Advice: Separation, VA Claims, and Disability Insurance

[Drägerman]

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I will soon be in the process of separating after my GMO tour and am looking for advice on the claims/separation process. It has been my experience that people are quite thorough when submitting VA claims.

1) How will VA claims impact disability insurance?
2) Is there a downside to being as thorough as possible? Or will any benefit likely buff out with increased disability insurance costs?
3) Surgical vs non-surgical fields

I appreciate the help as someone who is disability insurance naive.

 

[pgg]

Doesn't help you now, but maybe it'll help someone else -

The time to get a DI policy was while you were on AD, prior to separating and documenting every ache to milk the gov disability machine.

Mass Mutual will underwrite an own-occ DI policy at a reasonable rate, with a future insurability rider so you can crank it up without another round of exams and qualification, once you exit active duty. Other companies wouldn't touch active duty people - at least that was the case a few years ago.


What should you do now? If you have, or had, injuries or other problems, by all means see the VA about them. It won't make it impossible to get DI as a civilian, but it probably WILL mean all of those issues are line item excluded from a policy.

Anyway, don't be one of those ****s who pretends to have tinnitus to squeeze 5%, and then fakes OSA to squeeze a bit more, and then says ya know sometimes my back and knee hurt after a day spent shoveling gravel in my yard ...

 

[pawprint]

I’ve never understood why physicians are so into disability insurance. The statistic that gets floated around is that 1 in 7 doctors with disability insurance will end up filing a claim. I dunno, my personal opinion is that that means 86% of physicians who purchase disability insurance never end up using it. And I would guess that a lot of those are surgical specialities where an injury is more likely to impact your ability to work. As a primary care doctor, I think that statistic is pretty lousy. Others will disagree. I think we spend a LOT of time talking about it though. Almost every single one of my residency financial wellness lectures is on disability insurance.

In regards to VA claims, I also have an opinion that is probably unpopular. I think we pay out way too much money via that system. VA disability claims should only be used to:

1) establish service connected medical issues to guarantee medical care for those issues by the VA.
2) if a service member has a medical condition caused by their service that prevents them from working, only then should they be entitled to compensation. If you make a high enough taxable income, you don’t get paid by the VA.

I think it’s ridiculous that people get VA disability payments and then go on to work full time jobs. If you can work, the government shouldn’t be paying you money. If the government broke you enough that you can’t work, then it makes sense to compensate you.

Right now people are signing up to join the military with the intent on claiming VA disability after their 4 year enlistment. And I don’t blame them, if I knew that I could join the Air Force for 4 years as an IT specialist, then get out with the GI bill (free college for myself) and a monthly VA disability pension of up to $4k/month for the rest of my life, I’d strongly consider it too. All you have to do is put in a mental health claim as you are separating and say you suffer from daily ptsd symptoms and you’ll rate 70%+ without demonstrating any in service records. Happens all the time. And there are plenty of videos online that will walk you through how to claim things without any evidence.

At some point, the amount we are paying veterans becomes unsustainable. We need to focus on ensuring veterans have access to good healthcare, and only provide compensation if someone truly cannot work.

 

[comp1]

The above would be a truly massive overhaul to the VA system and would be completely untenable politically. Personally, I think we probably do a disservice by conceptualizing SC like it is identical to private disability insurance. In reality, it's an extremely politically popular social safety net that is highly utilized by people most often coming from some of the lowest socioeconomic strata (obviously not most people on this board). The individual cash benefits max out around $40k a year. It's not that different in amount from max SSDI, although obviously you don't need to have been a major earner to get SC. There are people who take inappropriate or even fraudulent advantage, no doubt, but I actually think society could benefit from extending parts of something like it to the civilian sector.
In terms of private disability insurance for physicians, I tend to agree that it's oversold in residency. I asked one of the peddlers if they had ever seen someone in my specialty file a claim and indeed they had not. I also tend to agree that it might be more appropriate for surgeons. Of course I'm extremely risk adverse, so I do have it.

 

[pawprint]

I totally agree that what I want would never happen 😂, it would not go over well politically.

The problem is that most people picture a “disabled veteran” as a 95 year old WWII veteran in a wheelchair, or a 80 year old Vietnam vet in a wheelchair.

