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Thursday, December 3, 2015

Important Things You Need to Know About Medicare Part D

 

This year, a relative of mine had two issues that affected her prescription plan.  First, she was diagnosed with an illness and prescribed new drugs.  Second, she forgot to pay her Medicare Part D premiums and lost her prescription coverage.  How do you choose a Medicare Part D plan?  How do changes in medication affect the Part D insurance plan a participant might choose?  

Medicare Part D is the health insurance that covers prescription medication for outpatient drugs.  Part D is a fairly recent addition to the Medicare Alphabet, having been added in 2006.  This plan seems incredibly confusing, and it can require some research to determine the best plan for each individual.

Medicare Part D is a federally subsidized drug benefit.  The participants will pay a monthly premium to an insurance company that has contracted with the government.  In 2015, the average premium is around $33.15 per month.  After a participant has paid the deductible $320.00, the participant will pay 25% of the cost of the drugs until the total cost of the prescription drugs has reached $2960.  The federal government pays $2,220 of this amount and the participant will pay $760.  

But how to choose a Medicare Part D plan?  Medicare has a pretty powerful program online that can help you make the decision.  Go to www.medicare.gov/find-a-plan.  It will ask you to enter the zip code of the participant, and then will ask for all of the medications the participant is taking, the dosage of the medications, and the number of pills purchased each time.  It will also ask for the pharmacy where the participant usually purchases the drugs.  Once all of that information is entered into the find-a-plan site, the site will spit out a list of plans with comparative information including the cost of premiums, the annual drug deductible, the estimated annual drug costs, and the rating of the plan based on 3 out of 5 stars assigned by Medicare. Medicare sometimes assigns a 5-star rating for a Part D insurance plan that will be indicated by a yellow star with a 5 in the middle next to the Medicare Part D plan.   Once you have entered all of the information, you can compare the costs of the various plans.  Of course, the information is only valid if all of the drugs in the correct dosages are entered into the system.  Be sure to check to see whether the cost of the drugs will go up during the year.  Usually, the cost of the prescription drugs goes down once the deductible is met, and goes up again when the participant hits the donut hole at $2960.

The participant will have to go to a pharmacy in the plan’s network in order to get the lower price you expect to pay. 

Not everyone needs a Medicare Part D plan.  Some retirees may have coverage under their retirement plans, veterans who qualify for free or reduced price medications may not need the coverage. That is called “creditable coverage.”  If you do need it, though, and don’t sign up for it when eligible, you will be charged a penalty when you do finally sign up.  The penalty is at least 1% for every month you delay enrolling past the Initial Enrollment Period.

 

 

 

 


Thursday, July 23, 2015

Four Ways to Pay for Long-Term Care

Concerned about how your parents will pay for their long-term care?  Here are the four basic ways to pay for care.


Read more . . .


Tuesday, July 1, 2014

VA Improved Pension and Medicaid

 

 

Joe, an 89-year-old veteran served in WWII.  He and his wife, Mary, have been living in an assisted living facility for three years and Joe has been receiving VA Pension with Special Monthly Pension for Aid and Attendance.  Joe recently fell, and his physician has decided Joe cannot return to the assisted living facility.  Joe is now in a Nursing Home and needs to apply for Medicaid to cover the cost of his care.   

 

VA Pension Benefits can be a lifesaver for veterans or their surviving spouses who need home care or assisted living facility care.  The added money the VA awards eligible veterans or their surviving spouses when added to social security income is often just enough to help a veteran or spouse afford to stay at home with companion care or be able to move to a good assisted living facility (ALF). 

