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At the core of any viable health system is the ability to sustain access to affordable qualified health care providers. This is particularly true for the MHS, which relies heavily on a direct care delivery model using Military Treatment Facilities. This system must be able to attract, recruit, and retain providers, which can often involve a significant service obligation commitment. While beyond the scope of this article, the effect on provider recruiting and retention from the demands placed on the MHS system must be considered in any comprehensive reform proposals. U.S. military operations in support of the GWOT have created — and will continue to create — additional challenges to ensuring access to primary and specialty care services. See Colarusso, L. M. and Bender, B., “Pentagon Fears Healthcare Costs Will Erode Readiness: Aging Population Is Driving Up Fees,” Boston Globe, March 5, 2007; Croasdale, M., “Military Doctor Recruiting Takes Wartime Hit: A Sharp Decline in Medical Students Accepting Army and Navy Scholarships Sparks a New Recruiting Campaign,” American Medical Association News, August 28, 2006; Philpott, T., “Surgeon General: Looming Doctor Shortage,” Stars and Stripes, July 13, 2006; Crawley, J. W., “Navy Going Civilian for Its Medical Conversion: 3,643 Positions to Be Eliminated by 2011,” San Diego Union-Tribune, August 9, 2004.Google Scholar

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The DoD “rates” the disability based on the severity of its impact on the member's military duties, much as the Social Security Disability system rates individuals based on their ability to pursue substantial gainful employment (see 42 U.S.C. §§401–433). If a disability is severe enough, the member is medically retired from the active service and receives a monthly pension (and other benefits) based on the percentage of disability assigned intended to compensate, in part, for the lost military career. Once separated from service, the service member must apply for care and benefits through the VA and must undergo a separate evaluation by the VA to determine the nature and scope of benefit eligibility (based on different criteria). Note that DoD disability payments are offset by VA benefit payments (i.e., they are not aggregated). Although VA disability payments are exempt from federal income tax, military disability pay is not.Google Scholar

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“While both the [DoD] and the DVA use the Department of Veterans Affairs Schedule for Rating Disabilities, not all the general policy provisions set forth in the Rating Schedule apply to the military. Consequently, disability ratings may vary between the two. The [DoD] rates only conditions terminating the [Service member's] career. The DVA may rate all service-connected impairments. Another difference is the term of the rating. The [DoD's] ratings are permanent upon final disposition. DVA ratings may fluctuate with time, depending upon the progress of the condition. Further, the [DoD's] disability compensation is affected by years of service and basic pay; while VA compensation is a flat amount based upon the percentage rating received.” Department of the Army, Information Paper: Overview of the Army Physical Disability Evaluation System, April 11, 2007; see GWOT Task Force Report, supra note 17, at 22.Google Scholar

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This dual disability rating process has led to considerable confusion and inconsistency and has obvious and serious implications for patients who risk the consequences of differing disability ratings whose elements and outcomes are geared to each agency's mission rather than the overall status and future of the individual. Receipt of a less severe disability rating from the VA can lead to the diminution of promised benefits as well as a personal sense of abandonment by the DoD. In truth, the distinctions between the two rating systems reflect their unique purposes (i.e., to measure fitness for DoD service on the one hand, and the receipt of ongoing care through the VA on the other), but the meaning of these policy and administrative distinctions tends to fall away, because they are so little understood. See Pendleton's Testimony, supra note 13, at 6.Google Scholar

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The disability rating awarded by the DVA Rating Board, specifically for the military unfitting medical condition(s), will serve as the basis for determining a DES Pilot participant's final disposition (separation with disability severance pay or disability retirement). The DVA Rating Board's combined disability award, for all medical conditions rated, shall be the basis for determining disability compensation payments and benefits administered by the DVA.Google Scholar

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