The A to Z Guide to VA Disability Benefits
JimStrickland912
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Not yet one year old and I was receiving official
mail from USMC Marine Barracks, Quantico.
mail from USMC Marine Barracks, Quantico.
Emergency Care In Civilian Facilities
Also see;
http://www.nonvacare.va.gov/millbill.asp
Millennium Health Care and Benefits Act
The rule below is where the VA hangs you up on paying for hospitalization in non-VA facilities no matter how hard you try to work with VHA.
Let's say you're admitted through an emergency room to a civilian facility. You tell the civilians that you have VA coverage and you need to be transported there. Calling VA isn't a high priority for the civilian staff...they've done it before and they know just how inefficient it can be.
The next morning you get a phone and you call yourself. You get the usual runaround and you're connected to Fee Basis where the phone rings forever. You call back and you're connected to bed central where they tell you that your civilian doctor has to call a VA doctor.
You may be told there aren't any beds available.
One thing leads to the next and 4 days later you're discharged from the civilian hospital convinced you've done all you can and that VA will cover you.
Then the hospital bills start coming...along with the bills from the doctor, the lab, radiology and all the others.
You're eventually told by VA that you didn't have prior authorization to go to a non-VA facility and you get to pay the bill.
Yes, you are ultimately going to be held responsible. It's how your VA cares for you. Read the rule below for a better understanding
§17.121 Limitations on payment or reimbursement of the costs of emergency hospital care and medical services not previously authorized.
Claims for payment or reimbursement of the costs of emergency hospital care or medical services not previously authorized will not be approved for any period beyond the date on which the medical emergency ended.
For the purpose of payment or reimbursement of the expense of emergency hospital care or medical services not previously authorized, an emergency shall be deemed to have ended at that point when a VA physician has determined that, based on sound medical judgment, a veteran:
(a) Who received emergency hospital care could have been transferred from the non-VA facility to a VA medical center for continuation of treatment for the disability,
or
(b) Who received emergency medical services, could have reported to a VA medical center for continuation of treatment for the disability.
From that point on, no additional care in a non-VA facility will be approved for payment by VA .
In other words, as soon as the "emergency" was over, you were obligated to get up, sign out and get yourself to a VA facility no matter the circumstances.
This is one of the more difficult and challenging moments you'll have if you ever need emergency civilian care.
The best defense is to be prepared with a good understanding of just how this all works.
Read on by clicking http://www.nonvacare.va.gov/millbill.asp
Reimbursement
Erectile Dysfunction
The term "ED" wasn't popularized until that little blue pill came along. Suddenly it was OK for a man to speak openly of erectile dysfunction and impotence.
There are many causes and contributing factors to ED, almost all of them may be somehow service connected.
You may suffer a degree of ED if you're a have any degree of diabetes. If you're diabetes is service connected (because of Vietnam service for example), the ED condition should be rated as secondary to the primary service connected condition.
Erectile dysfunction or impotence is referred to as "loss of a creative organ" in the rules that apply to the condition. No doubt the verbiage addressing loss of a creative organ was first meant to cover such events as a gunshot or other wounding to a man's penis or testicles or any part of a woman's reproductive organs.
Over time it's been recognized that "loss" may also refer to function as well as the physical loss.
ED is rated as a Special Monthly Compensation above and beyond any other ratings you may have. The rating will be SMC-k and will compensate you at about $100.00 per month.
Often enough, even though ED may be noted or implied, you'll have to ask for it.
ED may also be service connected as a secondary condition to such things as side effects of medications taken for SC conditions or other physical and mental conditions.
San Antonio, TX 2002
My dad (left) and friends attending the 4th Marine
Division reunion. These men landed at Saipan, Tinian &
Iwo Jima together as teenagers and haven't lost touch
since those days.
My dad (left) and friends attending the 4th Marine
Division reunion. These men landed at Saipan, Tinian &
Iwo Jima together as teenagers and haven't lost touch
since those days.
Evidence
Updated October 27th 2009
Thom Stoddart is a veteran and former VA rater. He writes for The Veterans Voice when he's not busy assisting veterans with their claims. You may email Thom at <vetsvoice@blackfoot.net>
The following is provided courtesy of Thom and The Veterans Voice.