 

When a veteran, his or her spouse or surviving spouse needs skilled nursing care in a skilled nursing facility or nursing home, though, the VA Pension is often not enough to cover the cost of that level of care.  The average cost of a semi-private room in a nursing home in Georgia is about $181.00/day or about $5430.00 for a 30-day month, according to the MetLife Survey of Long-Term Care Costs published in November of 2012.    For 2014, the maximum VA Pension award for a married couple is $2085.00. *(This maximum amount includes Basic Improved Pension plus Special Monthly Pension for Aid and Attendance).  Currently, the Social Security Administration estimates that the average Social Security benefit for an aged couple when both are receiving benefits is $2,111., while the average for a single aged widow or widower is $1243 per month.   Since the combined VA Pension and Social Security rarely exceed the $5000 monthly price tag for a nursing home stay, the veteran or spouse may need to qualify for Medicaid in order to afford to live in the nursing home. 

 

Medicaid is a federal/state program available to people with low assets and income who meet the physical requirements for admission to a nursing home.  Generally, that means that the person is deficient in some of the activities of daily living.  While circumstances vary, usually a Medicaid recipient pays his or her monthly income to the nursing home, and then Medicaid pays the difference up to the amount Medicaid has contractually agreed to pay the nursing home. 

 

A single veteran who qualifies for Medicaid will have his entire VA pension benefit reduced to $90.00.  If a veteran is married and qualifies for Medicaid, whether or not he can continue to receive Improved Pension will depend on whether his spouse’s income is sufficiently reduced by unreimbursed medical expenses to make them eligible for the Improved Pension award. 

 

A married veteran can still receive the VA pension benefit and the additional part considered to be aid and attendance, so long as he would be otherwise eligible for the benefit.  If the income of the couple is less than the pension amount, the award can be apportioned to the spouse who is not in the Nursing Home and receiving Medicaid.

 

If Joe goes into the Nursing Home and begins receiving Medicaid, his Pension with Aid & Attendance can be apportioned for Mary to spend on her Assisted Living Care. 

 

 

 

 


Monday, June 30, 2014

Adaptive Housing for Veterans with Disabilities

Steve, a veteran who receives service-connected compensation for ALS, amyotrophic lateral sclerosis, often known as Lou Gehrig’s disease, has trouble walking up the stairs and it is getting increasingly difficult for him to get in to the bathtub.  His wife, Jane, can no longer lift him into the tub.

Steve may be eligible for a grant from the VA to adapt his house to accommodate his disability.  The VA provides grants to Service members and Veterans who have total service-connected disabilities to help modify a home, purchase an already adapted home, build an adapted home on land already acquired, or pay down the unpaid principal on the mortgage of an adapted home the Service member or Veterans has already acquired. 

There are two types of grants, with unfortunately similar acronyms:  the Specially Adapted Housing (SAH) Grant, which provides up to $67,555 or the Special Housing Adaptation (SHA) Grant, which provides a maximum of $13,511 in 2014.

The SAH Grant is available to Service members and Veterans who have certain permanent and total service-connected disabilities, such as the loss of or loss of use of both legs.   The medical requirements for the SAH are presumed for those with ALS with a service-connected rating of 100%.  In addition to the medical requirements, the disability must require that the Veteran or Service member have the regular and constant use of a wheelchair, brace, crutches or canes as the regular mode of locomotion. 

 The SHA Grant is available to Veterans and Service members who have service-connected disabilities which include: blindness in both eyes with 5/200 visual acuity or less; the anatomical loss or loss of use of both hands; certain severe burn injuries; or certain severe respiratory injuries.

Steve will need to file an application on VA Form 26-4555, Veteran’s Application in Acquiring Specially Adapted Housing or Special Housing Adaptation Grant. Those Service members or Veterans whose disability is not one presumed to meet the medical requirements for the grants will need to make sure that the VA Loan Guaranty office at their Veterans Regional Office gets a report of examination or hospitalization and VA Form 10-4555b, Certificate of Medical Feasibility.

 

 

 

 

 


Friday, February 28, 2014

FIDUCIARY APPOINTMENTS BY THE VA

What is a Fiduciary and why does the VA want to appoint one for my dad?

George, a veteran of WWII who now lives in an assisted living facility, applied for Improved Pension with Aid & Attendance.  After a few months, the VA sent him a letter explaining that George had been awarded the Pension, but would not receive his retroactive check until the VA determined whether he was competent to handle his affairs and whether the VA should appoint a fiduciary to manage his checks. What is a Fiduciary and why does the VA want to appoint one for my dad?

