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TRICARE for Any Vet Found 'Unfit'

Military.com
Tom Philpott |
September 21, 2007


Bush to Seek Lifetime TRICARE for Medically 'Unfit' Vets

The Bush administration will ask Congress to provide lifetime TRICARE coverage to any service member discharged as "unfit" due to service-related physical or mental health conditions, said Donna Shalala, co-chair of the President's Commission on Care for America's Returning Wounded Warriors.

The TRICARE change will be one of the most expensive initiatives in a legislative package the White House will send to Congress by the end of September. The package is to implement key recommendations of the wounded warrior panel, also known as the Dole-Shalala Commission.

The TRICARE proposal, if enacted into law, would open military healthcare to a wave of new beneficiaries, potentially as many as 9,000 to 10,000 newly-disabled veterans each year plus their families.

The Dole-Shalala commission report, released in July, said the TRICARE change should only apply to service members separated for combat-related disabilities. But White House officials, at the urging of Defense officials and service associations, have decided to ask Congress to extend lifetime TRICARE coverage to all medically-discharged veterans. 

Shalala said the White House will propose that the TRICARE expansion be applied retroactively to veterans medically separated since 2001. Shalala didn't mention a specific retroactive date but Congress two years ago made eligibility for traumatic injury insurance retroactive to Oct. 7, 2001, the day U.S. forces invaded Afghanistan and began the Global War on Terrorism.

Under current law, members are separated rather than retired if found unfit for duty because of conditions rated below 20 percent disabling. They receive a disability severance award rather than retired pay. Because they are not "retirees," they and their families are ineligible for lifetime TRICARE coverage. They can get VA health care but family members cannot.

From 2000 to 2006, an average of 9,600 service members a year were separated as medically unfit with disability ratings of 20 percent or less, according to statistics gathered by the Veterans' Disability Benefits Commission, which is due to release its report on Oct. 3. Nearly nine of 10 disabled soldiers were separated rather than retired. Sixty-four percent of sailors with disabilities, 73 percent of disabled airmen and 82 percent of disabled Marines also were released with ratings of 20 percent or less.

Shalala and her co-chairman, retired Sen. Robert Dole, said six of 34 "action steps" that their commission recommends requires legislation. They urged lawmakers to enact the White House initiatives this fall if possible.

In addition to expanding TRICARE, they said, Congress should:

-- Authorize the Department of Veterans Affairs (VA) to provide lifetime treatment of Post Traumatic Stress Disorder to any veteran deployed to Iraq or Afghanistan who seeks treatment. This "presumptive eligibility" for PTSD diagnosis and treatment should occur regardless of how much time has passed since exposure to combat, Shalala said. She said 500,000 service members have deployed to Iraq and Afghanistan multiple times, increasing their odds of experiencing PTSD, which "can be devastating."

-- Strengthen support for military families caring for wounded warriors by making them eligible for TRICARE-provided respite care and aid and attendant benefits. Shalala said many families are caring for loved ones at home who are suffering from complex injuries. The families need help with around the clock care, she said.

-- Amend the Family and Medical Leave Act (FMLA) so that families of combat-injured service members see unpaid leave protection extended from the current limit of 12 weeks up to 6 months. Shalala said two thirds of injured service members have had a family member or close friend stay with them while they were hospitalized and one in five had to give up their job to do so. "That is simply unacceptable," Shalala said. The Senate already has passed this provision in its Support for Injured Service Members Act but the House should "quickly follow suit," she said.

-- End the dual Department of Defense and VA disability systems, by giving DoD responsibility only for finding a members unfit for duty, Dole said. DoD should pay disabled members an immediate lifetime annuity based on rank and years of service. The revised VA disability pay system should include a monthly transition payment, perhaps equal to final military basic pay. That would be replaced after the veteran settles into civilian life with payment to replace reduced earnings tied to their level of disability and payable until age 65. Veterans also should get a lifetime quality-of-life payment to compensate for life effects of their disabilities.

The commission gave no amounts for these payments, leaving that for the Bush administration and Congress to decide.

The commission, Dole said, recommended lifetime TRICARE coverage for any member found unfit for continued service as a result of injuries "acquired in combat, [while] supporting combat or preparing for combat. That takes [in] about everybody," he said.

"We think the White House is going even further," Shalala said, "to recommend that everyone who is declared unfit for service for health reasons -- that they will cover the individual and their family's healthcare forever."

"The advantage of that is obvious," she said. Disabled veterans who can work only part time still won’t have to worry about medical care for themselves or their families. "It's a tremendous step forward," Shalala said.

Congress shouldn't worry about the cost, Dole added.

"My view was if we spent billions and billons and billions of dollars on getting young men and women in harms way, we ought to spend what it takes to get them back to nearly a normal life as possible."

To that remark, veterans in the hearing room broke into applause.

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