Compensation and Pension Process (Mobile Accessible)

1. Compensation and Pension Process (Mobile Accessible) Presented by: Leslie Arwin MD, MPH Chief Medical Officer Compensation and Pension Exams Program (CPEP) Lucile Burgo MD National Co-Director Post-Deployment Integrated Care Initiative

2. Module Topics • Post-Deployment Care • Understanding Military Culture • Compensation & Pension / Benefits • Environmental Agents Exposures

3. Purpose • Educate VA staff about the Compensation & Pension (C&P) process and benefits • Promote discussion to ensure Veterans have the information, guidance and support needed to access available benefits and resources

4. Learning Objectives • Define “service connection” (SC) • Define “presumptive” conditions • Explain the role of the Primary Care Provider (PCP) and other clinical staff relative to the Compensation & Pension (C+P) process • Acquire awareness of registry exams, follow-up programs, and other benefits available for Veterans from different eras • Recognize that the C&P exam process is at the heart of a Veteran-centric Veterans Affairs (VA)

5. History 2010: Department of Veterans Affairs • VHA role is to provide medical exams & healthcare • VBA role is to administer benefits • Cemeteries 1592: Queen Elizabeth I • Compensated injured seaman 1776: Continental Army • Pension program 1865: President Lincoln • Promised to care for him who shall have borne the battle

6. VHA Organization • Veterans Health Administration’s (VHA) role is to provide healthcare services • Veterans Benefit Administration’s (VBA) role is to administer benefits • Cemeteries

7. Veterans Benefits Administration 2008 Budget – Millions of Dollars

8. VA Compensation and Pension • Of the 23.4 million living Veterans, nearly 3/4 served during a war period • More than 1/4 of the nation’s population is potentially eligible for VA benefits and services based on status as Veterans, family members or survivors of Veterans

9. VA Compensation and Pension (cont’d) • In 2008, VA provided $38.9 billion in disability compensation, death benefits and pension to 3.7 million people • About 3.2 million Veterans received disability compensation or pension from VA in 2008 • In addition, 554,700 spouses, children, and parents of deceased Veterans received VA benefits Source: VA Facts January 2009

10. Larry’s story; My ex-wife told me to come to the VA… • I was in Vietnam during the Tet Offensive. • When I got home, things didn’t go so great. • I married my high school sweetheart; it didn’t work out. I tried a couple more times; it never lasted. • I tried college; I didn’t fit in. I quit college and went to work In a gas station at night.

11. Larry’s story: My ex-wife told me to come to the VA…(cont’d) • I never talk to anyone. I keep to myself. • I drank a lot. I smoked a lot. I couldn’t sleep. • I’ve been jumpy ever since. • My ex-wives say I have a short fuse. • I got diabetes 5 years ago…now I’ve got that “prostate” disease… • I haven’t had regular work in a long time so I ran out of my meds and I can’t pay for them. I hope the VA can help me.

12. Why is Service Connection Important? • Compensation is financial payment made to Veterans for average loss of earning capacity resulting from service connected health conditions • Pension is paid to Veterans who have impairments arising from health conditions unrelated to military service

13. Why is Service Connection Important? (cont’d) C&P exam is to help determine service connection • Not for diagnosis or treatment • Describes physical or mental functional limitations Purpose of exam • Provide medical evidence for VBA rating specialists to assign benefits from 0% to 100% for each claimed condition

14. C&P for Returning OEF/OIF Veterans • Enrolled returning Veterans have 5 years of priority access to health services • Service connected conditions will ensure continued care after the initial 5-year period

15. Common Service Connection Injuries and Illness

16. Principles of Service Connection (1 of 3) • Illness/injury incurred during time in active service (or during an applicable period) • Must be chronic in character (>6 months) • If a condition was present prior to service, service connection is possible; compensation is based on the extent of aggravation • No time limit on claiming service connection for any potentially service connected condition

