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Suggested Citation:"B Committee Charge." Institute of Medicine. 2007. A 21st Century System for Evaluating Veterans for Disability Benefits. Washington, DC: The National Academies Press. doi: 10.17226/11885.
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Appendix B
Committee Charge

STATEMENT OF TASKS

  1. How well do the medical criteria in the Department of Veterans Affairs (VA) Rating Schedule and VA rating regulations enable assessment and adjudication of the proper levels of disability to compensate both for the impact on quality of life and impairment in earnings capacity? Provide an analysis of the descriptions associated with each condition’s rating level that considers progression of severity of condition as it relates to quality-of-life impairment and impairment in average earnings capacity.

  2. Certain criteria and/or levels of disability are required for entitlement to ancillary and special-purpose benefits. To what extent, if any, do the required thresholds need to change? Determine from a medical perspective at what disability rating level a veteran’s medical or vocational impairment caused by disability could be improved by various special benefits such as adapted housing, automobile grants, clothing allowance, and vocational rehabilitation. Consideration should be given to existing and additional benefits.

  3. Analyze the current application of the individual unemployability (IU) extraschedular benefit to determine whether the Rating Schedule descriptions need to more accurately reflect a veteran’s ability to participate in the economic marketplace. Propose alternative medical approaches, if any, to IU that would more appropriately reflect individual circumstances in the determination of benefits. For the population of disabled veterans, analyze

Suggested Citation:"B Committee Charge." Institute of Medicine. 2007. A 21st Century System for Evaluating Veterans for Disability Benefits. Washington, DC: The National Academies Press. doi: 10.17226/11885.
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the cohort of IU recipients. Examine the base rating level to identify patterns. Determine if the Rating Schedule descriptions of conditions provide a barrier to assigning the base disability rating level commensurate with the veteran’s vocational impairment.

  1. What are the advantages and disadvantages of adopting universal medical diagnostic codes rather than using a unique system? Compare and contrast the advantages and disadvantages of the VA Schedule for Rating Disabilities and the American Medical Association Guides to the Evaluation of Permanent Impairment.

  2. From a medical perspective, analyze the current VA practice of assigning service connection on “secondary” and “aggravation” bases. In secondary claims, determine what medical principles and practices should be applied in determining whether a causal relationship exists between two conditions. In aggravation claims, determine what medical principles and practices should be applied in determining whether a preexisting disease was increased due to military service or was increased due to the natural process of the disease.

  3. Compare and contrast the role of health-care professionals in the claims and appeals processes in VA and the Department of Defense (DoD), the Social Security Administration, and federal employee disability benefits programs. What skills, knowledge, training, and certification are required of the persons performing the examinations and assigning the ratings?

Suggested Citation:"B Committee Charge." Institute of Medicine. 2007. A 21st Century System for Evaluating Veterans for Disability Benefits. Washington, DC: The National Academies Press. doi: 10.17226/11885.
×
Page 302
Suggested Citation:"B Committee Charge." Institute of Medicine. 2007. A 21st Century System for Evaluating Veterans for Disability Benefits. Washington, DC: The National Academies Press. doi: 10.17226/11885.
×
Page 303
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21st Century System for Evaluating Veterans' Disability Benefits recommends improvements in the medical evaluation and rating of veterans for the benefits provided by the Department of Veterans Affairs (VA) to compensate for illnesses or injuries incurred in or aggravated by military service. Compensation is a monthly cash benefit based on a rating schedule that determines the degree of disability on a scale of 0 to 100. Although a disability rating may also entitle a veteran to ancillary services, such as vocational rehabilitation and employment services, the rating schedule is out of date medically and contains ambiguous criteria and obsolete conditions and language. The current rating schedule emphasizes impairment and limitations or loss of specific body structures and functions which may not predict disability well. 21st Century System for Evaluating Veterans' Disability Benefits recommends that this schedule could be revised to include modern concepts of disability including work disability, nonwork disability, and quality of life.

In addition to the need for an updated rating schedule, this book highlights the need for the Department of Veterans' Affairs to devote additional resources to systematic analysis of how well it is providing services or how much the lives of veterans are being improved, as well as the need for a program of research oriented toward understanding and improving the effectiveness of its benefits programs.

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