The need to reform compensation for veterans with mental health disabilities

When wounded, ill, or injured service members are no longer able to perform their military duties, their medical conditions are evaluated to determine appropriate pay and benefits. This process is intended to fulfill the armed forces’ primary obligation to maintain combat readiness by removing unfit troops, while simultaneously ensuring fair compensation for veterans’ disabilities. Its legal roots date back to the Civil War, when the Union Army discovered that its peacetime officer corps was perilously aged, infirm and incapable of command.

Over the past decade, the Pentagon and the Department of Veterans Affairs (VA) have partnered on an integrated disability system wherein the military adjudicates fitness for duty and the VA rates individuals’ medical conditions. Although far from perfect, this joint endeavor has marked a major improvement for soldiers in terms of both seamless transition to VA benefits and consistency in disability ratings.

{mosads}Previously, the military and VA evaluated claimants separately, leading to wide discrepancies in ratings for the same conditions. As a general rule, the military’s ratings were less generous, which adversely impacted troops’ post-service benefits. Military disability ratings of 30 percent or more trigger medical retirement and associated entitlements, whereas ratings below that threshold qualify only for a one-time severance payment.

In its 2008 military budget, Congress mandated that the Pentagon and VA work together to fix the problem, and that the armed forces follow the VA ratings schedule when determining soldiers’ status. In a sign of lawmakers’ concern over the military’s penchant for shortchanging its personnel, Congress took the additional step of establishing a special review board to assess the fairness and accuracy of post-9/11 disability ratings under 30 percent.

Unfortunately, one loophole remained, and it disproportionately hurts service members suffering from mental health impairments. When a condition is deemed serious but unstable, the armed forces can temporarily retire a member and then reevaluate their status within three years to make a final disposition. Temporary retirement cases are reviewed and rerated by the military, not the VA, meaning they are subject to the process as it existed before the aforementioned improvements. Often the military proposes to lower the initial disability rating, putting the onus on veterans to prove they are still sick.

Citing the VA’s requirement that veterans with “mental disorders due to traumatic stress” be assessed to see whether their condition has improved, the Pentagon elected to deem post-traumatic stress disorder (PTSD) automatically impermanent and unstable. Service members incapacitated by PTSD, traumatic brain injury (TBI), and various mental health conditions attributed to trauma are thus temporarily retired by default and risk having their benefits stripped upon reevaluation.

This policy puts mentally ill veterans at a double disadvantage. First, unlike the vast majority of their physically injured comrades, their initial VA rating is subject to future second-guessing by the military and the threat of downgraded status. Second, veterans with severe mental illness are often the least likely to seek follow-up care, track their medical records, and show up for reexamination, which is precisely the evidence that the armed forces use in determining an updated rating. Stories of combat veterans who have no permanent address or support network and lose their PTSD rating based on a lack of current medical documentation are sadly not apocryphal.

This state of affairs stands in direct contradiction to the Pentagon’s well-publicized efforts to destigmatize mental health illness and treatment. It assumes that all trauma-related conditions are transient and curable. While time and distance from a traumatic event can surely aid the healing process, mental health disorders are oftentimes chronic and lifelong diseases, just like back or knee pain.

One thing for certain is that the current system, which makes mentally ill veterans plead sickness or else lose their retirement benefits, creates exactly the wrong therapeutic incentives for them to actually get better. Whereas a veteran with a bad back can pursue rehabilitation without jeopardizing their military rating, a clean bill of health from a psychiatrist or neurologist can spell economic doom for a temporarily retired veteran with PTSD or TBI.

Given that these invisible wounds of war are the signature scars of America’s post-9/11 conflicts, we can and must do better. The military has no doubt come a long way since General George S. Patton slapped soldiers claiming “combat exhaustion” and publicly accused them of cowardice. Yet a decade after Congress stepped in to reform the disability system, it may be time for another look to ensure equitable treatment for mentally ill veterans.

Charles G. Kels is a lieutenant colonel in the U.S. Air Force and Dr. Lori H. Kels is a psychiatrist at the University of the Incarnate Word medical school in San Antonio, TX. Their views do not reflect those of the Air Force or Department of Defense.

The views expressed by this author are their own and are not the views of The Hill.