George, a veteran of WWII who now lives in an assisted living facility, applied for Improved Pension with Aid & Attendance.  After a few months, the VA sent him a letter explaining that George had been awarded the Pension, but would not receive his retroactive check until the VA determined whether he was competent to handle his affairs and whether the VA should appoint a fiduciary to manage his checks. 

Often veterans or their surviving spouses applying for VA Pension or Compensation benefits have some mental disease or injury that affects their ability to manage their financial affairs.  Before the VA will issue payment, the VA wants to know that if the veteran or spouse cannot manage the money they receive from the VA, someone trustworthy will be able to manage their money for them. 

The VA may appoint an individual or a corporation to serve as a fiduciary, or may authorize someone who has been appointed by a court to serve as a fiduciary.  A fiduciary is a person or legal entity that has been appointed by the VA to receive VA funds on behalf of a beneficiary for the use and benefit of the beneficiary and his/her dependents.  See A Guide for VA Fiduciaries. A beneficiary is an individual entitled to receive VA benefits.    The definition of incompetent for VA purposes is a minor or an adult who is rated incompetent by the VA or is under a legal disability by reason of court action.

The VA first makes a determination based on the evidence submitted that the veteran or surviving spouse is not able to manage their money.   If the veteran or spouse wishes, they can tell the VA that they are incompetent and request someone they know and trust be appointed to serve as the fiduciary. 

Before the VA appoints the person, though, they will do what is called a “field examination” to check that the person is trustworthy.

A VA employee, called a Field Examiner, will interview the potential fiduciary to ask whether they are willing to serve, will check the person’s credit rating, do a criminal background check, and ask for personal references.  If the veteran or surviving spouse does not have anyone they trust, or if the VA finds that the person nominated by the veteran or surviving spouse is not trustworthy, the VA can appoint a corporate fiduciary.  In some cases, the VA appoints an employee of an institution, such as an assisted living or nursing home,  to serve as a fiduciary.

The fiduciary is responsible to oversee the veteran or spouse’s VA award, and is required to use the VA funds to pay the basic living expenses for the beneficiary and his or her dependents first, and to provide goods and services to improve the lifestyle of the beneficiary and dependents only once the basic needs are met.

George requested that the VA appoint his oldest son, John, as his fiduciary.  Once the VA investigated John, they made him the payee of George’s VA check.  John received George’s retroactive Pension payment, and now receives George’s monthly check.  John must keep the deposits separate from his own accounts and keep records of payments he makes for George from the VA funds. He also agreed to keep the VA informed of any changes in George’s residence or medical condition, and to file a Federal Fiduciary’s Account, VA Form 21P-4706b, every year.


Thursday, February 13, 2014

UPDATE: Spouse for VA Purposes

Who is a spouse for VA benefit purposes?

The United States Code and the Code of Federal Regulations – the rulebook for the VA – state that a spouse is a person of the opposite sex, whose marriage meets the requirements of the state in which the parties resided at the time of the marriage.  [1]

The Supreme Court recently struck down a provision in the Defense of Marriage Act that stated that for federal purposes, a marriage between members of the same gender could not be valid.  Why did the Supreme Court strike this down?  Primarily because marriage has historically been a state law question.  In other words, each state has defined the rules for marriage as that state sees fit.  Recently, some states have changed their laws to allow two people of the same sex to marry.  Since some state laws conflicted with parts of the Defense of Marriage Act (DOMA), the Supreme Court ruled that that part of DOMA was unconstitutional and ordered the federal government to change its regulations to comply.

