It’s important for all servicemembers to realize that the Department of Veterans Affairs (VA) has its own disability process independent of the Armed Forces. Servicemembers are evaluated by the VA for a rating after separation.
To summarize:
The severity of the DOD disability rating will affect (if you have served less than 20 years) whether or not you receive military retirement pay, life insurance, health insurance, and access to military commissaries.
The VA disability rating will determine how much disability pay you receive and in which priority group you will be placed, which affects your access to care.
WHO IS ELIGIBLE FOR MEDICAL BENEFITS?
The VA offers a full range of outpatient and inpatient services to all enrolled veterans – but not all vets who are enrolled in the system can actually access care. The key to being able to use these benefits is in which priority group you are assigned. The VA has developed this ranking system in order to control the number of veterans who use the healthcare system. Once you are enrolled, you can receive health care at any VA facility in the country.
The casualties from the wars in Iraq and Afghanistan that have taxed the limits of the DOD healthcare system, are also taxing the VA system. Veterans with service-connected disabilities and those below the low-income threshold are given priority for care.
The criteria for eligibility for most veterans’ healthcare benefits is based solely on active military service in the Army, Navy, Air Force, Marines, or Coast Guard (or in the Merchant Marines during World War II) AND a discharge under other than dishonorable conditions. Reservists and National Guard members who were called to active duty by a Federal Executive Order (for example, to serve in Iraq or Afghanistan) may qualify for VA health care benefits.
Returning servicemembers, including Reservists and National Guard members who served on active duty in a theater of combat operations, have special eligibility for hospital care, medical services, and nursing home care for FIVE years following discharge from active duty.
You are not required to enroll if:
1. you are a veteran with a service-connected disability of 50 percent or more
2. you are a veteran, within 12 months of discharge, seeking care for a disability the military determined was incurred or aggravated in the line of duty, but which the
VA has not yet rated
3. you are a veteran seeking care for a service-connected disability only.
If you are in one of those three groups, completing the paperwork for enrollment is not required in order to seek care, but is strongly advised.
YOUR PRIORITY GROUP AFFECTS YOUR ACCESS TO CARE
You are assigned to a priority group based on the VA evaluation of your medical condition, your service experience (if you were a POW or were awarded a purple heart), and your income level. These are the 8 groups.
Priority 1
» Veterans with service-connected disabilities rated 50% or more disabling, or
» Veterans determined by VA to be unemployable due to service-connected conditions.
Priority 2
» Veterans with service-connected disabilities rated 30% or 40% disabling
Priority 3
» Veterans with service-connected disabilities rated 10% or 20% disabling
» Veterans who are former POWs
» Veterans awarded the Purple Heart
» Veterans whose discharge was for a disability that began in the line of duty
» Veterans who are disabled because of VA treatment or participation in VA vocational Rehabilitation program
Priority 4
» Veterans who are receiving aid and attendance or household benefits (on pension) from VA
» Veterans who have been determined by VA to be catastrophically disabled
Priority 5
» Veterans receiving VA pension benefits
» Veterans who are eligible for Medicaid programs
» Veterans with income and assets below VA Means Test Thresholds
Priority 6
» World War I veterans
» Veterans with 0 percent service-connected veterans, but receiving VA compensations
» Veterans exposed to Ionizing Radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki
» Project 112/SHAD participants
» Veterans who served in a theater of combat operations after November 11, 1998 as follows:
Currently enrolled Veterans and new enrollees who were discharged from active duty on or after January 28, 2003, are eligible for the enhanced benefits for 5 years post discharge
Veteran discharged from active duty before January 28, 2003, who apply for enrollment on or after January 28, 2008 are eligible for this enhanced enrollment benefit through January 27, 2011
Priority 7
» Veterans who agree to pay specified co-pay with income and/or net worth above VA Income Threshold and income below the Geographic Means Test Threshold
›Subpriority a: Noncompensable 0% service-connected veterans who were enrolled in VA Health Care System on a specified date and who have remained enrolled since that date.
›Subpriority c: Nonservice-connected veterans who were enrolled in VA Health Care System on a specified date and who have remained enrolled since that date.
Priority 8
»New VA regulations now permit certain veterans in Priority Group 8 to enroll in the VA healthcare system. Previously, veterans in Priority Group 8, whose household incomes exceeded VA income thresholds, were denied enrollment. VA will now enroll Priority Group 8 veterans if their household income does not exceed VA income thresholds by more than 10%.
» Also eligible for enrollment are veterans with income and/or net worth above the VA National Income Thresholds and the VA National Geographic Income Thresholds who agree to pay copays.
» Other veterans eligible for enrollment include: Noncompensable 0% service-connected and:
›Subpriority a: Enrolled as of January 16, 2003, and who have remained enrolled since that date and/or placed in this subpriority due to changed eligibility status
›Subpriority b: Enrolled on or after June 15, 2009 whose income exceeds the current VA National Income Thresholds or VA National Geographic Income Thresholds by 10% or less
» Also eligible for enrollment are: Nonservice-connected veterans and:
›Subpriority c: Enrolled as of January 16, 2003, and who have remained enrolled since that date and/or placed in this subpriority due to changed eligibility status
›Subpriority d: Enrolled on or after June 15, 2009 whose income exceeds the current VA National Income Thresholds or VA National Geographic Income Thresholds by 10% or less
The following veterans are not eligible for enrollment: They do not meet the criteria above:
›Subpriority e: Noncompensable 0% service-connected
›Subpriority g: Nonservice-connected
Veterans assigned to Priority Groups 8e or 8g are not eligible for enrollment as a result of the enrollment restriction which suspended enrolling new high-income veterans who apply for care after January 16, 2003. Veterans enrolled in Priority Groups 8a or 8c will remain enrolled and eligible for the full-range of VA health care benefits.
Peter S. Gaytan is the author of For Service to Your Country, The Insider’s Guide to Veterans’ Benefits (Citadel, 2008), available from Amazon, Barnes and Noble, and other booksellers. He has served as an advocate in securing and protecting the earned benefits of America’s veterans for more than a decade. Gaytan is the Executive Director of the American Legion, the largest veterans service organization in America.
*Material released with permission of the authors.
Image courtesy of www.facethefacts.org.