Evidence Is Everything With the VA
By Thom Stoddert
When making a claim with the VA always keep in mind you must have evidence to support your request. Over and over I hear from angry veterans “they denied my claim.” When in reality the vet is at fault for not providing reasonable evidence to support the claim. I spend 90% of my time with veterans working entirely on this essential issue.
Once a veteran submitted a claim to the VA for service connection of PTSD subsequent to having been assaulted by his fellow service members, his claim was denied for several reasons:
There was no medical evidence in the vet’s service medical record (that the VA had obtained on his behalf) of ever having been injured. The veteran did not provide any evidence of his own as instructed by his state’s Regional Office. A year or two later he submitted new evidence consisting of pages copied from a year book that had individual pictures high-lighted with fluorescent yellow. These pictures were accompanied by a statement from the vet saying these were his fellow service members who had assaulted him and now we had the evidence we needed to give him the favorable decision that he demanded, and I mean demanded. Can you see the weakness in all of this?
At this point you may be thinking each vet is not cookie cut and molded. Thus evidence comes in many forms focused on the needs of each veteran. So what evidence does the VA need?
The basic requirements for evidence that the Veteran’s Benefits Administration needs is fairly simple. Something happened on active duty and it is still causing you problems. Now there must be evidence linking your ailment to what happened on active duty. Evidence links both the present and the past.
For issues such as arthritis of the joints it’s pretty simple. You were inured in service and now there is traumatic arthritis. You identify to the VA that you were injured playing unit sports, etc. The VA then obtains your service medical records and finds that you were injured playing in a game. Your present doctor gives a history of complaints and diagnosis.
But what about when you get hurt and there are no records because you went to your good buddy the Medic. I have seen many vets get favorable decisions when they submitted good lay statements from people who witnessed the injury, or treated the injury. Former commanders, NCOs, medics, and/or several folks who witnessed the same thing are excellent sources of evidence. People who stand to benefit from any favorable decision are not usually considered good lay witnesses.
How do you locate former members of your unit? There are many easy ways that do not trespass any privacy laws. Go to www.theveteransvoice.com and you will find links to some of my favorite sites for this. Go to your old unit and see if there is any one you remember or who remembers you. Establish contact and see if that person remembers the incident and will write a statement.
Do an Internet search for your unit and repeat the above process. Most units do have some sort of reunion functions. Old letters to friends and family carry very valuable credible for proof. I have also seen old newspapers do the trick for a deserving vet.
Sometimes there is no clear link between what you have and what happened in the service. This is when a written opinion of an expert explaining why your disease is linked to Agent Orange exposure in Viet Nam. This is just one example, but an expert opinion with a credible explanation usually works for all issues.
Frequently I have seen claims for PTSD denied for lack of a credible stressor event. This is when a lay statement from a former buddy comes in. Another example; a vet was in the artillery and as such would not receive a Combat Infantry Badge. Yet he was in frequent fire fights protecting his firebase. The VA denied his claim for lack of proof of a verifiable stressor such as a combat award. But the vet provided details as to the time he was in the unit that was attacked. He provided time, places, details and the name of key personnel he served under. All of his information was verified through the various methods that VA has and granted him a favorable decision.
In almost all cases when a claim has been denied, it usually is the lack of good strong credible evidence. So that is where you start if you submit an appeal or a notice of disagreement. Plan your evidence carefully.
The following is provided courtesy of Thom and The Veterans Voice.
Evidence Is Everything With the VA
By Thom Stoddert
When making a claim with the VA always keep in mind you must have evidence to support your request. Over and over I hear from angry veterans “they denied my claim.” When in reality the vet is at fault for not providing reasonable evidence to support the claim. I spend 90% of my time with veterans working entirely on this essential issue.
Once a veteran submitted a claim to the VA for service connection of PTSD subsequent to having been assaulted by his fellow service members, his claim was denied for several reasons:
There was no medical evidence in the vet’s service medical record (that the VA had obtained on his behalf) of ever having been injured. The veteran did not provide any evidence of his own as instructed by his state’s Regional Office. A year or two later he submitted new evidence consisting of pages copied from a year book that had individual pictures high-lighted with fluorescent yellow. These pictures were accompanied by a statement from the vet saying these were his fellow service members who had assaulted him and now we had the evidence we needed to give him the favorable decision that he demanded, and I mean demanded. Can you see the weakness in all of this?
