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    soldier on guard in the night

    The Disability Ratings Game

    An Army officer returns from Afghanistan as a double amputee.

    By Daniel M. Gade and Daniel Xin Huang

    December 1, 2021
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    • SFC (ret) LLoyd A. Conway

      This story is incorrect on one important point: Sleep Apnea can be rated as high as 50%, if a veteran is prescribed a CPAP or similar device as necessary for treating the condition, and sleep apnea has to be service-connected, which means something happened in uniform - burn pit exposure, onset of chronic allergies or sinus infections, etc., that triggered it. Many sleep apnea claims rate 0% or 30%, so it's not quite the easy-money bonanza the author alleges. A search for the VA rating tables will confirm what is stated above.

    They knew the bombs were there. Earlier in the day, a raid camera had filmed four suspected Taliban fighters sitting in a trench beside a cemetery. In the footage, one of the combatants walked out into the open road and took a knee. After a few minutes, he returned to his position.

    Tyson Quink’s field artillery platoon had been trained on the enemy’s tactics. The Taliban had great patience. They liked to plant IEDs (improvised explosive devices) in the ground, then find cover nearby. They liked to sit and wait, for hours if they had to, until they saw American soldiers approaching. That’s when they attached the battery, when the trigger hit the charge, when things went boom.

    Tyson was in charge of the third platoon. His guys had already gone out that day, a breezy morning patrol in which they went to a local village and interviewed some locals about nearby drug routes and enemy activity. While second platoon went out to interdict the enemy team, third platoon kept watch and later moved to establish a blocking position down the road.

    Second platoon didn’t find the enemy team; in typical fashion the enemy had fled immediately. But they had uncovered three IEDs. Better yet, they had detained two suspected combatants and now they needed replacements so they could bring the captives in. Tyson and his platoon continued their second mission of the day, moving to relieve second platoon.

    It was June 2011, his third month in Afghanistan on his first deployment. Two years earlier, he had graduated from West Point. Growing up in the San Francisco Bay Area, he had never heard of the legendary United States Military Academy at West Point or ever considered joining the armed forces. Then one day during his senior year, he got a phone call. It was a college football coach on the line with a question: Did he want to keep playing football?

    “Yes,” Tyson said. Ever since he was little, tossing a football around with the neighborhood kids, the sport had been the one constant in his life.

    The coach went on: Did he want to keep competing, keep pushing himself mentally and physically beyond his own limits?

    “Yes,” Tyson said.

    Finally, the coach asked: Was he willing to come out east?

    “Yes,” Tyson said.

    He took to the turf as an Army Black Knight.

    Four seasons later he had six months left of school and sixty pounds to shed from his playing weight in order to graduate. Offensive linemen aren’t usually worried about cutting down. They’re wired to bulk up. But just as Tyson knew to hit the books for his final exams, he hit the cardio room to slim down, and while his full dress gray still felt a little tight on commencement day, he strode across the stage and received his diploma, beaming.

    Life at West Point had been a nonstop juggle between academics and football, with little energy left to consider what came next. Reminders of the sacred duty that awaited, however, were everywhere. “You’re surrounded by it,” Tyson said. “Most of your teachers are military. All your leadership have combat deployments. Their job is to train you so you can leave.” Reminders also came in the form of casualty rolls reported on TV, or the latest military operations launched from the halls of Washington. They came as announcements through the mess hall loudspeakers, names of West Point grads killed or wounded in combat as cadets spooned down their cereal for breakfast. Most times, the names weren’t familiar. Sometimes they were. Following the roll there would always be a moment of silence, and following the silence there would always be a mood that might last the rest of the day, might linger for several days, but eventually Tyson had to get back to studying and training, back to the balancing act of Division I student athletics. Back then the other stuff was easier to compartmentalize. The other stuff happened to soldiers, people who went to war. He was there to win football games.

