Are you Non-Service Connected and Considered Catastrophically Disabled? - Brent Follas

If you are non-service connected and meet the criteria of catastrophically disabled but not in Priority Group 4, you could be paying unnecessary copays.


Based on a VA clinical decision, Veterans are considered to be Catastrophically Disabled when they have a severely disabling injury, disorder or disease that permanently compromises their ability to carry out the activities of daily living. The disability must be of such a degree that the Veteran requires personal or mechanical assistance to leave home or bed, or require constant supervision to avoid physical harm to themselves or others, according to Title 38 CFR 17.36(e).

Veterans determined Catastrophically Disabled are placed into Priority Group 4 unless eligible for a higher Priority Group placement based on other eligibility criteria such as being a compensable service-connected Veteran, a former Prisoner of War, or a Medal of Honor or Purple Heart recipient.

A Catastrophically Disabled determination may be authorized when a VA clinician determines that there is sufficient medical documentation without further evaluation. Veterans may also request a Catastrophically Disabled evaluation by contacting the Enrollment Coordinator at their local VA health care facility. It is VA policy to provide a Catastrophically Disabled Veteran an evaluation within 30 days of the request. There is no charge for this examination.

VA Form 10-0383 “Catastrophic Disabled Veteran Evaluation” is the form needed to record the evaluation which can be done in person or by record review.  The Katz Index of Independence in Activities of Daily Living (ADL’s) scale may be needed to prove that you need assistance in at three ADL’s or more. 

·         Paraplegia to include those incomplete

·         Quadriplegia to include those that are incomplete

·         International Classification Diseases (ICD -9-CM)

·         ICD-10 diseases if they meet a score of 30 or lower using Global Assessment of Functioning

·         Other disabilities listed on VA Form 10-0383 as well.

Additionally, On May 5, 2010, the President signed Public Law 111-163, the Caregiver and Veterans Omnibus Health Services Act of 2011. The law provides Veterans determined by VA to be Catastrophically Disabled an exemption from inpatient, outpatient and prescription copays. Veterans with catastrophic disabilities are also exempt from copayments applicable to the receipt of non-institutional respite care, non-institutional geriatric evaluation, non-institutional adult day health care,

Homemaker/Home Health Aide, Purchased Skilled Home Care, Home Based Primary Care, and any other non-institutional alternative extended care services. Copayments for other extended care services (ex. Nursing Home Care) not mentioned still apply.

So if you are a non-service connected veteran and meet the criteria of catastrophically disabled but not in Priority Group 4, contact your physician or specialty clinic to inquire and start the process.  You can also contact your local Paralyzed Veterans of America Service Officer or Accredited Secretary for assistance.

See What Your State Has To Offer - Jeremy Lile

Aside from the common VA benefits, each U.S state offers additional veteran benefits. Most state benefits range from free college and employment resources to free hunting and fishing licenses. Some states also offer tax breaks for their veterans and specialized license plates, and then others even provide their veterans with cash bonuses just for serving in the military. Veteran benefits are always changing, therefore it is important to try and stay update to date.

The state of Missouri provides several veteran benefits. First of all, Missouri has seven veterans homes located in Cameron, Cape Girardeau, Mexico, Mt. Vernon, St. James, St. Louis, and Warrensburg. To be eligible for admission, a veteran must have lived in Missouri for 180 days and require skilled nursing care. In regards to financial benefits, Missouri offers property tax credits for eligible veterans. The Missouri Property Tax Credit Claim gives credit to some 100 percent VA disabled veterans for a portion of the real estate taxes or rent paid for the year. The maximum credit is $750 for renters and $1,100 for homeowners. The actual credit is based on the amount of real estate taxes or rent paid and total household income (taxable and nontaxable). If you’re looking to go hunting or fishing in Missouri, there are available benefits to help you get started. Any honorably discharged veteran with a service-connected disability of 60% or more can fish or hunt without permit. You must have proof of eligibility on your person, some trout or turkey tags may be required. Lastly, there are five State Veterans Cemeteries, one in Springfield, Higginsville, Bloomfield, Fort Leonard Wood, and Jacksonville. There is no charge for any of the services provided. Eligibility is the same as a federal cemetery and there is no residency requirement. Spouses and dependent children may also be eligible for burial.

