representing 23 separate impairments for which veterans had already been awarded VA disability compensation benefits. All relevant medical information necessary to deciding a rating was taken from the case files: Copies were then sent to rating boards at 56 of the 58 VA regional offices participating in the assessment. At each location, one or more rating boards (or a combination of board members) assigned disability ratings using the medical information supplied. Although some of the disabilities were not rated by all participating regional offices, the study showed that, for the 23 impairments: 11 were assigned two different ratings; 6 were assigned three different ratings; 4 were assigned four different ratings; and 2 were assigned five different ratings. Several veterans were assigned a wide range of disability ratings, which would result in significantly different monthly benefit payments. For example, one veteran with hypertensive heart disease was assigned five different ratings, ranging from 10 to 100 percent; 25 rating boards rated This study demonstrated that veterans were given different ratings dependent on the subjective judgment of the rating specialists. This study concluded that the vagueness and generality of the rating schedule contributed to the lack of uniformity between rating boards in rating disabilities. Conclusions The VA rating schedule is a key factor in determining a veteran's claim for disability benefits; however veterans may not be awarded consistent and equitable disability benefits because the medical criteria in VA's rating schedule are neither complete nor current. Also, the military services Figure 2.3: Extent to Which Medical Page 20 use the VA rating schedule to make decisions for disabled military personnel. Although some sections of the rating schedule have been revised recently, the schedule has not been comprehensively updated since 1945. Medical experts and VA rating specialists told us that the rating schedule's medical criteria need to be updated. VA does not systematically review the rating schedule to identify needed improvements. Without a clinically sound and up-to-date system of classifying impairments, rating specialists may not assign medically accurate or uniform ratings. Although some sections of the rating schedule may continue to require predominantly judgmental decisions by rating specialists, the medical criteria can be made more up-to-date and complete. This will reduce reliance on individual judgment, and contribute to more equitable decisions. Need to Update Medical Criteria Used in VA's To better ensure that the rating schedule serves as a practical tool in assigning uniform disability ratings to veterans, GAO recommends that the Administrator prepare a plan for a comprehensive review of the rating schedule and, using the results of the review, revise medical criteria accordingly and implement a procedure for systematically reviewing the rating schedule so as to keep it up-to-date in the future. We requested comments on a draft of this report from va and the Department of Defense. Their comments are summarized below. Their written comments are presented in full in appendixes IV and V respectively. VA agreed with our recommendation that it prepare a plan for a comprehensive review of the rating schedule and, using the results of the review, revise medical criteria accordingly. VA stated that in preparing such a plan it would perform a methodical review of the rating schedule by body system. However, the medical criteria will not be revised until the rating schedule changes have cleared the public notice and comment process. VA also agreed with our recommendation that it implement a procedure for systematically reviewing the rating schedule to keep it up-to-date. VA stated that the comprehensive review established under the first recommendation will become a cyclical process. The Department of Defense stated that it agreed with our conclusions and recommendations. Jefferson Medical College Clinical Review of the VA Disability Rating Schedule Report to the United States General Accounting Office (Contract # 8130080) A CLINICAL REVIEW OF THE VETERANS ADMINISTRATION DISABILITY RATING SCHEDULE February 1988 Jefferson Medical College For additional information: Daniel Z. Louis, Managing Director Center for Research in Medical Education and Health Care 1025 Walnut Street Philadelphia, PA 19107 215-928-8907 |