What does that mean for veterans who are in same sex marriages – or are thinking about marrying someone of the same sex- for purposes of qualifying for veteran’s benefits that are available to veterans with spouses?   The answer currently is that it seems to depend on which state the veteran is in when he or she applies for the benefits. The Obama administration decided to extend military spousal benefits to legally married same –sex couples.  However, since whether a same-sex marriage – or any marriage- is legal is left to the individual states, whether a couple is legally married for military and veterans benefits will depend on which state the parties are in when they apply for the benefits. [2]

For example, Georgia does not allow same sex marriages.  In fact, Georgia does not recognize same-sex marriages even if they were entered into in a state that does allow them.  If a veteran married legally in another state,  moves to Georgia with his or her spouse and then applies for benefits claiming a spouse as a dependent, the VA most likely will not award the benefits since the marriage is not valid in Georgia. 

Contrast this with the same veteran who applies for the same benefits in a state in which same-sex marriage is valid.  He or she will be eligible for the increase in benefits based on the spouse and will most likely be awarded the benefits.  If he or she then moves to Georgia with the spouse, he or she will continue to receive the increased award based on a spousal dependent.  The VA will not likely take the benefits away once awarded.

The VA is currently in the process of changing the language in its code sections, federal regulations, and manuals to comply with the decision in the Windsor case. 

Until the VA does re-write its manuals, and until the new marriage policies are known to all those at the VA, veterans and their spouses may face inconsistent decisions from the VA and my need to fight to obtain benefits to which they are entitled.

Recently, Attorney General Eric Holder announced that the Justice Department would no longer deny certain benefits to legally married same-sex spouses.  Specifically, Holder stated that spouses would not be compelled to testify against their spouse in court, that spouses can now visit their incarcerated spouse in a federal penitentiary, and that couples can now apply for federal benefits under programs such as the Sept. 11 victim’s fund.   Holder did not specifically mention any VA programs, however, the statements seem to be an indication that the government intends to end forms of discrimination against same-sex couples at least in the programs which are truly federal programs.



[1] 38 U.S.C. Section 101(31) and 38 C.F.R. Section 3.50(a) and Section 3.1(j)

[2] Currently 13 states and the District of Columbia have legal same-sex marriage.  The states allowing same-sex marriage:  California, Connecticut, Iowa, New Hampshire, Massachusetts, Delaware, Minnesota, Rhode Island, Vermont, Maine, Maryland, Washington, and Washington, D.C.


Friday, November 29, 2013

How to Talk to Your Parents, Friends, In-laws, etc. about VA Benefits

How to talk to your parents,

Siblings, Friends and Neighbors about Veterans Benefits

Most of us know someone who served in the military at some point in time.  We’ve seen pictures of them in uniform posted on their walls, or we’ve heard them talk about when they were in Korea, or Viet Nam, or Fort Benning. 

Today, there is a lot of anxiety about healthcare costs, education costs, and long-term care costs.  Have you ever asked someone who served in the military whether they are receiving any benefits or have thought about receiving benefits?  Often veterans or their families will say, “When my dad came back from the war, he never wanted to talk about the war and the VA just reminded him of a really bad time in his life. “  Or, my dad visited a VA hospital and it was too confusing and overwhelming for him.  He was told he didn’t qualify for anything because he had too much money, or didn’t serve at the right time or had never been injured in service, so he just gave up.

To be frank, the VA often does a really bad job of informing veterans about what benefits they might qualify for.  The VA is especially bad in giving advice over the telephone.  Of course, as most of us know, in any business the advice you get depends on who happens to answer the telephone when you call.  What I’ve learned as an attorney is that the caller has to be responsible for asking enough questions and asking them in as many different ways as possible to get to the right answer.  Step one is often to learn the language of the institution you are calling.  When you call your doctor’s office, you try to convey your symptoms in a way that will let the office know enough about your illness or injury to let you know whether you need to rush to the emergency room, or whether your symptoms are nothing to worry about.  You know the doctor will want to know whether you have a fever, whether you are bleeding, when was the onset of the fever.  In order to get the best advice, you are responsible for using language that the doctor’s office will understand.

In order to get the best advice possible from the VA, and in order to help your family and friends get the benefits they deserve, you can learn how to talk to them about VA benefits.

