References. Class Objectives

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1 For those who care enough to take those extra steps to make sure all Missouri Veterans and their Dependents pursue the Federal and State Veterans benefits for which they are legally entitled because of the Veteran s Brave and Faithful Service in the United States Military Developed by Bonnie McNeill-Boyt Missouri Veterans Commission Workforce Development Office September, 2007 Class Objectives Upon conclusion of this seminar, participants will: 1. Understand the basics of what benefits are available to Veterans and their qualified dependents from the Dept. of Veterans Affairs and the State of Missouri. 2. Understand the importance of using Accredited Veterans Service Officers when filing for claim through the Department of Veterans Affairs to ensure accuracy and timeliness in obtaining benefits. 3. Understand how health care providers can work in partnership with Veterans Service Officers to obtain funding to pay for needed in-home health care and care in nursing homes. 4. Feel comfortable that their questions have been answered, or follow-up will occur, or they have received a referral to the proper authority when needed. 2 References 38 Code of Federal Regulations Department of Veterans Affairs * Website: Missouri Veterans Commission * Workforce Development Office * Website: 3 1

2 What We ll Cover Today Missouri Veterans Commission Programs Compensation Live and Death Pension Hospital 4 What to Expect? Cover the Basics of the Topics Questions & Answers At the End of the Briefing 5 Missouri Veterans Commission (MVC) MVC is a state agency which provides professional veterans advocacy for Missouri Veterans and their Dependents 6 2

3 MVC Program Overview Veterans Services Program Provides 50 highly trained Accredited Veterans Service Officers, Assistants and staff who explain VA and State veterans benefits to all MO Veterans and their dependents, apply for benefits on behalf of those with potential eligibility, and provide follow-up services to ensure clients received the maximum amount of benefits for which they are legally entitled Missouri Veterans Homes Program Operates seven (7) Highly Skilled Professional Award Winning Veterans Nursing Homes located strategically throughout the state Missouri Veterans Cemetery Program Operates Four (4) (soon to be five (5)) State Veterans Cemeteries located statewide Minority Veterans Benefits Program Provides Advocacy and outreach awareness for Minority Veterans in Kansas City area Women s Veterans Provides Advocacy and outreach awareness for Missouri s Women Veterans Incarcerated Veterans Re-Entry Program Provides Referrals to Incarcerated and Newly Released Veterans to our accredited Veterans Service Officers/Assistants for the purposes of advocacy, Veterans 7 benefits assistance and professional referrals to other Missouri Re-entry Programs Veteran s Life Cycle & Beyond MVC s goal is to provide veterans benefits assistance and care for all Missouri s Veterans from prior to discharge throughout his/her lifetime and beyond. Veterans Services Program Minority Veterans Program Women s Veterans Program Provides Assistance in Obtaining all VA Benefits and Assistance in Using all MVC Programs throughout h t the veteran s lifetime as well as throughout h t the veteran s qualified dependents d lifetime. Cemetery Pre-Certification Cemetery Perpetual Care MO Veterans MO Veterans Nursing Homes Cemeteries Entry into Military Discharge Nursing Care needed Vet s Death Dependent Private Nursing Care needed Dependent Death Live Vet s Benefits: Comp, Education, Pension, Loan, Hospital, etc Dependent s Live & Death Benefits: Burial, Marker, Death Pension/DIC Education, Loan, etc 8 About Department of Veterans Affairs Programs Veterans Health Administration (VHA) Veterans t Benefits Administration i ti (VBA) National Cemetery Administration (NCA) 9 3

4 Service Connected Claims commonly referred to as Compensation Objectives * To learn the basic ways a veteran can be service connected for their disabilities which were caused by military service * To learn some basic terminology pertaining to Comp claims 10 Topics Service Connection Definition Types of Service-Connection * Direct service-connection * Aggravated service-connection * Presumptive service-connection * Secondary service-connection Special Category * 38 USC 1151 (compensated as if service connected) 11 What is a Service-Connected Condition? Service-Connected Condition: any injury or disease that is caused by or aggravated by active military service, or treatment of service- connected disabilities. It can also be a condition that is associated secondarily to a condition that is service-connected. 12 4

5 What are the eligibility requirements for service connection? Service of the veteran must have been terminated by discharge or separation under conditions other than dishonorable. There is no minimum length of service. Service Connection may not be established for transitory illnesses or superficial injuries with no ascertainable chronic or permanent residuals. The injury itself must not have been due to the service member s own willful misconduct, i.e. due to drugs, alcohol, breaking the law 13 What are the commonly used terms which apply to Compensation? Service Connected Injury or Illness * The term service connected injury or illness refers to the veteran s disability itself and the fact that it was caused or aggravated by military service Example: A service member is shot in the hand and has lost the use of that hand. The hand injury is considered service connected. Service connected veteran * The term service connected veteran refers to a veteran who the VA has recognized as having a service connected injury or illness. Compensation * The term compensation refers to the monthly payment a veteran receives due to a service connected injury or illness that is at least 10% disabling. Non-compensable service connection * The term Non-compensable service connection refers to a service connected injury or illness that has been recognized by the VA, but is not disabling enough to the veteran to rate at least 10%. The veteran can receive treatment for this 14 type of injury or illness, but does not draw any payment. Simplistic Timeline for a Veteran s Life Prior to Entry Into Military Date of Entry into Military Active Duty Time Period Date of Military Discharge Balance of Veteran s Lifetime 15 5

