The Basic Compensation Claim Process
What VA Does after It Receives Your Claim
After VA receives your Application for Compensation, it sends you a letter. The letter explains what VA needs in order to help grant your claim. It states how VA assists in getting records to support your claim. The letter may include forms for you to complete, such as medical releases. They help VA obtain pertinent medical records from your doctor or hospital. You should try to complete and return all forms VA sends within a month. Your claim can often be processed more quickly if you send a copy of your own medical records.
What Records VA Obtains to Support Your Claim
VA then attempts to get all the records relevant to your claimed medical conditions from the military, private hospitals or doctors, or any other place you tell VA. The person who decides your claim (called a Rating Veterans Service Representative) may order a medical examination. This examination is free of charge. It is extremely important that you report for your examination at the scheduled time to avoid delaying your claim.
What to Expect during the Medical Examination
You should expect the examiner performing your medical examination to evaluate the condition(s) listed on your claim for benefits. Depending on the number and type of disabilities claimed, the length of the examination will vary. Psychiatric examination or that for multiple disabilities requires more time to evaluate. The examiner may ask more questions about your disability’s history, review pertinent medical records, or order additional testing or examinations,
if necessary. The examination will not include any form of treatment for disabilities or acute illnesses.
Unless additional information, tests, or evaluations are needed, the completed evaluation will be documented and forwarded to the VA Regional Office for processing.
What VA Does after Obtaining Your Records
After the Rating Veterans Service Representative has attempted to secure all the records (or evidence) required by law (including the report of any examinations), he/she reviews your file and makes a decision on the claim according to the law and the particular facts in your case. In the rating decision, the Rating Veterans Service Representative lists the evidence, the decision, and the reasons for it. VA then sends the decision with a cover letter. If benefits are granted, the letter provides the monthly payment amount and the effective date. Payments usually begin soon after you receive the letter.
However, if benefits are not granted and you think the decision was in error, or if you think the percentage evaluation or effective date is wrong, you may appeal.
Medical Benefits Package – Standard Benefits
VA’s medical benefits package provides the following health care services to all enrolled veterans. You must be an enrolled member in the VA Healthcare system for these benefits.
- Preventive Care
- Services Immunizations
- Physical Examinations
- Health Care Assessments
- Screening Tests
- Health Education Programs
- Ambulatory (Outpatient) Diagnostic and Treatment Services
- Emergency outpatient care in VA facilities
- Medical Surgical (including reconstructive/plastic surgery as a result of disease or trauma)
- Chiropractic Care
- Mental Health
- Bereavement Counseling
- Substance Abuse
- Hospital (Inpatient) Diagnostic and Treatment
- Emergency inpatient care in VA facilities
- Medical Surgical (including reconstructive/plastic surgery as a result of disease or trauma)
- Mental Health
- Substance Abuse
- Medications and Supplies
- Prescription medications
- Over-the counter medications
- Medical and surgical supplies
Generally, they must be prescribed by a VA provider and be available under VA’s national formulary system
Will VA pay for medications written by a non-VA physician?
Generally only veterans with special eligibility, such as veterans receiving Aid and Attendance or Housebound benefits.
Determining Your Eligibility
Eligibility for health care through VA is a two-step process:
- VA must determine your eligibility status as a veteran by reviewing your Character of Discharge from active military service,and your Length of active military service
- VA must determine whether you qualify for one of the eight enrollment priority groups.
Step 1. Determine your qualifying military service The character of discharge you received from the military can be a factor. It is not an issue if you received:
- An honorable discharge
- A general discharge
- A discharge under honorable conditions
The length of your service may also matter. It depends on when you served. There’s no length of service requirement for: Former enlisted persons who started active duty before September 8, 1980, or Former officers who first entered active duty before October 17, 1981 All other veterans must have 24 months of continuous active duty military service or meet one of the exceptions described below. If you have a different character of discharge, you may still be eligible for care.
