Tagged: Veterans Affairs

Travel Expense Reimbursement for VA Visits

Posted by Debi Teter
travel-cost-to-VA-reimbursedAccording the Census Bureau, there are 21.8 million veterans of the U.S. armed forces as of 2014. Unfortunately, most of those veterans do not live within a few city blocks of a VA center. So when faced with getting to a center for care, they wonder if there’s a way to have that cost covered. Travel costs can be reimbursed. Here’s the lowdown…   Eligible veterans may be provided mileage reimbursement or, when medically indicated, special mode transport (e.g. wheelchair van, ambulance) when traveling for approved VA medical care. Mileage reimbursement is 41.5 cents per mile and is subject to a deductible of $3 for each one-way trip and $6 for a round trip; with a maximum deductible of $18 or the amount after six one-way trips (whichever occurs first) per calendar month. The deductible may be waived when travel is in relation to a VA compensation or pension examination; travel is by special mode; or when imposition would cause a severe financial hardship. Eligibility The following are eligible for VA travel reimbursement:
  • Veterans rated 30 percent or more service-connected.
  • Veterans traveling for treatment of service-connected conditions.
  • Veterans who receive a VA pension.
  • Veterans traveling for scheduled compensation or pension examinations.
  • Veterans whose income does not exceed the maximum annual VA pension rate.
  • Veterans in certain emergency situations.
  • A veteran whose medical condition requires a special mode of transportation and travel is pre-authorized. (Advanced authorization is not required in an emergency and a delay would be hazardous to life or health).
  • Certain non-Veterans when related to care of a Veteran (Caregivers, attendants & donors).
Beneficiary travel fraud can take money out of the pockets of deserving Veterans. Inappropriate uses of beneficiary travel benefits include: incorrect addresses provided resulting in increased mileage; driving/riding together and making separate claims; and taking no cost transportation, such as DAV, and making claims. Veterans making false statements for beneficiary travel reimbursement may be prosecuted under applicable laws.

How to File a Claim for Non-VA Care

Posted by Debi Teter
militaryauthority.com_file-a-nonVA-care-claimThe VA may authorize veterans to receive care at a non-VA health care facility when the needed services are not available at the VA health care facility, or when the veteran is unable to travel the distance to the VA health care facility, or in the case of an emergency. Non-VA care must be authorized by VA in advance. Veterans may also obtain services not covered in the benefits package through private health care providers at their own expense. In limited circumstances, VA may authorize payment for health care services outside a VA Medical Center. Payment for care outside VA is governed by strict federal regulations; service-connected disability rating is the basic criteria for most authorized care outside a VA facility. Contact your local VA health care facility’s Fee Basis office or the Health Benefits Services Call Center at 1-877-222-VETS (8387) for additional information. Payment decisions are based upon eligibility criteria, medical necessity, and availability of the service within the VA HealthCare system. A veteran may always submit a claim for payment consideration. How to File a Claim for Preauthorized Non-VA Provided Care Claims submitted for payment consideration of costs of preauthorized medical services provided to veterans must include a completed CMS 1500 and/or UB-04 billing forms to include, at a minimum the following information:
  • Full name (include middle initial)
  • Full address (include zip code)
  • Patient Full Social Security Number
  • Full name of provider
  • National Provider Identifier (NPI) Number
  • Provider taxonomy code(s), if known
  • Tax Identification Number (TIN/EIN)
  • Professional Status of Provider (ex. MD, PhD, CRNA, etc.)
  • Physical address where care was provided
  • Mailing address where payment should be sent
  • All appropriate medical coding
  • Any other health insurance information
Note: If you are requesting reimbursement for bills you’ve paid “out-of-pocket”, you must have the claims information listed above, as well as receipts (cash, check, or credit card) clearly acknowledging payment made for specific medical care and services Claims for payments for your health care should be submitted to the Fee Department of the VA facility that authorized payment of care in advance. If you are not sure if VA authorized payment of care in advance, you may submit health care claims to the nearest VA Medical Center Fee Department. Please keep copies of all documents submitted to the Fee Office.