6 Veteran s Life Timeline as it Pertains to Service Connected Benefits e Time Pre- Service Travel Tim me Prior to Entry ry into Military Date of Ent Training Period Active Duty for Active Duty Time Period charge from Military Date of Disc Travel Tim me Following Discharge m Date of Discharge One Year fro 3 Years from Date of Discharge 7 Years from Date of Discharge erans Death Date of Vete The specific time when an injury occurs or illness is diagnosed will determine what type of Service Connected Claim it is. 16 Aggravated Service Connection Timeline vice Time Period Pre- Serv Travel Tim me Prior to Entry ry into Military Date of Ent Training Period Active Duty for T Active Duty Time Period charge from Military Date of Disc Travel Tim me Following Discharge m Date of Discharge One Year fro 3 Years from Date of Discharge 7 Years from Date of Discharge erans Death Date of Vete Aggravated Service Connection Time Period 17 Aggravated Service-Connection Definition Aggravated Service Connection: * the injury/disease existed prior to military service but is now worse because of participation in service * In order to be considered for aggravation of a preexisting condition, the veteran must provide medical evidence that the condition has progressed beyond the normal course of the condition due to his/her participation in active military service. 18 6

7 Aggravated SC Condition Examples Examples * Prior to enlisting, the service member injured his/her right knee playing basketball. The injury was not so bad that it prevented entry into service. During a military exercise involving climbing steep hills, the service member re-injured the same knee. The result of that injury was that the right knee was in worse physical condition that it was when the service member entered the military. * Another example might be asthma which existed prior to entry, but was made worse because of military service. *Note: The VA must determine how bad the injury was upon enlistment. If no degree of disability can be found, the veteran is presumed to have been 100% able (meaning 0% disabled). The VA then pays that veteran for the full amount of current disability. If the entrance records show a 10% disability, the VA would reduce the current disability by the 10% shown upon entry. 19 Direct Service Connection Timeline Pre- Servi ce Time Travel Tim me Prior to Entry Date of En try into Military Active Duty for Training Period Date of Dis scharge from Military Travel Tim me Following Discharge Active Duty Time Direct Service Connection Time Period 20 Direct Service-Connection Definition Direct: the injury/disease was incurred in/began during a qualifying period of service and was not due to misconduct * In order for a condition to be considered d under Direct, the veteran must show there is a current condition and an incident or treatment in service for that condition or symptoms associated to that condition. 21 7

8 Examples Direct SC Condition Examples * While on active duty for training, the service member injured his/her right shoulder while lifting heavy equipment. Treatment was performed on the right shoulder which h allowed him/her to return to duty. * A service member who was exposed to radiation during an anatomic test suffered a severe skin condition which has become chronic. * A service member is diagnosed with diabetes while on active duty, and must take insulin to keep blood sugar levels normal. 22 Presumptive Service Connection Timeline to Military Date of Entry int Active Duty Time Period rge from Military Date of Dischar Date of Discharge One Year from D Date of Discharge 3 Years from D Date of Discharge 7 Years from D ns Death Date of Veteran Presumptive Time Line 23 Presumptive Service-Connection Presumptive: diseases that are known to be caused by specific exposures while on active military service, or injuries and diseases that manifest to the 10% level within a specific time frame 24 8

9 Presumptive Service-Connection Examples Examples: * Many years after a veteran served in country during the Vietnam War, the veteran is diagnosed with diabetes and lung cancer due to Agent Orange exposure * Within a year of the discharge date, a peacetime veteran is diagnosed with diabetes with a compensable rating(minimum10%) * Within 3 years of the discharge date, a veteran is diagnosed with TB with a compensable rating * Within 7 years of the discharge date, a veteran is diagnosed with MS with a compensable rating * Many years after exposure to nuclear radiation, a veteran is diagnosed with bone cancer. 25 Secondary Service Connection e Time Pre- Service Travel Tim me Prior to Entry ry into Military Date of Ent Training Period Active Duty for T Active Duty Time Period charge from Military Date of Disc Travel Tim me Following Discharge m Date of Discharge One Year fro 3 Years from Date of Discharge 7 Years from Date of Discharge erans Death Date of Vete Aggravated Direct Presumptive Secondary 26 Secondary Service-Connection Secondary: a disease or injury that is directly attributed to a condition for which the veteran is already service-connected. * In order for a condition to be listed as secondary, there must be medical evidence linking the secondary condition to the primary serviceconnected condition in a cause and effect nature. 27 9

10 Secondary Service Connection Examples A Veteran is service connected for his hip. Because of the pain in that hip, his gait is uneven which causes extra wear and tear on his back. His back could be secondary to his service connected hip. A Veteran must take large amounts of ibuprofen to control the pain of his service connected knee condition. The ibuprofen has done damage to his stomach. His stomach condition could be secondary to his knee. A Veteran is service connected for PTSD (Post Traumatic Stress Disorder). Because of the anxiety suffered because of the PTSD, the veteran develops high blood pressure, ulcers, and a heart attack. All of those conditions could be secondary to the PTSD. A Veteran is service connected for seizures. While driving, the veteran suffers a seizure which results in the veteran wrecking. The veteran suffers permanent damage to the jaw. The jaw could be secondary to the seizure condition Service-Connected Claims 38 USC 1151: These claims involve a veteran who has been injured by a VA Medical Facility. This injury can result from services provided for service-connected disabilities or it may result from some other treatment procedure. Disabilities are considered under 1151 are compensated as if they were service-connected in nature. 29 Service-Connection cont d The difference between aggravated, direct, presumptive and secondary service connected conditions and 1151 Claims is that 1151 Claims do not involve anything that pertains to military service itself. Basically, 1151 claims are malpractice claims and the resulting money drawn from the claim is routed through the VA the same as a regular comp claim

