DEPARTMENT OF VETERANS SERVICES TRAINING MANUAL

DEPARTMENT OF VETERANS SERVICES TRAINING MANUAL This book was compiled by the Massachusetts Department of Veterans Services and the Massachusetts Veterans Service Officers Association from various government sources. It is intended as a study manual for individuals preparing to take the State certification veterans service officer examination and used a guide for assisting the veterans and their dependents in the commonwealth. Published by DVS 8/1/2016 Massachusetts Department of Veterans Services Page 1

Massachusetts Department of Veterans Services Page 2

Chapter 1 Health Care Benefits... 5 Chapter 2 VA Medical Programs... 22 Chapter 3 Service-Connected Disabilities... 38 Chapter 4 Vocational Rehabilitation and Employment... 44 Chapter 5 VA Pensions... 48 Chapter 6 Education and Training... 50 Chapter 7 Home Loan Guaranty... 57 Chapter 8 Life Insurance... 65 Chapter 9 Burial and Memorial Benefits... 70 Chapter 10 Reserve and National Guard... 78 Chapter 11 Special Groups of Veterans... 89 Chapter 12 Transition Assistance... 95 Chapter 13 Dependents & Survivors Health Care... 102 Chapter 14 Dependents & Survivors Benefits... 105 Chapter 15 Appeals of VA Claims Decisions... 111 Chapter 16 Military Medals and Records... 113 Chapter 17 Benefits Provided by Other Federal Agencies... 116 Chapter 18 FULLY DEVELOPED CLAIM GUIDANCE... 121 Chapter 19 Gathering Evidence for a FDC Compensation... 127 Chapter 20 Submission of Claims... 129 Chapter 21 FDC for Post-Traumatic Stress Disorder (PTSD)... 130 Chapter 22 FDC for PTSD Personal Assault or Military Sexual Trauma (MST)... 132 Chapter 23 FDC for Individual Unemployability (IU)... 134 Chapter 24 FDC Criteria for Dependency and Indemnity Compensation (DIC) for Service- Connected Deaths... 137 Chapter 25 FDC Criteria for Veterans Non-Service Connected Pension Benefits... 140 Chapter 26 FDC Criteria for Survivors Pension... 144 Chapter 27 Special Monthly Compensation: Aid and Attendance... 147 Chapter 28 The Appeals Process... 149 Chapter 29 Accrued Benefits and Substitution of Claimant... 152 Chapter 30 VA Forms and Titles... 155 Chapter 31 STATE Education Benefits... 158 Chapter 32 Motor Vehicle Benefits... 161 Chapter 33 Property Tax Exemptions... 165 Chapter 34 Housing... 167 Chapter 35 SAVE Program... 174 Chapter 36 Employment... 175 Chapter 37 Women Veterans... 180 Chapter 38 Veterans Bonuses... 184 Chapter 39 Annuities... 187 Chapter 40 State Burial Benefits... 188 Chapter 41 Mass Veterans Advisor... 191 APENNDIX B VR&E Subsistence Allowance Rates... 193 APPENDIX C VA Funding Fee Rates... 194 APPENDIX D Reserve Educational Assistance Rates... 195 APPENDIX E DIC Payment Rates for Surviving Spouses... 196 Massachusetts Department of Veterans Services Page 3

APPENDIX F: Improved Pension Veterans Rates... 197 Massachusetts Department of Veterans Services Page 4

Chapter 1 Health Care Benefits VA operates the nation s largest integrated health care system with more than 1,700 sites of care, including hospitals, community clinics, community living centers, domiciliary, Vet Centers, and various other facilities. For additional information on VA health care, visit: www.va.gov/health. Basic Eligibility A person who served in the active military service and were separated under any condition other than dishonorable may qualify for VA health care benefits. Current and former members of the Reserves or National Guard who were called to active duty by a federal order and completed the full period for which they were called or ordered to active duty may be eligible for VA health benefits as well. Minimum Duty Requirements: Veterans who enlisted after Sept. 7, 1980, or who entered active duty after Oct. 16, 1981, must have served 24 continuous months or the full period for which they were called to active duty in order to be eligible. This minimum duty requirement may not apply to Veterans discharged for hardship, early out or a disability incurred or aggravated in the line of duty. VA encourages all Veterans to apply so that we may determine their enrollment eligibility. Enhanced Eligibility Certain Veterans may be afforded enhanced eligibility status when applying and enrolling in the VA health care system. Veterans who: Are a Former Prisoner of War (POW) In receipt of the Purple Heart Medal. In receipt of the Medal of Honor. Have a compensable VA awarded service-connected disability of 10% or more. In receipt of a VA Pension. Were discharged from the military because of a disability (not preexisting), early out, or hardship. Served in a Theater of Operations for 5 years post discharge. Served in the Republic of Vietnam from January 9, 1962 to May 7, 1975. U.S. Navy and Coast Guard ships associated with military service in Vietnam Served in the Persian Gulf from August 2, 1990 to November 11, 1998. Were stationed or resided at Camp Lejeune for 30 days or more between August 1, 1953 and December 31, 1987. Are found by VA to be Catastrophically Disabled. Previous years' household income is below VA's National Income or Geographical-Adjusted Thresholds Massachusetts Department of Veterans Services Page 5

