Military Disability - PowerPoint Presentation

Slide1

Military DisabilitySlide2
Disability Compensation

A

tax-free monetary benefit paid to Veterans with disabilities that are the result of a disease or injury incurred or aggravated during active military service. The benefit amount is graduated according to the degree of the Veteran's disability on a scale from 10 percent to 100 percent (in increments of 10 percent). Compensation may also be paid for disabilities that are considered related or secondary to disabilities occurring in service and for disabilities presumed to be related to circumstances of military service, even though they may arise after service. Generally, the degrees of disability specified are also designed to compensate for considerable loss of working time from exacerbations or illnesses.Slide3

Types of Compensation

VA disability compensation provides monthly benefits to Veterans in recognition of the effects of disabilities, diseases, or injuries incurred or aggravated during active military service. The program also provides monthly payments to surviving spouses, dependent children, and dependent parents in recognition of the economic loss caused by a Veteran's death during military service or, after discharge from military service, as a result of a service-connected disability

..Slide4
Disability Percentage Pay Charts ~ 2015

Dependent Status

30

40

50

60

Veteran Alone

$407.75$587.36$836.13$1,059.09Veteran with Spouse Only$455.75$651.36$917.13$1,156.09Veteran with Spouse & One Parent$494.75$703.36$982.13$1,234.09Veteran with Spouse and Two Parents$533.74

$755.36$1,047.13$1,312.09

Veteran with One Parent$446.75$639.36$901.13$1,137.09Veteran with Two Parents$485.75$691.36$966.13$1,215.09Additional for A/A spouse (see footnote b

)$44.00$59.00*$74.00$89.00

Dependent Status708090100Veteran Alone$1,334.71$1,551.48$1,743.48$2,906.83Veteran with Spouse Only$1,447.71$1,680.48$1,888.48$3,068.90

Veteran with Spouse and One Parent$1,538.71$1,784.48$2,005.48$3,198.96

Veteran with Spouse and Two Parents$1,629.71$1,888.48$2,122.48$3,329.02Veteran with One Parent$1,425.71$1,655.48$1,860.48$3,036.89Veteran with Two Parents$1,516.71$1,759.48$1,977.48

$3,166.95Additional for A/A spouse (see footnote b)$104.00$118.00$133.00

$148.64Dependent Status30%40%50%60%Veteran with Spouse and Child$491.75$699.36$976.13$1,227.09Veteran with Child Only

$439.75$630.36$890.13$1,124.09Veteran with Spouse, One Parent and Child

$530.75$751.36$1,041.13$1,305.09Veteran with Spouse, Two Parents and Child$569.75$803.36$1,106.13

$1,383.09Veteran with One Parent and Child$478.75$682.36$955.13

$,1202.09Veteran with Two Parents and Child$517.75$734.36$1,020.13$1,280.09Add for Each Additional Child Under Age 18$24.00$32.00$40.00

$48.00Each Additional Schoolchild Over Age 18 (see footnote a)$78.00$104.00$130.00$156.00

Additional for A/A spouse (see footnote b)$44.00$59.00$74.00$89.00Dependent Status70%80%90%100%Veteran with Spouse and Child$1,530.71$1,775.48$1,995.48$3,187.60Veteran with Child Only$1409.71

$1,637.48$1,840.48$3,015.22Veteran with Spouse, One Parent and Child$1,621.71$1,879.48$2,112.48$3,317.66Veteran with Spouse, Two Parents and Child$1,712.71$1,983.48

$2,229.48$3,447.72Veteran with One Parent and Child$1,500.71$1,741.48$1,957.48$3145.28Veteran with Two Parents and Child$1,591.71$1,845.48$2,074.48$3,275.34Add for Each Additional Child Under Age 18$56.00$64.00$72.00$80.52Each Additional Schoolchild Over Age 18 (see footnote a)$182.00$208.00$234.00$260.13Additional for A/A spouse (see footnote b)$104.00$118.00$133.00$148.64Slide5

Presentation Intent

Sooner or later you will submit your disability packet at ACAP. When you do, you will submit your medical records and DD214 then wait for notification on when to report to the medical doctors who will evaluate your medical claim.

But are you ready?

Did you do your homework for your claim?

D

o you know how to substantiate your claims in medical documents

BEFORE

the evaluators determine the outcome for percentage?

Well, that's what I will attempt to do today…educate you on how to validate your packet for the best possible outcome. It all starts with the timeline…..Slide6

Before We do..

Convalescence

VA may grant a temporary 100 percent disability compensation rating to recover from surgery or immobilization of a joint by a cast without surgery for a service-connected

disability

while awaiting final disability rating results.

Hospitalization

VA may grant a temporary 100% disability compensation rating to a Veteran who is hospitalized for more than 21 days for a service-connected

disability

while awaiting final disability rating results.

Individual Unemployability

VA may pay disability compensation at the 100% rate to certain Veterans who are unable to maintain substantially gainful employment as a result of service-connected disabilities,

even though VA has not rated their service-connected disabilities at the total level.

Did you knowDid you KnowDid you knowSlide7

educate

Assess

Print out and review the

Disability

Benefits Questionnaires (DBQs)

based on your complains

Assess your overall medical condition with primary care doctor

The day you make the decision to retire

Obtain all medical documentation / DVDs, and x-rays that support your conditions from any medical facility Tricare referred you to related to your conditions and get them in your records (keep copies of everything)

Always review the DBQs before you seek medical care especially a year out from separation

When VA sends you to the evaluators make sure you read the DBQs to insure you know what they will ask pertaining to your condition (s)

12 month mark

Document and obtain

Review

File your BDD disability with ACAP VA Reps

Event

TimelineSlide8

Assessment

Medical

Understanding

the

ProcessSlide9
Types of Claims

Fully Developed Claim

VA established the

Fully Developed Claim Program

to expeditiously process claims certified by the claimant or his/her representative as meeting the Fully Developed Claim criteria. In order for you to participate in the Fully Developed Claim Program,

you

must obtain the relevant service treatment and personnel records and provide them to VA.If VA decides your claim before one year from the date it is received, you will still have the remainder of the one-year period to submit additional information or evidence necessary to support your claim. For this program, VA will only obtain service treatment records and Federal treatment records when you identify them. Standard Claim

As a standard claim, VA is responsible for getting relevant records from any Federal agency that you adequately identify and authorize VA to obtain.VA will make every reasonable effort to obtain relevant records not held by a Federal agency that you adequately identify and authorize VA to obtain. These may include privately held evidence and information you tell us about (such as records from a private doctor or hospital) and/or records from State or local governments or current or former employers.VA will provide a medical examination for you, or get a medical opinion, if determined it is necessary to make a claims decision.Slide10
Types of Claims

Types of Claims

There are numerous types of claims that apply to disability compensation. They can be based on disabilities that existed when entering military service, but were made worse, disabilities that occurred during service, or disabilities that arose after you left military service. Additionally, there are claims that are filed for special circumstances

.

Pre-Discharge Claims

Servicemembers that are within 180 days of separation or retirement from active duty or full time National Guard duty may file claims for disability compensation.

