Disability system for veterans strays far from its official purpose
The room fell silent for seven minutes as Illinois Rep. Tammy Duckworth upbraided a government contractor.
"Shame on you," the congresswoman scolded Braulio Castillo at an oversight hearing in Washington, D.C., last year, accusing the business owner of gaming the veterans disability system.
Castillo had filed a claim with the U.S. Department of Veterans Affairs after learning that a disability rating would give his technology company preferential standing for federal contracts.
His disability: A foot injury suffered playing football at the U.S. Military Preparatory Academy in 1984.
Though the injury didn't prevent him from going on to play quarterback at the University of San Diego, the VA rated him 30% disabled — good for $450 a month, tax-free.
Duckworth, an Army veteran who lost both legs in Iraq in 2004 when her helicopter was shot down, noted that her severely damaged right arm was rated only 20%.
"You, who never picked up a weapon in defense of this great nation, very cynically took advantage of the system," she said. "You broke the faith with this nation."
Duckworth directed her ire at Castillo, but the real culprit was the broad eligibility criteria of the disability system itself. The contractor had played by the rules for benefits and, as many Washington lawmakers know, those benefits cover ailments from sports injuries to bullet wounds, resulting in disability payouts that totaled $58 billion this fiscal year — up from $49 billion last year.
Routinely criticized in government reviews as out of touch with modern concepts of disability, the system has strayed far from its official purpose of compensating veterans for their lost earning capacity.
Yet lawmakers are unwilling to support reforms — or even to criticize the system publicly.
"If Social Security is the third rail of American politics, then the VA disability system is the fourth, nuclear rail," said Michael McLendon, a top VA policy official until 2006.
Duckworth, a Democrat, declined to be interviewed about the disability system. So did Republicans who have led attempts to end unnecessary federal spending, including Arizona Sen. John McCain and Reps. Darrell Issa of California and Paul Ryan of Wisconsin.
Florida Republican Jeff Miller, chairman of the House Committee on Veterans' Affairs who has aggressively investigated the VA for mistreatment of veterans, last week canceled two scheduled appointments for an interview and declined to answer written questions.
"I defy you to find another side to the discussion about vets," said Bill Brew, a Vietnam veteran who spent 25 years on staff of the Senate Committee on Veterans' Affairs before retiring in 2011. "It doesn't exist."
As the number of U.S. veterans has declined from 26.4 million to 22 million over the last 14 years and military service has fallen to a small number of volunteers, "Thank you for your service" has become a national meme as the political parties compete to stand up for them.
The arcane rules of the disability system are protected by what Brew and others on staff came to refer to as "the iron triangle": The VA, veterans groups and lawmakers.
"The easy course is to spew the rhetoric that is wildly supportive of veterans," Brew said.
Anybody who spends significant time in the military stands a high chance of becoming a disabled veteran.
"It's not like the common perception," said Daniel Gade, a public policy professor at the U.S. Military Academy who lost his right leg in a 2005 IED attack in Iraq. "Americans are pro-disabled veterans, because they think of veterans in wheelchairs who lost limbs. That's a tiny percentage."
Still an Army officer, Gade won't collect disability pay until he retires.
Amputees account for roughly 2,000 of the 904,839 Afghanistan and Iraq veterans on the disability rolls as of May. Though the VA did not provide figures on how many combat veterans are among the 3.9 million total beneficiaries, officials said they are a minority. More than 680,000 veterans in the system served during peacetime periods before 1991.
The system pays monthly for nearly any medical condition that can be tied to the time a veteran was enlisted. Once benefits are awarded, they are usually for life — even in extreme circumstances. Castillo, for example, was charged this April with murdering his wife. If convicted, VA rules stipulate that his disability rating would drop to 10%, or about $130 a month, while he is in prison.
Many of the most common conditions in the system are relatively minor ailments such as joint and muscle pain and tinnitus.
A woman who had a hysterectomy in the military can receive $900 a month for life. Delivering a baby by caesarean section is worth $130 a month — if the surgical scar is tender.
Payments for sleep apnea, which is most often caused by weight gain and is usually manageable, top $1.5 billion a year. Retiring Oklahoma Sen. Tom Coburn included the spending in this year's edition of his annual "Wastebook."
In one case reviewed by The Times, a schizophrenic man spent 38 days in Air Force basic training in 1975 before being discharged. He later served 10 years in prison for second-degree murder. In 2004, the VA deemed him 100% disabled and started paying him about $3,000 a month.
High disability ratings do not necessarily reflect serious impairment.
Ryan Zinke, who spent 23 years as a Navy SEAL and was elected to Congress in November, was awarded an 80% disability rating in 2008, according to records released during the campaign. His disabilities include arthritis in his back, undiagnosed pain in all of his limbs, a strained wrist, tinnitus, a deviated septum and athlete's foot.
"It's kind of like I'm a prizefighter that has been beat up," the 53-year-old Montana Republican said. He is paid at least $1,950 a month in addition to his pension. "I still run. I still work out. I'm just not as fast. And it hurts a lot more than it used to."
