Once a veteran has achieved service connection for his or her disability, the next question to be addressed is somehow evaluating (or rating) the severity of the symptoms to determine the appropriate level of compensation. The VA uses what has evolved from a 1945 Schedule for Rating Disabilities, which is codified at 38 C.F.R. Part 4 (known as the "rating schedule"). The rating schedule is designed to compensate veterans based on the average impairment of their industrial (or earning) capacity. Explained simply, the rating schedule is a collection of disabilities, grouped by body systems that delineate a group of different symptoms in an increasing order of severity. Percentages of disability are assigned to each level of symptoms from zero (non-compensable disabling) to one hundred percent (totally disabling) in ten percent increments. Each disorder is assigned an identifying diagnostic code. If a particular disorder is not listed, it is rated by analogy to a listed disorder that most closely approximates it. See 38 C.F.R. ? 4.20. Multiple disability ratings are combined according to a complex tabulation matrix, rather than added together, to produce a combined rating of all service-connected disabilities. See id, ? 4.25. Essentially, the adjudicator reviews the medical evidence of record, finds the compatible diagnostic code and compares the clinical evidence of the severity of the veteran's current symptoms with the list of symptoms under that diagnostic code. The commensurate rating percentage is assigned. Each year, Congress sets the monetary level of compensation for each percentage level.

Anyone would be hard pressed to say that the VA's rating schedule even approaches perfection. It is antiquated, imprecise, and vulnerable to great subjectivity and does not take into account the diminution of a disabled veteran's quality of life. However, given the uniqueness of the veterans' benefits system, the rating schedule, in principle, does serve its essential purpose. With certain refinements, the rating schedule may be able to live up to its original expectations.

Part of the current problem with the rating schedule is that it was formulated at a time when disabled veterans were returning home from World War II. Veterans were universally admired and their disabilities were, for the most part, clear-cut. Orthopedic injuries, amputations, psychiatric disorders; these are known quantities. Since World War II, however, veterans have returned with more insidious illnesses. Diseases such as hepatitis C and HIV (which were unknown until decades later), diseases as the result of exposure to chemical, biological and/or radiological agents, mysterious syndromes such as Gulf War Illness and chronic fatigue syndrome, were not contemplated by the framers of the original rating schedule.

In the 1940s, the United States was more of an industrial society. Quite naturally, the emphasis within the VA disability compensation scheme was on the impairment of a veteran's earning capacity. However, times have changed. Advances in medicine have allowed for qualitatively greater treatment, cures and rehabilitation. Medical knowledge has increased exponentially in the last five decades, diagnostic tools have been refined and today's medical professionals are practicing medicine in ways that could not have been envisioned by doctors even two generations ago. Yet the rating schedule remains static. While new disorders have been added from time to time and the symptoms listed in the diagnostic codes have been updated here and there, it is long past time for a wholesale revision of the rating schedule to bring it in synchronization with the state of modern medicine and American society.

One example of the inadequacy of the current rating schedule is rather glaring. VA regulations have historically adopted the nomenclature and diagnostic criteria of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). See 38 C.F.R. 4.125(a). The DSM recognizes the differences among the various psychiatric disorders (e.g., psychoses, like schizophrenia, and neuroses, like PTSD). Some psychiatric disorders are organic in natures, some are acquired and some are congenital. Some are chronic, some are intermittent and acute. Yet the rating schedule completely ignores such differences. Instead, it lumps all psychiatric disorders together and evaluates them under the exact same list of symptoms. See 38 C.F.R. ? 4.130. This is both inherently inconsistent and illogical. The DSM diagnostic criteria are expressly adopted, but fundamental differences among various psychiatric disorders are virtually ignored.

Consequently, the VA should initially undertake a comprehensive review of the rating schedule in concert with medical, psychiatric and vocational experts. New rating criteria should be developed that take into account not only impairment in industrial capacity, but also the psychiatric effects of physical disability and the effect of physical and psychiatric disability on the veteran's quality of life. VVA often advocates for a "Veterans' Health Care System", rather than a health care system for veterans, based on the unique nature of veterans' disabilities. Such disabilities are incurred in unique ways and have unique consequences. It is the very "veteran-ness" of a veteran's disability that demands a system of evaluating disabilities that keeps pace with technology, current medical standards and practices, socioeconomic factors and individual self-esteem.

Once the rating schedule has been adequately revised, it may be utilized just as it is today. It works logically, the documented symptomology is compared with the diagnostic criteria and a commensurate rating results. As long as Congress sets adequate payment levels for the various ratings (which, in equity, should be higher than they currently are), veterans should receive adequate compensation.

Meaningful Accountability and Training of VA Adjudication Personnel

It is axiomatic that a system is only as good as the people who run it. The VA disability compensation system can be flawlessly designed; however, if the personnel who operate it not are not adequately trained, supervised and held accountable for repeated errors, the system will grind toward disaster.

In a recent rather disturbing press conference, VA Secretary R. James Nicholson, Inspector General Richard Griffin and Under Secretary for Benefits Daniel Cooper, announced a May 19, 2005, VA Inspector General's (IG) Report, entitled "State Variances in VA disability Payments". The report was generated following newspaper reports of low disability compensation payments for Illinois veterans as compared to veterans in other states. In response, several Illinois Representatives requested the VA investigate the disparity. Following the investigation, the IG conceded that variances in average disability compensation payments by states have existed for decades, and stated that "[p]ayments by state are affected by legislated pay increases, an antiquated rating schedule, veteran demographics and inconsistent rating decisions [including] claims processing practices, disability examinations, timeliness pressures, staffing levels, rate experience and training, and fraud." Executive Summary and Management Comments of State Variances in VA Disability Compensation Payment? IG Report No. 05-00765 (May 19, 2005) at x. The IG further concluded that "some disabilities are inherently prone to subjective rating decisions, especially for conditions such as PTSD where much of the information needed to make a rating decision is not physically apparent and is more susceptible to interpretation and judgment [which] leads to inconsistency in rating decisions." Id.

In VVA's view, the IG report got it half right. We believe that the IG is dead right when it identified inconsistent rating practices, staffing and training issues, and pressure to produce decisions quickly as factors resulting in wide decisional variances. Where VVA strongly disagrees, however, is the identification of claimant fraud and subjectivity in the face of missing evidence. It would seem that the IG is attempting to shift the blame of rating inconsistencies to the claimants themselves. We are perplexed, but not surprised, by this approach. The fact of the wide variances in ratings speak to inadequate training and supervision of VA adjudicators. The VA rating system is subject to uniform adjudication standards, procedures, training materials and data. See VA Adjudication Procedures Manual M21-1. The Veterans Benefits Administration and the C&P Service routinely issue "fast" letters to all of the VAROs with specific instructions on specific adjudicatory matters. If everyone is reading off the same page of music, the tune should remain consistent from musician to musician. This is clearly not the case at the VA.