First, you can ask about their service.   When I was a kid, we had a green gas mask stored in our basement storage closet.  My dad would take it out occasionally – usually when entertaining the male teachers he supervised – and tell them the story of how he was part of a unit that used chemicals to experiment on monkeys.  My father was stationed at the Aberdeen Proving Grounds during the Korean War where they experimented with chemical weapons.  I know that my father was stationed there and that my sister was born while he was stationed there in 1953.  I also know that shortly after my sister was born, my dad must have been discharged since they moved back to South Dakota where my dad was a teacher for the next 40 years.

But, how can I prove that my dad was in the service?  First, I can ask him if he has his discharge paper.  The discharge paper is often referred to as the DD-214, for the Department of Defense form number that is used now for most discharges.  However, in WWII and the Korean War it may have been referred to as a separation paper, a Certificate of Discharge, an Enlisted Report and Record of Separation, or some similar title.

There is a lot of information on the discharge paper, and the veteran will need it or a copy to get benefits.  One question you can ask is whether the veteran has that paper or if he or she recorded the paper with the county in which he or she was living at some point after discharge.  If the veteran does not have that paper, he or she will need to get one.  You can help get the discharge paper, but you will need to know the following information:  Branch of Service, Dates of Service (approximate is okay, although the more accurate the information the better chance you’ll have of getting the document) and Social Security number.  You’ll need to know the veterans full name – make sure it is the name he or she used while in the service.  I’ve known veterans who never used the name on their birth certificate, but their military records are all under the name as on the birth certificate.  Be sure you know the spelling used on the birth certificate, too.

If you don’t have the paper, you can order it from the archives.  Here is the website:  www.archives.gov/veterans/.

There was a fire in the storage facility in St. Louis in the 1970’s where many military records were stored.  Thus, some records were destroyed.  Most can be reconstructed, but it may take a little longer to get the records if they were part of that group destroyed in the 1970’s.   You will need to have some patience.

If your parent is reluctant to find out what services are available through the VA or at the VA, ask what experiences they’ve had in the past – if any- and ask whether they would like to hear some of the benefits that are available.  If you know someone in a similar situation who is receiving benefits, you can discuss what benefits that person is receiving and maybe something about their experience with the VA.

I often talk to veterans who feel that the VA has been a lifesaver for them -especially for unemployed or self-employed veterans who may not have cheap affordable healthcare available to them in their area.   My friend swears by the care given to him at the VA.  He is a middle-aged, self-employed, Viet Nam Veteran, who needed care for a heart condition that he could not afford without health insurance.  He found that he was entitled to care at the VA, and since then he has been treated regularly at the VA.

Another client, a successful man in his 60’s, discovered that he had a form of cancer.  Since he was “in country” in Viet Nam, he is now receiving a service-connected disability payment for the cancer.  In addition, the VA is evaluating his claim for PTSD.

Many of my veteran clients now receive hearing aids and other help for hearing loss through the VA.  When they were young, they didn’t notice that their experience around noisy combat affected their hearing, but in older age, the hearing loss is apparent and the treatment for that hearing loss is their right.

I encourage my clients to enroll in the VA healthcare system by filing a form 10-10-EZ, Application for Health Benefits.  You can find that online at www.1010ez.med.va.gov/sec/fha/1010ez/.


Wednesday, November 27, 2013

Nursing Home Care for Veterans

Nursing Home Care for Veterans

The VA provides “Community Living Centers”, or what used to be called Nursing Homes.  These are operated by the VA, and are usually in a Veterans Administration Hospital.  These Community Living Centers (CLC’s) provide rehabilitation for veterans recovering from injury and illness in the short-term, but also provide long-term skilled nursing care for veterans who need care for long periods of time for a service-connected injury.

For veterans rated at 70% service-connected or higher, or for those who need nursing home care for their service-connected injuries, the VA pays for their nursing home placement as part of their package of healthcare benefits.

The CLC’s are available for non-service connected veterans who are enrolled in VHA healthcare, and need short term services such as rehabilitation, hospice, respite, and for those waiting for placement in the community.