    All of that had now changed. As soon as he graduated, Tyson was no longer a student. He was no longer a Black Knight, either, no longer stationed at the edge of the O-line, his job to flank the guards and shield the quarterback. Soon, he was at Basic Officer Leadership Course, getting pushed beyond anything he had known on what General Douglas MacArthur had once called “the fields of friendly strife.” Then he was meeting his platoon at Fort Drum, getting to know the men he would lead, and not long after that, he was sitting with them inside a transport aircraft, getting dropped off in Afghanistan. Now he was strapping on his gear in Kandahar, about to lead twenty-six soldiers into the cold, dark night.

    They arrived at a vineyard; blankets of twisting leaves spread across dirt-packed mounds. Someone gave a shout. Two guys from the second platoon had discovered another IED. Tyson made his way over and someone from his platoon joined him. Then they stopped. A path cut out in front of them, a little too clean not to be suspicious. Tyson decided to send someone down with a metal detector.

    It was nine in the evening, no moon in the sky. Flashlight beams swiveled through the air like swords. Tyson propped his night vision goggles over his helmet then took one step back to give the order. He heard something click beneath his foot. “Oh shit,” he whispered, and the partial darkness turned into complete, infinite black.

    Tyson didn’t feel the blast because he didn’t feel anything – in an instant he had lost all sensation in his body. He couldn’t see, couldn’t hear, couldn’t feel. Somewhere in the infinite blackness, he heard his own voice. “What the f--k?”

    Then he heard himself say, “I’m f--king dead.”

    The thought played on loop.

    “I’m f--king dead. I’m f--king dead. I can’t believe I’m f--king dead.”

    A moment later: “Man, you can talk to yourself for eternity? This f--king sucks.”

    Eternity lasted for about three seconds. Then his vision came back, the world returned, and he was back in the vineyard again, lying flat on his back. Debris was falling everywhere.

    Tyson lifted his head and saw that his right foot was gone. He could only see the jagged edge, bone white as milk. His left leg lay hidden from his view beneath a shredded pant leg. But the sensation in his body had returned. “It felt like I was standing in a fire,” he remembered.

    He yelled. No one came.

    He yelled again and still nothing, and after a few breaths, it occurred to him why. Surely there were still more IEDs in the ground, still more buried parcels of shells and shrapnel waiting to cut him and his men into still smaller pieces. It would do no good for anyone to come charging in and set off another. Once Tyson understood this reality, he felt a sense of calm. He had a team of soldiers behind him and they had been expressly trained for situations like this. They would know what to do.

    Tyson unbuckled his helmet and removed his eyewear. He took off his gloves. Then he put the items in his helmet and put his hands on his chest. And then he waited.

    Eventually, one of Tyson’s squad leaders crawled up next to him. He tried to put a tourniquet on Tyson’s legs but wasn’t able to – the explosion had thrown him into a wall, rattling his brain and giving him a severe concussion. Two other soldiers were wounded. One had been knocked out cold; the other suffered a severed ear and wounds to both arms.

    After they cleared the area, the medics began tending to the wounded. The medevac helicopter arrived and Tyson, who had caught the worst of the blast, was carried onboard. Inside the Black Hawk, the wounded men huddled, heads in their hands as if to keep their brains from shaking.

    In the air the medics kept working on Tyson’s legs. He was conscious for every second of it, the pain so intense he thought he was becoming delirious. When the helicopter touched back down at Kandahar Airfield, he was lifted onto a stretcher and rushed inside the hospital. Suddenly a doctor’s face was hovering over him, blocking out the ceiling lights. The doctor’s mouth was moving, asking where it hurt and what he could feel, while Tyson tried to stay engaged, stay alive. Then halfway down the hallway, he blinked, and his body shut down.

    Tyson woke up in Walter Reed Army Hospital. For several days after the blast, he had drifted in and out of consciousness. Medics flew him from Kandahar to Bagram Airfield, just north of Kabul, then to Landstuhl in Germany for more treatment. Most of his waking moments blurred into a scramble, but a few snapshots lingered in his mind. On one of his flights, he woke up just long enough to register an intense craving for watermelon. Other times his eyes flicked open to gauge the Sharpie marks on his blood infusion bags, the black notch sinking every hour, red liquid flowing back into his body.

