March 16, 2009 – Since reconvening in January, Congress has proven surprisingly capable of swift movement to redress some of the worst injustices of the past eight years.
The past two months alone have brought legislation in support of job creation, equal pay for women, and expanded health coverage for children, raising hopes for the relief of other vulnerable groups. Among those most in need of renewed attention are veterans of our all-volunteer military who have come home from war seeking disability benefits for Post-Traumatic Stress Disorder (PTSD).
While the dysfunctional state of the VA claims adjudication system has become a matter of growing public concern, the rhetoric surrounding our obligation to returning troops still falls short of actual legislative priorities.
Meanwhile, recent efforts to reform the VA benefits system through litigation have only affirmed the need for legislative action, with courts repeatedly dismissing the issue as a Congressional matter. The resulting inertia makes the passage of the recently introduced COMBAT PTSD Act especially vital.
Under current VA policy, these disability claims are effectively presumed fraudulent until proven otherwise; beyond establishing their medical condition, claimants must prove through elaborate documentation that their disability stems from their military service.
While the disability claims process imposes a toll on all veterans seeking benefits, its burden falls with particular weight on those with Post-Traumatic Stress Disorder (PTSD), who must identify the specific stressor that triggered their condition, even if they have already been diagnosed and referred to treatment.
In response, Congressman John Hall has introduced legislation to eliminate this added step for all veterans who served in combat and were subsequently diagnosed with PTSD.
Under the existing system, the VA Clinician’s Guide warns examiners that PTSD symptoms are “relatively easy to fabricate,” directing them to supplement treatment records with elaborate documentation from claimants’ family and friends concerning changes from pre- to post-service status. Despite the fact that one of the diagnostic criteria for PTSD is an inability to recall important aspects of a trauma, reviewers routinely deny or remand claims due to incomplete information.
As labor-intensive for reviewers as for claimants themselves, this system has yielded a backlog of over 900,000 claims.
At the same time, the VA continues to measure employee productivity by number of cases processed, offering reviewers an incentive to take any shortcut necessary to clear their desks of pending claims. The resulting combination of too much work and too little time ultimately gives rise to premature — and inaccurate — determinations, setting in motion years of appeals.
Additionally, since the proof requirement calls for the release of extensive military personnel data, it poses a particular disadvantage to claimants with irregular or inaccessible records.
Claimants seeking compensation for Military Sexual Trauma, for example, are inevitably obstructed by the military’s policy of retaining harassment complaint files for only two years, eliminating critical evidence of the stressor that gave rise to their condition. Even in the best of circumstances, the retrieval of military records is a bureaucratic struggle, requiring protracted negotiation with a central archive in Missouri.
In spite of these inequities, the VA defends its current system as a precaution against claimant fraud.
According to VA spokeswoman Kerri Childress, eliminating the proof requirement “would be a travesty for veterans — an assault to the pride of honest soldiers when other vets scammed the system.”
Such cynicism, however, hardly seems justified by actual numbers; not only are 50{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of rejected claims reversed at the first level of appeal, but 90{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of claims that reach the final stage of review are ultimately approved. Far from ensuring the veracity of claims, the proof requirement serves chiefly to postpone the delivery of benefits, often until too late.
It should also be noted that no other disability insurance system, be it the Social Security Administration or the private medical insurance industry, is designed around a presumption of claimant fraud.
A useful analogy, offered by Kennedy School professor Linda Bilmes, is the approach the IRS uses for taxes: instead of investigating the accuracy of every claim, it handles most transactions with minimal processing, and audits a small subset of the total.
“The expectation” Bilmes explains, “is that the majority of claims received are approximately correct, because making them perfect would cause unacceptable delays.”
In fact, most states require by law that the medical insurance industry pay providers within 30-60 days of receiving the claim, with financial penalties for non-compliance. Federal veteran law, on the other hand, includes neither a timeline for the processing of claims nor penalties for unreasonable delays. Instead of enjoying a privileged status for their service, veterans are in fact subject to requirements unknown to any other disabled population.
Establishing service in combat as the presumptive stressor for the incurrence of PTSD would be a long overdue first step towards fixing a notoriously broken system. As Congressman Hall has emphasized, claimants would still need to be clinically diagnosed with PTSD to be eligible for benefits; they would simply be relieved of the obligation of “proving” the events that caused this diagnosis.
If we trust our troops to represent us honorably in battle, then surely we should afford them the benefit of the doubt when they seek compensation for their losses — suffered on our behalf — upon their return.