Claims Based on Pre-Service DisabilitiesIndividuals may enter military service with a known disability. Should this disability become worse due to military service, VA may be able to pay compensation. This is known as aggravation; however, compensation can only be paid for the level of aggravation. For example, at entry into military service, an individual has a disabling condition that could be considered 10% disabling. In order for this condition to be considered aggravated, it would have to have worsened due to military service to at least 20

%.Claims Based on In-Service DisabilitiesThese claims are based on disabilities that are a result of an injury or disease that occurred in active service, and in the line of duty. Injuries or diseases as a result of the Veteran's own willful misconduct or abuse of alcohol or drugs are excluded.Claims Based on Post-Service DisabilitiesClaims for post-service disabilities would include claims for disabilities that are a result of disabilities considered to be service-related, even though the disability arose after service. There are various classifications of presumptive disabilities which can be based on location or circumstances of service or just by military service itself. Claims Based on Special CircumstancesClaims regarding compensation are not always based on an in-service event. In other words, after a disability has been determined to be service connected, there may be other types of claims a Veteran or surviving spouse may wish to file. This might include a claim for a temporary 100% rating due to surgery for a service-connected disability, or additional compensation based on being in need of regular aid and attendance. Slide11

Assessment

Medical

The Benefits Delivery at Discharge (BDD)

(this is

what you file at ACAP)Slide12

Benefits Delivery at Discharge (BDD)

Requirements To Participate

BDD Program

Do I have a known separation date?

Yes

How far away is my known separation date?

60 - 180 daysWhen must I submit my service treatment records to VA?At the time claim is submittedWhen and where must I complete all phases of my VA/DoD medical separation examination process?At your point of separation, prior to release from the militaryWhen may I apply?If you meet all of the BDD requirements above, you may apply for BDD 60-180 days prior to separation.Benefits Delivery at Discharge (BDD)BDD allows a Servicemember to submit a claim for disability compensation 60 to 180 days prior to separation, retirement, or release from active duty or demobilization. BDD can help you receive VA disability benefits sooner, with a goal of within 60 days after release or discharge.EligibilityBDD requires a minimum of 60 days to allow sufficient time to complete the medical examination process (which may involve multiple specialty clinics) prior to separation from service. If you are closer than 60 days to separation from service, you can submit a Quick Start claim. BDD is available nationwide and open to all Servicemembers on full time active duty, including members of the National Guard and Reserve. Members of the Coast Guard may also participate.Slide13

Step 3 (Documentation)

Whenever you seek medical care related to the injury or illness keep in mind what documentation VA will want to see pertaining to their questionnaires and get it documented in your medical records

Step 2 (Prepare Yourself)

Print out the DBQ that relates to your issue and read the questionnaire to identify the “evidence” the VA evaluators are looking for

Enter the DBQ ( i.e

21-0960G-2s

Gallbladder and Pancreas

Conditions

), into google search or go to the central registry and click on the DBQ you seek

Step 1 (educate yourself)

Identify which chronic illness or injury you intend to claim by

Disability Benefits Questionnaires (DBQ), such as:

21-0960G-2s

Gallbladder and Pancreas Conditions

Documentation, consistency, and education are your keys to a fair disability rating

(http://

www.benefits.va.gov/compensation/dbq_ListByDBQFormName.asp)Slide14

Assessment

Medical

Disability Benefits Questionnaires (DBQs) Slide15

Sample DBQ( the actual forms you are evaluated against by VA appointed specialists but that you don’t get to see…)Slide16

INSIDE

MEDICAL

21-0960G-1

Esophageal Conditions (Including GERD, Hiatal Hernia and Other Esophageal Disorders)

21-0960G-2

Gallbladder and Pancreas Conditions

21-0960G-3Intestinal Conditions (other than Surgical or Infectious) Including Irritable Bowel Syndrome, Crohn’s Disease, Ulcerative Colitis and Diverticulitis21-0960G-4Intestinal Surgery (Bowel Resection, Colostomy, Illiostomy)21-0960G-5Hepatitis, Cirrhosis, and other Liver Conditions21-0960G-6Peritoneal Adhesions21-0960G-7Stomach and Duodenal Conditions (not including GERD or Esophageal Disorders)21-0960G-8Infectious Intestinal Disorders (including Bacterial and Parasitic Infections)

Evaluation of conditions affecting the esophagus such as stricture, spasm, or other conditions with lump in throat or chest, pain on swallowing, or regurgitation.

Esophageal Conditions (including GERD, Hiatal Hernia, and Other Esophageal Disorders)Evaluation of gallbladder disease, with inflammation, gallstones, pain after eating fatty food, or pancreatic conditions including pancreatitis that manifests as severe recurrent abdominal pain.Gallbladder and Pancreas ConditionsEvaluation of Irritable Bowel Syndrome (IBS) (chronic recurrent diarrhea or constipation). Ulcerative colitis (chronic inflammatory bowel condition leading to erosions and bleeding) and other conditions with Bloody stools, fistulas, and/or abscess.Intestinal Conditions (other than surgical or infectious) including Irritable Bowel Syndrome, Crohn's Disease, Ulcerative Colitis, and DiverticulitsEvaluation of hepatitis (which refers to a variety of inflammatory and infectious conditions) and Cirrhosis (chronic liver disease resulting from liver injury leading to degeneration of the liver)and other conditions characterized by jaundice, ascitis, fluid retention.

Hepatitis, Cirrhosis and Other Liver ConditionsEvaluation of peritoneal adhesions, which are scars of the visceral lining of the abdominal structures that produces episodes of partial or complete bowel obstruction.Peritoneal AdhesionsEvaluation of stomach and duodenum conditions such as peptic ulcer disease, recurrent pain relieved by antacids, bloody stools, nausea or vomiting, indigestion.Stomach and Duodenum Conditions (not including GERD or Esophageal Disorders)

Evaluation of Amebiasis, dysentery, and various types of intestinal parasites with recurrent diarrhea, alteration in stool consistency or foul smell.Infectious Intestinal Disorders, including Bacterial and Parasitic InfectionsEvaluation of removal of portions of the intestine and reconstruction and diversion of the intestinal tract: bowel diversion that requires use of external bags to collect stool.Intestinal Surgery (Bowel Resection, Colostomy, and Ileostomy)Gastrointestinal

Condition Form Name

Disability Benefits Questionnaires (DBQs) The chart matches the Disability Benefits Questionnaires (DBQs) to medical conditions or symptoms to the corresponding Disability Benefits Questionnaire (DBQs).Gastrointestinal (GI) Symptoms and the Anxiety Disorder connectionGastrointestinal (GI) disturbances commonly include symptoms of stomach pain, heartburn, diarrhea, constipation, nausea and vomiting. When no medical cause for GI disturbances is und, they are often termed “functional GI symptoms.” Many studies have shown a coforrelation between anxiety, depression and functional GI symptoms. Generally, study results have demonstrated that people who have at least one GI symptom are more likely to have an anxiety disorder or depression than those without any GI symptoms

.(So check it out and see mental health if you see a connection)Slide17

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MEDICAL

Evaluation of varicose veins, arterial diseases, producing swelling, claudication of legs, or

pain on walking, skin/nail changes

Artery and Vein Conditions (Vascular Diseases including varicose veins)

Evaluation of high blood pressure (BP):

how to determine significance of BP readings or BP reading abnormalities.HypertensionConditions including: heart attack (MI), irregular rhythm, heart murmurs and heart surgery.Heart Conditions (Including IHD, Non-IHD, Arrhythmias Valvular Disease and Cardiac Surgery)Heart/ArterialCondition Form NameDisability Benefits Questionnaires (DBQs) The chart matches

the Disability Benefits Questionnaires (DBQs) to medical conditions or symptoms to the corresponding Disability Benefits Questionnaire (DBQs).Form # Cardiovascular

21-0960A-2Artery and Vein Conditions (Vascular Diseases including Varicose Veins)21-0960A-3Hypertension21-0960A-4Heart Conditions (including IHD, Non-IHD, Arrhythmias, Valvular Disease and Cardiac Surgery)Hypertension means "High blood pressure; transitory or sustained elevation of systemic arterial blood pressure to a level likely to induce cardiovascular damage or other adverse consequences."