11 Service Connected Claims that Worsen A veteran can, at any time, open his/her claim for service-connected disabilities based on an increase in severity of a condition that is currently service-connected, or may open to add a condition that they failed to raise during the initial claim for service connection. Example: A Veteran is drawing a 20% service connected rating for a right knee condition and has been drawing this benefit for 10 years. The condition has worsened to the point that the knee can only bend ½ as far as it did 10 years ago and the veteran is now taking increasing amounts of pain medicine. Example: A Veteran is drawing 10% for diabetes. Even though the veteran is taking insulin, activities such as exercising and other physical activity have become severely limited. 31 Briefing Topics * Compensation *DIC * Pension * Death Pension * VA Medical Care * Burial Benefits * Special VA Benefits 32 Dependency & Indemnity Compensation - DIC 11

12 Class Objectives To learn the basic ways a dependent can be eligible for benefits based on veterans who died because of service connected disabilities To learn some basic terminology 34 DIC Paid to surviving spouses, dependent children, and dependent parents when * service member dies on active duty * when death occurs after military service if a service-connected connected disability either directly caused or contributed substantially and materially to the death of the veteran. * The veteran dies from medical treatment received through DVA medical system or from Voc Rehab training. 35 Service-Connected Death Examples: A veteran is service connected for a heart condition, then dies from a heart attack. A veteran is service connected for Multiple Sclerosis. He has a bad fall, and ends up in the hospital. While in the hospital, he ends up with pneumonia and dies. The MS was what led up to the fall and then the pneumonia, so this death could be considered service connected, thus allowing for DIC. A veteran dies from taking prescription drugs which were clearly marked in VA hospital records as being toxic to the veteran, but were accidentally given anyway by hospital staff

13 Non Service Connected Deaths & DIC When vet had been rated 100% service connected for ten or more years at time of death and dies from non-service connected (NSC) causes other than willful misconduct For vets who pass away within ten years from discharge date and die from NSC causes, DIC is payable when vet was rated 100% SC for at least 5 years prior to death. 37 Parent s DIC Death must be service connected Income based benefit Different income limits based on whether one or both parents survive, if they are married to each other, have or have not remarried, whether one or both parents needs A&A. Net Worth NOT a factor 38 Requirements of DIC for Dependents Not required that dependent be recognized prior to death of vet Surviving spouse must have been married to vet for at least one year prior to vet s death or any length of time if a child was born of the marriage or before the marriage 39 13

14 Briefing Topics * Compensation *DIC * Pension * Death Pension * VA Medical Care * Burial Benefits * Special VA Benefits 40 Non-Service Connected Pension Benefits 41 Objectives Non-Service Connected Pension Benefits * To learn the basic requirements for a veteran to be eligible for non-service connected pension * To learn some basic terminology 42 14

15 Topics for Coverage What is Pension? Eligibility War Periods Income Determination & Net Worth Disability Housebound Aid & Attendance 43 Pension What is Pension? * The VA s Pension program is an income based program to ensure a basic standard of living for eligible veterans and their dependents. 44 Eligibility Wartime Service (at least one day) Character of discharge under honorable conditions A certain length of service Veteran is permanently & totally disabled Family Income under a certain limit Net worth is not excessive 45 15

16 War Periods Mexican Border Period: 5/9/16-4/5/17 WWI: 4/6/17-11/11/18 WWII: 7/7/41 12/31/46 Korea: 6/27/50-1/31/55 Vietnam: 8/5/64-5/7/75 * a beginning date of 2/28/61 for in-country service as a forward observer Gulf War: 8/2/90 to??? * Date to be determined by law or Presidential proclamation 46 Eligibility (enlistment prior to 9/7/80) 90 days or more with at least one (1) day during a wartime period Certain exceptions apply * Discharge for sc disability or hardship * Serving the entire period for which called up (National Guard and Reserves) 47 Eligibility (enlistment after 9/7/80) 24 consecutive months or more with at least one (1) day during a wartime period Certain exceptions apply * Discharge for sc disability or hardship * Serving the entire period for which called up (National Guard and Reserves) 48 16

17 Disability Requirements The veteran must be permanently and totally disabled (100% P&T) * Unemployability a single disability rated at 60% or more or multiple disabilities combining to 70% with at least one 40% Veterans must be considered based on determinations of Individual Unemployability. *NOTE: Disabilities which were caused by the veteran s own willful misconduct (drugs, alcohol, while breaking the law) are NOT considered. 49 Exceptions to Proving Disability for the Basic Pension Rate Currently, the VA presumes permanent and total disability if a veteran is: * a patient in a nursing home for long-term care due to disability, or * receives Social Security Benefits for disability, or * is age 65 or older when the VA application is received (no need to list medical problems) 50 Disability Measuring More than What is Required for the Basic Pension Amount Housebound * A veteran or widow(er) will qualify for the housebound rate if he/she has a single disability rated at 100% and a second disability rated at 60%, or where the claimant has a disability that substantially confines them to their home or immediate premises and which is reasonably certain to remain throughout his/her lifetime