VA provides care to veterans based on a priority system.  There are currently 8 categories of veterans based on service- connection and financial need.  For example, a veteran who is 50% service-connected or higher is in category 1.  A non-service connected veteran with significant assets and income is most likely going to be enrolled in category 8.

Veterans in category 1 will be eligible for placement in a CLC, and will not have a co-pay, but those in category 8 will be placed in a CLC only if there is availability and no one in a higher category needs the bed.  The veteran in category 8 will pay a daily co-pay for services in the CLC.

In Atlanta, the CLC is located in the VA hospital on Clairmont Road, and is almost always full to capacity with a waiting list.  For those veterans for whom nursing home care is not part of the package of medical benefits, they may be able to find placement in one of the two Georgia War Veterans Homes.

The two Georgia War Veterans Homes in Georgia are not run by the national VA, but are available to veterans.  The Georgia Department of Veterans Services and the Georgia Health Sciences University operate the Georgia War Veterans Nursing Home in Augusta.   The Georgia War Veterans Home in Milledgeville is operated by United Veteran Services of Georgia, Inc., which operates the home for the Georgia Department of Veterans Services. 

In order to be eligible for admission to a Georgia War Veterans Home, the person must be domiciled in Georgia, and must have resided in Georgia for the five years immediately preceding admission.  He or she must have been a “war veteran”, defined as any veteran who served on active duty in the Armed Forces of the U.S. during wartime or during the period between January 31, 1955 and May 7, 1975.  In addition, the U.S. Department of Veterans Affairs must approve them as “eligible for care and treatment”.  Veterans accepted into the Georgia War Veterans Homes will be required to pay some expenses such as Medicare or health-care insurance deductibles and co-pays.  The forms to apply for admission to the Georgia War Veterans Homes are found at veterans.georgia.gov/gwvh-forms.


Sunday, November 24, 2013

Services Available to Blind and Low Vision Veterans

VA and Blind and Low Vision Veterans

As the veteran population ages, and as veterans come back from war with increasing numbers of traumatic brain injury (TBI), the number of veterans who are legally blind or have low vision is increasing exponentially.  Low vision and blindness can be caused by accidents, and brain injuries, but many veterans are losing their vision because of age and disease-related factors, such as macular degeneration and diabetes.

President Franklin D. Roosevelt signed an Executive Order on January 8, 1944, which declared:  “No blinded serviceman from World War II (WWII) would be returned to their homes without adequate training to meet the problems of necessity imposed upon them by their blindness.”   After the war ended, the VA accepted the responsibility of adjustment training for blinded veterans.

Legal blindness is defined as: central acuity of 20/200 or less in the better eye with ordinary corrective glasses; or, central visual acuity better than 20/200 in the better eye, and a field defect in which the peripheral field at its widest tested diameter is less than 20 degrees.  The VA estimates that there are 160,000 legally blind veterans.

In addition, there are over one million veterans with low vision, which is defined as uncorrectable visual impairment between 20/70 up to legal blindness.

The VA addresses the problems associated with veterans who are blind or have low vision in many ways.  Currently, there are 10 Blind Rehabilitation Centers (BRC), and many Visual Impairment Services Teams (VIST) throughout the country. 

The Blind Rehabilitation Centers offer daily training and counseling for veterans who are totally blind, as well as those veterans who have low vision. The programs are designed for inpatient stays, but in certain circumstances the veterans can receive the services on an outpatient basis. The programs offer classes in orientation and mobility, including training on aids for travel, such as canes.  Veterans are fitted with low vision devices and are trained in how better to use their remaining senses.  The VA also funds training for one family member who will play a significant role in the Veteran’s continued adjustment to community living.

Veterans and active duty personnel who are eligible for VA health care and meet the criteria of legal blindness or need comprehensive treatment in order for the veteran’s safety or functional independence or to be restored.