The normal level for blood pressure is below 120/80, where 120 represents the systolic measurement (peak pressure in the arteries) and 80 represents the diastolic measurement (minimum pressure in the arteries). Blood pressure between 120/80 and 139/89 is called prehypertension (to denote increased risk of hypertension), and a blood pressure of 140/90 or above is considered hypertension. Hypertension may be classified as essential or secondary. Essential hypertension is the term for high blood pressure with unknown cause. It accounts for about 95% of cases. Secondary hypertension is the term for high blood pressure with a known direct cause, such as kidney disease, tumors, or birth control pills. Slide18

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MEDICAL

Skin/scars

Dental

ENT

Disability Benefits Questionnaires (DBQs)

The chart matches the Disability Benefits Questionnaires (DBQs) to medical conditions or symptoms to the corresponding Disability Benefits Questionnaire (DBQs). 21-0960F-1Scars/Disfigurement21-0960F-2Skin DiseasesForm #Dental / Oral

21-0960M-15Temporomandibular Joint (TMJ) Conditions21-0960D-1Oral and Dental Conditions, including Mouth, Lips, and Tongue (other than Temporomandibular Joint Conditions)

Form #Ear, Nose, Throat21-0960N-1Ear Conditions (including Vestibular and Infectious Conditions)21-0960N-3Loss of Sense of Smell and/or Taste21-0960N-4Sinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and Pharynx

Form # Scars/SkinEvaluation of all dental and oral conditions, except TMJ Conditions.

Dental and Oral ConditionsEvaluation of conditions affecting the TMJ joint with pain in the jaw when biting and clicks and sounds in the jaw.Temporomandibular Joint (TMJ) ConditionsEvaluation for infectious and non-infectious diseases of the skin: how to evaluate rashes, spots, athlete's foot, sweating, and acne skin lesions.Skin DiseasesEvaluation of palpable or disfiguring scars, producing distortion or asymmetry.Scars and Disfigurement

Evaluation of various conditions of the ear including: infections, dizziness, vertigo, acoustic tumors and other conditions with ringing in the ears (tinnitus).Ear Condition (including: Vestibular and Infectious Conditions)Evaluation of Anosmia (inability to detect any odor), Hyposmia (reduced ability to detect odors), Ageusia (complete lack of taste), Hypogeusia (decrease in sense of taste) and other conditions affecting the sense of smell and taste.

Loss of Sense of Smell and/or TasteEvaluation of conditions affecting, the sinuses, nose, throat, larynx, and pharynx, including, but not limited to deviated nasal septum and organic aphonia, vocal chord problems.Sinusitis, Rhinitis, and other Conditions of the Nose, Throat, Larynx, and PharynxCondition Form Name

Have constant headaches? Make sure you talk to your doctor about the possibility of Temporomandibular Joint (TMJ) ConditionsIf so make sure you claim both

Dentistry

Dental benefits are provided by the Department of Veterans Affairs (VA) according to law. In some instances, VA is authorized to provide extensive dental care, while in other cases treatment may be limited.Slide19

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MEDICAL

Endocrinological

Genitourinary

Disability Benefits Questionnaires (DBQs)

The chart matches the Disability Benefits Questionnaires (DBQs) to medical conditions or symptoms to the corresponding Disability Benefits Questionnaire (DBQs). Form #Endocrinological21-0960E-1Diabetes Mellitus21-0960E-2Endocrine Diseases (other than Thyroid and Parathyroid, or Diabetes Mellitus)21-0960E-3

Thyroid and Parathyroid ConditionsForm #

Genitourinary21-0960J-1Kidney Conditions (Nephrology)21-0960J-2Male Reproductive Organ Conditions21-0960J-3Prostate Cancer21-0960J-4Urinary Tract (including Bladder and Urethra) Conditions (excluding Male Reproductive System)

Conditions - SymptomsForm NameEvaluation of DM Type I or II, with alteration of blood sugar regulation, abnormal Glucose Tolerance Test (GTT), requiring medication or hospitalization or complications.Diabetes Mellitus (DM)Evaluation of conditions affecting the hormone glands, including, but not limited to Cushing's syndrome, Acromegaly, and Addison's Disease.

Endocrine Diseases (other than Thyroid and Parathyroid, or Diabetes Mellitus)Evaluation of conditions affecting the functions regulated by the thyroid and parathyroid glands, including, but not limited to growth and metabolism.Thyroid and Parathyroid ConditionsEvaluation of renal diseases including Nephritis, renal insufficiency, and other diseases of the kidney: kidney failure, abnormal kidney function tests, protein in the urine, edema, kidney stones.Kidney Conditions (Nephrology)Evaluation of diseases of the urethra, penis, testes, and scrotum, producing pain on urination, swelling, blood in urine or incontinence.Male Reproductive Organ ConditionsEvaluation of malignant lesions of the prostate gland with frequent diurnal or nocturnal urination.Prostate CancerEvaluation of conditions affecting the bladder and urethra, including, but not limited to voiding dysfunctions and infections.Urinary Tract (Bladder and Urethra)Slide20

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MEDICAL

Blood

Eye

Respiratory

Rheumatological

Disability Benefits Questionnaires (DBQs) The chart matches the Disability Benefits Questionnaires (DBQs) to medical conditions or symptoms to the corresponding Disability Benefits Questionnaire (DBQs). Form # 21-0960B-1Hematologic and LymphaticHairy Cell and Other B-Cell Leukemias21-0960B-2Hematologic and Lymphatic Conditions, including Leukemia

Conditions - SymptomsForm NameEvaluation of conditions of red and white blood cells, producing anemias, leukemias on tumors such as lymphomas.

Hematologic and Lymphatic ConditionsEvaluation of various diseases of the eye, such as inflammation, infection, glaucoma, deformities, alteration of tear ducts, cataracts, retina disease, and other conditions.Eye ConditionsForm #Ophthalmological21-0960N-2

Eye ConditionsEvaluation of the respiratory system except Sleep Apnea and Tuberculosis.Respiratory Conditions (other than TB and Sleep Apnea)Evaluation of disorder characterized by cessation of breathing during sleep and provides information necessary to determine functional impact (sleep apnea, snoring) daytime complications

.Sleep ApneaEvaluation of Chronic Fatigue Syndrome. Components including but not limited to tiredness, loss of memory or concentration and enlarged lymph nodes.Chronic Fatigue SyndromeForm #Respiratory21-0960L-1Respiratory Conditions (other than Tuberculosis and Sleep Apnea)21-0960L-2Sleep Apnea

Form #Rheumatological21-0960Q-1Chronic Fatigue Syndrome

Note before you go further: when reviewing DBQs you may have to do your homework because some cross reference others such as in the case of:21-0960N-2 (eye conditions), and 21-0960P-3 (Post Traumatic Stress Disorder). 21-0960M-8 (Hip and Thigh Conditions), and 21-0960M-9 (Knee and lower leg conditions).Keep that in mind when seeing the medical evaluatorsSlide21

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MEDICAL

General Surgery

Psychological

Disability Benefits Questionnaires (DBQs)

Conditions - Symptoms

Form NameEvaluation of conditions involving internal organs bulging through the muscle, except hiatal hernia.Hernias (including Abdominal, Inguinal, and Femoral Hernias)Evaluation of rectum and anus conditions causing alteration of sphincter control, stricture of prolapse, fistula, and other symptoms. Bowel incontinence or severe constipation blood in stools.Rectum and Anus Conditions (including Hemorrhoids)Form #General Surgery21-0960H-1

