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Basically, you are eligible for health care from the Department of Veterans Affairs if:
"Served in the active military, naval or air services" means that you served in the uniformed services (Army, Navy, Marine Corps, Air Force, Coast Guard) on active duty. If you were in the Reserves or National Guard AND you received federal orders calling you up for active duty AND you completed the full period for which you were called or ordered to active duty, then you may be eligible for VA health care.
National Guard or Reserve duty does not count toward eligibility for VA healthcare if:
Most veterans who enlisted after September 7, 1980, or entered active duty after October 16, 1981, must have served 24 continuous months or the full period for which they were called to active duty to be eligible.
The minimum duty requirement may NOT apply if:
Note: There are a number of other exceptions to the minimum duty requirements, VA encourages all Veterans to apply so that VA can determine your enrollment eligibility if it's not clear.
"Were separated from the service under conditions other than dishonorable" simply means that you did NOT receive a DISHONORABLE DISCHARGE (DD) or a BAD CONDUCT DISCHARGE (BCD). There are many different ways to be discharged or separated from the military. Your separation code can be found on your DD-214. It's Item 26. You'll recall if you received a DD or BCD, because there would have been a court-martial involved. For enlisted personnel, the general court martial would have resulted in a BCD (typically resulting in a confinement to a military prison), which would later be changed to a DD when all appellate reviews are completed. For officers, the general court martial is considered dishonorable if the sentence included "dismissal" from the service.
Like most everything in the VA, there are exceptions to almost every rule, including exceptions for some veterans with DD or BCD who may remain eligible for VA health care. To see if an exception applies to your case, we suggest that you attempt to enroll in VA health care at your nearest VA facility and that you disclose the circumstances surrounding your DD or BCD to the VA's enrollment and eligibility department.
Each year, Congress allocates a certain amount of money for VA health care. Based upon the amount of money, the Secretary of the Department of Veterans Affairs determines the number of veterans who can be enrolled in VA's health care programs. Enrollment priority groups have been established so that the Secretary can exclude veterans in certain priority groups if inadequate funds are provided by Congress to serve all veterans.
When you enroll for health care, you will be assigned to a priority group. If you qualify under multiple priority groups based on different criteria, you will be assigned to the highest priority group for which you are eligible.
Priority groups range from 1 (highest eligibility) to 8 (lowest eligibility) and take into consideration any service-connected disabilities, military awards, 1151 benefits, catastrophic disabilities, geographic means tests and other factors. It is probably easiest to determine your priority group by referencing the table below.
| Priority Group | Who Qualifies |
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1 |
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2 |
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3 |
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4 |
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5 |
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6 |
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7 |
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8 |
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Priority group 8, Sub-priority groups
|
Sub-Priority Groups |
Which Priority Group 8 veterans qualify |
|
8a |
Veterans who are noncompensable 0% service-connected and who were enrolled for VA healthcare as of January 16, 2003, and who have remained enrolled since that date and/ or placed in this subpriority due to changed eligibility status. |
|
8b |
Veterans who are noncompensable 0% service-connected and who enrolled for VA health care on or after June 15, 2009 and whose income exceeds the current VA National Income Thresholds or VA National Geographic Income Thresholds by 10% or less. |
|
8c |
Veterans who are nonservice-connected and who enrolled for VA health care as January 16, 2003, and who remained enrolled since that date and/ or placed in this subpriority due to changed eligibility status |
|
8d |
Veterans who are nonservice-connected and who enrolled for VA health care on or after June 15, 2009 and whose income exceeds the current VA National Income Thresholds or VA National Geographic Income Thresholds by 10% or less |
|
8e |
Veterans not meeting the criteria above and who are noncompensable 0% service connected. |
|
8f |
Veterans not meeting the criteria above and who are nonservice-connected. |
Veterans are Catastrophically Disabled when their injury, disorder or disease:
Benefits of the Catastrophically Disabled determination:
The catastrophically disabled evaluation occurs when:
The following is a list of some injuries, disorders and diseases that may qualify as a catastrophic disability:
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.
Benefits specific to the catastrophically disabled classification:
"Combat Veterans" are defined as:
"Combat Veterans" are assigned to Priority Group 6, unless eligible for enrollment in a higher priority group, for a period of five years after discharge. During this time, VA provides cost-free (no VA copayments) health care services and nursing home care for conditions potentially related to service in the theater of operations.
Sometime during the 5 year period of cost-free care, Veterans need to enroll in the VA Health Care System using the VA Form 10-10EZ. Enrollment during the 5 years of cost-free care, maintains the Veterans enrollment status in the VA Health Care System when the 5 year period ends. At that time, VA will reassess the Veteran's eligibility and make a new enrollment priority group determination.
A medial benefits package is a package of health care services that is designed to promote good health, preserve your current health and/or restore you to better health. Within the VA, the medical benefits package includes treating illnesses and injuries, preventing secondary health conditions or future health problems, improving functional abilities and enhancing your quality of life.