17. Principles of Service Connection (2 of 3) • The C&P clinician may be asked to opine whether a Veteran’s condition is “at least as likely as not” due to an in-service illness, injury, or event • Service connection is denied only when the preponderance of the evidence is unfavorable (against service connection) • This rule resolves reasonable doubt in the Veteran’s favor

18. Principles of Service Connection (3 of 3) Service connection may be: • Direct • Secondary • Aggravation • Presumptive

19. Direct SC for injury or disease occurring during active duty: • Evidence of current impairment related to the condition • Evidence in service treatment records (STR) of an illness/injury/event • Current impairment must be at least as likely as not caused by a result of the documented in-service illness/injury/event

20. Secondary Diseases or conditions caused by or a result of a SC condition If SC for one condition, then possible SC for: • Orthopedic -> right knee disability may result in right hip disability • HTN -> stroke

21. Aggravation Benefits paid for the extent to which a non-service-connected condition was permanently aggravated (beyond normal progression) during service or by a service-connected condition • Knee injury prior to service permanently aggravated during active duty • Asthma worsened by environmental factors • Mental health conditions

22. Presumptive Certain categories of Veterans may have conditions that are presumptively considered service connected • Agent Orange-exposed Veterans • Gulf War Veterans with undiagnosed or unexplained chronic illnesses • Ionizing radiation-exposed Veterans • Former Prisoners Of War (POW)

23. Ex-POW Presumptive Conditions Include: • Atherosclerotic heart disease • Hypertensive vascular disease • Stroke • Cirrhosis of the liver • Irritable bowel syndrome • Residuals of frostbite • Psychosis, anxiety states (PTSD), depression

24. Argent Orange Exposure Presumptive Conditions Include: • Type 2 diabetes mellitus • Soft-tissue sarcoma, Hodgkin’s disease, non-Hodgkin’s lymphoma • Respiratory cancers • Prostate cancer • Spina bifida in children Recently added presumptive conditions • Ischemic heart disease • Parkinson’s disease • Expanded to all B-cell leukemias

25. Ionizing Radiation Presumptive Conditions Include: • All forms of leukemia (except for chronic lymphocytic leukemia) • Solid tumors: thyroid, pancreas, brain, ovary • Bronchoalveolar carcinoma • Multiple myeloma • Non-Hodgkin’s lymphomas • Primary liver cancer

26. Gulf War Presumptive Conditions Include: Included are medically unexplained chronic multi-symptom illnesses defined by a cluster of signs or symptoms that have existed for six months or more, such as: • Chronic fatigue syndrome • Fibromyalgia • Functional gastrointestinal disorders (including irritable bowel syndrome) • Any diagnosed or undiagnosed illness that the Secretary of veterans affairs determines warrants presumption of service condition Signs or symptoms of an undiagnosed illness include but are not limited to: fatigue, skin symptoms, headaches, muscle pain, joint pain, neurological symptoms, respiratory symptoms, sleep disturbance, FI symptoms, cardiovascular symptoms, weight loss, menstrual disorders

27. Cold Injury Sequelae Many Veterans with cold injuries served in the Battle of the Bulge or in the Korean War Long-term and delayed sequelae of cold injuries include: • Peripheral neuropathy • Skin cancer in frostbite scars • Post-traumatic arthritis in involved limbs • Raynaud’s phenomenon

28. Ratings and Benefits (1 of 3) 0% • Designates service connection without impairment in earning capacity • Qualifies for free medical care for that condition • No monetary compensation is paid at 0% • Request an increase in compensation 10% • Medical care at little or no cost for service connected conditions

29. Ratings and Benefits (2 of 3) 20% • Qualifies veteran for vocational rehabilitation, including further education 30% • Qualifies Veteran for additional benefits for dependents 50% • All medications are no cost; no co-pay for visits

30. Ratings and Benefits (3 of 3) 70% • Free access to healthcare; free long-term care 100% • Maximum benefits including full dental; severe disabilities or special conditions may entitle Veteran to special monthly compensation

