Hospital and Outpatient Care
Eligibility for VA hospital and outpatient care is divided into two categories: In the first category of veterans, VA shall provide any needed hospital and outpatient care to the extent and in the amount that Congress appropriates funds. In the second category, VA may furnish any needed hospital and outpatient care to the extent resources and facilities are available, if the veteran makes a copayment.
Category 1 is composed of the following: veterans in need of care for a service-connected condition; veterans who have a compensable service-connected disability; veterans whose discharge or release from active military service was for a compensable disability that was incurred or aggravated in the line of duty; veterans who are former prisoners of war; veterans of the Mexican Border period or World War I; veterans who were exposed to Agent Orange in Vietnam, ionizing radiation, or environmental hazards in the Persian Gulf; and veterans whose annual income and net worth is below the “means test” threshold. The threshold is adjusted annually and published in January.
Category 2 is composed of all other veterans, including nonservice-connected veterans with incomes and net worth above the “means test” threshold and zero percent service-connected veterans needing care for any nonservice-connected disability.
These veterans must agree to make copayments. VA holds these patients responsible for the Medicare deductible for the first 90 days of care during any 365-day period. For each additional 90 days of hospital care, the patient is charged one-half the Medicare deductible. In addition to these charges, the patient is charged $10 a day for hospital care and $5 a day for VA nursing-home care. For outpatient care, the copayment is 20 percent of the cost of an average outpatient visit.
Applying for Medical Care
Veterans who are nonservice-connected or zero percent service-connected and not receiving monetary benedfits from VA are required to complete a financial assessment. The income of the patient and the incomes of the patient’s spouse and dependents are considered in making a “means test” eligibility assessment. The assessment includes Social Security, U.S. Civil Service retirement, U.S. Railroad Retirement, military retirement, unemployment insurance, any other retirement income, total wages from all employers, interest and dividends, workers’ compensation, black lung benefits and any other gross income for the calendar year prior to application for care. Also considered are assets such as the market value of stocks, bonds, notes, individual retirement accounts, bank deposits, savings accounts and cash. Debts are subtracted from income and assets to determine net worth. The patient’s primary residence and personal property are excluded from the net worth determination.
The patient must fill out VA Form 10-10F, Financial Worksheet, at the time care is requested. VA has the authority to compare income information provided by the veteran with information obtained from the Social Security Administration and the Internal Revenue Service.
Billing Insurance Companies
When applying for medical care, all veterans will be asked to provide information pertaining to health insurance coverage, including policies held by spouses. VA is authorized to submit claims to insurance carriers for the recovery of costs for medical care provided to nonservice-connected veterans and service-connected vet erans for nonservice-connected conditions.
Veterans will not be held responsible for the deductible requirements and copayments established by their insurance carriers.
They also will not be responsible for portions of an insurance claim not covered by the policy. Veterans above certain income levels, however, are responsible for the copayments required by federal law.
Nursing care in VA or private nursing homes is provided for veterans who are not acutely ill and not in need of hospital care. If space and resources are available in VA facilities, VA may provide nursing-home care. Veterans who have a service-connected disability are given first priority for nursing-home care. The following may be provided nursing-home care without an income eligibility assessment: veterans with service-connected disability, veterans who were exposed to herbicides while serving in Vietnam, veterans exposed to ionizing radiation during atmospheric testing or in the occupation of Hiroshima and Nagasaki, veterans with a condition related to an environmental exposure in the Persian Gulf, former prisoners of war, veterans on VA pension, veterans of the Mexican Border period or World War I and veterans eligible for Medicaid.
Nonservice-connected veterans and zero percent noncompensable service-connected veterans requiring nursing-home care for any nonservice-connected disability must submit an income eligibility assessment form, VA Form 10-10F, to determine whether they will be billed for nursing-home care.
Income assessment procedures are the same as for hospital care. If the veteran agrees to make the applicable copayment, nursing-home care may be authorized for nonservice-connected veterans and zero percent service-connected veterans.