For low vision veterans, there is an outpatient program similar to the BRC called VISOR, or visual impairment services outpatient rehabilitation.  VISOR is a nine-day outpatient program, which teaches skills similar to those taught in the BRC’s.  The difference is that for those veterans enrolled in VISOR, they must be able to take care of all of their own activities of daily living.  VISOR does provide safe accommodations where participants can stay during the nine-day outpatient treatment.

Here is a link for more information about the blind and low vision services available to veterans:  http://www.aao.org/veterans/news/low-vision.cfm.


Saturday, November 23, 2013

Vocational Rehabilitation Services for Veterans

Vocational Rehabilitation 

What are vocational rehabilitation benefits?

The Department of Veterans Affairs provides services for qualified veterans with service-connected disabilities who need assistance to become suitably employed or to maintain employment or who need assistance or training in order to become independent in daily living.

The services provided may include counseling, as well as education and specialized training. 

Which veterans are qualified?

In order to qualify for the program, the veteran must either have, or will receive, an honorable or other than dishonorable discharge, have more than a 10% service-connected disability rating, and must apply for vocational rehabilitation services.

Generally, the veteran must apply for the vocational rehabilitation within 12 years from the separation from active duty, or from the date the veteran was first notified of a service-connected disability rating.

Once the veteran applies, a VA Vocational Rehabilitation Counselor provides a Comprehensive Evaluation, which assesses the veteran’s interests, aptitudes and abilities to determine whether the veteran is entitled to the vocational rehabilitation services and whether the service-connected disability impairs the veterans ability to find or hold a job with the skills the veteran already has.

What services are available?

Some of the services the veteran may be eligible for include post-secondary education benefits, on the job training, assistance with finding a job, medical referrals, and independent living services for veterans unable to work because their disabilities are so severe.

Are there any services available for children or spouses of veterans who need education or rehabilitation?

Vocational rehabilitation services may be available for children with spina bifida, who have one or both parents who served in the Republic of Vietnam during the Vietnam War, or in certain military units in the demilitarized zone of Korea between September 1, 1967, and August 31, 1971.  


Friday, November 22, 2013

Service Connection: What is it?

Service-Connection:  What is it?

The Department of Veterans Affairs administers many benefits to veterans and their spouses and families, but some benefits are available only to those who are classified as “Service-Connected” veterans.

Service-connected means that the veteran was injured or developed or contracted a disease or aggravated a pre-existing injury or disease while he or she was on active duty with one of the branches of service – the Navy, the Army, the Marines, the Air Force or the Coast Guard, or their Reserve Components- and that the injury or disease caused a present disability.   Some disabilities or diseases are presumed to have been caused by the veteran’s service if he or she develops the disease or becomes disabled after leaving the service.  We will discuss presumed service connection in a later post.

Some benefits available to service-connected veterans are financial, and the VA pays the veteran a certain amount of money each month based on the level of disability.  Think of that as “worker’s compensation” – the VA is paying the veteran for the loss to his or her earning abilities.  The VA prescribes a percentage based on a complicated ratings system, and a disability can be rated at 0% - meaning no compensation will be paid because, although the veteran may have some form of disability that can be traced to his or her time in the service, the veterans earnings potential is not impaired by the disability.  If the disability later impairs earnings, though, the rating can be increased.  The ratings increase in increments of 10%.   Once a disability is rated at 10%, the veteran will receive a monthly check from the VA.

Service-connected veterans receive other non-monetary benefits from the VA, including healthcare benefits and vocational rehabilitation services.   The Veterans Health Administration (VHA) provides a host of healthcare benefits, but the package of benefits available to an individual veteran, and whether he or she will have a co-pay for those benefits, depends on his or her placement in one of eight categories, known as Priority Groups. Those in Priority Group One have the most complete healthcare benefits package, while those in Priority Groups 7 and 8 must pay a co-pay for any healthcare services provided. 

The VA is only able to provide healthcare benefits based on the amount of money Congress gives them each year, so in times when the money runs low, the VA could provide benefits to those only in the higher groups.  Those veterans rated at least 10% service-connected are placed no lower than Priority Group Three. 


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