Enrollment VA operates an annual enrollment system that helps to manage the provision of health care. VA applies a variety of factors during the application verification process when determining a Veterans eligibility for enrollment, but once a Veteran is enrolled, that Veteran remains enrolled in the VA health care system and maintains access to certain VA health benefits. Once the application is successfully processed, he or she will be assigned an enrollment Priority Group. Certain Veterans may be eligible for more than one Enrollment Priority Group. In that case, VA will always place you in the highest Priority Group that you are eligible. Under the VA Health Benefits Package, the same services are generally available to all enrolled Veterans. Once enrolled, the veteran will receive a personalized Veterans Handbook, which will detail his or hers VA health benefits and provide important information concerning accessing VA health care. Priority Groups During enrollment, each Veteran is assigned to a priority group. VA uses priority groups to balance demand for VA health care enrollment with resources. Changes in available resources may reduce the number of priority groups VA can enroll. If this occurs, VA will publicize the changes and notify affected enrollees. A description of priority groups follows: Group 1: Veterans with service-connected disabilities 50 percent or more disabling Veterans determined by VA to be unemployable due to service-connected conditions. Group 2: Veterans with service-connected disabilities rated 30 or 40 percent. Group 3: Veterans who are former prisoners of war (POWs). Veterans awarded the Purple Heart medal. Veterans awarded the Medal of Honor. Veterans whose discharge was for a disability incurred or aggravated in the line of duty. Veterans with VA service-connected disabilities rated 10 percent or 20 percent. Veterans awarded special eligibility classification under Title 38, U.S.C., 1151, benefits for individuals disabled by treatment or vocational rehabilitation. Massachusetts Department of Veterans Services Page 6

Group 4: Veterans receiving increased compensation or pension based on their need for regular aid and attendance or by reason of being permanently housebound. Veterans determined by VA to be catastrophically disabled. Group 5: Nonservice-connected Veterans and non compensable service connected Veterans rated 0 percent, whose annual income and/ or net worth are not greater than VA financial thresholds. Veterans receiving VA Pension benefits. Veterans eligible for Medicaid benefits. Group 6: Compensable 0 percent service-connected Veterans. Veterans exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki. Project 112/SHAD participants. Veterans who served in the Republic of Vietnam between Jan. 9, 1962 and May 7, 1975. Veterans who served in the Persian Gulf War from Aug. 2, 1990, through Nov. 11, 1998. Veterans who served on active duty at Camp Lejeune, N.C., for no fewer than 30 days beginning Jan. 1, 1957 and ending Dec. 31, 1987. Veterans who served in a theater of combat operations after Nov.11, 1998, as follows: Currently enrolled Veterans and new enrollees who were discharged from active duty on or after January 28, 2003, are eligible for the enhanced benefits for five years post discharge. Currently enrolled Veterans and new enrollees who were discharged from active duty on or after January 28, 2003, are eligible for the enhanced benefits for five years post discharge. Group 7: Veterans with incomes below the geographic means test income thresholds and who agree to pay the applicable copayment. Group 8: Veterans with gross household incomes above VA national income threshold and the geographically-adjusted income threshold for their resident location and who agrees to pay copayments. Veterans eligible for enrollment: Non-compensable 0-percent service-connected: Sub priority a: Enrolled as of Jan. 16, 2003, and who have remained enrolled since that date and/ or placed in this sub priority due to changed eligibility status. Massachusetts Department of Veterans Services Page 7

Sub priority b: Enrolled on or after June 15, 2009 whose income exceeds the current VA national income thresholds or VA national geographic income thresholds by 10 percent or less Veterans eligible for enrollment: nonservice-connected and Sub priority c: Enrolled as of Jan. 16, 2003, and who remained enrolled since that date and/ or placed in this sub priority due to changed eligibility status. Sub priority d: Enrolled on or after June 15, 2009 whose income exceeds the current VA national income thresholds or VA national geographic income thresholds by 10 percent or less Veterans NOT eligible for enrollment: Veterans not meeting the criteria above: Sub priority e: Non-compensable 0 percent service-connected Sub priority f: Nonservice-connected VA s income thresholds change annually and current levels can be located at: http://www.va.gov/healthbenefits/cost/income_thresholds.asp. Recently Discharged Combat Veterans Veterans, including activated reservists and members of the National Guard, are eligible for the enhanced combat Veteran benefits if they served on active duty in a theater of combat operations after Nov.11, 1998, and have been discharged under other than dishonorable conditions. Combat Veterans discharged from active duty on or after Jan. 28, 2003, are eligible for enhanced enrollment placement into Priority Group 6 (unless eligible for higher enrollment Priority Group placement) for five years post discharge and are eligible to receive VA health care and medication at no cost for any condition that may be related to their combat service. Veterans who enroll with VA under this combat Veteran authority will remain enrolled even after their five-year post discharge period ends. At the end of their post discharge period, VA will reassess the Veteran s information (including all applicable eligibility factors) and make a new enrollment decision. For additional information, call 1-877-222- VETS (8387), Monday through Friday between 8:00 a.m. and 8:00 p.m. Eastern time. Special Access to Care Service-disabled Veterans: who are rated by VA as 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. Massachusetts Department of Veterans Services Page 8