18 Aid & Attendance A veteran will be considered to be in need of regular Aid & Attendance (A&A) if he/she is a patient in a nursing home, is helpless, is blind, or is so nearly helpless or blind as to need the assistance of another person. A&A may only be authorized when the claimant is in receipt of Improved Pension 52 Aid & Attendance In determining the need for Aid & Attendance the claimant must be deficient in 3 of the 5 following categories: * Dress unassisted * Bathe unassisted * Toilet unassisted * Eat unassisted * Walk in and out of home unassisted 53 Aid & Attendance A person may qualify for Aid & Attendance where they have been determined as bedridden or totally blind by the VA. * Total blindness is determined as visual acuity of 5/200 or less in both eyes. * Or standing 5 feet from a 16 foot tall E and not seeing it

19 A&A and Housebound The Housebound and A&A rates are determined by the Veteran s health only. If the veteran has a dependent who is severely disabled, the VA will not pay the vet the housebound rate or the A&A rate based on the dependent s health. But, the VA will allow medical expenses associated with the care required for that dependent to be used to offset income which could potentially increase the veteran s benefit. 55 Net Worth Requirements Family net worth is the value of assets owned by the veteran and his/her dependents. Assets such as the home the veteran is living in and personal property p such as a car, furniture, jewelry, etc are not counted. If the family net worth is less than $80,000, the net worth is not usually a problem. The VA may at any time request living expense information to determine if net worth is too high based on the veteran s estimated life expectancy, but this does not mean the veteran won t qualify. 56 Income Requirements Since pension is an income based benefit, the VA must obtain all veteran s and dependents income information in order to determine how much the veteran will be paid. Basically all income most people receive (including dependent s income) will be used when calculating the benefit. One exception is SSI (Supplemental Security Income) from Social Security

20 Aid & Attendance $18,234 yr/ $1519 mo Housebound $13,356 yr/ $1113 mo Maximum Annual Pension Rate $10,929 yr/ $910 mo $ $10,929 yr/ $910 mo Maximum VA Payment (Veteran with zero income) Zero Income Although Veterans may have paid medical expenses, there is no reason to submit them as there is no other income to offset. 58 Aid & Attendance $18,234 yr/ $1519 mo Housebound $13,356 yr/ $1113 mo Maximum Annual Pension Rate $10,929 yr/ $910 mo Maximum VA Payment (Veteran with other income) Social Security Railroad Retirement Interest Dividends Other Income Zero Income $ $10,929 yr/ $910 mo Other Income Vet w/no Countable Income VA Payment Less income Out of Pocket Family Medical Expenses Veterans with income other than VA should always submit their medical expenses to reduce the other income so they can receive maximum VA benefits! 59 Family Out-of-Pocket Medical Expenses That Lower Income Medical expenses * Prescription and over the counter medicine * Non prescription medicine * Doctor, dentist, hospital payments * Glasses, dental work, mileage to and from doctors, dentists, etc Medical insurance premiums Medicare premiums Nursing Home costs *If the claimant receives reimbursement for expenses, a deduction is not allowable

21 Net Worth Requirements Net worth is the market value of all real estate and personal property owned by claimant (not including primary residence, furnishings, and automobile) minus his/her expenses. * Primary residence is considered as main residence and reasonable adjoining land as determined by housing market in the area. 61 Net Worth Requirements The purpose of evaluating net worth is to determine whether or not the veterans financial resources are sufficient to meet his/her basic needs without assistance from VA If a claimant s assets are sufficiently large, the claimant is expected to use these assets to pay for living expenses. 62 Net Worth Includes: Stocks, Bonds, Bank Deposits Real Estate (other than the veteran s primary residence) Investment property such as an antique car or coin collection 63 21

22 Briefing Topics * Compensation *DIC * Pension * Death Pension * VA Medical Care * Burial Benefits * Special VA Benefits 64 Death Pension Objectives Non-Service Connected Death Pension Benefits * To learn the basic requirements for a dependent to be eligible for non-service connected death pension * To learn some basic terminology 66 22

23 Topics for Coverage What is Death Pension? Eligibility Income Determination & Net Worth Disability Factors 67 What is Death Pension? Death pension is an income based monthly benefit paid to the surviving spouse and children of eligible veterans who died of nonservice connected causes. 68 Eligibility Requirements Conditions necessary for death pension eligibility include: * Deceased veteran had qualifying military service * Claimant s income is under applicable limit (uses the same process as for live pension, although the benefit is less than for live pension * Claimant s net worth is within VA limits * Claimant can prove dependency 69 23

24 Wartime Eligibility Requirements The wartime eligibility requirements are the same as those for live pension 70 Dependent Eligibility Requirements 3 Requirements for dependents: * Ability to establish death of veteran death certificate * Ability to establish dependency Married one year or had a child with the vet Marriage info must have month, year, city, state * Income for VA Purposes is within applicable limits and net worth is not a bar. 71 Income factors The items which can be used to deduct from the veteran s income for live pension purposes can be used for death pension. A commonly used deduction that is a tremendous help for reducing income for death pension is the use of the paid last illness and death expenses. As with live pension, paid death expenses reduces the surviving spouse s income, thus allowing for a higher death pension benefit for the first 12 months after the payment of death expenses