The VA is one of the Nation's largest health care providers and educators of the future medical practitioners. The VA provides a full range of medically necessary services. These services are provided based upon the judgment of a VA primary care physician and in accordance with the generally accepted standards of clinical practice. Services provided by the VA include:
There are a number of specialized care units in the VA health care system. These inpatient units provide specialized health services to veterans with certain medical needs.
Polytrauma care is for veterans and returning servicemembers who have sustained injuries to one or more physical region or organ system, one of which may be life threatening, and which results in physical, cognitive, psychological or psychosocial impairment and functional disability.
Polytrauma care is provide in a hub and spoke system. That means that there are different levels of services that are provided at different VA facilities, but they should coordinate with one another to ensure that a veteran in need of PolyTrauma services is always receiving the most medically appropriate services by a competent team of experts.
Learn more about the VA Polytrauma Rehabilitation System.
There are:
Solid organ (kidney, kidney/pancreas, liver, heart, heart/lung, and lung) and bone marrow/stem cell transplants are an important, life- saving procedure provided to eligible veterans by the Department of Veterans Affairs (VA). VA Transplant Centers are located across the country and have offered solid organ transplant services since 1962 and bone marrow transplant services since 1982. The VA National Transplant Program (VA Program) received over 1,500 referrals last year and performed approximately 400 transplants.
The transplant referral process has several steps and begins at the primary VA medical center where the patient is enrolled and eligibility is determined. If the veteran is determined to be a potential transplant candidate by the local VA medical center, a transplant referral packet is prepared locally and submitted to the VA Program located in Washington, DC. Questions regarding this process can be directed to the VA Program at 202.461.7130 or 1.800.60.HEART.
Over 100,000 men, women, and children are currently listed on the United Network for Organ Sharing (UNOS) national waiting list. Those veterans listed through the VA Transplant Centers are part of that same waiting list. Every 12 minutes another name is added to the list and an average of 18 people die each day because there are not enough organs available in this country. VA encourages all veterans, their families, and VA employees to become an organ donor by signing a donor card, identifying yourself as an "organ donor" in your state, e.g., joining your state donor registry, notice on driver's license; and discussing your decision to be an organ, tissue and eye donor with your family.
VA Transplant Centers are located at:
Bone Marrow
Kidney
Liver
Heart
Lung
Dental Services in the VA are provided to Veterans with certain eligibility requirements and they differ significantly from eligiblity requirements for all other types of medical care. The dental benefits are categorized into eligibility classes. Categories Class I, IIA, IIC, or IV are eligible to receive any necessary dental care to maintain or restore oral health and masticatory function, including repeat care. Other classes have time and/or service limitations.
If eligible, You can ask your VA primary care physician to obtain a referral to the outpatient dental clinic at the nearest VA medical facility or by using VA Form 10-10EZ "Application for Health Benefits" to apply online at https://www.1010ez.med.va.gov.
If you are not eligible for one of the classes, you may obtain dental services and treatment via the VA comprehensive national VA Dental Insurance Program, VADIP, which provides enrolled VA Healthcare Veterans and CHAMPVA receipients with the opportunity to purchase reduced cost dental insurance either with Delta Dental or MetLife. Participation is voluntary. Purchasing a plan does not affect the Veterans current eligibility for VA dental services and treatment.
You are eligible for outpatient dental care if you meet one of the following criteria:
|
If you: |
You are eligible for: |
Through |
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Have a service-connected compensable dental disability or condition. |
Any needed dental care |
Class I |
|
Are a former prisoner of war. |
Any needed dental care. |
Class IIC |
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Have service-connected disabilities rated 100% disabling, or are unemployable and paid at the 100% rate due to service-connected conditions. |
Any needed dental care. [Please note: Veterans paid at the 100% rate based on a temporary rating, such as extended hospitalization for a service-connected disability, convalescence or pre-stabilization are not eligible for comprehensive outpatient dental services based on this temporary rating]. |
Class IV |
|
Apply for dental care within 180 days of discharge or release (under conditions other than dishonorable) from a period of active duty of 90 days or more during the Persian Gulf War era. |
One-time dental care if your DD214 certificate of discharge does not indicate that a complete dental examination and all appropriate dental treatment had been rendered prior to discharge.*
|
Class II |
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Have a service-connected noncompensable dental condition or disability resulting from combat wounds or service trauma. |
Any dental care necessary to provide and maintain a functioning dentition. A Dental Trauma Rating (VA Form 10-564-D) or VA Regional Office Rating Decision letter (VA Form 10-7131) identifies the tooth/teeth/condition(s) that are trauma rated. |
Class IIA |
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Have a dental condition clinically determined by VA to be associated with and aggravating a service-connected medical condition. |
Dental care to treat the oral conditions that are determined by a VA dental professional to have a direct and material detrimental effect to your service connected medical condition. |
Class III |
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Are actively engaged in a 38 USC Chapter 31 vocational rehabilitation program. |
Dental care to the extent necessary as determined by a VA dental professional to:
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Class V |
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Are receiving VA care or are scheduled for inpatient care and require dental care for a condition complicating a medical condition currently under treatment. |
Dental care to treat the oral conditions that are determined by a VA dental professional to complicate your medical condition currently under treatment. |
Class VI |
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Are an enrolled Veteran who may be homeless and receiving care under VHA Directive 2007-039. |
A one-time course of dental care that is determined medically necessary to relieve pain, assist you to gain employment, or treat moderate, severe, or complicated and severe gingival and periodontal conditions. |
Class IIB |
VA Dental Insurance Program (VADIP)
VADIP was created to assess Veterans' interest in and the effectiveness of providing a premium-based dental insurance plan to eligible individuals. The program is mandated by Public Law 111-163, Caregivers and Veterans Omnibus Health Services Act of 2010. The three-year, national pilot program was launched January 1, 2014.
