Federal Benefits for Veterans, Dependents and Survivors
Online Edition
Chapter 1 Health Care Benefits
Federal Benefits for Veterans, Dependents and SurvivorsFederal Benefits for Veterans, Dependents and SurvivorsVA operates the nation’s largest integrated health care system with more than 1,700 sites of care, including hospitals, community clinics, community living centers, domiciliaries, Vet Centers, and various other facilities. For additional information on VA health care, visit: www.va.gov/health.
Basic EligibilityA person who served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable may qualify for VA health care benefits. Reservists and National Guard members may also qualify for VA health care benefits if they were called to active duty (other than for training only) by a Federal order and completed the full period for which they were called or ordered to active duty.
Minimum Duty Requirements: Veterans who enlisted after Sept. 7, 1980, or who entered active duty after Oct. 16, 1981, must have served 24 continuous months or the full period for which they were called to active duty in order to be eligible. This minimum duty requirement may not apply to Veterans discharged for hardship, early out or a disability incurred or aggravated in the line of duty.
EnrollmentFor most Veterans, entry into VA health care system begins by applying for enrollment. Veterans can now apply and submit their application for enrollment (VA Form 1010EZ), online at http://www.1010ez.med.va.gov/sec/vha/1010ez/. If assistance is needed while completing the on-line enrollment form, an online chat representative is available to answer questions Monday – Friday between 8 a.m. and 8 pm EST. Veterans can also enroll by calling 1-877-222-VETS (8387) Monday through Friday, 8 a.m. to 8 p.m. ESTS, or at any VA health care facility or VA regional office. Once enrolled, Veterans can receive health care at VA health care facilities anywhere in the country.
Veterans enrolled in VA health care system are afforded privacy rights under federal law. VA’s Notice of Privacy Practices, which describes how VA may use and disclose Veterans’ medical information, is also available on line at www.va.gov/vhapublications/viewpublication.asp?pub_ID=1089
The following four categories of Veterans are not required to enroll, but are urged to do so to permit better planning of health resources:
Group 1: Veterans with service-connected disabilities rated 50 percent or more and/or Veterans determined by VA to be unemployable due to service-connected conditions.
Group 2: Veterans with service-connected disabilities rated 30 or 40 percent.
Group 3:
Veterans with incomes below the geographic means test income thresholds and who agree to pay the applicable copayment.
Group 8:
Recently Discharged Combat VeteransVeterans, including activated reservists and members of the National Guard, are eligible for the enhanced combat Veteran benefits if they served on active duty in a theater of combat operations after Nov. 11, 1998, and have been discharged under other than dishonorable conditions.
Combat Veterans discharged from active duty on or after Jan. 28, 2003, are eligible for enhanced enrollment placement into Priority Group 6 (unless eligible for higher enrollment Priority Group placement) for five years post discharge and are eligible to receive VA health care and medication at no cost for any condition that may be related to their combat service.
Veterans who enroll with VA under this combat Veteran authority will remain enrolled even after their five-year post discharge period ends. At the end of their post discharge period, VA will reassess the Veteran’s information (including all applicable eligibility factors) and make a new enrollment decision. For additional information, call 1-877-222-VETS (8387), Monday through Friday between 8:00 a.m. and 8:00 p.m. Eastern time.
Special Access to CareService-disabled Veterans: who are rated by VA as 50 percent or more disabled from service-connected conditions, unemployable due to service-connected conditions, or receiving care for a service- connected disability receive priority in scheduling of hospital or outpatient medical appointments.
Women VeteransWomen Veterans are eligible for the same VA benefits as male Veterans. Comprehensive health services are available to women Veterans including primary care, specialty care, mental health care, residential treatment and reproductive health care services VA provides management of acute and chronic illnesses, preventive care, contraceptive and gynecology services, menopause management, and cancer screenings, including pap smears and mammograms. Maternity care is covered in the Medical Benefits package. Women Veterans can receive maternity care from an OB/ GYN, family practitioner, or certified nurse midwife who provides pregnancy care.
VA covers the costs of care for newborn children of women Veterans for seven days after birth. Infertility evaluation and limited treatments are also available. Women Veterans Program Managers are available at all VA facilities to assist women Veterans in their health care and benefits. For more information, visit www.womenshealth.va.gov/.
Lesbian Gay Bisexual and Transgender (LGBT) VeteransLGBT Veterans are eligible for the same VA benefits as any other Veteran and will be treated in a welcoming environment. Comprehensive health services are available to LGBT Veterans including primary care, specialty care, mental health care, residential treatment and reproductive health care services. VA provides management of acute and chronic illnesses, preventive care, contraceptive and gynecology services, menopause management, and cancer screenings.
Transgender Veterans will be treated based upon their self- identified gender, including room assignments in residential and inpatient settings. Eligible transgender Veterans can receive cross- sex hormone therapy, gender dysphoria counseling, preoperative evaluations, as well as post-operative and long-term care following sex reassignment surgeries.
Same-Sex Couples: VA launched a new website to inform Veterans and beneficiaries of the recent changes in the law and procedures involving same-sex marriages. The new website provides important information to help Veterans and beneficiaries understand the eligibility requirements under federal law and VA regulations, and answers frequently asked questions. Veterans can learn more about VA’s guidance regarding same-sex marriages at www.va.gov/opa/marriage/ or by reaching out to VA call centers at 1-800-827- 1000.
Military Sexual TraumaMilitary sexual trauma (MST) is the term that the Department of Veterans Affairs uses to refer to sexual assault or repeated, threatening sexual harassment that occurred while a Veteran was serving on active duty (or active duty for training if the service was in the National Guard or Reserves). VA health care professionals provide counseling and treatment to help Veterans overcome health issues related to MST. Veterans who are not otherwise eligible for VA health care may still receive these services. Appropriate services are provided for any injury, illness or psychological condition related to such trauma. For additional information visit: www.mentalhealth.va.gov/msthome.asp
Presumptive Eligibility for Psychosis and Other Mental IllnessCertain Veterans who experienced psychosis within a specified time- frame are to have their psychosis presumed to be service-connected for purposes of VA medical benefits. In addition, VA will presume that Persian Gulf War Veterans are service-connected for purposes of VA medical benefits if such Veterans develop mental illness other than psychosis within two years after discharge or release from service and before the end of the 2-year period beginning on the last day of the Persian Gulf War. Under this authority Veterans who are not otherwise eligible for VA health care and meet the description stated can receive treatment only for psychosis or mental illness and other conditions directly related to psychosis or mental illness at no cost.
Psychosis: Eligibility for treatment of psychosis, and such condition is exempted from copayments for any Veteran who served in the United States active duty military, naval, or air service and developed such psychosis within two years after discharge or release from the active military duty, naval or air service; and before the following date associated with the war or conflict in which the Veteran served:
Veteran Served DuringDateWorld War IIJuly 26, 1949
Korean ConflictFebruary 1, 1957
Vietnam EraMay 8, 1977
Persian Gulf WarDate to be determinedMental Illness (other than Psychosis). Eligibility for benefits is established for treatment of an active mental illness (other than psychosis), and such condition is exempted from copayments for any Veteran of the Persian Gulf War who developed such mental illness:
There are five SCI centers that provide long-term care for Veterans with SCI/D. In VA facilities that do not have SCI centers, there is a designated team that consists of a physician, nurse, and social worker to address primary care needs for Veterans with SCI/D and to make referrals to SCI Centers. These SCI Centers and the teams in facilities that do not have centers, comprise VA SCI System of Care. Some of the services provided in this system of care include rehabilitation, prosthetics and durable medical equipment, orthotics, sensory aids, assistive technology, environmental modifications, telehealth, ventilator weaning and care, chronic pain management, mental health treatment, drivers training, peer counseling, substance abuse treatment, vocational counseling, and caregiver training and support.
There is a long-standing memorandum of agreement between VA and the Department of Defense (DoD) to provide specialized care at VA medical facilities for Active Duty Servicemembers who have sustained a spinal cord injury. Ongoing collaboration and education between VA and DoD ensures continuity of care and services. For more information about SCI/D care and the eligibility requirements for the above benefits and services, contact your local VA SCI/D Center and/or visit http://www.sci.va.gov/.
OEF/OIF/OND Care ManagementEach VA medical center has an Operation Enduring Freedom/ Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Care Management team in place to coordinate patient care activities and ensure that Servicemembers and Veterans are receiving patient- centered, integrated care and benefits. All OEF/OIF/OND era Veterans are screened for the need for case management services to identify Veterans who may be at risk so VA can intervene early and provide assistance. More information for connecting with OEF/OIF/ OND Care Management teams can be found at http://www.oefoif.va.gov/
Health Care LawThe Affordable Care Act, also known as the health care law, was created to expand access to affordable health care coverage, lower costs, and improve quality and care coordination. Under the law, people will:
Financial AssessmentMost Veterans not receiving VA disability compensation or pension payments must provide a financial assessment, also known as a means test, upon initial application to determine whether they are below VA income thresholds. VA is currently not enrolling new applicants who decline to provide financial information unless they have a special eligibility factor exempting them from disclosure.
VA’s income thresholds are located at: http://www.va.gov/HEALTHBENEFITS/cost/income_thresholds.asp
The financial assessment includes all household income and net worth, including Social Security, retirement pay, unemployment insurance, interest and dividends, workers’ compensation, black lung benefits and any other income. Also considered are assets such as the market value of property that is not the primary residence, stocks, bonds, notes, individual retirement accounts, bank deposits, savings accounts and cash.
Beginning in 2014, VA will no longer require enrolled non-service connected and 0 percent noncompensable service connected Veterans to provide their financial information annually. A means test will continue to be collected from Veterans at the time of application for enrollment. In lieu of the annual financial reporting, VA will confirm the Veteran’s financial information using information obtained from the Internal Revenue Service and Social Security Administration.
Medical Services and Medication CopaymentsSome Veterans are required to make copayments (copays) to receive VA health care and/or medications.
Inpatient Care: Priority Group 7 and certain other Veterans are responsible for paying 20 percent of VA’s inpatient copay, which totals $243.20 for the first 90 days of inpatient hospital care during any 365-day period. For each additional 90-day period, the charge is $121.60. In addition, there is a $2 per diem charge. Copay amounts may change on an annual basis.
Priority Group 8 and certain other Veterans are responsible for VA’s inpatient copay , which totals $1,216 for the first 90 days of care during any 365-day period. For each additional 90-day period, the charge is $ 608. In addition, there is a $10 per diem charge. Copay amounts may change on an annual basis.
Extended Care Services: Veterans may be subject to a copay for extended care services. The copay amount is based on the Veteran’s available resources and is determined by a calculation using the financial information from VA Form 10-10EC, Application for Extended Care Services. The copay can range from $0 to a maximum copay amount of $97 a day.
Note: VA social workers or case managers will counsel Veterans or their family representatives on the potential copay amounts for extended care services. Veterans determined to be catastrophically disabled are exempt from copays applicable to the receipt of non- institutional respite care, non-institutional geriatric evaluation, non-institutional adult day health care, homemaker/home health aide, purchase skilled home care, home-based primary care, hospice services and any other non-institutional alternative extended care services. Copayments for other extended care services not mentioned (e.g. Nursing Home Care) may be subject to copays.
Outpatient Care: While many Veterans qualify for free health care services based on a VA compensable service-connected condition or other qualifying factor, most Veterans are asked to provide a financial assessment, to determine if they qualify for free services. Veterans whose income exceeds the established VA Income Thresholds as well as those who choose not to complete the financial assessment must agree to pay required copays to become eligible for VA health care services.
Outpatient Visits Not Requiring Copays: Certain services are not charged a copay. Copays do not apply to publicly announced VA health fairs or outpatient visits solely for preventive screening and/or vaccinations, such as vaccinations for influenza and pneumococcal, or screening for hypertension, hepatitis B, tobacco, alcohol, hyperlipidemia, breast cancer, cervical cancer, Human papillomavirus (HPV), colorectal cancer by fecal occult blood testing, education about the risks and benefits of prostate cancer screening, HIV testing and prevention counseling (including the distribution of condoms), and weight reduction or smoking cessation counseling (individual and group). Laboratory, flat plain film radiology, electrocardiograms, and hospice care and in-home video telehealth are also exempt from copays. While hepatitis C screening and HIV testing and counseling are exempt, medical care for HIV and hepatitis C are NOT exempt from copays.