31. Payments • Monthly compensation (not disability) payments vary according to degree of SC and number of dependents • VA benefits are not subject to federal or state taxes • Military retirement pay, disability severance pay, and separation incentive payments can affect the amount of compensation

32. Payments (cont’d) 2009 compensation • 10% SC received $123/month • 50% SC received $770/month • 100% with no dependents received $2,673/month If 30% SC or more, eligible for additional allowance for each dependent

33. Encounter Form

34. Sign Orders

35. Initiating a C&P Claim • Veterans fills out claim request • A service officer from one of the Veterans Service Organizations can help • A complete list of all the services organization will be included in our resource guide • Families may also complete claim request Veteran service representative

36. FAQs: What should we say to our Veterans? • “You should submit a claim for any conditions you feel may be related to service so that you receive support and care for those conditions” • “Filing a claim is necessary to ensure you will receive all the care and benefits for which you are eligible” • “These benefits may provide support not only for you but for certain family members, too.”

37. FAQs: What should we say to our Veterans? (cont’d) • “Additional benefits may be available to you and your family if you become unable to care for yourself.” • “The treatment and care you receive will become part of the record and may be used in the claims process.” • “It is not your VA provider who determines service connection or % of compensation; that is done by the Regional Office using C&P exams and other medical evidence.”

38. FAQs: What should we NOT say to our Veterans? The PCP should not direct the Veteran to the C&P department • The C&P department cannot provide an exam until you submit a claim to the regional office

39. Other Benefits Considerations • Good care means team-based care • Social workers are an essential part of the team in helping Veterans • Social workers and Veterans Benefits Counselors can help Veterans determine if he/she is eligible for other benefits • VHA can provide additional support for qualified Veterans, including care management, home-based primary care, ancillary services, prosthetics, etc.

40. Additional Benefits for Non-Service connected Veterans Additional monetary benefits may be payable when a Veteran: • Needs the regular aid and attendance by another person (including the Veteran’s spouse) • Is permanently housebound • These benefits may also be available to surviving spouses

41. Special Monthly Compensation • Veteran must be service-connected • Enables provision of necessary care • Example categories • Amputations/loss of use • Blindness • Combinations of severe disabilities • Aid and Attendance

42. Special Benefits for Surviving Spouse • Housebound or Aid and Attendance • Considerations are: • Housebound • Inability to leave home • Aid and Attendance • Needs protection from hazards of daily living

43. Other Benefits • Education, Training and Employment assistance • VA educational benefits: GI Bill, Veterans Employment Specialists, Transition assistance Program (Hire Vets First), Small Business Administration Patriot Express Loans • Vocational rehabilitation • VA home loan guaranties • Life insurance • Burial benefits and more

44. Health Registry Exams • Specialized registry exam • Non related to treatment • Examples of registry exams include: • Agent Orange • Gulf War • POW • Ionizing radiation • Depleted uranium • Toxic embedded fragments • Project shipboard Hazards and Defense (SHAD)

45. Resources • A resource guide will be included in this training • Veterans’ Health Initiative Books • On-line and in facility libraries • For more information, call Toll-Free 1-800-82-100 or • Visit our Web site at: www.va.gov

46. Summary • VA staff should understand the C&P process • For many veterans, this exam is the gateway to VA healthcare • Many Veterans perceive this process as validation of their service experience

47. Summary (cont’d) VA staff should have a basic understanding of: • The C&P process • The Veteran’s SC status • Benefits information to offer support to the Veteran • The role of the Veteran’s team includes helping to ensure that the Veteran has the information and access to all VA resources that will enhance their health and medical care

48. Resources (cont’d) • Information for Veterans and families • Newsletter • VA Web site (www.va.gov), ombudsman assistance fore educational loans • Department of Veterans Affairs Telephone Assistance Service hotline number 1-888-827-1000