The State of Illinois runs four Veterans homes in Anna, LaSalle, Manteno, and Quincy. The homes are open to Illinois veterans with military service of one day or more, Veterans who served during a period of war are given precedence in admission, though peacetime veterans, spouses, surviving spouses and Gold Star parents are also eligible. Then Illinois offers bonus payments for veterans who served in World War II, Korean, Vietnam, Persian Gulf, and the Global War on Terrorism efforts. For an example, there is the Vietnam Veteran Survivors Compensation. Survivors are entitled to a payment of $1,000 if veteran's death is service-connected or is the direct result of service-connected disabilities incurred in the period specified. There is also a Specially Adapted Housing Tax Exemption. No property tax is due on a home that was purchased with the Specially Adapted Housing Grant for as long as the veteran, spouse, or unmarried surviving spouse live there. Mobile homes purchased with the Specially Adapted Housing Grant are also exempt from county mobile home tax. Then there is the Disabled Veterans' Standard Homestead Exemption. A reduction in the assessed value of the home of a veteran with a service-connected disability. For veterans with a disability between 30 - 50 percent, the exemption is $2,500; for veterans with a 50 - 70 percent disability, the exemption is $5,000; veterans with a service-connected disability of at least 70% are exempt from property taxes on their primary residence. The State of Illinois also offers recreational benefits such as assistance with Camping and Admission Fees as well as Hunting and Fishing Licenses.

There are many other Missouri and Illinois benefits not mentioned in this article. For a complete list of available benefits by state, be sure to visit the following website:


VA Mission Act Signed into Law - Brent Follas

This VA reform law affects a wide range of areas and the “official” name of this law says a lot of about its’ focus; informally known as the VA Mission Act, this legislation’s formal name is the VA Maintaining Systems and Strengthening Integrated Outside Networks Act.

President Trump signed the Mission Act into law on June 6, 2018. The VA now must work on the criteria to be considered including wait times for VA appointments, quality of VA care and distance from a VA facility.

Over 30 veteran service organizations (VSOs) have endorsed this reform effort as it worked its’ way through legislative channels.

Eliminating Funding Gaps, Consolidating Programs, And Modernization

The VA Mission Act does some important things in the short term as well as introducing long-care fixes. The short-term improvements are crucial for some veterans; the Act eliminates a gap in care due to funding issues associated with the VA Choice program.

VA Choice funding ended on May 31, 2018. VA Choice was designed to help veterans get non-VA healthcare if distance or wait list issues are a problem. VA Choice continues to be funded in the short-term until replaced.

The long-term fixes are associated with the replacement of VA Choice; the VA Mission Act consolidates seven different programs offering community care including VA Choice into a single entity.

Funding is also provided for education and training, VA medical staff recruitment, and a review of VA medical facilities. This review process is intended as the first step in a modernization program for VA locations that need upgrades.

Veteran Care Program

In the past, among of the chief complaints about VA healthcare involved timely scheduling of appointments, care and services. Under the VA Mission Act, the Department of Veterans Affairs is required to coordinate timely care including help for those who need VA medical services outside their region of residence. The VA is also tasked with making sure veterans “do not experience a lapse in health care services.”

A significant improvement under the VA Mission Act is that the Department of Veterans Affairs is now required to provide, “access to community care if VA does not offer the care or services the veteran requires, VA does not operate a full-service medical facility in the state a veteran resides, the veteran was eligible for care in the community under the 40-mile rule in the Veterans Choice Program” and when the veteran meets certain requirements. The VA is required to enter into contracts with private networks to insure veterans get this care when warranted.

Authorization For Veteran Care Contracts

To implement the Veteran Care Program, the VA is authorized to enter into contracts-Veterans Care Agreements-with community healthcare providers with rates comparable to the VA Veterans Community Care Program. In addition to this authorization, certain procedures are also included in the act to guide this process in terms of making the agreements, how they are paid, and how they are enforced.

Veteran Care Homes

The VA is now authorized to enter Veteran Care Agreements with State Veterans Homes with the purpose of eliminating competitive contracting; State Veterans Homes are not technically considered to be federal contractors, but under the VA Mission Act these homes are required to follow federal Fraud, Waste, And Abuse requirements.

Veteran Access To Walk-In Services

Veterans have walk-in care access under the VA Mission Act, but this portion of the law includes certain conditions including a requirement that vets must have used VA healthcare services within a 24-month period prior to

requesting walk-in services. Walk-in care is available from community healthcare providers who have a contract or other agreement with the VA to provide the services.

According to the text of the law, “Veterans who are not required to make a co-payment at VA would be entitled to two visits without a co-payment and then VA would be authorized to charge an adjustable co-payment”.

Those who are required to co-pay may pay for the first two walk-in visits, with a VA-authorized co-payment adjustment for successive walk-in care. The Department of Veterans Affairs is required to “ensure continuity of care” including accessibility to medical records from walk-in care providers and medical record sharing between VA and these agencies.