Medication Copays: While many Veterans are exempt for medication copays, nonservice-connected Veterans in Priority Groups 7 and 8 are charged $9 for each 30-day or less supply of medication provided on an outpatient basis for the treatment of a nonservice-connected condition. Veterans enrolled in Priority Groups 2 through 6 are charged $8 for each 30-day or less supply of medication; the maximum copay for medications that will be charged in calendar year 2013 is $960 for nonservice-connected medications.
NOTE: Copays apply to prescription and over-the-counter medications, such as aspirin, cough syrup or vitamins, dispensed by a VA pharmacy. Copays are not charged for medical supplies, such as syringes or alcohol wipes. Copays do not apply to condoms.
Health Savings Accounts (HSA) can be utilized to make VA copayments. HSAs are usually linked to High Deductible Health Plans (HDHPs).
Private Health Insurance BillingVA is required to bill private health insurance providers for medical care, supplies and medications provided for treatment of Veterans’ nonservice-connected conditions. Generally, VA cannot bill Medicare, but can bill Medicare supplemental health insurance and/or TRICARE for Life (TFL) for covered services. VA is authorized to bill and accept reimbursement from High Deductible Health Plans (HDHPs) for care provided for nonservice-connected conditions.VA may also accept reimbursement from Health Reimbursement Arrangements (HRAs) for care provided for nonservice-connected conditions.
Release of Information (ROI) for Sensitive DiagnosisAn ROI authorization form VAF 10-5345 is a VA standard form used to obtain authorization to release sensitive (protected) health information to an insurance company for purposes of reimbursement.
Veterans/patients who were treated or offered treatment for a sensitive condition of drug abuse, alcohol abuse or alcoholism, HIV testing or treatment, and sickle cell anemia or trait must provide written authorization to allow VA to release their sensitive information to a third party (insurance company).
NOTE: Any non-service connected care provided by the VA that has a sensitive diagnosis cannot be billed to the Veteran’s third party health insurance without a signed release of information (ROI) by the Veteran. The Veteran is either co-pay exempt or co-pay required based upon their means test and/or eligibility. If the Veteran does not sign the ROI form permitting VA to bill his/her insurance and is also in a required co-pay status, then the Veteran will be responsible for their entire co-pay amount because VA is not able to offset the Veteran’s account dollar for dollar based on what the insurance company would have reimbursed.
Reimbursement of Travel CostsEligible Veterans and non-veterans may be provided mileage reimbursement or, when medically indicated, special mode transport (e.g. wheelchair van, ambulance) when travel is in relation to VA medical care.
Mileage reimbursement is 41.5 cents per mile and is subject to a deductible of $3 for each one-way trip and $6 for a round trip; with a maximum deductible of $18 or the amount after six one-way trips (whichever occurs first) per calendar month.
The deductible may be waived when travel is; in relation to a VA compensation or pension examination; by a special mode of transportation; by an eligible non-Veteran; will cause a severe financial hardship, as defined by current regulatory guidelines. Eligibility: The following are eligible for VA travel benefits:
Reporting Fraud: Help VA’s Secretary ensure integrity by reporting suspected fraud, waste or abuse in VA programs or operations.
Report fraud to:
VA Inspector General Hotline
P.O. Box 50410
Washington, DC 20091-0410
E-mail: [email protected]
VAOIG hotline 1-800-488-8244
Fax: (202) 565-7936
VA Medical ProgramsVeteran Health RegistriesCertain Veterans can participate in a VA health registry and receive free evaluations. These evaluations include a medical history, physical exam, and if deemed necessary by the clinician, laboratory tests or other studies. VA maintains health registries to provide special health evaluations and health-related information. To participate, contact the Environmental Health Coordinator at the nearest VA health care facility or visit www.publichealth.va.gov/ exposures to see a directory which lists Environmental Health Coordinators by state and U.S. territory. Veterans should be aware that a health registry evaluation is not a disability compensation exam. A registry evaluation does not start a claim for compensation and is not required for any VA benefits.
Gulf War Registry:For Veterans who served on active military duty in Southwest Asia during the Gulf War, which began in 1990 and continues to the present, and includes Operation Iraqi Freedom (OIF) and Operation New Dawn (OND). The Gulf War registry was designed to identify possible health effects resulting from U.S. military personnel service in certain areas of Southwest Asia. Potential exposures include endemic infectious diseases and hazardous occupational or environmental exposures, including heavy metals, air pollutants (particulate matter and gases such as nitrogen oxides, carbon monoxide sulfur oxides, and hydrocarbons).
Depleted Uranium RegistriesDepleted uranium (DU) is uranium left over after most of the more radioactive U-235 isotope has been removed. DU possesses about 60 percent of the radioactivity of naturally occurring uranium; it is a radiation hazard only in very large exposures for prolonged time. DU has some chemical toxicity related to being a heavy metal (similar to lead) which occurs at lower doses and is the main concern for Veterans with embedded DU fragments.
Veterans who are identified by the DoD or have concerns about possible depleted uranium (DU) exposure are eligible for a DU evaluation at their local facility.
Embedded Fragment RegistryOEF, OIF, and OND Veterans who have or likely have an embedded fragment as the result of an injury they received while serving in an area of conflict are eligible for inclusion into the Embedded Fragment Registry. This registry was designed to identify track and conduct long-term medical surveillance of Veterans who potentially have embedded fragments. Clinical data captured in the Embedded Fragment Registy will be used to help develop medical and surgical guidelines to allow VA clinicians to deliver appropriate medical care to these Veterans.
Agent Orange RegistryAgent Orange is an herbicide the U.S. military used between 1962 and 1971 during the Vietnam War to remove jungle that provided enemy cover. Veterans serving in Vietnam were possibly exposed to Agent Orange or its dioxin contaminant. Veterans eligible for this registry evaluation are those who served on the ground in Vietnam between Jan. 9,1962, and May 7,1975, regardless of the length of service; this includes Veterans who served aboard boats that operated on inland waterways (“Brown Water Navy”) or who made brief visits ashore.
Other Veterans with possible exposure who are eligible include those who served: along the demilitarized zone in Korea (between Apr. 1, 1968 and Aug. 31, 1971), on certain bases or in certain units in Thailand (between Feb. 28, 1961 and May 7, 1975), or on certain U.S. bases or locations in other countries where Agent Orange or other herbicides were tested or stored.
VA maintains a DoD-provided list of locations and dates where Agent Orange or other herbicides were tested or stored at military bases in the U.S. or locations in other countries at www.publichealth.va.gov/ exposures. For sites not listed, the Veteran should provide some proof of exposure to obtain a registry evaluation. Information is also available through VA’s Special Issues Helpline at 1-800-749-8387.
Ionizing Radiation RegistryFor Veterans who have received nasopharyngeal (nose and throat) radium irradiation treatments while on active duty and Veterans possibly exposed to radiation during the following “radiation-risk activities:”
On-site participation in:
No in-person medical evaluation is required to become registered. However, Veteran participants are eligible for an optional no-cost medical evaluation from VA. Participants already enrolled in VA health care should contact their primary care provider or Patient Aligned Care Team (PACT) to schedule anevaluation. Veterans not already enrolled in VA health care should contact an Environmental Health Coordinator at a nearby VA facility by visiting the following link: (http://www.publichealth.va.gov/exposures/coordinators.asp) or calling 1-877-222-8387.
Vet Center Readjustment Counseling ServicesVA provides readjustment counseling services, to include direct counseling, outreach, and referral, through 300 community-based Vet Centers located in all 50 states, the District of Columbia, Guam, Puerto Rico, and American Samoa.
Eligibility: Veterans and active-duty Servicemembers, to include federally-activated members of the National Guard and Reserve components, are eligible to receive readjustment counseling services at a Vet Center if they:
Services Offered: Vet Center counselors provide individual, group, marriage, and family readjustment counseling to those individuals that have served in combat zones or areas of hostilities to assist them in making a successful transition from military to civilian life; to include treatment for posttraumatic stress disorder (PTSD) and help with any other military related problems that affect functioning within the family, work, school or other areas of everyday life. Other psycho-social services include outreach, education, medical referral, homeless Veteran services, employment, VA benefit referral, and the brokering of non-VA services.
The Vet Centers also provide counseling to individuals who have experienced military sexual trauma of both genders and of any era of military service.
Bereavement Counseling related to ServicemembersBereavement counseling is available through VA’s Vet Centers to all immediate family members (including spouses, children, parents, and siblings) of Servicemembers who die while serving on active service. This includes federally-activated members of the National Guard and reserve components. Vet Center bereavement services for surviving family members of Servicemembers may be accessed by calling (202) 461-6530. For additional information, contact the nearest Vet Center, listed in the back of this book, or visit www.vetcenter.va.gov/.
Vet Center Combat Call Center(1-877-WAR-VETS) is an around the clock confidential call center where combat Veterans and their families can call to talk about their military experience or any other issue they are facing in their readjustment to civilian life. The staff is comprised of combat Veterans from several eras as well as family members of combat Veterans.
Prosthetic and Sensory AidsVeterans receiving VA care for any condition may receive VA prosthetic appliances, equipment and services, such as home respiratory therapy, artificial limbs, orthopedic braces and therapeutic shoes, wheelchairs, powered mobility, crutches, canes, walkers, special aids, appliances, optical and electronic devices for visual impairment and other durable medical equipment and supplies. Veterans who are approved for a guide or service dog may also receive service dog benefits including veterinary care and equipment.
VA medical services include diagnostic audiology and diagnostic and preventive eye care services. VA will provide hearing aids and eyeglasses to the following Veterans:
Home Improvements and Structural AlterationsVA provides up to $6,800 lifetime benefits for service-connected Veterans/Servicemembers and up to $2,000 lifetime benefits for nonservice-connected Veterans to make home improvements and/ or structural changes necessary for the continuation of treatment or for disability access to the Veterans/Servicemembers home and essential lavatory and sanitary facilities.
Modifications can include but are not limited to: Ramps allowing entrance to, or exit from, the Veterans/Servicemembers primary residence; Widening of doorways to allow access to essential lavatory and sanitary facilities; Raising or lowering kitchen or bathroom sinks and/or counters; Improving entrance paths or driveways in immediate area of the home to facilitate access to the home by the Veteran/Servicemember; Improving plumbing or electrical systems made necessary due to installation of dialysis equipment or other medically sustaining equipment in the home.
For application information, contact the Prosthetic Representative at the nearest VA medical center.
Special Eligibility ProgramsSpecial Eligibility for Children with Spina BifidaVA provides comprehensive health care benefits, including outpatient, inpatient, pharmacy, prosthetics, medical equipment, and supplies for certain Korea and Vietnam Veterans’ birth children diagnosed with spina bifida (except spina bifida occulta).
Special Eligibility for Veterans Participating in Vocational RehabilitationVeterans participating in VA’s vocational rehabilitation program may receive VA health care benefits including prosthetics, medical equipment, and supplies.
Limitations on Benefits Available to Veterans outside the U.S: Veterans outside the U.S. are eligible for prosthetics, medical equipment, and supplies only for a service-connected disability or any disability associated with, or found to be aggravating, a service-connected disability.
Services for Blind and Visually Impaired VeteransSeverely disabled blind Veterans may be eligible for case management services at a VA medical center and for admission to an inpatient or outpatient VA blind or vision rehabilitation program. In addition, blind Veterans enrolled in VA health care system may receive:
Mental Health services are also available in medical settings in which patients are receiving treatment, such as inpatient medicine and outpatient specialty medical clinics. In addition to general mental health care, this may include specialized PTSD services, treatment for Veterans with psychological conditions related to a history of military sexual trauma, psychosocial rehabilitation and recovery services, treatment for substance use disorders, suicide prevention programs, geriatric mental health problems, violence prevention, evidence-based psychotherapy programs, treatment with psychiatric medications consistent with the VA National Formulary, integrated care services, and mental health disaster response/post deployment activities. Extended hours care is available for Veterans at VA medical centers. Veterans should contact their local facility mental health service for more information.