Eligibility for VADIP
Veterans enrolled in the VA health care program and CHAMPVA beneficiaries are eligible to participate in VADIP. Participation in VADIP does not affect Veterans' eligibility for VA dental services and treatment. Dependents of Veterans, except those eligible under CHAMPVA, are not eligible for VADIP.
Dental Plan Information
VA has contracted with Delta Dental and MetLife, private insurers, to administer VADIP. Individuals interested in participating in VADIP can complete an application online, over the phone or by mail. A direct link to each provider's VADIP webpage is available from www.va.gov/healthbenefits/VADIP. The following table shows contact information for each provider.
|
PROVIDER |
TOLL-FREE NUMBER |
WEBSITE |
MAILING ADDRESS |
|
Delta Dental |
1-855-460-3302 |
www.deltadentalvadip.org |
Delta Dental of California Federal Government Programs PO Box 537009 Sacramento, CA 95853-7009 |
|
MetLife |
1-888-310-1681 |
www.metlife.com/VADIP |
MetLife Dental Claims PO Box 981282 El Paso, TX 79998-1282 |
Coverage will be provided throughout the United States and its territories. The initial participation period will be at least 12 calendar months. Afterward, VADIP beneficiaries can renew their participation for another 12-month period or be covered month-to-month, as long as the participant remains eligible for coverage and VA continues VADIP. Multiple plan options allow participants to select a plan that provides benefits and premiums that meet their dental needs and budget. Offered plans vary and may include diagnostic, preventative, surgical, emergency and endodontic/restorative treatment. Each participant will pay a fixed monthly premium for coverage, in addition to any copayments required by his or her plan.
For more information on VADIP, visit www.va.gov/healthbenefits/VADIP and click the insurer's link for specific information regarding registration, rates and services, or call Delta Dental at 1-855-370-3303 or MetLife at 1-888-310-1681.
Notes
a. Veterans paid at the 100% rate based on a temporary rating, such as extended hospitalization for a service-connected disability, convalescence or pre-stabilization are not eligible for comprehensive outpatient dental services based on this temporary rating.
b. Public Law 83 enacted June 16, 1955 amended Veterans' eligibility for outpatient dental services. As a result, any Veteran who received a dental award letter from VBA dated before 1955 in which VBA determined conditions to be noncompensable are no longer eligible for Class II outpatient dental treatment.
The VA Pharmacy dispenses medically necessary medications as prescribed by VA physicians and authorized medical personnel. The VA uses a formulary, or a list of medications and medical supplies, that it keeps in stock at all times. According to VA, the formulary medications are preferred because they are:
Because the VA is one of the Nation's largest buyers of medications and medical supplies, it receives tremendous discounts when it purchases large quantities of the same medications from the same manufacturers. This is not to say that a Veteran cannot get a non-formulary medication or supply item, it simply means that the VA will require the Veteran's physician to go through a process for "non-formulary items". In essence, the VA clinician will have to explain why the non-formulary item is medically necessary and why the formulary item isn't as medically safe or effective.
Will the VA fill prescriptions from non-VA physicians or providers?
In general, the answer is no. The VA Pharmacy is not authorized to fill prescriptions unless they written by a VA provider. The exception is that the VA will fill non-VA prescriptions for Veterans who are in receipt of Aid and Attendance or Housebound benefits. Veterans in receipt of Aid and Attendance or Housebound benefits should contact their local VA's Pharmacy service for more information.
VetsFirst Advocacy Tip: If you are an eligible Veteran and are enrolled in VA health care but you also see non-VA physicians, you should keep your VA primary care physician and any VA specialists up to date on any and all medications prescribed by your non-va providers. There are a couple of important reasons for doing so:
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VA's Prosthetics and Sensory Aids Service (PSAS) furnished properly prescribed prosthetic equipment, sensory aids and other devices to eligible Veterans. PSAS' purpose is to provide the most appropriate medically prescribed technology to a Veteran, regardless of cost, in a timely manner.
See the related Knowledge Books on VA Prosthetics for more detailed information.
VetsFirst Advocacy Tip: PSAS is the "case manager" for the prosthetic and equipment needs of Veterans. With rare exception, PSAS personnel are purchasing agents who are tasked with fulfilling the prescriptions for prosthetics items and durable medical equipment that has been prescribed by your VA physician. PSAS may coordinate or participate in certain clinics (i.e. Wheelchair and Seating Clinic), but they are not clinicians. Be sure to discuss your specific needs with your VA physician or clinician, so that he or she can prescribe what he or she wants PSAS to purchase. The items provided through PSAS are medical devices and should be treated with the same respect as other prescribed items such as medication.