25 Disability for Death Pension The surviving spouse and/or children do not need to be disabled to be eligible for this benefit as long as they meet all other criteria. But * There are higher rates for those dependents are either Housebound or in need of Aid and Attendance. The requirements needed to meet these disability ratings are the same as for live pension. 73 Briefing Topics * Compensation *DIC * Pension * Death Pension * VA Medical Care * Burial Benefits * Special VA Benefits 74 Veterans Health Administration (VHA) 25

26 VHA Vision VHA Vision Statement Healthcare Value begins with VA. The new Veterans Healthcare System supports innovation, empowerment, productivity, accountability and continuous improvement. Working together, we provide a continuum of high qualify health care in a convenient, responsive, caring manner - and at a reasonable cost. 76 Office of Academic Affiliations Medical Education and Health Professions training: VA manages the largest program in U.S. VA facilities are affiliated with: 107 medical schools 55 dental schools more than 1200 other schools *Each year approximately 81,000 health professionals are trained in VA medical centers. *More than half of the physicians practicing in US received part of their education in the VA Healthcare System. 77 Office of Readjustment Counseling Since 1979, the VA Readjustment counseling Service has operated 206 Vet Centers who provide: Psychological counseling for war related trauma Community outreach Case management and referral activities Supportive social services to veterans and family members Since Vet Center Program began 1.6 million veterans have been helped: 126,000 veterans served each year with over 900,000 visits to Vet Centers across the country

27 Office of Readjustment Counseling (cont d) Eligibility for Services at Vet Centers Any veteran with service in combat theater during wartime or anytime during a period of armed hostilities Any veteran who was sexually assaulted or harassed while on active duty Family members of eligible veterans 79 Veterans Integrated Service Networks (VISNs) The VA medical system consists of 22 Integrated networks of care that are focused on pooling and aligning g resources to better meet local health needs and provide greater access to care. 80 VISNs VISN 1: VA New England Healthcare System VISN 3: VA (NY/N) Veterans Healthcare VISN 5: VA Capitol Healthcare Network VISN 7: The Atlanta Network VISN 9: Mid South Veterans Healthcare VISN 11: Veterans Integrated Healthcare VISN 13: VA Upper Midwest Healthcare VISN 15: VA Heartland Network VISN 17: VA Heart of Texas Health Care VISN 19: Rocky Mountain Network VISN 21: Sierra Pacific Network VISN 2: VA Healthcare Upstate NY VISN 4: VA Stars & Stripes Healthcare VISN 6: The Mid-Atlantic Network VISN 8: VA Sunshine Network VISN 10: VA Ohio Healthcare Systems VISN 12: The Great Lakes Health Care VISN 14: Central Plains Health Network VISN 16: Veterans Integrated Service VISN 18: VA Southwest Healthcare Network VISN 20: Northwest Network VISN 22: Desert Pacific Healthcare Network 81 27

28 PRIORITIES VA Hospitals current have 8 Eligibility Status Groups Which are divided into 2 Categories *Non-Discretionary *Discretionary 82 PRIORITIES Non-Discretionary VA shall provide any needed hospital and outpatient care to the extent and in the amount that Congress appropriates funds. Discretionary VA may furnish any hospital and outpatient care to the extent resources and facilities are available if the veteran makes a co-payment. 83 Non-Discretionary Priority Groups Priority Group 1 Veterans rated 50% or more service connected Priority Group 2 Veterans rated 30% or 40% serviced connected Priority Group 3 Veterans who are former POWs Veterans discharged for service connected disability Veterans rated 10% or 20% service connected Veterans awarded eligibility under 38 USC 1151 Veterans awarded the Purple Heart 84 28

29 Non-Discretionary Priority Groups (cont d) Priority Group 4 Veterans in receipt of A&A or Housebound benefits Veterans the VA has determined to be catastrophically disabled (some may be responsible for co-payments Priority Group 5 Non service-connected veterans Veterans rated 0% service connected disabled Veterans in receipt of VA pension Veterans eligible for Medicaid (annual incomes and net worth are below income level) 85 Non-Discretionary Priority Groups (cont d) Priority Group 6 This group includes all other eligible veterans who are not required to make co-payments for their care, including: WW I and Mexican Border War Veterans Veterans receiving care solely for disabilities resulting from exposure to toxic substances, radiation or for disorders associated with service in the Gulf War; or for any illness associated with service in combat in any war after the Gulf War or during a period of hostility after Nov. 11, For other treatment these vets are required to make copayments based on Geographic Means Test co-payment levels or the full medical care co-payment rate. Compensable 0% service connected veterans (4 separate conditions each rated 0% SC) 86 Discretionary Priority Group Priority Group 7 Veterans whose income is above the VA Means Test threshold but below the applicable Geographic Means Test threshold who agree to co-payments (inpatient co-payments reduced by 80%) 7a. Noncompensable 0% service connected veterans 7c. Non Service connected veterans Following veterans are not eligible for enrollment if an enrollment decision to restrict enrollment of new Priority group 7 veterans has been made 7e. Zero percent noncompensable service connected veterans who applied for enrollment after the date of an enrollment decision to restrict enrollment of new priority group 7 veterans 7g. Nonservice connected veterans who applied for enrollment after the date of an enrollment decision to restrict enrollment of new priority group 87 7 veterans agree to make copayments 29

