Thousands of vets get payments for hemorrhoids, other minor claims

By LISA HOFFMAN
Wednesday, March 28, 2007

As it braces for a flood of war-disabled veterans, the nation's disability compensation system for former troops has become a $26 billion behemoth bloated and backlogged in part by overgenerous benefits for minor maladies barely tied to military service, if at all.

Case in point: More than 120,000 vets from earlier eras are collecting lifetime benefits for hemorrhoids, which they are not required to show resulted from their military duty.

Thousands of more veterans are receiving monthly compensation for bumps on their faces from shaving or for scars so small they are hard to see _ and will for the rest of their lives.

In fact, hemorrhoids are the 11th most common disability for which U.S. vets are compensated, after such conditions as defective hearing, arthritis, diabetes and hypertension. A conservative calculation of the cost of the benefits to veterans for hemorrhoids alone could be $14 million a year or more.

With the first wave of what could be as many as 700,000 veterans of the wars in Iraq and Afghanistan already applying for benefits, worries grow that they could soon suffer from delays or a funding crunch because the system has expanded far beyond its initial intent of compensating veterans for loss of earning power due to service-related illnesses or injuries.

As a result, some critics estimate that perhaps 775,000 of the 2.6 million veterans on the rolls in 2005 are getting monthly checks for ailments that don't hurt their ability to work, often are treatable, are common in the civilian world, and frequently are the result of the ordinary aging process.

Darryl Kehrer, former staff director for the House Veterans Affairs subcommittee on benefits, says the combat veterans of the "war on terror" will be ill-served by a system that some studies have shown spends $1 billion a year on such claims, which also contribute to the current 600,000-claim backlog. The average wait now for benefits is six months, a lag that could balloon to twice that, or more, once Iraq and Afghanistan vets fully enter the pipeline.

"This does a disservice to veterans who are truly disabled, (and) to the men and women coming back from combat," who now must get in the back of the line, Kehrer said.

For the first time in 50 years, these issues and others weighted with similar emotion are being examined by a blue-ribbon commission charged by Congress with finding fixes for a system that all agree is overloaded and under fire.

While veterans service organizations such as the American Legion and the Disabled American Veterans find plenty to fault in the current system, they vehemently object to any effort to limit the kinds of disabilities for which veterans can be compensated, or to require more stringent proof that a condition is directly connected to time in uniform.

They serve as vigilant defenders of the parameter that has come to underpin the disability compensation system: that any disease or injury that occurred during active military service, or was aggravated by it, entitles a former GI to lifetime indemnity payments that the nation owes to those who serve in uniform, in compensation for their sacrifice. If the price tag is astronomical, so be it.

"Whatever it takes, for anyone with a service-connected condition. Period," said David Autry, deputy director of communications for the disabled vets group.

Government audits for more than a decade have criticized the system as a post-World War II relic predicated on 1945 standards that don't reflect the change in America's economy from a farming and manufacturing base to a service one. Vast advances in medical care and technological progress has led to new devices that improve life for the disabled and allow them to work.

The Department of Veterans Affairs uses a rating system for allocating benefits that classifies a vet's condition as between 0 percent and 100 percent disabling. By the most recent count, more than 700,000 of the 2.6 million veterans receiving compensation were rated 10 percent disabled _ the lowest level eligible for cash benefits. At that grade today, the monthly check for a veteran is $115.

Vets do not have to show that their service caused the impairment or that their wages are lower than they could have been. And, although it is not explicit in the disability laws Congress has passed, there exists an implied intent to compensate vets for losses in their quality of life. That does not have to be proved.

Instead, the standard is, essentially, that a condition must have manifested itself during the time the soldier was in uniform _ whether or not the ailment was a direct result of military duty. And, once approved, the benefit continues _ even for those who are retired or in well-paying jobs _ until the veteran dies. The only disqualification comes if the condition occurred as a result of misconduct.

Among those recently granted a new 10 percent disability was a veteran who had been wounded in combat in Vietnam, hit by a fragment from a grenade in October 1966. Nearly 30 years after that injury, the vet filed for benefits at the Veterans Affairs office in Chicago, not for the shrapnel wound _ for which he already was being compensated _ but for his hemorrhoids.

Though his medical exam when he left the service after his Vietnam tour documented no sign of the hemorrhoids, and he first sought VA medical care for the affliction in 1993, his hemorrhoids were ruled to be military service-connected. As such, the vet was eligible to receive $115 a month for the rest of his life in compensation, the VA's Board of Veterans' Appeals deemed last May.

The former soldier, whose name was not publicly revealed by the board, thus joined the ranks of more than 124,000 veterans who are receiving monthly disability checks for the painful but treatable condition and will continue to do so for the rest of their lives

Hundreds of thousands of other vets get perpetual benefits for other relatively minor ailments, including "shaving bumps," a skin malady known as pseudofolliculitis barbae, that erupts in reaction to shaving.

Also qualifying for monthly cash in perpetuity are those with small, superficial scars _ such as ones on the tip of a finger or toe.

For example, a veteran in Albuquerque, N.M., who retired in 1975 after 23 years in uniform, had received benefits since 1996 for a quarter-inch scar on his left eyebrow stemming from the removal of a cancerous growth.

The veteran, also unnamed in the veterans' appeal board records, appealed last June to increase his 10-percent disability to 20 percent, and thus to boost his check to about $225 a month. The board noted the scar was neither tender nor disfiguring and denied the claim.

Veterans groups say it is far more common for vets to be denied legitimate claims than approved for illegitimate ones. The Legion's benefits expert Steve Smithson and others also contend that the military is a singular institution that comes with inherent stresses and strains that, in some cases, may not trigger medical problems for years. Unlike those in other professions, soldiers do not have the luxury of quitting a job at will. "Service members are on duty 24-7," Smithson said.

And, though some might consider service-connected hemorrhoids to be "a bizarre sounding thing, you can get hemorrhoids from military duty," he said.

Former House panel counsel Kehrer contends that hemorrhoids are a good example of the sorts of afflictions that many vets would suffer as they aged, whether or not they had served in the military. Experts say about 3 out of 5 American adults will suffer from the painful swelling of veins in the rear region at some point in their life, usually beginning in middle age.

A U.S. Government Accountability Office report in 2003 classified hemorrhoids as one of an array of conditions that are generally neither caused nor aggravated by military service. Also included were osteoarthritis, uterine fibroids, arteriosclerotic heart disease and hysterectomy.

Another government report, this one by the Congressional Budget Office the same year, found that about 290,000 veterans had collected $970 million in benefits due to those illnesses in 2002.

Since then, GAO has recommended that Congress consider eliminating them from the list of service-connected ailments. Other critics have suggested doing away entirely with the 10 percent disability category, for which $1 billion in benefits were paid in 2005.

These issues are on the table in a top-to-bottom examination of the overtaxed and controversial system. In 2004, Congress created a select commission to study the criticisms and suggest fixes. The Veterans' Disability Benefits Commission is slated to release its report by October 1.

A companion study is under way by the National Academy of Science's Institute of Medicine to evaluate the medical underpinnings of the disability system. It is specifically studying the use of the percentage rating method and researching the medical basis for determining disability.

Monitoring these efforts closely is the veterans community, which is poised to vociferously object and mobilize millions of vets to protest to Congress if efforts begin to limit the disabilities or veterans covered.

"You start picking and choosing, you get on a really slippery slope," the Legion's Smithson said.