Veterans who need nursing-home care may be transferred at VA expense to private nursing homes from VA medical centers, nursing homes or domiciliaries. VA-authorized care normally may not be provided in excess of six months, except for veterans who need nursing-home care for a service-connected disability or for veterans who were hospitalized primarily for treatment of a service-connected disability.
Direct admission to private nursing homes at VA expense is limited to: (1) a veteran who requires nursing care for a service-connected disability after medical determination by VA; (2) a patient in a military hospital who requires a protracted period of nursing care and who will become a veteran upon discharge from the Armed Forces; and (3) a veteran who had been discharged from a VA medical center and is receiving home health services from VA.
Domiciliary care provides rehabilitative and long-term, health-maintenance care for veterans who require minimal medical care but who do not need the skilled nursing services provided in nursing homes. VA may provide domiciliary care to veterans whose annual 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.
Outpatient Pharmacy Services
Pharmacy services are provided free to: (1) veterans receiving medication for treatment of service-connected conditions; (2)veterans rated with 50 percent or more service-connected disability; and (3) veterans whose annual income does not exceedthe maximum VA pension. Nonservice-connected veterans and veterans with a service-connection rated less than 50 percent receiving medication on an outpatient basis from VA facilities for the treatment of nonservice-connected ailments are charged$2 for each 30-day supply.
Outpatient Dental Treatment
Outpatient dental treatment provided by VA includes examinations and the full spectrum of diagnostic, surgical, restorative andpreventive techniques. Nonservice-connected veterans who are authorized outpatient dental care may be billed the applicablecopayment if their income exceeds the maximum threshold. The following may be eligible for free dental care:
1. Dental conditions or disabilities that are service connected and compensable will be treated.
2. Service-connected dental conditions or disabilities that are not compensable may receive one-time treatment if the conditions can be shown to have existed at discharge or within 180 days of release from active service. Veterans who served on active duty for 90 days or more during the Persian Gulf War are included in this category. Veterans must apply to VA for dental care within 90 days following separation. Veterans will not be considered eligible if their separation document indicates that necessary treatment was completed during the 90 days prior to separation.
3. Veterans may receive treatment for service-connected, noncompensable dental conditions resulting from combat wounds or service injuries, and service-connected, noncompensable dental conditions of former prisoners of war who were incarcerated less than 90 days .
4. Veterans who were prisoners of war for 90 days or more may receive complete dental care.
5. Veterans may receive complete dental care if receiving disability compensation at the 100-percent rate for service-connected conditions or if eligible to receive it by reason of unemployability.
6. Nonservice-connected dental conditions that are determined by VA to be aggravating a service-connected medical problem may be treated.
7. Veterans participating in a vocational rehabilitation program may be treated.
8. Veterans may be treated for nonservice-connected dental conditions when treatment was begun while in a VA medical center, when it is professionally determined to be reasonably necessary to complete such dental treatment on an outpatient basis.
9. Veterans scheduled for admission to inpatient services or who are receiving medical services may receive outpatient dental care if the dental condition is determined to be complicating a medical condition which VA is currently treating.
Persian Gulf, Agent Orange and Ionizing Radiation
Veterans who served in the Persian Gulf War or who claim exposure to Agent Orange or atomic radiation are provided with free, comprehensive medical examinations, including base-line laboratory tests and other diagnostic tests deemed by an examining physician necessary to determine current health status. Results of the examinations, which include preparation of the veteran’s military service and exposure history, are entered into special, computerized data bases, called registries. These data bases assist VA in analyzing the types of health conditions being reported by veterans. Registry participants are advised of the results of their examinations in personal consultations. Veterans wishing to participate should contact the nearest VA health-care facility for an examination. VA operates a toll-free hotline at 800-749-8387 to inform Persian Gulf veterans about VA programs, their benefits and the latest information available about Persian Gulf affairs.
VA provides medical treatment to any Vietnam-Era veteran who, while serving in Vietnam, may have been exposed to dioxin or to a toxic substance in a herbicide or defoliant used for military purposes, for conditions related to such exposure.