Specialized programs, such as mental health intensive case management, psychosocial rehabilitation and recovery centers, and work programs are provided for Veterans with serious mental health problems. VA’s Program of Comprehensive Assistance for Family Caregivers entitles the designated primary and secondary family caregiver(s) access to mental health. These services may be offered at VA and/or contracted agencies. General caregivers (of all era Veterans) can receive counseling and other services when necessary if the treatment supports the Veteran’s treatment plan. For more information on VA mental health services visit www.mentalhealth.va.gov/VAMentalHealthGroup.asp
Veterans Crisis LineVeterans experiencing an emotional distress/crisis or who need to talk to a trained mental health professional may call the Veterans Crisis Line 1-800-273-TALK (8255). The hotline is available 24 hours a day, seven days a week. When callers press “1”, they are immediately connected with a qualified and caring provider who can help.
Chat feature: Veterans Chat is located at the Veterans Crisis Line and enables Veterans, their families and friends to go online where they can anonymously chat with a trained VA counselor. Veterans chat can be accessed through the suicide prevention website www. Veterancrisisline.net by clicking on the Veterans chat tab on the right side of the webpage.
Text feature: Those in crisis may text 83-8255 free of charge to receive confidential, personal and immediate support.
European access: Veterans and members of the military community in Europe may now receive free, confidential support from the European Military Crisis Line, a new initiative recently launched by VA. Callers in Europe may dial 0800-1273-8255 or DSN 118 to receive confidential support from responders at the Veterans Crisis Line in the U.S. For more information about VA’s suicide prevention program, visit: www.mentalhealth.va.gov/suicide_prevention/ or http://www.veteranscrisisline.net/.
Make the ConnectionResources help Veterans and their family members connect with information and services to improve their lives. Visitors to http://www.maketheconnection.net/ will find a one-stop resource where Veterans and their family and friends can privately explore information, watch stories similar to their own, research content on mental health issues and treatment, and easily access support and information that will help them live more fulfilling lives.
At the heart of Make the Connection are powerful personal testimonials, which illustrate true stories of Veterans who faced life events, physical injuries or psychological symptoms; then reached out for support; and found ways to overcome their challenges. Veterans and their families are encouraged to “make the connection” - with strength and resilience of Veterans like themselves, with other people who care, and with information and available resources for getting their lives on a better track. For more information, go to www.MakeTheConnection.net
Coaching Into CareCoaching Into Care works with family members or friends who become aware of the Veteran’s post-deployment difficulties, and supports their efforts to find help for the Veteran. This national clinical service provides information and help to Veterans and the loved ones who are concerned about them. More information about the service can be found at www.mirecc.va.gov/coaching/contact.asp
VA’s National Center for PTSDVA’s National Center for PTSD serves as a resource for health care professionals, Veterans and families. Information, self-help resources, and other helpful information can be found at http://www.ptsd.va.gov/.
The PTSD CoachThe PTSD Coach is a mobile application that provides information about PTSD, self-assessment and symptom management tools and information tabout how to connect with resources that are available for those who might be dealing with post trauma effects. The PTSD Coach is available as a free download for iPhone or Android devices.
Mental Health Residential RehabilitationMental Health Residential Rehabilitation Treatment Programs (MH RRTP) including domiciliaries, provide residential rehabilitative and clinical care to Veterans who have a wide range of problems, illnesses, or rehabilitative care needs, which can be medical, psychiatric, substance use, homelessness, vocational, educational, or social. The MH RRTP provides a 24-hour therapeutic setting utilizing a peer and professional support environment. The programs provide a strong emphasis on psychosocial rehabilitation and recovery services that instill personal responsibility to achieve optimal levels of independence upon discharge to independent or supportive community living. The MH RRTP also provides rehabilitative care for homeless Veterans.
Eligibility: VA may provide domiciliary care to Veterans whose annual gross household income does not exceed the maximum annual rate of VA pension or to Veterans whom the Secretary of Veterans Affairs determines have no adequate means of support. The copays for extended care services apply to domiciliary care. Call the nearest benefits or health care facility to obtain the latest information.
Outpatient Dental TreatmentDental benefits are provided by VA according to law. In some instances, VA is authorized to provide extensive dental care, while in other cases treatment may be limited by law. This Fact Sheet table describes dental eligibility criteria and contains information to assist Veterans in understanding their eligibility for VA dental care.
By law, the eligibility for outpatient dental care is not the same as for most other VA medical benefits. It is categorized in classes. Those eligible for VA dental care under Class I, IIA, IIC, or IV are eligible for any necessary dental care to maintain or restore oral health and masticatory function, including repeat care. Other classes have time and/or service limitations.
*Note: Public Law 83 enacted June 16, 1955, amended Veterans’ eligibility for outpatient dental services. As a result, any Veteran who received a dental award letter from VBA dated before 1955 in which VBA determined the dental conditions to be non-compensable are no longer eligible for Class II outpatient dental treatment.
Veterans receiving hospital, nursing home, or domiciliary care will be provided dental services that are professionally determined by a VA dentist, in consultation with the referring physician, to be essential to the management of the patient’s medical condition under active treatment. For more information about eligibility for VA medical and dental benefits, contact VA at 1-877-222-8387, Monday through Friday between 8 am and 8 pm EST or www.va.gov/healthbenefits. (See chart on page 26)
VA Dental Insurance Program (VADIP)Veterans enrolled in VA health care and CHAMPVA beneficiaries have the opportunity to purchase dental insurance coverage at a reduced cost through Delta Dental and MetLife. Delta Dental and MetLife offer multiple plans to choose from. Coverage, available throughout the United States and its territories, includes diagnostic, preventative, surgical, emergency, and endodontic/restorative treatment and services.
Enrolled Veterans and CHAMPVA beneficiaries may sign up to participate in VADIP by completing an application with Delta Dental or MetLife – online, over the phone, or by mail – for the plan that best meets their dental needs and budget. Each participant will pay fixed monthly premiums for coverage and copayments identified in the plan they select. The program is voluntary and there are no eligibility limitations based on service-connected disability or other factors. Participation in the program does not affect eligibility for VA-provided dental services and treatment.
Vocational and Work Assistance ProgramsVHA Therapeutic & Supported Employment Services (TSES) Programs: VHA provides vocational assistance and therapeutic work opportunities through three primary TSES programs for Veterans enrolled in the VAhealth care system. These programs are designed to assist Veterans to live and work as independently as possible in their respective communities. Participation in TSES vocational services cannot be used to deny or discontinue VA disability benefits. Payments received from Compensated Work Therapy Sheltered Workshop and Transitional Work and Incentive Therapy cannot be used to deny or discontinue SSI and/or SSDI payments and they are not subject to IRS taxes.
Dental Eligibility ChartIf you:You are eligible for:ThroughHave a service-connected compensable dental disability or condition.Any needed dental care.Class I
Are a former prisoner of war.Any needed dental care.Class IIC
Have service-connected disabilities rated 100 percent disabling, or are unemployable and paid at the 100 percent rate due to service- connected conditions.Any needed dental care. [note: Veterans paid at the 100 percent rate based on a temporary rating, are not eligible for comprehensive outpatient dental services.Class IV
Apply for dental care within 180 days of discharge or release from of active duty (under conditions other than dishonorable) of 90 days or more during the Gulf War era.One-time dental care if a DD214 certificate of discharge does not indicate that a complete dental examination and all appropriate dental treatment had been rendered prior to discharge.Class II
Have a service-connected noncompensable dental condition or disability resulting from combat wounds or service trauma.Any dental care necessary to provide and maintain a functioning dentition. A Dental Trauma Rating (VA Form 10-564-D) or VA RO Decision letter (VA Form 10- 7131) identifies the tooth/teeth/ condition(s) that are trauma rated.Class IIA
Have a dental condition clinically determined by VA to be associated with and aggravating a service- connected medical condition.Dental care to treat the oral conditions that are determined by a VA dental professional to have a direct and material detrimental effect to a service-connected medical condition.Class III
Are actively engaged in a 38 USC Chapter 31 vocational rehabilitation program.Dental care to the extent necessary to: to enter, achieve goals, and prevent interruption of a rehab program; hasten the return to a rehab program because of a dental condition; or to secure and adjust to employment during employment assistance, or enable to achieve maximum independence in dailyClass V
Are receiving VA care or are scheduled for inpatient care and require dental care for a condition complicating a current medical lDiveinngta.Dental care to treat the oral conditions that are determined by a VA dental professional to complicate a medical condition currently under treatment.Class VI
Are an enrolled Veteran who may be homeless and receiving care under VHA Directive 2007-039.A one-time course of dental care that is determined medically necessary to relieve pain, assist in gaining employment, or treat moderate to severe gingival and periodontal conditions.Class IIB
Compensated Work Therapy/Transitional Work (CWT/TW)Compensated Work Therapy/Transitional Work (CWT/TW) is a vocational assessment program that operates in VA medical centers and/or local community business and industry. CWT/TW participants are matched to real life work assignments for a time-limited basis. Veterans are supervised by personnel of the sponsoring site, under the same job expectations experienced by non-CWT workers. Veterans participating in the CWT/TW program are not employees of either the Federal government or a host company and, as such, receive no traditional employee benefits. CWT/TW participants receive, at a minimum, the greater of Federal or state minimum wage for all hours worked. Approximately 40 percent of participants secure competitive employment at the time of discharge.
CWT/Supported Employment (CWT/SE)CWT/Supported Employment (CWT/SE)is a recovery-based intervention provided through an integrated partnership with the primary Mental Health treatment team. The employment is intended to be an extension of treatment to manage symptoms and advance recovery. CWT/SE consists of full- or part-time competitive employment with extensive clinical supports to Veterans, and accommodations/supervision guidance to employers.
Other Initiatives include the adaption of SE evidence-based principles for specialty TSES programs for Veterans diagnosed with spinal cord injury, polytrauma, traumatic brain injury, and/or posttraumatic stress disorder. A list of CWT program sites can be found on the Location Page at http://www.cwt.va.gov/.
Vocational Assistance is a set of assessment, guidance, counseling, or other related services that may be offered to groups or individuals. These services are designed to enable Veterans to realize skills, resources, attitudes and expectations needed to prepare for searching for employment, succeeding in the employment interview process, and succeeding in employment.
CWT/Sheltered Workshop (CWT/SW) operates sheltered workshops at approximately 25 VA medical centers. CWT/SW is a pre-employment vocational activity that provides an opportunity for work hardening and assessment in a simulated work environment. Participating Veterans are paid the greater of Federal or state minimum wage on a piece rate basis.
Incentive Therapy (IT)Incentive Therapy (IT) is a pre-employment program that provides a limited work experience at VA medical centers for Veterans who are not actively seeking competitive employment and exhibit severe mental illness and/or physical impairments. IT services may consist of full- or part-time work with nominal remuneration limited to the maximum of one half of the Federal minimum wage.
Long-term ServicesVA provides institution based services (nursing home level of care) to Veterans through three national programs: VA owned and operated Community Living Centers (CLC), State Veterans’ Homes owned and operated by the states, and the community nursing home program. Each program has admission and eligibility criteria specific to the program. VA is obligated to pay the full cost of nursing home services for enrolled Veterans who need nursing home care for a service-connected disability, or Veterans or who have a 70 percent or greater service-connected disability and Veterans with a rating of total disability based on individual un-employability. VA provided nursing home care for all other Veterans is based on available resources. Institution based nursing home care is expected to be person centered and serves Veterans of all ages.
VA Community Community Living Centers (CLCVA Community Community Living Centers (CLC) provide a dynamic array of short stay (less than 90 days) and long stay (91 days or more) services. Short stay services include but are not limited to skilled nursing, respite care, rehabilitation, hospice, and continuing care for Veterans awaiting placement in the community. Long stay services include but are not limited to dementia care and continuing care to maintain the Veteran’s level of functioning. Short stay and long stay services are available for Veterans who are enrolled in VA health care and require CLC services.
State Veterans’ Home ProgramState Veterans homes are owned and operated by the states. The states petition VA for grant dollars for a portion of the construction costs followed by a request for recognition as a state home. Once recognized, VA pays a portion of the per diem if the state meets VA standards. States establish eligibility criteria and determine services offered for short and long-term care. Specialized services offered are dependent upon the capability of the home to render them.
