Tuesday, September 29, 2015

A VA Travel Guide: The Road to VA Health Care and Benefits

As veterans transition from military service to civilian life, seeking health care from the VA can leave them feeling overwhelmed, underserved, and even unaware of benefits they’re eligible for.



The history of the United States Department of Veteran’s Affairs (VA) dates back as far as 1636. However, it’s modern presence as a hospital system began in 1811, when the first domiciliary and medical facility for veterans was established by the federal government (VA 2014). Its presence has expanded throughout the years into three distinct branches:

• Veteran’s Health Administration (VHA), the largest branch responsible for the medical care of veterans.

• Veteran’s Benefits Administration (VBA), responsible for the financial needs of veterans (including GI bill, home loans, compensation and pension).

• National Cemetery Association (NCA), responsible for the respectful and honorable burial of veterans.

The encompassing VA system is predicated on noble intentions to support veterans as they transition from military to civilian service. However, its actualization has not always upheld its intentions. Successfully navigating the VHA should not be as difficult as it sometimes is. Veterans and their families seeking healthcare from the VA often end up feeling overwhelmed, underserved, and even unaware of benefits for which they are eligible. Having a guide can alleviate some of the complications in receiving care, and also help veterans to receive better and broader care.

As of the 2014 census, there are 21.8 million veterans in the United States, 9.866 million of whom are age sixty-five and older (Census Bureau 2012, VA 2014). Any professionals who work with older adults are almost guaranteed to also work with veterans and their families. Given the medical needs of older populations, professionals will encounter the need to aid clients in navigating the VHA especially. This article will serve to provide information predominantly on navigating the VHA, but also information on navigating the VBA, especially in ways where compensation and pension directly relate to the receipt of health care. One article alone can’t provide all the information needed on navigating the VA, so it is recommended that professionals seek additional information from its comprehensive website, www.va.gov, as well as local VA hospitals and regional offices serving veterans. The accompanying case study will give you a real-world example of how advocacy and care can be achieved.

Enrollment in VA Health Care
Most present-day veterans are given the option to enroll in the VA upon their discharge, but previous generations were often not made aware of their VA benefits. Many have never enrolled in VA health care, and some are not even sure if they are eligible for enrollment. The general rule for enrollment in the VHA is that any veteran who served active duty in the U.S. military and was discharged for any reason other than dishonorable, is eligible to enroll (VA 2014). Most veterans who enlisted after September 7, 1980 need to serve active duty for at least twenty-four months in order to meet enrollment requirements. However, there are additional factors that may contribute to enrollment eligibility.

When in doubt, apply. The VA will simply say no if a veteran doesn’t meet requirements. Some veterans are exempt from having to enroll due to already being service connected for a disability or seeking examination for an environmental health hazard to which they may have been exposed during their service, such as agent orange or a burn pit. Even if a veteran is exempt
from enrollment, the VA still strongly encourages going through the enrollment process, because this allows the VA to better prioritize care. When it comes to VA enrollment, “all roads lead to Rome.” Whether a veteran presents in person to a local enrollment office, calls the enrollment hotline 1-877-222-VETS (8387), or completes the enrollment online, he or she will need to fill out VA Form 10-10EZ. It’s very helpful to direct veterans and their families to this form online to learn what information they will need to have.


Once a veteran is enrolled in the VHA, he or she is given a priority, ranging from 1 (highest) to 8 (lowest). Priority 1 veterans are often disabled at 50 percent or higher due to a disability incurred during or because of their military service. Veterans in the 8 priority group often have strong incomes and private medical insurance. While they are wholly eligible to receive care at the VA, they may not be prioritized above other veterans who are unable to afford going outside of the VA. Each stage in between has its own characteristics, which are provided in more detail in the resources section of va.gov/health benefits.

Once enrolled, they may now begin receiving health care. The VA has transitioned to a Patient-Aligned Care Team (PACT) model where patients can receive a multitude of services through their primary care team. Many primary care teams have doctors, pharmacists, nurses, and specialty care like behavioral health, in one common setting. Within this setting, there should be social workers present or on call who can aid veterans in understanding additional health care services available at the VA, if needed, as well as benefits for which veterans will have to contact the VBA.

Navigating the VA System
It is after a veteran becomes enrolled in VA health care and begins receiving services, like primary care, where many veterans become confused by the system. Some believe that receiving health care means they are service connected for the condition for which they are receiving care. Some believe the VA is paying for all of their care when their private insurance is actually being billed, and they are shocked when they receive bills for copays and deductibles. These and other assumptions often leave veterans feeling confused, underserved and also lacking in important benefits for years.

The first step to resolving some of these issues is to understand the differences between the branches of the VA. The VHA provides health care and its affiliated needs (helping patients obtain durable medical equipment, or providing information on assisted living facilities in the area). It does not provide income, so veterans who assume that the VHA is paying their medical bills or providing them with pensions are misinformed.