Hernias (including Abdominal, Inguinal, and Femoral Hernias)21-0960H-2Rectum and Anus Conditions (including Hemorrhoids)

Evaluation for anorexia, bulimia, and other eating disorders.Eating DisordersEvaluation of symptoms, history, and impact related to mental disorders: depression, mood and affective disorders, psychosis, etc.Mental Disorders (other than PTSD)Evaluation of beginning and extent of symptoms (acute - length of symptoms is usually less than 3 months, chronic - symptoms usually last 3 months or more, with delayed onset - usually at least 6 months have passed between the traumatic experience and the beginning of symptoms). Symptoms may include: recurrent experiences of a traumatic event, avoiding an excitant or irritant associated with the trauma, deadening of general responsiveness, increased arousal, including insomnia, recurrent nightmares, and extreme caution; exhibiting an inflated frightened response; and experiencing changes in hostility..Review Evaluation of PTSD

Form #Psychological

21-0960P-1Eating Disorders21-0960P-2Mental Disorders (other than PTSD)21-0960P-3Review Post Traumatic Stress Disorder (PTSD)Post Traumatic Stress Disorder: In addition to the evidence above, you must also submit: A completed VA Form 21-0781, "Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (download form)," OR If claiming PTSD based on personal assault, VA Form 21-0781a, "Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder Secondary to Personal Assault (download form).“What’s other than PTSD?Borderline Personality disorderSchizophrenia Anxiety disorder(to name a few)

Look through PTSD medical documentation …sometimes they will report more than just one diagnosis as in the case of anxiety disorder and PTSD.If so make sure you claim both

To receive VA compensation for PTSD there are two items of evidence that must exist.  One without the other is worthless in establishing your claim to VA compensation for PTSD. 

Stressor:  In a recent regulatory revision, the VA will accept as a stressor the fact that a veteran was in "fear of military or terrorist activity."  Likewise any event that involves actual or threatened death or serious injury could also be considered as a stressor.  That fear or event must be consistent with the places, types, and circumstances of the veteran's service.  Moreover, a VA psychiatrist or psychologist, or those working under contract to the VA, must confirm that the claimed stressor is adequate to support a diagnosis of PTSD.

Diagnosis: A diagnosis of Post-Traumatic Stress Disorder rendered by a psychiatrist. Counseling reports prepared by Vet Centers may be considered in determining the degree of your impairment; however, there must be a diagnosis of PTSD made by a physician specialized in psychiatry. The chart matches the Disability Benefits Questionnaires (DBQs) to medical conditions or symptoms to the corresponding Disability Benefits Questionnaire (DBQs). Slide22
General Rating Formula for Mental Disorders:

Total

occupational and social impairment, due to such symptoms as: gross impairment in thought process or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name

…………………..100%

Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships

...................................... 70%

Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining Effective work and social relationships

………………..50%  Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events) ............................ 30%  Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication .................. 10%A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication .............................. 0% Slide23

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MEDICAL

Infectious

Disease

Disability Benefits Questionnaires (DBQs)

The chart

matches the Disability Benefits Questionnaires (DBQs) to medical conditions or symptoms to the corresponding Disability Benefits Questionnaire (DBQs). Conditions - SymptomsForm NameEvaluation of conditions associated with the Human Immunodeficiency Virus (HIV) and its treatment.HIV-Related IllnessesEvaluation of infectious diseases not specifically-associated with either HIV or military service in a tropical area, the Persian Gulf, or Afghanistan.Infectious DiseasesEvaluation of infectious diseases associated with military service in tropical areas with exposure to salmonella, shigella, etc. producing symptoms such as chronic diarrhea.Persian Gulf and Afghanistan Infectious Diseases

Evaluation of conditions in which the immune system begins attacking healthy body tissues, including, but not limited to, Goodpasture's syndrome and Guillain-Barre syndrome.Systemic Lupus Erthematosus (SLE) and Other Autoimmune DiseasesEvaluation of pulmonary and extrapulmonary tuberculosis symptoms.

Tuberculosis (TB)For use in evaluation of vitamin deficiencies (Beriberi, Pellagra, syndromes of dermatitis, diarrhea dementia in POW, post-GI surgery, bypass procedures, undernutrition and malabsorption.)Nutritional DeficienciesForm #Infectious Diseases21-0960I-1

Persian Gulf and Afghanistan Infectious Diseases21-0960I-2HIV-Related Illnesses21-0960I-3Infectious Diseases (other than HIV-Related Illness, Chronic Fatigue Syndrome, or Tuberculosis)21-0960I-4Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases

21-0960I-5Nutritional Deficiencies21-0960I-6TuberculosisGulf War IllnessesGulf War Veterans suffering from what is commonly referred to as "Gulf War Syndrome," which is a cluster of medically unexplained chronic symptoms that can include fatigue, headaches, joint pain, indigestion, insomnia, dizziness, respiratory disorders, and memory problems may be eligible for disability compensation. In addition, Gulf War Veterans who served in Southwest Asia and have a disability resulting from certain infectious diseases may be eligible for disability compensation.Slide24
The Registries you should consider signing up with:

Depleted Uranium Registry

Depleted Uranium is natural uranium left over after most of the U-235 isotope has been removed, such as that used as fuel in nuclear power plants. DU possesses about 60% of the radioactivity of natural uranium; it is a radiation hazard primarily of internalized, such as in shrapnel, contaminated wounds, and inhalation, DU has some chemical toxicity related to being a heavy metal (similar to lead).

Veterans who are identified by the DOD or have concerns about possible DU exposure are eligible for a DU evaluation. VA maintains two registries for veterans possibly exposed to depleted uranium.

The first is for veterans who served in the Gulf War including OIF. The second is for veterans who served elsewhere including Bosnia and Afghanistan.

Exposures to Hazardous Materials

Veterans may have been exposed to a range of chemical, physical, and environmental hazards during military service. Veterans may be entitled to disability compensation if exposure to these hazards resulted in a disease or injury. Examples include exposure to radiation, mustard gas, and asbestos.

Gulf War RegistryFor veterans who served on Active Military duty in Southwest Asia during the Gulf War, which began in 1990 and continues to present, including OIF. The Gulf War examination registry was established after the first Gulf War to identify possible diseases resulting from US military personnel service in certain areas of Southwest Asia. These diseases were endemic to the area or may have been due to hazardous exposures, including heavy metals. Furthermore, air pollutants, i.e.., carbon monoxide sulfur oxides, hydrocarbons, particulate matter, and nitrogen oxides, singly or in combination, could have caused chronic health problems.http://www.publichealth.va.gov/exposures/burnpits/registry.asp

http://www.publichealth.va.gov/exposures/gulfwar/benefits/registry-exam.asp

http://www.publichealth.va.gov/exposures/depleted_uranium/index.aspSlide25

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MEDICAL

Musculoskeletal

Disability Benefits Questionnaires (DBQs)

The chart

matches

the Disability Benefits Questionnaires (DBQs) to medical conditions or symptoms to the corresponding Disability Benefits Questionnaire (DBQs). Conditions - SymptomsForm NameEvaluation of extremity, limb or digit (complete or partial amputation), and complications. Evaluation of stumps.AmputationsEvaluation of ankle pain, persistent deformity (ankylosis), ankle injuries, reduction of movement, and use of assistive device.Ankle ConditionsEvaluation for non-degenerative arthritic conditions such as Gout and Rheumatoid Arthritis: recurrent painful and swollen joints.Non-degenerative Arthritis (including Inflammatory, Autoimmune, Crystalline, and Infectious Arthritis) and Dysbaric OsteonecrosisEvaluation of injuries, deformities, loss of elbow and forearm producing motion limitation.Elbow and Forearm Conditions

Evaluation of reduction or loss of toe function and motion, and alteration in mobility.Foot conditions including flatfoot (pes planus)Evaluation of alteration in motion of the wrists or digits due to tendon or muscle injuries, and alteration in motion and function of the hand including ankylosis, trigger finger, loss of finger movement.

