National Academies Press: OpenBook

A 21st Century System for Evaluating Veterans for Disability Benefits (2007)

Chapter: E Diagram: Assessing Impairment and Functional Disability

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Suggested Citation:"E Diagram: Assessing Impairment and Functional Disability." 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 E
Diagram: Assessing Impairment and Functional Disability

The purpose of this diagram is to illustrate a process for compensating veterans for impairment and functional limitations resulting from service-connected injury or disease. (It does not include compensation for loss of quality of life [QOL], because the methodology for determining loss of QOL remains to be determined based on a research and development effort.)

In addition to distinguishing between the criteria appropriate for determining impairment severity, such as the New York Heart Association (NYHA) classification of cardiovascular limitations and failure and the METS (metabolic equivalents of task) measure of congestive heart failure, and those appropriate for determining functional capacity, such as activities of daily living (ADLs) and instrumental activities of daily living (IADLs), the diagram shows how evaluation of disability could be connected directly to rehabilitation services.

Suggested Citation:"E Diagram: Assessing Impairment and Functional Disability." 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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Suggested Citation:"E Diagram: Assessing Impairment and Functional Disability." 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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Suggested Citation:"E Diagram: Assessing Impairment and Functional Disability." 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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Page 374
Suggested Citation:"E Diagram: Assessing Impairment and Functional Disability." 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 375
Suggested Citation:"E Diagram: Assessing Impairment and Functional Disability." 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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Page 376
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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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