Eyeglasses
Hearing Aids
Automotive Adaptive Equipment
Automobile Access Equipment
Wheelchairs, Scooters, Walkers, Canes, and Crutches
Home Improvement and Structural Alteration (HISA) Grants
Clothing Allowance Benefits
Coordinated Care for Traveling Veterans
The VA in 2015 has initiated a traveling Veterans program. Traveling Veterans are Veterans who are enrolled in the VA Healthcare System and plan to spend extensive time away from their primary residence and preferred VA facility near their home.
Traveling Veteran Categories:
The VA medical facility closest to the Veteran's primary residence is called the Veteran's preferred facility. The VA facility away from the Veteran's home is known as the Veteran's alternate VA facility. The reason for the alternate facility is either due to extended time that the Veteran will be away from their primary residence or from complex clininical needs that are only provided by specific VA Medical Facilities. An example of such a scenario would be a Veteran living in Philadelphia, PA who is enrolled in the Philadelphia, PA VA medical center. The Philadelphia VA medical center would be the Veteran's preferred VA facility. The Philadelphia Veteran spends 6 months a year in Florida. The Tampa, Florida VA medical center would be the Philadelphia Veteran's alternate VA facility for the 6 months that the Veteran is visiting Tampa, Florida.
The program is implemented via the Traveling Veteran Coordinators (TVC) located at VA Medical Centers. The Traveling Coordinators replace the Referral Case Managers. TVC' must be a Registered Nurse, Physician Assistant, or Licensed Independent Practitioner.
The process begins when the Veteran notifies their Primary Care Practitioner (PCP) or the Patient Aligned Care Team (PACT) of the Veteran's travel plans. It is important to give as much advance notice of your departure date as possible. The PCP or PACT will send a referral to the TVC. The TVC will arrange for VA medical services at your alternate VA medical facility.
It is vital that you make sure that your TVC has the correct temporary address and telephone number(s) so that your medication refills can be sent to your temporary address. Always stay in touch with your traveling coordinator. Make sure that your TVC is aware of your return date to your preferred or home VA medical facility. Contact your TVC for unanticipated health care needs that arise while you are away, prosthetic device issues, medication issues, or other problems while you are away.
Traveling Veterans will not be assigned to a PACT, Patient Aligned Care Team, at the alternate VA medical facility. Veterans at their home or preferred VA medical facility who have multi-PACT assignments or dual assignments might not be considered for the traveling Veteran program. Clinical assessment and approval of muti-PACT assignments for the Veteran is required for the traveling program. Exceptions to the one PACT rule for the traveling program are:
There is a long history of smoking and tobacco use in the military. If you are a Veteran who uses tobacco, there is a good chance you started during your military service.
Many Veterans:
In the past, some addiction counselors and providers were mistakenly taught that encouraging patients to smoke would help them overcome their other addictions.
The opposite is truescientific studies have shown that quitting smoking will increase the chance that you can also successfully stop abusing alcohol and other drugs.
People who quit smoking in recovery are less likely to relapse to alcohol or other drug use
Talk to your addiction counselor or health care provider about quitting smoking. You can quit smoking at the same time you are quitting another substance, or, if you are worried that quitting smoking might interfere with your recovery, then wait until you feel ready to try to quit smoking.
If you do not attend a substance use clinic or your addiction counselor is not able to counsel you, your regular health care provider can help. He or she can provide you with counseling and medications and refer you to a smoking cessation specialty clinic.
Tobacco smoke contains harmful chemicals. These chemicals are responsible for many health problems in Veterans and those who breathe in secondhand smoke.
Learn more about harmful ingredients in tobacco from the U.S. Department of Health and Human Services.
Nicotine is the addictive chemical in tobacco. While nicotine itself does not cause cancer, the body can become addicted to it, causing physical cravings.
Increased risk of cancer
Tobacco use increases your risk of many types of cancer. While many people associate tobacco use with lung cancer, this is just one type of cancer it causes. Tobacco use and exposure to cigarette smoke can also result in:
Women who smoke have almost 18 times the risk of dying of lung cancer compared to women who don't smoke. Learn more about women and smoking.
Tobacco worsens other health conditions
As you take this huge step in improving your health and life, VA is there for you.
Veterans enrolled in VA health care have access to:
Talk to your VA health care provider to customize a quit strategy.
