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MICHELE NORRIS, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.

ROBERT SIEGEL, host:

I'm Robert Siegel.

And we start this hour with an important question facing members of the armed services who are injured in Iraq or Afghanistan. How does the military decide if a veteran is disabled, and what determines a vet's level of disability?

NORRIS: Men and women who leave military service because of injuries or other illness go through a bewildering system to get health and disability benefits. Sometimes their health care even gets cut off when they need it most. Some retired soldiers and their families worry that the Pentagon won't spend enough money to give veterans the care they deserve.

NPR's Joseph Shapiro reports.

JOSEPH SHAPIRO: On this much everyone agrees. Tim Ngo almost died in a grenade attack in Iraq. Surgeons had to cut out part of his skull. At Walter Reed Army Hospital in Washington, he learned to walk and talk again. When he got back home to Minnesota, he wore a white plastic helmet to protect the thinned-out patches of his skull.

People on the streets snickered, so Tim Ngo's mother took a black marker and wrote on the helmet: U.S. Army back from Iraq. Here is the part where there is dispute. The Army says Sergeant Ngo is just 10 percent disabled.

Sergeant TIM NGO (Retired, U.S. Army): I was hoping that I'd get at least 50 or 60 or 70 percent, but they said, yeah, you're only going to get 10 percent. And I'm thinking, okay. And I was pretty outraged.

SHAPIRO: Outraged because when a service member is retired for medical reasons, that disability rating makes a difference. If Tim Ngo had been rated 30 percent disabled or higher, he would've gotten a monthly disability check instead of a small severance check, and Tim Ngo would've stayed in the military's health care system.

Instead, he enrolled with the Department of Veterans Affairs. Typically there's a waiting period for the VA. Last October, while Tim Ngo had no insurance, he got rushed to the nearest emergency room.

Sgt. NGO: I was outside and I looked to the backyard and then I blacked out.

SHAPIRO: He had a seizure caused by his war injury. He fell to the ground on the driveway.

Sgt. NGO: My girlfriend was freaking out because she didn't know what to do. She didn't know if I was going to die because I had hit the wrong side of my head.

SHAPIRO: An ambulance took him to the ER for treatment. The cost to Tim Ngo -$10,000.

Sgt. NGO: It's still not resolved. It's still not resolved. The bills are not resolved yet.

SHAPIRO: Since that day, Ngo has gotten health coverage through the VA. And earlier this month, the VA said it would pick up his leftover bills from the ER. The VA has been more generous all around. It rated Tim Ngo 100 percent disabled, not the 10 percent the Army says. The VA gives him a monthly disability check. That helps. With his head injury and posttraumatic stress disorder, Ngo has been unable to hold on to even a simple job since coming home. Hong Wyberg is Tim Ngo's mother. She thinks she knows why the Army gives soldiers like her son low disability ratings.

Ms. HONG WYBERG: To save money. I don't fully think that they were prepared for the length of time this war is going to last, and they didn't realize how much injuries or, you know, the types of injuries that were going to come out of this.

SHAPIRO: Michael Parker thinks her suspicion is correct.

Lieutenant Colonel MICHAEL PARKER (Retired, U.S. Army): The more I look into it, the more I realized that system did not have soldiers' back at all.

SHAPIRO: Parker was a lieutenant colonel when he retired from the Army last October. He has a disabling condition similar to rheumatoid arthritis. Parker got the Pentagon's lifelong health coverage; that's because he'd been in the military long enough - for at least 20 years. But he wanted to help other soldiers who didn't do so well.

He started digging through Pentagon data, and the numbers shocked him. Parker says the Pentagon is giving fewer veterans disability retirement benefits now than before the Iraq War.

Lt. Col. PARKER: It went from 102,000 and change in 2001 timeframe. And now it's down to eighty-nine-five. Well, it's counter-intuitive. Why are the number of disability retirees shrinking during wartime?

SHAPIRO: That's the kind of question that came up at a Senate hearing last week. Retired Army Lieutenant General James Terry Scott heads a commission set up by Congress to study veterans disability benefits. Scott said his commission compared the way the Pentagon and the VA rated the same soldiers.

Lieutenant General JAMES TERRY SCOTT (Retired, U.S. Army): To cite an example, those rated zero, 10 or 20 percent by DOD were rated in the 30 to 100 percent range by VA more than half of the time.

SHAPIRO: In other words, troops often get small disability checks and no military health care when rated by the Pentagon's disability boards, but then go to a VA board with the same injuries and get much more. Scott said one reason is that the military's ratings determine if a person is fit for duty. The VA will accept all conditions that create health problems for a veteran, so the VA ends up rating more disabilities per retired service member.

But Scott said another reason may be that the Pentagon wants to keep down its costs. Deputy Defense Secretary Gordon England told the senators that wasn't the case.

Mr. GORDON ENGLAND (Deputy Defense Secretary): I can tell you, there's no incentive to do that, Senator. I mean maybe that's read into it. But I can tell you, we try to treat people fairly and accurately. So there's certainly no incentive.

SHAPIRO: Pentagon officials did concede that the disability system doesn't work as well as it should; that it's too bureaucratic and too often adversarial. They said they'll listen to several study groups making suggestions for change. But change in the future will come too late for many soldiers like April Croft. She was serving in Afghanistan when she was diagnosed with leukemia. She was treated for a year at Walter Reed Army Medical Center. The cancer seemed to go into remission and she was sent home. Mark Croft is her husband.

Mr. MARK CROFT: They told her that she was only eligible for a 10 percent rating for disability with the illness of leukemia. She was livid. She's actually contested that situation about three times already.

SHAPIRO: The Army never increased its 10 percent rating, but the VA rated her 100 percent disabled.

Mr. CROFT: Right now she's writing me messages.

SHAPIRO: Croft spoke from his wife's room in the VA hospital in Seattle, where she recently got a bone marrow transplant.

Mr. CROFT: She has written here that the VA originally gave her 50 percent and upped it to 100 percent once I got - once she got sicker.

SHAPIRO: The VA provided the life-saving operation she needed. But the low rating from the Army still mattered, because April Croft has two young children living with their grandparents in California. The VA only covers veterans, not their families. The military health care system will insure an entire family, but only if April Croft had gotten that disability rating of 30 percent or more.

The kids eventually did get military health care, but just recently, because their mother married Mark Croft, who's still in the Army.

Mr. CROFT: We got married on March the 17th? It was earlier than that. That's amazing.

SHAPIRO: Forgive him for having to ask his wife for the exact date. It's been a crazy couple months for the Crofts. They got married in Reno. Then he flew back to his Army base in Kansas; got leave from the Army; drove his pickup truck back West to his wife; and instead of a honeymoon, they drove to Seattle and checked into the hospital.

It's the kind of complicated arrangements that many veterans go through to make their way through the military's complicated disability system.

Joseph Shapiro, NPR News, Washington.

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