VA Veteran Community Care Program ► Proposed Rules Published

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VA Veteran Community Care Program ► Proposed Rules Published

On 22 FEB the U.S. Department of Veterans Affairs (VA) announced the publication of a proposed regulation in the Federal Register for the new Veterans community care program, including access standards. The proposed regulation would establish new rules for the Veterans community care program required by section 101 of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act (MISSION Act) of 2018. Last month, VA Secretary Robert Wilkie announced its proposed access standards for community care and urgent care provisions that will take effect in June and guide when Veterans can seek care to meet their needs under the MISSION Act – be it with VA or with community providers.

Under the MISSION Act, signed by President Trump in June 2018, there are six different eligibility criteria for community care:

  • Services unavailable
  • Residence in a State without a full-service VA medical facility
  • 40-mile legacy/grandfathered from the Choice program
  • Access standards
  • Best medical interest
  • Needing care from a VA medical service line that VA determines is not providing care that complies with VA’s standards for quality

ACCESS STANDARDS

VA is proposing new access standards, effective when the final regulations publish (expected in June 2019), to ensure Veterans have greater choice in receiving care. Eligibility criteria and final standards as follows were based on VA’s analysis of all of the best practices both in government and in the private sector and tailored to the needs of our Veteran patients:

  • Access standards will be based on average drive time and appointment wait times.
  • For primary care, mental health, and non-institutional extended care services, VA is proposing a 30-minute average drive time standard.
  • For specialty care, VA is proposing a 60-minute average drive time standard.
  • VA is proposing appointment wait-time standards of 20 days for primary care, mental health care, and non-institutional extended care services, and 28 days for specialty care from the date of request with certain exceptions.

Eligible Veterans who cannot access care within those standards would be able to choose between eligible community providers and care at a VA medical facility. VA Secretary Robert Wilkie said, “Our medical services must meet our Veterans’ needs and reinforce the trust that forms the basis for every interaction with VA. Our new access standards are a vital part of this effort. b“Most Americans can already choose the health care providers that they trust, and President Trump promised that Veterans would be able to do the same. With VA’s new access standards, the future of the VA health care system will lie in the hands of Veterans – exactly where it should be.”

Secretary Wilkie’s full statement from Jan. 28 is available here. . The proposed regulation (RIN 2900-AQ46) is currently available online at https://federalregister.gov/d/2019-03030. The proposed regulation was published in the Federal Register tomorrow on 22 FEB and VA encourages the public to provide input on the proposed regulation by March 25, 2019, during the public comment period. For instructions on how to submit a comment, visit the Federal Register website at www.regulations.gov and search for RIN 2900-AQ46. [Source: VA News Release | February 22, 2019 ++]

VA Disability Claims Update 02 ► Priority Processing for Purple Heart Awardees

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VA Disability Claims Update 02 ► Priority Processing for Purple Heart Awardees

On 26 FEB at a congressional hearing before the House Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies, VA Secretary Robert Wilkie announced that effective in April, VA will provide priority disability benefits claims processing for the initial claims from discharged combat Veterans who have been awarded the Purple Heart Medal. “Those who hold the Purple Heart, the recognition of wounds taken in battle, will now receive priority consideration when it comes to claims before the Department of Veterans Affairs,” said Secretary Wilkie. The Veterans Benefits Administration will amend its priority processing categories to include initial claims received from Purple Heart recipients on or after April 1, 2019. Purple Heart recipients are already treated on a priority basis at VA hospitals and are exempt from co-payments for their medical care. The Purple Heart award is the oldest U.S. military decoration and is awarded to U.S. service members for wounds suffered at the hands of the enemy. General George Washington awarded the first purple-colored heart-shaped badges to soldiers who fought in the Continental Army during the American Revolution. In 1932, it was revived to commemorate Washington’s 200th birthday.

