PTSD Compensation and Military Service (2007) / Chapter Skim
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2 Background – Disability Compensation
2 Background – Disability Compensation
Pages 27-69
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From page 27... ...
Thus the major disability-compensation systems that exist in the United States today -- veterans' disability compensation, Social Security disability programs, workers' compensation, and, to some extent, private disability insurance programs -- are multifactorial legacy systems. This committee was charged with addressing veterans' compensation policy and, specifically, veterans' compensation for posttraumatic stress disorder (PTSD)
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From page 28... ...
Fishback, in his essay on public assistance during the American colonial period (Fishback et al., 2006) , notes that the Philadelphia Almshouse, 1 Under England's Poor Law of 1601 -- also known as the Elizabethan Poor Law -- the local community was required to provide certain maintenance through compulsory taxation when a family was unable to provide for a mentally ill member.
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From page 29... ...
An exception to this pattern is the system of public assistance for the veteran, as a centralized policy for the maintenance of disabled soldiers was established very early on, during the Revolutionary War period. VETERANS' DISABILITY COMPENSATION The Pilgrims at Plymouth are credited with passing the first pension law in America (Burke, 1899)
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From page 30... ...
. Largely in response to growing pressure from military leaders, plans for the relief of disabled veterans were formulated and ratified, becoming what is known as the Military Pension Law of 1776 (Bradley Commission, 1956)
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From page 31... ...
During the early part of this period the locus of benefits administration, with often protracted and circuitous modification, shifted away from state-level jurisdiction to adjudication at various offices at the federal level. While Congress retained final authority over claims, the Secretary of War generally assumed the responsibilities of compensation administration in 1789 (Bradley Commission, 1956)
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From page 32... ...
. The Society was composed of officers of the Revolutionary War, and its express purpose in the years following the war's end was to "pressure the government to fulfill the pledges made to the officers" (Rockoff, 2006)
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. The War of 1812 Through the Civil War Period Between the Revolutionary War and the Civil War veterans' disability policy went through a series of changes (Rockoff, 2006)
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From page 34... ...
also notes that in the 39-year period while Northern veterans of the Civil War were waiting for service pensions, their numbers decreased from 1,830,000 to 821,000. 12 Only Union soldiers were eligible for pensions.
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From page 35... ...
It was during the Civil War era that military physicians first attempted to isolate the causes of an increasing number of heart disorders of unclear etiology (Meagher, 1919)
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From page 36... ...
. By the time World War I approached, at least two patterns in veterans' disability policy had emerged: benefits were established at the start of wars, despite considerable protest of many legislators and other stakeholders; and, as time passed, the amount of time between death or onset of disability and receipt of compensation awards was gradually reduced (Bradley Commission, 1956)
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From page 37... ...
. The War Risk Insurance Act of 1914, originally intended to insure the assets of the American shipping industry, was amended in 1917 not only to provide 14 For purposes of veterans' benefits in the United States, WWI service is defined as service after April 5, 1917, and before November 12, 1918, except for U.S.
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From page 38... ...
. The activities of the Bureau of War Risk Insurance after the passage of the Vocational Rehabilitation Law included insurance, health care services, vocational rehabilitation, and compensation for death and disability (Bodenger, 1971)
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. One issue that had an eventual effect on veterans disability policy for mental disorders was compensation of tuberculosis cases.
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From page 40... ...
. A compromise version of the amendment eventually passed, shifting the burden of proof from the veteran to the government for cases of tuberculosis and mental disorders (DVA, 1993)
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. Thus a variety of therapeutic options were used on the 80,000 cases of shell shock returned to British hospitals.
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. As had occurred after the Civil War, veterans of WWI organized, seeking to ensure the delivery of promised benefits.
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. Under the law establishing it, all functions of the Bureau of War Risk Insurance and the Federal Board of Vocational Rehabilitation as well as all functions of the U.S.
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. Grinker and Spiegel observed in 1945 that among WWII soldiers many cases of "gross stress reaction" did not manifest on the field but rather emerged much later, and could persist for several months or even several years (Scott, 1990)
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. 19 A more detailed discussion of issues regarding the administration of the VA is contained in the IOM report A st Century System for Evaluating Veterans for Disability Benefits (2007)
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From page 46... ...
. It was during the Korean War that the original Diagnostic and Statistical Manual of Mental Disorders (DSMI)
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From page 47... ...
Veterans Affairs Canada takes a broad view of the intent of its disability benefits system: To put on the uniform of one's country -- and this is as true today as it was in 1914 -- is to make an extraordinary commitment: to put oneself at risk, as required, in the interests of the nation. It is this commitment that explains and justifies veterans' benefits.
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From page 48... ...
providing for immediate payment of the World War I bonus 1937 The category "totally disabled" is established for veterans with certain disabilities 1938 Service members injured in the line of duty are guaranteed disability benefits in light of a potential draft 1939 Rating schedule is revised
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From page 49... ...
