Daniel Gade lost his right leg in Iraq. But Gade, an assistant professor of political science at the U.S. Military Academy, does not consider himself disabled. Instead, he uses himself as an example of how the U.S. Department of Veterans Affairs often inaccurately assesses disability.
“I have a Ph.D. in public policy, I do Ironman triathlons, I rode my bike across the country in 2012. But according to the VA, when I leave the army, I will be 100 percent disabled, unable to work, completely disabled. That’s an illustration of the fact that this is a really broken system.”
According to Gade, the VA currently uses a “medical model” to determine disability, rather than a “social model.” This means that the VA only looks at the medical condition, stripped of all context. A “social model” considers the medical condition, but within the broader context of other factors in the veteran’s life that might be unique to each situation. In cases like veterans suffering from post-traumatic stress disorder (PTSD), the VA does not even require veterans to try to obtain treatment before they deem them disabled.
Gade discussed this and other problems with the government’s treatment of veterans with PTSD with a panel of experts at the American Enterprise Institute on Thursday morning. The panelists shared their thoughts on how to improve the system. The methods the VA uses to define disability, according to the panelists, may be leading programs to benefit the wrong people.
In one example, nearly half of the veterans entering the VA’s “Individual Unemployability” program for the first time are 60 and over, and almost 20 percent are over 75—turning an unemployment program into a supplemental retirement program. Meanwhile, the unemployment rate for veterans between the ages of 18 and 24 remains around 20 percent.
The panelists also addressed the concern that disability programs may set up perverse incentives by rewarding unemployment. They stressed that disability should not be incompatible with work. Several also suggested that seeking treatment should be a prerequisite to qualifying for disability. Mandatory treatment might help sort out the truly dire cases, and help “wean” more manageable cases off the program and rehabilitate them back into civilian life.
Two psychiatrists on the panel, Stephen N. Xenakis and Sally Satel, both criticized the VA’s medical procedures. “The disability system that we as Army physicians and the VA use was first laid down in the '50s, and has had little change since then. It was an industrial-age model,” says Xenakis. “Medicine has changed in 60 years immeasurably. The regulations and the guidelines have not…I can’t believe it. In the early '70s, we didn’t even have an idea what PTSD was and what it meant.” Xenakis, like Gade, wants a more comprehensive system that considers factors like family, relationships, diet, and exercise.
Satel calls the current methods for determining whether someone is disabled by PTSD “clinically invalid.” She says that it makes “no sense” to make a disability determination without someone being treated, since a psychiatrist cannot determine a patient’s future prospects without treatment. “To take someone out of the workforce is devastating…we should only put someone at risk for that kind of loss at a very high threshold.”