[Source: VA News Release | February 26, 2019]

VA Privatization Update 16 ► We Are Not Privatizing Says VHA’s Executive In Charge

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VA Privatization Update 16 ► We Are Not Privatizing Says VHA’s Executive In Charge

Talk of the possible privatization of the Department of Veterans Affairs is a hot topic in the veterans community. But as far as Dr. Richard Stone – VA’s Executive in Charge of the Veterans Health Administration – is concerned, the department’s recent efforts are counter to any efforts at privatizing the health-care system. Stone said that although VA is working to provide veterans with more care choices, “We are not moving money to dissemble our health-care system. We are not privatizing,” Stone told The American Legion’s Veterans Affairs & Rehabilitation Commission on 25 FEB during the organization’s Washington Conference. “We believe the future of the VA health-care system should be in the hands of veterans, and you should decide what we have.

“The accusation that we are privatizing – if I was privatizing, why would we be spending over $10 billion to put
into electronic medical records? Why would we be hiring more than 11,000 more employees than we had a year ago at this time? Why would we be working so hard to ensure your trust? If this is a model of privatization, we’re doing a pretty bad job of it. We think the future of this health-care system is strong, and is a model for all of American health care for access in most places.”

Stone said that VA also has focused on quality of care and restoring trust among its patients. “What you deserve in a health-care system as veterans is a health-care system that is reliable in the way it operates,” he said. “We have, therefore, just last week begun to roll out in the first 18 hospitals what we call our ‘Movement to Zero Harm.’ Humans make mistakes. Humans make errors. But they shouldn’t cause harm to patients. What we’re moving toward is a system in which we can really move to zero harm.” On the subject of veterans using the Choice program to seek health care outside VA, Stone said the numbers are both low and telling. “Anybody more than 40 miles away (from a VA facility), you could go out into the community,” he said. “Nine out of 10 (veterans) did not go out. Of the 1 in 10 who went out, 90 percent of those … went out for one visit and then came back to us.”

VA Under Secretary for Benefits Dr. Paul Lawrence discussed VA’s new programs made possible by the current version of the GI Bill, the Harry W. Colmery Veterans Educational Assistance Act:

  • The Veteran Employment Through Technology Education Courses (VET TEC), which is designed to give
    veterans an edge in the high-tech job market, and
  • Additional benefits for STEM education, including up to nine extra months of benefits (not to exceed
    $30,000) for veterans who meet the criteria.

“The GI Bills continue to become a wonderful program,” Lawrence said. “This works, and tens of millions of people have taken advantage of it.” On the subject of legislation that would provide disability benefits to those Blue Water Navy veterans who claim to have suffered toxic exposure to Agent Orange during their service in the Vietnam War, Lawrence said a divide remains. In January, the U.S. Court of Appeals for the Federal Circuit ruled in favor of Alfred Procopio Jr., who served aboard USS Intrepid during the war. Procopio, 73, suffers from diabetes and prostate cancer, both of which are linked to Agent Orange exposure. “VA’s in the process of reviewing this decision and figuring out the response. That’s all I can really say,” Lawrence said. “The science isn’t there, from our position. I know we disagree on that, and that’s unfortunate. But one day, whatever happens, we won’t disagree, and we’ll be on the same side. When that happens, it will be our intention to execute whatever that results in as efficiently and as effectively as we can for veterans.”

Lawrence was also questioned about the current policy that requires veterans who receive both military retired pay and VA disability compensation simultaneously to waive part of their service retired pay. VA&R Commission Chairman Ralph Bozella called the practice “terribly unfair.” Lawrence agreed. “I understand that this is a legislative issue, and I certainly never want to give advice to congressional oversight people,” he said. “Having said that, I am an economist, and I do think about money things all the time. I’ll make the following observation: pension is deferred compensation. Payments for disability are the payments your country committed for the economic impairment you suffered under your time in the military. Those are two different things. That would be my statement.” [Source: The American Legion | Steven B. Brooks | February 25, 2019 ++]

VA Individual Unemployability Update 07 ►

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VA Individual Unemployability Update 07 ►

What It Is in plain, understandable English. Unfortunately, many veterans are too often confused about Department of Veterans Affairs (VA) 100 percent disability ratings and whether or not they are allowed to secure gainful employment if rated at 100 percent. While complex, and sometimes confusing to the most experienced VSO, let’s take a look at the four types of 100 percent disability ratings in plain, understandable English.