Over the last decade, government studies have described the system as badly antiquated and ill-defined in its purpose.
It was created nearly a century ago, and though hundreds of new disabilities have been added, the basic philosophy remains. Each condition carries a rating that is supposed to reflect how much, on average, it cuts into a veteran's earning capacity.
That calculation was easier when most jobs required physical labor and medicine offered fewer interventions. But today, the ratings often seem arbitrary.
Why is the removal of three ribs a 30% disability when losing a pinkie is 20%? Why is losing sense of smell a 10% disability when high blood pressure is as much as 60%?
Monthly compensation is determined using a formula that combines a veteran's conditions into a single rating of up to 100%.
The Government Accountability Office, the Institute of Medicine, a presidential commission and other groups have suggested reforms to give veterans disability ratings based on how they function rather than the severity of their medical conditions. Recommendations have included one-time payments for certain ailments, quality-of-life payments and incentives for disability recipients to seek treatment and vocational rehabilitation.
But none of that is likely to happen, according to Brad Flohr, the VA's senior advisor for compensation. Benefit reductions are rarely proposed, he said. "That's never very popular — not among our stakeholders, not among members of Congress."
Looking for more
Air Force veteran Roland Griggs dislocated his left shoulder in basic training in 1965. Stationed in California and Turkey during Vietnam, he was eventually deemed 10% disabled.
His right shoulder, which he favored because of his disability, eventually required surgery. He said years of taking ibuprofen had caused acid reflux, which he believes led to cancer of the esophagus. Now he wants to boost his disability rating.
"I'm hoping for as much as I can get — 60% or 100%," said Griggs, a retired IRS agent.
For help, last month he went to the Long Beach American Legion post, where Legion and VA officials were visiting as part of a 12-city tour to assist veterans with disability claims and other problems.
Verna Jones, head of the Legion office in Washington, D.C., said assistance with claims was an important part of drawing in new members as the older generation disappears.
The Legion and other major veterans organizations, which hold power of attorney for hundreds of thousands of disabled veterans, are fervent defenders of the system. A 2012 GAO review found that veterans groups generally regard the current rating scheme as an equitable way to determine disability pay.
Medical conditions that seem trivial can actually be very debilitating, Jones said. For example, she said, she had once scoffed at VA payments for pseudofolliculitis barbae — a condition better known as razor bumps, a persistent irritation caused by shaving.
"Then I saw a very bad case," she said.
"We can't always look at numbers," she said. "Replace those pens and calculators with some human kindness."
Jones, who served in the Army from 1987 to 1995 and remained out of war zones, said she has a disability rating but declined to discuss it.
Veterans organizations have tremendous lobbying power in Congress and the VA.
Sen. Richard Burr of North Carolina saw the influence in 2008 after sponsoring a bill to give veterans with post-traumatic stress disorder, depression or anxiety a financial incentive to get better before signing them up for a lifetime of disability pay. They would receive $11,000 if they attend treatment and wait at least a year to apply for compensation for those conditions.
But veterans groups said they could not support any measure that restricted disability claims.
Not even Burr's fellow Republicans on the Senate Committee on Veterans' Affairs were willing to co-sponsor the bill.
Burr reintroduced the bill last year as payments for PTSD soared and more VA mental health providers expressed concern that the financial incentives of the disability system were undermining their ability to assess and treat patients.
An official from Disabled American Veterans told the committee that the group supports stipends to promote treatment and early intervention. "However, DAV strongly opposes any provision that attempts to link wellness stipend payments to a veteran's right to file a disability claim," he testified.
The bill has gone nowhere.
The last major attempt to remake the disability system came six decades ago.
A commission formed after World War II by President Eisenhower found that the VA focused too much on compensating veterans without enough attention on rehabilitation.
Of 2.1 million veterans on the disability rolls in 1955, a quarter had been hurt in combat. Roughly half were paid for minor conditions that didn't impair them.
"When so-called 100% disabled veterans engage in highly remunerative employment, the Veterans Administration program becomes susceptible to misunderstanding and criticism," the commission reported.
Eisenhower, a five-star general, believed that military service should not entitle people to special privilege and that the social safety net created by the New Deal made many benefits redundant. He wanted to refocus the system on the severely impaired and the mentally ill
Congress dismissed his recommendations.
In that era, sheer numbers gave veterans political power. About 40% of adult men were veterans in 1960.
"Back then, veterans were 'us,'" said retired Army Col. Andrew Bacevich, a military historian and professor emeritus at Boston University. "Today, veterans are 'them.'"
Roughly 1% of U.S. adults served in Afghanistan or Iraq.
"Over the past 30 years, it's become politically advantageous and even fashionable to treat those who serve as exalted figures," said Bacevich, whose son, also an Army officer, was killed in Iraq in 2007.
"Americans have put soldiers — and by extension veterans — on a pedestal," he said. "Once you do that, common sense rules of economy and accountability get waived. It's not surprising that costs go through the roof."