What they don’t realize is that a large portion of people who receive VA disability compensation are people who have normal aging problems that get labeled as “service connected” (such as back pain, hypertension, sleep apnea), or have several minor conditions that aren’t truly disabling. Most never served in a combat zone. Many never deployed. I don’t think most of these people are actively being fraudulent, which is why the actual fraud numbers are low. But I do think there are a lot of people who have conditions that arent truly disabling and they file a claim because they know they can and who wouldn’t turn down the additional money if all you have to do is say something hurts?

The actual disability benefits for a 100% disabled veteran are substantial:
- $50,000/year, tax free. Equivalent to a $65k salary job
- free health care for you and your family (CHAMPVA covers your family. It max $3k/year OOP). This can be worth $20k/year with current health care costs.
- State benefits can include: exempt from property tax (this can be like $5-10k/year savings), free college for kids (this can be $200k/kid….huge benefit).

You could easily have the equivalent of full time job paying $90-100k/year depending on the state you are in. And this is just to exist…you aren’t required to make any appointments to check on these conditions or do anything. Sometimes the VA will reopen a claim and make a veteran attend appointments but it’s pretty rare unless a veteran activates a new claim.

 

[Barrel Proof]

In FY 2025, the total VA budget was about 5% of overall federal spending. Roughly 40–50% of the VA budget is disability compensation and related benefit payments. As a result, VA disability compensation accounts for approximately 2.5–3% of the total federal budget. It’s bonkers.

 

[DrMetal]

I’ve never understood why physicians are so into disability insurance. The statistic that gets floated around is that 1 in 7 doctors with disability insurance will end up filing a claim. I dunno, my personal opinion is that that means 86% of physicians who purchase disability insurance never end up using it.

Quite true. As with any kind of insurance, you always weigh the cost (of the premium) to benefit ratio. It costs me $50/year to insure my collections of guitars (collectively worth ~$25,000). It's worth it to me. Benefit (replacement if damaged or stolen) >> cost

Life insurance, usually cheap, with a big payout. Benefit >> cost

For DI, I was on the fence for a long time. Cost = benefit, maybe cost > benefit. So I opted not to partake. Have a lot in savings instead. DI is not the worst idea in the world, we spend money on much other crap (guitars, cars, golf). I wouldn't fault anyone for doing it. But I chose not to.

VA benefits? We don't know the half of it. The system is corrupt beyond our wildest nightmares. If you're on active duty and you commit a heinous crime and get hurt while doing it, you get the same VA disability as a soldier injured in an IED blast.

 

[MHYDE]

My dad was a physician who developed a disabling neurologic condition in his mid-50s and could no longer work in any capacity. He had let his DI lapse because, surprise, he neglected to pay the premium when his brain started to fail on him. I bought DI and put the payments on auto and told my wife and siblings about it too. I guess like anything else, we all value different things and spend our money accordingly.

 

[flightdoc09]

1. It might, it might not. When you get DI, you have to tell them everything you've seen a doctor about, and answer various health related questions regarding mental health and physical health and I think family history. That information goes into some big actuarial table and the insurance company determines what to charge you to make money and minimize their risk of losing money. If you document a rolled ankle that now is fine, then that probably won't count against you. But if you document a persistent limp and inability stand for long periods of time, that might.
2. I would get DI now, and then document everything. Remember that the big thing is to just "register the complaint." You don't have to act a fool and limp into the VA pretending to have debilitating back pack when really it's just occasional aches from a ruck march where you tweaked it. Later on, if it gets worse, it is on the record.
3. Not sure the question.

Regarding DI. It is emphasized in physician circles because we often live relatively lavish lifestyles, and start saving for retirement late in life. Many of us only start really saving in our mid-30's after paying off tons of debt (outside of HPSP), but we let our lifestyles grow much faster than our savings. So losing income could mean repossession of vehicles, home foreclosure, or worse. If you have tons of savings, a spouse that's earning, family that can bail you out, or assets you can sell, should something catastrophic happens, your need for DI is less. It's all about risk.

