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1- The author argues that veterans will exaggerate issues when financial compensation is the known outcome, specifically to PTSD. The author does not search different view points, but provides evidence for his claim.
2- The argument is indeed persuasive, and uses case study to back it. The evidence is cited, and supports all levels of his claim.
3- The author does not show bias but concurrently does not show opposing view points or supporting evidence. It is not overtly unfair but does not acknowledge many aspects of this.
4- I have run into many persons arguing the disability process can be falsified or exaggerated, however this article maintains the most evidence.
5- This source clearly challenges my own argument. I agree that this can be persuasive however does not specifically handle the view points of how PTSD and mental illness can be varied day to day. The exam must be clarified on their worst days, not just the current day as there is only one evaluation which may take months to be scheduled.
6- The purpose of the article is the same as mine, to reevaluate the VA disability process, but with a different aim.

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1- The author argues there are subgroups of veterans who are not being adequately represented or denied care due to status and overburdened government system.
2- The argument is less persuasive than the previous post as the numbers and studies are less focused. There is evidence provided but it is also a less clear read. Opposing view points are presented with citations as well, but continues to use weaker arguments to defend.
3- The authors stance is to ensure veterans have the availability and opportunity to claim their injuries. Both views viewed fairly.
4- This argument has been made prior, but enjoyed how it talked about the overburdened system and how it fails the current process.
5- This article supports my position with viewpoints and angles I previously did not think of. Specifically how the system is failing do to people using it as intended.
6- The intended audience remains those seeking reform for the largest government health care program in existance.

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ABSTRACT

The general consensus in studies of individuals seeking federal disability compensation is that individuals "denied" disability compensation are healthier than those "awarded." In contrast, studies of military veterans seeking U.S. Department of Veterans Affairs (VA) disability compensation suggest that those "denied" ("denied applicants") may be as impaired as those "awarded" ("awarded applicants"), and likely have critical, albeit unmet health care needs. Moreover, although social isolation among U.S. Veterans has received some attention, its broad influence on health and health care consumption among veterans "denied" VA disability compensation is not well understood. Objectives: To provide a more thorough understanding of "denied" applicants' health, health care utilization, and social conditions. Methods: We reviewed published reports of health, health care utilization, and social isolation "relevant" to U.S. Veterans "denied" VA disability compensation. Among 122 research items initially reviewed, a total of 47 met our inclusion criteria and are summarized herein. Results: Compared to veterans "awarded" VA disability compensation, those "denied" have poorer health, use less VA health care, and may experience social isolation. Conclusions: Veterans "denied" VA disability compensation may comprise a vulnerable subgroup of veterans in need of supportive services. Such needs may be addressed through evidence-based targeted outreach programs.

INTRODUCTION

Accessing VA Disability Compensation

A veteran seeking VA disability compensation benefits must first file a claim. In evaluating the claim, a review team gathers medical and military service-related evidence. In the process, the VA confirms the current disability, and subsequently determines whether the existing disability is linked to military service. If so, the VA assigns a combined disability rating (38 U.S.C. §1155) and establishes a date of award with payment based on the rating. For those veterans awarded service connection, the VA can grant a full award, or a partial award. If no service connection is found, the claim is denied.

The VA disability compensation adjudication process, which begins with an application and ends with either an initial decision or a decision in response to an appeal, can be onerous. In 2011, the average claims processing time was 197 days, whereas the average appeals processing time was 747 days. Veterans "denied" service connection receive no cash compensation.

Accessing VA Health Care

Access to veteran health benefits (38 CFR §17.36) begins with a VHA enrollment application, that is separate from the application for disability compensation. The VHA may also require some veterans to complete a financial assessment-"means test"-to establish eligibility for health care and to determine the individual's contribution to the costs or that of his/her private insurance company. Those veterans who, based on their gross household income, do not qualify for free care are responsible for copays.

VA Disability Compensation Award Status

The literature suggests that the cohort of veteran compensation seekers comprise heterogeneous subgroups, which can be defined by their "award status" (e.g., denied applicant, awarded applicant) within the VA disability compensation system. These groups are differentiated by "unique" health, health care utilization, sociodemographic and psychosocial characteristics., In considering "award status," however, knowing what happens to veterans "denied" VA disability compensation may be more important than knowing what happens to those whose compensation claims have been "awarded" "because the former leave the disability claims process with far fewer resources and a much thinner safety net."

In view of the VA commitment to targeting veterans with the most need, and given emerging evidence suggesting that "denied" applicants may be at increased risks of poverty and homelessness, a greater focus on this particularly vulnerable subgroup seems timely and justified.

The aim of the present review is to

- Provide an overview of prior work on health and health care utilization "relevant" to U.S. Veterans "denied" VA disability compensation.

- Provide an overview of prior work on relationships between correlates of social isolation and health and health care utilization "relevant" to U.S. Veterans "denied" VA disability compensation.

- Highlight knowledge gaps, as well as key policy issues emerging from this research, and suggest avenues for future scholarship on this topic.

METHODS

Our review of prior work relating to health and health care utilization among U.S. Veterans "denied" VA disability compensation ( Table I) occurred between 2012 and 2014. Electronic and nonelectronic sources were used to gather English language literature, and included peer-reviewed journal articles, government reports, Congressional testimony, federal regulations and statutes, court decisions and legal opinions, as well as information provided by authoritative websites (e.g., www.va.gov). We initially reviewed 122 research items, ultimately citing those 47 items that can be found in the reference section.

Search Strategy

Research materials cited in this review cover a period from 1983 to 2014. Internet search engines, including Google and Google Scholar, were used to identify relevant literature. We also used PubMed, a publicly available, open access database to expand our search.

A broad search began with the following individual and combined words: "veterans, deployment, service-connected, department of veterans affairs, disability compensation, federal, military, denied, awarded, compensation status, compensation-seeking, application, social security, health, health care, utilization, consumption, resource use, dual use, United States, American, comparative analysis, social isolation, psychosocial determinants, social capital, and social determinants." In the process, the search widened using a "snowball search technique" where we followed up references from reviewed materials until we could no longer find any additional relevant studies.