Health-care services are available for medical conditions possibly related to any veteran’s exposure to ionizing radiation from the detonation of a nuclear device in connection with nuclear tests, or with the American occupation of Hiroshima and Nagasaki, Japan, during the period beginning Sept. 11, 1945, and ending July 1, 1946. VA also provides priority treatment to any Persian Gulf War veteran who may have been exposed to a toxic substance or environmental zard during the Persian Gulf War, for any disability possibly related to such exposure.
Veterans are eligible for payment or reimbursement for travel costs to receive VA medical care. Travel payments are subject to a deductible of $3 for each one-way trip and an $18 per month maximum payment. Two exceptions to this rule are travel for a compensation or pension examination and travel by special modes of transportation, such as an ambulance or a specially-equipped van. Beneficiary travel payments may be made to the following:
1. Veterans whose service-connected disabilities are rated at 30 percent or more.
2. Veterans who are traveling for treatment of a service-connected condition.
3. Veterans who receive a VA pension.
4. Veterans traveling for compensation or pension examinations.
5. Veterans whose income is less than or equal to the maximum VA pension rate .
6. Veterans whose medical condition requires use of a special mode of transportation, if the veteran is unable to defray the costs and travel is pre-authorized. If the medical condition is a medical emergency, travel need not be pre-authorized when a delay to obtain authorization would be hazardous.
Alcohol and Drug Dependence Treatment
Veterans eligible for VA medical care may apply for substance abuse treatment. Veterans without service-connected disabilities whose incomes exceed the threshold for free medical care may be authorized treatment for alcohol and drug dependence only if the veteran agrees to make a copayment. After hospitalization for alcohol or drug treatment, veterans may be eligible for outpatient care or may be authorized to continue treatment or rehabilitation at VA expense in private facilities such as halfway houses.
Veterans may apply for prosthetic services for conditions requiring hospital and outpatient care. Veterans seeking assistance should contact Prosthetic Service at the nearest VA medical center or outpatient clinic.
Services and Aids for Blind Veterans
Blind veterans may be eligible for services at a VA medical center or for admission to a VA blind rehabilitation center or clinic.
Services are available at all VA medical facilities through the Visual Impairment Services (VIS) coordinator. In addition, blind veterans entitled to receive disability compensation may receive VA aids for the blind. Benefits for blind veterans include:
1. A total health and benefits review by a VA Visual Impairment Services team.
2. Adjustment to blindness training.
3. Home Improvements and Structural Alterations to homes (HISA Program).
4. Specially adapted housing and adaptations.
5. Low-vision aids and training in their use.
6. Electronic and mechanical aids for the blind, including adaptive computers and computer-assisted devices.
7. Guide dogs, including the expense of training the veteran to use the dog and the cost of the dog’s medical care.
8. Talking books, tapes and Braille literature, provided from the Library of Congress.
Home Improvements and Structural Alterations
The Home Improvements and Structural Alterations program helps pay for home improvements necessary to provide disability access to the home. VA will pay up to $4,100 for alterations for a veteran being treated for a service-connected disability or a veteran with a disability rating of 50 percent or more. Up to $1,200 may be paid to other eligible veterans. Apply at the nearest VA medical center.
The following are eligible for counseling to assist in readjusting to civilian life: veterans who served on active duty in a combat theater during World War II, the Korean Conflict, the Vietnam Era, the Persian Gulf War, or the campaigns in Lebanon, Grenada, Panama or Somalia. In addition, veterans who served in the active military during the Vietnam Era, even though they were not in a combat theater. Counseling is provided at Vet Centers to help veterans resolve war-related psychological difficulties and to help them achieve a successful post-war readjustment to civilian life. Assistance includes group, individual and family counseling; community outreach; and education. Veterans are placed with non-VA agencies if needed.
One common readjustment problem is post-traumatic stress disorder, or PTSD. This refers to such symptoms as nightmares, intrusive recollections or memories, flashbacks, anxiety or sudden reactions after exposure to traumatic conditions.
Readjustment difficulties may affect functioning in school, family or work. Counseling also is provided veterans for difficulties due to sexual assault or harassment while on active duty. In areas distant from Vet Centers or VA medical facilities, veterans may obtain readjustment counseling from private-sector professionals who are on contract with VA. To locate a contract provider, contact the nearest Vet Center.