Hand and Finger ConditionsEvaluation of alteration in extension and flexion, poor postural and body support, and alteration of rotation of the hip.Hip and Thigh ConditionsEvaluation of ankylosis of the knee, subluxation of the knee, knee instability, meniscus lesions, and functional limitations knee cartilage problems, locked knee.Knee and Lower Leg ConditionsEvaluation of traumatic and other injuries resulting in loss or alteration of function, location, type, tears, and weakness: torn scarred muscles.Muscle InjuriesEvaluation of bone infections producing fever, local alteration of function, residuals from a bone infection with persistent drainage or bone alteration

Osteomyelitis

Form #Form Name21-0960M-1Amputations21-0960M-2Ankle Conditions21-0960M-3Non-Degenerative Arthritis (including Inflammatory, Autoimmune, Crystalline and Infectious Arthritis) and Dysbaric Osteonecrosis21-0960M-4

Elbow and Forearm Conditions21-0960M-6Foot Conditions, Including Flatfoot (Pes Planus)21-0960M-7

Hand and Finger Conditions21-0960M-8Hip and Thigh Conditions21-0960M-9Knee and Lower Leg Conditions21-0960M-10Muscle Injuries21-0960M-11OsteomyelitisAutomobile AllowanceVA may provide Veterans with a one-time allowance to purchase a new or used car to accommodate a service-connected disability. This benefit is available to Veterans with certain severe service-connected disabilities, such as loss of, or permanent loss of use of, a hand or foot. This benefit can also be used to purchase adaptive equipment.Clothing AllowanceVA may provide an annual clothing allowance to Veterans who use a prosthetic or orthopedic device (including a wheelchair) because of a service-connected disability, or has a service-connected skin condition and uses a medication that causes irreparable damage to outer garments.Slide26

INSIDE

MEDICAL

Musculoskeletal

(cont)

Disability Benefits Questionnaires (DBQs)

The chart

matches the Disability Benefits Questionnaires (DBQs) to medical conditions or symptoms to the corresponding Disability Benefits Questionnaire (DBQs). Evaluation of arm limitation of function, dislocation, alteration in joint function, incomplete movements, deformity, dislocation, nonunion, and fracture complications : frozen shoulder.Shoulder and Arm ConditionsEvaluation of arthritis and neck deformities.Neck (Cervical Spine) ConditionsEvaluation of unfavorable or incomplete wrist motion due to ankylosis (limitation in range), painful or other alteration in function, resulting from traumatic or other injury complications, joint replacement.Wrist ConditionsEvaluation of chronic low back pain, arthritis and back injuries, spinal conditions or disc disease: low back pain with sciatica.Back (Thoracolumbar Spine) Conditions

Form #

Form Name21-0960M-12Shoulder and Arm Conditions21-0960M-13Neck (Cervical Spine) Conditions21-0960M-14Back (Thoracolumbar Spine) Conditions21-0960M-16Wrist Conditions

Condition Form NameTitle 38 U.S.C. 1151 ClaimsVA may provide compensation for injuries incurred or aggravated while receiving care from VA, such as medical treatment or vocational rehabilitation.Slide27

INSIDE

MEDICAL

Neurological

(Part #1)

Disability Benefits Questionnaires (DBQs)

The chart

matches the Disability Benefits Questionnaires (DBQs) to medical conditions or symptoms to the corresponding Disability Benefits Questionnaire (DBQs). Conditions - SymptomsForm NameEvaluation of progressive degenerative disease of the brain and spinal cord with progressive muscle weakness and wasting, speech, swallowing and breathing problems.Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease)Evaluation of alteration of the function of the nerves (motor and sensory), related to Diabetes Mellitus: weakness, numbness, tingling of legs and arms related to diabetes.Diabetic Sensory-Motor Peripheral NeuropathyEvaluation of numerous other neurologic conditions such as: meningitis, HIV, brain abscess, Lyme Disease, encephalitis, stroke, brain tumor, and spinal cord injury.Central Nervous System and Neuromuscular Diseases (except TBI, ALS, Parkinson's Disease, MS, Headaches, TMJ, Epilepsy, Narcolepsy, Peripheral Nerves, Sleep Apnea, Cranial Nerves, Fibromyalgia, and Chronic Fatigue Syndrome)Evaluation of

conditions affecting the following nerves in the Cranium: V (trigeminal, VII (facial), IX (glossopharyngeal), X (vagus), XI (spinal accessory), and XII (hypoglossal). (Conditions affecting cranial nerves I (olfactory), II (optic), III (oculomotor), IV (trochlear), VI(abducens), and VIII (vestibulocochlear (auditory)) are addressed in other DBQs.)Cranial Nerve ConditionsEvaluation of recurrent episodes of head pain producing work limitation or incapacitation: with other symptoms such as nausea, vomiting, tearing etc.

Headaches (including Migraine Headaches)Evaluation of fibromyalgia components, including, but not limited to sleep problems, muscle and joint pain, and altered affect.FibromyalgiaEvaluation of seizure conditions including epilepsy.Seizure DisordersForm #Form Name21-0960C-2

Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease)21-0960C-4Diabetic Sensory-Motor Peripheral Neuropathy21-0960C-5Central Nervous System and Neuromuscular Diseases (except TBI, ALS, PD, MS, Headaches, TMJ, Epilepsy, Narcolepsy, Peripheral Nerves, Sleep Apnea, Cranial Nerves, Fibromyalgia, and CFS)

21-0960C-3Cranial Nerve Conditions21-0960C-7Fibromyalgia21-0960C-8Headaches (Including Migraine Headaches)21-0960C-11Seizure DisordersPrestabilization

VA may grant a temporary 12-month 50 or 100 percent initial rating to a Veteran who recently separated from service and has an unstable disability and is in need and cannot be self-sufficient.Examples:Lou Gehrig's Disease, MS, Parkinson's DiseaseSlide28

INSIDE

MEDICAL

Neurological

(Part

#2)

Disability Benefits Questionnaires (DBQs)

The chart matches the Disability Benefits Questionnaires (DBQs) to medical conditions or symptoms to the corresponding Disability Benefits Questionnaire (DBQs). Conditions - SymptomsForm NameEvaluation of disorders of the myelin sheath of the central nervous systems producing recurrent alterations of neurological function: such as weakness, numbness, urine incontinence, visual symptoms.Multiple Sclerosis (MS)Evaluation of symptoms that may include tremors, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. Other symptoms may include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions.Parkinson's DiseaseEvaluation of narcolepsy components, including, but not limited to, sleep attacks, sleepiness, paralysis, and cataplexy.NarcolepsyEvaluation of alteration of the function of Nerves associated with metabolic disorders, exposure to toxins, infections, immunological disorders, or inflammation and other conditions.