Listing of VA facility locations in Alabama:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=AL
Listing of VA facility locations in Alaska:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=AK
Listing of VA facility locations in Arizona:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=AZ
Listing of VA facility locations in Arkansas:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=AR
Listing of VA facility locations in California:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=CA
Listing of VA facility locations in Colorado:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=CO
Listing of VA facility locations in Connecticut:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=CT
Listing of VA facility locations in Delaware:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=DE
Listing of VA facility locations in the District of Columbia:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=DC
Listing of VA facility locations in Florida:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=FL
Listing of VA facility locations in Georgia:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=GA
Listing of VA facility locations in Hawaii:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=HI
Listing of VA facility locations in Idaho:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=ID
Listing of VA facility locations in Illinois:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=IL
Listing of VA facility locations in Indiana:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=IN
Listing of VA facility locations in Iowa:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=IA
Listing of VA facility locations in Kansas:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=KS
Listing of VA facility locations in Kentucky:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=KY
Listing of VA facility locations in Louisiana:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=LA
Listing of VA facility locations in Maine:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=ME
Listing of VA facility locations in Maryland:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=MD
Listing of VA facility locations in Massachusetts:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=MA
Listing of VA facility locations in Michigan:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=MI
Listing of VA facility locations in Minnesota:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=MI
Listing of VA facility locations in Mississippi:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=MS
Listing of VA facility locations in Missouri:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=MO
Listing of VA facility locations in Montana:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=MO
Listing of VA facility locations in Nebraska:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=NE
Listing of VA facility locations in Nevada:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=NV
Listing of VA facility locations in New Hampshire:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=NH
Listing of VA facility locations in New Jersey:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=NJ
Listing of VA facility locations in New Mexico:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=NM
Listing of VA facility locations in New York:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=NY
Listing of VA facility locations in North Carolina:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=NC
Listing of VA facility locations in North Dakota:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=ND
Listing of VA facility locations in Ohio:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=OH
Listing of VA facility locations in Oklahoma:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=OK
Listing of VA facility locations in Oregon:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=OR
Listing of VA facility locations in Pennsylvania:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=PA
Listing of VA facility locations in Rhode Island:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=RI
Listing of VA facility locations in South Carolina:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=SC
Listing of VA facility locations in South Dakota:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=SD
Listing of VA facility locations in Tennessee:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=TN
Listing of VA facility locations in Texas:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=TX
Listing of VA facility locations in Utah:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=UT
Listing of VA facility locations in Vermont:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=VT
Listing of VA facility locations in Virginia:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=VA
Listing of VA facility locations in Washington:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=WA
Listing of VA facility locations in West Virginia:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=WV
Listing of VA facility locations in Wisconsin:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=WI
Listing of VA facility locations in Wyoming:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=WY
Listing of VA facility locations in American Samoa:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=AS
Listing of VA facility locations in Guam:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=GU
Listing of VA facility locations in the Philippines:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=PI
Listing of VA facility locations in Puerto Rico:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=PR
Listing of VA facility locations in the U.S. Virgin Islands:
https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=VI
Nursing Home Care for Veterans
Please visit the link below and enter your location in the search box to view information about the quality of care provided in nursing homes in your area.
The nursing home options displayed are VA Community Living Centers and private sector nursing homes with whom VA contracts.
This data will be updated quarterly.
NOTE: We recommend you contact each facility to determine if they still maintain a contract with VA or contact your nearest VA Medical Center’s Nursing Home Coordinator for an up-to-date listing.
For a complete listing of VA Nursing Homes in your area, please visit:
https://www.accesstocare.va.gov/CNH/Statemap
Most veterans are aware they can appeal their compensation and pension decisions from the VA if they disagree with an entire VA decision or even just a portion of their decision. An appeal is a veteran's disagreement with a determination by VA to deny a benefit, request for reconsideration of a determination, or direct appeal to a higher level, such as the Board of Veterans' Appeals (Board).
What many veterans don't know is that almost any VA decision, with a few exceptions, can be appealed in one way or another. This includes many decision made by the Veterans Health Administration (VHA) as well.
Health benefit appeals are also known as medical appeals. Health benefits appeals include questions of eligibility for hospitalization, outpatient treatment, and nursing home and domiciliary care; for sensori-neural aids such as eyeglasses and hearing aids; and for other benefits administered by VHA. Health benefits appeals do not include medical determinations, such as the need for and appropriateness of specific types of medical care and treatment for an individual. Refer to 38 CFR 20.101(b)
The majority VHA appeals fall into three categories:
As of the August, 2013, VHA Directive Provision, when a Veteran expresses disagreement with a VA benefit determination, the Veteran must be advised of the right to appeal the decision and the correct process for initiating the appeal. This means that the VA Medical Center handling the appeal complies with all appeal procedures, such as notice of appellate rights and issuing Statement of the Case (SOC) and duties, such as, the duty to notify and duty to assist that apply in the VBA appeals process.
There are two types of appeals stemming from a VHA decision and two different appeal paths. The first type of appeal is an administrative denial or an administrative appeal. In this type of appeal a veteran is usually appealing some type of administrative decision such as a denial of medical service because a veteran is not eligible for VA care or an appeal for reimbursement for medical care. We also see these types of appeals where VA denied fee basis care, otherwise known as fee for care provided outside of the VA Medical System. These appeals pertain to VA decisions that are administrative in nature rather than medical in nature. An administrative appeal can be appealed through the VHA administrative appeal process or through the traditional appeal process. An administrative appeal, just like a compensation and pension appeal, can be heard by the Board, Court of Appeals for Veterans Claims (CAVC), Court of Appeals for the Federal Circuit (CAFC) and possibly by the United States Supreme Court (USSC). An administrative appeal provides you with greater due process protections and gives you more chances to prevail.