RESULTS

Health

Studies of health status among "denied" applicants suggest that at least some of these applicants are burdened by health limitations, although the number of studies is small. An early study of psychiatrically impaired veterans conducted in 1983 found high levels of psychiatric impairment, regardless of whether these veterans were receiving full, partial, or no VA disability compensation. This finding was underscored by results from an analysis of Social Security disability compensation that led the author to speculate that some individuals suffering from schizophrenia or anxiety disorder may, in fact, be denied disability benefits because their psychiatric impairments are so severe that they are "not able to give a sufficiently coherent history [or] provide the necessary documentation for eligibility for disability." A similar contention was expressed in a subsequent study of health among recipients of "government" disability payments and nonrecipients.

Rosenheck et al analyzed "functional health" and "quality of life" among 280 homeless mentally ill veterans seeking Social Security disability benefits as part of the SSA (Social Security Administration)-VA Joint Outreach Initiative. Overall, the study concluded that compared to "denied" applicants, "awarded" applicants "may have been no more disabled." Comparison of Addiction Severity Index Scores revealed no significant differences between "awarded" and "denied" in psychiatric illness (27.20 vs. 27.41, p = 0.953) or medical illness (42.79 vs. 50.31, p = 0.326), although Quality of Life Index Scores indicated that "awarded" had significantly better quality of life (2.96 vs. 2.67, p = 0.004).

Murdoch et al examined symptom severity as well as physical functioning among veterans who had filed for VA disability compensation based on a claim of post-traumatic stress disorder (PTSD). Overall, veterans "denied" service connection were "not less disabled than those who obtained service connection." Thus, compared to "awarded" applicants, those "denied" had lower Penn Inventory Scores, indicating less PTSD symptom severity (43.4 vs. 39.6, p < 0.0001), but also lower Research and Development Corporation (RAND) Revised Physical Functioning Scores, indicating poorer physical functioning (29.2 vs. 28.6, p = 0.001).

A longitudinal study subsequently reported PTSD symptoms, mental and physical functioning, and subjective wellbeing among veterans who had been "awarded" or "denied" VA disability compensation. It was found that although both "awarded" and "denied" applicants were clinically impaired, "awarded" had significantly higher PTSD Symptom Checklist Scores (60.18 vs. 52.66, p < 0.01), and were significantly more disabled (38.98 vs. 31.39, p < 0.05), as measured by the WHO Disability Assessment Schedule II.

Finally, a recent cohort study analyzed overall health in a stratified nationally representative sample of VA disability compensation-seeking veterans with PTSD. It was found that 10 years after applying for disability benefits, both "awarded" and "denied" applicants continued to experience clinically relevant PTSD symptoms, as well as poor physical functioning.

Access to Health Care

The limited number of studies that examined health care utilization among veterans "denied" VA disability compensation report equivocal findings., Two prospective cohort studies conducted in 2004 and 2005, analyzed pre- and postclaim VA health care utilization patterns among veterans with PTSD who had applied for VA disability compensation. In both studies, postclaim medical care service use rose equally among "awarded" and "denied" applicants, whereas postclaim mental health care service use increased only among the "awarded."

A subsequent analysis examined the relationship between VA disability compensation award status and VA health care service use among a sample of veterans with PTSD who filed disability compensation claims between 1997 and 1999. It found that although "awarded" applicants did not use more postclaim "medical" health care services than "denied" applicants, they did use significantly more preclaim ( p < 0.001) and postclaim ( p < 0.001) "mental" health care services.

Laffaye et al reviewed seven studies of VA health care utilization among veterans seeking VA disability compensation for PTSD. Overall, the study found that "awarded" applicants generally utilized more VA medical and mental health care services than "denied" applicants.

Finally, a subsequent prospective study reported postclaim VA mental health care service use among a sample of veterans who had been "awarded" or "denied" VA disability compensation for PTSD. The study reported increased postclaim VA mental health care service use "only" among "awarded" applicants ( p < 0.01).

Social Isolation

Social isolation, narrowly defined as "disengagement from social ties, institutional connections, or community participation," is an important determinant of health. Studies have consistently found that individuals with few close personal relationships and limited social support tend to have poorer health outcomes, higher mortality risk,,⁻ and some studies have reported greater health-related resource use.,⁻ Socially isolated individuals are also more likely to be disabled, and to suffer anxiety and depression;,⁻ and, results from several studies suggest that mental illness may mediate the effects of social isolation on health.,⁻

Undoubtedly, the pathways by which social isolation influences health are complex, and no single variable can measure all of its dimensions., Nevertheless, prior work has cited an array of factors which when considered together, may be useful in characterizing one's social circumstances. In addition to small social networks and infrequent contacts,, other oft-cited contributing factors have included rural residence,, inadequate transportation, living arrangements,, few family members or close friends, limitations in mobility,, limited access to health-related information and feedback, and being unmarried., Although health challenges related to isolation may be particularly acute among the elderly, social isolation nevertheless remains strongly associated with poorer health status across all age groups.

At the same time, it is widely acknowledged that the adverse health effects of social isolation are often felt more acutely by individuals with low socioeconomic status., According to Locher et al, "poverty also is associated with other social conditions, such as lower educational levels, which contribute to social isolation and lesser ability and power to command and access community resources and services." Commonly cited socioeconomic measures have included gender, minority status,, unemployment, low income and high debt levels,, limited educational attainment, and lack of health insurance.

Social Isolation Among Veterans

Studies of post deployment social structure suggest that when returning from active duty service, many veterans experience social isolation;, and this increase can begin "immediately upon returning home." Veteran studies further suggest that social isolation can influence health through multiple pathways, such as homelessness, lower levels of encouragement, support and health-related feedback, reduced consumption of medical care and other health-related services,, and reduced labor force participation.

There is, unfortunately, a paucity of data on social isolation among veterans "denied" VA disability compensation. Nevertheless, results from studies of other populations lend support to our hypothesis that veterans "denied" VA disability compensation may be isolated and socioeconomically disadvantaged.

One such study analyzed a small sample of homeless veterans with mental illness who had applied for Social Security disability compensation benefits. Baseline comparisons revealed no significant differences in the proportions of "awarded" and "denied" who were unemployed (50% vs. 62%, p = 0.24), had a high school education or less (62% vs. 66%, p = 0.81), were single (28% vs. 29%, p = 0.32), or were divorced (54% vs. 62%, p = 0.32). However, compared to "awarded," those "denied" did have significantly lower monthly employment income ($306 vs. $132.71, p = 0.08), higher monthly food stamp income ($34.18 vs. $54.15, p = 0.09), and spent less monthly income on housing ($196.67 vs. $99.37, p = 0.01) or health care ($6.67 vs. $0.37, p = 0.04).

