Link to naval ships that are being accepted for Agent Orange claims
Service Officer FAQ’s About Claims and Benefits
The following are frequently asked questions asked by members and appropriate answers
Provided through the VFW Pennsylvania Department’s Service Officer Program.
Do I have to enroll to receive VA health care?
“While most veterans must be enrolled to receive VA health care, some veterans are exempt from the enrollment requirement due to meeting special eligibility criteria. If you fall into one of the following categories, you are not required to enroll: if you are seeking care for a VA-rated service connected disability; if VA has rated you with a service-connected disability of 50% or more; and if less than one year has passed since you were discharged for a disability that the military determined was incurred or aggravated in the line of duty, but that VA has not yet rated.”
Why does VA encourage enrollment from those veterans who Congress specifically exempted from the process?
“The reason we encourage all potential VA health care patients to enroll is for planning and budgeting purposes. Enrollment numbers help to identify the potential demand for VA services. By including all potential patients in the enrollment count, including those that are exempt, we are in a much better position to identify necessary funding levels to Congress.”
How long will it take to receive a decision on my claim?
“The length of time it takes to receive a decision depends on several factors, such as the complexity of your disability(ies), the number of disabilities you claim, and the availability of evidence needed to decide your claim. The regional office will keep you informed as your claim or appeal progresses.
Do I need to do anything if I have a claim or appeal pending with VA?
“No, you do not have to do anything additional with regard to your pending claim or appeal.”
Can I file a claim for another disability while I have a claim or an appeal pending?
“Yes, if you have another disability that is not part of your current claim or appeal, you should submit a new claim by using VA Form 21-4138, Statement of Support of Claim, or write a letter. Be sure to specify the additional disability and submit any current medical evidence that supports your claim. Include your VA claim number or Social Security number on all correspondence. Mail the completed form or letter and any evidence you have to your VA regional office. If you have designated a Veterans Service Organization to represent you on your pending claim or appeal, be sure to also contact your claims representative for assistance in filing a new claim.”
If VA increases my disability rating or adds another disability, when will my increased benefits be effective?
“The effective date for your increased benefits will be the date VA received your claim for an increase or a new disability. Note: VA may award an earlier effective date for an individual evaluation of a current service-connected disability if the medical evidence reveals that there is an increase in the veteran’s disability and a claim is received within one year. For example, if there is medical evidence to show that the veteran’s service-connected left knee arthritis was worse on June 13, 2007 and we receive a claim for an increased evaluation for the veteran’s left knee arthritis on December 6, 2007, then the effective date for the increased evaluation will be June 13, 2007.
Can I get back pay to when I was discharged?
“Generally, VA can only pay benefits based on the date VA received your claim. However if it has been less than a year from your discharge, your award will be retroactive to your separation date.”
I already receive VA care, but I don’t remember enrolling. How can I verify my enrollment?
“If you are uncertain of your enrollment status, check with the Enrollment Coordinator at your local VA health care facility or you may call the VA Health Benefits Service Center at 1-877-222-VETS (8387).
Must I reapply in subsequent years and will I receive an enrollment confirmation?
“If you have previously enrolled, your enrollment will be reviewed annually without any action necessary on your part. Veterans who are required to update their financial information are still required to provide their income information on an annual basis using the form VA 10-10EZR. Depending on your priority group and the availability of funds for VA to provide medical benefits to all enrollees, your enrollment will be automatically renewed without any action on your part. Should there be any change to your enrollment status, you will be notified in writing
If enrolled, must I use the VA as my exclusive health care provider?
“While there is no requirement that VA become your exclusive provider of care, please be aware that our authority to pay for non-VA care is extremely limited. You may, however, elect to use your private health insurance benefits as a supplement for your VA health care benefits.
What income is counted for the Means Test and is family size considered?
“VA considers your previous year’s total household income (both earned and unearned) for you as well as your spouse and dependent children. Earned income is usually wages you receive from working. Unearned income can be interest earned, dividends received, money from retirement funds, Social Security payments, annuities or earnings from other assets. The number of persons in your family will be factored into the calculation to determine the applicable incomethreshold – both the VA national income threshold and the income threshold for your geographic region.”
What is a Geographic Threshold?
“By regulation, VA is required to identify veterans who agree to make VA medical care copayments and whose family incomes are below the “low-income” limits for the geographical area set annually by the U.S. Department of Housing and Urban Development (HUD) for public housing benefits. Those veterans whose incomes and assets fall between the VA means test limits and the HUD low-income limits will have their inpatient medical care co-payments reduced by 80%. The remaining higher income veterans will continue to pay the full inpatient medical care co-payments and will be assigned the means test status “MT Co-payment Required”. This regulation has no affect on outpatient and medication co-payments.”
For those veterans who have more than one residence, which address is used for means testing under the geographically-based income thresholds?
“The address used to determine your geographically-based income threshold is your permanent address. Typically, it is the location in which you declare residency for voting and tax purposes.”
How frequently are the thresholds updated?
“Income thresholds, used for the national Means Test as well as for geographic adjustments for high cost-of-living areas, are updated annually.”
I am a recently discharged combat veteran. Must I pay VA co-payments?
“If the services are provided for the treatment of a condition that may be related to your military service, you will not be charged any co-payments. This benefit is limited to a two-year period following military discharge. You will, however, be subject to means testing (and co-payments, if applicable) for care of any condition clearly not related to your military service such as a broken limb or a problem that existed prior to entering service.”