30 Discretionary Priority Group Priority Group 8 Veterans not included in priority group 4, 6, or 7 who are eligible for care only if they agree to pay the medical care co-payment. 8a. Zero percent noncompensable service connected veterans 8b. Non service connected veterans Veterans who are not eligible for enrollment. These veterans are eligible for care of NSC conditions on a humanitarian emergency basis and for care of SC conditions Zero percent noncompensable service connected veterans who applied for enrollment after Jan. 16, 2003 Non service connected veterans who applied for enrollment after Jan. 16, VA Healthcare Eligibility Priority Categories 1-8 All Veterans honorably discharged prior to 9/7/80 All Veterans honorably discharged after 9/7/80 who completed at least 24 months of active duty unless: *release was for convenience of the government, OR *for disability 89 Eligibility for FREE VA Healthcare Any service-connected condition A former prisoner of war A veteran of the Mexican Border Period A veteran of World War I A veteran eligible for Medicaid A veteran receiving VA NSC pension benefits A Purple Heart Award veteran 90 30

31 Additional Eligibility for FREE VA Healthcare - Protocol Exams A veteran fitting the following classifications, can receive free VA medical care for that or a related condition: * Conditions resulting from exposure to herbicides (Agent Orange) in Vietnam, or to ionizing radiation in WW II * Conditions resulting from military service in the Persian Gulf * Conditions resulting from sexual trauma while in military service 91 The MEANS TEST Completion of EZ Is a measure of a veteran s family income/assets and is based on income/assets from the previous calendar year. Is used to determine eligibility for free VA healthcare (no co-payments) Most non-service connected veterans and noncompensable 0% service connected veterans are required to complete the means test. If Family income/assets of veterans for previous calendar year fall below means test threshold, veteran pays no co-payment. 92 *Current Means Test Threshold Based on geographical area 93 31

32 FREE Medications from VA Pharmacy Veterans rated 50% or more service connected (any condition) Medications for treatment of service connected conditions Veteran in receipt of NSC VA pension Veteran s annual income is below established Geographical thresholds. 94 CO-PAYMENTS OUTPATIENT MEDICAL CARE at Primary Care Clinics $15 per visit Specialty Clinics $50 per visit (Multiple appointments $50 NOT $65) 95 CO-PAYMENTS INPATIENT CARE for veterans whose income is above the means threshold but below the geographically based threshold: Veteran is responsible for paying 20% of the Medicare deductible for first 90 days of inpatient hospital care during any 365 day period. For each additional 90 days of in patient hospital care, they are charged 10 percent of the Medicare deductible. In addition, the patient is charged a $2 a day for hospital care. NSC veterans and noncompensable zero percent SC veterans with incomes above the geographical income threshold will be charged the full Medicare deductible for the first 90 days of care during any 365 day period. For each additional 90 days, they are charged one half of the Medicare deductible and $10 per day

33 Prescription Drugs PRESCRIPTION DRUGS $8 per 30 day or less supply (including OTC drugs) *There is a maximum cap of $960 for veterans in Categories 2 through 6 on what the veteran must pay to VA in one year. On Categories 7 and 8, there are no caps on out of pocket expenses to the VA. 97 THIRD PARTY BILLING VA is authorized to bill insurance companies for the cost of medical care furnished to all veterans for non-service connected conditions covered by health insurance policies Veterans are NOT responsible and WILL NOT be charged for ANY co-payment or co-insurance required by THEIR health insurance policies. The veteran IS responsible for any co-payments due the VA! 98 Dental Dental services are provided by the VA to veterans on an outpatient basis under the following conditions: 1. Vets are considered eligible and may apply at any time if: a. Vet receives SC comp for a dental condition or disability b. Vet is rated at 0% for SC dental conditions as result of combat wounds or service injuries c. Vet was POW with no distinctions based on length of captivity d. Vet receives, or is entitled to receive but for military retired pay, disability comp at the 100% rate for one or more SC conditions, or is rated SC and totally disabled because of individual unemployability e. Veteran s dental condition is NSC and is determined by the VA to be associated with and aggravating a SC condition. f. Vet is participating in a VA Voc Rehab program g. Certain enrolled homeless veterans participating in specific 99 health care programs. 33

34 Dental cont. 2. Veteran must apply within 90 days of separation from active duty if his/her dental conditions or disabilities are shown to have been in existence at the time of his/her discharge or release from active service of at least 180 days. (DD 214 must state Dental Care Not Provided. Dental treatment claimed is for a NSC condition and dental treatment was begun while receiving hospital care at VA expense, and it is professionally determined to be reasonably necessary to complete the remainder of this dental care on an outpatient basis. Dental condition must be considered by the VA Physician to be detrimental to the veteran s current 100 condition to qualify Sensory-Neural Aids (eyeglasses, contact lenses and hearing aids) Are provided by VA to: Veterans who are service connected for vision or hearing loss VA will furnish needed hearing aids to veterans who have service connected hearing disabilities rated 0% if there is organic conductive, mixed or sensory hearing impairment and loss of pure tone hearing sensitivity which contribute to a loss of communication ability. Veterans 10% or more service connected for any condition 101 Sensory-Neural Aids The following veterans are eligible if they are receiving VA care or service: Former Prisoners of War Who are in receipt of 38 USC 1151 benefits Who have a visual or hearing impairment secondary to another medical condition being treated by the VA Who have a significant functional or cognitive impairment NOT including normally occurring visual or hearing impairments Whose visual or hearing impairment is so severe that the provision of sensory-neural aids are necessary to permit active participation in their own medical treatment