Regarding VA disability scams and corruption. I think it's a mixed bag. I definitely think that it is ridiculous how people try to game the system to get disability. When I see a LCpl with no deployments coming in with pages of claims, I just want to slap him. The VA has very specific criteria about what constitutes a valid claim.

But, I used to have really poor opinion of VA disability until one doc explained it to me this way. In the civilian world if your boss tells you to do something that can hurt you, or you don't want to do, you don't do it and quit. You don't have that option in the military. If you have to hike 20 miles with a pack on, you do it, even if it hurts. (or go to sick call and pretend you're hurt). But the military puts a lot of wear and tear on the body - at least in combat arms. It makes sense for the VA disability to compensate an individual for decreased function related to injuries, or just increased wear and tear. For example, maybe when you're young your knees are fine from carrying heavy loads in the field. But as you get older, that cartilage you partially wore through is now fully wearing through when you're 50 instead of when you're 70. The idea is that you're being compensated for decreased functional work ability later in life.

That being said, lots of things I don't understand about the system and the system needs reform. Disability in general, not just VA disability needs reform. More and more people in this country are going on some type of disability for, quite frankly, not disabling issues. Not sure if it's a function of aging populations, or people taking advantage of government bureaucracy and safety net programs, but it is unsustainable.

I got my DI before finishing residency, in my mid-30's, after my flight surgeon time. And definitely had some things I saw physical therapy for over the prior 7 years, and one thing I saw mental health for. I felt like it didn't make a difference on my DI premium.

 

[Apollyon]

I do VA disability exams as a subcontractor for the VAMC. I've never yet - in 3 years - had someone try to game me. In fact, even an officer didn't understand - this person has hardware in the foot that was eroding. That's what I examined. Then, this major complained that I only touched their foot. But, the majority have physical things, so I can test those. I don't do anything psych. I've case I recall was a person in the USAF in the 50s, who got malignant melanoma. And I found research that USAF members had a higher incidence of skin ca than the average public. However, I couldn't link this person's MM to service. That was a bummer. I knew it, but couldn't prove it.

So, if Seaman Timmy just separated, and complains about his knee, I just range it, according to the clearly written guidelines. Anyone who is trying for a rating has to encounter a doctor. Even if they found a sucker before, it's unlikely to find several. And, I found one medical officer's note that clearly outlined carpal tunnel syndrome, without actually saying those words, and didn't rx or recommend wrist splints (this person did computer work). He even had a positive Tinel's sign (which he said was "so cool" - I had to warn him not to elicit it, or he could damage his median nerve). Had this doctor (not a medic or IDC) just put splints on, this guy might not have gotten a rating.

And, as a bonus, I have met some of the finest people I might ever encounter. I also have learned a lot about intelligence gathering (nothing classified, of course).

 

[pawprint]

I do VA disability exams as a subcontractor for the VAMC. I've never yet - in 3 years - had someone try to game me. In fact, even an officer didn't understand - this person has hardware in the foot that was eroding. That's what I examined. Then, this major complained that I only touched their foot. But, the majority have physical things, so I can test those. I don't do anything psych. I've case I recall was a person in the USAF in the 50s, who got malignant melanoma. And I found research that USAF members had a higher incidence of skin ca than the average public. However, I couldn't link this person's MM to service. That was a bummer. I knew it, but couldn't prove it.

So, if Seaman Timmy just separated, and complains about his knee, I just range it, according to the clearly written guidelines. Anyone who is trying for a rating has to encounter a doctor. Even if they found a sucker before, it's unlikely to find several. And, I found one medical officer's note that clearly outlined carpal tunnel syndrome, without actually saying those words, and didn't rx or recommend wrist splints (this person did computer work). He even had a positive Tinel's sign (which he said was "so cool" - I had to warn him not to elicit it, or he could damage his median nerve). Had this doctor (not a medic or IDC) just put splints on, this guy might not have gotten a rating.

And, as a bonus, I have met some of the finest people I might ever encounter. I also have learned a lot about intelligence gathering (nothing classified, of course).

Cool, now here’s my stories:

I had a marine who was skateboarding in his kitchen and broke his ankle. Got rated 100% disability for it. Had nothing to do with his service and he was a terrible worker.