Women Veterans Women Veterans are eligible for the same VA benefits as male Veterans. Comprehensive health services are available to women Veterans including primary care, specialty care, mental health care, residential treatment and reproductive health care services VA provides management of acute and chronic illnesses, preventive care, contraceptive and gynecology services, menopause management, and cancer screenings, including pap smears and mammograms. Maternity care is covered in the Medical Benefits package. Women Veterans can receive maternity care from an OB/GYN, family practitioner, or certified nurse midwife who provides pregnancy care. VA covers the costs of care for newborn children of women Veterans for seven days after birth. Infertility evaluation and limited treatments are also available. Women Veterans Program Managers are available at all VA facilities to assist women Veterans in their health care and benefits. For more information, visit http://www.womenshealth.va.gov/. Lesbian Gay Bisexual and Transgender (LGBT) Veterans LGBT Veterans are eligible for the same VA benefits as any other Veteran and will be treated in a welcoming environment. Comprehensive health services are available to LGBT Veterans including primary care, specialty care, mental health care, residential treatment and reproductive health care services. VA provides management of acute and chronic illnesses, preventive care, contraceptive and gynecology services, menopause management, and cancer screenings. Transgender Veterans will be treated based upon their self-identified gender, including room assignments in residential and inpatient settings. Eligible transgender Veterans can receive cross-sex hormone therapy, gender dysphoria counseling, preoperative evaluations, as well as post-operative and long-term care following sex reassignment surgeries. Same-Sex Couples: VA launched a new website to inform Veterans and beneficiaries of the recent changes in the law and procedures involving same-sex marriages. The new website provides important information to help Veterans and beneficiaries understand the eligibility requirements under federal law and VA regulations, and answers frequently asked questions. Veterans can learn more about VA s guidance regarding same-sex marriages at http://www.va.gov/opa/marriage/ or by reaching out to VA call centers at 1-800-827-1000. Military Sexual Trauma Military sexual trauma (MST) is the term that the Department of Veterans Affairs uses to refer to sexual assault or repeated, threatening sexual harassment that occurred while a Veteran was serving on active duty (or active duty for training if the service was in the Massachusetts Department of Veterans Services Page 9

National Guard or Reserves). VA health care professionals provide counseling and treatment to help Veterans overcome health issues related to MST. Veterans who are not otherwise eligible for VA health care may still receive these services. Appropriate services are provided for any injury, illness or psychological condition related to such trauma. For additional information visit: http://www.mentalhealth.va.gov/msthome.asp Presumptive Eligibility for Psychosis and Other Mental Illness Certain Veterans who experienced psychosis within a specified timeframe are to have their psychosis presumed to be service-connected for purposes of VA medical benefits. In addition, VA will presume that Persian Gulf War Veterans are service-connected for purposes of VA medical benefits if such Veterans develop mental illness other than psychosis within two years after discharge or release from service and before the end of the 2-year period beginning on the last day of the Persian Gulf War. Under this authority Veterans who are not otherwise eligible for VA health care and meet the description stated can receive treatment only for psychosis or mental illness and other conditions directly related to psychosis or mental illness at no cost. Psychosis: Eligibility for treatment of psychosis, and such condition is exempted from copayments for any Veteran who served in the United States active duty military, naval, or air service and developed such psychosis within two years after discharge or release from the active military duty, naval or air service; and before the following date associated with the war or conflict in which the Veteran served: World War I (April 6, 1917 November 11, 1918) World War II (December 7, 1941 December 31, 1946) Korean conflict (June 27, 1950 January 31, 1955) Vietnam era (February 28, 1961 May 7, 1975 for veterans who served in the Republic of Vietnam during that period; otherwise August 5, 1964 May 7, 1975) Gulf War (August 2, 1990 through a future date to be set by law or Presidential Proclamation) Mental Illness (other than Psychosis). Eligibility for benefits is established for treatment of an active mental illness (other than psychosis), and such condition is exempted from copayments for any Veteran of the Persian Gulf War who developed such mental illness: a. Within two years after discharge or release from the active duty military, naval, or air service; and b. Before the end of the two-year period beginning on the last day of the Persian Gulf War (end date not yet determined). Massachusetts Department of Veterans Services Page 10

Veterans with Spinal Cord Injury/Disorders There are 24 VA-operated Spinal Cord Injury Centers (SCI) that provide services for Veterans with spinal cord injuries and disorders (SCI/D). Comprehensive rehabilitation, SCI/D specialty care, medical, surgical, primary, preventive, psychological, respite, and home care are provided at these centers by interdisciplinary teams which include physicians, nurses, therapists (physical, occupational, kinesiotherapists, therapeutic recreation), psychologists, social workers, vocational counselors, dieticians, respiratory therapy, and other specialists as needed. There are five SCI centers that provide long-term care for Veterans with SCI/D. In VA facilities that do not have SCI centers, there is a designated team that consists of a physician, nurse, and social worker to address primary care needs for Veterans with SCI/D and to make referrals to SCI Centers. These SCI Centers and the teams in facilities that do not have centers comprise VA SCI System of Care. Some of the services provided in this system of care include rehabilitation, prosthetics and durable medical equipment, orthotics, sensory aids, assistive technology, environmental modifications, telehealth, ventilator weaning and care, chronic pain management, mental health treatment, drivers training, peer counseling, substance abuse treatment, vocational counseling, and caregiver training and support. There is a long-standing memorandum of agreement between VA and the Department of Defense (DoD) to provide specialized care at VA medical facilities for Active Duty Service members who have sustained a spinal cord injury. Ongoing collaboration and education between VA and DoD ensures continuity of care and services. For more information about SCI/D care and the eligibility requirements for the above benefits and services, contact your local VA SCI/D Center and/or visit http://www.sci.va.gov. OEF/OIF/OND Care Management Each VA medical center has an Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Care Management team in place to coordinate patient care activities and ensure that Service members and Veterans are receiving patient-centered, integrated care and benefits. All OEF/OIF/OND era Veterans are screened for the need for case management services to identify Veterans who may be at risk so VA can intervene early and provide assistance. More information for connecting with OEF/OIF/OND Care Management teams can be found at www.oefoif.va.gov Health Care Law The Affordable Care Act, also known as the health care law, was created to expand access to affordable health care coverage, lower costs, and improve quality and care coordination. Under the law, people will: Massachusetts Department of Veterans Services Page 11