35 Fee Basis Card Eligibility Service connected veterans Veterans in receipt of SMP WW I Veterans Requires recurrent outpatient medical treatment No Dept. of VA facilities available or the VA facility cannot treat the medical condition 103 Using the Fee-Basis Card Vet should locate the doctor of their choice who is willing to participate in Fee basis program Payment is limited to $125 per month for the conditions listed on Fee Basis card Procedures costing more than $125 must be pre- approved by Medical Center where enrolled Doctor must accept Fee Schedule payments as Paid in Full Vet should not be billed for excesses above schedule unless services were for unapproved conditions 104 Fee Basis Special Notes Fee Basis ID Cards are for outpatient treatment only (no dental, hospital, prosthetic or any other purposes) All vets are re-evaluated periodically to determine continued eligibility for Fee basis care (not permanent status for any vet)

36 Insurance Info VA will bill insurance companies for treatment of all non-service connected conditions Veterans with 50% SC or more will still get billed for treatment t t for non-service-connected conditions VA will not bill the veteran if the insurance carrier does not pay 106 VA Authorization of Emergency- Outpatient Treatment Service connected 50% - 100% * Any Emergent condition Service-connected less than 50% * Emergent treatment for SC conditions only A&A, Housebound, or WWI veterans * Any Emergent condition VA facilities are not feasibly available 107 VA Authorization of Emergency Outpatient Treatment (cont d) Must be reported within 15 days from date of Emergent condition Notification of such Emergency may be made by telephone, telegram or letter Vet must submit all invoices, medical reports and substantiation for treatment of medical emergency Notification must be made to VAMC where vet is enrolled

37 NSC Emergency Care Benefits only if funds are available from VA Enrolled in VA Health Care System Provided care by VA within last 24 months Provided hospital emergency department No other form of health insurance NO Medicare, Medicaid, or a state program No coverage under any other VA program No DVA or Federal Facility feasibly available at time of emergency Reasonable person would judge a delay would endanger vet s life 109 NSC Emergency Care Benefits (cont d) Vet is financially liable to emergency care provider for that treatment Vet has no other contractual or legal recourse against a third party that will pay all or part of the bill VA Medical Center should be contacted ASAP VA will only pay the private facility until your condition stabilizes 110 Eligibility and Procedures to File a Claim for Unauthorized Emergent OP Medical Services Emergent treatment for a SC disability Emergent treatment for any condition for vets with A&A or 100% SC No VA facilities feasibly available Emergent Medical Conditions only Payment request within 2 years of date of treatment

38 How to File All bills, vouchers, invoices, or receipts or other evidence establishing that such amount was paid Emergency g y room reports An explanation of circumstances necessitating the use of private emergent care Submit to Medical Center where enrolled 112 Briefing Topics * Compensation *DIC * Pension * Death Pension * VA Medical Care * Burial Benefits * Special VA Benefits 113 Burial Benefits 38

39 Class Objectives To learn about Missouri Veterans Commission Veterans Cemeteries To learn what benefits are available for the funeral, transportation, and interment of a deceased veteran, and what requirements are for eligibility of such benefits. To learn the requirements for burial in a National Cemetery 115 All services at no charge Military Honors Program Services available upon request to Funeral Director Predetermination of eligibility forms available and encouraged Burial in MO State Veterans Cemeteries 116 Missouri Veterans Cemetery Eligibility Requirements Any deceased veteran discharged from US Armed Forces under conditions other than dishonorable Military Service after 9/7/80 requires a minimum of 24 months of service except under special circumstances.. Individuals with 20 or more years of service in the NG or Reserves, entitled to retired pay are eligible for burial. Spouses, surviving spouses, dependent children and adult, handicapped children are also eligible

40 Veteran s Death Benefits Burial benefits * for veterans who die of a SC disability burial allowance for the total cost of the funeral, burial and transportation from place of death to final interment, t or $2000, whichever h is less An additional amount is payable for transportation if the veteran is buried in a National Cemetery. Amount is based on the place of death of vet to nearest National Cemetery No Time Limit for filing for burial or transportation 118 Veterans Death Benefits Burial benefits * for veterans who die of a Non-SC disability May be entitled to burial benefit of $300 with an additional $300 for plot or interment allowance. Additional amount payable for transportation costs to a National Cemetery or from place of death if death occurred in DVA Medical Center, non-dva Medical Center if under DVA authorization, while travelling under DVA authorization. If in an approved state nursing home, and no other entitlement, $300 is payable. Time limit for filing: 2 years from date of final interment or burial. 119 Burial Benefit Entitlement Requirements Must be in receipt of comp or pension, or was entitled to either benefit but for waiver of military retired pay or If veteran, at time of death, had a claim pending for comp or pension that would have entitled the vet to payment or If vet has wartime era service and the body is unclaimed or» Continued on next page

