Healing Veterans Injured During Service

President Bush is promising a better deal for 600,000 veterans who feel they have been tangled in bureaucratic red tape.

Many veterans have been wondering for many months whether Washington will allow them to collect benefit payments to compensate for physical or mental problems related to their active military service. And to provide them with guaranteed treatment through VA hospitals and clinics.

The president’s promise may be good news for lots of people. Some examples:

* A Vietnam infantryman, 55, who just found out he has diabetes.

* A sailor who served during World War II, who injured his knee when he slipped while swabbing the deck. He’s had some occasional discomfort since then, but the doctor says that now, at age 80, he must have knee replacement.

* A combat pilot who served in Korea and walked away from two crash landings. Fifty years later, he started having nightmares about the crashes and is taking sleeping pills and seeing a psychiatrist.

If their current problems are deemed service-related, the veterans will qualify for two important benefits: a financial payment from Veterans Affairs and free lifetime care and treatment for the ailment.

Many applicants are more than 70 years old, President Bush told the American Legion convention in San Antonio last month. “Think about that: There are thousands of men who served their country in Korea and World War II, or both,” he said. “The last thing they need to hear from any federal office is more--more routine excuses. That’s wrong, and this administration is going to get it right.”

Bush pledged more money, more personnel and a determined effort to clear up the backlog of applications. His budget for the government’s fiscal 2002, which begins next month, includes an additional $133 million to hire 890 new employees to handle claims. With no opposition on Capitol Hill, Congress is expected to approve the budget request. This will reverse a pattern under which the number of VA jobs has been declining for four years.

Fulfilling Bush’s promise means more than simply adding staff at the VA; it will require a change in attitude. The new presumption is that the veterans’ claims are valid and that the government should make it easier, not harder, for veterans to get their benefits.

“We are trying to change the culture of our organization,” said Stewart Liff, VA administrator for the nine-county region of California that includes Los Angeles and Orange counties. “The feeling is, when in doubt, we will grant the benefits to people, rather than having them fight for years through the system,” he said. Approving more benefit applications the first time around will result in fewer appeals and fewer reviews of cases, Liff said. His region also is hiring 70 additional people to work through the backlog of compensation applications.

Veterans’ efforts to get compensation frequently have been hampered by the complex VA system, in which claims may take years to evaluate. The rule of thumb has been that the veteran must be able to prove a direct connection between something that happened during his or her active duty and the current medical problem.

The obvious cases are the easier ones. A battle wound, a disabling accident during training, an ailment with lasting impact immediately diagnosed during active duty. These claims are more likely to be handled in a timely manner because the judgment was made quickly during the veteran’s time on active duty. The problematic cases, on the other hand, result from claims filed years later. The veteran is guaranteed free care for life and a monthly compensation check. The VA decides how much a person’s ability to work is limited by the ailment and awards a monthly payment, ranging from $100 to $2,400.

Compensation can be collected regardless of whether a person is working at a regular job. It is strictly a VA assessment of the degree of disability caused by the service-related problem.

The more difficult cases--and the ones that have been piling up in VA files--involve veterans who left the service, returned to civilian life and went about their careers. But something that happened to them in their service has led to subsequent problems that weren’t apparent when they left active duty.

After a claim is filed, a VA doctor will get the veteran’s military records, and then conduct a physical examination to determine the person’s current health status. If the doctor determines there is a link between something that occurred during active duty, and today’s medical problem, the veteran will be entitled to compensation. The government pays compensation when, in the VA’s judgment, a person’s ability to work has been reduced by at least 10%.

A Vietnam veteran with diabetes, for example, might file a successful claim because the law was changed a few years ago to say that exposure to Agent Orange is presumed to cause diabetes. Anyone who served in Vietnam during the war when Agent Orange was used as a defoliant is presumed to have a claim.

A World War II veteran might argue, for instance, that the knee injury he suffered in 1943, when he spent a day in the ship’s hospitals but quickly recovered, may have ultimately forced the need for a knee replacement today.

The VA physicians and officials who review the files have had lots of leeway in handling claims, deciding whether veterans deserved the compensation payments.

Before, “the VA was able to disallow a claim and say simply it was not well-grounded,” said Jim Fischl, director of veterans affairs and rehabilitation at the American Legion. “They did not have to give their reasons, and they did not have to tell the veteran what was required to make the claim plausible.”

The VA now operates under new rules mandated by Congress last year. “They have to tell you why the claim has been disallowed, and what it would take to grant the claim,” Fischl said. The missing link, whether it is a statement from a civilian doctor, or medical records from years ago, or testimony from former employer, might be crucial in giving the VA the information needed to win a favorable verdict for the veteran.

A veteran may have been treated for a condition and yet not realize it was connected to his military service, Fischl noted.

Some veterans are applying for the first time, while others are asking for a review of their status. Some veterans who have previously been collecting compensation and whose health has deteriorated may be entitled to a larger benefit payment under the new rules. But their cases must be reviewed.

About 2.7 million of the nation’s 25.5 million veterans now receive disability compensation payments or pensions from the VA. (Pensions are an income supplement for poor veterans.)

Beginning Oct. 1, the VA will begin offering new benefits to a particular category of people. These are the spouses or children of a certain group of military personnel: those who died while on active duty, or who suffered injuries leaving them permanently and totally disabled.

The spouses and children are entitled to special consideration when they reach 65, the eligibility age for Medicare. Medicare does not pay for prescription drugs, an important and expensive item for older people. And Medicare charges $792 for the first day of a hospital stay and has a $100 annual deductible for physician services. The law now makes these people--the spouses and children--eligible for Champva for Life, a VA program that pays for all prescription drugs, the full hospital deductible and $37.50 of the doctors’ fee deductible.

In another little-known benefit, the VA is now reaching out to the widows of World War II soldiers, sailors and airmen who died in combat. They received monthly payments when the spouses were killed. But the money stopped if they remarried. The VA is now seeking those who have become single again. Either they divorced, or have become widows again through the death of their second spouse. They are now eligible again for the monthly benefit check, called Dependent Indemnity Compensation (DIC).

Information on VA programs and benefits is available at the agency’s main information line, (800) 827-1000. The Web site is https://www.va.gov.

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Bob Rosenblatt welcomes your questions, suggestions and tips about coping with the changing world of health care. You can contact him by writing Bob Rosenblatt, Health, Los Angeles Times, Times Mirror Square, Los Angeles, CA 90053, or by e-mailing bob.rosenblatt@latimes.com. Health Dollars & Sense runs the second Monday of each month