At this point you may be thinking each vet is not cookie cut and molded. Thus evidence comes in many forms focused on the needs of each veteran. So what evidence does the VA need?
The basic requirements for evidence that the Veteran’s Benefits Administration needs is fairly simple. Something happened on active duty and it is still causing you problems. Now there must be evidence linking your ailment to what happened on active duty. Evidence links both the present and the past.
For issues such as arthritis of the joints it’s pretty simple. You were inured in service and now there is traumatic arthritis. You identify to the VA that you were injured playing unit sports, etc. The VA then obtains your service medical records and finds that you were injured playing in a game. Your present doctor gives a history of complaints and diagnosis.
But what about when you get hurt and there are no records because you went to your good buddy the Medic. I have seen many vets get favorable decisions when they submitted good lay statements from people who witnessed the injury, or treated the injury. Former commanders, NCOs, medics, and/or several folks who witnessed the same thing are excellent sources of evidence. People who stand to benefit from any favorable decision are not usually considered good lay witnesses.
How do you locate former members of your unit? There are many easy ways that do not trespass any privacy laws. Go to www.theveteransvoice.com and you will find links to some of my favorite sites for this. Go to your old unit and see if there is any one you remember or who remembers you. Establish contact and see if that person remembers the incident and will write a statement.
Do an Internet search for your unit and repeat the above process. Most units do have some sort of reunion functions. Old letters to friends and family carry very valuable credible for proof. I have also seen old newspapers do the trick for a deserving vet.
Sometimes there is no clear link between what you have and what happened in the service. This is when a written opinion of an expert explaining why your disease is linked to Agent Orange exposure in Viet Nam. This is just one example, but an expert opinion with a credible explanation usually works for all issues.
Frequently I have seen claims for PTSD denied for lack of a credible stressor event. This is when a lay statement from a former buddy comes in. Another example; a vet was in the artillery and as such would not receive a Combat Infantry Badge. Yet he was in frequent fire fights protecting his firebase. The VA denied his claim for lack of proof of a verifiable stressor such as a combat award. But the vet provided details as to the time he was in the unit that was attacked. He provided time, places, details and the name of key personnel he served under. All of his information was verified through the various methods that VA has and granted him a favorable decision.
In almost all cases when a claim has been denied, it usually is the lack of good strong credible evidence. So that is where you start if you submit an appeal or a notice of disagreement. Plan your evidence carefully.
Evidence
Updated October 26th 2009
Back to The Basics, it's All About the Evidence
The VA requires reasonable proof that any claim you make is factual. This isn't an untenable obligation or burden on the veteran when applied fairly.
The evidence your VA likes to see most of all is what I refer to as The Golden Thread.
The Golden Thread begins with an event in service (or known before service and aggravated by service) that causes a condition. It ends at the successful award of a deserved benefit. The Golden Thread must remain unbroken.
The original event (for example, an injured knee) is noted in some official record and treated medically. Whether treatment is minor or major is of little consequence, that the event itself has been recorded is the critical action and begins the thread.
The thread must then go on unbroken. The condition precipitated by the event (that hurt knee) must continue to be a bother to the injured person. Ideally, the person will seek medical attention because the condition is disabling to some degree. That medical attention should be recorded, and the thread goes on.
As before, the degree of medical attention or disability isn't important in the Golden Thread, only that there is some record of the continuity of the original injury.
Eventually there is a completion of the person's military service obligation and an honorable discharge...ETS. The thread continues with an exit exam that would note that the individual has sought attention to the knee during active service. Whether there is a disability rating assigned at ETS isn't particularly important.
Within a reasonable period of time after ETS, to continue that Golden Thread unbroken, the veteran will seek attention from a health care professional regarding the original injury. Ideally, the first contact will be within one year of ETS.
And so it goes up to the point of making a formal claim for service connected disability compensation benefits with your VA.
The thread must have continued unbroken. Regularly recorded visits with professionals to treat the condition keep the Golden Thread intact.
The reality is that should the veteran go 2 or 3 years without a treatment record of that original injury, the claim isn't likely to succeed without an appeal. If there is no record at all of the veteran being treated for a decade or more after ETS for a condition claimed as service connected, it's a sure bet that the claim will be denied and probably won't survive appeal either.
This is particularly true of joint conditions. Whether of the neck, the spine, knees, hips or shoulders, as we age we can all have x-rays done that show degenerative changes. This is a normal part of the process of getting older and can't be assigned to routine military service.