Have health coverage that meets a minimum standard (called minimum essential coverage) by Jan.1, qualify for an exemption; or pay a fee when filing their taxes if they have affordable options but remain uninsured. Key Information for Veterans about the Health Care Law VA wants all Veterans to get health care that improves their health and well-being. Veterans who are enrolled in VA health care don t need to take additional steps to meet the health care law coverage standards. The health care law does not change VA health benefits or Veterans out-of-pocket costs. Veterans who are not enrolled in VA health care can apply at any time. For additional information about the VA and the health care law, visit www.va.gov/aca call 1-877-222-VETS (8387). Financial Assessment A financial assessment is a means of collecting the Veteran s household income information which is used to determine whether a Veteran is eligible for enrollment and whether or not the Veteran would be required to pay copays for care or prescription medication. VA is required by law to collect this information. There is no change in VA s long-standing policy to provide no-cost care to Veterans who cannot afford to pay for their care, Veterans with catastrophic medical conditions, Veterans with a disability rating of 50 percent or higher, or for conditions that are officially rated as service-connected. Veterans Required to Provide a Financial Assessment Not all Veterans are required to provide their income information to VA when applying for enrollment. Only certain Veterans who do not have a VA-rated service connected disability, who do not receive a VA pension payment or have a special eligibility, such as a recently discharged Combat Veteran or a Purple Heart recipient, must provide their gross household income (which includes spouse/partner and dependent children, if applicable) for the previous year when applying for enrollment for VA health care. This part of the application process is called an income assessment or financial assessment (also formerly called a means test) and is used to determine if these Veterans are eligible for enrollment and whether or not they have to pay copays for their health care or prescription medication. Massachusetts Department of Veterans Services Page 12

Financial Assessments are not Required to be Updated Yearly Enrolled Veterans are no longer required to provide their financial assessment on an annual basis if they had a current financial assessment on file as of March 24, 2014. This means Veterans can enjoy their VA health care benefits without worrying about having to submit updated income information to VA every year. If the enrolled Veteran does not have a financial assessment on file as of March 24, 2014, the Veteran will be required to provide updated income information. Veterans may update their financial assessment when they visit their VA facility at their next appointment. Veterans may also update their information by submitting VA Form 1010EZR, which is available online, at their local VA medical center or by contacting 1-877-222-VETS (8387), to have the form mailed. This form is available online at https://www.1010ez.med.va.gov Income Updates from IRS and SSA VA securely receives income information from the IRS and SSA to confirm Veterans continued enrollment eligibility. VA will contact the Veteran (and spouse/partner and dependents, if applicable) only if the income information received from IRS and SSA indicates a change in the Veteran s eligibility or copay requirements. Veterans will still have access to care during the period of review should they do not agree with the information VA receives from IRS and SSA. Exceptions Veterans applying for enrollment must provide income information by using VA Form 1010EZ. This form is available online at https://www.1010ez.med.va.gov/ and can also be obtained at any VA medical center, Veteran Service Office, or by contacting 1-877-222-VETS (8387), to have the form mailed. Enrolled Veterans who are eligible because their household income is below the VA income limit (e.g., NSC and 0% SC Veterans without any special eligibility) will: Not be required to update their income on a yearly basis. Be required to complete a financial assessment at their next health care visit if they do not have a current financial assessment on file as of March 24, 2014. Veterans Required to Provide Yearly Income Updates Veterans who complete a financial assessment to determine their eligibility for cost-free medications or for Beneficiary Travel only are required to submit their income yearly. Recent Combat Veterans Combat Veterans who served in combat after the Gulf War or in combat against a hostile force after November 11, 1998, are eligible for free care for five years for any illness that may be related to their military service beginning on the date of the Veteran s discharge. Massachusetts Department of Veterans Services Page 13

These Veterans are now eligible for an additional year of eligibility based on the Clay Hunt Act. For more information, please visit the Clay Hunt webpage. These Combat Veterans are not required to provide their income for care related to their service in the theater of operations; however, they may complete the financial assessment to determine their eligibility for a higher priority status in the VA health care system, eligibility for beneficiary travel benefits, or for cost-free care for treatment not related to their military service. Veterans Exposed to Agent Orange, Ionizing Radiation or Environmental Contaminants Veterans who were exposed to Agent Orange in Vietnam, ionizing radiation, or exposed to environmental contaminants in the Persian Gulf receive free care for treatment related to their exposure. These Veterans are not required to provide their income; however, they may complete the financial assessment to determine if they are required to pay copays for care not related to their exposure. Veterans who Decline to Provide Income Information Veterans who decline to provide their income information and agree to pay copays for their care are not required to provide their income information; however, unless otherwise eligible (e.g. Compensable service-connected, former POW, Combat Veterans, served in the Republic of Vietnam, service during certain periods in Southwest Asia) the Veteran s enrollment may be denied based on the enrollment restriction. Information from IRS and SSA If the information received from IRS and SSA may result in a change in the Veteran s eligibility or copay requirement, VA will notify the Veteran and give the Veteran an opportunity to provide input. For more information about the income verification process, see the Income Verification section below. Changes to Income and Personal Information VA encourages Veterans to continue to report changes in their income information, as well as their personal information, such as address, phone numbers, dependents, next of kin and health insurance, using VA Form 1010EZR available online or at their local medical center. These changes can be submitted at any time. Massachusetts Department of Veterans Services Page 14