  1. Combined. When a veteran’s service-connected disabilities are combined to reach 100 percent, he/she is allowed to work full time or part time. For example, if a veteran is rated 70% for PTSD, and 30% for IBS, the two disabilities equal 100% (sometimes – see rating table), and the veteran is allowed to hold a full time or part time job.
  2. TDIU or IU. Total Disability/Individual Unemployability. This is a specific type of claim made by a veteran, requesting that he/she be paid at the 100 percent rate even though his/her disabilities do not combine to reach 100%. The request is often made because the veteran is unable to maintain “gainful employment” because his/her service connected disabilities prevent him/her from doing so. The basic eligibility to file for Individual Unemployability (IU) is that the veteran has one disability rated at 60 percent or one at 40 percent and enough other disabilities that result in a combined rating of 70 percent or more. The one disability at 40 percent criteria can be a combined rating of related disabilities.

Meeting the basic criteria is not a guarantee that the veteran will be awarded 100 percent under IU criteria. The medical evidence must show that the veteran is unable to work in both a physical and sedentary job setting. A veteran not meeting the percentage criteria may still be awarded IU if the disabilities present a unique barrier to gainful employment. If a veteran is granted 100 percent under IU he is prohibited from working full-time, because in filing the claim for IU the veteran is stating he/she is unable to work because of his/her service-connected disabilities. However, receiving IU does not necessarily prevent a veteran from all employment circumstances. The veteran can work in a part-time “marginal” employment position and earn up to a certain amount annually, but not allowed to surpass a certain amount.

  1. Temporary 100 percent rating. If a veteran is hospitalized 21 days or longer or had surgery for a service-connected disability that requires at least a 30-day convalescence period, the VA will pay at the 100 percent rate for the duration of the hospital stay or the convalescence period. For example, if a veteran has a total hip replacement for a service connected hip disability, the VA will pay 100 percent compensation for up to 13 months, the standard recovery period for a replacement of a major joint. The duration of 100 percent temporary disability for any other type of surgery will depend on what the doctor reports as the recovery period.
  2. Permanent and total. A 100 percent “permanent and total” rating is when the VA acknowledges that the service connected conditions have no likelihood of improvement and the veteran will remain at 100 percent permanently with no future examinations. The P&T rating provides additional benefits, such as Chapter 35 education benefits for dependents, among others. Veterans sometimes make the mistake of requesting a P&T rating simply because they want education benefits for their dependents. The one caveat that veterans need to keep in mind is that when P&T is requested, all of their service-connected disabilities will be re-evaluated. If improvement is noted during the subsequent examinations, a reduction from 100 percent can possibly be proposed.

Because many veterans are service-connected for conditions that VA says have a “likelihood of improvement,” most ratings are not considered permanent and are subject to future review. The only time veterans can’t work a full-time position, that is considered a gainfully-employed job is if they were awarded 100 percent disability through a claim for IU. Additionally, a 100 percent rating under either IU or combined ratings may or may not be rated as permanent and total. A temporary 100 percent rating is just that: temporary due to being hospitalized or recovering from surgery on a service-connected condition.

If a veteran is approved by the VA for IU, not only do they receive the 100-percent service-disabled rate of pay but they may also receive additional benefits including health insurance for their dependents, Property Tax Credit, a service-disabled military ID card and a $10,000 life insurance policy with a waiver on monthly premiums. To apply for IU download Veteran’s Application for Increased Compensation Based on Unemployability form VA Form 21- 8940. Complete the form, and mail it to Department of Veterans Affairs. Evidence Intake Center, PO Box 4444, Janesville, WI. 53547. Veterans may fax form to 1-844-531-7818. Keep in mind, it is always best for a veteran to work with an accredited Veteran Service Officer (VSO) who can explain the complex workings of the VA benefit system.