Without the Golden Thread, denial of the claim is often swift in coming. The usual first argument that veterans want to make when they are denied is, "I was in pain for 25 years after that injury but I toughed it out until now. I didn't have time to go to a doctor and keep records of my pain, I was busy working."
The veteran may also submit "buddy letters" from friends or family who have known them for a long time and who will attest that the veteran complained of pain or disability because of that condition. As a rule, VA doesn't consider those statements as credible because the witnesses have no first hand knowledge of the original event and no particular medical expertise.
If you have some record of an event in your military service, whether it's back strain, neck strain, a sore joint or a pulled muscle, that isn't enough to establish that you have developed a chronic disabling condition because of that event.
If you had an event and sought medical care once or twice but nothing beyond that, you're going to have a very steep uphill climb to prove that the event then is the reason for your disabling condition today.
Time is not on your side. If it's been a decade or two or three since your event but now you need the money so you're going to file for it, think twice before you do.
If you can't plainly see the Golden Thread with your own eyes, the VA won't see it either. Save yourself a lot of angst and save the VA some time and take a pass on filing a claim you aren't going to win.
Back to The Basics, it's All About the Evidence
The VA requires reasonable proof that any claim you make is factual. This isn't an untenable obligation or burden on the veteran when applied fairly.
The evidence your VA likes to see most of all is what I refer to as The Golden Thread.
The Golden Thread begins with an event in service (or known before service and aggravated by service) that causes a condition. It ends at the successful award of a deserved benefit. The Golden Thread must remain unbroken.
The original event (for example, an injured knee) is noted in some official record and treated medically. Whether treatment is minor or major is of little consequence, that the event itself has been recorded is the critical action and begins the thread.
The thread must then go on unbroken. The condition precipitated by the event (that hurt knee) must continue to be a bother to the injured person. Ideally, the person will seek medical attention because the condition is disabling to some degree. That medical attention should be recorded, and the thread goes on.
As before, the degree of medical attention or disability isn't important in the Golden Thread, only that there is some record of the continuity of the original injury.
Eventually there is a completion of the person's military service obligation and an honorable discharge...ETS. The thread continues with an exit exam that would note that the individual has sought attention to the knee during active service. Whether there is a disability rating assigned at ETS isn't particularly important.
Within a reasonable period of time after ETS, to continue that Golden Thread unbroken, the veteran will seek attention from a health care professional regarding the original injury. Ideally, the first contact will be within one year of ETS.
And so it goes up to the point of making a formal claim for service connected disability compensation benefits with your VA.
The thread must have continued unbroken. Regularly recorded visits with professionals to treat the condition keep the Golden Thread intact.
The reality is that should the veteran go 2 or 3 years without a treatment record of that original injury, the claim isn't likely to succeed without an appeal. If there is no record at all of the veteran being treated for a decade or more after ETS for a condition claimed as service connected, it's a sure bet that the claim will be denied and probably won't survive appeal either.
This is particularly true of joint conditions. Whether of the neck, the spine, knees, hips or shoulders, as we age we can all have x-rays done that show degenerative changes. This is a normal part of the process of getting older and can't be assigned to routine military service.
Without the Golden Thread, denial of the claim is often swift in coming. The usual first argument that veterans want to make when they are denied is, "I was in pain for 25 years after that injury but I toughed it out until now. I didn't have time to go to a doctor and keep records of my pain, I was busy working."
The veteran may also submit "buddy letters" from friends or family who have known them for a long time and who will attest that the veteran complained of pain or disability because of that condition. As a rule, VA doesn't consider those statements as credible because the witnesses have no first hand knowledge of the original event and no particular medical expertise.
If you have some record of an event in your military service, whether it's back strain, neck strain, a sore joint or a pulled muscle, that isn't enough to establish that you have developed a chronic disabling condition because of that event.
If you had an event and sought medical care once or twice but nothing beyond that, you're going to have a very steep uphill climb to prove that the event then is the reason for your disabling condition today.
Time is not on your side. If it's been a decade or two or three since your event but now you need the money so you're going to file for it, think twice before you do.
If you can't plainly see the Golden Thread with your own eyes, the VA won't see it either. Save yourself a lot of angst and save the VA some time and take a pass on filing a claim you aren't going to win.