41 Entitlement Requirements (cont d) Vet died hospitalized at DVA Medical Center or while receiving care at a non-dva Medical Center under contract or Veteran died while traveling under DVA authorization and expense was to or from a specified place for examination, treatment, or care. vet died while a patient in an approved state nursing home Vet was indigent or the body is unclaimed (documentation from responsible officials required) 121 Order of Precedence of Claimant for Payment of Benefits Funeral Director if any portion of funeral bill is unpaid The person or entity from whom the plot was purchased or who provided interment services (other than the FD) if any portion to of the bill is unpaid pad The person whose personal funds were used to pay the expenses of the funeral, transportation and burial The executor of the veteran s estate or estate of the person who paid the expenses of the veteran s burial or provided such services 122 Headstone or Marker Provided upon request to mark the gravesite of an eligible veteran in any cemetery around the world No time limit for ordering the marker Headstones provided for eligible spouses and dependents of veterans when buried in National, Military, or State Veterans Cemetery. Note: Dependents buried in private cemeteries are NOT eligible for a headstone

42 Headstone or Marker Eligibility Any deceased veteran discharged from US Armed Forces under conditions other than dishonorable Military Service after 9/7/80 requires a minimum of 24 months service except under special circumstances. Individuals with 20 or more years of service in National Guard or Reserves, entitled to retired pay subsequent to October 27, 1992 are entitled to a marker 124 Headstone or Marker Eligibility For veterans who died after 12/27/01, entitlement exists even though the grave is already marked. Prior to 12/27/01, marked graves did not qualify for government markers. 125 United States Flag VA furnishes flags to drape the caskets of veterans, National Guardsmen, and Reservists discharged or released from military service under conditions other than dishonorable. The flag is presented to the next of kin or close friend following interment

43 Presidential Memorial Certificate Program initiated March 1962 by President Kennedy to honor the memory of honorably discharged, deceased veterans. Certificate bears the current President s signature and expresses the country s grateful recognition of vet s service. One application can suffice for multiple requests for same veteran - must have complete names and addresses referenced. 127 DVA National Cemetery System Burial includes gravesite, headstone, opening and closing of grave, and perpetual care. 128 National Cemetery Eligibility Requirements Any deceased veteran discharged from US Armed Forces under conditions other than dishonorable Military Service after 9/7/80 requires a minimum of 24 months of service except under special circumstances.. Individuals with 20 or more years of service in the NG or Reserves, entitled to retired pay are eligible for burial. Spouses, surviving spouses, dependent children and adult, handicapped children are also eligible

44 National Cemetery System (cont d) Only one gravesite is authorized for the interment of all eligible members of a family. Gravesites are not reserved before it is needed for burial. 130 Burial in Arlington National Cemetery Any active duty member of Armed Forces (except those on active duty for training only) Any veteran retired from the active military Any veteran retired from the Reserves upon reaching age 60 and drawing retired pay; and who served a period of active duty (other than for training) 131 Burial in Arlington National Cemetery Any former member of the Armed Forces separated honorably prior to Oct. 1, 1949 for medical reasons and who was rated at 30% or greater disabled effective on the day of discharge Any former member of the Armed Forces who has been awarded one of the following decorations: * Medal of Honor * Distinguished Service Cross (Navy Cross or Air Force Cross) * Distinguished Service Medal * Silver Star * Purple Heart

45 Burial in Arlington National Cemetery The President of the United States or any former President of the United States Former members of Armed Forces who served on active duty (other than for training) who held any of the following positions: * An elective office of the U.S. Govt * Office of the Chief Justice of the US or of an Assoc. Justice of the Supreme Court of the US * An office listed, at the time the person held the position, in 5 USC 5312 or 5313 (Levels I and II of the Executive Schedule) 133 Briefing Topics * Compensation *DIC * Pension * Death Pension * VA Medical Care * Burial Benefits * Special VA Benefits 134 Special Benefits 45

46 Special Benefits Objectives To learn about many of the specialized benefits that can enhance the lives of veterans 136 Special Benefits Prosthetic devices, medical accessories etc Automobile and Special Adaptive Equipment Home Assistance & Structural Alterations CHAMPVA Minority Veterans Outreach Women Veterans Services Military Sexual Trauma Counseling Spina Bifida & Children of Women Vets Benefits Special Benefits Rates Table Bereavement Counseling Blind Veterans Services Combat Veteran Eligibility Homeless Programs 137 Prosthetic (Medical Equipment and Sensory Aids) Enrolled veterans receiving VA care for any condition may receive medically necessary VA prosthetic appliances, equipment and devices, such as artificial limbs, orthopedic braces and shoes, wheelchairs, crutches and canes, and other durable medical equipment and supplies. Certain veterans who are not enrolled are also eligible for prosthetic items: veterans needing prosthetic items for a service-connected disability and veterans rated service-connected 50% or more. VA will provide hearing aids and eyeglasses to veterans who receive increased pension based on the need for regular aid and attendance or being permanently housebound, receive compensation for a service-connected disability or are former prisoners of war. Otherwise, hearing aids and eyeglasses are provided only in special circumstances, and not for normally occurring hearing or vision loss. For additional information, veterans can contact the prosthetic representative at the nearest VA Health Care Facility