How many co-payments charges may be assessed during a single day?
“Generally you will be charged only one co-payment on a single day, whether it be an inpatient, outpatient, or long –term care co-payment, based on the highest level of service provided on that day. Medication co-payments, which are applicable only to outpatients, vary depending upon the number of prescriptions filled. If you are an outpatient who has both a specialty care visit as well
as a basic care visit on the same day, you will be charged for the specialty care visit since it is the more expensive level of care. Inpatient co-payments are based on both a standard charge for each 90 days of care within a 365-day period as well as a per diem (daily) charge. Since longterm care co-payments can apply for inpatient or outpatient-type services, the co-payments vary
based upon the service provided and your ability to pay.”
Who qualifies for the annual cap on medication co-payments?
“The annual cap on medication co-payments applies to Priority Groups 2 through 6 (Priority Group 1 is exempt from ALL copayments). Because of their higher financial status, veterans in Priority Groups 7 and 8 do NOT qualify for the medication co-payment annual cap. For those who qualify, once the annual limit is reached, all subsequent prescriptions filled during the calendar year will be free of the co-payment requirement.”
Hearing aids and eyeglasses are listed as “limited” benefits. Under what circumstancesdo I qualify?
“To qualify for hearing aids and eyeglasses you must have a VA service-connected disability rating of 10% or more. You may also qualify if you are a former prisoner of war or are receiving increased pension based on your need for regular aid and attendance or being permanently housebound.”
Am I eligible for dental care?
“You are eligible for dental services if your care is for a service-connected condition or if you have a service-connected rating of 100 percent. You may also qualify if you are a former prisoner of war, a participant in a VA vocational rehabilitation program, or if your dental condition is aggravating a medical problem under VA treatment. In addition, you may also qualify for onetime dental treatment if you have been recently discharged from military service, had a documented dental condition while in service, and your discharge certificate does not include certification that all appropriate treatment had been rendered prior to being released.”
Am I limited to a specific number of inpatient days or outpatient visits during a given period a time?
“For acute care services (inpatient days of care and outpatient visits) there are no limits.”
Do I qualify for routine health care of non-VA facilities at VA expense?
“To qualify for routine non-VA care at VA expense (otherwise known as fee-basis care), you must first be given specific authorization. Included among the factors in determining whether such care will be authorized is your medical condition and availability of VA services within your geographic area.”
Am I eligible for emergency care at non-VA facilities?
“You are eligible if the non-VA emergency care is for a service-connected condition or, if enrolled, you have been provided care by a VA clinician or provider within the past 24 months and have no other coverage or ability to pay for the services. Also, it must be determined that VA health care facilities were not feasibly available, that a delay in medical attention would have endangered your life or health, and that you are personally liable for the cost of the services.”
If VA approval needed before I obtain non-VA emergency services?
“While approval is not required, notification to the nearest VA health care facility must be made within 48 hours if hospitalization is required. Since VA payment is limited up to the point your condition is stable for transportation to a VA facility, transfer arrangements should be made soon as possible.”
Does the VA offer compensation for travel expenses to and from a VA facility?
“If you meet specific criteria, you are eligible for travel benefits. In most cases, travel benefits are subject to a deductible. Exceptions to the deductions requirement are: 1)travel for a compensation and pension examination; and 2) travel by an ambulance or a specially
equipped van. Because travel benefits are subject to annual mileage rate and deductible changes, we publish a separate document each year.”
Do I qualify for travel benefits?
“You may qualify for beneficiary travel payments if you fall into one of the following categories
You have a service-connected rating of 30 percent or more
You are traveling for treatment of a service-connected condition
You receive a VA pension
You are traveling for a scheduled compensation or pension examination
Your household income does not exceed the maximum annual VA pension rate
Your medical condition requires an ambulance or a specially equipped van, you are unable to defray the cost, and the travel is pre-authorized (authorization is not required for emergencies if a delay would endanger your life or health.”
I already provided financial information on my initial VA application. Why is it necessary to complete a separate financial assessment for long-term care?
Unlike the information collected from the Means Test which is based on your previous year’s income, the 10-10EC is designed to assess your current financial status, including current expenses. This in-depth analysis provides the necessary monthly income/expense information to determine whether you qualify for cost-free care or a significant reduction from the maximum copayment charge.”
Once I submit a completed VA Form 10-10EC, who notifies me of my long-term care copayment requirements?
“The social worker or case manager involved in your long-term care placement will provide you with an annual projection of your monthly co-payment changes.”
Assuming I qualify for nursing home care, how is it determined whether the care will be provided in a VA facility or a private nursing home at VA expenses?
“Generally, if you qualify for indefinite nursing home care, that care will be indefinite nursing home care, that care will be furnished in a VA facility. Care may be provided in a private facility under VA contract when there is compelling medical or social need. If you do not qualify for indefinite care, you may be placed in a community nursing home – generally not to exceed six months – following an episode of VA care. The purpose of this short-term placement is to provide assistance to you and your family while alternative, long term arrangements are explored.”
For veterans who do not qualify for indefinite nursing home care at VA expense, what
assistance is available for making alternative arrangements?
“When the need for nursing home care extends beyond the veteran’s eligibility, our social workers will help family members identify possible sources for financial assistance. Our staff will review basic Medicare and Medicaid eligibility and direct the family to the appropriate sources for further assistance, including possible application for additional VA benefit programs.”
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