; it provides home loans, education assistance, and other readjustment services to veterans 1952 American Psychiatric Association publishes the first edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-I) ; the volume includes an entry for the combat-related disorder "gross stress reaction" 1956 Report of the President's Commission on Veterans' Benefits released 1956 Social Security Disability Insurance is established to cover disability-related "involuntary retirement" 1957 Veterans Benefits Act of 1957 1958 All laws concerning veterans' benefits updated 1965 Service members' Group Life Insurance -- subsidized term life insurance purchased from private insurers -- is made available 1962 Second edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM II)
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From page 50... ...
It is likely that some proportion of disabled veterans may have their therapeutic needs met though available health care systems and consequently forgo the disability application process, especially for conditions, such as PTSD, to which a stigma is attached. These countries do not have what is sometimes referred to as a -hours--days-per-week TABLE 2-2 UK Rating Table for Mental Disorders Level Injury 8 Permanent mental disorder, causing severe functional limitation and restriction 10 Permanent mental disorder, causing moderate functional limitation and restriction 11 Mental disorder, which is functionally limiting and restricting, and has continued, or is expected to continue, for 5 years 12 Mental disorder, which has caused or is expected to cause functional limitation and restriction at 2 years, from which the claimant has made or is expected to make substantial recovery within 5 years 13 Mental disorder, which has caused, or is expected to cause, functional limitation and restriction, at 26 weeks, from which the claimant has made, or is expected to make, a substantial recovery within 2 years 14 Mental disorder, which has caused, or is expected to cause, functional limitation and restriction at 6 weeks, from which the claimant has made, or is expected to make, a substantial recovery within 26 weeks NOTES: 1.
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From page 51... ...
As part of its work, the committee examined the literature describing these other programs. Below the information collected about compensation programs for mental disorders and PTSD provided by the U.S.
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From page 52... ...
One of the reasons that societies form is to provide safety and security for their members, so when individuals put themselves at risk to preserve a society's security, social justice implies that they should be compensated for losses resulting from taking that risk. VA benefits are not contingent on work status (except for the individual unemployability benefit and 100 percent mental disorders disability status)
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From page 53... ...
A main premise of this model is that people with severe medical conditions are unable to work (Burkhauser and Stapleton, 2003)
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. The percentage of SSDI recipients with disabling mental disorders has also increased over time, but not as rapidly.
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, and SSDI beneficiaries with disabling mental disorders remain on the rolls significantly longer than those with other diagnoses (Hennessey and Dykacz, 1989)
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From page 56... ...
with no loss of benefits, but once earnings exceed that amount for nine nonconsecutive months plus a three-month grace period, all SSDI cash benefits cease. This is referred to as the "earnings cliff" (Stapleton et al., 2006)
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From page 57... ...
. submit factual evidence of employment factors or incidents alleged to have caused or aggravated the psychiatric condition, medical evidence establishing the existence of a mental disorder or emotional condition, and "rationalized medical opinion evidence establishing that his emotional condition is causally related to the identified compensable employment factors" (Turner, 2004)
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From page 58... ...
. In every jurisdiction, the benefits paid under workers' compensation include all medical care for the specific injury or illness, temporary disability benefits for days out of work as a result of the injury, death benefits, and permanent disability benefits for residual disability (or impairment)
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From page 59... ...
. The permanent disability benefits provided in workers' compensation and, in particular, the approach of paying according to the loss of wage-earning capacity is most similar to the VA approach.
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From page 60... ...
Return-to-work dates may be established as part of the initial award of benefits. For persons whose impairments indicate that they will be unable to work over the long term, case-management techniques such as assuring proper medical treatment, vocational rehabilitation, and job accommodation or modification may begin during the STD payment period.
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From page 61... ...
In 2006 the maximum duration of benefits was 26 weeks in Hawaii, New York, and New Jersey, and 52 weeks in California. Rationale for Private-Sector Work Disability Programs The underlying principle for private-sector work disability programs can be traced to the ideas of social justice discussed above.
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From page 62... ...
Risk categories for work disability are sorted out by individual characteristics such as age, work skills, and health as well as by the type of work performed (classified by industries and occupations)
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. Assessment of Work Disability Private-sector programs require the presence of a medically established condition.
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From page 64... ...
The most successful of these programs involve employees in their design and assure a proper mix of work incentives and appropriate benefit payments (Akabas et al., 1992; Shrey, 1998)
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From page 65... ...
1987. Permanent Disability Benefits in Workers' Compensation.
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From page 66... ...
Thousand Oaks, CA: Sage Publications. Bradley Commission (The President's Commission on Veterans' Pensions)
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From page 67... ...
2007. A st Century System for Evaluating Veterans for Disability Benefits.
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From page 68... ...
In: K Rupp, and SH Bell, eds. Paying for Results in Vocational Rehabilitation: Will Provider Incentives Work for Ticket to Work.
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From page 69... ...
1918. Eight months of War Risk Insurance work.
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