Mental Health Care for Veterans

Posted by Debi Teter
PTSD and veterans mental healthVeterans eligible for VA medical care may apply for general mental health treatment including specialty services such as Post Traumatic Stress Disorder and substance abuse treatment. Contact the nearest VA health care facility to apply. VA’s Comprehensive Assistance for Family Caregivers Program entitles the designated Family Caregiver access to mental health. These services may be offered at the VA and/or contracted agencies. General Caregivers (of all era Veterans) can receive counseling and other services when necessary if the treatment supports the Veteran’s treatment plan. For more information on VA Mental Health services visit the VA website.

Suicide Prevention Hotline

Veterans experiencing an emotional distress/crisis or who need to talk to a trained mental health professional may call the Veterans Crisis Line lifeline 1-800-273-TALK (8255). The hotline is available 24 hours a day, seven days a week. When callers press “1”, they are immediately connected with a qualified and caring provider who can help. Chat feature: Veterans Chat is located at the Veterans Crisis Line and enables Veterans, their families and friends to go online where they can anonymously chat with a trained VA counselor. Veterans Chat can be accessed through the suicide prevention Website www.Veterancrisisline.net by clicking on the Veterans Chat tab on the right side of the Webpage. Text feature: Those in crisis may text 83-8255 free of charge to receive confidential, personal and immediate support. European access: Veterans and members of the military community in Europe may now receive free, confidential support from the European Military Crisis Line, a new initiative recently launched by VA. Callers in Europe may dial 0800-1273-8255 or DSN 118 to receive confidential support from responders at the Veterans Crisis Line in the U.S. For more information about VA’s suicide prevention program visit: www.mentalhealth.va.gov/VAMentalHealthGroup.asp Make the Connection Resources: help Veterans and their family members connect with information and services to improve their lives. Visitors to MakeTheConnection.net will find a one-stop resource where Veterans and their family and friends can privately explore information, watch stories similar to their own, research content on mental health issues and treatment, and easily access support and information that will help them live more fulfilling lives. At the heart of Make the Connection are powerful personal testimonials, which illustrate true stories of Veterans who faced life events, experiences, physical injuries or psychological symptoms; reached out for support; and found ways to overcome their challenges. Veterans and their families are encouraged to “make the connection” – with strength and resilience of Veterans like themselves, with other people who care, and with information and available resources for getting their lives on a better track. For more information, go to: www.MakeTheConnection.net Coaching Into Care: works with family members or friends who become aware of the Veteran’s post-deployment difficulties, and supports their efforts to find help for the Veteran. This national clinical service provides information and help to Veterans and the loved ones who are concerned about them. More information about the service can be found at www.mirecc.va.gov/coaching/contact.asp. VA’s National Center for PTSD serves as a resource for healthcare professionals, Veterans and families. Information, self-help resources, and other helpful information can be found at www.ptsd.va.gov. The PTSD Coach is a mobile application that provides information about PTSD, self assessment and symptom management tools and provides information about to connect with resources that are available for those who might be dealing with post trauma effects. The PTSD Coach is available as a free download for iPhone or Android devices.

Mental Health Residential Rehabilitation

Mental Health Residential Rehabilitation Treatment Programs (MH RRTP) (including domiciliaries) provide residential rehabilitative and clinical care to Veterans who have a wide range of problems, illnesses, or rehabilitative care needs which can be medical, psychiatric, substance use, homelessness, vocational, educational, or social. The MH RRTP provides a 24-hour therapeutic setting utilizing a peer and professional support environment. The programs provide a strong emphasis on psychosocial rehabilitation and recovery services that instill personal responsibility to achieve optimal levels of independence upon discharge to independent or supportive community living. MH RRTP also provides rehabilitative care for homeless Veterans. Eligibility: VA may provide domiciliary care to Veterans whose annual gross household income does not exceed the maximum annual rate of VA pension or to Veterans the Secretary of Veterans Affairs determines have no adequate means of support. The co-pays for extended care services apply to domiciliary care. Call the nearest benefits or health care facility to obtain the latest information.

Should Shinseki Resign?