Income Verification VA is required by law to verify Veterans self-reported household income (including spouse/partner and dependents, if any) with the Internal Revenue Service (IRS) and Social Security Administration (SSA). The Income Verification (IV) process is used to confirm the accuracy of Veterans eligibility for VA health care, copay status and enrollment priority group assignment. Because of the timeframe for taxpayers to report income to the IRS, the IV process typically begins in July of the following year of reported income. For example, income for the year 2015 is available from IRS/SSA in July of 2016. Veterans Included in the Income Verification Process VA does not verify all enrolled Veterans income. Only Veterans who receive free medical care and/or medications based on their self-reported household income are included in the income verification process. Income Verification Process If a Veteran s income is below VA's income limits (see income limits table), but the income information received from the IRS/SSA indicates the Veteran s household income is above VA s income limits, the Veteran and spouse/partner, if applicable, will be notified by letter and given an opportunity to verify or dispute this information. If no response is received after 45 days, a reminder letter is mailed, offering the opportunity for the Veteran to verify or dispute the income reported by IRS/SSA and to submit additional deductible expenses, if any. If no response is received within 75 days, it is assumed the IRS/SSA information is correct and a letter will be sent informing the Veteran his/her copay status will be changed and of their copay responsibility. This may also impact the Veteran s eligibility for enrollment. The Veteran will also receive information on how to appeal the decision. When VA receives a response, an IV case manager will be assigned to work with the Veteran and/or the Veteran s representative. The IV case manager will provide assistance and guidance to the Veteran through the income verification process, and will assist the Veteran in identifying any authorized deductions that may reduce the Massachusetts Department of Veterans Services Page 15

Veterans total gross household income below VA s income limits. It is our goal to work closely with the Veteran to resolve and close the income verification case within 75 days. If after the review process the information does not reduce the Veteran s income below VA s income limits, a final letter is mailed to the Veteran explaining that the Veteran will be responsible for copays and required to pay copays for care received during the income year under review. The letter also contains information on how to appeal the decision. Financial Hardship VA has programs that may help if the Veteran is unable to pay the copay charges. For more information, visithttp://www.va.gov/healthbenefits/cost/financialhardship.asp. For more Information about the Income Verification program or financial assessments, contact the Income Verification office at 1-800-929-VETS (8387). Medical Services and Medication Copayments Some Veterans are required to make copayments (copays) to receive VA health care and/or medications. Outpatient Copays Primary Care Services: $15 Specialty Care Services: $50 Prescriptions: 30-day or less supply for certain Veterans: $8 30-day or less supply for higher income Veterans: $9 NOTE: The copay amount is limited to a single charge per visit regardless of the number of health care providers seen in a single day. The copay amount is based on the highest level of clinical service received. Outpatient Visits Not Requiring Copays: Certain services are not charged a copay. Copays do not apply to publicly announced VA health fairs or outpatient visits solely for preventive screening and/ or vaccinations, such as vaccinations for influenza and pneumococcal, or screening for hypertension, hepatitis B, tobacco, alcohol, hyperlipidemia, breast cancer, cervical cancer, Human papillomavirus (HPV), colorectal cancer by fecal occult blood testing, education about the risks and benefits of prostate cancer screening, HIV testing and prevention counseling (including the distribution of condoms), and weight reduction or smoking cessation counseling (individual and group). Laboratory, flat plain film radiology, electrocardiograms, and hospice care and in-home video telehealth are also exempt from copays. While hepatitis C screening and HIV testing and counseling are exempt, medical care for HIV and hepatitis C are NOT exempt from copays. Massachusetts Department of Veterans Services Page 16

Inpatient Copays There are two inpatient copay rates, the full rate and the reduced rate. Priority Group 7 and certain other Veterans are responsible for paying 20 percent of VA's inpatient copay rate. Inpatient Copay for the first 90 days of care during a 365-day period $257.60 Inpatient Copay for each additional 90 days of care during a 365-day period $128.00 Daily Charge $2/day Priority Group 8 and certain other Veterans are responsible for VA's full inpatient copay rate. Inpatient Copay for the first 90 days of care during a 365-day period $1,288.00 Inpatient Copay for each additional 90 days of care during a 365-day period $644 Daily Charge $10/day Geriatrics and Extended Care Long term care copays are based on three levels of care: Inpatient: Up to $97 per day (Community Living (Nursing home), Respite, Geriatric Evaluation) Outpatient: $15 per day (Adult Day Health Care,Respite, Geriatric Evaluation) Domiciliary: $5 per day **Copayments for Long-Term Care services start on the 22nd day of care during any 12- month period there is no copayment requirement for the first 21 days. Actual copayment charges will vary from Veteran to Veteran depending upon financial information submitted on VA Form 10-10EC. Note: VA social workers or case managers will counsel Veterans or their family representatives on the potential copay amounts for extended care services. Veterans determined to be catastrophically disabled are exempt from copays applicable to the receipt of non-institutional respite care, non-institutional geriatric evaluation, noninstitutional adult day health care, homemaker/home health aide, purchase skilled home care, home-based primary care, hospice services and any other non-institutional alternative extended care services. Copayments for other extended care services not mentioned (e.g. Nursing Home Care) may be subject to copays. Massachusetts Department of Veterans Services Page 17