Special Categories for Medical Care
Merchant Marine Seamen
Merchant Marine seamen who served in World War II may be qualified for veterans benefits. When applying for medical care, seamen must present their DD-214 discharge certificate from the Defense Department to the VA medical facility. VA regional offices can assist in obtaining a certificate.
VA is authorized to provide reciprocal medical care to veterans of nations allied or associated with the United States during World War I or World War II. Such treatment is available at any VA medical facility if authorized and reimbursed by the foreign government. VA also is authorized to provide hospitalization, outpatient and domiciliary care to former members of the armed forces of Czechoslovakia or Poland who participated during World Wars I and II in armed conflict against an enemy of the United States, if they have been citizens of the United States for at least 10 years.
Medical Care for Dependents and Survivors
CHAMPVA, the VA Civilian Health and Medical Program, shares the cost of medical care for dependents and survivors of veterans. If not eligible for CHAMPUS or Medicare, Part A, the following are eligible for CHAMPVA:
1. The spouse or child of a veteran who has a permanent and total service-connected disability.
2. The spouse or child of a veteran who died of a service-connected condition, or who, at the time of death, was permanently and totally disabled from a service-connected condition.
3. The spouse or child of a person who died in the line of duty, not due to misconduct, within 30 days of entry into active service.
Dependents are not eligible for CHAMPVA benefits if they are eligible for medical care under CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) or Medicare, Part A, as a result of reaching age 65.
Beneficiaries age 65 or older who lose eligibility for CHAMPVA by becoming potentially eligible for Medicare, Part A, or who qualify for Medicare, Part A, benefits on the basis of a disability may re-establish CHAMPVA eligibility by submitting documentation from the Social Security Administration certifying they are not entitled to or have exhausted Medicare, Part A, benefits. Persons under age 65 who are enrolled in both Medicare Parts A and B may become eligible for CHAMPVA as a secondary payer to Medicare. Apply to the CHAMPVA Center, P.O. Box 65024, Denver, CO 80206-5024, or call 1-800-733-8387.
A number of VA benefits assist homeless veterans, including disability compensation, pension, education and burial benefits.
Homeless veterans also are provided special assistance through many VA program initiatives.
In addition, VA provides health and rehabilitation programs for homeless veterans. Health Care for Homeless Veterans programs provide outreach and comprehensive medical, psychological and rehabilitation treatment programs. Domiciliary Care for Homeless Veterans programs provide residential rehabilitation services. VA has a growing number of Compensated Work Therapy/Therapeutic Residence group homes, special daytime, drop-in centers, and Comprehensive Homeless Centers.
VA’s Homeless Providers Grant and Per Diem Program assists nonprofit and local government agencies to establish housing or service centers for homeless veterans. Grants are awarded for the construction, acquisition or renovation of facilities, and for the purchase of vans for the transportation of homeless veterans.
VA also has joined with the Department of Housing and Urban Development, the Social Security Administration, veterans service organizations, and community nonprofit homeless service providers to assist homeless veterans. For information on benefits for homeless veterans, contact the nearest VA facility.
Women veterans are eligible for the same VA benefits as male veterans. VA is required to provide appropriate and timely medical care to any eligible woman veteran. In addition to routine medical care, each VA medical facility provides women veterans the following: complete physical exams that include breast and pelvic examinations; general reproductive health care; gynecology services; and referrals for services that may not be available at that facility.
To ensure privacy for women veterans, VA medical centers have made structural changes or renovated areas. Women veteran coordinators are available at each VA medical center and regional office to counsel women veterans seeking treatment and benefits.
VA also may provide counseling to overcome psychological trauma resulting from physical assault, battery of a sexual nature or sexual harassment during active duty. This counseling is provided at VA medical centers and Vet Centers. In addition, treatment is authorized for physical conditions resulting from sexual trauma.
VA will pay for medical services for the treatment of service-connected disabilities and related conditions for veterans abroad.