Posted by Debi Teter
should-Shinseki-resign_militaryauthority.comWith an emergency Congressional hearing last night about the serious problems with Veterans Affairs, pressure is mounting on VA Secretary Shinseki to resign. Officials on both sides of the political aisle are demanding Shinseki step down amidst the controversy, saying that it is taking too long for anyone to be held accountable. Two major issues at hand are the long wait times for VA care and, more recently, that 42 VA facilities are under investigation for misconduct. Shinseki does have some supporters, though, noting that he is a former member of the military and Vietnam veteran. He could have taken a private sector job after his military retirement, but instead chose to continue to serve by taking charge of the VA. They also note that with 18 reports going back as far as 2005, the problems at the VA with increasingly long wait times for care will take a long time to diagnose and repair. However, Shinseki has been in his job for five years now, and there are no significant changes to the VA processes and no one in a position of major responsibility has been disciplined or fired. Tell us how you feel about Shinseki. Do you think he needs more time to turn things around or has he had his chance and should be replaced? Let us know in the comments.  

Shinseki: “I have work to do”

Posted by Debi Teter
Shinseki-asked-to-resign_militaryauthority.comIn an interview with The Wall Street Journal Tuesday, Eric Shinseki, the head of the Department of Veterans Affairs, said “I serve at the pleasure of the president. I signed on to make some changes, I have work to do.” Several veterans groups and some members of Congress have called for Shinseki’s resignation after allegations of misconduct at several VA hospitals have surfaced, including the use of a secret wait list used at the Phoenix VA created to cover up delays in appointment times for veterans seeking medical care. Shinseki admitted he has work to do to rebuild the confidence of veterans, but also tried to highlight what he said were positive changes he has made while heading the department. The VA, the VA’s inspector general and the House Committee on Veterans Affairs are conducting reviews of the Phoenix VA. “As a result of what’s under way in Phoenix, I’m very sensitive to the allegations,” Shinseki told the Journal. “I need to let the independent IG complete his investigation.” There are allegations of mismanagement at other VA facilities including Pittsburg; Memphis; Atlanta; Columbia, SC; Augusta, GA; and Fort Collins, CO. Meanwhile, the House Veterans’ Affairs Committee today issued a subpoena over the scandal in Phoenix. #VAscandal #Shinseki  

Mental Health and PTSD Among the Troops

Posted by Debi Teter
PTSD and mental health resource for soldiersTwo shootings at military installations in a week. More suicides by service members in a year than deaths in combat. These are the realities of today’s military. Theories are varied as to why suicides and murders by service members and veterans are on the rise. One point that everyone agrees on is that mental health issues have been stigmatized for so long that many people who need help are afraid to ask for it. The Defense Department and VA are concerned. When Leon Panetta was Secretary of Defense, he laid out a four-pillar strategic approach to prevent military suicides: leadership; improving health care quality and access; elevating the importance of mental fitness; and increasing research into suicide prevention. There is clearly still much work to be done, but there are resources available. The VA lists more than 20 organizations and services available to active duty personnel, veterans and families. The US Army offers a Psychological Health Care Fact Sheet. The American Psychiatric Nurses Association offers general mental health assistance in addition to services specific for PTSD and Traumatic Brain Injury. USAA provides a book on suicide prevention that is free to download. PTSD and other mental health issues also take a toll on military spouses and can cause serious health issues. Active duty troops and veterans alike may be able to benefit from the recent emphasis on suicide prevention. If you are currently feeling despair or hopeless, or if you are concerned about someone else’s health, please contact the National Suicide Prevention Hotline at 1-800·273-TALK (8255). #FtHood #PTSD #mentalhealth #veteransresources

Should We Use Marijuana to Treat PTSD?

Posted by Jason Van Steenwyk

militaryauthority.com medical marijuana for ptsdIn a move that could cause a massive eastward migration of veterans from Hawaii and California and boost New England Cheetos sales numbers by double digits, the State of Maine has authorized the use of medical marijuana to treat post-traumatic stress disorder, or PTSD. 

A competing therapy – thus far legal, though not yet proven – involves injecting an anesthetic directly into the spine with a horse needle.

We’ll take option A, thanks, and throw in a bag of Doritos. 

Don’t look for the Bangor, Maine VA clinic to start handing out dime-bags like it’s going out of style, though. While a number of states have actually legalized marijuana under their own state laws, and a half-dozen states have specifically authorized medical marijuana as an approved treatment for PTSD, old Mary Jane is still illegal under federal law. Federal policy prohibits VA doctors from prescribing it or even assisting with documentation required to get other doctors to prescribe it. 

Furthermore, marijuana is still listed as a Schedule I drug – a drug for which there are “no currently accepted medical uses,” according to the Controlled Substances Act. However, in 2010 and 2011, the Department of Veterans Affairs relaxed its existing policies against medical marijuana by affirming that veterans who were using marijuana under a legal state program could still participate in VA-sponsored therapeutic activities without fear of punishment.

