America owes military veterans a lot – perhaps enough to fudge their death certificates a little.
Most medical examiners have been asked by the next of kin of a deceased veteran to put a disease or condition on the death certificate that will entitle them to benefits. Examples include:
Add Parkinson’s disease to the death certificate of a veteran whose cause of death was coronary heart disease.Add post-traumatic stress disorder to the certificate of a veteran who died from a heroin overdose because the family blames the deceased’s drug abuse on military-related stress.A fair number of families claim they were told by the Veterans Administration that the benefit they believe they are entitled to will not be initiated or continued unless the relevant condition appears on the death certificate. I’ve heard this is sometimes the case even when benefits were paid before the veteran died – VA doctors were treating the condition and death has no bearing on payments to families.
This seems nuts. Perhaps some VA representatives are eager to avoid paperwork. Perhaps general bureaucratic idiocy is to blame. Whatever the reason, so many families report similar experiences with VA recalcitrance that it’s impossible to dismiss them as misunderstandings.
Scientifically, some family requests make no sense. For instance, if a veteran is run over by a truck, the fact that he or she had a condition associated with exposure to Agent Orange or an Iraqi burn pit is irrelevant.
All medical examiners are occasionally asked to change a certification from suicide to accident or to list a recent minor injury as contributory to a natural death so the family can collect insurance money. We routinely deny such requests – many of which differ little from requests made by veterans’ families.
Most medical examiners view the lengthy list of diseases said to be caused by Agent Orange with skepticism. Since these diseases also afflict people who never served in the military and were never exposed to Agent Orange, it’s clear that other genetic and environmental factors trigger the diseases, too. Who knows whether Agent Orange played any role in a specific case, particularly when exposure is minimal or questionable.
The government presumes that all service members who were in Korea or Vietnam during a years-long time period, including those who served on naval vessels in the vicinity, were exposed to Agent Orange – far from a scientific or medical standard for confirming exposure and causation.
Even if the association is valid, the VA is the custodian of military service records, and it’s like pulling teeth to get them. So medical examiners feel scapegoated. Why should we be required to attest to information the VA already has and doesn’t readily share?
On the other hand, death certificates serve more than one purpose. Medical examiners view them as a scientific statement of the cause of death, but they also play an important role in legal and societal transactions.
We readily accept family accounts of medical history when out-of-state medical records are difficult or impossible to obtain, so why not accept the statements of veterans’ families when service records aren’t available?
If the government has decided by fiat that all soldiers in or near a given theater have been exposed to X and that exposure to X causes Y, perhaps medical examiners should just go along with the presumption if that’s what it takes to wring survivor benefits out of the VA.
Or maybe we should stick to our medical and scientific principles.
Dr. Carol J. Huser, a forensic pathologist, served as La Plata County from 2003-12. She now lives in Florida and Maryland. Reach her at firstname.lastname@example.org.