Expanding the VA Veteran Caregiver Program

Important changes to the VA Comprehensive Assistance For Family Caregivers includes expanded eligibility for veterans with service-connected medical issues. In the past access to this program was more limited and emphasized post-9/11 military service.

Healthcare while Traveling - Rodney Harris

Are you planning a trip outside of the United States anytime soon? If so, are you service connected? Do you know about the VA’s Foreign Medical Program (FMP)?

The FMP is a health benefits program for U.S. veterans who are residing or traveling abroad and have a VA rated service connected condition/disability. VA assumes responsibility of payment for certain necessary health care services associated with treatment for those service connected disabilities or any disability associated with and held to be aggravating a service-connected condition. Veterans living in Canada are under the jurisdiction of FMP; however, inquiries and claims must be directed to the Foreign Countries Operations in Canada. Additionally, VA may authorize necessary foreign medical services for any condition of a veteran participating in the VA Vocational Rehabilitation Program (38 U.S.C. 31).

How do I know if I am eligible for FMP?

The eligibility requirements are different for veterans outside the U.S. than for those within the U.S. VA may authorize foreign medical services for veterans only for a VA rated service connected condition, or a condition associated with and aggravated by a VA rated service connected disability. Disability percentage has no bearing on determining eligibility for FMP.

Should I notify FMP if I am traveling abroad?

Pre-registration for eligible veterans is not necessary. However, veterans who are permanently relocating to a country under the FMP Office's jurisdiction are encouraged to notify the FMP Office upon establishing a permanent foreign mailing address (address and telephone number). At that time, arrangements will be made for FMP registration and the mailing of detailed program material. Included in the program material will be an FMP Program Guide which provides detailed information on benefit coverage and limitations, how to select health care providers and claim filing instructions. Veterans who are simply traveling abroad need not bother with notification. However, program information is available upon request. Please use VA Form 10-7959f-1 when registering with FMP.

What is/is not covered under FMP?

Unlike typical health benefit/insurance plans, where the range of benefits is standard among all enrolled beneficiaries/subscribers, FMP benefits are limited to services that are medically necessary to treat a VA rated, service-connected disability or for a condition that is associated with and held to be aggravating a service-connected disability. Supporting medical documentation is always required. The FMP does not pre-authorize services. A copy of the medical documentation must be submitted to determine if the care was related to a service connected disability. Claims filed under the FMP should be submitted no later than 2 years from the date of services or in the case of inpatient care, within 2 years of discharge date.

Covered benefits include:

 Durable medical equipment

 Emergency services

 Hospitalization

 Skilled nursing care

 Outpatient services

 Physical therapy, when under the direct supervision of a licensed physician

 Prescription drugs (including insulin) that are FDA approved

 Emergency ambulance services to the nearest medical facility for a VA rated service connected disability

 HISA-Home Improvement and Structural Alteration grant (must be preauthorized)

There are a number of exclusions to FMP, so before relocating contact the Health Administration Center in Denver, Colorado at 303-331-7950 for help. For more information visit the PC@HAC website at or contact your local PVA NSO for assistance.

Monthly Compensation vs Improvised Pension - Jeremy Lile

I have encountered many veterans that do not fully understand the difference between monthly compensation and pension. Therefore, I believe it is a good idea to shed some much needed light on the ways a veteran may be eligible based on their time spent in the military. First I will explain what service connection means and then discuss the four different categories by which a veteran can be service connected (38 CFR §3.304, 3.306, 3.307, 3.310).

A veteran that is injured or contracts a disease while on active duty, may be eligible for a tax-free monthly com-pensation benefit from the Department of Veteran’s Affairs. VA Compensation is quite similar to workers' com-pensation in that monetary benefits and/or medical care is provided to workers who are injured or become ill as a direct result of their job.

The first is called direct service connection. This means that the veteran’s injuries are directly related to his or her military service. For example, the veteran worked on an airfield where there were loud noises and now ex-periences ringing in his ears. A claim could be filed for Tinnitus due to the exposure to loud noises.

The next category is a pre-existing injury or condition that was aggravated while in the military. This is when a veteran had a medical issue prior to military service, but then something occurred while on active duty that made the pre-existing condition worse. For example, veteran has psoriasis prior to entering the military, but then is exposed to some chemicals that made the psoriasis worse than it ever would have been on its own. A service connection claim could be filed for aggravation a pre-existing injury or condition.