“VHA policy does not administratively prohibit Veterans who participate in State marijuana programs from also participating in VHA substance abuse programs, pain control programs, or other clinical programs where the use of marijuana may be considered inconsistent with treatment goals,” stated the VA in a fit of clarity.  “While patients participating in State marijuana programs must not be denied VHA services, the decisions to modify treatment plans in those situations need to be made by individual providers in partnership with their patients.”


Leadership from the Top

If there’s ever been a president who should be open to legalizing marijuana for this purpose, you’d think it would be Barack Obama, the notorious former head of the pot-smoking “Choom Gang,” while a high school student at the elite Punahou prep school in Honolulu, Hawaii. But this President has been widely seen to have led a crackdown on marijuana users now that he is president. Further confusing the matter, though, the DoJ announced it won’t challenge State marijuana laws and will focus only on serious trafficking cases.

Is marijuana effective? It seems to be – though conducting a full-scale clinical trial is very difficult due to federal restrictions. But a study done on rats from the University of Haifa indicates that a quick hit of marijuana just after a traumatic incident may even help prevent the development of PTSD symptoms…if you believe that people behave like rats. 

Meanwhile, the folks down the road in Tel Aviv have discovered that sleep deprivation may also help mitigate the effects of PTSD.


How do you feel about medical marijuana and its potential usefulness in treating PTSD? Should research be allowed despite it being an illegal drug? Tell us in the comments.

House Passes Bill to Fund VA

Posted by Jason Van Steenwyk

militaryauthority.com house funds va during shutdownThe House of Representatives moved to fund the Veterans Administration through the shutdown and into fiscal year 2014. The House passed the bill, H.J. Res. 72., on Thursday, October 3rd, with overwhelming Republican support. Democrat opposition was strong, but they still got 35 Democrats to sign on as well. The final vote was 259 in favor, 157 opposed. 

The bill, dubbed the “Honoring Our Promise to America’s Veterans Act,” restores funding for disability compensation, monthly stipends under the GI Bill and survivors’ benefits. 

The bill required a two-thirds majority for passage. It failed to pass on a first attempt on Tuesday, when just 33 House Democrats voted in favor. 

The House of Representatives, controlled by Republicans, has passed a series of bills providing partial funding for various popular segments of government. This tactic puts Democrats in an uncomfortable position, as it forces Democrats to either go on record voting against funding popular government programs or provide their leadership, Sen. Harry Reid (D-NV) and President Obama, progressively less leverage with which to negotiate with Republicans to keep the Affordable Care Act intact. 

“Today, more than 160 House Democrats chose to put politics before the needs of America’s veterans and their loved ones,” said Rep. Jeff Miller (R – FL) in a statement. “November payments to veterans and their survivors for a variety of earned benefits are now in jeopardy in the event of a prolonged government shutdown. Our veterans have already gone above and beyond for our nation. The last thing they deserve is for the country they courageously defended to abandon them. It’s unfortunate that some in Congress seem to be fighting to ensure that happens.”

The bill is not a complete restoration. The House did not authorize funding for IT, nor the VA Inspector General’s office, the National Cemetery Administration and for state veterans homes. 

The total funding package for benefits also results in a $6 billion reduction compared to its own 2014 funding appropriation back in June, according to reporting from Rick Maze at the Military Times.

The Democratic-controlled Senate does not, however, plan to take up the bill, so its own Senators will not be forced into the vote. The White House staff has also indicated the President will veto the bill if it reaches his desk. 

Curiously, the Department of Veterans Affairs itself is not arguing to make the case for its own funding. 


The House Committee on Veterans’ Affairs has scheduled a hearing tomorrow, October 9th, at 10:30 AM, to gather information and testimony regarding the impact of the shutdown on veterans and their families. 

Can I Sue the VA For Malpractice?

Posted by Jason Van Steenwyk

militaryauthority.com can i sue the vaIf you believe you have been the victim of medical malpractice in a Veterans Affairs hospital or clinic, you may have recourse in the courts. That said, suing the government over anything is a notoriously tricky process.

