Shifting the Responsibility for Disability in Uniform
Moderatix note: This post will be United States Military centric, as that is the perspective I offer, and the broken system within which I currently exist and attempt to navigate. Other voices are welcome and experiences appreciated within the context of the conversation, since I can not pretend to know every thing about every military experience from every branch in every country.
Disability issues overlap many facets of life, and one of our goals here at FWD is to bring as many of those to light as possible. One voice I want to offer here is that of the disabled U.S. Veteran. Specifically in feminist circles I feel that the disabled veteran is a voice that is seldom heard, and while hir voice may be part of a very small percentage, sie is facing a unique set of challenges.
One of those challenges is getting a diagnosis and care in the first place. A person gives hir time and life to the military for one of a variety of reasons and find hirself trained for any number of jobs. Sie can travel the world, see exciting places, or be sent off to fight in wars. In the blink of an eye hir world is turned upside down. Suddenly life isn’t what it was before. Hir body/mind/soul are not what they once were, and coming to terms with that is no easy task. If sie is one of the ones who has survived combat injuries or someone who became sick or injured while doing hir job in a Stateside base, sie does what sie has been taught to do…sie makes a routine appointment at the local Military Treatment Facility (MTF) to see her Primary Care Manager (PCM).
Hir PCM might evaluate hir, refer hir out for tests with specialists, or set hir on a merry-go-round of treatments. When the ride stops sie may or may not have any answers, and there may or may not be a Medical Review Board pending to tell hir the terms of the future of hir career.
This is where things get interesting. By interesting, I mean kind of fucked up. One, any or all of those specialists might have diagnosed hir. Those doctors start treating hir accordingly, because while TRICARE (military medical insurance) has its flaws, it kicks a lot of arse, and sie gets the care sie needs, mentally and physically (until her PCM deploys, but that is another post altogether, just you wait!), all under the umbrella of hir diagnosis. But then the Medical Review comes up, and all of hir doctors have to write these recommendations, and suddenly things change in terms of hir care. In hir appointments hir doctors start getting vague about care plans, and start talking around the actual words for hir condition…sie might suddenly feel dismissed or as if hir questions are not being answered.
As we read earlier this year, it isn’t a coincidence that military doctors are getting dodgier than Sarah Palin in an interview. There seems to be pressure to not diagnose active duty personnel while active duty, and it isn’t just PTSD. This service member might have received treatment for months leading up to hir review board only to have hir diagnosis revoked for the board so that the military could discharge hir with a lower rating.
It’s not too hard to understand why this happens. The rating system breaks down a little like this:
A medical team of medical officers somewhere in Officer Land and look at your whole military medical record, and all these nifty letters written by the doctors who have seen you, along with some reports from your Chain of Command (CoC). Based on all of this information they determine whether or not to separate you from the military. They also give you a percentage rating of how disabled they think you are before discharging your from the military (there is also something called Permanent Limited Duty, which I can talk about sometime in another post). It goes 0%-100% (the percentage is ultimately the amount of money they give you and “how disabled” they think you are). Unless they give you at least a 10% rating you get nothing. There is a list somewhere of what constitutes what percentages, and the military’s is different from the VA’s and each branch seems to interpret it differently. Anything between 10 and 20% will grant you a one time award (I love that they use the word “award”, like somehow you have won a prize) based on your pay over the number of years you spent active duty (minus taxes, but including any bonuses you earned). Most medical review boards fall in this range. The magic number seems to be 30%, which gives you a monthly stipend based on the same numbers. This math works all the way up to 100%. After 80%, however, you receive what is called a Medical Retirement, which, regardless of how many years you have served, you retain your full benefits (insurance, commissary, exchange and medical) as if you had retired after 20 years of service. That, I think is the rub. It’s money.
When I had my review, it went a lot like that as well. I could have been Sgt. X (well, Petty Officer X) in the rheumatologist’s office w/ a tape recorder. The same guy who had written in my record that he was treating me for fibromyalgia had written in my medical review that there was no way to know for sure, that I could in fact have fibro, but that I could also have CFS, or PTSD, or just be really depressed, so there was no real answer. His best advice was for a medical discharge and a referral to the VA for follow up care. He also suddenly became angry because I didn’t want to be on Cymbalta, because I didn’t feel the need to be on another anti-depressant when ADs weren’t helping my pain (Lyrica wasn’t out yet, and Cymbalta was a new-ish treatment). When a doctor tells me “I guess you don’t want to get better”, without listening to my concerns I know I have lost a battle.
After my review board findings came back (10% if you are nosy), my doctors seemed to have a shift in my care. I was receiving less pain management care (well, less pharmaceutical) and the focus was more on mental health. My review board found that I was too depressed to continue with active duty service, oh, and Trichotillomania sounded weird, I guess, so they tossed that on there, even though no one gave a fuck about it before. Pretty much all of my care was to be managed through Mental Health (which, should be noted, is in no way a slam on mental health. In my case, it was not the treatment I needed, even though for some people it is what they need), which made my physical needs very difficult to acquire while I was still active duty. Yes, I was depressed, but I was depressed because I was in so much pain that I was having a hard time dealing with life and a child, and because no one was listening to me. I was not in pain because I was depressed. No one seemed to be interested in the sequence of events. Before my review board findings I had a PCM, a neurologist, a rheumatologist, a chiropractor, an internal specialist, and a pain management specialist all convinced that all signs point to fibromyalgia. Afterward you could have dropped a pin in room of crickets for the voices that came to my defense.
After my discharge I began the process of filing the VA claim. It is pretty much the exact same process, minus the stuff from the CoC. Oh, and it takes longer. Hmmm. I wonder why that is.
I firmly believe in my heart that military doctors (and doctors employed by the military) are being pressured to push us out the door and to let the VA sort us out because it is easier on the budget. The Armed Forces Committee seems content to thank soldiers by one-lining them out of the fiscal year’s planning, and it pisses me off. When I was given my board findings and told to sign off on it I was able to glance at the list of others who had been reviewed with my own. I remember seeing at least a dozen names with finding for PTSD or other things that are “invisible”, all with a 10% or lower finding. Brothers and sisters who have served their country, and this is the thanks we get when shit didn’t go as planned. I know that this is happening to many service members, military wide. I know that this is happening because our disabilities are invisible and easy to dismiss. Veterans are slipping through the cracks, and Congress and the DoD is not only letting it happen, but damn well encouraging it.
This is the first in what will hopefully be a series of posts on navigating disability in the military health care system.