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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
Module Topics
1. Post-Deployment Care
2. Understanding Military Culture
3. Compensation & Pension / Benefits
4. Environmental Agents Exposures
2
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
3
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)
4
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
5
VHA Organization
Veterans Health Administration’s (VHA) role is to
provide healthcare services
Veterans Benefit Administration’s (VBA) role is to
administer benefits
Cemeteries
6
Veterans Benefits Administration
2008 Budget – Millions of Dollars
7
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
8
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
9
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.
10
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.
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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
12
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
13
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
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Common Service Connection
Injuries and Illness
15
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
16
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
17
Principles of Service
Connection (3 of 3)
Service connection may be:
Direct
Secondary
Aggravation
Presumptive
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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
19
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
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Aggravation
Benefits paid for the extent to which a non-serviceconnected 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
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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)
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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
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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
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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
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Gulf War Presumptive
Conditions Include:
Included are medically unexplained chronic multisymptom 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
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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
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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
28
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
29
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
30
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
31
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
32
Encounter Form
33
Sign Orders
34
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
35
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.”
36
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.”
37
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
38
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, homebased primary care, ancillary services, prosthetics,
etc.
39
Additional Benefits for NonService 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
40
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
41
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
42
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
43
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)
44
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 1-800-82100 or
Visit our Web site at:
www.va.gov
45
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
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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
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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
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