Community Nursing Home ProgramVA health care facilities establish contracts with community nursing homes. The purpose of this program is to meet the nursing home needs of Veterans who require long-term nursing home care in their own community close to their families, and who meet the enrollment and eligibility requirements.
Admission Criteria The general criteria for nursing home placement in each of the three programs requires that a resident must be medically stable, i.e. not acutely ill, have sufficient functional deficits to require inpatient nursing home care, and be determined by an appropriate medical provider to need institutional nursing home care. Furthermore, the Veteran must meet the specific eligibility criteria for community living center care or the contract nursing home program and the eligibility criteria for the specific state Veterans home.
Home and Community Based ServicesIVA offers a variety of community-based non-institutional long-term services and supports these services either directly or by contract with community-based agencies. Home and community based services are expected to be person centered and serve Veterans of all ages. Veterans receiving these services may be subject to a copay.
In-Home and Community Based CareSkilled home health care, homemaker/home health aide services, community adult day health care; Hhospice and Palliative Care, Veteran Directed Care.
Respite CareDesigned to relieve the Family Caregiver from the constant burden of caring for a chronically ill or disabled Veteran at home. Services can include in-home care, a short stay in an institutional setting or adult day health care.
Primary CareGeri Patient Aligned Care Teams (PACT) provide geriatric focused primary care in an outpatient setting; Home Based Primary Care PACT provides primary care in the home; Geriatric Evaluation and Management (GEM) provides inpatient or outpatient short- term comprehensive geriatric evaluation and management.
Emergency Medical Care in U.S. Non-VA Facilities In the case of medical emergencies, VA may reimburse or pay for emergency non-VA medical care not previously authorized that is provided to certain eligible Veterans when VA or other federal facilities are not feasibly available. This benefit may be dependent upon other conditions, such as notification to VA, the nature of treatment sought, the status of the Veteran, the presence of other health care insurance, and third party liability.
Because there are different regulatory requirements that may affect VA payment and Veteran liability for the cost of care, it is very important that the nearest VA medical facility to where emergency services are furnished be notified as soon as possible after emergency treatment is sought. If emergency inpatient services are required, VA will assist in transferring the Veteran to a Department facility, if available. Timely filing claim limitations apply. For additional information, contact the nearest VA medical facility. Please note that reimbursement criteria for Veterans living or traveling outside the United States fall under VA’s Foreign Medical Program (FMP), and differ from the criteria for payment of emergency treatment received in the United States.
Foreign Medical ProgramVA may authorize reimbursement for medical services for service- connected disabilities or any disability associated with and found to be aggravating a service-connected disability for those Veterans living or traveling outside the United States. This program may also reimburse for the treatment of foreign medical services needed as part of an approved VA vocational rehabilitation program. Veterans receiving health care services in the Philippines should register with the U.S. Veterans Affairs office in Pasay City. Veterans calling from within the Philippines may contact the VA office in Pasay City at 1-800-1888- 8782. If calling from outside of the Philippines, the number is 011- 632-318-8387. Veterans may also register by email at IRIS.va.gov. All other Veterans living or planning to travel outside the U.S. should register with the Foreign Medical Program, P.O. Box 469061, Denver, CO 80246-9061, USA; telephone 303-331-7590. For information visit: www.va.gov/hac/forbeneficiaries/fmp/fmp.asp.
Some Veterans traveling or living overseas can telephone the Foreign Medical Program toll free from these countries: Germany 0800-1800- 011; Australia 1-800-354-965; Italy 800-782-655; United Kingdom (England and Scotland) 0800-032-7425; Mexico 001-877-345-8179; Japan 00531-13-0871; Costa Rica 0800-013-0759; and Spain 900- 981-776. (Note: Veterans in Mexico or Costa Rica must first dial the United States country code.)
On occasion Veterans will ask to have prescriptions mailed outside the United States and its territories. VA Pharmacy Service is not authorized to ship medications or medical/surgical supply items outside of the United States or US Territories (Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands). For Veterans registered with the Foreign Medical Program, prescription reimbursement is approved only for United States Food and Drug Administration (FDA) approved medications.
Within the United States and prior to travel abroad, VA facilities may opt to fill outpatient medications prior to the normal dispensing date in the event that a Veteran will be traveling and unable to obtain medications while abroad. This may be done on a limited basis and requires prior consultation with the Veteran’s VA provider prior to dispensing.
Online Health ServicesVA offers Veterans, Servicemembers, their dependents and caregivers their own personal health record through My HealtheVet, found at www.myhealth.va.gov.
My HealtheVet’s free, online Personal Health Record is available 24 hours a day, seven days a week with Internet access. Those with an upgraded account (obtained by completing the one-time in-person authentication* process) can:
My HealtheVet helps Veterans partner with VA health care teams by providing tools to make shared, informed decisions. Simply follow the directions on the website to register. VA patients registered on My HealtheVet can begin to refill VA medications online. Veterans can also use VA Blue Button to view, print, or download the health data currently in their My HealtheVet account. Veterans can share this information with family, caregivers or others such as non-VA health care providers. It puts the Veteran in control of their information stored in My HealtheVet. VA Blue Button also provides Veterans who were discharged from military service after 1979 access to DoD Military Service Information. This information may include Military Occupational Specialty (MOS) codes, pay details, service dates, deployment, and retirement periods.
*To access the advanced My HealtheVet features, Veterans will need to get an upgraded account by completing a one-time process at their VA facility. Visit My HealtheVet at www.myhealth.va.gov, register and learn more about in-person authentication plus the many features and tools available with Internet access. Veterans with questions should contact the My HealtheVet Coordinator at their VA facility.
Caregiver Programs and ServicesVA has long supported family caregivers as vital partners in providing care worthy of the sacrifices by America’s Veterans and Servicemembers. Each VA medical center has a Caregiver Support Program coordinated by a Caregiver Support Coordinator (CSC). The CSC coordinates caregiver activities and serves as a resource expert for Veterans, their families and VA providers. Several programs are available for all Veteran caregivers including:
In-Home and Community Based CareSkilled home health care, homemaker/home health aide services, community adult day health care and Home Based Primary Care.
Respite CareDesigned to relieve the family caregiver from the constant burden of caring for a chronically ill or disabled Veteran at home. Services can include in-home care, a short stay in an institutional setting or adult day health care.
Post-9/11 Caregiver ProgramThe Caregivers and Veterans Omnibus Health Services Act of 2010 allows VA to provide unprecedented benefits to eligible Caregivers (a parent, spouse, child, step-family member, extended family member, or an individual who lives with the Veteran, but is not a family member) of eligible Veterans who incurred or aggravated a serious injury in the line of duty on or after Sept. 11, 2001 (post-9/11 Veterans) under the Program of Comprehensive Assistance for Family Caregivers. Services include:
Family Support ServiceThese support groups can be face-to- face or on the telephone. They include family counseling, spiritual and pastoral care, family leisure and recreational activities and temporary lodging in Fisher Houses.
Travel: VA’s Comprehensive Assistance for family caregivers Program entitles the designated family caregiver to beneficiary travel benefits.
These benefits include:
Veterans Canteen ServiceEstablished in 1946, the Veterans Canteen Service (VCS) was created to provide merchandise and services at reasonable prices to Veterans enrolled in the VA health care system, caregivers, and visitors. The VCS PatriotStoreDirect 1-800-664-8258 provides services to those who cannot visist a VA facility. For more information, visit VCS online at www.vacanteen.va.gov for more information.
Federal Benefits for Veterans, Dependents and SurvivorsFederal Benefits for Veterans, Dependents and SurvivorsVA operates the nation’s largest integrated health care system with more than 1,700 sites of care, including hospitals, community clinics, community living centers, domiciliaries, Vet Centers, and various other facilities. For additional information on VA health care, visit: www.va.gov/health.
Basic EligibilityA person who served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable may qualify for VA health care benefits. Reservists and National Guard members may also qualify for VA health care benefits if they were called to active duty (other than for training only) by a Federal order and completed the full period for which they were called or ordered to active duty.
Minimum Duty Requirements: Veterans who enlisted after Sept. 7, 1980, or who entered active duty after Oct. 16, 1981, must have served 24 continuous months or the full period for which they were called to active duty in order to be eligible. This minimum duty requirement may not apply to Veterans discharged for hardship, early out or a disability incurred or aggravated in the line of duty.
EnrollmentFor most Veterans, entry into VA health care system begins by applying for enrollment. Veterans can now apply and submit their application for enrollment (VA Form 1010EZ), online at http://www.1010ez.med.va.gov/sec/vha/1010ez/. If assistance is needed while completing the on-line enrollment form, an online chat representative is available to answer questions Monday – Friday between 8 a.m. and 8 pm EST. Veterans can also enroll by calling 1-877-222-VETS (8387) Monday through Friday, 8 a.m. to 8 p.m. ESTS, or at any VA health care facility or VA regional office. Once enrolled, Veterans can receive health care at VA health care facilities anywhere in the country.
Veterans enrolled in VA health care system are afforded privacy rights under federal law. VA’s Notice of Privacy Practices, which describes how VA may use and disclose Veterans’ medical information, is also available on line at www.va.gov/vhapublications/viewpublication.asp?pub_ID=1089
The following four categories of Veterans are not required to enroll, but are urged to do so to permit better planning of health resources:
- Veterans with a service-connected disability of 50 percent or more.
- Veterans seeking care for a disability the military determined was incurred or aggravated in the line of duty, but which VA has not yet rated, within 12 months of discharge.
- Veterans seeking care for a service-connected disability only.
- Veterans seeking registry examinations (Ionizing Radiation, Agent Orange, Gulf War/Operation Enduring Freedom/ Operation Iraqi Freedom/ Operation New Dawn (OEF/OIFOND) depleted uranium, airborne hazards and Airborne Hazards and Open Burn Pit Registry).
Group 1: Veterans with service-connected disabilities rated 50 percent or more and/or Veterans determined by VA to be unemployable due to service-connected conditions.
Group 2: Veterans with service-connected disabilities rated 30 or 40 percent.
Group 3:
- Veterans who are former prisoners of war (POWs). Veterans awarded the Purple Heart medal. Veterans awarded the Medal of Honor.
- Veterans whose discharge was for a disability incurred or aggravated in the line of duty.
- Veterans with VA service-connected disabilities rated 10 percent or 20 percent.
- Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151, “benefits for individuals disabled by treatment or vocational rehabilitation.”
- Veterans receiving increased compensation or pension based on their need for regular aid and attendance or by reason of being permanently housebound.
- Veterans determined by VA to be catastrophically disabled.
- Nonservice-connected Veterans and noncompensable service- connected Veterans rated 0 percent, whose annual income and/ or net worth are not greater than VA financial thresholds. Veterans receiving VA Pension benefits.
- Veterans eligible for Medicaid benefits.
- Compensable 0 percent service-connected Veterans. Veterans exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki. Project 112/SHAD participants.
- Veterans who served in the Republic of Vietnam between Jan. 9, 1962 and May 7, 1975.
- Veterans who served in the Southwest Asia theater of operations from Aug. 2, 1990, through Nov. 11, 1998.
- Veterans who served in a theater of combat operations after Nov.11, 1998, as follows:
- Veterans discharged from active duty on or after Jan. 28, 2003, for five years post discharge;
- Veterans who served on active duty at Camp Lejeune, N.C., for no fewer than 30 days beginning Jan. 1, 1957 and ending Dec. 31, 1987.
Veterans with incomes below the geographic means test income thresholds and who agree to pay the applicable copayment.
Group 8:
- Veterans with gross household incomes above VA national income threshold and the geographically-adjusted income threshold for their resident location and who agrees to pay copayments. Veterans eligible for enrollment: Noncompensable 0-percent service-connected:
- Subpriority a: Enrolled as of Jan. 16, 2003, and who have re- mained 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 percent or less
- Veterans eligible for enrollment: nonservice-connected and Subpriority c: Enrolled as of Jan. 16, 2003, and who 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 percent or less
- Veterans NOT eligible for enrollment: Veterans not meeting the criteria above:
- Subpriority e: Noncompensable 0 percent service-connected
- Subpriority f: Nonservice-connected
Recently Discharged Combat VeteransVeterans, including activated reservists and members of the National Guard, are eligible for the enhanced combat Veteran benefits if they served on active duty in a theater of combat operations after Nov. 11, 1998, and have been discharged under other than dishonorable conditions.