Murdoch et al examined physical and social functioning among a sample of veterans who were seeking VA disability compensation for PTSD. The study used the Social Adjustment Scale (SAS) to measure social functioning across the following domains: social and family interactions, "work" role (e.g., employed, student), and economic self-sufficiency. Overall, compared to "awarded" applicants, those "denied" had significantly poorer social functioning (2.7 vs. 2.8, p < 0.0001), as indicated by higher SAS scores as well as poorer physical functioning (29.2 vs. 28.6, p = 0.001), as indicated by lower RAND Revised Physical Functioning scores. Mean social functioning scores among "denied" applicants were lower than those of individuals with schizophrenia, substance abuse, or clinical depression.

Finally, a cohort study by Murdoch et al analyzed health and social functioning among veterans seeking VA disability compensation for PTSD. Overall, "denied" and "awarded" applicants continued to exhibit comparably poor social functioning at 6 years of follow-up. Moreover, compared to "awarded," those "denied" were more likely to have been homeless (12.0% vs. 20.0%, p = 0.02) and impoverished (15.2% vs. 44.8%, p < 0.001), and less likely to have been married (61.7% vs. 49.1%, p < 0.001), leading the authors to conclude that "denied" applicants "might represent an appropriate group for targeted outreach."

DISCUSSION

Summary of Findings

Considering overall health, existing studies have consistently reported that "denied" applicants are often burdened by poor health and disability that can hamper multiple aspects of functioning. In addition to limitations in activities of daily living and instrumental activities of daily living, widely cited as valid measures of disability severity, an overwhelming number of "denied" applicants report functional impairments and deteriorating overall subjective health, mental illness, poor physical functioning, and health-related work limitations. Such significant health challenges, exacerbated by poverty, may make "denied" applicants especially vulnerable to additional health-compromising burdens, including substance abuse, and homelessness.

However, whether "denied" applicants are, in fact, sicker than "awarded" applicants cannot be resolved by the existing research evidence. Unfortunately, prior work is sparse and among the relatively few studies that have analyzed health among compensation-seeking veterans, many have focused exclusively on PTSD,, or compared outcomes across inherently different, and therefore, potentially inappropriate comparison groups:, as one example, comparative analyses of applicants with nonapplicants may be inappropriate because subjects who apply for disability compensation tend to be much sicker than those who never apply.

At the same time, results from limited health care utilization analyses suggest that "denied" applicants utilize "less" VA health care than comparably impaired "awarded" applicants. Reduced health care service use by veterans with poor health stands in stark contrast to studies of the general population that have consistently reported an association between poorer health and increased health care resources use. "What might explain this contrast?"

Most utilization studies reviewed restricted their analysis to VA health care service use. Absent data on "dual system use" (e.g., VA and Medicare), it is conceivable that "denied" applicants may use less VA health care but not necessarily less "overall" health care. Future analyses of dual use among "denied" applicants could be useful in resolving this critical issue.

Although studies have implicated a constellation of factors, the question of which determinants "most" impede access to health care among "denied" applicants remains unresolved. Undoubtedly, some "denied" applicants confront "financial barriers" to care. Thus, "denied" applicants who are poor, but whose income exceeds the VA's income threshold may respond to the loss of free VA health care by either foregoing any health care or, instead, by availing themselves of alternative sources of care. In addition, strongly held "beliefs" or "attitudes" may further influence health care seeking., For example, denial of a disability compensation claim may discourage VA service use.

Unfortunately, no existing veterans study has specifically addressed the role of social isolation in the health and health care utilization patterns of veterans "denied" VA disability compensation. However, characterizations of samples of "denied" applicants suggest that veterans "denied" VA disability compensation are, indeed, socially isolated. Prior work by Sayer et al (2004) and Murdoch et al (2005, 2011), reveals that "denied" applicants tend to be renters rather than home owners, and are often unmarried with few if any dependents. In addition to low socioeconomic status (e.g., low income, limited education, low labor force participation), "denied" applicants exhibit dysfunction across a wide spectrum of social activities (e.g., occupational, economic self-sufficiency). Finally, they tend to use fewer VA health care services, and such reduced utilization may deprive them of an important, and reliable formal social support system.,

Strengths and Limitations

This is the first comprehensive review of the research literature concerned with health, health care utilization, and social isolation among American Veterans "denied" VA disability compensation. Our review was restricted to English language studies, because it focuses on U.S. military Veterans. Unfortunately, quantitative analysis was not possible due to the heterogeneity of outcomes and sampling. Thus, although it is conceivable that a meta-analysis might have produced different results, these findings were consistent across existing work and, therefore, we are confident that our conclusions would not differ significantly from such an analysis.

CONCLUSION

The broad picture of veterans "denied" VA disability compensation that emerges from available data shows them, compared to those "awarded," to have comparative poor health, lower VA health service utilization, as well as greater poverty, unemployment, and social isolation. Such burdens coupled with evidence of increased risks of homelessness and premature mortality support our hypothesis that veterans "denied" VA disability compensation are indeed a particularly vulnerable subgroup.

We emphasize that denial of VA disability compensation signifies only that a condition cannot be attributed to military service; it does not imply that a condition is not severe, or that it is not worthy of supportive services. Given this nation's obligation to serve the "neediest" veterans, future research might evaluate new initiatives (e.g., offering case management services to veterans with serious, nonservice-connected disabilities; extending VA Vocational Rehabilitation Services, and/or Tele health Services to veterans "denied" VA disability compensation) that could be tailored to veterans who are not awarded VA disability compensation, but who, nevertheless, are burdened by health limitations.

REFERENCES

Author notes

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Health and Health Care Service Utilization Among U.S. Veterans Denied VA Service-Connected Disability Compensation: A Review of the Literature

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The general consensus in studies of individuals seeking federal disability compensation is that individuals "denied" disability compensation are healthier than those "awarded." In contrast, studies of military veterans seeking U.S. Department of Veterans Affairs (VA) disability compensation suggest that those "denied" ("denied applicants") may be as impaired as those "awarded" ("awarded applicants"), and likely have critical, albeit unmet health care needs.

