Jefferson Medical College Clinical Review of the VA Disability Rating Schedule I. THE REVIEW PANEL Clinical reviews of the current Veteran's Administration's Disability Rating Schedule were carried out by a selected group of Physicians on the faculty of Jefferson Medical College of Thomas Jefferson University. The project was managed by Jefferson's Center for Research in Medical Education and Health Care. A number of meetings were held (see below) and attended by GAO and Jefferson project staff to refine project goals, review project progress and initial drafts of this report. The U.S. General Accounting Office Staff provided valuable input throughout the course of the project. The clinical reviews, however, represent the professional judgment of the Jefferson project staff and consulting physicians, and do not represent an official opinion of the GAO or the United States Government. Jefferson Medical College Clinical Review of the VA Disability Rating Schedule II. BACKGROUND Title 38, United States Code, Section 355 provides for the adoption by the Veteran's Administration (VA) of a Schedule for Rating Disabilities. This schedule serves as the official guide for classifying clinical findings and converting these findings into degrees of disability. The rating schedule is a guide for evaluating disability resulting from all types of diseases and injuries sustained while serving in the military service. The disease or injury need not be the result of combat action. Disability is an administrative term that encompasses medical impairment and economic loss. Impairment is a functional loss due to alterations in the anatomic, pathologic or physiologic systems caused by disease or injury. Use of this schedule in the adjudication of disability requires a complete medical examination. A lay rating specialist interprets the records of the treating facility and physician and then makes the disability determination. If consistent and fair decisions are to be made, the taxonomy must be up-to-date and consistently interpretable. While some parts of the VA Rating schedule have been revised recently, the schedule has not undergone a complete update since 1945. The U.S. General Accounting Office (GAO), concerned with the equity of VA disability decisions, is conducting a review of the VA criteria for rating disabilities. In particular, the GAO wishes to determine whether or not the disability rating schedule reflects sufficient current medical knowledge and terminology to allow rating specialists to make equitable disability determinations, |