Home → Veterans Guide to VA Healthcare → Who's Eligible for VA Healthcare? → Catastrophically Disabled Veterans

1.3. Catastrophically Disabled Veterans

Veterans are Catastrophically Disabled when their injury, disorder or disease:

• Compromises their ability to carry out activities of daily living to such a degree that one requires personal or mechanical assistance to leave home or bed; or
• Requires constant supervision to avoid physical harm to oneself or others.

Benefits of the Catastrophically Disabled determination:

• The Veteran will be placed into priority group 4 ,unless eligible for a higher priority group.
• As of May 5, 2010 Per Public Law 111-163, the Caregiver and Veterans Omnibus Health Services Act of 2011,  Catastrophically disabled veterans are exempted from inpatient, outpatient, and prescription copays.   However, Veterans of this status may still be subject to copayments for extended care, long-term care, services.

The catastrophically disabled evaluation occurs when:

• A VA Clinician determines that there is sufficient medical documentation without further evaluation.
• A Veteran requests the evaluation by contacting:
  • the Enrollment Coordinator at their local VA health care facility, or
  • The Veteran should request to be evaluated by your VA primary care physician or VA Rehabilitation physician.  If you have medical evidence of a permanent, severely disabling injury, disorder or disease, from a non-VA physician or hospital, bring a copy of the evidence with you. Your VA physician may have to repeat certain tests, but bringing the evidence may speed up the evaluation process.  Note that the VA policy is to provide the evaluation wtihin 30 days of the request and there is no charge for the evaluation.

The following is a list of some injuries, disorders and diseases that may qualify as a catastrophic disability:

• Spinal Cord Injury-Quadriplegia and Quadriparesis or Paraplegia
• Persistent Vegetative State
• Traumatic Brain Injury
• Blindness
• Amputations- two amptuations but not of the same limb
• Multiple Sclerosis
• Parkinson's Disease
• Lou Gehrig's Disease (Amyotrophic Lateral Sclerosis (ALS)
• Neurological Disorders
• Psychological Conditions

There are three qualifying categories for this determination on the VA Form 10-0383 Evaluation:

Category 1A : The Veteran is catastrophically disabled if the Veteran has one of the following permanent conditions: Quadriplegia and Quadriparesis, Paraplegia, Blindness, or Persistent Vegetative State

Category 1B : The Veteran is catastrophically disabled if the Veteran has a permanent condition resulting from two amputations that were not of the same limb.

Category 2   : The Veteran is catastrophically disabled if the Veteran meets one of the following conditions.  Choose the scale evaluation that reflects the Veterans situation.

• Dependent in 3 or more activities of daily living (eating, dressing, toileting, transferring, incontinence of bowel, and/or bladder) with at least 3 of the being permanent with a score of 1, using the Katz Scale { Pro- Test is simple & Con- Limited range of activities assessed with ratings being subjective}, or
• A score of 10 or lower using the Folstein Mini-Mental State Examination {A brief psychological test to differentiate amond dementia, psychosis, and affective disorders.  It measures and evaluates cognitive function and mental impairment.}, or  
• A score of 2 or lower on at least 4 of the 13 motor items using the functional independence measure (FIM) { Scale for measuring level of assistance in Physical Rehabilitation}, or
• A score of 30 or lower using the Global Assessment of Functioning (GAF) (This test subjectively rates the social, occupational, and psychological functioning of adults.  Scores are given in a range.   The score of 21-30 states: Behavior is considerabley influenced by delusions or hallucinations or serious impairment, in communication or judgement {sometimes inchoherent, acts grossly inappropriately, or suicidal preoccupation} or inability to function in almost all areas {stays in bed all day, no job, home or friends})

Benefits specific to the catastrophically disabled classification:

• Category 4 status, despite incomes over attributable income limit, unless the Veteran qualifies for a higher priority category being priority categories 1, 2 or 3. 
• No co-pays for: VA Hospital care, VA medical services including out-patient services, Non-institutional alternative extended care services such as adult day health care or VA medications prescribed on an outpatient basis.  Note: There is a co-pay for VA Nursing Home Care.