Peripheral Nerve Conditions (not including Diabetes Sensory-Motor peripheral Neuropathy)

Form #Form Name21-0960C-1Parkinson’s Disease21-0960C-9Multiple Sclerosis (MS)21-0960C-6Narcolepsy21-0960C-10Peripheral Nerve Conditions (Not Including Diabetic Sensory-Motor Peripheral Neuropathy)

Special Monthly Compensation (SMC)SMC is an additional tax-free benefit that can be paid to Veterans, their spouses, surviving spouses and parents. For Veterans, Special Monthly Compensation is a higher rate of compensation paid due to special circumstances such as the need of aid and attendance by another person or by specific disability, such as loss of use of one hand or leg. For spouses and surviving spouses, this benefit is commonly referred to as aid and attendance and is paid based on the need of aid and attendance by another person.Slide29

FEMALE (SPECIFIC) MEDICAL

Form #

Form Name

21-0960K-1

Breast Conditions and Disorders

21-0960K-2

Gynecological ConditionsGynecologicalAssault TraumaConditions - SymptomsForm NameEvaluation of inflammatory neoplastic and cystic lesions of the breast: Breast mass or lumps.Breast Conditions and DisordersEvaluation of diseases of the female genital tract including: uterus, vagina, cervix, ovaries, endometriosis, complications of pregnancy, and other conditions.

Gynecological ConditionsThe chart matches

the Disability Benefits Questionnaires (DBQs) to medical conditions or symptoms to the corresponding Disability Benefits Questionnaire (DBQs). Post Traumatic Stress Disorder: In addition to the evidence above, you must also submit: A completed VA Form 21-0781, "Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (download form)," OR If claiming PTSD based on personal assault, VA Form 21-0781a, "Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder Secondary to Personal Assault Evaluation of beginning and extent of symptoms (acute - length of symptoms is usually less than 3 months, chronic - symptoms usually last 3 months or more, with delayed onset - usually at least 6 months have passed between the traumatic experience and the beginning of symptoms). Symptoms may include: recurrent experiences of a traumatic event, avoiding an excitant or irritant associated with the trauma, deadening of general responsiveness, increased arousal, including insomnia, recurrent nightmares, and extreme caution; exhibiting an inflated frightened response; and experiencing changes in hostility..Review Evaluation of PTSD

21-0960P-3Review Post Traumatic Stress Disorder (PTSD)PTSD Can also be claimed for personal assault and TraumaBirth Defects/Spina Bifida

VA may provide a tax-free monetary allowance to children with Spina Bifida or certain birth defects born to women who served in the Republic of Vietnam or served in or near the demilitarization zone in Korea during certain time periods.Specialty CareManagement and screening of chronic conditions includes heart disease, diabetes, cancer, glandular disorders, osteoporosis, and fibromyalgia as well as sexually transmitted diseases such as HIV/AIDS and hepatitis.Reproductive health care includes maternity care, infertility evaluation and limited treatment; sexual problems, tubal ligation, urinary incontinence, and others. VA is prohibited by legislative authority from providing either in-vitro fertilization or abortion services.Rehabilitation, homebound, and long-term care. VA referrals are given to those in need of rehabilitation therapies such as physical therapy, occupational therapy, speech-language therapy, exercise therapy, recreational therapy, and vocational therapy. Homebound and long-term care services are available as well, limited to those meeting specific requirements.Woman Veterans who are interested in receiving care at VA should contact the nearest VA Medical Center and ask for the Women Veterans Program Manager.Slide30

Many Doctors are given guidance by the VA

and are discouraged from ranking you high on the DBQs claims so

Get

Second

Opinions !!

Read and make sure you have support documentation in your record that supports your DBQs

If your Doctor will not review and sign your DBQ based on the documentation and eval DBQ, then find another doctor. Why? Because chances are he/she is receiving guidance from VA and is working for them (not for you) when it comes to your DBQ claimThe Key to your rating is to find a Doctor that will support your DBQs

TRICARE

Army HospitalsVA facilitiesSlide31

So now you have your rating.

Now what do you do about post military health care

TRICARE?

VA Facility?

The following slides are some talking points

After Service CareSlide32

VA Medical Care

NOW FOR THE BAD NEWS:

Just because you are now approved for compensation doesn’t mean you can be seen at a VA medical Hospital even if you receive 100%

Care at a VA facility is income based and if you’re retired you probably don’t qualify UNLESS the care you intend on receiving is SERVICE CONNECTED and relates to WAR TIME SERVICE.Slide33
VA Priority Groups per care

Priority Groups

The number of Veterans who can be enrolled in the health care program is determined by the amount of money Congress gives VA each year. Since funds are limited, VA set up Priority Groups to make sure that certain groups of Veterans are able to be enrolled before others.

Once you apply for enrollment, your eligibility will be verified.  Based on your specific eligibility status, you will be assigned a Priority Group. The Priority Groups range from 1-8 with 1 being the highest priority for enrollment. Based on eligibility and income, some Veterans may have to agree to pay copay to be placed in certain Priority Groups and some Veterans may not be eligible for enrollment.

You may be eligible for more than one Enrollment Priority Group. In that case, VA will always place you in the highest Priority Group that you are eligible for. Under the Medical Benefits Package, the same services are generally available to all enrolled Veterans.VA determines your eligibility for VA’s comprehensive medical benefits package through our patient enrollment system, which is based on Priority Groups from 1 through 8.

Priority Group 1

Veterans with VA-rated service-connected disabilities 50% or more disablingVeterans determined by VA to be unemployable due to service-connected conditionsPriority Group 2Veterans with VA-rated service-connected disabilities 30% or 40% disablingPriority Group 3

Veterans who are Former Prisoners of War (POWs)Veterans awarded a Purple Heart medalVeterans whose discharge was for a disability that was incurred or aggravated in the line of dutyVeterans with VA-rated service-connected disabilities 10% or 20% disablingVeterans awarded special eligibility classification under Title 38, U.S.C., § 1151, “benefits for individuals disabled by treatment or vocational rehabilitation”Veterans awarded the Medal Of Honor (MOH)Priority Group 4Veterans who are receiving aid and attendance or housebound benefits from VAVeterans who have been determined by VA to be catastrophically disabledPriority Group 5Nonservice-connected Veterans and noncompensable service-connected Veterans rated 0% disabled by VA with annual income below the VA’s and geographically (based on your resident zip code) adjusted income limits.Veterans receiving VA pension benefitsVeterans eligible for Medicaid programsSlide34
Priority Groups (Continued)

Priority Group 6

Compensable 0% service-connected Veterans

Veterans exposed to Ionizing Radiation during atmospheric testing or during the occupation of Hiroshima and NagasakiProject 112/SHAD participants

Veterans who served in the Republic of Vietnam between January 9,1962 and May 7,1975Veterans of the Persian Gulf War who served between August 2, 1990 and November 11, 1998

*Veterans who served on active duty at Camp Lejeune for not fewer than 30 days beginning August 1, 1953 and ending December 31, 1987Veterans who served in a theater of combat operations after November 11, 1998 as follows:

Currently enrolled Veterans and new enrollees who were discharged from active duty on or after January 28, 2003, are eligible for the enhanced benefits for 5 years post discharge.Combat Veterans who were discharged between January 2009 and January 2011, and did not enroll in the VA health care during their 5 year period of eligibility have an additional one year to enroll and receive care.  The additional one-year eligibility period began February 12, 2015 with the signing of the Clay Hunt Suicide Prevention for America Veterans Act.Note: At the end of this enhanced enrollment priority group placement time period Veterans will be assigned to the highest Priority Group their unique eligibility status at that time qualifies for.