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1- This article again specifically uses PTSD as a reference to the ability for PTSD compensation to increase quality of life. The author argues that those who receive benefits continue to have life long issues, but maintain livable lives.
2- The article is persuasive and approaches from both viewpoints while citing their evidence. There are few assumptions, but the ones made can be stretched. The author assumes veterans maintain PTSD issues due to their possible desire for continued income.
3- The author stands to maintain current payouts due to large success in reduction of homelessness, self medication, and meaningful relationships.
4- This article cover much of the same angles as others, but with more numbers and sources which is why it was chosen. I do need to refute his position of how PTSD symptoms remain due to financial desire and not sustained hardship from twenty years of war.
5- This article both supports my position as it confirms VA disability is required to sustain a quality of life otherwise impossible, while also arguing it is currently sufficient.
6- Same audience as above, and maintains its position that most of what needs to be addressed is very individualized for veterans which would make the process incredible difficult to improve.

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Long-term Outcomes of Disability Benefits in US Veterans With Posttraumatic Stress Disorder

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Context Most studies examining the clinical impact of disability benefits have compared aid recipients with people who never applied for benefits. Such practices may bias findings against recipients because disability applicants tend to be much sicker than never-applicants. Furthermore, these…

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1- The author argues the point that half the VA budget that goes towards VA disability compensation should be overhauled and reviewed in its entirety. The author states that the system was built in 1945 following a time when the payments were more for those losing compensation in manual labor jobs, and how it remains the only federal program that pays throughout a persons lifetime.
2- The arguement is persuasive in the fact that our country is having problems with the national debt and consistently finding a way to trim federal programs. The author brings valid points to changes in societal norms, however the author does not cite any sources or links to defend his position.
3- The authors stance seems firm but also holds a viewpoint that the nations veterans need to be taken care of. He seems to believe in a new approach that still assists those who are deserving while still preserving and protecting the funds being collected from the general public.
4- The idea is not uncommon and has come up multiple times because the idea that this is an outdated program is not entirely true. The program is to assist with those who lose compensation for what they would normally be able to do prior to injuries. Indeed there are less manual labor jobs but this does not take into effect the veterans desires in career path, or secondary means of income.
5- This article opposes my opinion and follows the arguement that this program can be abused, or overused to the point that it becomes a drain on government funds. I would refute his position by stating that the same health problems that have affected veterans since 1945 still remain an issue for employment and compensation today.
6- The authors intended audience are most likely members outside of the military to garnish support for a position that would be difficult to proceed with. Even as well intentioned as he seems after twenty years of war it would be difficult to go after major changes to a program that so many veterans rely on after service.

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1- The author makes arguments that all military veterans who receive or intend on filing for disability benefits understand how the funds can constantly be adjusted do to changes in disability status. The author states the reasons why the VA does this, as well as the timeframes usually abided to. The author also points to how income should not effect your disability rating.
2- The argument that all benefits should not be impacted by personal financial compensation from civilian careers is persuasive in the fact that the disability rating is to bridge the gap of possible earned income. In this aspect I found it easy to be persuaded by this, however am biased in the aspect of being a recipient.
3- The author is not biased and provides input from both sides, stating specifically why the VA does this and to include extreme cases such as fraud. The writing treats each opposing side with the same respect.
4- I do not recognize any information that I have either run into in the past or have heard about. I am unaware of any timelines or reasons VA disability would be reevaluated other than the ones stated in the opinion piece.
5- This source both helps and opposes my opinion by stating that personal income should not effect the rating scale, and also that disability rated "static" or permanent can be reevaluated. For example, cancer can go from 100% disabled to 0% if in remission, regardless of the chances of reoccurances.
6- Again the intended audience would be recipients of this program or those that wish to use it in the future. Civilians would find it interesting as their taxes pay these subsided programs.

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If you're a veteran receiving medical care and disability compensation, notification of a benefits review from the U.S. Department of Veterans Affairs might feel like getting audited by the IRS.

After all, they have one thing in common: the higher the stakes the higher the anxiety.

"The disability compensation is a tax-free benefit and a reliable source of income for many veterans," said retired U.S. Army Lt. Col. Elizabeth G. Kubala, a teaching professor and the executive director of the Betty and Michael D. Wohl Veterans Legal Clinic (VLC) at the Syracuse University College of Law.

"An unexpected change to that benefit can be stressful and potentially create a financial hardship. Unfortunately, many veterans are not aware that the VA may reduce their rating in certain situations. Fortunately, veterans facing a proposed reduction by the VA can take steps to challenge that reduction."

The VA disability 5-year rule allows the VA to revisit an existing disability rating within five years of a veteran's initial rating but only if the disability condition in question is reasonably expected to show improvement.

The VA cannot reduce a veteran's disability rating if it has been in place for five years or more unless the condition shows sustained improvement over time.

A re-examination of status could in some cases lead to an increase in benefits. But that possibility isn't the norm and it certainly doesn't relieve the stress of a review for veterans who depend on disability compensation to make ends meet.

When Will the VA Reevaluate Your Disability Rating?

A reevaluation can be scheduled anywhere from two to five years from the initial VA disability rating if the VA has reason to believe a condition is likely to improve.

Do veterans know a reevaluation is in the offing? In most cases, they should. In many cases, they don't.

"Every vet is informed," said Chas Sampson, a former VA rater, when asked if the VA's intention to reevaluate is included in the initial disability rating.

"They're told it's part of the decision. But it is hidden in plain sight. These decisions are 10 to 15 pages long. There might be one or two sentences where they're told the VA believes it is likely, given their condition, that a future examination (will take place.) Most vets don't read that part. They focus on the percentage of disability and the money."

One common example is a mental health disability rating. The VA reserves the right to reevaluate your condition within the two-to-five-year time frame to determine if your disability rating should stay the same, be increased or decreased.

Similarly, a reevaluation could be scheduled for any condition where there is evidence of material improvement. If medical evidence shows your condition has significantly improved, or it's determined your condition is not permanent, the VA can reexamine your status even after five years.

"The No. 1 condition that gets reduced is cancer," said Sampson, a veteran and CEO of Seven Principles Group, which helps veterans navigate disability claims. "Obviously it's because people go in and out of remission."

Why Does the VA Reevaluate Your Disability Rating?

Disabilities are not treated uniformly by the VA, for obvious reasons.

One condition - loss of limbs for instance, or blindness - might leave a veteran with a permanent and total disability. A mental health disability, or a cancer diagnosis, on the other hand, may not be considered permanent.