Had another marine who cried SI on deployment because he just wanted to go home about 2 weeks into it. Psychiatrist evaluated him and determined he was full of crap and was just looking for a way out. We sent him home anyway. Got promoted 6 months later. Never followed up on any psych appointments after that. Got rated 100% for mental health on his way out about a year later.

Another deployment example: had a marine fall out of a window at the barracks while intoxicated. Tore some stuff in his hip. Rated 100%.

I also spent a lot of time at my squadron just hanging out in the spaces and getting to know people. Most of the enlisted I worked with knew about VA disability and wanted me to help them get 100% when they got out so that they could get a paycheck the rest of their life. They never asked me to lie for them…just be lenient on my diagnosing (which I never did).

None of these folks committed fraud. They submitted stuff exactly the way the VA rates it. And that’s the problem. We shouldn’t be paying people a large sum of money + benefits for the things I described above…but we do because most people think of the type of person you are describing when they hear VA disability

 

[Apollyon]

Cool, now here’s my stories:

I had a marine who was skateboarding in his kitchen and broke his ankle. Got rated 100% disability for it. Had nothing to do with his service and he was a terrible worker.

Had another marine who cried SI on deployment because he just wanted to go home about 2 weeks into it. Psychiatrist evaluated him and determined he was full of crap and was just looking for a way out. We sent him home anyway. Got promoted 6 months later. Never followed up on any psych appointments after that. Got rated 100% for mental health on his way out about a year later.

Another deployment example: had a marine fall out of a window at the barracks while intoxicated. Tore some stuff in his hip. Rated 100%.

I also spent a lot of time at my squadron just hanging out in the spaces and getting to know people. Most of the enlisted I worked with knew about VA disability and wanted me to help them get 100% when they got out so that they could get a paycheck the rest of their life. They never asked me to lie for them…just be lenient on my diagnosing (which I never did).

None of these folks committed fraud. They submitted stuff exactly the way the VA rates it. And that’s the problem. We shouldn’t be paying people a large sum of money + benefits for the things I described above…but we do because most people think of the type of person you are describing when they hear VA disability

I copy all that. Whoever rated the guy 100% for SI got played. One thing is how we see it: I get them when things occurred on AD; no matter how foolish or bogus appearing, it is what it is. I don't see them at sick call.

Also, I remember the folks who were getting a legit screwing from the VA. The cheesy ones, PFC $hitbag types, I push out of my mind. They have been a few, but not the majority.

 

[flightdoc09]

I do VA disability exams as a subcontractor for the VAMC.

Getting off topic here, but have had a curiousity that I haven't gotten a great answer to in years. I'm no longer a GMO/FS, but still curious.

When someone comes in and wants to get something documented, let's say they spilled jet fuel on themselves, or got exposed to something at work. There's no medical workup/treatment indicated. Do they need to get seen in an appointment, or can you just put a T Con/note in the chart stating "patient claims they spilled jet fuel on themselves last night and would like to get it documented in case of future health issue." If they end up getting cancer or something, would that work? Or do they need an ICD10 in their chart at a formal encounter to show "exposure to chemical" or something like that?

Also, at the separation physical, people come in with 100 things listed that they never saw medical for. In my mind, unless something on their is life threatening (like, unexplained weight loss with blood in stool) I'm not doing any workup. As far as showing something existed prior to separation from the military, is that sufficient documentation? Or do they need to start seeing medical for everything in the months prior to separation?

For example, when I did an ENT rotation in residency there was a MSgt who got referred by his PCP to ENT because a decade earlier he broke his nose sparring, and it is now deviated. Didn't want any treatment or anything, just wanted it documented. Would it have been sufficient to just write on the separation physicial "broke nose, now crooked, from sparring back in 2014," should the PCM have simply asked if he wanted surgery or documentation, and noted it in the chart, or is it best to get ENT to be like "yep, patient has a crooked nose from remote trauma, declines surgery."

It sounds like anything claimed by the service member will get evaluated by the VA anyways, so no workup necessary unless indicated prior to discharge.

Also, does the service member need to individually claim stuff? Or does the VA look at the chart at a ratings exam and see that he went to PT for neck pain, or back pain, and ask the individual about all things that could count?

Thanks

 

[Apollyon]

Getting off topic here, but have had a curiousity that I haven't gotten a great answer to in years. I'm no longer a GMO/FS, but still curious.