    He sat up in his room and took in the scene around him. Troop levels in Afghanistan had peaked in 2011, and it was reflected in the capacity of the medical facilities back home. For his first few nights at Walter Reed, Tyson had been assigned to the intensive care unit, which was quickly filling with so many injured and wounded that the only available beds were in the wing for treating brain injuries. He had been to the hospital one time before, the previous October for an eye surgery before his deployment. A man had limped by on a prosthetic leg. He was holding a spare prosthetic in his hands. Tyson remembered thinking, “Man, that would be so terrible if it happened.”

    soldier on guard in the night

    Photograph by Sgt. Matthew Freire (public domain)

    It happened. At first, all he could do was lie in bed, too exhausted to even watch television. Medical personnel filed in and out in a constant stream, cleaning out his wounds, removing dead tissue, cutting away the parts of him that were succumbing to infection. Fifteen surgeries in total – every Monday, Wednesday, Friday for three weeks. Three weeks of feeling a little bit better on Sunday, then wiped back down to nothing on Monday. Feeling better on Tuesday, wiped out on Wednesday; better Thursday, wiped again Friday.

    “The first few weeks you’re just exhausted,” he said. “I didn’t even have time or energy to process what the future was going to be.”

    It finally started to sink in when they brought in his wheelchair. “Man, this is absolutely miserable,” Tyson thought. The chair was stiff and painful, invasive in all the wrong places. His center of gravity had shifted with the amputations and all his movements felt wrong, too much or too little, a far cry from the precision he took for granted as an athlete and soldier. Even getting through doors was a challenge; he had to depend on the medical staff for the most basic tasks. “That was the hardest part,” he said. “You go from being in charge of all these people – all these life and death decisions you make – to being 100 percent dependent on everybody else.”

    On the Fourth of July, a hospital aide wheeled him outside to watch the fireworks. It was his first time outside since arriving at Walter Reed in critical condition a few weeks earlier. Bright flashes lit the sky and the celebratory night should have been a moment of triumph, but Tyson felt uncomfortable, angry, lost. He was still young – only twenty-five years old. He hadn’t planned on staying in the military forever, but like many young soldiers, he would have gone to hell and back for the guys around him, and his goal had been to one day make battery command.

    Now he was a wounded combat vet, a double below-knee amputee. In his better moments, he was thankful to be alive. Most times, though, it was other thoughts that overwhelmed him.

    How did this happen to me?

    What will happen now?

    What the hell is my life going to be?

    One of his first hurdles would be the evaluation process for translating his injuries into disability status. A few weeks after Tyson arrived at Walter Reed, a nurse case manager sat down with him to explain the military’s medical board procedure. After sustaining an injury or illness, all soldiers are given a window of time to stabilize, and to see if they can rehabilitate and return to duty.

    As Tyson started making progress in rehab, chatter about the medical board and disability process became a prevalent theme in the conversations around him. Whether sitting in physical therapy or having lunch in the dining facility, discussions in the Warrior Transition Unit (WTU) invariably turned to the disability ratings system. Tyson reported, “People would say, ‘Oh, you got to claim everything. When you go to meet the doctor, tell them you have these issues.’”

    The motivations to secure a high rating, Tyson learned, were primarily financial. Service members determined by the Physical Evaluation Board (PEB) to be no longer fit for duty must begin their separation from the military. After getting discharged, they plug into the VA benefits system. Disability ratings are determined by the VA in increments of 10 percent, from 0 to 100, with each score corresponding to a different amount in monthly benefits. (A 100 percent disability rating equates to tax-free compensation of more than $3,000 each month.) Veterans receive an individual rating for each disability they list when filing their claims, combined at the end to calculate their total disability rating. In the WTU, trafficking tips on the easiest conditions to claim, and how best to sound convincing, were “rampant,” Tyson said.