The VA reserves the right to re-examine veterans and reduce the benefits of those whose conditions might be expected to improve given time and proper treatment.

The VA mission is to fairly compensate veterans. But it is also charged with monitoring how the money is used.

"You have to remember these benefits come from taxpayer dollars," Sampson said. "The goal is to make sure veterans get the benefits they deserve while also minding the best intentions of taxpayers who are funding those benefits."

How Does the VA Reevaluate Your Disability Rating?

You should know at the time of your initial rating whether your status is subject to a reexamination within two to five years. But what you don't always know is when the VA will determine that your condition is showing improvement.

The VA is required to send advance notice 60 days ahead of a reexamination. That notice might well suggest the VA believes the medical evidence on file doesn't support a continuation of benefits at the current rate.

"If you get that notice [unexpectedly], you're likely already a little behind the curve," Sampson said. "If a vet has been clueless about the process until they get that notification, it's probably too late. If you haven't been proactive in keeping documents, it's going to be very difficult [to fight a ratings reduction.] The deed is somewhat done."

It's important you keep that reexamination appointment. As stressful as the prospect is of losing benefits, avoidance makes it worse. The VA could eliminate your benefits if you miss your reexamination appointment.

If the VA decides to reduce benefits for whatever reason, you do have some recourse.

"The VA is required to notify the veteran of the proposal to reduce their rating," Kubala said. "Veterans may then request a hearing where they can provide the VA with new information and evidence to fight the proposed reduction.

"Often a hearing is very beneficial because it allows time for the veteran to gather information such as new medical records and updated diagnoses. Veterans may also use the hearing to describe their current condition and explain their current symptoms and lack of improvement in their own words."

Veterans can continue to appeal the VA's determination of the need for a reduced rating even after a hearing.

Sampson's advice is to wait six months to a year to have time to gather new supporting evidence to appeal.

"You can appeal at any time," Sampson said. "But your test for winning is really low if you're arguing your case without new supporting evidence. You'll likely get another denial and ticked off all over again."

What to Do If Your Rating Is Reduced?

Lyle Solomon, principal attorney at Oak View Law Group in Auburn, Calif., says veterans have three recourses - all of which involve appealing the decision:

Filing new and relevant evidence: "This is the simplest recourse, and all that is required is to provide more proof beyond what was available when the first claim was examined. To submit a Supplemental Claim, veterans must complete VA Form 20-0995 and follow the instructions provided on the VA website. Any time the veteran comes across new and relevant evidence, the veteran may submit it as proof."

Requesting a higher level review: "If the veteran wants a second opinion on their claim but has no additional proof to submit, the veteran may use this option. The veteran must file VA Form 20-0996 within a year of the first decision date. The veteran can call their reviewer and argue why they think a modification is necessary. On average, this procedure takes 5 months to complete. Visit the VA website for a detailed explanation of the procedure. This is a single-time option; further appeals need additional evidence, which may only be submitted as a supplemental claim."

Appealing to a Veterans Law Judge: "A veteran can also appeal before the Board of Veterans' Appeals ("BVA") by filing Form 10182. The veteran will get the option to offer additional evidence if they want to appeal the reexamination evaluation before the BVA. Depending on the complexity of the veteran's request and the volume of supporting documentation they provide, the whole process might take up to a year. If the veteran's supplemental claim or higher-level review was denied, only then should they consider appealing before the BVA, but not in quick succession.

The BVA court will either agree with the veteran and accept their request, or rule against the veteran and reject their claim, or remand their claim and order further investigation. In such a scenario, the veteran should consult an expert in the field of appeals. After a final judgment is made at this stage, the sole recourse is to file an appeal with the federal circuit court or a supplemental claim to provide fresh evidence."

Other VA Disability Rules and Ratings

Veterans with permanent disabilities are awarded benefits. So, too, are veterans with conditions that might be expected to improve.

The idea behind the 5-year rule is that five years is a reasonable time to determine if the disability is permanent.

The 5-year rule is not the only barometer for disability benefit status. There are other protections for veterans receiving disability benefits, and also exceptions to those protections.

VA Disability 10-Year Rule

This means the VA can't eliminate a rating that's been in place for 10 years or more. So, no worries? Well, the VA can still reduce the rating if substantial medical evidence provides evidence of an improved condition.

Or if it's determined the original disability claim was based on fraud.

The VA Disability 20-Year Rule

If your rating has been in effect for 20 years or more, this rule stipulates that the VA can't reduce it below its lowest rating.

Exception: you guessed it - fraud.

VA Disability 55-Year Rule

If you're over 55, your rating is ostensibly protected since veterans past that age are exempt from periodic future examinations. The VA can schedule an examination only under unusual circumstances.

One qualifying scenario is that examinations are required six months after a veteran has completed treatment for certain cancers.

VA Disability 100 Percent Rule

A 100 percent VA disability rating is considered a total disability. A veteran with a 100 percent disability rating will only see a reduction of benefits if material evidence indicates that the condition has significantly improved.
In that case, the burden is on the VA to show evidence of significant improvements in a veteran's daily life.

Reduction or Elimination of VA Disability Benefits

One rating the VA can never reduce or eliminate is the Permanent and Total Disability rating. A "total" disability is an impairment that makes it impossible for a veteran to hold a gainful occupation. "Permanent" means it's reasonably certain the disability will continue throughout the disabled veteran's life.

A Permanent and Total Disability rating (it's possible to be one or the other or both) protects the veteran from any reduction of benefits unless fraud is proven.

Veterans with other ratings are protected, too, under the various rules already mentioned. A reduction of benefits can occur after reexamination, though the veteran can contest the findings or reapply for an increase of benefits after that reduction. Again, fraud is the one trump card that the government can use to disqualify a claim.

"Some ratings are absolutely more prone to a reexamination and change in benefit status, like cancer that has been removed or is in remission," Kubala said. "Unfortunately, even a condition such as Post Traumatic Stress Disorder can be vulnerable if the veteran is in treatment and appears to be improving.

"This entire process is complex and can be confusing and stressful for many veterans. The best advice for veterans who find themselves facing a proposed reduction is to enlist the assistance of a VA-accredited representative or lawyer to assist them in retaining the benefits they earned."

One common question is how work might affect a VA rating. It's simpler to say lack of work can be a major factor in a disability rating.