Dispelling a myth

From time to time, you may hear someone say ‘you can’t sue the government.’ Well, that’s not quite true, except for most members of the armed services, it is true that there is an overarching legal principle called ‘sovereign immunity’ that says that government need not subject itself to the same rules that government need not subject itself to the same rules that apply to the rest of us.

It goes back to English common law, from whence we inherited our own legal traditions and precedents – and perhaps even before that. The theory is that since it was the sovereign that created the courts to begin with, the sovereign, crown, king, lord or czar cannot be held subject to a court order.

For a long time, that was the case in the United States, as well. Sovereign immunity was the law of the land – until someone crashed a B-25 bomber into the Empire State Building in New York City.

And sovereign immunity is still the law of the land – except the United States has waived its immunity in certain limited ways, via a federal law called the Federal Tort Claims Act.

The FTCA provides a legal window for veterans who believe they may be victims of medical malpractice on the part of VA personnel to file suit and recover compensatory damages. The law forbids punitive damages, however, and also does not apply to willful torts committed by government employees. However, you may have recourse under other areas of law to sue these individuals, personally.

The FTCA basically carves out a limited exception to the doctrine of sovereign immunity. As it applies in the context of claims against the Veterans Administration, the law only allows veterans to sue to recover damages incurred due to negligence of an employee or agent acting “within the scope of their employment.” Furthermore, the law only allows for damages if the plaintiff would ordinarily be entitled to damages even if the negligence or omission was due to the actions of an employee of a private company, under the laws in effect where the incident happened.

This last condition, in turn, means that state laws must be taken into account when formulating a lawsuit against the VA, and not just federal laws.

What you must do

Under the FTCA, you can’t just go directly to the courts to file a lawsuit. You must first go to the VA or other federal agency that harmed you and notify them of your complaint. You must give the agency the opportunity to settle the claim. Only when the agency refuses, takes no action, or comes back with an unacceptable settlement offer can you file a suit for damages. 

What kinds of damages are you entitled to?

Provided you can show you were harmed, and that it was due to the negligence, failure or omission of a federal employee or agent, you are entitled to three different kinds of damages, as a jury may direct:

  • Economic damages. These are awards designed to compensate you for quantifiable losses such as the lost wages, the costs of medical care, and the like.
  • Non-economic damages.  These include damages for pain and suffering, emotional distress, disfigurement, and the like. These are all things that are difficult to translate into monetary terms, but juries have to try to find a way through it, nevertheless.
  • Future damages. These are damages you have not yet incurred, at the time of the verdict, but which are reasonably predictable and which you believe will occur, or continue to occur, in the future.

Limitations. If the act that harmed you was committed by a contractor, the Federal Tort Claims Act generally does not kick in, unless the contractor was being closely supervised at the time by the VA itself, in a relationship more common in employer-employee settings. You cannot go after the government for damages, unless the government was in close supervision of the day-to-day activities, say, of a physician in private practice contracted with the VA.

You may be able to sue the contractor, however. In the case of physicians, they will normally have medical malpractice insurance in place that will provide funds for a settlement or to satisfy a judgment, if appropriate.

Active duty members, Guardsmen on military orders, ROTC cadets, members of the Temporary Disability Retired List, and Public Health Service officers cannot sue the VA, however, under the Feres Doctrine. The Feres Doctrine does not normally apply to spouses and dependents, however.

Foreign claims excluded. If the tort occurred outside of the United States, you can’t sue under the FTCA. You may be able to find another area of law to pursue the claim, but the lawsuit will not work if you rely on the FTCA.

Timelines. You can’t dilly-dally on the claim forever: You must notify the agency in a timely manner – in the case of the VA by filing an administrative claim at the regional VA office. You must then give the agency six months to resolve it.

Once that six months has elapsed, or you have sooner gotten a denial from the agency, you then have six months to file a lawsuit under FTCA.

In addition, you must file the lawsuit within two years of the day the claim first accrues. Note that this might be a different date than the date on which the tort occurred; It could be the date you first became aware there was a problem resulting from a medical procedure that occurred – or failed to occur – well prior to that.

To file, you submit a Standard Form 95 to the court. The form requires you to specify the damages you are seeking. Since there is no provision for punitive damages under the FTCA, the amount you specify is the most you are going to receive, unless new facts come to light that were not foreseeable at the time of filing.

