As Malvin Espinosa prepared to retire from the Army in 2011, a Veterans Affairs counselor urged him to apply for disability pay.
List all your medical problems, the counselor said.
Espinosa, a mechanic at Ft. Lee in Virginia, had never considered himself disabled. But he did have ringing in his ears, sleep problems and aching joints. He also had bad memories of unloading a dead soldier from a helicopter in Afghanistan.
"Put it all down," he recalled the counselor saying.
Espinosa did, and as a result, he is getting a monthly disability check of $1,792, tax free, most likely for the rest of his life. The VA deems him 80% disabled due to sleep apnea, mild post-traumatic stress disorder, tinnitus and migraines.
The 41-year-old father of three collects a military pension along with disability pay — and as a civilian has returned to the base, working full-time training mechanics. His total income of slightly more than $70,000 a year is about 20% higher than his active-duty pay.
Similar stories are playing out across the VA.
With the government encouraging veterans to apply, enrollment in the system climbed from 2.3 million to 3.7 million over the last 12 years.
The growth comes even as the deaths of older former service members have sharply reduced the veteran population. Annual disability payments have more than doubled to $49 billion — nearly as much as the VA spends on medical care.
More than 875,000 Afghanistan and Iraq war veterans have joined the disability rolls so far. That's 43% of those who served — a far higher percentage than for any previous U.S. conflict, including World War II and Vietnam, which had significantly higher rates of combat wounds.
Disabled veterans of the recent wars have an average of 6.3 medical conditions each, also higher than other conflicts.
Incentives to seek disability ratings have increased due to changes in VA policy, including expanded eligibility for post-traumatic stress disorder and a number of afflictions that affect tens of millions of civilians.
Nearly any ailment that originated during service or was aggravated by it — from sports injuries to shrapnel wounds — is covered under the rationale that the military is a 24/7 job.
The disability system was unprepared for the massive influx of claims, leading to backlogs of veterans waiting months or longer to start receiving their checks.
But once the payments begin, many veterans say, they are a life-saver.
Ray Lopez struggled to keep a steady job after leaving the Marines in 2001. Stints as a TSA screener, insurance agent and soft drink salesman ended badly.
At 35, Lopez is rated 70% disabled for back, shoulder and knee pain, as well as post-traumatic stress disorder from having witnessed a deadly helicopter crash off the coast of San Diego.
He couldn't support his wife and two children, he said, without the monthly $1,800 disability check. "If it wasn't for that, I'd be on the streets," he said.
Lopez trains boxers three days a week and is pursuing a community college degree.
The generosity of veterans benefits is on an upswing in a pendulum arc as old as the republic.
During the Revolutionary War, disability payments were limited to soldiers who lost limbs or suffered other serious wounds.
Lobbying by Civil War veterans led to coverage that included peacetime injuries and illnesses.
After World War I, compensation was scaled back to cover only combat injuries and diseases contracted in war. But World War II brought an expansion to include all conditions that appeared during service or shortly afterward.
In the 1950s, President Eisenhower — a former five-star general — tried to rein in the costs. He found little support in Congress, and the basic system has remained the same ever since.
The VA uses a formula that combines a veteran's conditions into a rating of between 0% and 100% — in 10% increments. The higher the rating, the larger the disability payment.
Nearly half of those in the system have ratings of 30% or below. They can apply for higher ratings if ailments grow worse.
"The disability system has this escalator quality," said David Autor, an economist at MIT. "Once you get on, you just keep going up."
The current benefits boom began with a political battle over Agent Orange and other herbicides used to clear jungle brush in Vietnam.
In 1991, Congress and the VA started paying veterans who had served on the ground there — meaning possible exposure to Agent Orange — and went on to develop diseases that eventually included lung and prostate cancer.
Then in 2001, the VA added Type 2 diabetes to the list. The disease affects 1 in 4 U.S. senior citizens and has not been definitely linked to Agent Orange. But veterans groups lobbied to include it.
