Wednesday, September 18, 2013

Anthony Principi: Wounded Vets Deserve Better

"To care for him who shall have borne the battle, and for his widow, and his orphan."
Abraham Lincoln's words light the path of America's eternal responsibility to those who have served in uniform. But we have lost our focus on Lincoln's command: Veterans and their families wait far too long for the benefits they have earned. Too often, this is because those who have been injured in military service—including our most recent vets—must wait in line with those who served but were not wounded.
On Aug. 22, Secretary of Veterans Affairs Eric Shinseki said that the department has reduced a backlog of disability claims by 20% to some 773,000 cases, including about 480,000 that have been pending for more than 125 days. Yet no number of new claims processors will be skilled enough, no computer fast enough or shortcut quick enough to deal with the ever-rising tide of claims unless the VA refocuses on the kind of care the system was designed to deliver. The enumeration of benefits has evolved far beyond the nation's obligation to those who became ill or injured while in service. It is time to return to original principles.
Twelve years ago, America went to war. Since then, about 6,000 service members have been killed in action and some 50,000 wounded. Their claims for disability compensation are not choking the Veterans Affairs benefits system. They are the victims of the sclerosis now overwhelming the veterans-benefits program—a system that often puts the most needy in line behind everyone else.
Every year more than a million veterans file claims for "service-connected" disability compensation; that is, for any disability or disease arising while on active duty, regardless of how the disability or disease was incurred. Nearly 80% of those claims are from veterans whose service predates Sept. 11, 2001. According to the Department of Veterans Affairs website, 37% are filed by my fellow Vietnam War veterans. More than 100,000 claims were filed last year by veterans who served during peacetime.
The price for allowing veterans to file claims throughout their lives is paid by the veteran who has lost a leg to a land mine in Afghanistan; whose ability to think clearly was clouded by the explosion of an improvised explosive device in Iraq; or by the grieving widow of a newly deceased young corporal. Every claim for compensation must fend for itself in a bureaucracy for which every veteran is the first priority—which means, of course, that no veteran is the first priority.
When everyone applies for disability compensation, those who embody the reason that Veterans Affairs exists must lose out. Their claims are one more folder in an ever-higher pile. Restoring Lincoln's focus will require rethinking what VA benefits are intended to achieve. Benefits and services should respond to disabilities incurred by veterans while in service, especially disabilities incurred in combat or while training for combat.
This is not always the case today. One example: A Vietnam veteran need provide no evidence beyond a discharge showing in-country service and a diagnosis for diseases presumed to be the result of exposure to Agent Orange to get automatic service-connection. That presumption is based on tenuous medical science described by the Institute of Medicine as only "weak" or "suggestive."
Today, veterans who spent just one day in Vietnam are automatically service-connected for Type II diabetes (irrespective of other lifestyle or heredity factors); Parkinson's disease; prostate cancer; lung cancer (irrespective of smoking history) and ischemic heart disease. All of these are among the most common diseases of older men, veteran or non-veteran. Veterans Affairs examines veterans not just for the primary disease they may have, but also for conditions that may flow from it. Because these diseases get worse as veterans age, they have every incentive to regularly reopen their claims.
As a Vietnam veteran, I will be able to file a claim if I get sick at age 92, or 102. If any of those diseases contributes to my death, my widow will get the same compensation as the spouse of a service member killed in Afghanistan. My widow's claim will contribute to the pile of claims that must be processed along with the Afghanistan spouse's claim.
As the Republican chief counsel to the Senate Veterans Affairs Committee, and later as George W. Bush's secretary of Veterans Affairs, I was part of the process that created these presumptions. I make no apology for my actions. But our obligation to future veterans calls for refocusing the benefits we provide. Clear thinking can restore balance to the system while retaining its fairness.
Shouldn't there be a cutoff date—either in age or years since service in Vietnam—for disabilities that may be related to Agent Orange? At some point, the system now goes far beyond what the law requires—resolving reasonable doubt about the degree of disability in favor of the veteran, after careful consideration of all available data—as Veterans Affairs is required to do. This makes no sense when older veterans are compensated for the expected and ordinary effects of aging.
Another source of claims crowding the line for VA benefits is the concept of "individual unemployability." Veterans Affairs can pay disability compensation at a 100% rate to veterans with lesser disabilities—evaluated as little as 60% disabled—if their disability prevents them from working. That makes sense for working-age veterans. But does it make sense when a veteran files his first claim when he is 80 or 90 years old?
Veterans Affairs is compelled to devote the same resources to deciding these claims as it does to the claims of veterans just back from Afghanistan. And these older veterans receive 100% disability compensation—as retirees, in effect—while Afghanistan veterans with below-the-knee amputations get only 40% (the degree to which the VA believes such an impairment affects a veteran's ability to work). That's just wrong.
Some have called for Secretary Shinseki's resignation. I do not. Instead, Washington—from Congress to the Pentagon—must reassess what laws, regulations and rules can be changed to ensure that benefits and other decisions Veterans Affairs makes are beyond reproach and based on the best facts available.
Let's ensure that the department's limited resources are focused on its core mission rather than dispersed in an effort to remedy every possible problem for every veteran. Remember, when everyone is first priority, no one is.

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