"Often, veterans with high ratings have workplace issues, so lack of employment is a huge consideration," Sampson said. "But if you go out and get a job and then excel at that job - go from making $40,000 to $200,000 - that won't be used as a deterrent against benefits.

"They don't look at it in that fashion. It may be considered as part of the total package, along with personal considerations like relationships, divorces, legal and behavioral issues."

While it's the case that VA pension benefits are contingent on income level and net worth, disability compensation benefits are not. Disability compensation benefits are based on the level of disability.

Knowing what to expect and your protections against a disability ratings reduction can offer some peace of mind to a reevaluation process that can be stressful if not managed with help from an VA-accredited rep, agency or attorney.

"Think of the differences in how people pay taxes," Sampson said. "Some taxpayers pay late. Some pay on time. Some pay quarterly. Our best clients are the ones who get a rating and say, 'I don't want to mess this up.' They keep on top of things. Being proactive is the approach to take."

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What Is the VA Disability 5-Year Rule? - Military Money

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If you're a veteran receiving medical care and disability compensation, notification of a benefits review from the U.S. Department of Veterans Affairs might feel like getting audited by the IRS. After all, they have one thing in common: the higher the stakes the higher the anxiety.

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1- The author argues that most likely military disability payments currently exceed what the loss in pay would be from their injuries sustained in service. The author presents things from both perspectives with background information and historical issues.
2- The argument is persuasive in the amount of information and backing information it brings. This article uses minimum presumptions and plenty of facts.
3- The author does not present a large bias and presents arguments from both sides equally, coming to a final conclusion of disability payments exceed what loss of income would provide. The author considers all points well.
4- The information in this article is largely original or more in depth than other articles I have come across during my research. The article is also formatted more effectively.
5- This source clearly challenges my opinion and uses a large basis of facts to assist in its claim. I need to acknowledge this aspect and find non biased ways to argue against it.
6- This article is meant to persuade others that the current program is outdated largely benefits current veterans. The audience is those whose tax money goes towards these programs as well as people such as myself who disagree with their stance.

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Short abstract

This article examines the adequacy of disability compensation to offset the reduction in civilian earnings opportunities that are associated with veterans' service-connected disabilities.

Abstract

The Departments of Defense and Veterans' Affairs (DoD and VA) pay about $35 billion in disability compensation to about 3.2 million veterans each year. Their disabilities range from battlefield injuries to health conditions like diabetes and asthma. This research examines the adequacy of disability compensation to offset the reduction in civilian earnings opportunities that are associated with service-connected disabilities (SCDs). The authors focus on cohorts of veterans who left active military service between fiscal year (FY) 1993 and FY 2004. They track these veterans' civilian earnings and labor force participation for up to 12 years, from 1994 through 2005, compare the labor-market success of veterans with and without SCDs, and recommend changes to disability compensation.

Casualties in Iraq and Afghanistan have heightened concern about whether disability compensation and programs provide adequate support for military veterans. The Departments of Defense and Veterans' Affairs pay about $35 billion in disability compensation to about 3.2 million veterans each year. Their disabilities range from battlefield injuries to health conditions like diabetes and asthma.

This research looks at the adequacy of disability compensation to offset the reduction in civilian earnings opportunities that are associated with service-connected disabilities (SCDs). Compensation is based on a schedule of ratings that nominally reflects the average loss in civilian earnings related to each disability. Until recent years, research has not directly compared disability payments with the actual civilian earnings losses of veterans.

Our analysis focuses on recent cohorts of veterans who left active military service between fiscal year (FY) 1993 and FY2004. We track their civilian earnings and labor force participation (LFP) for up to 12 years, from 1994 through 2005.* We follow civilian labor-market outcomes for veterans in these cohorts and compare the labor-market success of veterans with and without SCDs.

This research addresses four questions:

1. How do civilian LFP and earnings vary with SCD rating? We examine whether disability compensation is sufficient to offset civilian earnings losses.

2. Are earnings losses larger for some groups of veterans than for others? Veterans vary substantially by education, age at military separation, and other factors, so earnings losses might be adequate for some groups and inadequate for others.

3. Do earnings losses differ for those in the DoD and VA compensation programs? Christensen et al. (2007) argued that DoD underrates disabilities relative to the VA. If that is so, then we would expect veterans in the DoD program to have greater earnings losses than veterans with the same rating in the VA program.

4. How do civilian earnings losses vary over time? Disabled veterans might have more difficulty than others in finding a good civilian job match. If so, they may have large initial earnings losses (i.e., take more time finding a civilian job or have lower initial wages) than other veterans, but these problems may abate after an initial transition period. Disabilities might hamper a veteran's transition to civilian employment and have a smaller effect on subsequent labor-market success. In addition, some SCDs might become more limiting over time, so initial market outcomes might provide a distorted indication of how SCDs are affecting earnings losses.

Background on Disability Compensation Programs

DoD and VA have separate programs that compensate veterans for SCDs. The DoD program compensates servicemembers with SCDs who receive a disability separation from active military duty because they are medically unfit to perform their duties.** The VA compensation program compensates veterans who have a SCD and receive a nondisability separation from active duty. Some nondisability separatees are eligible for military retirement (i.e., career members), but most serve fewer years and leave at the end of the term of service. In addition, many veterans in the DoD program apply for and receive disability benefits through the VA program soon after leaving active duty. The VA benefits offset disability payments available from the DoD.

Our research also compared features of the DoD and VA system with civilian disability programs.

VA Disability Program

The VA spends about $34 billion per year on compensation to over 3 million veterans with SCDs. Compensation amounts are based on the Veterans Affairs Schedule of Rated Disabilities (VASRD). Ratings are assigned in 10-percentage-point intervals associated with specific medical conditions for each veteran with a SCD. Medical evaluations are conducted by DoD as part of active duty separation procedures, but many veterans are reassessed by the VA.

By federal regulation, the VASRD is based on the "average impairment in civilian occupational earning capacity" associated with each SCD (see 38 CFR §4.1, 2010). SCDs are broadly defined for active duty personnel, so the injury or condition is not necessarily related to military training or deployment. For example, servicemembers who are injured in an off-duty automobile accident are eligible for disability compensation. The key factors in determining the eligibility for compensation for a SCD are that the condition is related to time served on active military duty and is not self-inflicted.***

The VA program has faced several types of criticism in recent years:

VASRD is out of date. Several recent studies have argued that the schedule does not reflect current medical practices or the current limitations of medical conditions. Furthermore, the payment schedule is only nominally related to actual earnings losses.