VA does not authorize nursing-home care in foreign jurisdictions, except for the Philippines. Services in most foreign countries must be authorized by the Foreign Medical Program Office, PO Box 65021, Denver, CO 80206-5021, USA, Phone 303-331-7590. Services provided in Canada are under the jurisdiction of the VA Center in White River Junction, Vermont 05009-0001, USA, phone 802-296-6379. Services provided in the Philippines are under the jurisdiction of the United States VA office in Pasay City, phone 011-632-833-4566.
Other Overseas Benefits
Virtually all VA monetary benefits, including compensation, pension, educational assistance and burial allowances, are payable regardless of place of residence. There are, however, some program limitations in foreign jurisdictions. Home-loan guaranties are available only in the United States and selected territories and possessions. Educational benefits are limited to approved degree-granting programs in institutions of higher learning. Beneficiaries residing in foreign countries should contact the nearest American embassy or consulate for information and claims assistance. In Canada, veterans should contact the local office of Veterans Affairs Canada.
Benefits for Special Groups
A number of groups who have provided military-related service to the United States have been granted VA benefits. For the service to qualify, the Defense Secretary must certify that the group has provided active military service. Individual members must be issued a discharge by the Defense Secretary to qualify for VA benefits. Service in the following groups has been certified as active military service for benefits purposes:
1. Women’s Air Forces Service Pilots (WASPs).
2. Signal Corps Female Telephone Operators Unit of World I.
3. Engineer Field Clerks.
4. Women’s Army Auxiliary Corps (WAAC).
5. Quartermaster Corps female clerical employees serving with the American Expeditionary Forces in World War I.
6. Civilian employees of Pacific naval air bases who actively participated in defense of Wake Island during World War
7. Reconstruction aides and dietitians in World War I.
8. Male civilian ferry pilots.
9. Wake Island defenders from Guam.
10. Civilian personnel assigned to OSS secret intelligence.
11. Guam Combat Patrol.
12. Quartermaster Corps members of the Keswick crew on Corregidor during World War II.
13. U.S. civilians who participated in the defense of Bataan.
14. U.S. merchant seamen who served on blockships in support of Operation Mulberry in the World War II invasion of Normandy.
15. American merchant marines in oceangoing service during World War II.
16. Civilian Navy IFF radar technicians who served in combat areas of the Pacific during World War II.
17. U.S. civilians of the American Field Service who served overseas in World War I.
18. U.S. civilians of the American Field Service who served overseas under U.S. armies and U.S. army groups in World War II.
19. U.S. civilian employees of American Airlines who served overseas in a contract with the Air Transport Command between Dec. 14, 1941, and Aug. 14, 1945.
20. Civilian crewmen of U.S. Coast and Geodetic Survey vessels who served in areas of immediate military hazard while conducting cooperative operaions with and for the U.S. Armed Forces between Dec. 7, 1941, and Aug. 15, 1945.
21. Members of the American Volunteer Group (Flying Tigers) serving between Dec. 7, 1941, and July 18, 1942.
22. U.S. civilian flight crew and aviation ground support employees of United Air Lines who served overseas in a contract with Air Transport Command between Dec. 14, 1941, and Aug. 14, 1945.
23. U.S. civilian flight crew and aviation ground support employees of Transcontinental and Western Air, Inc. (TWA), who served overseas in a contract with the Air Transport Command between Dec. 14, 1941, and Aug. 14, 1945.
24. U.S. civilian flight crew and aviation ground support employees of Consolidated Vultee Aircraft Corp. (Consairway Division) who served overseas in a contract with Air Transport Command between Dec. 14, 1941, and Aug. 14, 1945.
25. U.S. civilian flight crew and aviation ground support employees of Pan American World Airways and its subsidiaries and affiliates, who served overseas in a contract with the Air Transport Command and Naval Air Transport Service between Dec. 14, 1941, and Aug. 14, 1945.
26. Honorably discharged members of the American Volunteer Guard, Eritrea Service Command, between June 21, 1942, and March 31, 1943.
27. U.S. civilian flight crew and aviation ground support employees of Northwest Airlines who served overseas under the airline’s contract with Air Transport Command from Dec. 14, 1941, through Aug. 14, 1945.
28. U.S. civilian female employees of the U.S. Army Nurse Corps who served in the defense of Bataan and Corregidor in 1942.