    He went on, “Someone would say, ‘Oh yeah, they can’t really check for PTSD so put that down.’ Or, ‘Tell them you have hearing issues.’ All the [conditions] that are more difficult to track, not the physical wounds that you can see.” Claims approved for tinnitus, or ringing in the ears, could be rated up to 10 percent, while sleep apnea, another common diagnosis, with little, if any, plausible connection to military service, carried a rating of 50 percent, paying out roughly $1,000 each month, in addition to free lifetime medical care and other valuable benefits.

    Tyson’s initial reaction was disbelief. “I was like, ‘This is crazy! Just put down what you have.’” Double-amputees presented a straightforward profile; the schedule typically considered them at 100 percent disability. It made no sense to Tyson that others would spend so much time and energy trying to exaggerate their conditions. He observed that many of the patients hatching schemes had not even served in combat roles, a distinction long noted by soldiers at the front lines. The military historian Paul Fussell wrote of soldiers in World War II: “Those who actually fought on the line in the war, especially if they were wounded, constitute an in-group forever separate from those who did not. Praise or blame does not attach: rather, there is the accidental possession of a special empirical knowledge, a feeling of a mysterious shared ironic awareness manifesting itself in an instinctive skepticism about pretension, public enunciated truths, and the pomp of authority.” Tyson could relate to the skepticism as he watched the gaming of the system.

    Soon he encountered stories that expanded his view, forcing him to question the VA schedule’s basic logic. One soldier’s case became a widely cited cautionary tale. “There was a guy there who was a single below-knee amputee. He got a super low rating and tried to fight it,” Tyson recounted. But the only condition the other soldier had claimed was his amputation. “If you look at the schedule, he got the maximum he could for that injury.” According to the VA ratings handbook, a single below-knee amputation qualifies for a 40 percent rating, scoring lower than sleep apnea.

    It was clear to Tyson that some soldiers viewed their disability evaluation with a sense of entitlement, an attitude of I need to get as much compensation as I can. But even for those who approached the process earnestly, it could feel like if there was one slip in the system, you quickly got screwed. “I can see how people get frustrated,” he said. One soldier loses a leg in combat and receives a 40 percent disability rating, qualifying him for monthly benefits of $700. Another cites a couple lines about irregular sleep and gets rated at 50 percent. Suddenly the VA is paying him a grand or more every month.

    “How are those comparable?” Tyson wondered. “It just doesn’t look right.”

    Soon Tyson’s nurse case manager was urging him to start the medical board phase for himself. Alarm bells went off. He had heard that service members going through the Integrated Disability Evaluation System (IDES) couldn’t leave their WTU until they had completed the whole procedure. Officially, IDES aimed to process soldiers through the evaluation boards in under 220 days, but the reality often fell far short of the targets. The possibility of being stuck at Walter Reed for months terrified Tyson. One guy, he heard, had been there for three years.

    Tyson knew that if he was to have a shot at the kind of recovery he wished for, he had to get out of the WTU. He had to be in a place where others were pushing him to excel again, not where those around him were emphasizing their impairment, conspiring to raise their disability percentages. “I knew I didn’t want to be there,” he said.

    He filed a petition to transfer back to West Point and requested to delay his med board phase until he had gotten out of Walter Reed. Then, like so many recovering service members anxiously anticipating their future, he waited for the bureaucracy to determine his fate.


    From Wounding Warriors: How Bad Policy Is Making Veterans Sicker and Poorer by Daniel M. Gade and Daniel Xin Huang

    Contributed By

    Daniel M. Gade is a retired Army lieutenant colonel. He was wounded in combat in Iraq twice, losing his entire right leg, and decorated for valor. He has been a consistent advocate for positive change to the VA system that will result in better outcomes for our warfighters.

    Contributed By

    Daniel Xin Huang is a freelance journalist based in Washington, DC. He previously worked as a staff reporter for the Wall Street Journal, where he covered finance and veterans issues. Since 2016, Daniel has lived and reported from across Asia, the Middle East, and the United States.

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