By Sandra Basu
WASHINGTON — With the uproar over VA’s disability claims backlog, a former VA secretary is calmly asking a vital question: What can be done to prevent future veterans, especially those with wounds and injuries, from getting caught in a bottleneck of claims when they need care?
The solution, according to former VA Secretary Anthony Principi, who served from 2001 to 2005, is not another VA program to speed up claims processing, neither is it a change in leadership, as some legislators maintain. Instead, Principi says the nation needs to look at refocusing benefits all together.
“We need to come together, and by that I am talking about members of Congress, the administration, the secretary and those who represent veterans, to look at the program, to see if it is the right program for the 21st century and if it is meeting the needs of those who have been injured or wounded. That is what I believe is important,” he told U.S. Medicine.
Principi has not been quiet about his views. This summer, in an op-ed piece published in The Wall Street Journal, which followed a speech he gave earlier on the topic, Principi wrote that “the enumeration of benefits has evolved far beyond the nation’s obligation to those who became ill or injured while in service.”
He wrote that “every year more than a million veterans file claims for ‘service-connected’ disability compensation; that is for any disability or disease arising while on active duty, regardless of how the disability or disease was incurred.” Most of those claims are from veterans who served before Sept. 11, 2001, he says.
The most recent veterans, especially those who have been wounded or injured in war, pay the price, facing monthslong claims delays, he suggested.
“I think we need to give priority to those who have been wounded in conflict, whether it be a mental or physical wound,” Principi said in an interview.
Growth in Benefits
VA leaders have acknowledged that the growth in benefits has contributed to the backlog. In written testimony earlier this year, VA’s Undersecretary for Benefits Allison Hickey explained that VA Secretary Eric Shinseki’s decision to add three presumptive conditions — Parkinson’s disease, ischemic heart disease and B-cell leukemias — for veterans exposed to Agent Orange, contributed to the snarl in disability claims.
“The decision to expand the number of illnesses presumed to be linked with Agent Orange exposure redirected over one-third of VBA’s workforce to process 260,000 Agent Orange claims. This grew the backlog, but it was the right decision to make for our Vietnam Veterans who, in some cases, were waiting over 40 years,” she wrote in a blog post in March.
Principi, a Vietnam veteran, points out, however, that veterans who spent even a day in that theater of operation are automatically service-connected for Type II diabetes, Parkinson’s disease, prostate cancer, lung cancer and ischemic heart disease. While VA recognizes these conditions as presumptive diseases associated with Agent Orange, they are also “common diseases of older men,” he pointed out.
Principi explained in his article that presumption that these diseases are a result of exposure to Agent Orange “is based on tenuous medical science described by the Institute of Medicine as only ‘weak’ or ‘suggestive.’
“If it is 60 years later and you are 70 years old or 80 years and get prostate cancer, one has to question whether that is because of disease that comes with aging, or exposure,” Principi told U.S. Medicine.
He questions whether there should be a cutoff date — either in age or years of service since service in Vietnam — for covered disabilities that may be related to Agent Orange.
“I think the scientists can tell us, if you don’t have certain diseases within 10 years of exposure or 20 years of exposure, than, more likely than not, it is not related to your exposure,” he said.
Another problem with the current compensation system is with the concept of “individual unemployability,” he suggested.
“Veterans Affairs can pay disability compensation at a 100% rate to veterans with lesser disabilities evaluated as little as 60% disabled if their disability prevents them from working. That makes sense for working-age veterans. But does it make sense when a veteran files his first claim when he is 80 or 90 years old?” he wrote in the Wall Street Journal.
Principi has readily acknowledged that he contributed to the current situation when he was VA secretary by approving type 2 diabetes on the list of diseases automatically service-connected for Agent Orange.
Still, he said now is the time to relook at the program. Otherwise, he warned, wounded and injured veterans “will continue to face delays in having their claims for disability compensation processed by many, many months.”
“It is not right and it is not fair,” he said. “I don’t have all of the answers or the solutions, but I do know if people come together and sit down and look at this program and say, ‘Do we need to make changes? What are those changes going forward?’ I think that is the best way to proceed.”