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.