[Source: USVCP | July 9, 2018 ++]

VA Vet Choice Update 84 ► Program Eligibility Mileage Change

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VA Vet Choice Update 84 ► Program Eligibility Mileage Change

Many veterans are unaware of recent VA changes to policies, programs and procedures that have a major effect on their benefits. For instance, to expand eligibility for the Veterans Choice Program, VA will determine eligibility for the Veterans Choice Program based on the distance between a veteran’s place of residence and the nearest VA medical facility using driving distance rather than straight-line distance. This change has been published in the Federal Register for reference if needed. The change from straight-line to driving distance roughly doubles the number of eligible veterans eligible for the program. VA sent letters to the newly eligible veterans to let them know they are now eligible for the Veterans Choice Program under this new expansion policy. If a veteran does not remember receiving a Veterans 21 Choice Card or has other questions about the Choice Program, they can call 866-606-8198. Additionally, VA changed the mileage calculation for beneficiary travel. The change will ensure consistency in VA’s mileage calculations across the two programs. For clarification of VA changes, veterans are advised to contact their Veterans Service Officer (VSO) or local VAMC. [Source: USVCP | August 31, 2018 ++]

VA Disability Review ► Frequently Requested to Check Severity of Disabilities

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VA Disability Review ► Frequently Requested to Check Severity of Disabilities

A thorough review of disability examinations is often requested by the Department of Veterans Affairs (VA) to check on the severity of a previously rated service-connected disability. VA staff use review exams, and any other relevant evidence, to assess the current severity of a disability and, If possible, reduce the initial rating assigned. VA regulations point out specific timelines for “examination checks,” but, it is not a hard and fast rule, and, oftentimes, ignored by VA personnel. But, rest assured, it will happen at some point. By law, VA should and will request a review exam under the following circumstances:

  • VA needs to assess the severity of a disability; · Additional or more relevant evidence indicates there has been an important and significant (or material) change in a disability; or
  • Because of law, VA personnel are required to conduct a periodic review.

The Examination Process
Oftentimes, a contracted medical professional or VA medical professional will conduct the disability review exam. The medical examiners and staff will not answer specific questions about benefits, pension program or compensation. Nor, will they consult with a veteran about the disability compensation process. Acting as a stoic conduit within strict bureaucratic protocol, the medical examiners methodically go through a set of procedures to assess disability conditions. Typically, the examination is conducted in a medically approved facility, with the veteran and medical staff member. In very rare cases, VA personnel may decide that an examination by telephone would be the most appropriate route.

The medical examiner will often conduct the following procedures:

  • Ask a veteran questions related to the disability in question; · Perform a physical exam related to the disability; · If multiple disability conditions are to be examined the medical examiner will conduct one examine at-a-time; · Send the veteran for lab work, which may include: blood work, X-rays, MRI, etc.; · While conducting exam, the medical examiner will pay very close attention to how the veteran reacts to certain procedures; · At the conclusion of the exam, sometimes the medical examiner is required to go over the veterans medical file with him/her;
  • In some instances, if the veteran is accompanied by someone familiar with the disability the veteran is having examined, the medical examiner may ask that person questions related to the disability being examined. It is important to understand that the medical examiner is not involved in making a rating decision about the disability. The medical examiners’ job is simply to conduct the examination based upon certain set of criteria established by VA. However, the words the examiner uses in describing the examination review, may ultimately affect the thinking of the VA rater and how a disability is to be perceived. The medical examiner may select words and sentence structures that may be perceived in a way that a reduction in compensation benefits is necessary, or that an increase is appropriate or no change at all is necessary.

Based on a thorough review of the disability examined, VA raters may issue a new or updated medical decision and contact the veteran by mail. After the decision has been made, VA will do 1 of 3 possible outcomes:

  • The veteran’s disability rating will remain unchanged;
  • It was concluded that the disability has worsened and an increase in compensation benefits may be approved. If not approved for an increase it will be annotated in a veteran’s disability file that an increase was not warranted, but the worsening of the disability condition has been recorded and recognized;
  • The disability has improved significantly enough that a reduction in compensation benefits may be appropriate at this time.

If a veteran misses a review exam, it may negatively affect the outcome of any potential increase in compensation benefits. The veteran should always call their VA Regional Office (VARO) to reschedule their appointment as soon as reasonably possible once they realize they won’t make it to the scheduled review exam. Harsh, but true, if a veteran misses an exam without details as to why, VA may be required by law to propose an immediate reduction in the disability that was to be examined or an immediate termination of compensation benefits for that specific disability.