*Note: While eligible for Priority Group (PG) 6; until system changes are implemented you would be assigned to PG 7 or 8 depending on your income.Priority Group 7Veterans with gross household income below the geographically-adjusted income limits (GMT) for their resident location and who agree to pay copaysPriority Group 8Veterans with gross household income above the VA and the geographically-adjusted income limits for their resident location and who agrees to pay copaysVeterans eligible for enrollment:Noncompensable 0% service-connected:Sub priority a:  Enrolled as of January 16, 2003, and who have remained enrolled since that date and/or placed in this sub priority due to changed eligibility statusSub priority b:  Enrolled on or after June 15, 2009 whose income exceeds the current VA or geographic income limits by 10% or lessNonservice-connected and:Sub priority c:  Enrolled as of January 16, 2003, and who have remained enrolled since that date and/or placed in this sub priority due to changed eligibility statusSub priority d:  Enrolled on or after June 15, 2009 whose income exceeds the current VA or geographic income limits by 10% or lessVeterans not eligible for enrollment:Veterans not meeting the criteria above:Sub priority e: Noncompensable 0% service-connected (eligible for care of their SC condition only)Sub priority g: Nonservice-connectedSlide35

Determine if you will keep TRICARE for yourself vs VA

At your first appointment take all the prescription medication with you to your first appointment with primary care

3

Apply on line for the Registries

(whether you qualify for VA Facility care or not)

Should you qualify for VA care, attend the facility orientation and you will be assigned to a clinic for primary care

Once you receive your VA compensation letter (spelling out percentages), take it along with your DD214 and Retirement *Green Card* to your nearest VA Medical Center and apply for your VA Card

2

1

2011

4

GETTING IN THE SYSTEMSlide36

Medical follow-up

When people finally receive their VA determination they tend to mitigate their conditions and rationalize their decision to stop taking required medication overtime.

Its important to note that VA might decide to reevaluate you years down the road…if you don’t see the need to follow up with care, don’t expect the VA to compensate you for it.

(Keep your medications current and follow your care regiment per your doctor).

Refilling Medications

There are several ways you can refill your prescriptions

.

Online

You can use the "My Health

eVet" Website to refill your VA prescriptions and view your VA prescription history online. To access Prescription Refill, you must be a registered user of My Health

eVet. If you are not a registered user, to register and learn how to use Prescription Refill, visit the My HealtheVet Web site.Mail OrderMedication refills can be requested by mailing the refill notice provided to you at the time of your original fill. Your order will be processed through our Pharmacy mail-out program. Routine refills cannot be processed at the Pharmacy windows (unless there are special circumstances).TelephoneSome VA Pharmacies have toll-free automated telephone refill systems. See the phone number listing for your local VA Facility.Slide37

Syringe treatment

Make sure you retrieve your medical shot record and keep it current through your primary care doctor. Consider the shingles shot if you have ever had Chicken

Pox as

well as seasonal flu shots.Slide38

What about an appeal?

~And ~

Do you have a family member who has never filed but was injured or taken ill while on active duty (never reached retirement and was never medically chaptered?)

If I die can my spouse continue to receive my disability pay?

The following slides review the process

Additional InformationSlide39

Filing an appeal ~or~ for Family member with prior service

Use

DBQs for Faster Service

VA’s Disability Benefits Questionnaires (DBQs)

speed the Fully Developed Claims process.These forms provide medical information that is directly relevant to determining a disability rating and ensure that VA’s ratings specialists have the precise information to assess claims.

Private and VA medical providers are qualified to complete these forms. If you’re filing by mail, ask a VA or private provider to fill out all applicable DBQs (find them by form name or symptom name) and fax or mail them to the regional office.

If you’re filing electronically, gather completed DBQs from your medical providers and upload them through the eBenefits system.FDC Checklist for Disability CompensationMake sure your Fully Developed Claim is right the first time by following this checklist, depending on the type of claim you are filing.Step 1: Log on to eBenefits.va.gov.Click "Apply for Benefits".Click "Apply for Disability Compensation".Start by answering questions about your claim.Hit "Save & Continue" to preserve the date from which VA may be able to pay you if your claim is approved. You have a year from the start date to gather evidence and submit the claim. VA will not process your claim until you hit "Submit".Step 2: Tell us about your Federal/State records:Tell us if you receive Social Security benefits for a condition you are claiming.Tell us where your military medical records and/or military personnel records (OMPF) are located (If you have copies, submit them).Identify all (if any) relevant medical records held by a Federal agency, such as the Social Security Administration, so that VA may obtain these records for you. Include the date ranges of your medical treatment records for your claimed conditions. You may also submit copies of these records if you have them in your possession.For members of the National Guard or Reserve components, include copies of all relevant treatment and personnel records in the custody of your unit(s).Step 3: Gather non-Federal records (as applicable):Request and submit copies of relevant private medical treatment records from your private medical provider.If you are claiming a disability as a result of an incident that you believe is not recorded in your military records, then submit statements supporting your claim from you, family, friends, clergy members, law enforcement, or other persons who you may have spoken with or who have knowledge of your claimed medical condition(s) and how/when it occurred.Slide40

Step 4: Choose Your Type of Claim:

Original Disability Claim

An original claim is the first claim you file for disability compensation from VA and can be submitted at any time after your discharge from the military. However, you are encouraged to submit your claim as soon as you are able to ensure all available documents are on hand.

Evidence required:

Medical evidence of a current physical or mental disability; AND

Evidence of an event, injury or disease in service; AND

Evidence of a link between your current disability and the event, injury, or disease in military service. Medical records or medical opinions are usually required to establish this relationship.New Disability ClaimA new claim is a claim for service connection for a disability that has not been filed before.Evidence Required:Medical evidence of a current physical or mental disability; ANDEvidence of an event, injury or disease in service; ANDEvidence of a link between your current disability and the event, injury, or disease in military service. Medical records or medical opinions are usually required to establish this relationship.Reopened Disability ClaimThis is a claim already filed that VA could not grant and the decision is over one year old.Evidence required: To reopen these claims, VA must receive new evidence that has never been considered, which pertains to the issue claimed.Claim For Increased DisabilityThis is a claim for an increased evaluation of a disability that VA has already determined to be service-connected.Evidence Required: Current medical evidence that shows your disability has gotten worse.Secondary Disability ClaimThis is a claim for a disability that developed as a result of or was worsened by a disability which VA has already determined to be service-connected.Evidence Required: Medical evidence that shows you have a disability that was caused or aggravated by an already established service-connected disability.(cont)Slide41
(cont)

There are other special issues where additional forms and evidence may be needed

:

Individual Unemployability as determined by VA:

In addition to the evidence above, you must also submit:

A completed VA Form 21-8940, "Veteran's Application for Increased Compensation Based on Unemployability" (

download form),A completed VA Form 21-4192, "Request for Employment Information in Connection with Claim for Disability Benefits" (download form,) completed by your last employer, ANDMedical evidence that a service-connected disability prevents you from obtaining or maintaining substantially gainful employment

.Post Traumatic Stress Disorder: In addition to the evidence above, you must also submit: A completed VA Form 21-0781, "Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (download form)," OR If claiming PTSD based on personal assault, VA Form 21-0781a, "Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder Secondary to Personal Assault (download form).“Step 5: Upload the documents:Scan all of the documents. Note that depending on how many documents you have you may need to split them into smaller batches and then upload.Under the "Upload Documents" tab, select "Manage Files".Upload the documents.If you have an appointed Veterans Service Officer, your representative will be able to check your claim and make sure you have all the required documents.Once all records are uploaded and your Veterans Service Officer has reviewed the claim, verify that you have "No More Evidence" and click "Submit".Slide42
Dependency and Indemnity Compensation (DIC)

DIC

is a tax-free monetary benefit generally

payable to a surviving spouse, child, or parent of Servicemembers who died while on active duty, active duty for training, or inactive duty training, or to survivors of Veterans who died from

their service-connected disabilities

.