Applying for VA Financial Benefits. The financial needs of veterans, including compensation, home loans, vocational rehabilitation, education, and others
are met by the VBA. In order to receive any of these benefits, a veteran must apply through the VBA. This means that even though veterans may be enrolled in and receiving VA health care, they may be eligible for additional benefits, which they are not receiving because they haven’t applied for them. Many of these benefits are tied intimately to a veteran’s care with the VHA, including service connection, and aid and attendance. Additional benefits available through the VBA include survivor’s pensions, life insurance, special monthly compensation, assistance for homeless vets, and others. Information on the full range of benefits the VBA has to offer can be found on its website.

For the most part, a veteran can apply for benefits one of three ways: online at ebenefits.va.gov, through an appointed representative (an attorney or a Veteran’s
Service Officer (VSO) who is appointed at the state or federal level), or in person at a local regional office. Once the application has been submitted, a veteran may need to complete additional documents or present in person to a regional office.

Service-Connection. A service-connection is a diagnostic designation, such as tinnitus (ringing in the ears), that has been determined by the VA to originate during, be exacerbated by, or result from one’s military service. A service-connected disability provides a monthly stipend, ranging from $44 to $3447.72, depending on the percentage for which someone is service-connected (0-100 percent) and how many dependents a veteran has. It also designates free or reduced-cost care through the VA for the service-connected disability. For example, a veteran who is 100 percent service-connected for post-traumatic stress disorder (PTSD), who is married with dependent children, may receive up to $3,447.72 per month and free VA services to treat his or her PTSD, including
psychiatric care, medication, and so on.


Aid & Attendance. 

Aid & Attendance (A&A) 

and Housebound Pensions are stipends that may be added to existing pension amounts, meaning a veteran must first be pension eligible tor receive these benefits. A&A and Housebound are mutually exclusive pension
supplements, meaning veterans may not receive both at the same time—they either receive A&A or Housebound. As of 2015, a single veteran is eligible for up to $1,788 per month. A veteran with a spouse is eligible for up to up to $2,120 per month, and a surviving spouse may be eligible for up to $1,149 per month.

A non-service-connected (NSC) pension is a financial stipend similar to social security that can provide for the needs of lower income veterans whose annual income is below a certain threshold. This will allow veterans who are receiving no or minimal social security income to increase their income to more of a livable wage. A disability is not required.

All veterans may apply for VA benefits, and they are encouraged to apply for as many benefits as they need. It is not uncommon for a veteran to receive multiple benefits, such as pension income, home loans, and educational benefits, at the same time.

Symbiosis of the Systems
As you can imagine, understanding which aspect of the VA supports which need can be confusing. It is very easy for veterans to assume that they are receiving all
of the benefits for which they are eligible, even though there may be a whole avenue of care that is unexplored. Although this article has focused on the surface level aspects of obtaining basic healthcare and financial benefits, truth is that VA healthcare is among the most encompassing and best medical care in the United States (Longman 2012). However, part of the process of obtaining that care is knowing how to get enrolled and connect with the right care providers. An additional aspect of the process is applying through a separate system for additional benefits that may directly relate to the receipt of health care, or indirectly provide for a better quality of life that improves veterans’ wellness.


Growth and Change
One often thinks of the VA as a very fixed system, but in truth, it is constantly changing and growing. The VA is opening and further developing programs, such as those that aid LGBT populations, victims of military sexual trauma, and homeless veteran populations. They have developed local recovery coordinators to work with community resources to serve more veterans, and recently implemented changes, like the Veteran’s Choice Act have expanded VA care to private providers outside of the VA that meet certain criteria. Sometimes even the healthcare providers within the system are unaware of some of the changes and expansion of services, which is why it is important for veterans to have outside advocates and be aware of how and whom to contact about benefits.

VA hospitals have come a long way since 1811, as have the needs of the veteran population. Knowledge of the inner workings of the system as well as how to navigate the basic enrollment and application procedures provides the solid foundation that veterans need to establish care and learn about the multitude of options they have for support as they reintegrate into civilian life, or live out the remainder of their years with the impact of their military service. As professionals who serve older populations, we have a unique opportunity to “serve those who have served” by helping them to understand, establish, and navigate care in this comprehensive system. •CSA

Carilyn Ellis, PsyD, is a resident psychologist with the Samaritan Waldport Clinic in Waldport, Oregon, a part of Samaritan Health Services. Previously, she was a Fellow at the Boise VA Medical Center. She has specialized training in geropsychology, palliative care, oncology, neuropsychology, and integrated primary care. She may be contacted at cellis@samhealth.org, or 541-563-3197.


A VA Travel Guide: The Road to VA Health Care and Benefits was featured in CSA Journal 63.

Blog posting provided by Society of Certified Senior Advisors.