It’s very important that a veteran review exam results as soon as possible. All too often, what is written by the medical examiner differs quite a bit from what the veteran witnessed. For instance, some veterans have reported that the medical examiner indicated that a certain instrument was used during the exam, and the veteran was sure no such instrument was ever used. Checking the accuracy of the medical exam is crucial. Some veterans use the Post Examination Assessment Form immediately after medical examinations conducted by VA medical staff. In doing so, the veteran has an opportunity to record exam results as he/she remembers them, and the form provides a structured format the way VA personnel like to work with.

Lastly, it is vital to the outcome of any medical examination conducted by VA personnel that the veteran comb over all details of correspondence sent to them related to the medical examination. Addressing any and all issues related to the medical examination is a must. If VA is asking for information, it is very important that a veteran respond to the question as soon as humanly possible. Some veterans may require the help of a certified VSO in interpreting information sent to them be VA personnel. Understanding what a veteran receives from VA is of utmost importance. [Source: USVCP | June 2018 ++]

VA Appeals Status Tracker ► How to check the Status of Your Claim

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VA Appeals Status Tracker ► How to check the Status of Your Claim

Knowing what stage of the appeals process your claim is in can help you avoid missing deadlines and better understand how the VA claims and appeals process works.

Generally, there are eight steps that disability claims follow:

1) Claim Received. Your claim is moved to this stage once it has been received by VA.

2) Under Review. A Veterans Service Representative is reviewing your claim to determine if there is a need for additional evidence. This includes the results of your Compensation and Pension Exam, which VA will schedule.

3) Gathering of Evidence. If the Veterans Service Representative deems that your claim requires additional evidence, he or she will request it from the appropriate sources.

4) Review of Evidence. All evidence is received and is under review.

5) Preparation for Decision. At this stage, the Veterans Service Representative has recommended a decision and is preparing documents detailing that decision.

6) Pending Decision Approval. The Veterans Service Representative’s decision is reviewed, and a decision is made.

7) Preparation for Notification. Your decision is being prepared for mailing.

8) Complete. The award or decision is sent to you via U.S. mail, along with the details surrounding this decision.

VA allows veterans to track the progress of their claims throughout the claim stream in three ways:

  • By visiting a local VA regional office;
  • By calling VA’s national toll-free phone number at 800-827-1000;
  • Or by logging into gov and using VA’s appeals tracker.

Online VA Appeals Status Tool VA has created its online appeal status tracker in an attempt to improve transparency and allow veterans easier access to their appeal’s status. VA describes this tool as easy to use and provides accessible information to veterans. To use this tool, veterans can sign into vets.gov using:

o DS Logon, which is the same logon as your eBenefits account;

o My HealtheVet account; o ID me account.

If you do not yet have a login, create an ID me account at https://api.id.me/en/registration/new. Once you are logged in, select the “Check your claim and appeal status” option to access the appeals tracker tool. The main page entitled “Your Compensation Appeals and Claims” will show the type of claim that is under appeal (e.g. Appeal of Compensation Decision), the date you received the claim decision, the appeal’s status (e.g. a Decision Review Officer is reviewing your appeal), the issues on appeal (e.g. increased rating), and a “View Status” option that will lead you to detailed information about your appeal.

On the “View Status” page, veterans can view the current status of their appeal followed by a description of what happens during the next step of the process (e.g. The Board will make a decision). On this screen, you may also select “See past events” which displays a timeline of events that have already occurred throughout your appeal process. Below this timeline, you will see the “Current Status” of your appeal. If your appeal stage requires action, an alert box will be highlighted in yellow under this portion of the webpage. This section will describe what action must be taken in order to continue on with your appeal and the date by which it must be completed. For example, if a veteran recently received a Statement of the Case, this section will instruct the veteran to submit a VA Form 9 within 60 days of receiving it and provide the deadline.

