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All VA health care for a 100% P & T veteran is provided at no cost

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Posted on: Tuesday, November 29, 2011

Jim,

haven't talked to you in awhile hope all is well. I have a question concerning va healthcare. If you are on I/U and rated total and permanent isn't all your care at the VA free? Would appreciate any feed back

Reply:

Yes. All VA health care for a 100% P & T veteran is provided at no cost to him/her. I avoid the term "free" as I don't believe that is correct. These benefits were paid for far in advance during the veterans active duty service to our country.

Veterans who are 100% Permanently and Totally (P & T) disabled are entitled to a number of added benefits.

The problems that crop up with such things as copays and a veterans dependents eligibility for benefits like Chapter 35 and CHAMPVA lie within the Department of Veterans Affairs being able to understand its own rules and language.

When an award letter is issued, the language used to write it is often incomprehensible. VA doesn't have a single standard for how these letters should be scripted. The author uses formatted scripts that are available on a computer screen and copies, cuts and pastes bits and pieces that seem appropriate. Often this adds up to a jumble of sentences and paragraphs that are disconnected.

To make it all even more confusing, the VBA award letter never uses the term "permanent and total". Rather, the letter may say "eligibility to apply for dependents Chapter 35 benefit is established". If you know how to speak the arcane language of VBA you will understand that means that the veteran is 100% permanently and totally disabled. No dependents are eligible to apply for Chapter 35 DEA unless the veteran is 100% P & T.

There is also a phrase in the award letter that may say "no future exams are scheduled". If the decision to rate the veteran as permanently and totally disabled is made, the veteran is no going to be subjected to intermittent C & P exams that would look for improvement in the rated condition(s). If the award letter says "future examinations are scheduled" this indicates that the award is temporary and that the rater believes there is a likelihood that the condition will improve and the rating will be lowered.

Why doesn't the VBA use common language and use a simple statement that says "100% permanently & totally disabled"? Nobody really knows.

The problem that the obtuse language causes is common all throughout the VA. When a veteran receives an award letter for the TDIU benefit and sees the phrase "no future exams", he may realize that he is 100% P & T. He then applies for Chapter 35 DEA benefits so that his eligible children can have some help with college expenses.

The VA employees who work in the C-35-DEA department of the VA are in another state. They get the application and don't see the magic words "100% permanently and totally disabled" so the application is quickly denied. This also happens often with CHAMPVA and in your circumstance, at VA medical centers.

The VA employees who work outside the Veterans Benefits Administration (VBA) don't speak the VA language that the VBA uses. I see denials every day of these dependents benefits for the TDIU veteran.

The record of the TDIU veteran usually reflects the base rating...let's say 70%. Within that rating the vet may have 4 separate ratings of 40%, 40%, 30% and 30% and using the Combined Ratings Table the overall rating will be 70%. If that veteran is unable to hold gainful employment because of the service connected disabilities, he is then eligible to apply for the TDIU rating of 100% disabled.

However, the VA employees at other division of the VA who must determine eligibility don't understand this. They see 70% and that clearly isn't 100%. They know that only 100% disabled veterans are eligible so they deny access to the benefit.

And the veteran is charged a copay at his VA health facility when he is treated for a non-service connected disability, or his dependents are denied their benefits. Many veterans who have recently received the TDIU benefit will head to the dental treatment facility to schedule an appointment. This becomes available to all 100% P & T rated veterans. Most will be turned away because their electronic medical record says they are less than 100% and the clerical staff doesn't see the TDIU rating.

The permanent and total TDIU rating reflects that the veteran has the same eligibility and privileges as the 100% schedular rated veteran. TDIU is always 100% although it may be a temporary rating. The permanence of the TDIU rating makes the vet as eligible for the additional benefits in the same way that a 100% P & T schedular rating does.

If you are being charged copays for non-service connected conditions or medications, you must make a visit to the medical facility's eligibility office and begin to correct things there. If you aren't able to get excellent service, it's time to begin to write letters as appeals and formalize the issue.

Please see http://www.vawatchdog.org/tdiu-unemployability.html for more about TDIU and thenhttp://www.vawatchdog.org/permanent-and-total---p---t-.html for more on P & T.

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