Reforming veterans benefits will be controversial, but necessary

As part of our commitment to those that have served, taxpayers will spend $100 billion in 2019 towards benefits programs for veterans. Costs for these programs have more than quadrupled since the year 2000. Few programs of this size and importance have received less attention from a policy perspective.

The VA’s disability compensation system is complex, cumbersome and frequently difficult to navigate. The approval process can be frustrating and slow — from obtaining copies of military service records to undergoing a comprehensive evaluation known as the Compensation and Pension examination, which is used to assign a disability rating from 0-100 percent.

{mosads}The exam itself was first conceived in the 1940’s. It has only been modified through iterative changes and may fail to properly acknowledge some of the most common issues facing today’s veterans, such as post traumatic stress (PTS).   

Veterans who are dissatisfied with initial decisions often seek higher ratings. Despite real progress by VA in recent years, the backlog of appeals remains large and hundreds of thousands of veterans wait on a system impeded by legislative restrictions and its own bureaucracy. This perpetuates an adversarial relationship between the veteran and VA. Many veterans who struggle to obtain an initial benefits’ decision become locked into a complicated process to prove their needs.

Few incentives exist for veterans to improve their health status and decrease their disability rating. Under current policies, veterans that improve may receive lower monthly payments. This also impacts veteran’s prospects in the workforce.

A recent study published in The National Bureau of Economic Research found that that changes broadening disability compensation eligibility were associated with a decrease in workforce participation among disabled veterans. This lies in stark contrast to the large body of evidence suggesting that employment has a clear positive effect on veteran’s physical and mental well-being.

Disability compensation should be aligned with efforts to facilitate improvements in veteran’s health and financial security. To that end, we believe the following five policy principles should be considered by VA and the 116th Congress. These ideas would allow the VA to test new compensation models as they modernize an antiquated system: 

1. Disability ratings should be updated to reflect contemporary workforce needs. The current system places a high priority on physical attributes necessary for manual labor and does not acknowledge present day opportunities for many disabled veterans to hold jobs in an increasingly digital economy.

2. VA should make better use of its vast data to make more personalized disability compensation determinations. Leveraging what has become commonplace in the private sector, predictive analytic models can allow VA to tailor compensation more accurately. It may also be used to predict which veterans will need more resources later in life due to individual characteristics or known disability profiles. Using these data to provide better initial determinations would allow VA to move away from a flawed and expensive appeals and re-rating process. 

3. VA should utilize best practices in behavioral economics to incentivize decisions that promote well-being and financial independence. Veterans should be incentivized to access healthcare when needed (e.g. PTS treatment). There should be simpler and more efficient linkages between the disability and the healthcare systems. When appropriate, the disability system should be integrated with programs that provide service dogs, adaptive sports and other programs that help veterans regain functional and financial independence.     

4. VA should facilitate savings plans in the form of an individualized retirement account to reduce financial uncertainty for veterans unable to participate in the workforce. With defaults that favor saving, VA can make it easier for veterans to plan for the long-term financial implications of returning from service with significant disability.   
5. The benefits program should offer a lump sum payment option. Lump sum payments can provide veterans with the resources needed to buy a house, start a business, or make other decisions that require capital resources up front. Lump sum payments are also advantageous to taxpayers because they can reduce future liabilities and create greater financial certainty over long lifetimes.  

Reforming veterans benefits will be controversial, but necessary. If left as is, the current system is at risk of becoming financially unsustainable. Reactionary funding cuts would harm veterans and further compromise public trust in upholding our responsibility to caring for our veterans.  The commitment Americans have to our veterans is too important to forgo needed reforms.  

Kyle Sheetz, M.D., was a White House Fellow from 2017-18 working on benefits reform and David Shulkin, M.D., was the ninth secretary of the U.S. Department of Veteran Affairs.