The “What happens next?” feature will display a projected wait time for reaching the next step in the appeal process. Using the same example as mentioned above, the “What happens next?” section will show an estimate of when your case will be transferred to The Board if you do not submit new evidence with your VA Form 9. In this case, a timeline of two events will be provided because veterans are able to submit new evidence in support of their claim at this stage. If you did submit new evidence, you will subsequently receive another Statement of the Case, called a Supplemental Statement of the Case, and a new projected timeframe.

Once your appeal has been certified to the Board, you will be able to see a progress bar beneath “What happens next?” showing where your appeal is on the Board’s docket. This progress bar shows the total number of appeals on the docket, and the number of appeals ahead of you. Although you are able to see the progress of your docket number, no time estimate is provided here as the Board is not required to adhere to any deadlines.

At the top of the page, there is a tab entitled “Issues” where you are able to see what issues are currently on appeal and previous issues that have been closed whether they were granted, denied, or withdrawn. If you need assistance during any point of the appeal process, do not hesitate to contact a VA-accredited claims agent, Veteran Service Organization, or VA-accredited attorney. [Source: Chisholm Chisholm & Kilpatrick LTD | July 5, 2018 ++]

VA Mission Act Update 11 ► Top Questions Answered

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VA Mission Act Update 11 ► Top Questions Answered

On 6 JUN VA implemented changes to community care under the VA MISSION Act. The changes included expanded eligibility for community care and a new urgent care benefit. As part of our outreach and engagement efforts, the VA collected the top questions received from Veterans and provided answers to each one below with the goal of making it easier to access the care you have earned.

General Health Care

  • When can I receive community care? Eligibility for community care depends on your individual health care needs or circumstances. You should discuss community care eligibility with your VA care team to determine if you are eligible. This video provides a quick overview of Veteran community care.
  • Can I get dental care through the MISSION Act? Eligibility for dental services has not changed under the MISSION Act. You should talk to your VA care team about eligibility for dental services. Click here for more information about dental care.
  • How does a community provider know I am eligible to receive community care? If your VA care team has determined that you are eligible for community care and you chose a community provider, VA will send the provider a referral and authorization prior to you receiving care. You must receive approval from VA prior to obtaining care from a community provider in most circumstances.
  • I was authorized for community care under the Choice program. What happens now? The Choice program expired on June 6, 2019, and specific Choice eligibility for community care is no longer being used. If you were eligible for community care under Choice, you should speak with your VA care team or a VA staff member at your local VA medical facility about updated eligibility for community care. This video also provides a quick primer regarding community care eligibility under the new Veteran community care program.

Urgent Care

  • How do I become eligible for the urgent care benefit? You must be enrolled in VA health care and have received care through VA from either a VA or community provider within the past 24 months to be eligible for the urgent care benefit.
  • How can I find an urgent care provider? To find an urgent care location in VA’s contracted network, use the VA facility locator at https://www.va.gov/find-locations . Select the link entitled “Find VA approved urgent care locations and pharmacies near you”.
  • What is the difference between urgent care and emergency care? Urgent care consists of medical services provided for minor illnesses or injuries that are not life-threatening such as strep throat, pink eye, or influenza. Emergency care consists of inpatient or outpatient hospital services that are necessary to prevent death or serious impairment of health such as severe chest pain, seizures or loss of awareness, heavy uncontrollable bleeding, or moderate to severe burns.
  • Do I have to pay a copayment if I receive urgent care that relates to my service-connected condition? Copayments for urgent care are different from other VA medical copayments. Copayments for urgent care depend on your assigned priority group and the number of times you visit any urgent care provider in a calendar year. Visit the Urgent Care webpage for more information about copayments.
  • How do I get prescription medication related to an urgent care visit? VA will pay for or fill prescriptions for urgent care. For urgent care prescription medication longer than a 14-day supply, the prescription must be submitted to VA to be filled. For urgent prescriptions written by an urgent care provider, you can fill a 14-day supply of medication at a contracted pharmacy within the VA network, in VA, or at a non-contracted pharmacy. If a non-contracted pharmacy is used, you must pay for the prescription and then file a claim for reimbursement with your local VA medical facility. Go to https://www.va.gov/COMMUNITYCARE/pubs/factsheets.asp for more detailed information on community care and urgent care.

[Source: VA News| June 19, 2019 ++]