"Average impairment" may shortchange some. Veterans have diverse skills and opportunities in the civilian sector. Reimbursement based on "average impairment" at each ratings level may leave considerable variability in how compensation benefits offset the earnings losses of veterans with different levels of experience and education.

VASRD includes quality of life (QOL). The compensation payments under VASRD are not a linear function of the rated disability percentage. The payments for high rating are disproportionately large relative to those for smaller ratings. Some argue that the VASRD implicitly includes payments for reduced QOL. QOL is not necessarily proportional to earnings losses for particular SCDs, however, so it is unclear how the schedule could effectively blend QOL with earnings loss.

Disability compensation "crowds out" retirement compensation. Until recent years, most military retirees received the maximum of their retirement entitlement and their disability entitlement. This policy is being phased out under a new "concurrent receipt" law that allows veterans with highly rated disabilities to receive full disability and retirement payments.****

DoD Disability Program

DoD provides disability compensation to servicemembers who sustain an SCD that renders them unfit to perform their military job. These members receive a disability separation from active duty. DoD has two disability separation alternatives-disability severance and disability retirement. Members with SCDs rated below 30 percent receive a disability severance-a one-time lump sum payment based on member experience and pay grade (irrespective of the rating level). Members with ratings of 30 percent or more receive a disability retirement where ongoing monthly payments are a function of the disability rating, years of experience, and military paygrade.

Most recipients of disability severance and retirement payments apply to the VA for disability payments soon after their separation from active duty. The high application rate is driven by three factors. First, the DoD payments are generally taxable, whereas VA disability compensation is tax-free. Second, DoD assigns a rating based solely on the condition that makes a servicemember unfit to remain on active duty. Most veterans leave with multiple conditions, so they may receive a higher rating from the VA than the DoD. VA disability payments offset the DoD payments. Third, DoD severance is a one-time lump sum while VA disability compensation is a lifetime annuity. Many members perceive the annuity as being worth more than the lump sum payment, perhaps because their rating may be increased in the future.

Civilian Disability Programs

A wide variety of civilian programs provide benefits to disabled employees. Many of the programs are government-sponsored insurance. Some cover job-related injures; others cover injuries or illnesses outside the workplace.

A common feature of most programs is that most are means-tested (i.e., payments are proportional to pre-injury earnings up to some cap) and payments end when a worker returns to work. The premise of the programs is that they replace employment earnings while a worker is out of work.

Military compensation differs from these programs in several respects. First, servicemembers receive full military pay and benefits while recovering from an injury. If a member retires from the military with an injury, the benefit is based on a disability rating assigned using the VA's schedule. Second, military disability compensation for veterans continues for life, irrespective of civilian earnings.

Measuring Earnings Losses

We have longitudinal measures of labor force participation and civilian earnings for all active duty veterans leaving military service from 1994 through 2005. We compare the labor market outcome for all veterans from these cohorts with and without SCDs. We examine how these labor-market outcomes changed from year to year as veterans settled into the civilian labor market. This tracking is useful because, although new veterans (with and without SCDs) may have transition issues as they switch from military to civilian employment, these problems may abate as they adjust to civilian employment. In addition, veterans with SCDs may have different short- and long-term losses in the labor market. Our analysis includes a measure of civilian labor-market experience that separates the short- and long-term effects of SCDs on earnings.

Civilian labor-market opportunities vary systematically with an individual's education, age, race/ethnicity, and gender. Two broad classifications differentiate veterans from one another and are likely to shape their subsequent civilian labor-market opportunities. First, enlisted members have different backgrounds and experience than officers. Enlisted members generally enter the military with little or no college preparation. Officers generally have more professional or management responsibilities in the military than enlisted members, and this experience translates into different civilian opportunities after leaving the military. Second, many members serve one or two terms in the military and leave without earning a nondisability retirement. Nondisability retirees are older than other veterans and have considerably more military experience. The retirees enter civilian employment at midcareer and often have well-defined occupational skills. In contrast, most in the nonretiree group have often served on active duty only about four to six years, and these members have skills more suited for entry-level positions in the civilian labor market.

Based on these considerations, we divided veterans into five broad groups that are likely to characterize different portions of the civilian labor market: enlisted males (excluding enlisted nondisability retirees), enlisted females (excluding enlisted nondisability retirees), enlisted nondisability retirees, officer nondisability retirees, and other officers (e.g., officers leaving the military before reaching eligibility for a length of service retirement). Each group includes some veterans with SCDs who successfully completed their military service (some receiving a retirement based on length of service and some leaving before retirement eligibility). Disability retirees were grouped with enlisted males, enlisted females, and other officers, since these veterans were generally much younger than enlisted and officer nondisability retirees.

We examined how SCDs affected the civilian labor force participation and earnings of veterans by comparing the earning losses of veterans without SCDs to those of veterans with various disability ratings. We conducted separate analyses for each of the five groups. Each model contained disability ratings (VA ratings except for DoD retirees who did not apply to the VA) and specific controls for separation cohort (FY1993 through FY2004) and years of civilian experience after leaving active duty. Subsets of specifications included controls for age at separation from active duty, education level, race/ethnicity, gender (where applicable), disability retirement or severance (where applicable), Armed Forces Qualification Test (AFQT) score (where applicable), service branch, participation in the Afghanistan or Iraq conflicts from 2001 to 2004, and whether the individual had a competitive promotion in the top 25th percentile of their entry cohort.*****

Results

The earnings losses for most active duty veterans with SCDs are much smaller than the disability compensation provided by the VA or the corresponding component of DoD retirement pay. For example, veterans with a 30-percent disability are better off financially than other similar veterans with no SCD. The loss in civilian earnings for veterans with SCDs is more than offset by the size of disability payments, the tax-free status of those payments, and the availability of concurrent receipt for nondisability retirees with ratings of 50 percent or greater. The "extra" payments increase with disability ratings and are higher for enlisted veterans than for veteran officers. The disability payments associated with the VASRD are generally higher than the actual earnings losses for each rating level and across most types of veterans.