Combat Veterans discharged from active duty on or after Jan. 28, 2003, are eligible for enhanced enrollment placement into Priority Group 6 (unless eligible for higher enrollment Priority Group placement) for five years post discharge and are eligible to receive VA health care and medication at no cost for any condition that may be related to their combat service.
Veterans who enroll with VA under this combat Veteran authority will remain enrolled even after their five-year post discharge period ends. At the end of their post discharge period, VA will reassess the Veteran’s information (including all applicable eligibility factors) and make a new enrollment decision. For additional information, call 1-877-222-VETS (8387), Monday through Friday between 8:00 a.m. and 8:00 p.m. Eastern time.
Special Access to CareService-disabled Veterans: who are rated by VA as 50 percent or more disabled from service-connected conditions, unemployable due to service-connected conditions, or receiving care for a service- connected disability receive priority in scheduling of hospital or outpatient medical appointments.
Women VeteransWomen Veterans are eligible for the same VA benefits as male Veterans. Comprehensive health services are available to women Veterans including primary care, specialty care, mental health care, residential treatment and reproductive health care services VA provides management of acute and chronic illnesses, preventive care, contraceptive and gynecology services, menopause management, and cancer screenings, including pap smears and mammograms. Maternity care is covered in the Medical Benefits package. Women Veterans can receive maternity care from an OB/ GYN, family practitioner, or certified nurse midwife who provides pregnancy care.
VA covers the costs of care for newborn children of women Veterans for seven days after birth. Infertility evaluation and limited treatments are also available. Women Veterans Program Managers are available at all VA facilities to assist women Veterans in their health care and benefits. For more information, visit www.womenshealth.va.gov/.
Lesbian Gay Bisexual and Transgender (LGBT) VeteransLGBT Veterans are eligible for the same VA benefits as any other Veteran and will be treated in a welcoming environment. Comprehensive health services are available to LGBT Veterans including primary care, specialty care, mental health care, residential treatment and reproductive health care services. VA provides management of acute and chronic illnesses, preventive care, contraceptive and gynecology services, menopause management, and cancer screenings.
Transgender Veterans will be treated based upon their self- identified gender, including room assignments in residential and inpatient settings. Eligible transgender Veterans can receive cross- sex hormone therapy, gender dysphoria counseling, preoperative evaluations, as well as post-operative and long-term care following sex reassignment surgeries.
Same-Sex Couples: VA launched a new website to inform Veterans and beneficiaries of the recent changes in the law and procedures involving same-sex marriages. The new website provides important information to help Veterans and beneficiaries understand the eligibility requirements under federal law and VA regulations, and answers frequently asked questions. Veterans can learn more about VA’s guidance regarding same-sex marriages at www.va.gov/opa/marriage/ or by reaching out to VA call centers at 1-800-827- 1000.
Military Sexual TraumaMilitary sexual trauma (MST) is the term that the Department of Veterans Affairs uses to refer to sexual assault or repeated, threatening sexual harassment that occurred while a Veteran was serving on active duty (or active duty for training if the service was in the National Guard or Reserves). VA health care professionals provide counseling and treatment to help Veterans overcome health issues related to MST. Veterans who are not otherwise eligible for VA health care may still receive these services. Appropriate services are provided for any injury, illness or psychological condition related to such trauma. For additional information visit: www.mentalhealth.va.gov/msthome.asp
Presumptive Eligibility for Psychosis and Other Mental IllnessCertain Veterans who experienced psychosis within a specified time- frame are to have their psychosis presumed to be service-connected for purposes of VA medical benefits. In addition, VA will presume that Persian Gulf War Veterans are service-connected for purposes of VA medical benefits if such Veterans develop mental illness other than psychosis within two years after discharge or release from service and before the end of the 2-year period beginning on the last day of the Persian Gulf War. Under this authority Veterans who are not otherwise eligible for VA health care and meet the description stated can receive treatment only for psychosis or mental illness and other conditions directly related to psychosis or mental illness at no cost.
Psychosis: Eligibility for treatment of psychosis, and such condition is exempted from copayments for any Veteran who served in the United States active duty military, naval, or air service and developed such psychosis within two years after discharge or release from the active military duty, naval or air service; and before the following date associated with the war or conflict in which the Veteran served:
Veteran Served DuringDateWorld War IIJuly 26, 1949
Korean ConflictFebruary 1, 1957
Vietnam EraMay 8, 1977
Persian Gulf WarDate to be determinedMental Illness (other than Psychosis). Eligibility for benefits is established for treatment of an active mental illness (other than psychosis), and such condition is exempted from copayments for any Veteran of the Persian Gulf War who developed such mental illness:
- Within two years after discharge or release from the active duty military, naval, or air service; and
- Before the end of the two-year period beginning on the last day of the Persian Gulf War (end date not yet determined).
There are five SCI centers that provide long-term care for Veterans with SCI/D. In VA facilities that do not have SCI centers, there is a designated team that consists of a physician, nurse, and social worker to address primary care needs for Veterans with SCI/D and to make referrals to SCI Centers. These SCI Centers and the teams in facilities that do not have centers, comprise VA SCI System of Care. Some of the services provided in this system of care include rehabilitation, prosthetics and durable medical equipment, orthotics, sensory aids, assistive technology, environmental modifications, telehealth, ventilator weaning and care, chronic pain management, mental health treatment, drivers training, peer counseling, substance abuse treatment, vocational counseling, and caregiver training and support.
There is a long-standing memorandum of agreement between VA and the Department of Defense (DoD) to provide specialized care at VA medical facilities for Active Duty Servicemembers who have sustained a spinal cord injury. Ongoing collaboration and education between VA and DoD ensures continuity of care and services. For more information about SCI/D care and the eligibility requirements for the above benefits and services, contact your local VA SCI/D Center and/or visit http://www.sci.va.gov/.
OEF/OIF/OND Care ManagementEach VA medical center has an Operation Enduring Freedom/ Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Care Management team in place to coordinate patient care activities and ensure that Servicemembers and Veterans are receiving patient- centered, integrated care and benefits. All OEF/OIF/OND era Veterans are screened for the need for case management services to identify Veterans who may be at risk so VA can intervene early and provide assistance. More information for connecting with OEF/OIF/ OND Care Management teams can be found at http://www.oefoif.va.gov/
Health Care LawThe Affordable Care Act, also known as the health care law, was created to expand access to affordable health care coverage, lower costs, and improve quality and care coordination. Under the law, people will:
- have health coverage that meets a minimum standard (called minimum essential coverage) by Jan.1, qualify for an exemption; or pay a fee when filing their taxes if they have affordable options but remain uninsured.
- VA wants all Veterans to get health care that improves their health and well-being.
- Veterans who are enrolled in VA health care don’t need to take additional steps to meet the health care law coverage standards.
- The health care law does not change VA health benefits or Veterans’ out-of-pocket costs.
- Veterans who are not enrolled in VA health care can apply at any time.
Financial AssessmentMost Veterans not receiving VA disability compensation or pension payments must provide a financial assessment, also known as a means test, upon initial application to determine whether they are below VA income thresholds. VA is currently not enrolling new applicants who decline to provide financial information unless they have a special eligibility factor exempting them from disclosure.
VA’s income thresholds are located at: http://www.va.gov/HEALTHBENEFITS/cost/income_thresholds.asp
The financial assessment includes all household income and net worth, including Social Security, retirement pay, unemployment insurance, interest and dividends, workers’ compensation, black lung benefits and any other income. Also considered are assets such as the market value of property that is not the primary residence, stocks, bonds, notes, individual retirement accounts, bank deposits, savings accounts and cash.
Beginning in 2014, VA will no longer require enrolled non-service connected and 0 percent noncompensable service connected Veterans to provide their financial information annually. A means test will continue to be collected from Veterans at the time of application for enrollment. In lieu of the annual financial reporting, VA will confirm the Veteran’s financial information using information obtained from the Internal Revenue Service and Social Security Administration.
Medical Services and Medication CopaymentsSome Veterans are required to make copayments (copays) to receive VA health care and/or medications.
Inpatient Care: Priority Group 7 and certain other Veterans are responsible for paying 20 percent of VA’s inpatient copay, which totals $243.20 for the first 90 days of inpatient hospital care during any 365-day period. For each additional 90-day period, the charge is $121.60. In addition, there is a $2 per diem charge. Copay amounts may change on an annual basis.
Priority Group 8 and certain other Veterans are responsible for VA’s inpatient copay , which totals $1,216 for the first 90 days of care during any 365-day period. For each additional 90-day period, the charge is $ 608. In addition, there is a $10 per diem charge. Copay amounts may change on an annual basis.
Extended Care Services: Veterans may be subject to a copay for extended care services. The copay amount is based on the Veteran’s available resources and is determined by a calculation using the financial information from VA Form 10-10EC, Application for Extended Care Services. The copay can range from $0 to a maximum copay amount of $97 a day.
Note: VA social workers or case managers will counsel Veterans or their family representatives on the potential copay amounts for extended care services. Veterans determined to be catastrophically disabled are exempt from copays applicable to the receipt of non- institutional respite care, non-institutional geriatric evaluation, non-institutional adult day health care, homemaker/home health aide, purchase skilled home care, home-based primary care, hospice services and any other non-institutional alternative extended care services. Copayments for other extended care services not mentioned (e.g. Nursing Home Care) may be subject to copays.
Outpatient Care: While many Veterans qualify for free health care services based on a VA compensable service-connected condition or other qualifying factor, most Veterans are asked to provide a financial assessment, to determine if they qualify for free services. Veterans whose income exceeds the established VA Income Thresholds as well as those who choose not to complete the financial assessment must agree to pay required copays to become eligible for VA health care services.
- Primary Care Services: $15
- Specialty Care Services: $50
Outpatient Visits Not Requiring Copays: Certain services are not charged a copay. Copays do not apply to publicly announced VA health fairs or outpatient visits solely for preventive screening and/or vaccinations, such as vaccinations for influenza and pneumococcal, or screening for hypertension, hepatitis B, tobacco, alcohol, hyperlipidemia, breast cancer, cervical cancer, Human papillomavirus (HPV), colorectal cancer by fecal occult blood testing, education about the risks and benefits of prostate cancer screening, HIV testing and prevention counseling (including the distribution of condoms), and weight reduction or smoking cessation counseling (individual and group). Laboratory, flat plain film radiology, electrocardiograms, and hospice care and in-home video telehealth are also exempt from copays. While hepatitis C screening and HIV testing and counseling are exempt, medical care for HIV and hepatitis C are NOT exempt from copays.
Medication Copays: While many Veterans are exempt for medication copays, nonservice-connected Veterans in Priority Groups 7 and 8 are charged $9 for each 30-day or less supply of medication provided on an outpatient basis for the treatment of a nonservice-connected condition. Veterans enrolled in Priority Groups 2 through 6 are charged $8 for each 30-day or less supply of medication; the maximum copay for medications that will be charged in calendar year 2013 is $960 for nonservice-connected medications.
NOTE: Copays apply to prescription and over-the-counter medications, such as aspirin, cough syrup or vitamins, dispensed by a VA pharmacy. Copays are not charged for medical supplies, such as syringes or alcohol wipes. Copays do not apply to condoms.
Health Savings Accounts (HSA) can be utilized to make VA copayments. HSAs are usually linked to High Deductible Health Plans (HDHPs).
Private Health Insurance BillingVA is required to bill private health insurance providers for medical care, supplies and medications provided for treatment of Veterans’ nonservice-connected conditions. Generally, VA cannot bill Medicare, but can bill Medicare supplemental health insurance and/or TRICARE for Life (TFL) for covered services. VA is authorized to bill and accept reimbursement from High Deductible Health Plans (HDHPs) for care provided for nonservice-connected conditions.VA may also accept reimbursement from Health Reimbursement Arrangements (HRAs) for care provided for nonservice-connected conditions.
Release of Information (ROI) for Sensitive DiagnosisAn ROI authorization form VAF 10-5345 is a VA standard form used to obtain authorization to release sensitive (protected) health information to an insurance company for purposes of reimbursement.