The second type of appeal is a clinical appeal. A clinical appeal relates to a VA medical decision such as denying a veteran a particular medication or a form of treatment. These are decisions that rely upon the professional judgment of a medical professional rather than on VA administrative policy and procedures.
Clinical appeals on the other hand can't be appealed above the local level. That is to say these types of appeals cannot be heard by the Board or any level above the Board as they lack jurisdiction over medical determinations. If you are in disagreement with a VA medical decision by the VA Healthcare System, you have the right of a written notice of the decision and a copy of your appeal rights. The VA has created a "Clinical Appeals process" for contested medical decisions. A clinical appeal must be appealed through the VHA administrative appeal process. The decision of the Clinical Appeals Process is final and there is no right to judicial review.
The Director of the VHA facility is responsible for attempting to resolve any clinical disputes. VHA healthcare facilities are supposed to be the first point of contact for disputes and every effort should be made to resolve disputes as close to the point of care as possible. It is also the facility Director's responsibility to provide written notice of the facility's final determination to the patient, or the patient's representatives. This notification must also describe the clinical appeals process to the claimant.
That's right! Not only must the VA notify you in writing but they must also provide you with information regarding how to initiate a clinical appeal. So do not let the VA simply tell you "no." Make them put it in writing and inform you of your appellate rights. It may be necessary for you, or your representative, to force the issue with the VA. If the VA will not comply send them a polite and professional letter demanding a written notice of why your request was denied and also request VA provide you with a notice of your appellate rights. Be sure to make a copy of this letter and mail it in some manner that allows you to track and confirm receipt.
In theory the Chief Medical Officer (CMO) acts as an intermediary between the veteran and the facility and all efforts to resolve the dispute are sent to the CMO by the medical facility. The CMO determines the patient's current medical needs and acts to notify the patient and or representative that their appeal has been received and requests that submission of supporting documents be submitted within one week where applicable.
Next the CMO develops a decision paper regarding the appeal and sends it to the Veterans Integrated Service Network (VISN) Director. The VISN Director then makes a decision whether or not to request an external audit.
Whether an external audit is requested or not ultimately the veteran and their representative receive a final decision within 30 to 45 days. The decision will officially place the veteran on notice of what the VA decided in their appeal. If the appeal was a clinical appeal regarding a VA medical decision the appeal is over as the decision cannot be appealed to the Board. There may be unofficial action a veteran can take but there is no official appellate review after this decision is issued.
Please remember that both a clinical appeal and an administrative appeal can follow the above path. Although an administrative appeal could be prosecuted in this manner it is usually advantageous to follow the traditional or administrative appeal process.
When a veteran applies for any type of benefit (for example, disability compensation, outpatient treatment, hospitalization, and prosthetic appliances, etc.) which a VA facility denies in whole or in part, that veteran or accredited representative has the right to appeal the denial decision, which is known as due process. When a VA health facility or the Health Eligibility Center (HEC) determines that a veteran is not legally entitled to the benefits sought, the veteran or his or her accredited representative must be notified in writing of this decision.
The VA facility or HEC must include VA Form 4107, Notice of Procedural and Appellate Rights (http://www.va.gov/vaforms/va/pdf/VA4107.pdf), with each denial letter. This form advises a veteran of their right to appeal the decision made by the VA facility or the HEC, the time limits for filing the appeal, the veteran's right to representation and all other pertinent facts relating to the appeal process. VA must also include VA Form 4107 when denying a private healthcare provider's request for reimbursement. Private healthcare providers also have the right to appeal a denied claim.
A veteran, medical provider or the veteran's accredited representative, such as an attorney, fiduciary or an estate representative for a deceased veteran, may send a written statement, disagreeing with a factual or legal conclusion of the VA. There is no set wording or form necessary, and the statement does not have to make specific allegations of error of fact or law. It is not material that the claimant's contentions may appear to have no merit.
The written statement may contain wording such as:
Please consider payment of my bills, this was an emergency, the VA hospital was called and they told us to go to the nearest hospital
or other similar statements. These statements may be considered as a NOD and the NOD must be signed and dated by the veteran or duly appointed representative. A complaint letter will not automatically be considered to be a NOD.
Although the minimum requirements for a NOD are established by law, there is no specific VA form required to submit a NOD. Although many claimants use VA Form 21-4138 (Statement in Support of Claim), a NOD can be as simple as a letter to the regional office. Whatever means is used, a NOD must be dated, state the date of the rating decision with which the claimant disagrees, and be signed by the claimant or the claimant's VA-accredited representative. A claimant does not have to give any reasons for disagreeing with the decision, although he or she can do so. It is also good practice to specifically put "NOTICE OF DISAGREEMENT" somewhere in the NOD.
It is also extremely important that a NOD be filed with the correct office or facility. NOD's regarding a change in status from copay exempt to copay required should be filed directly with HEC and not the facility providing care. If a veteran sends or takes it to their local facility, the local facility should forward it to the HEC for processing and the issuance of a Statement of the Case (SOC).
