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Veterans Affairs (VA) Benefits - Treatment Priority Groups

Veterans will be enrolled for VA Health Care benefits to the extent Congressional appropriations allow. All veterans are also classified into one of two medical treatment categories. If appropriations are limited, enrollment will occur based on the following priorities:

1.   Veterans with service-connected disabilities rated 50 percent or more and/or veterans determined by VA to be unemployable due to service-connected conditions.

2.   Veterans with service-connected conditions who are rated 30 or 40 percent disabled.

3.   Veterans who are former POWs or were awarded a Purple Heart, veterans with disabilities rated 10 and 20 percent, veterans awarded special eligibility for disabilities incurred in treatment or participation in a VA Vocational Rehabilitation program, and veterans whose discharge was for a disability incurred or aggravated in the line of duty.

4.   Veterans who are receiving aid and attendance or housebound benefits and/or veterans who have been determined by VA to be catastrophically disabled. Some veterans in this group may be responsible for copayments.

5.   Veterans receiving VA pension benefits or eligible for Medicaid programs, and non-service connected veterans (an eligible veteran who has been discharged from active military duty and does not have an illness or injury that has determined to have been incurred in or aggravated during military service) and non-compensable service connected veterans rated 0% disabled, whose annual income and net worth are below the established means test thresholds.

6.   Veterans of the Mexican border period or of World War I; veterans seeking care solely for a disorder associated with exposure to radiation or exposure to herbicides while serving in Vietnam, for any illness associated with service in combat service in a war after the Gulf War or during a period of hostility after November 11, 1998, for any illness associated with participation in tests conducted by the Defense Department as part of Project 112/Project SHAD; and veterans with zero percent service-connected disabilities who are receiving disability compensation benefits.

7.   Nonservice-connected veterans and noncompensable zero percent service-connected veterans with income above VA's national means test threshold and below VA's geographic means test threshold, or with income below both the VA national threshold and the VA geographically based threshold, but whose net worth exceeds VA's ceiling (currently $80,000) who agree to pay copayments.

8.   All other nonservice-connected veterans and zero percent noncompensable service-connected veterans who agree to pay copayments. (Note: Effective Jan. 17, 2003, VA no longer enrolls new veterans in priority group 8).

These groups are enrollment priorities only. The services and treatment available to enrolled veterans generally are not based on enrollment priority groups. Enrollment will be reviewed each year and veterans will be notified in writing of any change in their enrollment status. Call your nearest health-care facility or the Health Benefits Service Center, 1-877-222-8387, to obtain the latest information.

Special Access to Care

Service Disabled Veterans: Veterans who are 50 percent or more disabled from service-connected conditions, unemployable due to service-connected conditions, or receiving care for a service-connected disability receive priority in scheduling of hospital or outpatient medical appointments.

Combat Veterans: Veterans who served in combat since Nov. 11, 1998, including veterans of Iraq and Afghanistan, are now eligible for five years of free medical care for most conditions from the Department of Veterans Affairs (VA). This measure increases a two-year limit that has been in effect nearly a decade.

The five-year deadline has no effect upon veterans with medical conditions related to their military service. Veterans may apply at any time after their discharge from the military -- even decades later -- for medical care for service-connected health problems.

The new provision, part of the National Defense Authorization Act of 2008 signed by President Bush on Jan. 28, 2008, applies to care in a VA hospital, outpatient clinic or nursing home. It also extends VA dental benefits -- previously limited to 90 days after discharge for most veterans -- to 180 days.

Combat veterans who were discharged between Nov. 11, 1998 and Jan. 16, 2003, and who never took advantage of VAs health care system, have until Jan. 27, 2011 to qualify for free VA health care.

The five-year window is also open to activated Reservists and members of the National Guard, if they served in a theater of combat operations after Nov. 11, 1998 and were discharged under other than dishonorable conditions.

Veterans who take advantage of this five-year window to receive VA health care can continue to receive care after five years, although they may have to pay copayments for medical problems unrelated to their military service.

For additional information call the Health Benefits Service Center, 1-877-222-8387.


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