Medication Copays: While many Veterans are exempt for medication copays, nonservice-connected Veterans in Priority Groups 7 and 8 are charged $9 for each 30- day or less supply of medication provided on an outpatient basis for the treatment of a nonservice connected condition. Veterans enrolled in Priority Groups 2 through 6 are charged $8 for each 30-day or less supply of medication; the maximum copay for medications that will be charged in calendar year is $960 for nonservice-connected medications. NOTE: Copays apply to prescription and over-the-counter medications, such as aspirin, cough syrup or vitamins, dispensed by a VA pharmacy. Copays are not charged for medical supplies; such as syringes or alcohol wipes. Copays do not apply to condoms. Health Savings Accounts (HSA) can be utilized to make VA copayments. HSAs are usually linked to High Deductible Health Plans (HDHPs). Private Health Insurance Billing VA is required to bill private health insurance providers for medical care, supplies and medications provided for treatment of Veterans nonservice-connected conditions. Generally, VA cannot bill Medicare, but can bill Medicare supplemental health insurance and/or TRICARE for Life (TFL) for covered services. VA is authorized to bill and accept reimbursement from High Deductible Health Plans (HDHPs) for care provided for nonservice- connected conditions.va may also accept reimbursement from Health Reimbursement Arrangements (HRAs) for care provided for nonservice-connected conditions. Release of Information (ROI) for Sensitive Diagnosis An ROI authorization form VAF 10-5345 is a VA standard form used to obtain authorization to release sensitive (protected) health information to an insurance company for purposes of reimbursement. Veterans/patients who were treated or offered treatment for a sensitive condition of drug abuse, alcohol abuse or alcoholism, HIV testing or treatment, and sickle cell anemia or trait must provide written authorization to allow VA to release their sensitive information to a third party (insurance company). NOTE: Any non-service connected care provided by the VA that has a sensitive diagnosis cannot be billed to the Veteran s third party health insurance without a signed release of information (ROI) by the Veteran. The Veteran is either co-pay exempt or copay required based upon their means test and/or eligibility. If the Veteran does not sign the ROI form permitting VA to bill his/her insurance and is also in a required co-pay status, then the Veteran will be responsible for their entire co-pay amount because VA is not able to offset the Veteran s account dollar for dollar based on what the insurance company would have reimbursed. Massachusetts Department of Veterans Services Page 18

Beneficiary Travel (BT) The Beneficiary Travel program provides eligible Veterans and other beneficiaries mileage reimbursement, common carrier (plane, train, bus, taxi, light rail etc.), or when medically indicated, "special mode" (ambulance, wheelchair van) transport for travel to and from VA health care, or VA authorized non-va health care for which the Veteran is eligible. Beneficiary Travel Benefits A Veteran may be eligible for Beneficiary travel services if the following criteria are met: See more at: http://www.va.gov/healthbenefits/vtp/beneficiary_travel.asp#sthash.nzchrmbg.dpuf YOU QUALIFY IF: you have a service-connected (SC) rating of 30 percent or more, or you are traveling for treatment of a SC condition, or you receive a VA pension, or your income does not exceed the maximum annual VA pension rate, or your income does not exceed the maximum annual VA pension rate, or you are traveling for a scheduled compensation or pension YOU QUALIFY FOR SPECIAL MODE TRANSPORTATION (Ambulance, Wheelchair Van etc.) IF: you meet one of the eligibility criteria in the left column, and your medical condition requires an ambulance or a specially equipped van as determined by a VA clinician, and the travel is pre-authorized (authorization is not required for emergencies if a delay would be hazardous to life or health) How to Apply for travel reimbursement Veterans may apply for travel reimbursement by completing VA Form 10-3542 (Veteran/Beneficiary Claim for Reimbursement of Travel Expenses). The travel reimbursement form replaces older versions and local forms and improves the process for Veterans applying for mileage reimbursement at more than one VA facility. Methods to request travel pay: Visit the Beneficiary Travel Office after completing an appointment, or Call the Beneficiary Travel Office (this method will require an added step to complete and sign the travel reimbursement form), or Send the travel reimbursement form via either secure fax or mail to the local Beneficiary Travel Office. Applications for payment must be submitted within 30 calendar days from the date the travel is completed or the date the applicant is notified he or she is eligible for travel payments if the request is based on a change in eligibility. Mileage Rates Massachusetts Department of Veterans Services Page 19