The third category is presumptive service connection. This is when a veteran suffers from certain conditions or diseases that are presumed to be service connected. For example, any veteran that was in Vietnam and exposed to Agent Orange and now has a diagnosis of Parkinson's disease, could file for a presumed service connection.

The last category is secondary service connection. This is when one service connected disability causes another disability. The second disability does not need to be directly related to military service, but would not have oc-curred without the first service connected disability. For an example, a veteran that is service connected for Type II Diabetes may experience kidney failure or peripheral neuropathy. Both of these conditions could then be filed as a secondary service connection to the Type II Diabetes.

When filing any of these service connection claims, it is always necessary to have adequate medical documenta-tion to file along with the claim. Likewise, an ideal piece of evidence for any claim is a nexus letter from a physi-cian confirming diagnosis or providing a link to the issue or disease to military service.

The next topic is the VA Pension (38 CFR §3.3). The first requirement for a veteran to qualify for the VA Im-proved Pension is to have served for at least 90 days on active duty, with at least (1) day during a wartime period. Serving during a wartime period does require the veteran to have physically been involved in the battle. For vet-erans that enlisted into the military after September 7, 1980, they must have served at least 24 months with at least (1) day during a wartime period. Other criteria requires that the veteran have limited or no income, 65 or older, or if under age 65, be permanently and totally disabled but not as a result of willful misconduct.

The income requirement set by Congress dictates that the annual income requirement for a single veteran must not exceed $13,166. The annual income requirement for a veteran with one dependent is $17,241. A veteran that cannot perform their activities of daily living (i.e. Eating, Bathing, Toileting) may be eligible for a Special Monthly Pension. And so, a veteran without dependents cannot exceed $21,962 annually and a veteran with one dependent cannot exceed $26,036 annually.

If a veteran’s income does exceed the threshold, the veteran can submit what is called unreimbursed medical expenses. The VA will then subtract the amount of the unreimbursed medical expenses from the veteran’s monthly income. As a rule, the VA will assess those unreimbursed medical expenses that exceed 5% of the maximum annual VA pension payment rate. Hospital expenses, prescription/non-prescription drug costs, and medical insurance premiums are just a few of the many items that can be submitted as unreimbursed medical expenses.

As always, seek the assistance of a highly trained veteran service officer for any questions and/or assistance when there is a need to file a compensation or pension claim.

Forever GI Bill - Brent Follas

Harry W. Colmery Veterans Educational Assistance Act

The President signed into law the Harry W. Colmery Veterans Educational Assistance Act also known as the “Forever GI Bill,” which will bring significant changes to Veterans education benefits. The law is named after the American Legion National Commander who wrote the original GI Bill language in 1944, and will allow more Veter-ans to use the GI Bill and more time to use it. Some of the changes will go into effect immediately, most will not. The majority of the changes enhance or expand education benefits for Veterans, Service members, Families and Survivors.

Some new provisions that go into effect immediately include:

 The 15-year time limitation to use Post-9/11 GI Bill benefits is eliminated for Veterans who left active duty on or after January 1, 2013, children who became eligible for the Fry Scholarship on or after January 1, 2013, and all Fry scholarship eligible spouses.

 The VA Education Department is now authorized to restore benefits and provide relief to Veterans affected by school closures or disapprovals. The application is named, “Department of Veterans Affairs Education Benefit Entitlement Restoration Request Due to School Closure or Withdrawal.”

 Reservists who had eligibility under the Reserve Educational Assistance Program (REAP) and lost it due to the program sunset provision, will have that service credited toward the Post-9/11 GI Bill program. We are in the process of identifying the approximately 2,800 Reservists affected by this and will send them letters with instruc-tions.

 Certain work-study is permanently authorized; previously it had to be re-approved by Congress every few years.

 Anyone eligible for the Forever GI Bill can use their benefits at an accredited independent study program at an area career and technical school, or a postsecondary vocational school providing postsecondary level education. There is no action for you to take here, as these programs will go through the normal course of approval by the appropriate State Approving Agency. Any new programs will be added to the GI Bill Comparison Tool.

 The Vet Success on Campus program will be available to students across the country

 VA will help Veterans to more clearly identify schools that offer them priority enrollment


 Provisions explained.

 See communications on the Forever GI Bill.

 Take advantage of your local Veterans Service Officers to help you navigate the new information.

 Join the conversation on our Facebook page or on Twitter.

 Announcements will be made on the GI Bill homepage.

 The Education Call Center is available at 1-888-442-4551 (Monday – Friday, 7 a.m. – 6 p.m. CST) for any ques-tions about GI Bill benefits.