Parents DIC is an income-based benefit for parents who were financially dependent on of a Servicemember or Veteran who died from a service-related cause.Slide43
VA Travel Reimbursement

Reimbursement

for mileage or public transportation may be paid to the following:

Veterans with service-connected disabilities rated at 30% or more;

Veterans traveling for treatment of a service-connected condition;

Veterans receiving a VA pension;

Veterans traveling for scheduled compensation or pension examinations;

Veterans whose income does not exceed the maximum VA pension rate;Mileage Reimbursement is at the rate of 41.5 cents per mile. These mileage subject to a deductible of $3 for a one way trip, $6 for a round trip, with a maximum of $18 per or the amount after six one-way trips (whichever occurs first) per calendar month. However, these deductibles can be waived if they cause a financial hardship to the veteran.The deductible is also waived for veterans traveling for scheduled compensation or pension examinations.Slide44

Do I qualify even if I'm also receiving VA disability?

How does the process work?

Is it Tax Free like VA Disability?

How does it affect my medical insurance?

Social Security Disability

Social Security disability, conversely, does not compensate disability claimants based on a partial loss of employability. You are either totally disabled or not disabled under this programSlide45
Is this legal

“Yes”

Social

security Disability is your own income withheld as part of your tax withholdings each month. If you are considered disabled you are paid from the SSD fund account until

you reach SS retirement age when the account changes to your

regular Social Security account (its just a matter of different pots of money for payment purposes).

It's not uncommon for veterans to have both Social Security and Veterans Disability claims going on at the same time. Alternatively, some veterans receive veterans disability benefits before applying for Social Security disability. VA disability benefits, also known as service-connected disability, is not based on income, so you can receive VA disability compensation and Social Security disability insurance (SSDI) at the same time. There is also VA pension, which is a needs-based program similar to Supplemental Security Income (SSI). VA pension is paid to veterans who have very little or no income and are disabled based on non-service disabilities. It is possible to receive SSI and VA pension at the same time. Slide46
Does Getting Benefits in one Program Help Getting Benefits in the Other Program?

Overall

, the answer is yes, but it does depend on your circumstances.

VA approval can help get Social Security disability.

If

you are the recipient of a very high VA rating (70% or higher), then your chances for success on your Social Security disability claim are quite high. This is because another federal agency has already found that you are either incapable of work or you are at a level where full-time work would be very difficult. One advantage many veterans with high disability ratings is that, while VA only considers service-connected disabilities, the SSA will consider all impairments, whether they are service-related or not.

Because of the similarity between a VA finding of unemployability and what it means to be disabled under the Social Security disability program, it is the rule in many federal circuit courts that VA disability ratings are entitled to “great weight.”

(See McCartey v. Massanari, 298 F.3d 1072 (9th Cir. 2002); Chambliss v. Massanari, 269 F.3d 520, 522 (5th Cir. 2001); Brady v. Heckler, 724 F.2d 914, 921 (11th Cir. 1984); and De Loatche v. Heckler, 715 F.2d 148, 150 n.1 (4th Cir. 1983).) And one circuit court said that VA disability ratings were entitled to “substantial weight.” (Kane v. Heckler, 776 F.2d 1130, 1135 (3d Cir. 1985).) In addition, Social Security Ruling 06-3p says that the decision and the evidence used to make the VA decision “may provide insight into the individual’s mental and physical impairment(s) and show the degree of disability determined by these agencies based on their rules." All of this comes down to the fact that Social Security should strongly consider that you were approved for disability benefits in making its decision on benefits.Slide47
When do I apply?

Note: If your considered totally disabled you should apply for SSD after you have received your 70% (or higher) disability rating from VA. VA disability results are viewed by the Social Security Disability evaluators but if you plan on applying for both you should wait a few months between the VA determination and filing for SSD so the system can update at social security.

Why? Because the reverse is not true….

So file VA first then SSD

Social Security approval does not necessarily help get VA benefits.

Unfortunately, if you are disabled under SSA rules, the VA may not give Social Security's decision as much weight, since it's not usually clear whether the disability is based on service-connected or non-service disabilities. Many veterans have a wide array of both types of disabilities, and the VA can be quick to attribute total disability to a host of non-service disabilities. The VA must be able to make a specific finding on what disabilities prevent employability. To convince the WA that the disability was caused by service-connected impairments, a veteran may need to hire a Vocational Expert to specifically attribute the unemployability to service-related disabilities

.Slide48

Things you should know..

Taxes

Social

Security Disability pay is TAXABLE income when filing your tax returns so if you are lucky enough to receive SSD have the Social Security Administration hold some back for taxes.

Bulk Payment

Just like with VA Disability you will receive a bulk payment upfront which is also TAXABLE Income so hold back at least 10% or more to avoid an April sticker shock.

Health Insurance

As with pay, health care benefits are tied together. This means that you will have to sign up for Medicare part A and B if you want to keep TRICARE. If you don’t, TRICARE will be notified by SS and TRICARE will cancel itself which could result in a 6 month delay to get signed up for Medicare A / B

& penalties

under Obama Care if you miss the sign up window.

Pitfall

#1

Pitfall #2Pitfall #3Slide49
Differences Between Social Security and Veterans Disability

Total

disability vs percentage of disability.

One

major difference between Social Security disability and veterans disability is that you don’t need to be totally disabled in order to be eligible for VA compensation. In fact, most veterans who receive VA compensation do not receive a total disability rating. Veterans can receive a compensable rating as low as 10% (and can have a rating as low as 0%). (In many cases, it makes sense to get a 0% rating even though its not compensable. The reason for this is that it means the veteran will at least have proven a service-connected disability -- which may deteriorate into a more serious problem and turn into a compensable disability. See

Filing for Social Security Disability as a Veteran

.)Slide50

~Or~ don’t sign up for Medicare part B if you intend on using just your local VA Hospital for care (just remember your TRICARE will cancel)

Make sure you sign up for Medicare part A & B if you want to keep TRICARE for yourself (does not affect TRICARE pertaining to your family…just you)

3

When you receive the initial bulk pay hold back at least 10% for taxes

When you start receiving SSD call the social security office and have them hold back a monthly amount against taxes

Apply for SSD after receiving your VA determination if you receive 100%

2

1

2011

4

The process for SSD

https://www.youtube.com/watch?v=OvQFbwq4dNA&list=PLGSYaZN04xzFCoEqDlY3n7xgWLh55vvDhSlide51

Decisions / Options to Healthcare Coverage

Adding Up the Costs

Just use VA facilities

(Cost: 0)

VA facilities and TRICARE

(

Single

: $282.60 per

year) VA, TRICARE & Medicare Part BTRICARE $282.60 per yearMEDICARE B: $121.80 Per Month (or higher depending on your income)

Service Connect

100%

ers

100% ers< 100% (VA)< 100% (VA)

Service Connect

Everything is interconnected: If you want to keep TRICARE then you have to sign up for MEDICARE Part B. TRICARE premiums are taken out of your retirement check and MEDICARE B is taken out of your SSD check “see costs above”.Slide52
Source References

http://www.disabilitysecrets.com/resources/disability/disability-social-security/overview-social-security-va-veterans-disability

http://www.benefits.va.gov/COMPENSATION/claims-special-index.asp

http://www.benefits.va.gov/compensation/dbq_ListByDBQFormName.asp

Social Security Disability

VA Disability Compensation

The Benefits Delivery at Discharge (BDD

) printable formsBurn Pit Registry http://www.publichealth.va.gov/exposures/burnpits/registry.asp