When someone comes in and wants to get something documented, let's say they spilled jet fuel on themselves, or got exposed to something at work. There's no medical workup/treatment indicated. Do they need to get seen in an appointment, or can you just put a T Con/note in the chart stating "patient claims they spilled jet fuel on themselves last night and would like to get it documented in case of future health issue." If they end up getting cancer or something, would that work? Or do they need an ICD10 in their chart at a formal encounter to show "exposure to chemical" or something like that?

Also, at the separation physical, people come in with 100 things listed that they never saw medical for. In my mind, unless something on their is life threatening (like, unexplained weight loss with blood in stool) I'm not doing any workup. As far as showing something existed prior to separation from the military, is that sufficient documentation? Or do they need to start seeing medical for everything in the months prior to separation?

For example, when I did an ENT rotation in residency there was a MSgt who got referred by his PCP to ENT because a decade earlier he broke his nose sparring, and it is now deviated. Didn't want any treatment or anything, just wanted it documented. Would it have been sufficient to just write on the separation physicial "broke nose, now crooked, from sparring back in 2014," should the PCM have simply asked if he wanted surgery or documentation, and noted it in the chart, or is it best to get ENT to be like "yep, patient has a crooked nose from remote trauma, declines surgery."

It sounds like anything claimed by the service member will get evaluated by the VA anyways, so no workup necessary unless indicated prior to discharge.

Also, does the service member need to individually claim stuff? Or does the VA look at the chart at a ratings exam and see that he went to PT for neck pain, or back pain, and ask the individual about all things that could count?

Thanks

That is all outside of what I do. The claims are given to me to examine. They've already been entered. If a vet has another claim, I can't evaluate it. Also, I am diagnostic only - no treatment. I am not a PCM or AD - I am well after the fact civilian.

 

[Volatile]

There’s lots wrong with military medicine and some of it could be easily fixed. VA disability- come up with a salary # where if you’re making that you no longer receive disability payments, say $80k a year civilian pay. That eliminates all physicians from gaming the system. You can still get your VA care, just not the monthly payments.

Same thing with the outrageous number of physicians that make themselves not deployable. If you’re not deploying you don’t get your physician bonus, that bonus now gets divided among everyone that is deploying. If you’re not doing 100% of the job, you don’t get 100% of the salary. Of course none of this would pass.

 

[flightdoc09]

There’s lots wrong with military medicine and some of it could be easily fixed. VA disability- come up with a salary # where if you’re making that you no longer receive disability payments, say $80k a year civilian pay. That eliminates all physicians from gaming the system. You can still get your VA care, just not the monthly payments.

Same thing with the outrageous number of physicians that make themselves not deployable. If you’re not deploying you don’t get your physician bonus, that bonus now gets divided among everyone that is deploying. If you’re not doing 100% of the job, you don’t get 100% of the salary. Of course none of this would pass.

Yes and no. It makes sense that if you make a certain amount, you shouldn't need disability. But it goes back to what the disability is intended for. Is it to compensate you for your inability to make as much money due to the disability? Or to compensate you for decreased quality of life or limited functionality?

Like if I lose a finger, or develop hearing loss, or severe back pain, I may still be able to function as a high earning physician. But my quality of life will suffer. Does the military owe me for my decreased quality of life, even though I make over a certain number? Did someone who makes less than 80k deserve that compensation, but not someone that makes over that?

To be honest, I don't know. Disability has become a welfare system that is out of control - not just military disability, but civilian disability programs as well. The argument for the military disability is that a service member can't decline orders. But a civilian can just quit their job.

 

[pawprint]

Yes and no. It makes sense that if you make a certain amount, you shouldn't need disability. But it goes back to what the disability is intended for. Is it to compensate you for your inability to make as much money due to the disability? Or to compensate you for decreased quality of life or limited functionality?

Like if I lose a finger, or develop hearing loss, or severe back pain, I may still be able to function as a high earning physician. But my quality of life will suffer. Does the military owe me for my decreased quality of life, even though I make over a certain number? Did someone who makes less than 80k deserve that compensation, but not someone that makes over that?