Remember if VA denies you a benefit they should inform you where you should submit your NOD. If you are unsure whether you should submit your NOD to your local VA facility or the HEC play it safe and submit it to both. As always submit your NOD in some manner that allows for tracking receipt by VA.
A NOD must be filed within one year. The year to file a NOD starts on the date on the VA letter forwarding the rating decision, which VA presumes to be the mailing date. The NOD must be postmarked within one year of the date of the VA letter forwarding the decision. Where the date on the VA letter is much different (earlier) than the postmark on the envelope, there is a chance that VA may allow a NOD within one year of the postmark date. There is absolutely no reason to risk an appeal in this way as a NOD can and should be submitted as soon as possible following an unfavorable decision. DO NOT WAIT ANY LONGER THAN NECESSARY.
If the claimant does not file a NOD within one year of the date of the adverse rating decision, the decision becomes final. If this occurs, under most circumstances any benefits for the period since the application was filed are lost and cannot be recovered. The exceptions to finality rule are discussed elsewhere in this KNOWLEDGE BOOK.
Once VA receives the NOD they should send the claimant or representative or both a letter, stating that the NOD was received and that the appeal process will be initiated. This step is not required but some VA facilities follow this practice.
A veteran may request that the VA facility reconsider their request or they may appeal directly to the Board. The veteran has 60-days from the initial denial to submit a reconsideration request; however, the file can be reopened during the one year period from the initial date of the denial.
Any reconsideration should be made by the immediate supervisor of the initial VA decision maker.
The immediate supervisor should review the entire record, including the claimant's statement on the NOD, to determine if additional development is needed. The supervisor should also attempt to obtain any evidence the claimant indicates is available or that the VA failed to attempt to obtain previously. Additionally they should correct any previous oversights that may be discovered and take necessary steps to assist the claimant in developing the evidence needed to substantiate the appeal including:
- Obtaining medical documentation and reports from private healthcare providers
- Obtaining service department or VA records
-Obtaining Vocational Rehabilitation records
After reviewing the entire claim and associated evidence a written decision is rendered that will affirm, reverse or modify the initial decision.
To convey their decision to the veteran the VA will issue a Statement of the Case (SOC). An SOC is another explanation for why VA decided the issue or issues the way it did. For each claim appealed, the SOC must contain a description of the evidence considered by the VA in making the decision, the VA regulations applicable to the decision, and an explanation of and reasons for the decision.
A SOC can be very lengthy, but should be carefully read. Despite their length, SOC's sometime contains errors of fact or law or are otherwise inaccurate. Claimants should review the SOC in order to identify any errors which could affect the appeal.
The SOC may be divided into the following sections:
-Cover page containing notice to the appellant
This gives directions to the claimant about the appeal, when to submit the substantive appeal and information about representation.
-Issue
This states the specific benefit or benefits that were denied by VA
Summary of the Evidence
Should list the veterans' service branch, dates or active duty military service, any service-connected disabilities and the effective dates. In chronological order every action taken from the date the benefit was sought or treatment provided to the date the Statement of the Case was prepared. VA will not necessarily go into great detail of each event since all records and documents will eventually be made available to the Board if necessary.
Pertinent Laws and VA Regulations
A listing of the specific Code of Federal Regulations or U.S. Code sections VA relied upon when making their decision.
Decision
Restates the issue and the VA's decision to grant or deny.
Reasons for Decision
Fully explains how the decision was reached and how evidence was applied according to cited regulations. Explain why the veteran was or was not eligible for the benefit sought.
Signatures
The original SOC should include a signature section listing who prepared the decision with date, printed name, credentials, signature of the person who prepared the SOC and "approved by" with date; printed name and signature of the approving official.
VA will then forward a copy of the SOC to the veteran along with a VA Form 9 (http://www.va.gov/vaforms/va/pdf/VA9.pdf) and instructions. A copy should also be sent to the veterans representative if applicable. To "perfect" an appeal the VA Form 9 must be filed with the office or facility that issued the SOC. By statute, a claimant must perfect an appeal within 60 days after the date of the SOC cover letter or within one year from the date of the initial rating decision that is being appealed, whichever is longer. If a claimant does not meet this deadline, the rating decision will become final. A claimant must use a VA Form 9 to perfect an appeal. Not using this form risks rejection of the appeal.
After an appeal has been perfected the local VA facility or office must take certain steps which include reviewing the entire record and take appropriate action such as:
-Award the benefit sought
-Uphold the denial
-Determine the appeal is deficient in either information contained, fact or law and advise the claimant and any representative of the deficiencies. VA will usually provide the claimant with a certain time period in which to respond if they can help cure the defects.
-Prepare case for review by the Board
-Prepare a Supplemental Statement of the Case (SSOC) if it discovered that the SOC contained a material error or the claimant submitted additional evidence.
The claimant will then have 60 days from the date of mailing the SSOC to respond. A response to the SSOC is optional and is not required to perfect the appeal. At the expiration of the time period the appeal will be certified to the Board. In many cases it can take years for an appeal to be certified to the Board. Be prepared for a marathon and not a sprint.
