Rating system needs improvement

After a three-year effort by the departments of Defense and Veterans Affairs to improve the process, ill and injured military members still endure a long, complex and often contentious evaluation system when seeking disability ratings and compensation for service-related health conditions.

The process has been made more convenient and even shortened by an average six to eight months under a pilot program jointly run by the two departments and which continues to be expanded to more military bases.

Yet the Defense Department’s personnel chief and the Army’s surgeon general have said publicly that the “integrated” disability evaluation system, or IDES, remains a disappointment.

More dramatic changes, they suggest, have to occur.

Clifford L. Stanley, under secretary of defense for personnel and readiness, revealed his concern to the annual Military Health System conference in January. Stanley said he had been “raising Cain” over the time that injured and ill members still spent in “limbo” awaiting medical appointments and medical review board decisions.

Stanley said he agrees with that criticism of IDES, though the pilot continues to be improved as it replaces, base by base, the far more flawed legacy DES.

The legacy system, still used for 40 percent of members seeking disability ratings, requires each service to conduct a medical evaluation to identify only “unfitting” conditions and award them a rating.

If the rating is 30 percent or higher, the member is retired and draws a lifetime annuity and other retiree benefits including access to military medical care. If the rating is below 30 percent, the member is separated, usually with a lump sum severance payment. Veterans then go to VA where a new evaluation process begins, this time of every service-related condition found. VA ratings and compensation usually are higher than the service allowed.

Back in 2007, it took an average of 540 days to clear both DES processes.

The pilot program to integrate them uses one set of medical examinations done by VA doctors to VA standards. It has honed the process time down to an average of just more than 300 days. Members leave service with their military and VA ratings set and with their compensation, usually based on the VA, starting immediately.

Recommendations to improve IDES will be presented to Defense Secretary Robert Gates and VA Secretary Eric Shinseki at the end of April.

The ideal system, Stanley said, would produce “a single evaluation based upon one medical record,” and over which Defense and VA officials “have joined hands and made a decision: ‘Here’s the disability rating. Period.’

That’s what we’re looking for…That’s nirvana.”

But such a change, presuming the one and only rating were set by VA, would make many more military members eligible to be disabled “retirees” thus driving up DoD retirement and medical costs.

The 2007 Dole-Shalala Commission, which was formed after the scandal involving neglected wounded warriors on the campus at Walter Reed Army Medical Center, recommended getting “DoD completely out of the disability business” by giving VA sole responsibility for setting disability ratings and awarding compensation. It urged replacing “confusing parallel systems” of DoD and VA ratings with a single simple and more generous system.

Congress instead passed more modest reforms to partially integrate the two processes.