Strategies to improve compensation and pension timeliness: lessons learned from high-performing facilities.

The compensation and pension (C&P) process is the mechanism by which injured Veterans are assigned their medical and disability benefits. As part of the documentation and rating process performed by the Veterans Benefits Administration (VBA), many Veterans need supplemental medical examinations performed by the Veterans Health Administration (VHA). Improving C&P examination timeliness is a goal of many VHA facilities. To identify strategies to improve examination timeliness, we used national performance measures to identify high-performing VHA facilities. We then interviewed seven facilities using Donabedian's structure-process-outcome framework to determine characteristics attributed to their high-performance. We developed a list of high-performance characteristics common to all facilities, which relied on a tailored relationship between each VHA facility and VBA office. Additional characteristics were grouped thematically into three management foci - financial incentives, role specialization, and process reliability. Distillation of these characteristics provides guidance to other VHA facilities seeking to improve their C&P timeliness.

US Department of Veterans Affairs disability policies for posttraumatic stress disorder: administrative trends and implications for treatment, rehabilitation, and research.

An accumulating body of empirical data suggests that current Department of Veterans Affairs (VA) psychiatric disability and rehabilitation policies for combat-related posttraumatic stress disorder (PTSD) are problematic. In combination, recent administrative trends and data from epidemiological and clinical studies suggest theses policies are countertherapeutic and hinder research efforts to advance our knowledge regarding PTSD. Current VA disability policies require fundamental reform to bring them into line with modern science and medicine, including current empirically supported concepts of resilience and psychiatric rehabilitation.

Modeling an integrative physical examination program for the Departments of Defense and Veterans Affairs.

Current policies governing the Departments of Defense and Veterans Affairs physical examination programs are out of step with current evidence-based medical practice. Replacing periodic and other routine physical examination types with annual preventive health assessments would afford our service members additional health benefit at reduced cost. Additionally, the Departments of Defense and Veterans Affairs repeat the physical examination process at separation and have been unable to reconcile their respective disability evaluation systems to reduce duplication and waste. A clear, coherent, and coordinated strategy to improve the relevance and utility of our physical examination programs is long overdue. This article discusses existing physical examination programs and proposes a model for a new integrative physical examination program based on need, science, and common sense.

Improved outcomes of veterans' compensation and pension examinations using nurse practitioners.

A historic change to improve outcomes of a long-standing problem in completing veterans' compensation and pension examinations has resulted in increased access to care, higher client satisfaction, and increased system efficiencies. This article describes the change from medical care as the exclusive responsibility of physicians to an innovative use of nurse practitioners in a system that exists in a highly structured, centrally coordinated patient care practice.

Misplaced rewards: Veterans' Administration system and symptom magnification.

The process of disability determination in the Veterans' Administration system and the maladaptive patterns of behavior that may develop in veterans attempting to qualify for disability benefits have been subjects of considerable interest to those who care for these individuals. The potential misuse of disability payments by veterans, especially for purposes of financing drug and alcohol dependence, is a related issue of concern. The quest for disability status is frequently an all consuming process, as the veteran attempts to document the presence and severity of his or her disorder to the degree necessary to obtain approval for compensation. Veterans' Administration patients may engage in symptom magnification as a means of convincing healthcare workers of the veracity of their complaints and to establish the necessary paper trail for their disability claims. It is clear when dealing with this challenging patient population that it is exceedingly difficult to know when a patient has a prominent psychologic overlay to his or her condition, is embellishing existing symptoms, or is prevaricating in an effort to obtain disability payments. Although it is essential to focus on the objective signs of disease while attempting to evaluate the subjective correlates, it is also important to determine the motivation of the patient. Rewarding individuals for pain and disability, particularly on a long term basis, can have numerous negative consequences and ultimately may be a disservice to the patient.