To be honest, I don't know. Disability has become a welfare system that is out of control - not just military disability, but civilian disability programs as well. The argument for the military disability is that a service member can't decline orders. But a civilian can just quit their job.

I would argue that no, the military shouldn’t compensate you for “loss of quality of life”.

If you sign up to join the military, you should be responsible for assuming some level of risk knowing that you might develop chronic back pain if you fly helicopters. I don’t think it’s the taxpayers responsibility to compensate all our helicopter pilots indefinitely for developing back pain because they chose a career where they are known to develop back pain.

No other job works that way. workers comp doesn’t work that way even.

And there’s a balance there somewhere. I think if you get shot, I would argue that’s worth compensating. Yes, you signed up knowing that risk, but I think we should care for those who were injured in combat. But People who develop expected problems doing hard jobs that they signed up for? No.

 

[comp1]

It would be a very unique disability system if it compensated someone for a decreased quality of life as opposed to ability to work. I am not saying that is right or wrong, but it is not how disability coverage exists pretty much anywhere else and might be where some of the confusion comes from. It would kind of function more like a tort claim with some limited liability (~$50k a year) in that case.

 

[pgg]

It would be a very unique disability system if it compensated someone for a decreased quality of life as opposed to ability to work. I am not saying that is right or wrong, but it is not how disability coverage exists pretty much anywhere else and might be where some of the confusion comes from. It would kind of function more like a tort claim with some limited liability (~$50k a year) in that case.

Military disability IS a very unique system. For example, a hysterectomy is a permanent 50% disability rating.

I'm not saying that's right, or wrong, or that the percentage should be higher, or lower.

But that's more or less a perfect example of compensation for a decreased quality of life as opposed to ability to work.

Moreover, we can presume that the uterus was removed for a good reason, and so the overall benefit of the procedure was deemed to exceed its risks and negative consequences. A lot of hysterectomies are done for somewhat elective reasons, aiming at improving overall quality of life. Does it make sense for a disability policy to pay someone whose quality of life has improved, who can also continue to work ... but NOT pay for the decreased quality of life she suffered prior to the hysterectomy?

Should it matter (in terms of disability claim payout) if the hysterectomy was for postpartum hemorrhage in a 28 yo woman who wanted to have more children, vs a hysterectomy that cured a 48 yo woman's endometrial cancer?


Oooooor maybe we should just leave these kinds of questions out of the hands of insurance actuaries and beancounters and very concerned taxpayers, and have a simple system with simple fixed payouts for simply-specified conditions/injuries. Even if it means some undeserving people get some free cheese.

 

[flightdoc09]

I would argue that no, the military shouldn’t compensate you for “loss of quality of life”.

If you sign up to join the military, you should be responsible for assuming some level of risk knowing that you might develop chronic back pain if you fly helicopters. I don’t think it’s the taxpayers responsibility to compensate all our helicopter pilots indefinitely for developing back pain because they chose a career where they are known to develop back pain.

No other job works that way. workers comp doesn’t work that way even.

And there’s a balance there somewhere. I think if you get shot, I would argue that’s worth compensating. Yes, you signed up knowing that risk, but I think we should care for those who were injured in combat. But People who develop expected problems doing hard jobs that they signed up for? No.

Yeah, I used to think like that too. And I think there has to be a balance. If you're an infantryman, you have to ruck heavy weights. And often you have to do so even when you're already hurting. You can't call in sick (even though many try).

In some respect there are known hazards, but no one becomes a helo pilot thinking they'll get debilitating back pain. Some want to be C130 pilots, or F18, and end up flying small helos with horrible vibration and small cockpits that cause long term pain and issues.

And then sometimes accidents happen. Had a marine a few months ago who lost half a finger when someone released a vehicle brake at the wrong time and it smushed his finger.

The intent of disability should be to compensate you for potential loss of future income. If you're a young marine mechanic that lost half a finger, that could be a huge issue to future income. If you're a radiologist that lost half a finger, you can probably scroll and push the dragon button with another finger. I'm not sure the radiologist shouldn't get anything because they make more money.

I think the system is broke and full of abuse. Definitely needs reform. There's probably a middle ground somewhere that fairly compensates people for injuries without making it into a welfare system.