Mileage Calculations The mapping tool VA uses for beneficiary travel will now calculate the driving distance using the fastest route and shortest route according to Bing maps. This is a change to the Beneficiary Travel program that will make the distance determinations consistent with distance calculations under the Veterans Choice Program. The current mileage reimbursement rate is $0.415 (41.5 cents) per mile for general travel. Scheduled appointments qualify for round-trip mileage. Unscheduled visits may be limited to return mileage only. The reimbursement will be paid for travel to the closest VA facility unless a different location was determined by VA. Mileage reimbursement rate Deductible The deductible is $3.00 one-way ($6.00 round trip). Deductible requirement is subject to a monthly cap of $18. Upon reaching $18 in deductibles or six one-way (or three round trip) trips, whichever comes first, in a calendar month travel payments for the balance of that month will be free of deductible charges. Waiver of Deductible A waiver of the deductible may be provided, if you are eligible for travel and are: In receipt of a VA pension, or A Non-Service-Connected Veteran and your previous year s income does not exceed (or your projected current calendar year s income, in the year of application will not exceed) the applicable VA pension rate, or A Service-Connected Veteran and your previous year s income does not exceed (or your projected current calendar year s income in the year of application will not exceed) the applicable national means test income threshold or Traveling for a scheduled compensation and pension exam. For detailed information visit VA National Income Thresholds and/or Pension income thresholds. Beneficiary travel fraud can take money out of the pockets of deserving Veterans. Inappropriate uses of beneficiary travel benefits include: incorrect addresses provided resulting in increased mileage; driving/riding together and making separate claims; and taking no cost transportation, such as DAV, and making claims. Veterans making false statements for beneficiary travel reimbursement may be prosecuted under applicable laws. Massachusetts Department of Veterans Services Page 20

Reporting Fraud: Help VA s Secretary ensure integrity by reporting suspected fraud, waste or abuse in VA programs or operations. Report fraud to: VA Inspector General Hotline P.O. Box 50410 Washington, DC 20091-0410 E-mail: vaoighotline@va.gov VAOIG hotline 1-800-488-8244 Fax: (202) 565-7936 Massachusetts Department of Veterans Services Page 21

Chapter 2 VA Medical Programs Veteran Health Registries Certain Veterans can participate in a VA health registry and receive free evaluations. These evaluations include a medical history, physical exam, and if deemed necessary by the clinician, laboratory tests or other studies. VA maintains health registries to provide special health valuations and health-related information. To participate, contact the Environmental Health Coordinator at the nearest VA health care facility or visit www.publichealth.va.gov/exposures to see a directory which lists Environmental Health Coordinators by state and U.S. territory. Veterans should be aware that a health registry evaluation is not a disability compensation exam. A registry evaluation does not start a claim for compensation and is not required for any VA benefits. Gulf War Registry: For Veterans who served on active military duty in Southwest Asia during the Gulf War, which began in 1990 and continues to the present, and includes Operation Iraqi Freedom (OIF) and Operation New Dawn (OND). The Gulf War registry was designed to identify possible health effects resulting from U.S. military personnel service in certain areas of Southwest Asia. Potential exposures include endemic infectious diseases and hazardous occupational or environmental exposures, including heavy metals, air pollutants (particulate matter and gases such as nitrogen oxides, carbon monoxide sulfur oxides, and hydrocarbons). Depleted Uranium Registries: Depleted uranium (DU) is uranium left over after most of the more radioactive U-235 isotope has been removed. DU possesses about 60 percent of the radioactivity of naturally occurring uranium; it is a radiation hazard only in very large exposures for prolonged time. DU has some chemical toxicity related to being a heavy metal (similar to lead) which occurs at lower doses and is the main concern for Veterans with embedded DU fragments. Veterans who are identified by the DoD or have concerns about possible depleted uranium (DU) exposure are eligible for a DU evaluation at their local facility. Embedded Fragment Registry: OEF, OIF, and OND Veterans who have or likely have an embedded fragment as the result of an injury they received while serving in an area of conflict are eligible for inclusion into the Embedded Fragment Registry. This registry was designed to identify track and conduct long-term medical surveillance of Veterans who potentially have embedded fragments. Clinical data captured in the Embedded Fragment Registry will be used to help develop medical and surgical guidelines to allow VA clinicians to deliver appropriate medical care to these Veterans Massachusetts Department of Veterans Services Page 22

Agent Orange Registry: Agent Orange is an herbicide the U.S. military used between 1962 and 1971 during the Vietnam War to remove jungle that provided enemy cover. Veterans serving in Vietnam were possibly exposed to Agent Orange or its dioxin contaminant. Veterans eligible for this registry evaluation are those who served on the ground in Vietnam between Jan. 9,1962, and May 7,1975, regardless of the length of service; this includes Veterans who served aboard boats that operated on inland waterways ( Brown Water Navy ) or who made brief visits ashore. Other Veterans with possible exposure who are eligible include those who served: along the demilitarized zone in Korea (between Apr. 1, 1968 and Aug. 31, 1971), on certain bases or in certain units in Thailand (between Feb. 28, 1961 and May 7, 1975), or on certain U.S. bases or locations in other countries where Agent Orange or other herbicides were tested or stored. VA maintains a DoD-provided list of locations and dates where Agent Orange or other herbicides were tested or stored at military bases in the U.S. or locations in other countries at www.publichealth.va.gov/exposures. For sites not listed, the Veteran should provide some proof of exposure to obtain a registry evaluation. Information is also available through VA s Special Issues Helpline at 1-800-749-8387. Ionizing Radiation Registry: For Veterans who have received nasopharyngeal (nose and throat) radium irradiation treatments while on active duty and Veterans possibly exposed to radiation during the following radiation-risk activities: On-site participation in: An atmospheric detonation of a nuclear device, whether or not the testing nation was the United States; Occupation of Hiroshima or Nagasaki from Aug. 6, 1945, through July 1, 1946; or Internment as a POW in Japan during World War II, which VA determines resulted in an opportunity for exposure to ionizing radiation comparable to that of Veterans involved in the occupation of Hiroshima or Nagasaki, or service at Department of Energy gaseous diffusion plants at Paducah, Ky.; Portsmouth, Ohio; or the K-25 area at Oak Ridge, Tenn., for at least 250 days before Feb. 1, 1992, if the Veteran was monitored for each of the 250 days using dosimetry badges to monitor radiation to external body parts; or Amchitka Island, Alaska, before Jan. 1, 1974, if the Veteran served for at least 250 days in a position that had exposures comparable to a job that was monitored using dosimetry badges in proximity to Longshot, Milrow, or Cannikin underground nuclear tests. Massachusetts Department of Veterans Services Page 23