This is why it’s important to work with an experienced attorney: A good lawyer will be able to walk you through not just the economic damages, but also help you estimate what you may be able to get in non-economic damages, based on familiarity with other precedents. He or she should also be able to help you determine reasonable estimates for future damages as well, depending on your condition.

For a more thorough discussion of the issues surrounding the Federal Tort Claims Act, specifically as it applies to the VA, see this white paper published by the Tully Rinkey law firm, with offices in New York, Washington, D.C. and Arlington, Virginia.

Government Rolls Back Military Pay While Union VA Employees Get Big Bonuses

Posted by Jason Van Steenwyk

militaryauthority.com VA gives bonues while military pay is cutThe Pentagon is broke, say Administration officials, citing spiraling personnel costs that threaten to crowd out needed operational, infrastructure and modernization spending. So the Obama Administration, under former Secretary Leon Panetta and the current Secretary Chuck Hagel, has already tried to slash TRICARE benefits, and increase premiums. The have already tried to eliminate the Tuition Assistance program at three of the four uniformed defense services. They held military pay increases to 1 percent for 2014 – well below the 1.8 percent level normally called for by existing pay formulas. Now they are looking to slash military pensions for retired servicemembers and cut BAH rates, forcing military members to pay more out of their own pockets for housing – even as current on-base military housing – already inadequate even at post-cold-war levels, is allowed to decay.

But the Veterans Administration, apparently, is flush with cash. So flush, in fact, that the VA was able to grant lavish bonuses of tens of thousands of dollars to its government employees union work force. Bonus recipients include Michael Moreland, the administrator of the Pittsburgh, PA VAMC, under whose watch at least  five veterans died of legionnaire’s disease – a preventable illness brought about by unsanitary conditions. As many as fifteen other veterans were possibly or definitely infected at the hospital.

The problem wasn’t just in Pittsburgh, however: A GAO report found that a failure to implement precautions against the deadly disease was endemic at VA hospitals nationwide.

In all, more than two thirds of all the VA’s claims processing staff received bonuses totaling 5.5 million dollars in 2012, according to a Stars & Stripes report. Among others, bonuses as high as $50,000 and $60,000 went to construction managers who had significant delays and cost overruns on their projects, to physicians who left interns unsupervised during surgery and who were caught practicing without a license.

Per a report from USAToday,

According to a Government Accountability Office report recently issued, investigators found that during the 2010 and 2011 fiscal years:

  • A $7,663 performance-pay bonus went to a VA doctor who was reprimanded for practicing medicine with an expired license for three months.
  • A $11,189 bonus was given to a surgeon who was suspended without pay for 14 days after leaving an operating room before surgery was completed, allowing residents to continue unsupervised.
  • A $7,500 pay bonus went to a doctor who was reprimanded for refusing to see assigned patients in an emergency room, actions that forced 15 patients to wait six hours to be treated and led nine other patients to leave without treatment. 
  • An $8,216 bonus was paid to a radiologist whose privileges had been reduced for failing to read mammograms and other complex images competently. 

All told, bonuses to VA medical staff totaled $150 million in 2011 alone.

Meanwhile, backlogs of unresolved claims  – now finally starting to decline as an automated system comes online (though some observers believe that the decline happened as workers looking to maximize their bonuses front-loaded “easy cases” to boost case rate, while hard cases continued to decline, and while error rates skyrocketed.)

“You stated the VA ‘can and will do more to prevent future incidences,’” Wrote Representative Tim Murphy (R – PA), wrote in a letter to Secretary of Veterans Affairs Eric K. Shinseki. “While preventing the spread of infectious diseases should be a top priority for VA leadership, the department must also hold responsible those in a position of authority who did not adhere to the VA’s own directives and standards of care. And at the very least, the taxpayers should not be giving them bonuses.”

Uniformed military services personnel, of course, are not eligible for performance bonuses. They also have a less finely graduated pay scale that requires many service members to wait many years before receiving a pay increase based on a promotion, while federal employees even within a GS level can receive as many as 10 interim pay increases without being promoted just by getting bumped up the “step” system. 

Military members, also, are not unionized. The VA, on the other hand, has a largely union labor force – members of the American Federation for Government Employees, or AFGE. 

The net result, of course, is that the Administration would like to fund bonuses for union workers and bureaucrats at the expense of fighters and their families who already endure more hardship and receive lower compensation.