This is the third hearing this Subcommittee has held regarding VA’s claims processing system.  As we have discussed before, this system has not lived up to expectations and has left many disabled veterans without proper and timely compensation and other benefits. 

At the heart of this system is the VA Schedule for Rating Disabilities (or VASRD).   The Rating Schedule, as we know it today is divided into 14 body systems, which incorporate approximately 700 codes that describe illness or injury symptoms and levels of severity.   Ratings range from 0 to 100 percent and are in increments of 10.  This schedule was uniquely developed for use by VA, but the Defense Department has also mandated its use when the service branches conduct evaluation boards on service members who are unfit for duty. Otherwise, it is not used by any other governmental agencies or private sector disability plans.

In its study, the Veterans’ Disability Benefits Commission (VDBC) concluded that the VA Rating Schedule has not been comprehensively updated since 1945.  Although sections of it have been modified, no overall review has been satisfactorily conducted leaving some parts of the schedule out of date, relying on arcane medical practices, and not in sync with modern disability concepts.  The notion of a Rating Schedule was first crafted in 1917, so that returning World War I veterans could be cared for when they could no longer function in their pre-war occupations.  At the time, the American economy was primarily agricultural based and labor intensive.  Today’s economy is different and the effects of disability are understood to be greater than the average loss of earning capacity.  Many disability specialists agree that quality of life, functionality, and social adaptation are just as important.  Our nation’s disabled veterans deserve to have a system that is based on the most available and relevant medical knowledge.

There are several issues pertaining to the Rating Schedule I hope to have us discuss today:

First would be the need to remove out-of-date and archaic criteria that is still part of the schedule for some conditions and replace them with current medical and psychiatric evaluation instruments for determining and understanding disabilities. The medical community relies on codes from the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders.  Should the VBA be relying on these and other AMA guides as well? 

Individual Unemployability (IU) as a rating gives VA an alternative means by which to compensate veterans who cannot sustain gainful occupation, but might not otherwise be rated 100 percent. The Government Accountability Office found that the use of IU was ineffective and inefficient since it relies on old data, outdated criteria, and lacks guidance.  The VDBC, IOM, and CNA also studied IU and expressed their concerns over how it is utilized instead of scheduled ratings.  I look forward to hearing more from them today.

The criteria for psychiatric disabilities, especially for Posttraumatic Stress Disorder (PTSD) are in dire need of expansion. The current Rating Schedule has only one schedule for all of mental health, which is based on the Global Assessment of Functioning Scale (GAF).  The IOM noted that one of the many problems with GAF is that it was developed for Schizophrenia, therefore not as accurate for other disorders and recommended that VA replace it as a diagnostic tool.  I am especially concerned about this issue and how it pertains to PTSD and other mental disorders.  

The VDBC also recommended that traumatic brain injury (TBI) be a priority area of concentration, and for VA to improve the neurological criteria for TBI, which has become one of the signature injuries of this war. 

I know there has been much discussion on how to compensate veterans for their quality of life losses.  Both the VDBC and the Dole/Shalala Reports recommended that this be a new category added to the Rating Schedule in some fashion. But, they did not necessarily agree or provide clear guidance on how to do this or whether the current system does so implicitly. So, next steps are still needed.

Presumptions have had a major impact on VA compensation over the last few decades for conditions related to Ionizing Radiation, Agent Orange and the Gulf War.  The IOM therefore engaged in a lengthy study for the VDBC on presumptions and recommended that there be evidence-based criteria, which could impact the Rating Schedule.  I commend Secretary Peake for changing the regulation on PTSD, but we also might want to add a presumption that combat zone service is a stressor when evaluating PTSD.

I look forward to the testimony today on these complex Rating Schedule issues.  I know there is a lot to be done to improve the VA claims processing system, but with the Rating Schedule at the core of the process, it seems that the centerpiece is in need of immediate comprehensive repair, which I intend to advocate.  

I look forward to working with Ranking Member Lamborn and the members of this Subcommittee in providing oversight for the VA Schedule for Rating Disabilities.  VA needs the right tools to do the right thing, so our nation’s disabled veterans get the right assistance.