Airborne Hazards and Open Burn Pit Registry: Participation in the Airborne Hazards and Open Burn Pit Registry is voluntary and open to any Veteran or active-duty Service member who served in one or more of the following locations during eligible timeframes: OEF/OIF/ON: Djibouti, Africa after Sept.11, 2001; Operations Desert Shield or Desert Storm; Southwest Asia theater of operations after Aug. 2, 1990. The Southwest Asia theater of operations includes Iraq, Saudi Arabia, Bahrain, Gulf of Aden, Gulf of Oman, Oman, Qatar, United Arab Emirates, waters of the Persian Gulf, Arabian Sea, and the Red Sea. Eligible Service members and Veterans can enroll in the registry by completing a webbased self-assessment questionnaire. Veterans will be asked about deployments, environmental and work-related exposures, health care usage, and current health. Unlike other registries, when Veterans complete the Airborne Hazards and Open Burn Pit Registry self-assessment questionnaire via the internet, they are in the registry. No in-person medical evaluation is required to become registered. However, Veteran participants are eligible for an optional no-cost medical evaluation from VA. Participants already enrolled in VA health care should contact their primary care provider or Patient Aligned Care Team (PACT) to schedule an evaluation. Veterans not already enrolled in VA health care should contact an Environmental Health Coordinator at a nearby VA facility by visiting the following link: (http://www.publichealth.va.gov/exposures/coordinators.asp) or calling 1-877-222-8387. Vet Center Readjustment Counseling Services VA provides readjustment counseling services, to include direct counseling, outreach, and referral, through 300 community-based Vet Centers located in all 50 states, the District of Columbia, Guam, Puerto Rico, and American Samoa. Eligibility: Veterans and active-duty Service members, to include federally-activated members of the National Guard and Reserve components, are eligible to receive readjustment counseling services at a Vet Center if they: Have served on active military duty in any combat theater or area of hostility such as World War II, the Korean War, the Vietnam War, the Gulf War, or the campaigns in Lebanon, Grenada, Panama, Somalia, Bosnia, Kosovo, Afghanistan, and Iraq; Experienced a military sexual trauma while serving on active military duty; Provided direct emergent medical care or mortuary services, while serving on active military duty, to the casualties of war; Served as a member of an unmanned aerial vehicle crew that provided direct support to operations in a combat zone or area of hostility; or Are Veterans who served in the active military during the Vietnam-era, but not in the Republic of Vietnam, and have requested services at a Vet Center before January 1, 2004. Massachusetts Department of Veterans Services Page 24

Vet Center readjustment counseling services are free to the eligible Veterans and their family without time limitations. Service members and Veterans are not required to enroll in the VA health care system or have received a service connection for conditions caused by military service. These services are also provided regardless of the nature of the Veteran s discharge. This includes service provision to those individuals with problematic discharges. Services Offered: Vet Center counselors provide individual, group, marriage, and family readjustment counseling to those individuals that have served in combat zones or areas of hostilities to assist them in making a successful transition from military to civilian life; to include treatment for posttraumatic stress disorder (PTSD) and help with any other military related problems that affect functioning within the family, work, school or other areas of everyday life. Other psycho-social services include outreach, education, medical referral, homeless Veteran services, employment, VA benefit referral, and the brokering of non-va services. The Vet Centers also provide counseling to individuals who have experienced military sexual trauma of both genders and of any era of military service. Locations: Boston Vet Center 665 Beacon Street, Boston, MA 02215(617) 424-0665 Brockton Vet Center1041L Pearl Street, Brockton, MA 02301(508) 580-2730 Hyannis Vet Center 474 West Main Street, Barnstable, MA 02601(508) 778-012416 Lowell Vet Center 73 East Merrimack Street, Lowell, MA 08152(978) 453-1151 New Bedford Vet Center 468 North Street, New Bedford, MA 02740(508) 999-6920 Springfield Vet Center 1985 Main Street, Springfield, MA 01103(413) 737-5167 Worcester Vet Center 691 Grafton Street, Worcester, MA 01604(508)753-7902 Bereavement Counseling related to Service members: Bereavement counseling is available through VA s Vet Centers to all immediate family members (including spouses, children, parents, and siblings) of Service members who die while serving on active service. This includes federally-activated members of the National Guard and reserve components. Vet Center bereavement services for surviving family members of Service members may be accessed by calling (202) 461-6530. For additional information, contact the nearest Vet Center, listed in the back of this book, or visit www.vetcenter.va.gov/. Vet Center Combat Call Center: (1-877-WAR-VETS) is an around the clock confidential call center where combat Veterans and their families can call to talk about their military experience or any other issue they are facing in their readjustment to civilian life. The staff is comprised of combat Veterans from several eras as well as family members of combat Veterans. Massachusetts Department of Veterans Services Page 25