned his Master of Business Administration (MBA) and Master of Aeronautical Science (MAS) from Embry-Riddle Aeronautical University, Master of Public Administration (MPA) and Education Specialist Degree (Ed. S.) from the University of Arizona, and Juris Doctorate (JD) from Seattle University School of Law. He is also a graduate of both the VA Blind Rehabilitation Service and the VA Vocational Rehabilitation & Employment Program.
VIETNAM VETERANS OF AMERICA
January 30, 2011
The national organization Vietnam Veterans of America (VVA) is a non-profit veterans' membership organization registered as a 501(c) (19) with the Internal Revenue Service. VVA is also appropriately registered with the Secretary of the Senate and the Clerk of the House of Representatives in compliance with the Lobbying Disclosure Act of 1995.
Executive Director for Policy and Government Affairs
VVA is not currently in receipt of any federal grant or contract, other than the routine allocation of office space and associated resources in VA Regional Offices for outreach and direct services through its Veterans Benefits Program (Service Representatives). This is also true of the previous two fiscal years.
For Further Information, Contact:
Vietnam Veterans of America.
(301) 585-4000, extension 127