WASHINGTON — Service officer Rene Deschene advises military men and women with amputated limbs, post-traumatic stress and injuries invisible to the naked eye in the Veterans of Foreign Wars office at the Togus VA Medical Center in Augusta.
Soldiers returning from duty in Iraq and Afghanistan are common clients in his office, as are those who served in Vietnam more than 30 years ago. But these men and women do not come to see Deschene to discuss their ailments or mental flashbacks.
Patients turn to him for guidance through a system that can seem as complex and daunting to newcomers as the first day of boot camp — the bureaucracy of military health care. Many who pay Deschene a visit are in the midst of medical and physical evaluations required to receive disability ratings for service compensation.
Disability ratings — on a zero to 100 percent scale — are assigned to wounded service members. The ratings determine whether members get medical retirement and what disability payments they will receive after they are discharged from military medical care.
The Department of Veterans Affairs uses the rating system to determine for each veteran what service-related health problems will be covered by its facilities. Though VA facilities use the same guidelines that are used by military facilities to determine an individual’s overall rating, the measures can vary drastically between the two systems.
Rating discrepancies between military and VA facilities occur because of the differing focus each places on medical and physical evaluations, officials from the VA and Department of Defense said.
Inside the bureaucracy
Sgt. 1st Class Brian Levensailor of Guilford, Maine, an outpatient at Walter Reed Army Medical Center in Washington, started his disability rating process in early March after several months of medical care at the facility. He said he has yet to receive his initial claim recommendation.
Levensailor, who has been in the military for 24 years and served in Afghanistan, shows few signs of physical injuries at first glance. He said he hopes to receive a Pentagon rating above 30 percent, enabling him to take medical retirement, though he fears he may receive one much lower. Soldiers rated below 30 percent, who choose not to appeal, receive severance compensation without additional benefits.
“I’ve been told my injuries are degenerative in nature because I have arthritis now [from previous war injuries in Afghanistan],” Levensailor said. “The Army doesn’t seem to care that I have arthritis from aging in the service — not just from aging.”
The Department of Defense determines whether a person is fit or unfit for military duty according to physical and mental health and assigns a rating based on that standard. The VA evaluates the well-being of the person regardless of ability to continue military service, taking into account even minor health concerns, a process that often results in a higher rating estimate.
Soldiers can appeal their rating but risk receiving a lower score. Rating changes often occur when new medical records are brought before the Physical Evaluation Board, said Col. Andy Buchanan, the U.S. Army’s deputy commanding officer of the Physical Disability Agency at Walter Reed. If a rating is lowered it may be the result of a recent evaluation in which the individual performed better than on the same exam in the past, he said.
“Rather than the government doing what is in the best interest of the soldier and determining what is going to yield the best outcome, the medical care does a disservice,” Sen. Olympia Snowe, R-Maine, said in a telephone interview.
Because of the influx of returning wounded Iraqi war veterans, older Vietnam claims are backlogged.
“We have made [Operation Iraqi Freedom] claims a priority within the VA process because those returning from combat have a significant need for a rating,” said James Whitson, director of VA benefits for 16 New England regional offices, including Togus.
Those who served in Iraq and Afghanistan now represent 8 percent to 10 percent of pending VA disability claims, Whitson said.
“The older vets are being pushed behind for treatment now that the [Iraq] service members are coming home,” Deschene said.
Deschene and other service officers from veterans organizations throughout the state serve as resources for soldiers receiving VA medical care at Togus. But those awaiting disability ratings at military hospitals such as Walter Reed lack a strong network of on-site soldier advocates, according to critics of the system.
At Togus, service officers such as Deschene are paid by their affiliate veterans organization, not the hospital.
“The department service officer is the only person legally able to represent a veteran and present a [disability] claim to the VA,” said James Bachelder, senior vice commander of the Maine Veterans of Foreign Wars. “They go through much training to do so.”
Without soldier advocates to advise them, some service members in military care are unaware of the options for their service pay and what might be most beneficial to them, making the transition into VA care and civilian life increasingly difficult.
Although soldiers in military facilities are assigned case managers by the Department of Defense for help with medical appointments and care, most case managers lack in-depth knowledge of the disability rating system. Some soldiers settle on disability claims unaware of other options because they lack guidance, Levensailor said.
Medical injuries and illness deeply rooted in a soldier’s past can affect medical and physical service evaluations in military and VA facilities, Buchanan of Walter Reed said.
But some soldiers interpret low ratings given for various reasons as the Army’s attempt to save money.
“The ultimate goal seems to be to put everybody out that [the military] can without medically retiring them,” Levensailor said. “Medical retirees’ pay comes out of the Army budget, so if soldiers are pushed out onto VA, then they receive VA compensation out of the VA budget.”
Buchanan said the Physical Evaluation Board follows strict guidelines used by all military service branches to ensure each soldier is accurately and fairly assessed.
Two-thirds of the service members evaluated by the Department of Defense have muscular and skeletal injuries that often result in a disability rating below 30 percent based on their determined fitness for duty, Buchanan said.
According to data from the Physical Evaluation Board, on average 20 percent of evaluated soldiers received disability ratings each fiscal year that make them eligible for medical retirement.
“We are stringent about treating everybody fairly and equally,” Buchanan said. “A bullet doesn’t discriminate, so we don’t want to discriminate between injuries.”
Wounded Warrior Act
The Wounded Warrior Act, introduced in March and now under consideration in the Senate, would address many of the concerns raised by soldiers in military care, Snowe said.
Under the bill, stricter routine inspections in military facilities would be enforced and additional services would be available to those in care, easing the transition into VA services.
“There are no advocates for the soldiers and I think that is a very important assessment we need to act upon,” Snowe said.
Sen. Susan Collins, R-Maine, said in a telephone interview that providing additional resources for soldiers in these facilities rivals the urgency of increasing hospital staff.
“Waiting times [for disability ratings] are far too long,” Collins said.
The next step
Changes to the medical system are under way and the processing time for disability claims has improved in the past few months, Buchanan said, noting that the quality of medical care remains consistent.
The Army released a pocket booklet the last week of April outlining the disability rating process, and it will be distributed to service members at Walter Reed and military facilities throughout the country, he said. The booklet serves as a reference point for soldiers at various stages of the rating process.
Buchanan also said Physical Evaluation Board members from each service branch are expected to convene early this month to determine why the number of Army medical retirees is lower than that in other service branches when the same rating schedule is used to evaluate disability claims.
“All but two of my physicians on the Physical Evaluation Board [who assess soldiers for disability claims] are retired military,” Buchanan said. “They understand where these guys are coming from and they treat all equally in their evaluations.”
Collins, who sits on the Senate Armed Services Committee, said there is a lot of work under way at the Pentagon and in Congress to assess the disability rating system and reform military health care.
“I am very concerned that [the] transition between the military health care system and the VA system is a confusing bureaucracy for far too many injured veterans,” Collins said. “That really troubles me.”