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.

12 Comments

  1. I am looking forward to this series a lot, since I am woefully ignorant about what it’s like to receive health care through the military, let alone what it’s like trying to navigate the system with a disability. As someone on the outside looking in, I can say that the VA’s determined refusal to avoid classifying many disabilities as service-related is very troubling, and upsetting.
    .-= meloukhia´s last blog ..In the Streets =-.

  2. I am looking forward to this series, too. I have a friend who is currently in the middle of waiting to see what her final disability rating from the VA will be.

  3. My husband spent 20 years and 20 days in the Navy. He found out he had type 2 diabetes when the Navy did his physical 6 months before discharge and took him off his ship (can’t serve on board a ship if you’re diabetic). So he did his last 6 months on shore duty. He had other disabilities besides the diabetes – carpal tunnel in both wrists, partial deafness in one ear, arthritis in his knees and both feet (I guess the diabetes is considered a service-related disability if you didn’t have it when you enlisted but get it before you’re discharged or retire).
    He was an HT1, and rated at 50% disabled when he retired 14 years ago, that has increased to 90% in the last couple of years (he’s had a couple of compensation and pension reviews as his condition changes/worsens). He’s going in to have his left knee replaced some time in the next month or so, and he needs to have carpal tunnel surgery on his left hand, so those surgeries will probably change his disability rating again (to 100%).
    He hasn’t had any problems with his care at the VA as long as he makes it to his appointments (and if he can’t make it to one, he gets in to see them on time anyway as long as we call and reschedule as soon as they send us notification of an appointment, which is usually a month in advance). And because he’s at least 50% disabled and lives 50 miles or more from a VA facility, he gets travel pay when he drives to his doctor’s appointments.
    He’s been lucky. There are a lot of veterans that haven’t had it as easy with the VA.
    .-= vesta44´s last blog ..New kitteh =-.

  4. Thanks for writing about this important topic. I look forward to learning more about it.
    .-= Rosemary´s last blog ..Glee and Beer =-.

  5. My brother was an… Electrician’s Mate Second? I think? When he and the Navy parted ways due to medical reasons — he may have a degenerative disc condition, though he insists he just damaged it being all athletic. The last injury involved volleyball and a carrier flight deck. :p

    I don’t think he got an award (yeah, it’s an ugly construction but the idea that people with disabilities have won something when we get assistance is very common) on his separation from the Navy but he reports that the VA has been mostly helpful.

  6. My dad retired from the AF with 100% disability, and got all of his health care at military facilities or local hospitals with CHAMPUS (the predecessor of TRICARE) footing the bill. My husband was medboarded out of the Army with 20% – he does receive a monthly stipend at 20%. I think it’s lower than 20% gets the one-time payout. At a higher level, it’s medical retirement, which is more like conventional retirement. He got severance pay from the Army, and his monthly stipend “repays” that for a few years, and then he’ll actually receive the check. We’ve had decent luck with the VA system for his healthcare, but we’ve lived in DC and Chicago, where the facilities are OK. It’s not his primary care, though, as he is a US Army civilian now. His injuries are service-connected and he had combat injuries previously, which carries a bit more capital in the medboard process.

    The process and support structures during the process varies wildly from command to command. My husband was on the General’s staff of a division headquarters element, so he had some big guns (and names) watching over his packet. Not everyone is so fortunate. We also knew the system well, and our liaison knew that, so she was extra-vigilant with us, because she knew we could raise holy hell and someone would listen.

    We *shouldn’t* have been so fortunate – that’s a huge indication that something is amiss. I do think the docs are under tremendous pressure – and the civilian ones are fleeing the system. I don’t blame them.

    I do miss my Tricare, though. Managing a genetic connective tissue disorder, even with good federal employees’ insurance, is breaking my piggy bank. I had two MRIs tonight – I have sticker shock.

  7. Thank you for writing on this topic. My brother just when to basic this month, so this topic is of a great deal of interest to me and no something I had really thought about before.
    .-= thetroubleis´s last blog ..On work. =-.