The Board is an independent organization within VA that has jurisdiction to review all factual and legal issues in a rating decision without considering how the VHA decided the issues. The Board consists of a Chairman and approximately sixty members who are designated as a "Veteran Law Judge" ("VLJ"). Although historically the Board sat in panels of three members, the typical appeal is now decided by a single VLJ.
An appeal can be resolved "on the papers" or following a hearing with a VLJ. Hearings can either be in person in Washington, DC, or at a local regional office or by video conference. Before the Board, a claimant (technically an "appellant" once the appeal is certified) can represent himself or herself or can be represented by a person of his or her choosing, including a service officer, non-attorney agent, or attorney. Board hearings are informal and a claimant can submit written material, such as a summary of the claimant's argument, for consideration by the Board.
The Board is required to review all the evidence presented to it and issue a written decision. The Board can grant or deny a claim, or remand (send back) all or part of a claim to the regional office or the Appeals Management Center ("AMC") for further development. The AMC is an office in Washington, DC, that VA uses to assist regional offices on appeals were the claimant is self-represented or has designated a Veterans Service Organization ("VSO") as his or her representative. A Board decision is required to be written and identify the "reasons and bases" for each conclusion. The Board's reasons are important because inadequate reasons and bases are the most common ground for challenging a Board decision denying an award.
If the Board agrees with a claimant now called an "appellant" and orders an award, the claims file is returned to the regional office, possibly via the AMC, for processing of the resulting benefit payment. Action by the regional office also may include deciding any issues that were not resolved by the Board. For example, if a claim was initially denied and the Board ordered an award, the regional office will need to determine a numerical rating and effective date before payments can begin. In addition, even if the Board decided all the issues for an award, only the regional office can authorize payments. So, unless the Board denies all aspects of an appealed decision, the C-file must be returned to the regional office for additional action.
If the Board agrees with a claimant that the decision contained errors but is not sure whether or not an award should be granted, it will order the rating decision withdrawn and require the AMC or regional office or other VA facility to take specific actions to further develop the claim. While not an award, a remand provides a claimant a further opportunity to provide additional evidence in support of his or her claims. Additionally, a remand means that there will be further delay in resolving a claim.
A claimant disappointed by a Board decision can request the Board "reconsider" or "vacate" its decision. The Board rarely grants reconsideration. If it does, the Board decision will be withdrawn and a new decision issued. A motion for Board reconsideration can be filed at any time.
A disappointed appellant can also appeal an unfavorable Board decision to the Court of Appeals for Veterans Claims, known as the "CAVC" or "Court." The CAVC was established by Congress in 1988 to provide a further level of review for claimants denied benefits. The Court exists primarily to review Board decisions for legal errors. As a practical matter, this means that a claimant-appellant must identify a legal error in a Board decision to win an argument before the Court. Simply disagreeing with a Board decision is not enough to win an appeal at the Court.
Unlike a motion for Board reconsideration, an appeal to the Court has a very specific period in which to file for Court review. To appeal to the Court, an appellant has 120 days from the date of mailing of the Board decision to file a "Notice of Appeal" at the Court, not the regional office or the Board. As many veterans have sadly learned, the Court takes this 120-day period very seriously and strictly enforces it. A claimant-appellant wanting to appeal a Board decision should file his or her Notice of Appeal as soon as possible to avoid missing this deadline. VA cannot appeal a Board decision.
The process at the Court is very different than at the regional office or Board. The VA Secretary is now formally an "opposing party" and will argue against the claimant-appellant's position in an adversarial legal action. This means, among other things, that it is now the claimant-appellant's duty to identify the legal basis for his or her appeal and why the Board decision is wrong. Claimant-appellants are also responsible for meeting all the Court's deadlines and following the Court's rules. In other words, VA will no longer assist the claimant in his or her case. So, while claimants can and do represent themselves before the Court, it is much harder to do effectively than when the claim is being developed.
Once a number of procedural matters are completed a claimant-appellant submits a Brief, the Secretary submits his Brief, and the claimant-appellant can submit a Reply Brief. Initially, a single judge is assigned to each case. If one or more of the issues in the case is deemed significant enough, the Court assigns a three-judge panel to decide the case. Oral argument can be requested and, while not common, is scheduled for significant issues.
In its decision, the Court will either (1) affirm (agree with) the Board, (2) remand one or more issues for further development, or (2) reverse (overrule) the Board. Reversals are rare, with the most common result being either affirmation of the Board decision or remand for further consideration by the Board of one or more issues. As with the Board, the Court does not calculate awards or authorize payments, so even if a claimant-appellant wins a fully favorable decision at the Court, the decision and the C-file must be returned, first to the Board and then to the AMC or regional office from which it came.
Either the claimant-appellant or the Secretary can appeal an unfavorable CAVC decision to the Court of Appeals for the Federal Circuit and, after that, to the United States Supreme Court. Appeals to these courts are significant and expensive actions that need to be carefully considered. For those reasons, VETSFIRST does not recommend claimants undertake such appeals without competent legal advice and representation.