Veterans/patients who were treated or offered treatment for a sensitive condition of drug abuse, alcohol abuse or alcoholism, HIV testing or treatment, and sickle cell anemia or trait must provide written authorization to allow VA to release their sensitive information to a third party (insurance company).
NOTE: Any non-service connected care provided by the VA that has a sensitive diagnosis cannot be billed to the Veteran’s third party health insurance without a signed release of information (ROI) by the Veteran. The Veteran is either co-pay exempt or co-pay required based upon their means test and/or eligibility. If the Veteran does not sign the ROI form permitting VA to bill his/her insurance and is also in a required co-pay status, then the Veteran will be responsible for their entire co-pay amount because VA is not able to offset the Veteran’s account dollar for dollar based on what the insurance company would have reimbursed.
Reimbursement of Travel CostsEligible Veterans and non-veterans may be provided mileage reimbursement or, when medically indicated, special mode transport (e.g. wheelchair van, ambulance) when travel is in relation to VA medical care.
Mileage reimbursement is 41.5 cents per mile and is subject to a deductible of $3 for each one-way trip and $6 for a round trip; with a maximum deductible of $18 or the amount after six one-way trips (whichever occurs first) per calendar month.
The deductible may be waived when travel is; in relation to a VA compensation or pension examination; by a special mode of transportation; by an eligible non-Veteran; will cause a severe financial hardship, as defined by current regulatory guidelines. Eligibility: The following are eligible for VA travel benefits:
- Veterans rated 30 percent or more service-connected. Veterans traveling for treatment of service-connected. conditions.
- Veterans who receive a VA pension.
- Veterans traveling for scheduled compensation or pension. examinations.
- Veterans whose income does not exceed the maximum. annual VA pension rate.
- Veterans in certain emergency situations.
- Veterans whose medical condition requires a special mode of transportation and travel is pre-authorized. (Advanced authorization is not required in an emergency and a delay would be hazardous to life or health).
- Certain non-Veterans when related to care of a Veteran (caregivers, attendants, donors and other claimants subject to current regulatory guidelines)
Reporting Fraud: Help VA’s Secretary ensure integrity by reporting suspected fraud, waste or abuse in VA programs or operations.
Report fraud to:
VA Inspector General Hotline
P.O. Box 50410
Washington, DC 20091-0410
E-mail: [email protected]
VAOIG hotline 1-800-488-8244
Fax: (202) 565-7936
VA Medical ProgramsVeteran Health RegistriesCertain Veterans can participate in a VA health registry and receive free evaluations. These evaluations include a medical history, physical exam, and if deemed necessary by the clinician, laboratory tests or other studies. VA maintains health registries to provide special health evaluations and health-related information. To participate, contact the Environmental Health Coordinator at the nearest VA health care facility or visit www.publichealth.va.gov/ exposures to see a directory which lists Environmental Health Coordinators by state and U.S. territory. Veterans should be aware that a health registry evaluation is not a disability compensation exam. A registry evaluation does not start a claim for compensation and is not required for any VA benefits.
Gulf War Registry:For Veterans who served on active military duty in Southwest Asia during the Gulf War, which began in 1990 and continues to the present, and includes Operation Iraqi Freedom (OIF) and Operation New Dawn (OND). The Gulf War registry was designed to identify possible health effects resulting from U.S. military personnel service in certain areas of Southwest Asia. Potential exposures include endemic infectious diseases and hazardous occupational or environmental exposures, including heavy metals, air pollutants (particulate matter and gases such as nitrogen oxides, carbon monoxide sulfur oxides, and hydrocarbons).
Depleted Uranium RegistriesDepleted uranium (DU) is uranium left over after most of the more radioactive U-235 isotope has been removed. DU possesses about 60 percent of the radioactivity of naturally occurring uranium; it is a radiation hazard only in very large exposures for prolonged time. DU has some chemical toxicity related to being a heavy metal (similar to lead) which occurs at lower doses and is the main concern for Veterans with embedded DU fragments.
Veterans who are identified by the DoD or have concerns about possible depleted uranium (DU) exposure are eligible for a DU evaluation at their local facility.
Embedded Fragment RegistryOEF, OIF, and OND Veterans who have or likely have an embedded fragment as the result of an injury they received while serving in an area of conflict are eligible for inclusion into the Embedded Fragment Registry. This registry was designed to identify track and conduct long-term medical surveillance of Veterans who potentially have embedded fragments. Clinical data captured in the Embedded Fragment Registy will be used to help develop medical and surgical guidelines to allow VA clinicians to deliver appropriate medical care to these Veterans.
Agent Orange RegistryAgent Orange is an herbicide the U.S. military used between 1962 and 1971 during the Vietnam War to remove jungle that provided enemy cover. Veterans serving in Vietnam were possibly exposed to Agent Orange or its dioxin contaminant. Veterans eligible for this registry evaluation are those who served on the ground in Vietnam between Jan. 9,1962, and May 7,1975, regardless of the length of service; this includes Veterans who served aboard boats that operated on inland waterways (“Brown Water Navy”) or who made brief visits ashore.
Other Veterans with possible exposure who are eligible include those who served: along the demilitarized zone in Korea (between Apr. 1, 1968 and Aug. 31, 1971), on certain bases or in certain units in Thailand (between Feb. 28, 1961 and May 7, 1975), or on certain U.S. bases or locations in other countries where Agent Orange or other herbicides were tested or stored.
VA maintains a DoD-provided list of locations and dates where Agent Orange or other herbicides were tested or stored at military bases in the U.S. or locations in other countries at www.publichealth.va.gov/ exposures. For sites not listed, the Veteran should provide some proof of exposure to obtain a registry evaluation. Information is also available through VA’s Special Issues Helpline at 1-800-749-8387.
Ionizing Radiation RegistryFor Veterans who have received nasopharyngeal (nose and throat) radium irradiation treatments while on active duty and Veterans possibly exposed to radiation during the following “radiation-risk activities:”
On-site participation in:
- An atmospheric detonation of a nuclear device, whether or not the testing nation was the United States;
- Occupation of Hiroshima or Nagasaki from Aug. 6, 1945, through July 1, 1946; or
- Internment as a POW in Japan during World War II, which VA determines resulted in an opportunity for exposure to ionizing radiation comparable to that of Veterans involved in the occupation of Hiroshima or Nagasaki, or service at
- Department of Energy gaseous diffusion plants at Paducah, Ky.; Portsmouth, Ohio; or the K-25 area at Oak Ridge, Tenn., for at least 250 days before Feb. 1, 1992, if the Veteran was monitored for each of the 250 days using dosimetry badges to monitor radiation to externa body parts; or
- Amchitka Island, Alaska, before Jan. 1, 1974, if the Veteran served for at least 250 days in a position that had exposures comparable to a job that was monitored using dosimetry badges in proximity to Longshot, Milrow, or Cannikin underground nuclear tests.
No in-person medical evaluation is required to become registered. However, Veteran participants are eligible for an optional no-cost medical evaluation from VA. Participants already enrolled in VA health care should contact their primary care provider or Patient Aligned Care Team (PACT) to schedule anevaluation. Veterans not already enrolled in VA health care should contact an Environmental Health Coordinator at a nearby VA facility by visiting the following link: (http://www.publichealth.va.gov/exposures/coordinators.asp) or calling 1-877-222-8387.
Vet Center Readjustment Counseling ServicesVA provides readjustment counseling services, to include direct counseling, outreach, and referral, through 300 community-based Vet Centers located in all 50 states, the District of Columbia, Guam, Puerto Rico, and American Samoa.
Eligibility: Veterans and active-duty Servicemembers, to include federally-activated members of the National Guard and Reserve components, are eligible to receive readjustment counseling services at a Vet Center if they:
- Have served on active military duty in any combat theater or area of hostility such as World War II, the Korean War, the Vietnam War, the Gulf War, or the campaigns in Lebanon, Grenada, Panama, Somalia, Bosnia, Kosovo, Afghanistan, and Iraq;
- Experienced a military sexual trauma while serving on active military duty;
- Provided direct emergent medical care or mortuary services, while serving on active military duty, to the casualties of war;
- Served as a member of an unmanned aerial vehicle crew that provided direct support to operations in a combat zone or area of hostility; or
- Are Veterans who served in the active military during the Vietnam-era, but not in the Republic of Vietnam, and have requested services at a Vet Center before January 1, 2004.
Services Offered: Vet Center counselors provide individual, group, marriage, and family readjustment counseling to those individuals that have served in combat zones or areas of hostilities to assist them in making a successful transition from military to civilian life; to include treatment for posttraumatic stress disorder (PTSD) and help with any other military related problems that affect functioning within the family, work, school or other areas of everyday life. Other psycho-social services include outreach, education, medical referral, homeless Veteran services, employment, VA benefit referral, and the brokering of non-VA services.
The Vet Centers also provide counseling to individuals who have experienced military sexual trauma of both genders and of any era of military service.
Bereavement Counseling related to ServicemembersBereavement counseling is available through VA’s Vet Centers to all immediate family members (including spouses, children, parents, and siblings) of Servicemembers who die while serving on active service. This includes federally-activated members of the National Guard and reserve components. Vet Center bereavement services for surviving family members of Servicemembers may be accessed by calling (202) 461-6530. For additional information, contact the nearest Vet Center, listed in the back of this book, or visit www.vetcenter.va.gov/.
Vet Center Combat Call Center(1-877-WAR-VETS) is an around the clock confidential call center where combat Veterans and their families can call to talk about their military experience or any other issue they are facing in their readjustment to civilian life. The staff is comprised of combat Veterans from several eras as well as family members of combat Veterans.
Prosthetic and Sensory AidsVeterans receiving VA care for any condition may receive VA prosthetic appliances, equipment and services, such as home respiratory therapy, artificial limbs, orthopedic braces and therapeutic shoes, wheelchairs, powered mobility, crutches, canes, walkers, special aids, appliances, optical and electronic devices for visual impairment and other durable medical equipment and supplies. Veterans who are approved for a guide or service dog may also receive service dog benefits including veterinary care and equipment.
VA medical services include diagnostic audiology and diagnostic and preventive eye care services. VA will provide hearing aids and eyeglasses to the following Veterans:
- Those with any compensable service-connected disability.
- Those who are former Prisoners of War (POWs).
- Those who were awarded a Purple Heart.
- Those in receipt of benefits under Title 38 United States Code (U.S.C.) 1151.
- Those in receipt of an increased pension based on being rated permanently housebound or in need of regular aid and attendance.
- Those with vision or hearing impairment resulting from diseases or the existence of another medical condition for which the Veteran is receiving care or services from VHA, or which resulted from treatment of that medical condition, e.g., stroke, polytrauma, traumatic brain injury, diabetes, multiple sclerosis, vascular disease, geriatric chronic illnesses, toxicity from drugs, ocular photosensitivity from drugs, cataract surgery, and/or other surgeries performed on the eye, ear, or brain resulting in vision or hearing impairment.
- Those with significant functional or cognitive impairment evidenced by deficiencies in the ability to perform activities of daily living. but not including normally occurring visual or hearing impairments. Note: Veterans with normally occurring visual and/or hearing impairments that interfere with their medical care are eligible for eyeglasses and hearing aids.
- Those who have vision or hearing impairment or combined visual and hearing impairments severe enough that it interferes with their ability to participate actively in their own medical treatment. Note: The term “severe” is to be interpreted as a vision and/or hearing loss that interferes with or restricts access to, involvement in, or active participation in health care services (e.g., communication or reading medication labels). The term is not to be interpreted to mean that a severe hearing or vision loss must exist to be eligible for hearing aids or eyeglasses.
- Veterans who have a service-connected hearing disabilitiy that contributes to a loss of communication ability. However, hearing aids are to be provided only as needed for the service-connected hearing disability. Nonservice-connected (NSC) Veterans are eligible for hearing aids or eyeglasses on the basis of medical need. All such Veterans (including Medal of Honor recipients who do not have entitling conditions or circumstances and catastrophically disabled Veterans) must receive a hearing evaluation by a state-licensed audiologist prior to determining eligibility for hearing aids or an appropriate evaluation by an optometrist or ophthalmologist prior to determining eligibility for eyeglasses to establish medical justification for provision of these devices. These Veterans must meet the following criteria for eligibility based on medical need:
- Be enrolled at VA medical facility where they receive their health care; and
- Have hearing or vision loss that interferes with or restricts communication to the extent that it affects their active participation in the provision of health care services as determined by an audiologist or an eye care practitioner or provider.