Contact your Enrollment
Coordinator at your local VA health care facility to see if you qualify. Minimum Service Requirement You do not have to meet the 24 continuous months of active duty service requirement if you: Were a reservist who was called to Active Duty and who completed the term for which you were called, and who was granted an other than dishonorable discharge, or Were a National Guard member who was called to Active Duty by federal executive order, and who completed the term for which you were called, and who was granted an other than dishonorable discharge, or Only request a benefit for or in connection with: a service-connected condition or disability; or treatment and/or counseling of sexual trauma that occurred while on active military service; or treatment of conditions related to ionizing radiation; or head or neck cancer related to nose or throat radium treatment while in the military. Were discharged or released from active duty for a hardship , or Were discharged with an “early out”; or Were discharged or released from active duty for a disability that began in the service or got worse because of the service; or Have been determined by VA to have compensable service-connected conditions; or Were discharged for a reason other than disability, but you had a medical condition at the time that Was disabling, and In the opinion of a doctor, would have justified a discharge for disability (in this last case, the disability must be documented in service records)
Step 2. Enrollment in VA Health Care System Generally, you must be enrolled in VA health care system to receive benefits offered in the Medical Benefits Package. Certain veterans do not need to be enrolled to receive medical care benefits. You do not have to be enrolled if you: Have been determined by VA to be 50% or more disabled from service-connected (SC) conditions Are seeking care for a VA rated service-connected disability only It is less than one year since you were discharged for a disability that the military determined was incurred or aggravated by your service, but that VA has not yet rated However, enrolling will assist VA in planning and budgeting resources.
Veterans can fill in forms for health, other benefits online
BY TONY LEE ORR | GCN STAFF
The Veterans Affairs Department has unveiled two Web applications that move it closer to its electronic-government goal of letting veterans apply for benefits online. To apply for health care benefits, veterans – a growing number of whom have Internet access – can fill out and submit the Veterans Health Administration’s 10-10EZ Form at https://www.1010ez.med. va.gov/sec/vha/1010ez.
Before moving the form online in November, VA tested the application at 30 facilities.
Input, encode, sign here After a user fills in the form, the app automatically encrypts the data and e-mails it to the appropriate VA health facility.
Employees check the data, print the form and mail it to the veteran for signature. Users can speed up the process by printing the form at home, signing it and mailing it to the center they have selected for services. The second program is run by the Veterans Benefits Administration. The Veterans Online Application Web Site, known as VONAPP, lets users apply for VBA compensation, pension and vocational rehabilitation at vabenefits.vba.va.gov/vonapp.
Once the information is transmitted to VA, it is transferred to a server behind the department’s firewall, said Edward F. Meagher, the VA secretary’s special assistant for information technology. Meagher is awaiting Senate confirmation to his appointment as VA’s deputy assistant secretary for IT. VBA hosts the Web site in Philadelphia on two quad-processor Compaq ProLiant 6000 servers, said Stephen D. Frans, a contract employee from Impact Innovations Group of
Atlanta, which managed the site development for VA. The servers, which have four 400-MHz Pentium III Xeon processors each, run Microsoft SQL Server Version 7.0 under Microsoft Windows NT with Service Pack 6A.
Submitted electronic enrollment forms are initially stored outside the VA’s firewall, Frans said. Regional VBA offices sign on periodically and use the VONAPP program to pull the information behind the firewall, he said.
Listed are the eight priority groups for VA Healthcare and their priority description:
Priority Description
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 housebound 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:
Veterans with 0% service-connected conditions, but receiving VA compensation
Veterans seeking care only for disorders relating to Ionizing Radiation and Project 112/SHAD
Veterans seeking care for Agent Orange Exposure during service in Vietnam
Veterans seeking care for Gulf War Illness or for conditions related to exposure to Environmental Contaminants during service in the Persian Gulf
Veterans of World War I or the Mexican Border War
Veterans who served in combat in a war after the Gulf War or during a period of hostility after November 11, 1998 for 2 years following discharge or release from the military
Priority 7:
Veterans who agree to pay specified copayments with income and/or net worth above VA Means Test 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
Subpriority e: Noncompensable 0% service-connected veterans not included in Subpriority a above. VA is not currently using Subpriority e.
Subpriority g: Nonservice-connected veterans not included in Subpriority c above. VA is not currently using Subpriority g.
Priority 8:
Veterans who agree to pay specified copayments with income and/or net worth above VA Means Test threshold and the Geographic Means Test Threshold.
Subpriority a: Noncompensable 0% service-connected veterans enrolled as of January 16, 2003 and who have remained enrolled since that date
Subpriority c: Nonservice-connected veterans enrolled as of January 16, 2003 and who have remained enrolled since that date
Subpriority e: Noncompensable 0% service-connected veterans applying for enrollment after January 16, 2003
Subpriority g: Nonservice-connected veterans applying for enrollment after January 16, 2003
If you have any questions about any of the articles or information posted on this page, feel free to contact Bill Hutton at lasd2@yahoo.com