"The feeling was, let's give them whatever they need and move on," said Anthony Principi, the VA secretary at the time. Through 2013, the number of veterans receiving compensation for diabetes climbed from 46,395 to 398,480.
The Obama administration added three more conditions in 2010: Parkinson's disease, a rare form of leukemia and ischemic heart disease. Since then, more than 100,000 cases of heart disease — the leading cause of death in the U.S. — have been added to the disability rolls.
Veterans of all generations also have been encouraged to apply for compensation for post-traumatic stress disorder, with Vietnam and the recent wars driving the growth in roughly equal measure over the last decade.
Some veterans said they have lived with the disorder ever since leaving the military. Others kept it at bay until recent wars or major life changes released old demons. The economic uncertainties of retirement age also gave veterans more incentive to apply.
As post-traumatic stress disorder claims boomed, the Obama administration made them easier to win.
The VA had long required documentation of a traumatic event that resulted in post-traumatic stress disorder. But in 2010, in keeping with the current science, the administration said a qualifying trauma could simply be a fear-inducing situation such as traveling through enemy territory.
Karen Olszewski, who works in Long Beach for the nonprofit Vietnam Veterans of America, said that once the rules changed, she started calling men whose cases she had rejected.
"I told them to come back," she said.
More than 1.3 million veterans of the Vietnam era received $21 billion in disability pay last year. From Afghanistan and Iraq, the cost was $9.3 billion — but it is growing fast.
Among disabled veterans of recent wars, 43% have tinnitus, the most common condition. Rounding out the top 10 are back or neck strain, knee problems, post-traumatic stress disorder, migraines, arthritis of the spine, scars, ankle trouble, defective hearing and high blood pressure.
"They're filing for the basic wear and tear of military service, not combat injuries," said Phillip Carter, a veterans expert at the Center for a New American Security, a nonpartisan think tank.
One of the latest trends, resulting from another policy change, is a rise in disability determinations related to sleep apnea — from 11,742 to 164,107 over the last decade.
The Pentagon had long prohibited veterans from receiving disability pay in addition to their military pensions. But in 2003, officials lifted the ban if a veteran had a disability rating of at least 50%. The change triggered a surge in claims costing billions of dollars — including many by veterans with sleep apnea, which is typically rated as a 50% disability.
The condition tends to strike in middle age due to weight gain and can usually be managed by wearing a breathing mask while sleeping, but the VA does not consider such external devices in its disability decisions.
Retired Navy veteran David Adams said he was surprised that sleep apnea, for which he wears a breathing mask, qualified him for disability pay. At 49, he works as an electrician in an aluminum factory in Davenport, Iowa. He said his monthly disability pay of $910 gives his family financial security by boosting his $1,800-a-month military pension.
"Most of the time, the rules are against you," Adams said. "You get one that's for you, you don't question it."
The expansion of disability benefits signals a change in attitude about the purpose of the payments, long intended to compensate veterans for lost income. Studies have found that many disabilities in the system have no effect on average earnings. One showed that veterans receiving disability pay tend to have higher total incomes than those who do not.
In the age of an all-volunteer military and after two unpopular wars, disability pay has come to be seen as a lifetime deferred payment for service.
Roderick Atkinson, who spent 26 years on active duty and as a reservist, said he views it as compensation for the hardships he endured.
"The real kicker was the time I spent away from my family," Atkinson said.
The 53-year-old's voice flattened when talking about how he developed post-traumatic stress disorder after living in fear of mortar attacks in Iraq — and how it rendered him unable to work around other people. The Santa Monica mail carrier counts knee and ankle problems among his ailments.
He has a 100% disability rating, entitling him to a monthly check of $3,200.
Espinosa, the Ft. Lee trainer, said his monthly $1,792 disability check is scarcely making him rich. All of it goes to for his son's college education.
He has filed new claims for back and knee pain, gastrointestinal problems and vertigo in an attempt to boost his 80% disability rating.
"I believe my disability rating — and I'm not trying to sound greedy — should be 100%," he said. "I know what I went through."Copyright © 2015, Los Angeles Times