These overpayments might be interpreted as some QOL compensation for veterans with SCDs. This explanation has two weaknesses. First, current law dictates that disability payments should cover only average civilian earnings loss. Second, the disability schedule does not identify QOL in any way, so overpayments are unlikely to appropriately reflect QOL impairments across veterans. Adding QOL adjustments would require a new or revised disability schedule that measure how QOL was affected by each SCD. Some injuries (e.g., a facial scar) might be detrimental to QOL and have little effect on civilian earnings. Similarly, limited knee mobility from a SCD might have little effect on the civilian earnings of a veteran working as a computer programmer and have a large effect on the veteran's recreational activities.

While compensation exceeds earnings loss for most veterans, some do suffer civilian financial losses from their SCD, and some veterans with medical separations fare worse than others with comparable ratings. The disability payments are proportionately less generous for former officers than for former enlisted members and are insufficient to offset earnings losses for some groups. This gap reflects the fact that veteran officers have higher civilian earnings than enlisted veterans, but the disability compensation schedule does not differentiate on prior rank. Junior officers with low ratings are worse off than comparable junior officers without SCDs, i.e., the disability compensation for these veterans is not sufficient to offset their earnings loss.

We found that veterans with disability separations from active duty have much lower earnings than do comparable other veterans with the same rating. For some reason, disability retirees and members with military severances have worse civilian labor-market outcomes than do comparable veterans who successfully complete their term and leave active duty with similar SCDs.

We found substantial differences between labor market outcomes of nondisability retirees and veterans who completed their enlistment term and left before retirement eligibility. The incidence of SCDs is higher for nondisability retirees than for others who successfully complete their enlistments, but the comparable ratings have a smaller effect on nondisability retirees than on these other veterans. The higher incidence reflects both that the retiree has spent more time at risk of a SCD and that many health conditions are inherently tied to aging. The reasons for the better labor-market outcomes are less clear. Perhaps the older retirees work in less physically demanding jobs than the other veterans, so their SCDs have less effect on their job productivity. Alternatively, older veterans have a different mix of conditions than young veterans, and those conditions may relate to civilian opportunities differently. We did not have access to medical conditions, so we were unable to compare the mix of conditions across the two groups.

Finally, we looked at the timing of possible earnings losses as veterans transitioned to civilian employment after leaving active military duty. We found that veterans with SCDs fared no worse in the first two years of civilian employment than they did in subsequent years. While SCDs do reduce earnings opportunities, they do not disproportionately decrease them in the first few years of civilian experience. We also found that civilian labor-market outcomes were not very sensitive to increases in veteran ratings over the first several years of civilian experience.

Conclusions

Based on our findings, we strongly suspect that disability compensation for all cohorts of veterans with SCDs exceeds the average earnings losses for those veterans. Since we only look at earnings for 12 recent cohorts, it is possible that the "extra" compensation in these cohorts is entirely offset by "insufficient" compensation for veterans from earlier cohorts. Many veterans who left active duty before FY1993 are now retiring from the civilian labor force. Veterans with SCDs are better off financially than other veterans when they retire from the civilian workforce because they receive disability compensation with no current civilian earnings loss.

Perhaps disabled veterans' payments compensate for QOL losses over and above the earnings losses associated with their injuries, but we are not convinced that the VASRD reflects QOL loss in any meaningful way. DoD and VA do not collect information on how SCDs impede the functionality of veterans. This type of information would be needed to quantify QOL losses and is not reflected in the VASRD.

We have several recommendations for policy.

Better Define Objectives of Disability Compensation

Congress and program managers should better define the goals and objectives of disability compensation. Policymakers and researchers struggle with what exactly "average earnings loss" means and the implicit intent of disability regulations. The regulations should spell out the purpose of the program and exactly what should be the basis of compensation awards. Perhaps this would include such things as compensation for QOL or loss of functioning.

Update VASRD

VASRD should reflect changes in modern medicine and the limitations of SCDs in the current labor market. The VA should explicitly measure how SCDs affect veteran functionality and integrate this information into the VASRD. If QOL or nonwork limitations are objectives of disability compensation, then these factors should be explicitly built into the VASRD along with earnings losses. Regular review of the VASRD is needed to ensure that the ratings are consistent with the goals and objectives of disability compensation.

The research described in this article was prepared for the Office of the Secretary of Defense (OSD). The research was conducted within the RAND National Defense Research Institute, a federally funded research and development center sponsored by OSD, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

Notes

* The analysis does not track more-recent separations and earnings of veterans, because we were unable to obtain civilian earnings data for years beyond 2005.

** Active-duty personnel retire from the military with either a nondisability or disability retirement. Nondisability retirement is based on length of service-usually 20 or more years. A number of nondisability retired veterans have a service-connected disability and are eligible for military disability compensation from the VA. These retirees are "nondisability retired veterans with a disability," but the disability was not severe enough to preclude them from satisfactorily completing their military service.

*** In the past couple of years, VA physicians have begun reviewing the ratings of members declared unfit by Physical Evaluation Boards. This new policy is designed to create more consistency between DoD and VA ratings for members leaving active duty, but the effects of the policy have not yet been evaluated.

**** The new law applied to veterans who received a nondisability retirement and have a disability rating of 50 percent or more. Veterans with a disability retirement are still subject to having their retirement benefits offset by their disability benefits.

***** Some controls are not relevant in some groups for various reasons. We have separate groups for enlisted males and females, so we do not control for gender in these models. The AFQT is only given to enlisted personnel, so AFQT controls are not used for officers. By construction, veterans with disability retirement or severance are grouped with enlisted males, enlisted females, and other officers. Therefore, these controls are only relevant for these groups.

Reference

CFR-See Code of Federal Regulations.

Christensen, Eric, McMahan Joyce, Schaefer Elizabeth, Jaditz Ted, and Harris Dan, Final Report for the Veterans' Disability Benefits Commission: Compensation, Survey Results, and Selected Topics, CAN, CRM D0016570.A2, 2007. [Google Scholar]

Code of Federal Regulations, Title 38-Pensions, Bonuses, and Veterans' Relief, 2003. As of February 28, 2011: http://www.access.gpo.gov/nara/cfr/waisidx_03/38cfr4_03.html

Articles from Rand Health Quarterly are provided here courtesy of The RAND Corporation

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Is Military Disability Compensation Adequate to Offset Civilian Earnings Losses from Service-Connected Disabilities?

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This article examines the adequacy of disability compensation to offset the reduction in civilian earnings opportunities that are associated with veterans' service-connected disabilities. The Departments of Defense and Veterans' Affairs (DoD and VA) pay about $35 billion in disability compensation to about 3.2 million veterans each year.