Home Improvements and Structural AlterationsVA provides up to $6,800 lifetime benefits for service-connected Veterans/Servicemembers and up to $2,000 lifetime benefits for nonservice-connected Veterans to make home improvements and/ or structural changes necessary for the continuation of treatment or for disability access to the Veterans/Servicemembers home and essential lavatory and sanitary facilities.
Modifications can include but are not limited to: Ramps allowing entrance to, or exit from, the Veterans/Servicemembers primary residence; Widening of doorways to allow access to essential lavatory and sanitary facilities; Raising or lowering kitchen or bathroom sinks and/or counters; Improving entrance paths or driveways in immediate area of the home to facilitate access to the home by the Veteran/Servicemember; Improving plumbing or electrical systems made necessary due to installation of dialysis equipment or other medically sustaining equipment in the home.
For application information, contact the Prosthetic Representative at the nearest VA medical center.
Special Eligibility ProgramsSpecial Eligibility for Children with Spina BifidaVA provides comprehensive health care benefits, including outpatient, inpatient, pharmacy, prosthetics, medical equipment, and supplies for certain Korea and Vietnam Veterans’ birth children diagnosed with spina bifida (except spina bifida occulta).
Special Eligibility for Veterans Participating in Vocational RehabilitationVeterans participating in VA’s vocational rehabilitation program may receive VA health care benefits including prosthetics, medical equipment, and supplies.
Limitations on Benefits Available to Veterans outside the U.S: Veterans outside the U.S. are eligible for prosthetics, medical equipment, and supplies only for a service-connected disability or any disability associated with, or found to be aggravating, a service-connected disability.
Services for Blind and Visually Impaired VeteransSeverely disabled blind Veterans may be eligible for case management services at a VA medical center and for admission to an inpatient or outpatient VA blind or vision rehabilitation program. In addition, blind Veterans enrolled in VA health care system may receive:
- A total health and benefits review as well as counseling on obtaining benefits that may be due to the Veteran but have not been received.
- Adjustment to blindness training and counseling.
- Home improvements and structural alterations.
- Specially adapted housing and adaptations.
- Automobile grant.
- Rehabilitation assessment and training to improve independence and quality of life.
- Low-vision devices and training in their use.
- Electronic and mechanical aids for the blind, including adaptive computers and computer-assisted devices such as reading machines and electronic travel aids.
- Facilitation and recommendation for guide dogs and support in the use of guide dogs.
- Costs for veterinary care and equipment for guide dogs.
- Talking books, tapes and Braille literature.
- Family education and support.
- A total health and benefits review.
- Adjustment to vision loss counseling.
- Rehabilitation assessment and training to improve independence and quality of life.
- Low-vision devices and training in their use.
- Electronic and mechanical aids for the visually impaired, including adaptive computers and computer-assisted devices, such as reading machines and electronic travel aids, and training in their use.
- Family education and support.
Mental Health services are also available in medical settings in which patients are receiving treatment, such as inpatient medicine and outpatient specialty medical clinics. In addition to general mental health care, this may include specialized PTSD services, treatment for Veterans with psychological conditions related to a history of military sexual trauma, psychosocial rehabilitation and recovery services, treatment for substance use disorders, suicide prevention programs, geriatric mental health problems, violence prevention, evidence-based psychotherapy programs, treatment with psychiatric medications consistent with the VA National Formulary, integrated care services, and mental health disaster response/post deployment activities. Extended hours care is available for Veterans at VA medical centers. Veterans should contact their local facility mental health service for more information.
Specialized programs, such as mental health intensive case management, psychosocial rehabilitation and recovery centers, and work programs are provided for Veterans with serious mental health problems. VA’s Program of Comprehensive Assistance for Family Caregivers entitles the designated primary and secondary family caregiver(s) access to mental health. These services may be offered at VA and/or contracted agencies. General caregivers (of all era Veterans) can receive counseling and other services when necessary if the treatment supports the Veteran’s treatment plan. For more information on VA mental health services visit www.mentalhealth.va.gov/VAMentalHealthGroup.asp
Veterans Crisis LineVeterans experiencing an emotional distress/crisis or who need to talk to a trained mental health professional may call the Veterans Crisis Line 1-800-273-TALK (8255). The hotline is available 24 hours a day, seven days a week. When callers press “1”, they are immediately connected with a qualified and caring provider who can help.
Chat feature: Veterans Chat is located at the Veterans Crisis Line and enables Veterans, their families and friends to go online where they can anonymously chat with a trained VA counselor. Veterans chat can be accessed through the suicide prevention website www. Veterancrisisline.net by clicking on the Veterans chat tab on the right side of the webpage.
Text feature: Those in crisis may text 83-8255 free of charge to receive confidential, personal and immediate support.
European access: Veterans and members of the military community in Europe may now receive free, confidential support from the European Military Crisis Line, a new initiative recently launched by VA. Callers in Europe may dial 0800-1273-8255 or DSN 118 to receive confidential support from responders at the Veterans Crisis Line in the U.S. For more information about VA’s suicide prevention program, visit: www.mentalhealth.va.gov/suicide_prevention/ or http://www.veteranscrisisline.net/.
Make the ConnectionResources help Veterans and their family members connect with information and services to improve their lives. Visitors to http://www.maketheconnection.net/ will find a one-stop resource where Veterans and their family and friends can privately explore information, watch stories similar to their own, research content on mental health issues and treatment, and easily access support and information that will help them live more fulfilling lives.
At the heart of Make the Connection are powerful personal testimonials, which illustrate true stories of Veterans who faced life events, physical injuries or psychological symptoms; then reached out for support; and found ways to overcome their challenges. Veterans and their families are encouraged to “make the connection” - with strength and resilience of Veterans like themselves, with other people who care, and with information and available resources for getting their lives on a better track. For more information, go to www.MakeTheConnection.net
Coaching Into CareCoaching Into Care works with family members or friends who become aware of the Veteran’s post-deployment difficulties, and supports their efforts to find help for the Veteran. This national clinical service provides information and help to Veterans and the loved ones who are concerned about them. More information about the service can be found at www.mirecc.va.gov/coaching/contact.asp
VA’s National Center for PTSDVA’s National Center for PTSD serves as a resource for health care professionals, Veterans and families. Information, self-help resources, and other helpful information can be found at http://www.ptsd.va.gov/.
The PTSD CoachThe PTSD Coach is a mobile application that provides information about PTSD, self-assessment and symptom management tools and information tabout how to connect with resources that are available for those who might be dealing with post trauma effects. The PTSD Coach is available as a free download for iPhone or Android devices.
Mental Health Residential RehabilitationMental Health Residential Rehabilitation Treatment Programs (MH RRTP) including domiciliaries, provide residential rehabilitative and clinical care to Veterans who have a wide range of problems, illnesses, or rehabilitative care needs, which can be medical, psychiatric, substance use, homelessness, vocational, educational, or social. The MH RRTP provides a 24-hour therapeutic setting utilizing a peer and professional support environment. The programs provide a strong emphasis on psychosocial rehabilitation and recovery services that instill personal responsibility to achieve optimal levels of independence upon discharge to independent or supportive community living. The MH RRTP also provides rehabilitative care for homeless Veterans.
Eligibility: VA may provide domiciliary care to Veterans whose annual gross household income does not exceed the maximum annual rate of VA pension or to Veterans whom the Secretary of Veterans Affairs determines have no adequate means of support. The copays for extended care services apply to domiciliary care. Call the nearest benefits or health care facility to obtain the latest information.
Outpatient Dental TreatmentDental benefits are provided by VA according to law. In some instances, VA is authorized to provide extensive dental care, while in other cases treatment may be limited by law. This Fact Sheet table describes dental eligibility criteria and contains information to assist Veterans in understanding their eligibility for VA dental care.
By law, the eligibility for outpatient dental care is not the same as for most other VA medical benefits. It is categorized in classes. Those eligible for VA dental care under Class I, IIA, IIC, or IV are eligible for any necessary dental care to maintain or restore oral health and masticatory function, including repeat care. Other classes have time and/or service limitations.
*Note: Public Law 83 enacted June 16, 1955, amended Veterans’ eligibility for outpatient dental services. As a result, any Veteran who received a dental award letter from VBA dated before 1955 in which VBA determined the dental conditions to be non-compensable are no longer eligible for Class II outpatient dental treatment.
Veterans receiving hospital, nursing home, or domiciliary care will be provided dental services that are professionally determined by a VA dentist, in consultation with the referring physician, to be essential to the management of the patient’s medical condition under active treatment. For more information about eligibility for VA medical and dental benefits, contact VA at 1-877-222-8387, Monday through Friday between 8 am and 8 pm EST or www.va.gov/healthbenefits. (See chart on page 26)
VA Dental Insurance Program (VADIP)Veterans enrolled in VA health care and CHAMPVA beneficiaries have the opportunity to purchase dental insurance coverage at a reduced cost through Delta Dental and MetLife. Delta Dental and MetLife offer multiple plans to choose from. Coverage, available throughout the United States and its territories, includes diagnostic, preventative, surgical, emergency, and endodontic/restorative treatment and services.
Enrolled Veterans and CHAMPVA beneficiaries may sign up to participate in VADIP by completing an application with Delta Dental or MetLife – online, over the phone, or by mail – for the plan that best meets their dental needs and budget. Each participant will pay fixed monthly premiums for coverage and copayments identified in the plan they select. The program is voluntary and there are no eligibility limitations based on service-connected disability or other factors. Participation in the program does not affect eligibility for VA-provided dental services and treatment.
Vocational and Work Assistance ProgramsVHA Therapeutic & Supported Employment Services (TSES) Programs: VHA provides vocational assistance and therapeutic work opportunities through three primary TSES programs for Veterans enrolled in the VAhealth care system. These programs are designed to assist Veterans to live and work as independently as possible in their respective communities. Participation in TSES vocational services cannot be used to deny or discontinue VA disability benefits. Payments received from Compensated Work Therapy Sheltered Workshop and Transitional Work and Incentive Therapy cannot be used to deny or discontinue SSI and/or SSDI payments and they are not subject to IRS taxes.
Dental Eligibility ChartIf you:You are eligible for:ThroughHave a service-connected compensable dental disability or condition.Any needed dental care.Class I
Are a former prisoner of war.Any needed dental care.Class IIC
Have service-connected disabilities rated 100 percent disabling, or are unemployable and paid at the 100 percent rate due to service- connected conditions.Any needed dental care. [note: Veterans paid at the 100 percent rate based on a temporary rating, are not eligible for comprehensive outpatient dental services.Class IV
Apply for dental care within 180 days of discharge or release from of active duty (under conditions other than dishonorable) of 90 days or more during the Gulf War era.One-time dental care if a DD214 certificate of discharge does not indicate that a complete dental examination and all appropriate dental treatment had been rendered prior to discharge.Class II
Have a service-connected noncompensable dental condition or disability resulting from combat wounds or service trauma.Any dental care necessary to provide and maintain a functioning dentition. A Dental Trauma Rating (VA Form 10-564-D) or VA RO Decision letter (VA Form 10- 7131) identifies the tooth/teeth/ condition(s) that are trauma rated.Class IIA
Have a dental condition clinically determined by VA to be associated with and aggravating a service- connected medical condition.Dental care to treat the oral conditions that are determined by a VA dental professional to have a direct and material detrimental effect to a service-connected medical condition.Class III
Are actively engaged in a 38 USC Chapter 31 vocational rehabilitation program.Dental care to the extent necessary to: to enter, achieve goals, and prevent interruption of a rehab program; hasten the return to a rehab program because of a dental condition; or to secure and adjust to employment during employment assistance, or enable to achieve maximum independence in dailyClass V
Are receiving VA care or are scheduled for inpatient care and require dental care for a condition complicating a current medical lDiveinngta.Dental care to treat the oral conditions that are determined by a VA dental professional to complicate a medical condition currently under treatment.Class VI
Are an enrolled Veteran who may be homeless and receiving care under VHA Directive 2007-039.A one-time course of dental care that is determined medically necessary to relieve pain, assist in gaining employment, or treat moderate to severe gingival and periodontal conditions.Class IIB
Compensated Work Therapy/Transitional Work (CWT/TW)Compensated Work Therapy/Transitional Work (CWT/TW) is a vocational assessment program that operates in VA medical centers and/or local community business and industry. CWT/TW participants are matched to real life work assignments for a time-limited basis. Veterans are supervised by personnel of the sponsoring site, under the same job expectations experienced by non-CWT workers. Veterans participating in the CWT/TW program are not employees of either the Federal government or a host company and, as such, receive no traditional employee benefits. CWT/TW participants receive, at a minimum, the greater of Federal or state minimum wage for all hours worked. Approximately 40 percent of participants secure competitive employment at the time of discharge.