  8. Vesta, Kaninchenzero, and Leelee:

    It is worlds different with a physical disability that you can point to and say “See?”, because the doctors are more likely to believe you (general “you”). If there is a blood test or a scan for it then it is a lot easier to get support from the doctors in the Active Duty system. Please note that I am talking specifically here about the DoD side, not the DoVA side, which is two entirely separate entities, and which I am only beginning to get into. I am talking about the split between the two, where one side wants to make the other responsible. Also, whether it was diabetes discovered while you were in or a slipped disc playing a game during PT on a carrier deck, if it didn’t exist before you signed your life to service then it is the military’s responsibility to take care of it, no matter what they tell you (because someone will tell you otherwise unless you fight for it). These medical professionals are being pressured to turn away people with disabilities and illnesses and battle wounds that we can’t see and easily diagnose in the name of the bottom line of a budget. I am so very happy for the service members who get their med boards successfully handled prior to separating, because it should NOT be up to the VA to sort this out. The military needs to step up here and care for these troops as well…

    One of the biggest issues I have with this is that giving a lower diagnosis in the name of a tighter budget is going to set up a veteran for a difficult time getting the proper care (as I can attest to w/ my mental health only regimen that was forced on me) after separation. You shouldn’t have to fight so hard to get the correct diagnosis, especially when doctors have already told you what is wrong with you.

    Leelee: I think I said that 20% gets you a one time payment, because there are two magic numbers: 30 will get you monthly payments and 80 gets you “medical retirement”, which is what I said in the OP.

    And yes, if you get any award form the DoD/military, and then are awarded a VA claim that VA claim first must pay back the DoD/military for the money they gave you, and then you receive money after that is balanced out. You also have to go back annually to be re-evaluated just to make sure you are still disabled, and your rating can change at any time.

    Everyone here who mentioned a loved one, thank them, as a sibling in arms, for their service (K, Electrician’s Mate, Second Class. 😀 He would have been a Second Class Petty Officer, no?)

  9. thetroubleis: Write to him. Write to him a lot, and let him know that you support him (even if you don’t support the war). Send him bits from home and mundane news. Encourage him and tell him that you are sure things suck, but that it’s going to be awesome soon, and that no matter what you are proud. Tell him what movies you liked and tidbits of news or about sports teams or whatever he liked, because he is totally shut off from the world. It helps. Send pictures and stuff and keep it light, and when he is done with basic, my best advice is to make a copy of everything. Every time a slip of paper goes into a record from his hands, copy it first and keep it in a file at home, because shit disappears and no one cares.

  10. The VA’s guidelines for PTSD say that there has to be a precipitating event. In my case, the event was a 22-hour suicidal firefight that left six people dead, used up our ammo down to the last few mags, and pitted us 40 against 800 insurgents.

    It was also filmed. We were guiding along a few dozen civvies, and one of them had a video camera.

    The VA inititally refused to view the video, then reluctantly did so, then said, “So…did you have a traumatic childhood?”

    I had to have a root canal this week because the VA either didn’t read my file or just didn’t give a shit. A month ago I went in for a toothache; they gave me penicillin. Two weeks ago, the toothache came back and even vicodin didn’t make it better. The VA’s blood pressure machines wouldn’t work, they didn’t get an accurate temp, and so I had to suffer for three days. By the time they deigned to see me, I had a high fever, sky-high blood pressure, a red and grotesquely swollen face, and eyes clouded with blood. The tooth had gotten infected and an abscess had formed. When they drained it, the doctor estimated that they’d cleared out a tablespoon and a half from the abscess. All this because the ER staff—I was the only patient—just didn’t give a shit. Two weeks of utter agony. That pretty much sums up my experiences with the VA.

  11. Jeebuz, ginmar.

    Everytime I have to interact w/ the VA, I think of you and all the shit I have read that you have been through (your name precedes you). I am only beginning to scratch the surface of starting the VA half of the process, I am still dealing w/ how I feel after basically being told to fuck off from the military side of it all. If I wasn’t married to a current AD Sailor I know that I would be fucked right now…I make no mistake in knowing how privileged I am my daughter are there.

    The thing w/ “precipitating event” is that it seems that they make it intentionally vague…don’t they?

  12. Hi, ginmar,

    The VA’s guidelines for PTSD say that there has to be a precipitating event…We were guiding along a few dozen civvies, and one of them had a video camera. The VA initially refused to view the video, then reluctantly did so, then said, “So…did you have a traumatic childhood?”

    What the flying *fuck?!*

    (Sorry I have nothing more coherent to say. But…jebus. Grrr).
    .-= Tera´s last blog ..Rosemary =-.