CWT/Supported Employment (CWT/SE)CWT/Supported Employment (CWT/SE)is a recovery-based intervention provided through an integrated partnership with the primary Mental Health treatment team. The employment is intended to be an extension of treatment to manage symptoms and advance recovery. CWT/SE consists of full- or part-time competitive employment with extensive clinical supports to Veterans, and accommodations/supervision guidance to employers.
Other Initiatives include the adaption of SE evidence-based principles for specialty TSES programs for Veterans diagnosed with spinal cord injury, polytrauma, traumatic brain injury, and/or posttraumatic stress disorder. A list of CWT program sites can be found on the Location Page at http://www.cwt.va.gov/.
Vocational Assistance is a set of assessment, guidance, counseling, or other related services that may be offered to groups or individuals. These services are designed to enable Veterans to realize skills, resources, attitudes and expectations needed to prepare for searching for employment, succeeding in the employment interview process, and succeeding in employment.
CWT/Sheltered Workshop (CWT/SW) operates sheltered workshops at approximately 25 VA medical centers. CWT/SW is a pre-employment vocational activity that provides an opportunity for work hardening and assessment in a simulated work environment. Participating Veterans are paid the greater of Federal or state minimum wage on a piece rate basis.
Incentive Therapy (IT)Incentive Therapy (IT) is a pre-employment program that provides a limited work experience at VA medical centers for Veterans who are not actively seeking competitive employment and exhibit severe mental illness and/or physical impairments. IT services may consist of full- or part-time work with nominal remuneration limited to the maximum of one half of the Federal minimum wage.
Long-term ServicesVA provides institution based services (nursing home level of care) to Veterans through three national programs: VA owned and operated Community Living Centers (CLC), State Veterans’ Homes owned and operated by the states, and the community nursing home program. Each program has admission and eligibility criteria specific to the program. VA is obligated to pay the full cost of nursing home services for enrolled Veterans who need nursing home care for a service-connected disability, or Veterans or who have a 70 percent or greater service-connected disability and Veterans with a rating of total disability based on individual un-employability. VA provided nursing home care for all other Veterans is based on available resources. Institution based nursing home care is expected to be person centered and serves Veterans of all ages.
VA Community Community Living Centers (CLCVA Community Community Living Centers (CLC) provide a dynamic array of short stay (less than 90 days) and long stay (91 days or more) services. Short stay services include but are not limited to skilled nursing, respite care, rehabilitation, hospice, and continuing care for Veterans awaiting placement in the community. Long stay services include but are not limited to dementia care and continuing care to maintain the Veteran’s level of functioning. Short stay and long stay services are available for Veterans who are enrolled in VA health care and require CLC services.
State Veterans’ Home ProgramState Veterans homes are owned and operated by the states. The states petition VA for grant dollars for a portion of the construction costs followed by a request for recognition as a state home. Once recognized, VA pays a portion of the per diem if the state meets VA standards. States establish eligibility criteria and determine services offered for short and long-term care. Specialized services offered are dependent upon the capability of the home to render them.
Community Nursing Home ProgramVA health care facilities establish contracts with community nursing homes. The purpose of this program is to meet the nursing home needs of Veterans who require long-term nursing home care in their own community close to their families, and who meet the enrollment and eligibility requirements.
Admission Criteria The general criteria for nursing home placement in each of the three programs requires that a resident must be medically stable, i.e. not acutely ill, have sufficient functional deficits to require inpatient nursing home care, and be determined by an appropriate medical provider to need institutional nursing home care. Furthermore, the Veteran must meet the specific eligibility criteria for community living center care or the contract nursing home program and the eligibility criteria for the specific state Veterans home.
Home and Community Based ServicesIVA offers a variety of community-based non-institutional long-term services and supports these services either directly or by contract with community-based agencies. Home and community based services are expected to be person centered and serve Veterans of all ages. Veterans receiving these services may be subject to a copay.
In-Home and Community Based CareSkilled home health care, homemaker/home health aide services, community adult day health care; Hhospice and Palliative Care, Veteran Directed Care.
Respite CareDesigned to relieve the Family Caregiver from the constant burden of caring for a chronically ill or disabled Veteran at home. Services can include in-home care, a short stay in an institutional setting or adult day health care.
Primary CareGeri Patient Aligned Care Teams (PACT) provide geriatric focused primary care in an outpatient setting; Home Based Primary Care PACT provides primary care in the home; Geriatric Evaluation and Management (GEM) provides inpatient or outpatient short- term comprehensive geriatric evaluation and management.
Emergency Medical Care in U.S. Non-VA Facilities In the case of medical emergencies, VA may reimburse or pay for emergency non-VA medical care not previously authorized that is provided to certain eligible Veterans when VA or other federal facilities are not feasibly available. This benefit may be dependent upon other conditions, such as notification to VA, the nature of treatment sought, the status of the Veteran, the presence of other health care insurance, and third party liability.
Because there are different regulatory requirements that may affect VA payment and Veteran liability for the cost of care, it is very important that the nearest VA medical facility to where emergency services are furnished be notified as soon as possible after emergency treatment is sought. If emergency inpatient services are required, VA will assist in transferring the Veteran to a Department facility, if available. Timely filing claim limitations apply. For additional information, contact the nearest VA medical facility. Please note that reimbursement criteria for Veterans living or traveling outside the United States fall under VA’s Foreign Medical Program (FMP), and differ from the criteria for payment of emergency treatment received in the United States.
Foreign Medical ProgramVA may authorize reimbursement for medical services for service- connected disabilities or any disability associated with and found to be aggravating a service-connected disability for those Veterans living or traveling outside the United States. This program may also reimburse for the treatment of foreign medical services needed as part of an approved VA vocational rehabilitation program. Veterans receiving health care services in the Philippines should register with the U.S. Veterans Affairs office in Pasay City. Veterans calling from within the Philippines may contact the VA office in Pasay City at 1-800-1888- 8782. If calling from outside of the Philippines, the number is 011- 632-318-8387. Veterans may also register by email at IRIS.va.gov. All other Veterans living or planning to travel outside the U.S. should register with the Foreign Medical Program, P.O. Box 469061, Denver, CO 80246-9061, USA; telephone 303-331-7590. For information visit: www.va.gov/hac/forbeneficiaries/fmp/fmp.asp.
Some Veterans traveling or living overseas can telephone the Foreign Medical Program toll free from these countries: Germany 0800-1800- 011; Australia 1-800-354-965; Italy 800-782-655; United Kingdom (England and Scotland) 0800-032-7425; Mexico 001-877-345-8179; Japan 00531-13-0871; Costa Rica 0800-013-0759; and Spain 900- 981-776. (Note: Veterans in Mexico or Costa Rica must first dial the United States country code.)
On occasion Veterans will ask to have prescriptions mailed outside the United States and its territories. VA Pharmacy Service is not authorized to ship medications or medical/surgical supply items outside of the United States or US Territories (Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands). For Veterans registered with the Foreign Medical Program, prescription reimbursement is approved only for United States Food and Drug Administration (FDA) approved medications.
Within the United States and prior to travel abroad, VA facilities may opt to fill outpatient medications prior to the normal dispensing date in the event that a Veteran will be traveling and unable to obtain medications while abroad. This may be done on a limited basis and requires prior consultation with the Veteran’s VA provider prior to dispensing.
Online Health ServicesVA offers Veterans, Servicemembers, their dependents and caregivers their own personal health record through My HealtheVet, found at www.myhealth.va.gov.
My HealtheVet’s free, online Personal Health Record is available 24 hours a day, seven days a week with Internet access. Those with an upgraded account (obtained by completing the one-time in-person authentication* process) can:
- Participate in secure messaging with VA health care team members
- View key portions of DoD military service information
- Get VA wellness reminders
- View VA appointments
- View VA lab results
- View VA allergies, adverse reactions and other key portions of their VA electronic health record
- View their VA Comprehensive Care Document (CCD)
My HealtheVet helps Veterans partner with VA health care teams by providing tools to make shared, informed decisions. Simply follow the directions on the website to register. VA patients registered on My HealtheVet can begin to refill VA medications online. Veterans can also use VA Blue Button to view, print, or download the health data currently in their My HealtheVet account. Veterans can share this information with family, caregivers or others such as non-VA health care providers. It puts the Veteran in control of their information stored in My HealtheVet. VA Blue Button also provides Veterans who were discharged from military service after 1979 access to DoD Military Service Information. This information may include Military Occupational Specialty (MOS) codes, pay details, service dates, deployment, and retirement periods.
*To access the advanced My HealtheVet features, Veterans will need to get an upgraded account by completing a one-time process at their VA facility. Visit My HealtheVet at www.myhealth.va.gov, register and learn more about in-person authentication plus the many features and tools available with Internet access. Veterans with questions should contact the My HealtheVet Coordinator at their VA facility.
Caregiver Programs and ServicesVA has long supported family caregivers as vital partners in providing care worthy of the sacrifices by America’s Veterans and Servicemembers. Each VA medical center has a Caregiver Support Program coordinated by a Caregiver Support Coordinator (CSC). The CSC coordinates caregiver activities and serves as a resource expert for Veterans, their families and VA providers. Several programs are available for all Veteran caregivers including:
In-Home and Community Based CareSkilled home health care, homemaker/home health aide services, community adult day health care and Home Based Primary Care.
Respite CareDesigned to relieve the family caregiver from the constant burden of caring for a chronically ill or disabled Veteran at home. Services can include in-home care, a short stay in an institutional setting or adult day health care.
Post-9/11 Caregiver ProgramThe Caregivers and Veterans Omnibus Health Services Act of 2010 allows VA to provide unprecedented benefits to eligible Caregivers (a parent, spouse, child, step-family member, extended family member, or an individual who lives with the Veteran, but is not a family member) of eligible Veterans who incurred or aggravated a serious injury in the line of duty on or after Sept. 11, 2001 (post-9/11 Veterans) under the Program of Comprehensive Assistance for Family Caregivers. Services include:
- Monthly stipend based on the personal care needs of the Veteran
- Travel expenses, including lodging and per diem while accompanying Veterans undergoing care
- Access to health care insurance through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) if the Caregiver is not already entitled to care or services under a health plan
- Mental Health services and counseling
- Comprehensive VA Caregiver training
- Respite care
- Appropriate caregiving instruction and training
Family Support ServiceThese support groups can be face-to- face or on the telephone. They include family counseling, spiritual and pastoral care, family leisure and recreational activities and temporary lodging in Fisher Houses.
Travel: VA’s Comprehensive Assistance for family caregivers Program entitles the designated family caregiver to beneficiary travel benefits.
These benefits include:
- Transport, lodging, and subsistence for period of caregiver training
- Transport, lodging, and subsistence while traveling as Veteran’s attendant to and from VA Health care as well as duration of care at VA or VA authorized facility.
- Mileage or common carrier transport.
- Lodging and/or subsistence at 50 percent of local federal employee rates
Veterans Canteen ServiceEstablished in 1946, the Veterans Canteen Service (VCS) was created to provide merchandise and services at reasonable prices to Veterans enrolled in the VA health care system, caregivers, and visitors. The VCS PatriotStoreDirect 1-800-664-8258 provides services to those who cannot visist a VA facility. For more information, visit VCS online at www.vacanteen.va.gov for more information.
